RetinaDigest

In eyes with epiretinal membrane, retinal nerve fiber layer schisis (sRNFL) and ILM tears—markers of advanced inner retinal traction—do not represent irreversible visual dysfunction, as significant functional recovery occurs postoperatively with outcomes comparable to eyes without these findings.

Retinal displacement occurs in nearly all eyes (97%) following PPV for macula-involving rhegmatogenous retinal detachment repair when assessed with infrared image overlay technique, a substantially higher prevalence than previously reported using fundus autofluorescence.

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In this multicenter propensity-matched study of over 6,000 phakic eyes, phacovitrectomy achieved anatomic outcomes comparable to PPV alone for primary rhegmatogenous retinal detachment repair, with a small visual acuity advantage that was largely attributable to cataract removal rather than a retinal treatment effect.

A 10-year analysis of 230,802 Medicare RD repair surgeries revealed significant racial, geographic, and gender disparities among both patients and surgeons, with non-White race, higher area deprivation index, and greater comorbidity burden associated with increased odds of complex RD repair.

Iris manipulation (mechanical pupillary expansion or synechiolysis) during phacovitrectomy for retinal detachment repair was independently associated with a 3.64-fold increased odds of postoperative PVR development, suggesting iris trauma may amplify intraocular inflammation and contribute to PVR pathogenesis.

A retrospective study of 17 patients demonstrated that epiretinal proliferation (EP) embedding combined with temporal inverted ILM flap technique achieved 100% anatomical closure in lamellar macular holes, with significant improvements in both visual acuity (LogMAR 0.53 to 0.18) and central retinal thickness.

Primary surgical repair of rhegmatogenous retinal detachment in young adults yields favorable long-term anatomic and visual outcomes, with scleral buckling remaining an effective first-line approach and a 26.9% cumulative risk of fellow-eye intervention warranting ongoing surveillance.

In fovea-off rhegmatogenous retinal detachment treated with scleral buckling, more advanced baseline morphologic stage was independently associated with worse postoperative BCVA and greater metamorphopsia at all timepoints up to 12 months, underscoring the importance of early surgical intervention.

Patients with a prior contralateral RRD or retinal break and fellow eye lattice degeneration face a 4.5-fold increased risk of fellow eye RRD/RB, and prophylactic laser retinopexy or cryopexy is significantly more efficient in this high-risk group (NNT ~4–5) compared to those without prior contralateral events (NNT ~43–46).

Dark without pressure (DWOP) was identified in 25.5% of myopic eyes, with significantly higher prevalence in high myopia (44.3%), predominantly in the inferotemporal mid-periphery, and with dynamic boundaries that change over time.

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In a propensity-matched retrospective cohort study of 2,464 patients, preoperative statin use was associated with a 25% reduced risk of repeat retinal detachment repair within one year (16.1% vs. 21.1%), with the strongest signal observed for simvastatin.

In a propensity score-matched cohort of diabetic patients with pulmonary arterial hypertension, prostacyclin analog (PCA) therapy was associated with a significantly reduced 5-year incidence of nonproliferative diabetic retinopathy and diabetes-related ophthalmic complications compared to other pulmonary hypertension therapies.

In a retrospective cohort of over 524,000 diabetic patients, baseline diabetic retinopathy severity was independently associated with increased mortality risk, with proliferative DR (without DME) conferring a 128% higher hazard of death compared to diabetes without DR, even after adjustment for clinical and demographic confounders.

In diabetic eyes, deep capillary plexus geometric perfusion deficits (GPDd) on OCTA robustly predicted retinal nonperfusion across all regions on ultrawidefield fluorescein angiography, while FAZ enlargement was limited to predicting posterior nonperfusion only.

The NEW DAY phase 4 RCT found that the fluocinolone acetonide 0.19 mg intravitreal implant achieved similar visual and anatomic outcomes compared to aflibercept loading therapy in DME, with fewer than half the total injections, though the primary endpoint of superior rescue injection reduction was not met.

In this cross-sectional study of 234 diabetic patients, SS-OCTA–derived nonperfusion area (NPA) emerged as a significant noninvasive biomarker for diabetic nephropathy, independently associated with albuminuria, CKD presence, CKD severity, and KDIGO risk categories after multivariate adjustment.

The AI diabetic retinopathy screening system VeriSee DR demonstrated strong performance (sensitivity 0.88, specificity 0.86, AUC 0.87) in a real-world Taiwanese cohort of 11,713 diabetic patients, but showed reduced accuracy in older patients and failed to reliably detect glaucoma identified by ophthalmologists.

In a large retrospective cohort study spanning 2000–2022, diabetic retinal disease rates remained proportionally stable across age groups, with no evidence that younger patients (≤25 years) are progressing faster—while older patients (≥65 years) showed significant declines in both prevalence and incidence of vision-threatening diabetic retinopathy.

In this retrospective multicenter study of 74 eyes with DME, faricimab loading phase produced significant improvements in visual acuity and central macular thickness regardless of baseline HbA1c level, which did not emerge as an independent predictor of anatomical or functional outcomes.

In a 2-year prospective study of 142 diabetic eyes, quantitative OCT/OCTA metrics—particularly deep vessel diameter index (VDI) and choroidal vascularity index (CVI)—emerged as promising biomarkers for early detection, staging, and longitudinal monitoring of diabetic retinopathy, with vascular changes detectable even before clinical retinopathy develops.

This post hoc analysis of the PULSAR trial found that aflibercept 8 mg dosing intervals were maintained or extended through 96 weeks in the majority of treatment-naïve nAMD patients, regardless of baseline BCVA, CRT, or MNV area, supporting its use across a broad patient spectrum.

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A modified Delphi consensus study established the Beckman classification as the level 1 reference standard for AI-based AMD screening algorithms, with OCT identified as the preferred imaging modality for detecting key AMD features including drusen, geographic atrophy, and choroidal neovascularization.

In the MACUSTAR study, hyperreflective foci contiguous with the RPE (rpeHRF) were independently associated with impaired visual function in intermediate AMD, suggesting their utility as a prognostic biomarker and potential enrichment criterion for clinical trials.

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This post hoc subgroup analysis of the PULSAR trial demonstrates that aflibercept 8 mg with extended dosing intervals (every 12 or 16 weeks) achieves comparable visual and anatomic outcomes to aflibercept 2 mg every 8 weeks across all baseline disease severity subgroups in treatment-naïve neovascular AMD.

Switching refractory White PCV patients to faricimab resulted in anatomical and functional stability in the majority of eyes, with 71.4% maintaining or improving BCVA and 85.7% showing stable or reduced CRT over four monthly injections.

From 2014 to 2023, intravitreal anti-VEGF injections among Medicare beneficiaries surpassed 36 million total, driven primarily by rising aflibercept use and rapid faricimab adoption, while marked geographic variation and shifting reimbursement patterns highlight ongoing access and cost disparities.

This retrospective cohort study found that systemic tyrosine kinase inhibitor (TKI) therapy in cancer patients ≥50 years old was not consistently associated with a reduced risk of incident AMD diagnosis, suggesting no population-level protective effect of systemic TKIs on AMD development.

In treatment-naïve neovascular AMD, three monthly loading injections of aflibercept 8 mg and faricimab produced comparable improvements in visual acuity, central retinal thickness reduction, and fluid resolution rates, supporting either agent as an effective first-line option.

In nAMD patients treated with aflibercept, OCTA demonstrated poor diagnostic performance (AUC 0.49, sensitivity 72%, specificity 27%) for detecting exudative recurrence compared to SD-OCT, and substituting OCTA for SD-OCT did not reduce unnecessary intravitreal injections.

In this real-world multicenter analysis of over 12,500 eyes, initiating aflibercept 8 mg or faricimab as first-line therapy achieved greater treatment durability and anatomic improvement compared to switching from older anti-VEGF agents, supporting early adoption of these agents over step-therapy protocols.

This systematic review and meta-analysis of 22 studies found that obstructive sleep apnea (OSA) is associated with a 43% increased risk of AMD (HR 1.43), and a morning chronotype is independently associated with higher odds of AMD development.

In a post hoc analysis of the GATHER1/2 trials, avacincaptad pegol (ACP) 2 mg significantly reduced ellipsoid zone (EZ) loss and degradation over 12 months compared to sham, while baseline EZ attenuation measures emerged as important predictors of future geographic atrophy (GA) progression and photoreceptor loss.

Medicare Advantage (MA) beneficiaries were significantly less likely to receive higher-cost anti-VEGF agents compared to Fee-For-Service (FFS) enrollees, with MA patients more frequently treated with lower-cost bevacizumab, raising concerns about restricted access to newer anti-VEGF therapies.

In this randomized trial of 55 treatment-naïve PCV eyes, early reduction in branching neovascular network (BNN) vessel density at week 12—rather than lesion size reduction—was independently associated with polypoidal lesion closure at week 52, suggesting OCTA-derived vascular metrics may serve as non-invasive biomarkers of treatment response.

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In a large retrospective cohort study, anti-VEGF tyrosine kinase inhibitors (TKIs) were associated with a nearly 3-fold increased hazard of central retinal vein occlusion (CRVO) within 3 years of initiation, while non-anti-VEGF TKIs demonstrated a more favorable retinal vascular safety profile compared to other antineoplastic therapies.

Several retinal conditions—most commonly vitreomacular interface disorders, large retinal capillary aneurysms, and central serous chorioretinopathy—can closely mimic macular telangiectasia type 2 (MacTel), with OCT and fundus autofluorescence providing the highest sensitivity for accurate differentiation.

A single intravitreal injection of UGX-201, an AAV-based optogenetic therapy delivering a chimeric opsin to retinal ganglion cells, demonstrated a favorable safety profile and meaningful visual improvements in patients with advanced nonsyndromic retinitis pigmentosa over 52 weeks, including restoration of light perception in patients with no baseline light perception.

This systematic review of 70 patients with Danon disease found retinal abnormalities in 81% of cases, most commonly midperipheral salt-and-pepper pigmentary changes with frequent macular involvement, highlighting that ophthalmic findings may be the first or sole manifestation of this life-threatening lysosomal storage disorder.

In a retrospective series of 27 genetically confirmed MPS III patients, parafoveal outer retinal layer degeneration was the predominant finding across all subtypes, with MPS IIIA patients demonstrating the most severe retinal involvement consistent with their more aggressive neurocognitive course.

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In a prospective 8-year cohort of 155 highly myopic children, short-term axial length (AL) changes over just 2 years significantly improved prediction of long-term myopic maculopathy (MM) progression, with an optimal AL change rate cut-off of 0.325 mm/year identifying high-risk patients.

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This case report describes a rare presentation of presumed JC virus (JCV) retinitis in a 29-year-old HIV/AIDS patient with concurrent progressive multifocal leukoencephalopathy (PML), diagnosed via Next Generation Sequencing of vitreous fluid, with stabilization achieved through immune restoration.

Adalimumab demonstrated significant efficacy in controlling ocular and systemic inflammation in refractory Behçet's uveitis over 1 year, with meaningful steroid-sparing effects and an acceptable safety profile.

Adjunctive intravitreal anti-VEGF combined with moxifloxacin, alongside systemic anti-tubercular therapy, facilitated resolution of intraocular tubercular granulomas in 9 of 10 eyes with visual acuity improvement in 8 patients.

This systematic review and meta-analysis of 19 studies found significant sex-based differences in uveitis etiology, with autoimmune-associated causes (SLE, MS, sarcoidosis, JIA, VKH) predominating in females and HLA-B27-associated conditions (ankylosing spondylitis, Behçet's disease) and certain infectious etiologies (syphilis, sympathetic ophthalmia) predominating in males.

This multicenter case series expands the phenotypic spectrum of unilateral retinal pigment epithelium dysgenesis (URPED), demonstrating that it ranges from overt to covert forms unified by Bruch membrane-RPE dysgenesis on OCT, with frequent associations with hamartomatous lesions and choroidal neovascularization.

In resolved central serous chorioretinopathy (CSCR), longer symptom duration, complex CSCR, and irregular photoreceptor outer segment thickening at baseline are associated with ellipsoid zone (EZ) atrophy, highlighting key prognostic factors for predicting structural and visual outcomes.

A simulation-based workforce projection study found that the U.S. uveitis specialist workforce of 224 physicians is geographically maldistributed and at risk of significant decline, with future supply ranging from a 35% decrease to an 87% increase by 2055 depending on trainee pipeline growth.

The Multimodal Imaging in Uveitis (MUV) Taskforce used a structured consensus process to classify imaging features in noninfectious posterior uveitis as suggestive of active disease, inactive disease, or equivocal, producing standardized imaging-based outcome measures across five major disease entities.

This perspective article reviews the broad spectrum of atypical, variant, and secondary forms of non-infectious posterior uveitides (NIPUs), emphasizing that a substantial proportion of cases deviate from classical presentations and that masquerade syndromes must always be considered to avoid misdiagnosis and inappropriate treatment.

In this long-term follow-up (median 7 years) of the PLACE and SPECTRA trials, patients with chronic central serous chorioretinopathy (cCSC) who responded to initial half-dose PDT achieved better visual and anatomical outcomes than non-responders, though BCVA remained stable from the first post-treatment visit onward in both groups.

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A 25-year-old male with refractory VKH disease unresponsive to corticosteroids, cyclosporine, MMF, and adalimumab achieved complete resolution of subretinal fluid and sustained disease stability following initiation of oral upadacitinib, a selective JAK-1 inhibitor.

In this cross-sectional case-control study, children with mevalonate kinase deficiency (MKD) demonstrated elevated choroidal vascularity index (CVI) and luminal area compared to healthy controls, while macular microvascular parameters and subfoveal choroidal thickness remained comparable between groups.

The Multimodal Imaging in Uveitis (MUV) Taskforce established consensus-based multimodal imaging guidelines for tubercular choroiditis (TBC), defining distinct imaging features of tubercular serpiginous-like choroiditis (TB-SLC) and choroidal tuberculomas/tubercles to standardize diagnosis, disease monitoring, and treatment response assessment.

In a prospective case series of three patients with IRVAN syndrome, systemic infliximab therapy induced regression of retinal and optic nerve head aneurysms, resolution of vascular leakage, and stable or improved visual acuity, suggesting a potential role for anti-TNF therapy in this rare condition.

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In this largest reported series of RPE tumors spanning five decades and 948 eyes, solitary congenital hypertrophy of the RPE (CHRPE) was the most common diagnosis (79%), with most lesions remaining stable over time; however, combined hamartoma of the retina and RPE, RPE adenoma, and adenocarcinoma carried the greatest risk of visual loss and growth.

In this population-based SEER cohort study of 1,375 pediatric retinoblastoma patients, residing in non-metropolitan areas was independently associated with higher odds of enucleation and greater likelihood of regional/distant disease at presentation, with geography also amplifying existing racial and socioeconomic disparities in care.

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Ultra-widefield swept-source OCT (UWF-OCT) achieved 100% complete measurability of small and medium choroidal tumors in a single scan, substantially outperforming SD-OCT, though it consistently underestimated tumor dimensions compared to ultrasonography and MRI.

A multicenter study across 33 high-income countries found that while overall retinoblastoma incidence remained stable from 2017 to 2024, the proportion of familial retinoblastoma increased significantly by 46.5% (7.1% to 10.4%), suggesting a growing hereditary contribution to disease burden.

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This systematic review of 13 studies (635 patients) demonstrates that symptomatic vitreous opacities are associated with significantly elevated rates of depression, anxiety, and perceived stress compared to healthy controls despite preserved visual acuity, and that both Nd:YAG vitreolysis and pars plana vitrectomy confer measurable psychological benefit.

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In a retrospective analysis of over 1 million eyes from the IRIS Registry, post-injection endophthalmitis (PIE) occurred in 0.059% of first-time anti-VEGF injections, with residence in US territories and prior intravitreal corticosteroid exposure identified as key risk factors, while nonsmoking status was protective.

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In a retrospective review of 3,496 eyes undergoing microincisional vitrectomy with membrane peeling, high myopia and myopic tractional maculopathy (MTM) were identified as independent risk factors for postoperative infectious endophthalmitis, likely mediated by lower early postoperative intraocular pressure facilitating microbial ingress.

This retrospective case series of 8 patients with PPS maculopathy found a high prevalence of concomitant colonic disease—including severe adenomatous polyposis requiring colectomy in 75% of patients—expanding the recognized systemic toxicity of pentosan polysulfate sodium beyond the eye.

A large single-center retrospective study of 149 patients undergoing sutureless intrascleral fixation (SIS) for retained lens fragments found meaningful long-term complication rates including 11% IOL dislocation, 2% endophthalmitis, 5% vitreous hemorrhage, and 4% retinal detachment over an average follow-up of ~2.5 years.

Prophylactic intravitreal antibiotics administered at the time of primary repair significantly reduced endophthalmitis rates in posterior segment magnetic IOFB injuries (4.7% vs. 13.6%), with lens capsule rupture and IOFB size >2 mm identified as key risk factors for both endophthalmitis and poor visual outcomes.

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