Ocular and Systemic Risk Factors for Disease Worsening Among Patients with NPDR: Post Hoc Analysis of the PANORAMA Trial

– The article is a post hoc analysis of the PANORAMA phase 3 trial, which aimed to identify baseline systemic and ocular factors associated with worsening of nonproliferative diabetic retinopathy (NPDR) and the impact of intravitreal aflibercept injection (IAI) on these associations.

– Five baseline factors were identified as being associated with increased risk of NPDR worsening in sham-treated eyes: fluorescein leakage, retinal nonperfusion area, thicker central subfield thickness, eosinophil level, and proteinuria.

– The risk of developing vision-threatening complications (VTCs), center-involved diabetic macular edema (CI-DME), or ≥ 2-step Diabetic Retinopathy Severity Scale (DRSS) worsening increased with increasing fluorescein leakage area and retinal nonperfusion area in the sham group.
– However, among IAI-treated eyes, increasing baseline fluorescein leakage or retinal nonperfusion areas did not increase the risks of NPDR worsening.
This suggests that IAI treatment can mitigate the effect of these baseline risk factors and reduce the likelihood of NPDR worsening.
– The findings of this analysis can help identify patients at increased risk of disease progression and inform closer monitoring or earlier intervention strategies for these patients.

The article concludes that increased areas of fluorescein leakage and retinal nonperfusion at baseline are key ocular biomarkers associated with NPDR worsening in sham-treated patients, but IAI treatment can mitigate this risk.

Prognosis, Risk Factors and Clinical Features of Intraocular Recurrence in Primary Vitreoretinal Lymphoma

– The study investigated the clinical features, risk factors, and prognosis of intraocular recurrence in primary vitreoretinal lymphoma (PVRL).
– The study included 51 patients with PVRL, of which 14 patients experienced intraocular recurrence.
– The recurrence rate of intraocular involvement in PVRL was found to be 27.5% over a mean follow-up period of 42.5 months.

There was no significant difference in the central nervous system lymphoma (CNSL) relapse rate and median time to CNSL between the intraocular non-recurrence and intraocular recurrence groups.
– There was also no significant difference in survival outcomes, such as mortality rate and median overall survival, between the two groups.
Younger onset age, isolated PVRL, and no history of intravitreal chemotherapy were identified as independent risk factors for intraocular recurrences.
– Approximately 23.6% of patients with intraocular recurrence were asymptomatic and were diagnosed during routine follow-up.
– The rate of interleukin-10 (IL-10)/IL-6>1 was significantly lower at recurrence compared to the initial diagnosis, but the rate of IL-10≥50 pg/mL was high and not significantly different.
– The study suggests that intraocular recurrence does not have a significant impact on CNS manifestations or survival outcomes in patients with PVRL.
Younger patients have a higher risk of intraocular recurrence, and combined systemic and intravitreal chemotherapy may reduce intraocular recurrence.
– Regular ophthalmic follow-up and IL-10 testing are recommended to detect intraocular recurrence.

Webpage address: Liu, Shixue, et al. “Prognosis, Risk Factors and Clinical Features of Intraocular Recurrence in Primary Vitreoretinal Lymphoma.” Ophthalmology Retina, vol. 0, no. 0, 31 Oct. 2023, doi:10.1016/j.oret.2023.10.021.

Polypoidal choroidal vasculopathy: evaluation based on 3-dimension reconstruction of OCT angiography

This article presents a clinical case series that aims to describe novel observations of polypoidal choroidal vasculopathy (PCV) using three-dimensional (3D) reconstruction of swept source OCT angiography (SS-OCTA) images.

The study compares these observations with similar images of type I neovascular age-related macular degeneration (nAMD). The study included patients with PCV in either eye, and the images were obtained and reconstructed in 3D using a pre-specified SS-OCTA imaging protocol.

The researchers evaluated three specific features:

the pattern of flow signal within the polypoidal lesions (PLs).

the configuration of the branching neovascular network (BNN), and.

the spatial arrangement of the PLs in relation to the BNN.

The results showed that all PLs exhibited internal vascular architecture in the form of coil-like loops and none exhibited homogenous flow. Small focal nodules were present within this internal vascular architecture in 70% of cases.

The BNN exhibited a hypermature/mature configuration and was associated with thicker choroid compared to typical nAMD type I neovascularization.

The study concludes that proliferating vasculature is present in both the PL and the BNN, and the configuration suggests that the BNN represents a more chronic and inactive lesion than the PL. The findings provide insights into the nature and structure of PCV and its component parts.

The article is available at the following address: [Polypoidal choroidal vasculopathy: evaluation based on 3-dimension reconstruction of OCT angiography – Ophthalmology Retina].

مقایسه درمان فتو دینامیک تراپی نصف دوز با لیزر میکروپالس آستانه پایین (زرد) برای درمان رتینوپاتی سروزی مرکزی

هدف مقایسه نتایج آناتومیکی و عملکردی فتو دینامیک تراپی با دوز نصف (PDT) و لیزر میکروپالس آستانه پایین – زرد 577 نانومتری- (SMLT) در درمان بیماران مبتلا به رتینوپاتی سروزی مرکزی مزمن (CSCR).

طراحی آزمایشی بالینی کنترل شده تصادفی، آینده نگر، دو سو کور.

شرکت کنندگان بیماران مبتلا به CSCR مزمن که با ویژگی های بالینی و تصویربرداری تایید شده اند.

روش ها بیماران واجد شرایط به طور تصادفی (1:1) برای دریافت PDT با دوز نصف یا SMLT اختصاص داده شدند. در صورت مشاهده مایع زیر شبکیه (SRF) پایدار، درمان تکرار شد. پاسخ های درمان پس از 1 ماه پس از درمان و هر 3 ماه تا نقطه پایان در 12 ماه ارزیابی شد.

اقدامات پیامد اصلی اقدام نتیجه اولیه، ازبین رفتن کامل مایع زیر شبکیه در (OCT) در ماه 12 بود. پیامدهای ثانویه شامل تغییرات در بهترین حدت بینایی تصحیح شده (BCVA)، ضخامت ماکولای مرکزی (CMT) طبق OCT، حساسیت شبکیه طبق میکروپریمتری و کیفیت زندگی مرتبط با بینایی با استفاده از پرسشنامه عملکرد بینایی 25 آیتمی موسسه ملی چشم بود.

نتایج بین آوریل 2017 و اکتبر 2020، 68 بیمار وارد مطالعه شدند.

در یک ماه پس از درمان، SRF در 8 (24.2 درصد) بیمار تحت درمان با SMLT و 20 (58.8 درصد) بیمار تحت درمان با PDT با دوز نصف برطرف شد. این میزان در گروه SMLT به 23 (82.1 درصد) و در گروه PDT با دوز نصف به 30 (90.9 درصد) در 12 ماه پیگیری افزایش یافت.

82.1 % vs 90.9 %

منحنی های بقا Kaplan-Meier نشان داد که حل SRF در گروه PDT با دوز نصف به طور قابل توجهی سریعتر از گروه SMLT است (p=0.016).

هر دو گروه در مقایسه با خط پایه در 12 ماه بهبود قابل توجهی در

BCVA (-0.12 ± 0.21، p=0.005 برای SMLT؛ -0.13 ± 0.12، p<0.001 برای PDT با دوز نصف)،

CMT (-154.2 ± 105.6، p<0.001 برای SMLT؛ -140.8 ± 94.0، p<0.001 برای PDT با دوز نصف) و

حساسیت شبکیه (5.70 ± 5.02، p<0.001 برای SMLT؛ 6.05 ± 3.83، p<0.001 برای PDT با دوز نصف) نشان دادند.

هیچ تفاوت معنی داری بین دو گروه درمان در هر نقطه زمانی در تمام آزمایشات به جز BCVA در 3 ماه (p=0.03) وجود نداشت.

نتیجه گیری هنگام مقایسه PDT با دوز نصف با SMLT آستانه زیر، این مطالعه نشان داده است که هر دو درمان گزینه های مناسبی هستند و PDT با دوز نصف موفقیت آناتومیکی سریعتر و بهبود عملکردی را به دست می آورد.