To assess the evolution of retinal atrophy secondary to focal laser photocoagulation (FLP) for telangiectatic capillaries (TelCaps) in patients with diabetic macular oedema (DMO) or macular oedema secondary to retinal vein occlusion (MERVO). A multicentre retrospective study was conducted in DMO or MERVO patients who underwent at least one FLP session for TelCaps followed for 36 months after FLP. The post-FLP horizontal diameter and surface area of atrophic scars were measured by Optical Coherence Tomography (OCT) and on the OCT infrared image, respectively. The degree of atrophy was quantified on the OCT B-scan. Sixty-nine eyes of 61 patients were included, corresponding to 86 laser scars analysed. The mean scar diameter increased from 315 ± 162 µm at month 1 (M1) to 350 ± 167 µm at M36 (mean increase: 35 µm, p < 0.001). The mean scar area increased from 0.10 ± 0.09 mm2 at M1 to 0.13 ± 0.10 mm2 at M36 (mean increase: 0.03 mm2, p < 0.01) At M1, 2 (2.6%), 74 (96%) and 1 (1.3%) scars were respectively considered "complete Outer Retinal Atrophy" (c-ORA), "incomplete Retinal pigment epithelium and Outer Retinal Atrophy" (i-RORA) and "complete Retinal pigment epithelium and Outer Retinal Atrophy" (c-RORA). At M36, 1 (1.8%), 40 (72.7%) and 14 (25.4%) scars were respectively considered c-ORA, i-RORA and c-RORA. The size of retinal atrophy secondary to FLP for TelCaps increases significantly over time. Moreover, retinal atrophy undergoes phenotypic changes. Therefore, it seems imperative to respect a laser impact-free perifoveolar safety zone.

To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy. Retrospective chart review of two patients' records between 2019 and 2023. Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week postoperatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the intraocular lens dislocated and was exchanged with scleral fixation of a new intraocular lens. On postoperative Day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on postoperative Day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable for years but resulted in reduced central vision. Hypotony after vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.

To describe a new technique for placing large epiretinal human amniotic membrane grafts in two eyes with high myopia and recurrent retinal detachment resulting from large breaks over staphyloma not amenable to laser or cryoretinopexy. Surgical technique demonstration with video and images. We examined two high myopic eyes with large retinal breaks and recurrent rhegmatogenous retinal detachment that had undergone rhegmatogenous retinal detachment repair with silicone oil tamponade. Break was seen over nasal staphyloma in the first case and over an atrophic area along with retinoschisis at posterior pole in the second case. 25 G vitrectomy with silicone oil removal was done and a large multilayered hAM graft was placed over large retinal breaks. Both eyes receive gas tamponade. The patients were positioned face down for the first week after surgery. Optical coherence tomography scans were performed in the follow-up visits. Retinal breaks could be successfully closed in both eyes at 2 weeks and 3 months follow-up. Large hAM grafts were stable and nicely visualized on postoperative optical coherence tomography scans and fundus photographs. These grafts were well tolerated with no displacement even at 12 months follow-up. There was no recurrence of rhegmatogenous retinal detachment noted in either eye. The large overlay hAM grafting is an effective and safe technique for closing large retinal breaks over staphyloma or atrophic retina in high myopes.

Whole eye transplantation (WET) has long been looked to as a potential solution for the aesthetic and functional deficits caused by severe ocular pathology and trauma. Here, we describe the first successful combined face and whole eye transplantation (FT/WET), highlighting the logistical, ethical, and technical considerations that enabled this milestone. A 46-year-old male with severe facial and ocular deficits underwent multidisciplinary evaluation and was deemed a candidate for FT/WET. Subsequently, a surgical algorithm was developed through rigorous preoperative planning and team based surgical simulations. This process focused on techniques that would allow for efficient graft procurement and inset, while simultaneously limiting trauma to the globe and its adnexa. Longitudinal monitoring demonstrated maintained graft viability throughout the postoperative period. Fluorescein angiography and ICG angiography confirmed robust retinal and choroidal perfusion. Diffusion-weighted MRI revealed structural preservation of the optic tracts, despite inner retinal atrophy. The patient has also experienced significant improvement in facial aesthetics and functionality with no episodes of graft rejection to date. This case demonstrates the feasibility of addressing deficits once deemed irreparable through advanced surgical techniques, preoperative planning, and multidisciplinary collaboration. Although functional vision recovery has not been observed, this innovation expands the reconstructive options available for patients with severe facial and ocular deficits, paving the way for future advancements in vascularized composite allotransplantation.

Primary angle-closure glaucoma (PACG), an irreversible blinding disease characterized by retinal ganglion cell damage and optic nerve atrophy, exerts significant effects on brain functional networks. Using resting-state functional magnetic resonance imaging (rs-fMRI) data from 34 PACG patients and 34 matched healthy controls (HCs), we extracted four types of connectivity features-voxel-wise static functional connectivity (FC), dynamic functional connectivity (dFC), effective connectivity (EC), and dynamic effective connectivity (dEC)-via the AAL90 (Automated Anatomical Labeling 90) atlas following preprocessing. Elastic net feature selection was applied independently to each connectivity type to retain the top 10% most discriminative features. We evaluated the classification performance of ten machine learning models using individual feature types as well as their combined features, with the FC-based logistic regression (LR) model achieving optimal diagnostic efficacy (accuracy = 0.92, AUC = 0.96). SHapley Additive exPlanations (SHAP) of the model identified 20 critical connections, revealing abnormal patterns at both the region of interest (ROI)-level and network-level within brain networks such as the visual network (VSN), dorsal attention network (DAN), and sensorimotor network (SMN). Statistical group comparisons validated reduced connectivity (e.g., VSN-SMN, VSN-DAN) and enhanced DAN-thalamus connectivity in patients, while voxel-wise analyses of key regions confirmed diminished connectivity to visual areas. The results provide insights into how machine learning can be effectively employed to detect PACG-specific brain network disruptions and highlight potential neuroimaging biomarkers.

Choroidal neovascularization is a complication associated with retinal diseases such as age-related macular degeneration (AMD), a leading cause of vision loss in the developed world. Choroidal neovascular membrane (CNVM) refers to the abnormal growth of blood vessels in the retina which results in exudation and/or hemorrhage, leading to photoreceptor damage and vision loss. Currently first-line treatment for CNVM include intravitreal injections of vascular endothelial growth factor (VEGF)-binding antibodies that prevent the growth of these leaky blood vessels. Unfortunately, anti-VEGF drugs often require frequent injections, and prolonged VEGF inhibition has been associated with retinal atrophy and decreased long term effectiveness in some patients. This study presents the use of Acriflavine, a small molecule HIF1α inhibitor loaded polyurethane nanocapsules to treat CNVM in a rat model. Fourteen days following laser injury and intravitreal drug administration, CMVM size was significantly reduced in acriflavine nanocapsule and free acriflavine treated animals as compared to drug free controls. Moreover, acriflavine nanocapsules reduce CNVM incidence compared to drug free controls by approximately 25%. Among the different delivery routes tested, intravitreal delivery of acriflavine nanocapsules was found to be superior to subretinal and suprachoroidal delivery for reducing CNVM area without causing significant damage to the neural retina. This paper presents the synthesis, characterization and the effectiveness of the polyurethane based acriflavine delivery system in treating choroidal neovascularization.

ObjectiveHemophagocytic lymphohistiocytosis (HLH) associated retinopathy remains poorly characterized in terms of clinical phenotypes and pathogenesis. This retrospective study aimed to systematically define the multimodal imaging features of retinal lesions in patients with HLH and investigate its underlying pathological mechanisms to inform clinical practice.MethodsA retrospective case series analysis was conducted on 15 HLH patients with retinal lesions. Comprehensive ophthalmic evaluations, including fundoscopy and optical coherence tomography (OCT), were integrated with systemic multimodal imaging data.ResultsImaging analysis revealed characteristic retinal structural alterations, including retinal hemorrhage (26 eyes, 86.67%), outer retinal atrophy (20 eyes, 66.67%), outer retinal hyperreflective foci (7 eyes, 23.33%), ellipsoid zone disruption (17 eyes, 56.67%) and ellipsoid zone thinning (10 eyes, 33.33%). Multimodal imaging findings suggest a potential association between HLH related retinopathy and a hypoperfused ischemic state of the retina, though this requires further validation through larger scale statistical analysis. Notably, characteristic damage to the outer retinal structures was observed across HLH patients of different etiological subtypes and could manifest at any stage of the disease, including before and after interventions such as chemotherapy and hematopoietic stem cell transplantation.DiscussionThe study data indicate potential involvement of HLH induced systemic cytokine storms, secondary hemoglobin reduction, and hematologic abnormalities such as thrombocytopenia in the observed retinal changes. These interpretations should be understood as hypothesis generating observations within the constraints of descriptive research methodology. Therefore, while cytokine cascade control remains a cornerstone of management, future studies should explore the potential benefit of blood component supplementation as an adjunctive therapy in HLH related retinopathy.ConclusionThese findings highlight the necessity of establishing early warning indicators for HLH associated retinopathy and conducting multicenter prospective studies to optimize evidence based diagnostic and therapeutic strategies.

PurposeTo evaluate the association between structural optical coherence tomography (OCT) biomarkers and functional outcomes in intermediate age-related macular degeneration (iAMD) and to investigate whether stratifying eyes by OCT-based biomarkers identifies phenotypes of iAMD with impaired visual function.MethodsThe baseline cohort of the PINNACLE trial underwent OCT imaging, microperimetry, best-corrected visual acuity (BCVA), and low-luminance visual acuity (LLVA) testing. OCT volumes were assessed for the presence of different morphologic features. Drusen volume and outer nuclear layer (ONL) and ellipsoid zone (EZ) thickness were quantified. Linear mixed-effect models evaluated associations between each feature and functional outcomes, including a stratification into phenotypes based on significant OCT morphology with each eye assigned to a single group.ResultsThis analysis included 247 eyes of 190 patients (mean age, 74.2 ± 7.4 years). The presence of subretinal drusenoid deposits (SDDs) and markers of retinal atrophy were significant contributors to lower mean retinal sensitivity (P < 0.05). Also, higher drusen volume and lower ONL and EZ thickness were associated with lower sensitivity. Significant changes in BCVA, LLVA, and low-luminance deficits (LLDs) were associated with increasing drusen volume and the presence of hyperreflective foci (HRF). Significant functional differences were found between individual phenotypic groups, especially highlighting functional deficit in eyes with signs of early atrophy.ConclusionsIntegrating comprehensive analyses of structural OCT biomarkers with functional assessments revealed distinct phenotypic subtypes of iAMD that are associated with significant functional deficits. Particularly, early atrophy markers should be considered for patient selection and risk assessment in clinical trials and routine practice.

PurposeTo assess the impact of type 1 macular neovascularization (MNV) on mesopic and dark-adapted (DA) cyan retinal sensitivity using fundus-controlled perimetry (FCP [microperimetry]) in patients with age-related macular degeneration (AMD).MethodsThis index study includes baseline data from AMD patients with type 1 MNV without complete retinal pigment epithelium and outer retinal atrophy (cRORA). Mesopic and DA-cyan sensitivity were measured using FCP with standardized and MNV-lesion-tailored test grids. We applied linear mixed-effects models to compare retinal sensitivity in regions with versus without co-localized type 1 MNV. Age-specific hill-of-vision data that served as reference were estimated using Bayesian quantile regressions.ResultsOf the 55 eyes with baseline data, 27 eyes without cRORA (27 patients; mean age, 76.8 ± 6.7 years; 74.1% female) were included in this detailed analysis. In regions co-localizing with type 1 MNV, unadjusted mesopic sensitivity was significantly increased by a mean of 2.10 dB (95% confidence interval [CI], 1.58–2.63; P < 0.001), whereas unadjusted DA-cyan sensitivity was significantly reduced by 3.12 dB (95% CI, 2.38–3.86; P < 0.001) compared to regions without evidence of MNV. When adjusting for age-specific hill-of-vision reference data, mesopic sensitivity remained significantly higher by 0.78 dB (95% CI, 0.29–1.28; P = 0.002) and DA-cyan sensitivity remained significantly lower by 2.07 dB (95% CI, 1.33–2.80; P < 0.001) in regions co-localizing with type 1 MNV versus those without MNV.ConclusionsIn AMD, areas overlying type 1 MNV showed higher mesopic but reduced DA-cyan sensitivity, suggesting localized preservation yet subtype-specific vulnerability. These findings will be further examined through structural analyses and prospective validation in our ongoing study.

We investigated the characteristics of neurovascular degeneration in diabetic retinopathy (DR) using optical coherence tomography (OCT) and OCT angiography (OCTA). En-face 3 × 3mm OCTA images were obtained from 327 eyes of DR patients without macular edema. Nonperfusion squares (NPSs) were defined as 15 × 15-pixel regions lacking vascular signals. Neurovascular parameters were extracted from five subfields of the Early Treatment Diabetic Retinopathy Study grid. High-dimensional data were embedded into a two-dimensional space using Uniform Manifold Approximation and Projection, and clustering revealed three distinct groups: Mild, Intermediate, and Severe. Eyes with central subfield thickness (CST) < 246μm were classified as having diabetic macular atrophy. The Mild group exhibited lower NPS counts, while the Intermediate group showed increased NPS counts in the deep layer. The Severe group had the highest NPS counts and the lowest CST, with a significant negative correlation between CST and superficial NPS counts (ρ = - 0.252, P = 0.039). Eyes with diabetic macular atrophy in the Severe group demonstrated higher NPS counts, worse visual acuity, and more frequent ellipsoid zone disruption compared to the Mild and Intermediate groups (P < 0.001). These findings suggest a pathological relationship between macular ischemia and retinal atrophy, offering new insights into DR progression.

To investigate the clinical features and biomarkers associated with intraocular inflammation (IOI) following brolucizumab treatment in Asian switched neovascular age-related macular degeneration (nAMD) patients. Multi-center, retrospective cohort study. This study included 109 eyes from 93 nAMD patients switched from other anti-vascular endothelial growth factor (VEGF) agents to brolucizumab (Beovu) without loading. Baseline characteristics, IOI timing, initial symptoms, and risk factors were assessed. IOI was observed in 17 eyes from 14 patients, including anterior uveitis (AU, n = 7), intermediate uveitis (IU, n = 5), and panuveitis with or without retinal vasculitis (RV, n = 5). Two eyes were asymptomatic. The median duration for IOI onset was 26 days, with 11 of 17 eyes (82.4%) developing IOI before the third brolucizumab injection. Firth-penalized multivariate Cox regression analysis depicted that the total number of anti-VEGF injections within one year prior to brolucizumab initiation (HR = 1.4, p = 0.009) and retinal angiomatous proliferation (RAP) (HR = 10.9, p = 0.009), may be associated with IOI development. In contrast, baseline macular neovascularization (MNV) size and the presence of retinal pigment epithelial and outer retinal atrophy were not associated with IOI occurrence. Vigilant examination after the initial brolucizumab injections is critical. Patients with identified risk factors may need meticulous monitor following brolucizumab injections.

PurposeTo conduct a comprehensive analysis of the distinct manifestations of two primary phenotypes of Crumbs cell polarity complex component 1 (CRB1)-related retinal dystrophy, pan-retinopathy, and maculopathy.MethodsA cohort of 75 patients with biallelic pathogenic variants in the CRB1 gene was recruited. Clinical evaluations including visual acuity, refractive errors, fundus autofluorescence imaging, optical coherence tomography, visual field testing, and full-field ERG.ResultsGenetic analysis identified 89 disease-causing CRB1 variants. Patients with biallelic loss-of-function variants were significantly more prevalent in the pan-retinopathy group (40.3%) than in the maculopathy group (7.1%) (P = 0.03). The proportion of patients harboring biallelic variants expressing wild-type CRB1-B was significantly higher in the maculopathy group (30.8%) than in the pan-retinopathy group (8.1%). In the pan-retinopathy group, visual function was significantly worse (P < 0.01). The pan-retinopathy group also showed marked hyperopia, shorter axial lengths, severe visual field impairment, and severely attenuated ERG responses (all P < 0.05). Initial visual acuity was better in the maculopathy group, but a critical decline occurred after 18.94 years. Optical coherence tomography and fundus autofluorescence imaging revealed distinct patterns: pan-retinopathy predominantly showed outer retinal atrophy (98.2%), parafoveal thickening (58.9%–60.7%), and diffuse hypofluorescence (87.5%), whereas maculopathy was characterized by macular edema/schisis (66.7%) and bilateral localized macular hypofluorescence (45.5%).ConclusionsThis study establishes CRB1-associated pan-retinopathy and maculopathy as clinically and genetically distinct entities. The maculopathy group initially has relatively stable vision but shows significant deterioration after adulthood.

Optical Coherence Tomography and Optical Coherence Tomography Angiography Features of Optic Disc Melanocytoma: Peripapillary Hyperreflective Ovoid Mass-like Structures, Perfusion Deficits, and Association With Vision Loss.

PurposeTo investigate liver function and lipid indexes in patients with high myopia and their association with myopic macular degeneration (MMD).MethodsThis cross-sectional comparative study included 995 emmetropic patients and 805 highly myopic patients. Serum levels of liver function and lipid indexes were measured using a Roche C702 biochemical analyzer. Ultra-widefield fundus photographs of eyes were classified according to the International META-PM Classification: Category 0: No myopic retinal degeneration, Category 1: tessellated fundus, Category 2: diffuse choroidal retinal atrophy, Category 3: patchy choroidal retinal atrophy, Category 4: macular atrophy. A machine learning model based on liver function indexes was employed to predict the presence of MMD in patients with high myopia.ResultsSerum levels of albumin (Alb), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT) and triglyceride (TG) were significantly lower, whereas high-density lipoprotein cholesterol (HDL) and apolipoprotein-A (Apo-A) were higher in patients with high myopia than those in emmetropic patients (all P < 0.05). Significant differences in serum ALT and GGT were found among MMD categories (both P < 0.05). Multivariate logistic regression showed that MMD4 was associated with lower serum GGT than MMD1 (P < 0.05). The decision tree model to predict MMD achieved an area under the curve (AUC) of 0.735 using serum GGT (sensitivity = 53.12%; specificity = 82.09%; P < 0.001). When using multiple liver function indexes, the AUC of the model reached 0.803 (sensitivity = 73.4%; specificity = 76.1%; P < 0.001).ConclusionWe identified close associations between liver function and MMD, suggesting serum GGT serve as a potential diagnostic indicator for MMD among highly myopic patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04491-0.

Non-exudative macular neovascularization (NE-MNV) has been linked to smaller areas of geographic atrophy (GA), suggesting it may slow the progression of complete retinal pigment epithelium and outer retinal atrophy (cRORA). This study aims to determine whether NE-MNV affects the prevalence and progression to later stages of age-related macular degeneration (AMD) over 3 years in the fellow eyes of patients with unilateral exudative AMD. Observational study including 61 patients with unilateral exudative AMD assessing 3-year cRORA progression and exudative conversion in the fellow eye. Patients were grouped based on the presence (NE-MNV) or absence of NE-MNV (no NE-MNV). The prevalence and progression of tomographic cRORA, GA on fundus autofluorescence (FAF) and exudative conversion rates were compared. Sixty-one patients were included in our cohort. The prevalence of NE-MNV was 24.6%. We identified a 36.3% bilateral exudative conversion rate (n = 4) in the NE-MNV group and a 15.2% conversion rate in the eyes without NE-MNV (n = 7) at 3 years (p = 0.036). There were no significant differences in cRORA or FAF GA prevalence between groups (2/15 (13.3%) with NE-MNV vs. 11/35 (31.4%) without NE-MNV, p = 0.410). Eyes with NE-MNV presented a significantly smaller cRORA greatest linear diameter (GLD) than eyes without NE-MNV (1342.3 ± 1260 vs. 2897 ± 1925.3, p = 0.023), and a smaller FAF GA area (4.5 ± 3.7 vs. 11.9 ± 10.6 mm2, p = 0.042). The presence of reticular pseudodrusen and hypertransmission defects were significantly associated with the GA phenotype (p = 0.002 and p < 0.001, respectively) while the identification of concurrent large drusen was significantly associated with the presence of MNV, both exudative and non-exudative (p = 0.023). The increase in OCTA NE-MNV area and the presence of anastomosis and loops pattern were associated with exudative conversion (p = 0.046 and p = 0.032, respectively). The presence of NE-MNV was associated with smaller cRORA GLD and FAF GA area, corroborating that NE-MNV may prevent the progression of cRORA. One third of the eyes with NE-MNV converted to exudative AMD over 3-years. Reticular pseudodrusen, hypertransmission defects and concurrent large drusen were significant OCT biomarkers for late stages AMD. Extended monitoring is required to confirm these results at long term.

PurposeTo report on the long-term clinical course of a young, healthy patient who presented with a solitary posterior pole lesion as the initial manifestation of acute retinal necrosis (ARN).MethodsDescriptive case report.ResultsA 37-year-old man presented with a two-day history of right eye redness, pain and central scotoma. Examination revealed panuveitis and a solitary whitish-yellow retinal infiltrate in the posterior pole, with an otherwise normal retinal periphery. Given the clinical suspicion of Bartonella-associated retinitis, empiric systemic antibiotic therapy was initiated. One week later, new peripheral whitish-yellow retinal infiltrates emerged. Anterior chamber tap was positive for varicella zoster virus (VZV). The patient was diagnosed with acute retinal necrosis (ARN). Systemic and intravitreal antiviral therapy was initiated in combination with prednisone. All retinal lesions regressed completely. Areas of macular and peripheral retinal atrophy subsequently developed. At one-year of follow-up, visual acuity improved significantly from logMAR 1.0 to 0, with no disease recurrence or additional complications.ConclusionsPosterior pole involvement as the initial manifestation of ARN in immunocompetent individuals is uncommon. This case highlights the importance of recognizing atypical clinical phenotypes of ARN. While the intensive medical therapy did not prevent the loss of retinal tissue, it successfully halted the progression of the infection toward the fovea, thereby allowing the preservation of excellent final visual acuity. Although uncommon, macular involvement should be included in the differential diagnosis of viral retinopathies. Prompt diagnosis and appropriate antiviral therapy are critical to preserving visual function and preventing further complications.

PurposeTransgenic pig models are a valuable model for preclinical testing of gene and cell therapies. Subretinal injection (SRI) is a common drug delivery method but has been associated with retinal thinning and atrophy. This study examined whether SRI volume correlates with retinal thinning in the pig eye and compared the effects of balanced salt solution (BSS) and adeno-associated virus (AAV) injections.MethodsTen eyes from five transgenic pigs were included in this study. Eight eyes received escalating subretinal injection volumes (SRVs) (50, 100, 150, and 200 µL) of either BSS or AAV [5 × 1011 vg/mL], targeting the cone-rich area centralis of the pig eye. After six months, outer retinal thickness inside versus outside the bleb area (ΔORT) was quantified using optical coherence tomography (OCT). Histology was performed to confirm OCT findings.ResultsTreated eyes showed clinically relevant (−21.5 ± 2.7 µm) outer retinal thinning inside the bleb area (P = 0.0001). A strong, statistically significant, linear correlation (R² = 0.73 P = 0.0068) was found between SRV and ORT loss. There was a 1 µm loss of ORT for every 9 µL of SRV. ORT loss was similar between AAV and BSS, except at the highest volume (200 µL, 1 × 1011 vg), where greater thinning occurred with AAV over BSS (Δ11 µm).ConclusionsThis study supports the notion that SRV could be an independent factor in development of outer retinal thinning in the pig eye. Modifying surgical technique to favor the placement of multiple smaller blebs of <100 µL might mitigate retinal thinning because of volumetric stress and enhance the preclinical safety profile of investigational therapies.

To investigate baseline predictors of macular neovascularization (MNV) phenotypes and prognostic outcomes, including changes in visual acuity (VA) and the development of macular atrophy (MA) and fibrosis. A retrospective, observational, cohort study was performed on a total of 102 eyes from 97 patients with intermediate age-related macular degeneration (AMD) converting to MNV subtypes. Baseline features, including age, drusen, reticular pseudodrusen (RPD), subfoveal choroidal thickness (SFCT), and central retinal thickness (CRT), were analyzed. Predictive models that considered the baseline characteristics predicting the different MNV subtypes and prognostic outcomes were developed using Cox regression and generalized linear models. Of the included eyes, 68.6% developed type 1 MNV, 15.7% type 2 MNV, and 15.7% type 3 MNV. SFCT was a significant predictor of type 2 MNV, with thicker choroid predisposing to the lesion development (HR: 1.02, CI95%: 1, 1.03, p = 0.001). Age was the primary predictor for type 3 MNV (HR: 1.1, CI 95%: 1, 1.2, p = 0.02). Type 2 MNV exhibited the highest rate of fibrosis at follow-up (71.4%), compared to both type 1 (43.5%) and type 3 MNV (26.7%) (p = 0.04). Age at baseline and best-corrected visual acuity (BCVA) were factors associated with final vision loss (p < 0.001), while the presence of drusen alone appeared protective (p = 0.03). SFCT at baseline also reduced the risk of outer retinal atrophy (p = 0.01). SFCT served as a key indicator for type 2 MNV while aging predominantly predicted type 3 MNV. The findings may improve the early identification and tailored management of MNV phenotypes, optimizing visual outcomes and mitigating complications such as fibrosis and atrophy.

Objective: To comparatively evaluate the efficacy and safety of intravitreal topotecan (IVT) versus intravitreal melphalan (IVM) combined with IVT in the treatment of vitreous seeds in retinoblastoma (RB). Methods: Retrospective cohort study. This study collected clinical data from 34 patients with unilateral vitreous seeds in RB who were diagnosed and treated at the Department of Ophthalmology of Eye & ENT Hospital of Fudan University from December 2015 to May 2025. All patients developed refractory or recurrent vitreous seeds after receiving intravenous chemotherapy or intra-arterial chemotherapy. Baseline data, ocular characteristics and detailed treatment histories were analyzed. Patients were treated with IVT (single-drug group) or IVT combined with IVM (double-drug group), which was administered at 4-week intervals until the vitreous seeds disappeared or became stably calcified. The primary outcome measures were the control of vitreous seeds and the globe-salvage rate. The ocular and systemic adverse effects following intravitreal chemotherapy were also recorded. Statistical analyses were performed using the t test, the Mann-Whitney U test and the χ² test. The Kaplan-Meier method was used to plot globe-salvage curves and differences were compared using the log-rank test. Results: There were 21 (61.8%) males and 13 (38.2%) females. The median age at initial diagnosis was 29.5 (19.5, 38.0) months. Among them, 8 (23.5%) had bilateral RB, all with unilateral vitreous seeds and the affected eye received intravitreal chemotherapy and 26 (76.5%) had unilateral RB. Of the affected eyes, 15 (44.1%) were left eyes and 19 (55.9%) were right eyes. According to the International Intraocular Classification of Retinoblastoma, 13 (38.2%) eyes were classified as group E, 20 (58.8%) as group D, and 1 (3.0%) as group C. The single-drug group included 15 eyes (44.1%), with a median age at initial diagnosis of 21.0 (11.0, 30.0) months and a follow-up duration of 19.0±10.0 months. Among them, 1 eye was classified as group C, 7 eyes as group D, and 7 eyes as group E. Each affected eye received a mean of 3.1±1.1 intravitreal injections, with a total topotecan dose of 89.3±34.3 μg per eye. The double-drug group included 19 eyes (55.9%), with a median age at initial diagnosis of 33.0 (22.0, 42.0) months and a follow-up duration of 67.9±30.4 months. Among them, 13 eyes were classified as group D and 6 eyes as group E. Each affected eye received a mean of 5.0±1.7 intravitreal injections, with a total melphalan dose of 111.1±44.5 μg and a total topotecan dose of 74.7±44.0 μg per eye. During the follow-up period, vitreous seeds in all affected eyes in both groups were controlled (100%), and no orbital or systemic metastases were observed. Compared with the double-drug group, the single-drug group exhibited fewer local adverse effects. The incidence of cataract was 0/15 and 9/19, while the incidence of phthisis bulbi was 0/15 and 6/19, respectively (both P<0.05). Some patients in both groups developed retinal pigment epithelial and choroidal atrophy, vascular occlusion or optic nerve atrophy, but the differences were not statistically significant (both P>0.05). The final globe-salvage rates were 14/15 in the single-drug group and 14/19 in the double-drug group. Conclusions: IVT can effectively treat vitreous seeds in RB. Compared with the regimen combining melphalan, the IVT monotherapy is associated with fewer intraocular adverse effects.

ObjectivesTo assess the long-term efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy on best-corrected visual acuity (BCVA) and foveal morphology in patients with extrafoveal macular neovascularisation (MNV) secondary to age-related macular degeneration (AMD) over five years.MethodsA total of 104 eyes with treatment-naïve extrafoveal MNV treated with intravitreal anti-VEGF injections were analysed retrospectively. BCVA was assessed at baseline and annually for five years. Central foveal thickness (CFT), intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachments (PED), subretinal hyperreflective material (SHRM), and foveal atrophy (incomplete/complete retinal pigment epithelium and outer retinal atrophy (iRORA/cRORA))—were documented.ResultsAfter five years, 46% of the eyes had unchanged or improved vision by one or more lines, whereas mean BVCA declined from 0.28 ± 0.20 logMAR at baseline to 0.50 ± 0.49 logMAR after five years (p = 0.016). CFT, and the prevalence of IRF and SRF decreased significantly (p < 0.001), while iRORA (p = 0.041), and cRORA (p < 0.001) increased by year five. Presence of cRORA was associated with worse five-year BCVA (p < 0.001).ConclusionAnti-VEGF therapy for extrafoveal MNV secondary to AMD stabilised or improved BCVA in approximately half of the patients; however, mean BCVA declined after five years. Long-term functional benefits were limited due to morphological changes in the macula, such as subfoveal atrophy.