Journal of VitreoRetinal Diseases最新文献

Purpose: To describe a case of endophthalmitis caused by Haemophilus influenzae, an encapsulated bacterium, after intravitreal (IVT) injection of pegcetacoplan. Methods: A single retrospective case was evaluated. Results: An 88-year-old woman with a history of diabetes mellitus, on dialysis for chronic kidney disease, hypertension, hypothyroidism, diffuse large B-cell lymphoma, and geographic atrophy in both eyes received an IVT injection of pegcetacoplan in both eyes. She subsequently developed endophthalmitis in the right eye caused by H influenzae. Further bloodwork showed Proteus mirabilis bacteremia. Conclusions: Pegcetacoplan, a complement inhibitor, may be associated with intraocular infections with encapsulated organisms, especially in immunocompromised patients.

Purpose: To describe a case of an eccentric macular hole (MH) overlying a choroidal cavitation in a nonmyopic eye with secondary choroidal neovascularization (CNV). Methods: A case report is presented. Results: A 101-year-old man was referred for an asymptomatic retinal pigmentary abnormality in the right eye. A fundus examination showed a yellow-orange circular lesion with a white center and mild associated hemorrhage. Optical coherence tomography showed an eccentric full-thickness MH overlying a choroidal cavitation with intraretinal cystic change and subretinal hyperreflective material suggestive of CNV. The patient was treated with intravitreal antivascular endothelial growth factor and had a good response. Conclusions: Typically described as being adjacent to the optic disc and in myopic fundi, eccentric macular choroidal cavitations may be seen in nonmyopic eyes and associated with full-thickness MHs ("macular sinkholes") and CNV. This case report expands the spectrum of potentially visually significant findings associated with choroidal cavitary disease.

Purpose: To report a case of suprachoroidal migration of mitomycin-C (MMC) with ensuing retinal toxicity after trabeculectomy. Methods: A case report of retinal toxicity is described with multimodal imaging. Results: A patient developed occlusion of the retinal and choroidal vasculature in a segmental fashion that could be explained by suprachoroidal diffusion. Fundus autofluorescence showed a stippled pattern over an area of hypofluorescence in the superonasal quadrant, and a late fluorescein angiogram image showed staining of the superonasal quadrant with dependent leakage toward the optic nerve and macula. Conclusions: MMC is commonly used in glaucoma-filtering surgical procedures, and few cases of postoperative posterior segment toxicity have been reported. To our knowledge, we are the first to describe suprachoroidal migration of MMC with subsequent retinal toxicity.

Purpose: To review the first Research and Safety in Therapeutics (ReST) Committee webinar and summarize the most current recommendations regarding diagnosis and management. Methods: The ReST Committee is comprised of members of the American Society of Retina Surgeons (ASRS). At regular internal meetings, safety issue reports from the website are reviewed. A webinar series was started in 2021 to update members on multiple relevant potential safety events. Results: Topics reviewed in the webinar included pentosan polysulfate sodium (Elmiron) maculopathy, intraocular pressure elevation reported with the aflibercept prefilled syringe (PFS), and brolucizumab-associated inflammation with occlusive retinal vasculitis. Retinal toxicity related to intraoperative medications was reviewed, including hemorrhagic occlusive retinal vasculitis after intraocular vancomycin, dilution errors with intravitreal aminoglycosides, inadvertent overdoses of cefuroxime after cataract surgery, and toxic posterior segment syndrome after dropless cataract surgery using compounded triamcinolone-moxifloxacin. Indocyanine green toxicity has been reported after its use as an adjuvant during macular hole surgery. Conclusions: The past decade has seen advances in retinal pharmaceuticals and drug-delivery devices. The ASRS ReST Committee collects data from its website reporting system to inform members about up-to-date pharmaceutical and device safety concerns. Recently, a webinar was used to inform members of pigmentary maculopathy associated with pentosan polysulfate sodium, safety regarding the aflibercept PFS, intraocular inflammation and occlusive retinal vasculitis secondary to brolucizumab, and retinal toxicity from intraoperative ocular medications.

Purpose: To review sustained-release intraocular platforms used to treat diseases of the retina and choroid. Methods: A literature review of the current applications of biomaterials for sustained-release therapy in retinal and choroidal diseases was performed. Results: Retinal and choroidal diseases, such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), and uveitis, are commonly treated using intravitreal (IVT) therapies that require frequent IVT injections. Multiple sustained-release options for IVT therapy have been approved by the US Food and Drug Administration for the treatment of inflammatory eye diseases, including noninfectious uveitis, infectious diseases, and exudative retinal diseases (eg, retinal venous occlusive disease and DME) using drugs such as fluocinolone acetonide, ganciclovir, and dexamethasone. The platforms for these drugs are biodegradable or nonbiodegradable. They use biomaterials such as polymers and hydrogels and are typically implanted surgically or injected into the vitreous, where they release the drug gradually over months or years. Building on these technologies, novel platforms are being studied that are intended to treat conditions including nAMD, DR, DME, and uveitis. These platforms are being tested for their safety, efficacy, and ability to reduce the injection and visit burden. Conclusions: Multiple sustained-release ocular drug-delivery platforms are currently commercially available, and many new sustained-release IVT platforms are being investigated. The hope is that meaningfully reducing the injection burden by extending intervals between treatments while maintaining optimal efficacy will improve long-term outcomes.

Purpose: To describe a potential new phenotypic presentation of pentosan polysulfate sodium maculopathy. Methods: An observational case was analyzed. Results: A 55-year-old woman with interstitial cystitis who was treated with oral pentosan polysulfate sodium for 10 years presented with reports of decreased vision and metamorphopsia that had worsened over the past 3 months. On funduscopic examination, there were bilateral areas of retinal pigment epithelial hyperplasia inferior to the fovea with a surrounding halo of drusenoid material. Neurosensory retinal detachments with drusenoid deposition at the edges of the detachment were seen on spectral-domain optical coherence tomography. Conclusions: These findings could be mistaken for age-related macular degeneration, central serous retinopathy, Best disease, or adult vitelliform dystrophy. In this case, a review of pertinent medications assisted in making the diagnosis of toxic maculopathy. Proper diagnosis and prompt discontinuation of the inciting medication are necessary to avoid the risk for potentially irreversible retinal damage and vision loss.

Purpose: To compare the anatomic and visual acuity (VA) outcomes of rhegmatogenous retinal detachment (RRD) repair in eyes with a multifocal intraocular lens (IOLs) and eyes with monofocal IOLs. Methods: This retrospective matched-cohort study comprised pseudophakic eyes that had pars plana vitrectomy (PPV) or PPV with scleral buckling for RRD. Eyes with multifocal IOLs (multifocal group) were matched with eyes with monofocal IOLs (control group) in a 1:2 ratio for age, sex, primary surgeon, timing of surgery from presentation, type of surgery, and macular status. Results: The multifocal group included 67 eyes and the control group, 134 eyes. The mean (±SD) follow-up was 785 ± 595 days and 746 ± 566 days, respectively (P = .57). Overall, the single-surgery anatomic success rate was 76.1% in the multifocal group and 86.6% in the control group (P = .06); 75.0% and 85.9%, respectively, for PPV (P = .06); and 100% for PPV with scleral buckling in both groups (P = 1.00). The mean final logMAR VA was 0.26 ± 0.34 (20/36 Snellen) in the multifocal group and 0.27 ± 0.36 (20/37 Snellen) in the control group (P = .60). Conclusions: In pseudophakic eyes with an RRD, there was a trend toward better single-surgery anatomic success in eyes with a monofocal IOL than in eyes with a multifocal IOL treated with PPV, with similar anatomic outcomes for PPV with scleral buckling. Visual outcomes were similar between the groups and significantly improved compared with baseline.

Purpose: To report a case of polypoidal choroidal vasculopathy (PCV) recalcitrant to treatment with ranibizumab and with a ranibizumab port delivery system (Susvimo) but responsive to faricimab-svoa. Methods: A case and its findings were analyzed. Results: A 69-year-old Filipino man with PCV in the left eye was treated for 2 years with multiple ranibizumab intravitreal (IVT) injections followed by ranibizumab port delivery combined with rescue ranibizumab IVT injections, with no significant response clinically or on imaging. The visual acuity (VA) worsened to 20/100 OD. IVT treatment was switched to faricimab-svoa injections. After 2 injections, there was significant improvement on optical coherence tomography and in VA (20/60). Conclusions: This case shows the potential therapeutic benefits of targeting angiopoietin-2 in addition to vascular endothelial growth factor to treat PCV refractory to ranibizumab. Faricimab may provide an alternative to therapy with ranibizumab and verteporfin photodynamic therapy for the treatment of PCV.

Purpose: To describe the ophthalmic outcomes and complications after silicone oil (SO) removal. Methods: This nonrandomized retrospective review comprised patients who had SO removal from January 2020 to December 2022. Data collected included patient demographics, visual acuity (VA), intraocular pressure (IOP), initial tamponade, indication for SO placement, duration of SO in the eye, indication for SO removal, cataract progression, rates of retinal redetachment, cornea-related complications, additional surgical interventions, and other complications. Results: The study comprised 107 eyes (mean age, 56.6 years; 67% male). The most common indications for SO tamponade were rhegmatogenous retinal detachment (RRD), RRD with proliferative vitreoretinopathy (PVR), and tractional RD. The mean SO tamponade duration was 9.3 months and was longer for patients who did not have redetachment than for those who had detachment (10 months vs 6.8 months; P = .024). The mean preoperative logMAR VA had significantly improved by the final follow-up (1.44 vs 1.19; P < .001). The mean IOP was 16.43 mm Hg preoperatively and 16.81 mm Hg at the final visit (P = .672). Retinal redetachment occurred in 20.6% of patients, and the anatomic success rate at the final follow-up was 86.0%. A history of recurrent detachment and PVR was not associated with increased rates of postoperative redetachment. The overall rate of hypotony was 3.7% and of ocular hypertension, 7.5%. Significant cataract progression occurred in 69% of eyes. Conclusions: After SO removal, there was an overall improvement in VA and a stable IOP. Cataract progression was the most common complication. Although there is a risk for redetachment after SO removal, it may not have a detrimental effect on redetachment rates with a longer duration of SO tamponade.

Purpose: To describe choriocapillaris loss on optical coherence tomography angiography (OCTA) imaging in a pediatric patient with congenital cytomegalovirus (CMV). Methods: A case was evaluated. Results: A 7-year-old female patient was referred for retinal evaluation of maculopathy in the right eye. She was diagnosed with congenital CMV at 14 months of age, at which time treatment was not deemed necessary. At 7 years of age, the patient was asymptomatic with 20/20 Snellen visual acuity. Funduscopy and colored fundus photographs showed macular scarring. Ancillary testing was performed, with retinal pigment epithelium alterations and disruption of the outer retinal layers seen on OCT and choriocapillaris loss in the area of the macular scar seen on OCTA. Conclusions: For patients with congenital CMV, OCTA imaging can show significant changes in choriocapillaris function. These changes do not necessarily correlate with visual function parameters. OCTA may be useful as an additional screening or surveillance modality for patients with congenital CMV or CMV retinitis.