Journal of VitreoRetinal Diseases最新文献

Purpose: Diabetes and its microvascular complications have significant social and economic impact, and targeted prevention strategies are paramount. Wearable technology may play an important role in personalized diabetes management. This study assesses the association between physical activity measured by wearable activity trackers and the presence of diabetic retinopathy (DR) in individuals with diabetes. Methods: Retrospective chart review of accelerometer data obtained on personal fitness (Fitbit) trackers from adults with diabetes who had >1 month of linked activity tracking data registered in the All of Us Research Program Registered Tier dataset (version 7). Binary logistic regression models were used to assess adjusted associations between presence of DR and physical activity measures of mean number of daily steps and mean number of daily minutes spent on moderate-to-vigorous activities. Results: Of the 668 participants, 63% were female and 37% were male, 80% were non-Hispanic White, and 42.5% had a history of smoking. Mean age was 64.3 years (range, 25-91 years). A unit increase of 1000 daily steps walked by participants was significantly associated with a 45% reduction in the odds of having DR (odds ratio [OR] 0.55, 95% CI 0.33-0.91). A 1-minute unit increase in the mean number of daily minutes spent on moderate-to-vigorous activity was significantly associated with a 24% reduction in the odds of having DR (OR 0.76, 95% CI 0.63-0.92). Conclusions: These findings demonstrate that increased physical activity, as measured through objective quantification of both daily steps and minutes of activity, is inversely correlated with the presence of DR. This may indicate a role for wearable technology in personalizing diabetes management.

Purpose: To describe a rare case of spontaneous resolution and subsequent recurrence of subretinal fluid (SRF) associated with circumscribed choroidal hemangioma. Methods: A single case was reviewed. Results: A 67-year-old woman presented with a circumscribed choroidal hemangioma and visually significant SRF. Three weeks after initial presentation and before planned treatment, the patient's vision returned to baseline, and imaging confirmed complete resolution of SRF. She was observed without intervention. Two months later, the SRF recurred, and the patient was successfully treated with photodynamic therapy, achieving complete resolution. Conclusions: Spontaneous resolution of SRF secondary to circumscribed choroidal hemangioma can occur, albeit rarely. At the time of treatment planning, reassessment of symptoms and repeat imaging may help identify such spontaneous improvement. If resolution occurs, patients should be closely followed up for the possibility of fluid recurrence.

Purpose: Stargardt disease is an inherited form of retinal degeneration characterized by early-onset central vision loss. This report describes the long-term retinal histologic characteristics of a patient with Stargardt disease after human embryonic stem cell-derived retinal pigment epithelium (hESC-RPE) transplantation. Methods: Eyes were obtained postmortem from an 80-year-old legally blind male patient with Stargardt disease. The patient had previously undergone hESC-RPE transplantation of his left eye, and the right eye (untransplanted) served as a control. Fluorescence lifetime imaging microscopy was used to study retinal structure and metabolic activity. Staining of the retina for lipofuscin was performed using the Armed Forces Institute of Pathology method. Results: Metabolic analysis showed that the macular area had more oxidative phosphorylation relative to the mid-peripheral retina, in both the transplanted and untransplanted eye. Melanin-laden RPE cells were detected in the transplanted eye, which correlated with a pigment band present on fundus images post-hESC-RPE transplantation. Conclusions: This case description illustrates the long-term survival of subretinal hESC-RPE cells post-transplantation in a patient with Stargardt disease.

Purpose: To report the clinical features and outcomes in eyes with fishing-related ocular injury. Methods: We performed a retrospective, consecutive case series of all eyes evaluated at Bascom Palmer Eye Institute between January 1, 2013, and January 1, 2023, with a history of fishing-related ocular trauma. Results: The study cohort included 75 eyes. The cause of injury included contact with a fishhook in 27 eyes (37%), sinker in 26 (35%), and fishing pole in 7 (10%). Open-globe injury occurred in 17 (23%) eyes, and endophthalmitis was suspected preoperatively or intraoperatively in 3 (18%) of these eyes. Eyes with fishhook injuries were more likely to sustain an open-globe injury (13/24 [54%]) compared with those with non-fishhook injuries (4/44 [9%]; P < .001). Eyes with open-globe injury had worse mean best-corrected visual acuity during their last follow-up examination (1.4 logMAR [Snellen equivalent 20/501]) compared with eyes without open-globe injury (0.46 logMAR [Snellen equivalent 20/58]; P = .002). When documented, 5 (42%) of 12 eyes with open-globe injuries received intraoperative intravitreal antibiotics, while 5 (42%) eyes with injuries localized to the anterior segment received intracameral antibiotics. Eleven (92%) of 12 patients with open-globe injury underwent repair on an outpatient basis and were discharged on the day of surgery without intravenous antibiotics. There were no newly diagnosed cases of endophthalmitis in the postoperative period. Conclusions: Poor visual outcomes occurred most commonly after open-globe injuries caused by fishhooks. Most eyes with open-globe injuries received intracameral or intravitreal antibiotics at the time of surgical treatment, without postoperative inpatient admission or intravenous antibiotics, and no cases of postoperative endophthalmitis were observed.

Purpose: Central serous chorioretinopathy (CSCR) typically resolves spontaneously within 4-6 months. Observation is the mainstay of management, but low-fluence photodynamic therapy (PDT) is a well-established treatment. This study investigates risk factors for CSCR recurrence in patients managed with observation versus PDT. Methods: This retrospective case-control study included patients with a first-time CSCR diagnosis between January 2014 and January 2018. All patients were initially managed with 4-6 months of observation and followed up for at least 1 year to monitor CSCR resolution or recurrence, defined as presence of new subretinal fluid after prior resolution. For patients who received PDT following initial observation, an additional year of follow-up post-PDT was required. Demographics, medical history, and retinal imaging findings were analyzed for recurrence associations. Results: Among 90 patients with CSCR, 56 (62.2%) were managed with observation alone, and 34 (37.8%) received PDT. The groups had comparable demographic characteristics. Exogenous hormone use was higher in the PDT group than in the observation group (17.6% vs 3.6%; P = .025). Recurrence occurred in 25 patients (27.8%): 14 (25.0%) in the observation group and 11 (32.4%) in the PDT group (P = .57). Post-PDT recurrence was noted in 5 patients (14.7%). Baseline visual acuity was worse in the PDT group than in the observation group (mean ± SD 0.41 ± 0.33 vs 0.23 ± 0.27 logMAR; P < .001), but baseline central retinal thickness was similar between groups (mean ± SD 403 ± 169 vs 398 ± 166 µm; P = .89). Exogenous hormone use was a significant predictor of CSCR recurrence (odds ratio 5.2, 95% confidence interval 1.1-23.6; P = .034). Conclusions: Patients with exogenous hormone exposure may be at increased risk of recurrent CSCR and may be more likely to receive PDT. Reducing or avoiding exogenous hormones may lower CSCR recurrence risk.

Purpose: To investigate the relationship between preoperative volumetric optical coherence tomography (OCT) features of full-thickness macular holes (FTMHs), including intraretinal cysts and 3-dimensional hole symmetry, and both visual acuity outcomes and surgical prognosis in patients with FTMH. Methods: This multicenter, retrospective cohort study assessed patients with FTMH who underwent pars plana vitrectomy from 2017 to 2022. In-depth manual segmentation of each pre- and postoperative OCT volumetric scan (60 B-scans per volume) was performed by 3 graders. Correlations between preoperative cystoid volume and FTMH symmetry and preoperative visual acuity, preoperative minimum linear diameter (MLD), improvement in visual acuity at 6 months postsurgery, and FTMH closure rate postsurgery were assessed using linear regression models, adjusted for baseline lens status, duration of symptoms, and MLD. Results: A total of 69 eyes of 69 patients with FTMH were included. Mean (± SD) visual acuity was 0.69 ± 0.44 logMAR (Snellen 20/98) before surgery, and improved to 0.39 ± 0.23 logMAR at 6 months after surgery (Snellen 20/49). FTMH closure after a single surgery was 96%. Greater cystoid volume before surgery was associated with larger FTMH MLD (P < .001), worse preoperative visual acuity (P = .003), and greater visual acuity improvement at 6 months after surgery (P = .02). Greater hole asymmetry before surgery was associated with smaller MLD (P = .04), but not associated with preoperative visual acuity (P = .74) or postoperative FTMH closure rates (P = .19). Conclusions: This study on OCT volumetric measurements showed that intraretinal cystoid volume correlated with larger macular holes and greater visual acuity improvement while smaller macular holes tended to be more asymmetric.

Purpose: To present a sequential surgical approach for macular hole (MH)-associated retinal detachment using preoperative pneumatic retinopexy followed by pars plana vitrectomy, and to review the published literature on surgical strategies for this condition. Methods: A retrospective chart review was conducted for 2 patients who developed MH-associated retinal detachment. For the literature review, PubMed was used as the primary reference database to identify relevant studies. Results: Two patients with MH-associated retinal detachment were described. Both underwent pneumatic retinopexy to treat the retinal detachment, followed by pars plana vitrectomy with amniotic membrane plug or internal limiting membrane (ILM) peel, achieving successful MH closure. The literature review included 502 cases of MH-associated retinal detachment. Of these, 65% (333/502) were female and 90% were myopic. Fewer than 2% of patients underwent sequential repair of the retinal detachment and MH. In 7% of cases, laser photocoagulation was performed around the MH following vitrectomy. More than half the eyes underwent conventional ILM peel, with other techniques including ILM peel with insertion into the MH, ILM inverted and draped over or inserted into the MH, or amniotic membrane plug. The overall MH closure rate was 64%, and the initial retinal reattachment rate was 95%. Conclusions: We reviewed 2 cases that underwent a sequential surgical approach for the treatment of MH-associated retinal detachment, converting an emergent retinal detachment into an elective MH case and enhancing the likelihood of hole closure.

Purpose: To examine the clinical usage and safety profile in real-world patients with age-related macular degeneration (AMD) receiving intravitreal pegcetacoplan (Syfovre) for the treatment of geographic atrophy, and to explore the effect of intravitreal pegcetacoplan on neovascular AMD (nAMD) disease activity. Methods: Information on patient demographics, AMD classification, treatment history, visual acuity, and ocular adverse events were extracted from the electronic medical records. Results: A total of 1069 patients (1451 eyes) initiated intravitreal pegcetacoplan treatment between February 2023 and October 2023 and were followed up until March 2024. Patients received a mean (±SD) 3.3 ± 2.1 injections, and the mean (±SD) follow-up after pegcetacoplan administration was 7.5 ± 2.3 months. The majority of this cohort displayed stable visual acuity throughout treatment, with logMAR values in 821 patients remaining within 0.20 of the initial value. Ocular hypertension occurred in 36 patients (2.5% of eyes). Seventy-six patients (5.2% of eyes) with non-neovascular AMD at treatment initiation subsequently developed nAMD. Five patients (0.34% of eyes) had intraocular inflammation, including 3 with anterior uveitis, 1 with nonocclusive retinal vasculitis, and 1 with hemorrhagic occlusive retinal vasculitis with subsequent poor outcomes. A rate of retinal vasculitis of 0.03% per injection and a rate of overall intraocular inflammation of 0.1% per injection were observed. In total, 460 patients with nAMD received intravitreal pegcetacoplan. Stability of the anti-vascular endothelial growth factor (anti-VEGF) treatment interval was observed in 289 of 396 patients (73%). Preserved or improved visual acuity while undergoing anti-VEGF therapy was noted in 384 of 396 patients (97%). Conclusions: Real-world data on intravitreal pegcetacoplan treatment identifies clinician practice patterns and demonstrates an acceptable safety profile, with complications leading to long-term vision loss following pegcetacoplan administration being rare in this cohort.

Purpose: To describe a rare case of late reactivation of retinopathy of prematurity (ROP) in a treatment-naive adult female patient. Methods: Clinical examination and multimodal imaging techniques were used to diagnose the patient and guide the treatment, and genetic saliva testing was performed. Results: We describe a 30-year-old female patient who presented with late reactivation of treatment-naive ROP. She was born prematurely and never received a diagnosis of ROP. She presented at the age of 30 years with new onset of flashes and floaters. Fundoscopic examination was consistent with a diagnosis of ROP, with peripheral avascularity evident in the temporal retina bilaterally, a temporal ridge in the right eye, and focal leakage seen bilaterally on fluorescein angiography. The patient was treated with panretinal photocoagulation laser therapy. Genetic testing demonstrated a heterozygous mutation in ZNF408. Conclusions: Retinopathy associated with prematurity may reactivate in adulthood. This late reactivation may be influenced by a history of untreated ROP or by mutations associated with familial exudative vitreoretinopathy.

Purpose: To analyze the financial cost and environmental impact of supplies used during routine intravitreal injection of antivascular endothelial growth factor (anti-VEGF) therapies. Methods: The authors conducted a life cycle assessment of all supplies consumed during intravitreal injections of bevacizumab, aflibercept 2 mg, aflibercept 8 mg, and faricimab at a single academic institution. Data collected included weight, material composition, and retail price of the supplies. Two models, including a process-based approach and a hybrid life cycle assessment featuring an economic input-output model, were used to estimate the environmental impact. Three procedural protocols were analyzed, with an increasing supply consumption from protocol 1 to protocol 3. Results: Excluding the anti-VEGF medication, protocols 1, 2, and 3 cost $12.05, $40.79, and $88.69 and resulted in 3, 11, and 20 kg carbon dioxide equivalents, respectively, using the hybrid life cycle assessment. Extrapolating averaged findings from the hybrid life cycle assessment to the national volume of 15 million injections per year, this procedure may yield 5200 metric tons of waste, approaching $27 billion in material costs and more than 7.2 million metric tons of carbon dioxide equivalents annually. Excluding the anti-VEGF medication pack, this amounts to a procedural supply cost of more than $710 million and an environmental impact of 170 000 metric tons of carbon dioxide equivalents. Limiting supply consumption for all injections to protocol 1 may save more than 800 tons in waste, more than $500 million in cost, and 120 000 metric tons of carbon dioxide equivalents annually. Conclusion: Decreasing supply consumption during intravitreal injections with procedural variations, including the removal of speculums, calipers, or sterile gloves, may yield significant reductions in financial costs and environmental impact.