We evaluated the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapies for macular edema (ME) secondary to retinal vein occlusion (RVO), a leading cause of vision loss. A comprehensive sear...We evaluated the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapies for macular edema (ME) secondary to retinal vein occlusion (RVO), a leading cause of vision loss. A comprehensive search of 6 databases identified 17 RCTs involving 4272 eyes. Eligible studies reported outcomes such as visual acuity, ETDRS letter scores, central retinal thickness (CRT), and adverse events, with follow-up of at least 6 months. Anti-VEGF therapy showed significant efficacy, with a pooled mean difference (MD) of 15.14 ETDRS letters (95 % CI: 14.24-16.03, p < 0.001). Over 12 months, patients were 2.87 times more likely to achieve gains of > 15 ETDRS letters (OR 2.87, 95 % CI: 2.21-3.72). CRT decreased by MD of -350 µm (95 % CI: -0.363 to -0.338, p < 0.001). Safety analysis revealed reduced treatment-related adverse events (TRAEs) (OR 0.88, p = 0.035) with no significant systemic risks. Intraocular pressure elevation (OR 1.924, p < 0.001) warrants monitoring. Subgroup analysis highlighted faricimab as most effective, with aflibercept, ranibizumab, and bevacizumab providing substantial benefits. Anti-VEGF therapy is an effective, safe cornerstone for managing ME in RVO. Further research should explore biomarkers and combination treatments to refine therapeutic approaches.
Ophthalmic trauma (OT) is a leading cause of monocular vision loss that preferentially affects certain populations. In this narrative review, we aim to discuss the impact of social determinants of health (SDOH) on the pr...Ophthalmic trauma (OT) is a leading cause of monocular vision loss that preferentially affects certain populations. In this narrative review, we aim to discuss the impact of social determinants of health (SDOH) on the prevalence and outcomes of OT. We conducted a literature search to identify studies published between 2019 and 2024 that discuss the impact of SDOH on OT. A total of 92 studies were included. Overall, males, particularly those of younger and working age groups, are most commonly affected with OT, with assault-, firearm-, and occupation-related injuries being the most frequent. In comparison, falls and intimate partner violence are the most common causes of OT in women. Children are more prone to toys, sports, and firework-related injuries, while falls represent the leading cause in elderly and frequently results in open globe injury. Black and Hispanic individuals suffer disproportionately from assault- and firearm-related injuries. Unemployed individuals, those of rural residence or of low socioeconomic status have higher rates of OT. Our review underscores the impact of demographic, social, and economic factors on the risk and outcomes of OT and its subtypes. Only by understanding the patterns, targeted interventions and policy changes can be undertaken to address these disparities.
A 59-year-old woman presented with right periorbital frontal headache and vertical binocular diplopia. Computed tomography (CT) angiography of the head and neck with contrast was negative. C-reactive protein was 7.3 mg/d...A 59-year-old woman presented with right periorbital frontal headache and vertical binocular diplopia. Computed tomography (CT) angiography of the head and neck with contrast was negative. C-reactive protein was 7.3 mg/dL (normal, <0.9 mg/dL) and erythrocyte sedimentation was 79 mm/hr. Despite a negative temporal artery biopsy, she was treated for biopsy-negative giant cell arteritis. Symptoms worsened over time. A review of the initial CT demonstrated paranasal sinus disease and a mass in the right medial orbit with disruption of the medial orbital wall. Magnetic resonance imaging showed an enhancing lesion in the inferomedial portion of the right orbit associated with opacification and enhancement of the right ethmoid, maxillary and frontal sinuses. Antineutrophil cytoplasmic antibodies (ANCA) were negative for myeloperoxidase (perinuclear ANCA) but positive for proteinase 3 (cytoplasmic ANCA). An intranasal biopsy demonstrated a nonspecific ulcer site reaction with a mixed inflammatory cell composition and focal vascular injury. Upon further questioning, the patient admitted to intranasal insufflation of cocaine confirming the diagnosis of cocaine-induced midline destructive lesions.
Choroidal hypopigmented lesions (CHLs) represent significant diagnostic and therapeutic challenges due to their diverse and complex etiologies, including neoplastic, infectious, and inflammatory origins. Accurately diffe...Choroidal hypopigmented lesions (CHLs) represent significant diagnostic and therapeutic challenges due to their diverse and complex etiologies, including neoplastic, infectious, and inflammatory origins. Accurately differentiating between benign lesions with good prognoses and malignant or life-threatening conditions is crucial in directing the appropriate management and avoiding unnecessary invasive interventions. We integrate the latest research and clinical guidelines on advanced multimodal imaging modalities, emphasizing their comparative diagnostic value across varied etiologies of CHLs. In contrast to prior studies, we comprehensively evaluates the clinical implications of these techniques in accurately differentiating between benign from malignant choroidal lesions. Emphasis is placed on the role of advanced imaging modalities, including swept-source optical coherence tomography, B-scan ultrasound, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography, in enhancing diagnostic precision. These technologies have substantially increased the capability to distinguish between lesion types, improving diagnostic accuracy and giving more targeted therapeutic strategies.
The choroid, a highly vascularized tissue, supplies the outer retina and is responsible for other functions such as thermoregulation, secretion of growth factors, and possibly emmetropization. Choroidal changes, therefor...The choroid, a highly vascularized tissue, supplies the outer retina and is responsible for other functions such as thermoregulation, secretion of growth factors, and possibly emmetropization. Choroidal changes, therefore, may play a role in various chorioretinal diseases. The recent surge in publications focusing on the choroid can be attributed to improvements in both resolution and field of view of optical coherence tomography and indocyanine green angiography. Advancements in imaging have transitioned from manual to semi-automated and now fully automated methods for qualitative and quantitative choroidal analysis. These qualitative parameters include choroidal vascular patterns and focal or diffuse changes in the vascular wall, either bulbosity or tortuosity. Quantitative parameters include choroidal thickness, volume, vascularity index, contour, three-dimensional vessel quantification, and blood flow measurements using laser Doppler holography. We discuss these qualitative and quantitative biomarkers in detail, i.e., the underlying principles, clinical use, changes in normal and disease states, and their limitations. This will provide invaluable insights to clinicians in understanding the choroidal changes in physiological and pathological states.
We systematically review and compare the available evidence on the various types of regional anesthesia and topical anesthesia (TA) in vitreoretinal surgery and evaluate their respective outcomes. The principles outlined...We systematically review and compare the available evidence on the various types of regional anesthesia and topical anesthesia (TA) in vitreoretinal surgery and evaluate their respective outcomes. The principles outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for network meta-analysis were adhered to throughout this systematic review. The primary outcome measures were intraoperative pain score, the number of patients requiring additional anesthesia, and the number of adverse events. A preestablished protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), ID Number: (CRD42023449755). Fifty-three studies were screened in full text, resulting in 11 with nearly 1076 patients who met our criteria. Most patients had a retrobulbar block, and the average surgical time was 48 min. Regarding the pain score, sub-Tenon (ST) injection had the best results, and TA was significantly less effective when compared to ST and peribulbar (PB) injection (SMD=1.28 and 0.88, 95 % confidence interval (CI) to 2.46 and 0.18-1.58). ST had significantly less risk of requiring additional anesthesia when compared to all other techniques. Six studies reported adverse events, and PB had the least risk of an adverse event. Future research should continue to explore direct comparisons between each type.
Augmented reality (AR) and virtual reality (VR) are game-changing technologies in retinal care, offering significant advancements in surgical training, diagnostic accuracy, and vision rehabilitation. We explore how AR/VR...Augmented reality (AR) and virtual reality (VR) are game-changing technologies in retinal care, offering significant advancements in surgical training, diagnostic accuracy, and vision rehabilitation. We explore how AR/VR is being used in surgical training, intraoperative guidance, and vision restoration, focusing on their impact on surgical proficiency, diagnostic precision, and the management of retinal diseases. We analyzed studies from the Web of Science Core Collection, adhering to PRISMA 2020 guidelines. We included randomized controlled trials (RCTs) and prospective cohort studies that examined AR/VR applications in retinal surgery, diagnosis, and rehabilitation. Bias was evaluated using RoB 2.0 for RCTs and ROBINS-I for observational studies. Ten studies met our criteria (3 RCTs and 7 prospective cohort studies) with 6-48 participants, focusing on AR/VR's role in surgical simulation, diagnostics, and vision rehabilitation. The Eyesi Surgical Simulator significantly improved surgical skills, reduced complications, and accelerated learning curves. AR-assisted diagnostics enhanced retinal disease detection, while VR rehabilitation programs helped improve contrast sensitivity and visual acuity; however, methodological differences between studies made direct comparisons difficult. AR/VR technologies have the potential to enhance retinal care by improving surgical safety, diagnostic precision, and rehabilitation outcomes. Despite these benefits, high costs, accessibility challenges, and a lack of standardization remain significant barriers. Integrating AR/VR into medical training and clinical practice is recommended, but larger, long-term studies are needed to validate their effectiveness.
Rhegmatogenous retinal detachment (RRD) is a potentially blinding separation of neurosensory retina from retinal pigment epithelium by fluid passing from the vitreous cavity into the subretinal space through one or more...Rhegmatogenous retinal detachment (RRD) is a potentially blinding separation of neurosensory retina from retinal pigment epithelium by fluid passing from the vitreous cavity into the subretinal space through one or more retinal breaks, holes or tears. Although most RRDs can be repaired surgically with one operation, some visual loss often results, especially if the macula has been detached, and a small fraction of RRDs require multiple surgeries with significant morbidity, including permanent severe visual loss. Vitrectomy, the most popular RRD surgery, is associated with temporary visual loss and postoperative positioning with limited activity for 1 or 2 weeks; phakic patients usually require cataract surgery within 2 years. Consequently, RRD prevention would be ideal, achieved by early accurate diagnosis of retinal tears and prophylactic outpatient retinopexy, easy, highly successful in sealing retinal breaks and usually uncomplicated. The interval between retinal tears and detachment of the retina is often long enough for laser retinopexy; however, the importance of retinal tear symptoms and prompt evaluation is not well known by the public nor nonophthalmic medical providers, causing a delay that prevents retinopexy and results in surgical repair. New educational programs are needed. Most RRDs are idiopathic but traumatic RRDs also can be avoided by protective eye wear in hazardous sports and occupations and also timely eye examination and retinopexy. Suggestions for improved retinal tear diagnosis are offered.
Cifuentes-González C, Le Tong Y, Rojas-Carabali W
… +18 more, Mejía-Salgado G, Putera I, Song XYR, Walter CFY, Shengjuan Z, Chan R, Mobasserian A, Nora RD, Biswas J, Gangaputra S, Pulido JS, Kempen JH, Nguyen QD, de la Torre A, Gupta V, Rosenbaum JT, Agrawal R, REVISE-IUSG study group
We investigate the clinical characteristics and complications of retinal vasculitis (RV), categorizing cases into Secondary RV (associated with systemic disease), Syndromic RV (linked to ocular syndromes without systemic...We investigate the clinical characteristics and complications of retinal vasculitis (RV), categorizing cases into Secondary RV (associated with systemic disease), Syndromic RV (linked to ocular syndromes without systemic disease), Idiopathic RV (without systemic disease or ocular syndrome diagnoses), and Multiple Etiology RV (cohorts of retinal vasculitis with more than one subcategories of the above). A systematic search was conducted on June 14, 2023, across PubMed, Embase, Cochrane (Ovid), VHL, and ProQuest databases, following PRISMA guidelines (PROSPERO registration: CRD42023489232). Out of 5533 screened articles, 97 studies involving 7619 patients with RV met the eligibility criteria. Bilateral involvement (64 %) and reduced vision (52 %) were common across all RV categories, with Idiopathic RV showing the highest rates of bilateral involvement (80 %) and vision loss (79 %). Syndromic RV was characterized by retinal ischemia (76 %) and vitreous hemorrhage (46 %), while Secondary RV exhibited higher incidences of cystoid macular edema (32 %) and neovascular glaucoma (24 %). Geographic variations were evident in Multiple Etiology RV, with inflammation in more than 1 intraocular structure more prevalent in Asia (64 %) than in Europe (29 %). These findings highlight the heterogeneity in RV presentation and complications, illustrating the need for standardized diagnostic criteria and improved clinical reporting to enable better classification, treatment strategies, and patient outcomes.
Optimization of diabetic macular edema (DME) treatment pathways can aid in the efficient introduction of new therapies that provide value to patients and healthcare systems. We performed a systematic literature review an...Optimization of diabetic macular edema (DME) treatment pathways can aid in the efficient introduction of new therapies that provide value to patients and healthcare systems. We performed a systematic literature review and multicorrelation analysis to identify and evaluate anatomic biomarkers as potential surrogate endpoints (SEs) for visual acuity (VA) in patients with DME. We performed EMBASE and MEDLINE searches to identify studies reporting on 4 priority biomarkers previously identified by clinical experts: hyperreflective foci, intraretinal cyst, macular volume (MV), and subretinal fluid. Endpoint and treatment effect correlation analyses were performed to establish correlation coefficients between MV and VA using Pearson's correlation. A total of 105 studies reported change from baseline data for VA, and at least 1 biomarker, with MV investigated most often (n = 70 studies). Data extracted from 55 studies focusing on the 6-mm zone for MV were used in statistical analyses. A moderate correlation was observed between MV and VA at the endpoint level (r = 0.58; p < 0.01); however, a corresponding treatment effect was not found (r = 0.32; p = 0.19). Our findings suggest MV's potential as an SE for VA in future clinical practice; however, the lack of a significant treatment effect warrants that these findings be interpreted cautiously. Further evidence and improvements in reporting the methods for collecting biomarker data are needed. Analysis of outliers and subanalyses by other optical coherence tomography measures could establish the most meaningful MV values correlating with VA.
Leber congenital amaurosis (LCA) is a hereditary retinal disease typically manifesting as severe vision impairment in infancy. With the advancement of precision medicine, genetic diagnosis and targeted therapies offer ne...Leber congenital amaurosis (LCA) is a hereditary retinal disease typically manifesting as severe vision impairment in infancy. With the advancement of precision medicine, genetic diagnosis and targeted therapies offer new hope for LCA patients, significantly improving both diagnostic accuracy and therapeutic efficacy. We summarize the epidemiological characteristics, clinical manifestations, and molecular genetics underlying LCA. We also highlight recent developments in precision treatment strategies, including gene replacement therapy, CRISPR/Cas9-mediated gene editing and antisense oligonucleotide therapies. In addition, we discuss the applications of induced pluripotent stem cells and retinal organoids in LCA treatment research. Furthermore, we explore preventive strategies and future treatment directions for LCA, including the development of novel gene therapy vectors, the optimization of combinatorial treatment strategies, and the formulation of personalized treatment approaches. These advancements hold significant potential to offer improved treatment options and enhance the quality of life for LCA patients.
The therapeutic potential of rho kinase (ROCK) inhibitors in ophthalmology is gaining attention, given their multifaceted role in cellular regulation, particularly within ocular pathologies. This review synthesizes findi...The therapeutic potential of rho kinase (ROCK) inhibitors in ophthalmology is gaining attention, given their multifaceted role in cellular regulation, particularly within ocular pathologies. This review synthesizes findings from clinical and preclinical studies on the efficacy and safety of ROCK inhibitors across glaucoma, corneal, and retinal diseases. We performed a systematic database search in Ovid MEDLINE and Ovid Embase on 5th April 2022 using the following keywords: 'primary open angle glaucoma', 'glaucoma surgery', 'corneal wound healing', 'corneal endothelial dysfunction', 'diabetic retinopathy', 'diabetic macular oedema', 'age-related macular degeneration', 'rho kinase inhibitor', 'rho-kinase inhibitor', rock inhibitor', 'ripasudil', 'netarsudil' and 'fasudil'. Abstracts were screened for relevant studies and results summarized in tables. The analysis of trials done for ROCK inhibitors reveals that they are safe and efficacious drugs, demonstrating noninferiority to existing medical treatments and effective when combined with existing treatments, and are approved for use in treating glaucoma, but not corneal or retinal diseases. Questions remain, however, regarding optimal dosage, patient selection, and cost-effectiveness. ROCK inhibitors demonstrate significant efficacy in reducing intraocular pressure by improving aqueous humour outflow. Additionally, ROCK inhibitors show promise in enhancing endothelial cell migration, thus providing a novel treatment avenue for corneal diseases such as Fuchs endothelial dystrophy. In retinal conditions, including diabetic retinopathy and age-related macular degeneration, ROCK inhibitors reduce vascular permeability, inflammation, and fibrosis, stabilising disease progression.
Grassmeyer JJ, Pennesi ME, Yang P
… +2 more, Tschetter W, Everett LA
Surv Ophthalmol
· 2025 · PMID 40228746
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Full text
The electroretinogram (ERG) is a well-established method to investigate retinal function and can often provide critical diagnostic information for underlying retinal disorders. ERG responses rely on the neuronal activity...The electroretinogram (ERG) is a well-established method to investigate retinal function and can often provide critical diagnostic information for underlying retinal disorders. ERG responses rely on the neuronal activity of retinal cells which, like neurons elsewhere, are subject to perturbation by a wide spectrum of neuromodulating substances. These agents have the potential to confound electrophysiologic recordings used to evaluate visual function. We provide a comprehensive literature review of studies that have examined the impact of pharmacologic agents on human electrophysiologic testing of retinal function. This review is focused primarily on full-field ERG data, but also includes a limited number of studies examining effects of medications on pattern ERG and visual evoked potential recordings. The studies reviewed are categorized by medication class and evidence level according to the strength of the supporting data; for example, some included studies have a lower evidence level because they included a small number of subjects or did not use international electrophysiology testing standards. We identified numerous widely-used medications and some recreational substances that have been shown to alter ERG responses, underscoring the need to take a complete medical and medication history for each patient undergoing ERG testing.
Posner-Schlossman syndrome (PSS) is thought to be associated with cytomegalovirus (CMV) infection; however, the prevalence of CMV infection and its characteristics in PSS patients varies across studies. Therefore, global...Posner-Schlossman syndrome (PSS) is thought to be associated with cytomegalovirus (CMV) infection; however, the prevalence of CMV infection and its characteristics in PSS patients varies across studies. Therefore, global estimates of CMV prevalence in PSS are needed to provide clearer insights for informing epidemiological surveillance and guiding treatment strategies. Embase, MEDLINE, Scopus, and Web of Science were searched for population-based, clinic-based, and secondary health care database studies that reported prevalence or incidence of CMV in patient with PSS published between database inception and October 31, 2024. Meta-analysis was conducted by using a random-effects model. The primary outcome was prevalence of CMV infection in patient with PSS. Secondary outcomes were characteristics of CMV infection in patient with PSS, such as corneal endothelial cell density and filtering surgery rate. Twenty-one studies, enrolling 1265 patients with PSS, were included. The pooled prevalence of CMV infection in patients with PSS was 44.5 % (95 % CI: 36.2 %-53.1 %; I= 73.9 %). The affected eye in patients with CMV infection had significantly lower endothelial density (mean difference, -389.8 cell/mm; 95 % CI: -553.8 to -225.9 cell/mm; p < 0.001; I ² = 53.8 %) and a higher risk of requiring filtration surgery than that in patients without CMV infection (pooled OR: 8.9, 95 % CI: 3.0-26.4; p < 0.001; I ² = 0 %). We highlight the prevalence and clinical outcomes of CMV infection in patients with PSS. The causal relationship between CMV infection and PSS requires exploration to inform effective diagnosis and treatment strategies.