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

Purpose: To introduce a vitrectomy technique for the submacular hemorrhage (SMH) combined with subretinal tenecteplase (TNK-tPA) injection, intravitreal conbercept administration, perfluoropropane (C3F8) gas tamponade, and to evaluate its efficacy and safety.

Methods: In this single-center, prospective, interventional study, patients underwent 25-gauge vitrectomy with subretinal TNK-tPA and intravitreal conbercept injection, followed by 0.5-1.0 mL of pure C3F8 gas tamponade. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed at baseline, and 1, 3, and 6 months post-operatively. Favorable outcome was defined as a BCVA ≤0.5 logarithm of the minimum angle of resolution (log MAR) at 6 months.

Results: Twenty eyes of 20 patients with treatment-naïve spontaneous SMH (≤30 days) secondary to polypoidal choroidal vasculopathy (70%) or retinal arterial macroaneurysms (30%) were included. Mean CRT significantly decreased from 887.1±52.2μm to 276.7±83.8μm (P < 0.001) at 6 months. Notably, 75% of the treated eyes (13 out of 20) achieved a favorable outcome (BCVA ≤0.5 log MAR; Snellen equivalent ≈20/63). Pearson's correlation analysis revealed that the SMH onset-vitrectomy interval (SOVI) was significantly negatively correlated with a favorable outcome (r = -0.452, P = 0.045). After adjusting for potential interaction effect, the SOVI remained a statistically significant predictor of worse log MAR BCVA (odds ratio [OR] = 1.023, 95% confidence interval [CI] 1.013-1.034, P < 0.001).

Conclusions: The present technique for treatment-naïve spontaneous SMH, in combination with subretinal TNK-tPA injection, intravitreal conbercept administration, and C3F8 gas tamponade, demonstrated potential for visual improvement in eyes treated within 30 days of SMH onset.

Purpose: To describe the clinical characteristics of secondary tumour-associated neovascularization (STN) in retinoblastoma (RB) patients and the outcomes and complications of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) in the treatment of STN.

Methods: A single-centre retrospective study. Intravitreal injections of anti-VEGF were given to RB patients once STN was confirmed by fundus fluorescein angiography and performed monthly until neovascularization was resolved. Demographic characteristics, clinical characteristics, treatment outcomes, and complications after anti-VEGF therapy were recorded.

Results: STN was detected in twelve eyes of 11 RB patients with a mean age of onset of 15 months. Eleven eyes received intra-arterial chemotherapy (IAC) (mean: 6 cycles, range: 2-11 cycles) before neovascularization onset. After receiving a mean of 4.6 (range: 1-18) intravitreal anti-VEGF injections, 6 eyes first exhibited reduced neovascularization with no relapse; 5 eyes first achieved resolution of neovascularization, but recurrence was observed at follow-up; and one eye received two anti-VEGF injections, but control of neovascularization was not achieved and further injections were refused. Common complications related to anti-VEGF injection included tractional retinal detachment (n=6) and hyaloid membranes (n =5). None of the eyes needed enucleation. All the patients were alive without extraocular extension or metastases (mean follow-up 64 months, range: 37-112 months).

Conclusion: STN can occur in RB patients after multiple comprehensive therapies, especially IAC. Intravitreal anti-VEGF injection contributes to the resolution of neovascularization, but anti-VEGF treatment-related complications must be recognized and anticipated.

Purpose: To investigate the impact of anti-vascular endothelial growth factor (anti-VEGF) therapy on epiretinal macrophage-like cells (eMLC) in BRVO-ME patients.

Methods: This retrospective study included 58 BRVO-ME patients treated with anti-VEGF agents, divided into two groups: 28 eyes (1-2 Injection group) and 30 eyes (3 Injection group). The 3-injection group comprised 20 early responders (ERs) and 10 limited early responders (LERs). Longitudinal changes in macular eMLC count and density were assessed via En face OCT during the early response phase (baseline to 3 months post-initial injection). Linear regression and Spearman correlation analyzed eMLC density's relationship with OCTA parameters and systemic inflammatory indices.

Results: The 3-injection group exhibited greater reductions in macular edema and eMLC density than the 1-2 injection group. Macular eMLC density significantly decreased in ERs, while LERs showed no significant alteration. Post-treatment CMT change positively correlated with eMLC density change (r=0.57). Baseline systemic inflammatory indices (NLR, r=-0.46; NPR, r=-0.36; SII r=-0.33; SIRI, r=-0.31;) negatively correlated with post-treatment eMLC density change.

Conclusion: Anti-VEGF therapy reduces macular eMLC in BRVO-ME patients, especially in early responders receiving three injections. Macular eMLC are closely associated with inflammation and may serve as a valuable treatment response biomarker.

Purpose: This study aims to describe the longitudinal retinal degenerative changes associated with the p.Gly208Asp PRPH2 variant using multimodal imaging.

Methods: A prospective, longitudinal cohort study was conducted, including 7 patients heterozygous for the pathogenic p.Gly208Asp PRPH2 variant and 9 age-matched controls. Demographics and best corrected visual acuity (BCVA) were obtained. Imaging included optical coherence tomography (OCT) and fundus autofluorescence (FAF). Mesopic microperimetry assessed retinal sensitivity.

Results: At baseline, all cases exhibited a central areolar chorioretinal dystrophy (CACD) phenotype with 4 cases exhibiting stage IV and 3 cases at stage II. Six patients had longitudinal data with a mean follow-up of 1 year. Overall, mean retinal thickness significantly reduced (p=0.001), although microperimetric mean sensitivity was not significantly altered with follow-up. In atrophic eyes, areas of definitely decreased autofluorescence increased significantly (p < 0.001) with follow-up.

Conclusion: This study highlights an association with the CACD phenotype in patients carrying the p.Gly208Asp PRPH2 variant. Multimodal imaging identified short-term markers of progression that may be useful for disease monitoring and potential future clinical trials.

Purpose: To investigate layer-specific microvascular changes in the nerve fiber layer plexus (NFLP) and ganglion cell layer plexus (GCLP) using optical coherence tomography angiography (OCTA) and correlate them with visual outcomes after surgery for idiopathic epiretinal membrane (iERM).

Methods: This retrospective study analyzed 47 eyes with iERM and 30 healthy controls. We assessed preoperative and 6-month postoperative best-corrected visual acuity (BCVA), retinal sensitivity, and OCTA-derived vascular density (VD) in the NFLP, GCLP, and superficial vascular complex (SVC). Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curves, and prognostic value was determined via correlation and multiple linear regression analyses.

Results: Preoperatively, iERM eyes showed significantly increased VD and PA in the NFLP, GCLP and SVC compared to controls (P < 0.01). NFLP parameters demonstrated superior diagnostic accuracy over SVC metrics.Preoperatively, increased NFLP vascular metrics were associated with higher BCVA improvement(all P < 0.05). Conversely, greater baseline 6×6 mm2 GCLP vascular metrics were associated with a lower BCVA improvement(all P < 0.05). In multivariate analysis, preoperative GCLP VD was an independent predictor of both better final postoperative BCVA (β = 1.84, P = 0.045) and higher postoperative retinal sensitivity (β = 0.048, P < 0.001).

Conclusion: Stratified analysis of the NFLP and GCLP via OCTA provides distinct and powerful biomarkers for iERM. NFLP metrics excel in diagnosis, while preoperative GCLP integrity is a key predictor of postoperative functional recovery, offering more nuanced insights than traditional SVC analysis.

Purpose: To evaluate sparing or embedding technique for lamellar hole-associated epiretinal proliferation and in comparison with traditional internal limiting membrane and epiretinal membrane peeling in lamellar macular holes.

Methods: PubMed, Web of Science, Medline, EMBASE, Cochrane, CNKI, Wan Fang, and VIP Databases (PROSPERO number CRD42024466392) were searched. Trials of various lamellar hole-associated epiretinal proliferation removal or preservation techniques in lamellar macular holes were included (case reports of only 1 case excluded). Postoperative changes in best-corrected visual acuity were calculated. Central retinal thickness and number of patients with new postoperative intact ellipsoid zones were secondary outcomes.

Results: Eight studies were eligible and four compared with peeling groups. Preservation groups showed a significant visual improvement operatively (mean difference = -0.25 logMAR; 95% confidence interval = -0.30 to -0.21; P < 0.00001) and improved compared with peeling groups (mean difference = -0.19 logMAR; 95% confidence interval = -0.29 to -0.1; P < 0.0001). In addition, the number of patients with intact ellipsoid zones increased in the preserving groups (odd ratio = 2.55; 95% confidence interval = 1.48-4.38; P = 0.0007) and also increased compared with peeling groups (odd ratio =10.80; 95% confidence interval = 1.86-62.83; P = 0.008).

Conclusion: Based on the current evidence, lamellar hole-associated epiretinal proliferation sparing or embedding technique has favorable postoperative outcomes compared with peeling technique for lamellar macular holes.