Ophthalmology. Retina最新文献

Topic: The G-ROP criteria, incorporating postnatal weight gain, are widely validated for retinopathy of prematurity (ROP) screening. We assessed the G-ROP algorithm's diagnostic accuracy across various outcomes and explored heterogeneity sources.

Clinical relevance: If G-ROP maintains sensitivity with fewer exams, it would optimize screening for this blinding disease.

Method: We searched PubMed, EMBASE, and Cochrane databases (through September 2024) for studies using G-ROP to predict type 1, type 2, treated, or any-stage ROP. We assessed risk of bias using QUADAS-2 and certainty of evidence using GRADE approach. The protocol was prospectively registered with PROSPERO (CRD42024571794).

Results: Twenty-three studies were included. For type 1 ROP (17 cohorts; 1,406 infants), sensitivity was 0.99 (95% CI: 0.99-1.00; I²=44.5%) and specificity (9 cohorts; 2,522 infants) was 0.34 (95% CI: 0.32-0.36; I²=96.3%).The diagnostic odds ratio (DOR) was 6.22 (95% CI: 2.34-16.53; I²=40.7%) ; AUC was 0.87 (95% CI: 0.83-0.90). Certainty of evidence was high for sensitivity and low for specificity and DOR. For type 2 ROP, pooled sensitivity from 9 cohorts (871 infants) was 0.98 (95% CI: 0.97-0.99; I²=41.4%), while specificity from 3 cohorts (621 infants) was 0.25 (95% CI: 0.22-0.29; I²=92.2%). The DOR was 3.21 (95% CI: 1.24-8.28; I²=0%); AUC was 0.76 (95% CI: 0.72-0.80). Certainty was high for sensitivity, very low for specificity, and moderate for DOR. For any-stage ROP, pooled sensitivity from 16 cohorts (3,674 infants) was 0.87 (95% CI: 0.86-0.88; I²=90.2%), while specificity from 13 cohorts (2,846 infants) was 0.45 (95% CI: 0.43-0.47; I²=95.8%). The DOR was 5.88 (95% CI: 3.89-8.89; I²=75.3%), and the AUC was 0.78 (95% CI: 0.74-0.81). Certainty was low for sensitivity, low for specificity, and moderate for DOR.

Conclusions: The G-ROP algorithm demonstrates consistently high sensitivity, particularly for type 1 and treated ROP, supporting its use as a screening tool for severe disease. While the model reduces examinations compared with current standards, its low specificity may limit its usefulness in low-resource settings, where minimizing unnecessary screening is essential.

Purpose: To investigate whether metformin use is associated with decreased odds of new-onset International Classification of Disease (ICD) coding of neovascular age-related macular degeneration (nAMD).

Design: Case-control study.

Participants: 22,205 cases with new-onset ICD coding of nAMD and 22,126 matched controls without AMD were identified in the Merative™ MarketScan® Research Databases between 2008 and 2017. A subgroup of patients diagnosed with diabetes included 6,664 cases and 5,513 controls.

Methods: Cases with new-onset ICD coding of nAMD were propensity score matched to controls without AMD. Multivariable conditional logistic regression analyzed the association between new-onset ICD coding of nAMD and metformin use controlling for (1) AMD risk factors, including diabetes, diabetic retinopathy, hyperlipidemia, obesity, and smoking, (2) exposures to other antidiabetic medications, including insulin, sulfonylureas, glitazones, meglitinides, other diabetic medications, and statins, and (3) the number of antidiabetic medications.

Main outcome measures: Adjusted odds ratios of new-onset ICD coding of nAMD for any metformin use and cumulative two-year metformin dose in grams (g).

Results: Any metformin use was associated with decreased adjusted odds of new-onset nAMD (aOR 0.84, 95% CI 0.74-0.95). In an exploratory dosing analysis, associations across cumulative-dose categories were heterogeneous, with the largest magnitude in the mid-dose range (between 271 and 600 g; aOR 0.73, 95% CI 0.63-0.85); because adherence cannot be verified from claims, dose-response findings are interpreted as hypothesis-generating. These associations persisted among diabetic patients (Any metformin use: aOR 0.83, 95% CI 0.72-0.94; 271 to 600 g: aOR 0.72, 95% CI 0.61-0.85; >1080 g: aOR 0.85, 95% CI 0.72-0.999). Any metformin use in diabetic patients without retinopathy was associated with decreased odds of new-onset ICD nAMD (aOR 0.85, 95% CI 0.78-0.93); however, this association was absent in diabetic patients with retinopathy.

Conclusions: In this claims-based analysis, metformin use was associated with lower odds of incident ICD-coded nAMD, and an exploratory dosing analysis suggests a low to moderate cumulative dose may be associated with the greatest decrease. These associations persisted among diabetic patients without retinopathy. Causal inference is limited by the observational design, potential diagnostic misclassification, imperfect exposure measurement, and residual confounding. Replication with validated case definitions, active-comparator new-user designs, and adjudicated outcomes is warranted.

Purpose: To highlight the role of en face OCT in the measurement of choroidal hypertransmission defects (hyperTDs) in complete retinal pigment epithelial and outer retinal atrophy (cRORA), and to refine the definition of retinal pigment epithelium (RPE)-related alterations associated with cRORA.

Design: Consensus meeting.

Participants: Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists.

Methods: As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed the role of en face OCT in the assessment of cRORA. A structured study was conducted, consisting of an exercise to assess en face OCT cases, reviewed jointly during the 8^th CAM meeting, and to explore the utility of this advanced tool for disease staging and progression. Additionally, definitions previously applied to RPE abnormalities were discussed and refined leading to modifications. The current report summarizes the methods employed during the consensus meeting and the outcomes achieved as pertains to the application of en face OCT for cRORA grading and simplification of the RPE assessment criteria.

Main outcome measure: Defining the role of en face OCT in the detection and quantification of hyperTDs, improving classification of cRORA, and refining the terminology related to RPE alterations to enhance grading consistency.

Results: During the consensus case discussions, high levels of agreement were achieved for hyperTD detection using en face OCT. The CAM group affirmed the role of en face OCT as a critical adjunct to traditional B-scan analysis, for more precise measurement of the area of cRORA lesions and for distinguishing threshold cRORA from smaller incomplete (iRORA) lesions. Additionally, merger of RPE attenuation and RPE disruption into a unified category termed "abnormal RPE band" significantly reduced inter-reader variability, leading to greater consistency among graders.

Conclusions: The integration of en face OCT with cross-sectional B-scan imaging enhances the accurate classification and area measurement of early atrophic alterations in AMD, improving diagnostic consistency and lesion assessment. The consensus panel's adoption of the abnormal RPE band term as a unified category for RPE abnormalities may reduce confusion regarding the definition of RPE degeneration and has the potential to improve inter-reader variability.

Objective: To describe the multimodal imaging characteristics of retinal pigment epithelial hamartomas associated with familial adenomatous polyposis (RPEH-FAP).

Design: Prospective, observational case series.

Participants: Twenty-four eyes of 12 patients diagnosed with FAP based on systemic clinical findings.

Methods: Multimodal imaging of RPEH-FAP lesions included: Ultra-wide field fundus photography, ultra-wide field fundus autofluorescence, enhanced-depth imaging optical coherence tomography (EDI-OCT) and angiography (OCT-A).

Main outcomes measured: Features of RPEH-FAP on multimodal imaging.

Results: The mean age of patient was 46.8 years (range 20-72 years). There were 8 females (66.7%), and all patients were Caucasian. Two hundred and thirty-three RPEH-FAP lesions were identified (mean of 9.7 lesions per eye, range 1-31). The superotemporal quadrant was the most commonly involved quadrant (36.1%). Most were outside the posterior pole (92.7%). The most common appearance were small circular pigmented dots (42.9%). Depigmented margins were seen in 113 (48.5%) lesions. The pigmented portion of the lesion was hypoautofluorescent in 93.3% of cases, and when present, the depigmented halos/fish tails were either isoautofluorescent (46.8%) or hyperautofluorescent (35.1%). OCT was obtained for 49 lesions. Mean sub-lesional choroidal thickness was not different compared with choroidal thickness 50μm outside the margin. The RPE was relatively thickened in 67.3% of cases. Retinal thinning occurs in the outer retina, with thinning or absence of the outer nuclear layer in 83.7% of cases and of the ellipsoid zone in 93.9% of cases. Hyperreflective retinal spots were seen in 14 cases (28.6%). Eleven lesions (22.4%) had an associated pigment epithelial detachment (PED). One lesion demonstrated a subretinal cleft. No lesion demonstrated cystoid edema or subretinal fluid. No OCTA signal was observed on OCT-A.

Conclusions: In this series, a mean of about 10 RPEH-FAP lesions were identified in each eye. RPEH-FAP are usually hypoautofluorescent with outer retinal loss on OCT and as such are similar to typical solitary Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) lesions not associated with FAP. However, key features differentiating RPEH-FAP from typical solitary CHRPE are the higher number of lesions involving both eyes, bilateral involvement, presence of an iso- or hyperautofluorescent depigmented halo or fish tail and the absence of lacunae or cystoid edema. The presence of PEDs is a new finding.

Topic: With advancements in surgical techniques and diagnostic methodologies, this meta-analysis aims to assess the diagnostic yield of pars plana vitrectomy (PPV) in undifferentiated uveitis.

Clinical relevance: Undifferentiated uveitis poses significant diagnostic challenges in ophthalmology. While diagnostic PPV has been employed to identify underlying etiologies, the diagnostic utility of this procedure is still unclear.

Methods: A comprehensive literature search was conducted on March 24^th, 2025 using PubMed, Embase, and Scopus to identify studies evaluating the diagnostic yield of PPV in undifferentiated uveitis. Studies were included if they evaluated the diagnostic yield of PPV in undifferentiated uveitis and contained various outcome measures: identification rates of infectious and malignant etiologies, confirmation of pre-operative suspicion, changes in management, and rates of retinal detachment. A random-effects model was used to compute pooled estimates, and heterogeneity was assessed using the I² statistic. ROBINS-I, NIH Quality Assessment Tool, and GRADE were used to assess risk of bias and strength of certainty.

Results: Seventeen studies (1,032 eyes) met inclusion criteria. The pooled diagnostic yield of PPV was 45.5% [95% CI: 37.4-53.6%], with significant heterogeneity (I²=84.5%). Subgroup analysis indicated a higher diagnostic yield in studies (10 studies, 521 eyes) performed after 2010 (53.4%) [95% CI: 45.0-61.6%] compared to those (7 studies, 511 eyes) before 2010 (35.2%) [95% CI: 23.0-48.3%, p=0.0217]. Infectious etiologies were identified in 60.9% [95% CI: 50.8-70.5%] of cases, while malignant causes accounted for 33.2% [95% CI: 23.6-44.4%]. Pre-operative clinical suspicion for infection or malignancy was confirmed in 70.2% [95% CI: 57.1-82.0%] and 51.7% [95% CI: 34.6-68.6%] of cases, respectively. Conversely, cases without a clear pre-operative suspicion resulted in a diagnostic yield in only 25.2% [95% CI: 12.8-39.7%]. A change in management was observed in 21.6% [95% CI: 12.6-32.1%] of cases following PPV. Post-operative retinal detachment occurred in 3.9% [95% CI: 1.5-7.1%] of eyes. Using GRADE tool, two outcomes were graded low and four were graded very low due to the retrospective nature of all studies included for analysis.

Conclusions: Diagnostic PPV may serve as a useful adjunct in the evaluation of undifferentiated uveitis; however, its diagnostic yield is greater when guided by a specific pre-operative diagnostic hypothesis, particularly for suspected infectious or malignant etiologies.

Objective: To evaluate outcomes and complications of pars plana vitrectomy (PPV) for nonclearing vitreous hemorrhage (NCVH) secondary to proliferative diabetic retinopathy (PDR) in the small gauge, anti-vascular endothelial growth factor (anti-VEGF) era.

Design: Retrospective consecutive case series of patients seen at Cole Eye Institute from 2014-2022 SUBJECTS: 306 eyes undergoing PPV for NCVH.

Methods: Key inclusion criteria included PPV specifically indicated for NCVH without tractional retinal detachment secondary to diagnosis of DR of any severity. Patients without preoperative documentation or 6 - and 12 -month follow-up visit were excluded. Pertinent data was then manually extracted from the electronic medical record. Descriptive statistics, univariate analysis, and propensity score matched regression analysis was performed.

Main outcome measures: Post-operative vitreous hemorrhage, repeated vitrectomy, and best corrected visual acuity (BCVA) at 12 months.

Results (short): Anti-VEGF was used in 199 of 306 eyes (65.0%) preoperatively with an average number of 1.67 ± 0.8 injections prior to vitrectomy. At 12 months after surgery 94.8% of patients gained or maintained their BCVA. Seventy-five of 306 (24.5%) of patients had a postoperative vitreous hemorrhage with only 48 of 306 (15.6%) requiring a second vitrectomy. Preoperative anti-VEGF injections was not associated with reduced odds of recurrent vitreous hemorrhage, improved 12-month BCVA, nor did it protect against repeat vitrectomy.

Conclusions: This study did not find evidence that preoperative anti-VEGF provided significant benefit in visual rehabilitation, reoperation or overall postoperative vitreous hemorrhage in NCVH cases without preoperative evidence of tractional detachment.