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Common properties of all contact and noncontact wide-angle systems are an inverted fundus view and a device to convert the image to a normally oriented view of the field. Wide-angle viewing systems may be used for all intraocular procedures involving vitrectomy and diagnostic inspection of the peripheral and posterior retina during surgery. Retained lens material is an example of a situation where a wide-angle viewing system can be used. Complex surgery for diabetic vitreous hemorrhage and traction retinal detachment can be simplified with the use of a wide-angle viewing system. Wide-angle viewing facilitates dissection of anterior proliferative vitreoretinopathy, gas–fluid exchanges, and silicone oil injection, with either a gas–silicone exchange or perfluorocarbon liquid–silicone exchange. True bimanual vitreoretinal surgery can be attained using the multiport illumination system. Visualization for posterior segment vitrectomy surgery was initially accomplished with hand-held, planoconcave contact lenses.

Purpose To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of anti–vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (AMD). Design Single-practice retrospective chart review. Participants One hundred nine eyes with exudative AMD receiving continuous fixed-interval dosing (every 4–8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept) for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year. Methods Snellen visual acuity was recorded at baseline and all subsequent injections. Changes from baseline were calculated at yearly intervals. Main Outcome Measures The primary outcome measure was mean change in letter score at 5, 6, and 7 years; secondary outcomes included the percentage of patients with 20/40 vision or better at 7 years and the mean change in letter score at each yearly time point based on baseline visual grouping (20/40 or better, 20/50–20/100, 20/200 or worse). Results Forty-four, 75, and 109 patients with 7, 6, and 5 years, respectively, of continuous treatment were identified. Mean change in letter score at year 5 was +14.0 letters ( P = 3.9 × 10 −9 ), +12.2 letters at 6 years ( P = 1.5 × 10 −7 ), and +12.1 letters at 7 years ( P = 3.8 × 10 −5 ). Driving vision (20/40 or better) was achieved in 43.2% of treated eyes. Subanalysis revealed that the greatest visual gains at 5 and 7 years were seen in those patients with baseline visual acuity worse than 20/200 (+24.5 and +25.5 letters), followed by those with 20/50 to 20/100 vision (+6.7 and +6.9 letters), and finally those with 20/20 to 20/40 (+3.7 and +3.4 letters). Patients received an average of 10.5 injections per year. Conclusions Continuous fixed-interval dosing of anti-VEGF therapy in patients with exudative AMD results in favorable long-term preservation out to 7 years, with vision stabilizing or improving in 93.2% of eyes. Additionally, 43.2% of patients maintained driving vision in the treatment eye at 7 years compared with 10.1% at baseline. Our data suggest better outcomes with continuous therapy over published results with sporadic, as-needed therapy.