Purpose: To evaluate functional and anatomic outcomes over 12 months in patients with recalcitrant neovascular age-related macular degeneration (nAMD) whose treatment was transitioned to faricimab. Methods: This retrospective observational study included 36 patients (41 eyes) with treatment-recalcitrant nAMD previously treated with bevacizumab, ranibizumab, or aflibercept. Patients received 4 monthly intravitreal faricimab injections followed by individualized treatment intervals. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) images, and swept-source OCT angiography images were assessed at baseline, 6 months, and 12 months. Anatomic features evaluated included intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), macular neovascularization (MNV), and geographic atrophy (GA). Results: Mean (±SD) BCVA remained stable over the 12-month period (baseline, 0.289 ± 0.350 logMAR; 12 months, 0.306 ± 0.394 logMAR; P = .41). Treatment intervals increased from a mean of 5.29 weeks prior to the switch to faricimab to 7.58 weeks afterward. Anatomically, the proportion of eyes without IRF or SRF improved from 34.14% at baseline to 74.68% at 12 months. A significant reduction in PED maximum height was observed at 6 months, along with decreases in mean PED height and volume. MNV metrics demonstrated a significant decline in vessel area density at 6 months (P = .031), although no sustained significant changes were observed at 12 months. GA size increased by a mean of 0.41 mm²/year over the study period (P = .026). Conclusions: Switching to faricimab in treatment-recalcitrant nAMD maintained visual acuity, improved anatomic outcomes, and significantly extended injection intervals. These findings underscore faricimab's efficacy in managing refractory nAMD cases.
Purpose:To evaluate whether transpupillary thermal therapy and cryotherapy could improve control of small choroidal melanoma and reduce scleral extension risk. Methods:A retrospective review identified 30 patients with clinically diagnosed unilateral choroidal melanoma treated sequentially with transpupillary thermal therapy and cryotherapy between 2001 and 2025. Data collected included demographics, tumor characteristics, treatment response, complications, visual acuity, metastasis, and mortality. Treatment failure was defined as the need for brachytherapy or enucleation. An exploratory comparison with a 2008 study of transpupillary thermal monotherapy was performed. Results:All tumors (100%) showed growth prior to treatment. Mean tumor thickness was 1.63 mm (range, 0.50-2.80 mm), and maximum basal linear diameter was 7.80 mm (range, 5.00-12.00 mm). The mean follow-up was 5.80 years. Tumor regression was achieved posttreatment in 97% of cases; 1 patient required brachytherapy. All-cause mortality was 10%, with 1 patient experiencing death from metastatic melanoma. Compared with the 2008 transpupillary thermal monotherapy study (24% treatment failure rate, 32% complication rate, 8% extraocular extension), the current series demonstrated a 3% treatment failure rate, 53% complication rate, and no intrascleral or extrascleral extension. Macular pucker was the most common complication, occurring in 53%. Conclusions:Sequential transpupillary thermal therapy and cryotherapy may provide effective tumor control for small choroidal melanoma. Sequential transpupillary thermal therapy with cryotherapy was associated with low rates of treatment failure and scleral extension. However, the cohort also had relatively high complication rates for conditions such as macular pucker, vascular occlusion, and refractory cystoid macular edema. Further investigations with larger sample sizes and longer follow-up are warranted to assess the safety and efficacy of sequential transpupillary thermal therapy with cryotherapy.
Purpose:To describe how 15-letter loss of visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) results in transient fluctuations in vision. In addition, to compare recoverability of letter loss in patients treated with antivascular endothelial growth factor (anti-VEGF) with untreated patients. Methods:Patients with previously untreated nAMD in the Comparisons of AMD Treatments Trials were assigned to transient and nontransient groups based on recovery of baseline best-corrected VA within 8 weeks. Magnitude of recoverable letter loss was modeled via linear regression. Results:Two hundred fifty-three of 1018 patients (25%) experienced 15-letter loss: 68 transient (7%) and 185 nontransient (18%). Two-year outcomes were better without 15-letter loss (+12 letters, 95% CI, 11-13, n = 772) compared with transient 15-letter loss (+0.4 letters, 95% CI, -4 to 5) and nontransient 15-letter loss (-14 letters, 95% CI, -17 to -12). Nontransient losses up to -2.5 letters were expected to be recoverable (95% CI, -6.0 to 1.0). Fifteen-letter loss was associated with smoking (P = .02) and poor nontransient outcomes with higher blood pressure (P = .04). Conclusions:Patients experiencing transient and nontransient 15-letter loss differed significantly in outcomes. Nontransient losses were not expected to be recoverable. These findings may help guide the selection of measures in clinical trial design.
Purpose:To synthesize current evidence on the pathophysiology, clinical relevance, and implications for age-related choroidal thinning. Methods:A systematic literature search of relevant publications was conducted across MEDLINE, Embase, and Cochrane Library, up to and including May 2024. Identified studies reported choroidal thickness changes with aging. Data on subfoveal choroidal thickness, choroidal vascularity index, and associated factors (ethnicity, systemic disease, axial length) were analyzed (PROSPERO ID: CRD420251041101). Results:Choroidal thickness declines with age, with ethnicity-specific rates ranging from -0.93 µm/year in Spanish cohorts to -4.00 µm/year in Chinese populations. Age-related choroidal thinning correlates with retinal and neurodegenerative pathologies, including glaucoma (nasal choroidal thinning >250 µm in older adult patients), myopic maculopathy (subfoveal choroidal thickness <100 µm in high myopia), and Alzheimer disease (subfoveal choroidal thickness 169 µm vs 253 µm in control patients). Enhanced depth imaging optical coherence tomography (OCT) and swept-source OCT reveal preferential vascular loss (choroidal vascularity index <30%) and stromal atrophy. Systemic risks, such as hypertension or smoking, accelerate choroidal thinning. Conclusions:Age-related choroidal thinning exists on a continuum between physiologic aging and pathology, with implications for retinal and systemic health. Future prospective studies will help determine diagnostic thresholds (subfoveal choroidal thickness <200 µm in nonmyopic adults >60 years or rapid thinning beyond ethnic normative values), management recommendations for high-risk cohorts (glaucoma, age-related macular degeneration, high myopia), and therapeutic considerations for monitoring of choroidal thickness changes from moderate- to low-certainty evidence.
Purpose: To summarize current evidence on clinical features, multimodal imaging findings, diagnostic techniques, and management strategies for vitreoretinal lymphoma. Methods: A literature review was performed to provide updated information on available treatment options for vitreoretinal lymphoma. Results: Diagnosis of vitreoretinal lymphoma requires vitreous biopsy, with or without retinal/subretinal tissue, for cytology and immunohistochemistry, along with ancillary tests such as flow cytometry, cytokine profiling (interleukin-10/interleukin-6 ratio >1), immunoglobulin heavy chain gene rearrangement analysis, and detection of the MYD88 L265P mutation. Optical coherence tomography and other multimodal imaging techniques have become increasingly useful in raising suspicion, guiding biopsy, and monitoring treatment response. No standardized treatment protocol exists for isolated vitreoretinal lymphoma. Management options include intravitreal chemotherapy (methotrexate and/or rituximab), radiation therapy, and systemic chemotherapy, often showing a good initial response, but relapse and subsequent central nervous system (CNS) involvement are common, resulting in poor overall prognosis and survival. For vitreoretinal lymphoma with CNS disease, current strategies favor high-dose methotrexate-based systemic chemotherapy, with or without intrathecal chemotherapy; whole-brain radiation is generally reserved as rescue therapy. Emerging directions for earlier diagnosis include metagenomic deep sequencing, and chimeric antigen receptor T-cell (CAR-T) therapy has shown promise for treatment of selected relapsed/refractory cases of primary CNS lymphoma with a potential to prolong survival. Conclusions: Treatment of vitreoretinal lymphoma requires a multidisciplinary, individualized approach that integrates multimodal imaging, cytologic and molecular diagnostics, CNS evaluation, and tailored local or systemic therapy. Prospective multicenter studies are needed to refine diagnostic algorithms and standardize management.
Purpose: To evaluate the outcomes of macular holes (MH) repaired using the viscostretch technique. Methods: This multicenter, multi-surgeon retrospective consecutive case series analyzed MH repaired with the viscostretch technique. Charts were retrospectively reviewed to assess baseline characteristics and outcomes. Results: Twenty eyes underwent complex MH repair with viscostretch. Baseline MH features included mean MH duration of 7 months (range, 0.75-18), baseline vision of 20/250 (20/50 to counting fingers), minimal linear MH diameter of 621 µm (range, 219-890), and maximal linear MH diameter of 1031 µm (range, 584-1498). MH were characterized by the presence of the following nonmutually exclusive complex MH features: recurrent/refractory MH (12/20 eyes [60%]); large MH (>400 µm minimal linear diameter, 17/20 eyes [85%]); and chronic MH (≥6 months duration, 10/20 eyes [50%]). Five of 20 eyes (25%) had large, chronic MH; 7 eyes (35%) had large, refractory/recurrent MH; 2 eyes (10%) had chronic, refractory/recurrent MH; and 4 eyes (20%) had large, chronic, refractory/recurrent MH. MH closure was achieved in 13 of 20 (65%) cases. There were no differences in baseline characteristics in eyes that achieved MH closure and those that did not. In eyes that achieved MH closure, there was a significant improvement in mean visual acuity from 20/200 to 20/100 ( P = .04). No surgical or postoperative complications were identified. Conclusions: The viscostretch surgical technique achieved MH closure in 65% of eyes in a cohort of various complex MH. Further studies are necessary to determine the use of this technique for complex MH.
Purpose: To determine whether a topical rho-kinase inhibitor used in eyes with primary rhegmatogenous retinal detachment (RRD) at high risk for proliferative vitreoretinopathy (PVR) reduces the rate of recurrent RD due to grade C or worse PVR. Methods: This randomized, double-masked, placebo-controlled trial (ClinicalTrials.gov: NCT05660447) included patients with primary RRD undergoing pars plana vitrectomy (PPV), with or without scleral buckling, who had 1 to 3 PVR risk factors: 3 or more breaks, 2 or more quadrants of RD, RD for longer than 3 weeks, vitreous hemorrhage, or choroidal detachment. Participants were randomized to netarsudil 0.02% or artificial tears, administered once daily for 8 weeks starting on postoperative day 1. The primary outcome was the rate of recurrent RD due to grade C PVR at 6 months. Results: A total of 79 patients were randomized (40 to netarsudil, 39 to placebo). After excluding dropouts and those lost to follow-up, 38 netarsudil and 34 placebo participants were analyzed. There was no significant difference in baseline high-risk features for PVR between the netarsudil and placebo arms. Eight eyes (21.1%) in the netarsudil arm vs 6 eyes (17.6%) in the placebo arm developed redetachment ( P = .77), with 4 vs 6 of the redetachments due to PVR (10.5% vs 17.6%; P = .5). At 6 months, epiretinal membrane was found in 55.2% of eyes in the netarsudil group and in 63.6% in the placebo group ( P > .99). Median logMAR (Snellen equivalent) visual acuity in the netarsudil vs placebo arm was 1.24 (20/350) vs 1.35 (20/450) at baseline ( P = .87), 0.7 (20/100) vs 0.48 (20/60) at month 3 ( P = .27), and 0.48 (20/60) vs 0.54 (20/70) at month 6 ( P = .91). Conclusions: Treatment of eyes with primary RRD at high risk for PVR with netarsudil 0.02% once daily for 8 weeks after PPV with or without scleral buckling did not appear to affect PVR redetachment or visual outcomes compared with placebo.
Purpose:To examine the correlation between hydroxychloroquine levels with real body weight and ideal body weight dose and identify patient characteristics at risk for subtherapeutic or supratherapeutic dosing. Methods:A retrospective chart review of 181 patients with lupus (429 unique hydroxychloroquine whole blood levels) was performed. Hydroxychloroquine levels <100 (indicating medication noncompliance) were excluded (n = 26). Summary statistics, linear regression of hydroxychloroquine level and real body weight/ideal body weight, and odds ratios (ORs) for factors associated with supratherapeutic (>2000 ng/mL) or subtherapeutic (<750 ng/mL) hydroxychloroquine levels were calculated. Results:The correlation of real body weight and hydroxychloroquine level was r = 0.124. Ideal body weight and hydroxychloroquine level had a correlation of r = 0.324. The OR of body mass index (BMI) >30 kg/m2 and supratherapeutic hydroxychloroquine level was 4.95 (95% CI, 1.98-12.39). The OR of BMI <20 kg/m2 and subtherapeutic hydroxychloroquine level was 2.90 (95% CI, 1.58-5.37). Three of 71 patients screened for toxicity had hydroxychloroquine maculopathy. These subjects had mean hydroxychloroquine levels of 1314 ng/mL (range, 1101-1553 ng/mL), 2402 ng/mL (range, 1754-3050 ng/mL), and 1223.8 ng/mL, and BMIs of 20.8 kg/m2, 29.7 kg/m2, and 19.8 kg/m2, respectively. Conclusions:All dosing schedules show variability in hydroxychloroquine levels. Ideal body weight may correlate more strongly with hydroxychloroquine level than real body weight. Under real body weight-based guidelines, obesity may increase the risk for supratherapeutic hydroxychloroquine levels, and low weight may increase the risk for subtherapeutic levels.
Purpose: To analyze the clinical profile, surgical management, and outcomes of patients with pediatric endogenous endophthalmitis over a decade at a tertiary eye care center in South India. Methods: This retrospective study included 32 eyes of 32 children younger than 15 years. Demographics, systemic illness, microbiological profile, surgical intervention, and outcomes were evaluated. Statistical analysis assessed the relationship between risk factors, complications, and outcomes. Results: The mean age was 7.5 ± 4.4 years; 17 patients were male, and 17 cases involved the right eye. Systemic illness or intravenous therapy preceded infection in 18 patients (56%). In all cases, surgery was performed within 48 hours of presentation. All eyes underwent pars plana vitrectomy with intravitreal antibiotics and intravitreal antifungal agents. Based on intraoperative assessment and the surgeon’s discretion, silicone oil tamponade was used in 16 eyes. Good functional outcomes (best-corrected visual acuity >20/400) occurred in 37.5% of patients, while favorable anatomic outcomes were seen in 46.9%. Median vision improved significantly from hand motions to 20/2400 ( P < .05). Ocular complications were seen in 53.1%, including retinal detachment (7 eyes), secondary glaucoma (2 eyes), and phthisis bulbi (5 eyes), which were significantly associated with poor outcomes ( P < .05). Unique organisms identified included Pantoea agglomerans , Burkholderia cepacia , Rothia dentocariosa , Serratia marcescens , and Alternaria . Conclusions: In this study, pediatric patients with endogenous endophthalmitis had significant visual morbidity despite appropriate surgical intervention. Early vitrectomy aids anatomic recovery, but ocular complications remain the main determinants of unfavorable outcomes.
Purpose: To characterize the clinical course of 3 cases of nonarteritic anterior ischemic optic neuropathy during treatment of geographic atrophy with pegcetacoplan. Methods: This retrospective case series includes longitudinal analysis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained by spectral-domain optical coherence tomography (OCT). Automatically generated RNFL scans were manually re-segmented when necessary. Results: Three patients developed nonarteritic anterior ischemic optic neuropathy after receiving 6 to 11 pegcetacoplan injections administered every 6 to 8 weeks. One patient was asymptomatic, and the diagnosis was made only through routine optic nerve monitoring. In all eyes, RNFL thickness increased gradually before the onset of nonarteritic anterior ischemic optic neuropathy, at a greater rate in affected eyes than in fellow eyes. Conclusions: Peripapillary RNFL thickness measured by OCT may be useful for monitoring patients receiving pegcetacoplan therapy and may allow earlier detection of nonarteritic anterior ischemic optic neuropathy. Changes in RNFL thickness may precede the development of nonarteritic anterior ischemic optic neuropathy.
Purpose: To compare longitudinal retinal and choroidal imaging findings in patients with mild cognitive impairment and cognitively normal control participants. Methods: Eyes of patients with mild cognitive impairment and cognitively normal controls were imaged using Zeiss Cirrus HD-5000 optical coherence tomography (OCT) with AngioPlex OCT angiography (OCTA). Macular vessel density and perfusion density were assessed. The Mini-Mental State Examination was administered at study entry and at least 18 months later. The velocity of change in OCT and OCTA parameters was compared between controls, nonamnestic patients with mild cognitive impairment, and amnestic patients with mild cognitive impairment. Results: Eighty-five eyes of 43 patients with mild cognitive impairment and 85 eyes of 43 control participants were analyzed at baseline, and 45% of those were analyzed at an average follow-up of 28 months. The entire cohort of patients with mild cognitive impairment demonstrated faster rates of decline in perfusion density (/year) in 3-mm circle ( P = .02) and ring ( P = .01) as well as in vessel density (mm -1 /year) in 3-mm circle ( P = .05) and ring ( P = .04) vs control participants. Amnestic patients with mild cognitive impairment demonstrated faster decline in perfusion density in 3-mm circle compared with nonamnestic patients with mild cognitive impairment ( P = .04) and control participants ( P = .007). Amnestic patients had a greater rate of decline in vessel density in 3-mm circle compared with nonamnestic patients ( P = .03) and control participants ( P = .02). The entire group of patients with mild cognitive impairment and the subgroup of nonamnestic patients had a faster rate of decline in perfusion density compared with control participants ( P = .01 and P < .001, respectively). Conclusions: The rate of decline in perfusion and vessel density was faster in the entire cohort of patients with mild cognitive impairment compared with control participants, with no significant change in Mini-Mental State Examination score. Amnestic patients with mild cognitive impairment demonstrated faster rates of decline in perfusion and vessel density compared with nonamnestic patients with mild cognitive impairment.
Purpose:To compare the direct and indirect costs of aflibercept 8 mg with aflibercept 2 mg in patients with diabetic macular edema (DME) using the published data from the PHOTON trial. Methods:Three groups of patients with DME were compared: 163 patients under a protocol of aflibercept 2 mg every 8 weeks, 328 patients under a protocol of aflibercept 8 mg every 12 weeks, and 167 patients under a protocol of aflibercept 8 mg every 16 weeks. A model-based comparative analysis was conducted using estimates of direct and indirect costs based on the mean number of injection visits and mean number of injections administered at the end of 96 weeks in the PHOTON aflibercept 8 mg clinical trial. The costs were adjusted for inflation to 2025 US dollars. Results:Using point estimates of real-world data, patients in the aflibercept 8 mg every 16 weeks group had the lowest overall total costs (mean $32,259.54), followed by those in the aflibercept 8 mg every 12 weeks group (mean $37,550.14). Patients in the aflibercept 2 mg every 8 weeks group had the highest total costs (mean $41,124.26). Cost differences were primarily driven by the higher number of injection visits in the 2 mg every 8 weeks regimen compared with the higher-dose, extended-interval 8 mg schedules at 96 weeks. Multi-way deterministic sensitivity analysis showed that the aflibercept 8 mg every 16 weeks regimen was the least costly option across all 10 000 Monte Carlo cost simulations. Conclusions:Across both deterministic and simulated analyses, aflibercept 8 mg at extended dosing intervals (every 12 or 16 weeks) resulted in statistically significant cost savings compared with the standard 2 mg every 8 weeks regimen.
Purpose:To evaluate retinal and choroidal changes in patients with chronic obstructive pulmonary disease using spectral-domain optical coherence tomography (SD-OCT) in Kazakhstan. Methods:A total of 51 patients with chronic obstructive pulmonary disease (49.1% females; age range 39-67 years) and 51 age- and sex-matched healthy controls were enrolled in the study. Retinal nerve fiber layer (RNFL) thickness, ganglion cell complex thickness, and subfoveal choroidal thickness were measured using SD-OCT. Results:In patients with chronic obstructive pulmonary disease, the mean subfoveal choroidal thickness decreased progressively with increasing disease severity (P < .001). The thickness of the ganglion cell complex in all quadrants was significantly lower in the Global Initiative for Chronic Obstructive Lung Disease 3 to 4 (severe to very severe) group compared with the control group (P < .01). The thickness of the ganglion cell complex was also significantly greater in the Global Initiative for Chronic Obstructive Lung Disease 1 to 2 (mild to moderate) group than in the Global Initiative for Chronic Obstructive Lung Disease 3 to 4 group (P < .01). RNFL thickness was higher in the control group than in the Global Initiative for Chronic Obstructive Lung Disease 3 to 4 group (P < .01). Similarly, RNFL thickness was significantly greater in the Global Initiative for Chronic Obstructive Lung Disease 1 to 2 group than in the Global Initiative for Chronic Obstructive Lung Disease 3 to 4 group (P < .01). Conclusions:Significant reductions in subfoveal choroidal thickness, RNFL thickness, and ganglion cell complex thickness were associated with increasing severity of chronic obstructive pulmonary disease. These OCT-derived parameters may serve as useful biomarkers of ocular involvement and visual comorbidities in patients with chronic obstructive pulmonary disease.
Purpose: To quantify the annual environmental impact of intravitreal (IVT) injections at a retina group practice and explore methods to reduce waste. Methods: In this retrospective analysis, environmental waste generated by IVT injections was quantified by weighing each disposed item and recording its mass in kilograms. Variation in the use of optional items was investigated by comparing the injection techniques of all 6 physicians at 1 of our office locations. The total annual waste was extrapolated based on the total number of injections of each medication administered across the entire practice in 2024. Potential targets for waste reduction were identified and calculated in percentages. Results: The total amount of environmental waste generated by the items strictly necessary for administering 92 622 injections of 7 medications in 2024 was 3.81 metric tons. Analysis of individual packaging components revealed that the outer packaging box was the greatest contributor to the packaging mass for most medications, accounting for 46.3% to 72.6% of the total packaging weight. Among the medications evaluated, bevacizumab generated the least packaging waste, while dexamethasone generated the most. Conclusions: This practice-wide analysis identified key contributors to environmental waste produced from IVT injections and highlighted several opportunities for waste reduction. Strategies such as the use of prefilled syringes, improved packaging efficiency, digital package inserts, and the elimination of optional injection components can help minimize environmental waste generation. These findings may help physicians and manufacturers reduce environmental waste through procedural modifications and improved packaging efficiency.
Purpose: To evaluate the real-world ocular safety profile of intravitreal (IVT) avacincaptad pegol for geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Methods: This retrospective study evaluated eyes with GA secondary to AMD, including those with concurrent neovascular AMD (nAMD) treated with avacincaptad pegol. Conversion (new-onset nAMD) and reactivation (>1 year treatment-free quiescence) were defined as exudation requiring antivascular endothelial growth factor (anti-VEGF) treatment. Demographics, treatment characteristics, visual acuity (VA), intraocular pressure, and adverse events were assessed. Results: Overall, 845 eyes of 590 patients (mean age, 81.8 ± 7.6 years; 71.9% female) received 5608 avacincaptad pegol injections. The mean injection interval was 53.7 ± 22.5 days, with a mean follow-up of 304 ± 173 days. Intraocular inflammation and endophthalmitis rates were low (1 eye each; 0.02% per injection). Conversion occurred in 21 of 590 at-risk eyes (3.6%; 4.3% annualized) after a median of 3 injections (interquartile range, 3-5; range, 1-22). At baseline, nAMD was present in 25.1% of fellow eyes but accounted for 38.1% of conversions, reflecting a higher subgroup conversion rate of 5.4% (6.7% annualized). Among 26 eyes with quiescent nAMD, reactivation occurred in 1 eye (3.8%) after a treatment-free interval of 7.5 years. For eyes requiring concurrent therapy, anti-VEGF treatment intervals remained unchanged. VA remained largely stable (+0.03 logMAR). Persistent ocular hypertension occurred in 8 eyes (1.0%), with no ischemic optic neuropathy or retinal vasculitis observed. Conclusions: In this real-world cohort, a favorable safety profile was found with avacincaptad pegol, with low rates of inflammatory events, endophthalmitis, persistent ocular hypertension, and nAMD conversion, providing clinically relevant data to inform patient counseling and monitoring.
Purpose: To describe subretinal fluid (SRF) identified using handheld optical coherence tomography (OCT) in a pediatric patient with nonaccidental trauma and document its structural resolution on follow-up imaging. Methods: A single case was retrospectively reviewed. Results: We report a pediatric case of nonaccidental trauma with retinal involvement evaluated using dilated fundus examination and handheld OCT. Fundus examination demonstrated bilateral multilayered retinal hemorrhages involving the posterior pole and extending into the periphery. OCT revealed inner retinal abnormalities, outer retinal changes including ellipsoid zone thickening, punctate hyperreflective foci, and SRF. The patient was managed conservatively. Follow-up OCT demonstrated complete structural resolution of the retinal abnormalities without intervention. Conclusions: Handheld OCT provides high-resolution, objective assessment of retinal microstructural injury and can detect subclinical findings in nonaccidental trauma, complementing fundus examination and widefield retinal imaging. To our knowledge, SRF has not been widely recognized as a distinct OCT finding in this condition. This case highlights transient SRF as a potential manifestation of retinal injury in nonaccidental trauma.
Purpose:To investigate patient characteristics, operative patterns, and postoperative complications to aid in the discussion of the safety profile of pars plana vitrectomy (PPV) for visually symptomatic floaters. Methods:Preoperative characteristics, intraoperative techniques, and postoperative outcomes were reviewed for patients receiving PPV for floaters. Data were collected on the postoperative course, including incidence, timing, and management of complications. Results:Clinical and surgical data on 413 eyes of 288 patients were analyzed (362 complete operative reports available for review). The mean (±SD) age of patients was 65.8 ± 9.6 years. A total of 125 patients (43.4%) underwent PPV for floaters in both eyes. Most eyes were pseudophakic (n = 315, 76.3%), and most had a posterior vitreous detachment (PVD) (n = 364, 88.1%) at the time of PPV. Only 30 eyes (8.3%) had PVD induced at the time of vitrectomy. Most eyes underwent 25-gauge PPV (n = 367, 98.9%). Sub-Tenon block anesthesia was administered with most procedures (n = 329, 90.9%), and most eyes received postprocedure subconjunctival antibiotics (n = 334, 91.3%). Intraoperative endolaser was performed in 34/362 eyes (9.4%). Most eyes underwent sutureless surgery (n = 337, 93.1%), and the majority received aqueous/balanced salt solution tamponade (n = 300, 82.6%). After the procedure, 279 eyes (67.6%) had more than 6 months of follow-up, with 382 eyes (92.5%) achieving a best-corrected visual acuity of 20/20 to 20/30. The most severe complication was endophthalmitis, which was encountered in 5 eyes (1.2%). Vitreous hemorrhage (VH) occurred in 23 eyes (5.6%), and postoperative retinal tear/retinal detachment (RD) occurred in 7 eyes (1.7%). Conclusions:This is the largest retrospective case series describing operative patterns and outcomes associated with PPV for floaters. Rates of serious postoperative complications, including endophthalmitis, VH, and retinal tear/RD requiring surgery, were low. Certain surgical patterns were associated with higher rates of complications. In carefully selected patients counseled on serious complications, PPV for floaters is relatively safe and achieves good visual outcomes.
Purpose:To evaluate the relationship between macular retinal thickness on optical coherence tomography (OCT) and retinal sensitivity on microperimetry in children, adolescents, and young adults with sickle cell disease. Methods:This cross-sectional study included 63 eyes of 34 patients with sickle cell disease. Data included demographics, macular retinal thickness determined by OCT, and retinal sensitivity on Macular Integrity Assessment (CenterVue) using a 68-point, 10-degree grid under mesopic conditions. Total retinal thickness was measured in the central, parafoveal, and perifoveal regions. The relationship between OCT macular thickness and retinal sensitivity on mesopic microperimetry was assessed in specific macular regions, including differences by peripheral sickle cell retinopathy status. Results:The median age of the 34 patients (63 eyes) was 14.6 years, and the median best-corrected visual acuity (BCVA) at the time of testing was 0 logMAR (Snellen 20/20). Of the 63 eyes, 55 (87.3%) had ≤30% fixation loss and thus were considered for the primary analysis. In multivariate regression analyses adjusted for patient age, BCVA, sickle cell genotype, sex, and race and ethnicity, decreased retinal sensitivity measured by microperimetry was associated with a decrease in OCT macular thickness (β = 0.06, 95% CI, 0.015-0.104; P = .009). Moreover, eyes with peripheral sickle cell retinopathy had lower temporal perifoveal retinal sensitivity on mesopic microperimetry compared with eyes without retinopathy (β = -6.3, 95% CI, -10.9 to -1.7; P = .008). BCVA at the time of testing was not associated with decreased macular sensitivity (P = .817) or with decreased OCT macular thickness (P = .086). Conclusions:Children, adolescents, and young adult patients with sickle cell maculopathy demonstrated reduced visual function, which was correlated with the degree of retinal thinning. Eyes with peripheral sickle cell retinopathy had lower temporal macular sensitivity compared with eyes without peripheral retinopathy. There was no difference in visual acuity between the groups, suggesting that functional tests are required to assess vision in sickle cell disease comprehensively.
