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Purpose: To report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors., Methods: Retrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes., Results: The median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06)., Conclusion: A retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate., Trial Registration Number: ID NCT05647928 (12th April 2022)., (© 2024. The Author(s).)

Purpose: The purpose of this paper is to evaluate macular microvascular changes and their correlation with visual outcomes after idiopathic epiretinal membrane (iERM) surgery. Methods: Forty-seven eyes operated for iERM were included in this retrospective case series. The foveal avascular zone (FAZ) area, and the vessel density (VD) in the superficial and the deep capillary plexus (SCP and DCP) were evaluated using optical coherence tomography angiography (OCTA). The association between the OCTA parameters and best-corrected visual acuity (BCVA) was examined preoperatively and postoperatively. Regression analyses were conducted to determine the potential predictive factors for visual recovery. Results: At baseline, the FAZ area in iERM eyes was significantly smaller than that in the control eyes ( p < 0.001). iERM eyes also had a lower macular VD in both the SCP and the DCP ( p < 0.001). Preoperative BCVA was negatively correlated with the FAZ area (r = -0.499, p < 0.001) and macular VD in the DCP (r = -0.422, p = 0.003). A negative correlation was also found between postoperative BCVA and macular VD in both the SCP (r = -0.394, p = 0.006) and the DCP (r = -0.569, p < 0.001). In the bivariate analyses, age, preoperative BCVA, iERM stage, and baseline macular VD in the SCP were significantly associated with BCVA at 6 months post-surgery. Multivariate regression analysis revealed that the preoperative BCVA was the only predictor of visual outcomes in iERM eyes ( p < 0.001). Conclusions: Idiopathic epiretinal membrane (iERM) causes microvascular changes, including foveal avascular zone (FAZ) contraction and decreased macular vessel density (VD) in both the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). These changes were significantly correlated with pre- and/or postoperative best-corrected visual acuity (BCVA). However, none of these alterations appeared to have prognostic value for visual outcomes in patients with iERM.

Introduction: The aim of the study was to determine the prevalence of metamorphopsia following rhegmatogenous retinal detachment (RRD) surgery, as well as associated predictive factors., Methods: A total of 107 eyes successfully operated for RRD underwent metamorphopsia severity assessment using M-CHARTS, and foveal microstructure analysis by spectral domain optical coherence tomography, at 1 and 6 months postoperatively. Univariate and multivariate logistic regression rendered evaluation of preoperative risk factors. The correlation between metamorphopsia score and outer retinal layer (ORL) integrity was investigated and preoperative risk factors evaluated., Results: The prevalence of postoperative metamorphopsia decreased from 51.4 to 29.9% and the median metamorphopsia score significantly improved (0.5, 95% CI: 0.3; 0.9, to 0.2, 95% CI: 0; 0.5, p &lt; 0.001) from 1 to 6 months, respectively. Preoperative macular detachment was the only predictor found (OR 11.0, 95% CI: 3.1; 39.4, p &lt; 0.001). Metamorphopsia severity was significantly associated with outer nuclear layer thickness and the status of the ellipsoid and cone interdigitation zones. One-month M-CHARTS had 81% sensitivity and 87% specificity in predicting full metamorphopsia recovery at 6 months (0.45 cut-off score)., Conclusion: The prevalence of metamorphopsia decreased in parallel to ORL restoration, thus demonstrating the etiological role of photoreceptor-level morphological changes. M-CHARTS allowed for monitoring and predicting metamorphopsia recovery after RRD., (© 2024 S. Karger AG, Basel.)

Background: This study aims to assess and compare the impact of Orthokeratology Double Reservoir Lens (DRL) versus Single Vision Lenses (SVL) on axial elongation and anterior chamber biometric parameters in myopic children over a 6- and 12-month treatment period in France., Methods: A retrospective study involving 48 patients aged 7 to 17 years, who underwent either orthokeratology treatment or single-vision spectacle correction, was conducted. Changes in refractive error, axial length, and anterior chamber depth were examined., Results: Twenty-five patients comprised the Orthokeratology (OK) group, while twenty-three were in the control group (single-vision spectacle group). Significant increases in mean axial length were observed over time in both the control (0.12 ± 0.13 mm and 0.20 ± 0.17 mm after 6 and 12 months, respectively; F (2,28.9) = 27.68, p  < 0.001) and OK groups (0.02 ± 0.07 mm and 0.06 ± 0.13 mm after 6 and 12 months, respectively; F (2,29.1) = 5.30, p  = 0.023). No statistically significant differences in axial length were found between male and female children ( p  > 0.620). Age-specific analysis revealed no significant axial elongation after 12 months in the 14-17 years group in the OK group. Anterior biometric data analysis at 6 and 12 months showed statistical significance only for the DRL group., Conclusion: Orthokeratology resulted in an 86 and 70% reduction in axial elongation after 6 and 12 months of lens wear, respectively, compared to the single-vision spectacles group. Myopia progression was more pronounced in younger children, underscoring the importance of initiating myopia control strategies at early ages., Competing Interests: JP are supported by and have financial interest in DRL contact lenses. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Queirós, Rolland le Moal, Angioi-Duprez, Berrod, Conart, Chaume and Pauné.)

Purpose: To evaluate the effect of the temporal inverted internal limiting membrane (ILM) flap technique compared with that of conventional ILM peeling on the extent of the dissociated optic nerve fiber layer (DONFL) and retinal sensitivity in patients undergoing macular hole (MH) surgery., Design: Single-center, prospective, open-label, randomized controlled clinical trial., Participants: Patients requiring vitrectomy for MHs sized > 250 μm., Methods: Patients were randomly assigned (1:1) to 1 of the following 2 groups: (1) the control group undergoing standard ILM peeling and (2) the experimental group (flap group) undergoing the temporal inverted ILM flap technique., Main Outcome Measures: The primary outcome measure was the total DONFL score at 3 months after surgery. Important secondary outcomes were microperimetry results, primary MH closure rate, external limiting membrane (ELM) and ellipsoid zone (EZ) recovery rates, and best-corrected visual acuity (BCVA)., Results: Sixty-five patients were recruited between February 2018 and July 2020; primary outcome data were available for 60 patients. The median DONFL score was 7.0 (3.0-12.5) in the control group and 5.0 (1.5-8.5) in the flap group at 3 months after surgery (P = 0.145). The focal depressions characteristic of the DONFL were limited to the temporal side of the fovea in the flap group, whereas they were found all around the fovea in the control group on spectral-domain OCT images. The MH closure rate (P = 1), EZ and ELM recovery rates (P = 0.252), and BCVA (P = 0.450) were similar between the 2 groups. The 3-month overall median retinal sensitivity (MRS) (P = 0.142) and MRS improvement (P = 0.916) in the control group were comparable with those observed in the flap group. In addition, there was no significant difference between the 2 techniques when considering the temporal area (P = 0.105) or the nasal area (P = 0.468)., Conclusions: The temporal inverted ILM flap technique reduced the extent of the DONFL by preserving the nasal part of the fovea. However, the overall DONFL score was similar between the 2 techniques. In addition, the MRS and BCVA did not differ from those obtained after complete ILM peeling., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: To evaluate the effect of an intravitreal injection of bevacizumab at the time of rhegmatogenous retinal detachment (RRD) surgery, on postoperative proliferative vitreoretinopathy (PVR) in high-risk patients selected by laser flare photometry., Methods: This single-center observational retrospective cohort study included 137 consecutive patients who underwent pars plana vitrectomy and gas tamponade for primary RRD with increased aqueous flare between July 2016 and June 2021. From June 2019, an intravitreal injection of bevacizumab was administered as an adjunct to RRD repair. Patients who underwent surgery before this time and who did not receive intravitreal bevacizumab served as controls. The main outcome was the rate of retinal redetachment due to PVR., Results: The median flare value was 22.0 (16.5-36.5) pc/ms in the control group and 28.2 (19.7-41.0) pc/ms in the bevacizumab group (p = 0.063). Eyes treated with bevacizumab were more likely to have macula-off RRD (p = 0.003), grade B PVR (p = 0.038), and worse visual acuity (p = 0.004) than controls. The rate of PVR redetachment was significantly lower in the bevacizumab group (11.1%) than in the control (30.1%) (p = 0.012). This difference was more pronounced after adjusting for potential confounding factors (p = 0.005); the risk of developing PVR was 4.5-fold higher in controls (95% CI, 1.6-12.8). After adjustment, the final median visual acuity was also significantly higher in eyes treated with bevacizumab (p = 0.025)., Conclusion: This pilot study provides preliminary evidence that bevacizumab may reduce the risk of PVR-related recurrent RRD and improve visual outcomes in high-risk patients selected by laser flare photometry., (© 2023 S. Karger AG, Basel.)

Purpose: To evaluate macular microvascular changes and their correlation with visual outcomes after rhegmatogenous retinal detachment (RRD) surgery., Design: Retrospective case series., Participants: The study included 74 eyes successfully operated for RRD., Methods: The foveal avascular zone area in the superficial capillary plexus, the vessel density (VD) in the superficial capillary plexus, vessel density deep capillary plexus (VD DCP), and choriocapillary plexus were evaluated using octangiography at 1 and 6 months postoperatively. The fellow eyes were used as controls for comparison., Main Outcome Measures: The correlation between octangiography parameters and postoperative best-corrected visual acuity (BCVA) was assessed using a hybrid linear mixed model. We also analyzed the relationship between octangiography parameters and the integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) of photoreceptors., Results: The median VD DCP was significantly decreased in RRD eyes at 1 month (P = 0.019), but gradually improved over time to reach the value of the fellow eyes at 6 months (P = 1). There was no significant difference between the 2 groups in median foveal avascular zone area, superficial capillary plexus, and choriocapillary plexus (P = 0.579, P = 0.618, P = 0.068 and P = 0.819, P = 1, and P = 1, respectively) at both 1 and 6 months postoperatively. Postoperative BCVA was positively correlated with VD DCP (P = 0.009) in multivariate analysis. Eyes with low 1-month VD DCP tended to have worse final BCVA (P = 0.067). There was no correlation between VD DCP and ELM and/or EZ integrity at both 1 (P = 0.156) and 6 months postoperatively (P = 0.161). Eyes with intact ELM and EZ at 6 months, however, had significantly higher 1-month VD DCP than those with disrupted ELM and/or EZ (P = 0.027)., Conclusion: The VD DCP was affected in RRD eyes as well as strongly associated with postoperative BCVA and the restoration of photoreceptor layers. It might thus serve as a predictor for visual recovery following successful RRD surgery., (Copyright © 2022. Published by Elsevier Inc.)

Background: To report the prevalence of posterior vitreous attachment (PVA) in patients with idiopathic epiretinal membrane (iERM) and to determine associated preoperative predictive factors., Methods: Retrospective observational case series of 408 eyes who underwent surgery for iERM without vitreomacular traction. The status of the posterior hyaloid was assessed intraoperatively. Predictive factors were analysed using univariate and multivariate logistic regression. We also evaluated the effect of PVA on the anatomical and functional outcomes of surgery., Results: Eighty-two (20.1%) eyes were found to have an undetached posterior hyaloid during vitrectomy. In multivariate analysis, axial length (AL) and lens status were strongly associated with the posterior vitreous status (p = 0.031 and p = 0.048). The odds of having a PVA decreased by a factor 0.81 per mm of AL (95% CI, 0.66-1.00). Phakic eyes had a 2.88-fold increased risk of exhibiting PVA compared to those with previous cataract extraction (95% CI, 1.10-7.52). The presence of PVA did not have any effect on postoperative anatomical and functional outcomes. In contrast, we found that eyes with shorter axial length, low preoperative visual acuity and disruption of the ellipsoid zone exhibited worse visual recovery (p = 0.006, p < 0.001 and p = 0.037)., Conclusion: PVA was observed in 20.1% of eyes undergoing vitrectomy for iERM. Shorter AL and phakic status were strong predictive factors of PVA in those eyes. However, the morphological features and the surgical prognosis of iERMs with PVA did not differ from those with posterior vitreous detachment., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: The aim of the study was to investigate the effect of tamponade duration on retinal changes induced by silicone oil (SO) in patients who underwent successful rhegmatogenous retinal detachment (RRD) surgery., Methods: Retrospective comparative case series of 68 patients who underwent SO tamponade for RRD. Patients were divided into 2 groups based on timing of SO removal: <6 months (group 1, n = 34) versus ≥6 months (group 2, n = 34). The main outcome measure was the change in central macular, inner, and outer retinal layer thickness (CMT, IRLT, and ORLT) before and after SO removal (SOR)., Results: The median tamponade duration was 4 [Clin Ophthalmol. 2016;10:471-6, Zhonghua Yan Ke Za Zhi. 1997 Jan;33(1):39-41] months in group 1 and 8 [Arch Ophthalmol. 1994 Jun;112(6):778-85, Retina. 2004 Dec;24(6):871-7] months in group 2 (p < 0.001). The mean CMT significantly increased from 245.3 ± 22.2 μm and 238.8 ± 41.6 μm under SO to 281.3 ± 60.2 μm and 259.0 ± 43.5 μm after SOR in group 1 (p = 0.009) and in group 2 (p = 0.007), respectively. Automated segmentation measurement revealed a significant increase in mean IRLT (p = 0.014 and p = 0.013) but no change in mean ORLT (p = 0.080 and p = 0.257) in both groups. After adjustment, there was no difference between the 2 groups in terms of mean final CMT, IRLT, and ORLT and mean retinal thickness changes after SOR. There was also no correlation between the tamponade duration and macular microstructural changes or visual recovery., Conclusion: SO tamponade causes a thinning of all retinal layers, mainly affecting the inner retinal layer. However, these changes resolved following SO extraction and were not affected by longer tamponade duration., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

Purpose: To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula-off rhegmatogenous retinal detachment (RD)., Methods: Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral-domain optical coherence tomography (SD-OCT) macular images at 1, 3, 6 and 12 months after surgery., Results: Over the follow-up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD-OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001)., Conclusion: Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD-OCT lesions after macula-off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare the expression profiles of various cytokines and chemokines in vitreous samples from patients with retinal detachment (RD) to those from controls and to analyze their association with various clinical features., Methods: In this prospective study, undiluted vitreous fluid was obtained from 41 patients with primary RD and 33 controls with macular hole or vitreomacular traction. A multiplex bead immunoassay was performed to determine the expression of 27 inflammatory mediators., Results: Eleven mediators were significantly upregulated in the vitreous of RD patients compared with controls, including the following: cytokines IL-1ra, IL-6, IL-7, IL-8, IFN-γ; chemokines CCL2, CCL3, CCL4, CXCL10 and CCL11 and growth factor G-CSF. Correlation analyses showed that levels of IL-1ra, CXCL10, CCL11 and G-CSF were positively correlated to the extent of detachment, while those of IL-1ra and CXCL10 were associated with the duration of detachment. There was also a positive association between the concentrations of CXCL10 and CCL11 and preoperative flare values. Additional analysis revealed that flare values and both CXCL10 and CCL11 levels were significantly higher in eyes with grade B or C proliferative vitreoretinopathy (PVR)., Conclusion: Our results confirm that RD induces a marked inflammatory response with a complex cytokine network. We identified proteins specifically linked to several clinical features that might contribute to photoreceptor degeneration and PVR-related redetachment. These proteins may represent potential therapeutic targets for improving the anatomical and functional outcomes of RD surgery., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate and to compare functional outcomes and complication rates of the same-day versus delayed pars plana vitrectomy (PPV) for intravitreal retained lens fragments after cataract surgery., Methods: Retrospective comparative series of 135 eyes with retained lens fragments that underwent PPV between August 2014 and July 2016. Sixty-two eyes received same-day PPV (group 1) and seventy-three eyes underwent delayed PPV (group 2). Outcome measures included best-corrected visual acuity (BCVA) at 6 months and postoperative complications., Results: The mean time to PPV in group 2 was 4.3±5.3 days. Mean axial length, lens fragment size and surgical technique were comparable in both groups. At 6 months, BCVA was 0.27±0.40 logMAR in group 1, and 0.35±0.30 logMAR in group 2, with no significant difference (P=0.205). Fifty-one (82.2%) eyes in group 1 and 53 (72.6%) eyes in group 2 achieved BCVA of+0.30 logMAR (20/40) or better (P=0.183). The most common complications were macular edema, elevated intraocular pressure>25mmHg, and retinal detachment occurring respectively in 10 (16.1%) eyes, 4 (6.4%) eyes and one eye (1.6%) in group 1 and 11 (15.0%) eyes, 5 (6.8%) eyes and 2 (2.7%) eyes in group 2. Overall, the complication rate was similar in both groups (P=1)., Conclusion: Our study shows that visual acuity outcomes and complication rates were similar regardless of timing of the PPV. The optimal timing of surgery remains a multifactorial decision involving patient preferences, transportation, surgeon availability and severity of the initial presentation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To develop and investigate an evidence-based performance test for assessment of vitreoretinal surgical skills on the EyeSi Surgical Simulator., Methods: Ten junior residents without any surgical experience, eight senior residents with prior experience in cataract surgery and five vitreoretinal surgeons were included in the study. The test consisted of seven modules and was completed twice by all groups during a single session. Validity evidence was evaluated using Messick's validity framework. Senior residents completed four additional test sessions and were retested 3 months after to assess skill acquisition and retention., Results: Content was aligned with vitreoretinal surgical skills as evaluated by expert surgeons. Response process was ensured through standardized instruction and data collection. The test showed satisfactory internal consistency with Cronbach's α = 0.76 (internal structure) and significant discriminative ability between the residents and the experienced surgeons (relation to other variables). A pass/fail level was determined at 596 using the contrasting groups' method. Consequences of applying this standard resulted in no false positive and no false negative. Senior residents significantly improved their simulator skills over time, reaching a plateau at the fifth iteration and equalling expert performance (p = 0.420). This level of competency was retained during the post-3-month retention testing (p = 0.062)., Conclusion: We established a performance test with solid evidence for assessment of vitreoretinal surgical skills on the EyeSi Simulator and determined a benchmark criterion that may be used for future implementation of proficiency-based training for novices., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Introduction: To study the functional and anatomical effects of internal limiting membrane (ILM) peeling in macular hole surgery with a minimum follow-up of 10 years., Methods: Retrospective study of patients who underwent successful macular hole surgery prior to 2010. All patients underwent vitrectomy and ILM peeling after staining. Functional assessment included measurement of visual acuity and retinal sensitivity using microperimetry (NIDEK MP-3) as well as a subjective visual function questionnaire. Anatomical assessment was based on evaluation of the macular region and optic nerve using spectral domain optical coherence tomography (SD-OCT) with comparison to the fellow eye., Results: Fourteen women and five men were included. Visual acuity of operated eyes (0.07±0.08logMar) was not significantly different from that of fellow eyes (0.04±0.08logMar) (P=0.10). The mean retinal sensitivity of the operated eyes was 25.1±1.9dB with no difference from the fellow eyes 25.2±1.6dB (P=0.82). However, 2 patients exhibited 2 relative scotomas >10dB. On questioning, 3/19 patients (16%) described a disturbing scotoma in monocular vision, while 11/19 (58%) described metamorphopsia, and 3 subjectively assessed their visual loss at more than 60%. The external limiting membrane was present and intact in all patients, and the ellipsoid zone was restored in 16/19 patients (84%). The cone interdigitation zone was intact in 9 patients, altered in one patient and not interpretable in 9 patients. Retinal optic nerve fiber layer thickness showed a moderate loss of fibers in the operated group 95.9±9.5 versus 101.5±10.9 (P=0.001) in the fellow eyes. The ganglionic complex thickness in the operated eyes (90.1±8.3) was not significantly different from that of fellow eyes (91.9±8.8) (P=0.37)., Conclusion: ILM peeling in macular hole surgery induces anatomical changes in the inner layers of the retina, still visible on SD-OCT 10 years after the procedure. However, this remodeling of the inner layers does not appear to have significant deleterious effects on patients' retinal sensitivity or vision., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate and to compare the anatomical and functional results of phacovitrectomy and pars plana vitrectomy (PPV) alone for phakic rhegmatogenous retinal detachment., Methods: Retrospective, comparative case series of 266 phakic eyes that underwent either combined phacovitrectomy or PPV alone for primary retinal detachment. The primary anatomical success rate, the final best-corrected visual acuity, and the refractive outcomes were analyzed., Results: One hundred and twenty-seven eyes were included in the combined group and 139 in the PPV group. The primary anatomical success rate was 84.3% in the combined group and 89.2% in the PPV group (P = 0.311). One hundred and nine (78.4%) eyes of the PPV group required cataract removal for visual rehabilitation during the follow-up period. There was no significant difference between the two groups in terms of the mean final best-corrected visual acuity (P = 0.185) and mean visual changes (P = 0.470). Overall, combined cataract extraction resulted in a significant myopic shift compared with delayed cataract surgery (P = 0.047)., Conclusion: Combined phacoemulsification and PPV is a safe and effective procedure to treat retinal detachment. The anatomical and functional results were comparable with those obtained with PPV and delayed cataract surgery. However, the refractive outcomes were less favorable and shifted toward myopia, especially in macula-off cases.

Purpose: To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery., Methods: E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded., Results: A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54)., Conclusion: No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: Rhegmatogenous retinal detachment (RD) involving the macula is a major cause of visual impairment despite high surgical success rate, mainly because of cone death. RD causes the infiltration of activated immune cells, but it is not clear whether and how infiltrating inflammatory cells contribute to cone cell loss., Methods: Vitreous samples from patients with RD and from control patients with macular hole were analyzed to characterize the inflammatory response to RD. A mouse model of RD and retinal explants culture were then used to explore the mechanisms leading to cone death., Results: Analysis of vitreous samples confirms that RD induces a marked inflammatory response with increased cytokine and chemokine expression in humans, which is closely mimicked by experimental murine RD. In this model, we corroborate that myeloid cells and T-lymphocytes contribute to cone loss, as the inhibition of their accumulation by Thrombospondin 1 (TSP1) increased cone survival. Using monocyte/retinal co-cultures and TSP1 treatment in RD, we demonstrate that immune cell infiltration downregulates rod-derived cone viability factor (RdCVF), which physiologically regulates glucose uptake in cones. Insulin and the insulin sensitizers rosiglitazone and metformin prevent in part the RD-induced cone loss in vivo, despite the persistence of inflammation CONCLUSION: Our results describe a new mechanism by which inflammation induces cone death in RD, likely through cone starvation due to the downregulation of RdCVF that could be reversed by insulin. Therapeutic inhibition of inflammation and stimulation of glucose availability in cones by insulin signaling might prevent RD-associated cone death until the RD can be surgically repaired and improve visual outcome after RD., Trial Registration: ClinicalTrials.gov NCT03318588.

Purpose: To report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine its associated preoperative risk factors., Methods: 253 eyes successfully operated for macula-off RRD were included in the study. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) of the photoreceptors was assessed at 1 month and 6 months using spectral-domain optical coherence tomography. Risk factors were analysed using univariate and multivariate logistic regression. The correlation between ORL integrity and visual outcomes was also evaluated., Results: CIZ, EZ and ELM defects were found in, respectively, 198 (93.4%) eyes, 100 (47.2%) eyes, 64 (30.2%) eyes at 1 month and in 160 (63.2%) eyes, 44 (17.4%) eyes and 18 (7.1%) eyes at 6 months. In multivariate analysis, duration of macular detachment was the only factor associated with ORL damage at 6 months (p=0.007). Best-corrected visual acuity significantly improved from 0.5±0.3 at 1 month to 0.3±0.3 logarithm of minimal angle of resolution at 6 months (p<0.001) and was strongly correlated with the number of affected bands (p<0.001)., Conclusion: Prevalence of outer retinal band defects substantially decreased through the study period, confirming the ability of photoreceptors to recover over time. However, shorter interval to surgery and better visual outcomes were significantly associated with fewer defects within the ORL at 6 months. These findings suggest that earlier surgery may limit RRD-associated photoreceptor degeneration and improve the patient's visual prognosis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To report the causes, clinical features and surgical outcomes of retinal detachment (RD) in young adults., Methods: Retrospective study of 111 eyes of 99 patients aged between 18 and 40 years, who underwent primary RD surgery between January 2011 and January 2019. All patients underwent either scleral buckling or pars plana vitrectomy. We analyzed the demographic data, characteristics of the RD, primary and final anatomic success rate and best-corrected visual acuity (BCVA) at the conclusion of follow-up., Results: The mean age of the patients was 30.3±6.5 years. RD was more frequent in males, with a gender ratio of 1.8. The breaks were atrophic round holes or retinal dialysis in 49 (44.2%) cases and were associated with posterior vitreous detachment in 62 (55.8%) cases. The main etiologies were high myopia (45.0%) and trauma (9.0%). Retinal reattachment was achieved in 74 (66.5%) eyes overall with a single procedure and in 108 (97.2%) eyes with two or more procedures. The primary success rates were 69.6% (46/66 eyes) with scleral buckling and 62.2% (28/45 eyes) with vitrectomy. High myopia was a risk factor for surgical failure (P<0.01). The mean BCVA improved from 0.71±0.64 logMAR to 0.41±0.35 logMAR (P<0.01) CONCLUSION: RD in young adults differs from that in older adults in clinical features and etiology. The main causes are trauma and high myopia. The anatomic outcomes appear less favorable, with a primary reattachment rate of 66.5%. However, the functional prognosis remains satisfactory with an improvement of 3 lines of visual acuity., (Copyright © 2020. Published by Elsevier Masson SAS.)

Purpose: To evaluate anatomical and functional outcomes of surgical displacement of macular hemorrhages complicating exsudative age-related macular degeneration (AMD) after vitrectomy, subretinal rtPA (recombinant tissue plasminogen activator) injection, intravitreal bevacizumab injection and gaz tamponade., Methods: Retrospective case series, including 26 patients with submacular hemorrhage, who underwent a surgical displacement within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was carried out to measure the diameter of the hemorrhage and to specify the relation with retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage away from the fovea at first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit., Results: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5,8 (±7,2) lines (P=0.0003) at 1 month postoperatively, 7,4 (±6,7) lines (P=0.0004) at 6 months and 7,4 (±7,4) lines (P=0.0002) at final postoperative visit (16,5±19,8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient P=-0.60 (IC 95% [-0.81; -0.26]; P=0.002))., Conclusion: Vitrectomy with subretinal rtPA injection was found to be effective for the displacement of AMD hemorrhage in 81 % of the patients. Mean final visual acuity improved by more than 7 lines., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: Macular subretinal hematoma is a complication of age related macular degeneration (AMD) responsible for a severe change in vision. We evaluated anatomic and functional results of surgical treatment of hematoma by vitrectomy, subretinal injection of r-tPA (recombinant tissue plasminogen activator), intravitreal bevacizumab injection and air tamponade., Methods: Retrospective case series including 26 patients with submacular hemorrhage who underwent vitrectomy within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was performed to measure the diameter of the hemorrhage and specify the location in relation to the retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage out of the fovea at the first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit., Results: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5.8 (±7.2) lines (P=0.0003) at 1 month postoperatively, 7.4 (±6.7) lines (P=0.0004) at 6 months and 7.4 (±7.4) lines (P=0.0002) at the final postoperative visit (16.5±19.8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient ρ=-0.60 (IC 95% [-0.81; -0.26]; P=0.002))., Conclusion: Vitrectomy with subretinal r-tPA injection was found to be effective for the displacement of AMD hemorrhage in 81% of the patients. Mean final visual acuity improved by more than 7 lines, confirming the efficacy and functional benefit of surgical displacement., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Purpose: To investigate the validity of six vitreoretinal modules on the Eyesi Surgical Simulator., Methods: Fifteen residents with no vitreoretinal experience and six trained vitreoretinal surgeons (>100 procedures per year) were included in the study. Four modules were selected in agreement with an experienced surgeon: the navigation (Nav), forceps (For), vitrector (Vit) and epiretinal membrane (ERM) peeling modules. The first level of the basic training modules (Nav1 and For1) and the first two levels of the more procedural modules (Vit1, Vit2, ERM1 and ERM2) were completed twice by both groups in the above order. The performance parameters for each task were calculated by the simulator software. The results from both iterations were recorded for analysis., Results: Experienced vitreoretinal surgeons outperformed residents with regard to the overall score on the Nav1 (p = 0.01), For1 (p < 0.01), ERM1 (p = 0.02) and ERM2 (p = 0.04) modules. No differences in overall score were found between the two groups on the Vit1 (p = 0.17) and Vit2 modules (p = 0.26)., Conclusion: Validity for the simulator metrics was found on four vitreoretinal modules not previously investigated, with regard to construct validity, content and the response process. These exercises could be included in a future competency-based training programme that could potentially be applied in the standard ophthalmological curriculum., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare performance on the EyeSi surgical simulator in 3 training modules by users with different levels of experience in ophthalmology., Methods: We included 18 surgeons (6 residents with no cataract experience, 6 residents with little experience (1 to 10 cases) and 6 experienced cataract surgeons (over 500 cases). Three modules were selected (capsulorhexis, phacoemulsification-cracking and irrigation and aspiration). All subjects completed 12 levels of increasing difficulty twice, and the results of the second trial were analyzed according to the surgeon's experience., Results: For the capsulorhexis module, experienced surgeons achieved higher total scores than the other 2 groups in exercise 1 (P=0.0102). For the phaco-cracking module, experienced surgeons achieved higher total scores in exercise 8 (P=0.0495) and a tendency toward significance in exercises 3 (P=0.0934) and 5 (P=0.0938). Participants with greater experience had lower total task time in exercises 1 (P=0.0444), 4 (P=0.06) and 5 (P=0.0189)., Conclusion: Experienced surgeons outperformed residents with regard to overall score in 4 exercises of the capsulorhexis and phaco-cracking modules. Our results confirm previously demonstrated construct validity for these modules on the EyeSi simulator. These findings will help in the development of relevant training programs that could potentially be applied to the standard ophthalmological curriculum., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the anatomical and functional outcomes of macular hole (MH) surgery with a temporal inverted internal limiting membrane (ILM) flap technique., Methods: Monocentric retrospective study of 24 patients who were operated on for macular hole between March 2014 and April 2017 at Nancy University Hospital. All patients underwent pars plana vitrectomy with the inverted ILM flap technique. ILM peeling was restricted to the temporal side of the fovea, and the macular hole was then covered with the ILM flap, followed by SF6 tamponnade and first day face-down positioning. The main outcome measures included macular hole closure rate and visual acuity at 1 month postoperatively., Results: Eight men and 16 women of mean age 67.0±5.4 years were included. The mean axial length was 23.5±1.2mm. The mean diameter of the MH was 362±123μm. Closure of the MH was achieved in 23 of 24 eyes (95.8%) after one surgery. The mean BVCA improved significantly from 0.71±0.20 logMar to 0.29±0.22 logMar (P<0.001) at 1 month postoperatively, for a gain of 0.42±0.24 logMar., Conclusion: Macular hole surgery with the inverted ILM flap technique results in good anatomical and functional outcomes, comparable to those obtained with the classic technique with complete ILM peeling., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire., Materials and Methods: A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. The questionnaires were completed by patients in consultation before surgery and then at six months postoperatively. A subgroup analysis was conducted to identify potential risk factors such as smoking, orbital decompression, duration of disease progression, number of surgeries, previous treatments or gender influences on the progression of the postoperative score., Results: Thirty-three patients (15 men/18 women) underwent surgery, with mean age 56 years; 16 (48 %) were smokers, 24 (70 %) were operated for the first time for strabismus. 8 patients (24 %) had a history of surgical orbital decompression. The mean preoperative GO QOLf was 30 (±23.8), which increased to 72 (±29.6) postoperatively (P=0.004). All the answers to the questions proposed were improved by surgery. The most improved items were difficulty in extreme gaze+6.82 points (P=0.001) and going down stairs +6.81 (P=0.002). Smokers had a lower preoperative GO QOLf than non-smokers (25±22.84 vs. 34±24.55); the same was true for their postoperative improvement (35±34.5 points vs. 50±18.8, P=0.002). History of orbital decompression did not appear to influence quality of life (21±25.39 vs. 65±33.98); the same was true for previous corticosteroid or immunosuppressant treatment (28±23.52 vs. 67±28.24), respectively P=0.42; P=0.73. Gender did not appear to influence the results P=0.17. First-time strabismus surgery patients showed a tendency which was not significant toward better improvement after 2 or 3 surgeries (respectively 45 vs. 39 vs. 33) P=0.056. There was no correlation between the duration of the disease and the change in the GO QOLf (R=0.04)., Conclusion: This study confirms that strabismus surgery significantly improves the quality of life of patients with Graves' ophthalmopathy. The GO QOLf demonstrates its effectiveness in highlighting this progression. Our ten additional questions proved to be very good tools for assessing this condition., (Copyright © 2018. Published by Elsevier Masson SAS.)

Purpose: To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR)., Design: Retrospective, interventional, comparative case series., Methods: Setting, study population, observationalprocedures and Main outcome measures., Setting: Institutional., Study Population: Seventy-five consecutive patients who underwent vitrectomy for primary macula-off RD complicated by grade B PVR., Observational Procedures: Patients were divided into an ILM peeling (Group P) and a no ILM peeling group (Group NP)., Main Outcome Measures: Anatomic success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6 months., Results: In all, 37 eyes with ILM peeling were included in Group P and 38 eyes without ILM peeling were included in Group NP. The anatomic success rate after single surgery was higher in Group P (89%) than in Group NP (66%, P = .03). Mean final visual acuity was 0.41 ± 0.40 logMAR in Group P vs 0.43 ± 0.22 logMAR in Group NP (P = .82). We found no epiretinal membrane (ERM) formation in Group P, whereas 5 cases of ERM (20%) were detected in Group NP (P = .012). The 2 groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage., Conclusions: ILM peeling during vitrectomy in macula-off RD complicated by grade B PVR reduces the need for a second surgery for redetachment or macular pucker., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The host immune reaction during endophthalmitis, studied in particular through the intraocular cytokine network, is essential for the comprehension of the disease and the development of new therapies. Therefore, the purpose of this study was to elucidate the cytokine composition of aqueous humor during endophthalmitis., Methods: In a multicenter case-control study, forty-nine patients with postoperative endophthalmitis and 60 controls (cataract surgery) were included. Visual acuity, local inflammatory grading, medical history and intraocular levels of 27 cytokines and chemokines (measured by multiplex immunoassay) were recorded., Results: During endophtalmitis, an increase in total cytokines was observed. The raise of Th1 cytokines was particularly noticeable. Chemokines, such as IL-8, MIP-1 β, MCP-1, G-CSF and IP-10, also increased. Pearson's correlation analyses showed a poor visual prognosis with high levels of IL-8, MCP-1 and VEGF and a low level of IL-10 at admission., Conclusion: An increase in inflammatory cytokines is noticeable during endophthalmitis, with a particular emphasis on IL-8, MCP-1 and VEGF. Targeted anti-inflammatory and anti-VEGF treatments may be of interest in the future.

Introduction: Although the general increase in ambulatory surgery allows for a 20% reduction in costs of hospitalization, the necessity of a day 1 postoperative visit remains the main problem for elderly patients or those who reside at considerable distance. For these reasons, in 2014, we decided to only see patients with uncomplicated filtering surgery at D5 and D21 and to replace the D1 visit with a telephone call. The primary goal of our study was to analyze a population of patients undergoing uncomplicated filtering surgery who were not seen at D1 and to describe the frequency of postoperative complications, intraocular pressure results and therapeutic management at D5 and D21., Patients and Methods: This was a retrospective monocentric study in the department of ophthalmology. All patients (naïve of surgical treatment for glaucoma) underwent surgery for primary open-angle glaucoma in an ambulatory surgery unit between May 2014 and July 2016. A nurse made a phone call to the patients at day 1 and they responded to a standardized questionnaire. Depending upon their responses, the patients were seen quickly (<24hr) or on the systematic schedule at day 5 and day 21., Results: One hundred and forty-four eyes (126 patients) were included in our study. The mean preoperative IOP was 20.4±6.4mmHg. After the phone call, only five patients were examined before the first planned follow-up at day 5. For 3 of them, the examination revealed the presence of a hyphema, and their topical medication was changed. The other two patients had no treatment modifications. At day 5, the mean IOP was 10.6±5.9mmHg. Thirty-two eyes (22.2%) required a change in their medication at day 5. The mean IOP at day 21 was 12.9±4.6mmHg. Our success rate (IOP<21mmHg with no topical medication) at day 21 was 95.6%., Discussion: The guidelines for filtering glaucoma surgery recommend examining the patient at day 1 (or at least before day 3), day 8, day 15 and day 30 or more frequently according to the case. We replaced the day 1 visit with a telephone call. We did not note a substantial rate of complications due to the elimination of the D1 visit. The criteria of success of filtering glaucoma surgery vary in the literature, but our success rate at D21 seems to be similar that in the literature and may suggest that the day 1 visit is not necessary if the surgery for primary open angle glaucoma is uncomplicated., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)