Chromophore-Assisted Retinal Break Detection to Manage Challenging Situations in Retinal Detachment Redo Surgery.

INTRODUCTION: The purpose of this case series is to demonstrate that subretinal blue dye injection, with and without 180-degree endolaser retinopexy, can be considered a useful tool in finding occult rhegmatogenous retinal breaks in eyes with recurrent retinal detachment. Case Presentation. Three patients with recurrent retinal detachment were treated between January and March 2018. In all cases, the intraoperative internal search did not demonstrate any obvious break or hole. MembraneBlue-Dual (Trypan Blue 0.15% + Brilliant Blue G 0.025% + 4% PEG) was then injected into the subretinal space using a 41-gauge cannula. The eye was rotated such that the dye was pushed through a tiny break which was causing the retinal detachment. 180-degree laser retinopexy was performed on a single eye. After silicon oil removal and absorption of the gas tamponade, retinas remained attached at three-months follow-up. CONCLUSIONS: Chromophore-assisted occult retinal break detection can be considered a useful but not risk-free surgical technique in managing some unexpected and challenging intraoperative situations.

New surgical intervention for the weakening of the inferior oblique muscle: equatorial scleral anchor.

PURPOSE: To evaluate the efficacy of a new surgical technique in reducing inferior oblique muscle overaction. METHODS: Anterior transposition and myectomy of the inferior oblique muscle represent the gold-standard treatment in dissociated vertical deviation, including cases in which a simultaneous inferior oblique muscle overaction is also present. A new surgical procedure that consists of suturing the muscle to the sclera at the Gobin point with tendon sparing using a micro-incision to minimize the related tissue trauma and induce a faster recovery was developed. RESULTS: Two of 8 patients with essential infant esotropia had a complete resolution of the elevation in adduction with no residual vertical imbalance. All patients experienced an improvement in lateral incomitance. CONCLUSIONS: The new "equatorial scleral anchor" surgical procedure gives a similarly good outcome when compared with the classic inferior oblique anterior transposition technique, with the advantages being simple, safe, reversible, and modular in terms of suturing.

Inadvertent dexamethasone implant injection into the lens body management.

PURPOSE: Dexamethasone intravitreal implant is an approved preparation in the treatment of macular edema. The most common adverse reactions are increased intraocular pressure and cataract but the inadvertent injection of the dexamethasone implant into the capsular bag is an extremely rare event. METHODS: We present a case of a 78-year-old man treated for persistence of cystoid macular edema (CME) with Ozurdex intravitreal implant in which the procedure was complicated by the injection of the dexamethasone implant into the lens body and discuss the management. RESULTS: The patient underwent phacoemulsification of the lens, replacement of the Ozurdex, and implant of a 3-piece lens in the posterior chamber. CONCLUSIONS: The injection of an intravitreal dexamethasone implant (Ozurdex) into the lens body is an extremely rare complication that can be effectively and successfully managed with the surgical extraction of the implant from the lens body and implant of a 3-piece intraocular lens in the sulcus.

SD-OCT imaging of idiopathic macular holes with spontaneous closure.

Spectral-domain optical coherence tomography serial changes in three cases of spontaneous closure of idiopathic macular hole at stages II, III, and IV are described. Initial and serial spectral-domain optical coherence tomography images document the progressive closure. Macular holes apparently resolved spontaneously through two different mechanisms: posterior hyaloid detachment in case 1 and a contraction of epiretinal macular membrane in cases 2 and 3. The spontaneous closure of idiopathic full-thickness macular holes may occur in any stage of idiopathic macular hole; the small size of the hole is a common feature in all cases of spontaneous closure reported.