Outcomes in the Treatment of Subretinal Macular Hemorrhage Secondary to Age-Related Macular Degeneration: A Systematic Review.

Background: Subretinal macular hemorrhage (SRMH) secondary to age-related macular degeneration (AMD) is a relatively rare condition in ophthalmology characterized by blood collection between the neurosensory retina and the retinal pigment epithelium (RPE). Without prompt treatment, visual prognosis is poor. A plethora of treatment approaches have been tried over the past years ranging from intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy to direct subretinal surgery, with no conclusive superiority of one over the other. Materials and Methods: We conducted a systematic review of the outcomes and treatment modalities of SRMH from inception to 14 June 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence was assessed for all included articles according to the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: A total of 2745 articles were initially extracted, out of which 1654 articles were obtained after duplicates were removed and their abstracts screened. A total of 155 articles were included for full-text review. Finally, 81 articles remained that fulfilled the inclusion criteria. Conclusions: Even though there are solid results supporting a variety of treatments for SRMH, the best treatment modality has still not been conclusively demonstrated and further research is needed.

Outcomes of Abrupt Switch to Bevacizumab of Patients Undergoing Aflibercept Intravitreal Injections for Neovascular Age-Related Macular Degeneration in a Tertiary Center in Lombardy, Italy: A Real-Life Retrospective Analysis.

PURPOSE: To assess real-life anatomical and functional outcomes of switch to bevacizumab in patients undergoing aflibercept intravitreal injections for nAMD. METHODS: Retrospective chart review of all patients diagnosed with nAMD and undergoing intravitreal injections of aflibercept who switched to bevacizumab after the resolution XI/1986 of Lombardy Region. RESULTS: Among 128 patients undergoing intravitreal injections, a total of 29 eyes of 29 patients met all inclusion criteria and were included in the statistical analysis. Best corrected visual acuity and central macular thickness did not change significantly (p > 0.05) between baseline, after the loading phase, and at the last follow-up. CONCLUSION: Switching to bevacizumab has been safe and efficacious in patients responding to the loading phase. According to our results, the restrictions imposed by Lombardy Region did not cause any harm to patients undergoing intravitreal anti-VEGF injections.

Pneumatic tools for vitreoretinal surgery.

One of the difficulties of microsurgery is learning how to control physiological tremors. The pneumatic tool eliminates the physiological tremor, but no tactile feedback is provided. The manual tremor when closing the forceps is completely eliminated and the exact target can be more easily grabbed. Forceps closure pressure can rise up to 50 psi, whereas the scissors can be used in two modes: multicut and proportional. When performing bimanual surgery the pedal range is divided into two steps: in the first step, the forceps are controlled, and in the second step, the forceps remain closed. At the same time the scissors start to work in the preselected mode. No adverse events occurred and no iatrogenic retinal breaks were produced. Precision and control sensation were a grateful surprise.

Chronic macular edema medical treatment in Irvine-Gass syndrome: case report.

PURPOSE: The advent of intravitreal pharmacologic therapies opened a new perspective in the treatment of Irvine-Gass syndrome with potential side effects. In this case report we evaluated the efficacy of steroid sub-Tenon injection treatment in chronic macular edema. METHODS: Five sub-Tenon injections, each of 0.8 cc of 4 mg betamethasone, were performed at 1-week intervals, followed by a second cycle of 5 sub-Tenon injections with the same cadency injections 4 months after the first cycle in a 52-year-old Caucasian woman with post-cataract surgery macular edema (Irvine-Gass syndrome). RESULTS: At first examination, the patient showed a best spectacle-corrected visual acuity (BSCVA) of 0.52 (logMAR). Optical coherence tomography (OCT) showed a foveal thickness of 893+/-4 microm and total macular volume of 15.41 mm3. Eleven months after starting treatment, BSCVA was 0.39 (logMAR) with reduction in metamorphopsia and better color sensitivity. OCT showed a foveal thickness of 217 microm and total macular volume of 8.05 mm3. Differential map between the first and the last OCTs showed a foveal thickness reduction of 660 microm. CONCLUSIONS: The significant improvement observed in this case of postsurgical macular edema showed how sub-Tenon steroidal injections proved to be useful as a first-step therapy.

Tangential topography corneal map to diagnose laser treatment decentration.

PURPOSE: To describe the use of corneal topography to determine the cause of decentration and pseudodecentration after laser ablation. METHODS: A total of 148 eyes referred for treatment of decentration after primary excimer laser surgery were evaluated using corneal topography. The criteria and maps used to distinguish between decentration and pseudodecentration are described. All eyes were analyzed with the tangential algorithm of the CSO corneal topographer and the NIDEK OPD-Scan. RESULTS: Eyes were classified into two groups: decentered and pseudodecentered. Only 5 (3.4%) eyes were decentered, and 143 eyes were classified as pseudodecentered. Analysis of the different causes of pseudodecentration included 28 cases due to an irregular ablation, 107 cases due to high corneal dioptric gradient, and 8 cases due to central islands. Instantaneous corneal topography was the most suitable map to determine decentration and pseudodecentration. CONCLUSIONS: Decentration and pseudodecentration were due to corneal topographic abnormalities causing sudden changes of corneal curvature in the midperiphery. The evaluation of the instantaneous curvature maps in this study underscores the importance of these peripheral changes by highlighting their impact on the optical performance of the central cornea.

Pharmacological management of night vision disturbances after refractive surgery Results of a randomized clinical trial.

PURPOSE: To evaluate the efficacy and safety of diluted aceclidine eyedrops in reducing night vision disturbances after refractive surgery. SETTING: Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milano, Italy. METHODS: This double-masked randomized clinical trial included 30 patients (60 eyes) with chronic night vision disturbance after refractive surgery. Patients were randomly allocated to receive (1) placebo, (2) aceclidine 0.016%, or (3) aceclidine 0.032%. Drugs were administered once or twice daily. Anterior segment, haze, uncorrected visual acuity, best corrected visual acuity, intraocular pressure, corneal maps, and scotopic pupil size were determined at baseline and at follow-up examinations (15 and 30 days after inclusion). Halos and double vision 4-step scales were built to determine subjective grading of night vision disturbance, and the root mean square (RMS) was calculated to determine objective changes in night vision disturbance. RESULTS: The effect of diluted aceclidine started about 15 minutes after instillation and lasted for about 5 hours. No difference between the 2 dilutions could be found. Thirty-nine of 40 treated eyes showed a reduction in night vision disturbance. The mean reduction in halos and double vision grading was 1.42 +/- 0.5 (SD) and 1.14 +/- 0.4, respectively. A mean decrease in pupil size of 2.5 mm was measured. Thirty minutes after the instillation of diluted aceclidine, the topography-derived wavefront error showed a statistically significant reduction in RMS values (total, spherical, astigmatic, coma, and higher order), which was maintained for 5 hours. A transitory conjunctival hyperemia was the only side effect reported. CONCLUSION: Diluted aceclidine seemed to be an effective and safe treatment for night vision disturbance following refractive surgery.

Mutations in the myocilin gene in families with primary open-angle glaucoma and juvenile open-angle glaucoma.

OBJECTIVES: To investigate the prevalence of myocilin (MYOC) mutations in Italian families with glaucoma and to determine the relationship of these mutations to primary open-angle glaucoma (POAG), juvenile open-angle glaucoma (JOAG), and pigmentary dispersion glaucoma. METHODS: Twenty-six patients with POAG were selected based on a positive family history of glaucoma. All patients and 210 relatives had an accurate clinical characterization. MAIN OUTCOME MEASURE: Each index patient was screened by single-stranded conformational polymorphism analysis for mutations in the MYOC gene. RESULTS: A MYOC gene mutation was found in 2 families. In one family, a previously reported p.K423E mutation was transmitted from the index patient with POAG to the 2 sons with JOAG. In the second family, a p.C25R change, affecting the signal peptide, was transmitted from the index patient with POAG to the son with JOAG, but not to the son with pigmentary dispersion glaucoma. CONCLUSIONS: Clinical characterization of 2 families with MYOC gene mutations indicates that POAG and JOAG are the 2 sides of a continuum phenotypical spectrum due to a common molecular defect. On the other hand, our results confirm the different origin of pigmentary dispersion glaucoma. CLINICAL RELEVANCE: Because MYOC gene mutations may be responsible for a fraction (2 [8%] of 26) of families with POAG/JOAG, a molecular genetic diagnosis should be included in the management of patients with glaucoma.

One-year results of butterfly laser epithelial keratomileusis.

PURPOSE: To evaluate the risks, complications, and refractive results at 1 year after modified laser epithelial keratomileusis (Butterfly LASEK). METHODS: In a non-randomized prospective study of 773 eyes (452 patients; mean age 34.3 +/- 16.5 years, mean preoperative spherical equivalent refraction -5.30 +/- 3.70 D; mean sphere -4.80 +/- 3.60 D; mean cylinder -1.00 +/- 1.40 D; range -22.50 to +5.50 D), we used a modified LASEK technique and evaluated complications and refractive results at 1 year. The technique is based on the formation of the epithelial flap utilizing alcohol (20% diluted solution applied on the epithelium for 5 to 30 seconds), paracentral abrasion, blunt dissection of the epithelium from the underlying plane; the epithelium is then separated by means of a specially designed retractor. Ablation was performed with a Nidek EC-5000 excimer laser, followed by smoothing and repositioning of the epithelial flap. RESULTS: After 1 year, we analyzed the results of 542 (70.1%) treated eyes with the following outcome: mean postoperative spherical equivalent refraction -0.20 +/- 1.40 D; mean sphere -0.10 +/- 1.30 D; mean cylinder -0.10 +/- 0.60 D; range -2.50 to +0.75 D. In 83.0% of treated eyes, achieved refraction was within +/-0.50 D of planned correction, with uncorrected visual acuity greater than or equal to 1.2 in 19.0% of treated eyes, greater than or equal to 1.0 in 56.0%, and greater than or equal to 0.8 in 19%. Concerning visual acuity, 0.3% of eyes lost 1 line, 49.8% of eyes had no change; 41.8% gained 1 line, 9.8% gained 2 lines, and 1.6% gained more than 2 lines. CONCLUSION: One-year results of this preliminary study showed that Butterfly LASEK was easy to perform, safe, and led to excellent long-term refractive results.