Stripping of the Posterior Hyaloid for the Treatment of Vitreomacular Traction.

PURPOSE: To describe and evaluate the effectiveness of stripping the posterior hyaloid as vitreomacular traction treatment. METHODS: This prospective, consecutive, interventional study examined 10 eyes of 10 patients who underwent vitrectomy for vitreomacular traction. RESULTS: The best-corrected visual acuity improved from 20/63 (0.5 ± 0.18 logMAR) preoperatively to 20/36 (0.25 ± 0.15 logMAR) 3 months after the surgeries. Optical coherence tomography analysis showed a reduction of the mean foveal thickness from 462 ± 82 µ to 372 ± 28 µ at 3-month follow-up in all the eyes. No postoperative complications were reported. CONCLUSION: Stripping of the posterior hyaloid for the treatment of vitreomacular traction could improve the symptoms and visual acuity of patients, alleviating the traction on the macula and avoiding secondary retinal damage as macular hole formation.

Kaminari Kagura: the "lightning bolt shape" technique for posterior vitreous detachment induction.

PURPOSE: To describe and evaluate the effectiveness of the Kaminari Kagura technique as a posterior hyaloid detachment treatment. STUDY DESIGN: This was a prospective, consecutive, randomized interventional study. METHODS: This study examined 30 eyes from 30 patients divided into two groups: (1) a Kaminari Kagura group (15 eyes) and (2) a control group (15 eyes) scheduled for vitrectomy with an optical coherence tomography (OCT)-based diagnosis of adherent posterior hyaloid. RESULTS: The mean time for posterior vitreous detachment (PVD) induction in the Kaminari Kagura group was 58 ± 6.6 s, and that in the control group was 69 ± 9 s (p < 0.005). No intra- or post-operative complications were reported. CONCLUSIONS: The Kaminari Kagura technique results in effective posterior hyaloid detachment in less time than that required for posterior vitreous cortex engagement.

Chandelier-Assisted Scleral Buckling: A Literature Review.

The treatment of retinal detachment (RD) has seen numerous advancements in the last decades. Scleral buckling (SB) is a surgical procedure introduced in the 1950s that has seen a drastic reduction with the advent of vitrectomy. However, due to the new surgical visualization systems, SB has evolved and continues to be an extremely useful procedure in certain conditions. The presence of different case reports or interventional studies with comparable outcomes, as well as the lack of recent studies with direct comparison, may result in an underestimation of its potential nowadays. The aim of this review is to provide a comprehensive update on chandelier-assisted scleral bucking (CSB), with an overview of the surgical evolution, outcomes, advantages, and complications.

Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study.

OBJECTIVE: To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy. METHODS: Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months. RESULTS: Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p = 0.02). CONCLUSIONS: Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review.

Globe perforation following peribulbar anesthetic injection is a rare but dreaded complication that often results in poor visual outcomes. This case report is on a female patient who sustained vitreous hemorrhage, retinal detachment, and macular breaks due to a peribulbar block administered in the setting of cataract extraction. The retina was repaired with pars plana vitrectomy, endolaser of the peripheral retinal break only, and an internal limiting membrane inverted flap for the macular breaks to avoid the endolaser on the macular area, achieving stable visual outcomes. The authors discussed various modes of local anesthesia for vitreoretinal surgery, risks for globe perforations, and how to approach retinal detachment secondary to needle perforations, which are complex cases at high risk for proliferative vitreoretinopathy. Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer axial length, superior, and multiple perforations are at higher risk of developing complications such as retinal detachment and vitreous hemorrhage. Complications such as retinal detachment, macular injury, and vascular occlusion are risk factors for poor prognosis.

Two-Port "Dry Vitrectomy" as a New Surgical Technique for Rhegmatogenous Retinal Detachment: Focus on Macula-on Results.

We evaluated a new surgical technique for treating primary rhegmatogenous retinal detachment (RRD), consisting of localized vitrectomy near the retinal break associated with drainage of subretinal fluid without infusion. Twelve eyes of twelve patients with primary RRDs with macula-on superior, temporal, and/or nasal quadrants' RRD with retinal breaks between 8 and 4 o'clock, pseudophakic or phakic eyes, were enrolled. All eyes underwent a two-port 25-gauge vitrectomy with localized removal of the vitreous surrounding the retinal break(s), followed by a 20% SF6 injection and cryopexy. The difference between pre-operative (T0) and post-operative mean BCVA at 6 months follow-up (T6) was not statistically significant (0.16 logMAR vs. 0.21 logMAR; p = 0.055). Primary anatomic success at 6 months was achieved by 86% of patients. No other complications, except for two retinal re-detachments linked to an incorrect head position of the patients, were recorded. Although further studies are necessary to evaluate the treatment's efficacy, we believe our technique could be considered a valid alternative for managing primary RRD.

Dynamics of Epiretinal Membrane Peeling under Perfluorocarbon Liquid Evaluated by Intraoperative OCT.

BACKGROUND: The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS). METHODS: This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6. RESULTS: The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups (p < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, p = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups (p < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups (p = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group. CONCLUSION: We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness.

Applications of Human Amniotic Membrane Patching Assisted Vitrectomy in the Management of Postoperative PVR in Complex Retinal Detachments.

Human amniotic membranes (hAMs) are extraembryonic tissues currently employed in the treatment of many ocular and systemic diseases. Several reports indicate that hAMs can suppress the signaling pathway of tissue growth factor beta (TGF-ß), a cytokine that plays a major role in the pathogenesis of proliferative vitreoretinopathy (PVR) through the induction of epithelial-mesenchymal transition (EMT) in exposed retinal pigmented epithelium (RPE) cells. The present study was conducted to evaluate the efficacy of a modified vitrectomy procedure (hAMP-V) involving the extensive coverage of exposed RPE with hAM patches to prevent postoperative PVR in a series of 15 cases of retinal detachment complicated by severe preoperatory PVR. The primary outcome was to assess the rate of successful retinal reattachment of a single hAMP-V procedure at 6 months from silicone oil removal. Secondary outcomes included the collection of intraoperative data concerning the quantity, size, and scope of hAM patches, and the assessment of postoperative improvements in mean LogMar BCVA at 3 and 6 months. Successful retinal reattachment was obtained in 14 out of 15 eyes (93.3%). Surgical failure due to major recurrence of PVR occurred in 1 out of 15 eyes (6.7%). Postoperative improvements in mean LogMar BCVA were statistically significant (p < 0.05, paired t-test). No intraoperative and postoperative adverse effects were reported. The study helped to refine the surgical technique while also offering cues for future improvements.

NEW ARTIFICIAL INTELLIGENCE ANALYSIS FOR PREDICTION OF LONG-TERM VISUAL IMPROVEMENT AFTER EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To predict improvement of best-corrected visual acuity (BCVA) 1 year after pars plana vitrectomy for epiretinal membrane (ERM) using artificial intelligence methods on optical coherence tomography B-scan images. METHODS: Four hundred and eleven (411) patients with Stage II ERM were divided in a group improvement (IM) (≥15 ETDRS letters of VA recovery) and a group no improvement (N-IM) (<15 letters) according to 1-year VA improvement after 25-G pars plana vitrectomy with internal limiting membrane peeling. Primary outcome was the creation of a deep learning classifier (DLC) based on optical coherence tomography B-scan images for prediction. Secondary outcome was assessment of the influence of various clinical and imaging predictors on BCVA improvement. Inception-ResNet-V2 was trained using standard augmentation techniques. Testing was performed on an external data set. For secondary outcome, B-scan acquisitions were analyzed by graders both before and after fibrillary change processing enhancement. RESULTS: The overall performance of the DLC showed a sensitivity of 87.3% and a specificity of 86.2%. Regression analysis showed a difference in preoperative images prevalence of ectopic inner foveal layer, foveal detachment, ellipsoid zone interruption, cotton wool sign, unprocessed fibrillary changes (odds ratio = 2.75 [confidence interval: 2.49-2.96]), and processed fibrillary changes (odds ratio = 5.42 [confidence interval: 4.81-6.08]), whereas preoperative BCVA and central macular thickness did not differ between groups. CONCLUSION: The DLC showed high performances in predicting 1-year visual outcome in ERM surgery patients. Fibrillary changes should also be considered as relevant predictors.

Modified Carlevale Intraocular Lens Fixation Technique: Two Vitrectomy Ports As Lens Plug Fixation Sites.

PURPOSE: To describe and evaluate the effectiveness of the modified Carlevale intraocular lens (IOL) fixation technique, using two vitrectomy ports as lens plug fixation sites. MATERIALS AND METHODS: This prospective, consecutive, interventional study examined 60 eyes in 60 patients, who underwent 25- or 23-gauge vitrectomy for an IOL subluxation/luxation, lens dislocation, or aphakia, with Carlevale IOL implantation. RESULTS: Postoperatively, transient ocular hypotension was observed in four eyes. The mean refractive prediction error was -0.27 ± 0.78 diopters. No postoperative complications, such as retinal detachment, endophthalmitis, or IOL dislocation, were observed in the 4-month follow-up. CONCLUSION: This new technique may be simple, fast, and effective because of fewer scleral wounds and fewer postoperative complications.

Subretinal Transplant of Human Amniotic Membrane in Advanced Age-Related Macular Degeneration.

Macular neovascularization (MNV) and geographic atrophy can complicate age-related macular degeneration (AMD) and lead to severe visual acuity reduction. Despite the medical treatments available, with a defect in the retinal pigmented epithelium (RPE) there is no possibility of restoring acceptable visual acuity. We evaluated postoperative outcomes in patients affected by advanced AMD who underwent subretinal implant of the human amniotic membrane (hAM) as a source of pluripotent stem cells. This retrospective, consecutive, non-randomized interventional study included 23 eyes of 21 patients affected by AMD complicated by MNV, and five eyes of five patients affected by geographic atrophy. All eyes underwent a pars plana vitrectomy, neovascular membrane removal for the MNV group, a subretinal implant of hAM, and gas tamponade, and were followed for 12 months. The primary study outcome was visual acuity improvement. Secondary outcomes were postoperative complications, OCT-angiography parameters correlated with best-corrected visual acuity (BCVA) and MNV recurrence. The mean preoperative BCVA was 1.9 logMAR, and the mean final BCVA value was 1.2 logMAR. In the MNV group, the mean BCVA improved from 1.84 logMAR to 1.26 logMAR, and from 1.84 logMAR to 1.32 logMAR in the geographic atrophy group. No MNV recurrence was evident in 12 months of follow-up. An OCT-angiography scan was used to evaluate the retinal vascularization in the treated eye, which showed a high correlation between BCVA and deep vascular density. This study demonstrates the hAM potential and safety in promoting a partial restoration of retinal function together with an increase in visual acuity.

Treatment of recurrent high myopic macular hole associated with retinal detachment using a human amniotic membrane.

PURPOSE: To determine the efficacy of using a human amniotic membrane to close macular hole retinal detachment in highly myopic eyes. STUDY DESIGN: Prospective, consecutive, nonrandomized interventional study. METHODS: We included 19 high myopic eyes from 19 patients affected by macular hole retinal detachment who had already undergone vitrectomy with internal limiting membrane peeling. The patients underwent vitrectomy with amniotic membrane transplant. RESULTS: Primary success was achieved after 3 months in 89.5% (17 of 19 eyes) and final macular hole closure was obtained in 94.7% (18 of 19 eyes) of the patients. The final retinal reattachment rate was 100%. The final 12-month mean BCVA improved from 20/2000 (2 logMAR) to 20/250 (1.1 logMAR). OCT-angiography revealed a high correlation between the superficial and deep capillary plexus and the final BCVA. CONCLUSION: Human amniotic membrane patches can effectively repair macular hole retinal detachment in high myopic eyes in terms of anatomic results and BCVA recovery.

Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results.

PURPOSE: To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy. DESIGN: A prospective, consecutive, interventional study. METHODS: Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications. RESULTS: Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time. CONCLUSION: An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.

Subretinal Pigment Epithelium Illumination Combined With Focal Electroretinogram and Visual Acuity for Early Diagnosis and Prognosis of Non-Exudative Age-Related Macular Degeneration: New Insights for Personalized Medicine.

PURPOSE: To evaluate the correlation between functional visual acuity and focal electroretinograms (fERGs) and morphological abnormalities in the retinal pigment epithelium and outer retinal atrophy (RORA) assessed by subretinal illumination (SRI) parameter at optical coherence tomography (OCT) examinations as signs of early disease in early and intermediate non-exudative age-related macular degeneration (ne-AMD). METHODS: One hundred forty-one eyes of 74 patients were retrospectively evaluated. A subgroup of patients (34/74) had a follow-up of at least 1 year. The study included both cross-sectional and longitudinal analyses. All eyes were assessed by OCT to measure the macular outer nuclear layer thickness, extent of ellipsoid zone interruption, absence or presence of drusen/reticular pseudodrusen in the foveal and perifoveal fields, and the SRI area closest to the fovea. Additionally, fERGs were performed. RESULTS: In the cross-sectional analysis, visual acuity and fERG amplitude were correlated (P < 0.01) with the SRI area. The fERG amplitude was correlated (P < 0.01) with the extent of ellipsoid zone interruption and tended to be lower in reticular pseudodrusen compared with drusen. In the longitudinal analysis, fERG amplitudes and outer retinal thickness tended to decrease on average by 15% and 18%, respectively, after 1 year of follow-up. The baseline RORA area, but not fERG amplitude or visual acuity, significantly predicted with 77% accuracy (P < 0.01) morphological deterioration, which was determined by an increase in the RORA area after 1 year. CONCLUSIONS: Functional visual acuity and its morphological correlations can be assessed in early and intermediate ne-AMD eyes. SRI, as a result of RORA, is a potential predictor of ne-AMD progression in a short-term follow-up. TRANSLATIONAL RELEVANCE: SRI assessment, an objective method to measure RORA, is a potential biomarker for non-exudative AMD progression.