LONG-TERM RESULTS OF AUTOLOGOUS RETINAL PIGMENT EPITHELIUM AND CHOROID TRANSPLANTATION FOR THE TREATMENT OF EXUDATIVE AND ATROPHIC MACULOPATHIES.

PURPOSE: To evaluate the long-term results of autologous retinal pigment epithelium (RPE) and choroid transplantation (RPE-choroid patch) for exudative and atrophic maculopathies. METHODS: Consecutive chart review of 120 eyes, which underwent RPE-choroid patch, from 2007 to 2017 for RPE atrophy or choroidal neovascular membrane secondary to exudative and hemorrhagic age-related macular degeneration, myopia, angioid streaks, and laser. Eyes were tested with best-corrected visual acuity (BCVA), reading ability, optical coherence tomography, fluorescein angiography and indocyanine green angiography, autofluorescence, and microperimetry. RESULTS: Eighty-eight eyes of 84 patients had complete data, with 2- to 10-year follow-up. Mean age was 71.9 ± 9.06 years. Mean preoperative and postoperative BCVA was 20/320 (1.2 ± 0.2 logMAR) and 20/200 (0.94 ± 0.36 logMAR), respectively (P = 0.009). Reading ability recovered in 43% of cases. Microperimetry showed central fixation. A gain of at least 15 letters was obtained in 40% of eyes. Integrity (P = 0.009) of external limiting membrane and higher preoperative BCVA (P = 0.001) predicted better final BCVA. Complications were retinal detachment (11.4%), macular atrophy (7%), subretinal hemorrhage (4.5%), epiretinal membrane (4.5%), recurrent choroidal neovascular membrane (4.5%), macular hole (3.4%), and cystoid edema (3%). CONCLUSION: Autologous RPE-choroid patch achieved long-lasting BCVA improvement and central fixation, in eyes with choroidal neovascular membrane and intact external limiting membrane. Atrophic maculopathies only obtained temporary visual benefit.

Partial thickness sclerectomy to treat exudative retinal detachment secondary a submacular choroidal hemangioma in a Sturge-Weber syndrome.

PURPOSE: To demonstrate the safety and efficacy of partial thickness sclerectomies to treat exudative retinal detachment secondary to choroidal hemangioma, non-suitable with photodynamic therapy in a 5-year-old child with Sturge-Weber syndrome. METHODS: A 5 year-old child presented exudative retinal detachment secondary to choroidal subfoveal diffuse hemangioma. The child was non-compliant to undergo a photodynamic therapy. A partial thickness sclerectomy was made in each quadrant under general anesthesia. RESULTS: The retina was re-attached with improvement in vision from 20/400 to 20/80. Two years after primary surgery, the retinal detachment relapsed. Drainage of the subretinal fluid was obtained by the revision of the sclerectomies. After obtaining retinal reattachment, photodynamic therapy was applied to treat the hemangioma. No complications were reported after treatment. CONCLUSION: Sclerectomies may be considered an efficient and safe surgical option for the management of exudative retinal detachment secondary to choroidal hemangioma in patients non-suitable for photodynamic therapy, waiting for photodynamic therapy to be practicable directly on the hemangioma.

Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety.

BACKGROUND: Postoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease. METHODS: The charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered. RESULTS: The mean follow-up was 6.26±7.78 months (range 1-12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded. CONCLUSION: Intracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable. SUMMARY STATEMENT: The standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster's abstract was not published.

COMBINED AUTOLOGOUS TRANSPLANTATION OF NEUROSENSORY RETINA, RETINAL PIGMENT EPITHELIUM, AND CHOROID FREE GRAFTS.

PURPOSE: To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole. METHODS: During vitrectomy, an RPE-choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE-choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE-choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases. RESULTS: Mean follow-up was 7 ± 5.5 months (range 3-19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2-3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7-2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina-choroid-RPE free graft (n = 1). CONCLUSION: Combined autologous RPE-choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.

Etiopathogenesis and therapy of epithelial ingrowth after Descemet's stripping automated endothelial keratoplasty.

Descemet's stripping endothelial keratoplasty is an emerging technique finalized to treat endothelial dysfunction replacing only the pathological portion of cornea. The advent of any new technique puts us in front of new complications. The epithelial ingrowth is a well-known complication already studied in case of ocular trauma and more recently in refractive surgery. This job analyzed the potential etiopathogenesis of epithelial ingrowth after DSAEK, reviewing the cases described in literature, and suggests the potential therapy.

Evaluation of the efficacy of 50% autologous serum eye drops in different ocular surface pathologies.

PURPOSE: This study evaluated the efficacy of 50% autologous serum eye drops in ocular surface diseases not improved by conventional therapy. METHODS: We analyzed two groups: (1) acute eye pathologies (e.g., chemical burns) and (2) chronic eye pathologies (e.g., recurrent corneal erosion, neurotropic keratitis, and keratoconjunctivitis sicca). The patients were treated for surface instability after conventional therapy. The patients received therapy 5 times a day until stabilization of the framework; they then reduced therapy to 3 times a day for at least 3 months. We analyzed the best corrected visual acuity, epithelial defects, inflammation, corneal opacity, and corneal neovascularization. We also analyzed symptoms such as tearing, burning, sense of foreign body or sand, photophobia, blurred vision, and difficulty opening the eyelids. RESULTS: We enrolled 15 eyes in group 1 and 11 eyes in group 2. The average therapy period was 16 ± 5.86 weeks in group 1 and 30.54 ± 20.33 weeks in group 2. The epithelial defects all resolved. Signs and symptoms improved in both groups. In group 2, the defect recurred after the suspension of therapy in 2 (18%) patients; in group 1, no defects recurred. CONCLUSIONS: Autologous serum eye drops effectively stabilize and improve signs and symptoms in eyes previously treated with conventional therapy.