Journal of VitreoRetinal Diseases最新文献

Purpose: To evaluate the short-term efficacy and safety of intravitreal brolucizumab combined with sub-Tenon triamcinolone acetonide in treating diabetic macular edema (DME). Methods: Medical records were retrospectively reviewed for 11 patients with DME (14 eyes) treated with intravitreal brolucizumab and sub-Tenon triamcinolone acetonide injections at our hospital using a 1 + pro re nata injection regimen. Data collected included best-corrected visual acuity (BCVA), central macular thickness (CMT), injection frequency, and adverse events. Patients were followed up for at least 6 months. Results: At baseline, the mean BCVA was 0.43 logMAR, and the mean CMT was 418.4 µm. After 1 month of treatment, BCVA improved, and CMT significantly decreased in all cases. These improvements were maintained over 6 months of treatment, with a mean injection frequency of 1.14 injections over 6 months. This combination therapy was effective both in patients who were treatment naïve at baseline and in those who were previously treated with an anti-vascular endothelial growth factor agent. No significant complications, such as intraocular inflammation or elevated intraocular pressure, were observed during follow-up. Conclusions: Combination therapy with intravitreal brolucizumab and sub-Tenon triamcinolone acetonide may offer anatomic benefits in patients with DME, requiring fewer injections. Further evaluation using larger, prospectively designed studies is warranted to confirm its functional efficacy and long-term safety.

Purpose: To characterize uveitis specialists and identify the sociodemographic and geographic access disparities to uveitis care in the United States. Methods: In this retrospective, cross-sectional study, we identified uveitis specialists using 3 public online databases. Descriptive statistics were used to characterize uveitis specialists. An origin-destination cost matrix was used to assess travel time and distance from each US census tract to the nearest uveitis specialist. Results: We identified 447 uveitis specialists in the United States. Of these, 122 (27.3%) were women. Most (280 [62.6%]) had medical and/or surgical retina training. More than half (265 [59.3%]) completed a uveitis-specific fellowship. The majority (257 [57.5%]) were in private practice. Greater proportions of university or hospital-based (51.7% vs 29.1%; P < .001) and female (79.5% vs 51.7%; P < .001) uveitis specialists completed uveitis-specific fellowship training. More female uveitis specialists practiced in university or hospital-based settings (54.9% vs 37.8%; P < .001). No uveitis specialists were identified in 6 states. Mean ± SD travel time and distance to the nearest uveitis specialist were 45.8 ± 51.9 minutes and 40.7 ± 55.9 miles (65.5 ± 89.9 km), respectively. In a multivariate regression analysis, those traveling 60 miles (96.6 km) or more to the nearest uveitis specialist were more likely to reside in rural census tracts that were rural (P < .001), outside the Northeast (P < .001), and with greater proportions of the population below the federal poverty level (P < .001). Conclusions: There are imbalances in the composition of identified uveitis specialists and in the geographic access to uveitis care in the United States. These imbalances help to inform the allocation of training resources and to emphasize areas of critical need for uveitis care.

Purpose: To describe a case of allergic reaction to intravitreal (IVT) injection of antivascular endothelial growth factor (anti-VEGF) medications in patients with alpha-gal syndrome. Methods: A single case was evaluated. Results: A 57-year-old woman with a known diagnosis of alpha-gal syndrome was evaluated. Clinical presentation, prior treatment history, and response to different anti-VEGF agents were reviewed. The patient presented with worsening vision in her right eye due to a subfoveal choroidal neovascular membrane secondary to neovascular age-related macular degeneration in the right eye. She had experienced a systemic allergic reaction following an IVT injection of bevacizumab, but subsequently tolerated ranibizumab without any adverse effects, resulting in improvement in her vision. Conclusions: Bevacizumab, aflibercept, and faricimab are recombinant immunoglobulins produced by DNA technology in Chinese hamster ovary cells, which may contain galactose-α-1,3-galactose (alpha-gal), a potential allergen for patients with alpha-gal syndrome. Patients with alpha-gal syndrome may develop allergic reactions to certain IVT anti-VEGF agents derived from mammalian expression systems. Ranibizumab, produced using an Escherichia coli expression and lacking alpha-gal, seems to be a safe and effective option for patients with alpha-gal syndrome requiring IVT anti-VEGF therapy.

Purpose: To compare the long-term outcomes of scleral-sutured intraocular lens (IOL) fixation using expanded polytetrafluoroethylene vs polypropylene sutures, with a focus on suture-related complications. Methods: A retrospective comparative review was conducted of 102 patients who underwent scleral-sutured IOL fixation between 2015 and 2019. Forty-eight eyes of 48 patients received 4-point fixation with expanded polytetrafluoroethylene sutures, and 55 eyes of 54 patients received 2-point fixation with polypropylene sutures. Postoperative complications, visual outcomes, and risk factors for suture-related complications were analyzed over a minimum follow-up of 5 years. Results: No instances of suture breakage were observed in either group over an average follow-up of 6.7 years. Suture exposure rates were 10.4% (5/48) for expanded polytetrafluoroethylene and 18.2% (10/55) for polypropylene (P = .27). The mean time to suture exposure was 2.7 ± 3.3 years in the expanded polytetrafluoroethylene group and 2.9 ± 2.5 years in the polypropylene group (P = .88). Mean logMAR visual acuity at final follow-up was 1.0 ± 1.2 in the expanded polytetrafluoroethylene group and 1.5 ± 1.2 in the polypropylene group (P = .06). The only significant risk factor for suture exposure was concurrent corneal transplantation or glaucoma surgery (odds ratio [OR], 9.3; P = .003). Surgical correction was required in all cases of exposure with expanded polytetrafluoroethylene sutures and in 2 cases with polypropylene sutures. One case of suture-associated infectious scleritis with endophthalmitis occurred in the expanded polytetrafluoroethylene group, and 1 case of endophthalmitis related to an explanted corneal graft occurred in the polypropylene group. Conclusions: Both expanded polytetrafluoroethylene and polypropylene sutures demonstrated durable outcomes with similar complication rates. Suture breakage was not observed in either group, and there were no differences in suture exposure rates between the 2 groups. Risk factors for suture exposure included the performance of a concurrent procedure.

Purpose: Torpedo maculopathy is a rare congenital anomaly of the retinal pigment epithelium (RPE) involving the temporal edge of the macula, often diagnosed incidentally. There is minimal evidence in the ophthalmic literature regarding the multimodal imaging characteristics of these lesions. Existing classification systems inadequately describe detailed optical coherence tomography (OCT) features of the entity. Methods: This retrospective study included 18 torpedo maculopathy lesions from 16 patients at a tertiary care ophthalmic institution in Southern India over 6 years. Patients underwent detailed sociodemographic analysis and multimodal imaging. Prominent OCT biomarkers were analyzed in detail for each case. Results: The mean lesion size was 4.25 mm² (median, 2.96 mm²). Best-corrected visual acuity (BCVA) was 20/20 in the majority (75.0%) of cases. The fovea was involved in 4 patients. Interdigitate zone (IZ) disorganization was observed in all cases. Outer retinal cavitation was present in 7 lesions, often associated with focal choroidal excavation or inner retinal thinning. The remaining 11 lesions from 9 patients did not show outer retinal cavitation. Based on these findings, we propose a modified OCT-based classification for torpedo maculopathy. In the new system, type 1 describes lesions without outer retinal cavitation, whereas type 2 includes lesions with outer retinal cavitation, further subdivided into 4 groups based on inner retinal changes and focal choroidal excavation. Conclusions: This study provides a detailed description of OCT biomarkers associated with torpedo lesions and proposes a more descriptive OCT-based classification system for torpedo maculopathy.

Purpose: To describe the management and outcome of a patient with optic disc coloboma-associated cavitary disc maculopathy treated with optic nerve sheath fenestration and adjunctive juxtapapillary laser photocoagulation. Methods: A single case was evaluated. Results: A 20-year-old woman with a history of deep amblyopia in the right eye presented with total serous retinal detachment associated with optic disc coloboma. The patient underwent optic nerve sheath fenestration as the primary treatment. One month after surgery, adjunctive juxtapapillary laser photocoagulation was performed to create a barricade and reduce the risk of recurrent subretinal fluid accumulation. Visual acuity remained stable at 20/400 in the affected eye. Following optic nerve sheath fenestration and laser treatment, the retinal detachment resolved completely. Conclusions: Optic nerve sheath fenestration combined with juxtapapillary laser photocoagulation may be an effective therapeutic approach for managing select cases of optic disc coloboma with associated cavitary disc maculopathy.

Purpose: To investigate differences in gaze behavior among vitreoretinal surgeons of varying experience levels during simulated pars plana vitrectomy with epiretinal membrane peeling using a 3-dimensional heads-up display (HUD) system with integrated eye-tracking. Methods: Twenty-six ophthalmologists-postgraduate year 4 residents (n = 10), vitreoretinal fellows (n = 9), and attending surgeons (n = 7)-performed simulated vitrectomy on model eyes using a 3-dimensional HUD system with eye-tracking. Gaze metrics (fixations, saccades, field awareness, HUD focus, and tear angle) and surgical performance (International Council of Ophthalmology, Ophthalmology Surgical Competency Assessment Rubric vitrectomy score) were evaluated. Statistical analysis included Pearson correlation, analysis of variance (ANOVA), and post hoc Tukey tests. Results: Surgical performance increased with experience (postgraduate year 4: 26.6 ± 1.3; attending: 42.5 ± 1.6; P < .0001). Attendings demonstrated fewer fixations (3454.0 ± 548.0 vs postgraduate year 4: 6114.0 ± 1349.0; P < .0001), shorter fixation durations (0.21 ± 0.015 seconds vs 0.277 ± 0.034 seconds; P < .05), and smaller saccade lengths (0.168° ± 0.082° vs 0.325° ± 0.094°; P < .01). They also showed greater HUD utilization (76.3% ± 7.3% vs postgraduate year 4: 45.0% ± 8.9%; P < .01), broader visual field awareness (51.3% ± 9.7% vs 17.3% ± 5.7%; P < .001), and more controlled membrane peel angles (7.1° ± 2.6° vs postgraduate year 4: 89.5° ± 22.6°). Novices primarily focused on instrument tips, whereas experts exhibited feed-forward gaze strategies with anchored fixation and situational awareness. Conclusions: Expert vitreoretinal surgeons demonstrate distinct visual strategies characterized by efficient gaze behavior, broad field awareness, and HUD-focused attention. These gaze patterns correlate with surgical proficiency and may serve as benchmarks for training. Eye-tracking integrated with HUD systems may enhance surgical education by allowing trainees to model expert gaze behavior and improve operative performance.

Purpose: Scedosporium apiospermum is a rare cause of chronic endophthalmitis following routine cataract surgery. Methods: We present a case report and literature review of Scedosporium apiospermum endophthalmitis and related infections. Results: A 59-year-old Trinidadian woman with chronic endophthalmitis following cataract surgery presented for evaluation in the United States. Prior to presentation, she had been treated with intravitreal (IVT) vancomycin and had undergone 2 pars plana vitrectomies (PPVs). Examination revealed hand motion vision, significant anterior chamber inflammation with a hypopyon, and posterior chamber inflammation without retained lens fragments. After failing treatment with topical steroids and IVT antibiotics, she underwent repeat PPV, vitreous biopsy, anterior chamber washout, and intraocular lens removal with the capsular bag. Intraocular cultures were positive for Scedosporium apiospermum sensitive to voriconazole. The patient was successfully treated with oral voriconazole. Conclusions: Fungal endophthalmitis should be considered in patients with chronic endophthalmitis refractory to IVT antibiotics.

Purpose: To compare the outcomes of phakic and pseudophakic eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR) that underwent pars plana vitrectomy (PPV) with retinectomy. Methods: A retrospective matched cohort study was performed in patients who underwent PPV with retinectomy for RRD with PVR with a minimum follow-up of 6 months. Phakic eyes that did not undergo lensectomy were matched to pseudophakic control eyes in a 1:1 ratio for age, gender, and macular status. The main outcome measure was single-surgery anatomic success at 6 months. Results: The study included 138 eyes (69 in each of the phakic and pseudophakic groups). The mean follow-up duration was 28.7 ± 9.2 months. Baseline characteristics, including macular status, preoperative visual acuity (VA), and RRD extent and retinectomy did not differ significantly between groups. The single-surgery anatomic success after initial retinectomy did not differ significantly between the phakic and pseudophakic groups at 3 months (69.6% vs 82.6%, respectively; P = .110) or 6 months (56.6% vs 66.7%, respectively; P = .294). The final retinal reattachment was achieved in 98.6% of the phakic group and 97.1% of the pseudophakic group (P > .99). Both groups showed significant visual improvement at 6 months and final follow-up visit (P < .05). Postoperative VA did not differ significantly between groups (P > .05). Conclusions: Eyes that underwent retinectomy for RRD with PVR may achieve acceptable outcomes regardless of the lens status. There was no difference in outcomes between phakic eyes that did not undergo lensectomy and pseudophakic eyes.

Purpose: To analyze vitreous base indentation achieved with absorbable vs permanent scleral imbrication sutures during retinal detachment repair. Methods: This retrospective, consecutive case series included patients who underwent scleral imbrication sutures with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair. Single-surgery anatomic success rate and visual acuity (VA) were assessed at 6 to 9 months postoperatively. Scleral indentation was measured by B-scan ultrasonography more than 6 weeks after surgery. Results: Sixteen patients were included. The single-surgery anatomic success rate was 88% (14 of 16) at 6 months. Vitreous base indentation greater than 2 mm, initially present in all quadrants, persisted beyond 6 weeks in 100% (13 of 13) of quadrants with polyester (Mersilene) scleral imbrication sutures and in 14% (2 of 14) with polyglactin 910 (Vicryl) scleral imbrication sutures. Median VA improved from baseline 0.36 logMAR (interquartile range [IQR], 0 to 1.15) to 0.18 logMAR (IQR, 0.01 to 0.51) postoperatively. Conclusions: Scleral imbrication sutures can produce either temporary or sustained vitreous base indentation. They may serve as a useful adjuvant to PPV for primary RRD repair when avoidance of a buckle element is desired.