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

Purpose: To compare anatomical and functional outcomes as well as postoperative complication rates between cryotherapy and illuminated endolaser retinopexy in chandelier-assisted scleral buckling (CASB) for rhegmatogenous retinal detachment (RRD).

Methods: This retrospective study included 63 eyes from 63 patients treated with CASB between January 2021 and January 2024. Group 1 (n=31) underwent retinopexy with cryotherapy, while Group 2 (n=32) received illuminated endolaser through the same cannula as the chandelier light. All surgeries were performed using a noncontact wide-angle viewing system (WAVS) by a single experienced vitreoretinal surgeon. Outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), swept-source OCT, and postoperative complications.

Results: Mean BCVA improved significantly in both groups. In Group 1, BCVA improved from 1.39 ± 0.74 logMAR (approx. Snellen 20/490) to 1.01 ± 0.63 (20/204), p<0.001. In Group 2, BCVA improved from 1.50 ± 0.67 (20/632) to 1.14 ± 0.66 (20/276), p<0.001. Final BCVA (p=0.21) and retinal reattachment rates (p=0.67) were similar. However, cystoid macular edema occurred significantly more in Group 1 (19.3%) than in Group 2 (3.1%) (p=0.04). Rates of epiretinal membrane, cataract, and IOP elevation did not differ significantly (p>0.05). No buckle exposure or infection was observed.

Conclusion: Both techniques are effective for CASB. Endolaser provides a lower risk of CME and enhanced surgical precision, suggesting it may be a favorable option in selected cases.

Purpose: To investigate the relationship between the spatial arrangement of pachyvessels and polypoidal choroidal vasculopathy (PCV) lesions in relation to recurrence.

Methods: This retrospective study included 58 eyes of 58 patients with treatment-naïve PCV who were followed for at least 1 year after receiving anti-vascular endothelial growth factor injections, with or without photodynamic therapy. Using en face optical coherence tomography, the eyes were categorized into two groups based on the presence or absence of transmacular pachyvessels passing beneath PCV lesions (polypoidal lesions or branching neovascular networks). The primary outcome was the recurrence rate of PCV within 1 year.

Results: Of the 58 eyes, 35 (60.3%) had pachyvessels located beneath PCV lesions. The 1-year recurrence rate was significantly higher in eyes with than without pachyvessels (71.4% vs. 39.1%, P = 0.017). Univariable logistic regression analysis identified the presence of pachyvessels beneath lesions as a significant predictor (odds ratio, 3.89; 95% confidence interval, 1.28-11.84; P = 0.017). This remained the only significant predictor of recurrence within 1 year on multivariable logistic regression (odds ratio, 3.84; 95% confidence interval, 1.22-12.09; P = 0.022).

Conclusion: The presence of transmacular pachyvessels may serve as a novel biomarker to predict prognosis and guide individualized treatment strategies for patients with PCV. These findings suggest that the anatomical relationship between pachyvessels and PCV lesions could be a critical factor in treatment response.

Purpose: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in neovascular age-related macular degeneration (nAMD) using automated volumetric retinal fluid analysis.

Methods: This retrospective study included 186 eyes with nAMD showing inadequate response after ≥3 bevacizumab injections. Patients were switched to a second-line anti-VEGF agent and categorized as early (3-5 injections) or late (≥6 injections) switchers. Optical coherence tomography (OCT) scans were analyzed using the Notal-OCT Analyzer (NOA™), an AI-based algorithm for retinal fluid quantification. Parameters included total retinal fluid (TRF), intraretinal fluid (IRF) volume, subretinal fluid (SRF) volume, pigment epithelial detachment (PED) volume, central subfield thickness (CST), and visual acuity (VA), assessed at baseline, post-bevacizumab, and following three injections of the new agent.

Results: Early switchers showed an increase in TRF from 105nL to 158nL after bevacizumab, then a reduction to 20nL post-switch (p<0.001); PED volume decreased post-switch (p=0.010). Late switchers showed fluid reductions both after bevacizumab and post-switch (TRF: p<0.001; PED: p=0.007). CST significantly improved only in early switchers (p=0.004), while VA changes were not statistically significant.

Conclusions: Automated fluid analysis reliably quantifies treatment response in nAMD. Early switchers showed worsening after bevacizumab, while late switchers had partial responses. These findings highlight the potential of automated analysis to support more individualized, data-driven treatment strategies. Prospective studies are required to confirm impact on patient outcomes.

Purpose: To evaluate the retinal, peripapillary, and choroidal microvascular structures in patients with essential thrombocythemia (ET), a myeloproliferative neoplasm characterized by sustained thrombocytosis and an increased risk of thrombotic events, using optical coherence tomography angiography (OCTA).

Methods: This prospective, cross-sectional study included 20 ET patients and 20 age- and sex-matched healthy controls. All participants underwent spectral-domain OCTA to assess vessel density (VD) in the superficial and deep retinal capillary plexuses(SCP and DCP), radial peripapillary capillary (RPC) network, and choriocapillaris (CC). Structural parameters, including central macular thickness (CMT), macular ganglion cell complex (mGCC), retinal nerve fiber layer (RNFL), and foveal avascular zone (FAZ), were also evaluated. Statistical analyses included independent samples t-tests or Mann-Whitney U tests based on data distribution.

Results: ET patients exhibited significantly increased CMT compared to controls (p = 0.019), while RNFL and mGCC thicknesses showed no significant differences. Peripapillary whole image VD and RPC VD in the nasal-inferior quadrant were significantly reduced in the ET group (p = 0.042 and p = 0.039, respectively). Most notably, DCP VD was significantly decreased in both parafoveal (p = 0.004) and perifoveal (p = 0.010) regions across all quadrants. No significant differences were observed in SCP VD, FAZ metrics, or CC flow parameters (p > 0.05 for all).

Conclusion: ET patients demonstrate subclinical retinal microvascular alterations predominantly affecting the DCP and peripapillary circulation, while superficial retinal and choroidal vasculature remains relatively preserved. OCTA may serve as a sensitive, non-invasive tool for detecting early retinal involvement in ET.

Purpose: To describe the multimodal imaging characteristics and clinical associations of choroidal synphlebia, a newly recognized configuration of the choroidal venous system.

Methods: This retrospective study analyzed patients imaged with the DREAM swept-source OCT system (Intalight, San Jose, CA), capable of deep choroidal penetration. Choroidal synphlebia was defined as a confluent vascular structure ≥750 µm in smallest lateral or vertical dimension. The multimodal imaging characteristics were evaluated.

Results: Nineteen eyes of sixteen patients (mean age 63.2 years; eight male) were identified. Associated diagnoses included central serous chorioretinopathy (CSC) in 16 eyes, neovascular age-related macular degeneration in 2, and myopia in 1. Three patients had bilateral involvement. Two morphologic patterns were observed: (1) broad confluence of large choroidal veins forming a lobulated venous lake, and (2) a caput medusa-type arrangement with smaller tributaries converging radially into a dilated central channel. The lesions often occurred near presumed choroidal watershed zones. Macular neovascularization was present in 7 eyes. In several CSC cases, subretinal fluid was resistant to photodynamic therapy but responsive to faricimab.

Conclusions: Choroidal synphlebia represents a distinct choroidal venous phenotype characterized by fusion or coalescence of major veins with a lack of visible vessels in the overlying Sattler's layer and inner choroid. Alterations in the capacitance, resistance, and pressure distribution in the venous drainage system appear to be affected by synphlebia lesions. Recognition of synphlebia may provide insight into choroidal hemodynamics and may help explain atypical or treatment-resistant CSC and neovascular presentations.

Purpose: To evaluate large-sized human amniotic membrane (hAM) patch-assisted vitrectomy for managing postoperative proliferative vitreoretinopathy (PVR) in complex rhegmatogenous retinal detachment (RRD).

Methods: A retrospective analysis of 12 eyes (12 patients) with complex RRD and severe PVR undergoing large-sized hAM patch-assisted vitrectomy. Indications included open globe injury-associated RRD (n = 8) and RRD with PVR grade D (n = 4). Surgical procedures, clinical outcomes, and complications were documented.

Results: Patients were followed for 9.75 ± 1.60 months. Each eye received 2.75 ± 1.22 hAM patches (mean area: 3.37 ± 1.51 cm2). Two eyes (Cases 1 and 2) with small and regular retinal defects achieved full hAM coverage and retinal reattachment without significant PVR. 10 eyes with extensive defects could not achieve complete coverage of the exposed retinal pigment epithelium (RPE). In five eyes (Cases 3-7), the hAM patches covered the most exposed RPE and retinal edge, but PVR on hAM surface caused hAM-traction of retina, leading to recurrent detachment in three eyes. In the other five eyes (Cases 8-12), a hAM-retina gap was maintained and prevented retinal interference from hAM contraction. Visual acuity improved significantly from 2.40 ± 0.25 LogMAR (Snellen: 20/5023) to 1.43 ± 0.60 LogMAR (Snellen: 20/533) (p = 0.003).

Conclusion: hAM patch-assisted vitrectomy is a promising strategy for managing complex RRD with advanced PVR. When complete coverage of the exposed RPE is not feasible, maintaining a hAM-retina gap reduces postoperative traction and improves anatomical/functional outcomes.