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

Purpose: To compare the visual and anatomic outcomes of pars plana vitrectomy between myopic maculoschisis with and without macular detachment (MD).

Methods: This retrospective comparative study included 38 eyes of 38 patients who received pars plana vitrectomy for myopic maculoschisis between July 2021 and July 2022. Two groups were identified based on whether preoperative MD was detected via optical coherence tomography: 16 eyes with MD and 22 eyes without MD. Surgical effects were assessed by the final best-corrected visual acuity, ellipsoid zone (EZ) state, and the rate of complete fovea relief.

Results: The postoperative follow-up was 15.25 ± 3.70 and 15.55 ± 3.39 months in the groups with and without MD, respectively ( P = 0.800). The preoperative logarithm of the minimal angle of resolution best-corrected visual acuity was 1.21 ± 0.65 and 0.55 ± 0.37 in the groups with and without MD, respectively ( P = 0.001). Nevertheless, no difference existed in the postoperative best-corrected visual acuity at final visit between the groups with and without MD (0.51 ± 0.29 logarithm of the minimal angle of resolution, ∼20/64 VS . 0.40 ± 0.41 logarithm of the minimal angle of resolution, ∼20/50, P = 0.345). During the follow-up period, the rates of EZ band reconstruction were 40.00% (6/15) and 33.33% (2/6) in the groups with and without MD, respectively ( P = 0.590). Finally, a total of 33 eyes achieved complete fovea relief, including 13 eyes (81.25%) in the group with MD and 20 eyes (90.91%) in the group without MD ( P = 0.701).

Conclusion: In myopic maculoschisis eyes, the presence of MD did not significantly affect postoperative visual or anatomical outcomes in our cohort.

Purpose: To assess the efficacy and safety of suprachoroidal triamcinolone acetonide in the management of noninfectious cystoid macular edema of various etiologies.

Methods: Retrospective observational study of 61 eyes of 56 patients with noninfectious cystoid macular edema who received suprachoroidal triamcinolone acetonide injection. Primary outcomes were treatment response, central subfield thickness, visual acuity, and intraocular pressure at baseline, 1 month, and 3 months after injection.

Results: Cystoid macular edema etiology included postoperative, uveitis, diabetes mellitus, and retinal vein occlusion. Complete resolution of cystoid macular edema occurred in 34 eyes (58.6%) at 1 month and 23 eyes (50.0%) at 3 months. Median central subfield thickness improved from 430.0 µ m (IQR, 366.0-547.5) to 297.0 µ m (IQR, 277.0-392.0) at 1 month ( P < 0.001) and 326.5 µ m (IQR, 263.9-380.6) at 3 months ( P < 0.001). Visual acuity improved from logarithm of the minimal angle of resolution 0.60 (IQR, 0.40-0.88) [20/80] at baseline to 0.48 (IQR, 0.30-0.70) [20/60] at 1 month ( P = 0.002) and logarithm of the minimal angle of resolution 0.44 (IQR, 0.18-0.88) [20/60] at 3 months ( P = 0.019). Significant intraocular pressure elevation was noted in seven eyes (11.5%) overall, with no occurrences of infection, cataract progression, or suprachoroidal hemorrhage.

Conclusion: Suprachoroidal triamcinolone acetonide demonstrated significant anatomical and functional improvements in eyes with noninfectious cystoid macular edema and a reassuring side effect profile.

Purpose: Relentless placoid chorioretinitis is a rare condition, and although it may require long-term immunosuppressive therapy, there are no standardized treatment guidelines. Within this study, we discuss outcomes of the largest group of patients from a single institution with a diagnosis of relentless placoid chorioretinitis.

Methods: This is a retrospective cohort study of patients diagnosed with relentless placoid chorioretinitis treated at the Associated Retinal Consultants in Royal Oak, Michigan from January 2015 to January 2024.

Results: A total of eight patients (11 eyes) were included. Initial treatments included oral prednisone (10 of 11 eyes) and topical steroids (5 of 11 eyes). Four patients were treated with methotrexate as their initial immunomodulatory therapy agent and achieved disease quiescence. One patient (2 eyes) was treated with cyclosporine followed by mycophenolate and successfully tapered off all therapy after remaining quiescent for more than 10 years. All patients were able to achieve control of disease activity with no active lesions on final follow-up. Visual acuity either improved or remained stable in all 11 eyes with presenting and final mean logMAR visual acuities of 0.61 (20/80, Snellen) and 0.10 (20/25, Snellen), respectively ( P = 0.013) [a mean of 3.4 lines of improvement]. The four patients treated with methotrexate had presenting and final mean logMAR visual acuities of 1.13 (20/320, Snellen) and 0.27 (20/40, Snellen), respectively ( P = 0.047) [a mean of six lines of improvement].

Conclusion: To our knowledge, this is the largest cohort of relentless placoid chorioretinitis patients in a single study. Care for these patients involves multimodal imaging as well as multidisciplinary care.

Purpose: To assess the morphologic risk of full-thickness macular hole (FTMH) formation in the fellow eye based on posterior vitreous detachment (PVD) status and preceding vitreomacular interface changes using optical coherence tomography data of the fellow eye.

Methods: The natural history of fellow eyes of patients with unilateral FTMH was reviewed for tractional maculopathies, symmetry of the foveal contour, inner and outer retinal irregularities, and PVD status on spectral domain optical coherence tomography. Posterior vitreous detachment was classified as incomplete (incomplete PVD = vitreomacular adhesion or traction) or macular (mPVD = vitreomacular detachment). Foveal contour changes were classified as inner foveal irregularity (IFI) if mPVD was present without evidence of other tractional maculopathies.

Results: Seventy-two eyes of 72 consecutive patients were included. Nine (12.5%) developed FTMH during a mean follow-up of 19.1 ± 23.8 (range: 3.0-133.0) months. Incomplete PVD at baseline was not associated with a higher incidence of FTMH at follow-up (10.5% mPVD vs. 14.7% incomplete PVD, P = 0.727). Nine of 38 eyes (23.7%) with mPVD had inner foveal irregularity at baseline. Inner foveal irregularity was a risk factor for FTMH formation after mPVD ( P = 0.033, OR = 14.0). The cumulative risk of IFI-FTMH conversion was 16.7% at 12 months and 44.4% at 24 months.

Conclusion: Inner foveal irregularity can be frequently documented in the fellow eyes of patients with FTMH and may be an early morphologic risk factor for FTMH formation after mPVD in the context of previous fellow eye involvement.

Purpose: To investigate the quantitative contrast sensitivity function (qCSF) changes in macular telangiectasia type 2 eyes and to assess associations with structural optical coherence tomography biomarkers.

Methods: Cross-sectional, observational study including 49 macular telangiectasia type 2 eyes and 277 propensity score matched control eyes with same-day visual acuity, qCSF testing, and multimodal retinal imaging. Quantitative contrast sensitivity function metrics included area under the logarithm of contrast sensitivity function, contrast acuity, and contrast sensitivity thresholds at 1 to 18 cycles per degree. Structural optical coherence tomography biomarkers comprised presence and location of ellipsoid zone discontinuity, outer retinal hyperreflectivity, outer retinal cavitations, as well as macular neovascularization presence.Mixed-effects linear regression models, adjusted for age and lens status, compared the macular telangiectasia type 2 and the control groups and explored relationships with optical coherence tomography biomarkers.

Results: Macular telangiectasia type 2 eyes showed significantly lower qCSF-measured contrast sensitivity than controls (β*: -1.28 to -0.78; all P < 0.001) for all analyzed qCSF metrics. Multivariable analysis revealed significant associations between reduced contrast sensitivity and structural biomarkers (β*: -1.03 to -0.51; all P < 0.05), except for macular neovascularization ( P > 0.05).

Conclusion: Our findings indicate that qCSF testing can identify reduced contrast sensitivity in macular telangiectasia type 2 across various spatial frequencies compared with controls. These changes seem particularly associated with early structural optical coherence tomography alterations.

Purpose: To compare the anatomical and functional outcomes of heavy silicone oil (HSO) and standard silicone oil (SSO) in primary rhegmatogenous retinal detachment, along with postoperative complications.

Methods: Meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered on PROSPERO (CRD42024507061). We retrieved randomized trials, prospective and retrospective studies comparing HSO and SSO to manage primary inferior/posterior or complex rhegmatogenous retinal detachments published from 2000 to nowadays in PubMed/Medline-Embase-Cochrane-Scholar-Web of Science. This meta-analysis focused on primary success rates, best-corrected visual acuity improvement, and postoperative complications.

Results: A total of 6 studies on 984 eyes (615 in SSO and 369 in HSO group) were included. In a fixed-effect model ( P = 0.112, I 2 = 43.99%), HSO and SSO tamponades showed comparable primary anatomic success rates (odds ratios 1.461, 95% confidence interval [CI]: 0.890-2.399, P = 0.134). Average best-corrected visual acuity improvement was similar between the two groups (I 2 = 79.21%, weighted mean difference -0.071 logarithm of the minimum angle of resolution; 95% CI: -0.524 to 0.382, P = 0.61). Conversely, HSO tamponade was associated with higher rates of IOP elevation (I 2 = 37.42%, odds ratios 2.073, 95% CI: 1.182-3.634, P = 0.011) and emulsification (I 2 = 16.43%, odds ratios 2.953, 95% CI: 1.109-7.862, P = 0.030). Finally, inflammation rates did not differ between HSO and SSO (I 2 = 66.46%, odds ratios 2.015, 95% CI: 0.234-17.323, P = 0.523).

Conclusion: Heavy silicone oils showed similar rates of primary anatomic success when compared with SSOs in complex primary rhegmatogenous retinal detachments. Although hindered by poor baseline values, visual outcomes were generally comparable among the two groups. In contrast, HSO group showed higher rates of postoperative IOP elevation and emulsification.

Purpose: To explore the safety of high-dose intravitreal topotecan for recurrent retinoblastoma management in human eyes.

Methods: There were 81 consecutive injections of high-dose intravitreal topotecan (90 μ g/0.18 cc‒100 µ g/0.20 cc on a monthly basis) in 25 eyes with recurrent retinoblastoma. Tumor control and injection-related complications were assessed at each visit. Each tissue was reviewed for complication-associated alterations, and systemic evaluation for myelosuppression, infection, metastasis, and death was assessed.

Results: At the time of injection, the mean patient age was 26 months, and in all cases, the injection was for recurrent retinoblastoma (n = 24 eyes, 100%) involving intraretinal tumor (n = 6 eyes, 24%), vitreous seeds (n = 3 eyes, 12%), subretinal seeds (n = 13 eyes, 52%), or multiple tumor types (n = 3 eyes, 12%). The mean intraretinal tumor thickness was 2.2 mm, vitreous seed thickness varied from pinpoint to confluent seeds, and subretinal seed was 0.9 mm. The total number of high-dose intravitreal topotecan injections was 81 (mean 3.2 per eye) with 39 (48%) injections given without concurrent chemotherapy and 42 (52%) given with concurrent intravenous or intra-arterial chemotherapy. At mean follow-up of 10 months after first injection, tumor control was achieved in all cases (n = 81 injections, 100%), and there was no local or systemic complication in any of the 81 injections. There was no case of extraocular tumor extension, myelosuppression, infection, metastasis, or death.

Conclusion: Based on this analysis, high-dose intravitreal topotecan is safe and effective in the management of recurrent small retinoblastoma in humans. Further investigation of the limits of this therapy is warranted.

Purpose: To investigate the role of widefield en face imaging of retinal pigment epithelium (RPE) alterations using swept-source optical coherence tomography for rapid classification of central serous chorioretinopathy (CSCR).

Methods: In this cross-sectional, single-center study, eyes diagnosed with unilateral CSCR were included. Volume swept-source optical coherence tomography scans (12 × 12 mm) were obtained for all the participants. High-quality structural en face images were automatically generated at the level of Bruch membrane based on artificial intelligence to evaluate the RPE alterations.

Results: The study included 122 affected eyes from patients with unilateral CSCR, with a mean age of 46.3 ± 9.1 years. In 51 of the 122 cases, fundus autofluorescence, fundus fluorescein angiography, indocyanine green angiography, and en face imaging were assessed simultaneously. Among these, 17 eyes were categorized as complex CSCR. Fundus autofluorescence exhibited the highest detection rate of RPE abnormalities (94.1%). En face imaging revealed RPE abnormalities in 15 of 17 eyes (88.2%), whereas indocyanine green angiography detected RPE abnormalities in 12 of 17 eyes (70.6%). Only 6 of 17 eyes (35.3%) showed RPE abnormalities in fundus fluorescein angiography. The RPE alterations in the remaining 71 eyes with CSCR were evaluated solely using en face imaging, wherein 17 eyes were designated as complex CSCR and 54 eyes were categorized as simple CSCR.

Conclusion: Evaluation of RPE alterations using widefield en face imaging has potential as a reliable, noninvasive approach to rapid classification of CSCR using the latest classification system, particularly when combined with contralateral eye imaging results.

Background/purpose: To characterize the delay between symptom onset and diagnosis in patients with early-, intermediate-, and late-onset Stargardt disease (STGD) and identify possible factors contributing to this delay.

Methods: Chart review was conducted for patients with confirmed STGD molecular diagnosis seen by an inherited retinal disease (IRD) specialist at a tertiary academic institution.

Results: Eighty-seven patients were included. Average time from symptom onset to first IRD specialist visit was 10.95 years (SD = 12.74). Average time between seeing a subspecialist and IRD specialist was 8.09 years (SD = 12.2), with the intermediate-onset group having a significantly longer delay (mean 13.1 years) compared with early-onset (mean 5.01 years, P = 0.025) and late-onset group (mean 3.1 years, P = 0.02). Visual acuity significantly decreased between seeing a subspecialist and IRD specialist ( P = 0.047). Patients with late-onset STGD were more likely to have intact subfoveal ellipsoid zone compared with early and intermediate-onset patients.

Conclusion: Patients with STGD face long delays from symptom onset to molecular diagnosis, with progressive vision loss and missed opportunities for clinical trial enrollment. Contributing factors include age of onset, types of initial symptoms, and transitions in care from subspecialist to IRD specialist. Multimodal screening, more streamlined referral pathways, expedited genetic testing, and greater awareness of highly variable STGD phenotypes may mitigate these delays.

Purpose: To determine the characteristics and treatment of the extensive subretinal fibrosis (ESF) in eyes with rhegmatogenous retinal detachment but without a tractional retinal detachment in patients with familial exudative vitreoretinopathy.

Methods: Ten eyes of nine men and one woman with ESF in patients with rhegmatogenous retinal detachment-familial exudative vitreoretinopathy were studied. The characteristics, surgical procedures, and the outcomes after the removal of the ESF were determined. The ESF was excised by either stripping the ESF from small retinotomies or by en bloc excision through a >180° retinotomy or retinectomy at the ora serrata.

Results: The median age of the patients was 12.5 years. All cases had a unilateral macula-off retinal detachment with a total detachment in four eyes and detachment over two quadrants in six eyes. The first case underwent ESF stripping through small retinotomies that required seven additional surgeries with a final visual acuity of hand motion. The subsequent 9 cases underwent en bloc excision resulting in a retinal reattachment with silicone oil tamponade. The silicone oil was removed without a recurrence of the RD during a median follow-up period of 7 years. The median final visual acuity was 20/66 with a range of 20/17 to 20/500.

Conclusion: Extensive subretinal fibrosis can be found in familial exudative vitreoretinopathy eyes with a slowly progressive rhegmatogenous retinal detachment. We conclude that the en bloc excision of the ESF is an effective and safe procedure to reattach the retina and thus improve the visual acuity.