Ophthalmology. Retina最新文献

{"title":"Anti-Vascular Endothelial Growth Factor Injection-to-Surgery Interval in Diabetic Vitrectomy: A Systematic Review and Meta-Analysis.","authors":"Fahad R Butt, Salem Abu Al-Burak, Fatima Abid, Justin Shad, Korolos Sawires, BScPharm Marko M Popovic, Mohammed Alfalah, Peter J Kertes","doi":"10.1016/j.oret.2026.09.027","DOIUrl":"https://doi.org/10.1016/j.oret.2026.09.027","url":null,"abstract":"<p><strong>Topic: </strong>To evaluate how outcomes of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) vary with the preoperative anti-vascular endothelial growth factor (anti-VEGF) injection-to-surgery interval.</p><p><strong>Clinical relevance: </strong>Preoperative anti-VEGF facilitates vitrectomy in PDR, but the influence of the interval is unclear; longer intervals may increase fibrovascular contraction and tractional retinal detachment (TRD) risk.</p><p><strong>Methods: </strong>This prospectively registered review (CRD420250651229) searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to March 17, 2026 for comparative studies of PPV for PDR with preoperative anti-VEGF. The prespecified confirmatory comparison was anti-VEGF versus no anti-VEGF, with early postoperative vitreous hemorrhage (VH) as the principal outcome; interval analyses (no anti-VEGF, 1 to 3, 4 to 7, 8 to 14, and more than 14 days) were exploratory. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using random-effects models (restricted maximum likelihood, Hartung-Knapp, prediction intervals) and sensitivity models for sparse events and clustered arms. Certainty of evidence was rated separately for the anti-VEGF effect and interval effects.</p><p><strong>Results: </strong>Thirty-three studies (3,419 eyes; 12 randomized) were included. Anti-VEGF was associated with lower early postoperative VH (OR, 0.40; 95% CI, 0.23 to 0.69), lower intraoperative VH (OR, 0.20; 95% CI, 0.10 to 0.40), fewer reoperations (OR, 0.58; 95% CI, 0.41 to 0.82), and less endodiathermy (OR, 0.21; 95% CI, 0.10 to 0.43). Final visual acuity was slightly better but heterogeneous (MD, -0.15 logarithm of the minimum angle of resolution; 95% CI, -0.29 to 0.00). Late VH, retinal detachment, silicone oil use, and TRD did not differ. Single-group proportions were lowest at 1 to 3 and 4 to 7 days, but the interval modeled continuously was not associated with either hemorrhage outcome. Certainty was moderate for early postoperative VH and low to very low otherwise.</p><p><strong>Conclusion: </strong>Preoperative anti-VEGF is associated with less intraoperative and early postoperative hemorrhage and fewer reoperations at diabetic vitrectomy, with the lowest hemorrhage rates when injection precedes surgery by 1 to 7 days. The evidence does not identify a precise optimal interval; higher TRD and reoperation rates beyond 14 days derive from a single cohort. Interval associations are hypothesis-generating given observational, low-certainty evidence.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Modjtahedi et al. Guidelines for the diagnosis, management, and study of autoimmune retinopathy from the American Academy of Ophthalmology's Task Force (Ophthalmol Retina. 2025;9:1005-1016).","authors":"Russell N Van Gelder, Kathryn L Pepple, Nisha R Acharya, Douglas A Jabs, Gary N Holland, Russell W Read, Debra A Goldstein, Lynn M Hassman","doi":"10.1016/j.oret.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.015","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Geographic Atrophy Growth and Visual Decline in a longitudinal Asian cohort.","authors":"Kelvin Y C Teo, Lisa Maria George, Ali Forouhari, Dun Jack Fu, Sobha Sivaprasad, Beau Fenner, Marieh Esmaeelpour, Rolf Herrmann, Chui Ming Gemmy Cheung","doi":"10.1016/j.oret.2026.09.020","DOIUrl":"https://doi.org/10.1016/j.oret.2026.09.020","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize GA growth and visual outcomes in Asian eyes with geographic atrophy (GA) secondary to age-related macular degeneration and to evaluate the incremental prognostic value of deep learning-derived optical coherence tomography (OCT) biomarkers.</p><p><strong>Design: </strong>Prospective longitudinal observational cohort study.</p><p><strong>Participants: </strong>One hundred fifty-five eyes of 139 patients with GA and 12-month follow-up.</p><p><strong>Methods: </strong>Participants underwent baseline and month-12 multimodal imaging with fundus autofluorescence (FAF) and spectral-domain OCT. GA area was quantified on FAF. A validated deep learning algorithm segmented retinal pigment epithelium layer loss (RPEL), photoreceptor degeneration (PRD), hypertransmission (HTR), and retinal pigment epithelium and outer retinal atrophy (RORA). Layer-specific excess metrics beyond RORA were derived. Multivariable mixed-effects models were constructed to identify predictors of GA growth and month-12 best-corrected visual acuity (VA), with nested models assessing incremental value beyond conventional demographic and imaging features.</p><p><strong>Main outcome measures: </strong>Twelve-month change in GA area and month-12 VA.</p><p><strong>Results: </strong>Mean baseline GA area was 3.89±4.24 mm² and increased by 0.83±0.92 mm² at month 12 (P<0.01). In lesions with baseline area ≥2.5mm², one year growth rate was 1.32 ± 0.96 mm². Baseline GA area, multifocality, and subretinal drusenoid deposits (SDD) were independently associated with faster growth. When analysed by baseline GA area, SDD were associated with increased growth in eyes with smaller baseline GA area (<2.5mm²). PRD-RORA excess was independently associated with GA growth and provided incremental predictive value beyond conventional predictors (ΔR²=0.02, P=0.04). Predictors differed by baseline lesion size. Mean VA decreased minimally from 0.68±0.56 at baseline to 0.72±0.57 logMAR at 1-year (P<0.01). Central 1-mm OCT occupancy measures provided greater explanatory value for month-12 VA than 6-mm OCT occupancy.</p><p><strong>Conclusions: </strong>Photoreceptor degeneration extending beyond established atrophy provided modest incremental prognostic information beyond conventional features evaluated. Central 1-mm OCT features showed limited association with month-12 VA and may serve as complementary structural correlates of visual function.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Muste et al.: Outcomes and complications of pars plana vitrectomy for nonclearing vitreous hemorrhage without tractional elements (Ophthalmology Retina. 2026;10:596-605).","authors":"Abhinandan R Patil, Goni Girija","doi":"10.1016/j.oret.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.005","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REPLY.","authors":"Alexander T Hong, Forest Lin, Jeremy D Keenan, Jay M Stewart","doi":"10.1016/j.oret.2026.08.022","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.022","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Stroke Risk and Trends in Secondary Prevention after Retinal Artery Occlusion.","authors":"Robin Vora, Aubrey L Gilbert, Daniel Lee, Hannah El-Sabrout, Noah Banoub, Ronak Shah, Amar Patel, Mary Reed, Mubarika Alavi, Nikita Vora, Cindy Hwang, Tova Mannis, Adrian Dokey, Shannan Moore, Molly Burnett, Dana Sax","doi":"10.1016/j.oret.2026.09.014","DOIUrl":"10.1016/j.oret.2026.09.014","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the short-term risk of stroke and myocardial infarction (MI) after acute, ophthalmologist-confirmed nonarteritic retinal artery occlusion (RAO) and to assess patterns of secondary preventive care in a large community setting.</p><p><strong>Design: </strong>Retrospective self-controlled cohort study.</p><p><strong>Participants: </strong>One thousand three hundred eighty adults with acute, embolic RAO (654 CRAO [central RAO], 726 BRAO [branch RAO]) who presented within 30 days of symptom onset to Kaiser Permanente Northern California (2015-2023).</p><p><strong>Methods: </strong>Three fellowship-trained ophthalmologists independently verified each RAO diagnosis. Incident stroke and MI events were identified through diagnosis codes and were manually confirmed. Poisson regression was used to estimate vascular event risk across time intervals relative to a pre-RAO control period (181-365 days).</p><p><strong>Main outcome measures: </strong>Incidence rate ratios (IRRs) of stroke and MI before, on the day of, within 30 days of, and within 1 year of RAO presentation as well as rates of neuroimaging, carotid and cardiac evaluation, and initiation of secondary preventive therapies within 30 days of presentation.</p><p><strong>Results: </strong>The risk of stroke peaked on the day of RAO presentation, particularly in the CRAO subgroup: all RAO (IRR: 5.67; 95% confidence interval [CI]: 2.38-13.5; P < 0.0001) and CRAO (IRR: 8.67; 95% CI: 2.62-28.6; P = 0.0004). Elevated stroke risk persisted throughout the first 30 days after presentation for all subgroups: all RAO (IRR: 5.67; 95% CI: 2.38-13.5; P < 0.0001), CRAO (IRR: 5.14; 95% CI: 2.29-11.6; P < 0.0001), and BRAO (IRR: 6.67; 95% CI: 1.98-22.4; P = 0.002). Beyond 30 days, stroke risk remained modestly elevated for up to 1 year. Myocardial infarction risk showed no statistically significant increase in any subgroup. Within 30 days, patients with CRAO were more likely than those with BRAO to undergo neuroimaging (68.0% vs. 48.8%; P < 0.0001), carotid imaging (85.6% vs. 80.6%; P = 0.0147), and cardiac evaluation (77.1% vs. 67.8%; P = 0.0001). Adherence to guideline-recommended diagnostic testing and preventive therapy increased steadily over the study period.</p><p><strong>Conclusions: </strong>Acute RAO is associated with a significantly higher short-term risk of acute stroke. Although rates of recommended evaluation and preventive measures have improved over time, opportunities remain to optimize vascular risk mitigation after RAO.</p><p><strong>Financial disclosure(s): </strong>The authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Burden of Age-Related Macular Degeneration, with Forecast up to 2050: A Modeling Study.","authors":"Yi Deun Jeong, Sangeon Jeon, Wonseok Shin, Seoyoung Park, Taehwan Park, Tae Hyeon Kim, Lee Smith, Masoud Rahmati, Jee Myung Yang, Dong Keon Yon","doi":"10.1016/j.oret.2026.09.019","DOIUrl":"10.1016/j.oret.2026.09.019","url":null,"abstract":"<p><strong>Topic: </strong>We aimed to estimate the prevalence of age-related macular degeneration (AMD) using a single standardized classification and provide comparable global, regional, and national burden estimates from 1990 to 2050.</p><p><strong>Clinical relevance: </strong>Because of the marked heterogeneity in AMD classification criteria across the included studies, there remains a need to delineate the burden of AMD using a unified and standardized classification system.</p><p><strong>Methods: </strong>After registration (CRD420251067039), searches were conducted in PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Eligible epidemiologic studies reporting AMD prevalence were included, and extracted prevalence data were harmonized according to the Beckman classification. An expectation-maximization algorithm was applied to disaggregate data to early, intermediate, geographic atrophy (GA), and neovascular AMD (nAMD). Prevalence was modeled for 204 countries and territories using disease modeling meta-regression, with projections to 2050 using a hybrid machine learning approach, including scenario analyses of tobacco reduction and increased physical activity. Estimates were stratified by clinical stage and ethnicity with 95% uncertainty intervals (UIs). The prevalence of AMD stratified by clinical stage (early, intermediate, GA, and nAMD), age, sex (male and female), and ethnicity across 204 countries from 1990 to 2021, with projections and risk-reduction scenarios through 2050.</p><p><strong>Results: </strong>In 2021, the global prevalence of AMD across all stages was 10.03% (95% UI, 8.30-12.06): early AMD, 5.40% (95% UI, 4.72-6.14); intermediate AMD, 4.01% (95% UI, 3.41-4.66); GA, 0.32% (95% UI, 0.26-0.39); and nAMD, 0.31% (95% UI, 0.26-0.36). Prevalence increased from 1990 to 2021, whereas age-standardized rates declined. Age-related macular degeneration prevalence rose sharply with age, with no significant sex differences in early or intermediate AMD. Geographic atrophy prevalence was highest among Hispanic populations, whereas nAMD was highest among European populations. Projections indicate continued increases through 2050, with reductions under tobacco reduction and increased physical activity scenarios.</p><p><strong>Conclusion: </strong>This study provides the global, regional, and national prevalence estimates of AMD stratified by the Beckman classification, offering evidence to inform clinical practice and health policy.</p><p><strong>Financial disclosure(s): </strong>The authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submacular Hemorrhage Secondary to Cytomegalovirus Retinitis after Chimeric Antigen Receptor T-Cell Therapy.","authors":"Tomohiko Torikai, Yuya Masuda, Atsushi Shiraishi","doi":"10.1016/j.oret.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.028","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Bellanda et al: Screening for retinal ischemic perivascular lesions in patients undergoing cardiovascular assessment: a cross-sectional study (Ophthalmol Retina. 2026;10:34-352).","authors":"Federico Bernardo Rossi, Antonio Gallo, Cédric Dulière, Yohan Cohen-Solal, Michel Paques","doi":"10.1016/j.oret.2026.08.023","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.023","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gas versus Air Tamponade in Surgery for Full-Thickness Macular Hole: A Systematic Review and Meta-Analysis.","authors":"Salem Abu Al-Burak, Fahad Butt, Vitaliy Voznyy, Mohd Salim Harun Gigani, Hashem Abu Serhan","doi":"10.1016/j.oret.2026.09.016","DOIUrl":"10.1016/j.oret.2026.09.016","url":null,"abstract":"<p><strong>Topic: </strong>Gas versus room air tamponade after pars plana vitrectomy for full-thickness macular hole.</p><p><strong>Clinical relevance: </strong>Room air is increasingly used instead of long-acting fluorinated gas after macular hole surgery, but the comparative evidence has not previously been synthesized. Clarifying whether gas improves anatomical closure or visual outcomes is important because room air may reduce tamponade duration and postoperative burden.</p><p><strong>Methods: </strong>MEDLINE, Embase, CENTRAL, and Web of Science were searched through August 7, 2026, without language restriction (PROSPERO: CRD420261474491). Randomized and nonrandomized studies comparing intraocular gas with room air, with at least 10 eyes per arm, were included. Studies were screened and data extracted in duplicate. Random-effects meta-analysis with Hartung-Knapp adjustment was performed, with randomized and nonrandomized evidence pooled separately. Primary outcomes were single-operation anatomical closure and best-corrected visual acuity at the longest available follow-up. Certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Results: </strong>Fourteen studies involving 1585 eyes were included, comprising only 3 randomized trials, 2 of which were at high risk of bias, and 11 nonrandomized studies. Among 10 studies reporting primary closure in primary idiopathic holes, gas was not associated with significantly greater closure than room air (risk ratio, 1.07; 95% confidence interval [CI], 0.95-1.19; P = 0.23; I² = 76.7%). Results were similar in randomized trials (risk ratio, 1.16; 95% CI, 0.85-1.58) and nonrandomized studies (risk ratio, 1.02; 95% CI, 0.88-1.18; P for interaction = 0.18). Neither gas species, mean hole diameter, surgical era, internal limiting membrane technique, combined phacoemulsification, center, or surgeon number, nor timing of closure assessment explained the heterogeneity. Visual acuity did not differ (mean difference, -0.01 logarithm of the minimum angle of resolution; 95% CI, -0.29 to 0.27). Certainty was very low for every outcome.</p><p><strong>Conclusions: </strong>Current evidence, of very low certainty throughout and resting on only 3 randomized trials, does not demonstrate superior anatomical or visual outcomes with fluorinated gas over room air after macular hole surgery. Confidence intervals remain compatible with a clinically important benefit of gas; the one trial powered for noninferiority did not establish it for air in holes of 400 μm or smaller, and the only stratified data >520 μm favored gas. Randomized trials in larger holes, with posturing standardized between arms, are needed.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}