Associated Retinal Consultants

Among patients receiving ongoing intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy who experience stroke or myocardial infarction (MI), evidence is limited on the systemic safety of continuing injections and whether treatment should be paused or modified. To evaluate whether, among patients receiving intravitreal anti-VEGF therapy who experience cardiovascular events (CVE), there exist associations between anti-VEGF treatments administered shortly before or after CVE (peri-CVE) and mortality or major functional outcomes, and to evaluate whether systemic outcomes differ by anti-VEGF agents. This was a retrospective cohort study of TriNetX network deidentified electronic health records (EHR) from 2005 to 2025. This study setting was a multicenter, EHR-based network analysis including individuals with stroke or MI with established anti-VEGF history (≥3 months pre-CVE), matched between those receiving 1 or more anti-VEGF injections within 14 days before or up to 6 weeks after CVE and those with no anti-VEGF from 3 months before to 3 months after. Propensity score matching (PSM) balanced demographics, comorbidities, procedures, systemic medications, laboratory values, and anti-VEGF agent history. Exposures included intravitreal anti-VEGF during the peri-CVE window vs no peri-CVE anti-VEGF. Sensitivity analyses restricted exposure to 14 days or fewer pre-CVE and compared aflibercept, bevacizumab, or ranibizumab with other agents. The primary outcomes were 3-month and 1-year all-cause mortality, poststroke neurologic deficits, and post-MI heart failure. Data were expressed in relative risks (RRs) with 95% CIs. A total of 6073 and 5381 individuals with stroke or MI, respectively, were included before PSM. After PSM (1526 pairs with stroke; exposure [received peristroke anti-VEGF], mean [SD] age, 72.1 [12.9] years; 822 female [53.9%]; control [did not receive peristroke anti-VEGF], 72.7 [13.3] years; 840 female [55.0%]; and 1523 pairs with MI, exposure [received peri-MI anti-VEGF], 71.4 [13.5] years; 809 male [53.1%]; control [did not receive peri-MI anti-VEGF], 71.5 [13.3] years; 798 male [52.4%]), peristroke anti-VEGF was associated with lower mortality at 3 months (RR, 0.39; 95% CI, 0.29-0.53) and 1 year (RR, 0.52; 95% CI, 0.43-0.63) and fewer neurologic deficits at 3 months (RR, 0.64; 95% CI, 0.46-0.89) but not 1 year (RR, 0.79; 95% CI, 0.62-1.01). Peri-MI exposure was associated with lower mortality at 3 months (RR, 0.34; 95% CI, 0.26-0.43) and 1 year (RR, 0.58; 95% CI, 0.49-0.68) and lower heart failure at 3 months (RR, 0.65; 95% CI, 0.46-0.93) but not 1 year (RR, 0.87; 95% CI, 0.68-1.11). Timing-restricted analyses showed similar mortality findings without differences in neurologic deficits or heart failure. In agent-specific comparisons, there were no differences across aflibercept, bevacizumab, or ranibizumab for any outcome. Results of this cohort study reveal that peri-CVE anti-VEGF was not associated with increased mortality or morbidity. Outcomes did not differ among commonly used agents, supporting the safety of continuing intravitreal anti-VEGF therapy without modification during the peri-CVE period.

Purpose: To describe optical coherence tomography (OCT) changes that occur with silicone oil tamponade that may contribute to vision loss. Methods: A retrospective consecutive cohort study was conducted on patients seen at a single center from 2015 to 2023. Inclusion criteria were patients who underwent pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment repair. Results: Thirteen patients met the inclusion criteria. In the macula-on group, average visual acuity (VA) was 20/60 (0.47 logMAR) while oil was in the eye, and at last follow-up following oil removal, was 20/30 (0.18 logMAR). Seven of 8 patients had resolved OCT outer retinal changes on oil removal. There was a significant improvement in vision with oil removal in comparison with VA prior to oil removal (P = .04). In the macula-off detachment group, patients' average VA prior to surgery with silicone oil was 20/400 (1.5 logMAR). Average VA was 20/400 (1.4 logMAR) during silicone oil tamponade, and at last follow-up, was 20/80 (0.61 logMAR). After oil removal, all OCT outer retinal changes resolved without improvement in vision compared with before oil removal (P = .057). Conclusions: We report outer retinal OCT changes with a subsequent decline in VA. More than 90% of these changes resolved, and VA improved following oil removal. Timely removal upon identification of these changes may improve final visual outcomes, depending on macular detachment status on presentation.

PurposeThe purpose of this study was to evaluate the relationship between retinal vascular density and retinal thickness (RT) using optical coherence tomography angiography (OCTA) in subjects with diabetic retinopathy (DR).MethodsOCTA scans were obtained on non-diabetic (control) and subjects with DR. DR was classified as mild nonproliferative DR (NPDR) or referable DR (moderate NPDR and worse) based on color fundus photographs. Full, superficial, and deep RT were quantified. Corresponding layer-specific capillary densities were quantified as vessel skeleton density (VSD) with and without large vessels. Tissue perfusion density (TPD) was defined as the ratio of layer-specific VSD-to-RT. Generalized estimating equations were used to adjust for inter-eye correlation, age, sex, hypertension, and hyperlipidemia.ResultsIn total, 147 subjects were recruited including 44 control subjects (73 eyes, 34% male subjects) and 103 subjects with subjects (144 eyes, 56% male subjects). In the superficial retinal layer, we observed: (1) capillary VSD and TPD were significantly lower with increased DR severity (P < 0.001), (2) no significant difference in full RT among study groups, (3) a novel significant association between VSD and RT among controls (r = 0.439, P < 0.001) that was absent or attenuated among subjects with diabetes. Similar findings were replicated in analyses of the full and deep retinal layers.ConclusionsThere is a significant correlation between retinal capillary density and thickness in control subjects which is absent or attenuated in DR. This relationship is reflected in a lower TPD measure that is primarily driven by a decrease in retinal capillary density in our cohort.

Purpose: To report clinical indications and outcomes of select vitreoretinal surgery in patients with Marfan syndrome. Methods: A retrospective consecutive case series of patients with Marfan syndrome undergoing surgery was performed. Data collected included demographics, systemic and ocular history, refraction, and preoperative and postoperative examination findings. Results: Twenty-seven patients (39 eyes) with Marfan syndrome who underwent vitreoretinal surgery were included. Mean age at time of surgery was 37 years, and mean follow-up duration was 4 years. Surgical indications for patients with Marfan syndrome included visually significant crystalline lens subluxation (n = 25 eyes), rhegmatogenous retinal detachment (RRD) (n = 9 eyes), and dislocated intraocular lens implants (n = 5 eyes). Best-corrected visual acuity was 20/40 or better in 21 eyes undergoing surgery for lens subluxation. For patients undergoing surgery for RRD, anatomic reattachment was achieved by last follow-up in 8 eyes (89%). Conclusions: Pars plana lensectomy and vitrectomy for crystalline lens subluxation was the most common vitreoretinal surgery in patients with Marfan syndrome.

Purpose: To analyze anatomic and visual outcomes of young adults with uncomplicated primary rhegmatogenous retinal detachment (RRD) treated with scleral buckle, pars plana vitrectomy (PPV), or combined PPV and scleral buckle. Methods: Patients included in the Primary Retinal Detachment Outcomes study with a minimum of 6 months follow-up were evaluated in this multicenter interventional cohort study,. Patients with complex RRDs were excluded. Primary outcomes were single surgery anatomic success and final visual acuity (VA). Results: Scleral buckle was performed in 91 eyes (55%), PPV in 32 (19%), and combined PPV and scleral buckle in 42 (25%). Single surgery anatomic success rates were 79.3% for PPV alone, 83.7% for primary scleral buckle, and 92.7% for combined PPV and scleral buckle (analysis of variance, P = .25). When adjusting for potential risk factors, eyes that had PPV alone were more likely to redetach compared with those that had combined PPV and scleral buckle (hazard ratio [HR], 7.24, 95% CI, 1.25-42.1; P = .03), while rates of redetachment were similar in eyes that had scleral buckle alone and combined PPV and scleral buckle (HR, 3.24, 95% CI, 0.63-16.63; P = .16). However, eyes that had combined PPV and scleral buckle were less likely to result in good vision compared with eyes that had scleral buckle alone (odds ratio [OR], 0.26, 95% CI, 0.07-0.94; P = .04). Similarly, eyes that had PPV alone were less likely to obtain good vision compared with eyes that only had scleral buckle (OR, 0.20, 95% CI, 0.05-0.81; P = .02). Conclusions: For young adults in this study, the best visual outcomes resulted from scleral buckle, and a higher single surgery success rate was found with combined PPV and scleral buckle.

Uveal melanoma (UM) is an aggressive cancer of the eye that frequently results in metastatic death. UMs are most likely to metastasize when they are small, at a time when they are difficult to distinguish from benign nevi and often observed without treatment. Unfortunately, little is known about the early genetic evolution of UM or potential biomarkers to indicate small tumors undergoing malignant transformation. Here, we performed targeted next generation sequencing for the 7 canonical UM driver mutations in 1140 primary UMs, including 131 small early-stage tumors. We found that the evolutionary burst of genetic aberrations that determines the archetypal UM subtypes and metastatic propensity has already occurred by the time most small tumors are biopsied, although a significantly larger proportion of small tumors are still evolving compared to larger tumors. We found that the 15-gene expression profile (15-GEP) support vector machine discriminant score was the best indicator of tumors in transition from low-risk Class 1 to high-risk Class 2 signature. While BAP1, SF3B1 and EIF1AX mutations were associated with poor, intermediate and good prognosis, respectively, mutation analysis was inferior to the prospectively validated 15-GEP + PRAME expression classifier for predicting metastasis-free and overall survival. These results provide a more complete picture of genetic evolution in UM, and they move us closer to a molecular definition of malignant transformation in this cancer type.

ABSTRACT Purpose We report a case of an atypical multifocal choroiditis with retinal vasculitis associated with positive West Nile serology. Methods Retrospective case report. Results A healthy 18-year-old man presented with floaters in the left eye that started while backpacking in Wyoming. Examination and testing revealed numerous chorioretinal lesions in the left eye, as well as retinal vasculitis and evidence of branch retinal vein occlusion. Serology was positive for West Nile Virus. Conclusion West Nile virus may be a trigger for development of multifocal choroiditis in susceptible individuals.

Libraries are no longer just repositories of books; they are dynamic spaces where information is curated, organized, and disseminated. In this modern era, the field of Library and Information Science (LIS) demands more than just technical knowledge. Soft skills, including communication, empathy, adaptability, and problem-solving play a crucial role in the success of library professionals. This paper explores the significance of soft skills in LIS, their impact on various aspects of library services, and the evolving role of librarians in the digital age. In today’s context, soft skills are a buzz word to minimize the knowledge gap among the various operational individuals of an organization, which deals with personal attributes, social skills, and qualities. Soft skills are crucial in the workplace and in various aspects of life, as they often determine how well someone can work with others, solve problems, and navigate complex situations. These skills are not typically taught in formal education settings but are developed through experience, social interactions, and self-reflection. This analytical study is based on the research output of the publications on ‘soft skills with reference to LIS education and librarianship’. Today soft skills are need of the hour, as these minimize the gaps, what we preach and practice in the field of library and information science. This analytical study depicted that organizations/institutions are striving for soft skills training and development for their different stakeholders such as students and employees. Authors extracted (n=510) papers for the period 2011 to 2020 using various ontological key words based search. Based on the combination of keywords-based searches, the outcome was that in 2020 (n = 94) had the maximum number of documents. Among the other countries, the USA has the highest number of publications (n = 237) and the most studied document type is article (n = 283). Based on this analysis, the authors want to examine the inferences the need of soft skills development in the country to minimize the knowledge gap in the field of library and information science.

To describe multiple retained intraocular foreign bodies felt to be from a vitrectomy instrument. Observational case report. A 66-year-old man with history of rhegmatogenous retinal detachment repaired with pars plana vitrectomy, scleral buckle, endolaser, and fluid-air exchange presented with dyschromatopsia in the right eye. Optical coherence tomography demonstrated metallic vitrector shavings detected on optical coherence tomography above the optic nerve head and macula. Repeat optical coherence tomography 9 months later demonstrated movement of the vitrector shavings throughout the vitreous. We demonstrate retained intraocular foreign body shavings, which are rarely seen after vitrectomy. These can be confirmed using optical coherence tomography.