Journal of VitreoRetinal Diseases最新文献

Purpose: To determine the outcomes of physician-directed pausing of anti-vascular endothelial growth factor (anti-VEGF) injections in eyes with branch retinal vein occlusion (BRVO). Methods: This retrospective review investigated eyes of patients with BRVO-associated macular edema that received ≥3 anti-VEGF injections within the first 6 months of diagnosis, followed by a ≥6-month physician-directed treatment pause, with ≥1 year of follow-up, between January 1, 2015, and December 1, 2022. The rate and timing of treatment reinitiation, as well as associated changes in visual acuity (VA) and optical coherence tomography (OCT) characteristics, were evaluated. Results: Of 402 eyes that received a mean of 9 injections over a mean of 14.3 months before treatment suspension, 253 (62.9%) did not need further treatment for a mean of 35.5 months. Mean VA at time of pause (0.35 logMAR [Snellen 20/45]) stayed stable at 1 year (0.38 logMAR [Snellen 20/48]; P = .113) but worsened slightly by the final visit (0.4 logMAR [Snellen 20/50]; P = .011). Mean central foveal thickness at time of pause (215 µm) remained stable at 1 year (209 µm; P = .961) and at final visit (217 µm; P = .466). For the remaining 37.1% of eyes, treatment was resumed after a mean of 17.7 months. Longer last-injection intervals (P = .010), residual fluid at time of pause (P < .001), and shorter time from edema diagnosis to first injection (P = .049) were associated with resumption. Conclusion: In most patients with BRVO who had a physician-directed pause of anti-VEGF therapy due to disease inactivity, the VA and OCT metrics remained stable for almost 3 years. However, more than one-third of eyes required additional injections, highlighting the importance of continued follow-up after treatment cessation.

Purpose: To compare outcomes of vitreous lavage with and without intraoperative fluorescein angiography (FA) in eyes with delayed postoperative vitreous cavity hemorrhage. Methods: This prospective case-control study included patients with postoperative vitreous cavity hemorrhage who were randomized into 2 groups (intraoperative FA and lavage-only groups). Findings such as areas of untreated capillary nonperfusion, active neovascularization, and diffuse peripheral leakage in the retinal periphery were noted in the intraoperative FA group. Appropriate steps were performed, including additional endolaser and/or cryotherapy. In the lavage-only group, these steps were based on the surgeon's discretion. Results: Twenty eyes of 19 patients were included in each group. All eyes showed unlasered areas of capillary nonperfusion on intraoperative FA, and targeted photocoagulation was performed. Six eyes showed diffuse peripheral leakage near the ora serrata in addition to areas of capillary nonperfusion, for which cryotherapy was performed. At 6 months, none of the patients in the intraoperative FA group had a recurrence of postoperative vitreous cavity hemorrhage, whereas 3 eyes in the lavage-only group developed recurrence. This difference was not statistically significant (P = .92). There was no significant difference in the best-corrected visual acuity between the groups at 6 months. Conclusions: There were no instances of recurrent hemorrhage in the intraoperative FA group. Preliminary data suggest the potential role of this technique to determine the causes of postoperative vitreous cavity hemorrhage as well as to reduce the rate of recurrence.

Purpose: To describe optical coherence tomography (OCT) changes that occur with silicone oil tamponade that may contribute to vision loss. Methods: A retrospective consecutive cohort study was conducted on patients seen at a single center from 2015 to 2023. Inclusion criteria were patients who underwent pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment repair. Results: Thirteen patients met the inclusion criteria. In the macula-on group, average visual acuity (VA) was 20/60 (0.47 logMAR) while oil was in the eye, and at last follow-up following oil removal, was 20/30 (0.18 logMAR). Seven of 8 patients had resolved OCT outer retinal changes on oil removal. There was a significant improvement in vision with oil removal in comparison with VA prior to oil removal (P = .04). In the macula-off detachment group, patients' average VA prior to surgery with silicone oil was 20/400 (1.5 logMAR). Average VA was 20/400 (1.4 logMAR) during silicone oil tamponade, and at last follow-up, was 20/80 (0.61 logMAR). After oil removal, all OCT outer retinal changes resolved without improvement in vision compared with before oil removal (P = .057). Conclusions: We report outer retinal OCT changes with a subsequent decline in VA. More than 90% of these changes resolved, and VA improved following oil removal. Timely removal upon identification of these changes may improve final visual outcomes, depending on macular detachment status on presentation.

Purpose: To describe a case of suspected tofacitinib-induced Vogt-Koyanagi-Harada (VKH)-like syndrome presenting with multifocal serous retinal detachments and choroidal involvement. Methods: A single case was reviewed. Results: A 66-year-old man with a history of vitiligo and vertigo presented with acute unilateral metamorphopsia. Clinical examination and multimodal imaging demonstrated multifocal serous retinal detachments with associated choroidal infiltration in the affected eye. The patient was monitored closely and experienced rapid resolution of symptoms and imaging abnormalities after discontinuation of tofacitinib. Conclusions: This case suggests a possible drug-induced VKH-like syndrome associated with tofacitinib use. Tofacitinib may be a potential risk factor for serous retinal detachment with choroidal involvement, warranting further investigation.

Purpose: To describe an unusual case of Bartonella henselae-associated neuroretinitis complicated by acquired vitelliform-like maculopathy following initial treatment with corticosteroid monotherapy. Methods: A single case was reviewed. Results: A 43-year-old man presented with acute, painless vision loss and central visual haziness in the right eye. Initial treatment with intravenous methylprednisolone and oral prednisone at an outside facility failed to improve visual acuity (VA). Subsequent evaluation at a tertiary care center revealed optic disc edema, macular star exudates, atypical subfoveal vitelliform-like changes on optical coherence tomography, and elevated Bartonella henselae titers consistent with infectious neuroretinitis. The patient was treated with a prolonged course of oral doxycycline, resulting in gradual clinical and structural improvement over 20 weeks, with a final VA of 20/60. Conclusions: This case emphasizes the importance of thorough diagnostic evaluation before initiating treatment for optic disc edema and highlights a potential sequela of treating infectious neuroretinitis with corticosteroid monotherapy.

Purpose: To compare the outcomes of intraocular lens (IOL) scleral fixation using Akreos (Bausch + Lomb) lenses with polytetrafluoroethylene (Gore-Tex CV-8, W.L. Gore & Associates) sutures vs 3-piece IOLs (Alcon MA60AC) with 10-0 Prolene (Ethicon, a Johnson & Johnson Company) sutures. Methods: Patients undergoing pars plana vitrectomy between January 2019 and July 2021 were retrospectively selected regardless of the technique used. Patients who completed at least 6 months of follow-up were invited to a new clinic visit to evaluate outcomes of their procedures. The protocol included intraocular pressure assessment using a Goldmann tonometer, subjective refraction, corneal topography with a Pentacam HR (Oculus, Optikgeräte GmbH), IOL decentration assessment on biomicroscopy via slitlamp, and optic disc cupping evaluation by indirect ophthalmoscopy. Complications such as corneal edema, ocular hypertension, hypotony, hyphema, IOL decentration, cystoid macular edema, vitreous hemorrhage, suture breakage, retinal detachment, or uveitis-glaucoma-hyphema syndrome were investigated. Results: A total of 20 eyes from 20 participants were classified into 2 groups according to surgical technique: Akreos plus GoreTex (n=11) or MA60AC plus Prolene (n=9). The results showed no statistically significant differences between the 2 groups in terms of refractive outcomes, postoperative complications, or demographic variables, suggesting both techniques provide similar efficacy and safety. Conclusions: Both the Akreos with Gore-Tex and MA60AC with Prolene scleral fixation techniques are effective and safe for patients requiring IOL implantation in the absence of adequate capsular support. Further research is needed to solidify these observations and guide future clinical decisions.

Purpose: The Area Deprivation Index (ADI) is a validated composite measure of socioeconomic status (SES) in which higher percentiles correspond to lower SES. This study sought to assess differences in the use of anti-vascular endothelial growth factor (anti-VEGF) therapy and treatment response across national ADI scores in patients with diabetic macular edema (DME). Methods: This was a US single-center, retrospective review of patients diagnosed with DME between 2014 and 2022 and followed for up to 24 months after diagnosis. Primary outcomes were best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular volume (MV), measured at 6-month intervals from DME diagnosis. Patients were classified as either low ADI (higher SES) or high ADI (lower SES) using the 75th national ADI percentile. Results: The low ADI group comprised 60 patients, and the high ADI group comprised 57 patients. Baseline functional and anatomic characteristics were similar between groups. There were no significant treatment differences (type or number of anti-VEGF and steroid injections) between groups. After 24 months, mean BCVA was 0.82 logMAR (95% CI, 0.61-1.03) in the high ADI group and 0.51 logMAR (95% CI, 0.31-0.71) in the low ADI group (P = .03). Mean final CFT and MV were not significantly different between groups (P > .05); however, patients in the low ADI group were more likely to receive cataract surgery within the treatment period (P = .04). Conclusions: Socioeconomic disadvantage does not appear to influence anti-VEGF treatment patterns or anatomic outcomes in patients with DME. However, BCVA was significantly better in the low ADI group at the end of the 24-month study period. This finding may be due to socioeconomically advantaged patients being more likely to receive cataract surgery during the treatment period.

Purpose: To describe the pathogenesis and common features of myopic traction maculopathy (MTM) and propose a new clinical classification. Methods: A review of existing findings regarding MTM was performed, outlining features of the myopic environment that contribute to its development and diverse clinical manifestations. The findings are incorporated in a new clinically oriented classification scheme for MTM, designed to differentiate between stable and progressive variants of the disease. Results: MTM is a macular disease unique to eyes with degenerative myopia, in which the presence of a small radius and deep staphyloma play a major role. Traction may arise from taut, less elastic retinal components such as arterioles and internal limiting membrane (type 1 MTM: intraretinal traction) or by anomalous vitreoretinal adhesion (type 2 MTM: vitreoretinal traction), generating a wide spectrum of anomalies linked by retinal stretching, with a mixed form of traction present in some eyes (type 3 MTM). The most common type of intraretinal MTM is the schisis-like form, where the retina stretches at the level of the outer plexiform layer. When confined to the most concave areas of the staphyloma, MTM is usually a stable disease; however, when the fovea is involved, MTM is a slowly progressive condition that can lead to macular hole formation and posterior retinal detachment. Conclusions: MTM is uniquely characterized by differing anatomy, structural differences, and various forces on the field, distinguishable by striking optical coherence tomography images. This new classification scheme for MTM, derived from decades of observation and surgical experience, may help the clinician decide the best approach for disease management.

Purpose: To report a rare case of bilateral pachychoroid spectrum disease presenting asymmetrically as chronic central serous chorioretinopathy (CSCR) in 1 eye and type 3 uveal effusion syndrome in the contralateral eye. Methods: A single case was reviewed. Results: A 47-year-old man presented with a 1-month history of decreased vision in the left eye while being on oral corticosteroids. Best-corrected visual acuity was 20/20 OD and 2/80 OS. Multimodal imaging revealed features of CSCR with an ink-blot leak in the right eye and idiopathic type 3 uveal effusion syndrome with exudative retinal and choroidal detachment in the left eye. The patient was treated with a tapering course of oral corticosteroids, resulting in complete resolution of both conditions. During a 2-year follow-up period, a recurrence of subretinal fluid was observed in the right eye. Conclusions: This unusual case highlights the spectrum of venous overload choroidopathy and emphasizes the overlapping yet distinct clinical features of CSCR and uveal effusion syndrome. Multimodal imaging plays a pivotal role in the diagnosis and management of such unique presentations.

Purpose: To report the clinical features, microbiologic aspects, and clinical outcomes of delayed scleral buckle removal. Methods: This retrospective study included all eyes undergoing delayed scleral buckle removal at Bascom Palmer Eye Institute between 2013 and 2024. Delayed removal was defined as removal more than 1 month after placement. Only eyes with exposure, extrusion, or infection were included. Cases of scleral buckle removal for reasons such as ocular pain or strabismus were excluded. Clinical examination findings, operative reports, and microbiologic culture results were reviewed. Results: The current study included 50 eyes of 50 patients. The median time from scleral buckle placement to removal was 134 months (range, 1-564). Common presenting symptoms included eye pain, foreign body sensation, discharge, redness, and blurry vision. Six eyes were asymptomatic at presentation. Conjunctival erosion was present in 49 eyes, most frequently located in the superonasal (35%) and superotemporal (35%) quadrants. The most commonly explanted element was an encircling band (81%), with sponges removed in 14% of cases. Microbiologic cultures were positive in 40% of eyes, most commonly yielding Staphylococcus aureus (5 cases), Pseudomonas aeruginosa (4 cases), and S. epidermidis (3 cases). Recurrent retinal detachment occurred in 4 eyes (8.3%), with a mean time to redetachment of 81.5 days. Conclusions: Scleral buckle removal was associated with a positive microbial culture rate of 40%. After buckle removal, the incidence of recurrent retinal detachment was low.