Current Opinion in Ophthalmology最新文献

Purpose of review: Retinal displacement is an occasional yet underrecognized sequela of rhegmatogenous retinal detachment (RRD) repair that can cause postoperative visual distortions and anisekonia. While retinal surgeons strive to achieve single-surgery success, more emphasis and understanding should also be placed on optimizing visual outcomes following RRD repair, including minimizing retinal distortions. This review explores the pathophysiology, clinical manifestations, imaging modalities, risk factors, and preventive strategies associated with retinal displacement.

Recent findings: Retinal displacement is associated with significant visual disturbances - most notably metamorphopsia, aniseikonia, and spatial mislocalization - despite preserved visual acuity. Imaging advances, particularly optical coherence tomography (OCT) overlays and OCT homography, have improved detection over traditional fundus autofluorescence. Risk factors for displacement include macula-off detachments, extensive detachment area, use of a complete intraocular gas fill, and surgical modality, with pneumatic retinopexy and scleral buckling associated with lower displacement rates. Computer modeling has suggested biomechanical forces contributing to displacement.

Summary: Retinal displacement significantly affects postoperative visual quality following RRD repair. Although often missed on standard examination, improved imaging and surgical refinement offer opportunities for early detection and prevention. Continued research into the mechanisms and outcomes of displacement is critical for optimizing both anatomical and functional success in retinal detachment surgery.

Purpose of review: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have gained popularity as an antidiabetic and weight loss agent with protective cardiovascular outcomes, but attention to the potential ocular side effects has grown. This review aims to consolidate the existing evidence on the effects of GLP-1RA on conditions such as diabetic retinopathy (DR), nonarteritic ischemic optic neuropathy (NAION), glaucoma, age-related macular degeneration (AMD), idiopathic intracranial hypertension (IIH), and dry eye disease (DED).

Recent findings: The effect of GLP-1RA on DR is controversial but likely linked to rapid correction of hemoglobin A1c levels. GLP-1RA may be associated with increased risk of NAION, although the mechanism remains elusive. Protective effects have been shown against glaucoma, AMD, and DED possibly due to its anti-inflammatory properties, and these medications may decrease intracranial pressure in IIH.

Summary: As the usage of GLP-1RA increases, further dedicated ocular safety trials are key to determining the risk of eye-related complications. Given the limited prospective evidence available and the proven systemic benefits of the medication, as well as its potential protective effects on certain eye diseases, GLP-1RA use should generally not be discouraged in most patients. Regular ophthalmologic follow up is important in patients considered at higher risk of ocular adverse events.

Purpose of review: The role of topical and subconjunctival antibiotics in reducing infection risk in major ocular surgeries remains unclear despite their widespread use. This review discusses the efficacy of both administration routes across various forms of surgery, underscoring evidence-based recommendations for quality practice patterns and limitations in current research.

Recent findings: Although intracameral antibiotics consistently result in low infection rates in phacoemulsification procedures, there may be some role for topical and subconjunctival antibiotic use, also influenced by regional preferences. Topical antibiotics may prove to be more beneficial in cases of pars plana vitrectomy and keratoprosthesis, but subconjunctival may be more beneficial in trabeculotomies.

Summary: Despite substantial data on infection incidence in ocular surgeries, gaps remain in the evaluation of specific antibiotic regimens, particularly for lesser studied procedures, such as minimally invasive glaucoma surgeries (MIGS) and ocular surface surgeries. Further research is needed to address these disparities and explore novel antimicrobial approaches.

Purpose of review: The management of retinoblastoma is an evolving field, with ongoing research focused on novel diagnostic techniques and therapeutic interventions. This review aims to summarize the current treatment options for retinoblastoma and explore future directions in the field.

Recent findings: Early diagnosis remains crucial for improving prognosis in retinoblastoma, as prompt identification significantly enhances treatment success. New diagnostic imaging strategies as well as prenatal testing are being developed to detect subclinical disease in high-risk patients, allowing for earlier intervention. Recurrent or refractory disease remains a challenge, but encouraging results have been observed with intravenous chemotherapy, intra-arterial chemotherapy, and intravitreal chemotherapy as salvage therapies. Other strategies, including anterior chamber chemotherapy, novel drug formulations, and advanced delivery methods like sustained release chemotherapy in the form of a chemoplaque, are being explored to address these persistent challenges.

Summary: Significant progress in retinoblastoma treatment has led to a dramatic improvement in globe salvage rates. Nevertheless, challenges remain. Delayed diagnosis, particularly in low-income and middle-income regions, continues to contribute to reduced survival rates. Additionally, the management of advanced disease, as well as recurrent or refractory tumors, remain critical issues. The development of new drugs and delivery methods as well as modified treatment strategies offer promise in overcoming these obstacles.

Purpose of review: As the prevalence of cataracts continues to rise, the increasing demand for cataract surgery may surpass the availability of ophthalmologists. This review examines the role of optometry in the co-management of patients with cataracts, including preoperative and postoperative care, and discusses the implications of expanding optometric scope-of-practice laws.

Recent findings: Collaboration between optometrists and ophthalmologists occurs through two primary models: referral-based and integrated management. Studies indicate that direct referrals from optometrists to ophthalmologists improve surgical listing rates and streamline patient care. Integrated models enhance efficiency by incorporating optometrists into ophthalmology practices, allowing ophthalmologists to focus on surgical interventions. Postoperative care co-managed by optometrists has demonstrated mostly favorable visual outcomes, with 86% of patients achieving 20/40 vision or better and low postoperative complication rates. However, legislative changes expanding optometric surgical privileges remain controversial due to concerns about training adequacy and patient safety. Sharing clinical responsibilities can lead to a "slippery slope" phenomenon encroaching on the surgeon's role and threatening patient care.

Summary: Optometry-ophthalmology co-management can enhance surgical efficiency, improve patient access, and alleviate workforce shortages. While co-management may be effective for routine cases, the expansion of optometric surgical privileges raises debate regarding clinical competency and regulatory oversight. Future efforts should focus on creating best practice guidelines for standardizing training, shared ethical responsibility, and ensuring high-quality, patient-centered care.

Purpose of review: Artificial intelligence (AI) is transforming retina care, with deep learning (DL) models shaping a new era of improved screening accessibility, diagnostic precision, and personalized disease monitoring. This review highlights recent AI-powered clinical applications in diabetic retinopathy (DR), and age-related macular degeneration (AMD) care.

Recent findings: Since the FDA's authorization of the first autonomous AI system for DR screening in 2018, multiple platforms have emerged, expanding access to diabetic eye care. Real-world studies have confirmed a significant improvement in screening adherence and diagnostic accuracy, illustrating AI's tangible impact on public health. Meanwhile, newly certified AI technologies that meet European regulatory standards are increasingly guiding clinical decision-making in the management of AMD and diabetic macular edema through automated analysis of optical coherence tomography (OCT) images. Most recently, FDA-authorized home OCT platforms are transforming AMD monitoring, enabling proactive and remote management of retinal fluid.

Summary: As AI increasingly empowers patients and providers, its widespread success still depends on ongoing work, including thorough validation, outcome-based metrics, and improved workflow integration. The next decade will reveal whether AI in retina care transitions from a promising innovation to an essential and indispensable tool in modern retina.

Purpose of review: This review summarizes the literature regarding vitreous and chorioretinal biopsy, with a focus on surgical techniques and methods to optimize diagnostic yield for the collected samples.

Recent findings: Various novel options for analyzing vitreous samples are being explored such as cell-free DNA analysis, single parameter flow cytometry, and mass spectrometry. These methods show promise in diagnosing primary intraocular lymphoma.

Summary: Vitreous and chorioretinal biopsies may be required in atypical cases of intraocular inflammation that do not respond to treatment or do not respond as anticipated. A thorough differential diagnosis is important, allowing the surgeon to order and prioritize the appropriate testing for an obtained sample. As these samples can be limited or challenging to collect, it is also crucial that vitreoretinal surgeons optimize their diagnostic yield by communicating with various labs that are involved with sample processing.

Purpose of review: Autoimmune retinopathy (AIR) is a rare but vision-threatening disorder characterized by retinal damage through humoral or cellular immune mechanisms. The purpose of this review is to summarize our current understanding on imaging, antibody testing, and immunosuppressive therapies for AIR.

Recent findings: AIR includes paraneoplastic forms - such as cancer-associated retinopathy (CAR) and melanoma-associated retinopathy (MAR) - as well as a nonparaneoplastic (np) variant (npAIR). Definitive diagnosis of AIR is challenging due the similar clinical findings between AIR and inherited retinal dystrophies and the lack of specific laboratory testing. Therefore, a multimodal diagnostic approach including electroretinography, fundus imaging, visual field testing, genetic testing, and serologic assays is necessary to support a diagnosis of AIR. Early diagnosis and treatment with systemic or local immunomodulators may preserve retinal function and lead to better visual outcomes.

Summary: This review highlights current diagnostic approach and treatment strategies in AIR. Advances in biomarkers and precision immunotherapy may improve diagnosis and outcomes.

Purpose of review: This review aims to summarize current knowledge on ocular surface side effects associated with novel systemic therapies for atopic dermatitis (AD) and psoriasis.

Recent findings: Interleukin inhibiting monoclonal antibodies such as dupilumab and tralokinumab, along with small molecule JAK-STAT inhibitors such as upadacitinib and abrocitibib, have revolutionized the treatment of AD and psoriasis. Despite their effectiveness in disease control, these agents have been increasingly associated with ocular adverse events, particularly conjunctivitis. While dupilumab-induced conjunctivitis is the most documented, emerging data highlights variable ocular safety profiles across different agents. Early recognition and grading of ocular inflammation through clinical examination allows for effective management with topical anti-inflammatory treatment. In severe or refractory cases, switching or discontinuing therapy may be necessary.

Summary: With the expanding use of novel systemic dermatologic therapies, ocular surface complications have become an important concern. Multidisciplinary collaboration and increased awareness are vital to prevent vision-threatening outcomes. Ongoing research is needed to elucidate pathophysiology and optimize therapeutic approaches that balance effective skin disease control with ocular health.

Purpose of review: To review the treatment modalities commonly available or under investigation for uveitic macular edema.

Recent findings: Corticosteroids are a mainstay of treatment and can be administered topically, periocularly, intravitreally, suprachoroidally, and systemically. Advances in drug development aim to target delivery of corticosteroids to the posterior segment while sparing anterior segment structures to avoid intraocular pressure elevation and cataract formation. Nonsteroidal alternatives including intravitreal anti-VEGF, intravitreal methotrexate, intravitreal anti-IL6, systemic acetazolamide, systemic antimetabolites, systemic biologics, and interferons have all been studied as alternatives that would allow for potential reduction or discontinuation of corticosteroid use. Pars plana vitrectomy remains a controversial option for patients with uveitic macular edema refractory to other medical therapies.

Summary: Uveitic macular edema is a common complication of uveitis that can cause significant vision loss and persist even after the resolution of other signs of intraocular inflammation. Treatment modalities aim to reduce macular edema while limiting adverse effects.