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Purpose: To examine the changes in retinal microvasculature in association with retinal layers’ condition in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). Methods: Participants in this study were 89 patients with macula off RRD, who were successfully treated with PPV and gas tamponade without internal limiting membrane peeling, in two centers. All participants underwent best corrected visual acuity (BCVA) measurement, slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) at week 5, month 3 and month 6 postoperatively. The fellow untreated eyes were also examined and served as control data. Results: A statistically significant enlargement in foveal avascular zone (FAZ) in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), accompanied with a statistically significant thinning of inner retinal layers, was noticed 5 weeks postoperatively. These changes, namely FAZ enlargement and thinning of inner retinal layers, in the operated eyes compared to the fellow eyes, remained unchanged till month 6 postoperatively. BCVA improved significantly from week 5 to months 3 and 6 postoperatively. The improvement in BCVA was associated with the gradual ellipsoid zone (EZ) recovery from the first (week 5) till the last examination (month 6). Conclusions: The FAZ enlargement in the operated eyes was accompanied with a statistically significant thinning in the inner retinal layers. Inter-correlation of BCVA and EZ integrity was noticed. © The Author(s) 2021.

Purpose: To evaluate the morphological characteristics in patients with diabetic macular edema (DME), either with co-existent non-proliferative diabetic retinopathy (NPDR) or with PDR. Methods: Retrospective study includes 138 treatment naïve patients with DME, either with NPDR (n = 96) or in combination with PDR (n = 42). All patients underwent best corrected visual acuity (BCVA) measurement, spectral domain-optical coherence tomography (SD-OCT) and fluorescein angiography, while demographic characteristics were also recorded. Specific clinical and morphological characteristics were analyzed and compared between the two groups. Results: Patients with DME and PDR presented higher central retinal thickness and mixed type of edema, with predominantly cystoid component and large cysts, extending in the foveal, peri- and para-foveal area, compared to patients with DME and NPDR. The presence of non-perfusion areas in patients with DME and PDR led to additional ellipsoid zone and external limiting membrane disruption in a higher percentage, accompanied with worse visual acuity compared to patients with DME and NPDR. Patients with DME and PDR had also higher vitreomacular traction percentage and higher HbA1c levels than those with DME and NPDR. Conclusion: Variations in morphological characteristics of DME on SD-OCT existed between patients with NPDR and those with PDR. These differences may explain the alterations in visual acuity and prognosis. © 2021, The Author(s), under exclusive licence to Springer Nature B.V.

Purpose: To evaluate the characteristics of corneal parameters in patients with diabetic macular oedema (DME) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Methods: Participants in this study were 36 patients with DME, treated with either intravitreal ranibizumab (n = 16) or aflibercept (n = 20). All participants underwent best-corrected visual acuity (BCVA) measurement, optical coherence tomography and non-contact specular microscopy to evaluate corneal endothelium parameters (endothelial cell density-ECD, hexagonality, coefficient of variation of the cell size and central corneal thickness-CCT), at baseline and at months 6 and 12 after the first intravitreal injection. Comparisons between baseline and months 6 and 12 were performed. Results: There was no statistically significant difference regarding ECD, hexagonality, coefficient of variation of the cell size and CCT at month 6 and 12 post initial injection compared to baseline in patients with DME. BCVA improved significantly at month 6 and 12 compared to baseline (p < 0.001 for both comparisons). Central retinal thickness was significantly reduced at month 6 and 12 compared to baseline (p < 0.001 for both comparisons). Conclusion: Intravitreal anti-VEGF injections in patients with DME were found not to affect corneal parameters, namely ECD, hexagonality, coefficient of variation of the cell size and CCT at the long-term follow-up of 12 months. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Purpose: To compare prospectively intravitreal ranibizumab treatment and pars plana vitrectomy (PPV) in patients with recurrent vitreous haemorrhage (VH) due to proliferative diabetic retinopathy (PDR), who were previously treated with PPV. Methods: Participants in this prospective study were 37 patients (37 eyes) with PDR, previously treated with PPV. All patients presented recurrent VH and were treated with either ranibizumab (n = 18) or PPV (n = 19). All participants were examined at week 2 post-treatment and every month thereafter for 1 year. Main outcomes were the need of PPV, the rate of recurrence of VH and the change in visual acuity by the end of the 12-month follow-up. Results: At month 12, there was statistically significant improvement in visual acuity in both groups compared to baseline, but the two groups did not differ regarding the change in visual acuity. In ranibizumab group, two patients presented recurrent VH during the follow-up and one patient needed PPV to clear the VH by month 12. In PPV group, two patients had mild recurrent VH, which cleared itself. No statistically significant difference was noticed regarding the rate of recurrent VH and the need of PPV between the two groups. Conclusion: Intravitreal ranibizumab seems to be a safe and effective treatment alternative in patients with recurrent VH secondary to PDR, who had been previously treated with PPV. © 2019, Springer Nature B.V.

BACKGROUND: The purpose of this retrospective study was to evaluate potential predictive factors of postoperative visual outcome in patients with idiopathic epiretinal membrane (iERM), treated with pars plana vitrectomy (PPV). METHODS: Participants in the study were 46 patients diagnosed with iERM, who underwent PPV. Best-corrected visual acuity measurement and spectral domain-optical coherence tomography (OCT) were performed at baseline (preoperatively), and at months 6 and 12 postoperatively. Demographic characteristics and OCT parameters were assessed as potential predictive factors for postoperative visual outcome. RESULTS: Increasing age, retinal thickness, presence of disorganization of inner retinal layers, ellipsoid zone disruption, and presence of vitreomacular traction were found to be negatively associated with postoperative visual acuity. Gender, presence of subretinal fluid, cysts in the inner or outer nuclear layer, and hyperreflective foci were not found to affect visual acuity. There was statistically significant improvement in visual acuity and central retinal thickness between baseline and months 6 and 12 in the study sample. CONCLUSIONS: It is important to determine predictive factors for visual outcome, so as to inform patients about prognosis and help in the decision-making of patients' management. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.

Purpose: To examine the retinal layers’ changes and alterations in retinal microvasculature in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). Methods: Participants in this study were 103 patients with RRD, 85 macula off and 18 macula on, who were treated with PPV and gas tamponade without internal limiting membrane peeling, in two centers. All participants underwent best corrected visual acuity measurement, slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography and optical coherence tomography angiography at week 5 and at month 6 postoperatively. The fellow untreated eyes were also examined and served as control data. Results: A statistically significant enlargement in foveal avascular zone (FAZ) in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) was noticed 5 weeks postoperatively in patients with RRD treated with PPV compared to the fellow eyes and remained 6 months after surgery. The FAZ enlargement in the operated eyes was accompanied with a statistically significant thinning of the inner retinal layer. In addition, there was a significant decrease in foveal and parafoveal vessel density (VD) in both SCP and DCP in the operated eyes compared to control eyes at week 5 postoperatively, which also remained at postoperative month 6. Conclusions: The study demonstrated that patients with RRD treated with PPV presented changes in the retinal microvasculature in both SCP and DCP, including enlargement of FAZ and decrease in VD. These changes seemed to be associated with inner retinal layer thinning. © 2020, Springer Nature B.V.

Purpose: To investigate the efficacy and safety of intravitreal dexamethasone implant as initial and only treatment for macular oedema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Methods: This study included 14 patients, who were diagnosed with macular oedema after PPV for RRD and who were treated with intravitreal dexamethasone implant. Patients were examined at the time of macular oedema diagnosis (baseline) and 1, 6 and 12 months after treatment, using best corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT). Results: The mean BCVA at baseline was 0.72 ± 0.29 logMAR and improved significantly to 0.37 ± 0.21, 0.42 ± 0.19 and 0.35 ± 0.22 logMAR at month 1, 6 and 12 after treatment with dexamethasone implant. The mean central retinal thickness (CRT) was 623 ± 142 μm at baseline and decreased significantly to 339 ± 163 μm, 428 ± 131 μm and 356 ± 147 μm at month 1, 6 and 12 after treatment. Total resolution of macular oedema was observed in 10 out of 14 patients (71.4%) at month 12. Ellipsoid zone was intact in 71.4% of patients at the end of the follow-up, while 71.4% of patients received only one implant until the end of the 12-month follow-up. No adverse events were observed. Conclusions: Intravitreal dexamethasone implant was found to be effective and safe as initial treatment for macular oedema after PPV for RRD. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Purpose: To analyze photoreceptors’ condition after intravitreal ranibizumab treatment according to the pattern of diabetic macular edema (DME) on spectral-domain optical coherence tomography (SD-OCT). Methods: Retrospective study includes 58 treatment naïve patients with DME, treated with intravitreal ranibizumab injections and followed up for at least 12 months. Patients were classified based on DME morphology on SD-OCT into: diffuse macular edema, cystoid macular edema (CME) and serous retinal detachment with CME (SRD/CME). The DME morphology was analyzed, while quantitative measurement of ellipsoid zone (EZ) defect, as well as qualitative assessment of the condition of external limiting membrane (ELM) and interdigitation zone (IZ) at foveal area, was taken before and after treatment. Results: Before treatment, patients with CME presented worse ELM and IZ condition and greater EZ defect than patients with diffuse macular edema or SRD/CME. After treatment, the restoration of EZ defect and IZ was more evident in patients with CME than in diffuse macular edema or SRD/CME. Conclusion: Patients with DME presented significant photoreceptors’ restoration after intravitreal ranibizumab injections at the 12-month follow-up. The improvement in EZ defect size and IZ was dependent on the pattern of DME on SD-OCT. © 2020, Springer Nature B.V.

Aims: To compare intravitreal ranibizumab as monotherapy or in combination with panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR) and coexistent diabetic macular edema (DME) in a long-term follow-up of 24 months. Methods: Participants in this prospective study were 47 patients with PDR and concurrent DME, who were randomized at baseline into two groups: (i) the “ranibizumab alone” group (n = 23), which was treated with at least 3 intravitreal ranibizumab injections as a loading phase, and (ii) the “combination” group (n = 24), which was treated with PRP and at least 3 intravitreal ranibizumab injections. Thereafter, all patients were followed up at a pro re nata (PRN) basis, with regular monthly monitoring for 24 months. At each visit, best corrected visual acuity (BCVA) and spectral domain-optical coherence tomography were performed, while regression of neovascularization was also recorded. Results: The “combination” group had better control of neovascularization and less events of vitreous hemorrhage than ranibizumab alone through the 2 years. BCVA did not differ significantly between the two groups at months 12 and 24 of the follow-up. The “ranibizumab” alone group presented greater reduction in central retinal thickness at month 12, which did not reach significance at month 24 compared to “combination” group. Greater number of injections was needed in the monotherapy group (mean 14 injections) compared to “combination” group (mean 11 injections) through month 24. Conclusions: Both intravitreal ranibizumab alone or in combination with PRP could be used effectively for the treatment of PDR and coexistent DME. Even though there was no difference in BCVA and CRT at the 24-month follow-up between the two groups, the combination group presented greater regression of neovascularization with less injections. © 2020, Springer-Verlag Italia S.r.l., part of Springer Nature.

Purpose: To investigate the coexistence of cilioretinal arteries (CRAs) with optic disc pit (ODP), and to delineate the characteristics of CRAs related to their number, location of their emergence and their association with the size of ODP. Methods: 47 patients (49 eyes) with ODP were diagnosed and followed-up between 1997 and 2017, using slit-lamp biomicroscopy, color fundus photographs, fluorescein angiography and indocyanine green angiography. The presence of CRAs was recorded in association with the size of the ODP, along with their number and location of emergence. The fellow normal eyes of patients were also analyzed. Results: 42 out of 49 eyes with ODP (85.7%) presented CRAs. In 35 out of 42 eyes (83.3%) CRAs emerged from the pit, either from bottom or from its margin. In 7.1% of cases, CRAs were emerged outside the ODP, while in 9.6% of cases, the type of CRA emergence could be characterized as mixed. The number of CRAs, that ranged from 1 to 4, was positively associated with ODP size. In the fellow normal eyes, CRAs was found in 22.2% of cases, difference which was significant compared to patients with ODP. Conclusion: Based on the high percentage of CRAs coexistence with ODP and the excessive frequency of their emergence from ODP (83.3%), it is supported that ODP as a developmental disorder could go along with further anatomic peculiarities, that also include the presence of multiple CRAs. ©, © Taylor & Francis.

Purpose: The purpose of this review is to summarize current knowledge on XEN implant for the treatment of glaucoma. Methods: A comprehensive literature review has been performed regarding XEN implant and its use on glaucoma management. Forty-two articles were checked and 37 were found to be relevant. Out of them, 21 were excluded as being case reports and reviews and the remaining 16 were eligible for the purpose of our review. Results: There was a significant reduction in intraocular pressure as well as in the number of medications needed in glaucoma patients treated with XEN implant either alone or combined with cataract surgery. In addition, combination of XEN implant with Baerveldt tubes has been shown to be beneficial in cases of refractory glaucoma, although complications may be present in this technique. Moreover, uveitic glaucoma may be a potential application of XEN implant. Conclusions: XEN implant devices have been developed as a surgical alternative for glaucomatous patients and are expected to play an important role in the management of glaucoma in the future. ©, © Taylor & Francis.

Purpose: To evaluate the qualitative changes of choriocapillaris in the presence of reticular pseudodrusen (RPD) and compare them with conventional small drusen due to dry age-related macular degeneration (AMD). Procedures: Participants in this study were 59 patients with non-neovascular AMD, presenting either RPD (23 patients) or drusen (36 patients) of similar size. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography. Results: The morphology of RPD in SD-OCT was depicted either as conical or as amorphous in shape. Both types were found to affect the ellipsoid zone. The presence of RPD was associated with choriocapillaris’ reduced blood flow signal (non-perfusion), while the same but less intense choriocapillaris’ non-perfusion appearance was noticed in the presence of drusen of the same size. In 13% of patients with RPD, ghost-like vessels were observed in the non-perfusion area of choriocapillaris, while in none patients with drusen ghost vessels were present. In all 23 patients with RPD, the choriocapillaris non-perfusion was correspondent to the location of RPD. Additionally, in about 35% of them, choriocapillaris’ impairment was also observed, covering areas outside RPD. Conclusions: Morphological impairment of choriocapillaris was more intense in patients with RPD than in those with conventional drusen of the same size. The existence of ghost vessels in the area of choriocapillaris’ density defect suggested that choriocapillaris’ alterations may occur in patients with RPD. © 2017, Springer Science+Business Media B.V.

Purpose: The purpose of this study was to evaluate refractive changes after intravitreal ranibizumab injections for the treatment of diabetic macular oedema. Methods: Participants in this retrospective study were 35 patients (35 eyes) with diabetic macular oedema, who received intravitreal ranibizumab injections. Spherical equivalent refractive power was evaluated before treatment and at least one month after the last injection where no fluid existed. Demographic characteristics, visual acuity, central retinal thickness and the number of injections were recorded and analysed. Results: The spherical equivalent refractive power did not differ significantly pre- or post-injections. Changes in visual acuity and central retinal thickness were statistically significant before and after injections. Conclusions: Intravitreal ranibizumab injections did not seem to affect the refractive power of patients with diabetic macular oedema. Therefore, appropriate spectacle correction can be prescribed any time during ongoing treatment with ranibizumab injections. © 2017 Optometry Australia

Purpose: The purpose of this prospective study was to evaluate the impact of epiretinal membrane (ERM) on anatomical and functional results in patients with wet age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth (anti-VEGF) injections. Methods: Participants in the study were 48 patients with either wet AMD alone (AMD group, n = 27) or AMD and ERM (AMD/ERM group, n = 21). All patients received intravitreal anti-VEGF injections (three monthly injections and PRN thereafter) and were followed up for at least 12 months. All participants had best-corrected visual acuity (BCVA) measurement and spectral domain-optical coherence tomography (SD-OCT) at each visit, while fluorescein angiography was performed at baseline and then at the discretion of the physician. Results: There was a statistically significant improvement in BCVA at month 12 compared to baseline in each group (p

Introduction: The purpose of this study was to investigate the extent and morphology of the choriocapillaris’ density defect in patients with drusen in non-neovascular age-related macular degeneration (AMD). Methods: Participants in this study were 36 patients with non-neovascular AMD and drusen. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain-optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). Results: In all studied cases, the presence of drusen was associated with choriocapillaris’ reduced blood flow signal of different extent and severity. Three types of choriocapillaris’ non-perfusion were observed, along with an association between the size of drusen and the morphology of choriocapillaris’ density defect. Moreover, the extent of choriocapillaris’ density change has been related to ellipsoid zone disruption and therefore to visual impairment. Conclusions: Our study showed that in patients with drusen due to non-neovascular AMD, there is choriocapillaris’ impairment of different morphology in OCTA, which is mainly related to the size and location of the drusen. © 2018, The Author(s).

Purpose: To evaluate the anatomical and functional outcomes in patients with ischemic central retinal vein occlusion (CRVO) treated with intravitreal anti-vascular endothelial growth factor (VEGF) agents. Methods: This retrospective study included 15 treatment-naive patients with ischemic CRVO and macular edema who were treated with intravitreal ranibizumab or aflibercept. The main outcomes were the evolution of retinal ischemia over time, as well as the change in best corrected visual acuity (BCVA) and in central subfield thickness (CST) at month 24. Results: At month 24, patients with ischemic CRVO gained +7.8 letters compared to baseline, while there was a significant decrease in CST by 243.7 μm. At baseline, ischemia was located mainly at the peripheral retina, while 6.6% of patients presented macular ischemia. At month 24, 20% of patients had macular ischemia, which was found to be negatively correlated with BCVA. The patients with macular ischemia had very poor final visual outcome and were advised to discontinue treatment. Conclusions: Our study showed that anti-VEGF treatment was effective in patients with ischemic CRVO, since it reduces macular edema and maintains or improves VA in the long term (24-month follow-up). It is worthy of note that in a small proportion of patients (13.3%) peripheral ischemia progressed to macular ischemia over time. In cases where macular ischemia is present, anti-VEGF treatment does not seem to offer any improvement in VA. © 2017 S. Karger AG, Basel.

Purpose: To evaluate macular thickness (MT) changes, using spectral domain optical coherence tomography (SD-OCT) in patients with optic disc pit (ODP) maculopathy after pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. Procedures: Our retrospective study included nine patients with ODP maculopathy, treated with either PPV (n = 5) or PPV with ILM peeling (n = 4). All participants, who had a mean long-term follow-up of 33.4 ± 7.0 months, underwent a complete ophthalmological examination and SD-OCT. Due to the preoperative macular elevation, the postoperative MT in the operated patients was compared with that of fellow eyes and with normative data. Results: A significant reduction in MT was noticed in all macular sectors of the operated cases at the last examination. The reduction was more evident in the group of PPV with ILM peeling. At the last examination of the follow-up, there was a statistically significant improvement regarding BCVA in both groups in comparison with baseline, while the two groups did not differ significantly in between (p = 0.245). Conclusions: In the long-term follow-up period, our study demonstrated a significant reduction in MT in patients with ODP maculopathy treated with PPV, which was more profound in those cases where PPV included ILM peeling. © 2015 Taylor & Francis.

Purpose: The objective of this study was to compare the anatomical and functional outcomes of ranibizumab versus aflibercept for the treatment of macular edema due to central retinal vein occlusion (CRVO) in routine clinical practice. Methods: Participants in this observational study included 62 treatment-naïve patients with CRVO who received intravitreal injections of either ranibizumab or aflibercept. The demographic data, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) characteristics were evaluated at baseline and at months 1, 2, 3, 6, 12 and 18 post-treatment. Results: At month 18, the mean BCVA of ranibizumab-treated eyes increased 7.9 letters, compared to 7.4 letters for eyes receiving aflibercept, with a similar number of injections. There was no statistically significant difference between the two groups in letters or in central subfield thickness at month 18. At the end of the follow-up, 50% of patients in the ranibizumab group and 42.9% in the aflibercept group showed complete resolution of macular edema. Conclusions: Ranibizumab and aflibercept demonstrated similar anatomical and functional outcomes over 18-month follow-up in patients with macular edema due to CRVO, with a similar number of injections. © 2017, Springer-Verlag Berlin Heidelberg.

Purpose: We present the evolution of X-linked juvenile retinoschisis (XLRS) in a male patient using optical coherence tomography (OCT) with a long-term follow-up time of 15 years. Case Description: A 10-year-old male patient presented at the Medical Retina Department of our hospital complaining for blurred vision in both eyes. At the initial presentation in 2001, his best corrected visual acuity (BCVA) was 6/12 in both eyes on the Snellen chart. Based on clinical and OCT findings, the diagnosis of XLRS was made, and it was confirmed by genetic testing. No treatment was performed, but the patient was regularly examined. His BCVA and OCT findings remained relatively stable from 2001 to 2012, when BCVA decreased to 6/18 and 6/24 in the right and left eye, respectively. In 2016, his BCVA was 6/24 and 6/36 in right and left eye, respectively, while OCT depicted significant macular thinning, accompanied by irregularities of the foveal contour in both eyes. Conclusion: Patients with XLRS should be monitored regularly to evaluate the progression of the disease and manage the potential complications. © 2017 The Author(s).

Introduction: Postoperative eccentric macular hole (MH) formation is an uncommon complication after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane or MH treatment. Herein, we present a case of eccentric MH formation after PPV with ILM peeling for MH. Case Description: A 72-year-old female patient underwent 23-gauge PPV with ILM peeling for idiopathic MH in her right eye. The visual acuity was 6/24 in the right eye. One week postoperatively the retina was attached and the MH seemed to be closed, while visual acuity was 6/12. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by OCT. The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted, and at the 6-month follow-up the visual acuity and the size of the eccentric MH remained stable. Conclusions: Eccentric MHs can develop after PPV and are usually managed conservatively by observation. © 2017 The Author(s) Published by S. Karger AG.

Purpose: To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT). Methods: Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30–127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release. Results: 66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, being female, phakic lens status, increased vitreofoveal angle, V-shaped and loose vitreomacular adhesion, small adhesion area, thin vitreous strands at the adhesion site and absence of an epiretinal membrane. Four new cases of ellipsoid line changes and subretinal fluid development became evident at day 7 compared to baseline. Lamellar macular hole (LMH) in four cases was first noticed at day 28 post injection. Formation of cystoid macular edema (CME) was noticed in three new cases at day 28 compared to baseline. Conclusions: Our study demonstrated a VMT release rate of 66.7 %. Apart from the known baseline factors that influence VMT release after ocriplasmin injection, the size of the vitreofoveal angle, a V-shaped and loose vitreomacular adhesion, a small adhesion area, and thin vitreous strands at the adhesion site, could additionally affect the outcome of VMT release. In addition, we studied when VMT release and concomitant events occur and for how long the induced complications lasted. © 2015, Springer-Verlag Berlin Heidelberg.

Introduction: Optic disc pit is a rare congenital abnormality of the optic nerve head and can lead to visual impairment due to serous macular detachment. Recent advances in retinal imaging brought new insights into the pathophysiology of the disease, while new therapeutic options have also described. Areas covered: We made a comprehensive search of the literature in PubMed regarding the current treatment modalities for optic disc pit maculopathy. In addition, we describe the potential origin of the fluid as well as the pathophysiology of optic disc pit maculopathy. Expert commentary: The management of optic disc pit maculopathy remains challenging. In patients with optic disc pit, who are basically asymptomatic, counselling about the risk of maculopathy development is of significant value. Although there have been reported some cases of spontaneous resolution, current management of optic disc pit maculopathy involves surgical approach when it is diagnosed. Nowadays, the most commonly used treatment alternative for optic disc pit maculopathy management is vitrectomy, either alone or in combination with other treatment modalities, such as gas tamponade or laser photocoagulation. Other options, like scleral buckling or inner fenestration, are also used, based on the recent findings about pathophysiology of the disease. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Purpose: We aimed to provide a meta-analysis of the factors affecting vitreomacular traction (VMT) resolution after ocriplasmin use. A comprehensive systematic review of the complications after ocriplasmin use for VMT and macular hole was also done. Methods: A literature search in PubMed was performed for studies about ocriplasmin published before 30 June 2015. Then a meta-analysis of the factors affecting the VMT resolution after ocriplasmin use was done, providing the pooled odds ratios for each factor and 95 % confidence intervals (CIs). We also described the potential adverse events after ocriplasmin use in a systematic review. Results: A total of 194 abstracts were screened and 19 eligible studies were included in the meta-analysis. Age

Purpose: The purpose of this study was to evaluate the anatomical and functional findings in patients with vitreomacular traction (VMT) combined with epiretinal membrane (ERM) in the same eye. Methods: In this retrospective, cross-sectional study, we studied 65 patients with VMT and ERM. In 36 of them, ERM/VMT had a 'unified' appearance (group Ι) but in 29, VMT and ERM coexisted without an interrelationship (group ΙΙ). All patients were examined with spectral-domain optical coherence tomography (SD-OCT). We recorded the macular thickness, the presence, type and location of macular edema, the horizontal diameter of VMT, ellipsoid zone/external limiting membrane (EZ/ELM) status, the vitreofoveal angle of VMT nasally and temporally and the best corrected visual acuity (BCVA). Results: Group Ι presented with increased macular thickness, a broader adhesion diameter, extensive EZ/ELM defect and decreased BCVA compared to those where VMT and ERM were not intercorrelated. In group I ('unified' VMT and ERM), cystoid macular edema was found at a greater percentage (41.7%), while in patients where the 2 entities were not intercorrelated, diffuse macular edema was more evident (69%). There was no statistically significant difference between the 2 groups in the vitreofoveal angle temporally and nasally. Conclusions: Macular thickness, type of macular edema, adhesion diameter, the extent of the EZ/ELM defect and BCVA appeared different in cases where VMT and ERM were unified compared to cases where ERM and VMT coexisted but were not intercorrelated. © 2016 S. Karger AG, Basel.

PurporseTo determine the associated balance of forces of the vitreofoveal interface in focal vitreomacular traction evolving to full-thickness macular hole (FTMH) and to link/explain the observed changes in the context of mathematical and physics models.Patients and methodsThis is a multicenter, prospective, and observational case series conducted at the Vitreoretinal Department of three different referral centers. Fellow eyes of patients with unilateral idiopathic FTMH were included. Eighty-nine patients were included in the analysis. The fellow normal eye of the study patients was imaged with spectral-domain optical coherence tomography. The main outcome measure was the optical-coherence-tomography-defined characteristics of the vitreofoveal interface and their analysis with mathematical and physics models at the end of follow-up period. Results Of the included 89 patients (66 women and 23 men; mean age±SD, 68.5 years±9.8), 10 (11.2%) developed FTMH at the fellow eye at the end of the follow-up period. We observed two types of vitreofoveal attachment. A V-shaped (cord-like) configuration and a U-shaped configuration. The eyes with the V-shaped attachment demonstrated initial structural changes in the outer foveal layers and the eyes with the U-shaped attachment showed inner morphological changes. Conclusion We hypothesize that the type (V- or U-shaped) of the vitreofoveal attachment may affect the type and location of the initial structural change leading to the formation of FTMH from the stage of the focal vitreomacular traction. © 2014 Macmillan Publishers Limited All rights reserved.

Although intravitreal ranibizumab represents an established therapeutic approach for exudative age-related macular degeneration (AMD), the possible occurrence of adverse events remains under ongoing research. The purpose of this report is to present an incidence of an extensive submacular hemorrhage after intravitreal ranibizumab administration. Methods. Interventional case report. Results. A 72-year-old woman was referred to our retinal department for sudden visual loss in the right eye (RE). She had undergone an intravitreal ranibizumab injection 48 hours prior to her presentation. She had known AMD with a confirmed occult choroidal neovascularization (CNV) for which she had been subjected to a total of 24 intravitreal injections in the RE (with monthly intervals) over the last 2 years. Clinical examination revealed an extensive submacular hemorrhage in the RE. Conclusions. To our knowledge, this is the first report of a submacular hemorrhage soon after ranibizumab administration in a patient with a small occult CNV. Although such a correlation cannot be established, the authors underline the possibility of such an adverse event in patients with small CNVs following a long therapeutic course involving high injection volume. © 2011 Wichtig Editore.

PURPOSE. To report a case of full-thickness macular hole (FTMH) after intravitreal injection of ranibizumab in a patient with retinal pigment epithelium detachment (PED) and tear. METHODS. A 67-year-old woman with PED and retinal pigment epithelium (RPE) tear due to age-related macular degeneration was studied by biomicroscopy, fluorescein and indocyanine green angiography, and optical coherence tomography and was treated with intravitreal ranibizumab. RESULTS. The patient developed a FTMH that was observed 1 month after the ranibizumab injection. CONCLUSIONS. Intravitreal ranibizumab may create focal sites of tractional forces on the retinal surface while contraction of the choroidal neovascular membrane may also place forces on the RPE and outer retina. Both actions may have as a result contraction and tearing of the retina leading to the formation of a FTMH. © 2010 Wichtig Editore.

Purpose: To compare intraocular pressure (IOP) readings taken using dynamic contour tonometry (DCT) with IOP readings taken with Goldmann applanation tonometry (GAT) in eyes with glaucoma or ocular hypertension. Methods: The present study included 100 eyes in 100 patients with glaucoma or ocular hypertension. After pachymetry DCT and GAT were performed. Intraocular pressures as measured with DCT and GAT were compared with one another and with central corneal thickness (CCT). Results: Mean DCT IOP measurements (20.1 ± 4.3 mmHg) were significantly (p < 0.001) higher than GAT IOP values (17.9 ± 4.7 mmHg). The mean difference between DCT and GAT measurements was 2.1 mmHg (range - 3.4 to 9.7 mmHg). The difference followed a normal distribution. Measurements made with DCT and GAT correlated significantly with one another (Spearman's rho = 0.761, p < 0.001). Neither GAT nor DCT measurements showed a significant correlation with CCT (537 ± 39 μm, range 458-656 μm). Multivariate regression analysis has shown that the difference between DCT and GAT is influenced significantly by ocular pulse amplitude (r = - 0.334, p = 0.001) and it is not influenced by CCT (r = - 0.106, p = 0.292). Conclusions: In eyes with glaucoma or ocular hypertension, DCT facilitates suitable and reliable IOP measurements which are in good concordance with GAT readings. Variation in CCT cannot by itself explain the differences in measurements taken with DCT and GAT in a number of eyes. © 2008 Acta Ophthalmol.

PURPOSE. To report in a single case the effectiveness of bevacizumab in the treatment of feeder vessels (FVs) of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS. One patient received intravitreal bevacizumab (Avastin) (1.25 mg) which was repeated 4 weeks after the first intravitreal injection. Fluorescein angiography and optical coherence tomography (OCT) were performed. Visual acuity (VA) was also checked. RESULTS. Occlusion of the FVS was observed 4 weeks after starting treatment. During the follow-up period and in the final examination 13 months after the first injection, the FVs remained occluded. Complete resolution of macular edema and improvement of the VA were noticed after the second bevacizumab intravitreal injection. CONCLUSIONS. This report documents the successful occlusion of FVs of subfoveal neovascularization after two intravitreal bevacizumab injections in a patient who was followed up for 1 year after the occlusion. Further long-term investigation is warranted given the promising 12-month results.

PURPOSE. To evaluate by optical coherence tomography (OCT) the vitreous involvement in full thickness macular hole associated with optic disk pit maculopathy. METHODS. Two patients with optic disk pit maculopathy and full thickness macular hole underwent OCT for evaluation of vitreous involvement in the pathogenesis of the disease. Fluorescein angiography and fundus photographs were also performed. RESULTS. OCT documented the presence of vitreous traction at the edge of the full thickness macular hole in the first case and on the elevated macula in the second case. Partial posterior vitreous detachment was also noticed. CONCLUSIONS. Previously unreported OCT findings such as vitreous traction at the edge of the macular hole and on the elevated macula were found. OCT provided evidence for vitreous participation in full thickness macular hole associated with optic diskpit maculopathy, OCT was also able to show that the full thickness macular hole and optic disk pit maculopathy were probably caused by similar vitreous tractional forces.

Aims: To compare and correlate retinal nerve fiber layer (RNFL) measurements obtained by scanning laser polarimetry (SLP) with defects detected by short-wavelength automatic perimetry (SWAP) in eyes with ocular hypertension (OHT). Methods: SLP and SWAP were performed in 96 eyes of 48 consecutive patients with OHT. Results: Twenty-five eyes (26%) had SWAP visual field defects. Twenty-seven eyes (28.1%) had abnormal RNFL evaluation defined by the GDx neural network ('number'>29). Fourteen eyes of 10 patients (14.5%) had abnormal RNFL evaluation and SWAP visual field defects. RNFL thickness measurements were significantly reduced in eyes with abnormal SWAP. A weak but statistically significant correlation between the 'number' and pattern standard deviation (r = 0.3, p = 0.006) and the corrected pattern standard deviation (r = 0.3, p = 0.007) in SWAP was found. Areas of abnormal RNFL thickness corresponded to the localization of the SWAP visual field defects in corrected pattern deviation plots in 10 of the 14 eyes with defects in both tests. Conclusions: SWAP visual field defects frequently coexist and correspond with abnormalities of RNFL detected by SLP in eyes with OHT. In certain eyes, however, the two methods detect different glaucoma properties. Copyright © 2006 S. Karger AG.

PURPOSE. To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months. METHODS. Case report. RESULTS. A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved. CONCLUSIONS. Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.

Purpose: To describe the morphologic characteristics of uveitic macular edema by the use of optical coherence tomography (OCT) and to investigate the correlation between tomographic features and visual acuity (VA). Design: Cross-sectional study. Participants: Seventy consecutive patients with uveitis in a university-based practice with a clinical diagnosis of macular edema in at least one eye. Inclusion criteria were: (1) verification of macular edema by OCT, (2) adequate media clarity for fundus visualization, and (3) absence of coexisting ocular disease limiting visual potential. Methods: Complete ophthalmic examination: best-corrected Snellen VA, slit-lamp examination, fundus biomicroscopy, indirect ophthalmoscopy, and OCT. Fluorescein angiography was performed in selected cases. Main Outcome Measures: Best-corrected Snellen VA and tomographic features of the macula, including macular thickness measurement and correlation of macular thickness with VA. Results: Eighty-four eyes of 60 patients met the inclusion criteria. The mean VA (Snellen test) was 20/36. There were 3 patterns of macular edema: diffuse macular edema (DME), cystoid macular edema (CME), and serous retinal detachment (RD). Serous retinal detachment was detected in 17 eyes (20.2%). Patients were classified into the following groups: DME (46 eyes, 54.8%), CME (21 eyes, 25%), DME and RD (5 eyes, 5.9%), CME and RD (12 eyes, 14.3%). Epiretinal membrane was detected by OCT in 34 eyes (40.5%). Eight eyes (9.5%) demonstrated vitreomacular traction. The mean retinal thickness at the central fovea was 333 +/- 171 mum (mean +/- standard deviation). Macular edema was located mainly in the outer retinal layers. Eyes with CME had significantly greater retinal thickness measurements than eyes with DME (P

Purpose: To evaluate macular function, before and after photodynamic therapy (PDT) using multifocal electroretinogram (MF-ERG), in eyes suffering from classic subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (ARMD). Methods: Twenty eyes of 20 patients (10 male, 10 female) with classic subfoveal CNV resulting from ARMD were studied. All received PDT with verteporfin. Fluorescein angiography and mF-ERG were performed in each patient 1 day before and 1 week, 3 months and 6 months after photodynamic therapy. Results: Before treatment, visual acuity (VA) and electrical retinal response densities (RRD) in the foveal and parafoveal areas were low in all patients. The mean VA (ETDRS chart) before PDT was 24.35 (SD, 15). The mean RRD before PDT in area 1 was 4.39 nV/deg(2) (SD, 2.59) and in area 2 it was 2.11 (SD, 1.86). Six months after treatment, the mean VA was stable in 70% of the patients. However, the mean RRD after PDT was 2.24 nV/deg(2) in area 1 (SD, 2.59) and 1.07 nV/deg(2) in area 2 (SD, 1.59). Conclusion: Multifocal ERG objectively evaluates the macular function in eyes with CNV attributable to ARMD. In this study, the stability of VA coincided with a clear impairment of electrical activity of the foveal and parafoveal areas. This finding suggests that MF-ERG should be adopted to assess the efficacy of PDT objectively in the treatment of ARMD.

Purpose: To evaluate the macular function by means of multifocal electroretinogram (MF ERG) in eyes with congenital optic disc pit and serous macular detachment. The evaluation was performed before and after the successful surgical intervention. Design: Nonrandomized, comparative (self-control led), interventional trial. Participants. Ten patients (10 eyes) with optic disc pit with serous macular detachment were treated with the macular buckling procedure and followed up from March 1999 through May 2001. Methods: In all patients included in the study, IVIF ERG was recorded before and after treatment. For recording, the VERIS III system (Visual Evoked Response Imaging System; Tomey, Nagoya, Japan) was used. Main Outcome Measures: The retinal response densities were studied before and after treatment in areas 1 and 2 and were compared with visual acuity. Results: The MF ERG before treatment showed decreased retinal response densities in all 10 cases. Twelve months after the surgical intervention, the electrical response densities in areas 1 (foveal area) and 2 (parafoveal area) improved. Further improvement was noted in 3 of the 10 patients who completed a follow-up of 18 months after treatment. In 8 of the 10 patients, postoperative visual acuity also increased. In the remaining two patients, visual acuity did not change after treatment, despite improvement of the retinal response densities. Conclusions: In eyes with congenital optic disc pit with serous macular detachment, the decrease in retinal electrophysiologic response before treatment was not limited to the fovea, but also involved the perifoveal area. In all 10 eyes 12 months after treatment, the electrical activities in areas 1 and 2 improved. This improvement was not always followed by an increase in visual acuity. In 2 of the 10 patients, visual acuity remained unchanged. The values of retinal response densities before treatment cannot be used alone as a prognostic factor for the postoperative functional retinal results. It should also be stressed that the results of this study cannot be compared with the results of studies where spontaneous resolution of the macular detachment occurred. Ophthalmology 2002;109:2295-2302 (C) 2002 by the American Academy of Ophthalmology.

Purpose: To evaluate macular function before and after successful surgical peeling of idiopathic epimacular membranes by means of multifocal electroretinogram (ERG) and measuring the first order Kernel. Methods: Multifocal ERG of 10 patients (10 eyes) with idiopathic epimacular membrane were recorded before and after successful macular peeling. The retinal response densities of areas I and 2 were compared pre- and postoperatively and the functional state of the retina beneath the epimacular membrane was evaluated. The postoperative period was 3-6 months. Results: Preoperatively, the electrical retinal response densities in the foveal and the perifoveal area were apparently decreased. After a mean postoperative period of 3 months the electrical response densities of the above areas improved. This improvement continued 6 months after the operation. Conclusion: In idiopathic epimacular membranes, the decrease in retinal electrophysiologic response was not limited to the fovea but also involved the perifoveal area. The electrical retinal response density of these areas gradually improved after peeling of the epimacular membrane.

To evaluate the visual function of 15 eyes suffering from macular hole the multifocal ERG was used pre and postoperatively. In all the cases a successful vitrectomy has been done with macular hole closure in all the eyes. The Multifocal ERG shows an improvement of retinal response density in regions 1 and 2, even in the 2 eyes with unchanged visual acuity postoperatively. Although a relationship exist between the postoperative retinal response density and the visual acuity, the retinal response density varies between eyes with the same visual acuity.

In a seventy-five-year old man an optic nerve coloboma with generalised retinal degeneration associated with a cystic microphthalmia of the other eye is described. The MR imaging revealed the existence of a left microphthalmic eye with a lower lid cyst. From the other eye an optic nerve coloboma with a cystic ectasia of the coloboma area freely open to the vitreous cavity was apparent. The ERG recorded from this eye was extinguished.

To evaluate the prognostic value of ERG in cases of central retinal vein occlusion (CRVO) regardingm the development of neovascularisation (NV), we studied 20 patients with unilateral CRVO. Half of them were allocated in the non-perfused group and the other 10 finally developed NV and were allocated in the non-perfused group. Flash ERG was recorded from all patients. Our findings suggest that b-wave latency is the most reliable parameter in predicting NV, followed by the a-wave latency. The b/a wave amplitude of ERG ratio does not seem to be suitable for clinical use.

Neovascularization in branch retinal vein occlusion usually develops 6-12 months after the onset of the disease, although some cases have been reported in which neovascularization and subsequent vitreous haemorrhage developed 2-3 years later. This is a report of nine cases of late appearance of vitreous haemorrhage due to branch retinal vein occlusion, which occurred 3-6 years after the initial onset of the disease. In two of these nine cases the vitreous haemorrhage was very profound and had to be managed by vitrectomy. We have studied the remaining seven cases, which had retinal ischaemia and optic disc or retinal neovascularization documented by fluorescein angiographic examination. Laser coagulation was applied in these seven cases, which resulted in considerable regression of the neovascularization and absorption of the vitreous haemorrhage. In one out of the seven cases recurrent vitreous haemorrhages appeared and it was finally treated by vitrectomy. Visual acuity improved in six of the seven cases. The follow-up period ranged from 12 to 48 months. The late appearance of the ischaemic type of branch retinal vein occlusion with neovascularization can be attributed to the change in character of the initially mild oedematous form of the disease. Partial posterior vitreous detachment and traction exerted at some later stage upon the neovascularization could be additional factors of the late appearance of vitreous haemorrhage. Patients with branch retinal vein occlusion should be followed up regularly over a long period of time in order to avoid late complications of the disease, such as vitreous haemorrhage following optic disc or retinal neovascularization. © 1996 Kluwer Academic Publishers.

Cataract is a very common disease of the eye lens known since ancient times. Different mechanisms are responsible for the biogenesis of cataract but most scientists agree with the theory that cataract formation can be attributed to metabolism disorders in the lens. Instrumental neutron activation analysis has been applied in this work for the determination of the following trace elements: antimony, cobalt, iron, rubidium, selenium and zinc in human lenses with mature cataract. The results are statistically treated and correlated with age and sex of patients. Based on these findings, the concentration of elements studied does not have any correlation with the age and/or sex of the patients, i.e. when the lens becomes totally opaque. © 1989 Akadémiai Kiadó.

For the detection and determination of the trace elements Ag and Sc in mature human cataractous lenses, the method of neuron activation analysis was used. As regards Ag, attempts made in the past to establish its presence in the cataractous lens had failed, while Sc has not so far been thoroughly investigated. Our study of the two elements was also correlated to the age and sex of the patients with senile cataract. It was found that once senile cataract has fully matured, the determined trace-element concentrations no longer appear to be related to age and/or sex of the patients.

In two cases, primary neoplasms originating in the cornea were observed. The first case concerned a woman, 54 years old, whose right cornea developed a blackish-gray formation, 4 × 2 mm. Visual acuity of right eye was light perception. After the enucleation, histologic examination showed that the tumor consisted of dense, diffuse neoplastic cells of moderate size, spindle shaped, slightly rounded, and irregular in some parts; some of them contained melanin. In other areas, an ample polymorphy and anisochromasia of the nuclei were observed. In this case, almost certainly "en route" to malignancy, there were also small, flat aggregations of nevus cells in other sites of the cornea. The second case concerned a man, 62 years old, who developed a longitudinal berry-like formation in the medial part of the cornea 8 × 3.5 mm. Histology revealed a pigmented nevus with no signs of malignancy. In both cases, these neoplasms arose from the cornea. In the first case repeat sections did not reveal any relationship between the tumor and the limbus. © 1973.

Involve mo ill of the retinal and choroidal vessels in malignant choroidal melanomas is not a common feature. The findings, by means of fluorescein angiography, which are described up lo the present date, concern mainly individual cases. Changes in the retinal vessels were observed in four out of 24 malignant choroidal melanomas. These changes in the first ease were a granular localized fluorescence of the wall of the vessels and a narrowing of the lumen of the same vessels. In the second case the prominent feature was a beading appearance mainly in the main arterial branches. In the third and fourth cases we have found an incomplete filling of the vessel stems of the retina. Changes in the choroidal vessels were observed in Iwo eases which were found to have an irregular and coarse choroidal vasc ular wall with a narrowed vascular lumen at different segment of the vessel. The findings of the cases one, five and six may be attributed to the infiltration of the wall by the melanoma cells. These vessel changes, could constitute an additional differential diagnostic feature which might help in distinguishing malignant from benign tumors of the choroid. © 1971 S. Karger AG, Basel.