Intravitreal injections (IVI) are a common, effective therapy for multiple retinal diseases although can be associated with significant psychological effects that reduce adherence to treatment. We reviewed the psychologi...Intravitreal injections (IVI) are a common, effective therapy for multiple retinal diseases although can be associated with significant psychological effects that reduce adherence to treatment. We reviewed the psychological impacts of IVI to characterise their causes, consequences, and solutions. We searched the electronic databases PubMed, OVID Medline, OVID Embase, Google Scholar and Cochrane Reviews and retrieved 1252 peer-reviewed articles. Thirty-four articles were ultimately included and analysed. The majority of retrieved articles pertained to anxiety; however, other impacts were also identified with limited available evidence regarding depression. Pre-procedural anxiety was generally mild to moderate and reported in 17.3-85 % of patients undergoing IVI. Key contributing factors to anxiety included a lack of patient education, pain and discomfort during the procedure, and travel and waiting times. Potential strategies to reduce anxiety included person-centred education, alternatives to speculum use, reducing clinic wait times, and music or handholding during the procedure. Patients experience significant anxiety from IVI, owing to multiple factors, including lack of education about the procedure, lack of procedural familiarity, and pain, which require a patient-centred approach to addressing that considers individual needs and preferences. Little data pertain to non-anxiety effects of IVI, and thus further research may identify additional barriers to adherence and their solutions.
Dry eye disease (DED) is one of the most prevalent ophthalmic conditions. Placebo or vehicle administration is frequently used in DED trials, yet its effects remain poorly characterized. This study evaluates the presence...Dry eye disease (DED) is one of the most prevalent ophthalmic conditions. Placebo or vehicle administration is frequently used in DED trials, yet its effects remain poorly characterized. This study evaluates the presence, magnitude, and factors associated with DED vehicle or placebo effects to inform future trial design.Eligible vehicle- or placebo-controlled dry eye trials were identified using PubMed. Three authors independently extracted trial characteristics and outcome measures, including Schirmer test, tear breakup time (TBUT), conjunctival and corneal staining, and Ocular Surface Disease Index (OSDI). Random-effect models and meta-regression were used to evaluate placebo/vehicle effects and predictors. Forty-nine trials with 3529 participants in placebo/vehicle groups were included. Meta-analyses revealed significant placebo/vehicle effects on DED symptoms measured by OSDI (mean difference: -8.44; 95 % CI: -11.56 to -5.33, p < 0.01) and on signs including TBUT (0.50; 95 % CI: 0.13-0.87, p = 0.01), corneal staining (-0.55; 95 % CI: -0.90 to -0.20, p < 0.01), and conjunctival staining (-0.46; 95 % CI: -0.91 to -0.02, p = 0.04). Meta-regression revealed that a higher percentage of female participants and worse baseline OSDI scores were associated with a greater vehicle or placebo responses for OSDI (p = 0.04 and p = 0.001, respectively). No predictors were found for placebo/vehicle effects on DED signs. Placebo/vehicle effects in DED trials are substantial and should be considered in trial design. Female sex and worse baseline symptoms were associated with larger effects on OSDI. Future studies should explore mechanisms underlying these effects and approaches to mitigate their impact in DED trials.
The term pachychoroid, derived from the Greek word pachy meaning "thick," refers to a choroidal phenotype characterized by increased choroidal thickness, dilated outer choroidal vessels (pachyvessels), and attenuation of...The term pachychoroid, derived from the Greek word pachy meaning "thick," refers to a choroidal phenotype characterized by increased choroidal thickness, dilated outer choroidal vessels (pachyvessels), and attenuation of the overlying Sattler layer and choriocapillaris. Initially recognized in central serous chorioretinopathy, this phenotype is now acknowledged as the underlying pathophysiological basis for a broader spectrum of retinal disorders, including pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, pachydrusen and pachychoroid geographic atrophy. Collectively referred to as the pachychoroid disease spectrum, these entities share common features such as structural choroidal remodeling, choroidal vascular hyperpermeability, and outer retinal or retinal pigment epithelial changes. The introduction of enhanced depth imaging and swept-source optical coherence tomography (OCT), OCT angiography, and ultra-widefield indocyanine green angiography has significantly expanded the understanding of choroidal anatomy and function, leading to the identification of additional features such as vortex vein abnormalities, intervortex venous anastomoses, and localized choroidal hypoperfusion. These insights have prompted a reevaluation of disease classification. Moreover, pachychoroid-driven neovascularization demonstrates distinct therapeutic behaviour, including variable responses to anti-vascular endothelial growth factor agents and potential benefit from photodynamic therapy. We explore current controversies related to the etiopathogenesis, disease classification, and treatment of pachychoroid disorders, emphasize the importance of multimodal imaging in accurate diagnosis, and propose a clinically relevant algorithm to help ophthalmologists identify and manage true pachychoroid spectrum disorders effectively.
Thyroid eye disease (TED) is defined as a common ocular manifestation of graves' disease, which affects the dynamics of the retinal vessels by various autoimmune and mechanical ways. Herein, we evaluate the retinal micro...Thyroid eye disease (TED) is defined as a common ocular manifestation of graves' disease, which affects the dynamics of the retinal vessels by various autoimmune and mechanical ways. Herein, we evaluate the retinal microvascular alterations in TED subjects using optical coherence tomography angiography (OCTA). PubMed, Scopus and Web of Sciences were systematically searched for relevant studies assessing OCTA measurements in TED patients and healthy controls. Meta-analysis was conducted on OCTA parameters with at least two studies using the same OCTA device. Fifteen related studies assessed the total of 771 TED eyes (13 studies evaluating inactive TED and 10 with active TED). Patients with active TED exhibited significantly reduced vessel density (VD) in both the superficial and deep capillary plexuses compared to inactive TED and healthy controls, particularly in whole image analyses and parafoveal region. Additionally, the foveal avascular zone was significantly enlarged in active TED relative to inactive TED and HCs. Radial peripapillary capillary VD was reduced in active TED compared to the inactive stage. These highlights the potential of OCTA as a valuable noninvasive tool for TED's diagnosis assistance and disease progression monitoring. Future research should aim to assess retinal VDs in larger and more diverse samples, considering disease activity, to achieve more conclusive results.
The Miyake-Apple technique for retrolenticular video analysis has proven itself to be a valued tool in research and education for anterior segment surgery, intraocular lens (IOL) design, implantation techniques and evalu...The Miyake-Apple technique for retrolenticular video analysis has proven itself to be a valued tool in research and education for anterior segment surgery, intraocular lens (IOL) design, implantation techniques and evaluating surgical complications. Such a knowledge base could also be incorporated into surgical simulators which are generally more readily available to training ophthalmologists. We identified 139 papers in the initial search. After screening 100 papers, 94 were included in the review. In all 94 studies, the employment of the Miyake-Apple technique for visualization was used for post-mortem eye analysis, yielding information about its role in (1) teaching and training, (2), understanding the effects of IOL implantation, (3), visualizing the impacts of experimental surgical techniques on the eye, and (4), its modern technical advancements to facilitate Miyake-Apple views with lower-resource endoscopic equipment. Our findings support the conclusion that the Miyake-Apple system can play an imperative role in the training and testing of ophthalmic surgeons, devices and surgical techniques. This technology has the potential to aid in the development of newer IOL explantation and replacement techniques as well as IOL fixation techniques. With advancing technology and innovative endoscopic posterior viewing techniques, barriers have lowered for adopting the Miyake-Apple system in ophthalmic surgical training globally.
Silicone oil removal-related vision loss (SORVL) is a sight-threatening condition affecting a small fraction of patients after the removal of silicone oil, possibly underestimated. To date, a few cases have been thorough...Silicone oil removal-related vision loss (SORVL) is a sight-threatening condition affecting a small fraction of patients after the removal of silicone oil, possibly underestimated. To date, a few cases have been thoroughly investigated; however, no clear and unique explanation has been found for this phenomenon. Most of the literature has been focusing on SORVL and in situ SORVL, gathering the 2 conditions under the same pathogenic mechanism. In this review, we provide a detailed update on SORVL describing its epidemiology and the reported signs and symptoms. Furthermore, we explore possible underlying mechanisms that may contribute to the development of SORVL giving insights into the pathophysiology of this rare and severe condition.
Retinal diseases represent a group of vision-threatening disorders with a complex pathogenesis that involves interactions among various cellular and molecular factors. Inflammation and immune cells play a pivotal role in...Retinal diseases represent a group of vision-threatening disorders with a complex pathogenesis that involves interactions among various cellular and molecular factors. Inflammation and immune cells play a pivotal role in the initiation, progression, and repair of retinal diseases. Recently, advancements in optical coherence tomography angiography (OCTA) technology have enabled the in vivo detection of macrophage-like cells (MLCs) at the vitreoretinal interface and allowed for assessment of retinal inflammation, representing a landmark advancement for understanding the pathophysiology of retinal diseases, particularly regarding the role of MLCs. We review the role of MLCs at the vitreoretinal interface and discuss recent advances in OCTA technology for detecting MLCs across various retinal diseases, thus demonstrating new advances in inflammatory biomarkers for retinal diseases.
Intraocular seeds in retinoblastoma are formed from dispersion of the tumor into the adjacent liquid or semiliquid compartments. They are highly resistant to traditional treatment modalities and remain the most important...Intraocular seeds in retinoblastoma are formed from dispersion of the tumor into the adjacent liquid or semiliquid compartments. They are highly resistant to traditional treatment modalities and remain the most important cause of treatment failure. Intraocular seeds can be focal or diffuse in the vitreous, retrohyaloid, subretinal or aqueous compartments. Intravitreal and intracameral chemotherapy with melphalan and/or topotecan have allowed targeted drug delivery in desired concentration to achieve improved outcomes of seed regression and globe salvage. Group E disease, diffuse and recurrent seeds, as well as anterior chamber seeds continue to have suboptimal prognosis. We review the published literature on intraocular seeds, the evolution of their management, and the outcomes and complications of established treatment modalities.
Anti-vascular endothelial growth factor (anti-VEGF) injections are a crucial treatment for neovascular age-related macular degeneration (nvAMD); however, each injection carries the risk of complications, including macula...Anti-vascular endothelial growth factor (anti-VEGF) injections are a crucial treatment for neovascular age-related macular degeneration (nvAMD); however, each injection carries the risk of complications, including macular hole (MH) formation. A comprehensive literature search of the PubMed, Embase, and Google Scholar databases identified studies reporting MH formation after anti-VEGF injections for nvAMD. Demographic characteristics included age, sex and affected eye. The presence of intraretinal fluid, subretinal fluid (SRF), pigment epithelial detachment (PED), posterior vitreous detachment, epiretinal membrane, vitreomacular adhesion (VMA), vitreomacular traction (VMT), and retinal pigment epithelial (RPE) tears was recorded. This review includes 15 articles, encompassing 50 eyes. Median patient age was 76.0 years, and 54 % were female. Prior to MH formation, SRF and PED were present in 68 % of eyes. VMA or VMT was observed in 36 % of eyes and the median number of injections before MH development was 3, with a median time to diagnosis of 60 days. While anti-VEGF is an essential therapy, clinicians must be aware of the risk of MH Predisposing factors including PEDs, VMT, and significant intra- or subretinal fluid, should be considered. Further research is needed to fully understand the mechanisms and explore preventative strategies.
Surgical induction of posterior vitreous detachment (IPVD) is a well-known risk factor for retinal breaks (RB) during vitrectomy; however, risk factors for breaks in the subgroup of eyes requiring IPVD are poorly charact...Surgical induction of posterior vitreous detachment (IPVD) is a well-known risk factor for retinal breaks (RB) during vitrectomy; however, risk factors for breaks in the subgroup of eyes requiring IPVD are poorly characterised. We summarize and explore existing literature on demographic, clinical, and operative risk factors for RB in eyes that require IPVD. We conducted a comprehensive search of electronic databases (PubMed, Ovid MEDLINE, EMBASE, and Google Scholar) in August, 2024. We included English-language meta-analyses, randomised control trials, and observational studies or series that reported data addressing risk factors for retinal breaks during surgical IPVD. Case reports, conference abstracts, and pharmacological IPVD were excluded. A total of 10 studies were included, comprising observational studies (n = 4) and case series (n = 6). Risk factors identified in existing literature included age, surgical indication and gauge size. Younger age was associated with higher RB risk during IPVD (OR 0.959, 95 % CI 0.924, 0.996, p = 0.028). Surgical indication findings were conflicting, suggesting either macular hole or epiretinal membrane surgery may increase the rate of RB. Gauge size had no consistent impact on RB rates. Weak evidence exists that 20-G may increase RB rate compared to 23-G (23 G 3.1 % vs 20-G 15.8 %, p = 0.0234). The wide range in IPVD-related RB reflects highly heterogenous study designs, differences in IPVD induction technique, and failure to discriminate between IPVD-related and sclerotomy-related breaks. There remains no large-scale studies or meta-analyses exploring risk factors for RB during IPVD. Younger age is a risk factor for RB in IPVD. The impact of gauge size and surgical indication is conflicting in existing literature, and claims are supported by weak evidence. There is a lack of exploration of risk factors for RB during IPVD in existing literature. Further exploration of patient and operative risk factors is needed and may impact risk counselling and surgical approaches for eyes requiring IPVD.
Rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs) pose significant surgical challenges, lacking a universally accepted treatment standard. Heavy silicone oils (HSOs), specifically Densiron® 68...Rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs) pose significant surgical challenges, lacking a universally accepted treatment standard. Heavy silicone oils (HSOs), specifically Densiron® 68 and Densiron XTRA, have emerged as promising endotamponade agents because of their specific gravity, which is greater than that of water, allowing effective tamponade in the inferior retina. Unlike earlier HSO formulations, these newer variants show reduced rates of intraocular inflammation while maintaining favorable anatomical outcomes, even when compared with concomitant scleral buckle use; however, their usage remains limited, particularly in the U.S. We assessed clinical indications, anatomical reattachment rates, and intraocular inflammation linked to Densiron 68 and Densiron XTRA. A comprehensive search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL identified 616 references, of which 22 studies involving 970 eyes met the inclusion criteria. Pooled analyses revealed a 16.7 % rate of oil dispersion and emulsification, 13.0 % incidence of intraocular inflammation, and 7.1 % occurrence of oil migration into the anterior chamber. Notably, anatomical retinal reattachment following endotamponade removal was achieved in 80.1 % of cases. These findings underscore the efficacy of Densiron 68 and Densiron XTRA in managing complex primary and secondary RRDs, offering a potentially viable solution with lower complication rates than prior HSOs. Their demonstrated success in achieving high anatomical reattachment rates positions them as promising tools in advancing RRD treatment.
The human amniotic membrane (hAM) has gained recognition as a valuable biological adjunct in vitreoretinal surgery, with its applications rapidly expanding since its initial use for macular holes (MHs). We examine the de...The human amniotic membrane (hAM) has gained recognition as a valuable biological adjunct in vitreoretinal surgery, with its applications rapidly expanding since its initial use for macular holes (MHs). We examine the development and present applications of hAM in vitreoretinal surgery, assessing its use in treating various pathological conditions such as MHs, retinal detachments (RDs) with proliferative vitreoretinopathy (PVR), high myopia-associated MHs with posterior staphyloma, optic pit maculopathy, and other vitreoretinal disorders. We evaluate the differences between cryopreserved and lyophilized hAM preparations and compares outcomes of subretinal and epiretinal placement techniques. Evidence from the literature suggests that hAM serves as an important therapeutic option for complex vitreoretinal conditions, demonstrating anatomical success rates ranging from 80 % to 95 % across various indications. The strongest evidence indicates its efficacy in refractory MHs (closure rates 85-100 %), myopic macular holes associated with posterior staphyloma (86-92 %), and complex RDs with proliferative vitreoretinopathy (76-92 %). Both cryopreserved and lyophilized preparations exhibit efficacy; however, their surgical handling characteristics and biological properties vary, which may affect outcomes in particular indications. Current evidence suggests that subretinal positioning is typically used for large, highly myopic, or refractory MHs, whereas epiretinal placement is preferred in cases of PVR and optic pit maculopathy. While the results are promising, it is essential to standardize techniques, obtain long-term follow-up data, and conduct randomized controlled trials comparing hAM to conventional approaches to establish definitive recommendations.
Retinal degenerative diseases (RDD) are a group of age-related blinding eye diseases characterized by progressive degeneration and functional impairment of retinal photoreceptors or ganglion cells, for which there are cu...Retinal degenerative diseases (RDD) are a group of age-related blinding eye diseases characterized by progressive degeneration and functional impairment of retinal photoreceptors or ganglion cells, for which there are currently no effective treatments. The complement system is an important innate immune system in the human body, activated through 3 pathways (classical pathway, lectin pathway, and alternative pathway) to ultimately form a membrane attack complex that acts on target cells. Microglia are the innate immune cells of the retina, responsible for maintaining retinal homeostasis. Complement system activation and microglial activation have been identified in RDD. Complement activation products C3 and C5 generate anaphylatoxins C3a and C5a, whose receptors C3aR and C5aR1 can activate microglia. Activated microglia can further produce complement C1q to activate the complement system, forming a positive feedback loop that exacerbates retinal damage. In this review, we focus on the crosstalk between the complement system and microglia in age-related macular degeneration, diabetic retinopathy, glaucoma, and pathological myopia-related retinal degeneration, and summarize clinical studies targeting the complement system and microglia for the treatment of RDD.
Although the indications for retinal laser have diminished over the past 2 decades due to the rise of intravitreal injection therapy, retinal laser remains a useful clinical tool, with novel laser technologies continuing...Although the indications for retinal laser have diminished over the past 2 decades due to the rise of intravitreal injection therapy, retinal laser remains a useful clinical tool, with novel laser technologies continuing to emerge. Continuous wave photocoagulation remains the most well-characterized laser in terms of its histopathological effects. Information about the histological effects of newer retinal laser modalities is relatively scarce. Available evidence supports the notion that short pulse applications result in less collateral damage to the neurosensory retina, but that at sufficient energy settings thermal injury is observed irrespective of the laser type.
Less than a decade has passed since deep learning (DL) was first applied in ophthalmology. With tremendous growth in this field since then, DL is expected to transform and enhance the efficiency of traditional ophthalmol...Less than a decade has passed since deep learning (DL) was first applied in ophthalmology. With tremendous growth in this field since then, DL is expected to transform and enhance the efficiency of traditional ophthalmology practice. Central serous chorioretinopathy (CSC) is a common chorioretinal disorder whose etiopathogenesis remains largely unknown. The diagnosis and management of CSC rely heavily on multimodal imaging data, detailed analysis of which may exceed the capacity of many practices. In this comprehensive review, we examine how DL can address such issues through automated analysis of CSC-related imaging biomarkers, including subretinal fluid, pigment epithelial detachment, subretinal hyperreflective material, hyperreflective foci, retinal pigment epithelium atrophy, ellipsoid zone loss, and choroidal layer, sublayers, vessels, and neovascularization. Their prognostic yield and therapeutic implications are covered as well. We describe how DL enables rapid, noninvasive visualization of choroidal vasculature, a primary source of pathology in CSC, in unprecedented detail. We also review the state-of-the-art DL models designed for automated CSC diagnosis, classification, prognostication, and treatment outcome prediction based on imaging data. We highlight the challenges and gaps in this field, discuss some recommended counter measures, and suggest future research directions.
We provide a comprehensive clarification of the demographics, clinical features, management, prognostic factors, and complications of traumatic optic neuropathy (TON). About 6068 patients from 109 studies were included....We provide a comprehensive clarification of the demographics, clinical features, management, prognostic factors, and complications of traumatic optic neuropathy (TON). About 6068 patients from 109 studies were included. The pooling results indicated that TON was male-dominated (84 %) with road traffic accidents as the leading cause (67 %). After trauma, 46 % of cases had no light perception (NLP), and the most frequent associated injury was craniofacial fractures (70 %). Optic canal fractures (OCF) were detected in 34 % of cases via computed tomography and in 47 % intraoperatively. The general visual improvement rate of conservative treatment, steroid pulse therapy (SPT), optic nerve decompression (OND) and intravenous erythropoietin injection were 34 %, 48 %, 56 %, and 61 %, respectively. OND and SPT showed similar efficacy in patients with both NLP (37 % vs. 28 %) and residual vision (76 % vs. 73 %), but were superior to observation only in patients with residual vision. Patients without OCF also responded similarly to OND (57 %) and SPT (62 %), whereas those with OCF showed a higher response rate to OND (53 %) compared to SPT (24 %). Early intervention (within 7 days post-trauma) improved outcomes for both OND and SPT. Complications from OND were rare. TON mainly affects males, causes severe vision impairment, and is often associated with craniofacial fractures. OND may provide greater benefit than SPT for patients with OCF, while both treatments appear similarly effective for those without OCF, regardless of baseline vision status; however, heterogeneity in the definition and diagnostic criteria of TON, as well as variability in study designs, warrants cautious interpretation of these findings.
Age-related macular degeneration (AMD) represents a leading cause of vision loss worldwide, while vitreoretinal interface (VRI) abnormalities constitute a dynamic boundary where posterior vitreous interacts with the reti...Age-related macular degeneration (AMD) represents a leading cause of vision loss worldwide, while vitreoretinal interface (VRI) abnormalities constitute a dynamic boundary where posterior vitreous interacts with the retinal surface. We explore the intricate relationship between VRI abnormalities and AMD, examining prevalence, underlying pathophysiological mechanisms, and their reciprocal influence on disease development, progression, and treatment outcomes. Evidence suggests a higher prevalence of vitreomacular adhesion in exudative versus nonexudative AMD, while complete posterior vitreous detachment may exert protective effects against AMD progression. Tractional forces, inflammatory mediators, and structural disruption associated with VRI abnormalities may promote AMD progression and confound assessment of anti-vascular endothelial growth factor therapy efficacy. Recent findings underscore that epiretinal membranes might act as physical barriers reducing drug penetration, while VMT/VMA can alter macular morphology, potentially mimicking or obscuring therapeutic response. Surgical management of VRI abnormalities in AMD can achieve anatomical success, though visual outcomes may be limited by underlying macular pathology. Early detection and characterization of VRI abnormalities in AMD patients could improve risk stratification, guide treatment timing, and potentially lead to novel preventive strategies, highlighting the importance of comprehensive evaluation and individualized management approaches for optimizing outcomes in this complex patient population.