Anatomical Outcomes Research Articles

Chandelier-assisted bimanual technique for securing infusion in eyes with hazy media.

Hazy media with resultant difficulties in visualisation hamper the surgical approach and outcomes in various vitreoretinal surgical scenarios, including eyes with keratoprosthesis in situ. We propose a novel chandelier-assisted bimanual infusion using a flute needle to overcome the inability to secure infusion safely in such eyes. The surgical technique was performed with the assistance of chandelier illumination. The irrigation tubing from the vitrectomy machine was connected to a flute needle for infusion. A bimanual technique was utilized with the flute needle connected to infusion in one hand and the cutter in the other hand. A 34-year-old monocular male patient with a keratoprosthesis in his seeing eye developed late-onset endophthalmitis with retroprosthetic membranes. The visual acuity had dropped from 20/20 to hand motions. Our novel bimanual technique helped secure infusion safely for vitrectomy. The patient recovered well to a visual acuity of 20/60 with a good anatomical outcome. Early vitrectomy may be essential for ensuring optimal outcomes in certain eyes with endophthalmitis. Surgical intervention in eyes with keratoprosthesis with secondary endophthalmitis is challenging due to difficulties in visualisation. This was overcome in our case with a novel bimanual chandelier-assisted technique for securing infusion.

Beyond the numbers: Impact of obesity on obstetric anal sphincter injury (OASI) outcomes in women.

To compare the risk profiles, anatomical, and functional outcomes between obese and non-obese women who experienced obstetric anal sphincter injury (OASI). A retrospective electronic database study was conducted at Cork University Maternity Hospital (CUMH). Women with missing data/repairs conducted outside CUMH were excluded. Participants were categorized into obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. Primary measure was a composite adverse outcome assessed 6 months post-delivery, including one or more of the following: resting pressure <40 mmHg, squeezing pressure <100 mmHg, defects in the internal and/or external anal sphincter. Statistical analyses were performed using SPSS version 28. Among the 349 women included in the study, 285 (81.7%) had a BMI <30 kg/m2 and 64 (18.3%) had a BMI ≥30 kg/m2. Gestational diabetes was significantly higher in obese women. No significant differences were observed in newborn weight or mode of delivery. The majority of tears were classified as grade 3B in both groups. Attendance rates at the OASI clinic did not differ between the groups. Among those attending, no statistical differences were noted in manometry results, which were reduced in both groups. Rates of internal anal sphincter defects were lower in the obese group (7.0% vs 15.6%, P = 0.15) and external anal sphincter defects were significantly lower in obese women (0% vs 9.1%, P = 0.04). No difference was found in the rates of composite adverse outcomes between the groups. Functional outcomes and manometry results did not differ, but non-obese women had higher rates of anatomical defects in OASI, requiring further study.

Comparison Between Anterior-Apical Mesh (Surelift) and Anterior Mesh (Surelift-A) in Transvaginal Pelvic Organ Prolapse Surgery: Surgical and Functional Outcomes at 1-Year Follow-Up.

Surelift is a transvaginal synthetic mesh (TVM) kit that is intended to treat anterior and apical pelvic organ prolapse (POP). The kit can be configured to use an anterior-apical (Surelift) or anterior (Surelift A) approach. The aims of this study were to evaluate the short-term objective and subjective outcomes of the different approaches at the 1-year follow-up. From June 2018 to April 2021, a total of 280 patients with symptomatic advanced POP (stages III and IV) had surgery with the Surelift or Surelift A. The primary outcome was postoperative de novo stress urinary incontinence (SUI), as well as subjective evaluation based on the Urinary Distress Inventory 6 (question 3 score > 1) and Incontinence Impact Questionnaire 7, during the 1-year follow-up period. Secondary outcomes measured quality of life, the presence of lower urinary tract symptoms, and complications. In total, 265 patients were assessed. Among these, 137 had Surelift, whereas 128 underwentSurelift A with SSF. At 1-year postoperative follow-up, de novo urodynamic stress incontinence occurred more frequently in the Surelift group than in the Surelift-A group (28.8% vs 9.1% respectively, p = 0.012). Additionally, Surelift patients had a higher rate of de novo SUI than Surelift A (33.2 vs 11.4 respectively, p = 0.013). Both study groups experienced improvements in their quality of life indicators. The Surelift device is a safe and effective technique of treating advanced-stage POP. De novo urine incontinence appears to be more common in the Surelift group than in the Surelift-A group. We found good anatomical outcomes and subjective relief in both study groups, with a low complication rate.

Visual and anatomical evaluation of navigated subthreshold micropulse laser versus photodynamic therapy in managing chronic central serous chorioretinopathy.

To compare the visual and anatomical results of navigated subthreshold micropulse laser (nSML) and photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR). Patients who underwent either half-dose PDT or nSML for the management of chronic CSCR were included in this study. Comprehensive ophthalmic examination, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) were performed at baseline and at 1-, 3-, and 6-month follow-up visits after nSML or PDT. Fluorescein angiography and indocyanine green angiography were performed only at baseline. Main outcome measures were best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and choroidal vascularization index (CVI) that were collected at baseline and at each follow-up visit for up to 6 months. Forty-two eyes of 42 patients (PDT group-20 eyes, nSML group-22 eyes) affected by chronic CSCR were enrolled. At 6-month follow-up, no significant differences were observed between the nSML group compared to the PDT group in BCVA (0.10 [0.00; 0.20]) and 0.10 [0.10; 0.10], respectively, p=0.69, and between some OCT parameters, namely CMT and CVI. SFCT was significantly reduced in the PDT group more than in the nSML group (p=0.01). Twelve eyes (60%) in the PDT group had complete resolution of the SRF at 6 months compared to 8 eyes (36.4%) in the nSML group, but the difference was not statistically significant (p=0.14). Results from patients treated with PDT and nSML showed that, at 6 months, no significant differences except for choroidal thickness. nSML is less invasive than PDT and can be used as an effective alternative to PDT. WHAT IS KNOWN : Treating chronic CSCR is a therapeutic conundrum for clinicians because of a lack of definitive consensus over remediation options, two of which are photodynamic therapy (PDT) and navigated subthreshold micropulse laser (nSML) therapy. Results from patients treated with PDT and nSML showed no significant differences except for choroidal thickness. Even though patients treated with PDT recovered more quickly, retreatment was necessary due to fluid recollection. Although patients treated with nSML also needed retreatment, nSML is less invasive than PDT and can be used as an effective alternative to PDT.

Occlusive retinal vasculitis and scleritis following brolucizumab treatment: A case report.

Brolucizumab is an anti-vascular endothelial growth factor agent. Clinical trials have demonstrated excellent efficacy of brolucizumab for neovascular age-related macular degeneration in terms of both visual and anatomic outcomes. However, compared with conventional anti-vascular endothelial growth factor therapy, this new treatment has a higher incidence of complications, particularly the development of occlusive retinal vasculitis. In this case report, we describe a patient who developed occlusive retinal vasculitis following brolucizumab treatment for age-related macular degeneration, followed by scleritis 141 days later. A 67-year-old Japanese man with a diagnosis of polypoidal choroidal vasculopathy in his right eye has received 18 intravitreal injections of aflibercept in the past 4 years. Because of a decline in treatment efficacy, intravitreal brolucizumab injection (IVBr) was initiated. However, 17 days after the second IVBr, the patient developed extensive occlusive retinal vasculitis with intraocular inflammation. Occlusive retinal vasculitis in the right eye was diagnosed as a complication of brolucizumab therapy. Corticosteroid treatment was initiated. The occlusive retinal vasculitis resolved 121 days after the second IVBr, and corticosteroid treatment was discontinued on day 138. However, on day 158 after the second IVBr, scleritis with intraocular inflammation developed. By day 184 after the second IVBr, both the scleritis and intraocular inflammation had resolved with the resumption of topical corticosteroid treatment. This case underscores the potential for brolucizumab-induced scleritis and emphasizes the importance of recognizing and promptly managing this complication. Furthermore, it highlights the need for long-term careful follow-up in patients who develop occlusive retinal vasculitis after brolucizumab treatment.

Dexamethasone implant in naive versus refractory patients with diabetic macular edema: a Meta-analysis.

To evaluate the efficacy and safety of the intravitreal dexamethasone implant in naive and refractory patients with diabetic macular edema (DME). PubMed, Embase, Web of Science, and Medline databases were searched. The main outcomes were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). The secondary outcomes included mean number of injections, intraoperative or postoperative complications including intraocular pressure (IOP) elevation and cataract. Ten comparative studies involving a total of 1000 DME eyes including 402 naive eyes and 598 refractory eyes were selected. The postoperative BCVA in the naive group was significantly better than in the refractory group [mean difference (MD) -0.11, 95% confidence interval (CI) -0.17 to -0.05, P=0.0003; MD 8.69, 95%CI 5.08 to 12.30, P<0.00001)]. Additionally, the naive group got greater improvement of BCVA change as well as more gains of BCVA letters than the refractory group [MD 7.71, 95%CI 2.02 to 13.40, P=0.008; odds ratio (OR) 2.99, 95%CI 2.05 to 4.37, P<0.00001]. The subgroup analysis revealed that the naive group had significantly higher BCVA gains of ≥5, ≥10, and ≥15 letters compared to the refractory group (P=0.002, 0.0001, 0.003, respectively). No significant difference was detected between the two groups in either postoperative CRT (MD -22.36, 95%CI -46.39 to 1.66, P=0.07) or the overall mean number of injections (MD -0.08, 95%CI -0.38 to 0.22, P=0.61). Intraoperative and postoperative complications including the elevation of IOP (OR 0.47, 95%CI 0.20 to 1.13, P=0.09) and cataract (OR 1.78, 95%CI 0.97 to 3.24, P=0.06) showed no significant differences between the two groups during the follow-up time. Intravitreal dexamethasone implants for DME can improve anatomical and functional outcomes in both naive and refractory eyes and have a well-acceptable safety profile. Moreover, naive eyes maintain better visual outcomes than refractory eyes. It provides further evidence of better visual response when used for naive eyes as first-line therapy.

Influence of vortex vein engorgement for photodynamic therapy in central serous chorioretinopathy

This study evaluates the efficacy of photodynamic therapy (PDT) in treating central serous chorioretinopathy (CSC) based on the number of engorged vortex vein draining macula visualized on ultra-widefield (UWF) indocyanine green angiography (ICGA). Thirty-six eyes of 36 patients with treatment-naïve CSC were included. Macula-draining vortex veins were assessed in each quadrant using UWF ICGA. The resolution of subretinal fluid (SRF), pigment epithelial detachment (PED), ellipsoid zone (EZ) disintegrity, and retinal pigment epithelium (RPE) irregularity were evaluated at 3 months after PDT. Visual and anatomical improvements were monitored for 12 months. Logistic regression analysis was performed to identify factors associated with poor visual outcomes. A higher number of macula-draining vortex vein was associated to persistent SRF (p = 0.004), PED (p = 0.001), EZ disintegrity (p = 0.011), and RPE irregularity (p = 0.001). Macula-draining vortex veins were also correlated with poor EZ restoration and limited best corrected visual acuity (BCVA) improvements. In multivariate analysis, the number of macula-draining vortex vein (B = 0.197, p = 0.047) was a risk factor for worse BCVA at 12 months. Increased macula-draining vortex vein was related with unfavorable anatomical and poor visual outcomes after PDT in CSC patients.

Post-operative face-up or face-down positioning after silicone oil tamponade in retinal surgery: Results of a retrospective study.

To compare the complications related to silicone oil, and anatomical and functional outcomes in patients nursed in different postoperative positionings after pars plana vitrectomy with silicone oil injection in retinal surgery. The retrospective cohort study was conducted at the Department of Ophthalmology, King AbdulAziz Medical City, Riyadh, Saudi Arabia, and comprised data of patients who underwent pars plana vitrectomy with silicone oil tamponade from January 2016 to October 2022. The patients were divided into two groups depending on how they were nursed in the postoperative period. Group A patients were nursed in postoperative face-down positioning and group B patients were nursed in the face-up position. Complications related to silicone oil tamponade, visual outcomes and anatomical results were compared between the groups. Data was analyzed using SPSS 26. Of the 157, 97(62%) were males and 60(38%) were females. The overall mean age was 5320 years. Group A had 87(55.4%) patients, while group B had 70(44.6%). There were 185 eyes involved; 104(56.2%) in group A and 81(43.8%) in group B. Overall, mean postoperative follow-up duration was 2519 months. Migration of silicone oil in the anterior chamber was more common in group A (p=0.470). Pupil block glaucoma was seen in 2(1.9%) eyes in group A only.Silicone oil-related complications, functional outcomes and anatomical outcomes were non-significantly different between the grpups (p>0.05) except a weak significant difference with respect to redetachments after removal of silicone oil (p=0.047). There was no difference seen in terms of complications as well as anatomical and physiological outcomes related to silicone oil tamponade in face-down or face-up postoperative positioning after pars plana vitrectomy with silicone oil tamponade for complicated retinal detachment surgery.

Transretinal puncture with a 41G cannula for posterior residual subretinal fluid in fovea-off retinal detachments treated by vitrectomy VS fluid tolerance VS other conventional drainage techniques: a comparative study.

To compare functional and anatomical outcomes between posterior drainage of residual fluid using a 41G cannula, fluid tolerance (R-SRF), and conventional complete drainage methods, including removal through peripheral retinal breaks (PRB), perfluorocarbon liquid (PFCL), and posterior retinotomy (PR). In this retrospective, multicenter study, we evaluated cases for visual acuity (VA) at 3 months of follow-up. Secondary outcomes included surgical success, postoperative metamorphopsia, shifts, full-thickness folds (FTF), optical coherence tomography (OCT) parameters, and safety. Subgroup analyses were also conducted. VA did not differ significantly between the three main groups. Subgroup analyses revealed worse VA for PR with 1.131 LogMAR (20/270 in Snellen conversion, p=0,002), with significantly more grade C proliferative vitreoretinopathy (PVR, 40.0%, p=0,003). R-SRF tended to offer better secondary outcomes, without statistical significance except for postoperative epiretinal membrane (ERM, 30.8%, p=0,041). Subgroup analyses found significantly more shifts with PFCL (91,7%, p=0,036). No cases of postoperative FTF or macular holes were observed with the 41G. Our study introduced the 41G technique, indicating favourable outcomes for fovea-off retinal detachments. Nevertheless, fluid tolerance appeared to be the best option, offering a cost-effective and faster method, with an optimal microstructural profile and VA comparable to that of complete drainage techniques.

Sacrocolpopexy: The Way I Do It.

Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP. This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications. Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele. Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

Comparative analysis of pre-operative findings and post-operative outcomes in primary and secondary macular holes at a tertiary eye hospital in South India

PurposeThis study aimed to compare demographics, clinical characteristics, and post-surgical outcomes between idiopathic and secondary full-thickness macular holes (MHs).MethodsA retrospective analysis of 348 eyes from 339 patients treated between June 2017 and December 2023 was conducted. The study included both idiopathic and secondary MHs, excluding cases where surgery was not performed or lacked sufficient follow-up. Demographic data, visual acuity (VA), ocular characteristics, and optical coherence tomography measurements were analyzed.ResultsIdiopathic MHs were identified in 308 eyes (89%), and secondary MHs in 40 eyes (11%). Idiopathic MH patients were older (mean age: 68.26 vs. 60.13 years; p = 0.001) and more commonly female (63% vs. 40%; p = 0.005). Post-surgical closure was achieved in 86% of all MHs, with a median VA improvement of 15 ETDRS letters (3 Snellen lines). However, secondary MHs had a lower closure rate (67% vs. 89%, p = 0.001) and less VA improvement (2 lines vs. 3 lines, p = 0.001) compared to idiopathic MHs. Significant differences in maximal basal diameter and diameter hole index were noted between the groups.ConclusionsSecondary MHs, accounting for 11% of surgical cases, show poorer anatomical and visual outcomes than idiopathic MHs. Despite lower success rates, early surgical intervention in secondary MHs is recommended to enhance outcomes. Differentiating between idiopathic and secondary MHs is crucial for optimal management.

Long-Term Functional Outcomes of Retinal Detachment Due to Acute Retinal Necrosis: A Case Series.

Objectives: To evaluate the long-term anatomical and functional prognosis of patients with retinal detachment (RD) secondary to acute retinal necrosis (ARN) treated with pars plana vitrectomy (PPV). Methods: This retrospective case series included 21 eyes from 21 patients with RD secondary to ARN. The study analyzed vitreous or aqueous biopsy results, the impact of antiviral therapy, time to retinal detachment, changes in visual acuity (VA), and anatomical and surgical outcomes. All cases underwent 23-gauge PPV with silicone oil tamponade, and an episcleral encircling band was used in 11 cases. All patients received systemic antiviral therapy at diagnosis. Results: Retinal reattachment was achieved in 91% of cases during follow-up, with an average follow-up period of 39.5 ± 36.8 months. The average time from ARN diagnosis to RD onset was 33.3 ± 27.5 days. VZV was detected in 10 eyes through PCR analysis. Significant differences in visual prognosis were found between macula-off and macula-on RD (p = 0.048). Eyes with optic nerve head inflammation had worse final VA (p = 0.010). No significant difference was observed between preoperative VA and VA at the end of follow-up (p = 0.665). Conclusions: VZV was the primary virus associated with ARN-related RD. Early involvement of the macula and optic nerve in retinitis negatively impacted the final visual prognosis.

Influence of foveal glial tissue after macular hole surgery on outer retinal restoration and visual acuity

Purpose: To investigate the impact of foveal glial tissue on the anatomical and functional results after macular hole (MH) surgery. Methods: This study included 141 consecutive eyes that underwent successful vitrectomy for full-thickness MH between January 2015 and December 2022. The best-corrected visual acuity (BCVA) and the length of outer retinal defects were evaluated preoperatively and at 6 months postoperatively. MH with retinal detachment, recurrent MH, and traumatic MH were excluded. Multiple regression analyses were conducted on outer retinal restoration and visual acuity using foveal glial tissue size, surgical technique of internal limiting membrane (ILM) peeling or inverted ILM flap, and high myopia as explanatory variables. Results: Analyses revealed that the foveal glial tissue significantly limited the outer nuclear layer (ONL), external limiting membrane (ELM) restoration, and ellipsoid zone (EZ) restoration as well as BCVA improvement (r = −0.380, p &lt; 0.001; r = −0.314, p = 0.035; r = −0.530, p = 0.015; r = −0.00027, p = 0.001; respectively). Meanwhile, the surgical technique and high myopia did not significantly affect the restoration of ONL, ELM, EZ, and BCVA after surgery. Conclusion: Foveal glial tissue after MH surgery attenuated ONL, ELM, and EZ restoration as well as BCVA improvement.

Comparative analysis of methods of surgical correction of post-hysterectomy pelvic organ prolapse

BACKGROUND: The incidence of prolapse after hysterectomy requiring surgical intervention is estimated at 36 cases per 10,000 women. A universal surgical treatment method for post-hysterectomy pelvic organ prolapse is lacking, prompting the need for new approaches. AIM: To comparatively analyze the results of laparoscopic sacrocolpopexy, sacrospinous fixation, and the developed new method of surgical correction of pelvic organ prolapse after hysterectomy. MATERIAL AND METHODS: This prospective non-randomized study included 57 patients with stage II, III, or IV symptomatic post-hysterectomy prolapse of the pelvic organs who were admitted at the clinical hospital RZD-Medicine in Tula, Russia, between August 2019 and September 2023. The first group (n=18) consisted of women who underwent surgical correction of post-hysterectomy pelvic organ prolapse in a newly developed method; the second group (n=19) included women who underwent laparoscopic promontofixation according to the conventional technique; and the third group (n=20) involved patients who underwent installation of an apical sling using a UroSling-1 mesh endoprosthesis (Lintex LLC, St. Petersburg). The patients’ quality of life was assessed using specialized validated questionnaires: Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Patients were asked to complete questionnaires before surgery and 12 and 24 months after surgical correction of PGP. The patients were invited for a follow-up examination after 1, 6, 12, and 24 months. RESULTS: The duration of the operation in the second group significantly exceeded the indicators of the first and third groups. The average duration of hospital stay of patients was 4.4±0.6 (95% CI: 4.1–4.7) bed days in the first group, 4.9±1.1 (95% CI: 4.6–5.3) in the second, and 4.6±0.6 (95% CI: 4.3–4.9) in the third. The differences were insignificant (p1–2=0.437; p1–3=0.137; p2–3=0.235). The anatomical results after 24 months at points Aa and Ba showed significant differences. At point Aa, p1–3=0.007 and p2–3=0.004, and at point Ba, p1–3=0.032 and p2–3=0.041. A comparative assessment of the questionnaire data before surgery and 12 and 24 months after surgery showed a significant improvement in the quality of life of patients in the three groups. CONCLUSION: The proposed method of correction of post-hysterectomy pelvic organ prolapse provides high anatomical and functional results and reduces the posibility of repeated surgical intervention for recurrence.

Pediatric macular hole associated with vitreoretinal traction on epiretinal lesions – a case report and literature review

Purpose: We describe a case of non-traumatic macular hole in a pediatric patient associated with numerous epiretinal lesions throughout the macula. Methods: A healthy 9-year-old girl presented to retina clinic with several months of blurry vision in the right eye. Clinically, there was a full-thickness macular hole with serous detachment and white epiretinal tufts. Spectral-domain optical coherence tomography confirmed the presence of the full-thickness macular hole with hyperreflective epiretinal proliferations in the right eye and an unremarkable left eye. Systemic work-up was negative. After a short period of observation, the patient underwent vitrectomy with internal limiting membrane peel and 14% C3F8 gas tamponade in the right eye. Multiple intraoperative samples were sent for further testing, which were also negative. Results: At one and six-month postoperative visits, examination showed successful closure of the full-thickness macular hole with resolution of the subretinal fluid and improved visual acuity. Conclusion: Non-traumatic macular holes in pediatric patients warrant systemic and ocular work-up, including fluorescein angiography and lab testing. Good anatomic and visual outcomes are generally seen with spontaneous and surgical closures of macular holes in this age group. Early vitrectomy with histological analysis of ocular samples should be considered in pediatric macular hole cases associated with vitreoretinal traction, especially those with epiretinal abnormalities.

Long-term surgical outcomes and prognostic factors for advanced-stage retinopathy of prematurity after vitrectomy

Background/aimsThe aims of this study is to evaluate the anatomic, visual outcomes and associated prognostic factors in patients with advanced retinopathy of prematurity (ROP) following vitrectomy.MethodsA retrospective cohort study of...

Preoperative Evaluation, Informed Consent and Postoperative Care in Pediatric Vitreoretinal Surgery

In childhood, vitreoretinal surgery may be required due to trauma and some congenital or developmental disorders. Pediatric vitreoretinal surgery differs from that of adults in terms of etiology, anatomical and surgical characteristics, response to treatment and follow-up. This process has many challenges that require patient follow-up over many years as the child develops. Pre-operative preparation according to the age of the patient and the nature of the pathology will make it easier for the surgeon to manage all the processes. The consent of the child must be obtained in accordance with the child's cognitive abilities, in addition to the informed consent of the family. Despite surgical and technological advances in pediatric vitrectomy, anatomical and functional outcomes are worse than in adults. This article discusses pediatric vitreoretinal surgery in terms of preoperative preparation, informed consent and follow-up.

Corneal stromal lenticule transplantation for the treatment of congenital optic disc pit maculopathy : a case report and review

BackgroundCongenital optic disc pit (ODP) is a relatively uncommon congenital anomaly of the optic disc, which seriously affects the patient’s vision when combined with optic disc pit maculopathy(ODP-M). Currently, the treatment of ODP-M remains a clinical challenge and a focus of research.Case presentationA boy had a pit in the inferotemporal segment of the optic disc with ODP-M. Optical Coherence Tomography(OCT) showed ODP and serous retinal detachment. He was treated with pars plana vitrectomy(PPV), followed by Corneal Stromal Lenticule (CSL) sealing and C3F8 tamponade. In the end, significant anatomical improvement was achieved, and the Best Corrected Visual Acuity(BCVA) was improved.ConclusionsThe CSL transplantation may be a viable therapeutic option for improving ODP-M with stable anatomical and functional result. However, more cases and longer follow-up are needed to confirm the safety and effectiveness of the technology.

Efficacy and safety of treat-and-extend intravitreal brolucizumab in naive and switched patients with macular neovascularization: one-year follow-up study

Backgroundto analyze, at one year, the efficacy and safety of treat-and-extend (T&E) intravitreal (IV) Brolucizumab in patients affected by macular neovascularization (MNV). Both naïve and previously treated (i.e., switched) patients were included, and the data from the two groups were compared.Methodsanatomical (i.e., central subfoveal thickness, CST; presence of fluid), functional (i.e., best corrected visual acuity, BCVA) and treatment-related (i.e., number of IV injections within the study period; number of patients reaching a 12-weeks interval between treatments) data from 41 eyes of 41 subjects (20 naïve and 21 switched) were analyzed. Patients were treated with 3 monthly IV injections followed by a T&E regimen based on a disease activity assessment performed at each scheduled IV treatment.Resultssignificant CST reduction (from 412.1 ± 115.8 to 273.2 ± 61.6; p < 0.05) and BCVA (mean; p) improvement were observed in the naïve group, while in the switched cohort, both parameters were almost stable. In the naïve and switched groups, 55% and 33.5% of patients, respectively, reached a 12-week IV interval at one year, with a mean of 6.55 ± 1 and 7.43 ± 0.68 IV treatments, respectively. One patient with mild anterior uveitis without sequelae was recorded.ConclusionIn patients with MNV, IV Brolucizumab injections following a T&E regimen demonstrated great efficacy and a good safety profile, with greater anatomical and functional results in naïve patients.Trial registrationThis study was approved by the Local Ethics Committee (protocol number 155/2020, general registry number n°11486, InterHospital Ethics Committee, San Luigi Gonzaga Hospital, Orbassano, Italy).

Surgical Reconstruction in Malignant Eyelid Tumors.

To report the histopathological subtypes of malignant eyelid tumors treated surgically in the author's clinic and to present the author's graft and flap preferences in the reconstruction of the eyelid defect after surgical excision. This retrospective study included 33 patients who underwent malignant eyelid tumor excision, followed by eyelid reconstruction. A frozen section was performed during surgery to assess surgical margins in all patients. Demographic characteristics, histological classification, localization, and size of the tumor, postoperative defect size, follow-up period, complications, and recurrence rate were recorded. Of the patients with a mean age of 66.6 ± 15.3 (range: 23-94), 15 (45.5%) were females and 18 (54.5%) were males. The lower eyelid was the most commonly involved site in 27 (81.8%) patients. Basal cell carcinoma was the most frequently diagnosed type of malignant cancer in 81.8% (n = 27) of the cases. Among the tumor subtypes, nodular type basal cell carcinoma was the most frequently observed subtype in 10 (30.3%) patients. Wide excision with different flap and graft techniques was performed in 26 (78.8%) patients with defect sizes of 40% or larger. In the author's study, the most preferred flap technique for anterior lamella reconstruction was the Tenzel semicircular flap (30.3% n = 10). The most frequently preferred flap for posterior lamella reconstruction was the Hughes tarsoconjunctival flap (30.3% n = 10). There were no flap or graft failures in any of the author's cases. In the treatment of malignant eyelid tumors, different local flap and graft techniques selected according to the size of the defect have successful anatomical results in reconstructive surgery after frozen section controlled excision.