The Effect of Combining Scleral Buckle Surgery with Pars Plana Vitrectomy for Treatment of Recurrent Retinal Detachment Secondary to Proliferative Vitreoretinopathy.

Objectives: The objectiove of the study is to evaluate and compare the outcomes of pars plana vitrectomy (PPV) and PPV combined with scleral buckle (SB) in vitrectomised cases with recurrent retinal detachment (RD) and to analyze the effects of adding SB to the procedure. Methods: Patients with recurrent RD due to grade C proliferative vitreoretinopathy (PVR) were included in this retrospective comparative case series. Patients who underwent re-PPV with or without SB were included and two groups (re-PPV; re-PPV+SB) were compared in terms of anatomical and functional success. Results: Sixty-five cases were included in the study: 32 underwent re-PPV and 33 underwent re-PPV+SB procedures. Reattachment was achieved in 59.4% of the re-PPV group versus 81.8% of the re-PPV+SB group (p=0.047). Although preoperative BCVA was worse in the re-PPV+SB group (p=0.005), postoperative BCVA at the last visit was similar in both groups (p=0.065). Conclusion: In the treatment of recurrent RD with grade C PVR, combining the SB procedure with PPV contributes to anatomical and functional outcomes.

Based on the Real-Life Data of Türkiye; Comparison of Anatomical and Functional Outcomes of Phakic and Pseudophakic Patients in Wet Type Age-Related Macular Degeneration.

Objectives: The aim of the study was comparison of wet-type age-related macular degeneration in phakic and pseudophakic patients in terms of anatomical and functional success based on the real-life data of Türkiye. Methods: The multicenter retrospective real-life study data of the. retinal study group were used in this study. Among 867 eyes of 867 patients were included in the study. Patients were divided into two groups according to the status of the lens; phakic group and pseudophakic group. The follow-up period of the two groups, the number of injections at the 1st, 2nd, and 3rd years, and changes in the central macular thickness (CMT, µ) and visual acuity (VA, logMAR) of the patients at the beginning, 6th, 12th, 24th, and 36th months were examined. Results: In our study, the number of injections in the 1st, 2nd, and 3rd years, respectively, was 4.2±2.0, 1.8±1.9, and 1.0±1.7 in the phakic group, and 3.9±2.0, 1.7±1.9, and 0.8±1.4 in the pseudophakic group. When the two groups were compared in terms of the number of injections, there was a statistically significant difference in the 1st year, but there was no significant difference in the 2nd and 3rd years (p=0.001, p=0.350, and p=0.288, respectively). There was no statistically significant difference between the groups in terms of CMT in the baseline, 6th, 12th, 24th, and 36th months (p=0.991, p=0.327, p=0.652, p=0.599, and p=0.873, respectively). Although there was no difference in VA between groups at the beginning (p=0.052), the phakic group showed statistically better VA in controls at 3rd, 6th, 12th, 24th, and 36th months (p=0.001, p=0.001, p=0.000, p=0.000, and p=0.003, respectively). Conclusion: Differences in the number of injections and visual results between phakic and pseudophakic patients in wet type AMD may necessitate the creation of different treatment and follow-up protocols.

Results of anti-VEGF treatment for neovascular AMD in eyes with different baseline visual acuity in Turkish population-based on real life data-Bosphorus retina study group.

BACKGROUND: To investigate the anatomical and visual outcomes of the patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF), according to the baseline best-corrected visual acuity (BCVA) based on the multicenter real-life data. METHODS: Five-hundred-ninety patients who had taken the Pro Re Nata (PRN) treatment regimen with three loading doses and at least one year of follow-up were included. The patients were divided into three groups according to the baseline BCVA: Group 1 (BCVA ≥ 1.3 Logmar), Group 2 (1.3 Logmar > BCVA ≥ 0.3 Logmar), and Group 3 (BCVA ≤ 0.2 Logmar). BCVA, central macular thickness (CMT), and the number of injections and visits were evaluated. RESULTS: There were 175, 322, and 93 patients in Group 1, Group 2, and Group 3, respectively. The number of visits and injections in the 1st year was not different between the groups (p = 0.58 and p = 0.08) and was 7.09 and 4.41 (Group 1), 6.59 and 5.58 (Group 2), 6.77 and 4.08 (Group 3). There was a significant difference in CMT between the baseline and 12th month in Group 1 and Group 2 (p < 0.001, p < 0.001, respectively) but not in Group 3 (p = 0.84). BCVA was significantly better in the 12th month in Group 1 (p < 0.001), slightly worse in Group 2 (p = 0.79), and significantly worse in Group 3 (p < 0.001). CONCLUSION: This study provides evidence that an inadequate number of injections cannot protect vision. Moreover, it can cause vision loss, especially in the eyes with good vision.

Prognostic factors affecting macular hole closure types.

PURPOSE: In this study, we aimed to evaluate the relationship between macular hole closure types assessed by optical coherence tomography (OCT) and the preoperative prognostic factors. MATERIALS AND METHODS: In total, 183 patients who underwent pars plana vitrectomy and internal limiting membrane peeling for idiopathic macular hole between August 2014 and August 2019 were reviewed retrospectively. The preoperative measurements of the macular hole including minimum linear diameter (MLD), basal hole diameter (BHD) and hole height (HH) were measured on OCT images. The patients were divided into two closure types on the basis of postoperative OCT findings (type 1 closure: retinal edges were flat and there was no defect of the neurosensory retina on the fovea; type 2 closure: retinal edges were flat and there was a defect of the neurosensory retina on the fovea). The difference of prognostic factors such as age; duration of symptoms; preoperative best-corrected visual acuity (BCVA); preoperative macular hole measurements, including MLD, BHD and HH; and rate of reopening between two types were statistically analysed. RESULTS: The mean age of patients was 66.33 ± 8.09 years (range: 48-88 years). According to OCT imaging, 117 eyes (63.9%) were classified into the type 1 closure group, and 66 eyes (36.1%) were classified into the type 2 closure group. There were no significant differences between two groups in age, duration of symptoms and preoperative BCVA (p = 0.694, p = 0.092 and p = 0.15). MLD and BHD were significantly larger, and reopening was significantly more common in type 2 group (p < 0.05, p = 0.04 and p < 0.005); however, there was no significant difference in HH between two groups (p = 0.239). CONCLUSION: Preoperative horizontal measurements of macular hole may help to determine postoperative visual expectations and anatomical success, and predict the possibility of reopening.

Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume in patients with idiopathic epiretinal membrane.

PURPOSE: To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects. METHODS: We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters. RESULTS: Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects. CONCLUSION: The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.

Preoperative Evaluation of Tractional Retinal Detachment with B-Mode Ultrasonography in Diabetic Vitreous Hemorrhage.

OBJECTIVES: This study was designed to evaluate the reliability of preoperative ultrasonography (USG) to detect tractional retinal detachment (TRD) in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy. METHODS: The medical records of patients with VH who underwent A- and B-scan ultrasonography prior to a vitrectomy between November 2016 and May 2017 were reviewed in this retrospective study. All of the patients were assessed using USG before surgery with 4-quadrant transverse and 1-quadrant longitudinal scans whether to determine if the VH was accompanied by TRD. The USG results were compared with the vitrectomy findings. RESULTS: A total of 111 eyes of 106 patients with VH were evaluated. Twenty-three eyes were excluded from the study due to non-diabetic diagnoses, such as retinal vein-artery occlusion, trauma, intraocular mass, choroidal neovascular membrane, or macroaneurysm. The remaining 88 eyes with diabetic VH were included in the study. Preoperatively, VH alone was observed in 65 eyes (73.8%) and VH accompanied with TRD was determined in 23 eyes (26.2%) using USG. TRD was not found during the operation in 2 eyes (2.2%) diagnosed as VH with TRD by USG (false positive), and in 8 eyes (9.1%), TRD was detected during surgery though VH alone had been recorded based on the USG results (false negative). CONCLUSION: USG is a reliable diagnostic tool that will provides accurate preoperative information about the presence of TRD in diabetic VH; however, in some cases TRD may go undetected, especially in eyes with peripherally localized or small TRD.

Real-Life Data of Patients with Exudative Age-Related Macular Degeneration.

OBJECTIVES: The aim of this study was to examine and provide real-life data of patients with exudative-type age-related macular degeneration (AMD). METHODS: A total of 189 eyes of 160 patients with exudative AMD treated with intravitreal anti-vascular endothelial growth factor therapy (anti-VEGF) injections (ranibizumab 0.3 mg/0.05 mL, aflibercept 2 mg/0.05 mL, bevacizumab 1.25 mg/0.05 mL) were included in the study. Patient demographic characteristics, and details of the clinical examinations, number of injections, best-corrected visual acuity (BCVA) measured with the Snellen chart, optical coherence tomography, and fundus fluorescein angiography images were evaluated at the first visit and during the follow-up period. RESULTS: In the study group, 78 of the patients were female (48.8%) and 82 were male. The mean age was 72.20±8.97 years. While no treatment had been applied to 151 eyes before the first examination, 38 had previously received an intravitreal injection at another center. The mean number of patient visits was 5.83 in the first year, 4.68 in the second year, and 3.84 in the third year, and the mean number of injections was 4.70 in the first year, 2.08 in the second year, and 1.51 in the third year. The mean BCVA change between the first visit and the first, second, and third years was not statistically significant (p>0.05), and a significant change was observed in the mean central macular thickness (p<0.05). CONCLUSION: Anatomical and functional success was achieved with anti-VEGF treatment after fewer injections and visits than have been reported in randomized, controlled, clinical studies in the literature. The number of injections and visits recorded in this study was consistent with the data of other real-life studies.

Evaluation of choroidal thickness and retinal vessel density in patients with inactive Graves' orbitopathy.

BACKGROUND: To investigate choroidal thickness using spectral domain-optical coherence tomography and retinal vessel density with optical coherence tomography angiography in patients with inactive Graves' orbitopathy. METHODS: A total of 36 eyes of 36 patients with inactive Graves' orbitopathy (6 men and 30 women in Group 1) and 36 eyes from 36 controls (8 men and 28 women in Group 2) were recruited for this prospective case-control study. Choroidal thickness measurements were obtained using enhanced depth imaging with spectral domain-optical coherence tomography. Optical coherence tomography angiography images were generated with 6 × 6-mm angiographic optical coherence tomography scans. Retinal vessel densities of the superficial retinal layer and deep retinal layer of the macula and foveal avascular zone measurements were obtained for each eye. RESULTS: The mean age was 42.5 ± 9.9 years in Group 1 and 42.8 ± 6.5 years in Group 2 (p = 0.76). The mean choroidal thickness was 370.7 ± 83.5 µm and 338.2 ± 72.4 µm in Group 1 and 2, respectively (p = 0.09). There was no significant difference between the groups in retinal vessel density either in superficial or deep retinal layers (p > 0.05 for all), and no difference was found between the groups in foveal avascular zone area and perimeter (p = 0.69, p = 0.73, respectively). CONCLUSIONS: Similar retinal vessel density values were found in both superficial and deep retinal layers in Graves' orbitopathy compared with healthy subjects. Although statistically insignificant, choroidal thickness was slightly higher in patients with Graves' orbitopathy than in healthy subjects. Foveal avascular zone area and perimeter measurements were unaffected by the disease.

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group.

AIM: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS: Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS: The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits. CONCLUSION: The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Evaluation of Choroidal Thickness in Patients with Proliferative and Non-Proliferative Macular Telangiectasia Using Enhanced Depth Imaging Optical Coherence Tomography.

Purpose: To compare subfoveal choroidal thickness (SFCT) in eyes with non-proliferative macular telangiectasia (MacTel) type 2 with or without subretinal neovascularization (SRNV) and healthy control eyes.Methods: Consecutive patients with non-proliferative and proliferative MacTel type 2 were included in the current study. For comparisons subjects with no ocular pathology were recruited and used as controls. Best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated. Since axial length (AL) may affect choroidal thickness, AL measurements were performed to avoid confusion in SFCT between the groups.Results: Of the 63 eyes of 38 MacTel type 2 patients, 38 eyes had only MacTel type 2 (group 1) and 25 eyes had SRNV caused by MacTel type 2 (group 2). Fourty eyes of 20 subjects served as controls (group 3). BCVA was found to be significantly higher in control group compared with group 1 and group 2 (p < .005). Whereas, no difference was detected between group 1 and group 2 (p = .75). No difference was noted in CMT between the groups (p = .35). Axial length measurement was very similar among all three groups (p = .62). After adjusting for age and axial length SFCT was significantly thinner in group 3 than the other groups (p < .001), but no statistically significant difference was found between group 1 and group 2.Conclusions: Choroidal thickness did not vary between eyes with MacTel type 2 with SRNV and without SRNV. Choroid was significantly thicker in MacTel type 2 with SRNV and without SRNV than healthy eyes.

Clinical Use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion Compared with Intravitreal Anti-Vascular Endothelial Growth Factor.

OBJECTIVES: Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections. METHODS: Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured. RESULTS: Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 µm and 545±165 µm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 µm to 308±132 µm at month 2 (p<.001), 450±195 µm at month 4 (p<.001), and 510±190 µm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 µm to 486±162 µm at month 2 (p<.001), 516±168 µm at month 4 (p<.001), and 528±171 µm at month 6 (p=0.037). CONCLUSION: Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

Foveal avascular zone area measurements with optical coherence tomography angiography in patients with nanophthalmos.

PURPOSE: To compare the area of the superficial foveal avascular zone (SFAZ) and deep foveal avascular zone (DFAZ) between patients with nanophthalmos and age matched controls. METHODS: This prospective and comparative study included 19 eyes from 11 patients with nanophthalmos (study group) and 19 eyes from 19 healthy subjects (control group). SFAZ and DFAZ were measured with optical coherence tomography angiography (OCT-A). All participants underwent a standardised ocular examination including best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) anterior chamber depth (ACD), axial length (AL), and refractive error (RE) measurements. RESULTS: Mean SFAZ and DFAZ area in the nanophthalmic eyes and in the control eyes were 0.09 ± 0.12 mm2, 0.10 ± 0.10 mm2 and 0.37 ± 0.10 mm2, 0.37 ± 0.10 mm2 respectively (p < 0.001 and p < 0.001). Mean BCVA, RE, AL, ACD CMT, SFCT, were 0.40 ± 0.34 logMAR Unit, 10.0 ± 2.2 18.1 ± 1.5 mm, 2.15 ± 0.28 mm, 367.1 ± 87.4 µm, 489.2 ± 85.2 µm respectively, in nanophthalmic eyes and there was a statistically significant difference between groups (p < 0.001 for each). There were negative correlations for both SFAZ and DFAZ with RE (r = -0.733 and r = -0.758, p < 0.001), CMT (r = -0.823 and r = -0.82, p < 0.001), SFCT (r = -0.647 and r = -0.717 p < 0.001) for the entire study population. SFAZ and DFAZ area were significantly correlated with AL (r = 0.732 and r = 0.745, p < 0.001) and ACD (r = 0.614 and r = 0.654, p < 0.001). In study group, 5 eyes did not have neither SFAZ nor DFAZ, 3 eyes had only DFAZ and 1 eye had only SFAZ in the OCT-A images. CONCLUSIONS: SFAZ and DFAZ area were significantly smaller in nanophthalmic eyes than control eyes.

Comparison of outcomes for traumatic retinal detachment surgery using 1000- or 5000-centistoke silicone oil.

PURPOSE: To compare the efficacy and complications associated with higher viscosity (5000-centistoke) versus lower viscosity (1000-centistoke) silicone oil in traumatic retinal detachment surgery. MATERIAL AND METHODS: Patients who underwent 23-gauge pars plana vitrectomy using 1000- or 5000-centistoke silicone oil to treat retinal detachment associated with traumatic globe injury were retrospectively analysed. Anatomical and visual outcomes were compared. RESULTS: Forty-four eyes of 44 patients were included in the study, which included 22 eyes in each group. Patients were significantly younger in the 5000-centistoke group compared to the 1000-centistoke group (median: 22 vs. 54 years old, respectively, p < 0.001) and open trauma was more common (77% vs. 36%, respectively, p = 0.006). Anatomical success was similar in both groups (73% and 77%, 5000- and 1000-centistoke groups, respectively; p = 0.73). Although ambulatory vision (>5/200) at the final follow-up visit was more common in the 1000-centistoke group compared to the 5000-centistoke group (55% vs. 9%, respectively, p < 0.001), there was no significant difference between the groups with respect to change in visual acuity postoperatively compared with preoperatively. CONCLUSION: Surgeons prefer 5000-centistoke silicone oil for use in more complicated cases. Anatomical outcomes were similar using 1000- and 5000-centistoke silicone oil.

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1.

OBJECTIVES: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. MATERIALS AND METHODS: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. RESULTS: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 µm (range: 91-1582), 330±115 µm (range: 99-975), and 332±114 µm (range: 106-1191), respectively. CONCLUSION: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies.

BACKGROUND: The prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated. METHODS: Patients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories. RESULTS: Twenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores. CONCLUSION: OTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs.

Pediatric Traumatic Retinal Detachment: Clinical Features, Prognostic Factors, and Surgical Outcomes.

PURPOSE: We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD). METHODS: Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies. RESULTS: The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS. CONCLUSIONS: Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.

Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema.

PURPOSE: To compare the visual and anatomic outcomes in patients with persistent diabetic macular edema (DME) who switched from ranibizumab to aflibercept with those who continued with previous ranibizumab therapy. METHODS: In this retrospective comparative study, medical records of consecutive patients with center-involved DME ≥ 350 µm who had at least three recent consecutive monthly ranibizumab injections followed by as-needed therapy with either aflibercept or ranibizumab were reviewed. Data were collected at presentation (preinjection), at the intermediary visit, and at the last visit (at the end of the follow-up period). RESULTS: Forty-three eyes of 43 patients were divided into two groups: the switch group (n = 20) and the ranibizumab group (n = 23). Though no significant improvement was found in the mean BCVA from the intermediary visit to the last visit, there was a difference in the mean CMT in the switch group and the ranibizumab group (p < 0.001 and p = 0.03, resp.). The mean CMT decreased after the intermediary visit by 188.6 ± 120.5 µm in the switch group and by 60.3 ± 117.1 µm in the ranibizumab group (p = 0.003). CONCLUSIONS: Both aflibercept and ranibizumab decreased CMT in patients with persistent DME who showed a poor response to ranibizumab injections. However, switching to aflibercept provided only morphologic improvement.

Early choriocapillaris changes after half-fluence photodynamic therapy in chronic central serous chorioretinopathy evaluated by optical coherence tomography angiography: Preliminary results.

BACKGROUND: The purpose of this study is to examine the choridal perfusion in patients with chronic central serous chorioretinopathy (CSC) after half-fluence photodynamic therapy (PDT) in the early post-treatment period. METHODS: This retrospective study included patients with chronic CSC. Indocyanine green angiography (ICGA) guided half-fluence PDT was applied to the all eyes. Best corrected visual acuity (BCVA) was assessed by Snellen chart and central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) was measured by spectral domain optical coherence tomography (SD-OCT) before PDT and at 3 and 30 days following the therapy. Optical coherence tomography angiography (OCTA) was performed to evaluate choriocapillaris perfusion in all patients before PDT and 3 and 30 days of therapy. RESULTS: Of the patients participating in this study, the mean age was 49.8 ±â€¯14.1 years. BCVA remained stable in all eyes during follow-up period. CRT was 360 ±â€¯148 µm at baseline, 327 ±â€¯133 µm at day 3 and 203 ±â€¯40 µm at day 30 after treatment. Subretinal fluid totally resolved at day 30 in all eyes. The mean SFCT was 493 ±â€¯67 µm at baseline, 498 ±â€¯71 µm at day 3 and 450 ±â€¯63 µm at day 30. At day 3, OCTA revealed markedly decreased choriocapillaris flow limited to the site of PDT spot. The choriocapillaris perfusion appeared to be normal in all eyes in OCTA images at day 30. CONCLUSIONS: OCTA is a noninvasive imaging tool for detecting choroidal vascular changes after PDT in CSC. In this preliminary study of a limited number of CSC patients, choroiocapillaris perfusion seemed to decreased in very early period following half-fluence PDT and then returned to normal until 30 days of therapy.

Five-year Outcomes of Ranibizumab in Neovascular Age-related Macular Degeneration: Real Life Clinical Experience.

PURPOSE: To evaluate the outcomes of 5-year ranibizumab treatment in neovascular age-related macular degeneration (nAMD) in a single center and real life clinical setting. METHODS: The records of nAMD patients who were treated with ranibizumab between January 2010 and June 2011 were retrospectively reviewed. Patients who completed 5 years of follow-up were included. Main outcome measures were change in best-corrected visual acuity, central retinal thickness, and visit and injection numbers. RESULTS: Forty-four eyes of 37 patients were included. Mean best-corrected visual acuity decreased from 0.82 ± 0.69 to 1.11 ± 0.65 logarithm of minimal angle of resolution after 5 years. Twenty-four eyes (54.5%) had visual acuity loss ≥3 lines, and 20 eyes (45.5%) had stable or improved vision (loss <3 lines, remained stable, or gained ≥1 line) at month 60. The mean total number of visits was 25.3 ± 5.8 (range, 14 to 42), and the mean total number of injections was 12.6 ± 6.4 (range, 3 to 26) at month 60. CONCLUSIONS: Half of the ranibizumab-treated nAMD patients maintained their vision during the 5 years of follow-up. Visit and injection numbers were found to be lower than in prospective studies, reflecting a real world clinical practice.

Thickness of the retinal photoreceptor outer segment layer in healthy volunteers and in patients with diabetes mellitus without retinopathy, diabetic retinopathy, or diabetic macular edema.

PURPOSE: The purpose of this study was to investigate whether the severity of diabetic disease in the retina is paralleled by changes in the photoreceptor layer. METHODS: This cross-sectional study included healthy volunteers (30 volunteers, 60 eyes) and patients with diabetes (48 patients, 96 eyes). Each patient underwent a single session of spectral domain optical coherence tomography (OCT) in which each retina was imaged twice. On each OCT image, the thickness of the PROS layer was measured at the foveal center and at points 750 µm temporal to and nasal to the center. For statistical analyses, OCT images were assigned to one of the following groups: healthy, diabetes without retinopathy (DM), diabetic retinopathy (DR), or diabetic retinopathy with macular edema (DME). RESULTS: The mean PROS thickness at the foveal center in the first and second-obtained OCT images was as follows: healthy, 38.5 µm and 38.6 µm; DM, 38.2 µm and 38.2 µm; DR, 35.6 µm and 36.1 µm; DME, 32.6 µm and 32.6 µm. In the first and second-obtained images, significant differences were found between the healthy group and DR and DME (p < 0.05 for all), between the DM group and the DME (p < 0.05 for all), and between the DR group and the DME group (p < 0.05 for all). No significant differences between groups were found at the nasal and temporal locations. CONCLUSION: The PROS layer at the foveal center was thinner in patients who had diabetic retinopathy or diabetic macular edema than both the healthy volunteers and diabetic patients without retinopathy.