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

Purpose: To assess the prevalence and degree of retinal vascular abnormalities in retinopathy of prematurity-treatment naïve adults born preterm with very low birth weight (VLBW; birth weight <1500 g).

Methods: Both eyes of 64 VLBW participants and 81 term-born controls from the Finnish birth cohort were examined at mean age of 38 years. Macular developmental arrest and foveal avascular zone were assessed from optical coherence tomography and angiography (optical coherence tomography angiography) images, and persistent avascular retina from Optos widefield images and analyzed with co-effect of perinatal and cardiovascular factors.

Results: The foveal avascular zone of VLBW eyes was smaller ( P < 0.001) than that of control eyes and showed a strong association with macular developmental arrest (odds ratios 13.90, P < 0.001). All eyes had normal visual acuity. Foveal avascular zone size below the fifth control percentile was recorded in 57% and totally vascularized fovea in 14% of the VLBW eyes. Twenty-three percent of the VLBW eyes had persistent avascular retina, and this was associated with macular developmental arrest (odds ratios 3.39, P = 0.029) and hypertension (odds ratios 3.96, P = 0.008). Regressed retinopathy of prematurity-like retinal features were recorded in 20% of the VLBW eyes.

Conclusion: Uncomplicated persistent avascular retina and small, or even absent, foveal avascular zone are frequently seen as a natural course of retinal vascularization in adults born preterm with VLBW.

Purpose: To evaluate ophthalmology trainee's experience with BIONIKO 3D-printed eye model in internal limiting membrane peeling.

Methods: Ophthalmology trainees were randomly assigned to two groups, BIONIKO-first and Eyesi-first, performing internal limiting membrane peels on both models. Surgical performance was assessed via Eyesi score output, while an anonymous survey assessed model effectiveness.

Results: Thirty-nine trainees participated (20 BIONIKO-first, 19 Eyesi-first). The BIONIKO-first group had a higher mean Eyesi score (50.63 ± 31.68 vs. 37.53 ± 30.30, P = 0.497). The Eyesi-first group achieved a higher internal limiting membrane peeling rate inside the macula (95.05% ± 4.58 vs. 92.66% ± 10.75, P = 0.039). Completion time and forceps use were comparable. The BIONIKO-first group had fewer total spotted hemorrhages (2.4 ± 2.1 vs. 4.4 ± 3.6, P = 0.035), while macular and retinal injuries were similar.Subgroup analysis by training level showed that in the junior group, BIONIKO-first resulted in fewer hemorrhages ( P = 0.012), while Eyesi-first had higher internal limiting membrane peeling rate inside the macula ( P = 0.002). Among seniors, BIONIKO-first demonstrated a statistically lower area of macular injury (0.02 mm 2 ± 0.05 vs. 0.07 mm 2 ± 0.12, P = 0.020).Survey results favored BIONIKO for tactile feedback ( P = 0.002) and surgical realism ( P < 0.001), while Eyesi was preferred for procedural feedback ( P < 0.001).

Conclusion: BIONIKO and Eyesi models offer complementary advantages. A hybrid approach may optimize skill acquisition and patient safety in vitreoretinal surgery training.

Purpose: To investigate the factors influencing the number of injections in myopic choroidal neovascularization as well as to identify the clinical features of patients who require a limited number of injections to inactive myopic choroidal neovascularization.

Methods: This retrospective study included 86 eyes (86 patients) affected by treatment-naïve myopic choroidal neovascularization who were treated with pro re nata antivascular endothelial growth factor injections with a follow-up at 12 months. Patients underwent complete ophthalmic visits, optical coherence tomography and optical coherence tomography angiography both at baseline and at 12 months.

Results: Overall, the mean age of the study population was 62 ± 14 years. The mean number of intravitreal injections administered in the 12-month study period was 4.28 ± 2.17. The multivariate analysis showed an association of baseline central macular thickness and best-corrected visual acuity ( P = 0.02 and 0.036, respectively) while the final factors related to injections number were subretinal fibrosis and final best-corrected visual acuity ( P < 0.001 and P = 0.022, respectively). Patients who required one or two injections showed significant clinical differences in optical coherence tomography, optical coherence tomography angiography, and clinical parameters in comparison to patients who require more injections.

Conclusion: Baseline poorer best-corrected visual acuity and baseline higher central macular thickness are significantly associated with the need of more injections to stabilize the clinical picture in eyes affected by myopic choroidal neovascularization.

Purpose: To evaluate the efficacy of internal limiting membrane (ILM) peeling combined with gas tamponade in nonvitrectomizing vitreous surgery (NVS) for macular holes (MHs).

Methods: A total of 21 patients (21 eyes) with MHs who underwent NVS with ILM peeling and a small C3F8 gas bubble tamponade and completed at least 6 months of follow-up were included. The status of hole closure and visual acuity change were evaluated.

Results: There were two secondary MHs and 19 idiopathic MHs with the mean minimal diameter of 309.47 ± 165.71 µ m at baseline. Hole closure was achieved in 19 (90.47%) eyes after the primary operation. The best-corrected visual acuity was improved from preoperative 20/400-20/28 (0.74 ± 0.29 logMAR) to postoperative 20/166-20/22 (0.32 ± 0.22 logMAR) ( P < 0.001).

Conclusion: The procedure of NVS with ILM peeling combined with short-term gas tamponade can promote closure of small- to medium-sized MHs. This simplified surgical approach relieves the tangential force coming from the ILM and releases the vitreous adhesion from the macular surface while preserving the vitreous cortex.

Purpose: To describe an improved snare technique for the removal of an intraocular foreign body (IOFB) from the posterior segment.

Methods: The snare is fashioned from a 23 or 25-gauge blunt-tipped cannula, a 5-0 or 6-0 nylon suture, and a cotton-tipped applicator. The snare is introduced through a 23 or 25-gauge vitrectomy port and tightened around the IOFB, maintaining a closed system. The IOFB can be extracted from the eye by pulling the cannula and extending the circumferential sclerotomy.

Results: Four cases of IOFBs were treated using the improved nylon suture snare technique. Three of the four were traumatic open-globe injuries with retained IOFB, for which the snare technique was suitable for removal of the object. In the fourth case, the snare technique was used to remove a posteriorly dislocated silicone intraocular lens optic. No cases of postoperative retinal detachments or endophthalmitis were observed.

Conclusion: This snare is fashioned from readily available, inexpensive materials and provides a safe and reliable method for IOFB removal through the vitrectomy port. By maintaining a closed system during IOFB mobilization and removal, the view through the cornea remains stable and intraocular pressure remains constant. Moreover, the snare can grasp irregularly shaped or large IOFBs.

Purpose: To report results of a modified Yamane technique for scleral fixation of the intraocular lens.

Methods: Data from all patients treated with scleral fixation using the Avansee AN6A at our hospital by a single surgeon were obtained and retrospectively analyzed from our database. In our technique, the trailing haptic was externally inserted into the lumen of the 30-G needle. The preoperative measurements included three variables: best-corrected visual acuity (Snellen), intraocular pressure (mmHg), and corneal endothelial cell count (cells/mm 2 ). Postoperative measurements included refractive error (D), aqueous depth (mm), tilt (°), decentration (mm), and the three preoperative variables.

Results: This study included 20 eyes (mean age, 65.3 ± 13.5 years). Preoperative conditions included lens subluxation (4 eyes), intraocular lens dislocation (13 eyes), and aphakia (3 eyes). The best-corrected visual acuity improved from 20/32 preoperatively to 20/20 postoperatively. The mean preoperative corneal endothelial cell density was 2,282 cells/mm 2 and changed to 2,091 cells/mm 2 at the last visit. Postoperative refractive error was slightly myopic (-0.13 ± 1.4 D). Regarding the position of fixated intraocular lenses, postoperative tilt was 5.57 ± 3.35° and postoperative decentration was 0.50 ± 0.26 mm.

Conclusion: The simplified Yamane technique showed good overall clinical outcomes and stability of refractive predictability when performed by a single surgeon, making it easier to master. Further studies are required to expand on this simplified procedure.

Purpose: To examine the association between gout and subsequent development and progression of age-related macular degeneration (AMD).

Methods: In this retrospective cohort study, a multicenter health care research network was used to identify patients with an International Classification of Diseases, 10th Revision for idiopathic gout and a prescription for uric acid-lowering agent (Gout cohort) compared with a matched cohort of patients without a diagnosis of gout (Control cohort) for ophthalmic outcomes. Propensity score matching was applied to balance baseline demographics and health status between cohorts.

Results: Patients with gout had an increased risk of developing dry AMD (relative risk, 2.73, 95% confidence intervals, 2.30-3.25; P < 0.001), advanced dry AMD (relative risk, 2.64, 95% confidence intervals, 1.32-5.28; P < 0.001), wet AMD (relative risk, 2.48, 95% confidence intervals, 1.82-3.38; P < 0.001), and needing subsequent antivascular endothelial growth factor therapy (relative risk, 2.80, 95% confidence intervals, 2.14-3.67; P < 0.001) compared with those without gout at 5 years. Similar trends were observed among patients with early AMD and gout compared with those with early AMD without gout.

Conclusion: In a national multicenter database, an increased risk of AMD development and progression to advanced disease stages was found among patient with gout compared with controls. Additional investigation into the mechanisms and effects of hyperuricemia are necessary to clarify these associations.

Purpose: Develop a short form of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) using Rasch methodology in patients with neovascular age-related macular degeneration.

Methods: Data on 32 items of the NEI VFQ-25 were analyzed from 1,294 patients in 3 studies of ranibizumab in neovascular age-related macular degeneration. Items were first grouped by visual function type; iterative multiple-group rating scale Rasch analyses were used to derive the Visual Function Questionnaire-Short Form (VFQ-SF). Item and scale-level VFQ-SF psychometric properties were assessed with estimation of meaningful within-patient change.

Results: Fourteen of 32 items were eliminated initially; the final optimal subset included 7 items measuring 5 domains. The seven-item VFQ-SF had strong internal consistency (average item-total correlation 0.67, Cronbach alpha 0.88), test-retest reliability (intraclass correlation coefficient 0.79-0.91), and high NEI VFQ-25 composite score correlation (r = 0.93). Convergent (mean r = 0.76) and divergent (mean r = 0.24) validity were demonstrated. Known-groups validity was shown by mean VFQ-SF scores monotonically increasing with best-corrected visual acuity severity categories with large between group effect sizes (>2.8). Responsiveness was confirmed with VFQ-SF change linearly related to best-corrected visual acuity change. A meaningful within-patient change estimate of seven points was derived.

Conclusion: The seven-item VFQ-SF measures composite vision-related functioning, met all psychometric benchmarks, and is fit-for-purpose in neovascular age-related macular degeneration patients.

Purpose: To evaluate the efficacy and safety of subretinal balanced salt solution (BSS) injection for diabetic macular edema (DME) patients with hard exudates (HEs) using a 40-gauge curved needle.

Methods: DME patients with HEs were randomized to injection group (subretinal BSS injection combined with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, n = 28) or control group (PPV and ILM peeling, n = 28). Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), HEs, foveal avascular zone (FAZ), and mean macular thickness (MMT) were compared. Patient demographics, laboratory results, and surgical complications were recorded and compared.

Results: Baseline characteristics were similar (P > 0.05). In the injection group, compared with the preoperative indicators, the postoperative BCVA (Snellen) improved from 20/426 ± 20/98 to 20/163 ± 20/59, CMT decreased from 453.32 ± 125.90 μm to 305.14 ± 119.23 μm, HEs area decreased from 3.00 ± 1.68 mm2 to 1.50 ± 1.24 mm2, FAZ area decreased from 0.41 ± 0.11 mm2 to 0.32 ± 0.11 mm2, MMT decreased from 411.77 ± 64.52 μm to 322.96 ± 52.62 μm (P < 0.001, respectively). Postoperative BCVA, CMT, HEs area, FAZ, and MMT in the injection group were different from those in the control group (P < 0.05). Postoperative complications did not differ (P > 0.05). The mean follow-up duration was 7.13 ± 2.02 months.

Conclusion: Subretinal BSS injection with a 40-gauge curved needle is safe and effective for DME with HEs, improving macular structure and vision.

Purpose: Endophthalmitis is a rare but severe complication of intravitreal injections (IVIs) that can result in significant vision loss. This systematic review and meta-analysis aims to evaluate the efficacy of topical antibiotic prophylaxis in reducing endophthalmitis incidence, a topic of ongoing controversy and varied clinical practice worldwide.

Methods: A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane, and Web of Science through July 2025. Studies comparing endophthalmitis incidence in IVIs with and without antibiotic prophylaxis were included; reviews, case reports, and studies lacking outcome data were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the ROBINS-I tool. Data were pooled using a random-effects model. The protocol was registered in PROSPERO (CRD420251102460).

Results: Twenty-two studies encompassing 5,834,932 IVIs (3,426,671 with prophylaxis and 2,408,261 without) were included. Overall, no significant difference in endophthalmitis incidence was observed between groups (p = 0.09). However, a subgroup analysis of anti-VEGF injections showed a significantly higher risk of endophthalmitis in the antibiotic group (Odds Ratio, 1.56; 95% CI, 1.03-2.36; I2 = 31%; very low-certainty evidence).

Conclusions: Topical antibiotic prophylaxis was not associated with a reduced risk of endophthalmitis and may increase the risk in patients receiving anti-VEGF IVIs. These findings suggest that the routine use of antibiotic prophylaxis for these injections is unwarranted.