Cataract surgery with new monofocal intraocular lens enhanced for intermediate vision and standard monofocal intraocular lens for retinal disorder.

AIM: To investigate the difference in the initial surgical results between a new monofocal intraocular lens (IOL) with enhanced intermediate vision and the standard monofocal IOL in patients with retinal disease. METHODS: We retrospectively reviewed the medical records of patients with retinal disease who underwent cataract surgery due to accompanying cataracts. Types of retinal diseases were investigated and best-corrected distant visual acuity, distant uncorrected visual acuity (UCVA), intermediate UCVA, near UCVA, and spherical equivalent were recorded at each visit. The surgical results were investigated at 1 day, 1 week, and 1 month after surgery. RESULTS: Seventeen eyes treated with a new monofocal IOL enhanced for intermediate vision (ICB00 group) and 18 eyes treated with the standard monofocal IOL (AAB00 group) were included in this study. There were no significant differences in the baseline characteristics, including the type of underlying retinal disease, between the groups. There were no significant differences between the groups in terms of distant, intermediate, or near UCVA at day 1 and week 1 after surgery. However, at 1 month after surgery, the ICB00 group showed a significantly better intermediate vision improvement than the AAB00 group (p = 0.001). CONCLUSION: Even in patients with cataract accompanied by retinal disease, the use of the ICB00 IOL showed significant improvement in intermediate vision compared to the use of the AAB00 (standard monofocal) IOL. The ICB00 IOL might be a good option for patients with cataract and retinal disease in the era of increased intermediate vision needs in daily life.

Surgical management of a case of double optic disc pits with maculopathy.

BACKGROUND: Double optic disc pit maculopathy is a rare entity. It can be difficult to manage because of excessive leakage and chronic maculopathy. PURPOSE: To describe surgical management in a case of double optic disc pits with maculopathy. SYNOPSIS: A 42-year-old male presented with double optic disc pits with macular detachment in the left eye. The best-corrected visual acuity (BCVA) was 20/60, N12. Preoperative OCT showed the presence of two disc pits. The macular region had large retinoschisis and subretinal fluid (SRF) with a central foveal thickness of 879 microns and loss of the ellipsoid zone. A shallow communication from the temporal aspect of the disc to the submacular area was also noted. Among the options of observation, laser photocoagulation, and surgery, the patient opted for surgical management. SURGICAL TECHNIQUE: A standard-3 port 23-gauge pars plana vitrectomy was done. After staining the ILM with brilliant blue, ILM peeling was done with the help of forceps and Finesse loop. ILM flaps were inverted over to cover the optic disc pits and sealed with a drop of fibrin glue. Next, 20% SF6 gas was used for tamponade. Pre- and post-surgery parameters such as visual acuity and OCT were evaluated. POSTOPERATIVE EVALUATION: After 6 weeks, left eye BCVA was 20/40 with OCT showing reduced SRF and reduced intraretinal schisis with a foveal thickness of 546 microns. At 3 months of follow-up, the vision in the left eye had improved to 20/30 with further reduction in the retinoschisis and foveal thickness of 482 microns. HIGHLIGHTS: In this interesting case, we demonstrate a unique way of sealing the defect surgically by vitrectomy and inverted ILM flap with fibrin glue over the disc pits. Despite sealing the maculopathy is slow to resolve. VIDEO LINK: https://youtu.be/s9nY5UPe1s4.

Pits of Fire: Post Scleral Graft Vasculitis in Patients With Optic Disc Pit Maculopathy.

Occlusive vasculitis is a rare complication following an uneventful surgery. In this article, we report two cases of optic disc pit maculopathy that underwent scleral graft and developed vasculitis following uneventful surgery. Both patients underwent autologous scleral graft for optic disc pit maculopathy through 25-gauge pars plana vitrectomy. Scleral graft was harvested from patient's same eye and plugged in the optic disc pit. After a postoperative period of approximately 3 months, both patients developed features of occlusive vasculitis with vitreous base contraction. Uveitic workup did not reveal other causes of vasculitis. Both patients were treated with topical and systemic steroids and responded well until the last follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:172-175.].

Long-term results of cataract surgery in type 2 diabetics, a 20-year prospective longitudinal study.

PURPOSE: To investigate the 20-year outcome, in best-corrected visual acuity (BCVA), and subjective visual function (VF-questionnaire, VF-14) after cataract surgery in type 2 diabetics, compared with non-diabetics. METHODS: 109 type 2 diabetics and 698 non-diabetics, who had cataract surgery during 1 year at one institution, were included in this prospective, longitudinal, population-based cohort study. BCVA and VF-14 responses were recorded pre- and postoperatively, and every 5 years up to 20 years after surgery. Retinopathy was graded before surgery. RESULTS: There was no significant difference between diabetics and non-diabetics, in change in BCVA from 10 years or more after surgery, p = 0.45, p = 0.44 and p = 0.83, at 10, 15 and 20 years, respectively, as well as in self-perceived visual function (VF-14) at any time after surgery, p = 0.72, p = 0.20 and p = 0.78, 10-20 years, respectively. At any follow-up, there was no significant difference in BCVA in relation to retinopathy level before surgery, p = 0.1 at 20 years. There was a trend from 10 years after surgery and onward that patients with no retinopathy at baseline lost fewer letters during the 20 years than diabetics with retinopathy. Patients with known type 2 diabetes at surgery had a significantly lower survival compared with the non-diabetics at each follow-up, p = 0.003. CONCLUSION: In surviving diabetics, BCVA and subjective visual function were retained in most cases up to 20 years after cataract surgery. Cataract extraction is effective in causing a sustainable improvement in visual function also in type 2 diabetics. Knowledge of these long-term outcomes is essential when counselling diabetics for cataract surgery.

Use of 30 gauge needle to prevent hypotony during silicone oil removal.

Silicone oil (SO) is used as an intraocular tamponade after complex vitreoretinal surgeries because of its properties such as transparency, inertness, high surface tension, and interfacial tension with water. The only disadvantage of SO tamponade is the need for a second surgery for its removal. However, there is a risk of ocular hypotony soon after the removal of the infusion cannula, especially in retinal vascular conditions, such as diabetic retinopathy. We hereby present a silicone oil removal (SOR) technique using a 30 G needle that prevents intraocular hypotony during SOR.

A cross-sectional study of macular displacement after macular hole surgery with ILM peeling in patients with idiopathic macular hole.

PURPOSE: To examine the retinal displacement and change in mean superficial foveal avascular zone (FAZ) after successful closure of macular hole (MH) with vitrectomy with internal limiting membrane peeling (ILM) and gas tamponade. METHODS: A total of 45 patients with idiopathic MH who underwent 23G pars plana vitrectomy with ILM peeling and tamponade with 20% SF6/14% C3F8 were included. Follow-up visits were performed at 2, 4, and 8 weeks. OCT and OCT-A scans were performed along with detailed ocular examination. Distance between optic disc and an easily identifiable vascular bifurcation nasal and temporal to fovea, FAZ, was noted. Chi-square test (categorical data) and Mann-Whitney U test and t tests for other parameters were performed for statistical analysis. RESULTS: The mean displacement (µm) of an easily identifiable vascular bifurcation in the nasal quadrant was 96.58 ± 36.55 at 8 weeks and in the temporal quadrant was 273.07 ± 85.51 at 8 weeks. The change was statistically significant in the temporal quadrant (P = <0.001). The mean BCVA changed from a minimum of 0.08 at the preoperative timepoint to a maximum of 0.23 at 8 weeks (P = <0.001). The mean FAZ area (mm²) decreased from a maximum of 0.37 at the preoperative timepoint to a minimum of 0.19 at 8 weeks (p = <0.001). CONCLUSION: The retina in the temporal quadrant is displaced significantly more than nasal quadrant after successful closure of macular hole. The mean superficial FAZ also decreases suggesting a centripetal movement of the foveal tissue postoperatively.

Repair of a Tractional Retinal Detachment in the Setting of an Idiopathic Vasoproliferative Tumor.

Vasoproliferative tumors (VPT) are benign retinal lesions that may cause epiretinal membrane proliferation and tractional retinal detachments (TRD). We describe a case of a 71-year-old woman who presented with a macula involving TRD in the setting of a VPT. Given the limited number of publications on the management of these cases, we aim to articulate some principles we believe may be helpful in planning a surgical approach that maximizes postoperative anatomic and functional outcomes. We hope that our video provides useful guidance in preparing the vitreoretinal surgeon for managing this uncommon entity. [Ophthalmic Surg Lasers Imaging Retina 2023;54:485-488.].

Retinal phototoxicity after macular hole surgery in a patient under paclitaxel.

BACKGROUND: The purpose is to report the second case, to our knowledge, of suspected paclitaxel-induced phototoxic maculopathy following pars plana vitrectomy surgery. CASE PRESENTATION: 63-year-old phakic female who underwent an uneventful phaco-vitrectomy to treat a complete macular hole, developing macular phototoxicity in the post-operatively period that could not be explained by the surgery itself and could only be attributed to a possible photosensitization induced by the previous use of paclitaxel. CONCLUSIONS: The use of paclitaxel has been widely extended as a chemotherapy drug to treat breast cancer. It works by altering the intracellular microtubular reorganization and, based on this mechanism of action, photosensitivity has been previously described. We report a case of suspected paclitaxel-induced macular phototoxicity following ocular endoillumination during vitrectomy surgery.

Appropriateness and Readability of ChatGPT-4-Generated Responses for Surgical Treatment of Retinal Diseases.

OBJECTIVE: To evaluate the appropriateness and readability of the medical knowledge provided by ChatGPT-4, an artificial intelligence-powered conversational search engine, regarding common vitreoretinal surgeries for retinal detachments (RDs), macular holes (MHs), and epiretinal membranes (ERMs). DESIGN: Retrospective cross-sectional study. SUBJECTS: This study did not involve any human participants. METHODS: We created lists of common questions about the definition, prevalence, visual impact, diagnostic methods, surgical and nonsurgical treatment options, postoperative information, surgery-related complications, and visual prognosis of RD, MH, and ERM, and asked each question 3 times on the online ChatGPT-4 platform. The data for this cross-sectional study were recorded on April 25, 2023. Two independent retina specialists graded the appropriateness of the responses. Readability was assessed using Readable, an online readability tool. MAIN OUTCOME MEASURES: The "appropriateness" and "readability" of the answers generated by ChatGPT-4 bot. RESULTS: Responses were consistently appropriate in 84.6% (33/39), 92% (23/25), and 91.7% (22/24) of the questions related to RD, MH, and ERM, respectively. Answers were inappropriate at least once in 5.1% (2/39), 8% (2/25), and 8.3% (2/24) of the respective questions. The average Flesch Kincaid Grade Level and Flesch Reading Ease Score were 14.1 ± 2.6 and 32.3 ± 10.8 for RD, 14 ± 1.3 and 34.4 ± 7.7 for MH, and 14.8 ± 1.3 and 28.1 ± 7.5 for ERM. These scores indicate that the answers are difficult or very difficult to read for the average lay person and college graduation would be required to understand the material. CONCLUSIONS: Most of the answers provided by ChatGPT-4 were consistently appropriate. However, ChatGPT and other natural language models in their current form are not a source of factual information. Improving the credibility and readability of responses, especially in specialized fields, such as medicine, is a critical focus of research. Patients, physicians, and laypersons should be advised of the limitations of these tools for eye- and health-related counseling. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Papillomacular bundle sparing versus conventional internal limiting membrane peeling for idiopathic macular hole ≤400 µm.

Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ≤400 µm. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC-IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.

Long-term retinal changes after strabismus surgery, suspected signs of past scleral perforations.

Purpose: Scleral perforation during strabismus surgery is considered a rare complication that usually results in no significant consequences. The true rate of such occurrences is difficult to evaluate due to the young age of most patients and the occult nature of most events. This study aimed to evaluate long-term retinal changes under the suture areas in patients post-strabismus surgery as presumed signs indicating past undiscovered scleral perforations. Methods: The study population consisted of patients with a follow-up of at least 10 years post-strabismus surgery at the [redacted for review] Eye Institute and with no known retinal conditions as well as with wide fundus visibility. We performed slit-lamp retinal periphery examinations in search of retinal scars or changes at the suture sites. Results: Seventy-one eyes from 43 patients were examined. The mean age (±standard deviation [SD]) at the time of examination was 27 years (±14), and the mean number of strabismus surgeries per patient was 1.8. Three of the examined eyes showed retinal changes at the suture sites, yielding an overall incidence rate of suspected perforation/penetration of 4.2% per eye and 3.6% per strabismus surgery. These three patients were all asymptomatic. Conclusion: Scleral perforations during strabismus surgeries could remain unnoticed since a comprehensive exam of the retinal periphery is challenging in young children, especially during the postoperative period. While retinal changes caused by inadvertent scleral perforations appear to have no clinical sequelae in a time frame of 10 years, such changes should be noted for future fundoscopic examinations.

Progress of iPS cell-based transplantation therapy for retinal diseases.

The discovery of induced Pluripotent Stem) (iPS) cells has instigated innovation in various fields, including ophthalmology. Cell therapy has shown tremendous progress in translational research on retinal diseases, including the first-in-human transplantation of autologous iPS cell-derived retinal pigment epithelium (RPE) cells for patients with age-related macular degeneration (AMD). Cell therapy for retinitis pigmentosa (RP) has also been developed. Retinal organoid and photoreceptor cell transplantation has been shown to incorporate into the degenerated host retina, forming synapses with host neurons and resulting in functional recovery. Based on preclinical data, first-in-human transplantation of iPS cell-derived retinal sheets has been conducted. In this review, we summarize the current progress in iPS cell-based retinal cell transplantation research for retinal diseases, addressing some remaining challenges and future prospects.

A Comparison of Peel-Induced Maculopathy Following ILM Peeling Using a Microvacuum Pick Versus Forceps.

OBJECTIVE: To compare peel-induced maculopathy (PIM) using surgical forceps versus the microvacuum pick (MVP). METHODS: Consecutive eyes undergoing internal limiting membrane (ILM) peeling using either the MVP or forceps were assessed. En face optical coherence tomography (OCT) images at the level of the nerve fiber layer were generated for 6-month postoperative visit. The percentage of the imaged area showing PIM was termed the PIM index. PIM severity was additionally measured using a qualitative PIM severity scale. RESULTS: Seventy-four consecutive eyes underwent ILM peeling with either the MVP (36/74; 49%) or forceps (38/74; 51%). At month-6 postoperatively, the mean PIM index for forceps was 7.7% vs 4.7% for the MVP (P < 0.001, R2 = 0.15). At 6 months, 26/38 eyes (68.5%) in the forceps group had either moderate or severe PIM compared to 12/36 eyes (33.3%) in the MVP group (P = 0.001). CONCLUSIONS: ILM peeling with the MVP resulted in lower PIM severity compared to forceps. [Ophthalmic Surg Lasers Imaging Retina 2023;54:37-42.].

PROGRESSION OF MYOPIC MACULOPATHY IN PATIENTS WITH MYOPIC TRACTION MACULOPATHY AFTER VITRECTOMY.

PURPOSE: To compare the progression of myopic maculopathy with or without vitrectomy in patients with myopic traction maculopathy (MTM). METHODS: Seventy-seven eyes with MTM were classified into either the observation group (n = 38) or the vitrectomy group (n = 39). Progression of myopic maculopathy was assessed with fundus photography using infrared images. Progression within stage was evaluated as an increase in the area of atrophic lesions on infrared images using ImageJ software. The rate of progression was compared using the paired t -test. RESULTS: The mean follow-up period was 60.0 ± 47.5 months. The initial mean stage of myopic maculopathy for the observation group was 1.86 ± 0.86, and it progressed to 2.00 ± 0.83 ( P = 0.023) at the last visit. For the vitrectomy group, the stage progressed from 1.82 ± 0.96 to 2.05 ± 1.09 ( P = 0.011). Four eyes (10.5%) in the observation group showed progression at 87.3 months, and seven eyes (17.9%) in the vitrectomy group showed progression at 31.3 months. CONCLUSION: Surgery in patients with MTM may accelerate the progression of myopic maculopathy. Therefore, care should be taken when considering surgery for patients with MTM.

COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM AT PEDIATRIC AGE: Surgical Versus Conservative Approach.

PURPOSE: To report outcomes of pediatric patients with combined hamartoma of the retina and the retina pigment epithelium followed up conservatively or after pars plana vitrectomy. METHODS: This retrospective multicenter study included 62 eyes of 59 pediatric patients with combined hamartoma of the retina and the retina pigment epithelium from 13 different international centers with an average age of 7.7 ± 4.7 (0.3-17) years at the time of the diagnosis and having undergone pars plana vitrectomy or followed conservatively. At baseline and each visit, visual acuity values, optical coherence tomography for features and central foveal thickness, and tumor location were noted. Lesions were called as Zone 1, if it involves the macular and peripapillary areas, and the others were called as Zone 2 lesions. RESULTS: Twenty-one eyes of 20 patients in the intervention group and 41 eyes of 39 patients in the conservative group were followed for a mean of 36.2 ± 40.4 (6-182) months. Best-corrected visual acuity improved in 11 (68.8%) of 16 eyes in the intervention group and 4 (12.9%) of 31 eyes in the conservative group ( P < 0.001). The mean central foveal thickness decreased from 602.0 ± 164.9 µ m to 451.2 ± 184.3 µ m in the intervention group, while it increased from 709.5 ± 344.2 µ m to 791.0 ± 452.1 µ m in Zone 1 eyes of the conservative group. Posterior location of tumor, irregular configuration of the foveal contour and ellipsoid Zone defect in optical coherence tomography, subretinal exudate and prominent vascular tortuosity were associated with poor visual acuity. CONCLUSION: Vitreoretinal surgery is safe and effective in improving vision and reducing retinal distortion in Zone 1 combined hamartoma of the retina and the retina pigment epithelium in children.