PEELING OF THE INTERNAL LIMITING MEMBRANE WITH FOVEAL SPARING FOR TREATMENT OF DEGENERATIVE LAMELLAR MACULAR HOLE.

PURPOSE: To compare the functional and anatomical results of fovea-sparing internal limiting membrane peeling during vitrectomy with those of observation for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation. DESIGN: A prospective, randomized, comparative pilot study. METHODS: Thirty-six eyes were randomized to undergo surgery with foveal internal limiting membrane sparing (Group S) or observation only (Group C). The main outcome measures were foveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: After 6 months, a significant difference was found in foveal retinal sensitivity between Group S (12.8 ± 1.7 dB) and Group C (9.39 ± 1.8 dB; P < 0.001). Similarly, best-corrected visual acuity improved in Group S and remained stable in Group C (respectively, 0.17 ± 0.13 and 0.46 ± 0.21 logMAR; P < 0.001). A significant increase in central retinal thickness was observed in Group S, but not in Group C (272 ± 24 vs. 147 ± 20 µm, P < 0.001). CONCLUSION: Fovea-sparing internal limiting membrane peeling is a feasible treatment for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation, yielding better improvements in best-corrected visual acuity and foveal retinal sensitivity than observation alone. Further studies are needed to optimize this new surgical approach.

Combination of ranibizumab and indomethacin for neovascular age-related macular degeneration: randomized controlled trial.

PURPOSE: The aim of this study was to evaluate whether indomethacin eye drops and intravitreal ranibizumab (IVR) injections would provide additional benefit over ranibizumab alone in the treatment of choroidal neovascularization (CNV). PARTICIPANTS AND METHODS: This was a randomized, prospective pilot study of eyes with new-onset CNV. Fifty-eight patients were randomized 1:1 into a ranibizumab monotherapy (RM) group and a ranibizumab plus indomethacin (RI) group. All patients received monthly 0.5 mg IVR injections for 3 months, followed by monthly injections administered as needed. RI group patients also self-administered one drop of 0.5% indomethacin three times a day for 12 months. All patients were followed up for 12 months. RESULTS: At 12 months, both groups showed significant improvement in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). The mean BCVA change from baseline to 12 months was -0.12±0.04 LogMAR and -0.20±0.04 LogMAR in the RM and RI groups, respectively, with the degree of change being significantly different between the two groups (P=0.04). At 12 months, the mean CRT in the RM group (316±41.2 µm) was significantly higher than that in the RI group (287±31.5 µm; P=0.004). The mean required number of IVR injections was 7.38±0.78 and 6.34±0.67 in the RM and RI groups, respectively (P<0.001). CONCLUSION: Compared to IVR monotherapy, combination therapy with indomethacin eye drops and IVR provides superior anatomical and visual outcomes in patients with naive CNV lesions. Moreover, topical indomethacin might reduce the frequency of IVR injections, which is very beneficial considering the chronic and expensive nature of IVR therapy.

Comparison of Smartphone Ophthalmoscopy With Slit-Lamp Biomicroscopy for Grading Vertical Cup-to-Disc Ratio.

PURPOSE OF THE STUDY: The purpose of the study was to determine the agreement between smartphone ophthalmoscopy and slit-lamp indirect biomicroscopy when assessing vertical cup-to-disc ratios (VCDRs). MATERIALS AND METHODS: This was a clinical-based, prospective, comparative instrument study performed in 110 patients with ocular hypertension (OH) or primary open angle glaucoma (POAG). Patients underwent estimation of VCDR by undilated smartphone ophthalmoscopy and slit-lamp biomicroscopy by 2 masked glaucoma specialists. RESULTS: The differences between the mean VCDR estimations obtained by each techniques were not statistically significant. Overall exact agreement between the 2 modalities was found in 21 of 29 eyes (72.4%; simple κ=0.63, confidence interval, 0.52-0.73, P<0.001) in POAG patients and in 52 of 78 eyes (66.7%) in OH patients. The optic nerve head was not gradable with smartphone ophthalmoscopy in 1 eye with POAG and in 2 eyes with OH because of media opacities and/or small pupil diameter. CONCLUSIONS: Smartphone ophthalmoscopy showed substantial agreement with slit-lamp examination for the estimation of the VCDR. The ubiquitous diffusion of the smartphones, together with their connectivity and portability features, enables an extensive benefit for this technology to be used in glaucoma screening, especially in low-resource settings.