Pub Date : 2026-02-01Epub Date: 2026-01-01DOI: 10.1016/j.oret.2025.10.017
Hou-Ren Tsai MD , Yu-Jie Lin MSc , Ching-Hui Loh DrPH , Yuan-Chieh Lee PhD , Huei-Kai Huang PhD
Purpose
To evaluate the risk of developing Alzheimer disease (AD) and related dementia in patients with newly diagnosed retinal vascular occlusion.
Design
A nationwide population-based cohort study using claims data from Taiwan’s National Health Insurance Research Database (NHIRD).
Participants and Controls
A total of 39 540 individuals with diagnoses of retinal vascular occlusion between 2011 and 2019 in Taiwan and 395 400 age- and sex-matched nonretinal vascular occlusion individuals without prior diagnoses of any dementia.
Methods
Patients with newly diagnosed retinal vascular occlusion were identified in the NHIRD, and baseline characteristics were collected. The study endpoints, including AD, vascular dementia (VD), and all-cause dementia, were determined by ≥2 separate outpatient diagnoses or a single discharge diagnosis. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates and control potential confounders. Cox proportional hazards models were used to estimate the hazard ratio (HR) for each outcome.
Main Outcome Measures
Development of AD, VD, and all-cause dementia.
Results
After IPTW, 38 522 patients with retinal vascular occlusion and 395 740 nonretinal vascular occlusion individuals were included. Patients with retinal vascular occlusion had increased risks of AD (HR, 1.57; 95% confidence interval [CI], 1.39–1.80), VD (HR, 1.76; 95% CI, 1.58–1.95), and all-cause dementia (HR, 1.58; 95% CI, 1.50–1.65). Both retinal artery occlusion and retinal vein occlusion were associated with increased risks of AD (HR, 1.59; 95% CI, 1.14–2.23; and HR, 1.58; 95% CI, 1.39–1.80, respectively), VD (HR, 1.79; 95% CI, 1.32–2.43; and HR, 1.77; 95% CI, 1.59–1.98, respectively), and all-cause dementia (HR, 1.62; 95% CI, 1.42–1.86; and HR, 1.58; 95% CI, 1.52–1.67, respectively).
Conclusions
Patients with retinal vascular occlusion had moderately increased risks of AD and related dementias. Therefore, monitoring for dementia symptoms in patients with retinal vascular occlusion may facilitate earlier detection and intervention.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Risk of Alzheimer Disease and Related Dementia after Retinal Vascular Occlusion","authors":"Hou-Ren Tsai MD , Yu-Jie Lin MSc , Ching-Hui Loh DrPH , Yuan-Chieh Lee PhD , Huei-Kai Huang PhD","doi":"10.1016/j.oret.2025.10.017","DOIUrl":"10.1016/j.oret.2025.10.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of developing Alzheimer disease (AD) and related dementia in patients with newly diagnosed retinal vascular occlusion.</div></div><div><h3>Design</h3><div>A nationwide population-based cohort study using claims data from Taiwan’s National Health Insurance Research Database (NHIRD).</div></div><div><h3>Participants and Controls</h3><div>A total of 39 540 individuals with diagnoses of retinal vascular occlusion between 2011 and 2019 in Taiwan and 395 400 age- and sex-matched nonretinal vascular occlusion individuals without prior diagnoses of any dementia.</div></div><div><h3>Methods</h3><div>Patients with newly diagnosed retinal vascular occlusion were identified in the NHIRD, and baseline characteristics were collected. The study endpoints, including AD, vascular dementia (VD), and all-cause dementia, were determined by ≥2 separate outpatient diagnoses or a single discharge diagnosis. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates and control potential confounders. Cox proportional hazards models were used to estimate the hazard ratio (HR) for each outcome.</div></div><div><h3>Main Outcome Measures</h3><div>Development of AD, VD, and all-cause dementia.</div></div><div><h3>Results</h3><div>After IPTW, 38 522 patients with retinal vascular occlusion and 395 740 nonretinal vascular occlusion individuals were included. Patients with retinal vascular occlusion had increased risks of AD (HR, 1.57; 95% confidence interval [CI], 1.39–1.80), VD (HR, 1.76; 95% CI, 1.58–1.95), and all-cause dementia (HR, 1.58; 95% CI, 1.50–1.65). Both retinal artery occlusion and retinal vein occlusion were associated with increased risks of AD (HR, 1.59; 95% CI, 1.14–2.23; and HR, 1.58; 95% CI, 1.39–1.80, respectively), VD (HR, 1.79; 95% CI, 1.32–2.43; and HR, 1.77; 95% CI, 1.59–1.98, respectively), and all-cause dementia (HR, 1.62; 95% CI, 1.42–1.86; and HR, 1.58; 95% CI, 1.52–1.67, respectively).</div></div><div><h3>Conclusions</h3><div>Patients with retinal vascular occlusion had moderately increased risks of AD and related dementias. Therefore, monitoring for dementia symptoms in patients with retinal vascular occlusion may facilitate earlier detection and intervention.</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 2","pages":"Pages 117-127"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878580","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 : 2026-02-01Epub Date: 2025-06-27DOI: 10.1016/j.oret.2025.05.029
Tingming Deng MD, Yingshi Zou MD, PhD, Mingming Yang MD, PhD
{"title":"Vascular Hyperreflectivity in Lipemia Retinalis","authors":"Tingming Deng MD, Yingshi Zou MD, PhD, Mingming Yang MD, PhD","doi":"10.1016/j.oret.2025.05.029","DOIUrl":"10.1016/j.oret.2025.05.029","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Page e15"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529046","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 : 2026-02-01Epub Date: 2025-08-13DOI: 10.1016/j.oret.2025.08.006
Charles Zhang MD , Daniel A. Lai MD , Georges AbouKasm BS , Sinan Ersan BS , Nicholas Leung BA , Daniel Zhu MD , Nimesh A. Patel MD , Harry W. Flynn Jr. MD , Nicolas A. Yannuzzi MD
Topic
This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).
Clinical Relevance
Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.
Methods
A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.
Results
A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44–0.64; I2 = 24%, P < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38–0.72; I2 = 11%, P < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41–0.67; I2 = 39%, P < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (P = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated “low” for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.
Conclusion
Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies are needed.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Rates of Endophthalmitis in Prefilled versus Nonprefilled Syringes for Intravitreal Injections","authors":"Charles Zhang MD , Daniel A. Lai MD , Georges AbouKasm BS , Sinan Ersan BS , Nicholas Leung BA , Daniel Zhu MD , Nimesh A. Patel MD , Harry W. Flynn Jr. MD , Nicolas A. Yannuzzi MD","doi":"10.1016/j.oret.2025.08.006","DOIUrl":"10.1016/j.oret.2025.08.006","url":null,"abstract":"<div><h3>Topic</h3><div>This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).</div></div><div><h3>Clinical Relevance</h3><div>Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.</div></div><div><h3>Results</h3><div>A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44–0.64; I<sup>2</sup> = 24%, <em>P</em> < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38–0.72; I<sup>2</sup> = 11%, <em>P</em> < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41–0.67; I<sup>2</sup> = 39%, <em>P</em> < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (<em>P</em> = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated “low” for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.</div></div><div><h3>Conclusion</h3><div>Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies are needed.</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 2","pages":"Pages 165-175"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859410","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 : 2026-02-01Epub Date: 2025-08-19DOI: 10.1016/j.oret.2025.08.011
Xinyi Ding MD , Jia Xu MD , Francesco Romano MD , Itika Garg MD , Jenny Gan , Katherine M. Overbey , Mauricio D. Garcia , Mridula Shan , Ricardo Marrero-Alattar , Filippos Vingopoulos MD , Ying Cui MD , Ying Zhu MD , Ioanna Ploumi MS , Isabella Stettler MD , Matthew J. Finn MD , Demetrios G. Vavvas MD , Deeba Husain MD , David M. Wu MD , Nimesh A. Patel MD , Leo A. Kim MD , John B. Miller MD
Purpose
To assess the severity and clinical significance of intraretinal microvascular abnormalities (IRMAs) using expanded field swept-source OCT angiography (SS-OCTA) in eyes with nonproliferative diabetic retinopathy (NPDR).
Design
Cross-sectional, observational study.
Participants
One hundred thirty-nine eyes from 101 subjects with NPDR.
Methods
The montage of 12 × 12–mm angiography centered on the macula and optic nerve was evaluated by 2 masked graders for (1) the presence of IRMA in each 6 × 6–mm field, including center, superotemporal, inferotemporal, superonasal (SN), and inferonasal (IN) to the macula, and SN and IN to the optic nerve and (2) subtypes of IRMA (dilated trunk, net shape, loop, sea fan, and tufted IRMA). Nonperfusion areas (NPA) were quantified using FIJI. Nonproliferative diabetic retinopathy grading was initially collected from chart diagnoses and subsequently verified using ultra-widefield color fundus photos. Logistic and linear regression models were used to evaluate the relationships between IRMA features, diabetic retinopathy (DR) severity, and NPA.
Main Outcome Measures
Intraretinal microvascular abnormality features associated with severe NPDR.
Results
Intraretinal microvascular abnormalities, observed with SS-OCTA, were present in 58.3% of all NPDR eyes and more prevalent in severe (96.6%) than mild (28.8%) to moderate (70.6%) NPDR. The number of affected fields and IRMA subtypes increased with DR severity (P < 0.01). The most common subtype of IRMA is the dilated trunk, comprising 58.3%, followed by the net shape subtype at 35.3%, loop at 11.5%, sea fan at 6.5%, and tufts at 5.8%. Significant predictors of severe NPDR included the presence of IRMA in the central field (odds ratio [OR]: 8.7; P = 0.01), more widely distributed IRMA (OR: 2.2; P < 0.01), a greater variety of IRMA subtypes (OR: 4.2, P < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; P = 0.02), sea fan (OR: 26.0; P < 0.01), and tufted IRMA (OR: 13.4; P = 0.03). Center-involving IRMA (β = 5.8; P = 0.046) and IRMA with loops (β = 7.0; P = 0.043) were found to be associated with increased NPA.
Conclusions
Our study demonstrates that IRMA lesions identified on OCT angiography, particularly their distribution and morphology, are associated with DR severity and provide complementary information that may facilitate the integration of SS-OCTA into clinical evaluation of DR.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：应用扩展视野扫描源OCT血管造影（SS-OCTA）评价非增殖性糖尿病视网膜病变（NPDR）眼视网膜内微血管异常（IRMA）的严重程度及临床意义。设计：横断面观察性研究。参与者：来自101名NPDR患者的139只眼睛。方法：以黄斑和视神经为中心的12x12-mm血管造影蒙太奇，采用2个蒙太奇评分法评价：1)每个6x6-mm视场是否存在IRMA，包括黄斑的中心、颞上（ST）、颞下（IT）、鼻上（SN）和鼻间（SN），以及视神经的SN和in；2) IRMA亚型（扩张干状、网状、环状、海扇和丛状IRMA）。非灌注区（NPA）采用FIJI量化。NPDR分级最初从图表诊断中收集，随后使用超广角彩色眼底照片进行验证。采用Logistic和线性回归模型评估IRMA特征、DR严重程度和NPA之间的关系。主要结局指标：与严重NPDR相关的IRMA特征。结果：SS-OCTA观察到的IRMA存在于58.3%的NPDR眼睛中，重度（96.6%）比轻度（28.8%）至中度（70.6%）NPDR更普遍。随着DR严重程度的增加，感染区数和IRMA亚型数增加（p < 0.01）。IRMA最常见的亚型是扩张干型，占58.3%，其次是网状型，占35.3%，环型占11.5%，海扇型占6.5%，丛状占5.8%。严重NPDR的显著预测因子包括中心区IRMA的存在（OR: 8.7, p < 0.01），更广泛分布的IRMA (OR: 2.2, p < 0.01)，更多种类的IRMA亚型（OR: 4.2, p < 0.01），以及特定亚型如净形（OR: 16.1, p=0.02），海扇（OR: 26.0, p < 0.01）和簇状IRMA （OR: 13.4, p=0.03）的存在。中心相关的IRMA （beta=5.8, p=0.046）和带环路的IRMA （beta=7.0, p=0.043）与NPA增加有关。结论：我们的研究表明，在OCTA上发现的IRMA病变，特别是它们的分布和形态，与DR的严重程度有关，并提供了补充信息，可能有助于将SS-OCTA纳入糖尿病视网膜病变的临床评估。
{"title":"Association of OCT Angiography-Detected Intraretinal Microvascular Abnormalities with Diabetic Retinopathy Severity","authors":"Xinyi Ding MD , Jia Xu MD , Francesco Romano MD , Itika Garg MD , Jenny Gan , Katherine M. Overbey , Mauricio D. Garcia , Mridula Shan , Ricardo Marrero-Alattar , Filippos Vingopoulos MD , Ying Cui MD , Ying Zhu MD , Ioanna Ploumi MS , Isabella Stettler MD , Matthew J. Finn MD , Demetrios G. Vavvas MD , Deeba Husain MD , David M. Wu MD , Nimesh A. Patel MD , Leo A. Kim MD , John B. Miller MD","doi":"10.1016/j.oret.2025.08.011","DOIUrl":"10.1016/j.oret.2025.08.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the severity and clinical significance of intraretinal microvascular abnormalities (IRMAs) using expanded field swept-source OCT angiography (SS-OCTA) in eyes with nonproliferative diabetic retinopathy (NPDR).</div></div><div><h3>Design</h3><div>Cross-sectional, observational study.</div></div><div><h3>Participants</h3><div>One hundred thirty-nine eyes from 101 subjects with NPDR.</div></div><div><h3>Methods</h3><div>The montage of 12 × 12–mm angiography centered on the macula and optic nerve was evaluated by 2 masked graders for (1) the presence of IRMA in each 6 × 6–mm field, including center, superotemporal, inferotemporal, superonasal (SN), and inferonasal (IN) to the macula, and SN and IN to the optic nerve and (2) subtypes of IRMA (dilated trunk, net shape, loop, sea fan, and tufted IRMA). Nonperfusion areas (NPA) were quantified using FIJI. Nonproliferative diabetic retinopathy grading was initially collected from chart diagnoses and subsequently verified using ultra-widefield color fundus photos. Logistic and linear regression models were used to evaluate the relationships between IRMA features, diabetic retinopathy (DR) severity, and NPA.</div></div><div><h3>Main Outcome Measures</h3><div>Intraretinal microvascular abnormality features associated with severe NPDR.</div></div><div><h3>Results</h3><div>Intraretinal microvascular abnormalities, observed with SS-OCTA, were present in 58.3% of all NPDR eyes and more prevalent in severe (96.6%) than mild (28.8%) to moderate (70.6%) NPDR. The number of affected fields and IRMA subtypes increased with DR severity (<em>P</em> < 0.01). The most common subtype of IRMA is the dilated trunk, comprising 58.3%, followed by the net shape subtype at 35.3%, loop at 11.5%, sea fan at 6.5%, and tufts at 5.8%. Significant predictors of severe NPDR included the presence of IRMA in the central field (odds ratio [OR]: 8.7; <em>P</em> = 0.01), more widely distributed IRMA (OR: 2.2; <em>P</em> < 0.01), a greater variety of IRMA subtypes (OR: 4.2, <em>P</em> < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; <em>P</em> = 0.02), sea fan (OR: 26.0; <em>P</em> < 0.01), and tufted IRMA (OR: 13.4; <em>P</em> = 0.03). Center-involving IRMA (β = 5.8; <em>P</em> = 0.046) and IRMA with loops (β = 7.0; <em>P</em> = 0.043) were found to be associated with increased NPA.</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that IRMA lesions identified on OCT angiography, particularly their distribution and morphology, are associated with DR severity and provide complementary information that may facilitate the integration of SS-OCTA into clinical evaluation of DR.</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 2","pages":"Pages 185-193"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963658","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 : 2026-02-01Epub Date: 2025-08-16DOI: 10.1016/j.oret.2025.08.008
Cameron M. Carpenter BS , Aileen G. MacLachlan BS , Caitlyn Y. Kwun BA , Taylor J. Johnson MD , Bryce T. Baugh MD , Guillermo A. Requejo Figueroa BS , Saul Rivera-Flores BS , Xiuzhen Liu PhD , Gregory J. Stoddard MPH , Jessica A. Kraker MD, MS , Eileen S. Hwang MD, PhD
Topic
To compare the relative risk of retinal detachment between patients with COL2A1 and COL11A1 Stickler syndrome.
Clinical Relevance
It is unclear whether the rate of retinal detachment differs between COL2A1 and COL11A1 Stickler syndrome. Previous studies included too few patients to detect a difference between genotypes.
Methods
Individual patient data meta-analysis of cohort studies, case-control studies, cross-sectional studies, case series, and case reports across the MEDLINE, Embase, Scopus, Web of Science Core Collection, and Web of Science Preprint Citation Index databases from 1991 to 2025. Articles providing eye examination results in subjects with genetically confirmed COL2A1 or COL11A1 Stickler syndrome were included. From the included articles, individual patient data on affected gene, age at last follow-up, and presence or absence of retinal detachment were extracted. Patients who had prophylactic retinopexy were excluded. A mixed effects logistic regression adjusted for clustering by article and family was used to determine the relative risk of retinal detachment. A risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. The study was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023428144). The overall certainty of evidence was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation.
Results
Of the 1420 articles screened, 179 were eligible for inclusion, and 141 provided individual patient data for a total of 673 patients from 430 families. Retinal detachment was present in 229 of 491 (47%) patients with COL2A1 Stickler syndrome and 51 of 182 (28%) patients with COL11A1 Stickler syndrome. The relative risk of retinal detachment was 1.78 times higher in COL2A1 compared with COL11A1 Stickler syndrome (95% confidence interval: 1.30–2.43, P < 0.001). The certainty of evidence was moderate.
Conclusion
Our findings indicate a higher risk of retinal detachment in COL2A1 compared with COL11A1 Stickler syndrome, which may aid clinicians in determining individualized management plans for patients with Stickler syndrome. However, due to reporting biases inherent to the case series and case reports from which we obtained data, the overall certainty of evidence was rated as moderate, and our analysis was limited to providing relative risk of retinal detachment, not absolute risk.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
题目：比较COL2A1和COL11A1 Stickler综合征患者视网膜脱离的相对危险性。临床相关性：目前尚不清楚COL2A1和COL11A1 Stickler综合征的视网膜脱离率是否不同。先前的研究纳入的患者太少，无法检测到基因型之间的差异。方法：对1991年至2025年MEDLINE、Embase、Scopus、Web of Science核心合集和Web of Science预印本引文索引数据库中的队列研究、病例对照研究、横断面研究、病例系列和病例报告进行个体患者数据荟萃分析。纳入了遗传学证实COL2A1或COL11A1 Stickler综合征受试者的眼科检查结果的文章。从纳入的文章中，提取了受影响基因的个体患者数据，最后随访时的年龄，以及是否存在视网膜脱离。排除预防性视网膜手术患者。采用混合效应logistic回归（按文章和家庭进行聚类调整）来确定视网膜脱离的相对风险。使用JBI病例系列关键评估清单评估偏倚风险。该研究在PROSPERO进行了前瞻性注册（CRD42023428144）。证据的总体确定性通过推荐评估、发展和评价分级来评估。结果：在筛选的1420篇文章中，179篇符合纳入条件，141篇提供了来自430个家庭的673名患者的个人数据。491例COL2A1 Stickler综合征患者中有229例（47%）出现视网膜脱离，182例COL11A1 Stickler综合征患者中有51例（28%）出现视网膜脱离。COL2A1患者视网膜脱离的相对风险是COL11A1 Stickler综合征患者的1.78倍（95% CI: 1.30-2.43 p < 0.001）。证据的确定性是中等的。结论：我们的研究结果表明，与COL11A1 Stickler综合征相比，COL2A1患者视网膜脱离的风险更高，这可能有助于临床医生确定Stickler综合征患者的个体化治疗计划。然而，由于我们获得数据的病例系列和病例报告固有的报告偏倚，证据的总体确定性被评为中等，我们的分析仅限于提供视网膜脱离的相对风险，而不是绝对风险。
{"title":"Relative Risk of Retinal Detachment in COL2A1 Compared with COL11A1 Stickler Syndrome","authors":"Cameron M. Carpenter BS , Aileen G. MacLachlan BS , Caitlyn Y. Kwun BA , Taylor J. Johnson MD , Bryce T. Baugh MD , Guillermo A. Requejo Figueroa BS , Saul Rivera-Flores BS , Xiuzhen Liu PhD , Gregory J. Stoddard MPH , Jessica A. Kraker MD, MS , Eileen S. Hwang MD, PhD","doi":"10.1016/j.oret.2025.08.008","DOIUrl":"10.1016/j.oret.2025.08.008","url":null,"abstract":"<div><h3>Topic</h3><div>To compare the relative risk of retinal detachment between patients with <em>COL2A1</em> and <em>COL11A1</em> Stickler syndrome.</div></div><div><h3>Clinical Relevance</h3><div>It is unclear whether the rate of retinal detachment differs between <em>COL2A1</em> and <em>COL11A1</em> Stickler syndrome. Previous studies included too few patients to detect a difference between genotypes.</div></div><div><h3>Methods</h3><div>Individual patient data meta-analysis of cohort studies, case-control studies, cross-sectional studies, case series, and case reports across the MEDLINE, Embase, Scopus, Web of Science Core Collection, and Web of Science Preprint Citation Index databases from 1991 to 2025. Articles providing eye examination results in subjects with genetically confirmed <em>COL2A1</em> or <em>COL11A1</em> Stickler syndrome were included. From the included articles, individual patient data on affected gene, age at last follow-up, and presence or absence of retinal detachment were extracted. Patients who had prophylactic retinopexy were excluded. A mixed effects logistic regression adjusted for clustering by article and family was used to determine the relative risk of retinal detachment. A risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. The study was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023428144). The overall certainty of evidence was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation.</div></div><div><h3>Results</h3><div>Of the 1420 articles screened, 179 were eligible for inclusion, and 141 provided individual patient data for a total of 673 patients from 430 families. Retinal detachment was present in 229 of 491 (47%) patients with <em>COL2A1</em> Stickler syndrome and 51 of 182 (28%) patients with <em>COL11A1</em> Stickler syndrome. The relative risk of retinal detachment was 1.78 times higher in <em>COL2A1</em> compared with <em>COL11A1</em> Stickler syndrome (95% confidence interval: 1.30–2.43, <em>P</em> < 0.001). The certainty of evidence was moderate.</div></div><div><h3>Conclusion</h3><div>Our findings indicate a higher risk of retinal detachment in <em>COL2A1</em> compared with <em>COL11A1</em> Stickler syndrome, which may aid clinicians in determining individualized management plans for patients with Stickler syndrome. However, due to reporting biases inherent to the case series and case reports from which we obtained data, the overall certainty of evidence was rated as moderate, and our analysis was limited to providing relative risk of retinal detachment, not absolute risk.</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 2","pages":"Pages 194-203"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874326","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 : 2026-02-01Epub Date: 2025-08-06DOI: 10.1016/j.oret.2025.07.019
Andrew J. Barkmeier MD , Yihong Deng PhD , Kavya Sindhu Swarna MPH , Jeph Herrin PhD , Eric C. Polley PhD , Guillermo E. Umpierrez MD , Rodolfo J. Galindo MD , Joseph S. Ross MD, MHS , Mindy M. Mickelson MA , Rozalina G. McCoy MD, MS
<div><h3>Purpose</h3><div>To investigate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents differ with respect to the risk of developing sight-threatening diabetic retinopathy complications in patients with type 2 diabetes at moderate cardiovascular risk.</div></div><div><h3>Design</h3><div>Retrospective observational study under the target trial emulation framework involving adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014 to December 31, 2022. The study population included adults with type 2 diabetes, moderate cardiovascular disease risk, no baseline advanced diabetic retinopathy, and minimum 1 year enrollment before GLP-1 RA treatment.</div></div><div><h3>Methods</h3><div>Because of differences in GLP-1 RA agent use over time, we performed both a 3-way comparison of patients initiating liraglutide, dulaglutide, or exenatide from January 1, 2015, to December 31, 2021, and a 2-way comparison of patients initiating semaglutide or dulaglutide between January 1, 2019, and December 31, 2021. We assessed differences in complications using inverse propensity score weighted Cox proportional hazards models.</div></div><div><h3>Main Outcome Measures</h3><div>Treatment for diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR).</div></div><div><h3>Results</h3><div>When comparing patients who initiated treatment with exenatide (<em>n</em> = 14 076, median follow-up 969 days; interquartile range [IQR] 578–1444) to those starting dulaglutide (<em>n</em> = 54 787, median follow-up 948 days; IQR 551–1457) or liraglutide (<em>n</em> = 25 562, median follow-up 1007 days; IQR 575–1494), no differences were found in the hazard (hazard ratio [HR]) of composite treatment for DME or PDR: exenatide versus dulaglutide (HR 0.90; 95% confidence interval (CI): 0.73–1.12), liraglutide versus dulaglutide (HR: 0.97; 95% CI: 0.79–1.19), or liraglutide versus exenatide (HR: 1.08; 95% CI: 0.83–1.38), nor were differences found in any comparisons for treatment of DME (HR: 0.93 [95% CI: 0.74–1.18]; HR 0.99 [95% CI: 0.79–1.24]; HR: 1.06 [95% CI: 0.80–1.40]) or PDR individually (HR: 1.16 [95% CI: 0.81–1.67]; HR: 1.05 [95% CI: 0.73–1.51]; HR: 0.91 [95% CI: 0.58–1.40). Likewise, when comparing patients initiating semaglutide (<em>n</em> = 30 911, median follow-up 625 days [IQR: 455–850]) versus dulaglutide (<em>n</em> = 32 844, median follow-up 639 days [IQR: 459–878]), the hazards for treatment of DME or PDR (HR: 0.88; 95% CI: 0.70–1.11), DME (HR: 0.89; 95% CI: 0.69–1.14), and PDR (HR: 0.70; 95% CI: 0.45–1.09) all found no difference between drugs.</div></div><div><h3>Conclusions</h3><div>Despite the differences in systemic efficacy among the examined GLP-1 RAs, we identified no difference in the risk of sight-threatening diabetic retinopathy after initiation of different GLP-1 RA agents among adults with type 2 diabetes at moderate cardiovascular risk.</div></div><
{"title":"Risk of Sight-Threatening Diabetic Retinopathy with Glucagon-Like Peptide-1 Receptor Agonist Use in Routine Clinical Practice","authors":"Andrew J. Barkmeier MD , Yihong Deng PhD , Kavya Sindhu Swarna MPH , Jeph Herrin PhD , Eric C. Polley PhD , Guillermo E. Umpierrez MD , Rodolfo J. Galindo MD , Joseph S. Ross MD, MHS , Mindy M. Mickelson MA , Rozalina G. McCoy MD, MS","doi":"10.1016/j.oret.2025.07.019","DOIUrl":"10.1016/j.oret.2025.07.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents differ with respect to the risk of developing sight-threatening diabetic retinopathy complications in patients with type 2 diabetes at moderate cardiovascular risk.</div></div><div><h3>Design</h3><div>Retrospective observational study under the target trial emulation framework involving adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014 to December 31, 2022. The study population included adults with type 2 diabetes, moderate cardiovascular disease risk, no baseline advanced diabetic retinopathy, and minimum 1 year enrollment before GLP-1 RA treatment.</div></div><div><h3>Methods</h3><div>Because of differences in GLP-1 RA agent use over time, we performed both a 3-way comparison of patients initiating liraglutide, dulaglutide, or exenatide from January 1, 2015, to December 31, 2021, and a 2-way comparison of patients initiating semaglutide or dulaglutide between January 1, 2019, and December 31, 2021. We assessed differences in complications using inverse propensity score weighted Cox proportional hazards models.</div></div><div><h3>Main Outcome Measures</h3><div>Treatment for diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR).</div></div><div><h3>Results</h3><div>When comparing patients who initiated treatment with exenatide (<em>n</em> = 14 076, median follow-up 969 days; interquartile range [IQR] 578–1444) to those starting dulaglutide (<em>n</em> = 54 787, median follow-up 948 days; IQR 551–1457) or liraglutide (<em>n</em> = 25 562, median follow-up 1007 days; IQR 575–1494), no differences were found in the hazard (hazard ratio [HR]) of composite treatment for DME or PDR: exenatide versus dulaglutide (HR 0.90; 95% confidence interval (CI): 0.73–1.12), liraglutide versus dulaglutide (HR: 0.97; 95% CI: 0.79–1.19), or liraglutide versus exenatide (HR: 1.08; 95% CI: 0.83–1.38), nor were differences found in any comparisons for treatment of DME (HR: 0.93 [95% CI: 0.74–1.18]; HR 0.99 [95% CI: 0.79–1.24]; HR: 1.06 [95% CI: 0.80–1.40]) or PDR individually (HR: 1.16 [95% CI: 0.81–1.67]; HR: 1.05 [95% CI: 0.73–1.51]; HR: 0.91 [95% CI: 0.58–1.40). Likewise, when comparing patients initiating semaglutide (<em>n</em> = 30 911, median follow-up 625 days [IQR: 455–850]) versus dulaglutide (<em>n</em> = 32 844, median follow-up 639 days [IQR: 459–878]), the hazards for treatment of DME or PDR (HR: 0.88; 95% CI: 0.70–1.11), DME (HR: 0.89; 95% CI: 0.69–1.14), and PDR (HR: 0.70; 95% CI: 0.45–1.09) all found no difference between drugs.</div></div><div><h3>Conclusions</h3><div>Despite the differences in systemic efficacy among the examined GLP-1 RAs, we identified no difference in the risk of sight-threatening diabetic retinopathy after initiation of different GLP-1 RA agents among adults with type 2 diabetes at moderate cardiovascular risk.</div></div><","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Pages 142-151"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799776","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 : 2026-02-01Epub Date: 2025-06-17DOI: 10.1016/j.oret.2025.05.024
Prithvi Ramtohul MD, Clément Richard MD, Thierry David MD, PhD
{"title":"Retinal Venous Malformation Associated with Superior Ophthalmic Vein Dilation","authors":"Prithvi Ramtohul MD, Clément Richard MD, Thierry David MD, PhD","doi":"10.1016/j.oret.2025.05.024","DOIUrl":"10.1016/j.oret.2025.05.024","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 2","pages":"Page e14"},"PeriodicalIF":5.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317553","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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