Background:To compare the visual gains of faricimab and aflibercept 8 mg as first-line in real-world management of retinovascular diseases. Methods:Retrospective multicenter interventional case series with retinovascular diseases initiated on faricimab or aflibercept 8 mg till August 30, 2025. Main outcome measure was visual gain in logMAR. Linear mixed-effects model was used to compare vision increase between the two drug groups. In addition, comparative Phase 3 trials were supplemented by a literature review of treatment-naïve eyes using major databases till September 30, 2025. Results:We collected 500 treated eyes from 35 collaborating centers. The treatment groups included 395 eyes receiving faricimab vs 105 receiving aflibercept 8 mg distributed into neovascular macular degeneration (270 vs 58), diabetic macular edema (97 vs 39) and macular edema associated with retinal vein occlusion (28 vs 8). Adjusted visual gains were comparable between the two drugs in various retinal categories (p=0.672). Conclusion:Visual acuity improved significantly and equally in both aflibercept 8 mg and faricimab in several treatment-naïve retinovascular diseases.

Purpose: To describe a modified approach to managing bilateral simultaneous rhegmatogenous retinal detachment (RRD) based on factors other than macular status to guide surgical timing and sequencing. Methods: We retrospectively reviewed 47 patients with bilateral simultaneous RRD and grouped them into cohorts by macular status at presentation: cohort AA (both macula-attached, n = 23), cohort DD (both detached, n = 10), and cohort DA (1 attached and 1 detached, n = 14). Cohort DA was further divided, based on which eye was operated on first, into 3D (macula-detached eye first, n = 6) and 3A (macula-attached eye first, n = 4). Mean postoperative logMAR visual acuity (VA) is reported. Results: The mean ± SD time to surgery was 3.4 ± 10.2 days for the first eye and 19.4 ± 30.2 days for the second. No patients experienced RD progression in the second eye between surgeries. There was no difference in postoperative VA between the first and second-operated eyes in cohort AA (0.1 vs 0.1, P = .90) and cohort DD (0.4 vs 0.9, P = .10). In cohort DA, in macula-detached eyes, visual outcomes were significantly better when the macula-detached eye was operated on first (0.5 in group 3D vs 0.9 in group 3A, P = .03). In macula-attached eyes, no significant difference was observed (0.1 in group 3D vs 0.2 in group 3A, P = .63). Across all cohorts, the first-operated eye tended to be more symptomatic, lack signs of chronicity, or have a larger detachment. Conclusions: Bilateral simultaneous RRD often presents with chronic features. Surgical decision-making should consider symptom duration and clinical indicators of chronicity, not just macular status. Prioritizing eyes with more acute presentation may improve visual outcomes, while eyes with chronic findings may tolerate delayed repair.

PURPOSE:To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS:This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS:One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS:Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

PURPOSE:To assess the long-term efficacy of intravitreal antivascular endothelial growth factor injections (IVI), alone or in combination with verteporfin photodynamic therapy (IVI/PDT), for management of choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome (POHS).METHODS:Retrospective, comparative, interventional case series analyzing 82 eyes in 74 patients treated with either IVI or IVI/PDT for presumed ocular histoplasmosis syndrome choroidal neovascularization from January 2006 to January 2021.RESULTS:The average logarithm of the minimum angle of resolution VA in year 5 was 0.40 (20/50) and 0.52 (20/67) for IVI versus IVI/PDT groups, respectively ( P = 0.33), and in year 10 was 0.53 (20/58) and 0.64 (20/86), respectively ( P = 0.50). The average number of annual injections over the first 5 years of follow-up was 3.3 versus 1.7 for IVI versus IVI/PDT groups, respectively ( P < 0.001), and over 10 years was 3.3 versus 1.6, respectively ( P < 0.001). Treatment-free interval of 5 years was reached by 39% versus 60% in IVI versus IVI/PDT groups, respectively ( P = 0.95).CONCLUSION:Our study found both IVI and IVI/PDT to be effective in long-term management of presumed ocular histoplasmosis syndrome choroidal neovascularization, with a fewer number of annual injections and longer treatment-free interval in the combination group. However, given the limitations of a retrospective study, a prospective randomized study is necessary to determine whether the addition of PDT significantly decreases treatment burden.

Purpose To analyze the recovery course of foveal microstructures in eyes with nonsurgical healing of full-thickness macular hole (FTMH). Methods By serial OCT scans, the temporal healing sequences were analyzed in ocular trauma, vitreomacular traction (VMT), cystoid macular edema (CME), and the remaining group. We evaluated correlations between the final best-corrected spectacle visual acuity and reconstruction time of external limiting membrane (ELM), and inner segment/outer segment (IS/OS). Results The healing (mean±standard deviation in months) most involved fusion at the level of the outer nuclear layer (ONL) (6.3±10.5) followed by restoration of ELM (9.1±13.8), and lastly, by IS/OS regeneration (13.1±19.5). In severe blunt ocular trauma, healing was fast and involved subretinal zipper glue-like reapposition with resulting outer retinal atrophy. Best spectacle-corrected visual acuity correlated with normalization of the clivus ( p =0.012), faster ELM ( p =0.006), and IS/OS reconstitution ( p =0.024). Recurrence of FTMH occurred when the healing was halted (3 eyes) or was aberrant by lamellar hole epiretinal proliferation (LHEP) (3 eyes) or by the persistence of VMT (1 eye). Conclusion Recovery sequences proceeded from the ONL to the deeper layers with BCVA correlating absolutely and temporally with the restoration of outer retinal layer integrity.

PURPOSE:To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH).METHODS:Retrospective collaborative study of FTMH that closed without surgical intervention.RESULTS:A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 µm in size and 24.7 for more than 200 µm.CONCLUSION:Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 µm.

Purpose: To evaluate if off-label Age-Related Eye Disease Study 2 (AREDS2) supplementation prevents visual and anatomical deterioration in non-proliferative Idiopathic Macular Telangiectasia Type 2 (IMT2). Patients and Methods: This is a single-center retrospective, comparative study of 82 IMT2 eyes treated with AREDS2 from January 1st, 2013 to January 1st, 2018. The study analysis consisted of a non-comparative arm, which included all AREDS2 eyes, and a comparative arm (27 AREDS2 and 42 untreated eyes) that only included eyes with complete follow-up data. Eyes were evaluated at baseline, 12 and 24 months. Better/worse eye subanalysis was performed in the comparative study arm. Primary outcomes were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) anatomical characteristics including largest cavitation diameter, central macular thickness (CMT), and length of ellipsoid zone (EZ) loss at 24 months. Results: In the non-comparative arm, AREDS2 eyes showed stable BCVA (0.28 +/- 0.18 logMAR at baseline vs 0.26 +/- 0.19 logMAR at 24 months; p = 0.35) and OCT anatomical features after 24 months of supplementation. In the comparative arm, BCVA mean difference was greater for untreated eyes at 24 months (-0.09 +/- 0.15 vs 0.03 +/- 0.11 logMAR; p = <0.001). AREDS2 eyes had decreased cavitary diameter and EZ loss compared to untreated eyes at the study endpoint (p = 0.01 and p = 0.02, respectively). CMT remained stable for both cohorts throughout the study. For better/worse eye analysis, untreated eyes had worse BCVA at 24 months in both better and worse eyes (both p = 0.01). For anatomical outcomes, increases in both EZ loss (p = 0.04) and cavitary diameter (p = 0.001) among untreated eyes were only significant for eyes with worse baseline BCVA. Conclusion: Our results suggest that off-label AREDS2 supplementation in non-proliferative IMT2 may prevent anatomical and visual deterioration in a subset of eyes.

To evaluate the relationship between superficial, deep foveal avascular zone (FAZ) and foveal cyst areas in eyes with cystoid macular oedema (CMO) associated with gyrate atrophy of the choroid and retina (GA). This is a retrospective collaborative multicenter study of optical coherence tomography-angiography (OCTA) images in GA. Superficial and deep FAZ and foveal cyst were measured using Image J by two independent experts. Values were corrected for myopia magnification. These values were compared with age-matched controls from normative data. Twenty-three eyes from 12 patients with GA and CMO were included in the study. The mean ± standard deviation age was 22 ± 19.7 years, mean Snellen spectacle-corrected visual acuity of 20/70 with mean myopia of 5.7 ± 4.1 dioptres. Qualitatively, no focal occlusion of superficial and deep capillary plexus was noted. Mean superficial FAZ area (0.484 ± 0.317 mm2), deep FAZ area (0.626 ± 0.452 mm2), and foveal cyst area (0.630 ± 0.503 mm2) were significantly larger than superficial and deep FAZ areas in controls of same age range (p < 0.001). Macular cyst area correlated with superficial FAZ area (R = 0.59; p = 0.0057) and more strongly with deep FAZ area (R = 0.69; p < 0.001). The superficial and deep FAZ area in GA-associated CMO were noted to be significantly larger than in controls. It seems that RPE dysfunction leads to foveal cyst enlargement displacing the capillary plexus with resultant enlarged superficial and deep FAZ area.

BACKGROUND AND OBJECTIVE: Intravitreal triamcinolone acetonide (IVTA) used as a surgical adjuvant for pars plana vitrectomy (PPV) can stain cortical vitreous, control postoperative inflammation, and reduce retinal edema. Sterile endophthalmitis uncommonly complicates office-based IVTA injection. The authors report a new complication of IVTA depot injection at the end of PPV. PATIENTS AND METHODS: Retrospective records review of all patients treated at the Cincinnati Eye Institute with PPV between January 1, 2011, and December 31, 2017, who developed a triad of sterile endophthalmitis, atrophic retinal breaks under the depot IVTA in the inferior retina, and rhegmatogenous retinal detachment (RRD). Eyes with flap tears, solely superior breaks, or stretch holes from proliferative vitreoretinopathy causing RRD were excluded. RESULTS: Eight eyes of eight patients (four males and four females; mean age: 73.7 years) who received 4 mg or 8 mg IVTA depot at the end of PPV surgery presented at a mean of 23.5 days following PPV with RRD (one macula-involving, seven macula-sparing), requiring treatment with PPV in six eyes and laser retinopexy alone in two eyes. Seven eyes that underwent membrane peeling (MP) received IVT to prevent cystoid macular edema (CME) and one eye with prior MP was treated for CME. Mean vitreous inflammation was 2+ cell at 1 week postoperatively. Two patients had documented sterile endophthalmitis within the first week requiring vitreous cultures and antibiotics injections. Visual acuity (VA) for eyes requiring PPV for RD repair declined from 20/90 preoperatively to 20/212 at 6 months postoperatively. VA for eyes amenable to laser alone improved from 20/53 to 20/35. All eyes remained attached, with the exception of one patient who refused further treatment after developing recurrent detachment from PVR. CONCLUSIONS: Particle-induced sterile endophthalmitis from IVTA depot at the end of PPV surgery resulted in atrophic inferior retinal breaks and RRD as a newly described entity coined “erosive retinopathy.” All retinal detachment surgeries required silicone oil tamponade. Poor visual outcome at 6 months was common for eyes requiring PPV for RD repair. The authors recommend avoiding IVTA depot injection at the end of PPV. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:613–619.]

PURPOSE:The purpose of this study was to evaluate the functional and anatomical outcomes of combined phacovitrectomy with multifocal intraocular lens (mfIOL) implantation.METHODS:Retrospective, interventional, non-comparative case series of six eyes that received a combined phacoemulsification surgery with apodized, diffractive mfIOL implantation for cataract and pars plana vitrectomy (PPV) with membrane peeling for epiretinal membrane (ERM). Outcome measures included distance and near visual acuities (DVA and NVA), central macular thickness (CMT), intraocular pressure (IOP), and disruption of external limiting membrane (ELM) or inner-segment outer-segment (IS/OS) junction.RESULTS:Mean logMAR glare DVA improved from 0.40 (Snellen 20/50) preoperatively to a mean uncorrected DVA of 0.038 (Snellen 20/22) (P=0.004) at 6 months after surgery. All eyes achieved NVA of J2 or better by 12 months postoperatively. Median CMT improved by 10 µm and mean IOP increased by 1 mmHg at 12 months postoperatively. Percentage of patients with ELM or IS/OS disruptions decreased from 66.7% to 33.3%. Two eyes demonstrated residual metamorphopsia on Amsler grid testing postoperatively. Postoperatively, four eyes required laser capsulotomy and one required LASEK for refractive correction.CONCLUSION:Combined phacovitrectomy, membrane peeling, and mfIOL implantation improved VA in patients with idiopathic ERM. Multifocality was achieved, but final visual outcome was delayed due to posterior capsular opacification and macular healing.

PURPOSE:To report complications after serial anterior chamber (AC) paracentesis for sustained elevation of intraocular pressure after intravitreal injection.METHODS:A retrospective interventional case series of five patients who had received AC paracentesis after intravitreal injection.RESULTS:Five patients presented with either decreased vision or increased pain after intravitreal injection with planned AC paracentesis. Of the five patients, three patients presented with profound hypotony due to persistent wound leak from the AC paracentesis site. Of these three, one resolved with pressure patch and cycloplegia. The other two patients required further intervention with either polyethylene glycol hydrogel or nylon suture for wound closure. The fourth patient presented with IOL optic prolapse into the AC that resolved with dilation. The fifth patient presented with vitreous prolapse through the AC paracentesis wound and was treated with YAG vitreolysis.CONCLUSION:A single AC paracentesis has been shown to demonstrate a favorable safety profile. Serial AC paracenteses may degrade the integrity of the peripheral cornea in patients with sustained elevation of intraocular pressure after repeated intravitreal injections.

PURPOSE:There is no established therapy for exudative-hemorrhagic complications in primary retinal arteriolar macroaneurysm (RAM).METHODS:Retrospective multicenter interventional study of anti-vascular endothelial growth factor in symptomatic RAMs. Central macular thickness in μm and best-corrected visual acuity in logMar were correlated with the RAM size and distance to the macula. Statistical analyses were performed using paired comparisons and Pearson correlation.RESULTS:Thirty-two eyes (32 patients) were treated with a mean of 2.7 injections over a mean follow-up of 16.6 months. Initial best-corrected visual acuity correlated with the RAM size and distance to the macula (P = 0.02). Central macular thickness decreased by 131,180, and 211 μm at 1, 2, and 3 months after the first injection (P < 0.001). Best-corrected visual acuity improved by 0.47 and 0.38 Early Treatment Diabetic Retinopathy Study lines at 2 and 3 months (P = 0.005). Anti-vascular endothelial growth factor response correlated with the RAM size (P = 0.04) and the distance to the macula (P = 0.009).CONCLUSION:Symptomatic RAMs can be treated successfully with anti-vascular endothelial growth factor injections, leading to a decrease in macular edema.

Purpose: To report the clinical outcome after intravitreal dexamethasone implant in patients with retinitis pigmentosa and cystoid macular edema. Methods: Multicenter retrospective case series of eyes with retinitis pigmentosa and cystoid macular edema that underwent intravitreal dexamethasone implant. Primary outcome measures were best-corrected visual acuity in LogMAR and central macular thickness. Statistical analyses used two-tailed comparison with Wilcoxon signed-rank test. Results: There were a total of 45 eyes from 34 patients with a mean age of 32.7 years (range 16–57) and mean follow-up of 15.5 ± 13.0 months. At Month 3 after the first injection, mean initial best-corrected visual acuity improved from 0.61 ± 0.38 (20/81) to 0.37 ± 0.16 (20/47) (P = 0.012), whereas mean central macular thickness (μm) decreased from 506 ± 288 μm to 311.7 ± 71.6 μm (P < 0.001) and mean intraocular pressure increased from 15.7 ± 2.3 mmHg to 19.8 ± 11.0 mmHg (P = 0.01). Fourteen eyes had multiple injections (1–7 reinjections) at a mean interval of 6 months. Treatment effect was durable with multiple injections, but with seven eyes developing visually significant cataracts. Conclusion: Best-corrected visual acuity improved up to 4 months in around half of the eyes. Eyes that benefited the most were pseudophakic, steroid nonresponsive, with large initial central macular thickness, and profuse fluorescein dye leakage.

OBJECTIVE:To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs).METHODS:The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR).RESULTS:Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PPV group (P=0.62). Postoperative anterior chamber fibrin was highly correlated with PVR formation (PVR 13% vs no PVR 0.7%, P=0.003; odds ratio =68.37, P=0.007). Separate analysis of medium- to high-complexity cases showed similar SSAS (PPV 86% vs SB with PPV 83%, P=0.45).CONCLUSION:SB with PPV versus PPV alone were similarly efficacious for repair of primary RRDs of varying complexity. SSAS rates, PVR incidence, and final visual acuities were not significantly different.

New Surgical Applications for the Sidefl o Cannula Intraoperative condensation on the posterior surface of posterior chamber intraocular lenses during pars plana vitrectomy can severely impair the vitreoretinal surgeon’s view of the posterior segment, particularly under a widefield viewing system. Persistent adherence of silicone oil droplets onto the surface of intraocular lenses (IOL) can also compromise the patient’s visual acuity considerably. The former frequently occurs during a fluid-air exchange in pseudophakic eyes with a posterior chamber intraocular lens and an open posterior capsule and is especially problematic with silicone IOLs. The latter is typically encountered after removal of silicone oil from pseudophakic eyes that underwent complicated retinal detachment repair. Each scenario exemplifies the often challenging task of removing an obstructive substance from the posterior IOL surface in the presence of a posterior capsulotomy. Several methods have been described for managing this problem, including removal of the condensation by manually wiping the IOL with a soft-tipped aspiration cannula. This method while an effective and lasting solution for acrylic IOLs is limited by the rapid reaccumulation of condensation on silicone IOLs. Angling the air infusion toward the IOL can provide temporary relief but requires an assistant to redirect the infusion and poses risk for inadvertently pulling the infusion from the vitreous into the suprachoroidal space. Investigators have proposed reversing the temperature gradient between the posterior surface of the IOL and the posterior segment to reduce condensation by raising the anterior segment temperature. Successful prevention of condensation was achieved using an irrigating contact lens with heated fluid; however, in an age where widefield viewing systems are favored, applications of this technique are restricted. Viscoelastic coating of the posterior IOL surface has been shown to be an effective method for completely clearing condensation on acrylic and silicone IOLs. Although clarity of the retinal view was found to be markedly improved, image distortion was observed, particularly in the setting of silicone IOLs. Distortion was reduced with the application of a thinner layer of viscoelastic evenly across the posterior surface of the IOL. Achieving a thin and even coat of viscoelastic can be challenging when applied using the angled axial cannula packaged with the viscoelastic. Inability to completely remove adherent silicone oil droplets from the surface of the IOL can significantly degrade the optical performance of the IOL. Aspiration and irrigation techniques of the oil droplets have been advocated as have the injection of sodium hyaluronate and hydroxypropylmethylcellulose across the IOL surface. The effectiveness of these methods are contingent on being able to orient the balanced salt solution or viscoelastic directly at the posterior IOL surface. This is of particular importance with the hydroxypropylmethylcellulose technique which additionally relies on a mechanical side-to-side sweeping maneuver of the injecting cannula between the silicone oil droplet and IOL. Achievement of the proper orientation with a cannula inserted through the vitrectomy port would be aided by an egress orifice located perpendicular to the posterior IOL surface. We propose a novel method for administration of fluid or viscoelastic across the posterior IOL surface using the SideFl o (MedOne Surgical, Sarasota, FL) cannula for a smooth and controlled application. The SideFl o cannula was designed to improve the safety and efficiency of injection of vital dyes and perfluorocarbon liquids during small-gauge vitrectomy surgery. Its inner injection and outer venting lumen design with an egress port and four vent ports all located on the side of the cannula eliminates the risk of axial fluid jet damage and enhances passive fluid outflow when compared with existing axial dual bore cannulas. The side placement of the egress port allows it to be oriented nearly perpendicular with the posterior surface of the IOL after inserting the cannula through a vitrectomy port or sclerotomy (Figure 1). The straight cannula additionally offers a mechanical advantage in the displacement of condensation or oil droplets during viscoelastic application or balanced salt solution From the *Cincinnati Eye Institute, Cincinnati, Ohio; and †Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio. C. D. Riemann is a consultant to MedOne Surgical, LLC and Alcon. The remaining authors have no financial/conflicting interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.retinajournal.com). Reprint requests: Robert A. Sisk, MD, 1945 CEI Drive, Cincinnati, OH 45242; e-mail: rsisk@cincinnatieye.com

Purpose: To report the outcomes of combined cataract surgery with toric intraocular lens (IOL) implantation when performed in conjunction with transconjunctival sutureless pars plana vitrectomy. Design: Retrospective interventional case series. Participants: Consecutive series of 55 eyes of 51 patients from April 2007 to December of 2010. Methods: All eyes underwent combined simultaneous small incision cataract surgery, toric IOL implantation, and transconjunctival sutureless vitrectomy surgery. Main Outcome Measures: Postoperative visual acuity, postoperative astigmatism, and rotational stability of the IOL. Results: Preoperative best-corrected visual acuity was 0.32 ± 0.15 logMar (Snellen 20/43) and improved to 0.16 ± 0.10 (Snellen 20/29) postoperatively uncorrected (P < 0.01) and to 0.08 ± 0.11 best-corrected (Snellen 20/24) (P < 0.01). Preoperative astigmatism was 1.75 ± 1.0 diopters (D) (range, 0–4.75 D) and improved to 0.5 ± 0.50 D (range, 0–2.5 D) postoperatively (P < 0.01). Final measured postoperative IOL axis deviation from target axis was 4 ± 6° (range, 0–32). Final IOL axis was within 5° of target in 47 (85%) eyes, within 10 degrees of target in 51 (93%) eyes, and was within 15° of target in 52 (95%) eyes. Conclusion: Toric lens position and axis remained stable after implantation during combined cataract surgery and transconjunctival sutureless vitrectomy.

Purpose: To report outcomes of patients who have undergone combined Trabectome and pars plana vitrectomy. Methods: Institutional Review Board-approved retrospective chart review of patients seen at the Cincinnati Eye Institute before January 2014 undergoing combined Trabectome and pars plana vitrectomy for uncontrolled glaucoma and visually significant retina pathology. Charts were reviewed to identify changes in intraocular pressure, visual acuity, and change in glaucoma medication requirement up to 1 year after surgery. Results: Four patients met the inclusion criteria with 12-month follow-up, and two of the patients were male. All patients underwent 25-gauge pars plana vitrectomy and Trabectome surgery. Mean preoperative LogMAR visual acuity was 0.39 (20/49) and 12-month LogMAR visual acuity was 0.21 (20/32) (P = 0.06). Mean preoperative intraocular pressure was 17 mmHg and mean preoperative glaucoma medication requirement was 2.5 topical medications. Twelve-month mean intraocular pressure was 12.8 mmHg (P = 0.07), and mean topical glaucoma medication requirement was 2.3 medications (P = 0.39). All patients were off steroids and anti-inflammatories at the final visit. One patient developed a hyphema requiring anterior chamber washout at 1 week. No other complications occurred. Conclusion: The results suggest that combined Trabectome and pars plana vitrectomy seems effective in the management of glaucoma in patients with visually significant retina pathology.

Ocular histoplasmosis (OHS) is a potential cause of advanced vision loss in the United States, especially in endemic areas including the Ohio–Mississippi River Valley. Most patients are symptomatic, exhibiting peripapillary and peripheral chorioretinal scars and macular pigmentary changes. Some, however, develop vision loss owing to choroidal neovascularization (CNV) of the macula, associated with subretinal bleeding, intraretinal and subretinal fluids, and fibrosis in advanced cases.

BACKGROUND AND OBJECTIVE:To test the hypothesis that although intravitreal aflibercept (IVA) is expected to be more expensive, the extra cost of treatment would not result in additional vision gain compared with intravitreal bevacizumab (IVB) for the treatment of wet age-related macular degeneration (AMD).PATIENTS AND METHODS:A retrospective chart review of patients receiving IVB or intravitreal ranibizumab (IVR) who were subsequently changed to IVA for active wet AMD.RESULTS:Thirty-three eyes were included in the study. The mean number of IVB, IVR, and IVA injections per eye over a 6-month period was seven, six, and five, respectively. Visual outcomes were similar in all three groups at the end of the study period. The average drug cost of IVB, IVR, and IVA injections per eye over 6 months was $326, $11,400, and $9,720, respectively.CONCLUSION:Aflibercept may allow a modest extension of the treatment interval, but cost makes IVA an expensive alternative without a visual benefit compared with IVB in patients with active wet AMD.