Ophthalmology. Retina最新文献

{"title":"Subfoveal Deposits in Morquio Syndrome","authors":"","doi":"10.1016/j.oret.2024.02.014","DOIUrl":"10.1016/j.oret.2024.02.014","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194319","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}

{"title":"Academic versus Community Retinal Surgery for Primary Retinal Detachment","authors":"","doi":"10.1016/j.oret.2024.04.021","DOIUrl":"10.1016/j.oret.2024.04.021","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare operative time and case characteristics of primary rhegmatogenous retinal detachment (RRD) repairs between academic and community vitreoretinal surgeons.</div></div><div><h3>Design</h3><div>A retrospective, observational clinical study.</div></div><div><h3>Subjects</h3><div>Patients who underwent primary RRD repair surgeries at Massachusetts Eye and Ear between 2019 and 2021.</div></div><div><h3>Methods</h3><div>A random sample of 20 vitreoretinal surgeons distributed evenly among the academic or community setting was selected. Fifteen consecutive cases of primary RRD repair surgeries were included from each surgeon. A cost analysis was performed for the teaching modifier for the physician fee and for hospital costs.</div></div><div><h3>Main Outcome Measures</h3><div>Length of surgery.</div></div><div><h3>Results</h3><div>Of 300 primary RRD repairs, fellows were present in 75%, which comprised all academic surgeon cases and 50% of community surgeon cases, <em>P</em> &lt; 0.001. Mean operation length was shorter for community surgeon cases without fellows (55.0 ± 24.1) than either academic (73.0 ± 30.8) or community surgeon cases with fellows (75.7 ± 32.5) (<em>P</em> &lt; 0.001). There was a higher percentage of macula-off RRDs in academic versus community surgeon cases (52.7% vs. 38.0%, <em>P</em><span> = 0.002) and higher rates of combined scleral buckle (SB)/pars plana vitrectomy (PPV) repairs (14% vs. 3%, </span><em>P</em> &lt; 0.001). When excluding combined SB/PPV cases, there was no difference in operative time between academic and community surgeon cases. Among RRDs repaired by PPV only, there was a 31.4% (16.6 minutes) greater procedure duration in cases with fellows compared with cases without fellows (<em>P</em><span><span> &lt; 0.001). Covariates associated with greater surgery time: addition of an SB (β = 32.6), membrane peel (β = 18.5), presence of a fellow (β = 14.5), proliferative vitreoretinopathy (β = 12.8), and greater number of </span>retinal breaks (β = 2.4). The teaching modifier adds 16% extra reimbursement ($184.16) to the physician fee, which is 50.9% of what is necessary to cover the percentage increase in surgeon time (31.4%). Using a time-driven activity-based costing for hospital costs, the extra 16.6 minutes leads to an additional $1038.00, which is 5.6 times more than the reimbursement for the modifier.</span></div></div><div><h3>Conclusions</h3><div>Retinal detachment repair cases performed by academic surgeons are more likely to be macula-off and include the addition of an SB, which drive longer operative times. Medicare’s reimbursement of the assistant modifier in a teaching facility significantly undercompensates the time-driven activity-based costing of trainee participation.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861171","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}

{"title":"Influence of Vitreous Cortex Remnants on Normal Retinal Anatomy in Eyes with Primary Rhegmatogenous Retinal Detachment","authors":"","doi":"10.1016/j.oret.2024.04.015","DOIUrl":"10.1016/j.oret.2024.04.015","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the influence of vitreous cortex remnants (VCRs) removal on normal retinal anatomy in eyes with rhegmatogenous retinal detachment (RRD).</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Subjects</h3><div>Patients with primary RRD operated with pars plana vitrectomy (PPV).</div></div><div><h3>Methods</h3><div>Blue fundus autofluorescence and spectral-domain OCT were obtained preoperatively, and at 1 and 6 months after operation.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcomes: rate of retinal displacement and outer retinal folds (ORFs) at 1 month after operation. Secondary outcomes: continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ), and the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at 6 months after operation.</div></div><div><h3>Results</h3><div>One hundred three eyes were included. Intraoperatively, peripheral VCRs (pVCRs) were found in 42 eyes (40.8%) and successfully peeled off from ≥2 quadrants in 37 eyes. Macular VCRs (mVCRs) were detected in 37 (35.9%) and successfully peeled off in 29 eyes. At the end of operation 44.7% and 55.3% of the eyes were tamponaded with 20% sulfur hexafluoride gas and silicone oil 1000 centistokes, respectively. The only variable significantly associated with displacement was the use of gas tamponade versus silicone oil (<em>P</em> = 0.001), whereas no significant association was found between retinal displacement and pVCRs (<em>P</em> = 0.58) or number of quadrants from which pVCRs were peeled off (<em>P</em> = 0.39). At 1 month postoperatively, ORFs were globally detected in 24 eyes (23.3%). Regression analysis showed a direct correlation between ORFs and the intraoperative detection of mVCRs (<em>P</em> = 0.02) and an indirect correlation between ORFs and mVCRs peeling (<em>P</em> = 0.004). Macular VCRs peeling did not influence the continuity of ELM and EZ at the 6-month follow-up (FU). Intraoperative absence of mVCRs (<em>P</em> = 0.0016) and peeling of mVCRs (<em>P</em> = 0.003) were associated with logMAR BCVA ≤0.3 at the 6-month FU.</div></div><div><h3>Conclusions</h3><div>Peeling of pVCRs did not seem to influence the rate of retinal displacement, whereas peeling of mVCRs was associated with a reduced risk of developing ORFs without detrimental effect on the continuity of ELM/EZ at 6-month FU. The patients without mVCRs detected intraoperatively, or who underwent mVCRs peeling during operation, showed a significantly better visual acuity at the 6-month FU.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Blue-Light Autofluorescence and Ultrawidefield Green-Light Autofluorescence for Assessing Geographic Atrophy","authors":"","doi":"10.1016/j.oret.2024.04.017","DOIUrl":"10.1016/j.oret.2024.04.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The goal of this study was to evaluate and compare the intermodality and interreader agreement of manual and semiautomated geographic atrophy<span> (GA) area measurements in eyes with GA due to age-related macular degeneration (AMD) using conventional blue-light fundus autofluorescence (FAF) and ultrawidefield (UWF) green-light FAF systems.</span></div></div><div><h3>Design</h3><div>Prospective Cohort Study.</div></div><div><h3>Subjects</h3><div>Seventy-two eyes of 50 patients with a diagnosis of advanced nonneovascular AMD with GA.</div></div><div><h3>Methods</h3><div>Fundus autofluorescence images of eyes with GA were obtained during a single visit using both the Spectralis HRA + OCT2 device and the Optos California device. The area of the GA lesion(s) was segmented and quantified (mm²) with a fully manual approach where the lesions were outlined using Optos Advance and Heidelberg Eye Explorer (HEYEX) software. In addition, for the Heidelberg blue FAF images, GA lesions were also measured using the instrument’s semiautomated software (Region Finder 2.6.4). For comparison between modalities/grading method, the mean values of the 2 graders were used. Intraclass correlation coefficients were computed to judge the agreement between graders.</div></div><div><h3>Results</h3><div>Seventy-two eyes of 50 patients were included in this study. There was nearly perfect agreement between graders for the measurement of GA area for all 3 modalities (intraclass correlation coefficient: 0.996 for manual Optos Advance, 0.996 for manual Heidelberg HEYEX, and 0.995 for Heidelberg Region Finder). The measurement of GA area was strongly correlated between modalities, with Spearman correlation coefficients of 0.985 (<em>P</em> &lt; 0.001) between manual Heidelberg and manual Optos, 0.991 (<em>P</em> &lt; 0.001) for Region Finder versus manual Heidelberg, and 0.985 (<em>P</em> &lt; 0.001) for Region Finder versus manual Optos. The absolute mean area differences between the Heidelberg manual versus Region Finder, manual Optos versus Region Finder, and manual Optos versus manual Heidelberg were 1.61 mm² (<em>P</em> &lt; 0.001), 0.90 mm² (<em>P</em> &lt; 0.006), and 0.71 mm² (<em>P</em> &lt; 0.001), respectively.</div></div><div><h3>Conclusions</h3><div>We observed excellent interreader agreement for measurement of GA using either 30-degree blue-light FAF or UWF green-light FAF, establishing the reliability of UWF imaging for macular GA assessment. Although the absolute measurements between devices were strongly correlated, they differed significantly, highlighting the importance of using the same device for a given patient for the duration of a study.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867796","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}

{"title":"Extension of Choroidal Neovascular Membrane into Subhyaloid Space after Trauma","authors":"","doi":"10.1016/j.oret.2024.03.001","DOIUrl":"10.1016/j.oret.2024.03.001","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787619","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}

{"title":"Pattern Macular Dystrophy Caused by CTNNA1 Gene Mutation","authors":"","doi":"10.1016/j.oret.2024.03.003","DOIUrl":"10.1016/j.oret.2024.03.003","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781924","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}

{"title":"Revision of Initial Referral Diagnosis after Genotypic Confirmation of Familial Exudative Vitreoretinopathy","authors":"","doi":"10.1016/j.oret.2024.06.010","DOIUrl":"10.1016/j.oret.2024.06.010","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469810","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}

{"title":"Loss to Follow up in Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States","authors":"","doi":"10.1016/j.oret.2024.04.016","DOIUrl":"10.1016/j.oret.2024.04.016","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the rate of loss to follow up (LTFU) in patients with proliferative diabetic retinopathy<span> (PDR) treated with anti-VEGF therapy and/or panretinal photocoagulation (PRP) in the United States.</span></div></div><div><h3>Design</h3><div>Retrospective cohort study using the national IRIS® (Intelligent Research in Sight) Registry data.</div></div><div><h3>Subjects</h3><div>A total of 73 595 eyes of 56 590 patients with PDR diagnosed between 2013 and 2015 and treated between 2013 and 2018.</div></div><div><h3>Methods</h3><div>Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).</div></div><div><h3>Main Outcome Measures</h3><div>Loss to follow up was no follow up within 12 months from last treatment.</div></div><div><h3>Results</h3><div>For patient eyes treated for PDR, 11.7% (95% CI, 11.5–12.0) were LTFU. Among patients with PDR treated with anti-VEGF therapy alone, PRP alone, and anti-VEGF and PRP, the rates of LTFU were 12.3% (95% CI, 11.8–12.7), 12.6% (95% CI, 12.1–13.0), and 10.8% (95% CI, 10.4–11.1), respectively. Risk factors for LTFU include Black or African American race/ethnicity (odds ratio [OR], 1.26; 95% CI, 1.13–1.41; <em>P</em> &lt; 0.001), Hispanic ethnicity (OR, 1.28; 95% CI, 1.16–1.42; <em>P</em> &lt; 0.001), Native American/Alaska Native or Native Hawaiian/Other Pacific Islander race/ethnicity (OR, 2.69; 95% CI, 2.14–3.38; <em>P</em> &lt; 0.001), and unilateral disease (OR, 2.05; CI, 1.88–2.23; <em>P</em> &lt; 0.001). Odds for LTFU were higher with patients with baseline vision of 20/50 to 20/200 (OR, 1.25; 95% CI, 1.15–1.36; <em>P</em> &lt; 0.001) and with vision worse than 20/200 (OR, 1.22; 95% CI, 1.05–1.42; <em>P</em><span> = 0.01) than for patient eyes with a baseline visual acuity of 20/40 or better. Odds for LTFU were lower for Medicare Fee-for-Service (OR, 0.71; 95% CI, 0.64–0.79; </span><em>P</em> &lt; 0.001) and Medicare Managed (OR, 0.66; 95% CI, 0.56–0.78; <em>P</em> &lt; 0.001) compared with private insurance. Odds for LTFU were lower for patients treated in the Midwest (OR, 0.72; 95% CI, 0.64–0.81; <em>P</em> &lt; 0.001) and West (OR, 0.83; 95% CI, 0.74–0.94; <em>P</em> = 0.003) compared with in the South region.</div></div><div><h3>Conclusions</h3><div>The rate of LTFU is between 10% and 12% among patients with PDR who were treated with anti-VEGF injections and/or PRP. Risk factors include Black or African American race/ethnicity, Hispanic ethnicity, baseline vision worse than 20/40, private insurance, South region, and unilateral disease.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768326","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}

{"title":"Peripapillary Hyperreflective Ovoid Mass-Like Structures in Stickler Syndrome","authors":"","doi":"10.1016/j.oret.2024.05.008","DOIUrl":"10.1016/j.oret.2024.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To report a previously undescribed finding of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in Stickler syndrome.</div></div><div><h3>Design</h3><div>Noncomparative case series.</div></div><div><h3>Subjects</h3><div>Twenty-two eyes with anomalous optic disc from 11 Stickler syndrome patients were identified and imaged.</div></div><div><h3>Methods</h3><div>Peripapillary hyperreflective ovoid mass-like structures were graded using enhanced-depth imaging OCT (EDI-OCT) according to the consensus recommendations of the Optic Disc Drusen Studies Consortium. All EDI-OCT scans were obtained using the Heidelberg Spectralis (Heidelberg Engineering) with a dense horizontal raster (15 × 10°, 97 sections) centered on the optic nerve head and graded by 2 independent assessors. In case of disagreement, the image was graded by a third assessor. The presence of any coexisting optic disc drusen was also assessed using EDI-OCT and autofluorescence.</div></div><div><h3>Main Outcome Measures</h3><div>The presence of PHOMS, clinical characteristics and genetic mutations.</div></div><div><h3>Results</h3><div>A pilot sample of 22 eyes with phenotypic optic disc abnormalities from 11 Stickler syndrome patients were identified and imaged. Eight patients were female and 3 were male. The mean age was 31 years (13–58 years). Peripapillary hyperreflective ovoid mass-like structures were present in 91% (n = 20) of imaged eyes. Seventy percent (n = 14) were type 1 Stickler syndrome and 30% (n = 6) were type 2 Stickler syndrome. All eyes were myopic and the degree of myopia did not seem to affect whether or not PHOMS was present in this cohort. One eye with PHOMS had retinal detachment, and 77.3% (n = 17) of eyes had undergone 360^o prophylactic retinopexy. Thirty-two percent (n = 7) of eyes with PHOMS were present in patients with coexisting hearing loss and 22.7% (n = 5) had orofacial manifestation of Stickler syndrome in the form of a cleft palate. Seventy-seven percent (n = 15) of eyes with PHOMS were present in patients who reported joint laxity or symptoms of arthritis. No coexisting optic disc drusen were identified and raised intracranial pressure was also excluded after neurological investigation.</div></div><div><h3>Conclusions</h3><div>These data suggest that PHOMS are a novel finding in Stickler syndrome patients and should be considered when evaluating the optic nerves of these patients.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Pellegrini et al.: Descemet membrane epiretinal graft for refractory full-thickness macular hole (Ophthalmol Retina. 2024;8:611–613)","authors":"","doi":"10.1016/j.oret.2024.07.005","DOIUrl":"10.1016/j.oret.2024.07.005","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976280","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}