Multimodal imaging and histopathological evaluation in silicone oil keratopathy.

PURPOSE: To describe features in silicone oil keratopathy using multimodal imaging and histopathological examination. METHODS: Case report. RESULT: A 21-year-old male developed right corneal decompensation in the heavy SO (HSO)-filled eye. The patient underwent an initial lensectomy, pars plana vitrectomy (PPV) and HSO tamponade due open-globe injury with corneal wound, lens damage and in two retained intravitreal glass foreign bodies, followed by a revisional PPV with HSO tamponade due to tractional detachment associated with proliferative vitreoretinopathy and epiretinal membrane. One month after the removal of HSO, ophthalmic examination of the right eye showed corneal decompensation. The AS-OCT showed corneal thickening, intrastromal scattered hyperreflective dots and large rounded/oval hyporeflective space; the latter were suggestive of emulsified HSO microbubbles and larger bubbles, respectively. In vivo confocal microscopy showed multiple presumed SO-related corneal changes, including hyper-reflective fibrotic changes in the basal epithelium, reduced density ans altered morphology of keratocytes cell population, increased pleomorphism and polymegathism of the endothelium with reduced endothelial cell, and presence of inflammatory cells. The patient underwent a penetrating keratoplasty, pupilloplasty and retropupillary iris-claw IOL implantation. The histopathological examination of the host corneal button showed Descemet's membrane irregularity and thickened corneal stroma with focal intrastromal silicone oil vacuoles, surrounded by macrophages. CONCLUSION: We described for the first time intrastromal hyperreflective dots as a sign associated with SO-related keratopathy. Moreover, this case report supports the ability of emulsified SO to penetrate the cornea inducing a local low-grade chronic inflammation.

Predictability of the vault after implantable collamer lens implantation using OCT and artificial intelligence in White patient eyes.

PURPOSE: To compare the predicted vault using machine learning with the achieved vault using the online manufacturer's nomogram in patients undergoing posterior chamber implantation with an implantable collamer lens (ICL). SETTING: Centro Oculistico Bresciano, Brescia, Italy, and I.R.C.C.S.-Bietti Foundation, Rome, Italy. DESIGN: Retrospective multicenter comparison study. METHODS: 561 eyes from 300 consecutive patients who underwent ICL placement surgery were included in this study. All preoperative and postoperative measurements were obtained by anterior segment optical coherence tomography (AS-OCT; MS-39). The actual vault was quantitatively measured and compared with the predicted vault using machine learning of AS-OCT metrics. RESULTS: A strong correlation between model predictions and achieved vaulting was detected by random forest regression (RF; R2 = 0.36), extra tree regression (ET; R2 = 0.50), and extreme gradient boosting regression ( R2 = 0.39). Conversely, a high residual difference was observed between achieved vaulting values and those predicted by the multilinear regression ( R2 = 0.33) and ridge regression ( R2 = 0.33). ET and RF regressions showed significantly lower mean absolute errors and higher percentages of eyes within ±250 µm of the intended ICL vault compared with the conventional nomogram (94%, 90%, and 72%, respectively; P < .001). ET classifiers achieved an accuracy (percentage of vault in the range of 250 to 750 µm) of up to 98%. CONCLUSIONS: Machine learning of preoperative AS-OCT metrics achieved excellent predictability of ICL vault and size, which was significantly higher than the accuracy of the online manufacturer's nomogram, providing the surgeon with a valuable aid for predicting the ICL vault.

Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade.

Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.

COVID-19 AdenoviralVector Vaccine and Central Retinal Vein Occlusion.

PURPOSE: The purpose of this article is to report a case of sudden onset ischemic retinal central vein occlusion after a second dose of COVID-19 adenoviral vector vaccine. CASE REPORT/OBSERVATIONS: A 54-year-old woman with systemic arterial hypertension developed ischemic central retinal vein occlusion in her right eye on day 2 after the second dose of COVID-19 adenoviral vector vaccine ChAdOx1 nCoV-19/ AZD1222, Oxford-AstraZeneca. CONCLUSION: Adenoviral vector vaccine promotes both cellular and humoral immune responses, increasing the level of inflammatory cytokines. These cytokines are the same implied in the possible pathogenesis of central retinal vein occlusion. Subsequently, we recommend informing patients at risk of possible ocular adverse events, which require urgent evaluation.

Myopia: Mechanisms and Strategies to Slow Down Its Progression.

This topical review aimed to update and clarify the behavioral, pharmacological, surgical, and optical strategies that are currently available to prevent and reduce myopia progression. Myopia is the commonest ocular abnormality; reinstated interest is associated with high and increasing prevalence, especially but not, in the Asian population and progressive nature in children. The growing global prevalence seems to be associated with both genetic and environmental factors such as spending more time indoor and using digital devices, particularly during the coronavirus disease 2019 pandemic. Various options have been assessed to prevent or reduce myopia progression in children. In this review, we assess the effects of several types of measures, including spending more time outdoor, optical interventions such as the bifocal/progressive spectacle lenses, soft bifocal/multifocal/extended depth of focus/orthokeratology contact lenses, refractive surgery, and pharmacological treatments. All these options for controlling myopia progression in children have various degrees of efficacy. Atropine, orthokeratology/peripheral defocus contact and spectacle lenses, bifocal or progressive addition spectacles, and increased outdoor activities have been associated with the highest, moderate, and lower efficacies, respectively.

Visual and Refractive Outcomes Following Laser Blended Vision With Non-linear Aspheric Micro-anisometropia (PRESBYOND) in Myopic and Hyperopic Patients.

PURPOSE: To report 6-month visual and refractive outcomes following PRESBYOND Laser Blended Vision (Carl Zeiss Meditec) treatment using non-linear aspheric micro-anisometropia laser in situ keratomileusis (LASIK) for the correction of myopic and hyperopic presbyopia. METHODS: A retrospective, non-comparative study of 139 consecutive patients with a mean age of 53.13 ± 5.84 years (range: 42 to 70 years) treated with LASIK-induced micro-anisometropia using the MEL 90 excimer laser and VisuMax femtosecond laser (both Carl Zeiss Meditec). The target refraction was plano for distance eyes (dominant eye) and between -0.50 and -1.50 diopters (D) for near eyes. Patients were observed for 6 months. RESULTS: A total of 278 eyes (78 myopic and 200 hyperopic) from 139 patients completed the study. Mean preoperative spherical equivalent (SE) was -3.40 ± 1.83 D (range: -0.50 to -8.25 D) for myopic eyes and +1.61 ± 0.98 D (range: -1.25 to +4.63 D) for hyperopic eyes. Mean postoperative SE refraction of distance eyes was +0.20 ± 0.35 D (range: -0.38 to +1.00 D) and -0.14 ± 0.42 D (range: -1.38 to +0.88 D) for myopic and hyperopic eyes, respectively. Mean postoperative SE refraction of near eyes was -0.90 ± 0.44 D (range: -0.13 to -2.25 D) and -1.21 ± 0.48 D (range: -0.13 to -2.25 D) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected near visual acuity was 0.70 ± 0.28 logMAR (range: 0.32 to 1.00 logMAR) and 0.79 ± 0.27 logMAR (range: 0.25 to 1.00 logMAR) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected distance visual acuity was 1.19 ± 0.18 logMAR (range: 0.63 to 1.25 logMAR) and 1.14 ± 0.26 logMAR (range: 0.40 to 1.25 logMAR) for myopic and hyperopic eyes, respectively. Stereoacuity was better than 100 seconds of arc in 79% of myopic eyes and 85% of hyperopic eyes and all vision quality scores were greater than 90 of 100. No eyes lost two or more lines. CONCLUSIONS: The non-linear aspheric micro-anisometropia protocol resulted in safe and effective visual outcomes in patients with both myopic and hyperopic presbyopia. [J Refract Surg. 2022;38(5):288-297.].

Risk factors for postoperative eye pain in patients with non-painful eye disease undergoing pars plana vitrectomy: the VItrectomy Pain (VIP) study.

BACKGROUND: Pars plana vitrectomy (PPV), a surgical procedure used to treat different ophthalmic pathologies, could be associated with moderate to severe eye pain. The aim of the present study was to evaluate the incidence of postoperative eye pain and its risk factors following PPV in a selected population of patients with non-painful eye disease, receiving regional anesthesia and moderate sedation with benzodiazepines, without use of narcotics. METHODS: Single-center, prospective observational cohort study. We recorded the presence of pain at operating room discharge, at 6 and 24 hours, using the numeric rating scale (NRS). We recorded also age, sex, ethnic origin, American Society of Anaesthesia physical status (ASA PS) classification, Charlson Comorbidity Index, the etiology of the vitreoretinal pathology, length of surgery, and type of surgical procedure performed. RESULTS: Eye pain (NRS>3) was present in three patients (0.7%) at operating room discharge, 59 (13.2%) at six and 65 (14.6%) at 24 hours after surgery. LASSO logistic regression analysis identified age, ASA PS, race, along with tamponade as independent risk factors for eye pain at six hours. Scleral buckling was selected for eye pain at 24 hrs. CONCLUSIONS: A protocol for pain control after PPV should be considered, especially in younger, non-Caucasian people, and patients with high ASA PS grade. Moreover, attention must be paid when additional surgical procedures are requested, restricting them to selected patients, and using the appropriate agent for intraocular tamponade.

SURGICAL OUTCOMES OF VITREOMACULAR TRACTION TREATED WITH FOVEAL-SPARING PEELING OF THE INTERNAL LIMITING MEMBRANE.

PURPOSE: To compare sensitivity of the retina after complete internal limiting membrane (ILM) peeling versus foveal-sparing ILM peeling in vitrectomy for vitreomacular traction syndrome. METHODS: This was a randomized, prospective, comparative study. Thirty-four eyes were randomized to undergo peeling with foveal sparing of the ILM (FS group) or complete peeling group. Foveal and perifoveal retinal sensitivity, visual acuity, and central macular thickness were the main outcome measures. RESULTS: Parafoveal retinal sensitivity exhibited a significant improvement in both the FS and complete peeling groups (+2.43 ± 0.82 dB and +1.79 ± 0.86 dB, respectively; P = 0.037). Significant improvements were observed in both visual acuity and central macular thickness in both groups. No cases of epiretinal membrane recurrence were observed in the FS group. CONCLUSION: Both the FS and complete peeling surgical techniques are safe and yielded good anatomical and functional results; however, a significant difference in favor of FS was found in relation to the best-corrected visual acuity and perifoveal retinal sensitivity. Preservation of the foveal ILM disc allowed the anatomical restoration of the foveal architecture in most vitreomacular traction syndrome cases without signs of stiffening or ILM fibrosis over a follow-up period of 1 year.

Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment.

PURPOSE: To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). METHODS: This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. RESULTS: The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. CONCLUSION: Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.

Topography/wavefront-guided photorefractive keratectomy combined with crosslinking for the treatment of keratoconus: preliminary results.

PURPOSE: To evaluate the clinical outcomes of topography/wavefront-guided (TWFG) photorefractive keratectomy (PRK) using a new high-definition aberrometer combined with epithelium-off crosslinking (CXL-Plus). SETTING: Centro Oculistico Bresciano, Brescia, Italy. DESIGN: Prospective case series study. METHODS: Patients with grade I or II keratoconus, according to the Amsler-Krumeich classification, were included in this prospective case series. All cases underwent TWFG PRK using the VISX STAR S4 IR excimer laser and the new iDesign 2.0 system, followed by accelerated epithelium-off CXL. Visual, refractive, ocular aberrometric, and safety outcomes were evaluated during a 6-month follow-up. RESULTS: Thirty-five eyes of 19 patients were included. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < .001). Manifest sphere and cylinder were reduced significantly (P ≤ .001), with a total of 20 eyes (57%) and 30 eyes (86%) having a postoperative spherical equivalent within ±0.50 and ±1.00 diopter, respectively. Most corneal irregularity indexes and the level of ocular higher-order aberrations, primary coma, and trefoil (P < .05) were significantly reduced postoperatively. No significant corneal haze or safety issues were observed. CONCLUSIONS: TWFG PRK, using the iD2 system with simultaneous CXL, regularized the cornea by correcting the spherocylindrical error and minimizing the amount of higher-order aberrations in mild-to-moderate keratoconus.

Gene expression analysis identifies two distinct molecular clusters of idiopatic epiretinal membranes.

Idiopathic epiretinal membranes (ERMs) are fibrocellular membranes containing extracellular matrix proteins and epiretinal cells of retinal and extraretinal origin. iERMs lead to decreased visual acuity and their pathogenesis has not been completely defined. Aim of this study was to provide a molecular characterization of iERMs by gene expression analysis. To this purpose, 56 iERMs obtained by pars plana vitrectomy were analyzed for the expression levels of genes encoding biomarkers of the cellular and molecular events occurring in iERMs. RT-qPCR analysis showed significant differences in the levels of cell population, extracellular matrix and cytokine/growth factor biomarkers among the iERMs investigated. Hierarchical clustering of RT-qPCR data identified two distinct iERM clusters, Cluster B samples representing transcriptionally "activated" iERMs when compared to transcriptionally "quiescent" Cluster A specimens. Further, Cluster B could be subdivided in two subgroups, Cluster B1 iERMs, characterized by a marked glial cell activation, and Cluster B2 samples characterized by a more pro-fibrotic phenotype. Preoperative decimal best-corrected visual acuity and post-surgery inner segment/outer grading values were higher in Cluster A patients, that showed a prevalence of fovea-attached type iERMs with near-normal inner retina, than in Cluster B patients, that presented more severe clinical and spectral domain optical coherence tomography (SD-OCT) features. In conclusion, this molecular characterization has identified two major clusters of iERM specimens with distinct transcriptional activities that reflect different clinical and SD-OCT features of iERM patients. This retrospective work paves the way to prospective whole-genome transcriptomic studies to allow a molecular classification of iERMs and for the identification of molecular signature(s) of prognostic and therapeutic significance.

PEELING OF THE INTERNAL LIMITING MEMBRANE WITH FOVEAL SPARING FOR TREATMENT OF DEGENERATIVE LAMELLAR MACULAR HOLE.

PURPOSE: To compare the functional and anatomical results of fovea-sparing internal limiting membrane peeling during vitrectomy with those of observation for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation. DESIGN: A prospective, randomized, comparative pilot study. METHODS: Thirty-six eyes were randomized to undergo surgery with foveal internal limiting membrane sparing (Group S) or observation only (Group C). The main outcome measures were foveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: After 6 months, a significant difference was found in foveal retinal sensitivity between Group S (12.8 ± 1.7 dB) and Group C (9.39 ± 1.8 dB; P < 0.001). Similarly, best-corrected visual acuity improved in Group S and remained stable in Group C (respectively, 0.17 ± 0.13 and 0.46 ± 0.21 logMAR; P < 0.001). A significant increase in central retinal thickness was observed in Group S, but not in Group C (272 ± 24 vs. 147 ± 20 µm, P < 0.001). CONCLUSION: Fovea-sparing internal limiting membrane peeling is a feasible treatment for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation, yielding better improvements in best-corrected visual acuity and foveal retinal sensitivity than observation alone. Further studies are needed to optimize this new surgical approach.

FOVEA-SPARING VERSUS COMPLETE INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY FOR THE TREATMENT OF MACULAR HOLES.

PURPOSE: To compare the anatomical and functional outcomes of vitrectomy involving complete internal limiting membrane peeling (CP) with those of vitrectomy involving fovea-sparing internal limiting membrane peeling (FSP) for the treatment of macular holes measuring >250 µm. METHODS: This prospective, randomized, comparative study included 46 eyes with a medium or large macular hole that was randomized to undergo complete (CP group) or fovea-sparing (FSP group) internal limiting membrane peeling during vitrectomy. The main outcome measures included the foveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: Both groups showed significantly improved foveal retinal sensitivity after surgery; the mean foveal retinal sensitivity change at 12 months after surgery was +2.8 ± 2.1 dB in the CP group and +7.2 ± 2.3 dB in the FSP group. The visual acuity also showed a significant improvement in both groups, with no significant differences in values at any time point. Regarding central retinal thickness, there was a significant decrease in the CP group and no change in the FSP group. Nicks or dimples in the inner retinal layers were visible in the fovea and perifovea of nine eyes in the CP group. CONCLUSION: Our findings suggest that both CP and FSP are safe and effective treatments leading to functional and anatomical improvements in patients with all size macular holes. However, the fovea-sparing technique may provide better functional outcomes because of a greater improvement in foveal retinal sensitivity.

Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update.

Introduction: Intravitreal anti-VEGF is the most effective therapy for wet AMD, although systemic effects on the endothelium cannot be excluded. Areas covered: The purpose of this review was to evaluate risk of thromboembolic events associated with intravitreal anti-VEGF. Expert opinion: Current data are insufficient to confirm the safety of these compounds, due to the paucity of specific studies. Thus, pharmacovigilance for all anti-VEGF should be improved to verify the true role of anti-VEGF in the occurrence of systemic adverse events.

Treatment of exudative age-related macular degeneration with aflibercept combined with pranoprofen eye drops or nutraceutical support with omega-3: A randomized trial.

AIMS: The aim of this study was to determine whether a combination of intravitreal aflibercept (IVA) and pranoprofen eyedrops or nutraceutical support provides additional benefit over IVA monotherapy for the treatment of choroidal neovascularization (CNV) in age-related macular degeneration. METHODS: This was a prospective, randomized, pilot study in 60 patients with treatment-naïve CNV. Patients were randomized 1:1:1 into three groups: aflibercept monotherapy (AM), aflibercept plus pranoprofen (AP) or aflibercept plus nutraceutical (AN) tablets containing multivitamin antioxidant and mineral supplementation plus omega-3. RESULTS: At 12 months, all groups showed significant improvement in both best-corrected visual acuity (BCVA) and central retinal thickness (CRT). The mean BCVA change from baseline to 12 months was -0.26 ± 0.06 LogMAR, -0.30 ± 0.06 LogMAR and -0.24 ± 0.04 LogMAR in the AM, AP and AN groups, respectively. The mean CRT change from baseline to 12 months was -76.9 ± 10.9 µm, -129 ± 19.9 µm and -105 ± 11.6 µm in the AM, AP and AN groups, respectively. The AN group required one less IVA injection than the AM group. CONCLUSIONS: Compared with AM, both combination groups acted synergistically, although no significant benefits in BCVA were found over AM. Nutraceutical support with omega-3 leads to a reduced need for IVA.

Comparative assessment of intraocular inflammation following standard or heavy silicone oil tamponade: a prospective study.

PURPOSE: To evaluate the inflammation associated with the use of standard silicone oil (polydimethylsiloxane; PDMS) and heavy silicone oil (HSO) Densiron-68™ in patients undergoing vitrectomy for retinal detachment. MATERIALS AND METHODS: A prospective study was performed involving 35 patients scheduled to undergo vitrectomy for retinal detachment. Patients received PDMS or Densiron-68™ HSO according to superior or inferior retinal localization of the tears, respectively. For assessing the inflammation, prostaglandin E2 (PGE2 ) and interleukin-1α (IL-1α) levels were evaluated in the aqueous. RESULTS: Thirty-five eyes of 35 patients completed the study: 20 eyes received HSO, and 15 eyes received PDMS. The mean aqueous PGE2 level was significantly higher in HSO patients than in PDMS patients (869.16 ± 242.83 pg/ml versus 369.38 ± 209.7 pg/ml, respectively; p < 0.0001). The mean aqueous IL-1α level was also significantly higher in HSO patients than in PDMS patients (81.40 ± 36.9 pg/ml versus 40.8 ± 32.5 pg/ml, respectively; p = 0.002). In HSO, a moderate positive correlation between the endotamponade duration and both PGE2 (r = 0.44; p = 0.05) and IL-1α (r = 0.48; p = 0.033) levels was observed. In PDMS, a strong positive correlation between the endotamponade duration and both PGE2 (r = 0.89; p < 0.0001) and IL-1α (r = 0.68; p = 0.006) levels was observed. CONCLUSION: Although both HSO and PDMS yielded favourable success rates in the surgical treatment of complicated retinal detachments, HSO triggered a more severe inflammatory reaction, in a time-dependent manner.

EPIRETINAL MEMBRANE REMOVAL WITH FOVEAL-SPARING INTERNAL LIMITING MEMBRANE PEELING: A Pilot Study.

PURPOSE: To compare the retinal sensitivity after complete internal limiting membrane (ILM) peeling with that after foveal-sparing ILM peeling during vitrectomy for Type I epiretinal membrane. METHODS: This was a prospective, randomized, comparative study. Thirty-eight eyes were randomized to undergo complete peeling of the ILM (CP group) or peeling with foveal sparing (FS group). The main outcome measures were foveal and perifoveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: Foveal retinal sensitivity showed a significant improvement in the FS group (2.82 ± 0.85 dB, P = 0.037) versus a slight drop in the CP group (-0.66 ± 0.48 dB, P = 1). Perifoveal retinal sensitivity slightly improved in both groups (0.47 ± 0.37 dB, P = 1 in the CP group and 0.79 ± 0.42 dB, P = 0.77 in the FS group), showing a similar trend without significant differences. Significant improvements were observed in both visual acuity and central retinal thickness in both groups. However, three cases in the FS group showed epiretinal membrane recurrence and required revision surgery with complete ILM removal. CONCLUSION: Internal limiting membrane peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas. However, the higher epiretinal membrane recurrence rate after the foveal-sparing technique limits the effectiveness of this procedure. Further studies must be conducted to determine if it is safe to leave a portion of the ILM in front of the fovea.

Heavy and standard silicone oil: intraocular inflammation.

PURPOSE: Proliferative vitreoretinopathy in the inferior retina remains clinically challenging. Heavier-than-water intraocular tamponades have been developed to improve inferior tamponading properties, and their chemical compositions have been substantially improved over the years, in parallel with developments in vitrectomy instrumentation and surgical techniques. Herein we present an updated review of the clinical use of standard formulations and HSO, focusing on analysis of the intraocular inflammation associated with endotamponade agents, and comparison of the adverse effects of these agents on the physical and biological properties of the eye. METHODS: A detailed literature search was conducted on PubMed, EMBASE, Cochrane Library, and Google Scholar using the key words. Fifty-eight articles matched our inclusion criteria that were included in this systematic review. RESULTS: Perfluorocarbon liquids and partially fluorinated alkanes are associated with tamponade emulsification, intraocular inflammation, and rises in intraocular pressure, but these associations are not as strong when these substances are mixed with a heavy silicone oil (HSO). Two recently approved heavy silicone oil tamponades, Oxane HD and Densiron 68, are now available for use in clinical practice. While the complication spectrum of the new generation of these HSOs seems to be similar to that of conventional silicone oil tamponades, they provide better support for the inferior retina and the posterior pole. CONCLUSION: Both regular and heavy silicone oils usually yield good success rates in cases of complicated retinal detachment. Decisions as to whether to utilize heavy or regular silicone oil should be made on a case-by-case basis.

Comparison of half-dose photodynamic therapy and 689 nm laser treatment in eyes with chronic central serous chorioretinopathy.

PURPOSE: To compare visual and anatomical outcomes between half-dose photodynamic therapy (hd-PDT) and 689 nm laser therapy (689-LT) in chronic central serous chorioretinopathy (CSC). METHODS: Forty eyes of 40 patients with symptomatic chronic CSC were randomized in a 1:1 ratio to receive either hd-PDT or 689-LT delivering 95 J/cm2 via an intensity application of 805 mW/cm2 over 118 s. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography findings were compared between the two treatment groups. RESULTS: Mean CSC duration was 17.1 ± 6.66 weeks and 18.7 ± 7.46 weeks in the hd-PDT and 689-LT groups respectively. Both groups showed significant BCVA improvements, as well as reductions in central retinal and subfoveal choroidal thickness. Although hd-PDT led to a faster reduction in central retinal thickness, no significant differences were recorded between groups for any other measured parameter at any time point. Complete photoreceptor recovery was observed in eight and seven eyes in the hd-PDT and 689-LT groups respectively. CONCLUSIONS: Both hd-PDT and 689-LT were effective at treating chronic CSC. Further studies are warranted to evaluate long-term safety and efficacy.

Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery.

Surgical management of an idiopathic macular hole consists of vitrectomy to release vitreofoveal traction and intraocular tamponade to flatten and reappose the hole's edges. The intentional atraumatic removal of the internal limiting membrane has been proposed as cost-effective option in macular hole surgery. The internal limiting membrane contributes to tangential traction at the edges of the hole and acts as a platform on which glial cells proliferate. Removal of the internal limiting membrane increases the elasticity of the denuded macula and improves the anatomical success rate; however, the visual consequences of this surgical maneuver are still not fully known. We discuss the beneficial and adverse effects associated with internal limiting membrane peeling in macular hole surgery, highlighting the internal limiting membrane's role in macular hole etiology and pathogenesis and the anatomical and functional findings after its removal.