Jennifer I. Lim MD , Manuel J. Amador MD , Dilsher S. Dhoot MD , Avni Finn MD, MBA , Samantha Fraser-Bell MBBS, PhD , Kara Gibson PhD , Oluwatobi O. Idowu MD, MBA , Rahul N. Khurana MD , Paolo Lanzetta MD , Tai-Chi Lin MD, PhD , Florie A. Mar PhD , Andreas Pollreisz MD , Aleksandra Rachitskaya MD , Patricio G. Schlottmann MD , Yannan Tang PhD , Timothy Y.Y. Lai MD
{"title":"Anatomic Control with Faricimab versus Aflibercept in the YOSEMITE/RHINE Trials in Diabetic Macular Edema","authors":"Jennifer I. Lim MD , Manuel J. Amador MD , Dilsher S. Dhoot MD , Avni Finn MD, MBA , Samantha Fraser-Bell MBBS, PhD , Kara Gibson PhD , Oluwatobi O. Idowu MD, MBA , Rahul N. Khurana MD , Paolo Lanzetta MD , Tai-Chi Lin MD, PhD , Florie A. Mar PhD , Andreas Pollreisz MD , Aleksandra Rachitskaya MD , Patricio G. Schlottmann MD , Yannan Tang PhD , Timothy Y.Y. Lai MD","doi":"10.1016/j.oret.2025.01.017","DOIUrl":"10.1016/j.oret.2025.01.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare anatomic biomarkers on spectral-domain OCT between faricimab, a dual angiopoietin-2 (Ang-2)/VEGF-A inhibitor, and aflibercept in a pooled analysis of results from the YOSEMITE/RHINE trials in diabetic macular edema (DME).</div></div><div><h3>Design</h3><div>YOSEMITE/RHINE (NCT03622580/NCT03622593) were identical, randomized, double-masked, active comparator-controlled, 100-week phase III noninferiority trials.</div></div><div><h3>Participants</h3><div>Adults with visual acuity loss due to center-involving DME.</div></div><div><h3>Methods</h3><div>Patients were randomized 1:1:1 to faricimab 6.0 mg every 8 weeks (Q8W), faricimab 6.0 mg treat-and-extend (T&E), or aflibercept 2.0 mg Q8W for 100 weeks. The T&E up to every 16 weeks dosing regimen was based on central subfield thickness (CST) and best-corrected visual acuity changes.</div></div><div><h3>Main Outcome Measures</h3><div>Post hoc analyses comparing faricimab with aflibercept on CST change; the proportion of eyes with an absence of intraretinal fluid (IRF), subretinal fluid, or both IRF and subretinal fluid or achieving a CST <280 μm at key timepoints during the trials; time to first absence of IRF; and time to first achieving CST <280 μm.</div></div><div><h3>Results</h3><div>In total, 1891 patients were enrolled across YOSEMITE/RHINE (n = 632 faricimab Q8W; n = 632 faricimab T&E; n = 627 aflibercept). There were greater CST reductions from baseline with both faricimab dosing regimens compared with aflibercept over the 100 weeks (adjusted means and area-under-the-curve analysis). Higher proportions of eyes achieved an absence of IRF with faricimab Q8W (58%–63%) and faricimab T&E (44%–49%) versus aflibercept (36%–41%) at weeks 92 to 100. In eyes with IRF at baseline, the median time to first absence of IRF was achieved 40 weeks earlier with faricimab versus aflibercept. The proportion of eyes achieving a CST <280 μm at weeks 92 to 100 was 70% to 74% with faricimab Q8W, 61% to 65% with faricimab T&E, and 61% to 63% with aflibercept. In eyes with CST ≥280 μm at baseline, the median time to first instance of CST <280 μm was achieved 16 weeks earlier with faricimab versus aflibercept.</div></div><div><h3>Conclusions</h3><div>Dual Ang-2/VEGF-A inhibition with faricimab resulted in greater and faster improvements in anatomic outcomes compared with aflibercept at key timepoints over the pooled YOSEMITE/RHINE trials.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"9 7","pages":"Pages 655-666"},"PeriodicalIF":4.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365350","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}
Abhiram R Manda, Lok Hin Lee, Megan S Steinkerchner, Jinsong Sheng, Lindsay Veach, Sapna Gangaputra, Stephen J Kim
{"title":"Analysis of Aqueous Interleukin-6 in Diabetic Retinopathy: A Prospective, Controlled Trial of 328 Eyes.","authors":"Abhiram R Manda, Lok Hin Lee, Megan S Steinkerchner, Jinsong Sheng, Lindsay Veach, Sapna Gangaputra, Stephen J Kim","doi":"10.1016/j.oret.2025.06.014","DOIUrl":"10.1016/j.oret.2025.06.014","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the relationship of aqueous interleukin-6 (IL-6) with diabetic retinopathy (DR) severity.</p><p><strong>Design: </strong>Prospective, controlled trial at a tertiary academic medical center.</p><p><strong>Subjects: </strong>Three hundred twenty-eight eyes of 164 adult type II diabetic patients with varying levels of DR.</p><p><strong>Methods: </strong>A total of 328 eyes of 164 diabetic patients were enrolled based on DR severity: 46 eyes of 23 patients in the no DR group, 236 eyes of 118 patients in the moderate nonproliferative DR (NPDR) group, and 46 eyes of 23 patients in the proliferative DR (PDR) group. ETDRS visual acuity, spectral-domain OCT, and color fundus photographs were taken at baseline. Blood draw and aqueous sampling of each eye was performed. Blood glucose and hemoglobin A1c (HbA1c) were measured. Aqueous IL-6 was measured using a microparticle bead-based multiplex assay.</p><p><strong>Main outcomes measures: </strong>Aqueous IL-6 levels, HbA1c, DR severity, Diabetic macular edema (DME).</p><p><strong>Results: </strong>Median HbA1c differed between the 3 DR groups (P = 0.03), but there was no correlation between IL-6 and HbA1c (ρ = 0.08, P = 0.179). Baseline aqueous IL-6 levels were significantly different between DR groups. Median IL-6 and interquartile range was 5.40 pg/mL (2.99-8.77) for eyes in the no DR group, 9.25 pg/mL (5.35-22.35) for eyes in the moderate NPDR group, and 15.71 pg/mL (9.24-48.58) for eyes in the PDR group (P < 0.001). Median central subfield thickness (CST) did not differ significantly between the 3 groups (P = 0.351), but there was a significant positive correlation between IL-6 and CST (ρ = 0.18, P = 0.001). There was also a significant positive correlation between IL-6 and macular volume (ρ = 0.12, P = 0.031). Increased IL-6 was significantly associated with increased odds of having DME (odds ratio = 1.00, P = 0.015).</p><p><strong>Conclusions: </strong>We report the largest analysis of aqueous IL-6 in diabetic eyes. We observed that IL-6 is significantly associated with DR severity and DME. Our results considerably strengthen the prevailing evidence that IL-6 is a key contributor to the pathogenesis of DR and may represent both a biomarker of disease activity and a novel therapeutic target.</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":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparing Membrane Peeling Techniques in Lamellar Macular Hole Surgery: A Systematic Review and Meta-Analysis.","authors":"Yosra Er-Reguyeg, Elyazid Rhalem, Eunice Linh You, Anas Abu-Dieh, Mélanie Hébert, Huixin Zhang, Serge Bourgault, Mathieu Caissie, Éric Tourville, Ali Dirani","doi":"10.1016/j.oret.2025.06.004","DOIUrl":"10.1016/j.oret.2025.06.004","url":null,"abstract":"<p><strong>Topic: </strong>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</p><p><strong>Clinical relevance: </strong>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</p><p><strong>Methods: </strong>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</p><p><strong>Results: </strong>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD -0.20; 95% confidence interval [CI]: -0.31 to -0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: -10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: -236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (P = 0.2709). Preoperative IS/OS defect prevalence in the \"true\" LMH subgroup showed no significant difference among techniques (P = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (P = 0.0005).</p><p><strong>Conclusion: </strong>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnot","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302537","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}
Simon K H Szeto, Julia T W Lam, Amy H Y Yu, Christopher M K Pang, Timothy P H Lin, Vivian W K Hui, Ken K Tsang, Jason C K Chan, Li Jia Chen, Timothy Y Y Lai, Shaheeda Mohamed, Chi Wai Tsang
{"title":"Macular Hole Closure by Internal Limiting Membrane Flap without Gas Tamponade versus Conventional Surgery: A Comparative Study.","authors":"Simon K H Szeto, Julia T W Lam, Amy H Y Yu, Christopher M K Pang, Timothy P H Lin, Vivian W K Hui, Ken K Tsang, Jason C K Chan, Li Jia Chen, Timothy Y Y Lai, Shaheeda Mohamed, Chi Wai Tsang","doi":"10.1016/j.oret.2025.06.005","DOIUrl":"10.1016/j.oret.2025.06.005","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effectiveness and safety of the novel internal limiting membrane (ILM) flap with no gas tamponade technique and conventional surgery in repairing macular hole (MH).</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Participants: </strong>Consecutive patients with OCT confirmed full-thickness MH who underwent MH repair surgery by either conventional surgery or the ILM flap with no gas tamponade technique at the Hong Kong Eye Hospital from November 1, 2021, to July 31, 2024.</p><p><strong>Methods: </strong>Medical records were reviewed for demographics, perioperative clinical features, operative details, and OCT features.</p><p><strong>Main outcomes measures: </strong>The primary outcome was the rate of MH closure by postoperative month 3. Secondary outcomes included postoperative logarithm of the minimum angle of resolution visual acuity (VA) and OCT features, such as rate of foveal gliosis, dissociated optic nerve fiber layer (DONFL) score, integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), and MH closure pattern.</p><p><strong>Results: </strong>Ninety-three eyes from 93 patients were included in the study, of which 51 eyes underwent MH repair with conventional surgery and 42 underwent the ILM flap with no gas tamponade technique. The MH closure rates were comparably high in both groups (94.1% vs. 95.2%; P = 0.812). Visual acuity was significantly better in the no gas tamponade group at postoperative week 1 (1.48 vs. 0.84; P < 0.001) and month 1 (0.87 vs. 0.73; P = 0.048). There were no significant differences in VA by postoperative months 3 (0.54 vs. 0.49; P = 0.281) and 6 (0.41 vs. 0.47; P = 0.991). In multivariate analysis, the rate of foveal gliosis was lower in the no gas tamponade group (20.0% vs. 4.9%; P = 0.043) whereas the MH closure pattern, DONFL score, and ELM/EZ integrity were similar between the 2 groups.</p><p><strong>Conclusions: </strong>The ILM flap with no gas tamponade technique could achieve a high MH closure rate comparable to conventional surgery. This novel technique was associated with significantly better vision in the first month of the postoperative period, as well as a lower rate of foveal gliosis. These results demonstrated the feasibility of repairing MH without gas tamponade and warrant further prospective study.</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":4.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302538","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}
Peter Woodward-Court, Jeffry Hogg, Terry Lee, Priyal Taribagil, Cindy S Zhao, Vanessa Otti, William R Tucker, Michael Allingham, Oleg Alekseev, Siegfried K Wagner, David Myung, Loh-Shan Leung, Eleonora M Lad, Hani Hasan, James Talks, Daniel C Alexander, Pearse A Keane, Eliot R Dow
{"title":"Deep Learning Algorithm for the Diagnosis and Prediction of Hydroxychloroquine Retinopathy: An International, Multi-institutional Study.","authors":"Peter Woodward-Court, Jeffry Hogg, Terry Lee, Priyal Taribagil, Cindy S Zhao, Vanessa Otti, William R Tucker, Michael Allingham, Oleg Alekseev, Siegfried K Wagner, David Myung, Loh-Shan Leung, Eleonora M Lad, Hani Hasan, James Talks, Daniel C Alexander, Pearse A Keane, Eliot R Dow","doi":"10.1016/j.oret.2025.06.003","DOIUrl":"10.1016/j.oret.2025.06.003","url":null,"abstract":"<p><strong>Purpose: </strong>We present a deep learning algorithm-HCQuery-that detects the presence of hydroxychloroquine retinopathy and predicts its future occurrence from spectral-domain OCT (SD-OCT) images.</p><p><strong>Design: </strong>We trained and validated a deep learning algorithm using retrospective SD-OCT images from patients taking hydroxychloroquine.</p><p><strong>Subjects: </strong>The study involved a retrospective, nonconsecutive collection of 409 patients (171 positive for hydroxychloroquine retinopathy and 238 negative) and 8251 SD-OCT b-scans (1988 volumes) from 5 independent international clinical locations.</p><p><strong>Methods: </strong>Imaging macular volumes from 2 different SD-OCT devices (Heidelberg Spectralis and Zeiss Cirrus) at 2 clinical sites were used to train and validate a convolutional neural network (EfficientNet-b4) to produce a likelihood of retinopathy score for each SD-OCT b-scan. Likelihood of retinopathy score were processed across SD-OCT volumes for an eye-level and patient-level binary decision output for the presence or absence of retinopathy. The adjudicated consensus of ≤3 independent retina specialists using patient clinical data and multimodal testing served as the reference standard for hydroxychloroquine retinopathy. The algorithm was tested on 4 withheld test sets, 1 internal (data set 1), and 3 external (data sets 3-5). The test sets were obtained in 2 countries (United States and United Kingdom) and represented 2 SD-OCT devices each with diverse acquisition parameters.</p><p><strong>Main outcome measures: </strong>Sensitivity, specificity, accuracy, negative predictive value, positive predictive value, area under the receiver-operator characteristic curve, and area under the precision-recall curve for the detection of hydroxychloroquine retinopathy either at the time of clinical diagnosis or ≤18 months in advance of clinical diagnosis.</p><p><strong>Results: </strong>The algorithm discriminated hydroxychloroquine retinopathy at the time of clinical diagnosis as well as in advance of clinical diagnosis (mean: 220.8 days before clinical diagnosis; accuracy: 0.987 [95% CI: 0.962-1.00]; sensitivity: 1.00 [95% CI: 0.833-1.00]; specificity: 0.983 [95% CI: 0.952-1.00]; positive predictive value: 0.944 [95% CI: 0.836-1.00]; negative predictive value: 1.00 [95% CI: 0.937-1.00]). For eyes that developed retinopathy, it was identified as positive 2.74 years in advance of the clinical diagnosis on average.</p><p><strong>Conclusions: </strong>Our algorithm can detect retinopathy at all stages of disease, as well as predict retinopathy years in advance of clinical diagnosis.</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":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294195","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}