INTRAVITREAL INJECTION OF AIR FOR THE TREATMENT OF VITREOMACULAR TRACTION.

PURPOSE: To study the efficacy of a single intravitreal injection of air as a valuable alternative to current treatment options (conservative, pharmacological, and surgical) in patients with symptomatic, focal vitreomacular traction. METHODS: Interventional, nonrandomized clinical study including a consecutive series of patients who underwent a single injection of 0.3 mL of air for vitreomacular traction. Each patient underwent best-corrected visual acuity, and spectral domain optical coherence tomography before and after the procedure. Mean maximal horizontal vitreomacular adhesion and a maximal foveal thickness were measured manually. RESULTS: Four eyes of four patients, all males, were included in the study. Mean age was 71 ± 6.7 years; mean best-corrected visual acuity was 0.3 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (20/40 Snellen equivalent). One month following treatment, complete resolution of vitreomacular traction was achieved in 100% of eyes. Mean visual acuity postinjection was 0.18 ± 0.09 logMAR (20/32 Snellen equivalent) (Student's t test for repeated measures P = 0.03). No correlation has been found between horizontal vitreomacular adhesion and best-corrected visual acuity or maximal foveal thickness and best-corrected visual acuity (P = 0.7 and P = 0.9, respectively). CONCLUSION: Intravitreal injection of air could offer a minimally invasive, low-cost alternative treatment in patients with symptomatic, persisting vitreomacular traction. Additional studies on a larger number of patients are required.

Pilot Evaluation of a New Surgical Technique for Persistent or Recurrent Large Macular Holes.

BACKGROUND AND OBJECTIVE: To describe a new surgical technique for persistent or recurrent large macular holes (MHs). PATIENTS AND METHODS: Patients with recurrent or persistent large MHs following vitrectomy with internal limiting membrane (ILM) peeling were recruited between October and September 2017 in this pilot study. All patients underwent preoperative and postoperative best-corrected visual acuity (BCVA), slit-lamp ophthalmoscopy, and spectral-domain optical coherence tomography (SD-OCT). This new technique consisted in autologous ILM patch transplantation on top of MH under perfluorocarbon liquid (PFCL) bubble, using SF6 as tamponade. The patients maintained a prone position for 3 days. RESULTS: Five eyes of five consecutive patients (two males, three females; mean age: 67.4 years) with recurrent (one patient) or persistent (four patients) MHs were successfully treated. At 1-month follow-up, mean BCVA increased from approximately 20/400 to approximately 20/63, and MHs were closed in all cases. Mean follow-up was 5 months ± 2.2 months (6 months for four out of five included eyes). Positive outcomes were consistent at last follow-up. CONCLUSION: This new technique consisting of autologous ILM patch transplantation on top of MH under PFCL bubble using SF6 as tamponade may represent a validated surgical option for persistent or recurrent large MHs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:266-268.].

DualTrack Technology Improves Optical Coherence Tomography Angiography Image Quality.

BACKGROUND AND OBJECTIVE: To evaluate the effects of DualTrack Motion Correction Technology on the performance of AngioVue optical coherence tomography angiography (Optovue, Freemont, CA). PATIENTS AND METHODS: Fifty subjects underwent two consecutive examinations with AngioVue. The operator inactivated the eye-tracking (ET) technology before the second examination. Two operators measured execution time, excluded low-quality images, and counted the number of motion artifacts per image. RESULTS: The mean execution time was lower without ET in all the groups (P < .05), regardless of retinal diseases. Percentages of available images and low-quality images were 75.0% and 25.0%, respectively, with ET and 63.0% and 37.0%, respectively, without ET. Mean number of motion artifacts was significantly lower in images obtained using ET compared to images obtained without ET in all the groups (P < .0001), regardless of retinal diseases. CONCLUSION: Although ET technology increases the mean execution time, the reduction of motion artifacts and the increase of high-quality images may represent a great advantage in clinical practice. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:918-926.].

Retinal Pigment Epithelium Humps in High Myopia.

PURPOSE: To report on the presence of retinal pigment epithelium (RPE) humps in high myopia, and to describe the distinctive features from pathologic RPE detachments and choroidal neovascularizations (CNVs). DESIGN: Retrospective cross-sectional study. METHODS: Charts and imaging studies of highly myopic patients presenting between September 2015 and February 2017 at a university teaching hospital were consecutively reviewed. All patients underwent spectral-domain optical coherence tomography (OCT). RPE humps were defined as RPE elevations above its physiologic profile, without any evidence of pathologic sub-RPE material. Multimodal imaging was analyzed to assess abnormalities of the RPE and choroid. RESULTS: One hundred and ninety-five eyes of 101 highly myopic patients were included. RPE humps on structural OCT were identified in 99 out of 195 eyes (estimated prevalence of 50.8%; 43.8%-57.8, 95% confidence intervals). In all eyes, RPE humps corresponded to large choroidal vessels lifting the RPE. Patchy, diffuse, or CNV-related atrophy was more common in eyes with RPE humps (60.6% vs 34.4%; P < .05). The presence of a large choroidal vessel elevating the RPE and the absence of abnormal material between the RPE and the Bruch membrane were the features distinctive from pathologic RPE detachments and CNVs. DISCUSSION: RPE humps were frequently observed in highly myopic eyes and they resulted from the presence of an underlying large choroidal vessel. They are more likely to appear in highly myopic eyes with advanced choroidal atrophy. To prevent unnecessary treatments, they should be distinguished from pathologic RPE detachments and CNVs.

Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review.

Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°-50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. The aim of this narrative review was to provide an overview of the role of the most recent technique of ultra-wide-field fluorescein angiography in DR.