To evaluate the 2-year visual, refractive, and anatomical outcomes of a foldable single-piece intraocular lens (IOL) specifically designed for sutureless intrascleral fixation in eyes without adequate capsular support.
Design
Prospective, observational, multicenter study.
Participants
Two hundred thirty-four eyes of 232 patients undergoing secondary IOL implantation using a standardized sutureless intrascleral fixation technique.
Methods
All eyes received a foldable, 1-piece acrylic IOL implanted via a scleral flap technique. Best-corrected visual acuity (BCVA), spherical equivalent (SE), refractive prediction error (PE), and endothelial cell density (ECD) were assessed at baseline, 12 months, and 24 months. A subgroup analysis using anterior segment OCT evaluated IOL tilt, decentration, and surgically induced astigmatism (SIA), Multivariate regression explored biometric predictors of refractive outcomes.
Main Outcome Measures
Changes in BCVA, refractive stability, PE, IOL tilt and decentration, ECD, and postoperative complications.
Results
Mean BCVA improved from 0.74 ± 0.30 to 0.26 ± 0.24 logMAR at 24 months (P < 0.001). Spherical equivalent changed from 3.52 ± 5.92 diopters (D) at baseline to –0.33 ± 0.85 D at 24 months (P < 0.001). A PE within ±1.00 D was achieved in 77% of eyes. Mean absolute SIA remained stable (0.86 ± 0.44 D at 12 months vs. 0.90 ± 0.62 D at 24 months; P = 0.911). Intraocular lens tilt and decentration showed no significant change over time. ECD was preserved (P = 0.895). Visual decline occurred in 2.56% of eyes and no cases of IOL dislocation or endophthalmitis were observed.
Conclusions
Sutureless intrascleral fixation of a single-piece foldable IOL may lead to sustained visual improvement, high refractive accuracy, stable anatomical positioning, and a low rate of complications over 24 months. This technique demonstrates good tolerability and is associated with favorable visual outcomes for secondary implantation in eyes lacking capsular support.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Two-Year Visual, Refractive, and Anatomical Outcomes of Sutureless, Intrascleral, 1-Piece Intraocular Lens Fixation","authors":"Paola Marolo MD , Guglielmo Parisi MD , Fabio Conte MD , Francesca Cimorosi MD , Davide Tibaldi MD , Matteo Fallico PhD , Mario Damiano Toro PhD , Enrico Borrelli PhD , Lorenzo Motta MD , Agostino S. Vaiano MD , Michele Reibaldi PhD","doi":"10.1016/j.oret.2025.09.005","DOIUrl":"10.1016/j.oret.2025.09.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the 2-year visual, refractive, and anatomical outcomes of a foldable single-piece intraocular lens (IOL) specifically designed for sutureless intrascleral fixation in eyes without adequate capsular support.</div></div><div><h3>Design</h3><div>Prospective, observational, multicenter study.</div></div><div><h3>Participants</h3><div>Two hundred thirty-four eyes of 232 patients undergoing secondary IOL implantation using a standardized sutureless intrascleral fixation technique.</div></div><div><h3>Methods</h3><div>All eyes received a foldable, 1-piece acrylic IOL implanted via a scleral flap technique. Best-corrected visual acuity (BCVA), spherical equivalent (SE), refractive prediction error (PE), and endothelial cell density (ECD) were assessed at baseline, 12 months, and 24 months. A subgroup analysis using anterior segment OCT evaluated IOL tilt, decentration, and surgically induced astigmatism (SIA), Multivariate regression explored biometric predictors of refractive outcomes.</div></div><div><h3>Main Outcome Measures</h3><div>Changes in BCVA, refractive stability, PE, IOL tilt and decentration, ECD, and postoperative complications.</div></div><div><h3>Results</h3><div>Mean BCVA improved from 0.74 ± 0.30 to 0.26 ± 0.24 logMAR at 24 months (<em>P</em> < 0.001). Spherical equivalent changed from 3.52 ± 5.92 diopters (D) at baseline to –0.33 ± 0.85 D at 24 months (<em>P</em> < 0.001). A PE within ±1.00 D was achieved in 77% of eyes. Mean absolute SIA remained stable (0.86 ± 0.44 D at 12 months vs. 0.90 ± 0.62 D at 24 months; <em>P</em> = 0.911). Intraocular lens tilt and decentration showed no significant change over time. ECD was preserved (<em>P</em> = 0.895). Visual decline occurred in 2.56% of eyes and no cases of IOL dislocation or endophthalmitis were observed.</div></div><div><h3>Conclusions</h3><div>Sutureless intrascleral fixation of a single-piece foldable IOL may lead to sustained visual improvement, high refractive accuracy, stable anatomical positioning, and a low rate of complications over 24 months. This technique demonstrates good tolerability and is associated with favorable visual outcomes for secondary implantation in eyes lacking capsular support.</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 3","pages":"Pages 335-343"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113772","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: 2025-10-14DOI: 10.1016/j.oret.2025.10.006
Geoffrey K. Broadhead MBBS, PhD , Long Phan PhD , Tiarnán D.L. Keenan BM BCh, PhD , Jennifer Chin BOptom , Thomas Hong PhD , Emily Y. Chew MD , Andrew A. Chang MBBS, PhD
Topic
To evaluate the currently used definitions of treatment resistance in common retinal vascular diseases (neovascular age-related macular degeneration [nAMD], diabetic macular edema [DME], and retinal vein occlusion [RVO]) through a systematic scoping review of published studies.
Clinical Relevance
A notable proportion of patients receiving therapy for retinal vascular diseases exhibit suboptimal responses to anti-VEGF therapy, however, currently there are no well-recognized definitions of resistance to treatment in these conditions. Clear definitions of treatment resistance would aid in developing treatment strategies and guiding research studies for these patients.
Methods
The online databases PubMed, EMBASE, and the Cochrane Database of Systemic Reviews were searched on January 5, 2025, and August 16, 2025, for articles relating to treatment resistance in all 3 conditions.
Results
In total, 402 publications were identified, of which 88 met the eligibility criteria: 30 relating to nAMD, 48 relating to DME, and 10 relating to RVO. Wide heterogeneity exists in the definition of treatment resistance for each condition. Persistent intraretinal fluid and/or subretinal fluid (SRF) on OCT is the most commonly used criterion in each condition. Duration of prior treatment for defining resistance is commonly longest for nAMD, however, treatment frequency of approximately ≤6 weekly injections for defining resistance was generally similar across all 3 conditions.
Conclusion
There is wide variability in the definitions used, however, persistent intraretinal and/or SRF on OCT despite regular anti-VEGF therapy of approximately ≤6 weekly intervals are the most common criteria across all 3 conditions. Adoption of these definitions for future studies would help ensure consistency and may potentially improve patient outcomes by improving the validity of future studies and allowing for the development of treatment paradigms to manage this patient subgroup.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"How to Judge Failure","authors":"Geoffrey K. Broadhead MBBS, PhD , Long Phan PhD , Tiarnán D.L. Keenan BM BCh, PhD , Jennifer Chin BOptom , Thomas Hong PhD , Emily Y. Chew MD , Andrew A. Chang MBBS, PhD","doi":"10.1016/j.oret.2025.10.006","DOIUrl":"10.1016/j.oret.2025.10.006","url":null,"abstract":"<div><h3>Topic</h3><div>To evaluate the currently used definitions of treatment resistance in common retinal vascular diseases (neovascular age-related macular degeneration [nAMD], diabetic macular edema [DME], and retinal vein occlusion [RVO]) through a systematic scoping review of published studies.</div></div><div><h3>Clinical Relevance</h3><div>A notable proportion of patients receiving therapy for retinal vascular diseases exhibit suboptimal responses to anti-VEGF therapy, however, currently there are no well-recognized definitions of resistance to treatment in these conditions. Clear definitions of treatment resistance would aid in developing treatment strategies and guiding research studies for these patients.</div></div><div><h3>Methods</h3><div>The online databases PubMed, EMBASE, and the Cochrane Database of Systemic Reviews were searched on January 5, 2025, and August 16, 2025, for articles relating to treatment resistance in all 3 conditions.</div></div><div><h3>Results</h3><div>In total, 402 publications were identified, of which 88 met the eligibility criteria: 30 relating to nAMD, 48 relating to DME, and 10 relating to RVO. Wide heterogeneity exists in the definition of treatment resistance for each condition. Persistent intraretinal fluid and/or subretinal fluid (SRF) on OCT is the most commonly used criterion in each condition. Duration of prior treatment for defining resistance is commonly longest for nAMD, however, treatment frequency of approximately ≤6 weekly injections for defining resistance was generally similar across all 3 conditions.</div></div><div><h3>Conclusion</h3><div>There is wide variability in the definitions used, however, persistent intraretinal and/or SRF on OCT despite regular anti-VEGF therapy of approximately ≤6 weekly intervals are the most common criteria across all 3 conditions. Adoption of these definitions for future studies would help ensure consistency and may potentially improve patient outcomes by improving the validity of future studies and allowing for the development of treatment paradigms to manage this patient subgroup.</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 3","pages":"Pages 250-264"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308769","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: 2026-03-03DOI: 10.1016/j.oret.2025.11.012
Michael F. Marmor MD
{"title":"A New Visual Field for Hydroxychloroquine Screening","authors":"Michael F. Marmor MD","doi":"10.1016/j.oret.2025.11.012","DOIUrl":"10.1016/j.oret.2025.11.012","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Pages 221-222"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366162","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: 2025-09-09DOI: 10.1016/j.oret.2025.09.002
Victor Bellanda MD , Adrienne Delaney MD , Matthew J. Schulgit BS , Gabriel Castilho S. Barbosa MD , Andrea Arline MS , Yuka Mizuno MD , Nitesh Mohan BS , Bhairavi Rajasekar BS, MS , Suraj Bala BS , Madina Mahmoud BS , Allison Winter BS , Bolisa Savic RN, BSN , Stacie Dempsey , Kimberly Baynes RN, MSN , Sumit Sharma MD , Pulkit Chaudhury MD , Sunil K. Srivastava MD
Purpose
Retinal ischemic perivascular lesions (RIPLs) are OCT findings associated with chronic retinal ischemia. Previous studies have proposed that RIPLs may serve as anatomical biomarkers for cardiovascular disease; however, their clinical significance remains uncertain. This study aims to evaluate the prevalence of RIPLs in a cardiovascular clinic and assess their association with major adverse cardiovascular events (MACE).
Design
Observational cross-sectional study of prospectively enrolled patients.
Participants
A total of 559 patients undergoing cardiovascular ultrasound at a vascular imaging laboratory.
Methods
Nonmydriatic 6 × 6 mm OCT angiography scans were obtained on the same day of ultrasound, and RIPLs were manually identified based on inner retinal layer thinning with compensatory outer nuclear layer expansion.
Main Outcome Measures
The prevalence of RIPLs was compared between patients with and without a history of MACE, defined as prior myocardial infarction (MI), stroke, transient ischemic attack (TIA), or coronary/carotid revascularization.
Results
Among 559 included patients (mean age 61.9 ± 12.5 years; 54.4% female), 26.3% had at least 1 RIPL. A history of MACE was present in 35.1% of patients; however, the prevalence of RIPLs did not differ significantly between those with MACE (28.6%) and those without (25.1%) (P = 0.426), despite the MACE group having a higher prevalence of traditional cardiovascular risk factors, including hypertension, dyslipidemia, diabetes, and smoking history (P < 0.05). Similarly, no significant differences were found in subgroup analyses of patients with prior MI (P = 0.688), stroke/TIA (P = 0.394), or revascularization (P = 0.369). The prevalence of RIPLs did not differ across atherosclerotic cardiovascular disease risk categories in patients without prior MACE.
Conclusions
In this large, prospectively enrolled cardiovascular cohort, RIPLs were found in only a quarter of eyes, providing preliminary evidence for their prevalence in this population. Additionally, RIPLs were not significantly associated with a history of MACE. Although RIPLs may reflect microvascular pathology, these findings challenge prior reports linking them to broader systemic cardiovascular disease and call for prospective longitudinal studies to clarify their clinical utility in cardiovascular risk assessment.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Screening for Retinal Ischemic Perivascular Lesions in Patients Undergoing Cardiovascular Assessment","authors":"Victor Bellanda MD , Adrienne Delaney MD , Matthew J. Schulgit BS , Gabriel Castilho S. Barbosa MD , Andrea Arline MS , Yuka Mizuno MD , Nitesh Mohan BS , Bhairavi Rajasekar BS, MS , Suraj Bala BS , Madina Mahmoud BS , Allison Winter BS , Bolisa Savic RN, BSN , Stacie Dempsey , Kimberly Baynes RN, MSN , Sumit Sharma MD , Pulkit Chaudhury MD , Sunil K. Srivastava MD","doi":"10.1016/j.oret.2025.09.002","DOIUrl":"10.1016/j.oret.2025.09.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Retinal ischemic perivascular lesions (RIPLs) are OCT findings associated with chronic retinal ischemia. Previous studies have proposed that RIPLs may serve as anatomical biomarkers for cardiovascular disease; however, their clinical significance remains uncertain. This study aims to evaluate the prevalence of RIPLs in a cardiovascular clinic and assess their association with major adverse cardiovascular events (MACE).</div></div><div><h3>Design</h3><div>Observational cross-sectional study of prospectively enrolled patients.</div></div><div><h3>Participants</h3><div>A total of 559 patients undergoing cardiovascular ultrasound at a vascular imaging laboratory.</div></div><div><h3>Methods</h3><div>Nonmydriatic 6 × 6 mm OCT angiography scans were obtained on the same day of ultrasound, and RIPLs were manually identified based on inner retinal layer thinning with compensatory outer nuclear layer expansion.</div></div><div><h3>Main Outcome Measures</h3><div>The prevalence of RIPLs was compared between patients with and without a history of MACE, defined as prior myocardial infarction (MI), stroke, transient ischemic attack (TIA), or coronary/carotid revascularization.</div></div><div><h3>Results</h3><div>Among 559 included patients (mean age 61.9 ± 12.5 years; 54.4% female), 26.3% had at least 1 RIPL. A history of MACE was present in 35.1% of patients; however, the prevalence of RIPLs did not differ significantly between those with MACE (28.6%) and those without (25.1%) (<em>P</em> = 0.426), despite the MACE group having a higher prevalence of traditional cardiovascular risk factors, including hypertension, dyslipidemia, diabetes, and smoking history (<em>P</em> < 0.05). Similarly, no significant differences were found in subgroup analyses of patients with prior MI (<em>P</em> = 0.688), stroke/TIA (<em>P</em> = 0.394), or revascularization (<em>P</em> = 0.369). The prevalence of RIPLs did not differ across atherosclerotic cardiovascular disease risk categories in patients without prior MACE.</div></div><div><h3>Conclusions</h3><div>In this large, prospectively enrolled cardiovascular cohort, RIPLs were found in only a quarter of eyes, providing preliminary evidence for their prevalence in this population. Additionally, RIPLs were not significantly associated with a history of MACE. Although RIPLs may reflect microvascular pathology, these findings challenge prior reports linking them to broader systemic cardiovascular disease and call for prospective longitudinal studies to clarify their clinical utility in cardiovascular risk assessment.</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 3","pages":"Pages 344-352"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040805","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: 2025-10-08DOI: 10.1016/j.oret.2025.09.015
John Brown BS , Curtis Heisel MD , Nick Boucher BS , Nitika Aggarwal BS , Rusirini Fernando BS , Nikoo Hamzeh MD, MPH , Palak Patel MD , Mathew MacCumber MD, PhD , Manjot K. Gill MD, MS
Purpose
To identify risk factors in diagnosis of second-eye posterior vitreous detachment (PVD) after first-eye PVD and subsequent complications.
Design
Multicenter, retrospective observational study. Participants: 22.525 patients with first-eye PVD (2015-2024) from the CorEvitas Vestrum Health Database.
Methods
Onset of fellow eye PVD and development of fellow eye complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute unilateral PVD and throughout at 9-year study period.
Main Outcome Measures
Time to develop fellow eye PVD following acute unilateral PVD and risk factors associated with developing complications in fellow eye after PVD.
Results
Of 22 525 patients, 38.3% were diagnosed with complications after first-eye PVD within 1 year (24.3% vitreous hemorrhage [VH], 24.1% retinal break [RB], 5.2% retinal detachment [RD]). Second-eye PVD occurred in 21.2% of the 22,525 patients.
The median time to diagnosis of second-eye PVD was 37 months, with 74.5% of patients diagnosed with a second-eye PVD having it within 72 months. Increased risk of second-eye PVD was associated with first-eye VH (hazard ratio [HR] 1.08, P = 0.027), first-eye RB (HR 1.13, P < 0.001), lattice degeneration in either eye (HR 1.09, P = 0.037), and pseudophakia in the second eye (HR 1.21, P < 0.001). Age >65 years (HR 0.79, P < 0.001) and male gender (HR 0.93, P = 0.022) reduced risk. In eyes that experienced a second-eye PVD, 33.2% had associated complications, of which 21.1% were detected within 12 months. Risk factors included male gender (HR 1.46, P < 0.001), lattice degeneration in either eye (HR 1.38, P < 0.001), and first-eye VH (HR 2.09, P < 0.001), RB (HR 1.78, P < 0.001), or RD (HR 1.35, P = 0.004). Any complication in the first-eye PVD (HR 3.66, P < 0.001) greatly increased risk. Age >65 years reduced complication risk (HR 0.77, P < 0.001).
Conclusions
After first-eye PVD, second-eye PVD may occur after several years, necessitating the need for continuous follow-up especially in higher risk groups such as younger patients, patients with first-eye VH and RB, those with pseudophakia in the second eye, and those with lattice degeneration in either eye. After onset of second-eye PVD, high-risk groups such as male patients, those with lattice degeneration in either eye, or any history of complications in the first-eye PVD warrant closer and longer follow-up because of greater risk for complications after second-eye PVD.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：探讨第一只眼PVD后第二只眼PVD诊断的危险因素及其并发症。方法：这项多中心、回顾性、观察性研究分析了来自CorEvitas Vestrum健康数据库的22525例第一眼PVD患者（2015-2024）。结果：22525例患者中，有38.3%的患者在一年内出现首发眼PVD并发症（其中玻璃体出血[VH]占24.3%，视网膜破裂[RB]占24.1%，视网膜脱离[RD]占5.2%）。22525例患者中，第二眼PVD发生率为21.2%。诊断第二眼PVD的中位时间为37个月，其中74.5%的第二眼PVD患者在72个月内确诊。第二眼PVD的风险增加与第一眼VH （HR 1.08, p = 0.027）、第一眼RB （HR 1.13, p < 0.001）、双眼点阵变性（HR 1.09, p = 0.037）和第二眼假性晶状体（HR 1.21, p < 0.001）相关。年龄小于65岁（HR 0.79, p < 0.001）和男性（HR 0.93, p = 0.022）降低风险。33.2%的第二眼PVD患者有相关并发症，其中21.1%在12个月内被发现。危险因素包括男性（HR 1.46, p < 0.001）、双眼晶格变性（HR 1.38, p < 0.001）和第一只眼VH （HR 2.09, p < 0.001）、RB （HR 1.78, p < 0.001）或RD （HR 1.35, p = 0.004）。第一只眼PVD的任何并发症（HR 3.66, p < 0.001）都大大增加了风险。65岁降低并发症风险（HR 0.77, p < 0.001）。结论：继第一眼PVD后，第二眼PVD可能在数年后发生，特别是在年轻患者、第一眼VH和RB患者、第二眼假性晶状体患者和双眼晶格变性患者等高危人群中，需要持续随访。第二眼PVD发病后，由于第二眼PVD并发症的风险较大，男性患者、双眼晶格变性患者或有第一眼PVD并发症史的高危人群需要更密切和更长时间的随访。
{"title":"Analysis of Fellow Eye Posterior Vitreous Detachment and Complications Using a Large Database of Retina Specialists","authors":"John Brown BS , Curtis Heisel MD , Nick Boucher BS , Nitika Aggarwal BS , Rusirini Fernando BS , Nikoo Hamzeh MD, MPH , Palak Patel MD , Mathew MacCumber MD, PhD , Manjot K. Gill MD, MS","doi":"10.1016/j.oret.2025.09.015","DOIUrl":"10.1016/j.oret.2025.09.015","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify risk factors in diagnosis of second-eye posterior vitreous detachment (PVD) after first-eye PVD and subsequent complications.</div></div><div><h3>Design</h3><div>Multicenter, retrospective observational study. Participants: 22.525 patients with first-eye PVD (2015-2024) from the CorEvitas Vestrum Health Database.</div></div><div><h3>Methods</h3><div>Onset of fellow eye PVD and development of fellow eye complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute unilateral PVD and throughout at 9-year study period.</div></div><div><h3>Main Outcome Measures</h3><div>Time to develop fellow eye PVD following acute unilateral PVD and risk factors associated with developing complications in fellow eye after PVD.</div></div><div><h3>Results</h3><div>Of 22 525 patients, 38.3% were diagnosed with complications after first-eye PVD within 1 year (24.3% vitreous hemorrhage [VH], 24.1% retinal break [RB], 5.2% retinal detachment [RD]). Second-eye PVD occurred in 21.2% of the 22,525 patients.</div><div>The median time to diagnosis of second-eye PVD was 37 months, with 74.5% of patients diagnosed with a second-eye PVD having it within 72 months. Increased risk of second-eye PVD was associated with first-eye VH (hazard ratio [HR] 1.08, <em>P</em> = 0.027), first-eye RB (HR 1.13, <em>P</em> < 0.001), lattice degeneration in either eye (HR 1.09, <em>P</em> = 0.037), and pseudophakia in the second eye (HR 1.21, <em>P</em> < 0.001). Age >65 years (HR 0.79, <em>P</em> < 0.001) and male gender (HR 0.93, <em>P</em> = 0.022) reduced risk. In eyes that experienced a second-eye PVD, 33.2% had associated complications, of which 21.1% were detected within 12 months. Risk factors included male gender (HR 1.46, <em>P</em> < 0.001), lattice degeneration in either eye (HR 1.38, <em>P</em> < 0.001), and first-eye VH (HR 2.09, <em>P</em> < 0.001), RB (HR 1.78, <em>P</em> < 0.001), or RD (HR 1.35, <em>P</em> = 0.004). Any complication in the first-eye PVD (HR 3.66, <em>P</em> < 0.001) greatly increased risk. Age >65 years reduced complication risk (HR 0.77, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>After first-eye PVD, second-eye PVD may occur after several years, necessitating the need for continuous follow-up especially in higher risk groups such as younger patients, patients with first-eye VH and RB, those with pseudophakia in the second eye, and those with lattice degeneration in either eye. After onset of second-eye PVD, high-risk groups such as male patients, those with lattice degeneration in either eye, or any history of complications in the first-eye PVD warrant closer and longer follow-up because of greater risk for complications after second-eye PVD.</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 3","pages":"Pages 310-319"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275202","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: 2025-07-14DOI: 10.1016/j.oret.2025.06.011
Jade Y. Moon MD, Sandra R. Montezuma MD
{"title":"Retinal Vascular Malformation due to Multifocal Sporadic Venous Malformation","authors":"Jade Y. Moon MD, Sandra R. Montezuma MD","doi":"10.1016/j.oret.2025.06.011","DOIUrl":"10.1016/j.oret.2025.06.011","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 3","pages":"Page e22"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637683","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: 2025-09-16DOI: 10.1016/j.oret.2025.09.004
Frank G. Holz MD , Focke Ziemssen MD , Ulrike Bauer-Steinhusen PhD , Joachim Wachtlin MD , Markus Schürks MD , Katrin Lorenz MD , Paula Scholz MD , Tobias Machewitz MSc , Christine Rech PhD , Ines Lanzl MD , Albrecht Lommatzsch MD , Robert P. Finger MD , ANDROMEDA Study Group
Purpose
The ANDROMEDA (intravitreal Aflibercept in Neovascular amD: an obseRvational study assessing patient relevant OutcoMes, rEal-worlD treatment pattern And effectiveness) study was planned to assess adherence to intravitreal aflibercept (IVT-AFL) 2 mg treatment over 24 months for neovascular age-related macular degeneration (nAMD) and to identify patient- and physician-related factors for nonadherence (NA) in clinical settings.
Treatment-naïve and previously treated adult patients with nAMD under IVT-AFL treatment from 41 centers in Germany.
Methods
Time to first occurrence of NA was analyzed descriptively using Kaplan–Meier methods followed by a Cox model to explore the potential impact of patient- and physician-related factors on NA. Participants reported reasons for NA in standardized telephone interviews.
Main Outcome Measures
Primary endpoints were time to first occurrence of and reasons for NA. Secondary endpoints included change in best-corrected visual acuity and central retinal thickness from baseline to months 4, 12, and 24.
Results
The median time to first NA was 180 days in the 509 study participants (mean age: 77.2 years; 57.2% female). Among them, 44.0% were treatment-naïve, 22.6% were previously treated with IVT-AFL, and 33.4% were previously treated with other anti-VEGF agents (VEGF). Adherence rates, particularly among treatment-naïve participants, fell early and markedly: 69.6% at 4 months (95% confidence interval [CI]: 62.9%–75.3%), 53.0% at 12 months (95% CI: 46.0%–59.5%), and 40.1% at 24 months (95% CI: 33.3%–46.9%). Key risk factors for NA (hazard ratio [HR] <1 indicating a higher risk of NA for the mentioned factor, HR > 1 indicating a lower risk for the mentioned factor) included presence of any “other diseases” in the treatment-naïve cohort at baseline (HR: 0.57; 95% CI: 0.37–0.88), and patient-reported “lack of information for accompanying persons” (HR: 1.36; 95% CI: 1.03–1.79), involvement of referrals and multiple providers (HR: 0.76; 95% CI: 0.60–0.97), and “bilateral AMD” (HR: 0.73; 95% CI: 0.57–0.93) in the total cohort.
Conclusions
In the ANDROMEDA study, key determinants of NA were comorbidities, bilateral disease, treatment by multiple providers, and a lack of patient caregiver education. Thus, better adherence may be achieved through holistic patient management, considering additional disease parameters, single-center treatment, and improved (caregiver) education.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Adherence to Intravitreal Aflibercept in Neovascular Age-Related Macular Degeneration","authors":"Frank G. Holz MD , Focke Ziemssen MD , Ulrike Bauer-Steinhusen PhD , Joachim Wachtlin MD , Markus Schürks MD , Katrin Lorenz MD , Paula Scholz MD , Tobias Machewitz MSc , Christine Rech PhD , Ines Lanzl MD , Albrecht Lommatzsch MD , Robert P. Finger MD , ANDROMEDA Study Group","doi":"10.1016/j.oret.2025.09.004","DOIUrl":"10.1016/j.oret.2025.09.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The ANDROMEDA (intravitreal Aflibercept in Neovascular amD: an obseRvational study assessing patient relevant OutcoMes, rEal-worlD treatment pattern And effectiveness) study was planned to assess adherence to intravitreal aflibercept (IVT-AFL) 2 mg treatment over 24 months for neovascular age-related macular degeneration (nAMD) and to identify patient- and physician-related factors for nonadherence (NA) in clinical settings.</div></div><div><h3>Design</h3><div>Prospective, observational, noncontrolled, multicenter cohort study.</div></div><div><h3>Subjects</h3><div>Treatment-naïve and previously treated adult patients with nAMD under IVT-AFL treatment from 41 centers in Germany.</div></div><div><h3>Methods</h3><div>Time to first occurrence of NA was analyzed descriptively using Kaplan–Meier methods followed by a Cox model to explore the potential impact of patient- and physician-related factors on NA. Participants reported reasons for NA in standardized telephone interviews.</div></div><div><h3>Main Outcome Measures</h3><div>Primary endpoints were time to first occurrence of and reasons for NA. Secondary endpoints included change in best-corrected visual acuity and central retinal thickness from baseline to months 4, 12, and 24.</div></div><div><h3>Results</h3><div>The median time to first NA was 180 days in the 509 study participants (mean age: 77.2 years; 57.2% female). Among them, 44.0% were treatment-naïve, 22.6% were previously treated with IVT-AFL, and 33.4% were previously treated with other anti-VEGF agents (VEGF). Adherence rates, particularly among treatment-naïve participants, fell early and markedly: 69.6% at 4 months (95% confidence interval [CI]: 62.9%–75.3%), 53.0% at 12 months (95% CI: 46.0%–59.5%), and 40.1% at 24 months (95% CI: 33.3%–46.9%). Key risk factors for NA (hazard ratio [HR] <1 indicating a higher risk of NA for the mentioned factor, HR > 1 indicating a lower risk for the mentioned factor) included presence of any “other diseases” in the treatment-naïve cohort at baseline (HR: 0.57; 95% CI: 0.37–0.88), and patient-reported “lack of information for accompanying persons” (HR: 1.36; 95% CI: 1.03–1.79), involvement of referrals and multiple providers (HR: 0.76; 95% CI: 0.60–0.97), and “bilateral AMD” (HR: 0.73; 95% CI: 0.57–0.93) in the total cohort.</div></div><div><h3>Conclusions</h3><div>In the ANDROMEDA study, key determinants of NA were comorbidities, bilateral disease, treatment by multiple providers, and a lack of patient caregiver education. Thus, better adherence may be achieved through holistic patient management, considering additional disease parameters, single-center treatment, and improved (caregiver) education.</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 3","pages":"Pages 241-249"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086596","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: 2025-10-28DOI: 10.1016/j.oret.2025.10.015
Ko Eun Kim MD, PhD , Hyeon Yoon Kwon MD , Seong Joon Ahn MD, PhD
Purpose
To evaluate the diagnostic performance of the Humphrey 24-2C visual field (VF) protocol compared with the standard 10-2 and 30-2 strategies for detecting parafoveal and pericentral hydroxychloroquine (HCQ) retinopathy.
In total, 1081 patients (2104 eyes) receiving HCQ therapy without confounding ocular pathology were screened for retinopathy at a tertiary center between January 2021 and April 2025. The cohort included 1011 patients without retinopathy and 70 with confirmed retinopathy.
Methods
Participants underwent swept-source OCT, fundus autofluorescence, and Humphrey VF testing using the 10-2 Swedish Interactive Thresholding Algorithm (SITA) Fast, 24-2C SITA Faster, and/or 30-2 SITA Fast protocols. Retinopathy was defined according to the American Academy of Ophthalmology guidelines as the presence of at least 2 abnormalities on structural and/or functional tests. Sensitivity and specificity of each VF protocol were evaluated against OCT as the gold standard.
Main Outcome Measures
Sensitivity and specificity of the 10-2, 24-2C, and 30-2 protocols.
Results
In early cases without definitive OCT changes (ellipsoid zone loss), parafoveal retinopathy was detected in 71.4% with the 10-2, 57.1% with the 24-2C, and 28.6% with the 30-2. Early pericentral defects were detected on the 24-2C and 30-2 in 57.1% versus 9.5% on the 10-2. The 24-2C’s sensitivity matched that of the 10-2 for parafoveal disease (94.7%) and was comparable with the 30-2 for pericentral disease (90.8% vs 85.5%). Receiver operating characteristic analysis using the 24-2C yielded areas under the curve of 0.844 for mean deviation, 0.881 for pattern standard deviation, and 0.887 for VF index in detecting retinopathy. The mean test duration for 24-2C was 164.8 ± 40.2 seconds, significantly shorter than for 30-2 (253.2 ± 79.1 seconds; P < 0.001) among eyes that underwent both tests; among those tested with both 10-2 and 24-2C, 24-2C was also faster than 10-2 (237.4 ± 64.8 seconds; P = 0.001).
Conclusions
The Humphrey 24-2C protocol offers a reliable, time-efficient, and single-test solution for screening both parafoveal and pericentral HCQ retinopathy, with diagnostic performance comparable with that of the 10-2 protocol for parafoveal retinopathy and 30-2 protocol for pericentral one.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：评价Humphrey 24-2C视野（VF）方案与标准10-2和30-2策略在检测中央凹旁和中心周围羟氯喹（HCQ）视网膜病变中的诊断性能。设计：回顾性横断面诊断有效性评估。参与者：在2021年1月至2025年4月期间，共有1081名接受HCQ治疗的患者（2104只眼睛）在三级中心接受视网膜病变筛查。该队列包括1011名无视网膜病变患者和70名确诊视网膜病变患者。方法：参与者使用10-2瑞典交互式阈值算法（SITA） Fast、24-2C SITA Faster和/或30-2 SITA Fast协议进行扫描源光学相干断层扫描（OCT）、眼底自身荧光（FAF）和Humphrey VF测试。根据美国眼科学会的指南，视网膜病变被定义为在结构和/或功能检查中至少存在两种异常。以OCT为金标准评价各VF方案的敏感性和特异性。主要结局指标：10-2、24-2C和30-2方案的敏感性和特异性。结果：在无明确OCT改变（椭球区丢失）的早期病例中，10-2组71.4%，24-2C组57.1%，30-2组28.6%检出视网膜旁凹病变。24-2C和30-2的早期中心周围缺损检出率为57.1%，而10-2的检出率为9.5%。24-2C的敏感性与10-2对中央凹旁疾病的敏感性（94.7%）相当，与30-2对中央周围疾病的敏感性相当（90.8%对85.5%）。采用24-2C进行受试者工作特征分析，发现视网膜病变的平均偏差为0.844，模式标准差为0.881，视野指数为0.887。24-2C的平均检测时间为164.8±40.2秒，明显短于30-2（253.2±79.1秒）；P结论：Humphrey 24-2C方案为筛查中央凹旁和中央周HCQ视网膜病变提供了可靠、高效、单次检测的解决方案，其诊断性能与10-2方案诊断中央凹旁视网膜病变和30-2方案诊断中央周HCQ病变相当。
{"title":"Diagnostic Accuracy of a Humphrey 24-2C Protocol for Simultaneous Parafoveal and Pericentral Hydroxychloroquine Retinopathy Screening","authors":"Ko Eun Kim MD, PhD , Hyeon Yoon Kwon MD , Seong Joon Ahn MD, PhD","doi":"10.1016/j.oret.2025.10.015","DOIUrl":"10.1016/j.oret.2025.10.015","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic performance of the Humphrey 24-2C visual field (VF) protocol compared with the standard 10-2 and 30-2 strategies for detecting parafoveal and pericentral hydroxychloroquine (HCQ) retinopathy.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional diagnostic validity assessment.</div></div><div><h3>Participants</h3><div>In total, 1081 patients (2104 eyes) receiving HCQ therapy without confounding ocular pathology were screened for retinopathy at a tertiary center between January 2021 and April 2025. The cohort included 1011 patients without retinopathy and 70 with confirmed retinopathy.</div></div><div><h3>Methods</h3><div>Participants underwent swept-source OCT, fundus autofluorescence, and Humphrey VF testing using the 10-2 Swedish Interactive Thresholding Algorithm (SITA) Fast, 24-2C SITA Faster, and/or 30-2 SITA Fast protocols. Retinopathy was defined according to the American Academy of Ophthalmology guidelines as the presence of at least 2 abnormalities on structural and/or functional tests. Sensitivity and specificity of each VF protocol were evaluated against OCT as the gold standard.</div></div><div><h3>Main Outcome Measures</h3><div>Sensitivity and specificity of the 10-2, 24-2C, and 30-2 protocols.</div></div><div><h3>Results</h3><div>In early cases without definitive OCT changes (ellipsoid zone loss), parafoveal retinopathy was detected in 71.4% with the 10-2, 57.1% with the 24-2C, and 28.6% with the 30-2. Early pericentral defects were detected on the 24-2C and 30-2 in 57.1% versus 9.5% on the 10-2. The 24-2C’s sensitivity matched that of the 10-2 for parafoveal disease (94.7%) and was comparable with the 30-2 for pericentral disease (90.8% vs 85.5%). Receiver operating characteristic analysis using the 24-2C yielded areas under the curve of 0.844 for mean deviation, 0.881 for pattern standard deviation, and 0.887 for VF index in detecting retinopathy. The mean test duration for 24-2C was 164.8 ± 40.2 seconds, significantly shorter than for 30-2 (253.2 ± 79.1 seconds; <em>P</em> < 0.001) among eyes that underwent both tests; among those tested with both 10-2 and 24-2C, 24-2C was also faster than 10-2 (237.4 ± 64.8 seconds; <em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>The Humphrey 24-2C protocol offers a reliable, time-efficient, and single-test solution for screening both parafoveal and pericentral HCQ retinopathy, with diagnostic performance comparable with that of the 10-2 protocol for parafoveal retinopathy and 30-2 protocol for pericentral one.</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 3","pages":"Pages 223-230"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409126","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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