Journal of VitreoRetinal Diseases最新文献

Purpose: To study the clinical profile, treatment, and outcomes of patients 35 years or older diagnosed with Coats disease. Methods: A cross-sectional observational hospital-based study was performed. Results: The study included 74 eyes diagnosed with adult-onset Coats disease. The mean age at presentation was 50 years (range, 35-75). Most patients were men (72.5%) and had a unilateral presentation (92.8%). The most common stage at presentation was 2A (extrafoveal exudation) (39.2%) followed by 2B (foveal exudation (33.7%). Optical coherence tomography was performed in 40 eyes; 32 eyes (80.0%) had intraretinal fluid (IRF), 31 eyes (77.5%) had hard exudates, and 22 eyes (55.0%) had a disorganized retinal inner layer. Fluorescein angiography was performed in 35 eyes and showed an irregular foveal avascular zone in 28 eyes (80.0%). Multiple leaking microaneurysms were seen in 32 eyes (91.4%), with extensive vascular abnormalities involving the macula (86%) and extramacular zones (91%). Treatment modalities comprised laser photoablation (43.4%), cryotherapy with or without laser application (5.7%), and intravitreal injections (49%), alone or in combination. At a mean follow-up of 28 months (range, 3-293), 23 eyes (39.6%) had anatomic resolution of subretinal fluid and/or IRF. No statistical improvement was found in the mean best-corrected visual acuity (VA) between preoperatively and postoperatively (P > .05). Conclusions: Patients with adult-onset Coats disease have a unilateral presentation with a less severe stage than patients with childhood-onset disease. Despite the good anatomic responses after treatment, the final VA remained unchanged.

Introduction: To compare the retinal and choroidal architecture and microvasculature between patients with mild or moderate traumatic brain injury (TBI) and controls with normal cognition using optical coherence tomography (OCT) and OCT angiography (OCTA). Methods: Patients with a documented history of TBI, and age-matched and sex-matched controls were recruited. The primary outcome measures were differences between OCT parameters, including the choroidal vascularity index, and between OCTA superficial capillary plexus metrics, including foveal avascular zone (FAZ) circularity, 3.0 mm × 3.0 mm and 6.0 mm × 6.0 mm macular vessel density and perfusion density, and 4.5 mm × 4.5 mm peripapillary capillary perfusion density and capillary flux index. Results: Sixty-seven eyes of 36 patients with TBI and 72 eyes of 36 control patients met the inclusion criteria. Twelve patients (33.3%) had a diagnosis of mild TBI without loss of consciousness (LOC), 21 (58.3%) had mild TBI with LOC, and 3 (8.3%) had moderate TBI. There was a significant reduction in FAZ circularity and in 3.0 mm × 3.0 mm macular OCTA vessel density and perfusion density in patients with TBI. In cases with TBI associated with posttraumatic stress disorder, all macular OCTA parameters were significantly reduced. There was an increase in the choroidal vascularity index across the severity of TBI; however, it was reduced in those with more than 1 TBI (P = .03). Conclusions: There was a reduction in macular perfusion in eyes of patients with mild or moderate TBI. The choroidal vascularity index helps differentiate subtle effects of more severe or mild repeated TBI. Further prospective investigation will evaluate OCT imaging and OCTA imaging as a noninvasive screening modalities to assess changes in retinal and choroidal microvasculature.

Purpose: To describe a case of bilateral diffuse uveal melanocytic proliferation in the setting of metastatic ovarian cancer. Methods: A single case was analyzed and a literature review of treatment efficacy performed. Results: A 64-year-old woman presented to ophthalmology in July 2022 for evaluation of blurred vision in the setting of ovarian cancer and a possible reaction to chemotherapy. A comprehensive workup led to the diagnosis of bilateral diffuse uveal melanocytic proliferation. Treatment to potentially preserve the patient's vision comprised a sub-Tenon triamcinolone injection and plasmapheresis. Conclusions: Plasmapheresis did not improve the visual acuity (VA) in the patient's right eye; however, 6 months after the last treatment, the VA in the left eye improved from 20/50 to 20/30, corresponding to a decrease in macular edema. Given the rarity of bilateral diffuse uveal melanocytic proliferation, its uncertain pathogenesis, and its varied responses to treatment, it is imperative to establish a diagnostic management and treatment algorithm to improve visual outcomes.

Purpose: To describe 4 cases of posterior pole retinal detachment (RD) in patients with pathologic myopia that were repaired with a prototype myopia support device. Methods: A case series was evaluated. Results: Four cases of posterior pole RD were treated, 3 of which were accompanied by myopic maculoschisis and 1 that was accompanied by a choroidal neovascular membrane and a macular hole (MH). Preoperative and postoperative assessments included visual acuity, optical coherence tomography and fluorescein angiography findings, and axial lengths when available. Three patients had vitrectomy and device placement, while the other patient received device placement alone. All cases had successful repair of the RD, with complete resolution of maculoschisis and MH when present. The myopia support device provided the desired indentation, aiding in the repair. Follow-up varied between 2 months and 17 months. Conclusions: The myopia support device is a valuable addition for repair of posterior pole RDs in patients with pathologic myopia, with or without maculoschisis or MH. It can be used in conjunction with vitrectomy or as a standalone technique.

Introduction: To determine the presenting clinical characteristics of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling and the impact on final visual outcomes and to determine the postoperative primary attachment rate, complications, and subsequent management. Methods: This retrospective observational study comprised patients with RRD who had scleral buckling surgery from January 2016 to December 2021 with a minimum follow-up of 6 months. Results: The study comprised 307 eyes of 290 patients; 97% of eyes were phakic. Primary anatomic attachment was achieved in 93% of eyes. Macula-on detachment had a significant relationship with visual gain, while age, refractive status, number of breaks, configuration of the detachment, traumatic etiology, and lens status did not. Eyes with recurrent detachment did not have a significant visual gain after subsequent pars plana vitrectomy (PPV). Conclusions: Most eyes that underwent scleral bucking were phakic. Macular status played a significant role in the visual prognosis. The primary anatomic attachment rate after scleral buckling surgery is comparable to that after PPV. Thus, scleral buckling is far from being a procedure of the past. Multiple breaks, inferior detachments, and traumatic etiology do not appear to adversely affect the visual outcomes. Multiple vitreoretinal surgeries may not result in a visual gain in cases of recurrent detachment.

Purpose: To describe a case of spontaneous closure of a pediatric traumatic macular hole (MH) using serial optical coherence tomography (OCT) imaging. Methods: A single case was evaluated. Results: An 8-year-old girl developed a full-thickness MH in the right eye after sustaining blunt trauma from a bungee cord. She was observed monthly. By 3 months, the MH spontaneously closed, at which time an epiretinal membrane (ERM) developed. Spontaneous release of the posterior hyaloid and ERM at 5 months resulted in a relatively normal foveal contour. At the patient's last follow-up, the visual acuity in the right eye had improved from 20/80 to 20/30. Conclusions: Observation of a pediatric traumatic MH is a viable initial treatment option. Serial OCT imaging was useful in observing the natural history and mechanism behind spontaneous closure of a traumatic MH.

Purpose: To present a case of bilateral endogenous endophthalmitis as the first presentation of endocarditis. Methods: A single case was evaluated. Results: A 64-year-old Black woman presented with rapidly progressive bilateral vision loss. The visual acuity was no light perception (NLP) OD and LP OS. The initial diagnosis of infectious endophthalmitis was confirmed by a blood culture positive for Streptococcus pneumoniae and an echocardiogram that indicated endocarditis. Despite treatment with intravitreal antibiotics and vitrectomy, the patient's visual prognosis remained poor. Conclusions: Although in general the visual prognosis for S pneumoniae-related endogenous endophthalmitis is poor, early detection and identification of the primary infection source are crucial and can significantly improve the chance of the patients' survival.

Purpose: To describe a case of a drusenoid pigment epithelial detachment that resolved after retinal detachment (RD) repair using multimodal imaging. Methods: A single case was evaluated. Results: An 83-year-old woman with intermediate age-related macular degeneration had repair of a rhegmatogenous RD with subsequent resolution of macular drusen and improved visual acuity and metamorphopsia. Conclusions: RD repair may be associated with resolution of drusen, leading to improved functional outcomes.

Purpose: To compare the modeled costs of the Protocol AC bevacizumab-first treatment protocol (with a switch to aflibercept for sub-responders) with real-world costs for treatment-naïve patients with diabetic macular edema (DME) over a 2-year period. Methods: Published data from the Diabetic Retinopathy Clinical Research Network (DRCR) Protocol AC bevacizumab-first arm (154 eyes) were used to model 2-year treatment costs. Real-world costs were modeled using data from the Vestrum Health electronic medical records database from a 2016 to 2018 cohort of treatment-naïve eyes with DME (n = 1062) treated with antivascular endothelial growth factor monotherapy. The visual acuity (VA) before treatment in the real-world cohort was matched to Protocol AC. A secondary cost analysis further matched VA gains after treatment in the real-world cohort (n = 346) to Protocol AC. Results: In Protocol AC, the modeled 2-year DME treatment cost in the bevacizumab-first arm was $18,952, with a mean of 16.1 injections over 22.5 visits and 70% of eyes being switched to aflibercept by year 2. (Within 2 years, 57% of injections were bevacizumab and 43% were aflibercept.) Over the same period, the modeled 2-year real-world cost ($11,459) was 40% lower, with a mean of 8.6 injections over 13.8 visits (42% bevacizumab, 45% aflibercept, 13% ranibizumab). Even when matched for baseline VA and a 14-letter VA gain over 2 years, the real-world cost ($15,394) was still 19% lower than the modeled cost in the Protocol AC bevacizumab-first arm. Conclusions: The real-world cost of treating DME over 2 years was significantly lower than the Protocol AC bevacizumab-first cost. Application of Protocol AC findings into real-world utilization, as with step therapy mandates, should only be considered if the same intensive protocol could be followed. These data suggest that existing real-world costs that reflect physician choice are already significantly lower than protocol-mandated step therapy, even when controlling for similar VA outcomes.