Ophthalmology. Retina最新文献

Purpose: To characterize the prevalence of some critical optical coherence tomography (OCT) biomarkers-including cuticular drusen and acquired vitelliform lesions (AVLs)-and to identify their relative risk for progression to late age-related macular degeneration (AMD) over two years in subjects with early or intermediate AMD in the Amish Eye Study.

Design: Prospective, observational, longitudinal, population-based cohort study.

Participants: This study included 276 eyes from 171 subjects with early or intermediate AMD at baseline who completed the two-year follow-up.

Methods: Baseline OCT scans were evaluated for the presence of: cuticular drusen, AVLs, subretinal drusenoid deposits (SDD), high drusen volume (defined as ≥0.2mm³ within the central 5mm), intraretinal hyperreflective foci (IHRF), hyporeflective drusen cores (hDC), thick/thin double-layer sign, and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA). Subfoveal choroidal thickness (SFCT) was also measured.

Main outcome measures: Incidence of late AMD (geographic atrophy or macular neovascularization) at two years as determined by multimodal imaging (OCT, color fundus photography (CFP), and confocal fundus autofluorescence (FAF)).

Results: By 2-years of follow-up, 26 eyes (10.7%) progressed to late AMD. The most prevalent baseline features in this cohort, in descending order, were cuticular drusen (52.3%), IHRF (17.3%), hDC (16.0%), thin DLS (11.9%), SDD (8.2%), iRORA (7.8%), AVL (7.0%), and high drusen volume (2.5%). The mean SFCT was 243.23 ± 75.45 μm. Univariate analysis demonstrated that the presence of thick DLS, iRORA, AVL, SDD, IHRF, hDC, and SFCT were associated with increased risk of progression. In multivariate regression, however, only the presence of iRORA (OR: 29.60; 95% CI: 6.86-127.84; p < 0.001) and AVL (OR: 15.90; 95% CI: 3.24-78.00; p < 0.001) remained significant, while the presence of IHRF showed borderline significance (OR: 4.71; 95% CI: 1.00-22.16; p = 0.050).

Conclusions: In this cohort, the presence of iRORA and AVL was independently associated with progression to late AMD over 2 years. Although cuticular drusen were highly prevalent, their presence, as assessed in this study, was not significantly associated with an increased risk of progression to late AMD.

Purpose: To describe swept-source OCT and OCT angiography (OCTA) B-scan findings in inflammatory retinal vascular changes.

Design: Observational cross sectional study of prospectively enrolled patients.

Participants: A total of 87 eyes from 50 patients with inflammatory retinal vascular changes.

Methods: Swept-source OCTA, which provides both structural OCT and OCTA B-scan data, and ultra-widefield fluorescein angiography were obtained on the same day or within 2 weeks. Structural OCT and OCTA B-scans corresponding to vessel points with inflammatory findings on fluorescein angiography were analyzed for vascular and perivascular structural changes. In eyes with comparable active and inactive phases, B-scan parameters were measured and their changes were compared.

Main outcome measures: Retinal thickness and elevation ratio, outer nuclear layer (ONL) thinning ratio, horizontal and vertical flow signal diameters of retinal veins and arteries, and perivascular changes.

Results: The mean age was 42.9 years. Hyporeflective and/or hyperreflective perivascular changes were observed around the flow signal in the active phase. The mean retinal thickness significantly decreased from 318.5 μm in the active phase to 260.3 μm in the inactive phase (P < 0.01) for veins, and 300.5 to 247.0 μm (P < 0.01) for arteries. The mean vertical flow signal diameter for veins decreased from 154.5 to 134.5 μm (P < 0.01) and, for arteries, from 104.8 to 92.0 μm (P = 0.07). The mean horizontal flow signal diameters for veins changed from 145.0 to 130.1 μm (P = 0.07) and, for arteries, from 80.1 to 79.5 μm (P = 0.72). The mean retinal elevation ratio for veins significantly decreased from 1.15 to 1.06 (P < 0.01) and, for arteries, 1.09 to 1.05 (P = 0.08). The mean ONL thinning ratio for veins was 0.74 in the active phase and 0.81 in the inactive phase (P < 0.01), and, for arteries, 0.90 and 0.95 (P = 0.90), respectively.

Conclusions: Optical coherence tomography and OCTA B-scan data identified significant changes in retinal thickness, elevation ratio, ONL thinning ratio, and vertical flow signal diameter of veins between the active and inactive phases of inflamed retinal vessels. Additionally, OCT B-scan identified unique perivascular changes, suggesting its potential in identifying inflammatory activity.

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

Purpose: Ophthalmologists who diagnose and treat injection drug use-associated endogenous endophthalmitis (IDU-EE) are on the frontlines of the ongoing opioid epidemic and can facilitate a multidisciplinary approach to the care of persons with substance use disorders (SUDs). To identify influential factors and opportunities for intervention, we examined recent SUD care and ophthalmic outcomes in the context of IDU-EE with attention to historical trends.

Design: Retrospective cohort study SUBJECTS: Patients diagnosed with IDU-EE at a single, academic, tertiary-referral center from 2015 to 2021.

Methods: The clinical features, treatment, and outcomes of SUDs and IDU-EE were analyzed.

Main outcome measures: Addiction medicine outcomes: injection drug type, consultation by the addiction consult service (ACS), and initiation of medication(s) for opioid use disorder (MOUD). Ophthalmic outcomes: visual acuity (VA), ophthalmic intervention, ocular sequelae, and isolated organisms.

Results: Sixty-two patients (65 eyes) with IDU-EE were included. Injected drugs included heroin (74.2%), cocaine (19.4%), and fentanyl (17.7%). Initial ophthalmic treatments were tap-and-inject (TAI) in 51 (78.5%) eyes and pars plana vitrectomy (PPV) with intravitreal antimicrobials in 9 (13.8%) eyes. Subsequent PPV was performed in 30 (46.2%) eyes. Intraocular cultures were positive in 34 (54.8%) eyes. Tap-and-inject was less likely to yield a positive culture (11/52) compared with PPV (26/39; P < 0.0001). Median VA improved from 1.30 (interquartile range [IQR]: 0.80-2.4) logarithm of the minimum angle of resolution (LogMAR) at presentation to 0.48 (IQR: 0.097-2.1) LogMAR at most recent follow-up (P = 0.0003); VA improved in 43 (68.2%) eyes. Retinal detachment occurred in 15 (23.1%) eyes. Initial TAI versus PPV did not influence final VA. Reported fentanyl use significantly increased the odds of off-chart (less than or equal to counting fingers) VA outcome (odds ratio: 5.25, 95% confidence interval: 1.3-20.9, P = 0.012) at the most recent follow-up. Among 54 patients who were admitted, 37 (68.5%) saw the ACS while hospitalized. All eligible patients who saw the ACS were offered a MOUD. Of these 24 patients, 13 (54.2%) accepted a new MOUD. No MOUDs were initiated for inpatients or outpatients who did not see the ACS.

Conclusions: Addiction consult services provide potentially life-saving care for patients with IDU-EE. The incidence and visual outcomes of this condition may be worsening in correlation with fentanyl use, which confers higher odds of poor visual outcomes. Initial vitrectomy may facilitate pathogen identification.

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

Purpose: Despite mechanistic links connecting malnutrition and gut microbiome with retinal health, clinical research exploring the relationship between malabsorption syndromes and age-related macular degeneration (AMD) remains limited. This study compared the risks of AMD diagnosis in patients with and without various malabsorption syndrome diagnoses.

Design: Retrospective cohort study of aggregated, de-identified patient data from multiple healthcare organizations across the United States using the TriNetX U.S. Collaborative Research Network in 11/2025.

Participants: Adults with a cataract-related International Classification of Diseases (ICD) encounter diagnosis codes and no baseline AMD ICD encounter diagnosis codes were divided into groups based on the presence of ICD encounter diagnosis codes for celiac disease (CeD), ulcerative colitis (UC), Crohn's disease (CrD), chronic pancreatitis (CP), and short bowel syndrome (SBS). Within the CP cohort, patients with pancreatic enzyme replacement therapy (PERT) prescription orders were subanalysis. For each cohort, a corresponding control cohort of patients without the respective ICD encounter diagnosis codes was created.

Methods: The study and control cohorts were propensity-matched 1:1 on demographic factors, comorbidities, and disease-related conditions and prescription orders. The matched cohorts were compared on the risk of having AMD ICD encounter diagnoses.

Main outcome measure: Risk ratios (RR) and 95% confidence intervals (CI) of having an AMD ICD encounter diagnosis code with an accompanying retinal optical coherence tomography Common Procedural Terminology code. Significance was defined as CI ≤0.9 or ≥1.1.

Results: Compared to controls without IBD, the CrD cohort (n=9,537, RR=1.42, CI=1.16-1.74), but not the UC cohort (n=15,039, RR=1.28, CI=1.09-1.51), had a higher risk of having early/intermediate AMD. CP was associated with an increased risk of AMD (n=12,856, RR=1.82, CI=1.53-2.16), even in the PERT subset (n=3,812, RR=1.83, CI=1.35-2.48). SBS (n=3,747) was associated with an increased risk of advanced/exudative AMD (RR=1.98, CI=1.31-2.98), but not early/intermediate AMD (RR=1.28, CI=0.96-1.71). CeD was not associated with increased AMD risk (n=9,315, RR=1.09, CI=0.88-1.35).

Conclusions: Chronic non-infectious causes of malabsorption syndromes-CrD, CP, and SBS-may represent underrecognized risk factors of AMD. This explorative study adds clinical evidence for a potential role of the gut-retina axis in the pathogenesis of AMD.