Spyridon Dimopoulos

Rate and timing of spontaneous resolution in a vitreomacular traction group: Should the role of watchful waiting be re-evaluated as an alternative to Ocriplasmin therapy?

Introduction The incidence of spontaneous resolution of vitreomacular traction (VMT) is low in studies of Ocriplasmin that have had a limited follow-up. Previous studies did not look for morphological parameters in the natural history using spectral-domain ocular coherence tomography (SD-OCT) imaging. The purpose of this study was to investigate how often and when spontaneous VMT resolution occurs in candidates for Ocriplasmin therapy. Methods The study is a retrospective chart review of patients who would have high chances of a benefit by an Ocriplasmin injection, without epiretinal membrane or vitreomacular adhesion of 1500 µm or more on SD-OCT. Main outcome measures were the frequency of complete VMT resolution and the best corrected visual acuity seen in the natural history. Results Out of the 46 patients that were included after screening 889 SD-OCT images, 20 were found to exhibit spontaneous resolution during the follow-up period (median: 594 days, 95% CI 567 to 719 days), the majority after 6–12 months of observation (95% CI 266 to 617 days). The group with spontaneous VMT resolution and a mean improvement of one line in best corrected visual acuity included a few patients losing vision by macular hole formation. In the absence of resolution, patients lost on average one early treatment diabetic retinopathy study letter per year. Younger age was found to increase the chance of spontaneous resolution. Conclusions A shorter follow-up might underestimate the incidence of spontaneous VMT resolution as the functional outcome of watchful waiting. The likelihood of resolution does not seem to decrease after 12 months.

Micro-invasive suture trabeculotomy after canaloplasty: preliminary results

In this study, a conjunctival‐sparing ab interno approach for circumferential trabeculotomy, termed micro‐invasive suture trabeculotomy (MIST) and its preliminary results are presented.

Outcomes of Ahmed Glaucoma Valve Implantation for Glaucoma Secondary to Fuchs Uveitis Syndrome

ABSTRACT Purpose: To present the outcomes of Ahmed glaucoma valve implantation (AGV) in glaucoma secondary to Fuchs uveitis syndrome (FUS). Methods: In this retrospective chart review, two definitions of success were used: 6 mmHg ≤intraocular pressure (IOP) ≤21 mmHg (success 1), and 6 mmHg ≤ IOP ≤21 mmHg and at least 25% reduction from baseline (success 2). Depending on the need of postoperative antiglaucoma medication, success was defined as either complete or qualified. Results: In total, 17 eyes of 17 patients were included. Complete success rates (both definitions) were 23.5% (n = 17) after 1 year and 23% (n = 13) after 3 years. Qualified success rates (both definitions) were 58.3% (n = 17) after 1 and 38.4% (n = 13) after 3 years. Encapsulated bleb formation was the most common complication (47% of eyes). Conclusions: AGV was moderately successful in the management of glaucoma secondary to FUS. Success rates are improved by medications, needling, and cycloablative procedures.

Treatment efficacy and safety of canaloplasty for open‐angle glaucoma after 5 years

(SD 0.9), and postoperative score was 0.7 (SD 0.5). Average change in corneal score was −1.1 (SD 0.9, P-value = 0.001). Five eyes experienced complete resolution of keratopathy, and 11 had mild epithelial keratopathy. Half of patients had concomitant procedures: lower lid tightening +/− mid-face lift (six eyelids), direct brow lift (three eyelids) and lateral tarsorrhaphy (two eyelids). The change in MRD1 was −1.3 mm (+/− 1.2) with weight only, and −1.1 mm (+/− 1.4) in weight plus another procedure (P-value = 0.77). The change in lagophthalmos was 2.6 mm (+/− 1.3) with weight only, and 4.5 mm (+/− 1.9) with weight plus another procedure (P-value = 0.03). Average preoperative lagophthalmos was 4 mm (+/− 2.4) in the weight only cohort, and 6 mm (+/− 2.9) in the weight plus another procedure group. None experienced infection, migration or extrusion. There were no complaints regarding cosmesis or ptosis. Our technique combines recession of the levator aponeurosis with supratarsal weight implantation. The implant becomes a ‘spacer’ between the recessed levator aponeurosis and tarsus. It addresses both lagophthalmos and eyelid retraction caused by weakened orbicularis tone. Additionally, it addresses the visible and palpable weight contour with pretarsal placement. This study is first to quantify preoperative and postoperative MRD1, lagophthalmos and corneal changes with upper eyelid loading. Other studies have reported extrusion and complication rates or corneal changes. No previous study separately analysed subjects undergoing other procedures in addition to weight placement. Tower and Dailey’s manuscript is the only study that quantified change in lagophthalmos. All patients experienced significant improvement in lagophthalmos and corneal status. Our average reduction of 3.5 mm lagophthalmos was similar to 3.2 mm reported by Tower and Dailey, although we used on average 1.5 gm, compared to their standardized 2.2 gm. We achieved upper lid recession of 1.2 mm, which was statistically significant. We believe this should be sufficient to address upper lid retraction from weakened orbicularis tone. Concomitant lower lid tightening +/− cheek lift had significantly more reduction of lagophthalmos than weight placement alone. This seems intuitive, as both lower lid retraction and upper lid closure contribute to lagophthalmos. Those with other procedures in addition to weight placement had more lagophthalmos preoperatively. No patients had implant migration or extrusion, with an average of 11.5 months follow-up. Posterior extrusion of the weight remains a concern, as only Müller’s and conjunctiva separate the weight from the surface of the globe, and late extrusion has previously been described. Our study is limited by small size, and retrospective review of a single surgeons cases. These do not negate the efficacy of our modification of a widely accepted procedure. This modification is simple, efficacious and cosmetically acceptable. It can be added to the surgical armamentarium for treating exposure keratopathy due to lagophthalmos. Ali Mokhtarzadeh MD, Edward W Lee MD, Behin I Barahimi MD, Michael S Lee MD and Andrew R Harrison MD Departments of Ophthalmology, Ophthalmology, Neurology and Neurosurgery and Ophthalmology and Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA Received 10 April 2015; accepted 12 April 2015.

Injection scheme for intravitreal bevacizumab therapy for macular oedema due to central retinal vein occlusion: results of a multicenter study

Bonnin P, Pournaras JA, Lazrak Z et al. (2010): Ultrasound assessment of short-term ocular vascular effects of intravitreal injection of bevacizumab (Avastin) in neovascular age-related macular degeneration. Acta Ophthalmol 88: 641–645. Cunningham ET Jr, Adamis AP, Altaweel M et al. (2005): A phase II randomized Double masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology 112: 1747–1757. Gragoudas ES, Adamis AP, Cunningham ET Jr et al. (2004): Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351: 2805–2816. Papadopoulou DN, Mendrinos E, Mangioris G et al. (2009): Intravitreal ranibizumab may induce retinal arteriolar vasoconstriction in patients with neovascular age-related macular degeneration. Ophthalmology 116: 1755–1761. Wroblewski JJ, Wells JA 3rd & Gonzales CR (2010): Pegaptanib sodium for macular edema secondary to branch retinal vein occlusion. Am J Ophthalmol 149: 147–154.

Submacular predominantly hemorrhagic choroidal neovascularization: resolution of bleedings under anti-VEGF therapy

Purpose To report the visual and morphological outcomes following intravitreal bevacizumab in neovascular age-related macular degeneration (nAMD) with submacular, predominantly hemorrhagic, lesions. Methods Retrospective study of patients with a follow-up after 1 year. All eyes with submacular hemorrhages larger than 50% of the total lesion size and received only anti-VEGF (vascular endothelial growth factor) monotherapy (intravitreous administration of 1.25 mg bevacizumab, PRN). The primary endpoint was the change in hemorrhage size and time to resolution, in association with the mean best-corrected visual acuity (BCVA). The eyes were grouped based on the size of the hemorrhage: group A (≥1 to <4 disc area [DA]), group B (≥4 to <9 DA), and group C (≥9 DA). Results Forty-six consecutive eyes were included. The mean area of the hemorrhage was 6 DA at baseline. Eyes with smaller bleeding (group A) had better chances of stabilized or improved vision. Complete resolution of the hemorrhage was seen in 96% of the eyes within 1 year. The mean BCVA increased from 0.81 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI]: 0.70–0.92) (Snellen 20/125) at baseline to 0.75 logMAR (95% CI: 0.62–0.88) (20/125) after 1 year (P=0.11). BCVA improved (one or more ETDRS [Early Treatment of Diabetic Retinopathy Study] lines) in 57% of the eyes (13/23) in group A; 53% (8/15) in group B; and 38% (3/8) in group C. Conclusion Many of the eyes with hemorrhagic lesions showed stabilization or improvement of the mean BCVA after treatment within 1 year. Anti-VEGF treatment can be considered as a useful treatment option in eyes with hemorrhages secondary to nAMD.

Anatomical and visual outcomes of autologous thrombocyte serum concentrate in the treatment of persistent full-thickness idiopathic macular hole after ILM peeling with brilliant blue G and membrane blue dual

with end-gripping forceps (Fig. 2B,C). No bleeding was observed. At the 2and 4-week follow-up, BCVAwas 20/25 and 20/22, respectively. VF defects had improved slightly while retaining perifoveal scotomas (Fig. 1B). Retinal thickness gradually decreased to 240 and 195 lm in the follow-up visits (Fig. 1D). In the 8-week follow-up visit, the arterial phase on FFA was restored (Fig. 1H). Newly formed arterial anastomoses were noticed, deriving from the radial peripapillary and epipapillary arterioles (Fig. 1H). We found no data about spontaneous resolution of CE. In our opinion, embolectomy is the only feasible treatment for arterial occlusion caused by CE (Arum ı et al. 2006; Brunner & Binder 2013; Matonti et al. 2013). However, the formation of vascular anastomoses can also play a role in the restoration of retinal blood flow and visual functions. To the best of our knowledge, this is the first case report of BRAO associated with myxomatous mitral valve degeneration and MV calcification, treated successfully with embolectomy, 10 days (240 h) after the onset and followed by significant BCVA improvement. In spite the risks, SE has to be considered in the early period of CRAO or BRAO caused by CE.

Comparison of ab externo trabeculotomy in primary open-angle glaucoma and uveitic glaucoma: long-term outcomes

Background The aim of this study was to compare the long-term outcomes of ab externo trabeculotomy in primary open-angle glaucoma (POAG) and uveitic glaucoma (UG). Design This was a retrospective single-center case series study. Participants Twenty eyes of 17 patients with POAG and 22 eyes of 18 patients with UG were included in this study. Patients and methods The medical records of all consecutive patients with POAG and UG who underwent ab externo trabeculotomy since 2004 were reviewed. Main outcome measure The main outcome measure was change in median intraocular pressure (IOP). Success was defined as IOP ≤21 mmHg (success 1) and IOP ≤21 mmHg and at least 25% reduction from baseline (success 2). Results In the POAG group, the median IOP decreased significantly from 22 mmHg (95% CI 21–25 mmHg; n=20) at baseline to 14 mmHg (95% CI 12–16; n=13) after 4 years, P<0.001. In the UG group, the median IOP decreased significantly from 27 mmHg (95% CI 24.5–30.5 mmHg; n=22) at baseline to 12 mmHg (95% CI 9–15 mmHg; n=15) after 4 years, P<0.001. Seven eyes in the UG group failed within the first year after surgery compared to none in the POAG group. Of these, four eyes had Fuchs’ uveitis syndrome and two had granulomatous uveitis. No sight-threatening complications occurred in both POAG and UG groups. Conclusion Ab externo trabeculotomy effectively reduced IOP in both UG and POAG groups. However, the success rates in the UG group were significantly lower due to the high failure rate in patients with Fuchs’ uveitis syndrome and granulomatous uveitis. The procedure demonstrated a high safety profile in both UG and POAG patients.

Real-life experience with intravitreal ocriplasmin on vitreomacular traction and full-thickness macular holes.

of primary RRD is seen in many centres around the world (FalknerRadler et al. 2011; Wong et al. 2014). The role of PPV is likely to further increase over time, as smaller gauge vitrectomy becomes more commonly used, and continuous improvement is seen in anatomical and visual outcomes (Tsang et al. 2008; Falkner-Radler et al. 2011). Our data have shown an increasing incidence of macular hole surgery which has coincided with improvement in optical coherence tomography and vital dyes (Rodrigues et al. 2007). The number of vitreoretinal surgical operations from complications of advanced diabetic retinopathy (tractional retinal detachment and vitreous haemorrhage) has remained constant which may be a reflection of better awareness amongst healthcare providers, improved diabetic control and the establishment of the national diabetic retinopathy screening programme. The study provides useful numbers for the planning of resources for a vitreoretinal service with detail on the pattern of surgical practice and use of various agents required for a vitreoretinal service. Changes in practice include an increased use of small gauge surgery and a resultant reduction in the need for per-operative suturing. Gases and intra-ocular dyes are used regularly, but changes in the agents used with time have been identified. Current trend has major implications on the future education and training of vitreoretinal surgeons and in particular suggests the use of scleral buckle surgery may further decrease in developed nations.