Current Opinion in Ophthalmology最新文献

Purpose of review: To provide an overview of research from recent randomized clinical trials (RCTs) on novel binocular treatments for amblyopia, inherently designed to force binocular integration by simultaneous dichoptic stimulation. Second, to present an update on the most recent research.

Recent findings: In recent years, binocular treatments as either standalone or adjunct first-line therapies for amblyopia have been gaining acceptance, particularly for older patients and those who are either resistant to or noncompliant with traditional penalization therapy. The findings from a growing body of high-level clinical evidence are highlighted.

Summary: Clinically significant improvements in visual acuity and stereopsis can be achieved with binocular therapy. Several of these therapies are commercially available and have consistently shown noninferiority over standard patching treatment or full-time refractive correction. The data suggest binocular treatments should be considered as standalone or adjunct first-line therapy. However, more research is necessary to support some reports of superiority and long-term stability of gains, and to establish specific clinical recommendations with consideration of patient's age and amblyopia etiology.

Purpose of review: Proliferative vitreoretinopathy (PVR) is a severe complication of retinal detachment and trauma, posing significant challenges to surgical success and visual prognosis. Despite advancements in vitreoretinal surgery, PVR incidence remains unchanged, this review presents a synthesis of the principal clinical and preclinical research findings from recent years.

Recent findings: Recent research has focused on anti-inflammatory, antiproliferative, and antifibrotic agents. Corticosteroids, such as triamcinolone and dexamethasone, show promise in reducing inflammation but have inconsistent results. Methotrexate and mitomycin C demonstrate efficacy in preclinical and select clinical scenarios. Anti-vascular endothelial growth factor agents and immunotherapies, like infliximab, have shown limited clinical benefits despite promising preclinical data. Novel approaches, including CB2 receptor agonists, exosome-based drug delivery, and nuclear factor kappa B pathway inhibitors, are gaining traction. Additionally, RNA-based and multitargeted therapies highlight the importance of addressing inflammation, fibrosis, and proliferation simultaneously.

Summary: Effective management of PVR requires multifaceted therapies targeting its complex pathogenesis. While current treatments are limited, ongoing research in precision drug delivery and combination therapies offers hope for improved outcomes. Future strategies should focus on translating promising preclinical findings into robust clinical applications.

Purpose of review: The goal of this review is to summarize emerging clinical trial and real world evidence for faricimab and high dose aflibercept (8 mg), two recently approved treatments for wet age-related macular degeneration and diabetic macular edema.

Recent findings: Faricimab, a bispecific monoclonal antibody targeting vascular endothelial growth factor (VEGF) and angiopoietin-2, and high-dose aflibercept have demonstrated significant potential for extending treatment intervals while maintaining efficacy. Pivotal clinical trials such as YOSEMITE, and RHINE established faricimab to be noninferior to standard anti-VEGF therapy with superior durability. Real-world data corroborated these results, demonstrating improved anatomic outcomes with extended treatment intervals, though improvements in best corrected visual acuity (BCVA) remains varied. High-dose aflibercept has similarly demonstrated noninferiority in landmark clinical trials such as PHOTON and PULSAR, with extended dosing intervals. However, comprehensive real-world data for high dose aflibercept remains limited and warrants further investigation.

Summary: Both faricimab and high-dose aflibercept show promise in reducing treatment burden for wet age-related macular degeneration and diabetic macular edema through extended dosing intervals while maintaining or improving clinical outcomes compared to standard anti-VEGF therapy. Faricimab has demonstrated this both in clinical trials as well as real-world studies, while high-dose aflibercept has demonstrated similar durability in trials but requires additional real-world evidence.

Purpose of review: To describe recent evidence regarding surgical techniques for secondary scleral fixation of intraocular lenses (IOLs), with attention to information most relevant to the surgical practice of vitreoretinal surgeons.

Recent findings: Recent studies have reported favorable outcomes in patients treated with scleral fixation of IOLs using Gore-Tex suture and flanged intrascleral haptic fixation (ISHF). ISHF can be achieved using trocar-cannulas or double needle-based techniques. Recent data has focused on refractive outcomes data, as well as postoperative complications related to specific IOL choices, including haptic breakage, rotation/ tilt, and opacification. Studies directly comparing Gore-Tex sutured and ISHF techniques offer additional insights.

Summary: Favorable refractive and surgical outcomes can be achieved using both sutured and sutureless scleral fixation techniques. These techniques can be combined effectively with pars plana vitrectomy (PPV) and are thus well suited for the skillset of a vitreoretinal surgeon. Future studies on iris-based fixation techniques and IOL types not yet available in the United States will be of interest. As these techniques are more widely used, prospective data as well as longer term outcomes will continue to clarify their risk/benefit profile.

Purpose of review: To examine the role of the ophthalmologist in screening for ocular candidiasis in patients with Candidemia .

Recent findings: Recent evidence has shown that previously published incidence rates of endophthalmitis in Candidemia were overestimating risk due to nonuniform guidelines. Newer data suggest a very low rate of endophthalmitis in the Candidemia population. There is currently a lack of definitive data proving that retinal findings lead to significant changes in the clinical management of patients with regards to systemic treatment and overall outcomes.

Summary: Given the low rates of endophthalmitis, minimal management changes with positive retinal findings, and recently published guidelines from the American Academy of Ophthalmology, we posit that ocular screening of all patients with Candidemia is not warranted. However, more research is required to better delineate high-risk features that could guide which patients would require ophthalmologic examination. Further collaboration between ophthalmology and infectious disease specialists is vital to create new evidence-based guidelines based on the recent data.

Purpose of review: Radiation retinopathy is a vision-threatening complication of radiotherapy involving the eye or surrounding structures. This review aims to summarize recent advances in understanding the incidence, risk factors, pathophysiology, and utilization of new diagnostic imaging tools for radiation retinopathy. It will also focus on the current prophylaxis approaches to prevent or delay the development of radiation-related side effects and treatment strategies once radiation retinopathy occurs.

Recent findings: The incidence of radiation retinopathy is influenced by radiation dose, fractionation schedule, and patient-specific factors such as diabetes mellitus and hypertension. Advances in imaging techniques, including optical coherence tomography angiography (OCTA) and ultra-widefield fluorescein angiography (UWFA), have enhanced early detection by identifying subclinical retinal changes. Novel insights into pathophysiology suggest a role for endothelial damage, inflammation, and oxidative stress in disease progression. Prophylactic approaches, such as intravitreal antivascular endothelial growth factor (anti-VEGF) agents, have shown promise in reducing the onset of retinopathy in high-risk patients. Therapeutic options, including intravitreal anti-VEGF and corticosteroids, have demonstrated efficacy in managing macular edema and preserving vision. However, the outcomes remain variable, necessitating personalized treatment strategies. To address some of these unanswered questions, the Diabetic Retinopathy Clinical Research Network (DRCR) Protocol AL is currently enrolling patients and preparing to analyze the long-term effects of treating patients prophylactically with intravitreal faricimab or the 0.19 mg fluocinolone acetonide implant compared to observation, to identify which patients will benefit from which specific regimen, therefore moving towards a personalized approach for this condition as well.

Summary: Radiation retinopathy remains a significant challenge in ophthalmology. Early recognition through advanced imaging and tailored interventions, including prophylaxis and treatment, are crucial for optimizing visual outcomes. Further research into underlying mechanisms and novel therapies is essential to reduce the burden of this condition and improve patient quality of life.

Purpose of review: Post-injection endophthalmitis (PIE) is the most concerning complication that accompanies intravitreal injections. This review discusses the recent literature in endophthalmitis prophylaxis including types of antisepsis, the use of topical antibiotics, methods of anesthesia, masking, and office-based versus operating room-based injections.

Recent findings: Povidone iodine (PI) remains the gold standard for PIE prophylaxis. Chlorhexidine gluconate (CHG) is an alternative antiseptic agent utilized in other areas of medicine with similar broad spectrum antibacterial activity. Recent clinical trials have demonstrated that the rate of endophthalmitis is similar with CHG prophylaxis compared to PI prophylaxis while offering improved patient comfort at a similar cost. Routine use of topical antibiotics should be avoided as they do not appear to reduce endophthalmitis risk and may promote bacterial resistance. All methods of anesthesia appear to be acceptable. In-office injections are not associated with an increased rate of endophthalmitis compared to operating room injections.

Summary: The rate of post-injection endophthalmitis is extremely low due to a myriad of measures employed by retina specialists. Topical antisepsis is the most important tool to combat post-injection endophthalmitis. CHG is emerging as an alternative to PI due to its efficacy and enhanced patient comfort.

Purpose of review: Epiretinal membrane (ERM) surgery has undergone significant investigation over the last 2 years including assessment of novel surgical techniques and regarding the necessity of internal limiting membrane (ILM) peeling. This review seeks to highlight the latest literature in regards to ERM surgery from unique ERM profiles to clinical trials of surgical approach.

Recent findings: The summative literature highlight that peeling of ILM may reduce recurrence compared to solely peeling ERM; however, these recurrences tend to be mild and nonvisually significant. Optical coherence tomography (OCT) has been leveraged preoperatively, intra-operatively, and postoperatively to enrich knowledge regarding risk factors for worse visual outcomes and deep learning models that are able to predict the anatomic outcome of ERM surgery after review of the preoperative OCT. There is no significant difference in outcomes between sequential and concurrent ERM surgery with cataract surgery. In uveitis evaluations related to ERM, posterior and intermediate uveitis were most associated with ERM, while in pediatric ERM, extent of diffuseness of central ERM correlated with surgical visual improvements.

Summary: The latest ERM research has richly expanded the literature, allowing surgeons to better predict visual improvements postoperatively. This includes using OCT imaging biomarkers, but there remains a litany of unresolved questions about best surgical practices that are actively undergoing assessment.