Retina-The Journal of Retinal and Vitreous Diseases最新文献

Purpose: The natural course of the visual acuity in eyes with myopic macular neovascularization (myopic MNV) is poor. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents have demonstrated safety and efficacy in the short-term for managing myopic MNV. The purpose of this study was to determine the 4-year outcomes of intravitreal aflibercept (IVA) injections.

Method: A retrospective monocentric study including 49 eyes of 48 patients diagnosed with myopic MNV. These patients underwent treatment with IVA using the pro re nata (PRN) regimen after the first injection. The minimum follow-up duration was 4 years.

Results: The patients had an average age of 63.8 years and an average axial length of 29.7 mm. The mean number of IVA injections was 1.6, and 30 eyes (61.2%) had a single injection. At the baseline and at 1-, 2-, 3-, and 4-years, the mean best-corrected visual acuities (BCVAs) were 20/45, 20/41, 20/43, 20/51, and 20/53, respectively. The differences in the BCVA at the different times from that at the baseline were not significant.

Conclusion: IVA therapy with the PRN regimen provides a 4-year visual benefit in eyes with myopic MNV, and it is better than the reported natural course in maintaining the BCVA.

Purpose: To evaluate the surgical outcomes of pediatric familial exudative vitreoretinopathy (FEVR) complicated by tractional maculopathy.

Methods: Retrospective case series. Chart review of 14 children (15 eyes) diagnosed with tractional maculopathy-complicated FEVR who received vitrectomy.

Results: The mean age at surgery was 7.2 years. The mean follow-up duration was 14.1 months. The logarithm of the minimum angle of resolution (logMAR) of best-corrected visual acuity (BCVA) improved from 1.0±0.6 (20/200 Snellen) to 0.6±0.6 (20/80 Snellen) post-operation (t=4.293, p=0.001). The peripapillary temporal inner angle (PTIA, 63.9(15.7) ° vs. 71.1(31.2) °, z=-2.726, p=0.006) and peripapillary temporal outer angle (PTOA, 63.4±25.2° vs. 69.6±23.5°, t=-2.820, p=0.014) widened post-operation. Postoperative BCVA was superior in eyes with a shorter time between symptom onset and surgery (r=0.688, p=0.019), better preoperative logMAR BCVA (r=0.830, p<0.001), and preoperative widening of the outer nuclear layer (ONL, r-pb=0.730, p=0.007) and foveal avascular zone (FAZ, r-pb=0.794, p=0.002), and in eyes with postoperative ellipsoid (r-pb=0.641, p=0.018) and interdigitation zones integrity (r-pb=0.614, p=0.026), widening of the ONL(r-pb=0.816, p=0.001) and FAZ (r-pb=0.940, p<0.001), and absence of the inner retinal layer at the fovea (r-pb=0.672, p=0.012).

Conclusion: Vitrectomy is effective for pediatric FEVR complicated by tractional maculopathy. Patient selection is crucial and iatrogenic complications should be avoided.

Purpose: To study the real-world outcomes of intravitreal faricimab (IVF) in longstanding neovascular age-related macular degeneration (nAMD) over a one-year study period.

Methods: Retrospective single-center cohort study of patients with previously treated nAMD receiving IVF with at least 12 months of follow up. Main outcome measures include injection intervals, visual acuity (VA), and optical coherence tomography features.

Results: 263 eyes from 217 patients received 6.4±2.3 IVF injections over one year. Injection interval increased after switching to IVF (5.9±1.8 vs 7.6±2.4 weeks) (p<0.01). There was no improvement in VA after switching to IVF at any time period (p>0.15). Average CST decreased after the first IVF injection and was sustained for one year (313.7±96.0 vs. 288.2±80.6 μm) (p<0.01). There was a statistically significant resolution of subretinal fluid but not IRF at all time points (40.8-50.4%) (p<0.01). Persistent fluid after the first IVF injection was resolved in 34.4% (n=45) by one year. IVF was discontinued in 31 eyes (11.8%), four (1.6%) that experienced intraocular inflammation.

Conclusions: Longstanding nAMD eyes switched to IVF experienced a significant extension in injection interval, stable visual acuity, improvement in CST, and resolution of fluid on OCT in many patients over one year.

Purpose: To distinguish between central serous chorioretinopathy (CSC) with and without thick choroid and to elucidate their characteristics of choroidal vasculature.

Methods: This prospective observational study enrolled 76 eyes with treatment-naive CSC and 76 normal eyes. Mean + 2 times SD of subfoveal choroidal thickness of healthy individuals was set as the upper limit of normal choroidal thickness to divide patients with CSC into two groups: the thick-choroid and non-thick-choroid groups. Their choroid blood flow was compared using widefield swept-source optical coherence tomography angiography.

Results: According to the discrimination value of subfoveal choroidal thickness as 326.8 µm, 76 eyes with CSC were divided into the thick-choroid (55, 72.4%) and non-thick-choroid (21, 27.6%) groups. Higher proportions of vortex vein anastomosis were found in the thick-choroid group (81.8% vs. 33.3%, P < 0.001). Choroid thickness, three-dimensional choroidal vascularity index, and mean choroidal stroma volume per 1 mm2 were higher in the thick-choroid group. In multivariate analysis, younger age, higher percentages of vortex vein anastomosis, and double layer sign were the independent predictors of choroid thickening in CSC.

Conclusion: There are discrepancies in the degree of choroidal congestion and distribution of vortex veins in the CSC with different choroidal thicknesses.

Purpose: To report a novel optical coherence tomography sign in the context of CRB1 -related maculopathy termed outer retinal columnar abnormalities (ORCA).

Methods: Retrospective, multicenter, observational case series of 14 eyes of eight patients with molecularly confirmed CRB1 -related maculopathy and ORCA. Multimodal imaging scans and medical records of patients with CRB1 -related maculopathy were reviewed. Outcome measures included best-corrected visual acuity, central subfield thickness on spectral-domain optical coherence tomography, presence of ORCAs, and analysis of their change in appearance over time.

Results: At baseline, mean age was 18±10 years (range 9-36 years). All patients had an isolated macular dystrophy except for 1 case harboring a triallelic pathogenic variant. Variant c.498_506del was found in 9 cases (88%). At presentation, ORCA were visible on macular spectral-domain optical coherence tomography in all cases as multiform, vertical, hyperreflective, columnar alterations extending from the ellipsoid to the outer plexiform layer, with a variable degree of hyporeflective cystic spaces in the outer and inner nuclear layers. Over 6±4.7 follow-up years, the presence of ORCA varied greatly with a decrease in ORCA associated with sequential development of retinal atrophy.

Conclusion: A high suspicion for CRB1 -associated retinal dystrophy should arise in the presence of ORCA on spectral-domain optical coherence tomography, prompting genetic testing.

Purpose: To investigate the surgical outcomes and intraoperative parameters of 3D visualization system for macular diseases in highly myopic eyes.

Methods: In this single-center, prospective, randomized, comparative interventional study, 40 highly myopic eyes (axial length > 26 mm) were randomly assigned to either a 3D visualization system or a conventional microscope group. Surgical outcomes and intraoperative parameters, including the number of indocyanine green injections, surgical time, and epiretinal membrane/internal limiting membrane peeling time, were compared.

Results: The 3D group required significantly fewer indocyanine green injections (1.3 ± 0.5 vs. 2.3 ± 0.7, P < 0.001), had shorter epiretinal membrane/internal limiting membrane peeling times (522.8 ± 258.0 vs. 751.8 ± 320.2 seconds, P < 0.05), and experienced fewer intraoperative retinal hemorrhages (0 vs. 7 cases, P < 0.05) compared with the conventional microscope group. Anatomical and functional outcomes were comparable between the two groups.

Conclusion: The 3D system exhibited a lower number of indocyanine green injections, shorter epiretinal membrane/internal limiting membrane peeling times, and a reduced incidence of intraoperative retinal hemorrhages, suggesting the 3D visualization system may offer advantages for macular surgery in highly myopic eyes.

Purpose: Retentional pigment epithelial detachment (PED) associated with age-related scattered hypofluorescent spots on late-phase indocyanine green angiography (ASHS-LIA) is hypothesized to be caused by Bruch membrane's lipid barrier. This study aimed to report the natural course of retentional PED and evaluate the relationship between retentional PED evolution and ASHS-LIA.

Methods: Patients with treatment-naïve retentional PED were enrolled and observed every 3 months for at least 12 months. Treatment was not performed except for secondary macular neovascularization.

Results: In 55 studied eyes with a median follow-up of 18.0 (range: 12-36) months, 87.3% (48/55) of the retentional PEDs persisted, 7.3% (4/55) resolved, and 5.5% (3/55) progressed to polypoidal choroidal vasculopathy. The mean PED area significantly increased during the follow-up ( P < 0.001) and with the ASHS-LIA grade at each follow-up point (all P <0.05), especially during the first 6 months before approaching the edge of confluent ASHS-LIA. Persistent PEDs were mostly stable (52.1%) or enlarged (45.8%) but reduced in only 1 case (2.1%) because of retinal pigment epithelium microrip at the edge of PED. The persistent PEDs were all within the ASHS-LIA region, especially the macular confluence region. The resolved PEDs all had grade 1 ASHS-LIA and resolved after gradual expansion of PED beyond the confluent ASHS-LIA region. Pigment epithelial detachments that progressed to macular neovascularization all had confluent grade 2 or 3 ASHS-LIA. Retinal pigment epithelium microrips or apertures within PED did not affect the progression of the PED.

Conclusion: The natural course of retentional PED is closely related to the features of ASHS-LIA and supports its lipid-barrier hypothesis.

Purpose: To describe a novel positioning maneuver for patients with rhegmatogenous retinal detachment after pneumatic retinopexy (PnR).

Methods: Single-center prospective case series of primary rhegmatogenous retinal detachments referred to St. Michael's Hospital, Toronto, Canada, between 2021 and 2023. All patients underwent PnR. Baseline ultra-widefield fundus imaging and repeat imaging 10 minutes after the gas injection was performed. After PnR, patients were instructed to perform the mini-steamroll maneuver, which consists of a face-down position for 10 minutes followed by positioning to the retinal break. The reduction of subretinal fluid volume after the initial face-down position was evaluated with clinical examination and ultra-widefield imaging.

Results: Six patients who presented with primary bullous rhegmatogenous retinal detachment and a sizable superior break were enrolled. The mini-steamroll maneuver resulted in a rapid and significant reduction of subretinal fluid in all patients with bullous rhegmatogenous retinal detachment and large superior breaks, allowing subretinal fluid to be expressed into the vitreous cavity with 10 minutes of face-down positioning. One patient required a sequential PnR. Primary retinal reattachment was achieved in all cases. This approach was well-tolerated by patients.

Conclusion: This case series demonstrates that the mini-steamroll maneuver may be a suitable alternative for patient positioning after PnR in certain cases. The mini-steamroll is a simpler positioning regimen with the potential benefits of direct-to-break and full steamroller maneuver.

Purpose: Novel therapies for diabetes have potent effects on glycemic control, obesity, and cardiovascular risk reduction, but some, including the popular drug semaglutide, have also been implicated in worsening of diabetic retinopathy (DR). Given the ubiquity of these new agents, understanding the risks to vision is important. Here, we review the data for several newly available agents in terms of systemic efficacy and retinal safety.

Methods: Literature review.

Results: Novel antihyperglycemic treatments include incretin mimetics and enhancers, sodium-glucose cotransporter inhibitors, long-acting insulins, and insulin delivery systems. All improve glycemic control, and some have been shown to reduce major cardiovascular outcomes. In a pivotal trial, semaglutide was associated with approximately 75% increased risk of DR worsening. The novel long-acting insulin icodec, formulated for once weekly dosing, showed increased risk of DR worsening over a once daily insulin. No other recent antihyperglycemic agent was associated with DR worsening, although following the semaglutide trials, nearly all studies excluded patients with preexisting DR. Cases of DR worsening were rare in all instances. Dedicated safety studies for semaglutide in DR are currently underway.

Conclusion: For most patients being considered for treatment with a novel antihyperglycemic agent, benefits on systemic metabolic and cardiovascular health are very likely to outweigh potential retinal harms. Although the true risks of the new agents on DR are unclear because their safety data come from secondary end points, the most vulnerable patients are those with preexisting high-risk DR, poor baseline glycemic control, and using insulin.