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

Purpose: To analyze the frequency of misdiagnoses in macular telangiectasia type 2 (MacTel) and to investigate factors influencing the probability of receiving an incorrect diagnosis.

Methods: A retrospective analysis of 288 patients with confirmed diagnosis of MacTel from the Natural History Observation Registry at the University Eye Hospital Bonn was performed. Patients were grouped as follows: correct diagnosis of MacTel, misdiagnosis, and incidental finding. Clinical and demographic data, including best-corrected visual acuity, symptoms, and prior treatments, were recorded. Misdiagnoses were categorized, and predictors were analyzed using mixed effect models.

Results: Of 288 patients, 174 (60.4%) were correctly diagnosed, 103 (35.8%) were misdiagnosed, and 11 (3.8%) diagnosed incidentally. Misdiagnoses included macular hole (17.3%), maculopathy (12.5%), and AMD (12.5%). Mean age at symptom onset was 54.7 (±9.8) years; mean time to correct diagnosis was 38.5 ± 50.3 months, decreasing from 115 months (2000-2005) to 5.9 months (after 2020). Younger age at symptom onset reduced the probability of misdiagnosis (odds ratio 0.96, 95% CI: 0.94-0.98), subjective glare sensitivity increased misdiagnosis probability (odds ratio 2.01, 95% CI: 1.14-3.55).

Conclusion: Misdiagnoses of MacTel are common and may delay care. Improved awareness and imaging have shortened these delays. Early multimodal imaging and clinician education remain key to timely diagnosis and better management.

Purpose: To evaluate the long-term incidence of hypercoagulable complications in young patients with retinal vein occlusions and negative workups compared with matched controls.

Methods: A retrospective cohort study was conducted using the TriNetX Analytics Network. Patients aged 18 to 50 with newly diagnosed retinal vein occlusion and no history of hypertension, glaucoma, thrombophilia, or recent oral contraceptive use were compared with age-matched controls. Propensity score matching was performed to balance baseline demographics and comorbidities. Primary outcomes included the cumulative incidence and risk ratio (RR) of deep vein thrombosis, pulmonary embolism, cerebral infarction, anticoagulant use, composite embolic events, myocardial infarctions and composite cardiovascular events over 1, 3, and 5 years. A secondary validation cohort was performed using controls diagnosed with astigmatism.

Results: After propensity score matching, 2,731 patients were included in each cohort. Patients with retinal vein occlusion had significantly higher rates of venous thromboembolism, cerebral infarction, anticoagulation use, and composite embolic outcomes at 1, 3, and 5 years (all P < 0.0001). No significant differences were observed in myocardial infarctions or composite cardiovascular event outcomes.

Conclusion: Young patients with retinal vein occlusion and no identifiable vascular or hypercoagulable risk factors are at significantly increased risk for venous thrombosis and stroke, but not myocardial infarction.

Purpose: To examine multimodal imaging findings in eyes before and after the onset of exudative macular neovascularization (ExMNV) bypassing the stage of pigmentation in Macular Telangiectasia Type-2.

Methods: From a total of 798 patients, Macular Telangiectasia Type-2 eyes with ExMNV that exhibited no signs of focal hyperpigmentation on color fundus photograph, fundus autofluorescence, and spectral-domain optical coherence tomography were retrospectively evaluated.

Results: There were 16 eyes of 16 patients (2%) with a mean age of 50.60 ± 9.82 years. Among them, 11 eyes had ExMNV at the time of examination, whereas the remaining five eyes developed ExMNV during the follow-up period, all lacking pigment when it occurred. The average time for ExMNV development in the five eyes was 27.6 months (range: 11-46 months). Preceding signs of ExMNV included right-angled vessels and telangiectatic leaks causing the following optical coherence tomography changes-temporal parafoveal thickening in three eyes, minimal intraretinal fluid pockets in three eyes, convex hyporeflective subretinal space in two eyes, and subretinal fluid in two eyes. With further declension/descent of inner into outer retina, progression of ellipsoid zone loss was seen and outer retinal hyperreflectivity formed in areas with preexisting ellipsoid zone loss with visual acuity decline. Multiple retinal vessels formed an anastomosis with each other and extended into the center of the subretinal neovascular lesion.

Conclusion: Patients with early Macular Telangiectasia Type-2 can proceed directly to ExMNV without pigmentation. Recognizing the signs before ExMNV develop will allow for closer follow-up and earlier treatment of these patients to prevent irreversible visual loss.

Purpose: To investigate the incidence of ocular hypertension (OHT) after suprachoroidal injection of triamcinolone acetonide (SCS-TA) for noninfectious uveitic macular edema.

Methods: Retrospective review of eyes undergoing SCS-TA. The primary outcome was incidence of OHT (intraocular pressure [IOP] > 24 mmHg). Secondary outcomes included incidence of IOP > 30 mmHg, IOP rise ≥10 mmHg above baseline, and treatment for OHT.

Results: Seventy-six eyes of 70 patients were treated with a mean of 1.71 (range 1-5) SCS-TA injections with an average follow-up of 7.6 (range 3.0-14.9) months. Nine eyes (11.8%) developed OHT, four eyes (5.3%) had IOP > 30 mmHg, and nine eyes (11.8%) had an IOP elevation of ≥ 10 mmHg above baseline at any point after their first injection. Eyes that developed OHT were treated with topical therapy (7 eyes, mean 1.9 agents, range 1-4 agents) or close observation (2 eyes). No eyes required incisional glaucoma surgery. Eyes with a history of glaucoma or OHT (7/34, 20.1%) were more likely to develop OHT versus eyes with no history (2/42, 4.8%, P = 0.03).

Conclusion: In this real-world cohort, SCS-TA was associated with a low-incidence of OHT, consistent with clinical trial data. A history of glaucoma or OHT is a significant association for developing OHT after SCS-TA.

Purpose: To compare the clinical features, multimodal imaging characteristics, and treatment outcomes of primary and secondary large retinal capillary aneurysms (LRCAs).

Methods: A total of 34 eyes were included: seven with primary LRCA and 27 with secondary LRCA. All patients underwent fundus photography, optical coherence tomography (OCT), and fundus fluorescein angiography. Indocyanine green angiography and OCT-angiography were performed in selected cases. Various clinical, morphologic, and vascular features and treatment outcomes were evaluated and compared between the primary and secondary LRCA groups.

Results: All lesions in the primary LRCA group were unilateral, and five of seven were unifocal. However, in the secondary LRCA group, 19% of patients had bilateral involvement and lesions were multifocal in 48% of eyes. OCT characteristics, including the horizontal and vertical diameters of aneurysmal lesions and mean subfoveal choroidal thickness, were similar for the groups ( P > 0.05). During follow-up, neither visual acuity nor central macular thickness changed significantly in the primary LRCA group and no cases responded to treatment, whereas these improved significantly in the secondary LRCA group.

Conclusion: Clinical and imaging characteristics of primary and secondary LRCA lesions were similar, although treatment outcomes were more favorable in secondary LRCA lesions because of the differing pathophysiology and etiology.

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.