Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.05.024
Prithvi Ramtohul MD, Clément Richard MD, Thierry David MD, PhD
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Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.07.019
Andrew J. Barkmeier MD , Yihong Deng PhD , Kavya Sindhu Swarna MPH , Jeph Herrin PhD , Eric C. Polley PhD , Guillermo E. Umpierrez MD , Rodolfo J. Galindo MD , Joseph S. Ross MD, MHS , Mindy M. Mickelson MA , Rozalina G. McCoy MD, MS
<div><h3>Purpose</h3><div>To investigate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents differ with respect to the risk of developing sight-threatening diabetic retinopathy complications in patients with type 2 diabetes at moderate cardiovascular risk.</div></div><div><h3>Design</h3><div>Retrospective observational study under the target trial emulation framework involving adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014 to December 31, 2022. The study population included adults with type 2 diabetes, moderate cardiovascular disease risk, no baseline advanced diabetic retinopathy, and minimum 1 year enrollment before GLP-1 RA treatment.</div></div><div><h3>Methods</h3><div>Because of differences in GLP-1 RA agent use over time, we performed both a 3-way comparison of patients initiating liraglutide, dulaglutide, or exenatide from January 1, 2015, to December 31, 2021, and a 2-way comparison of patients initiating semaglutide or dulaglutide between January 1, 2019, and December 31, 2021. We assessed differences in complications using inverse propensity score weighted Cox proportional hazards models.</div></div><div><h3>Main Outcome Measures</h3><div>Treatment for diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR).</div></div><div><h3>Results</h3><div>When comparing patients who initiated treatment with exenatide (<em>n</em> = 14 076, median follow-up 969 days; interquartile range [IQR] 578–1444) to those starting dulaglutide (<em>n</em> = 54 787, median follow-up 948 days; IQR 551–1457) or liraglutide (<em>n</em> = 25 562, median follow-up 1007 days; IQR 575–1494), no differences were found in the hazard (hazard ratio [HR]) of composite treatment for DME or PDR: exenatide versus dulaglutide (HR 0.90; 95% confidence interval (CI): 0.73–1.12), liraglutide versus dulaglutide (HR: 0.97; 95% CI: 0.79–1.19), or liraglutide versus exenatide (HR: 1.08; 95% CI: 0.83–1.38), nor were differences found in any comparisons for treatment of DME (HR: 0.93 [95% CI: 0.74–1.18]; HR 0.99 [95% CI: 0.79–1.24]; HR: 1.06 [95% CI: 0.80–1.40]) or PDR individually (HR: 1.16 [95% CI: 0.81–1.67]; HR: 1.05 [95% CI: 0.73–1.51]; HR: 0.91 [95% CI: 0.58–1.40). Likewise, when comparing patients initiating semaglutide (<em>n</em> = 30 911, median follow-up 625 days [IQR: 455–850]) versus dulaglutide (<em>n</em> = 32 844, median follow-up 639 days [IQR: 459–878]), the hazards for treatment of DME or PDR (HR: 0.88; 95% CI: 0.70–1.11), DME (HR: 0.89; 95% CI: 0.69–1.14), and PDR (HR: 0.70; 95% CI: 0.45–1.09) all found no difference between drugs.</div></div><div><h3>Conclusions</h3><div>Despite the differences in systemic efficacy among the examined GLP-1 RAs, we identified no difference in the risk of sight-threatening diabetic retinopathy after initiation of different GLP-1 RA agents among adults with type 2 diabetes at moderate cardiovascular risk.</div></div><
{"title":"Risk of Sight-Threatening Diabetic Retinopathy with Glucagon-Like Peptide-1 Receptor Agonist Use in Routine Clinical Practice","authors":"Andrew J. Barkmeier MD , Yihong Deng PhD , Kavya Sindhu Swarna MPH , Jeph Herrin PhD , Eric C. Polley PhD , Guillermo E. Umpierrez MD , Rodolfo J. Galindo MD , Joseph S. Ross MD, MHS , Mindy M. Mickelson MA , Rozalina G. McCoy MD, MS","doi":"10.1016/j.oret.2025.07.019","DOIUrl":"10.1016/j.oret.2025.07.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents differ with respect to the risk of developing sight-threatening diabetic retinopathy complications in patients with type 2 diabetes at moderate cardiovascular risk.</div></div><div><h3>Design</h3><div>Retrospective observational study under the target trial emulation framework involving adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014 to December 31, 2022. The study population included adults with type 2 diabetes, moderate cardiovascular disease risk, no baseline advanced diabetic retinopathy, and minimum 1 year enrollment before GLP-1 RA treatment.</div></div><div><h3>Methods</h3><div>Because of differences in GLP-1 RA agent use over time, we performed both a 3-way comparison of patients initiating liraglutide, dulaglutide, or exenatide from January 1, 2015, to December 31, 2021, and a 2-way comparison of patients initiating semaglutide or dulaglutide between January 1, 2019, and December 31, 2021. We assessed differences in complications using inverse propensity score weighted Cox proportional hazards models.</div></div><div><h3>Main Outcome Measures</h3><div>Treatment for diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR).</div></div><div><h3>Results</h3><div>When comparing patients who initiated treatment with exenatide (<em>n</em> = 14 076, median follow-up 969 days; interquartile range [IQR] 578–1444) to those starting dulaglutide (<em>n</em> = 54 787, median follow-up 948 days; IQR 551–1457) or liraglutide (<em>n</em> = 25 562, median follow-up 1007 days; IQR 575–1494), no differences were found in the hazard (hazard ratio [HR]) of composite treatment for DME or PDR: exenatide versus dulaglutide (HR 0.90; 95% confidence interval (CI): 0.73–1.12), liraglutide versus dulaglutide (HR: 0.97; 95% CI: 0.79–1.19), or liraglutide versus exenatide (HR: 1.08; 95% CI: 0.83–1.38), nor were differences found in any comparisons for treatment of DME (HR: 0.93 [95% CI: 0.74–1.18]; HR 0.99 [95% CI: 0.79–1.24]; HR: 1.06 [95% CI: 0.80–1.40]) or PDR individually (HR: 1.16 [95% CI: 0.81–1.67]; HR: 1.05 [95% CI: 0.73–1.51]; HR: 0.91 [95% CI: 0.58–1.40). Likewise, when comparing patients initiating semaglutide (<em>n</em> = 30 911, median follow-up 625 days [IQR: 455–850]) versus dulaglutide (<em>n</em> = 32 844, median follow-up 639 days [IQR: 459–878]), the hazards for treatment of DME or PDR (HR: 0.88; 95% CI: 0.70–1.11), DME (HR: 0.89; 95% CI: 0.69–1.14), and PDR (HR: 0.70; 95% CI: 0.45–1.09) all found no difference between drugs.</div></div><div><h3>Conclusions</h3><div>Despite the differences in systemic efficacy among the examined GLP-1 RAs, we identified no difference in the risk of sight-threatening diabetic retinopathy after initiation of different GLP-1 RA agents among adults with type 2 diabetes at moderate cardiovascular risk.</div></div><","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 142-151"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.08.008
Cameron M. Carpenter BS , Aileen G. MacLachlan BS , Caitlyn Y. Kwun BA , Taylor J. Johnson MD , Bryce T. Baugh MD , Guillermo A. Requejo Figueroa BS , Saul Rivera-Flores BS , Xiuzhen Liu PhD , Gregory J. Stoddard MPH , Jessica A. Kraker MD, MS , Eileen S. Hwang MD, PhD
Topic
To compare the relative risk of retinal detachment between patients with COL2A1 and COL11A1 Stickler syndrome.
Clinical Relevance
It is unclear whether the rate of retinal detachment differs between COL2A1 and COL11A1 Stickler syndrome. Previous studies included too few patients to detect a difference between genotypes.
Methods
Individual patient data meta-analysis of cohort studies, case-control studies, cross-sectional studies, case series, and case reports across the MEDLINE, Embase, Scopus, Web of Science Core Collection, and Web of Science Preprint Citation Index databases from 1991 to 2025. Articles providing eye examination results in subjects with genetically confirmed COL2A1 or COL11A1 Stickler syndrome were included. From the included articles, individual patient data on affected gene, age at last follow-up, and presence or absence of retinal detachment were extracted. Patients who had prophylactic retinopexy were excluded. A mixed effects logistic regression adjusted for clustering by article and family was used to determine the relative risk of retinal detachment. A risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. The study was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023428144). The overall certainty of evidence was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation.
Results
Of the 1420 articles screened, 179 were eligible for inclusion, and 141 provided individual patient data for a total of 673 patients from 430 families. Retinal detachment was present in 229 of 491 (47%) patients with COL2A1 Stickler syndrome and 51 of 182 (28%) patients with COL11A1 Stickler syndrome. The relative risk of retinal detachment was 1.78 times higher in COL2A1 compared with COL11A1 Stickler syndrome (95% confidence interval: 1.30–2.43, P < 0.001). The certainty of evidence was moderate.
Conclusion
Our findings indicate a higher risk of retinal detachment in COL2A1 compared with COL11A1 Stickler syndrome, which may aid clinicians in determining individualized management plans for patients with Stickler syndrome. However, due to reporting biases inherent to the case series and case reports from which we obtained data, the overall certainty of evidence was rated as moderate, and our analysis was limited to providing relative risk of retinal detachment, not absolute risk.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
题目：比较COL2A1和COL11A1 Stickler综合征患者视网膜脱离的相对危险性。临床相关性：目前尚不清楚COL2A1和COL11A1 Stickler综合征的视网膜脱离率是否不同。先前的研究纳入的患者太少，无法检测到基因型之间的差异。方法：对1991年至2025年MEDLINE、Embase、Scopus、Web of Science核心合集和Web of Science预印本引文索引数据库中的队列研究、病例对照研究、横断面研究、病例系列和病例报告进行个体患者数据荟萃分析。纳入了遗传学证实COL2A1或COL11A1 Stickler综合征受试者的眼科检查结果的文章。从纳入的文章中，提取了受影响基因的个体患者数据，最后随访时的年龄，以及是否存在视网膜脱离。排除预防性视网膜手术患者。采用混合效应logistic回归（按文章和家庭进行聚类调整）来确定视网膜脱离的相对风险。使用JBI病例系列关键评估清单评估偏倚风险。该研究在PROSPERO进行了前瞻性注册（CRD42023428144）。证据的总体确定性通过推荐评估、发展和评价分级来评估。结果：在筛选的1420篇文章中，179篇符合纳入条件，141篇提供了来自430个家庭的673名患者的个人数据。491例COL2A1 Stickler综合征患者中有229例（47%）出现视网膜脱离，182例COL11A1 Stickler综合征患者中有51例（28%）出现视网膜脱离。COL2A1患者视网膜脱离的相对风险是COL11A1 Stickler综合征患者的1.78倍（95% CI: 1.30-2.43 p < 0.001）。证据的确定性是中等的。结论：我们的研究结果表明，与COL11A1 Stickler综合征相比，COL2A1患者视网膜脱离的风险更高，这可能有助于临床医生确定Stickler综合征患者的个体化治疗计划。然而，由于我们获得数据的病例系列和病例报告固有的报告偏倚，证据的总体确定性被评为中等，我们的分析仅限于提供视网膜脱离的相对风险，而不是绝对风险。
{"title":"Relative Risk of Retinal Detachment in COL2A1 Compared with COL11A1 Stickler Syndrome","authors":"Cameron M. Carpenter BS , Aileen G. MacLachlan BS , Caitlyn Y. Kwun BA , Taylor J. Johnson MD , Bryce T. Baugh MD , Guillermo A. Requejo Figueroa BS , Saul Rivera-Flores BS , Xiuzhen Liu PhD , Gregory J. Stoddard MPH , Jessica A. Kraker MD, MS , Eileen S. Hwang MD, PhD","doi":"10.1016/j.oret.2025.08.008","DOIUrl":"10.1016/j.oret.2025.08.008","url":null,"abstract":"<div><h3>Topic</h3><div>To compare the relative risk of retinal detachment between patients with <em>COL2A1</em> and <em>COL11A1</em> Stickler syndrome.</div></div><div><h3>Clinical Relevance</h3><div>It is unclear whether the rate of retinal detachment differs between <em>COL2A1</em> and <em>COL11A1</em> Stickler syndrome. Previous studies included too few patients to detect a difference between genotypes.</div></div><div><h3>Methods</h3><div>Individual patient data meta-analysis of cohort studies, case-control studies, cross-sectional studies, case series, and case reports across the MEDLINE, Embase, Scopus, Web of Science Core Collection, and Web of Science Preprint Citation Index databases from 1991 to 2025. Articles providing eye examination results in subjects with genetically confirmed <em>COL2A1</em> or <em>COL11A1</em> Stickler syndrome were included. From the included articles, individual patient data on affected gene, age at last follow-up, and presence or absence of retinal detachment were extracted. Patients who had prophylactic retinopexy were excluded. A mixed effects logistic regression adjusted for clustering by article and family was used to determine the relative risk of retinal detachment. A risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. The study was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023428144). The overall certainty of evidence was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation.</div></div><div><h3>Results</h3><div>Of the 1420 articles screened, 179 were eligible for inclusion, and 141 provided individual patient data for a total of 673 patients from 430 families. Retinal detachment was present in 229 of 491 (47%) patients with <em>COL2A1</em> Stickler syndrome and 51 of 182 (28%) patients with <em>COL11A1</em> Stickler syndrome. The relative risk of retinal detachment was 1.78 times higher in <em>COL2A1</em> compared with <em>COL11A1</em> Stickler syndrome (95% confidence interval: 1.30–2.43, <em>P</em> < 0.001). The certainty of evidence was moderate.</div></div><div><h3>Conclusion</h3><div>Our findings indicate a higher risk of retinal detachment in <em>COL2A1</em> compared with <em>COL11A1</em> Stickler syndrome, which may aid clinicians in determining individualized management plans for patients with Stickler syndrome. However, due to reporting biases inherent to the case series and case reports from which we obtained data, the overall certainty of evidence was rated as moderate, and our analysis was limited to providing relative risk of retinal detachment, not absolute risk.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 194-203"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.11.001
Leila Chew MD , Jeffrey Feng BS , Elizabeth Hutchins MD , Ashley F. Stein-Merlob MD , Eric H. Yang MD , Melissa G. Lechner MD, PhD , Edmund Tsui MD, MS
{"title":"Immune Checkpoint Inhibitor-Associated Uveitis: Predictors and Survival Impact","authors":"Leila Chew MD , Jeffrey Feng BS , Elizabeth Hutchins MD , Ashley F. Stein-Merlob MD , Eric H. Yang MD , Melissa G. Lechner MD, PhD , Edmund Tsui MD, MS","doi":"10.1016/j.oret.2025.11.001","DOIUrl":"10.1016/j.oret.2025.11.001","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 215-217"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.05.023
Indu J. Nair DNB, MRCS(Ed), Unnikrishnan Nair R FRCS, MS, Manoj Soman FRCS, DNB
{"title":"Retinochoroidal Anastomosis in Macular Scarring Induced by Hard Exudate Migration","authors":"Indu J. Nair DNB, MRCS(Ed), Unnikrishnan Nair R FRCS, MS, Manoj Soman FRCS, DNB","doi":"10.1016/j.oret.2025.05.023","DOIUrl":"10.1016/j.oret.2025.05.023","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Page e13"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.07.018
Alexander T. Hong BS , Ivan Y. Luu BS , Jeremy D. Keenan MD, MPH , Jay M. Stewart MD
Objective
To evaluate the association between metformin use and the risk of developing age-related macular degeneration (AMD) among patients with diabetes, with a focus on exposure duration and AMD subtypes.
Design
Retrospective cohort study.
Participants
Patients were identified from the TriNetX network using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes for diabetes and ophthalmic care. Patients aged ≥60 years with diabetes and no documentation of AMD were included in the cohort.
Methods
Patients were required to have no AMD diagnoses at 2 eye care visits ≥1 year apart, with the second visit serving as the index event for analysis. The main exposure was yearly metformin use for ≥5 years, with subanalysis up to 10 years. The outcome was incident AMD. Propensity score matching controlled for potential confounders, including demographics, comorbidities, medications, laboratory values, and health care utilization. The association between metformin and AMD was assessed using survival analysis. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs).
Main Outcome Measures
The primary outcome was a new diagnosis of AMD. Secondary outcomes included a new diagnosis of dry AMD and wet AMD.
Results
After propensity score matching, the main cohort analysis included 7496 patients, of whom 3748 had ≥5 consecutive years of metformin use. Incident AMD was documented in 122 (3.3%) patients who had been exposed to metformin and 184 (4.9%) who had not (HR, 0.68; 95% CI, 0.54–0.85). The metformin group had lower rates of both dry AMD (HR, 0.69; 95% CI, 0.53–0.90) and wet AMD (HR, 0.84; 95% CI, 0.50–1.39), although the association with wet AMD was not statistically significant. The metformin use for ≥6 consecutive years showed consistent protective effects; 1 to 4 years showed weaker associations.
Conclusions
Prolonged metformin use in patients with diabetes was associated with a reduction in AMD risk in this claims database. These findings suggest a potential protective role for metformin, warranting further exploration of its long-term effects on AMD prevention.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：评估二甲双胍使用与糖尿病患者发生年龄相关性黄斑变性（AMD）风险之间的关系，重点关注暴露时间和AMD亚型。设计：回顾性队列研究。参与者：使用国际疾病分类第十版（ICD-10）和糖尿病和眼科护理的现行程序术语（CPT）代码从TriNetX网络中确定患者。年龄≥60岁的糖尿病患者和无AMD记录的患者被纳入队列。方法：要求患者至少间隔一年两次眼科检查无AMD诊断，第二次检查作为指标事件进行分析。主要暴露是每年使用二甲双胍至少5年，亚分析长达10年。结果是偶发性AMD。倾向评分匹配控制了潜在的混杂因素，包括人口统计学、合并症、药物、实验室值和医疗保健利用。使用生存分析评估二甲双胍与AMD之间的关系。结果以95%置信区间（ci）的风险比（hr）报告。结局指标：主要结局是AMD的新诊断。次要结果包括干性AMD和湿性AMD的新诊断。结果：倾向评分匹配后，主队列分析纳入7496例患者，其中3748例患者连续使用二甲双胍≥5年。有122例（3.3%）患者暴露于二甲双胍，184例（4.9%）患者未暴露于二甲双胍（HR 0.68, 95% CI 0.54, 0.85）。二甲双胍组干性AMD （HR 0.69, 95% CI 0.53, 0.90）和湿性AMD （HR 0.84, 95% CI 0.50, 1.39）的发生率均较低，但与湿性AMD的相关性无统计学意义。连续使用≥6年具有一致的保护作用；1-4岁的相关性较弱。结论：在该索赔数据库中，糖尿病患者长期使用二甲双胍与AMD风险降低相关。这些发现表明二甲双胍具有潜在的保护作用，值得进一步探索其对AMD预防的长期影响。
{"title":"Long-Term Metformin Use and Reduced Risk of Age-Related Macular Degeneration","authors":"Alexander T. Hong BS , Ivan Y. Luu BS , Jeremy D. Keenan MD, MPH , Jay M. Stewart MD","doi":"10.1016/j.oret.2025.07.018","DOIUrl":"10.1016/j.oret.2025.07.018","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between metformin use and the risk of developing age-related macular degeneration (AMD) among patients with diabetes, with a focus on exposure duration and AMD subtypes.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>Patients were identified from the TriNetX network using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes for diabetes and ophthalmic care. Patients aged ≥60 years with diabetes and no documentation of AMD were included in the cohort.</div></div><div><h3>Methods</h3><div>Patients were required to have no AMD diagnoses at 2 eye care visits ≥1 year apart, with the second visit serving as the index event for analysis. The main exposure was yearly metformin use for ≥5 years, with subanalysis up to 10 years. The outcome was incident AMD. Propensity score matching controlled for potential confounders, including demographics, comorbidities, medications, laboratory values, and health care utilization. The association between metformin and AMD was assessed using survival analysis. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was a new diagnosis of AMD. Secondary outcomes included a new diagnosis of dry AMD and wet AMD.</div></div><div><h3>Results</h3><div>After propensity score matching, the main cohort analysis included 7496 patients, of whom 3748 had ≥5 consecutive years of metformin use. Incident AMD was documented in 122 (3.3%) patients who had been exposed to metformin and 184 (4.9%) who had not (HR, 0.68; 95% CI, 0.54–0.85). The metformin group had lower rates of both dry AMD (HR, 0.69; 95% CI, 0.53–0.90) and wet AMD (HR, 0.84; 95% CI, 0.50–1.39), although the association with wet AMD was not statistically significant. The metformin use for ≥6 consecutive years showed consistent protective effects; 1 to 4 years showed weaker associations.</div></div><div><h3>Conclusions</h3><div>Prolonged metformin use in patients with diabetes was associated with a reduction in AMD risk in this claims database. These findings suggest a potential protective role for metformin, warranting further exploration of its long-term effects on AMD prevention.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 135-141"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.oret.2025.08.004
Linda A. Cernichiaro-Espinosa MD , Sue L. Choi BS , David J. Taylor Gonzalez MD , Tristan Hayes MSc , Joseph Mastellone , Rhonda S. Roberson RN , Michael Stinson , Lawrence M. Pfeffer PhD , Lillian H. Rinker MD , Hyo Young Choi PhD , Benjamin A. King MD , Matthew W. Wilson MD
Objective
Episcleral plaque brachytherapy (EPBT) provides effective local tumor control in uveal melanoma (UM), although dosing regimens vary across institutions. We report a single institution’s experience of using low-dose-rate Iodine-125 EPBT for the treatment of UM over a period of 38 years, evaluating long-term outcomes, complications, and survival rates.
Design
Retrospective chart review.
Subjects
One-thousand eight-hundred-seven patients diagnosed with UM and treated with low-dose-rate Iodine-125 EPBT between 1984 and 2022.
Methods
We reviewed medical records of UM patients treated with EPBT between 1984 and 2022 where we delivered a targeted dose of 85 Gy to the tumor apex at a rate of 52.8 cGy/hour over 168 hours. We applied Cox proportional hazards models and Kaplan–Meier survival analysis to evaluate survival outcomes and recurrence risks.
Main Outcome Measures
Local tumor control, incidence of radiation-related complications, disease-specific, and overall patient survival.
Results
Of 1807 patients, 1674 (93%) achieved local control, 762 (42%) developed radiation retinopathy, and 332 (18%) developed radiation optic neuropathy. Kaplan–Meier estimates of local recurrence at 5 and 10 years were 12% and 18%, respectively. Increasing age (P = 0.01) and juxtapapillary location (P < 0.001) were correlated with increased risk of recurrence. At 10 years, 1472 patients (82%) were alive without metastasis, 75 (4%) were alive with metastasis, 120 (7%) had died from metastasis, 27 (2%) had died from non-UM causes, and 113 (6%) had died from unknown causes. Age at surgery and advanced American Joint Cancer Committee T stage were associated with lower overall survival (P < 0.001).
Conclusions
Low-dose-rate Iodine-125 EPBT yields similar complication rates to those reported in the literature. The incidence of local recurrence, albeit slightly higher, was comparable to other large cohorts. The consistency of low-dose-rate EPBT over 3 decades served as a reliable framework for a standardized UM treatment protocol.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Efficacy of Low-Dose-Rate Iodine-125 Plaque Brachytherapy in the Treatment of Uveal Melanoma","authors":"Linda A. Cernichiaro-Espinosa MD , Sue L. Choi BS , David J. Taylor Gonzalez MD , Tristan Hayes MSc , Joseph Mastellone , Rhonda S. Roberson RN , Michael Stinson , Lawrence M. Pfeffer PhD , Lillian H. Rinker MD , Hyo Young Choi PhD , Benjamin A. King MD , Matthew W. Wilson MD","doi":"10.1016/j.oret.2025.08.004","DOIUrl":"10.1016/j.oret.2025.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>Episcleral plaque brachytherapy (EPBT) provides effective local tumor control in uveal melanoma (UM), although dosing regimens vary across institutions. We report a single institution’s experience of using low-dose-rate Iodine-125 EPBT for the treatment of UM over a period of 38 years, evaluating long-term outcomes, complications, and survival rates.</div></div><div><h3>Design</h3><div>Retrospective chart review.</div></div><div><h3>Subjects</h3><div>One-thousand eight-hundred-seven patients diagnosed with UM and treated with low-dose-rate Iodine-125 EPBT between 1984 and 2022.</div></div><div><h3>Methods</h3><div>We reviewed medical records of UM patients treated with EPBT between 1984 and 2022 where we delivered a targeted dose of 85 Gy to the tumor apex at a rate of 52.8 cGy/hour over 168 hours. We applied Cox proportional hazards models and Kaplan–Meier survival analysis to evaluate survival outcomes and recurrence risks.</div></div><div><h3>Main Outcome Measures</h3><div>Local tumor control, incidence of radiation-related complications, disease-specific, and overall patient survival.</div></div><div><h3>Results</h3><div>Of 1807 patients, 1674 (93%) achieved local control, 762 (42%) developed radiation retinopathy, and 332 (18%) developed radiation optic neuropathy. Kaplan–Meier estimates of local recurrence at 5 and 10 years were 12% and 18%, respectively. Increasing age (<em>P</em> = 0.01) and juxtapapillary location (<em>P</em> < 0.001) were correlated with increased risk of recurrence. At 10 years, 1472 patients (82%) were alive without metastasis, 75 (4%) were alive with metastasis, 120 (7%) had died from metastasis, 27 (2%) had died from non-UM causes, and 113 (6%) had died from unknown causes. Age at surgery and advanced American Joint Cancer Committee T stage were associated with lower overall survival (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Low-dose-rate Iodine-125 EPBT yields similar complication rates to those reported in the literature. The incidence of local recurrence, albeit slightly higher, was comparable to other large cohorts. The consistency of low-dose-rate EPBT over 3 decades served as a reliable framework for a standardized UM treatment protocol.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 204-214"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822164","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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