Nd:YAG Laser Hyaloidotomy: A Therapeutic Approach for Valsalva Premacular Hemorrhage.

Subhyaloid hemorrhage, characterized by localized vitreoretinal detachment due to blood accumulation, often results in sudden vision loss, especially in the macular area. This case report highlights a 23-year-old female presenting with exercise-related Valsalva retinopathy leading to premacular subhyaloid hemorrhage. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy, a non-invasive procedure, leading to rapid blood drainage and visual recovery. The patient's initial visual acuity was severely impaired, with a significant premacular hemorrhage obscuring the macula. A week later, due to the expanding hemorrhage, Nd:YAG laser hyaloidotomy was performed, demonstrating successful blood dispersion and restoration of vision. Follow-up revealed significant improvement with demarcation of the previous hemorrhage and no evidence of new findings. The case emphasizes the importance of prompt intervention and considers alternative treatments for premacular subhyaloid hemorrhage. While associated with ocular pathologies, such as macular holes and retinal detachment, Nd:YAG laser hyaloidotomy remains a safe and effective outpatient procedure for managing premacular subhyaloid hemorrhage, avoiding the risks of more invasive surgical interventions. The presented case highlights the significance of tailored interventions based on patient history, minimizing the need for invasive procedures and their associated risks.

Unilateral Cataract and Retinitis Pigmentosa in a Patient With Polyneuropathy, Hearing Loss, Ataxia, Retinitis Pigmentosa, and Cataract (PHARC) Syndrome: A Case Report.

Patients with mutations in the α/ß-hydrolase (ABHD) 12 gene develop ocular complications including cataracts and retinitis pigmentosa (RP), as part of the polyneuropathy, hearing loss, ataxia, RP, and cataract (PHARC) syndrome. A chart review on a patient with a heterozygous mutation on the ABHD12 gene underwent a comprehensive ophthalmic evaluation. Visual acuity was 0 and 1.3 (logMAR) on the right eye (OD) and left eye (OS), respectively. There was pseudophakia in the OS. Fundus examination in OD was normal and pale optic nerve, attenuated vessels, cystoid macular edema, and mid-peripheral bony spicules were found in OS. Visual field test showed a ring scotoma in the OS. Macular optical coherence tomography (OCT) and fundus autofluorescence were compatible with cystoid macular edema of the OS. The electroretinogram (ERG) of left eye was flat. Patient's systemic findings included: polyneuropathy and hearing loss. Unilateral presentation of cataract and RP in a patient with a heterozygous pathogenic mutation on the ABHD12 gene is rare. This could be due to mosaicism. Retinal follow-up is warranted in this patient since manifestations may occur later in the contralateral eye. A heterozygous pathogenic mutation on the ABHD12 gene may lead to partial ocular and systemic manifestations of the PHARC syndrome.

Efficacy and Safety of Brolucizumab for Diabetic Macular Edema: The KINGFISHER Randomized Clinical Trial.

Importance: Despite the effectiveness of existing anti-vascular endothelial growth factor (VEGF) therapies, a need remains for further treatment options to improve response rates and/or reduce injection or monitoring frequency in patients with diabetic macular edema (DME). Objective: To evaluate the efficacy and safety of brolucizumab vs aflibercept dosed every 4 weeks in participants with DME. Design, Participants, and Setting: This 52-week, double-masked, phase 3 randomized clinical trial included treatment-naive adults and adults who had previously received anti-VEGF therapy. Data were collected from September 2019 to March 2020, and data were analyzed from April 2020 to February 2021. Intervention: Brolucizumab, 6 mg, intravitreal injection every 4 weeks or aflibercept, 2 mg, intravitreal injection every 4 weeks. Main Outcomes and Measures: Participants were randomized 2:1 to brolucizumab, 6 mg, or aflibercept, 2 mg. The primary end point was change from baseline in best-corrected visual acuity at week 52. Secondary end points were the proportion of participants with a 2-step improvement or greater from baseline in Diabetic Retinopathy Severity Scale score, the proportion of eyes with absence of both subretinal fluid and intraretinal fluid, change from baseline in central subfield thickness, and safety at week 52. Results: A total of 517 participants were randomized to brolucizumab (n = 346) or aflibercept (n = 171); 299 (57.8%) were male, and the mean (SD) age was 60.7 (10.2) years. Brolucizumab was noninferior to aflibercept in best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letter score) change from baseline at week 52 (brolucizumab, 12.2-letter improvement; aflibercept, 11.0-letter improvement; difference, 1.1; 95% CI, -0.6 to 2.9; noninferiority margin, 4; P < .001). Brolucizumab was superior to aflibercept for the proportion of eyes without subretinal and intraretinal fluid (brolucizumab, 144 of 346 [41.6%]; aflibercept, 38 of 171 [22.2%]; difference, 20.0%; 95% CI, 12.5to 28.6; P < .001) and mean central subfield thickness change from baseline at week 52 (brolucizumab, -237.8 µm; aflibercept, -196.5 µm; difference, -41.4; 95% CI, -58.9 to -23.8; P < .001). Incidence of intraocular inflammation was 4.0% (14 of 346) in the brolucizumab arm and 2.9% (5 of 171) in the aflibercept arm, incidence of retinal vasculitis was 0.9% (3 of 346) and 0.6% (1 of 171), respectively, and incidence of retinal vascular occlusion was 0.3% (1 of 346) and 0.6% (1 of 171). One participant in the brolucizumab arm had retinal artery occlusion. Conclusions and Relevance: In these study participants with DME, no clinically meaningful differences in visual outcomes were noted between the brolucizumab and aflibercept arms; some superior anatomic improvements were noted in the brolucizumab arm. No new safety concerns were identified. Trial Registration: ClinicalTrials.gov Identifier: NCT03917472.

Characteristics Upon Presentation of Patients with Type 2 Macular Telangiectasia in Puerto Rico.

OBJECTIVE: To describe the systemic disease associations and clinical features upon initial presentation of a cohort of patients with type 2 macular telangiectasia who live in Puerto Rico. METHODS: A retrospective review of patients with macular telangiectasia was performed in 4 private retina practices in Puerto Rico. The demographic and clinical characteristics were recorded. RESULTS: Twenty-one patients who were diagnosed with macular telangiectasia were included in the analysis. The median age of presentation was 62 years; 86% were female, and all patients were Hispanics. The median visual acuity at presentation was 20/50. A prior medical diagnosis of type II diabetes mellitus was found in 15 (71.4%) patients, essential hypertension in 12 (57.1%), and dyslipidemia in 9 (42.9%). All patients had bilateral disease. The most common ocular findings were the presence of right-angle vessels in 32 (76.2%) eyes and angiographic hyperfluorescence temporal to the fovea, found in 22 (52.4%) of the affected eyes. One eye had evidence of choroidal neovascularization. CONCLUSION: Our cohort showed a higher prevalence of type 2 diabetes in patients with type 2 macular telangiectasia than in other cohorts. It also supports the findings of other studies showing that macular telangiectasia patients are more likely to have type 2 diabetes and hyperlipidemia. However, the increased prevalence of diabetes and hyperlipidemia may be due to selection bias, and further studies are needed to assess the significance of these findings.

Expanding the phenotype of TTLL5-associated retinal dystrophy: a case series.

BACKGROUND: Inherited retinal dystrophies describe a heterogeneous group of retinal diseases that lead to the irreversible degeneration of rod and cone photoreceptors and eventual blindness. Recessive loss-of-function mutations in Tubulin Tyrosine Ligase Like 5 (TTLL5) represent a recently described cause of inherited cone-rod and cone dystrophy. This study describes the unusual phenotypes of three patients with autosomal recessive mutations in TTLL5. Examination of these patients included funduscopic evaluation, spectral-domain optical coherence tomography, short-wavelength autofluorescence, and full-field electroretinography (ffERG). Genetic diagnoses were confirmed using whole exome capture. Protein modeling of the identified variants was performed to explore potential genotype-phenotype correlations. RESULTS: Genetic testing revealed five novel variants in TTLL5 in three unrelated patients with retinal dystrophy. Clinical imaging demonstrated features of sectoral cone-rod dystrophy and cone dystrophy, with phenotypic variability seen across all three patients. One patient also developed high-frequency hearing loss during a similar time period as the onset of retinal disease, potentially suggestive of a syndromic disorder. Retinal structure findings were corroborated with functional measures including ffERG findings that supported these diagnoses. Modeling of the five variants suggest that they cause different effects on protein function, providing a potential reason for genotype-phenotype correlation in these patients. CONCLUSIONS: The authors report retinal phenotypic findings in three unrelated patients with novel mutations causing autosomal recessive TTLL5-mediated retinal dystrophy. These findings broaden the understanding of the phenotypes associated with TTLL5-mediated retinal disease and suggest that mutations in TTLL5 should be considered as a potential cause of sectoral retinal dystrophy in addition to cone-rod and cone dystrophies.

Genetic analysis of patients with nonsyndromic and syndromic retinitis pigmentosa in Puerto Rico: a genetic legacy.

BACKGROUND: Retinitis pigmentosa (RP) is a genetically heterogeneous group of diseases characterized by complete progressive vision loss; it has a prevalence of approximately one in 2500-7000. Patients with RP may have isolated findings, or the disorder can occur as part of a constellation of other abnormalities that, together, are known as syndromic RP. The aim of this study was to describe the results of a genetic analysis of a cohort of Puerto Ricans with a clinical diagnosis of RP. MATERIALS AND METHODS: This was a cross-sectional study with a cohort of 224 Puerto Rican patients who carried a clinical diagnosis of RP. During a local (Puerto Rico) RP convention, the patients were offered genetic analysis. Volunteering patients signed consent forms for the study. Saliva samples were obtained and analyzed. Patients were evaluated by at least one of the authors. Patients with pathogenic mutation(s), according to the panel, were classified as positive and sorted based on the results. RESULTS: Of 224 patients, 161 (71.9%) had pathogenic gene variants associated with IRDs. 54.5% (122/224) of cases were conclusive. More than half (72/122) of these cases are explained by mutations in the BBS1, PDE6B, CNGB1, and USH2A genes. Genetic analysis showed that the highest rate of pathogenic variants in our cohort was found in the BBS1 gene. CONCLUSIONS: This was the first genetic analysis in Puerto Rico of patients with RP. The most common mutation associated with RP was found in the BBS1 gene. The frequency of other pathogenic variants related to RP in Puerto Rico were different to those reported in Spain.

Evaluation of cardiac parameters and other safety outcomes of brolucizumab treatment in patients with neovascular age-related macular degeneration.

This was a prospective, single-dose, single-arm, open-label, non-randomized, multicenter clinical study to determine cardiovascular safety after a single brolucizumab 6 mg intravitreal injection in neovascular age-related macular degeneration patients (N = 14). Electrocardiogram (ECG) data were collected at different time points using 12-lead Holter and standard ECG, and patients were followed up to 8 days (end of study) for any signs of ocular and non-ocular adverse events (AEs). No clinically meaningful changes were observed in cardiac parameters. No patient had a ≥30 msec change from baseline in heart rate-corrected QT using Fridericia's formula (QTcF), and no patient had a new QTcF value of ≥450 msec between 20 and 24 h after treatment. No deaths or serious AEs were reported during the study period. These results are in line with the absence of new cardiovascular safety signal based on the ECG recordings collected over the first year of the pivotal studies performed with brolucizumab in DME. Trial Registration: ClinicalTrials.gov identifier: NCT03954626.

KESTREL and KITE: 52-Week Results From Two Phase III Pivotal Trials of Brolucizumab for Diabetic Macular Edema.

PURPOSE: To compare the efficacy and safety of brolucizumab with aflibercept in patients with diabetic macular edema (DME). DESIGN: Double-masked, 100-week, multicenter, active-controlled, randomized trials. METHODS: Subjects were randomized 1:1:1 to brolucizumab 3 mg/6 mg or aflibercept 2 mg in KESTREL (n = 566) or 1:1 to brolucizumab 6 mg or aflibercept 2 mg in KITE (n = 360). Brolucizumab groups received 5 loading doses every 6 weeks (q6w) followed by 12-week (q12w) dosing, with optional adjustment to every 8 weeks (q8w) if disease activity was identified at predefined assessment visits; aflibercept groups received 5 doses every 4 weeks (q4w) followed by fixed q8w dosing. The primary endpoint was best-corrected visual acuity (BCVA) change from baseline at Week 52; secondary endpoints included the proportion of subjects maintained on q12w dosing, change in Diabetic Retinopathy Severity Scale score, and anatomical and safety outcomes. RESULTS: At Week 52, brolucizumab 6 mg was noninferior (NI margin 4 letters) to aflibercept in mean change in BCVA from baseline (KESTREL: +9.2 letters vs +10.5 letters; KITE: +10.6 letters vs +9.4 letters; P < .001), more subjects achieved central subfield thickness (CSFT) <280 µm, and fewer had persisting subretinal and/or intraretinal fluid vs aflibercept, with more than half of brolucizumab 6 mg subjects maintained on q12w dosing after loading. In KITE, brolucizumab 6 mg showed superior improvements in change of CSFT from baseline over Week 40 to Week 52 vs aflibercept (P = .001). The incidence of ocular serious adverse events was 3.7% (brolucizumab 3 mg), 1.1% (brolucizumab 6 mg), and 2.1% (aflibercept) in KESTREL; and 2.2% (brolucizumab 6 mg) and 1.7% (aflibercept) in KITE. CONCLUSION: Brolucizumab 6 mg showed robust visual gains and anatomical improvements with an overall favorable benefit/risk profile in patients with DME.

Reactivation of Acute Retinal Necrosis following SARS-CoV-2 Infection.

PURPOSE: To report on a case of reactivation of acute retinal necrosis following SARS-CoV-2 infection. METHODS: Observational case report. Observations. A 32-year-old female with a distant history of left retinal detachment secondary to necrotizing herpetic retinitis complained of right-eye vision loss, pain, redness, and photophobia. An ophthalmological examination revealed findings consistent with acute retinal necrosis of the right eye. A polymerase chain reaction (PCR) analysis of the right vitreous was positive for herpes simplex virus type 2 (HSV-2). A coronavirus disease 2019 (COVID-19) screening test using reverse transcriptase- (RT-) PCR was positive for SARS-CoV-2 RNA. CONCLUSIONS: Our case suggests that COVID-19 may cause a latent HSV infection to reactivate, causing contralateral involvement in patients with a prior history of HSV-associated acute retinal necrosis.

Evaluation of Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy: Results From the PANORAMA Randomized Clinical Trial.

IMPORTANCE: Proactive treatment of nonproliferative diabetic retinopathy (NPDR) reduces the risk of progression to vision-threatening complications. OBJECTIVE: To evaluate vascular endothelial growth factor blockade therapy with intravitreal aflibercept injections in eyes with severe NPDR without diabetic macular edema (DME). DESIGN, SETTING, AND PARTICIPANTS: The Study of the Efficacy and Safety of Intravitreal Aflibercept for the Improvement of Moderately Severe to Severe Nonproliferative Diabetic Retinopathy (PANORAMA) was a double-masked 100-week randomized clinical trial conducted in multiple centers worldwide. The study included 402 adults with Diabetic Retinopathy Severity Scale (DRSS) level 47 or 53 with no DME and best-corrected visual acuity of 20/40 or better. INTERVENTIONS: Intravitreal injections of aflibercept, 2 mg, every 16 weeks after 3 initial monthly doses and one 8-week interval (aflibercept 2q16 group); intravitreal injections of aflibercept, 2 mg, every 8 weeks after 5 initial monthly doses, with pro re nata (PRN) dosing beginning at week 56 (aflibercept 2q8/PRN group); or sham injections (control group). MAIN OUTCOMES AND MEASURES: Proportions of eyes with a 2-step or greater improvement in DRSS level, vision-threatening complications, and center-involved DME from baseline to weeks 24, 52, and 100. RESULTS: Among 402 participants (1 eye per participant), the mean (SD) age was 55.7 (10.5) years; 225 (56.0%) were male, and 310 (77.1%) were White. A total of 135 were randomized to the aflibercept 2q16 group, 134 to the aflibercept 2q8/PRN group, and 133 to the control group. At 24 weeks, treatment with aflibercept resulted in a 2-step or greater improvement in DRSS level in 157 of 269 eyes (58.4%) in the combined aflibercept groups vs 8 of 133 eyes (6.0%) in the control group (adjusted difference, 52.3%; 95% CI, 45.2%-59.5%; P < .001). At 52 weeks, 88 of 135 eyes (65.2%) in the aflibercept 2q16 group (adjusted difference, 50.1%; 95% CI, 40.1%-60.1%) and 107 of 134 eyes (79.9%) in the aflibercept 2q8/PRN group (adjusted difference, 64.8%; 95% CI, 55.8%-73.9%) compared with 20 of 133 eyes (15.0%) in the control group (P < .001 for both comparisons) showed a 2-step or greater improvement in DRSS level. Fewer eyes treated with aflibercept vs sham injections developed vision-threatening complications and/or center-involved DME through week 100 (22 of 135 eyes [16.3%] in the 2q16 group [adjusted difference, -34.2%; 95% CI, -44.6 to -23.8] and 25 of 134 eyes [18.7%] in the 2q8/PRN group [adjusted difference, -31.7%; 95% CI, -42.5 to -20.9] compared with 67 of 133 eyes [50.4%] in the control group; P < .001 for both comparisons). No new safety signals were identified. CONCLUSIONS AND RELEVANCE: In this study, significantly more eyes with moderately severe to severe NPDR that were treated with aflibercept showed a 2-step or greater improvement in DRSS level at 24, 52, and 100 weeks, and significantly fewer eyes treated with aflibercept vs sham developed vision-threatening complications and center-involved DME. Outcomes on the DRSS between year 1 and 2 emphasize the need for ongoing vascular endothelial growth factor suppression and adherence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02718326.

Optical coherence tomography angiography findings in macular toxoplasma retinochoroiditis: A case report.

PURPOSE: To report the optical coherence tomography angiography (OCT-A) findings in a patient with macular toxoplasma retinochoroiditis (TRC). OBSERVATIONS: A 14-year old female presented with a 2-week history of decreased vision of her right eye. Upon presentation, on the right eye, visual acuity was 20/200 and the fundus revealed 2+ vitritis and an active parafoveal area of retinitis superotemporally. Toxoplasma serology revealed positive IgG and negative IgM. Initial treatment consisted of intravitreal clindamycin (1.0mg in 0.1 mL) with dexamethasone (1.0 mg in 0.1 mL) along with oral trimethoprim/sulfamethoxazole, azithromycin and prednisone; of which the trimethoprim/sulfamethoxazole was discontinued 4 days into therapy due to a pruritic rash. Six-weeks after the presentation, the oral prednisone had been tapered off, and all therapy discontinued. The patient had complete resolution of TRC and recovered 20/20 vision. OCT-A analysis of the right macula, performed after completion of treatment, revealed preservation of foveal perfusion along a parafoveal area of ischemia, superotemporally, at the superficial and deep retinal vascular complexes, including the choriocapillaris. CONCLUSION AND IMPORTANCE: In macular TRC, OCT-A may help to assess therapeutic outcomes from a vascular perspective. To our knowledge, our case represents the first description in the medical literature of OCT-A findings in macular TRC.

UNILATERAL NEURORETINITIS AS A LATE-ONSET MANIFESTATION OF THE CHIKUNGUNYA FEVER: A CASE SERIES.

PURPOSE: To report 3 cases of unilateral neuroretinitis associated with the chikungunya fever (CHIKV). METHODS: Retrospective noncomparative case series. RESULTS: Three female patients with similar complains of blurry vision and decreased visual acuity that started several weeks after experiencing symptoms of the CHIKV. All patients had decreased best-corrected visual acuity and distortion on the Amsler grid in the affected eye. Evidence of unilateral optic nerve swelling and macular exudates was noted in all patients. No pharmacologic therapy was given. At 2-month follow-up evaluation, all patients had regained at least 3 lines in the Snellen chart, and subretinal fluid and optic nerve swelling had resolved. CONCLUSION: Unilateral neuroretinitis can present as a late-onset manifestation of CHIKV. Three patients with diagnosis of CHIKV developed unilateral neuroretinitis weeks after the acute viral syndrome, suggesting a possible immunological etiology for this manifestation. To our knowledge, this is the first case series of CHIKV leading to neuroretinitis in the Western World.

SPONTANEOUS CLOSURE OF A FULL-THICKNESS MACULAR HOLE SECONDARY TO IRVINE-GASS SYNDROME.

PURPOSE: To report a case of spontaneous closure of a full-thickness macular hole after a posterior subtenon injection of triamcinolone in a patient with Irvine-Gass syndrome. METHODS: Case report and literature review. RESULTS: A 70-year-old man presented to the retina clinic with visual disturbance in his right eye after an uneventful cataract surgery. Patient was found to have macular edema associated with a full-thickness macular hole, treated with a posterior subtenon injection of triamcinolone with subsequent spontaneous closure of the hole and excellent visual acuity. CONCLUSION: This case demonstrates possible resolution of a condition which traditionally requires surgical intervention, with a nonsurgical approach.

Acute retinal necrosis secondary to herpes simplex virus type 2 in neonates.

Acute retinal necrosis (ARN) should be in the differential diagnosis of a neonate who presents with vitritis. This report includes three cases of neonatal ARN at the Bascom Palmer Eye Institute from 2004 to 2009. Medical treatment with acyclovir helped reduce sequelae of herpes simplex virus (HSV) 2 infection. Patients with ARN are at risk for retinal detachment and blindness. Although mothers are screened during pregnancy, they are at risk of reactivation or primary contraction of HSV. A neonate presenting with vitritis should raise suspicion of ARN.

Unilateral choroidal neovascular membrane as a herald lesion for Crohn's disease.

Crohn's disease is a diffuse inflammatory disease primarily affecting the gastrointestinal tract but with associated ophthalmologic complications that often appear after the initial diagnosis. The authors report a case in which the appearance of a choroidal neovascular membrane prior to the final diagnosis of Crohn's disease suggests its role as an advance lesion heralding an inflammatory state. A 13-year-old boy was referred for evaluation of a clinically isolated, unilateral choroidal neovascular membrane, which stabilized after treatment with intravitreal bevacizumab. Two years later, the patient was diagnosed with Crohn's disease. Choroidal neovascular membranes, reported previously as a complication of Crohn's disease following diagnosis, may be a precursor lesion.

Endophthalmitis caused by Achromobacter xylosoxidans after cataract surgery.

PURPOSE: To report Achromobacter xylosoxidans as a cause of both acute-onset and delayed-onset postoperative endophthalmitis after cataract surgery. METHODS: A noncomparative consecutive case series of patients with culture-proven A. xylosoxidans endophthalmitis between 1970 and 2012. Cataract surgery and intraocular lens placement were performed in all patients before endophthalmitis. Positive cultures were obtained from the vitreous, capsular bag, and/or the removed intraocular lens. RESULTS: The clinical diagnosis was confirmed in four patients with positive cultures. Two patients with endophthalmitis had a preliminary culture report of Pseudomonas species. In addition to receiving intravitreal antibiotics, all patients underwent capsulectomy and intraocular lens removal at the time of pars plana vitrectomy. Visual acuity at last follow-up was 20/40 or better in 2 (50%) of the 4 patients, but the remaining 2 patients were 20/200 or worse. CONCLUSION: A. xylosoxidans may be a cause of acute, recurrent, and delayed-onset postoperative endophthalmitis after cataract surgery. Complete capsulectomy and intraocular lens removal can be considered in recurrent and recalcitrant patients.

Management of 2 intraocular lenses in the same eye.

OBJECTIVE: To present options for managing a patient with a dislocated intraocular lens (IOL) in the presence of a second, nondislocated IOL. METHODS: A review of 3 consecutive cases and the surgical maneuvers used in managing them. RESULTS: The anterior chamber IOL was removed after scleral fixating the dislocated posterior chamber IOL in 1 case with corneal disease. The foldable, dislocated, original posterior chamber IOL was manipulated around an existing posterior chamber IOL and then removed at the limbus in 2 other cases. The visual acuity and retained IOL were stable in all 3 eyes. CONCLUSIONS: Existing techniques with minimal modifications can be applied to managing an eye with a dislocated IOL and a coexisting nondislocated IOL with satisfactory results, but treatment needs to be customized to the specific situation.

Low-dose methotrexate for the treatment of chronic central serous chorioretinopathy: a retrospective analysis.

PURPOSE: To evaluate the utility of oral methotrexate (MTX) for the treatment of chronic central serous chorioretinopathy (CSCR). METHODS: Retrospective review of all eyes of patients on oral MTX as treatment for chronic CSCR in three different centers. Visual acuity as well as optical coherence tomography central macular thickness and total volume parameters were analyzed. Complete blood count and serum chemistry results were monitored. RESULTS: Nine eyes of 9 patients treated with MTX for chronic CSCR met the criteria for analysis. Mean duration of CSCR was 28 months (range, 3-94 months). Mean starting dose of oral MTX was 7.04 mg (range, 5-10 mg), and mean final dose was 7.27 mg (range, 5-10 mg). The mean duration of treatment was 89 days. Mean visual acuity improved from 20/67 at baseline to 20/35 at 8 weeks (P < 0.01, paired t-test). Mean central macular thickness improved from 309 µm to 213 µm at 8 weeks (P < 0.01, paired t-test). Mean total macular volume improved from 8.14 to 7.21 at 8 weeks (P ≤ 0.02, paired t-test). Eighty-three percent of the patients achieved total resolution of subretinal fluid. No MTX-associated toxicity was evident. CONCLUSION: Methotrexate may have a role in the treatment of chronic CSCR as evidenced by these results. A randomized controlled clinical trial is warranted to better understand the effects of MTX in these patients.

Minimal refractive change induced by sutureless 23- and 25-gauge pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: This study reports the induced refractive error after 23- and 25-gauge (G) pars plana vitrectomy (PPV). PATIENTS AND METHODS: In this non-randomized retrospective case series, refractive status was assessed with an autokeratorefractometer 1 week or more before and 6 months after surgery. Patients who had suture placement to close the sclerotomies were excluded from the study. RESULTS: Among the 50 patients (50 eyes), the mean age was 63 years (range: 42 to 76 years) and 57% were female. Thirty eyes underwent 23-G PPV and 20 eyes underwent 25-G PPV. The mean refractive change was +0.50 diopters (D) sphere, +0.25 D cylinders and the mean axis of cylinder change was 6° for the 23-G group; the mean refractive change was +0.12 D sphere, +0.12 D cylinders and the mean axis of cylinder change was 17° for the 25-G group. CONCLUSION: Following sutureless small-gauge vitrectomy, there were mild and minimally significant refractive changes in the 23-G and 25-G groups from baseline.

Posterior subhyaloid precipitates in cytomegalovirus retinitis.

PURPOSE: This study aims to report a novel finding of posterior subhyaloid precipitates (PSPs) in two patients with cytomegalovirus (CMV) retinitis. METHODS: A small case series was conducted. RESULTS: Clinical findings, treatment, and follow-up of two patients with CMV and PSPs are presented. CONCLUSIONS: Inflammatory precipitates may collect in the posterior subhyaloid space in acute CMV retinitis and resolve with treatment.