Complications of intravitreal ocriplasmin for vitreomacular traction and macular hole: a prospective spectral-domain optical coherence tomography study

Objective: The purpose of this study was to evaluate the safety of intravitreal ocriplasmin prospectively, reporting potential complications in patients with vitreomacular traction (VMT) alone or associated with macular hole (MH). Materials and methods: Participants in this prospective, multicenter study, were 24 patients with VMT (17 with VMT alone and seven with MH combined with VMT). All patients were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 7, 28 and the last examination of the follow-up for each patient (mean ± SD: 64.2 ± 24.4 d, range: 40–145 d). Best-corrected visual acuity (BCVA) was assessed, and spectral-domain optical coherence tomography was performed at each visit while the percentage of resolution of VMT and the association with various potential adverse events were recorded and analyzed. Results: 66.7% of patients presented VMT release at the end of the follow-up, while 28.6% exhibited MH closure. Severe adverse events, such as enlargement of preexisting MH and formation of lamellar MH, were observed in one and four cases, respectively and remained till the end of the follow-up. Moderate adverse events, such as ellipsoid zone disruption and subretinal fluid development, became evident seven days after injection, in four cases. Formation of cystoid macular edema (CME), not evident at baseline, was noticed in three cases at day 28 after injection. Mild adverse events, like vitreous floaters, photopsias, eye pain and foreign body sensation, were noticed at day 7 and resolved till the end of the follow-up. Conclusions: Mild and moderate adverse events occurred mainly during the first week of the follow-up, while severe adverse events, such as the lamellar MH formation and CME at day 28 post injection were seen. © 2015 Taylor & Francis

Long-Term Anatomical and Functional Outcomes in Patients with Ischemic Central Retinal Vein Occlusion Treated with Anti-Vascular Endothelial Growth Factor Agents

Purpose: To evaluate the anatomical and functional outcomes in patients with ischemic central retinal vein occlusion (CRVO) treated with intravitreal anti-vascular endothelial growth factor (VEGF) agents. Methods: This retrospective study included 15 treatment-naive patients with ischemic CRVO and macular edema who were treated with intravitreal ranibizumab or aflibercept. The main outcomes were the evolution of retinal ischemia over time, as well as the change in best corrected visual acuity (BCVA) and in central subfield thickness (CST) at month 24. Results: At month 24, patients with ischemic CRVO gained +7.8 letters compared to baseline, while there was a significant decrease in CST by 243.7 μm. At baseline, ischemia was located mainly at the peripheral retina, while 6.6% of patients presented macular ischemia. At month 24, 20% of patients had macular ischemia, which was found to be negatively correlated with BCVA. The patients with macular ischemia had very poor final visual outcome and were advised to discontinue treatment. Conclusions: Our study showed that anti-VEGF treatment was effective in patients with ischemic CRVO, since it reduces macular edema and maintains or improves VA in the long term (24-month follow-up). It is worthy of note that in a small proportion of patients (13.3%) peripheral ischemia progressed to macular ischemia over time. In cases where macular ischemia is present, anti-VEGF treatment does not seem to offer any improvement in VA. © 2017 S. Karger AG, Basel

Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange

Anatomical and Functional Changes in the Coexistence of Vitreomacular Traction and Epiretinal Membrane: A Spectral-Domain Optical Coherence Tomography Study

Purpose: The purpose of this study was to evaluate the anatomical and functional findings in patients with vitreomacular traction (VMT) combined with epiretinal membrane (ERM) in the same eye. Methods: In this retrospective, cross-sectional study, we studied 65 patients with VMT and ERM. In 36 of them, ERM/VMT had a 'unified' appearance (group Ι) but in 29, VMT and ERM coexisted without an interrelationship (group ΙΙ). All patients were examined with spectral-domain optical coherence tomography (SD-OCT). We recorded the macular thickness, the presence, type and location of macular edema, the horizontal diameter of VMT, ellipsoid zone/external limiting membrane (EZ/ELM) status, the vitreofoveal angle of VMT nasally and temporally and the best corrected visual acuity (BCVA). Results: Group Ι presented with increased macular thickness, a broader adhesion diameter, extensive EZ/ELM defect and decreased BCVA compared to those where VMT and ERM were not intercorrelated. In group I ('unified' VMT and ERM), cystoid macular edema was found at a greater percentage (41.7%), while in patients where the 2 entities were not intercorrelated, diffuse macular edema was more evident (69%). There was no statistically significant difference between the 2 groups in the vitreofoveal angle temporally and nasally. Conclusions: Macular thickness, type of macular edema, adhesion diameter, the extent of the EZ/ELM defect and BCVA appeared different in cases where VMT and ERM were unified compared to cases where ERM and VMT coexisted but were not intercorrelated. © 2016 S. Karger AG, Basel

The Effect of Eplerenone in Chronic Central Serous Chorioretinopathy Refractory to Photodynamic Therapy

Purpose: To evaluate the efficacy and safety of oral eplerenone in cases of central serous chorioretinopathy (CSCR) refractory to photodynamic therapy (PDT). Methods: 19 patients with chronic CSCR and persistent subretinal fluid (SRF) were treated with oral eplerenone for 6 months, starting at a dose of 25 mg/day for 4 weeks and then 50 mg/day for 5 months. All patients underwent visual acuity measurement and optical coherence tomography (OCT), while fluorescein angiography was also performed at baseline, before treatment. Resolution of SRF, changes in retinal thickness and BCVA changes at month 6 and 12 post-treatment initiation were assessed. In addition, creatinine and electrolyte test was done on each patient every month for potential complications. Results: Two out of 19 cases were excluded, since one presented with hyperkaliemia 15 days after eplerenone intake and one with skin rash one day after the treatment initiation. At month 12, 88.2% of patients exhibited visual acuity improvement and 76.4% SRF resolution, while in 11.8% of patients SRF remained stable. Conclusions: This study has shown that eplerenone is safe and effective in cases of chronic CSCR, refractory to previous PDT. ©, © Taylor & Francis

Evolution of macular microvasculature and retinal layers alterations in patients with macula off retinal detachment after vitrectomy

Purpose: To examine the changes in retinal microvasculature in association with retinal layers’ condition in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). Methods: Participants in this study were 89 patients with macula off RRD, who were successfully treated with PPV and gas tamponade without internal limiting membrane peeling, in two centers. All participants underwent best corrected visual acuity (BCVA) measurement, slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) at week 5, month 3 and month 6 postoperatively. The fellow untreated eyes were also examined and served as control data. Results: A statistically significant enlargement in foveal avascular zone (FAZ) in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), accompanied with a statistically significant thinning of inner retinal layers, was noticed 5 weeks postoperatively. These changes, namely FAZ enlargement and thinning of inner retinal layers, in the operated eyes compared to the fellow eyes, remained unchanged till month 6 postoperatively. BCVA improved significantly from week 5 to months 3 and 6 postoperatively. The improvement in BCVA was associated with the gradual ellipsoid zone (EZ) recovery from the first (week 5) till the last examination (month 6). Conclusions: The FAZ enlargement in the operated eyes was accompanied with a statistically significant thinning in the inner retinal layers. Inter-correlation of BCVA and EZ integrity was noticed. © The Author(s) 2021