Epiretinal membrane-induced intraretinal neovascularization.

PURPOSE: To report a 71-year-old male patient diagnosed with epiretinal membrane-induced intraretinal neovascularization. OBSERVATIONS: The presence of an epiretinal membrane (ERM) was confirmed by Optical Coherence Tomography (OCT), fluorescein and indocyanine angiography. Optical coherence tomography angiography (OCT-A) revealed a neovascular membrane within the ERM. Intravitreal ranibizumab injections were administered three times at four-week intervals. Imaging revealed a stable membrane with no leakage. Five months after the third injection, OCT revealed intraretinal fluid. OCT-A showed a new branch of the neo-vascular membrane at the superficial capillary plexus. Following an additional ranibizumab injection, the membrane stabilized. CONCLUSIONS AND IMPORTANCE: It is conceivable that neovascularization developed due to, or in close conjunction with an epiretinal membranes already in place.

Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts.

PURPOSE: To propose guidelines for the management of patients with wet age-related macular degeneration (wAMD), taking into account the results of large multicenter studies and clinical experience of retina experts. METHOD: A team of retina experts developed a consensus paper after three consecutive meetings. The group was focused on guidelines to help clinical decision-making around the definition of successful treatment and the definition of non-response to therapy. RESULTS: Parameters suggestive of a successful response to treatments included: any gain in best corrected visual acuity (BCVA) or vision loss that is less than 5-10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, reduction of central retinal thickness, partial or complete absorption of subretinal fluid (SRF), reduction of intraretinal fluid, reduction of pigment epithelial detachment or restoration of the anatomy of outer retinal layers. Non-response to current treatment was considered in the case of loss of BCVA greater than 10 ETDRS letters, increased retinal edema or increase of SRF as evidenced by optical coherence tomography or new bleeding in biomicroscopy. CONCLUSION: The introduction of anti-VEGF agents revolutionized the treatment of wAMD. Given the complexity of the disease, the emerging new agents and the difference of cases recruited in clinical trials compared to those appearing in every-day practice, it is essential to individualize treatment options taking into account the results of clinical trials.

Heterologous, Fresh, Human Donor Sclera as Patch Graft Material in Glaucoma Drainage Device Surgery.

PURPOSE: To determine the safety and efficacy of fresh, human sclera allografts as a patch graft material in glaucoma drainage device (GDD) surgery. DESIGN: Retrospective, noncomparative, interventional, consecutive case series. SUBJECTS: All GDD cases operated between 2008 and 2013 in which fresh human corneoscleral rims were used immediately after the central corneal button was used for penetrating or endothelial keratoplasty. METHODS: Surgery was performed by 2 surgeons at 2 facilities. The Ahmed Glaucoma Valve (FP-7) was used exclusively in this cohort. Sixty-four eyes of 60 patients were identified; demographic data were recorded along with intraocular pressure (IOP), medication requirements, visual acuity, complications, and subsequent interventions. MAIN OUTCOME MEASURES: Incidence of complications. IOP and medication requirements at the last follow-up. Quilified success utilizing Tube Versus Trabeculectomy study criteria. RESULTS: The mean age of the cohort was 66.2±19.1 years; the average preoperative IOP was 33.2±11.1 mm Hg on 4.2±1.3 IOP-lowering agents before GDD surgery. IOP decreased significantly to 14.1±4.7 mm Hg (P<0.001) on 1.6±1.2 IOP-lowering agents (P<0.001) after an average follow-up of 18.2±15.4 months. There were no cases of early or late blebitis or endophthalmitis, and there was 1 case of conjunctival erosion and tube/plate exposure (1.6%) occurring 30 days after surgery. Qualified success was estimated as 90.5% and 81% at 1 and 2 years, respectively, using Tube Versus Trabeculectomy study criteria. CONCLUSIONS: Heterologous, fresh, human donor sclera appears to be a safe material for GDD tube coverage. It provides a cost-efficient alternative compared with traditional patch graft materials associated with a low risk of pathogen transmission.

Cataract-related acute vitreomacular traction syndrome.

PURPOSE: To report the acute and transient (within 10 days) presentation of vitreomacular traction following routine cataract surgery. METHODS: This is a case series of 5 patients with no evidence of posterior vitreous detachment preoperatively who presented with acute vitreomacular traction following routine cataract surgery. All patients presented the first postoperative day with dramatically reduced visual acuity. The patients underwent optical coherence tomography and if necessary fundus fluorescein angiography. Images were suggestive of vitreomacular syndrome. RESULTS: In all 5 cases, there was spontaneous resolution of the traction within 10 days. The latter was probably related to the development of posterior vitreous detachment due to the uncomplicated cataract surgery. In 2 cases there were significant retinal pigment epithelium changes and decreased retinal thickness following the resolution of the traction leaving permanent metamorphopsia and slightly decreased visual acuity. CONCLUSIONS: Cataract-related acute vitreomacular traction is a rare phenomenon and not well-recognized; however, it resolves spontaneously within 10 days.

Vitrectomy for treatment of a lamellar hole in a patient with exudative macular degeneration: the role of vitreous traction elimination.

PURPOSE: Lamellar macular hole (LMH) represents a well-defined clinical entity with variable pathophysiologic mechanisms and a controversial therapeutic approach. The purpose of the present work is to present a patient with an epiretinal membrane (ERM)-associated LMH on the background of exudative age-related macular degeneration (AMD) that was successfully managed with pars plana vitrectomy. METHODS: Interventional case report. RESULTS: A 67-year-old man presented with progressive visual loss OS of 5 months' duration. He was diagnosed with an ERM-associated LMH with coexisting subretinal fluid arising by a neovascular membrane on the background of exudative AMD confirmed with fundus fluorescein angiography. He underwent a 3-port pars plana vitrectomy with ERM-internal limiting membrane peeling and gas tamponade (14% C3F8) for treatment of the LMH and ERM with a view to undergo anti-vascular endothelial growth factor treatment for the exudative AMD. Postoperative optical coherence tomography demonstrated complete closure of the LMH with simultaneous total subretinal fluid absorption that was maintained at the 2-month follow-up period. CONCLUSIONS: To our knowledge, this is the first report whereby pars plana vitrectomy in a patient with an ERM-associated LMH on the background of exudative AMD resulted in improvement of both clinical entities. The latter strengthens the role of vitreous traction elimination in exudative AMD and highlights the need for further research.