Pub Date : 2026-02-01DOI: 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.
{"title":"Noninvasive Synthesis of Multiframe Ultra-Widefield Fluorescein Angiography from Color Fundus Photographs","authors":"Ruoyu Chen MD , Kezheng Xu MD , Kangyan Zheng MD , Weiyi Zhang MS , Yan Lu MD, PhD , Mingguang He MD, PhD , Danli Shi MD, PhD","doi":"10.1016/j.oret.2025.08.002","DOIUrl":"10.1016/j.oret.2025.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Design</h3><div>A cross-sectional study involving generative AI.</div></div><div><h3>Participants</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Main Outcome Measures</h3><div>The area under the receiver operating characteristic curve for DR grading.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>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.</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 176-184"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812251","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 : 2026-02-01DOI: 10.1016/j.oret.2025.11.005
Hemal Patel MD, Sharon Fekrat MD, FASRS
{"title":"Exploring the Link between Retinal Vascular Occlusion and Dementia","authors":"Hemal Patel MD, Sharon Fekrat MD, FASRS","doi":"10.1016/j.oret.2025.11.005","DOIUrl":"10.1016/j.oret.2025.11.005","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 115-116"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098467","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 : 2026-02-01DOI: 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.
{"title":"Risk of Alzheimer Disease and Related Dementia after Retinal Vascular Occlusion","authors":"Hou-Ren Tsai MD , Yu-Jie Lin MSc , Ching-Hui Loh DrPH , Yuan-Chieh Lee PhD , Huei-Kai Huang PhD","doi":"10.1016/j.oret.2025.10.017","DOIUrl":"10.1016/j.oret.2025.10.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of developing Alzheimer disease (AD) and related dementia in patients with newly diagnosed retinal vascular occlusion.</div></div><div><h3>Design</h3><div>A nationwide population-based cohort study using claims data from Taiwan’s National Health Insurance Research Database (NHIRD).</div></div><div><h3>Participants and Controls</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Main Outcome Measures</h3><div>Development of AD, VD, and all-cause dementia.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 117-127"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878580","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 : 2026-02-01DOI: 10.1016/j.oret.2025.05.029
Tingming Deng MD, Yingshi Zou MD, PhD, Mingming Yang MD, PhD
{"title":"Vascular Hyperreflectivity in Lipemia Retinalis","authors":"Tingming Deng MD, Yingshi Zou MD, PhD, Mingming Yang MD, PhD","doi":"10.1016/j.oret.2025.05.029","DOIUrl":"10.1016/j.oret.2025.05.029","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Page e15"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529046","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 : 2026-02-01DOI: 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。
{"title":"Association of OCT Angiography-Detected Intraretinal Microvascular Abnormalities with Diabetic Retinopathy Severity","authors":"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","doi":"10.1016/j.oret.2025.08.011","DOIUrl":"10.1016/j.oret.2025.08.011","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Design</h3><div>Cross-sectional, observational study.</div></div><div><h3>Participants</h3><div>One hundred thirty-nine eyes from 101 subjects with NPDR.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Main Outcome Measures</h3><div>Intraretinal microvascular abnormality features associated with severe NPDR.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 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; <em>P</em> = 0.01), more widely distributed IRMA (OR: 2.2; <em>P</em> < 0.01), a greater variety of IRMA subtypes (OR: 4.2, <em>P</em> < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; <em>P</em> = 0.02), sea fan (OR: 26.0; <em>P</em> < 0.01), and tufted IRMA (OR: 13.4; <em>P</em> = 0.03). Center-involving IRMA (β = 5.8; <em>P</em> = 0.046) and IRMA with loops (β = 7.0; <em>P</em> = 0.043) were found to be associated with increased NPA.</div></div><div><h3>Conclusions</h3><div>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.</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 185-193"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963658","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 : 2026-02-01DOI: 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.
{"title":"Rates of Endophthalmitis in Prefilled versus Nonprefilled Syringes for Intravitreal Injections","authors":"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","doi":"10.1016/j.oret.2025.08.006","DOIUrl":"10.1016/j.oret.2025.08.006","url":null,"abstract":"<div><h3>Topic</h3><div>This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).</div></div><div><h3>Clinical Relevance</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; I<sup>2</sup> = 24%, <em>P</em> < 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; I<sup>2</sup> = 11%, <em>P</em> < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41–0.67; I<sup>2</sup> = 39%, <em>P</em> < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (<em>P</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</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 165-175"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859410","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 : 2026-02-01DOI: 10.1016/j.oret.2025.05.024
Prithvi Ramtohul MD, Clément Richard MD, Thierry David MD, PhD
{"title":"Retinal Venous Malformation Associated with Superior Ophthalmic Vein Dilation","authors":"Prithvi Ramtohul MD, Clément Richard MD, Thierry David MD, PhD","doi":"10.1016/j.oret.2025.05.024","DOIUrl":"10.1016/j.oret.2025.05.024","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Page e14"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317553","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}
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