BACKGROUND AND OBJECTIVE:Estrogen in hormone replacement therapy (HRT) exerts anti-inflammatory effects believed to oppose age-related macular degeneration (AMD) pathogenesis, but whether HRT can be protective against AMD is contested. The aim of the study was to evaluate the association between HRT use and the risk of development and progression of AMD in postmenopausal women. PATIENTS AND METHODS:This was a retrospective cohort study utilizing ICD-10 codes for HRT usage and rates of AMD development and progression. RESULTS:There was a decreased risk of developing AMD in patients more than 60 years of age at 5 years (RR 0.72, 95% CI: 0.63-0.82) and 8 years (0.68, 0.60-0.76) after HRT initiation. Patients more than 75 years of age also demonstrated a reduced risk of developing AMD after 5 years (0.70, 0.60-0.82) and 8 years (0.64, 0.56-0.74) of HRT use. Patients more than 75 years of age had a reduced risk of progression to exudative AMD at 8 years (0.66, 0.49-0.89) after HRT initiation. CONCLUSION:HRT may be associated with a decreased risk of developing AMD, with continued effects at more chronic timepoints after HRT initiation.
BACKGROUND AND OBJECTIVE:Degenerative retinoschisis is an age-related condition characterized by splitting of the neurosensory retina. While the diagnosis is typically made by clinical examination, imaging techniques are useful to further characterize the condition and differentiate it from retinal detachment. The purpose of the current study was to review the imaging features of degenerative retinoschisis and illustrate the multimodal findings in four eyes using contemporary imaging modalities. MATERIALS AND METHODS:This was a retrospective, consecutive case series of patients with degenerative retinoschisis. Clinical notes and multimodal imaging findings were reviewed. RESULTS:The study comprised four eyes of two patients with degenerative retinoschisis. Visual acuity and anatomic features on multimodal imaging were stable in all eyes at 6 months or more of follow-up. CONCLUSIONS:Degenerative retinoschisis is usually asymptomatic and nonprogressive. Emerging technologies allowing potentially more accurate diagnosis in select cases include widefield swept-source optical coherence tomography, high-resolution B-scan, and ultrasound biomicroscopy.
The aim of this study was to describe outcomes of non-operative management of retinal strike sites in penetrating open-globe injury with formed vitreous. A retrospective series of patients with open-globe injuries with retinal strike sites and without retained foreign body. Primary repair and follow-up were conducted at Mass Eye and Ear with examination, fundus photographs, and B-scan ultrasonography as indicated by the clinical course. Patients did not undergo secondary vitrectomy for management of retinal strike sites. A total of three cases were included. Two patients were managed by observation; one received laser retinopexy. Retinal detachment did not develop in any patient with follow-ups of 2 years, 3 years, and 18 months, respectively. Two patients, one of whom received laser retinopexy, developed mild, non-progressive vitreous traction adjacent to the strike site. Two patients achieved final visual acuity of 20/20; one patient had final visual acuity of 20/40 due to corneal astigmatism. All patients were younger than 25 years of age and did not have posterior vitreous detachment (PVD) through at least 18 months follow-up. In three cases of penetrating injury into vitreous with a retinal strike site, young patients without a PVD maintained good anatomic and visual outcomes without vitrectomy. Future work should evaluate how age and vitreous status might influence indications for vitrectomy.
BACKGROUND AND OBJECTIVE:This study aimed to evaluate the association between statin use and frequency of proliferative vitreoretinopathy (PVR) and return to the operating room in eyes undergoing rhegmatogenous retinal detachment (RRD) repair. PATIENTS AND METHODS:This was a retrospective study of all patients ≥18 years of age who underwent RRD repair between January 2015 and November 2024, identified in the Vestrum Health Retina Database. RESULTS:A total of 54,876 eyes were included in the final analysis, of which 17,922 (33%) were taking statins. The frequency of PVR development within 90 days following primary RRD repair was significantly lower in the statin group compared to the non-statin group (6.67% vs. 8.17%, P < .001). In a multivariate regression analysis adjusted for age, sex, smoking history, lens status, diabetes, and surgery type, statin use was independently associated with a decreased likelihood of PVR (odds ratio: 0.70, 95% CI: 0.66 to 0.75). CONCLUSION:Statin use was associated with a significantly lower risk for PVR formation and return to the operating room following primary RRD repair.
This retrospective chart review presents a case of bilateral noninfectious retinitis exhibiting cotton wool spot-like lesions, associated with combined retinal vasculitis. A 26-year-old woman with no known systemic illness presented with bilateral combined retinal vasculitis, associated with multiple cotton wool-like lesions along the vessels. Swept-source optical coherence tomography (SS-OCT) revealed a prominent middle limiting membrane (MLM) sign with cystoid macular edema. Fundus fluorescein angiography (FFA) showed blocked hypofluorescence and optic disc leakage, but notably, no vascular leakage. Serological investigations and neuroimaging were unremarkable, except for a positive antinuclear antibody (ANA). Following initiation of oral corticosteroids, the cotton wool spot-like lesions began to resolve within 2 days, accompanied by an increase in hemorrhagic components, which subsequently resolved over 3 weeks. After complete resolution, optic disc pallor and retinal thinning were observed. This rare case of bilateral combined retinal vasculitis with distinctive cotton wool spot-like lesions along the vascular arcades showed a rapid response to corticosteroid therapy and remained clinically quiescent over long-term follow-up.
Background and Objective: This study aimed to investigate serum levels of insulin-like growth factor-1 (IGF-1) and its association with parameters related to insulin resistance, in patients diagnosed with central serous chorioretinopathy (CSCR). Patients and Methods: In this cross-sectional comparative study, patients were classified as simple ( n = 30) or complex ( n = 25) CSCR based on multimodal imaging findings. Following a comprehensive ophthalmologic examination, fasting venous blood samples were collected for the biochemical analysis of glucose, insulin, IGF-1, C-reactive protein (CRP), and glycated hemoglobin (HbA1c). Subsequently, body mass index (BMI) and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) values were calculated for each participant. Results: Mean serum IGF-1 levels were significantly higher in simple and complex CSCR groups compared with controls ( P < .05). No significant differences were observed among the groups in glucose, HbA1c, CRP, BMI, or HOMA-IR ( P > .05). Conclusion: Elevated IGF-1 levels in CSCR patients suggest that this growth factor may contribute to disease pathogenesis through mechanisms involving choroidal vascular permeability and retinal endothelial activity.
This report presents a retrospective case series of fundus photography artifacts encountered during telemedicine-based retinopathy of prematurity (ROP) screenings that closely resemble stage 1 and 2 ROP as defined by the International Classification of Retinopathy of Prematurity (ICROP). Images were obtained from preterm infants undergoing routine ROP screening through Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) and TeleROP telemedicine screening programs using the RetCam Envision 130° pediatric camera. Photographs taken by trained neonatal intensive care unit nurses were securely transmitted to ROP specialists for interpretation. Review of the photographs revealed several artifacts that appeared similar to early-stage ROP. Artifacts notably shifted position across multiple redundant images and retinal vessels extended beyond the demarcation line, confirming their nonpathologic nature. Awareness of these imaging artifacts is critical for ophthalmologists involved in ROP diagnosis and management. Comparing multiple images from slightly different angles allows graders to reliably distinguish artifacts from true ROP pathology, thereby avoiding misdiagnosis and unnecessary interventions.
Background and Objective: This expert opinion review is intended to provide guidelines for diagnosis and management of intraocular inflammation (IOI) and vasculitis following pegcetacoplan. Patients and Methods: A case series of all post-marketing reports classified by experts as definite or suspected vasculitis over an 18-month period was assessed. Results: A total of 306,000 pegcetacoplan intravitreal injections were given in the real world between March 1, 2023, and August 31, 2024. Twenty-four eyes from 22 patients (mean age 76 years, 59% female) with definite or suspected vasculitis were evaluated. Comorbidities included hypertension (55%), hypothyroidism (27%), and recent COVID-19 infection (14%). Twelve eyes were classified as vasculitis with occlusion, seven as vasculitis without occlusion, and five as suspected vasculitis. Median time from intravitreal injection to symptoms was 10 days and 88% ( n = 21) occurred after the first injection. Symptoms included reduced vision (71%), eye pain (33%), and elevated intraocular pressure (50%). All patients received corticosteroids and 29% received antibiotics. At last follow-up, six eyes recovered visual acuity to within one line of baseline, seven lost between 2 to 5 lines, and 11 lost 6 lines or more. Conclusion: While IOI and vasculitis are rare, patients can be educated to call a retina specialist promptly if symptoms or any vision loss develop, especially within the 2 weeks following the first injection. In addition to excluding an infectious etiology, individualized management with multiroute corticosteroids can be considered.
Background and Objective: This study aimed to perform a comprehensive quantitative analysis of patients with macular holes undergoing pars plana vitrectomy (PPVx) to identify factors associated with macular holes and with recurrence of macular holes after initial closure. Patients and Methods: This case-control study included 37 eyes which underwent 25-gauge vitrectomy without combined cataract extraction between January 2010 and January 2023 by a single surgeon (JIL). Various factors about each eye were noted across multiple visits. Linear regression and various statistical testing methods were used to analyze the data. Results: Larger hole size was associated with women, absence of a posterior vitreous detachment, and absence of cystoid macular edema. Higher likelihood of macular hole recurrence was associated with presence of an epiretinal membrane and in eyes that later underwent cataract extraction with insertion of intraocular lens (CEIOL). Conclusion: Analysis demonstrates that specific factors are associated with larger macular holes or higher rates of macular hole recurrence, which could provide predictive utility.
BACKGROUND AND OBJECTIVE:With rising incidence of pediatric retina disease, this study aimed to identify geographic and socioeconomic factors that predict residential access to pediatric retinal specialists. PATIENTS AND METHODS:This cross-sectional, retrospective study identified pediatric retina specialists in the United States and de-identified census tract-level data from public datasets. An origin-destination cost matrix was used to calculate travel time to the closest pediatric vitreoretinal specialist. RESULTS:Factors associated with greater travel burden to the nearest pediatric retinal specialist included residing in census tracts that were rural (P < .001), in the South vs Northeast (P = .009), low income (P < .0001), and low education (associate and some college vs bachelor's degree; P = .003 and .015). Counties with higher proportion of very low birth weight infants had significantly less travel time (P < .001). CONCLUSIONS:Counties with higher incidences of very low birth weight infants experience reduced travel durations to pediatric retina specialists. However, residents in rural, low-income, low-education census tracts, particularly in Southern regions, face greater travel burdens.
Macular hole, a rare but vision-threatening complication in Alport syndrome, presents unique therapeutic challenges. Although the ocular manifestations of Alport syndrome, such as anterior lenticonus and retinal flecks, have been well documented for decades, the progressive nature of the associated vitreoretinopathy has historically limited the ability of clinicians to prevent irreversible visual deterioration. A 39-year-old woman with genetically confirmed Alport syndrome presented with a 2-month history of progressive bilateral blurred vision. Multimodal ophthalmic imaging revealed wheel-like retinal changes accompanied by full-thickness foveal defects in both eyes. Pars plana vitrectomy combined with amniotic membrane transplantation was performed on the left eye. At 5-month follow-up, the visual acuity of the left eye remained 6/20, consistent with the preoperative best-corrected visual acuity of the same eye. Optical coherence tomography confirmed complete closure of the left macular hole. Pars plana vitrectomy combined with human amniotic membrane transplantation represents a promising therapeutic strategy for the management of macular holes in patients with Alport syndrome.
BACKGROUND AND OBJECTIVE:Suprachoroidal (SC) injection enables targeted posterior drug delivery but relies on subjective tactile feedback to confirm depth. This can require multiple passes or cause intravitreal delivery, increasing patient discomfort and complication risk. This study evaluates whether ultrasound biomicroscopy (UBM) can guide custom needle selection based on scleral thickness to improve first-pass SC injection success. PATIENTS AND METHODS:Ten ex vivo porcine eyes underwent pre-injection UBM to measure scleral thickness. Custom-length needles (0.5-1.5 mm) were selected accordingly. SC injections were performed under UBM guidance, with imaging confirming entry and injectate spread. RESULTS:UBM confirmed successful SC injection in all specimens, with hypoechoic separation between sclera and choroid. Post-injection, scleral thickness increased significantly (1.13 ± 0.13 mm to 2.28 ± 0.19 mm, P < .0001), validating drug delivery. CONCLUSION:UBM-guided needle selection enables accurate SC injection and may reduce failed attempts. This approach could enhance the efficacy of SC delivery and support broader clinical use across posterior segment diseases.
BACKGROUND AND OBJECTIVE:This study sought to provide a recent estimate for the prevalence of macular telangiectasia type 2 (MacTel) with respect to age, race/ethnicity, and sex. PATIENTS AND METHODS:A cross-sectional study from 2015 to 2024 was performed for adults in the United States aged ≥ 35 years within an electronic health record data platform. Patients with MacTel were identified as those with a corresponding International Classification of Diseases 10th revision (ICD-10) diagnosis code. The prevalence of MacTel was calculated at each year of the study period and stratification was performed by age, race, ethnicity, and sex. RESULTS:In 2024, the prevalence of MacTel was 9.06 patients per 100,000, representing a 1.91-fold increase from 2015 (95% CI 1.79-2.03). Over that same timespan, the ratio of increase in MacTel was greater than the ratio of increase of age-related macular degeneration (AMD) (odds ratio 1.25, 95% 1.17-1.33). CONCLUSION:The prevalence of MacTel is lower than previously estimated but has been increasing at a striking rate from 2015 to 2024 that outpaces AMD.
