Surgical Outcomes for Persistent Macular Hole After Ocriplasmin.

BACKGROUND AND OBJECTIVE: To report surgical and visual acuity outcomes in eyes with unresolved full-thickness macular hole (FTMH) after treatment with ocriplasmin who subsequently underwent vitrectomy. PATIENTS AND METHODS: Retrospective case series of four eyes. Vision and anatomy via optical coherence tomography (OCT) were assessed before and after intravitreal ocriplasmin as well as 6 months after subsequent vitrectomy. RESULTS: Initial visual acuity ranged from 20/70 to 20/200. OCT showed focal vitreomacular traction (VMT) with FTMH ranging from 136 to 311 µm in diameter. Following ocriplasmin, VMT released in all four eyes without closure of the FTMH. All FTMHs enlarged over follow-up after ocriplasmin (mean increase 133 µm). Subsequent vitrectomy led to anatomic FTMH closure in all eyes. Final vision improved in all eyes (20/30 to 20/70). CONCLUSION: Initial ocriplasmin treatment of FTMH in this series of patients did not reduce the effectiveness of vitrectomy, which was required for definitive FTMH repair.

Retinal Pigment Epithelial Adenocarcinoma Presenting as an Amelanotic Mass.

Retinal pigment epithelium (RPE) neoplasms are extraordinarily rare and have been infrequently described in the literature. Most RPE tumors are pigmented and may simulate choroidal melanoma. The best management of RPE tumors has not yet been elucidated. In the current case, a 36-year-old man presenting with visual disturbance is found to have biopsy-proven RPE adenocarcinoma with subfoveal fluid. He is treated with grid laser over the lesion with complete resolution of fluid. RPE adenocarcinoma can present as an amelanotic mass, and grid laser over the lesion may represent a novel approach for treating associated subretinal fluid.

Sustained-release dexamethasone intravitreal implant for persistent macular edema after vitrectomy for epiretinal membrane.

BACKGROUND AND OBJECTIVE: Persistent macular edema (ME) after surgical removal of epiretinal membrane (ERM) may impair postoperative visual recovery. Sustained-release dexamethasone intravitreal implant (DEX) was used to treat recalcitrant ME after vitrectomy for ERM. PATIENTS AND METHODS: Retrospective chart review of eyes treated with DEX for ME after ERM removal. Visual and anatomic outcomes were evaluated. RESULTS: Five eyes with refractory ME on optical coherence tomography (OCT) after ERM surgery were treated with DEX. Four of five eyes demonstrated reduction in macular thickness on OCT (mean: 106 µm), with mean percentage reduction in central foveal thickness of 25%. Visual acuity improved by one or more Snellen lines in four of five eyes. DEX effect duration was 3 to 9 months. Two eyes with OCT and visual improvement after initial DEX received multiple DEX implants for maintenance therapy. CONCLUSION: Inflammatory factors may contribute to persistent ME after vitrectomy for ERM. DEX may be a treatment option in such cases.