To assess the merits of internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) in subjects with a tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). One hundred and ninety one PDR subjects undergoing PPV for the principal indication of TRD 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, while Cohort B patients did not undergo ILM peeling. The main outcome was postsurgical epiretinal membrane (ERM) development at 6 months. The secondary outcome was attainment of ≥ 20/50 visual acuity (Snellen) at 6 months. One hundred and thirty nine subjects underwent randomization and completed the study's 6-month trial period. Cohort A had 3.1% (2/64) of subjects develop an ERM postoperatively, while Group B had 26.7% (20/75) of subjects develop an ERM postoperatively at 6 months (p<0.001). Attainment of ≥ 20/50 visual acuity (Snellen) at 6 months was found in 21.9% (14/64) of subjects in Cohort A and 9.3% (7/75) of subjects in Cohort B (p=0.039). PDR patients undergoing PPV for TRD have a lower frequency of postsurgical ERM 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 PPV an important surgical maneuver in this patient population.

To determine the effect of different durations of topical anesthesia on intravitreal injection (IVI) pain. This was a double-blinded randomized comparative study. Three hundred and twelve sequential eyes undergoing IVI were randomized to one of six groups according to the duration of topical anesthesia (from 1 to 30 minutes, one group for every 5-minute range, Group 1-6). Topical anesthesia before IVI was standardized. Patients graded their pain using the visual analogue scale (VAS) and the Wong-Baker FACES Scale (WBF) at 15 minutes after the procedure. The pain scores among the six groups were significantly different for the VAS (P = 0.013) and WBF (P = 0.024). The mean pain scores for Group 4 were 1.97 ± 1.04 (VAS) and 2.02 ± 1.08 (WBF) and were significantly lower than those of Group 1, 2, 5, or 6. The duration of topical anesthesia was significantly correlated with IVI pain. Preoperative 0.5% proparacaine hydrochloride drops were most effective in relieving IVI pain 11-20 minutes after topical administration.

To evaluate the impact of different intraocular tamponades on the visual-related quality of life (VRQOL) after idiopathic epiretinal membrane (IEM) surgery with epiretinal membrane peeling. We prospectively enrolled 50 patients diagnosed with IEM who underwent pars plana vitrectomy (PPV). Patients were consecutively assigned to either the air tamponade (air) group (25 patients) or the balanced salt solutions (BSS) tamponade group (25 patients). The following data were collected before and after surgery and compared between two groups: VRQOL, best corrected visual acuity (BCVA), intraocular pressure (IOP), metamorphopsia, contrast sensitivity (CS), and central macular thickness (CMT). PPV was performed in 50 eyes. At baseline, there were no significant differences between the two groups. At 6 months postoperatively, VRQOL (p < 0.001), BCVA (p < 0.001), CMT (p < 0.001), CS (p < 0.001), and metamorphopsia (p < 0.001) improved significantly in comparison to baseline, without significant differences between the air tamponade and BSS groups. Removing IEM significantly improved visual function and VRQOL. Despite improvements, our study showed no difference postoperatively whether air or BSS tamponade was used during surgery. As a result, air tamponade may not be a mandatory treatment for IEM surgery and provides no additional advantage compare with BSS tamponade.

To verify whether disposable microforceps can be magnetized to atraumatically attract and then grasp intraocular foreign bodies. An effective magnetization protocol was developed. The clinical relevance was tested and a first practical application performed. The magnetic flux density (MFD) of a bar magnet and an electromagnet was measured. Steel screws were used to determine the magnetization protocol. Disposable microforceps was magnetized, MFD generated at the tip measured and the weight that can be lifted was tested. Foreign body removal with such forceps was performed. The electromagnet MFD was much higher than the bar magnet. The most effective magnetization protocol was to pass the screw from the end along the shaft and back over the electromagnet. Magnetized microforceps had a 7.12 mT change in MFD at the tip. Steel balls up to 87 mg could be lifted in BSS. In clinical use, the intraocular foreign body could be attracted and grasped safely. Disposable microforceps can be easily and inexpensively magnetized. The achievable MFD is clinically relevant to attract typical intraocular foreign bodies. An electromagnet is best suited for this purpose. With such prepared forceps, foreign bodies can be attracted atraumatically and grasped securely.

To evaluate whether combining spectral-domain optical coherence tomography (SD-OCT) with monoscopic fundus photography using a non-mydriatic camera (MFP-NMC) improves the accuracy of diabetic macular edema (DME) referrals in a teleophthalmology diabetic retinopathy screening program. We conducted a cross-sectional study with all diabetic patients aged ≥18 years who attended screening from September 2016 to December 2017. We assessed DME according to the three MFP-NMC and the four SD-OCT criteria. The sensitivity and specificity obtained for each criterion were estimated by comparing them with the ground truth of DME. This study included 3918 eyes (1925 patients; median age, 66 years; interquartile range, 58-73; females, 40.7%; once-screened, 68.1%). The prevalence of DME ranged from 1.22% to 1.83% and 1.54% to 8.77% on MFP-NMC and SD-OCT, respectively. Sensitivity barely reached 50% in MFP-NMC and less for the quantitative criteria of SD-OCT. When macular thickening and anatomical signs of DME were considered, sensitivity increased to 88.3%, and the false DMEs and non-gradable images were reduced. Macular thickening and anatomical signs showed the highest suitability for screening, with a sensitivity of 88.3% and a specificity of 99.8%. Notably, MFP-NMC alone missed half of the true DMEs that lacked indirect signs.

To propose the InTraocular EMulsion of Silicone oil (ITEMS) grading system for the assessment of silicone oil (SiO) emulsion, applicable in a routine clinical setting and validated through an expert-led consensus procedure. Seven experts on intraocular liquid tamponades, led by a facilitator, performed a literature review on the detection of SiO emulsion. Based on the proposed ideas, a questionnaire was developed and submitted to the experts on the methods to detect SiO emulsion and the items to grade. After two rounds of individual ranking using a nine-point scale and related discussion, the final grading system was developed including items that reached consensus (score ≥7 from ≥75% of members). The agreed ITEMS grading system includes the identification of SiO microbubbles and large SiO bubbles through slit lamp biomicroscopy, gonioscopy, fundus examination under mydriasis or ultra-widefield fundus photography. Moreover, macular and disc OCT are used to detect SiO-associated hyperreflective dots. An evidence-based expert-led consensus was conducted to develop grading system of SiO emulsion, allowing, for the first time, homogenous collection of data on SiO emulsion. This has the potential to improve our understanding of the role and clinical relevance of SiO emulsion allowing comparisons between different studies.

To assess the topographical distribution of intraretinal cystoid space (IRC) and its prognostic value in idiopathic epiretinal membrane (iERM). One hundred twenty-two eyes of iERM that had been followed up for 6 months after membrane removal were included. Based on the baseline IRC distribution, the eyes were divided into groups A, B, and C (absence, IRC within 3 mm, and 6 mm from the fovea, respectively). The best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), ectopic inner foveal layer, and microvascular leakage (ML) were assessed. Fifty-six (45.9%) eyes had IRC, of which 35 (28.7%) were in group B and 21 (17.2%) in group C at baseline. Compared to group B, group C showed worse BCVA, thicker CSMT, and a greater association with ML (OR = 5.415; P = 0.005) at baseline; and also presented with worse BCVA, thicker CSMT, and wider distribution of IRC postoperatively. A wide distribution of IRC was an unfavorable baseline factor in achieving good visual acuity (OR = 2.989; P = 0.031). Widely distributed IRCs were associated with advanced disease phenotype as poor BCVA, thick macula, and baseline ML in iERM and also showed a poor visual outcome after membrane removal.

To describe new histological findings involving the inner retina in birdshot chorioretinopathy. Evaluation of the inner retinal pathology of the eye of a patient with bilateral birdshot chorioretinopathy who underwent enucleation for a unilateral ciliochoroidal melanoma. Histopathological sections showed focal perivascular lymphocytic infiltration at the optic nerve head that extended into the adjacent inner retina, mainly involving the ganglion and nerve fiber layers. We have previously shown that birdshot chorioretinopathy has multiple foci of lymphocytes in the choroid. This is the first report that demonstrates lymphocytic infiltration of the inner retinal layers. This may lead to the bipolar and Muller cell dysfunction that ultimately results in an electronegative ERG.

To evaluate the incidence and timing of pigment epithelial detachment (PED) and subretinal fluid(SRF) development in type 3 macular neovascularization (MNV). This retrospective study included 84 patients who were diagnosed with treatment-naïve type 3 MNV who did not show SRF at diagnosis. All patients were initially treated with three loading injections of ranibizumab or aflibercept. Following the initial loading injections, as-needed regimen was performed for retreatment. The development of either PED or SRF was identified. The incidence and timing of PED development in patients without PED at diagnosis and that of SRF development in patients with PED at diagnosis were evaluated. The mean follow-up period was 41.3±20.7 months after diagnosis. Among the 32 patients without serous PED at diagnosis, PED developed in 20 (62.5%) at a mean of 10.9±5.1 months after diagnosis. PED development was noted within 12 months in 15 patients (46.8%; 75.0% among the PED development cases). In 52 patients with serous PED and without SRF at diagnosis, 15 developed SRF (28.8%) at a mean of 11.2±6.4 months after diagnosis. SRF development was noted within 12 months in 9 patients (17.3%; 66.6% among the SRF development cases). PED and SRF developed in a substantial proportion of patients with type 3 MNV. The average period of development of these pathologic findings was within 12 months of diagnosis, suggesting the need for active treatment during the early treatment period to improve treatment outcomes.

To assess the efficacy of a 0.18 mg intravitreal fluocinolone acetonide (FA) implant (Yutiq, EyePoint Pharmaceuticals, Watertown, MA) as a treatment option for patients with radiation retinopathy-related cystoid macular edema (CME). A retrospective review of 7 patients treated for uveal melanoma who developed radiation retinopathy-related CME. They were initially treated with intravitreal anti-VEGF and/or steroid injections and then transitioned to intravitreal FA implant. Primary outcomes include BCVA, central subfield thickness (CST), and number of additional injections. After FA implant insertion, BCVA and CST remained stable in all patients. The variance in BCVA decreased from 75.5 ETDRS letters (range 0-199 letters) to 29.8 (range 1.2-134) following FA implant insertion. Mean CST was 384 μm (range 165-641) and 354 μm (range 282-493) before and after FA implant insertion, resulting in a 30 μm mean reduction. The number of intravitreal injections (average 4.9, range 2-10) decreased following intravitreal FA implant insertion with only two patients requiring one additional FA implant (average 0.29, range 0-1) over a mean of 12.1 months (range 0.9-18.5) follow-up. Intravitreal FA implant is an effective treatment for CME radiation retinopathy. The slow release of steroid allows for sustained control of macular edema, which correlated with stable visual acuity and decreased injection burden for patients.