PURPOSE:To study the morphologic characteristics of Type1 macular neovascularization (MNV) in eyes with chronic central serous chorioretinopathy (CSCR) using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS:Patients with chronic CSCR and secondary Type 1 MNV were included in the study. Macular OCT and OCTA images were acquired, and morphologic characteristics along with quantifiable features were analyzed. RESULTS:Twenty eyes of 19 patients were included. All eyes exhibited neovascular flow signal on OCTA images. Nineteen eyes (95%) showed flat-irregular pigment epithelium detachment (flat irregular pigment epithelium detachment [FIPED]). Subretinal fluid (SRF) was detected in 90% of patients with no intraretinal fluid. Membranes were mostly located at the subfoveal area (65%). All membranes were identified in the location overlying choroidal pachyvessels. Mature membranes with a loose vascular configuration were identified in 75% of eyes. Morphologic biomarkers of "indistinct" (65%), "tangled" (30%), and "sea-fan" (5%) patterns were recorded. Feeder vessels was identified in 75% of membranes. The average vascular density was measured as 46% (±10%). CONCLUSION:Neovascular membranes of chronic CSCR sprout under the retinal pigment epithelium within the macular area (Type 1 MNV) inside an FIPED overlying pachyvessels. Morphologic characteristics assessed by OCTA of loose and indistinct pattern improve our understanding of vessel formation and maturation in patients with chronic CSCR and might be valuable to guide therapy.

OBJECTIVE:To assess long-term functional and structural outcomes in eyes treated with laser photocoagulation for retinopathy of prematurity (ROP). METHODS:Patients treated for ROP (1997-2004) underwent best-corrected visual acuity (BCVA) assessment, autorefraction, biometry, OCT, and OCT angiography of the macula and optic disc. Patient characteristics were retrieved from neonatal medical records. RESULTS:Sixty-three eyes of 33 patients with a mean follow-up of 19 years, and 22 eyes of 11 age-matched controls were included. The laser-treated group had a mean BCVA of 0.133 (±0.17) logMAR. Poor anatomical outcome occurred in 6.3% (n = 4), with 2 eyes requiring surgery. Mean spherical equivalent was -5.04 (±5.13) D. Corneal curvature and lens thickness were significantly higher in the study group (p < .001). Central macular thickness was greater in ROP eyes (311.97 μm vs 252.57 μm; p < .001). Vascular density was increased in the foveal region and decreased in other regions (p < .001), and the foveal avascular zone was smaller (p < .001). Optic disc analysis showed a reduction in cup-to-disc ratios and peripapillary capillary density (p < .001). CONCLUSIONS:Two decades after laser treatment, our patients demonstrated excellent visual acuity and favourable anatomic outcomes. Myopia was linked to increased corneal curvature and lens thickness. Significant alterations in the vascular plexuses of the macula and optic disc occur and may impact visual function in adulthood.

PURPOSE:To characterize the etiologic distribution of uveitis in the United States through a systematic review and meta-analysis. METHODS:A systematic search of PubMed, Scopus, PubMed Central, and Web of Science identified U.S.-based cohort and cross-sectional studies reporting uveitis etiology. Random-effects meta-analyses pooled proportional estimates. Study quality was assessed using Newcastle-Ottawa-based tools. Included studies spanned 1987-2023, encompassing 11,146 patients across 11 tertiary referral centers and one population-based registry. RESULTS:Twelve studies were included. Undifferentiated uveitis was the most common etiology, accounting for 42.18% (95% CI 32.68-52.29%). Among non-infectious causes, HLA-B27-associated uveitis (5.65%) and sarcoidosis (4.98%) were most prevalent. Toxoplasmosis was the leading infectious cause (4.07%), followed by HSV (3.70%) and CMV (3.14%). Heterogeneity was observed, partly explained by publication era. Sensitivity analyses confirmed a significant temporal trend for undifferentiated uveitis and identified the pre-HAART era as a driver of heterogeneity in infectious etiologies. CONCLUSIONS:Undifferentiated uveitis remains the predominant diagnosis in the U.S. with HLA-B27, sarcoidosis, and toxoplasmosis representing key defined etiologies. Because these pooled estimates were derived predominantly from tertiary referral centers and a single population-based cohort, they primarily reflect the included U.S. cohorts and should be extrapolated to the general U.S. population with caution. Regional, temporal, and methodological differences contribute to heterogeneity and should be considered in clinical evaluation and research.

This systematic review and meta-analysis aimed to characterize etiological patterns of uveitis in individuals aged 60 years or older. Following the PRISMA 2020 and MOOSE reporting guidelines, we searched PubMed/MEDLINE, Scopus, PubMed Central (PMC), and Web of Science (January 1, 2005–January 1, 2025). Data extraction focused on study characteristics, sample size, uveitis location, and reported causes. Random-effects models were used to pool proportions across studies, heterogeneity assessed by the I2 statistic. Methodological quality was evaluated via the Newcastle–Ottawa Scale for cohort studies and the JBI Critical Appraisal Checklist for cross-sectional studies. Out of 10,829 retrieved citations, 16 studies met the inclusion criteria. Idiopathic uveitis constituted the largest proportion, with a pooled proportion of 41.45

PURPOSE:To evaluate the prevalence, direction, and characteristics of postoperative retinal displacement after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair using infrared (IR) image overlay technique in a multicenter cohort. DESIGN:Multicenter retrospective cohort study. SUBJECTS:Patients undergoing PPV for primary macula-involving RRD with available high-quality predetachment and postoperative IR imaging. METHODS:Pre-RRD and post-RRD repair IR images were overlaid using a validated overlay technique that aligns deep retinal structures to assess displacement of the superficial retinal vessels. Retinal displacement was graded by masked readers based on magnitude (mild, moderate, or severe), direction, and displacement vectors. Macular stretch or compression was assessed vertically and horizontally. Associations between clinical, surgical, and imaging variables and displacement outcomes were analyzed. MAIN OUTCOME MEASURES:Prevalence, magnitude, direction, and vector characteristics of retinal displacement after PPV for RRD repair. RESULTS:Seventy eyes of 70 patients met the inclusion criteria. Postoperative retinal displacement was detected in 97% of eyes. All eyes with fovea-off RRD demonstrated retinal displacement, whereas 82% of fovea-on cases were displaced. Inferior displacement was the predominant direction (80%), most commonly oriented inferotemporally. Displacement severity was graded as mild, moderate, and severe in 34%, 42%, and 23% of cases, respectively. Silicon oil tamponade was associated with reduced displacement severity and a higher rate of superior displacement compared with gas tamponade (P < 0.01). Intraoperative perfluorocarbon liquid use was significantly associated with horizontal macular stretch (P = 0.04). The extent of retinal detachment was the primary predictor of displacement severity on multivariable analysis. CONCLUSIONS:Retinal displacement occurs in nearly all eyes after PPV for macula-involving RRD repair when assessed using overlay-based IR imaging, at rates substantially higher than previously reported using fundus autofluorescence. Perfluorocarbon liquid was associated with temporal macular stretch. Surgical factors, particularly tamponade choices, influence the severity and pattern of displacement. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To investigate the prognostic factors for development of gliosis after idiopathic macular hole (IMH) surgery and its relationship to functional and anatomical success. METHODS:This retrospective study included patients with IMH that underwent pars plana vitrectomy using internal limiting membrane flap technique. Optical coherence tomography examinations were done at baseline, 1 month, and 6 months postoperatively. Postoperative parameters on optical coherence tomography included hole closure, outer retinal layers continuity, and development of gliosis. RESULTS:Sixty-five patients with IMH were included in the study. Forty-three underwent temporal flap and 22 an inverted flap 360° around the hole. Gliosis was present at 8 (12.3%) eyes at 1 and 6 months postoperatively. Patients with gliosis at 6 months had larger minimal hole diameter at presentation (622 µ m ± 140 vs. 423 ± 178, P = 0.004). Gliosis was associated with worse best-corrected visual acuity at presentation (0.86± 0.49 logMAR [20/145] vs. 0.43 ± 0.37 [20/54], P = 0.008) and 1 month postoperatively (0.91 ± 0.59 logMAR [20/160] vs. 0.42 ± 0.48 [20/53], P = 0.013) but not at 6 months postoperatively (0.55 ± 0.31 logMAR [20/70] vs. 0.43 ± 0.33 [20/54], P = 0.222). CONCLUSION:Our study supports the use of inverted internal limiting membrane flap for IMH as a primary procedure. No gliosis was shown in small macular holes undergoing this technique. Even in large IMH where gliosis has developed, an improvement in visual acuity was shown after surgery.

To evaluate endophthalmitis rates following intravitreal injection of aflibercept, comparing between vial preparation and prefilled syringe use. We retrospectively collected data from ten ophthalmology departments in Israel. The number of intravitreal anti-VEGF injections administered in years 2022 and 2023 was recorded. Endophthalmitis rates in 2022 (vial use) and in 2023 (prefilled syringe use) were compared. Clinical details of endophthalmitis cases were reviewed. In 2022, out of 119,904 intravitreal injections, 31,991 (27

BACKGROUND:Kearns Sayre syndrome (KSS) is a rare multisystem mitochondrial disorder. KSS primarily targets energy supply in cells through impaired oxidative metabolism and reduced ATP (Adenosine triphosphate) production. KSS is clinically characterized by a classic triad of chronic progressive external ophthalmoplegia, retinitis pigmentosa and cardiac conduction defect. Additional features may include neurological abnormalities, endocrinopathies, renal disease, growth failure, myopathy and more. MATERIALS AND METHODS:We present a case of a young male with KSS, retinal dystrophy and multiple systemic abnormalities. RESULTS:Despite treatment with three intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, the CNV demonstrated limited response and progressive enlargement, leading to poor final visual outcome. CONCLUSION:To our knowledge, CNV has not been previously documented in Kearns -Sayre syndrome. This report underscores the need for ongoing surveillance in patients with rare retinal dystrophies, given the potential for unforeseen complications.

BACKGROUND AND OBJECTIVE:Epiretinal membrane (ERM) is a transparent membrane that forms on the surface of the neurosensory retina, causing tangential traction on the retinal surface, which may contribute to cell proliferation and contraction. Epiretinal membranes (ERMs) may be asymptomatic in some patients, while in others the membranes can progress, resulting in macular thickening and macular traction, thus distorting and inducing loss of central visual function and metamorphopsia. Currently, treatment options include follow-up or pars plana vitrectomy with an ERM peel, aiming to relieve the macular traction and improve vision and metamorphopsia. No specific criteria exist for predicting which patients might progress and need early surgery to improve and maintain good vision. The decision for surgery is based on the individual's symptoms and the physician's judgment. This study aimed to evaluate the mechanical impact in terms of stress and deformations of the ERM and to qualitatively compare them with the clinical progression of fovea thickening observed through optical coherence tomography (OCT) images. METHODS:Numerical simulation on a three-dimensional geometrical retina and ERM model was applied to isolate factors that can be used to predict its progression and prognosis. OCT images of 14 patients with ERM were used to derive the fovea thickness progression before and after vitrectomy surgery with ERM peeling. RESULTS:The results clearly show that the increase in ERM contractility level increases the developed stress at the fovea, which spreads and advances toward its base. The highest stress level (2.1 kPa) was developed at the highest and asymmetric contractility, producing non-uniform distributed deformations that distort the fovea structure. CONCLUSIONS:These findings imply that high and asymmetric ERM contractility should be evaluated clinically as a factor that might signal the need for early vitrectomy surgery to avoid irreversible visual loss. Moreover, the OCT images revealed that in some cases, the thickness of the fovea indeed remains high, even after ∼12 months postoperatively, which also indicates that the deformation of the fovea in these cases is irreversible.

Introduction: The aim of our study was to assess the outcome of Gore-Tex sutures in minimally invasive scleral fixation of subluxated posterior chamber intraocular lenses (PCIOLs) and to demonstrate a method for validating the lens position. Methods: Retrospective study of patients who underwent lasso in-the-bag scleral fixation of a subluxated PCIOL using the snare technique with Gore-Tex suture from 2019 to 2021 in a single tertiary medical center. Functional outcome was analyzed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM). Results: A total of 18 eyes were included. The mean duration of follow-up was 140 days (range 23-659), and the median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25-10.75). All patients had ocular comorbidities, mainly glaucoma (n = 6) and pseudoexfoliation syndrome (n = 5). Best corrected visual acuity improved from a median of 6/30 (0.7 logMAR) to a median of 6/12 (0.35 logMAR) (p = 0.06); postoperative astigmatism measured 0.91 +/- 2.19 diopters. UBM demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (p = 0.84; p = 0.94; p = 0.62; p = 0.085). The fixated PCIOL showed <10% decentration with reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r = -0.76, p = 0.037). Postoperative complications included transient ocular hypertension (n = 3), corneal decompensation with subsequent keratoplasty (n = 3), temporary hypotony (n = 2), cystoid macular edema (n = 1), suture exposure (n = 1), and endophthalmitis (n = 1). Conclusions: Subluxated PCIOLs are amenable to treatment with minimally invasive fixation using Gore-Tex suture with good anatomic outcomes. UBM image analysis may serve as a valuable method for assessing PCIOL position following scleral fixation.

Introduction: The aim of our study was to assess the outcome of Gore-Tex sutures in minimally invasive scleral fixation of subluxated posterior chamber intraocular lenses (PCIOLs) and to demonstrate a method for validating the lens position. Methods: Retrospective study of patients who underwent lasso in-the-bag scleral fixation of a subluxated PCIOL using the snare technique with Gore-Tex suture from 2019 to 2021 in a single tertiary medical center. Functional outcome was analyzed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM). Results: 18 eyes were included . Mean duration of follow-up was 140 days (range 23–659), and median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25-10.75). All patients had ocular comorbidities, mainly glaucoma (n=6) and pseudoexfoliation syndrome (n=5). Best corrected visual acuity improved from a median of 6/30 (0.7 logMAR) to a median of 6/12 (0.35 logMAR) (P=0.06); postoperative astigmatism measured 0.91±2.19 diopters. UBM demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (P=0.84;P=0.94;P=0.62;P=0.085). The fixated PCIOL showed < 10% decentration in reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r=-0.76, P=0.037). Postoperative complications included transient ocular hypertension (n=3), corneal decompensation with subsequent keratoplasty (n=3), temporary hypotony (n=2), cystoid macular edema (n=1), suture exposure (n=1) and endophthalmitis(n=1). Conclusions: Subluxated PCIOLs are amenable to treatment with minimally invasive fixation using Gore-Tex suture with good anatomic outcomes. UBM image analysis may serve as a valuable method for assessing PCIOL position following scleral fixation.

PURPOSE:To recognize prognostic factors for better final visual acuity (VA) in patients presenting with submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration.METHODS:This retrospective study included patients who presented to a tertiary ophthalmology department between 2012 and 2019 with SMH and were treated by pars plana vitrectomy (PPV) or injection of tissue plasminogen activator (tPA) with pneumatic displacement. Baseline characteristics included demographic data, VA and optical coherence tomography (OCT) characteristics of the SMH. Patients were divided into groups by improvement of at least 2 lines in BCVA (best corrected visual acuity), and by having a final BCVA better than 20/200.RESULTS:Forty-three eyes of 43 patients were included. Mean age was 86.72 ± 7.18. Prognostic factors for final VA better than 20/200 included better VA at presentation (1.25 vs 1.90 logMAR, p < 0.001), smaller area of SMH in the infra-red image (19.47 mm2 vs 38.45 mm2, p = 0.024), and lower height of SMH as measured by OCT (713.5 µm vs 962.5 µm, p = 0.03). Third of the patients improved in ≥2 lines from presentation, all in the group of the pneumatic and TPA displacement.CONCLUSION:Smaller SMHs with good VA at presentation have a better chance for improvement and result in a better final VA. These patients may benefit the most from pneumatic displacement of the SMH with intravitreal tPA and gas.

BACKGROUND:During combined phacovitrectomy, it is common practice to suture the main corneal incision to prevent intraoperative and postoperative wound leak. However, it may be possible to avoid suturing using a self-sealing corneal incision technique as in standard cataract surgery.OBJECTIVES:To evaluate the clinical outcome, safety, and complications of combined phacovitrectomy without preventive suturing.METHODS:This retrospective case series study included consecutive patients who underwent combined phacovitrectomy between January 2018 and June 2019 for mixed indications. Surgeries were performed at a tertiary university hospital. All surgeries were performed by the same two retinal surgeons. Cataract surgery was performed first, followed by insertion of trocars and vitrectomy. Corneal sutures were not planned but were used at the discretion of the surgeon.RESULTS:The cohort included 106 eyes of 102 patients. Suturing of the main corneal incision was deemed necessary in five cases (5%) because of a main incision leak or anterior chamber shallowing during trocar insertion. No other complications related to the absence of prophylactic corneal sutures were encountered during surgery or follow-up.CONCLUSIONS:Preventive corneal suturing may not be necessary in combined phacovitrectomy surgery and can be used in the few cases in which it is indicated during surgery.

PURPOSE:To compare morphologic characteristics of type 1 macular neovascularization (MNV) flow pattern in treatment-naïve and previously treated patients with age-related macular degeneration (AMD) as assessed by optical coherence tomography angiography (OCTA).STUDY DESIGN:Cross-sectional study.MATERIALS AND METHODS:Macular OCT angiography images were acquired using RTVue XR Avanti with AngioVue. Distinct morphologic biomarkers and quantifiable features of the neovascular membranes were studied on en-face projection images comparing treatment-naïve and previously treated patients.RESULTS:The study included 68 eyes of 58 patients. Among them, 24 eyes were treatment-naïve, and the remaining eyes had received a mean of 19.6 injections. Immature lesions were more associated with treatment-naïve eyes and hyper-mature lesions were associated with previously treated eyes (p = 0.005). Tangle pattern was associated with treatment-naïve eyes (p = 0.013), whereas mature core vessels and sea fan pattern were associated more with previously treated eyes (p = 0.001 and p = 0.044, respectively). Vascular density of the neovascular membrane was higher in the treatment-naïve group (p = 0.036) and the average MNV area was similar between the 2 groups (p = 0.683).CONCLUSIONS:Based on OCTA, morphologic biomarkers of type 1 MNV might be an indication of previous treatment. The MNV pattern can improve our understanding of its maturation under anti-VEGF treatment and might be valuable to better guide therapeutic decisions and provide more personalized care to patients with AMD.

PURPOSE:To report a case of laser photocoagulation for the treatment of a combined coloboma and optic nerve head pit-related maculopathy in a patient with bilateral chorioretinal coloboma.METHODS:A case report.RESULTS:A 15-year-old woman, presented with the visual acuity of 20/100 in her right eye for six weeks. She was diagnosed with macular detachment secondary to optic nerve head pit in her right eye and bilateral chorioretinal coloboma. Multimodal imaging, including color photography, fluorescein angiography, and spectral-domain optical coherence tomography, was used to identify and demonstrate the location of the tract of fluid from the optic nerve head pit, isolated from the coloboma. Optical coherence tomography-guided laser photocoagulation treatment at the location of the tract resulted in complete resolution of macular fluid with visual recovery to 20/25.CONCLUSION:Our case stresses the value of correct diagnosis directing photocoagulation treatment of combined optic nerve head pit-related maculopathy in eyes with chorioretinal coloboma using multimodal imaging.

Purpose: The aim of this study was to evaluate whether the method of delivery has an effect on the incidence rate of recurrent rhegmatogenous retinal detachment in women who have been previously treated surgically for rhegmatogenous retinal detachment. Methods: In this retrospective cohort study, data were collected from computerized files on Rabin Medical Center and Clallit Health Services databases, to create the study group: Women who were surgically treated due to rhegmatogenous retinal detachment and who had given birth after their ocular surgery. A primary list of women aged 18-43 who underwent Pars Plana Vitrectomy or Scleral Buckling between the years 2005-2018 was obtained from the Rabin Medical Center Surgical database. The study protocol was approved by the institutional Helsinki Committee at Rabin Medical Center (0417-18-RMC).The main outcome compared was the incidence rate of recurrent rhegmatogenous retinal detachment following childbirth for every type of delivery; vaginal, assisted delivery, and cesarean section. Results: Fourteen women had given birth after their ocular surgery, and all underwent Scleral Buckling. Ten of the women had a normal vaginal delivery, 3 women underwent a cesarean section and one woman had a vacuum-assisted vaginal delivery. No case of recurrent retinal detachment was documented. Conclusion: We conclude from this study that the method of delivery does not have an influence on the recurrence of rhegmatogenous retinal detachment, thus vaginal delivery is not contraindicated in women with previously treated rhegmatogenous retinal detachment.

Purpose: To investigate the correlation between time from diagnosis of treatment-naïve exudative age-related macular degeneration (AMD) to the introduction of anti-VEGF treatment and anatomical and functional outcomes. Design: Retrospective cohort study. Methods: Included were treatment-naïve exudative AMD patients who presented to a single tertiary medical center between 2012 and 2018. All patients were treated within the first 30 days of their diagnosis with three monthly intravitreal injections of bevacizumab. Patients were divided into three groups: group 1 (prompt anti-VEGF) were injected with bevacizumab within ten days, group 2 (intermediate anti-VEGF) within 11–20 days, and group 3 (delayed anti-VEGF) within 21–30 days from diagnosis. Baseline characteristics and clinical outcomes were compared up to two years from treatment. Results: 146 eyes of 146 patients were included. Sixty-eight patients were in the prompt anti-VEGF group, 31 in the intermediate anti-VEGF group, and 47 in the delayed anti-VEGF group. Following the induction phase of three intravitreal bevacizumab injections, the mean central subfield macular thickness (328.0 ± 115.4 µm vs. 364.6 ± 127.2 µm vs. 337.7 ± 150.1 µm, p = 0.432) and the best-corrected visual acuity (0.47 ± 0.38 vs. 0.59 ± 0.48 vs. 0.47 ± 0.44 logMAR units, p = 0.458) were comparable between the prompt, intermediate and delayed anti-VEGF groups. Anatomical and functional outcomes, treatment burden, number of relapses and eyes with second-line anti-VEGF therapy were comparable between the groups at both 1-year and 2-year timepoints. Conclusions: Our real-world evidence data emphasize that even if anti-VEGF induction cannot be initiated promptly within ten days from diagnosis of naïve exudative AMD, the visual and anatomical prognosis of the patients may not worsen if the treatment is started within one month of diagnosis.

Purpose To evaluate the effects of intravitreal injection of tissue plasminogen activator (tPA) and gas vs. pars plana vitrectomy (PPV) surgery as first-line treatment for subretinal hemorrhage. Methods Retrospective study of 107 adults treated for subretinal hemorrhage at a tertiary hospital during 2008–2019; 51 received injection of tPA and gas and 56 underwent PPV. Results No between-group differences were found in age and sex, medical history, use of anticoagulants or antiplatelets, history of ocular surgeries, and previous use of intravitreal anti-VEGF. Overall follow-up time was longer in the PPV group (median 4.9 vs 3.28 years, p = 0.005). The hemorrhage was displaced in a similar percentage of patients in the tPA-and-gas group (n = 40, 78.4%) and the PPV group (n = 45, 80.4%) (p = 0.816). Approximately 80% of patients in the tPA-and-gas group were able to forgo PPV surgery. Visual acuity (in LogMAR) was similar in the two groups prior to the diagnosis of subretinal hemorrhage but better in the tPA-and-gas group at the end of follow-up (p < 0.001). Conclusion Injection of gas and tPA can be done immediately following diagnosis of subretinal hemorrhage as an office procedure. Visual acuity outcome is good, with a high rate of blood displacement. About 20% of patients might require additional PPV as secondary intervention.