Ophthalmology. Retina最新文献_第2页

The Association between Retinal Vascular Occlusions and Dementia 视网膜血管闭塞与痴呆之间的关系：英国生物库回顾性纵向研究。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.08.010

Audrey Gao BA , Fatima Tuz-Zahra MS , Viha Vig MBChB , Rebecca Zeng MD , Yorghos Tripodis PhD , Thor D. Stein MD, PhD , Michael L. Alosco PhD , Steven Ness MD , Xuejing Chen MD , Nicole Siegel MD , Manju L. Subramanian MD

Purpose

Vascular disease is associated with increased incidence of dementia and has the potential to be an indicator of underlying cognitive disease. The goal of this study is to investigate the association between retinal vascular occlusions and neurodegenerative disorders that lead to dementia, including all-cause dementia, Alzheimer disease (AD), and vascular dementia (VD).

Design

Retrospective longitudinal cohort study.

Participants

This study consists of 502 133 participants from the UK Biobank, aged 40 to 69 years at recruitment. There are 1463 individuals with retinal vascular occlusion and 500 670 individuals without.

Methods

Individuals were categorized as having retinal vein occlusion (RVO), retinal artery occlusion (RAO), and any retinal vascular occlusion (both RVO and RAO). Prevalence and incidence of all-cause dementia, AD, and VD were calculated. The patients with RVO were then matched on age, sex, education, and employment score on a 1:3 ratio to controls. Univariate and multivariate Cox proportional hazards models on the matched participants were used to determine associations over time to all-cause dementia, AD, and VD, with added adjustments for diabetes, hypertension, and smoking status.

Main Outcome Measures

Prevalence and hazard ratios (HRs) of all-cause dementia, AD, and VD.

Results

The prevalence of all-cause dementia and AD is significantly increased among patients with RVO, RAO, and any retinal vascular occlusion, whereas the prevalence of VD is significantly increased in RVO and any retinal vascular occlusion. In the matched analysis, increased risk for all-cause dementia was seen in patients with any retinal vascular occlusion (HR, 1.52; confidence interval [CI], 1.11–2.07, P = 0.01) and RVO (HR, 1.38; CI, 1.01–1.90, P = 0.04). When adjusting for covariates, RVO did not show increased risk of all-cause dementia, AD, and VD.

Conclusions

Any retinal vascular occlusions and RVO are associated with increased risk of all-cause dementia, and individuals with RVO also have higher risk of VD. After adjusting for shared risk factors, there is no association between dementia and retinal vascular occlusions. Findings from this study are both consistent and in conflict with prior reports, and indicate that the connection between retinal vascular occlusions and neurodegenerative diseases causing dementia may be due to their shared pathogenesis and risk factors.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：血管疾病与痴呆发病率增加相关，有可能成为潜在认知疾病的指标。本研究的目的是研究视网膜血管闭塞与导致痴呆的神经退行性疾病之间的关系，包括全因痴呆、阿尔茨海默病（AD）和血管性痴呆（VD）。设计：回顾性纵向队列研究。参与者：本研究包括来自英国生物银行的502133名参与者，招募时年龄在40-69岁之间。有1463人患有视网膜血管闭塞，500670人没有。方法：将个体分为视网膜静脉闭塞（RVO）、视网膜动脉闭塞（RAO）和任何视网膜血管闭塞（RVO和RAO）。计算全因痴呆、AD和VD的患病率和发病率。然后将视网膜血管闭塞患者的年龄、性别、教育程度和就业得分与对照组按1:3的比例进行匹配。使用匹配参与者的单因素和多因素Cox比例风险模型来确定随时间推移与全因痴呆、AD和VD的关系，并对糖尿病、高血压和吸烟状况进行调整。主要结局指标：全因痴呆、AD和VD的患病率和风险比。结果：RVO、RAO和任何视网膜血管闭塞患者的全因痴呆和AD患病率显著增加，而RVO和任何视网膜血管闭塞患者的VD患病率显著增加。在匹配分析中，任何视网膜血管闭塞（HR 1.52, CI 1.11-2.07, p=0.01）和RVO （HR 1.38, CI 1.01-1.90, p=0.04）的患者患全因痴呆的风险增加。当调整协变量时，视网膜血管闭塞并没有显示出全因痴呆、AD和VD的风险增加。结论：任何视网膜血管闭塞和RVO都与全因痴呆的风险增加有关，RVO患者也有更高的VD风险。在调整了共同的危险因素后，痴呆和视网膜血管闭塞之间没有关联。本研究的结果与先前的报道既一致又矛盾，表明视网膜血管闭塞与引起痴呆的神经退行性疾病之间的联系可能是由于它们共同的发病机制和危险因素。

{"title":"The Association between Retinal Vascular Occlusions and Dementia","authors":"Audrey Gao BA , Fatima Tuz-Zahra MS , Viha Vig MBChB , Rebecca Zeng MD , Yorghos Tripodis PhD , Thor D. Stein MD, PhD , Michael L. Alosco PhD , Steven Ness MD , Xuejing Chen MD , Nicole Siegel MD , Manju L. Subramanian MD","doi":"10.1016/j.oret.2025.08.010","DOIUrl":"10.1016/j.oret.2025.08.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Vascular disease is associated with increased incidence of dementia and has the potential to be an indicator of underlying cognitive disease. The goal of this study is to investigate the association between retinal vascular occlusions and neurodegenerative disorders that lead to dementia, including all-cause dementia, Alzheimer disease (AD), and vascular dementia (VD).</div></div><div><h3>Design</h3><div>Retrospective longitudinal cohort study.</div></div><div><h3>Participants</h3><div>This study consists of 502 133 participants from the UK Biobank, aged 40 to 69 years at recruitment. There are 1463 individuals with retinal vascular occlusion and 500 670 individuals without.</div></div><div><h3>Methods</h3><div>Individuals were categorized as having retinal vein occlusion (RVO), retinal artery occlusion (RAO), and any retinal vascular occlusion (both RVO and RAO). Prevalence and incidence of all-cause dementia, AD, and VD were calculated. The patients with RVO were then matched on age, sex, education, and employment score on a 1:3 ratio to controls. Univariate and multivariate Cox proportional hazards models on the matched participants were used to determine associations over time to all-cause dementia, AD, and VD, with added adjustments for diabetes, hypertension, and smoking status.</div></div><div><h3>Main Outcome Measures</h3><div>Prevalence and hazard ratios (HRs) of all-cause dementia, AD, and VD.</div></div><div><h3>Results</h3><div>The prevalence of all-cause dementia and AD is significantly increased among patients with RVO, RAO, and any retinal vascular occlusion, whereas the prevalence of VD is significantly increased in RVO and any retinal vascular occlusion. In the matched analysis, increased risk for all-cause dementia was seen in patients with any retinal vascular occlusion (HR, 1.52; confidence interval [CI], 1.11–2.07, <em>P</em> = 0.01) and RVO (HR, 1.38; CI, 1.01–1.90, <em>P</em> = 0.04). When adjusting for covariates, RVO did not show increased risk of all-cause dementia, AD, and VD.</div></div><div><h3>Conclusions</h3><div>Any retinal vascular occlusions and RVO are associated with increased risk of all-cause dementia, and individuals with RVO also have higher risk of VD. After adjusting for shared risk factors, there is no association between dementia and retinal vascular occlusions. Findings from this study are both consistent and in conflict with prior reports, and indicate that the connection between retinal vascular occlusions and neurodegenerative diseases causing dementia may be due to their shared pathogenesis and risk factors.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 128-134"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874327","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}

引用次数: 0

Tumor Artery-Retinal Vein Anastomosis in Juxtapapillary Retinal Capillary Hemangioma 乳头旁视网膜毛细血管瘤的肿瘤动脉-视网膜静脉吻合。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.05.022

Gongpeng Sun MD , Meixia Zhang MD, PhD

引用次数: 0

Noninvasive Synthesis of Multiframe Ultra-Widefield Fluorescein Angiography from Color Fundus Photographs 彩色眼底照片无创合成多帧超宽视场荧光素血管造影。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.08.002

Ruoyu Chen MD , Kezheng Xu MD , Kangyan Zheng MD , Weiyi Zhang MS , Yan Lu MD, PhD , Mingguang He MD, PhD , Danli Shi MD, PhD

Purpose

To generate dye-free ultra-widefield fluorescein angiography (UWF-FA) images from noninvasive ultra-widefield color fundus photography (UWF-CFP) using generative artificial intelligence (AI) and to evaluate its effectiveness in diabetic retinopathy (DR) screening.

Design

A cross-sectional study involving generative AI.

Participants

This study included 1263 patients with DR (2747 UWF-CFP images and 18 321 UWF-FA images) from the Second People's Hospital of Foshan.

Methods

Ultra-widefield CFP and UWF-FA image pairs were matched and used to train a pix2pixHD generative adversarial network (GAN)-based model modified with Gradient Variance Loss. The generated UWF-FA images were evaluated using quantitative similarity metrics and qualitative ophthalmologist evaluation. An external data set, DeepDRiD, was used to validate the contribution of the generated UWF-FA images to DR grading.

Main Outcome Measures

The area under the receiver operating characteristic curve for DR grading.

Results

The generated early-, mid-, and late-phase UWF-FA images demonstrated high authenticity, with multiscale similarity scores ranging from 0.70 to 0.91 and qualitative evaluation scores from 1.64 to 1.98 (1 = real UWF-FA quality). In a Turing test with 50 randomly selected images, 56% to 76% of the generated images were indistinguishable from real images. Generated UWF-FA images successfully depict details of DR lesions, such as a nonperfusion area and leakage. The incorporation of these generated UWF-FA images in DR grading significantly improved the area under the receiver operating characteristic curve from 0.869 to 0.904 compared with the baseline model using UWF-CFP images alone (P < 0.001).

Conclusions

The study suggests that the GAN-based model can successfully generate realistic multiframe UWF-FA images, which could enhance DR grading without the need for IV dye injection, with the potential to improve the safety and accessibility of DR screening.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：利用生成式人工智能（GenAI）从无创UWF彩色眼底摄影（UWF- cfp）生成无染料超宽场荧光素血管造影（UWF- fa）图像，并评估其在糖尿病视网膜病变（DR）筛查中的有效性。设计：涉及GenAI的横断面研究。研究对象：本研究纳入佛山市第二人民医院1263例DR患者，其中UWF-CFP图像2747张，UWF-FA图像18321张。方法：将UWF-CFP和UWF-FA图像对进行匹配，利用梯度方差损失修正后的pix2pixHD gan模型进行训练。生成的UWF-FA图像使用定量相似性指标和定性眼科医生评价进行评估。使用外部数据集DeepDRiD来验证生成的UWF-FA图像对DR分级的贡献。主要观察指标：DR分级的受试者工作特征曲线下面积（AUROC）。结果：生成的UWF-FA早、中、后期图像具有较高的真实性，多尺度相似性评分（MS-SSIM）范围为0.70 ~ 0.91，定性评价评分范围为1.64 ~ 1.98（1=真实UWF-FA质量）。在对50张随机选择的图像进行图灵测试时，生成的图像中有56%到76%与真实图像无法区分。生成的UWF-FA图像成功地描绘了DR病变的细节，如非灌注区域和泄漏。与仅使用UWF-CFP图像的基线模型相比，将这些生成的UWF-FA图像纳入DR分级显著提高了AUROC，从0.869提高到0.904 （P < 0.001）。结论：本研究提示基于gan的模型可以成功生成逼真的多帧UWF-FA图像，无需静脉注射染料即可提高DR分级，具有提高DR筛查安全性和可及性的潜力。

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引用次数: 0

Exploring the Link between Retinal Vascular Occlusion and Dementia 探索视网膜血管闭塞与痴呆之间的联系

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.11.005

Hemal Patel MD, Sharon Fekrat MD, FASRS

引用次数: 0

Long-term Retained Perfluoro-n-Octane Not Impacting Patient’s Vision 长期保留的全氟辛烷不影响患者视力。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.06.001

Normila Barthelemy MD , Maura Abraham MD , Zelia M. Correa MD, PhD

引用次数: 0

Risk of Alzheimer Disease and Related Dementia after Retinal Vascular Occlusion 视网膜血管闭塞后阿尔茨海默病和相关痴呆的风险：一项全国性队列分析

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.10.017

Hou-Ren Tsai MD , Yu-Jie Lin MSc , Ching-Hui Loh DrPH , Yuan-Chieh Lee PhD , Huei-Kai Huang PhD

Purpose

To evaluate the risk of developing Alzheimer disease (AD) and related dementia in patients with newly diagnosed retinal vascular occlusion.

Design

A nationwide population-based cohort study using claims data from Taiwan’s National Health Insurance Research Database (NHIRD).

Participants and Controls

A total of 39 540 individuals with diagnoses of retinal vascular occlusion between 2011 and 2019 in Taiwan and 395 400 age- and sex-matched nonretinal vascular occlusion individuals without prior diagnoses of any dementia.

Methods

Patients with newly diagnosed retinal vascular occlusion were identified in the NHIRD, and baseline characteristics were collected. The study endpoints, including AD, vascular dementia (VD), and all-cause dementia, were determined by ≥2 separate outpatient diagnoses or a single discharge diagnosis. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates and control potential confounders. Cox proportional hazards models were used to estimate the hazard ratio (HR) for each outcome.

Main Outcome Measures

Development of AD, VD, and all-cause dementia.

Results

After IPTW, 38 522 patients with retinal vascular occlusion and 395 740 nonretinal vascular occlusion individuals were included. Patients with retinal vascular occlusion had increased risks of AD (HR, 1.57; 95% confidence interval [CI], 1.39–1.80), VD (HR, 1.76; 95% CI, 1.58–1.95), and all-cause dementia (HR, 1.58; 95% CI, 1.50–1.65). Both retinal artery occlusion and retinal vein occlusion were associated with increased risks of AD (HR, 1.59; 95% CI, 1.14–2.23; and HR, 1.58; 95% CI, 1.39–1.80, respectively), VD (HR, 1.79; 95% CI, 1.32–2.43; and HR, 1.77; 95% CI, 1.59–1.98, respectively), and all-cause dementia (HR, 1.62; 95% CI, 1.42–1.86; and HR, 1.58; 95% CI, 1.52–1.67, respectively).

Conclusions

Patients with retinal vascular occlusion had moderately increased risks of AD and related dementias. Therefore, monitoring for dementia symptoms in patients with retinal vascular occlusion may facilitate earlier detection and intervention.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

目的：评价新诊断的视网膜血管闭塞患者发生阿尔茨海默病（AD）及相关痴呆的风险。参与者和对照组：2011年至2019年期间，台湾共有39540名被诊断为视网膜血管闭塞的个体，以及39400名年龄和性别匹配且未被诊断为任何痴呆的非视网膜血管闭塞个体。方法：在NHIRD中识别新诊断的视网膜血管闭塞患者，并收集基线特征。研究终点，包括AD、血管性痴呆（VD）和全因痴呆，由≥2个单独的门诊诊断或单个出院诊断确定。应用治疗加权逆概率（IPTW）来平衡基线协变量和控制潜在混杂因素。使用Cox比例风险模型估计每个结局的风险比（HR）。主要结局指标：AD、VD和全因痴呆的发展。结果：IPTW术后纳入38 522例视网膜血管闭塞患者和395740例非视网膜血管闭塞患者。视网膜血管闭塞的患者患AD （HR, 1.57； 95%可信区间[CI]， 1.39-1.80）、VD （HR, 1.76; 95% CI, 1.58-1.95）和全因痴呆（HR, 1.58; 95% CI, 1.50-1.65）的风险增加。视网膜动脉闭塞和视网膜静脉闭塞均与AD （HR, 1.59; 95% CI, 1.14-2.23； HR, 1.58; 95% CI, 1.39-1.80）、VD （HR, 1.79; 95% CI, 1.32-2.43； HR, 1.77; 95% CI, 1.59-1.98）和全因痴呆（HR, 1.62; 95% CI, 1.42-1.86； HR, 1.58; 95% CI, 1.52-1.67）的风险增加相关。结论：视网膜血管闭塞的患者患AD和相关痴呆的风险中等程度增加。因此，监测视网膜血管闭塞患者的痴呆症状可能有助于早期发现和干预。财务披露：作者在本文中讨论的任何材料中没有专有或商业利益。

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引用次数: 0

Vascular Hyperreflectivity in Lipemia Retinalis 视网膜脂血症的血管高反射率。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.05.029

Tingming Deng MD, Yingshi Zou MD, PhD, Mingming Yang MD, PhD

引用次数: 0

Iris Metastasis as Presenting Feature of Uterine Cervix Cancer 虹膜转移是宫颈癌的表现特征。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.05.019

Eduardo Labbé MD, Graciela Blanco MD, Karen Goset MD

引用次数: 0

Association of OCT Angiography-Detected Intraretinal Microvascular Abnormalities with Diabetic Retinopathy Severity OCT血管造影检测视网膜内微血管异常与糖尿病视网膜病变严重程度的关系。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.08.011

Xinyi Ding MD , Jia Xu MD , Francesco Romano MD , Itika Garg MD , Jenny Gan , Katherine M. Overbey , Mauricio D. Garcia , Mridula Shan , Ricardo Marrero-Alattar , Filippos Vingopoulos MD , Ying Cui MD , Ying Zhu MD , Ioanna Ploumi MS , Isabella Stettler MD , Matthew J. Finn MD , Demetrios G. Vavvas MD , Deeba Husain MD , David M. Wu MD , Nimesh A. Patel MD , Leo A. Kim MD , John B. Miller MD

Purpose

To assess the severity and clinical significance of intraretinal microvascular abnormalities (IRMAs) using expanded field swept-source OCT angiography (SS-OCTA) in eyes with nonproliferative diabetic retinopathy (NPDR).

Design

Cross-sectional, observational study.

Participants

One hundred thirty-nine eyes from 101 subjects with NPDR.

Methods

The montage of 12 × 12–mm angiography centered on the macula and optic nerve was evaluated by 2 masked graders for (1) the presence of IRMA in each 6 × 6–mm field, including center, superotemporal, inferotemporal, superonasal (SN), and inferonasal (IN) to the macula, and SN and IN to the optic nerve and (2) subtypes of IRMA (dilated trunk, net shape, loop, sea fan, and tufted IRMA). Nonperfusion areas (NPA) were quantified using FIJI. Nonproliferative diabetic retinopathy grading was initially collected from chart diagnoses and subsequently verified using ultra-widefield color fundus photos. Logistic and linear regression models were used to evaluate the relationships between IRMA features, diabetic retinopathy (DR) severity, and NPA.

Main Outcome Measures

Intraretinal microvascular abnormality features associated with severe NPDR.

Results

Intraretinal microvascular abnormalities, observed with SS-OCTA, were present in 58.3% of all NPDR eyes and more prevalent in severe (96.6%) than mild (28.8%) to moderate (70.6%) NPDR. The number of affected fields and IRMA subtypes increased with DR severity (P < 0.01). The most common subtype of IRMA is the dilated trunk, comprising 58.3%, followed by the net shape subtype at 35.3%, loop at 11.5%, sea fan at 6.5%, and tufts at 5.8%. Significant predictors of severe NPDR included the presence of IRMA in the central field (odds ratio [OR]: 8.7; P = 0.01), more widely distributed IRMA (OR: 2.2; P < 0.01), a greater variety of IRMA subtypes (OR: 4.2, P < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; P = 0.02), sea fan (OR: 26.0; P < 0.01), and tufted IRMA (OR: 13.4; P = 0.03). Center-involving IRMA (β = 5.8; P = 0.046) and IRMA with loops (β = 7.0; P = 0.043) were found to be associated with increased NPA.

Conclusions

Our study demonstrates that IRMA lesions identified on OCT angiography, particularly their distribution and morphology, are associated with DR severity and provide complementary information that may facilitate the integration of SS-OCTA into clinical evaluation of DR.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：应用扩展视野扫描源OCT血管造影（SS-OCTA）评价非增殖性糖尿病视网膜病变（NPDR）眼视网膜内微血管异常（IRMA）的严重程度及临床意义。设计：横断面观察性研究。参与者：来自101名NPDR患者的139只眼睛。方法：以黄斑和视神经为中心的12x12-mm血管造影蒙太奇，采用2个蒙太奇评分法评价：1)每个6x6-mm视场是否存在IRMA，包括黄斑的中心、颞上（ST）、颞下（IT）、鼻上（SN）和鼻间（SN），以及视神经的SN和in；2) IRMA亚型（扩张干状、网状、环状、海扇和丛状IRMA）。非灌注区（NPA）采用FIJI量化。NPDR分级最初从图表诊断中收集，随后使用超广角彩色眼底照片进行验证。采用Logistic和线性回归模型评估IRMA特征、DR严重程度和NPA之间的关系。主要结局指标：与严重NPDR相关的IRMA特征。结果：SS-OCTA观察到的IRMA存在于58.3%的NPDR眼睛中，重度（96.6%）比轻度（28.8%）至中度（70.6%）NPDR更普遍。随着DR严重程度的增加，感染区数和IRMA亚型数增加（p < 0.01）。IRMA最常见的亚型是扩张干型，占58.3%，其次是网状型，占35.3%，环型占11.5%，海扇型占6.5%，丛状占5.8%。严重NPDR的显著预测因子包括中心区IRMA的存在（OR: 8.7, p < 0.01），更广泛分布的IRMA (OR: 2.2, p < 0.01)，更多种类的IRMA亚型（OR: 4.2, p < 0.01），以及特定亚型如净形（OR: 16.1, p=0.02），海扇（OR: 26.0, p < 0.01）和簇状IRMA （OR: 13.4, p=0.03）的存在。中心相关的IRMA （beta=5.8, p=0.046）和带环路的IRMA （beta=7.0, p=0.043）与NPA增加有关。结论：我们的研究表明，在OCTA上发现的IRMA病变，特别是它们的分布和形态，与DR的严重程度有关，并提供了补充信息，可能有助于将SS-OCTA纳入糖尿病视网膜病变的临床评估。

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引用次数: 0

Rates of Endophthalmitis in Prefilled versus Nonprefilled Syringes for Intravitreal Injections 玻璃体内注射用预充与非预充注射器的眼内炎发生率：一项系统综述和荟萃分析。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-02-01 DOI: 10.1016/j.oret.2025.08.006

Charles Zhang MD , Daniel A. Lai MD , Georges AbouKasm BS , Sinan Ersan BS , Nicholas Leung BA , Daniel Zhu MD , Nimesh A. Patel MD , Harry W. Flynn Jr. MD , Nicolas A. Yannuzzi MD

Topic

This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).

Clinical Relevance

Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.

Methods

A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.

Results

A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44–0.64; I² = 24%, P < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38–0.72; I² = 11%, P < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41–0.67; I² = 39%, P < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (P = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated “low” for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.

Conclusion

Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies are needed.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

主题：本研究比较使用预充和非预充注射器进行玻璃体内注射（IVI）后眼内炎的发生率。临床相关性：静脉注射是视网膜疾病治疗中最常用的医疗程序之一。虽然静脉注射通常是安全的，但它有很小的眼内炎风险，导致毁灭性的视力丧失。鉴于每年进行的注射量很大，尽量减少危险因素至关重要。方法：根据PRISMA指南（PROSPERO ID: CRD420251030471），使用PubMed、Embase和Scopus进行系统评价和荟萃分析。研究比较了使用制造商预充式注射器、药房复合注射器和玻璃小瓶制剂进行静脉注射的患者眼内炎风险。风险比荟萃分析用于评估所有眼内炎和培养阳性病例的发生率。结果：共纳入11项研究进行荟萃分析，发表日期为2018年至2023年。预充式联合注射器组共1523597支，玻璃小瓶组共5907310支。预充式注射器的眼内炎总发生率为1:5461，而玻璃小瓶制剂的眼内炎总发生率为1:320。预充式注射器组眼内炎总发生率显著低于预充式注射器组(风险比[RR] = 0.53；95%置信区间[CI]， 0.44-0.64；I2 = 24%, p < 0.00001)。按制剂法分层时，复方药物组（6项研究）的眼内炎总发生率为1:4664次注射，而生产厂家预充式注射器组（7项研究）的眼内炎总发生率为1:59 909次注射。两种复方药物发生眼内炎的风险仍显著降低(RR = 0.52；95% ci, 0.38-0.72；I2 = 11%, p < 0.0001)和制造商预充式注射器(RR = 0.53；95% ci, 0.41-0.67；I2 = 39%, p < 0.00001)。配药注射器和生产厂家预充注射器之间没有亚组差异（P = 0.97）。使用GRADE框架的证据质量被评为“低”，用于整体预填充与玻璃小瓶制备的比较，以及通过制备方法进行的亚组分析。结论：与玻璃小瓶制剂相比，静脉注射使用配药注射器或制造商预充注射器的报告眼内炎风险分别降低48%和47%。这些发现表明，预充注射器可能是一种更安全的选择，尽管还需要进一步的前瞻性研究。

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引用次数: 0