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

Purpose: To assess neurodegeneration and chorioretinal thickness in subjects with and without chronic kidney disease (CKD).

Methods: PubMed, Web of Science, Scopus and Embase were searched using proper keywords for articles published in the English language from their inception until January 2024. Publications were included if they reported optical coherence tomography (OCT) measurements of retinal or choroidal layers in patients with CKD compared to healthy or non-CKD controls. We used a random-effects model to calculate pooled standardized mean difference (SMD) estimates and 95% confidence intervals (CIs).

Results: Twelve studies, with 29,340 patients, were included in quantitative synthesis. In comparison to controls, patients with CKD had a significantly lower value for average retinal thickness (SMD [CI]: -0.35 [-0.58; -0.12], P = 0.028), choroidal thickness (SMD [CI]: -1.84 [-4.17; 0.49], P = 0.122), macular ganglion cell-inner plexiform layer (GC-IPL) (SMD [CI]: -0.58 [-0.78; -0.38]], P < 0.001), and peripapillary retinal nerve fiber layer (RNFL) thickness (SMD [CI]: -0.32 [-0.44; -0.20], P < 0.001). Significant RNFL thinning was observed in both diabetic CKD excluded and not excluded subgroups.

Conclusion: Compared to controls, the eyes of patients with CKD have significantly thinner retina, GC-IPL, and RNFL.

Purpose: To describe the clinical characteristics of macular holes (MH) with an intact bacillary layer.

Methods: This retrospective study analyzed the characteristics and surgical results of 23 eyes with MH and an intact bacillary layer, with or without rhegmatogenous retinal detachment (RRD).

Results: Among the 23 eyes, 11 had only MH, and 12 had concurrent fovea-off RRD. Ten eyes (43.5%) were highly myopic. In the MH-only group, no bacillary layer detachment (BALAD) was observed before MH formation. Ten eyes underwent vitrectomy with internal limiting membrane (ILM) peeling and intravitreal injection of C3F8, and the other one received an intravitreal C3F8 only. The MH closure rate was 90.9% after one operation and 100% after two. In the RRD group, 66.7% had BALAD. ILM peeling was performed in 8 eyes (66.7%). The MH closure rate was 91.7% after one operation and 100% after two. Both groups showed significant visual improvement after surgery (P < 0.05).

Conclusions: An intact bacillary layer can be observed in MH with or without concurrent fovea-off RRD. Surgical outcomes are similar to typical MH cases, and the intact bacillary layer may not facilitate MH sealing like the ILM. An ILM flap should be considered for large MHs or highly myopic eyes.

Purpose: Macular Telangiectasia type 2 (MacTel2) is a rare disorder affecting retina's vascular structure and MacTel2-associated full-thickness macular holes (MHs) are extremely rare in general population. Since their management is still controversial, this literature review aims to gather evidences on the surgical management of MacTel2-associated MHs.

Methods: A retrospective review on the Cochrane Central, PubMed, Web of Science, and ClinicalTrials.gov databases for papers regarding MacTel2 and MHs. The search period was set from January 2000 to February 2024, and any kind of article was taken into account.

Results: We took into account 10 studies analyzing surgical outcomes of MacTel2-associated MHs, with a total number of 95 treated eyes. Different surgical techniques were used, with a better anatomical outcome after internal limiting membrane (ILM) inverted flap surgery but with very controversial functional outcomes. In a comparative report, ILM peeling alone (34 eyes) was associated with a 47% anatomical success rate, ILM inverted flap (22 eyes) with 90% successful closure and autologous retinal transplantation (5 eyes) with a 100% success rate, but without visual improvement.

Conclusion: Since the exact pathophysiology of MacTel2 macular holes is not clear yet, even if the ILM inverted flap technique could be an effective treatment for these patients, visual outcomes are poor. This underlines the necessity of a deeper comprehension of the pathophysiology of the disease and the development of new surgical approaches.

Purpose: To characterize long-term functional and anatomical outcomes in patients with familial exudative vitreoretinopathy (FEVR).

Methods: A retrospective chart review was conducted of all patients with a diagnosis of FEVR at a tertiary academic institution and its affiliated children's hospital treated from January 2003 through January 2024. Demographic and clinical data were collected. Functional vision was defined as at least one eye with Snellen visual acuity (SVA) ≥20/40 and ambulatory vision defined as at least one eye with SVA ≥20/200.

Results: A total of 186 eyes from 96 patients comprised the FEVR cohort, of which 90 eyes from 46 patients were included for analysis. Average age at presentation was 6.4 years (SD 8.6) and average duration of follow-up was 9.1 years (SD 7.3, range 0-40).At most recent exam, 77.3% of patients had functional vision and 88.6% had ambulatory vision. Globe salvage was achieved in 98.4% of eyes. Of the exam findings studied, only retinal detachment at presentation was significantly associated with worse vision in multivariable analysis.

Conclusions: Patients in our FEVR cohort show promising long-term functional and ambulatory vision outcomes. More than 75% of patients were 20/40 or better, and 89% of patients avoided legal blindness.

Purpose: To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM).

Methods: A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery.

Results: Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group.

Conclusion: Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.

Purpose: Propose new terminology and evaluate the effectiveness of Therapeutic Refractive Vitrectomy (TRV) for selective removal of vitreous floaters and opacities (VFO) utilizing Standardized Kinetic Anatomical Functional Testing of VFO (SK VFO Test) and new ultra widefield (UWF) OCT imaging techniques.

Methods: Retrospective analysis. Twenty eyes underwent TRV for symptomatic VFO. Pre-/post-TRV assessments: SK-VFO Test, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside non-contact imaging including a new UWF OCT to evaluate changes in vitreous anatomical and optical properties.

Results: Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HDA 22%, LDA 54.4% (p=0.013), and C-Quant 7.8% (p=0.034). Patient reported outcomes statistically significantly improved (p=0.022). Corrected distance visual acuity (CDVA) changes were marginal. New UWF 26 mm with a 12 mm imaging window OCT facilitated detailed vitreous imaging, confirming status of posterior vitreous detachment (PVD) (100%). Post-TRV UWF and OCT imaging demonstrated restoration of vitreous clarity, confirmed presence of residual cortical vitreous and absence of new PVDs.

Conclusion: TRV is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in CDVA was minimal representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of TRV on visual function and quality of life.

Purpose: To investigate the surgical effect of complete drainage of suprachoroidal fluid (SCF) before vitrectomy to avoid perioperative steroids in rhegmatogenous retinal detachment combined with choroidal detachment (RRD-CD) eyes.

Methods: It was a prospective, randomized controlled trial. 58 eyes were randomly divided into the no steroids (NS) group and local steroids (LS) group, 29 eyes each, respectively. Patients in the LS group received a single preoperative periocular injection of methylprednisolone, while SCF drainage was performed before vitrectomy in eyes of the NS group. Follow-up assessments were performed at 1 week, 1 month, 3 months, 6 months postoperatively.

Results: The postoperative retinal reattachment rate was similar in the NS and LS groups (96.6% vs 93.1%, p = 1.00). Best-corrected visual acuity was improved in 72.4% and 75.9% in the NS and LS groups, respectively. Inflammation occurred in 5 eyes (17.2%) in the NS group and 6 eyes (20.7%) in the LS group (p = 0.74). Hypotony occurred in 11 (37.9%) and 14 (48.3%) eyes in the LS and NS groups (p = 0.43), respectively. Macular chorioretinal folds were found in 21 (72.4%) and 22 (75.9%) eyes in the LS and NS groups (p = 0.76), respectively. Hypotony and chorioretinal folds disappeared after 1 week postoperatively.

Conclusions: Preoperative steroids may not be necessary for RRD-CD patients if the SCF is completely drained before vitrectomy. Postoperative retinal reattachment does not depend on the use of preoperative steroids; instead, surgeons should focus on improving surgical techniques in RRD-CD to improve the retinal reattachment rate.

Purpose: To investigate the clinical course and prognostic factors of age-related macular degeneration (AMD) without macular neovascularization (MNV) in patients presenting with pigment epithelial detachment (PED) and the associated subretinal fluid (SRF).

Methods: Morphological characteristics of spectral-domain optical coherence tomography images were analyzed to determine anatomic outcomes. Factors associated with the progression to late AMD, defined as complete retinal pigment epithelium and outer retinal atrophy (cRORA) or MNV, were investigated.

Results: Fifty eyes of 41 patients were included in this study. The most common SRF location was the angle of the PED (56%), and there was a significant decrease in SRF thickness and PED height and width over the follow-up period. Eleven (22%) eyes developed cRORA, and seven (14%) eyes developed MNV during a mean period of 52.1 months. Multivariate analysis revealed that hyperreflective foci and MNV in the fellow eye were associated with the development of cRORA, and higher PED height was a significant factor associated with the development of MNV.

Conclusions: In patients with AMD, SRF can be accompanied by PED in the absence of MNV. Notably, patients with this characteristic entity can progress to late AMD, including cRORA and MNV, in a significant proportion of cases.