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

Purpose: We evaluated the alterations of applying artificial intelligence (AI) diagnostic system for diabetic retinopathy (DR) screening in real-world practice.

Methods: This retrospective study included 11,713 diabetic patients from the government-led Diabetes Shared Care Network. The AI system Verisee was integrated into the clinical workflow to identify referable diabetic retinopathy (RDR). Its performance was compared with ophthalmologist grading at the patient level using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). Subgroup analysis was performed by age and gender, with additional referral diseases identified by ophthalmologists.

Results: Verisee achieved a sensitivity of 0.88, specificity of 0.86, accuracy of 0.86, PPV of 0.58, NPV of 0.97, and AUC of 0.87 in detecting RDR. Performance declined with increasing age, whereas sex distribution remained consistent across age groups. The AI system identified a higher proportion of RDR than ophthalmologists (27.45% vs. 18.15%). In addition to 1,818 patients with RDR, ophthalmologists identified other referral-warranted ocular conditions in 4.5% of cases. The AI system referred age-related macular degeneration (grades 2-4), whereas referral decisions for macular hole and macular edema (grades 1-2) varied; however, glaucoma (grades 0-1) identified by clinicians was not consistently referred.

Conclusion: Verisee demonstrated high accuracy in detecting RDR but exhibited reduced performance in older patients. It had a higher referral rate than ophthalmologists yet missed certain conditions such as glaucoma. Despite effectiveness in DR screening, further refinement is required to support broader ophthalmic disease detection.

Purpose: To determine if iris manipulation during phacovitrectomy for retinal detachment (RD) repair is associated with the development of proliferative vitreoretinopathy (PVR).

Methods: Single-center, comparative, retrospective cohort study of 536 eyes who underwent phacovitrectomy for cataract extraction and RD repair between 2013 and 2024. Eligible eyes had at least three months follow-up. Iris manipulation was defined as mechanical pupillary expansion or synechiolysis. Patients with a history of uveitis were excluded. The primary outcome was the development of PVR, and secondary outcomes included the development of other postoperative complications.

Results: Of the included eyes, 66 were in the iris manipulation group and 470 were in the control group. The average follow-up time was 18.9 ± 16.0 weeks. Among the 34 eyes without baseline PVR in the iris manipulation group, 5 eyes (14.7%) developed PVR. Among the 282 eyes without baseline PVR in the control group, 12 (4.3%) developed PVR. After adjusting for patients who had prior retinal surgery in an additional regression analysis, iris manipulation remained a significant predictor for PVR development (odds ratio (OR) 3.64; p = 0.038). There were no significant differences in the OR for the development of the other postoperative complications between the groups.

Conclusion: Iris manipulation during phacovitrectomy for RD repair and cataract extraction was significantly associated with development of PVR in the absence of active inflammation, despite a similar profile of other postoperative complications. These findings highlight the potential role of iris trauma in amplifying intraocular inflammation and contributing to PVR pathogenesis.

Purpose: To evaluate the prevalence of achromatopsia (ACHM) associated with variants of RPGRIP1 , especially c.2710+374_2895+78del ( RPGRIP1 -ex18-DEL), and to confirm that these phenotypes were consistent with ACHM in Japanese patients.

Methods: This retrospective observational study involved a review of medical records from 52 patients across 47 Japanese families; all clinically diagnosed with ACHM.

Results: Causative variants for ACHM were identified in 39 families via whole-exome sequencing, whole-genome sequencing, or polymerase chain reaction: PDE6C (13 families), RPGRIP1 -ex18-DEL (11 families), CNGA3 (11 families), CNGB3 (2 families), and GNAT2 (2 families). Patients with ACHM associated with RPGRIP1 -ex18-DEL variants did not exhibit significant difference in phenotype, including spherical equivalent refractive error, best-corrected visual acuity (BCVA), fundus appearance, ellipsoid zone grading of optical coherence tomography, and fundus autofluorescence pattern, compared to those with variants in CNGA3 or PDE6C at baseline (all, P > 0.05). For five ACHM patients with RPGRIP1 -ex18-DEL variants, no change in BCVA or ellipsoid zone grading was noted over a follow-up period of >10 years (all, P > 0.05).

Conclusions: Variants in RPGRIP1 -ex18-DEL are unique hotspots with a high prevalence among Japanese patients with ACHM. Clinical findings in these patients are consistent with those in patients with ACHM from other causative genes.

Purpose: To evaluate the incidence, mechanisms, and clinical implications of silicone oil (SO) droplet transmission during intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVIs) and to review strategies to mitigate contamination risks.

Methods: A systematic review of observational and review studies from PubMed and MEDLINE was conducted, focusing on incidence, contributing factors, and clinical outcomes of SO contamination during IVIs. Specific attention was given to syringe design, storage conditions, variations among anti-VEGF agents, and injection techniques.

Results: The review found that prevalence is high in chronically injected eyes, though per-injection rates are low, often clustering due to syringe batches or techniques. Contributing factors include freeze-thaw cycles, mechanical agitation, spray-siliconized low-dead-space syringes, and improper plunger handling, which can lead to asymptomatic droplets or symptomatic floaters. No severe complications like endophthalmitis were reported. Hypotheses link SO to ocular hypertension or inflammation via trabecular obstruction or immunogenic responses, but the reviewed studies show no direct evidence. Mitigation involves the use of silicone-free/prefilled syringes, strict storage, gentle handling, and refined techniques such as priming and smooth plunger depression.

Conclusion: SO contamination during IVIs can be minimized through careful optimization of syringe design, handling practices, and injection techniques. Embracing silicone-free or low-silicone syringe systems, alongside meticulous procedural protocols, offers the potential to enhance the safety and clinical outcomes of intravitreal anti-VEGF therapy.

Purpose: To estimate the incidence and prevalence of non-infectious uveitis (NIU).

Methods: A systematic literature search was conducted of electronic databases including Ovid Medline, Embase, and Scopus from 2020 to September 2025. A random-effects meta-analysis pooled incidence and prevalence data across various demographic and comorbid contexts.

Results: From 15,172 initial studies, 106 were included. The pooled prevalence of NIU was 131.6 (95% CI 28.1-613.9) for adults and 27.4 (95% CI 6.3-118.3) for pediatrics per 100,000 persons. Pooled incidence of NIU was 204.4 (95% CI 0.0-438.9) for adults and 16.0 (95% CI 6.5-25.6) for pediatrics per 100,000 person-years. Increased incidence and prevalence of NIU were seen in populations of Juvenile idiopathic arthritis (JIA), undifferentiated Spondyloarthritis (SpA), Psoriatic arthritis (PsA), Ankylosing spondylitis (AS), and Behcet disease (BD). Prevalence of NIU in JIA was 129.2 (95% CI 94.2-174.7) per 1,000 persons and incidence was 22.4 (95% CI 2.5-42.4) per 1,000 person-years. Prevalence and incidence of NIU in SpA was 153.5 (95% CI 122.0-191.4) per 1,000 persons and 33.5 (95% CI 0.0-69.2) per 1,000 person-years, respectively. Prevalence and incidence of NIU in PsA was 27.3 (95% CI 18.1-41.2) per 1,000 persons and 13.1 (95% CI 0.0-32.5) per 1,000 person-years, respectively. Prevalence of NIU in AS and BD was 183.5 (95% CI 137.8-240.1) and 148.6 (95% CI 17.6-629.9) per 1,000 persons, respectively.

Conclusions: NIU incidence and prevalence were higher in adults than in children, and in populations with specific conditions like JIA and AS.

Purpose: To investigate risk factors of infectious endophthalmitis (IE) in micro-incision vitrectomy surgery and membrane peeling (MIVS-MP).

Methods: We retrospectively reviewed the medical records of patients who underwent MIVS-MP for idiopathic and secondary epiretinal membranes (ERM). IE incidence and its causative micro-organisms were collected. Risk factors for IE development - including age, gender, simultaneous cataract surgery, axial length (AL), refractive error, intraocular pressure (IOP), myopic tractional maculopathy (MTM), and diabetes mellitus (DM) were assessed. Main outcome measures were association between IE development and clinical factors.

Results: Of 3,496 eyes, IE occurred in 16 eyes (0.45%). The causative micro-organisms were detected in 12 eyes (75%) showing S. epidermidis (n=9), S. aureus (n=1), S. capitis (n=1), and E. faecalis (n=1). More IE developed in female (0.74% vs 0.12%, p=0.01), eyes with MTM (5.0% vs 0.35%, p=0.001) and high myopia (1.7% vs 0.34%, p=0.001). Mean AL (25.2±3.0 vs 24.0±1.8 mm), mean age (67.4±8.0 vs 62.4±12.2 years), simultaneous cataract surgery (0.54% vs 0.27%), and presence of DM (18.7% vs 20.9%) were not different between eyes with and without IE. High myopia and MTM were significantly associated with IE (logistic regression; p=0.009, p=0.046, respectively). Eyes with MTM (n=80) and high myopia (n=294) exhibited significantly lower IOP on day 1 (11.2±4.6 mmHg and 12.0±5.1 mmHg, respectively), compared to age-matched controls (13.9±4.3 mmHg and 13.6±4.4 mmHg) (p=0.001 and p=0.01, respectively).

Conclusion: In MIVS-MP, eyes with high myopia and MTM, which were likely to have lower IOP in the early postoperative period, were more susceptible to postoperative IE.

Purpose: To evaluate the safety and efficacy of multiwavelength photobiomodulation (PBM) in nonexudative (dry) age-related macular degeneration (AMD).

Methods: LIGHTSITE III employed a double-masked, randomized, sham-controlled, parallel-group, prospective study design. Subjects were enrolled with a diagnosis of dry AMD and treated with multiwavelength PBM (Valeda® Light Delivery System; 590, 660 and 850 nm) or Sham treatment. A treatment series included 9 PBM or Sham treatments delivered 3x/week over 3-5 weeks every 4 months (M) for 24M.

Results: A total of 148 eyes (100 subjects) with dry AMD were randomized into the study. LIGHTSITE III met the prespecified primary BCVA efficacy endpoint at M21 with a significant difference between treatment groups (p = 0.0036) and a +6.2 letter gain following PBM. At M21, 61.5% of PBM-treated eyes showed ≥5, 23.1% showed ≥10, and 4.4% showed ≥15 letter gains. A favorable safety profile was observed with no signs of phototoxicity. Disease progression to Geographic Atrophy (GA) showed a significant decrease in incidence (Sham, 24.0% vs. PBM, 6.8%; p = 0.007) following PBM treatment at M24. Significant benefit in vision QoL was observed.

Conclusions: Multiwavelength PBM represents an interventional therapy that restores visual function and has potential disease-modifying effects in intermediate dry AMD.

Purpose: To evaluate the outcomes of pars plana vitrectomy combined with epiretinal proliferation (EP) embedding and temporal inverted internal limiting membrane (ILM) flap technique in cases of lamellar macular hole (LMH).

Methods: This retrospective study included data from 17 consecutive patients who underwent EP embedding combined with the temporal inverted ILM flap technique for LMH. The best-corrected visual acuity (BCVA) and optic coherence tomography data were analyzed at baseline and postoperative period.

Results: Anatomic closure was achieved in 100% of patients. The mean baseline and final BCVA were LogMAR 0.53 ± 0.25 (Snellen 20/67) and 0.18 ± 0.19 (Snellen 20/30), respectively, demonstrating a statistically significant improvement (p < 0.001). Furthermore, final BCVA was significantly higher in patients with a preoperative BCVA better than LogMAR 0.5 (Snellen > 20/63) (p =0.001). The central retinal thickness (CRT) improved considerably from 115.5± 40.8 μm preoperatively to 208.4 ± 51.5 μm (p<0.001) at the final visit.

Conclusions: The EP embedding surgery combined with the temporal inverted ILM flap technique can provide improved anatomical and functional outcomes in patients with LMH. Our findings highlight that early intervention prior to severe visual loss and outer retinal defect development can be further beneficial in LMH cases.

Purpose: To evaluate and compare the initial functional and anatomical outcomes of aflibercept 8 mg and faricimab during the loading phase in treatment-naïve neovascular age-related macular degeneration (AMD).

Methods: This retrospective observational study included 100 eyes of 100 patients with treatment-naïve neovascular AMD who were administered three consecutive monthly loading injections of either aflibercept 8 mg (aflibercept 8 mg group, n=51) or faricimab (faricimab group, n=49). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT), as well as complete resolution of subretinal and intraretinal fluids, were compared between groups. Within each group, BCVA and CRT at baseline were compared with values at 3 months.

Results: In the aflibercept 8 mg group, mean BCVA, measured in logarithm of the minimal angle of resolution (logMAR), improved from 0.59±0.51 (Snellen equivalent, 20/77) at baseline to 0.39±0.44(20/49) at 3 months(P<0.001). Correspondingly, mean CRT decreased from 450.6±157.0 µm to 287.3±82.3 µm(P<0.001). In the faricimab group, mean BCVA improved from 0.62±0.47 logMAR(20/83) to 0.45±0.38(20/56)(P<0.001), and mean CRT decreased from 442.4±163.8 µm to 248.5±81.2 µm(P<0.001). No significant differences were observed between groups in BCVA improvement(P=0.685) or CRT reduction(P=0.320). Complete retinal fluid resolution was observed in 80.4% and 87.8% of patients in the aflibercept 8 mg and faricimab groups, respectively, with no significant difference in fluid resolution between groups(P=0.234).

Conclusions: Aflibercept 8 mg and faricimab achieved significant and comparable functional and anatomical outcomes after three loading injections in treatment-naïve neovascular AMD, suggesting that either agent may serve as an effective first-line treatment for this condition.

Purpose: To evaluate whether baseline glycosylate hemoglobin (HbA1C) levels play a predictive role in faricimab loading phase outcomes. Additionally, we assessed the efficacy of faricimab loading phase for diabetic macular edema (DME).

Methods: We conducted a retrospective, multicentric, interventional cohort study including 74 eyes, presenting with a central macular thickness (CMT) > 280 µm, visual acuity (VA) > 20/200, and OCT-based diagnosis of DME.

Results: A statistically significant negative correlation was found between baseline HbA1c and the change in VA following intravitreal faricimab injections (ρ = -0.32, p = 0.006) ). In multivariable regression this association was not significant (β ≈ -0.026 logMAR per 1% HbA1c; p=0.26; ≈ +1.3 letters/1%). The correlation between baseline HbA1c and the change in CMT was not statistically significant (ρ = +0.13, p = 0.279). VA improved significantly from baseline to post-treatment ((-0.18± 0.22 Δ LogMAR ;p < 0.0001). Mean baseline CMT (440.4 ± 152.9 micron) significantly decreased (310.9 ± 87.8 micron, p < 0.0001). We observed a significant reduction of hyperreflective foci(p < 0.0001) and intraretinal fluid (IRF) (p = 0.0014), and the subretinal fluid (SRF) decreased from 29.7% to 10.8% after treatment (p = 0.023).

Conclusion: Systemic glycemic status may influence functional outcomes, supporting the importance of maintaining optimal HbA1c levels in the overall management of diabetic patients. However, baseline HbA1c did not emerge as an independent predictor in this cohort. Notably, Faricimab provided clear anatomical and functional benefits regardless of glycemic control, confirming its efficacy as a treatment for DME.