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

Purpose: To report our initial experience of a modified intraocular lens (IOL) scleral fixation technique using 6/0 prolene in a double-flanged sutureless technique with a 27-gauge needle.

Methods: 29 consecutive patients with IOL surgery were retrospectively reviewed between December 2021 and October 2023. Early Treatment Diabetic Retinopathy Study (ETDRS) letters, spherical equivalent (SE), astigmatism axial degree and intraocular pressure (IOP) were evaluated at baseline, and 1, 2, 3, and 6 months postoperatively. Surgery-related complications were evaluated during follow-up.

Results: ETDRS letters or SE at 1, 2, 3, and 6 months postoperation was significantly improved compared to baseline levels. Patients with younger (estimate [SE] = 8.011 [2.485], p = 0.006), preoperative lens drop (estimate [SE] = 8.621 [2.906], p = 0.009), idiopathic cataract (estimate [SE] = 6.021 [2.099], p = 0.048), high baseline ETDRS letters (estimate [SE] = 15.449 [2.352], p < 0.001), or low baseline SE (estimate [SE] = 6.357 [2.406], p = 0.018) had the greatest improvement in ETDRS letters during follow-up. Patients with preoperative lens or IOL dislocation had a greater postoperative SE improvement than those with preoperative lens or IOL subluxation (dislocation vs. subluxation: estimate [SE] = -189.235 [70.692], p = 0.016). There were no cases of vitreous hemorrhage, cystoid macular edema, endophthalmitis, subluxation or dislocation were observed during the 6-month follow-up.

Conclusions: Our modified IOL scleral fixation technique is a simple, safe, efficient method that avoids haptic manipulation and slippage, reduces postoperative complications, achieves completely sutureless surgery, and results in an achievement of surgical refractive goals.

Purpose: Evaluate visual evoked potential (VEP) and ocular trauma score (OTS) efficacy in predicting visual potential in globe trauma without optic nerve involvement.

Methods: A retrospective cohort study analyzed clinical data from eye globe injury cases undergoing flash VEP between January 2000 and May 2021. Inclusion criteria: flash VEP completion within 48 hours, pre-surgical intervention. Exclusions: head trauma, optic nerve injuries. Abnormal VEP: <7 µV amplitudes, >120ms latencies. The OTS was computed, and penetrating injuries were categorized.

Results: Of 85 eyes meeting the criteria (mean age: 31.9±20.6 years, 82.4% male), the median follow-up was 22 months. OTS directly correlated with the amount of Early Treatment Diabetic Retinopathy Study letters gained at follow-up and was inversely correlated with ocular penetration extent, and VEP signal amplitude. VEP amplitude is inversely correlated with maintaining/improving visual acuity. Positive predictive value for normal VEP predicting maintained/improved visual acuity: 75.6%, negative predictive value: 21.3%. In blunt trauma, baseline VEP amplitude had superior predictive value compared to penetrating injury.

Conclusion: This study highlights a correlation between VEP signal amplitude and OTS with visual outcomes in traumatic eye injuries without optic nerve involvement. OTS emerges as a reliable VEP substitute, particularly in blunt trauma cases, where baseline VEP amplitude predicts visual recovery more accurately than penetrating injuries.

Purpose: Obstructive sleep apnea (OSA) may increase the risk of age-related macular degeneration (AMD) due to repetitive oxygen deprivation or other mechanisms, though whether OSA increases the risk of AMD progression is unknown. We analyzed associations between OSA and AMD risk in the Taiwanese population.

Methods: We identified patients diagnosed with OSA between 2000 and 2018 in the Taiwan National Health Insurance Research Database and used 1:1 propensity score matching on demographics and co-morbidities to create a non-OSA cohort. We used Cox proportional hazard modeling to investigate the risk of AMD and the risk of progression from nonexudative to exudative AMD in OSA versus non-OSA patients.

Results: A total of 66,869 OSA patients were matched with 66,869 non-OSA patients. The hazard ratio (HR) of AMD in the OSA cohort was 1.36 (95% confidence interval[CI]: 1.31-1.43, p<.0001). The HR for progression from nonexudative to exudative AMD for the OSA cohort was 0.94 (95%CI: 0.77-1.14, p=0.5073).

Conclusion: OSA is associated with a higher risk of developing AMD. However, no increased risk of AMD progression is observed among people with OSA and existing non-exudative AMD.

Purpose: To evaluate systemic vascular fitness measured by finger photoplethysmography (PPG) in diabetic retinopathy (DR).

Methods: This was a cross sectional observational study on type-II Diabetes Mellitus patients from October 2020 to May 2021. Data collected include systolic/diastolic blood pressure (BP), visual acuity, HbA1c, and central macular thickness (CMT). DR severity was categorised using the ETDRS classification. PPG signals were acquired using pulse-oximeter modules (OEM-60, Dolphin Medical Inc) measured for 90 seconds at 275Hz sampling rate and 16-bits resolution which records photoplethysmography fitness index (PPGF), vascular-risk prediction index (VRPI) and vascular age (VascA).

Results: One-hundred-and-forty-one patients were equally distributed into six DR categories. Mean age was 58.8±9.9 years, with female-to-male ratio of 1.27. There were significant differences in mean systolic (125.5±10.0mmHg, p=0.007) and diastolic-BP (80.0±8.8mmHg), mean HbA1c (7.6±1.9%, p=0.005), median LogMAR (0.3, IQR:0.2-0.5, p<0.001) and CMT (p=0.003) across DR severity. Significant differences were also seen in PPGF (p=0.001), VRPI (p<0.001) and VascA (p=0.001), with poorer values in severe compared to mild/moderate DR. After adjusting for age, BP and HbA1c, PPGF reduces by 3.3% (regression coefficient, b= -3.27, p<0.001), VascA increases by 2.5 years (b=2.54, p=0.002) and VRPI increases by 3.1 (b= 3.08, p<0.001) with every DR worsening.

Conclusions: More severe DR were associated with poorer PPG vascular markers.

Purpose: To assess the real-world outcome of best-corrected visual acuity (BCVA) following 2-year intervention for treatment-naïve diabetic macular edema (DME) since the approval of anti-vascular endothelial growth factor (VEGF) therapy.

Methods: A total of 1,780 treatment-naïve eyes with DME for which intervention was initiated between 2015 and 2019, and which were followed for 2 years, were extracted from the longitudinal medical records of 37 retinal disease institutions in Japan. Interventions included anti-VEGF therapy, topical corticosteroid therapy, macular photocoagulation, and vitrectomy. The baseline and final BCVA, and the number and timing of interventions were recorded. Eyes were classified according to the year in which intervention was initiated.

Results: Over a 2-year period, BCVA improved annually, finally reaching 7 letters. The proportion of eyes in which good vision was maintained (BCVA >20/40) increased to 73.3% in the latest period. The administration of anti-VEGF therapy remained stable, accounting for approximately 90% of eyes. Notably, the proportion of eyes receiving anti-VEGF drugs as first-line treatment increased dramatically to approximately 80%.

Conclusion: Anti-VEGF therapy has become the first-line treatment since the approval of anti-VEGF drugs for DME. These findings reflect the evolution of DME treatment and highlight the superiority of anti-VEGF therapy and its increased uptake over time.

Purpose: This study aimed to evaluate the effectiveness of single-field fundus photography for diabetic retinopathy (DR) screening and monitoring versus six-field imaging in community settings.

Methods: Adults aged ≥30 years with type 2 diabetes from 15 communities in Northeast China were recruited for this prospective cohort study (n=2006 at baseline and n=1456 at follow-up). Participants underwent both single-field and six-field digital fundus photography at baseline and follow-up visits (mean duration of 21.2±3.2 months). Photographs were graded using international standards. Agreement in DR severity grading, referral recommendations, and detection of DR progression were compared between single-field and six-field fundus photography.

Results: Single-field grading showed substantial agreement with multi-field grading in classifying DR severity (81.9% identical at baseline, 80.6% at follow-up, Gwet's AC1 0.79 and 0.77). For referring eyes with moderate non-proliferative DR or worse, single-field grading had ∼70% sensitivity and 100% specificity compared to six-field grading. Single-field grading identified 74.9% or 79.7% of eyes progressing or regressing by six-field grading, respectively.

Conclusions: Single-field fundus photography demonstrated reasonable effectiveness for DR screening and monitoring in a community setting, supporting its use for improving access to DR detection. However, reduced sensitivity compared to multi-field imaging should be acknowledged.

Purpose: To assess the Gaiha Prio Retino +™Artificial Intelligence (AI) software for detecting diabetic retinopathy (DR).

Methods: This prospective study was conducted from March 1, 2021 to September 30, 2022 in the Ophthalmology department of the Abass NDAO Hospital (Dakar, Senegal). The clinical classification of DR was based on American Academy of Ophthalmology's. The clinical results were compared to those obtained from the automated reading of retinophotos taken using Gaiha Prio Retino +™, a software designed to detect DR.

Results: The study covered 305 eyes. Referable DR was observed in 104 eyes by the ophthalmologist and in 96 eyes by AI, corresponding with a sensitivity of 92.31%, a specificity of 99%, and an area under the curve (AUC) of 0.989. Vision-threatening DR was detected in 102 eyes by the ophthalmologist and in 94 eyes by AI, with a corresponding sensitivity of 92.16%, specificity of 99.01%, and an AUC of 0.975. Maculopathy was identified in 93 eyes by the ophthalmologist and in 89 eyes by AI, with a corresponding sensitivity of 95.7%, specificity of 97.17%, and an AUC of 0.988.

Conclusion: Considering these results, we may conclude that Gaiha Prio Retino +™ is an effective tool for screening referable DR.

Purpose: To design and build a new disease registry to track the natural history and outcomes of approved gene therapy in patients with inherited retinal diseases (IRDs).

Methods: A core committee of 6 members was convened to oversee the construction of the FIRB! module. A further 11 experts formed a steering committee, which discussed disease classification and variables to form minimum datasets via a consensus approach.

Results: The web-based FIRB! registry records baseline demographic, clinical and genetic data together with follow-up data. The Human Phenotype Ontology and Monarch Disease Ontology nomenclature were incorporated within the FIRB! architecture to standardise nomenclature. The registry software assigns individual diagnoses to one of 7 broad phenotypic groups, with minimum datasets dependent upon the broad phenotypic group. Additionally, minimum datasets were agreed upon for patients undergoing approved gene therapy with voretigene neparvovec (Luxturna). New patient entries can be completed in 5 minutes, and follow-up data can be entered in 2 minutes.

Conclusions: Fight Inherited Retinal Blindness! (FIRB!) is an organized, web-based system that uses observational study methods to collect uniform data from IRD patients to track natural history and (uniquely) treatment outcomes. It is free to Users, who have control over their data.