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

Purpose: To evaluate the ability of ChatGPT-5 to predict long-term anatomical and functional outcomes following full-thickness macular hole (FTMH) surgery, and to compare its performance with retinal specialists' predictions and real-world results.

Methods: This retrospective study included 50 eyes of 50 patients undergoing pars plana vitrectomy for FTMH (2021-2024). De-identified clinical summaries with preoperative demographics, ocular history, best-corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters, foveal B-scan OCT images, and surgical details were entered into ChatGPT-5 using a standardized prompt to predict 12-month BCVA and anatomical closure. Predictions were compared with actual results and assessments from two senior retina specialists.

Results: At 12 months, closure occurred in 44/50 eyes (88%), and mean BCVA improved from 20/100 (0.7 ± 0.4 logMAR) to 20/63 (0.5 ± 0.5 logMAR) (p = 0.03). Anatomical prediction accuracy was 72-86% (specialists), and 90% (ChatGPT-5). ChatGPT achieved perfect accuracy in closure cases but failed to identify non-closure, reflecting optimism bias. For functional outcomes, accuracy was 42-44% (specialists) and 66% (ChatGPT-5). ChatGPT-5 performed well when vision improved (60%) but poorly for stable (≤13%) or worsened (0%) cases. Mean BCVA prediction error was 11.4 ± 10.8 letters, with ∼60% within two lines of the true outcome.

Conclusions: ChatGPT-5 demonstrated apparent accuracy in predicting FTMH surgery outcomes; however, this was largely driven by an optimism bias that overestimated closure and visual recovery. This model still lack clinical judgment. Larger prospective studies are needed before clinical use.

Purpose: To evaluate the frequency, clinical and optical coherence tomography (OCT) predictors, and postoperative anatomical and functional outcomes of bacillary layer detachment (BALAD) in eyes undergoing surgical repair for fovea-off rhegmatogenous retinal detachment (RRD).

Methods: This retrospective, single-center observational study was conducted at a tertiary eye care hospital in India. Primary fovea-off RRD that underwent surgical repair between January 2020 and December 2024 were analyzed. Preoperative spectral-domain OCT images were reviewed for BALAD and other predefined retinal biomarkers. Clinical and imaging parameters were compared between BALAD and non-BALAD groups. Univariate and multivariable logistic regression analyses identified predictors of BALAD formation. Occurrence rate and pre-operative predictors of BALAD were analysed and postoperative macular reattachment, external limiting membrane (ELM)/ ellipsoid zone (EZ) continuity, best-corrected visual acuity (BCVA), and single-surgery success were assessed over 24 weeks.

Results: Two hundred and seventy primary fovea-off RRD eyes were analysed. BALAD was detected in 51 eyes (18.9%). Younger age (p=0.014) and greater subretinal fluid height (p=0.002) were independent predictors of BALAD. Anatomical reattachment rates at 24 weeks were 88.5% in BALAD eyes and 77.3% in non-BALAD eyes (p=0.286). ELM/EZ restoration occurred in 42.3% and 33.3%, respectively (p=0.247). BCVA improvement trajectories were similar, though slower in BALAD eyes (p<0.001). Re-surgery rates were comparable between groups (p>0.999).

Conclusion: BALAD is a relatively common OCT feature in fovea-off RRD, predominantly affecting younger, fluid-rich eyes with higher subretinal fluid height. Its presence does not adversely affect anatomical reattachment or single-surgery success.

Purpose: This study aimed to investigate peripheral retinal angiographic features using ultra-widefield fluorescein angiography (UW-FAG) in eyes with idiopathic epiretinal membrane (iERM), compare them with fellow unaffected eyes, and assess their association with disease severity.

Methods: This retrospective study included 84 patients (168 eyes) with unilateral iERM. UW-FAG images were analyzed in both eyes, and peripheral angiographic findings were categorized as vascular-associated or nonvascular. The frequencies of these features were compared between iERM and fellow unaffected eyes. The iERM eyes were further classified as early (stages 1-2) or advanced (stages 3-4) according to optical coherence tomography grading.

Results: The mean age of patients was 65.1 ± 7.3 years, and 64.3% were female. Peripheral abnormalities were significantly more frequent in iERM eyes, including granular hyperfluorescence (39.3% vs. 15.5%, p < 0.001), late-phase leakage (89.3% vs. 56.0%, p < 0.001), and microaneurysms (60.7% vs. 31.0%, p < 0.001). Advanced-stage iERM eyes showed higher rates of late-phase leakage (53.8% vs. 23.8%, p < 0.001), microaneurysms (59.0% vs. 31.0%, p = 0.001), and granular hyperfluorescence (26.9% vs. 7.1%, p = 0.005). The iERM severity positively correlated with late-phase leakage (r = 0.32, p = 0.0008) and microaneurysms (r = 0.25, p = 0.007).

Conclusions: Peripheral angiographic abnormalities are more prevalent in iERM eyes and correlate with disease severity. These findings suggest that iERM is not confined to the macula but may reflect broader retinal pathophysiology. UW-FAG serves as a valuable adjunctive tool in comprehensively evaluating eyes with iERM.

Purpose: To evaluate the association between retinal vein occlusion (RVO) and leukemia.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, Embase, and Web of Science up to August 2025, following PRISMA guidelines and a registered PROSPERO protocol (CRD420251134924). Observational studies reporting ocular findings in leukemia were included. Data extraction and risk of bias assessment were performed independently using the JBI and ROBINS-I tools. Pooled effect sizes were calculated using Comprehensive Meta-Analysis (CMA v4.0), expressed as logit event rates with 95% confidence intervals. Case reports were narratively summarized but excluded from quantitative synthesis.

Results: Eight studies encompassing approximately 800 participants were included in the meta-analysis. The pooled logit event rate for overall ocular manifestations was -0.3307 (95% CI: -0.456 to -0.206; p < 0.0001), corresponding to a prevalence of 42%. Retinal hemorrhage was the most frequent finding (logit = -1.90; ≈13-15%), followed by retinal infiltration (logit = -3.55; ≈3%) and RVO (logit = -4.41; ≈1.2%). Heterogeneity was low for infiltration (I2 = 10.2%) and RVO (I2 = 0%).

Conclusion: Ocular involvement occurs in nearly half of leukemia patients, with retinal hemorrhages and microvascular compromise as dominant manifestations. Although RVO is rare, it signifies advanced hematologic derangement. These findings highlight the importance of routine ophthalmic screening-fundus examination, OCT, and OCTA-as integral components of leukemia management for early detection, systemic correlation, and vision preservation.

Purpose: This study investigated the clinical characteristics and prognosis of rhegmatogenous retinal detachment (RRD) in patients with implantable collamer lens (ICL).

Methods: A retrospective review was conducted of medical records from patients with ICL who underwent RRD surgery between 2015 and 2024. Data collected included medical history, preoperative and postoperative best-corrected visual acuity (BCVA), fundus features, intraocular tamponade type, and arch height (AH).

Results: Fifteen eyes from 13 male patients (mean age: 32.93 ± 4.01 years) were included. The mean interval from ICL implantation to RRD was 4.53 ± 2.46 years. Twelve eyes (80%) was macula-off and three eyes (20%) was macula-on detachments. The primary anatomical success rate was 80% (12/15), and the final anatomical success rate was 93% (14/15). At the final follow up, the mean BCVA significantly improved from 1.21 ± 0.75 logMAR (Snellen equivalent: 6/100) at baseline to 0.63 ± 0.64 logMAR (23/100) (P = 0.006). The ICL was retained during primary retinal reattachment surgery. There was no significant change in AH before and after intraocular tamponade (P = 0.216).

Conclusion: Surgical management is a key to the success of RRD in patients with ICL. ICL removal is not required during vitreoretinal surgery when using wide-angle viewing systems in our series. Intraocular tamponade does not significantly affect AH.

Purpose: To evaluate the prognostic significance of baseline subretinal fluid (SRF) optical density ratio (ODR) in first-onset Central Serous Chorioretinopathy (CSCR).

Methods: This retrospective study included patients with a new diagnosis of CSCR, no prior retinal disease, and at least 3 months of follow-up. Eyes were categorized as resolved or non-resolved based on SRF resolution at 3 months. ODR was calculated as the ratio between SRF and vitreous optical densities on baseline OCT scans.

Results: Thirty-nine patients (33 men, 6 women; mean age 41.4 ± 9.1 years) met inclusion criteria. At 3 months, SRF resolved in 19 eyes and persisted in 20 eyes. Baseline ODR was significantly higher in the non-resolved group compared with the resolved group (1.03 ± 0.32 vs. 0.80 ± 0.27; p = 0.018). Visual acuity at follow-up was significantly better in the resolved group (20/21.4 [logMAR 0.03 ± 0.05] vs. 20/26.4 [logMAR 0.12 ± 0.16]; p = 0.035). No significant differences were found between groups in age, sex, or choroidal thickness. In multivariate logistic regression, ODR remained the only independent predictor of SRF persistence at 3 months.

Conclusion: Baseline ODR is associated with both fluid persistence and visual outcomes. As the only independent predictor of persistent SRF in this cohort, ODR shows promise as a potential prognostic biomarker requiring no additional cost to identify patients at higher risk for chronic disease at initial presentation.

Purpose: Inherited retinal diseases (IRDs) are among the most common causes of visual impairment in children and young adults. The aim of our study was to characterize early clinical manifestations, main IRDs and causative genes and in a pediatric cohort.

Methods: Retrospective study case series of children with a diagnosed IRD. Data extracted from medical charts included IRD type, clinical manifestations, demographic details and molecular analysis when available.

Results: We have identified 199 children. The earliest and most common symptom was nystagmus (mean age: 1.78 years), followed by photophobia, strabismus and high refractive errors. The most common diagnoses were retinitis pigmentosa (RP), achromatopsia and CSNB; achromatopsia and Leber's congenital amaurosis presented significantly earlier than other IRDs. Most common identified genes were CNGA3, TRPM1, CNGB3 and CRB1.

Conclusions: Nystagmus was the earliest and most common symptom, particularly if disease manifests during the first year of life. Photophobia, strabismus and high refractive errors were also common. Main IRDs in our studied population were RP, achromatopsia and CSNB, and the most common genes identified were CNGA3 and TRPM1, differing from the ones seen later in adulthood.Identification of IRDs early clinical manifestations can help affected families reach early diagnosis, support and family planning.

Purpose: We described the clinical characteristics of age-related retinal pigment epithelium disease (ARPED). This looks like an age-related, retinal disease showing a primary RPE involvement, no typical age-related macular degeneration features, and no pachychoroid-related characteristics.

Methods: The study was designed as observational, both cross-sectional and retrospective investigation. We collected data from patients affected by ARPED, defined by precise diagnostic criteria. We performed both qualitative and quantitative multimodal retinal imaging investigations. The main outcome measure is the characterization of ARPED, defined by precise diagnostic criteria, about age-related macular degeneration. Secondary outcome is the identification of differential diagnostic features about other retinal diseases.

Results: We included 31 ARPED eyes (62 patients). Intergraders agreement for detecting ARPED was 0.98 ( P < 0.05). Age-related retinal pigment epithelium disease is characterized by the absence of age-related macular degeneration-related findings, such as drusen and pseudodrusen. Moreover, it is characterized by the absence of pachychoroid-related features, as also confirmed by fluorescein angiography and indocyanine green angiography.

Conclusion: Although further studies are warranted to better define ARPED features and if it may be considered a distinct macular disease, the characteristics of this clinical phenotype introduce new intriguing pathophysiologic features and should be carefully considered both in clinical practice and research contexts.

Purpose: To describe the multimodal imaging findings of the angular sign of Henle fiber layer hyperreflectivity at baseline and follow-up in patients with contusion maculopathy.

Methods: Eleven eyes of 10 patients were captured with multimodal imaging after nonpenetrating ocular blunt trauma from a soccer ball, fist, or airsoft pellet. Baseline clinical and imaging characteristics and follow-up outcomes are presented.

Results: Hyperreflective lesions extending along the Henle fiber layer from the ellipsoid zone to the outer plexiform layer consistent with angular sign of Henle fiber layer hyperreflectivity were identified with optical coherence tomography. The mean presenting visual acuity was logMAR 0.59 ± 0.64 (Snellen visual acuity 20/77, range 20/25 to counting fingers) and the follow-up visual acuity was logMAR 0.43 ± 0.35 (Snellen visual acuity 20/53, range 20/20-20/200). Additional optical coherence tomography findings included external limiting membrane attenuation and retinal pigment epithelium disruption. On follow-up, resolution of angular sign of Henle fiber layer hyperreflectivity was accompanied by outer nuclear layer thinning with varying degrees of ellipsoid zone attenuation and retinal pigment epithelium loss. A macular hole was detected in one patient on follow-up.

Conclusion: Angular sign of Henle fiber layer hyperreflectivity is a distinctive acute optical coherence tomography feature of contusion maculopathy secondary to blunt injury, causing disruption of the photoreceptors and presumably anterograde alterations in the Henle fiber layer. Associated retinal pigment epithelium alterations may ensue, either acutely or delayed, and are a biomarker of persistent structural abnormalities and variable visual outcomes.