Current Opinion in Ophthalmology最新文献

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.

Purpose of review: To summarize recent evidence about the association between different lifestyle modifications and environmental risk factors and glaucoma.

Recent findings: Incorporating moderate exercise into the routine of glaucoma patients may help slow the progression of the condition. However, caution should be taken when using swim goggles, and it may be advisable to avoid certain yoga positions and heavy weight-lifting exercises, as they have been linked to intraocular pressure (IOP) spikes and potential risks for glaucoma patients. Various relaxation techniques may lower IOP. The evidence remains inconclusive about the association between vitamins intake and glaucoma. Dietary nitric oxide has been associated with a lower risk of glaucoma. Higher smoking intensity has been linked to faster visual field decline and retinal nerve fiber layer thinning. Additionally, there is currently insufficient evidence to support the use of marijuana in managing glaucoma, with side effects outweighing the proposed benefits. A significant association has been found between air pollutants and ganglion cell layer thinning, as well as a greater burden of glaucoma.

Summary: Lifestyle and environmental factors are increasingly recognized as significant contributors to glaucoma development and progression. These modifications should be integrated into a comprehensive treatment approach alongside medications or surgical interventions.

Purpose of review: This review highlights new Federal Drug Administration (FDA) approved glaucoma treatments to familiarize providers with immediately available options.

Recent findings: New FDA-approved treatments include the bimatoprost implant, travoprost implant, direct selective laser trabeculoplasty (DSLT), and ocular pressure adjusting pump. The bimatoprost implant is approved for a single administration with effects lasting for about 1 year, as opposed to the nearly 3-year effect for the travoprost implant. Meanwhile, the DSLT lowers intraocular pressure (IOP) by applying a laser through the limbus within 2 s. Lastly, the ocular pressure adjusting pump is a noninvasive, nonpharmaceutical device that lowers IOP with negative pressure within a pair of goggles. Not only do these modalities lower IOP, but they also improve the patient experience by reducing drop burden, decreasing laser duration, or lowering side effects. Although the list of therapies still in development is extensive, another two promising devices under review include a supraciliary stent and an adjustable aqueous tube shunt.

Summary: Glaucoma treatment has considerably evolved over the last decade with the introduction of novel topical medications, minimally invasive glaucoma surgeries, sustained-release drug delivery systems, and wearable devices. This expansion in glaucoma has enabled more patient-centric decision-making regarding treatment.

Purpose of review: The purpose of this review is to present two cases of overlap syndrome, or concurrent pigment dispersion syndrome and pseudoexfoliation syndrome. The summary of existing literature highlights the importance of accurate diagnosis and potential treatment options of overlap syndrome.

Recent findings: The cases describe two patients with overlap syndrome and resulting progressive glaucoma. The condition tends to present after age 50 years old, with presence of both pseudoexfoliative material and pigment dispersion signs. The pigment dispersion syndrome may be quiescent at the time of pseudoexfoliation onset and may have gone undiagnosed. This form of glaucoma poses challenges in controlling intraocular pressure and may progress rapidly, often requiring surgical intervention.

Summary: This paper reviews the common examination findings of pigment dispersion syndrome and pseudoexfoliation, which may aid clinicians in the diagnosis of the rare condition, overlap syndrome. The connection between the two conditions remains unclear, though studies of possible genetic associations are underway. The two-hit theory, or initial damage to the trabecular meshwork increasing susceptibility to future damage, is plausible given the severe nature of the condition. Though definitive conclusions regarding treatment strategies and outcomes of overlap syndrome are lacking, increased awareness, diagnosis, and study of the condition may help guide the management of overlap syndrome.