Journal of VitreoRetinal Diseases最新文献

Aim: To describe the retro-mode scanning laser ophthalmoscopy (SLO) findings in acute idiopathic maculopathy and highlight its complementary role in disease assessment and follow-up. Methods: A single case was reviewed. Results: A 22-year-old woman presented with acute visual disturbances in her left eye 4 days following a flu-like illness. Multimodal imaging, including optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography, and retro-mode SLO, revealed characteristic features of acute idiopathic maculopathy, including subretinal hyperreflective material (SHRM), retinal pigment epithelium thickening, and choroidal inflammation. The patient was managed with a short tapering course of oral corticosteroids. Follow-up imaging demonstrated resolution of SHRM and subretinal fluid, restoration of the ellipsoid zone, and reduction in choroidal inflammation, with improvement in visual acuity from 6/18 to 6/6. Retro-mode SLO provided additional structural insights beyond conventional imaging, revealing persistent perifoveal granularity and subtle choroidal alterations despite apparent normalization on OCT. Conclusions: This is the first report to describe distinctive retro-mode SLO findings in acute idiopathic maculopathy, underscoring its potential utility as a complementary imaging modality for the diagnosis and longitudinal evaluation of this rare inflammatory condition.

Purpose: To examine the rate and outcomes of secondary vitrectomies following pneumatic retinopexy for indications other than recurrent retinal detachment (RD). Methods: This was a retrospective consecutive case series reviewing the period from 2010 to 2020. Patients were included if they required a secondary vitrectomy after a successful pneumatic retinopexy for any indication, excluding recurrent RD. Indication and time between pneumatic retinopexy and secondary vitrectomy were the primary outcome measures. Results: A total of 296 eyes that underwent pneumatic retinopexy for primary RD repair were included in the study. Six eyes underwent secondary vitrectomy after successful pneumatic retinopexy. Indications for vitrectomy included 2 eyes with epiretinal membrane (0.7 %), 1 eye with full-thickness macular hole (0.3%), and 3 eyes with vitreous opacities (1.0 %). The mean (±SD) time to vitrectomy was 6 ± 5.7 months for epiretinal membrane, 22 ± 2.1 months for vitreous opacities, and 10 months for macular hole. Conclusions: Following pneumatic retinopexy for RD repair, 2% of eyes required vitrectomy for indications other than recurrent RD. Time to secondary vitrectomy varied among the indications. Patients should be counseled appropriately for the possibility of a secondary vitrectomy following a successful pneumatic retinopexy.

Purpose: To compare the diagnostic and management accuracy of large language model chatbots vs that of humans in performing outpatient retina triage in on-call telephone emergencies. Methods: Four large language model chatbots, 3 vitreoretinal surgery fellows, and 3 certified ophthalmic technicians with on-call experience were presented with 10 simulated retina cases representing after-hours telephone calls from patients. Diagnosis and triage recommendations were obtained from chatbots and humans. Recommendations were graded for each chatbot and human respondent. Results: Human graders were significantly more accurate than chatbots in diagnosis (95% vs 76.7%, respectively; P < .01) and follow-up recommendations (85% vs 70%, respectively; P = .03). However, chatbot performance varied. ChatGPT (OpenAI; 90%, P = .4) and Claude (Anthropic; 83.3%, P = .11) were noninferior to humans in diagnosis, while Meta (Meta Platforms Inc; 76.7%, P = .01) and Gemini (Google LLC; 56.7%, P < .001) performed significantly worse than humans. ChatGPT (93.3%, P = .32) and Claude (90%, P = .74) were also noninferior to humans in follow-up recommendations, but Gemini (50%, P < .001) and Meta (46.7%, P < .001) were worse than humans. Conclusions: The current pilot study found that overall, humans performed better than large language model-based chatbots in diagnosing and triaging retina-specific on-call telephone emergencies. However, chatbot accuracy was variable, with ChatGPT and Claude showing noninferior performance compared with humans. These findings suggest that with further validation, certain large language models could serve as useful aides for managing emergency telephone calls of varying medical urgency.

Purpose: To understand the current disparities in visual deficits across race and ethnicity in patients with diabetic retinal disease (DRD). Methods: The Sight Outcomes Research Collaborative was used to identify all patients with DRD, diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) from 2015 to 2023. We created descriptive cohorts for each of the 3 diseases based on patients self-describing as White (non-Hispanic), Black/African American (non-Hispanic), Hispanic, or none of these categories (grouped as Other). We implemented a linear regression model with generalized estimating equations to estimate differences in characteristics between groups. The primary outcome was percentage of eyes with visual deficits to a visual acuity (VA) level of 20/200 or worse. Results: Percentages of eyes with VA of 20/200 or worse at inclusion were as follows: for DRD, 6.7% (1208 of 17 909 eyes) in the White (non-Hispanic) group, compared with 10.2% (779 of 7644 eyes) in the Black/African American group, 11.6% (499 of 4295 eyes) in the Hispanic group, and 7.8% (314 of 4040 eyes) in the Other group (each P < .001); for DME, 5.1% (214 of 4218 eyes) in the White (non-Hispanic) group, compared with 4.9% (81 of 1670 eyes) in the Black/African American group, 3.4% (29 of 844 eyes) in the Hispanic group, and 4.9% (43 of 877 eyes) in the Other group (each P = .21); for PDR, 16.4% (958 of 5838 eyes) in the White (non-Hispanic) group, compared with 23.3% (684 of 2935 eyes) in the Black/African American group, 24.4% (459 of 1879 eyes) in the Hispanic group, and 19.0% (242 of 1271 eyes) in the Other group (each P < .001). Conclusions: Disparities in visual deficits between races and ethnicities continue to exist.

Purpose: To describe 3 cases of angiographically silent cystoid macular edema (CME) associated with paclitaxel therapy in patients with clinical or genetic features suggestive of an underlying inherited retinal disease (IRD). Methods: A series of 3 patients was reviewed. Results: All 3 patients presented with decreased vision and bilateral, angiographically silent CME shortly after starting paclitaxel. Clinical findings in each case raised suspicion of a concurrent IRD. Genetic testing revealed a pathogenic mutation in the NR2E3 gene, consistent with enhanced S-cone syndrome in 1 patient, several variants of uncertain significance in LRP2 and RBP3 in another, and a heterozygous pathogenic mutation in PEX1, associated with peroxisome biogenesis disorders, in the third. Discontinuation of paclitaxel and initiation of various local and systemic therapies, including carbonic-anhydrase inhibitors and steroids, resulted in improvement or resolution of CME and improved visual acuity in all patients. Conclusions: This series suggests that patients with underlying or suspected IRD may be predisposed to developing CME upon initiation of paclitaxel therapy. Further investigation is warranted to better understand this potential susceptibility and to guide management in at-risk individuals.

Purpose: To describe a case of bilateral peripheral neovascularization (NV) secondary to hemoglobin C trait. Method: A single case was evaluated. Results: A 74-year-old African American woman presented asymptomatically with peripheral nonperfusion and NV on examination and angiography during an anemia evaluation, which led to a diagnosis of hemoglobin C trait. Conclusion: Hemoglobin C trait is a rare but known cause of NV. This case highlights the importance of hemoglobinopathy screening in cases of peripheral NV, as these findings may indicate systemic disease and require a multidisciplinary approach.

Purpose: To describe a rare case of cystoid macular edema (CME) associated with immunoglobulin A κ smoldering multiple myeloma and highlight the importance of considering myeloma spectrum disorders in unexplained CME. Methods: A single clinical case was reviewed. Results: A 67-year-old man presented with a 2-week history of episodic blurry vision in his left eye. Physical examination and multimodal imaging revealed CME in the left eye and minimal ellipsoid zone abnormalities in the right eye. The CME persisted despite treatment with topical nonsteroidal anti-inflammatory drugs and corticosteroids but slowly improved with topical dorzolamide. No systemic treatment for smoldering multiple myeloma was initiated during the observation period. Conclusions: This case represents a rare ocular manifestation of smoldering multiple myeloma and underscores the importance of considering myeloma spectrum disorders in cases of unexplained or treatment-resistant CME.

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.