Journal of VitreoRetinal Diseases最新文献

Introduction: To explore the effect of cigarette smoking on the risk for developing diabetic macular edema (DME) among patients with diabetes. Methods: This retrospective exactly-matched cohort study used claims data for patients from all 50 states in the United States from 2010 through 2020. Patients with an initial diagnosis of diabetes were stratified into 3 cohorts as follows: active smokers, never smokers, and former smokers. After exact matching based on demographics and comorbidities, Kaplan-Meier survival functions for the 3 cohorts were compared using pairwise log-rank tests. Results: After matching, there were 42 298 patients in each cohort. Over 6 years of follow-up, the cumulative risk for DME was significantly higher among never smokers (1.18%) than among active smokers (0.88%) and former smokers (0.90%) (both P < .001). Conclusions: Among patients with diabetes, smoking may decrease the risk for developing DME. Although the harms of smoking far outweigh any potential protective benefits, further investigation into the mechanisms behind these findings has potential to uncover new therapeutic targets.

Purpose: To determine the efficacy of switching to intravitreal (IVT) faricimab in patients with treatment-resistant neovascular age-related macular degeneration (nAMD) and determine the rates of reversion to original antivascular endothelial growth factor (anti-VEGF) therapy. Methods: A retrospective chart review was performed of patients with nAMD and persistent fluid on optical coherence tomography previously treated with anti-VEGF injections who received at least 1 IVT faricimab injection between March 1, 2022, and January 31, 2023. Results: The study comprised 135 eyes of 119 patients. Before switching to IVT faricimab, the mean number of anti-VEGF injections in the previous 12 months was 10.7 ± 2.6 (SD) with a mean interval of 4.8 ± 1.3 weeks (range, 2-8). The mean follow-up was 11.6 ± 2 months. Thirty eyes (22.2%) switched to IVT faricimab returned to the original therapy. Of 105 eyes remaining on IVT faricimab, 66 (62.9%) had no fluid at the last follow-up. Compared with the original treatment, there was a significant improvement in logMAR visual acuity at the last follow-up in eyes on IVT faricimab (0.42 vs 0.38; P < .01) and in central subfield thickness (286 µm vs 246 µm; P < .0001). There was also a significant increase in the dosing interval after the third injection vs before IVT faricimab was prescribed (4.8 weeks vs 5.5 weeks; P < .001). Conclusions: Faricimab has a potent drying effect and potential for increasing the injection interval in many eyes with nAMD and persistent fluid on other anti-VEGF agents. Although nearly 25% of eyes reverted to the original therapy because of an insufficient response or adverse events, the majority did not achieve fluid resolution after reversion.

Purpose: To describe a case of endophthalmitis caused by Haemophilus influenzae, an encapsulated bacterium, after intravitreal (IVT) injection of pegcetacoplan. Methods: A single retrospective case was evaluated. Results: An 88-year-old woman with a history of diabetes mellitus, on dialysis for chronic kidney disease, hypertension, hypothyroidism, diffuse large B-cell lymphoma, and geographic atrophy in both eyes received an IVT injection of pegcetacoplan in both eyes. She subsequently developed endophthalmitis in the right eye caused by H influenzae. Further bloodwork showed Proteus mirabilis bacteremia. Conclusions: Pegcetacoplan, a complement inhibitor, may be associated with intraocular infections with encapsulated organisms, especially in immunocompromised patients.

Purpose: To describe a case of an eccentric macular hole (MH) overlying a choroidal cavitation in a nonmyopic eye with secondary choroidal neovascularization (CNV). Methods: A case report is presented. Results: A 101-year-old man was referred for an asymptomatic retinal pigmentary abnormality in the right eye. A fundus examination showed a yellow-orange circular lesion with a white center and mild associated hemorrhage. Optical coherence tomography showed an eccentric full-thickness MH overlying a choroidal cavitation with intraretinal cystic change and subretinal hyperreflective material suggestive of CNV. The patient was treated with intravitreal antivascular endothelial growth factor and had a good response. Conclusions: Typically described as being adjacent to the optic disc and in myopic fundi, eccentric macular choroidal cavitations may be seen in nonmyopic eyes and associated with full-thickness MHs ("macular sinkholes") and CNV. This case report expands the spectrum of potentially visually significant findings associated with choroidal cavitary disease.

Purpose: To report a case of suprachoroidal migration of mitomycin-C (MMC) with ensuing retinal toxicity after trabeculectomy. Methods: A case report of retinal toxicity is described with multimodal imaging. Results: A patient developed occlusion of the retinal and choroidal vasculature in a segmental fashion that could be explained by suprachoroidal diffusion. Fundus autofluorescence showed a stippled pattern over an area of hypofluorescence in the superonasal quadrant, and a late fluorescein angiogram image showed staining of the superonasal quadrant with dependent leakage toward the optic nerve and macula. Conclusions: MMC is commonly used in glaucoma-filtering surgical procedures, and few cases of postoperative posterior segment toxicity have been reported. To our knowledge, we are the first to describe suprachoroidal migration of MMC with subsequent retinal toxicity.

Purpose: To review the first Research and Safety in Therapeutics (ReST) Committee webinar and summarize the most current recommendations regarding diagnosis and management. Methods: The ReST Committee is comprised of members of the American Society of Retina Surgeons (ASRS). At regular internal meetings, safety issue reports from the website are reviewed. A webinar series was started in 2021 to update members on multiple relevant potential safety events. Results: Topics reviewed in the webinar included pentosan polysulfate sodium (Elmiron) maculopathy, intraocular pressure elevation reported with the aflibercept prefilled syringe (PFS), and brolucizumab-associated inflammation with occlusive retinal vasculitis. Retinal toxicity related to intraoperative medications was reviewed, including hemorrhagic occlusive retinal vasculitis after intraocular vancomycin, dilution errors with intravitreal aminoglycosides, inadvertent overdoses of cefuroxime after cataract surgery, and toxic posterior segment syndrome after dropless cataract surgery using compounded triamcinolone-moxifloxacin. Indocyanine green toxicity has been reported after its use as an adjuvant during macular hole surgery. Conclusions: The past decade has seen advances in retinal pharmaceuticals and drug-delivery devices. The ASRS ReST Committee collects data from its website reporting system to inform members about up-to-date pharmaceutical and device safety concerns. Recently, a webinar was used to inform members of pigmentary maculopathy associated with pentosan polysulfate sodium, safety regarding the aflibercept PFS, intraocular inflammation and occlusive retinal vasculitis secondary to brolucizumab, and retinal toxicity from intraoperative ocular medications.

Purpose: To review sustained-release intraocular platforms used to treat diseases of the retina and choroid. Methods: A literature review of the current applications of biomaterials for sustained-release therapy in retinal and choroidal diseases was performed. Results: Retinal and choroidal diseases, such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), and uveitis, are commonly treated using intravitreal (IVT) therapies that require frequent IVT injections. Multiple sustained-release options for IVT therapy have been approved by the US Food and Drug Administration for the treatment of inflammatory eye diseases, including noninfectious uveitis, infectious diseases, and exudative retinal diseases (eg, retinal venous occlusive disease and DME) using drugs such as fluocinolone acetonide, ganciclovir, and dexamethasone. The platforms for these drugs are biodegradable or nonbiodegradable. They use biomaterials such as polymers and hydrogels and are typically implanted surgically or injected into the vitreous, where they release the drug gradually over months or years. Building on these technologies, novel platforms are being studied that are intended to treat conditions including nAMD, DR, DME, and uveitis. These platforms are being tested for their safety, efficacy, and ability to reduce the injection and visit burden. Conclusions: Multiple sustained-release ocular drug-delivery platforms are currently commercially available, and many new sustained-release IVT platforms are being investigated. The hope is that meaningfully reducing the injection burden by extending intervals between treatments while maintaining optimal efficacy will improve long-term outcomes.

Purpose: To describe a potential new phenotypic presentation of pentosan polysulfate sodium maculopathy. Methods: An observational case was analyzed. Results: A 55-year-old woman with interstitial cystitis who was treated with oral pentosan polysulfate sodium for 10 years presented with reports of decreased vision and metamorphopsia that had worsened over the past 3 months. On funduscopic examination, there were bilateral areas of retinal pigment epithelial hyperplasia inferior to the fovea with a surrounding halo of drusenoid material. Neurosensory retinal detachments with drusenoid deposition at the edges of the detachment were seen on spectral-domain optical coherence tomography. Conclusions: These findings could be mistaken for age-related macular degeneration, central serous retinopathy, Best disease, or adult vitelliform dystrophy. In this case, a review of pertinent medications assisted in making the diagnosis of toxic maculopathy. Proper diagnosis and prompt discontinuation of the inciting medication are necessary to avoid the risk for potentially irreversible retinal damage and vision loss.

Purpose: To compare the anatomic and visual acuity (VA) outcomes of rhegmatogenous retinal detachment (RRD) repair in eyes with a multifocal intraocular lens (IOLs) and eyes with monofocal IOLs. Methods: This retrospective matched-cohort study comprised pseudophakic eyes that had pars plana vitrectomy (PPV) or PPV with scleral buckling for RRD. Eyes with multifocal IOLs (multifocal group) were matched with eyes with monofocal IOLs (control group) in a 1:2 ratio for age, sex, primary surgeon, timing of surgery from presentation, type of surgery, and macular status. Results: The multifocal group included 67 eyes and the control group, 134 eyes. The mean (±SD) follow-up was 785 ± 595 days and 746 ± 566 days, respectively (P = .57). Overall, the single-surgery anatomic success rate was 76.1% in the multifocal group and 86.6% in the control group (P = .06); 75.0% and 85.9%, respectively, for PPV (P = .06); and 100% for PPV with scleral buckling in both groups (P = 1.00). The mean final logMAR VA was 0.26 ± 0.34 (20/36 Snellen) in the multifocal group and 0.27 ± 0.36 (20/37 Snellen) in the control group (P = .60). Conclusions: In pseudophakic eyes with an RRD, there was a trend toward better single-surgery anatomic success in eyes with a monofocal IOL than in eyes with a multifocal IOL treated with PPV, with similar anatomic outcomes for PPV with scleral buckling. Visual outcomes were similar between the groups and significantly improved compared with baseline.

Purpose: To report a case of polypoidal choroidal vasculopathy (PCV) recalcitrant to treatment with ranibizumab and with a ranibizumab port delivery system (Susvimo) but responsive to faricimab-svoa. Methods: A case and its findings were analyzed. Results: A 69-year-old Filipino man with PCV in the left eye was treated for 2 years with multiple ranibizumab intravitreal (IVT) injections followed by ranibizumab port delivery combined with rescue ranibizumab IVT injections, with no significant response clinically or on imaging. The visual acuity (VA) worsened to 20/100 OD. IVT treatment was switched to faricimab-svoa injections. After 2 injections, there was significant improvement on optical coherence tomography and in VA (20/60). Conclusions: This case shows the potential therapeutic benefits of targeting angiopoietin-2 in addition to vascular endothelial growth factor to treat PCV refractory to ranibizumab. Faricimab may provide an alternative to therapy with ranibizumab and verteporfin photodynamic therapy for the treatment of PCV.