Journal of VitreoRetinal Diseases最新文献

When encountering diseases of the anterior vitreous and peripheral retina (ie, the "middle segment" of the eye), vitreoretinal (VR) surgeons are specifically trained in surgical techniques for managing the vitreous and visualizing the peripheral retina during anterior vitrectomy, and therefore they are well equipped to address the complications of surgery involving the anterior vitreous space. This clinical update reviews and compares the current literature discussing techniques and patient outcomes related to complete pars plana vitrectomy versus incomplete, subtotal pars plana vitrectomy, and addresses the proposition of developing an abridged training curriculum for non-VR surgeons to acquire the knowledge and skills required to perform these procedures. Recent studies confirmed that operating in the anterior vitreous carries potential risk of retinal tear, retinal detachment, and other adverse events that may cause vision loss. To mitigate these risks, studies suggest that use of dedicated visualization equipment and illumination instruments are necessary for surgeons to safely perform anterior vitrectomy and recognize complications, should any occur. Performing VR surgery in the absence of wide-angle viewing systems, endoillumination, careful peripheral examinations, modern vitrectomy platforms, and appropriate training may lead to outcomes that are detrimental to patient safety.

Purpose: To investigate the progression of epiretinal membrane (ERM) following cataract surgery using optical coherence tomography (OCT)-based biomarkers. Methods: A retrospective review was conducted from January 2012 to February 2022, assessing eyes with preexisting idiopathic ERM that underwent uncomplicated cataract surgery. An established ERM grading scale was used, and OCT features, along with visual outcomes, were evaluated. Results: The study followed 67 eyes for an average of 47.8 months after cataract surgery. Initially, 83.6% of eyes had stage 1 ERM, 13.4% had stage 2, and 3% had stage 3. Nonsignificant ERM progression occurred 59 weeks postoperatively. Among stage 1 eyes, 16.1% progressed to stage 2; 11.1% of stage 2 eyes progressed to stage 3; and 50% of stage 3 eyes progressed to stage 4. Additionally, 10.4% developed or experienced worsened macular edema following cataract surgery, and 6% underwent vitrectomy. In eyes managed without vitrectomy, visual acuity (VA) improved 1 month after cataract surgery (P = .018) and remained stable over a 4-year period. Conclusions: Eyes with mild-stage ERM that demonstrate improved VA after cataract surgery tend to maintain these improvements over a 4-year period and do not typically progress.

Purpose: To evaluate the impact of personal, professional, and academic experiences on the publication productivity of academically affiliated female retina specialists in the United States. Methods: Between April and July 2023, a survey was distributed to academically affiliated female retina specialists in the US whose emails were found on public faculty webpages of ophthalmology departments at academic institutions. The survey gathered demographic information and the timing of personal, professional, and academic life experiences. H-indexes and most productive years were obtained from Scopus. Quantitative data were analyzed using Excel (Microsoft Corp). Results: A total of 59 responses were recorded, yielding a 38.6% response rate. The mean h-index of the cohort was 17.2 ± 15.7 (range, 0-74; IQR, 2.2-32.2). Of the 17 respondents (28.8%) who completed a research year during medical school, 16 (94.1%) reported that it was productive owing to their choice of mentor, who was male in 82.4% of cases. Of the 48 respondents (81.4%) with children, 19 (39.6%) delayed childbearing until after their fellowship, while 16 (33.3%) had children during their fellowship. The most productive year corresponded with the years of residency graduation (P < .05) and fellowship graduation (P < .05). Conclusions: Academically affiliated female retina specialists in the US experience male-dominated mentorship and tend to complete residency and fellowship before childbearing. Their average h-index is higher compared to some colleagues. Peaks in productivity correspond with the completion of training, specifically the years of residency and fellowship graduation.

Purpose: To evaluate the long-term outcomes of silicone oil (SO) tamponade using the reservoir technique vs standard oil fill technique for complex vitreoretinal surgery. Methods: This retrospective comparative case series evaluated 313 SO tamponade surgeries (230 eyes). In the reservoir technique, the posterior segment is filled with SO. The infusion line is temporarily opened to atmosphere, allowing SO to egress into the line, creating the reservoir. The pressurized air infusion is then reset to 15 mm Hg to maintain a complete SO fill during sclerotomy closure. In the palpation method, SO is introduced without creating a reservoir or moderating infusion pressure, and digital palpation of the globe determines adequate fill. Results: Moderately severe ocular hypertension (intraocular pressure [IOP] ≥ 30 mm Hg) occurred less frequently in the reservoir group (1.6%) compared with the palpation group (9.3%; P = .005). Prolonged ocular hypertension (IOP ≥ 25 mm Hg for ≥ 2 visits) was also less frequent in the reservoir group (2.9% vs 9.1%; P = .02). SO emulsification was less frequent in the reservoir group (2.7% vs 9.4%; P = .04). Eyes in the reservoir group required fewer SO placement surgeries (1.2 vs 1.5 surgeries per eye; P = .01), while final anatomic success rates were similar (reservoir: 80.4%, palpation: 78.2%; P = .5). Visual outcomes were comparable between groups. Conclusions: The reservoir technique for SO tamponade placement reduces the risk of IOP elevation, minimizes the need for reoperation, and decreases SO complications. These findings support the reservoir technique as a reliable and consistent method for SO placement in complex vitreoretinal surgeries.

Purpose: To evaluate (1) anesthesia options and (2) endophthalmitis rates in patients with open-globe injury and retained intraocular foreign bodies. Methods: This retrospective, consecutive, nonrandomized comparative study analyzed eyes with open-globe injury and retained intraocular foreign body treated between January 1, 2015, and December 1, 2023. Results: A total of 134 eyes were included. Regional anesthesia with monitored anesthesia care (MAC) was used in 128 eyes (96%) at initial surgery. There was no difference in mean best-corrected visual acuity (BCVA) at last follow-up between eyes that received general anesthesia (1.39 [20/491]) and those that received regional anesthesia with MAC (0.81 [20/129]; P = .12). Endophthalmitis was diagnosed pre- or intraoperatively in 11 eyes (8%) and postoperatively in 2 eyes (1%) with an associated wound infection. Subconjunctival antibiotics were administered in 132 eyes (99%) and intravitreal (IVT) antibiotics in 130 eyes (97%). Eyes that received intraoperative IVT antibiotics were less likely to develop postoperative endophthalmitis (1 of 130 [0.8%]) compared with those that did not (1 of 4 [25%]; P < .001). Conclusions: Regional anesthesia with MAC was the most common form of anesthesia used during surgery. The use of intraoperative IVT antibiotics was associated with a lower rate of postoperative endophthalmitis.

Purpose: To compare long-term visual outcomes in neovascular age-related macular degeneration (AMD) patients who received frequent vs infrequent antivascular endothelial growth factor injections. Methods: This retrospective case series included treatment-naïve AMD patients receiving either frequent injections (≤ 6-week intervals) or infrequent injections (≥ 10-week intervals). Best-available visual acuity (VA) and anatomic outcomes were assessed at the initial visit, 52 weeks, 104 weeks, and final visit. Results: A total of 151 eyes were studied over a mean follow-up of 42.6 months: 81 eyes (54%) in the frequent group and 70 eyes (46%) in the infrequent group. Baseline central foveal thickness (CFT) was higher in the frequent group (320 µm vs 265 µm; P = .002). Though CFT improved in both groups, it remained higher in the frequent group at 52 weeks (230 µm vs 185 µm; P = .004), 104 weeks (203 µm vs 173 µm; P = .004), and final visit (197 µm vs 165 µm; P = .015). The frequent group showed more subretinal and intraretinal fluid at all times. Baseline logMAR VA was 0.63 and 0.84 in the frequent and infrequent groups, respectively (P = .10). Visual improvement was similar between groups at 52 weeks (0.21 vs 0.22 logMAR; P = .916), 104 weeks (0.21 vs 0.18 logMAR; P = .714), and final visit (0.1 vs 0.05 logMAR; P = .510). Poor baseline VA (P < .001) and geographic atrophy (P = .025) were associated with worse outcomes. Conclusions: Over 4 years, despite higher CFT and more fluid, frequent injections showed similar visual improvement to infrequent injections. Baseline vision was the strongest predictor of final outcomes, regardless of injection frequency.

Purpose: To describe the clinical characteristics and outcomes of incarcerated patients with rhegmatogenous retinal detachment (RRD). Methods: This is a retrospective case series of incarcerated patients evaluated at the University of California, Davis Medical Center. Results: Twenty-five patients (25 eyes) were included in the study. The mean (±SD) duration of symptoms prior to presentation was 41 ± 105.3 days, and a history of trauma was reported in 12 (48%) patients. Mean preoperative logMAR visual acuity was 1.9 ± 0.2, and this improved to 1.3 ± 0.2 (P = .034) at last follow-up (mean follow-up, 9.4 ± 4.5 months). Single-surgery success was achieved in 9 patients (56.3%) with 3 months or more of follow-up. Conclusions: A significant proportion of incarcerated patients with RRD report a history of trauma and present for care after significant delay. Prompt access to care may improve outcomes.

Purpose: To examine whether vitrectomy surgery for macular hole alters the 3-dimensional shape of the macula. Methods: Macular shape was measured on radially oriented spectral-domain optical coherence tomography scans centered on the fovea. Eyes of patients with a macular hole were imaged before and after surgical repair. Eyes of individuals who had experienced a spontaneous posterior vitreous detachment (PVD) were also imaged. Pre- and postoperative shape was compared using the mean and range of best-fit curvature, and the difference between the best-fit curvature and retinal shape. Results: Fifty-two eyes of 17 men and 35 women with a macular hole (mean ± SD age 69.2 ± 8.0 years) were studied. The mean (±SD) axial length was 23.84 ± 1.63 mm. A successful surgical outcome was achieved in 48 of the 52 eyes. Mean (±SD) macular curvature was significantly reduced, from 0.027 ± 0.016 mm^-1 presurgery to 0.025 ± 0.015 mm^-1 postsurgery (P = .01). There were no other significant differences in macular shape measurements between the pre- and postoperative states (all P > .05). No significant change in macular shape was observed in the 28 eyes scanned before and after spontaneous PVD. Conclusions: Surgery for macular hole produces a significant reduction in macular curvature, not seen in eyes that develop a spontaneous PVD. These findings support the hypothesis that a mechanical force acts broadly across the macula in macular hole and may have implications for the area of intervention required for surgical repair.

Purpose: To perform a cost-utility analysis comparing primary pars-plana vitrectomy (PPV) within 24 hours with primary nonsurgical vitreous tap (or tap and inject [T&I]) for the management of endophthalmitis. Methods: Retrospective cost-utility analysis using decision tree modeling. The Victorian Endophthalmitis Registry was used to model outcome probabilities and costs from a third-party payer perspective. Australian Medicare data were used to calculate costs in a hospital-based setting (Australian dollars [A$]). Cost utility was based on preserved visual acuity and cost per quality-adjusted life year (QALY). Results: The authors identified 206 eyes treated between January 1, 2011, and January 1, 2021; 36 eyes received PPV, and 170 eyes received T&I. Seventeen eyes in the T&I group required delayed PPV. Mean incident ages were 76.29 years (53% female) in the PPV group and 74.28 years (55% female) in the T&I group. Imputed costs were A$1,523 and A$310 for PPV and T&I, with additional per-night admission costs of A$1,177. The mean presenting vs discharge logMAR of endophthalmitis was 2.24 vs 1.25 for the PPV group and 1.88 vs 1.03 for the T&I group. The mean durations of admission were 4.33 nights (PPV) and 4.04 nights (T&I). Total calculated costs per admission were A$6,929.41 and A$5,065.08 for PPV and T&I, respectively. Estimated lifetime QALYs gained were 2.23 (PPV) and 2.45 (T&I). The final costs derived per QALY were A$3,107 (PPV) and A$2,067 (T&I). Conclusions: PPV and T&I are both cost-effective per gained QALY, though the latter provided superior cost utility. A prospective randomized trial is indicated as the 2 groups differed at baseline, with eyes receiving vitrectomy having worse presenting visual acuity and prognosis.