PURPOSE: To report clinical characteristics of exudative neovascular age-related macular degeneration (AMD) in centenarian patients. METHODS: A retrospective, longitudinal study conducted in two retinal referral centers...PURPOSE: To report clinical characteristics of exudative neovascular age-related macular degeneration (AMD) in centenarian patients. METHODS: A retrospective, longitudinal study conducted in two retinal referral centers in Europe. Clinical characteristics of neovascular AMD patients having at last follow up at least ≥ 100 years were reviewed. RESULTS: Twenty-eight eyes from 14 patients (13 females), with a mean baseline age of 95.7 (SD 4.1) years and a mean follow-up duration of 89 months (39.9). The mean age at last follow-up was 102.4 (1.7) years. Most eyes (86%) presented type 1 macular neovascularization (MNV). At the last follow-up, best corrected visual acuity (BCVA) was stable or improved in 57% of eyes, with a mean final BCVA of 53 letters (21.8) Snellen equivalent 20/100. Eyes with better visual outcomes (>50 letters) had significantly higher baseline BCVA (p<0.001) and thicker subfoveal choroidal thickness (p=0.03). Macular hemorrhage (25%) and macular atrophy (53.6%) were associated with poorer BCVA. CONCLUSION: Centenarian patients with neovascular AMD can maintain vision with long-term anti-VEGF therapy. These findings underscore the need for tailored management strategies for the challenges faced by centenarians with neovascular AMD.
Hou KK, Yun JS, Fortes BH
… +10 more, Yamamoto MH, Au AC, Prasad PS, McCannel CA, Tsui I, McCannel TA, Hosseini H, Lozano Giral D, Barzelay-Wollman A, Pettenkofer MS
PURPOSE: To compare functional and anatomical outcomes of combining intravitreal dexamethasone implant (Ozurdex®) with navigated subthreshold yellow (577 nm) micropulse laser (SMLT) versus dexamethasone monotherapy in di...PURPOSE: To compare functional and anatomical outcomes of combining intravitreal dexamethasone implant (Ozurdex®) with navigated subthreshold yellow (577 nm) micropulse laser (SMLT) versus dexamethasone monotherapy in diabetic macular edema (DME). METHODS: In this prospective randomized study, 80 eyes with center-involving DME were allocated to two groups: 40 eyes received dexamethasone implant followed four weeks later by navigated SMLT (DEX-I + SMLT), and 40 eyes received dexamethasone implant alone (DEX-I). Best-corrected visual acuity (BCVA, ETDRS letters), central subfield thickness (CST), and ETDRS subfield thicknesses were measured at baseline and at 2, 4, 6, 9 and 12 months. Reinjection-free survival was analyzed over 12 months. RESULTS: At 6 months, mean BCVA improvement was greater in the DEX-I + SMLT group than in the DEX-I monotherapy group (6.2 ± 5.1 vs 4.1 ± 6.4 letters; p = 0.03), and this difference persisted at 12 months (5.8 ± 6.5 vs 3.6 ± 6.8 letters; p = 0.05). Mean CST was lower in the DEX-I + SMLT group at 6 months (295 ± 46 vs 321 ± 58 µm; p = 0.02) and remained lower at 12 months (315 ± 60 vs 342 ± 70 µm; p = 0.05). Median retreatment-free survival was longer in the combination group (11.2 vs 8.3 months). CONCLUSION: Within the 12-month follow-up period, sequential navigated SMLT performed four weeks after dexamethasone implantation was associated with improvements in visual and anatomical outcomes and with a longer retreatment-free interval compared with dexamethasone monotherapy, without additional safety concerns.
PURPOSE: To describe an optical coherence tomography finding termed the "Bucket Handle Sign" in patients with a history of endophthalmitis. METHODS: The electronic heath record from a single institution was queried for t...PURPOSE: To describe an optical coherence tomography finding termed the "Bucket Handle Sign" in patients with a history of endophthalmitis. METHODS: The electronic heath record from a single institution was queried for the international classification of disease 9/10 codes (H44.0X) corresponding to endophthalmitis from January 1, 2013 to December 31, 2022. Identified patients were cross-referenced with optical coherence tomographies to quantify patients with bucket handles. Histopathologic analysis of the corresponding tissue was performed on one eye that underwent vitrectomy. RESULTS: A total of 854 patients were diagnosed with endophthalmitis. Of these, 244 had gradable optical coherence tomographies, and 20 (8.2%) demonstrated a bucket handle sign. Key features of the bucket handle sign include a thickened hyper-reflective band separated from the underlying retina, a convex shape and a rounded angle of contact. Histologic analysis demonstrated that this optical coherence tomography finding was postendophthalmitis bullous internal limiting lamina separation. CONCLUSION: The bucket handle sign was seen in a significant minority of patients with a history of endophthalmitis. Its presence was rarely visually significant and warranted surgical intervention in select cases. Further research is required to understand the mechanism and to identify other pathologies where the bucket handle sign may be observed.
PURPOSE: To characterize intraocular lenses (IOL) position, IOL stability and iris dynamics in eyes with sutureless intrascleral haptic fixated intraocular lenses (SIS-IOLs). METHODS: This nonconsecutive observational st...PURPOSE: To characterize intraocular lenses (IOL) position, IOL stability and iris dynamics in eyes with sutureless intrascleral haptic fixated intraocular lenses (SIS-IOLs). METHODS: This nonconsecutive observational study used ultrasound biomicroscopy to better characterize SIS-IOLs. We included individuals who had SIS-IOL surgery between October 2014 and October 2018. We excluded individuals younger than18 years and those with active uveitis, advanced glaucoma, known ocular syndrome(s), and those with repeated SIS-IOL dislocations before the time of the ultrasound evaluation. Serial ultrasound biomicroscopy were performed in both the seated/supine positions and IOL position and stability were described as our primary outcome. As a secondary outcome, iris mobility was evaluated through dynamic ultrasound biomicroscopy in both the SIS-IOL and posterior chamber IOL (surgery between 2001 and 2019) groups. RESULTS: Analysis of ultrasound biomicroscopy of 22 SIS-IOLs and 10 posterior chamber IOLs, showed that on average, SIS-IOLs were positioned significantly more posteriorly than standard posterior chamber IOLs (aqueous depth = 0.59 vs. 0.48 mm; P < 0.00006)). Over time, SIS-IOLs demonstrated a slight posterior displacement of the IOL (0.18 mm shift posteriorly). Finally, in eyes with SIS-IOLs there was a high degree of iris mobility when compared with the posterior chamber IOL group (Fleiss Kappa 0.887). CONCLUSION: This study provides ultrasound-based evidence demonstrating a more posterior IOL position with increased iris mobility in eyes with an SIS-IOL. These data provide valuable information which may inform surgeons as they consider IOL selection and surgical technique.
PURPOSE: This research investigated the risk factors and multimodal imaging characteristics associated with the onset of central serous chorioretinopathy (CSCR) in the contralateral eye during follow-up of patients initi...PURPOSE: This research investigated the risk factors and multimodal imaging characteristics associated with the onset of central serous chorioretinopathy (CSCR) in the contralateral eye during follow-up of patients initially presenting with unilateral complex CSCR. METHODS: In this retrospective cohort, patients observed between 2015 and 2023 were classified into two groups: those progressing from unilateral to bilateral CSCR formed the study group, whereas patients who did not develop contralateral disease during follow-up comprised the control group. Demographic characteristics and smoking status were recorded. Multimodal imaging was documented. RESULTS: A total of 126 eyes from 63 patients were evaluated, including 31 with bilateral disease (Group 1) and 32 with unilateral CSCR (Group 2). In Group 1, the mean interval between involvement of the first and second eye was 21.29 ± 18.46 months. At baseline, the mean subfoveal choroidal thickness in affected eyes was 293 ± 67 µm in the study group, significantly lower than the 356 ± 64 µm observed in controls (P < 0.001). Multivariate regression analysis demonstrated that smoking, the presence of CSCR-related changes in the fellow eye on initial fundus fluorescein angiography (FFA), and reduced choroidal thickness in the first affected eye were independent predictors of bilateral disease progression. CONCLUSION: The findings indicate that smoking, early CSCR-related changes in the contralateral eye on baseline FFA, and reduced choroidal thickness in the initially affected eye represent significant risk factors for bilateral CSCR development.
PURPOSE: This systematic review investigates how sociodemographic factors influence diabetic retinopathy (DR) screening adherence among individuals with diabetes. The review examines individuals with diabetes as the targ...PURPOSE: This systematic review investigates how sociodemographic factors influence diabetic retinopathy (DR) screening adherence among individuals with diabetes. The review examines individuals with diabetes as the target population, focusing on the impact of various sociodemographic exposures on DR screening uptake. METHODS: A comprehensive systematic search was conducted across Ovid MEDLINE, Embase, and the Cochrane Library from inception to November 2024. The primary outcome was the overall rate of DR screening among individuals, while secondary outcomes included the odds ratios or proportions of individuals screened for DR, stratified by sociodemographic factors. RESULTS: Thirty-three studies were included, spanning more than 100,000 participants. Older age, higher education, higher income, and private insurance were consistently associated with higher screening adherence. Employed individuals, particularly those in manual labor or with rigid schedules, had lower participation. Women generally showed higher adherence, although findings varied. Ethnic disparities were observed, with Black and Hispanic populations demonstrating lower screening rates. Geographic distance and travel burden were frequently reported barriers. CONCLUSION: This review demonstrates that sociodemographic factors significantly affect DR screening adherence. Strengths include the broad geographic scope and diversity of populations studied. Limitations involve study heterogeneity and occasional reliance on self-reported data.
PURPOSE: To compare surgical outcomes of foveal-sparing internal limiting membrane (ILM) peeling (button-hole) with conventional ILM peeling in patients with retinal arterial macroaneurysm rupture accompanied by sub-ILM...PURPOSE: To compare surgical outcomes of foveal-sparing internal limiting membrane (ILM) peeling (button-hole) with conventional ILM peeling in patients with retinal arterial macroaneurysm rupture accompanied by sub-ILM hemorrhage (sub-ILMh) and subretinal hemorrhage, focusing on visual and anatomical results and postoperative macular hole formation. METHODS: A retrospective review was conducted on 42 eyes (42 patients) who underwent vitrectomy for retinal arterial macroaneurysm rupture with sub-ILMh and subretinal hemorrhage between September 2016 and December 2023. Patients were divided into two groups: conventional ILM peeling (Group 1, n = 22) and foveal-sparing ILM peeling (button-hole) (Group 2, n = 20). Subgroup analyses were performed based on macular hole presence or absence detected preoperatively or intraoperatively. RESULTS: Both groups showed significant improvement in best-corrected visual acuity, with Group 1 improving from 20 to 55 ETDRS letters and Group 2 from 25 to 65 ETDRS letters (P < 0.001). Postoperative best-corrected visual acuity was significantly better in Group 2 (P = 0.039). Macular hole formation occurred in 22.7% eyes of Group 1 but not in Group 2 (P = 0.049). Subgroup analysis showed consistent benefits of the button-hole technique even after adjusting for baseline differences (P = 0.034). CONCLUSION: Foveal-sparing ILM peeling (button-hole) has superior visual and anatomical outcomes than conventional ILM peeling, reducing postoperative macular hole incidence in patients with retinal arterial macroaneurysm rupture.
PURPOSE: To explore the functional and anatomic outcomes of eyes with resistant diabetic macular edema undergoing a loading phase of four intravitreal faricimab. METHODS: Prospective research on 46 eyes with diabetic mac...PURPOSE: To explore the functional and anatomic outcomes of eyes with resistant diabetic macular edema undergoing a loading phase of four intravitreal faricimab. METHODS: Prospective research on 46 eyes with diabetic macular edema previously treated with aflibercept or ranibizumab. At baseline (V0) and each monthly follow-up examination (V1-V4), we evaluated best-corrected visual acuity, optical coherence tomography, and angiography. Biomarkers such as central macular thickness, integrity of the ellipsoid zone/external limiting membrane, hyperreflective foci, disorganization of inner retina layers, and presence/absence of epiretinal membrane and subretinal fluid were collected, along with the vessel density (VD) in the superficial capillary plexi and deep capillary plexi and the foveal avascular zone area. RESULTS: Best-corrected visual acuity significantly improved from baseline to V4 (0.55 ± 0.42 vs. 0.36 ± 0.30 logMAR; P = 0.03). Sixty-five percent of eyes showed visual improvement during follow-up, whereas 91% showed anatomic improvement, with a mean central macular thickness reduction of 108.4 µm (P = 0.0002). At V0, 20 eyes (43%) had irregularities of the external limiting membrane/ellipsoid zone complex compared with 14 eyes (30%) at V4 (P = 0.28). Hyperreflective focis were visible in 87% of cases at baseline but reduced their prevalence up to 24 eyes (52%) at V4 (P = 0.0005). Disorganization of inner retina layers was reported in eight eyes (17%) at baseline and resolved in three eyes. Foveal avascular zone area was stable during follow-up, as well as superficial capillary plexi's VD, whereas the parafoveal deep capillary plexi's VD significantly increased from V0 to V4 (P = 0.04). CONCLUSION: Faricimab loading phase showed promising results in visual outcomes and structural improvement in resistant diabetic macular edema.
PURPOSE: To examine trends in retinal detachment (RD) repair surgeries from 2011 to 2021 in the Medicare population that characterizes the types of patients most at risk and in need of surgery. The authors also examined...PURPOSE: To examine trends in retinal detachment (RD) repair surgeries from 2011 to 2021 in the Medicare population that characterizes the types of patients most at risk and in need of surgery. The authors also examined the impact of retinal surgeon demographics and location of practice on RD repair. METHODS: Retrospective study of RD repair surgeries performed between 2011 and 2021 on Medicare beneficiaries. Patient and surgeon characteristics associated with each claim were extracted and analyzed. RESULTS: In total, 230,802 RD repair surgeries were performed on Medicare beneficiaries from 2011 to 2021. The amount of scleral buckle surgeries steadily declined from 6.38% of all surgeries in 2011 to 1.95% in 2021. The odds of having complex RD repair were associated with non-White race, higher area deprivation index, diabetes, and Charlson Comorbidity Index >0. Most retinal surgeons were male (84%) and practiced in urban areas (95.3%), although the proportion of female retinal surgeons increased over time. Around 20% of patients lived in rural areas, while only 4.7% of retina surgeons practiced in a rural setting. The annual surgical volume was higher for male compared with female surgeons (8.1 vs. 4.9, P < 0.001) and higher in surgeons practicing in rural than urban areas (9.3 vs. 7.5, P < 0.001). CONCLUSION: Significant racial, geographic, and gender differences are observed within the Medicare patient population receiving RD repair surgeries, as well as significant geographic and gender disparities in the retinal surgery workforce. Further research and initiatives to explore and address these disparities are needed.
PURPOSE: To evaluate anatomical and functional outcomes after four monthly intravitreal faricimab injections in White patients with polypoidal choroidal vasculopathy previously treated with other antivascular endothelial...PURPOSE: To evaluate anatomical and functional outcomes after four monthly intravitreal faricimab injections in White patients with polypoidal choroidal vasculopathy previously treated with other antivascular endothelial growth factor agents. MATERIALS AND METHODS: The authors retrospectively reviewed medical records and optical coherence tomography (OCT) scans from patients switched to faricimab. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), OCT biomarkers, and treatment interval extension were analyzed. Ocular and systemic adverse events were recorded as part of routine clinical follow-up to assess treatment tolerability. RESULTS: Twenty-eight eyes were included. BCVA remained stable in 53.57% of eyes, improved by five to nine letters in 17.85% and decreased by more than five letters in 28.57%. Overall, 71.42% maintained or improved BCVA. CRT remained stable in 71.42% of eyes; increased by more than 50 µ m in four eyes; and decreased by more than 50 µ m in four eyes. Overall, 85.71% of eyes demonstrated stable or reduced CRT after conversion to faricimab. Most eyes showed no changes in OCT biomarkers. Complete resolution of subretinal fluid and intraretinal fluid occurred in 35.71% of cases. Twelve patients (42.85%) were able to have their injection interval extended. No cases of intraocular inflammation, retinal vasculitis, endophthalmitis, or systemic adverse events were observed during the study period. CONCLUSION: Switching to faricimab resulted in anatomical and functional stability in most previously treated polypoidal choroidal vasculopathy patients and was well-tolerated during the study period.
PURPOSE: To determine if iris manipulation during phacovitrectomy for retinal detachment repair is associated with the development of proliferative vitreoretinopathy (PVR). METHODS: Single-center, comparative, retrospect...PURPOSE: To determine if iris manipulation during phacovitrectomy for retinal detachment repair is associated with the development of proliferative vitreoretinopathy (PVR). METHODS: Single-center, comparative, retrospective cohort study of 536 eyes who underwent phacovitrectomy for cataract extraction and retinal detachment repair between 2013 and 2024. Eligible eyes had at least 3-month follow-up. Iris manipulation was defined as mechanical pupillary expansion or synechiolysis. Patients with a history of uveitis were excluded. The primary outcome was the development of PVR, and secondary outcomes included the development of other postoperative complications. RESULTS: Of the included eyes, 66 were in the iris manipulation group and 470 were in the control group. The average follow-up time was 18.9 ± 16.0 weeks. Among the 34 eyes without baseline PVR in the iris manipulation group, 5 eyes (14.7%) developed PVR. Among the 282 eyes without baseline PVR in the control group, 12 (4.3%) developed PVR. After adjusting for patients who had previous retinal surgery in an additional regression analysis, iris manipulation remained a significant predictor for PVR development (odds ratio 3.64; P = 0.038). There were no significant differences in the odds ratio for the development of the other postoperative complications between the groups. CONCLUSION: Iris manipulation during phacovitrectomy for retinal detachment repair and cataract extraction was significantly associated with development of PVR in the absence of active inflammation, despite a similar profile of other postoperative complications. These findings highlight the potential role of iris trauma in amplifying intraocular inflammation and contributing to PVR pathogenesis.
PURPOSE: The authors evaluated the alterations of applying artificial intelligence (AI) diagnostic system for diabetic retinopathy screening in real-world practice. METHODS: This retrospective study included 11,713 diabe...PURPOSE: The authors evaluated the alterations of applying artificial intelligence (AI) diagnostic system for diabetic retinopathy screening in real-world practice. METHODS: This retrospective study included 11,713 diabetic patients from the government-led Diabetes Shared Care Network. The AI system VeriSee DR was integrated into the clinical workflow to identify referable diabetic retinopathy (RDR). Its performance was compared with ophthalmologist grading at the patient level using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Subgroup analysis was performed by age and sex, with additional referral diseases identified by ophthalmologists. RESULTS: VeriSee DR achieved a sensitivity of 0.88, specificity of 0.86, accuracy of 0.86, positive predictive value of 0.58, negative predictive value of 0.97, and area under the receiver operating characteristic curve of 0.87 in detecting RDR. Performance declined with increasing age, whereas sex distribution remained consistent across age groups. The AI system identified a higher proportion of RDR than ophthalmologists (27.45% vs. 18.15%). In addition to 1,818 patients with RDR, ophthalmologists identified other referral-warranted ocular conditions in 4.5% of cases. The AI system referred age-related macular degeneration (Grades 2-4), whereas referral decisions for macular hole and macular edema (Grades 1-2) varied; however, glaucoma (Grades 0-1) identified by clinicians was not consistently referred. CONCLUSION: VeriSee DR demonstrated high accuracy in detecting RDR but exhibited reduced performance in older patients. It had a higher referral rate than ophthalmologists yet missed certain conditions such as glaucoma. Despite effectiveness in diabetic retinopathy screening, further refinement is required to support broader ophthalmic disease detection.
PURPOSE: To evaluate the incidence, mechanisms, and clinical implications of silicone oil (SO) droplet transmission during intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVIs) and to review strat...PURPOSE: To evaluate the incidence, mechanisms, and clinical implications of silicone oil (SO) droplet transmission during intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVIs) and to review strategies to mitigate contamination risks. METHODS: A systematic review of observational and review studies from PubMed and MEDLINE was conducted, focusing on incidence, contributing factors, and clinical outcomes of SO contamination during IVIs. Specific attention was given to syringe design, storage conditions, variations among anti-VEGF agents, and injection techniques. RESULTS: The review found that prevalence is high in chronically injected eyes, though per-injection rates are low, often clustering due to syringe batches or techniques. Contributing factors include freeze-thaw cycles, mechanical agitation, spray-siliconized low-dead-space syringes, and improper plunger handling, which can lead to asymptomatic droplets or symptomatic floaters. No severe complications like endophthalmitis were reported. Hypotheses link SO to ocular hypertension or inflammation via trabecular obstruction or immunogenic responses, but the reviewed studies show no direct evidence. Mitigation involves the use of silicone-free/prefilled syringes, strict storage, gentle handling, and refined techniques such as priming and smooth plunger depression. CONCLUSION: SO contamination during IVIs can be minimized through careful optimization of syringe design, handling practices, and injection techniques. Embracing silicone-free or low-silicone syringe systems, alongside meticulous procedural protocols, offers the potential to enhance the safety and clinical outcomes of intravitreal anti-VEGF therapy.