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}
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