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

Purpose: To report anatomical and functional outcomes of epiretinal proliferation (EP) embedding without internal limiting membrane (ILM) peeling for lamellar macular holes (LMHs) with EP.

Methods: This retrospective interventional case series involved patients with idiopathic LMHs and EP who underwent pars plana vitrectomy using the EP-embedding technique without ILM peeling. The EP was peeled centripetally, left connected to the LMH edge, and embedded into the retinal cleavage plane. 20% sulfur hexafluoride gas tamponade was applied. Following surgery, patients were recommended to avoid lying face-up.

Results: Fifteen eyes of 15 patients were included, the mean follow-up was 12 ± 8 months. LMH closure was achieved in 100% of cases. Best-corrected visual acuity and central retinal thickness showed significant postoperative improvement, from 0.31 ± 0.20 logMAR (20/40 Snellen) and 156.5 ± 40.7 μm preoperatively to 0.10 ± 0.12 logMAR (20/25 Snellen) (p = 0.002) and 221.5 ± 46.5 μm (p < 0.001), respectively. Ellipsoid zone and external limiting membrane restoration rates were 50% and 100%. No cases of full-thickness macular hole formation, LMH recurrence, or major complications were observed.

Conclusions: EP-embedding without ILM peeling yields favorable anatomical and functional outcomes in LMHs with EP and supports the non-tractional pathophysiology of the condition.

Purpose: To evaluate outcomes of intravitreal faricimab in polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV), focusing on subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI), compared with ranibizumab and aflibercept.

Methods: This retrospective cohort study included 96 treatment-naïve eyes with PCV or PNV, allocated by 1:1:1 propensity score matching to receive three consecutive monthly intravitreal injections of faricimab, ranibizumab, or aflibercept (n = 32 each). Best-corrected visual acuity (BCVA), central macular thickness (CMT), SFCT, and the CVI were evaluated at baseline and at months 1-3. In addition, total choroidal area (TCA), luminal area (LA), and stromal area (SA) were quantified.

Results: Baseline characteristics were similar. BCVA and CMT changes were not significantly different. Faricimab induced greater SFCT reduction than ranibizumab (P < 0.001 at months 1-3) and aflibercept (P = 0.029, 0.005, 0.004 at months 1-3). CVI reduction was also greater with faricimab than ranibizumab (P = 0.001, < 0.001, 0.010 at months 1-3) and aflibercept (P = 0.032, 0.024 at months 2-3). This was driven by larger LA reduction relative to TCA and SA (LA vs TCA: P < 0.001 at months 1-2, P = 0.006 at month 3; LA vs SA: P < 0.001 at months 1-3). Ranibizumab and aflibercept showed proportional decreases without significant differences.

Conclusions: Faricimab achieved greater SFCT and CVI reductions, suggesting enhanced vascular stabilization and reduced pachyvessel congestion. These results support the therapeutic potential of dual vascular endothelial growth factor-A/angiopoietin-2 inhibition in PCV and PNV.

Purpose: To characterize peripapillary hyperreflective ovoid mass-like structures (PHOMS) in affected and fellow eyes of patients with intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH), and to assess whether PHOMS height is associated with IHAPSH involvement.

Methods: This retrospective observational study included 14 IHAPSH patients who underwent optic nerve head optical coherence tomography (OCT). PHOMS presence, distribution, and height were characterized in affected and fellow eyes. Interocular differences in PHOMS height, spherical equivalent (SE), and optic disc tilt were compared. The association between PHOMS height and IHAPSH involvement was then analyzed using a linear mixed-effects model (LMM), adjusting for SE and optic disc tilt.

Results: All 14 IHAPSH patients had unilateral involvement. PHOMS were detected in all affected eyes and 78.6% (11/14) of fellow eyes. PHOMS were nasally located, with occasional superior or inferior extension. PHOMS height was greater in affected eyes (546.37 ± 98.33 µm) than in fellow eyes (357.12 ± 224.12 µm; P = 0.002). Affected eyes showed more myopic SE (-3.87 ± 1.57 D vs. -3.13 ± 1.76 D; P = 0.007), with no difference in optic disc tilt (P = 0.457). In the LMM, PHOMS height was independently associated with IHAPSH involvement, with affected eyes showing 159.07 µm greater height than fellow eyes (β = 159.07 µm; P = 0.011) after adjustment for SE and optic disc tilt.

Conclusion: PHOMS height was greater in affected than in fellow eyes and independently associated with IHAPSH involvement, suggesting that increased PHOMS height may reflect structural susceptibility to IHAPSH.

Purpose: To determine how fundus visibility relates to optical coherence tomography (OCT)-derived morphologic and topographic features of focal choroidal excavation (FCE) and to evaluate systemic and ocular associations in a health-screening cohort.

Methods: We analyzed 19,048 individuals undergoing health examinations with spectral-domain OCT and fundus photography. FCEs were classified as fundus-visible or fundus-invisible. A 1:2 propensity score matching (age/sex) was performed to compare participants with FCE against non-FCE controls. Generalized estimating equations were used to analyze lesion characteristics, systemic comorbidities, and ocular parameters including intraocular pressure (IOP), choroidal thickness, and macular degeneration.

Results: We identified 252 FCE lesions in 192 participants (1.0%). Compared to matched controls, the FCE group showed no significant differences in systemic comorbidities but had significantly lower IOP (P = 0.026), greater choroidal thickness (P < 0.001), and a higher prevalence of macular degeneration (P = 0.002). Among FCEs, fundus-visible lesions had greater median horizontal diameter (681.0 vs 518.0 µm; P < 0.001) and depth (69.5 vs 45.0 µm; P < 0.001), were located closer to the fovea (611.5 vs 1385.0 µm; P < 0.001), and exhibited higher rates of steep slopes (62.5% vs 42.7%; P = 0.002) and outer nuclear layer thickening (61.7% vs 31.5%; P < 0.001) compared to fundus-invisible lesions.

Conclusion: FCE is associated with distinct ocular profiles, including lower IOP and increased choroidal thickness, independent of systemic risk factors. Fundus visibility indicates larger, deeper, and paramacular lesions with specific structural alterations, underscoring the need to recognize subtle fundoscopic irregularities for early OCT detection.

Purpose: The evaluation of retinal vasculopathies such as diabetic retinopathy (DR) and retinal vein occlusion (RVO) increasingly benefits from integrating ultra-widefield fluorescein angiography (UWF-FFA) and single-scan ultra-widefield optical coherence tomography angiography (UWF-OCTA). This study aimed to assess the real-life application of retinal angiography and OCTA for detecting retinal neovascularization and peripheral ischemia.

Methods: While UWF-FFA remains the only dynamic modality capable of capturing perfusion flow and leakage, OCTA provides non-invasive, high-resolution, depth-resolved vascular imaging without systemic risks. In this real-world study, UWF-FFA performed with the Optos Silverstone was compared with UWF-OCTA obtained using the DREAM OCT platform, capturing up to 130° in a single acquisition and 200° with montage reconstruction.

Results: Among 50 enrolled patients-mostly with varying stages of DR, including proliferative disease and prior pan-retinal photocoagulation (PRP)-the number of neovascularizations identified was comparable across modalities. Profound, meaning well-defined retinal ischemia and visually obvious due to significant image contrast between perfused and non-perfused retinal areas was also comparable, whilst mild and meaning less defined retinal ischemia was more extensive in UWF-FFA due to the larger imaged area. Foveal avascular zone (FAZ) measurements appeared larger on FFA, whereas IRMAs were more frequently identified on UWF-OCTA. Despite its smaller single-scan field, UWF-OCTA provided excellent image quality and high sensitivity to vascular abnormalities, even with media opacities.

Conclusion: These findings support the complementary roles of UWF-FFA and UWF-OCTA, emphasizing their combined value in enhancing diagnostic precision, guiding treatment, and monitoring disease progression in retinal vascular disorders.

Purpose: Investigate the structure-function relationships between epiretinal membrane (ERM) stage, tractional abnormalities, and the gap area between the ERM and the retinal surface, in relation to visual acuity and quantitative contrast sensitivity function (qCSF) in patients with idiopathic epiretinal membrane.

Methods: This was a retrospective, cross-sectional study involving 111 participants diagnosed with idiopathic epiretinal membrane (iERM). All patients underwent a comprehensive ophthalmological examination, optical coherence tomography imaging (SD-OCT) using the SPECTRALIS® Heidelberg system, and contrast sensitivity (CS) testing utilizing the qCSF method.

Results: Progressive stages of ERM were associated with declines in both CS and visual acuity (β*=-0.45 to -0.19, p<0.02), with CS showing a more pronounced reduction than visual acuity, especially between controls and stage 1. Ectopic inner foveal layer (EIFL) thickness exhibited a similar pattern of decline in both visual acuity (β*=0.42, p<0.001) and CS (β*= -0.46 to -0.18, all p <0.02). In contrast, SUKIMA showed no significant association with any of the visual measurements assessed. Among the tractional abnormalities, the cotton ball sign correlated with diminished vision, particularly reflected by a notable drop in CS at the highest spatial frequencies tested with reduced CS at 12 cpd (β*=-0.44, p=0.02) and 18 cpd (β*=-0.46, p=0.02).

Conclusion: qCSF testing is particularly important for assessing visual function in ERM development, especially in the early stages.

Purpose: To compare the efficacy of detecting diabetic retinal neovascularization (NV) by single captured 24×20mm ultra-widefield optical coherence tomography angiography (UWF-OCTA) with ultra-widefield color fundus photography (UWF-CFP) and ultra-widefield fluorescein angiography (UWF-FA).

Methods: This cross-sectional study included eyes with diabetic retinopathy (DR) undergoing UWF-FA, UWF-CFP, and UWF-OCTA at Guangdong Provincial People's Hospital (February 2022-May 2023). Images were captured using the Optos California system for UWF-CFP and UWF-FA, and the Toward Pi BM400K system for UWF-OCTA. NV was graded based on defined criteria for each imaging modality, with FA serving as the gold standard. The intraclass correlation coefficient (ICC), specificity and sensitivity were analyzed by SPSS v19. ICC assessed agreement between UWF-OCTA and the other modalities, while specificity and sensitivity were calculated using UWF-FA as the reference.

Results: Among ninety eyes (56 participants), UWF-OCTA demonstrated high sensitivity (0.97), specificity (1.0), and accuracy (0.99) for NV detection. UWF-OCTA and UWF-FA showed excellent agreement in NV count within the 24×20 mm field (ICC=0.994, P<0.001) and in total number (ICC=0.904, 95%CI: 0.742-0.959, P<0.001). Combing UWF-OCTA and UWF-CFP panoramically improved NV detection(ICC=0.988, 95%CI: 0.975-0.994, P<0.001).

Conclusions: 24×20 mm UWF-OCTA is highly effective for NV detection, with excellent agreement to UWF-FA. Combined with UWF-CFP, it serves as a reliable, non-invasive alternative to FA for DR evaluation.

Purpose: To explore whether the proteome of aqueous collected during primary repair of rhegmatogenous Retinal Detachment (RD), differs between patients who experience recurrency (Recurrent RD Group) and those who do not (No Recurrent RD Group).

Methods: The aqueous proteome collected during primary surgery of 13 patients undergoing Recurrent RD was compared to 11 age and sex-matched patients successfully operated for rhegmatogenous RD with no recurrency after 12-months follow-up, regardless of surgical technique. A label-free shotgun proteomics approach identified and quantified the repertoire of aqueous proteins. Differential protein expression between Groups was determined using the Limma moderated Bayesian t-test, followed by False Discovery Rate (FDR) validation using Storey's q-test.

Results: Aqueous profiling identified >800 unique proteins; 45 exclusive to the Recurrent RD group, 10 exclusive to the no Recurrent RD group and 33 differently expressed between groups (log2fold-change≥∣0.57∣, FDR≤0.05). Proteins upregulated in Recurrent RD patients, clearly pointed to mechanisms of cell:cell and cell:matrix adhesiveness and mechano-transduction signalling pathways. Upregulated proteins included extracellular matrix components such as type I and IV collagens, bi-glycan, proteoglycans, and cell-membrane adhesion molecules.

Conclusion: The baseline aqueous composition of RD patients that will eventually develop recurrency, differs significantly from those who will not, and already contains molecular signatures that may help identify the risk of recurrency at the time of primary repair. While acknowledging the pilot nature of the study, our findings strongly suggest that Recurrent RD is associated with cell adhesiveness pathways early alterations, offering targets for prognostic assessment and therapy.