Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole.

Purpose: To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). Methods: This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. Results: The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. Conclusions: An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.

Routine use of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment.

PURPOSE: To evaluate the safety and efficacy of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) and complete drainage of subretinal fluid. METHODS: For this retrospective study, we reviewed the medical charts of 273 patients (275 eyes) who consecutively underwent PPV, subretinal fluid drainage and filtered air tamponade to treat primary RRD between 2018 and 2022. As primary outcome we evaluated the anatomical success considered as retinal reattachment after single surgery. As secondary outcomes: final mean best corrected distance visual acuity (BCDVA), complications, and mean intraocular pressure (IOP) trends. RESULTS: The anatomical success was reached by 262 (95.6%) of cases. Mean BCDVA improved from 0.73 LogMAR at baseline, to 0.21 LogMAR at the end of follow-up. As complications we recorded: 5 cases of clinically relevant macular pucker, 1 full thickness macular hole, and 1 PFO bubble under the retina. The mean IOP remained on normal values during the overall follow-up period.

A Conservative Surgical Approach to the Treatment of Optic Disc Pit Maculopathy: Four Case Reports.

The purpose of this report is to present the outcomes of surgical interventions in 4 patients with maculopathy associated with optic disc pit (ODP). We report 4 cases of patients affected by ODP maculopathy and treated by core vitrectomy with induction of posterior vitreous detachment and peeling of the internal limiting membrane restricted to the interpapillary macular zone without laser treatment and gas tamponade. The patients had rapid resolution of the multilayer inner retinoschisis-like separation and progressive slow reabsorption of the macular intraretinal and subretinal fluid up to complete retinal reattachment. Currently, there are still no widely accepted guidelines related to the best technique in the management of the maculopathy associated with ODP. We used a conservative approach, without the adoption of intravitreal gas injection or laser.

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article.

Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.

Repeatability and reproducibility of fast macular thickness mapping with stratus optical coherence tomography.

OBJECTIVE: To determine the repeatability and reproducibility of retinal thickness measurements with the fast macular thickness mapping protocol of Stratus optical coherence tomography. METHODS: Ten eyes of 10 healthy subjects and 15 eyes of 15 diabetic patients with clinically significant macular edema (CSME) underwent 2 scanning sessions before and after pupil dilation during the same visit by 2 experienced examiners. Healthy subjects also received a third scanning session during a second visit. Repeatability and reproducibility for the foveolar center and for each of 9 Early Treatment of Diabetic Retinopathy Study (ETDRS)-like regions were calculated by their repeatability and reproducibility coefficients and intraclass correlation coefficients. RESULTS: The coefficients of repeatability were less than 8% in healthy subjects and less than 9% in patients with diabetes and CSME. The reproducibility coefficients were less than 10% and 11% in healthy subjects and diabetic patients with CSME, respectively. There was no significant difference between scans acquired by different observers or during different visits. The intraclass correlation coefficients were always greater than 0.80 and 0.98 in healthy subjects and diabetic patients with CSME, respectively. Average +/- SD thickness was found to be 223 +/- 14 and 404 +/- 108 mum for the central ETDRS-like region in healthy subjects and diabetic patients with CSME, respectively. CONCLUSION: With the fast macular thickness mapping protocol of Stratus ocular coherence tomography, our results indicate that retinal thickness measurements in dilated and undilated eyes of healthy subjects and diabetic patients with CSME are repeatable and reproducible.