Purpose:Inherited retinal diseases (IRDs) are among the most common causes of visual impairment in children and young adults. The aim of this study was to characterize early clinical manifestations, main IRDs, and causative genes in a pediatric cohort.Methods:Retrospective study case series of children with a diagnosed IRD. Data extracted from medical charts included IRD type, clinical manifestations, demographic details, and molecular analysis when available.Results:The authors have identified 199 children. The earliest and most common symptom was nystagmus (mean age: 1.78 years), followed by photophobia, strabismus, and high refractive errors. The most common diagnoses were retinitis pigmentosa, achromatopsia, and congenital stationary night blindness; achromatopsia and Leber congenital amaurosis presented significantly earlier than other IRDs. Most common identified genes were CNGA3, TRPM1, CNGB3, and CRB1.Conclusion:Nystagmus was the earliest and most common symptom, particularly if disease manifests during the first year of life. Photophobia, strabismus, and high refractive errors were also common. Main IRDs in their studied population were retinitis pigmentosa, achromatopsia, and congenital stationary night blindness, and the most common genes identified were CNGA3 and TRPM1, differing from the ones seen later in adulthood. Identification of IRDs' early clinical manifestations can help affected families reach early diagnosis, support, and family planning.
Purpose:To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy.Methods:This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 & micro;m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed.Results:Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the "scolex" sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the "scolex" sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls.Conclusion:The "scolex" sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.
Purpose:To characterize the normative distribution of wide-field retinal and choroidal thickness in a large cohort of Chinese children aged 7 to 19 years and to evaluate the associations with age, sex, intraocular pressure(IOP), and refractive status.Methods:This cross-sectional study included 2032 healthy Chinese students (1,487 primary school students and 545 middle school students). Primary school students underwent comprehensive ocular examinations including IOP, axial length (AL), refractive status, corneal curvature, and wide-field optical coherence tomography (OCT); middle school students received basic examinations and OCT. Correlation analyses assessed relationships between retinal/choroidal thickness and ocular parameters.Results:Longer AL was associated with higher IOP, lower vertical corneal curvature (K2), and greater myopia. Older age correlated with greater myopia, longer AL, and reduced K2. Men had longer AL; women had higher K2. The mean subfoveal retinal thickness was 267.69 +/- 20.80 & micro;m, progressively decreasing toward the temporal periphery, up to 15 mm from the fovea. By contrast, the mean subfoveal choroidal thickness was 304.11 +/- 65.61 & micro;m, with the thinnest region located nasally, near the optic nerve. Choroidal thickness decreased with age, AL, myopia severity, and lower K2. Retinal and choroidal thickness showed opposite spatial trends.Conclusion:Wide-field retinal and choroidal thickness exhibited distinct distribution patterns associated with age, myopia, and multiple ocular parameters in children, providing normative data to facilitate early detection, monitoring, and research of ocular development and pediatric eye diseases.
Purpose:To investigate layer-specific microvascular changes in the nerve fiber layer plexus (NFLP) and ganglion cell layer plexus (GCLP) using optical coherence tomography angiography and correlate them with visual outcomes after surgery for idiopathic epiretinal membrane. Methods:This retrospective study analyzed 47 eyes with idiopathic epiretinal membrane and 30 healthy control eyes. Preoperative and 6-month postoperative best-corrected visual acuity, retinal sensitivity, and optical coherence tomography angiography-derived vascular density were assessed in the NFLP, GCLP, and superficial vascular complex. Diagnostic accuracy was evaluated using receiver operating characteristic curves, and prognostic value was determined through correlation and multiple linear regression analyses. Results:Preoperatively, idiopathic epiretinal membrane eyes showed significantly increased vascular density and perfusion area in the NFLP, GCLP, and superficial vascular complex compared with control eyes (P < 0.01). Nerve fiber layer plexus parameters demonstrated superior diagnostic accuracy over superficial vascular complex metrics. Preoperatively, increased NFLP vascular metrics were associated with higher best-corrected visual acuity improvement (all P < 0.05). Conversely, greater baseline 6 mm2 & times; 6 mm2 GCLP vascular metrics were associated with a lower best-corrected visual acuity improvement (all P < 0.05). In multivariate analysis, preoperative GCLP vascular density was an independent predictor of both better final postoperative best-corrected visual acuity (beta = 1.84, P = 0.045) and higher postoperative retinal sensitivity (beta = 0.048, P < 0.001). Conclusion:Stratified analysis of the NFLP and GCLP through optical coherence tomography angiography provides distinct and powerful biomarkers for idiopathic epiretinal membrane. Nerve fiber layer plexus metrics excel in diagnosis, whereas preoperative GCLP integrity is a key predictor of postoperative functional recovery, offering more nuanced insights than traditional superficial vascular complex analysis.
Purpose:This study aimed to prospectively assess the impact of preeclampsia severity on chorioretinal microvasculature using optical coherence tomography angiography.Methods:Sixty-six eyes from 66 patients were included and classified into mild (n = 33) and severe (n = 33) preeclampsia groups. Optical coherence tomography angiography imaging was performed before delivery, on the second day postpartum, and 6 weeks after delivery. Measurements at each time point were compared within and between groups. Correlations between optical coherence tomography angiography parameters and systemic blood pressure were also evaluated.Results:In the mild preeclampsia group, deep capillary plexus vessel density increased significantly after delivery. In the severe preeclampsia group, both deep capillary plexus vessel density and radial peripapillary capillary vessel density showed significant increases postpartum. However, deep capillary plexus vessel density and radial peripapillary capillary vessel density values measured before delivery and on the second day postpartum were significantly lower in the severe preeclampsia group compared with the mild preeclampsia group. Significant negative correlations were found between deep capillary plexus vessel density, radial peripapillary capillary vessel density, and systemic blood pressure.Conclusion:Deep capillary plexus vessel density and radial peripapillary capillary vessel density are inversely correlated with systemic blood pressure and are affected by preeclampsia severity. Although microvascular density improves after delivery in both groups, recovery is slower in patients with severe preeclampsia, indicating a more prolonged vascular impact.
Purpose:Endophthalmitis is a rare but severe complication of intravitreal injections that can result in significant vision loss. This systematic review and meta-analysis aimed to evaluate the efficacy of topical antibiotic prophylaxis in reducing endophthalmitis incidence, a topic of ongoing controversy and varied clinical practice worldwide.Methods:A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane, and Web of Science through July 2025. Studies comparing endophthalmitis incidence in intravitreal injections with and without antibiotic prophylaxis were included; reviews, case reports, and studies lacking outcome data were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the risk of bias in nonrandomized studies of interventions tool. Data were pooled using a random-effects model. The protocol was registered in PROSPERO (CRD420251102460).Results:Twenty-two studies encompassing 5,834,932 intravitreal injections (3,426,671 with prophylaxis and 2,408,261 without) were included. Overall, no significant difference in endophthalmitis incidence was observed between groups (P = 0.09). However, a subgroup analysis of antivascular endothelial growth factor injections showed a significantly higher risk of endophthalmitis in the antibiotic group (odds ratio, 1.56; 95% confidence interval, 1.03-2.36; I2 = 31%; very low-certainty evidence).Conclusion:Topical antibiotic prophylaxis was not associated with a reduced risk of endophthalmitis and may increase the risk in patients receiving antivascular endothelial growth factor intravitreal injections. These findings suggest that the routine use of antibiotic prophylaxis for these injections is unwarranted.
Purpose:To evaluate the gradable rate of the retinal images acquired with DRSplus retinographer in patients with diabetes and to estimate the diabetic retinopathy (DR) severity, comparing different methods of analysis and grading.Methods:Prospective, cross-sectional, observational study. A mosaic of overlapped retinal images in nonmydriatic condition was acquired, evaluating the gradable images rate at both image and eye-levels, from the human-study team (consensus grading), Reading Center, and an Artificial Intelligence (AI) system, respectively. The DR severity was graded by the Reading Center and the AI.Results:A total of 844 images of 422 eyes from 224 patients were included. The gradable rate was 87.4%, 97.4%, and 96.9% at image-level and was 81.3%, 97.4%, and 95.0% at eye-level, according to the consensus grading, the Reading Center, and the AI, respectively. Artificial intelligence sensitivity for detecting referable DR was 97.3%, the specificity was 80.4%, and the accuracy was 86.6%.Conclusion:DRSplus retinographer allowed to image the retina in nonmydriatic condition in more than 80% of eyes, with a higher gradable rate with Reading Center and AI in comparison with consensus grading. The estimation of the DR severity showed a high sensitivity for referral cases for AI system, indicating the potentialities of telemedicine-based tool for the DR screening.
Purpose: Sleep apnea (SA) is a systemic vascular risk factor, but its association with retinal vein occlusion (RVO) in younger adults is unclear. This study evaluated the relationship between SA and RVO, including central RVO and branch RVO, in individuals <= 55 years. Methods:A retrospective cohort study was conducted using the TriNetX US Collaborative Network (August 2005-2025). Patients <= 55 years with SA (N = 2,087,539) were propensity score-matched 1:1 with controls (N = 2,087,539) by age, sex, race, body mass index, and comorbidities. Outcomes included incident RVO, central RVO, and branch RVO. Risk ratios, hazard ratios, and Kaplan-Meier cumulative incidence analysis with log-rank tests were performed. Results:Among 2,087,539 patients per group, 547 SA patients (0.026%) and 475 controls (0.023%) developed RVO (risk ratio = 1.152, 95% confidence interval: 1.018-1.302; P = 0.024; hazard ratio = 1.219, 95% confidence interval: 1.078-1.378; chi 2 = 9.958; P = 0.002). Branch RVO occurred in 305 SA patients (0.015%) versus 237 controls (0.011%) (risk ratio = 1.287, 95% confidence interval: 1.086-1.525; P = 0.003; hazard ratio = 1.367, 95% confidence interval: 1.153-1.619; chi 2 = 13.109; P < 0.001). Conclusion:Sleep apnea was associated with increased risk of RVO in younger adults, primarily driven by branch RVO. These findings highlight the need for early recognition and management of SA to mitigate retinal vascular complications.
Purpose:To investigate a new method for controlling the direction of subretinal hematoma migration during tissue plasminogen activator (tPA) treatment by selecting the tPA injection site.Methods:Retrospective, interventional case series. An artificial retinal detachment was created by subretinal injection of tPA into the healthy lower retina of 18 patients, temporal to the fovea. The posterior pole of the detached retina was continuous with the subretinal hematoma, allowing tPA to access the lesion. After tPA infusion, the vitreous cavity was filled with SF6 gas, and the surgery was concluded.Results:Foveal subretinal hematoma size decreased from 610 +/- 489 & micro;m preoperatively to 68 +/- 134 & micro;m 1 month postoperatively. In all the cases, the subretinal hematoma moved downward from the temporal side of the fovea. Postoperatively, the mean difference in the angle between the tPA injection site (centered on the fovea centralis) and the hematoma's final position was 19 degrees +/- 14 degrees, and the hematomas migrated toward the artificial retinal detachment site.Conclusion:It is feasible to manipulate the migration of subretinal hematoma toward an artificial retinal detachment created by subretinal tPA injection outside the lesion. This approach may minimize macular compromise in lesions superior to the macula.
Purpose:Report the clinico-microbiological characteristics of multidrug-resistant acute postcataract bacterial endophthalmitis.Methods:Consecutive 32 cases from a prospective multicenter study in India were analyzed for the clinical features, presenting visual acuity, and inflammation score before and 3 months after treatment. Absolute risk reduction and number needed to treat to avoid globe loss were calculated.Results:The multidrug-resistant incidence was 7.8% (32/410). It included 28 gram-negative bacilli (GNB, 87.5%) and 4 gram-positive cocci (GPC, 12.5%). The presenting visual acuity was light perception to hand motions in 93.9% (30/32) of patients. The mean inflammation score was 17.34 +/- 3.96. The primary treatment was vitrectomy and intravitreal antibiotics; all patients required a second intervention-vitreous lavage and intravitreal antibiotics (mean 2.43). GNBs were resistant to fluoroquinolones, aminoglycosides, and cephalosporins (39.3% each) and polymyxins (17.6%). Most amikacin- and ceftazidime-resistant (81.8%) GNBs were susceptible to colistin. After treatment, 9.4% of eyes developed phthisis, 46.9% did not improve vision, and 9.4% of eyes had >= 20/40. The absolute risk reduction was higher and the number needed to treat was lower to avoid one globe loss with colistin than with other antibiotics.Conclusion:Colistin could be an alternative to treating multidrug-resistant postcataract endophthalmitis caused by gram-negative bacilli in India.
Purpose:To discuss the influence of posterior staphyloma types on clinical outcomes of patients with high myopic macular hole (HMMH) and discover clinical characteristics related to postoperative visual acuity, vessel densities, and retinal function.Methods:This study included 44 eyes with HMMH, of whom 18 underwent internal limiting membrane (ILM) peeling technique and 26 eyes underwent inverted ILM flap technique. Ophthalmic examinations were performed preoperatively and postoperatively, including best-corrected visual acuity, intraocular pressure, optical coherence tomography angiography, and multifocal electroretinogram (mf-ERG). Three-dimensional magnetic resonance imaging (3D-MRI) reconstruction and ocular B-ultrasound were used to classify and grade posterior staphylomas.Results:Axial length was correlated with both depth and width of posterior staphyloma. Also, superficial capillary plexus vessel densities of narrow macular staphyloma type were significantly higher than that of the wide type in the peeling group. Furthermore, in grade 2 and grade 3, and both wide and narrow macular staphyloma types, the macular hole (MH) closure rate of the flap group was significantly higher than that of the peeling group. Correlation analysis showed that the presence of retinal detachment and initial best-corrected visual acuity (BCVA) were correlated with the final BCVA in the flap group, the age was correlated with the postoperative vessel density in the flap group, and microstructure restoration were correlated with the postoperative vessel density in both flap and peeling group.Conclusion:Under similar posterior staphylomas condition, the inverted ILM flap technique may provide better MH closure outcomes and retinal function.
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 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 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: To evaluate the safety and efficacy of multiwavelength photobiomodulation (PBM) in nonexudative (dry) age-related macular degeneration (AMD). Methods: LIGHTSITE III used a double-masked, randomized, sham-controlled, parallel-group, prospective study design. Subjects were enrolled with a diagnosis of dry AMD and treated with multiwavelength PBM (Valeda Light Delivery System; 590, 660, and 850 nm) or sham treatment. A treatment series included 9 PBM or sham treatments delivered 3x/week over 3 to 5 weeks every 4 months (M) for 24M. Results: A total of 148 eyes (100 subjects) with dry AMD were randomized into the study. LIGHTSITE III met the prespecified primary BCVA efficacy end point at M21 with a significant difference between treatment groups ( P = 0.0036) and a +6.2 letter gain after PBM. At M21, 61.5% of PBM-treated eyes showed ≥5, 23.1% showed ≥10, and 4.4% showed ≥15 letter gains. A favorable safety profile was observed with no signs of phototoxicity. Disease progression to Geographic Atrophy (GA) showed a significant decrease in incidence (Sham, 24.0% vs. PBM, 6.8%; P = 0.007) after PBM treatment at M24. Significant benefit in vision QoL was observed. Conclusion: Multiwavelength PBM represents an interventional therapy that restores visual function and has potential disease-modifying effects in intermediate dry AMD.
Purpose:To describe the clinical and multimodal imaging features of a novel form of macular neovascularization (MNV), designated Type 4 MNV, defined by mixed Type 1 and Type 2 neovascularization (NV), extensive intraretinal anastomotic NV, and central posterior hyaloid fibrosis.Methods:This multicenter retrospective observational case series included patients with neovascular age-related macular degeneration exhibiting both Type 1 and 2 MNV and an overlying anastomotic intraretinal NV network. This was confirmed with optical coherence tomography (OCT) and OCT angiography (OCTA). Demographics, baseline visual acuity (VA), and OCT imaging biomarkers including the hyperreflective oblique band sign, central posterior hyaloid fibrosis, epiretinal membrane, and OCTA NV subtype were assessed.Results:Eleven eyes from 11 patients (mean age: 76.9 years; 36.4% female) met inclusion criteria. Baseline VA was logMAR 1.56 +/- 0.45 (approximate to 20/630) and 90.9% of subjects presented with severe visual loss. All eyes showed the hyperreflective oblique band sign. Central posterior hyaloid fibrosis was observed in 81.8% (9/11 subjects). Epiretinal membrane with radial traction was present in 81.8%. OCT angiography illustrated mixed Type 1 and 2 MNV with a prominent overlying intraretinal anastomotic network extending into the preretinal space.Conclusion:Type 4 MNV represents a distinct age-related macular degeneration phenotype with aggressive anatomical features including mixed Type 1 and 2 MNV, inner retinal and preretinal proliferation and anastomosis and retinal disorganization. The visual prognosis is invariably poor with recalcitrance to anti-vascular endothelial growth factor therapy. The recognition of this signature NV lesion subtype further refines the MNV classification system and can affect therapeutic strategies for neovascular age-related macular degeneration.
Purpose:To assess the morphologic risk of full-thickness macular hole (FTMH) formation in the fellow eye based on posterior vitreous detachment (PVD) status and preceding vitreomacular interface changes using optical coherence tomography data of the fellow eye.Methods:The natural history of fellow eyes of patients with unilateral FTMH was reviewed for tractional maculopathies, symmetry of the foveal contour, inner and outer retinal irregularities, and PVD status on spectral domain optical coherence tomography. Posterior vitreous detachment was classified as incomplete (incomplete PVD = vitreomacular adhesion or traction) or macular (mPVD = vitreomacular detachment). Foveal contour changes were classified as inner foveal irregularity (IFI) if mPVD was present without evidence of other tractional maculopathies.Results:Seventy-two eyes of 72 consecutive patients were included. Nine (12.5%) developed FTMH during a mean follow-up of 19.1 +/- 23.8 (range: 3.0-133.0) months. Incomplete PVD at baseline was not associated with a higher incidence of FTMH at follow-up (10.5% mPVD vs. 14.7% incomplete PVD, P = 0.727). Nine of 38 eyes (23.7%) with mPVD had inner foveal irregularity at baseline. Inner foveal irregularity was a risk factor for FTMH formation after mPVD (P = 0.033, OR = 14.0). The cumulative risk of IFI-FTMH conversion was 16.7% at 12 months and 44.4% at 24 months.Conclusion:Inner foveal irregularity can be frequently documented in the fellow eyes of patients with FTMH and may be an early morphologic risk factor for FTMH formation after mPVD in the context of previous fellow eye involvement.
Purpose:To report the clinical presentation, management, complications, and outcomes after retinal injuries caused by intravitreal injections.Methods:Retrospective case series of 12 eyes presenting with visual deterioration because of vitreoretinal complications secondary to trauma caused by intravitreal injections. Detailed ocular history, clinical examination, vitreoretinal complications, management, final anatomical, and visual outcomes are documented.Results:We observed 12 cases of direct retinal trauma by the needle tip of intravitreal injection. All retinal injuries were located in the temporal mid-periphery, usually near the inferior arcade. Of the 12 patients, four eyes developed a retinal detachment, all with proliferative vitreoretinopathy, six had vitreous hemorrhage, and two eyes presented with a focal chorioretinal atrophic lesion. The patients either underwent surgical procedure or were closely monitored after the injury. The surgical intervention was successful in anatomical outcomes in all cases. Ten eyes had a final visual acuity similar to baseline, whereas two eyes experienced visual deterioration during a follow-up of at least 6 months.Conclusion:Direct retinal injury with the intravitreal injection needle is a rare but possibly underreported adverse event. Early detection of these complications, especially if associated with retinal detachment, is important for timely and appropriate management to avoid permanent loss of vision.
PURPOSE:To assess factors associated with retinal detachment (RD) in eyes presenting with endogenous endophthalmitis (EE). METHODS:Multicenter retrospective study of individuals with an EE diagnosis from seven tertiary care centers. Demographics, medical history, ocular examination findings, microbial cultures (blood or intraocular), and management strategies were assessed relative to subsequent RD occurring within 6 months of EE diagnosis. Of note, this study did not distinguish between intraocular cultures without growth and eyes that were not sampled for an intraocular organism. RESULTS:A total of 201 eyes from 171 patients presented with EE. Of these, 22.4% (45/201) had a subsequent RD. Eyes that experienced a subsequent RD had worse presenting visual acuity ( P = 0.006) and lower intraocular pressure at presentation (RD: 13.7 ± 5.4 mmHg vs. No RD: 15.7 ± 6.5 mmHg, P = 0.04). Compared with other forms of bacteremia, S. aureus bacteremia was associated with increased odds of subsequent RD (OR: 6.10, CI: 1.82-20.41, P = 0.003). Eyes with a subsequent RD did not have significantly greater rates of therapeutic pars plana vitrectomy (RD: 11/48, 22.9% vs. No RD: 36/153, 23.5%). CONCLUSION:Eyes presenting with visual acuity ≤ light perception or S. aureus bacteremia had a higher risk of subsequent RD and may warrant closer surveillance. Although no therapeutic strategies were associated with reduced odds of subsequent RD, a pars plana vitrectomy was not associated with an increased risk of RD, suggesting that it may aid in eyes with lackluster responses to systemic and intravitreal pharmacotherapy.
PURPOSE:To describe the progression of atrophy in pathologic myopia eyes with prior retinal inflammatory lesions consistent with punctate inner choroidopathy. METHODS:Retrospective case series of 21 eyes with pathologic myopia and resolved retinal inflammatory lesions compared with 26 noninflamed controls (14 fellow eyes; 12 external myopic eyes with pre-existing patchy atrophy). The primary outcome was annual atrophy-area change (mm2/year) on multimodal imaging. Secondary outcomes included incident/enlarging atrophy, multifocal versus unifocal appearance, and META-PM category progression. Group comparisons used Welch t tests and Fisher exact tests; an age-adjusted linear regression examined independent associations. RESULTS:Over 5.2 ± 3.2 years in inflamed eyes and 5.3 ± 2.4 years in controls, patchy atrophy progressed faster with inflammation (0.76 ± 0.67 vs. 0.38 ± 0.47 mm2/year; P = 0.03). Among eyes starting in myopic macular degeneration Category 1 to 2, incident atrophy occurred in 14 of 14 (100%) inflamed versus 4 of 11 (36.4%) controls (P < 0.01). Overall atrophy activity (new or enlarging) was 21 of 21 (100%) in inflamed eyes versus 19 of 26 (73.1%) controls (P < 0.01). Multifocal atrophy was more frequent with inflammation (15/21, 71.4%) than in controls (6/26, 23.1%; P < 0.01). In age-adjusted regression, inflammation remained independently associated with faster atrophy expansion (β = 0.41 mm2/year; 95% CI, 0.04-0.78; P = 0.033). CONCLUSION:In pathologic myopia, prior retinal inflammation is independently associated with more frequent multifocal involvement, higher risk of incident atrophy, and a substantially faster atrophy-expansion. Beyond mechanical factors, inflammation seems to be a key driver of atrophic progression in this population.
