Ophthalmology. Retina最新文献

Objective: To compare anatomical and visual outcomes of pars plana vitrectomy (PPV) versus phacovitrectomy for primary rhegmatogenous retinal detachment (RRD) repair in phakic eyes using a large multicentre database.

Design: Multicentre propensity score-matched cohort study.

Participants: Phakic eyes of patients aged >45 years undergoing primary RRD repair recorded in the BEAVRS-EURETINA vitreoretinal database (2008-2024). Eyes with oil or PFCL tamponade, secondary or complex detachments, redo surgery, macular holes, buckles, relaxing retinectomy, or inadequate follow-up (<8 weeks) were excluded. The visual cohort excluded eyes with co-pathology affecting vision or missing postoperative visual acuity.

Methods: Generalised full propensity score matching was performed. Primary anatomical success was assessed using weighted logistic regression and a log-linked Poisson model with robust variance. Follow-up logMAR visual acuity was assessed using weighted linear regression. Sensitivity analyses adjusted for baseline cataract and restricted analyses to eyes pseudophakic at outcome assessment.

Main outcome measures: Primary anatomical success (stable retinal reattachment ≥8 weeks after surgery without oil or PFCL tamponade), follow-up logMAR visual acuity ≥8 weeks, and postoperative complications ≥8 weeks.

Results: A total of 6 113 eyes were included in anatomical analyses (PPV 5 647/6 113 (92.4%); phacovitrectomy 466/6 113 (7.6%)) and 4,726 eyes in visual analyses (PPV 4 313/4 726 (91.3%); phacovitrectomy 413/4 726 (8.7%)). Anatomical success exceeded 90% in both groups. In matched analyses, phacovitrectomy showed no significant difference in anatomical success compared with PPV (OR 1.20, 95% CI 0.92-1.60; p=0.19; adjusted RR 1.02, 95% CI 0.97-1.07; p=0.41). In the matched visual cohort, phacovitrectomy was associated with better follow-up visual acuity (-0.056 logMAR, ≈3 ETDRS letters; 95% CI -0.091 to -0.009; p=0.019). This attenuated after accounting for baseline cataract and restricting to pseudophakic eyes. Cystoid macular oedema was more frequent after phacovitrectomy (8/413 (1.94%) vs 15/4 313 (0.35%); p<0.001). Other complications were uncommon, although epiretinal membrane rates were slightly higher after PPV.

Conclusions: Phacovitrectomy achieved anatomical outcomes comparable to PPV for primary RRD repair in phakic eyes. A small visual advantage was observed but attenuated in sensitivity analyses, suggesting the benefit is largely lens-related rather than a retinal treatment effect.

Purpose: Acute ischemic ocular events (IOEs), including retinal artery occlusion (RAO) and amaurosis fugax, pose significant risk for impending ischemic stroke (IS) or transient ischemic attack (TIA). The objective is to investigate clinical characteristics that impact IS/TIA risk following the first RAO or amaurosis fugax among adult patients.

Design: Case-control study.

Subjects: The Truveta Electronic Health Record database was used to identify patients with incident IOE diagnosed between January 1, 2019 and September 30, 2024.

Methods: Logistic regression was applied to estimate odds ratios (ORs) for potential risk factors, including baseline demographics and comorbidities at or before the IOE.

Main outcomes: The occurrence of a stroke (IS or TIA) within one year following the IOE.

Results: Of 11,297 individuals with an IOE (mean age 69.7±12.8 years; 53.7% female), 1548 (13.5%) had an IS, 1231 a TIA (10.9%), and 22.8% an IS and/or TIA (IS/TIA). IS/TIA occurred on the same day as the IOE in 9.4% of individuals. Older age (OR every 10 years: 1.11; 95% CI: 1.00-1.11), hypertension (OR: 1.99; 95% CI: 1.06-1.32), cardiovascular disease without history of MI (OR: 1.89; 95% CI: 1.62-2.22), and carotid artery stenosis (CAS; OR: 1.60; 95% CI: 1.42-1.80) carried increased risk for IS/TIA when adjusting for other characteristics. In the IS cohort, older age (OR every 10 years: 1.11; 95% CI: 1.00-1.22), CAS (OR: 1.75; 95% CI: 1.52-2.02) and hypertension (OR: 1.36; 95% CI: 1.18-1.58) also carry increased risk, along with ischemic heart disease (OR: 1.23; 95% CI: 1.08-1.40) and peripheral vascular disease (OR: 1.18; 95% CI: 1.02-1.37). In the TIA cohort, older age (OR every 10 years: 1.11; 95% CI: 1.11-1.22), cardiovascular disease without history of MI (OR: 4.88; 95% CI: 3.57-6.87), and CAS (OR: 1.46; 95% CI: 1.24-1.71) were associated with greater risk.

Conclusion: Patients with IOEs are at significant risk for IS/TIA, with a high rate of diagnosis within 30 days after the IOE. Older age, underlying cardiovascular disease, CAS, and hypertension notably increased vulnerability to events. This highlights the need for not only immediate work-up but also close follow-up of those with IOEs, especially with these risk factors.

Objective: To evaluate the impact of baseline disease severity on clinical outcomes with aflibercept 8 mg with extended dosing intervals versus aflibercept 2 mg in patients with treatment-naïve neovascular age-related macular degeneration (nAMD).

Design: Post hoc descriptive subgroup analysis of PULSAR (NCT04423718), a 96-week, double-masked, randomized, active-controlled clinical trial investigating treatment of nAMD with aflibercept 8 mg with extended dosing intervals or aflibercept 2 mg every 8 weeks. Patients were subgrouped according to severity of baseline disease characteristics, namely best-corrected visual acuity (BCVA), central retinal thickness (CRT), choroidal neovascularization (CNV) lesion type, and CNV area.

Participants: Patients with nAMD who were randomly assigned to receive aflibercept 8 mg or 2 mg. Overall, 869 patients completed treatment through week 96.

Intervention: Aflibercept 8 mg was administered every 12 or 16 weeks (8q12 or 8q16) after 3 initial monthly injections. Dosing intervals could be shortened in years 1 and 2 and extended in year 2 based on prespecified disease activity criteria. Aflibercept 2 mg every 8 weeks was administered after 3 initial monthly injections.

Main outcome measures: BCVA and CRT outcomes among subgroups defined by baseline BCVA (≤54, 55-73, and ≥74 ETDRS letters), CRT (≤278 μm, 279-343 μm, 344-422 μm, and ≥423 μm), CNV lesion type (minimally classic, occult only, and predominantly classic), and CNV area (<1.3 mm², 1.3 to <4 mm², 4 to <5 mm², and ≥5 mm²). Last assigned dosing interval at week 96 for the aflibercept 8q12 and 8q16 treatment arms was also analyzed by disease severity.

Results: Patients in the aflibercept 8q12 and 8q16 arms achieved visual and anatomic outcomes at week 96 comparable to those in the 2q8 arm within subgroups defined by baseline disease severity. Most patients randomized to the 8q12 and 8q16 arms in each subgroup defined by baseline disease severity had last assigned dosing intervals of ≥12- and ≥16 weeks, respectively, at week 96.

Conclusions: Treatment with aflibercept 8 mg can achieve the functional and anatomic benefits observed with aflibercept 2 mg, but with prolonged dosing intervals, regardless of disease severity at initiation.

Objective: Two recent studies have suggested that younger diabetes mellitus (DM) patients are progressing to DRD at higher rates than in previous years. This study aims to determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed across age groups over time.

Design: Retrospective cohort study comprised of members of commercial and Medicare Advantage health plans between 2000 and 2022 SUBJECTS: Cohorts of patients aged ≤25, 26-45, 46-64, and age ≥65 were created from all patients with DM identified using ICD-9/-10 codes.

Methods: Logistic and Poisson regression models were used to estimate prevalence and incidence, respectively.

Main outcome measure: The main outcomes were the unadjusted prevalence and incidence of DRD, VTDR, DME, and PDR.

Results: Age cohorts remained proportional with respect to DRD prevalence(P) and incidence(I) over the 20 years analyzed. The ≤25 age cohort was always the lowest, followed by the 26-45, 46-64, and ≤65 cohorts, respectively (2001-2021 ≤25 P=3.0-4.5%, I=5.1-11.1[cases/1000 person years]; 26-45 P=6.3-10.9%, I=9.7-21.0; 46-64 P=10.6-15.7% I=14.7-30.9, ≥65 P=13.2-23.1%, I=20.0-39.2). Similar proportional relationships were seen for VTDR and DME prevalence. However, VTDR and DME incidence saw differences with ≥65 age cohort (2022 VTDR I=6.0 cases/1000 py; DME I=5.0), ending lower than the 44-64 age cohort (2022 VTDR I=7.1, DME=5.5) while the 26-45 (2022 VTDR I=4.7, DME I=3.2) and ≤25 (2022 VTDR I=2.0 DME I=1.7) were the next lowest, respectively (p<0.001 for all comparisons across age in 2022). PDR prevalence was highest in the≥65 cohort (3.7%) until 2021, when it became similar to the 46-64 age cohort (3.5%) (p=0.40). PDR incidence also declined significantly in ≥65 cohort (2022 I=2.3) ending lower than 46-64 cohort (I=3.8) and similar to the 26-44 cohort (I=2.6), but still higher than the ≤25 cohort (I=0.6)(p=0.007for ≥65v≤25 and p<0.001 for ≥65v46-64, p=0.07 for ≥65v26-45).

Conclusions and relevance: In contrast to recent studies, no evidence was found to suggest DRD is progressing faster in those ≤25. Those ≥65 saw significant declines in DRD prevalence and incidence over the observation period.