MACULAR ATROPHY AFTER MACULAR HOLE SURGERY ASSISTED BY MEMBRANE BLUE DUAL: A CASE SERIES.

PURPOSE: The aim of this study is to describe the clinical and multimodal imaging findings in patients with macular atrophy after macular hole surgery assisted by Membrane Blue Dual. METHOD: This study is a monocenter, retrospective, observational case series that included patients who presented with macular atrophy following macular hole surgery. RESULTS: Among the patients included in this study, four were operated for idiopathic macular hole and one for total retinal detachment associated with macular hole. In all patients, the internal limiting membrane was brittle and adherent, and multiple stains were required. One month postoperatively, all patients showed a reduced visual acuity except the patient with total retinal detachment. At fundus examination all patients showed patchy atrophy with a mottled hypopigmented and hyperpigmented appearance in the macular region. Optical coherence tomography scans demonstrated a closed macular hole with retinal thinning, disruption of the external retinal layers, and irregular retinal pigment epithelium thickening. Fundus autofluorescence showed a well-defined area of both hypoautofluorescence and hyperautofluorescence involving the macular area. CONCLUSION: Macular atrophy after Membrane Blue Dual-assisted internal limiting membrane peeling represents a severe complication that vitreoretinal surgeons should be aware of and that should be taken into account in preoperative evaluation and surgical procedure planning. To reduce the risk of this complication, we recommend to ensure the best conditions of visibility, to reduce as much as possible the intensity and the distance of the endoillumination from the retina, and to use as little dye as possible.

Ocular steroidome in human eyes and in eyes with complex central serous chorioretinopathy (CSCR).

The exact link between systemic and ocular endogenous corticoids (steroidome) is unclear and whether the ocular steroidome is altered in CSCR eyes is unknown. The aims of this study were to analyze the human steroidome in the aqueous humor as a function of age, sex and time of the day, to correlate systemic and ocular steroidome and to analyze the ocular steroidome in long lasting complex inactive CSCR. Based on our results, we present two CSCR cases treated by the combination of oral mineralocorticoid antagonist and glucocorticoids drops. In a cross-sectional study, aqueous humor (AH) was collected between 8am and 6 pm from 50 unaffected individuals (25 men and 25 women) and from 14 patients with chronic CSCR, during cataract surgery. In addition, simultaneous serum and AH were collected from 27 individuals undergoing cataract surgery and, simultaneous AH and vitreous were collected from 9 patients undergoing cataract and vitrectomy to estimate corticoids levels in the different compartments. The steroidome was determined using a LC-MS/MS method that quantifies 13 endogenous corticoids from the gluco, mineralocorticoid and androgen pathways. In AH and vitreous, the highest corticoid level is reached by cortisol (F), that represents less than 10% of F serum level. The cortisol levels in the serum did not correlate with ocular cortisol levels. Serum and ocular cortisone (E) levels correlate, although less than 5% of circulating E reaches the eye. The only mineralocorticoids measured in the AH were corticosterone (B) and its inactive form, the 11-desoxycorticosterone (A). There was no influence of circadian rhythm on cortisol ocular levels and there was no correlation between the age or the sex and the level of F, E, A, and B. In eyes with chronic inactive CSCR, the levels of the active glucocorticoid form F was lower than in control eyes and the F/E ratio was reduced by 50% but the B/A ratio was higher indicating imbalance towards active mineralocorticoids. Base on this observation, we propose to combine an antagonist of the mineralocorticoid receptor together with topical glucocorticoids in two CSCR patients, resistant to all other treatments, with favorable outcome. Our results indicate that the ocular psteroidome is highly regulated suggesting a local metabolism of ocular corticoids. In eyes with long-lasting complex inactive CSCR, the steroidome analysis shows lower active glucocorticoids and higher active mineralocorticoids.

Risk Factors of Cystoid Macular Edema After Pars Plana Vitrectomy for Pseudophakic Retinal Detachment.

INTRODUCTION: This study aimed to investigate the prevalence of cystoid macular edema after pars plana vitrectomy for the treatment of pseudophakic rhegmatogenous retinal detachment and identify possible related risk factors. METHODS: A retrospective monocentric study was conducted within a cohort of pseudophakic patients undergoing vitrectomy for rhegmatogenous retinal detachment between January 2019 and December 2022. Demographic data, initial and intraoperative characteristics of rhegmatogenous retinal detachment, and postoperative data were analyzed. Cystoid macular edema was defined on optical coherence tomography exclusively. RESULTS: A total of 164 eyes of 164 patients were included for analysis. The mean age of the patients at surgery was 65.7 ± 12.0 years. The mean best-corrected visual acuity was 2.1 ± 1.0 logMAR preoperatively and 1.0 ± 0.7 logMAR postoperatively. The mean follow-up was 13.4 ± 7.7 months. The prevalence of cystoid macular edema was 17.1% [9.8-26.4]. In multivariate analysis, severe proliferative vitreoretinopathy (relative risk 3.6 [1.3-9.7]) and laser retinopexy (relative risk 8.4 [1.1-64.7]) were independently and significantly associated with cystoid macular edema. CONCLUSION: The prevalence of cystoid macular edema in pseudophakic rhegmatogenous retinal detachment after pars plana vitrectomy was 17.1%. Severe proliferative vitreoretinopathy stage and the use of endolaser retinopexy were independent risk factors for development of cystoid macular edema.

Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment.

BACKGROUND/OBJECTIVES: The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade. SUBJECTS/METHODS: The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed. RESULTS: 48 patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6 and 100% vs 100%, all P values > 0.05). Postoperative best-corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2 ± 0.4 vs 2.6 ± 0.5, P < 0.001 and 0.1 ± 0.4 vs 0.4±0.9, P = 0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02). CONCLUSIONS: Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.

Mineralocorticoid Receptor Pathway and Its Antagonism in a Model of Diabetic Retinopathy.

Diabetic retinopathy remains a major cause of vision loss worldwide. Mineralocorticoid receptor (MR) pathway activation contributes to diabetic nephropathy, but its role in retinopathy is unknown. In this study, we show that MR is overexpressed in the retina of type 2 diabetic Goto-Kakizaki (GK) rats and humans and that cortisol is the MR ligand in human eyes. Lipocalin 2 and galectin 3, two biomarkers of diabetes complications regulated by MR, are increased in GK and human retina. The sustained intraocular delivery of spironolactone, a steroidal mineralocorticoid antagonist, decreased the early and late pathogenic features of retinopathy in GK rats, such as retinal inflammation, vascular leakage, and retinal edema, through the upregulation of genes encoding proteins known to intervene in vascular permeability such as Hey1, Vldlr, Pten, Slc7a1, Tjp1, Dlg1, and Sesn2 but did not decrease VEGF. Spironolactone also normalized the distribution of ion and water channels in macroglial cells. These results indicate that MR is activated in GK and human diabetic retina and that local MR antagonism could be a novel therapeutic option for diabetic retinopathy.

Impact of Video Technology for Improving Success of Medial Canthus Episcleral Anesthesia in Ophthalmology.

BACKGROUND AND OBJECTIVES: Efficient learning of regional anesthesia in ophthalmology remains challenging because trainees are afforded limited opportunity to practice ocular anesthesia. The aim of this prospective, randomized, blinded study was to determine whether teaching with video improves regional anesthesia skills of residents in ophthalmology. METHODS: From January to October 2016, 32 novice anesthesiology residents were evaluated while performing medial canthus episcleral procedures during a 5-day rotation. Residents were randomly assigned to either receive or not receive a video review of their performance at day 3. The primary outcome was a comparison of akinesia using a 12-point scale before incision assessed by the blinded surgeon. RESULTS: A total of 288 blocks were performed by 32 residents and were assessed by 3 surgeons before the intervention (144 blocks) and after the intervention (144 blocks). Residents in the review group improved to a greater degree compared with residents in the no-review group. The median overall akinesia scores for the review and no-review groups were similarly low (6; interquartile range [IQR], 2-11; and 6 [IQR, 2-9], respectively) on day 1 of the rotation, whereas anesthesia performed by residents in the video group provided a better akinesia score (12 [IQR, 10-12] vs 8 [IQR, 6-10]; P < 0.001) on day 5 of the rotation. CONCLUSIONS: Video-assisted teaching significantly improves performance of medial canthus episcleral anesthesia performed by novice trainees.

Displacement of retained subfoveal perfluorocarbon liquid after vitreoretinal surgery.

OBJECTIVE: To report a novel surgical procedure to displace retained subfoveal perfluorocarbon liquid (PFCL). METHODS: Retrospective cases series. Three patients had retained subfoveal droplets after PFCL was used in vitrectomy repair of retinal detachment. In each case, submacular PFCL was displaced to the subretinal space in the inferior periphery. A retinal detachment at the posterior pole and the inferior periphery was created by injecting balanced salt solution through a retinal puncture near the inferotemporal vessels. Fluid-air exchange was performed, followed by short-term postoperative upright head positioning. RESULTS: In all cases, PFCL droplets were successfully displaced toward the inferior periphery, with good visual recovery. CONCLUSION: This procedure seems to be safe and is an alternative to direct aspiration of PFCL through a juxtafoveal retinotomy, which risks damage to the foveal region.

Identification of anastomosis between the central retinal artery and the central retinal vein in a case of central retinal vein occlusion due to arteriovenous malformation.

PURPOSE: To report the identification of an arteriovenous anastomosis over the optic nerve head in a case of arteriovenous malformation. CASE REPORT: Dynamic scanning laser angiography was performed in a 12 year old girl with a severe arteriovenous malformation complicated by central retinal vein occlusion. RESULTS: The presence of an arteriovenous anastomosis between the central retinal artery and vein was identified. This anastomosis later regressed completely. CONCLUSIONS: An arteriovenous anastomosis between central vessels within the optic nerve may be a cause of central retinal vein occlusion. Spontaneous regression of the anastomoses may lead to improvement of fundus features.

Traumatic globe rupture following penetrating keratoplasty.

PURPOSE: To evaluate the mechanism, clinical characteristics, management and visual outcome of ocular trauma following penetrating keratoplasty (PK). METHODS: Twenty-six patients (13 men, 13 women) who suffered surgical wound dehiscence after PK because of ocular blunt trauma between 1994 and 2001 were included in this retrospective study. Graft dehiscence was managed with primary wound closure in all patients. Visual acuity, intraocular pressure, and funduscopy were evaluated in the follow-up. RESULTS: The mean age at trauma was 50+/-24 years (range 9-88 years). Mean interval between transplantation and trauma was 45.5+/-64 months (range 1 month to 20 years). Globe rupture occurred at the graft-host junction in all patients. Nine of 13 phakic eyes (69.2%) presented lens expulsion. Eight of nine pseudophakic eyes (88.9%) had lost their implants. Retinal detachment occurred in seven eyes (27%) within 3 months following the trauma. Five patients (19.2%) underwent vitreous surgery for posterior segment damage. Two eyes (7.7%) were regrafted. At the last examination, only seven eyes (27%) had visual acuity of 20/200 or better. CONCLUSIONS: Traumatic wound dehiscence may occur, and the prognosis is poor after the injury. Globe rupture at the graft-host junction showed persistence of wound weakness even a long time after PK. Prevention of ocular trauma should be performed following PK.

Late swelling and removal of Miragel buckles: a comparison with silicone indentations.

BACKGROUND: To describe the indications for removal of Miragel episcleral buckles and to compare them with removed silicone sponges and solid silicone indentations. METHODS: Retrospective analysis of the charts of patients successfully treated for retinal detachment in whom the episcleral buckle was removed after surgery, with a minimal follow-up of 6 months. RESULTS: In a series of 90 eyes of 90 patients, including 38 cases of Miragel elements, 25 cases of solid silicone, and 27 cases of silicone sponge removal, the duration of indentation before removal was significantly longer with Miragel (91.9 months) than with solid silicone (10.6 months) and silicone sponges (18.6 months). In eyes treated with Miragel elements, swelling of the material with progressive limitation of ocular motility and protrusion of the buckle beneath the eyelids indicated its removal in 34 (89.5%) eyes. Infection of the buckle and erosion of the conjunctiva with an exposed indentation were significantly more common with silicone buckles. Overall, scleral perforation occurred in four (4.4%) eyes, and retinal redetachment occurred in eight (8.8%) eyes. CONCLUSION: Late swelling of Miragel buckling elements represents a common indication for buckle removal, significantly different from silicone indentations.

Cryoextraction of episcleral Miragel buckle elements: a new technique to reduce fragmentation.

A step-by-step description of a surgical technique for episcleral Miragel buckle removal is reported. After dissection of the conjunctiva and the capsule surrounding the Miragel element, the extremity of the buckle is pulled out with a cryoprobe. The removal of Miragel episcleral buckle with the cryoprobe is a safe and effective technique with a low fragmentation rate and a reduction of the surgical risk related to the use of sharp forceps near a possibly weakened sclera. Procedure time seems also to be reduced.