Ophthalmology. Retina最新文献

{"title":"Association of OCT Angiography-Detected Intraretinal Microvascular Abnormalities with Diabetic Retinopathy Severity.","authors":"Xinyi Ding, Jia Xu, Francesco Romano, Itika Garg, Jenny Gan, Katherine M Overbey, Mauricio D Garcia, Mridula Shan, Ricardo Marrero-Alattar, Filippos Vingopoulos, Ying Cui, Ying Zhu, Ioanna Ploumi, Isabella Stettler, Matthew J Finn, Demetrios G Vavvas, Deeba Husain, David M Wu, Nimesh A Patel, Leo A Kim, John B Miller","doi":"10.1016/j.oret.2025.08.011","DOIUrl":"10.1016/j.oret.2025.08.011","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the severity and clinical significance of intraretinal microvascular abnormalities (IRMAs) using expanded field swept-source OCT angiography (SS-OCTA) in eyes with nonproliferative diabetic retinopathy (NPDR).</p><p><strong>Design: </strong>Cross-sectional, observational study.</p><p><strong>Participants: </strong>One hundred thirty-nine eyes from 101 subjects with NPDR.</p><p><strong>Methods: </strong>The montage of 12 × 12-mm angiography centered on the macula and optic nerve was evaluated by 2 masked graders for (1) the presence of IRMA in each 6 × 6-mm field, including center, superotemporal, inferotemporal, superonasal (SN), and inferonasal (IN) to the macula, and SN and IN to the optic nerve and (2) subtypes of IRMA (dilated trunk, net shape, loop, sea fan, and tufted IRMA). Nonperfusion areas (NPA) were quantified using FIJI. Nonproliferative diabetic retinopathy grading was initially collected from chart diagnoses and subsequently verified using ultra-widefield color fundus photos. Logistic and linear regression models were used to evaluate the relationships between IRMA features, diabetic retinopathy (DR) severity, and NPA.</p><p><strong>Main outcome measures: </strong>Intraretinal microvascular abnormality features associated with severe NPDR.</p><p><strong>Results: </strong>Intraretinal microvascular abnormalities, observed with SS-OCTA, were present in 58.3% of all NPDR eyes and more prevalent in severe (96.6%) than mild (28.8%) to moderate (70.6%) NPDR. The number of affected fields and IRMA subtypes increased with DR severity (P < 0.01). The most common subtype of IRMA is the dilated trunk, comprising 58.3%, followed by the net shape subtype at 35.3%, loop at 11.5%, sea fan at 6.5%, and tufts at 5.8%. Significant predictors of severe NPDR included the presence of IRMA in the central field (odds ratio [OR]: 8.7; P = 0.01), more widely distributed IRMA (OR: 2.2; P < 0.01), a greater variety of IRMA subtypes (OR: 4.2, P < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; P = 0.02), sea fan (OR: 26.0; P < 0.01), and tufted IRMA (OR: 13.4; P = 0.03). Center-involving IRMA (β = 5.8; P = 0.046) and IRMA with loops (β = 7.0; P = 0.043) were found to be associated with increased NPA.</p><p><strong>Conclusions: </strong>Our study demonstrates that IRMA lesions identified on OCT angiography, particularly their distribution and morphology, are associated with DR severity and provide complementary information that may facilitate the integration of SS-OCTA into clinical evaluation of DR.</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":5.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963658","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 Ring-Shaped Retinitis Pigmentosa in Usher Syndrome Type IV.","authors":"Zhihao Jiang, Xintong Jiang","doi":"10.1016/j.oret.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.oret.2025.07.011","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963716","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 Association between Retinal Vascular Occlusions and Dementia: A UK Biobank Retrospective Longitudinal Study.","authors":"Audrey Gao, Fatima Tuz-Zahra, Viha Vig, Rebecca Zeng, Yorghos Tripodis, Thor D Stein, Michael L Alosco, Steven Ness, Xuejing Chen, Nicole Siegel, Manju L Subramanian","doi":"10.1016/j.oret.2025.08.010","DOIUrl":"10.1016/j.oret.2025.08.010","url":null,"abstract":"<p><strong>Purpose: </strong>Vascular disease is associated with increased incidence of dementia and has the potential to be an indicator of underlying cognitive disease. The goal of this study is to investigate the association between retinal vascular occlusions and neurodegenerative disorders that lead to dementia, including all-cause dementia, Alzheimer disease (AD), and vascular dementia (VD).</p><p><strong>Design: </strong>Retrospective longitudinal cohort study.</p><p><strong>Participants: </strong>This study consists of 502 133 participants from the UK Biobank, aged 40 to 69 years at recruitment. There are 1463 individuals with retinal vascular occlusion and 500 670 individuals without.</p><p><strong>Methods: </strong>Individuals were categorized as having retinal vein occlusion (RVO), retinal artery occlusion (RAO), and any retinal vascular occlusion (both RVO and RAO). Prevalence and incidence of all-cause dementia, AD, and VD were calculated. The patients with RVO were then matched on age, sex, education, and employment score on a 1:3 ratio to controls. Univariate and multivariate Cox proportional hazards models on the matched participants were used to determine associations over time to all-cause dementia, AD, and VD, with added adjustments for diabetes, hypertension, and smoking status.</p><p><strong>Main outcome measures: </strong>Prevalence and hazard ratios (HRs) of all-cause dementia, AD, and VD.</p><p><strong>Results: </strong>The prevalence of all-cause dementia and AD is significantly increased among patients with RVO, RAO, and any retinal vascular occlusion, whereas the prevalence of VD is significantly increased in RVO and any retinal vascular occlusion. In the matched analysis, increased risk for all-cause dementia was seen in patients with any retinal vascular occlusion (HR, 1.52; confidence interval [CI], 1.11-2.07, P = 0.01) and RVO (HR, 1.38; CI, 1.01-1.90, P = 0.04). When adjusting for covariates, RVO did not show increased risk of all-cause dementia, AD, and VD.</p><p><strong>Conclusions: </strong>Any retinal vascular occlusions and RVO are associated with increased risk of all-cause dementia, and individuals with RVO also have higher risk of VD. After adjusting for shared risk factors, there is no association between dementia and retinal vascular occlusions. Findings from this study are both consistent and in conflict with prior reports, and indicate that the connection between retinal vascular occlusions and neurodegenerative diseases causing dementia may be due to their shared pathogenesis and risk factors.</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":5.7,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874327","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":"Relative Risk of Retinal Detachment in COL2A1 Compared with COL11A1 Stickler Syndrome: An Individual Patient Data Meta-Analysis.","authors":"Cameron M Carpenter, Aileen G MacLachlan, Caitlyn Y Kwun, Taylor J Johnson, Bryce T Baugh, Guillermo A Requejo Figueroa, Saul Rivera-Flores, Xiuzhen Liu, Gregory J Stoddard, Jessica A Kraker, Eileen S Hwang","doi":"10.1016/j.oret.2025.08.008","DOIUrl":"10.1016/j.oret.2025.08.008","url":null,"abstract":"<p><strong>Topic: </strong>To compare the relative risk of retinal detachment between patients with COL2A1 and COL11A1 Stickler syndrome.</p><p><strong>Clinical relevance: </strong>It is unclear whether the rate of retinal detachment differs between COL2A1 and COL11A1 Stickler syndrome. Previous studies included too few patients to detect a difference between genotypes.</p><p><strong>Methods: </strong>Individual patient data meta-analysis of cohort studies, case-control studies, cross-sectional studies, case series, and case reports across the MEDLINE, Embase, Scopus, Web of Science Core Collection, and Web of Science Preprint Citation Index databases from 1991 to 2025. Articles providing eye examination results in subjects with genetically confirmed COL2A1 or COL11A1 Stickler syndrome were included. From the included articles, individual patient data on affected gene, age at last follow-up, and presence or absence of retinal detachment were extracted. Patients who had prophylactic retinopexy were excluded. A mixed effects logistic regression adjusted for clustering by article and family was used to determine the relative risk of retinal detachment. A risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. The study was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023428144). The overall certainty of evidence was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>Of the 1420 articles screened, 179 were eligible for inclusion, and 141 provided individual patient data for a total of 673 patients from 430 families. Retinal detachment was present in 229 of 491 (47%) patients with COL2A1 Stickler syndrome and 51 of 182 (28%) patients with COL11A1 Stickler syndrome. The relative risk of retinal detachment was 1.78 times higher in COL2A1 compared with COL11A1 Stickler syndrome (95% confidence interval: 1.30-2.43, P < 0.001). The certainty of evidence was moderate.</p><p><strong>Conclusion: </strong>Our findings indicate a higher risk of retinal detachment in COL2A1 compared with COL11A1 Stickler syndrome, which may aid clinicians in determining individualized management plans for patients with Stickler syndrome. However, due to reporting biases inherent to the case series and case reports from which we obtained data, the overall certainty of evidence was rated as moderate, and our analysis was limited to providing relative risk of retinal detachment, not absolute risk.</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":5.7,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874326","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":"Rates of Endophthalmitis in Prefilled versus Nonprefilled Syringes for Intravitreal Injections: A Systematic Review and Meta-Analysis.","authors":"Charles Zhang, Daniel A Lai, Georges AbouKasm, Sinan Ersan, Nicholas Leung, Daniel Zhu, Nimesh A Patel, Harry W Flynn, Nicolas A Yannuzzi","doi":"10.1016/j.oret.2025.08.006","DOIUrl":"10.1016/j.oret.2025.08.006","url":null,"abstract":"<p><strong>Topic: </strong>This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).</p><p><strong>Clinical relevance: </strong>Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.</p><p><strong>Results: </strong>A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44-0.64; I² = 24%, P < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38-0.72; I² = 11%, P < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41-0.67; I² = 39%, P < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (P = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated \"low\" for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.</p><p><strong>Conclusion: </strong>Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies 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":5.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859410","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":"Long-Term Metformin Use and Reduced Risk of Age-Related Macular Degeneration: A Large Database Study.","authors":"Alexander T Hong, Ivan Y Luu, Jeremy D Keenan, Jay M Stewart","doi":"10.1016/j.oret.2025.07.018","DOIUrl":"10.1016/j.oret.2025.07.018","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between metformin use and the risk of developing age-related macular degeneration (AMD) among patients with diabetes, with a focus on exposure duration and AMD subtypes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>Patients were identified from the TriNetX network using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes for diabetes and ophthalmic care. Patients aged ≥60 years with diabetes and no documentation of AMD were included in the cohort.</p><p><strong>Methods: </strong>Patients were required to have no AMD diagnoses at 2 eye care visits ≥1 year apart, with the second visit serving as the index event for analysis. The main exposure was yearly metformin use for ≥5 years, with subanalysis up to 10 years. The outcome was incident AMD. Propensity score matching controlled for potential confounders, including demographics, comorbidities, medications, laboratory values, and health care utilization. The association between metformin and AMD was assessed using survival analysis. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Main outcome measures: </strong>The primary outcome was a new diagnosis of AMD. Secondary outcomes included a new diagnosis of dry AMD and wet AMD.</p><p><strong>Results: </strong>After propensity score matching, the main cohort analysis included 7496 patients, of whom 3748 had ≥5 consecutive years of metformin use. Incident AMD was documented in 122 (3.3%) patients who had been exposed to metformin and 184 (4.9%) who had not (HR, 0.68; 95% CI, 0.54-0.85). The metformin group had lower rates of both dry AMD (HR, 0.69; 95% CI, 0.53-0.90) and wet AMD (HR, 0.84; 95% CI, 0.50-1.39), although the association with wet AMD was not statistically significant. The metformin use for ≥6 consecutive years showed consistent protective effects; 1 to 4 years showed weaker associations.</p><p><strong>Conclusions: </strong>Prolonged metformin use in patients with diabetes was associated with a reduction in AMD risk in this claims database. These findings suggest a potential protective role for metformin, warranting further exploration of its long-term effects on AMD prevention.</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":5.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848203","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":"Efficacy of Low-Dose-Rate Iodine-125 Plaque Brachytherapy in the Treatment of Uveal Melanoma.","authors":"Linda A Cernichiaro-Espinosa, Sue L Choi, David J Taylor Gonzalez, Tristan Hayes, Joseph Mastellone, Rhonda S Roberson, Michael Stinson, Lawrence M Pfeffer, Lillian H Rinker, Hyo Young Choi, Benjamin A King, Matthew W Wilson","doi":"10.1016/j.oret.2025.08.004","DOIUrl":"10.1016/j.oret.2025.08.004","url":null,"abstract":"<p><strong>Objective: </strong>Episcleral plaque brachytherapy (EPBT) provides effective local tumor control in uveal melanoma (UM), although dosing regimens vary across institutions. We report a single institution's experience of using low-dose-rate Iodine-125 EPBT for the treatment of UM over a period of 38 years, evaluating long-term outcomes, complications, and survival rates.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Subjects: </strong>One-thousand eight-hundred-seven patients diagnosed with UM and treated with low-dose-rate Iodine-125 EPBT between 1984 and 2022.</p><p><strong>Methods: </strong>We reviewed medical records of UM patients treated with EPBT between 1984 and 2022 where we delivered a targeted dose of 85 Gy to the tumor apex at a rate of 52.8 cGy/hour over 168 hours. We applied Cox proportional hazards models and Kaplan-Meier survival analysis to evaluate survival outcomes and recurrence risks.</p><p><strong>Main outcome measures: </strong>Local tumor control, incidence of radiation-related complications, disease-specific, and overall patient survival.</p><p><strong>Results: </strong>Of 1807 patients, 1674 (93%) achieved local control, 762 (42%) developed radiation retinopathy, and 332 (18%) developed radiation optic neuropathy. Kaplan-Meier estimates of local recurrence at 5 and 10 years were 12% and 18%, respectively. Increasing age (P = 0.01) and juxtapapillary location (P < 0.001) were correlated with increased risk of recurrence. At 10 years, 1472 patients (82%) were alive without metastasis, 75 (4%) were alive with metastasis, 120 (7%) had died from metastasis, 27 (2%) had died from non-UM causes, and 113 (6%) had died from unknown causes. Age at surgery and advanced American Joint Cancer Committee T stage were associated with lower overall survival (P < 0.001).</p><p><strong>Conclusions: </strong>Low-dose-rate Iodine-125 EPBT yields similar complication rates to those reported in the literature. The incidence of local recurrence, albeit slightly higher, was comparable to other large cohorts. The consistency of low-dose-rate EPBT over 3 decades served as a reliable framework for a standardized UM treatment protocol.</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":5.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822164","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":"Noninvasive Synthesis of Multiframe Ultra-Widefield Fluorescein Angiography from Color Fundus Photographs.","authors":"Ruoyu Chen, Kezheng Xu, Kangyan Zheng, Weiyi Zhang, Yan Lu, Mingguang He, Danli Shi","doi":"10.1016/j.oret.2025.08.002","DOIUrl":"10.1016/j.oret.2025.08.002","url":null,"abstract":"<p><strong>Purpose: </strong>To generate dye-free ultra-widefield fluorescein angiography (UWF-FA) images from noninvasive ultra-widefield color fundus photography (UWF-CFP) using generative artificial intelligence (AI) and to evaluate its effectiveness in diabetic retinopathy (DR) screening.</p><p><strong>Design: </strong>A cross-sectional study involving generative AI.</p><p><strong>Participants: </strong>This study included 1263 patients with DR (2747 UWF-CFP images and 18 321 UWF-FA images) from the Second People's Hospital of Foshan.</p><p><strong>Methods: </strong>Ultra-widefield CFP and UWF-FA image pairs were matched and used to train a pix2pixHD generative adversarial network (GAN)-based model modified with Gradient Variance Loss. The generated UWF-FA images were evaluated using quantitative similarity metrics and qualitative ophthalmologist evaluation. An external data set, DeepDRiD, was used to validate the contribution of the generated UWF-FA images to DR grading.</p><p><strong>Main outcome measures: </strong>The area under the receiver operating characteristic curve for DR grading.</p><p><strong>Results: </strong>The generated early-, mid-, and late-phase UWF-FA images demonstrated high authenticity, with multiscale similarity scores ranging from 0.70 to 0.91 and qualitative evaluation scores from 1.64 to 1.98 (1 = real UWF-FA quality). In a Turing test with 50 randomly selected images, 56% to 76% of the generated images were indistinguishable from real images. Generated UWF-FA images successfully depict details of DR lesions, such as a nonperfusion area and leakage. The incorporation of these generated UWF-FA images in DR grading significantly improved the area under the receiver operating characteristic curve from 0.869 to 0.904 compared with the baseline model using UWF-CFP images alone (P < 0.001).</p><p><strong>Conclusions: </strong>The study suggests that the GAN-based model can successfully generate realistic multiframe UWF-FA images, which could enhance DR grading without the need for IV dye injection, with the potential to improve the safety and accessibility of DR screening.</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":5.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812251","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":"Risk of Sight-Threatening Diabetic Retinopathy with Glucagon-Like Peptide-1 Receptor Agonist Use in Routine Clinical Practice: Comparative Effectiveness of Semaglutide, Dulaglutide, Liraglutide, and Exenatide.","authors":"Andrew J Barkmeier, Yihong Deng, Kavya Sindhu Swarna, Jeph Herrin, Eric C Polley, Guillermo E Umpierrez, Rodolfo J Galindo, Joseph S Ross, Mindy M Mickelson, Rozalina G McCoy","doi":"10.1016/j.oret.2025.07.019","DOIUrl":"10.1016/j.oret.2025.07.019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents differ with respect to the risk of developing sight-threatening diabetic retinopathy complications in patients with type 2 diabetes at moderate cardiovascular risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective observational study under the target trial emulation framework involving adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014 to December 31, 2022. The study population included adults with type 2 diabetes, moderate cardiovascular disease risk, no baseline advanced diabetic retinopathy, and minimum 1 year enrollment before GLP-1 RA treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Because of differences in GLP-1 RA agent use over time, we performed both a 3-way comparison of patients initiating liraglutide, dulaglutide, or exenatide from January 1, 2015, to December 31, 2021, and a 2-way comparison of patients initiating semaglutide or dulaglutide between January 1, 2019, and December 31, 2021. We assessed differences in complications using inverse propensity score weighted Cox proportional hazards models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Treatment for diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When comparing patients who initiated treatment with exenatide (n = 14 076, median follow-up 969 days; interquartile range [IQR] 578-1444) to those starting dulaglutide (n = 54 787, median follow-up 948 days; IQR 551-1457) or liraglutide (n = 25 562, median follow-up 1007 days; IQR 575-1494), no differences were found in the hazard (hazard ratio [HR]) of composite treatment for DME or PDR: exenatide versus dulaglutide (HR 0.90; 95% confidence interval (CI): 0.73-1.12), liraglutide versus dulaglutide (HR: 0.97; 95% CI: 0.79-1.19), or liraglutide versus exenatide (HR: 1.08; 95% CI: 0.83-1.38), nor were differences found in any comparisons for treatment of DME (HR: 0.93 [95% CI: 0.74-1.18]; HR 0.99 [95% CI: 0.79-1.24]; HR: 1.06 [95% CI: 0.80-1.40]) or PDR individually (HR: 1.16 [95% CI: 0.81-1.67]; HR: 1.05 [95% CI: 0.73-1.51]; HR: 0.91 [95% CI: 0.58-1.40). Likewise, when comparing patients initiating semaglutide (n = 30 911, median follow-up 625 days [IQR: 455-850]) versus dulaglutide (n = 32 844, median follow-up 639 days [IQR: 459-878]), the hazards for treatment of DME or PDR (HR: 0.88; 95% CI: 0.70-1.11), DME (HR: 0.89; 95% CI: 0.69-1.14), and PDR (HR: 0.70; 95% CI: 0.45-1.09) all found no difference between drugs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite the differences in systemic efficacy among the examined GLP-1 RAs, we identified no difference in the risk of sight-threatening diabetic retinopathy after initiation of different GLP-1 RA agents among adults with type 2 diabetes at moderate cardiovascular risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Financial disclosure(s): &lt;/strong&gt;Proprietary or commercial discl","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799776","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":"Randomized Trial of Biosimilar ABP 938 Compared with Reference Aflibercept in Adults with Neovascular Age-Related Macular Degeneration.","authors":"Scott Friedman, Nikolas London, Jan Hamouz, Ágnes Kerényi, Andras Papp, Tamás Pregun, Vincent Chow, Bianca Bautista, Daidong Wang, Gary Grachev, Janet Franklin","doi":"10.1016/j.oret.2025.07.015","DOIUrl":"10.1016/j.oret.2025.07.015","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical efficacy, safety, and immunogenicity of biosimilar ABP 938 compared with the aflibercept reference product (RP) in adults with neovascular (wet) age-related macular degeneration (nAMD).</p><p><strong>Design: </strong>A randomized, double-masked, active-controlled, multiregional clinical study.</p><p><strong>Participants: </strong>A total of 579 patients with active treatment-naïve choroidal neovascularization secondary to nAMD were randomized.</p><p><strong>Methods: </strong>Evaluable patients (N = 576) received 2 mg of ABP 938 (n = 288) or aflibercept RP (n = 288) by intravitreal injection every 4 weeks for the first 3 doses, then every 8 weeks through week 48. At week 16, the ABP 938 group continued on ABP 938 (n = 273), whereas the aflibercept RP group was rerandomized to continue on aflibercept RP (n = 136) or transition to ABP 938 (n = 134).</p><p><strong>Main outcome measures: </strong>The primary efficacy end point was the least squares (LS) mean difference in change in best-corrected visual acuity (BCVA), measured by ETDRS letter score, from baseline to week 8. Secondary efficacy end points, safety, and immunogenicity were analyzed descriptively. In a substudy of patients, serum drug concentration profiles were assessed.</p><p><strong>Results: </strong>Demographic and baseline characteristics and exposure to treatment were similar between groups. Among initially randomized patients, the LS mean difference in change from baseline in BCVA at week 8 between ABP 938 and aflibercept RP was 0.1, with a 2-sided 95% confidence interval (CI: -1.3, 1.5) and 90% CI (-1.1, 1.3) falling within prespecified similarity margins (-3.9, 3.9, and -3, 3, respectively); thus, the primary clinical efficacy end point was met. Secondary efficacy end points (parallel-arm and posttransition) were overall similar between groups. No clinically meaningful differences were observed in the incidence of ocular and nonocular adverse events or events of interest. A low and similar incidence of binding antidrug antibodies was observed in all groups. The substudy confirmed low systemic exposure of free drug concentrations of ABP 938 and aflibercept RP.</p><p><strong>Conclusions: </strong>This study supports the conclusion of no clinically meaningful differences in efficacy, safety, and immunogenicity between ABP 938 and aflibercept RP in patients with nAMD. Additionally, transitioning from aflibercept RP to APB 938 at week 16 resulted in comparable efficacy, safety, and immunogenicity between treatment groups.</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":5.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794945","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}