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Purpose: To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy and diabetic retinopathy., Methods: Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent sickle cell retinopathy and diabetic retinopathy between January 01, 2014, and December 31, 2021., Results: The study included 20 eyes of 14 patients. Indications for surgery included tractional retinal detachment in 12 eyes (60%), combined tractional retinal detachment/rhegmatogenous retinal detachment in 6 eyes (30%), and vitreous hemorrhage in 2 eyes (10%). Pars plana vitrectomy was performed in all eyes. One eye received a scleral buckle at the same time as pars plana vitrectomy. There was no change in mean best-corrected visual acuity at the last follow-up examination (1.5 [20/678]) when compared with mean preoperative best-corrected visual acuity (1.6 [20/762], P = 0.83). Preoperative best-corrected visual acuity correlated with postoperative best-corrected visual acuity at the last follow-up examination in eyes with retinal detachment (r = 0.49, P = 0.04). Single operation anatomic success was achieved in 11 of 17 eyes (65%) with retinal detachment., Conclusion: Functional and anatomic outcomes after surgery in eyes with concurrent sickle cell retinopathy and diabetic retinopathy are relatively poor.

Purpose: To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients., Methods: This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications., Results: The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery., Conclusion: Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

Purpose: A prior study revealed discrepancies in self-reported surgical numbers between male and female ophthalmology residents. This study further investigates the gender differences in self-reported procedural volume among vitreoretinal surgery fellows and examines the differences for surgical, medical, and total self-reported procedural volume between male and female vitreoretinal fellows., Methods: A retrospective review of case logs submitted to the American Society of Retina Specialists by first-year and second-year vitreoretinal fellows from July 1, 2018, to June 30, 2019, was performed. Fellows who reported fewer than 100 pars plana vitrectomies were excluded. A total of 133 fellows were included., Results: Overall, 37 of 57 (65%) first-year fellows and 59 of 76 (78%) second-year fellows were male. An average of 1,120 procedures were self-reported among all vitreoretinal fellows. In the group of second-year fellows at the completion of fellowship, men reported more total procedures (1,171 [864-1,600] vs. 1,005 [719-1,257]; P = 0.072). Women reported statistically significant fewer endolaser (P = 0.018), internal limiting membrane peel (P = 0.042), and cryoretinopexy (P = 0.002) procedures compared with men. When splitting the data by total surgical versus medical procedures, men reported more procedures than women both surgically (1,077 [799-1,490] vs. 925 [622-1,208]; P = 0.085) and medically (72 [41-116] vs. 56 [20-94]; P = 0.141), although these differences were not statistically significant., Conclusion: There is a trend for female vitreoretinal fellows to report fewer surgical procedures than their male counterparts, raising concerns for gender gaps in vitreoretinal surgical training. Further research is needed to verify this discrepancy and identify potential barriers that female vitreoretinal surgeons are facing in training.

Purpose: To evaluate characteristics associated with misrepresentation of publication record, future career placement, and subsequent academic output among vitreoretinal surgical fellowship applicants., Methods: A retrospective review of 337 vitreoretinal surgical applicants between 2015 and 2018 was conducted. Publications reported in the applications were verified using PubMed, Google, and Google Scholar. Applications were considered misrepresented if there was no record of the publication or if there was an inconsistency in authorship. Applicants were followed after graduation and their employment position and postgraduation publications were recorded. The main outcome measures were the number of unverifiable publications, postfellowship job placement, and postgraduate peer-reviewed publications., Results: Of the 377 applicants, 309 (82.0%) listed peer-reviewed publications. Of those with a publication, 32 (10.4%) had misrepresentations. A reported desire to pursue an academic career was associated with a future career in academic medicine, whereas Alpha Omega Alpha status was correlated with a future career in private practice. Alpha Omega Alpha status, a reported desire to pursue an academic career, and the number of peer-reviewed publications before fellowship were positively correlated with higher numbers of peer-reviewed publications after fellowship., Conclusion: Unverifiable authorship among vitreoretinal surgical fellowship applicants is significant, affecting nearly one in 10 applicants with peer-reviewed publications. A reported desire to pursue academic medicine as listed on the fellowship application is a useful indicator for a future career in academics, and for increased number of peer-reviewed publications after fellowship.

Purpose: To report clinical course and visual and anatomical outcomes of six eyes with histopathologically confirmed vitreous cavity and retina epithelial downgrowth., Methods: This is a retrospective 15-year review of archived pathologic slides and corresponding medical records of patients with vitreous cavity and retina epithelial downgrowth. Posterior segment epithelial downgrowth was defined as epithelial or goblet cells in the vitreous cavity or on the surface of the retina., Results: Histopathologic diagnosis of epithelial downgrowth was made in 122 patients. Of those, 6 patients (5%) had vitreous cavity and retina epithelial downgrowth. Three patients developed blind painful eye, and epithelial downgrowth was identified in enucleated specimens. The other three eyes with visual potential presented with tractional retinal detachments. Epithelial downgrowth was identified in epiretinal membranes obtained during pars plana vitrectomy. The latter group had more previous surgeries (P = 0.03), and all had keratoprosthesis implantation as their last surgery. All three had pathologic specimens obtained at the time of the keratoprosthesis implantation; no anterior segment epithelial downgrowth was noted in two patients, and one patient had involvement of corneal button, iris, and posterior capsule. Final visual acuity ranged from hand motion to light perception., Conclusion: In the current study, vitreous cavity and retina epithelial downgrowth occurred after multiple intraocular surgeries, including repair of the open globe injuries both in enucleated specimens and in eyes with visual potential. In eyes with visual potential, keratoprosthesis implantation seems to predispose the development of posterior segment epithelial downgrowth.

Purpose: To report wide-field fluorescein angiography findings in the peripheral retina of eyes with childhood glaucoma., Methods: Fluorescein angiograms were examined retrospectively in 12 patients with childhood glaucoma who underwent wide-field fluorescein angiography after surgical or medical treatment of glaucoma. This series included 12 eyes of 6 patients with primary congenital glaucoma, 5 eyes of 3 patients with glaucoma associated with congenital cataract surgery, 4 eyes of 2 patients with glaucoma associated with a systemic condition, and 1 eye of 1 patient with phakomatosis pigmentovascularis Type II. RetCam fundus photography images and digital fluorescein angiography were performed under general anesthesia., Results: The most common finding observed in our series was peripheral retinal nonperfusion, which affected 20 eyes (91%). Other notable features seen were circumferential branching of the retinal vessels parallel to the ora serrata (77%), venous shunts (50%), and abnormal capillary branching patterns, including capillary dilatation (41%) and tortuous capillary tangles (18%). Leakage at the junction of vascular and avascular retina was not commonly seen (13.6%). None of the eyes had evidence of retinal neovascularization or fibrovascular proliferation., Conclusion: Retinal vascular abnormalities and peripheral nonperfusion are novel findings in childhood glaucoma. Further studies are needed to understand the significance and possible long-term consequences of these findings.

Purpose: To report Achromobacter xylosoxidans as a cause of both acute-onset and delayed-onset postoperative endophthalmitis after cataract surgery., Methods: A noncomparative consecutive case series of patients with culture-proven A. xylosoxidans endophthalmitis between 1970 and 2012. Cataract surgery and intraocular lens placement were performed in all patients before endophthalmitis. Positive cultures were obtained from the vitreous, capsular bag, and/or the removed intraocular lens., Results: The clinical diagnosis was confirmed in four patients with positive cultures. Two patients with endophthalmitis had a preliminary culture report of Pseudomonas species. In addition to receiving intravitreal antibiotics, all patients underwent capsulectomy and intraocular lens removal at the time of pars plana vitrectomy. Visual acuity at last follow-up was 20/40 or better in 2 (50%) of the 4 patients, but the remaining 2 patients were 20/200 or worse., Conclusion: A. xylosoxidans may be a cause of acute, recurrent, and delayed-onset postoperative endophthalmitis after cataract surgery. Complete capsulectomy and intraocular lens removal can be considered in recurrent and recalcitrant patients.

Purpose: To describe exudative retinal detachment following laser photocoagulation after 40 weeks of postmenstrual age (PMA) for retinopathy of prematurity in premature infants, its medical management, and outcomes., Methods: Two pediatric vitreoretinal surgeons at 2 different quaternary care institutions retrospectively identified children who received laser photocoagulation after 40 weeks of PMA and subsequently developed exudative detachment. Hospital course, management, and outcomes were identified., Results: Three infants were identified that developed exudative retinal detachments following laser photocoagulation for retinopathy of prematurity after 40 weeks of PMA. The average gestational age was 25 weeks with an average birth weight of 650 g. All babies were Zone II at initial examination and developed Stage 3 with pre-plus or plus disease after 40 weeks of PMA (average 42 weeks of PMA). Therapy consisted of topical cyclogyl (0.5%) and topical prednisolone acetate (1%) to the affected eyes and intravenous dexamethasone in all cases. The exudative retinal detachments resolved by 50 weeks of PMA in all infants. Hard exudates following resolution were found in all eyes. Two eyes demonstrated temporal macular dragging., Conclusion: Premature infants who require laser photocoagulation for retinopathy of prematurity at >40 weeks of PMA may be predisposed to develop exudative retinal detachments. In the absence of identifiable traction, systemic corticosteroid use can be considered to achieve favorable anatomic outcomes.

Purpose: To assess the rate of infectious endophthalmitis and to describe the clinical and microbiological features of eyes that develop clinically suspected endophthalmitis after an intravitreal injection of vascular endothelial growth factor antagonists., Methods: The medical records of patients undergoing intravitreal injections of anti-vascular endothelial growth factor agents from January 1, 2005, through December 31, 2010, at a single university referral center and associated satellite clinics were retrospectively analyzed to determine the rate of infectious endophthalmitis after intravitreal anti-vascular endothelial growth factor injections., Results: Twelve cases (11 patients) of clinically suspected endophthalmitis were identified after a total of 60,322 injections (0.02%; 95% confidence interval, 0.0114%-0.0348%). Of the 12 cases, 11 presented within 3 days of the injection. Of the 7 culture-positive cases, 5 were because of Streptococcus species. In 4 of the 5 Streptococcus cases, final visual acuity was hand motions or worse. The rate of clinically suspected endophthalmitis was 0.018% after bevacizumab and 0.027% after ranibizumab injections., Conclusion: A very low rate of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents was observed. Patients typically presented within 3 days of injection. Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes.

Purpose: The purpose of this study was to describe a subset of severely affected patients with neurofibromatosis type 2 (NF2), multiple central nervous system tumors, and characteristic retinal lesions., Methods: This is a retrospective observational case series of 4 patients with NF2. The time domain-optical coherence tomography findings of three patients have previously been described in another series., Results: Ophthalmic signs were identified at a mean age of 6 years, and NF2 was diagnosed at a mean age of 11 years. Patients presented with diminished visual acuity in one or both eyes and epiretinal membranes in the absence of posterior vitreous detachment. The biomicroscopic and optical coherence tomography features were distinct from secondary epiretinal membranes or combined hamartomas of the retina and retinal pigment epithelium and pathognomonic for NF2. The ophthalmic manifestations were recognized before neurologic signs and led to the diagnosis of NF2 in 3 of the 4 patients. Each patient had > or =2 central nervous system tumors at the time of diagnosis, and 3 of 4 eventually required neurosurgical interventions for symptomatic, compressive lesions at a mean age of 12 years., Conclusion: Recognition of epiretinal membranes with a characteristic optical coherence tomography appearance may permit early diagnosis in neurologically asymptomatic children with a severe phenotype of NF2.

Purpose: To compare outcomes after switching from intravitreal bevacizumab (Avastin) to ranibizumab (Lucentis) in patients with neovascular age-related macular degeneration (AMD)., Methods: A retrospective review was performed of patients with neovascular AMD who were switched from treatment with intravitreal bevacizumab to intravitreal ranibizumab once ranibizumab became commercially available. All reviewed patients had at least three bevacizumab injections before being switched to ranibizumab. The treatment outcomes included comparisons of visual acuity and dosing frequency while receiving both drugs., Results: Eighty-four eyes met the inclusion criteria. Mean baseline visual acuity was 20/100. Mean duration of bevacizumab treatment was 7.1 months followed by 7.3 months with ranibizumab (P = 0.68). Best-obtained visual acuity during treatment was 20/63 with bevacizumab and 20/63 with ranibizumab (P = 0.5). Last mean visual acuity after receiving bevacizumab at the time of the first ranibizumab injection was 20/80. Mean visual acuity at the last ranibizumab follow-up visit was 20/80 (P = 0.49). Mean injection rates per month while receiving bevacizumab and ranibizumab were 0.66 (P = 0.98)., Conclusion: In this subset of patients with neovascular AMD switched from bevacizumab to ranibizumab therapy, there were no apparent differences in visual acuity outcomes or injection rates. Larger prospective studies are under way to directly compare these drugs for the treatment of neovascular AMD.

Purpose: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin, Genentech) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and hemiretinal vein occlusion (HRVO)., Methods: A retrospective review was performed of consecutive patients treated with intravitreal bevacizumab (1.25 mg) for ME secondary to BRVO/HRVO from May 2005 to August 2006 with follow-up through February 2007. Re-treatment was performed at monthly or longer intervals at the discretion of the treating physician., Results: Fifty-two eyes with a BRVO and 13 eyes with an HRVO received intravitreal bevacizumab at baseline. Visual acuity improved by a mean of 12 letters at 1 month (n = 51; P < 0.001), 13 letters at 3 months (n = 61; P < 0.001), 13 letters at 6 months (n = 42; P < 0.001), 14 letters at 9 months (n = 27; P < 0.001), and 15 letters at 12 months (n = 17; P = 0.015). The mean optical coherence tomography (OCT) thickness decreased by 184 microm (P < 0.001), 131 microm (P < 0.001), 161 microm (P < 0.001), 158 microm (P = 0.002), and 205 microm (P = 0.002) at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. The mean number of injections was 1.4, 2.1, 2.7, and 3.1, and 3.3 at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. No ocular or systemic adverse events were observed., Conclusion: Improvements in visual acuity and OCT outcomes were observed during the first year after intravitreal bevacizumab in patients with ME secondary to BRVO and HRVO.

Purpose: To evaluate the long-term safety and efficacy of intravitreal bevacizumab injections (Avastin, Genentech Inc., San Francisco, CA) for the treatment of macular edema secondary to central retinal vein occlusions., Methods: A retrospective review was performed of eyes treated from May 2005 to August 2006 with follow-up through February 2007. The dose of bevacizumab was 1.25 mg (0.05 mL). Retreatment was performed at monthly or longer intervals at the discretion of the treating physician., Results: Fifty-seven eyes received intravitreal bevacizumab at baseline. Visual acuity improved by a mean of 14 letters (N = 53; P < 0.001) at 1 month, 13 letters at 3 months (N = 53; P < 0.001), 9 letters at 6 months (N = 30; P = 0.001), 9 letters at 12 months (N = 17; P = 0.004). The mean optical coherence tomography thickness decreased by 299 microm at 1 month (N = 53; P < 0.001), 144 microm at 3 months, (N = 53; P < 0.001), 127 microm at 6 months (N = 30; P = 0.011), and 276 microm at 12 months (N = 17; P < 0.001). No ocular or systemic adverse events were observed., Conclusion: Improvements in visual acuity and optical coherence tomography were observed during the first year following intravitreal bevacizumab for macular edema secondary to central retinal vein occlusions. These retrospective results provide additional evidence to support the perceived safety and efficacy of intravitreal bevacizumab in this disorder.

Purpose: To report on the clinical characteristics and outcomes of premature infants developing signs of anterior segment ischemia after laser therapy for threshold retinopathy of prematurity treated or referred to a university institution., Methods: A retrospective review of the medical records of premature infants with a primary diagnosis of retinopathy of prematurity undergoing laser therapy for threshold disease from January 1, 2001, to June 1, 2006., Results: A total of 10 eyes in six patients were identified that developed signs of anterior segment ischemia for which a 1-year follow-up was available. The mean gestational age of patients developing anterior segment ischemia was 26.1 weeks. The mean weight was 855 g. The mean gestational age when laser photoablation was initiated was 36.3 weeks. All infants developing ischemia were treated with intermittent dense laser pattern using the diode laser. No infants treated thus far with confluent laser pattern have developed anterior segment ischemia., Conclusion: Confluent laser pattern in our experience does not predispose to anterior segment ischemia. Anterior segment ischemia primarily affects premature infants less than 28 weeks gestational age with low birthweights, less than 1,075 g. Intravitreal steroids at the time of pars plana vitrectomy and lensectomy may be beneficial in selected patients.

Purpose: To report the short term anatomic response of intravitreal bevacizumab (Avastin, Genentech) as salvage treatment in progressive retinopathy of prematurity (ROP) in a small series of patients., Methods: The study included five eyes of three patients with progressive ROP despite peripheral laser ablation. Patients received intravitreal injections of bevacizumab (Avastin, Genentech). RetCam (Clarity Medical Systems, Inc., Pleasanton, CA) photography and ultrasonography were used to document effect., Results: Three patients were transferred to the Bascom Palmer Eye Institute/Jackson Memorial Hospital for management of progressive ROP despite laser therapy at an outside facility. RetCam fundus photography and ultrasonography were used to document all cases. After informed consent was obtained from the parents, the patients received off-label intravitreal bevacizumab as salvage treatment. Repeat intravitreal injections of bevacizumab were utilized in several cases. The ROP stabilized allowing laser supplementation. There was varying development of tractional retinal detachments in several of the eyes but the ROP component quieted in all cases., Conclusions: Off-label use of bevacizumab appears to be useful as a salvage treatment for ROP when laser treatment is precluded. It improves dilation, quiets the disease when visibility is difficult, and temporizes the disease until laser can be supplemented.

Purpose: To review the rates of globe salvage and final visual acuity outcomes for patients undergoing repetitive laser ablation therapy for advanced Coats' disease., Methods: This study was a retrospective chart review of all patients diagnosed with primary Coats' disease treated on the Ocular Oncology Service of the Bascom Palmer Eye Institute from 1991-2006. Patients underwent repetitive diode laser ablation (two to nine sessions) to telangiectatic vessels and areas of exudative retinal detachment. Main outcome measures included ability to achieve globe salvage, final visual acuity, and anatomic success., Results: Seventeen patients were identified who met all of the inclusion criteria for the study. All of the eyes in this study had advanced disease with some degree of exudation with or without a retinal detachment. The median length of follow-up was 10 months (mean, 21 months). The median number of laser applications required was 4.8 (mean, 5). Fourteen patients (82%) achieved anatomic success with complete resolution of the telangiectasis and exudative retinal detachments. Sixteen patients (94%) achieved globe salvage. The final visual acuity was excellent (20/20-20/50) in 7 patients (47%), moderate (20/60-20/100) in 1 patient (7%), and poor (worse than 20/200) in 7 patients (47%)., Conclusion: A majority of patients with Coats' disease can achieve globe salvage and about half of patients can retain useful vision with aggressive repetitive diode laser therapy even if the disease is very advanced at presentation.

Purpose: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) as treatment for macular edema associated with central retinal vein occlusion (CRVO)., Methods: A retrospective review was performed of data for 40 consecutive patients (40 eyes) with CRVO and macular edema treated with IVTA at the Bascom Palmer Eye Institute (Miami, FL)., Results: Median duration of symptoms before the first injection was 3 months (range, 1 day to 8 years). Median Snellen visual acuity was 20/400 at baseline (range, 20/60 to light perception; n = 40), 20/300 at 1 month (P = 0.010; n = 37), 20/300 at 3 months (P = 0.007; n = 33), 20/400 at 6 months (P = 0.726; n = 28), and 8/200 at 1 year (P = 0.569; n = 17). Vision improved by > or =3 lines in 21% of eyes at 1 month, 27% at 3 months, 14% at 6 months, and 12% at 1 year. Visual acuity was unchanged from baseline in 71% of eyes at 6 months and 1 year. By 1 year, 50% of eyes received more than one injection (mean = 1.6 injections; range 1-4 injections). Overall, intraocular pressure increased by > or =10 mmHg in 24% of eyes at 1 year. Trabeculectomy was performed on 2 of 12 eyes with preexisting open-angle glaucoma., Conclusion: IVTA can substantially improve vision in some patients, but most patients have stable visual acuity compared with baseline at 1 year despite repeated injections.