Current Opinion in Ophthalmology最新文献

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.

Purpose of review: This review highlights treatment options, both under investigation and currently available, for treating postcataract macular edema. An update on current clinical studies for postcataract macular edema has been summarized.

Recent findings: Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery leading to decreased visual acuity due to inflammation promoting vascular permeability and macular edema. There is no gold standard protocol for treatment with physicians choosing topical NSAIDs and corticosteroids most commonly. Recent developments in a therapeutic approach to PCME include improved delivery methods via implantation and improved drugs and combinational therapies.

Summary: While PCME treatments are poorly studied due to their common sudden resolution without medical intervention, chronic PCME is debilitating for patients. Clinical studies show hope for improved drug delivery methods, practices to prevent potential PCME, and improved therapeutics.

Purpose of review: In contrast to current clinically used tamponades including oils and gases, hydrogels offer a vitreous replacement that has the potential to present a niche for vitreous cells and elevate vitreous substitutes to the level of tissue engineering. This article, therefore, highlights and discusses recent hydrogel-based vitreous replacement strategies as well as the latest progress on vitreous cells, towards the development of a cellularized vitreous substitute.

Recent findings: A variety of different crosslinked hydrogel systems have been recently investigated as preformed and in situ forming vitreous substitutes, based on biopolymers and/or synthetic polymers. In addition, a comprehensive understanding of the precise function and immunological significance of hyalocytes as vitreous macrophages has recently emerged using advanced imaging techniques and high-throughput transcriptional and protein analyses.

Summary: Tissue engineering offers transformative potential for vitreous replacement by combining advanced hydrogel systems with hyalocytes as vitreous cells to further replicate the versatile characteristics and functions of the native vitreous.

Purpose of review: Management of diabetic tractional retinal detachments (TRDs) remains technically challenging. The purpose of this review is to provide an updated overview of current surgical techniques and important considerations when treating this condition.

Recent findings: Recent advances in imaging have provided critical insights into hyaloid status and tractional forces in diabetic TRDs, greatly aiding surgical planning. Updates in vitrectomy instruments have also greatly improved anatomic success rates. However, a comprehensive preoperative evaluation and plan remains key in optimizing visual outcomes for this difficult condition.

Summary: The surgical management of diabetic TRDs requires several key elements for successful outcomes. Timely intervention and presurgical planning are crucial, particularly in rapidly progressing cases. The use of advanced imaging and instruments enhances visualization and precision during surgery. Finally, a collaborative multispecialty approach with clear communication with patients about their prognosis is fundamental to effective care. These strategies collectively improve patient outcomes and promote visual recovery in those affected by diabetic TRDs.

Purpose of review: Full-thickness macular holes (FTMH) can result in significant visual impairment if untreated. Although conventional treatment achieves high closure rates, FTMH can persist or reopen in some cases. This review examines recent advances in surgical approaches for managing refractory FTMH and highlights their effectiveness and limitations.

Recent findings: Approaches to refractory FTMH aim to relieve traction, encourage glial cell proliferation, improve RPE pump efficiency, increase retinal compliance, and/or provide replacement tissue. A variety of techniques targeting these mechanisms, including various autologous or allogeneic transplants such as internal limiting membrane (ILM) or human amniotic membrane grafts, or surgical manipulations such as macular detachment or relaxing retinotomies, have been proposed. These techniques are reviewed here.

Summary: Multiple techniques have shown promise for refractory FTMH. Choice of technique should be guided by characteristics of the FTMH, including size and chronicity, availability of desired tissue or instrumentation, and surgeon familiarity.

Purpose of review: Neurodegeneration is a common endpoint of various blinding retinal diseases. Yet, despite exciting advances in disease treatment, there continues to exist a critical need for the development of neuroprotective strategies to prevent retinal cell death. Here, we summarize the recent advances in neuroprotective strategies.

Recent findings: From laboratory deciphering of the mechanisms involved in disease, many novel neuroprotective strategies have emerged and are currently under investigation for the treatment of various retinal and ocular diseases such as inherited retinal degeneration, retinal detachment, diabetic retinopathy, age-related macular degeneration, macular telangiectasia type 2, and glaucoma. These strategies include gene therapies, Fas inhibition, and targeting inflammatory, metabolic and reduction-oxidation abnormalities. Interestingly, investigation of several treatments across different diseases suggests shared neuroprotection mechanisms that can be targeted regardless of the particular disease.

Summary: Retinal neuroprotection can improve treatment of different retinal diseases. Fortunately, the current landscape, with a plethora of novel neuroprotective therapies, portends a better future for patients.

Purpose of review: Optic disc pit maculopathy (ODPM) is a rare yet serious condition that can lead to visual impairment. While pars plana vitrectomy (PPV) remains the gold standard for ODPM that requires treatment, there is ongoing debate regarding adjunctive surgical techniques. This review explores the latest surgical advancements and innovations in the management of ODPM from the past few years.

Recent findings: Vitrectomy remains an effective procedure for ODPM management, achieving high success rates. Adjunctive techniques, including internal limiting membrane (ILM) peeling, gas tamponade, and juxtapapillary laser photocoagulation, have demonstrated efficacy, though their roles remain debated. Novel approaches using ILM plugging, amniotic membrane grafts, and autologous platelet concentrate offer promise, especially in refractory cases. High-level evidence remains scarce, and most recent publications are relatively small case series. Therefore, it remains unclear whether the additional techniques confer additional benefit beyond vitrectomy alone, although the novel approaches can be effective options for refractory cases. Larger comparative studies are required to provide better evidence.

Summary: Vitrectomy with or without additional maneuvers is an effective treatment for ODPM. Emerging adjunctive surgical techniques provide new possibilities, but further research is required to assess for comparative efficacy and optimize outcomes.

Purpose of review: Rapid increase in the prevalence of myopia has been documented worldwide. Myopia, especially high myopia, is not only an important risk factor for having open angle glaucoma (OAG), but also has a strong linking with the progression of OAG. Since myopic axial length (AXL) elongation is associated with nonglaucomatous optic nerve head (ONH) and visual field abnormalities, myopia poses a challenge in differential diagnosis of OAG. This review provides an overview of literature studying relationships between myopic AXL-elongation and diagnosis and prognosis of OAG, and functional and structural changes in the eye.

Recent findings: Studies using optical coherence tomography (OCT), OCT-angiography, those using standard automated perimetry (SAP), other perimetric or electrophysiological methods showed dose-dependent effects of myopic AXL elongation on the structural changes in the ONH and parapapillary tissues, and functional abnormalities of an eye. Large cohort studies showed approximately one quarter of eyes with nonpathologic high myopia were complicated with various patterns of visual field defects including glaucoma-like ones.

Summary: Findings of cross-sectional and longitudinal studies obtained using various fundus imaging devices must be integrated to perimetric results to improve differential diagnosis of OAG in myopic eyes, in which artificial intelligence technology may be useful.