Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?

Purpose: We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). Methods: A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥20/50 and a PDR-associated macula-involving TRD of >6 months duration with a minimum follow-up of 12-months. Results: There were 58 patients analyzed over an average follow-up period of 27.6 (±7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (-0.30 ±0.52 logMAR). Although the rates of maintaining ≥20/200 Snellen VA and ≥20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥2 lines of VA during the study period (p=0.002). Conclusion: Patients presenting with good VA and a PDR-associated macula-involving TRD of >6 months were more likely to gain ≥2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred.

Topography-Guided LASIK: A Prospective Study Evaluating Patient-Reported Outcomes.

Purpose: To evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK). Methods: Patients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire. Results: Forty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87-4.26) to 5.00 (4.81-5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively. Conclusion: Patient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large.

One Year Results of Faricimab for Aflibercept-Resistant Diabetic Macular Edema.

Purpose: To assess the 12 month outcomes of intravitreal faricimab (IVF) in treatment-resistant diabetic macular edema (DME) recalcitrant to intravitreal aflibercept (IVA). Methods: This study was undertaken as a retrospective interventional case series of DME subjects receiving care at a single private practice facility. Subjects at baseline had undergone ≥8 IVA injections over the previous 12 months, ≥4 IVA injections over the previous 6 months, had an optical coherence tomography (OCT)-measured central macular thickness (CMT) of ≥320 microns, and had observable edema on OCT. The baseline visit for this study's purpose was considered the examination in which the subject was changed from IVA to IVF. Subjects were managed with a treat-and-extend (TAE) protocol and followed over 12 months from baseline. Results: A total of 51 eyes of 51 subjects were analyzed. There were 39.2% (20/51) of patients who reached a treatment interval of ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT of the patient population reduced from 400.2 (385.3-415.3) microns at baseline to 340.6 (324.3-356.9) microns at 12 months (p<0.01). There were 21.6% (11/51) of patients who improved ≥3 lines of Snellen visual acuity at 12 months. The visual acuity of the overall study population improved from 0.60 (0.54-0.66) logMAR (Snellen 20/80) at baseline to 0.47 (0.41-0.53) logMAR (Snellen 20/59) at 12 months (p<0.01). Conclusion: A longer treatment interval and improved functional and anatomical outcomes at 12 months may be attained in a clinically significant minority of aflibercept-resistant DME patients after changing to IVF when a TAE protocol is employed. Specialists may consider IVF whenever resistance to IVA is experienced in this patient population.

One-Year Outcomes of Faricimab Treatment for Aflibercept-Resistant Neovascular Age-Related Macular Degeneration.

Purpose: To assess the 12-month outcomes of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects recalcitrant to intravitreal aflibercept (IVA). Methods: This study was conducted as a retrospective interventional case series of nAMD patients receiving treatment at a single private practice institution. All included patients at baseline had undergone six or more IVA injections over the previous 12 months, four or more IVA injections over the previous 6 months, had a central macular thickness (CMT) ≥320 µm on optical coherence tomography (OCT), and were observed to have intraretinal and/or subretinal fluid on OCT assessment. The baseline exam for the purpose of this study was considered the visit in which the patient was switched from IVA to IVF. Patients were managed with a real-world treat-and-extend protocol and followed over a 12-month study period. Results: A total of 54 eyes of 54 subjects were analyzed. Overall, 31.5% (17/54) of subjects attained a treatment interval ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT decreased from 395.4 (383.5-407.3) µm at baseline to 350.0 (335.1-364.8) µm at the end of the 12-month study interval (p<0.01). There were 16.7% (9/54) of subjects who gained three or more lines of Snellen visual acuity at the end of the study. Visual acuity improved from 0.72 (0.67-0.77) logMAR (Snellen 20/105) at baseline to 0.59 (0.55-0.64) logMAR (Snellen 20/78) at the end of the study (p<0.01). Conclusion: A clinically significant minority of aflibercept-resistant nAMD subjects may attain longer treatment intervals and improved outcomes at 12 months after switching to IVF when a treat-and-extend treatment protocol is utilized. IVF use may be considered whenever resistance to IVA is encountered in this patient population.

Patient-Reported Dry Eye Outcomes After Myopic Femtosecond-LASIK: A 6-Month Prospective Analysis.

Purpose: To evaluate patient-reported outcomes in relation to dry eye symptoms following femtosecond LASIK (FS-LASIK). Methods: This study was conducted as a prospective, observational case series of patients undergoing bilateral myopic FS-LASIK at a single private practice institution. Enrolled patients were prospectively administered a standardized Dry Eye Symptom Index survey (analog score of 1 to 5 with 5 being the worst) prior to treatment and at 6-months after FS-LASIK. The following objective measurements were also recorded: objective scatter index (OSI), tear film osmolarity (TFO), and automated tear break-up times (TBUT). Results: There were 40 enrolled patients who underwent bilateral myopic FS-LASIK and completed the 6-month study period. The Dry Eye Symptom Index score improved from 2.3 (2.0-2.6, 95% Confidence Intervals) prior to treatment to 1.3 (1.0-1.5) at 6 months (p < 0.0001). Subset analysis of the subjective dry eye symptoms showed improvement in "grittiness" (p = 0.001) but not in "light sensitivity" or "soreness" (p = 0.13 and p = 0.24, respectively). There were no significant changes in the OSI, TFO, or TBUT measurements at 6 months (p > 0.05 for all), and there were no adverse events or complications during the study period. Conclusion: Patient-reported dry eye symptoms improve after 6 months following myopic FS-LASIK. This did not correlate with the objective dry eye measurement changes at 6 months.

Timing of the Initial Postoperative Care After Cataract Surgery: A Patient's Perspective.

Purpose: To evaluate patient preferences in regards to the timing of the initial postoperative examination after undergoing cataract surgery. Methods: A retrospective, consecutive case series analysis from a single private practice institution was performed using a standardized phone survey on patients who underwent cataract surgery. Subjects were classified into one of two possible study groups according to the timing of their initial postoperative cataract surgery examination: Group A received the initial postoperative cataract surgery examination on the same day as the surgery, whereas Group B received the initial postoperative cataract surgery examination on the day following the operation. Results: There were 80 subjects contacted for the phone survey of which 70 (35 in each study group) completed the survey and therefore were included in the analysis. Group A subjects responded favorably in regards to preference and realizing reduced time and cost savings compared to Group B (p < 0.0001 for both). There were no subjects in Group A who would have preferred next-day initial postoperative care, whereas 31.4% of subjects in Group B would have preferred same-day care if given the opportunity. Conclusion: Patients undergoing cataract surgery both prefer and report time and cost savings with same-day initial postoperative care compared to next-day initial postoperative care. Patient preferences regarding their postoperative care should be one of the many factors that a surgeon ought to take into consideration when providing follow-up care after cataract surgery.

INTERNAL LIMITING MEMBRANE PEELING IN PATIENTS UNDERGOING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT SECONDARY TO DIABETIC RETIONPATHY.

PURPOSE: To assess the merits of internal limiting membrane (ILM) peeling during pars plana vitrectomy in subjects with a tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS: One hundred and ninety-one proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the principal indication of tractional retinal detachment were enrolled into this randomized controlled trial. Study subjects were intraoperatively randomized into one of the following treatment groups: Cohort A patients underwent ILM peeling, whereas Cohort B patients did not undergo ILM peeling. The main outcome was postsurgical epiretinal membrane development at 6 months. The secondary outcome was attainment of ≥ 20/50 visual acuity (Snellen) at 6 months. RESULTS: One hundred and thirty-nine subjects underwent randomization and completed the study's 6-month trial period. Cohort A had 3.1% (2 of 64) of subjects developing an epiretinal membrane postoperatively, whereas Group B had 26.7% (20 of 75) of subjects developing an epiretinal membrane postoperatively at 6 months ( P < 0.001). Attainment of ≥ 20/50 visual acuity (Snellen) at 6 months was found in 21.9% (14 of 64) of subjects in Cohort A and 9.3% (7 of 75) of subjects in Cohort B ( P = 0.039). CONCLUSION: Proliferative diabetic retinopathy patients undergoing pars plana vitrectomy for tractional retinal detachment have a lower frequency of postsurgical epiretinal membrane formation and a greater likelihood of attaining ≥20/50 Snellen visual acuity at 6 months when ILM peeling is conducted. Specialists may consider peeling of the ILM during pars plana vitrectomy an important surgical maneuver in this patient population.

Intravitreal Faricimab for Aflibercept-Resistant Neovascular Age-Related Macular Degeneration.

Purpose: To evaluate the short-term effects of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects previously treated with intravitreal aflibercept (IVA). Methods: A retrospective review was conducted on nAMD patients undergoing IVA therapy at a single private practice institution. Subjects were divided into Study and Control groups. Both Study and Control subjects had undergone ≥6 IVA treatments during the previous 12 months, ≥4 IVA treatments during the previous 6 months, had a central macular thickness (CMT) on optical coherence tomography (OCT) of ≥300 microns, and had observable intraretinal and/or subretinal fluid on OCT prior to group assignment. Study subjects were switched from IVA to IVF and received 3 treatments within 4 months. Control subjects remained on IVA during the same time period and received 3 treatments within 4 months. Results: There were a total of 55 subjects analyzed. There were 39.3% (11/28) in the Study Group and 7.4% (2/27) in the Control Group attaining a CMT of less than 300 microns without retinal fluid on OCT at the end of the 4-month study period (p = 0.004). There were 35.7% (10/28) in the Study Group and 7.4% (2/27) in the Control Group gaining 2 or more lines of visual acuity at the end of the 4-month study period (p = 0.008). Conclusion: IVF can improve the visual and anatomic outcomes in a significant minority of treatment-resistant nAMD subjects previously managed with IVA. A greater follow-up period is needed to determine if such improvements can be maintained.

Faricimab for Treatment-Resistant Diabetic Macular Edema.

Purpose: To assess the short-term outcomes in treatment-resistant diabetic macular edema (DME) patients changed from intravitreal aflibercept (IVA) to intravitreal faricimab (IVF). Methods: A retrospective review was undertaken on DME subjects receiving IVA therapy at a single private practice. Patients were separated into study and control cohorts. Both study and control patients had received more than or equal to six IVA injections during the preceding 12 months, more than or equal to four IVA injections during the preceding 6 months, had a central macular thickness (CMT) on optical coherence tomography (OCT) of ≥300 µm, and had retinal fluid on OCT before cohort assignment. Study patients were switched to IVF and underwent three injections within 4 months, whereas control patients stayed on IVA during the same period and received three injections within 4 months. Results: There were 51 patients analyzed. There were 37.5% (9/24) in the study group and 3.7% (1/27) in the control group who achieved a CMT of less than 300 µm without retinal fluid on OCT at the end of the 4-month study (p=0.001). There were 41.7% (10/24) in the study group and 11.1% (3/27) in the control group who had gained two or more lines of visual acuity at the end of the 4-month study (p=0.01). Conclusion: For a significant minority, IVF can improve the short-term visual and anatomic outcomes in treatment-resistant DME patients formerly managed with IVA. Longer follow-up is needed to determine if such improvements can be preserved.

Gas Tamponade for the Prevention of Postoperative Vitreous Hemorrhaging After Diabetic Vitrectomy: A Randomized Clinical Trial.

PURPOSE: To compare vitreous substitution with sulfur hexafluoride (SF6) gas to balanced salt solution (BSS) for the prevention of postoperative vitreous hemorrhage (VH) in proliferative diabetic retinopathy (PDR) patients undergoing pars plana vitrectomy (PPV) for the indication of non-clearing VH. METHODS: One hundred forty-four PDR subjects requiring PPV for the indication of non-clearing VH were enrolled into the trial. Subjects were prospectively randomized into 1 of 2 vitreous substitution groups: Group A subjects underwent 20% to 30% SF6 gas tamponade, whereas Group B subjects underwent vitreous substitution with BSS. The primary outcome was the incidence of postoperative VH during the 6-month trial period. Secondary outcomes were unplanned PPV for VH and best corrected visual acuity (BCVA) at 6-months follow-up. RESULTS: Ninety-six subjects underwent randomization and completed 6-months follow-up. Postoperative VH during the trial period occurred in 6 of 54 subjects in Group A (SF6) (11.1%) and 14 of 42 in Group B (BSS) (33.3%) (P = .008). Unplanned PPV during the trial period for postoperative VH occurred in 2 of 54 in Group A (3.7%) and 6 of 42 in Group B (14.2%) (P = .06). The mean BCVA was not significantly different at 6-months follow-up between groups (P = .58). CONCLUSIONS: This trial indicates that vitreous substitution with SF6 gas lowers the incidence of postoperative VH compared with BSS in PDR subjects undergoing PPV for the indication of non-clearing VH at 6-months follow-up. Specialists may consider SF6 gas tamponade during PPV as a means of helping reduce postoperative VH in this patient population. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Patient Attitudes and Desirability Regarding Immediate Sequential Bilateral Cataract Surgery.

Purpose: To analyze patient attitudes and desirability regarding routine immediate sequential bilateral cataract surgery (ISBCS). Methods: This study was conducted as a prospective, consecutive survey-based case series from a single private practice institution serving a mostly rural population. A standardized phone survey assessing patient perspectives on ISBCS was administered to patients before and after routine delayed sequential bilateral cataract surgery (DSBCS) was performed. Subject responses were analyzed, including a subset analysis on patient responses under a variety of circumstances. Results: There were 61 patients enrolled into the study and 47 completed the surveys before and after routine DSBCS (77.0% completion rate). Thirty-nine (83.0%) of respondents had a favorable outlook of ISBCS preoperatively, whereas 36 (76.6%) had a favorable outlook of ISBCS postoperatively (p>0.05). On the postoperative questionnaire, twenty-five (53.2%) of respondents were willing to accept additional surgical risk if necessary to receive ISBCS, and this finding was significant between the subgroup of patients with systemic health co-morbidities compared to those without systemic health co-morbidities (p=0.05). Conclusion: Most patients had a favorable outlook of ISBCS before and after undergoing DSBCS. Patients with underlying systemic health co-morbidities were most likely to accept additional surgical risk if necessary to receive ISBCS. From a patient's perspective, ISBCS may be an acceptable option to routinely implement when cataract surgery is required for both eyes.

VITRECTOMY FOR DIABETIC COMPLICATIONS: A Pooled Analysis of Randomized Controlled Trials Using Modern Techniques and Equipment.

PURPOSE: To report updated clinical outcomes in subjects undergoing pars plana vitrectomy (PPV) using modern techniques and equipment for the treatment of proliferative diabetic retinopathy-related complications. Pooled analysis of five randomized clinical trials conducted at the same institution and included both study and control subjects from the trials. METHODS: There were 943 subjects who prospectively underwent small-gauge PPV with antivascular endothelial growth factor pretreatment for proliferative diabetic retinopathy-related complications and completed 6-month follow-up. RESULTS: The visual acuity of the study population improved from median 2.00 (interquartile range 1.3, 2.3) at baseline to median 1.00 (interquartile range 0.5, 1.3) at 6 months. One hundred and eighty-four patients (19.5%) achieved 20/50 or better acuity, and 652 patients (69.1%) achieved 20/200 or better acuity at 6 months. The vision improved or remained stable in 901 patients (95.5%), and 11 patients (1.2%) developed no light perception at 6 months. Intraoperative complications occurred in 343 cases (36.4%), and 199 cases (21.1%) experienced a postoperative complication. The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3% of all complications). Unplanned secondary PPV was necessary in 86 cases (9.1%). CONCLUSION: This study reports updated clinical outcomes in patients undergoing PPV for proliferative diabetic retinopathy-related complications which compares favorably with the age before small-gauge PPV and antivascular endothelial growth factor pretreatment.

Complications Leading to Keratoplasty among Contact Lens Users and LASIK Patients: A 10-Year Cross-Sectional Analysis.

PURPOSE: To determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States. METHODS: Population data was obtained from the United States Census Bureau and the Centers for Disease Control. A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a ten-year period. The main outcome was best-corrected visual acuity (BCVA) at 2 years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use versus LASIK. RESULTS: The study's geographic area had 46,545 CL users in one or both eyes during any given year and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and 3 post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval (OR 1.77 [0.53-5.87, 95% CI]; p=0.35). BCVA at 2 years was 1.45 [1.0-1.90] logMAR (20/564 Snellen) in the CL using cohort and 0.07 [-1.19-1.33] logMAR (20/23 Snellen) in post-LASIK cohort following PK (p=0.04). CONCLUSIONS: Patients who underwent PK secondary to complications related to CL use had worse visual outcomes at 2 years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK.

OUTCOMES IN PATIENTS RESUMING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOLLOWING TREATMENT DELAY DURING THE CORONAVIRUS-19 PANDEMIC.

PURPOSE: To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti-vascular endothelial growth factor therapy. METHODS: A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti-vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic. RESULTS: Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti-vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both). CONCLUSION: Treatment delay in subjects undergoing anti-vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.

Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Treatment-Naïve Diabetic Macular Edema: A Prospective, Uncontrolled Pilot Study.

PURPOSE: To report the outcomes in subjects undergoing pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for the management of treatment-naïve diabetic macular edema (DME). METHODS: Ten treatment-naïve subjects with non-proliferative diabetic retinopathy prospectively underwent PPV with ILM peeling for the treatment of DME at a single university-affiliated institution. The preoperative features, intraoperative details and postoperative outcomes were collected and analyzed. RESULTS: All 10 subjects underwent PPV with ILM peeling without significant intraoperative or postoperative complications at 6 months follow-up. Visual acuity improved from a baseline of 0.74 (95% CI: 0.48-1.0) logMAR (Snellen 20/110) to 0.46 (95% CI: 0.3-0.62) logMAR (Snellen 20/58) at 6 months follow-up (p=0.045). Optical coherence tomography central macular thickness reduced from a baseline of 456 (95% CI: 394.7-516.4) microns to 316.8 (95% CI: 275.9-357.7) microns at 6 months follow-up (p < 0.001). CONCLUSION: This pilot study suggests that PPV with ILM peeling may be a viable treatment option for the management of treatment naïve DME in subjects with non-proliferative diabetic retinopathy. Development of a randomized controlled trial may be justified to validate the results of this study. CLINICALTRIALSGOV IDENTIFIER #: NCT03660345.

Femtosecond-Assisted Laser in situ Keratomileusis with de novo Flap Creation Following Previous Microkeratome Laser in situ Keratomileusis.

PURPOSE: To report the outcomes of laser in situ keratomileusis (LASIK) in patients with previous microkeratome LASIK using a femtosecond laser platform to create a de novo flap. METHODS: The charts of 17 patients that underwent femtosecond-assisted LASIK with de novo flap creation for consecutive refractive error following previous microkeratome LASIK were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed. RESULTS: All 17 eyes underwent femtosecond-assisted LASIK with de novo flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 6 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed epithelial ingrowth during the postoperative period. CONCLUSION: The femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK following previous microkeratome LASIK. Future investigations are required to further validate the findings in this study.

Optical Coherence Tomography-Guided Femtosecond LASIK in the Setting of Corneal Scarring.

PURPOSE: To report the outcomes of femtosecond-assisted laser in situ keratomileusis (LASIK) in patients with previous corneal scarring using optical coherence tomography (OCT) imaging to determine flap depths. METHODS: The charts of 11 eyes of 9 patients with previous off-visual axis corneal scarring that underwent femtosecond LASIK using OCT guidance for flap depth determination were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed. RESULTS: All 11 eyes underwent femtosecond laser flap creation and LASIK without any significant intraoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 3 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed any flap complications during the postoperative period. CONCLUSION: The OCT-guided femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK in the setting of previous corneal scarring. Future investigations are required to further validate the findings in this study.

SILICONE OIL VERSUS PERFLUOROPROPANE GAS TAMPONADE DURING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT OR FIBROUS PROLIFERATION: A Randomized Clinical Trial.

PURPOSE: To compare vitreous substitution with silicone oil to perfluoropropane gas in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy (PPV) for the treatment of tractional retinal detachment or extensive fibrous proliferation. DESIGN: Randomized clinical trial. METHODS: Three hundred and two proliferative diabetic retinopathy subjects with tractional retinal detachment or extensive fibrous proliferation requiring PPV were enrolled into the trial. Subjects were prospectively randomized into one of two vitreous substitution groups during PPV: Group A subjects underwent 1,000 centistoke silicone oil tamponade, whereas Group B subjects underwent 14% to 16% silicone oil to perfluoropropane gas tamponade. The principal outcome was the best-corrected visual acuity at 6-month follow-up. Secondary outcomes were postoperative complications and unplanned PPV during the 6-month trial interval. RESULTS: Two hundred and fifty-eight subjects were randomized to receive a vitreous substitute and completed 6-month follow-up. Group B had better best-corrected visual acuity, more subjects ending up with 0.4 logarithm of the minimum angle of resolution (20/50) or better visual acuity, and more subjects ending up with 1 logarithm of the minimum angle of resolution (20/200) or better visual acuity at 6 months compared with Group A (P < 0.001, P = 0.02, P < 0.001, respectively). There were no significant differences in baseline characteristics, intraoperative or postoperative complications, or incidence of unplanned PPV between groups. CONCLUSION: This trial demonstrated that vitreous substitution with silicone oil to perfluoropropane gas resulted in better visual acuity at 6 months compared with silicone oil tamponade in proliferative diabetic retinopathy patients undergoing PPV for tractional retinal detachment or extensive fibrous proliferation. Surgeons should consider silicone oil to perfluoropropane gas tamponade as the first-line vitreous substitute in this patient population.

INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE: A Randomized Clinical Trial.

PURPOSE: To evaluate the benefits of internal limiting membrane peeling in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the treatment of vitreous hemorrhage. METHODS: Two hundred and fifty-eight proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage were enrolled into the trial. Patients were randomized into one of two cohorts: Group A patients underwent internal limiting membrane peeling, whereas Group B patients did not undergo internal limiting membrane peeling. The main outcome was best-corrected visual acuity at 6 months. Secondary outcomes were optical coherence tomography central macular thickness at 6 months, incidence of diabetic macular edema treatment during the postoperative trial period, and incidence of epiretinal membrane at 6 months. RESULTS: Two hundred and seven patients were randomized and completed 6 months follow-up. Group A had better best-corrected visual acuity at 6 months than Group B (P < 0.01). Group A had a lower incidence of diabetic macular edema treatment during the postoperative trial period and a lower incidence of epiretinal membrane at 6 months than Group B (P = 0.02 and P < 0.001, respectively). There was a trend toward lower central macular thickness on optical coherence tomography in Group A than Group B (P = 0.09). There were no significant differences in baseline details or complications intraoperatively or postoperatively between cohorts. CONCLUSION: This trial demonstrated better vision, fewer postoperative diabetic macular edema treatments, and a lower incidence of epiretinal membrane at 6 months when internal limiting membrane peeling was performed. Internal limiting membrane peeling may be considered a vital maneuver to perform in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage.