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Purpose: PERSEUS-IT (NCT02289924) was a prospective, observational, 2-year study evaluating the effectiveness and treatment patterns of intravitreal aflibercept (IVT-AFL) in patients with neovascular age-related macular degeneration (nAMD) in routine clinical practice in Italy., Methods: Treatment-naïve patients with nAMD receiving IVT-AFL per routine clinical practice were enrolled. The primary endpoint was mean change in visual acuity (VA; decimals) from baseline to month (M) 12 and M24. Outcomes were evaluated for the overall study population and independently for the 2 treatment cohorts: regular (3 initial monthly doses, ≥ 7 injections by M12, and ≥ 4 injections between M12 and M24) and irregular (any other pattern)., Results: Of 813 patients enrolled, 709 were included in the full analysis set (FAS); VA assessments were available for 342 patients at M12 (FAS1Y, 140 regular and 202 irregular) and 233 patients at M24 (FAS2Y, 37 regular and 196 irregular). In the overall FAS, the mean ± SD change in VA from baseline to M12 and M24 was + 0.09 ± 0.24 and + 0.02 ± 0.25 decimals, and there was a statistically significant difference between the regular and irregular cohorts in both FAS1Y (p = 0.0034) and FAS2Y (p = 0.0222). Ocular treatment-emergent adverse events were reported in 4.1% (n = 33/810 [safety set]) of patients., Conclusion: In PERSEUS-IT, clinically relevant functional and anatomic improvements were observed within the first 12 months of IVT-AFL treatment in routine clinical practice in Italy in patients with treatment-naïve nAMD. These gains were generally maintained across the 2-year study. The safety profile of IVT-AFL was consistent with prior studies., Trial Registration Number: ClinicalTrials.gov Identifier: NCT02289924., Date of Registration: November 13, 2014., (© 2022. The Author(s).)

Purpose: To describe functional and histopathological findings after macular peeling using different dyes., Methods: Prospective, randomized, comparative, interventional, and immunohistochemical study. Forty-five eyes from 45 patients with idiopathic epiretinal membrane (ERM) underwent pars plana chromovitrectomy with ERM and inner limiting membrane (ILM) using trypan blue 0.15% + brilliant blue 0.05% + lutein 2% in group 1 (15 eyes), trypan blue 0.15% + brilliant blue 0.025% + polyethylene glycol 3350 4% in group 2 (15 eyes), and indocyanine green 0.05% in group 3 (15 eyes). We evaluated visual acuity (VA) and macular sensitivity (MS) preoperatively, 1, 3, and 6 months after surgery. The expression of glial fibrillary acidic protein (GFAP) and neurofilament protein (NF) was assessed immunohistochemically on the ILMs peeled as markers of glial and neuronal cells., Results: In group 1, both mean VA and MS were significantly better at 1 and 3 months after surgery (P < 0.05), whereas no significant difference was found after 6 months. GFAP and NF expression was significantly lower in group 1 (P < 0.05)., Conclusions: The ERM/ILM peeling is thought to rip off the intraretinal tissue, based on the amounts of GFAP and NF in the specimens. The use of lutein dyes reduces iatrogenic stress to the retinal tissue and allows a faster functional recovery in the first 3 months after surgery, suggesting a less iatrogenic adhesion to the retinal tissue.

Purpose: To study the natural history and morphologic characteristics of lamellar macular holes (LMHs) in the eyes with pathological myopia., Methods: Retrospective observational case series of 44 eyes of 44 patients examined at a single institutional vitreoretinal practice. The included eyes must present an irregular foveal contour and schitic or cavitated lamellar separation of neurosensory retina on spectral-domain optical coherence tomography (SD-OCT) and an area of increased autofluorescence on blue fundus autofluorescence (B-FAF) to be included. Presence of retinoschisis and posterior staphyloma, posterior vitreous status, changes of logarithm of minimum angle of resolution best-corrected visual acuity (BCVA), and changes of morphologic characteristics were evaluated., Results: The mean follow-up period was 50.1 ± 28.9 months; 75% of the enrolled patients were female. At baseline, a standard epiretinal membrane (ERM) was detected in 93.2%, lamellar hole-associated epiretinal proliferation (LHEP) in 75%, and concomitant ERM and LHEP in 68.2% of the eyes, respectively. Visual acuity did not correlate with LMH diameters but correlated with central foveal thickness (p < 0.001). During the follow-up, the morphologic and functional parameters studied were relatively stable/improved in 60% of the eyes independently from the associated epiretinal material. Four eyes evolved to full-thickness (FT) MHs whereas spontaneous improvement was observed in five cases., Conclusions: LMHs in highly myopic eyes are more prevalent in females, are frequently associated with ERM and LHEP, and show substantial stability of BCVA and the anatomic parameters evaluated with B-FAF and SD-OCT over years-long follow-up.

Background: To evaluate demographic, functional, and morphological parameters of idiopathic lamellar macular hole (ILMH)., Methods: Observational longitudinal retrospective study. Optical coherence tomography examinations and corresponding clinical charts of a series of consecutive patients affected by ILMH, between January 2010 and March 2015, from the database of the Department of Ophthalmology of Trento Hospital, Italy, have been collected and examined. Demographic and functional parameters were: age (year), gender (male/female), eye (right/left), lens status, best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (LogMAR). Tomographic parameters were: LMH shape pattern (intraretinal splitting LMH, IR split LMH, and V-shaped LMH, V LMH), posterior vitreous detachment (PVD yes/ PVD no), ERM type (conventional ERM and atypical ERM), integrity of ellipsoid zone (EZ) and external limiting membrane (ELM), residual foveal thickness (RFT) micron (μ), maximal diameter of intraretinal splitting (MDIRS) (μ)., Results: One hundred and eighty-nine eyes of 175 patients were included. The mean age was 72.84 ± 9.6, range 41-96 years. BCVA mean was 0.24 ± 0.25, range 0 -1.3 LogMAR. One hundred and forty-one eyes (74.6 %) were affected by IR split LMH, 48 eyes (25.4 %) were affected by V LMH. Every cases of ILMH were associated with ERM: 117 (61.9 %) conventional ERM, 72 (38.1 %) atypical ERM. A significant prevalence of female gender, phakic condition, and PVD in conventional ERM ILMH subgroup (P = 0.000) was found. BCVA mean was better in the conventional ERM ILMH subgroup (P = 0.000). An association between the interruption of the outer retinal layers (EZ and ELM) and atypical ERM ILMH subgroup was highlighted (P = 0.000). The statistical analysis showed a correlation between BCVA and integrity of ELM (P = 0.000). RFT significantly decreased in atypical ERM ILMH subgroup at 24 months compared to time point 0 (P = 0.027). A progressive increase of MDIRS in both subgroups at 12 months and in atypical ERM ILMH subgroup at 24 months (P = 0.007) was highlighted., Conclusions: This study demonstrated that ILMH was not a stable condition, showing morphological changes and an involvement of the outer retinal layers during the 2 years of follow-up.

Purpose: We aimed to study the morphological characteristics of myopic posterior staphyloma in Caucasians and to evaluate the correlation between posterior staphyloma, myopic macular lesions and visual acuity., Methods: Ninety eyes of 67 consecutive patients affected by high myopia associated with posterior staphyloma were recruited between January 2012 and December 2013. Posterior staphyloma was classified according to Curtin's criteria. Every patient underwent fundoscopic examination and best corrected visual acuity measurement (BCVA). A and B-scan ultrasound (US), high-resolution, three-dimensional magnetic resonance image (MRI), optical coherence tomography (OCT), fundus autofluorescence (FAF), red free (RF) and color fundus photography studies were performed., Results: The mean age was 64.4 ± 9.48 years (range: 41-82). The mean BCVA was 0.7 ± 0.5 logMAR (range: 0-2). The mean axial length was 29.92 ± 2.39 millimeters (range: 24.25-36.53). The authors found four types of posterior staphyloma according to Curtin's classification: I, II, IV and IX. Significant prevalence of posterior staphyloma in female sex was observed (p = 0.0235). Significant correlation between the depth and the diameters of posterior staphyloma was demonstrated (p < 0.0001). Significant association between posterior staphyloma type and tomographic foveal patterns (p = 0.0230) was highlighted. Posterior staphyloma type I was more frequently associated with peripapillary atrophy and less with macular atrophy compared to type II and IX (p = 0.0169). The prevalence of macular atrophy was more than double in posterior staphyloma type II (33.3 %) in comparison to posterior staphyloma type I (12.5 %)., Conclusions: This study confirms that the type I and II are the most common types of posterior staphyloma, as already highlighted in the literature. A significant association between the type of posterior staphyloma and the MRI ocular shape pattern, the OCT patterns of macular profile and the location of chorioretinal atrophy was highlighted. The correlation between the depth and the width of posterior staphyloma has demonstrated that the deeper the staphyloma, the wider it was. The deepest area of the posterior staphyloma was characterized by a greater thinning of the sclera and by a higher prevalence of chorioretinal atrophy compared to the other parts of the eye. More studies are necessary to support our findings and to add more information on the natural evolution of posterior staphyloma and on its associated complications.

Background: To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PPV) with or without combined cataract surgery for the treatment of idiopathic epiretinal membrane (ERM)., Methods: Retrospective, non-comparative, interventional case series. Data included patient age, indication for surgery, and intra- and post-operative complications. The follow-up lasted 1 year. Best-corrected visual acuity (BCVA logMAR), central foveal thickness (CFT micron-μ) and the incidence of intra-retinal cysts were evaluated. CME was defined as post-operative observation of intra-retinal cysts at optical coherence tomography, preventing improvement or causing reduction of BCVA when compared to the pre-operative value. Statistical analysis was performed to identify the risk factors of CME., Results: Two hundred and forty two eyes of 242 patients underwent PPV for the treatment of idiopathic ERM. Statistical analysis showed that the presence of preoperative intra-retinal cysts were associated with persistent CME following surgery (odds ratio 3.89; 95%CI: 1.63-9.28, P = 0.0004). However, postoperative CME occurred in 10 % of eyes that did not show preoperative CME. In addition, there was a significant correlation between the baseline value of CFT and the values of CFT at each time point during the follow up (p < 0.0001), with greater values of the pre-operative thickness correlating to greater values of post-operative thickness., Conclusions: Persistent or new CME following surgery for idiopathic ERM are frequently identified after PPV for ERM. The statistical results of the current study suggest that intraretinal cysts and increased preoperative CFT are associated with reduced visual acuity after surgery.

Background: Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared., Methods: Forty-two eyes affected by RD associated with MMH were included. The surgical technique involved standard 3-port 20-gauge PPV with long-term tamponade. The patients were divided into two groups, according to the intraocular tamponade: SO in group 1 (n = 17), and HSO in group 2 (n = 25). Internal limiting membrane (ILM) removal was performed in 15 cases of group 1 and 20 cases of group 2. Tamponade removal was performed 2 to 5 months after primary surgery. The patients were assessed 1 week and 1 month after primary surgery, and then 1 week and 1 month after tamponade removal or after further surgery if macular redetachment had occurred. The patients were also visited every 2 months for at least 1 year after final tamponade removal. Follow-up was considered closed at 1 year after final tamponade removal., Results: Preoperative best-corrected visual acuity (BCVA), expressed as LogMar, was 2.8 ± 0.77 for group 1 and 2.1 ± 0.94 for group 2. At the last visit, the BCVA was 1.41 ± 0.96 and 1.48 ± 0.77 for groups 1 and 2 respectively. Retinal reattachment was achieved with one operation in 13 eyes of group 1 (76.5%) and 18 of group 2 (81.8%) (P = 0.69). The average number of surgery needed to achieve retinal attachment by patients of group 1 and 2 was respectively 1.36 ± 0.63 and 1.46 ± 0.59 (P = 0.77). Five patients of group 1 and four of group 2 developed a chronic glaucoma (P = 0.238)., Conclusions: PPV with ILM peeling and long-term tamponade was demonstrated to be a good surgical option to treat RD due to MMH; SO and HSO seemed to be equally effective, although the success rates remained far from an ideal 100%.

Background: To evaluate the feasibility of transplanting a full-thickness patch of choroid, choriocapillaries, Bruch's membrane and RPE (RPE-choroid FTAP) from the peripheral to the subfoveal area of the same eye, after performing a 180 degrees peripheral retinotomy and removing subfoveal choroidal neovascularization. Thereafter, to study the surgical complications, anatomical outcome and patch perfusion during follow-up., Methods: A retrospective case series of 13 eyes of 13 consecutive patients with a follow-up of 4 to 20 months. All patients suffered from advanced subfoveal choroidal neovascularization and were non-responders to standard care. After performing a complete vitrectomy, a 180 degrees peripheral temporal retinotomy and the removal of subfoveal neovascularization, a FTAP of choroid, choriocapillaris, Bruch's membrane and the RPE were isolated from the mid periphery of the uveal bed, transpositioned under the fovea and covered with the retina. Patients received a complete ophthalmic examination, fluorescein angiography (FA), indocyanin green angiography (ICGA) and optical coherence tomography (OCT) during follow-up., Results: An FTAP could be harvested in every eye and transplanted under the fovea. No intraoperative complications occurred. The FTAP was recognizable at FA, ICGA and OCT at each time point, up to 20 months postoperatively. Perfusion of the choroidal bed were observed into the FTAP during follow-up, from one week after surgery., Conclusion: The creation of an FTAP through a 180 degrees peripheral retinotomy is feasible and safe. The FTAP is vital and perfused. Further studies are needed to collect more data.

Background: To study the incidence of endophthalmitis after 23-gauge pars plana vitrectomy and to compare it with the endophthalmitis rate after 20-gauge pars plana vitrectomy performed in the same ophthalmology department., Methods: The charts of 4,021 consecutive 20-gauge or 23-gauge pars plana vitrectomies performed at a single institution, between August 1 2003 and April 1 2008, were reviewed to search for the occurrence of postoperative endophthalmitis. This is a retrospective, interventional, comparative cohort study., Results: Endophthalmitis developed in one of 3,078 eyes after 20-gauge vitrectomy (0.03%) and in none of 943 eyes after 23-gauge vitrectomy., Conclusions: We did not find an increased risk of endophthalmitis after 23-gauge sutureless vitrectomy.