伊藤 逸毅

PURPOSE: Recurrent retinal detachment (re-RD) after rhegmatogenous retinal detachment (RRD) surgery is associated with poor visual outcomes. This retrospective study evaluated the incidence and risk factors for re-RD following primary 25-gauge pars plana primary vitrectomy (25G-PPV). STUDY DESIGN: Retrospective observational study METHODS: Consecutive patients who underwent initial 25G-PPV at Fujita Health University Hospital between January 2011 and March 2019 were included. After applying exclusion criteria, preoperative and surgical factors were obtained from medical records. Patients were categorized into re-RD and initial reattachment groups. Univariate analysis was used to identify factors associated with re-RD, followed by multivariate analysis of significant variables. RESULTS: Among 1399 eyes, the mean age was 56.5±11.0 years. The re-RD and reattachment groups included 89 and 1310 eyes, respectively. The initial reattachment rate was 93.2%. Significant differences were observed between macular detachment and inferior retinal break (RB). The odds ratios of macular detachment and inferior RB in the re-RD group were 1.70 (95% confidence interval [CI] 1.05-2.79) and 2.26 (1.40-3.61), respectively. CONCLUSION: The initial reattachment rate with 25G-PPV was 93.2%. The re-RD group showed higher rates of macular detachment and a higher proportion of inferior RB, identified as risk factors for re-RD. RD due to inferior RB with macular detachment may require vitrectomy combined with buckling.

PURPOSE: To investigate the association between serum high-density lipoprotein cholesterol (HDL-C) levels and ganglion cell complex (GCC) thickness in a nonglaucomatous Japanese population. DESIGN: A retrospective cross-sectional observational study. PARTICIPANTS: We included 588 nonglaucomatous Japanese adults who underwent comprehensive ophthalmic and systemic health screening. METHODS: Participants underwent OCT imaging, anthropometric measurements, including brachial-ankle pulse wave velocity, spirometry, and hematologic profiling. Multivariable linear regression models were used to assess the association between HDL-C levels and GCC thickness. Covariates were selected using a stepwise variable selection procedure, with the final model including age and axial length. A piecewise linear regression model further evaluated the association across different HDL-C ranges. MAIN OUTCOME MEASURES: Average GCC thickness. RESULTS: Older age (P = 0.002), longer axial length (P < 0.001), and higher HDL-C levels (P < 0.001) were significantly associated with thinner GCC thickness. A nonlinear relationship was observed, with GCC thickness inversely associated with HDL-C levels outside the 60 to 67 mg/dL range (P = 0.005). CONCLUSIONS: High-density lipoprotein cholesterol levels are significantly associated with GCC thickness in nonglaucomatous individuals, which suggests a potential role of lipid metabolism in early neuroretinal thinning. High-density lipoprotein cholesterol may serve as a biomarker for neurodegenerative changes, even before glaucomatous alterations become clinically apparent. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.