Journal of VitreoRetinal Diseases最新文献

Purpose: To describe 3 cases of angiographically silent cystoid macular edema (CME) associated with paclitaxel therapy in patients with clinical or genetic features suggestive of an underlying inherited retinal disease (IRD). Methods: A series of 3 patients was reviewed. Results: All 3 patients presented with decreased vision and bilateral, angiographically silent CME shortly after starting paclitaxel. Clinical findings in each case raised suspicion of a concurrent IRD. Genetic testing revealed a pathogenic mutation in the NR2E3 gene, consistent with enhanced S-cone syndrome in 1 patient, several variants of uncertain significance in LRP2 and RBP3 in another, and a heterozygous pathogenic mutation in PEX1, associated with peroxisome biogenesis disorders, in the third. Discontinuation of paclitaxel and initiation of various local and systemic therapies, including carbonic-anhydrase inhibitors and steroids, resulted in improvement or resolution of CME and improved visual acuity in all patients. Conclusions: This series suggests that patients with underlying or suspected IRD may be predisposed to developing CME upon initiation of paclitaxel therapy. Further investigation is warranted to better understand this potential susceptibility and to guide management in at-risk individuals.

Purpose: To describe a case of bilateral peripheral neovascularization (NV) secondary to hemoglobin C trait. Method: A single case was evaluated. Results: A 74-year-old African American woman presented asymptomatically with peripheral nonperfusion and NV on examination and angiography during an anemia evaluation, which led to a diagnosis of hemoglobin C trait. Conclusion: Hemoglobin C trait is a rare but known cause of NV. This case highlights the importance of hemoglobinopathy screening in cases of peripheral NV, as these findings may indicate systemic disease and require a multidisciplinary approach.

Purpose: To describe a rare case of cystoid macular edema (CME) associated with immunoglobulin A κ smoldering multiple myeloma and highlight the importance of considering myeloma spectrum disorders in unexplained CME. Methods: A single clinical case was reviewed. Results: A 67-year-old man presented with a 2-week history of episodic blurry vision in his left eye. Physical examination and multimodal imaging revealed CME in the left eye and minimal ellipsoid zone abnormalities in the right eye. The CME persisted despite treatment with topical nonsteroidal anti-inflammatory drugs and corticosteroids but slowly improved with topical dorzolamide. No systemic treatment for smoldering multiple myeloma was initiated during the observation period. Conclusions: This case represents a rare ocular manifestation of smoldering multiple myeloma and underscores the importance of considering myeloma spectrum disorders in cases of unexplained or treatment-resistant CME.

Purpose: To evaluate the short-term efficacy and safety of intravitreal brolucizumab combined with sub-Tenon triamcinolone acetonide in treating diabetic macular edema (DME). Methods: Medical records were retrospectively reviewed for 11 patients with DME (14 eyes) treated with intravitreal brolucizumab and sub-Tenon triamcinolone acetonide injections at our hospital using a 1 + pro re nata injection regimen. Data collected included best-corrected visual acuity (BCVA), central macular thickness (CMT), injection frequency, and adverse events. Patients were followed up for at least 6 months. Results: At baseline, the mean BCVA was 0.43 logMAR, and the mean CMT was 418.4 µm. After 1 month of treatment, BCVA improved, and CMT significantly decreased in all cases. These improvements were maintained over 6 months of treatment, with a mean injection frequency of 1.14 injections over 6 months. This combination therapy was effective both in patients who were treatment naïve at baseline and in those who were previously treated with an anti-vascular endothelial growth factor agent. No significant complications, such as intraocular inflammation or elevated intraocular pressure, were observed during follow-up. Conclusions: Combination therapy with intravitreal brolucizumab and sub-Tenon triamcinolone acetonide may offer anatomic benefits in patients with DME, requiring fewer injections. Further evaluation using larger, prospectively designed studies is warranted to confirm its functional efficacy and long-term safety.

Purpose: To characterize uveitis specialists and identify the sociodemographic and geographic access disparities to uveitis care in the United States. Methods: In this retrospective, cross-sectional study, we identified uveitis specialists using 3 public online databases. Descriptive statistics were used to characterize uveitis specialists. An origin-destination cost matrix was used to assess travel time and distance from each US census tract to the nearest uveitis specialist. Results: We identified 447 uveitis specialists in the United States. Of these, 122 (27.3%) were women. Most (280 [62.6%]) had medical and/or surgical retina training. More than half (265 [59.3%]) completed a uveitis-specific fellowship. The majority (257 [57.5%]) were in private practice. Greater proportions of university or hospital-based (51.7% vs 29.1%; P < .001) and female (79.5% vs 51.7%; P < .001) uveitis specialists completed uveitis-specific fellowship training. More female uveitis specialists practiced in university or hospital-based settings (54.9% vs 37.8%; P < .001). No uveitis specialists were identified in 6 states. Mean ± SD travel time and distance to the nearest uveitis specialist were 45.8 ± 51.9 minutes and 40.7 ± 55.9 miles (65.5 ± 89.9 km), respectively. In a multivariate regression analysis, those traveling 60 miles (96.6 km) or more to the nearest uveitis specialist were more likely to reside in rural census tracts that were rural (P < .001), outside the Northeast (P < .001), and with greater proportions of the population below the federal poverty level (P < .001). Conclusions: There are imbalances in the composition of identified uveitis specialists and in the geographic access to uveitis care in the United States. These imbalances help to inform the allocation of training resources and to emphasize areas of critical need for uveitis care.

Purpose: To describe a case of allergic reaction to intravitreal (IVT) injection of antivascular endothelial growth factor (anti-VEGF) medications in patients with alpha-gal syndrome. Methods: A single case was evaluated. Results: A 57-year-old woman with a known diagnosis of alpha-gal syndrome was evaluated. Clinical presentation, prior treatment history, and response to different anti-VEGF agents were reviewed. The patient presented with worsening vision in her right eye due to a subfoveal choroidal neovascular membrane secondary to neovascular age-related macular degeneration in the right eye. She had experienced a systemic allergic reaction following an IVT injection of bevacizumab, but subsequently tolerated ranibizumab without any adverse effects, resulting in improvement in her vision. Conclusions: Bevacizumab, aflibercept, and faricimab are recombinant immunoglobulins produced by DNA technology in Chinese hamster ovary cells, which may contain galactose-α-1,3-galactose (alpha-gal), a potential allergen for patients with alpha-gal syndrome. Patients with alpha-gal syndrome may develop allergic reactions to certain IVT anti-VEGF agents derived from mammalian expression systems. Ranibizumab, produced using an Escherichia coli expression and lacking alpha-gal, seems to be a safe and effective option for patients with alpha-gal syndrome requiring IVT anti-VEGF therapy.

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.