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

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.

Purpose: To identify preoperative clinical characteristics of macular hole (MH) formation after vitrectomy for submacular hemorrhage (SMH) due to ruptured retinal arterial macroaneurysm (RAM).

Methods: We retrospectively analyzed eyes with SMH due to ruptured RAM in patients who underwent vitrectomy and had more than one month of follow-up. We compared background factors and imaging findings between groups classified by MH presence. The primary outcomes were best-corrected visual acuity, and fundus and optical coherence tomography findings.

Results: We identified 48 eyes with SMH due to RAM rupture. MHs were identified in 8 eyes (16.3%); 4 intraoperatively and 4 postoperatively. Preoperative OCT findings revealed that all MH cases exhibited the highest retinal thickness at the foveal lesion with sub-internal limiting membrane (ILM) hemorrhage preoperatively. We termed this finding the "foveal mountain peak" (FMP) sign, characterized by sub-ILM hemorrhage where the peak of the retinal thickness coincides with the fovea. The incidence of FMP sign (+) cases was significantly higher in the MH (+) group compared with the MH (-) group (100% vs. 47.5%, respectively; P = 0.006).

Conclusion: The presence of the FMP sign may indicate an increased risk of SMH-associated MH.

Purpose: Qualitative and quantitative analyzes of retinal arteriolar tortuosity (RAT) in patients with COL4A1 and COL4A2 mutations to identify a tortuosity index (TI) threshold for detecting increased RAT.

Methods: Fifty-two eyes of 28 patients were included. Group 1 included eyes with a normal arteriolar pattern (n=19, 37%), group 2 included eyes with moderately increased arteriolar tortuosity (n=13, 25%), and group 3 included eyes with typical abnormal arteriolar tortuosity (n=20, 38%). The TI was measured by calculating the arc-to-chord ratio of arterioles and venules in the posterior pole.

Results: The mean arteriolar TI was significantly higher in all groups with a COL4A1/A2 mutation compared to controls: 1.19 ± 0.03, 1.24 ±0.05, and 1.57 ± 0.23 in groups 1, 2 and 3, respectively, vs. 1.12 ± 0.01 (all p <0.0001). The TI threshold was 1.13, with a sensitivity of 98.1% and a specificity of 100%. The area under the curve was 0.995.

Conclusion: Measuring the arteriolar TI allowed diagnosing increased RAT in all eyes with a COL4A1/A2 mutation, whereas the subjective assessment suspected or detected it in only 62% of eyes. In adult patients with cerebral microangiopathy, detecting increased RAT, even when mild, directs the diagnosis towards COL4A1/A2-related cerebroretinal angiopathy.

Purpose: We aimed to evaluate the impacts of the different types of posterior staphyloma (PS) in high myopia on parapapillary microvasculature and parapapillary atrophy (PPA, i.e., γ-zone and δ-zone) with optical coherence tomography angiography.

Methods: This cross-sectional study included 152 high myopic eyes (152 participants) with γ-zone. After matching, high myopic eyes were stratified into PS (n = 33) and non-PS (n = 33) groups. PS types, parapapillary microvasculature characteristics, the prevalence of non-juxtapapillary microvasculature dropout (NJ-MvD), the longest radial width from the optic disc edge to retinal pigment epithelium atrophy edge (PPA-w), γ-zone, and δ-zone with changes in visual field and best-corrected visual acuity (BCVA) were evaluated and analyzed.

Results: According to Curtin's classification, we identified five types of PS included: primary types I, II, III, and compound types VII, and IX. Eyes with type II showed a higher optic disc tilted ratio and larger PPA-w compared to other primary PS. Subjects with type IX were the oldest. Eyes with types VII and IX had wider γ-zone and δ-zone, worse visual field outcomes, poorer BCVA, and a higher incidence of NJ-MvD compared to primary PS. Choroidal and intrascleral vessels were associated with NJ-MvD and were located near or connected to the circle of Zinn-Haller.

Conclusions: Eyes with high myopia and PS show wider PPA, affecting the γ-zone and δ-zone, and are at a higher risk of developing NJ-MvD. Specifically, eyes with PS types VII and IX are more susceptible to visual field damage and decreased BCVA. These results highlight the importance of impact of PS on PPM and PPA in high myopia.

Purpose: To investigate the anatomical and visual outcomes of inverted internal limiting membrane (i-ILM) flap insertion versus single-layered i-ILM flap covering in highly myopic macular holes (HMMHs) associated with macular retinoschisis (MRS).

Methods: A retrospective study compared 23G vitrectomy with i-ILM flap insertion (30 eyes) or covering (31 eyes) in HMMH patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis (MHS) was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA.

Results: The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group (P=0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group (P=0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared to the insertion group (1/28) finally (P=0.026). Final BCVA improved significantly in both groups (P<0.001), the BCVA was better in closed HMMHs in the covering group (P=0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β=0.386, P=0.001) and MHS stage (β=0.309, P=0.004) were independent predictive factors for the final BCVA.

Conclusion: The single-layered i-ILM flap covering favored foveal structure recovery and provided a better visual prognosis in closed HMMHs compared with insertion. The preoperative BCVA and MHS stage were independent predictors of visual outcomes in patients with HMMHs.