Journal of VitreoRetinal Diseases最新文献

Purpose: To compare the long-term outcomes of scleral-sutured intraocular lens (IOL) fixation using expanded polytetrafluoroethylene vs polypropylene sutures, with a focus on suture-related complications. Methods: A retrospective comparative review was conducted of 102 patients who underwent scleral-sutured IOL fixation between 2015 and 2019. Forty-eight eyes of 48 patients received 4-point fixation with expanded polytetrafluoroethylene sutures, and 55 eyes of 54 patients received 2-point fixation with polypropylene sutures. Postoperative complications, visual outcomes, and risk factors for suture-related complications were analyzed over a minimum follow-up of 5 years. Results: No instances of suture breakage were observed in either group over an average follow-up of 6.7 years. Suture exposure rates were 10.4% (5/48) for expanded polytetrafluoroethylene and 18.2% (10/55) for polypropylene (P = .27). The mean time to suture exposure was 2.7 ± 3.3 years in the expanded polytetrafluoroethylene group and 2.9 ± 2.5 years in the polypropylene group (P = .88). Mean logMAR visual acuity at final follow-up was 1.0 ± 1.2 in the expanded polytetrafluoroethylene group and 1.5 ± 1.2 in the polypropylene group (P = .06). The only significant risk factor for suture exposure was concurrent corneal transplantation or glaucoma surgery (odds ratio [OR], 9.3; P = .003). Surgical correction was required in all cases of exposure with expanded polytetrafluoroethylene sutures and in 2 cases with polypropylene sutures. One case of suture-associated infectious scleritis with endophthalmitis occurred in the expanded polytetrafluoroethylene group, and 1 case of endophthalmitis related to an explanted corneal graft occurred in the polypropylene group. Conclusions: Both expanded polytetrafluoroethylene and polypropylene sutures demonstrated durable outcomes with similar complication rates. Suture breakage was not observed in either group, and there were no differences in suture exposure rates between the 2 groups. Risk factors for suture exposure included the performance of a concurrent procedure.

Purpose: Torpedo maculopathy is a rare congenital anomaly of the retinal pigment epithelium (RPE) involving the temporal edge of the macula, often diagnosed incidentally. There is minimal evidence in the ophthalmic literature regarding the multimodal imaging characteristics of these lesions. Existing classification systems inadequately describe detailed optical coherence tomography (OCT) features of the entity. Methods: This retrospective study included 18 torpedo maculopathy lesions from 16 patients at a tertiary care ophthalmic institution in Southern India over 6 years. Patients underwent detailed sociodemographic analysis and multimodal imaging. Prominent OCT biomarkers were analyzed in detail for each case. Results: The mean lesion size was 4.25 mm² (median, 2.96 mm²). Best-corrected visual acuity (BCVA) was 20/20 in the majority (75.0%) of cases. The fovea was involved in 4 patients. Interdigitate zone (IZ) disorganization was observed in all cases. Outer retinal cavitation was present in 7 lesions, often associated with focal choroidal excavation or inner retinal thinning. The remaining 11 lesions from 9 patients did not show outer retinal cavitation. Based on these findings, we propose a modified OCT-based classification for torpedo maculopathy. In the new system, type 1 describes lesions without outer retinal cavitation, whereas type 2 includes lesions with outer retinal cavitation, further subdivided into 4 groups based on inner retinal changes and focal choroidal excavation. Conclusions: This study provides a detailed description of OCT biomarkers associated with torpedo lesions and proposes a more descriptive OCT-based classification system for torpedo maculopathy.

Purpose: To describe the management and outcome of a patient with optic disc coloboma-associated cavitary disc maculopathy treated with optic nerve sheath fenestration and adjunctive juxtapapillary laser photocoagulation. Methods: A single case was evaluated. Results: A 20-year-old woman with a history of deep amblyopia in the right eye presented with total serous retinal detachment associated with optic disc coloboma. The patient underwent optic nerve sheath fenestration as the primary treatment. One month after surgery, adjunctive juxtapapillary laser photocoagulation was performed to create a barricade and reduce the risk of recurrent subretinal fluid accumulation. Visual acuity remained stable at 20/400 in the affected eye. Following optic nerve sheath fenestration and laser treatment, the retinal detachment resolved completely. Conclusions: Optic nerve sheath fenestration combined with juxtapapillary laser photocoagulation may be an effective therapeutic approach for managing select cases of optic disc coloboma with associated cavitary disc maculopathy.

Purpose: To investigate differences in gaze behavior among vitreoretinal surgeons of varying experience levels during simulated pars plana vitrectomy with epiretinal membrane peeling using a 3-dimensional heads-up display (HUD) system with integrated eye-tracking. Methods: Twenty-six ophthalmologists-postgraduate year 4 residents (n = 10), vitreoretinal fellows (n = 9), and attending surgeons (n = 7)-performed simulated vitrectomy on model eyes using a 3-dimensional HUD system with eye-tracking. Gaze metrics (fixations, saccades, field awareness, HUD focus, and tear angle) and surgical performance (International Council of Ophthalmology, Ophthalmology Surgical Competency Assessment Rubric vitrectomy score) were evaluated. Statistical analysis included Pearson correlation, analysis of variance (ANOVA), and post hoc Tukey tests. Results: Surgical performance increased with experience (postgraduate year 4: 26.6 ± 1.3; attending: 42.5 ± 1.6; P < .0001). Attendings demonstrated fewer fixations (3454.0 ± 548.0 vs postgraduate year 4: 6114.0 ± 1349.0; P < .0001), shorter fixation durations (0.21 ± 0.015 seconds vs 0.277 ± 0.034 seconds; P < .05), and smaller saccade lengths (0.168° ± 0.082° vs 0.325° ± 0.094°; P < .01). They also showed greater HUD utilization (76.3% ± 7.3% vs postgraduate year 4: 45.0% ± 8.9%; P < .01), broader visual field awareness (51.3% ± 9.7% vs 17.3% ± 5.7%; P < .001), and more controlled membrane peel angles (7.1° ± 2.6° vs postgraduate year 4: 89.5° ± 22.6°). Novices primarily focused on instrument tips, whereas experts exhibited feed-forward gaze strategies with anchored fixation and situational awareness. Conclusions: Expert vitreoretinal surgeons demonstrate distinct visual strategies characterized by efficient gaze behavior, broad field awareness, and HUD-focused attention. These gaze patterns correlate with surgical proficiency and may serve as benchmarks for training. Eye-tracking integrated with HUD systems may enhance surgical education by allowing trainees to model expert gaze behavior and improve operative performance.

Purpose: Scedosporium apiospermum is a rare cause of chronic endophthalmitis following routine cataract surgery. Methods: We present a case report and literature review of Scedosporium apiospermum endophthalmitis and related infections. Results: A 59-year-old Trinidadian woman with chronic endophthalmitis following cataract surgery presented for evaluation in the United States. Prior to presentation, she had been treated with intravitreal (IVT) vancomycin and had undergone 2 pars plana vitrectomies (PPVs). Examination revealed hand motion vision, significant anterior chamber inflammation with a hypopyon, and posterior chamber inflammation without retained lens fragments. After failing treatment with topical steroids and IVT antibiotics, she underwent repeat PPV, vitreous biopsy, anterior chamber washout, and intraocular lens removal with the capsular bag. Intraocular cultures were positive for Scedosporium apiospermum sensitive to voriconazole. The patient was successfully treated with oral voriconazole. Conclusions: Fungal endophthalmitis should be considered in patients with chronic endophthalmitis refractory to IVT antibiotics.

Purpose: To compare the outcomes of phakic and pseudophakic eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR) that underwent pars plana vitrectomy (PPV) with retinectomy. Methods: A retrospective matched cohort study was performed in patients who underwent PPV with retinectomy for RRD with PVR with a minimum follow-up of 6 months. Phakic eyes that did not undergo lensectomy were matched to pseudophakic control eyes in a 1:1 ratio for age, gender, and macular status. The main outcome measure was single-surgery anatomic success at 6 months. Results: The study included 138 eyes (69 in each of the phakic and pseudophakic groups). The mean follow-up duration was 28.7 ± 9.2 months. Baseline characteristics, including macular status, preoperative visual acuity (VA), and RRD extent and retinectomy did not differ significantly between groups. The single-surgery anatomic success after initial retinectomy did not differ significantly between the phakic and pseudophakic groups at 3 months (69.6% vs 82.6%, respectively; P = .110) or 6 months (56.6% vs 66.7%, respectively; P = .294). The final retinal reattachment was achieved in 98.6% of the phakic group and 97.1% of the pseudophakic group (P > .99). Both groups showed significant visual improvement at 6 months and final follow-up visit (P < .05). Postoperative VA did not differ significantly between groups (P > .05). Conclusions: Eyes that underwent retinectomy for RRD with PVR may achieve acceptable outcomes regardless of the lens status. There was no difference in outcomes between phakic eyes that did not undergo lensectomy and pseudophakic eyes.

Purpose: To analyze vitreous base indentation achieved with absorbable vs permanent scleral imbrication sutures during retinal detachment repair. Methods: This retrospective, consecutive case series included patients who underwent scleral imbrication sutures with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair. Single-surgery anatomic success rate and visual acuity (VA) were assessed at 6 to 9 months postoperatively. Scleral indentation was measured by B-scan ultrasonography more than 6 weeks after surgery. Results: Sixteen patients were included. The single-surgery anatomic success rate was 88% (14 of 16) at 6 months. Vitreous base indentation greater than 2 mm, initially present in all quadrants, persisted beyond 6 weeks in 100% (13 of 13) of quadrants with polyester (Mersilene) scleral imbrication sutures and in 14% (2 of 14) with polyglactin 910 (Vicryl) scleral imbrication sutures. Median VA improved from baseline 0.36 logMAR (interquartile range [IQR], 0 to 1.15) to 0.18 logMAR (IQR, 0.01 to 0.51) postoperatively. Conclusions: Scleral imbrication sutures can produce either temporary or sustained vitreous base indentation. They may serve as a useful adjuvant to PPV for primary RRD repair when avoidance of a buckle element is desired.

Purpose: To present longitudinal, multimodal imaging findings of leptovitelliform maculopathy, an underrecognized condition within the spectrum of adult vitelliform lesions. Methods: A single case was evaluated over 5 years. Results: A 70-year-old man presented with vitelliform lesions accompanied by subretinal drusenoid deposits/reticular pseudodrusen and a thin choroid (leptochoroid). Multimodal imaging demonstrated progressive collapse of the vitelliform lesions, followed by extensive and worsening outer retinal atrophy. Conclusions: Leptovitelliform maculopathy may demonstrate progressive collapse of vitelliform lesions, ultimately leading to significant outer retinal atrophy. Longitudinal multimodal imaging is valuable in characterizing this aggressive and underrecognized disease entity.

Purpose: To describe a modified approach to managing bilateral simultaneous rhegmatogenous retinal detachment (RRD) based on factors other than macular status to guide surgical timing and sequencing. Methods: We retrospectively reviewed 47 patients with bilateral simultaneous RRD and grouped them into cohorts by macular status at presentation: cohort AA (both macula-attached, n = 23), cohort DD (both detached, n = 10), and cohort DA (1 attached and 1 detached, n = 14). Cohort DA was further divided, based on which eye was operated on first, into 3D (macula-detached eye first, n = 6) and 3A (macula-attached eye first, n = 4). Mean postoperative logMAR visual acuity (VA) is reported. Results: The mean ± SD time to surgery was 3.4 ± 10.2 days for the first eye and 19.4 ± 30.2 days for the second. No patients experienced RD progression in the second eye between surgeries. There was no difference in postoperative VA between the first and second-operated eyes in cohort AA (0.1 vs 0.1, P = .90) and cohort DD (0.4 vs 0.9, P = .10). In cohort DA, in macula-detached eyes, visual outcomes were significantly better when the macula-detached eye was operated on first (0.5 in group 3D vs 0.9 in group 3A, P = .03). In macula-attached eyes, no significant difference was observed (0.1 in group 3D vs 0.2 in group 3A, P = .63). Across all cohorts, the first-operated eye tended to be more symptomatic, lack signs of chronicity, or have a larger detachment. Conclusions: Bilateral simultaneous RRD often presents with chronic features. Surgical decision-making should consider symptom duration and clinical indicators of chronicity, not just macular status. Prioritizing eyes with more acute presentation may improve visual outcomes, while eyes with chronic findings may tolerate delayed repair.

Purpose: To report a rare case of sub-internal limiting membrane (sub-ILM) hemorrhage following femtosecond laser in situ keratomileusis, successfully managed conservatively. Methods: A single postoperative case was reviewed. Results: A 32-year-old woman presented with unilateral vision loss 1 month after femtosecond laser in situ keratomileusis. Clinical examination revealed a sub-ILM hemorrhage involving the macula, with an initial best-corrected visual acuity (BCVA) of 6/24. The patient underwent conservative management with serial follow-up examinations. Over the following months, the hemorrhage demonstrated progressive spontaneous resolution. At 4 months, the patient had a normal fundoscopic examination, and the BCVA improved to 6/6 without surgical intervention. Conclusions: Sub-ILM hemorrhage may occur as a rare posterior segment complication after laser in situ keratomileusis, even in otherwise healthy patients without known risk factors. Prompt diagnosis and close monitoring are crucial, and surgical intervention should be reserved for cases that fail to resolve spontaneously. To the best of our knowledge, this is the first documented case of sub-ILM hemorrhage following femtosecond laser in situ keratomileusis. Laser in situ keratomileusis. Further research is warranted to understand the effects of femtosecond laser in situ keratomileusis on intraocular pressure dynamics and retinal vasculature.