Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100168
Yiyang Shu , Chaoyang Zhang , Yanlong Bi , Jingfa Zhang
Purpose
To evaluate the correlation between hyperreflective foci (HRF), the biomarker of activated microglia, and subretinal fluid (SRF), representing the dysfunction of retinal pigment epithelium (RPE), in treatment-naïve patients with diabetic macular edema (DME).
Methods
Sixty-one treatment-naïve patients (61 eyes) with DME were included in the research. Participants were divided into two categories based on the presence or absence of SRF. Basic characteristics were recorded. The parameters, including the HRF number in inner and outer retina, central macular thickness (CMT), intraretinal cyst (IRC), as well as the width, height and area of SRF, were analyzed with optical coherence tomography angiography (OCTA). The correlations between HRF and the parameters including SRF, IRC and CMT were analyzed accordingly.
Results
The mean CMT in DME with SRF group was much thicker than that in DME without SRF group (P < 0.0001). The mean HRF number in the outer retina and whole retina was markedly higher in DME patients with the presence of IRC or SRF when compared to those without IRC or SRF (P < 0.05). Further analysis showed that the width, height and area of SRF were positively correlated with the HRF number in the outer retina and the ratio of outer/whole retina HRFs (P < 0.05).
Conclusion
The positive correlation between the increased number of HRF, especially in the outer retina, and the formation of SRF in patients with DME supports the hypothesis that microglia activation represented by HRF might cause the dysfunction of RPE and the breakdown of the outer blood-retinal barrier (oBRB), which leads to the increased fluid leakage in subretinal space.
{"title":"Hyperreflective foci and subretinal fluid predicts microglia activation involved in the breakdown of outer blood-retinal barrier in treatment-naïve patients with diabetic macular edema","authors":"Yiyang Shu , Chaoyang Zhang , Yanlong Bi , Jingfa Zhang","doi":"10.1016/j.apjo.2025.100168","DOIUrl":"10.1016/j.apjo.2025.100168","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the correlation between hyperreflective foci (HRF), the biomarker of activated microglia, and subretinal fluid (SRF), representing the dysfunction of retinal pigment epithelium (RPE), in treatment-naïve patients with diabetic macular edema (DME).</div></div><div><h3>Methods</h3><div>Sixty-one treatment-naïve patients (61 eyes) with DME were included in the research. Participants were divided into two categories based on the presence or absence of SRF. Basic characteristics were recorded. The parameters, including the HRF number in inner and outer retina, central macular thickness (CMT), intraretinal cyst (IRC), as well as the width, height and area of SRF, were analyzed with optical coherence tomography angiography (OCTA). The correlations between HRF and the parameters including SRF, IRC and CMT were analyzed accordingly.</div></div><div><h3>Results</h3><div>The mean CMT in DME with SRF group was much thicker than that in DME without SRF group (<em>P</em> < 0.0001). The mean HRF number in the outer retina and whole retina was markedly higher in DME patients with the presence of IRC or SRF when compared to those without IRC or SRF (<em>P</em> < 0.05). Further analysis showed that the width, height and area of SRF were positively correlated with the HRF number in the outer retina and the ratio of outer/whole retina HRFs (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>The positive correlation between the increased number of HRF, especially in the outer retina, and the formation of SRF in patients with DME supports the hypothesis that microglia activation represented by HRF might cause the dysfunction of RPE and the breakdown of the outer blood-retinal barrier (oBRB), which leads to the increased fluid leakage in subretinal space.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100168"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100242
Timothy Y.Y. Lai , Keiko Kataoka , Yi-Ting Hsieh , Rajendra S. Apte , Muna Bhende , Andrew Chang , Voraporn Chiakitmongkol , Youxin Chen , Li Jia Chen , Gemmy C.M. Cheung , Jay Chhablani , Kenneth C.S. Fong , Robyn H. Guymer , Fumi Gomi , Suber S. Huang , Judy E. Kim , Gregg T. Kokame , Adrian Koh , Xiaoxin Li , Jennifer I. Lim , Dennis S.C. Lam
Neovascular age-related degeneration (nAMD) is one of the leading causes of visual impairment in older populations in the developed world. With the aging population, the incidence of nAMD is growing globally. Despite advancements in diagnostic investigations and treatment modalities over the past three decades, there remains considerable controversies in the pathogenesis, classification and optimal management strategies. An international panel of 31 experts from 11 countries/regions prepared and voted on consensus statements in five key areas: (1) etiology controversies; (2) diagnosis controversies; (3) treatment controversies; (4) future development controversies; and (5) healthcare deliveries controversies. Among the 31 consensus statements, 28 (90.3 %) have achieved over 75 % agreement. These statements can provide a practical guide for ophthalmologists to provide the optimal care of patients with nAMD and for planning future research priorities in order to address the unmet needs in nAMD.
{"title":"International consensuses and guidelines on etiology, diagnosis, treatment, and future developments of neovascular age-related macular degeneration (nAMD) by the Asia-Pacific Vitreo-retina Society (APVRS), the Asia-Pacific Ocular Imaging Society (APOIS) and the Academy of the Asia-Pacific Professors of Ophthalmology (AAPPO)","authors":"Timothy Y.Y. Lai , Keiko Kataoka , Yi-Ting Hsieh , Rajendra S. Apte , Muna Bhende , Andrew Chang , Voraporn Chiakitmongkol , Youxin Chen , Li Jia Chen , Gemmy C.M. Cheung , Jay Chhablani , Kenneth C.S. Fong , Robyn H. Guymer , Fumi Gomi , Suber S. Huang , Judy E. Kim , Gregg T. Kokame , Adrian Koh , Xiaoxin Li , Jennifer I. Lim , Dennis S.C. Lam","doi":"10.1016/j.apjo.2025.100242","DOIUrl":"10.1016/j.apjo.2025.100242","url":null,"abstract":"<div><div>Neovascular age-related degeneration (nAMD) is one of the leading causes of visual impairment in older populations in the developed world. With the aging population, the incidence of nAMD is growing globally. Despite advancements in diagnostic investigations and treatment modalities over the past three decades, there remains considerable controversies in the pathogenesis, classification and optimal management strategies. An international panel of 31 experts from 11 countries/regions prepared and voted on consensus statements in five key areas: (1) etiology controversies; (2) diagnosis controversies; (3) treatment controversies; (4) future development controversies; and (5) healthcare deliveries controversies. Among the 31 consensus statements, 28 (90.3 %) have achieved over 75 % agreement. These statements can provide a practical guide for ophthalmologists to provide the optimal care of patients with nAMD and for planning future research priorities in order to address the unmet needs in nAMD.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100242"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100232
Andrii Ruban , Vitalyi Prudyus , Anna Zolnikova , Beáta Éva Petrovski , Goran Petrovski , Andrzej Grzybowski , Lyubomyr M. Lytvynchuk
Background
The current classification of idiopathic full thickness macular holes (IFTMH) based on the minimum linear diameter (MLD) parameter does not provide the surgeon with accurate prognostic information regarding the surgical outcome.
Purpose
To investigate whether the preoperative Foveal Actual Defect (FAD) can predict postoperative macular hole outcomes and could be a key point in new Decision Support System for IFTMHs surgery.
Patients and methods
Fifty-seven eyes of fifty-three patients with iFTMH, who underwent 25-gauge PPV, ILM peeling and gas tamponade (GT) were recruited for this retrospective, consecutive case, interventional study. The choice of additional surgical techniques was determined individually depending on the size of the FAD. Surgery outcome-related factors were also assessed.
Results
The primary closure rate was 94.7 % (54/57). Three eyes (5.3 %) with persistent MHs required an additional surgery. In all of these eyes, the MH closed after the second surgery. Mean BCVA (logMAR) significantly improved after surgery from 0.8 ± 0.3 (ME = 0.7; IQR: 0.5–1.0) to 0.1 ± 0.2; (ME = 0.1; IQR: 0.1–0.2) (P = 0.0001). There is a statistically significant difference (U = 78.0; Р = 0.05) in the preoperative FAD indicators between groups with a primary closed holes at the first day (ME = 217; IQR: 140–391) and unclosed holes (ME = 370; IQR: 222–697). The probability of MH closing by 14 days after surgery with FAD < 400 µm increases 1.3 times (RR = 1.3, 95 %CI: 1.0–1.6; φ = 0.4; P = 0.02). The MLD indicator in the primary hole closing group at first postop day did not statistically significantly different from those who did not close, but in the group with a primary closed holes at 14-th postop day the MLD indicator statistically significantly (U = 10.0; P = 0.005) was less (ME = 390; IQR: 277 – 492) compared to the unclosed holes (ME = 642; IQR: 558 – 866). There is a statistically significant correlation between postoperative BCVA at 6 month and preoperative OCT parameters: BD - ρ = 0.23 (P = 0.02), MLD - ρ = 0.34 (P = 0.005), FAD - ρ = 0.37 (P = 0.002).
The regression model showed that PreopBCVA, FAD, and BD were statistically significant: PostBCVA = 0.22 × PreBCVA + 0.00001 × BD + 0.00001 × FAD (σPreBCVA = 0.05, σBD = 0.000006, σFAD = 0.000005, R² = 0.75, P < 0.01).
Conclusion
The proposed Decision Support System based on a new preoperative OCT-parameter Foveal Actual Defect (FAD) allows a personalized assessment of macular hole surgery.
{"title":"Foveal actual defect (FAD): A novel OCT biomarker for prognosis and surgical decision support in idiopathic full-thickness macular hole","authors":"Andrii Ruban , Vitalyi Prudyus , Anna Zolnikova , Beáta Éva Petrovski , Goran Petrovski , Andrzej Grzybowski , Lyubomyr M. Lytvynchuk","doi":"10.1016/j.apjo.2025.100232","DOIUrl":"10.1016/j.apjo.2025.100232","url":null,"abstract":"<div><h3>Background</h3><div>The current classification of idiopathic full thickness macular holes (IFTMH) based on the minimum linear diameter (MLD) parameter does not provide the surgeon with accurate prognostic information regarding the surgical outcome.</div></div><div><h3>Purpose</h3><div>To investigate whether the preoperative Foveal Actual Defect (FAD) can predict postoperative macular hole outcomes and could be a key point in new Decision Support System for IFTMHs surgery.</div></div><div><h3>Patients and methods</h3><div>Fifty-seven eyes of fifty-three patients with iFTMH, who underwent 25-gauge PPV, ILM peeling and gas tamponade (GT) were recruited for this retrospective, consecutive case, interventional study. The choice of additional surgical techniques was determined individually depending on the size of the FAD. Surgery outcome-related factors were also assessed.</div></div><div><h3>Results</h3><div>The primary closure rate was 94.7 % (54/57). Three eyes (5.3 %) with persistent MHs required an additional surgery. In all of these eyes, the MH closed after the second surgery. Mean BCVA (logMAR) significantly improved after surgery from 0.8 ± 0.3 (ME = 0.7; IQR: 0.5–1.0) to 0.1 ± 0.2; (ME = 0.1; IQR: 0.1–0.2) (<em>P</em> = 0.0001). There is a statistically significant difference (U = 78.0; <em>Р</em> = 0.05) in the preoperative FAD indicators between groups with a primary closed holes at the first day (ME = 217; IQR: 140–391) and unclosed holes (ME = 370; IQR: 222–697). The probability of MH closing by 14 days after surgery with FAD < 400 µm increases 1.3 times (RR = 1.3, 95 %CI: 1.0–1.6; φ = 0.4; <em>P</em> = 0.02). The MLD indicator in the primary hole closing group at first postop day did not statistically significantly different from those who did not close, but in the group with a primary closed holes at 14-th postop day the MLD indicator statistically significantly (U = 10.0; <em>P</em> = 0.005) was less (ME = 390; IQR: 277 – 492) compared to the unclosed holes (ME = 642; IQR: 558 – 866). There is a statistically significant correlation between postoperative BCVA at 6 month and preoperative OCT parameters: BD - ρ = 0.23 (<em>P</em> = 0.02), MLD - ρ = 0.34 (<em>P</em> = 0.005), FAD - ρ = 0.37 (<em>P</em> = 0.002).</div><div>The regression model showed that PreopBCVA, FAD, and BD were statistically significant: PostBCVA = 0.22 × PreBCVA + 0.00001 × BD + 0.00001 × FAD (σPreBCVA = 0.05, σBD = 0.000006, σFAD = 0.000005, R² = 0.75, <em>P</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>The proposed Decision Support System based on a new preoperative OCT-parameter Foveal Actual Defect (FAD) allows a personalized assessment of macular hole surgery.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100232"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100248
De-Kuang Hwang , Danny S.C. Ng , Zhuyun Qian , Rupesh Agrawal , Anita S.Y. Chan , Jay Chhablani , Pitipol Choopong , Vishali Gupta , Alessandro Invernizzi , Peter McCluskey , Christopher Seungkyu Lee , Sundaram Natarajan , Rina La Distia Nora , Vicente Victor Ocampo Jr , Ramandeep Singh , Thanapong Somkijrungroj , Koh-Hei Sonoda , Wenbin Wei , Ian Y.H. Wong , Dennis S.C. Lam , Yong Tao
With the paradigm changes in antiviral therapy, there are a myriad of emerging controversies in the management of cytomegalovirus retinitis (CMVR). A certain extent of variability exists in the management of CMVR among clinical practices worldwide. Hence, alignment in the management strategy is important towards optimizing the care of CMVR. An international panel of experts (IPE) formulated consensus statements for CMVR regarding to its 1) diagnosis, 2) screening, 3) treatment, 4) management in special populations and 5) emerging technologies. The clinical diagnosis of CMVR relies on patient’s susceptibility due to compromised immune function and characteristic fundus manifestations. Polymerase chain reaction (PCR) of intraocular fluid for detection of CMV is indicated when confirmation is necessary. Oral valganciclovir is the preferred first-line treatment, and intravitreal ganciclovir injection when CMVR threatens to involve the posterior pole. Cessation of maintenance treatment can be considered after 6 months when CMVR remains inactive with immune reconstitution. Immune recovery uveitis (IRU) must be distinguished from CMVR relapse. Screening is recommended for high risk cases. Utilization of telemedicine and artificial intelligence-aided interpretation will help to alleviate the resources required for CMVR screening. Evidence for novel antiviral and immunotherapy have been appraised as second-line treatment options.
{"title":"International consensuses and guidelines on diagnosing and managing cytomegalovirus (CMV) retinitis by the Asia-Pacific Vitreo-retina Society (APVRS), the Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII)","authors":"De-Kuang Hwang , Danny S.C. Ng , Zhuyun Qian , Rupesh Agrawal , Anita S.Y. Chan , Jay Chhablani , Pitipol Choopong , Vishali Gupta , Alessandro Invernizzi , Peter McCluskey , Christopher Seungkyu Lee , Sundaram Natarajan , Rina La Distia Nora , Vicente Victor Ocampo Jr , Ramandeep Singh , Thanapong Somkijrungroj , Koh-Hei Sonoda , Wenbin Wei , Ian Y.H. Wong , Dennis S.C. Lam , Yong Tao","doi":"10.1016/j.apjo.2025.100248","DOIUrl":"10.1016/j.apjo.2025.100248","url":null,"abstract":"<div><div>With the paradigm changes in antiviral therapy, there are a myriad of emerging controversies in the management of cytomegalovirus retinitis (CMVR). A certain extent of variability exists in the management of CMVR among clinical practices worldwide. Hence, alignment in the management strategy is important towards optimizing the care of CMVR. An international panel of experts (IPE) formulated consensus statements for CMVR regarding to its 1) diagnosis, 2) screening, 3) treatment, 4) management in special populations and 5) emerging technologies. The clinical diagnosis of CMVR relies on patient’s susceptibility due to compromised immune function and characteristic fundus manifestations. Polymerase chain reaction (PCR) of intraocular fluid for detection of CMV is indicated when confirmation is necessary. Oral valganciclovir is the preferred first-line treatment, and intravitreal ganciclovir injection when CMVR threatens to involve the posterior pole. Cessation of maintenance treatment can be considered after 6 months when CMVR remains inactive with immune reconstitution. Immune recovery uveitis (IRU) must be distinguished from CMVR relapse. Screening is recommended for high risk cases. Utilization of telemedicine and artificial intelligence-aided interpretation will help to alleviate the resources required for CMVR screening. Evidence for novel antiviral and immunotherapy have been appraised as second-line treatment options.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100248"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100244
Ikhwanuliman Putera , Carlos Cifuentes-González , William Rojas-Carabali , Zheng Xian Thng , Sivaraman Bala Murugan , Rachel Song , Liang Yao , Rubens Belfort Jr. , Andre Curi , Nicholas Jones , Jennifer E. Thorne , Rina La Distia Nora , Alejandra de-la-Torre , Rupesh Agrawal , on behalf of TITAN consensus guidelines group
This international consensus effort, convened by The Infectious Uveitis Treatment Algorithm Network (TITAN) group, brought together 103 uveitis experts to address long-standing controversies in the management of ocular toxoplasmosis (OT), a leading cause of infectious posterior uveitis worldwide. Despite the availability of advanced diagnostic tools, variability persists in clinical decision-making. Controversies were identified from previous surveys on OT management, which served as the foundation for developing the survey questions in this study. Using a two-round modified Delphi method, experts reviewed evidence and rated recommendations across three domains: diagnosis and investigations, treatment, and follow-up management. Key consensus findings include support for antiparasitic therapy in most active cases, selective use of polymerase chain reaction (PCR) testing for atypical presentations, and prophylactic therapy in high-risk scenarios. These expert-derived consensus provide a framework for best practices in OT clinical management and highlight priorities for future prospective studies.
{"title":"Controversy and consensus on the management of ocular toxoplasmosis: A joint statement by the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII), the Asia-Pacific Vitreo-Retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and The Infectious Uveitis Treatment Algorithm Network (TITAN) Group","authors":"Ikhwanuliman Putera , Carlos Cifuentes-González , William Rojas-Carabali , Zheng Xian Thng , Sivaraman Bala Murugan , Rachel Song , Liang Yao , Rubens Belfort Jr. , Andre Curi , Nicholas Jones , Jennifer E. Thorne , Rina La Distia Nora , Alejandra de-la-Torre , Rupesh Agrawal , on behalf of TITAN consensus guidelines group","doi":"10.1016/j.apjo.2025.100244","DOIUrl":"10.1016/j.apjo.2025.100244","url":null,"abstract":"<div><div>This international consensus effort, convened by <strong>The Infectious Uveitis Treatment Algorithm Network (</strong>TITAN) group, brought together 103 uveitis experts to address long-standing controversies in the management of ocular toxoplasmosis (OT), a leading cause of infectious posterior uveitis worldwide. Despite the availability of advanced diagnostic tools, variability persists in clinical decision-making. Controversies were identified from previous surveys on OT management, which served as the foundation for developing the survey questions in this study. Using a two-round modified Delphi method, experts reviewed evidence and rated recommendations across three domains: diagnosis and investigations, treatment, and follow-up management. Key consensus findings include support for antiparasitic therapy in most active cases, selective use of polymerase chain reaction (PCR) testing for atypical presentations, and prophylactic therapy in high-risk scenarios. These expert-derived consensus provide a framework for best practices in OT clinical management and highlight priorities for future prospective studies.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100244"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100197
Ryan B. Rush , Pedro Luis Gomez , Pedro Gomez Bastar , Sloan W. Rush
Purpose
To evaluate the effectiveness of different endolaser photocoagulation treatment amounts during pars plana vitrectomy (PPV) in patients with a vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR).
Design
Randomized clinical trial
Methods
One hundred and forty-four treatment-naïve PDR patients with an ocular media-obscuring VH were enrolled into this clinical trial. Participants were randomized into one of two possible treatment groups: Group A subjects underwent PPV and received 250 + /- 50 endolaser applications during surgery, while Group B subjects underwent PPV and received 550 + /- 50 endolaser applications during surgery. The primary outcome was the rate of postoperative VH, and the secondary outcome was visual acuity at 6 months.
Results
Ninety-one patients underwent PPV and completed the 6-month trial period. Group A had 30.0 % (15/50) of participants develop a postoperative VH, while Group B had 12.2 % (5/41) of subjects develop a postoperative VH at 6 months (P = 0.002). The visual acuity of 0.4 (0.23–0.57) logMAR (Snellen 20/50) in Group B was better than that of 0.79 (0.58–1.01) logMAR (Snellen 20/120) in Group A at the end of the 6 month trial period (P = 0.006).
Conclusions
Treatment-naïve PDR subjects undergoing PPV for an ocular media-obscuring VH have a lower incidence of postoperative VH and better visual acuity at 6 months when 550 + /- 50 endolaser applications were administered compared to 250 + /- 50 endolaser applications during PPV. Further research is warranted on this topic to verify the generalizability of these findings to a broader PDR population.
{"title":"Panretinal photocoagulation during vitrectomy for diabetic vitreous hemorrhage: A clinical trial comparing endolaser application amounts","authors":"Ryan B. Rush , Pedro Luis Gomez , Pedro Gomez Bastar , Sloan W. Rush","doi":"10.1016/j.apjo.2025.100197","DOIUrl":"10.1016/j.apjo.2025.100197","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effectiveness of different endolaser photocoagulation treatment amounts during pars plana vitrectomy (PPV) in patients with a vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR).</div></div><div><h3>Design</h3><div>Randomized clinical trial</div></div><div><h3>Methods</h3><div>One hundred and forty-four treatment-naïve PDR patients with an ocular media-obscuring VH were enrolled into this clinical trial. Participants were randomized into one of two possible treatment groups: Group A subjects underwent PPV and received 250 + /- 50 endolaser applications during surgery, while Group B subjects underwent PPV and received 550 + /- 50 endolaser applications during surgery. The primary outcome was the rate of postoperative VH, and the secondary outcome was visual acuity at 6 months.</div></div><div><h3>Results</h3><div>Ninety-one patients underwent PPV and completed the 6-month trial period. Group A had 30.0 % (15/50) of participants develop a postoperative VH, while Group B had 12.2 % (5/41) of subjects develop a postoperative VH at 6 months (<em>P</em> = 0.002). The visual acuity of 0.4 (0.23–0.57) logMAR (Snellen 20/50) in Group B was better than that of 0.79 (0.58–1.01) logMAR (Snellen 20/120) in Group A at the end of the 6 month trial period (<em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>Treatment-naïve PDR subjects undergoing PPV for an ocular media-obscuring VH have a lower incidence of postoperative VH and better visual acuity at 6 months when 550 + /- 50 endolaser applications were administered compared to 250 + /- 50 endolaser applications during PPV. Further research is warranted on this topic to verify the generalizability of these findings to a broader PDR population.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100197"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100252
Nishant V. Radke , Elon H.C. van Dijk , Richard F. Spaide , Frank G. Holz , Hideki Koizumi , K. Bailey Freund , Yousif Subhi , Clemens Lange , Sumit Randhir Singh , Haoyu Chen , Li Jia Chen , San-Ni Chen , Jay Chhablani , Francine Behar-Cohen , Taraprasad Das , Adrian T. Fung , Fumi Gomi , Min Kim , Chi-Chun Lai , Timothy Y.Y. Lai , Camiel J.F. Boon
Purpose
To establish consensus-based guidelines on the diagnosis, classification, and management of central serous chorioretinopathy (CSC) through a structured expert panel initiated by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), and the Academia Retina Internationalis (ARI), addressing the existing clinical controversies.
Methods
An international panel of 26 experts from 13 countries collaboratively drafted consensus statements spanning five key areas: disease definition, pathophysiology, investigations, current management, and future developments. Consensus was reached through an iterative Delphi process and anonymous voting using a five-point Likert scale. Statements were accepted when >75 % agreement (‘agree’ & ‘strongly agree’) was achieved.
Results
Consensus was achieved for all 25 statements, reflecting strong alignment among experts. Key agreements included defining CSC as a pachychoroid-driven chorioretinal disorder characterized by neurosensory retinal and/or RPE detachment, with multimodal imaging (optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography) recognized as essential for diagnosis. Half-dose photodynamic therapy (PDT) was unanimously endorsed as the first-line treatment for chronic CSC. Oral mineralocorticoid receptor antagonists (MRAs) lacked consensus for therapeutic benefit, aligning with evidence from the VICI and SPECTRA trials. Anti-vascular endothelial growth factor receptor therapy was recommended solely for CSC complicated by a macular neovascularization. Future priorities highlighted standardizing disease classification and exploring targeted therapies through genetic and nanomedicine research.
Conclusion
This consensus initiative provides a robust, evidence-based framework for the diagnosis and management of CSC, promoting standardization across clinical practices and guiding future research directions to address persistent gaps in CSC care.
{"title":"International consensuses and guidelines on central serous chorioretinopathy (CSC) by the Asia Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI)","authors":"Nishant V. Radke , Elon H.C. van Dijk , Richard F. Spaide , Frank G. Holz , Hideki Koizumi , K. Bailey Freund , Yousif Subhi , Clemens Lange , Sumit Randhir Singh , Haoyu Chen , Li Jia Chen , San-Ni Chen , Jay Chhablani , Francine Behar-Cohen , Taraprasad Das , Adrian T. Fung , Fumi Gomi , Min Kim , Chi-Chun Lai , Timothy Y.Y. Lai , Camiel J.F. Boon","doi":"10.1016/j.apjo.2025.100252","DOIUrl":"10.1016/j.apjo.2025.100252","url":null,"abstract":"<div><h3>Purpose</h3><div>To establish consensus-based guidelines on the diagnosis, classification, and management of central serous chorioretinopathy (CSC) through a structured expert panel initiated by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), and the Academia Retina Internationalis (ARI), addressing the existing clinical controversies.</div></div><div><h3>Methods</h3><div>An international panel of 26 experts from 13 countries collaboratively drafted consensus statements spanning five key areas: disease definition, pathophysiology, investigations, current management, and future developments. Consensus was reached through an iterative Delphi process and anonymous voting using a five-point Likert scale. Statements were accepted when >75 % agreement (‘agree’ & ‘strongly agree’) was achieved.</div></div><div><h3>Results</h3><div>Consensus was achieved for all 25 statements, reflecting strong alignment among experts. Key agreements included defining CSC as a pachychoroid-driven chorioretinal disorder characterized by neurosensory retinal and/or RPE detachment, with multimodal imaging (optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography) recognized as essential for diagnosis. Half-dose photodynamic therapy (PDT) was unanimously endorsed as the first-line treatment for chronic CSC. Oral mineralocorticoid receptor antagonists (MRAs) lacked consensus for therapeutic benefit, aligning with evidence from the VICI and SPECTRA trials. Anti-vascular endothelial growth factor receptor therapy was recommended solely for CSC complicated by a macular neovascularization. Future priorities highlighted standardizing disease classification and exploring targeted therapies through genetic and nanomedicine research.</div></div><div><h3>Conclusion</h3><div>This consensus initiative provides a robust, evidence-based framework for the diagnosis and management of CSC, promoting standardization across clinical practices and guiding future research directions to address persistent gaps in CSC care.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100252"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the efficacy and safety of a novel non-inverted, free single-layer internal limiting membrane (ILM) flap technique for treating large full-thickness macular holes (FTMHs).
Methods
Patients with FTMHs underwent a standard 3-port pars plana vitrectomy using the 23-gauge vitrectomy system. Unique to this technique, a “tongue-shaped” ILM flap was initially created, followed by the formation of two “handles” and the bottom of “plastic bag” ILM flaps. Under perfluoro-n-octane (PFO), the two-point fixed “plastic bag” ILM flap was transferred to the free flap and dragged to cover MH using the ocular viscoelastic device (OVD) to cover the margin of the ILM flap, followed by gas tamponade. Preoperative and postoperative assessments included best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT).
Results
The 13 patients (mean age 64.38 ± 8.08 years, macular diameter 664.85 ± 153.38μm) demonstrated a significant improvement in BCVA from 1.03 ± 0.22 logMAR preoperatively to 0.78 ± 0.26 logMAR postoperatively (P = 0.0004). In all cases, successful closure of the MH was accomplished, including 10 (76.92 %) U-shaped closure, 1 (7.69 %) flat closure, 1 (7.69 %) W-shaped closure, 1 (7.69 %) flap closure, with no ILM flap dislocations.
Conclusions
The non-inverted single-layer “plastic bag” ILM flap technique has been demonstrated to be both a safe and effective method for managing large FTMHs, offering a promising alternative to traditional methods with improved anatomical restorations and stable visual outcomes.
{"title":"Non-inverted and single-layer “plastic bag” ILM flap novel technique to treat large macular holes","authors":"Tian Tian , Dian Jiao , Xiang Zhang, Mingyang Wang, Shipeng Guo, Jiao Lyu, Peiquan Zhao","doi":"10.1016/j.apjo.2025.100164","DOIUrl":"10.1016/j.apjo.2025.100164","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the efficacy and safety of a novel non-inverted, free single-layer internal limiting membrane (ILM) flap technique for treating large full-thickness macular holes (FTMHs).</div></div><div><h3>Methods</h3><div>Patients with FTMHs underwent a standard 3-port pars plana vitrectomy using the 23-gauge vitrectomy system. Unique to this technique, a “tongue-shaped” ILM flap was initially created, followed by the formation of two “handles” and the bottom of “plastic bag” ILM flaps. Under perfluoro-n-octane (PFO), the two-point fixed “plastic bag” ILM flap was transferred to the free flap and dragged to cover MH using the ocular viscoelastic device (OVD) to cover the margin of the ILM flap, followed by gas tamponade. Preoperative and postoperative assessments included best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT).</div></div><div><h3>Results</h3><div>The 13 patients (mean age 64.38 ± 8.08 years, macular diameter 664.85 ± 153.38μm) demonstrated a significant improvement in BCVA from 1.03 ± 0.22 logMAR preoperatively to 0.78 ± 0.26 logMAR postoperatively (<em>P</em> = 0.0004). In all cases, successful closure of the MH was accomplished, including 10 (76.92 %) U-shaped closure, 1 (7.69 %) flat closure, 1 (7.69 %) W-shaped closure, 1 (7.69 %) flap closure, with no ILM flap dislocations.</div></div><div><h3>Conclusions</h3><div>The non-inverted single-layer “plastic bag” ILM flap technique has been demonstrated to be both a safe and effective method for managing large FTMHs, offering a promising alternative to traditional methods with improved anatomical restorations and stable visual outcomes.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100164"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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