Ophthalmology. Retina最新文献_第3页

Internal Limiting Membrane Flap and Insertion Techniques Improve Prognosis in Macular Hole-Associated Retinal Detachment 内限定膜瓣及植入术可改善黄斑孔相关性视网膜脱离的预后。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.07.006

Ke Zhu MD , Boya Lei MD , Ling Wang PhD , Ling Chen PhD , Yingqin Ni PhD , Yanqiong Zhang PhD , Xin Huang PhD , Qing Chang PhD , Gezhi Xu PhD

Purpose

To compare the long-term anatomic and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.

Design

Retrospective and comparative study.

Participants

Two hundred eighty-eight patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.

Methods

Two hundred ninety-five eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade, and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.

Main Outcome Measures

Anatomic and visual outcomes of MHRD treated with ILM peeling, insertion, or flap techniques.

Results

The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs 87% vs 54%, P < 0.001) along with a greater BCVA improvement (P < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs 83%, P < 0.005). In eyes with non-high myopia (axial length <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomic advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion, and ILM flap techniques were significantly associated with MH closure (P = 0.011, 0.001, and P < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (P = 0.003, 0.009, 0.006, and 0.014 and P < 0.001, respectively).

Conclusions

The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.

Financial Disclosure(s)

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

目的：比较内限制膜（ILM）剥离、内限制膜插入和内限制膜瓣倒置技术治疗黄斑孔（MH）相关性视网膜脱离（MHRD）的长期解剖和视觉效果。设计：回顾性和对比性研究参与者：288例在复旦大学眼耳鼻喉科医院行玻璃体切除和ILM技术的MHRD患者。方法：将295只眼分为ILM剥离组（138眼）、ILM插入组（54眼）和ILM皮瓣组（103眼），并根据视网膜脱离程度、非高度/高度近视、增殖性玻璃体视网膜病变（PVR）程度和脉络膜视网膜萎缩（CA）程度进行细分。评估初始视网膜再附着率、MH闭合率、术后最佳矫正视力（BCVA）及BCVA改善情况。主要观察指标：采用ILM剥离、插入或皮瓣技术治疗MHRD的解剖和视觉效果。结果：与ILM剥离相比，ILM皮瓣和插入技术具有更好的初始MH关闭率（91% vs. 87% vs. 54%, P < 0.001）以及更大的BCVA改善（P < 0.001）。采用ILM皮瓣技术改善BCVA的眼睛比例高于ILM植入术（96%比83%，P < 0.005）。结论：与ILM剥离技术相比，ILM插入和皮瓣技术治疗MHRD具有更高的MH闭合率和BCVA改善。在功能恢复方面，ILM皮瓣技术优于ILM插入技术。

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引用次数: 0

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

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

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

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

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

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

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

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

Main outcome measures: Development of AD, VD, and all-cause dementia.

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

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

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

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

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引用次数: 0

Regression of Retinal Metastasis with Combined Chemotherapy and Immunotherapy 化疗与免疫联合治疗视网膜转移的消退。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.05.016

Prithvi Ramtohul MD , Laurent Greillier MD, PhD , Thierry David MD, PhD

引用次数: 0

Intraoperative Fragmatome Fracture in a Posterior Lens Dislocation 后晶状体脱位术中碎块骨折。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.05.001

Ashish Markan MD, MCh , Saloni Une MBBS , Ramandeep Singh MS

引用次数: 0

Intraretinal Fluid Resolution in Macular Hole Surgery without Face-Down Position 非面朝下体位黄斑孔手术视网膜内液体溶解。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.09.006

Maiko Maruyama-Inoue MD, Shin Tanaka MD, Tatsuya Inoue MD, Yasuo Yanagi MD, Shohei Kawasaki OD, Kazuaki Kadonosono MD

引用次数: 0

Topographic Features in Retinopathy of Prematurity With en Face Ultra-Widefield OCT 早产儿视网膜病变的正面超宽视场光学相干断层成像的地形图特征。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.07.003

David A. Sutter BS , Mani K. Woodward BS , John Jackson MD , Yakub Bayhaqi PhD , Aaron S. Coyner PhD , Shuibin Ni PhD , Susan Ostmo MS , Michael F. Chiang MD , Benjamin K. Young MD , Yifan Jian PhD , John Peter Campbell MD, MPH

Purpose

This study presents 2 methods of en face visualization enabled by ultra-widefield (UWF) OCT, which provide topographic information of retinopathy of prematurity (ROP) without requiring direct visualization of cross-sectional scans.

Design

Evaluation of diagnostic technology.

Subjects

Infants undergoing ROP screening at Oregon Health Science University between June 2023 and October 2024, who consented to research imaging.

Methods

An investigational contact-based UWF-OCT captured 800 × 800 A-scans. Max intensity projections (MIP) were constructed, from the highest intensity pixel in each A-scan's x-y coordinate plane. Retinal thickness maps (RTMs) were generated by first segmenting the retina with a previously trained U-net, then calculating the retinal thickness at each position in microns, and displaying it with a topographic colormap.

Main Outcome Measures

Cross-sectional and longitudinal qualitative evaluation of the diagnostic utility of MIP and RTM across the spectrum of ROP stage.

Results

MIP highlights areas of high signal attenuation, such as blood vessels and the atypical neurovascular thickening accompanying stage 1 or greater ROP. Retinal thickness maps reflect thickness information in the retina that highlights complementary aspects of the progression and spectrum of the stage. Retinal thickness maps also reveal subclinical elements of ROP morphology, such as the foveal contour, in some cases “stage 0” ROP, and cystoid macular edema.

Conclusions

This study presents 2 techniques to visualize pathology in ROP from UWF-OCT. Together, they enable both high-contrast visualization of the vascular features of ROP and the associated topographic changes across the spectrum of ROP.

Financial Disclosure(s)

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

目的：介绍两种基于超宽视场光学相干断层扫描（UWF-OCT）的面部可视化方法，该方法可提供早产儿视网膜病变（ROP）的地形信息，而无需直接可视化横断面扫描。设计：诊断技术评估受试者：2023年6月至2024年10月期间在OHSU接受ROP筛查的婴儿，同意进行研究成像。方法：基于接触的UWF-OCT采集800x800 a扫描。从每个a扫描X-Y坐标平面上的最高强度像素构建最大强度投影（MIP）。视网膜厚度图（RTMs）的生成方法是：首先用事先训练好的U-net对视网膜进行分割，然后以微米为单位计算视网膜在每个位置的厚度，并用地形色图显示。主要结果测量：横截面和纵向定性评价MIP和RTM在整个ROP阶段的诊断效用。结果：MIP突出高信号衰减区域，如血管和伴有1期或更大ROP的非典型神经血管增厚。RTMs反映视网膜的厚度信息，突出了阶段进展和频谱的互补方面。RTM还显示了ROP形态的亚临床特征，如中央凹轮廓，在某些情况下为“0期”ROP，以及黄斑囊样水肿。结论：本研究提出了两种利用超宽视场光学相干断层扫描（UWF-OCT）可视化ROP病理的技术。总之，它们既可以实现ROP血管特征的高对比度可视化，也可以实现ROP频谱中相关的地形变化。

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引用次数: 0

Association of Low Serum Vitamin D Levels with Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Repair 低血清维生素D水平与孔源性视网膜脱离修复后增殖性玻璃体视网膜病变的关系。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.07.014

Steven Ness MD , Rin Mitsiades BS , Vasiliki Poulaki MD, PhD

Objective

To evaluate whether low serum vitamin D level is a risk factor for proliferative vitreoretinopathy (PVR) after primary rhegmatogenous retinal detachment (RRD) repair.

Design

Retrospective, multisite, case–control study.

Participants

Subjects undergoing pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB for primary RRD in the Veterans Administration Healthcare System between January 1, 2015, and January 1, 2020. Subjects were required to have a serum 25-hydroxy vitamin D measurement within 1 year of RRD surgery and to have greater than 90 days' follow-up after surgery.

Methods

Clinic notes and operative reports were reviewed to collect the following data points: sex, race, age, geographic location, date of diagnosis, eye laterality, macula and lens status, symptom duration, date and type of surgery, number and location of retinal tears, extent of RRD, presence of vitreous hemorrhage or choroidal detachment, date and level of vitamin D laboratory draw, development of PVR, and need for additional surgeries.

Main Outcome Measures

Incidence of PVR after surgical RRD repair comparing the normal and low vitamin D groups.

Results

A total of 313 subjects met inclusion criteria, of whom 119 (38.0%) had serum vitamin D levels below the laboratory normal limit. Most subjects were male (96.4%) and White (82.4%). Among all subjects, 42 (13.4%) were diagnosed with PVR after initial surgical repair. On univariate analysis, subjects with low vitamin D levels were almost 4 times more likely to develop PVR than those with normal vitamin D levels (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.98–7.87; P < 0.001). This association of vitamin D level and PVR remained significant in multivariable analysis (OR, 4.27; 95% CI, 2.09–8.69; P < 0.001) and when only considering subjects with a vitamin D laboratory draw before or within 90 days of RRD diagnosis. When evaluating vitamin D level as a continuous variable, each 1 ng/mL decrease in serum vitamin D below the laboratory specified lower limit of normal resulted in a 4% increase in the risk of PVR development (OR, 1.04; 95% CI, 1.02–1.08; P = 0.002).

Conclusions

To the best of our knowledge, this study is the first to report an association between low serum vitamin D levels and an increased risk of PVR development after RRD repair. Future studies with more diverse patient populations are required to verify this potential association.

Financial Disclosure(s)

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

目的：探讨低血清维生素D水平是否是原发性孔源性视网膜脱离（RRD）修复后增殖性玻璃体视网膜病变（PVR）的危险因素。设计：回顾性、多地点、病例对照研究参与者：在2015年1月1日至2020年1月1日期间，在退伍军人管理局医疗保健系统中接受玻璃体切割（PPV）、巩膜扣（SB）或PPV/SB联合治疗原发性RRD的受试者。受试者被要求在RRD手术后1年内进行血清25-羟基维生素D测量，并在手术后随访超过90天。方法：回顾临床记录和手术报告，收集以下数据点：性别、种族、年龄、地理位置、诊断日期、眼睛侧边、黄斑和晶状体状态、症状持续时间、手术日期和类型、视网膜撕裂的数量和位置、RRD的程度、玻璃体出血或脉络膜脱离的存在、维生素D实验室提取的日期和水平、PVR的发展以及是否需要额外的手术。结果：共有313名受试者符合纳入标准，其中119名（38.0%）血清维生素D水平低于实验室正常限度。以男性（96.4%）和白种人（82.4%）居多。在所有受试者中，42例（13.4%）在首次手术修复后被诊断为PVR。在单因素分析中，维生素D水平低的受试者发生PVR的可能性几乎是维生素D水平正常受试者的4倍（OR 3.95, 95% CI 1.98-7.87）。结论：据我们所知，本研究首次报道了低血清维生素D水平与RRD修复后PVR发生风险增加之间的关联。未来需要更多不同患者群体的研究来验证这种潜在的关联。

{"title":"Association of Low Serum Vitamin D Levels with Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Repair","authors":"Steven Ness MD , Rin Mitsiades BS , Vasiliki Poulaki MD, PhD","doi":"10.1016/j.oret.2025.07.014","DOIUrl":"10.1016/j.oret.2025.07.014","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether low serum vitamin D level is a risk factor for proliferative vitreoretinopathy (PVR) after primary rhegmatogenous retinal detachment (RRD) repair.</div></div><div><h3>Design</h3><div>Retrospective, multisite, case–control study.</div></div><div><h3>Participants</h3><div>Subjects undergoing pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB for primary RRD in the Veterans Administration Healthcare System between January 1, 2015, and January 1, 2020. Subjects were required to have a serum 25-hydroxy vitamin D measurement within 1 year of RRD surgery and to have greater than 90 days' follow-up after surgery.</div></div><div><h3>Methods</h3><div>Clinic notes and operative reports were reviewed to collect the following data points: sex, race, age, geographic location, date of diagnosis, eye laterality, macula and lens status, symptom duration, date and type of surgery, number and location of retinal tears, extent of RRD, presence of vitreous hemorrhage or choroidal detachment, date and level of vitamin D laboratory draw, development of PVR, and need for additional surgeries.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of PVR after surgical RRD repair comparing the normal and low vitamin D groups.</div></div><div><h3>Results</h3><div>A total of 313 subjects met inclusion criteria, of whom 119 (38.0%) had serum vitamin D levels below the laboratory normal limit. Most subjects were male (96.4%) and White (82.4%). Among all subjects, 42 (13.4%) were diagnosed with PVR after initial surgical repair. On univariate analysis, subjects with low vitamin D levels were almost 4 times more likely to develop PVR than those with normal vitamin D levels (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.98–7.87; <em>P</em> < 0.001). This association of vitamin D level and PVR remained significant in multivariable analysis (OR, 4.27; 95% CI, 2.09–8.69; <em>P</em> < 0.001) and when only considering subjects with a vitamin D laboratory draw before or within 90 days of RRD diagnosis. When evaluating vitamin D level as a continuous variable, each 1 ng/mL decrease in serum vitamin D below the laboratory specified lower limit of normal resulted in a 4% increase in the risk of PVR development (OR, 1.04; 95% CI, 1.02–1.08; <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge, this study is the first to report an association between low serum vitamin D levels and an increased risk of PVR development after RRD repair. Future studies with more diverse patient populations are required to verify this potential association.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 17-25"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Spontaneous Collapse of Retinoschisis Due to Formation of Outer Layer Breaks 由于外层破裂形成的视网膜裂的自发塌陷。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.04.014

Amreen Qureshi MBBS, FRCOphth, Shivesh Varma MBBS, FRANZCO, Daniel Chiu MBBS, FRANZCO

引用次数: 0

Late-Onset Retinoblastoma 晚发性视网膜母细胞瘤：5岁以上儿童的临床和遗传特征。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.07.012

William I. Evans MD , Barrett N. Thompson MD , Benjamin A. King MD , Rose B. McGee MS, CGC , Cassi-Jo Groshek PA-C , Ibrahim Qaddoumi MD , Carlos Rodriguez-Galindo MD , Rachel C. Brennan MD , Matthew W. Wilson MD

Objective

To define the clinical features and genetics of children with retinoblastoma diagnosed at ≥5 years of age.

Design

Retrospective review.

Subjects

Children ≥5 years of age treated for retinoblastoma at a single institution between January 1999 and January 2022.

Methods

A chart review including demographics, genetic testing, laterality, presenting signs and symptoms, initial diagnosis if not retinoblastoma, and procedures performed on affected eyes before diagnosis of retinoblastoma.

Main Outcome Measures

Tumor classification, treatments and outcomes, and genetic data on tumors.

Results

Of the 529 retinoblastoma patients identified, 25 (4.7%) were diagnosed at ≥5 years of age (median age 6.0 years, range 5.1–11.3 years). Most patients (24 of 25, 96%) presented with unilateral disease. Nine of 25 (36%) were misdiagnosed before presentation. Pathogenic RB1 germline mutations were identified in 6 of the 24 (25%) patients who underwent testing; 1 child had a positive family history. Further evaluation in 6 tumors (from 6 patients) identified hypermethylation of the RB1 gene promoter in 2 patients.

Conclusions

Older children with retinoblastoma are commonly misdiagnosed before presentation. Germline predisposition to retinoblastoma was more common than anticipated for patients with late-onset unilateral disease. This may have important implications for treatment and prognosis.

Financial Disclosure(s)

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

背景：超过90%的视网膜母细胞瘤儿童在5岁时被诊断出来。诊断时超过这个年龄的儿童是一个独特的人群，误诊和延误治疗的风险更大。这些患者被认为是散发疾病，由于出现较晚和单侧优势。目的：探讨5岁以上儿童视网膜母细胞瘤的临床特征和遗传学特征。设计：回顾性研究对象：1999年1月至2022年1月在单一机构接受视网膜母细胞瘤治疗的5岁或5岁以上儿童。方法：图表回顾，包括人口统计学、基因检测、侧边性、表现体征和症状、如果不是视网膜母细胞瘤的初步诊断，以及在视网膜母细胞瘤诊断之前对受影响的眼睛进行的手术。结果：在529例视网膜母细胞瘤患者中，25例（4.7%）在≥5岁时确诊（中位年龄6.0岁，范围5.1 - 11.3岁）。大多数患者（25例中的24例，96%）表现为单侧疾病。25例中有9例（36%）在就诊前被误诊。24名接受检测的患者中有6名（25%）发现了致病性RB1种系突变；一个孩子有阳性家族史。在6个肿瘤（来自6名患者）的进一步评估中，2名患者发现了RB1基因启动子的超甲基化。结论：大龄儿童视网膜母细胞瘤在发病前常被误诊。视网膜母细胞瘤的生殖系易感性在迟发性单侧疾病患者中比预期的更常见。这可能对治疗和预后有重要意义。

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引用次数: 0

Visual Outcomes in Cases of Endogenous Endophthalmitis 内源性眼内炎（VOICE）病例的视力结果：一项多中心研究。

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2026-01-01 DOI: 10.1016/j.oret.2025.07.009

Peter J. Weng MD, PhD , Richmond Woodward MD , Walter Duy MD , Gabriel Gomide MD , Ahmed Alshaikhsalama MD , Krista Thompson MD , Bita Momenaei MD , Thomas Jenkins MD , Peter Fioramonti BS , Lauren Dimalanta BS , Joel Epling MD , David Hinkle MD , Alice Yang Zhang MD , Mark Breazzano MD , Sunir Garg MD , Angeline L. Wang MD , Royce Chen MD , Margaret Greven MD , Sharon Fekrat MD

Purpose

To assess factors affecting visual outcomes in endogenous endophthalmitis (EE).

Design

Retrospective cohort study from 8 tertiary care centers.

Participants

Eyes with EE and at least 4 weeks of follow-up.

Methods

Demographics, visual acuity (VA), vitrectomy use, and microbial cultures from blood, aqueous, or vitreous fluid were collected and evaluated relative to change in VA and enucleation/evisceration.

Main Outcome Measures

Presenting VA and microbial culture results associated with improvements to VA.

Results

Two hundred sixty-two eyes from 231 patients diagnosed with EE were evaluated. Eyes presenting with VA of either count fingers or hand motion (CF/HM) had significantly greater improvement in VA, compared with eyes presenting with either VA ≥20/800 or VA of light perception (LP) or no LP (less than or equal to LP) (P < 0.01). Twenty-eight eyes underwent enucleation/evisceration, and 23 (82.1%) of these eyes had VA less than or equal to LP at presentation. Forty-six point 9 percent of all study eyes (139 of 262) were from patients with positive blood cultures. Positive growth from blood cultures was associated with greater odds of VA improvement (odds ratio [OR]: 1.78, confidence interval [CI]: 1.07–2.95, P = 0.03) in all study eyes and reduced odds of enucleation/evisceration in eyes presenting with VA less than or equal to LP (OR: 0.12, CI: 0.04–0.42, P < 0.001). Compared with eyes from patients with positive blood cultures, eyes from patients with negative blood cultures had significantly lower rates of treatment with both systemic antimicrobials and intravitreal antimicrobial injections (P < 0.001). In eyes from patients with negative blood cultures, there was a trend for greater improvement after initial treatment with both antibacterial and antifungal injections compared with initial treatment with either antibacterial or antifungal injection alone (P = 0.05).

Conclusions

Eyes presenting with a VA of CF/HM have the greatest potential for VA improvement. Patients with EE without any organisms identified on blood cultures may benefit from broad initial intravitreal antimicrobial coverage to reduce the odds of worsening VA.

Financial Disclosure(s)

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

目的：探讨内源性眼内炎（EE）患者视力预后的影响因素。设计：来自8个三级医疗中心的回顾性队列研究。参与者：患有内源性眼内炎的眼睛，随访至少4周。方法：收集人口统计学、视力（VA）、玻璃体切除术的使用，以及血液、水或玻璃体液中的微生物培养物，并评估VA和去核/去内脏的变化。主要结果测量：显示VA和与VA改善相关的微生物培养结果。结果：对231例EE患者的262只眼睛进行了评估。与VA≥20/800或VA光觉或无光觉（≤LP）的眼相比，以数指或手部运动VA （CF/HM）为表现的眼的VA改善显著（p < 0.01）。28只眼行去核/剜出，23只眼（82.1%）就诊时VA≤LP。46.9%的眼睛（139/262）来自血培养阳性患者。在所有研究的眼睛中，血液培养的阳性生长与VA改善的几率更大（OR: 1.78, CI: 1.07 - 2.95, p = 0.03）相关，并且与VA≤LP的眼睛中去核/内脏切除的几率降低相关（OR: 0.12, CI: 0.04 - 0.42, p < 0.001）。与血培养阳性患者的眼睛相比，血培养阴性患者的眼睛接受全身抗菌素和玻璃体内抗菌素注射的治疗率明显较低（p < 0.001）。在血培养阴性患者的眼睛中，与单独使用抗菌或抗真菌注射相比，首次使用抗菌和抗真菌注射后有更大的改善趋势（p = 0.05）。结论：CF/HM的VA有很大的改善潜力。在血液培养中未发现任何微生物的EE患者可能受益于广泛的初始玻璃体内抗菌药物覆盖，以减少VA恶化的几率。

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引用次数: 0