Aflibercept for Diabetic Macular Edema in Real-Life Practice in GREece: Three-Year Outcomes of the ADMIRE Study.

PURPOSE: To evaluate the efficacy and safety of intravitreal aflibercept injections for diabetic macular edema (DME) treatment in a tertiary referral center in Greece. METHODS: ADMIRE was a prospective, observational cohort study of patients with DME. Efficacy was assessed by change in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to month 36 after treatment with intravitreal aflibercept in treatment-naive patients and previously treated patients. Safety was evaluated by recording any patients-reported events. RESULTS: Participants in the study were 94 patients with DME, 70 treatment naive and 24 previously treated with ranibizumab. At month 36 of the follow-up period, the mean change in BCVA was +7.4 letters compared to baseline (p < .001). The mean change in BCVA in treatment-naive patients was +8.9 letters and differed significantly compared to previously treated patients (+5.9 letters, p = .041). In addition, patients who received a loading dose of 5 monthly injections at the initiation of treatment provided better VA outcomes (+11.4 vs. +6.1 letters, p < .001). Accordingly, the mean CST at month 36 (369.6 ± 72.8 µm) was significantly decreased compared to baseline (479.2 ± 68.3 µm, p < .001). Overall, the mean number of injections at month 36 was 13.4. Safety analysis showed that the reported ocular adverse events during the 36-month study period were mild and not sight-threatening. CONCLUSION: Intravitreal aflibercept was found to be safe and effective for the treatment of DME in real-life in a Greek population. Treatment-naive patients and those who received a loading dose of five consecutive monthly injections at initiation of treatment exhibited better outcomes, suggesting that early and effective treatment may prevent vision loss.

Optical Coherence Tomography Angiography Changes in Macular Area in Patients with Proliferative Diabetic Retinopathy Treated with Panretinal Photocoagulation.

BACKGROUND: The purpose of this study was to investigate the changes in macular microvasculature using optical coherence tomography angiography (OCTA) in association with functional changes in patients with proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) with a follow up of 12 months. METHODS: The participants in this study were 28 patients with PDR and no macular oedema, who were eligible for PRP. All participants underwent best-corrected visual acuity (BCVA) measurement, optical coherence tomography (OCT), and OCT angiography (OCTA) at baseline (before treatment) and at months 1, 6, and 12 after the completion of PRP treatment. The comparison of OCTA parameters and BCVA between baseline and months 1, 6, and 12 after PRP was performed. RESULTS: There was a statistically significant decrease in foveal avascular zone (FAZ) area at months 6 and 12 of the follow-up period compared to baseline (p = 0.014 and p = 0.011 for month 6 and 12, respectively). Of note is that FAZ became significantly more circular 6 months after PRP (p = 0.009), and remained so at month 12 (p = 0.015). There was a significant increase in the mean foveal and parafoveal vessel density (VD) at all quadrants at the superficial capillary plexus (SCP) at month 6 and month 12 after PRP compared to baseline. No difference was noticed in VD at the deep capillary plexus (DCP) at any time-point of the follow up. BCVA remained the same throughout the follow-up period. CONCLUSIONS: At months 6 and 12 after PRP, foveal and parafoveal VD at SCP significantly increased compared to baseline, while the FAZ area significantly decreased and FAZ became more circular.

Evolution of macular atrophy in eyes with neovascular age-related macular degeneration compared to fellow non-neovascular eyes.

PURPOSE: Τo evaluate the evolution of macular atrophy (MA) in patients with neovascular AMD (nAMD), compared with their fellow eyes exhibiting dry AMD (dAMD). METHODS: This retrospective study included 124 patients from three centers treated with anti-VEGF in their nAMD eye and having dAMD in the fellow eye. Patients without MA at baseline were analyzed to study the time to first MA development. Synchronous and unsynchronous time course of MA was also studied. MA was evaluated using near-infrared images, while all available optical coherence tomography (OCT) images were used to confirm the criteria proposed by the Classification of Atrophy Meetings group for complete MA. RESULTS: MA first detection in nAMD eyes increased significantly from year 2 to 6 compared to dAMD eyes. Over the study's follow-up, 45.1% of nAMD-E developed MA, compared to 16.5% of fellow eyes (p < 0.001). When MA in the two eyes was compared in a synchronous paired manner over 4 years, nAMD eyes had an average MA progression rate of 0.275 mm/year versus 0.110 mm/year in their fellow dAMD eyes. Multivariate ANOVA revealed significant time (p < 0.001), eye (p = 0.003), and time-eye interaction (p < 0.001) effects. However, when MA did develop in dAMD eyes and was compared in an asynchronous manner to MA of nAMD eyes, it was found to progress faster in dAMD eyes (dAMD: 0.295 mm/year vs. nAMD: 0.176 mm/year) with a significant time-eye interaction (p = 0.015). CONCLUSIONS: In this study, a significant difference in MA incidence and progression was documented in eyes with nAMD under treatment, compared to fellow eye exhibiting dAMD. Eyes with nAMD tended to develop more MA compared to fellow dAMD eyes. However, when atrophy did develop in the fellow dAMD eyes, it progressed faster over time compared to MA in nAMD eyes.

Branch Retinal Vein Occlusion After COVID-19 Infection: A Case Report.

A 65-year-old male patient presented to the ED complaining of blurred vision in the left eye for the last three days. The patient had just recovered from COVID-19 infection and had a negative polymerase chain reaction (PCR) test two days after the initiation of symptoms. His family and medical history were clear. Ophthalmological examination and imaging revealed branch retinal vein occlusion (BRVO) with macular edema in the left eye, while the right eye was normal. The visual acuity was 6/6 in the right eye and 6/36 in the left eye. Laboratory tests, as well as the full cardiovascular and thrombophilia evaluation, were normal. Since the patient did not have known risk factors for BRVO, we hypothesize that it was related to COVID-19 infection. However, the causality between the two entities remains under investigation.

Correlation Between Imaging Morphological Findings and Laboratory Biomarkers in Patients with Retinal Vein Occlusion.

INTRODUCTION: The aim of this study was to investigate the possible correlation between peripheral blood biomarkers and morphological characteristics of retinal imaging in patients with retinal vein occlusion (RVO). METHODS: Participants in this cross-sectional observational study were 65 consecutive patients (65 eyes) with treatment-naïve RVO, who underwent spectral-domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA). In addition, peripheral blood samples were taken to evaluate full blood count and biochemical parameters. The association between imaging characteristics and laboratory parameters was examined. RESULTS: Eyes with subretinal fluid presented significantly higher neutrophil-to-lymphocyte ratios (p = 0.028). Hyperreflective foci on SD-OCT were found to be associated with higher triglyceride levels (p = 0.024). The presence of cysts on SD-OCT was associated with significantly higher triglycerides (p = 0.010). Central subfield thickness (CST) higher than 464 µm was associated with higher lymphocyte count (p = 0.016) and higher urea (p = 0.015). No significant associations were found between laboratory parameters and intraretinal fluid, ellipsoid zone and external limiting membrane condition, or epiretinal membrane and macular ischemia. CONCLUSIONS: Specific imaging morphological characteristics were found to be associated with laboratory parameters in patients with RVO. These findings may help reveal the pathophysiology of RVO and its correlation with the development of specific clinical signs, while they could guide individualized treatment.

Co-existence of Age-Related Macular Degeneration and Diabetic Retinopathy in a Tertiary Referral Center in Greece.

PURPOSE: To investigate the co-existence of diabetic retinopathy (DR) and age-related macular degeneration (AMD), based on five-year data in a University setting. METHODS: Participants in the study included 1739 patients with diabetes mellitus, who were examined in our setting from 2015 to 2019. The presence of DR and AMD was recorded while the clinical characteristics of patients were evaluated. RESULTS: In our study sample, 183 out of 1739 patients with diabetes mellitus (10.5%) were diagnosed with AMD, 116 without any sign of DR, and 67 with DR. In the group of patients with DR, dry AMD was noticed mostly in patients with mild non-proliferative DR (NPDR) (11.5% dry AMD) compared to those with moderate NPDR (4.5% dry AMD), severe NPDR (4.2%) and proliferative DR (PDR) (2.4%). Similar results were found for neovascular AMD (3% in mild NPDR, 1.9% in moderate NPDR, 1% in severe NPDR, and 1.8% in PDR). There was a significant correlation between the co-existence of both diseases and the severity of DR, with AMD being less prevalent in patients with more severe DR. In patients with diabetic macular edema, dry AMD was observed in 12 (4.6%) and neovascular AMD in nine (3.4%). CONCLUSIONS: The five-year prevalence of AMD in DR patients was 9% while in diabetic patients without DR it was found to be 11.5%. Therefore, the co-existence of DR and AMD is not common, suggesting that DR may be protective for AMD development.

The impact of laboratory findings and optical coherence tomography biomarkers on response to intravitreal anti-VEGF treatment in patients with retinal vein occlusion.

AIMS: To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with retinal vein occlusion (RVO). METHODS: Participants in this prospective study were 53 patients with treatment naïve macular edema secondary to RVO, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity measurement, dilated fundoscopy, optical coherence tomography and fluorescein angiography (FFA), while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as "favorable" or "non-response". Potential associations between laboratory/imaging biomarkers and treatment response were assessed. RESULTS: Univariate analysis showed that "favorable" response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST) < 464 µm (p < 0.001), absence of subretinal fluid (p = 0.004), absence of hyperreflective foci (HF) (p = 0.004), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p < 0.001 and p = 0.001, respectively), absence of epiretinal membrane (ERM) (p = 0.020) and absence of macular ischemia on FFA (p < 0.001), while increased monocytes-to-lymphocytes ratio was also associated with "favorable" treatment response (p = 0.010). All other laboratory parameters did not reach statistical significance. However, at the multivariate analysis, EZ and ELM status, HF, macular ischemia and monocytes-to-lymphocytes ratio were found to be independent predictors of treatment response. CONCLUSIONS: Intact EZ and ELM, absence of HF, absence of macular ischemia and increased monocytes-to-lymphocytes ratio at baseline can predict "favorable" treatment response in patients with treatment naïve macular edema secondary to RVO.

The Impact of Laboratory Findings and Optical Coherence Tomography Biomarkers on Response to Intravitreal Anti-VEGF Treatment in Patients with Diabetic Macular Edema.

PURPOSE: To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with diabetic macular edema (DME). METHODS: The study included 36 treatment naïve patients with DME, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity (BCVA) measurement, dilated fundoscopy, optical coherence tomography, color fundus photography and fluorescein angiography, while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as "favorable" or "non-response". Potential associations between laboratory/imaging biomarkers and treatment response were assessed. RESULTS: Univariate analysis showed that favorable response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST)≤405 µm (p < .001), absence of subretinal fluid (p = .034), absence of exudates (p = .041), absence of disorganization of the inner retinal layers (p = .037), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p < .001 and p = .002, respectively), absence of epiretinal membrane (ERM) (p = .040) and absence of macular ischemia (p = .042), while increased lipoprotein(a) was associated with no treatment response (p = .025). At the multivariate analysis, CST was found to be independent predictor of treatment response, while EZ, ELM and ERM were found to predict treatment response perfectly and they could not be entered in the model. CONCLUSION: Intact EZ and ELM, absence of ERM and CST≤405 µm at baseline can predict favorable treatment response in patients with treatment naïve DME, while no correlation with baseline laboratory parameters was found.

Evolution of macular microvasculature and retinal layers alterations in patients with macula off retinal detachment after vitrectomy.

PURPOSE: To examine the changes in retinal microvasculature in association with retinal layers' condition in patients with rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). METHODS: Participants in this study were 89 patients with macula off RRD, who were successfully treated with PPV and gas tamponade without internal limiting membrane peeling, in two centers. All participants underwent best corrected visual acuity (BCVA) measurement, slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) at week 5, month 3 and month 6 postoperatively. The fellow untreated eyes were also examined and served as control data. RESULTS: A statistically significant enlargement in foveal avascular zone (FAZ) in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), accompanied with a statistically significant thinning of inner retinal layers, was noticed 5 weeks postoperatively. These changes, namely FAZ enlargement and thinning of inner retinal layers, in the operated eyes compared to the fellow eyes, remained unchanged till month 6 postoperatively. BCVA improved significantly from week 5 to months 3 and 6 postoperatively. The improvement in BCVA was associated with the gradual ellipsoid zone (EZ) recovery from the first (week 5) till the last examination (month 6). CONCLUSIONS: The FAZ enlargement in the operated eyes was accompanied with a statistically significant thinning in the inner retinal layers. Inter-correlation of BCVA and EZ integrity was noticed.

Disentangling the association between retinal non-perfusion and anti-VEGF agents in diabetic retinopathy.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in patients with DM. In the pathogenesis of DR, chronic hyperglycemia leads to biochemical and structural alterations in retinal blood vessels' wall, resulting in hyperpermeability and non-perfusion. Since vascular endothelial growth factor (VEGF) has been found to play a significant role in the pathogenesis of DR, this review sheds light on the effect of intravitreal anti-VEGF agents on retinal non-perfusion in patients with DR. Based on the existing literature, anti-VEGF agents have been shown to improve DR severity, although they cannot reverse retinal ischemia. The results of the published studies are controversial and differ based on the location of retinal non-perfusion, as well as the imaging modality used to assess retinal non-perfusion. In cases of macular non-perfusion, most of studies showed no change in both fundus fluorescein angiography (FFA) and optical coherence tomography (OCTA) in patients with DR treated with intravitreal anti-VEGF agents, while few studies reported worsening of non-perfusion with enlargement of foveal avascular zone (FAZ). Regarding peripheral ischemia, studies using wide-field-FFA demonstrated an improvement or stability in non-perfusion areas after anti-VEGF treatment. However, the use of wide-field-OCTA revealed no signs of re-perfusion of retinal vessels post anti-VEGF treatment. Further prospective studies with long follow-up and large sample size are still needed to draw solid conclusions.

Efficacy and safety of vitamin supplements with resveratrol in diabetic macular edema: Long-term results of a comparative study.

PURPOSE: To investigate the adjunct efficacy and safety of vitamin supplements, including resveratrol, in patients with diabetic macular edema (DME) treated with intravitreal anti-vascular endothelial factor (anti-VEGF) agents. METHODS: Participants in this prospective study were 45 patients with DME, who were treated with either intravitreal anti-VEGF injections (n = 23, Group I) or with combination of intravitreal anti-VEGF injections and vitamin supplements, including resveratrol (n = 22, Group II). All patients underwent visual acuity measurement, slit-lamp examination and spectral domain-optical coherence tomography (SD-OCT) at baseline and monthly after the loading phase of three-monthly anti-VEGF injections, following a PRN protocol. RESULTS: There was a statistically significant improvement in visual acuity in both groups at month 12 compared to baseline, although the mean change in visual acuity did not differ between the two groups (p = 0.183). Accordingly, there was a statistically significant decrease in central retinal thickness in both groups at month 12 compared to baseline, while the mean difference in central retinal thickness was significantly greater in the "combination" group. The mean number of intravitreal anti-VEGF injection was less in Group II (6.45 ± 1.12 in Group II vs. 7.39 ± 1.31 in Group I, p = 0.018). CONCLUSIONS: Vitamin supplements with resveratrol was found to be an effective adjunct to intravitreal anti-VEGF injections in patients with DME, offering better anatomic restoration with less injections at the 12-month follow-up.

Cancer-associated retinopathy 4 years after surgery for ovarian cancer.

A 71-year-old woman presented with progressive, bilateral, blurred vision and nyctalopia for the last 6 months. Her past medical history included total hysterectomy and chemotherapy for ovarian cancer 4 years ago, without metastases. Optical coherence tomography revealed outer retinal layers' thinning bilaterally, while diffuse retinal pigment epithelium abnormalities were found in fundus autofluorescence. Full-field electroretinogram showed abnormalities in both a- and b-waves with significant reduction of retinal sensitivity, affecting however more the rod system. The patient was positive for alpha-enolase and was diagnosed with cancer-associated retinopathy (CAR), which developed 4-year primary cancer. Computerized tomography scan revealed an enlarged para-aortic lymph node at the left kidney, and the patient was started on chemotherapy, combined with immunosuppressive treatment. In conclusion, CAR should be suspected in patients experiencing unexplained visual disturbances, especially in the context of previous cancer.

Correlation between Imaging Morphological Findings and Laboratory Biomarkers in Patients with Diabetic Macular Edema.

PURPOSE: To investigate the potential association between peripheral blood biomarkers and morphological characteristics of retinal imaging in patients with diabetic macular edema (DME). METHODS: Participants in this cross-sectional study were 36 consecutive patients (36 eyes) with treatment-naïve DME, who underwent spectral domain-optical coherence tomography (SD-OCT), fundus photography, and fundus fluorescein angiography (FFA). In addition, peripheral blood samples were taken to evaluate full blood count and biochemical parameters. Correlation between imaging characteristics and laboratory parameters was examined. RESULTS: Eyes with central subfield thickness greater than 405 µm presented significantly higher neutrophils/lymphocytes (p = 0.043) and higher lipoprotein (a) compared to eyes with CST < 405 µm (p = 0.003). Presence of hyperreflective foci on SD-OCT was associated with significantly higher white blood cell count (p = 0.028). Ellipsoid zone disruption was associated with significantly lower hematocrit (p = 0.012), hemoglobin (p = 0.009), and red blood cell count (p = 0.026), as well as with higher lipoprotein (a) (p = 0.015). Macular ischemia on FFA was associated with significantly higher monocytes (p = 0.027) and monocytes/HDL (p = 0.019). No significant associations were found between laboratory parameters and subretinal fluid, intraretinal fluid, exudates, cysts, disorganization of inner retinal layers, epiretinal membrane, and external limiting membrane condition. CONCLUSION: Specific imaging morphological characteristics were found to be associated with laboratory parameters in patients with DME. These findings may shed light on the pathophysiology of DME and its correlation with the development of specific clinical signs.

Chemical synthesis of C6-tetrazole á´ -mannose building blocks and access to a bioisostere of mannuronic acid 1-phosphate.

Alginate is a biocompatible and industrially relevant polysaccharide that derives many of its important properties from the charged carboxylate groups within its polyuronic acid backbone. The design and inclusion of isosteric replacements for these carboxylates would underpin provision of new oligo-/polysaccharide materials with alternate physicochemical properties. Presented herein is our synthesis of mannuronic acid building blocks, appropriately modified at the carboxylate C6 position with a bioisosteric tetrazole. Thioglycosides containing a protected C6-tetrazole are accessed from a C6-nitrile, through dipolar cycloaddition using NaN3 with n-Bu2SnO. We also demonstrate access to orthogonally C4-protected donors, suitable for iterative oligosaccharide synthesis. The development of these building blocks is showcased to access anomeric 3-aminopropyl- and 1-phosphate free sugars containing this non-native motif.

Effect of COVID-19-Associated Lockdown on Patients With Diabetic Retinopathy.

Purpose To evaluate the effect of the coronavirus disease 2019 (COVID-19)-related lockdown in the management of patients with diabetic retinopathy (DR), including diabetic macular edema (DME), in a tertiary reference center in Greece. Methods In this retrospective study, we first compared the number of patients who were diagnosed with DR or DME in our clinic during the period of the lockdown and during the same period of the previous year. In addition, we included consecutive patients with DR or DME, who were followed up and treated regularly in our clinic and their appointments deferred due to lockdown, so as to compare the visual acuity, fundoscopy, and optical coherence tomography (OCT) findings prior to and post lockdown. Results During the lockdown period, there was a statistically significant decrease in patients with DR and DME as compared to the same period in the previous year. Regarding patients with previously diagnosed DME, there was a statistically significant worsening in their visual acuity and central retinal thickness after lockdown as compared to the last visit before lockdown (p<0.001 for both comparisons). Concerning patients diagnosed with DR and without DME before lockdown, 30% of patients with severe non-proliferative diabetic retinopathy (NDPR) and 8.3% of patients with quiescent proliferative DR (PDR) progressed to active PDR while four out of 107 patients (3.7%) developed DME during the lockdown. Multivariate regression analysis revealed that only the time interval between the last visit before lockdown and the first visit after the lockdown was associated with the best-corrected visual acuity (BCVA) change (p=0.017). Conclusions The COVID-19-related lockdown was related to the postponement in patient care, which resulted in significantly worse visual acuity outcomes in patients with DR.

Evaluation of morphological characteristics of diabetic macular edema in patients with non-proliferative versus proliferative diabetic retinopathy: a spectral-domain optical coherence tomography study.

PURPOSE: To evaluate the morphological characteristics in patients with diabetic macular edema (DME), either with co-existent non-proliferative diabetic retinopathy (NPDR) or with PDR. METHODS: Retrospective study includes 138 treatment naïve patients with DME, either with NPDR (n = 96) or in combination with PDR (n = 42). All patients underwent best corrected visual acuity (BCVA) measurement, spectral domain-optical coherence tomography (SD-OCT) and fluorescein angiography, while demographic characteristics were also recorded. Specific clinical and morphological characteristics were analyzed and compared between the two groups. RESULTS: Patients with DME and PDR presented higher central retinal thickness and mixed type of edema, with predominantly cystoid component and large cysts, extending in the foveal, peri- and para-foveal area, compared to patients with DME and NPDR. The presence of non-perfusion areas in patients with DME and PDR led to additional ellipsoid zone and external limiting membrane disruption in a higher percentage, accompanied with worse visual acuity compared to patients with DME and NPDR. Patients with DME and PDR had also higher vitreomacular traction percentage and higher HbA1c levels than those with DME and NPDR. CONCLUSION: Variations in morphological characteristics of DME on SD-OCT existed between patients with NPDR and those with PDR. These differences may explain the alterations in visual acuity and prognosis.

The effect of intravitreal anti-vascular endothelial growth factor injections on corneal endothelium in patients with diabetic macular oedema.

PURPOSE: To evaluate the characteristics of corneal parameters in patients with diabetic macular oedema (DME) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: Participants in this study were 36 patients with DME, treated with either intravitreal ranibizumab (n = 16) or aflibercept (n = 20). All participants underwent best-corrected visual acuity (BCVA) measurement, optical coherence tomography and non-contact specular microscopy to evaluate corneal endothelium parameters (endothelial cell density-ECD, hexagonality, coefficient of variation of the cell size and central corneal thickness-CCT), at baseline and at months 6 and 12 after the first intravitreal injection. Comparisons between baseline and months 6 and 12 were performed. RESULTS: There was no statistically significant difference regarding ECD, hexagonality, coefficient of variation of the cell size and CCT at month 6 and 12 post initial injection compared to baseline in patients with DME. BCVA improved significantly at month 6 and 12 compared to baseline (p < 0.001 for both comparisons). Central retinal thickness was significantly reduced at month 6 and 12 compared to baseline (p < 0.001 for both comparisons). CONCLUSION: Intravitreal anti-VEGF injections in patients with DME were found not to affect corneal parameters, namely ECD, hexagonality, coefficient of variation of the cell size and CCT at the long-term follow-up of 12 months.

Predictive Factors for Long-Term Postoperative Visual Outcome in Patients with Macula-Off Rhegmatogenous Retinal Detachment Treated with Vitrectomy.

PURPOSE: The purpose of this prospective study was to evaluate potential predictive factors of long-term postoperative outcomes in patients with macula-off rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). METHODS: Participants in this study were 86 patients diagnosed with macula-off RRD, who underwent PPV. Demographic characteristics and preoperative characteristics of RRD were recorded, while best corrected visual acuity (BCVA) was measured preoperatively and at specific postoperative time points (6 weeks and 6, 12, and 24 months). In addition, spectral domain-optical coherence tomography (SD-OCT) characteristics at postoperative week 6 were assessed as potential factors affecting the long-term postoperative visual outcome 24 months after PPV for RRD. RESULTS: Increasing age, duration of RD of more than 1 week, presence of proliferative vitreoretinopathy, increasing central retinal thickness, ellipsoid zone disruption, and external limiting membrane disruption were significantly associated with a worse BVCA. BCVA was not associated with gender, lens status, the location of breaks, the gas tamponade agent used in PPV, the presence of subretinal fluid, and intraretinal fluid. CONCLUSIONS: It is important to determine predictive factors for visual outcomes in order to inform patients about their prognosis and help in the decision-making process for patient management.

Macular Edema after Successful Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Factors Affecting Edema Development and Considerations for Treatment.

Purpose: To investigate the incidence of macular edema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair, the factors affecting its development and the efficacy of intravitreal dexamethasone implant for its treatment.Methods: Participants in this study 86 patients with RRD. All patients were examined postoperatively and those with macular edema were treated with intravitreal dexamethasone implant and were followed-up for 12 months.Results: 14 out of 86 patients presented macular edema post PPV for RRD repair. Patients with preoperative macula off RRD, duration of RRD >1 week and proliferative vitreoretinopathy were more prone to develop macular edema. There was a statistically significant improvement in best corrected visual acuity and central retinal thickness at month 12 post intravitreal dexamethasone implant compared to baseline.Conclusions: The incidence of macular edema post PPV for RRD repair was found to be 16.3%. Intravitreal dexamethasone implant seemed to be safe and effective in cases with post-PPV macular edema after RRD repair.

Multimodal Imaging for the Assessment of Geographic Atrophy in Patients with "Foveal" and "No-Foveal" Sparing.

INTRODUCTION: The aim of the study was to evaluate the applicability of optical coherence tomography (OCT) angiography (OCTA) for measuring geographic atrophy (GA) areas in age-related macular degeneration (AMD) patients with "foveal" and "no-foveal" sparing disease and compare it to other imaging modalities. METHODS: A multimodal imaging protocol was applied, using infrared (IR) imaging, fundus autofluorescence (FAF), OCTA, and en-face OCT in 35 eyes of 23 AMD patients with GA. Patients were classified into 2 groups, with and without foveal sparing disease. GA area measurements for all imaging modalities were compared for each group separately. RESULTS: The measured GA area was estimated to be 6.68 ± 3.18 mm2 using IR; 6.99 ± 3.09 mm2 using FAF; 6.56 ± 3.11 mm2 using OCTA, and 6.65 ± 3.14 mm2 using en-face OCT. There was no statistically significant difference in the GA area between different modalities (p = 0.977). When separate analysis was conducted for patients with "foveal" and "no-foveal" sparing disease, although GA measurements in FAF imaging displayed higher numerical values than the other modalities, especially in patients with foveal sparing, no statistically significant difference in the GA area was found between the different imaging modalities in either group (p = 0.816 for foveal sparing; p = 0.992 for no-foveal sparing group). CONCLUSIONS: OCTA can be reliably used in the assessment of GA in AMD patients with and without foveal sparing disease. For both groups, measurements are comparable to IR, en-face OCT, and FAF, despite the fact that the latter recorded larger area of GA, mainly in the foveal sparing cases.