Pub Date : 2024-08-08DOI: 10.1016/j.oret.2024.07.025
Maria Vittoria Cicinelli, Eugenio Barlocci, Federico Rissotto, Alessandro Russo, Chiara Giuffrè, Ugo Introini, Francesco Bandello
Purpose: To investigate the discrepancy between visual acuity (VA) decline and foveal involvement in geographic atrophy (GA) secondary to nonexudative age-related macular degeneration (AMD), and to explore how early retinal changes impact the progression of visual impairment.
Design: Retrospective, longitudinal cohort study.
Subjects: This study evaluated 80 eyes from 60 patients (mean age, 74.2 ± 10 years) with progressing non-neovascular AMD.
Methods: Blue-light fundus autofluorescence (FAF) and spectral-domain OCT (SD-OCT) were utilized to monitor GA progression and the onset of foveal involvement. The study analyzed VA changes over an average follow-up of 60 ± 26.4 months, encompassing 785 observations. Mixed-effects models with natural splines assessed the effects of demographic and ocular characteristics on baseline VA and its rate of decline. Survival analyses compared the timing of anatomic changes with the most rapid functional declines, indicated by the highest first derivative of VA trajectories. Discrepancies between visual and anatomic changes were explored using generalized linear mixed-effects models.
Main outcome measures: Monthly VA changes, onset and impact of foveal involvement, and factors influencing baseline VA and rate of decline.
Results: Visual acuity declined consistently by an average of 0.010 logarithm of the minimum angle of resolution (LogMAR) per month (standard error [SE], 0.0003; P < 0.001). The onset of foveal involvement significantly exacerbated this decline, adding an average loss of 0.15 LogMAR (SE, 0.02; P < 0.001). Stabilization of VA typically occurred around 41 months post-foveal involvement. Significant factors associated with worse baseline VA were older age, female gender, unifocal GA morphology, and drusen-associated forms of GA (P < 0.05). The most rapid declines in VA typically occurred about 9 months (interquartile range, 0-27 months) before detectable subfoveal changes. The reticular FAF pattern (27/46 [59%] vs. 2/13 [15%], P = 0.02) and smaller baseline GA lesions (P = 0.01) were associated with faster deterioration preceding visible foveal damage.
Conclusions: This study demonstrates that significant VA loss in GA can precede detectable foveal involvement, suggesting a window for early interventions to slow the progression of visual impairment. Identifying specific GA characteristics and FAF patterns as predictors of rapid VA decline supports the need for personalized treatment strategies to optimize outcomes for patients with nonexudative AMD.
Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Pub Date : 2024-08-03DOI: 10.1016/j.oret.2024.07.024
Abdulla Shaheen, Divy Mehra, Seyyedehfatemeh Ghalibafan, Shivam Patel, Fatima Buali, Sugi Panneerselvam, Nathalie Perez, Sandra Hoyek, Harry W Flynn, Nimesh Patel, Nicolas A Yannuzzi
Topic: This systematic review and meta-analysis investigates the efficacy and safety of anti-VEGF injections compared with surgical intervention in improving visual acuity (VA) and reducing complications for patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD).
Clinical relevance: Determining the optimal intervention for SMH in AMD is crucial for patient care.
Methods: We included studies on anti-VEGF injections or surgical interventions for SMH in AMD from 7 databases, searched up to May 2024. Data extraction and quality assessment were done by 2 independent reviewers. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis employed random-effects models. Primary outcomes were pooled mean logarithm of the minimum angle of resolution VA difference (initial examination minus last follow-up VA) and adverse events rates.
Results: A total of 43 observational studies were included: 21 (960 eyes) on anti-VEGF and 22 (455 eyes) on surgery. Comparisons were made across separate studies due to lack of head-to-head studies. Meta-analysis included 11 anti-VEGF studies (444 eyes) and 12 surgical studies (195 eyes) for VA outcomes. The mean difference in VA was -0.16 (95% confidence interval (CI), -0.24 to -0.08) for anti-VEGF and -0.36 (95% CI, -0.68 to -0.04) for surgery, with no significant difference between groups (chi-square = 1.70, df = 1, P = 0.19). Heterogeneity was high in surgical studies (I2 = 96.2%, τ2 = 0.23, P < 0.01) and negligible in anti-VEGF studies (I2 = 7%, τ2 = 0.003, P = 0.38). The GRADE certainty was moderate for anti-VEGF and low for surgery. Anti-VEGF had lower rates of cataract (0% vs. 4.6%), proliferative vitreoretinopathy (0.1% vs. 2.0%), and retinal detachment (0.1% vs. 10.6%), but similar rates of recurrent hemorrhage (5.4% vs. 5.3%). Complications were summarized descriptively due to zero-cell problem.
Conclusion: Both anti-VEGF and surgery treat SMH in AMD with similar VA outcomes but different safety profiles. Anti-VEGF is preferred for less severe hemorrhage, whereas surgery is suited for extensive hemorrhage. Despite uncertain comparative VA outcomes, treatment should be guided by clinical judgment and patient factors.
Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
主题本系统综述和荟萃分析研究了抗血管内皮生长因子（anti-VEGF）注射与手术干预相比，在改善新生血管性老年黄斑变性（AMD）引起的黄斑下出血（SMH）患者视力（VA）和减少并发症方面的有效性和安全性：临床相关性：确定治疗老年性黄斑变性黄斑下出血的最佳干预方法对患者护理至关重要：我们从 7 个数据库中纳入了有关抗血管内皮生长因子注射或手术干预 AMD SMH 的研究，检索时间截至 2024 年 5 月。数据提取和质量评估由两名独立审稿人完成。对证据的确定性采用 GRADE 方法进行评估。元分析采用随机效应模型。主要结果为汇总的平均对数MAR VA差值（初始检查减去最后一次随访VA）和不良事件发生率：共纳入 43 项观察性研究：结果：共纳入 43 项观察性研究：21 项研究（960 只眼）涉及抗 VEGF，22 项研究（455 只眼）涉及手术。由于缺乏 "头对头 "研究，因此对不同研究进行了比较。Meta 分析纳入了 11 项抗血管内皮生长因子研究（444 只眼）和 12 项手术研究（195 只眼）的 VA 结果。抗血管内皮生长因子的 VA 平均差异（MD）为-0.16（95%CI：-0.26,-0.07），手术为-0.36（95%CI：-0.68,-0.04），组间差异不显著（X2=1.70，df=1，p=0.19）。手术研究的异质性较高（I2=96.2%，tau2=0.23，p2=7%，tau2=0.003，p=0.38）。抗血管内皮生长因子的 GRADE 确定性为中度，手术的 GRADE 确定性为低度。抗 VEGF 的白内障（0% vs 4.6%）、增殖性玻璃体视网膜病变（PVR，0.1% vs 2.0%）和视网膜脱离（RD，0.1% vs 10.6%）发生率较低，但复发性出血发生率相似（5.4% vs 5.3%）。结论：抗血管内皮生长因子和手术都能治疗视网膜病变：抗血管内皮生长因子和手术治疗 AMD SMH 的 VA 结果相似，但安全性不同。抗血管内皮生长因子疗法适用于不太严重的出血，而手术则适用于大面积出血。尽管视网膜损伤的比较结果不确定，但治疗应根据临床判断和患者因素而定。
{"title":"Efficacy and Safety of Anti-VEGF Injections and Surgery for Age-Related Macular Degeneration-Related Submacular Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Abdulla Shaheen, Divy Mehra, Seyyedehfatemeh Ghalibafan, Shivam Patel, Fatima Buali, Sugi Panneerselvam, Nathalie Perez, Sandra Hoyek, Harry W Flynn, Nimesh Patel, Nicolas A Yannuzzi","doi":"10.1016/j.oret.2024.07.024","DOIUrl":"10.1016/j.oret.2024.07.024","url":null,"abstract":"<p><strong>Topic: </strong>This systematic review and meta-analysis investigates the efficacy and safety of anti-VEGF injections compared with surgical intervention in improving visual acuity (VA) and reducing complications for patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD).</p><p><strong>Clinical relevance: </strong>Determining the optimal intervention for SMH in AMD is crucial for patient care.</p><p><strong>Methods: </strong>We included studies on anti-VEGF injections or surgical interventions for SMH in AMD from 7 databases, searched up to May 2024. Data extraction and quality assessment were done by 2 independent reviewers. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis employed random-effects models. Primary outcomes were pooled mean logarithm of the minimum angle of resolution VA difference (initial examination minus last follow-up VA) and adverse events rates.</p><p><strong>Results: </strong>A total of 43 observational studies were included: 21 (960 eyes) on anti-VEGF and 22 (455 eyes) on surgery. Comparisons were made across separate studies due to lack of head-to-head studies. Meta-analysis included 11 anti-VEGF studies (444 eyes) and 12 surgical studies (195 eyes) for VA outcomes. The mean difference in VA was -0.16 (95% confidence interval (CI), -0.24 to -0.08) for anti-VEGF and -0.36 (95% CI, -0.68 to -0.04) for surgery, with no significant difference between groups (chi-square = 1.70, df = 1, P = 0.19). Heterogeneity was high in surgical studies (I<sup>2</sup> = 96.2%, τ<sup>2</sup> = 0.23, P < 0.01) and negligible in anti-VEGF studies (I<sup>2</sup> = 7%, τ<sup>2</sup> = 0.003, P = 0.38). The GRADE certainty was moderate for anti-VEGF and low for surgery. Anti-VEGF had lower rates of cataract (0% vs. 4.6%), proliferative vitreoretinopathy (0.1% vs. 2.0%), and retinal detachment (0.1% vs. 10.6%), but similar rates of recurrent hemorrhage (5.4% vs. 5.3%). Complications were summarized descriptively due to zero-cell problem.</p><p><strong>Conclusion: </strong>Both anti-VEGF and surgery treat SMH in AMD with similar VA outcomes but different safety profiles. Anti-VEGF is preferred for less severe hemorrhage, whereas surgery is suited for extensive hemorrhage. Despite uncertain comparative VA outcomes, treatment should be guided by clinical judgment and patient factors.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.01.003
{"title":"Ultrawidefield OCT Angiography of Incontinentia Pigmenti with Macular Hole","authors":"","doi":"10.1016/j.oret.2024.01.003","DOIUrl":"10.1016/j.oret.2024.01.003","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.02.016
Purpose
To determine the relationship between structural biomarkers on OCT that increase the risk of disease progression and microperimetric retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD).
Design
Prospective cross-sectional, observational study.
Participants
Forty-five eyes of 23 patients with iAMD.
Methods
Patients underwent OCT and microperimetry. OCT scans were evaluated for the risk factors intraretinal hyperreflective foci (HRF), hyporeflectivity within drusenoid lesions (HRDL), subretinal drusenoid deposits, double-layer sign (DLS), and drusen volume. Microperimetric retinal sensitivity was analyzed with a 33-point grid covering the macula. With a novel method of determining what part of the retina corresponded to each microperimetry point, a Voronoi diagram was constructed, dividing the macula in cells consisting of the region nearer to each point than any other. The Voronoi diagram was superimposed on the OCT, making it possible to determine the point-to-point location of the OCT risk factors. Univariable and multivariable linear mixed-effect models were used for analysis.
Main Outcome Measures
Association between microperimetric retinal sensitivity and OCT risk factors at individual measuring points.
Results
One thousand four hundred seventy-nine points of retinal sensitivity and corresponding structural area on OCT were included in this study. Retinal sensitivity was significantly decreased with presence of the OCT risk factors HRF, HRDL, DLS, and drusen volume (all P < 0.001) when analyzed with the univariable linear mixed-effect model. The multivariable model showed a significant decrease of retinal sensitivity with presence of HRF (P < 0.001), DLS (P = 0.025), and greater drusen volume (P < 0.001).
Conclusions
Presence of HRF, DLS, and greater drusen volume, all of which increase the risk of disease progression, is significantly and independently associated with decreased microperimetric retinal sensitivity in patients with iAMD.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：确定增加中度年龄相关性黄斑变性（iAMD）患者疾病进展风险的光学相干断层扫描（OCT）结构生物标志物与显微透视视网膜灵敏度之间的关系 设计：前瞻性横断面观察研究 参与者：23 名 iAMD 患者：23 名 iAMD 患者的 45 只眼睛 方法：患者接受 OCT 和微观视力测定。根据视网膜内高反射灶（HRF）、类髓鞘病变内低反射（HRDL）、视网膜下类髓鞘沉积（SDD）、双层征（DLS）和髓鞘体积等风险因素对 OCT 扫描进行评估。用覆盖黄斑的 33 点网格分析了微透视视网膜灵敏度。用一种新方法确定视网膜的哪个部分与每个微透视点相对应，构建了一个沃罗诺伊图，将黄斑划分为由比其他任何点都更接近每个点的区域组成的单元。将 Voronoi 图叠加到 OCT 上，就能确定 OCT 风险因素的点对点位置。采用单变量和多变量线性混合效应模型进行分析：单个测量点的微透视视网膜灵敏度与 OCT 风险因素之间的关联 结果：本研究纳入了 1479 个视网膜灵敏度点和相应的 OCT 结构区。采用单变量线性混合效应模型进行分析时，视网膜灵敏度随 OCT 风险因素 HRF、HRDL、DLS 和色素沉着量的存在而明显下降（所有 P <0.001）。多变量模型显示，存在 HRF（P < 0.001）、DLS（P = 0.025）和更大的色素沉着量（P < 0.001）时，视网膜灵敏度会显著降低。
{"title":"Microperimetry and Structural Risk Factors on OCT in Intermediate Age-Related Macular Degeneration","authors":"","doi":"10.1016/j.oret.2024.02.016","DOIUrl":"10.1016/j.oret.2024.02.016","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To determine the relationship between structural biomarkers on OCT that increase the risk of </span>disease progression and microperimetric retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD).</p></div><div><h3>Design</h3><p>Prospective cross-sectional, observational study.</p></div><div><h3>Participants</h3><p>Forty-five eyes of 23 patients with iAMD.</p></div><div><h3>Methods</h3><p>Patients underwent OCT and microperimetry<span>. OCT scans were evaluated for the risk factors intraretinal hyperreflective foci (HRF), hyporeflectivity within drusenoid lesions (HRDL), subretinal drusenoid deposits, double-layer sign (DLS), and drusen volume. Microperimetric retinal sensitivity was analyzed with a 33-point grid covering the macula. With a novel method of determining what part of the retina corresponded to each microperimetry point, a Voronoi diagram was constructed, dividing the macula in cells consisting of the region nearer to each point than any other. The Voronoi diagram was superimposed on the OCT, making it possible to determine the point-to-point location of the OCT risk factors. Univariable and multivariable linear mixed-effect models were used for analysis.</span></p></div><div><h3>Main Outcome Measures</h3><p>Association between microperimetric retinal sensitivity and OCT risk factors at individual measuring points.</p></div><div><h3>Results</h3><p><span>One thousand four hundred seventy-nine points of retinal sensitivity and corresponding structural area on OCT were included in this study. Retinal sensitivity was significantly decreased with presence of the OCT risk factors HRF, HRDL, DLS, and drusen volume (all </span><em>P</em> < 0.001) when analyzed with the univariable linear mixed-effect model. The multivariable model showed a significant decrease of retinal sensitivity with presence of HRF (<em>P</em> < 0.001), DLS (<em>P</em> = 0.025), and greater drusen volume (<em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Presence of HRF, DLS, and greater drusen volume, all of which increase the risk of disease progression, is significantly and independently associated with decreased microperimetric retinal sensitivity in patients with iAMD.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.01.005
{"title":"Removal of the Metallic Intraocular Foreign Body via Posterior Capsule Defect","authors":"","doi":"10.1016/j.oret.2024.01.005","DOIUrl":"10.1016/j.oret.2024.01.005","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.02.015
Objective
To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR).
Design
Retrospective consecutive observational case series of patients at a large county hospital in Dallas, Texas, from 2014 to 2019.
Collected data included demographics, surgical indication, adjuvant therapies, intraoperative course, complications, and best corrected visual acuity (BCVA). Patients with < 6 months of follow-up were excluded. Best corrected visual acuity was converted to logarithm of the minimum angle of resolution for analysis. Statistics performed included t test, analysis of variance, and multivariate analyses.
Main Outcome Measures
Postoperative BCVA, primary anatomic success rate, and postoperative complications.
Results
Three hundred ninety-three patients were male (509 eyes; 54.5%) with an average age of 52 years. Postoperative BCVA at 6 months was significantly different among surgical indications: 0.79 versus 0.77 versus 1.20 (P < 0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities, and tractional retinal detachment (TRD), respectively. Adjuvant preoperative therapy with panretinal photocoagulation (PRP) versus no PRP (0.95 vs. 1.25; P < 0.001) and insulin versus no insulin (0.99 vs. 1.17; P < 0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased postoperative vision (1.40 vs. 0.88; P < 0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared with macula-on/macula-off TRD, with odds ratios of 0.36, 0.46, and 0.53, respectively. Patients experiencing recurrent detachment postsurgery had worse preoperative visual acuity (VA) (1.93 vs. 1.63; P < 0.01) and were younger (47.6 vs. 50.0; P = 0.02). Postoperative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated intraocular pressure (149, 16%) being the most common. Two hundred thirty-six eyes (25%) required a second PPV operation. Endophthalmitis (1 eye; <1%) and choroidal detachment (5 eyes; <1%) were rare.
Conclusions
In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presentin
目的：评估影响手术效果的临床特征：评估影响因增殖性糖尿病视网膜病变（PDR）并发症而接受玻璃体旁切除术（PPV）患者手术效果的临床特征：2014-2019年德克萨斯州达拉斯市一家大型县级医院患者的回顾性连续观察病例系列：方法：收集的数据包括人口统计学、手术指征、辅助治疗、术中过程、并发症和最佳矫正视力（BCVA）。随访时间不足 6 个月的患者排除在外。BCVA转换为logMAR进行分析。进行的统计包括t检验、方差分析（ANOVA）和多变量分析：主要结果测量指标：术后BCVA、主要解剖成功率和术后并发症：393名患者为男性（509眼，54.5%），平均年龄52岁。不同手术适应症患者术后 6 个月的 BCVA 有显著差异：0.79 vs. 0.77 vs. 1.20（p结论：在这组分析 PDR 并发症患者手术效果的回顾性系列研究中，玻璃体切除术平均改善了患者的视力，有相当一部分患者接受了额外的手术干预。手术指征、当前视力、年龄和辅助疗法似乎都会影响手术效果。
{"title":"Clinical Characteristics and Surgical Outcomes of Patients Undergoing Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy","authors":"","doi":"10.1016/j.oret.2024.02.015","DOIUrl":"10.1016/j.oret.2024.02.015","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy<span> (PPV) for complications of proliferative diabetic retinopathy (PDR).</span></p></div><div><h3>Design</h3><p>Retrospective consecutive observational case series of patients at a large county hospital in Dallas, Texas, from 2014 to 2019.</p></div><div><h3>Subjects</h3><p>Seven hundred thirty-two patients (933 eyes) undergoing PPV for PDR complications.</p></div><div><h3>Methods</h3><p><span>Collected data included demographics, surgical indication, adjuvant therapies, intraoperative course, complications, and best corrected visual acuity<span> (BCVA). Patients with < 6 months of follow-up were excluded. Best corrected visual acuity was converted to logarithm of the minimum angle of resolution for analysis. Statistics performed included </span></span><em>t</em><span> test, analysis of variance, and multivariate analyses.</span></p></div><div><h3>Main Outcome Measures</h3><p>Postoperative BCVA, primary anatomic success rate, and postoperative complications.</p></div><div><h3>Results</h3><p>Three hundred ninety-three patients were male (509 eyes; 54.5%) with an average age of 52 years. Postoperative BCVA at 6 months was significantly different among surgical indications: 0.79 versus 0.77 versus 1.20 (<em>P</em><span><span> < 0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities, and tractional </span>retinal detachment<span> (TRD), respectively. Adjuvant preoperative therapy with panretinal photocoagulation (PRP) versus no PRP (0.95 vs. 1.25; </span></span><em>P</em> < 0.001) and insulin versus no insulin (0.99 vs. 1.17; <em>P</em> < 0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased postoperative vision (1.40 vs. 0.88; <em>P</em> < 0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared with macula-on/macula-off TRD, with odds ratios of 0.36, 0.46, and 0.53, respectively. Patients experiencing recurrent detachment postsurgery had worse preoperative visual acuity (VA) (1.93 vs. 1.63; <em>P</em> < 0.01) and were younger (47.6 vs. 50.0; <em>P</em><span><span> = 0.02). Postoperative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated intraocular pressure<span> (149, 16%) being the most common. Two hundred thirty-six eyes (25%) required a second PPV operation. Endophthalmitis (1 eye; <1%) and </span></span>choroidal detachment (5 eyes; <1%) were rare.</span></p></div><div><h3>Conclusions</h3><p>In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presentin","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.01.026
Purpose
The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of vision loss worldwide. Complement aberrations are also implicated in many systemic immune-mediated inflammatory diseases (IMIDs), but the relationship between AMD and these conditions remains undescribed. The aim of this study is to first assess the association between AMD and IMIDs, and then assess the risk of AMD in patients with specific IMIDs associated with AMD.
Design
Cross-sectional study and cohort study.
Subjects and Controls
Patients with AMD were compared with control patients with cataracts and no AMD to ensure evaluation by an ophthalmologist. Patients with IMIDs were compared with patients without IMIDs but with cataracts.
Methods
This study used deidentified data from a national database (2006–2023), using International Classification of Diseases 10 codes to select for IMIDs. Propensity score matching was based on patients on age, sex, race, ethnicity, and smoking. Odds ratios were generated for IMIDs and compared between AMD and control patients. For IMIDs associated with AMD, the risk of AMD in patients with the IMID versus patients without IMIDs was determined utilizing a cohort study design.
Main Outcome Measures
Odds ratio of IMID, risk ratios (RRs), and 95% confidence intervals (CIs) of AMD diagnosis, given an IMID.
Results
After propensity score matching, AMD and control cohorts (n = 217 197 each) had a mean ± standard deviation age of 74.7 ± 10.4 years, were 56% female, and 9% of patients smoked. Age-related macular degeneration showed associations with systemic lupus erythematosus (SLE), Crohn’s disease, ulcerative colitis, rheumatoid arthritis (RA), psoriasis, sarcoidosis, scleroderma, giant cell arteritis, and vasculitis. Cohorts for each positively associated IMID were created and matched to control cohorts with no IMID history. Patients with RA (RR, 1.40; 95% CI, 1.30–1.49), SLE (RR, 1.73; 95% CI, 1.37–2.18), Crohn’s disease (RR, 1.42; 95% CI, 1.20–1.71), ulcerative colitis (RR, 1.45; 95% CI, 1.29–1.63), psoriasis (RR, 1.48; 95% CI, 1.37–1.60), vasculitis (RR, 1.48; 95% CI, 1.33–1.64), scleroderma (RR, 1.65; 95% CI, 1.35–2.02), and sarcoidosis (RR, 1.42; 95% CI, 1.24–1.62) showed a higher risk of developing AMD compared with controls.
Conclusions
The results suggest that there is an increased risk of developing AMD in patients with RA, SLE, Crohn’s disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis compared with patients with no IMIDs.
{"title":"Propensity-Matched Analysis of the Risk of Age-Related Macular Degeneration with Systemic Immune-Mediated Inflammatory Disease","authors":"","doi":"10.1016/j.oret.2024.01.026","DOIUrl":"10.1016/j.oret.2024.01.026","url":null,"abstract":"<div><h3>Purpose</h3><p><span>The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of </span>vision loss<span> worldwide. Complement aberrations are also implicated in many systemic immune-mediated inflammatory diseases (IMIDs), but the relationship between AMD and these conditions remains undescribed. The aim of this study is to first assess the association between AMD and IMIDs, and then assess the risk of AMD in patients with specific IMIDs associated with AMD.</span></p></div><div><h3>Design</h3><p>Cross-sectional study and cohort study.</p></div><div><h3>Subjects and Controls</h3><p>Patients with AMD were compared with control patients with cataracts and no AMD to ensure evaluation by an ophthalmologist. Patients with IMIDs were compared with patients without IMIDs but with cataracts.</p></div><div><h3>Methods</h3><p><span>This study used deidentified data from a national database (2006–2023), using International Classification of Diseases 10 codes to select for IMIDs. </span>Propensity score matching<span> was based on patients on age, sex, race, ethnicity, and smoking. Odds ratios were generated for IMIDs and compared between AMD and control patients. For IMIDs associated with AMD, the risk of AMD in patients with the IMID versus patients without IMIDs was determined utilizing a cohort study design.</span></p></div><div><h3>Main Outcome Measures</h3><p>Odds ratio of IMID, risk ratios (RRs), and 95% confidence intervals (CIs) of AMD diagnosis, given an IMID.</p></div><div><h3>Results</h3><p><span><span><span>After propensity score matching, AMD and control cohorts (n = 217 197 each) had a mean ± standard deviation age of 74.7 ± 10.4 years, were 56% female, and 9% of patients smoked. Age-related macular degeneration showed associations with systemic lupus erythematosus (SLE), Crohn’s disease, </span>ulcerative colitis, </span>rheumatoid arthritis (RA), </span>psoriasis<span><span>, sarcoidosis, </span>scleroderma<span>, giant cell arteritis<span><span><span><span>, and vasculitis. Cohorts for each positively associated IMID were created and matched to control cohorts with no IMID history. Patients with RA (RR, 1.40; 95% CI, 1.30–1.49), SLE (RR, 1.73; 95% CI, 1.37–2.18), Crohn’s disease (RR, 1.42; 95% CI, 1.20–1.71), </span>ulcerative colitis (RR, 1.45; 95% CI, 1.29–1.63), </span>psoriasis (RR, 1.48; 95% CI, 1.37–1.60), vasculitis (RR, 1.48; 95% CI, 1.33–1.64), </span>scleroderma<span> (RR, 1.65; 95% CI, 1.35–2.02), and sarcoidosis (RR, 1.42; 95% CI, 1.24–1.62) showed a higher risk of developing AMD compared with controls.</span></span></span></span></p></div><div><h3>Conclusions</h3><p>The results suggest that there is an increased risk of developing AMD in patients with RA, SLE, Crohn’s disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis compared with patients with no IMIDs.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commer","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.02.010
Purpose
To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity.
Design
Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial.
Participants
Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial.
Methods
Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning–enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12–48) of treatment. These features were examined for their associations with anatomic and functional outcomes.
Main Outcome Measures
Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ–retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA).
Results
Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (P < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (P < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ r ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ r ≤ 0.41; SHRM volume: −0.33 ≤ r ≤ −0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all P < 0.01) and greater gains in BCVA (all P < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters.
Conclusions
Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Compartmental Exudative Dynamics in Neovascular Age-Related Macular Degeneration","authors":"","doi":"10.1016/j.oret.2024.02.010","DOIUrl":"10.1016/j.oret.2024.02.010","url":null,"abstract":"<div><h3>Purpose</h3><p>To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity.</p></div><div><h3>Design</h3><p>Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial.</p></div><div><h3>Participants</h3><p>Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial.</p></div><div><h3>Methods</h3><p>Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning–enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12–48) of treatment. These features were examined for their associations with anatomic and functional outcomes.</p></div><div><h3>Main Outcome Measures</h3><p>Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ–retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA).</p></div><div><h3>Results</h3><p>Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (<em>P</em> < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (<em>P</em> < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ <em>r</em> ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ <em>r</em> ≤ 0.41; SHRM volume: −0.33 ≤ <em>r</em> ≤ −0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all <em>P</em> < 0.01) and greater gains in BCVA (all <em>P</em> < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters.</p></div><div><h3>Conclusions</h3><p>Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468653024000794/pdfft?md5=0fa791a3b6c0be9472ec29c2e40841fd&pid=1-s2.0-S2468653024000794-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.oret.2024.02.007
Objective
To evaluate the incidence of bacillary layer detachment in patients with neovascular age-related macular degeneration (nAMD) and their response to anti-VEGF therapy.
Design
Post hoc analysis of the brolucizumab 6-mg and aflibercept 2-mg arms from the HAWK clinical trial, a 48-week, prospective, double-masked, phase III trial.
Participants
Participants (n = 652 and 652 eyes) randomized to brolucizumab 6-mg and aflibercept 2-mg arms from HAWK (NCT02307682).
Methods
Spectral-domain OCT scans were obtained at 4-week intervals throughout the HAWK trial and segmented automatically using a proprietary, machine learning–enabled, higher-order feature extraction platform.
Main Outcome Measures
The incidence of bacillary layer detachment and effect of anti-VEGF therapy in these eyes on best-corrected visual acuity (BCVA), central subfield thickness (CST), retinal fluid volumes, subretinal hyper-reflective material (SHRM) volume, and ellipsoid zone (EZ) integrity from baseline to week 48.
Results
Classic bacillary layer detachment was identified in 7.2% (47/652) of eyes, demonstrating worse BCVA and higher CST, EZ total attenuation, subretinal fluid (SRF), and SHRM volume at baseline than eyes without bacillary layer detachment. Anti-VEGF treatment resulted in resolution of bacillary layer detachment in 97.9% of eyes by week 48. In eyes with bacillary layer detachment, anti-VEGF treatment improved BCVA and decreased SRF and SHRM volume; however, eyes with bacillary layer detachment never reached the level of BCVA improvement as eyes without bacillary layer detachment. A greater proportion of eyes with bacillary layer detachment had high-exudative volatility (increased mean standard deviation after loading dose) of CST, SRF, and total fluid than eyes without bacillary layer detachment (P < 0.05 for each comparison).
Conclusions
Bacillary layer detachment, an OCT signature representing photoreceptor schisis, is identifiable in a notable proportion of eyes with nAMD. Anti-VEGF therapy resulted in a very high proportion of bacillary layer detachment resolution with significantly decreased SRF and SHRM volumes. The majority of eyes with bacillary layer detachment have high-exudative volatility, which may be associated with lower BCVA outcomes. The presence of bacillary layer detachment may provide an important imaging biomarker to be considered for clinical trial inclusion/exclusion based on trial design and therapeutic goals because of its unique behavior.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration from a Phase III Clinical Trial","authors":"","doi":"10.1016/j.oret.2024.02.007","DOIUrl":"10.1016/j.oret.2024.02.007","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the incidence of bacillary layer detachment in patients with neovascular age-related macular degeneration (nAMD) and their response to anti-VEGF therapy.</p></div><div><h3>Design</h3><p>Post hoc analysis of the brolucizumab 6-mg and aflibercept 2-mg arms from the HAWK clinical trial, a 48-week, prospective, double-masked, phase III trial.</p></div><div><h3>Participants</h3><p>Participants (n = 652 and 652 eyes) randomized to brolucizumab 6-mg and aflibercept 2-mg arms from HAWK (NCT02307682).</p></div><div><h3>Methods</h3><p>Spectral-domain OCT scans were obtained at 4-week intervals throughout the HAWK trial and segmented automatically using a proprietary, machine learning–enabled, higher-order feature extraction platform.</p></div><div><h3>Main Outcome Measures</h3><p>The incidence of bacillary layer detachment and effect of anti-VEGF therapy in these eyes on best-corrected visual acuity (BCVA), central subfield thickness (CST), retinal fluid volumes, subretinal hyper-reflective material (SHRM) volume, and ellipsoid zone (EZ) integrity from baseline to week 48.</p></div><div><h3>Results</h3><p>Classic bacillary layer detachment was identified in 7.2% (47/652) of eyes, demonstrating worse BCVA and higher CST, EZ total attenuation, subretinal fluid (SRF), and SHRM volume at baseline than eyes without bacillary layer detachment. Anti-VEGF treatment resulted in resolution of bacillary layer detachment in 97.9% of eyes by week 48. In eyes with bacillary layer detachment, anti-VEGF treatment improved BCVA and decreased SRF and SHRM volume; however, eyes with bacillary layer detachment never reached the level of BCVA improvement as eyes without bacillary layer detachment. A greater proportion of eyes with bacillary layer detachment had high-exudative volatility (increased mean standard deviation after loading dose) of CST, SRF, and total fluid than eyes without bacillary layer detachment (<em>P</em> < 0.05 for each comparison).</p></div><div><h3>Conclusions</h3><p>Bacillary layer detachment, an OCT signature representing photoreceptor schisis, is identifiable in a notable proportion of eyes with nAMD. Anti-VEGF therapy resulted in a very high proportion of bacillary layer detachment resolution with significantly decreased SRF and SHRM volumes. The majority of eyes with bacillary layer detachment have high-exudative volatility, which may be associated with lower BCVA outcomes. The presence of bacillary layer detachment may provide an important imaging biomarker to be considered for clinical trial inclusion/exclusion based on trial design and therapeutic goals because of its unique behavior.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468653024000666/pdfft?md5=60d3416c65809146ff7275c5633d7e5f&pid=1-s2.0-S2468653024000666-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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