Outcomes and Complications of Concurrent Pars Plana Vitrectomy and Scleral-Fixated Intraocular Lens Placement Using Gore-Tex Suture.

Purpose: The authors aim to describe the visual outcomes and postoperative complications of concurrent pars plana vitrectomy and scleral-fixated intraocular lens (IOL) placement using Gore-Tex suture. Methods: A retrospective review of medical records was performed on 27 eyes of 27 patients undergoing concurrent pars plana vitrectomy and scleral-fixated IOL with Gore-Tex suture. Outcome measures were change in preoperative and postoperative visual acuity, final manifest refraction, and incidence of intraoperative and postoperative complications. Results: The mean age was 69.2 ± 11.3 years; there were 16 male patients (59%). The duration of follow-up ranged from 33 to 576 days with a mean of 200 ± 143 days. All patients received Bausch + Lomb Akreos AO60 IOL. The overall mean best-corrected visual acuity in Snellen equivalent improved from 20/276 preoperatively to 20/44 postoperatively (P < .001). The mean postoperative manifest spherical equivalent refraction was -0.35 ± 1.34 diopters (D). Seventy-five percent of eyes were ± 1.0 D of target refraction. Postoperative complications included corneal edema (26.0%), ocular hypertension (25.9%), hypotony (7.4%), cystoid macular edema (7.4%), vitreous hemorrhage (7.4%), and hyphema (3.7%). No cases of suture breakage, IOL dislocation, retinal detachment, or uveitis-glaucoma-hyphema syndrome were identified. Conclusions: The use of Gore-Tex suture for posterior chamber IOL fixation resulted in favorable outcomes. No suture-related complications occurred during the follow-up period. Final refraction in this setting is typically within ± 1.0 D of target.

Optical coherence tomography angiography characteristics in diabetic patients without clinical diabetic retinopathy.

PURPOSE: The purpose of this study is to measure optical coherence tomography angiography (OCTA)-defined retinal vascular and choriocapillaris parameters in diabetic patients without clinically evident diabetic retinopathy. METHODS: Retrospective case series of eyes in patients with a documented history of either type 1 or type 2 diabetes mellitus without any clinical signs of diabetic retinopathy seen at the Vanderbilt Eye Institute. All eyes underwent dilated funduscopic examination along with OCTA. OCTA analytics were performed to calculate vessel density, flow area, and foveal avascular zone size. RESULTS: Thirty-seven eyes of 20 patients were included in the analysis. The mean glycated hemoglobin A1c of the 20 patients was 7.2%. All patients underwent dilated funduscopic examination by a fellowship-trained retina specialist. No patients had any overt retinopathy on clinical examination. Fifteen eyes had vascular abnormalities (microaneurysms) present on OCTA. Patients with microaneurysms and patients without microaneurysms were compared. Vessel density of the 6 × 6 mm macular cube images was significantly increased in patients with microaneurysms compared with patients without microaneurysms. There were no other significant differences in OCTA characteristics. CONCLUSION: OCTA can detect microvascular changes not otherwise noted on dilated clinical examination. These pre-clinical findings may facilitate earlier intervention for improved glycemic control and prevention of the onset of clinical retinopathy.

27-GAUGE VITRECTOMY WOUND INTEGRITY: A Randomized Pilot Study Comparing Angled Versus Straight Entry in Fluid-Filled Vitrectomized Eyes.

PURPOSE: To compare clinical outcomes using angled versus straight trocar insertion during 27-gauge pars plana vitrectomy for epiretinal membrane. METHODS: Pilot randomized controlled trial. Thirty eyes of 30 patients undergoing 27-gauge pars plana vitrectomy with membrane peeling for epiretinal membrane were randomized 1:1 to receive angled or straight trocar insertion. Intraocular pressure (IOP) and postoperative wound-related complications were compared. RESULTS: Fifteen eyes were randomized to each the angled and straight incision groups. No significant difference in phakic status (P = 0.71) or preoperative IOP (15.1 ± 3.4 vs. 14.6 ± 3.0 mmHg, P = 0.67) existed between groups. On postoperative Day 1, eyes in the straight group had lower IOP compared with the angled group (11.8 ± 3.9 vs. 15.3 ± 5.2 mmHg, P = 0.04) and a relative decrease in IOP compared with preoperative values (11.8 ± 3.9 vs. 15.1 ± 3.4 mmHg, P < 0.01). No IOP difference between groups was present at Day 7 (P = 0.43) or Day 30 (P = 0.42). Postoperative complications included transient hypotony (1 eye, straight group) and serous choroidal detachment (1 eye, angled group). CONCLUSION: Eyes with straight incisions had transiently lower IOP on postoperative Day 1, possibly suggestive of subclinical wound leak in the very early postoperative period. Overall, rates of hypotony and sclerotomy-related complications were similarly low between wound construction strategies.

Evolving Concepts in the Management of Retinopathy of Prematurity.

PURPOSE: The introduction of anti-vascular endothelial growth factor (VEGF) agents has stimulated considerable reexamination of treatment strategies for the management of retinopathy of prematurity (ROP). Herein we summarize and review evolving concepts and provide a personal perspective on clinical management today and future directions of treatment. DESIGN: Literature review. METHODS: To synthesize the evolving management concepts for diagnosis and treatment of retinopathy of prematurity and to provide interpretation and perspective on current emerging therapies. RESULTS: Although initial treatment strategies focused on ablative therapy for threshold ROP, earlier treatment for type 1 or pre-threshold disease has been found to decrease unfavorable visual and structural outcomes. Vascular endothelial growth factor has emerged as a significant contributor to retinal-vascular diseases in the previous 2 decades. The potential role of anti-VEGF treatment for type 1 ROP has become a focus in recent years, but the protracted recurrence of disease and unknown adverse ocular and systemic effects have caused concern from some clinicians. In addition, the use of telemedicine technologies may provide the ability to screen remote areas with a shortage of ROP providers, thereby reducing the burden of disease. CONCLUSIONS: The diagnosis and management of ROP has changed over the past 40 years; the role of anti-VEGF therapy remains to be established in current treatment strategies. Screening for initial disease and progression will likely be impacted by the increasing prevalence of telemedicine and relative shortage of clinicians.

Outer Retinal Changes on Spectral-Domain Optical Coherence Tomography Pre- and Post-Silicone Oil Removal.

BACKGROUND AND OBJECTIVE: To evaluate outer retinal changes present on spectral-domain optical coherence tomography (SD-OCT) in eyes pre- and post-silicone oil (SiO) removal (SOR). PATIENTS AND METHODS: Retrospective case series of patients who underwent pars plana vitrectomy with SiO instillation and had SD-OCT completed pre- and post-SOR. SD-OCT parameters included presence of subretinal fluid, epiretinal membrane, ellipsoid zone disruption (EZD), external limiting membrane disruption, central subfield thickness (CST), and choroidal thickness. Visual acuities (VAs) and duration of SiO instillation were recorded. RESULTS: Thirty eyes of 30 patients were included. Mean Snellen VA pre- and post-SOR was 20/762 and 20/206, respectively (P < .001). Eyes with EZD under SiO had significantly longer duration of SiO tamponade (P = .029) along with worse VA post-SOR (P = .002). EZD was noted in 20 eyes with SiO and only 10 eyes post-SOR. Of these 10 eyes with resolution of EZD post-SOR, mean VA was significantly better (Snellen equivalent 20/133) compared to eyes with persistent EZD (Snellen equivalent 20/513; P = .01). CST and choroidal thickness decreased post-SOR (P = .117, P = .07). CONCLUSION: Outer retinal abnormalities on SD-OCT in SiO-filled eyes may improve in some patients following SOR. Some changes may be related to duration of SiO tamponade. EZD in SiO-filled eyes may portend a worse clinical outcome post-SOR despite surgical success. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:978-982.].

Both surgical clipping and endovascular embolization of unruptured intracranial aneurysms are associated with long-term improvement in self-reported quantitative headache scores.

BACKGROUND: The most common presenting symptom for unruptured intracranial aneurysms (UIAs) is headache (HA). However, most experts believe that UIAs associated with HAs are unrelated and incidental. OBJECTIVE: To analyze the incidence and characterization of HAs in patients with UIAs before and after treatment with either surgical clipping or endovascular embolization. METHOD: We prospectively determined the presence, sidedness, and severity of HAs preoperatively in patients who presented to the senior author with a UIA. A validated, quantitative 11-point HA pain scale was used in all patients. The same HA assessments were performed again on these patients an average of 32.4 months postoperatively. RESULTS: In this study, 92.45% (n = 53) of patents for whom we were able to obtain both a preoperative and postoperative pain score had an improvement in their HAs. The average quantitative HA score was 5.87 preoperatively vs 1.39 postoperatively (P < .001). There was no relationship found between the following: (1) HA severity vs aneurysm size, (2) sidedness of aneurysm vs sidedness of HA, and (3) HA improvement after surgical vs endovascular treatment. CONCLUSION: This study suggests that surgical and endovascular treatment of a UIA is associated with dramatic improvement in self-reported HA score an average of 32.4 months postoperatively.