Long-term outcomes of iris-sutured subluxated intraocular lenses.

PURPOSE: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing. SETTINGS AND DESIGN: Retrospective chart review. METHODS: Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure. RESULTS: A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 ± 7.0 years. The mean follow-up duration was 46.8 ± 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 ± 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 ± 0.59 vs. 0.21 ± 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved. CONCLUSIONS: The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.

Accuracy of automated machine learning in classifying retinal pathologies from ultra-widefield pseudocolour fundus images.

AIMS: Automated machine learning (AutoML) is a novel tool in artificial intelligence (AI). This study assessed the discriminative performance of AutoML in differentiating retinal vein occlusion (RVO), retinitis pigmentosa (RP) and retinal detachment (RD) from normal fundi using ultra-widefield (UWF) pseudocolour fundus images. METHODS: Two ophthalmologists without coding experience carried out AutoML model design using a publicly available image data set (2137 labelled images). The data set was reviewed for low-quality and mislabeled images and then uploaded to the Google Cloud AutoML Vision platform for training and testing. We designed multiple binary models to differentiate RVO, RP and RD from normal fundi and compared them to bespoke models obtained from the literature. We then devised a multiclass model to detect RVO, RP and RD. Saliency maps were generated to assess the interpretability of the model. RESULTS: The AutoML models demonstrated high diagnostic properties in the binary classification tasks that were generally comparable to bespoke deep-learning models (area under the precision-recall curve (AUPRC) 0.921-1, sensitivity 84.91%-89.77%, specificity 78.72%-100%). The multiclass AutoML model had an AUPRC of 0.876, a sensitivity of 77.93% and a positive predictive value of 82.59%. The per-label sensitivity and specificity, respectively, were normal fundi (91.49%, 86.75%), RVO (83.02%, 92.50%), RP (72.00%, 100%) and RD (79.55%,96.80%). CONCLUSION: AutoML models created by ophthalmologists without coding experience can detect RVO, RP and RD in UWF images with very good diagnostic accuracy. The performance was comparable to bespoke deep-learning models derived by AI experts for RVO and RP but not for RD.

Predictive modeling of proliferative vitreoretinopathy using automated machine learning by ophthalmologists without coding experience.

We aimed to assess the feasibility of machine learning (ML) algorithm design to predict proliferative vitreoretinopathy (PVR) by ophthalmologists without coding experience using automated ML (AutoML). The study was a retrospective cohort study of 506 eyes who underwent pars plana vitrectomy for rhegmatogenous retinal detachment (RRD) by a single surgeon at a tertiary-care hospital between 2012 and 2019. Two ophthalmologists without coding experience used an interactive application in MATLAB to build and evaluate ML algorithms for the prediction of postoperative PVR using clinical data from the electronic health records. The clinical features associated with postoperative PVR were determined by univariate feature selection. The area under the curve (AUC) for predicting postoperative PVR was better for models that included pre-existing PVR as an input. The quadratic support vector machine (SVM) model built using all selected clinical features had an AUC of 0.90, a sensitivity of 63.0%, and a specificity of 97.8%. An optimized Naïve Bayes algorithm that did not include pre-existing PVR as an input feature had an AUC of 0.81, a sensitivity of 54.3%, and a specificity of 92.4%. In conclusion, the development of ML models for the prediction of PVR by ophthalmologists without coding experience is feasible. Input from a data scientist might still be needed to tackle class imbalance-a common challenge in ML classification using real-world clinical data.

Band keratopathy developing after denosumab injections.

We report the case of a 75-year-old woman who developed band keratopathy following denosumab therapy. The patient was referred for evaluation of progressive vision loss and new-onset band keratopathy in both eyes following denosumab therapy. She had no prior ocular history. On examination, she had calcific deposits in a horizontal band in the interpalpebral superficial cornea. Laboratory workup was negative. Denosumab was discontinued, and she was treated with keratectomy with ethylene-diamine-tetra-acetic acid. Denosumab influences calcium metabolism and consequently reduces bone turnover and increases bone density. It is commonly used for treatment of osteoporosis at high-risk for fracture. Very few cases of ocular adverse drug reactions have been reported. However, because of temporal association and biological plausibility, we believe our patient developed progressive band keratopathy after administration of denosumab.

RETINAL DETACHMENT ASSOCIATED WITH PERIPHERAL TEAR OF THE RETINAL PIGMENT EPITHELIUM IN PACHYCHOROID SPECTRUM DISEASE.

PURPOSE: To describe a rare case of an exudative retinal detachment associated with a peripheral tear of the retinal pigment epithelium in a young myopic pachychoroid eye. METHODS: Clinical case report and literature review. Imaging was obtained with color fundus photography, spectral domain optical coherence tomography, fluorescein angiography, and fluorescein angiography. RESULTS: A 33-year-old white man presented with an exudative choroidopathy resulting in an exudative neurosensory detachment, associated with peripheral retinal pigment epithelium tears. Spectral domain optical coherence tomography demonstrated a pachychoroid (628 µm) with subfoveal fluid. Despite a secondary pars-plana vitrectomy with silicone oil and later, Densiron-68 (Labtician Ophthalmics Inc) endotamponade, there was an area of persistent subretinal fluid inferiorly. A previously placed scleral buckle was removed, and scleral window surgery performed, with complete resolution of fluid and restoration of vision. Choroidal thickness improved to 333 µm postoperatively. CONCLUSION: Peripheral retinal pigment epithelium tear-associated retinal detachment can be seen in patients with pachychoroid spectrum disease. Scleral window surgery may be considered in the management of these retinal detachments.

Boston keratoprosthesis type 1 device leak.

OBJECTIVE: To report a leak at the cornea-anterior front plate interface of the Boston keratoprosthesis type 1 (KPro) leading to hypotony. DESIGN: Retrospective interventional case series. PARTICIPANTS: Three patients (3 eyes) who experienced development of hypotony after Boston KPro type 1 implantation surgery at the Centre Hospitalier de l'Université de Montréal. METHODS: Medical records of the 3 patients at our institution were reviewed with regard to preoperative and postoperative best corrected visual acuity (BCVA), digital intraocular pressure (IOP), time to diagnosis of hypotony, related complications, and the need for medical and surgical treatment. RESULTS: Pre-KPro BCVA ranged from counting fingers to light perception and improved to a mean of 20/100 in the operated eye. The incidence rate of leaks after KPro type 1 implantation was 2.7% (3 patients). The hypotony was noted at a mean of 13.7 months postoperatively. All patients had uveitis and vitritis preceding choroidal and retinal detachments, and required vitreoretinal surgeries for repair. In all patients, an objective leak through the cornea-anterior front plate interface of the KPro was seen intraoperatively by the vitreoretinal surgeon. Mean BCVA in these patients stabilized at 20/300 after the complication resolved, with a mean IOP of 10 mm Hg. CONCLUSIONS: Leak next to the KPro stem can occur after several months and can lead to significant visual loss. Prompt recognition and team management of this complication are required.

A neovascularized epiretinal membrane in a patient with terson syndrome.

PURPOSE: We report on a patient with Terson syndrome in the left eye complicated by a neovascularized epiretinal membrane likely secondary to cocaine use. METHODS: Case report and literature review using the Medline database (1966-2007). RESULTS: A woman known for cocaine use was seen in the ophthalmology clinic for Terson syndrome in the left eye after subarachnoid hemorrhage. Ten months later, a neovascularized epiretinal membrane was noted in the left eye and confirmed with retinal angiography and optical coherence tomography. After vitrectomy, the neovascular membrane was sent for histopathological examination, revealing neovascular capillaries. CONCLUSION: Neovascularized epiretinal membranes have never been reported in Terson syndrome and in our patient this likely occurred due to an ischemic retinal environment created by cocaine use and decreased retinal perfusion after subarachnoid hemorrhage.

Intravitreal bevacizumab for the treatment of choroidal neovascularization associated with pathological myopia.

BACKGROUND: The recent discovery of vascular endothelial growth factor and its role in the pathogenesis of ocular neovascularization has led to the development of new pharmacological agents that could block its action. This study was carried out to investigate the effect of intravitreal injections of bevacizumab on choroidal neovascularization (CNV) associated with pathological myopia. METHODS: We retrospectively reviewed the charts of all patients who had CNV secondary to pathological myopia and who had been treated with intravitreally administered bevacizumab between November 2005 and April 2007 at Notre-Dame Hospital in Montréal, Québec. Data on best-corrected visual acuity (BCVA), previous treatments, number of injections, fundus photography, and fluorescein angiography were collected. RESULTS: Ten eyes from 9 patients were followed for a mean period of 9.7 (range 2.5-14) months. At baseline the mean (SD) logMAR BCVA was 0.62 (0.25) (Snellen equivalent 6/24). The mean number of injections per eye was 2.6 (range 1-5). At the end of the study the mean (SD) logMAR BCVA had significantly improved to 0.26 (0.16) (Snellen equivalent 6/10.5; p < 0.001). Vision improved by a mean of 3.9 (range 0-7) lines on the Snellen visual acuity chart. Leakage from the CNV on fluorescein angiography had resolved in 7 of the 10 eyes and was reduced in the 3 other eyes. No drug-related side effects or complications were observed during the follow-up period. INTERPRETATION: Intravitreal injection of bevacizumab appears to be a safe and effective treatment alternative for CNV associated with pathological myopia.

Photodynamic therapy in young patients with choroidal neovascularization following traumatic choroidal rupture.

PURPOSE: To assesses the role of photodynamic therapy (PDT) with verteporfin in young patients with choroidal neovascularization (CNV) secondary to traumatic choroidal rupture. DESIGN: Retrospective case series. METHODS: Of 26 eyes with traumatic choroidal rupture followed since 1984 at the retina service of university hospitals, all eyes diagnosed with CNV and treated with PDT were included. Medical records including comprehensive eye examination, retinal photography, and intravenous fluorescein angiography (IVFA) were studied. RESULTS: Five patients (mean age, 18 years) developed CNV and received an average of two PDT treatments. Three patients had improved visual acuity (VA), one remained stable, and one experienced visual loss. Final IVFA showed absence of leakage in four eyes and decreased leakage in the eye with decreased VA. CONCLUSIONS: In young patients, PDT may be a reasonable treatment for CNV secondary to choroidal rupture. No ocular or systemic PDT complications were encountered in this young population.

Chorioretinal atrophy in a patient with moyamoya disease. Case report.

Moyamoya disease is characterized by constrictions of segments of the internal carotid arteries (ICAs) and a resultant abnormal anastomotic network. In the literature, visual disturbances from cerebrovascular accidents in patients with moyamoya disease have been described, but very few reports of intraocular pathological conditions have been published. The authors describe a patient with moyamoya disease who presented with chorioretinal atrophy; an association between these two diseases has not previously been reported in the literature. Findings of a clinical ophthalmological evaluation and angiographic series are presented. During the fundic examination, evidence of chorioretinal atrophy was found in this patient. Choroidal vascular insufficiency was revealed by intravenous fluorescein angiography and occlusion of the ICAs proximal to the origin of the posterior communicating arteries by selective carotid and vertebral arteriography. The vertebrobasilar system provided anastomotic connections via the posterior communicating arteries. This is the first case report of chorioretinal atrophy associated with moyamoya disease. It is believed that the vasoocclusive effects of moyamoya disease may predispose the patient to atrophic changes in the peripheral retina. The development of an anastomotic network precludes the progression of this fundic anomaly.

Trypan blue-assisted peeling of the internal limiting membrane during macular hole surgery.

PURPOSE: To evaluate the outcome of surgeries for macular holes using trypan blue to facilitate delamination of the internal limiting membrane. DESIGN: A retrospective series of 18 patients. METHOD: All patients underwent a three-port pars plana vitrectomy with internal limiting membrane delamination using trypan blue 0.06% to assist visualization. The main outcome measures were postoperative visual acuity and clinically evident retinal pigment epithelial changes. RESULTS: The median preoperative visual acuity was 20/200, and the median postoperative visual acuity was 20/70. All but one macular hole were closed after surgery (94%). At the last recorded follow-up, 10 patients (56%) had improved visual acuity of at least two chart lines. No adverse reaction related to trypan blue was observed up to 1 year postsurgery. CONCLUSIONS: Trypan blue staining of internal limiting membrane may accomplish more complete dissections of the internal limiting membrane and better surgical and visual outcomes.

Epiretinal membrane surgery assisted by trypan blue.

PURPOSE: To evaluate patient outcome following epiretinal membrane surgery using trypan blue to facilitate visualization and delamination. DESIGN: A retrospective noncomparative review of 23 patients. METHOD: Patients underwent a three-port pars plana vitrectomy with delamination using trypan blue 0.06%. RESULTS: The median preoperative visual acuity was 20/100. The median postoperative visual acuity was 20/60. Seventeen patients (74%) improved their visual acuity by at least 2 chart lines. No adverse reaction related to trypan blue was observed up to 1 year postoperatively. CONCLUSIONS: Trypan blue staining of the epiretinal membrane facilitated visualization and delamination without any signs of toxicity.