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

Purpose: To validate the presence of residual non-emulsified silicone oil (SO) following conventional surgical removal techniques used in vitreoretinal surgery and provide insights for optimizing surgical parameters and reducing subsequent emulsification-related complications.

Methods: The two surgical steps of repeated fluid-air exchange (FAX), including aspiration and infusion, were simulated in vitro to investigate their effectiveness in removing residual non-emulsified SO under various clinical settings. Aspiration was performed at three different positions with respect to the SO interface (i.e., within the SO phase, at the SO/BSS interface, and within the BSS phase) with a 25-gauge probe. An infusion was positioned near the SO/BSS interface with an intraoperatively standardized flow rate (5mL/min). In a further ex vivo study, the volume of residual non-emulsified SO (collected by Dichloromethane) was quantified by Flourier-transform infrared spectroscopy (FTIR) in both repeated FAX and passive drainage (PD) groups.

Results: In the in vitro model, regardless of which position a 25-gauge probe was located, residual non-emulsified SO could not be effectively removed even under high aspiration levels (p>0.05). Continuous BSS infusion led to small SO droplet formation. Residual SO in both non-emulsified and emulsified forms was observed in the ex-vivo model subjected to repeated FAX. The volume of residual non-emulsified SO was quantified, ranging from 2.75 to 24.71 μL, without significant difference among experimental groups (p>0.05).

Conclusions: Complete residual non-emulsified SO removal was technically challenging by conventional surgical techniques. This residual non-emulsified SO could serve as a source of ongoing SO emulsification.

Purpose: To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) and the changes in these findings over time.

Methods: Fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FA), spectral domain optical coherence tomography (OCT), B-scan ultrasonography (US), and ultrasound biomicroscopy (UBM) images of the patients diagnosed with BDUMP at a single institution between years 2006-2023 were evaluated.

Results: Sixteen eyes of 8 patients with BDUMP were included. The median age was 68 years (Range: 49 - 77 years), and the median follow-up time was 11 months (Range: 1 - 79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in FAF and FA. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in OCT; optic disc hyperfluorescence, and peripheral vascular leakage in FA; 360° ciliary body thickening, and anterior rotation of the ciliary body in UBM were detected.

Conclusions: We presented various novel multimodal imaging features of BDUMP that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to BDUMP pathogenesis, which may have implications for treatment.

Purpose: Retinal ischemic perivascular lesions (RIPLs) have been reported as potential biomarkers for cardiovascular diseases and stroke. We aimed to investigate the RIPLs in carotid artery stenosis (CAS) patients and their association with stenotic degree.

Methods: Patients with unilateral CAS or carotid artery occlusion were recruited. Optical coherence tomography (OCT) was conducted for assessing the presence, number, and distribution of RIPLs. OCT angiography (OCTA) was used for evaluating microvascular density in superficial vascular complex (SVC) and deep vascular complex (DVC).

Results: Eighty hundred and fifty-four eyes from 474 CAS patients were included. Ipsilateral eyes had more PRILs compared to contralateral eyes (all p < 0.01). CAS patients with cerebral infarction had a higher incidence and broader distribution of RIPLs compared to those without infarction (both p <0.05). The presence, number, and distribution of RIPLs were positively associated with stenotic degree (all p < 0.001). Eyes with RIPLs had lower SVC density (p = 0.020) compared to eyes without RIPLs.

Conclusions: RIPLs are anatomical markers of ischemia and are suggested to be associated with cerebral infarction and stenotic degree in CAS patients. OCT/OCTA is a noninvasive tool to detect retinal ischemic changes and quantitatively measure retinal microvascular changes in CAS patients.

Purpose: To study the prevalence of choroidal caverns (CCs) in patients with type 2 diabetes (T2DM) and their association with demographic and clinical data.

Methods: We included patients with T2DM and nondiabetic controls in a cross-sectional, monocenter study. The main outcome measure was the presence of CCs. Exploratory variables included age, sex, diabetic retinopathy (DR) status, duration of T2DM, visual acuity, arterial hypertension (aHT), hyperlipidemia, HbA1c, choroidal thickness (CT) and choroidal vascularity index (CVI). Group differences between eyes with and without CCs and associations with demographic and clinical variables were assessed.

Results: After including a total of 205 eyes of 116 patients, the prevalence of CCs was 25% in the control, 28% in the T2DM without DR and 9.5% in the DR groups. The locations of the caverns were: choriocapillaris (N=2, 4.2%), Sattler's (N=29, 60.4%) and Haller's layer (N=17, 35.4%). 34.3% of patients had caverns in both eyes. We found no significant differences in systemic conditions (including aHT, hyperlipidemia, HbA1c or T2DM disease duration). CVI was the only parameter independently associated with the presence of choroidal caverns (OR 1.37).

Conclusions: We found choroidal caverns in almost a quarter of patients with and without T2DM. CCs were mainly located in the Sattler's layer. CVI was independently associated with the presence of CCs. These findings suggest that the presence of CCs may be a sign of a higher metabolic activity within the choroidal microenvironment, irrespective of T2DM status.

Purpose: To investigate the relationship between social determinants of health (SDoH) and the prevalence of age-related macular degeneration (AMD).

Methods: This analysis included adult respondents (>50 years old) from the 2017 National Health Interview Survey (NHIS). The primary outcomes were self-reported diagnosis of AMD and self-reported vision loss due to AMD. Univariable and multivariable logistic regression models were employed for analysis.

Results: A total of 14,267 NHIS participants were included, of whom 668 (4.7%) reported an AMD diagnosis. In the multivariable analysis, respondents aged over 81 years had higher odds of AMD (OR=7.54, 95%CI=[4.76, 11.96], p<0.001) compared to those aged 51-60. Divorced, separated, or widowed participants (OR=1.27, 95%CI=[1.01, 1.61], p=0.042) were also associated with higher odds of AMD compared to married participants. Conversely, Black/African-American (OR=0.23, 95%CI=[0.14, 0.39], p<0.001), Asian (OR=0.38, 95%CI=[0.16, 0.88], p=0.023), and gay, lesbian, or bisexual respondents (OR=0.45, 95%CI=[0.22, 0.93], p=0.032) had lower odds of AMD compared to White and heterosexual respondents, respectively. Employment was also associated with lower odds of AMD (OR=0.71, 95%CI=[0.53, 0.96], p=0.026) compared to unemployment.

Conclusion: Several SDoH were associated with self-reported AMD diagnosis. These factors should be considered by policymakers and clinicians to effectively orchestrate public health initiatives aimed at promoting equitable care.

Purpose: To conduct a simulation study to evaluate the effect of disease stage, frequency, and clustering of visual field (VF) tests, and inclusion of one or both eyes on sample size calculation in clinical trials on retinitis pigmentosa.

Methods: A series of VFs were simulated on the basis of test-retest VF data in the early, moderate, and advanced stages of retinitis pigmentosa. VF measurements were scheduled 8 times in approximately 2 years. The probability to detect significant difference between treatment and control groups was measured. The investigation was conducted for 50%, 40%, 30%, 20% and 10% treatment effects.

Results: When only one eye was used in each patient with a treatment effect of 50%, 80% probability of significance was observed in the moderate stage when sample size was 70 eyes in each arm (140 eyes in both arms). Early stage disease and inclusion of both eyes decreased this number to 30 eyes (60 eyes in both arms); these decreasing effects were larger than performing additional VFs at the beginning and end of the observation. A similar tendency was observed with 40%, 30%, 20% and 10% treatment effects.

Conclusions: When planning a clinical trial, it is important to consider disease stage, in addition to VF schedule and inclusion of one or both eyes.

Purpose: To investigate the distribution of macrophage-like cells (MLCs) across different stages of posterior vitreous detachment (PVD).

Methods: A total of 168 eyes from 168 subjects were included. MLCs were imaged by acquiring en face OCT images at depths of 5 to 10 µm on the inner limiting membrane, as well as using B-scan OCT. Participants were categorized into three groups according to the degree of PVD: Group A for stage 1a PVD, Group B for stages 1b and 2 PVD, and Group C for stages 3 and 4 PVD. Localized vitreoretinal relationships were categorized into vitreoretinal adhesions, type 1a PVD, where the vitreous and retina are not clearly separated, and type 1b PVD, where there is clear separation.

Results: MLC density was sequentially lower in Groups A, B, and C. Multiple linear regression analysis revealed that MLC density was correlated with both the PVD group and age (both P < 0.001). In Group A, MLC density was significantly higher in type 1a PVD than in the vitreoretinal adhesion area. In Group B, the distribution of MLCs in the vitreoretinal adhesion region was significantly less than in type 1a PVD and type 1b PVD. MLCs were more sparsely distributed in Group C.

Conclusions: MLCs exhibit distinct distribution patterns in various stages of PVD.

Purpose: This study investigated the clinical features and surgical outcomes of full-thickness macular holes (FTMHs) without focal vitreomacular traction (VMT) and discusses possible underlying mechanisms.

Methods: This was a retrospective observational study included patients aged 18 years or older with stage 2 FTMHs who underwent pars plana vitrectomy at three hospitals between December 2016 and March 2024. Patients diagnosed without focal VMT in the macula were classified as VMT- and those with focal VMT were classified as VMT+. Medical records and comprehensive ophthalmologic examinations, including best-corrected visual acuity (BCVA) and optical coherence tomography assessments, were reviewed.

Results: This study analyzed 94 eyes that underwent surgery for stage 2 MHs. Patients in the VMT- were younger (VMT- vs VMT+: 63.6 vs 69.1 years, P = 0.008), had a longer axial length (AL) (25.2 vs 24.0 mm, P = 0.004), and had better preoperative BCVA [0.41 (20/43) vs 0.66 (20/74) logMAR, P = 0.002 ] compared with the VMT+. The VMT- had a higher prevalence of epiretinal proliferation (EP) compared with the VMT+ (76 vs 5 %, P<0.001). Postoperatively, no significant difference in visual outcomes was found between the two groups . VMT- showed significantly thicker central retinal thickness at 1 month (244 vs 201 μm, P = 0.021) and poorer external limiting membrane status at 1 month compared with the VMT+.

Conclusions: FTMHs without focal VMT were associated with younger age, longer AL, better baseline visual acuity, and a higher incidence of EP compared with FTMHs with VMT.

Purpose: This study aimed to evaluate the efficacy and safety of using an absorbable gelatin sponge as an intrascleral buckle in rabbit eyes; it also monitored degradation of the gelatin sponge over time.

Methods: Ten New Zealand white rabbits underwent surgery to implant an absorbable gelatin sponge as an intrascleral buckle. Weekly ophthalmic examinations were conducted before and after the procedure until the implant was fully absorbed. Assessments included external eye and fundus examinations, color fundus imaging, and optical coherence tomography. Safety and efficacy were determined by comparing pre-operative and post-operative conditions.

Results: The surgery was successfully completed in 12 of 20 eyes, yielding favorable postoperative outcomes. Eight eyes were excluded due to issues with scleral tunneling, including accidental penetration, suprachoroidal implantation of the sponge, and choroidal excavation, resulting in a success rate of 60%. The indentation produced by the gelatin sponge implant progressively decreased, entirely disappearing within 2 weeks. No complications, such as retinal or choroidal hemorrhage or detachment, were observed.

Conclusion: Intrascleral implantation of absorbable gelatin sponge was safe and effective for scleral buckling in rabbits, demonstrating favorable biodegradation characteristics.

Purpose: This study aims to compare macular vessel density (VD) in eyes with macula-off rhegmatogenous retinal detachment (RRD) after vitrectomy with gas or silicone oil (SO) tamponade.

Methods: Patients with macula-off RRD who underwent vitrectomy with either gas or SO tamponade were included. Best-corrected visual acuity (BCVA) and VD in superficial and deep retinal capillary plexuses (SCP and DCP), choriocapillaris (CCP), and foveal avascular zone (FAZ) were assessed using optical coherence tomography angiography (OCTA). Comparisons were made with the unaffected fellow eye.

Results: Fifty patients (average age: 57.9±9.1 years) participated, with 26 eyes undergoing SO tamponade and 24 gas tamponade. No significant differences were found in baseline characteristics. Postoperative BCVA significantly improved in both groups. In the SO group, BCVA improved from 2.00±0.77 logMAR (20/2000 Snellen) to 0.95±0.52 logMAR (20/178 Snellen). In the gas tamponade group, BCVA improved from 2.12±0.70 logMAR (20/2636 Snellen) to 0.70±0.55 logMAR (20/100 Snellen) (p<0.001 for both groups). Moreover, the gas tamponade group achieved significantly better postoperative BCVA compared to the silicone oil group (p<0.05). SO tamponade group exhibited significantly lower VD in SCP, DCP, and CCP quadrants (p<0.05), while gas tamponade showed no significant differences.

Conclusion: This study reveals a decrease in VD in SCP, DCP, and CCP induced by SO tamponade, suggesting potential toxic effects on macular perfusion. Gas tamponade resulted in superior BCVA outcomes and preserved VD. Further investigation into SO's underlying mechanisms and careful patient selection is warranted. Gas tamponade may offer better outcomes for macula-off RRD.