Papillomacular bundle sparing versus conventional internal limiting membrane peeling for idiopathic macular hole ?400 µm

Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.

Morphological characterization of subretinal hyper-reflective material in posterior uveitis using swept-source optical coherence tomography and optical coherence tomography angiography

Purpose: To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA). Methods: In this observational study, subjects with quiescent posterior uveitis and the presence of SHRM on SS-OCT were subjected to SS-OCTA to identify the presence of an intrinsic choroidal neovascular (CNV) network. OCT features were compared for SHRM harboring CNV (vascular SHRM) with those without CNV network (avascular SHRM) to identify clinical signs pointing toward the presence of CNVM inside SHRM. Results: Forty-two eyes of 33 subjects (18 males; mean age: 29.52 ± 12.56 years) were evaluated. Two-thirds (28/42) of eyes having SHRM on SS-OCT harbored intrinsic neovascular network (vascular SHRM). Increased reflectivity of SHRM (P < 0.001) and increased transmission of OCT signal underlying SHRM (P = 0.03) were suggestive of the absence of CNVM. The presence of intra/subretinal fluid (P = 0.08) and pitchfork sign (P = 0.017) were important markers of vascular SHRM. Conclusion: SHRM is an important OCT finding in eyes with posterior uveitis. Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying the underlying intrinsic neovascular network.

Redrawing vitreoretinal surgical training program in the COVID-19 era: Experiences of a tertiary care institute in North India

Purpose: The COVID?19 pandemic has brought medical and surgical training to a standstill across the medical sub?specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This “loss” has adversely impacted trainees’ morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three?pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands?on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three?pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID?19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.

Aggressive posterior retinopathy of prematurity in infants ≥1500 g birth weight.

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty‑nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co‑morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty‑five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co‑morbidities could be a contributing factor.

Structural sequelae and refractive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes.

Aim: The aim was to study the structural sequelae and refractive outcome after laser treatment for Type 1 prethreshold retinopathy of prematurity (ROP) in Asian Indian eyes. Materials and Methods: A retrospective chart review of infants with Type 1 prethreshold ROP (defined according to the Early Treatment for Retinopathy of Prematurity study) undergoing laser treatment at a tertiary center between January 2004 and December 2008 was done. The 1-year outcome of infants was analyzed. Results: Sixty-nine eyes of 36 infants were included. The mean birth weight was 1121.69 ± 254.81 g and the gestational age was 28.99 ± 2.03 weeks. Sixty-five eyes (94.2%) had zone 2 and 4 (5.8%) had zone 1 disease. Forty-four (63.77%) eyes had stage 2 ROP with plus disease and 25 (36.23%) eyes had prethreshold (fewer than five contiguous or eight cumulative clock hours) stage 3 ROP with plus disease. None of the eyes developed retinal structural sequelae. On cycloplegic retinoscopy, 59.4% eyes had nonsignificant hyperopia [spherical equivalent (SE) ≤ 4 D], 14.5% eyes had no refractive error (SE 0 D), 24.7% eyes had low myopia (SE < 5 D), and 1.4% eyes had high myopia (SE > 5.0 D). Eyes developing myopia were associated with a greater number of clock hours of ROP, greater number of laser spots used, and a longer time to disease regression. Two infants (5.6%) had esotropia and one (2.8%) had exotropia. Conclusion: Asian Indian infants treated for Type 1 prethreshold ROP did not develop retinal structural sequelae. Myopia was seen in nearly one-fourth of the eyes.The risk factors for myopia were a greater number of clock hours of ROP, greater number of laser spots, and a longer time to regression of ROP.