Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy.

AIM: To analyze the distribution of fibrovascular proliferative membranes (FVPMs) in proliferative diabetic retinopathy (PDR) patients that treated with pars plana vitrectomy (PPV), and to evaluate the outcomes separately. METHODS: This was a retrospective and cross-sectional study. Consecutive 25-gauge (25-G) PPV cases operated for PDR from May 2018 to April 2020. According to the FVPMs images outlined after operations, subjects were assigned into three groups: arcade type group, juxtapapillary type group, and central type group. All patients were followed up for over one year. General characteristics, operation-related variables, postoperative parameters and complications were recorded. RESULTS: Among 103 eyes recruited, the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different (both P<0.01), with 95 (92.23%) FVPMs located in the nasal quadrants, and 74 (71.84%) in the inferior. The eyes with a central FVPM required the longest operation time, with silicon oil used in most patients, generally combined with tractional retinal detachment (RD) and rhegmatogenous RD, the worst postoperative best-corrected visual acuity (BCVA) and the highest rates of recurrent RD (all P<0.05). FVPM type, age of onset diabetes mellitus, preoperative BCVA, and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement (all P<0.05). Compared with the central type group, the arcade type group had higher rates of BCVA improvement. CONCLUSION: FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels. Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

Ciliochoroidal Detachment After Intrascleral Lens Fixation Using the Yamane Technique.

PURPOSE: The purpose of this study was to compare the incidence of ciliochoroidal detachment (CCD) after intrascleral lens fixation using the Yamane technique and other vitrectomy procedures. METHODS: This retrospective study evaluated patients who underwent intrascleral lens fixation using the Yamane technique at Hiroshima University Hospital between March 2023 and February 2024 and who could be followed up for at least one month. Patients who underwent vitrectomy for macular disease without air-fluid exchange comprised the control group. The frequency of CCD was compared using anterior segment optical coherence tomography imaging. RESULTS: Forty-five eyes of 45 patients (26 men and 19 women, mean age 70.8 years) were included. There were no significant differences in the population means or proportions between the intrascleral fixation and control groups for age, sex ratio, right-to-left eye ratio, preoperative visual acuity, preoperative intraocular pressure (IOP), ocular axis, and corneal thickness. The population mean of IOP on the day after surgery was significantly lower in the Yamane intrascleral fixation group (8.4 mmHg) than in the control group (11.5 mmHg) (P < 0.05). There was no significant difference in the population proportions of CCD on the day after surgery between the Yamane intrascleral fixation group and the control group. However, the CCD incidence was 20 eyes (80%) for the Yamane intrascleral fixation group and 12 eyes (60%) for the control group, which was higher in the intrascleral fixation group. There was no significant difference in population means of IOP or population proportions of CCD at one week and one month. CONCLUSIONS: There was no significant difference in population proportions of CCD on the day after surgery, although the CCD rate for the Yamane intrascleral fixation group was higher, and the population mean of the IOP was significantly lower. The Yamane technique assumedly lowered IOP because of the stress placed on the ciliary body. One week after the procedure, the IOP in the intrascleral fixation group normalized.

Endophthalmitis caused by Hathewaya histolytica: A diagnostic dilemma.

A 76-year-old male presented with pain, redness, and decreased vision in the left eye for 5 days. The patient had undergone combined cataract extraction and vitrectomy for a macular hole 2 weeks back. The vision had reduced to the perception of light in the left eye. Clinical examination revealed lid edema, conjunctival congestion, hazy cornea, and exudative membrane in the pupillary axis with no view of the fundus. Ultrasound examination of the left eye showed plenty of moderate reflective dot echoes. The patient was diagnosed with postoperative endophthalmitis and underwent vitrectomy with intravitreal injection of antibiotics. Growth of Hathewaya histolytica was obtained from the vitreous sample. The organism was sensitive to imipenem. Three weeks following the presentation, visual acuity had improved to counting fingers at one meter in the left eye. This is the first report of endophthalmitis due to H. histolytica. Ophthalmologists should be aware of such ocular infections due to a rare microorganism.

Risk of ocular neovascular conversion and systemic bleeding complications in patients with AMD on DOACs or Warfarin.

PURPOSE: Conversion to neovascular disease in patients with non-neovascular age-related macular degeneration (AMD) initiated on direct oral anticoagulants (DOAC) compared to matched patients treated with warfarin. DESIGN: Retrospective cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: The study included 20,300 patients and 13,387 patients with non-neovascular AMD initiated on DOACs or warfarin, respectively, before propensity score matching (PSM). METHODS, INTERVENTION, OR TESTING: TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with non-neovascular AMD stratified by treatment with DOACs or warfarin with at least six months of follow-up. Propensity score matching was performed to control for baseline demographics and medical comorbidities. MAIN OUTCOME MEASURES: Relative risk (RR) of developing neovascular AMD, macular hemorrhage (MH), vitreous hemorrhage (VH), and requiring an ocular intervention (intravitreal anti-vascular endothelial growth factor (VEGF) therapy or pars plana vitrectomy (PPV)) within six months and one year. Patients with chronic atrial fibrillation (AF) on anticoagulation were separately evaluated for the same measures within 5 years after initiating therapy. RESULTS: Treatment with warfarin was associated with higher risk of developing neovascular AMD at six months (RR,1.24, 95% CI, 1.12 - 1.39; P<.001) and one year (RR, 1.26, 95% CI, 1.14 - 1.40; P<.001) when compared to matched patients treated with DOACs. There was an increased risk of requiring intravitreal anti-VEGF therapy (6 months: RR, 1.30; 95% CI, 1.13-1.49; P<.001; 1 year: RR, 1.31, 95% CI, 0.72 - 2.05; P<.001) and PPV (6 months: RR, 1.16; 95% CI, 1.16-3.94; P = .01; 1 year: RR, 2.29, 95% CI, 1.30 - 4.05; P=.003). Among patients with AMD and AF treated with warfarin, there was an increased risk of ocular complications (neovascular AMD: RR, 1.25; 95% CI, 1.14-1.38; P<.001; MH: RR, 1.86; 95% CI, 1.47-2.35; P<.001; VH: RR, 2.22; 95% CI, 1.51-3.26; P<.001) and need for intravitreal anti-VEGF therapy (RR, 1.34; 95% CI, 1.18-1.52; P<.001) over an extended 5-year period. There was no significant difference in the development of major systemic hemorrhagic events between the two cohorts over five years. CONCLUSIONS: Patients with non-neovascular AMD treated with warfarin were more likely to develop neovascular disease and require ocular intervention for hemorrhagic complications when compared to matched patients initiated on DOACs.

Comparative analysis of internal limiting membrane peeling versus internal limiting membrane flap insertion for treating idiopathic macular holes.

OBJECTIVE: To evaluate the clinical efficacy of internal limiting membrane (ILM) peeling combined with perimacular hole massage versus ILM flap insertion in the management of patients with idiopathic macular holes was conducted. METHODS: 35 patients (total of 35 eyes) with idiopathic macular holes (with hole diameters ranging from 366 to 1430 µm) were divided into two groups-Group A consisted of 20 eyes that underwent pars plana vitrectomy (PPV) combined with ILM peeling and perimacular hole massage, while Group B comprised 15 eyes that underwent PPV combined with ILM flap insertion. Subsequent follow-up examinations were performed at 1 week, 1 month, and 3 months post-surgery. The study also involved a comparison of best corrected visual acuity (BCVA) and optical coherence tomography (OCT) classifications between both the patient groups. RESULTS: The macular hole closure rates in Group A were 60%, while in Group B, the closure rate was 93%. There was significant difference in hiatus healing rate between the two groups (t = 4.843, p = 0.048). The difference in BCVA at 3 months post-operation between the two groups was statistically significant (t = 3.221, p = 0.003). Three months post-operatively, the BCVA in Group B demonstrated improvement compared to the pre-operative BCVA, with a statistically significant difference (p > 0.05). Three months post-operatively, the BCVA in Group A demonstrated improvement compared to the pre-operative BCVA, but this difference was not statistically significant (p > 0.05). CONCLUSION: The combination of PPV with ILM flap insertion demonstrates favorable therapeutic efficacy in the treatment of idiopathic macular holes, leading to improved visual acuity.

Removal of Subinternal Limiting Membrane Hemorrhage Secondary to Valsalva Retinopathy Using a Fovea-Sparing Internal Limiting Membrane Fissure Creation Technique.

Introduction: Valsalva retinopathy can cause submacular hemorrhage (SMH), which may lead to visual disturbances. SMH can extend into the subinternal limiting membrane (ILM) and vitreous spaces, sometimes occurring concomitantly with full-thickness macular holes (FTMHs). Herein, we describe a case in which sub-ILM hemorrhage was removed without peeling the ILM of the central fovea, thus preserving the foveal ILM. Case Presentation: A 48-year-old female patient developed rapid-onset bilateral visual impairment due to SMH secondary to Valsalva retinopathy. The SMH predominantly consisted of sub-ILM hemorrhage. However, detailed observation was challenging due to the dense sub-ILM hemorrhage in the left eye. Initial best-corrected visual acuity (BCVA) in the right and left eyes were 1.2 and 0.03, respectively. Intravitreal tissue plasminogen activator (tPA) and sulfur hexafluoride (SF6) gas injections were initially administered to displace the SMH in the left eye; however, the SMH could not be successfully displaced. A vitrectomy was then performed. Intraoperatively, an ILM fissure beyond the foveal region was created using ILM forceps. The balanced salt solution was sprayed onto the ILM, and the sub-ILM hemorrhage was drained into the vitreous cavity from the ILM fissure. The surgery successfully displaced the sub-ILM hemorrhage while preserving the foveal ILM. No postoperative complications were observed. Visual acuity remained at 1.2 in the right eye and improved to 1.2 in the left eye 6 months postoperatively. Conclusion: Removing foveal sub-ILM hemorrhage without peeling the foveal ILM can be a viable treatment option to preserve the foveal ILM.

Xen gel stent implant for persistent glaucoma after silicone oil removal.

PURPOSE: To evaluate the effectiveness and safety of the XEN-Stent for managing unresponsive to medical therapy secondary glaucoma after silicone oil (SO) removal. METHODS: This retrospective chart reviewed 12 patients who underwent vitrectomy and SO endotamponade. They experienced intraocular pressure (IOP) elevation after SO removal despite taking the maximum tolerated glaucoma medication. Eleven eyes underwent an XEN-implant, while 1 underwent an XEN-implant with phacoemulsification/IOL implantation. The primary outcome was to achieve success criteria: IOP <18 mmHg and >20% IOP reduction without medication (complete success) or with medication (qualified success) and without a secondary IOP-lowering procedure. IOP, best-corrected visual acuity (BCVA), and the number of glaucoma medications (Glaucoma Medication Score-GMS) were recorded at baseline, 1 day, 1 week, 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months postoperatively. RESULTS: Baseline characteristics included males percentage 66.6%, mean age of 61.8 ± 5.7 years, BCVA 0.69 ± 0.3 logMAR, IOP 30 ± 4.2 mmHg, and GMS 3.1 ± 0.5. There was a significant reduction in IOP by 14 ± 1.9 mmHg and GMS by 0.27 ± 0.6 at M12 compared to baseline (p < 0.01), but no significant change in BCVA (p = 0.21). Complete success dropped to 50% (M3), rising to 75% (M6, M12) after needling. Two patients achieved qualified success at M12. Needling was performed in 6 eyes, with 3 requiring a second procedure. Ex-PRESS was required in 1 eye. One eye experienced hypotony and hyphema, which resolved within a week. CONCLUSION: XEN implant may be an initial treatment for persistent post SO removal glaucoma with minimal complications. Needling procedures can help maintain or restore surgical success.

Electroretinograms Recorded with Skin Electrodes from Post-Vitrectomy Silicone Oil Filled Eyes with Proliferative Diabetic Retinopathy.

Purpose: To determine the physiological status of the retina by electroretinography (ERG) using skin electrodes and the RETevalTM system in eyes that had undergone pars plana vitrectomy (PPV) with silicone oil (SO) tamponade. The vitrectomy was performed for a retinal detachment and proliferative diabetic retinopathy (PDR). Design: Retrospective case series. Methods: ERGs were recorded with the RETevalTM system (LKC Technologies Inc. Gaithersburg, MD; Welch Allyn, Inc. Skaneateles Falls, NY) from eight eyes with PDR before and after the SO removal. The amplitudes and implicit times of the a- and b-waves of the ERGs before the SO removal were compared to that after the SO removal. Results: ERGs were recordable in four eyes before and after the SO removal and the a- and b-amplitudes improved in three eyes and worsened in one eye after the SO removal. In the remaining four eyes, ERGs were non-recordable both before and after the SO removal. Conclusion: These results indicate that ERGs picked up by skin electrodes can be used to assess the physiology of the retina in eyes with a SO tamponade. The flat ERGs in the SO-filled eye indicated the presence of diffuse retinal damage which was confirmed by the flat ERGs after the SO removal.

There has been an increasing number of reports on evaluating the retinal function using electroretinography (ERG) with skin electrodes. The main advantage of this system is the ability to record ERGs with a skin electrode that does not touch the cornea and ocular surface. This reduces the risk of infection especially in the postoperative period and in clinical situations where infection is suspected. In addition, there have been only a few reports evaluating the function of the retina by ERG in SO-filled eyes. We recorded ERGs with the RETeval (LKC Technologies Inc. Gaithersburg, MD; Welch Allyn Inc. Skaneateles Falls, NY) device, a relatively new ERG recording system that uses skin electrodes and is less invasive. We recorded ERGs from eight SO-filled eyes with proliferative diabetic retinopathy (PDR). In 4 SO filled eyes, the amplitudes increased in three eyes after the SO removal. In the other four eyes, ERGs were non-recordable before and after the SO removal. These results suggest that the RETeval system that uses skin electrodes can be used to assess the retinal function in PDR eyes with a SO tamponade. We suggest that the absence of ERGs in the SO filled eyes was not due to the electrical non-conductive effects of SO but may indicate the presence of diffuse retinal damage which was confirmed after the SO removal.

Use of intravitreal antiviral injection during vitrectomy in the treatment of acute retinal necrosis: anatomic and visual outcomes.

PURPOSE: To investigate whether intravitreal antiviral injection (IAI) during vitrectomy reduces the postsurgical retinal detachment (RD) rate and improves the visual prognosis of patients with acute retinal necrosis (ARN). METHODS: This retrospective cohort study included ARN patients treated at a tertiary hospital between January 2013 and December 2020. Patients who underwent pars plana vitrectomy (PPV) alone or combined with intraoperative IAI were classified in PPV-only group and PPV + IAI group, respectively. The incidence of postsurgical RD and the best corrected visual acuity (BCVA) between the groups was compared. A multivariate Cox hazard analysis was employed to explore the risk factors of postsurgical RD. A multivariate logistic regression analysis was applied to assess the impact of intraoperative IAI on preventing severe vision loss (SVL). RESULTS: Fifty-seven eyes with ARN with a median follow-up of 18.5 months were included in the study. There was no significant association between intraoperative IAI during vitrectomy and a reduced risk of postsurgical RD (hazard ratio [HR], 2.65; 95% CI, 0.71-9.89) or SVL at the 6-month follow-up visit (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.25-3.35). Better baseline best-corrected visual acuity (BCVA) was identified to associate with a higher risk of postsurgical RD (HR, 0.33; 95% CI, 0.14-0.81) and a lower risk of SVL at 6 months (OR, 2.28; 95% CI, 1.10-4.89). CONCLUSION: We did not observe a significant effect of intraoperative IAI on the anatomic and visual outcomes of ARN patients in this study. Intraoperative IAI may not be a necessary treatment option for ARN patients who receive vitrectomy.

[Predictive parameters for anatomical surgical success in full-thickness macular holes : A retrospective evaluation of 391 eyes]. / Prädiktive Parameter für den anatomischen Operationserfolg bei durchgreifenden Makulaforamina : Eine retrospektive Auswertung von 391 Augen.

BACKGROUND: Full-thickness macular hole (FTMH) is a rare disease. Not all FTMHs can be closed by primary surgical intervention. OBJECTIVE: This work aims to characterize a large patient population with FTMHs and to detect possible predictive factors for anatomical treatment success. MATERIALS AND METHODS: The study comprises a retrospective analysis of all consecutive idiopathic macular holes between March 2008 and June 2019 at the University Eye Hospital Cologne. Epidemiologic data, preoperative parameters (size of the FTMH), and surgical technique were examined in relation to the closure rate following primary surgery. RESULTS: The anatomical closure rate for idiopathic FTMH after primary surgery was 83.6%. No association between age, gender, and lens status and closure rate could be shown. Regarding anatomical surgical success, the favorable prognostic factors identified were a small FTMH size, short symptom duration, performance of transconjunctival 23-gauge vitrectomy, and application of the inverted flap technique of the internal limiting membrane (ILM). CONCLUSION: Surgical treatment represents a valuable treatment option for patients with macular holes due to good prospects of success. Prompt intervention after diagnosis using 23-gauge vitrectomy and an ILM flap with gas tamponade seems to result in the most favorable outcomes.

A novel approach to remove retained lens material: Suction-assisted elevation and anterior chamber phacoemulsification.

PURPOSE: To describe and evaluate the feasibility of a novel pars plana vitrectomy (PPV) technique for the removal of retained lens material (RLM), which obviates the need for either 20-gauge intravitreal fragmentation or perfluorocarbon-assisted elevation. METHODS: Interventional case series. After thorough 23-gauge PPV, the hard lens material is engaged and held adherent to the vitreous cutter using aspiration, then raised into the anterior chamber. There, a standard phacoemulsification probe, inserted through a corneal incision, is used to fragment and remove the material. RESULTS: Three eyes of 3 patients were operated on. In all eyes, RLM could be removed completely. Postoperatively, 2 of 3 eyes (67%) achieved 20/20 best-corrected visual acuity. No complications such as glaucoma, cystoid macular edema, corneal edema, or retinal detachments were recorded. Intraoperatively, retinal tears were detected in 2 of 3 (67%) eyes and treated with endolaser retinopexy and fluid-air exchange. One eye subsequently developed macular hole requiring further surgery. CONCLUSION: Suction-assisted lens elevation may be a viable and convenient technique to remove RLM during PPV. Although the comparison with other methods is beyond the scope of this preliminary study, visual outcomes and complication rates were encouraging and should be validated in a larger group of patients.

Large macular hole and autologous retinal transplantation: a systematic review and meta-analysis.

INTRODUCTION: Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software. RESULTS: We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I2 = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I2 = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I2 = 59%). CONCLUSION: ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.

Optical coherence tomography angiography based prognostic factors and visual outcomes in primary rhegmatogenous retinal detachment after pars plana vitrectomy.

PURPOSE: To evaluate the visual outcomes and changes in the retinal microcirculation in patients with primary rhegmatogenous retinal detachment (RRD) following successful pars plana vitrectomy (PPV). METHODS: Nine macula-on RRD and 23 macula-off RRD eyes were retrospectively evaluated. Clinical data was collected at admission and 3 months after PPV. Optical coherence tomography angiography (OCTA) was performed 3 months after PPV. Superficial vascular plexus data obtained with OCTA was compared between affected and fellow eyes and according to macular involvement. Quantitative measurements of the superficial retinal capillary associated with the preoperative and intraoperative factors were analyzed. RESULTS: Overall RRD inner vessel densities (IVD), full vessel densities (FVD), inner perfusion densities (IPD) and full perfusion densities (FPD) were significantly and positively correlated with best corrected visual acuity (BCVA)(p = 0.002, p = 0.006, p = 0.009, p = 0.023, respectively). In the macula-off RRD, IVD and FVD were significantly decreased compared with macula-on RRD (p = 0.014 and p = 0.034, respectively) and significantly correlated with a longer duration and larger extension of detachment. Higher differences of IVD and FVD between the fellow and affected eyes were significantly correlated with worse BCVA in the macula-off subgroup. CONCLUSION: Macula-off RRD presented worse OCTA superficial vascular parameters compared with the macula-on group and fellow eyes, which were correlated with a poorer visual outcome and exacerbated by a longer duration and larger extension of the detachment. Macula-off RRD causes not only retinal structural damage but also a reduction in retinal perfusion despite successful anatomical repair.

Profound improvement in vision and electroretinogram after intensive steroid treatment in unexplained visual loss after silicone oil removal.

Purpose: Unexplained vision loss after silicone oil removal is a well-documented but incompletely understood entity for which there is no effective treatment described in the existing literature. We present a case where intensive oral and periocular steroid treatment resulted in significant subjective and objective clinical improvement. Observations: After successful pars plana vitrectomy with silicone oil endotamponade to repair a macula sparing retinal detachment, the patient's best corrected visual acuity was 20/20 with silicone oil in the operative eye. However, seven weeks after uncomplicated combined silicone oil removal and cataract extraction with intraocular lens insertion, best corrected visual acuity was 20/250 with no new ophthalmic pathology to explain the vision loss. After a four week course of oral prednisone and three periocular triamcinolone injections over a period of nine weeks, visual acuity improved to 20/25 -2 in the operative eye. Serial multifocal electroretinography initially showed severely diminished amplitudes but improved markedly over the course of steroid treatment. Conclusions and Importance: Although no effective treatments are described in the existing literature, improvement in visual acuity, visual field, and electroretinogram in this case suggests that intensive steroid treatment (periocular and systemic) may be efficacious in treating unexplained vision loss after silicone oil removal.

Autosomal Recessive ADAMTSL4-Related Isolated Ectopia Lentis in the Ohio Old Order Amish and Mennonite Communities.

Purpose: To present a series of 4 patients from the Ohio Amish or Mennonite populations with isolated ectopia lentis. Methods: A case series was evaluated. Results: Four cases with bilateral lens subluxations were diagnosed with a homozygous c.767_786del pathogenic variant in ADAMTSL4. Their ages ranged from 2 to 22 years. Three cases were symptomatic and were managed surgically with lensectomy, vitrectomy, and endolaser photocoagulation with or without secondary intraocular lens (IOL) implantation. One asymptomatic patient was observed. The postoperative visual acuity ranged from 20/20 to 20/60 in nonamblyopic eyes. Conclusions: The pathogenic homozygous c.767_786del variant in ADAMTSL4 may be a cause of bilateral isolated ectopia lentis in the Ohio Amish and Mennonite populations, likely as a result of a founder effect. Vitrectomy and lens extraction with or without secondary IOL implantation may lead to good visual outcomes. There were no cases of retinal detachment.

Late-onset capsular bag distension syndrome 33 years after cataract surgery.

Purpose: Describe the clinical features and management of this uncommon case of late-onset Capsular bag distension syndrome that occurred 33 years after cataract surgery. Observation: An 87-year-old male was referred to our clinic complaining of blurred and gradual, painless reduction in vision in his left eye over the past year. A complete ophthalmological examination, Ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT), and optical biometry were performed to confirm the diagnosis. A 25-gauge pars plana vitrectomy combined with posterior capsulotomy was performed. The aspirated fluid was sent for microbiological analyses. After surgery, the patient's visual acuity returned to previous values, and anterior chamber depth slightly deepened. Samples taken were negative for bacteria. Conclusions and Importance: Late-onset Capsular bag distension syndrome may occur up to 33 years following cataract surgery. A surgical approach offers the advantage of complete clearance of the turbid fluid, also removing the residual cortical material and enabling microbial and pathological testing.

Clinical outcomes of radial optic neurotomy versus pars plana vitrectomy in recent onset non-arteritic anterior ischemic optic neuropathy.

INTRODUCTION: This study investigated the effect of pars plana vitrectomy (VIT) versus pars plana vitrectomy combined with radial optic neurotomy (RON) on recent onset non-arteritic anterior ischemic optic neuropathy (NAION). METHODS: In this prospective interventional case series, individuals with recent-onset NAION, lower than one month and low vision (lower than 20/200) were recruited. Patients randomly underwent either VIT, or RON. RESULTS: 34 eyes of 34 patients were included in this study. 10, 9, and 15 eyes were randomly included in VIT, RON, and control groups, respectively. The BCVA of the VIT group improved significantly from 1.84 ± 0.5 logMAR at baseline to 1.29 ± 0.67, 0.93 ± 0.53, and 0.77 ± 0.47 logMAR at 1, 3, and 6 months, respectively (Ps < 0.05). The corresponding values for RON group were 1.73 ± 0.53 logMAR at baseline, which improved to 1.04 ± 0.65, 0.64 ± 0.28, and 0.61 ± 0.26 logMAR at the same follow-up visit times (P < 0.05).The corresponding values for the control group were 1.6 ± 0.58 log MAR at baseline, which improved to 1.03 ± 0.29, 1.00 ± 0.32, and 0.32 ± 0.83 log MAR at the same follow-up visit times. There was no significant statistical difference in BCVA between the three groups. However, both interventions resulted in statistically significant improvement in mean deviation (MD) of visual field (VF) compared with the control group at the end of 6 months (VIT P = 0.006, RON P = 0.043). RNFLT decreased from baseline 235.3 ± 44.01 to 75.6 ± 17.68 at 1 month in the VIT group (P < 0.001), from baseline 268.22 ± 65.9 to 76.67 ± 10.59 at 1 month in RON (P < 0.001), while it decreased from baseline 179.48 ± 39.02 to 112.92 ± 44.51 at 1 month in the control group. CONCLUSION: VIT and RON showed promising results in terms of MD of VF, and optic disc edema resolved faster in these groups compared to the control group in recent onset NAION. A larger sample size study is deemed necessary to generalize the results of this study.

CO2 laser-assisted sclerectomy surgery for secondary open-angle glaucoma after vitrectomy.

Purpose: To explore the efficiency and safety of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with glaucoma secondary to vitrectomy. Methods: This retrospective study consisted of 16 eyes from 16 patients with glaucoma secondary to vitrectomy who underwent CLASS and were followed up for 12 months. Main outcome measures included preoperative and postoperative intraocular pressure, best corrected visual acuity (BCVA), number of anti-glaucoma medications, and postoperative surgical success rate and complications. Results: The postoperative IOP and number of anti-glaucoma medications used at all follow-up time point were significantly lower than those preoperatively. The difference in BCVA was not significant before and after surgery. The main complicatios were peripheral anterior synechiae (PAS) and scleral reservoir reduction, which were controlled after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 2 (12.50%) patients underwent re-operation. The complete and total success rates at 12 months were 68.75% and 87.50%, respectively. Conclusion: CLASS is a safe and effective procedure for Chinese patients with glaucoma secondary to vitrectomy. PAS and scleral reservoir reduction is a major contributor to postoperative IOP elevation, and trabecular minimally invasive perforation with the Nd:YAG laser is effective in lowering IOP and increasing scleral cistern volume.

Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Diabetic Macular Edema Following Pars Plana Vitrectomy Using a Modified Custom Microneedle.

Purpose: The present study evaluated the efficacy of suprachoroidal injection of Triamcinolone Acetonide (SCTA) in diabetic macular edema (DME) following pars plana vitrectomy (PPV) using a modified microneedle. Patients and methods: A prospective interventional study was conducted on 60 eyes of 60 patients with centrally involved diabetic macular edema following pars plana vitrectomy (PPV). SCTA was performed at the baseline and repeated after 3 months in case of persistent subretinal or intraretinal fluid, central macular thickness (CMT) more than 300 µm or visual loss by more than one line of the Snellen chart. Results: The present study detected significant reduction of the CMT from 498.3 ± 94.8 µm at the baseline to 212.3 ± 11.9 µm after 12 months of injection with p < 0.001 and a significant improvement of best corrected visual acuity (BCVA) from 1 (0.9-1.2) at the baseline to 0.5 (0.3-0.7) after 12 months of injection with p < 0.001. The intraocular pressure (IOP) increased significantly after 3 months of injection with p < 0.001 and then gradually declined to its normal level after 6 months. Inner segment/outer segment (IS/OS) disruption was the only significant predictor of the final CMT; however, the number of injections, IS/OS disruption, baseline BCVA and the HbA1C level were the significant predictors of the final BCVA after injection. Conclusion: Suprachoroidal injection of TA using this microneedle resulted in significant anatomical and functional improvement in previously vitrectomized diabetic macular edema patients with no recorded ocular or systemic adverse events.