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Ayushi Gupta and Vishal Agrawal
This 28YO male presented 5-6 hours following a perforating thorn injury to his left eye. He was standing in an open-moving loading vehicle when an Acacia tree branch suddenly hit his eye. Vision was 20/20 in his normal OD and 20/40 OS.
External examination showed a thorn lodged in the inferonasal sclera. There were moderate anterior chamber cells on slit lamp examination with a fibrinous pupillary membrane.
Fundus examination revealed vascular sheathing predominantly in the nasal quadrant, multiple white-centered retinal hemorrhages, and vitreous exudates. The thorn penetrated the retina, extending into the vitreous cavity.
Despite being taken to surgery approximately two hours later, intraoperatively, there was a dramatic increase in vascular sheathing extending into the macula. Pars plana vitrectomy was performed with removal of the thorn foreign body, repair of the scleral laceration, cryotherapy, endolaser photocoagulation around the retinal break, silicone oil tamponade, and intravitreal antibiotic injection. The thorn measured approximately 15mm.
On the first postoperative day, the posterior segment appeared healthy with resolved vascular sheathing. One week postop, vision was 20/50 with a +5-diopter sphere, the retina remained completely attached, and good laser scarring was noted around the penetration site (not shown).
Retina. 2026 Sep 1;46(9):1505-1512. doi: 10.1097/IAE.0000000000004852.
MacTel2 ciliary neurotrophic factor therapy seems to slow retinal degeneration and preserve visual function. Further trials are needed to assess long-term efficacy — Systematic Review
Purpose: To assess the structural and functional outcomes of treatment with ciliary neurotrophic factor for patients with Type 2 macular telangiectasia (MacTel).
Methods: Studies were retrieved from inception to May 2024 from MEDLINE, Embase, and Cochrane Library databases. The primary outcome was final best-corrected visual acuity and changes in best-corrected visual acuity from baseline, while ellipsoid zone discontinuity area was a secondary outcome. Risk of bias for observational studies and randomized clinical trials were assessed using the ROBINS-1 tool and Cochrane ROB2 tools, respectively.
Results: Five studies reporting on 498 eyes of 422 patients were included in this systematic review. One randomized clinical trials of 99 eyes found decreased progression of retinal degeneration and reduced decline in reading speed in implant-treated eyes compared with sham-treated eyes. An uncontrolled Phase 1 safety trial involving 14 eyes in 7 patients with MacTel undergoing ciliary neurotrophic factor therapy demonstrated good tolerance, with no significant differences in visual acuity or retinal sensitivity between treated and untreated eyes over 36 months, although five participants experienced persistent miosis in the implanted eye. One study highlighted smaller changes in ellipsoid zone defect areas in ciliary neurotrophic factor-treated eyes compared with sham-treated eyes. Recently published data demonstrated significant structural progression slowing, although functional outcomes were variable and safety was comparable with sham aside from increased delayed dark adaptation and miosis.
Conclusion: Ciliary neurotrophic factor therapy seems to slow retinal degeneration and preserve visual function in patients with MacTel. While ciliary neurotrophic factor shows promise for earlier stages of MacTel, further trials are required to fully assess its long-term efficacy.
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