Ophthalmology. Retina最新文献

Purpose: To evaluate the 10-year anatomical and functional outcomes after vitrectomy with the inverted internal limiting membrane (ILM) flap technique for full-thickness macular hole (FTMH) and assess the incidence of long-term postoperative complications.

Design: Retrospective consecutive case series.

Subjects: From 295 patients (323 eyes), who had pars plana vitrectomy with inverted ILM flap technique for idiopathic FTMH in our clinic in the years 2007- 2014 in our clinic, 89 patients (99 eyes) completed a 10-year follow-up.

Methods: Medical records were reviewed retrospectively. Patients, who had pars plana vitrectomy with the inverted ILM flap technique for idiopathic FTMH in the years 2007- 2014, were invited for a 10-year follow-up. Preoperative and postoperative parameters were analyzed, including age, sex, visual acuity, initial hole size, SS-OCT parameters, surgical technique, and postoperative complications.

Main outcome measures: Primary outcomes were long-term anatomical closure at 10 years and BCVA. Secondary outcomes included OCT-based macular morphology (ellipsoid zone [EZ], interdigitation zone [IZ], foveal contour) and complication rates (e.g., epiretinal membrane, gliosis, secondary glaucoma, retinal detachment, and AMD progression).

Results: The initial closure rate in 323 eyes was 93.5%; final closure rate after reoperation was 100%. 20/40 vision was achieved in 44.5% of eyes one year after surgery and in 70.7% of eyes followed until the 10^th year. The number of eyes with >20/25 vision improved from 12% to 42.4% during that time. Patients achieving final BCVA better than 20/25 had a continuous IZ and EZ line until the hole margin before surgery (p=0.03), and a continuous IZ and EZ line one year after surgery (p=0.01). Foveal contour improved gradually over time. No FTMH reopenings were observed. Epiretinal gliosis developed in 7% of cases, associated with larger baseline hole size and preoperative ERM, but did not significantly impact final visual acuity. Retinal detachment incidence was 0.85% per patient/year.

Conclusions: The inverted ILM flap technique provides sustained anatomical and functional success in idiopathic FTMH over a 10-year period. Continued improvement in BCVA beyond the first year and low complication rates support the use of this technique as an effective and durable surgical approach.

Purpose: To develop artificial intelligence (AI)-based models for estimating the risk of myopic macular neovascularization (MNV) in highly myopic eyes.

Design: Retrospective, single-center cohort study.

Participants: A total of 4235 eyes from 2501 patients with high myopia who were enrolled between October 2011 and May 2021 at the Institute of Science Tokyo.

Methods: Baseline fundus photographs and seven clinical variables were used for model development and validation. Three image-based deep learning (DL) models with a DenseNet-121 backbone were trained to predict the risk of MNV within 1, 3, and 5 years after baseline. A multimodal survival model based on the DeepSurv framework was further developed by integrating image-derived features with clinical variables to estimate time-to-event risk. Model performance was evaluated using discrimination, calibration, and clinical utility metrics. Model interpretability was explored using gradient-weighted class activation mapping and Shapley additive explanation (SHAP) analyses.

Main outcome measures: Area under the receiver operating characteristic curve (AUROC) for the DL models and concordance index (C-index) for the multimodal DeepSurv model.

Results: The DL models achieved AUROCs of 0.785 (95% CI, 0.474-0.988), 0.798 (95% CI, 0.687-0.900), and 0.729 (95% CI, 0.614-0.832) for the 1-, 3-, and 5-year predictions, respectively. The multimodal DeepSurv model achieved a C-index of 0.683 (95% CI, 0.582-0.775) and enabled stratification of eyes into subgroups with distinct long-term probabilities of MNV development. Heatmaps showed activation in clinically relevant regions, and SHAP analysis indicated that axial length and pathologic myopia category showed prominent conditional contributions within the multimodal model.

Conclusions: AI-based models enabled fixed-horizon risk estimation and longitudinal time-to-event risk assessment for MNV in highly myopic eyes, providing clinically meaningful risk stratification. With further external validation, this approach may support risk-adapted long-term monitoring strategies in high myopia.

Patients with nAMD in TENAYA/LUCERNE always on extended faricimab dosing (≥12-weeks) achieved robust disease control throughout 2 years. Additionally, 56% of patients could have potentially extended to every-20-week dosing had the protocol allowed.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown both protective and adverse effects on ocular outcomes. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RA, achieves greater glycemic and cardiometabolic improvements than non-GIP agonistic GLP-1RAs, yet its ocular safety profile remains poorly characterized.

Purpose: To compare the risk of retinal complications in patients with type 2 diabetes (T2D) treated with tirzepatide versus non-GIP GLP-1RAs.

Design: A retrospective cohort study analyzed a nationwide electronic health records network from June 2022 to June 2025.

Participants: Adults with T2D initiating tirzepatide or a non-GIP GLP-1RA, with no prior use of either drug class. Individuals who initiated any other second-line glucose-lowering therapies within six months prior to or during the study period were excluded to isolate the effect of the medication.

Methods: A cohort of patients initiating therapy with tirzepatide were compared to another cohort initiating a non-GIP GLP-1RA. Hazard ratios (HRs) for several ocular outcomes over a 36-month follow-up period were calculated, using propensity score-matched cohorts (1:1) to address confounding from demographics, comorbidities, and medication use. Similar analyses were performed among subpopulations of metformin- or insulin-users at cohort entry and among those who initiated additional antihyperglycemic therapy after index prescription.

Main outcome measures: Risk of diabetic retinopathy (DR), diabetic macular edema (DME), vitreous hemorrhage/retinal detachment (VH/RD), need for vision-saving interventions (intravitreal injections, panretinal photocoagulation, or pars plana vitrectomy), and non-arteritic anterior ischemic optic neuropathy (NAION).

Results: After matching, each cohort included 102,590 patients. Tirzepatide use was associated with decreased risk of DR (HR 0.60, 95% confidence interval [CI] 0.54-0.65), DME (HR 0.63, 95% CI 0.52-0.74), VH/RD (HR 0.36, 95% CI 0.23-0.55), DR-related vision-saving interventions (HR 0.44, 95% CI 0.32-0.60), and NAION (HR 0.31, 95% CI 0.15-0.64) compared with non-GIP GLP-1RA use. Associations were consistent among metformin and insulin users and in those who initiated additional antihyperglycemic therapy during follow-up.

Conclusions: Among patients with T2D taking a GLP-1RA, tirzepatide was associated with lower risks of retinal complications, need for vision-saving interventions, and NAION compared to GLP-1RAs without GIP activity. These findings support a favorable ocular safety profile for tirzepatide, though confirmation in prospective studies is warranted.