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

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.

Purpose: To compare the anatomical and functional outcomes of heavy silicone oil (HSO) and standard silicone oil (SSO) in primary rhegmatogenous retinal detachment, along with postoperative complications.

Methods: Meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered on PROSPERO (CRD42024507061). We retrieved randomized trials, prospective and retrospective studies comparing HSO and SSO to manage primary inferior/posterior or complex rhegmatogenous retinal detachments published from 2000 to nowadays in PubMed/Medline-Embase-Cochrane-Scholar-Web of Science. This meta-analysis focused on primary success rates, best-corrected visual acuity improvement, and postoperative complications.

Results: A total of 6 studies on 984 eyes (615 in SSO and 369 in HSO group) were included. In a fixed-effect model ( P = 0.112, I 2 = 43.99%), HSO and SSO tamponades showed comparable primary anatomic success rates (odds ratios 1.461, 95% confidence interval [CI]: 0.890-2.399, P = 0.134). Average best-corrected visual acuity improvement was similar between the two groups (I 2 = 79.21%, weighted mean difference -0.071 logarithm of the minimum angle of resolution; 95% CI: -0.524 to 0.382, P = 0.61). Conversely, HSO tamponade was associated with higher rates of IOP elevation (I 2 = 37.42%, odds ratios 2.073, 95% CI: 1.182-3.634, P = 0.011) and emulsification (I 2 = 16.43%, odds ratios 2.953, 95% CI: 1.109-7.862, P = 0.030). Finally, inflammation rates did not differ between HSO and SSO (I 2 = 66.46%, odds ratios 2.015, 95% CI: 0.234-17.323, P = 0.523).

Conclusion: Heavy silicone oils showed similar rates of primary anatomic success when compared with SSOs in complex primary rhegmatogenous retinal detachments. Although hindered by poor baseline values, visual outcomes were generally comparable among the two groups. In contrast, HSO group showed higher rates of postoperative IOP elevation and emulsification.

Purpose: To explore the safety of high-dose intravitreal topotecan for recurrent retinoblastoma management in human eyes.

Methods: There were 81 consecutive injections of high-dose intravitreal topotecan (90 μ g/0.18 cc‒100 µ g/0.20 cc on a monthly basis) in 25 eyes with recurrent retinoblastoma. Tumor control and injection-related complications were assessed at each visit. Each tissue was reviewed for complication-associated alterations, and systemic evaluation for myelosuppression, infection, metastasis, and death was assessed.

Results: At the time of injection, the mean patient age was 26 months, and in all cases, the injection was for recurrent retinoblastoma (n = 24 eyes, 100%) involving intraretinal tumor (n = 6 eyes, 24%), vitreous seeds (n = 3 eyes, 12%), subretinal seeds (n = 13 eyes, 52%), or multiple tumor types (n = 3 eyes, 12%). The mean intraretinal tumor thickness was 2.2 mm, vitreous seed thickness varied from pinpoint to confluent seeds, and subretinal seed was 0.9 mm. The total number of high-dose intravitreal topotecan injections was 81 (mean 3.2 per eye) with 39 (48%) injections given without concurrent chemotherapy and 42 (52%) given with concurrent intravenous or intra-arterial chemotherapy. At mean follow-up of 10 months after first injection, tumor control was achieved in all cases (n = 81 injections, 100%), and there was no local or systemic complication in any of the 81 injections. There was no case of extraocular tumor extension, myelosuppression, infection, metastasis, or death.

Conclusion: Based on this analysis, high-dose intravitreal topotecan is safe and effective in the management of recurrent small retinoblastoma in humans. Further investigation of the limits of this therapy is warranted.

Purpose: To investigate the role of widefield en face imaging of retinal pigment epithelium (RPE) alterations using swept-source optical coherence tomography for rapid classification of central serous chorioretinopathy (CSCR).

Methods: In this cross-sectional, single-center study, eyes diagnosed with unilateral CSCR were included. Volume swept-source optical coherence tomography scans (12 × 12 mm) were obtained for all the participants. High-quality structural en face images were automatically generated at the level of Bruch membrane based on artificial intelligence to evaluate the RPE alterations.

Results: The study included 122 affected eyes from patients with unilateral CSCR, with a mean age of 46.3 ± 9.1 years. In 51 of the 122 cases, fundus autofluorescence, fundus fluorescein angiography, indocyanine green angiography, and en face imaging were assessed simultaneously. Among these, 17 eyes were categorized as complex CSCR. Fundus autofluorescence exhibited the highest detection rate of RPE abnormalities (94.1%). En face imaging revealed RPE abnormalities in 15 of 17 eyes (88.2%), whereas indocyanine green angiography detected RPE abnormalities in 12 of 17 eyes (70.6%). Only 6 of 17 eyes (35.3%) showed RPE abnormalities in fundus fluorescein angiography. The RPE alterations in the remaining 71 eyes with CSCR were evaluated solely using en face imaging, wherein 17 eyes were designated as complex CSCR and 54 eyes were categorized as simple CSCR.

Conclusion: Evaluation of RPE alterations using widefield en face imaging has potential as a reliable, noninvasive approach to rapid classification of CSCR using the latest classification system, particularly when combined with contralateral eye imaging results.

Background/purpose: To characterize the delay between symptom onset and diagnosis in patients with early-, intermediate-, and late-onset Stargardt disease (STGD) and identify possible factors contributing to this delay.

Methods: Chart review was conducted for patients with confirmed STGD molecular diagnosis seen by an inherited retinal disease (IRD) specialist at a tertiary academic institution.

Results: Eighty-seven patients were included. Average time from symptom onset to first IRD specialist visit was 10.95 years (SD = 12.74). Average time between seeing a subspecialist and IRD specialist was 8.09 years (SD = 12.2), with the intermediate-onset group having a significantly longer delay (mean 13.1 years) compared with early-onset (mean 5.01 years, P = 0.025) and late-onset group (mean 3.1 years, P = 0.02). Visual acuity significantly decreased between seeing a subspecialist and IRD specialist ( P = 0.047). Patients with late-onset STGD were more likely to have intact subfoveal ellipsoid zone compared with early and intermediate-onset patients.

Conclusion: Patients with STGD face long delays from symptom onset to molecular diagnosis, with progressive vision loss and missed opportunities for clinical trial enrollment. Contributing factors include age of onset, types of initial symptoms, and transitions in care from subspecialist to IRD specialist. Multimodal screening, more streamlined referral pathways, expedited genetic testing, and greater awareness of highly variable STGD phenotypes may mitigate these delays.

Purpose: To determine the characteristics and treatment of the extensive subretinal fibrosis (ESF) in eyes with rhegmatogenous retinal detachment but without a tractional retinal detachment in patients with familial exudative vitreoretinopathy.

Methods: Ten eyes of nine men and one woman with ESF in patients with rhegmatogenous retinal detachment-familial exudative vitreoretinopathy were studied. The characteristics, surgical procedures, and the outcomes after the removal of the ESF were determined. The ESF was excised by either stripping the ESF from small retinotomies or by en bloc excision through a >180° retinotomy or retinectomy at the ora serrata.

Results: The median age of the patients was 12.5 years. All cases had a unilateral macula-off retinal detachment with a total detachment in four eyes and detachment over two quadrants in six eyes. The first case underwent ESF stripping through small retinotomies that required seven additional surgeries with a final visual acuity of hand motion. The subsequent 9 cases underwent en bloc excision resulting in a retinal reattachment with silicone oil tamponade. The silicone oil was removed without a recurrence of the RD during a median follow-up period of 7 years. The median final visual acuity was 20/66 with a range of 20/17 to 20/500.

Conclusion: Extensive subretinal fibrosis can be found in familial exudative vitreoretinopathy eyes with a slowly progressive rhegmatogenous retinal detachment. We conclude that the en bloc excision of the ESF is an effective and safe procedure to reattach the retina and thus improve the visual acuity.

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 evaluate the long-term functional and anatomical outcomes of pars plana vitrectomy (PPV) combined with subretinal recombinant tissue plasminogen activator (tPA) injection and gas tamponade in patients with subretinal hemorrhage secondary to retinal arterial macroaneurysm (RAM) rupture.

Methods: This retrospective multicenter study included 18 eyes of 18 patients who underwent PPV with subretinal tPA injection and gas tamponade for subfoveal hemorrhage due to RAM rupture. Baseline demographic and clinical features, pre- and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT), postoperative complications, and the relationship between symptom-to-surgery interval and visual outcomes were evaluated over a minimum follow-up period of 12 months.

Results: The mean preoperative BCVA was approximately 20/3300 (2.22 ± 0.73 logMAR), improving to about 20/140 (0.85 ± 0.57 logMAR) at the 12-month visit (p < 0.001). Earlier surgical intervention (≤14 days) was associated with greater improvement in BCVA. Subfoveal retinal pigment epithelium (RPE) atrophy developed in 38.9% of patients and was significantly associated with worse visual outcomes compared to extrafoveal atrophy (p = 0.02). ILM peeling was performed in 44.4% of cases; although those patients tended to have greater BCVA gains, the difference was not statistically significant. RPE atrophy was observed in 77.8% of patients postoperatively, with varying progression patterns.

Conclusions: PPV with subretinal tPA injection and gas tamponade appears to be an effective treatment for RAM-related subretinal hemorrhage, with significant improvements in visual acuity, particularly when performed within two weeks of symptom onset. The location of postoperative RPE atrophy is a critical prognostic factor for visual outcomes.