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

Purpose: To investigate the relationship between the spatial arrangement of pachyvessels and polypoidal choroidal vasculopathy (PCV) lesions in relation to recurrence.

Methods: This retrospective study included 58 eyes of 58 patients with treatment-naïve PCV who were followed for at least 1 year after receiving anti-vascular endothelial growth factor injections, with or without photodynamic therapy. Using en face optical coherence tomography, the eyes were categorized into two groups based on the presence or absence of transmacular pachyvessels passing beneath PCV lesions (polypoidal lesions or branching neovascular networks). The primary outcome was the recurrence rate of PCV within 1 year.

Results: Of the 58 eyes, 35 (60.3%) had pachyvessels located beneath PCV lesions. The 1-year recurrence rate was significantly higher in eyes with than without pachyvessels (71.4% vs. 39.1%, P = 0.017). Univariable logistic regression analysis identified the presence of pachyvessels beneath lesions as a significant predictor (odds ratio, 3.89; 95% confidence interval, 1.28-11.84; P = 0.017). This remained the only significant predictor of recurrence within 1 year on multivariable logistic regression (odds ratio, 3.84; 95% confidence interval, 1.22-12.09; P = 0.022).

Conclusion: The presence of transmacular pachyvessels may serve as a novel biomarker to predict prognosis and guide individualized treatment strategies for patients with PCV. These findings suggest that the anatomical relationship between pachyvessels and PCV lesions could be a critical factor in treatment response.

Purpose: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in neovascular age-related macular degeneration (nAMD) using automated volumetric retinal fluid analysis.

Methods: This retrospective study included 186 eyes with nAMD showing inadequate response after ≥3 bevacizumab injections. Patients were switched to a second-line anti-VEGF agent and categorized as early (3-5 injections) or late (≥6 injections) switchers. Optical coherence tomography (OCT) scans were analyzed using the Notal-OCT Analyzer (NOA™), an AI-based algorithm for retinal fluid quantification. Parameters included total retinal fluid (TRF), intraretinal fluid (IRF) volume, subretinal fluid (SRF) volume, pigment epithelial detachment (PED) volume, central subfield thickness (CST), and visual acuity (VA), assessed at baseline, post-bevacizumab, and following three injections of the new agent.

Results: Early switchers showed an increase in TRF from 105nL to 158nL after bevacizumab, then a reduction to 20nL post-switch (p<0.001); PED volume decreased post-switch (p=0.010). Late switchers showed fluid reductions both after bevacizumab and post-switch (TRF: p<0.001; PED: p=0.007). CST significantly improved only in early switchers (p=0.004), while VA changes were not statistically significant.

Conclusions: Automated fluid analysis reliably quantifies treatment response in nAMD. Early switchers showed worsening after bevacizumab, while late switchers had partial responses. These findings highlight the potential of automated analysis to support more individualized, data-driven treatment strategies. Prospective studies are required to confirm impact on patient outcomes.

Purpose: To evaluate the retinal, peripapillary, and choroidal microvascular structures in patients with essential thrombocythemia (ET), a myeloproliferative neoplasm characterized by sustained thrombocytosis and an increased risk of thrombotic events, using optical coherence tomography angiography (OCTA).

Methods: This prospective, cross-sectional study included 20 ET patients and 20 age- and sex-matched healthy controls. All participants underwent spectral-domain OCTA to assess vessel density (VD) in the superficial and deep retinal capillary plexuses(SCP and DCP), radial peripapillary capillary (RPC) network, and choriocapillaris (CC). Structural parameters, including central macular thickness (CMT), macular ganglion cell complex (mGCC), retinal nerve fiber layer (RNFL), and foveal avascular zone (FAZ), were also evaluated. Statistical analyses included independent samples t-tests or Mann-Whitney U tests based on data distribution.

Results: ET patients exhibited significantly increased CMT compared to controls (p = 0.019), while RNFL and mGCC thicknesses showed no significant differences. Peripapillary whole image VD and RPC VD in the nasal-inferior quadrant were significantly reduced in the ET group (p = 0.042 and p = 0.039, respectively). Most notably, DCP VD was significantly decreased in both parafoveal (p = 0.004) and perifoveal (p = 0.010) regions across all quadrants. No significant differences were observed in SCP VD, FAZ metrics, or CC flow parameters (p > 0.05 for all).

Conclusion: ET patients demonstrate subclinical retinal microvascular alterations predominantly affecting the DCP and peripapillary circulation, while superficial retinal and choroidal vasculature remains relatively preserved. OCTA may serve as a sensitive, non-invasive tool for detecting early retinal involvement in ET.

Purpose: To describe the multimodal imaging characteristics and clinical associations of choroidal synphlebia, a newly recognized configuration of the choroidal venous system.

Methods: This retrospective study analyzed patients imaged with the DREAM swept-source OCT system (Intalight, San Jose, CA), capable of deep choroidal penetration. Choroidal synphlebia was defined as a confluent vascular structure ≥750 µm in smallest lateral or vertical dimension. The multimodal imaging characteristics were evaluated.

Results: Nineteen eyes of sixteen patients (mean age 63.2 years; eight male) were identified. Associated diagnoses included central serous chorioretinopathy (CSC) in 16 eyes, neovascular age-related macular degeneration in 2, and myopia in 1. Three patients had bilateral involvement. Two morphologic patterns were observed: (1) broad confluence of large choroidal veins forming a lobulated venous lake, and (2) a caput medusa-type arrangement with smaller tributaries converging radially into a dilated central channel. The lesions often occurred near presumed choroidal watershed zones. Macular neovascularization was present in 7 eyes. In several CSC cases, subretinal fluid was resistant to photodynamic therapy but responsive to faricimab.

Conclusions: Choroidal synphlebia represents a distinct choroidal venous phenotype characterized by fusion or coalescence of major veins with a lack of visible vessels in the overlying Sattler's layer and inner choroid. Alterations in the capacitance, resistance, and pressure distribution in the venous drainage system appear to be affected by synphlebia lesions. Recognition of synphlebia may provide insight into choroidal hemodynamics and may help explain atypical or treatment-resistant CSC and neovascular presentations.

Purpose: To evaluate large-sized human amniotic membrane (hAM) patch-assisted vitrectomy for managing postoperative proliferative vitreoretinopathy (PVR) in complex rhegmatogenous retinal detachment (RRD).

Methods: A retrospective analysis of 12 eyes (12 patients) with complex RRD and severe PVR undergoing large-sized hAM patch-assisted vitrectomy. Indications included open globe injury-associated RRD (n = 8) and RRD with PVR grade D (n = 4). Surgical procedures, clinical outcomes, and complications were documented.

Results: Patients were followed for 9.75 ± 1.60 months. Each eye received 2.75 ± 1.22 hAM patches (mean area: 3.37 ± 1.51 cm2). Two eyes (Cases 1 and 2) with small and regular retinal defects achieved full hAM coverage and retinal reattachment without significant PVR. 10 eyes with extensive defects could not achieve complete coverage of the exposed retinal pigment epithelium (RPE). In five eyes (Cases 3-7), the hAM patches covered the most exposed RPE and retinal edge, but PVR on hAM surface caused hAM-traction of retina, leading to recurrent detachment in three eyes. In the other five eyes (Cases 8-12), a hAM-retina gap was maintained and prevented retinal interference from hAM contraction. Visual acuity improved significantly from 2.40 ± 0.25 LogMAR (Snellen: 20/5023) to 1.43 ± 0.60 LogMAR (Snellen: 20/533) (p = 0.003).

Conclusion: hAM patch-assisted vitrectomy is a promising strategy for managing complex RRD with advanced PVR. When complete coverage of the exposed RPE is not feasible, maintaining a hAM-retina gap reduces postoperative traction and improves anatomical/functional outcomes.

Purpose: To characterize persistent diffuse photoreceptor disorganization (PDPD), a newly recognized retinal disorder, and establish diagnostic criteria differentiating it from similar outer retinopathies.

Methods: This retrospective observational case series included 14 patients (21 eyes) with subacute vision loss, unremarkable fundus, and persistent diffuse photoreceptor disorganization on OCT, from 2020 to 2025. Medical records, multimodal imaging (OCT, fundus autofluorescence [FAF], fluorescein angiography [FA], indocyanine green angiography [ICGA]), and visual function (electroretinography [ERG], visual field) findings were analyzed.

Results: Patients (mean age 30.7 years) presented with subacute vision loss [mean BCVA 0.9 LogMAR (20/160), range, 2.0-0.2 (FC-20/32)]. Seven patients (50%) had bilateral involvement. Infectious uveitis and known retinal dystrophy mutations (via whole-exome sequencing) were excluded. Fundus, FAF, and ICGA were largely unremarkable. OCT revealed blurred/rough ellipsoid zone and absent interdigitation zone in the posterior pole of all eyes (including fovea in 100% of cases, periphery in 92.9%). The RPE layer was preserved. Outer retina thickness was significantly thinner in involved eyes compared to fellow eyes (118.3 vs. 147.6 µm, p=0.031). FA showed peripheral venous leakage in 75% of eyes. Full-field ERG indicated reduced amplitudes (normal latency, scotopic/photopic), and visual fields showed significant defects. Eleven patients received immunosuppressive therapies. Over 17 months, OCT abnormalities persisted, outer retina thickness slowly decreased, and visual acuity remained stable with gradual deteriorations in some patients.

Conclusions: PDPD is characterized by subacute, diffuse, and persistent photoreceptor disorganization with largely unremarkable fundus, distinct from other outer retinopathies. Visual prognosis is generally poor, necessitating further research into pathogenesis and treatment.

Key words: photoreceptor disorganization; ellipsoid zone; interdigitation zone; OCT.

Purpose: To assess the clinical characteristics and surgical outcomes of retinal detachment (RD) associated with presumed trematode-induced granulomatous intermediate uveitis (PTIGIU).

Methods: A review of the medical records of patients diagnosed with RD secondary to PTIGIU over a 3-year period was conducted. Main outcome measures were the type and morphology of RD, final functional and anatomical outcomes.

Results: Out of 98 eyes with PTIGIU, 41 eyes (41.8%) were diagnosed with RD secondary to PTIGIU and were operated upon and completed 6 months follow up period. Mean age was 12.6 years and logMAR CDVA 1.76. All eyes had vitritis of variable grades. Thirty-five eyes (85.4%) had tractional retinal detachment (TRD) and four eyes (9.8%) had combined tractional-rhegmatogenous retinal detachment. According to the extent of retinal detachment, the eyes were grouped into Group 1: 28 eyes, with subtotal peripheral RD, and Group 2: 13 eyes, with total RD or subtotal RD reaching posterior pole. The former group showed better functional and anatomical outcomes (p=0.019 and 0.028 respectively). 80.5% of all eyes showed final anatomical success and visual improvement (median CDVA 0.40, p<0.001) at the final follow up.

Conclusion: Tractional retinal detachment is a common complication to PTIGIU, and early intervention is essential to avoid devastating ocular complications.

Purpose: To study the morphological characteristics of type1 macular neovascularization (MNV) in eyes with chronic central serous chorioretinopathy (CSCR) using optical coherence tomography (OCT) and OCT angiography (OCTA).

Methods: Patients with chronic CSCR and secondary type 1 MNV were included in the study. Macular OCT and OCTA images were acquired, and morphological characteristics along with quantifiable features were analyzed.

Results: Twenty eyes of 19 patients were included. All eyes exhibited neovascular flow signal on OCTA images. Nineteen (95%) of eyes showed flat-irregular pigment epithelium detachment (FIPED). Subretinal fluid was detected in 90% of patients with no intra-retinal fluid. Membranes were mostly located at the subfoveal area (65%). All membranes were identified in the location overlying choroidal pachyvessels. Mature membranes with a loose vascular configuration were identified in 75% of eyes. Morphological biomarkers of "indistinct" (65%), "tangled" (30%) and "sea-fan" (5%) patterns were recorded. Feeder vessels was identified in 75% of membranes. Average vascular density was measured as 46% (± 10%).

Conclusion: Neovascular membrane of chronic CSCR sprout under the retinal pigment epithelium within the macular area (type 1 MNV) inside a FIPED overlying pachyvessels. Morphologic characteristics assessed by OCTA of loose and indistinct pattern improve our understanding of vessel formation and maturation in chronic CSCR patients and might be valuable to guide therapy.

Purpose: Optical coherence tomography angiography (OCTA) is widely used to detect choroidal neovascularization (CNV) in retinal diseases, but acquiring high-density raster scans can prolong acquisition time and increase motion artifacts due to patient fatigue. This study evaluates whether the 250 kHz ultra-high-speed mode (3× faster than baseline) reduces scan time and motion artifacts while maintaining image quality compared to the FDA-approved 125 kHz mode.

Methods: Fifty-eight eyes underwent 10°×10° fovea-centered OCTA imaging using both modes. In 38 CNV eyes, AngioTool was used to analyze vascular metrics. In 20 non-CNV eyes, superficial foveal avascular zone (FAZ) area was measured using ImageJ. Two masked retina specialists graded paired images for image quality, motion artifacts, and clinical diagnosis. Acquisition time was recorded.

Results: The 250 kHz mode reduced acquisition time by 43% (17.5 ± 9.0 s vs. 33.6 ± 20.7 s, p < 0.00001). Image quality and motion artifacts favored the 250 kHz mode. Clinical diagnosis was rated similarly across modes. Quantitative metrics, including vessel area, junctions, lacunarity, and FAZ area, showed no significant differences (all p > 0.1).

Conclusions: This is the first intra-individual comparison of Heidelberg's 250 kHz and 125 kHz OCTA modes. The findings demonstrate that ultra-high-speed scanning can enhance efficiency and image quality without compromising diagnostic or quantitative utility, highlighting its potential clinical impact pending FDA approval.

Purpose: To evaluate subclinical retinal and peripapillary microvascular alterations in pediatric Henoch-Schönlein purpura (HSP) patients without ocular involvement using optical coherence tomography angiography (OCTA).

Methods: This prospective observational study included 95 right eyes of 95 children aged 5-15 years, comprising 40 HSP patients and 55 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic examination and OCTA imaging. Quantitative parameters included superficial (SCP) and deep capillary plexus (DCP) vessel densities (VD) in foveal, parafoveal, and perifoveal regions; foveal avascular zone (FAZ) area; radial peripapillary capillary vessel density (RPC-VD); and peripapillary retinal nerve fiber layer (pRNFL) thickness. Intergroup comparisons and correlation analyses between OCTA metrics and disease duration, clinical finding score, and disease activity score were performed in the HSP group.

Results: Baseline ocular parameters were comparable between the HSP and control groups, except for lower central corneal thickness (p=0.002). OCTA revealed significantly decreased foveal SCP-VD (p=0.003) and decreased DCP-VD in the nasal perifoveal region (p=0.004) in HSP patients. Correlation analysis revealed that FAZ area positively correlated with disease duration (r=0.48, p=0.001), whereas parafoveal SCP-VD negatively correlated with clinical finding score (r=-0.45, p=0.004). Additionally, nasal perifoveal DCP-VD showed significant negative correlations with both clinical finding score (r=-0.52, p<0.001) and disease duration (r=-0.44, p=0.005).

Conclusion: Pediatric HSP patients without clinical ocular involvement demonstrate measurable macular microvascular impairment and FAZ enlargement on OCTA. OCTA may serve as a sensitive, noninvasive tool for early detection of subclinical retinal vascular alterations, facilitating risk stratification and individualized ophthalmic monitoring.