Serological Evidence for Henipa-like and Filo-like Viruses in Trinidad Bats.

Bat-borne zoonotic pathogens belonging to the family Paramxyoviridae, including Nipah and Hendra viruses, and the family Filoviridae, including Ebola and Marburg viruses, can cause severe disease and high mortality rates on spillover into human populations. Surveillance efforts for henipaviruses and filoviruses have been largely restricted to the Old World; however, recent studies suggest a potentially broader distribution for henipaviruses and filoviruses than previously recognized. In the current study, we screened for henipaviruses and filoviruses in New World bats collected across 4 locations in Trinidad near the coast of Venezuela. Bat tissue samples were screened using previously established reverse-transcription polymerase chain reaction assays. Serum were screened using a multiplex immunoassay to detect antibodies reactive with the envelope glycoprotein of viruses in the genus Henipavirus and the family Filoviridae. Serum samples were also screened by means of enzyme-linked immunosorbent assay for antibodies reactive with Nipah G and F glycoproteins. Of 84 serum samples, 28 were reactive with ≥1 henipavirus glycoprotein by ≥1 serological method, and 6 serum samples were reactive against ≥1 filovirus glycoproteins. These data provide evidence of potential circulation of viruses related to the henipaviruses and filoviruses in New World bats.

THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON IDIOPATHIC EPIRETINAL MEMBRANE SURGERY, WITH A REVIEW OF THE LITERATURE.

PURPOSE: To examine the effect of internal limiting membrane (ILM) removal on epiretinal membrane (ERM) surgery by comparing best-corrected visual acuity (BCVA), optical coherence tomography central macular thickness (CMT) changes, ERM recurrence, and need for repeat surgery. METHODS: Retrospective study of 251 consecutive patients (251 eyes) who underwent pars plana vitrectomy for idiopathic ERM by a single surgeon with over 1 year of follow-up data. Data were collected preoperatively and postoperatively at 3 months, 1 year, 2 years, and at the last visit. The ILM was not specifically removed in the earlier group of patients and was removed after staining of the ILM in the later group. RESULTS: One hundred and forty eyes (55.8%) did not have an ILM peel (non-ILM group), and 111 eyes (44.2%) did have an ILM peel (ILM group). There were no significant differences between groups in age, gender, preoperative BCVA, preoperative intraocular pressure, preoperative CMT on optical coherence tomography, and cataract status. Total follow-up time for the ILM group was 32.1 months and 45.4 months for the non-ILM group (P = 0.002). Both groups had improvement in BCVA. The ILM group improved by 12 Early Treatment Diabetic Retinopathy Study letters and the non-ILM group improved by 10.5 Early Treatment Diabetic Retinopathy Study letters. There was no significant difference in the final BCVA (P = 0.18) or total change of BCVA (P = 0.48). Cataract status preoperatively did not affect the total change of BCVA, but being phakic at the most recent visit was associated with a slight loss of visual acuity. Both groups had improvement in optical coherence tomography appearance, for the CMT in the ILM group decreased by 83 µm and the CMT in the non-ILM group decreased by 110 µm. There was no significant difference in the final CMT (P = 0.07); however, the non-ILM group tended to have a lower final CMT. Some degree of ERM recurrence was detected by slit-lamp biomicroscopy in 2 eyes (1.8%) of the ILM group and in 32 eyes (22.9%) of the non-ILM group (P ≤ 0.0001). None of the eyes with ILM removal required repeat vitrectomy, whereas 17 eyes (12.1%) of the non-ILM group did require vitrectomy, showing that ILM removal had a significant effect on the need for repeat vitrectomy (P < 0.0001) between non-ILM versus ILM peel groups. CONCLUSION: The rate of recurrent ERM and need for repeat ERM surgery is lower in eyes where the ILM is removed with the ERM, whereas BCVA and CMT were similar with or without ILM removal. Complete ILM removal around the macula should be considered for the treatment of eyes with idiopathic ERMs to reduce the incidence of ERM recurrences.

LONG-TERM FOLLOW-UP OF INTRAOCULAR PRESSURE AFTER VITRECTOMY IN EYES WITHOUT PREEXISTING GLAUCOMA.

PURPOSE: To identify whether vitrectomy is associated with an increased risk of elevated intraocular pressure (IOP) and to report the incidence of open-angle glaucoma after vitrectomy. METHODS: In this retrospective case series of 234 consecutive patients without a history of glaucoma or diabetes undergoing primary unilateral vitrectomy for an idiopathic epiretinal membrane or macular hole with a minimum of 2 years follow-up, mean IOP in operative and fellow eyes were compared at baseline and multiple postoperative times. Eyes were also assessed for the development of open-angle glaucoma. RESULTS: The mean baseline IOP was 14.91 mmHg, and the mean final IOP was 14.6 (P = 0.278) in the operative eyes. Linear regression analysis of IOP in operative eyes from baseline to the final visit found an increase of 0.000047 mmHg per year compared with -0.00027 mmHg per year in the fellow eyes with no significant difference in the slope of the 2 regression lines (P = 0.27). Six vitrectomy eyes were diagnosed with new-onset open-angle glaucoma during a mean follow-up of 4.4 years; however, only one was not also diagnosed with glaucoma or ocular hypertension in the fellow unoperated eye. CONCLUSION: Vitrectomy does not seem to be correlated with increased risk of IOP elevation or glaucoma development in comparison with fellow control eyes.

Outcomes of Pars Plana Vitrectomy With Membrane Peel for Lamellar Macular Holes and Related Conditions Using a New Optical Coherence Tomography Consensus Definition.

Purpose: To characterize the change in visual acuity (VA) in eyes treated with vitrectomy using the 2020 international consensus-based optical coherence tomography (OCT) definition of lamellar macular hole (LMH), macular pseudohole (MPH), and epiretinal membrane with foveoschisis (ERMF). Methods: A retrospective chart review was performed from 2000 to 2022 of patients who had vitrectomy for symptomatic decreased VA from LMH, MPH, or ERMF performed by the same surgeon at a community hospital. Preoperative spectral domain (SD-OCT) was reviewed to classify patients using the consensus guidelines. Primary outcomes were the mean change in best-corrected VA at 3 months, 1 year, and the final postoperative examination. Results: Fifty-one patients were included, 30 with LMH, 14 with MPH, and 7 with ERMF. The VA was 20/63 at baseline, 20/62 (P = .79) 3 months postoperatively, 20/40 (P = .003) at 1 year, and 20/52 (P = .10) at the final examination for LMH; 20/64, 20/50 (P = .16), 20/40 (P = .040), and 20/40 (P = .02), respectively, for MPH; and 20/53, 20/50 (P = .42), 20/30 (P = .03), and 20/38 (P = .04), respectively, for ERMF. Subgroup analysis showed that eyes with LMH without ellipsoid zone (EZ) disruption on SD-OCT improved from 20/57 at baseline to 20/39 (P = .01) at the final examination. Conclusions: There was no significant improvement in VA at the final postvitrectomy examination in eyes with LMH, while there was significant improvement in eyes with MPH and ERMF. This supports surgery in selected eyes with MPH and ERMF but possibly not in eyes with LMH, unless OCT shows no EZ disruption.

Prospective Study of Silicone Oil Microdroplets in Eyes Receiving Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in 3 Different Syringes.

PURPOSE: To compare the prevalence of intravitreal silicone oil microdroplets detected by slit-lamp biomicroscopy in eyes with 6 or more injections of the same anti-vascular endothelial growth factor (VEGF) drug. DESIGN: Prospective, cross-sectional case series. PARTICIPANTS: A total of 260 consecutive eyes receiving 1 of 3 intravitreal anti-VEGF drugs for choroidal neovascularization, diabetic macular edema, or venous occlusive disease. The control group included 147 fellow eyes with no prior intravitreal injections. METHODS: The anterior and mid-vitreous were carefully examined using 12× to 16× magnification through dilated pupils with ocular saccades before an injection. Silicone oil microdroplets were graded on a scale from 0 to 4+ based on the number and size of droplets. MAIN OUTCOME MEASURES: Presence and severity of silicone oil microdroplets in the vitreous. RESULTS: Silicone oil microdroplets were observed in 78.3% of eyes receiving bevacizumab in Becton Dickinson (BD, Franklin Lakes, NJ) 0.3-mL polypropylene syringes, 14.4% of eyes receiving ranibizumab in 1.0-mL BD polypropylene syringes or more recently glass prefilled syringes, 48.5% of eyes receiving aflibercept in 1.0-mL BD polycarbonate syringes, and 0% of eyes in controls. The differences among the 4 groups were statistically significant at P < 0.001. The severity of silicone oil microdroplets was significantly greater in eyes using BD 0.3-mL polypropylene syringes than BD 1.0-mL polypropylene syringes, BD 1.0-mL polycarbonate syringes, or controls (P < 0.001). The severity of silicone oil microdroplets in eyes using BD 1.0-mL polycarbonate syringes was significantly greater than BD 1.0-mL polypropylene syringes (P = 0.012) and controls (P < 0.001). There was no significant difference between silicone oil microdroplet severity between BD 1.0-mL polypropylene syringes and controls (P = 1.0). CONCLUSIONS: The BD 0.3-mL polypropylene syringes with repackaged bevacizumab and the BD 1.0-mL polycarbonate syringes with aflibercept cause a higher likelihood of silicone oil microdroplets. Intravitreal injections in eyes receiving multiple regular anti-VEGF injections should be supplied in silicone-free syringes.

Cytomegalovirus Retinitis in a Patient Taking Tocilizumab: A Case Report.

Purpose: This report discusses a case of cytomegalovirus (CMV) retinitis in a patient taking tocilizumab for maintenance and remission of giant cell arteritis (GCA). Methods: A case report is presented. Results: A 78-year-old African American woman with no significant past medical history and an ocular history of primary open-angle glaucoma presented to the retina clinic with vitritis in the right eye. Four months earlier, she had been diagnosed with biopsy-proven GCA and prescribed 30 mg of prednisone daily and 162 mg tocilizumab subcutaneously weekly. Diagnostic vitrectomy with polymerase chain reaction of the vitreous was positive for CMV. Her retinitis gradually resolved after 3 months of treatment with valganciclovir, with no recurrence 4 months after discontinuing the valganciclovir. Conclusions: Physicians should be aware of the potential to develop CMV retinitis in the setting of tocilizumab use for GCA treatment.

Office Examinations-Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy.

Purpose: In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD). Methods: An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed. Treatment parameters were estimated using US population statistics, published literature, and Centers for Medicare & Medicaid Services, provider utilization data. Costs and benefits were compared for the 4 treatment scenarios. Results: Although yearly examinations and optical coherence tomography costs were higher for injection series, T&E, and as-needed protocols compared with automatic treatment, our model predicts reduced yearly injection and travel costs for those same treatment scenarios also, saving $2.9 billion (injection series), $7.2 billion (T&E), and $6.1 billion (as-needed) annually for the US population. Same-day injections accounted for 21%, 8%, and 9% of the savings, respectively, because of reduced travel burden. Furthermore, early detection of wAMD in the fellow eye during office examinations allows for a 1.8, 2.1, and 2.5 quality-adjusted life-year benefit, respectively. Conclusions: Office examinations-directed antivascular endothelial growth factor therapy for wAMD reduces travel and treatment expenses and improves screening of the fellow eye, resulting in robust cost savings and quality-adjusted life-year benefit for the US population.

Optical coherence tomography-based consensus definition for lamellar macular hole.

BACKGROUND: A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed. METHODS: The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions. RESULTS: The panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness. CONCLUSIONS: The use of the proposed definitions may provide uniform language for clinicians and future research.

Should Indocyanine green should be used to facilitate removal of the internal limiting membrane in macular hole surgery.

Indocyanine green (ICG) is one of several vital dyes that are used in vitreoretinal surgery to aid visualization of diaphanous collagenous tissues in what has been called chromovitrectomy. As shown herein, much has been written about the use and rather narrow safety profile of ICG. The discussion surrounding its applications would have ended long ago were it not for the occasional patient who keeps returning to the office with permanent central scotomas after ICG-assisted macular hole surgery. The purpose of this Viewpoint is to reemphasize potential methods of proper use and clarify safety issues of this particular vital dye that enhances surgical technique but not necessarily visual outcome.

Patterns of referral of retinal patients for low vision intervention in the anti-VEGF era.

PURPOSE: The goal of this study was to see how the availability of ranibizumab affected the referral patterns for low vision (LV) evaluation. METHODS: This study used a retrospective review and a comparison of all patients newly referred from retinal Practice 1 (J.T.T., R.N.S.) for LV consultation, from July 2005 to June 2006 (Year 1, preranibizumab) and from July 2006 to June 2007 (Year 2, ranibizumab available), and a retrospective review of patients referred by retinal Practice 2 (M.J.E.) since February 2007. RESULTS: Practice 1: In Year 1, 24 patients with choroidal neovascularization were referred for LV, and in Year 2, only 12 were referred. There was a trend for those patients referred in Year 2 to have worse visual acuity and Pelli-Robson contrast sensitivity than those in Year 1. In Years 1 and 2, 18 and 11 patients with other conditions were referred for LV consultation, respectively. For these patients without choroidal neovascularization, there was no significant difference between groups for visual acuity or contrast sensitivity. Practice 2: The mean best-corrected visual acuity of patients with bilateral choroidal neovascularization referred was 20/145, and no patient had visual acuity > or =20/100. CONCLUSION: Although the use of antivascular endothelial growth factor agents puts visual acuity in a zone more favorable for successful LV intervention, patients with better acuities may not be referred for LV evaluation despite their residual visual impairments and their scotomas, and despite the fact that without LV intervention, they are having difficulty with reading and other activities of daily living. The frequent visits required for monthly injection, the tendency to wait until a course of therapy is complete before referring patients, and a lesser appreciation for the need for LV intervention in patients with only moderate visual loss may be factors in explaining this.