Ophthalmic surgery, lasers & imaging retina最新文献

Background and objective: Neovascular age-related macular degeneration (nAMD) is a sight-threatening condition with growing prevalence, but few therapies exist to prevent its development. This study investigates whether metformin reduces the odds of new nAMD diagnosis.

Patients and methods: This was a case-control study using a nationwide insurance claims database of patients ages 55 and older with newly diagnosed nAMD from January 2008 to December 2019. Multivariable conditional logistic regression was utilized to determine how various exposures impacted the odds of new nAMD diagnosis.

Results: Among 55,080 cases with new nAMD diagnosis and 55,066 matched controls, any metformin exposure reduced 5-year odds of new nAMD diagnosis compared to individuals not on metformin (odds ratio [OR]: 0.94; 95% CI: 0.90 to 0.99). Insulin and sulfonylurea exposures were also protective. These findings were consistent in subgroup analyses of patients with diabetes without diabetic retinopathy.

Conclusion: Metformin may reduce the 5-year odds of developing nAMD, particularly in diabetic patients without diabetic retinopathy.

This report presents the fluocinolone-loaded intraocular lens (IOL) with scleral suspension (FLISS) technique as a surgical approach for managing macular edema (ME) in patients with compromised lens-iris diaphragm and dislocated IOL. A 74-year-old woman with a subluxated bag-IOL complex and chronic ME underwent pars plana vitrectomy. After IOL removal, Gore-Tex CV-8 sutures were used to secure a 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien) to the haptic of a Micro-pure IOL and subsequently fix the lens to the sclera. Three months later, visual acuity had improved from 20/160 to 20/50, and there was no ME. The FAc implant remained stable and well positioned outside the visual axis. The FLISS technique, herein described for the first time, offers a promising alternative for addressing chronic ME in eyes requiring secondary IOL implantation, with the benefits of no additional scleral manipulation (compared to standard IOL scleral fixation) and low risk of implant migration.

Background and objective: The DRCR Retina Network Protocol S established anti-vascular endothelial growth factor (anti-VEGF) therapy as non-inferior to panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). This study examines PDR treatment trends in the United States from 2016 to 2023.

Patients and methods: This retrospective study used the TriNetX US Collaborative Network to identify PDR patients diagnosed between 2016 and 2023. Patients were stratified by treatment type (anti-VEGF, laser/PRP, or both) and demographic factors. Treatment rates were analyzed using prevalence ratios (PRs) with 95% confidence intervals (CIs).

Results: From 2016 to 2023, laser/PRP treatment rates decreased (PR 0.76, CI 0.71-0.80), while anti-VEGF (PR 1.61, CI 1.52-1.71) and combination treatment rates (PR 1.21, CI 1.12-1.32) increased. Hispanic patients had declining anti-VEGF rates during 2020 to 2023 but had higher laser rates than White patients.

Conclusion: There is a growing preference for multimodal treatment, though single therapies remain dominant. Disparities among minority groups warrant further investigation.

This report presents a novel heterozygous mutation in RP1L1 resulting in an asymptomatic retinitis pigmentosa (RP) phenotype. A 37-year-old woman with no visual complaints and 20/20 best-corrected visual acuity was incidentally found to have bilateral retinal pigment mottling and diffuse speckled hypoautofluorescence in both eyes. Ultra-high-resolution optical coherence tomography (OCT) showed intact outer retinal structures. Visual field testing only showed nonspecific defects, in the context of multiple fixation losses and poor reliability. Genetic testing identified a novel mutation in the RP1L1 gene, and three other mutations of unknown significance in the RP GTPase regulator interaction protein 1 gene (RPGRIP1), ATP-binding cassette transporter 4 gene (ABCA4), and glutamate metabotropic receptor 6 gene (GRM6). While RP1L1 is typically associated with autosomal recessive inheritance and is polymorphic among those screened for inherited retinal disease, it is hypothesized that the combination of multiple mutations may contribute to the patient's phenotypic manifestations, despite her heterozygous status for RP1L1.

Background and objective: This study aimed to determine whether cigarette dependence is an independent risk factor for new-onset proliferative diabetic retinopathy (PDR) and related neovascular complications in patients with type 2 diabetes mellitus (DM) and to assess the impact of smoking cessation.

Patients and methods: A retrospective cohort analysis using a clinical database was conducted with adult type 2 DM patients, excluding those with conditions affecting PDR progression. Propensity score matching was used to balance demographic and clinical factors between cigarette-dependent patients and controls.

Results: After matching, cigarette dependence was seen to significantly increase the risk of first-instance PDR (hazard ratio [HR] 1.195), vitreous hemorrhage (HR 1.450), neovascular glaucoma (HR 1.469), and tractional retinal detachment (HR 1.670). Smoking cessation attempts reduced these risks (HR 0.716 for PDR, 0.722 for complications).

Conclusions: Cigarette dependence increases the risk of PDR and its complications in type 2 DM, and smoking cessation reduces these risks.

Fibroblast growth factor receptor (FGFR) inhibitors are increasingly used in cancer therapy but cause ocular side effects, including subretinal fluid (SRF). Baseline vitreomacular traction (VMT) may predispose patients to drug-induced SRF. A 75-year-old man with bladder cancer and VMT developed SRF after initiating erdafitinib therapy. Baseline and follow-up findings were analyzed, including ophthalmic examinations, optical coherence tomography (OCT), and fluorescein angiography (FA). One month after starting erdafitinib, the patient's vision decreased, and OCT revealed new bilateral SRF. Erdafitinib was discontinued, leading to gradual SRF resolution and visual acuity improvement. Repeated OCT demonstrated complete SRF resolution and stable VMT at the final follow-up visit. Erdafitinib can induce SRF, particularly in patients with predisposing retinal conditions such as VMT. Awareness of these risks and early intervention can prevent vision loss. Further research is needed to explore underlying mechanisms and preventive strategies.

Background and objective: A quality improvement project was conducted to improve operating room (OR) access and utilization for elective ophthalmic cases at a university-affiliated eye center.

Patients and methods: This prospective, interventional case series assessed OR utilization across three ORs during a baseline 3-month period. Case scheduling protocols were reviewed, and key drivers of inefficiency were identified. Targeted interventions were implemented to address these barriers.

Results: During the baseline period, a mean of 290 surgeries were performed monthly. Scheduling delays were attributed to the lack of standardized order forms for special preoperative/operative needs, untimely completion of special preoperative tests, poor communication regarding open OR times, and inadequate enforcement of an established 14-day block time release. Following interventions, OR utilization increased by 20% and average monthly case volume rose to 350, adding approximately 60 surgeries per month. These improvements were accompanied by a more than twofold increase in use of the standardized EPIC surgical order with laterality (from 39 to 97 cases per month), demonstrating measurable adoption of workflow changes.

Conclusions: Targeted, multidisciplinary interventions improved OR utilization by 20%. Quality improvement projects enhance patient access and optimize the use of institutional resources.

This report presents a rare case of bilateral exudative retinal detachment (ERD) as an early manifestation of differentiation syndrome (DS) in a woman in her early 30s undergoing induction therapy for acute promyelocytic leukemia (APL) with all-trans retinoic acid (ATRA) and arsenic trioxide. Nineteen days into therapy, she presented with bilateral blurring of vision. Ocular examination revealed bilateral multiple small closely spaced ERDs. Fundus autofluorescence and optical coherence tomography revealed focal retinal pigment epithelial disruptions. No systemic features of DS were recognised by the treating oncologist. ATRA was withheld, and systemic and topical corticosteroids were initiated, leading to complete resolution of subretinal fluid and full recovery of vision. ATRA was successfully reintroduced without recurrence of symptoms. This case highlights the potential for ocular findings to precede systemic signs of DS and underscores the importance of early ophthalmic evaluation and timely intervention to preserve vision and ensure uninterrupted leukemia treatment.