Clinical significance of signal shadowing during intraoperative optical coherence tomography-assisted vitreoretinal surgery.

This study aimed to analyze the clinical significance of signal shadowing during intraoperative optical coherence tomography (iOCT)-assisted vitreoretinal surgery caused by vitreoretinal instruments, tissue dyes, and vitreous substitutes, and to objectively quantify its impact on iOCT imaging. This is a retrospective observational study of postoperative image analysis from one hundred seventeen (117) patients who underwent iOCT-assisted vitrectomy. The image data were divided into three groups: vitreoretinal instruments, tissue dyes, and vitreous substitutes. The data was then processed using graphic software to measure the grade of picture quality distortion and compared to paired image controls without clinically perceptive interference, then analyzed statistically. The intraocular portion of all studied vitreoretinal instruments caused a high average gray level interference compared to controls ranging from 32 to 68% reduction, obscuring the area of interest significantly. The tips of the instruments produced low-grade shadowing, allowing the underlying tissue to be distinguished. The analyzed dyes demonstrated a wide interference range: ICG (- 75.12%), and triamcinolone (- 26.13%) showed dose-dependent high shadowing, while VITREODYNE™ (49.3%) and brilliant blue G (14.06%) exhibited no perceived distortions whilst increasing average gray levels. All analyzed vitreous substitutes (air, SF6, C3F8, PFCL, and silicone oil) showed an insignificant shadowing effect on iOCT. Certain dyes and vitreous substitutes produce a negligible shadowing effect compared to controls and other dyes, providing an advantage during real-time iOCT imaging. All analyzed vitreoretinal instruments showed a significant interference that should prompt the development of new imaging techniques or the implementation of materials with low-grade interference to overcome a clinically relevant shadowing effect on iOCT, maximizing the technology's visual accuracy and surgical diagnostic aid proficiency.

[Role of vitreous in the pathogenesis of neovascular age-related macular degeneration]. / Die Rolle des Glaskörpers in der Pathogenese der exsudativen altersabhängigen Makuladegeneration.

Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA.

[Vitreous body in the treatment of exudative age-related macular degeneration : The medium is the message]. / Glaskörper bei der Therapie der exsudativen altersabhängigen Makuladegeneration : Das Medium ist die Message.

BACKGROUND: Intravitreal anti-vascular endothelial growth factor (VEGF) is the standard treatment for exudative age-related macular degeneration (AMD). The constitution of the vitreomacular interface varies greatly in cases of attached (with or without traction) or detached vitreous body, which can impact the effectiveness of the anti-VEGF treatment. OBJECTIVE: Based on the current literature this article displays the current state of the science on whether the constitution of the vitreous body has an effect on the anti-VEGF treatment. MATERIAL AND METHODS: The published data extracted from current trials and post hoc analyses concerning this topic are presented and put into the clinical context. RESULTS: The presence of a vitreomacular adhesion reduces the efficacy of anti-VEGF treatment of exudative AMD. Posterior vitreous body detachment represents a positive prognostic factor concerning the efficacy of anti-VEGF treatment but not necessarily the prognosis for visual acuity. CONCLUSION: Patients with attached vitreous body need a more intensive treatment monitoring compared to patients with detached vitreous body. Therefore, in eyes with initial posterior vitreous body detachment receiving a treat and extend regimen, the interval between anti-VEGF injections can be extended to 4 instead of 2 weeks without endangering the success of treatment.

[Vitreoretinal surgery in age-related macular degeneration]. / Vitreoretinale Chirurgie bei altersabhängiger Makuladegeneration.

The structure of the vitreous body, its interaction with the retinal surface and tractive alterations of the vitreoretinal interface may play a role in the pathogenesis and the development of age-related macular degeneration (AMD). From clinical trials it can be concluded that posterior vitreous detachment (PVD) or vitreous removal may protect against the development of neovascular AMD. Vitreomacular adhesions may promote neovascular AMD and may have an impact on the efficacy and frequency of intravitreal vascular endothelial growth factor (VEGF) inhibition. Therefore, vitreomacular surgery may be considered as a treatment option in selected cases. Peeling of epimacular membranes and the internal limiting membrane (ILM) may contribute to stabilizing visual acuity and reducing the treatment burden of current intravitreal pharmacotherapy. At present, surgical interventions in AMD are mainly performed in cases of submacular hemorrhage involving the fovea. The treatment is not standardized and consists of liquefaction of the blood using recombinant tissue plasminogen activator (rTPA) and its pneumatic displacement, potentially combined with VEGF inhibition. Other submacular surgical strategies, such as choroidal neovascularization (CNV) extraction, macular translocation or transplantation of retinal pigment epithelium (RPE) are currently limited to selected cases as a salvage treatment; however, the development of these submacular surgical interventions has formed the basis for new approaches in the treatment of dry and neovascular AMD including submacular or intravitreal gene and stem cell therapy.

Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis.

INTRODUCTION: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. METHODS: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. RESULTS: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = - 0.58, 95% CI = - 1.16 to 0.00) and post-op (SMD = - 0.45, 95% CI = - 0.60 to - 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = - 0.15 to 1.13). CONCLUSION: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.

Subretinal Implantation of RPE on a Carrier in Minipigs: Guidelines for Preoperative Preparations, Surgical Techniques, and Postoperative Care.

Degenerative disorders of the retina (including age-related macular degeneration), which originate primarily at or within the retinal pigmented epithelial (RPE) layer, lead to a progressive disorganization of the retinal anatomy and the deterioration of visual function. The substitution of damaged RPE cells (RPEs) with in vitro cultured RPE cells using a subretinal cell carrier has shown potential for re-establishing the anatomical structure of the outer retinal layers and is, therefore, being further studied. Here, we present the principles of a surgical technique that allows for the effective subretinal transplantation of a cell carrier with cultivated RPEs into minipigs. The surgeries were performed under general anesthesia and included a standard lens-sparing three-port pars plana vitrectomy (PPV), subretinal application of a balanced salt solution (BSS), a 2.7 mm retinotomy, implantation of a nanofibrous cell carrier into the subretinal space through an additional 3.0 mm sclerotomy, fluid-air exchange (FAX), silicone oil tamponade, and closure of all the sclerotomies. This surgical approach was used in 29 surgeries (18 animals) over the past 8 years with a success rate of 93.1%. Anatomic verification of the surgical placement was carried out using in vivo fundus imaging (fundus photography and optical coherence tomography). The recommended surgical steps for the subretinal implantation of RPEs on a carrier in minipig eyes can be used in future preclinical studies using large-eye animal models.

Retinal detachment during COVID-19 era: a review of challenges and solutions.

Background: Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, there have been obstacles in the proper diagnosis and management of many diseases. We evaluated the changes in retinal detachment (RD) presentation and surgery during the COVID-19 pandemic and propose solutions to minimize the detrimental effects of lockdown on RD diagnosis. Materials and methods: PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched for relevant articles with the keywords "Retinal detachment" AND "Coronavirus OR COVID-19 OR SARS OR MERS." Results: The COVID-19 lockdown was associated a 53-66% reduction in RD presentation. The decrease in the rate of macula-on RD, the increase in the mean duration of symptoms, and the rise in the number of patients with proliferative vitreoretinopathy were all suggestive of a delayed presentation of RD. Moreover, a drop of 56-62% in RD repair surgeries was observed. However, the most frequently performed ophthalmic surgery changed from cataract surgery in April 2019 to RD repair in April 2020. Using phacovitrectomy instead of vitrectomy alone can reduce the number of operations in ophthalmology centers, decrease the use of personal protective equipment by 50%, and cut costs per patient by 17-20%. Also, developing a well-organized telemedicine system can decrease unnecessary visits and delayed presentations. Conclusion: Delay in RD presentation and surgery is associated with a poorer prognosis. Optimizing the guidelines of RD management and developing a well-organized telemedicine system can minimize the impact of lockdown on RD management.

Novel Needle for Intravitreal Drug Delivery: Comparative Study of Needle Tip Aspirates, Injection Stream and Penetration Forces.

PURPOSE: To study the efficacy of a novel needle for intravitreal injection (IVI) in comparison to the conventional needle under experimental conditions. METHODS: The newly designed 30-gauge (G) needle (NDN) (EP 18158 542.3, patent pending) with occluded outer orifice and a side port for drug delivery was compared to the conventional standard hypodermic 30 G needle for IVI (SHN). An animal study to obtain needle tip aspirates was performed on 10 albino rat eyes. During IVIs, cellular content, which was cut by the needle tip, was aspirated. Cellular material was studied in regard to cell types and their quantity. The injection stream was studied using trypan blue dye in vitro and pig cadaver eyes. The penetration force was tested on polyurethane Testing Foil Strips PU 04 (Melab, Leonberg, Germany) by applying a velocity of 100 mm/min. The results were analyzed using descriptive statistics, correlation matrices and t-test methods with p<0.05 as statistically significant. RESULTS: Cytological analysis of the needle aspirates showed the presence of cellular content in each case. The amount of conjunctival, ciliary body epithelial cells and granulated basophilic protein sediments (sign of cellular damage) in the case of the NDN tips was significantly lower compared to the SHN. The average penetration force of the NDN was 0.791 N, and in the case of the SHN was 0.566 N. The injection stream study revealed a difference in the initial injection phase between the two needle types, although the diffuse filling of the vitreous area which surrounded the needle tip appeared to be similar. DISCUSSION: The NDN demonstrated superior performance with regard to a significantly reduced number of cells being captured by the needle tip. Delivery of the injected fluid into the vitreous cavity was comparable. In order to investigate superior properties of the NDN needle design, further studies with improved prototypes would be necessary.

Biometric technology in "no-gate border crossing solutions" under consideration of privacy, ethical, regulatory and social acceptance.

Biometric technologies have become the main focus in the design of state-of-the-art border security solutions. While respective research in the field of multimedia vision has been centred around improving quality and accuracy of identity recognition, the impact of such technologies upon society and legal regulations still remains a topic unaddressed, specifically within the engineering community. Research in technology can and in some respect must include collaboration with social sciences and social practice. Building on participation in the EU funded research project PERSONA [18] (Privacy, Ethical, Regulatory and SOcial No-gate crossing point solutions Acceptance), authors of this paper look at the challenges associated with biometrics-based solutions in no-gate border crossing point scenarios. This included the procedures needed for the assessment of their social, ethical, privacy and regulatory acceptance, particularly in view of the impact on both, the passengers and border control authorities as well as the potential pitfalls of biometric technology due to fraudulent activities. In consultation with the collaborating border control authorities, the paper reports on the formal assessment of biometric technologies for real-world acceptance to cope with the increasing demand of global travellers crossing state borders.

Dynamic intraoperative optical coherence tomography for inverted internal limiting membrane flap technique in large macular hole surgery.

BACKGROUND/OBJECTIVES: To assess the efficacy of dynamic intraoperative spectral-domain optical coherence tomography (iSD-OCT) imaging for inverted internal limiting membrane (ILM) flap technique (IILMFT) in large macular hole (MH) surgery. SUBJECTS/METHODS: Prospective, non-randomized, observational study was conducted on 8 eyes of 7 patients with large, chronic and recurrent MHs, which were treated by pars plana vitrectomy (PPV) with IILMFT. All patients underwent standard pre- and postoperative examination. The iSD-OCT imaging was performed using microscope integrated systems before, during, and after ILM peeling. The iSD-OCT data were post-processed using graphic software and reviewed for tissue behavior and instruments position. RESULTS: The real-time iSD-OCT-assisted IILMFT allowed for real-time imaging of the entire surgery with visualization of the MH, vitreoretinal instruments, and all steps of inverted ILM flap formation. In spite of shadowing created by the steel instruments, it was possible to follow and control the distance between the instrument tips and retinal layers. Dynamic imaging of the surgical maneuvers including ILM peeling and mechanical apposition of MH edges revealed the iatrogenic impact on the retina (depression and appearance of hyporeflective zones). iSD-OCT imaging could confirm the proper position of the inverted ILM flap at the very end of the surgery after fluid-air exchange. CONCLUSIONS: iSD-OCT imaging is an effective tool for learning and performing a well-controlled and safe inverted ILM flap technique in patients with large MH. Clinical significance of the structural iSD-OCT findings has to be further studied.

New Scleral Depressor Marker for Retinal Detachment Surgery.

PURPOSE: To report the efficacy of the use of a new scleral depressor marker during scleral buckling surgery for retinal detachment. DESIGN: Noncomparative, consecutive case series study. PARTICIPANTS: Eleven patients (11 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling surgery performed by 2 experienced vitreoretinal surgeons. METHODS: The prototype of a new indenter marker was used during scleral buckling surgery. MAIN OUTCOME MEASURES: The possibility of performing simultaneous indentation and selected marking of the desired area was assessed. Additionally, the precision of the fiber light-assisted indentation as well as force of indentation were evaluated. RESULTS: The use of a new depressor marker facilitated a quick and effective flow of the standard surgery for retinal detachment. It was possible to perform indentation and marking as separate steps of 1 session. Only desired areas of the sclera were marked during the same indentation session. The indentation required less force. When combined with chandelier light, the precision of the marking was improved as demonstrated by a light from the chandelier indicating the highest point of the indentation area. There were no complications related to the use of the new instrument. CONCLUSIONS: The newly developed scleral depressor marker facilitated simultaneous indentation and marking on the sclera. The new instrument allowed for the selective marking of the desired areas during the same session of indentation. Additionally, it can be combined with chandelier fiber light, which improves the precision of the marking.

Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments.

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let fluid pass from the vitreous cavity to the subretinal space. Pars plana vitrectomy (PPV), scleral buckling surgery and pneumatic retinopexy are three accepted management strategies whose efficacy remains controversial. Pneumatic retinopexy is considered in a separate Cochrane Review. OBJECTIVES: The primary objective of this review was to assess the efficacy of PPV versus scleral buckling for the treatment of simple RRD (primary RRD of any extension with up to two clock hours large break(s) regardless of their anterior/posterior localisation) in people with (phakia) or without (aphakia) a natural lens in the eye, or with an artificial lens (pseudophakia). A secondary objective was to assess any data on economic and quality-of-life measures. SEARCH METHODS: We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 5 December 2018. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing PPV versus scleral buckling surgery with at least three months of follow-up. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. Two review authors independently extracted the data and study characteristics from the studies identified as eligible after initial screening. We considered the following outcomes: primary retinal reattachment, postoperative visual acuity, final anatomical success, recurrence of retinal detachment, number of interventions needed to achieve final anatomical success, quality of life and adverse effects. We assessed the certainty of evidence using GRADE. MAIN RESULTS: This review included 10 RCTs (1307 eyes of 1307 participants) from Europe, India, Iran, Japan and Mexico, which compared PPV and scleral buckling for RRD repair. Two of these 10 studies compared PPV combined with scleral buckling with scleral buckling alone (54 participants). All studies were high or unclear risk of bias on at least one domain. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.There was little or no difference in the proportion of participants who achieved retinal reattachment at least 3 months after the operation in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16; 9 RCTs, 1261 participants, low-certainty evidence). Approximately 67 in every 100 people treated with scleral buckling had retinal reattachment by 3 to 12 months. Treatment with PPV may result in 4 more people with retinal reattachment in every 100 people treated (95% confidence interval (CI) 2 fewer to 11 more).There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10, 6 RCTs, 1138 participants, low-certainty evidence).There was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR 1.01, 95% CI 0.99 to 1.04, 9 RCTs, 1235 participants, low-certainty evidence). There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.Retinal redetachment was reported in fewer participants in the PPV group compared to the scleral buckling group (RR 0.75 (95% CI 0.59 to 0.96, 9 RCTs, 1320 participants, low-certainty evidence). Approximately 28 in every 100 people treated with scleral buckling had retinal detachment by 3 to 36 months. Treatment with PPV may result in seven fewer people with retinal detachment in every 100 people treated (95% CI 1 to 11 fewer).Participants treated with PPV on average needed fewer interventions to achieve final anatomical success but the difference was small and data were skewed (MD -0.20, 95% CI -0.34 to -0.06, 2 RCTs, 682 participants, very low-certainty evidence).Very low-certainty evidence on quality of life suggested that more people in the PPV group were "satisfied with vision" compared with the scleral buckling group (RR 6.22, 95% CI 0.88 to 44.09, 1 RCT, 32 participants).All included studies reported adverse effects, however, it was not always clear whether they were reported as number of participants or number of adverse effects. Cataract development or progression was more prevalent in the PPV group (RR 1.71, 95% CI 1.45 to 2.01), choroidal detachment was more prevalent in the scleral buckling group (RR 0.19, 95% CI 0.06 to 0.65) and new/iatrogenic breaks were observed only in the PPV group (RR 8.21, 95% CI 1.91 to 35.21). Estimates of the relative frequency of other adverse effects, including postoperative proliferative vitreoretinopathy, postoperative increase in intraocular pressure, development of cystoid macular oedema, macular pucker and strabismus were imprecise. Evidence for adverse effects was low-certainty evidence. AUTHORS' CONCLUSIONS: Low- or very low-certainty evidence indicates that there may be little or no difference between PPV and scleral buckling in terms of primary success rate, visual acuity gain and final anatomical success in treating primary RRD. Low-certainty evidence suggests that there may be less retinal redetachment in the PPV group. Some adverse events appeared to be more common in the PPV group, such as cataract progression and new iatrogenic breaks, whereas others were more commonly seen in the scleral buckling group such as choroidal detachment.

Mapping Retinal and Choroidal Thickness in Unilateral Nongranulomatous Acute Anterior Uveitis Using Three-Dimensional 1060-nm Optical Coherence Tomography.

Purpose: To analyze retinal thickness (RT) and choroidal thickness (ChT) changes in patients with unilateral nongranulomatous acute anterior uveitis (AAU) using three-dimensional (3D) 1060-nm optical coherence tomography (OCT). Methods: Retinal and choroidal thickness maps were statistically analyzed for 24 patients with newly diagnosed unilateral AAU before therapy. A total of 17 patients were followed until resolution of inflammatory activity (twice in the first week, then weekly). Resolution occurred in all subjects within 6 weeks after the initial diagnosis. After resolution, thickness maps were again generated. All patients were imaged by high-speed spectral-domain (SD) 3D 1060-nm OCT over a 10 × 10-mm field of view. The spatial distribution of retinal and choroidal thickness was mapped and analyzed using the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Results: The choroid was significantly thicker in eyes affected by AAU than in fellow eyes before therapy with a mean thickness difference of 37 ± 11.44 µm (mean ± SD, Bonferroni correction, α = 0.0125). Following therapy, ChT significantly decreased with a mean change of 24 ± 6.9 µm (mean ± SD, Bonferroni correction, α = 0.0125). There was no significant difference in RT between AAU and fellow eyes before therapy or in AAU eyes before and after therapy. Conclusions: Eyes affected by AAU demonstrate an increase in ChT before and a subsequent decrease after therapy while retinal thickness seems unaltered by disease and therapy. ChT might be a useful biomarker in monitoring posterior involvement and response to therapy in patients with AAU.

Intraoperative optical coherence tomography assisted analysis of pars Plana vitrectomy for retinal detachment in morning glory syndrome: a case report.

BACKGROUND: The pathogenesis of non-rhegmatogenous retinal detachment (non-RRD) associated with morning glory syndrome (MGS) is not established, as well as best surgical approach to treat RD. Our purpose was to analyse intraoperative optical coherence tomography data (iOCT) in all steps of pars plana vitrectomy (PPV) for non-RRD in MGS, in order to follow pathophysiological aspects of the disease and to understand the tissues behaviour during surgical workflow. CASE PRESENTATION: Intraoperative spectral domain optical coherent tomography (iSD-OCT) assisted PPV using Rescan 700 (Carl Zeiss Meditech, Jena, Germany) with epiretinal membrane (ERM) and internal retinal membrane (ILM) peeling, and air endotamponade was performed on the only eye of a 21 years old female with non-RRD associated with MGS. BCVA, pre-, intra- and postoperative OCT were performed along with standard ocular examination. iOCT video and snapshots were analysed intra- and postoperatively using post-processing approach using graphic software. The progression of non-RRD resulted in best corrected visual acuity (BCVA) decrease from 0.8 to 0.2. Triamcinolone enhanced iOCT imaging revealed strong vitreous traction and adhesion above the macula and optic disc. Internal limiting membrane was peeled under iOCT control to prevent the peeling of inner layers of the retinal schisis. No retinal break was detected, and only air endotamponade was performed. The retina reattached during first 4 weeks of follow-up with gradual resolution of intraretinal- and subretinal fluid, and remained stable in 12 months. BCVA improved to 0.8. CONCLUSION: Based on iSD-OCT findings we assume that non-RRD in this case of MGS is caused primarily by the vitreous traction with further possible formation of the retinal breaks. Retinal reattachment reached only with air endotamponade strongly advocates the tractional component of non-RRD and retinal schisis assotiated with MGS. Early PPV for central non-RRD and retinal schisis with the use of iOCT can be performed in more safe and controlled manner and has to be considered to reduce the risk of retinal break formation and to prevent the central vision loss.

Comparative cyto-histological study of needle tip aspirates and entry sites after intravitreal injection using different needle types.

A comparison of the cellular content of needle tip aspirates and entry sites after transconjunctival intravitreal injection (IVI) using different needle types was performed. White outbred rats and human cadaver eyes were used for IVI by hypodermic 27 gauge (G) and 30G needles, and spinal anesthesia Pencan 27G needles. Aspiration of vitreous for quantitative morphological and cell cultivation analysis, as well as cyto-histological analysis of aspirates and entry sites were carried out. The most common cells in the aspirates from all needle types were conjunctival epithelial-, ciliary body non-pigmented epithelial- and sclerocyte-like cells and granular proteins. Crystallized vitreous specimens were present in each aspirate. The entry sites of hypodermic needles showed marked trauma in all wall layers of rat and human eyes accompanied by cellular destruction and hemorrhages. Pencan 27G needle caused less tissue trauma with partial reposition of sclerocytes. Transconjunctival IVIs with hypodermic 27G and 30G, and Pencan 27G needles result in trauma of all layers of the eyeball. The possible consequences of cellular content being cut and injected into the eye, as well as the entry site wound shape deserve future consideration and improvements.

Mapping diurnal changes in choroidal, Haller's and Sattler's layer thickness using 3-dimensional 1060-nm optical coherence tomography.

PURPOSE: To test the significance of diurnal changes in choroidal, Haller's and Sattler's layer thickness in healthy subjects using spatial analysis of three-dimensional (3D) 1060-nm optical coherence tomography (OCT) scans. METHODS: Automatically generated choroidal, Haller's and Sattler's layer thickness maps were statistically analyzed for 19 healthy subjects at two time points (8 a.m. and 6 p.m.) that represent the currently proposed ChT peak and nadir. All subjects were imaged by high-speed 1060-nm OCT over a 36° × 36° field of view. Spatial distribution of layer thickness was analyzed using the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. RESULTS: The choroid was significantly thicker at 8 a.m. than at 6 p.m. (p < 0,0125, paired t-test, Bonferroni correction). Diurnal variation of mean choroidal thickness (ChT) for all ETDRS subfields was 12 µm. Haller's layer thickness showed no significant diurnal variation (P > 0.0125), but Sattler's layer was thicker in the morning than in late afternoon (P < 0.0125). CONCLUSIONS: Our measurements indicate that diurnal ChT variation may exist, but is less relevant than previously proposed by studies using single location imaging. Sattler's layer shows diurnal variation in line with ChT.

Primary Retinal Detachment Surgery: Changes in Treatment and Outcome in an Austrian Tertiary Eye Center.

PURPOSE: The surgery of choice for primary retinal detachment (RD) has shifted towards primary vitrectomy (PPV) in recent years. In this study, 2 cohorts of consecutive patients, treated by 8 retinal surgeons within a 7-year time span were compared. METHODS: Baseline demographic data, surgical procedure, and outcome of patients with primary RD surgery between January 2007 and December 2008 (group 1, G1) and January 2012 and December 2013 (group 2, G2) were compared. Statistical analysis included univariate comparisons (Wilcoxon rank-sum test and χ2 test) and ANCOVA (analysis of covariance) models. RESULTS: The most common primary procedure was scleral buckling (n = 92, 66%) in G1 and PPV (n = 252, 85%) in G2 (p < 0.0001). Primary anatomical success rates were comparable (89%). The percentage of eyes with best corrected visual acuity (BCVA) equal or better than 0.3 logMAR (6/12) at final follow-up was significantly higher in G2 (61%, n = 156) compared to 49% (n = 68) in G1 (p = 0.0223). CONCLUSIONS: Within 7 years, a complete trend reversal could be observed shifting the primary surgical approach for RD towards PPV. Primary and final anatomical success rates were comparable, yet the later group experienced a significantly higher gain in BCVA, which approves the change in treatment regimen.