Scleral Buckling Surgery For Stage 4A and 4B Retinopathy of Prematurity in Critically Ill Neonates.

Purpose: To determine the efficacy of scleral buckling in eyes with stage 4A and 4B retinopathy of prematurity (ROP).Methods: Seven eyes of five premature infants underwent scleral buckling for stage 4 ROP in zone II. Five eyes had stage 4A ROP, and two eyes had stage 4B ROP. Six eyes had previous diode laser photocoagulation, and one eye had received an intravitreal ranibizumab injection. Scleral buckling was the procedure of choice due to lack of access to specialized pediatric vitrectomy instrumentation. Average age at surgery was 3.4 months. Postoperative anatomic retinal status, visual acuity outcome and refractive error were assessed. Results: The scleral buckle was removed on average 8 months after surgery. Retinal reattachment was achieved in all seven eyes. At final follow-up one eye had macular ectopia and disc dragging, one eye had a macular traction fold and two eyes had optic disc pallor. Average myopic error after buckle removal was -7.5 D.Conclusion: Scleral buckling can be performed safely and effectively in 4A and 4B stage ROP in critically-ill infants, when access to specialized pediatric vitrectomy instrumentation is limited. This surgical technique may provide adequate relief of vitreoretinal traction with improved visual potential.

Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT

The purpose of this study was to determine the relationship between a posterior vitreous detachment (PVD) and retinoschisis (RS) in 73 highly myopic (HM) young patients age 16.4 ± 6.9 years and 24 non-HM children age 8.4 ± 1.5 years. The presence of the paravascular retinal abnormalities was determined in the images obtained by a ultra-widefield OCT (UWF OCT) instrument with an image field of 23 × 20 mm. The results showed that a partial PVD was detected in 15 (21%) of the HM patients, and the number increased significantly with increasing age (P = 0.02). PVDs of any type were not found in the non-HM eyes. The number of microvascular folds also increased with age in the HM patients (P = 0.03). Medium-reflective columnar tissues were present between the detached vitreous and inner retinal surface in 4 (5%) eyes of the HM patients. Myopic RS was found in 3 (4%) HM patients in the paravascular area but not in the macular area. These results suggest that early partial PVD may play a role in pathological and proliferative vitreous changes of HM eyes. An intense vitreoretinal traction with bridging tissues may cause the various paravascular retinal abnormalities. In HM eyes, paravascular RS is already present at an early age which may progress to macular RS with aging.

Influence of vitreoretinal traction localization on horseshoe tear configuration and risk of rhegmatogenous retinal detachment

Purpose. To evaluate the relationship between the shape of horseshoe tear and the localization of vitreoretinal tractions (VRT) using methods of the peripheral vitreoretinal interface visualization and classify horseshoe tears by shape for surgical planning. Material and methods. We studied horseshoe tears parameters of 52 patients (52 eyes). The localization of VRT was determined by wide-field OCT, the horseshoe tear shape was determined as the ratio of length to width of the tear (l/b) by multispectral laser scanning. The ratio of the obtained data was evaluated by the Spearman correlation analysis. We used Ward's method of hierarchical clustering to classify the horseshoe tears by shape. The obtained data were used to perform YAG- laser excision of the vitreoretinal adhesion zone in patients with rhegmatogenous retinal detachment as part of the combined microinvasive laser-surgical technology. Results. The l/b ratio ranged from 1/4 to 3/1. A strong negative correlation has been revealed between the horseshoe tear shape and the fixation of vitreoretinal tractions (rs -0.95; p <0.05). Horseshoe tears were identified in 4 groups using Ward's method of clustering. Each group corresponded to a specific localization of VRT. The extension of VRT beyond the tear was associated with a high risk of rhegmatogenous retinal detachment. Conclusion. A significant correlation has been found between the studied factors confirm the possibility of using data on the horseshoe tear shape for an approximate evaluation of vitreoretinal adhesion localization. The obtained data allows to determine the exact VRT excision zone when performing combined laser-surgical technology without the need for preoperative wide-field OCT. Key words: rhegmatogenous retinal detachment, wide-field OCT, horseshoe tear, vitreoretinal traction, YAG – laser retinotomy.

YAG-laser retinotomy in the complex treatment of horseshoe tear and rhegmatogenous retinal detachment

Horseshoe-shaped retinal tear leads to rhegmatogenous retinal detachment (RRD) in 61-83% of cases. Vitreoretinal traсtion is the main factor in the development of horseshoe tears and RRD. In this aspect, YAG-laser retinotomy is promising, which makes it possible to eliminate the traction component by excision area of the horseshoe tear with vitreoretinal adhesion (VRA). Purpose. To analyze the results of YAG-laser retinotomy in the treatment of patients with complicated horseshoe tears and rhegmatogenous retinal detachment. Material and methods. The study included 97 patients (100 eyes). Of these, 54 patients (57 eyes) with complicated horseshoe retinal tears and 43 patients (43 eyes) with local RRD. Patients with complicated horseshoe tears underwent YAG-laser retinotomy at the base of the horseshoe tear. Patients with local RRD underwent a combined laser-surgical technology, which included YAG-laser retinotomy of the horseshoe tear area with vitreoretinal adhesion, pneumatic retinopexy and barrier laser photocoagulation. Results. In the group of patients with complicated horseshoe tears, complete retinal attachment was achieved in 15 eyes (58%), partial retinal attachment - in 7 eyes (27%). In the group of patients with local RRD complete retinal attachment was achieved in 40 patients (93%). There was a stable anatomical result and no changes in functional parameters. Conclusion. YAG-laser retinotomy eliminates vitreoretinal traction in the area of horseshoe tear and prevents the development of rhegmatogenous retinal detachment. Application of YAG-laser retinotomy as the first step of a microinvasive combined laser-surgical technology for the treatment of RRD makes it possible to obtain a high anatomical result, reduce the risk of retinal redetachment, and also preserve the initially high visual functions of patients.

Postoperative Multimodal Analysis in Successful Gas Displacement of a Submacular Hemorrhage

In this report, we describe a case of timely gas vitrectomy to displace a moderate submacular hemorrhage from the submacular space without tPA, release vitreoretinal traction along the borders of a posterior retinal tear, and analyze postoperative multimodal imaging findings in a 34-year-old male patient whose right eye was injured by a stone. The patient underwent a successful nontissue plasminogen activator gas vitrectomy 3 days after the accident. A multimodal evaluation with spectral-domain optical coherence tomography (SD-OCT), 10-2 and 30-2 campimetry, microperimetry, multifocal electroretinography (mfERG), and visual evoked potentials was performed 6 months after the accident. The multimodal imaging tests yielded abnormal foveal SD-OCT patterns, with a fibrous sealed tear in the retinal pigment epithelium. Campimetry showed low levels of retinal sensitivity; microperimetry and mfERG revealed a subnormal retinal response and a reduction in the N1 and P1 wave amplitudes. The visual evoked potential responses were normal. Multidisciplinary examination at 6 months postoperatively revealed a structurally and functionally abnormal macula. The retina remained attached. Our functional findings indicate that submacular hemorrhage should be treated in a timely manner to minimize photoreceptor damage.

Posterior Vitreous Detachment and Paravascular Retinoschisis in Highly Myopic Young Patients Detected by Ultra-Widefield OCT

The purpose of this study was to determine the relationship between a posterior vitreous detachment (PVD) and retinoschisis (RS) in 73 highly myopic (HM) young patients and 24 non-HM children. The presence of the paravascular retinal abnormalities was determined in the images obtained by a ultra-widefield OCT (UWF OCT) instrument with an image field of 23 x 20 mm. The results showed that a partial PVD was detected in 15 (21%) of the HM patients, and the number increased significantly with increasing age (P=0.02). PVDs of any type were not found in the non-HM eyes. The number of microvascular folds also increased with age in the HM patients (P=0.03). Medium-reflective columnar tissues were present between the detached vitreous and inner retinal surface in 4 (5%) eyes of the HM patients. Myopic RS was found in 3 (4%) HM patients in the paravascular area but not in the macular area. These results suggest that early partial PVD may play a role in pathological and proliferative vitreous changes of HM eyes. An intense vitreoretinal traction with bridging tissues may cause the various paravascular retinal abnormalities. In HM eyes, paravascular RS is already present at an early age which may progress to macular RS with aging.

Anti-vegf therapy in treatment of vitreous hemorrhage due to proliferative diabetic retinopathy

Purpose.To investigate the possibility of anti-VEGF therapy use in treatment of vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction. Materials and methods.In this case series study, 8 patients with severe vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction were treated with intravitreal ranibizumab injections using treat-and-extend regimen. Patients were followed for 1254 months. Results.. Intravitreal ranibizumab injections using treat-and-extend regimen promoted a complete resolution of vitreous hemorrhage in one month after the 2ndor the 3rdmonthly ranibizumab injection, followed by a significant visual acuity improvement. Conclusion.Anti-VEGF therapy using treat-and-extend regimen could be recommended for treatment of vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction.

Outcomes of Intravitreal Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: To determine the functional and anatomical outcome of intravitreal Bevacizumab in patients withmacular edema secondary to branch retinal vein occlusion.Study Design: Quasi Experimental study.Place and Duration of Study: Institute of Ophthalmology, Mayo hospital, Lahore, from February 2016 to December 2018.Material and Methods: Forty eyes of 40 patients with macular edema on OCT secondary to BRVO were included in the study. All the patients suffering from other types of macular edemacaused by diabetes, epi-retinal membrane (ERM), surgery involving posterior segment, vitreoretinal traction andhistory of intravitreal VEGF or steroids were excluded from the study. Intravitreal Bevacizumab was given whenmacular thickness was > 300 μm or Visual acuity was < 6/12. Follow-up was at 1st, 3rd, 6th and 12th month.Results: The mean age of the patients was 52.12 ± 5.63 years. Male to female ratio was 1.5:1. Infero-temporalvenous arcade was the most common site of BRVO (55%) followed by supero-temporal (35%) and macularBRVO (10%). Baseline visual acuity was 6/12 or better in 17.5% of the patients at presentation. This proportionincreased to 27.5%, 40%, 52.5% and 67.5% at 1, 3, 6 and 12 months respectively. Macular thickness measuredat presentation was 540 ± 120 μm. Macular thickness gradually reduced on follow-up. At one month meanmacular thickness was 430 ± 90 μm. It was less than 300 μm after 6 months.Conclusion: Intravitreal bevacizumab results in improved functional and anatomical outcomes in cases ofmacular edema secondary to BRVO.