Presumed Silicone Oil Droplets After Intravitreal Pegcetacoplan Injections.

Importance: Recently, intravitreal pegcetacoplan became the first drug to gain US Food and Drug Administration approval for the treatment of geographic atrophy associated with nonexudative age-related macular degeneration, but the administration of this medication may be associated with unanticipated posttreatment complications. Objective: To assess the prevalence of presumed silicone oil droplets in the vitreous cavity after intravitreal injection of pegcetacoplan. Design, Setting, and Participants: This case series study involved a retrospective record review of all 55 patients treated with intravitreal pegcetacoplan, 0.1 mL in 150-mg/mL solution, between March 24 and June 5, 2023, at a single specialty retina practice. All injections were done using needles from the kit supplied by Apellis Pharmaceuticals on a 1-mL McKesson Luer lock syringe. Main Outcomes and Measures: The presence or absence of presumed silicone bubbles detected during dilated biomicroscopic fundus examination and/or on color fundus photographs, the presence or absence of symptoms, change in visual acuity, and/or increase in intraocular pressure. Results: A total of 62 intravitreal pegcetacoplan injections were given to 55 patients (mean [SD] age, 83.8 [7.8] years; 33 women [60%]) from March 24 to June 5, 2023. Of the 55 patients, 16 (29%; mean [SD] age, 83.8 [7.4] years; 9 women [56%]) had presumed intravitreal silicone droplets discovered 2 to 4 weeks after treatment, 3 of which were documented on color fundus photographs. Of the 16 patients, 14 (88%) were symptomatic for new floaters that they described as persistent, while 2 (13%) were asymptomatic. There were no signs of inflammation or infection, no increases in intraocular pressure, and no changes in visual acuity for all 16 patients. Conclusions and Relevance: A substantial percentage of patients had symptomatic floaters from presumed intravitreal silicone oil droplets after injections of pegcetacoplan using a McKesson 1-mL Luer lock syringe. These findings support consideration of informing patients of this potential adverse effect, avoiding use of the McKesson syringe, and considering use of silicone-free syringes for pegcetacoplan injections.

Reversal of diabetic retinopathy in two patients following the use of physiologic insulin Resensitization.

We followed two patients with diabetic retinopathy over the course of their treatment with physiologic Insulin resensitization. Both patients showed improvement of their diabetic retinopathy, after treatment.

Full-thickness macular hole after LASIK for the correction of myopia.

PURPOSE: To describe 19 patients (20 eyes) who developed a macular hole (MH) after undergoing bilateral LASIK for the correction of myopia. DESIGN: Noncomparative, interventional, retrospective, multicenter case series. PARTICIPANTS: Nineteen patients (20 eyes) who developed an MH after bilateral LASIK for the correction of myopia at 10 institutions in Venezuela, Colombia, Puerto Rico, Spain, and the United States. METHODS: Chart review. MAIN OUTCOME MEASURE: Macular hole development. RESULTS: The MH formed between 1 to 83 months after LASIK (mean, 12.1). In 60% of cases, the MH developed < or =6 months after LASIK, and in 30% of cases it developed > or =1 year after LASIK. Eighteen of 19 (94.7%) patients were female. Mean age was 46 years (range, 25-65). All eyes were myopic (range, -0.50 to -19.75 diopters [mean, -8.9]). Posterior vitreous detachment was not present before and was documented after LASIK in 55% of eyes. A vitrectomy closed the MH on the 14 eyes that underwent surgical management, with an improvement of final best-corrected visual acuity in 13 of 14 (92.8%) patients. Our 20 eyes with a full-thickness MH after LASIK reflect an incidence of approximately 0.02% (20/83938). CONCLUSION: An MH may infrequently develop after LASIK for the correction of myopia. Our study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with an MH after LASIK. Vitreoretinal interface changes may play a role in MH formation after LASIK for the correction of myopia.

Maculopatías luego de queratomileusis in situ asistida por láser (LASIK) para la corrección de miopía / Maculopathy then of keratomileusis for laser (LASIK) in situ the correction of myopia

Reportar nuestra experiencia con el uso de propósito: describir veinte y ocho ojos (26 pacientes) que desarrollaron agujeros maculares (AM) unilaterales de espersor total (16 ojos de 15 pacientes) o membranas neovasculares o coroideas subfoveales (CNV)(12 ojos de 11 pacientes) luego de procedimiento de LASIK bilateral para la correción de miopía. Serie de casos. Los AM se formaron ente una 30 meses luego de LASIK (promedio: 7.5 meses), 93.7 por ciento de los pacientes fueron género femenino. La media edad fue de 43.9 años (25-58). Todos los ojos fueron miopes (rango: -0.50 a -15.25 dioptrias [D]; promedio: -7.94 D). El despremdimiento del Vítreo posterior estuvo no presente antes del LASIK y se documentó posterior al procedimiento en 56.2 por ciento de los ojos. La Viterctomía cerró los agujeros maculares en 11 ojos que fueron a manejo quirúrgico mejorandose la agudeza visual final corregida en todos los pacientes. La incidencia de nuestros quince pacientes (ojos) con AM de espesor cpmpleto post LASIK reflejaron un valor de 0.03 por ciento (16/46,486). Adicionalmente, la CNV ocurrió en una media de 25.2 meses (rango: 1 a 60 meses) luego del LASIK. La miopia en este grupo de pacientes presentó un promedio de -15.12D (rengo:-13:00D a-25.50D). Nuve de nuestros casos se beneficiearon de la Terapia fotdinámica (PDT) con mejoría o estabilidad de la agudeza visual en 77.7 por ciento de los casos. Nuestros doce pacientes con CNV luego del LASIK representan una incidencia del 0.02 por ciento (12/46,486).El LASIK parece ser un procedimiento seguro con una baja incidencia de complicaciones vitero-retinales, sin embargo la CNV y el agujero macular pueden desarrollarse luego del LASIK