Search Results (184)

Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) therapy reduces retinal disease incidence among adults with OSA and BMI between 25.0 and 30.0 kg/m². After 1:1 propensity score matching, 101,754 patients were included in the analysis. Retinal outcomes included diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vein occlusion (RVO), and central serous chorioretinopathy (CSC). CPAP use was associated with a modest but statistically significant reduction in DR (3.2% vs. 3.4%, RR: 0.922, p = 0.016) and AMD (2.1% vs. 2.3%, RR: 0.906, p = 0.018), while no significant differences were found for RVO or CSC. These findings support prior evidence linking CPAP to improved retinal microvascular health and suggest a protective effect against specific retinal complications. Limitations include a lack of data on CPAP adherence, OSA severity, and imaging confirmation. Still, this study highlights the importance of interdisciplinary care between sleep and eye health, and the need for further prospective studies to validate CPAP’s role in preventing retinal disease progression in OSA patients. Full article

Background: Retinal diseases are becoming an important public health issue, with early diagnosis and timely intervention playing a key role in preventing vision loss. Optical coherence tomography (OCT) remains the leading non-invasive imaging technique for identifying retinal conditions. However, distinguishing between diabetic macular edema (DME) and macular edema resulting from retinal vein occlusion (RVO) can be particularly challenging, especially for clinicians without specialized training in retinal disorders, as both conditions manifest through increased retinal thickness. Due to the limited research exploring the application of deep learning methods, particularly for RVO detection using OCT scans, this study proposes a novel diagnostic approach based on stacked convolutional neural networks. This architecture aims to enhance classification accuracy by integrating multiple neural network layers, enabling more robust feature extraction and improved differentiation between retinal pathologies. Methods: The VGG-16, VGG-19, and ResNet50 models were fine-tuned using the Kermany dataset to classify the OCT images and afterwards were trained using a private OCT dataset. Four stacked models were then developed using these models: a model using the VGG-16 and VGG-19 networks, a model using the VGG-16 and ResNet50 networks, a model using the VGG-19 and ResNet50 models, and finally a model using all three networks. The performance metrics of the model includes accuracy, precision, recall, $F_2$-score, and area under of the receiver operating characteristic curve (AUROC). Results: The stacked neural network using all three models achieved the best results, having an accuracy of 90.7%, precision of 99.2%, a recall of 90.7%, and an $F_2$-score of 92.3%. Conclusions: This study presents a novel method for distinguishing retinal disease by using stacked neural networks. This research aims to provide a reliable tool for ophthalmologists to improve diagnosis accuracy and speed. Full article

Background: The retina, a light-sensitive tissue of the central nervous system that is located at the posterior part of the eye, is particularly vulnerable to alterations in oxygen levels. In various retinal diseases, such as central retinal vein occlusion, glaucoma, and diabetic retinopathy, hypoxia (a condition of low oxygen levels) is commonly observed. Müller glia, the principal glial cells in the retina, play a crucial role in supporting the metabolic needs of retinal neurons. They are also responsible for sensing oxygen levels and, in response to hypoxia, express Hypoxia-Inducible Factor 1 (HIF-1), a transcription factor that activates signaling pathways related to hypoxia. Methods: In this study, primary rat Müller glial cells were cultured and exposed to a 1% oxygen for 72 h. Following this, immunohistochemical assays were conducted to assess the effects of hypoxia on various parameters, including HIF-1α expression, cell survival, Müller glia-specific markers (CRALBP and GS), gliosis (GFAP expression), apoptosis (caspase-3 expression), cell proliferation (Ki-67 expression), and metabolic stress (indicated by the number of mitochondria per cell). Results: Under hypoxic conditions, a decrease in Müller glial survival and proliferation was observed. Conversely, there was an increase in HIF-1α expression, GFAP expression, caspase-3-positive cells, and the number of mitochondria per cell. However, no significant changes were noted in the expression of the Müller glial markers GS and CRALBP. Conclusions: In conclusion, hypoxia resulted in reduced proliferation and survival of Müller glial cells, primarily due to increased apoptosis and heightened metabolic stress. Full article

Background/Objectives: This study evaluates whether ultrawide-field optical coherence tomography angiography (UWF-OCTA) can guide navigated laser therapy for non-perfused areas (NPAs) in branch retinal vein occlusion (BRVO). It further explores whether the laser spots can be accurately placed according to plan, considering that the retina is three-dimensional (3D), while UWF-OCTA provides two-dimensional (2D) images. Methods: UWF-OCTA images from three devices—VG200, Xephilio OCT-S1, and Bmizar—guided the treatments. These images were superimposed onto NAVILAS^® system images to guide NPA treatments. Pre-treatment planning was strategically designed to avoid normal and collateral vessels, with immediate post-laser OCTA and en face images assessing the efficacy of the laser spots in avoiding these vessels as planned. The accuracy of navigated laser therapy was further analyzed by comparing the intended laser locations with the actual spots. Results: All montaged OCTA images from the three devices were seamlessly integrated into the navigated laser system without registration errors. All patients received treatments targeting the NPAs as planned. However, not all collateral or normal vessels were successfully avoided by the laser spots. A further analysis revealed that the actual locations of the laser spots deviated slightly from the planned locations, particularly in the mid-periphery areas. Conclusions: UWF-OCTA-guided navigated laser photocoagulation is feasible and precise for treating NPAs in BRVO. Nonetheless, minor deviations between planned and actual locations were observed. This discrepancy, particularly important when treating diseases of the macular area, should be carefully considered when employing OCTA-guided navigated laser photocoagulation. Full article

Purpose: This study aims to evaluate the clinical utility of a prototype ultra-widefield (UWF) single-capture optical coherence tomography (OCT) lens developed to image large areas of the retina. Material and Methods: This study included OCT and angio-OCT measurements performed with a REVO FC 130 (Optopol Technology, Poland) with an add-on widefield lens in a case series of 215 patients with retinal pathologies and 39 healthy subjects. The imaging width provided by the lens was 22 mm (covering a 110-degree field of view), while the scanning window height ranged from 2.8 to 6 mm. Results: The quality of the peripheral UWF OCT and angio-OCT images obtained by REVO FC 130 with the attachable lens is very good and sufficient for patient diagnosis, follow-up, and treatment planning. Both the boundaries of the non-perfusion zones and the location and extent of vascular proliferations can be accurately traced. Furthermore, the vitreoretinal interface can also be accurately assessed over a large area. The imaging quality of the macula with UWF OCT angiography is also good. The mean thickness measurement difference between a UWF and a standard 10 mm 3D retinal scan in a healthy individuals for the Central ETDRS sector was −1.37 ± 2.96 µm (the 95% limits of agreement (LoA) on Bland–Altman plots ranged from −6.82 to 2.43); for the Inferior Inner sector, it was −2.81 ± 1.09 µm (95% LoA, −4.94 to −0.68); for the Inferior Outer sector, it was −1.31 ± 2.58 µm (95% LoA, −6.38 to 3.75); for the Nasal Inner sector: −1.46 ± 1.19 µm (95% LoA, −3.79 to 0.88); for the Nasal Outer sector, it was −0.56 ± 2.61 µm (95% LoA, −5.67 to 4.55); for the Superior Inner sector, it was −2.71 ± 3.16 µm (95% LoA, −8.91 to 3.48); for the Superior Outer sector, it was −1.82 ± 1.39 µm (95% LoA, −4.55 to 0.91); for the Temporal Inner sector, it was −1.77 ± 2.24 µm (95% LoA, −6.16 to 2.62); for the Temporal Outer sector, it was −3.61 ± 1.43 µm (95% LoA, −6.41 to −0.81). Discussion: The proposed method of obtaining UWF OCT and UWF angio-OCT images using an add-on lens with the REVO FC 130 gives high-quality scans over the entire 110-degree field of view. This study also shows a high agreement of the ETDRS sector’s thickness measurements between UWF and standard retinal scans, which allows UWF to be used for quantitative macular thickness analysis. Considering its image quality, simplicity, and reliability, an add-on lens can be successfully used for the UWF OCT and OCT angiography evaluation of the retina on a daily basis. Full article

Pericytes, specialized mural cells surrounding microvessels, play a crucial role in maintaining vascular homeostasis and function across various organs, including the eye. These versatile cells regulate blood flow, support the integrity of the blood–retinal barrier, and contribute to angiogenesis. Recent advancements in molecular and cellular biology have revealed the heterogeneity of pericytes and their critical involvement in ocular physiology and pathology. This review provides a comprehensive analysis of pericyte functions in ocular health and their implications in diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, and retinal vein occlusion. Pericyte dysfunction is implicated in vascular instability, neurovascular coupling failure, inflammation, and pathological neovascularization, contributing to vision-threatening disorders. The review further explores recent findings on pericyte-targeted therapies, including pharmacological agents, gene therapy, and cell-based approaches, aiming to restore pericyte function and preserve ocular health. Full article

Retinal diseases can result in blindness and visual impairment. They represent a significant medical burden and adversely affect life expectancy. Recently, antibody- and nucleic acid-based pharmaceuticals have increasingly been used to treat retinal diseases, with improvement or cure as the goal; however, these drugs are currently only administered by intravitreal injection. In this study, we present a novel approach to treating retinal diseases using eye drops that contain PnkRNA, a single-stranded RNA nucleic acid. PnkRNA-loaded liposomes were shown to effectively deliver retinal drugs and significantly inhibit retinal thickening in a mouse retinal-vein occlusion model. Cationic modification of the liposome surface enhanced the delivery of nucleic acids and therapeutic efficacy. Moreover, to reduce the frequency of eye-drop administration, liposomes were incorporated into the thermoresponsive gels. This formulation provided sustained retinal delivery and exhibited superior therapeutic efficacy compared with liposomal eye drops. This nucleic acid retinal delivery technology represents a significant advancement in drug-delivery technology, offering a safe and simple treatment for retinal diseases. Full article

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health. Full article

Background/Objectives: Retinal vein occlusion (RVO) represents a common ophthalmological disorder that, if untreated, often leads to severely impaired vision. The classic vascular risk factors, aging and glaucoma, represent the core pathogenic factors for RVO. However, antiphospholipid syndrome (APS) has been involved in a non-negligible number of patients with RVO. The main objective of the present study was to assess the performance of the new 2023 ACR/EULAR classification criteria for APS in a cohort of patients with RVO fulfilling the Sydney classification criteria. Methods: A prospective study of consecutive patients with RVO diagnosed with APS in a third-level university hospital. The new 2023 ACR/EULAR classification criteria for APS were applied to all patients. Vascular risk factors, the antiphospholipid antibody (aPL) profile, clinical management, and clinical outcomes were assessed and compared between those fulfilling the Sydney and the 2023 ACR/EULAR criteria. Results: Sixty-nine RVO-APS patients were included in the study. After applying the new classification criteria, 18 patients (26.1%) did not fulfill the new criteria for APS. Specifically, 17 (24.6%) were excluded due to the new Domain 8 (p < 0.001) as they presented only aPL IgM serology, and 1 patient (1.4%) was excluded due to having high venous thromboembolic risk (VTE) with a clinical domain score < 3. Interestingly enough, the presence of high arterial risk (45.1% vs. 50%; p = 0.72) was greater than the presence of high VTE (3.9% vs. 5.6%; p = 0.99); in both cases, the 51 RVO-APS patients were classified with the 2023 ACR/EULAR criteria, and the 18 cases were excluded according to the new classification criteria. Except for the expected differences in serological domains (Domain 7, p < 0.001, and Domain 8, p < 0.001), we did not find other significant differences in terms of prognosis or risk of recurrence between both groups of patients. Conclusions: The implementation of the new ACR/EULAR 2023 classification criteria for APS resulted in the exclusion of about one out of four previously diagnosed RVO-APS patients. The higher prevalence of manifestations of high arterial risk compared with high VTE among both newly classified and excluded APS patients highlights the importance of monitoring cardiovascular risk factors for both the prevention and the management of potential retinal and cardiovascular events. Full article

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of the Korean National Health and Nutrition Examination Survey 2017–2021 aged ≥19 years (n = 16,358). RVO diagnosis was based on fundus imaging or was self-reported. Based on their daily Mg intake, we categorized participants into low (<120 mg), intermediate (men: 120–300 mg; women: 120–400 mg), and sufficient (men: ≥300 mg; women: ≥400 mg) intake groups and compared their characteristics across groups. Results: RVO prevalence was 0.7%. Compared to the non-RVO group, the RVO group was characterized by older individuals, fewer current alcohol consumers, a higher prevalence of hypertension and chronic kidney disease, and a lower intake of fiber, iron, calcium, vitamin E, and Mg. After full adjustment, sufficient Mg intake was significantly associated with a 64% reduced risk of RVO (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18–0.71, p = 0.003). This association was particularly notable among individuals aged 19–59 years (OR 0.18, 95% CI 0.04–0.82, p = 0.027), those with hypertension (OR 0.29, 95% CI 0.13–0.67, p = 0.003), and those without glaucoma (OR 0.33, 95% CI 0.15–0.71, p = 0.004). Conclusions: Sufficient Mg intake may reduce RVO risk among adults aged <60 years, individuals with hypertension, and those without glaucoma. Further research should validate the benefits of Mg supplementation in preventing RVO. Full article

Background: Bacterial endophthalmitis is a rare but serious complication of intravitreal injections (IVIs). Prefilled syringes have been introduced to reduce contamination risk during drug preparation. However, whether they lower the incidence of bacterial endophthalmitis compared to vials remains unclear. Methods: This retrospective cohort study analyzed aflibercept IVIs performed at 17 clinical centers in Japan between 2015 and 2022. Patients aged ≥20 years who received aflibercept IVIs (vial or prefilled syringe) for age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or myopic choroidal neovascularization were included. Bacterial endophthalmitis was diagnosed based on clinical signs (e.g., rapid vision loss, pain, hypopyon, vitreous opacity). Incidence rates were compared using Fisher’s exact test. Results: Among 152,039 injections (43,684 prefilled syringes; 108,355 vials), 12 cases of bacterial endophthalmitis were identified (0.0046% vs. 0.0092%, p = 0.53). Poor visual outcomes were associated with Enterococcus faecalis, Streptococcus spp., and diabetes. Conclusions: Although incidence was lower in the prefilled syringe group, the difference was not statistically significant. Detecting a significant difference requires a larger sample. Further studies are needed to confirm the potential benefits of prefilled syringes in reducing endophthalmitis risk. Full article

Background/Objectives: Macular edema (ME), due to retinal vein occlusion (RVO), is a major cause of vision impairment. Many patients experience suboptimal responses to anti-vascular endothelial growth factor (anti-VEGF) monotherapy, necessitating alternative treatment approaches. Faricimab, a bispecific antibody targeting VEGF-A and angiopoietin-2 (Ang-2), introduces a novel dual-mechanism therapy. This study evaluates the short-term real-world efficacy of switching to Faricimab in patients with treatment-resistant ME secondary to RVO. Methods: This retrospective study included patients from LMU University Hospital who were switched to Faricimab due to an inadequate response or adverse events related to prior intravitreal therapy (Ranibizumab, Aflibercept, or Ozurdex^TM). All patients completed a structured loading phase of four monthly injections. Key outcome measures included changes in best-corrected visual acuity (BCVA, logMAR), central subfield thickness (CST, µm), and intraretinal fluid (IRF) presence on optical coherence tomography (OCT). Changes were assessed from baseline (mo0) to three months (mo3). Results: The study included 19 eyes from 19 patients (mean age 63.0 ± 14.2 years). BCVA improved from 0.20 logMAR at baseline to 0.00 logMAR at mo3 (p < 0.01). CST decreased from 325 µm to 280 µm (p < 0.01). The proportion of eyes with IRF reduced from 100% to 32% (p < 0.01). Significant reductions in retinal volume within the 1 mm and 6 mm (both p < 0.01) circles of the ETDRS grid were observed. Conclusions: Switching to Faricimab in patients resulted in significant short-term improvements in BCVA, CST, and IRF resolution. Given the small sample size and retrospective design, these findings should be interpreted as exploratory and hypothesis-generating. Further studies are needed to evaluate long-term efficacy and optimal treatment regimens. Full article

Purpose: To assess the feasibility and effectiveness of remote monitoring for patients with retinal vein occlusion (RVO) treated with intravitreal anti-VEGF injections. Methods: A retrospective analysis was conducted at the Eye Clinic of the University of Catania. Thirty-four eyes of 34 patients with RVO were included for a 12-month follow-up period. After a comprehensive baseline ophthalmic examination, the patients received a loading treatment consisting of three monthly intravitreal injections of anti-VEGF, followed by monthly or bimonthly remote follow-up visits at peripheral centers. Optical coherence tomography (OCT) images and clinical data were shared online with our eye clinic for remote evaluations. Data on hospital and peripheral center visits, intravitreal injections, and OCT scans were collected and analyzed. Results: The patients had an average of 5.71 ± 1.14 visits to peripheral centers and 2.1 ± 0.8 visits to our center for fluorescein angiography. The mean number of injections was 5.26 ± 1.29 and the mean improvement in best-corrected visual acuity (BCVA) was 11.47 ± 5.56 letters. Remote OCT evaluations accounted for 194 scans, there was a high agreement between two expert in-hospital examinators (Cohen’s κ = 0.927) with only 14 cases requiring hospital visits for inconclusive results. Conclusions: Remote monitoring for RVO patients significantly reduced hospital admissions for follow-up visits, reducing the clinical burden on medical staff, patients, and caregivers, while maintaining reliable patient assessments. Full article

Retinal thickness analysis using optical coherence tomography (OCT) has become an indispensable tool in retinal disease management, providing high-resolution quantitative data for diagnosis, monitoring, and treatment planning. This analysis has been found to be particularly useful for both diagnostic and monitoring purposes across a wide range of retinal diseases, enabling precise disease characterization and treatment evaluation. This paper explores its applications across major retinal conditions, including age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, and inherited retinal diseases. Emerging roles in other diseases such as neurodegenerative diseases and retinal drug toxicity are also highlighted. Despite challenges such as variability in measurements, segmentation errors, and interpretation difficulties, advancements in artificial intelligence and machine learning have significantly improved accuracy and efficiency. The integration of retinal thickness analysis with telemedicine platforms and standardized protocols further underscores its potential in delivering personalized care and enabling the early detection of ocular and systemic diseases. Retinal thickness analysis continues to play a pivotal and growing role in both clinical practice and research, bridging the gap between ophthalmology and broader medical fields. Full article

Paracentral acute middle maculopathy (PAMM) is a macular condition primarily detected using optical coherence tomography (OCT) imaging. It presents as hyperreflective bands within the inner nuclear layer (INL) of the retina, often leading to localized degenerative phenomena. PAMM is a condition that reveals a dysfunction in the microvascular network of the retina. However, it is not an isolated phenomenon but rather an indicator of deeper and even systemic, prevalently vascular-related issues related to a wide array of conditions that impact circulation, including retinal vein and artery occlusion, diabetic retinopathy, and hypertensive retinal vascular changes. PAMM occurs due to impaired perfusion within the retinal deep capillary plexus, clinically leading to subtle but noticeable blind spots (scotomas) in the central visual field. Recent advances in imaging technology, particularly optical coherence tomography angiography (OCTA), have provided a clearer view of the underlying vascular alterations. Thus, PAMM may currently serve as a biomarker in broader ocular and systemic pathologies before disease progression. This review explores the latest reports in the literature on PAMM, from its characteristic imaging features to the evolving theories behind its development. By bridging the gap between ophthalmology and systemic health, PAMM may facilitate earlier diagnosis and tailored management strategies for conditions that extend far beyond the eye. Understanding this entity could ultimately transform our approach to assessing vascular health toward further research, risk prediction, and patient care. Full article