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

Purpose: To investigate the hyperreflective spots (HRS) across different stages of epiretinal membrane using optical coherence tomography and their relationship with anatomical and functional parameters.

Methods: This observational study included 111 patients with epiretinal membrane, categorized into early (Stages 1-2, n = 43) and late (Stages 3-4, n = 68). Total HRS (HRST), visual acuity, central retinal thickness, and outer nuclear layer thickness were measured using optical coherence tomography. Statistical analyses included Mann-Whitney U test for group comparisons and Spearman correlation to assess relationships between HRST and visual acuity.

Results: Total hyperreflective spots increased significantly from early (27.67 ± 12.57) to late (35.15 ± 17.28, P = 0.015) stages. In early stages, HRST showed a moderate positive correlation with visual acuity (ρ = 0.48, P = 0.001), whereas this correlation diminished in late stages (ρ = 0.036, P = 0.426). Central retinal thickness also increased significantly from early to late stages (380.05 ± 94.51 µ m vs. 523.54 ± 83.92 µ m, P < 0.001). Outer nuclear layer thickness showed no significant difference between the stages ( P = 0.543). In early stages (Stage 1-2), linear regression model showed that HRST and central retinal thickness were valuable visual acuity predictors (Adjusted R 2 = 0.284, P < 0.05).

Conclusion: Total hyperreflective spots progressively increases with epiretinal membrane severity, correlating with visual function in early stages but losing this association in advanced stages. These findings suggest that HRST could be a prognostic marker for early disease progression and highlight the need for timely intervention to preserve visual function.

Purpose: To investigate the ultrastructure of inner limiting membrane (ILM) pores in whole-retina specimens, and to compare with surgically excised specimens from eyes with vitreo-maculopathies.

Methods: Ultrastructural analysis included 1) three-dimensional serial block-face scanning electron microscopy (3D SBF-SEM) of inner retinal layers from macular area of two human donor eyes and 2) transmission electron microscopy (TEM) of ILM specimens obtained from 25 eyes with tractional vitreo-maculopathies that tested positive for the presence of ILM pores.

Results: SBF-SEM analysis revealed circumscribed areas of ILM thinning and multiple retinal cell processes protruding into the ILM with or without ILM breakthrough. In the peri-pore regions, the ILM was thin and bulged toward the vitreous. Müller cells had finger-like extensions through the ILM forming small individual breakthrough points. Surgically removed ILM specimens also showed regions with ILM thinning and protruding retinal cell fragments in the ILM but with no preexisting ILM breakthroughs. Epiretinal cells were found on the vitreal side of the ILM pore regions.

Conclusion: There is evidence that ILM pores are newly formed by retinal Müller cells, growing their processes through the ILM toward its vitreal side in health and disease. These pore regions may contribute to the formation of epiretinal membranes.

Purpose: To explore whether the proteome of aqueous collected during primary repair of rhegmatogenous Retinal Detachment (RD), differs between patients who experience recurrency (Recurrent RD Group) and those who do not (No Recurrent RD Group).

Methods: The aqueous proteome collected during primary surgery of 13 patients undergoing Recurrent RD was compared to 11 age and sex-matched patients successfully operated for rhegmatogenous RD with no recurrency after 12-months follow-up, regardless of surgical technique. A label-free shotgun proteomics approach identified and quantified the repertoire of aqueous proteins. Differential protein expression between Groups was determined using the Limma moderated Bayesian t-test, followed by False Discovery Rate (FDR) validation using Storey's q-test.

Results: Aqueous profiling identified >800 unique proteins; 45 exclusive to the Recurrent RD group, 10 exclusive to the no Recurrent RD group and 33 differently expressed between groups (log2fold-change≥∣0.57∣, FDR≤0.05). Proteins upregulated in Recurrent RD patients, clearly pointed to mechanisms of cell:cell and cell:matrix adhesiveness and mechano-transduction signalling pathways. Upregulated proteins included extracellular matrix components such as type I and IV collagens, bi-glycan, proteoglycans, and cell-membrane adhesion molecules.

Conclusion: The baseline aqueous composition of RD patients that will eventually develop recurrency, differs significantly from those who will not, and already contains molecular signatures that may help identify the risk of recurrency at the time of primary repair. While acknowledging the pilot nature of the study, our findings strongly suggest that Recurrent RD is associated with cell adhesiveness pathways early alterations, offering targets for prognostic assessment and therapy.

Purpose: To compare the characteristics of pediatric patients with pars planitis (PP) who received treatment versus those who were observed without treatment.

Methods: Retrospective chart review of pediatric patients diagnosed with pars planitis at a tertiary referral center from 2000 to 2024.

Results: Out of 158 eyes from 84 patients with PP, 127 (80.4%) eyes received treatment, and 31 (19.6%) eyes were observed. Eyes that were observed presented with less anterior chamber cell (p<0.007), vitreous cell (p=0.0005), vitreous haze (p=0.003), and optic nerve head edema (p=0.03). The untreated group had significantly lower total fluorescein angiography (FA) scores (p<0.0001) than the treated group and specifically scored lower in disc leakage (p=0.006) and retinal capillary leakage (p<0.0001). In the treated group, 66 (52%) eyes developed ocular hypertension and 24 (18.9%) developed glaucoma, whereas the untreated group had no cases of either. Final visual acuity was similar between treated and untreated groups (20/32 vs 20/25, p=0.13), and no untreated eyes developed complications requiring surgery.

Conclusion: Not all patients with pediatric PP require treatment. Select mild cases may be safely observed without developing sequelae of chronic inflammation. Proper identification of these patients can reduce side effects and medication burden.

Purpose: This cross-sectional study explored the association between sleep deprivation and epiretinal membrane (ERM) using machine learning applied to data from the Korean National Health and Nutrition Examination Survey 2017-2020.

Methods: Data from 2018-2020 were used for training and internal validation, and from 2017 for external validation. Participants were divided into ERM and non-ERM groups, and their sociodemographic, lifestyle, and clinical characteristics were assessed. Sleep deprivation was defined as sleeping <6 h on weekdays. Machine learning-based logistic regression was used to model the association between sleep deprivation and ERM, adjusting for confounders. The consistency of the results and importance of each feature were assessed using subgroup analyses and Shapley additive explanations.

Results: Data from 15,240 participants were included, with an ERM prevalence of 9.59%. The final adjusted model achieved an area under the ROC curve of 0.763 (95% CI 0.733-0.792) in external validation. Sleep deprivation was significantly associated with increased ERM risk (adjusted odds ratio [OR], 1.247; 95% CI 1.051-1.481), particularly among non-high-risk alcohol consumers (OR 1.216; 95% CI 1.057-1.399) and individuals with diabetes mellitus (OR 1.259; 95% CI 1.069-1.481). Sleep deprivation was the fourth most influential predictor (5.3%), following age, cataract surgery, and dyslipidaemia.

Conclusions: Sleep deprivation was significantly associated with a 1.25-fold increase in the prevalence of ERM, especially among non-high-risk alcohol consumers and those with diabetes. Weekday sleep deprivation may be a modifiable risk factor for ERM. Prospective studies are warranted to confirm causality and explore the underlying mechanisms.

Purpose: To characterize the imaging features of choroiditis across different disease stages using the blend function in ultra-widefield imaging (UWFI) and compare its findings with fundus autofluorescence (FAF).

Methods: This study included 30 patients ( 25 eyes) with choroiditis, categorized into active, resolving, and healed stages. UWFI images were analyzed using the red and green channels to assess specific imaging characteristics at each disease stage. FAF findings were compared to evaluate disease activity and progression.

Results: Active choroiditis lesions were distinctly visualized on the green channel with well-defined inflammatory borders, whereas the red channel showed faintly discernible lesions without clear margins. FAF revealed diffuse hyperautofluorescence but lacked precise border delineation. In the resolving stage, lesion hyperintensity progressively diminished on the green channel, while red channel visibility decreased significantly. FAF changes were subtle, with reduced autofluorescence intensity. Healed lesions exhibited isointense areas on the green channel with well-defined borders, while hyperpigmented regions appeared as hypointense patches on the red channel. FAF showed uniformly dark zones corresponding to healed areas. Retinal vascular abnormalities were more prominently detected on the green channel compared to other imaging modalities.

Conclusion: The blend function in UWFI offers a novel, stage-wise characterization of choroiditis, with the green channel providing superior delineation of active inflammatory lesions compared to FAF. The red channel serves as an adjunct in assessing disease resolution. This imaging approach enhances diagnostic accuracy and facilitates objective disease monitoring, potentially improving clinical decision-making in inflammatory chorioretinal disorders.

Purpose: To assess the diagnostic value of tomographic signs on OCT and OCT-A, particularly paracentral acute middle maculopathy (PAMM), in predicting temporal artery biopsy (TAB) positivity in suspected giant cell arteritis (GCA), irrespective of ophtalmological involvement.

Methods: This prospective monocentric study included patients referred for TAB between January and October 2023. All underwent bilateral macular and optic nerve OCT and OCT-A using AngioPlex™ CIRRUS™ HD-OCT (Carl Zeiss Meditec). TAB-positive patients were considered biopsy-proven GCA. Primary analysis focused on the association between PAMM and TAB positivity. Secondary analysis explored vascular choroidal index (CVI), radial peripapillary capillaries (RPC), and OCT-A abnormalities.

Results: Among 70 patients, 22 (31%) had positive TAB. PAMM was observed exclusively in TAB+ patients (n=8), with specificity and positive predictive value of 100%. Sensitivity and negative predictive value were 38.1% and 77.6%, respectively. Homolateral anterior ischemic optic neuropathy (AION) was always associated with GCA. CVI and other OCT-A findings did not differ significantly between groups. RPC density was significantly reduced in eyes with ophthalmological involvement (p=0.017).

Conclusion: PAMM is a highly specific OCT sign of TAB positivity in suspected GCA. This non-invasive marker may support early therapeutic decisions in suspected GCA.

Purpose: To estimate the efficacy of intravitreal injection (IVI) VS subretinal injection (SRI) of tissue plasminogen activator (tPA) in the treatment of submacular hemorrhage (SMH).

Methods: A comprehensive literature search was conducted in six major datasets from inception to 31 October 2025. Random effects meta-analysis was performed to evaluate the final best-corrected visual acuity (BCVA, logMAR) and the changes in central retinal thickness (CRT, μm) and the risk ratio (RR) of complete displacement of hemorrhage.

Results: A total of 7 studies on 353 eyes were finally included. BCVA was similar between the IVI and SRI groups at 1 month and 6 months post-operation, while better in the IVI group 3 months postoperatively. The final CRT was similar between the two groups. There were no statistical differences between the two groups in the RRs of complete displacement of hemorrhage, total adverse events, recurrent SMH, increased IOP, postoperative retinal detachment and vitreous hemorrhages.

Conclusions: The IVI group showed a better BCVA at 3 months, the two groups showed comparable results in the recovery of BCVA, CRT and complete hemorrhage displacement at the final visit (within 6 months).