Journal of VitreoRetinal Diseases最新文献

Purpose: To describe the association between short telomere syndrome and exudative retinopathies in adults. Methods: This case series compared the presentation, course of treatment, and visual outcomes of 2 patients with adult-onset retinopathy associated with short telomere syndrome. Results: In Case 1, a 53-year-old man initially presented with bilateral retinal telangiectasias and preretinal hemorrhage in the left eye, which was followed by multiple vitreous hemorrhages. In the subsequent 15 years, the patient was diagnosed with pulmonary fibrosis, liver cirrhosis, and a RTEL1 gene mutation, consistent with short telomere syndrome. In Case 2, a previously asymptomatic 26-year-old man with paternally inherited short telomere syndrome (TERC gene mutation) presented with floaters, bilateral peripheral retinal capillary nonperfusion, and an aneurysmal lesion with surrounding exudation. Conclusions: Short telomere syndromes, with systemic features that can be life-threatening, can manifest initially in adulthood with retinal telangiectasia, aneurysmal lesions, exudation, or peripheral retinal capillary nonperfusion, preceding systemic manifestations. Because the systemic manifestations of retinal telangiectasia and peripheral retinal capillary nonperfusion are progressive and can be life-threatening, recognizing these findings in adults with retinal telangiectasia is crucial.

Purpose: To report a patient with a sub-inner limiting membrane (ILM) hemorrhage secondary to dengue fever treated with neodymium:YAG (Nd:YAG) laser hyaloidotomy. Methods: A single case was evaluated. Results: A 41-year-old man presented with sudden vision loss in the left eye 10 days after being diagnosed with dengue fever. Fundoscopy showed a sub-ILM macular hemorrhage in the left eye. Out of concern for retinal toxicity and to quickly restore visual acuity (VA), an Nd:YAG laser hyaloidotomy was performed. One month after the procedure, the VA in the left eye improved from 0.1 to 1.0 with complete resolution of the hemorrhage. Conclusions: Given the substantial increase in cases of dengue fever and its possible ophthalmologic involvement, this case highlights the importance of an ophthalmologic examination with fundoscopy in patients with a sub-ILM hemorrhage and the possibility of treatment with an Nd:YAG laser.

Purpose: To describe a patient with a traumatic choroidal rupture and a submacular hemorrhage, the course of which was complicated by delayed-onset posterior uveitis resembling a white-dot syndrome.

Methods: A single case was evaluated.

Results: A 34-year-old man presented after being struck in the left eye with a tennis ball. The visual acuity (VA) was 20/30 with otherwise normal ophthalmic vitals. An examination showed traumatic iritis and choroidal rupture with a submacular hemorrhage without subfoveal involvement. Despite treatment of anterior segment inflammation and a worsening hemorrhage with topical agents and intravitreal aflibercept, the VA decreased to 20/600. A repeat examination with optical coherence tomography showed new optic disc edema, placoid outer retinal lesions adjacent to the choroidal rupture, and corresponding ellipsoid zone atrophy. A broad workup was unremarkable, and the patient completed a long taper of high-dose oral prednisone without recurrence.

Conclusions: Traumatic exposure of the immunologically privileged subretinal space to high-flow choroidal circulation likely triggered a pathway involving self-autoantigenicity and a uveitic response.

Purpose: To evaluate whether infrared video imaging can supplement traditional examination and imaging methods to identify and quantify symptomatic vitreous opacities. Methods: A prospective nonrandomized nonmasked series was performed that included eyes of consecutive patients with a primary complaint of symptomatic vitreous opacities. A macular vitreous opacity score (0-4) was developed to grade the size of the opacities in relation to the macula after refixation of up, down, left, and right saccades. Grade 0 indicated an absence of opacities. Grades 1 to 4 represented how many quadrants of the macula were obscured by opacities for more than 50% of the total video capture time (grade 1 = 1%-25%; grade 2 = 26%-50%, grade 3 = 51%-75%; grade 4 = 76%-100%). Grade 2 opacities were divided into subcategories 2A and 2B depending on whether they were central enough to obscure the fovea for more than 50% of the time. Results: The study comprised 52 eyes of 40 patients. Thirty-two eyes (62%) with symptomatic vitreous opacities were grade 1, 6 (11%) were grade 2A, 6 (11%) were grade 2B, 5 (10%) were grade 3, and 3 (6%) were grade 4. Conclusions: Infrared video imaging is a useful supplement to traditional examination and imaging methods for the identification and quantification of symptomatic vitreous opacities. The macular vitreous opacity score can help standardize vitreous opacity documentation in the clinical setting for future case selection.

Purpose: To compare the effects of intravitreal (IVT) 0.7 mg dexamethasone implants on the intraocular pressure (IOP) in Black patients and White patients with diabetic macular edema (DME). Methods: A retrospective cohort study was performed of Black patients and White patients with DME who received dexamethasone implants with 12 or more months of follow-up. Results: The study included 145 eyes (69 Black; 76 White) with a mean (±SD) of 3.6 ± 3.9 dexamethasone implants and 58 ± 31 months of follow-up. Black patients had higher baseline rates of glaucoma (23% vs 8%; P = .010) but similar rates of ocular hypertension after receiving IVT dexamethasone (20% vs 16%; P = .52). By the last follow-up visit, the mean central subfield thickness had decreased from 387 ± 129 µm to 314 ± 104 µm (P < .001). Conclusions: IVT dexamethasone implants decreased macular thicknesses in patients with DME; however, there was no difference in the rate of ocular hypertension after IVT dexamethasone between Black patients and White patients.

Purpose: To assess the differences in measures of diabetic retinopathy (DR) disease burden between patients in high-income vs low-income ZIP codes when presenting to retina specialists. Methods: This retrospective cohort study comprised patients who presented to a retina specialist at Duke Eye Center between 2014 and 2023 for the management of DR. The quartile of patients with the highest income was compared with the quartile with the lowest income. Demographic data included age, sex, and race. Clinical data included glycosylated hemoglobin A_1c (HbA_1c), visual acuity (VA), DR diagnostic stage, presence of diabetic macular edema (DME) or vitreous hemorrhage, and whether treatment was indicated. Measures of DR disease burden included HbA_1c, VA, presence of DME or vitreous hemorrhage, severity of DR, and need for intervention. Results: The analysis included 430 eyes of 215 patients. After controlling for age, sex, race, and glycemic control, it was found that patients in the low-income group were more likely to have DME at presentation (P < .01), to have more severe DR at presentation (P < .001), and to require an intervention for DR (P < .001). The VA was worse in the low-income group than in the high-income group (20/50 vs 20/32; P < .10); however, this did not reach statistical significance. Conclusions: Patients living in low-income ZIP codes have greater DR severity, prevalence of DME, and need for treatment than their high-income counterparts when first presenting to a retina specialist. These findings suggest that patients from low-income backgrounds may face additional barriers before being evaluated by a retina specialist, resulting in more clinically advanced stages of DR at presentation.

Purpose: To report a case of macular chorioretinal atrophy associated with Stickler syndrome in a pediatric patient with a genetically confirmed COL2A1 mutation. Methods: A single case was evaluated. Results: A 3-year-old girl was found to have macular chorioretinal atrophy in the right eye and a retinal detachment in the left eye. Optical coherence tomography (OCT) showed macular chorioretinal atrophy and retinal thinning in the right eye. Conclusions: Macular chorioretinal atrophy can occur in Stickler syndrome. OCT imaging can be an important tool to characterize and differentiate these lesions from infectious or degenerative processes. These macular findings in collagen disorders can affect vision, making disease identification essential for early diagnosis and management.

Purpose: To describe the efficacy of belzutifan as a treatment for juxtapapillary retinal hemangioblastomas in patients with von Hippel-Lindau disease. Methods: A case and its findings were analyzed, and a systematic literature review was conducted using PubMed and Ovid MEDLINE. Results: At a routine follow-up, a 63-year-old woman with a history of von Hippel-Lindau disease and slowly progressive bilateral juxtapapillary retinal hemangioblastomas presented with decreased visual acuity (VA) in the right eye resulting from significant lesion growth and an increase in central macular edema and exudate. Oral belzutifan therapy was initiated. A significant bilateral regression and decrease in tumor size, improved macular thickening and edema, and improved VA were seen over a 6-month period. Conclusions: The current literature on the therapeutic effects of oral belzutifan is limited; however, recent reports have been promising. This case shows the potential efficacy of belzutifan as a first-line treatment for vision-threatening juxtapapillary retinal hemangioblastomas in patients with von Hippel-Lindau disease.