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To review the existing literature about the optical coherence tomography angiography (OCTA) findings regarding peripapillary and macular vessel density (VD) in patients with pseudoexfoliative glaucoma (PXG).A comprehensive search of the PubMed database was conducted to include articles up to November 1, 2021, using an appropriate search algorithm. The retrieved articles were assessed for eligibility and filtered manually to exclude duplicates, while articles and book chapters cited in the reference lists of the eligible articles obtained by this method were reviewed so as not to miss any relevant studies.There is consistency among the studies published so far that a significant decrease in peripapillary VD exists in eyes with PXG compared to controls, and macular VD has also been reported to be significantly lower in PXG eyes than controls. However, the existing literature remains controversial regarding OCTA findings in eyes with PXG compared to those with primary open-angle glaucoma (POAG). Several studies have found that peripapillary VD and macular VD were significantly lower in PXG than POAG, while other studies reported no significant difference.Eyes with PXG were found to present decreased peripapillary and macular VD compared to control eyes, suggesting that a vascular component, including optic nerve hypoperfusion, may be implicated in the pathogenesis of PXG.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in patients with DM. In the pathogenesis of DR, chronic hyperglycemia leads to biochemical and structural alterations in retinal blood vessels' wall, resulting in hyperpermeability and non-perfusion. Since vascular endothelial growth factor (VEGF) has been found to play a significant role in the pathogenesis of DR, this review sheds light on the effect of intravitreal anti-VEGF agents on retinal non-perfusion in patients with DR. Based on the existing literature, anti-VEGF agents have been shown to improve DR severity, although they cannot reverse retinal ischemia. The results of the published studies are controversial and differ based on the location of retinal non-perfusion, as well as the imaging modality used to assess retinal non-perfusion. In cases of macular non-perfusion, most of studies showed no change in both fundus fluorescein angiography (FFA) and optical coherence tomography (OCTA) in patients with DR treated with intravitreal anti-VEGF agents, while few studies reported worsening of non-perfusion with enlargement of foveal avascular zone (FAZ). Regarding peripheral ischemia, studies using wide-field-FFA demonstrated an improvement or stability in non-perfusion areas after anti-VEGF treatment. However, the use of wide-field-OCTA revealed no signs of re-perfusion of retinal vessels post anti-VEGF treatment. Further prospective studies with long follow-up and large sample size are still needed to draw solid conclusions.摘要: 糖尿病视网膜病变 (DR) 是糖尿病 (DM) 最常见的微血管并发症, 也是DM患者致盲的主要原因。在DR的发病机制中, 慢性高血糖会引起视网膜血管壁的生化和结构发生改变, 并导致高渗和无灌注。由于血管内皮生长因子 (VEGF) 在DR的发病机制中起着重要作用, 本文综述了玻璃体内抗VEGF药物对DR患者视网膜非灌注区的影响。根据现有文献, 抗VEGF药物已被证明可以改善DR的严重程度, 但仍不能逆转视网膜缺血。目前已发表的研究结果存在争议, 并根据视网膜无灌注的位置以及用于评估视网膜无灌注的成像方式而有所不同。在黄斑区无灌注的病例中, 大多数研究报道了玻璃体内抗VEGF药物治疗后的DR患者, 其眼底荧光素血管造影(FFA)和光学相干断层成像(OCTA)均无变化, 而少数研究则报道了无灌注区域的加重伴随中央凹无血管区(FAZ)的增大。关于外周缺血, 使用广角FFA的研究表明, 抗VEGF治疗后的无灌注区有一定的改善或稳定。然而, 在抗VEGF治疗后, 使用广角OCTA并未发现视网膜血管有再灌注的迹象。未来还需要进一步的长期随访和大样本的前瞻性研究才能得出可靠的结论。.

Purpose. To investigate the potential association between peripheral blood biomarkers and morphological characteristics of retinal imaging in patients with diabetic macular edema (DME). Methods. Participants in this cross-sectional study were 36 consecutive patients (36 eyes) with treatment-naïve DME, who underwent spectral domain-optical coherence tomography (SD-OCT), fundus photography, and fundus fluorescein angiography (FFA). In addition, peripheral blood samples were taken to evaluate full blood count and biochemical parameters. Correlation between imaging characteristics and laboratory parameters was examined. Results. Eyes with central subfield thickness greater than 405 μm presented significantly higher neutrophils/lymphocytes ( p = 0.043 ) and higher lipoprotein (a) compared to eyes with CST < 405 μ m ( p = 0.003 ). Presence of hyperreflective foci on SD-OCT was associated with significantly higher white blood cell count ( p = 0.028 ). Ellipsoid zone disruption was associated with significantly lower hematocrit ( p = 0.012 ), hemoglobin ( p = 0.009 ), and red blood cell count ( p = 0.026 ), as well as with higher lipoprotein (a) ( p = 0.015 ). Macular ischemia on FFA was associated with significantly higher monocytes ( p = 0.027 ) and monocytes/HDL ( p = 0.019 ). No significant associations were found between laboratory parameters and subretinal fluid, intraretinal fluid, exudates, cysts, disorganization of inner retinal layers, epiretinal membrane, and external limiting membrane condition. Conclusion. Specific imaging morphological characteristics were found to be associated with laboratory parameters in patients with DME. These findings may shed light on the pathophysiology of DME and its correlation with the development of specific clinical signs.

The role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in routine cataract surgery has been established since decades. Topical NSAIDs have been shown to reduce postoperative ocular inflammation and pain, preserve intraoperative mydriasis, and reduce the risk of postoperative cystoid macular oedema, whilst carrying a very low side-effect profile. Nepafenac is one of the currently available topical NSAIDs. The studies have shown that is has a high ocular penetration, allowing for potentially better results than other NSAIDs. This review gathers the current literature on the role of nepafenac in cataract surgery aiming to help surgeons maximise the benefits of its use to achieve improved surgical outcomes.

Purpose: To evaluate the sensitivity of Spectral Domain Optical Coherence Tomography (SD-OCT) regarding the diagnosis of posterior vitreous detachment (PVD) in vitreomacular interface disorders (VID). Methods: A total of 48 eyes of 48 patients were included in this prospective cohort study. PVD in eyes with VID was investigated. We determined the status of posterior vitreous cortex using slit lamp (SL) biomicroscopy and SD-OCT preoperatively, during vitrectomy and on the intraoperative video recording. Sensitivity and specificity of the examining methods were analysed. Four masked independent examiners participated in this study. Results: PVD was diagnosed in 16 eyes (33.3%) on SD-OCT, 20 eyes (41.7%) on SL examination and 28 eyes (58.3%) during vitrectomy. Sensitivity and specificity for diagnosis of PVD was 37.5% and 31.3% using SD-OCT, 90% and 64.3% on the SL examination, 92.9% and 90% on the video recording respectively, compared to the intraoperative PVD diagnosis. Conclusion: SD-OCT shows a relatively low detection sensitivity of PVD in VID. Thorough OCT investigation is necessary to establish an appropriate diagnosis of PVD and treatment in VID.

Purpose To evaluate the effect of the coronavirus disease 2019 (COVID-19)-related lockdown in the management of patients with diabetic retinopathy (DR), including diabetic macular edema (DME), in a tertiary reference center in Greece. Methods In this retrospective study, we first compared the number of patients who were diagnosed with DR or DME in our clinic during the period of the lockdown and during the same period of the previous year. In addition, we included consecutive patients with DR or DME, who were followed up and treated regularly in our clinic and their appointments deferred due to lockdown, so as to compare the visual acuity, fundoscopy, and optical coherence tomography (OCT) findings prior to and post lockdown. Results During the lockdown period, there was a statistically significant decrease in patients with DR and DME as compared to the same period in the previous year. Regarding patients with previously diagnosed DME, there was a statistically significant worsening in their visual acuity and central retinal thickness after lockdown as compared to the last visit before lockdown (p

The purpose of this study is the development and validation of a novel and robust genotyping method for a new lysyl oxidase-like 1 (242 DNA samples from 49 PXS, 64 PXG, 50 primary open-angle glaucoma (POAG) patients and 79 healthy age-matched controls were analyzed. Novel methodologies were developed and optimized, in order to genotype the intronicThe real-time qPCR methodology was reliable, demonstrating good efficiency, reproducibility, accuracy in genotyping (100% concordance with the PCR-RFLP method and DNA Sequencing), with good allele discrimination (Tm = 53.26°C for C allele, Tm = 61.83°C for G allele, ΔTm = 8.57°C). The results were characterized by Hardy-Weinberg equilibrium in all groups. An increase from 18% in healthy controls to 61% in PXS patients was detected for the G/G homozygote thus, the C allele is protective for PXS with OR = 0.22 (95%CI: 0.11-0.42,A statistically significant association was verified for the intronic

Purpose: The purpose of this study was to evaluate health-related quality of life in patients with retinal vein occlusion (RVO) and investigate the possible risk factors for poor quality of life in...

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.Participants in this study were 36 patients with DME, treated with either intravitreal ranibizumab (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 (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.

Purpose: The purpose of this study was to investigate the changes of optical coherence tomography angiography (OCTA) parameters in diabetic retinopathy (DR) using an updated software with 3D projec...

To evaluate the morphological characteristics in patients with diabetic macular edema (DME), either with co-existent non-proliferative diabetic retinopathy (NPDR) or with PDR. Retrospective study includes 138 treatment naive 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. 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. 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.

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

The present review describes the procedures that intervene directly in covering and stuffing the optic disc pit (ODP).We made a comprehensive review of the literature regarding the new treatment modalities for the treatment of ODP maculopathy, mainly concentrated on covering and stuffing of the ODP. We presented the anatomical and functional outcomes of these techniques in patients with ODP maculopathy, while potential risks and complications of these techniques are also discussed.The most commonly used treatment alternative for ODP maculopathy is vitrectomy, which seems to be more successful if it is associated with the covering of the ODP by internal limiting membrane (ILM) inverted flapping. The results of the procedure are successful, if the origin of the fluid comes from the vitreous cavity. Another new procedure aims at the stuffing of the ODP by rolled ILM-flap, autologous scleral tissue or human amniotic membrane, providing promising anatomical results. The so far anatomical and functional results are discussed in detail. The literature, however, is limited regarding these techniques and based mainly on case reports with short-term follow-up. Additionally, the stuffing technique is possible to provoke further damage of optic nerve tissue and remain challenging in its use.Both covering and stuffing techniques of the ODP seem to have promising results, when used as adjunct to vitrectomy. One should take into account special considerations and possible further complications for their use in the treatment of ODP maculopathy.

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.

To stratify the literature on angioid streaks, from pathophysiology to treatment.Review of the current literature.Angioid streaks are crack-like dehiscences of Bruch membrane, which may coexist with systemic diseases, such as pseudoxanthoma elasticum, Paget disease, Ehlers-Danlos syndrome, hemoglobinopathies, or other diseases of the collagen. Various diagnostic methods, including infrared and red-free retinography, autofluorescence, optical coherence tomography, fluorescein angiography, and indocyanine green angiography, are useful to diagnose, evaluate, and monitor angioid streaks. Choroidal neovascularization consists of a major complication of angioid streaks leading to visual impairment. Therefore, observation could not be a treatment option. Photodynamic treatment or anti-vascular endothelial growth factor agents have been used for the treatment of angioid streaks, offering promising but short-term results. Currently, the available treatment may limit the disease, but not permanently inactivate it.This review discusses the epidemiology, pathophysiology, diagnosis, and treatment of angioid streaks, presenting the existing literature on this topic.

Purpose: The aim of this study was to investigate the efficacy and safety of intravitreal dexamethasone implant for the treatment of macular edema after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal. Methods: This prospective study included 27 patients who were diagnosed with macular edema after PPV for ERM removal and who were treated with either intravitreal dexamethasone implant (n = 15) or were observed without intervention (n = 12). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed 1, 6, and 12 months ­after treatment. Results: Patients treated with intravitreal dexamethasone implant showed significant improvement in BCVA and reduction in CRT at months 1, 6, and 12 after treatment, while patients in the control group showed improvement that did not reach statistical significance. The two groups differed significantly in terms of BCVA and CRT at all time points of the follow-up period, in favor of the dexamethasone implant group. Eighty percent of the patients treated with intravitreal dexamethasone needed only one implant until month 12, while no serious adverse events were noticed in any group. Conclusions: Intravitreal dexamethasone implant was found to be effective and safe for the treatment of macular edema after PPV for ERM removal.

Purpose: The purpose of this study was to investigate retinal layers’ changes in patients with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and to evaluate if these changes may affect treatment response. Methods: Participants in this prospective study were 110 treatment-naïve patients with center involved DME, who were treated with anti-VEGF agents and followed up for at least 12 months. A qualitative and quantitative analysis of retinal layers that can affect visual acuity was performed. Patients with persistent DME were defined, and factors which could affect this outcome were determined. Results: Visual acuity was significantly improved, while there was also a statistically significant reduction in central retinal thickness and in all separate retinal layers’ thickness at month 12 compared to baseline (p < 0.001). Visual acuity was associated with central retinal thickness and outer retinal layers’ thickness;51.8% of the patients presented with persistent DME at month 12, which was found to be significantly associated with baseline visual acuity and HbA1C levels. Conclusions: Anti-VEGF treatment is effective in reducing retinal thickness as a whole and in all separate retinal layers at 12-month follow-up in patients with DME. Changes in central retinal thickness and in outer retinal layers were found to affect visual acuity. HbA1c was the most significant factor to determine persistence of DME at month 12.

Introduction The purpose of this review is to present the current and emerging treatment alternatives for Leber’s hereditary optic neuropathy (LHON), emphasizing the most recent use of idebenone and stem cells or gene therapy. Methods A comprehensive literature review was performed at the PubMed database regarding the various treatment modalities for LHON. Results Treatment modalities for LHON include nutritional supplements, activators of mitochondrial biogenesis, brimonidine, and symptomatic and supportive treatment, but nowadays attention is being paid to idebenone and gene therapy or stem cells. Conclusion The treatment of LHON remains challenging, given the nature of the disease and its prognosis.

PURPOSE: The purpose of this study was to investigate the efficacy of intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) in very elderly patients aged 90 years or older at 2 years after treatment initiation. METHODS: In this multicentre retrospective data analysis from electronic medical record, consecutive treatment-naive patients with nAMD treated with aflibercept with at least 2 years follow-up were stratified into those aged

The purpose of this review is to shed light into the diagnostic challenges regarding idiopathic intracranial hypertension (IIH), giving more emphasis to the role of optical coherence tomography (OCT) in IIH, while it also presents recent advances in the management of IIH. A literature search in PubMed was performed for studies about the diagnosis and management of IIH published before June 30, 2017. Then, a comprehensive review of the eligible studies and the relevant references was performed. Apart from the updated modified criteria, OCT has been found to be important for the diagnosis of IIH, along with assessment of clinical signs and symptoms, brain imaging, and lumbar puncture. On the other hand, there is no current consensus for the management of IIH, but various interventions have been used, such as dietary therapy (weight loss, bariatric surgery, lifestyle modification, low-salt diet), medications, and surgical treatment. IIH is a challenging and serious disorder, which may lead to permanent visual impairment if there is a delay in its diagnosis. Advances in retinal imaging have led to better understanding of the pathogenesis of the disease and prompt diagnosis even in subtle cases can be done using OCT. Surgical interventions should be minimized and only used in cases refractory to medical treatment and in those with rapid progression.

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.

Introduction The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome. Methods The study included 54 patients with DME refractory to previous antivascular endothelial growth factor (anti-VEGF) who were treated with intravitreal dexamethasone implant. Predictive factors for visual outcome were assessed. In addition, the change in best-corrected visual acuity (BCVA) and the percentage of patients with edema resolution were evaluated. Results At the end of the 12-month follow-up, patients with DME gained + 5.2 letters (about 1 Snellen line), while 57.4% of patients presented total resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, phakic status, the presence of intraretinal fluid, hyperreflective foci, hard exudates, as well as external limiting membrane and ellipsoid zone disruption. The mean number of injections was 2.1. Conclusions The various predictive factors that determine the visual outcome and possibly define patient prognosis after dexamethasone intravitreal implant in DME cases have been studied. The long follow-up showed that dexamethasone intravitreal implant seems to be a safe and effective treatment for this disease, requiring a limited number of injections.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM) and is considered the leading cause of visual impairment in working-aged adults worldwide. The duration of DM and hyperglycemia have been associated with DR, although the exact role in the pathogenesis of DR and diabetic macular edema remains controversial. As a result, a reasonable question arising is whether control of blood glucose levels may alter the course of DR. Studies have shown that glycemic control remains an important factor for the presence and progression of DR. HbA1c seems to be an indicator which cannot demonstrate exactly the degree of glycemic control, while sudden variations of blood glucose may play an important role in DR; therefore, glycemic variability may be useful to predict DM complications, such as DR.

Introduction Postoperative eccentric macular hole formation is an uncommon complication after pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling for the treatment of epiretinal membrane (ERM). We present a case of eccentric macular hole formation after PPV for ERM without ILM peeling. Case report A 68-year-old male patient presented with ERM and visual acuity of 6/24 in his left eye. He underwent 23-gauge PPV without ILM peeling for treatment of ERM. One week postoperatively the retina was attached and the epiretinal membrane was successfully removed, while visual acuity was 6/9. One month after PPV, a single eccentric retinal hole below the macula was detected using fundoscopy and subsequently confirmed by optical coherence tomography. At this time the visual acuity was 6/9 and the patient reported no symptoms. No further intervention was attempted and at the 9-month follow-up, the visual acuity and the size of the eccentric macular hole remained stable. Conclusion Eccentric macular holes can be developed after PPV even without ILM peeling and are usually managed conservatively by observation.

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.

Stamatina A Kabanarou,1 Tina Xirou,1 George Mangouritsas,1 Christina Garnavou-Xirou,2 Eirini Boutouri,1 Ilias Gkizis,1 Irini Chatziralli3 1Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece; 2Retina Department, King’s College Hospital, London, UK; 32nd Department of Ophthalmology, University of Athens, Athens, Greece Purpose: Macular hole (MH) is part of a group of age-related degenerative diseases characterized by pathology of vitreomacular interface. Similarly, neovascular age-related macular degeneration (nAMD) affects older patients and is a leading cause of irreversible visual loss. The purpose of this case series is to describe the development of full-thickness MH in patients with nAMD, following antivascular endothelial growth factor (anti-VEGF) treatment.Methods: Participants in this case series were four patients with nAMD, who received anti-VEGF injections with variable therapeutic response to treatment. Patients were examined at baseline (when AMD was diagnosed) and monthly thereafter. The examination included visual acuity measurement, slit-lamp biomicroscopy, and optical coherence tomography.Results: All patients were found to develop full-thickness MH within 1–4 months after the last anti-VEGF injection, even in the absence of pre-existing vitreomacular interface abnormalities in some cases. The median number of injections before the MH formation was 3.Conclusion: MH formation may represent an adverse effect of anti-VEGF treatment in patients with nAMD and could be also coexisting pathology with nAMD in older individuals. Keywords: macular hole, age-related macular degeneration, anti-VEGF

To examine the retinal layers’ changes and alterations in retinal microvasculature in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). 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. 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. 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.

Purpose. To summarize the role of widefield optical coherence tomography angiography (WF-OCTA) in diabetic retinopathy (DR), extending from the acquisition strategies to the main clinical findings. Methods. A PubMed-based search was carried out using the terms “Diabetic retinopathy”, “optical coherence tomography angiography”, “widefield imaging”, and “ultra-widefield imaging”. All studies published in English up to August 2020 were reviewed. Results. WF-OCTA can be obtained with different approaches, offering advantages over traditional imaging in the study of nonperfusion areas (NPAs) and neovascularization (NV). Quantitative estimates and topographic distribution of NPA and NV are useful for treatment monitoring and artificial intelligence-based approaches. Curvature, segmentation, and motion artifacts should be assessed when using WF-OCTA. Conclusions. WF-OCTA harbors interesting potential in DR because of its noninvasiveness and capability of objective metrics of retinal vasculature. Further studies will facilitate the migration from traditional imaging to WF-OCTA in both the research and clinical practice fields.

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 d...

Background:Several studies have focused on oxidative stress on diabetes mellitus (DM). Our purpose was to investigate the impact of oxidative stress on progression of diabetic retinopathy (DR) in insulin-dependenttype 2DM patients, measuring serum malondialdehyde (MDA), as well as to examine the effect of vitamin E on DR progression in the above-mentioned patients.Methods:Participants in the study were 282 insulin-dependenttype 2DM patients with DR. All participants underwent a thorough ophthalmological examination, so as to grade DR, along with serum MDA measurement. All participants received 300mg vitamin E daily for 3 months and were examined again. Serum MDA pre- and post-intake of Vitamin E was the main outcome.Results:Serum MDA was positively associated with DR stage, while there was a statistically significant difference pre- and post-intake of vitamin E in all DR stages. In a subgroup analysis of patients with proliferative DR, there was a significant difference at baseline between patients who have received prior laser photocoagulation and the treatment naïve patients, while after intake of vitamin E, no statistically significant difference was noticed.Conclusion:Oxidative stress has been found to play significant role in the pathogenesis and progression of DR, while vitamin E seems to reduce MDA levels and subsequent oxidative stress, suggesting that it might have protective role in DR progression.

The purpose of this prospective study was to investigate the potential risk factors associated independently with central serous retinopathy (CSR) in a Greek population, using multivariate approach.Participants in the study were 183 consecutive patients diagnosed with CSR and 183 controls, matched for age. All participants underwent complete ophthalmological examination and information regarding their sociodemographic, clinical, medical and ophthalmological history were recorded, so as to assess potential risk factors for CSR. Univariate and multivariate analysis was performed.Univariate analysis showed that male sex, high educational status, high income, alcohol consumption, smoking, hypertension, coronary heart disease, obstructive sleep apnea, autoimmune disorders, H. pylori infection, type A personality and stress, steroid use, pregnancy and hyperopia were associated with CSR, while myopia was found to protect from CSR. In multivariate analysis, alcohol consumption, hypertension, coronary heart disease and autoimmune disorders lost their significance, while the remaining factors were all independently associated with CSR.It is important to take into account the various risk factors for CSR, so as to define vulnerable groups and to shed light into the pathogenesis of the disease.

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.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.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.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.

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.

Purpose: The purpose of this study was to investigate the potential association between rhegmatogenous retinal detachment (RRD) and BAX and BCL2 polymorphisms. Methods: This is a case control study of 99 patients with RRD and 120 healthy control subjects of Greek origin, surveyed for BAX and BCL2 polymorphisms (rs2279115 and rs4645878) and a potential correlation to RRD. Results: The rs4645878 AA genotype was found to be significantly associated with RRD (p = 0.003; OR: 6.89, 95% CI: 1.76-26.93), while the rs2279115 CC genotype as well as the C allele was not found in patients with RRD. Conclusions: This is the first study evaluating the potential relationship between BCL2 and BAX gene polymorphisms and RRD in a Greek population, showing a significant association between BAX rs4645878 polymorphism and RRD susceptibility. This finding suggests that an apoptotic mechanism is implicated in the pathogenesis of RRD.

Introduction The purpose of our study was to investigate the impact of ketorolac addition to the well-established combination of antibiotic-steroid agent in terms of vision-related quality of life. Methods Patients were randomized to: (1) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid (n = 68) and (2) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid, plus ketorolac tromethamine 0.5%, one drop tid (n = 70). All patients completed the VFQ-25 questionnaire to assess their functional vision before cataract surgery and postoperatively on days 7, 28 and 42. The statistical analysis comprised the point-wise comparison between the two groups at the four time points for all sub-scales of the VFQ-25 questionnaire, as well as the composite score. Results No significant differences were noted regarding the composite score, as well as all subscales in all examined time points. Conclusions The addition of ketorolac did not seem to offer any additional benefit in terms of vision-related quality of life.

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 ...

The purpose of this study was to evaluate the outcomes over 12 months in patients with neovascular age-related macular degeneration (nAMD) with insufficient response to ranibizumab who were switched directly to 8-weekly fixed dosing of aflibercept without a loading phase.Retrospective interventional study.Consecutive patients with nAMD who were switched from pro re nata (PRN) intravitreal ranibizumab to 8-weekly fixed aflibercept because of persistent disease activity from November 1, 2013, to September 30, 2014, were included.Demographic data, visual acuity (VA), and spectral-domain optical coherence tomography characteristics over time were evaluated to determine the prognostic indicators of final visual outcome at 12 months.The VA, central subfield thickness (CST), presence of macular fluid at month 12 compared with baseline, and the definition of prognostic indicators of final visual outcome at month 12.A total of 431 patients (447 eyes) were included in this study. There was no statistically significant difference in VA between baseline and month 12 (P = 0.79), whereas the CST significantly decreased at month 12 compared with baseline (P0.001). At the 12-month follow-up, 48.3% of eyes had no macular fluid compared with 8.5% at baseline. The mean number of injections at month 12 was 6.8±1.75. Poor prognostic indicators included increasing age, increasing CST, the presence of intraretinal fluid, pigment epithelial detachment, and subfoveal thickening.Patients who have not yet "responded" to PRN ranibizumab seem to exhibit retinal dehydration after switching to aflibercept, whereas there was no demonstration of VA benefit. Baseline features at the point of switching can independently predict outcomes.

Purpose To evaluate the potential efficacy and safety of primary intravitreal ranibizumab in patients with symptomatic retinal arterial macroaneurysm (RAM). Methods This prospective study comprised 5 eyes with RAM treated with intravitreal ranibizumab. At baseline, all patients underwent best-corrected visual acuity (BCVA) measurement, ophthalmic examination including slit-lamp biomicroscopy, and central foveal thickness (CFT) measurement using optical coherence tomography. Fluorescein angiography was also performed to confirm diagnosis. Patients were examined at 1 month after injection and monthly thereafter. Main outcome measures included changes in BCVA and CFT. Safety was assessed by ophthalmic examination and report of systemic adverse effects. Results There was a statistically significant difference in BCVA (pConclusions Intravitreal ranibizumab seems to be effective and safe for the treatment of symptomatic RAM.

PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.

Purpose To evaluate the anatomical and functional findings in patients with vitreomacular traction (VMT) alone or in combination with epiretinal membrane (ERM). Methods In this retrospective, cross-sectional study, we studied 102 patients with VMT, either alone (n = 37) or combined with ERM (n = 65). All patients were examined with spectral-domain optical coherence tomography (SD-OCT). We recorded the vitreofoveal angle of VMT nasally and temporally, the horizontal diameter of VMT, macular thickness, the presence, type, and location of macular edema, the ellipsoid zone (ΕΖ)/external limiting membrane (ELM) status, and the visual acuity. Results Patients with VMT combined with ERM presented smaller vitreofoveal angle nasally and temporally, broader adhesion diameter, and a greater extent of EZ defect compared to patients with VMT alone, although there was no statistically significant difference in EZ and ELM condition regarding the number of affected cases. There is also no statistically significant difference between the 2 groups concerning the visual acuity. In the majority of patients with VMT alone, cystoid macular edema was present mainly at the foveal area. In cases where VMT coexisted with ERM, macular edema was mostly found to be diffuse, while cystoid or mixed type, extending to the whole macular area, was also present. Conclusions Patients with VMT in association with ERM have different characteristics in SD-OCT compared to those with VMT alone regarding the type and location of macular edema, the extent of EZ defect, as well as the vitreofoveal angle and the VMT diameter. Moreover, they presented worse visual acuity compared to those with VMT alone, although the difference did not reach statistical significance.

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.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.A total of 194 abstracts were screened and 19 eligible studies were included in the meta-analysis. Age65 years, female gender, vitreomacular adhesion diameter1500 μm, phakic lens status and epiretinal membrane absence were found as positive predictive factors for VMT resolution, while macular hole size250 μm was significantly associated with macular hole closure at the meta-analytical level. Various complications after ocriplasmin use were reported by frequency, including mainly vitreous floaters, photopsias, visual acuity decrease, ellipsoid zone changes, subretinal fluid development, enlargement of macular hole, anterior segment changes and electroretinogram alterations. It has to be noted that significant methodological weaknesses were identified, such as the absence of control groups or lack of transparency in the recruitment process and the examination procedure.It is important to carefully select patients for ocriplasmin injection, taking into account the various predictive factors for VMT resolution. Patients should be informed about the potential adverse events of ocriplasmin, although they mainly seemed to be transient and usually mild/moderate in severity, suggesting that ocriplasmin is a safe and effective new treatment alternative for VMT and macular hole. However, due to the limited study quality, the uncertainty concerning the efficacy of this new approach is increased.

Objective. This historical epidemiological study aims to investigate ocular conditions in Greek refugees during the Interwar pe­riod (1926-1940) in the region of Imathia, Greece. Materials and Methods. The archival material encompasses 15,921 patients who were admitted to the Refugee Hospital of Veria, Imathia, Greece. Descriptive statistics were estimated. Results. Twenty-two cases of ocular conditions were identified. Ten patients had anterior segment conditions, such as keratitis, blepharoconjunctivi­tis, conjunctivitis, epithelioma, leukoma and an operated cataract. Another patient was diagnosed with ocular trachoma. Four patients presented sympathetic ophthalmia; two additional patients suffered from ophthalmia due to syphilis. One patient was diagnosed with ocular malaria. Four cases of ocular traumas were recorded, among which an ocular burn due to gunpowder, a motorcycle accident leading to a retro-ocular hematoma, and a kick in the eye resulting in ocular trauma were notable. Conclu­sion. The disease spectrum in Greek refugees reflects the adverse conditions during the Interwar era.

Purpose: The purpose of this retrospective study was to evaluate the disorganization of the retinal inner layers (DRIL) as a potential predictive factor of postoperative visual outcome in patients with idiopathic epiretinal membrane (iERM), treated with pars plana vitrectomy (PPV). Methods: Participants in the study were 46 consecutive patients diagnosed with iERM, who underwent PPV. Best corrected visual acuity (BCVA) measurement and spectral-domain optical coherence tomography (SD-OCT) were performed at baseline (preoperatively), and at months 3 and 6 postoperatively. DRIL and additional OCT parameters were assessed at 1-mm-wide foveal centered area. Results: DRIL was observed in 47.8% of patients at baseline. There was statistically significant improvement in BCVA and central retinal thickness (CRT) between baseline and months 6 and 12 in all patients. There was a statistically significant difference in BCVA and CRT change between patients with and without DRIL at months 6 and 12 compared to baseline, showing that there was a correlation between change in BCVA or CRT and baseline DRIL. Ellipsoid zone and external limiting membrane were intact in 91.3 and 95.7%, respectively, not affecting our results. Conclusions: Baseline DRIL has been shown to be predictive of postoperative visual outcome in patients with iERM, treated with PPV.