Purpose: To evaluate vitreoretinal surgeons' access to operating rooms and potential barriers to care. Methods: An electronic survey of the American Society of Retina Specialists was performed in 2025. Results: Of the 276 respondents, most (90% [248]) were concerned about obtaining sufficient operating room time, with more than half (54% [150]) reporting increased difficulty accessing hospital operating rooms even during the weekdays and 45% (124) reporting increased difficulty accessing hospital operating rooms at nights and weekends. The most common reasons for limited access to operating rooms included block time/scheduling conflicts (61% [169]), anesthesia limitations (59% [162]), staffing limitations (51% [142]), and lower relative reimbursements for vitreoretinal surgeries (45% [125]). Most surgeons (94% [259]) believed that restricting operating room access adversely impacted patient care, leading to delays for urgent retinal detachment repairs (77% [212]), increased travel burden for patients (62% [170]), and worse patient outcomes (41% [113]). Patients treated in lower socioeconomic areas had to travel farther for surgery (median of 19 vs 9 miles for ambulatory surgery centers, P < .001, and 17 vs 9 miles for hospitals, P < .001). Practices have compensated by relying more on in-office procedures (46% [128]) and referrals to academic centers (39% [108]). Conclusions: Vitreoretinal surgeons were concerned about access restrictions to operating rooms and the potential impact on patients. Potential reasons for limited operating room access were likely multifactorial but included limited block time, restrictions in anesthesia and staff availability, and lower relative surgical reimbursements.
Purpose: To evaluate the outcomes of macular holes (MH) repaired using the viscostretch technique. Methods: This multicenter, multi-surgeon retrospective consecutive case series analyzed MH repaired with the viscostretch technique. Charts were retrospectively reviewed to assess baseline characteristics and outcomes. Results: Twenty eyes underwent complex MH repair with viscostretch. Baseline MH features included mean MH duration of 7 months (range, 0.75-18), baseline vision of 20/250 (20/50 to counting fingers), minimal linear MH diameter of 621 µm (range, 219-890), and maximal linear MH diameter of 1031 µm (range, 584-1498). MH were characterized by the presence of the following nonmutually exclusive complex MH features: recurrent/refractory MH (12/20 eyes [60%]); large MH (>400 µm minimal linear diameter, 17/20 eyes [85%]); and chronic MH (≥6 months duration, 10/20 eyes [50%]). Five of 20 eyes (25%) had large, chronic MH; 7 eyes (35%) had large, refractory/recurrent MH; 2 eyes (10%) had chronic, refractory/recurrent MH; and 4 eyes (20%) had large, chronic, refractory/recurrent MH. MH closure was achieved in 13 of 20 (65%) cases. There were no differences in baseline characteristics in eyes that achieved MH closure and those that did not. In eyes that achieved MH closure, there was a significant improvement in mean visual acuity from 20/200 to 20/100 ( P = .04). No surgical or postoperative complications were identified. Conclusions: The viscostretch surgical technique achieved MH closure in 65% of eyes in a cohort of various complex MH. Further studies are necessary to determine the use of this technique for complex MH.
PURPOSE:Vitrectomy with an internal limiting membrane (ILM) flap has been used in the repair of macular holes (MH). Topical drops have been attempted for smaller MHs with limited data. This study aims to demonstrate the effectiveness of a topical drop regimen in failing MHs after ILM flap surgery. METHODS:Review of 3 eyes with open MHs after vitrectomy with ILM flap. Preoperative visual acuity, MH size, tamponade used during surgery, time-to-hole closure, and final visual acuity were collected. RESULTS:Average MH size among all eyes was 743.3µm (+ 150.4). At the postoperative visit, the MHs were open. All eyes were started on topical steroid, nonsteroidal, and carbonic anhydrase inhibitor drops twice daily for a mean time of 33 days (+ 11 days). There was successful closure of the MHs with topical therapy in all cases. CONCLUSIONS:Topical therapy may aid in post-operative MH closure.
Purpose: To examine the rate and outcomes of secondary vitrectomies following pneumatic retinopexy for indications other than recurrent retinal detachment (RD). Methods: This was a retrospective consecutive case series reviewing the period from 2010 to 2020. Patients were included if they required a secondary vitrectomy after a successful pneumatic retinopexy for any indication, excluding recurrent RD. Indication and time between pneumatic retinopexy and secondary vitrectomy were the primary outcome measures. Results: A total of 296 eyes that underwent pneumatic retinopexy for primary RD repair were included in the study. Six eyes underwent secondary vitrectomy after successful pneumatic retinopexy. Indications for vitrectomy included 2 eyes with epiretinal membrane (0.7 %), 1 eye with full-thickness macular hole (0.3%), and 3 eyes with vitreous opacities (1.0 %). The mean (±SD) time to vitrectomy was 6 ± 5.7 months for epiretinal membrane, 22 ± 2.1 months for vitreous opacities, and 10 months for macular hole. Conclusions: Following pneumatic retinopexy for RD repair, 2% of eyes required vitrectomy for indications other than recurrent RD. Time to secondary vitrectomy varied among the indications. Patients should be counseled appropriately for the possibility of a secondary vitrectomy following a successful pneumatic retinopexy.
Purpose To evaluate the safety, tolerability, and preliminary bioactivity of a single suprachoroidal injection of AXT107 (Gersizangitide), a multimodal integrin-disrupting peptide that acts on both the VEGFA pathway and angiopoietin-Tie2 pathway, in eyes with neovascular age-related macular degeneration (nAMD). Design Phase 1/2a, open-label, dose-escalation clinical trial. Participants Fifteen subjects with active nAMD, including 11 treatment-experienced partial responders to intravitreal anti-vascular endothelial growth factor (VEGF) therapy and 4 treatment-naive subjects; 14 eyes met the protocol-specified baseline imaging criterion and were included in efficacy analyses. Methods Study eyes received a single suprachoroidal injection of AXT107 microparticles at doses of 0.125, 0.25, or 0.5 mg and were followed for 40 weeks. Protocol-specified rescue intravitreal anti-VEGF treatment was permitted from week 12 based on protocol-specified best-corrected visual acuity (BCVA) or central subfield thickness (CST) criteria; anti-VEGF treatment before Week 12 was investigator-initiated. Primary outcomes were ocular and systemic safety through week 40; secondary outcomes included change in CST, change in BCVA, and time to first protocol-specified rescue injection. Main Outcome Measures Incidence of ocular and systemic adverse events, intraocular pressure (IOP), CST, BCVA, and time to first protocol-specified rescue injection. Results Twenty subjects were screened and 15 enrolled across 4 U.S. sites; 3 eyes received 0.125 mg, 3 received 0.25 mg, and 9 received 0.5 mg of AXT107. No serious adverse events related to AXT107 occurred, and no cases of endophthalmitis, retinal detachment, suprachoroidal hemorrhage, or clinically significant intraocular inflammation were observed through week 40. No clinically meaningful intraocular pressure (IOP) elevations occurred at any dose, and no subject required chronic IOP-lowering therapy. Among the 14 eligible eyes included in efficacy analyses, 2 eyes (01-04 and 01-05) completed 40 weeks without protocol-specified anti-VEGF rescue, and 1 eye (02-04) first received protocol-specified rescue at week 36. At the last on–treatment visit, BCVA changes ranged from +15 to -31 ETDRS letters; 3 eyes gained≥5 letters, 3 gained≥10 letters, and 1 gained≥15 letters. Among the 14 eligible eyes, anatomical improvements in CST were observed in at least 1 eye in each dose cohort. The most durable responses were seen in treatment–experienced eyes receiving 0.5 mg (median durability of 36 weeks), whereas treatment–naive 0.5-mg eyes showed more variable courses and generally earlier protocol–specified rescue in this small cohort. Conclusions In this first-in-human study, a single suprachoroidal injection of AXT107 up to 0.5 mg was well tolerated through Week 40, with no drug-related serious adverse events, no clinically significant intraocular inflammation, and no sustained IOP elevations. After a single suprachoroidal AXT107 injection, 2 eyes completed 40 weeks without protocol-specified rescue anti-VEGF treatment, and 1 additional eye received its first protocol-specified rescue treatment at Week 36. The exploratory observation that durability appeared greatest in treatment-experienced eyes supports further controlled study of AXT107, particularly in treatment-experienced nAMD populations.
