Geographic atrophy (GA), the late-stage of non-neovascular age-related macular degeneration, is characterized by progressive degeneration of photoreceptors, retinal pigment epithelium, and the choriocapillaris, ultimately leading to irreversible central vision loss. Advances in multimodal imaging, particularly the optical coherence tomography (OCT) based definition of complete retinal pigment epithelium and outer retinal atrophy (cRORA), have substantially improved the diagnostic consistency of GA. The recent approval of complement inhibitors, pegcetacoplan (complement C3 inhibitor) and avacincaptad pegol (complement C5 inhibitor) marks a treatment milestone, demonstrating efficacy in slowing atrophy progression. However, the efficacy of existing drugs still mainly focuses on structural endpoints, with limited protective effects on functions. This reveals the core challenge of "structural-function dissociation" in GA. In recent years, attention has been drawn to early endpoints such as incomplete retinal pigment epithelium and outer retinal atrophy transforming into cRORA; sensitive functional assessment tools such as micro-perimetry, as well as artificial intelligence-assisted OCT stratified analysis and individualized progression prediction models, have also continuously expanded the assessment and management capabilities of GA. Additionally, diverse treatment strategies such as gene therapy, stem cell transplantation, and neurotrophic protection are also being actively explored, further broadening the future intervention pathways. It is worth noting that the prevalence and clinical manifestations of GA in Asian populations are significantly different from those in Western populations, suggesting that the disease characteristics and mechanisms may have racial specificity. Currently, there is a lack of systematic local data in China, and it is urgent to establish a multicenter longitudinal cohort based on cRORA criteria, and incorporating multimodal imaging and functional assessments, to facilitate GA characterization, risk prediction, and the development of individualized intervention strategies in the Chinese population.
ObjectiveTo evaluate the efficacy of intravitreal injection (IVI) of expansile gas alone to treat idiopathic full-thickness macular hole (FTMH).MethodsThis is a prospective interventional case series. Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study. There were 5 males (5 eyes) and 21 females (21 eyes), with the mean age of (59±12) years. All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography and three-dimensional optical coherence tomography (OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon, OCT-2000). Based on the diameter, the holes were classified as small FTMH (equal or lesser than 250 μm), medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm). The mean BCVA was 0.85±0.29. There were 7, 10 and 9 eyes with small, medium and large FTMH. There were 10 eyes with vitreous- macular traction (VMT). All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days. The follow-up ranged from 1 to 23 months. The BCVA, FTMH closure and complications were observed. If holes failed to close at 1 month after IVI, vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.ResultsFTMHs was able to close in 17/26 eyes (65.4%) had hole closure, failed to close in 9 /26 eyes (34.6%). All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas. The eyes failed in the closure initially with IVI of gas alone, all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade. The closure rate of small (6 eyes), medium (8 eyes) and large FTMH (3 eyes) was 85.7%, 80.0% and 33.3% respectively. The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8±122.8), (431.6±128.4) μm respectively, the difference was significant (t=?2.407, P=0.024). VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group, respectively, the difference was significant (t=?2.196, P=0.038). The mean preoperative BCVA was 0.51±0.36. There was a significant difference between pre-and postoperative BCVA (t=4.758, P＜0.05). Two eyes developed local retinal detachment, which achieved hole closure and retinal reattachment after vitrectomy.ConclusionIVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.
