Ophthalmology. Retina最新文献

{"title":"Three-Year Outcomes of VEGF Inhibitors in Naive Branch Retinal Vein Occlusion","authors":"","doi":"10.1016/j.oret.2024.04.014","DOIUrl":"10.1016/j.oret.2024.04.014","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>To evaluate the 3-year outcomes of VEGF inhibitors in the treatment of </span>cystoid macular edema due to </span>branch retinal vein occlusion (BRVO) in an international multicenter cohort of eyes.</div></div><div><h3>Design</h3><div>Multicenter, international, BRVO database study.</div></div><div><h3>Subjects</h3><div>Seven hundred forty-seven patients (760 eyes) undergoing intravitreal therapy for BRVO for 3 years in a multicenter international setting.</div></div><div><h3>Methods</h3><div>Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, central subfield thickness (CST), treatments, number of injections, and visits data was collected using a validated web-based tool.</div></div><div><h3>Main Outcome Measures</h3><div>Visual acuity gain at 3 years in logarithm of the minimum angle of resolution letters. Secondary outcome measures included anatomical results, treatment pattern, and percentage of completers. A subgroup analysis by study drug was conducted for clinical outcomes.</div></div><div><h3>Results</h3><div><span><span><span>Mean adjusted VA change was +11 letters (95% confidence interval 9–13), mean adjusted change in CST was −176 μm (−193, −159). Median number of injections/visits was 16 of 24 at 3 years of follow-up. Most eyes received VEGF inhibitors exclusively (89%, n = 677) and as a </span>monotherapy in 71% (n = 538). Few eyes were switched to steroids (11%, n = 83). Suspensions in treatment &gt;180 days occurred in 26% of study eyes. </span>Aflibercept showed greater CST reductions (−147 vs. −128 vs. −114 μm; </span><em>P</em> &lt; 0.001) and significantly lower switching rates (14% vs. 38% vs. 33%; <em>P</em><span><span> &lt; 0.001) compared with ranibizumab and </span>bevacizumab, respectively.</span></div></div><div><h3>Conclusions</h3><div>This international study of 3-year BRVO outcomes after starting treatment with VEGF inhibitors found adequate visual and anatomical results in routine clinical care. Visual outcomes were similar among the different initiating VEGF inhibitors, although eyes starting with aflibercept had better anatomical outcomes and a lower switching rate.</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":"140767356","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":"Depigmented Fundus and Fovea Plana in Hermansky-Pudlak Syndrome","authors":"","doi":"10.1016/j.oret.2024.03.002","DOIUrl":"10.1016/j.oret.2024.03.002","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":"140756159","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":"Optic Nerve Neovascularization in Radiation Retinopathy Seen on Magnetic Resonance Imaging","authors":"","doi":"10.1016/j.oret.2024.03.008","DOIUrl":"10.1016/j.oret.2024.03.008","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":"140764360","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":"Spontaneous Regression of Myopic Schisis","authors":"","doi":"10.1016/j.oret.2024.03.007","DOIUrl":"10.1016/j.oret.2024.03.007","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":"140781056","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":"Imaging Characteristics and Clinical Utility of Half-Dose versus Full-Dose Ultrawidefield Fundus Fluorescein Angiography","authors":"","doi":"10.1016/j.oret.2024.04.024","DOIUrl":"10.1016/j.oret.2024.04.024","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>In early 2022, a fluorescein shortage occurred in the United States. To meet the standard of care for patients who required ultrawidefield </span>fundus fluorescein angiography (UWFFA), a regimen of half-dose (250 mg) </span>sodium fluorescein<span> (10%) was adopted instead of the full dose (500 mg) at the Cole Eye Institute (CEI). In this paper, we compare the image quality, clinical utility, and the side-effect profile of half-dose versus full-dose fluorescein in UWFFA for a cohort of stable patients.</span></div></div><div><h3>Design</h3><div>Retrospective chart review.</div></div><div><h3>Participants</h3><div>Patients with retinal vascular disease were included if they received half-dose and full-dose UWFFA (Optos California) within 6 months at the CEI. Eyes were excluded if they received intraocular injections<span>, laser procedures, new immunosuppression, and worsened or improved inflammation on clinical examination.</span></div></div><div><h3>Methods</h3><div>Quantitative assessment of vascular leakage was performed using a machine learning-enhanced automated segmentation platform. Leakage from late-phase UWFFA images was compared between half-dose and full-dose images. Qualitative assessment of image quality and relative vascular leakage was performed by 2 masked independent reviewers. Side effects after fluorescein administration were recorded for each patient.</div></div><div><h3>Main Outcome Measures</h3><div>Masked leakage grading and automated leakage scores.</div></div><div><h3>Results</h3><div><span><span>There were 52 eyes of 35 patients, 42 (81%) uveitic, 5 (9%) diabetic, and 4 (8%) normal controls. Patients had no change to their visual acuity (logarithm of the minimum angle of resolution mean, 0.3 ± 0.6), </span>anterior chamber and vitreous cell between UFFWA’s. UWFFA images were deemed of equal quality and leakage by both masked reviewers (78%–87% agreement; κ, 0.642). Automated leakage analysis showed mildly increased leakage in half-dose images overall (3.8% vs. 2.8%; </span><em>P</em> = 0.01) and in the macula (1.5% vs. 0.6%; <em>P</em> = 0.01). Side effects included nausea (half [n = 3, 9%] vs. full [n = 2, 6%]; <em>P</em><span> = 0.69) and urticaria (n = 0, 0% vs. n = 1, 2%; </span><em>P</em> = 0.99) and were not different between doses.</div></div><div><h3>Conclusions</h3><div>In this cohort, half-dose UWFFA produced images that were of similar quality, clinical utility and with a similar side effect<span> profile compared with full dose. Half-dose UWFFA can be used to accurately assess the retinal vasculature and could be used primarily as a method to save cost and prevent waste.</span></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":"140891660","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":"Comparative Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists, Sodium-Glucose Cotransporter 2 Inhibitors, Dipeptidyl Peptidase-4 Inhibitors, and Sulfonylureas for Sight-Threatening Diabetic Retinopathy","authors":"","doi":"10.1016/j.oret.2024.05.003","DOIUrl":"10.1016/j.oret.2024.05.003","url":null,"abstract":"<div><h3>Objective</h3><div><span>To investigate whether the choice of glucose-lowering agent for type 2 diabetes (T2D) impacts a patient’s risk of developing sight-threatening </span>diabetic retinopathy complications.</div></div><div><h3>Design</h3><div>Retrospective observational database study emulating an idealized target trial.</div></div><div><h3>Subjects</h3><div>Adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014, to December 31, 2021, with T2D and moderate cardiovascular disease (CVD) risk who had no baseline history of advanced diabetic retinal complications, initiating treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sulfonylureas.</div></div><div><h3>Methods</h3><div>We used inverse propensity scoring weights in time-to-event Cox proportional hazards models.</div></div><div><h3>Main Outcome Measures</h3><div><span>Treatment for either diabetic macular edema or </span>proliferative diabetic retinopathy.</div></div><div><h3>Results</h3><div>The final study population included 371 698 patients, of whom 42 265 initiated GLP-1 RA, 53 476 initiated SGLT2i, 78 444 initiated DPP-4i, and 197 513 initiated sulfonylurea agents. The probability of treatment for sight-threatening retinopathy<span> within 2 and 5 years was 0.3% and 0.7% for patients initiating SGLT2i (median follow-up 830 [interquartile range (IQR), 343–1401] days), 0.4% and 1.0% for GLP-1 RA (669 [IQR, 256–1167] days), 0.4% and 0.9% for DPP-4i (1263 [IQR, 688–1938] days), and 0.5% and 1.2% for sulfonylurea (1223 [IQR, 662–1879] days). Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of treatment for sight-threatening retinopathy compared with all other medication classes, including GLP-1 RA (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55–0.97), DPP-4i (HR, 0.79; 95% CI, 0.64–0.97), and sulfonylurea (HR, 0.61; 95% CI, 0.50–0.74). Glucagon-like peptide-1 receptor agonists use was associated with a similar risk of sight-threatening retinopathy as DPP-4i (HR, 1.07; 95% CI, 0.85–1.35) and sulfonylurea (HR, 0.83; 95% CI, 0.67–1.03).</span></div></div><div><h3>Conclusions</h3><div>Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of sight-threatening diabetic retinopathy among adults with T2D and moderate CVD risk compared with other glucose-lowering therapies. Glucagon-like peptide-1 receptor agonists do not confer increased retinal risk, relative to DPP-4i and sulfonylurea medications.</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":"140912317","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":"Isolated Retinal Neovascularization in Retinopathy of Prematurity","authors":"","doi":"10.1016/j.oret.2024.04.025","DOIUrl":"10.1016/j.oret.2024.04.025","url":null,"abstract":"<div><h3>Objective</h3><div>Isolated retinal neovascularization<span> (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity<span> (ROP). This study aimed to further classify the clinical course<span> and significance of these lesions (previously described as “popcorn” based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT).</span></span></span></div></div><div><h3>Design</h3><div>Single center, retrospective case series.</div></div><div><h3>Participants</h3><div>Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit.</div></div><div><h3>Methods</h3><div>A prototype UWF-OCT device captured <em>en face</em><span> scans (&gt;140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression.</span></div></div><div><h3>Main Outcome Measures</h3><div>Differences in clinical demographics and disease progression between patients with and without IRNV.</div></div><div><h3>Results</h3><div>Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, <em>P</em> = 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, <em>P</em> = 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, <em>P</em> &lt; 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, <em>P</em> &lt; 0.001) and receive treatment (54.5% vs. 15.8%, <em>P</em> = 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, <em>P</em> &lt; 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (<em>P</em> = 0.02) and requiring treatment (<em>P</em> = 0.03), controlling for GA, BW, and initial zone 1 disease.</div></div><div><h3>Conclusions</h3><div>In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future.</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":"140912320","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":"Three Intraocular Lenses in Vitreous Cavity","authors":"","doi":"10.1016/j.oret.2024.03.006","DOIUrl":"10.1016/j.oret.2024.03.006","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":"140778746","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":"Clinical Implications of Alternating Hypointense Bands on OCT Angiography in Retinal Vascular Occlusive Disease","authors":"","doi":"10.1016/j.oret.2024.04.022","DOIUrl":"10.1016/j.oret.2024.04.022","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To demonstrate the relationship between alternating hypointense signal bands on OCT<span> angiography (OCTA), real-time </span></span>fluorescein angiography<span> (FA), and structural OCT findings in patients with retinal vascular occlusive disease (RVOD).</span></div></div><div><h3>Design</h3><div>Retrospective, consecutive case series.</div></div><div><h3>Subjects</h3><div>Consecutive patients with a clinical diagnosis of acute RVOD and alternating bands of hypointense OCTA flow signal on en face projections.</div></div><div><h3>Methods</h3><div><span><span>Complete ophthalmic examination and </span>multimodal imaging, including color </span>fundus photography, real-time FA, spectral-domain OCT, and OCTA performed with different instruments having different scan speeds and acquisition protocols.</div></div><div><h3>Main Outcome Measures</h3><div><span>The primary outcomes were: hypointense OCTA band characteristics (number, width, orientation, and location), OCTA acquisition characteristics (speed and scan direction), and FA findings including delayed arteriovenous (AV) transit and pulsatile flow. Secondary outcomes were: structural OCT changes including retinal fluid, paracentral acute middle </span>maculopathy (PAMM) lesion, and a prominent middle limiting membrane (p-MLM) sign.</div></div><div><h3>Results</h3><div><span>OCT angiography hypointense bands were detected in the superficial and deep vascular plexuses in 9 eyes of 9 patients with either partial </span>central retinal vein occlusion<span> (RVO) or nonischemic RVO. When obtained on the same device, hypointense bands were thinner and more numerous at lower (100 kHz) scan speeds compared with higher (200 kHz) scan speeds. Band orientation was parallel to the OCTA scan direction, and their extent correlated with the area of delayed AV transit on FA. Structural OCT showed multiple PAMM lesions in 78% of cases and a p-MLM sign centered in the fovea in 44% of cases.</span></div></div><div><h3>Conclusions</h3><div>OCT hypointense bands are a novel biomarker in RVOD indicating delayed AV transit and pulsatile filling without the need for dye angiography. Structural OCT often shows PAMM in these eyes and, less commonly, a p-MLM sign.</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":"140891560","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":"Incontinentia Pigmenti in a Newborn","authors":"","doi":"10.1016/j.oret.2024.02.013","DOIUrl":"10.1016/j.oret.2024.02.013","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":"140194318","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}