Journal of VitreoRetinal Diseases最新文献

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.

Purpose: To compare the postoperative outcomes after combined phacovitrectomy for epiretinal membrane and cataract (combined group) vs standalone phacoemulsification (control group). Methods: A systematic literature search of Ovid MEDLINE, CINAHL, and the Cochrane Library was performed. The primary outcomes were the refractive predictive error and mean absolute error expressed as the spherical equivalent. Secondary outcomes were the best-corrected visual acuity (BCVA). The weighted mean prediction error was calculated, and the mean absolute error outcomes were combined for a meta-analysis. When a meta-analysis was not feasible, a narrative synthesis was performed. Results: Of 3632 articles identified in the database search, 6 retrospective case control studies and 1 prospective case study met the inclusion criteria. The 7 studies comprised a total of 584 eyes (combined group, 278 eyes; control group, 306 eyes). The combined weighted mean (±SD) prediction error was -0.41 ± 0.85 D in the combined group, showing a myopic shift, and 0.09 ± 0.45 D in the control group. The meta-analysis for the postoperative mean absolute error showed a significant difference between groups (mean deviation, 0.10; 95% CI, 0.02-0.17; P = .01), favoring the control group. The mean BCVA was 0.34 ± 0.21 logMAR in the combined group and 0.575 ± 0.23 logMAR in the control group (Snellen equivalent, 6/12 and 6/19, respectively). Conclusions: The results of the meta-analysis showed that phacovitrectomy for ERM and concurrent cataract leads to higher prediction errors than standalone phacoemulsification for cataract. However, the postoperative BCVA was comparable between the 2 procedures.

Purpose: To present a pediatric patient with a unique configuration of torpedo maculopathy complicated by macular choroidal neovascularization (CNV). Methods: A single case was retrospectively reviewed. Results: An 8-year-old male child presented with decreased vision in the left eye and was found to have 2 distinct torpedo maculopathy lesions, 1 a smaller hypopigmented lesion in the temporal parafovea and the other a larger hyperpigmented comet-shaped lesion in the temporal periphery. Multimodal imaging showed active CNV. The patient received 2 intravitreal injections of ranibizumab with regression of CNV and recovery of visual acuity. Conclusions: CNV is a rare complication of torpedo maculopathy that can affect pediatric patients in the absence of choroidal excavation. The presence of a hyperpigmented peripheral lesion exhibiting symmetry across the horizontal raphe lends support to the hypothesis that an alteration in the development and migration of retinal pigment epithelium cells across the fetal bulge results in this disorder.

Purpose: To present a patient with stellate nonhereditary idiopathic foveomacular retinoschisis found with multimodal imaging. Methods: A single case was evaluated. Results: A 70-year-old woman presented with schisis cavities in the outer plexiform layer in the left eye on macular optical coherence tomography. No leakage was detected by fluorescein angiography. After ruling out other causes of nonvasogenic cystoid maculopathy, the patient was diagnosed with stellate nonhereditary idiopathic foveomacular retinoschisis. After 5 years, the best-corrected visual acuity remained stable. The retinoschisis in the left eye had resolved, and cystoid spaces appeared in the lower portion of the macula in the right eye despite the absence of vitreomacular traction. There was no history of ocular procedures or medication use that could have affected the course of the pathology during the intervening period. Conclusions: This case emphasizes the importance of performing multimodal imaging to monitor the characteristics of stellate nonhereditary idiopathic foveomacular retinoschisis as they evolve.

Purpose: To evaluate the combined relationship between ischemia, retinal fluid, and layer thickness measurements with visual acuity (VA) outcomes in patients with retinal vein occlusion (RVO). Methods: Swept-source optical coherence tomography (OCT) data were used to assess retinal layer thickness and quantify intraretinal fluid (IRF) and subretinal fluid (SRF) using a deep learning-based, macular fluid segmentation algorithm for treatment-naïve eyes diagnosed with visual impairment resulting from central RVO (CRVO) or branch RVO (BRVO). Patients received 3 loading doses of 2 mg intravitreal aflibercept injections and were then put on a treat-and-extend regimen. Image analysis was performed at baseline and postoperatively at 3 months and 6 months. The baseline OCT morphologic features and fluid measurements were correlated with the changes in best-corrected VA (BCVA) using the Pearson correlation coefficient (r). Results: The study comprised 49 eyes. A combined model incorporating thickness in the outer plexiform layer (OPL), retinal nerve fiber layer (RNFL), and presence of IRF had the strongest overall correlation for CRVO (r = 0.865; P < .05). For BRVO, the addition of IRF to the OPL-inner nasal model had a strong correlation (r = 0.803; P < .05). The baseline ischemic index in the deep capillary complex showed a notable correlation with the 6-month change in BCVA for CRVO (r = 0.9101; P < .001) and BRVO (r = 0.9200; P < .001). Conclusions: A combined model of IRF volume, OPL, and RNFL layer thicknesses, along with ischemic indices, provides the best correlation to BCVA changes. Combined fluid and layer segmentation of OCT images provides clinically useful biomarkers for RVO patients. These results give insight into the pathology of RVOs and describe the relationship between deep capillary complex ischemia and OPL/RNFL thickness in BCVA outcomes.

Purpose: To evaluate the prevalence of geographic atrophy (GA) lesions in patients with a diagnosis of intermediate age-related macular degeneration (iAMD). Methods: A retrospective cross-sectional study was performed of patients with an International Classification of Diseases, 10th Revision, diagnosis of iAMD. The primary outcome was the percentage of eyes diagnosed with iAMD with an undocumented GA lesion identified on imaging. Multiple logistic regression was used to assess risk factors for atrophic lesions in patients with iAMD. Results: The study included 690 eyes of 428 patients with a diagnosis of iAMD. The mean age was 79.4 ± 8.4 years, and 66.3% of patients were women. Forty-nine eyes (7.1%) were graded as having GA lesions, and 34% of these eyes had foveal involvement. The mean visual acuity (VA) was better in patients without GA lesions than in patients with GA lesions (72.9 ± 12.9 letters vs 66.4 ± 13.8 letters; P = .001). No systemic comorbidity was associated with an increased risk of GA lesions in this cohort. Conclusions: A notable proportion of eyes diagnosed with iAMD by eye care providers had underlying GA lesions in this real-world cohort. The use of optical coherence tomography as an adjunctive tool helped increase the detection of early GA in these patients.

Purpose: To understand the environmental burden associated with intravitreal injections (IVIs) and propose actionable solutions to mitigate this impact. Methods: An analysis of current IVI practices was conducted, focusing on packaging waste, energy consumption, the carbon footprint, and disposal processes. Data on the environmental footprint of IVIs were collected from the literature and industry reports. Sustainable practices were evaluated for their feasibility and impact on reducing waste and emissions. Industry efforts to address these environmental concerns were also surveyed. Results: This study found that the packaging of IVI medications, especially brand-name drugs, generates considerable waste. In addition, transportation and storage of these medications substantially contribute to carbon emissions. Implementing take-back programs, reducing packaging size, and using reusable or biodegradable coolers could significantly decrease waste. Adopting multidose packaging and streamlining injection practices can reduce both waste and costs. Sustainable practices have the potential for considerable environmental and economic benefits without compromising patient care. Conclusions: Addressing the environmental burden of IVIs requires a multifaceted approach involving many different parties. Collaboration among retina specialists, industry partners, and stakeholders is essential to foster sustainable practices, reduce waste, and minimize carbon emissions. This effort will ensure that our commitment to patient care matches our commitment to environmental stewardship.

Purpose: To describe a modified technique for negative and positive (Yin-Yang) staining of the internal limiting membrane (ILM) to create a nonstained ILM flap that covers large idiopathic macular holes (MHs). Methods: Consecutive patients with large idiopathic MHs (>400 μm) were prospectively included in the study. After the central vitreous was removed, a droplet of triamcinolone acetonide was injected, covering the MH and surrounding area. Subsequently, indocyanine green (ICG) was injected to stain the outer area of the ILM, followed by creation of a flap from the temporal stained area. Finally, the nonstained ILM flap was inverted to cover the MH. The main outcomes included the best-corrected visual acuity (BCVA), macular contour, and integrity of the outer retina. Results: This study comprised 31 patients (31 eyes). Of the eyes, 28 (90.3%) achieved primary MH closure. The mean minimum linear diameter and base diameter of the MH was 593 ± 119 μm and 1082 ± 242 μm, respectively. At the 6-month follow-up, 12 eyes (38.7%) and 9 eyes (29.0%) had regained a U-shaped or V-shaped macular contour, respectively. In addition, the mean logMAR BCVA improved from 1.06 ± 0.30 preoperatively to 0.56 ± 0.31 (P < .001). Twenty-one eyes (67.7%) and 16 eyes (51.6%) had regained integrity of the external limiting membrane and ellipsoid zone, respectively, at the 6-month follow-up. Conclusions: The modified ILM staining technique using triamcinolone acetonide and ICG sequentially is a safe and effective method of creating a nonstained ILM flap that covers large MHs and prevents the foveal area from coming into direct contact with ICG.

Purpose: To describe a case of frosted branch angiitis-like retinal vasculitis that developed after scleral buckle surgery. Methods: A single case was evaluated. Results: Five days after nondrainage scleral buckle surgery with a segmental buckle and encircling band, an otherwise healthy 39-year-old man presented with frosted branch angiitis. Treatment initially involved oral corticosteroids. After 5 days of treatment, there was a decrease in the subretinal exudation; however, the break appeared to be lifting with persistent subretinal fluid. Pars plana vitrectomy (PPV) with silicone oil (SO) injection was performed. A vitreous biopsy was taken during the PPV that was negative for bacterial, fungal, and viral markers. The patient's blood and urine culture showed no microbial growth, ruling out an infectious cause. Ultimately, the SO was removed, with a good visual outcome. Conclusions: Although the cause is unknown, retinal vasculitis may occur after scleral buckle surgery, albeit rarely.

Purpose: To identify baseline characteristics that predict visual outcomes after a lapse in treatment among patients with diabetic macular edema (DME) who received intravitreal antivascular endothelial growth factor injections. Methods: In this retrospective study, patients with DME who had lapses in treatment of 3 months or longer were separated into 2 groups (stable vision, n = 201; vision loss, n = 61) based on an Early Treatment Diabetic Retinopathy Study vision loss threshold of 10 letters. Stepwise backward logistic regression was used to analyze baseline factors associated with vision loss and to create a predictive algorithm. Results: In the final regression model, the length of lapse in treatment (odds ratio [OR]; 1.15, 95% CI, 1.07-1.25), diabetic foot disease (OR, 3.02; 95% CI, 1.09-8.2), and Medicaid insurance (OR, 4.60; 95% CI, 1.20-18.7) were positively associated with vision loss (P < .05). Time since diagnosis of diabetic retinopathy (OR, 0.95; 95% CI, 0.91-0.99) was negatively associated with vision loss (P < .05). The final prediction model had a sensitivity of 20% and a specificity of 84%, with an area under the curve of 65%. Conclusions: For patients with DME at high risk for a lapse in treatment, baseline characteristics can help predict vision loss and guide management.