Abstract Objective To assess the clinical indications for scleral buckle removal (SBR) and evaluate the functional and anatomic outcomes, including the risk of recurrent retinal detachment (RD) following SBR. Design Retrospective chart review. Methods A single-center analysis of patients operated for SBR was conducted at the Centre hospitalier universitaire de Québec – Université Laval in Quebec, Canada between 2008 and 2023 with a minimum of 1 year follow-up. Data were gathered on preoperative characteristics, indication for SBR, time to SBR, surgical techniques used and postoperative outcomes including final best-corrected visual acuity (BCVA). The primary outcome was the incidence of recurrent RD after SBR. Results Among 2375 eyes that had placement of scleral buckle for RD, 35 (1.5%) required SBR. Infection (34%) and pain (31%) were the most common reasons for SBR. The median time from buckle placement to removal was significantly shorter for infectious cases (2.4 months) compared to non-infectious cases (12.6 months) (p = 0.006). Four patients (11%) experienced recurrent RD, with 3/4 of those cases occurring when buckle explantation was performed within the first month. Postoperative BCVA at final follow-up improved from logMAR 0.70 to logMAR 0.30 (Snellen equivalent of 20/100 to 20/40). A multivariate logistic regression analysis demonstrated no statistically significant predictors of recurrent RD. Conclusion Infection and pain are the leading indications for SBR, with infections requiring earlier removal. Recurrent RD occurred in 11% of cases, especially with early removal, with all recurrences occurring within 3 months of SBR. Despite these risks, visual outcomes post-SBR are generally favorable. Close monitoring during the early postoperative period is therefore recommended.

BACKGROUND:Optical coherence tomography (OCT) and OCT angiography (OCT-A) have been studied as biomarkers for Alzheimer's disease (AD), with promising results. Nevertheless, their potential in the logopenic variant of primary progressive aphasia (lvPPA), which shares the same amyloid pathology, has not yet been explored. This work aimed to characterize retinal changes in lvPPA compared to healthy controls. METHODS:Ten participants with lvPPA and eleven controls underwent OCT and OCT-A imaging. Amyloid pathology in lvPPA was confirmed by lumbar puncture. Retinal parameters included retinal nerve fiber layer (RNFL) thickness and foveal avascular zone (FAZ). RESULTS:Compared to controls, lvPPA participants exhibited reduced RNFL thickness in the temporal sector (p = 0.013) and significantly decreased FAZ circularity (p = 0.002). DISCUSSION:RNFL thinning may reflect trans-synaptic degeneration from cortical atrophy, while reduced FAZ circularity suggests early microvascular changes related to amyloid burden. Our findings support OCT and OCT-A as potential biomarkers for lvPPA. Highlights:For the first time, OCT and OCT-A are studied as potential biomarkers for lvPPA.Compared to healthy controls, retinal nerve thickness is decreased in lvPPA patients.Retinal vasculature exhibits structural alterations in lvPPA patients.

The logopenic variant of Primary Progressive Aphasia (lvPPA) is a neurodegenerative disorder affecting primarily language functions. In 86% of lvPPA cases, the underlying pathology is amyloidopathy, as seen in Alzheimer's disease (AD). Since the retina is considered an extension of the brain, recent research has explored optical coherence tomography (OCT) and OCT-angiography (OCT-A) as non-invasive biomarkers in AD. However, their potential in lvPPA remains unexplored. The aim of this study was to compare retinal findings in lvPPA patients and healthy controls using OCT and OCT-A. We conducted a cross-sectional study recruiting participants with lvPPA (diagnostic criteria by Gorno-Tempini, 2011) and healthy controls matched for sex and age. Participants were excluded if they had preexisting neurological or eye conditions. An extensive ophthalmological assessment was conducted to rule out eye diseases. OCT/OCTA imaging was then performed for all participants. For lvPPA patients, the Clinical Dementia Rating scale and a lumbar puncture were performed to assess disease stage and underlying pathology. Ten lvPPA patients and eleven controls were enrolled. All lvPPA patients had amyloidopathy confirmed by lumbar puncture. Mean CDR global score was 0.55 ± 0.16 (indicating mild dementia). Retinal nerve fiber layer (RNFL) in the temporal region was significantly thinner in the lvPPA group compared to controls (63.1 ± 3.3 μm vs 75.6 ± 3.2 μm, p  = 0.013). Foveal avascular zone (FAZ) circularity was also significantly lower in the lvPPA group (0.69 ± 0.02 vs 0.77 ± 0.02, p  = 0.002). Our findings suggest decreased RNFL thickness and reduced FAZ circularity in lvPPA. Decreased RNFL thickness reflects neuronal degeneration and its underlying mechanisms include retinal amyloid accumulation or retrograde degeneration. This suggests that amyloid-induced brain atrophy leads to a lack of trophic factors, resulting in thinning of the RNFL while reduced FAZ circularity could signal early vascular alterations induced by amyloid. Altogether, these findings suggest that OCT and OCT-A could serve as valuable biomarkers for lvPPA, thus enhancing early diagnosis.

Scleral buckling (SB) is an established treatment for rhegmatogenous retinal detachment (RRD). Once the gold standard for RRD repair, SB became less performed with the rise of pars plana vitrectomy (PPV). This retrospective interventional cohort study aims to provide 10 years of real-world data on SB surgical outcomes in a Canadian tertiary eye center. Patients undergoing primary SB surgery at the CHU de Québec between January 2014 and December 2023 for primary RRD with at least 3 months of postoperative follow-up were included. Multiple linear and logistic regression models were developed to identify variables associated with final BCVA and single surgery anatomical success (SSAS). A total of 187 phakic patients undergoing primary SB surgery with a median [Q1, Q3] follow-up (FU) of 23.0 [11.0, 38.9] months were included. Females constituted 56.1

BackgroundRecent studies have explored optical coherence tomography (OCT) and OCT-angiography (OCT-A) as biomarkers for Alzheimer's disease (AD). However, correlations between OCT/OCT-A and neurodegeneration metrics remain underexplored.ObjectiveWe performed a systematic review of OCT/OCT-A and structural brain imaging using MRI across various neurodegenerative disorders.MethodsWe searched Medline, Embase, and various other databases from January to June 2023 using keywords regarding neurodegenerative conditions and OCT/OCT-A. Out of 2962 citations. 93 articles were reviewed, and 28 met our inclusion criteria.ResultsLayer-or-region-specific retinal metrics were the most promising for non-vascular neurodegeneration, while vascular retinal parameters had the unique capacity to reflect vascular lesions. Both types of biomarkers correlated with global brain atrophy. Microstructural brain alterations best correlated with layer-specific thinning of retina.ConclusionsA better understanding of associations between retinal and brain lesions could eventually lead to the clinical application of retinal biomarkers for the early diagnosis of neurodegenerative conditions.

Purpose: To analyze the anatomic and functional outcomes of lamellar macular hole (LMH) surgery. Patients and methods: This is a retrospective interventional cohort study of ninety patients with unilateral idiopathic LMH who underwent pars plana vitrectomy (PPV) with membrane peeling for LMH between 2014 and 2021. We evaluated the anatomic and functional success of PPV with membrane peeling for treating LMH, compared surgical outcomes between the two LMH subtypes (true LMH and epiretinal foveoschisis (ERMF)), and identified predictive factors for anatomical and functional success. Primary outcomes included final postoperative best-corrected visual acuity (BCVA) and LMH closure. Variables associated with final BCVA were assessed using a multiple linear regression model. Results: 51 subjects presented with ERMF, while 39 presented with true LMH. LMH closure occurred in 80 cases. True LMH cases had a lower rate of closure (true LMH closure rate: 76.9%, vs. ERMF closure rate: 94.2%, p=0.005) and were more at risk of developing a postoperative macular hole (p=0.008). A significant difference was observed between median [Q1, Q3] preoperative BCVA (0.42 [0.26, 0.61]) and final BCVA (0.31 [0.14, 0.48], p=0.024). True LMH without epiretinal proliferation (β=0.194, p=0.040) was associated with worse final BCVA in multivariate analysis. Conclusion: Results support the effectiveness of PPV as a treatment for LMH. True LMHs had worse anatomic outcomes than ERMFs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of the Centre Universitaire d'Ophtalmologie - Centre de Recherche du Centre Hospitalier Universitaire de Quebec (CUO - CRCHU de Quebec) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

TOPIC:To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery. CLINICAL RELEVANCE:Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment. METHODS:This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies. RESULTS:Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD -0.20; 95% confidence interval [CI]: -0.31 to -0.09 logarithm of the minimum angle of resolution; I2 = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I2 = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I2 = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: -10.57 to 115.67] μm (n = 4 studies; I2 = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I2 = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: -236.56 to 441.12] μm (n = 2 studies; I2 = 85.7%; very low certainty) for the FS group (P = 0.2709). Preoperative IS/OS defect prevalence in the "true" LMH subgroup showed no significant difference among techniques (P = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (P = 0.0005). CONCLUSION:Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Aims: To compare outcomes of standard and alternative membrane peeling techniques in LMH surgery. Methods: A systematic review and meta-analysis was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pairwise meta-analysis of mean change in best corrected visual acuity (BCVA as logMAR) and LMH closure rate between flap embedding (FE) and standard peeling (ST) were conducted. A proportional meta-analysis evaluated FTMH prevalence for each technique. Results: 36 studies of 1200 eyes were included. Three techniques were identified: ST (29 studies), FE (7 studies) and fovea-sparing peeling (4 studies). FE was superior to ST in BCVA change (MD -0.21; CI -0.33 to -0.10), LMH closure (RR 1.53; CI 1.23–1.90) and postoperative FTMH (RR 0.08; CI 0.01 to 0.58). LMH closure rate was higher (0.97; CI 0.88 to 0.99 vs. 0.81; CI 0.70 to 0.88) in alternative vs. ST, with postoperative FTMH occurring only in ST peelings (0.026; CI 0.013-0.054). Conclusions: Alternative peeling techniques have superior outcomes. Further randomized controlled studies are needed to confirm their efficacy and innocuity.

Background/Objectives:To analyze outcomes in recurrent rhegmatogenous retinal detachment (re-RRD) repair using pars plana vitrectomy (PPV) combined with scleral buckle (SB) at the first or second surgery. Subjects/Methods:Patients with primary uncomplicated RRD at initial presentation who were operated for re-RRD between 2014 and 2018 were included in this retrospective cohort study (n = 127). Patients were compared based on first and second surgery sequence: PPV then PPVSB (PPV-PPVSB: n = 51, 40%), or PPVSB then PPV (PPVSB-PPV: n = 76, 60%). Anatomical and functional outcomes were evaluated with second surgery success (2SS) defined as absence of reoperation after the second surgery and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR), respectively. Results:Mean age at initial presentation was 65.7 years. There were 78 (61%) men and 56 (44%) pseudophakic patients. Median [Q1, Q3] baseline PHVA in logMAR was 0.70 [0.18, 2.30]. SB at first or second surgery did not significantly alter 2SS (PPV-PPVSB: 38, 75% vs PPVSB-PPV: 57, 75%; p = 1.00) or silicone oil use at second surgery (PPV-PPVSB: 18, 35% vs PPVSB-PPV: 36, 47%; p = 0.40). At final follow-up, PHVA did not significantly differ by sequence (p = 0.16). Conclusion:In re-RRD repair, SB at first or second surgery did not alter 2SS and final PHVA.

Posterior scleritis (PS) is a potentially sight-threatening inflammation of the sclera located behind the ora serrata. Variable clinical presentation and low incidence rates make PS a complex ophthalmologic diagnosis, and it is an often underdiagnosed disease that can lead to many ocular complications. Associated anterior uveitis is a common clinical sign of PS,1Benson WE Posterior scleritis.Surv Ophthalmol. 1988; 32: 297-316Abstract Full Text PDF PubMed Scopus (186) Google Scholar but in some severe cases it can progress to diffuse panuveitis (PU). There has been growing awareness recently regarding immune-mediated reactions to vaccinations. Adverse events seen with the influenza vaccine remain low, and ocular events are exceptional. Prior literature has documented cases of isolated PS or PU following influenza vaccination,2Thurairajan G Hope-Ross MW Situnayake RD Murray PI Polyarthropathy, orbital myositis and posterior scleritis: an unusual adverse reaction to influenza vaccine.Rheumatology. 1997; 36: 120-123Crossref Scopus (42) Google Scholar but no prior literature reported a case of concomitant PS and PU following any type of vaccine, to our knowledge. We report a case of bilateral PS complicated by concurrent PU following the 2022 Fluzone Quadrivalent influenza vaccine (Sanofi Pasteur Inc, Bridgewater, NJ). A 67-year-old white female with no pertinent medical or ocular history presented with headache and ocular pain 24 hours after administration of the Fluzone Quadrivalent inactivated influenza vaccine. Floaters appeared in her vision another 48 hours later. Initially, the patient consulted an optometrist, who referred her to a glaucoma specialist for bilateral ocular hypertension. Two weeks after the start of symptoms, the patient was diagnosed with glaucoma, and bimatoprost was prescribed. A week later, the patient presented to the ophthalmology emergency department due to worsening of her condition despite treatment compliance. She was now reporting bilateral decreased visual acuity (VA) in addition to the initial symptoms. The patient at this time had a VA of 20/50+1 OD and 20/150+1 OS without correction, mild cataracts OU, quiet anterior chambers OU, presence of 1+ vitreous cells OU, and an intraocular pressures of 22 mm Hg OD and 19 mm Hg OS. Dilated fundus examination showed floaters and diffuse macular hyperautofluorescence OU suggestive of intermediate and posterior uveitis, respectively. Optical coherence tomography showed choroidal folds, subretinal fluid, scleral thickening, and vitreous opacities (Fig. 1). B-scan ultrasound demonstrated the pathognomonic T-sign bilaterally confirming PS. An oral nonsteroidal anti-inflammatory drug was prescribed as well as an autoimmune, inflammatory, and infectious work-up (i.e., complete blood count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibodies (ANAs), angiotensin-conversion enzyme, lysozyme, antineutrophil cytoplasmic antibodies (ANCAs), human leukocyte antigens B27, QuantiFERON-TB Gold (Quiagen, Germantown, MD), venereal disease research laboratory test and fluorescent treponemal antibody absorption test for syphilis; rheumatoid factor, anti-citrullinated protein antibodies, and a chest x-ray). A 48-hour follow-up was scheduled, and an urgent referral to the uveitis clinic also was made. The patient did not present to her scheduled follow-up and instead was seen a week later, now reporting new floaters. VA was 20/500 OD and hand motion OS without correction, intraocular pressure was 27 mm Hg OD and 20 mm Hg OS, dilated fundus examination showed increased vitreous opacities (Fig. 2), and optical coherence tomography showed increased subretinal fluid. Autoimmune and infection disease work-up was negative except for a non-significantly increased ANAs. An additional extensive autoimmune work-up also was ordered by a rheumatologist (i.e., hepatitis B and C serology, HIV serology, rheumatoid factor, cytoplasmic ANCAs, perinuclear ANCAs, thyroid-stimulating hormone, anti-proteinase 3, antibodies directed against myeloperoxidase, anti-cyclic citrullinated peptides, antibodies against extractable nuclear antigens, double-stranded DNA, soluble ANAs, and protein electrophoresis). This additional work-up did not yield more evidence of autoimmune disease. Oral prednisone and brinzolamide-timolol eyedrops OU were prescribed. Three days later, the vitreoretinal diseases specialist diagnosed a progression of the posterior uveitis into PU, so prednisolone acetate 1% eyedrops were added. All subsequent follow-ups demonstrated a favourable response to treatment and a resolution of symptoms. At last follow-up 30 days after starting oral prednisone, the fundus showed resolution of choroidal folds OU, and final VA was 20/40 OD and 20/20 OS. The thickness map also objectified decreased scleral thickness and resolution of subretinal fluid OU. With the advent of mass vaccination campaigns, there has been lately a growing awareness of possible rare adverse events. We report a case of bilateral PS with concomitant PU following the 2022 Fluzone Quadrivalent vaccine. To our knowledge, this is the first case of bilateral PS associated with bilateral PU following an influenza vaccine reported in the literature. Reports of postvaccination PS are limited. Thurairajan et al.2Thurairajan G Hope-Ross MW Situnayake RD Murray PI Polyarthropathy, orbital myositis and posterior scleritis: an unusual adverse reaction to influenza vaccine.Rheumatology. 1997; 36: 120-123Crossref Scopus (42) Google Scholar were the first and only to report a case of bilateral PS following the 1993 Fluvirin inactivated influenza vaccine (CSL Seqirus, Holly Springs, NC). No subsequent paper mentioned other cases of PS following influenza vaccination. Severe intraocular inflammation in association with influenza vaccination was reported in only a few patients with bilateral PU following the influenza vaccine.3Manusow JS Rai A Yeh S Mandelcorn ED Two cases of panuveitis with orbital inflammatory syndrome after influenza vaccination.Can J Ophthalmol. 2015; 50: e71-e74Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,4Wells MB Garg S Bilateral panuveitis after influenza vaccination.Retin Cases Brief Rep. 2009; 3: 386-387Crossref PubMed Google Scholar No patients reported simultaneous PS and PU bilaterally after vaccination. PS is usually associated with systemic disease such as rheumatoid arthritis. Bilateral PS represents approximately 10%–33% of all cases and about 80% of autoimmune cases.1Benson WE Posterior scleritis.Surv Ophthalmol. 1988; 32: 297-316Abstract Full Text PDF PubMed Scopus (186) Google Scholar In addition to being a rare case of bilateral PS without underlying autoimmunity, our patient also had no ocular history compared with reports of PU after the influenza vaccine.3Manusow JS Rai A Yeh S Mandelcorn ED Two cases of panuveitis with orbital inflammatory syndrome after influenza vaccination.Can J Ophthalmol. 2015; 50: e71-e74Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,4Wells MB Garg S Bilateral panuveitis after influenza vaccination.Retin Cases Brief Rep. 2009; 3: 386-387Crossref PubMed Google Scholar A recent pathophysiologic hypothesis surrounding PS suggests that it could be caused by a type III hypersensitivity reaction from antigen–antibody immune complex deposition. In this case, the influenza vaccine may have produced a similar reaction. However, with mass vaccination campaigns, chances of adverse events also will increase without a true underlying association. This makes a causal association difficult, if not impossible, to prove in this case. In any case, this would not constitute a contraindication to influenza vaccination given the proven benefits to reducing morbidity and mortality at large. In conclusion, we report a case of bilateral PS with bilateral PU following influenza vaccine. In the absence of another identifiable infectious or inflammatory etiology, this suggests that the influenza vaccine could be a possible etiology due to temporal association. However, we acknowledge that causal association cannot be confirmed, and this could have occurred after the influenza vaccine coincidentally. Nevertheless, ophthalmologists should be aware of possible rare vaccine-related adverse events so as to inquire about recent vaccination to better counsel patients on possible prophylactic treatments for future doses. This case does not outweigh the multiple benefits of vaccination. The authors have no proprietary or commercial interest in any materials discussed in this correspondence.

Purpose: To determine the long-term anatomic outcomes and surgical complications of pars plana vitrec-tomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation. Design: Retrospective, multicenter, multisurgeon case series. Participants: Ninety-seven patients in tertiary eye care centers. Methods: The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up. Main Outcome Measures: Uncorrected visual acuity (VA), complication rates or types, and refraction. Results: Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean +/- standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 +/- 0.73 (20/200 Snellen equivalent) before surgery to 0.66 +/- 0.65 (20/80) at 6 months after surgery (P < 0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of +/- 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment. Conclusions: The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up. Ophthalmology Retina 2023;7:59-66 (c) 2022 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective To review the clinical usefulness of chorioretinal biopsies in diagnostically undefined cases of intraocular inflammation or chorioretinal lesions. Design Retrospective case series. Participants Seven patients who underwent chorioretinal biopsies. Methods This case series included all consecutive patients who underwent chorioretinal biopsies in 2 academic tertiary care centres in the province of Quebec between 2014 and 2020. Results A total of 7 patients were included in the study. Five patients with intraocular inflammation underwent chorioretinal biopsies to rule out an infectious or neoplastic etiology, whereas 2 patients underwent biopsies for suspicion of neoplastic chorioretinal masses. Final diagnoses included primary chorioretinal lymphoma (n = 2), toxoplasmosis (n = 1), benign choroidal mass (n = 1), nonnecrotizing granuloma (n = 1), and peripheral exudative hemorrhagic chorioretinopathy (n = 1). No specific diagnosis was defined in 1 case of panuveitis with scleritis. No postoperative complications were reported. Conclusions Chorioretinal biopsies clarified the diagnosis in 6 of 7 patients, including a definitive diagnosis of lymphoma in 2 patients. This is a high rate of diagnosis that also represents clinically meaningful results that influence management. Future directions include identifying patients in whom adjuvant chorioretinal biopsy would yield a high rate of diagnosis.

Background Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF 6 ) or perfluoropropane gas (C 3 F 8 ) tamponade. Methods Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF 6 or C 3 F 8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8–10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results. Discussion This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina’s recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C 3 F 8 is necessary. Trial registration ClinicalTrials.gov NCT05863312. Registered on 18 May 2023.