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Purpose: To describe the ophthalmic outcomes and complications after silicone oil (SO) removal. Methods: This nonrandomized retrospective review comprised patients who had SO removal from January 2020 to December 2022. Data collected included patient demographics, visual acuity (VA), intraocular pressure (IOP), initial tamponade, indication for SO placement, duration of SO in the eye, indication for SO removal, cataract progression, rates of retinal redetachment, cornea-related complications, additional surgical interventions, and other complications. Results: The study comprised 107 eyes (mean age, 56.6 years; 67% male). The most common indications for SO tamponade were rhegmatogenous retinal detachment (RRD), RRD with proliferative vitreoretinopathy (PVR), and tractional RD. The mean SO tamponade duration was 9.3 months and was longer for patients who did not have redetachment than for those who had detachment (10 months vs 6.8 months; P  = .024). The mean preoperative logMAR VA had significantly improved by the final follow-up (1.44 vs 1.19; P  < .001). The mean IOP was 16.43 mm Hg preoperatively and 16.81 mm Hg at the final visit ( P  = .672). Retinal redetachment occurred in 20.6% of patients, and the anatomic success rate at the final follow-up was 86.0%. A history of recurrent detachment and PVR was not associated with increased rates of postoperative redetachment. The overall rate of hypotony was 3.7% and of ocular hypertension, 7.5%. Significant cataract progression occurred in 69% of eyes. Conclusions: After SO removal, there was an overall improvement in VA and a stable IOP. Cataract progression was the most common complication. Although there is a risk for redetachment after SO removal, it may not have a detrimental effect on redetachment rates with a longer duration of SO tamponade., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article., (© The Author(s) 2024.)

Background and Objective: To report the long-term anatomic and visual outcomes of patients with Stickler syndrome undergoing retinal detachment (RD) surgery., Patients and Methods: Retrospective, interventional, consecutive case series of patients with Stickler syndrome undergoing RD repair from 1999 to 2017 at the Long Island Vitreoretinal Consultants, New York. Retinal attachment status and visual acuity (VA) at 1-year and last follow-up were assessed., Results: Successful reattachment was achieved in 28 of 29 eyes (97%) with an average of 2.3 surgeries (including silicone oil removal surgeries). Redetachment after the first surgery occurred in 13 eyes (45%). Mean Snellen VA at initial presentation, 1-year follow-up, and last follow-up were 20/289, 20/118 (P = .012), and 20/103 (P = .022), respectively., Conclusions: Anatomic success can be achieved in most eyes. However, redetachments are common, and multiple surgeries are often required. Reasonable visual recovery is possible in many eyes. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:612-616.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To describe the clinical features of and identify the mutation responsible for an autosomal dominant pattern dystrophy occurring in a three-generation family., Methods: Five affected family members underwent clinical examination and additional testing including intravenous fluorescein angiography where indicated. Mutation screening of the peripherin/RDS gene was performed., Results: Visual acuity ranged from 20/20 to counting fingers. All patients who reported vision loss noted the onset after the age of 40 years. Predominantly perifoveal, discrete, retinal pigment epithelial changes were present in all patients. Two patients had extensive peripheral yellowish flecks, and one had an atrophic macular scar. Mutation screening of the complete peripherin/RDS coding sequence and exon/intron boundaries revealed a novel splice site mutation., Conclusion: A three-generation family with an autosomal dominant pattern dystrophy arising from a previously unreported splice site mutation in the RDS gene is described.

Purpose: To study the characteristics and management of macular holes that develop after prior rhegmatogenous retinal detachment (RD) repair., Design: Retrospective, interventional, consecutive case series., Methods: The setting was a clinical practice. The case records of all of our patients (n = 12) who developed a new full-thickness macular hole after prior RD repair over an 8-year period were examined. Patients who developed a macular hole after prior RD repair were offered either surgical repair of the macular hole or continued observation. For eyes that underwent macular hole repair, main outcome measures included macular attachment status and postoperative visual acuity., Results: Twelve full-thickness macular holes were detected in a series of 2,380 eyes (0.5% prevalence), which had undergone surgery for prior primary RD. Ten macular holes developed after scleral buckling surgery, two after pneumatic retinopexy, and none were seen after primary vitrectomy. The fovea had been detached in 11 of the 12 eyes at the time of RD. The median time to macular hole diagnosis after RD repair was 3.4 months (range, 0.3-161 months). Eight of the eight eyes (100%) undergoing surgical repair achieved macular reattachment with a median of 3.5 lines of visual improvement at a median of 14.8 months of follow-up. Seven of these eight eyes had an improvement in visual acuity of at least 3 Snellen lines, and four of the eight had at least 20/40 visual acuity postoperatively. Four eyes with macular holes were observed., Conclusions: Macular holes developed in less than 1% of eyes that had previously undergone repair of rhegmatogenous RD. In our series, these atypical holes were seen predominantly after macula-off detachments, most commonly occurring after scleral buckling procedures. They were effectively repaired using conventional pars plana vitrectomy with long-acting gas tamponade and a variety of adjuvant therapies. A good visual outcome is possible with this approach.

Background: In patients with concurrent central retinal artery occlusion (CRAO) and giant cell arteritis (GCA), prompt recognition and early treatment are crucial to prevent further visual loss in the contralateral eye. The objective of this study was to describe a series of patients with CRAO resulting from GCA and to compare them with patients with isolated CRAO., Methods: The patient database for a retina service in Philadelphia was searched to identify patients admitted between 1983 and 1993 with a diagnosis of biopsyproven GCA and CRAO. For every patient with CRAO caused by GCA, the next patient admitted for management of acute isolated CRAO was identified; these latter patients constituted the control group. The visual acuity and baseline characteristics of the two groups were compared., Results: Eleven patients with acute CRAO and GCA were admitted during the study period. In both the case and control groups seven patients (64%) were women and nine patients (82%) were white. Six subjects (54%) in the case group and seven (64%) in the control group had a history of hypertension; the values for diabetes mellitus were two (18%) and zero respectively. Four patients (36%) with CRAO and GCA were cigarette smokers, compared with eight patients (73%) with CRAO alone. None of these differences were statistically significant. Patients with CRAO related to GCA were more likely than those with isolated CRAO to have counting fingers or better vision at presentation (odds ratio 2.22 [95% confidence interval 0.37 to 13.2]), but this trend was not statistically significant., Interpretation: Patients who presented with CRAO related to GCA were more than twice as likely as those with CRAO alone to have counting fingers or better visual acuity at the time of presentation. However, owing to the small sample, the power of this study to detect a true difference between the two groups was limited.

Background and Objective: To discuss the options for management and review the authors' experience with dislocated posterior chamber intraocular lens implants., Patients and Methods: A retrospective review was performed over a 3-year period of 12 consecutive patients with posterior chamber intraocular lens (PC IOL) implants dislocated into the vitreous cavity. The patients were managed with pars plana vitrectomy, repositioning or exchange, and transscleral suture fixation of the PC IOL., Results: The visual acuity was 20/50 or better in 9 patients and the transscleral suture fixated PC IOL was in good position in 12 patients at the most recent follow-up. Perioperative complications included corneal edema, cystoid macular edema, retinal breaks and detachments, and suture erosion., Conclusion: Visual and anatomic outcomes were favorable.

To assess for the possible development of a phototoxic lesion, we exposed five Dutch belted rabbit retinas to constant illumination with an implantable "chandelier" light source at maximal intensity for 1 hour. No clinically apparent lesion developed in any of the experimentally treated eyes by 48 to 72 hours posttreatment. Light and electron microscopic examination failed to reveal any of the characteristic changes of retinal phototoxicity. A control eye treated with a 20-minute exposure to a standard endoiluminator probe at maximal intensity held 2 mm from the retinal surface demonstrated typical light and electron microscopic phototoxic abnormalities, whereas a retina similarly treated with a 5-minute exposure was normal. We have confirmed that a standard endoilluminator probe can create a phototoxic lesion in the experimental setting. Furthermore, no phototoxicity from the sustained retinal exposure to a fixed, implantable light source for a clinically relevant duration could be demonstrated.

The short- and long-term effects of a 10-mg dose of intravitreal gentamicin were studied in the subhuman primate eye with regard to the changes in clinical appearance, fluorescein angiography, electroretinography, histopathologic finding, and electron microscopy. The gentamicin produced retinal whitening with a cherry-red spot, generalized vascular incompetence, diffuse retinal necrosis, thrombosis of the large retinal blood vessels, widespread loss of the retinal capillary pericytes and endothelial cells, and a rapid extinction of the electroretinogram.

Retinitis pigmentosa is a subset of inherited diseases associated with progressive degeneration of the retina otherwise classified as retinal dystrophies. Clinically, patients have nyctalopia (night blindness), progressive visual field loss, and eventually loss of central vision. Patients with retinitis pigmentosa should be evaluated for other ocular conditions that may simulate the condition, as well as for systemic disorders.

Intraocular invasion by neoplastic plasma cells is a rare ophthalmic manifestation of plasma cell dyscrasias. A 67-year-old man who had documented multiple myeloma presented with an infiltration of the iris that simulated a nongranulomatous uveitis. Cytologic examination of the aspirate obtained by anterior chamber paracentesis demonstrated that the infiltrate was composed of neoplastic plasma cells.

One hundred fifty-seven patients with subretinal neovascularization (SRN) were treated in a prospective, nonrandomized, consecutive study with the krypton red laser (KRL). The patients were analyzed with respect to age, etiology of the SRN, location of the SRN, and pre- and post-treatment visual acuity in patients with at least three months follow-up. Previous studies have not investigated KRL photocoagulation within the foveal avascular zone (FAZ). The results of this study compare favorably with other large series in which patients with SRN located outside the FAZ were treated with the argon blue-green laser (ABGL).

A 52-year-old woman was found to have a small juxtapapillary pigmented lesion in the choroid of the left eye. This lesion remained clinically stationary for one year, but subsequent growth prompted enucleation of the eye. The tumour was diagnosed histologically as a choroidal malignant melanoma of mixed cell type. Approximately 52 months later the patient developed proptosis of the contralateral (right) eye. Orbital ultrasonography showed a large mass in the right orbit, which was confirmed by needle biopsy to be a melanoma. In addition the patient was found to have metastatic melanoma to the choroid, right lower eyelid area, and liver. The development of simultaneous orbital, choroidal, and eyelid metastases from a contralateral choroidal melanoma is of ophthalmic interest and appears to be unique.

The clinical, fluorescein angiographic, and histopathologic features of a prepapillary vascular loop are described in a patient whose eye was obtained postmortem. The prepapillary vascular loop communicated with the retinal arterial system and did not have an internal elastic lamina. It was supported by a connective tissue sheath that was lined by a cellular lamina. The cellular lamina was continuous with the inner retina, isolating the vascular loop from the vitreous. The histologic findings were correlated with the clinical examination and fluorescein angiography.

To assess the efficacy of flurbiprofen sodium 0.03% at maintaining pupillary dilation during vitreoretinal surgery, we performed a randomized, double-masked, controlled trial of 139 consecutive patients. The mean decrease in pupil size during surgery in patients who received flurbiprofen was 0.9 mm; for patients who did not receive the drug it was 0.8 mm. The type of surgery performed (vitrectomy or scleral buckle), gender, age, lens status, and a history of diabetes or previous intraocular surgery were assessed and the addition of flurbiprofen to routine preoperative dilation did not significantly affect the mean change in pupil size for any of these subgroups. Of the nine patients who developed at least 3 mm of miosis, five received flurbiprofen and four did not. Use of flurbiprofen did not appear to reduce intraoperative miosis during vitreoretinal surgery in a clinically meaningful manner.

We present a consecutive series of ten patients (12 eyes) with symptomatic intraocular metastases from primary cutaneous malignant melanoma, with emphasis on the variation in clinical features and extent of intraocular involvement. An investigation of each patient's history and the presence of other concurrent metastatic foci help to establish the diagnosis. Palliative radiation therapy may help to control the intraocular metastatic foci and limit the visual loss.

Little is known about the predictive value of ocular pneumoplethysmography in patients with ophthalmic disease. We evaluated eight patients with unilateral increased intraocular pressure due to neovascular glaucoma who did not have evidence of severe extracranial carotid stenosis by duplex scanning and continuous-wave Doppler ultrasound. The ophthalmic systolic pressure measured by ocular pneumoplethysmography was decreased in the affected eye of all eight patients, indicating that neovascular glaucoma may be a cause of abnormal ocular pneumoplethysmographic results. Patients with neovascular glaucoma tended to have larger interocular ophthalmic systolic pressure differences than other patients with false-positive ocular pneumoplethysmographic results by noninvasive criteria.