Journal of VitreoRetinal Diseases最新文献

Purpose: To better understand patient experiences associated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection techniques. Methods: A total of 1111 patients receiving anti-VEGF injections at 5 Retina Consultants of Texas clinic locations completed surveys about their experiences during and after injection. Responses were compared using t-test, analysis of variance, and Tukey-Kramer test. Results: Patients rated overall discomfort with injection techniques as a mean visual analog scale score < 2 (scale 1-10, ranging from mild to worst possible). Techniques for anesthetization, lid retraction, and povidone-iodine (Betadine) application varied. Lidocaine pledgets were associated with the most discomfort (P < .05). Patient preference was significantly higher for manual lid retraction over speculum use (P = .0017). Betadine-soaked cotton tips were considered significantly more comfortable than Betadine drops, and drops more comfortable than Betadine swabs (each P < .05). Regarding side effects ever experienced after injection, subconjunctival hemorrhages were reported by 64.0% of participants (n = 702), floaters by 64.4% (n = 685), and eye irritation by 51.1% (n = 530), resolving within 2 days for 37.9% (n = 215), 51.1% (n = 334), and 48.6% (n = 254), respectively. Of returning participants, 41.1% found injections administered by physicians on the survey day more comfortable than injections administered by previous physicians. Common complaints included inadequate anesthesia and irritation from Betadine. Conclusions: Most patients tolerate anti-VEGF injections well, with minimal side effects. Surveyed patients preferred topical gel or subconjunctival injections, manual lid retraction, and Betadine-soaked cotton tips. Future studies may consider the safety associated with each technique.

Purpose: To describe a case of severe scleritis with uveitis as the initial presentation of underlying eosinophilic granulomatosis with polyangiitis. Methods: Case report from a university ophthalmology clinic describing ocular findings, diagnostic workup, and treatment for a 75-year-old woman presenting with severe anterior scleritis and panuveitis. Results: The patient was initially misdiagnosed and treated for presumed infectious scleritis for 1 month without improvement. Further workup revealed elevated perinuclear anti-neutrophil cytoplasmic antibodies, supporting a diagnosis of eosinophilic granulomatosis with polyangiitis. Prompt initiation of high-dose oral corticosteroids led to rapid resolution of ocular inflammation. Conclusions: Severe scleritis with uveitis can be the first manifestation of occult eosinophilic granulomatosis with polyangiitis. A high index of suspicion for underlying autoimmune disease and timely rheumatologic workup are essential for accurate diagnosis. Early systemic immunosuppressive therapy is critical to optimize visual outcomes and prevent irreversible ocular damage.

Purpose: To describe an atypical phenotype of retinal dystrophy in the setting of a heterozygous missense mutation (CRX-RD). Methods: The case is a 71-year-old woman previously diagnosed with advanced, non-neovascular, nonexudative age-related macular degeneration (AMD) who presented with longstanding blurry vision for consideration of intravitreal anti-complement factor therapy. Results: Ophthalmic examination showed geographic atrophy (GA) in both eyes, without evidence of drusen or drusenoid deposits. Genetic panel testing revealed a pathogenic, heterozygous missense mutation in CRX, the NM_000554.6(CRX) variant c.128G>A (p.Arg43His) (RCV001228802.6). Although CRX-RD is known to have phenotypic heterogeneity, cases with macular atrophy most commonly display bullseye maculopathy or benign concentric annular macular dystrophy. Conclusions: This case presenting with bilateral GA is consistent with a novel phenotype associated with a pathogenic variant of CRX and is an atypical presentation of RD simulating AMD.

Purpose: To characterize real-world use of intravitreal aflibercept 8 mg across 22 US retina practices. Methods: Retrospective review of patients who received at least 1 intravitreal aflibercept 8 mg injection for treatment of neovascular age-related macular degeneration, diabetic macular edema, or diabetic retinopathy through April 1, 2024. Data from health records were collected retrospectively, including best-corrected visual acuity (BCVA), interval between treatments, and adverse events. Results: A total of 8323 eyes of 6271 patients received 20 385 intravitreal aflibercept 8 mg injections. A total of 669 eyes (8.0%) were not previously treated. Among treatment-naive eyes, mean logMAR BCVA improved from 0.57 (Snellen equivalent ~20/80) at the time of the first intravitreal aflibercept 8 mg injection, to 0.47 (Snellen equivalent ~20/60) (P < .001), 0.46 (Snellen equivalent ~20/60) (P < .001), and 0.48 (Snellen equivalent ~20/60) (P = .012) at the second, third, and fourth intravitreal aflibercept 8 mg injections, respectively. Among previously treated eyes, mean logMAR BCVA improved from 0.46 (Snellen equivalent ~20/60) at the time of the first intravitreal aflibercept 8 mg injection, to 0.42 (Snellen equivalent ~20/50) (P < .001), 0.43 (Snellen equivalent ~20/50) (P < .001), and 0.45 (Snellen equivalent ~20/60) (P = .70) at the second, third, and fourth intravitreal aflibercept 8 mg injections, respectively. Treatment intervals to time of second, third, and fourth intravitreal aflibercept 8 mg injections increased compared to baseline intervals, by a mean of 2.2 days (P < .001), 2.5 days (P < .001), and 13.5 days (P < .001), respectively. Intraocular inflammation was observed in 11 eyes (1 in 1853 injections). Nine eyes (1 in 2265 injections) developed suspected endophthalmitis. Conclusions: In this real-world clinical setting, intravitreal aflibercept 8 mg treatment demonstrated improvements in BCVA outcomes, with increased intervals between injections. Rates of intraocular inflammation and endophthalmitis were low.

Purpose: To evaluate the efficacy of intravitreal (IVT) pegcetacoplan monthly vs avacincaptad pegol monthly (primary analysis), and pegcetacoplan every other month vs avacincaptad pegol monthly (secondary analysis), for geographic atrophy (GA). Methods: Matching-adjusted indirect comparisons (MAIC) were conducted across global phase 3 trials using individual patient data from 2 pegcetacoplan trials (OAKS, NCT03525613; DERBY, NCT03525600) and published aggregate data from the avacincaptad pegol GATHER2 trial (NCT04435366). GATHER2 inclusion and exclusion criteria were applied to the OAKS and DERBY individual patient data. Key baseline variables were balanced using propensity score weighting. GA lesion growth at month 12 was assessed. Results from the MAIC were combined using meta-analysis. Results: The primary analysis included 103 patients from OAKS and 102 patients from DERBY who met the GATHER2 inclusion and exclusion criteria, and 447 patients from GATHER2. In OAKS vs GATHER2, the adjusted difference in GA lesion growth at month 12 between pegcetacoplan monthly and avacincaptad pegol was -0.716 mm² (95% CI, -1.385 to -0.046; P = .04), statistically favoring pegcetacoplan monthly. In DERBY vs GATHER2, the adjusted difference was -0.234 mm² (95% CI, -1.354 to 0.885; P = .68), directionally favoring pegcetacoplan monthly. After meta-analysis, the pooled effect for pegcetacoplan monthly vs avacincaptad pegol was -0.589 mm² (95% CI, -1.164 to -0.014; P = 0.04), statistically favoring pegcetacoplan monthly. A numerically greater reduction in GA lesion growth was observed with pegcetacoplan every other month vs avacincaptad pegol monthly (95% CI, -1.130 to -0.300; P = .25). Conclusions: Matching-adjusted indirect comparisons support a greater reduction in GA growth with pegcetacoplan monthly vs avacincaptad pegol monthly and no significant difference between pegcetacoplan every other month and avacincaptad pegol monthly.

Purpose: Neurofibromatosis type 1 (NF1) is a multisystem neurocutaneous syndrome that includes ocular manifestations. This systematic literature review aimed to examine evidence of an association between NF1 and retinal detachment (RD). Methods: Ovid MEDLINE, EMBASE, and PubMed were searched from database inception to February 2024 for reports of RD related to NF1. An additional case of spontaneous RD in a young patient with NF1 is reported. Results: In total, 27 reported cases of NF1-associated RD were identified, of which 14 were associated with intraocular or intraorbital space-occupying lesions. Lesion-associated RDs were exudative and presented in patients at a median age of 19.6 years (range 10 to 36 years). The remaining 13 cases, and the novel case reported herein of a patient with RD secondary to a giant retinal tear, were spontaneous rhegmatogenous RD, presenting in patients at a median age of 19.1 years (range 22 months to 49 years). The most common presentation of spontaneous RD was an asymptomatic finding on routine exam (55% of reported cases). Conclusions: NF1 may increase the risk of RD through 2 mechanisms: exudation caused by space-occupying intraorbital lesions, or rhegmatogenous RD resulting from irregularities in vitreoretinal adhesion due to abnormal collagen production. While further evidence is needed, extended ocular screening of patients with NF1 into adulthood may be considered.

Purpose: To evaluate the long-term effects of smoking on retinal microcirculation and choriocapillaris flow, and to compare microvascular alterations between healthy smokers and nonsmokers using optical coherence tomography (OCT) angiography. Methods: A total of 160 patients (86 smokers, 74 nonsmokers) were enrolled in this prospective, cross-sectional study. Non-flow and foveal avascular zone (FAZ) parameters, vessel density parameters of the macula and optic disc, and choriocapillaris flow area were obtained using OCT angiography. Results: The mean FAZ area in the whole retina and FAZ perimeter were significantly larger in the smoker group compared with the nonsmoker group (P = .003 and P = .002, respectively). Significant differences were also observed in vessel density of the superficial and deep capillary plexus, except in some zones of superficial perifovea, deep perifovea, and deep parafovea. No significant differences were found in vascular density of the optic disc region between groups (P > .05) The choriocapillaris flow within the 3 mm radius area was lower in smokers than in nonsmokers (P < .05). Conclusions: Cigarette smoking was associated with reduced retinal and choroidal vascularity as measured by OCT angiography. These findings support a potential detrimental role of smoking in the development of ocular diseases.

Purpose: To describe a patient with idiopathic hypereosinophilic syndrome (HES) associated with panuveitis. Methods: An interventional case report is presented. Results: A 70-year-old woman presented with intermittent cutaneous eruptions, bilateral panuveitis, and a ground-glass pattern on chest CT-scan, with isolated eosinophilia of 12.8 × 10⁹/L. A complete uveitis workup was performed, and the patient was evaluated to rule out secondary causes of eosinophilia, with a thorough focus on infections, eosinophilic granulomatosis with polyangiitis, sarcoidosis, and drug-related syndromes. A bone marrow biopsy ruled out primary eosinophilia. Cytogenetics were also negative. Under steroid treatment there was no recurrence of skin rashes and panuveitis was satisfactorily resolved, but further use of mepolizumab was needed to normalize the hemogram. Conclusions: The diagnosis of HES requires a comprehensive evaluation. Ocular involvement is rare. We present the ocular findings during the acute stage for the first time, along with the current management approach.

Purpose: To present long-term changes in swept-source optical coherence tomography angiography (SS-OCTA) after different approaches in rhegmatogenous retinal detachment. Methods: This was a retrospective study of patients after segmental buckling, circumferential buckling, primary vitrectomy, or combined surgery (vitrectomy and scleral buckling) in whom SS-OCTA was performed at 1 month and 24 months after surgery. Central retinal thickness, central choroidal thickness visual acuity, macula-on vs macula-off status, vascular density, and fovea avascular zones (FAZs) in superficial and deep vascular retinal layers were analyzed. Results: We included 150 eyes of 150 patients. Final visual acuity was better in macula-on vs macula-off cases (P < .05). In comparison with the fellow eyes, final central choroidal thickness was lower in macula-off retinal detachments (P = .042). Deep vessel density was also lower in macula-off eyes when compared with their fellow eyes, which was of high significance in lower quadrants (P = .008). Patients after primary vitrectomy had lower deep FAZ, superficial vessel density, and deep vessel density when compared with eyes after circumferential and segmental buckling (P = .005, P = .037, and P < .001, respectively). After segmental and circumferential buckling, deep vessel density increased between the first and last follow-up visits (P = .018). After primary vitrectomy, no improvements in deep vessel densities after surgery were observed. Macular edema was observed in 13 eyes during the observation period. Multiple variate analysis revealed that the only factor responsible for later occurrence of macular edema was low deep vessel density 1 month after surgery. Conclusion: Segmental buckling does not affect vasculature when visualized with SS-OCTA. Long-term changes observed after circumferential buckling were less pronounced than after primary vitrectomy or combined procedures using perfluorocarbon liquid, silicone oil, and internal limiting membrane peeling. Macula-off patients had a lower postoperative vessel density, correlating with the development of macular edema and decreased final vision.

Purpose: Herein, we describe a case of paracentral acute middle maculopathy occurring after routine sinus surgery. Methods: A single case was evaluated. Results: The patient presented with an inferocentral scotoma in the left eye 2 days after an uneventful sinuplasty procedure performed under local anesthesia. Examination and optical coherence tomography demonstrated paracentral acute middle maculopathy. A complete workup and urgent stroke evaluation revealed no clear underlying etiology. Conclusion: Sinus procedures may rarely be associated with paracentral acute middle maculopathy, possibly due to the vasoconstrictive effects of local anesthetics. Ophthalmologists and head and neck surgeons should be aware of this potential complication.