Addition of intravitreal carboplatin with melphalan for management of vitreous seeding in retinoblastoma.

PURPOSE: To evaluate the efficacy and toxicity of intravitreal carboplatin plus melphalan for the treatment of vitreous seeds in eyes with retinoblastoma (RB). METHODS: This retrospective series at a tertiary referral center included 22 consecutive RB patients who had received intravitreal carboplatin (16 µg per 0.05 ml) combined with melphalan (30 µg in 0.03 ml) [IVi (Ca-Me)] for treatment of vitreous seeds. Tumor control and drug toxicities were recorded. RESULTS: There were 22 eyes of 22 patients, divided into primary group (n = 13) without history of previous intravitreal chemotherapy (IViC) and refractory group (n = 9) with history of previous IViC using melphalan and/or topotecan. The demographics and clinical findings of the primary and refractory groups did not differ significantly. The 6-month follow-up revealed complete vitreous seed control (77% vs. 89%, p = 0.47). Vitreous seed recurrence was detected in 1 eye of each group at 6 months. During the next 18-month follow-up period, no recurrence of seed was observed. The response to IVi (Ca-Me) was not significantly influenced by previous IViC (p = 0.70), primary systemic or intra-arterial chemotherapy (p = 0.45), or the type of regression (p = 0.35). The most common tumor treatment complications were retinal detachment (RD) (n = 2), early hypotony (n = 2) and late hypotony (n = 4, unrelated), cataract (n = 2), and severe pigment dispersion (n = 1). Enucleation was performed in 8 eyes, for total RD (n = 1), phthisis bulbi (n = 5), and extensive solid tumor recurrence (n = 2). There was no case of orbital invasion, systemic metastasis, or death. CONCLUSION: Based on this interventional case series for primary and refractory vitreous RB seeds, carboplatin plus melphalan therapy may be effective with few toxic side effects.

Retinal displacement following pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

PURPOSE: To evaluate the frequency of retinal displacement after pars plana vitrectomy (PPV) using silicone oil tamponade in patients with rhegmatogenous retinal detachment (RRD). METHODS: Patients with fresh RRD were enrolled in this prospective interventional case series. A standard 3-port PPV with silicone oil tamponade was performed in all cases. A complete ocular examination, optical coherence tomography and fundus autofluorescence (FAF) imaging were performed at 1 and 3 months follow-up. Orthoptic examinations including synoptophore and light on-off tests were also performed at 3 months. RESULTS: Twenty-three eyes from 23 patients with mean age of 56.6 ± 11 (range: 38-82) years were included. All patients were pseudophakic. Downward retinal displacement was found in 2 eyes (8.7%) showing hyperautofluorescent lines parallel to retinal vessels in FAF image. The patients with retinal displacement did not complain of metamorphopsia and did not show abnormality in orthoptic tests. CONCLUSION: Unintentional retinal shift following PPV with silicone oil tamponade for RRD is uncommon and might have little clinical significance.

Optical coherence tomography angiography changes in macula-off rhegmatogenous retinal detachments repaired with silicone oil.

PURPOSE: To evaluate the changes on optical coherence tomography angiography (OCTA) in macula-off rhegmatogenous retinal detachments (RRD) treated with pars plana vitrectomy (PPV) and silicone oil (SO) 5000-cSt tamponade. MATERIALS AND METHOD: Forty-five eyes with macula-off RRD treated with PPV and SO tamponade were enrolled with the fellow eye being used as a control. OCT-A was obtained using the RTVue XR 100 Avanti (Optovue, Inc., Fremont, CA, USA) at the 1-week, 1-month, and 3-month postoperative visit. Retinal vascular density, choroidal flow area, retinal thickness, and foveal avascular zone area were evaluated at each follow-up visit. Changes in these parameters in the postoperative eye were tracked at each follow-up visit as were the relative differences between the postoperative eye and the contralateral eye. RESULTS: Vascular density of parafoveal superficial capillary plexus and total retina demonstrated significant decrease in the postoperative silicone-filled eye when compared to the fellow eye (P < 0.0001). Although there was some improvement in these values at subsequent follow-ups, they remained less than the fellow eye. Foveal (P = 0.002) and parafoveal (P < 0.0001) thickness were less than the fellow eye. Choroidal flow area did not show a significant change in operated eye compared with the fellow eye. CONCLUSION: Eyes with macula-off RRD repaired with PPV and SO, at 3-month follow-up, demonstrated less retinal vascular density at parafoveal area as well as lower retinal thickness at fovea when compared to the healthy fellow eyes.

Fabrication of 3D microfibrous composite polycaprolactone/hydroxyapatite scaffolds loaded with piezoelectric poly (lactic acid) nanofibers by sequential near-field and conventional electrospinning for bone tissue engineering.

Near-field electrospinning (NFES) has recently gained considerable interest in fabricating tissue engineering scaffolds. This technique combines the advantages of both 3D printing and electrospinning. It allows for the production of fibers with smaller resolution and the ability to make regular structures with suitable pores. In this study, a microfibrous composite scaffold of polycaprolactone (PCL)/hydroxyapatite (HA) was prepared by NFES in the first step. The microfibrous scaffold had a fiber spacing of 414.674 ± 24.9 µm with an average fiber diameter of 94.695 ± 16.149 µm. However, due to the large fiber spacing, the surface area was insufficient for cell adhesion. Therefore, the hybrid scaffold was prepared by adding aligned and random electrospun poly (L-lactic acid) (PLLA) nanofibers to the microfibrous scaffold. Cellular studies showed that cell adhesion to the hybrid scaffold increased by 334 % compared to the microfibrous scaffold. These nanofibers also exhibited piezoelectric properties, which helped stimulate bone regeneration. Aligned nanofibers in the hybrid scaffold enhanced alkaline phosphatase activity and the intensity of alizarin red staining 1.5 and 1.6 times, respectively, compared to the microfibrous scaffold. Furthermore, the elastic modulus and ultimate tensile strength increased by 268 % and 130 %, respectively, by adding aligned nanofibers to the microfibrous scaffold. Therefore, the hybrid microfibrous composite scaffold of PCL/HA containing aligned electrospun PLLA nanofibers with improved properties showed the potential for bone regeneration.

Influence of Oxygen Content in the Protective Gas on Pitting Corrosion Resistance of a 316L Stainless Steel Weld Joint.

Gas tungsten arc welding (GTAW) is commonly used for joining pipelines; however, it often leads to discoloration in the heat-affected zone (HAZ). In this study, 316L pipes were welded with different concentrations of oxygen present in the argon purge gas during welding. The objective of this study was to investigate the effect of oxygen concentration in the protective gas on the pitting corrosion resistance of welded pipes. The experimental results showed that the thickness of the oxide layer formed in the HAZ depends on the concentration of oxygen in the protective gas. Increasing the oxygen concentration in the protective gas resulted in an increase in pitting corrosion resistance until a critical value, beyond which the resistance decreased. The results showed that the thickness of the oxide layer formed in the HAZ depends on the concentration of oxygen in the protective gas. Increasing the oxygen concentration in the protective gas increased the pitting corrosion resistance until a critical value, beyond which the resistance decreased due to the formation of iron oxide. This study provides valuable insights for improving the corrosion resistance of welded pipes in the oil and gas industry.

Massive Uveal Relapse of Retinoblastoma Presumed to Be Choroidal Tumorous Involvement: Case Series.

We report the choroidal and ciliary body invasion by retinoblastoma (RB) in a salvaged eye after complete and successful primary treatment. Case 1: A 25-month-old boy was referred due to group B RB lesions based on the International Classification of RB (ICRB; groups A-E) in the right eye (OD). His left eye (OS) was enucleated because of advanced group E RB. After 47 months of uneventful follow-up (F/U), a new lesion recurred and was treated with transpupillary thermotherapy. Four months later, a fast-growing pigmented subretinal mass was detected that was treated by brachytherapy with the apical dose of 80 Gy. Three weeks later, the lesion regressed completely, and no recurrence happened after 6 years of F/U. Case 2: A 4-month-old girl with a deletion in chromosome 13 was referred for bilateral RB. OD was enucleated because of unresponsive RB and anterior segment involvement. In OS, group B lesions had multiple recurrences after systemic chemotherapy. After a while, a single mass appeared in the nasal periphery which was controlled well with brachytherapy. Four months later, AC involvement was controlled with IAC, intravitreal, and intracameral chemotherapy, but posterior synechia and cataract appeared later. One year after the last treatment, UBM showed a ring-shaped ciliary body mass. Her parents refused enucleation again, and she received intravenous chemotherapy. Two years later, magnetic resonance imaging showed orbital and optic canal involvement with a deformed globe. In conclusion, RB recurrence can appear as local choroidal and ciliary body involvement even after a time of complete remission. The role of B-scan and UBM in early diagnosis and successful treatment is valuable.

Near-Field Electrospinning: Crucial Parameters, Challenges, and Applications.

Near-field electrospinning (NFES) is a micro- or nanofiber production technology based on jetting molten polymer or polymer solution. Thanks to the programmable collector and nozzle movement, it can generate designed patterns in the presence of an electric field. Despite a few shortcomings of NFES, its high resolution, simplicity, precision, high throughput, reproducibility, and low costs have convinced researchers to employ it for various purposes. Furthermore, as the paradigm of fiber-based structures shifts from random textures toward delicate designs, NFES can bridge the gap between existing inefficient processes and aspired technologies for precise patterning. NFES facilitates the production of ultrafine nanofibers because it can be used to fabricate them in every laboratory. These robust fibers are convenient tools for small and additive manufacturing. As such, NFES is considered a potent additive fabrication technology that facilitates the production of complicated patterns as well. It is suggested that near-field electrospun fibers exhibit outstanding results in various applications, owing to their precise and controllable positioning. Meanwhile, the ongoing development of NFES has yet to reach its climax, making it attractive for further research. In this review, the basic principles of NFES, derivatives, limitations, and applications in nanomanufacturing, tissue engineering, microscale electronics, biosensors, and optics are presented.

Retinal Optical Coherence Tomography Angiography Findings following Retinoblastoma Treatment by Chemotherapy.

Purpose: To investigate the macular microvascular changes after different kinds of chemotherapy in patients with extramacular retinoblastoma (RB). Methods: In this study, 28 eyes of 19 patients with bilateral RB treated with intravenous systemic chemotherapy (IVSC group) and 12 eyes of 12 patients with unilateral RB treated with intra-arterial chemotherapy (IAC group) were compared with 6 normal fellow eyes of 6 patients with unilateral RB treated with IVSC (IVSC fellow eye group), and 7 normal fellow eyes of 7 unilateral RB patients treated with IAC (IAC fellow eye group), as well as 12 age-matched normal eyes. Enhanced depth imaging optical coherence tomography measurements of central macular and subfoveal choroidal thickness (CMT and SFCT) as well as optical coherence tomography angiography measurements such as retinal superficial capillary density (SCD), deep capillary density (DCD), and choriocapillaris density were documented. Results: Images of 2 eyes in the IVSC group and 8 eyes in the IAC group were excluded from the final image analysis due to severe retinal atrophy. Overall, 26 eyes with bilateral RB treated with IVSC and 4 eyes of 4 patients with unilateral RB treated with IAC were compared with the mentioned control groups. Best-corrected visual acuity was 1.03 logMAR in the IAC patients compared to 0.46 logMAR in the IVSC group at the time of imaging. While the CMT and SFCT were lower in the IAC group in comparison with the IAC fellow eye and normal groups (P < 0.05 for all), no remarkable difference was observed between the IVSC group and the control groups based on the mentioned parameters. Although the SCD showed no significant difference between the IVSC and control groups, this parameter was significantly lower in the eyes receiving IAC relative to the corresponding fellow eye group (P = 0.042) and normal control eyes (P = 0.047). The mean DCD was considerably lower in both the treatment groups compared to the control groups (P < 0.05 for all). Conclusion: Our study showed a substantial decrease in SCD, DCD, CMT, and choroidal thickness in the IAC group, which may explain the lower visual outcome in this group.

A case of autoenucleation associated with a contralateral field defect.

PURPOSE: To report a case of autoenucleation associated with contralateral field defect. DESIGN: Observational case report. METHODS: A 36-year-old man was referred to the emergency ward with his right eye attached to a fork. His history revealed drug abuse with ecstasy. RESULTS: Visual field examination revealed a temporal hemianopia on the left eye. There was no change in the visual field defect after intravenous steroid, two months after initial presentation. CONCLUSIONS: Contralateral visual field defect may be associated with autoenucleation. A visual field test is recommended in all cases with traumatic enucleation.

Five-Year Experience in Treatment of Retinoblastoma with Intra-Arterial Chemotherapy: A Single-Center Analysis.

PURPOSE: To report our 5-year experience in treating retinoblastoma (RB) with intra-arterial chemotherapy (IAC) as a primary or secondary therapy, without adjuvant intravitreal chemotherapy. METHODS: A retrospective study was conducted on 70 eyes with intraocular RB that were treated with primary or secondary IAC from December 2010-2015. Demographic characteristics, clinical features, tumor control, and treatment complications were compared and reported. RESULTS: Thirty-seven eyes had received IAC as a secondary therapy after failed/incomplete response to systemic chemotherapy, and 33 eyes had received IAC as a primary treatment. The mean age of patients was 25 ± 8.9 months, and the patients were followed for a mean of 24.5 ± 16.26 months. Overall, enucleation rates were significantly higher in advanced tumors (Group D and E) in both groups (both P < 0.05). The main reason for enucleation in this study group was being unresponsive to treatment (27.4%), with 76% of latter patients having vitreous seeds at the time of enucleation. Enucleation rates did not differ significantly between patients receiving primary (18/33, 54%) or secondary IAC (18/37, 48%) (P = 0.06). In addition, recurrence and complication rates did not differ significantly between eyes receiving IAC as their primary or secondary treatment (P > 0.05). CONCLUSION: In primary and secondary treatment of RB with IAC, the main findings that are globe salvage, recurrence, and complication rates were comparable when no adjuvant intravitreal chemotherapy was used.

Tamoxifen Induced Pachychoroid Pigment Epitheliopathy with Reversible Changes After Drug Discontinuation.

We report a case of breast cancer with clinically significant retinal toxicity induced by 7 years' Tamoxifen consumption in which patient's visual acuity and paraclinical findings remarkably improved after drug discontinuation. A 49-year-old woman with a history of breast cancer and Tamoxifen consumption was referred to our clinic for evaluation and treatment of gradual and progressive decrease visual acuity of both eyes (more prominent in right eye). Funduscopy showed bilateral macular pigmentary changes, with diffused tiny yellow crystals and reduced macular tessellation. On spectral-domain optical coherence tomography (SD-OCT), there was retinal pigment epithelium (RPE) abnormality and ellipsoid zone discontinuity accompanied by retinal thinning and choroidal thickness that was more prominent in the right eye. One year after discontinuation of the drug, visual acuity was significantly improved and SD-OCT revealed some surprising recoveries in the photoreceptor layers especially in her right eye.

Hypertension and Ischemic Stroke After Aflibercept for Retinopathy of Prematurity.

BACKGROUND: Retinopathy of prematurity is the leading cause of preterm infants' blindness. The preferred method for the management of aggressive posterior ROP is the anti-vascular endothelial growth factor (anti-VEGF). However, systemic and ocular adverse effects of anti-VEGF drugs remain a concern. CASE PRESENTATION: A case report of a preterm infant with a history of hypertension underwent intravitreal injection of aflibercept at the 50-week postmenstrual age because of aggressive posterior retinopathy of prematurity (ROP) in both eyes. Seven days after the intravitreal administration of aflibercept, he has a hypertension crisis and an ischemic stroke. Serial fundoscopies implied complete arrest of vascularization till seven months after receiving treatment. CONCLUSION: We report a case of an infant, with a history of hypertension, had an ischemic stroke just one week after the intravitreal injection of aflibercept for aggressive posterior ROP. We can conclude that in cases of preterm infants with systemic comorbidities, like uncontrolled hypertension, that predispose patients to thromboembolic events, we should be cautious about the potential increase in the risk of thromboembolic events after administration of anti-vascular endothelial growth factor agents (anti-VEGF), especially those with a longer half-life, like aflibercept.

Intravitreal Ziv-Aflibercept in Patients With Diabetic Macular Edema Refractory to Intravitreal Bevacizumab.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intravitreal ziv-aflibercept (IVZ) in patients with diabetic macular edema (DME) resistant to intravitreal bevacizumab (IVB). PATIENTS AND METHODS: This prospective study was conducted in patients with persistent DME. Patients were switched to IVZ no longer than 6 weeks after the last three consecutive monthly IVB treatments and monitored over a course of 12 weeks. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and macular volume on optical coherence tomography were compared. RESULTS: A total of 59 eyes (38 patients) were included. Mean BCVA improved from 0.84 to 0.71 logMAR (P = .001) after first IVZ treatment and remained significant. In a subgroup analysis, this significance was observed only in the group with baseline visual acuity of less than 20/50. Mean CMT decreased from 479 µm to 364 µm (P = .004) after the first IVZ injections and remained significant. CONCLUSION: IVZ may be best reserved for patients with persistent DME after initial failure with bevacizumab, with less likelihood for anatomic or functional improvement in those with mild persistent DME. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:145-151.].

Quantitative measurement of vascular density and flow using optical coherence tomography angiography (OCTA) in patients with central retinal vein occlusion: Can OCTA help in distinguishing ischemic from non-ischemic type?

BACKGROUND: To evaluate microvascular changes and quantitative parameters in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography angiography (OCTA) and finding difference between presumably ischemic and non ischemic CRVO. METHODS: Patients with CRVO (31) and healthy control (20) were enrolled in this observational case control study. The OCTA was done for each patient and control subject. In macular area 2 images were taken for each eye (3 × 3 mm and 8 × 8 mm). The images were analyzed at three capillary plexuses (superficial and deep retinal capillary layers and choriocapillaris layer). RESULTS: Thirty-one patients with CRVO (mean age 60.00 ± 13.72 years) and 20 healthy age/gender matched subjects (mean age 54.10 ± 12.33 years) were enrolled in this study (p = 0.095). The mean visual acuity of patients was 0.47 ± 0.54 LogMAR. Eyes with CRVO as compared with fellow eyes and control group showed significant reduction of flow in superficial (1.171 ± 0.262 vs. 1.362 ± 0.285 vs. 1.453 ± 0.105) and deep capillary plexus (1.042 ± 0.402 vs. 1.331 ± 0.315 vs. 1.526 ± 0.123) and choriocapillaris (1.206 ± 0.543 vs. 1.841 ± 0.308 vs. 1.966 ± 0.05) and vascular density in superficial (45.92 ± 4.2 vs. 50.99 ± 4.35 vs. 52.85 ± 2.99) and deep (48.03 ± 4.71 vs. 55.86 ± 3.81 vs. 58.2 ± 2.65) capillary plexuses. Some parameters (flow of both retinal capillary plexuses and parafoveal vascular density in deep plexus) showed significantly reduction in fellow eyes than control group. The parameters including flow [superficial (1.014 ± 0.264 vs. 1.279 ± 0.19) and deep (0.873 ± 0.442 vs. 1.152 ± 0.32) capillary plexuses and choriocapillaris (0.79 ± 0.327 vs. 1.424 ± 0.51)] and vascular density [superficial (44.24 ± 2.13 vs. 46.58 ± 4.13) and deep (45.28 ± 3.5 vs. 49.32 ± 3.94) capillary plexuses] were lower significantly in ischemic type than non ischemic CRVO. The most damaged parameter was flow in deep capillary plexus. The model with smallest Akaike information criterion and Bayesian information criterion was chosen as the best model. For easier calculation, we also calculated the reduced model. By choosing the threshold of 12.6, the formula [3.9 × F1S + 0.8 × F3S] can diagnose the presumably ischemic CRVO from non ischemic type with AUC of 0.84, sensitivity of 100% and specificity of 69%. (F1S: flow in the central 1 mm-radius-circle of superficial plexus and F3S: flow in the central 3 mm-radius-circle of superficial plexus). CONCLUSION AND RELEVANCE: In CRVO patients, the OCTA can accurately evaluate changes in microvascular structures. It may help in differentiation ischemic CRVO from non-ischemic CRVO.

Role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative macular edema in non-proliferative diabetic retinopathy.

PURPOSE: To evaluate the role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative diabetic macular edema (DME) in patients with no diabetic retinopathy or non-proliferative diabetic retinopathy (NPDR) and without macular edema. METHODS: In a prospective randomized clinical trial, 71 eyes from 71 diabetic patients with no diabetic retinopathy or mild NPDR and with central macular thickness (CMT) of less than 300 µm were enrolled and were randomized into two groups: combined phacoemulsification and intravitreal bevacizumab injection group and only phacoemulsification group. Our primary outcome measures included best corrected visual acuity (BCVA), CMT, and total macular volume (TMV) before and after (1 month and 3 months) the cataract surgery. RESULTS: The two groups did not show any significant difference in terms of baseline BCVA, age, CMT, stage of diabetic retinopathy. While the bevacizumab group showed lower CMT one month after the surgery compared to control group (267.3 ± 31.8 and 293.6 ± 53.7, respectively, P = 0.019), this difference did not remain significant 3 months after surgery (264.5 ± 21.9 and 291.4 ± 79.8, P = 0.089). The TMV and BCVA in the two groups showed no significant difference one month or 3 months after surgery. Considering our definition of post-cataract surgery diabetic macular edema (PME) in this study [CMT >300 µm using spectral domain optical coherence tomography (SD-OCT)], there was no significant difference between the incidence of PME at 1 month and at 3 months after surgery. CONCLUSIONS: Although the intravitreal injection of bevacizumab during phacoemulsification would result in decreased macular thickness in patients with no diabetic retinopathy or NPDR and without macular edema in the early postoperative period, this effect would no longer persistent at 3 months. In addition, the BCVA and TMV showed no significant difference between the two groups at any time during follow-up period.

Pellet gun injury as a source of ocular trauma; a retrospective review of one hundred and eleven cases.

PURPOSE: To report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries. METHODS: This study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patients' demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded. RESULTS: One hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (16-45 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (P < 0.001). At the end of follow-up, enucleation was performed for 20 patients (18%), and thirty-six patients (32%) had no light perception (NLP) in vision. CONCLUSION: Pellet gun injuries were more common among young male patients, and the only statistically significant indicator of post-treatment visual acuity was OTS at admission.

Comparison of Intravitreal Bevacizumab and Laser Photocoagulation in the Treatment of Retinopathy of Prematurity.

PURPOSE: To compare the outcomes of patients with type I retinopathy of prematurity (ROP) treated with either intravitreal bevacizumab (IVB) or retinal laser photocoagulation (RLP). DESIGN: Retrospective case series. PARTICIPANTS: Infants treated for type I ROP with IVB or RLP. METHODS: Patients who were born between January 2011 and December 2014 and were treated in Farabi Eye Hospital were included. The outcomes were stratified and analyzed, based on the treatment type and ROP zone. MAIN OUTCOME MEASURES: Need for retreatment, time to regression, refractive errors, retinal adverse anatomic outcomes, and rate of complications. RESULTS: Five hundred twenty-three patients were treated for type 1 ROP, of whom 493 (986 eyes) met inclusion criteria. Seven hundred twenty-four eyes (73.4%) received IVB, and 262 eyes (26.5%) received RLP. Re-treatment (because of recurrent or persistent retinopathy) occurred in 14.4% (106/724) of eyes initially treated with IVB and in 8.8% (23/262) eyes initially treated with RLP (P = 0.065). Re-treatment was not significantly different between the 2 groups for patients with zone I disease (P = 0.978). Re-treatment rate was considerably higher in patients with zone II disease treated with IVB (69/558 [12.3%]) compared with those treated with RLP (20/251 [7.9%]; P = 0.017). In the IVB group, 82.8% and 53.4% of eyes showed an avascular area in zone III (despite ROP regression) at 1 and 2 years after treatment, respectively. The spherical power and the spherical equivalent were significantly higher in eyes treated with RLP (-1.31±2.83 diopters [D] and -2.84±2.77 D, respectively) than eyes treated with IVB (0.19±3.21 D and -1.26±3.19 D, respectively; P = 0.016 and P = 0.007, respectively). Differences in astigmatic power were not significant. CONCLUSIONS: Both IVB and RLP are effective treatments for type 1 ROP. Longer follow-up time is necessary for infants treated with IVB. More patients with zone II disease treated with RLP achieved disease regression after a single treatment than those who received IVB, although outcomes after re-treatment were comparable except for a greater refractive error in patients treated with RLP.

Changes in Anterior Segment Morphology After Laser Peripheral Iridotomy in Acute Primary Angle Closure.

PURPOSE: To evaluate the anterior segment biometric changes measured by anterior segment optical coherence tomography (AS-OCT) in acute primary angle closure (APAC) after laser peripheral iridotomy (LPI). DESIGN: Prospective interventional study. METHODS: In this clinic-based study, 52 eyes of 52 patients with resolved APAC attack who underwent LPI were enrolled. Subjects underwent complete ophthalmic examination and AS-OCT imaging before and 6 weeks after LPI. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness (IT), iris area, iris curvature, lens vault (LV), anterior vault, angle opening distance (AOD500, AOD750), and trabecular iris space area (TISA500, TISA750) were measured in qualified images and compared before and after LPI. A linear mixed-model analysis was performed for potential predictors of change in AOD750. Main outcome measure was change in AOD750 after LPI. RESULTS: The mean age of participants was 60.7 ± 9.2 years. Mean angle width (Shaffer grade) changed from 0.25 ± 0.34 at baseline to 1.22 ± 0.86 after LPI (P < .001). However, 25 nasal angles (48.0%) and 28 temporal angles (53%) had iridotrabecular contact after LPI. All angle parameters (AOD500, AOD750, TISA500, TISA750; P ≤ .03), ACD (P = .001), and ACA (P < .001) increased significantly after LPI. Iris curvature and LV were reduced (P = .01 for both) after LPI, but there was no significant change in IT and iris area. After multivariate analysis, pre-LPI AOD750 was the only factor associated with change in AOD750 (ß = -0.992, P = .02). Exaggerated LV, defined as LV greater than one-third of the anterior vault (sum of LV and ACD), was present in 61.5% of the cases (32 eyes). The extent of change in angle parameters was not significantly different between groups with and without exaggerated LV after LPI. CONCLUSION: This study confirms that LPI results in a significant increase in the angle width, ACD, and ACA as well as flattening of the iris in APAC eyes. The extent of angle deepening is inversely related to baseline angle width. The lens shifts posteriorly after resolution of attack, especially in those with greater lens vault.

Macular Surgery Using Intraoperative Spectral Domain Optical Coherence Tomography.

PURPOSE: To report the use of intraoperative spectral domain optical coherence tomography (SD-OCT) for detecting anatomical changes during macular surgery. METHODS: In a consecutive case series, 32 eyes of 32 patients undergoing concurrent pars plana vitrectomy and intraoperative SD-OCT for macular hole (MH), epiretinal membrane (ERM) and vitreomacular traction (VMT) were enrolled. Intraoperative changes in retinal thickness and dimensions of the macular hole were measured in patients with ERM and VMT following surgical manipulation using a hand-held SD-OCT device (iVue, Optovue Inc., Fremont, CA, USA). RESULTS: SD-OCT images of sixteen eyes with macular hole were subjected to quantitative and qualitative analysis. All MH dimensions remained stable during consecutive stages of surgery except for MH apex diameter, which showed a significant decrease after internal limiting membrane (ILM) peeling (P=0.025). Quantitative analysis of ten patients with ERM showed a significant decrease in retinal thickness after membrane removal (P=0.018) which did not remain significant until the end of the procedure (P=0.8). In three cases, subretinal fluid was formed after ILM peeling. Quantitative analysis of five patients with VMT showed a decrease in retinal thickness during consecutive steps of the surgery, although these changes were not significant. In two cases, subretinal fluid was formed after ILM peeling. CONCLUSION: Intraoperative SD-OCT is a useful imaging technique which provides vitreoretinal surgeons with rapid awareness of changes in macular anatomy during surgery and may therefore result in better anatomical and visual outcomes.

Combined intravitreal melphalan and topotecan for refractory or recurrent vitreous seeding from retinoblastoma.

IMPORTANCE: Demonstrating the usefulness and complications of multiagent intravitreal chemotherapy is necessary for successful treatment in patients with recalcitrant vitreous seeding of retinoblastoma. OBJECTIVE: To determine the efficacy and complications of combined intravitreal chemotherapy (melphalan hydrochloride and topotecan hydrochloride) for viable vitreous seeding from retinoblastoma. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study was conducted in a hospital setting. Trans-pars plana intravitreal injection of melphalan hydrochloride (40 µg in 0.04 mL of diluent) combined with topotecan hydrochloride (8-20 µg in 0.04 mL of balanced salt solution) was performed in 9 eyes, followed by injection site cryotherapy. MAIN OUTCOMES AND MEASURES: Complete regression of vitreous seeds of retinoblastoma. RESULTS: Nine eyes, initially classified as group D (n = 6) or E (n = 3) according to International Classification of Retinoblastoma categorization, received a standard 6 cycles of intravenous chemotherapy and/or intra-arterial chemotherapy and subsequently developed recurrent viable vitreous seeds. Intravitreal administration of melphalan combined with topotecan produced complete control of vitreous seeds in all 9 eyes following a mean of 1.9 injections (median, 2; range, 1-3 injections). In 3 cases (33%), tumor control was achieved with a single injection, whereas in 6 (67%) cases, 2 or 3 injections were necessary. Three patients (33%) subsequently underwent enucleation because of recurrent tumor and persistent anterior chamber lesions. During a mean 15.2 months of follow-up (median, 16; range, 7-25 months), there was no recurrence of new tumor or vitreous seeds in the remaining 6 eyes. Complications included temporary hypotonia of 2 weeks or less (2 [22%]), temporary epithelial defect (1 [11%]), and vitreous hemorrhage (1 [11%]). There was no case of episcleral or orbital retinoblastoma extension or remote retinoblastoma metastasis. There was no change in the a and b waves of bright-flash electroretinograms. CONCLUSIONS AND RELEVANCE: Administration of combined intravitreal melphalan and topotecan in eyes not subsequently enucleated appears to be safe and effective for resistant or recurrent vitreous seeds from retinoblastoma. In 3 of the cases (33%), tumor control was achieved with a single injection.