Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes.

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07-2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04-8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33-7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06-3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.

Peripapillary Microvascularization Analysis Using Swept-Source Optical Coherence Tomography Angiography in Optic Chiasmal Compression.

PURPOSE: To evaluate the vessel density (VD) of the radial peripapillary capillary (RPC) network using swept-source optical coherence tomography angiography (SS-OCTA) "en face" images of eyes with chiasmal compression caused by brain tumors before and after decompressive surgery compared with healthy controls. METHODS: A cross-sectional study was conducted in 12 patients with chiasmal compression confirmed by neuroimaging. Sixteen healthy participants were also included. All patients with chiasmal compression underwent a neuro-ophthalmological examination one week before and 6 months after brain surgery, including static automated perimetry as well as measurement of the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) with spectral-domain optical coherence tomography (SD-OCT). Based on this neuro-ophthalmological examination, the presence of an optic neuropathy (ON) was evaluated. Peripapillary VD was obtained in four sectors on a 6 × 6 mm SS-OCTA image using the Cirrus Plex Elite 9000. RESULTS: Baseline average VD was significantly lower in patients with chiasmal compression and ON than in controls (median: 55.62; interquartile range (IQR): 2.96 vs. 58.53; IQR: 2.02; p=0.003). This decrease was also found in the temporal, superior, and nasal sectors. Average postoperative VD was decreased in patients with chiasmal compression compared with average preoperative VD (median: 56.16; IQR: 4.07 vs. 57.48; IQR: 3.83; p=0.004). Preoperative VD was significantly correlated with RNFL, GCC thickness, and visual field defects. CONCLUSIONS: The VD of the RPC network was decreased in chiasmal compressive ON, and it was further decreased at 6 months after decompressive surgery.

Perioperative risk of bleeding with antithrombotic agents in macular surgery: a national, prospective, multicentre study.

PURPOSE: To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery. METHODS: E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded. RESULTS: A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54). CONCLUSION: No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.

Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections.

AIMS: Clinical outcomes of diabetic macular edema (DME) have been widely described, but data on diabetic retinopathy perceptions by diabetes patients are limited. The aim of this survey was to explore the lived experience, knowledge, fears and expectations about disease, and treatment in patients with diabetes and macular edema treated with intravitreal injections (IVTI) and to characterize patient profiles. METHODS: Cross-sectional survey including a preliminary qualitative phase (20 patients with DME, treated or treatment-naive, 5 female and 15 male, age 36-74 years) followed by a quantitative survey (116 patients treated with IVTI for DME). Data ASKIA Analyze (version 5.3.3.5) was used for descriptive statistics, and R software (version 3.4.1) for multiple correspondence analysis. RESULTS: The qualitative phase identified the wording used by patients and information helpful to propose modalities of response in the quantitative phase. In the quantitative survey (116 patients, mean age 66.6 years), most patients were treated with anti-vascular endothelial growth factor. Overall, 71.9% reported that the disease negatively affected their daily activities and 33.1% considered that regular visits to the ophthalmologist were disrupting their life. Treatment expectations differed significantly between patients in terms of disease experience (visit and injection schedules), fears and feelings, and relationship with physicians, allowing three patient profiles to be identified: "Worried" patients (n = 45) felt isolated and were worried about the need for repeated treatment and possible side effects. They were mainly active men aged < 60 with type I diabetes (T1D) and DME diagnosed for > 2 years; "Curious" patients (n = 21) experienced insufficient support and requested more information on their disease and existing treatments. They were mainly single women aged 60-69 years; "Passive" patients (n = 50) felt sufficiently informed by their ophthalmologist and were not concerned by DME. They were older (mean age: 70 years) and mainly type 2 diabetic men. CONCLUSIONS: Patients with diabetes and macular edema treated with IVTI form a heterogeneous group regarding fears and expectations. Different patient profiles were identified and need to be confirmed in larger studies. A better understanding of psychological profiles may optimize compliance of diabetic patients.

Vitreomacular Interface Abnormalities and Glaucoma in an Elderly Population (The MONTRACHET Study).

Purpose: To investigate the prevalence of vitreomacular interface abnormalities (VMIAs) in a French elderly glaucomatous population. Methods: Using a population-based study, the MONTRACHET (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) study conducted in Dijon from 2009 to 2013 in individuals older than 75 years, the prevalence of VMIAs was estimated on glaucoma patients. Results: A total of 1130 participants (2225 eyes) were included in the study. The mean age of participants was 82.3 ± 3.8 years, and 62.74% were women. Regarding the frequency of all VMIAs, there was no statistical difference between glaucoma patients and nonglaucoma participants (51.85% vs. 53.92%, respectively, P = 0.372). In univariate analysis, vitreomacular adherences were more frequent in nonglaucoma participants (18.39% vs. 10.78%, P = 0.036). Epiretinal membranes were more frequent in the glaucomatous population (47.06% vs. 38.13%, P = 0.018). The prevalence of macular cysts was comparable in the two groups (7.84% vs. 5.64%, P = 0.262). Macular cysts were more frequent in eyes treated with preservative-free, IOP-lowering eye drops when compared with the eyes of nonglaucomatous participants treated with IOP-lowering eye drops containing a preservative (26.67% vs. 3.37% and 5.76%, respectively, P < 0.001). In multivariate analysis, these results were no longer significant. Conclusions: The prevalence of VMIAs was high in this elderly population and similar in both glaucomatous and nonglaucomatous participants. The information provided by macular optical coherence tomography scans should be considered with caution when used for glaucoma management in elderly patients.

Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients.

PURPOSE: To assess the rate of hemorrhagic complications after vitreoretinal surgery and the influence of antithrombotic agents. METHODS: Hemorrhagic complications of vitreoretinal procedures performed in seven ophthalmologic centers on patients treated or not treated with antiplatelet (AP) or anticoagulant (AC) agents were prospectively collected. Patients' characteristics, surgical techniques, and complications were recorded during surgery and for 1 month after. RESULTS: Eight hundred four procedures were performed between January 2015 and April 2015. Among them, 18.4% were treated with AP agents (n = 148) and 7.8% with AC agents (n = 63), with 18 of them treated with NOACS (new oral anticoagulants). AP or AC agents were continued in 96.5% and 80.7% of cases, respectively. Fifty-three patients (6.6%) developed one or more hemorrhagic complications in one eye during this period. In univariate analysis, AC agents were not associated with hemorrhagic complications (P = 0.329) in contrast to AP (P = 0.005). However, in multivariate analysis, AP agents were no longer associated with hemorrhagic complications and the intraoperative use of endodiathermy was the only factor associated with hemorrhagic complications (P = 0.001). CONCLUSIONS: This study showed that AP and AC agents were not a factor associated with hemorrhagic complications during vitreoretinal surgery. The continuation of these treatments should be considered without risk of severe hemorrhagic complications.