Ophthalmology. Retina最新文献

英文中文

Segmental Optic Nerve Hypoplasia. 节段性视神经发育不全。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-11 DOI: 10.1016/j.oret.2024.08.006

Savithiri Palanivel, Anand Rajendran

引用次数: 0

Striking Vitreoschisis in Proliferative Diabetic Retinopathy. 增生性糖尿病视网膜病变中的惊人玻璃体裂孔。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-11 DOI: 10.1016/j.oret.2024.08.009

Chandrakumar Balaratnasingam, Elon H C van Dijk

引用次数: 0

Lyophilized Amniotic Membrane Grafts in Optic Disc Pit with Macular Hole. 冻干羊膜移植物在有黄斑孔的视盘凹陷中的应用

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-09 DOI: 10.1016/j.oret.2024.07.021

Rita Serra, Laurent Kodjikian, Thibaud Mathis

引用次数: 0

Intravitreal Antibiotics versus Early Vitrectomy plus Intravitreal Antibiotics for Post-Injection Endophthalmitis: an IRIS® Registry (Intelligent Research in Sight). 玻璃体内抗生素与早期玻璃体切除术加玻璃体内抗生素治疗注射后眼内炎：IRIS® 登记（Intelligent Research in Sight）。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-09 DOI: 10.1016/j.oret.2024.09.002

Connor Ross, Sophia Ghauri, Joshua B Gilbert, Daniel Hu, Varun Ullanat, Dan Gong, Paul B Greenberg, Dean Eliott, Tobias Elze, Alice Lorch, Joan W Miller, Magdalena G Krzystolik

Purpose: To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections.

Design: Retrospective cohort study PARTICIPANTS: Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® Registry between 2016 and 2020.

Methods: Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and post-treatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis.

Main outcome measures: Post-treatment logMAR VA RESULTS: 1,044 patients diagnosed with post-injection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 [20/40-20/50] at baseline, 0.88 [∼20/150] at diagnosis, and 0.57 [20/70-20/80] post-treatment. There were no statistically significant differences in the visual outcomes between the two matched treatment groups (b = 0.05, p = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05, p = 0.452).

Conclusions: There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for post-injection endophthalmitis. The findings support the use of either treatment strategy.

目的：确定单纯玻璃体内注射抗生素与早期玻璃体旁切除术（PPV）加玻璃体内注射抗生素相比，对注射抗血管内皮生长因子（anti-VEGF）后患有眼内炎的患者而言，视觉预后是好还是坏：设计：回顾性队列研究参与者：2016年至2020年期间接受美国眼科学会IRIS®注册中心的玻璃体内抗血管内皮生长因子注射后发生眼内炎的患者：纳入标准：抗血管内皮生长因子注射后 1-28 天内确诊眼内炎，基线、确诊当天和治疗后记录视力 (VA)。仅注射组患者仅进行了抗生素的玻璃体内注射，而早期玻璃体切除术组患者在确诊后 2 天内接受了 PPV 和玻璃体内抗生素或玻璃体内注射，然后进行 PPV。如果患者在研究期间接受过白内障手术、在眼底病发生前接受过玻璃体内类固醇治疗或患有中度/后部葡萄膜炎或囊样黄斑水肿，则被排除在外。研究采用马哈拉诺比斯距离匹配法建立了 1:1 的匹配队列，考虑了基线和诊断时 VA 的差异：结果：1044 名诊断为注射后眼内炎的患者符合纳入和排除标准。在非匹配队列中，仅注射组有 935 名患者，早期玻璃体切割组有 109 名患者。在 1:1 匹配队列中，共纳入 218 名患者（每组 109 名）；基线时的中位 logMAR VAs 为 0.32 [20/40-20/50]，诊断时为 0.88 [∼20/150]，治疗后为 0.57 [20/70-20/80]。两个匹配治疗组之间的视力结果差异无统计学意义（b = 0.05，p = 0.23）；包括视力差于 1.0 logMAR 的亚组患者（b = 0.05，p = 0.452）：结论：仅接受注射治疗的患者与接受早期玻璃体切割术治疗的注射后眼内炎患者的最终视力结果没有明显差异。研究结果支持采用这两种治疗策略。

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引用次数: 0

Impact of a Recall of Intravitreal Bevacizumab: a Health Analytics in Ophthalmology Registry Review. 玻璃体内贝伐单抗召回的影响：HALO 登记回顾。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-02 DOI: 10.1016/j.oret.2024.08.021

Hasenin Al-Khersan, Elioenai Garcia, Kenneth C Fan, Patrick C Staropoli, Edward H Wood, Philip Storey, Murtaza K Adam, David W Parke, Lawrence S Halperin, Kevin Quinn, Charles C Wykoff

引用次数: 0

Acquired Vitelliform Lesions in Intermediate Age-Related Macular Degeneration 中度老年性黄斑变性中的获得性玻璃样病变：一项横断面研究

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-01 DOI: 10.1016/j.oret.2024.04.009

Purpose

This study aims to define the characteristics of acquired vitelliform lesions (AVLs) in patients with intermediate age-related macular degeneration (iAMD).

Design

Retrospective, observational, cross sectional study.

Subjects

This study included 217 eyes with AVLs associated with iAMD, and an equivalent number of control patients.

Methods

OCT scans were evaluated for qualitative and quantitative parameters at both the eye and lesion level. Eye-level parameters included the presence of: hyporeflective core drusen, intraretinal hyperreflective foci (IHRF), subretinal drusenoid deposits, macular pachyvessels, central retinal thickness, and central choroidal thickness. Lesion-level qualitative parameters included the presence of ellipsoid zone (EZ) and external limiting membrane disruption overlying the AVL, IHRF overlying the AVL, AVL overlying drusen, pachyvessels under the AVL, a solid core within AVL, and AVL location. Lesion-level quantitative characteristics included AVL height and width, AVL distance from the fovea, and sub-AVL choroidal thickness.

Main Outcome Measures

The primary outcomes assessed included the frequency of IHRF, the presence of macular pachyvessels, central choroidal thickness, and the dimensions (both height and width) of AVLs.

Results

Comparing the AVL and control groups, the frequency of IHRF (AVL: 49.3% vs. control: 26.3%) and macular pachyvessels (37.3% vs. 6.9%) was significantly higher in the AVL case group, and the central choroidal thickness (256.8 ± 88 μm vs. 207.1± 45 μm) was thicker in the AVL group. Acquired vitelliform lesions located over drusen, with overlying IHRF, or situated subfoveally, and AVL lesions with EZ disruption were found to have a greater lesion height and width compared with AVL lesions lacking these characteristics (P value < 0.001 for all). Additionally, a significant negative correlation was observed between the distance from the fovea and AVL height (Spearman rho: −0.19, P = 0.002) and width (Spearman rho: −0.30, P = 0.001).

Conclusions

This study represents the largest reported cohort of AVL lesions associated with iAMD. Novel findings include the higher frequency of pachyvessels in addition to the presence of a thicker choroid in these eyes, as well as the greater height and width of AVL closer to the foveal center. These findings may offer insights into pathophysiologic mechanisms underlying the development of AVL.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

本研究纳入了 217 名患有中度年龄相关性黄斑变性（iAMD）的获得性玻璃样病变（AVL）患者，以及同等数量的对照组患者。方法对 OCT 扫描进行眼部和病变水平的定性和定量参数评估。眼球层面的参数包括：低反射核心色素、视网膜内高反射灶（IHRF）、视网膜下类风湿沉积、黄斑丘疹、视网膜中央厚度和脉络膜中央厚度。病变水平的定性参数包括 AVL 上是否存在椭圆形区（EZ）和外缘膜破坏、AVL 上是否存在 IHRF、AVL 上是否存在类绒毛、AVL 下是否存在绒毛血管、AVL 内是否存在实性核心以及 AVL 的位置。病变水平的定量特征包括AVL的高度和宽度、AVL与眼窝的距离以及AVL下脉络膜的厚度。主要结果测量评估的主要结果包括IHRF的频率、黄斑睫状体的存在、中心脉络膜厚度以及AVL的尺寸（高度和宽度）。结果对比 AVL 组和对照组，AVL 病例组的 IHRF 发生率（AVL：49.3% 对对照组：26.3%）和黄斑区血管发生率（37.3% 对 6.9%）明显更高，AVL 组的中心脉络膜厚度（256.8 ± 88 μm 对 207.1 ± 45 μm）更厚。与缺乏这些特征的 AVL 病变相比，位于色素上方、上覆 IHRF 或位于眼窝下的获得性玻璃体病变以及 EZ 破坏的 AVL 病变的高度和宽度更大（P 值均为 0.001）。此外，还观察到离眼窝的距离与 AVL 高度（Spearman rho：-0.19，P = 0.002）和宽度（Spearman rho：-0.30，P = 0.001）之间存在明显的负相关。新的发现包括：这些眼球中除了存在较厚的脉络膜外，还存在较高频率的棘状血管，以及靠近眼窝中心的 AVL 高度和宽度更大。这些发现可能有助于深入了解AVL发生的病理生理机制。

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引用次数: 0

Congenital Stationary Night Blindness "先天性静止性夜盲症：122名患者的结构、功能和基因型-表型相关性"。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-01 DOI: 10.1016/j.oret.2024.03.017

Objective

To examine the molecular causes of Schubert–Bornschein (S–B) congenital stationary night blindness (CSNB), clinically characterize in detail, and assess genotype–phenotype correlations for retinal function and structure.

Design

Retrospective, longitudinal, single-center case series.

Participants

One hundred twenty-two patients with S–B CSNB attending Moorfields Eye Hospital, United Kingdom.

Methods

All case notes, results of molecular genetic testing, and OCT were reviewed.

Main Outcome Measures

Molecular genetics, presenting complaints, rates of nystagmus, nyctalopia, photophobia, strabismus, color vision defects and spherical equivalent refraction (SER). Retinal thickness, outer nuclear layer (ONL) thickness, and ganglion cell layer + inner plexiform layer (GCL+IPL) thickness from OCT imaging.

Results

X-linked (CACNA1F and NYX) and autosomal recessive (TRPM1, GRM6, GPR179 and CABP4) genotypes were identified. The mean (± standard deviation) reported age of onset was 4.94 ± 8.99 years. Over the follow-up period, 95.9% of patients reported reduced visual acuity (VA), half had nystagmus, and 64.7% reported nyctalopia. Incomplete CSNB (iCSNB) patients more frequently had nystagmus and photophobia. Nyctalopia was similar for iCSNB and complete CSNB (cCSNB). Color vision data were limited but more defects were found in iCSNB. None of these clinical differences met statistical significance. There was no significant difference between groups in VA, with a mean of 0.46 logarithm of the minimum angle of resolution, and VA remained stable over the course of follow-up. Complete congenital stationary night blindness patients, specifically those with NYX and TRPM1 variants, were more myopic. CACNA1F patients showed the largest refractive variability, and the CABP4 patient was hyperopic. No significant differences were found in OCT structural analysis during the follow-up period.

Conclusions

Retinal structure in CSNB is stationary and no specific genotype–structure correlates were identified. Visual acuity seems to be relatively stable, with rare instances of progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的研究舒伯特-博恩斯切因（S-B）先天性静止性夜盲（CSNB）的分子原因，详细描述其临床特征，并评估视网膜功能和结构的基因型-表型相关性：设计：回顾性、纵向、单中心病例系列研究：英国 Moorfields 眼科医院 122 名 S-B CSNB 患者：方法：回顾所有病例记录、分子遗传学检测结果和光学相干断层扫描（OCT）：分子遗传学、主诉、眼球震颤、夜视、畏光、斜视、色觉缺陷和球面屈光不正（SER）的发生率。OCT成像显示视网膜厚度、外核层厚度（ONL）和神经节细胞层+内丛状层（GCL+IPL）厚度：结果：发现了 X 连锁（CACNA1F 和 NYX）和常染色体隐性（TRPM1、GRM6、GPR179 和 CABP4）基因型。报告的平均发病年龄为 4.94 ± 8.99 岁。在随访期间，95.9%的患者视力下降，半数患者有眼球震颤，64.7%的患者有夜视。不完全 CSNB（iCSNB）患者更常见眼球震颤和畏光。眼球震颤与完全性 CSNB（cCSNB）相似。色觉数据有限，但在 iCSNB 中发现的色觉缺陷更多。这些临床差异均未达到统计学意义。cCSNB 患者，特别是 NYX 和 TRPM1 变异者，近视度数更高。CACNA1F 患者的屈光变异最大，而 CABP4 患者则是远视。在随访期间，OCT结构分析未发现明显差异：结论：CSNB 患者的视网膜结构是固定的，没有发现特定基因型与结构的相关性。视网膜视力似乎相对稳定，很少有恶化的情况。

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引用次数: 0

Surgical Outcomes of Retinal Detachment in Knobloch Syndrome 克诺布洛赫综合征视网膜脱离的手术效果。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-01 DOI: 10.1016/j.oret.2024.03.020

Purpose

To describe the rate, characteristics, and outcomes of rhegmatogenous retinal detachment (RD) in patients with Knobloch syndrome.

Design

A single-center retrospective cohort study.

Participants

Fifty patients with Knobloch syndrome diagnosed clinically, with or without molecular confirmation of recessive pathogenic COL18A1 variants.

Methods

A retrospective chart review of all patients diagnosed with Knobloch syndrome from November 1, 1983 to March 31, 2023. Demographic data, ophthalmic evaluation at baseline and follow-up, interventions, and final anatomic and visual outcomes were collected.

Main Outcome Measures

Rate, time of onset, characteristics, and treatment outcomes of RD.

Results

Fifty patients with Knobloch syndrome were included. Males constituted 56% of cases. The diagnosis was confirmed with molecular genetic testing in 37 (74%) patients. Twenty-two patients (44%) had documented occipital bony defects or scalp lesions. Forty-eight of 100 eyes (48%) developed RD at a mean (standard deviation [SD]) age of 6.5 (6.1) years. The mean (SD) follow-up was 7.7 (5.6) years (range, 6 months to 24.3 years). Macular hole-related RD comprised 33% of RD cases. The overall single-surgery success rate was 36% and the final anatomic success rate was 70%. Macular hole-related RD carried a slightly worse prognosis with a 58% final anatomic success rate. Vitrectomy with adjunct scleral buckle and silicone oil tamponade provided the highest single-surgery success (62.2%). In eyes with measurable best-corrected visual acuity (BCVA), the mean preoperative BCVA was 1.2 logarithm of the minimum angle of resolution (Snellen equivalent, 20/320). After successful repair, mean visual acuity was 1.3 logarithm of the minimum angle of resolution (Snellen equivalent, 20/500).

Conclusions

Retinal detachment in Knobloch syndrome is frequent and occurs in young children. Macular hole-related RD comprises one third of RD cases and requires careful macular evaluation. Vitrectomy, combined with scleral buckling and silicone oil tamponade, appears to provide the best anatomic outcomes.

Financial Disclosures

The authors have no proprietary or commercial interest in any materials discussed in this article.

目的：描述Knobloch综合征患者流变性视网膜脱离（RD）的发生率、特征和预后：设计：单中心回顾性队列研究：50例经临床诊断为克诺布洛赫综合征的患者，无论是否经分子鉴定证实存在隐性致病性COL18A1变异：对1983年11月1日至2023年3月31日期间诊断为克诺布洛赫综合征的所有患者进行回顾性病历审查。收集人口统计学数据、基线和随访时的眼科评估、干预措施以及最终的解剖和视觉结果：主要结果指标：RD的发病率、发病时间、特征和治疗结果：结果：纳入了 50 例克诺布洛赫综合征患者。结果：共纳入 50 例克诺布洛赫综合征患者，男性占 56%。37名患者（74%）通过分子基因检测确诊。22名患者（44%）有枕骨缺损或头皮病变的记录。100只眼睛中有48只（48%）在平均年龄6.5（SD = 6.1）岁时出现RD。平均随访时间为 7.7 (SD = 5.6) 年 [范围为 6 个月 - 24.3 年]。与黄斑孔相关的 RD 占 RD 病例的 33%。单次手术的总体成功率为36%，最终解剖成功率为70%。黄斑孔相关 RD 的预后稍差，最终解剖成功率为 58%。伴有巩膜扣带和硅油填塞的玻璃体切除术单次手术成功率最高（62.2%）。在可测量最佳矫正视力（BCVA）的眼睛中，术前 BCVA 平均值为 1.2 logMAR（斯奈伦等效值 20/320）。成功修复后，平均视力为 1.3 logMAR（相当于斯奈伦视力表 20/500）：结论：Knobloch 综合征的视网膜脱离很常见，而且多发于幼儿。黄斑孔视网膜脱离占 RD 病例的三分之一，需要对黄斑进行仔细评估。玻璃体切除术结合巩膜扣锁术和硅油填塞术似乎能提供最佳的解剖效果。

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引用次数: 0

Early Scleral Buckle Intrusion in a Vitrectomized Myopic Eye 玻璃体切除近视眼的早期巩膜扣带内陷。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-01 DOI: 10.1016/j.oret.2024.02.009

引用次数: 0

Dexamethasone Implant under a Proactive Treatment Regimen in a Clinical Setting 在积极治疗方案下植入地塞米松的真实体验：ProDEX 研究。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina

Pub Date : 2024-09-01 DOI: 10.1016/j.oret.2024.03.019

Purpose

To assess the effectiveness of switching intravitreal dexamethasone implants (DEX-implant) from pro re nata (PRN) treatment regimen to a proactive regimen in patients with macular edema of diverse etiologies.

Design

An observational, retrospective, uncontrolled, multicenter, national case series.

Participants

Eighty-one eyes from 68 patients treated between October 2015 and June 2023 were included.

Methods

This study included consecutive eyes treated with DEX-implant who were switched from a PRN regimen to a proactive regimen for diabetic macular edema (DME), retinal vein occlusion (RVO), noninfectious uveitis macular edema (UME; including postsurgical macular edema), and radiation maculopathy (RM).

Main Outcome Measures

The main outcome measures were change in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at each visit.

Results

According to the etiology, DME represented 49.4% of eyes, UME 24.3%, RVO 21.0%, and RM 6.2%. The mean (standard deviation [SD]) duration of follow-up under the PRN and proactive regimens was 20.6 (13.3) and 14.2 (10.3) months, respectively. Switching from a PRN to a proactive regimen significantly improved mean (SD) BCVA by 3.7 (12.9) ETDRS letters (P = 0.01) with a mean (SD) decrease in CMT of 108.0 (151.4) μm (P < 0.001). The proportion of visits with significant anatomic recurrence (> 50 μm) also decreased from 40.1% to 6.0% after switching to a proactive regimen (P < 0.001). The number of DEX-implant injections significantly increased during the proactive treatment period (P < 0.001), but the change in the number of visits was not significantly different (P = 0.2). The proactive treatment period was not associated with a significant increase in IOP (P = 0.6).

Conclusions

Switching to a proactive regimen in patients already treated with DEX-implant seems to significantly improve BCVA and CMT while maintaining stable IOP.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：评估在不同病因引起的黄斑水肿患者中，将玻璃体内地塞米松植入剂（DEX-植入剂）从临时治疗方案转为主动治疗方案的效果：设计：观察性、回顾性、非对照、多中心、全国性病例系列：方法：本研究纳入 2015 年 10 月至 2023 年 6 月期间接受治疗的 68 名患者的 81 只眼睛：本研究纳入了使用DEX-植入剂治疗糖尿病性黄斑水肿（DME）、视网膜静脉闭塞（RVO）、非感染性葡萄膜炎黄斑水肿（UME；包括手术后黄斑水肿）和放射性黄斑病变（RM）的从PRN方案转为主动方案的连续患者：主要结果指标：每次就诊时最佳矫正视力（BCVA）、黄斑中心厚度（CMT）和眼压（IOP）的变化：根据病因，DME 占 49.4%，UME 占 24.3%，RVO 占 21.0%，RM 占 6.2%。PRN和主动方案的平均（标清）随访时间分别为20.6（13.3）个月和14.2（10.3）个月。从PRN方案转为主动方案后，BCVA的平均（标度）显著提高了3.7（12.9）个ETDRS字母（p=0.01），CMT的平均（标度）下降了108.0（151.4）μm（p50μm），转为主动方案后，CMT的平均（标度）下降率也从40.1%降至6.0%（p结论：对于已经接受过 DEX-implant 治疗的患者，改用前瞻性方案似乎能显著改善 BCVA 和 CMT，同时保持眼压稳定。

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