Journal of VitreoRetinal Diseases最新文献

Purpose: To report a case of rapidly reversible cystoid macular edema (ME) associated with belzutifan therapy. Methods: A single case was reviewed. Results: A 70-year-old man with sporadic metastatic renal cell carcinoma developed acute symptomatic cystoid macular edema (CME) within 2 weeks of initiating belzutifan therapy. The CME began to improve within 1 week after treatment cessation and resolved completely thereafter. Belzutifan was subsequently restarted at a lower dose, following which CME recurred within 2 weeks. Conclusions: This is the first reported instance of rapidly reversible CME associated with the use of belzutifan in a real-world clinical setting, highlighting the need for ophthalmic monitoring in patients receiving hypoxia-inducible factor-2α inhibitors.

Purpose: Extensive macular atrophy with pseudodrusen (EMAP) is a bilateral retinal condition characterized by symmetric macular atrophy, typically affecting patients around age 45 years. Although rare, choroidal neovascularization (CNV) can occur with EMAP and remains poorly understood. Methods: A retrospective analysis of 87 patients with EMAP was conducted. Demographics, medical history, and imaging findings were evaluated. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to identify and classify CNV. Treatments included anti-vascular endothelial growth factor (anti-VEGF) agents. Results: Among 87 patients, 15 eyes of 10 individuals developed CNV. The mean age was 57 years. All patients had a history of childhood rheumatic fever and prolonged benzathine penicillin use (mean duration of use 13 years). Treatments included aflibercept (7 eyes), ranibizumab (1 eye), and 1 eye treated with combination therapy with aflibercept, ranibizumab, and faricimab (mean 8 injections/eye); 3 eyes had incomplete treatment information and 3 eyes did not receive treatment. OCT and OCTA revealed type 1 CNV in 46.7% of eyes and type 2 CNV in 46.7% of eyes. Conclusions: Early CNV diagnosis is crucial for timely treatment initiation, aiming to optimize anatomic and functional outcomes. While visual responses varied, our findings indicate that anti-VEGF therapy plays a significant role in stabilizing or improving vision.

Purpose: To report the successful use of intravitreal (IVT) caspofungin in the management of drug-resistant bilateral endogenous fungal endophthalmitis and to assess its clinical safety and efficacy. Methods: A single case was reviewed. Results: A 40-year-old woman developed bilateral endogenous endophthalmitis following ureteric stent removal. The right eye, which presented with pain, redness, and significant vision loss, was successfully treated with pars plana vitrectomy and IVT voriconazole. The left eye, initially managed with voriconazole and amphotericin B, deteriorated despite repeated antifungal injections, necessitating vitrectomy. Vitreous cultures grew Candida albicans resistant to fluconazole and voriconazole but sensitive to amphotericin B and caspofungin. IVT caspofungin (50 μg/0.1 mL) was administered in the left eye for persistent infection, leading to significant clinical improvement without drug-related adverse effects. At the final follow-up, infection was controlled in both eyes, and the patient's best-corrected visual acuity was 20/32 (0.2 logMAR) OD and 20/40 (0.3 logMAR) OS. Conclusions: IVT caspofungin appears to be a safe and effective treatment option for fungal endophthalmitis resistant to conventional antifungal agents and may serve as a valuable adjunct in refractory cases.

Purpose: To report a case of Purtscher-like retinopathy associated with Shingrix vaccination. Methods: A single case was reviewed. Results: A 58-year-old man with no past medical or ocular history received the Shingrix vaccine and subsequently developed acute vision loss in his left eye. Examination revealed a visual acuity of 20/150 OS with peripapillary and macular cotton wool spots in a circumferential distribution. Macular optical coherence tomography demonstrated multifocal areas of inner retinal thickening and hyperreflectivity. A systemic laboratory workup was unremarkable. At the 3-month follow-up, fundus findings resolved, and visual acuity returned to baseline. Conclusions: A presumptive diagnosis of Purtscher-like retinopathy associated with Shingrix vaccination was made. Purtscher-like retinopathy may be related to the upregulation of the complement cascade and proinflammatory state after vaccination. Patients should be counseled to see an ophthalmologist if visual changes occur after vaccination.

Purpose: To describe a unique case of acute macular outer retinopathy presenting immediately after rapid correction of severe hypokalemia and hypomagnesemia, and to explore the potential association between electrolyte repletion and outer retinal injury. Methods: A single clinical case was retrospectively reviewed. Results: A 29-year-old woman presented with acute macular outer retinopathy and vision loss immediately following rapid intravenous electrolyte replacement. Optical coherence tomography revealed disruption of the outer retinal layers, and microperimetry demonstrated a corresponding decrease in retinal sensitivity. The patient was monitored over 5 months without intervention and achieved visual stability with partial improvement of outer retinal structure on imaging. Conclusions: This case highlights a potential relationship between rapid variations in systemic electrolyte concentrations and the development of acute macular outer retinopathy. The findings emphasize the importance of caution during rapid electrolyte repletion and suggest that multimodal retinal imaging may be valuable in monitoring visual symptoms that arise during or after electrolyte correction.

Purpose: To describe long-term structural retinal changes in CNGA3-related achromatopsia using spectral-domain optical coherence tomography (SD-OCT) over a 10-year follow-up period. Methods: A single case was reviewed. Results: A 16-year-old girl with genetically confirmed CNGA3 mutations underwent annual SD-OCT imaging with concurrent assessment of best-corrected visual acuity (BCVA). Over the 10-year follow-up, BCVA remained stable; however, progressive foveal structural deterioration was observed. These included early external limiting membrane (ELM) hyperreflectivity and ellipsoid zone (EZ) disruption, followed by the development and enlargement of optically empty spaces, choroidal hypertransmission defects, and increasing hyperreflective foci. These findings were consistent with progression through a previously proposed OCT-based staging system for achromatopsia. Conclusions: This case demonstrates that CNGA3-related achromatopsia can exhibit clear structural progression on SD-OCT despite stable visual acuity, challenging the traditional view of the disease as stationary. SD-OCT is essential for detecting subtle but progressive foveal degeneration, and hyperreflective foci may represent an early marker of photoreceptor or retinal pigment epithelium compromise. These findings support further refinement and validation of OCT-based staging systems in CNGA3-related achromatopsia.

Aim: To describe the retro-mode scanning laser ophthalmoscopy (SLO) findings in acute idiopathic maculopathy and highlight its complementary role in disease assessment and follow-up. Methods: A single case was reviewed. Results: A 22-year-old woman presented with acute visual disturbances in her left eye 4 days following a flu-like illness. Multimodal imaging, including optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography, and retro-mode SLO, revealed characteristic features of acute idiopathic maculopathy, including subretinal hyperreflective material (SHRM), retinal pigment epithelium thickening, and choroidal inflammation. The patient was managed with a short tapering course of oral corticosteroids. Follow-up imaging demonstrated resolution of SHRM and subretinal fluid, restoration of the ellipsoid zone, and reduction in choroidal inflammation, with improvement in visual acuity from 6/18 to 6/6. Retro-mode SLO provided additional structural insights beyond conventional imaging, revealing persistent perifoveal granularity and subtle choroidal alterations despite apparent normalization on OCT. Conclusions: This is the first report to describe distinctive retro-mode SLO findings in acute idiopathic maculopathy, underscoring its potential utility as a complementary imaging modality for the diagnosis and longitudinal evaluation of this rare inflammatory condition.

Purpose: To examine the rate and outcomes of secondary vitrectomies following pneumatic retinopexy for indications other than recurrent retinal detachment (RD). Methods: This was a retrospective consecutive case series reviewing the period from 2010 to 2020. Patients were included if they required a secondary vitrectomy after a successful pneumatic retinopexy for any indication, excluding recurrent RD. Indication and time between pneumatic retinopexy and secondary vitrectomy were the primary outcome measures. Results: A total of 296 eyes that underwent pneumatic retinopexy for primary RD repair were included in the study. Six eyes underwent secondary vitrectomy after successful pneumatic retinopexy. Indications for vitrectomy included 2 eyes with epiretinal membrane (0.7 %), 1 eye with full-thickness macular hole (0.3%), and 3 eyes with vitreous opacities (1.0 %). The mean (±SD) time to vitrectomy was 6 ± 5.7 months for epiretinal membrane, 22 ± 2.1 months for vitreous opacities, and 10 months for macular hole. Conclusions: Following pneumatic retinopexy for RD repair, 2% of eyes required vitrectomy for indications other than recurrent RD. Time to secondary vitrectomy varied among the indications. Patients should be counseled appropriately for the possibility of a secondary vitrectomy following a successful pneumatic retinopexy.

Purpose: To compare the diagnostic and management accuracy of large language model chatbots vs that of humans in performing outpatient retina triage in on-call telephone emergencies. Methods: Four large language model chatbots, 3 vitreoretinal surgery fellows, and 3 certified ophthalmic technicians with on-call experience were presented with 10 simulated retina cases representing after-hours telephone calls from patients. Diagnosis and triage recommendations were obtained from chatbots and humans. Recommendations were graded for each chatbot and human respondent. Results: Human graders were significantly more accurate than chatbots in diagnosis (95% vs 76.7%, respectively; P < .01) and follow-up recommendations (85% vs 70%, respectively; P = .03). However, chatbot performance varied. ChatGPT (OpenAI; 90%, P = .4) and Claude (Anthropic; 83.3%, P = .11) were noninferior to humans in diagnosis, while Meta (Meta Platforms Inc; 76.7%, P = .01) and Gemini (Google LLC; 56.7%, P < .001) performed significantly worse than humans. ChatGPT (93.3%, P = .32) and Claude (90%, P = .74) were also noninferior to humans in follow-up recommendations, but Gemini (50%, P < .001) and Meta (46.7%, P < .001) were worse than humans. Conclusions: The current pilot study found that overall, humans performed better than large language model-based chatbots in diagnosing and triaging retina-specific on-call telephone emergencies. However, chatbot accuracy was variable, with ChatGPT and Claude showing noninferior performance compared with humans. These findings suggest that with further validation, certain large language models could serve as useful aides for managing emergency telephone calls of varying medical urgency.

Purpose: To understand the current disparities in visual deficits across race and ethnicity in patients with diabetic retinal disease (DRD). Methods: The Sight Outcomes Research Collaborative was used to identify all patients with DRD, diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) from 2015 to 2023. We created descriptive cohorts for each of the 3 diseases based on patients self-describing as White (non-Hispanic), Black/African American (non-Hispanic), Hispanic, or none of these categories (grouped as Other). We implemented a linear regression model with generalized estimating equations to estimate differences in characteristics between groups. The primary outcome was percentage of eyes with visual deficits to a visual acuity (VA) level of 20/200 or worse. Results: Percentages of eyes with VA of 20/200 or worse at inclusion were as follows: for DRD, 6.7% (1208 of 17 909 eyes) in the White (non-Hispanic) group, compared with 10.2% (779 of 7644 eyes) in the Black/African American group, 11.6% (499 of 4295 eyes) in the Hispanic group, and 7.8% (314 of 4040 eyes) in the Other group (each P < .001); for DME, 5.1% (214 of 4218 eyes) in the White (non-Hispanic) group, compared with 4.9% (81 of 1670 eyes) in the Black/African American group, 3.4% (29 of 844 eyes) in the Hispanic group, and 4.9% (43 of 877 eyes) in the Other group (each P = .21); for PDR, 16.4% (958 of 5838 eyes) in the White (non-Hispanic) group, compared with 23.3% (684 of 2935 eyes) in the Black/African American group, 24.4% (459 of 1879 eyes) in the Hispanic group, and 19.0% (242 of 1271 eyes) in the Other group (each P < .001). Conclusions: Disparities in visual deficits between races and ethnicities continue to exist.