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

Purpose: To evaluate intergrader variability in posterior vitreous detachment (PVD) classification in patients with epiretinal membrane and macular hole on spectral-domain optical coherence tomography (SD-OCT) and identify challenges in defining a reliable ground truth for artificial intelligence-based tools.

Methods: A total of 437 horizontal SD-OCT B-scans were retrospectively selected and independently annotated by six experienced ophthalmologists adopting four categories: "full PVD," "partial PVD," "no PVD," and "ungradable." Intergrader agreement was assessed using pairwise Cohen kappa scores. Consensus levels, accuracy, recall, specificity, and grading time were also analyzed using the majority vote as reference.

Results: The overall average Cohen kappa was 0.57. Agreement was highest for "partial PVD" (Cohen kappa = 0.70), followed by "full PVD" (Cohen kappa = 0.65), and lowest for "no PVD" (Cohen kappa = 0.14), indicating substantial diagnostic variability. Full consensus was achieved in only 31.1% of OCT scans, whereas 11.4% required adjudication. The sensitivity for "no PVD" was notably low (0.35 ± 0.32), and misclassified OCT scans took significantly longer to grade ( P < 0.001).

Conclusion: Our results underscore challenges associated with reliable OCT-based classification of PVD in patients with diseases of the vitreomacular interface, especially for cases with completely attached vitreous. Improving intergrader agreement through consensus grading and advanced imaging modalities will be critical for establishing a solid ground truth to support reliable, artificial intelligence-driven PVD detection systems.

Purpose: To report the clinical presentation, management, complications, and outcomes after retinal injuries caused by intravitreal injections.

Methods: Retrospective case series of 12 eyes presenting with visual deterioration because of vitreoretinal complications secondary to trauma caused by intravitreal injections. Detailed ocular history, clinical examination, vitreoretinal complications, management, final anatomical, and visual outcomes are documented.

Results: We observed 12 cases of direct retinal trauma by the needle tip of intravitreal injection. All retinal injuries were located in the temporal mid-periphery, usually near the inferior arcade. Of the 12 patients, four eyes developed a retinal detachment, all with proliferative vitreoretinopathy, six had vitreous hemorrhage, and two eyes presented with a focal chorioretinal atrophic lesion. The patients either underwent surgical procedure or were closely monitored after the injury. The surgical intervention was successful in anatomical outcomes in all cases. Ten eyes had a final visual acuity similar to baseline, whereas two eyes experienced visual deterioration during a follow-up of at least 6 months.

Conclusion: Direct retinal injury with the intravitreal injection needle is a rare but possibly underreported adverse event. Early detection of these complications, especially if associated with retinal detachment, is important for timely and appropriate management to avoid permanent loss of vision.

Purpose: To investigate the prognostic factors for development of gliosis after idiopathic macular hole (IMH) surgery and its relationship to functional and anatomical success.

Methods: This retrospective study included patients with IMH that underwent pars plana vitrectomy using internal limiting membrane flap technique. Optical coherence tomography examinations were done at baseline, 1 month, and 6 months postoperatively. Postoperative parameters on optical coherence tomography included hole closure, outer retinal layers continuity, and development of gliosis.

Results: Sixty-five patients with IMH were included in the study. Forty-three underwent temporal flap and 22 an inverted flap 360° around the hole. Gliosis was present at 8 (12.3%) eyes at 1 and 6 months postoperatively. Patients with gliosis at 6 months had larger minimal hole diameter at presentation (622 µ m ± 140 vs. 423 ± 178, P = 0.004). Gliosis was associated with worse best-corrected visual acuity at presentation (0.86± 0.49 logMAR [20/145] vs. 0.43 ± 0.37 [20/54], P = 0.008) and 1 month postoperatively (0.91 ± 0.59 logMAR [20/160] vs. 0.42 ± 0.48 [20/53], P = 0.013) but not at 6 months postoperatively (0.55 ± 0.31 logMAR [20/70] vs. 0.43 ± 0.33 [20/54], P = 0.222).

Conclusion: Our study supports the use of inverted internal limiting membrane flap for IMH as a primary procedure. No gliosis was shown in small macular holes undergoing this technique. Even in large IMH where gliosis has developed, an improvement in visual acuity was shown after surgery.

Purpose: To report outcomes of suprachoroidal hemorrhage (SCH).

Methods: Retrospective nonrandomized study of eyes with SCH from two sites (January 1, 2013-December 31, 2022). The primary outcome was the 6-month change in visual acuity (VA). Multivariable analysis was performed, as well as a comparison of matched eyes with and without systemic steroids.

Results: Overall, 143 eyes of 143 patients (mean age 70.8 years, 52.4% male) were included, with 72 perioperative, 24 traumatic, and 47 spontaneous SCH cases. The mean (SD) presenting VA was 2.07 (0.92) logMAR. 87 (60.8%) were managed nonsurgically, 24 (16.8%) underwent drainage, and 32 (22.4%) underwent drainage and vitrectomy; 36 (25.2%) received systemic steroids. At 6 months, the mean (SD) change in VA from presentation was -0.41 (0.84) logMAR. 102 eyes (71.3%) achieved anatomic success (complete retinal attachment). Concurrent retinal detachment was associated with worse VA change and anatomic success in multivariable analysis ( P < 0.05). In the matching analysis, eyes receiving systemic steroids were more likely to achieve ≥ 3-line gain in VA than matched eyes without systemic steroids (77.8% vs. 55.3%, P = 0.047).

Conclusion: The visual prognosis of eyes with SCH remains guarded. Systemic steroids may be associated with a modest benefit for visual outcomes. Concurrent retinal detachment portends worse outcomes.

Purpose: To describe the clinical and multimodal imaging features of a novel form of macular neovascularization (MNV), designated Type 4 MNV, defined by mixed Type 1 and Type 2 neovascularization (NV), extensive intraretinal anastomotic NV, and central posterior hyaloid fibrosis.

Methods: This multicenter retrospective observational case series included patients with neovascular age-related macular degeneration exhibiting both Type 1 and 2 MNV and an overlying anastomotic intraretinal NV network. This was confirmed with optical coherence tomography (OCT) and OCT angiography (OCTA). Demographics, baseline visual acuity (VA), and OCT imaging biomarkers including the hyperreflective oblique band sign, central posterior hyaloid fibrosis, epiretinal membrane, and OCTA NV subtype were assessed.

Results: Eleven eyes from 11 patients (mean age: 76.9 years; 36.4% female) met inclusion criteria. Baseline VA was logMAR 1.56 ± 0.45 (≈20/630) and 90.9% of subjects presented with severe visual loss. All eyes showed the hyperreflective oblique band sign. Central posterior hyaloid fibrosis was observed in 81.8% (9/11 subjects). Epiretinal membrane with radial traction was present in 81.8%. OCT angiography illustrated mixed Type 1 and 2 MNV with a prominent overlying intraretinal anastomotic network extending into the preretinal space.

Conclusion: Type 4 MNV represents a distinct age-related macular degeneration phenotype with aggressive anatomical features including mixed Type 1 and 2 MNV, inner retinal and preretinal proliferation and anastomosis and retinal disorganization. The visual prognosis is invariably poor with recalcitrance to anti-vascular endothelial growth factor therapy. The recognition of this signature NV lesion subtype further refines the MNV classification system and can affect therapeutic strategies for neovascular age-related macular degeneration.

Purpose: To analyze the frequency of misdiagnoses in macular telangiectasia type 2 (MacTel) and to investigate factors influencing the probability of receiving an incorrect diagnosis.

Methods: A retrospective analysis of 288 patients with confirmed diagnosis of MacTel from the Natural History Observation Registry at the University Eye Hospital Bonn was performed. Patients were grouped as follows: correct diagnosis of MacTel, misdiagnosis, and incidental finding. Clinical and demographic data, including best-corrected visual acuity, symptoms, and prior treatments, were recorded. Misdiagnoses were categorized, and predictors were analyzed using mixed effect models.

Results: Of 288 patients, 174 (60.4%) were correctly diagnosed, 103 (35.8%) were misdiagnosed, and 11 (3.8%) diagnosed incidentally. Misdiagnoses included macular hole (17.3%), maculopathy (12.5%), and AMD (12.5%). Mean age at symptom onset was 54.7 (±9.8) years; mean time to correct diagnosis was 38.5 ± 50.3 months, decreasing from 115 months (2000-2005) to 5.9 months (after 2020). Younger age at symptom onset reduced the probability of misdiagnosis (odds ratio 0.96, 95% CI: 0.94-0.98), subjective glare sensitivity increased misdiagnosis probability (odds ratio 2.01, 95% CI: 1.14-3.55).

Conclusion: Misdiagnoses of MacTel are common and may delay care. Improved awareness and imaging have shortened these delays. Early multimodal imaging and clinician education remain key to timely diagnosis and better management.

Purpose: To evaluate the long-term incidence of hypercoagulable complications in young patients with retinal vein occlusions and negative workups compared with matched controls.

Methods: A retrospective cohort study was conducted using the TriNetX Analytics Network. Patients aged 18 to 50 with newly diagnosed retinal vein occlusion and no history of hypertension, glaucoma, thrombophilia, or recent oral contraceptive use were compared with age-matched controls. Propensity score matching was performed to balance baseline demographics and comorbidities. Primary outcomes included the cumulative incidence and risk ratio (RR) of deep vein thrombosis, pulmonary embolism, cerebral infarction, anticoagulant use, composite embolic events, myocardial infarctions and composite cardiovascular events over 1, 3, and 5 years. A secondary validation cohort was performed using controls diagnosed with astigmatism.

Results: After propensity score matching, 2,731 patients were included in each cohort. Patients with retinal vein occlusion had significantly higher rates of venous thromboembolism, cerebral infarction, anticoagulation use, and composite embolic outcomes at 1, 3, and 5 years (all P < 0.0001). No significant differences were observed in myocardial infarctions or composite cardiovascular event outcomes.

Conclusion: Young patients with retinal vein occlusion and no identifiable vascular or hypercoagulable risk factors are at significantly increased risk for venous thrombosis and stroke, but not myocardial infarction.

Purpose: To examine multimodal imaging findings in eyes before and after the onset of exudative macular neovascularization (ExMNV) bypassing the stage of pigmentation in Macular Telangiectasia Type-2.

Methods: From a total of 798 patients, Macular Telangiectasia Type-2 eyes with ExMNV that exhibited no signs of focal hyperpigmentation on color fundus photograph, fundus autofluorescence, and spectral-domain optical coherence tomography were retrospectively evaluated.

Results: There were 16 eyes of 16 patients (2%) with a mean age of 50.60 ± 9.82 years. Among them, 11 eyes had ExMNV at the time of examination, whereas the remaining five eyes developed ExMNV during the follow-up period, all lacking pigment when it occurred. The average time for ExMNV development in the five eyes was 27.6 months (range: 11-46 months). Preceding signs of ExMNV included right-angled vessels and telangiectatic leaks causing the following optical coherence tomography changes-temporal parafoveal thickening in three eyes, minimal intraretinal fluid pockets in three eyes, convex hyporeflective subretinal space in two eyes, and subretinal fluid in two eyes. With further declension/descent of inner into outer retina, progression of ellipsoid zone loss was seen and outer retinal hyperreflectivity formed in areas with preexisting ellipsoid zone loss with visual acuity decline. Multiple retinal vessels formed an anastomosis with each other and extended into the center of the subretinal neovascular lesion.

Conclusion: Patients with early Macular Telangiectasia Type-2 can proceed directly to ExMNV without pigmentation. Recognizing the signs before ExMNV develop will allow for closer follow-up and earlier treatment of these patients to prevent irreversible visual loss.

Purpose: To investigate the incidence of ocular hypertension (OHT) after suprachoroidal injection of triamcinolone acetonide (SCS-TA) for noninfectious uveitic macular edema.

Methods: Retrospective review of eyes undergoing SCS-TA. The primary outcome was incidence of OHT (intraocular pressure [IOP] > 24 mmHg). Secondary outcomes included incidence of IOP > 30 mmHg, IOP rise ≥10 mmHg above baseline, and treatment for OHT.

Results: Seventy-six eyes of 70 patients were treated with a mean of 1.71 (range 1-5) SCS-TA injections with an average follow-up of 7.6 (range 3.0-14.9) months. Nine eyes (11.8%) developed OHT, four eyes (5.3%) had IOP > 30 mmHg, and nine eyes (11.8%) had an IOP elevation of ≥ 10 mmHg above baseline at any point after their first injection. Eyes that developed OHT were treated with topical therapy (7 eyes, mean 1.9 agents, range 1-4 agents) or close observation (2 eyes). No eyes required incisional glaucoma surgery. Eyes with a history of glaucoma or OHT (7/34, 20.1%) were more likely to develop OHT versus eyes with no history (2/42, 4.8%, P = 0.03).

Conclusion: In this real-world cohort, SCS-TA was associated with a low-incidence of OHT, consistent with clinical trial data. A history of glaucoma or OHT is a significant association for developing OHT after SCS-TA.

Purpose: To compare the clinical features, multimodal imaging characteristics, and treatment outcomes of primary and secondary large retinal capillary aneurysms (LRCAs).

Methods: A total of 34 eyes were included: seven with primary LRCA and 27 with secondary LRCA. All patients underwent fundus photography, optical coherence tomography (OCT), and fundus fluorescein angiography. Indocyanine green angiography and OCT-angiography were performed in selected cases. Various clinical, morphologic, and vascular features and treatment outcomes were evaluated and compared between the primary and secondary LRCA groups.

Results: All lesions in the primary LRCA group were unilateral, and five of seven were unifocal. However, in the secondary LRCA group, 19% of patients had bilateral involvement and lesions were multifocal in 48% of eyes. OCT characteristics, including the horizontal and vertical diameters of aneurysmal lesions and mean subfoveal choroidal thickness, were similar for the groups ( P > 0.05). During follow-up, neither visual acuity nor central macular thickness changed significantly in the primary LRCA group and no cases responded to treatment, whereas these improved significantly in the secondary LRCA group.

Conclusion: Clinical and imaging characteristics of primary and secondary LRCA lesions were similar, although treatment outcomes were more favorable in secondary LRCA lesions because of the differing pathophysiology and etiology.