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Vitreoretinal Disease: Clinical Insights and Treatment Strategies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 9740

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Prof. Dr. Makoto Inoue

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Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan
Interests: vitreoretinal diseases; vitreoretinal surgery; vitrectomy; macular edema; retinal detachment
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Special Issue Information

Dear Colleagues,

This Special Issue is dedicated to offering a comprehensive and cutting-edge overview of vitreoretinal diseases, their clinical presentations, and the latest advancements in diagnosis and treatment strategies. Vitreoretinal diseases encompass a diverse range of ocular conditions that affect the vitreous humor, retina, and surrounding structures, presenting significant challenges for both patients and ophthalmologists.

Within this collection, we explore the pathophysiology, epidemiology, and associated risk factors of various vitreoretinal diseases, including age-related macular degeneration (AMD), diabetic retinopathy, retinal detachment, vitreomacular traction, and more. The authors share recent research findings and diagnostic modalities that facilitate early detection and precise diagnosis of these conditions.

Emphasizing innovative treatment approaches and surgical techniques, this Special Issue sheds light on strategies aimed at improving visual outcomes and overall patient management. Therapeutic interventions like intravitreal injections, laser photocoagulation, vitrectomy, and emerging pharmacological therapies are discussed, with insights into their efficacy and safety profiles.

Esteemed experts in the field contribute their knowledge and experience, providing valuable insights and evidence-based recommendations for clinical decision-making. This Special Issue serves as a valuable resource for ophthalmologists, optometrists, researchers, and healthcare professionals involved in the management of patients with vitreoretinal diseases.

By consolidating the latest advancements and best practices, the Special Issue seeks to enhance understanding, facilitate early diagnosis, and promote effective treatment of vitreoretinal diseases. Ultimately, these efforts contribute to improved patient outcomes and an enhanced quality of life.

Prof. Dr. Makoto Inoue
Guest Editor

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Keywords

vitreoretinal disease
age-related macular degeneration
diabetic retinopathy
retinal detachments
retinitis pig-mentosa
flashes and floaters
macular holes

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Published Papers (8 papers)

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9 pages, 605 KiB

Open AccessArticle

Comparison of 27-Gauge to 25-Gauge Vitrectomy in Patients with Tractional Retinal Detachment Associated with Proliferative Diabetic Retinopathy

by Hiromi Ohara, Tomohiko Torikai, Jun Takeuchi, Tadashi Yokoi, Takashi Koto and Makoto Inoue

J. Clin. Med. 2025, 14(7), 2533; https://doi.org/10.3390/jcm14072533 - 7 Apr 2025

Viewed by 354

Abstract

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the Kyorin Eye Center from June 2021 to August 2023 and were followed for ≥3 months were studied retrospectively. The surgical outcomes of the 10,000 cut/min (cpm) 25G vitrectomy (25G group, 25 eyes) to that of the 20,000 cpm 27G vitrectomy (27G group, 58 eyes) were compared. Results: The preoperative PDR status, surgical procedures, and postoperative outcomes were assessed relative to the surgical success. The 25G group had significantly more eyes with severe PDR (p = 0.010), no prior laser photocoagulation (p = 0.027), macular detachment (p = 0.006), and the use of bimanual technique (p = 0.005). However, the operative times and incidence of iatrogenic breaks were not significantly different. The visual acuity improved significantly in both groups at 3 months postoperatively. The primary anatomical success was 88% in the 25G and 97% in the 27G groups (p > 0.05). The risk factors for a postoperative retinal detachment were significantly associated with the grade (p = 0.042) and type of PDR (p = 0.041), the use of perfluorocarbon liquid (p = 0.028), and bimanual techniques (p = 0.017). Conclusions: The high anatomical success for both groups for TRD secondary to PDR indicates that both can be used to treat eyes with PDR. The 27G vitrectomy may reduce the need for bimanual techniques. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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12 pages, 5601 KiB

Open AccessArticle

Association Between Arch-Shaped Hypo-Autofluorescent Lesions Detected Using Fundus Autofluorescence and Postoperative Hypotony

by Yuji Yoshikawa, Jun Takeuchi, Aya Takahashi, Masaharu Mizuno, Tomoka Ishida, Takashi Koto and Makoto Inoue

J. Clin. Med. 2024, 13(20), 6264; https://doi.org/10.3390/jcm13206264 - 20 Oct 2024

Viewed by 976

Abstract

Background: Chorioretinal folds are observed after vitrectomy due to ocular collapse caused by low intraocular pressure. The purpose of this study is to investigate the relationship between the postoperative hypotony, chorioretinal folds, and the fundus autofluorescence (FAF) findings. Methods: Two-hundred-and-seventy consecutive eyes that had undergone 25- or 27-gauge vitrectomy were examined. The associations between the arch-shaped hypo-autofluorescent lesions in the FAF images and the postoperative hypotony with intraocular pressure (IOP) ≤ 4 mmHg were determined on the day after the surgery. Results: Arch-shaped hypo-autofluorescent lesions were seen in 4 of the 270 eyes (1.5%), and hypo-autofluorescence was observed in 3 of 14 hypotonic eyes (18.5%). This was significantly more frequent than in the non-hypotony group (0.4%, p = 0.0004). Optical coherence tomography showed a loss of the ellipsoid zone and retinal pigment epithelial layer in the region of the arch-shaped lesions. None of the arch-shaped hypo-autofluorescent lesions involved the fovea, and the vision recovered in all cases. The hypo-autofluorescent lesions did not disappear during the 4 to 16 month observation period. Conclusions: The postoperative arch-shaped hypo-autofluorescent lesions were associated with postoperative hypotony and RPE damage due to chorioretinal folds. These findings remained even when the IOP was normalized and chorioretinal folds disappeared. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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18 pages, 10482 KiB

Open AccessArticle

Basal Linear Deposit: Normal Physiological Ageing or a Defining Lesion of Age-Related Macular Degeneration?

by Akshaya Lakshmi Thananjeyan, Jennifer Arnold, Mitchell Lee, Cheryl Au, Victoria Pye, Michele C. Madigan and Svetlana Cherepanoff

J. Clin. Med. 2024, 13(16), 4611; https://doi.org/10.3390/jcm13164611 - 7 Aug 2024

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Abstract

Objective: To determine if basal linear deposit (BLinD) is a specific lesion of age-related macular degeneration (AMD). Methods: The cohort was selected from a clinically and histopathologically validated archive (Sarks Archive) and consisted of 10 normal eyes (age 55–80 years) without any macular basal laminar deposit (BLamD) (Sarks Group I) and 16 normal aged eyes (age 57–88 years) with patchy BLamD (Sarks Group II). Only eyes with in vivo fundus assessment and corresponding high-resolution transmission electron microscopy (TEM) micrographs of the macula were included. Semithin sections and fellow-eye paraffin sections were additionally examined. BLinD was defined as a diffuse layer of electron-lucent vesicles external to the retinal pigment epithelium (RPE) basement membrane by TEM and was graded as follows: (i) Grade 0, absence of a continuous layer; (ii) Grade 1, a continuous layer up to three times the thickness of the RPE basement membrane (0.9 µm); (iii) Grade 2, a continuous layer greater than 0.9 µm. Bruch’s membrane (BrM) hyalinisation and RPE abnormalities were determined by light microscopic examination of corresponding semithin and paraffin sections. Results: BLinD was identified in both normal (30%) and normal aged (62.5%) eyes. BLinD was thicker in normal aged eyes (p = 0.045; 95% CI 0.04–3.4). BLinD thickness positively correlated with both the degree of BrM hyalinisation (p = 0.049; 95% CI 0.05–2.69) and increasing microscopic RPE abnormalities (p = 0.022; 95% CI 0.188–2.422). RPE abnormalities were more likely to be observed in eyes with increased BrM hyalinisation (p = 0.044; 95% CI 0.61–4.319). Conclusions: BLinD is most likely an age-related deposit rather than a specific lesion of AMD. Its accumulation is associated with increasing BrM hyalinisation and microscopic RPE abnormalities, suggesting a relationship with dysregulated RPE metabolism and/or transport. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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11 pages, 1034 KiB

Open AccessArticle

Nationwide Screening Practices for Tamoxifen Retinal Toxicity in South Korea: A Population-Based Cohort Study

by Seong Joon Ahn, Jiyeong Kim and Hyeon Yoon Kwon

J. Clin. Med. 2024, 13(8), 2167; https://doi.org/10.3390/jcm13082167 - 9 Apr 2024

Cited by 1 | Viewed by 1158

Abstract

(1) Background/Objectives: To investigate the nationwide screening practices and trends in tamoxifen retinal toxicity (tamoxifen retinopathy) in South Korea using national health insurance claims data. (2) Methods: A total of 43,848 patients who started tamoxifen therapy between 2015 and 2020 and had no prior ophthalmic diseases or other conditions requiring screening for retinopathy were included. The annual numbers of tamoxifen users and new initiators of tamoxifen therapy were assessed. The screening examinations were separated into baseline (first ophthalmic examination after tamoxifen administration) and subsequent monitoring examinations. The timing and modalities for the baseline and subsequent monitoring examinations performed between 2015 and 2021 were assessed in tamoxifen users. (3) Results: The annual number of tamoxifen users increased over the study period from 54,056 in 2015 to 81,720 in 2021. The number of patients who underwent ophthalmic examination after tamoxifen administration was 8961 (20.4%). Baseline screening was performed in 6.5% of patients within 1 year of use, and subsequent monitoring was performed in 27.8% of patients who underwent baseline screening. Funduscopy or fundus photography was performed most commonly for baseline screening and subsequent monitoring (99.0% and 98.6%, respectively), while optical coherence tomography was performed only in 21.9% and 29.6% of baseline and monitoring examinations, respectively. The average number of monitoring examinations per year was 0.68 ± 0.45. Although the annual percentage of patients receiving a baseline examination within 1 year gradually increased over time, the percentage of those with subsequent monitoring performed within 1 year was similar over the study period. (4) Conclusions: Our finding, appropriate screening in a small proportion of patients receiving tamoxifen, suggests the need to promote awareness among healthcare professionals and develop a standardized approach for screening for tamoxifen retinopathy. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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10 pages, 2751 KiB

Open AccessArticle

Autosomal Dominant Retinitis Pigmentosa Secondary to TOPORS Mutations: A Report of a Novel Mutation and Clinical Findings

by Alen T. Eid, Kevin Toni Eid, James Vernon Odom, David Hinkle and Monique Leys

J. Clin. Med. 2024, 13(5), 1498; https://doi.org/10.3390/jcm13051498 - 5 Mar 2024

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Abstract

Purpose: Mutations in Topoisomerase I–binding RS protein (TOPORS) have been previously documented and have been described to result in pathological autosomal dominant retinitis pigmentosa (adRP). In our study, we describe the various genotypes and clinical/phenotypic manifestations of TOPORS-related mutations of our unique patient population in Rural Appalachia. Methods: The medical records of 416 patients with inherited retinal disease at the West Virginia University Eye Institute who had undergone genetic testing between the years of 2015–2022 were reviewed. Patients found to have pathologic RP and mutations related to TOPORS were then analyzed. Results: In total, 7 patients (ages 12–70) were identified amongst three unique families. All patients were female in our study. The average follow-up period was 7.7 years. A mother (70 yr) and daughter (51 yr) had a novel heterozygous nonsense point mutation in TOPORS c.2431C > T, p.Gln811X (Exon 3) that led to premature termination of the desired protein resulting in early onset vision loss, cataract formation, and visual field restriction. The mother developed a full-thickness macular hole which was successfully repaired. Five other patients were found to have previously described TOPORS mutations. Visual field loss was progressive with age in both cohorts. Conclusions: Seven patients at our institution were identified to have mutations in TOPORS resulting in autosomal dominant retinitis pigmentosa. Two patients were found to have novel truncating mutations in the TOPORS gene resulting in profound night blindness and visual field loss, recurrent macular edema, and in one individual, epiretinal membrane formation leading to a macular hole which was able to be successfully repaired. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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12 pages, 1228 KiB

Open AccessArticle

Fixed Quarterly Dosing of Aflibercept after Loading Doses in Neovascular Age-Related Macular Degeneration in Chinese Eyes

by Daniel H. T. Wong and Kenneth K. W. Li

J. Clin. Med. 2024, 13(1), 145; https://doi.org/10.3390/jcm13010145 - 27 Dec 2023

Cited by 1 | Viewed by 1446

Abstract

We aimed to investigate the success rate of planned fixed quarterly aflibercept injections after three loading doses (QDA3L) to achieve stability without recurrence in neovascular age-related macular degeneration (nAMD) at a tertiary eye centre. A retrospective study was conducted over five years (2017–2021) by including all consecutive cases of nAMD treated with three initial aflibercept injections four weeks apart, followed by planned injection appointments every 12 to 16 weeks starting from week 20. The primary endpoint was to determine the proportion of patients who maintained disease inactivity at week 52 and week 104. A total of 40 eyes of 40 patients were included. The overall mean age was 80.8, with a male preponderance. The overall success rate in our study population was 52.9% and 53.6% at week 52 and week 104, respectively. The fovea remained dry at 85.3% at week 52 and 82.1% at week 104, and 85.3% and 85.7% of subjects lost fewer than 15 ETDRS letters at week 52 and week 104, respectively. While this study does not suggest the superiority of this regimen, the success and failure rates obtained in our study can be used in the counselling process for this particular fixed treatment regimen for nAMD. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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17 pages, 1000 KiB

Open AccessSystematic Review

COVID-19 Related Retinal Vascular Occlusion: A Systematic Review

by Argyrios Tzamalis, Maria Foti, Maria Georgiadou, Nikolaos Tsaftaridis and Nikolaos Ziakas

J. Clin. Med. 2025, 14(4), 1183; https://doi.org/10.3390/jcm14041183 - 11 Feb 2025

Viewed by 692

Abstract

Background/Objectives: To provide insight into populations at higher risk of COVID-19-related retinal vascular occlusion, we identified the baseline characteristics of COVID-19 patients and vaccine recipients who developed this condition by conducting a systematic review to summarize the findings and evaluate the current knowledge on this subject. Methods: An electronic search on the PubMed and Scopus databases was performed for relevant case reports or series regarding retinal vascular occlusion in patients with past or present COVID-19 infection or SARS-CoV-2 immunization. This study was conducted using a pre-determined protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 34 studies were enrolled in this systematic review. A total of 21 patients (14 males, 66.7%) have been diagnosed with COVID-19 related retinal vein occlusion (RVO, mean age = 41.9 ± 10.3 years), and 15 patients (12 males, 80%) have been diagnosed with retinal artery occlusion (RAO, mean age = 56.9 ± 13.2 years). The time to RVO since COVID-19 infection or SARS-CoV-2 immunization ranged from 8 h to 51 days (mean = 12.3 ± 15.7 days), while the time to RAO ranged from 2 to 40 days (mean = 14.9 ± 10.8 days). Fifteen out of the twenty-one patients (71.4%) with RVO had a significant improvement in visual acuity after the resolution of symptoms while eight out of the fifteen patients (53.3%) with RAO did not show improvement. Conclusions: COVID-19 seems to play a significant role in the pathogenesis of vascular occlusion, as it is suggested to increase the risk of thromboembolic episodes. However, the pathophysiologic mechanisms have not been fully elucidated, and further studies are expected to shed light on this phenomenon. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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8 pages, 217 KiB

Open AccessBrief Report

Prevalence and Associations of Epiretinal Membranes in an Elderly English Population: The Bridlington Eye Assessment Project

by Craig Wilde, Georgios D. Panos, Ali Pooschti, Hamish K. MacNab, Jonathan G. Hillman, Stephen A. Vernon and Winfried M. Amoaku

J. Clin. Med. 2024, 13(3), 739; https://doi.org/10.3390/jcm13030739 - 27 Jan 2024

Viewed by 1343

Abstract

Purpose: To determine the prevalence and risk factors of epiretinal membranes (ERMs) in an adult English population. Methods: The Bridlington Eye Assessment Project is a population-based study of eye disease among residents aged 65 years or older. Comprehensive interviews and ophthalmic examinations were conducted to assess potential risk factors. Digital mydriatic nonstereoscopic 30° colour fundus photography (CFP) was performed. ERMs were classified as primary/idiopathic or secondary on the basis of findings from the ocular examination and the structured questionnaire. Logistic regression models were used to determine the independence of potential risk factors for idiopathic ERMs. Results: In a comprehensive screening of 3588 patients aged over 65, we identified an eye-based prevalence of ERMs of 4.26% and a subject-based prevalence of ERMs of 6.88%. The majority of these cases were idiopathic in nature (90.7%), while 9.3% were secondary ERMs; predominantly, there was a history of cataract surgery (43.5%). No significant correlation between idiopathic ERMs and factors such as age, gender, diabetes, hypertension, a history of stroke, or the presence of AMD was found. Conclusions: The prevalence of ERMs in an elderly English population and the proportion of idiopathic and secondary ERMs are similar to previous reports. However, in elderly patients aged over 65 years, age is not a risk factor for the presence of idiopathic ERMs. The presence of diabetes, hypertension, a history of stroke, and AMD of any grade was not associated with ERMs. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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