Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes.

BACKGROUND: Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes. PURPOSE: To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD. METHODS: Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal. RESULTS: Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 - 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 - 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment. CONCLUSION: PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.

Acute Myopic Shift after a Single Dose of Acetazolamide: A Case Report and Review of the Literature.

We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg acetazolamide. The drug was discontinued and following cycloplegia and topical steroid therapy, we observed progressive deepening of the anterior chamber, reopening of the iridocorneal angle, and complete resolution of the myopic shift after 5 days. A literature review since 1956 identified 23 cases, including ours, which developed a myopic shift after a median time of 24 h (3 - 24) following a median dose of 500 mg (125 - 1000) acetazolamide, with about a third complicated by angle closure ocular hypertension. This presumed idiosyncratic reaction can occur without prior drug exposure and independent of the phakic status. Treatment options include systematic drug withdrawal associated with cycloplegia, anti-glaucomatous agents, and/or corticosteroids. Full recovery is achieved within about 5 days (2 - 14). Given the widespread use of acetazolamide, awareness of this idiosyncratic reaction is crucial to avoid complications of acute angle-closure glaucoma.

INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE COEXISTENT WITH RHEGMATOGENOUS RETINAL DETACHMENT.

PURPOSE: To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique. METHODS: Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported. RESULTS: The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent). CONCLUSION: Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.

Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in These Cases.

BACKGROUND: Marfan Syndrome is an autosomal dominant disease with multiple ocular abnormalities including ectopia lentis and a high incidence of rhegmatogenous retinal detachment (RRD). The management of RRD may be challenging in cases of aphakic patients with Marfan. PURPOSE: To report on the management of four cases of simultaneous RRD and aphakia with vitrectomy, silicone oil tamponade, and retropupillary iris-claw intraocular lens (IOL) implantation in patients with Marfan that have been operated at the Jules-Gonin Eye Hospital between 2019 and 2020. HISTORY AND SIGNS: Ages at presentation were 20, 30, 32, and 31 years, respectively. All patients had a history of extraction of a dislocated lens. None of the patients had a previous posterior vitrectomy. Two patients had records of previous measurements for IOL calculation by optical biometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) about 1 year prior to the RRD development. In two cases, measurements for IOL calculation by optical biometry were based on the contralateral eye. THERAPY AND OUTCOME: All patients underwent 23 G vitrectomy, peripheral iridotomy, and retropupillary iris-claw IOL. No intraoperative complications were encountered. All patients had silicone oil tamponade, one of which required heavy silicone oil. Silicone oil was removed 3 months following primary surgery. Minimum follow-up was 1 year. The single surgery anatomic success rate was 100%. All patients had visual acuity of at least 0.8 at the last follow-up (1.25, 1.0, 0.8, and 0.8 respectively). The targeted refractive results were accurately achieved in all four cases postoperatively. One patient presented ocular hypertension 2 weeks after surgery due to presumed steroid response and was managed conservatively. None of the patients had silicone oil migration into the anterior chamber. CONCLUSION: Retropupillary iris-claw IOL implantation in cases of RRD and aphakia creates a barrier to tamponades from the posterior segment, effectively preventing them from entering the anterior segment of the eye. Therefore, the management of aphakia and retinal detachment with simultaneous vitrectomy and a retropupillary iris-claw IOL may be a successful strategy in reducing postoperative complications in patients with Marfan syndrome.

APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE.

PURPOSE: We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery. METHODS: In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]). RESULTS: One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41). CONCLUSION: The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.

[Ocular manifestations of Covid-19]. / Ophtalmologie - Manifestations du Covid-19.

The most frequent ocular manifestation of the SARS-CoV-2 is a conjunctivitis. It is found in 1-3% of patients and has unusually a benign course. In those patients but also in patients without ocular involvement, the virus can be detected by PCR in conjunctival swabs or in the tears. Whereas the presence of the virus in the conjunctiva is proven, its transmission through the conjunctiva is still discussed. Despite the poor level of evidence, the use of protective eyewear is recommended. Ocular thromboembolic events have been described in Covid-19. They can be found in the context of the Covid-related coagulopathy. A multidisciplinary approach should be provided in these cases. In the ICU, severe ocular complications might be indirectly related to Covid-19 in ventilated patients.

La manifestation oculaire la plus fréquente du SARS-CoV-2 est une conjonctivite. Elle est retrouvée dans 1 à 3 % des cas et est généralement d'évolution bénigne. Dans le cas de conjonctivite mais aussi chez les patients asymptomatiques au niveau oculaire, le virus peut être retrouvé par PCR dans les larmes/le frottis conjonctival. Une transmission par la conjonctive reste toutefois incertaine. Par mesure de précaution, le port de lunettes de protection est recommandé. Les atteintes ophtalmologiques sévères de type thromboembolique peuvent être retrouvées dans le cadre de la coagulopathie liée au Covid-19. Dans ces cas, une prise en charge pluridisciplinaire est nécessaire. Des événements oculaires graves peuvent également être indirectement liés au Covid-19 chez les patients sous ventilation aux soins intensifs.

CHANGES IN VISUAL ACUITY AND PHOTORECEPTOR DENSITY USING ADAPTIVE OPTICS AFTER RETINAL DETACHMENT REPAIR.

PURPOSE: To quantify changes in photoreceptor density using adaptive optics fundus camera in patients after retinal detachment (RD) and to correlate them with macular involvement and best-corrected visual acuity. METHODS: At 1 and 3 months (M1 and M3) after vitrectomy, 194 patients underwent adaptive optics imagery in both eyes, at 5 locations, that we matched between time points using anatomical landmarks. Twenty-two patients (10 fovea-OFF [OFF] and 12 fovea-ON [ON]) had matched and analyzable adaptive optics images. We used analysis of variance for repeated measures. RESULTS: Best-corrected visual acuity (logarithm of the minimum angle of resolution and Snellen equivalent [SE]) was significantly different between OFF and ON RDs at baseline: 2.0 (2.3-0.95) (SE: 20/2000) versus 0 (0.1-0) (SE: 20/20); at M1: 0.35 (0.5-0.1) (SE: 20/40) versus 0.05 (0-0.1) (SE: 20/25); and at M3: 0.25 (0.3-0.1) (SE: 20/32) versus 0 (0-0) (SE: 20/20). We observed that cone density was stable in fellow eyes between M1 and M3 (P = 0.67); decreased in treated eyes than in fellow eyes (P < 0.05); and increased postoperatively in the ON group (P = 0.02) but not in the OFF group (P = 0.97). Visual acuity and RD type were independently correlated with cone density (P = 0.004, P = 0.000). CONCLUSION: Postoperative cone density was reduced in OFF RD, but also in the ON group, although the drop recovered during the 3-month follow-up. Cone density was significantly correlated with both visual acuity and type of RD at both time points.

EVOLUTION AND PATTERNS OF CHOROIDAL THICKNESS CHANGES IN RHEGMATOGENOUS RETINAL DETACHMENT.

PURPOSE: To evaluate the changes in choroidal thickness (CT) before and after a successful pars plana vitrectomy for rhegmatogenous retinal detachment (RD), and to compare the evolution of CT with respect to the extent of RD. METHODS: Fifty-four patients were divided into three groups: peripheral macula-on RD (>3 mm from the fovea; 14 eyes); paracentral macula-on RD (fovea-sparing; ≤3 mm from the fovea; 14 eyes); and macula-off RD (involving the fovea; 26 eyes). Choroidal thickness was measured at 1 month (M1) and 3 months (M3) postoperatively, preoperatively in macula-on RDs, with enhanced depth imaging optical coherence tomography, from the nasal side (+2.5 mm) to the temporal side (-2.5 mm) of the fovea. RESULTS: In peripheral macula-on RD, the intereye difference in CTs showed thickening throughout follow-up (subfoveally: preoperatively = 19.6% ± 43.9%, M1 = 22.9% ± 27.5%, M3 = 18.2% ± 35.6%). In paracentral macula-on RD, the intereye difference in CTs showed a thinning throughout follow-up (subfoveally: preoperatively = -7.8% ± 21.9%, M1 =-5.5% ± 26.1%, M3 = -9.3% ± 19.4%), as well as in the macula-off RD (subfoveally: M1 = -14.1% ± 18.7%, M3 = -9.9% ± 15%). CONCLUSION: The extent of RD was related to the evolution of the CT before and after surgery. Further studies are necessary to clarify the relationship between the changes in CT and the effects of circulatory alterations, vitrectomy, and RD.

Surgical Management of Intraocular Silicone Oil Microdroplet.

PURPOSE: Intraocular silicone oil microdroplets have been described after intravitreal injection of anti-VEGF agents packaged at a compound pharmacy. We present a case with the presence of an intraocular silicone oil microdroplet after a vitreoretinal operation using disposable instruments, and the surgical technique for its removal. METHODS: A 59-year-old patient who had been operated on for vitreous opacities using a disposable 27-g vitrectomy kit complained of a small round structure floating in the eye. It appeared a few days after surgery. The bubble was not present at all times and it disappeared for days on end. Clinical examination of the vitreous and retina during these uneventful periods was normal. The bubble reappeared intermittently without a link to any specific movement for some time but was again absent once the patient was examined. The physical properties of the mobile round lesion could be identified as lighter than aqueous humor, as it was described as being in the center of the visual field if the head was tilted forward. RESULTS: As the patient was very bothered by this bubble, a 23-g vitrectomy was performed. During deep indentation of the pars plana over 360 degrees, a tiny bubble of silicone oil could be found buried in the peripheral vitreous base, and controlled aspiration under deep indentation was performed. The patient has been without symptoms since the removal of the droplet and made an uneventful clinical recovery. CONCLUSION: Microdroplets of silicone oil may be present in disposable vitreoretinal instruments and stay in the eye after surgery, causing a visual disturbance. The origin of these droplets may be linked to the plastic tubing of the instruments.

Management of Anterior Chamber Dislocation of a Dexamethasone Implant.

PURPOSE: To characterise the surgical removal technique of a dislocated dexamethasone implant in the anterior chamber and to gauge its success by analysing corneal transparency and subsequent visual acuity recovery in the postoperative phase. METHODS: Description of a patient who presented with an anterior chamber dexamethasone implant migration through an inferior iridotomy performed previously for a silicone oil fill in aphakia. Visual acuity had dropped to counting fingers due to marked corneal oedema. RESULTS: The implant was removed using a 23-g needle aligned with the axis of the implant through a paracentesis. After the clinical follow-up at 2 months, best-corrected visual acuity had returned to 0.2, which remained stable at the last follow-up at 14 months with an intraocular pressure of 10 mmHg. The corneal oedema resolved completely. CONCLUSION: This novel surgical management of a dexamethasone implant dislocation into the anterior chamber was successful and resulted in no long-term corneal damage when the implant was removed without delay. A repeated Ozurdex injection in patients with previous inferior iridotomy may require prior suturing of the iridotomy.

[Highlights in the field of ophthalmology]. / Ce qui a marqué l'ophtalmologie en 2018.

Technological advances in ophthalmology are becoming more and more important. New imaging instruments and software analysis allow ultra-wide field visualization of the retina non-invasively. This creates important clinical advantages for an aging population affected by chronic pathologies such as cataract, age related macular degeneration, and diabetic retinopathy. In particular, it will be possible to organize screening programs and an individualized approach and follow up of the patients. While new retinal implants are under development a new drug is now available for the treatment of corneal scars.

La technologie devient de plus en plus présente dans l'ophtalmologie. Les nouvelles modalités d'imagerie ainsi que les analyses automatisées permettent une visualisation de la rétine à haute résolution et à grand champ de façon non invasive. Les avantages du point de vue clinique pour la population qui vieillit et qui présente des pathologies chroniques (cataracte, dégénérescence maculaire liée à l'âge, rétinopathie diabétique) sont immédiats : organisation de dépistage et prise en charge individualisée des patients. Les développements des implants rétiniens progressent et un nouveau traitement pour les cicatrices cornéennes est désormais disponible.

Primary rhegmatogenous retinal detachment: risk factors for macular involvement.

PURPOSE: Rhegmatogenous retinal detachment (RD) has diagnostically been divided into macula-OFF or macula-ON. The aim of this study was to describe the demographics and primary outcome of patients with RD following surgery with respect to the macular status, and to determine risk factors for macular involvement. METHODS: This prospective, observational, mono-centric cohort study was conducted at the Jules-Gonin Eye Hospital, from February 2015 until March 2017. The study included 194 eligible patients with primary RD. All patients underwent surgical treatment after baseline clinical examination. The dataset was analyzed using descriptive and analytic statistics. RESULTS: A total of 52.6% (102/194) of patients presented with macula-OFF RD. Mean age was 63.9 ± 12.0 vs. 59.7 ± 11.2 years in the OFF and ON group, respectively. There were 129 men (66.5%) and 65 (33.5%) women, and there were significantly more right eyes affected [right vs. left eyes 123 (63.4%) vs. 71 (36.6%), p = 0.000]. Significantly more myopes (<-3D) presented with a macula-ON RD (p = 0.04). There were more phakic patients in the cohort (55.7%), and phakic eyes were more likely to present with macula-ON RD (p = 0.01). Multivariate modeling showed that pseudophakic lens status and eyes with axial length less than 25 mm (p = 0.06) are independent predictive factors for macula-OFF RD (p = 0.02), whereas sex and laterality were not risk factors for macular involvement. CONCLUSION: Pseudophakic lens status and axial length < 25 mm are independent predictive factors for macula-OFF RD. While pseudophakic lens status is a recognized risk factor for RD, shorter axial length has not been previously identified as a risk factor for the macula-OFF RD.

[Ophthalmolgy: what's new in 2015?]. / Ce qui a marqué l'ophtalmologie en 2015.

Whilst imaging methods are developed allowing non-invasive analysis and quantification of corneal nerves, retinal nerve fibers and retinal vessels, the eye is considered as an open window on the nervous and vascular system. In the field of therapies, macular edema can be reduced using several drugs with different mechanisms of action and different kinetics. Artificial retina is now available in Switzerland and gene therapy continues to develop but should still be considered rather as a research tool than as a treatment. Finally, the more striking discovery of the year is probably the reversion of cataract by Lanosterol drops: towards the end of cataract surgery?

Incidence of presumed endophthalmitis after intravitreal injection performed in the operating room: a retrospective multicenter study.

PURPOSE: To evaluate the incidence of presumed endophthalmitis (EO) after intravitreal injection (IVI) of anti-vascular endothelial growth factor agents performed in the operating room. METHODS: Retrospective study at 2 Swiss eye hospitals between 2004 and 2012. Hospital records were used to identify patients treated with an IVI of an anti-vascular endothelial growth factor agent between 2004 and 2012 and those treated for EO, defined as any intraocular inflammation treated with intravitreal antibiotics. All IVIs were performed using standard sterile technique in a Swiss Class 1 operating room. No patient received preinjection topical antibiotics. Postinjection topical antibiotics were used only in one hospital. RESULTS: A total of 40,011 IVIs were performed at the 2 centers during the study period. Of the IVIs, ranibizumab was injected in 36,398 (91%), bevacizumab in 3,518 (9%), aflibercept in 89 (0.2%), and pegaptanib in 6 (<0.1%). Three cases of post-IVI presumed EO occurred, yielding a combined incidence of 0.0075% per injection (95% confidence interval: 0.0026-0.0220%) or 1 case per 13,337 IVIs. Two of the three cases of EO occurred in patients using post-IVI antibiotics. All three cases followed ranibizumab injection and were culture negative by anterior chamber tap or vitreous biopsy. CONCLUSION: The risk of EO after IVI performed under the sterile conditions of the operating room was very low.