Incidence of post vitrectomy endophthalmitis in India - A multicentric study by VRSI study Group.

INTRODUCTION: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

Multicolor imaging in macular telangiectasia-a comparison with fundus autofluorescence.

PURPOSE: To describe various clinical features of idiopathic juxtafoveal retinal telangiectasis group 2A or idiopathic macular telangiectasia type 2 (MacTel) on multicolor imaging (MCI) and compare imaging findings of MacTel on MCI with fundus autofluorescence (FAF). METHODS: Patients with a clinical diagnosis of MacTel based on Gass and Blodi's classification were included. FAF and MCI images were graded qualitatively for stage of disease, margins of involvement, hyperautofluorescence on FAF (corresponding retinal atrophy on MCI), and detection of crystals. FAF and MCI were graded quantitatively for the area and number of quadrants involved, hypoautofluorescene on FAF (corresponding intraretinal pigment hyperplasia or retinal pigment epithelium [RPE] atrophy on MCI), and foci of right-angled venules. RESULTS: Seventy-eight eyes of forty five patients were included with both imaging modalities showing no difference with respect to staging of non-proliferative MacTel. Retinal crystals were recognized on MCI but not on FAF. Neurosensory retinal atrophy and  subretinal neovascular membranes were detected using MCI with 92.3 and 83.3% sensitivity, respectively. Intraretinal pigmented hyperplasia was more accurately detected (70.1 vs 58.4%) compared with RPE atrophy on MCI. MCI showed larger area of involvement, higher number of quadrants involved (p < 0.001), and better delineation of margins (p = 0.002) compared with FAF. A higher mean number of vessel dipping foci was noted on MCI in comparison with FAF (3.34 vs 3.1). CONCLUSION: Various parameters were more easily defined using MCI compared with FAF which qualifies MCI as an enface depth-resolved imaging adjunct to conventional multimodal imaging in MacTel. The ability to detect enface as well as cross-sectional imaging features makes MCI a valuable tool in MacTel.

Epiretinal Neovascularization: A Novel OCT Angiography Finding in Macular Telangiectasia Type 2.

PURPOSE: To report a novel finding of epiretinal neovascularization (ERN) in cases of macular telangiectasia (MacTel) type 2 and describe its clinical and multimodal imaging features. DESIGN: Retrospective chart review. PARTICIPANTS: Patients attending the retina clinic from January 2017 through April 2018. Those diagnosed with MacTel by clinical and imaging findings were included. METHODS: Best-corrected visual acuity in logarithm of minimum angle of resolution units, anterior segment examination, slit-lamp biomicroscopy, fundus photography, spectral-domain OCT, autofluorescence imaging, fundus fluorescein angiography, and OCT angiography (OCTA) were performed in all MacTel patients. Length of ellipsoid zone disruption, external limiting membrane disruption, area of the ERN in square millimeters, and central macular thickness in micrometers were noted. MAIN OUTCOME MEASURES: The finding of an epiretinal membrane on spectral-domain OCT and a corresponding well-defined vascular complex on the vitreoretinal interface on OCTA in MacTel patients was considered to be evidence of epiretinal neovascular membrane (ERNM). RESULTS: Sixty-eight MacTel eyes underwent multimodal imaging, of which 7 eyes of 4 patients were identified as having ERN or ERNM. The ratio of men to women was 1:1 (n = 4); 1 patient had unilateral disease and 3 patients had bilateral disease. Mean age was 56.75 ± 10.71 years. Mean best-corrected visual acuity was 0.74 ± 0.39 logarithm of the minimum angle of resolution. Retinal pigment and dipping venules were present in 100% of eyes. Diffuse thinning and collapse sign were seen in all eyes. OCT angiography revealed a vascular membrane owing to the ERNM at the vitreoretinal interface. Mean area of the ERNM was 0.44 ± 0.248 mm2. This vascular membrane showed a demonstrable communication with the intraretinal abnormal vascular plexus in 6 of 7 eyes. None of the eyes showed a choroidal neovascular membrane. CONCLUSIONS: Epiretinal neovascularization is a novel finding in MacTel type 2. These neovascular membranes are visualized best using OCT and OCTA. They are associated with retinal pigment and diffuse retinal thinning. Histopathologic studies are needed to characterize these membranes further.

Perifoveal Exudative Vascular Anomalous Complex-Like Lesion as a Complication of Prepapillary Arterial Loops.

Perifoveal exudative vascular anomalous complex (PEVAC) and its expanded spectrum have been recently elucidated by multimodal imaging. Although there is some clarity about its characteristic features and natural history, the cause remains unknown. Herein, the authors describe a hitherto unknown association with prepapillary arterial loops and suggest a possible hypothesis for the development of a PEVAC-like lesion and its response to treatment with thermal laser. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:974-978.].