Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis.

BACKGROUND: Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS: To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS: Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION: Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION: Retrospectively registered.

Regional parafoveal vessel density changes in diabetic patients without retinopathy.

INTRODUCTION: Regional parafoveal vessel density changes have not been characterized in patients with type 2 diabetes without retinopathy. OBJECTIVE: To compare regional changes in vessel density between subjects without diabetes (group 1) and with diabetes without retinopathy (group 2). METHODS: Observacional, retrospective, cross-sectional, comparative study. Parafoveal vessel density by quadrants was compared between groups and between quadrants in each group; density of each quadrant and inner density were correlated, as well as the contribution of each quadrant to inner density (linear regression). RESULTS: Thirty-four eyes were analyzed in group 1 and 38 in group 2; in the latter, inner vessel density (20.75 vs. 21.85, p = 0.021) and that of superior quadrants (21.05 vs. 21.75, p < 0.001), and nasal quadrants (20.95 vs. 21.50, p = 0.023) were lower. In the regression analysis, superior and nasal quadrants had the largest contribution to the change in inner vessel density in group 2 (b = 0.361 and b = 0.294, respectively). CONCLUSIONS: Parafoveal inner vessel density decreases in diabetic patients without retinopathy at the expense of superior and nasal quadrants, which indicates that further evaluation is required for early microvascular disease to be detected.

INTRODUCCIÓN: Los cambios regionales de densidad vascular parafoveal no han sido caracterizados en los pacientes con diabetes tipo 2 sin retinopatía. OBJETIVO: Comparar los cambios regionales de densidad vascular entre sujetos sin diabetes (grupo 1) y con diabetes sin retinopatía (grupo 2). MÉTODOS: Estudio observacional, retrospectivo, transversal y comparativo. La densidad vascular parafoveal por cuadrantes se comparó entre grupos y entre cuadrantes en cada grupo; se correlacionó la densidad de cada cuadrante y la densidad interna, así como la contribución de cada cuadrante a la densidad interna (regresión lineal). RESULTADOS: Se analizaron 34 ojos en el grupo 1 y 38 en el grupo 2; en este fue menor la densidad vascular interna (20.75 versus 21.85, p = 0.021) y la de los cuadrantes superior (21.05 versus 21.75, p < 0.001) y nasal (20.95 versus 21.50, p = 0.023). En el análisis de regresión, los cuadrantes superior y nasal tuvieron la mayor contribución al cambio en la densidad vascular interna (b = 0.361, b = 0.294) en el grupo 2. CONCLUSIONES: La densidad vascular interna parafoveal disminuye en los pacientes diabéticos sin retinopatía, a expensas de los cuadrantes superior y nasal, por lo que se requiere evaluación adicional para detectar afecciones microvasculares tempranas.

Vessel/perfusion density in two optical coherence tomographic angiography protocols: Interchangeable?

INTRODUCTION: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. OBJECTIVE: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols in order to determine if their metrics could be interchanged. METHOD: Cross-sectional, prospective, comparative, observational, study between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. The R2 between central, inner, and full densities (3 x 3 mm protocol) and between central, inner, outer and full densities (6 x 6 mm protocol) was identified, both for vessel and perfusion densities. RESULTS: Seventy-eight eyes were evaluated; subjects' median age was 23 years. There were high R2 between inner and full densities with the 3 x 3 mm protocol (0.96), between outer and full densities with the 6 x 6 mm protocol (0.96), and between central vessel and perfusion densities (≥ 0.96); R2 between central vessel and perfusion densities of different protocols was ≤ 0.71. CONCLUSIONS: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, given that each one preferentially measures different macular areas. Metrics from different protocols should not be interchanged for follow up.

INTRODUCCIÓN: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. OBJETIVO: R2 entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. MÉTODO: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). RESULTADOS: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. CONCLUSIONES: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.

Fundus autofluorescence in the evaluation of diabetic macular edema treatment response.

INTRODUCTION: Fundus autofluorescence (FAF) has shown sensitivity in the detection of macular edema. OBJECTIVES: To evaluate indices formed with FAF and retinal anatomical-functional variables in patients with diabetic macular edema (DME) treated with ziv-aflibercept (ziv-AFL). METHODS: Twenty-nine eyes of 15 DME patients who received ziv-AFL intravitreal injections were included in the study. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), optical coherence tomography (OCT) and FAF were evaluated before treatment and at one and two months. OCT variables were central subfield thickness (CST), macular volume (MV) and macular cube average thickness (MCAT). FAF/BCVA, FAF/CS, FAF/CST, FAF/MV and AF/MCAT indices baseline values were obtained. Analysis was performed with Spearman's rank correlation coefficient and linear regression analysis. RESULTS: There was a significant correlation between baseline FAF/BCVA index and BCVA at second month (rs = - 0.78, p = 0.000), between baseline FAF/CS index and BCVA at second month (rs = -0.68, p = 0.0009) and between baseline FAF/CS index and MV at first month of follow-up (rs = 0.64, p = 0.002). CONCLUSIONS: In DME, composite indices with baseline FAF predict variables such as BCVA in the follow-up of patients receiving ziv-AFL.

INTRODUCCIÓN: La autofluorescencia retiniana (AF) ha mostrado sensibilidad en la detección del edema macular. OBJETIVOS: Evaluar índices formados con la AF y variables anatomofuncionales retinianas en pacientes con edema macular diabético (EMD) tratados con ziv-aflibercept (ziv-AFL). MÉTODOS: Fueron incluidos 29 ojos de 15 pacientes con EMD que recibieron inyecciones intravítreas de ziv-AFL. Se evaluó agudeza visual mejor corregida (AVMC), sensibilidad al contraste (SC), tomografía de coherencia óptica (TCO) y AF, antes del tratamiento, así como al primer y segundo mes de iniciado este. Las variables de la TCO fueron grosor foveal central (GFC), volumen macular (VM) y grosor promedio macular (GPM). Se obtuvieron los valores basales de AF/AVMC, AF/SC, AF/GFC, AF/VM y AF/GPM. Se realizó análisis con el coeficiente de correlación de rangos de Spearman y análisis de regresión lineal. RESULTADOS: Hubo una correlación significativa entre el índice AF/AVMC basal y la AVMC en el segundo mes (rs = −0.78, p = 0.000), entre el índice AF/SC basal y la AVMC en el segundo mes (rs = −0.68, p = 0.0009) y entre AF/SC basal y el VM en el primer mes de seguimiento (rs = 0.64, p = 0.002). CONCLUSIONES: En el EMD, los índices compuestos con AF basales predicen variables como AVMC en el seguimiento de pacientes que reciben ziv-AFL.

Preeclampsia as predisposing factor for hypertensive retinopathy: Participation by the RAAS and angiogenic factors.

Preeclampsia (PE) is a hypertensive complication of pregnancy. Its cause is still unknown and it could be a risk factor for future ophthalmic problems. Retinal vascular bed alterations have been described as a consequence of PE, suggesting a retinopathy. Factors related to angiogenesis and vascular permeability, such as vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) or components of the renin angiotensin aldosterone system (RAAS), prorrenin/renin receptor ((P)RR) and angiotensin II type I receptor (AT1R) have been located in the retina, participating in other retinopathies, but it is unknown if they could participate in PE. Our aim was to elucidate whether VEGF, PEDF, (P)RR and AT1R could be modified during PE and during hypertension induced in rats with a history of PE. We used female Wistar rats and subrrenal aortic coarctation to induce PE, and after delivery, we induced a second hit by Nω-nitro-L-arginine methyl ester (L-NAME) administration. We measured blood pressure, proteinuria and pups development. In both models, eye fundal exploration and immunoblot for VEGF, PEDF, (P)RR and AT1R were performed. We found that the development of hypertension occurred faster in previously PE rats than in normal animals. VEGF, PEDF, (P)RR and AT1R were increased in PE, but in L-NAME-induced hypertension only (P)RR and AT1R were altered. Eye fundal data indicated that PE induced a level I retinopathy, but L-NAME induced a faster and more severe retinopathy in previously PE animals compared to previously normal pregnancy rats. These results indicate that PE predisposes to development of a faster and more severe retinopathy after a second hit. They also suggest that VEGF and PEDF seem to participate only in PE retinopathy, but in both models, RAAS components seem to have a more critical participation.

Diagnostic accuracy of the Edinburgh Postnatal Depression Scale: consequences of screening in Mexican women.

INTRODUCTION: Postpartum depression is a non-psychotic depressive episode with serious repercussions on the bond between the mother and her child, hence the importance of detecting it in a timely manner. OBJECTIVE: To determine the accuracy of the Edinburgh Postnatal Depression Scale as a diagnostic test and to analyze the consequences of screening and the probability of depression after applying the test. METHOD: Screening of 411 women with the Edinburgh Postnatal Depression Scale during the postpartum period; Beck's Depression Inventory was used as reference. RESULTS: At a cutoff point of 12, a sensitivity of 70.4 %, specificity of 72.2 %, positive predictive value of 36.9 % and negative predictive value of 91.4 % were obtained with Edinburgh Postnatal Depression Scale, as well as an area under the curve of 0.729 and a p-value of 0.0003. Out of 49 women without treatment for postpartum depression, five were identified to require it. CONCLUSIONS: The Edinburgh Postnatal Depression Scale has moderate accuracy; its application is simple, accessible and should be routine. It is necessary for strategies to detect and treat postpartum depression to be implemented in Mexico.

INTRODUCCIÓN: La depresión posparto es un episodio depresivo no psicótico con repercusiones graves en el vínculo de la madre con su hijo, de ahí la importancia de detectarla oportunamente. OBJETIVO: Determinar la exactitud de la Escala de Depresión Posnatal de Edimburgo como prueba diagnóstica y analizar las consecuencias del tamizaje y la probabilidad de depresión después de aplicar la prueba. MÉTODO: Tamizaje con la Escala de Depresión Posnatal de Edimburgo a 411 mujeres durante el posparto; se utilizó el Inventario de Depresión de Beck como referencia. RESULTADOS: En un punto de corte de 12, con la Escala de Depresión Posnatal de Edimburgo se obtuvo sensibilidad de 70.4 %, especificidad de 72.2 %, valor predictivo positivo de 36.9 % y valor predictivo negativo de 91.4 %, así como un valor del área bajo la curva de 0.729 y p = 0.0003. De 49 mujeres sin atención para depresión posparto, en cinco se identificó que la necesitaban. CONCLUSIONES: La Escala de Depresión Posnatal de Edimburgo tiene una exactitud moderada; su aplicación es sencilla, accesible y debería ser rutinaria. Es necesario que en México se implementen estrategias para detectar y tratar la depresión posparto.

Clasificación de patrones anormales de autofluorescencia retiniana en el edema macular diabético.

INTRODUCTION: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. OBJECTIVE: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. METHOD: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. RESULTS: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), focal hyper-autofluorescent (17%), multi-focal hyper-autofluorescent (22%) and plaque-like hyper-autofluorescent (8%). The kappa coefficient was 0.906 (p = 0.000). CONCLUSIONS: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.

INTRODUCCIÓN: Los pacientes con edema macular diabético pueden presentar alteraciones en la autofluorescencia retiniana, que hasta el momento han sido analizadas más con sistemas de láser de barrido o confocales. OBJETIVO: Describir y clasificar los patrones anormales de autofluorescencia retiniana en pacientes con edema macular diabético mediante el sistema de autofluorescencia retiniana con cámara de flash. MÉTODO: Estudio observacional, retrospectivo, transversal y descriptivo. Se evaluaron imágenes digitales de autofluorescencia retiniana de casos no comparativos con edema macular diabético no tratado, obtenidas y almacenadas con el sistema de cámara de flash.Se evaluó la variabilidad interobservador. RESULTADOS: Se incluyeron 37 ojos de 20 pacientes. La opacidad de medios fue la causa más común de calidad inadecuada de imagen. Se observaron cinco diferentes patrones de autofluorescencia retiniana: disminuida (13 %), normal (40 %), hiperautofluorescente unifocal (17 %), hiperautofluorescente multifocal (22 %) e hiperautofluorescente en placa (8 %). El coeficiente kappa fue de 0.906 (p = 0.000). CONCLUSIONES: En pacientes con edema macular diabético se presentan diferentes patrones fenotípicos de autofluorescencia retiniana con los sistemas de cámara de flash. Una clasificación fenotípica más precisa pudiera ayudar a establecer factores pronósticos de pérdida visual o al diseño de ensayos clínicos relativos a edema macular diabético.

Classification of fundus autofluorescence abnormal patterns in diabetic macular edema.

INTRODUCTION: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. OBJECTIVE: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. METHOD: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. RESULTS: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), single-spot hyper-autofluorescent (17 %), multiple-spot hyper-autofluorescent (22 %) and plaque-like hyper-autofluorescent (8 %). The kappa coefficient was 0.906 (p = 0.000). CONCLUSIONS: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.

[Comparación de la densidad capilar parafoveal entre sujetos sanos y diabéticos con y sin retinopatía].

BACKGROUND: Parafoveal capillary density changes have not been characterized in type 2 diabetics without retinopathy. OBJECTIVE: To compare parafoveal capillary density between healthy subjects, and diabetics with and without retinopathy. METHOD: Observational, prospective, transversal and comparative study; subjects without diabetes (group 1), diabetics without retinopathy (group 2), with retinopathy (group 3) and with diabetic macular edema (group 4), without macular ischemia, were included. The study variable was parafoveal capillary density, and the predictor variables were the measures of the foveal avascular zone, retinal thickness and the group. The variables were compared between groups using Kruskal-Wallis and Spearman's Rho tests. RESULTS: One hundred and forty eyes were evaluated; parafoveal capillary density was higher in group 1 than in the rest (p < 0.05). Area, perimeter and diameter of the foveal avascular zone were higher in group 3. A positive correlation existed a positive between parafoveal capillary density and central field thickness in groups 1, 2 and 3. CONCLUSION: Parafoveal capillary density decreases as diabetes-induced damage increase; a reduction may exist in diabetics without retinopathy and normal retinal thickness and foveal avascular zone are normal. The clinical impact of this finding requires further evaluation.

ANTECEDENTES: Los cambios de densidad parafoveal no se han caracterizado en diabéticos tipo 2 sin retinopatía. OBJETIVO: Comparar la densidad capilar parafoveal entre sujetos sanos y diabéticos con y sin retinopatía. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo. Se incluyeron sujetos sin diabetes (grupo 1), diabéticos tipo 2 sin y con retinopatía (grupos 2 y 3), y con edema macular (grupo 4), sin isquemia macular. La variable de estudio fue la densidad capilar parafoveal, y las variables predictoras fueron las mediciones de la ZAF, el grosor retiniano y el grupo. Se compararon las diferencias entre grupos mediante las pruebas de Kruskal-Wallis y Rho de Spearman. RESULTADOS: 144 ojos; la densidad capilar parafoveal del grupo 1 superó la de los restantes (p < 0.05). El área, el perímetro y el diámetro de la ZAF fueron mayores en el grupo 3. Existió correlación positiva entre la densidad capilar parafoveal y el grosor del campo central en los grupos 1, 2, y 3. CONCLUSIONES: La densidad capilar parafoveal disminuye conforme avanza el daño por diabetes tipo 2; puede existir una reducción en sujetos con diabetes sin retinopatía, con grosor retiniano y ZAF normales. El impacto clínico de este hallazgo requiere evaluación adicional.

Retinal thickness after focal photocoagulation for diabetic macular edema with and without temporal perifoveal thickening.

BACKGROUND: Visual improvement after focal photocoagulation in diabetic macular edema is more common in eyes without temporal perifoveal thickening. This feature is related to a lower macular volume before treatment; the higher proportion of visual improvement could be associated with a shorter need of volume reduction. OBJECTIVE: To compare macular volume before and after focal photocoagulation in eyes with diabetic macular edema, with and without temporal perifoveal thickening. METHODS: Non-experimental, retrospective, longitudinal, comparative study in diabetics with macular edema treated with focal photocoagulation. Macular volume measured with optical coherence tomography, and best corrected visual acuity were compared between eyes with (group 1) and without temporal perifoveal thickening (group 2, independent samples Student's t test). The comparison was also performed after stratifying the groups by baseline visual acuity. RESULTS: One hundred and twenty eyes, 65 eyes from group 1 (54.2%) and 55 from group 2 (45.8%). Mean volume before and after treatment and mean absolute and percentage changes were lower in group 2 (p < 0.001) regardless of visual acuity. Macular volume decreased significantly in eyes of group 1; only eyes in group 2 with visual acuity < 0.5 before treatment increased their visual function (p < 0.001). CONCLUSIONS: Eyes without temporal perifoveal thickening had visual improvement, although their volume did not change statistically. The significant volume reduction in eyes with temporal perifoveal thickening was not associated to visual improvement. The anatomical change was not enough to explain the functional improvement.

[Comparison of macular volume change after photocoagulation, in eyes with diabetic macular edema, with and without visual improvement]. / Comparación del cambio del volumen macular entre ojos con y sin mejoría visual después de fotocoagulación en edema macular diabético.

OBJECTIVE: To compare the changes in macular volume after photocoagulation between eyes with diabetic macular edema with and without visual improvement. METHODS: Non-experimental, retrospective, longitudinal, comparative study in eyes with diabetic macular edema; the sample was divided in groups: eyes with visual improvement three weeks after photocoagulation (group 1) and eyes without it (group 2). The means of macular volume changes (potential, absolute and percentage) were compared between groups (Student's t test). RESULTS: 115 eyes, 50 from group 1 and 65 from group 2; mean macular volume before and after photocoagulation and mean potential, absolute, and percentage volume changes did not differ between groups. 13.9% of the sample had visual improvement and a significant volume reduction; the proportion of the latter did not differ between groups (p = 0.3). Macular volume and visual acuity decreased significantly in eyes without previous visual deficiency (p = 0.012); it was more common to find eyes without visual improvement with a non-significant volume reduction, than finding eyes with visual improvement and a significant macular volume reduction. CONCLUSION: The reduction of macular volume was not enough to explain visual improvement. Optimizing the outcome in patients with diabetic macular edema requires the identification of functional features with a prognostic value.

[Retinal sensitivity in diabetic macular edema, with and without decreased visual acuity]. / Sensibilidad retiniana en el edema macular diabético con y sin disminución de la agudeza visual.

OBJECTIVE: To compare retinal sensitivity in diabetics with macular edema, with and without decreased visual acuity. METHODS: An observational, prospective, cross-sectional comparative study in eyes with diabetic macular edema. The sample was divided into two groups: eyes with visual acuity ""≥ 0.5 (group 1) and < 0.5 (group 2). Foveal sensitivity was compared between groups (Mann-Whitney´s U), stratified according to the center point thickness. Correlations between visual acuity and retinal sensitivity and between visual acuity and macular volume were identified. RESULTS: 81 eyes, 59 from group 1 and 22 from group 2. The mean of retinal sensitivity in group 2 (24.4 ± 6.9 dB) was significantly lower than in group 1 (30.8 ± 3.4; p < 0.001). The correlation between visual acuity and retinal sensitivity was 0.49 (r2 = 0.25), and it was 0.37 in eyes with center point thickness within one standard deviation above the mean and 0.40 in eyes within two standard deviations (p < 0.001). The correlation between visual acuity and macular volume was -0.108 (r2 = 0.026). CONCLUSIONS: Retinal sensitivity in eyes with clinically significant macular edema and decreased visual acuity before treatment was significantly lower than in eyes with normal visual acuity; the difference did not change as center point thickness increased.

Choroidal Perfusion Changes After Vitrectomy for Myopic Traction Maculopathy.

BACKGROUND: The choroidal vasculature supplies the outer retina and is altered in many retinal diseases, including myopic traction maculopathy (MTM). Choroid health is typically assessed by measuring the choroidal thickness; however, this method has substantial limitations. The choroidal vascularity index (CVI) was recently introduced to provide quantitative information on the vascular flow in the choroid. This index has been evaluated in a wide range of diseases but has not been extensively used to characterize MTM. AIM: This study aimed to investigate the CVI across different stages of MTM and the influence of macular surgery on choroidal perfusion markers in different surgically resolved MTM stages. METHODS: Eighteen healthy myopic eyes in the control group and forty-six MTM eyes in the surgical group were evaluated using enhanced optical coherence tomography (OCT) imaging. Binarized OCT images were processed to obtain the luminal choroidal area (LCA) and stromal choroidal area (SCA), which were used to calculate CVI in the form of a percentage ratio. CVI data were collected at baseline, one and four months postoperatively, and at the final clinical visit. MTM eyes were divided into four stages based on disease severity. The choriocapillaris flow area (CFA) and central subfield thickness (CSFT) were measured along side the CVI. RESULTS: No significant differences were observed between the two groups at baseline, except for visual acuity (p < 0.0001). Surgery significantly improved vision at all postoperative time points (p < 0.0001). At baseline, there were no significant differences in CVI, CFA, or CSFT scores between the control and surgical groups. However, all three measurements were lower at the final visit in the surgical group (p ≤0.0001). No significant differences were found in any of the parameters among the four stages of MTM (p > 0.05). Ultimately, correlation and multivariate linear regression analyses did not reveal any significant association between CVI and visual acuity. CONCLUSIONS: This study did not find significant preoperative differences in CVI between healthy myopic eyes and eyes with MTM. However, the postoperative CVI and CFA values were significantly lower than those of the control eyes. Thus, CVI may not be a good biomarker for surgical outcomes, as the correlation between CVI and visual acuity was not statistically significant.The CVI and CFA decreased after surgery, providing evidence of choroidal changes after surgical management.

Effect of internal limiting membrane surgical techniques on the idiopathic and refractory management of macular holes: a systematic review and meta-analysis.

Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.

Early versus Delayed Vitrectomy for Open Globe Injuries: A Systematic Review and Meta-Analysis.

Background: Open globe injuries (OGIs) are a leading cause of monocular blindness worldwide and require prompt intervention to prevent proliferative vitreoretinopathy (PVR) and endophthalmitis when serious intraocular damage occurs. The management of OGIs involves initial wound closure within 24 hours, followed by vitrectomy as a secondary surgery. However, there is a lack of consensus regarding the optimal timing of vitrectomy for maximizing visual outcomes. This meta-analysis aimed to investigate whether early or delayed vitrectomy leads to better outcomes in patients with OGIs. Methods: This review was conducted based on PRISMA guidelines. The Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched (October 23, 2023). Clinical studies that used vitrectomy to manage OGIs as early (within 7 days) or delayed (8-14 days) interventions were included. Randomized controlled trials (RCTs) and non-RCTs were appraised using the Cochrane risk of bias and JBI tools, respectively. Results: Eleven studies met the inclusion criteria and were included in the quantitative analyses. There were 235 patients with OGIs who received early intervention and 211 patients who received delayed intervention. The retina was reattached in 91% and 76% of the patients after early and delayed intervention, respectively. Traumatic PVR was present in 9% and 41% of the patients in the early and delayed groups, respectively. The odds of retinal reattachment after vitrectomy were greater in the early group (OR = 3.42, p = 0.010, 95% CI=1.34-8.72), and the odds of visual acuity ≥ 5/200 were 2.4 times greater in the early group. The incidence of PVR was significantly greater in the delayed surgery group (OR = 0.16, p < 0.0001; 95% CI=0.06-0.39), which also required more than one vitrectomy surgery. Conclusion: Early vitrectomy results in better postoperative visual acuity, a greater proportion of retinal reattachment, and a decreased incidence of PVR.

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review.

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

[Vision-threatening retinopathy in diabetics not referred to an ophthalmologist]. / Retinopatía que amenaza la visión en pacientes diabéticos no referidos al oftalmólogo.

BACKGROUND: Vision-threatening forms of diabetic retinopathy (macular edema and proliferative retinopathy) can be efficiently treated with laser. Any delay in access to ophthalmic care may limit the opportunity of treatment. Diabetics that are not referred to an ophthalmologist are a vulnerable population, which could lose vision as a result of delayed attention. MATERIAL AND METHODS: Observational, descriptive, prospective, cross-sectional study in diabetics attending a hospital for non-ophthalmological causes, without prior evaluation of the ocular fundus. The proportion of eyes with vision-threatening diabetic retinopathy, and that of eyes in which visual loss could be prevented were identified. RESULTS: 100 patients, mean age 55.5 years, 53 females; 48 had diabetic retinopathy, six had proliferative retinopathy (6%; 95% CI: 1.3-10.7), and 23 had macular edema (23%; 95% CI: 14.8-31.2); the proportion of diabetic macular edema was higher than the one reported in the same population 15 years before (odds ratio 4.01; 95% CI: 1.98-8.15). Fifty-six percent of the patients with vision-threatening retinopathy did not have visual deficiency. CONCLUSION: Detection and referral of diabetic patients with risk of visual loss must be made easier, regardless of their visual symptoms, in order to achieve treatment efficacy by timely care.

Postoperative Choroidal Vascular Biomarkers in Eyes with Rhegmatogenous Retinal Detachment-Related Giant Retinal Tears.

PURPOSE: Choroidal vascularity index (CVI) and choriocapillaris flow area (CFA) are perfusion biomarkers relevant to retinal disease management. There is limited knowledge regarding these biomarkers in eyes that have been successfully treated for rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs). This study aimed to analyze the relationship between choroidal perfusion biomarkers and functional outcomes in surgically treated eyes with GRT-associated RRD and their fellow eyes. METHODS: A total of 33 GRT eyes and 29 fellow eyes were included in this study. All RRD-GRT eyes were treated with vitrectomy and categorized into two groups based on whether additional scleral buckles (SB) were placed. Visual and choroidal features were compared between the groups. RESULTS: The subjects had an average age of 55.18 years, a mean time of 2.36 weeks before surgery, and a mean follow-up time of 25.9 months. Best-corrected visual acuity (BCVA) was substantially worse in GRT eyes (1.9 logMAR) than in fellow control eyes (0.23 logMAR) but substantially improved after surgery (0.59 logMAR). There were no differences in the presurgical characteristics and BCVA between the eyes that did and did not undergo SB. Long-term CVI and CFA were lower in eyes with GRT than in their fellow eyes. Among eyes with GRT, those with SB had significantly lower CVI and CFA. Correlation analysis revealed that the CVI and CFA were positively correlated with visual outcomes (negative correlation with logMAR). CONCLUSION: Despite successful surgical repair, long-term functional and choroidal evaluations showed permanent changes in eyes with GRT. Positive correlations between perfusion biomarkers and visual function suggest that better choroidal vasculature is associated with better visual outcomes. The results of this study highlight the benefits of analyzing choroidal vasculature biomarkers and the relationship between the choroidal anatomy and vision.

Determining the Superiority of Vitrectomy vs Aflibercept for Treating Dense Diabetic Vitreous Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10-0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: -0.04-0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71-9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09-4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.

Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes.

BACKGROUND: We conducted a systematic review to compare  the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS: Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared  with  PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively.  Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL  or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.