Journal of VitreoRetinal Diseases

For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy.

Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI.

Herein, we present pooled safety and efficacy outcomes through 4 months.

Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months.

Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

To determine the relationship between morphological parameters of the foveal avascular zone (FAZ) in the optical coherence tomography angiographic (OCTA) images and the best-corrected visual acuity (BCVA) in branch retinal vein occlusion (BRVO).

This was a retrospective cross-sectional study. Eyes with BRVO without apparent macular edema were studied. The superficial FAZ in 3 × 3 mm OCTA images were delineated manually. The size and shape, the circularity and axial ratio, of the FAZ were determined, and the values were compared to that of the controls. The correlation of these parameters with the BCVA was analyzed.

The mean FAZ area was larger in BRVO eyes than in controls, but the larger size was not correlated with the BCVA (BRVO, 0.49 ± 0.12 mm²; control, 0.38 ± 0.12 mm²; P = .135). The axial ratio of the BRVO eyes was significantly larger than that of controls (P < .001). The axial ratio was significantly correlated with BCVA (R = .382, P = .050). Although the circularity was significantly smaller in the BRVO eyes than that in controls (P < .001), it was not significantly correlated with the BCVA.

The shape of the FAZ would be a more appropriate parameter than the size in determining BCVA in eyes with BRVO.

To evaluate the deeper choroidal vasculature in eyes with various ocular disorders using spectral domain (SD) optical coherence tomography angiography (OCTA) and swept source (SS) OCTA.

Patients underwent OCTA imaging with either SD-OCTA (Zeiss Cirrus Angioplex or Optovue AngioVue) or SS-OCTA (Topcon Triton). Retinal pigment epithelium (RPE) integrity, structural visualization of deep choroidal vessels on en face imaging, and OCTA of deep choroidal blood flow signal were analyzed. Choroidal blood flow was deemed present if deeper choroidal vessels appeared bright after appropriate segmentation.

Structural visualization of choroidal vessels was feasible in all eyes by en face imaging. In both SD-OCTA and SS-OCTA, choroidal blood flow signal was present in all eyes with overlying RPE atrophy (100% of eyes with RPE atrophy, 28.6% of all imaged eyes, P < .001).

While choroidal vessels can be visualized anatomically in all eyes by en face imaging, choroidal blood flow detection in deep choroidal vessel is largely restricted to areas with overlying RPE atrophy. Intact RPE acts as a barrier for reliable detection of choroidal flow using current OCTA technology, inhibiting evaluation of flow in deeper choroidal vessels in most eyes.

To highlight the diagnostic challenge of eyes with hypotony maculopathy with concurrent macular diseases and to present optical coherence tomography (OCT) imaging findings in hypotony maculopathy.

Retrospective review of 15 eyes of 12 patients with hypotony maculopathy at a single institution.

Low intraocular pressure (IOP) was caused by overfiltration from trabeculectomy in 9 eyes (of 15, 60%), overtreatment with topical aqueous suppressants after trabeculectomy in 3 eyes (of 15, 20%), bleb leak in 1 eye (of 15, 7%), and treatment with topical aqueous suppressants alone in 2 eyes (of 15, 13%). On OCT imaging, 7 eyes (of 15, 47%) had chorioretinal folds without intraretinal fluid (IRF) or subretinal fluid (SRF), 5 eyes (of 15, 33%) had either IRF or SRF with chorioretinal folds, and 3 eyes (of 15, 20%) had IRF or SRF without chorioretinal folds. The majority of eyes (11 of 15 eyes, 73%) had additional diagnoses apart from hypotony maculopathy that could have potentially caused IRF or SRF, which included epiretinal membrane, retinal vein occlusion, and age-related macular degeneration. Two eyes (of 15, 13%) were initially erroneously managed for a nonhypotony maculopathy pathology due to the diagnostic challenge in eyes with hypotony maculopathy.

Hypotony maculopathy demonstrates nonspecific OCT findings such as IRF and SRF that are commonly seen in other macular diseases. In eyes with these macular diseases, diagnosing hypotony maculopathy may be challenging; thus, attention to past ocular history and IOP must always be part of evaluation.

The purpose of this study is to examine the evidence for postoperative pain management in patients undergoing vitreoretinal surgery for retinal detachment by systematic review.

A systematic review of the literature was performed using multiple databases in July 2016 and September 2017. Two independent reviewers screened titles and abstracts and analyzed selected papers in detail. Included studies assessed patients undergoing vitreoretinal surgery for retinal detachment and described postoperative pain management. Risk of bias was assessed using the criteria outlined in the “risk of bias” tool in the Cochrane Handbook for Systematic Reviews of Interventions.

Nine randomized controlled studies comprising 517 patients met the inclusion criteria. Pain management included perioperative peribulbar, sub-Tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress. Pain scores were assessed with nominal, numerical, and visual analog scales. Risk of bias was low for 2 studies, unclear for 4 studies, and high for 3 studies. All studies reported better postoperative pain scores with the active treatment group except for a single study comparing retrobulbar chirocaine with and without clonidine. No serious adverse events were reported for any of the studies.

Heterogeneity of studies did not allow for meta-analysis, but qualitative analysis suggests that pain relief can be achieved in the short term with a variety of treatment interventions. Additional study is required to specifically examine pain management strategies according to the characteristics of the anesthesia and surgery as well as the needs of the patient.

To report the successful repair of a persistent full-thickness retinal fold secondary to hypotony from trabeculectomy surgery.

Laser suturelysis was performed on a patient to relieve an elevated intraocular pressure posttrabeculectomy surgery. This resulted in chronic hypotony, a full-thickness retinal fold, and a decline in visual acuity to “count fingers.” The patient underwent a pars plana vitrectomy with internal limiting membrane peeling, subretinal injection of balanced saline solution, fluid-air exchange, injection of F-Decalin, peripheral retinotomy, endolaser photocoagulation, and vitreous substitution with 15% C₃F₈ gas. Anatomic improvement was documented via multimodal imaging. Six months postoperatively best-corrected visual acuity (BCVA) returned to 20/30.

We describe a surgical approach to full-thickness retinal folds and review the management options previously reported in the setting of hypotony. We provide support for the active management of appositional full-thickness retinal folds involving the fovea and demonstrate that surgical correction can significantly improve BCVA even after 4 months of hypotony.

To report a case of bilateral central retinal vein occlusion in a young female patient with idiopathic pulmonary arterial hypertension.

Case report and literature review.

A 33-year-old female with a history of idiopathic pulmonary hypertension initially presented with progressive vision loss in the right eye and subsequently presented with vision loss in the left eye 2 weeks later.

Clinical examination revealed central retinal vein occlusion (CRVO) in the right eye followed by CRVO in the left eye within 2 weeks as confirmed by clinical examination, fundus photography, spectral domain optical coherence tomography, and fundus fluorescein angiography.

Central retinal vein occlusion is an ocular finding associated with pulmonary arterial hypertension and can be bilateral.