During the 2024 AAO annual meeting, researchers presented various studies on retinal disease and treatment options.
Bryon McKay, MD, PhD, and colleagues investigated the progression of outer retinal recovery over two years following vitrectomy for fovea-off rhegmatogenous retinal detachments (RRDs). A retrospective analysis of 198 eyes (average age 59) was conducted, focusing on best-corrected visual acuity (BCVA) and the structural integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IDZ) using spectral domain optical coherence tomography (SD-OCT). Results showed a significant BCVA improvement, from 1.45 logMAR pre-surgery to 0.51 logMAR at 24 months (P<0.05). ELM discontinuity decreased from 34% at 3 months to 21% at 24 months, EZ from 49% to 27%, and IDZ from 62% to 31%, all with statistical significance (P<0.05 or better). The study concluded that retinal microstructure restoration occurs gradually: the ELM repairs first, followed by the EZ and IDZ, with continuous improvement noted up to 24 months.
Andrea Cusumano, MD, and co authors examined retinal changes associated with cefuroxime ocular toxicity syndrome (COTS) after cataract surgery in four patients who developed serous retinal detachments following intracameral cefuroxime injection (1.0 mg/0.1 mL). Ophthalmological exams and optical coherence tomography (OCT) were conducted preoperatively (T0) and at intervals post-surgery: 1 day (T1), 1 week (T2), and 1 month (T3). Two patients also underwent electroretinography (ERG), and one had OCT angiography and visual field perimetry. Results showed that all patients had visual acuity < 20/200 on T1, improving to 20/20 by T2 and T3, with OCT revealing serous retinal detachments at T1 that resolved by T2. Vessel density decreased at T1 but partially recovered at T2-T3, while ERG and perimetric values were abnormal at T1, improving over time. Notably, two patients had undergone previous vitrectomy with internal limiting membrane (ILM) peeling, and one had an anterior vitrectomy due to an intraoperative posterior capsule rupture. The study concluded that COTS-related retinal changes may persist after fluid resolution, and prior vitrectomy or anterior vitrectomy may increase risk.
Glenn Oh, MD, and colleagues evaluated how post-penetrating keratoplasty (PK) complications, such as pars plana vitrectomy (PPV), retinal detachment (RD), and vitreous hemorrhage (VH), affect graft survival. A retrospective chart review was conducted on 835 eyes from 835 patients treated at a single tertiary center between May 2007 and September 2018. The data included demographics, medical and ocular history, and intraoperative and postoperative events. Thirty-two variables were analyzed using multivariate Cox regression after initial univariate analysis. Patients had an average age of 57.1 years, with a mean follow-up period of 4.22 years. Graft failure was reported in 35% of cases, typically occurring 1.9 years post-PK. Twelve variables significantly affected graft survival, with four post-PK retinal factors associated with higher failure risk: PPV (P =0.018), silicone oil tamponade (P =0.020), air tamponade (P =0.039), and VH (P =0.002). The study concluded that graft failure is a significant complication of PK, and specific post-PK interventions, including PPV and tamponade methods, are associated with an increased risk of graft failure.
Neil Sheth, MD, and colleagues analyzed national trends in retinal imaging and procedures from 2013 to 2021 using Medicare data. It focused on the use of optical coherence tomography (OCT), fundus photography (FP), fluorescein angiography (FA), indocyanine green angiography, ophthalmic ultrasound, panretinal photocoagulation (PRP), and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Results showed a 5.02% annual increase in OCT use, while FA declined by 12.17% per year, with other imaging modalities also decreasing as a share of retinal imaging (P<0.001). Anti-VEGF injections rose annually by 3.83%, while PRP usage declined by 8.96% each year, including a 30% drop from 2019 to 2020. The study concluded that OCT is increasingly replacing FA and PRP in retinal disease diagnosis and treatment, paralleling an increase in anti-VEGF injections. These trends were further intensified by the COVID-19 pandemic, which accelerated the decline in certain imaging and procedural modalities.
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