INTRAVITREAL INJECTION OF AIR FOR THE TREATMENT OF VITREOMACULAR TRACTION.

PURPOSE: To study the efficacy of a single intravitreal injection of air as a valuable alternative to current treatment options (conservative, pharmacological, and surgical) in patients with symptomatic, focal vitreomacular traction. METHODS: Interventional, nonrandomized clinical study including a consecutive series of patients who underwent a single injection of 0.3 mL of air for vitreomacular traction. Each patient underwent best-corrected visual acuity, and spectral domain optical coherence tomography before and after the procedure. Mean maximal horizontal vitreomacular adhesion and a maximal foveal thickness were measured manually. RESULTS: Four eyes of four patients, all males, were included in the study. Mean age was 71 ± 6.7 years; mean best-corrected visual acuity was 0.3 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (20/40 Snellen equivalent). One month following treatment, complete resolution of vitreomacular traction was achieved in 100% of eyes. Mean visual acuity postinjection was 0.18 ± 0.09 logMAR (20/32 Snellen equivalent) (Student's t test for repeated measures P = 0.03). No correlation has been found between horizontal vitreomacular adhesion and best-corrected visual acuity or maximal foveal thickness and best-corrected visual acuity (P = 0.7 and P = 0.9, respectively). CONCLUSION: Intravitreal injection of air could offer a minimally invasive, low-cost alternative treatment in patients with symptomatic, persisting vitreomacular traction. Additional studies on a larger number of patients are required.

Pilot Evaluation of a New Surgical Technique for Persistent or Recurrent Large Macular Holes.

BACKGROUND AND OBJECTIVE: To describe a new surgical technique for persistent or recurrent large macular holes (MHs). PATIENTS AND METHODS: Patients with recurrent or persistent large MHs following vitrectomy with internal limiting membrane (ILM) peeling were recruited between October and September 2017 in this pilot study. All patients underwent preoperative and postoperative best-corrected visual acuity (BCVA), slit-lamp ophthalmoscopy, and spectral-domain optical coherence tomography (SD-OCT). This new technique consisted in autologous ILM patch transplantation on top of MH under perfluorocarbon liquid (PFCL) bubble, using SF6 as tamponade. The patients maintained a prone position for 3 days. RESULTS: Five eyes of five consecutive patients (two males, three females; mean age: 67.4 years) with recurrent (one patient) or persistent (four patients) MHs were successfully treated. At 1-month follow-up, mean BCVA increased from approximately 20/400 to approximately 20/63, and MHs were closed in all cases. Mean follow-up was 5 months ± 2.2 months (6 months for four out of five included eyes). Positive outcomes were consistent at last follow-up. CONCLUSION: This new technique consisting of autologous ILM patch transplantation on top of MH under PFCL bubble using SF6 as tamponade may represent a validated surgical option for persistent or recurrent large MHs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:266-268.].

Risk factors for graft failure after penetrating keratoplasty: 5-year follow-up from the corneal transplant epidemiological study.

PURPOSE: To evaluate corneal graft survival over a 5-year period and to investigate whether factors related to the donor, eye bank practices, the recipient, surgery, and postoperative course influenced the outcome. METHODS: Nine hundred ninety-eight patients were randomly selected and monitored in the subsequent 3 years from a cohort of 4500 recipients who underwent penetrating keratoplasty between 2001 and 2004. Cox univariate regression analysis was used to select variables to be included in a multivariate Cox proportional hazards model with a backward selection procedure to identify potential risk factors for graft failure. Graft survival curves were obtained from Kaplan-Meier estimates. RESULTS: Ectasia/thinning was the most common indication (49.1%), followed by regraft (16.1%) and pseudophakic corneal edema (PCE) (9.4%). The overall rate of graft failure was 10.7% with 6 cases of primary graft failure. Adverse reactions and complications (other than graft failure) were reported in 2.7% of patients in the first postoperative week and in 22.8% during the full follow-up period. The probability of 5-year survival was 83.0%, best in eyes with ectasia/thinning (96.0%) and less favorable in PCE (67.0%) and regraft (64.0%). Multivariate analyses showed the following variables to be linked to an increased risk of graft failure: regraft for any reason, all clinical indication except PCE, history of ocular inflammation/infection, pseudophakic/aphakic eye, vitrectomy, graft Descemet folds, adverse reactions/complications, and surgeons' low caseload. CONCLUSIONS: Penetrating keratoplasty shows an overall positive prognosis in the long-term. However, the probability of graft survival is largely dependent on the preoperative clinical condition and the lack of complications during follow-up.

Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab.

A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

Residual bubble of oxane hd: a study by optical coherence tomography and fundus-related perimetry.

PURPOSE: Oxane HD is a mixture of silicone oil and a mixed fluorinated and hydrocarbonated olefin. The authors report a complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil. METHODS: A 71-year-old man who underwent vitrectomy with Oxane HD presented with adherence of a residual bubble of Oxane HD in the macula after removal of all visible heavy silicone oil. In this patient OCT displayed an optical artifact due to the residual bubble, and fundus-related perimetry revealed a predominantly eccentric and relatively unstable fixation and very low macular sensitivity. RESULTS: After surgical removal of the residual bubble, metamorphopsia resolved, sensitivity improved as revealed by fundus-related perimetry, and fixation became predominantly central and more stable. CONCLUSION: The authors suggest a way to manage this rare complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil.

Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy.

PURPOSE: To describe our experience treating diplopia after orbital decompression in patients with thyroid orbitopathy. PATIENTS AND METHODS: From May 1997 to July 2001, we performed orbital decompression on 102 patients (34 men and 68 women) with severe proptosis. In 10 (9.8%) of these patients who had no diplopia preoperatively, diplopia in primary gaze occurred after decompression. In 19 (18.6%) of the patients with diplopia in primary gaze before surgery, there was no modification of diplopia after decompression. In 24 (23.5%) of the patients with diplopia in primary gaze before surgery, a more severe imbalance occurred after decompression. Forty-four (83%) of these 53 patients underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. In 9 (17%) of the patients, diplopia was resolved with the use of prismatic lenses. RESULTS: In 31 (70.4%) of 44 patients, we obtained a stable resolution of diplopia in primary position (minimum follow-up, 6 months). In 10 (22.7%) of these patients, a second surgery on the oblique muscles was necessary 6 months after the first surgery to resolve torsional diplopia. In 3 (6.8%) of the patients, diplopia has been resolved with prismatic lenses. CONCLUSION: Orbital decompression reduces proptosis, but may cause diplopia or worsen it.