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Background: Submacular hemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD) precipitates rapid visual decline and impacts quality of life. Treatments vary, but combined recombinant tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) therapy has gained prominence as a viable treatment option., Objectives: This study aims to evaluate the efficacy of the combination of tPA and anti-VEGF., Methods: We conducted a systematic review meta-analysis following PRISMA guidelines, focusing on studies examining tPA and anti-VEGF therapy in SMH secondary to nAMD. Outcomes measured were change in best-corrected visual acuity (BCVA) and success rate of SMH displacement. Meta-regression assessed the relative efficacy of intravitreal and subretinal delivery., Results: Out of 257 initial reports, 22 studies involving 29 patient populations met inclusion criteria. Our analysis showed significant improvement in BCVA and a high rate of successful SMH displacement with combined tPA and anti-VEGF therapy. No significant differences were found between subretinal and intravitreal tPA administration. Furthermore, when evaluating the effects of subretinal versus intravitreal anti-VEGF administration in patients treated with subretinal tPA, the results indicated similar efficacy., Conclusions: Combined tPA and anti-VEGF therapy is effective in managing SMH in nAMD patients, significantly improving visual acuity and SMH displacement. The location of tPA and anti-VEGF delivery did not significantly impact outcomes., (The Author(s). Published by S. Karger AG, Basel.)

Purpose: To evaluate the early effects of dexamethasone implant in patients with diabetic macular edema (DME)., Methods: Eyes with DME were prospectively included in the study. Best-corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation, and spectral-domain optical coherence tomography were performed at baseline and 1, 2, 3, 7, 14, 21, 28, 60, and 90 days after treatment., Results: Twenty-three eyes of 20 patients were included in the study. Mean central retinal thickness (CRT) decreased rapidly after treatment (p < 0.0001, repeated measures ANOVA) from 511 μm at baseline to 469 μm after 1 day (p < 0.05), and 275 μm (p < 0.01) at the end of the follow-up. BCVA gain (p < 0.0001, repeated measures ANOVA) was on average +2 ETDRS letters at day 1 (not significant), +9 letters from day 28 to day 90 (p < 0.01)., Conclusion: Intravitreal dexamethasone implant showed an early and fast effect in reducing CRT and improving BCVA in DME patients., (© 2017 S. Karger AG, Basel.)

Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have proven to be useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morphofunctional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels., (© 2017 S. Karger AG, Basel.)

Purpose: To assess the impact of ethnicity, age, and ocular characteristics on ranibizumab efficacy in myopic choroidal neovascularization (CNV)., Methods: In this post hoc subgroup analysis from the phase III RADIANCE study, best-corrected visual acuity (BCVA) outcomes and treatment exposure were analyzed in 105 patients treated with ranibizumab 0.5 mg. Baseline categories included ethnicity, age, baseline BCVA, lesion area, CNV lesion area, refraction sphere, axial length, subretinal fluid, and location of CNV., Results: At month 12, the mean change in BCVA was numerically higher in East-Asians than in Caucasians (17.0 vs. 14.1 letters). The median number of injections varied with ethnicity (East-Asians vs. Caucasians: 2 vs. 3), baseline BCVA (highest vs. lowest: 1 vs. 4), CNV lesion area and lesion area (largest vs. smallest: 5 vs. 1 and 5 vs. 2)., Conclusions: East-Asians showed numerically higher BCVA gains than Caucasians. The number of injections varied across subgroups, emphasizing the need for individualized treatment., (© 2016 S. Karger AG, Basel.)

Purpose: To investigate the relationship among functional and morphological findings before and after macular pucker surgery., Methods: Thirty-eight eyes with idiopathic macular pucker that underwent 25-gauge vitrectomy and infracyanine green-assisted internal limiting membrane peeling were prospectively enrolled. Main outcome measures were best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography findings and MP-1 microperimetry findings., Results: Mean BCVA improvement was 0.34 logMAR (p < 0.0001). Mean central retinal thickness (CRT) reduction was 50 µm (p = 0.0041). Mean retinal sensitivity improvement was 0.9. Patients with a greater improvement of postoperative BCVA showed worse baseline BCVA (p < 0.001), shorter final inner/outer segment (IS/OS) interruption length (p = 0.039) and thinner final CRT (p = 0.035). Furthermore, final BCVA was correlated with baseline IS/OS interruption length (p = 0.001)., Conclusion: Baseline BCVA, CRT and IS/OS integrity can be used to predict the functional outcomes after macular pucker surgery., (© 2014 S. Karger AG, Basel.)

Purpose: To evaluate the early effects of the intravitreal erodible dexamethasone implant Ozurdex in patients with macular edema due to retinal vein occlusion (RVO)., Methods: Eyes with macular edema due to RVO were prospectively included in the study and received a 700-μg dexamethasone implant. Best-corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation and spectral-domain optical coherence tomography were performed at baseline and 1, 2, 3, 7, 14, 21, 28, 60, and 90 days after treatment., Results: Nineteen eyes of 18 patients were included in the study. Mean central retinal thickness (CRT) decreased rapidly after treatment (p < 0.0001) from 503 μm at baseline to 288 μm after 1 day and 199 μm at the end of the follow-up. BCVA gained on average +6 ETDRS letters after 1 day and +11 letters at day 90 (p = 0.0001)., Conclusion: The intravitreal dexamethasone implant showed a fast effect in reducing CRT and improving BCVA in RVO patients., (2014 S. Karger AG, Basel)

Purpose: To perform a risk mitigation review of intravitreal injections., Methods: A pan-European expert team conducted a healthcare failure modes and effects analysis (HFMEA) of intravitreal injection techniques. Possible failures at each stage were identified and potential causes and effects considered. A risk value (1-10) was assigned for each failure's severity, probability of occurrence and likelihood of going undetected, and a risk priority number (RPN) calculated., Results: This HFMEA revealed 91 intravitreal injection failure modes, of which 28, deemed to have an appreciable risk, were explored. Recommendations were proposed to reduce these risks, mostly relating to patient, staff, room and equipment preparation, injection procedure and patient discharge., Conclusions: The HFMEA process produced practical recommendations to improve the risk profile of intravitreal injection., (© 2013 S. Karger AG, Basel.)

Purpose: To evaluate the safety and exploratory efficacy of triple therapy (TT) with single-session intravitreal ranibizumab, modified juxtascleral triamcinolone, and photodynamic therapy (PDT) in exudative age-related macular degeneration non-responder to anti-vascular endothelial growth factor., Methods: Thirty consecutive eyes were included. The first 10 eyes (cohort 1) enrolled received same-day TT with reduced-fluence/reduced-irradiance PDT, 10 eyes (cohort 2) received same-day TT with reduced-fluence/standard irradiance PDT, the last 10 eyes (cohort 3) received same-day TT with standard fluence/standard irradiance PDT., Results: All patients completed the 6-month follow-up. Mean best corrected visual acuity (BCVA) at baseline was 1.1 (cohort 1), 0.9 (cohort 2) and 1.1 (cohort 3) logMAR. After 6 months, mean BCVA change was -0.15 (not significant), -0.13 (not significant) and 0.29 (p < 0.05) logMAR, respectively. Among eyes treated with standard fluence/standard irradiance PDT, 2 showed choroidal ischemia., Conclusions: The combination of modified juxtascleral triamcinolone, reduced-fluence PDT, and ranibizumab appears as a safe treatment option., (© 2013 S. Karger AG, Basel.)

Purpose: Neovascular age-related macular degeneration (AMD) is a leading cause of blindness, with an increasing incidence as the elderly population expands. Large, multi-center, randomized, clinical trials have been conducted exploring the safety and efficacy of anti-VEGF treatments. This paper aims to discuss the safety and efficacy of pegaptanib, ranibizumab, aflibercept and bevacizumab. New therapeutic agents and treatment strategies are also discussed., Procedures: Evidence available from prospective, multicenter, clinical studies and from a selective literature search is utilized to present the results of VEGF inhibition in neovascular AMD and to generate evidence-based recommendations., Results: Anti-VEGF treatment is indicated in choroidal neovascularization with active disease and produces a significant benefit in visual acuity., Conclusions: With the advent of anti-VEGF therapy, the prognosis of choroidal neovascularization has changed dramatically. Data from well-conducted clinical trials suggest that approved anti-VEGF drugs are effective and well tolerated., (Copyright © 2012 S. Karger AG, Basel.)

Retinal vein occlusion (RVO) can have severe consequences for the people affected by the disease, including visual loss with costly social repercussions. Currently, there is no European consensus with regard to the management of RVO. Following a careful review of the medical literature as well as the data from several clinical trials, a collaborative group of retina specialists put forth practical recommendations based on the best available scientific evidence for the clinical approach to RVO. Taking into consideration the recent advances in diagnostic tools and management options, the present document aims to provide the European ophthalmologists with guidelines for clinical practice to the benefit of their patients., (Copyright © 2011 S. Karger AG, Basel.)

Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have been proven useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morpho functional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels., (2010 S. Karger AG, Basel)

Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.

Many vitelliform macular diseases have been described through the years. Some arguments still exist about the appropriate terminology, the classification criteria and the etiopathogenesis. The alterations of the retinal pigment epithelium, the lipofuscin storage and the role of the choriocapillaris are being investigated. The aim of our study was to describe indocyanine angiographic features in Best's disease and pattern distrophies. Twenty-one eyes of 14 patients underwent indocyanine and fluorescein angiography. The indocyanine angiogram showed hypofluorescent and hyperfluorescent areas. The possible etiopathogenesis of the lesions includes a role of the retinal pigment epithelium.