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

Purpose: To report a new technique using tailored corneal punches to prepare round human amniotic membrane (hAM) plugs for the treatment of large full-thickness macular holes (FTMHs).

Methods: Eight eyes with large FTMHs (>650 μm) in eight patients were included. Pars plana vitrectomy (23 G) was performed and round hAM plugs were prepared from the hAM patch by using tailored corneal punches. The size of the hAM plug was chosen according to the size of the FTMH. Endotamponade was performed using 14% C3F8 after subretinal implantation of the hAM plugs. The patients were followed up for ≥6 months.

Results: The mean FTMH size was 737.0 ± 86.2 μm. All FTMHs (100%) were closed within the 6-month follow-up period. The best-corrected visual acuity (LogMAR, [Snellen]) improved significantly from 1.74 ± 0.30 (20/1000) before surgery to 0.76 ± 0.32 (20/100) at 6 months after surgery (P < 0.05). We did not observe any iatrogenic injuries associated with the surgical procedure, rejection of the hAM plug, or parafoveal atrophy throughout the six-month follow-up.

Conclusion: Subretinal implantation of hAM plugs prepared using tailored corneal punches was safe and effective for repairing large FTMHs. The procedures were successful and associated with promising visual acuity recovery.

Purpose: In this study, our goal was to deepen the understanding of the clinical significance and underlying pathogenic mechanisms of the hyperreflective ganglion cell layer (HGB) observed in optical coherence tomography (OCT) scans of patients with retinitis pigmentosa (RP).

Methods: The study was designed as observational, cross-sectional. RP patients with and without HGB were recruited and underwent complete multimodal retinal imaging assessment, including OCT, OCT angiography (OCTA) and Dense Automatic-RealTime (DART) OCTA. Morphological outcome measures included OCTA vessel density (VD), foveal avascular zone area and ellipsoid zone (EZ) width. Functional outcome measures were LogMAR best-corrected visual acuity (BCVA) and retinal sensitivity.

Results: Twenty eyes with HGB (20 RP patients) and 20 eyes without HGB (20 RP patients) were included. A reference control group was included as well. RP eyes with HGB were characterized by significantly worse LogMAR BCVA and retinal sensitivity, compared with RP eyes without HGB. Moreover, HGB subgroup showed significantly worse VD values of intraretinal capillary networks. The main superficial capillary plexus (SCP) VD reduction was detected in the extrafoveal region. DART OCTA allowed to support the SCP perivascular gliosis pathogenic origin of HGB. DART OCTA was able to detect (I) SCP perivascular hyperreflectivity; (II) SCP perfusion signal reduction and (III) peripheral SCP capillaries closure.

Conclusions: The presence of HGB is identified as an adverse finding in a subset of eyes affected by RP. HGB correlates with markedly deteriorated retinal morphology and function. The possible pathogenic mechanism underlying HGB manifestation is the perivascular gliosis of the SCP.

Purpose: To compare intravitreal aflibercept alone versus aflibercept combined with oral anti-inflammatory supplementation in patients with diabetic macular edema (DME).

Methods: A prospective, randomized study included 134 treatment-naive eyes with central-involving DME. Participants were assigned to receive either intravitreal aflibercept (Group A) or aflibercept with oral Lenidase® supplementation (Group B, containing baicalin, bromelain, and escin). Both groups followed a treat-and-extend (T&E) regimen. The primary outcome was the number of injections over 24 months. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and safety assessments.

Results: At 24 months, Group A required a mean of 14.34 ± 0.51 injections, while Group B required 12.96 ± 0.44 (P < 0.0001). Both groups showed significant improvement in BCVA: from 0.62 ± 0.12 logMAR (20/83 Snellen) to 0.43 ± 0.13 logMAR (20/54 Snellen) in Group A and from 0.64 ± 0.13 logMAR (20/87 Snellen) to 0.42 ± 0.15 logMAR (20/53 Snellen) in Group B (P < 0.0001 for both). CMT also significantly decreased in both groups (P < 0.0001). No significant differences were found between the groups for vision improvement (P=0.918) or CMT reduction (P=0.777). No ocular complications were reported.

Conclusions: Oral supplementation with Lenidase® showed similar efficacy to aflibercept monotherapy in DME, with fewer injections, potentially reducing treatment burden.

Purpose: To evaluate outcomes of rhegmatogenous retinal detachment (RRD) treated with a scleral buckle (SB) without external drainage of subretinal fluid during the modern vitrectomy era.

Methods: The records of 107 eyes of 107 patients that underwent treatment with nondrainage SB surgery for primary RRD with at least 3 months of follow-up were reviewed.

Results: SB surgery included segmental elements (radial, 44.9%; circumferential, 23.4%) and encircling procedures (31.8%). Most (68.2%) patients were under age 60 years, and most eyes (89.7%) were phakic. Single breaks were present in 53.3% of the eyes. The macula was attached preoperatively in 66 (61.7%) eyes. Myopia > 5.5 diopters (35.5%) and lattice degeneration (48.6%) were notable risk factors. Posterior vitreous detachment (PVD) was present in 37.4% of the eyes. Single surgery retinal reattachment was achieved in 104 eyes; three of these eyes also received pneumatic gas injections postoperatively. Four eyes underwent anatomically successful repeat surgery, including one eye that developed a recurrent RRD after release of an encircling element. One eye underwent removal of an exposed SB without sequalae, and one eye developed persistent diplopia treated with prism.

Conclusions: With proper case selection, nondrainage SB remains an excellent surgical procedure for repair of RRD in the modern vitrectomy era.

Methods: Baseline and 6-months measurements included Snellen acuity (SA), central retinal thickness (CRT), the presence of microcystic macular edema (MME), outer retinal cysts (ORC), disruptions of the ellipsoid zone (EZ) and external limiting membrane (ELM) and quantitative analysis on MC-SLO were analyzed. The study primarily evaluated postoperative SA improvement, CRT reduction, and the prevalence of ERM remnants. Additionally, the relationship between gliotic components and postoperative outcomes was analyzed.

Results: In stage 2 ERMs, clear ERMs had a higher incidence of ERM remnants after surgery (81.8% vs. 30.8%, p = 0.037). Both groups experienced visual acuity improvement (clear ERMs: +25 ETDRS letter score, cloudy ERMs: +15 ETDRS letter score p = 0.013). In stage 3 ERMs, no significant differences in SA or CRT changes were noted, but clear ERMs showed more inner retinal dimples (p = 0.015). Gliosis area and EIFL thickness showed significant correlation in cloudy stage 3 ERMs (p = 0.011).

Conclusions: Clear and cloudy ERMs differ in postoperative recovery. Cloudy stage 2 ERMs have less functional recovery but fewer remnants than clear ERMs. In stage 3, gliosis correlates with EIFL severity, and clear ERMs exhibit more inner retinal dimples.

Purpose: To explore the effectiveness and practicality of intraoperative fluorescein angiography (IOFA) in both common and rare retinal diseases.

Methods: We conducted a case series study involving three patients with vascular abnormality from various causes. A custom-designed, single-photon ultra-wideband spectral light source and integrated filters were utilized to perform IOFA. The cases included one patient with diabetic retinopathy, one with Coat's disease, and one with familial exudative vitreoretinopathy (FEVR). IOFA was performed, and individualized treatment was conducted based on the angiographic findings.

Results: All three patients had successful IOFA, and two of them also underwent pars plana vitrectomy (PPV) guided by the IOFA results. Postoperative outcomes were favorable, with controlled disease progression and improved or stable vision. The diabetic retinopathy patient's vision improved significantly post-surgery, the Coats disease patient's retinal detachment resolved without recurrence, and the FEVR patient showed no further bleeding on follow-up.

Conclusion: The integration of an enhanced light source and filters reduced the transition time from standard surgical mode to angiography mode to just 10 seconds. Moreover, this study demonstrates that IOFA can effectively guide PPV surgeries and treatment for both common and rare retinal vascular diseases, offering a promising direction for personalized retinal disease management. In addition, further research and clinical trials are warranted to confirm the efficacy of IOFA-guided targeted retinal photocoagulation, particularly in diabetic retinopathy-induced vitreous hemorrhage.

Purpose: To investigate any difference in the rate of serotonin reuptake inhibitor (SRI) use in patients with retinal vein occlusions (RVO), compared to an age matched control group.

Methods: Retrospective data collection of risk factors and prescribed drugs from consecutive electronic patient records of all patients diagnosed with RVO over 5 years. Routine, age matched patients were identified for a control group. The two groups were compared with Chi2 test and multiple Logistic regression. Odds ratios (OR) were calculated.

Results: In total, 775 patients were included in this study. 283 patients were in the RVO group and 492 in the control group. The rate of SRI and Statin use was significantly different in both groups for all ages (p<0.001). Logistic regression confirmed a significant reduction in RVO associated with SRI use (OR 0.39), Statins (OR 0.51) and combined drugs (OR 0.22) with all groups reaching statistical significance (p<0.001).

Conclusion: This study has found lower rates of RVO in patients receiving an SRI or a Statin compared to controls. This data suggests that individuals taking an SRI are less likely to suffer a RVO and SRIs may have an additive effect when combined with Statins.

Purpose: To compare the image quality and safety of ultra-widefield fluorescein angiography (UWFA) using 3 ml (300 mg) versus 1 ml (100 mg) of 10% fluorescein.

Methods: In this prospective, randomized clinical trial, a total of 144 patients who required UWFA examination for various retinal diseases were randomized 1:1 to 300 mg or 100 mg of fluorescein. Images were qualitatively graded by three retinal specialists and quantitatively analyzed. The primary outcome measure was the assessment of image quality (scored in a five-point scale). Quantitative sub-analysis among normal UWFA images through pixel intensity in posterior and mid-peripheral zone was also performed.

Results: A total of 67 participants in each group were included in the analysis. The mean difference of image quality between two dose groups was within the predefined non-inferiority margin of 0.5 (0.005; 95% confidence interval, -0.145 to 0.154). The mean pixel intensity showed no significant differences in both posterior and mid-peripheral zone (P = 0.988 and 0.726, respectively). In the safety analysis, significantly fewer adverse events were observed with the lower dose (300 mg, 10 of 67 [14.9%] vs. 100 mg, 3 of 67 [4.5%], P = 0.041).

Conclusion: We demonstrated the non-inferiority of image quality of low-dose fluorescein (100 mg) compared to a 300 mg dose with a reduction in the rate of adverse events associated with fluorescein angiography.