Impact of inverted internal limiting membrane-flap technique on functional outcome and structural restoration of small and medium size macular holes.

Purpose: To evaluate the impact of the inverted internal limiting membrane (ILM)-flap technique on the visual outcome and anatomical recovery for small (<250 µ), medium (<400 µ), and large (>400 µ) macular holes (MHs). Methods: Retrospective study included consecutive idiopathic MH cases operated on using the inverted ILM-flap technique. Clinical data were retrieved from electronic medical records (EMRs), surgical videos, and optical coherence tomography (OCT) machines. Eyes with axial length >25 mm, coexisting macular diseases, and follow-up <6 weeks were excluded. Data included the presence or absence of ILM flap and restoration of External Limiting Membrane (ELM), Ellipsoid Zone (EZ) lines. Mean visual improvement and structural recovery were compared between eyes showing ILM flap and those showing no flap in three MH size groups. Results: Forty eyes of 38 patients with a mean age of 62.7 ± 10.1 years and a mean MH diameter of 348 ± 152 µm were included. The mean follow-up was 527 ± 478 days with anatomical closure observed in all eyes. Mean best-corrected visual acuity (BCVA) improved significantly from 0.87 ± 0.38 to 0.35 ± 0.26. ILM flap was visible in 29 (72.5%) all MHs, 7 (53.8%) small MHs (n = 13), 8 (61.5%) medium MHs (n = 13), and 14 (100%) large MHs (n = 14). The mean BCVA change was 0.47 ± 0.34, 0.53 ± 0.48, and 0.56 ± 0.20 in large, medium, and small MHs, respectively, and the difference between eyes showing ILM flap versus no flap in each MH size group was not statistically significant (P > 0.05). However, for medium MHs, it was higher in the ILM flap (0.66 ± 0.52) group compared to the no flap (0.32 ± 0.37) group. One eye with small MH developed significant gliosis resulting in reduced BCVA. ELM was restored in all eyes with small and medium MHs. Conclusion: We observed that the ILM flap did not adversely affect anatomical and visual outcomes for MHs <400 µm. Restoration of ELM suggests minimal interference in structural recovery by an ILM flap.

Multiple Evanescent White Dot Syndrome Following Adenovirus Vector-Based COVID-19 Vaccine (Covishield).

PURPOSE: To report a case of multiple evanescent white dot syndrome (MEWDS) following adenovirus vector-based Coronavirus disease 2019 (COVID-19) vaccine, Covishield and to present a summary of previously reported cases of MEWDS following COVID-19 vaccines. METHODS: Retrospective case report and review of literature. RESULTS: A 22-year-old Indian female presented with blurred vision, scotomata, and photopsias in her left eye, a day after administration of second dose of Covishield vaccine. Her clinical findings and imaging features confirmed the diagnosis of MEWDS. Her symptoms resolved spontaneously after 2 weeks. CONCLUSION: This is the first reported case of MEWDS following an adenovirus vector-based COVID-19 vaccine. Comparison with previously reported cases of MEWDS following COVID-19 vaccination showed that patients are generally healthy, young to middle-aged women, who develop symptoms after a median time of one week and recover spontaneously over a median period of 4 weeks.

Bilateral neovascular age-related macular degeneration: unilateral regression following endophthalmitis with persistent activity in the fellow eye.

A woman in her 70s who was being followed up for neovascular age-related macular degeneration (nAMD) in both eyes for 2 years with recalcitrant choroidal neovascularisation (CNV) and had an episode of acute endophthalmitis in one eye was identified. After treatment of postinjection culture-negative right eye (RE) endophthalmitis with intravitreal vancomycin and tazobactam, the patient had complete regression of treatment-resistant CNV in RE to date with postinfection follow-up of 2 years. In contrast, the fellow eye continued showing activity in the choroidal neovascular membrane that required antivascular endothelial growth factor injections on a pro re nata basis to date. Prolonged regression of nAMD for 3 years in the affected eye and continued activity in the fellow eye support the hypothesis that inflammation accompanying endophthalmitis or the drugs used for the treatment can have a role in the regression of nAMD.

Virtual-reality headset mounted smartphone-based Indentation fundus videography.

To describe a simple and novel technique that overcomes the limitation of smartphone-based fundus photography and allows examiners to capture peripheral retinal images with indentation. Smartphone with video camera in flash-on mode was mounted on virtual-reality (VR) headset. This was combined with +28D lens and +20D lens and soft cotton bud to capture high-quality videos of peripheral fundus with indentation. Autofocus function of the camera and examiner's head movements to adjust the distance was used to obtain retinal video. The procedure is akin to indirect ophthalmoscopy. The feasibility of obtaining well-focused retinal images during indentation was checked. We could obtain good quality videos demonstrating indentation of the peripheral fundus in 10 eyes showing different pathologies such as laser marks, lattice degeneration, and pigmented lesions. VR headset-mounted smartphone-based indentation fundus videography is an innovative cost-effective technique to capture peripheral retinal images. The technique can be useful for documenting retinopathy of prematurity lesions and other situations where widefield photography is not possible.

Epiretinal Membrane from Uncontrolled Gliosis After Inverted ILM Flap Technique for Idiopathic Macular Hole.

We describe two cases with epiretinal membrane (ERM) from uncontrolled gliosis seen after multilayered inverted internal limiting membrane (ILM) flap technique for full thickness macular hole (FTMH). Two patients with FTMH who had undergone surgery with inverted ILM flap technique were examined by serial optical coherence tomography scans to evaluate the course of multilayered ILM flaps seen as foveal hyperreflective lesions postoperatively. We observed excessive uncontrolled gliosis over these hyperreflective ILM flaps with ERM formation, along with worsening metamorphopsia and best-corrected visual acuity. Case 1 underwent a repeat surgery for ERM. We report excessive uncontrolled gliosis as a rare complication of multilayered inverted ILM flap technique for FTMH. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:663-665.].

Arcuate Vitelliform detachment with morning glory disc maculopathy: OCT findings of evolution and resolution after early surgery.

Morning glory disc (MGD) is known to develop secondary maculopathy and vision loss. We followed a 7-year-old girl with MGD in right eye from 2010 to 2021. Her best-corrected Snellen visual acuity (BCVA) was 20/20 in both eyes till 2017. She presented with reduced vision in right eye with BCVA of 20/80 in 2018. Optical Coherence Tomography (OCT) revealed maculopathy related to MGD in right eye and arcuate Vitelliform neurosensory detachment (V-NSD) temporal to fovea. She underwent 25G vitrectomy with internal limiting membrane peeling. Resolution of retinoschisis and V-NSD was analysed by OCT and fundus autofluorescence (FAF) postoperatively. Arcuate V-NSD was hyperfluorescent on FAF and concentric to optic disc. It resolved slowly with BCVA improving to 20/20 at 18 and 30 months postoperatively. We report excellent outcome following early vitrectomy for MGD-related maculopathy and recommend serial follow-up and considering early vitrectomy whenever traction and BCVA worsens. We also describe arcuate V-NSD with MGD.

Intravitreal gas injection with prone positioning for giant retinal pigment epithelial tear.

We report a 78 year old male with acute RPE tear with sudden vision loss, who underwent intravitreal C3F8 injection for reattaching the RPE. The impact of gas on detached RPE was studied by serial OCTs and Fundus pictures.

Excellent visual outcome after vitrectomy for traumatic macular hole associated with choroidal rupture across papillomacular bundle.

PURPOSE: To report the visual result of Surgery for traumatic macular hole with choroidal rupture running across papillomacular bundle. METHOD: Observation case report Patient 20 year old male patient presented with acute vison loss in OS with BCVA reduced to 20/80 following blunt trauma. Examination revealed full thickness macular hole with choroidal rupture between disc and macula, spanning across papillomacular bundle (PMB) in OS. Patient underwent 25G Vitreous Surgery with ILM peeling and SF6 injection for OS. RESULTS: Macular hole was successfully closed at 4 weeks follow up and BCVA improved to 20/20. There was no postoperative complication. CONCLUSION: We report that Traumatic macular holes with associated choroidal rupture running through PMB can be successfully repaired with Vitreous surgery and these eyes may achieve good visual outcome.

Susceptibility of bacterial isolates to vancomycin and ceftazidime from patients with endophthalmitis: Is there a need to change the empirical therapy in suspected bacterial endophthalmitis?

To review the susceptibility of bacterial isolates to ceftazidime and vancomycin isolated from patients with endophthalmitis. Microbiology records of patients with endophthalmitis between June 2010 and May 2013 were reviewed. Vitreous and AC fluids obtained from patients with endophthalmitis were subjected to direct microscopy examination and culture. Antibiotic susceptibility of the isolates was performed by Kirby Bauer disk diffusion method. Resistant to ceftazidime in Gram negative bacteria (GNB) by disk diffusion method is confirmed by minimum inhibitory concentration using E test. Culture was positive for bacteria/Fungi in 224/356 patients (62.9 %). Out of 224 patients, 191 (85.2 %) patients showed bacterial growth and 33 (14.0 %) showed fungal growth. Mixed bacterial infection was seen in five patients. Among the GNB, 23/123 (18 %) of the isolates were resistant to ceftazidime, and all the Gram positive bacteria 73/73 (100 %) were susceptible to vancomycin. Sixteen of 123 (13 %) GNB were resistant to amikacin. Although there is an increase in resistance to ceftazidime compared to amikacin in GNB, amikacin intravitreal injection is associated with macular toxicity and no single antibiotic has full coverage for all GNB. Combination of vancomycin and ceftazidime empiric therapy can be continued in patients with suspected endophthalmitis and treatment is modified based on clinical response and susceptibility results.