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

Purpose: To evaluate the morphometric changes in macular neovascularization (MNV) architecture after faricimab treatment in neovascular age-related macular degeneration, comparing treatment-naive and previously treated eyes.

Methods: Prospective study analyzing 45 eyes (18 treatment naive, 27 switched) with neovascular age-related macular degeneration undergoing faricimab treatment. Optical coherence tomography angiography images were exported and the quantification of changes in MNV area, vessel area, vessel density, number of junctions, branching index, total vessel length, end points, and lacunarity was performed using AngioTool v0.6a. Follow-ups at baseline (V0), at the end of the loading phase (V1), and at 1 year (V2) were collected.

Results: Baseline MNV characteristics differed significantly between treatment-naive and switched eyes. Switched eyes exhibited greater MNV area ( P < 0.001), vessel area ( P < 0.001), junction count ( P = 0.004), vessel length ( P < 0.001), average vessel length ( P = 0.02), end point count ( P = 0.002), and lacunarity ( P = 0.04). Conversely, naive eyes had higher vessel density ( P < 0.001) and branching index ( P = 0.007). Posttreatment, MNV area ( P < 0.001), vessel area ( P < 0.001), junction count ( P = 0.001), and total vessel length ( P < 0.001) decreased, whereas lacunarity increased ( P = 0.001). Greater changes were observed in naive eyes, but the end point count only reduced in switched eyes ( P = 0.01), being stable in naive eyes. At V2, switched eyes still had larger MNV area ( P = 0.007), vessel area ( P = 0.004), junction count ( P = 0.002), vessel length ( P = 0.004), and end points ( P = 0.007).

Conclusion: Faricimab induces significant and sustained remodeling of the MNV network in neovascular age-related macular degeneration, with more pronounced changes in treatment-naive eyes. These changes were primarily driven by the loading phase, but then remained stable toward the 1-year follow-up.

Purpose: To explore the relationship between atopic dermatitis (AD) and the risk of developing age-related macular degeneration (AMD).

Methods: This retrospective cohort study used data from two large databases: the US-based TriNetX Research Network (46,018 patients with AD aged ≥50 years, spanning 2005-2021) and Taiwan's National Health Insurance Research Database (9,513 patients with AD aged ≥50 years, spanning 2003-2017). The main outcome was the incidence of AMD. The Cox regression analysis was used to calculate hazard ratios (HRs) for AMD. Additional analyses examined the risk of dry and wet AMD, with stratified assessments based on age, sex, ethnicity, race, and AD activity.

Results: Adults with AD exhibited a significantly elevated risk of developing AMD in both the TriNetX cohort (HR 1.97; 95% CI: 1.78-2.19) and the National Health Insurance Research Database cohort (HR 1.25; 95% CI: 1.11-1.41). Individual outcome analyses confirmed a heightened risk for both dry and wet AMD associated with AD. This increased risk was consistent across various groups stratified by demographic factors and AD activity.

Conclusion: AD in adulthood is linked to a greater likelihood of developing AMD. These findings underscore the importance of regular funduscopic evaluations and proactive management of AMD in patients with AD.

Purpose: To describe a noninvasive imaging technique for the detection of ocular amyloidosis using ultra-widefield images.

Methods: This was a retrospective, case-control study of patients with familial transthyretin amyloidosis seen at the Wills Eye Hospital and Moorfields Eye Hospital, United Kingdom. Pseudocolor, 100% red, and 100% green ultra-widefield fundus images of patients with familial transthyretin were reviewed, and s ensitivity, specificity, and area under the curve for the pattern abnormalities noted on fundus images for amyloidosis were calculated.

Results: A total of 19 eyes of 10 patients with transthyretin amyloidosis were included. Vitreous floaters were the most common posterior segment manifestation present in 57.9% (N = 11/19) eyes. The sensitivity and specificity for a hypointense or isointense pattern on 100% red and a hyperintense pattern on 100% green being amyloidosis were 57.9% (95% CI: 33.5%‒79.7%) and 100% (95% CI: 54.1%‒100%), respectively. The area under the curve was 0.79 (95% CI: 0.68-0.90). Excluding the hypomorphic V122I mutation, the sensitivity and specificity for a hypointense or isointense pattern on 100% red and a hyperintense pattern on 100% green being amyloidosis were 64.7% (95% CI: 38.3%‒85.8%) and 100% (54.1%‒100%), respectively. The area under the curve was 0.82 (95% CI: 0.71-0.94). Histopathological analysis showed that amyloid deposits were visible under green and blue filters but not under red filters.

Conclusion: The appearance of amyloid deposits can vary based on the type of scanning laser used. The methodology described in this study represents a novel and noninvasive approach to detect ocular amyloidosis with relatively high specificity.

Purpose: To identify clinical and surgical risk factors associated with recurrent rhegmatogenous retinal detachment (RRD) in the index eye and RRD in the fellow eye.

Methods: Retrospective observational study of adult patients who underwent RRD repair at two tertiary care centers over six years.

Results: Among 794 patients with primary RRD, recurrence occurred in 20.5%, and RRD in the fellow eye was observed in 5.2%. Postoperative visual acuity significantly improved at one year (95% CI -0.44 to 0.30; P < 0.001). Higher recurrence rates were found in patients with prolonged symptom duration ( P = 0.005), preoperative proliferative vitreoretinopathy ( P = 0.006), and worse initial visual acuity ( P < 0.001). Recurrences were most frequent within the first 90 days postoperatively, while fellow eye RRD primarily occurred after 1 year. Pneumatic retinopexy (SE 0.37; 95% CI 1.07-4.64, P = 0.03) and the extent of detachment (SE 0.04; 95% CI 1.0-1.2; P = 0.005) were significant predictors of recurrence in multivariate analyses. Age (SE 0.01; 95% CI 1.01-1.05; P = 0.01) and male sex (SE 0.38; 95% CI 1.66-7.47; P = 0.001) were significant predictors for fellow eye RRD.

Conclusion: The study highlights pneumatic retinopexy and detachment extent as significant predictors of RRD recurrence. It also identifies older age and male sex as risk factors for RRD in the fellow eye. Our findings emphasize the importance of risk stratification and recommend close monitoring during the first 90 days and beyond the one-year postoperative period.

Purpose: To determine the feasibility of developing an artificial intelligence (AI) algorithm based on optical coherence tomography (OCT) images as an automated screening tool for diagnosing retinal thinning in children with sickle cell disease (SCD).

Methods: This retrospective consecutive series included children with SCD who had an ophthalmic examination at a Pediatric Tertiary Care Hospital, including OCT imaging between January 1998 and August 2022. Three different machine learning algorithms were evaluated: logistic regression, K-Nearest Neighbors (KNN), and random forest.

Results: A total of 348 OCT scans from 174 eyes of 87 patients (54% males) were included. Using the original data set, KNN algorithm outperformed both the random forest and logistic regression algorithms when using two OCT scans per patient. However, with cross-validation, this model's accuracy dropped to 77.11%. When duplicating the data set's values, the random forest algorithm performed best, demonstrating the highest accuracy after cross-validation of 96.0%, AUC, sensitivity, specificity, and a F1 score all reaching 1, when using one OCT scan per patient.

Conclusion: AI-based analysis of OCT imaging is a promising tool in the early detection of sickle cell maculopathy in the pediatric population.

Purpose: To detect retinal photoreceptors and arterioles alterations among individuals with diabetes mellitus (DM) and nonproliferative diabetic retinopathy (DR) at cellular resolution.

Methods: Thirty subjects were recruited in the Guangdong Diabetic Retinopathy Multiple-omics Study. Adaptive optics scanning laser ophthalmoscopy was adopted for image acquisition. An AI-based algorithm conducted quantitative analyses of photoreceptor morphology, including cone density, spacing, and regularity. Vessel morphology (inner diameter, outer diameter, wall thickness, wall-to-lumen ratio) was manually assessed. The arteriolar index ratio was derived to assess arteriolar remodeling. Generalized estimating equation was used to compare the differences of inner diameter, outer diameter, wall thickness, wall-to-lumen ratio, and the arteriolar index ratio among healthy control, DM, and DR groups.

Results: Thirty patients, consisting of 9 healthy controls, 11 with DM, and 10 with DR, were evaluated (mean [SD] age, 66.33 [7.02]). A significant reduction in photoreceptor cell density in macular areas correlated with the presence of DM ( P = 0.033) and DR ( P = 0.006). Notably, a significant increase of the wall thickness was observed. These variations were pronounced in the arteriole segments of diabetic patients ( P < 0.001) and escalated with the presence of DR ( P = 0.018). Accounting for wall-to-lumen ratio, the DR group showed a significantly larger ratio comparing to control group ( P = 0.011). The arteriolar index ratio in small retinal arterioles differed significantly among DR ( P < 0.001), DM ( P = 0.024), and control groups.

Conclusion: Adaptive optics scanning laser ophthalmoscopy imaging showed delineating retinal photoreceptor and arteriolar alterations throughout DR progression, potentially serving as a predictive measure for anatomical or functional retinal changes in patients with DM and DR.

Purpose: To describe a novel Optical Coherence Tomography (OCT) finding called "scolex sign" in cases of central serous chorioretinopathy(CSCR).

Methods: This retrospective multicenter study included CSCR patients with serous pigment epithelial detachments(PED) greater than 100µm, with or without subretinal fluid(SRF). Eyes showing a distinct hyperreflective focus on the PED wall(scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on SRF status was also performed.

Results: Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared to 52 age-matched controls. Baseline characteristics including gender, systemic comorbidities, best recorded visual acuity(BRVA) and OCT parameters were similar in both the groups. However eyes with "scolex" sign exhibited more number of central PEDs and shorter distance from foveal centre. On follow-up, eyes with "scolex" sign showed a higher rate of PED flattening and SRF resolution trended to be higher compared to controls.

Conclusion: The "scolex" sign represents a novel, benign OCT feature seen in a subset of CSCR cases. While not associated with poorer outcomes or adverse sequalae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.