Journal of VitreoRetinal Diseases最新文献

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.

Purpose:To determine the economic impact of insurance company prior authorizations (PAs) for anti-vascular endothelial growth factor (anti-VEGF) therapies on society. Methods: PA denial and delay rates were derived from a large electronic database (SamaCare PA). Data were analyzed in a theoretical cost-effectiveness model to calculate the increased costs of PAs (in 2025 U.S. dollars). Results: Of 33 178 total PA requests, the majority were from Medicare Advantage plans (18 769, 58.2%), followed by commercial insurance carriers (10 047, 31.1%) and Medicaid (3438, 10.7%). Commercial carriers had the highest mean PA denial rates and approval delays (3.95% denials, 4.95 days delayed), followed by Medicaid (3.87% denials, 4.11 days delayed) and Medicare Advantage (1.18% denials, 1.54 days delayed). Over the average patient's lifetime, the PA process increased total societal costs by a mean $10,842.24 (range, $228.11-$90, 322.69), and the direct savings from denying a PA was only $27.11 per injection (range, $3.06-49.99). Each PA request increased the mean total societal costs by an additional $637.78 in the reference case (range, $25.35-$4,105.58). PAs annually cost the workplace an extra $588.17 (range, $9.98-$3,513.90), the patient and family an extra $362.92 (range, $20.93-$1,743.63), the provider an extra $11.61 (range, $1.14-$324.18), and the insurer an extra $4.92 per year (range, -$40.85 to $76.03). PAs were not cost saving in >99.9% of modeled scenarios. Insurance companies were the only sector of society to potentially save money. Conclusions: PA requests were ultimately approved in 97.7% of all cases, with 97.9% being delayed. The PA process was not cost-saving and increased the total societal costs of anti-VEGF treatments.

Purpose: To characterize retina specialist and patient attitudes toward artificial intelligence (AI) in retina clinical care. Methods: A parallel survey was concurrently administered to retina specialists electronically and to patients in 5 retina practices. Responses were based on a 5-point Likert scale. Data were analyzed using χ² and Mann-Whitney U tests. Results: A total of 291 (97%) of 300 patients approached participated, while 78 (17%) of 447 physicians responded electronically. Major differences (mean differences > 0.5) were seen in opinions on patients choosing whether AI is used in their care (mean, 3.3 for physicians vs 4.2 for patients; P < .0001), desire for AI use in clinical care (3.7 for physicians vs 2.9 for patients; P < .0001), and physicians being responsible for harm caused by AI (3.4 for physicians vs 4.1 for patients; P < .0001). Both groups aligned on discomfort with AI taking clinical roles such as deciding on treatments (2.6 for both; P = .9) and answering patients' questions about diagnosis and treatment (2.7 for both; P = .9). Conclusions: The present study demonstrated important differences in retina specialist and patient perceptions on the use of AI in clinical care, particularly pertaining to patient autonomy. Both groups expressed discomfort with AI taking direct clinical roles. As AI integration in clinical care progresses, physicians and developers should continue to understand and address patient concerns.

Purpose: To evaluate the real-world safety and efficacy of the 0.19 mg fluocinolone acetonide intravitreal implant for the management of diabetic macular edema (DME).

Methods: This retrospective study included 94 eyes from 58 patients, of whom all but 1 had type 2 diabetes. The mean age (± SD) was 75.5 ± 2.12 years. Each patient received at least 1 fluocinolone acetonide implant after a corticosteroid trial without significant intraocular pressure elevation. Data were collected from visits up to 18 months preimplantation (mean, 14.6 months) and 3 years postimplantation (mean, 51 months). Key outcomes included central subfield thickness (CST), visual acuity (VA), intraocular pressure, retinal thickness variability measures, and treatment frequency.

Results: Mean baseline VA remained stable, decreasing from 61.5 ± 1.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters preimplantation to 58.2 ± 0.3 ETDRS letters postimplantation (P = .034). Mean CST decreased significantly from 427.6 ± 20.8 µm 1 month preimplantation to 310.6 ± 11.4 µm at final follow-up (P < .001). Annual treatment frequency dropped significantly from 4.6 ± 0.95 injections preimplantation to 2.3 ± 0.25 injections postimplantation (P = .021). Retinal thickness variability improved significantly (80.4 ± 5.8 µm to 63.8 ± 4.6 µm; P = .027), with a corresponding CST area under the curve (351.1 ± 13.5 µm² to 296.7 ± 10.9 µm²; P = .002). Intraocular pressure remained stable, increasing slightly from 15.8 mmHg to 16.3 mmHg. No new safety signals were observed.

Conclusions: The fluocinolone acetonide implant demonstrated sustained visual stability, significant anatomical improvement, reduced treatment burden, and a manageable safety profile. These findings support its role as an effective long-term therapeutic option for DME, including in vitrectomized eyes.