Journal of VitreoRetinal Diseases最新文献

Purpose: To investigate the use of short-term postoperative endotamponade with perfluorocarbon liquids (PFCLs) for the treatment of giant retinal tear-associated rhegmatogenous retinal detachment (RRD). Methods: This retrospective study evaluated patients who had 2-stage surgery, which entailed pars plana vitrectomy (PPV) completed in 2 consecutive surgeries spaced 5 days apart, during which a short-term tamponade with PFCL was used (Group 1), and patients who had conventional single-stage PPV with long-term silicone oil (SO) tamponade (Group 2). Results: The study comprised 74 eyes of 68 patients, 52 in Group 1 and 22 in Group 2. The mean (±SD) patient age at presentation was 48.19 ± 15.73 years. Of the cases, 18.9% had high myopia and 13.5% had previous trauma. The improvement in best-corrected visual acuity (BCVA) was significantly better in Group 1 than in Group 2 at all postoperative visits (P = .004, postoperative day [POD] 15; P = .002, POD 90; P = .00006, final follow-up). Anatomic success (an attached retina) was achieved in 82.7% of patients in Group 1 and in 72.7% of patients in Group 2 (P = .33). At the 6-month postoperative follow-up, 54.5% of patients and 50% of patients, respectively, had a logMAR BCVA of 1.00 or better (P = .721). The mean change in intraocular pressure from baseline was statistically significant in both groups (Group 1, P = .012; Group 2, P = .018). Conclusions: Anatomic and functional outcomes in giant retinal tear-associated RRD can be improved with short-term postoperative endotamponade with PFCLs.

Purpose: To determine whether the availability of a cytopathology-confirming diagnosis is correlated with the prognostic accuracy of a gene expression profiling assay. Methods: A single-center retrospective review was performed of patients diagnosed with uveal melanoma who had a fine-needle aspiration biopsy and gene expression profiling before proton therapy from 2012 to 2020. The development of metastases was compared in patients with gene expression profiling and cytopathology (gene expression profiling+cytopathology group) and patients with gene expression profiling only (gene expression profiling only group). Results: Of 141 patients with gene expression profiling, 98 (69.5%) had cytopathology results and 43 (30.5%) did not. The median tumor thickness was greater in the gene expression profiling+cytopathology group (5.0 mm) than in the gene expression profiling only group (3.1 mm) (P = .0003). The distribution of gene expression profiling class in these 2 groups, respectively, was class 1A, 38 (38.8%) vs 20 (46.5%); class 1B, 20 (20.4%) vs 15 (34.9%); class 2, 40 (40.8%) vs 8 (18.6%). Class 1A tumors metastasized in 4 patients (10.5%) in the gene expression profiling+cytopathology group and 3 patients (15.0%) in the gene expression profiling only group. Class 1B tumors metastasized in 3 patients (15.0%) and 1 patient (6.7%), and class 2 tumors metastasized in 18 patients (45.0%) and 5 patients (62.5%) in these 2 groups, respectively. The median months from initial treatment to metastasis diagnosis within each gene expression profiling class for the gene expression profiling+cytopathology and gene expression profiling only groups, respectively, was class 1A, 36.7 vs 33.6 (P = .86); class 1B, 37.8 vs 68.6 (P = 1.0); class 2, 19.0 vs 15.8 (P = .70). Conclusions: We found no evidence that the lack of confirmatory cytology negatively affects the accuracy of gene expression profiling, and no significant differences were found in the overall rates of metastasis between patients with and patients without cytopathology or rates within each class of gene expression profiling.

Purpose: To characterize the clinical features and outcomes of open-globe injuries with associated retinal detachment (RD). Methods: A retrospective review was performed. Results: Thirty-six patients with open-globe injuries and subsequent rhegmatogenous RD were analyzed between January 2016 and September 2021. The median time to diagnosis and to the initial vitrectomy repair was 2.5 days and 20 days, respectively. Six months postoperatively, the median Snellen best-corrected visual acuity (BCVA) improved from light perception to hand motions. The logMAR BCVAs were significantly higher (worse) for patients who had more than 20 days between their injury and the initial vitrectomy repair (P = .01) and if their retinal detachment after open-globe injury score was higher than 5 (P = .03). The number of days between the open-globe injury and the initial vitrectomy repair was directly correlated with the final logMAR BCVA (P = .03). On multivariate analysis, a duration of more than 20 days between the open-globe injury and the initial vitrectomy repair was statistically significant for predicting the 6-month logMAR BCVA (P = .02). Conclusions: The final visual outcome for cases of RD associated with open-globe injury may be improved by minimizing the time between the injury and the initial vitrectomy repair.

Purpose: To evaluate the effect of antivascular endothelial growth factor (anti-VEGF) agents on the development of sustained intraocular pressure (IOP) elevations. Methods: This single-center retrospective cohort study included eyes receiving anti-VEGF injections for various indications along with nontreated fellow eyes from 2012 to 2022. Patients were grouped according to treatment with bevacizumab, ranibizumab, or aflibercept. Trends in IOP were recorded after treatment initiation for 1 year. The development of sustained IOP elevations (defined as an increase of 5 mm Hg or greater than baseline for 4 or more weeks) and glaucoma manifestations were recorded. Results: The analysis included 1604 eyes (injection cohort, 907; control cohort, 697). The mean age of the injection cohort was 83.3 years; 56.9% were women and 82.0% were White. Injections were for neovascular age-related macular degeneration (498 [54.9%]), diabetic retinopathy (219 [24.1%]), retinal vein occlusion (161 [17.8%]), and other indications (29 [3.2%)]. Bevacizumab was used in 521 eyes (57.4%), ranibizumab in 129 eyes (14.2%), and aflibercept in 257 eyes (28.3%). The mean age in the control cohort was 81.6 years; 56.1% were women and 84.1% were White. Sustained IOP elevations developed in 97 (6.0%) of 1604 eyes throughout the study. Compared with controls, treated eyes overall did not have an increased rate of sustained IOP elevations (P = .38) or glaucoma progression (P = .51), although patients treated with bevacizumab had a significantly greater incidence of IOP elevation than controls (relative risk, 1.81; 95% CI, 1.18-2.78). The mean number of injections to sustained IOP elevation was 5.4 and did not differ between agents (P > .05). Conclusions: Although not all anti-VEGF agents are associated with IOP-related adverse effects, bevacizumab carries an increased risk for sustained IOP elevation. Further investigation into the long-term effects of bevacizumab on IOP and glaucoma and a comparison with other anti-VEGF agents may be warranted.

Purpose: To investigate how home optical coherence tomography (OCT) influences the clinical decision-making of retina specialists for the management of neovascular age-related macular degeneration (nAMD). Methods: In this retrospective imaging review, 15 retina specialists each evaluated 10 home OCT data segments from 29 eyes being treated for nAMD. Based on OCT data, indications were identified for when eyes should be treated, which antivascular endothelial growth factor should be used, and the specific retinal fluid and time thresholds for notification. Results: Withholding treatment was recommended in 64 (42.7%) of 150 data segments (95% CI, 34.7-50.6), whereas 100% of eyes received treatment on the last day of each data segment. Treatment was recommended in 86 cases (57.3%), with treatment occurring 7 or more days before the actual treatment was advised in 52 (60.5%) of 86 data segments. This earlier treatment would have prevented the accumulation of intraretinal fluid (IRF), subretinal fluid (SRF), and total retinal fluid for 69.1 nL, 162.2 nL, and 231.2 nL days. Retina specialists chose a different type of treatment agent in 35 (40%) of 86 cases. The following notification values were set: IRF, mean 9.8 ± 14.9 nL (median, 5; IQR, 5); SRF, mean 10.2 ± 16.1 nL (median, 5.5; IQR, 5); total retinal fluid, mean 15.2 ± 24.0 nL (median, 10; IQR, 5). The time-based notification interval was set at a mean of 34.7 ± 21.9 days (median, 30; IQR, 2). Conclusions: Home OCT-based decision-making by retina specialists differed substantially from actual clinical care. Home OCT has the potential to facilitate personalized care in nAMD.

Purpose: To assess and compare the results of pars plana vitrectomy (PPV) with short-term perfluorocarbon liquid (PFCL) tamponade and combined PPV with scleral buckling to treat rhegmatogenous retinal detachment (RRD) with inferior retinal breaks complicated by proliferative vitreoretinopathy (PVR). Methods: The medical records of patients who had vitreoretinal surgery for RRD with inferior retinal breaks complicated by PVR were reviewed. Group 1 had PPV with PFCL, and Group 2 had PPV with scleral buckling. Silicone oil tamponade was used in all cases of PPV with scleral buckling. The anatomic and functional outcomes and duration of surgery were compared between the 2 groups. Results: Group 1 comprised 48 eyes and Group 2, 36 eyes. No statistically significant differences were found in the demographic and baseline clinical characteristics between the groups (P > .05). The mean (±SD) duration of the initial surgery was 42.82 ± 15.25 minutes (range, 25-65) in Group 1 and 81.46 ± 37.48 minutes (range, 45-115) in Group 2. The difference was significant (P < .001). At the end of the follow-up period, recurrent RD occurred in 3 eyes (6.2%) in Group 1 and 2 eyes (5.5%) in Group 2, with no significant difference (P > .05). There was no significant difference between the groups in the mean best-corrected visual acuity or mean intraocular pressure at 6 months (P > .05). Seven eyes (14.5%) in Group 1 had anterior chamber cells and flares after the initial surgery. The inflammation resolved with topical steroid application. Conclusions: The results of PPV with PFCL are similar to those of PPV with scleral buckling for managing RRD with inferior retinal breaks complicated by PVR. Favorable anatomic and functional outcomes are maintained.

Purpose: To present the management and outcomes of a case of acute submacular hemorrhage due to neovascular age-related macular degeneration (nAMD). Methods: A single case was retrospectively evaluated. Results: A 79-year-old man with a history of submacular hemorrhage from nAMD and persistent disease activity in the left eye presented with acute submacular hemorrhage in his better-seeing right eye, which was previously closely monitored for an extrafoveal serous pigment epithelial detachment without exudation. The patient received intravitreal antivascular endothelial growth factor (anti-VEGF) and subsequently had pars plana vitrectomy with subretinal tissue plasminogen activator and gas tamponade. After 5 days of face-down positioning, the hemorrhage was successfully displaced from the fovea. Recurrent disease activity 2 weeks postoperatively prompted intensive biweekly anti-VEGF therapy. By postoperative month 5, the patient's visual acuity improved from 20/400 to 20/70 OD. Conclusions: This case highlights the importance of close monitoring of patients with nAMD exhibiting aggressive disease as well as the efficacy of prompt surgical intervention and increased anti-VEGF frequency for large submacular hemorrhages.

Purpose: To examine the trends and outcomes in the management of Coats disease and evaluate the effects of a staged therapeutic approach using transpupillary laser vascular ablation, intravitreal (IVT) bevacizumab, and adjunct as-needed posterior sub-Tenon triamcinolone acetonide (used only in cases with a persistent active exudation) on globe retention, anatomic status, and visual acuity (VA). Methods: An evaluation was performed from 2005 to 2023. Previous case series published in the literature were reviewed. In total, the case series comprised 68 patients who were evaluated and treated. In addition, a retrospective consecutive chart review was performed of novel cases of children with advanced Coats disease (stage 3 and 4) who were treated with targeted laser ablation coupled with IVT bevacizumab injection and supplemented with as-needed posterior sub-Tenon triamcinolone acetonide. Results: All patients had total resolution of the retinal detachment, and no patient had evidence of neovascular glaucoma after treatment. At 24 months, 11 (42%) of 26 eyes had better than 20/50 visual acuity (VA), 10 (39%) of 26 eyes had better than 20/400 VA, and 5 (19%) of 26 eyes had better than 5/200 VA. No eye required enucleation or developed endophthalmitis or inflammation after therapy with IVT bevacizumab. In addition, no case required incisional surgery. Conclusions: Treatment trends for advanced Coats disease have evolved, leading to enhanced patient outcomes and improved quality of life. Combined treatment with IVT bevacizumab, transpupillary laser vascular ablation, and as-needed posterior sub-Tenon triamcinolone acetonide results in improved anatomic outcomes.

Purpose: To determine the various factors affecting the duration of scleral buckle surgery, the percentage of profitable scleral buckle cases, and the operational break-even point. Methods: This single-center retrospective consecutive series comprised patients diagnosed with primary rhegmatogenous retinal detachment (RD) repaired with scleral buckling between 2019 and 2021. The primary outcome was operative time. Factors associated with longer surgery time were identified using regression analysis. A time-driven activity-based cost analysis was performed. Results: Following are the mean values: duration of 108 primary RD scleral buckle repairs, 106 ± 35 minutes (range, 52-231; median, 98); number of breaks, 2.15 ± 1.5 (range, 0-10); extent of the RD, 4.3 ± 2.0 clock hours (range, 0-9); duration of follow-up with a retina physician, 489 ± 355 days (range, 0-1316). Twenty eyes (19%) required subsequent RD repair. A regression analysis showed the following main risk factors for prolonged duration of RD repair via scleral buckling: number of breaks (β = 5.98; P = .005), use of radial elements (β = 52.09; P = .001), and gas injection (β = 31.27; P < .001). The median cost per case was $7674.64, which was $2713.64 (55%) more than the maximum Medicare reimbursement of $4961.00. The break-even time was 54.43 minutes. Conclusions: Independent risk factors for a prolonged duration of primary scleral buckle surgery include multiple breaks, use of radial elements, and gas injection. These additive steps could justify a separate complex Current Procedural Terminology code. The large majority of cases were not profitable, with losses proportional to operative time. This study demonstrates the clear need for greater reimbursements and economic incentives for scleral buckle surgery.