INVERTED INTERNAL LIMITING MEMBRANE FLAP FOR SMALL-SIZED (<250 µ m) FULL-THICKNESS MACULAR HOLE : Anatomical and Functional Outcome.

PURPOSE: To compare the anatomical and functional outcome of small (<250 µ m) and medium (250-400 µ m) full-thickness macular holes (FTMHs) treated with internal limiting membrane (ILM) inverted flap (IF) or with the standard technique. METHODS: Retrospective longitudinal analysis of successfully operated eyes with small or intermediate FTMH. Outcome measures were best-corrected visual acuity (BCVA), microperimetric sensitivity (with fixation stability), and restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) at 6 months. RESULTS: Fifty small and 50 intermediate eyes with FTMH were included, half of each group (25) treated with the standard technique, half with IF. BCVA increased in every subgroup, similarly within the same stage regardless the technique. Small FTMH treated with IF disclosed inferior foveal sensitivity at 6 months (20.79 ± 0.48 dB) compared with the standard technique (21.51 ± 0.79 dB; P = 0.0035). At 1 month, inferior rates of ELM (24%) and EZ (24%) restoration were also found, compared with the standard technique (56% ELM P = 0.0420; 64% EZ P = 0.0095). At 6 months, ELM and EZ were similarly restored. CONCLUSION: The surgical repair of small FMTH with ILM IF seem to delay the foveal structural repair and to gain an inferior foveal sensitivity compared to the standard technique.

Panuveitis of undetermined origin after diagnostic pars plana vitrectomy: clinical characterization and long-term outcome from a tertiary referral center.

PURPOSE: To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy. METHODS: Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported. RESULTS: Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9 years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5 year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival. CONCLUSIONS: PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.

UNEXPLAINED VISUAL LOSS AFTER GAS TAMPONADE FOR MACULA-ON RETINAL DETACHMENT: Incidence and Clinical Characterization.

PURPOSE: To identify the incidence rate and the clinical characteristics of unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment. METHODS: Retrospective longitudinal analysis of all subjects undergoing vitrectomy with gas for primary macula-on rhegmatogenous retinal detachment from 2010 to 2019. Outcome was the unexplained visual loss evaluated after gas absorption, defined as a loss of vision to less than 20/200 without evident causes. The diagnostic workup was reviewed. RESULTS: Nine eyes with unexplained visual loss of 357 surgeries were found. The incidence proportion was 2.52 new cases every 1,000 eyes affected by macula-on rhegmatogenous retinal detachment treated with gas per year. All subjects had an absolute central scotoma, with a median postoperative visual acuity of 20/1,600 (counting fingers). Structural findings were consistent with an axonal damage; all eyes had microcystoid macular edema and reduced thickness of both macular ganglion cell and retinal nerve fiber layers. No photoreceptor structural damages were noted. CONCLUSION: The incidence of unexplained visual loss after gas tamponade for primary macula-on rhegmatogenous retinal detachment is 2.52 new cases every 1,000 eyes per year. This rare complication, which findings are suggestive of an axonal damage within retinal ganglion cells, remains a serious and unexplained concern for vitreoretinal surgeons.

Intraoperative efficacy and clinical outcomes of two commercial staining solutions used in idiopathic epiretinal membrane surgery.

PURPOSE: To compare two commercially available staining solutions (MembraneBlue Dual® by D.O.R.C., Netherlands, and TWIN by AL.CHI.MI.A. S.R.L., Italy), in terms of intraoperative handling, staining efficacy and safety, in eyes undergoing surgery for idiopathic epiretinal membrane (ERM). METHODS: In this observational cross-sectional study, the performance of the dyes used during the procedure (cohesion, ERM and internal limiting membrane [ILM] staining efficacy) was scored by the surgeon using a customized questionnaire after 10 procedures with each of the two dyes. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), blue-light fundus autofluorescence (BAF), and microperimetry-determined retinal sensitivity were reviewed preoperatively and then at 1 and 3 months after surgery. RESULTS: ILM staining efficacy with TWIN was scored 2.89 ± 0.33 by the surgeons, which turned out to be higher than with MembraneBlue Dual® (1.90 ± 0.31, P = 0.0002). The cohesion score was 2.70 ± 0.48 for TWIN and resulted significantly higher than with MembraneBlue Dual® (1.60 ± 0.51, P = 0.0010). BCVA, CFT and retinal sensitivity were similar in the two groups, 1 and 3 months postoperatively (P nonsignificant for all). CONCLUSIONS: Both TWIN and MembraneBlue Dual® dyes showed suitable staining properties and equivalent safety and efficacy profiles, both intra- and postoperatively. The TWIN dye might offer a solution for surgeons who prefer a more cohesive and stable dye.

HYPERREFLECTIVE FOVEAL SPOTS IN PATIENTS WITH VITREORETINAL ANOMALIES: A Qualitative and Quantitative Analysis.

PURPOSE: To describe structural optical coherence tomography (OCT) and OCT angiography features in patients who have developed hyperreflective foveal spots with or without vitreomacular interface abnormalities or with vitreous adhesion alone. METHODS: The study design was observational and cross sectional. The presence of defined epiretinal membrane was considered an exclusion criterion. All patients underwent complete ophthalmologic examination, with structural OCT and OCT angiography acquisitions. Both qualitative and quantitative analyses of OCT angiography reconstructions were performed for superficial capillary plexus, deep capillary plexus, and choriocapillaris. RESULTS: Thirty patients (20 men; mean age, 55.2 years) showing hyperreflective foveal spots on structural OCT and 30 healthy control subjects (20 men; mean age, 54.7 years) were enrolled. Best-corrected visual acuity was 0.0 ± 0.0 logarithm of the minimum angle of resolution (20/20 Snellen) for both patients and control subjects. Following global and parafoveal/extrafoveal analyses, both superficial capillary plexus and deep capillary plexus showed significant reduction (P < 0.001). Significant superficial capillary plexus and deep capillary plexus changes were also detected in contralateral eyes (P < 0.001). CONCLUSION: Hyperreflective foveal spots might be seen as the initial effect of traction forces causing Müller cell and external retinal layer disruption, leading to the onset of vitreomacular disease. These changes also have an effect on the retinal vascular network. Further larger prospective studies are necessary to confirm our findings.

Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction.

BACKGROUND: To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. METHODS: In this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection. RESULTS: After injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP (p = 0.2717) nor in the CC (p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection (p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007). CONCLUSIONS: Eyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.

Reduced vascular perfusion density in idiopathic epiretinal membrane compared to macular pseudohole.

PURPOSE: To investigate the retinal capillary perfusion density by means of optical coherence tomography angiography (OCT-A) in idiopathic epiretinal membrane (ERM) and macular pseudoholes (MPH). METHODS: This observational cross-sectional study examined consecutive patients affected by ERM and MPH presenting between June 2017 and December 2017, as well as the 30 eyes of 30 healthy subjects. All patients underwent swept-source OCT-A examination. For each patient, vessel perfusion density and foveal avascular zone (FAZ) area were measured. RESULTS: Twenty-five eyes of 20 patients with ERM and 28 eyes of 24 patients with MPH were enrolled. Thirty eyes of 30 age-matched healthy controls were included. The perfusion density in the superficial capillary plexus (SCP) of ERM (0.401 ± 0.012) turned out to be inferior that MPH (0.419 ± 0.018) and controls (0.415 ± 0.017) (p < 0.01), while no significant differences were evident among the three subgroups in the deep capillary plexus (DCP) (p = 0.1). The FAZ area in the SCP was smaller in the ERM group (0.168 ± 0.123 mm2), respectively, than MPH (0.295 ± 0.013 mm2) and controls (0.213 ± 0.107 mm2) (p < 0.01), otherwise no difference were noted in the DCP (p = 0.14). CONCLUSIONS: OCT-A morphological features differ between idiopathic ERM and MPH, showing lower perfusion density in idiopathic ERM compared to MPH.

HOW VITREOMACULAR INTERFACE MODIFIES THE EFFICACY OF ANTI-VEGF THERAPY FOR MYOPIC CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To evaluate the efficacy of intravitreal ranibizumab in the treatment of myopic choroidal neovascularization (mCNV) complicated by vitreoretinal interface alterations. METHODS: Thirty-two patients affected by mCNV and concurrent vitreoretinal interface disorders, including macular epiretinal membrane (18 patients), lamellar macular hole (4 patients), full-thickness macular hole (1 patient), broad/focal vitreomacular traction (3 patients), broad/focal vitreomacular adhesion (4 patients), and myopic foveoschisis (2 patients), were enrolled in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity (BCVA), fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first intravitreal ranibizumab. Further re-treatments were performed in the presence of choroidal neovascularization activity (new hemorrhages, leakage on fluorescein angiography, intraretinal/subretinal fluid on spectral-domain optical coherence tomography, visual acuity loss of five letters). Main outcome measure was the change in the BCVA and in the central foveal thickness. Data were compared with the historical control group with uncomplicated mCNV. RESULTS: The median BCVA in the epiretinal membrane-myopic choroidal neovascularization subgroup showed a stabilization from the baseline value of 0.30 logarithm of minimal angle resolution (20/40) to 0.40 (20/50, P: 0.49) at the last visit (30 ± 13 months). Median BCVA significantly improved from 0.30 (20/40) to 0.10 (20/25, P: 0.0005) in the mCNV group and was better than the epiretinal membrane-myopic choroidal neovascularization subgroup (0.008). Central foveal thickness reduced significantly within both groups, with no difference between the groups at the final examination. Considering the vitreoretinal alterations with lower prevalence, BCVA stabilization was registered after a follow-up of 28.9 ± 13 months, with a median BCVA of 0.3 logarithm of minimal angle resolution (20/40) at the baseline and at the final examination. A nonstatistically significant reduction in the median central foveal thickness was registered at the final examination (P: 0.12). CONCLUSION: The data show that ranibizumab is effective in controlling mCNV activity when associated with vitreoretinal interface alterations. However, a visual recovery was observed only in patients with uncomplicated mCNV.

Retinal vascular changes after vitrectomy for idiopathic epiretinal membrane: a pilot study with dynamic vessel analysis.

PURPOSE: To investigate, using the Dynamic Vessel Analyzer (DVA), the retinal vascular changes that may occur after vitrectomy for idiopathic epiretinal membrane (ERM). METHODS: Twenty-six eyes of 13 patients affected by unilateral idiopathic ERM were prospectively analyzed. 13 fellow eyes were used as control. The static (central retinal artery and vein equivalents) and dynamic (after flicker light stimulus) DVA analysis was performed at baseline (1 day before surgery) and 6 months after vitrectomy. RESULTS: The static DVA analysis did not highlight any significant change between investigational eyes and controls at baseline and 6 months after surgery. The DVA dynamic analysis showed similar arterial flicker response between cases and controls at baseline (p = 0.3396), but disclosed a significant reduction of the arterial flicker response after surgery in the study eyes compared to fellow eyes (p = 0.0024). No significant changes were appreciated in the venous flicker response after surgery between cases and controls, both at baseline (p = 0.3450) and at the follow-up examination (p = 0.4214). CONCLUSIONS: The physiological flicker-induced vasoconstriction is reduced after vitrectomy in arteries. The oxygen saturation change occurring after vitrectomy might have a role in the vascular tone modification.

Central Corneal Thickness Reproducibility among Ten Different Instruments.

PURPOSE: To assess agreement between one ultrasonic (US) and nine optical instruments for the measurement of central corneal thickness (CCT), and to evaluate intra- and inter-operator reproducibility. METHODS: In this observational cross-sectional study, two masked operators measured CCT thickness twice in 28 healthy eyes. We used seven spectral-domain optical coherence tomography (SD-OCT) devices, one time-domain OCT, one Scheimpflug camera, and one US-based instrument. Inter- and intra-operator reproducibility was evaluated by intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman test analysis. Instrument-to-instrument reproducibility was determined by ANOVA for repeated measurements. We also tested how the devices disagreed regarding systemic bias and random error using a structural equation model. RESULTS: Mean CCT of all instruments ranged from 536 ± 42 µm to 577 ± 40 µm. An instrument-to-instrument correlation test showed high values among the 10 investigated devices (correlation coefficient range 0.852-0.995; p values <0.0001 in all cases). The highest correlation coefficient values were registered between 3D OCT-2000 Topcon-Spectral OCT/SLO Opko (0.995) and Cirrus HD-OCT Zeiss-RS-3000 Nidek (0.995), whereas the lowest were seen between SS-1000 CASIA and Spectral OCT/SLO Opko (0.852). ICC and CV showed excellent inter- and intra-operator reproducibility for all optic-based devices, except for the US-based device. Bland-Altman analysis demonstrated low mean biases between operators. CONCLUSIONS: Despite highlighting good intra- and inter-operator reproducibility, we found that a scale bias between instruments might interfere with thorough CCT monitoring. We suggest that optimal monitoring is achieved with the same operator and the same device.

Role of ganglion cell complex in visual recovery following surgical internal limiting membrane peeling.

PURPOSE: To investigate the Ganglion Cell Complex (GCC) thickness change and visual recovery correlation after surgery for an idiopathic epiretinal membrane (ERM). METHODS: In this prospective, observational, case control study 30 eyes underwent vitrectomy for idiopathic ERM. We analysed best-corrected visual acuity (BCVA), mean macular thickness and mean GCC thickness one day before surgery, seven days and six months after surgery. Internal segment/outer segment junction, external limiting membrane, cone outer segment tips defects and intraretinalfluid were also investigated throughout the follow-up. RESULTS: Baseline GCC thickness was higher in patients with ERM (130 ± 13 µm) compared with healthy eyes (94 ± 5 µm; p < 0.0001). GCC thickness decreased after surgery to 89 ± 11 µm (p < 0.0001), reaching a value similar to controls (p = 0.12). Preoperative macular thickness was 318 ± 32 µm and decreased to 281 ± 18 µm (p < 0.0001), remaining significantly higher than controls (260 ± 8 µm; p < 0.0001). The GCC proportion of the whole macular thickness was also reduced six months after surgery (p < 0.0001). Post-operative BCVA gain showed direct correlation with GCC reduction (R = 0.67, p < 0.0001), but did not correlate with the mean macular thickness reduction (R < 0.01, p = 0.97). CONCLUSIONS: Ganglion cell complex thickness is higher in eyes with idiopathic ERM, and after surgery turns back to similar values of healthy eyes. Post-operative GCC reduction is proportionally higher than thinning of the whole retina, and this reduction is correlated with visual restoration.

A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome.

PURPOSE: To analyze the course of eyes with vitreomacular traction (VMT), and to find by optical coherence tomography (OCT) possible correlations between vitreomacular interface area changes and the chance of spontaneous VMT resolution. METHODS: Retrospective analysis of all consecutive patients presenting with VMT over a 24-month period. We introduced a novel OCT evaluation model to assess the vitreomacular interface area. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were also analyzed throughout follow-up. RESULTS: Twenty-six eyes of 18 symptomatic patients were followed for 12.9 ± 4.8 months. Eyes were subdivided into groups according to their clinical course. Six eyes (23%) had a spontaneous resolution of the VMT (group A), and the interface area before its occurrence (39565 ± 26409 µm(2)) was smaller than at study entry (99434 ± 38819 µm(2); p = 0.03). The interface area did not significantly change throughout follow-up in the group that underwent surgery (group B, 11 eyes) and in the group that remained overall stable (group C, 9 eyes). At baseline, the interface area was smaller in group A compared to groups with non-resolved VMT (mean values of group B and C together) (785095 ± 920721 µm(2); p = 0.002). CFT and BCVA did not significantly change in any of the studied groups. Vitreomacular interface area of 101002 µm(2) was identified as the threshold value separating the spontaneous VMT resolution group from the group with non-resolved VMT (p < 0.001). CONCLUSIONS: The more the vitreomacular interface area reduced over time, the higher was the chance of spontaneous VMT resolution. An area below 101002 µm(2) was the threshold value indicating a higher chance of spontaneous release of VMT.

Spectral-domain optical coherence tomography evaluation of vitreoretinal adhesions in idiopathic epiretinal membranes.

BACKGROUND: Vitreoretinal adhesions play a key role in the vector forces exerted on the vitreoretinal interface, leading to tractional retina deformation and macular hole formation. The aim of this study was to identify the presence of vitreopapillary and vitreofoveal adhesions in idiopathic epiretinal membranes (ERMs) with spectral-domain optical coherence tomography (SD-OCT) and to evaluate their influence on the vitreoretinal interface. METHODS: Sixty-five eyes (65 patients) with idiopathic ERM and 64 healthy eyes (64 patients) underwent SD-OCT analysis. We studied vitreopapillary and vitreofoveal adhesion prevalence in eyes with idiopathic ERM using different SD-OCT patterns ("adherent" or "tractional"). We analyzed their influence on central foveal thickness (CFT), on retinal nerve fiber layer (RNFL) thickness, and on morphological modifications (foveal depression profile and inner/outer photoreceptor junction). RESULTS: Vitreopapillary adhesion was present in 51.6 % of normal eyes and in 24.6 % of eyes with idiopathic ERM, while vitreofoveal adhesion was found in 14.1 % of normal eyes and in 15.4 % of eyes with ERM. Vitreopapillary adhesion prevalence was significantly higher in the tractional ERM subgroup (p = 0.01), than in the adherent ERM subgroup. Both adhesions had no influence on CFT, RNFL thickness, or inner segment/outer segment junction status. CONCLUSIONS: Our study suggests that vitreoretinal adhesions may influence the pathogenesis and course of idiopathic ERM. The absence of vitreopapillary adhesion in the adherent type, and its presence in the tractional type, seems to play a key role in ERM characterization.

Intravitreal ranibizumab for naive extrafoveal choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To investigate the effect of intravitreal ranibizumab on extrafoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: Eighteen eyes affected by extrafoveal choroidal neovascularization secondary to age-related macular degeneration were prospectively enrolled in this study. After an initial intravitreal ranibizumab, all patients were reevaluated monthly over 12 months of follow-up. Further retreatments were performed on a pro re nata basis, depending on detection of any type of fluid on optical coherence tomography and/or the presence of leakage on fluorescein angiography. Primary outcome measures were mean changes in best-corrected visual acuity and the proportion of eyes gaining at least 15 letters (3 Early Treatment Diabetic Retinopathy Study [ETDRS] lines) at the end of the follow-up. Secondary outcome measures were central macular thickness variations and changes in choroidal neovascularization size. RESULTS: Mean best-corrected visual acuity presented a significant improvement during the follow-up period, being 0.3 ± 0.2 logMAR at baseline and 0.2 ± 0.2 logMAR at the 12-month examination (P < 0.001). An improvement of at least 3 EDTRS lines was achieved by 6 eyes (33.3%), whereas 6 patients (33.3%) gained 1 to 2 lines. The mean central macular thickness at baseline was 314 ± 87 µm, changing to 268 ± 65 µm at the 12-month examination (P = 0.003). The mean lesion size was 1.4 ± 1.4 mm and remained stable throughout the follow-up, being 1.8 ± 2.9 mm at 12 months (P = 0.64). CONCLUSION: Intravitreal ranibizumab administered after a pro re nata regimen with monthly evaluation is a beneficial approach for the management of extrafoveal choroidal neovascularization secondary to age-related macular degeneration over 12 months of follow-up. Further studies are warranted to confirm our preliminary results.

Corneal descemetocele following Nd:YAG laser capsulotomy in a patient with Steven Johnson syndrome: A case report.

Purpose: To report a challenging case of corneal descemetocele following Nd:YAG laser capsulotomy for posterior capsule opacification in a patient with Steven Johnson syndrome (SJS). Observations: A single-eye 52 year-old man, with a history of Steven Johnson syndrome, presented with severe eye pain and profound vision reduction in his left eye two days after undergoing Nd:YAG laser capsulotomy using the standard Abraham contact lens. A corneal descemetocele was identified and subsequently confirmed by anterior segment optical coherence tomography. He was promptly treated with the application of a therapeutic contact lens and sustained antibiotic regimen (preservative-free fluoroquinolone drops every 4 hours for 6 weeks) until healing of the corneal epithelium. Throughout the following eight weeks AS-OCT showed favorable anatomical and functional outcomes, achieving a substantial spontaneous healing. Conclusions and Importance: Corneal descemetocele may occur after Nd:YAG laser capsulotomy in patients with Steven Johnson syndrome. This case strengthens the critical importance of a careful preoperative assessment and meticulous postoperative management in high-risk patients, such as those with Steven Johnson syndrome, even after seemingly routine and safe ophthalmic procedures.

Influence of intraocular tamponade on unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To investigate the relationship between type of intraocular tamponade and unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment. METHODS: Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment underwent 3-port pars plana vitrectomy with gas (C3F8) or silicone oil (polydimethylsiloxane) tamponade. Ophthalmologic examination and fundus autofluorescence were performed before surgery (baseline) and at the 7-day, 1-month, and 3-month postoperative visits. Macula sparing rhegmatogenous retinal detachment underwent fixation test (with microperimetry) at baseline and at the 7-day and 1-month follow-up examinations. RESULTS: Fundus autofluorescence revealed postoperative retinal displacement in 12 of the 23 eyes (52.2%). Occurrence of retinal displacement was higher in eyes with gas tamponade (10 of 14 eyes; 71.4%) compared with eyes with silicone oil (2 of 9 eyes; 22.2%) (P = 0.036). Retina shifted downward in all eyes with C3F8 and upward in all eyes with polydimethylsiloxane. Baseline and follow-up macular fixation was tested in 10 macula-on cases. In all cases, a shift of mean fixation point was present at the 7-day postoperative examination, with a partial return toward the baseline mean fixation point at the 1-month follow-up examination. CONCLUSION: In eyes with rhegmatogenous retinal detachment treated with vitrectomy and gas or silicone oil tamponade, retinal displacement may occur despite successful reattachment. Type of intraocular tamponade seems to influence the occurrence of retinal dislocation and its direction.

Review and perspectives on pharmacological vitreolysis.

The vitreous is involved in multiple diseases when an incomplete posterior vitreous detachment (PVD) occurs. An incomplete PVD can lead to several pathological conditions. Such visually threatening conditions are traditionally of exclusive surgical interest. In contrast, pharmacological vitreolysis is the effort to reduce or eliminate the pathogenetic role of the vitreous solely by means of drug delivery. Here we aim to review and summarize the evidence available to date about this challenging new approach.

The long-term outcome of eyes with unexplained visual loss after gas tamponade for macula-on retinal detachment.

PURPOSE: To analyze the long-term outcome of eyes suffering from unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment (RRD). METHODS: Cross-sectional analysis of all eyes with macula-on RRD experiencing an unexplained loss of vision after gas reabsorption that were treated and followed from 2010 to 2019. The investigational work-up included: best-corrected visual acuity (BCVA), clinical examination, spectral-domain optical coherence tomography (SD-OCT) and automated computerized perimetry. RESULTS: The 9 eyes of the 9 patients were analyzed after 5.9±2.4 years. BCVA improved by 0.54±0.50 logMAR from baseline, achieving a final value of 1.17±0.52 logMAR (∼20/320; p=0.0115). The thicknesses of the macula, of the macular ganglion cells and of the retinal nerve fiber layers were unchanged compared to the baseline, as well as the rate of ellipsoid zone defects (22.2%). The proportion of eyes with microcystoid macular edema (MME) significantly decreased to 44.4% (p=0.0294). Perimetry mean deviation increased from a baseline value of -18.06±2.72 to -17.23±2.29 dB (p=0.0390), with an unchanged pattern standard deviation (p=0.1289). In general, a reduction of the scotomata relative depth from baseline was evident in all eyes. CONCLUSIONS: Eyes with macula-on RRD suffering from unexplained visual loss after gas reabsorption, despite disclosing an overall unchanged structural macular morphology, showed a moderate, but significant, visual and perimetric improvement in the long-term.