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

Purpose: To evaluate longitudinal retinal and choroidal vascular changes in diabetic patients with and without diabetic retinopathy (DR) using OCT, OCTA, and MATLAB analysis, and to identify quantitative biomarkers of stage and progression.

Methods: In this prospective study, 142 diabetic eyes (Stage 0-3 DR) and 34 controls were followed for two years. Eyes with diabetic macular edema were excluded. Participants underwent SD-OCT, macular 6 × 6 mm OCTA, and wide-field FA at baseline, 8, 16, and 24 months. Parameters included retinal thickness, subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choriocapillaris flow, vessel density (VD), skeleton density (SD), fractal dimension (FD), vessel diameter index (VDI), vessel tortuosity (VT), foveal avascular zone (FAZ), and acircularity index (AI), quantified with MATLAB.

Results: At baseline, diabetic eyes had lower SFCT and CVI vs controls (p = 0.004, p = 0.035). Stage 0 eyes already showed impairment, with reduced VD, SD, and FD, and increased VDI and AI. Over two years, DR eyes exhibited declines in SFCT, CVI, and superficial VD, with rising VDI and AI. ROC analysis showed deep VDI best distinguished Stage 0 from Stage 1 (AUC = 0.764), superficial VDI separated Stage 2 from Stage 3 (AUC = 0.720), while deep VD and ischemic index distinguished Stage 0 from Stages 1-3 (AUC > 0.80).

Conclusions: DR is associated with retinal and choroidal vascular alterations detectable by OCT and OCTA. Quantitative metrics-particularly deep VDI and CVI-are promising biomarkers for early detection, staging, and monitoring of DR.

Purpose: This study utilized MIOCT to identify PDR patients with concurrent DME during vitrectomy and compared the efficacy of immediate versus delayed anti-VEGF treatment, as well as ranibizumab versus conbercept.

Methods: A prospective randomized controlled trial was conducted on PDR patients undergoing PPV. Patients with preoperatively unconfirmed DME were evaluated intraoperatively using MIOCT. Those with MIOCT-confirmed DME were randomly assigned to three groups: Group A received intravitreal ranibizumab during PPV with additional injections at 1 and 2 months postoperatively. Group B received intravitreal conbercept during PPV with additional injections at 1 and 2 months postoperatively. Group C received ranibizumab at 1, 2, and 3 months postoperatively. All groups followed a 3+PRN protocol. BCVA and CMT were measured at 1 day, 1 week, 1, 3, and 6 months post-PPV.

Results: A total of 115 eyes from 115 PDR patients (one eye per patient) with MIOCT-confirmed concurrent DME during PPV were enrolled and randomly assigned to treatment groups. Six eyes were lost to follow-up, and 109 eyes (94.8%) completed the entire 6-month study. Groups A and B showed significant BCVA and CMT improvements compared to Group C throughout the follow-up period, with Group B demonstrating superior early and sustained efficacy. Immediate anti-VEGF treatment during PPV, particularly with conbercept, was associated with reduced complications and accelerated recovery of visual function.

Conclusion: In PDR patients with MIOCT-identified DME during vitrectomy, immediate anti-VEGF treatment provides superior BCVA and CMT improvements compared to delayed treatment, with conbercept demonstrating better efficacy.

Purpose: To compare the efficacy and safety of adjunctive therapies for proliferative vitreoretinopathy (PVR) related to rhegmatogenous retinal detachment (RRD).

Methods: A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) from January 2000 to December 2025. A Bayesian random-effects network meta-analysis was used to compare different therapies.

Results: A total of 2,519 patients from 18 RCTs were included (1,339 receiving adjunctive treatments and 1,180 receiving placebo). Oral retinoic acid was associated with significantly higher primary (HR=2.86, 95%CI=[1.16, 7.53]) and final (HR=2.90, 95%CI=[1.12, 7.50]) retinal reattachment rates, improved visual acuity (MD=-0.89, 95%CI=[-1.68, -0.08]), and a lower incidence of postoperative macular pucker (HR=0.12, 95%CI=[0.02, 0.50]) compared to placebo. Oral prednisolone had a lower rate of PVR recurrence compared to placebo (HR=0.37, 95%CI=[0.17, 0.79]), while oral retinoic acid (HR=0.06, 95%CI=[0.00, 0.50]) and intravitreal dexamethasone (HR=0.23, 95%CI=[0.05, 0.81]) were associated with reduced rates of RRD reoperation.

Conclusion: Oral retinoic acid ranked highest for primary outcomes in PVR associated with RRD; however, this finding was driven by a single RCT with limited sample size. Oral prednisolone reduced PVR recurrence, while intravitreal dexamethasone lowered reoperation risk, compared to placebo.

Purpose: To evaluate intergrader variability in posterior vitreous detachment (PVD) classification in patients with epiretinal membrane and macular hole on spectral-domain optical coherence tomography (SD-OCT) and identify challenges in defining a reliable ground truth for artificial intelligence-based tools.

Methods: A total of 437 horizontal SD-OCT B-scans were retrospectively selected and independently annotated by six experienced ophthalmologists adopting four categories: "full PVD," "partial PVD," "no PVD," and "ungradable." Intergrader agreement was assessed using pairwise Cohen kappa scores. Consensus levels, accuracy, recall, specificity, and grading time were also analyzed using the majority vote as reference.

Results: The overall average Cohen kappa was 0.57. Agreement was highest for "partial PVD" (Cohen kappa = 0.70), followed by "full PVD" (Cohen kappa = 0.65), and lowest for "no PVD" (Cohen kappa = 0.14), indicating substantial diagnostic variability. Full consensus was achieved in only 31.1% of OCT scans, whereas 11.4% required adjudication. The sensitivity for "no PVD" was notably low (0.35 ± 0.32), and misclassified OCT scans took significantly longer to grade ( P < 0.001).

Conclusion: Our results underscore challenges associated with reliable OCT-based classification of PVD in patients with diseases of the vitreomacular interface, especially for cases with completely attached vitreous. Improving intergrader agreement through consensus grading and advanced imaging modalities will be critical for establishing a solid ground truth to support reliable, artificial intelligence-driven PVD detection systems.

Purpose: To investigate the prognostic factors for development of gliosis after idiopathic macular hole (IMH) surgery and its relationship to functional and anatomical success.

Methods: This retrospective study included patients with IMH that underwent pars plana vitrectomy using internal limiting membrane flap technique. Optical coherence tomography examinations were done at baseline, 1 month, and 6 months postoperatively. Postoperative parameters on optical coherence tomography included hole closure, outer retinal layers continuity, and development of gliosis.

Results: Sixty-five patients with IMH were included in the study. Forty-three underwent temporal flap and 22 an inverted flap 360° around the hole. Gliosis was present at 8 (12.3%) eyes at 1 and 6 months postoperatively. Patients with gliosis at 6 months had larger minimal hole diameter at presentation (622 µ m ± 140 vs. 423 ± 178, P = 0.004). Gliosis was associated with worse best-corrected visual acuity at presentation (0.86± 0.49 logMAR [20/145] vs. 0.43 ± 0.37 [20/54], P = 0.008) and 1 month postoperatively (0.91 ± 0.59 logMAR [20/160] vs. 0.42 ± 0.48 [20/53], P = 0.013) but not at 6 months postoperatively (0.55 ± 0.31 logMAR [20/70] vs. 0.43 ± 0.33 [20/54], P = 0.222).

Conclusion: Our study supports the use of inverted internal limiting membrane flap for IMH as a primary procedure. No gliosis was shown in small macular holes undergoing this technique. Even in large IMH where gliosis has developed, an improvement in visual acuity was shown after surgery.

Purpose: To report the clinical presentation, management, complications, and outcomes after retinal injuries caused by intravitreal injections.

Methods: Retrospective case series of 12 eyes presenting with visual deterioration because of vitreoretinal complications secondary to trauma caused by intravitreal injections. Detailed ocular history, clinical examination, vitreoretinal complications, management, final anatomical, and visual outcomes are documented.

Results: We observed 12 cases of direct retinal trauma by the needle tip of intravitreal injection. All retinal injuries were located in the temporal mid-periphery, usually near the inferior arcade. Of the 12 patients, four eyes developed a retinal detachment, all with proliferative vitreoretinopathy, six had vitreous hemorrhage, and two eyes presented with a focal chorioretinal atrophic lesion. The patients either underwent surgical procedure or were closely monitored after the injury. The surgical intervention was successful in anatomical outcomes in all cases. Ten eyes had a final visual acuity similar to baseline, whereas two eyes experienced visual deterioration during a follow-up of at least 6 months.

Conclusion: Direct retinal injury with the intravitreal injection needle is a rare but possibly underreported adverse event. Early detection of these complications, especially if associated with retinal detachment, is important for timely and appropriate management to avoid permanent loss of vision.

Purpose: To report outcomes of suprachoroidal hemorrhage (SCH).

Methods: Retrospective nonrandomized study of eyes with SCH from two sites (January 1, 2013-December 31, 2022). The primary outcome was the 6-month change in visual acuity (VA). Multivariable analysis was performed, as well as a comparison of matched eyes with and without systemic steroids.

Results: Overall, 143 eyes of 143 patients (mean age 70.8 years, 52.4% male) were included, with 72 perioperative, 24 traumatic, and 47 spontaneous SCH cases. The mean (SD) presenting VA was 2.07 (0.92) logMAR. 87 (60.8%) were managed nonsurgically, 24 (16.8%) underwent drainage, and 32 (22.4%) underwent drainage and vitrectomy; 36 (25.2%) received systemic steroids. At 6 months, the mean (SD) change in VA from presentation was -0.41 (0.84) logMAR. 102 eyes (71.3%) achieved anatomic success (complete retinal attachment). Concurrent retinal detachment was associated with worse VA change and anatomic success in multivariable analysis ( P < 0.05). In the matching analysis, eyes receiving systemic steroids were more likely to achieve ≥ 3-line gain in VA than matched eyes without systemic steroids (77.8% vs. 55.3%, P = 0.047).

Conclusion: The visual prognosis of eyes with SCH remains guarded. Systemic steroids may be associated with a modest benefit for visual outcomes. Concurrent retinal detachment portends worse outcomes.

Purpose: To describe the clinical and multimodal imaging features of a novel form of macular neovascularization (MNV), designated Type 4 MNV, defined by mixed Type 1 and Type 2 neovascularization (NV), extensive intraretinal anastomotic NV, and central posterior hyaloid fibrosis.

Methods: This multicenter retrospective observational case series included patients with neovascular age-related macular degeneration exhibiting both Type 1 and 2 MNV and an overlying anastomotic intraretinal NV network. This was confirmed with optical coherence tomography (OCT) and OCT angiography (OCTA). Demographics, baseline visual acuity (VA), and OCT imaging biomarkers including the hyperreflective oblique band sign, central posterior hyaloid fibrosis, epiretinal membrane, and OCTA NV subtype were assessed.

Results: Eleven eyes from 11 patients (mean age: 76.9 years; 36.4% female) met inclusion criteria. Baseline VA was logMAR 1.56 ± 0.45 (≈20/630) and 90.9% of subjects presented with severe visual loss. All eyes showed the hyperreflective oblique band sign. Central posterior hyaloid fibrosis was observed in 81.8% (9/11 subjects). Epiretinal membrane with radial traction was present in 81.8%. OCT angiography illustrated mixed Type 1 and 2 MNV with a prominent overlying intraretinal anastomotic network extending into the preretinal space.

Conclusion: Type 4 MNV represents a distinct age-related macular degeneration phenotype with aggressive anatomical features including mixed Type 1 and 2 MNV, inner retinal and preretinal proliferation and anastomosis and retinal disorganization. The visual prognosis is invariably poor with recalcitrance to anti-vascular endothelial growth factor therapy. The recognition of this signature NV lesion subtype further refines the MNV classification system and can affect therapeutic strategies for neovascular age-related macular degeneration.