Journal of VitreoRetinal Diseases最新文献

Purpose: To present 2 cases of acute total loss of vision after scleral buckle surgery for rhegmatogenous retinal detachment. Methods: A retrospective chart review of 2 cases and an analysis of the literature were performed. Results: An 18-year-old woman and a 67-year-old woman suffered complete loss of vision in their operative eye after primary scleral buckle surgery with encircling bands. Conclusions: Profound ocular ischemia resulting in total acute vision loss is a rare and devastating outcome of primary scleral buckle procedures and may be caused by strangulation of the eye with an encircling band. Attention paid to the key tenets of this often successful and useful surgical technique may lower the risk for this complication.

Purpose: To describe the multimodal imaging findings associated with benign yellow dot maculopathy. Methods: A case report was analyzed. Results: A healthy 42-year-old White man was evaluated after several weeks of photopsias and an inferior retinal tear in the right eye. The tear was treated with laser retinopexy. A fundus examination showed numerous small, yellow, subretinal lesions in and around the macula of the right eye only. The patient had no known systemic conditions and an unremarkable family and ocular history, with 20/20 visual acuity in both eyes. Multimodal imaging findings were consistent with the newly described phenotype of benign yellow dot maculopathy. Conclusions: This is the second known case of unilateral benign yellow dot maculopathy. Distinct multimodal imaging findings between unilateral cases and bilateral cases may suggest differences in their etiology and manifestation.

Purpose: To examine the risks associated with the use of pilocarpine hydrochloride 1.25% ophthalmic solution prescribed for presbyopia. Methods: The adverse ocular events reported after the use of pilocarpine were compared with the symptoms experienced by a 62-year-old presbyopic man shortly after taking pilocarpine. Results: The patient reported symptoms soon after instilling pilocarpine, including eye pain, hazy vision, and floaters. An examination showed a horseshoe retinal tear, vitreous hemorrhage, and posterior vitreous detachment, for which the patient received extensive clinical and surgical management. Conclusions: This case highlights the need for comprehensive eye examinations and patient education about the warning signs of retinal tears or detachments before prescribing pilocarpine for presbyopia. Vigilance regarding the potential rare adverse effects of this new pilocarpine ophthalmic solution is warranted.

Purpose: To report a case of retinal vasculitis after intravitreal faricimab-svoa injection. Methods: A case and its management were reviewed. Results: A 77-year-old woman presented with a painless decrease in visual acuity (VA) to counting fingers after receiving an intravitreal faricimab-svoa injection for neovascular age-related macular degeneration. An examination showed an anterior chamber reaction without hypopyon. Vitritis was present with numerous scattered retinal hemorrhages. Fluorescein angiography showed delayed filling with extensive vascular leakage consistent with nonocclusive vasculitis. The patient was immediately treated with intravenous steroids, resulting in rapid improvement and recovery of her 20/40 baseline VA. The vasculitis resolved without occlusion. Conclusions: Faricimab-svoa can be associated with significant vasculitis. Prompt treatment with intravenous steroids can be beneficial in the recovery of sight.

Purpose: To evaluate a recently developed technique using intraoperative optical coherence tomography (OCT) to measure subretinal tissue plasminogen activator (tPA) volumes in patients with submacular hemorrhage secondary to exudative age-related macular degeneration (AMD). Methods: Three patients (72 to 83 years old) had 25-gauge pars plana vitrectomy, subretinal tPA, and a partial gas fill. An investigational intraoperative OCT system with a modified widefield noncontact indirect viewing apparatus was used to image subretinal tPA blebs. Using the recently developed technique, the volume and surface area in the segmented region of interest were determined. Results: In each case, the delivered tPA volume measured from the syringe differed from the intraoperative OCT-measured subretinal tPA volume: Patient 1, 130 µL from syringe, 118 µL based on intraoperative OCT, 9% difference; Patient 2, 140 µL, 50 µL, 64%; Patient 3, 110 µL, 122 µL, 11%. The total bleb surface area was 129 mm² in Patient 1, 55 mm² in Patient 2, and 106 mm² in Patient 3. Conclusions: This was the first human study to implement and evaluate intraoperative OCT image-based methods to obtain volumetric bleb measurements in patients receiving subretinal tPA for exudative AMD. This proof-of-concept study showed that intraoperative OCT-obtained bleb volume differed from intraoperative recordings, which could be explained by tPA delivery into the vitreous, efflux through the retinotomy, or human error. Intraoperative OCT can provide visualization and quantification of subretinal tPA bleb volume and surface area, which has implications for improved safety, efficacy, and analysis of the effects of subretinal drug delivery.

Purpose: To evaluate the readability, accountability, accessibility, and source of online patient education materials for treatment of age-related macular degeneration (AMD) and to quantify public interest in Syfovre and geographic atrophy after US Food and Drug Administration (FDA) approval. Methods: Websites were classified into 4 categories by information source. Readability was assessed using 5 validated readability indices. Accountability was assessed using 4 benchmarks of the Journal of the American Medical Association (JAMA). Accessibility was evaluated using 3 established criteria. The Google Trends tool was used to evaluate temporal trends in public interest in "Syfovre" and "geographic atrophy" in the months after FDA approval. Results: Of 100 websites analyzed, 22% were written below the recommended sixth-grade reading level. The mean (±SD) grade level of analyzed articles was 9.76 ± 3.35. Websites averaged 1.40 ± 1.39 (of 4) JAMA accountability metrics. The majority of articles (67%) were from private practice/independent organizations. A significant increase in the public interest in the terms "Syfovre" and "geographic atrophy" after FDA approval was found with the Google Trends tool (P < .001). Conclusions: Patient education materials related to AMD treatment are often written at inappropriate reading levels and lack established accountability and accessibility metrics. Articles from national organizations ranked highest on accessibility metrics but were less visible on a Google search, suggesting the need for visibility-enhancing measures. Patient education materials related to the term "Syfovre" had the highest average reading level and low accountability, suggesting the need to modify resources to best address the needs of an increasingly curious public.

Purpose: To describe the use of serial intravitreal methotrexate to combat proliferative vitreoretinopathy (PVR) in a pediatric patient with recurrent retinal detachment (RD). Methods: A retrospective case analysis was performed. Results: A 6-year-old patient with bilateral panuveitis presented with recurrent RD in the right eye. After treatment with 2 RD surgeries performed elsewhere, the patient developed PVR that necessitated 5 additional surgeries for recurrent detachment. The patient subsequently received a total of 8 injections of methotrexate 400 µg/0.1 mL (0.1 mL) in the operating room at 1- to 2-week intervals over a 3-month period. Through 13 months of follow-up after the first methotrexate injection, there was no evidence of recurrent RD, PVR, or epiretinal membrane formation. Conclusions: Frequent serial intravitreal methotrexate injections apparently played a role in preventing recurrent PVR formation in this pediatric patient with a history of intraocular inflammation and recurrent RD.

Purpose: To present a series of 4 patients from the Ohio Amish or Mennonite populations with isolated ectopia lentis. Methods: A case series was evaluated. Results: Four cases with bilateral lens subluxations were diagnosed with a homozygous c.767_786del pathogenic variant in ADAMTSL4. Their ages ranged from 2 to 22 years. Three cases were symptomatic and were managed surgically with lensectomy, vitrectomy, and endolaser photocoagulation with or without secondary intraocular lens (IOL) implantation. One asymptomatic patient was observed. The postoperative visual acuity ranged from 20/20 to 20/60 in nonamblyopic eyes. Conclusions: The pathogenic homozygous c.767_786del variant in ADAMTSL4 may be a cause of bilateral isolated ectopia lentis in the Ohio Amish and Mennonite populations, likely as a result of a founder effect. Vitrectomy and lens extraction with or without secondary IOL implantation may lead to good visual outcomes. There were no cases of retinal detachment.

Purpose: To evaluate clinical trials in the literature that focus on suprachoroidal drug delivery for the treatment of noninfectious uveitis and other posterior segment diseases. Methods: A synthesis of the literature was performed. Results: In 2021, suprachoroidal space triamcinolone acetonide, a corticosteroid delivery system used for the treatment of uveitic macular edema (ME), was approved by the US Food and Drug Administration. The drug-delivery system targets the suprachoroidal space using a microneedle-based device and has a favorable pharmacokinetic profile. Suprachoroidally administered investigational therapies have also been assessed in clinical trials for other posterior segment diseases, including diabetic ME, retinal vein occlusion, age-related macular degeneration, and choroidal melanoma. Conclusions: The safety and efficacy of suprachoroidal corticosteroid injections to treat uveitic ME have been shown in recent phase III clinical trials. Multiple programs are also investigating this modality of drug delivery for use in many other retinal and choroidal pathologies.