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

Purpose: The natural course of the visual acuity in eyes with myopic macular neovascularization (myopic MNV) is poor. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents have demonstrated safety and efficacy in the short-term for managing myopic MNV. The purpose of this study was to determine the 4-year outcomes of intravitreal aflibercept (IVA) injections.

Method: A retrospective monocentric study including 49 eyes of 48 patients diagnosed with myopic MNV. These patients underwent treatment with IVA using the pro re nata (PRN) regimen after the first injection. The minimum follow-up duration was 4 years.

Results: The patients had an average age of 63.8 years and an average axial length of 29.7 mm. The mean number of IVA injections was 1.6, and 30 eyes (61.2%) had a single injection. At the baseline and at 1-, 2-, 3-, and 4-years, the mean best-corrected visual acuities (BCVAs) were 20/45, 20/41, 20/43, 20/51, and 20/53, respectively. The differences in the BCVA at the different times from that at the baseline were not significant.

Conclusion: IVA therapy with the PRN regimen provides a 4-year visual benefit in eyes with myopic MNV, and it is better than the reported natural course in maintaining the BCVA.

Purpose: To assess histopathology and outcomes following primary enucleation of eyes with retinoblastoma presenting with neovascular glaucoma (NVG).

Methods: This was an international multi-centre case series study across five continents. Retrospective review of patient charts was performed for all patients undergoing primary enucleation for retinoblastoma (n=1420) using a standardised data-collection spreadsheet. Clinical features, pathological grade, and outcomes were compared between NVG patients and those with an American Joint Commission on Cancer (AJCC) 8th edition clinical stage of cT2. High-risk histopathology was defined as AJCC 8th edition pathological stage ≥pT2b.

Results: NVG was seen in 224/1420 (16%) patients. Mean age at presentation of those with NVG was 30 months (median 25, range 0-120 months) and 131(58%) patients had high-risk histopathology. The univariate logistic regression odds ratio for NVG predicting high-risk histopathology was 1.73 (95% confidence interval: 1.3 to 2.31) and from multivariate logistic regression was 1.77 (95% confidence interval: 1.23 to 2.56). Patients with a longer duration of symptoms (p=0.03), buphthalmos (p=0.02) and ectropion uveae (p<0.01) were more likely to have high-risk histopathology. Patients with NVG were more likely to develop metastasis than cT2 patients (p=0.04).

Conclusions: There is a significant association between NVG at presentation, high-risk histopathology and metastatic risk.

Purpose: To comprehensively investigate the suprachoroidal space (SCS) in the context of rhegmatogenous retinal detachment (RRD) using swept-source optical coherence tomography (SS-OCT).

Methods: We conducted a post hoc analysis of 90 consecutive patients with a primary RRD. Baseline SS-OCT scans were graded for the presence and thickness of the suprachoroidal space. Available scans of the fellow eye were graded for comparison.

Results: The suprachoroidal space was visible in 31.6% (24/76) of gradable RRD scans, with a mean thickest location measuring 67.0µm (SD 25.9), mean thinnest location of 33.8µm (SD 11.1), and mean average thickness of 50.0µm (SD 16.8). Additionally, the SCS was detectable in 28.3% (13/46) of available fellow eye scans, with a mean thickest location measuring 47.0µm (SD 41.7), thinnest location of 25.2µm (SD 27.6) and mean average thickness of 35.8µm (SD 31.4). A statistically significant difference was found between RRD and fellow eyes in all measurements of SCS thickness.

Conclusion: In RRD, the suprachoroidal space serves as a crucial fluid reservoir influenced by dynamic shifts in intraocular hydrostatic and oncotic pressures. We found significant SCS engorgement in RRD eyes compared to fellow eyes, which may facilitate intra-SCS therapies such as suprachoroidal viscopexy (SCVEXY) or other pharmacologic interventions.

Purpose: To evaluate the effect on outer retina integrity of foveal sparing internal limiting membrane (ILM) peeling compared to standard ILM peeling on proliferative diabetic retinopathy (PDR) eyes affected by diabetic macular edema (DME) and epiretinal membrane (ERM).

Materials and methods: Eyes diagnosed with PDR, DME and ERM eligible for vitrectomy were prospectively recruited and randomly assigned to either foveal sparing (FS) group and no foveal sparing (nFS) group. Ellipsoid zone (EZ) lesion size, EZ reflectivity and external limiting membrane (ELM) integrity and angular sign of Henle Fiber Layer Hyperreflectivity (ASHH) were assessed preoperatively and 1 year postoperatively.

Results: Twelve (12) eyes and fifteen (15) eyes were included in FS and nFS group respectively. The two groups showed no differences in terms of EZ lesion size (p=0.549), EZ reflectivity (p=0.657) and ELM integrity (0.999) at preoperative examination. A significant increase in EZ lesion size was noted in nFS group between preoperative and postoperative examination (p=0.040) which was not present in FS group (p=0.862). Moreover, nFS group showed a higher prevalence of ASHH and a lower EZ reflectivity at follow up compared to FS group (respectively p=0.047 and p=0.041).

Conclusions: Vitrectomy with FS ILM peeling may result in a better preservation of the Muller-photoreceptors complex in PDR complicated with DME and ERM.

Purpose: Risk factors for the development of rhegmatogenous retinal detachments (RRDs) in the early postoperative period following open globe repair (OGR) are not well understood. RRDs are often diagnosed late after OGIs, which can negatively impact visual prognosis. We assessed the incidence and risk factors that predict the development of this complication.

Methods: We conducted a retrospective case-control study of all OGIs at a single ocular trauma center from January 2016 to September 2021 where at baseline the retina was attached. Cases were defined as postoperative RRDs that developed within 90 days of OGR.

Results: Of 96 eyes included, 40 (41.7%) subsequently developed RRD. Univariate analysis revealed initial visual acuity (VA) of light perception (LP) or worse (OR 7.64; 95% CI, 3.03-19.22; p < .01), zone 3 injuries (OR 7.54; 95% CI, 2.64-21.54; p < .01), no view of the lens (OR 4.26; 95% CI, 1.77-10.26; p < .01), and the presence of injuries external to the globe (OR 5.33; 95% CI, 2.09-13.63; p < .01) to be associated with early RRD development. On multivariate analysis, presenting VA of LP (p < .001), the presence of external injuries (p = .001), and zone 3 injuries (p = .037) remained significant. Of the 40 patients with early RD, 34 (85%) remained attached following repair, with variable visual outcomes.

Conclusion: Presenting VA of LP, zone 3 injuries, and external injuries to the globe confer increased risk of early postoperative RRD after OGR. The majority of RRDs can be successfully repaired.

Purpose: To evaluate the surgical outcomes of pediatric familial exudative vitreoretinopathy (FEVR) complicated by tractional maculopathy.

Methods: Retrospective case series. Chart review of 14 children (15 eyes) diagnosed with tractional maculopathy-complicated FEVR who received vitrectomy.

Results: The mean age at surgery was 7.2 years. The mean follow-up duration was 14.1 months. The logarithm of the minimum angle of resolution (logMAR) of best-corrected visual acuity (BCVA) improved from 1.0±0.6 (20/200 Snellen) to 0.6±0.6 (20/80 Snellen) post-operation (t=4.293, p=0.001). The peripapillary temporal inner angle (PTIA, 63.9(15.7) ° vs. 71.1(31.2) °, z=-2.726, p=0.006) and peripapillary temporal outer angle (PTOA, 63.4±25.2° vs. 69.6±23.5°, t=-2.820, p=0.014) widened post-operation. Postoperative BCVA was superior in eyes with a shorter time between symptom onset and surgery (r=0.688, p=0.019), better preoperative logMAR BCVA (r=0.830, p<0.001), and preoperative widening of the outer nuclear layer (ONL, r-pb=0.730, p=0.007) and foveal avascular zone (FAZ, r-pb=0.794, p=0.002), and in eyes with postoperative ellipsoid (r-pb=0.641, p=0.018) and interdigitation zones integrity (r-pb=0.614, p=0.026), widening of the ONL(r-pb=0.816, p=0.001) and FAZ (r-pb=0.940, p<0.001), and absence of the inner retinal layer at the fovea (r-pb=0.672, p=0.012).

Conclusion: Vitrectomy is effective for pediatric FEVR complicated by tractional maculopathy. Patient selection is crucial and iatrogenic complications should be avoided.

Purpose: To report the technique and long-term outcomes of patients with giant retinal tear associated retinal detachment (GRT-RD) treated with pneumatic retinopexy (PnR).

Methods: Retrospective cohort study. All patients presenting with GRT-RD with tears in the superior ten-clock hours who underwent primary PnR were included in this study.

Results: 31 patients were included in the study. 61.2% (19/31) achieved PARR with PnR at 3 months and 58.0% (18/31) at the final follow-up. Patients included in this study had a median follow-up of 24 months (interquartile range 46.5). The absence of retinal tears elsewhere at baseline was associated with a final PARR of 80% (16/20) (p= 0.007). Thirteen eyes required PPV after a failed PnR. Two eyes required the intraoperative use of perfluorocarbon liquids (PFCL). No eyes required silicone oil (SO). Visual acuity improved significantly from baseline to the last follow-up. Final anatomic reattachment rate was 100% (31/31).

Conclusion: For selected cases of GRT-RDs affecting the superior ten-clock hours, PnR could be a possible treatment option when patients consent to extra visits and the surgeon has substantial expertise. When lacking this extensive experience and comfort with PnR, PPV remains the treatment that is most likely to result in a primary anatomic reattachment. While this study provides guidance on PnR technique for GRT-RDs, it is essential to note that the reported PARR may be contingent on the expertise of the surgeon/center, and the authors recommend that those new to PnR first gain substantial experience in cases meeting clinical trial criteria.

Purpose: To identify the clinical parameters predictive of persistent subretinal fluid in acute central serous chorioretinopathy (CSC).

Methods: Clinical data of consecutive eyes diagnosed with first-time, acute, treatment-naïve CSC followed up for at least 6 months from symptom onset were evaluated retrospectively. Acute CSC was defined as CSC in which symptoms were noticed within 3 months of presentation. Subretinal fluid, central retinal thickness (CRT), subfoveal choroidal thickness, and fundus autofluorescence (FAF) were examined.

Results: Of the 48 eyes in 48 patients, 38% exhibited subretinal fluid persisting for at least 6 months after the symptom onset. FAF alterations at baseline were observed in 52 and 36% of affected and fellow eyes, respectively. Multivariable analysis showed that persistent fluid was significantly associated with the presence of FAF alterations in fellow eyes (odds ratio = 23.5, P = 0.024), in addition to greater age (odds ratio = 1.16, P = 0.015) and thicker CRT (odds ratio = 1.01, P = 0.022).

Conclusion: Fellow eye FAF alterations, in addition to older age and thicker CRT, were significant predictors of persistent subretinal fluid in patients with acute CSC. These findings underscore CSC's bilateral aspects and noninvasive markers' role in predicting persistent subretinal fluid.

Purpose: To describe the demographic and clinical characteristics, and treatment outcomes of choroidal osteoma in Indian patients.

Methods: This cross-sectional hospital-based study included 80 patients (100 eyes) between 2nd October 2012 and 15th May 2024.

Results: Forty-nine (61%) participants were female, and 31 (39 %) were male. The most common age group was the second decade (n=27, 34%). Tumor ossification with intact RPE was observed in 37 (44%) eyes and tumor deossification with/without RPE atrophy was observed in 55 (65%). Associated features observed were choroidal neovascularization (CNV) in 40 (40%) eyes, subretinal fluid without CNV in 4 (4%) eyes, and documented tumor growth in 6 (6%) eyes (mean interval, 4 years). At 4 and 8 years, Kaplan-Meier analysis revealed tumor growth in 18% and 38% of eyes, respectively. Of the 83 eyes, OCT showed the presence of choroidal lamellae in ossified zones in 30 eyes (100%), CNV in 40 (48%) eyes, SRF without CNV or growth in 8 (10%) eyes, and RPE atrophy with deossification in 53 (64%) eyes. Treatment included intravitreal anti-VEGF therapy for CNV in 39 eyes, transpupillary thermotherapy in 3, and focal laser photocoagulation in one eye to the perifoveal leaning edge with SRF without CNV. The mean BCVA changed from 0.4 to 0.6 logMAR units (6/15 to 6/24 Snellen's equivalent) at a mean follow-up of 19 months (3-149 months).

Conclusion: Choroidal osteoma is a unilateral condition observed in females. Although benign, the presence of CNV, SRF, or tumor growth requires treatment and periodic surveillance.