<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or
{"title":"Comparing Membrane Peeling Techniques in Lamellar Macular Hole Surgery","authors":"Yosra Er-reguyeg MD, MSc (C) , Elyazid Rhalem MD (C) , Eunice Linh You MD, MSc , Anas Abu-Dieh MD , Mélanie Hébert MD, MSc , Huixin Zhang MD , Serge Bourgault MD , Mathieu Caissie MD , Éric Tourville MD , Ali Dirani MD, MSc","doi":"10.1016/j.oret.2025.06.004","DOIUrl":"10.1016/j.oret.2025.06.004","url":null,"abstract":"<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or ","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 39-60"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.07.007
Alicia Chen MD , Ian Seddon DO , James Rhead BS , David J. Browning MD, PhD
Purpose
To examine near infrared reflectance (NIR) imaging in acute syphilitic outer retinitis.
Design
Retrospective case series.
Subjects
Patients diagnosed with ocular syphilis from 2015 to 2024 at Wake Forest Baptist Hospital.
Methods
Two authors independently graded NIR images for notable imaging characteristics with joint review with a third grader for disagreements.
Main Outcome Measures
Near infrared reflectance images were graded based on presence of white dot lesions, granular pattern (defined as a fine pattern of hyperreflective dots), geographic reflectivity changes (defined as an area of hyporeflectivity delineated by a demarcation line), and hyporeflectivity changes due to either subretinal fluid or pigment epithelial detachments.
Results
Thirty-nine eyes from 22 ocular syphilis patients with available NIR images were included in the study. The most common findings were white dots (79.5%), granular pattern (56.4%), and geographic reflectivity changes (38.5%). A new finding was a hyperreflective patch on NIR that correlated to a hyperreflective layer above the ellipsoid zone (EZ) on OCT. After penicillin therapy, this area of hyperreflectivity was replaced with white dots on NIR that correlated with new subretinal hyperreflective foci on OCT.
Conclusions
Near infrared reflectance imaging in ocular syphilis can highlight subtle retinal changes, including changes in the EZ layer and subretinal deposits. Understanding NIR findings in ocular syphilis can help make early diagnoses and monitor treatment responses.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Near Infrared Reflectance Imaging Changes in Acute Syphilitic Outer Retinitis","authors":"Alicia Chen MD , Ian Seddon DO , James Rhead BS , David J. Browning MD, PhD","doi":"10.1016/j.oret.2025.07.007","DOIUrl":"10.1016/j.oret.2025.07.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine near infrared reflectance (NIR) imaging in acute syphilitic outer retinitis.</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with ocular syphilis from 2015 to 2024 at Wake Forest Baptist Hospital.</div></div><div><h3>Methods</h3><div>Two authors independently graded NIR images for notable imaging characteristics with joint review with a third grader for disagreements.</div></div><div><h3>Main Outcome Measures</h3><div>Near infrared reflectance images were graded based on presence of white dot lesions, granular pattern (defined as a fine pattern of hyperreflective dots), geographic reflectivity changes (defined as an area of hyporeflectivity delineated by a demarcation line), and hyporeflectivity changes due to either subretinal fluid or pigment epithelial detachments.</div></div><div><h3>Results</h3><div>Thirty-nine eyes from 22 ocular syphilis patients with available NIR images were included in the study. The most common findings were white dots (79.5%), granular pattern (56.4%), and geographic reflectivity changes (38.5%). A new finding was a hyperreflective patch on NIR that correlated to a hyperreflective layer above the ellipsoid zone (EZ) on OCT. After penicillin therapy, this area of hyperreflectivity was replaced with white dots on NIR that correlated with new subretinal hyperreflective foci on OCT.</div></div><div><h3>Conclusions</h3><div>Near infrared reflectance imaging in ocular syphilis can highlight subtle retinal changes, including changes in the EZ layer and subretinal deposits. Understanding NIR findings in ocular syphilis can help make early diagnoses and monitor treatment responses.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 102-108"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.07.006
Ke Zhu MD , Boya Lei MD , Ling Wang PhD , Ling Chen PhD , Yingqin Ni PhD , Yanqiong Zhang PhD , Xin Huang PhD , Qing Chang PhD , Gezhi Xu PhD
Purpose
To compare the long-term anatomic and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.
Design
Retrospective and comparative study.
Participants
Two hundred eighty-eight patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.
Methods
Two hundred ninety-five eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade, and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.
Main Outcome Measures
Anatomic and visual outcomes of MHRD treated with ILM peeling, insertion, or flap techniques.
Results
The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs 87% vs 54%, P < 0.001) along with a greater BCVA improvement (P < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs 83%, P < 0.005). In eyes with non-high myopia (axial length <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomic advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion, and ILM flap techniques were significantly associated with MH closure (P = 0.011, 0.001, and P < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (P = 0.003, 0.009, 0.006, and 0.014 and P < 0.001, respectively).
Conclusions
The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
目的：比较内限制膜（ILM）剥离、内限制膜插入和内限制膜瓣倒置技术治疗黄斑孔（MH）相关性视网膜脱离（MHRD）的长期解剖和视觉效果。设计：回顾性和对比性研究参与者：288例在复旦大学眼耳鼻喉科医院行玻璃体切除和ILM技术的MHRD患者。方法：将295只眼分为ILM剥离组（138眼）、ILM插入组（54眼）和ILM皮瓣组（103眼），并根据视网膜脱离程度、非高度/高度近视、增殖性玻璃体视网膜病变（PVR）程度和脉络膜视网膜萎缩（CA）程度进行细分。评估初始视网膜再附着率、MH闭合率、术后最佳矫正视力（BCVA）及BCVA改善情况。主要观察指标：采用ILM剥离、插入或皮瓣技术治疗MHRD的解剖和视觉效果。结果：与ILM剥离相比，ILM皮瓣和插入技术具有更好的初始MH关闭率（91% vs. 87% vs. 54%, P < 0.001）以及更大的BCVA改善（P < 0.001）。采用ILM皮瓣技术改善BCVA的眼睛比例高于ILM植入术（96%比83%，P < 0.005）。结论：与ILM剥离技术相比，ILM插入和皮瓣技术治疗MHRD具有更高的MH闭合率和BCVA改善。在功能恢复方面，ILM皮瓣技术优于ILM插入技术。
{"title":"Internal Limiting Membrane Flap and Insertion Techniques Improve Prognosis in Macular Hole-Associated Retinal Detachment","authors":"Ke Zhu MD , Boya Lei MD , Ling Wang PhD , Ling Chen PhD , Yingqin Ni PhD , Yanqiong Zhang PhD , Xin Huang PhD , Qing Chang PhD , Gezhi Xu PhD","doi":"10.1016/j.oret.2025.07.006","DOIUrl":"10.1016/j.oret.2025.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the long-term anatomic and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.</div></div><div><h3>Design</h3><div>Retrospective and comparative study.</div></div><div><h3>Participants</h3><div>Two hundred eighty-eight patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.</div></div><div><h3>Methods</h3><div>Two hundred ninety-five eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade, and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.</div></div><div><h3>Main Outcome Measures</h3><div>Anatomic and visual outcomes of MHRD treated with ILM peeling, insertion, or flap techniques.</div></div><div><h3>Results</h3><div>The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs 87% vs 54%, <em>P</em> < 0.001) along with a greater BCVA improvement (<em>P</em> < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs 83%, <em>P</em> < 0.005). In eyes with non-high myopia (axial length <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomic advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion, and ILM flap techniques were significantly associated with MH closure (<em>P</em> = 0.011, 0.001, and <em>P</em> < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (<em>P</em> = 0.003, 0.009, 0.006, and 0.014 and <em>P</em> < 0.001, respectively).</div></div><div><h3>Conclusions</h3><div>The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 26-38"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.07.003
David A. Sutter BS , Mani K. Woodward BS , John Jackson MD , Yakub Bayhaqi PhD , Aaron S. Coyner PhD , Shuibin Ni PhD , Susan Ostmo MS , Michael F. Chiang MD , Benjamin K. Young MD , Yifan Jian PhD , John Peter Campbell MD, MPH
Purpose
This study presents 2 methods of en face visualization enabled by ultra-widefield (UWF) OCT, which provide topographic information of retinopathy of prematurity (ROP) without requiring direct visualization of cross-sectional scans.
Design
Evaluation of diagnostic technology.
Subjects
Infants undergoing ROP screening at Oregon Health Science University between June 2023 and October 2024, who consented to research imaging.
Methods
An investigational contact-based UWF-OCT captured 800 × 800 A-scans. Max intensity projections (MIP) were constructed, from the highest intensity pixel in each A-scan's x-y coordinate plane. Retinal thickness maps (RTMs) were generated by first segmenting the retina with a previously trained U-net, then calculating the retinal thickness at each position in microns, and displaying it with a topographic colormap.
Main Outcome Measures
Cross-sectional and longitudinal qualitative evaluation of the diagnostic utility of MIP and RTM across the spectrum of ROP stage.
Results
MIP highlights areas of high signal attenuation, such as blood vessels and the atypical neurovascular thickening accompanying stage 1 or greater ROP. Retinal thickness maps reflect thickness information in the retina that highlights complementary aspects of the progression and spectrum of the stage. Retinal thickness maps also reveal subclinical elements of ROP morphology, such as the foveal contour, in some cases “stage 0” ROP, and cystoid macular edema.
Conclusions
This study presents 2 techniques to visualize pathology in ROP from UWF-OCT. Together, they enable both high-contrast visualization of the vascular features of ROP and the associated topographic changes across the spectrum of ROP.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Topographic Features in Retinopathy of Prematurity With en Face Ultra-Widefield OCT","authors":"David A. Sutter BS , Mani K. Woodward BS , John Jackson MD , Yakub Bayhaqi PhD , Aaron S. Coyner PhD , Shuibin Ni PhD , Susan Ostmo MS , Michael F. Chiang MD , Benjamin K. Young MD , Yifan Jian PhD , John Peter Campbell MD, MPH","doi":"10.1016/j.oret.2025.07.003","DOIUrl":"10.1016/j.oret.2025.07.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study presents 2 methods of en face visualization enabled by ultra-widefield (UWF) OCT, which provide topographic information of retinopathy of prematurity (ROP) without requiring direct visualization of cross-sectional scans.</div></div><div><h3>Design</h3><div>Evaluation of diagnostic technology.</div></div><div><h3>Subjects</h3><div>Infants undergoing ROP screening at Oregon Health Science University between June 2023 and October 2024, who consented to research imaging.</div></div><div><h3>Methods</h3><div>An investigational contact-based UWF-OCT captured 800 × 800 A-scans. Max intensity projections (MIP) were constructed, from the highest intensity pixel in each A-scan's x-y coordinate plane. Retinal thickness maps (RTMs) were generated by first segmenting the retina with a previously trained U-net, then calculating the retinal thickness at each position in microns, and displaying it with a topographic colormap.</div></div><div><h3>Main Outcome Measures</h3><div>Cross-sectional and longitudinal qualitative evaluation of the diagnostic utility of MIP and RTM across the spectrum of ROP stage.</div></div><div><h3>Results</h3><div>MIP highlights areas of high signal attenuation, such as blood vessels and the atypical neurovascular thickening accompanying stage 1 or greater ROP. Retinal thickness maps reflect thickness information in the retina that highlights complementary aspects of the progression and spectrum of the stage. Retinal thickness maps also reveal subclinical elements of ROP morphology, such as the foveal contour, in some cases “stage 0” ROP, and cystoid macular edema.</div></div><div><h3>Conclusions</h3><div>This study presents 2 techniques to visualize pathology in ROP from UWF-OCT. Together, they enable both high-contrast visualization of the vascular features of ROP and the associated topographic changes across the spectrum of ROP.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 88-94"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.07.014
Steven Ness MD , Rin Mitsiades BS , Vasiliki Poulaki MD, PhD
Objective
To evaluate whether low serum vitamin D level is a risk factor for proliferative vitreoretinopathy (PVR) after primary rhegmatogenous retinal detachment (RRD) repair.
Design
Retrospective, multisite, case–control study.
Participants
Subjects undergoing pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB for primary RRD in the Veterans Administration Healthcare System between January 1, 2015, and January 1, 2020. Subjects were required to have a serum 25-hydroxy vitamin D measurement within 1 year of RRD surgery and to have greater than 90 days' follow-up after surgery.
Methods
Clinic notes and operative reports were reviewed to collect the following data points: sex, race, age, geographic location, date of diagnosis, eye laterality, macula and lens status, symptom duration, date and type of surgery, number and location of retinal tears, extent of RRD, presence of vitreous hemorrhage or choroidal detachment, date and level of vitamin D laboratory draw, development of PVR, and need for additional surgeries.
Main Outcome Measures
Incidence of PVR after surgical RRD repair comparing the normal and low vitamin D groups.
Results
A total of 313 subjects met inclusion criteria, of whom 119 (38.0%) had serum vitamin D levels below the laboratory normal limit. Most subjects were male (96.4%) and White (82.4%). Among all subjects, 42 (13.4%) were diagnosed with PVR after initial surgical repair. On univariate analysis, subjects with low vitamin D levels were almost 4 times more likely to develop PVR than those with normal vitamin D levels (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.98–7.87; P < 0.001). This association of vitamin D level and PVR remained significant in multivariable analysis (OR, 4.27; 95% CI, 2.09–8.69; P < 0.001) and when only considering subjects with a vitamin D laboratory draw before or within 90 days of RRD diagnosis. When evaluating vitamin D level as a continuous variable, each 1 ng/mL decrease in serum vitamin D below the laboratory specified lower limit of normal resulted in a 4% increase in the risk of PVR development (OR, 1.04; 95% CI, 1.02–1.08; P = 0.002).
Conclusions
To the best of our knowledge, this study is the first to report an association between low serum vitamin D levels and an increased risk of PVR development after RRD repair. Future studies with more diverse patient populations are required to verify this potential association.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
目的：探讨低血清维生素D水平是否是原发性孔源性视网膜脱离（RRD）修复后增殖性玻璃体视网膜病变（PVR）的危险因素。设计：回顾性、多地点、病例对照研究参与者：在2015年1月1日至2020年1月1日期间，在退伍军人管理局医疗保健系统中接受玻璃体切割（PPV）、巩膜扣（SB）或PPV/SB联合治疗原发性RRD的受试者。受试者被要求在RRD手术后1年内进行血清25-羟基维生素D测量，并在手术后随访超过90天。方法：回顾临床记录和手术报告，收集以下数据点：性别、种族、年龄、地理位置、诊断日期、眼睛侧边、黄斑和晶状体状态、症状持续时间、手术日期和类型、视网膜撕裂的数量和位置、RRD的程度、玻璃体出血或脉络膜脱离的存在、维生素D实验室提取的日期和水平、PVR的发展以及是否需要额外的手术。结果：共有313名受试者符合纳入标准，其中119名（38.0%）血清维生素D水平低于实验室正常限度。以男性（96.4%）和白种人（82.4%）居多。在所有受试者中，42例（13.4%）在首次手术修复后被诊断为PVR。在单因素分析中，维生素D水平低的受试者发生PVR的可能性几乎是维生素D水平正常受试者的4倍（OR 3.95, 95% CI 1.98-7.87）。结论：据我们所知，本研究首次报道了低血清维生素D水平与RRD修复后PVR发生风险增加之间的关联。未来需要更多不同患者群体的研究来验证这种潜在的关联。
{"title":"Association of Low Serum Vitamin D Levels with Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Repair","authors":"Steven Ness MD , Rin Mitsiades BS , Vasiliki Poulaki MD, PhD","doi":"10.1016/j.oret.2025.07.014","DOIUrl":"10.1016/j.oret.2025.07.014","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether low serum vitamin D level is a risk factor for proliferative vitreoretinopathy (PVR) after primary rhegmatogenous retinal detachment (RRD) repair.</div></div><div><h3>Design</h3><div>Retrospective, multisite, case–control study.</div></div><div><h3>Participants</h3><div>Subjects undergoing pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB for primary RRD in the Veterans Administration Healthcare System between January 1, 2015, and January 1, 2020. Subjects were required to have a serum 25-hydroxy vitamin D measurement within 1 year of RRD surgery and to have greater than 90 days' follow-up after surgery.</div></div><div><h3>Methods</h3><div>Clinic notes and operative reports were reviewed to collect the following data points: sex, race, age, geographic location, date of diagnosis, eye laterality, macula and lens status, symptom duration, date and type of surgery, number and location of retinal tears, extent of RRD, presence of vitreous hemorrhage or choroidal detachment, date and level of vitamin D laboratory draw, development of PVR, and need for additional surgeries.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of PVR after surgical RRD repair comparing the normal and low vitamin D groups.</div></div><div><h3>Results</h3><div>A total of 313 subjects met inclusion criteria, of whom 119 (38.0%) had serum vitamin D levels below the laboratory normal limit. Most subjects were male (96.4%) and White (82.4%). Among all subjects, 42 (13.4%) were diagnosed with PVR after initial surgical repair. On univariate analysis, subjects with low vitamin D levels were almost 4 times more likely to develop PVR than those with normal vitamin D levels (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.98–7.87; <em>P</em> < 0.001). This association of vitamin D level and PVR remained significant in multivariable analysis (OR, 4.27; 95% CI, 2.09–8.69; <em>P</em> < 0.001) and when only considering subjects with a vitamin D laboratory draw before or within 90 days of RRD diagnosis. When evaluating vitamin D level as a continuous variable, each 1 ng/mL decrease in serum vitamin D below the laboratory specified lower limit of normal resulted in a 4% increase in the risk of PVR development (OR, 1.04; 95% CI, 1.02–1.08; <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge, this study is the first to report an association between low serum vitamin D levels and an increased risk of PVR development after RRD repair. Future studies with more diverse patient populations are required to verify this potential association.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 17-25"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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