Efficacy and safety of brolucizumab for serous drusenoid pigment epithelium detachment non-responder to bevacizumab and aflibercept.

INTRODUCTION: We report the case of a woman with drusenoid pigment epithelial detachment (DPED) in age-related macular degeneration who was successfully treated with two monthly intravitreal injections of brolucizumab after failing to respond to previous intravitreal injections of bevacizumab and aflibercept. CASE DESCRIPTION: A 56-year-old woman with mixed DPED and overlying subretinal fluid in her right eye was initially treated with three intravitreal injections of bevacizumab and three intravitreal injections of aflibercept with no visual and anatomical improvement. Switching to intravitreal injection of brolucizumab was performed. After two consecutive monthly intravitreal injections of brolucizumab, optical coherence tomography (OCT) showed first subretinal fluid resolution and then DPED collapse in the following months. After nine months, the best corrected visual acuity had improved from 20/40 to 20/20. There were no signs of retinal atrophy and exudative activity on OCT examination. No serious or minor adverse events were reported during the follow-up period. CONCLUSIONS: Switching to intravitreal brolucizumab injection might be an effective therapeutic option for treatment of mixed DPED with subretinal fluid refractory to other anti-VEGF drugs.

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial.

PURPOSE: To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. METHODS: In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. RESULTS: We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p=0.49). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group (p=0.22). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences (p=0.18). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group (p < 0.001). CONCLUSION: A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

Intraocular lens power calculation in eyes with keratoconus.

PURPOSE: To assess the refractive accuracy of different formulas for intraocular lens (IOL) power calculation in eyes with keratoconus. SETTING: IRCCS Fondazione Bietti, Rome, Italy. DESIGN: Multicenter retrospective interventional study. METHODS: A consecutive series of eyes with keratoconus that had cataract surgery were evaluated. Keratometry, anterior chamber depth, and axial length were measured preoperatively with optical biometry; IOL power was calculated with the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. Subjective refraction was assessed at 1 month. The mean prediction error (PE), median absolute error (MedAE) and percentage of eyes with a PE within ±0.50 diopters (D), ±0.75 D, and ±1.00 D were calculated. RESULTS: The final spherical equivalent was -0.52 D ±1.61 (SD). In the whole sample (41 eyes), the mean PE was positive (hyperopic surprise) with all formulas; the lowest PE (0.91 D) and MedAE (0.62 D) were obtained with the SRK/T formula. In stage I eyes (n = 21), the MedAE ranged between 0.43 and 0.91 D; the SRK/T formula achieved the lowest MedAE and the highest rate of eyes with a PE within ±0.50 (61.9%). In stage II eyes (n = 13), the MedAE ranged between 0.75 D and 1.50 D; the SRK/T formula achieved the lowest MedAE and the highest rate of eyes with a PE within ±0.50 (30.8%). In stage III eyes (n = 7), the MedAE was higher than 2.50 D with all formulas. CONCLUSIONS: In keratoconus eyes, all formulas led to a hyperopic refractive outcome. The SRK/T was the most accurate formula. The results were worse in advanced stages of the disease.

Comparison of deep sclerectomy with implant and combined glaucoma surgery.

To evaluate the efficacy of combined glaucoma surgery, 42 glaucomatous patients were randomly divided into two groups: deep sclerectomy with implant (DS) alone was performed in 21 patients, and combined deep sclerectomy and phacoemulsification (PDS) was performed in the other 21 patients. Follow-up was carried out at regular intervals for 12 months. A comparative study on intraocular pressure (IOP) was designed. Although further study is needed, PDS appears to have better postoperative long-term results in IOP control than DS alone.