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Background and Objective: The use of intraoperative optical coherence tomography (iOCT) has been described with a variety of imaging devices and techniques. The purpose of this investigation is to examine the role of iVue (Optovue, Fremont, CA), a commercially available, handheld spectral-domain iOCT system, in vitreoretinal surgery. PATIENTS AND METHODS For this retrospective, observational case series, patients who underwent a vitreoretinal surgical procedure and were imaged with the iVue were identified. Images were qualitatively assessed., Results: Five cases were identified, including an examination under anesthesia, epiretinal membrane, macular hole, retinal detachment, and non-clearing vitreous hemorrhage in the setting of proliferative diabetic retinopathy., Conclusion: Clinically useful images were obtained in all cases, though it was difficult to center the scan on the area of interest in the retina. Further work is necessary to improve system design and investigate the ways in which iOCT can aid in vitreoretinal surgery., (Copyright 2016, SLACK Incorporated.)

Background and Objective: To determine early evolution of the vitreomacular interface and clinical efficacy and safety profile after ocriplasmin treatment., Patients and Methods: Retrospective, multicenter, observational case series. Patients with vitreomacular adhesion (VMA) confirmed on optical coherence tomography (OCT) received a single intravitreal ocriplasmin injection. Changes in the vitreomacular interface were evaluated by spectral-domain OCT. Adverse events were monitored at all visits., Results: Of 22 patients treated with ocriplasmin, 14 (64%) had VMA resolution, with six (43%) achieving VMA release within the first week. Eight patients (36%) showed improvement in visual acuity (VA) of at least two Snellen lines. Rate of VMA resolution was 79% for VA less than 20/40 and 38% for VA of 20/40 or greater. Safety findings include changes in the ellipsoid layer (n = 3) and transient increases in subretinal fluid (n = 6)., Conclusion: Ocriplasmin was effective for VMA resolution, with a rapid onset of action. Patients with worse baseline VA showed a higher VMA resolution rate., (Copyright 2015, SLACK Incorporated.)

IMPORTANCE Clinical trials indicate that visual impairment is significantly greater in patients receiving ocriplasmin than placebo. The mechanism of this symptom has not been explained. We report a patient with persistent darkening of her vision after intravitreal ocriplasmin and describe ancillary testing findings that may yield insights into the effects of ocriplasmin and the cause of this symptom. OBSERVATIONS We describe a 71-year-old woman with symptomatic vitreomacular traction who received intravitreal ocriplasmin and experienced darkening of vision in dim illumination for 4 months, despite improvement in visual acuity and release of symptomatic vitreomacular traction. We demonstrate that disruption of photoreceptor inner segment-outer segment (ellipsoid) layer on SD-OCT and reduced ERG amplitudes correspond to the patient's symptom of darkened vision. The ERG demonstrated a greater reduction in scotopic function compared with photopic function. CONCLUSIONS AND RELEVANCE On the basis of these findings, it is possible that ocriplasmin may have a diffuse enzymatic effect on photoreceptors or the retinal pigment epithelium that is not limited to areas of vitreomacular adhesion. The rod photoreceptors may be more susceptible than cone photoreceptors to the effects of ocriplasmin. Further work is needed to understand mechanisms of visual impairment after ocriplasmin.

Background and Objective: To assess anatomic and visual outcomes after pars plana vitrectomy for vitreomacular traction syndrome., Patients and Methods: Charts of 746 patients who had vitrectomy surgery with membrane peel between January 2002 and December 2007 were reviewed. Vitreomacular traction syndrome (VMT) was diagnosed based on optical coherence tomography (OCT) appearance. Twenty eyes of 20 patients were found to have had vitrectomy surgery for VMT and were included in the study., Results: Mean visual acuity was 20/122 preoperatively and 20/68 postoperatively (P = .005). Mean foveal thickness was 404.00 microm preoperatively and 250.55 microm postoperatively (P = .001). A subgroup analysis was performed based on preoperative OCT appearance. Improvement in vision was not significant in eyes with lamellar separation between the inner and outer fovea (P = .379), but was significant in eyes with cystoid macular edema (P = .045) or perifoveal traction (P = .040)., Conclusion: Overall, there was a significant improvement in visual acuity and central foveal thickness postoperatively. Eyes with lamellar separation of the inner and outer foveal layers preoperatively had worse visual results, whereas eyes with cystoid macular edema or perifoveal VMT had better visual results.

Purpose: The purpose of this study was to report the safety profile of the Alcon 23-gauge single-step preloaded transconjunctival vitrectomy system., Methods: This was a retrospective case series examining 118 eyes of 114 patients that underwent 23-gauge vitrectomy between July and November 2007. Patients were observed postoperatively for a minimum of 6 weeks. Main outcome measures were postoperative intraocular pressure (IOP), intraoperative complications, and postoperative adverse events., Results: The mean postoperative Day 1 IOP was 14.3 +/- 6.6 mmHg (median, 13 mmHg; range, 2-38 mmHg) and Month 1 IOP was 15.8 +/- 5.9 mmHg (median, 15 mmHg; range, 6-52 mmHg). Two eyes (1.7%) developed choroidal effusions. Four eyes (3.4%) developed intraoperative horseshoe tears. No retinal detachments or endophthalmitis occurred. Four eyes (3.4%) had postoperative hypotony. Intraoperative wound leak after cannula removal requiring a sclerotomy suture occurred in 38% of patients: 35 eyes requiring closure of 1 cannula site (29.6%), 8 eyes (6.8%) requiring closure of 2 cannula sites, and 2 eyes (1.7%) requiring closure of all 3 cannula sites., Conclusion: The Alcon 23-gauge single step preloaded transconjunctival vitrectomy system has few safety issues. Sclerotomy leaks after cannula removal are common, with 38% of eyes requiring suture closure of at least 1 cannula site.

Objectives: To compare structural changes in the retina seen on high-speed ultra-high-resolution optical coherence tomography (hsUHR-OCT) with multifocal electroretinography (mfERG) and automated visual fields in patients receiving hydroxychloroquine., Methods: Fifteen patients receiving hydroxychloroquine were evaluated clinically with hsUHR-OCT, mfERG, and automated visual fields. Six age-matched subjects were imaged with hsUHR-OCT and served as controls., Results: Distinctive discontinuity of the perifoveal photoreceptor inner segment/outer segment junction and thinning of the outer nuclear layer were seen with hsUHR-OCT in patients with mild retinal toxic effects. Progression to complete loss of the inner segment/outer segment junction and hyperscattering at the outer segment level were seen in more advanced cases. The mfERG abnormalities correlated with the hsUHR-OCT findings. Asymptomatic patients had normal hsUHR-OCT and mfERG results., Conclusion: Distinctive abnormalities in the perifoveal photoreceptor inner segment/outer segment junction were seen on hsUHR-OCT in patients receiving hydroxychloroquine who also were symptomatic and had abnormalities on automated visual fields and mfERG.

Background: Histopathological studies of acute multiple evanescent white dot syndrome (MEWDS) have not been reported because of the transient and benign nature of the disease. Ultrahigh resolution optical coherence tomography (UHR-OCT), capable of high resolution in vivo imaging, offers a unique opportunity to visualize retinal microstructure in the disease., Methods: UHR-OCT images of the maculae of five patients with MEWDS were obtained and analyzed. Diagnosis was based on clinical presentation, examination, visual field testing, and angiography., Results: UHR-OCT revealed disturbances in the photoreceptor inner/outer segment junction (IS/OS) in each of the five patients (six eyes) with MEWDS. In addition, thinning of the outer nuclear layer was seen in the case of recurrent MEWDS, suggesting that repeated episodes of MEWDS may result in photoreceptor atrophy., Conclusions: Subtle disruptions of the photoreceptor IS/OS are demonstrated in all eyes affected by MEWDS. UHR-OCT may be a useful adjunct to diagnosis and monitoring of MEWDS.

Transpupillary thermotherapy has recently emerged as a therapeutic option for patients with numerous posterior segment disorders. During the past decade, it has been used for the management of benign and malignant tumors, either as sole therapy or in combination with other treatments such a plaque radiotherapy. More recently, it has been used for management of choroidal neovascularization (CNV) secondary to age-related macular degeneration. A prospective, randomized, sham-controlled multicenter clinical trial (TTT4CNV) is currently underway to evaluate the effectiveness of TTT for the management of CNV.

A new inverted-image ophthalmoscopic contact lens provides 2X laser spot magnification and a 117 degrees degree instantaneous field of view. It has three times the resolution of very wide-field, inverted-image ophthalmoscopic contact lenses to permit effective use of higher slit-lamp magnifications. The lens was designed for transpupillary thermotherapy with large lesions and panretinal photocoagulation with hazy ocular media.

We developed a clinical strategy for dealing with situations in which ophthalmoscopic examination and vitreoretinal surgery are difficult in patients with an ARRAY refractive multifocal intraocular lens (IOL) implant. The ARRAY zonal-progressive IOL has a central 2.1-mm distance-vision zone for optically-unobstructed posterior pole observation. A concentric near-vision zone (+3.5-diopter add) surrounds this central zone. Optical ray-tracing is used to determine how a 2.1-mm pupil limitation restricts monocular and binocular retinal image size in head-mounted, slit-lamp, and operating microscope ophthalmoscopy. A 2.1-mm pupil decreases the retinal field of view of high magnification, narrow field lenses much more than that of wider-field, lower magnification lenses. This "worst-case" analysis suggests an ophthalmoscopic strategy, but is not strictly valid for the ARRAY lens because the near-vision zone surrounding its 2.1-mm central zone is not opaque. The near-vision zone contributes defocused information to the ophthalmoscopic image, diminishing its resolution and depth information. Wide-field, low magnification lenses are potentially less problematic than higher magnification lenses for examining and treating patients with an ARRAY IOL implant. This strategy is useful for panretinal photocoagulation or photodynamic therapy, but not for procedures requiring high magnification stereoscopic vision such as macular vitreoretinal surgery.

Objective: To evaluate optical coherence tomography (OCT), a novel noncontact and noninvasive imaging technique, for the diagnosis and quantitative characterization of epiretinal membranes., Methods: Optical coherence tomography is similar to an ultrasound B-scan, except that light rather than sound is used, which enables higher resolution. Over a 2-year period, OCT was used to examine 186 eyes of 160 patients who had a diagnosis of an epiretinal membrane. Optical coherence tomograms were correlated with visual acuity, slit-lamp biomicroscopy, fluorescein angiography, and funds photography., Results: Based on OCT, the epiretinal membrane was clearly separated from the retina with focal points of attachment in 49 eyes and globally adherent (no observed separation) in 125 eyes. Globally adherent membranes were associated with the following features: macular pseudohole (32 eyes), a difference in optical reflectivity between the membrane and retina (65 eyes), and/or a visible membrane tuft or edge (92 eyes). The membrane was undetectable on OCT in 12 eyes. The membrane thickness (mean +/- standard deviation) was 61 +/- 28 microns in the 169 eyes in which the thickness could be measured with OCT. Mean central macular thickness measured with OCT correlated with visual acuity (R2 = 0.73)., Conclusion: Optical coherence tomography was able to provide a structural assessment of the macula that was useful in the preoperative and postoperative evaluation of epiretinal membrane surgery. Quantitative measurements and the assessment of membrane adherence with OCT may be useful in characterizing the surgical prognosis of eyes with an epiretinal membrane.

Emergencies that affect the visual system can be devastating, with loss of vision being the most feared complication. In addition, visual signs and symptoms may indicate the coexistence of systemic conditions that can result in stroke, myocardial infarction and death. In patients who present with sudden loss of central or peripheral vision or pain in or around the eye, a careful examination of the eye and adnexa is warranted. Traumatic injuries also necessitate a careful examination to locate treatable problems. Prompt evaluation and treatment of vitreoretinal emergencies are important in the preservation of vision. These conditions can result in loss of vision or other severe consequences, especially if they are not promptly evaluated and treated by an ophthalmologist specializing in vitreoretinal disorders.

Purpose: To assess the potential of a new imaging technique, optical coherence tomography, for the diagnosis and monitoring of central serous chorioretinopathy. Optical coherence tomography is a novel noninvasive, noncontact imaging modality that produces high longitudinal resolution, cross-sectional tomographs of ocular tissue., Methods: Optical coherence tomography is analogous to ultrasound, except that it uses light rather than sound to obtain higher image resolution in the retina. Cross-sectional tomographs of optical reflectivity within the retina are produced with longitudinal resolution of 10 microns. Optical coherence tomography was used to examine 16 patients at a referral eye center whose initial examination disclosed the clinical diagnosis of central serous chorioretinopathy. The optical coherence tomography results were correlated with slit-lamp biomicroscopy, fundus photography, and fluorescein angiography., Results: The cross-sectional view produced by optical coherence tomography was effective in objectively quantifying the amount of serous retinal detachment in the disease. Optical coherence tomography disclosed detachments that were undetected by slit-lamp biomicroscopy. Longitudinal measurements with optical coherence tomography were successfully able to track the resolution of subretinal fluid accumulation., Conclusion: Optical coherence tomography is potentially useful as a new, noninvasive diagnostic technique for quantitative examination of patients with central serous chorioretinopathy and objectively monitoring the clinical course of the serous retinal detachment in this disease.

Background/purpose: To assess the potential of a new diagnostic technique called optical coherence tomography for imaging macular disease. Optical coherence tomography is a novel noninvasive, noncontact imaging modality which produces high depth resolution (10 microns) cross-sectional tomographs of ocular tissue. It is analogous to ultrasound, except that optical rather than acoustic reflectivity is measured., Methods: Optical coherence tomography images of the macula were obtained in 51 eyes of 44 patients with selected macular diseases. Imaging is performed in a manner compatible with slit-lamp indirect biomicroscopy so that high-resolution optical tomography may be accomplished simultaneously with normal ophthalmic examination. The time-of-flight delay of light backscattered from different layers in the retina is determined using low-coherence interferometry. Cross-sectional tomographs of the retina profiling optical reflectivity versus distance into the tissue are obtained in 2.5 seconds and with a longitudinal resolution of 10 microns., Results: Correlation of fundus examination and fluorescein angiography with optical coherence tomography tomographs was demonstrated in 12 eyes with the following pathologies: full- and partial-thickness macular hole, epiretinal membrane, macular edema, intraretinal exudate, idiopathic central serous chorioretinopathy, and detachments of the pigment epithelium and neurosensory retina., Conclusion: Optical coherence tomography is potentially a powerful tool for detecting and monitoring a variety of macular diseases, including macular edema, macular holes, and detachments of the neurosensory retina and pigment epithelium.

Objective: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin) as treatment for choroidal neovascularisation (CNV) associated with angioid streaks Methods: A non-randomised, interventional case series conducted on eyes with subfoveal CNV associated with angioid streaks. Intravitreal bevacizumab (1.25 mg in 0.05 ml) was injected into nine eyes of six patients between August 2005 and December 2007. Treatment efficacy was assessed based on preand post-treatment visual acuity and optical coherence tomography (OCT). Results: With a mean follow-up of 19 months (range 10 to 28 months), the best corrected visual acuity improved by three or more lines in four eyes (44.4%), remained within two lines of baseline in four eyes (44.4%) and decreased by three or more lines in one eye (11.1%). Central foveal thickness (CFT) measured by OCT decreased an average of 67.7 μm (range +11 to -175 μm) with an average improvement in standardised change in macular thickening of 46.6% (range -12% to +84.5%). No injection-related complications or drugrelated side effects were observed. Conclusions: Intravitreal bevazicumab for the treatment of subfoveal CNV secondary to angioid streaks mildly reduced central foveal thickness with a trend toward stabilisation of visual acuity. Additional follow-up and a larger patient cohort are needed to evaluate the long-term effects of this treatment. [ABSTRACT FROM AUTHOR]

Aim: Off-label intravitreal injections of bevacizumab (Avastin) have been given for the treatment of neovascular and exudative ocular diseases since May 2005. Since then, the use of intravitreal bevacizumab has spread worldwide, but the drug-related adverse events associated with its use have been reported only in a few retrospective reviews. The International Intravitreal Bevacizumab Safety Survey was initiated to gather timely information regarding adverse events from doctors around the world via the internet. Methods: An internet-based survey was designed to identify adverse events associated with intravitreal bevacizumab treatment. The survey web address was disseminated to the international vitreoretinal community via email. Rates of adverse events were calculated from participant responses. Results: 70 centres from 12 countries reported on 7113 injections given to 5228 patients. Doctor-reported adverse events included corneal abrasion, lens injury, endophthalmitis, retinal detachment, inflammation or uveitis, cataract progression, acute vision loss, central retinal artery occlusion, subretinal haemorrhage, retinal pigment epithelium tears, blood pressure elevation, transient ischaemic attack, cerebrovascular accident and death. None of the adverse event rates exceeded 0.21%. Conclusion: Intravitreal bevacizumab is being used globally for ocular diseases. Self-reporting of adverse events after intravitreal bevacizumab injections did not show an increased rate of potential drug-related ocular or systemic events. These short-term results suggest that intravitreal bevacizumab seems to be safe. [ABSTRACT FROM AUTHOR]