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Purpose To analyze the single surgery success rate and anterior segment complications related to phacoemulsification and intraocular lens implantation in a series of patients undergoing phacovitrectomy for all types of primary rhegmatogenous retinal detachment. Methods We performed a retrospective interventional case series on 302 eyes undergoing phacovitrectomy for primary rhegmatogenous retinal detachment repair between November 1, 2016, and February 2, 2019, in Edmonton, Canada. Primary outcomes included single surgery retinal reattachment rate and anterior segment complications. Secondary outcomes included the effects of proliferative vitreoretinopathy and macula and/or peripheral internal limiting membrane peeling on the rate of surgical success. Results The single surgery success rate of phacovitrectomy for all types of primary rhegmatogenous retinal detachment was 85.1%. The presence of proliferative vitreoretinopathy was associated with lower surgical success (odds ratio, 0.33; P = 0.01). Macular internal limiting membrane peeling was associated with higher surgical success (odds ratio, 2.4; P = 0.05). Anterior segment complications included posterior capsular opacification (28.8%), posterior synechiae (10.9%), and posterior capsular rupture (2.3%). Conclusion Phacovitrectomy is a safe and effective treatment option for the primary repair of rhegmatogenous retinal detachments. This study provides evidence to support the safe incorporation of phacoemulsification and intraocular lens implantation with retinal surgery.

Purpose To evaluate topical dorzolamide hydrochloride-timolol maleate as an adjunct therapy to intravitreous anti-vascular endothelial growth factor injections in eyes with retinal vein occlusion resistant to treatment. Methods Retinal vein occlusion patients with a history of persistent macular edema, despite fixed-interval intravitreous anti-vascular endothelial growth factor injections, were enrolled between April 4, 2016, and June 4, 2017. On enrollment, patients were instructed to administer one drop of topical dorzolamide-timolol twice daily for the duration of the study. They were maintained on the same anti-vascular endothelial growth factor drug and same interval between injections as preenrollment for the subsequent two visits. Primary outcome measures were change in central foveal thickness, central subfield thickness, and thickest macular cut at the final study visit. Results Eight patients (8 eyes) were eligible for enrollment and completed the study. There was a significant decrease in central foveal thickness (P = 0.02), central subfield thickness (P = 0.03), and thickest macular cut (P = 0.01) between the enrollment visit and the final visit. There was a decrease in mean (±SD) logarithm of the minimal angle of resolution from 0.52 (±0.35) (20/66, Snellen equivalent) at the enrollment visit to 0.41 (±0.35) (20/51, Snellen equivalent) at the final visit (P = 0.08). Conclusion Topical dorzolamide-timolol may have a beneficial anatomical and functional effect in eyes with macular edema secondary to retinal vein occlusion resistant to treatment.

Quantitative understanding about the dynamics of drug-target interactions in biological systems is essential, especially in rare disease programs with small patient populations. Follistatin, by antagonism of myostatin and activin, which are negative regulators of skeletal muscle and inflammatory response, is a promising therapeutic target for Duchenne Muscular Dystrophy. In this study, we constructed a quantitative systems pharmacology model for FS-EEE-Fc, a follistatin recombinant protein to investigate its efficacy from dual target binding, and, subsequently, to project its human efficacious dose. Based on model simulations, with an assumed efficacy threshold of 7-10% muscle volume increase, 3-5 mg/kg weekly dosing of FS-EEE-Fc is predicted to achieve meaningful clinical outcome. In conclusion, the study demonstrated an application of mechanism driven approach at early stage of a rare disease drug development to support lead compound optimization, enable human dose, pharmacokinetics, and efficacy predictions.

We report a case series of 12 eyes that underwent retinal detachment (RD) repair after secondary implantation of Akreos AO60 intraocular lens (IOL) with a subset experiencing the complication of IOL opacification. Major predisposing risk factors for retinal detachment included trauma (42%), prior vitrectomy (33%), and ectopia lentis (17%). Opacification developed in two eyes with gas tamponade and three with silicone oil tamponade. Two eyes required explantation of the IOL. Permanent visually significant Akreos AO60 lens opacification is a possible complication weeks after retinal detachment repair and can occur regardless of tamponade agent.

Purpose: The purpose of this article is to describe the characteristics and outcomes of retinal detachment (RD) repair associated with atopic dermatitis (AD). Methods: A single-center, retrospective review of all patients with RD associated with AD between January 2007 and December 2017 was conducted. Results: Ten patients (13 eyes) were included with a mean age of 23.5 ± 6.4 years; 6 of the patients were male (60%). The average follow-up was 41.3 ± 34.8 months. Seven eyes developed proliferative vitreoretinopathy (PVR) and recurrent RD (53.8%). The mean number of retinal surgeries was 2.3 ± 1.3. Three eyes had a scleral buckle alone (23.1%), 4 eyes had vitrectomy only (30.8%), and 6 eyes had both scleral buckle and vitrectomy (46.2%). Five eyes had prior cataract surgery (38.5%), 5 eyes had cataract at presentation (38.5%), and 5 eyes developed lens subluxation (38.5%). The mean presenting best-corrected visual acuity (BCVA) was 1.14 logarithm of the minimum angle of resolution (Snellen equivalent, 20/276) and the mean final BCVA was 1.06 (Snellen, 20/230; P = .83). The retina was successfully reattached at final follow-up in all 13 eyes (100%). Conclusions: RD is a challenging complication of AD with a high rate of PVR, recurrent RD, cataract, and lens subluxation. Patient education and physician awareness are necessary for timely diagnosis, appropriate counseling, and optimal surgical planning.

Purpose Pain associated with panretinal photocoagulation (PRP) can adversely affect the number and quality of retinal burns delivered and subsequently increase the number of treatment sessions required to achieve regression of proliferative diabetic retinopathy (PDR). We assessed comfort in patients undergoing treatment with yellow (577 nm) vs. green (532 nm) PRP for PDR. Design Prospective, single-center, randomized crossover clinical trial. Subjects Patients with PDR with high-risk characteristics. Methods Subjects were equally randomized to first receive PRP with a laser indirect ophthalmoscope with either green (IQ 532; IRIDEX, Mountain View, CA) or yellow (IQ 577; IRIDEX) laser, followed by additional treatment with the opposite laser using standardized settings in the superior hemisphere of a single treatment eye per patient. Topical anesthetic was used in all study eyes before each treatment and power was titrated until moderate grey-white retinal burns were achieved. Main Outcome Measures The primary outcome measure was patient's perceived pain as measured with a standardized 10-point pain scale. Secondary outcome measures included laser power, treatment time, number of treatment shots with each laser, and physician ease-of-use score with each laser on a 10-point scale. Results Forty patients (40 eyes) with a mean age of 54.0 years were enrolled. Mean pain scores were similar when comparing treatment with yellow and green laser (3.1 ± 2.3 vs. 2.8 ± 2.6; P = 0.40). No significant difference was seen in visual acuity ( P = 0.44) or central macular thickness ( P = 0.39) 1 month after PRP. Additionally, there were no significant differences when comparing minimum power required (243.2 ± 74.2 vs. 234.0 ± 59.6 mW; P = 0.55), treatment time (5.1 ± 3.6 vs. 5.6 ± 3.9 minutes; P = 0.384), and number of treatment shots (257.6 ± 12.6 vs. 258.0 ± 2.3; P = 0.68). Six of 7 co-investigators (85%) preferred using yellow laser over green and reported ease-of-use scores of 9.0 ± 1.2 and 7.6 ± 1.4, respectively ( P = 0.07). No severe adverse events occurred. Conclusions Patient comfort during PRP for PDR utilizing laser indirect ophthalmoscopy is similar for green and yellow wavelengths.

To describe two cases of vasculitis: one hemorrhagic and one nonhemorrhagic after uncomplicated cataract surgery with intracameral vancomycin.Retrospective case series.A 74-year-old female and a 54-year-old female developed severe visual loss within 2 weeks of uncomplicated cataract surgery with intracameral vancomycin. The first patient developed a fulminant hemorrhagic vasculitis, whereas the second patient developed a less severe nonhemorrhagic vasculitis. Partial visual recovery and prevention of neovascular glaucoma was achieved using a combination of topical, oral, and intravitreal corticosteroids, along with intravitreal antivascular endothelial growth factor agents in the first patient and a combination of topical and oral corticosteroids alone in the second patient.Hemorrhagic occlusive retinal vasculitis and nonhemorrhagic vasculitis after uncomplicated cataract surgery with intracameral vancomycin have been rarely reported. Early recognition and treatment may prevent devastating visual outcomes.

The following review describes the recent evidence regarding the effect of cataract surgery on age-related macular degeneration (AMD).For patients with both visually significant cataracts and AMD, recent evidence supports the role of cataract surgery with reports demonstrating improved visual acuity, absence of significant disease progression, and improved quality of life.Recent evidence does not find cataract surgery to cause or worsen AMD.

BACKGROUND AND OBJECTIVE: This study evaluated the residual subfoveal fluid (SFF) immediately after rhegmatogenous retinal detachment (RRD) repair using intraoperative optical coherence tomography (iOCT). PATIENTS AND METHODS: This retrospective cohort study assessed fovea-involving RRD repaired by pars plana vitrectomy (PPV) using different drainage techniques. iOCT images were acquired through the fovea at the start of the case prior to initiating vitrectomy and then again immediately prior to introduction of tamponade. RESULTS: Ten eyes (32.3%) received perfluoro-n-octane (PFO), 12 (38.7%) underwent a posterior drainage retinotomy, and nine (29.0%) had drainage through the retinal break. There was no significant difference in the mean SFF thickness between eyes in either group ( P = .85). There was no significant association between SFF thickness on iOCT and functional or anatomic outcomes ( P > .05). CONCLUSION: There is no difference in the amount of residual SFF as measured on iOCT during RRD repair with pars plana vitrectomy using either direct drainage, drainage retinotomy, or PFO. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:497–503.]

Objective The objective of this article was to describe the incidence, clinical characteristics, and visual outcomes of Vogt–Koyanagi–Harada disease in First Nations and Metis individuals. Design A retrospective chart review. Participants Nineteen First Nation and Metis Canadian residents in Northern Alberta. Methods Electronic records for a 17-year period (1994–2010) were reviewed. Charts were reviewed for age, sex, length of follow-up, location of primary residence, diagnostic criteria at presentation, disease stage at presentation, duration of symptoms before presentation, ocular and extraocular manifestations at presentation, treatments, compliance, and complications. The time to an eye reaching 20/40, 20/200, and a halving of the baseline visual angle was plotted using Kaplan–Meier methodology. Results Of 19 First Nations and Metis individuals identified, 84.2% were female, and the average age at presentation was 30.8 years. The most common presenting symptom and sign were blurred vision (89.5%) and anterior segment inflammation (89.5%), respectively. Fifteen (78.9%) patients had extraocular manifestations, the most common being alopecia (26.3%) and cerebrospinal fluid pleocytosis (26.3%). All patients were initially treated with corticosteroids; immunomodulatory therapy was used for 2 (10.5%) patients. Twelve (63.2%) patients experienced ocular complications; 47.4% of patients had difficulty with treatment compliance and attending follow-up appointments. The median time to achieve 20/40 vision was shorter for compliant patients compared with noncompliant patients (P = 0.048). Conclusions The features of Vogt–Koyanagi–Harada disease in First Nations and Metis Canadians are most similar to series of South Asian and Hispanic patients. Compliant patients were found to achieve 20/40 vision significantly sooner than noncompliant patients.

PURPOSE To describe the utility of microperimetry testing in the diagnosis of a bilateral occipital stroke. METHODS Retrospective case report. RESULTS A 57-year-old male with hypertension presented with complaints of bilateral blurred central vision and bilateral hypertensive retinopathy with cotton-wool spots. Automated perimetry demonstrated a central scotoma in both eyes that did not respect the vertical midline; however, microperimetry testing revealed a bilateral homonymous hemianopia that suggested cerebrovascular disease which was subsequently confirmed with magnetic resonance imaging. DISCUSSION In cases of unexplained central visual loss, microperimetry testing may be a useful ancillary test for the diagnosis of cerebrovascular disease.

Purpose of review The following review will provide an update on stem cell therapy with a focus on completed and ongoing human trials. Recent findings Significant progress has brought stem cell therapy from proof-of-concept animal models to human clinical trials. Although in its infancy, valuable safety and efficacy data are starting to emerge from trials looking at cell therapies for age-related macular degeneration, Stargardt's macular dystrophy, retinitis pigmentosa, and ischemic retinopathies. Summary Although clinical trials continue to enroll and evaluate stem cell therapy in patients with retinal diseases, preliminary results using both cellular replacement and trophic models have provided initial support for this exciting therapy. Results of these pivotal trials will form a key foundation for moving forward toward the ultimate goal of preventing blinding disease.

It has been documented that combination surgery (phacoemulsification, intraocular lens implantation, and vitrectomy) produces a postoperative myopic shift. We hypothesize that the myopic shift seen in patients treated with combination surgery, membrane stripping, and injection of C3F8 for treatment of a macular hole is due to an erroneously short preoperative axial length measurement by the IOLMaster.Retrospective chart review.Eleven eyes of 10 patients treated for a stage III or IV macular hole were recruited from a database search of 1 vitreoretinal practice in Regina, Sask.All eyes included in the study underwent combination surgery, membrane stripping, and injection of C3F8. None of the patients demonstrated concurrent eye pathology. Postoperative axial length measurements by the IOLMaster were obtained and compared with the same preoperative measurements.The mean (SD) postoperative myopic shift seen in the study eyes was -0.76 (0.65) D (z = -2.578, p0.01). The mean (SD) preoperative and postoperative axial length measurements were 23.54 (1.02) mm and 23.53 (1.01) mm, respectively. No significant difference in axial length was found between the preoperative and postoperative axial length measurements (t = 0.43, df = 10, p = 0.68).These findings do not support our hypothesis of an erroneous preoperative axial length measurement by the IOLMaster in patients with a stage III or IV macular hole treated with combination surgery, membrane stripping, and injection of C3F8. Further studies are required to determine the precise cause of the postoperative myopic shift.

The taxanes are chemotherapeutic agents that may, in rare cases, cause cystoid macular edema without leakage on fluorescein angiography. Two patients with evidence of taxane-related macular edema presented and were evaluated using novel en face optical coherence tomography (OCT) and OCT angiography (OCTA) imaging modalities. Although OCTA revealed no flow abnormalities in either patient, en face OCT revealed a striking bilateral symmetric cystic tessellation pattern. [ Ophthalmic Surg Lasers Imaging Retina . 2016;47:176–179.]

Significant reductions in glucose control immediately post bariatric surgery in patients with longstanding poor glycemic control can lead to the paradoxical progression of diabetic retinopathy (DR) in susceptible individuals. Bariatric surgery results in dramatic and immediate diabetic control postoperatively. We aimed to systematically review the literature to assess the effect of bariatric surgery on DR. A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library) was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. Inclusion criteria included English-speaking studies, enrolling ≥5 patients, and contained ophthalmological data on outcome of DR pre- and post bariatric surgery. Two independently reviewers screened abstracts, reviewed full text versions of all studies classified, and extracted data. All comparison studies included in the meta-analysis were assessed independently by two reviewers for methodological quality using the Cochrane Risk of Bias (RoB) tools. Disagreements were resolved by re-extraction, or third-party adjudication. Where possible and appropriate, a meta-analysis was conducted. A total of 277 studies were identified using our search criteria for screening. Four primary studies (n = 148 patients) met our inclusion criteria and were included in the systematic review. These included no randomized controlled trials and four non-randomized case series. Patients with no preoperative DR (n = 80), following bariatric surgery, an average of 92.5 ± 7.4 % remained disease free, while 7.5± 7.4 % of patients progressed to DR. Patients with diabetic retinopathy preoperatively (n = 68), following bariatric surgery, an average of 57.4 ± 18.5 % of patients had no change, 23.5 ± 18.7 % of patients had progression, and 19.2 ± 12.9 % of patients had improvement in their disease. Progression of diabetic retinopathy is a significant issue postoperatively following bariatric surgery. Patients with a diagnosis of DR prior to surgery are at increased risk of further progression in their disease and should receive adequate counseling and evaluation prior to undergoing a surgical procedure. However, the few primary studies in this systematic review limit any conclusion. Further studies are needed to further evaluate these results.

Retinopathy of prematurity (ROP), a leading cause of pediatric blindness, predominantly affects premature and low-birth-weight infants. Although many cases are self-limiting, a minority progress to retinal detachment despite treatment. Exudative retinal detachments, although uncommon, have been reported after conventional laser therapy.(1-3) We report 2 cases of exudative retinal detachment after laser therapy for prethreshold and threshold ROP that responded favourably to a series of intravitreal bevacizumab injections.

Objective: Age-related macular degeneration is a multifactorial disease involving inflammation, neovascularization, and vascular leakage. As a result, a rationale exists for investigating combination treatments that target the different pathological processes involved in this disease. We propose triple therapy consisting of verteporfin photodynamic therapy (PDT), intravitreal bevacizumab, and intravitreal dexamethasone. Design: Retrospective chart review. Participants: Thirty-two eyes of 30 patients were included. None of the patients demonstrated concurrent eye pathology, and none ofthe patients had received previous treatment for their choroidal neovascularization. Methods: One cycle of triple therapy consisted of reduced-fluence PDT (300 mW/cm2 for 83 seconds to deliver 25 J/cm2) followed immediately by an 800 mg (0.08 mL) intravitreal dexamethasone (IVD) injection. At 1 and 7 weeks after PDT and IVD, patients received a 1.25 mg (0.05 mL) bevacizumab injection. At 13 weeks after PDT and IVD, each patient had a repeat optical coherence tomography and fluorescein angiography to assess choroidal neovas-cularization activity. Patients were followed for 12 months. Results: The mean number of treatment cycles was 1.4. The mean number of bevacizumab injections was 2.8. Visual acuity improved from 0.74 (SD 0.33) logMAR (20/100) to 0.53 (SD 0.32) logMAR (20/70) ( p > 0.005). Foveal thickness decreased from 328 (SD 116) mm to 216 (SD 85) μm ( p > 0.001). Ninety-four percent of patients lost fewer than 3 lines, 31% gained more than 3 lines, and 6% lost more than 3 lines. Conclusions: By combining agents with complementary mechanisms of action, triple therapy could maintain visual acuity and macular anatomy while allowing a reduction in the number of anti-vascular endothelial growth factor injections required.

The purpose of this study was to investigate any correlations that may exist between retinal nerve fibre layer (RNFL) thickness and high myopia by optical coherence tomography (OCT).Case-control study.Ten patients (20 eyes) with high myopia and 10 control patients (20 eyes) matched for age and sex were recruited from a database search of 1 vitreoretinal practice in Regina, Sask.The RNFL thickness of 10 highly myopic patients and 10 control patients matched for age and sex from a clinical practice was determined using the Stratus OCT. All 10 highly myopic patients selected for the study had a spherical equivalent ofor = -10.0 D OU and an intraocular pressure21 mm Hg OU, and failed to display glaucomatous changes such as disc hemorrhages and glaucomatous cupping in either eye. None of the patients included in the study had evidence of concomitant ophthalmic disease and none had had previous refractive surgery. Axial length measurements were done on all patients using the IOL Master.The mean (SD) RNFL thicknesses in the control and myopic groups were 108.8 (10.6) microm and 80.0 (18.6) microm, respectively, with t = 6.0 and p0.001. A negative correlation -0.712 with p0.001 was found between RNFL thickness and axial length.When interpreting the RNFL thickness of highly myopic patients by OCT, careful attention must be given to the inherently thinner RNFL to avoid a false glaucoma diagnosis.

Objective: To describe 3 cases of oculoleptomeningeal amyloidosis (OLMA). Design: Descriptive case series. Participants: Three siblings who presented with floaters and decreased visual acuity. Methods: A complete ophthalmologic examination, magnetic resonance imaging, cytological, and genetic studies were carried out in clinical practice. Each sibling was treated by means of pars plana vitrectomy. Vitreous samples stained with Congo Red revealed apple-green birefringence when viewed under polarized light. Results: In each case, visual acuity improved greatly after pars plana vitrectomy. A Tyr69His mutation in the transthyretin (TTR) gene was genetically confirmed in 2 of the siblings. Conclusion: This report adds to the literature regarding OLMA and its association with a Tyr69His mutation in the TTR gene. Despite no proven therapy at this time, symptomatic treatment with pars plana vitrectomy appears to be beneficial.