Journal of VitreoRetinal Diseases最新文献

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.

Purpose: To present a sequential surgical approach for macular hole (MH)-associated retinal detachment using preoperative pneumatic retinopexy followed by pars plana vitrectomy, and to review the published literature on surgical strategies for this condition. Methods: A retrospective chart review was conducted for 2 patients who developed MH-associated retinal detachment. For the literature review, PubMed was used as the primary reference database to identify relevant studies. Results: Two patients with MH-associated retinal detachment were described. Both underwent pneumatic retinopexy to treat the retinal detachment, followed by pars plana vitrectomy with amniotic membrane plug or internal limiting membrane (ILM) peel, achieving successful MH closure. The literature review included 502 cases of MH-associated retinal detachment. Of these, 65% (333/502) were female and 90% were myopic. Fewer than 2% of patients underwent sequential repair of the retinal detachment and MH. In 7% of cases, laser photocoagulation was performed around the MH following vitrectomy. More than half the eyes underwent conventional ILM peel, with other techniques including ILM peel with insertion into the MH, ILM inverted and draped over or inserted into the MH, or amniotic membrane plug. The overall MH closure rate was 64%, and the initial retinal reattachment rate was 95%. Conclusions: We reviewed 2 cases that underwent a sequential surgical approach for the treatment of MH-associated retinal detachment, converting an emergent retinal detachment into an elective MH case and enhancing the likelihood of hole closure.

Purpose: To examine the clinical usage and safety profile in real-world patients with age-related macular degeneration (AMD) receiving intravitreal pegcetacoplan (Syfovre) for the treatment of geographic atrophy, and to explore the effect of intravitreal pegcetacoplan on neovascular AMD (nAMD) disease activity. Methods: Information on patient demographics, AMD classification, treatment history, visual acuity, and ocular adverse events were extracted from the electronic medical records. Results: A total of 1069 patients (1451 eyes) initiated intravitreal pegcetacoplan treatment between February 2023 and October 2023 and were followed up until March 2024. Patients received a mean (±SD) 3.3 ± 2.1 injections, and the mean (±SD) follow-up after pegcetacoplan administration was 7.5 ± 2.3 months. The majority of this cohort displayed stable visual acuity throughout treatment, with logMAR values in 821 patients remaining within 0.20 of the initial value. Ocular hypertension occurred in 36 patients (2.5% of eyes). Seventy-six patients (5.2% of eyes) with non-neovascular AMD at treatment initiation subsequently developed nAMD. Five patients (0.34% of eyes) had intraocular inflammation, including 3 with anterior uveitis, 1 with nonocclusive retinal vasculitis, and 1 with hemorrhagic occlusive retinal vasculitis with subsequent poor outcomes. A rate of retinal vasculitis of 0.03% per injection and a rate of overall intraocular inflammation of 0.1% per injection were observed. In total, 460 patients with nAMD received intravitreal pegcetacoplan. Stability of the anti-vascular endothelial growth factor (anti-VEGF) treatment interval was observed in 289 of 396 patients (73%). Preserved or improved visual acuity while undergoing anti-VEGF therapy was noted in 384 of 396 patients (97%). Conclusions: Real-world data on intravitreal pegcetacoplan treatment identifies clinician practice patterns and demonstrates an acceptable safety profile, with complications leading to long-term vision loss following pegcetacoplan administration being rare in this cohort.

Purpose: To describe a rare case of late reactivation of retinopathy of prematurity (ROP) in a treatment-naive adult female patient. Methods: Clinical examination and multimodal imaging techniques were used to diagnose the patient and guide the treatment, and genetic saliva testing was performed. Results: We describe a 30-year-old female patient who presented with late reactivation of treatment-naive ROP. She was born prematurely and never received a diagnosis of ROP. She presented at the age of 30 years with new onset of flashes and floaters. Fundoscopic examination was consistent with a diagnosis of ROP, with peripheral avascularity evident in the temporal retina bilaterally, a temporal ridge in the right eye, and focal leakage seen bilaterally on fluorescein angiography. The patient was treated with panretinal photocoagulation laser therapy. Genetic testing demonstrated a heterozygous mutation in ZNF408. Conclusions: Retinopathy associated with prematurity may reactivate in adulthood. This late reactivation may be influenced by a history of untreated ROP or by mutations associated with familial exudative vitreoretinopathy.

Purpose: To analyze the financial cost and environmental impact of supplies used during routine intravitreal injection of antivascular endothelial growth factor (anti-VEGF) therapies. Methods: The authors conducted a life cycle assessment of all supplies consumed during intravitreal injections of bevacizumab, aflibercept 2 mg, aflibercept 8 mg, and faricimab at a single academic institution. Data collected included weight, material composition, and retail price of the supplies. Two models, including a process-based approach and a hybrid life cycle assessment featuring an economic input-output model, were used to estimate the environmental impact. Three procedural protocols were analyzed, with an increasing supply consumption from protocol 1 to protocol 3. Results: Excluding the anti-VEGF medication, protocols 1, 2, and 3 cost $12.05, $40.79, and $88.69 and resulted in 3, 11, and 20 kg carbon dioxide equivalents, respectively, using the hybrid life cycle assessment. Extrapolating averaged findings from the hybrid life cycle assessment to the national volume of 15 million injections per year, this procedure may yield 5200 metric tons of waste, approaching $27 billion in material costs and more than 7.2 million metric tons of carbon dioxide equivalents annually. Excluding the anti-VEGF medication pack, this amounts to a procedural supply cost of more than $710 million and an environmental impact of 170 000 metric tons of carbon dioxide equivalents. Limiting supply consumption for all injections to protocol 1 may save more than 800 tons in waste, more than $500 million in cost, and 120 000 metric tons of carbon dioxide equivalents annually. Conclusion: Decreasing supply consumption during intravitreal injections with procedural variations, including the removal of speculums, calipers, or sterile gloves, may yield significant reductions in financial costs and environmental impact.

Purpose: To describe a case series with schisis-like presentations of genetically confirmed familial exudative vitreoretinopathy (FEVR) caused by FZD4 mutations. Methods: Retrospective case review of 4 patients with FEVR caused by FZD4 mutations, analyzed by optical coherence tomography (OCT) for schisis-like characteristics. Results: Three pediatric patients and 1 adult patient presented with unilateral, inner schisis in the retinal periphery. Overall, the schisis was characterized by thickening of the inner retinal layers and column-like structures affecting mostly the internal limiting membrane, nerve fiber layer, and ganglion cell layer, while mostly sparing the inner nuclear layer. Conclusions: Patients with genetically confirmed FEVR caused by mutations in FZD4 can have a schisis-like presentation. This is a distinct entity from other retinal disorders that involve schisis. Since it can be hard to visualize clinically, peripheral OCT imaging should be performed during a retinal examination with the patient under anesthesia to fully evaluate these presenting characteristics.

Purpose. To determine short-term changes in intraocular pressure (IOP) after intravitreal injection of 0.1 mL pegcetacoplan (Syfovre; Apellis Pharmaceuticals) for the treatment of geographic atrophy (GA). Methods. This prospective, interventional study evaluated a case series of patients with GA without corneal pathology or a history of vitreoretinal surgery who received pegcetacoplan injections. IOP was measured with a handheld applanation tonometer immediately prior to injection, immediately after injection, and at 5, 10, 20, and 30 minutes postinjection. Results. Fifty-one patients (total 73 eyes) were enrolled. The mean (±SD) preinjection IOP was 15.3 ± 3.3 mm Hg, which significantly increased to 40.2 ± 13.7 mm Hg (P < .001) immediately after injection. Subsequent IOP measurements showed a gradual decrease to 31.3 ± 11.6 mm Hg at 5 minutes (P < .001), 23.2 ± 9.7 mm Hg at 10 minutes (P < .001), 19.6 ± 8.6 mm Hg at 20 minutes (P < .001), and 16.4 ± 4.9 mm Hg at 30 minutes (P = .05) postinjection. No further treatment was required, except that the left eye of 1 patient with a history of primary open-angle glaucoma and persistent IOP elevation underwent anterior chamber tap 20 minutes after injection. Multivariate linear regression analysis revealed that a higher IOP at 30 minutes postinjection was significantly associated with the preinjection IOP (P = .004) and with a history of glaucoma (P = .019). Conclusions. Following pegcetacoplan injections, immediate IOP elevation was observed, which gradually declined within the first 30 minutes. Eyes with higher baseline IOP or a history of glaucoma exhibited higher postinjection IOP.