Ophthalmologica最新文献

Introduction: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy has become the mainstay of treatment in many retinal diseases. The comparative efficacy and safety of newer bispecific anti-VEGF/angiopoietin 2 (Ang2) agents in the treatment paradigm versus widely used monospecific anti-VEGF agents remains unclear.

Methods: A systematic literature search of MEDLINE, Embase, and Cochrane Library was conducted to identify comparative observational studies and randomized controlled trials published from 2015 to Jul 2024. With assessment by three independent reviewers, original English peer-reviewed full-text articles evaluating faricimab versus monospecific anti-VEGF agent(s) in FDA-indicated retinal disease with data on at least one set of efficacy and/or safety outcomes for each treatment arm and a minimum 3-month follow-up period were included. Data were appraised using the Cochrane RoB2 and ROBINS-I tools, PRISMA, and GRADE guidelines. All outcomes were collected at last follow-up. Random effects meta-analyses with 95% confidence intervals (CI) were conducted to calculate weighted mean differences (WMD) and risk ratios (RR). Change in best-corrected visual acuity (BCVA, ETDRS letters), change in central subfield thickness (CSFT, μm), and presence of retinal fluid were primary endpoints; ocular adverse events were secondary endpoints.

Results: Across 13 studies, in the context of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), 2226 eyes received anti-VEGF monotherapy and 3022 received faricimab. Final and change in BCVA were similar between treatment groups. Faricimab was associated with a significantly higher reduction in CSFT in DME and RVO eyes but not in nAMD eyes. The incidence of ocular adverse events were similar between groups.

Conclusion: There was no difference in BCVA between faricimab and anti-VEGF monotherapy in nAMD, DME, and RVO. While faricimab offered superior improvement in central subfield thickness at final follow-up for DME and RVO eyes, this effect was not seen in nAMD eyes. Future studies are needed to establish the long-term safety and efficacy of faricimab for retinal vascular disease.

Background: The aim of this study was to investigate demographic, anatomical, angiographic and functional parameters in patients suffering from polypoidal choroidal vasculopathy (PCV).

Methods: 60 eyes of 60 patients with a definite diagnosis of treatment-naïve exudative monolateral PCV were evaluated in this retrospective study. The fellow eyes and age-matched healthy subjects were enrolled as comparison. All subjects underwent a complete ophthalmic evaluation with multimodal imaging assessment, including spectral domain (SD) optical coherence tomography (OCT) and OCT angiography (OCTA). Main outcome measures in the comparison analysis were central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI), whereas Outcome measures for correlation analyses were best corrected visual acuity (BCVA), intraretinal fluid (IRF) and sub retinal fluid (SRF) presence, SRF thickness (SRFT), vascularized pigmented epithelial detachment (VPED) height, and PCV outer retina to choriocapillaris (ORCC) flow area (ORCCFA).

Results: CVI was significantly higher in affected and fellow eyes if compared with the healthy ones (p=0.049; p=0.003). Subfoveal choroid resulted to be thicker in the diseased eyes when compared with healthy ones (p=0.002). A negative correlation was assessed between age and SFCT, CMT and BCVA. In addition, a significant association between male gender and anatomical and functional parameters has been found with male prevalence at baseline in cases. No association between systemic conditions and PCV features was found.

Conclusions: Patients with monolater PCV show choroidal changes in terms of higher values of CVI, also in fellow eyes, that were negatively related with age. In our cohort of patients males showed the poorest diagnosis with a baseline lower BCVA and higher CMT when compared with females. PCV was not associated with any systemic condition.

Introduction: Several optical coherence tomography (OCT) biomarkers for postsurgical success among patients with idiopathic epiretinal membranes (iERM) undergoing pars plana vitrectomy and membrane peeling have been described in the past. The aim of this study was to examine the remission of OCT biomarkers in patients with iERM after pars plana vitrectomy with membrane peeling three months and one year after surgery.

Methods: This prospective study included patients scheduled for pars plana vitrectomy with membrane peeling for iERM. The postoperative remission of presurgical OCT biomarkers was analysed from OCTs at predefined time points (three months, one year) after surgery and correlated with visual acuity.

Results: Among 75 patients included, remission of pre-surgically present OCT biomarkers was observed in 87.5% of eyes with disorganization of retinal inner layers (DRIL), in 82.4% with cotton ball sign, in 70.4% with intraretinal cystoid changes, in 57.1% with hyperreflective foci, in 51.2% with ectopic inner foveal layer (EIFL), and in all eyes with defects of the ellipsoid zone. Central macular thickness (CMT) showed a significant reduction after surgery (p<0.001 and p=0.019) and was the only significant predictor for development of distance corrected visual acuity (DCVA) one year after surgery (p<0.001).

Conclusion: CMT was the only significant predictor for development of DCVA one year after surgery. Remission rates of most of the other OCT biomarkers were high, but did not significantly influence postsurgical DCVA.

Retinal vasculitis has heterogenous etiologies encompassing infections, autoimmune, masquerades and idiopathic. The heterogeneity in the underlying clinical features and aetiologies of retinal vasculitis makes its diagnosis challenging for clinicians and the work up thus becomes quite extensive and many a times several unwarranted investigations are done to look for a possible etiology. Timely and accurate diagnosis is crucial for effective management and vision preservation. The algorithmic approach needs understanding of the phenotype, clinical as well as imaging biomarkers so that only customized investigations are done in order to make the timely diagnosis and initiate specific therapy wherever required. In this review article, we shall present an algorithmic approach that combines clinical assessment, ophthalmic imaging, laboratory investigations, and targeted ancillary tests.

Introduction: In this study, we aimed to analyze the incidence of acute endophthalmitis after secondary intraocular lens (IOL) implantation in South Korea.

Methods: This study used information from the National Health Insurance Service (NHIS)-National Health Information Database (NHID). We identified patients who underwent secondary IOL implantation or IOL exchange surgeries during 2002-2021 due to diagnoses of IOL dislocation or mechanical complication of IOL. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. All statistical analyses were performed with a significance level p < 0.05, and we used the univariate and multivariate Cox proportional hazard model to identify risk factors.

Results: From 2002 to 2021, 39,364 patients received secondary IOL implantation, and acute POE was diagnosed in 62 patients. The overall incidence of acute POE was 0.16% during the 20-year period. More than half of the patients were diagnosed with POE within the first week after surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in the group with pre-existing glaucoma (hazard ratio [HR], 1.945; 95% confidence interval [CI], 1.036-3.652; p = 0.0385) and the group undergoing concurrent vitrectomy (hazard ratio [HR], 2.329; 95% confidence interval [CI], 1.003-5.405; p = 0.0491).

Conclusions: The incidence of acute endophthalmitis after secondary IOL implantation in South Korea was similar to that of other countries. This is the largest retrospective claims data-based study of acute endophthalmitis after secondary IOL implantation in patients in South Korea.

Introduction: The aim of the study was to analyse the clinical and demographic features of infants with gestational age (GA) of 32-37 weeks and birth weight (BW) of >1,500 g who developed treatment requiring retinopathy of prematurity (ROP).

Methods: Data on the infants with a GA of 32-37 weeks and BW >1,500 g who developed treatment requiring ROP (TR-ROP) were collected retrospectively from the 33 ROP centres in Turkiye. GA, BW, type of hospital, neonatal intensive care units (NICUs) level, presence of an ophthalmologist and neonatologist in the same hospital, length of stay in NICU, duration of oxygen therapy, comorbidities, type of ROP, and timing for TR-ROP development were analysed.

Results: A total of366 infants were included in the study. Mean GA and BW were 33 ± 1 weeks and 1,896 ± 316 g, respectively. Duration of hospitalization was 3-4 weeks in 46.8% of them. The first ROP examination was performed at postnatal 4-5 weeks in 80.3% of infants, which was significantly later in level 2 and lower NICUs and non-university clinics. At the first ROP examination, any stage of ROP was detected in 90.9% and TR-ROP was detected in 15.3% of the infants. The mean postnatal week of TR-ROP development was 6.16 ± 2.04.

Conclusion: Routine ROP screening thresholds need to be expanded in hospitals with suboptimal NICU conditions considering the development of TR-ROP in more mature and heavier preterm infants. The first ROP examination should be earlier than the fourth postnatal week.

Introduction: Anti-vascular endothelial growth factor (VEGF) treatment stands as the primary approach for neovascular age-related macular degeneration (nAMD). Faricimab has recently emerged as a novel anti-VEGF option for nAMD. This study aimed to assess the efficacy of faricimab in patients with refractory nAMD.

Method: This retrospective study focused on refractory nAMD patients treated with faricimab at Taipei Veterans General Hospital from March 2023 to December 2023. Primary outcomes assessed the change in mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) over the first 4 months. Secondary outcomes included the presence of subretinal and intraretinal fluid (SRF and IRF) and changes in pigment epithelial detachment (PED). Subgroup analysis for the successful and unsuccessful treatment groups was conducted to identify potential confounding factors influencing treatment response.

Result: This study included 42 eyes with refractory nAMD treated with faricimab. During a 6-month follow-up, no significant improvement in BCVA was observed, while CRT significantly decreased at all time points, except during the 5-month follow-up. Height PED showed significant reduction up to 5 months. The prevalence of SRF decreased significantly, while IRF remained lower but not significant. According to the treatment criteria, 67.4% successfully met the treatment goals. Subgroup analysis between successful and unsuccessful groups showed no significant differences in baseline characteristics, except a higher predominantly serous PED percentage in the successful group.

Conclusion: Faricimab showed favorable outcomes in refractory nAMD patients. Further investigations are needed to understand the factors contributing to its efficacy.

Introduction: The purpose of this study was to evaluate whether vital blue dyes could enhance the contrast of intraoperative optical coherence tomography (OCT) during macular surgery.

Methods: Consecutive patients undergoing elective pars plana vitrectomy for vitreomacular interface disorders were enrolled. Intraoperative OCT was performed with the Artevo 800 microscope (Carl Zeiss Meditec AG, Jena, Germany) before and after injection of 0.2 mL of Trypan Blue and Brilliant Blue G Ophthalmic Solution. The OCT contrast ratio was measured with ImageJ, while the overall scan quality was subjectively classified using a 4-point scale.

Results: Ten eyes of 10 patients were enrolled in the study. The OCT contrast ratio was 9.39 ± 5.35 without blue dye and significantly improved to 14.31 ± 10.50 after blue dye injection (p = 0.027). The percentage of patients with a grade 4 scan quality also significantly improved (from 40% without blue dye to 90% with blue dye injection; p = 0.012).

Conclusion: The use of blue dyes during intraoperative OCT is an effective strategy for improving contrast and scan quality without affecting the surgical time and workflow.

Introduction: This study aimed to investigate the macular structure and foveal pit characteristics in the unilateral full-thickness macular hole (FTMH) patients and healthy fellow eyes.

Methods: Our retrospective investigation included patients with unilateral FTMH as the study group, and age- and sex-matched individuals without vitreomacular diseases as the control group, all from one medical center. FTMHs were categorized into those with epiretinal proliferation, those without epiretinal proliferation, or those lacking vitreomacular separation. Macular parameters including foveal base width (FBW), central foveolar thickness (CFT), central subfield thickness (CST), central subfield volume, and retinal artery trajectory (RAT) were measured via optical coherence tomography and fundus photography. Comparisons of these parameters were made among lesioned eyes, contralateral healthy eyes and normal controls, as well as among different subgroups.

Results: Sixty-eight unilateral FTMH patients (39 women and 29 men) and 68 normal controls were enrolled. The fellow eyes of unilateral FTMH showed larger FBWs (446.8 ± 98.2 μm) than controls (338.4 ± 80.6 μm, p < 0.001). The lesioned and fellow eyes of unilateral FTMH had smaller RAT values (0.19 ± 0.06 and 0.14 ± 0.04) than controls (0.37 ± 0.14, p < 0.001), indicating wider RAT in both groups. No significant macular structure parameter differences were observed among different FTMH subgroups. Females exhibited larger FBW, thinner CFT and CST, and wider RAT than the age-matched males (p < 0.05).

Conclusions: Patients with unilateral FTMH had a wider RAT in both the lesioned and healthy eyes and a wider FBW in their healthy fellow eyes than in controls. Such macular structure characteristics may be prone to macular hole formation.