Evaluation of clinical outcomes of raised intraocular pressure following intravitreal triamcinolone acetonide injection.

Aim: To assess the incidence, risk factors, and treatment outcomes in intravitreal triamcinolone acetonide injection (IVTA) induced intraocular pressure rise and to compare IOP rise in 1-mg and 2-mg IVTA. Materials and methods: Prospective observational study conducted in all eyes receiving IVTA. Any pre-existing glaucoma and patients who received IVTA or dexamethasone implant in the last 6 months were excluded. Results: 9 between 61-70 years of age developed an IOP spike. The mean and standard deviation of age in years was 61.95 ± 8.70. Maximum eyes had ME due to Diabetic Retinopathy (53.3%). All cases of uveitic ME were reported to have an IOP spike. 2 out of 3 high myopic eyes and 1 eye with thyroid abnormality had an IOP spike. High IOP was found in 13 eyes, with more than 25 mm Hg rise in 4 eyes and more than 5 mm Hg rise from baseline IOP in 9 eyes. The mean and standard deviation of time taken for IOP raise (in days) was 46.39 ± 37.68. A total of 38 eyes received 1 mg of IVTA and the rest 22 received 2 mg of IVTA. 23.7% of 1 mg eyes experienced an IOP rise while it was 18.2% in eyes with 2 mg IVTA. The injection was repeated in 12 eyes and 41.7% developed an IOP spike among them. The independent "t" test results showed that there was a significant difference in the mean of IOP (Pre-injection) concerning the IOP rise (P=0.007*). 1 eye had IVTA crystals in the anterior chamber with raised IOP of 30 mm Hg. 1 out of 13 eyes with raised IOP needed 2 AGMs, the other 12 eyes responded well to 1 AGM. Discussion: IVTA is widely used in refractory cases of ME and steroid-induced glaucoma is the most common side effect of IVTA. To the best of our knowledge, there is a lack of literature on prospective studies on IVTA-associated risk factors, patterns of IOP elevation, and treatment outcomes. The pre-injection mean ± SD baseline IOP for uneventful eyes was 12.87±2.65 and the pre-injection mean IOP for eyes with IOP event was 15.23±2.89 (P=0.007*). Conclusion: We proposed that TA is an independent risk factor for post-intravitreal injection IOP spike. IVTA causes a maximum IOP spike at 1 to 2 months and has a protracted course that responds to anti-glaucoma medications. High baseline IOP, a repeated dose of IVTA, the presence of TA crystals in the anterior chamber, and high myopia were associated with significant IOP elevation. Abbreviations: ACD = Anterior chamber depth, AS = Anterior segment, AGM = Anti-glaucoma medications, ARMD = Age-related macular degeneration, BCVA = Best-corrected visual acuity, BRVO = Branch retinal vein occlusion, CCT = Central corneal thickness, CRVO = Central retinal vein occlusion, CME = Cystoid macular edema, CNVM = Choroidal neovascularization membrane, CSME = Clinically significant macular edema, DR = Diabetic retinopathy, ERM = Epiretinal membrane, IOP = Intraocular pressure, IGS = Irvine-Grass syndrome, GAGs = Glycosaminoglycans, IVTA = Intravitreal triamcinolone acetonide injection, ME = Macular edema, NVG = Neovascular glaucoma, OHT = Ocular hypertension, PDS = Pigment dispersion syndrome, PACG = Primary closed angle glaucoma, POAG = Primary open-angle glaucoma, PXF = Pseudoexfoliation, VA = Visual acuity, VEGF = Vascular endothelial growth factors, VH = Vonherick's grading, SD = Standard deviation, TA = Triamcinolone acetonide, TIGR = Trabecular meshwork inducible glucocorticoid response.

Surgical outcomes of petalloid multilayered inverted internal limiting membrane flaps in extra-large macular holes.

PURPOSE: To analyze the surgical outcomes of petalloid multilayered inverted internal limiting flap using perfluorocarbon liquid (PFCL) in extra-large macular holes (MHs) (minimum linear diameter >550 µm and basal diameter [BD] >1000 µm). METHODS: This was a prospective interventional series of 103 eyes of 99 patients with extra-large MHs which were treated with 25-gauge pars plana vitrectomy, petalloid multilayered inverted internal limiting membrane flaps under PFCL and 15% perfluoropropane (C3F8) gas tamponade. Intraoperative optical coherence tomography (i-OCT) was used to confirm correct positioning of flaps. Follow-up was at 1 week, 1 month, and 3 months postoperatively. RESULTS: Mean age of patients was 58.282 ± 16.3 years. Mean preoperative best corrected visual acuity (BCVA) was logarithm of minimum angle of resolution (logMAR) 1.206 ± 0.384, and the value at the third month was logMAR 0.793 ± 0.337. Mean minimum linear diameter (MLD) was 711.96 ± 270.744 µm. MLD ranged from 557µm (minimum MLD) to 2657 µm (maximum MLD). Mean BD was 1301.165 ± 425.914 µm. Type 1 closure was seen in 92.2% eyes, 5.8% eyes had type 2 closure, and 1.9% eyes had type 3 closure. Eyes with both type 1 closure (P = 0.001) and type 2 closure (P = 0.009) showed a significant improvement in BCVA postoperatively at 3 months. CONCLUSION: Petalloid multilayered inverted internal limiting membrane flap under PFCL technique with adjunctive use of i-OCT showed improved morphological and functional outcomes in the treatment of extra-large MHs. We present here a large series of extra-large MHs, in which a novel technique of petalloid multilayered inverted ILM flaps was used.

Efficacy of a single injection of brolucizumab in neovascular age-related macular degeneration on visual acuity and micromorphometry.

Purpose: To assess short-term efficacy of a single injection of brolucizumab in neovascular AMD. Methods: This was a multicenter, retrospective chart review of 25 eyes of 25 patients who received a single injection of brolucizumab. Visual acuity (VA) and optical coherence tomography (OCT) features such as central subfield thickness (CSFT), subretinal fluid (SRF), intraretinal fluid, and pigment epithelial detachment (PED) were recorded at baseline, first month, and third month. Results: Of the 25 eyes, 14 eyes were treatment-naïve and 11 eyes had received previous injections. VA improved from 0.68 ± 0.59 log MAR at baseline to 0.31 ± 0.43 log MAR at the end of 3 months. SRF height in first and third month was significantly reduced from baseline (P < 0.001). Subretinal hyperreflective material height significantly reduced from baseline (P value 0.008 at first month and 0.01 at third month, respectively). CSFT was 464.16 ± 247.97 microns at baseline and showed a significant reduction in first month (P < 0.001) and third month (P < 0.001). There was a significant reduction of PED height from baseline at both follow-ups. None of the eyes showed a recurrence of fluid at the end of 3 months. Conclusion: Our study demonstrated sustained improvement in VA and OCT parameters after a single injection of brolucizumab at 3 months. A longer follow-up may demonstrate even farther effects of a single injection.

Presumed Post-COVID Infection Retinitis - Clinical and Tomographic Features of Retinitis as a Post-COVID Syndrome.

PURPOSE: To study clinical and imaging features of presumed post-COVID infection retinitis. METHOD: Retrospective case series of patients presenting with retinitis lesions with evidence of recent COVID infection. Retinal findings and optical coherence tomography (OCT) features were studied at baseline and follow-ups. RESULTS: Twenty-four eyes of 17 patients were included. Mean age was 36.57 ± 11.78 years. Baseline visual acuity (VA) was log MAR 0.97 ± 0.43. Fundus findings included retinitis patches (n = 24),hard exudates (n = 8), and superficial hemorrhages (n = 16). OCT features included neurosensory detachment (NSD, n = 20), hyperreflective inner layers (n = 24), acute macular neuroretinopathy (AMN, n = 8), hyperreflective foci (n = 20). At final follow-up, VA was logMAR 0.43 ± 0.27. Retinitis patches persisted in four eyes, AMN in three eyes, and NSD in five eyes. Conclusion- Post- COVID infection retinitis adds to existing literature on post COVID syndromes.

Epiretinal Neovascularization: A Novel OCT Angiography Finding in Macular Telangiectasia Type 2.

PURPOSE: To report a novel finding of epiretinal neovascularization (ERN) in cases of macular telangiectasia (MacTel) type 2 and describe its clinical and multimodal imaging features. DESIGN: Retrospective chart review. PARTICIPANTS: Patients attending the retina clinic from January 2017 through April 2018. Those diagnosed with MacTel by clinical and imaging findings were included. METHODS: Best-corrected visual acuity in logarithm of minimum angle of resolution units, anterior segment examination, slit-lamp biomicroscopy, fundus photography, spectral-domain OCT, autofluorescence imaging, fundus fluorescein angiography, and OCT angiography (OCTA) were performed in all MacTel patients. Length of ellipsoid zone disruption, external limiting membrane disruption, area of the ERN in square millimeters, and central macular thickness in micrometers were noted. MAIN OUTCOME MEASURES: The finding of an epiretinal membrane on spectral-domain OCT and a corresponding well-defined vascular complex on the vitreoretinal interface on OCTA in MacTel patients was considered to be evidence of epiretinal neovascular membrane (ERNM). RESULTS: Sixty-eight MacTel eyes underwent multimodal imaging, of which 7 eyes of 4 patients were identified as having ERN or ERNM. The ratio of men to women was 1:1 (n = 4); 1 patient had unilateral disease and 3 patients had bilateral disease. Mean age was 56.75 ± 10.71 years. Mean best-corrected visual acuity was 0.74 ± 0.39 logarithm of the minimum angle of resolution. Retinal pigment and dipping venules were present in 100% of eyes. Diffuse thinning and collapse sign were seen in all eyes. OCT angiography revealed a vascular membrane owing to the ERNM at the vitreoretinal interface. Mean area of the ERNM was 0.44 ± 0.248 mm2. This vascular membrane showed a demonstrable communication with the intraretinal abnormal vascular plexus in 6 of 7 eyes. None of the eyes showed a choroidal neovascular membrane. CONCLUSIONS: Epiretinal neovascularization is a novel finding in MacTel type 2. These neovascular membranes are visualized best using OCT and OCTA. They are associated with retinal pigment and diffuse retinal thinning. Histopathologic studies are needed to characterize these membranes further.

Perifoveal Exudative Vascular Anomalous Complex-Like Lesion as a Complication of Prepapillary Arterial Loops.

Perifoveal exudative vascular anomalous complex (PEVAC) and its expanded spectrum have been recently elucidated by multimodal imaging. Although there is some clarity about its characteristic features and natural history, the cause remains unknown. Herein, the authors describe a hitherto unknown association with prepapillary arterial loops and suggest a possible hypothesis for the development of a PEVAC-like lesion and its response to treatment with thermal laser. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:974-978.].