Morphological outcome and indication for laser following intravitreal bevacizumab monotherapy for posterior retinopathy of prematurity.

The purpose of this study is to determine the natural course of retinal vascular development and recurrence requiring laser in eyes receiving intravitreal bevacizumab (IVB) for posterior retinopathy of prematurity (ROP). Data of babies receiving IVB for posterior ROP was retrospectively analyzed. Birth weight, gestational age (GA) and post-menstrual age (PMA) at injection, need for laser, retinal maturation, and their timing were recorded. The study included 63 eyes of 32 babies, born at a median GA of 31 (IQR 29-32) weeks, and birth weight 1410 (1280-1697.5) g. Aggressive posterior ROP was seen in 36 (57%) eyes and staged ROP in 27 (43%). IVB was injected at a median PMA of 36 (34.5-37) weeks. Complete retinal vascularization was seen in 33 (52.4%) at a median PMA of 52 (47-60) weeks, prophylactic laser was needed in 17 (27%) at 61 (55.5-63) weeks, and only 13 (20.6%) eyes had recurrence needing treatment laser, at 42 (39-57) weeks respectively. Babies requiring laser had a significantly lower birth weight (p = 0.033) and received injection earlier (p = 0.08). Retinal vascular development progresses with IVB monotherapy with 21% of eyes developing recurrence that requires laser in this subset of Indian babies. Following IVB, monotherapy laser can be selectively performed only in cases with recurrence or failure to mature.

Gradual resolution of foveal herniation after epiretinal membrane peeling.

We demonstrate the gradual resolution of foveal herniation with optical coherence tomography (OCT) images after epiretinal membrane (ERM) removal. A young male presented with diminished vision in the left eye (OS). Examination of OS revealed an ERM and thickening of the foveal region. OCT delineated the ERM clearly. It also showed a central defect in the ERM through which the inner retinal layers had prolapsed into the vitreous cavity leading to foveal herniation. The patient underwent vitrectomy and surgical removal of the ERM. After removing the source of macular traction, over a period of 4 months, gradual reduction in height of the elevated central foveal tissue was observed. At 6 months, the foveal bulge had reduced remarkably and remained stable. The resolution of foveal herniation after ERM removal is a slow process. The OCT images convey that it may take few months for the foveal bulge to decrease in height. When the outer retinal layers are normal, visual recovery, though delayed, is appreciable.

Non-proliferative type II macular telangiectasia variant with subfoveal detachment: role of anti-VEGF therapy.

AIMS: To describe a rare variant of non-proliferative stage of type II macular telangiectasia (MacTel2) with the presence of subfoveal detachment (SFD) and its response to intravitreal antivascular endothelial growth factor (VEGF) therapy. METHODS: A retrospective case series of patients diagnosed with a rare variant of non-proliferative MacTel2 (defined as MacTel2 with the presence of SFD on optical coherence tomography (OCT) in the absence of subretinal neovascularisation, confirmed on fluorescein angiography (FA)) over a period of 2 years. Patients were studied with biomicroscopy, OCT and FA. Patients were managed either with observation or anti-VEGF therapy. RESULTS: Twenty eyes of 13 patients, all female with a mean age of 52.2±6.1 years, were diagnosed with this variant of non-proliferative MacTel2. The best-corrected visual acuity at presentation ranged from 20/20 to 20/120. Six eyes were lost to follow-up. Eight eyes were kept under observation for a mean follow-up of 7.3±2.2 months and did not show resolution. Eight eyes underwent anti-VEGF therapy with a mean number of intravitreal injections of 2±1.07 per eye during a mean follow-up of 9.38±5.5 months. All eyes showed complete resolution of SFD, with a visual improvement of ≥1 line of Snellen's acuity in 87.5% of the eyes. CONCLUSION: This is the largest series of a variant of non-proliferative MacTel2 with SFD, which shows good anatomical and functional response to anti-VEGF therapy, in comparison to observation alone. Careful evaluation of the OCT images may be helpful in predicting the visual prognosis with anti-VEGF therapy.

Persistent macular detachment after successful macular hole closure and its management in an emmetropic eye.

Macular hole with a concomitant macular detachment is unusual in emmetropic eyes. A middle aged women was operated for a full thickness macular hole with inverted flap technique. There was persistence of subretinal fluid for 4 months even after the hole was successfully closed. A second surgery was performed to remove the highly viscous subretinal fluid. This report highlights the technical difficulties in managing such cases. This case also highlights the need for recognition of coexisting pathologies before deciding the surgery.

Peripheral retinal avascularity and capillary leakage in central serous chorioretinopathy.

PURPOSE: To report a novel finding of peripheral retinal avascularity (PRA) and peripheral capillary leakage (PCL) on wide-field fluorescein angiography (WFA) in non-dependent quadrants, in eyes with bilateral chronic central serous chorioretinopathy (CSCR). METHODS: Forty six patients with bilateral CSCR were studied. Four patients had PRA and PCL, and 42 patients did not. The demographic profile, clinical findings, and imaging characteristics of the two groups were compared. RESULTS: There was no significant difference between those patients with and without PRA and PCL with respect to the demographic profile, clinical findings, and imaging characteristics. Laser photocoagulation to extrafoveal points of leakage seen on fluorescein angiography (FA) was sufficient to cause complete resolution of CSCR in these 4 patients. PRA areas were not treated. CONCLUSION: The PRA and PCL in CSCR are novel findings, which have not been previously described.

Combined Parafoveal Telangiectasia, Multifocal Central Serous Chorioretinopathy, and Choroidal Hemangioma.

The exact pathogenesis of parafoveal telangiectasia (PFT) is unknown, but various associations have been reported in literature such as diabetes and hypertension. Coexisting pathologies like diabetic retinopathy with PFT are not uncommon. We encountered a unique combination of PFT with multifocal central serous chorioretinopathy and choroidal hemangioma in a patient with diabetes mellitus. Multimodal imaging confirmed the findings and focal treatment to central serous chorioretinopathy leaks led to resolution of the subretinal fluid. This unique combination has been rarely reported so far. The long-term follow-up of such cases can help us to understand if there exists common pathogenesis of these varied diseases.

Influence of orientation of the external linear incision created by the 25-gauge trocar and related factors on sclerotomy closure: A clinical and optical coherence tomographic study.

PURPOSE: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). METHODS: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. RESULTS: Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ≥5 when circumferential sclerotomies were used. CONCLUSION: Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.

Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body.

A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade under steroid cover. With continued use of systemic and topical steroids after surgery, complete resolution of FBA and improvement in vision were noted in a week. Prompt resolution of FBA after IOFB removal points toward a strong association between the presence of IOFB and FBA.

Vitrectomy for vitreopapillary traction in a nondiabetic 16-year-old girl.

Vitreopapillary traction (VPT) is an unusual clinical entity and its management and prognosis have been sparsely studied. It has been described in adults with various vitreomacular pathologies and the possible effects on visual functions. However, the role of surgical intervention in altering the course of the disease is not well understood. Hereby, we describe a case of idiopathic VPT in a 16-year-old girl who presented with decreased vision and visual field changes corresponding to the area of retinal traction. This case was managed with pars plana vitrectomy and epiretinal membrane removal that resulted in improved visual field sensitivity; thus, emphasizing the role of surgical intervention in such eyes.