Journal of VitreoRetinal Diseases最新文献

Purpose: To report the case of a 13-year-old boy who underwent immediate sequential bilateral retinal detachment surgery in the setting of Stickler syndrome and familial adenomatous polyposis syndrome. Methods: Retrospective chart review of a single case followed by descriptive analysis. Results: A 13-year-old boy with bilateral rhegmatogenous retinal detachment underwent immediate sequential bilateral vitreoretinal surgery because of socioeconomic limitations that restricted return visits. Intraoperatively, multiple areas of congenital hypertrophy of the retinal pigment epithelium were observed. The patient had a family history of Stickler syndrome and familial adenomatous polyposis. Genetic evaluation revealed pathogenic mutations in COL2A and APC. Conclusions: Complex genetic conditions such as Stickler syndrome and familial adenomatous polyposis require multidisciplinary management. This case underscores the challenges of managing a 13-year-old patient with Stickler syndrome and bilateral retinal detachment. Immediate sequential bilateral vitreoretinal surgery proved effective, highlighting the need for tailored approaches to Stickler syndrome management.

Purpose: To describe a case of severe Valsalva retinopathy secondary to habitual ear popping in the setting of chronic Eustachian tube dysfunction. Methods: A retrospective chart and literature review were conducted. Results: A 40-year-old woman with chronic Eustachian tube dysfunction developed sudden loss of vision in the left eye (to 20/400) following habitual ear popping. Examination demonstrated features consistent with Valsalva retinopathy, including vitreous, subhyaloid, sub-internal limiting membrane, and retinal hemorrhages. Following an initial observation period of 6 months, she underwent pars plana vitrectomy, which improved her vision to 20/20. Conclusions: Habitual ear popping can lead to severe Valsalva retinopathy and significant vision loss, particularly in individuals with underlying Eustachian tube dysfunction. Given the prevalence of Eustachian tube dysfunction, clinicians should be aware of the association between habitual ear popping and Valsalva retinopathy to ensure timely diagnosis and management.

Purpose: Diabetes and its microvascular complications have significant social and economic impact, and targeted prevention strategies are paramount. Wearable technology may play an important role in personalized diabetes management. This study assesses the association between physical activity measured by wearable activity trackers and the presence of diabetic retinopathy (DR) in individuals with diabetes. Methods: Retrospective chart review of accelerometer data obtained on personal fitness (Fitbit) trackers from adults with diabetes who had >1 month of linked activity tracking data registered in the All of Us Research Program Registered Tier dataset (version 7). Binary logistic regression models were used to assess adjusted associations between presence of DR and physical activity measures of mean number of daily steps and mean number of daily minutes spent on moderate-to-vigorous activities. Results: Of the 668 participants, 63% were female and 37% were male, 80% were non-Hispanic White, and 42.5% had a history of smoking. Mean age was 64.3 years (range, 25-91 years). A unit increase of 1000 daily steps walked by participants was significantly associated with a 45% reduction in the odds of having DR (odds ratio [OR] 0.55, 95% CI 0.33-0.91). A 1-minute unit increase in the mean number of daily minutes spent on moderate-to-vigorous activity was significantly associated with a 24% reduction in the odds of having DR (OR 0.76, 95% CI 0.63-0.92). Conclusions: These findings demonstrate that increased physical activity, as measured through objective quantification of both daily steps and minutes of activity, is inversely correlated with the presence of DR. This may indicate a role for wearable technology in personalizing diabetes management.

Purpose: To describe a rare case of spontaneous resolution and subsequent recurrence of subretinal fluid (SRF) associated with circumscribed choroidal hemangioma. Methods: A single case was reviewed. Results: A 67-year-old woman presented with a circumscribed choroidal hemangioma and visually significant SRF. Three weeks after initial presentation and before planned treatment, the patient's vision returned to baseline, and imaging confirmed complete resolution of SRF. She was observed without intervention. Two months later, the SRF recurred, and the patient was successfully treated with photodynamic therapy, achieving complete resolution. Conclusions: Spontaneous resolution of SRF secondary to circumscribed choroidal hemangioma can occur, albeit rarely. At the time of treatment planning, reassessment of symptoms and repeat imaging may help identify such spontaneous improvement. If resolution occurs, patients should be closely followed up for the possibility of fluid recurrence.

Purpose: Stargardt disease is an inherited form of retinal degeneration characterized by early-onset central vision loss. This report describes the long-term retinal histologic characteristics of a patient with Stargardt disease after human embryonic stem cell-derived retinal pigment epithelium (hESC-RPE) transplantation. Methods: Eyes were obtained postmortem from an 80-year-old legally blind male patient with Stargardt disease. The patient had previously undergone hESC-RPE transplantation of his left eye, and the right eye (untransplanted) served as a control. Fluorescence lifetime imaging microscopy was used to study retinal structure and metabolic activity. Staining of the retina for lipofuscin was performed using the Armed Forces Institute of Pathology method. Results: Metabolic analysis showed that the macular area had more oxidative phosphorylation relative to the mid-peripheral retina, in both the transplanted and untransplanted eye. Melanin-laden RPE cells were detected in the transplanted eye, which correlated with a pigment band present on fundus images post-hESC-RPE transplantation. Conclusions: This case description illustrates the long-term survival of subretinal hESC-RPE cells post-transplantation in a patient with Stargardt disease.

Purpose: To report the clinical features and outcomes in eyes with fishing-related ocular injury. Methods: We performed a retrospective, consecutive case series of all eyes evaluated at Bascom Palmer Eye Institute between January 1, 2013, and January 1, 2023, with a history of fishing-related ocular trauma. Results: The study cohort included 75 eyes. The cause of injury included contact with a fishhook in 27 eyes (37%), sinker in 26 (35%), and fishing pole in 7 (10%). Open-globe injury occurred in 17 (23%) eyes, and endophthalmitis was suspected preoperatively or intraoperatively in 3 (18%) of these eyes. Eyes with fishhook injuries were more likely to sustain an open-globe injury (13/24 [54%]) compared with those with non-fishhook injuries (4/44 [9%]; P < .001). Eyes with open-globe injury had worse mean best-corrected visual acuity during their last follow-up examination (1.4 logMAR [Snellen equivalent 20/501]) compared with eyes without open-globe injury (0.46 logMAR [Snellen equivalent 20/58]; P = .002). When documented, 5 (42%) of 12 eyes with open-globe injuries received intraoperative intravitreal antibiotics, while 5 (42%) eyes with injuries localized to the anterior segment received intracameral antibiotics. Eleven (92%) of 12 patients with open-globe injury underwent repair on an outpatient basis and were discharged on the day of surgery without intravenous antibiotics. There were no newly diagnosed cases of endophthalmitis in the postoperative period. Conclusions: Poor visual outcomes occurred most commonly after open-globe injuries caused by fishhooks. Most eyes with open-globe injuries received intracameral or intravitreal antibiotics at the time of surgical treatment, without postoperative inpatient admission or intravenous antibiotics, and no cases of postoperative endophthalmitis were observed.

Purpose: To report a novel case of bilateral concomitant cytomegalovirus (CMV) retinitis and acute retinal necrosis (ARN) due to varicella-zoster virus (VZV) in an immunocompromised adult. Methods: A case report was evaluated. Results: A 36-year-old immunocompromised man presented with acute painful vision loss in the left eye. On initial presentation, uncorrected distance visual acuity was 20/20 in the right eye and counting fingers at 3 feet (≈1 m), which deteriorated to no light perception (NLP) in the left eye. Fundus examination showed necrotizing retinitis in both eyes, with features of both CMV retinitis and ARN. One week after initiation of antiviral treatment, the patient's uncorrected distance visual acuity remained 20/20 in the right eye and improved from NLP to hand motions at 3 feet (≈1 m) in the left eye. Conclusions: VZV and CMV DNA were detected in the aqueous of a patient with bilateral concomitant CMV and VZV retinitis.

Purpose: Central serous chorioretinopathy (CSCR) typically resolves spontaneously within 4-6 months. Observation is the mainstay of management, but low-fluence photodynamic therapy (PDT) is a well-established treatment. This study investigates risk factors for CSCR recurrence in patients managed with observation versus PDT. Methods: This retrospective case-control study included patients with a first-time CSCR diagnosis between January 2014 and January 2018. All patients were initially managed with 4-6 months of observation and followed up for at least 1 year to monitor CSCR resolution or recurrence, defined as presence of new subretinal fluid after prior resolution. For patients who received PDT following initial observation, an additional year of follow-up post-PDT was required. Demographics, medical history, and retinal imaging findings were analyzed for recurrence associations. Results: Among 90 patients with CSCR, 56 (62.2%) were managed with observation alone, and 34 (37.8%) received PDT. The groups had comparable demographic characteristics. Exogenous hormone use was higher in the PDT group than in the observation group (17.6% vs 3.6%; P = .025). Recurrence occurred in 25 patients (27.8%): 14 (25.0%) in the observation group and 11 (32.4%) in the PDT group (P = .57). Post-PDT recurrence was noted in 5 patients (14.7%). Baseline visual acuity was worse in the PDT group than in the observation group (mean ± SD 0.41 ± 0.33 vs 0.23 ± 0.27 logMAR; P < .001), but baseline central retinal thickness was similar between groups (mean ± SD 403 ± 169 vs 398 ± 166 µm; P = .89). Exogenous hormone use was a significant predictor of CSCR recurrence (odds ratio 5.2, 95% confidence interval 1.1-23.6; P = .034). Conclusions: Patients with exogenous hormone exposure may be at increased risk of recurrent CSCR and may be more likely to receive PDT. Reducing or avoiding exogenous hormones may lower CSCR recurrence risk.

Purpose: To investigate the relationship between preoperative volumetric optical coherence tomography (OCT) features of full-thickness macular holes (FTMHs), including intraretinal cysts and 3-dimensional hole symmetry, and both visual acuity outcomes and surgical prognosis in patients with FTMH. Methods: This multicenter, retrospective cohort study assessed patients with FTMH who underwent pars plana vitrectomy from 2017 to 2022. In-depth manual segmentation of each pre- and postoperative OCT volumetric scan (60 B-scans per volume) was performed by 3 graders. Correlations between preoperative cystoid volume and FTMH symmetry and preoperative visual acuity, preoperative minimum linear diameter (MLD), improvement in visual acuity at 6 months postsurgery, and FTMH closure rate postsurgery were assessed using linear regression models, adjusted for baseline lens status, duration of symptoms, and MLD. Results: A total of 69 eyes of 69 patients with FTMH were included. Mean (± SD) visual acuity was 0.69 ± 0.44 logMAR (Snellen 20/98) before surgery, and improved to 0.39 ± 0.23 logMAR at 6 months after surgery (Snellen 20/49). FTMH closure after a single surgery was 96%. Greater cystoid volume before surgery was associated with larger FTMH MLD (P < .001), worse preoperative visual acuity (P = .003), and greater visual acuity improvement at 6 months after surgery (P = .02). Greater hole asymmetry before surgery was associated with smaller MLD (P = .04), but not associated with preoperative visual acuity (P = .74) or postoperative FTMH closure rates (P = .19). Conclusions: This study on OCT volumetric measurements showed that intraretinal cystoid volume correlated with larger macular holes and greater visual acuity improvement while smaller macular holes tended to be more asymmetric.