San-Ni Chen

To determine the sensitivity of ultra-widefield imaging (UWFI) for detecting retinal breaks in primary rhegmatogenous retinal detachment (RRD) and to evaluate its utility for preoperative localisation. We included adults with primary RRD who underwent PPV and had preoperative UWFI. Intraoperative scleral indentation served as reference standard. Breaks were classified by morphology and by a fovea-centred, right-eye standardised clock-hour system. The primary outcome was causative-break detection on UWFI and quadrant-level sensitivities were secondary. Among 363 eyes with primary RRD, 9 were excluded for vitreous haemorrhage, leaving 354 eyes for analysis. The causative break was detected on UWFI in 208 eyes (58.8%). All breaks were identified on UWFI in 148 eyes (41.8%). Compared with the not-detected group, the detected group was younger (57.8 ± 9.5 vs 61.3 ± 11.6, P = 0.003), had a higher phakic rate (84.6% vs 78.0%, P = 0.041), and showed a smaller detachment extent (1.88 ± 0.72 vs 2.08 ± 0.87 quadrants, P = 0.025). Horseshoe tears were more common in the detected group (80.3% vs 57.5%, P < 0.001), while round holes were more frequent in the not-detected group (42.5% vs 16.8%, P < 0.001). Overall sensitivity for all breaks was 49.1% (308/627). Detection was highest in the temporal quadrant (69.2%) and lower in the nasal (45.9%), superior (45.2%), and inferior (33.0%) quadrants. Clock-hour analysis peaked at 9 to 10 o'clock and was lowest at 5 to 6 o'clock, indicating better temporal and poorer inferior detection. UWFI alone has limited sensitivity for detecting retinal breaks in patients undergoing retinal detachment repair. UWFI may complement but not replace scleral indentation in perioperative evaluation.

This study aimed to investigate the anatomical and functional outcomes of branch retinal vein occlusion (BRVO) eyes treated with anti-vascular endothelial growth factor (anti-VEGF) injections using a novel one and stepped pro re nata protocol. This retrospective case series evaluated the electronic medical records from 22 BRVO patients who were treated with anti-VEGF agents under our novel “One and Stepped PRN” protocol at a single tertiary medical center between January 2016 and October 2022. Outcomes of interest included best-corrected visual acuity and central retinal thickness. Twenty-two treatment-naive BRVO eyes (14 males, 8 females) were included. The mean age was 65.82 ± 10.88 years. Average follow-up was 54.45 ± 7.65 weeks. 7 (31.81%) received mainly Ranibizumab, and 15 (68.18%) received mainly Aflibercept. The baseline average best corrected distance visual acuity was 45.86 ± 19.46 Early Treatment of Diabetic Retinopathy Study letters, and the baseline average central retinal thickness was 562.5 ± 164.02 μm. The mean number of injections received was 3.54 ± 1.74. Average best corrected distance visual acuity improvement was 23.91 ± 17.36 Early Treatment of Diabetic Retinopathy Study letters ( P < .0001) and average central retinal thickness improvement was 245.55 ± 153.31 μm ( P < .0001). Our results were comparable to the BRAVO and VIBRANT trials while comparatively using fewer anti-VEGF injections. In summary, our novel anti-VEGF protocol applied under real-world conditions achieved good anatomical and visual outcomes among treatment-naive BRVO eyes.

Purpose: To identify baseline characteristics that predict vision decline (VD) in patients with chronic central serous chorioretinopathy who have anatomically responded to half-dose photodynamic therapy. Methods: Patients with chronic central serous chorioretinopathy who underwent half-dose photodynamic therapy once and achieved subretinal fluid resolution were retrospectively reviewed. They were categorized into the VD group and the vision maintenance/improvement group based on visual acuity 6 months posttreatment. Baseline OCT, OCT angiography, fundus autofluorescence, and choroidal vascular hyperpermeability patterns were analyzed to identify predictive factors for the VD group. Predictive models were evaluated using the area under the curve from receiver operating characteristic curves to estimate the likelihood of VD. Results: A total of 63 patients were reviewed, with 14 in VD group and 49 in vision maintenance/improvement group. OCT measurements revealed that VD group had significantly thinner layers from internal limiting membrane (ILM) to external limiting membrane (IE) and from ILM to ellipsoid zone (IEZ) (IE: 79.3 ± 22.2 µm vs. 100.1 ± 20.1 µm, P = 0.001; IEZ: 93.9 ± 23.7 µm vs. 114.5 ± 19.8 µm, P = 0.002). The IE and IEZ cutoff values were 84 µm and 95.5 µm (P = 0.006 and 0.008), respectively. The predictive model's area under the curve was 0.743 for IE alone. The best model, which included IE, age, sex, spherical equivalent, fundus autofluorescence, and choroidal vascular hyperpermeability patterns, achieved an the area under the curve of 0.860. Conclusion: Baseline IE and IEZ are significant predictors of VD in patients with chronic central serous chorioretinopathy after half-dose photodynamic therapy, making them useful for identifying high-risk patients and discussing these potential outcomes in advance.

Purpose To compare the efficac and safety of a dual-blade 20,000 cuts per minute (cpm) vitrectomy probe with a single-blade 10,000 cpm probe for primary rhegmatogenous retinal detachment (RRD). Study design Prospective, randomized controlled clinical trial. Methods Evaluations were conducted preoperatively, intraoperatively, and at three months postoperatively. The main outcome measure focused on the duration of core vitrectomy, with secondary outcomes including peripheral vitreous shaving duration, balanced salt solution (BSS) consumption, anatomical and functional outcomes, as well as the incidence of surgical procedure-related complications. Results Overall, 35 cases in the 20,000 cpm group and 37 cases in the 10,000 cpm group completed the trial without significant differences in baseline demographic characteristics. The 20,000 cpm group demonstrated significantly shorter core vitrectomy duration (161.6 ± 10.4 vs. 206.8 ± 10.1 s) (P = 0.003) and peripheral vitreous shaving time (446.3 ± 20.3 vs. 544.2 ± 22.2 s) (P = 0.002) compared to the 10,000 cpm group. BSS consumption was higher in the 20,000 cpm group but without statistical significance (P = 0.231). There were no significant differences in the need for scleral sutures and the incidence of iatrogenic retinal breaks (P = 0.331 and 0.523). At the 3-month follow-up, there were no statistically significant differences in primary success, final anatomical success, or mean visual acuity (P > 0.9, P = 0.326). Rates of complications, including ocular hypertension, epiretinal membrane formation, and endophthalmitis also showed no statistically significant differences (P > 0.6). Conclusion The utilization of the new-generation 27-gauge system with a 20,000 cpm probe may herald a new paradigm of high-flow, smaller-diameter instrumentation, thereby enhancing the efficiency of the small gauge technique.

Rationale: The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections. Patient Concerns: A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye. Diagnosis: Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye. Interventions: Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye. Outcomes: The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved. Lessons: This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.

Introduction: Compare the anatomical and functional outcomes, operation duration, and complication rates between standard scleral buckling (SSB) and chandelier-assisted scleral buckling (CSB) for phakic eyes with rhegmatogenous retinal detachment (RRD). Methods: PubMed, Embase, and Cochrane Library databases were searched from inception to June 2024. The primary endpoint will be set as a final success. The secondary endpoint will be primary success, operation time, and final BCVA. Results: Our meta-analysis showed that there is no statistical difference between CSB and SSB for the final success rate (RR = 1.00, 95% CI = 0.97–1.03). For the primary success rate, there is no statistical difference between CSB and SSB (RR = 1.00, 95% CI = 0.94–1.06). For operation time, our meta-analysis showed that the CSB group is less than the SSB group (pooled MD = −15.8, 95% CI = −22.60 to −9.00). For postoperative complications, our study shows that the CSB group presented with lower pooled risk than the SSB group (RR = 0.59, 95% CI = 0.41–0.89). There is a trend that the ERM formation risk is higher in the CSB group if there is no routine suture for the sclerotomy (p = 0.08). Conclusion: CSB showcases a significantly reduced operation duration and less postoperative complication in contrast to the SSB group, maintaining comparable primary and ultimate anatomical success rates as well as final BCVA.

To investigate biometric and refractive results in patients with type 1 retinopathy of prematurity (ROP) treated by intravitreal injection (IVI) of ranibizumab (R) and bevacizumab (B) at the corrected age of 6. This is a single-center retrospective study. Infants diagnosed with type 1 ROP and treated with IVI of either R or B as the primary therapy were included. Data on axial length, anterior chamber depth (ACD), and lens thickness (LT) were obtained using A-scan ultrasound. Cycloplegic refraction, keratometry (K), and best-corrected visual acuity were also documented. Additionally, optical coherence tomography angiography was performed to assess the foveal avascular zone and the density of superficial and deep vessels. We analyzed the structural and functional differences between the 2 groups and compared them with findings from a previous study conducted when these children were between the ages of 1 and 3. The study included 60 eyes from 34 patients, with 34 eyes receiving B and 26 eyes receiving R injections for ROP. In biometric outcomes, there was still a deeper ACD (3.36 ± 0.24 mm in the B group; 3.52 ± 0.21 mm in the R group) and thinner LT (3.63 ± 0.16 mm in the B group; 3.53 ± 0.12 mm in the R group) in the R group, as previously reported at the age of 3. In the refractive aspect, the eyes treated with B had higher myopia at the ages of 1 and 3; however, at the age of 6, refractive errors did not differ significantly between the 2 groups. At the corrected age of 6, the eyes treated with IVI of R were associated with deeper ACD and thinner LT. Interestingly, the emmetropization process resulted in a similar incidence of high myopia at the age of 6, which was different from the outcomes observed at younger ages.

A recent resurgence in the incidence of syphilis has sparked a new interest in this old disease. Syphilitic uveitis remains a challenging disease, among the variable syphilis infections, due to the diagnostic complexity and the wide clinical manifestations. Here, we provide recommendations regarding clinical manifestations, diagnosis, and treatment for patients with syphilitic uveitis in Taiwan based on an expert meeting and consensus from experienced uveitis specialists.

To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI − 0.661 to − 0.126), duration of RRD (p = 0.021, CI − 0.576 to − 0.048) and presence of PVR (p = 0.001, CI − 0.131 to − 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.