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Background: A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features., Purpose: Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented., Methods: Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface., Results: The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies., Conclusion: The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH., (© 2024. The Author(s).)

Diabetic vitreopapillary traction syndrome (VPT) is a variant of diabetic retinopathy (DR) that can lead to vision loss in advanced stages. This review reports on the biomechanics of the vitreous in the pathogenesis of proliferative DR, in particular diabetic VPT. The article analyzes and summarizes literature data, presents the views of different authors on this problem, and provides the results of Russian and foreign scientific research on this pathology. It is concluded that further research in this area can lead to a significant improvement in the results of therapy, timely diagnosis, and preservation of vision in patients with DR.

Primary vitreoretinal lymphoma (PVRL) is a rare form of primary central nervous system (CNS) lymphoma (PCNSL) arising in the intraocular compartment without brain involvement. Despite its apparent indolent clinical course, PVRL can cause permanent vision loss and CNS relapse, the major cause of death in patients with PVRL. The pathophysiology of PVRL is unknown. As in PCNSL, the transformation of the tumor cells likely originates outside the CNS, before the cells migrate to the eye and proliferate within an immune-permissive microenvironment. PVRL exhibits a biased immunoglobulin repertoire, suggesting underlying antigen selection. The diagnosis remains challenging, requiring close coordination between ophthalmologists and cytologists. Because of their rarity and fragility in the vitreous, lymphoma cells cannot always be identified. Interleukin levels, molecular biology, and imaging are used in combination with clinical ophthalmological examination to support the diagnosis of PVRL. Multi-institutional prospective studies are urgently needed to validate the equivocal conclusions regarding treatments drawn from heterogeneous retrospective or small cohort studies. Intravitreal injection of methotrexate or rituximab or local radiotherapy is effective at clearing tumor cells within the eyes but does not prevent CNS relapse. Systemic treatment based on high-dose methotrexate chemotherapy, with or without local treatment, might reduce this risk. At relapse, intensive consolidation chemotherapy followed by stem cell transplantation can be considered. Single-agent ibrutinib, lenalidomide, and temozolomide treatments are effective in patients with relapsed PVRL and should be tested as first-line treatments. Therapeutic response assessment based on clinical examination is improved by measuring cytokine levels but still needs to be refined., (© 2021 by The American Society of Hematology.)

Purpose: To compare sensitivity of the retina after complete internal limiting membrane (ILM) peeling versus foveal-sparing ILM peeling in vitrectomy for vitreomacular traction syndrome., Methods: This was a randomized, prospective, comparative study. Thirty-four eyes were randomized to undergo peeling with foveal sparing of the ILM (FS group) or complete peeling group. Foveal and perifoveal retinal sensitivity, visual acuity, and central macular thickness were the main outcome measures., Results: Parafoveal retinal sensitivity exhibited a significant improvement in both the FS and complete peeling groups (+2.43 ± 0.82 dB and +1.79 ± 0.86 dB, respectively; P = 0.037). Significant improvements were observed in both visual acuity and central macular thickness in both groups. No cases of epiretinal membrane recurrence were observed in the FS group., Conclusion: Both the FS and complete peeling surgical techniques are safe and yielded good anatomical and functional results; however, a significant difference in favor of FS was found in relation to the best-corrected visual acuity and perifoveal retinal sensitivity. Preservation of the foveal ILM disc allowed the anatomical restoration of the foveal architecture in most vitreomacular traction syndrome cases without signs of stiffening or ILM fibrosis over a follow-up period of 1 year.

To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate., (© 2021. The Author(s).)

Purpose: To compare the flow dynamics of beveled-tip to that of flat-tip vitreous cutters., Method: The aspiration rates of balanced salt solution and swine vitreous were measured for 25-gauge and 27-gauge beveled-tip and flat-tip vitreous cutters. Fluorescent polymer microspheres were mixed with balanced salt solution to make the flow visible. The flow dynamics at maximal cutting rates and reflux of balanced salt solution were measured with video images of a high-speed camera., Results: The aspiration rates of balanced salt solution of the 25-gauge and 27-gauge beveled-tip cutters were significantly higher than that of the flat-tip cutters at 7,500 cut/min (P = 0.0001, P = 0.038, respectively). The aspiration rate of swine vitreous by the 25-gauge beveled-tip cutter was significantly higher than that of the flat-tip cutters (P = 0.006). The mean aspiration flow in front of the cutter was significantly faster for both beveled-tip than flat-tip cutters (P = 0.003, P = 0.023). The angle of the mean aspiration flow of both beveled-tip cutters was turned to the proximal side (P = 0.004, P = 0.003). The mean reflux flow of both beveled-tip cutters was significantly faster than that of the flat-tip cutters (P = 0.006, P = 0.006)., Conclusion: The beveled-tip cutters have a greater velocity of aspirating frontal and proximal flow resulting in higher aspiration rates and greater reflux flow velocity.

Purpose: The aim of this study was to evaluate the effect of vitreous reflux (VR) on the short-term effect of intravitreal ranibizumab injection., Materials and Methods: The study included 181 eyes of 81 age-related macular degeneration (AMD) and 100 diabetic macular edema (DME) patients. Treatment response was evaluated by measuring central macular thickness (CMT) as well as 1 mm and 3 mm central macular thicknesses (MT1 and MT3). Patients were grouped as; Group 1: no VR, Group 2: <3 mm VR, and Group 3: >3 mm VR according to conjunctival bleb diameters. The data were analyzed using variance, correlation and regression analyses., Results: In AMD patients, reduction of CMT values following the treatment were 88.3 ± 110.6 µm in Group 1, 85.6 ± 158.7 µm in Group 2, and 93.1 ± 92.2 µm in Group 3. Likewise, in DME patients, it was 82.4 ± 88.4 µm, 72.9 ± 109.9 µm, and 73.7 ± 113.7 µm, respectively. Reduction of MT1 values after the treatment were 47.4 ± 72.6 µm, 36.0 ± 131.9 µm, and 36.7 ± 114.4 µm in AMD patients, and 33.3 ± 72.5 µm, 36.6 ± 90.2 µm, and 46.9 ± 83.4 µm in DME patients. In all comparisons among groups of VR, macular thickness (MT) change did not exhibit significant difference following an intravitreal ranibizumab treatment ( p > .05)., Conclusion: We found that the increase in VR amount did not adversely affect the decrease in MT after intravitreal ranibizumab treatment in AMD and DME patients.

We propose a mechanical model of generation of vitreoretinal tractions in the presence of posterior vitreous detachment (PVD). PVD is a common occurrence with aging, and it consists in the separation of the vitreous body from the retina at the back pole of the eye, due to progressive shrinking of the vitreous gel. During this separation process, vitreoretinal tractions are generated at regions of high adhesion between the vitreous and the retina. Such tractions are mainly responsible for the creation of retinal tears, which can lead to retinal detachment. We describe the PVD evolution developing a continuum model of a shrinking soft body, representing the vitreous humor gel phase. In the model, the vitreous is surrounded by a membrane, stiffer than the bulk, the vitreous cortex, and it is contained within a rigid spherical domain, the vitreous chamber. The membrane is attached to the spherical wall and the adhesion strength is spatially non-uniform, increasing from the back to the front of the chamber, according to clinical observations. During the shrinking process, the vitreous undergoes elastic distortions, owing to the spatially variable adhesion on the wall, and this produces boundary tractions. We also consider the clinically relevant case of anomalous PVD, in which regions of focal adhesion between the vitreous and the retina exist, leading to the generation of strong, localized tractions. The model reproduces a PVD evolution in good qualitative agreement with clinical observations and makes it possible to correlate the shape of the detached vitreous with the intensity of vitreoretinal tractions.

In this cross-sectional study including 1150 eyes of 681 volunteers ≧ 65 years old without retinal pathology, factors affecting the progression of posterior vitreous detachment (PVD) were investigated. PVD stages were diagnosed based on swept-source optical coherence tomography (SS-OCT). Linear mixed effect model was used to determine whether age, gender, diabetes mellitus (DM), hypertension (HT), dyslipidemia (DL), and smoking status were associated with various stages of PVD. As a result, the multivariable analysis disclosed that the associations between older age and higher PVD stages (estimate [95% CI], 0.031 [0.020 to 0.042]; P < 0.0001), and current smokers and lower PVD stages (estimate [95% CI], - 0.24 [- 0.43 to - 0.056]; P = 0.011) were statistically significant. In contrast, female gender was not an independent factor affecting PVD stages in the elderly. Our analysis indicated that higher PVD stages observed in female eyes may be due to confounding effect, in which current smokers were predominantly males (i.e., 12.6% among males vs. 3.9% among females, P < 0.0001). In conclusion, our findings suggest that continuous smoking is associated with an adherent vitreoretinal interface in the elderly.

Discovering a relationship between axial length and vitreous volume would be helpful since the axial length is easier to measure than magnetic resonance imaging (MRI) parameters. This study aimed to analyze the topography of human eyes with pathological myopia through volume rendering images by high-resolution 3D-MRI and to establish a model to estimate the vitreous volume.This was a retrospective, non-randomized, controlled study of patients evaluated at Tongren Hospital from July 7, 2007 to December 12, 2018. The controls were emmetropic volunteers. All participants underwent ophthalmic examinations. Axial length was measured with an IOL Master. High-resolution 3D MRI and volume rendering was utilized for all the eyes. Logistic regression was used to establish a model to predict the vitreous volume.A total of 280 emmetropic eyes and 290 eyes with pathological myopia were included. Males represented 60.7% and 65.5% of the individuals. The mean axial lengths of those two groups were 23.1 ± 0.8 mm (95%CI: 22.7-23.4 mm) and 28.3 ± 2.2 mm (95%CI: 27.5-29.2 mm), respectively (P < .001). The regression model in the pathological myopic group for calculating the vitreous volume according to the axial length was: Vitreous volume = 546.27 × axial length - 6977.12. The regression model in the emmetropic group for calculating the vitreous volume according to the axial length was: Vitreous volume = 458.35 × axial length - 6331.14 (R = 0.360, P = .001).Elongation of the axial length is involved in eyeball enlargement in pathological myopic eyes. Measurement of the axial length could be recommended for the estimation of the vitreous volume during vitrectomy if vitreous cavity filling is needed.

The authors present a case of poorly controlled glaucoma following lensectomy. An examination under anesthesia revealed iris bombe of the anterior vitreous face. This case helps emphasize the importance of a generous anterior vitrectomy at the time of lensectomy in the pediatric population to avoid secondary glaucoma. [J Pediatr Ophthalmol Strabismus. 2020;57:e48-e50.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To evaluate the anatomical and functional outcomes with ocriplasmin in patients with vitreomacular traction (VMT) with or without macular hole (MH)., Methods: In a Phase 4, multicenter, single-arm, open-label study, eligible patients (VMT with focal adhesion, without epiretinal membrane, and with MH ≤400 µm [if present]) received a single intravitreal injection of ocriplasmin. Nonsurgical resolution of VMT (Day 28 [primary endpoint]), best-corrected visual acuity, MH closure, vitrectomy rate, and safety were assessed through Day 180., Results: Overall, 466 patients were included in the full analysis set, of whom 47.4% had VMT resolution by Day 28; resolution rates in patients with VMT without MH, VMT with MH ≤250 µm, and VMT with MH >250 to ≤400 µm were 43.4%, 68.6%, and 62.7%, respectively. Macular hole closure was higher in eyes with VMT and MH ≤250 µm (57.1%) than in eyes with VMT and MH >250 to ≤400 µm (27.5%) at Day 28. Overall, 30.8% of patients with VMT resolution gained ≥10 letters in best-corrected visual acuity at Day 180. Adverse events were consistent with the known safety profile of ocriplasmin., Conclusion: Ocriplasmin is effective for resolution of VMT without or with MH (≤400 μm); treatment outcomes can be optimized with patient selection.

Purpose: Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment is performed on vitreous floaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with vitreous floaters who previously underwent laser treatment with untreated control participants and healthy persons without vitreous floaters using quantitative ultrasonography to evaluate vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision., Design: Retrospective, comparative study., Participants: One eye was enrolled for each of 132 participants: 35 control participants without vitreous floaters, 59 participants with untreated vitreous floaters, and 38 participants with vitreous floaters previously Nd:YAG-treated. Of these, 25 were dissatisfied and sought vitrectomy; 13 were satisfied with observation., Methods: The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision., Main Outcome Measures: Results of NEI-VFQ-39, QUS, BCVA, and CSF., Results: Compared with control participants without vitreous floaters, participants with untreated vitreous floaters showed worse NEI-VFQ-39 results, 57% greater vitreous echodensity, and significant (130%) CSF degradation (P < 0.001 for each). Compared with untreated eyes with vitreous floaters, Nd:YAG-treated eyes had 23% less vitreous echodensity (P < 0.001), but no differences in NEI-VFQ-39 (P = 0.51), BCVA (P = 0.42), and CSF (P = 0.17) results. Of 38 participants with vitreous floaters who previously were treated with Nd:YAG, 25 were dissatisfied and seeking vitrectomy, whereas 13 were satisfied with observation. Participants seeking vitrectomy showed 24% greater vitreous echodensity (P = 0.018) and 52% worse CSF (P = 0.006). Multivariate linear regression models confirmed these findings., Conclusions: As a group, participants previously treated with Nd:YAG laser for bothersome vitreous floaters showed less dense vitreous, but similar visual function as untreated control participants with vitreous floaters. Because some treated eyes showed less dense vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose : To investigate the visual outcomes and occurrences of perioperative complications after three-dimensional (3D) heads-up vitrectomy compared with traditional microscopic (TM) surgery for vitreoretinal diseases. Methods : A retrospective case series comparison of 3D and TM vitrectomy performed on 124 and 202 eyes with a minimum follow-up of 6 months, respectively, by the same surgeon. Changes in visual acuity, primary anatomical success, operation time, and perioperative complications were evaluated. Results : There were no significant differences in age, gender, axial length, ocular and surgical history, surgical indication, and visual acuity between the two groups at baseline. Both groups showed a significant improvement in visual acuity at the final visit (both P < .05) and experienced comparable anatomical recoveries regarding epiretinal membranes, vitreous hemorrhage, macular holes, retinal detachment, and pathological myopic foveoschisis. The mean overall operation time was not significantly longer in the 3D group (31.0 ± 17.6 min) than the TM (31.0 ± 15.9 min) group ( P = .994). The incidence rates of postoperative complications during the follow-up were similar between the 3D (30.6%) and TM groups (30.2%) ( P = .932). Conclusions : The 3D and TM vitrectomy surgeries yielded comparable visual and anatomical outcomes for treatment of vitreoretinal diseases without a significant difference in the rate of complications. The 3D heads-up vitrectomy may be considered the treatment of choice for patients with various vitreoretinal diseases.

Aim: The aim of the study was to investigate the serum and vitreous levels of resistin in patients with the proliferative diabetic retinopathy (PDR) and to compare those with age-matched control subjects., Methods: The study included 45 eyes with PDR (group 1) and a control group of 22 (group 2). All eyes underwent vitrectomy surgery. The lipid profile, fasting blood glucose (FBG), HbA1c and resistin levels were investigated in blood samples of all subjects. Complete ophthalmological examinations were evaluated. Vitreous samples were collected from both groups during vitrectomy surgery and resistin levels were investigated in those samples. The results were evaluated using SPSS 9.0 software., Results: The demographic characteristics of the diabetic group and the control group were similar (p > 0.05). There was no significant difference between the groups in respect of mean visual acuity (VA), body mass index (BMI) values, or lipid profiles (p ˃ 0.05). There was no measurable value of resistin in the vitreous samples of all the eyes. The mean blood resistin level was 367 ng/ml in the control group and 387 ng/ml in the study group and the difference was not statistically significant (p > 0.05)., Conclusions: In the light of the findings of this study, it can be assumed that resistin did not pass through the vitreous at measurable levels. However, the serum resistin levels of the diabetic patients were higher than those of the control group although not statistically significant. Therefore, it can be considered that resistin does not play a major role in retinal neovascularization., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: OCT has revealed many details of retinal disease that were not available with older imaging technologies. In eyes of adults older than 60 years with healthy maculas as determined by color fundus photography (CFP) and a validated grading system, we screened for pathologic features using OCT. We also tested visual function to assess potential impact of the observed pathologic features on patients., Design: Cross-sectional study., Participants: Persons recruited from primary ophthalmology care clinics., Methods: Color fundus photographs were assessed by the 9-step Age-Related Eye Disease Study scale. OCT macular volumes of participants at step 1 on the Age-Related Eye Disease Study scale, considered healthy, were reviewed by a retina specialist masked to other participant characteristics. Participants were tested for 6 different cone- and rod-mediated visual functions., Main Outcome Measures: Percentage of participants with disorders detected on OCT review and visual function measures., Results: In 138 of 984 eyes (14%) considered healthy by CFP, pathologic features were detectable by OCT, with 8.4% having vitreomacular interface disorders. Among the low-prevalence disorders found, 5 eyes (0.5%) showed macular telangiectasia type 2. Relative to eyes lacking detectable chorioretinal pathologic features, eyes with any pathologic features were associated with poorer low-luminance visual acuity and rod-mediated dark adaptation. In eyes with epiretinal membranes, the largest single entity identified (n = 61 [6.2%]), significantly worse visual functions were best-corrected visual acuity (P = 0.0444), low-luminance visual acuity (P = 0.0151), and light sensitivity (central 3° and 9°; P = 0.0035 and P = 0.0097, respectively)., Conclusions: Macular pathologic features with functional visual implications not identified by clinical examination or CFP are detectable with OCT. Vitreomacular interface disorders often are visually significant and treatable conditions that are visible on OCT, but are easily missed on CFP and clinical examination. Another such condition best seen on OCT is macular telangiectasia type 2, an untreatable disorder for which a clinical trial is in progress. OCT has a potential role in primary eye care clinics to screen for retinal pathologic features, especially in eyes with decreased visual acuity and otherwise normal examination results., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Positive vitreous pressure can complicate cataract surgery during a triple procedure by inadvertently extending the capsulorhexis. This occurs because the procedure is open sky and positive vitreous pressure cannot be countered by injecting ophthalmic viscosurgical devices. We describe a new use of a pupillary expansion ring (Malyugin) to achieve a stable open anterior chamber under open sky during triple procedures. The scrolls are tucked under cut margins of the host cornea to create the capsulorhexis, the cataractous nucleus is removed, and an intraocular lens (IOL) is implanted in the bag. This technique is especially useful in cases of hypermature cataract and nondilating pupils with positive vitreous pressure in patients having triple procedures. The technique provides a stable open anterior chamber, increasing to the safety of the procedure and the chance of achieving a continuous curvilinear capsulorhexis and IOL implantation in the capsular bag., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

A 41-year-old patient presented with blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/150, improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye and the vision improved to 20/40. Postoperatively, the patient experienced significant floaters which persisted to the extent of necessitating explantation of implant., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the leading causes of blindness in working-age adults. No current animal models of diabetes and oxygen-induced retinopathy develop the full-range progressive changes manifested in human proliferative diabetic retinopathy (PDR). Therefore, understanding of the disease pathogenesis and pathophysiology has relied largely on the use of histological sections and vitreous samples in approaches that only provide steady-state information on the involved pathogenic factors. Increasing evidence indicates that dynamic cell-cell and cell-extracellular matrix (ECM) interactions in the context of three-dimensional (3D) microenvironments are essential for the mechanistic and functional studies towards the development of new treatment strategies. Therefore, we hypothesized that the pathological fibrovascular tissue surgically excised from eyes with PDR could be utilized to reliably unravel the cellular and molecular mechanisms of this devastating disease and to test the potential for novel clinical interventions. Towards this end, we developed a novel method for 3D ex vivo culture of surgically-excised patient-derived fibrovascular tissue (FT), which will serve as a relevant model of human PDR pathophysiology. The FTs are dissected into explants and embedded in fibrin matrix for ex vivo culture and 3D characterization. Whole-mount immunofluorescence of the native FTs and end-point cultures allows thorough investigation of tissue composition and multicellular processes, highlighting the importance of 3D tissue-level characterization for uncovering relevant features of PDR pathophysiology. This model will allow the simultaneous assessment of molecular mechanisms, cellular/tissue processes and treatment responses in the complex context of dynamic biochemical and physical interactions within the PDR tissue architecture and microenvironment. Since this model recapitulates PDR pathophysiology, it will also be amenable for testing or developing new treatments.

Purpose: To evaluate the efficacy of dexamethasone intravitreal implants (DEX implant) in patients with treatment-resistant macular edema (ME) owing to branch and central retinal vein occlusion (BRVO/CRVO), and the influence of prior vitrectomy on this treatment. Methods: Multicenter retrospective chart review was performed on 40 CRVO and 32 BRVO eyes with persistent ME despite intravitreal anti-vascular endothelial growth factor agents and/or intravitreal triamcinolone, and/or laser therapy. Each patient received ≥1 dexamethasone 700 μg implant between March 2011 and December 2015. Thirteen patients underwent prior vitrectomy. Data were collected on best-corrected visual acuity (BCVA), central macular thickness (CMT), time to relapse, and adverse events. Results: At the end of follow-up, BRVO eyes had a lesser CMT reduction from baseline compared to CRVO eyes (-122.50 ± 152.47 μm and -202.26 ± 194.09 μm, respectively). Neither BRVO nor CRVO eyes had a sustained BCVA benefit ( P  = 0.7041 and P  = 0.7027, respectively). Vitrectomized and nonvitrectomized eyes overall had a sustained significant CMT reduction throughout the study with -192.46 ± 172.62 μm and -164.02 ± 180.36 μm, respectively, at final follow-up. Similar time to relapse of 24.4 ± 6.5 and 23.3 ± 13.5 weeks, respectively, was observed. By the end of follow-up, BCVA had only improved in vitrectomized eyes. However, multivariable regression analyses showed no significant association between vitrectomy status and CMT or BCVA change after the first and last injection. Cataract formation and ocular hypertension occurred in 25% and 17%, respectively. Conclusions: Multiple DEX implant are effective in reducing CMT in patients resistant to previous treatments and appear to be similarly effective in vitrectomized and nonvitrectomized eyes.

Objective: To examine the efficacy and safety of yttrium-aluminium garnet (YAG) laser vitreolysis for the treatment of vitreous floaters., Methods: Consecutive adult patients with symptomatic vitreous floaters who attended Chongqing General Hospital from April to December 2016 were included in this prospective study. Patients had >3 mm between the vitreous opacity and retina/lens and acceptable quality peri-papillary Optical Coherence Tomography (OCT) images (i.e., signal strength ≥5). Those with history of glaucoma, severe cataracts, vitreous haemorrhages, retinal holes and/or macular disease were excluded from the study. Best corrected visual acuity (BCVA) and non-contact intraocular pressure (IOP) were measured before and for up to 6 months post-YAG laser vitreolysis. Anterior segment photography and peripapillary retinal nerve fibre layer (RNFL) measured by OCT were taken before and 6 months post-procedure. Questionnaires on patient satisfaction were completed 6 months post-procedure., Results: No statistically significant differences in BCVA and IOP were observed before or after treatment. Anterior segment photography showed that vitreous opacities partially or completely disappeared after YAG laser treatment. The thickness of RNFL in four directions (upper, below, nasal and temporal) was not statistically significant different before or 6 months after the procedure. 75% patients reported significant improvement and 25% reported moderate improvement., Conclusion: The results of this study conducted in a cohort of 30 Chinese patients showed that YAG laser vitreolysis was a well-tolerated and effective treatment for vitreous floaters. Randomised, controlled trials involving large numbers of participants monitored over an extended follow up period are required to confirm these results.

Background and Objective: Thickness and volume changes of the photoreceptor outer segment (PROS) layer on spectral-domain optical coherence tomography (SD-OCT) images are associated with various disease states. However, there are limited data on normal anatomical variation. This study evaluates the correlation of PROS volume with age, gender, refractive error, and presence of vitreomacular adhesion (VMA) in healthy subjects., Patients and Methods: SD-OCT scans of 68 normal eyes were analyzed. The ellipsoid zone and the apical retinal pigment epithelium boundary were segmented using an automated algorithm. The PROS volume was calculated as the region bounded by these two layers within a 6-mm diameter circle centered at the fovea. A general linear model was used for statistical analysis., Results: PROS volume increased with age to a significant degree (P = .013). Gender, refractive error, and presence of VMA were insignificant factors., Conclusion: PROS volume, as measured on routine SD-OCT, increases with age in healthy subjects, after adjusting for gender, refractive error, and VMA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:523-527.]., (Copyright 2018, SLACK Incorporated.)

Purpose: Contrast sensitivity function (CSF) declines with age. When unassociated with cataracts, this is hypothesized to be due to macular ganglion cell complex (GCC) thinning. However, other studies found associations with increased vitreous echodensity and posterior vitreous detachment (PVD). We investigate the relationship between CSF, vitreous echodensity, PVD, and GCC thickness as related to age in the same subjects., Methods: Age, CSF (Weber index: %W), vitreous echodensity (quantitative ultrasonography [QUS]), lens status (phakia or pseudophakia), best-corrected visual acuity (BCVA), and GCC thickness (SD-OCT) were evaluated in 57 eyes of 57 subjects with (n = 32, mean age = 62 years) and without (n = 25, mean age = 44 years) PVD (P < 0.001). A multivariate linear regression analysis was performed to assess the effects of independent variables on CSF., Results: CSF was 51.2% worse in eyes with PVD (2.98 ± 0.31 %W) compared to no PVD (1.97 ± 0.24 %W; P < 0.001). QUS was 55.8% greater in eyes with PVD than those without (P < 0.001). Among all subjects, PVD status, vitreous echodensity, and age were the only independent variables demonstrating significant effects on CSF. Lens status, BCVA, and GCC thickness did not demonstrate association with CSF., Conclusions: PVD, vitreous echodensity, and age are determinants of CSF. PVD and increased vitreous echodensity are each associated with diminished CSF, independent of age. Thus, in the absence of GCC thinning and cataracts, vitreous changes may be a cause of decreased CSF with age.

Purpose: To investigate the functional and anatomical outcomes following surgical management of persistent fetal vasculature (PFV)., Methods: Single-center, retrospective, interventional consecutive case series of 41 patients (44 eyes) who underwent vitrectomy with or without lensectomy through a limbal or pars plana/plicata approach with diagnosis of anterior, posterior, or combined anterior and posterior segment PFV were included., Results: The median age at the time of surgery was 3 months (range, 1-36 months), and the mean follow-up period was 37.2 ± 38.1 months (range, 12-164 months). Of the 44 eyes, 5 (11%) had clinical and ultrasonographic findings of anterior PFV, 5 (11%) had posterior PFV, and 34 (78%) had components of both anterior and posterior disease. At the last visit, 38 eyes (87%) were aphakic, 5 eyes (11%) were phakic, and 1 eye (2%) was pseudophakic. The mean Snellen equivalent VA at the final visit for the 14 (32%) eyes with measurable VA was 20/283. Nine (20%) eyes had final VA of only light perception or no light perception. The remaining 21 (48%) eyes behaved consistently with form vision, but the patients were not able to report VA., Conclusions: Most of the eyes achieved at least form vision, with acceptable postoperative complication rates. Functional and anatomical outcomes are not strictly dependent on axial length, and microphthalmic eyes with mild posterior segment involvement have the potential for good visual results. Outcomes after surgery for posterior PFV associated with tractional retinal detachment are limited. Anatomical success does not always equate to functional improvement.

Purpose: Our purpose was to assess anatomical and functional outcomes of vitrectomy in pediatric cases of Terson syndrome., Methods: A total of 11 eyes of seven children diagnosed with Terson syndrome secondary to traumatic brain injury and 17 eyes of 12 children diagnosed with Terson syndrome secondary to nontraumatic brain hemorrhage who had 20-gauge or 23-gauge pars plana or pars plicata vitrectomy were included in this retrospective study. The primary outcome was the change in visual acuity from the preoperative examination to postoperative final follow-up. Secondary outcomes were anatomic surgical success and postoperative complications., Results: The mean time between diagnosis and surgery was 62 ± 35 days (range, 30-150), and the average age at the time of the surgery was 4.5 ± 6.4 years (range, 3 months to 17 years). The mean preoperative logarithm of the minimum angle of resolution (logMAR) (Snellen) best corrected visual acuity (BCVA) was 2.6 ± 0.7 (20/7260) (n = 9) and in the remaining 19 eyes it was recorded as noncentral, unsteady, nonmaintained fixation. The mean follow-up period was 50 ± 54 months (range, 12-192 months). At the last follow-up visit, the mean logMAR BCVA was 0.46 ± 0.6 (20/60) (n = 19) and in eight eyes it was recorded as fix-and-follow. One eye developed a retinal detachment 14 months after the first operation, and one eye developed an epiretinal membrane after 2 years. Anatomical success was recorded in all patients at the final visit., Conclusions: In children with massive vitreous hemorrhage secondary to Terson syndrome, vitrectomy is an effective procedure and offers a rapid visual improvement. Earlier surgical treatment prevents amblyopia and blood-related potential complications.

Unintentional laser exposure is an increasing concern in many operational environments. Determining whether a laser exposure event caused a retinal injury currently requires medical expertise and specialized equipment that are not always readily available. The purpose of this study is to test the feasibility of using dynamic light scattering (DLS) to non-invasively detect laser retinal injuries through interrogation of the vitreous humor (VH). Three grades of retinal laser lesions were studied: mild (minimally visible lesions), moderate (Grade II), and severe (Grade III). A pre-post-treatment design was used to collect DLS measurements in vivo at various time points, using a customized instrument. VH samples were analyzed by liquid chromatography/tandem mass spectrometry (LC-MS/MS) and relative protein abundances were determined by spectral counting. DLS signal analysis revealed significant changes in particle diameter and intensity in laser-treated groups as compared with control. Differences in protein profile in the VH of the laser-treated eyes were noted when compared with control. These results suggest that laser injury to the retina induces upregulation of proteins that diffuse into the VH from the damaged tissue, which can be detected non-invasively using DLS.

Purpose: To explore a possible association between full-field electroretinograms with vitreomacular adhesion resolution and best-corrected visual acuity as part of the prospective, randomized, double-masked, sham-controlled Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial studying ocriplasmin., Methods: The ERG substudy enrolled 62 of 220 OASIS subjects (randomized 2:1) and analyzed full-field electroretinograms and their association with both vitreomacular adhesion resolution and best-corrected visual acuity from baseline through Month 24. Electroretinogram reductions were defined as acute full-field electroretinogram reductions in amplitude of ≥40% from baseline occurring at postinjection Day 7 or Day 28., Results: In the ocriplasmin group, 16/40 (40%) subjects developed ERG reductions, compared to 1/21 (4.8%) in the sham group; 13/16 (81.3%) and 1/1 (100%) resolved by study end, respectively. A total of 11/16 (68.8%) ocriplasmin-treated subjects with ERG reductions achieved vitreomacular adhesion resolution, compared to those without (9/24, 37.5%). The ocriplasmin-treated subjects with ERG reductions also gained more letters on average (11.3 vs. 9.3 letters) from baseline and had a difference of 6.7 letters in mean best-corrected visual acuity by study end compared to those without ERG reductions., Conclusion: Ocriplasmin-treated subjects with ERG reductions had a higher rate of vitreomacular adhesion resolution and showed better visual improvement than their counterparts without ERG reductions or sham subjects by study end.

Purpose: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy., Materials and Methods: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records., Results: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented., Conclusions: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.

Purpose: To investigate the influence of the vitreoretinal interface on the outcomes of different ranibizumab regimens for exudative age-related macular degeneration., Methods: We conducted a retrospective subanalysis of 2 prospective clinical trials. Patients were treated with ranibizumab for 12 months according to 3 different regimens: pro-re-nata (PRN), treat and extend (T&E), and monthly. Vitreoretinal interface was assessed for absence (group ON) or presence (group OFF) of posterior vitreous detachment (PVD)., Results: We included 64 eyes from 64 patients. Visual improvement was poorer for group ON (0.3 ± 10.7 letters) than for group OFF (9.2 ± 13.3; p = 0.007). A significant difference in letters of improvement between groups was observed in the PRN cohort (ON: -5.0 ± 12.9; OFF: 11.4 ± 11.9; p = 0.003), but not in the cohorts with monthly (ON: 5.7 ± 7.8; OFF: 7.9 ± 15.2; p = 0.735) or T&E (ON: 4.3 ± 4.3; OFF: 7.8 ± 11.1; p = 0.424) treatment., Conclusion: The negative impact of absence of PVD is regimen dependent, with monthly dosing providing similar outcomes to PVD patients. In the absence of PVD (group ON), PRN should be avoided, and T&E might be an alternative., (© 2018 S. Karger AG, Basel.)

Okayama University-type retinal prosthesis (OUReP TM ) is a photoelectric dye-coupled polyethylene film which generates electric potential in response to light and stimulates nearby neurons. This study aims to test surgical feasibility of subretinal implantation and functional durability of dye-coupled films in the subretinal space. The dye-coupled films were implanted subretinally by 25-gauge vitrectomy in the right eye of 11 normal beagle dogs: 2 dogs served for film removal after 5-month film implantation, 3 dogs for film removal after 3-month film implantation, 3 dogs for 3-month film implantation and pathological examination, and 3 dogs for sham surgery. The surface electric potential of the removed dye-coupled films in response to light was measured by the Kelvin Probe system. At surgery, rolled-up dye-coupled films in 5 × 5 mm square size could be inserted into subretinal space of retinal detachment induced by fluid injection with a 38-gauge polyimide tip. Retinal attachment was maintained by silicone oil injection in vitreous cavity. At autopsy, the retina in all dogs maintained the ganglion cell layer, inner and outer nuclear layers while it lost the outer segments in some part. All 5 sheets of removed dye-coupled films maintained the dye color. One sheet of the 5-month implanted film showed proportional increase of surface potential in response to increasing light intensity. Subretinal implantation of OUReP TM by vitrectomy was technically feasible in canine eyes, and OUReP TM maintained the function of generating light-evoked surface potential after 5 months in subretinal implantation.

Purpose: To assess the effect of ocriplasmin on visual function response (VFR) measured using visual acuity (VA) and vision-related quality of life, and to quantify the association between release of vitreomacular adhesion (VMA) at day 28 and VFR., Methods: Prespecified analysis of secondary endpoints from a randomized controlled trial. Of 220 participants with symptomatic VMA/vitreomacular traction (VMT), including VMT associated with a macular hole up to 400 μm, 146 received a single intravitreal injection of 125 μg ocriplasmin and 74 a sham injection. Based on principal components analysis results, a VFR was defined as either a VA improvement of ≥2 lines or an improvement exceeding the minimal clinically important difference (MCID) in the composite or the mental health subscale scores of the Visual Function Questionnaire (VFQ-25). The MCID was estimated using the standard error of measurement approach. The main outcome measure was the VFR at month 6, with further assessments at months 12 and 24., Results: The MCID was estimated at 3.71 points for the VFQ-25 composite score and 10.71 for the VFQ-25 mental health subscale score. A VFR occurred in 51.0% of ocriplasmin versus 23.3% of sham participants (P = 0.0001). The VFR was maintained through months 12 and 24: 53.1% and 50.3% in ocriplasmin versus 21.9% and 20.5% in sham participants, respectively (P < 0.0001). Resolution of VMA at day 28 significantly increased the odds of a VFR at each assessment period., Conclusions: Treatment with ocriplasmin compared with sham resulted in a significant improvement in VFR. The 6-month treatment effect was sustained at months 12 and 24.

Background: The purpose of this study was to use a physiological pressure transducer to measure real-time, continuous pressure changes in an ex vivo study model of porcine eyes to record the amount of force needed for scleral penetration and to measure acute intraocular pressure rise during intravitreal injections., Methods: A pressure transducer was inserted into the anterior chamber of 30 fresh porcine eyes, and intraocular pressure was measured 2 s prior to intravitreal injection until 2 s after. A force transducer plate was used to insert various gauge needles into the vitreous cavity and the amount of force in Newtons (N) required for scleral penetration was recorded., Results: For scleral perforation, 32- and 30-gauge needles required 0.44 N and 0.45 N, significantly less than larger gauge needles (P < 0.05). Similarly, 27- and 25-gauge needles required more force than smaller gauge needles but less than 19 gauge (P < 0.05). Intraocular pressure increased an average of 64.5 mmHg during intravitreal injection. Two seconds postinjection intraocular pressure readings showed a residual intraocular pressure increase of 11.1 mmHg from pre-injection baseline., Conclusion: Real-time continuous recordings of pressure reveal that an instantaneous intraocular pressure spike occurs during intravitreal injection and appears to be separate from the intraocular pressure spike that occurs during needle insertion. This pressure spike is transient and has not been captured by previous methods of intraocular pressure measurement, which rely on single time point measurements. The clinical significance of this brief intraocular pressure spike is unclear and warrants further investigation., (© 2017 Royal Australian and New Zealand College of Ophthalmologists.)

Importance: Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters., Objective: To evaluate YAG laser vitreolysis vs sham vitreolysis for symptomatic Weiss ring floaters from posterior vitreous detachment., Design, Setting, and Participants: This single-center, masked, sham-controlled randomized clinical trial was performed from March 25, 2015, to August 3, 2016, in 52 eyes of 52 patients (36 cases and 16 controls) treated at a private ophthalmology practice., Interventions: Patients were randomly assigned to YAG laser vitreolysis or sham YAG (control)., Main Outcomes and Measures: Primary 6-month outcomes were subjective change measured from 0% to 100% using a 10-point visual disturbance score, a 5-level qualitative scale, and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes included objective change assessed by masked grading of color fundus photography and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity., Results: Fifty-two patients (52 eyes; 17 men and 35 women; 51 white and 1 Asian) with symptomatic Weiss rings were enrolled in the study (mean [SD] age, 61.4 [8.0] years for the YAG laser group and 61.1 [6.6] years for the sham group). The YAG laser group reported greater symptomatic improvement (54%) than controls (9%) (difference, 45%; 95% CI, 25%-64%; P < .001). In the YAG laser group, the 10-point visual disturbance score improved by 3.2 vs 0.1 in the sham group (difference, -3.0; 95% CI, -4.3 to -1.7; P < .001). A total of 19 patients (53%) in the YAG laser group reported significantly or completely improved symptoms vs 0 individuals in the sham group (difference, 53%; 95% CI, 36%-69%, P < .001). Compared with sham, NEI VFQ-25 revealed improved general vision (difference, 16.3; 95% CI, 0.9-31.7; P = .04), peripheral vision (difference, 11.6; 95% CI, 0.8-22.4; P = .04), role difficulties (difference, 17.3; 95% CI, 8.0-26.6; P < .001), and dependency (difference, 5.6; 95% CI, 0.5-10.8; P = .03) among the YAG laser group. Best-corrected visual acuity changed by -0.2 letters in the YAG laser group and by -0.6 letters in sham group (difference, 0.4; 95% CI, -6.5 to 5.3; P = .94). No differences in adverse events between groups were identified., Conclusions and Relevance: YAG laser vitreolysis subjectively improved Weiss ring-related symptoms and objectively improved Weiss ring appearance. Greater confidence in these outcomes may result from larger confirmatory studies of longer duration., Trial Registration: clinicaltrials.gov NCT02897583.

A 35-year-old pregnant Caucasian woman at 27 weeks gestation presented with sudden onset painless loss of vision and a large floater in her left eye while doing yoga. She was found to have a dense vitreous haemorrhage with a small preretinal haemorrhage. Ultrasound imaging confirmed the haemorrhage and showed no other retinal damage. She was diagnosed with valsalva haemorrhagic retinopathy and was treated conservatively. After 5 months of follow-up, this woman had had a normal delivery and her haemorrhages and vision loss had resolved., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: To quantify the changes in vitreomacular interactions that occur with aging in diabetic eyes in comparison with age-matched control eyes., Methods: Spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering) foveal scans of diabetic patients, without evidence of cystoid macular edema, were included. Twenty-five raster foveal scans were performed on every subject. Area of vitreomacular adhesion was delineated using the Spectralis drawing tool and calculated in square millimeter. Data collected included gender, race, best-corrected visual acuity, and posterior vitreous detachment status. Subjects were divided into age groups according to decade of life., Results: Spectral-domain optical coherence tomography scans from 141 diabetic patients were analyzed. Area of vitreomacular adhesion (mm) showed a hyperbolic decline in diabetic patients (35.5 ± 0, 35.0 ± 3, 34.0 ± 3, 33.9 ± 5, 33.7 ± 6, 29.0 ± 11, 23 ± 15, 13 ± 15). With aging, incidence of posterior vitreous detachment increased and incidence of complete attachment decreased., Conclusion: Diabetes affects the magnitude of attachment of the vitreous gel to the macula that results in stronger and longer lasting attachment of the gel throughout life. Gender differences were not noticed in diabetic patients, suggesting that vitreomacular adhesion remains robust in both genders in diabetes despite aging.

Positive vitreous pressure occurs during anterior segment intraocular surgery associated with acute hypotony and is characterized by forward displacement of the lens-iris diaphragm with shallowing of the anterior chamber resistant to reformation, repeated iris prolapse, and, in severe cases, zonular rupture and vitreous or lens prolapse that can lead to a cascade of intraoperative complications. Positive vitreous pressure is particularly common during penetrating keratoplasty, conventional nuclear expression cataract extraction, and repair of anterior open-globe injury. Hypotony resulting from aqueous loss leads to elevated vitreous pressure from 3 possible causes: external scleral compression, acute intraocular intumescence, or rarely acutely increased vitreous volume. Understanding the pathophysiology of positive vitreous pressure helps in its prevention and management., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The pathogenic mechanism of equine recurrent uveitis (ERU) is still poorly defined and many variations between experimental animal models and spontaneous disease exist., Objectives: The aim of our study was to investigate if Th17 cell-mediated response plays role in the pathogenesis of the used experimental model in horses and to reveal its pathological findings., Methods: Experimental uveitis was induced in 6 healthy horses. The concentrations of retinal autoantigen CRALBP and IL-17 were measured using ELISA in aqueous humor and vitreous body of the 12 inflamed eyes as well as in 12 control non-inflamed eyes taken from 6 horses in slaughter house. After centrifugation of the two eye media, smears were prepared and cytological investigation was performed. Tissue specimens were taken from all eye globes and were submitted to histopathological investigation., Results: CRALBP and IL-17 concentrations were significantly elevated in eye media of horses with experimental uveitis in comparison with controls. Cytological and histopathological findings corresponded to the changes characteristic of chronic immune-mediated inflammation with mononuclear cell infiltration of uvea, choroid, retina, and eye media as well as severe retinal destruction., Conclusions: Our study demonstrated the involvement of the retinal autoantigen CRALBP as well as IL-17 in the pathogenesis of experimental uveitis in horses. These findings suggests that this experimental uveitis in horses may serve as a suitable animal model for investigation of IL-17- mediated immune response during spontaneous autoimmune uveitis in horses as well as in humans.

The purpose of this study was to investigate the interocular symmetry of ultrasonic biometric characteristics and anterior segment measurements between the fellow eyes of hyperopic anisometropes. Forty-two healthy hyperopic anisometropic cases (1 D mean spherical equivalent difference between eyes) without strabismus were recruited. A range of refractive and ultrasonic biometric parameters were measured in both eyes of each subject including keratometry, mean spherical equivalent, anterior chamber depth (ACD), lens thickness, vitreous depth (VD), axial length (AL), and anterior segment parameters (central corneal thickness (CCT), ACD, anterior chamber volume (ACV)) with Pentacam. Mean spherical equivalent anisometropia was 2.66 ± 1.233 (range 1.125 and 6.25) D, and there was a strong correlation between the degree of anisometropia and the interocular difference in AL (r = 0.632, P < 0.001). A total of 61.3 % of the anisometropia was related with AL (50.7 %) and mean keratometry (10.6 %). Every 1 mm change in AL and every 1 D change in mean keratometry caused a total of 2.82 D and 2.14 D refractive difference, respectively. Among Pentacam parameters, ACD was correlated with ACV (r = 0.528; P < 0.001) and AL (r = 0.510; P = 0.001); ACV was correlated with VD (r = 0.358; P = 0.020); and CCT was correlated with ACV (r = 0.510; P = 0.001) and AL (r = 0.318; P = 0.040). Among ultrasonographic measurements, ultrasonic-ACD was correlated with CCT (r = 0.510; P = 0.001) and lens thickness (r = -0.556; P < 0.001), and VD was correlated with AL (r = 0.937, r 2  = 0.877, P < 0.001). The hyperopic and the fellow eyes displayed a high degree of interocular symmetry for the other measured parameters. AL and mean keratometry are the leading causes of hyperopic anisometropia. However, ACD as measured with Pentacam also shows difference in hyperopic anisometropic eyes.

Although linked to several vitreoretinal pathologies including traumatic retinal tears, breaks, and symptomatic vitreomacular traction, the dynamic material behavior of the vitreous body in response to mechanical loads is not well understood. The purpose of this study was to evaluate spatiotemporal patterns of collagen fiber reorganization and vitreous deformation (strain) in response to tensile and compressive forces. Using thick slabs of bovine eyes we examined collagen fiber reorganization following tensile and compressive step-loading with quantitative polarized light imaging. Strains were measured from sparse marker arrays and temporal collagen behavior was estimated from creep compliance rheological tests. Results showed that under applied loads (1) collagen fibers became significantly more aligned at the vitreous base (near the pars plana and the ciliary body), (2) vitreous located directly behind the lens deformed significantly more than surrounding regions, and (3) changes in collagen fiber alignment occurred on a short (<5 s) timescale. Together these results show that, despite a homogeneous visual appearance, the vitreous body exhibits anisotropic material behavior in tension and compression. Spatiotemporal patterns of collagen rearrangement were consistent with epidemiological patterns of traumatic retinal damage and vitreoretinal topology. High strains in the vitreous corresponded with locations of lower collagen content that are prone to age-related degeneration. These data suggest that differential fiber alignment and mechanical deformation could contribute to the pathogenesis of these diseases. Computational models that incorporate these experimental data will help improve our understanding of the biomechanical mechanisms that contribute to the pathogenesis of traumatic retinal damage, vitreous degeneration, and vitreoretinal disease.

Aim: to investigate the state of vitreomacular interface in pseudophakic patients by means of spectral optical coherence tomography (OCT)., Material and Methods: Spectral OCT of the macular region was performed in 58 pseudophakic eyes that underwent laser treatment for secondary cataract, 28 newly pseudophakic eyes (day 1 after cataract phacoemulsification with IOL implantation), and 40 eyes with early senile cataract., Results: A higher incidence of subclinical fibrosis of the internal limiting membrane was noted in pseudophakic patients after YAG laser surgery for secondary cataract as compared to cataract patients and those right after cataract phacoemulsification., Conclusion: Fibrosis of the internal limiting membrane significantly more often develops in the late period after cataract extraction as compared to patients with early senile cataract and those who have just underwent phacoemulsification surgery. Fibrosis of the internal limiting membrane arising in the late period after cataract extraction cannot be unambiguously attributed to either primary or secondary. The resolution of spectral OCT is high enough to allow detection of preclinical ultrastructural changes in the vitreomacular interface.

Purpose: To evaluate whether posterior vitreous adhesion (PVA) contributes to retinal ischaemia in eyes suffering from central (CRVO) or branch retinal vein occlusion (BRVO)., Methods: Retrospective patient chart analysis of eyes with CRVO/BRVO receiving pars-plana vitrectomy (ppV). Prior to surgery fluorescence angiography was conducted to classify RVO as ischaemic or not., Results: Sixty eyes were included, thereof 36 (60%)/24 (40%) with CRVO/BRVO. In the CRVO group, 17 (47%)/19 (53%) eyes were classified as ischaemic/non-ischaemic. Respective results for BRVO-affected eyes were 16 (67%)/8 (33%). PVA/posterior vitreous detachment (PVD) was found in 33 (92%)/3 (8%) eyes with CRVO and in 23 (96%)/1 (4%) patients suffering from BRVO. Value differences of PVA/PVD between ischaemic- and non-ischaemic-typed RVO failed statistical significance for both, CRVO (p = 0.095) and BRVO (p = 1.0)., Conclusions: Posterior vitreous adhesion had no impact on retinal ischaemia in this investigation. As an attached posterior vitreous cortex acts as a scaffold and thus significantly increases neovascularization (NV) development in ischaemic-typed RVO, a prospective study evaluating the effect of enzymatic vitreolysis is indicated., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD., Methods: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant., Results: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%)., Conclusion: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.

Vascular diseases of the retina such as diabetic retinopathy and vascular occlusions account for a large proportion of visual morbidity and blindness worldwide. The role of vitreous in the pathogenesis of these conditions has been increasingly recognized. Despite advances in the surgical technique of pars plana vitrectomy, the use of intravitreal agents for the lysis of vitreous has received attention, guided largely by promising results from the trials involving patients with non-vascular retinal diseases such as vitreomacular traction. The purpose of this review is to provide a comprehensive summary of the present knowledge on pathophysiologic basis of pharmacologic vitreolysis and its efficacy in vascular diseases of the retina. A review of completed and ongoing clinical trials will be presented, along with insights into future directions of this therapy., (Copyright 2016, SLACK Incorporated.)

Purpose: To report the initial experience, clinical outcomes, and safety profile of 27 gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease., Design: Multicenter, retrospective, interventional case series., Methods: setting: Private practice and tertiary care settings., Study Population: Eyes undergoing 27 gauge PPV for a vitreoretinal surgery indication., Intervention: Three-port, transconjunctival 27 gauge PPV., Main Outcome Measures: Change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 90 days., Results: Ninety-five eyes met the inclusion criteria. Surgical indications included epiretinal membrane (n = 26), diabetic tractional retinal detachment (n = 14), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment with (n = 7) or without (n = 9) proliferative vitreoretinopathy (PVR), vitreous hemorrhage (n = 10), vitreous opacities (n = 8), endophthalmitis (n = 4), sub-silicone oil retinal detachment (n = 3), retained lens material (n = 1), submacular hemorrhage (n = 1), and aqueous misdirection (n = 1). Mean logMAR visual acuity improved from 1.08 ± 0.71 (20/240 Snellen equivalent) preoperatively to 0.53 ± 0.65 (20/67 Snellen equivalent) postoperatively (P < .001). Mean follow-up was 144 days (median 127 days, range 90-254 days). There were no intraoperative complications and no case required conversion to 20, 23, or 25 gauge instrumentation. A total of 3 sclerotomy sites (1.1%) were sutured at the conclusion of surgery. Postoperative complications included transient ocular hypertension in 8 eyes (8.4%), transient hypotony in 5 eyes (5.3%), and vitreous hemorrhage in 5 eyes (5.3%). No cases of postoperative endophthalmitis, sclerotomy-related retinal tears, or choroidal detachments were encountered in the follow-up period., Conclusion: The 27 gauge PPV was well tolerated with low rates of intraoperative and postoperative complications across varied surgical indications., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Ocriplasmin is a human plasmin fragment indicated for vitreomacular traction treatment. With its increasing use, several reported cases have suggested possible toxicity to the retina., Case: We describe a case of a 55-year-old woman with symptomatic vitreomacular traction and a macular hole in the right eye who showed an acute decrease in visual acuity after an intravitreal ocriplasmin injection. Spectral-domain optical coherence tomography showed an alteration in the ellipsoid layer. Significant retinal vessel constriction was observed by angiography. The visual acuity improved to 20/100, and the electroretinogram progressively improved after the 1-year follow-up and following pars plana vitrectomy., Conclusions: A decrease in visual acuity and an enlargement of the macular hole were observed while studying this patient. This study shows the recovery of adverse effects caused by intravitreal injection of ocriplasmin for 1-year follow-up.

Purpose: To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME)., Methods: In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications., Results: The mean baseline CMT for Group I was 456.85 ± 56.90 μm. The mean baseline CMT for Group II was 455.66 ± 57 μm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 μm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 μm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye., Conclusion: There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.

Aims: To report our experiences using Ozurdex, a biodegradable implant, containing 0.7 mg of dexamethasone in the treatment of noninfectious intermediate uveitis., Settings and Design: Retrospective study design., Methods: We conducted a retrospective study of medical records of patients with noninfectious intermediate uveitis having either cystoid macular edema (CME) or vitritis who were not responsive to standard treatment and subsequently received Ozurdex implant from March 2011 to April 2013. The outcomes measured were best-corrected visual acuity, central retinal thickness (CRT), and vitreous haze score., Statistical Analysis Used: Paired t-test was used to test the significance of difference between quantitative variables. A P < 0.05 is taken to denote significant relationship., Results: Twenty eyes of 15 patients with mean age of 39.8 years who received Ozurdex implant were included in the study. The mean baseline visual acuity improved from 0. 666 logarithm of the minimum angle of resolution (logMAR) units to 0.479 logMAR units at 6 weeks after the implant. The mean CRT improved from 536.1 to 361.4 microns at 6 weeks postimplant both parameters were statistically significant. The ocular inflammation was controlled in almost all the patients. Cataract and raised intraocular pressure were documented complications., Conclusion: Ozurdex implant is a promising treatment option and efficient in controlling the inflammation and CME in cases of noninfectious intermediate uveitis not responding to standard treatment.

This report describes changes documented on spectral-domain optical coherence tomography (SD-OCT) in the right eye of a 58-year-old woman who eventually developed a secondary full-thickness macular hole (FTMH). She had a history of vitreomacular traction (VMT) that had resolved spontaneously with a complete posterior vitreous detachment. Despite VMT resolution, a hyperreflective band from the internal to the external limiting membrane and evidence of photoreceptor disruption persisted on SD-OCT for 2 years, at which point an FTMH developed. Despite VMT release, the unexpected FTMH coupled with the preceding outer retinal changes suggest persistent secondary damage to Müller cells as a potential factor., (Copyright 2015, SLACK Incorporated.)