OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MORPHOLOGY AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR: ALIGN Post Hoc Analysis.

PURPOSE: To compare foveal avascular zone (FAZ) geometric indices using optical coherence tomography angiography (OCTA) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). FAZ morphology was assessed as a possible imaging feature of retinal displacement. METHODS: This ALIGN post hoc analysis included primary fovea-off RRDs that underwent successful PnR or PPV, and performed OCTA, and fundus autofluorescence at (FAF) 3 months postoperatively at St. Michael's Hospital, Toronto, Canada. FAZ area (mm 2 ), axial ratio, circularity, and roundness were measured, and FAF images were assessed for retinal displacement. RESULTS: Seventy-two patients were included, 78% (56/72) were male mean age was 60 ± 9 years, and 60% (43/72) were phakic. Sixty-five percent (47/72) and 35% (25/72) underwent PnR and PPV, respectively. The mean baseline logarithm of the minimum angle of resolution visual acuity was 1.49 ± 0.76. FAZ circularity was lower after PPV (0.629 ± 0.120) versus PnR (0.703 ± 0.122); P = 0.016. Sixty-six patients had gradable FAF images. Retinal displacement was present in 29% (19/66), 84.2% (16/19) of which had displacement in the macula. FAZ circularity was lower in eyes with displacement in the macula (0.613 ± 0.110) versus those without displacement (0.700 ± 0.124); P = 0.015. There was a moderate negative correlation between 12-month aniseikonia and FAZ circularity(r = -0.262; P = 0.041). CONCLUSION: FAZ circularity was lower after PPV and in eyes with retinal displacement in the macula. Circularity was negatively correlated with 12-month aniseikonia scores. FAZ circularity may be another imaging feature to consider postoperatively after RRD repair.

Pneumatic Retinopexy in Patients with Primary Rhegmatogenous Retinal Detachment Meeting PIVOT Trial Criteria.

PURPOSE: To identify the proportion of patients with primary rhegmatogenous retinal detachment (RRD) presenting to a retina practice that meet 'Pneumatic Retinopexy versus Vitrectomy for the Management of Primary RRD' (PIVOT) trial criteria and to assess anatomic and functional outcomes of pneumatic retinopexy (PnR) in this population. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Patients with primary RRD treated between October 2009 and November 2017 at an academic vitreoretinal practice in Canada. METHODS: Medical records of all cases >18 years old with primary RRD were reviewed and the proportion of patients meeting PIVOT criteria was determined. Patients that met PIVOT criteria who underwent PnR with a follow-up >3 months were included for further analysis. MAIN OUTCOME MEASURES: The primary outcome was the primary retinal reattachment rate at 12 months among patients meeting PIVOT criteria undergoing PnR. RESULTS: A total of 1,091 patients were identified, of which 577 (52.9%) met PIVOT criteria. Of these, 482/577 (83.5%) underwent PnR, but 54/482 (11.2%) were excluded as these had been enrolled in the PIVOT trial, and another 40/482 (8.3%) were excluded due to short follow-up (<3 months). Therefore, data pertaining to 388 patients is included in our analysis. 79.4% (308/388), 78.2% (280/358), 76.5% (241/315) and 73.9% (178/241) of patients who followed up at 3, 6, 12, and 24 months, respectively, had primary anatomic reattachment. A total of 20.6% (80/388) of patients did not reattach with the initial PnR or re-detached in the early post-procedure period (3 months), 2.1% (8/388) of patients re-detached between 3-12 months, and 1.3% (5/388) re-detached after 1 year. Phakic lens status was the only significant predictor of PnR success at 12 months in a multivariate logistic regression analysis (P = 0.006). Mean logMAR VA improved from 0.90 ± 0.90 (Snellen 20/159) at baseline t 0.34 ± 0.40 (Snellen 20/44) at 12 months (P < 0.001). CONCLUSIONS: Over 50% of patients presenting to an academic tertiary retina practice with primary RRD met PIVOT criteria and were eligible for PnR. Evidence from this study demonstrates a durable primary anatomic retinal reattachment rate with PnR in patients fulfilling PIVOT criteria, with similar results to those encountered in the PIVOT trial.

Surgical management of a live intravitreal nematode.

PURPOSE: To describe a novel surgical technique for the removal of a live intravitreal nematode. OBSERVATIONS: We describe the surgical management of a 35-year-old man with a live intravitreal nematode in his left eye. A 23-gauge pars plana limited core vitrectomy was performed to release the nematode from the surrounding vitreous strands. After creating a peritomy, a 20-gauge full thickness sclerotomy was created with a microvitreoretinal blade. The tip of a 20-gauge angiocath needle was cut obliquely and inserted through the sclerotomy. The external portion of the needle was attached to the viscous fluid extraction tubing for the Constellation vitrectomy machine (Alcon). Gentle aspiration pulled the nematode into the angiocath. The nematode was transferred to a syringe for parasitologic evaluation. CONCLUSIONS AND IMPORTANCE: The novel surgical technique described allows for aspiration of an intravitreal nematode in a controlled fashion. This technique can be used to manage this rare, but visually significant condition.