Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes.

BACKGROUND: Cardiovascular (CV) disease due to atherosclerosis is a major cause of morbidity and mortality in adult patients with diabetes, either type 1 or type 2 diabetes. The aim of the study was to assess the association of the frequency and the burden of subclinical carotid atherosclerotic disease in patients with type 1 diabetes according to the presence and severity of diabetic retinopathy (DR). METHODS: A cross-sectional study was conducted in 340 patients with type 1 diabetes (41.5% with DR), and in 304 non-diabetic individuals. All participants were free from previous CV disease and chronic kidney disease (CKD). B-mode carotid ultrasound imaging was performed in all the study subjects. Patients with type 1 diabetes underwent a full eye examination, and DR patients were divided into two groups: mild disease and advanced disease. RESULTS: In the group of patients with type 1 diabetes, the percentage of patients with carotid plaques was higher in those with DR compared with those without DR (44.7% vs. 24.1%, p < 0.001). Patients with DR also presented a higher incidence of ≥ 2 carotid plaques (25.5% vs. 11.1%, p < 0.001). Apart from other traditional cardiovascular risk factors, the presence of advanced stages of DR was independently associated with the presence (p = 0.044) and the burden (≥ 2 carotid plaques; p = 0.009) of subclinical carotid atherosclerosis. CONCLUSIONS: In patients with type 1 diabetes without previous CV disease or established CKD, the presence of advanced stages of DR is associated with a higher atherosclerotic burden in the carotid arteries. The presence of DR identifies patients at risk for carotid atherosclerotic disease.

Deep sclerectomy with supraciliary hema implant (Esnoper® V-2000): results and complications.

The aim was to report the results of deep sclerectomy (DS) with supraciliary hema implant and the influence of the surgical complications on intraocular pressure (IOP). Forty-eight eyes of 41 patients with open angle glaucoma (OAG), who underwent DS with supraciliary hema implant (Esnoper(®) V-2000), were included in this study. A significant IOP reduction was observed, changing from a preoperative mean of 24.6 ± 6.33 mmHg to 16.5 ± 4.4 mmHg (p < 0.001) at 12 months and 16.1 ± 3.4 mmHg (p < 0.001), at 24 months. Similarly, a significant reduction in the number of glaucoma drugs needed was observed, varying from 2.71 to 0.22 (p < 0.001) and 0.4 (p < 0.001), 1 and 2 years after surgery. Goniopuncture with the Nd:Yag Laser was performed in 30 eyes (62.5%) with a mean time between the surgery and the procedure of 150 days, producing a mean IOP reduction of 4.0 mmHg (p < 0.001). The main intraoperative complications were microperforation of the trabeculodescemetic membrane (TDM) in 1 eye (2.08%) The main early postoperative complications were seidel at 24 h in 11 eyes (22.91%), hyphema in 7 eyes (14.58%), choroidal detachment in 3 eyes (6.25%) with macular folds in 2 (4.16%) and need for additional mitomycin injections in 2 eyes (4.16%). All these complications were spontaneously resolved. No correlation between these complications and final IOP was found, but a significant correlation between the presence of hyphema and higher IOP 24 months postoperatively (p = 0.048) was observed. DS with supraciliary hema implant is a safe and effective technique for the management of OAG. The presence of hyphema during the first week after the surgery could be considered as a negative prognostic factor in DS with supraciliary implantation.

Macular hypotrophy after internal limiting membrane removal for diabetic macular edema.

PURPOSE: To compare the anatomic and functional effects of three different approaches to nontractional diabetic macular edema. METHODS: Retrospective comparative study. Sixty eyes of 60 patients diagnosed with cystoid diabetic macular edema and treated with 1.25 mg/mL intravitreal bevacizumab (Group A), laser photocoagulation (Group B), or vitrectomy with inner limiting membrane peeling (Group C) were included in the study. Changes in number of Early Treatment Diabetic Retinopathy Study letters, central macular thickness, largest diameter of the intraretinal cysts (IC), and choroidal thickness were investigated. Analyses were performed during follow-up visits at Months 1, 3, 6, 9, and 12. RESULTS: Visual acuity only significantly improved in Group A at the last follow-up (P = 0.004). Central macular thickness significantly decreased in every group throughout the follow-up period. Differences in central macular thickness between Groups A and B (P < 0.01), A and C (P < 0.01), and B and C (P < 0.01) were significant. Intraretinal cysts also significantly decreased in each group throughout the follow-up period. Differences in IC size between Groups A and B (P = 0.8), A and C (P = 0.1), and B and C (P = 0.1) were not significant. Choroidal thickness did not undergo any significant change in any group throughout the follow-up period. A significant correlation was also found in Group A between best-corrected visual acuity at month 12 and baseline central macular thickness (R = 0.3; P = 0.006), and in Group B between postoperative best-corrected visual acuity at month 12 and baseline IC size (R = 0.8; P < 0.01, negatively correlated at 92.4%). CONCLUSION: According to our retrospective data, diabetic macular edema with intraretinal cysts larger than 390 µm should not be treated with vitrectomy with ILM peeling, because this may induce subfoveal atrophy, defined as the "Floor Effect," and subsequent visual deterioration.

Quantitative Microvascular Change Analysis Using a Semi-Automated Algorithm in Macula-on Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

PURPOSE: The purpose of this study was to objectively evaluate the longitudinal changes observed in the retinal capillaries in eyes with macula-on rhegmatogenous retinal detachment (RRD), assessed with optical coherence tomography angiography (OCTA), and to assess the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. METHODS: This was a prospective, longitudinal study conducted on consecutive patients who underwent 25 G pars plana vitrectomy for primary RRD. The vessel area density (VAD), vessel skeleton density (VSD), and vessel diameter index (VDI) were assessed in the superficial (SCP) and deep (DCP) capillary plexuses. RESULTS: Twenty-three eyes with macula-on RRD were included in the study. The mean preoperative VDI, VAD, and VSD of the RRD eye were 18.6 ± 1.1, 0.43 ± 0.02, and 0.17 ± 0.01 in the SCP; and 18.6 ± 0.6, 0.38 ± 0.03, and 0.15 ± 0.01 in the DCP, respectively. At month 6, eight (34.8%) eyes achieved a best-corrected visual acuity (BCVA) gain ≥ 0.1 LogMAR. A preoperative VDI > 17.80, VSD > 0.170, and VDI-change > -0.395 in the SCP; and VDI > 18.11 and VDI change > -0.039 in the DCP were predictors of achieving a BCVA-gain ≥ 0.1 LogMAR. CONCLUSIONS: The preoperative VDI in SCP and DCP, the preoperative VSD in SCP, and their changes from preoperative values were predictors of visual outcomes. A quantitative OCTA analysis of capillary density and morphology may represent a potential predictive tool for surgical outcomes in RRD. The results reported in this study suggest that OCTA is a useful ancillary test for clinical disease management.

Quantitative Microvascular Change Analysis Using a Semi-Automated Software in Macula-off Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

Objective: To analyze the performance of custom semi-automated software for quantitative analysis of retinal capillaries in eyes with macula-off rhegmatogenous retinal detachment (RRD) and the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. Methods: A prospective, observational, and single-center study was conducted on consecutive patients who underwent 25G pars-plana vitrectomy for primary uncomplicated macula-off RRD. Optical coherence tomography angiography (OCTA) was performed in the fellow and RRD eyes before surgery and in months 1, 3, and 6 after surgery. The preoperative values of the fellow eyes were used as surrogates of macula-off ones. The primary endpoints were the mean vessel diameter index (VDI); vessel area density (VAD); and vessel skeleton density (VSD) at month 6. Results: Forty-four eyes (44 patients) were included in the study. Considering the fellow eyes as a surrogate of preoperative values of macula-off eyes, VDI in superficial (SCP) and deep (DCP) capillary plexuses was significantly reduced at month 6 (p = 0.0087 and p = 0.0402, respectively); whereas VSD in SCP increased significantly from preoperative values (p = 0.0278). OCTA built-in software parameters were significantly reduced from month 1 to month 6 in both SCP and DCP (p values ranged between 0.0235 and <0.0001). At month 6, 25 (56.8%) eyes achieved a best-corrected visual acuity BCVA ≥ 0.3 (LogMAR). The greater the preoperative BCVA, the greater the probability of achieving good visual outcomes (Odds ratio: 11.06; p = 0.0037). However, none of the OCTA parameters were associated with the probability of achieving a BCVA improvement ≥ 0.3. Conclusions: Quantitative evaluation of capillary density and morphology through OCTA and semi-automated software represents a valuable tool for clinical assessment and managing the disease comprehensively.

Correction: Díaz-Aljaro et al. Quantitative Microvascular Change Analysis Using a Semi-Automated Algorithm in Macula-on Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography. Diagnostics 2024, 14, 750.

In the original publication [...].

Fight Retinal Blindness SPAIN. Report 3: clinical outcomes of vascular endothelial growth factor inhibitors in low vision eyes with neovascular age-related macular degeneration. A national database study.

OBJECTIVES: To compare visual outcomes for low vision eyes (LVE) (<35 letters LogMAR or <20/200 Snellen) versus non-low vision eyes (NLVE) (>35 letters LogMAR or >20/200 Snellen) at the time of the first injection in a clinical practice setting. METHODS: Subgroup analysis of a multicenter national database of treatment- naïve eyes neovascular age related macular degeneration (nAMD) treated with anti-VEGF intravitreal injections divided into LVE and NLVE. Demographics, visual acuity (VA) at baseline and subsequent timepoints (12, 24, and 36 months), number of injections and visits data were collected using a validated web-based tool (Fight Retinal Blindness!). RESULTS: 3138 eyes were included, 705 LVE and 2433 NLVE. The LVE group had the greatest VA gain (p < 0.001), at 12, 24, and 36 months (+15, +15, and +13 letters respectively). The proportion of patients with VA loss (-5 letters) differed between groups at 12, 24, and 36 and was significantly greater (p < 0.001) in NLVE. The proportion of patients with VA gain (+5 letters) was significantly higher (p < 0.001) in LVE in all timeframes. The proportions of LVE that still had VA ≤ 35 letters at 12, 24, and 36 months were 54%, 54%, and 57%. Conversely, 8%, 9%, and 8% of LVE achieved VA ≥ 70 letters at 12, 24, and 36 months. LVE received fewer intravitreal injections than NLVE throughout follow-up (6, 9, 12 vs 7, 11, 15). CONCLUSION: Findings of this study support the need for ongoing therapy in patients with initial visual acuity less than 35 letters since sustained visual improvements can be achieved and maintained for the first 3 years of treatment.

Photodynamic therapy for symptomatic subretinal fluid related to choroidal nevus.

PURPOSE: The purpose of this article is to evaluate the role of photodynamic therapy (PDT) for symptomatic choroidal nevus with subretinal fluid (SRF) extending to the fovea. METHODS: Retrospective review of the medical records of all patients who underwent PDT for a symptomatic choroidal nevus with SRF. RESULTS: Seventeen patients were included in the study. The mean initial visual acuity was 20/80 (range, counting fingers to 20/20). The mean initial tumor thickness was 1.23 mm (range, 0.66-1.93 mm). All tumors presented at least 2 risk factors for growing (including orange pigment, symptoms, peripapillary location, SRF, and thickness >2 mm). The mean number of PDT sessions was 1.41 (range, 1-3). The mean final visual acuity improved to 20/60 (range, counting fingers to 20/20). Subretinal fluid was reduced in all eyes (100%) and had completely disappeared in 9 eyes (53%) after PDT. Of 9 cases with complete resolution of the SRF, 2 patients (22%) presented recurrence. The mean final tumor thickness increased to 1.24 mm (range, 0.66-2.01 mm) at a mean follow-up of 22.47 months (range, 6-60 months). Tumor thickness increased in 3 eyes (18%) and remained unchanged in 13 eyes (76%), and 1 lesion (6%) shrank down to a flat chorioretinal scar. CONCLUSION: Photodynamic therapy is a good treatment option to reduce SRF in symptomatic choroidal nevus with serous macular detachment. Further growth into melanoma was observed in 18% of cases. Thus, PDT may not allow a good local tumor control. Longer follow-up is required to determine its value in these patients.

Twenty-three-gauge pars plana vitrectomy, Densiron-68, and 360° endolaser versus combined 20-gauge pars plana vitrectomy, scleral buckle, and SF6 for pseudophakic retinal detachment with inferior retinal breaks.

PURPOSE: To compare the anatomical and functional outcomes of 23-gauge pars plana vitrectomy (PPV) with Densiron-68 tamponade and 360° endolaser versus 20-gauge PPV with encircling scleral buckling (ESB) and an SF6 gas tamponade for the repair of primary pseudophakic retinal detachment with inferior retinal breaks. METHODS: Prospective, randomized, comparative, interventional study. Eighty-two eyes of 82 consecutive patients were randomly assigned to 1 of the 2 treatment groups: 23-gauge PPV/Densiron-68 (44 eyes, 54%) or 20-gauge PPV/ESB/SF6 (20%) (38 eyes, 46%). The inclusion criterion was the presence of primary pseudophakic retinal detachment with at least 1 retinal break between the 4- and 8-o'clock positions. The study protocol involved a minimum of 7 visits: baseline, day of surgery, 1 week, and 1, 3, 6, and 9 months postoperation. Densiron-68 removal was performed within 12 weeks of the initial surgery. Two surgical procedures were required in the Densiron group to remove the oil. RESULTS: After the primary procedure, the retina was reattached in 90% (40 of 44) of cases in the 23-gauge PPV/Densiron group and in 92% (35 of 38) of cases in the 20-gauge PPV/ESB/SF6 group (P = 0.2, Fisher's exact test). After resolution of redetachments, final anatomical success rate rose to 97% (43 of 44) in the 23-gauge PPV/Densiron group and 94% (36 of 38) in the 20-gauge PPV/SB/SF6 group (P = 0.32, Fisher's exact test). Mean final best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.40 in the 23-gauge PPV/Densiron group and 0.48 in the 20-gauge PPV/ESB/SF6 group (P = 0.31, t-test). Operative time was significantly less in the 23-gauge PPV/Densiron group (P = 0.002, t-test). No statistically significant difference in the complication rate between the two groups was recorded. CONCLUSION: Twenty-three-gauge PPV combined with Densiron-68 and 360° endolaser and 20-gauge PPV combined with ESB/SF6 seemed to have similar efficacy in the repair of primary pseudophakic retinal detachment. Supplementary scleral buckling can be avoided using a Densiron-68 tamponade for retinal detachment with inferior retinal breaks.

Clinical characteristics, imaging findings, and genetic results of a patient with CEP290-related cone-rod dystrophy.

PURPOSE: To describe the clinical characteristics, the imaging findings, and the genetic results of a patient with cone-rod dystrophy (CORD) related to mutations in CEP290. METHODS: A case report of atypical CEP290-related CORD. Ophthalmological examination was performed, including best-corrected visual acuity (BCVA), fundus photography, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT), a visual field test, and electroretinography testing. The genetic test was performed by next-generation sequencing (NGS)-based panel test containing 336 genes. RESULTS: A 57-year-old female who had reported a visual loss for 5 years. BCVA was 20/100 in both eyes. The fundus examination revealed a hypopigmented halo around the fovea, showing a paracentral hyperautofluorescent ring on FAF. OCT demonstrated the presence of atrophy in the outer retinal layers. The genetic test identified the probably pathogenic variants c.4028delA and c.5254C>T in compound heterozygosis in CEP290. CONCLUSIONS: This is the first report to present the clinical characteristics, imaging findings, and genetic test results of a patient with CEP290-related CORD. Our case contributes to expanding the clinical involvement of CEP290 pathogenic variants. This study indicates that CEP290-related CORD may have a mild phenotype with late-onset dystrophy, making these patients interesting candidates for innovative treatments such as genetic therapeutic approaches.

Macular sensitivity changes for detection of chloroquine toxicity in asymptomatic patient.

PURPOSE: To describe the efficacy of microperimetry (MP-1) in detecting early retinal toxicity as a result of chronic use of chloroquine and in monitoring the changes in macular sensitivity in an asymptomatic patient with best-corrected visual acuity of 20/20 bilaterally. METHODS: A 60-year-old woman presented for routine ocular examination with a medical history of severe rheumatoid arthritis, for which she had been receiving 3 mg chloroquine (CQ) per kilogram for the past 17 years. The patient was asymptomatic with best-corrected visual acuity of 20/20 bilaterally. RESULTS: Microperimeter showed loss of sensitivity in the macular region with a dense scotoma within the central 12 degrees (2.80 +/- 4.7 dB right eye and 2.84 +/- 4.7 dB left eye). CQ treatment was discontinued and substituted by Plaquenil. CONCLUSIONS: Chloroquine retinal toxicity can be recognized in a subclincal form by the presence of early changes in macular sensitivity, detected by MP-1.

Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications.

Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient's quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.

Assessment of Inner Retinal Layers and Choroidal Thickness in Type 1 Diabetes Mellitus: A Cross-Sectional Study.

Recent studies have shown that retinal neurodegeneration may precede visible vascular changes in diabetic retinopathy (DR). In addition, the relationship of choroidal thickness (CT) with DR stage is not well defined. To assess the inner retinal and choroidal structural changes in type 1 diabetic subjects (T1D), a cross-sectional study was conducted in 242 T1D patients and in 69 age-matched, non-diabetic individuals. The nasal retinal nerve fibre layer (RNFL) thickness was lower in T1D patients without DR (p < 0.001), with mild DR (p < 0.001), and with advanced DR (p < 0.001) compared to control subjects. The ganglion cell layer (GCL) thickness was lower in T1D patients with advanced DR compared to those with mild DR (p = 0.003) and without DR (p < 0.001) and compared to the control subjects (p < 0.001). T1D subjects with no DR and mild DR had higher CT than the control subjects, but the CT in T1D patients with advanced DR was lower (p = 0.038) than that in T1D subjects with mild DR and was not significantly different from that of the control subjects. In conclusion, T1D subjects showed a significant thinning of the nasal RNFL in the early stages of the disease, even before any vascular changes in the retina. A decrease in the GCL thickness during advanced DR stages was observed. Choroidal thickness was higher in T1D subjects without DR and in early DR stages but decreased in advanced stages.

Is it worth reoperating on macular holes?

OBJECTIVE: To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs. DESIGN: Retrospective single-center case series. PARTICIPANTS: Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group). METHODS: All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery. MAIN OUTCOME MEASURES: Anatomic and visual results. RESULTS: All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; +/-standard deviation [SD]) before the second surgery was 0.14+/-0.10 (range, 0.01-0.33) in the reopened group and 0.10+/-0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (+/-SD) in the reopened group was 0.42+/-0.31 (range, 0.05-1) and in the unclosed group was 0.19+/-0.14 (range, HM-0.66). CONCLUSIONS: Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation.

Type 1 Diabetic Subjects with Diabetic Retinopathy Show an Unfavorable Pattern of Fat Intake.

Medical nutrition therapy is an important part of the management of type 1 diabetes mellitus (T1DM). Proper adherence to a healthy diet may have a favorable impact on diabetes management and its diabetic complications. Our aim was to assess differences in food and nutrient intake of type 1 diabetic patients with and without diabetic retinopathy (DR). This was a two-center, cross-sectional study in patients with T1DM, with and without DR. Subjects were recruited from the outpatient clinic of the two participating centers. A validated food frequency questionnaire was administered. A total of 103 T1DM patients with DR and 140 T1DM patient without DR were recruited. Subjects with DR showed a lower intake of total fat (p = 0.036) than that of their non-DR counterparts. DR was associated with increasing age (p = 0.004), hypertension (p < 0.001), and diabetes duration (p < 0.001), however there was a negative association with high educational level (p = 0.018). The multivariate-adjusted analysis showed that the intake of complex carbohydrates was positively related to the presence of DR (p = 0.031). In contrast, the intakes of total fat (p = 0.009), monounsaturated fatty acids (MUFAs) (p = 0.012), oleic acid (p = 0.012), and vitamin E (p = 0.006) were associated with the absence of DR. As conclusions, the intake of total MUFAs, oleic acid, and vitamin E is associated with a lower frequency of DR in patients with T1DM. These results suggest a potential protective effect of these lipid components for DR.

Two-year Results After Deep Sclerectomy With Nonabsorbable Uveoscleral Implant (Esnoper-Clip): Surgical Area Analysis Using Anterior Segment Optical Coherence Tomography.

PURPOSE: To report 2-year results of deep sclerectomy (DS) with mitomycin C and the uveoscleral implant Esnoper-Clip (AJL Ophthalmics, Álava, Spain), a nonabsorbable hema implant, and the morphologic analysis of the surgical area with anterior segment optical coherence tomography (AS-OCT). MATERIALS AND METHODS: In total, 41 eyes of 41 patients with medically uncontrolled open angle glaucoma who underwent DS with the uveoscleral implant were included in this prospective interventional study. Patients were recruited and selected sequentially. All patients were followed at least for 12 months and 36 of them for 24 months. Absolute success was defined as intraocular pressure (IOP)≤18 mm Hg and ≥20% of IOP reduction without topical medication. Relative success was defined with the same criteria but with the addition of any antihypertensive medication. Primary outcomes were IOP decrease in the postoperative stage. Secondary outcomes were number of medication, best-corrected visual acuity changes, rate of goniopuncture, needle revision, and AS-OCT analysis of the bleb area. AS-OCT analysis, using Visante OCT, was performed at 1, 12, and 24 months. RESULTS: Absolute success rate was 68.3% at 12 months and 61.1% at 2 years. Relative success was 78.0% and 71.4%, at 12 and 24 months, respectively. A significant IOP decrease was observed, from 27.3±6.3 to 14.9±4.4 mm Hg at 12 months and 15.3±5.2 mm Hg at 24 months (P<0.001). There was also a significant reduction in the number of medications, dropping from a mean of 2.5 to 0.28 one year and 0.36 two years after the surgery (P<0.001). Main postoperative complications were transient: 4 eyes with seidel phenomenon at 24 hours (10.3%), 3 hyphema (7.7%), and 1 choroidal detachment (2.6%). Mean intrascleral space height, measured by AS-OCT, was 0.78 mm and it showed a significant positive correlation with IOP at 12 months. Neodymium-doped yttrium aluminium garnet laser goniopuncture was performed in 25 eyes (61%) at 12 months and in 27 (66.8%) by 24 months. CONCLUSIONS: DS with the uveoscleral implant is a safe and effective procedure to lower IOP in open angle glaucoma patients. IOP reduction is maintained over 2 years and is correlated to the postoperative height of the intrascleral bleb. Supraciliary implantation reduces intrascleral lake dependency, being a simultaneous drainage alternative to the subconjunctival pathway.

Can the sequential use of conventional silicone oil and heavy oil be a strategy for the management of proliferative vitreoretinopathy?

INTRODUCTION: Densiron is a novel long-term tamponade. Its specific gravity is 1.06 g/mL and as such it is heavier than water and provides support for the inferior retina. As proliferative vitreoretinopathy (PVR) has a propensity for the inferior retina, we used Densiron on a consecutive series of 97 cases with inferior pathology. We hypothesised that the sequential use of conventional and heavy silicone oil is a strategy for the management of PVR. MATERIALS AND METHODS: A consecutive interventional case series involving the use of Densiron for PVR cases was studied. Patients were selected if conventional silicone oil and Densiron were used sequentially. Anatomical success was defined as total re-attachment in the absence of any tamponade agent for at least 3 months post oil removal. RESULTS: Of the 97 patients, 10 patients fulfilled the criteria. Surgery involving Densiron was successful in re-attaching the retina in 7 of 10 cases, with one sequence of alternating light then heavy oil operation, and with one further surgery using silicone oil in the remaining 3 cases. The mean LogMAR preoperative vision was 1.57 and the postoperative vision was 0.82. In 8 of 10 patients, the final vision was 20/200 or better; in 5 of 10 patients, 20/80 or better. The mean follow-up was 19.5 months (range, 9 to 45). CONCLUSIONS: The sequential use of conventional silicone oil and Densiron may be a strategy in reducing the number of re-operations. Our case series shows that despite multiple surgical procedures, favourable visual outcome can be achieved.