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Background: After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas., Methods: The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6., Results: 213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12., Conclusion: Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery., Trial Registration: NCT02146144., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: Post hoc analysis of the phase III HAWK and HARRIER studies to compare the reductions in subretinal hyper-reflective material (SHRM) thickness following brolucizumab 6 mg or aflibercept 2 mg treatment and to assess SHRM thickness and thickness variability as a potential biomarker of visual outcomes in patients with neovascular age-related macular degeneration (nAMD)., Methods: Optical coherence tomography images from the brolucizumab (n=700) and aflibercept (n=696) arms were analysed for the maximum SHRM thickness across the macula over 96 weeks. In a pooled treatment-agnostic analysis, the effect of week 12 SHRM thickness and SHRM thickness variability on best-corrected visual acuity (BCVA) through week 96 were also assessed., Results: Brolucizumab was associated with numerically higher percentage reductions from baseline in SHRM thickness versus aflibercept in all patients (week 96: 54.4% vs 47.6%, respectively) and also in the matched subgroups with disease activity at week 16 (week 96: 51.6% vs 33.8%, respectively). In eyes with lower SHRM measurements at week 12, mean BCVA gains from baseline were higher at week 96 (<200 µm, +6.47 Early Treatment Diabetic Retinopathy Study letters; ≥200 µm, +3.10 letters). Eyes with the lowest SHRM thickness variability from week 12 to week 96 showed the greatest mean BCVA gains from baseline (week 96: <12 µm, +7.42 letters; >71 µm, -2.95 letters)., Conclusions: In HAWK and HARRIER, greater reductions in maximum SHRM thickness from baseline were observed with brolucizumab compared with aflibercept. Furthermore, the data suggest that SHRM thickness postloading and SHRM thickness variability over time are biomarkers for visual outcomes in patients with nAMD., Competing Interests: Competing interests: SS: Consultant for Novartis, Allergan, Amgen, Apellis, Iveric, Nanoscope, Astellas, Jannsen, Roche/Genentech, Oxurion, Regeneron, 4DMT, Optos, Centervue, Heidelberg, Notal, Biogen, Boehringer Ingelheim. Speaker fees from Optos, Carl Zeiss Meditec, Nidek, Topcon, Novartis. DS: Consultant for Amgen, Bayer, Genentech, Iveric Bio, Novartis, Optovue; Research grants from Amgen, Boehringer, Genentech, Heidelberg, Optovue, Regeneron, Topcon; Speaker fees from Optovue. AMK: Consultant: Abbvie, Adverum, AGTC, Aldebaran Therapeutics, Alimera, Apellis, Arrowhead, Asclepix, Aviceda, Bausch and Lomb, Broadwing Bio, Cholgene, 4DMT, Eyepoint, Frontera Therapeutics, Gemini, Genentech, Graybug, Gyroscope, Iveric Bio, Janssen, Kartos Therapeutics, Kato Pharma, Kodiak, Kriya Therapeutics, Ocular Therapeutix, Oculis, Ocuterra, Opthea, Oxurion, Nanoscope, Novartis, Perfuse, PolyPhotonix, Protagonist, Ray Therapeutics, Recens Medical, Regeneron, Retrotope, Regenxbio, RevOpsis, Roche, Stealth, Thea, Unity Bio, Vanotech, Vial. Research Support: Adverum, Alkahest, Annexon, Apellis, Asclepix, 4DMT, Gemini, Genentech, Inc., Graybug Vision, Gyroscope, Iveric Bio, Kodiak, Neurotech, NGM Bio, Ocular Therapeutix, Oculis, Ocuterra, Opthea, Oxurion, Novartis, Recens Medical, Regenxbio, Roche, Unity Bio. Speaker: Abbvie, Apellis, Bausch and Lomb, Genentech, Novartis. Equity: Aviceda, Recens Medical, Retrotope, RevOpsis, PolyPhotonix. RT: Alcon, Apellis, Bausch and Lomb, FCI, Iveric Bio, Moria, Zeiss, Optovue, Topcon, Alimera, Allergan, Bayer, Novartis, Oculis, Genentech, Roche, Thea. AAC: Consultant: Novartis, Bayer, Roche, Alcon, Apellis; Speaker fees: Novartis, Bayer, Roche, Alcon, Apellis. Nidek; Grant funding: Novartis, Bayer, Roche. IS, KG: Employee of Novartis Pharma AG. DTW: Consultant for Abbvie, Alcon, Apellis, Bayer, Bausch Health, Biogen, Boehringer Ingelheim, Novartis, Ripple Therapeutics, Roche, Topcon, Zeiss. Research grants from Novartis, Roche., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To analyse the choroidal thickness (CT) and vessel pattern of myopic patients with dome-shaped macula (DSM) and their association with the DSM axis and serous retinal detachment (SRD)., Methods: Retrospective study. The CT and vessel pattern were assessed on optical coherence tomography (OCT), OCT-angiography and ultra-wide-field photography., Results: 27 eyes of 18 subjects (mean age: 65 years) were included. Compared with the 11 eyes (41%) with horizontal DSM, the 16 eyes (59%) with vertical DSM had a shorter axial length (25.8±2 mm vs 28.3±2.5 mm; p=0.01), a higher mean macular bulge height (624.4±207 µm vs 255.4±160.3 µm; p=0.0001) and a thicker CT (183.1±91.1 µm vs 72±38.3 µm; p<0.001). Large choroidal vessels crossed the macular area in 75% of eyes with vertical DSM vs 27% of eyes with horizontal DSM (p=0.02), whereas a watershed zone framing the macula was more often seen in horizontal DSM (72% vs 25%, p=0.02). Thirteen eyes (48%) had an SRD that was not associated with the DSM axis, the mean bulge height, the CT or the vessel pattern., Conclusion: The presence of an SRD did not correlate with the DSM axis, the CT or the vessel pattern. However, the rate of large choroidal vessels crossing the macula was higher in vertical DSM than in horizontal DSM., Competing Interests: Competing interests: PN, none; AC reports personal fees from Allergan, Bayer and Novartis, outside of the submitted work. DG, none; ST, none; GLG, none; AG, none; RT reports personal fees from Novartis, Bayer, Roche, Genentech, Allergan, Zeiss, Alcon and Oculus, outside of the submitted work; EP reports personal fees from Bayer and Novartis outside of the submitted work., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To analyse the prevalence and postoperative outcomes of a particular form of epiretinal membrane (ERM) with foveoschisis-like stretched hyporeflective spaces in emmetropic eyes., Methods: A retrospective study of all consecutive eyes operated for primary ERM over a 46-month period was conducted. The presence of foveoschisis-like stretched hyporeflective spaces was assessed on the preoperative optical coherence tomography B-scan in all eyes. Highly myopic eyes were excluded. Preoperative and postoperative characteristics of eyes with foveoschisis were compared with those of a control group of 100 consecutive eyes with primary ERM without cystoid spaces., Results: Of 544 eyes with primary ERM, 17 had foveoschisis, corresponding to a prevalence of 3.1%. After a mean postoperative follow-up of 17.9±10.9 months, the foveoschisis had completely resolved in 76.5% of eyes (n=13/17). In the four eyes (23.5%) with persistent foveoschisis, the remaining hyporeflective cystoid spaces were located exclusively in the inner nuclear layer. The postoperative visual acuity and central macular thickness did not differ between both groups at the final visit. However, an acute postoperative macular oedema occurred in 24% (n=4/17) of cases (vs 3% in the control group; p=0.0084)., Conclusion: Foveoschisis was found in about 3% of eyes with idiopathic ERM. After peeling, the foveoschisis usually resolves completely with functional outcomes similar to those achieved with other primary ERM. However, this feature was associated with a higher risk of postoperative macular oedema (in 1/4 of cases)., Competing Interests: Competing interests: EP reports personal fees from Bayer and Novartis, outside the submitted work. AG reports personal fees from Novartis, Bayer Healthcare and Thrombogenics, outside of the submitted work. RT reports personal fees from Novartis, Bayer, Roche, Genentech, Allergan, Zeiss, Alcon and Oculis, outside the submitted work. AC reports personal fees from Allergan, Bayer and Novartis, outside the submitted work. All authors attest that they meet the current ICMJE criteria for authorship., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To analyse the prevalence and evolution of hyper-reflective cystoid spaces with decorrelation signal detected using optical coherence tomography angiography (OCTA) in diabetic macular oedema (DMO)., Methods: A retrospective study of consecutive eyes with DMO imaged using OCTA over a 1-year period was conducted. All eyes with hyper-reflective cystoid spaces at baseline and at least 3 months of follow-up were included in a longitudinal analysis., Results: The prevalence of hyperreflective cystoid spaces with decorrelation signal was of 37% (61/165) in DMO eyes. Hyperreflective foci within hyperreflective cystoid spaces were observed in 85% of eyes. The longitudinal study included 33 eyes (10 observed and 23 treated with intravitreal anti-vascular endothelial growth factor), with a median follow-up of 15 months. The hyperreflective cystoid spaces resolved in 85% of eyes. The mean best-corrected visual acuity remained stable during the follow-up, even in the eyes achieving a resolution of the hyperreflective cystoid spaces. Hard exudates appeared in the area of resolved hyperreflective cystoid spaces in 33% of eyes., Conclusion: Hyperreflective cystoid spaces detected by OCTA affected more than one-third of the DMO eyes. Their disappearance was not associated with any functional improvement and led to the formation of new hard exudate deposits in about one-third of the eyes., Competing Interests: Competing interests: AC is a board member for Allergan (Ireland), Bayer HealthCare (Germany), Novartis Pharma (Switzerland) and has received travel grants from Allergan (Ireland) and Bayer HealthCare (Germany). RT is a board member for Alcon, Switzerland; Novartis, Switzerland; Roche, Switzerland; Allergan, USA; Bausch and Lomb, USA; Genentech, USA; Pfizer, USA; Alimera, USA; Bayer, Germany; FCI-Zeiss, France; Thrombogenics, Belgium, and consultant for Allergan, USA; DORC, Netherlands; Alcon, Switzerland; Novartis, Switzerland; Bausch and Lomb, USA; FCI-Zeiss, France; Thrombogenics, Belgium, has received lecture fees from Alcon, USA; Bausch and Lomb, USA; Novartis, Switzerland; Allergan, USA; Bayer, Germany; Alimera, USA, educational presentation fees from Bausch and Lomb, USA; Novartis, Switzerland; Zeiss, Germany; Sony, Japan; Alcon, Switzerland; Allergan, USA, meeting expenses from Novartis, Switzerland; Alcon, Switzerland; Allergan, USA; Bausch and Lomb, USA; Pfizer, USA; Bayer, Germany; DORC, Netherlands; Alimera, USA., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To estimate the 10-year incidence of referable diabetic retinopathy (DR) in a French population with type 1 and 2 diabetes mellitus (DM). A secondary objective was the assessment of safe screening intervals in patients with diabetes without retinopathy., Methods: Observational, prospective and multicentric study between June 2004 and September 2017 based on a regional screening programme for DR in the Paris region. The incidence of referable DR in patients without retinopathy at baseline was calculated by the Turnbull survival estimator. A safe screening interval was defined as a 95% probability of remaining without referable DR., Results: Among the 25 745 participants with type 1 (n=6086) or type 2 (n=19 659) DM, the 10-year cumulative incidence of referable DR was 19.10% (95% CI 17.21% to 21.14%) and 17.03% (15.78% to 18.35%), median (IQR) follow-up=3.33 (4.24) years. The safe screening interval for patients without DR at the first examination for type 1 and 2 DM was 2.2 (95% CI 2.0 to 2.4) and 3.0 (2.9 to 3.1) years, respectively. In a subgroup of low-risk patients with type 2 DM, the safe screening interval was 4.2 (3.8 to 4.6) years., Conclusions: These data suggest that in Paris area, a 2-year, 3-year and 4-year screening interval was considered safe for type 1 DM, type 2 DM and for low-risk patients with type 2 DM, respectively, without DR at the first examination. While these data might be used to support the consideration of extending screening intervals, a randomised clinical trial would be suitable to confirm the safety for patients with DM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed., Methods: The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions., Results: The panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness., Conclusions: The use of the proposed definitions may provide uniform language for clinicians and future research., Competing Interests: Competing interests: JPH: consultant for Alcon (Fort Wort, TX, USA), Allergan (Dublin, Ireland); Novartis (Basel, Switzerland), Bausch & Lomb (St Louis, USA); RFS: Consultant for Topcon Medical Systems (Tokyo, Japan). DS: consultant: Alcon (Fort Wort, Texas, USA), Orbit Biomedical (Ambler, Pennsylvania, USA) Zeiss (Oberkochen, Germany) Research funding: Alcon (Fort Wort, Texas, USA), Bayer (Leverkusen, Germany). MSF: consultant for Novartis (Basel, Switzerland), Alcon (Fort Wort, Texas, USA), Bayer (Leverkusen, Germany), Allergan (Dublin, Ireland), Hoffman LaRoche (Basel, Switzerland), Zeiss (Oberkochen, Germany); JS: consultant for Hoffman LaRoche (Basel, Switzerland); Zeiss (Oberkochen, Germany), EgbaVision; AG: personal fees from Novartis (Basel, Switzerland), personal fees from Bayer Healthcare (Leverkusen, Germany), personal fees from Thrombogenics; GS: financial support—Heidelberg Engineering (Heidelberg, Germany), Zeiss Meditec, Optovue, Optos, Centervue, Nidek, Novartis, Bayer, Allergan, Alcon; JTT: Genetech (Roche)—grant support and consultant Opthea—Grant support; EHR Command Center, LLC—Equity ownership; SC: Genentech—consultant (DSMC) Lowy Medical Research Institute—DSMC, uncompensated consultant Alcon—Travel reimbursement, FB: consultant for Novartis (Basel, Switzerland), Bayer (Leverkusen, Germany); RT: personal fees—Novartis (Basel, Switzerland), Bayer (Leverkusen, Germany), Roche (Basel, Switzerland), Genentech (San Francisco, California, USA), Allergan (Dublin, Ireland), Zeiss (Oberkochen, Germany), Alcon (Fort Wort, Texas, USA)., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options., Material and Methods: Retrospective multicentric chart review., Results: Of 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit., Conclusion: In case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI's efficacy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/aims: To assess risk factors for serous retinal detachment (SRD) in the fellow eye of patients with central serous chorioretinopathy (CSC) based on clinical data and multimodal imaging findings, including baseline late-phase indocyanine green angiography (ICGA)., Methods: Consecutive patients with unilateral CSC were retrospectively assessed. Inclusion criteria were the availability of late-phase ICGA and a spectral-domain optical coherence tomography (OCT) macular cube for both eyes at baseline and over 3 months. Subsequent OCT of fellow eyes was reviewed to detect the development of SRD during the follow-up. Baseline medical data and multimodal imaging findings were analysed using Kaplan-Meier survival curves (log-rank test)., Results: Sixty-eight patients with unilateral CSC were included. An SRD was detected in 19% of fellow eyes during a mean follow-up of 25.8±18.7 months. Hyperfluorescent plaques on midphase ICGA, hypofluorescent foci on late-phase ICGA, retinal pigment epithelium changes on fundus autofluorescence and fluorescein angiography abnormalities were associated with the occurrence of SRD (log-rank test; p<0.001, p=0.02, p=0.002 and p=0.001, respectively)., Conclusion: These results suggest that the fellow eyes with specific findings on multimodal imaging in patients with unilateral CSC should be carefully followed up for possible incidence of CSC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To study the relationship between the size of primary full-thickness macular hole (MH) and the vitreomacular attachment status., Design: Single-centre retrospective observational case series., Methods: The records of 100 consecutive eyes operated for primary full-thickness MH were retrospectively reviewed. The vitreous status and MH diameter were assessed on the preoperative optical coherence tomography scans. MH were classified depending on the presence or absence of vitreomacular traction (VMT) and their size as small (<250 µm), medium (250-400 µm) and large (>400 µm), as suggested in the International VMT Study Group Classification., Results: 22% of MH had VMT and 13% had both VMT and a diameter <400 µm. The MH diameter was not significantly different depending on the presence or absence of VMT (respectively, 339±134 and 423±191 µm (p=0.094)), with large overlap between groups. Small, medium and large MH were similarly distributed regardless of the presence or absence of VMT (p=0.69)., Conclusions: Our series of 100 MH did not reveal any significant relationship between the MH size and the presence or absence of VMT. Only 13% of MH had VMT and a diameter <400 mm, then were eligible for intravitreal ocriplasmin as a possible treatment., Competing Interests: Competing interests: EP: travel expenses (Novartis, Bayer, Allergan). EB-S: travel expenses (Bayer). AG: board membership (Alimera, Allergan, Thrombogenics), lectures (Heidelberg, Zeiss) and educational presentations (Novartis, Alcon). RT: board membership (Alcon, Novartis, Allergan, Bausch & Lomb, Pfizer, Alimera, Bayer, Zeiss, FCI, Genentech, Roche, Thrombogenics) and travel expenses (Novartis, Bayer, Allergan)., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background/aims: To identify predictive markers for the outcomes of anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (nAMD)., Methods: AURA was a retrospective, observational, multicentre study that monitored the 2-year outcomes following intravitreal ranibizumab treatment in patients with nAMD. Using stepwise regression analysis, we evaluated the association between visual acuity outcomes, baseline characteristics and resource utilisation in order to determine which variables are significantly linked to outcomes in AURA. We also examined the relationship between visual acuity outcomes and number of injections received., Results: Analyses were performed using data from year 1 (n=1695) and year 2 completers (n=1184). Logistic analysis showed that baseline visual acuity score, age at start of therapy, number of ophthalmoscopies and optical coherence tomography (OCT) (combined) and number of injections (ranibizumab) were significant (p<0.05) prognostic factors for vision maintenance (loss <15 letters) or vision gain (≥15 letters). Patients who received >7 injections (in 1 year) or >14 injections (over 2 years) gained more letters and demonstrated greater vision maintenance (loss of <15 letters) than patients who received fewer injections. There was a significant (p<0.05) association between number of injections and national reimbursement schemes and OCT., Conclusions: A number of factors that are predictive of treatment outcomes in a real-life setting were identified. Notably, the decline of treatment benefits may be linked to number of injections and a failure to visit clinicians and receive OCT as required. These findings may be helpful in guiding ophthalmologist treatment decisions under limited time and financial constraints., Trial Registration Number: NCT01447043., Competing Interests: FGH is a consultant to Acucela, Genentech, Novartis, Bayer HealthCare, Alcon, OPTOS, Heidelberg Engineering, Carl Zeiss Meditec, Allergan and Pfizer, and has received grants from OPTOS, Heidelberg Engineering, Carl Zeiss Meditec, Alcon, Genentech, Bayer HealthCare and Novartis. RT is a board member of Alcon, Novartis, Allergan, Bausch & Lomb, Pfizer, Alimera, Bayer HealthCare and FCI-Zeiss, and a consultant for Allergan, DORC, Alcon, Novartis, Takeda, Bausch & Lomb and FCI-Zeiss. He has received payment for lectures from Alcon, Bausch & Lomb, Novartis, Allergan, Pfizer, Takeda, Bayer HealthCare and Alimera, and has received payment for development of educational presentations from Bausch & Lomb, Novartis, Zeiss, Sony, Alcon and Allergan. He has also received support for meeting expenses (travel and accommodation) from Alcon, Novartis, Allergan, Bausch & Lomb, Pfizer, Bayer HealthCare, DORC, Takeda, Servier and Alimera. SB is a consultant and board member for Bayer HealthCare, and has received support for travel to meetings and fees for participation in review activities from Bayer HealthCare. AB has received honoraria from Bayer HealthCare, Novartis, Alcon and Allergan. Institutional research funding support was received from Bayer HealthCare, Novartis and Alcon. Fellowship support funding was received from Alcon, Bayer HealthCare, Novartis and Woodgreen Pharmacy. He has received travel fees and speaker fees and participated in advisory boards for Bayer HealthCare and Novartis. MGC is a consultant to Bayer HealthCare and has received support for travel to meetings from Bayer HealthCare and Alcon. PH has received grants from Bayer HealthCare, Allergan and Novartis, and acts as a consultant to Bayer HealthCare, Novartis and Allergan. He has also received support for travel to meetings, for participation in review activities and provision of writing assistance, medicines, equipment or administrative support from Bayer HealthCare, has received payment for lectures from Allergan and Novartis and has received support for conference attendance. GS acts as a consultant to Novartis, Bayer HealthCare, Allergan, Genentech, Roche, Heidelberg Engineering and Alcon. He has also received support for travel to meetings from Bayer HealthCare, Centervue, Heidelberg Engineering and Novartis. He has received payment for lectures from Zeiss, and is a patent holder in conjunction with Ocular Instruments, Inc. He has received payment for development of educational presentations for Roche. SS has received research grants from Bayer HealthCare, Novartis and Allergan that were paid to her institution. She has received travel fees and speaker fees and has participated in advisory boards for Bayer HealthCare, Novartis and Allergan, and has participated in an advisory board meeting for Roche. AA and KW-J are employees of Bayer HealthCare. JN and KK are employees of Mapi Group, who were contracted by Bayer HealthCare to perform the analyses., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Retinal vein occlusion (RVO) is a common cause of retinal vascular disease, resulting in potentially irreversible loss of vision despite the existence of several therapeutic options. The humanised monoclonal antibody fragment ranibizumab binds to and inhibits vascular endothelial growth factor, a key driver of macular oedema in RVO. In 2010, ranibizumab was approved in the USA for the treatment of macular oedema in RVO and, in 2011, ranibizumab was approved in the European Union for the treatment of visual impairment caused by macular oedema secondary to RVO in branch and central RVO. Ranibizumab provides an additional therapeutic option for this complex disease: an option that was not fully considered during the preparation of current international guidelines. An expert panel was convened to critically evaluate the evidence for treatment with ranibizumab in patients with visual impairment caused by macular oedema secondary to RVO and to develop treatment recommendations, with the aim of assisting physicians to optimise patient treatment., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background/aims: Real-life anti-vascular endothelial growth factor (VEGF) therapy use in patients with wet age-related macular degeneration (wAMD) was assessed in a retrospective, observational study in Canada, France, Germany, Ireland, Italy, the Netherlands, UK and Venezuela., Methods: Medical records of patients with wAMD, who started ranibizumab treatment between 1 January 2009 and 31 August 2009, were evaluated. Data were collected until the end of treatment and/or monitoring or until 31 August 2011., Results: 2227 patients who received ≥1 anti-VEGF injection with a baseline visual acuity assessment and ≥1 postbaseline visual acuity assessment for the treated eye were evaluated. Visual acuity improved until about day 120; thereafter, visual acuity gains were not maintained. Mean change in visual acuity score from baseline to years 1 and 2 was +2.4 and +0.6 letters, respectively. Patients received a mean of 5.0 and 2.2 injections in the first and second year, respectively. There were substantial differences in visual outcomes and injection frequency between countries. More frequent visits and injections were associated with greater improvements in visual acuity., Conclusions: In clinical practice, fewer injections are administered than in clinical trials. Anti-VEGF treatment resulted in an initial improvement in visual acuity; however, this was not maintained over time., Trial Registration Number: NCT01447043., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aims: To compare the retinal sensitivity and frequency of microscotomas found by spectral domain optical coherence tomography (SD-OCT) combined with scanning laser ophthalmoscopy (SLO) microperimetry after idiopathic macular hole closure, in eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not., Methods: This was a retrospective, non-randomised, comparative study. Combined SD-OCT and SLO microperimetry was performed in 16 consecutive eyes after closure of an idiopathic macular hole. A customised microperimetry pattern with 29 measurement points was used. The ILM was peeled in 8/16 eyes. The main outcome measure was mean retinal sensitivity., Results: Mean retinal sensitivity (in dB) was lower after peeling: 9.80 ± 2.35 dB with peeling versus 13.19 ± 2.92 without (p=0.0209). Postoperative microscotomas were significantly more frequent after ILM peeling: 11.3 ± 6.6 points with retinal sensitivity below 10 dB in eyes that underwent peeling versus 2.9 ± 4.6 in those that did not (p=0.0093)., Conclusions: These results suggest that ILM peeling may reduce retinal sensitivity, and significantly increase the incidence of microscotomas. Until a prospective trial confirming or not these results, it seems justified to avoid peeling the ILM when its potential benefit seems minor or unproved, and when peeling is carried out, to limit the surface peeled to the bare minimum.

Aim: To assess whether low concentrations of a fluorescent dye such as Rhodamine 6G would help the unaided human eye visualise the vitreous and the internal limiting membrane (ILM) under standard halogen illumination., Material/methods: The UV/Vis absorption (E) and fluorescence (I) spectra of Rhodamine 6G in water were measured and compared with Indocyanine Green (ICG). Surgery was performed in two rhesus monkeys and consisted of standard pars plana vitrectomy with halogen light source used for illumination. Rhodamine 6G was diluted in balanced salt solution (BSS). A few drops of the dye in a concentration of 0.1% (307 mOsm) were applied over the posterior pole in the air-filled globe and washed out by irrigation after 1 min. Immediately after surgery, the globes were enucleated, fixated and prepared for histological evaluation., Results: In contrast to ICG, both the maximum of the absorption and emission of Rhodamin 6G are very much within the spectral sensitivity of the human eye. The Rhodamine 6G-BSS itself appears red in colour. Using a dye concentration of 0.1%, there was no visible red-staining of the ILM as such. As the dye was irrigated out with BSS, a marked green fluorescence of the fluid within the vitreous cavity was noted. With halogen illumination through a standard 20-gauge light pipe, the dye provided a sufficient green fluorescence to identify and safely remove the ILM and to clearly differentiate areas of peeled from non-peeled ILM. During light microscopy, eyes revealed a peeled ILM demarcation with no signs of acute retinal toxicity., Conclusion: The findings indicate that a fluorescent dye can be used for ILM peeling. Assuming that the fluorophore provides a high enough fluorescence quantum yield after adsorption to the ILM, much lower dye concentrations could be used compared with absorbent dyes, thereby minimising toxic effects.

Aim: To investigate the prevalence of reticular pseudodrusen (RPD) in eyes of patients presenting with newly diagnosed choroidal neovascularisation (CNV) in age-related macular degeneration (AMD), and to analyse the association between RPD, age-related maculopathy (ARM) and AMD., Method: Two observational consecutive prospective series. In series 1, patients with AMD with newly diagnosed CNV were sampled to determine the incidence of RPD. Eyes with and without RPD were compared by the Mann-Whitney non-parametric test and Fisher's exact test for age, sex of patients, the eye involved and type of CNV. Series 2 comprised 100 patients referred for fundus photography, fluorescein and/or indocyanine green angiography, for whom pictures showed RPD. This second cohort was then selected from a larger group of patients., Results: Patients with newly diagnosed CNV in series 1 comprised 67 women and 33 men, aged 57-96 years (mean 79.5). CNV was "classic" (32 eyes), "occult" (41) or exhibited vascularised pigment epithelial detachment (PED, 11), retinal angiomatous proliferation (RAP) with or without PED (13), or haemorrhagic or fibrovascular scarring (3). In all, 24 (24%) eyes had RPD. The prevalence of RAP was significantly higher in eyes with RPD than in those without (p = 0.0128), despite the small number of patients with RAP. In series 2, 100 patients with RPD were enrolled in 3 months, and corresponded to 8% of the overall cases referred to our centre (Centre Ophtalmologique d'Imagerie et de Laser, Paris, France). There were 77 women and 23 men, aged 54-93 years (mean 79.2). Eyes with RPD (n = 155) usually exhibited signs of ARM or AMD, including soft drusen (101 eyes) and/or retinal pigment epithelium abnormalities (70), geographical atrophy (27) and/or CNV (61). In both studies, examination of blue-light fundus pictures was extremely helpful in diagnosing RPD., Conclusion: RPD have a high prevalence among patients with AMD with newly diagnosed CNV (24% of cases). RPD were commonly associated with ARM or AMD. This study suggests that eyes with RPD could be classified as a phenotype of ARM.

Aim: To investigate the relationship between the size of macular holes and the possible benefit of internal limiting membrane (ILM) peeling., Methods: 84 consecutive cases of idiopathic macular hole followed up for at least 3 months were included in this retrospective study. Surgery comprised pars plana vitrectomy, peeling of any epiretinal membrane, 17% C2F6 (hexafluoroethane) gas filling and 10 days of positioning. 36 eyes had ILM peeling. The main outcome measure was the macular hole closure rate checked by optical coherence tomography., Results: The overall postoperative closure rate was 90.5%. For macular holes > or =400 microm in diameter, the rate was 100% with ILM peeling versus 73.3% without (p = 0.015). For smaller macular holes, the rates were 100% in both groups. Postoperative gain in visual acuity was not significantly different in eyes with ILM peeling and those without., Conclusions: ILM peeling does not seem to be useful for macular hole <400 mum in diameter. Its likely benefit has to be investigated for larger macular hole sizes, for which the failure rate is higher.

Aims: To compare the values measured for retinal macular thickness with the first and last generations of the optical coherence tomograph (OCT1 and Stratus OCT, Zeiss, Humphrey Division)., Methods: This was a cohort study. 59 eyes were examined: 17 had a normal macula and 42 had a diabetic macular oedema. In each eye, mean retinal thickness (RT) was measured automatically in the nine macular Early Treatment Diabetic Retinopathy Study areas and at the foveal centre, using OCT1 and Stratus OCT. The paired mean RT values for each area and the type and proportion of artefacts were compared., Results: Of the 590 automatic measurements, 505 had no artefact, either with OCT1 or Stratus OCT. The mean difference between the OCT1 and Stratus OCT measurements was 25 (SD 26.2) microm (p<0.0001). With Stratus OCT, RT values were significantly higher, by 8.1% (7.8%), than with OCT1. Artefacts were only observed in cases of diabetic macular oedema and were significantly more frequent with OCT1 than Stratus OCT (10.5% versus 4.4, p<0.0001)., Conclusion: The macular retinal thickness values measured with Stratus OCT were significantly higher than those measured with OCT1. Stratus OCT has the advantage of producing fewer artefacts than OCT1 in pathological cases.

Aims: To report on visual hallucinations and Charles Bonnet syndrome (CBS) that may occur in patients with age related macular degeneration (AMD) treated by photodynamic therapy (PDT) with verteporfin for choroidal neovascularisation (CNV)., Methods: 100 consecutive patients were asked to respond to an orally administered questionnaire on visual hallucinations following PDT. Three groups of patients, respectively without visual hallucinations, with unstructured visual hallucinations, and with structured hallucinations-that is, CBS, were compared by ANOVA, Scheffe's test, or the chi(2) test, to establish whether age, sex, or visual acuity, as scored on ETDRS charts, are risk factors for the occurrence of visual hallucinations., Results: Five patients (5%) described transient structured visual hallucinations, including known or unknown faces and geometric patterns. Fifteen patients (15%) reported photopsias and flashing lights of various colours. These symptoms usually occurred a few days after PDT. There was no significant difference between the group of patients with structured visual hallucinations and the two other groups, with regard to age (p =0.435), sex (p =0.406), or visual acuity (p =0.835)., Conclusions: Visual hallucinations and CBS appear to be a possible, although unrecognised, side effect of PDT for CNV, which occur just after treatment. These results suggest the need to include the possibility of visual hallucinations in the information given to patients before PDT.