In-Office Sulfur Hexafluoride (SF6) Injection to Close Recently Operated or Reopened Macular Holes: A Minimal Approach Technique

To describe an in-office minimal approach technique for closing recently operated full thickness macular holes (FTMH), when closure was not fully achieved or there was macular hole re-formation, without performing another pars plana vitrectomy (PPV). Retrospective case series study. Nine patients were included in this case series. All patients were diagnosed with FTMH characterized by a decrease in visual acuity (VA) and metamorphopsias. All patients initially underwent a standard PPV procedure with 20% sulfur hexafluoride (SF6) injection. After 1-16 weeks, no closure or reformation of the macular hole was observed. Fluid-SF6 exchange was performed in the slit lamp, with the aim of injecting a 50% gas bubble of pure SF6 into the vitreous cavity, according to a minimally invasive in-office technique. Postoperatively, all patients achieved successful macular hole closure and VA showed an average improvement of approximately 4 lines on the EDTRS logarithm of the minimum angle of resolution (logMAR) chart. In particular, the mean corrected distance visual acuity improved from 0.99 ± 0.27 logMAR to 0.33 ± 0.23 logMAR (P = 0.03). The minimal surgical in-office technique of SF6 injection for the management of reopened macular holes after a recent PPV procedure shows promising results.

Molecular Biologic Milieu in Rhegmatogenous Retinal Detachment and Proliferative Vitreoretinopathy: A Literature Review

Multiple lines of evidence support an immunologic response along with inflammation to be implicated in the pathophysiology of primary rhegmatogenous retinal detachment (RRD) and the development of proliferative vitreoretinopathy (PVR). The purpose of this review is to provide an update on the signaling molecules in the vitreous and subretinal fluid (SRF) involved in these processes. A detailed literature search was performed in PubMed database until November 2021. We identified all papers referring to inflammatory and immunological mediators in the context of primary RRD and in cases complicated by PVR. We analyzed prospective and retrospective cohort studies and reference lists of the retrieved articles. A comprehensive investigation of immunological and inflammatory responses provides significant evidence for the implication of varying signaling molecules in the pathophysiology of RRD and the development of PVR. The reviewed series has revealed that disruption of the normal equilibrium during these processes may be present in the vitreous and SRF of these eyes. The precise role of cytokines, chemokines, and growth factors in the pathophysiology of these disorders remains to be clearly elucidated. Overall, immunological and inflammatory signaling molecules are widely implicated in both primary RRD and PVR. The reviewed literature indicates that precise knowledge concerning the pathological milieu sheds light on the underlying pathophysiology and potential therapeutic targets and highlights unmet needs to be addressed by future research.

Correlation between Bovine Arch and Thoracic Aortic Disease. A literature Review

The bovine artery is considered the most frequent aortic arch branching variation. Despite being considered a normal variation of the aortic arch branching, still it has been linked with various issues regarding the thoracic aorta. The aim of this study is to highlight the prevalence of bovine artery among specific vascular pathologies throughout the literature and to provide information to clinicians about the importance of identifying this variation. For this specific review, we acquired potentially relevant studies for inclusion from the electronic database of PubMed. We limited our investigation to papers published within the last decade (from 2011 to 2021). Single case reports, papers with language restrictions, letters to the editor, conference abstracts, studies that were non-human centered and studies with unextractable and incomplete data were not included. Searching the PubMed database, it was evident that there is a close relationship between bovine arch and thoracic aortic arch pathology. In the defined period 2011-2021 that our research was focused, we selected eight studies tackling this issue. The majority of the studies in this review (except one) provided concerning data about the prevalence of this aortic arch variant among patients with aortic aneurysmal dilatation and aortic dissection. Following our results, we strongly believe that bovine arch should no longer being considered as a normal variation with no clinical significance, but rather as a potential risk factor for thoracic aortic arch morbidities.

Sensitivity of spectral domain optical coherence tomography in the diagnosis of posterior vitreous detachment in vitreomacular interface disorders: A prospective cohort study

PURPOSE

To evaluate the sensitivity of Spectral Domain Optical Coherence Tomography (SD-OCT) regarding the diagnosis of posterior vitreous detachment (PVD) in vitreomacular interface disorders (VID).

METHODS

A total of 48 eyes of 48 patients were included in this prospective cohort study. PVD in eyes with VID was investigated. We determined the status of posterior vitreous cortex using slit lamp (SL) biomicroscopy and SD-OCT preoperatively, during vitrectomy and on the intraoperative video recording. Sensitivity and specificity of the examining methods were analysed. Four masked independent examiners participated in this study.

RESULTS

PVD was diagnosed in 16 eyes (33.3%) on SD-OCT, 20 eyes (41.7%) on SL examination and 28 eyes (58.3%) during vitrectomy. Sensitivity and specificity for diagnosis of PVD was 37.5% and 31.3% using SD-OCT, 90% and 64.3% on the SL examination, 92.9% and 90% on the video recording respectively, compared to the intraoperative PVD diagnosis.

CONCLUSION

SD-OCT shows a relatively low detection sensitivity of PVD in VID. Thorough OCT investigation is necessary to establish an appropriate diagnosis of PVD and treatment in VID.

Paracentral Acute Middle Maculopathy following Surgically Induced Branch Retinal Artery Occlusion During Vitrectomy

Paracentral acute middle maculopathy (PAMM) is a spectral-domain OCT finding of a thickened hyperreflective band at the level of the intermediate layers of the inner retina, attributed to the acute phase of intermediate capillary ischemia. The purpose of this paper is to report a case of PAMM deriving from a surgically induced branch retinal artery occlusion (BRAO) during vitrectomy for vitreous hemorrhage. A 70-year-old female referred to the posterior segment office with a 1-month history of visual loss in her right eye. Best-corrected visual acuity (BCVA) was "counting-fingers" (CF) due to a dense vitreous hemorrhage. She underwent a standard 23-gauge vitrectomy with a relatively close to the optic disc endodiathermy application to an avulsed vessel. Follow-up examination revealed a well-demarcated retinal whitening involving the inferior macula. SD OCT showed a surgically induced branch retinal artery occlusion exhibiting both a cotton wool spot and a PAMM lesion. Our case affords an insight into those pathological processes involved with PAMM, providing angiographic evidence of the retinal ischemic changes responsible for its development, by angiographically proving that branch retinal artery occlusion leads to a prompt formation of both a cotton wool spot and a PAMM lesion. Our aim is to raise awareness of this potential complication of vitrectomy surgery, especially when involving multiple traumatic manipulations onto the retinal surface.

Visual loss after treatment for idiopathic intracranial hypertension with lumboperitoneal shunting

Both idiopathic intracranial hypertension and intracranial cerebrospinal fluid hypotension, spontaneous or iatrogenic, display visual disturbances, including visual loss, visual field deficit, transient visual obscurations, and diplopia. We present a case of a long-standing idiopathic intracranial hypertension, primarily manifesting with visual disturbances and documented pre-existing concentric visual field deficit, treated with a lumboperitoneal shunt after conservative treatment failure, leading to an unexpected exacerbation of visual field deficit and acute visual loss, probably due to shunt catheter malfunction and subsequent intracranial hypotension. We provide a step-by-step documentation of cerebrospinal fluid volume and consequent intracranial pressure fluctuations effect on visual field alterations over a significant period of time, attempting an insight on pathogenetic mechanisms implicated in the relationship between intracranial pressure and optic nerve functionality. Interdepartmental collaboration in such cases could ensure prompt diagnosis and treatment, leading to the possibility of either halting the progression or even reversing established visual loss, sparing our patients from a lifetime disability and improving their quality of life.

The Impact of Epiretinal Membrane in Neovascular Age-Related Macular Degeneration Treatment: A Spectral-Domain Optical Coherence Tomography Study

PURPOSE

The purpose of this prospective study was to evaluate the impact of epiretinal membrane (ERM) on anatomical and functional results in patients with wet age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth (anti-VEGF) injections.

METHODS

Participants in the study were 48 patients with either wet AMD alone (AMD group, n = 27) or AMD and ERM (AMD/ERM group, n = 21). All patients received intravitreal anti-VEGF injections (three monthly injections and PRN thereafter) and were followed up for at least 12 months. All participants had best-corrected visual acuity (BCVA) measurement and spectral domain-optical coherence tomography (SD-OCT) at each visit, while fluorescein angiography was performed at baseline and then at the discretion of the physician.

RESULTS

There was a statistically significant improvement in BCVA at month 12 compared to baseline in each group (p < 0.001 for both groups), while the two groups did not differ significantly regarding BCVA at the end of the follow-up (p = 0.056). Additionally, there was a statistically significant reduction in CRT in both groups at month 12 (p < 0.001 for AMD group and p = 0.004 for AMD/ERM group) with no statistically significant difference between the groups (p = 0.183). Patients in the AMD group had a lower percentage of subretinal fluid (25.9%) than patients in the AMD/ERM group (52.4%) at the end of the follow-up, while ellipsoid zone disruption was found to be more profound in the AMD/ERM group (38.1%) than in the AMD group (18.5%). Patients in the AMD/ERM group needed more injections (7.1 ± 2.0 injections) than patients in the AMD group (4.8 ± 1.7 injections).

CONCLUSIONS

Patients in the AMD/ERM group had a higher percentage of subretinal and intraretinal fluid and ellipsoid zone interruption during the follow-up period. Anti-VEGF treatment appeared to have a beneficial effect in both groups, although the AMD/ERM group needed more injections compared to the AMD group.