Ophthalmology. Retina最新文献

{"title":"Neovascular and Non-Neovascular Subretinal Fluid Associated with Angioid Streaks: Comparative Imaging Analysis with Long-Term Follow-up.","authors":"Alessandro Feo, Elodie Bousquet, Andrea Coletto, Alberto Quarta, Prithvi Ramtohul, Diogo Cabral, Livia Faes, Riccardo Sacconi, Federico Rissotto, Meira Miri Fogel-Levin, Thanaporn Kritfuangfoo, Paolo Forte, Marko M Popovic, Giulia Corradetti, Hiok Hong Chan, Chui Ming Gemmy Cheung, Yousef Fouad, Mario R Romano, Giuseppe Querques, K Bailey Freund, SriniVas R Sadda, David Sarraf","doi":"10.1016/j.oret.2026.09.018","DOIUrl":"https://doi.org/10.1016/j.oret.2026.09.018","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the multimodal imaging features and long-term visual and structural outcomes of subretinal fluid (SRF) associated with angioid streaks (AS), and to compare neovascular and non-neovascular phenotypes.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Participants: </strong>Fifty-three eyes of 43 patients with AS-associated SRF.</p><p><strong>Methods: </strong>Medical records of patients with AS and SRF were retrospectively reviewed across multiple centers. Clinical and multimodal imaging data, including color fundus photography, fundus autofluorescence, optical coherence tomography (OCT), and OCT angiography, were analyzed at baseline and final follow-up. Eyes were classified as neovascular or non-neovascular based on evidence of choroidal neovascularization (CNV). OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT), SRF dimensions, and outer retinal integrity. Longitudinal visual and anatomical outcomes were compared between groups.</p><p><strong>Main outcome measures: </strong>Visual acuity (VA), SRF evolution, OCT structural changes, development of complete retinal pigment epithelium and outer retinal atrophy (cRORA), and comparison of outcomes between neovascular and non-neovascular SRF phenotypes.</p><p><strong>Results: </strong>Mean baseline VA was 0.36 ± 0.34 LogMAR (∼20/45 Snellen). CNV was identified in 37 eyes (69.8%), whereas 16 eyes (30.2%) demonstrated non-neovascular SRF. Mean follow-up duration was 4.1 ± 4.0 years. In the overall cohort, both CMT and SFCT significantly decreased over time (p<0.001 for both), whereas the prevalence of cRORA increased from 54.7% at baseline to 64.2% at final follow-up. SRF prevalence decreased in both groups, from 100% to 40.5% in neovascular eyes and from 100% to 72.7% in non-neovascular eyes. Final VA was similar between neovascular and non-neovascular groups (0.40 ± 0.30 LogMAR [∼20/50 Snellen] vs. 0.32 ± 0.20 LogMAR [∼20/40 Snellen]; p=0.62). Rates of cRORA at final follow-up were likewise comparable between groups (64.3% vs. 63.6%).</p><p><strong>Conclusions: </strong>SRF associated with AS may result from exudative CNV or non-neovascular mechanisms likely related to retinal pigment epithelium dysfunction. Despite distinct imaging phenotypes, long-term visual and structural outcomes were comparable between groups. These findings emphasize the importance of multimodal imaging confirmation of CNV to distinguish neovascular from non-neovascular fluid and avoid interpreting SRF alone as evidence of CNV activity.</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":"149002230","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":"Association of Reticular Pseudodrusen Burden and Dark Adaptation in Nonadvanced Age-Related Macular Degeneration: A Cross-Sectional and Longitudinal Study.","authors":"Ariel Yuhan Ong, Robbert R Struvyen, David A Merle, Kevin Mendez, Helia Ashourizadeh, Souvick Mukherjee, Afonso Lima-Cabrita, Jooyoung Chang, Dylan Wu, Shrinivas Pundlik, Demetrios G Vavvas, Ivana K Kim, Joan W Miller, Zhichao Wu, Pearse A Keane, John B Miller, Deeba Husain, Ines Lains","doi":"10.1016/j.oret.2026.09.003","DOIUrl":"10.1016/j.oret.2026.09.003","url":null,"abstract":"<p><strong>Purpose: </strong>Dark adaptation (DA) is an emerging functional outcome in age-related macular degeneration (AMD). Although reticular pseudodrusen (RPD) have been linked to poorer DA, previous studies have largely assessed RPD presence/absence or comprised small cross-sectional cohorts. We investigated whether automated quantification of RPD area and volume is associated with rod-mediated DA and its longitudinal decline in nonadvanced AMD.</p><p><strong>Design: </strong>Prospective cross-sectional and longitudinal study.</p><p><strong>Participants: </strong>Patients with nonadvanced AMD and controls aged >50 years.</p><p><strong>Methods: </strong>Participants underwent multimodal retinal imaging and extended protocol DA testing (20-minutes; AdaptDx, MacuLogix), yielding rod intercept time (RIT) and area under the DA curve (AUDAC). A deep learning algorithm quantified RPD en face area (mm², square-root transformed) and volume (mm³, cube-root transformed), including within the DA testing locus. Linear mixed-effects models were used, accounting for age, sex, smoking, classic drusen volume, and inter-eye correlation.</p><p><strong>Main outcome measures: </strong>Cross-sectional and longitudinal associations of RPD burden with RIT and AUDAC.</p><p><strong>Results: </strong>We included 545 eyes (52 early AMD, 285 intermediate AMD, 208 controls) from 310 patients (mean age, 69.6 ± 7.4 years); 128 (23.5%) had RPD. Greater RPD area and volume were associated with prolonged RIT (β = 1.59, P = 0.002; β = 9.29, P = 9.78 × 10^-5, respectively) and higher AUDAC (β = 0.032, P = 2.15 × 10^-4; β = 0.166, P = 5.88 × 10^-5, respectively). Overall macular RPD burden, rather than local burden at the testing locus, was independently associated with worse AUDAC (β = 0.005, P = 0.001). Longitudinally (n = 204 eyes; mean age, 2.8 ± 1.8 years), RPD presence (β = 0.011, P = 0.0067), area (β = 0.012, P = 4.48 × 10^-4), and volume (β = 0.054, P = 2.11 × 10^-4) were associated with faster AUDAC decline, and predictive of subsequent AUDAC (β = 0.048, P = 6.72 × 10^-5 and β = 0.198, P = 2.02 × 10^-4).</p><p><strong>Conclusions: </strong>Quantitative RPD burden is independently associated with impaired rod-mediated DA and subsequent functional decline, supporting its value as a prognostic structural biomarker for risk stratification and monitoring in nonadvanced AMD.</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":"148990870","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":"Victor Bellanda, Sumit Sharma, Adrienne Delaney, Pulkit Chaudhury, Sunil K Srivastava","doi":"10.1016/j.oret.2026.08.024","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.024","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990893","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":"Scleral Buckling in Primary Vitrectomy for Giant Retinal Tears: A Systematic Review and Meta-Analysis of Anatomical and Functional Outcomes.","authors":"Charles Zhang, Daniel A Lai, Adam Moosa, Nicholas Leung, Daniel Zhu, Justin H Townsend, Nicolas A Yannuzzi, Basil K Williams","doi":"10.1016/j.oret.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.030","url":null,"abstract":"<p><strong>Topic: </strong>Giant retinal tear-associated retinal detachments (GRT-RD) pose unique surgical challenges with high rates of recurrence and poor visual outcomes.</p><p><strong>Clinical relevance: </strong>Pars plana vitrectomy (PPV) is the gold-standard treatment, but the role of adjunctive scleral buckling (SB) remains controversial. This meta-analysis compares anatomic and functional outcomes between PPV + SB vs PPV alone.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature search after librarian review was performed on four databases (PubMed, Embase, CENTRAL, and Web of Science) on November 6^th, 2025. Studies with at least 10 patients per arm that compared single-surgery anatomic success (SSAS), final anatomic success (FAS), and final visual acuity (VA) of 20/200 Snellen or better were included. Risk of bias was assessed using the ROBINS-I tool. Quality of evidence was assessed using the GRADE framework.</p><p><strong>Results: </strong>The search yielded 1,306 unique abstracts, of which 177 underwent full-text review, and 11 were selected for meta-analyses. Across 10 studies, the SSAS did not differ between PPV + SB and PPV alone (RR = 1.07, p = 0.26). Post-hoc subgroup analysis showed no difference in studies with a mean age ≥ 40 years (RR = 0.97, p = 0.50), but significantly higher SSAS odds with PPV + SB in studies with mean age < 40 years (RR = 1.53, p = 0.002) and a significant interaction between subgroups (p = 0.002). Four studies evaluating FAS found no significant difference between groups (RR = 1.04, p = 0.14). Similarly, three studies comparing final VA ≥ 20/200 revealed no significant difference (RR = 1.07, p = 0.53). Across four studies, PPV + SB cases involved a significantly higher proportion of phakic eyes preoperatively (RR 1.36, p < 0.01). Additionally, two studies reported higher PVR rates and two reported more frequent inferior GRTs in the PPV + SB group. Due to imbalances in baseline characteristics that may affect the outcome, studies were graded as moderate to serious risk of confounding. Nine studies were at \"Serious\" risk of bias; two studies were evaluated as \"Moderate\" risk (ROBINS-I). The predefined outcomes of SSAS, FAS, and final VA were assessed as comprising very low quality of evidence (GRADE).</p><p><strong>Conclusions: </strong>PPV + SB may be associated with higher SSAS in younger patients with GRT-RDs, while final anatomic and visual outcomes may be comparable to PPV alone. Surgeons appear to use adjunctive SB in eyes with preoperative features that suggest higher risk of recurrent detachment. Prospective, randomized studies are needed to determine whether adjunctive SB confers a true therapeutic benefit.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990918","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":"The Significance of Assessing Systemic Factors in Diabetic Macular Edema.","authors":"Debora H Lee, Brian L VanderBeek","doi":"10.1016/j.oret.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.012","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990863","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":"Ten-Year Survival of First-in-Human Autologous Induced Pluripotent Stem Cell-Derived Retinal Pigment Epithelium Sheet Transplantation.","authors":"Daiki Sakai, Yasuhiko Hirami, Seiji Takagi, Midori Yamamoto, Kota Totani, Masahiro Yamanari, Masashi Fujihara, Sunao Sugita, Tadao Maeda, Masayo Takahashi, Michiko Mandai, Yasuo Kurimoto","doi":"10.1016/j.oret.2026.09.005","DOIUrl":"10.1016/j.oret.2026.09.005","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to report the 10-year follow-up results of the first-in-human study of induced pluripotent stem cell (iPSC)-derived retinal pigment epithelium (RPE) sheet transplantation, with a focus on long-term graft persistence assessed using multimodal imaging, including polarization-sensitive OCT (PS-OCT)-based melanin evaluation.</p><p><strong>Design: </strong>Follow-up of a single patient.</p><p><strong>Participant: </strong>A patient with neovascular age-related macular degeneration.</p><p><strong>Methods: </strong>Autologous iPSC-derived RPE sheets were transplanted into the subretinal space in 2014.</p><p><strong>Main outcome measures: </strong>Engraftment of the transplanted RPE sheet and preservation of the host retinal structure were evaluated using multimodal imaging, including color fundus photography, spectral-domain OCT, PS-OCT, and near-infrared autofluorescence (NIRAF), throughout the posttransplantation period.</p><p><strong>Results: </strong>The patient was aged 88 years at the 10-year posttransplantation follow-up. There was a stable anatomic appearance of the persistent subretinal pigmentation on color fundus photography. Spectral-domain OCT revealed the preservation of the outer nuclear layer over the graft. Choroidal thickness analysis indicated sustained structural preservation beneath the graft. Polarization-sensitive OCT demonstrated persistent depolarization signals of the RPE layer, which were separated from the overlying retina and corresponded to the pigmented area observed on color fundus photography. The combination of high polarimetric entropy on PS-OCT and low-to-isoautofluorescence on NIRAF further delineated the grafted area, distinguishing it from healthy and atrophic regions.</p><p><strong>Conclusions: </strong>Sustained preservation of the overlying neurosensory retina and underlying choroid, in conjunction with long-term pigment persistence, provides important evidence of the safety and structural stability of iPSC-based cell therapy. These findings support the potential of this approach for broader clinical application in regenerative medicine.</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":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983496","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":"Justin C Muste, Matthew J Schulgit, Sumit Sharma","doi":"10.1016/j.oret.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.004","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977378","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":"Ocular Toxoplasmosis Masquerading as Acute Retinal Necrosis and Cytomegalovirus Retinitis: A Systematic Review.","authors":"David Mikhail, Raphael Macaron, Jacqueline Coblentz, Guilherme Feltrin de Barros, Miguel N Burnier","doi":"10.1016/j.oret.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.oret.2026.09.004","url":null,"abstract":"<p><strong>Topic: </strong>This systematic review synthesizes clinical features, diagnostic pathways, interventions, and visual outcomes of atypical ocular toxoplasmosis initially masquerading as acute retinal necrosis (ARN) or cytomegalovirus (CMV) retinitis.</p><p><strong>Background: </strong>Ocular toxoplasmosis occasionally presents atypically, mimicking viral retinitides. This masquerade poses a challenge, as misdiagnosis and empiric corticosteroids for presumed viral inflammation delay anti-toxoplasma therapy and can precipitate fulminant, vision-threatening infection.</p><p><strong>Methods: </strong>Following PRISMA guidelines, MEDLINE and Embase were searched from database inception to February 2, 2026, for peer-reviewed studies reporting ocular toxoplasmosis initially misdiagnosed as ARN or CMV retinitis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for case reports and case series, and certainty of evidence was rated using GRADE. This study is registered with PROSPERO (CRD420261453307). Data on patient demographics, immune status, clinical presentation, diagnostic delay, and visual outcomes were analyzed.</p><p><strong>Results: </strong>The review included 14 studies comprising 43 patients (50 eyes) with a mean age of 52.9 years. Most (79.1%, n=34) were immunocompromised, and 65.1% (n=28) had prior corticosteroid use. The most frequent initial misdiagnoses were ARN (74.4%, n=32) and CMV retinitis (23.3%, n=10). The clinical masquerade led to a mean diagnostic delay of 26.4 days while patients received ineffective empiric antiviral therapies. Diagnosis was ultimately confirmed through serum serology (48.8%) or intraocular fluid polymerase chain reaction (34.9%). Upon correct diagnosis, patients were transitioned to anti-toxoplasma regimens, most commonly pyrimethamine-based (67.4%). Despite eventual anatomical consolidation of the active lesions, final visual outcomes were poor. Over half of the affected eyes (55.8%, n=24) retained a final visual acuity worse than 20/200, with 18.6% (n=8) progressing to light perception, no light perception, phthisis bulbi, or requiring enucleation.</p><p><strong>Conclusions: </strong>Very low certainty evidence suggests that typical ocular toxoplasmosis frequently masquerades as viral necrotizing retinitis, primarily in immunocompromised and corticosteroid-exposed individuals. As this evidence derives entirely from case reports and series subject to selection and publication bias, these findings should not be considered definitive. The resulting diagnostic delay leads to largely irreversible visual impairment. Early multimodal testing, specifically intraocular fluid PCR, and avoidance of empiric corticosteroids without concurrent anti-toxoplasma coverage may contribute to vision preservation.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983416","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":"Bobeck S Modjtahedi, Alan G Palestine, Lee M Jampol, David Sarraf, H Nida Sen, Lucia Sobrin, John J Chen, Paul Yang, Grazyna Adamus, Donald S Fong, Cynthia X Qian, Flora Lum","doi":"10.1016/j.oret.2026.08.016","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.016","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990943","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":"Bilateral Iridociliary Cysts in an Asymptomatic Patient.","authors":"Pranavi Kilaru, Sally S Ong","doi":"10.1016/j.oret.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.oret.2026.08.007","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990905","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}