Journal of VitreoRetinal Diseases最新文献

Purpose: Herein, we describe a case of paracentral acute middle maculopathy occurring after routine sinus surgery. Methods: A single case was evaluated. Results: The patient presented with an inferocentral scotoma in the left eye 2 days after an uneventful sinuplasty procedure performed under local anesthesia. Examination and optical coherence tomography demonstrated paracentral acute middle maculopathy. A complete workup and urgent stroke evaluation revealed no clear underlying etiology. Conclusion: Sinus procedures may rarely be associated with paracentral acute middle maculopathy, possibly due to the vasoconstrictive effects of local anesthetics. Ophthalmologists and head and neck surgeons should be aware of this potential complication.

Purpose: To compare the treatment outcomes of newly diagnosed unilateral neovascular age-related macular degeneration (nAMD) in established patients of a retina practice with those of patients referred by non-retina specialist providers. Methods: This is a retrospective cohort study of patients with unilateral nAMD treated with intravitreal antivascular endothelial growth factor (anti-VEGF) therapy and at least 12 months of follow-up. Group 1 included established patients with initially bilateral dry age-related macular degeneration (AMD) that subsequently converted to unilateral nAMD requiring anti-VEGF treatment. Group 2 patients were referred to the practice with newly diagnosed unilateral nAMD requiring anti-VEGF treatment. All included patients presented with cases of new neovascular disease of the first eye. Results: There were 253 patients in Group 1 and 392 in Group 2. Average logMAR (Snellen equivalent) best-corrected visual acuity (BCVA) at time of neovascular conversion was 0.40 (20/50) for Group 1 and 0.62 (20/80) for Group 2 (P < .001). The percentage of patients with submacular hemorrhage was 7.9% for Group 1 and 18.6% for Group 2 (P < .001). By 12 months, BCVA improved to 0.36 (20/40) for Group 1 and 0.52 (20/60) for Group 2 (P < .001). The mean ± SD number of injections in the first 12 months of therapy was 8.64 ± 2.17 for Group 1 and 9.19 ± 2.33 for Group 2 (P = .003). Conclusions: Visual outcomes were superior in established patients of retina specialists at the time of nAMD conversion in the first eye. It may be advantageous for patients with dry AMD to already be under the care of a retina specialist at the time of neovascular conversion.

Purpose: To evaluate the long-term outcomes and experiences of patients with the Argus II retinal prosthesis in individuals with advanced-stage retinitis pigmentosa. Methods: Chart review was conducted on 13 patients with the Argus II implant between June 2015 and February 2018 at the Cleveland Clinic Cole Eye Institute. Data collected included examination findings, adverse events, device usage, impact on quality of life, and patient satisfaction. Results: The average age of patients at implantation was 71 years, with 84.6% being male. All patients had severe visual impairment prior to surgery. Four patients experienced serious adverse events, including conjunctival erosion, vitreous hemorrhage, persistent corneal abrasion, and vertigo. None of the 10 patients who had recent follow-up appointments were currently using the device, with an average ± SD usage duration of 3.34 ± 2.65 years. Discontinuation reasons included performance issues, cognitive load, and physical discomfort, among others. Five patients reported that with the knowledge they currently have, they would choose to receive the implant again. Conclusions: Argus II provided potential benefits but also presented significant challenges related to device performance, cognitive demands, and long-term support. The cessation of commercial operations by the manufacturer and the resulting lack of support further complicated the experiences of patients. Despite this, the device remains a pioneering step in retinitis pigmentosa treatment, underscoring the need for ongoing innovation in visual prosthesis technology.

Purpose: To assess clinical outcomes in diabetic macular edema (DME) patients treated with high-dose aflibercept 8.0 mg (HDA), focusing on treatment intervals, anatomic changes, and best-corrected visual acuity (BCVA). Methods: This retrospective, single-center study included 67 DME patients (100 eyes) treated at Cole Eye Institute between August 2023 and November 2024. All patients received at least 3 HDA injections, with a true loading dose defined as 3 initial injections given ≤ 5 weeks apart. The primary outcome was proportion of eyes for which minimum ≥ 7-week treatment intervals were maintained. Secondary outcomes included changes in BCVA, central subfield thickness (CST), and macular fluid status. Results: Loading dose was completed in 73 eyes (73%) and not completed in 27 eyes (27%). Before HDA injections, 4.0% of eyes were anti-vascular endothelial growth factor naive. Mean (±SD) follow-up was 24.3 ± 5.0 weeks. From baseline to final visit, mean (±SD) CST significantly decreased (from 371.1 ± 134.6 μm to 330.0 ± 121.7 μm; P = .025), while BCVA remained stable (from 62.4 ± 18.8 to 63.5 ± 17.7 ETDRS letters; P = .676). For 32 eyes (32%), ≥ 7-week treatment intervals could not be maintained, with 18 eyes being switched to alternative therapy and 14 eyes requiring < 7-week injection intervals; these eyes had significantly higher baseline CST (P = .045). Persistent macular fluid was observed in 90% of eyes. Conclusion: HDA reduced CST and stabilized BCVA in DME patients. However, remaining challenges include frequent injections and persistent macular fluid, underscoring the chronic, treatment-resistant nature of DME and need for optimized treatment strategies.

Purpose: To describe the visual and electroretinographic (ERG) outcomes after inadvertent intravitreal injection of lidocaine. Methods: A 75-year-old man with neovascular age-related macular degeneration inadvertently received approximately 0.07 mL of lidocaine 2% intravitreally in his right eye. Serial 30 Hz flicker ERG was performed at 3, 6, and 24 hours postinjection. Results: Visual acuity decreased to count fingers immediately after the injection and returned to baseline of 20/30 within 24 hours. ERG showed increased amplitudes at 3 hours in the affected eye (47.7 microvolts) relative to the unaffected eye (35.7 microvolts) that normalized at hours 6 (23.5 microvolts OD, 29.1 microvolts OS) and 24 (13.4 microvolts OD, 11.8 microvolts OS). Mean implicit time (26.97 ms OD, 27.0 ms OS) was symmetric. Conclusions: In our case, visual acuity reduction and ERG changes specific to 0.07 mL intravitreal lidocaine 2% seem to be transient and may not require any specific therapy other than immediate intraocular pressure control.

When encountering diseases of the anterior vitreous and peripheral retina (ie, the "middle segment" of the eye), vitreoretinal (VR) surgeons are specifically trained in surgical techniques for managing the vitreous and visualizing the peripheral retina during anterior vitrectomy, and therefore they are well equipped to address the complications of surgery involving the anterior vitreous space. This clinical update reviews and compares the current literature discussing techniques and patient outcomes related to complete pars plana vitrectomy versus incomplete, subtotal pars plana vitrectomy, and addresses the proposition of developing an abridged training curriculum for non-VR surgeons to acquire the knowledge and skills required to perform these procedures. Recent studies confirmed that operating in the anterior vitreous carries potential risk of retinal tear, retinal detachment, and other adverse events that may cause vision loss. To mitigate these risks, studies suggest that use of dedicated visualization equipment and illumination instruments are necessary for surgeons to safely perform anterior vitrectomy and recognize complications, should any occur. Performing VR surgery in the absence of wide-angle viewing systems, endoillumination, careful peripheral examinations, modern vitrectomy platforms, and appropriate training may lead to outcomes that are detrimental to patient safety.

Purpose: To investigate the progression of epiretinal membrane (ERM) following cataract surgery using optical coherence tomography (OCT)-based biomarkers. Methods: A retrospective review was conducted from January 2012 to February 2022, assessing eyes with preexisting idiopathic ERM that underwent uncomplicated cataract surgery. An established ERM grading scale was used, and OCT features, along with visual outcomes, were evaluated. Results: The study followed 67 eyes for an average of 47.8 months after cataract surgery. Initially, 83.6% of eyes had stage 1 ERM, 13.4% had stage 2, and 3% had stage 3. Nonsignificant ERM progression occurred 59 weeks postoperatively. Among stage 1 eyes, 16.1% progressed to stage 2; 11.1% of stage 2 eyes progressed to stage 3; and 50% of stage 3 eyes progressed to stage 4. Additionally, 10.4% developed or experienced worsened macular edema following cataract surgery, and 6% underwent vitrectomy. In eyes managed without vitrectomy, visual acuity (VA) improved 1 month after cataract surgery (P = .018) and remained stable over a 4-year period. Conclusions: Eyes with mild-stage ERM that demonstrate improved VA after cataract surgery tend to maintain these improvements over a 4-year period and do not typically progress.

Purpose: To evaluate the impact of personal, professional, and academic experiences on the publication productivity of academically affiliated female retina specialists in the United States. Methods: Between April and July 2023, a survey was distributed to academically affiliated female retina specialists in the US whose emails were found on public faculty webpages of ophthalmology departments at academic institutions. The survey gathered demographic information and the timing of personal, professional, and academic life experiences. H-indexes and most productive years were obtained from Scopus. Quantitative data were analyzed using Excel (Microsoft Corp). Results: A total of 59 responses were recorded, yielding a 38.6% response rate. The mean h-index of the cohort was 17.2 ± 15.7 (range, 0-74; IQR, 2.2-32.2). Of the 17 respondents (28.8%) who completed a research year during medical school, 16 (94.1%) reported that it was productive owing to their choice of mentor, who was male in 82.4% of cases. Of the 48 respondents (81.4%) with children, 19 (39.6%) delayed childbearing until after their fellowship, while 16 (33.3%) had children during their fellowship. The most productive year corresponded with the years of residency graduation (P < .05) and fellowship graduation (P < .05). Conclusions: Academically affiliated female retina specialists in the US experience male-dominated mentorship and tend to complete residency and fellowship before childbearing. Their average h-index is higher compared to some colleagues. Peaks in productivity correspond with the completion of training, specifically the years of residency and fellowship graduation.

Purpose: To evaluate the long-term outcomes of silicone oil (SO) tamponade using the reservoir technique vs standard oil fill technique for complex vitreoretinal surgery. Methods: This retrospective comparative case series evaluated 313 SO tamponade surgeries (230 eyes). In the reservoir technique, the posterior segment is filled with SO. The infusion line is temporarily opened to atmosphere, allowing SO to egress into the line, creating the reservoir. The pressurized air infusion is then reset to 15 mm Hg to maintain a complete SO fill during sclerotomy closure. In the palpation method, SO is introduced without creating a reservoir or moderating infusion pressure, and digital palpation of the globe determines adequate fill. Results: Moderately severe ocular hypertension (intraocular pressure [IOP] ≥ 30 mm Hg) occurred less frequently in the reservoir group (1.6%) compared with the palpation group (9.3%; P = .005). Prolonged ocular hypertension (IOP ≥ 25 mm Hg for ≥ 2 visits) was also less frequent in the reservoir group (2.9% vs 9.1%; P = .02). SO emulsification was less frequent in the reservoir group (2.7% vs 9.4%; P = .04). Eyes in the reservoir group required fewer SO placement surgeries (1.2 vs 1.5 surgeries per eye; P = .01), while final anatomic success rates were similar (reservoir: 80.4%, palpation: 78.2%; P = .5). Visual outcomes were comparable between groups. Conclusions: The reservoir technique for SO tamponade placement reduces the risk of IOP elevation, minimizes the need for reoperation, and decreases SO complications. These findings support the reservoir technique as a reliable and consistent method for SO placement in complex vitreoretinal surgeries.

Purpose: To evaluate (1) anesthesia options and (2) endophthalmitis rates in patients with open-globe injury and retained intraocular foreign bodies. Methods: This retrospective, consecutive, nonrandomized comparative study analyzed eyes with open-globe injury and retained intraocular foreign body treated between January 1, 2015, and December 1, 2023. Results: A total of 134 eyes were included. Regional anesthesia with monitored anesthesia care (MAC) was used in 128 eyes (96%) at initial surgery. There was no difference in mean best-corrected visual acuity (BCVA) at last follow-up between eyes that received general anesthesia (1.39 [20/491]) and those that received regional anesthesia with MAC (0.81 [20/129]; P = .12). Endophthalmitis was diagnosed pre- or intraoperatively in 11 eyes (8%) and postoperatively in 2 eyes (1%) with an associated wound infection. Subconjunctival antibiotics were administered in 132 eyes (99%) and intravitreal (IVT) antibiotics in 130 eyes (97%). Eyes that received intraoperative IVT antibiotics were less likely to develop postoperative endophthalmitis (1 of 130 [0.8%]) compared with those that did not (1 of 4 [25%]; P < .001). Conclusions: Regional anesthesia with MAC was the most common form of anesthesia used during surgery. The use of intraoperative IVT antibiotics was associated with a lower rate of postoperative endophthalmitis.