WIDEFIELD SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF PERIPHERAL ROUND RETINAL HOLES WITH OR WITHOUT RETINAL DETACHMENT.

PURPOSE: To describe the widefield spectral-domain optical coherence tomography features of peripheral round retinal holes, with or without associated retinal detachment (RD). METHODS: Retrospective, observational study of 28 eyes with peripheral round retinal holes, with and without RD. Patients underwent imaging with a widefield 50-degree spectral-domain optical coherence tomography (Heidelberg Engineering, Germany) and Optos ultra-widefield imaging systems (Optos, United Kingdom). RESULTS: Vitreous attachment at the site of the retinal hole was detected in 27/28 (96.4%) cases. Cases were split into three groups: RHs with RD (n = 12); RHs with subretinal fluid (n = 5), and flat RHs (n = 11), with minimal or no subretinal fluid. 91.6% retinal holes associated with subretinal fluid or RD had vitreous attachment at the site of the hole. Eighty percent had vitreous attachment at both edges of the retinal hole, in a U-shape configuration, which appeared to exert traction. By contrast, flat retinal holes had visible vitreous attachment only at one edge of the retinal hole in 45.4%. CONCLUSION: Vitreous attachment was commonly seen at the site of round retinal holes. Vitreous attachment at both edges of the retinal hole in a U-shape configuration was more commonly seen at holes associated with subretinal fluid or RD.

Aflibercept in refractory wet AMD treated with ranibizumab: Anatomical and visual outcome.

PURPOSE: To assess the anatomical outcome of patients with exudative age-related macular degeneration resistant to ranibizumab treated with aflibercept. METHOD: Prospective, interventional, case series, where we treated a group of patients deemed resistant to Ranibizumab after 6 months of persistence of intra- or subretinal fluid despite continuous treatment. RESULTS: The study included 17 patients, 3 males and 14 females. The average males age was 85 (range 83-87), and that of females was 79.64 (range 68-88). At the start of the study, the central foveal thickness CFT average was 534.76 µm (range 252-999). At 1 month and after 1 injection of Aflibercept, the CFT average was 324.82 µm (range 222-585). At 4 months and after 3 consecutive injections of Aflibercept the CFT average was 294.76 µm (range 184-640). At 6 months the CFT average was 356 µm (range 206-609). At the 5th visit only 8 out 17 (47%) patients required repeated injection either for persistent fluids or for recurrence. At the 6th and final visit only 4 out of 17 (23.5%) needed repeated injections, of them only one was treated on the visit before and treatment was given as very little response was observed from last injection, and all other 3 were not treated on the visit before. CONCLUSION: Our results showed that aflibercept was able to dry the macula even in advanced case of wet AMD resistant to Ranibizumab.

Delayed full-thickness macular hole closure without vitreomacular traction release following ocriplasmin injection.

We report a case of a 77-year-old Caucasian woman, treated with ocriplasmin injection for vitreomacular traction (VMT) and full-thickness macular hole (FTMH), who had a persistence outer retinal defect on her 28-day review, without VMT resolution, then presented 3 months later with complete macular hole closure, with persistence of vitreomacular adhesion. This case raises the question on the validity of the 28-day fixed date to assess final outcome of ocriplasmin injection for FTMH associated with VMT, and sheds new lights on the behaviour of the posterior hyaloid in cases of vitreolysis by a chemical agent such as ocriplasmin.

Unusual Fundus Autofluorescence Appearance in a Patient with Hydroxychloroquine Retinal Toxicity.

PURPOSE: To report an unusual fundus autofluorescence aspect in a patient with suspected hydroxychloroquine retinal toxicity. METHOD: Case report of an unusual presentation of a patient treated for 9 consecutive years with a therapeutically recommended dose of hydroxychloroquine. RESULT: We report the case of a 53-year-old Caucasian female treated with 400 mg hydroxychloroquine for rheumatoid arthritis over 9 years, currently on methotrexate and folinic acid, who stopped treatment 3 years ago. The cumulative dose is estimated at 1.314 kg. She recently noticed a reduction of vision in both eyes to 0.34 logMAR, with colour vision problems and major distortion in central vision. Fundus autofluorescence revealed minimal foveal pigmentary changes and more pronounced changes in the retina elsewhere. Foveal changes were confirmed by optical coherence tomography in both eyes. The patient did not report any colour perception difficulties or night vision problems and has no family history of any eye condition. Her visual field tested by an optician was full, with some central changes. CONCLUSION: Retinal toxicity from hydroxychloroquine can present in a different aspect than the commonly known retinal toxicity, and it happens even after years of cessation of the drug. The role of cumulative dose in toxicity is supported in this paper.