Pseudophakia as a surprising protective factor in neovascular age-related macular degeneration.

PURPOSE: To assess the impact of lens status on macular function among patients treated for neovascular age-related macular degeneration (nvAMD) in whom scheduled intravitreal injections were delayed. METHODS: We reviewed demographic and clinical data as well as macular optical coherence tomographic images of 34 patients (48 eyes) who did not follow their injection schedule during the first wave of COVID-19 in Israel. Functional worsening was defined as a loss of at least 0.1 in decimal best-corrected visual acuity (BCVA). Morphological worsening was defined as new or increased subretinal/intraretinal fluid or a new hemorrhage. OCT indices of quality were used as a measure for cataract density and progression. RESULTS: Pseudophakia was associated with a better functional outcome than phakic status: there was a loss of 0.06±0.12 vs. 0.15±0.10 decimal BCVA in the pseudophakic and phakic eyes, respectively (P=.001). A similar trend was observed for morphological changes over the same period: there was an increase in macular thickness of 9±26% vs.12±40%, respectively (P=0.79). During the first wave of COVID-19, the index of OCT quality remained stable for phakic eyes (26±3.6 before the first wave of COVID-19, 26±2.9 afterward; P=1) and pseudophakic eyes (30±2.4 before the first wave of COVID-19, 30±2.6 afterward; P=1). CONCLUSION: Pseudophakic eyes with nvAMD that missed their scheduled intravitreal injections experienced fewer morphological and functional complications than phakic eyes with nvAMD.

Central serous chorioretinopathy following the BNT162b2 mRNA vaccine.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has accelerated vaccine development. The BNT162b2 messenger RNA (mRNA) vaccine is being administered worldwide. The purpose of this case series is to report a possible association between the BNT162b2 mRNA vaccine and Central serous chorioretinopathy (CSC). Although rare, CSC has been reported following the administration of anthrax, influenza and smallpox vaccines. METHODS: Four individuals who developed CSC following the BNT162b2 mRNA vaccine were examined in our institution using multimodal imaging of the retina, and their demographic data were analyzed and compared to all the similar cases published to date. RESULTS: Four patients (3 males, 1 female) between the ages of 35 and 65 presented with acute CSC (n=3) and relapsed CSC (n=1) within the first week following the administration of the BNT162b2 mRNA vaccine. Three individuals demonstrated hyper-reflective foci in the outer segments of the retina. CONCLUSIONS: The timing of the BNT162b2 mRNA vaccine administration relative to the development of CSC suggests a possible causal relationship. Further research is necessary to explore this possible association.

High intraocular pressure in four vitrectomized eyes with intravitreal C3F8 without high altitude travel.

IMPORTANCE: It is well known that altitude ascent with intravitreal gas can cause expansion of gas and intraocular pressure (IOP) elevation. According to Boyle's law, the gas bubble will not expand unless a higher altitude than the gas insertion site has been reached. We report four cases in which intravitreal gas was injected at an altitude of 790 m (Jerusalem). All four cases developed high IOP even though they did not reach a higher altitude in their post-operative period. OBSERVATIONS: A report of four patients following vitrectomy with 12% mixture of perfluoropropane and air are presented. All four patients arrived with ocular pain following the ascent by car of 765-1100 m to Jerusalem where the vitrectomy and gas insertion was conducted. Upon examination, all four patients had high IOP (30-55 mm Hg). IOP was well controlled with IOP-lowering medications. None of the patients suffered from long-term complications. CONCLUSIONS AND RELEVANCE: Caution should be taken with altitude changes in patients with intravitreal gas even if there was no ascent from the altitude in which the vitrectomy was performed.