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

Purpose: Venous overload choroidopathy (VOC), showing pachyvessels, choroidal intervortex venous anastomoses (CVA), asymmetric venous drainage (AVD), choroidal vascular hyperpermeability (CVH) and increased choroidal thickness (CT), is observed in the vast majority of central serous chorioretinopathy (CSC) patients based on ultra-widefield indocyanine green angiography (UWF ICGA). This report investigates how photodynamic therapy (PDT) alters signs of VOC.

Methods: The CERTAIN study is a monocentric, retrospective study on consecutive CSC patients who underwent UWF ICGA. For this report, patients who underwent UWF ICGA twice were included. Two independent graders assessed changes in pachyvessels, CVA, AVD, CT and CVH when comparing pre- and post-PDT images of treated and untreated eyes.

Results: In total, 38 eyes (19 patients) were included. Of those, 19 eyes had undergone PDT and 19 had not. PDT had no significant effect on pachyvessels, CVA, and AVD (all p > 0.05). Only CT (-51 ± 48 µm vs. 1 ± 43 µm, p = 0.006) and CVH within the PDT treatment area (79% vs. 0% reduced CVH, p < 0.0001) were significantly decreased in treated vs. untreated eyes.

Conclusion: PDT reduced CT and CVH within the treatment area while not significantly altering the overall choroidal vascular architecture associated with VOC.

Purpose: To report the impact of prophylactic 360° laser retinopexy and scleral buckle placement for retinal detachment (RD) prophylaxis in patients affected by Pierson syndrome (PS).

Method: This retrospective case series included 11 PS patients (2015-2024), analyzing demographic data, ophthalmological exams, and genetic testing. Prophylactic interventions were compared with post-RD surgical interventions based on RD occurrence and timing. A one-sample proportion test evaluated outcome differences.

Results: This study of 11 PS patients evaluated the effectiveness of prophylactic 360° laser retinopexy and scleral buckle (SB) placement. Ten patients carried the LAMB2 c.440A>G mutation and had associated findings of thyroid and renal disease. All retinal detachments (RDs) were combined tractional retinal detachment (TRD) and rhegmatogenous retinal detachment (RRD) due to posterior tears. Eight eyes with TRD-RRD were actively treated with laser retinopexy and SB; six (75%) experienced re-detachments. In contrast, seven eyes with TRD-RRD were treated prophylactically, with 86.6% of eyes treated with laser retinopexy and 100% of those receiving additional SB placement maintaining retinal integrity over an average follow-up of 3.4 years. Prophylactically treated eyes had significantly fewer RD recurrences compared to those treated surgically after RD onset (p < 0.01), highlighting the benefits of early combined intervention in PS.

Conclusion: This study's results suggest a potential role for prophylactic laser retinopexy and subsequent scleral buckle placement to prevent RD among patients with a confirmed diagnosis of Pierson syndrome.

Purpose: To evaluate the efficacy of heavy silicone oils (HSO) as endotamponades in the repair of primary complex rhegmatogenous retinal detachment (RRD).

Methods: This retrospective, single-centre, non-randomised study included 82 eyes of 82 patients with primary macular-off RRD associated with inferior proliferative vitreoretinopathy. Each eye was treated with one of two HSO tamponades: Oxane® HD or Densiron® 68. Study outcomes were primary and final success rates, final logMAR gain and postoperative complications. The final outcome was based on 12-month follow-up.

Results: Of the 82 eyes, 45 were treated with Oxane HD and 37 with Densiron 68. There were no significant differences in demographic and clinical characteristics between the groups. The primary and final surgical success rates were 66.6% and 75.7% for Oxane HD and 75.6% and 81% for Densiron 68, respectively; these differences were not statistically significant. In addition, the final logMAR gain was 0.36 ± 0.51 (median 0.2) in the Oxane HD group and 0.57 ± 0.58 (median 0.5) in the Densiron 68 group (p = 0.027). Complication rates were similar between groups (p > 0.05).

Conclusions: Our study suggests that HSOs may be an effective alternative for suitable patients in primary complex RRD cases, demonstrating high anatomical success and a low adverse event profile.

Purpose: To determine the pathoanatomical alteration of ectopic inner foveal layers (EIFL) and its relationship to visual recovery after epiretinal membrane (ERM) peeling surgery.

Methods: Clinical charts and tracked spectral-domain optical coherence tomography images of patients diagnosed with stage 3 and 4 ERM were reviewed and analyzed preoperatively and at 3 and 6 months postoperatively. Central macular thickness (CMT) and EIFL thickness were measured at these time points. Wilcoxon signed-rank test was used for analysis and P < 0.05 was considered statistically significant.

Results: The study cohort consisted of 54 eyes of 54 patients, 27 of whom were female. The mean age was 69.2 years. The mean Snellen VA improved from 20/50 preoperatively to 20/35 at 3 months (P<0.001) and remained 20/35 at 6 months, significantly better than preoperative levels (P=0.002). The mean preoperative EIFL thickness was 169.15 µm and decreased to 95.70 µm at 3 months (P = 0.001) and 90.95 µm at 6 months (P = 0.02). Similarly, CMT reduced from 510.00 µm preoperatively to 444.56 µm at 3 months (P < 0.001) and 415.50 µm at 6 months (P < 0.001). Reduction in EIFL thickness was significantly correlated with improvement in log-MAR VA (P =0.02) 6 months after surgery.

Conclusion: ERM peeling results in reduced EIFL thickness, restoration of the normal foveal pit structure, and a corresponding improvement in visual acuity. Reduction in EIFL thickness is correlated with visual improvement.

Purpose: To investigate the incidence and outcomes of rhegmatogenous retinal detachment (RRD) occurring after pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) for submacular hemorrhage (SMH).

Methods: Charts were reviewed between April 1, 2014 and September 1, 2023 for eyes that underwent PPV/subretinal tPA for SMH.

Results: Out of 167 eyes, 15 (9%) eyes developed RRD with macular detachment in 12 (80%) and proliferative vitreoretinopathy (PVR) in 9 eyes (60%). The median (interquartile range, IQR) time from PPV/subretinal tPA until RRD diagnosis was 41 (22-81) days. Single-surgery anatomic success was achieved in 11 eyes (85%) at three months and 9 eyes (70%) at the final visit. Four eyes (27%) developed redetachment and three underwent a median of two additional repairs. The final anatomic success rate for reattachment was 92% (12/13). The median (IQR) logMAR [Snellen] visual acuity at the preoperative visit following SMH was 2 (2-2.3) [20/2000], which worsened to 2.3 (2.2-2.7) [20/4000] at the time of RRD diagnosis (P=0.01) and plateaued by the final visit to 2.3 (2-2.7) [20/4000] (P=0.15).

Conclusion: Postoperative RRD occurred in nearly 1 in 10 eyes after PPV/subretinal tPA for SMH and was associated with a relatively high rate of PVR.

Purpose: To evaluate preoperative and early postoperative factors associated with changes in visual acuity in macula-off rhegmatogenous retinal detachment (RRD) patients.

Methods: A retrospective review of 59 eyes from 59 patients who underwent pars plana vitrectomy (PPV) and silicone oil (SiO) tamponade for macula-off RRD. Preoperative and early postoperative characteristics were analyzed using the classification and regression tree (CART) analysis.

Results: The baseline preoperative BCVA improved from 1.67 ± 0.97 logMAR to 0.21 ± 0.22 logMAR at final visit. Central foveal thickness (CFT) and BCVA showed significant increases from 1 week post-surgery onward. Mean CFT significantly increased from 136.97 ± 40.17 μm to 192.54 ± 34.09 μm (p < 0.001). The percentage of eyes with integrated external limiting membrane (ELM) and ellipsoid zone (EZ) was progressively increased from 45.76% and 10.17% to 98.31% and 71.19%, respectively (p < 0.001). BCVA at 1week after surgery, ELM integrity, preoperative intraretinal cysts, and macula-off duration were significantly associated with final visual recovery after surgery.

Conclusion: The first week postoperative BCVA is the most powerful predictor for final BCVA. ELM integrity, intraretinal cysts, and macula-off duration are also significantly associated with final visual recovery.

Purpose: To describe the patterns of ocular inflammation following COVID-19 vaccination, assess underlying commonalities and understand outcomes.

Methods: Retrospective, multicenter cohort study, conducted between 2020 and 2021. Patients with no previous uveitis history (de novo) or a known uveitis history (recurrent) who developed ocular inflammation within 42 days of COVID-19 vaccination were identified. Characteristics of the uveitis, treatment approaches and clinical outcomes were assessed.

Results: Fifty-five eyes of 39 patients with ocular inflammation temporally related to vaccination were identified. Twenty-two patients (36 eyes) were de novo, while 17 (19 eyes) were recurrent. Anterior uveitis was most common. HLA-B27 positivity was found in 6 (27.2%) de novo patients, and 5 (29.4%) recurrent patients. Most patients required only observation, topical or systemic corticosteroids. Amongst vaccinated patients, 12.3% of new uveitis referrals during the study period were related to COVID-19 vaccination. Among patients with a history of quiescent uveitis, only 0.85% experienced a flare following vaccination.

Conclusion: The majority of inflammation thought to be secondary to COVID-19 vaccination achieved quiescence with observation or steroids, and the overall incidence is low. Anterior uveitis was the most common. HLA-B27 positivity occurred at a higher rate than reported in the baseline population.

Purpose: Predicting long-term anatomical responses in neovascular age-related macular degeneration (nAMD) patients is critical for patient-specific management. This study validates a generative deep learning (DL) model to predict 12-month posttreatment optical coherence tomography (OCT) images and evaluates the impact of incorporating clinical data on predictive performance.

Methods: A total of 533 eyes from 513 treatment-naïve nAMD patients were analyzed. A conditional generative adversarial network (cGAN) served as the baseline model, generating 12-month OCT images using pretreatment OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA). We then sequentially added OCT after three loading doses, baseline visual acuity (VA), treatment regimen (pro re nata or treat-and-extend), drug type, and switching events. The generated and patient OCT images were compared for intraretinal fluid, subretinal fluid, pigment epithelial detachment, and subretinal hyperreflective material, both qualitatively and quantitatively.

Results: The baseline model achieved acceptable accuracy for four macular fluid compartments (range 0.74-0.96). Incorporating OCT after loading doses and other clinical parameters improved accuracy (range 0.91-0.98). With all the clinical inputs, the model achieved 92% accuracy in distinguishing wet macular status from dry macular status. The segmented fluid compartments in the generated images correlated positively with those in the patient images.

Conclusion: Integrating clinical and treatment data, particularly OCT data after loading doses, significantly enhanced the 12-month predictive performance of cGANs. This approach can help clinicians anticipate anatomical outcomes and guide personalized, long-term nAMD treatment strategies.

Purpose: To assess if drusen volume can serve as structural clinical outcome marker in Malattia Leventinese (ML), and to evaluate whether cones or rods are more affected by its progression, using multimodal imaging and mesopic and two-color scotopic microperimetry.

Methods: This was a prospective monocentric cross-sectional cohort study of participants with genetically confirmed ML. Participants were classified according to morphology. Mean drusen volume, calculated from SD-OCT, was compared to microperimetry parameters (mesopic retinal sensitivity, scotopic red and cyan function, difference between scotopic cyan-red function).

Results: Fourteen participants (28 eyes) were enrolled. Mean drusen volume increased (bilaterally P=0.028) and mesopic retinal sensitivity decreased with later stage (OD: P=0.028; OS: P=0.050). Scotopic microperimetry showed that scotopic cyan function was lower than scotopic red function in moderate stage. Scotopic red function decreased in severe stage. Mean drusen volume correlated to mesopic retinal sensitivity (OD: P<0.001; OS: P=0.007).

Conclusion: Retinal sensitivity diminishes with ML progression. Rod function declines prior to cone function, while at late stages, cone loss predominates. Drusen accumulation, initially speckled around the macula and optic disc and confluent with disease progression, correlates well with visual function loss and impaired quality of life. Thus, therapeutically reducing drusen accumulation could be efficacious.

Purpose: The light adjustable lens (LAL) (RxSight, Aliso Viejo, CA) is a premium intraocular lens that allows for correction of residual refractive error and astigmatism following implantation. Herein, we describe the surgical approach and evaluate the visual outcomes of patients following scleral fixation of the LAL.

Methods: Retrospective, single-surgeon surgical case series of 3 patients (3 eyes) with intraocular lens complications, who underwent combined pars plana vitrectomy and sutureless needle assisted intrascleral haptic fixation of the LAL between April 2022, to August 2023.

Results: A total of 3 patients (73.3 ± 4.4 years) underwent off-label application of sutureless intrascleral haptic fixation of the LAL. Indications for surgery included pseudophacodonesis (N=1), dislocated subluxed IOL with secondary vitreous hemorrhage (N=1), and multifocal IOL intolerance (N=1). Preoperative average visual acuity of 0.2 ± 0.1 (20/30) LogMAR improved to 0.03 ± 0.03 LogMAR (20/20) at 1 month follow-up after LAL ultraviolet light treatments. Preoperative sphere of +0.25 ± 0.9 improved to +0.0 ± 0.0 and preoperative cylinder of +0.4 ± 0.4 improved to +0.0 ± 0.0 postoperatively. No surgical complications were noted.

Conclusion: Scleral fixation of the LAL is a viable option for eyes without capsular support to maximize postoperative uncorrected visual acuity outcomes.