Journal of VitreoRetinal Diseases最新文献

Purpose: Scedosporium apiospermum is a rare cause of chronic endophthalmitis following routine cataract surgery. Methods: We present a case report and literature review of Scedosporium apiospermum endophthalmitis and related infections. Results: A 59-year-old Trinidadian woman with chronic endophthalmitis following cataract surgery presented for evaluation in the United States. Prior to presentation, she had been treated with intravitreal (IVT) vancomycin and had undergone 2 pars plana vitrectomies (PPVs). Examination revealed hand motion vision, significant anterior chamber inflammation with a hypopyon, and posterior chamber inflammation without retained lens fragments. After failing treatment with topical steroids and IVT antibiotics, she underwent repeat PPV, vitreous biopsy, anterior chamber washout, and intraocular lens removal with the capsular bag. Intraocular cultures were positive for Scedosporium apiospermum sensitive to voriconazole. The patient was successfully treated with oral voriconazole. Conclusions: Fungal endophthalmitis should be considered in patients with chronic endophthalmitis refractory to IVT antibiotics.

Purpose: To compare the outcomes of phakic and pseudophakic eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR) that underwent pars plana vitrectomy (PPV) with retinectomy. Methods: A retrospective matched cohort study was performed in patients who underwent PPV with retinectomy for RRD with PVR with a minimum follow-up of 6 months. Phakic eyes that did not undergo lensectomy were matched to pseudophakic control eyes in a 1:1 ratio for age, gender, and macular status. The main outcome measure was single-surgery anatomic success at 6 months. Results: The study included 138 eyes (69 in each of the phakic and pseudophakic groups). The mean follow-up duration was 28.7 ± 9.2 months. Baseline characteristics, including macular status, preoperative visual acuity (VA), and RRD extent and retinectomy did not differ significantly between groups. The single-surgery anatomic success after initial retinectomy did not differ significantly between the phakic and pseudophakic groups at 3 months (69.6% vs 82.6%, respectively; P = .110) or 6 months (56.6% vs 66.7%, respectively; P = .294). The final retinal reattachment was achieved in 98.6% of the phakic group and 97.1% of the pseudophakic group (P > .99). Both groups showed significant visual improvement at 6 months and final follow-up visit (P < .05). Postoperative VA did not differ significantly between groups (P > .05). Conclusions: Eyes that underwent retinectomy for RRD with PVR may achieve acceptable outcomes regardless of the lens status. There was no difference in outcomes between phakic eyes that did not undergo lensectomy and pseudophakic eyes.

Purpose: To analyze vitreous base indentation achieved with absorbable vs permanent scleral imbrication sutures during retinal detachment repair. Methods: This retrospective, consecutive case series included patients who underwent scleral imbrication sutures with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair. Single-surgery anatomic success rate and visual acuity (VA) were assessed at 6 to 9 months postoperatively. Scleral indentation was measured by B-scan ultrasonography more than 6 weeks after surgery. Results: Sixteen patients were included. The single-surgery anatomic success rate was 88% (14 of 16) at 6 months. Vitreous base indentation greater than 2 mm, initially present in all quadrants, persisted beyond 6 weeks in 100% (13 of 13) of quadrants with polyester (Mersilene) scleral imbrication sutures and in 14% (2 of 14) with polyglactin 910 (Vicryl) scleral imbrication sutures. Median VA improved from baseline 0.36 logMAR (interquartile range [IQR], 0 to 1.15) to 0.18 logMAR (IQR, 0.01 to 0.51) postoperatively. Conclusions: Scleral imbrication sutures can produce either temporary or sustained vitreous base indentation. They may serve as a useful adjuvant to PPV for primary RRD repair when avoidance of a buckle element is desired.

Purpose: To present longitudinal, multimodal imaging findings of leptovitelliform maculopathy, an underrecognized condition within the spectrum of adult vitelliform lesions. Methods: A single case was evaluated over 5 years. Results: A 70-year-old man presented with vitelliform lesions accompanied by subretinal drusenoid deposits/reticular pseudodrusen and a thin choroid (leptochoroid). Multimodal imaging demonstrated progressive collapse of the vitelliform lesions, followed by extensive and worsening outer retinal atrophy. Conclusions: Leptovitelliform maculopathy may demonstrate progressive collapse of vitelliform lesions, ultimately leading to significant outer retinal atrophy. Longitudinal multimodal imaging is valuable in characterizing this aggressive and underrecognized disease entity.

Purpose: To describe a modified approach to managing bilateral simultaneous rhegmatogenous retinal detachment (RRD) based on factors other than macular status to guide surgical timing and sequencing. Methods: We retrospectively reviewed 47 patients with bilateral simultaneous RRD and grouped them into cohorts by macular status at presentation: cohort AA (both macula-attached, n = 23), cohort DD (both detached, n = 10), and cohort DA (1 attached and 1 detached, n = 14). Cohort DA was further divided, based on which eye was operated on first, into 3D (macula-detached eye first, n = 6) and 3A (macula-attached eye first, n = 4). Mean postoperative logMAR visual acuity (VA) is reported. Results: The mean ± SD time to surgery was 3.4 ± 10.2 days for the first eye and 19.4 ± 30.2 days for the second. No patients experienced RD progression in the second eye between surgeries. There was no difference in postoperative VA between the first and second-operated eyes in cohort AA (0.1 vs 0.1, P = .90) and cohort DD (0.4 vs 0.9, P = .10). In cohort DA, in macula-detached eyes, visual outcomes were significantly better when the macula-detached eye was operated on first (0.5 in group 3D vs 0.9 in group 3A, P = .03). In macula-attached eyes, no significant difference was observed (0.1 in group 3D vs 0.2 in group 3A, P = .63). Across all cohorts, the first-operated eye tended to be more symptomatic, lack signs of chronicity, or have a larger detachment. Conclusions: Bilateral simultaneous RRD often presents with chronic features. Surgical decision-making should consider symptom duration and clinical indicators of chronicity, not just macular status. Prioritizing eyes with more acute presentation may improve visual outcomes, while eyes with chronic findings may tolerate delayed repair.

Purpose: To report a rare case of sub-internal limiting membrane (sub-ILM) hemorrhage following femtosecond laser in situ keratomileusis, successfully managed conservatively. Methods: A single postoperative case was reviewed. Results: A 32-year-old woman presented with unilateral vision loss 1 month after femtosecond laser in situ keratomileusis. Clinical examination revealed a sub-ILM hemorrhage involving the macula, with an initial best-corrected visual acuity (BCVA) of 6/24. The patient underwent conservative management with serial follow-up examinations. Over the following months, the hemorrhage demonstrated progressive spontaneous resolution. At 4 months, the patient had a normal fundoscopic examination, and the BCVA improved to 6/6 without surgical intervention. Conclusions: Sub-ILM hemorrhage may occur as a rare posterior segment complication after laser in situ keratomileusis, even in otherwise healthy patients without known risk factors. Prompt diagnosis and close monitoring are crucial, and surgical intervention should be reserved for cases that fail to resolve spontaneously. To the best of our knowledge, this is the first documented case of sub-ILM hemorrhage following femtosecond laser in situ keratomileusis. Laser in situ keratomileusis. Further research is warranted to understand the effects of femtosecond laser in situ keratomileusis on intraocular pressure dynamics and retinal vasculature.

Purpose: To highlight the clinical utility of ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) in evaluating diabetic retinopathy (DR), particularly focusing on its ability to detect peripheral ischemia and neovascularization. Methods: Eyes of 5 participants with varying severity of DR were imaged with expanded-field 12 × 12-mm SS-OCTA scans and ultra-widefield SS-OCTA montages. Montages were created by stitching five 21 × 26-mm scans, offering up to a 200° field of view. Cases were assessed for areas of nonperfusion, intraretinal microvascular abnormalities, and neovascularization extending beyond the posterior pole. Results: Ultra-widefield SS-OCTA imaging demonstrated progressive mid-peripheral and peripheral nonperfusion, intraretinal microvascular abnormalities, and neovascularization in association with increasing DR severity. Peripheral nonperfusion and neovascular changes were detected beyond the scope of standard 12 × 12-mm scan areas. Conclusions: Ultra-widefield SS-OCTA is effective in noninvasively detecting peripheral retinal lesions such as ischemia and neovascularization. This technology offers potential to refine DR staging, improve risk stratification, and guide earlier clinical interventions.

Purpose: To describe a case of persistent visual distortion following clinical resolution of intracameral cefuroxime-induced cystoid macular edema (CME). Methods: A single case was evaluated. Results: A 68-year-old woman developed persistent visual distortion after cataract surgery with intracameral cefuroxime administration. Although optical coherence tomography (OCT) revealed only a small ellipsoid zone defect indicating near-complete recovery, adaptive optics scanning laser ophthalmoscopy (AOSLO) uncovered a pronounced fissure-like lesion coursing through the macular photoreceptor mosaic. This discrepancy demonstrated localized photoreceptor disruption that was not apparent on OCT. Conclusions: Intracameral cefuroxime-induced CME may result in lasting photoreceptor damage despite apparent anatomic recovery on OCT. This case underscores the limitations of current clinical imaging and highlights the potential of AOSLO to detect photoreceptor damage underlying persistent blurred vision after resolution of CME.

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.