Evaluation of Diabetic Retinopathy in Patients With Diabetes Mellitus Using 2D-Shear Wave Elastography (SWE), Ultra-Microangiography (UMA), and Doppler Imaging.

To evaluate the long-term functional and anatomical outcomes of pars plana vitrectomy (PPV) combined with subretinal recombinant tissue plasminogen activator (tPA) injection and gas tamponade in patients with subretinal hemorrhage secondary to retinal arterial macroaneurysm (RAM) rupture. This retrospective multicenter study included 18 eyes of 18 patients who underwent PPV with subretinal tPA injection and gas tamponade for subfoveal hemorrhage because of RAM rupture. Baseline demographic and clinical features, pre- and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT), postoperative complications, and the relationship between symptom-to-surgery interval and visual outcomes were evaluated over a minimum follow-up period of 12 months. The mean preoperative BCVA was approximately 20/3,300 (2.22 ± 0.73 logMAR), improving to approximately 20/140 (0.85 ± 0.57 logMAR) at the 12-month visit ( P < 0.001). Earlier surgical intervention (≤14 days) was associated with greater improvement in BCVA. Subfoveal retinal pigment epithelium (RPE) atrophy developed in 38.9% of patients and was significantly associated with worse visual outcomes compared with extrafoveal atrophy ( P = 0.02). ILM peeling was performed in 44.4% of cases; although those patients tended to have greater BCVA gains, the difference was not statistically significant. RPE atrophy was observed in 77.8% of patients postoperatively, with varying progression patterns. PPV with subretinal tPA injection and gas tamponade appears to be an effective treatment for RAM-related subretinal hemorrhage, with significant improvements in visual acuity, particularly when performed within 2 weeks of symptom onset. The location of postoperative RPE atrophy is a critical prognostic factor for visual outcomes.

Previous studies have identified inequities in stroke epidemiology. Given retinal artery occlusion (RAO) is a stroke equivalent, we investigated risk factors and social determinants of health (SDOH) associated with RAO. This was a retrospective case-control study. The case group consisted of all patients diagnosed with RAO in the National Institutes of Health All of Us database from November 1992 to November 2020. The control group consisted of all patients without a diagnosis of RAO during that time frame. Associations of predictors of RAO were estimated using logistic regression models. There were 384 patients with an RAO diagnosis and 328,639 participants in the non-RAO group. Median age at RAO diagnosis was 66 years (interquartile range [IQR] 57-72). Median age at study was 74 years (IQR 67-81) for the RAO group and 58 years (IQR 42-69) for the control group. Age- and sex-adjusted multivariable analysis revealed factors positively associated with RAO, including older age {odds ratio [OR]: 2.19 (95% confidence interval [CI]: 2.01-2.39), P < 0.001}, male sex (OR: 1.54 [95% CI: 1.25-1.89], P < 0.001), Black race (OR: 1.62 [95% CI: 1.24-2.09], P < 0.001), military/Veterans Affairs insurance (OR: 2.44 [95% CI: 1.61-3.66], P < 0.001), and Medicaid (OR: 1.51 [95% CI: 1.06-2.15], P = 0.022). Having a college/advanced degree (OR: 0.76 [95% CI: 0.59-0.98], P = 0.031), annual household income between $50,000 and $100,000 (OR: 0.72 [95% CI: 0.52-0.98], P = 0.035), and annual household income between $100,000 and $200,000 (OR: 0.48 [95% CI: 0.32-0.70], P < 0.001) were protective against RAO. These findings confirm previously described associations between RAO and cardiovascular comorbidities and identified novel associations between RAO and SDOH, including Black race and Medicaid insurance. Stroke risk around the time of RAO was high in this cohort.

To contrast retinal and choroidal vascular alterations between carotid artery dissection (CAD) and carotid artery stenosis (CAS), and analyze their associations with cerebral infarction patterns and stenosis severity. This observational study included stenotic-degree-matched patients with CAD and patients with CAS. Retinal ischemic signs-cotton wool spots, retinal artery occlusion, and paracentral acute middle maculopathy-were evaluated using fovea-centered optical coherence tomography/angiography. Retinal vascular density and choroidal metrics (choriocapillaris density, thickness, vascular volume, and index) were analyzed. The final analysis included 863 eyes from 467 participants (85 with CAD, 274 with CAS, 108 controls). Patients with CAD showed a significantly higher prevalence of paracentral acute middle maculopathy than Patients with CAS (6.4% versus 0.61%, P<0.001). Although ipsilateral eyes in both groups showed reduced retinal vascular density (P<0.017), a divergent pattern was observed in the choroid: CAD-affected eyes demonstrated significantly higher choriocapillaris density, choroidal vascular volume, and choroidal thickness relative to both control and CAS-affected eyes (P<0.017). Clinically, retinal ischemic signs in CAD were significantly associated with cerebral infarction (P=0.022) and severe stenosis/occlusion (P=0.008). Notably, retinal signs correlated with cerebral infarction topography: subcortical infarctions were predominantly associated with paracentral acute middle maculopathy, whereas cortical infarctions were linked to cotton wool spots and retinal artery occlusion (P=0.004). Compared with atherosclerotic stenosis, CAD exhibits a distinct oculovascular phenotype characterized by a higher burden of acute retinal ischemia but compensatory choroidal hyperperfusion. Retinal imaging serves as a noninvasive window into CAD pathophysiology, offering biomarkers for assessing hemodynamic stability and thromboembolic risk. URL: www.chictr.org.cn; Unique identifier: ChiCTR2300074640.

Purpose: To report a rare case of invasive sino-orbital aspergillosis initially presenting with orbital apex syndrome and subsequently progressing to facial nerve palsy and ischemic stroke.Case summary: A 58-year-old man presented with right-sided ptosis, upper eyelid swelling, and diplopia. Imaging and clinical findings were consistent with orbital apex syndrome. Intravenous antibiotic therapy was initiated; however, there was rapid deterioration in vision and ocular motility. After consultation with the otolaryngology department, high-dose intravenous corticosteroids were administered. Subsequently, the patient developed right-sided facial nerve palsy, central retinal artery occlusion, and right internal carotid artery occlusion, indicating disease progression. Histopathological examination later confirmed invasive aspergillosis. Corticosteroids were discontinued, and antifungal therapy combined with orbital exenteration led to clinical improvement.Conclusions: Invasive aspergillosis can rapidly extend to the orbit and intracranial structures, and corticosteroid administration without first excluding fungal infection may accelerate disease progression. The presence of facial nerve palsy and cerebrovascular complications suggests extensive angioinvasive spread, highlighting the importance of early diagnosis, prompt antifungal therapy, and surgical debridement. In patients with immunocompromising conditions, such as diabetes mellitus, fungal infection should always be strongly suspected and excluded at the outset to prevent severe complications.

To describe the long-term clinical and imaging features of the perivascular phenotype of multifocal choroiditis with panuveitis (PV-MFCPU). Retrospective observational case series of eight patients (14 eyes) diagnosed with PV-MFCPU at tertiary uveitis referral centers. Clinical data and multimodal imaging-including ultra-widefield color fundus photography (CFP), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography-were reviewed at all available visits, with analyses focused on baseline and final follow-up visits. A comprehensive systemic work-up was performed to exclude infectious, autoimmune, and neoplastic etiologies. Median age at presentation was 27 years (IQR, 17-51), with a median follow-up of 5.4 years (IQR, 3-10.1). Disease was bilateral in 6/8 patients (75%). Lesions demonstrated a reproducible perivascular distribution along retinal arteries and/or veins, frequently extending into the mid- and far-periphery. On CFP and FAF, lesions appeared as pigmented, hypoautofluorescent spots evolving into sharply demarcated atrophic scars. FA showed late hyperfluorescent staining without leakage. OCT revealed outer retinal and retinal pigment epithelium disruption, subretinal hyperreflective material (SHRM), vertical hyperreflective column bridging the SHRM and overlying retinal vessels, and progression to atrophy. Infectious and inflammatory evaluations were negative in all cases. Mild, transient anterior segment or vitreous inflammation was observed in a minority of eyes. Median BCVA remained stable at 20/25 (IQR, 20/32-20/20). Choroidal neovascularization occurred in 3/14 eyes (21%) and responded to anti-VEGF therapy. PV-MFCPU represents a perivascular topographic phenotype within the MFCPU spectrum. Recognition of PV-MFCPU may improve differentiation from vasculitic and inflammatory chorioretinal mimickers.

Central Retinal Artery Occlusion: Early Diagnosis With Advanced Ultrasound Transorbital Doppler Imaging.

Rationale:Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by sustained thrombocytosis, which can lead to thrombotic complications including retinal artery occlusion. We report a rare case of recurrent central retinal artery occlusion (CRAO) as the initial manifestation of ET.Patient concerns:A 37-year-old female presented with recurrent transient monocular blindness in the right eye, progressing to persistent amaurosis. Ophthalmic examination revealed findings consistent with acute CRAO, accompanied by significantly elevated platelet counts. Emergency treatment for CRAO restored visual acuity from no-light-perception to 0.8 within 1 hour. Optical coherence tomography showed increased diffuse reflectance at the level of the inner nuclear layer consistent with paracentral acute middle maculopathy. Two recurrent CRAO episodes occurred over the following 2 years, with platelet counts persistently elevated.Diagnoses:Bone marrow biopsy revealed megakaryocytic hyperplasia, and genetic testing confirmed JAK2 mutation, establishing the diagnosis of ET.Interventions:The patient was treated with hydroxyurea and aspirin.Outcomes:Following treatment, the patient achieved normalization of platelet levels with no further episodes of amaurosis. However, discontinuation of medication led to recurrent thrombocytosis and a subsequent cerebral infarction.Lessons:This case highlights that recurrent CRAO in young patients should prompt investigation for underlying hematological disorders such as ET. Early diagnosis, appropriate cytoreductive and antiplatelet therapy, and long-term multidisciplinary follow-up are essential to prevent vision loss and life-threatening thrombotic complications.

To evaluate the prevalence and characteristics of retinal ischemic perivascular lesions (RIPLs) in the clinically unaffected fellow eyes of patients with unilateral central retinal artery occlusion (CRAO) using spectral-domain optical coherence tomography (SD-OCT). This retrospective case-control study included 39 fellow eyes of patients with CRAO and 57 age-, sex-, and hypertension-matched healthy controls. Macular SD-OCT scans were assessed for the presence, number, and morphology of RIPLs, classified as narrow (<300 µm, peaked apex) or wide (>300 µm, flattened apex). Between-group comparisons were performed using appropriate parametric/non-parametric tests, and odds ratios (ORs) were calculated for RIPL presence. RIPLs were detected in 29/39 eyes (74.4%) in the CRAO fellow-eye group and 14/57 eyes (24.6%) in controls (p < 0.001). The mean number of lesions per eye was significantly higher in the CRAO group (1.36 ± 1.22) than in controls (0.35 ± 0.73; p < 0.001). Among CRAO fellow eyes with RIPLs, 5 eyes (17.2%) showed wide-type lesions, whereas all lesions in controls were narrow. The odds of RIPL presence were higher in the CRAO group (OR 8.12, 95% CI 3.20-20.57; p < 0.001). Increased RIPL burden in the fellow eyes of CRAO patients suggests that microstructural retinal changes may be detectable even in eyes without clinically evident arterial occlusion. Further longitudinal, multimodal studies are needed to determine the temporal course and underlying mechanisms.

Optic nerve metastasis with secondary combined central retinal artery and vein occlusion from small cell lung cancer.

Risk of dementia following retinal vascular occlusions: A propensity-score matched cohort study using a global federated database.

Update on Acute Retinal Arterial Ischemic Disorders.

Abstract: Primary myelofibrosis (PMF) is a rare myeloproliferative neoplasm that typically affects older adults but may present aggressively in younger patients. Thromboembolic complications are well recognized, though arterial occlusions are uncommon in this age group. Ocular ischemia associated with systemic inflammatory conditions such as Sweet’s syndrome is exceedingly rare. A 22-year-old female with PMF, diagnosed 18 months earlier and managed initially with ruxolitinib, presented with sudden, complete loss of vision in her left eye. She also had a history of Sweet’s syndrome managed with oral corticosteroids and had received multiple blood transfusions. Ophthalmic evaluation revealed no light perception in the left eye, a pale retina with attenuated vessels, and a cherry-red spot. Optical coherence tomography (OCT) showed hyperreflectivity of the inner retinal layers, and OCT angiography demonstrated markedly reduced perfusion in all vascular plexuses. Carotid Doppler, echocardiography, and ECG excluded embolic sources. Despite ocular massage, anterior chamber paracentesis, acetazolamide, and anticoagulation with apixaban, vision did not recover. One week later, she developed anterior uveitis, keratic precipitates, and elevated intraocular pressure. Fundus showed Amalric’s sign of choroidal infarction and Elschnig spots, confirmed on fluorescein angiography. Inflammation responded to topical and systemic corticosteroids, with normalization of intraocular pressure. This is the first documented case of combined central retinal artery occlusion and posterior ciliary artery occlusion with anterior uveitis in a young PMF patient with Sweet’s syndrome. The case underscores the multifactorial contribution of hypercoagulability, systemic inflammation, and transfusion-related factors in ocular ischemia.

Correlation between fundus color and retinal microcirculation in Type 2 Diabetes Mellitus patients.

To evaluate whether the COVID-19 pandemic was associated with changes in the incidence of retinal vascular occlusions. We performed a retrospective cohort study at the Jules-Gonin Eye Hospital (Lausanne). All new diagnoses of central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), central retinal artery occlusion (CRAO), and branch retinal artery occlusion (BRAO) between January 1, 2019 and December 31, 2020 were included. Regional COVID-19 case counts were obtained from public health records. Incidence rate ratios (IRR) comparing 2019 cases versus 2020 were calculated using official population data. Pearson correlation was used to explore temporal associations between monthly COVID-19 cases and retinal vascular events. The study period largely reflects natural infection exposure, as COVID-19 vaccination in Switzerland began on December 23, 2020. In 2019, 66 retinal vein occlusions (38 CRVO, 28 BRVO) and 20 arterial occlusions (9 CRAO, 11 BRAO) were recorded. In 2020, 49 retinal vein occlusions (34 CRVO, 15 BRVO) and 21 arterial occlusions (14 CRAO, 7 BRAO) were recorded. The IRR for 2020 versus 2019 was 0.73 for vein occlusions (95% CI 0.51-1.05; p=.093) and 1.04 for arterial occlusions (95% CI 0.57-1.90; p=.896). Monthly analysis showed no significant temporal association between COVID-19 incidence and retinal vascular events (p=.08). In this regional study, we did not observe an increase in retinal vascular occlusive events during the early phase of the COVID-19 pandemic. While biologically plausible mechanisms have been proposed, these population-level trends do not support a strong association.

Susac syndrome is a rare autoimmune disorder defined by the triad of encephalopathy, branch retinal artery occlusions (BRAO), and sensorineural hearing loss. Its nonspecific presentation often leads to misdiagnosis and delayed treatment, resulting in irreversible complications. We report a 28-year-old woman with six months of progressive headaches, transient visual symptoms, and behavioral changes, initially diagnosed as migraine and functional neurological disorder. Further evaluation revealed right temporal quadrantanopia, right BRAO, and sensorineural hearing loss, confirming Susac syndrome. Immunosuppressive therapy improved headaches, behavior, and hearing; however, visual deficits were permanent. Early recognition and prompt treatment are essential to prevent lasting neurological and ophthalmic damage.

Background/Objectives: Brain death determination in children is clinically challenging. When standard clinical examination cannot be completed or reliably interpreted, ancillary testing is required-yet many established methods depend on infrastructure or patient transport that may not be feasible in critically ill pediatric patients. Orbital ultrasonography is bedside-applicable and non-invasive, but remains poorly characterized in children. Methods: We conducted a single-center retrospective study of 28 pediatric patients evaluated for suspected brain death between January 2021 and February 2025. Patients were classified as brain death-positive [BD(+), n = 20] or brain death-negative [BD(-), n = 8] based on clinical criteria independent of imaging findings. Orbital color Doppler parameters (ophthalmic artery, central retinal artery, posterior ciliary artery) and optic nerve sheath diameter (ONSD) were measured under a standardized protocol by a single experienced operator. Ophthalmic artery resistive index (OA-RI) was defined a priori as the primary outcome; ONSD was the secondary outcome. Group comparisons used the Mann-Whitney U test with Cliff's delta effect sizes; false discovery rate correction was applied to secondary and exploratory comparisons. ROC analyses were performed to assess discriminative performance. The study was reported in accordance with the STARD 2015 guidelines for diagnostic accuracy research. Results: OA-RI was markedly higher in BD(+) patients (0.84 [IQR 0.80-0.90] vs. 0.65 [0.58-0.69]; p < 0.001; δ = 0.975). ROC analysis yielded an AUC of 0.99 (95% CI: 0.96-1.00); at a cut-off of ≥0.77, sensitivity was 95.0% and specificity 100.0%. ONSD also differed significantly between groups (4.75 [4.15-5.08] mm vs. 3.90 [3.40-4.15] mm; p = 0.012; δ = 0.619; AUC = 0.81, 95% CI: 0.62-1.00; cut-off ≥ 4.2 mm; sensitivity and specificity both 75.0%). Across all three orbital vessels, end-diastolic velocity was consistently reduced and resistive indices elevated in BD(+) patients. Systolic velocities did not differ meaningfully between groups. Cut-off values represent cohort-specific statistical optima and should be interpreted as exploratory. Conclusions: Orbital Doppler ultrasonography demonstrates a coherent high-resistance hemodynamic pattern in pediatric brain death. OA-RI showed strong discriminative performance and may serve as a useful bedside adjunct in selected cases where ancillary testing is indicated. ONSD provides complementary anatomical evidence. These findings are exploratory and require prospective validation in larger, multicenter pediatric cohorts.

Abstract Ischemia-induced retinopathy is a defining feature of prevalent ocular conditions, including diabetic retinopathy and central retinal artery or vein occlusion. Therapeutic interventions for ischemic retinopathies show limited efficacy and adverse effects, highlighting the need to thoroughly investigate the underlying mechanisms. Histone deacetylase 3 (HDAC3), a member of the histone deacetylase family, plays a central role in regulating gene expression in myeloid cells (microglia and macrophages). We recently showed that myeloid HDAC3 deletion promotes tissue repair and functional recovery after retinal ischemia-reperfusion (IR) injury via efferocytosis, a process by which myeloid cells engulf and clear apoptotic cells. Here, we investigated the mechanism by which myeloid HDAC3 deletion enhances efferocytosis. Employing an in vitro efferocytosis assay coupled with RNA sequencing on HDAC3 KO macrophages revealed that the secreted protein, CD5 molecule-like (CD5L), was the most upregulated among other pro-efferocytic genes. In vivo, we found that CD5L levels markedly increased in the retinas of myeloid HDAC3 KO mice subjected to IR injury, and its expression colocalized with myeloid cells. Co-immunoprecipitation experiments showed that HDAC3 represses CD5L expression in a liver X receptor (LXRα)-dependent manner. Additionally, we found that CD36, a receptor for CD5L that facilitates the clearance of apoptotic cells, was upregulated in retinal myeloid cells after IR. In vitro, CD5L treatment enhanced efferocytosis via CD36. We then evaluated the role of CD5L in retinal IR injury using in vivo neuronal, vascular, structural, and functional endpoints. CD5L KO mice showed worsened outcomes after IR, whereas treatment with recombinant CD5L was protective against retinal ischemic injury. Collectively, our findings suggest that deleting HDAC3 enhances macrophage efferocytosis by upregulating the CD5L/CD36 axis. CD5L may serve as a promising therapeutic target to improve outcomes in ischemic retinopathy.

We aimed to evaluate the association of metabolic syndrome (MetS) with macular thickness and retinal vascular calibres in the population-based cohort (Northern Finland Birth Cohort). The population of 2242 individuals was divided into MetS (n = 344) and control groups (n = 1898). Cirrus HD-OCT 4000 was used to measure total macular thickness. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were calculated from the fundus images. The MetS was defined according to the National Cholesterol Education Program (Adult Treatment Panel III). A significant reduction in macular thickness was observed in subjects with MetS (279.4 ± 13.5 vs. 282.2 ± 14.1 μm, p < 0.001); the difference was greatest in the nasal and inferior subfields in the outer perimeter (-3.18 μm, p < 0.001 and - 3.68 μm, p < 0.001). Among the MetS components, waist circumference (WC) was particularly associated with thinning of the macula. Furthermore, subjects with MetS displayed decreased CRAE (139.8 ± 13.2 vs. 141.8 ± 14.0 μm, p = 0.014) and increased CRVE (221.7 ± 20.5 vs. 218.3 ± 19.0 μm, p = 0.007). The elevated systolic blood pressure and WC were associated with arterial narrowing, while dyslipidemia, hypertriglyceridemia and low HDL cholesterol were associated with venular widening. We detected a thinning of the macula in the MetS in our population-based cohort. The diameters of the retinal arteries decreased, and the venules increased in MetS. These findings suggest that obesity is related to structural changes in the eyes in middle-aged subjects, which may have implications for ocular health.

Central retinal artery occlusion - to thrombolyze or not to thrombolyze?