Long term positional stability of the Argus II retinal prosthesis epiretinal implant.

BACKGROUND: The Argus II Retinal Prosthesis System (Second Sight Medical Products, Sylmar, California) is an epiretinal prosthesis that serves to provide useful vision to people who are affected by retinal degenerative diseases such as retinitis pigmentosa (RP). The purpose of this study was to analyze postoperative movement of the electrode array. METHODS: Five patients diagnosed with profound retinal dystrophy who have undergone implantation of retinal prosthesis at Stony Brook University Hospital. Fundoscopy was performed at postoperative month 1 (M1), month 3 (M3), month 6 (M6), month 12 (M12), and month 24 (M24) visits. Fundoscopy was extracted and analyzed via NIH ImageJ. Data analysis was completed using IBM SPSS. Various lengths and angles were measured each postoperative month using ImageJ. RESULTS: There was no significant change in distance between the optic disc and the surgical handle (length AB) over the two-year span (F = 0.196, p = 0.705). There was a significant change in distance of length AB over time between patients between M3 and M6 (p = 0.025). A repeated measures ANOVA revealed that there was statistically significant change of the optic disc-tack-surgical handle angle (𝛾) (M1 to M24) (F = 3.527, p = 0.030). There was no significant change in angle 𝜟 (the angle to the horizontal of the image), angle 𝜶 (tack-optic disc-surgical handle), and angle 𝜷 (optic-disc-surgical handle-tack). CONCLUSION: Our results demonstrate that there may be postoperative movement of the retinal prosthesis over time, as a statistically significant downward rotation is reported over the 2 years span. It is important, moving forward, to further study this movement and to take into consideration such movement when designing retinal implants. It is important to note that this study is limited by the small sample size, and therefore, the conclusions drawn are limited.

Optical coherence tomography-based positioning regimen for macular hole surgery.

PURPOSE: To evaluate an optical coherence tomography (OCT)-based positioning regimen for patients undergoing macular hole surgery. METHOD: We reviewed the medical records of all patients in our practice who underwent macular hole repair, instituting a modified OCT-based positioning regimen from November 1, 2011 through July 31, 2013. The regimen consisted of prone positioning at the conclusion of surgery with daily OCT imaging until the hole was confirmed closed at which point positioning was halted. Clinical data that were collected and recorded included visual acuities, stage of hole, size of hole, chronicity, preoperative and postoperative OCT imaging, and length of follow-up. RESULTS: We identified 33 patients (35 eyes) with a mean baseline visual acuity of 20/220, a mean hole size of 465 µm. The mean final (postoperative) visual acuity was 20/135 with a mean follow-up of 7.7 months. Six patients (17%) in our study were diagnosed with myopic degeneration. Thirteen patients (37%) were found to have chronic (≥12 months) holes, and 19 (54%) were found to have large holes (>400 µm). Overall, 28 eyes (80%) had persistent closure of macular holes with an OCT-based positioning regimen. In the absence of high risk factors, such as myopic degeneration, chronic or large holes, the closure rate was 92%. In the presence of 2 or 3 of these risk factors, the closure rate was 85% and 74%, respectively. CONCLUSION: The presence of 2 or 3 high risk factors, such as myopic degeneration, chronic holes (≥12 months), or large holes (>400 µm) can compromise outcomes resulting in reopening after apparent early closure. Based on the presence of these risk factors, a modified postoperative positioning regimen can be used to obtain complete and persistent closure.

Pars plana vitrectomy in the management of patients diagnosed with endophthalmitis following intravitreal anti-vascular endothelial growth factor injection.

PURPOSE: To evaluate the possible benefit of pars plana vitrectomy in the treatment of patients with endophthalmitis following antivascular endothelial growth factor (VEGF) injection. METHOD: The authors retrospectively reviewed the medical records of all patients in their practice with a diagnosis of endophthalmitis from January 1, 2007, through December 31, 2011. Only those with a clinical presentation consistent with endophthalmitis after intravitreal anti-VEGF injection were included. Clinical data that were collected and recorded included visual acuities and the method of initial and subsequent treatment of endophthalmitis following anti-VEGF injection: tap and injection of intravitreal antibiotics (TAP) and tap and inject with subsequent pars plana vitrectomy (VIT). RESULTS: The authors identified 23 patients meeting criteria. Nineteen patients had received bevacizumab and four patients had received ranibizumab. The median time from last injection to presentation was 4 days (range, 1-18 days) with a median follow-up of 15 months (range, 5-48 months) after being diagnosed of endophthalmitis. Nine patients had positive cultures. The median baseline visual acuity (preendophthalmitis) was 20/70 (range, 20/25 to counting fingers at 2 ft) with a median presenting visual acuity of counting fingers at 1 ft (range, 20/50 to light perception vision). Overall, 90% (9/10) of the patients in TAP only group regained visual acuity within 1 line or better of baseline versus 46% (6 of 13) in the TAP and VIT group. Only one of the patients treated with TAP alone suffered more than one line of visual acuity loss. CONCLUSION: Patients diagnosed with endophthalmitis after anti-VEGF intravitreal injection who underwent TAP regained baseline visual acuity more often than those who underwent TAP and VIT. This study did not support a benefit for VIT in all patients, rather only in those cases who warranted it because of worsening clinical course. The study suggests that TAP is a viable primary intervention for endophthalmitis after anti-VEGF injection.

An evidence-based review of vascular endothelial growth factor inhibition in pediatric retinal diseases: part 2. Coats' disease, best disease, and uveitis with childhood neovascularization.

Vascular endothelial growth factor (VEGF) is an important factor in the pathogenesis of multiple retinal neovascular disorders. This report focuses on the quality and depth of new evidence for the use of VEGF inhibitors in selected pediatric ocular diseases, including Coats' disease, Best disease, and childhood uveitis. Because much of the literature comprises case reports and retrospective case series, the level of evidence supporting its use as a primary treatment option, or even as adjuvant therapy, is low. The standard of care is treatment of the underlying disorder to prevent neovascularization (retinal or subretinal), vitreous hemorrhage, or subsequent retinal detachment. However, these complications may not present until late in the disease course. It may then be useful to treat with these agents. Prospective studies are warranted to further elucidate the role of anti-VEGF therapy in these diseases.

An evidence-based meta-analysis of vascular endothelial growth factor inhibition in pediatric retinal diseases: part 1. Retinopathy of prematurity.

Recently there has been interest in the novel, off-label use of anti-vascular endothelial growth factor (anti-VEGF) agents for various stages of retinopathy of prematurity (ROP). The authors report on the quality and depth of new evidence published from 2009 to 2011 concerning the treatment of retinopathy of prematurity (ROP) with bevacizumab (Avastin; Genentech Inc., South San Francisco, CA) as either primary or adjunctive treatment for ROP. There is significant variability in the evidence, quality, and design of the studies available in the literature. There has been a trend in the scientific literature of the past 2 years toward larger, multi-center, randomized studies investigating the role of bevacizumab in the treatment of ROP. More recent evidence suggests that monotherapy with intravitreal bevacizumab may be a viable first-line treatment for select cases of zone I ROP and possibly for posterior zone II disease. Adjunctive treatment with bevacizumab may enhance outcomes in patients treated with laser photocoagulation or pars plana vitrectomy. However, there are significant concerns regarding its long-term safety profile. Further prospective studies are warranted to more fully determine the role of anti-VEGF therapy in this disease.

Immune reconstitution uveitis complicated by vitreoretinal traction and formation of a retinal tear.

The authors report a case of immune reconstitution uveitis induced by cytomegalovirus retinitis with subsequent development of vitreoretinal traction and a resultant retinal tear.

Macular epiretinal membrane peeling treatment outcomes in young children.

PURPOSE: The purpose of this study was to describe macular epiretinal membrane (ERM) peeling treatment outcomes in young children. METHODS: The medical records of all vitrectomies from 1998 through 2010 were retrospectively reviewed. Patients who were selected were 16 years or younger and had primarily macular or posterior pole disease secondary to an ERM. Patients with retinopathy of prematurity, Coats disease, Norrie disease, and incontinentia pigmenti were excluded. Fourteen patients underwent vitrectomy with ERM peeling, and their preoperative and postoperative visual acuities were compared. RESULTS: The mean age at surgery was 8 years, with an average follow-up of 4.2 years (range, 6 months to 11 years). The average presenting visual acuity was 20/258. Average postoperative visual acuity was 20/100, with improvement in 12 patients (86%) and no change of visual acuity in 2 patients (14%). CONCLUSION: Pediatric ERMs respond well to vitrectomy and membrane peel with a low likelihood of recurrence. Other associated pathology, such as familial exudative retinopathy and combined hamartomas of the retina and retinal pigment epithelium, was associated with complications, such as delayed-onset rhegmatogenous retinal detachment from peripheral traction and recurrence of ERM in 7% of patients.