OBJECTIVE:To determine the prevalence of retinal pigment epithelium (RPE) microrips within serous pigment epithelial detachments (PEDs) in first-episode acute central serous chorioretinopathy (CSCR) and to assess their spatial relationship with focal angiographic leakage using multimodal imaging. DESIGN:Retrospective observational case series. PARTICIPANTS:Thirty-nine eyes of 39 patients with acute CSCR (symptom duration <3 months). METHODS:All eyes underwent spectral-domain OCT, fluorescein angiography, and indocyanine green angiography (ICGA). Imaging biomarkers at leakage sites included PEDs, RPE microrips, outer retinal erosion and outer retinal pinching, pachyvessels, midphase ICGA hyperfluorescent plaques, and subfoveal choroidal thickness. Clinical outcomes included best-corrected visual acuity, subretinal fluid (SRF) resolution, recurrence, and progression to chronic disease. RESULTS:Mean age was 44.5 ± 10.0 years, and 61.5% of patients were male. PEDs colocalized with the focal leakage site in all eyes, whereas RPE microrips colocalized with the site of focal angiographic leakage in 66.7% of eyes, with good interobserver agreement (κ = 0.79) observed. Outer retinal erosion and outer retinal pinching were observed in 38.5% and 12.8% of eyes, respectively. Midphase ICGA hyperfluorescent plaques were observed in 56.4% and pachyvessels in 46.2% of cases. Mean best-corrected visual acuity improved from 0.24 ± 0.25 (20/34 Snellen) to 0.10 ± 0.17 logMAR (20/25 Snellen) at final follow-up, with complete SRF resolution in 68.4%. Baseline subfoveal choroidal thickness correlated with SRF height (P = 0.018), but no baseline imaging biomarkers predicted final visual or anatomical outcomes. CONCLUSIONS:RPE microrips within serous PEDs frequently are observed and precisely colocalize with focal leakage in acute CSCR, supporting a mechanical model of focal RPE dehiscence driven by increased choroidal pressure. These findings provide insight into CSCR pathophysiology and may inform therapeutic strategies.

A 69-year-old white woman with a history of vitreomacular traction (VMT) presented with a 2-week history of visual loss in the right eye. Visual acuity, with correction, measured 20/200 in the right eye. Examination revealed a partial posterior vitreous detachment and a stage 2 full-thickness macular hole (FTMH). Spectral-domain optical coherence tomography (SD-OCT) testing confirmed a stage 2 FTMH with VMT. Pars plana vitrectomy without internal limiting membrane peeling was planned and the patient was sent for preoperative clearance, where she was diagnosed with atrial fibrillation and wanted to delay surgery. Two months later, the patient returned for follow-up with a visual acuity of 20/80, a closed macular hole, and an incomplete posterior vitreous detachment in her right eye. Four months later, the patient exhibited a completely closed FTMH with a visual acuity of 20/30. Spontaneous resolution of FTMHs (stages 2 to 4) in the adult population is an extremely rare event, occurring in less than 4% of affected eyes. We describe a patient with a stage 2 FTMH who exhibited spontaneous resolution due to the resolution of VMT while awaiting preoperative clearance. [Ophthalmic Surg Lasers Imaging Retina 2025;56:54-56.].

Background We report the first case of Purtscher-like retinopathy in a patient with 17q12 deletion-associated maturity-onset diabetes of the young. Case presentation A 19-year-old diabetic Hispanic male with history of cataracts and toe amputations presented with sudden onset of painless bilateral vision loss for 1 week with no associated trauma. Visual acuity was counting fingers at six feet in both eyes. Dilated retinal examination revealed bilateral peripapillary cotton wool spots and intraretinal hemorrhages, and significant subretinal and intraretinal fluid on optical coherence tomography. Fluorescein angiography revealed arteriolar staining and leakage around the disc with areas of capillary nonperfusion, supporting the diagnosis of Purtscher-like retinopathy. Systemic workup revealed multiple diabetic complications including chronic osteomyelitis of multiple toes, nonhealing diabetic foot ulcers, neurogenic bladder and bowel, and bilateral lower-extremity muscular neuropathies. Genetic evaluation revealed a 17q12 deletion, which is associated with maturity-onset diabetes of the young 5. On follow-up examination, he received a single intravitreal antivascular endothelial growth factor injection in the left eye (off label) for persistent macular edema. Although his retinal edema improved, his visual acuity remained poor. Conclusions The presentation of our patient’s multiple diabetic complications along visual symptoms suggests Purtscher-like retinopathy can be a sequela of uncontrolled diabetes. Purtscher-like retinopathy is a rare but possible consideration in diabetic patients who present with acute-onset vision loss.

Importance Pigment epithelial detachment (PED) is a feature commonly associated with neovascular age-related macular degeneration (nAMD) and may be perceived as being difficult to treat. Therefore, this investigation explored changes in PEDs and visual acuity outcomes following an initial anti–vascular endothelial growth factor (VEGF) injection and identified factors associated with positive response. Objective To describe changes in treatment-naive pigment epithelial detachments associated with the initial anti-VEGF injection. Design, Setting, and Participants Post hoc analysis of patients from the Phase III, Double-masked, Multicenter, Randomized, Active Treatment-controlled Study of the Efficacy and Safety of 0.5 mg and 2.0 mg Ranibizumab Administered Monthly or on an As-needed Basis in Patients With Subfoveal Neovascular Age-Related Macular Degeneration (HARBOR) trial (NCT00891735) with PED at baseline. The HARBOR trial was a phase 3, randomized, multicenter, double-masked, active treatment–controlled trial. Participants included treatment-naive patients with subfoveal nAMD and PEDs at baseline; intervention arms were pooled for analysis (n = 586). The HARBOR study began in July 2009 and was completed in August 2012, and the post hoc analyses were conducted between October 2016 and May 2018. Interventions Intravitreal injections of ranibizumab, 0.5 mg and 2.0 mg, administered monthly or on an as-needed basis over 24 months. Main Outcomes and Measures Post hoc analyses of flattened PED frequency at month 1, univariate and multivariable analysis of patient and ocular characteristics at baseline and PED status at month 1, and total number of ranibizumab injections received stratified by PED status at month 1. Results A total of 35.5% of patients (208 of 586) with PED at baseline achieved a flattened PED after a single ranibizumab injection. An additional 17.3% subsequently achieved a flattened PED at month 2. Univariate analysis identified an association between older age, lower PED height, and lower subretinal fluid thickness with PED flattening after a single injection. Multivariable analysis identified PED height as a factor associated with this anatomical outcome. Best-corrected visual acuity scores were not superior based on PED flattening at month 1. On average, patients in the as-needed arm who achieved a flattened PED after a single ranibizumab injection required fewer injections by month 24 vs patients whose PED remained present at month 1 (11.0 vs 14.2; difference, 3.3; 95% CI, 1.9-4.6;P < .001). Conclusions and Relevance In this group of treatment-naive patients with PED from nAMD, after the initial ranibizumab injection approximately one-third and after the second injection approximately one-half had flattened PEDS, although visual outcomes were not superior among those that did vs did not have flattening. The findings suggest flattening may serve as a marker for less intensive as-needed injection frequencies. Trial Registration ClinicalTrials.gov Identifier:NCT00891735

IMPORTANCE: Pigment epithelial detachment (PED) is a feature commonly associated with neovascular age-related macular degeneration (nAMD) and may be perceived as being difficult to treat. Therefore, this investigation explored changes in PEDs and visual acuity outcomes following an initial anti-vascular endothelial growth factor (VEGF) injection and identified factors associated with positive response. OBJECTIVE: To describe changes in treatment-naive pigment epithelial detachments associated with the initial anti-VEGF injection. DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of patients from the Phase III, Double-masked, Multicenter, Randomized, Active Treatment-controlled Study of the Efficacy and Safety of 0.5 mg and 2.0 mg Ranibizumab Administered Monthly or on an As-needed Basis in Patients With Subfoveal Neovascular Age-Related Macular Degeneration (HARBOR) trial (NCT00891735) with PED at baseline. The HARBOR trial was a phase 3, randomized, multicenter, double-masked, active treatment-controlled trial. Participants included treatment-naive patients with subfoveal nAMD and PEDs at baseline; intervention arms were pooled for analysis (n = 586). The HARBOR study began in July 2009 and was completed in August 2012, and the post hoc analyses were conducted between October 2016 and May 2018. INTERVENTIONS: Intravitreal injections of ranibizumab, 0.5 mg and 2.0 mg, administered monthly or on an as-needed basis over 24 months. MAIN OUTCOMES AND MEASURES: Post hoc analyses of flattened PED frequency at month 1, univariate and multivariable analysis of patient and ocular characteristics at baseline and PED status at month 1, and total number of ranibizumab injections received stratified by PED status at month 1. RESULTS: A total of 35.5% of patients (208 of 586) with PED at baseline achieved a flattened PED after a single ranibizumab injection. An additional 17.3% subsequently achieved a flattened PED at month 2. Univariate analysis identified an association between older age, lower PED height, and lower subretinal fluid thickness with PED flattening after a single injection. Multivariable analysis identified PED height as a factor associated with this anatomical outcome. Best-corrected visual acuity scores were not superior based on PED flattening at month 1. On average, patients in the as-needed arm who achieved a flattened PED after a single ranibizumab injection required fewer injections by month 24 vs patients whose PED remained present at month 1 (11.0 vs 14.2; difference, 3.3; 95% CI, 1.9-4.6; P < .001). CONCLUSIONS AND RELEVANCE: In this group of treatment-naive patients with PED from nAMD, after the initial ranibizumab injection approximately one-third and after the second injection approximately one-half had flattened PEDS, although visual outcomes were not superior among those that did vs did not have flattening. The findings suggest flattening may serve as a marker for less intensive as-needed injection frequencies.

PURPOSE:To describe an atypical presentation of a patient with stellate nonhereditary idiopathic foveomacular retinoschisis with peripapillary retinoschisis of multiple layers.METHODS:Complete ophthalmic examination including dilated extended ophthalmoscopy, fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, and wide-field fundus photography.RESULTS:A 36-year-old Chinese American woman with mild myopia and good visual acuity (20/20) exhibited macular splitting of the outer plexiform layer on spectral domain optical coherence tomography with an attached hyaloid in her left eye. Peripheral spectral domain optical coherence tomography also demonstrated peripapillary and midperipheral inner retinoschisis, involving the outer plexiform layer and inner retina. The right eye was unremarkable. The diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis was made because of a lack of other associated ocular conditions and no family history of retinoschisis.CONCLUSION:Stellate nonhereditary idiopathic foveomacular retinoschisis is a recently described and uncommon cause of foveomacular retinoschisis in myopic women with good visual acuity. Recent evidence suggests that peripheral imaging is key in identifying other findings, including midperipheral or peripapillary inner retinoschisis, involving the outer plexiform layer and the inner retina. Our patient may represent a variant of stellate nonhereditary idiopathic foveomacular retinoschisis that can be characterized by multilayer peripapillary retinoschisis.

OBJECTIVES To assess the effect of bevacizumab injection on connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF) in the ocular fluids of patients with diabetic traction retinal detachment, and to determine whether intraoperative and postoperative complications are decreased in eyes given adjunctive preoperative bevacizumab injection. METHODS Twenty eyes of 19 patients were randomized to receive intravitreal bevacizumab or sham injection 3 to 7 days before vitrectomy for severe proliferative diabetic retinopathy. We collected aqueous samples before injection and at the time of vitrectomy and extracted undiluted vitreous samples. RESULTS Five eyes had decreased vascularization of membranes from preinjection to the time of vitrectomy (all in the bevacizumab treatment arm). Median visual acuities were 20/400 in control eyes at baseline and postoperative month 3 (POM3) and 8/200 in the bevacizumab-treated group at baseline and 20/100 at POM3 (P= .30 between control and bevacizumab-treated groups at POM3). All retinas were attached at POM3. Vitreous levels of VEGF were significantly lower in the bevacizumab group than in the control group (P= .03). Vitreous levels of CTGF were slightly lower in the bevacizumab group compared with the control group, but this difference was not statistically significant (P= .38). Levels of CTGF in the aqueous were strongly correlated with CTGF levels in the vitreous of controls (Spearman correlation coefficient, 0.95 [P< .001]). CONCLUSIONS Intravitreal bevacizumab injection reduces vitreous levels of VEGF and produces a clinically observable alteration in diabetic fibrovascular membranes. Ocular fluid levels of CTGF are not significantly affected within the week after VEGF inhibition. Retinal reattachment rates and visual acuity are not significantly altered by preoperative intravitreal bevacizumab injection at POM3. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01270542.

PURPOSE:To report an unusual case of paraneoplastic pseudovitelliform lesions associated with melanoma-associated retinopathy (MAR). DESIGN:Observational case report. METHODS:Retrospective review of the ophthalmic examination, fundus photography, fluorescein angiography, electroretinogram (ERG), and optical coherence tomography (OCT) of a patient with MAR. RESULTS:A 65-year-old Caucasian man with a two-year history of metastatic melanoma was referred for evaluation of a six-month history of nyctalopia. Funduscopic examination in both eyes revealed multiple, creamy, yellow, pseudovitelliform lesions in the posterior pole, varying in size from 100-500 mum, at the level of the outer retinal/retinal pigment epithelium (RPE) junction, coalescing along the inferior portion, with overlying macular neurosensory detachments. OCT showed bilateral macular neurosensory detachments with multiple small areas of high reflectivity at the level of the outer retinal/RPE junction. ERG demonstrated a selective loss of the b-wave and a normal a-wave under dark adapted, scotopic conditions. CONCLUSION:Clinicians should be aware of this atypical presentation of MAR that may include pseudovitelliform retinal findings.

A 38-year-old Hispanic man presented with painless decreased vision in his right eye for 7 days. He had had no light perception with his left eye for 7 years, for which he was unable to provide a history. Visual acuity was 20/70 in the right eye (OD) and no light perception in the left eye (OS), with normal pressures in both eyes (OU). Slit-lamp examination showed an unremarkable OD, but disclosed a glaucoma-implant tube in a formed anterior chamber in the left eye, with posterior synechiae of the iris and a white cataract. Ophthalmoscopy of the right eye showed a superotemporal branch retinal vein occlusion with an associated serous retinal detachment involving the macula, without vitreous cell. The optic nerve and the remaining vessels and periphery were unremarkable. There was no view to the fundus in the left eye. Echography of the right eye did not show choroidal thickening, and in the left eye, …

PURPOSE:To investigate the effect of oxygenated intraocular irrigating solutions on electroretinograms (ERGs) for postvitrectomy rabbits.METHODS:Eight groups of five rabbits each underwent pars plana vitrectomy on the right eye; the left eye of each rabbit served as control. The intraocular irrigating solutions were balanced salt solution (BSS), BSS-plus, BSS + oxygen (BSS + O2), BSS-plus + O2, and combinations of each with the addition of endoillumination (L). All animals were evaluated by single-flash scotopic electroretinography on the operated and nonoperated eyes before surgery and at 1 hour, 1 day, 1 week, and 1 month after surgery by an unmasked observer. The main outcome measures were dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios. The results for the different groups were compared by analysis of variance.RESULTS:Mean dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios +/- SD for BSS-plus and BSS-plus + O2 before surgery and 1 hour, 1 day, 1 week, and 1 month after surgery were 1.01 +/- 0.09, 0.50 +/- 0.11, 0.95 +/- 0.11, 0.97 +/- 0.11, and 0.99 +/- 0.08 and 0.98 +/- 0.08, 0.59 +/- 0.10, 0.92 +/- 0.06, 0.97 +/- 0.08, and 0.97 +/- 0.10, respectively. At both 1 hour and 1 day after surgery, rabbits treated with BSS-plus + O2 had an earlier b-wave return to baseline findings, but the differences were not statistically significant (P > 0.05). Mean dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios +/- SD for BSS and BSS + O2 before surgery and 1 hour, 1 day, 1 week, and 1 month after surgery were 1.02 +/- 0.10, 0.47 +/- 0.09, 0.77 +/- 0.07, 0.89 +/- 0.07, and 0.89 +/- 0.07 and 1.02 +/- 0.06, 0.62 +/- 0.16, 0.94 +/- 0.09, 0.97 +/- 0.08, and 0.96 +/- 0.06, respectively. One hour and 1 day after surgery, ERG readings for rabbits treated with BSS + O2 exhibited a statistically significantly earlier return of ERG voltage to baseline values compared with both BSS and BSS + L (P = 0.05 and P = 0.02, respectively). One day after surgery, rabbits treated with BSS alone had the lowest ERG ratios. One week and 1 month after surgery, for all solutions tested other than BSS, ERG values were within normal limits.CONCLUSION:The use of oxygenated solutions appears to affect ERG readings after pars plana vitrectomy. Further studies to evaluate the role of oxygenated solutions in different vitreoretinal surgical procedures are warranted.

PURPOSE:To review histopathology of vitrectomy specimens obtained during routine pars plana vitrectomy (PPV) for evidence of inadvertent introduction of conjunctival epithelium into the vitreous cavity during PPV.METHODS:Retrospective review of all vitreous specimens obtained from PPV over a 3-year period during which vitreous samples were routinely submitted from routine and diagnostic PPV. Patient charts and operative reports were reviewed, with particular attention to history of postoperative endophthalmitis, and the use of transconjunctival PPV.RESULTS:A total of 650 specimens were obtained over a 3-year period. Three specimens with conjunctival epithelium were identified. None of these cases resulted in endophthalmitis. Two of these three cases used transconjunctival techniques. In one case all three sclerotomies were made using transconjunctival techniques.CONCLUSIONS:The presence of conjunctiva in the vitreous aspirate from completely transconjunctival PPV indicates that conjunctival epithelium can be inadvertently introduced into the vitreous cavity during PPV. Although none of these cases resulted in endophthalmitis, special care to sterilize the conjunctiva before the creation of transconjunctival sclerotomies is warranted.