Ophthalmology. Retina最新文献

Purpose: To determine characteristics of eyes achieving absence of diabetic macular edema (DME) and very good vision after treatment with bevacizumab first, with a switch to aflibercept, versus aflibercept monotherapy using Diabetic Retinopathy Clinical Research Retina Network Protocol AC data.

Design: Post hoc analysis.

Subjects: Patients in the Diabetic Retinopathy Clinical Research Protocol AC.

Methods: Bevacizumab-first subjects were assigned to "bevacizumab-switch" or "bevacizumab-only" groups, and aflibercept monotherapy subjects were assigned to "aflibercept-switch-eligible" or "aflibercept-only" groups, based on predefined switch criteria. Absence of DME was defined as normal central subfield thickness per device-specific thresholds and very good vision as visual acuity ≥20/25 or ≥80 ETDRS letters.

Main outcome measures: Proportion of eyes in each group achieving absence of DME and very good vision and maintaining absence of DME and very good vision throughout follow-up.

Results: Of 312 patients enrolled in Protocol AC, 284 with sufficient follow-up were included. In the aflibercept monotherapy cohort, 81.4% (118/145) achieved absence of DME versus 71.9% (100/139) in the bevacizumab-first cohort (P = 0.068), within a mean time of 16.2 versus 30.8 weeks, respectively (P < 0.001). In the aflibercept monotherapy cohort, 68.3% (99/145) achieved very good vision versus 65.5% (91/139) in the bevacizumab-first cohort (P = 0.705), within a mean time of 24.6 versus 36.6 weeks, respectively (P = 0.002). In the aflibercept-only group, 94.9% (93/98) achieved absence of DME versus 84.1% (37/44) in the bevacizumab-only group (P = 0.048), in 11.8 versus 13.5 weeks (P = 0.444). The aflibercept-switch-eligible group had similar proportions achieving absence of DME and very good vision in similar times compared with the bevacizumab-switch group. The aflibercept-only group had a similar proportion achieving very good vision in a similar time compared with the bevacizumab-only group.

Conclusions: Aflibercept monotherapy eyes achieved absence of DME significantly sooner by 14.6 weeks and very good vision by 12 weeks compared to the other group. The proportion achieving absence of DME and very good vision was similar between the 2 cohorts. In eyes never meeting switch criteria, a significantly greater proportion in the aflibercept-only group achieved absence of DME compared with the bevacizumab-only group.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: To develop artificial intelligence-based models for estimating the risk of myopic macular neovascularization (MNV) in highly myopic eyes.

Design: Retrospective, single-center cohort study.

Participants: A total of 4235 eyes from 2501 patients with high myopia who visited the Institute of Science Tokyo between October 2011 and May 2021 were included for analysis.

Methods: Baseline fundus photographs and 7 clinical variables were used for model development and validation. Three image-based deep learning (DL) models with a DenseNet-121 backbone were trained to predict the risk of MNV within 1, 3, and 5 years after baseline. A multimodal survival model based on the DeepSurv framework was further developed by integrating image-derived features with clinical variables to estimate time-to-event risk. Model performance was evaluated using discrimination, calibration, and clinical utility metrics. Model interpretability was explored using gradient-weighted class activation mapping and SHapley Additive exPlanation analyses.

Main outcome measures: Area under the receiver operating characteristic curve for the DL models and concordance index for the multimodal DeepSurv model.

Results: The DL models achieved area under the receiver operating characteristic curves of 0.785 (95% confidence interval [CI], 0.474-0.988), 0.798 (95% CI, 0.687-0.900), and 0.729 (95% CI, 0.614-0.832) for the 1-, 3-, and 5-year predictions, respectively. The multimodal DeepSurv model achieved a concordance index of 0.683 (95% CI, 0.582-0.775) and enabled stratification of eyes into subgroups with distinct long-term probabilities of MNV development. Heatmaps showed activation in clinically relevant regions, and SHapley Additive exPlanation analysis indicated that axial length and pathologic myopia category showed prominent conditional contributions within the multimodal model.

Conclusions: Artificial intelligence-based models enabled fixed-horizon risk estimation and longitudinal time-to-event risk assessment for MNV in highly myopic eyes, providing clinically meaningful risk stratification. With further external validation, this approach may support risk-adapted long-term monitoring strategies in high myopia.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: To evaluate the 10-year anatomical and functional outcomes after vitrectomy with the inverted internal limiting membrane (ILM) flap technique for full-thickness macular hole (FTMH) and assess the incidence of long-term postoperative complications.

Design: Retrospective consecutive case series.

Subjects: From 295 patients (323 eyes), who had pars plana vitrectomy with inverted ILM flap technique for idiopathic FTMH in our clinic in the years 2007-2014, 89 patients (99 eyes) completed a 10-year follow-up.

Methods: Medical records were reviewed retrospectively. Patients who had pars plana vitrectomy with the inverted ILM flap technique for idiopathic FTMH in the years 2007-2014 were invited for a 10-year follow-up. Preoperative and postoperative parameters were analyzed, including age, sex (male/female), visual acuity, initial hole size, swept-source OCT parameters, surgical technique, and postoperative complications.

Main outcome measures: Primary outcomes were long-term anatomical closure at 10 years and best-corrected visual acuity (BCVA). Secondary outcomes included OCT-based macular morphology (ellipsoid zone [EZ], interdigitation zone [IZ], and foveal contour) and complication rates (e.g., epiretinal membrane [ERM], gliosis, or secondary glaucoma).

Results: The initial closure rate in 323 eyes was 93.5%; final closure rate after reoperation was 100%. Notably, 20/40 vision was achieved in 44.5% of eyes 1 year after surgery and in 70.7% of eyes followed until the 10th year. The number of eyes with >20/25 vision improved from 12% to 42.4% during that time. Patients achieving final BCVA better than 20/25 had a continuous IZ and EZ line before surgery (P = 0.03), and a continuous IZ and EZ line 1 year after surgery (P = 0.01). Foveal contour improved over time. No FTMH reopenings were observed. Epiretinal gliosis developed in 7% of cases, associated with larger baseline hole size and preoperative ERM, but did not significantly impact final visual acuity. Retinal detachment incidence was 0.85% per patient/year.

Conclusions: The inverted ILM flap technique provides sustained anatomical and functional success in idiopathic FTMH over a 10-year period. Continued improvement in BCVA beyond the first year and low complication rates support the use of this technique as an effective and durable surgical approach.

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