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

Purpose: This literature review synthetizes current evidence on the timing and efficacy of dexamethasone intravitreal injections for diabetic macular edema (DME) in patients undergoing cataract surgery, particularly phacoemulsification, to determine the optimal timing for improved outcome.

Methods: A systematic review of the literature was conducted across key databases to identify peer-reviewed studies, clinical trials, and meta-analyses addressing dexamethasone injections administered pre-, intra-, and post-operatively for DME in the context of cataract surgery. Studies were selected based on relevance to timing, visual outcomes, and inflammation control, with a focus on comparative efficacy.

Results: The findings suggest that timely dexamethasone injections can substantially reduce inflammation and enhance visual recovery for patients with DME undergoing cataract surgery. Studies indicate that preoperative injections may effectively dampen the inflammatory response triggered by surgical trauma, potentially preserving retinal integrity, while intraoperative and postoperative administrations contribute to sustained anti-inflammatory effects during the recovery phase. Comparative studies also highlight dexamethasone's advantages over other anti-inflammatory treatments, such as NSAIDs, particularly in preventing cystoid macular edema. Notably, there was considerable variation in dosage and timing across studies, underscoring the need for standardized treatment protocols.

Conclusions: Dexamethasone intravitreal injections offer a valuable intervention for managing DME in diabetic patients undergoing cataract surgery, with optimal timing playing a crucial role in maximizing therapeutic benefits. Preoperative injections appear to be particularly beneficial in reducing the risk of postoperative inflammatory complications. Further research should focus on developing comprehensive guidelines for timing and dosage to standardize treatment and improve patient outcomes in this high-risk population.

Purpose: To evaluate an alternative surgical approach for Port Delivery System with ranibizumab (PDS) implant and a novel application of Iridex laser system in Gottingen minipig model.

Methods: A total of seventeen male minipigs (Part 1: 9 animals in non-recovery and Part 2: 8 animals observed for 8-days post-surgery Part 2) received PDS implant insertion into each eye. The effect of Iridex 810 nm infrared diode laser with varying energy (power or duration) on transscleral pars plana ablation, surrounding ocular tissue and postsurgical vitreous hemorrhage (VH) was investigated.

Results: The most effective laser parameters for transscleral pars plana ablation in mitigating vitreous hemorrhage with no surrounding tissue damage were continuous wave mode, 1750 mW, 1000 ms, and 16 spots (8 overlapping spots/sweep applied over 2 rows) across a 4 mm segment, posterior to the limbus, delivering a total energy of 28 J. Minimal self-limiting scleral hemorrhage was observed with two of the implants and no VH were observed. µCT imaging was consistent with clinical ophthalmic.

Observations: On microscopic observations, no tissue damage was observed at these laser settings.

Conclusion: This Göttingen minipig model demonstrated a novel application of Iridex laser for transscleral pars plana ablation that streamlines the PDS implantation surgery.

Purpose: To describe an accessible method of structure-function correlation using optical coherence tomography (OCT) and virtual reality perimetry (VRP) for patients with retinal disease and glaucoma and to compare results with those of conventional Humphrey visual fields (HVF).

Methods: Patients with a diagnosis of glaucoma involving the central visual field or macula-involving retinal disease were recruited. Patients underwent ophthalmic examination followed by OCT imaging, HVF, and VRP testing. Both HVF and VRP results were compared to OCT scans to identify areas of visual field abnormality and their corresponding structural deficits. The correlation between HVF and VRP findings was evaluated.

Results: 36 eyes of 21 patients were included as part of this study. VRP was able to reliably identify visual field deficits that correlated with structural abnormalities on OCT in patients with both glaucoma involving the central visual field and complex macula-involving retinal pathology. Spearman's rank correlation coefficient was 0.83 (p<0.001) for mean deviation and 0.85 (p<0.001) for pattern standard deviation between VRP and HVF.

Conclusion: The combination of VRP and OCT allows for practical and accurate structure-function correlation of complex retinal disease and glaucoma. This approach is particularly valuable in identifying the contributions of confounding glaucoma and retinal disease in patients with multiple disorders.

Purpose: The objective of this study was to add to the limited literature of Focal Scleral Nodule (FSN).

Methods: This study was a single-centre, retrospective, observational case series performed at Manchester Royal Eye Hospital (United Kingdom). Nineteen eyes from nineteen patients over a thirteen year period (January 2011 to January 2024) were included. The principal observations were taken from patient demographic data, fundal and autofluorescence imaging, and OCT-EDI imaging.

Results: Most patients with FSN were female, with median age of 47 years and median visual acuity of 20/20 Snellen. FSN were yellow, yellow-white, orange or orange halo in appearance. Median horizontal length of a FSN was 2.02mm (range 0.34mm-4.79mm) and median thickness was 417μm (range 272μm-803μm). The choroid above the FSN was thinned in 9 and absent in 10 cases. Most FSN appeared hyper-autofluorescent on autofluorescence imaging. Extramacular FSN appeared directly inferiorly to the optic disc in 7, infero-temporally in 5, supero-nasally in 2, and supero-temporally in 5 cases. Seven patients demonstrated FSN within the macula, and 2 of these had subretinal fluid. Further investigation revealed one of these patients with subretinal fluid had polypoidal choroidal vasculopathy (PCV) at the same area as the FSN.

Conclusion: This study analysed FSN lesions of a medium-sized group over a large timeframe. It provides more data in the literature for an uncommon ophthalmic lesion. Furthermore, the study described the first known case in the literature of FSN with PCV in the same area. This finding highlights a potential new complication of the condition.

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

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

Results: Fifty-seven eyes with different diabetic retinopathy severity and 37 normal eyes were analyzed. Variable interscan time analysis OCTA provided diverse blood flow speed information, including pseudo-color OCTA and mean flow speed in different regions. Both deep capillary plexus VFS and deep capillary plexus VFS /(superficial and intermediate capillary plexuses) VFS were higher in diabetic retinopathy compared with normal eyes. Elevated deep capillary plexus VFS correlated with decreased deep capillary plexus vessel density in nonproliferative diabetic retinopathy.

Conclusion: Variable interscan time analysis OCTA can measure a quantitative biomarker for blood flow speed alterations in diabetic retinopathy and normal eyes as well as the association with vessel density in different capillary plexuses. Variable interscan time analysis OCTA is promising for studies of pathogenesis and early flow alterations, which may precede nonperfusion.

Purpose: Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure following rhegmatogenous retinal detachment (RRD). In this study, we aimed to explore ocular and systemic risk factors for PVR due to RRD in a large patient database.

Methods: Patients who have a diagnosis of RRD and PVR, and who have been seen in the last seven years prior to analysis (January 2015-February 2023) were identified in the Vestrum Health database. The variables selected for univariate and multivariate analysis in this study included age, gender, history of smoking, diabetes, hypertension, dyslipidemia, anemia, Wagner syndrome, Stickler syndrome, vitreous hemorrhage, high myopia, ocular trauma, choroidal detachment, uveitis, giant retinal tear, aphakia and endophthalmitis. Eyes with proliferative diabetic retinopathy and those that had a history of PVR before the RRD diagnosis date were excluded from the study. The incidence of PVR was determined within each subset of the patient population.

Results: There were 57,264 eyes that underwent a post-operative examination within 1 month following RRD diagnosis. Systemic factors younger age, female gender, smoking history, and hypertension, and ocular factors poor baseline visual acuity, history of ocular trauma, choroidal detachment, history of uveitis, giant retinal tear, pseudophakia, aphakia, and endophthalmitis were significantly and independently associated with increased odds of PVR development.

Conclusion: The findings of this study indicate that there are several systemic and ocular risk factors that increase PVR development. Ophthalmologists should keep these in mind when planning surgical and therapeutic interventions for PVR prevention and treatment in patients with RRD.

Purpose: Focusing the premature birth and its potential complications, this study analyzes Foveal Avascular Zone (FAZ) measured by Optical Coherence Tomography Angiography (OCTA) and its correlation with the severity of prematurity and neonatal growth.

Methods: A cross-sectional comparative study was performed, involving 71 children school-age with history of prematurity and a full-term children control group. Several variables from the neonatal period were collected, such as Gestational Age (GA), Birth Weight (BW), initial Weight Gain (WG) and Retinopathy of Prematurity (ROP). OCTA scans determined FAZ perimeter, circularity, and area on both Superficial Capillary Plexus (SCP) and Deep Capillary Plexus (DCP).

Results: A positive correlation between GA and FAZ area and perimeter was identified, with a smaller FAZ (p<0.001) in preterm children. Furthermore, scatter plots showed a rising trend for all FAZ values based on GA and BW. Thus, children with greater WG during the first 15 days of life had a larger FAZ (p<0.05). GA was also predictive (p<0.001) for FAZ area and perimeter, while the ROP stage was a better predictor (p<0.0232) for its circularity.

Conclusions: OCTA finds discrepancies in FAZ between premature and full-term children, with GA and neonatal growth having a greater influence than ROP itself.

Purpose: To evaluate the effects of mydriatics drops used primarily in routine eye examinations on the choroid tissue, which has a dense vascular network in the eye.

Methods: This prospective observational study included 90 eyes of 90 healthy children. Optical coherence tomography (OCT) images were obtained for all children before dilation. They were randomly divided into two groups (46/44). The tropicamide group received 0.5% tropicamide and the phenylephrine group received 2.5% phenylephrine. After dilation, a second OCT image was obtained for all children.

Results: Subfoveal choroidal thickness (SCFT) values ​​decreased significantly after dilation in the phenylephrine and tropicamide drop groups compared to pre-dilation measurements (p=0.001 for both). No significant difference was observed in the choroidal vascularity index (CVI) values ​​measured before and after dilation in either group (p=0.059, p=0.245).

Conclusion: While 2.5% phenylephrine and 0.5% tropicamide caused a decrease in SCFT values ​​after dilatation, there was no significant difference in CVI values. These results emphasize that when examining choroidal thickness and vascularity in individuals with chorioretinal disease, the selection of mydriatic agent should be taken into consideration, especially in choroidal thickness.