Ophthopedia’s Post

Ophthopedia Update:Impact of residual retinal fluid on treatment outcomes in neovascular age-related macular degeneration: Treatment decisions for neovascular age-related macular degeneration (nAMD) in the setting of individualised treatment regimens are adapted to disease activity. The main marker of disease activity and trigger for re-treatment with anti-vascular endothelial growth factor (anti-VEGF) agents is the presence of retinal fluid on optical coherence tomography (OCT). Recently, attention has focused on the impact of residual retinal fluid on nAMD management. Based on a literature review and the combined clinical experience of an international group of retinal specialists, this manuscript provides expert guidance on the treatment of nAMD according to fluid status and proposes an algorithm for determining when to administer anti-VEGF treatment according to residual fluid status. We explore the role of residual fluid in treatment decisions and outcomes in nAMD, taking into consideration fluid evaluation and, in particular, distinguishing between fluid in different anatomic compartments and at different stages during the treatment course. Current limitations to identifying and interpreting fluid on OCT, and the assumption that any residual retinal fluid reflects ongoing VEGF activity, are discussed. #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Association between metformin use with circumpapillary retinal nerve fibre layer thickness and capillary vessel density in glaucoma: Background/aims To investigate the association between use of metformin and circumpapillary retinal nerve fibre layer (cpRNFL) thickness, as well as whole image capillary density (wiCD), in patients with glaucoma.Methods This cross-sectional study included patients with glaucoma suspect or primary open-angle glaucoma (POAG) underwent optical coherence tomography angiography imaging. Use and duration of antidiabetic medications were assessed at the time of imaging. Multivariable linear mixed-effect modelling was used to estimate the effect of diabetes medication on wiCD and cpRNFL while controlling for covariates including age, race, body mass index, diagnosis, 24–2 visual field mean deviation, and intraocular pressure, average signal strength index as well as any variables that showed a p #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Decreased macular deep capillary plexus is associated with functional progression of normal tension glaucoma patients with unilateral visual field loss: Purpose To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina are associated with the development of visual field (VF) loss in the fellow eyes of normal tension glaucoma (NTG) patients with unilateral VF loss. Methods A longitudinal study was conducted in which 61 eyes with normal VF (mean VF mean deviation –0.7±1.6 dB) from 61 NTG patients were included. All subjects underwent OCTA imaging, spectral-domain-OCT imaging and VF testing. OCTA metrics of superficial capillary plexus and deep capillary plexus (DCP) in the macular region were measured. Relationships between baseline OCTA metrics, demographics and ocular characteristics and the risk of VF glaucoma progression were analysed with a Cox proportional hazards model. Results During a mean follow-up of 38 months, 11 fellow eyes (18.0%) with normal VF at baseline were determined to have VF progression, while 21.3% of affected eyes had VF progression. After adjustment for potential confounding factors, decreased baseline DCP in the fellow eyes was significantly associated with future VF progression (HR 1.33, 95% CI 1.03 to 1.73, p=0.031). Conclusion Decreased DCP was associated with a higher risk of developing VF damage in NTG patients with unilateral VF loss. Assessments of DCP may help improve the evaluation of the risk of functional deterioration in fellow eyes with an initially normal VF. #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Choroidal neovascularisation secondary toX-linked retinoschisis: Aims Choroidal neovascularisation (CNV) in patients with X-linked retinoschisis (XLRS) has been poorly documented. This study aims to investigate the prevalence and clinical characteristics of CNV in patients with XLRS, as well as analyse the preliminary genotype–phenotype correlation.Methods A retrospective case series of patients with genetically confirmed XLRS was included. Demographic, clinical and genetic features were analysed, with a comparison between CNV and non-CNV eyes.Results Among 185 eyes of 129 patients with XLRS, the prevalence of CNV was 8.1% (15/185). The mean diagnostic age of all patients with CNV is 5.1±2.56 years. CNV eyes exhibited a mean best-corrected visual acuity (BCVA) (logarithm of the minimal angle of resolution) of 1.37±0.74. All CNVs were classified as subretinal and active. Peripapillary CNVs accounted for 80.0% (12/15), while subfoveal CNVs accounted for 20.0% (3/15). In CNV eyes, the prevalence of macular atrophy (5/15, 33.3%, p=0.013) and bullous peripheral schisis (14/15, 93.3%, p=0.000) was higher compared with non-CNV eyes. Additionally, CNV eyes exhibited poorer integrity of the outer retina and BCVA (p=0.007) compared with non-CNV eyes. All 15 eyes with CNV underwent anti-vascular endothelial growth factor (anti-VEGF) therapy. Genotype analysis revealed that 7 of 10 patients (70.0%, 10 eyes) were predicted to have missense variants, while 3 of 10 patients (30.0%, 5 eyes) exhibited severe variants.Conclusions The prevalence of CNV in XLRS eyes was found to be 8.1%. All CNVs secondary to XLRS were active and classified as type 2. CNV eyes demonstrated poorer visual function and compromised retinal structures. Anti-VEGF therapy demonstrated effectiveness in treating XLRS-CNVs. No significant genotype–phenotype correlation was established. #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Retinotopic cortical mapping in objective functional monitoring of macular therapy: Background/Aims To determine the suitability of functional MRI (fMRI) as an objective measure of macular function following therapeutic intervention; conventional psychophysical measures rely heavily on patient compliance.Methods Twenty patients with neovascular age-related macular degeneration (nAMD) were studied with high-resolution fMRI, visual acuity, reading accuracy and speed, contrast sensitivity (CS) and microperimetry (MP) before and after 3 monthly intravitreal injections of ranibizumab. Population-receptive field retinotopic maps calculated from fMRI data were compared with psychophysical measures and optical coherence tomography.Results Best-corrected visual acuity (BCVA) responders (≥5 letters) showed an increase of 29.5% in activated brain area, while non-responders showed a decrease of 0.8%. Radial histograms over eccentricity allowed quantification of the absolute number of significant voxels and thus differences before and after treatment. Responders showed increases in foveal (α #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Foveal atrophy in patients with active central serous chorioretinopathy at first presentation: characteristics and treatment outcomes: Background/aims This study aimed to investigate the clinical characteristics and treatment outcomes of patients with active central serous chorioretinopathy (CSC) and foveal atrophy.Methods Patients diagnosed with active idiopathic CSC using multimodal imaging and followed up for at least 6 months were included. They were divided into two groups (foveal atrophy group vs foveal non-atrophy group) according to a cut-off central foveal thickness of 120 µm on baseline optical coherence tomography (OCT). Baseline characteristics, angiographic and tomographic features and treatment outcomes were compared between the two groups.Results Of the 463 patients, 92 eyes of 92 patients (19.9%) were in the foveal atrophy group and 371 eyes of 371 patients (80.1%) were in the foveal non-atrophy group. The baseline subretinal fluid (SRF) height was 111.3±76.8 µm in the foveal atrophy group and 205.0±104.4 µm in the foveal non-atrophy group on OCT images (p #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Intraocular pressure reduction and progression of highly myopic glaucoma: a 12-year follow-up cohort study: Aims To investigate any association between intraocular pressure (IOP) reduction amount and open-angle glaucoma (OAG) progression in highly myopic eyes and to determine the associated risk factors.Methods One hundred and thirty-one (131) eyes of 131 patients with highly myopic OAG, all of whom had received topical medications and been followed for 5 years or longer, were enrolled. Based on the IOP reduction percentage, patients were categorised into tertile groups, and subsequently, the upper-tertile and lower-tertile groups were compared for the cumulative probability of glaucoma progression. Kaplan-Meier survival analysis and log-rank testing were applied in the comparison, and multivariate analysis with Cox’s proportional hazard model, additionally, was performed to identify progression risk factors.Results Throughout the average 11.6±4.4 year follow-up on the 131 eyes (mean age, 41.2 years at initial visit; baseline IOP, 16.4 mm Hg), 72 eyes (55.0%) showed glaucoma progression. The upper-tertile group (IOP reduction percentage>23.7%) showed a high cumulative probability of non-progression relative to the lower-tertile group (IOP reduction percentage #Ophthalmology #Ophthotwitter #BJO

Although it has been estimated that cholecystitis develops in 3.5 – 12% of cases following the deployment of self-expandable metal stents (SEMS) for distal biliary obstruction during Endoscopic Retrograde Cholangiopancreatography (ERCP), our retrospective review indicates a lower incidence of 1.9%. Notably, all cases of cholecystitis occurred in patients with malignant biliary obstruction. The reduced incidence in our study may be attributed to the use of prophylactic antibiotics.

Honored to have contributed to the multicenter study led by Prof. Michael J. Bourke and first-authored by Tim O'Sullivan, published in Gut journal, on the impact of margin thermal ablation after EMR of large non-pedunculated colonic polyps on long-term recurrence. Another piece of evidence that could change clinical practice, produced by the #Westmead group. 🏬 4 international #centers involved, with Westmead Hospital as lead center 🛑 1152 LNPCPs treated 📉 Recurrence at SC2 was significantly lower in the MTA group compared to controls (0.2% vs 3.5%; p<0.001). For patients with successful #EMR and margin #ablation who are recurrence-free at SC1, the next surveillance could potentially be extended to 3-5 years, provided the colon is cleared of #synchronous neoplasia. Michael J. Bourke Tim O'Sullivan SIES-Westmead Sydney International Endoscopy Symposium Julia Gauci Anthony Whitfield Clarence Kerrison @James Elhindi @Catarina Neto do Nascimento Sunil Gupta @Oliver Cronin Anthony Sakiris @Juan Francisco Prieto Aparicio @Sophie Arndtz @Gregor Brown Spiro Raftopoulos David Tate Dr Eric Lee @Stephen Williams @Nicholas Burgess https://lnkd.in/gS6BNdeB

Neurovascular-Nugget 25 Reading of this manuscript may reflect 🎹 Key Findings: 🎹 ### Main Points ### #### Study Overview 👆**Objective:** Evaluate the safety and effectiveness of single-stent assisted coiling (L-stenting) in treating wide-neck bifurcation aneurysms (WNBAs). 👆 **Methods:** Retrospective study of 128 patients treated between 2015-2019 at three academic institutions. Angiographic imaging was evaluated by a core lab for accuracy. 👆 **Results:** 👆 **Patients:** 128 patients; 124 had follow-up angiographic data. 👆 **Outcomes:** - 88.7% had adequate occlusion (mRR 1 or 2). - 14.8% required retreatment. - Complications in 9.4% of patients, with 6.25% intraoperative SAEs. - **Predictors of Success:** Smaller aneurysm size and use of the transcellular technique. - **Predictors of Retreatment:** Larger aneurysm size, neck size, and dome to neck ratio. 👆 **Follow-Up:** Mean follow-up of 15.8 months. ### Main Points 🛜. **Effectiveness:** - High rate of adequate occlusion (88.7%). - 59.4% complete occlusion at last follow-up. 🛜. **Safety:** - 17 complications in 12 patients (9.4%). - No intraoperative or periprocedural aneurysmal ruptures. 🛜. **Technique:** - Single-stent L-stenting is effective and reduces the amount of metal used compared to dual-stent techniques. 🛜. **Comparison:** - Favorable outcomes compared to other techniques like Y-stenting and new devices like the WEB device. 🛜. **Predictors:** - Smaller aneurysm size and transcellular technique predict better outcomes. - Larger size and dome to neck ratio predict higher retreatment rates. ### Clinical Implications ### ✅**Treatment Choice:** - Single-stent L-stenting presents a viable alternative to dual-stent techniques, potentially reducing thromboembolic complications and procedural costs. ✅ **Patient Selection:** - Patients with smaller aneurysms and those suitable for the transcellular technique may benefit most from L-stenting. ✅ **Procedure Planning:** - Understanding predictors of success and retreatment can aid in better patient selection and pre-procedural planning. ✅ **Benchmarking:** - This study provides a validated comparator for future studies on new devices and techniques for WNBAs, setting a benchmark for efficacy and safety. ✅ **Cost Considerations:** - L-stenting could be more cost-effective due to the reduced use of stents and lower complication rates, though further studies are needed to confirm this. https://lnkd.in/dU984vPT