Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era.

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.

Cabbage Leaf Inverted Flap ILM Peeling for Macular Hole: A Novel Technique.

Large macular holes have poor surgical outcomes with conventional vitrectomy and internal limiting membrane (ILM) peeling surgery, but improved anatomical closure rates have been seen with an inverted ILM flap technique. Many studies have been reported with modifications in the original inverted ILM technique that help in better retention of the flap over the macular hole. The authors describe a new technique of inverted ILM flap in a case of chronic, large, full-thickness macular holes, in which multiple ILM flaps were inverted over each other and the hole-like cabbage leaves. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:830-832.].

Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines.

The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians.

Volumetric analysis of macular edema by scanning laser tomography in immune recovery uveitis.

OBJECTIVES: To evaluate the macular volume in eyes with immune recovery uveitis (IRU) and to describe a new method to quantify macular edema with the use of confocal scanning laser tomography (cSLT). METHODS: A prospective study was performed to assess the macular volume with cSLT in patients with and without IRU. None of the patients enrolled had cytomegalovirus retinitis within 3000 micro m of the fovea. Eight eyes had healed cytomegalovirus retinitis with IRU and cystoid macular edema (group A); 4 eyes had healed cytomegalovirus retinitis with IRU and clinically normal maculas (group B); 18 eyes had no IRU (group C); and 3 eyes underwent pars plana vitrectomy and epiretinal membrane peeling for epiretinal membranes associated with cystoid macular edema and IRU (group D). Patients with IRU underwent standard clinical examinations and cSLT. On cSLT, volume above the reference plane was calculated within a fovea-centered circle of 3 mm in diameter. We devised a novel system for defining the reference plane. Measurements were performed 3 times in masked fashion and the mean was used for analyses. RESULTS: The mean macular volume was highest in group A (1.97 mm3). This was significantly higher (P<.001) than that in groups B (1.15 mm3), C (1.02 mm3), and D (0.86 mm3). CONCLUSIONS: Macular edema in patients with IRU can be consistently and objectively quantitated by cSLT. The method of defining the reference plane used in our study is novel and can be used in other disorders causing macular edema.

Predictors of drusen reduction after subthreshold infrared (810 nm) diode laser macular grid photocoagulation for nonexudative age-related macular degeneration.

PURPOSE: To determine the predictors of drusen reduction in eyes with nonexudative age-related macular degeneration (ARMD) treated with subthreshold infrared (810 nm) diode laser macular grid photocoagulation. Additionally, to determine the relationship of laser-induced drusen reduction and best-corrected visual acuity (BCVA) 18 months after laser treatment. DESIGN: Randomized controlled clinical trial. METHODS: Fifty patients (100 eyes) with bilateral nonexudative ARMD were enrolled at two centers. One eye of each patient was randomized to the observation; the other eye was treated with 48 subthreshold (invisible end point) applications of infrared (810 nm) diode laser in a macular grid pattern. The eyes that received subthreshold laser treatment were compared with the eyes that received no treatment. The baseline fundus characteristics (number, size, and distribution of drusen, as well as focal hyperpigmentation) from two macula areas (central 1500 micro diameter, pericentral 1500 micro ring area) on stereo color photographs, the number of laser-induced lesions, and the area of laser induced retinal pigment epithelial (RPE) lesions on fluorescein angiography 3 months after treatment were studied as predictors of major drusen reduction (> or = 50% drusen reduction from baseline) 18 months after laser treatment. BCVA at baseline and 18 months later was compared in observation eyes and in laser-treated eyes. RESULTS: Eighteen months after randomization, 24 (48%) of 50 eyes treated with subthreshold laser had major drusen reduction compared with three (6%) of 50 observation eyes (P =.00001). At 3 months post-treatment in laser-treated eyes with major drusen reduction, the mean number of laser-induced lesions on fluorescein angiography was 30.7 and the mean area of RPE change was 0.81 mm(2) compared with 14.8 laser-induced lesions and 0.35 mm(2) area of RPE change in eyes without major drusen reduction (P =.0001 and P =.0003, respectively). At baseline, fundus characteristics were not significantly different between observation eyes and laser-treated eyes or between the major drusen reduction group and the nonmajor drusen reduction group. At 18 months after treatment, BCVA was not significantly different in laser-treated eyes and in observation eyes. CONCLUSIONS: Subthreshold infrared (810 nm) diode laser macular grid photocoagulation in eyes with nonexudative ARMD significantly reduced drusen 18 months after laser treatment. Both the number of subthreshold laser lesions and the area of RPE changes visible on fluorescein angiography 3 months after treatment appeared to be predictors for major drusen reduction 18 months after treatment. However, it remains to be determined whether laser-induced drusen reduction is beneficial for visual acuity or reduces the incidence of choroidal neovascularization (CNV) in eyes with nonexudative ARMD.