Bilateral uveal tumor — a case report

BACKGROUND: This case presentation reports a case of bilateral uveal tumor. CASE PRESENTATION: An 82-year-old patient reported to the ophthalmology department complaining of a limited visual field temporally in his left eye. Visual acuity in the right eye was 0.9, and in the left eye, it was 0.4. Intraocular pressure was 18 mm Hg in each eye. Indirect ophthalmoscopy in the left eye revealed a choroidal tumor. The diagnosis of uveal melanoma was confirmed, and the patient underwent a 125I brachytherapy procedure. During a follow-up visit, a tumor was observed to be spreading beyond the left eyeball, with evidence of metastatic deposits observed on the corneal endothelium. The patient underwent enucleation surgery. Two years later, the patient reported to our Ophthalmology Clinic with a significant deterioration of visual acuity in the right eye (0.2); intraocular pressure was 8 mm Hg. Indirect ophthalmoscopy revealed a choroidal tumor with subretinal fluid. CONCLUSION: The location of bilateral choroidal melanoma should always be considered. It becomes crucial to carefully and regularly examine both eyes when uveal melanoma is found in one eye. The result of the examination may determine the type of treatment undertaken and, thus the prognosis for long-term survival.

Late reperfusion with vision improvement in central retinal artery occlusion after surgical embolectomy — a case report

BACKGROUND: The objective was to report a case of central retinal artery occlusion (CRAO) with late gradual improvement of visual acuity after surgical embolectomy. CASE PRESENTATION: A 65-year-old woman with central retinal artery occlusion in the left eye for two days and visual acuity counting fingers (20/2000, logMAR 2.0). Due to a significant decrease in visual acuity and the long-term course of the disease, it was decided to perform a vitrectomy. The technique was adjusted to the location of the embolic material and the extent of retinal ischemia. The aim of the vitrectomy was evacuation of the embolus and improvement in perfusion.RESULTS: After treatment, visual acuity gradually improved. After 18 months of observation, the patient’s visual acuity was 20/63 (LogMAR 0.5). CONCLUSION: Despite the potential risk assessment, embolectomy could be considered as a treatment option in selected cases of central retinal artery occlusion

Epiretinal membranes – current diagnostics methods and surgical treatment

Błony nasiatkówkowe są częstym schorzeniem dotykającym głównie osoby po 50. r.ż. Podstawową metodą obrazowania błon nasiatkówkowych jest optyczna koherentna tomografia, zaś metodę z wyboru w leczeniu objawowych błon nasiatkówkowych stanowi witrektomia. W niniejszym artykule omówiono zastosowanie witrektomii w leczeniu błon nasiatkówkowych z uwzględnieniem aktualnego stanu wiedzy na temat wskazań do leczenia operacyjnego oraz możliwych powikłań pooperacyjnych.Epiretinal membranes occur in population over 50 years old. Optical coherence tomography has become a useful tool in diagnosis of this condition. Pars plana vitrectomy is a standard procedure in treatment of epiretinal membranes. The aim of this article is to present a current state of knowledge about surgical treatment and its complications

Autologous Lens Capsule Flap Transplantation for Persistent Macular Holes

Purpose. To analyze the anatomical and functional outcomes after autologous lens capsule transplantation in patients with persistent macular hole. Methods. This is a retrospective observational study of five eyes of five patients treated with vitrectomy and autologous lens capsular flap transplantation. Complete ophthalmic examination was performed preoperatively and seven days and 1, 3, 6, 12, and 18 months after surgery. Results. Successful macular hole closure was achieved in all patients. The mean minimum macular hole diameter before the surgery was 666.8 µm, and the mean basal diameter was 1086.4 µm. The mean visual acuity before lens capsular flap transplantation was 20/200, while after surgery, it was 20/125. Conclusions. Autologous lens capsular flap transplantation is a potential alternative treatment for patients with large persistent macular holes after other operative techniques have failed

Successful surgical treatment of traumatic macular hole with total rhegmatogenous retinal detachment in a child

Background: The purpose of this case report was to investigate the surgical results and morphologic characteristics of a pediatric traumatic macular hole with total rhegmatogenous retinal detachment. Case presentation: The 4-year-old male patient underwent scleral buckling surgery combined with vitrectomy with the inverted internal limiting membrane (ILM) flap technique and silicone oil tamponade for five months. Complete ophthalmic examination was performed preoperatively and 7 days, 1, 3, 6, 9, and 12 months after surgery. Successful retinal reattachment was achieved, and the macular hole was successfully closed. Visual acuity improved from hand motion at the initial visit to 20/80 (0.6 LogMAR) postoperatively. Conclusions: Scleral buckling surgery and vitrectomy with the inverted ILM flap technique appeared to give effectiveanatomical and functional results in the pediatric post-traumatic case with macular hole and retinal detachment

Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series

This study aimed to evaluate the usefulness of an encircling scleral buckling procedure to manage severe hypotony secondary to proliferative vitreoretinopathy (PVR)-induced retinal detachment. This retrospective study included six eyes of six patients (five women and one man) with hypotony (intraocular pressure [IOP] ≤ 6 mmHg) after multiple reattachment surgeries for PVR-induced retinal detachment. In patients with failure of hypotony resolution after conservative treatment (dexamethasone drops five times daily), 360° scleral buckling was performed under periocular anesthesia. The light perception was evaluated immediately postoperatively. The anatomic parameters were evaluated pre- and postoperatively observed on anterior segment swept-source optical coherence tomography. Ciliary body detachment (CBD) secondary to advanced cyclitic membranes associated with PVR grades C and D was detected in all eyes with hypotony. The mean IOP increased in all eyes (4.83 mmHg preoperatively vs. 10.17 mmHg postoperatively, p = 0.006), with subsequent improvement in best-corrected visual acuity (1.91 logMAR preoperatively vs. 1.50 logMAR postoperatively, p = 0.034). However, no eye showed any significant changes in CBD postoperatively. Scleral buckling surgery might be useful to increase IOP in eyes with persistent severe hypotonia secondary to PVR-induced CBD. Further studies are needed to improve outcomes in eyes with severe PVR-induced retinal detachment

Silicone sponge intrusion after scleral buckling surgery followed by vitrectomy for retinal detachment

Background: This study reports a case of silicone sponge intrusion as a late complication of scleral buckling surgery. Case presentation: A 57-year-old man underwent a silicone sponge scleral buckling surgery 19 years ago due to retinal detachment of his left eye. Visual acuity impairment of his left eye was noted. His best-corrected visual acuity (BCVA) was 20/80 (logMAR 0.6). Intraocular lens-capsular bag-capsular tension ring luxation with implant extrusion was observed in the inferior nasal quadrant. The patient underwent pars plana vitrectomy with retropupillary iris-claw lens implantation. His BCVA improved to 20/20. Conclusion: Although silicone sponge intrusion is a rare complication of scleral buckling procedures, it may lead to serious complications. The intruding sponge may be left intact unless there is a significant threat to the integrity of ocular structures. Manipulation of the encircling band or buckle does not necessarily alter the visual acuity or the status of the retina

Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial

Background Geographic atrophy is an advanced form of dry age-related macular degeneration that can lead to irreversible vision loss and high burden of disease. We aimed to assess efficacy and safety of avacincaptad pegol 2 mg in reducing geographic atrophy lesion growth.Methods GATHER2 is a randomised, double-masked, sham-controlled, 24-month, phase 3 trial across 205 retina clinics, research hospitals, and academic institutions globally. To be eligible, patients had to be aged 50 years or older with non-centrepoint-involving geographic atrophy and best corrected visual acuity between 20/25 and 20/320 in the study eye. Eligible patients were randomly assigned (1:1) to monthly avacincaptad pegol 2 mg administered as a 100 mu L intravitreal injection or sham for the first 12 months. Randomisation was performed using an interactive response technology system with stratification by factors known to be of prognostic importance in age-related macular degeneration. Patients, investigators, study centre staff, sponsor personnel, and data analysts were masked to treatment allocation. The primary endpoint was geographic atrophy lesion size measured by fundus autofluorescence at baseline, month 6, and month 12. Efficacy and safety analyses were done in the modified intention-to-treat and safety populations, respectively. This trial is registered with ClinicalTrials.gov, NCT04435366.Findings Between June 22, 2020, and July 23, 2021, 1422 patients were screened for eligibility, of whom 448 were enrolled and randomly assigned to avacincaptad pegol 2 mg (n=225) or sham (n=223). One patient in the sham group did not receive study treatment and was excluded from analyses. There were 154 (68%) female patients and 71 (32%) male patients in the avacincaptad pegol 2 mg group, and 156 (70%) female patients and 66 (30%) male patients in the sham group. From baseline to month 12, the mean rate of square-root-transformed geographic atrophy area growth was 0 center dot 336 mm/year (SE 0 center dot 032) with avacincaptad pegol 2 mg and 0 center dot 392 mm/year (0 center dot 033) with sham, a difference in growth of 0 center dot 056 mm/year (95% CI 0 center dot 016-0 center dot 096; p=0 center dot 0064), representing a 14% difference between the avacincaptad pegol 2 mg group and the sham group. Ocular treatment-emergent adverse events in the study eye occurred in 110 (49%) patients in the avacincaptad pegol 2 mg group and 83 (37%) in the sham group. There were no endophthalmitis, intraocular inflammation, or ischaemic optic neuropathy events over 12 months. To month 12, macular neovascularisation in the study eye occurred in 15 (7%) patients in the avacincaptad pegol 2 mg group and nine (4%) in the sham group, with exudative macular neovascularisation occurring in 11 (5%) in the avacincaptad pegol 2 mg group and seven (3%) in the sham group.Interpretation Monthly avacincaptad pegol 2 mg was well tolerated and showed significantly slower geographic atrophy growth over 12 months than sham treatment, suggesting that avacincaptad pegol might slow disease progression and potentially change the trajectory of disease for patients with geographic atrophy.Funding Iveric Bio, An Astellas Company.Copyright (c) 2023 Elsevier Ltd. All rights reserved