Pub Date : 2026-03-04DOI: 10.1016/j.oret.2026.02.019
Hejin Jeong, Sophie C Yue, David C Kaelber, Rishi P Singh, Katherine E Talcott
Purpose: Central retinal vein occlusion (CRVO) and retinal perfusion defects have been described as potential risks associated with systemic tyrosine kinase inhibitor (TKI) therapy, but current evidence is limited to case reports. Therefore, this study aimed to better characterize any associations between systemic TKIs and the risks of retinal artery occlusion (RAO) and retinal vein occlusion (RVO).
Design: Retrospective cohort study using multi-institutional electronic health records across the United States.
Participants: Adults with cancer diagnoses and no prior history of retinal vascular occlusions or maculopathy, based on International Classification of Diseases (ICD) encounter diagnosis codes, were included. Patients with prescriptions for TKIs with and without anti-vascular endothelial growth factor (anti-VEGF) activities were created, and were each compared to matched control patients with non-TKI antineoplastic prescriptions.
Methods: The study and control cohorts were propensity-score-matched 1:1 based on demographic factors, comorbidities, other antineoplastic therapy, and cancer stages. The matched cohorts were then compared for having new-onset ICD encounter diagnosis codes of any RAO, CRAO, BRAO, RVO, CRVO, and BRVO.
Main outcome measures: Lifetime risks of RAO, CRAO, BRAO, RVO, CRVO, and BRVO were compared via risk ratios (RRs). Rates of these outcomes within three years of antineoplastic initiation were also evaluated via hazard ratios (HRs). Differences in the outcome measures were considered statistically significant if the 95% confidence interval (CI) was ≤0.9 or ≥1.1.
Results: While the anytime-risks of having RAOs and RVOs were comparable between the anti-VEGF TKI cohort and controls (each n=6,728), the anti-VEGF TKI cohort had a significant hazard of having CRVO within three years of TKI initiation (HR=2.86, CI=1.44-5.69). In contrast, while the non-anti-VEGF TKI cohort (n=17,185) had a lower anytime-risk of having RAO (RR=0.61, CI=0.45-0.83) and BRVO (RR=0.51, CI=0.36-0.71) compared to the non-TKI controls (n=17,185), there was no difference in the HR among outcomes between the two cohorts.
Conclusions: Although non-anti-VEGF TKIs may have a more favorable safety profile with respect to BRVO and RAO compared to other antineoplastic therapies, patients initiating anti-VEGF TKIs may warrant closer ophthalmological monitoring for the incidence of CRVO during the first few years of treatment.
{"title":"Risks of Retinal Vascular Occlusions with the Systemic Use of Tyrosine Kinase Inhibitors.","authors":"Hejin Jeong, Sophie C Yue, David C Kaelber, Rishi P Singh, Katherine E Talcott","doi":"10.1016/j.oret.2026.02.019","DOIUrl":"https://doi.org/10.1016/j.oret.2026.02.019","url":null,"abstract":"<p><strong>Purpose: </strong>Central retinal vein occlusion (CRVO) and retinal perfusion defects have been described as potential risks associated with systemic tyrosine kinase inhibitor (TKI) therapy, but current evidence is limited to case reports. Therefore, this study aimed to better characterize any associations between systemic TKIs and the risks of retinal artery occlusion (RAO) and retinal vein occlusion (RVO).</p><p><strong>Design: </strong>Retrospective cohort study using multi-institutional electronic health records across the United States.</p><p><strong>Participants: </strong>Adults with cancer diagnoses and no prior history of retinal vascular occlusions or maculopathy, based on International Classification of Diseases (ICD) encounter diagnosis codes, were included. Patients with prescriptions for TKIs with and without anti-vascular endothelial growth factor (anti-VEGF) activities were created, and were each compared to matched control patients with non-TKI antineoplastic prescriptions.</p><p><strong>Methods: </strong>The study and control cohorts were propensity-score-matched 1:1 based on demographic factors, comorbidities, other antineoplastic therapy, and cancer stages. The matched cohorts were then compared for having new-onset ICD encounter diagnosis codes of any RAO, CRAO, BRAO, RVO, CRVO, and BRVO.</p><p><strong>Main outcome measures: </strong>Lifetime risks of RAO, CRAO, BRAO, RVO, CRVO, and BRVO were compared via risk ratios (RRs). Rates of these outcomes within three years of antineoplastic initiation were also evaluated via hazard ratios (HRs). Differences in the outcome measures were considered statistically significant if the 95% confidence interval (CI) was ≤0.9 or ≥1.1.</p><p><strong>Results: </strong>While the anytime-risks of having RAOs and RVOs were comparable between the anti-VEGF TKI cohort and controls (each n=6,728), the anti-VEGF TKI cohort had a significant hazard of having CRVO within three years of TKI initiation (HR=2.86, CI=1.44-5.69). In contrast, while the non-anti-VEGF TKI cohort (n=17,185) had a lower anytime-risk of having RAO (RR=0.61, CI=0.45-0.83) and BRVO (RR=0.51, CI=0.36-0.71) compared to the non-TKI controls (n=17,185), there was no difference in the HR among outcomes between the two cohorts.</p><p><strong>Conclusions: </strong>Although non-anti-VEGF TKIs may have a more favorable safety profile with respect to BRVO and RAO compared to other antineoplastic therapies, patients initiating anti-VEGF TKIs may warrant closer ophthalmological monitoring for the incidence of CRVO during the first few years of treatment.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369867","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 : 2026-03-04DOI: 10.1016/j.oret.2026.02.018
Shirley Wu, Hejin Jeong, Hayden A Reed, Nadia J Abbass, David C Kaelber, Katherine E Talcott, Rishi P Singh
Purpose: To evaluate the association between systemic tyrosine kinase inhibitor (TKI) therapy and the risk of age-related macular degeneration (AMD) onset, and whether this relationship varies by anti-VEGF activity of TKIs.
Design: Retrospective cohort study using a large de-identified electronic health records research platform.
Participants: Patients ≥50 years old with cancer encounter diagnoses were divided into groups with (treatment) and without (control) systemic TKI prescription codes and followed for incident AMD diagnosis.
Methods: Landmarked time-to-event analyses were performed at 1, 3, and 5 years post-cancer diagnosis. Treatment and control groups were propensity score matched, followed from landmark date until incident ICD-10 AMD encounter diagnosis, death, or last recorded clinical encounter, and compared using hazard ratios for incident AMD. A three-arm sub-analysis was also performed by stratifying TKIs by anti-VEGF activity, comparing the TKI-with-anti-VEGF and TKI-without-anti-VEGF subgroups to the control group, and to each other.
Main outcome measures: Hazard ratios (HRs) for an incident ICD-10 AMD encounter diagnosis code after the landmark date. Significance was defined as 95% confidence interval (CI) <0.9 and >1.1.
Results: Across landmark analyses, TKI prescriptions were not consistently associated with the hazard of receiving a new ICD-10 AMD encounter diagnosis code compared with matched controls: 1 year (HR=0.97; 95% CI=0.85, 1.12), 3 years (HR=0.90; 95% CI=0.78, 1.05), and 5 years (HR=0.81; 95% CI=0.69, 0.96). In the subanalysis, the TKI with-anti-VEGF subgroup showed significant reduction only at the 5-year landmark, HR=0.60; 95% CI=0.40, 0.89). The TKI-without-anti-VEGF subgroup demonstrated no significant association between systemic TKI exposure and the hazard of receiving a new ICD-10 AMD encounter diagnosis code at any time point: 1 year (HR=0.98; 95% CI=0.84, 1.15), 3 years (HR=0.97; 95% CI=0.82, 1.15), and 5 years (HR=0.87; 95% CI=0.73, 1.05). In contrast, across analyses, TKI prescriptions were consistently associated with increased hazards of mortality and fewer ophthalmology encounters.
Conclusions: This explorative study found that TKI prescriptions are not associated with incident AMD diagnosis. These findings do not support a population-level protective effect of systemic TKIs on AMD risk.
{"title":"Associations Between Systemic Tyrosine Kinase Inhibitors and Development of Age-Related Macular Degeneration in Patients with Cancer.","authors":"Shirley Wu, Hejin Jeong, Hayden A Reed, Nadia J Abbass, David C Kaelber, Katherine E Talcott, Rishi P Singh","doi":"10.1016/j.oret.2026.02.018","DOIUrl":"https://doi.org/10.1016/j.oret.2026.02.018","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between systemic tyrosine kinase inhibitor (TKI) therapy and the risk of age-related macular degeneration (AMD) onset, and whether this relationship varies by anti-VEGF activity of TKIs.</p><p><strong>Design: </strong>Retrospective cohort study using a large de-identified electronic health records research platform.</p><p><strong>Participants: </strong>Patients ≥50 years old with cancer encounter diagnoses were divided into groups with (treatment) and without (control) systemic TKI prescription codes and followed for incident AMD diagnosis.</p><p><strong>Methods: </strong>Landmarked time-to-event analyses were performed at 1, 3, and 5 years post-cancer diagnosis. Treatment and control groups were propensity score matched, followed from landmark date until incident ICD-10 AMD encounter diagnosis, death, or last recorded clinical encounter, and compared using hazard ratios for incident AMD. A three-arm sub-analysis was also performed by stratifying TKIs by anti-VEGF activity, comparing the TKI-with-anti-VEGF and TKI-without-anti-VEGF subgroups to the control group, and to each other.</p><p><strong>Main outcome measures: </strong>Hazard ratios (HRs) for an incident ICD-10 AMD encounter diagnosis code after the landmark date. Significance was defined as 95% confidence interval (CI) <0.9 and >1.1.</p><p><strong>Results: </strong>Across landmark analyses, TKI prescriptions were not consistently associated with the hazard of receiving a new ICD-10 AMD encounter diagnosis code compared with matched controls: 1 year (HR=0.97; 95% CI=0.85, 1.12), 3 years (HR=0.90; 95% CI=0.78, 1.05), and 5 years (HR=0.81; 95% CI=0.69, 0.96). In the subanalysis, the TKI with-anti-VEGF subgroup showed significant reduction only at the 5-year landmark, HR=0.60; 95% CI=0.40, 0.89). The TKI-without-anti-VEGF subgroup demonstrated no significant association between systemic TKI exposure and the hazard of receiving a new ICD-10 AMD encounter diagnosis code at any time point: 1 year (HR=0.98; 95% CI=0.84, 1.15), 3 years (HR=0.97; 95% CI=0.82, 1.15), and 5 years (HR=0.87; 95% CI=0.73, 1.05). In contrast, across analyses, TKI prescriptions were consistently associated with increased hazards of mortality and fewer ophthalmology encounters.</p><p><strong>Conclusions: </strong>This explorative study found that TKI prescriptions are not associated with incident AMD diagnosis. These findings do not support a population-level protective effect of systemic TKIs on AMD risk.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369911","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 : 2026-03-02DOI: 10.1016/j.oret.2026.02.008
Simon K H Szeto, Julia T W Lam, Chi Wai Tsang, Marcin Stopa
{"title":"Reply Letter.","authors":"Simon K H Szeto, Julia T W Lam, Chi Wai Tsang, Marcin Stopa","doi":"10.1016/j.oret.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.oret.2026.02.008","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326811","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 : 2026-03-01Epub Date: 2025-09-01DOI: 10.1016/j.oret.2025.08.020
Jasmine Yaowei Ge MBBS, FRCOphth , Alvin Wei Jun Teo MBBS, FRCOphth , Andrew S.H. Tsai FRCOphth, FAMS , Gavin Siew Wei Tan FRCS(Ed), PhD , Shu Yen Lee MBBS, FRCSEd(Ophth) , Ning Cheung MD , Wei-Chi Wu MD, PhD , Yih-Shiou Hwang MD, PhD , Chi-Chun Lai MD , Hung-Da Chou MD
<div><h3>Topic</h3><div>There is no consensus regarding management of macular hole retinal detachment (MHRD). Techniques such as trans pars plana vitrectomy (TPPV), macular buckle (MB), and combined approach have been described.</div></div><div><h3>Clinical Relevance</h3><div>To review anatomical and functional outcomes of different surgical interventions for MHRD.</div></div><div><h3>Methods</h3><div>A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number CRD42024586953). Literature search was performed in PubMed, Embase, Cochrane Library, and clinical trial databases for randomized controlled trials or retrospective comparative studies reporting MHRD outcomes until February 15, 2025. Retinal reattachment rates, macular hole closure rates, functional outcomes, and complications were assessed. Frequentist Meta-Analysis of Proportions and Bayesian Network Meta-Analysis were conducted. Study quality was assessed with Cochrane’s Risk of Bias in Nonrandomized Studies of Interventions 2.0 tool and Risk of Bias Tool 2.</div></div><div><h3>Results</h3><div>Five studies and 308 eyes were analyzed. Retinal reattachment rates were significantly higher in combined (96.9%) and MB (96.2%) versus vitrectomy (66.9%). There was no significant difference between combined and MB (<em>P</em> = 0.802; risk ratio [RR] = 1.03, 95% confidence interval [CI]: 0.94–1.12; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE], moderate certainty, 4 studies, 173 eyes), whereas TPPV did significantly worse relative to MB (<em>P</em> < 0.001; RR = 0.64, 95% CI: 0.50–0.79; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00; GRADE, moderate certainty, 4 studies, 233 eyes). Macular hole closure rates were highest in the combined group (86.0%; MB, 58.4%; and TPPV, 46.3%); (Combined vs. MB: <em>P</em> = 0.148; RR = 1.24, 95% CI: 0.88–1.61; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00%; GRADE, moderate certainty of evidence, 4 studies, 173 eyes); (Vitrectomy vs. MB: <em>P</em> = 0.158; RR = 0.73, 95% CI: 0.40–1.05; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00%; GRADE, low certainty of evidence, 4 studies, 233 eyes). The postoperative visual acuity improvements for MB, combined, and TPPV were a logarithm of the minimum angle of resolution of 0.533, 0.510, and 0.434, respectively.</div></div><div><h3>Conclusion</h3><div>Our study found that procedures involving MB was associated with better retinal reattachment rates in managing MHRD with moderate certainty. Further studies are required to evaluate macular hole closure rates, visual outcomes, and retinal reattachment rates after a combined procedure.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found after the references in the Footnotes an
{"title":"Macular Buckle, Vitrectomy, or Combined Approach for the Management of Macular Hole Retinal Detachment","authors":"Jasmine Yaowei Ge MBBS, FRCOphth , Alvin Wei Jun Teo MBBS, FRCOphth , Andrew S.H. Tsai FRCOphth, FAMS , Gavin Siew Wei Tan FRCS(Ed), PhD , Shu Yen Lee MBBS, FRCSEd(Ophth) , Ning Cheung MD , Wei-Chi Wu MD, PhD , Yih-Shiou Hwang MD, PhD , Chi-Chun Lai MD , Hung-Da Chou MD","doi":"10.1016/j.oret.2025.08.020","DOIUrl":"10.1016/j.oret.2025.08.020","url":null,"abstract":"<div><h3>Topic</h3><div>There is no consensus regarding management of macular hole retinal detachment (MHRD). Techniques such as trans pars plana vitrectomy (TPPV), macular buckle (MB), and combined approach have been described.</div></div><div><h3>Clinical Relevance</h3><div>To review anatomical and functional outcomes of different surgical interventions for MHRD.</div></div><div><h3>Methods</h3><div>A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number CRD42024586953). Literature search was performed in PubMed, Embase, Cochrane Library, and clinical trial databases for randomized controlled trials or retrospective comparative studies reporting MHRD outcomes until February 15, 2025. Retinal reattachment rates, macular hole closure rates, functional outcomes, and complications were assessed. Frequentist Meta-Analysis of Proportions and Bayesian Network Meta-Analysis were conducted. Study quality was assessed with Cochrane’s Risk of Bias in Nonrandomized Studies of Interventions 2.0 tool and Risk of Bias Tool 2.</div></div><div><h3>Results</h3><div>Five studies and 308 eyes were analyzed. Retinal reattachment rates were significantly higher in combined (96.9%) and MB (96.2%) versus vitrectomy (66.9%). There was no significant difference between combined and MB (<em>P</em> = 0.802; risk ratio [RR] = 1.03, 95% confidence interval [CI]: 0.94–1.12; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE], moderate certainty, 4 studies, 173 eyes), whereas TPPV did significantly worse relative to MB (<em>P</em> < 0.001; RR = 0.64, 95% CI: 0.50–0.79; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00; GRADE, moderate certainty, 4 studies, 233 eyes). Macular hole closure rates were highest in the combined group (86.0%; MB, 58.4%; and TPPV, 46.3%); (Combined vs. MB: <em>P</em> = 0.148; RR = 1.24, 95% CI: 0.88–1.61; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00%; GRADE, moderate certainty of evidence, 4 studies, 173 eyes); (Vitrectomy vs. MB: <em>P</em> = 0.158; RR = 0.73, 95% CI: 0.40–1.05; τ<sup>2</sup> = 0.00, <em>I</em><sup>2</sup> = 0.00%; GRADE, low certainty of evidence, 4 studies, 233 eyes). The postoperative visual acuity improvements for MB, combined, and TPPV were a logarithm of the minimum angle of resolution of 0.533, 0.510, and 0.434, respectively.</div></div><div><h3>Conclusion</h3><div>Our study found that procedures involving MB was associated with better retinal reattachment rates in managing MHRD with moderate certainty. Further studies are required to evaluate macular hole closure rates, visual outcomes, and retinal reattachment rates after a combined procedure.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found after the references in the Footnotes an","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Pages 320-334"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992956","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 : 2026-03-01Epub Date: 2025-09-26DOI: 10.1016/j.oret.2025.09.008
Pedro Marques-Couto MD , João Afonso MD , Inês Coelho-Costa MD , João Sérgio Neves MD, PhD , Manuel Falcão MD, PhD , Rita Laiginhas MD, PhD
<div><h3>Topic</h3><div>This systematic review and meta-analysis investigates the prevalence, natural history, clinical risk factors, and distinctive characteristics of diabetic macular edema (DME) in type 1 diabetes mellitus (T1D), highlighting comparisons with type 2 diabetes mellitus (T2D).</div></div><div><h3>Clinical Relevance</h3><div>Diabetic macular edema is the most common vision-threatening complication of diabetic retinopathy, significantly impacting quality of life. Although extensively studied in T2D, data in T1D remains limited, restricting targeted prevention and management. Given the increasing longevity of individuals with T1D, understanding its specific risk profile is critical to refine screening and treatment guidelines.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was registered (PROSPERO: CRD420251011398) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was performed in MedLine (via PubMed), Scopus, and Web of Science databases (July 15, 2024). Eligible studies included original observational studies explicitly reporting prevalence, incidence, natural history, or risk factors of DME in patients with T1D. Studies not differentiating T1D from T2D were excluded. The risk of bias was assessed using National Institutes of Health criteria. Meta-analysis and meta-regression were used for data synthesis.</div></div><div><h3>Results</h3><div>Of the 63 studies included, 27 were eligible for meta-analysis, encompassing 40 distinct study populations and a total of 20 074 patients. The pooled prevalence of DME in T1D was 11.1% (95% confidence interval: 7.9%–14.3%, <em>I</em><sup>2</sup> = 99.6%). Meta-regression identified disease duration and hemoglobin A1c (HbA1c) as significant predictors: at the sample means (19.9 years of diabetes; HbA1c 8.6%), the adjusted prevalence was 14.8%. Each additional year of disease increased prevalence by 1.2 percentage points, and each 1% increase in HbA1c raised prevalence by 4.7 percentage points, on average. Additional factors such as hypertension, dyslipidemia, and nephropathy were also associated with higher DME prevalence. The certainty of the evidence was rated as very low using the GRADE approach.</div></div><div><h3>Conclusion</h3><div>Diabetic macular edema prevalence in T1D is substantial, with a strong dependency on disease duration and glycemic control. Nonetheless, these findings should be interpreted with caution given the very low certainty of the evidence. These findings highlight the need for personalized screening intervals and early intervention strategies. Future research should focus on refining diagnostic criteria, integrating emerging biomarkers, and evaluating the impact of novel diabetes management technologies.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this art
本系统综述和荟萃分析探讨了1型糖尿病（T1D）患者糖尿病性黄斑水肿（DME）的患病率、自然病史、临床危险因素和特点，并与2型糖尿病（T2D）进行了比较。临床相关性：DME是糖尿病视网膜病变最常见的视力威胁并发症，显著影响患者的生活质量。虽然在T2D中得到了广泛的研究，但T1D的数据仍然有限，限制了有针对性的预防和管理。鉴于T1D患者的寿命越来越长，了解其特定的风险概况对于完善筛查和治疗指南至关重要。方法：本系统评价和荟萃分析已注册（PROSPERO: CRD420251011398），并按照PRISMA指南进行。在MedLine（通过PubMed）、Scopus和Web of Science数据库（2024年7月15日）中进行了全面的文献检索。符合条件的研究包括明确报告T1D患者DME患病率、发病率、自然史或危险因素的原始观察性研究。未区分T1D和T2D的研究被排除。使用NIH标准评估偏倚风险。采用元分析和元回归进行数据综合。结果：在纳入的63项研究中，27项符合荟萃分析的条件，包括40个不同的研究人群和总共20,074名患者。T1D患者DME的总患病率为11.1% （95% CI: 7.9-14.3%, I2=99.6%）。meta回归发现疾病持续时间和HbA1c是重要的预测因素：在样本均值（19.9年糖尿病；HbA1c 8.6%），调整后的患病率为14.8%。疾病每增加一年，患病率平均增加1.2个百分点，糖化血红蛋白每增加1%，患病率平均增加4.7个百分点。其他因素如高血压、血脂异常和肾病也与较高的DME患病率相关。使用GRADE方法，证据的确定性被评为非常低。结论：DME在T1D中的患病率很高，与病程和血糖控制密切相关。尽管如此，鉴于证据的确定性非常低，这些发现应谨慎解释。这些发现强调了个性化筛查间隔和早期干预策略的必要性。未来的研究应侧重于完善诊断标准，整合新兴的生物标志物，并评估新型糖尿病管理技术的影响。
{"title":"Prevalence and Risk Factors of Diabetic Macular Edema in Type 1 Diabetes","authors":"Pedro Marques-Couto MD , João Afonso MD , Inês Coelho-Costa MD , João Sérgio Neves MD, PhD , Manuel Falcão MD, PhD , Rita Laiginhas MD, PhD","doi":"10.1016/j.oret.2025.09.008","DOIUrl":"10.1016/j.oret.2025.09.008","url":null,"abstract":"<div><h3>Topic</h3><div>This systematic review and meta-analysis investigates the prevalence, natural history, clinical risk factors, and distinctive characteristics of diabetic macular edema (DME) in type 1 diabetes mellitus (T1D), highlighting comparisons with type 2 diabetes mellitus (T2D).</div></div><div><h3>Clinical Relevance</h3><div>Diabetic macular edema is the most common vision-threatening complication of diabetic retinopathy, significantly impacting quality of life. Although extensively studied in T2D, data in T1D remains limited, restricting targeted prevention and management. Given the increasing longevity of individuals with T1D, understanding its specific risk profile is critical to refine screening and treatment guidelines.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was registered (PROSPERO: CRD420251011398) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was performed in MedLine (via PubMed), Scopus, and Web of Science databases (July 15, 2024). Eligible studies included original observational studies explicitly reporting prevalence, incidence, natural history, or risk factors of DME in patients with T1D. Studies not differentiating T1D from T2D were excluded. The risk of bias was assessed using National Institutes of Health criteria. Meta-analysis and meta-regression were used for data synthesis.</div></div><div><h3>Results</h3><div>Of the 63 studies included, 27 were eligible for meta-analysis, encompassing 40 distinct study populations and a total of 20 074 patients. The pooled prevalence of DME in T1D was 11.1% (95% confidence interval: 7.9%–14.3%, <em>I</em><sup>2</sup> = 99.6%). Meta-regression identified disease duration and hemoglobin A1c (HbA1c) as significant predictors: at the sample means (19.9 years of diabetes; HbA1c 8.6%), the adjusted prevalence was 14.8%. Each additional year of disease increased prevalence by 1.2 percentage points, and each 1% increase in HbA1c raised prevalence by 4.7 percentage points, on average. Additional factors such as hypertension, dyslipidemia, and nephropathy were also associated with higher DME prevalence. The certainty of the evidence was rated as very low using the GRADE approach.</div></div><div><h3>Conclusion</h3><div>Diabetic macular edema prevalence in T1D is substantial, with a strong dependency on disease duration and glycemic control. Nonetheless, these findings should be interpreted with caution given the very low certainty of the evidence. These findings highlight the need for personalized screening intervals and early intervention strategies. Future research should focus on refining diagnostic criteria, integrating emerging biomarkers, and evaluating the impact of novel diabetes management technologies.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this art","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Pages 294-309"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186627","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 : 2026-03-01Epub Date: 2025-07-08DOI: 10.1016/j.oret.2025.06.008
Vivek K. Jha MS, Abhishek Das MS, Parag K. Shah DNB
{"title":"The “Moth-Eaten” Signature: OCT Clues to Astrocytic Hamartoma","authors":"Vivek K. Jha MS, Abhishek Das MS, Parag K. Shah DNB","doi":"10.1016/j.oret.2025.06.008","DOIUrl":"10.1016/j.oret.2025.06.008","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Page e19"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584387","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 : 2026-03-01Epub Date: 2025-07-26DOI: 10.1016/j.oret.2025.07.001
Shu Yu Qian MD , Marc Saab MD
{"title":"Choroidal Metastasis in a Man with Breast Cancer Causing Retinal Detachment","authors":"Shu Yu Qian MD , Marc Saab MD","doi":"10.1016/j.oret.2025.07.001","DOIUrl":"10.1016/j.oret.2025.07.001","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Page e26"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718204","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 : 2026-03-01Epub Date: 2025-09-01DOI: 10.1016/j.oret.2025.08.018
Moiz Lakhani MD(C), BHSc , Angela T.H. Kwan MD(C), MSc , Deeksha Kundapur MD , Marko M. Popovic MD, MPH , Karim F. Damji MD, FRCSC , Bernard R. Hurley MD, FRCSC
<div><h3>Objective</h3><div>Anti-VEGF therapies have transformed the management of neovascular age-related macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion. This class-wide pharmacovigilance study evaluated the disproportionality of reported ocular adverse events (AEs) among anti-VEGF agents using postmarketing data.</div></div><div><h3>Design</h3><div>A population-based, observational pharmacovigilance study.</div></div><div><h3>Participants</h3><div>Reports from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (January 2004–September 2024) for individuals treated with anti-VEGF agents.</div></div><div><h3>Methods</h3><div>Ocular AEs were identified from FAERS, and disproportionality was assessed by comparing each anti-VEGF agent to background reporting using reporting odds ratios (RORs, 95% confidence interval [CI]); signals were considered significant if information component (IC<sub>025</sub>) > 0. Ranibizumab, aflibercept, brolucizumab, and faricimab were evaluated to compare ocular AE profiles among agents.</div></div><div><h3>Main Outcome Measures</h3><div>Disproportionality of reported ocular AEs among anti-VEGF agents.</div></div><div><h3>Results</h3><div>Across included patients receiving anti-VEGF agents with ocular AEs, most were female and aged 65 to 85 years. When comparing intraocular inflammation (IOI) signals across anti-VEGF agents, the strongest association was observed with brolucizumab (ROR = 633.32), followed by faricimab (ROR = 156.44), aflibercept (ROR = 51.29), and ranibizumab (ROR = 16.90). Faricimab was notably associated with elevated disproportionality signals for reports of anterior segment inflammation, including anterior chamber flare (ROR = 270.95), unspecified anterior chamber inflammation (ROR = 226.28), iridocyclitis (ROR = 214.60), and iritis (ROR = 88.90). For posterior segment involvement, increased reporting of vitritis was observed with brolucizumab (ROR = 1769.33), faricimab (ROR = 466.99), aflibercept (ROR = 165.31), and ranibizumab (ROR = 56.67). Rare but clinically significant complications were reported across all agents, including for reports of endophthalmitis (aflibercept ROR = 208.88, ranibizumab ROR = 114.69, faricimab ROR = 99.75, and brolucizumab ROR = 56.15), noninfectious endophthalmitis (aflibercept, ROR = 846.11, 244.42 for brolucizumab, 65.45 for ranibizumab, and 59.08 for faricimab), and pseudoendophthalmitis, which showed the strongest signal with faricimab (ROR = 262.31; all 95% CI = 29.37–649.50, <em>P</em> < 0.0001, IC<sub>025</sub> > 0). Faricimab also demonstrated increased reporting of retinal vascular inflammation but showed comparatively lower signals for noninflammatory occlusive events and other serious ocular complications relative to other anti-VEGF agents.</div></div><div><h3>Conclusions</h3><div>This global pharmacovigilance study revealed variability in ocular AE reporting across
{"title":"Association of Anti-VEGF Therapy with Reported Ocular Adverse Events","authors":"Moiz Lakhani MD(C), BHSc , Angela T.H. Kwan MD(C), MSc , Deeksha Kundapur MD , Marko M. Popovic MD, MPH , Karim F. Damji MD, FRCSC , Bernard R. Hurley MD, FRCSC","doi":"10.1016/j.oret.2025.08.018","DOIUrl":"10.1016/j.oret.2025.08.018","url":null,"abstract":"<div><h3>Objective</h3><div>Anti-VEGF therapies have transformed the management of neovascular age-related macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion. This class-wide pharmacovigilance study evaluated the disproportionality of reported ocular adverse events (AEs) among anti-VEGF agents using postmarketing data.</div></div><div><h3>Design</h3><div>A population-based, observational pharmacovigilance study.</div></div><div><h3>Participants</h3><div>Reports from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (January 2004–September 2024) for individuals treated with anti-VEGF agents.</div></div><div><h3>Methods</h3><div>Ocular AEs were identified from FAERS, and disproportionality was assessed by comparing each anti-VEGF agent to background reporting using reporting odds ratios (RORs, 95% confidence interval [CI]); signals were considered significant if information component (IC<sub>025</sub>) > 0. Ranibizumab, aflibercept, brolucizumab, and faricimab were evaluated to compare ocular AE profiles among agents.</div></div><div><h3>Main Outcome Measures</h3><div>Disproportionality of reported ocular AEs among anti-VEGF agents.</div></div><div><h3>Results</h3><div>Across included patients receiving anti-VEGF agents with ocular AEs, most were female and aged 65 to 85 years. When comparing intraocular inflammation (IOI) signals across anti-VEGF agents, the strongest association was observed with brolucizumab (ROR = 633.32), followed by faricimab (ROR = 156.44), aflibercept (ROR = 51.29), and ranibizumab (ROR = 16.90). Faricimab was notably associated with elevated disproportionality signals for reports of anterior segment inflammation, including anterior chamber flare (ROR = 270.95), unspecified anterior chamber inflammation (ROR = 226.28), iridocyclitis (ROR = 214.60), and iritis (ROR = 88.90). For posterior segment involvement, increased reporting of vitritis was observed with brolucizumab (ROR = 1769.33), faricimab (ROR = 466.99), aflibercept (ROR = 165.31), and ranibizumab (ROR = 56.67). Rare but clinically significant complications were reported across all agents, including for reports of endophthalmitis (aflibercept ROR = 208.88, ranibizumab ROR = 114.69, faricimab ROR = 99.75, and brolucizumab ROR = 56.15), noninfectious endophthalmitis (aflibercept, ROR = 846.11, 244.42 for brolucizumab, 65.45 for ranibizumab, and 59.08 for faricimab), and pseudoendophthalmitis, which showed the strongest signal with faricimab (ROR = 262.31; all 95% CI = 29.37–649.50, <em>P</em> < 0.0001, IC<sub>025</sub> > 0). Faricimab also demonstrated increased reporting of retinal vascular inflammation but showed comparatively lower signals for noninflammatory occlusive events and other serious ocular complications relative to other anti-VEGF agents.</div></div><div><h3>Conclusions</h3><div>This global pharmacovigilance study revealed variability in ocular AE reporting across","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Pages 265-282"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992642","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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