An ImageJ macro tool for OCTA-based quantitative analysis of Myopic Choroidal neovascularization.

Myopic Choroidal neovascularization (mCNV) is one of the most common vision-threatening com- plications of pathological myopia among many retinal diseases. Optical Coherence Tomography Angiography (OCTA) is an emerging newer non-invasive imaging technique and is recently being included in the investigation and treatment of mCNV. However, there exists no standard tool for time-efficient and dependable analysis of OCTA images of mCNV. In this study, we propose a customizable ImageJ macro that automates the OCTA image processing and lets users measure nine mCNV biomarkers. We developed a three-stage image processing pipeline to process the OCTA images using the macro. The images were first manually delineated, and then denoised using a Gaussian Filter. This was followed by the application of the Frangi filter and Local Adaptive thresholding. Finally, skeletonized images were obtained using the Mexican Hat filter. Nine vascular biomarkers including Junction Density, Vessel Diameter, and Fractal Dimension were then computed from the skeletonized images. The macro was tested on a 26 OCTA image dataset for all biomarkers. Two trends emerged in the computed biomarker values. First, the lesion-size dependent parameters (mCNV Area (mm2) Mean = 0.65, SD = 0.46) showed high variation, whereas normalized parameters (Junction Density(n/mm): Mean = 10.24, SD = 0.63) were uniform throughout the dataset. The computed values were consistent with manual measurements within existing literature. The results illustrate our ImageJ macro to be a convenient alternative for manual OCTA image processing, including provisions for batch processing and parameter customization, providing a systematic, reliable analysis of mCNV.

Incidence of post vitrectomy endophthalmitis in India - A multicentric study by VRSI study Group.

INTRODUCTION: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

Anterior staphyloma repair following trauma and surgery - A retrospective review of techniques and outcomes over 25 years.

Purpose: To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. Methods: This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Results: Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Conclusion: Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES).

PURPOSE: To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals. METHODS: Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported. RESULTS: Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298-18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378-20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096-12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury. CONCLUSIONS: Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience.

PURPOSE: : To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH). METHODS: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25-33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35-74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months. RESULTS: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26-33.8 mm) to 26.2 mm (range 24-29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). CONCLUSION: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Correlation of morphological characteristics of staphyloma with the structural and functional outcomes of myopic traction maculopathy after macular buckle surgery.

Purpose: To compare morphological features of staphyloma (type and grade) with structural and functional outcomes in 11 patients with symptomatic myopic tractional maculopathy (MTM) who underwent macular buckle surgery. Methods: A retrospective observational case series, where a chart review was conducted of the type (Curtin classification) and grade of staphyloma (USG B-scan based). Optical coherence tomography (OCT) macula analysis done preoperatively and postoperatively 1 and 6-8 weeks), Visual acuity was recorded in log mar. Results: With an average myopia of -10.35 D (-5 to -14.5 D), there were four patients with types II and IX staphyloma and seven with type I staphyloma. The average axial length was 28.6 ± 0.98 mm in type II/IX and 26.2 ± 0.8 mm in type I. Preoperative OCT features were outer retinal layer schisis (11), retinal detachment (foveal: 2, macular: 8), macular hole (lamellar: 3, full thickness: 4), and taut posterior hyaloid (3). Postoperatively, patients with type II/IX staphyloma had significant gain in visual acuity from 1.05 ± 0.3 to 0.74 ± 0.2 Log Mar. The structural features also responded better in patients with types II/IX staphyloma, with all patients having more than 90% reduction in schisis and retinal attachment at 6 weeks. Whereas only two patients with type I staphyloma had similar reduction in schisis at 6 weeks and only one had complete retinal attachment. Conclusion: In patients with MTM, the staphyloma characteristics preoperatively can help us prognosticate about structural and functional success after macular buckle surgery. In our small case series, patients with type II/IX staphyloma and larger axial length had better structural and functional outcomes.

Prevalence and predictors of myopic macular degeneration among Asian adults: pooled analysis from the Asian Eye Epidemiology Consortium.

AIMS: To determine the prevalence and predictors of myopic macular degeneration (MMD) in a consortium of Asian studies. METHODS: Individual-level data from 19 885 participants from four population-based studies, and 1379 highly myopic participants (defined as axial length (AL) >26.0 mm) from three clinic-based/school-based studies of the Asian Eye Epidemiology Consortium were pooled. MMD was graded from fundus photographs following the meta-analysis for pathologic myopia classification and defined as the presence of diffuse choroidal atrophy, patchy chorioretinal atrophy, macular atrophy, with or without 'plus' lesion (lacquer crack, choroidal neovascularisation or Fuchs' spot). Area under the curve (AUC) evaluation for predictors was performed for the population-based studies. RESULTS: The prevalence of MMD was 0.4%, 0.5%, 1.5% and 5.2% among Asians in rural India, Beijing, Russia and Singapore, respectively. In the population-based studies, older age (per year; OR=1.13), female (OR=2.0), spherical equivalent (SE; per negative diopter; OR=1.7), longer AL (per mm; OR=3.1) and lower education (OR=1.9) were associated with MMD after multivariable adjustment (all p<0.001). Similarly, in the clinic-based/school-based studies, older age (OR=1.07; p<0.001), female (OR=2.1; p<0.001), longer AL (OR=2.1; p<0.001) and lower education (OR=1.7; p=0.005) were associated with MMD after multivariable adjustment. SE had the highest AUC of 0.92, followed by AL (AUC=0.87). The combination of SE, age, education and gender had a marginally higher AUC (0.94). CONCLUSION: In this pooled analysis of multiple Asian studies, older age, female, lower education, greater myopia severity and longer AL were risk factors of MMD, and myopic SE was the strongest single predictor of MMD.

Subconjunctival bevacizumab and argon laser photocoagulation for preexisting neovascularization following deep lamellar anterior keratoplasty.

We report a rare case of deep anterior lamellar keratoplasty (DALK) neovascularization managed with combination of subconjunctival bevacizumab and argon laser photocoagulation. A 24 year old male underwent Deep anterior lamellar keratoplasty for corneal stromal opacity following presumed viral keratitis. Deep corneal neovascularization was observed postoperatively which was successfully managed using a combination of subconjunctival bevacizumab and argon laser photocoagulation within one week of DALK. The neovascularization resolved by 3 months and at 2 years follow up, patient maintained good visual acuity of 6/12 Snellen's without recurrence of vascularization. A combination of bevacizumab and argon laser may be an effective approach to manage neovascularisation in the immediate postoperative phase (Post DALK) and improve graft survival.

Refractive outcomes of a single-step and a two-step approach for silicone oil removal and cataract surgery.

Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ≤±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (-1.73 ± 2.04 vs. -0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ≤±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.

Enhanced S-cone syndrome: Clinical spectrum in Indian population.

PURPOSE: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders. METHODS: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings. RESULTS: We included 14 patients (age range 4-39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years. CONCLUSION: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.

Outcome of Sutured Scleral-Fixated Intraocular Lens in Blunt and Penetrating Trauma in Children.

BACKGROUND AND OBJECTIVE: To determine the anatomical and functional outcomes of sutured scleral-fixated intraocular lens (SSFIOL) implantation in children with blunt and penetrating injuries to the eye. PATIENTS AND METHODS: This is a retrospective, interventional case series study. Case records of children who underwent SSFIOL implantation in a tertiary eye care facility for traumatic aphakia, cataract, or subluxation were screened. Relevant data on demographics, visual acuity (VA) outcomes, and complications and their management were collected. Results for blunt and penetrating trauma were compared. RESULTS: There was stability or improvement of vision in 88.9% of eyes during the follow-up period. Young age at time of trauma (P = .031) and SSFIOL implantation (P = .002), history of retinal detachment (RD) before SSFIOL implantation (P = .019), poor preoperative best-corrected VA (BCVA) (P = .004), and development of RD in the follow-up period (P = .046) were independent risk factors for low final BCVA on univariate regression analysis. RD rate was 6.53% and was comparable in open and closed globe injuries. Intraocular lens (IOL) dislocation rate was 3.9%, and probability of survival was higher for open globe (0.78) as compared to closed globe (0.64) injuries (P = .042). CONCLUSIONS: SSFIOL implantation results in good VA improvement in both open and closed globe injuries. RD remains an important vision-threatening complication. IOL dislocation is more likely to occur in closed globe injuries. A prospective study evaluating the outcomes would better elucidate the role of these IOLs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:757-764.].

Current concepts of macular buckle in myopic traction maculopathy.

Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm shift to the understanding of myopic macula, thereby helping in objective evaluation of the various manifestation of traction maculopathy. Staphyloma evaluation by ultrasound, wide-field fundus photography, and MRI scans along with OCT has led to the resurgence of MB surgery in the treatment of myopic traction maculopathy (MTM). Various surgical techniques with different buckle materials are being performed with encouraging anatomical and functional success rates. This article reviews the literature to explain the current concept of MB surgery based on its evolution, different kinds of buckle materials, rationale for planning MB surgery, and different surgical techniques for the management of MTM.

Postoperative endophthalmitis due to Pseudomonas luteola: First reported case of acute and virulent presentation from a tertiary eye care center in South India.

A 60-year-old male presented with pain and decreased vision 3 weeks following uneventful intracapsular cataract extraction with anterior vitrectomy for subluxated cataract. A diagnosis of acute endophthalmitis was made based on clinical and ultrasound features. Patient improved only after undergoing pars plana vitrectomies twice and repeated intravitreal antibiotic-steroid injections. Vitreous aspirate revealed Gram-negative bacillus identified as Pseudomonas luteola on culture. Patient returned with a retinal detachment at first follow-up which was treated with vitrectomy, endolaser, and silicone oil tamponade. To the best of our knowledge, this is the first case of P. luteola causing acute onset, virulent endophthalmitis reported in literature.

Surgical outcomes and complications of sutured scleral fixated intraocular lenses in pediatric eyes.

OBJECTIVE: To study the outcome and complications of sutured scleral fixated intraocular lenses (SSFIOL) in children. DESIGN: Retrospective study. SUBJECTS: A total of 279 eyes of 230 children who underwent SSFIOL at ≤18 years of age in a tertiary eye care centre in India. METHODS: Treatment-naive children having traumatic cataract or subluxated lens underwent a single-sitting lensectomy and pars plana vitrectomy (PPV), along with SSFIOL insertion. Children with aphakia underwent PPV with SSFIOL, and vitrectomized eyes underwent only SSFIOL implantation. Fixation of SSFIOL was done by the 4-point ab externo fixation technique using 10-0 prolene suture. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity, as well as intraoperative and postoperative complications. RESULTS: The mean age at which SSFIOL was performed was 10.8 ± 4.22 years. The most common indication of SSFIOL in our study was traumatic subluxation of lens (47.63%; n = 133 patients), followed by congenital subluxation in 38.7% (n = 108). Best-corrected visual acuity was maintained or improved from the preoperative visual acuity in 93.19% of eyes. The complications included choroidal detachment in 2.86% (n = 8), dispersed vitreous hemorrhage in 2.86% (n = 8), endophthalmitis in 0.72% (n = 2), raised intraocular pressure in 12.54% (n = 35), diplopia in 0.72% (n = 2), retinal detachment in 5.73% (n = 16), and dislocation of the SSFIOL in 4.6% (n = 13). The mean follow-up after SSFIOL implantation was 39.68 months. CONCLUSIONS: SSFIOLs are effective in correcting aphakia in children; long-term follow-up of these children is, however, necessary.

Culture and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Proven Mycobacterium Tuberculosis Endophthalmitis: A Case Series.

PURPOSE: To report early confirmation of Mycobacterium tuberculosis (MTB) endophthalmitis by detection of 85B mRNA in vitreous by a reverse transcriptase polymerase chain reaction (RT-PCR) technique. METHODS: Retrospective, interventional case series of 5 patients with MTB endogenous endophthalmitis. Vitreous aspirate was subjected to Ziehl-Neelsen (ZN) staining, BACTEC MicroMGIT culture, RT-PCR targeting the 85B gene, real-time PCR targeting the IS6110 region, and nested PCR targeting the MPB64 gene and IS6110 region. Correlation between detection of MTB RNA, culture positivity, and ZN staining was studied. RESULTS: Five patients with endophthalmitis with no history of tuberculosis revealed acid-fast bacilli on ZN staining of vitreous. RT-PCR detected 85B RNA within 24 h. Culture for MTB was positive in 3/5 patients after 1 month. None of the eyes recovered any useful vision. CONCLUSIONS: RT-PCR can detect viable MTB RNA and provide evidence of active infection much earlier than culture.

Enterococcus faecalis Endophthalmitis in Children - A 21 Year Study.

PURPOSE: To report Enterococcus faecalis endophthalmitis (EFE) in children and its comparison with adults. METHODS: Retrospective study of 19 children up to 18 years age, undergoing vitrectomy for EFE at a referral eye center from January 1995 to December 2015. The results were compared to 18 adults with EFE. RESULTS: The mean age was 7.4 ± 3.06 years. Post-traumatic EFE was seen in 17 (89.4%) children (p < 0.05) versus postoperative EFE seen in 12 (66%) adults. Broomstick 9 (52.9%) and hypodermic needle injury 6 (35.2%) were common associations. "Optimum functional outcome" was achieved in 12 (63.1%) eyes of children and 5 (27.7%) eyes of adults (p = 0.03). Sealed and Zone II wounds, lens, and needle injuries had good outcome whereas intervention after 3 days and retinal detachment had poor outcomes (p < 0.05). The was no correlation with the Ocular Trauma Score. CONCLUSION: EFE in children is rare; seen with broom stick and needle injuries, if managed early recovers optimum vision.

Retinal Detachment in 31 Eyes with Retinitis Pigmentosa.

OBJECTIVE: To describe clinical features and treatment outcomes of retinal detachment (RD) in eyes with retinitis pigmentosa (RP). DESIGN: Single-center, retrospective, interventional case series. SUBJECTS: All RP patients with RD examined between April 2003 and December 2013 and minimum 2 months of follow-up. METHODS: Medical records of RP patients were screened and 31 eyes with RD were included. Family history of RP, duration of symptoms, age at presentation, associated ocular and systemic findings, and detailed ophthalmic evaluation including presenting visual acuity, type and amount of refractive error, fundus findings, electroretinogram details, surgical details, and postoperative complications and outcomes were evaluated. Univariate analysis was done to determine risk factors associated with RD in eyes with RP and risk factors associated with poor visual outcomes after treatment. Subset analysis was also done for comparing the functional and anatomical outcomes between patients undergoing scleral buckling or vitrectomy. OUTCOME MEASURES: Final surgical reattachment rate, best-corrected visual acuity. RESULTS: Mean age at presentation was 22 years (median, 17; range, 4-63). Mean duration of symptoms was 12 months (median, 3 months: range, 3 days-60 months). Associated ocular findings included nyctalopia (n = 23), myopia (n = 21), and hyperopia (n = 10). Systemic associations included hearing loss (n = 5), deaf-mutism (n = 1), and Bardet-Biedel syndrome (n = 1). No association between degree of myopia and RD was noted (P = 0.63). Observed retinal breaks included horse-shoe-shaped tear (n = 15), lattice with hole (n = 7), atrophic retinal hole (n = 3), retinal dialysis (n = 3), and macular hole (n = 3). The most common location of breaks was superotemporal quadrant (n = 15). Younger age, male gender, and presence of posterior vitreous detachment were strongly associated with RD with odds ratio of 1.3 (P = 0.001), 8.3 (P = 0.010), and 6 (P = 0.003), respectively. Retinal reattachment was achieved in 13 of 13 eyes (100%) with scleral buckle and 9 of 10 eyes (90%) with vitrectomy. Vision improved from 1.63±0.52 to 0.87±0.25 logarithm of the minimum angle of resolution (P < 0.001) at a mean follow-up of 33 months (median, 24, range; 1-145). CONCLUSION: Rhegmatogenous RD in eyes with RP is rare. Precocious vitreous degeneration and sparse pigmentation in younger male patients has a role in etiopathogenesis. Visual prognosis remains poor despite satisfactory surgical outcomes.

Incidence, outcomes, and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy following photodynamic therapy in Indian subjects.

PURPOSE: To evaluate the incidence, outcomes, and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) following photodynamic therapy (PDT). METHODS: Medical records of 94 eyes of 86 consecutive patients with PCV who underwent PDT between January 2007 and December 2014 were retrospectively reviewed. The diagnosis of PCV was based on clinical features and indocyanine green angiography. Eyes were treated with PDT monotherapy or a combination of PDT plus anti-vascular endothelial growth factor. PDT was performed at (standard [SFPDT] or reduced fluence RFPDT). RESULTS: Ninety-four eyes had 119 PDT treatment sessions (mean: 1.3 sessions). Mean presenting vision was 0.46 ± 0.44 logarithm of the minimum angle of resolution (logMAR). Following PDT, ten eyes (11%) of nine patients had hemorrhagic complications such as subretinal hemorrhage (SRH; n = 5), subretinal pigment epithelium (RPE) hemorrhage (n = 1), breakthrough vitreous hemorrhage (BVH; n = 3), and SRH with sub-RPE hemorrhage and BVH (n = 1). Median interval to hemorrhage following PDT was 2 months. Age (P = 0.842), duration of symptoms (P = 0.352), number of laser spots (P = 0.219), and laser spot size (LSS) (P = 0.096) were not significantly associated with increased risk of hemorrhagic complications. Female gender was associated with reduced risk of hemorrhage (P = 0.045). SFPDT was significantly associated with increased risk of hemorrhage (P = 0.026). The probability of developing hemorrhagic complications in SFPDT group was 0.24 compared to 0.07 in RFPDT group (P = 0.039). Multivariate logistic regression analysis showed SFPDT as the only significant risk factor for hemorrhage following PDT (odds ratio 5.3, 95% confidence interval 1.1-24.8, P = 0.03). Mean final vision was 0.61 ± 0.53 logMAR at mean follow-up of 33 months (median = 22 months; range = 2-157 months). CONCLUSION: Age, LSS, number of laser spots, preexisting hemorrhages, or use of anticoagulants were not associated with increased risk of hemorrhagic complications. SFPDT was significantly associated with increased risk of hemorrhagic complications in such eyes.