Ophthalmology. Retina最新文献

Topic: To compare anatomic and visual outcomes of internal limiting membrane (ILM) flaps versus peeling in macular hole surgery. We also assessed the impact of hole size, symptom duration, and different flap types on outcomes.

Clinical relevance: The benefit of ILM flaps over standard ILM peeling in idiopathic, full-thickness macular holes (iFTMHs) remains unclear.

Methods: Prospectively registered systematic review and individual participant data (IPD) meta-analysis of randomized controlled trials comparing conventional ILM peeling with ILM flaps, as well different ILM flap subtypes, in adults undergoing primary iFTMH surgery (CRD42023494971). No exclusions were made based on hole size, symptom duration, or perioperative choices. Searches were performed in MEDLINE, Embase, Cochrane Library, and trial registries (January 2000-March 2023). Critical outcomes were hole closure and postoperative visual acuity at 6 months or nearest time point. Multilevel regression models were adjusted for age, sex, hole size, lens status, and preoperative visual acuity, allowing for non-linear effects. Evidence was appraised with Cochrane Risk of Bias, GRADE, and ICEMAN tools. Subgroup analyses considered hole size, symptom duration, flap subtypes, tamponade choice, and risk-of-bias.

Results: Of 14 eligible trials, 13 provided IPD for 792 eyes. Most (68.3%) had MLD ≥500 μm, with limited representation of holes <400 μm and ≥900 μm. The adjusted odds ratio (OR) for primary closure with ILM flap versus peeling was 4.80 (95% CI, 2.77-8.30; P<0.001), with a relative risk of 1.26 (1.20-1.30) (GRADE: moderate-certainty), and a number needed to treat of 6. Compared to peeling, the ILM flap group showed better postoperative visual acuity at 3-6 months, with a mean difference of -0.14 logMAR (-0.18 to -0.09; P<0.001), about 7 letters ETDRS (GRADE: moderate-certainty). ILM flaps were likely more beneficial for holes ≥500 μm (OR for closure: 3.14 to 9.64, P<0.001; MD in vision: -0.23 to -0.13, P<0.001). Non-linear analyses suggested probable benefits across a broader range of hole sizes (ICEMAN: moderate-confidence). Results were consistent across risk-of-bias assessments, with no significant differences between ILM flap techniques.

Conclusion: ILM flaps likely improve closure and visual recovery compared to peeling alone in iFTMH, with greater effects likely in holes >500 μm.

Purpose: To evaluate the short-term outcomes of patients with exudative neovascular age-related macular degeneration (nAMD) treated with high-dose aflibercept 8.0 mg (HDA), focusing on anatomical and functional changes, as well as the feasibility of extending treatment intervals in real-world clinical practice.

Design: Retrospective, noncomparative cohort study.

Subjects: 219 eyes from 184 patients with nAMD who received at least three HDAs between August 2023 and October 2024.

Methods: Patients included in this study were either treatment-naïve or had been previously treated with other anti-VEGF agents. Clinical outcomes, including best-corrected visual acuity (BCVA) and macular OCT parameters, were evaluated at baseline and after each HDA.

Main outcomes: The primary outcome was the proportion of eyes able to sustain an 8 ± 1 week or longer treatment interval without anatomical deterioration. Secondary outcomes included anatomical and functional changes.

Results: The average follow-up time was 22.9 ± 4.9 weeks. 209 eyes (95.4%) were previously treated, and 10 eyes (4.6%) were treatment-naïve. After the first three injections, 206 eyes (94.1%) received a fourth HDA and 70 eyes (31.9%) received a fifth HDA. 102 eyes (46.6%) of the total cohort with an interval shorter than 8 weeks after three initial injections had persistent macular fluid. 24 eyes (11.0%) were switched to another anti-VEGF agent. Overall, the mean BCVA was 61.9 ± 21.7 ETDRS letters at baseline and 61.7 ± 22.6 at the final visit, with no statistically significant difference observed (p = 0.934). Central subfield thickness and pigment epithelial detachment height remained stable. Significant reductions were observed in subretinal (54.3% to 41.1%, p = 0.006) and intraretinal fluid (53.9% to 39.3%, p = 0.002). Among previously treated eyes, the mean pre-switch treatment interval was 5.8 ± 2.5 weeks and increased to 7.4 ± 2.2 weeks after the three initial injections (p < 0.0001).

Conclusions: HDA demonstrated stable BCVA and significant reductions in macular fluid during the follow-up period. A considerable proportion of patients were unable to extend treatment intervals to at least 8-weeks due to persistent macular fluid. These findings suggest that HDA maintains functional stability while improving anatomic outcomes, though real-world challenges in managing chronic nAMD may limit the ability to extend treatment intervals.

Purpose: To report the clinical and multimodal imaging (MMI) findings and long-term follow-up of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) contiguous with midperipheral retinoschisis (MPRS) and to describe a severe SNIFR variant termed CARPET (Central Anomalous Retinoschisis with mid-PEripheral Traction).

Design: Retrospective case series.

Subjects: Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least one eye at baseline or final follow-up.

Methods: MMI features, including cross-sectional and en face macular and peripheral spectral-domain optical coherence tomography (OCT) and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit.

Main outcome measures: Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated.

Results: MPRS exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 48 months, respectively). SNIFR contiguous with MPRS partially regressed after 48 months in one patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, while the schisis resolved and vision improved after pars plana vitrectomy in the third case.

Conclusions: MPRS can progress to SNIFR over multiple years of follow-up. SNIFR with MPRS can also spontaneously resolve or remain stable. MPRS can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss.

Purpose: To determine the predictive value of international intraocular retinoblastoma classification schemes and the American Joint Committee on Cancer (AJCC) classification for histopathological high-risk features (HRF).

Design: Multicentric international collaborative retrospective case series.

Subjects: One thousand three hundred and sixty-two patients with retinoblastoma from 16 centers and 11 countries.

Intervention: Primary enucleation; adjuvant therapy in patients with HRF.

Main outcome measure: High-risk retinoblastoma defined as one or more HRF (anterior segment involvement, massive choroidal invasion, minor choroidal infiltration with prelaminar optic nerve invasion, retrolaminar or resected optic nerve cut end involvement, scleral or microscopic extrascleral infiltration); Metastasis-free survival (MFS) RESULTS: Of the 1362 patients, 751 (55.1%) had HRF. According to the International Classification of Retinoblastoma (ICRB) [Philadelphia vs. Los Angeles (LA)] vs. Children's Oncology Group (COG) classification schemes, the positive predictive value (PPV) of Group D eyes for HRF was 42.0% vs. 35.1% vs. 43.2% respectively and those for group E eyes were 58.5% vs. 59.0% vs. 59.5% respectively. Comparing Group D vs. Group E eyes, there was higher mean number of HRF (SD, range) among Group E eyes using the ICRB Philadelphia [0.7 (0.9, 0.0 - 6.0) vs. 1.3 (1.7, 0.0 - 9.0), p < 0.001], ICRB LA [0.6 (0.8, 0.0 - 6.0) vs. 1.3 (1.7, 0.0 - 9.0), p < 0.001] and COG [0.8 (1.2, 0.0 - 7.0) vs. 1.3 (1.6, 0.0 - 8.0), p < 0.001] classifications. The PPV for HRF was above 55% for AJCC clinical tumor (cT) group cT3a with increments through cT3e to 72.3%. Agreement between ICRB Philadelphia vs ICRB LA, ICRB LA vs COG and ICRB Philadelphia vs COG was 0.9, 0.8 and 0.8 respectively (p < 0.001). Metastasis-free survival rates and overall survival rates were also comparable between all intraocular retinoblastoma classification schemes but better stratified within the AJCC scheme.

Conclusions: All intraocular retinoblastoma classification schemes predict HRF and MFS equally. Group E includes a wide spectrum equivalent to AJCC group cT3. Uniform grouping with subcategorization of Group E might improve risk stratification. We propose that everyone across the retinoblastoma world henceforth adopts the AJCC classification for all reporting and publishing.

Purpose: To compare anatomic biomarkers on spectral-domain optical coherence tomography between faricimab, a dual angiopoietin-2 (Ang-2)/vascular endothelial growth factor-A (VEGF-A) inhibitor, and aflibercept in a pooled analysis of results from the YOSEMITE/RHINE trials in diabetic macular edema (DME).

Design: YOSEMITE/RHINE (NCT03622580/NCT03622593) were identical, randomized, double-masked, active comparator-controlled, 100-week phase 3 noninferiority trials.

Participants: Adults with visual acuity loss due to center-involving DME.

Methods: Patients were randomized 1:1:1 to faricimab 6.0 mg every 8 weeks (Q8W), faricimab 6.0 mg treat-and-extend (T&E), or aflibercept 2.0 mg Q8W for 100 weeks. The T&E up to every 16 weeks dosing regimen was based on central subfield thickness (CST) and best-corrected visual acuity changes.

Main outcome measures: Post hoc analyses comparing faricimab with aflibercept on CST change; proportion of eyes with an absence of intraretinal fluid (IRF), and/or subretinal fluid, or achieving a CST < 280 μm at key timepoints during the trials; time to first absence of IRF; and time to first achieving CST < 280 μm.

Results: One thousand eight hundred ninety-one patients were enrolled across YOSEMITE/RHINE (n = 632 faricimab Q8W; n = 632 faricimab T&E; n = 627 aflibercept). There were greater CST reductions from baseline with both faricimab dosing regimens compared with aflibercept over the 100 weeks (adjusted means and area-under-the-curve analysis). Higher proportions of eyes achieved an absence of IRF with faricimab Q8W (58-63%) and faricimab T&E (44-49%) versus aflibercept (36-41%) at weeks 92-100. In eyes with IRF at baseline, the median time to first absence of IRF was achieved 40 weeks earlier with faricimab versus aflibercept. The proportion of eyes achieving a CST < 280 μm at weeks 92-100 was 70-74% with faricimab Q8W, 61-65% with faricimab T&E, and 61-63% with aflibercept. In eyes with CST ≥ 280 μm at baseline, the median time to first instance of CST < 280 μm was achieved 16 weeks earlier with faricimab versus aflibercept.

Conclusions: Dual Ang-2/VEGF-A inhibition with faricimab resulted in greater and faster improvement in anatomic outcomes compared with aflibercept at key timepoints over the pooled YOSEMITE/RHINE trials.