Journal of VitreoRetinal Diseases最新文献

Purpose: The Area Deprivation Index (ADI) is a validated composite measure of socioeconomic status (SES) in which higher percentiles correspond to lower SES. This study sought to assess differences in the use of anti-vascular endothelial growth factor (anti-VEGF) therapy and treatment response across national ADI scores in patients with diabetic macular edema (DME). Methods: This was a US single-center, retrospective review of patients diagnosed with DME between 2014 and 2022 and followed for up to 24 months after diagnosis. Primary outcomes were best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular volume (MV), measured at 6-month intervals from DME diagnosis. Patients were classified as either low ADI (higher SES) or high ADI (lower SES) using the 75th national ADI percentile. Results: The low ADI group comprised 60 patients, and the high ADI group comprised 57 patients. Baseline functional and anatomic characteristics were similar between groups. There were no significant treatment differences (type or number of anti-VEGF and steroid injections) between groups. After 24 months, mean BCVA was 0.82 logMAR (95% CI, 0.61-1.03) in the high ADI group and 0.51 logMAR (95% CI, 0.31-0.71) in the low ADI group (P = .03). Mean final CFT and MV were not significantly different between groups (P > .05); however, patients in the low ADI group were more likely to receive cataract surgery within the treatment period (P = .04). Conclusions: Socioeconomic disadvantage does not appear to influence anti-VEGF treatment patterns or anatomic outcomes in patients with DME. However, BCVA was significantly better in the low ADI group at the end of the 24-month study period. This finding may be due to socioeconomically advantaged patients being more likely to receive cataract surgery during the treatment period.

Purpose: To describe the pathogenesis and common features of myopic traction maculopathy (MTM) and propose a new clinical classification. Methods: A review of existing findings regarding MTM was performed, outlining features of the myopic environment that contribute to its development and diverse clinical manifestations. The findings are incorporated in a new clinically oriented classification scheme for MTM, designed to differentiate between stable and progressive variants of the disease. Results: MTM is a macular disease unique to eyes with degenerative myopia, in which the presence of a small radius and deep staphyloma play a major role. Traction may arise from taut, less elastic retinal components such as arterioles and internal limiting membrane (type 1 MTM: intraretinal traction) or by anomalous vitreoretinal adhesion (type 2 MTM: vitreoretinal traction), generating a wide spectrum of anomalies linked by retinal stretching, with a mixed form of traction present in some eyes (type 3 MTM). The most common type of intraretinal MTM is the schisis-like form, where the retina stretches at the level of the outer plexiform layer. When confined to the most concave areas of the staphyloma, MTM is usually a stable disease; however, when the fovea is involved, MTM is a slowly progressive condition that can lead to macular hole formation and posterior retinal detachment. Conclusions: MTM is uniquely characterized by differing anatomy, structural differences, and various forces on the field, distinguishable by striking optical coherence tomography images. This new classification scheme for MTM, derived from decades of observation and surgical experience, may help the clinician decide the best approach for disease management.

Purpose: To report a rare case of bilateral pachychoroid spectrum disease presenting asymmetrically as chronic central serous chorioretinopathy (CSCR) in 1 eye and type 3 uveal effusion syndrome in the contralateral eye. Methods: A single case was reviewed. Results: A 47-year-old man presented with a 1-month history of decreased vision in the left eye while being on oral corticosteroids. Best-corrected visual acuity was 20/20 OD and 2/80 OS. Multimodal imaging revealed features of CSCR with an ink-blot leak in the right eye and idiopathic type 3 uveal effusion syndrome with exudative retinal and choroidal detachment in the left eye. The patient was treated with a tapering course of oral corticosteroids, resulting in complete resolution of both conditions. During a 2-year follow-up period, a recurrence of subretinal fluid was observed in the right eye. Conclusions: This unusual case highlights the spectrum of venous overload choroidopathy and emphasizes the overlapping yet distinct clinical features of CSCR and uveal effusion syndrome. Multimodal imaging plays a pivotal role in the diagnosis and management of such unique presentations.

Purpose: To report the clinical features, microbiologic aspects, and clinical outcomes of delayed scleral buckle removal. Methods: This retrospective study included all eyes undergoing delayed scleral buckle removal at Bascom Palmer Eye Institute between 2013 and 2024. Delayed removal was defined as removal more than 1 month after placement. Only eyes with exposure, extrusion, or infection were included. Cases of scleral buckle removal for reasons such as ocular pain or strabismus were excluded. Clinical examination findings, operative reports, and microbiologic culture results were reviewed. Results: The current study included 50 eyes of 50 patients. The median time from scleral buckle placement to removal was 134 months (range, 1-564). Common presenting symptoms included eye pain, foreign body sensation, discharge, redness, and blurry vision. Six eyes were asymptomatic at presentation. Conjunctival erosion was present in 49 eyes, most frequently located in the superonasal (35%) and superotemporal (35%) quadrants. The most commonly explanted element was an encircling band (81%), with sponges removed in 14% of cases. Microbiologic cultures were positive in 40% of eyes, most commonly yielding Staphylococcus aureus (5 cases), Pseudomonas aeruginosa (4 cases), and S. epidermidis (3 cases). Recurrent retinal detachment occurred in 4 eyes (8.3%), with a mean time to redetachment of 81.5 days. Conclusions: Scleral buckle removal was associated with a positive microbial culture rate of 40%. After buckle removal, the incidence of recurrent retinal detachment was low.

Purpose: To report a case of rapidly reversible cystoid macular edema (ME) associated with belzutifan therapy. Methods: A single case was reviewed. Results: A 70-year-old man with sporadic metastatic renal cell carcinoma developed acute symptomatic cystoid macular edema (CME) within 2 weeks of initiating belzutifan therapy. The CME began to improve within 1 week after treatment cessation and resolved completely thereafter. Belzutifan was subsequently restarted at a lower dose, following which CME recurred within 2 weeks. Conclusions: This is the first reported instance of rapidly reversible CME associated with the use of belzutifan in a real-world clinical setting, highlighting the need for ophthalmic monitoring in patients receiving hypoxia-inducible factor-2α inhibitors.

Purpose: Extensive macular atrophy with pseudodrusen (EMAP) is a bilateral retinal condition characterized by symmetric macular atrophy, typically affecting patients around age 45 years. Although rare, choroidal neovascularization (CNV) can occur with EMAP and remains poorly understood. Methods: A retrospective analysis of 87 patients with EMAP was conducted. Demographics, medical history, and imaging findings were evaluated. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to identify and classify CNV. Treatments included anti-vascular endothelial growth factor (anti-VEGF) agents. Results: Among 87 patients, 15 eyes of 10 individuals developed CNV. The mean age was 57 years. All patients had a history of childhood rheumatic fever and prolonged benzathine penicillin use (mean duration of use 13 years). Treatments included aflibercept (7 eyes), ranibizumab (1 eye), and 1 eye treated with combination therapy with aflibercept, ranibizumab, and faricimab (mean 8 injections/eye); 3 eyes had incomplete treatment information and 3 eyes did not receive treatment. OCT and OCTA revealed type 1 CNV in 46.7% of eyes and type 2 CNV in 46.7% of eyes. Conclusions: Early CNV diagnosis is crucial for timely treatment initiation, aiming to optimize anatomic and functional outcomes. While visual responses varied, our findings indicate that anti-VEGF therapy plays a significant role in stabilizing or improving vision.

Purpose: To report the successful use of intravitreal (IVT) caspofungin in the management of drug-resistant bilateral endogenous fungal endophthalmitis and to assess its clinical safety and efficacy. Methods: A single case was reviewed. Results: A 40-year-old woman developed bilateral endogenous endophthalmitis following ureteric stent removal. The right eye, which presented with pain, redness, and significant vision loss, was successfully treated with pars plana vitrectomy and IVT voriconazole. The left eye, initially managed with voriconazole and amphotericin B, deteriorated despite repeated antifungal injections, necessitating vitrectomy. Vitreous cultures grew Candida albicans resistant to fluconazole and voriconazole but sensitive to amphotericin B and caspofungin. IVT caspofungin (50 μg/0.1 mL) was administered in the left eye for persistent infection, leading to significant clinical improvement without drug-related adverse effects. At the final follow-up, infection was controlled in both eyes, and the patient's best-corrected visual acuity was 20/32 (0.2 logMAR) OD and 20/40 (0.3 logMAR) OS. Conclusions: IVT caspofungin appears to be a safe and effective treatment option for fungal endophthalmitis resistant to conventional antifungal agents and may serve as a valuable adjunct in refractory cases.

Purpose: To report a case of Purtscher-like retinopathy associated with Shingrix vaccination. Methods: A single case was reviewed. Results: A 58-year-old man with no past medical or ocular history received the Shingrix vaccine and subsequently developed acute vision loss in his left eye. Examination revealed a visual acuity of 20/150 OS with peripapillary and macular cotton wool spots in a circumferential distribution. Macular optical coherence tomography demonstrated multifocal areas of inner retinal thickening and hyperreflectivity. A systemic laboratory workup was unremarkable. At the 3-month follow-up, fundus findings resolved, and visual acuity returned to baseline. Conclusions: A presumptive diagnosis of Purtscher-like retinopathy associated with Shingrix vaccination was made. Purtscher-like retinopathy may be related to the upregulation of the complement cascade and proinflammatory state after vaccination. Patients should be counseled to see an ophthalmologist if visual changes occur after vaccination.

Purpose: To describe a unique case of acute macular outer retinopathy presenting immediately after rapid correction of severe hypokalemia and hypomagnesemia, and to explore the potential association between electrolyte repletion and outer retinal injury. Methods: A single clinical case was retrospectively reviewed. Results: A 29-year-old woman presented with acute macular outer retinopathy and vision loss immediately following rapid intravenous electrolyte replacement. Optical coherence tomography revealed disruption of the outer retinal layers, and microperimetry demonstrated a corresponding decrease in retinal sensitivity. The patient was monitored over 5 months without intervention and achieved visual stability with partial improvement of outer retinal structure on imaging. Conclusions: This case highlights a potential relationship between rapid variations in systemic electrolyte concentrations and the development of acute macular outer retinopathy. The findings emphasize the importance of caution during rapid electrolyte repletion and suggest that multimodal retinal imaging may be valuable in monitoring visual symptoms that arise during or after electrolyte correction.

Purpose: To describe long-term structural retinal changes in CNGA3-related achromatopsia using spectral-domain optical coherence tomography (SD-OCT) over a 10-year follow-up period. Methods: A single case was reviewed. Results: A 16-year-old girl with genetically confirmed CNGA3 mutations underwent annual SD-OCT imaging with concurrent assessment of best-corrected visual acuity (BCVA). Over the 10-year follow-up, BCVA remained stable; however, progressive foveal structural deterioration was observed. These included early external limiting membrane (ELM) hyperreflectivity and ellipsoid zone (EZ) disruption, followed by the development and enlargement of optically empty spaces, choroidal hypertransmission defects, and increasing hyperreflective foci. These findings were consistent with progression through a previously proposed OCT-based staging system for achromatopsia. Conclusions: This case demonstrates that CNGA3-related achromatopsia can exhibit clear structural progression on SD-OCT despite stable visual acuity, challenging the traditional view of the disease as stationary. SD-OCT is essential for detecting subtle but progressive foveal degeneration, and hyperreflective foci may represent an early marker of photoreceptor or retinal pigment epithelium compromise. These findings support further refinement and validation of OCT-based staging systems in CNGA3-related achromatopsia.