Purpose: To report a case of retinitis and choroiditis after the seventh intravitreal (IVT) injection of pegcetacoplan. Methods: A single case was retrospectively reviewed. Results: An 80-year-old woman with dry age-related macular degeneration with geographic atrophy presented with painless vision loss in the right eye 21 days after her seventh pegcetacoplan injection. Her visual acuity (VA) declined from 20/40 to counting fingers. Examination revealed vitritis, macular edema, and multifocal areas of retinal whitening and retinitis. An anterior chamber tap was performed, and IVT ceftazidime was administered. Gram stain and cultures were negative, and the infectious and inflammatory workup was unremarkable. The patient was started on oral prednisone and received antivascular endothelial growth factor injections. At 5-month follow-up, VA had returned to baseline, and the inflammation had resolved. Conclusions: Retinitis and choroiditis were temporally associated with IVT pegcetacoplan, including after multiple prior uneventful injections. Clinicians should be aware of the possibility of intraocular inflammation after repeated pegcetacoplan injections.
Purpose: To describe the clinical features of intraocular recurrences in patients treated for primary and secondary vitreoretinal lymphoma. Methods: A retrospective consecutive case study was performed of patients diagnosed with primary vitreoretinal lymphoma or secondary vitreoretinal lymphoma at Massachusetts Eye and Ear who achieved clinical remission after initial treatment and subsequently developed intraocular recurrence. Clinical features at presentation and recurrence were compared. Results: Twenty-five eyes of 20 patients were included. Mean age at diagnosis was 63 years, and 20 eyes had primary vitreoretinal lymphoma. All eyes had vitreous cells at both presentation and recurrence. At recurrence, there were higher rates of subretinal infiltrates (40% vs 24%) and cystoid macular edema (16% vs 0%) compared with initial presentation. Overall, 44% of eyes had different clinical features at recurrence compared with initial presentation. Mean visual acuity declined from logMAR 0.20 (Snellen ~20/30) at presentation to logMAR 0.40 (Snellen ~20/50) at recurrence. The majority of eyes with local recurrence only were treated with intravitreal methotrexate. Conclusions: Vitreoretinal lymphoma recurrences can present with clinical features different from initial presentation. Subretinal infiltrates and cystoid macular edema were more commonly noted at recurrence. Clinicians should evaluate for features beyond vitreous cells when monitoring for recurrence.
Purpose: To characterize intraocular temperature changes before, during, and after vitreoretinal surgery at predefined anatomic locations within the vitreous cavity. Methods: This prospective, observational, longitudinal study included patients undergoing vitreoretinal surgery. Intraocular temperature was measured using a 29-gauge/3-cm MT needle connected to a BAT-12R Physitemp thermometer at standardized anatomic sites (anterior, middle, and posterior vitreous) and predefined surgical stages, including pre-, intra-, and post-vitrectomy, as well as before and after phacoemulsification. Results: Twenty eyes were included. At the start of surgery, mean anterior chamber and vitreous cavity temperatures were 28.69°C and 32.16°C, respectively. After phacoemulsification, vitreous temperature decreased by 3.01°C. During vitrectomy, intraocular temperature decreased across all measured regions compared with baseline pre-vitrectomy values (−1.5°C anterior, −2.2°C middle, and −1.8°C posterior vitreous). A posterior-to-anterior temperature gradient was observed, with higher baseline temperatures in the posterior vitreous. Conclusions: Intraocular temperature varies dynamically during vitreoretinal surgery and is not uniformly distributed within the vitreous cavity. Intraoperative cooling and spatial temperature gradients suggest that intraocular thermodynamics may influence retinal physiology, fluidics behavior, and tamponade properties. These findings underscore the role of intraocular thermodynamics as a clinically relevant factor in vitreoretinal surgery.
Purpose: To evaluate the relationship between trimester of pregnancy and stage of diabetic retinopathy (DR) in a cohort of women with diabetes. Methods: In this single-center, retrospective cohort study, data were collected from adult women with diabetes who experienced a pregnancy at 5 timepoints: prepregnancy, each trimester, and postpregnancy. Progression, manifestation, and improvement of DR were tracked via logistic regression. Results: A total of 158 patients were analyzed. Among them, 13 (8.2%) showed progression to worse stage of DR during pregnancy, of whom 6.9%, 5.0%, and 14.3% had progression within the prepregnancy/first trimester, second trimester, and third trimester brackets, respectively, and 10.0% progressed postpregnancy; differences between the trimesters regarding incidence of DR progression were nonsignificant ( P = .42). Of patients with no retinopathy at baseline, 4.62%, 7.69%, and 5.88% developed DR in each of the 3 trimesters, respectively, and 6.45% developed DR postpregnancy; differences in rates of DR manifestation were nonsignificant ( P = .97). Conclusions: Pregnancy stage was not associated with risk of DR manifestation or progression in this cohort.
Purpose: To assess the current role of artificial intelligence (AI) to predict postoperative best-corrected visual acuity (BCVA) after macular pucker surgery using optical coherence tomography (OCT) data. Methods: A systematic search was conducted of PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Library. Data extraction included study design, demographics, AI model characteristics, and performance metrics. Study quality was assessed using the Prediction Model Risk of Bias Assessment + Artificial Intelligence tool, and results were synthesized narratively. Results: Six studies involving 2728 patients (65–71 years) were analyzed. Convolutional neural networks and gradient boosting decision trees were applied to predict postoperative BCVA. The convolutional neural networks ResNet-101 and Inception-ResNet-V2 outperformed human grading, with ResNet-101 achieving the highest area under the receiver operating characteristic curve (0.97). Interpretability techniques identified ectopic inner foveal layers (EIFL) and irregular inner nuclear layer-outer plexiform layer as key predictors. Conclusions: Deep learning models demonstrate potential in predicting postoperative outcomes from preoperative OCT scans after macular pucker surgery. Advanced architectures such as ResNet-101 and Inception-ResNet-v2 outperform simpler models and expert grading. However, clinical translation depends on model generalizability, interpretability, real-time application, and inclusion of functional data. Future research should emphasize multicenter validation to ensure broader applicability.
