Journal of VitreoRetinal Diseases最新文献

Purpose: To demonstrate immediate closure of macular holes (MHs) with internal limiting membrane (ILM) plug placement and heavy silicone oil (SO) tamponade after pars plana vitrectomy (PPV). Method: A retrospective review was performed of 14 eyes undergoing MH repair with 23-gauge PPV, ILM plug placement, and heavy SO (Densiron Xtra) tamponade. Clinical examination findings, optical coherence tomography (OCT)-confirmed MH closure, and visual acuity (VA) outcomes were evaluated with a follow-up of at least 6 months. Results: Complete MH closure was achieved in all eyes within 24 hours, with total resolution of cysts. No postoperative macular edema or bridging fibrosis was observed. Mean VA improved from 0.25 preoperatively to 0.5 at the final follow-up. Anatomic closure was consistent across all MH subtypes. Conclusions: The ILM plug technique combined with heavy SO tamponade resulted in 100% early MH closure within 24 hours postoperatively, with excellent anatomic improvement and stability, in addition to significant improvement in VA. This approach may represent a viable surgical option in selected complex MH cases.

Purpose: To report a rare case of Down-Klinefelter syndrome associated with bilateral congenital posterior polar cataracts and a novel MAPKAPK3 gene mutation. Methods: A single case was reviewed. Results: A 2-month-old male neonate presented with dysmorphic features, including a flat facial profile, low-set ears, and upslanting palpebral fissures, along with bilateral absence of the red reflex. Ocular examination revealed bilateral congenital posterior polar cataracts. Genetic testing confirmed Down-Klinefelter syndrome (48,XXY,+21) and identified a novel mutation in the MAPK-activated protein kinase 3 gene (MAPKAPK3, c.1039G>A, p.Asp347Asn). While characteristic features of Down syndrome were evident, manifestations of Klinefelter syndrome were not yet apparent owing to the patient's young age. The patient underwent bilateral pars plana vitrectomy and lensectomy to prevent the development of nystagmus, amblyopia, and strabismus. Conclusions: Down-Klinefelter syndrome (48,XXY,+21) is a rare chromosomal disorder. This case is notable for the coexistence of classic Down syndrome features, genomic confirmation of Klinefelter syndrome, and a previously unreported MAPKAPK3 mutation. Close and long-term follow-up will be essential to understand the clinical implications of this unique genetic combination.

Purpose: To compare functional and morphologic outcomes after loading doses of faricimab and high-dose aflibercept for treatment-naive neovascular age-related macular degeneration (nAMD). Methods: We retrospectively enrolled 62 consecutive patients (64 eyes) with nAMD whose initial visual acuity (VA) was ≤20/25. Patients received 3 consecutive monthly loading doses of intravitreal 6.0 mg/0.05 mL faricimab (IVF) or intravitreal 8.0 mg/0.07 mL high-dose aflibercept (IVHDA). Changes in best-corrected VA (BCVA) and fluid were assessed at 4, 8, and 16 weeks compared with baseline. Results: Two patients were excluded from the final analysis, yielding a total of 60 patients (62 eyes). In the IVF group (n = 31 eyes), the logMAR BCVAs at baseline, 4, 8, and 16 weeks were 0.40, 0.35, 0.33, and 0.30, respectively; significant improvement occurred at 16 weeks only (P = .004 vs baseline). In the IVHDA group (n = 31 eyes), the logMAR BCVAs at the respective timepoints were 0.44, 0.36, 0.30, and 0.32; significant improvements occurred at 8 and 16 weeks (P = .001 and P = .007, respectively, vs baseline). At 16 weeks, 90.3% of patients receiving IVF and 80.6% receiving IVHDA had dry macula (P = .473). Conclusion: Significant BCVA improvements were achieved with both treatments, although improvement was faster with IVHDA. High rates of dry macula were achieved at 16 weeks in more patients in the IVF group than in the IVHDA group.

Purpose: To evaluate the efficacy and safety of bovine pericardium (Tutopatch) to seal peripheral retinal breaks located over areas of chorioretinal atrophy in highly myopic eyes. Methods: Highly myopic patients with retinal detachment (RD) caused by retinal breaks over areas of chorioretinal atrophy underwent 25-gauge pars plana vitrectomy, subretinal fluid drainage, and silicone oil (SO) tamponade. A trimmed Tutopatch was placed over the retinal breaks. Follow-up assessments were performed over 12 months, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), fundus photography, and widefield optical coherence tomography. Results: Seven eyes of highly myopic patients were included in this study. All eyes achieved complete retinal reattachment, with no recurrence of detachment after SO removal. The median BCVA improved from 0.10 (20/200 Snellen) preoperatively to 0.20 (20/100 Snellen) postoperatively. In addition, the mean IOP increased preoperatively from 13.0 ± 2.6 mm Hg to 15.0 ± 4.2 mm Hg postoperatively. The Tutopatch remained adherent to the retina throughout follow-up, without signs of inflammation, epiretinal membrane formation, or other complications. Conclusions: Tutopatch appears to be a safe and effective method for sealing retinal breaks in areas of chorioretinal atrophy in which conventional treatments are not available. This technique may help prevent redetachment in highly myopic eyes. Larger studies are warranted to confirm our findings.

Purpose: To describe how risk factors such as repair of rhegmatogenous retinal detachment (RRD), cataract extraction, and myopia interrelate to influence the risk of retinal redetachment. Methods: This retrospective cohort study included patients with phakic RRD who had subsequent cataract extraction. The incidence and risk of redetachment were compared using Cox regression and χ² analyses. Stratified analyses were performed based on time after cataract extraction, age, myopia status, and retinal repair type. Results: Of 1222 patients identified, no significant association was found between myopia and the incidence of redetachment, although the proportion of redetachments increased with the degree of myopia (nonmyopes, 8.5%, myopes, 9.5%, high myopes, 15.6%; P = .36). Myopia and high myopia were not associated with an increased risk of redetachment over time (hazard ratio, 1.01, P = .96; hazard ratio, 1.54, P = .35, respectively). Additionally, the incidence of redetachment was not significantly correlated with the time after cataract extraction (P = .33). A significant difference was observed between the incidence of redetachment and age (P = .003). Patients between 18 and 35 years experienced the highest incidence of redetachment within 1, 3, and 12 months after cataract extraction (5.26%, 7.02%, 7.02%, respectively). Such patients were overrepresented among those who underwent complex surgeries for initial phakic RRD repair (30-39 years, residual: 2.71; 40-49 years, residual: 3.32). Conclusions: Among patients with a phakic RRD, myopia did not significantly increase the risk of redetachment after cataract extraction. However, an upward trend was noted between the proportion of redetachments and the degree of myopia. Younger patients exhibited the highest incidence of redetachment and should be closely monitored after cataract extraction.

Purpose: To evaluate prevalence trends of myopia-related retinal detachment (RD) in the United States from 2015 to 2024, with additional stratification by age, sex, and race/ethnicity. Methods: This serial cross-sectional study used the Research USA No Date Shift Network on the TriNetX platform. Using the International Classification of Diseases-10 and Current Procedural Terminology codes, retinal detachment cases were evaluated in a cohort of myopic patients. Retinoschisis, retinal cysts, and retinal breaks without detachment were excluded. Prevalence was stratified by age, sex, and race/ethnicity and reported per 100 000 outpatient visits, excluding patients younger than 10 years or with unknown sex. Prevalence ratios and 95% CIs were calculated. Results: Myopia-related RD prevalence increased from 1539 to 4069 cases per 100 000 from the years 2015 to 2024 (prevalence ratio, 2.64; 95% CI, 2.59-2.70). Male patients had the highest prevalence, with 4887 cases per 100 000, compared with 3561 cases per 100 000 in female patients (prevalence ratio, 2.75; 95% CI, 2.54-2.97) in 2024. Asian patients had the highest prevalence, with 4544 cases per 100 000, while Hispanic/Latino patients had the lowest prevalence at 3085 cases per 100 000 (prevalence ratio, 1.47; 95% CI, 1.39-1.57) in 2024. Patients aged 70 to 79 years had the highest prevalence, at 7550 cases per 100 000 in 2024. All demographic categories experienced an increase in myopia-related RD prevalence during the 10-year period. Conclusions: Our study demonstrated an increase in myopia-related RD prevalence, predominantly affecting White and Asian populations, male patients, and older patients.

Purpose: To determine whether alterations in retinal microvasculature seen on optical coherence tomography angiography (OCTA) can be used to identify individuals at elevated risk for heart failure. Methods: Patients with a 10-year risk of developing heart failure greater than 5%, as calculated by the Pooled Cohort Equation to Prevent Heart Failure, were enrolled in this prospective cohort study (n = 26; 49 eyes). Individuals with clinical heart failure or ocular opacities were excluded. Age-matched healthy controls (n = 22; 32 eyes) were identified from a departmental database. OCTA imaging segmented the full retinal slab into superficial capillary plexuses and deep capillary plexuses. The foveal avascular zone was manually delineated using FIJI, and vessel density and vessel length density were measured with a FIJI macro. OCTA parameters were analyzed using linear mixed-effects models with fixed effects for heart failure risk status, age, sex, hypertension and diabetes, and a random effect for patient. Coefficients for heart failure risk status determined statistical significance, with P values adjusted using the Benjamini-Hochberg procedure. Results: Patients with a 10-year risk of developing heart failure greater than 5% showed a reduction in deep capillary plexus vessel length density (-0.011 ± 0.008; adjusted P = .038) compared with controls. Conclusions: Vessel length density in the deep capillary plexus may be reduced in individuals at elevated risk for heart failure. This study is the first to identify retinal microvascular changes in patients with elevated risk of heart failure, supporting the potential use of OCTA as a noninvasive screening tool for cardiovascular disease.

Purpose: Retinopathy of prematurity (ROP) is a major cause of childhood blindness worldwide. Infant risk factors such as low birth weight, early gestational age, and oxygen exposure are strongly associated with development of ROP. Establishing possible maternal factors, including maternal asthma, may assist in quantifying preterm infants' risk of developing severe ROP. Methods: A retrospective observational study was performed using the records of the University of Colorado ROP registry from January 2006 to February 2024. Maternal asthma was identified upon review of patients' clinic notes. Odds ratios (ORs) (with 95% CIs) for ROP risk factors were determined using multinomial logistic regression models, with ROP measures (stage, zone, type, and treatment) as the outcome and history of maternal asthma as the primary explanatory variable. A multivariable analysis was performed to control for birth weight and gestational age. Results: A total of 2237 infants met the inclusion criteria based on birth weight and gestational age, of whom 301 (13.5%) had a mother with a history of asthma. Of these infants, 23 (7.6%) developed type 1 ROP and 28 (9.3%) required treatment. Among infants with maternal asthma history, the adjusted ORs for developing type 1 ROP and type 2 ROP were 2.39 (95% CI, 1.30-4.41; P = .005) and 2.14 (95% CI, 1.25-3.67; P = .006), respectively, and these infants also had 1.87 higher odds (95% CI, 1.13-3.08) of requiring treatment compared with infants who had mothers without asthma (P = .0145). Conclusions: In this Colorado cohort, maternal asthma was associated with development of treatment-warranted ROP.

Purpose: To evaluate the efficacy and stability of a visible-light curable hydrogel as a natural bioadhesive for closure of sclerotomy wounds. Methods: Sclerotomy wound closures were performed ex vivo on cadaveric human sclera and adult porcine eyeballs using a visible-light curable hydrogel, and the burst pressure was recorded. The scleral adhesivity of the hydrogel to human scleras (n = 12) under rotational shake was evaluated using anterior segment optical coherence tomography (OCT) and slitlamp biomicroscopy for 30 days. Results: The average burst pressure of sclerotomy wounds on human scleras closed with the visible-light curable hydrogel was 220.5 mm Hg (range, 75-400 [n = 10]), which was significantly higher compared with wounds closed with fibrin glue (133.7 mm Hg; range, 5-430 [n = 10]; P = .049) and no closures (20.5 mm Hg; range, 6.1-75.3 [n = 10]; P < .001). The average burst pressure of sclerotomy wounds in porcine eyeballs closed with the hydrogel was 234.9 mm Hg (range, 35-543 [n =10]), while the burst pressure in the control group was 25.4 mm Hg (range, 6.4-60.0 [n = 10]; P < .001). Regular slitlamp and anterior segment OCT examinations showed that the visible-light curable hydrogel was consistently attached to the human scleras during the 30 days of follow-up. Conclusions: This easily applied, novel visible-light curable hydrogel has potential use for closure of sclerotomy wounds after pediatric and adult pars plana vitrectomy and may reduce postoperative vitrectomy complications, including hypotony, endophthalmitis, and astigmatism.

Purpose: To examine the effects of the pandemic on the presentation and outcomes of patients with complications of proliferative diabetic retinopathy (PDR) treated with pars plana vitrectomy (PPV). Methods: A retrospective chart review of eyes of adult patients who underwent PPV for complications of PDR from March 20, 2018, to March 20, 2022, at 2 county-based safety-net hospitals. March 20, 2020, is the cutoff date separating the pre- and post-COVID periods. Eyes with repeat PPVs and/or eyes without 6 months of follow-up were excluded. The primary outcome was visual acuity (VA) at postoperative month 6. Results: During the pre- and post-COVID periods, 253 and 234 eyes, respectively, had PPVs for PDR and at least 6 months of follow-up. The mean time from evaluation to surgery increased by 18 days. Post-COVID, more eyes presented with tractional retinal detachment (167 eyes [48%] vs 139 eyes [35%]; P = .0009) and macula-involving detachment (91 eyes [26%] vs 77 eyes [19%]; P = .0024), and the mean ± standard error VA was worse at postoperative month 6 (logMAR 1.11 ± 0.05 vs 0.94 ± 0.05; P = .0132). Within 6 months, there was no difference in the incidence of postoperative complications. Conclusions: During the pandemic, patients had more severe PDR complications and delays in surgical care, associated with worse visual outcomes after PPV.