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

Purpose: to describe a new surgical technique that combines 4-point, flanged polypropylene scleral fixation with a hydrophobic IOL.

Methods: Using the Envista MX60 and 6.0 polypropylene, scleral 4-point fixation was achieved using a flanged-suture technique 5 times in a model eye and in a case series of 8 patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy (SEM) at fracture sites were studied.

Results: Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the LOTO and the simple-pass technique (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3 to 19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity (BAPUCVA) of 20/25-20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9 degrees (range: 0 to 9.6; median: 2.9 degrees). Two patients developed post-operative CME treated topically. The first case developed flange extrusion that was readily repaired in clinic.

Conclusions: This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.

Purpose: To analyze the accuracy and thoroughness of 3 large language models (LLMs) to produce information for providers about immune checkpoint inhibitor (ICI) ocular toxicities.

Methods: Eight questions were created about the general definition of checkpoint inhibitors, their mechanism of action, ocular toxicities, and toxicity management. All were inputted into ChatGPT 4.0, Bard, and LLaMA programs. Utilizing the 6-point Likert scale for accuracy and completeness, four ophthalmologists who routinely treat ocular toxicities of immunotherapy agents rated the LLMs answers. ANOVA testing was used to assess significant differences among the three LLMs and a post-hoc pairwise t-test. Fleiss kappa values were calculated to account for interrater variability.

Results: ChatGPT responses were rated with an average of 4.59 for accuracy and 4.09 for completeness; Bard answers were rated 4.59 and 4.19; LLaMA results were rated 4.38 and 4.03. The three LLMs did not significantly differ in accuracy (p=0.47) nor completeness (p=0.86). Fleiss kappa values were found to be poor for both accuracy (-0.03) and completeness (0.01).

Conclusions: All three LLMs provided highly accurate and complete responses to questions centered on ICI inhibitor ocular toxicities and management. Further studies are needed to assess specific ICI agents and the accuracy and completeness of updated versions of LLMs.

Purpose: This study aims to evaluate the non-pharmacological safety profile of intravitreal dexamethasone (DEX) implants in cases with different etiologies.

Methods: This retrospective university-based study analyzed clinical reports of patients receiving 0.7 mg DEX implant injections between 2013 and 2023. The study recorded patient demographics, injection indications, and follow-up data. Complications caused by the injection procedure and adverse events other than pharmacological side effects within a 3-month period were included.

Results: In this study, 3430 DEX implant injections were made into 1471 eyes of 1091 patients. Non-pharmacological complications developed in 611 injections (17.8%). Subconjunctival hemorrhage was noted as the leading non-pharmacological complication (n=576, 16.8%). Sight-threatening 35 non-pharmacological adverse events and complications (1.0%) were recorded. Cases of anterior chamber migration, vitreous hemorrhage, retinal detachment, endophthalmitis, hypotony, and implant misplacement were observed. Cases requiring intensive treatments and additional surgical interventions were encountered.

Conclusion: The injection of the DEX implant may lead to non-pharmacological complications caused by the mechanical impact of the injection or improper positioning of the implant, potentially resulting in vision loss. Severe outcomes such as corneal decompensation, retinal detachment, and endophthalmitis can ensue, emphasizing the gravity of these complications. Careful selection of patients and adherence to proper injection techniques are essential in reducing these risks.

Purpose: To study the factors which define the density of MLC of the inner retinal surface in healthy eyes.

Methods: Healthy individuals, including candidates for LASIK surgery, and post-LASIK patients were included. MLC density was calculated using structural en face projections of OCT angiography scans. The status of the vitreoretinal interface was assessed as the distance from the inner limiting membrane to the posterior hyaloid membrane on cross-sectional scans and as the area of tight posterior vitreous adhesion on en face projections. The correlation between MLC density and various demographic and anatomical parameters, including the status of the vitreoretinal interface was calculated.

Results: Fifty-four healthy individuals, 30 post-LASIK patients all without posterior vitreous detachment (PVD) as well as 20 patients with partial PVD were included. MLC density showed a statistically significant correlation with axial length, refractive error, age, subfoveal choroidal thickness, and the status of the vitreoretinal interface (p<0.05) in eyes without PVD. In multiple regression analysis the axial length was the main parameter independently correlated with MLC density (p=0.025). The status of the vitreoretinal interface had a statistically significant correlation with the axial length (p<0.001). Partial PVD was associated with almost complete loss of MLC (p<0.001).

Conclusion: The status of the vitreoretinal interface is a characteristic directly defining the density of retinal MLC in healthy eyes. However, axial length appears to be a key anatomical parameter which correlates with MLC density due to its effects on the adhesion of the posterior hyaloid membrane to the retinal surface.

Purpose: To assess the impact of inserting an ophthalmic viscoelastic device (OVD) into the dexamethasone (DEX) implant needle on pellet velocity in simulated vitrectomized eyes.

Methods: DEX implants were injected into a calibrated ex vivo test chamber filled with balanced salt solution (BSS). All DEX implants were administered by the same physician and aiming for the same button depression time. In Group 1, three DEX implant injections were performed without an OVD, while in Group 2, the OVD was safely inserted into the DEX implant needle using a 27-gauge cannula just prior to injection. The slow-motion video mode of the IPhone 14 was utilized to record the procedures and calculate time and distance measurements.

Results: Group 1 exhibited a mean velocity of 450 mm/sec for the DEX pellet in BSS, compared to 54.57 mm/sec in Group 2. Furthermore, DEX pellets in Group 1 had horizontal displacements of 24, 29, and 31 mm, while those in Group 2 had displacements of 17, 16, and 15 mm.

Conclusions: Injecting OVD into the DEX implant needle significantly decreases the velocity of the free pellet in BSS by 87.87%. This modification may help prevent potential velocity-related complications linked to DEX implantation in vitrectomized eyes.

Purpose: To evaluate the effect of diabetic retinopathy (DR) lesion type [hemorrhages and/or microaneurysms (H/Ma), intraretinal microvascular abnormalities (IRMA), new vessels elsewhere (NVE), venous beading], severity and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study (ETDRS)-Diabetic Retinopathy Severity Scale (DRSS).

Methods: Post-hoc analysis of a multi-center observational study of 544 eyes with nonproliferative DR and an ETDRS-DRSS score of Level 35-53. Disease worsening was defined as ETDRS-DRSS worsening by ≥2 steps from baseline or receipt of DR treatment over 4 years. DR lesions were evaluated based on the entire visible area in the ultrawide field color (UWF-color) and UWF-fluorescein angiography (UWF-FA) images.

Results: A significantly greater risk of disease worsening was associated with the presence of more severe lesion grades outside the ETDRS fields for H/Ma (HR:1.74 [95% CI:1.28-2.36]) on UWF-color; and for H/Ma (1.90 [1.38-2.61]), IRMA (1.68 [1.13-2.49]), and NVE (1.99 [1.36-2.93]) on UWF-FA.

Conclusion: These results suggest that features on UWF-color and UWF-FA may provide additional prognostic value in determining the risk of disease worsening. The use of UWF-FA improves identification of DR lesions and disease progression. However, the optimal method of disease risk assessment on UWF imaging still needs to be determined.

Purpose: To evaluate retinal circulation in eyes with central retinal artery occlusion (CRAO).

Methods: The best-corrected visual acuity (BCVA), fluorescein angiography (FA), and laser speckle flowgraphy (LSFG) values were measured at the first visit in 42 patients with CRAO (42 eyes; mean age, 66.0±14.0 years. LSFG was performed at baseline, 1 week, and 1, 3, and 6 months; the difference between the mean blur rate vessel area and mean blur rate tissue area (MV-MT), reflecting the retinal vessel blood flow, was measured. FA measured the arteriovenous passage (AV) time. Time-course changes in the MV-MT and BCVA and the relationship between MV-MT and final BCVA were examined.

Results: MV-MT was significantly correlated with AV time (P<0.001). The MV-MT increased significantly after 1, 3, and 6 months (P<0.001). The VA improved significantly until 1 month (P<0.01). Multivariate analysis showed a significant correlation between the baseline BCVA (P<0.001) and MV-MT at 1 month (P=0.01) and the final BCVA. Age and MV-MT were significantly negatively correlated at 1 month (P<0.001).

Conclusions: The retinal circulation improved significantly within 1 month; younger patients had better retinal circulation improvement. The baseline BCVA and retinal circulation within 1 month were correlated with the final BCVA.