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

Purpose: To evaluate the utility of three-dimensional hill of vision (HOV) analysis in assessing retinal sensitivity in X-linked retinitis pigmentosa (XLRP) patients under scotopic cyan, scotopic red, and mesopic microperimetry conditions.

Methods: Baseline microperimetry data from 31 eyes of 16 XLRP patients enrolled in the Horizon study were analyzed. HOVs were generated using Thin Plate Spline interpolation. Grid volumes of the central 20 degrees (V20) were compared between lighting conditions using the Wilcoxon Signed-Rank test with Bonferroni correction. Central and global deficits were evaluated across age groups and genotypes.

Results: The mesopic group showed the highest mean V20 (1.3 dB-Sr), followed by scotopic red (0.6 dB-Sr) and scotopic cyan (0.5 dB-Sr). Significant differences were found between mesopic and both scotopic conditions (p<0.01), but not between scotopic conditions (p=0.26). Central and global deficits were more prevalent under scotopic conditions and increased with age.

Conclusion: HOV analysis provides a comprehensive assessment of retinal sensitivity in XLRP, enabling detection of localized changes and quantification of sensitivity gradients. This volumetric approach offers advantages over traditional methods for diagnosis, monitoring progression, and evaluating treatment response.

Purpose: To investigate retinal capillary plexus capillary flow speed and vessel density in diabetic retinopathy (DR) and normal subjects using variable interscan time analysis (VISTA) optical coherence tomography angiography (OCTA).

Methods: High speed swept source OCTA imaging using multiple interscan times was performed over a 5 mm x 5 mm field-of-view with 600 kHz A-scan rate. Second-generation VISTA OCTA was used to measure a surrogate marker for capillary blood flow speed, VISTA flow speed (VFS), in the superficial and intermediate capillary plexuses, (SCP + ICP)VFS, and deep capillary plexus, DCPVFS. Vessel density was measured using OCTA.

Results: Fifty-seven eyes with different DR severity and 37 normal eyes were analyzed. VISTA OCTA provided diverse blood flow speed information, including pseudo-color OCTA and mean flow speed in different regions. Both DCPVFS and DCPVFS/(SCP + ICP)VFS were higher in DR compared to normal eyes. Elevated DCPVFS correlated with decreased DCP vessel density in non-proliferative DR.

Conclusion: VISTA OCTA can measure a quantitative biomarker for blood flow speed alterations in DR and normal eyes as well as the association with vessel density in different capillary plexuses. VISTA OCTA is promising for studies of pathogenesis and early flow alterations which may precede non-perfusion.

Purpose: The aim of the study was to evaluate the tangential retinal displacement occurring following macular hole surgery, and to assess the impact of the internal limiting membrane (ILM) peeling size on the extent of the retinal movement.

Methods: This retrospective study included patients with full-thickness macular hole undergoing 25-gauge pars plana vitrectomy with ILM peeling. Patients received either a small ILM peeling with a size of 2-disc diameters or a large peeling extended up to the vascular arcades. Near-infrared retinal imaging was performed with the Spectralis (Heidelberg Engineering, Carlsbad, Germany) before and 6 months after surgery. The tangential retinal displacement was evaluated comparing the optical flow of near-infrared images with a custom digital image analysis algorithm.

Results: 44 eyes of 44 patients undergoing vitrectomy with small (n = 24) or large (n = 20) ILM peeling were included. An average overall displacement of 31.3 ± 22.8 µm towards the optic disc was observed after surgery. Large ILM peeling was associated with a significantly higher overall displacement (P = 0.009), displacement in the central 4-mm circle (P < 0.001) and outer 8-mm ring (P = 0.001). Macular holes closure was achieved in 100% and 83.3% of patients in the large and small peeling group, respectively (P = 0.055).

Conclusions: Pars plana vitrectomy with ILM peeling for macular hole results in a tangential retinal displacement towards the optic disc. A larger extent of the ILM peeling leads to a greater tangential movement, possibly improving the macular hole closure rate.

Purpose: To determine whether optical coherence tomography (OCT) thickness values from macular volume scans can be used to detect uveitic retinal vasculitis.

Methods: Retrospective study of patients with noninfectious retinal vasculitis. Fluorescein angiogram (FA) and 61-line OCT macular volume scans with an overlying Early Treatment Diabetic Retinopathy study (ETDRS) grid were obtained. Correlation between 1mm and 6mm ETDRS ring values and posterior pole vasculitis was analyzed. A linear longitudinal model was used to assess the relationship between global retinal vasculitis scores and OCT macular thickness parameters.

Results: Ninety-nine eyes of 54 patients were included. A total of 460 OCT and fluorescein angiogram pairs were analyzed. Central (1mm) macular thickness was weakly correlated with posterior pole vasculitis (correlation coefficient [rho]=0.09, p=0.06). Both the mean 6mm ring (rho=0.11, p=0.018) and the average of the superior and inferior (S/I) 6mm ring values (rho=0.13, p=0.006) were strongly correlated with posterior pole leakage. The longitudinal model showed that S/I 6mm ring values are associated with vasculitis in the posterior pole, mid and far periphery (p<0.0001).

Conclusions: OCT-based macular volume thickness can detect uveitic retinal vasculitis and aid in monitoring disease activity.

Purpose: To evaluate the effectiveness of anterior subtenon triamcinolone (AST) injections in the management of refractory macular edema.

Methods: This is a retrospective case series of consecutive eyes with refractory macular edema treated with AST at a single vitreoretinal surgeon's practice at Toronto Western Hospital, University of Toronto, Canada in 2018-2023. Refractory was defined as persistent macular edema with a central subfield thickness of 250μm or greater over a 24-week period, receiving at least four intravitreal anti-VEGF injections. Vision outcomes and optical coherence tomography features for all eyes were compared for three visits pre-AST treatment and two visits post-AST treatment.

Results: Ninety-three patients (119 eyes; diabetic macular edema (26%), and pseudophakic CME (74%), with a mean follow-up duration of 161 days were included. The presence of subretinal fluid (p=0.0013), central subfield macular thickness (p<0.0001), cube average thickness (p=0.0024) and macular cube volume (p= 0.0017) significantly improved from pre-AST to post-AST treatment. Visual acuity also significantly improved from pre-AST treatment to post-AST treatment (p<0.0001). There was no significant change in the intraocular pressures from pre-AST to post-AST (p=0.7920) and no complications were noted throughout the follow-up period.

Conclusion: The findings from this study suggest that AST injections show modest improvement in anatomical and functional outcomes, and are safe for the treatment and management of refractory macular edema.

Purpose: To present a standardized surgical technique for endoresection of uveal melanoma (UM) minimizing the risk of serious adverse events, including fatal gas embolism.

Methods: Ten UM patients underwent endoresection following proton beam radiotherapy for radiotherapy-related vascular complications. Vortex veins located in correspondence of the tumor base had been cauterized at the time of tantalum markers placement. Endoresection was performed following complete 25G vitrectomy, endolaser and endodiathermy. The tumor was removed using a subretinal or transretinal approach depending on retinal infiltration. If needed, perfluorodecalin (PFD) was injected to stabilise the retina. Fluid-silicone oil (SO) or PFD-SO exchange was performed, avoiding air.

Results: Endoresection was successfully performed in all eyes with no intraoperative complications. Mean follow-up (FU) was 10.8 ± 3.2 months. One patient was enucleated due to neovascular glaucoma. At the last FU, the remaining patients had the eye preserved and no signs of local recurrence or neovascular glaucoma.

Conclusion: Our standardized surgical technique for UM endoresection appeared to be safe, minimizing the risk of serious intraoperative and postoperative adverse events.

Purpose: To describe intraocular pressure (IOP) changes after injection of subtenon triamcinolone (STT) during examination under anesthesia (EUA) for pediatric patients.

Methods: Multicenter, retrospective case series of pediatric patients STT from three tertiary care ophthalmic services between November 2018 and October 2023.

Results: Of 392 patients identified, 59 eyes of 41 patients (10.5%) were included. Laser was administered in 95.1% of the cases. STT dose ranged from 4 to 20 mg. The most common diagnosis was retinopathy of prematurity (43.9%). Two eyes (3.4%) of 2 patients (4.9%) were mild steroid responders. One eye (1.7%) of 1 patient (2.4%) was a moderate responder. There were no high steroid responders, and all eyes with steroid response showed a return of IOP to normal range at next visit without needing any IOP-lowering medications. No patients were diagnosed with glaucoma or required glaucoma surgery. Only 1 eye (1.7%) developed trace posterior subcapsular cataract, while no optic disc cupping or inflammation were noted.

Conclusions: Subtenon triamcinolone injection is commonly used to prevent inflammation at the time of retinal photocoagulation treatment in pediatric patients. It has a favorable safety profile in relation to IOP elevation and cataract formation. There was no requirement for IOP lowering medications or surgical interventions.