BACKGROUND/PURPOSE:To report choroidal neovascularization (CNV) after macular plug surgery for full-thickness macular hole, detailing four cases-two postinverted internal limiting membrane flap and two posthuman amniotic membrane (hAM) procedures. METHODS:Retrospective, observational small case series. Multimodal imaging investigation comprising optical coherence tomography, optical coherence tomography angiography, and fluoroscein angiography/indocyanine angiography of CNVs after macular plug surgery. RESULTS:In all cases, CNV affected the fovea, with two cases occurring in refractory macular holes and two in primary idiopathic macular holes. Choroidal neovascularizations in inverted flap cases showed high exudative and fibrotic potential with limited response to antivascular endothelial growth factor treatment. In hAM implantation cases, one CNV remained contained within the hAM, while the other exhibited late leakage near the hAM without exudation on optical coherence tomography. Three cases displayed type 2 CNV, while one showed a mixed CNV pattern. Visual acuity ranged from 20/120 to 20/200. The study categorized these lesions as CNV in plug surgery because of their unique pathogenesis. CONCLUSION:Choroidal neovascularization occurring after inverted internal limiting membrane flap surgery with a fill variant shares characteristics such as foveal involvement and poor visual outcomes, likely because of high exudative activity and fibrosis. These findings highlight the need for careful monitoring of CNV in patients undergoing macular plug surgery, particularly those using the inverted internal limiting membrane flap technique. Moreover, we describe the development of CNV inside hAM in the context of peri-hAM atrophy after successful refractory macular hole surgery, without exudative properties beyond the hAM.

To evaluate visual and anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD), and to assess outcomes according to the clinical indication for switching. Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7 What is new

PurposeThis study assessed retinal non-perfusion areas (RNPAs) and vascular density (VD) in the superficial (SCP) and deep (DCP) capillary plexuses of diabetic patients across three stages of diabetic retinopathy (DR): no DR (stage 0), non-proliferative DR (stage 1), and proliferative DR (stage 2).MethodsThirty-nine right eyes of 39 diabetic patients were included and underwent 3 × 3 mm and 15 × 15 mm Optical Coherence Tomography Angiography (OCTA) scans. A semiautomated software was utilized to quantify RNPAs and VD. Correlations with systemic and ocular factors were analyzed.ResultsSix eyes were in stage 0, 25 eyes were in stage 1 and 8 eyes were in stage 2. Mean RNPAs and VD from 15 × 15 mm OCTA scans differed significantly across the three DR stages. A positive correlation was found between DR stage and RNPA in both SCP (CC = 0.42; p = 0.04) and DCP (CC = 0.60; p = 0.004). Conversely, VD in DCP was negatively correlated with DR severity (CC = -0.51; p = 0.0018). Eyes with prior peripheral laser treatment showed significantly larger RNPAs and lower VD in wide-field scans. Macular edema was associated with increased RNPA and reduced VD in the SCP on 3 × 3 mm OCTA (p's < 0.001). No significant associations were observed between OCTA parameters and systemic factors (e.g., hypertension, nephropathy).ConclusionSemiautomated OCTA analysis of retinal ischemia correlates positively with DR stage, peripheral laser treatment, and macular edema. The lack of association with systemic factors highlights the critical role of local ocular changes in DR progression.

PURPOSE:To evaluate the effects of scleral iontophoresis lutein delivery on macular pigment optical density (MPOD), retinal anatomy and function in patients with intermediate age-related macular degeneration (iAMD). METHODS:This prospective pilot study included 15 phakic eyes from patients with iAMD. All participants underwent a single session of trans-scleral iontophoresis with a liposomal lutein formulation. MPOD, central macular thickness (CMT), choroidal vascularity index (CVI) and retinal sensitivity (RS) were assessed at baseline (T0), and at 1 month (T1), 3 months (T2) and 6 months (T3). RESULTS:MPOD showed a significant overall change across time points (χ²=11.01, p=0.012), with significant differences between T1 and T3 (p=0.006) and T2 and T3 (p=0.018). CMT significantly decreased at T3 compared with earlier visits (p≤0.002). RS declined at early time points (T1 and T2 vs T0; p=0.027 and p=0.002, respectively), while CVI exhibited modest reductions by T2 and T3 (p=0.021 and p=0.017). A significant inverse correlation was found between ΔMPOD and ΔRS at T2-T0 (ρ=-0.520, p=0.035). Best-corrected visual acuity remained stable across all visits. CONCLUSIONS:The inverse correlation between MPOD change and RS decline at 3 months raises the possibility that early augmentation of MP may provide a protective functional effect. These data support the short-term feasibility of scleral iontophoresis for targeted lutein delivery.

PURPOSE:To investigate whether the morphology of supra-retinal pigment epithelium (RPE) deposits influences anatomical and functional outcomes in idiopathic full-thickness macular holes (FTMHs). METHODS:In this retrospective study, 66 eyes from 66 patients with idiopathic FTMH undergoing vitrectomy with internal limiting membrane peeling were analyzed. Supra-RPE deposits were segmented from en face optical coherence tomography (OCT) slabs. Deposits were classified as fine deposits (FD) or granular deposits (GD) based on size. Baseline MH characteristics were measured on horizontal and vertical B-scans. Outcomes were assessed 6 months after surgery. Best-corrected visual acuity (VA) was recorded in logarithm of the minimum angle of resolution (logMAR) units. RESULTS:Thirty eight eyes (58%) showed FD and 28 eyes (42%) GD. Baseline characteristics were comparable between groups. At 6 months after surgery, eyes with GD achieved worse postoperative VA ( P = 0.03) and showed greater disruption of outer retinal bands, with larger ellipsoid zone defect (EZd) ( P = 0.035) and external limiting membrane defect (ELMd) ( P = 0.048). ΔVA was significantly smaller in GD eyes (-0.40 vs. -0.65 logMAR, P < 0.001). In FD eyes, deposit area correlated with postoperative changes in EZd and ELMd, whereas no such association was found in GD eyes. In multivariable regression deposit morphology (GD vs. FD) independently predicted poorer visual improvement (β = 0.15, 95% confidence intervals [0.02-0.29], P = 0.03). CONCLUSION:Supra-RPE deposits are frequently detectable by en face OCT in FTMH. GD identifies eyes with larger MHs and reduced likelihood of optimal postoperative functional recovery. These findings suggest that deposit phenotype may serve as an imaging biomarker of disease severity, although further work is required to confirm its independent prognostic value.

Intraretinal hyperreflective foci (IHRF) are a common but pathologically diverse optical coherence tomography (OCT) finding, increasingly recognized as a hallmark of retinal disease activity. IHRF have been described in age-related macular degeneration (AMD), where they may represent migrating retinal pigment epithelium cells, in diabetic retinopathy, retinal vein and artery occlusions, pachychoroid spectrum disorders, inherited retinal dystrophies, and ocular inflammatory diseases. Their appearance reflects a spectrum of underlying processes, including inflammatory cell recruitment, lipid or proteinaceous material deposition, and degenerative tissue remodeling. Advances in OCT technology and multimodal imaging have refined the characterization of IHRF, enabling correlations with histopathology, cytokine profiles, and genetic risk variants. Across diseases, their presence, number, distribution, and temporal evolution have been linked to structural progression, functional decline, and treatment response—serving as early indicators of atrophy or neovascularization in AMD, markers of inflammation and therapeutic responsiveness in vascular retinopathies, and predictors of recurrence or complication in pachychoroid disease. This review provides a comprehensive synthesis of the current literature on IHRF, summarizing their proposed histopathological correlates, multimodal imaging features, molecular associations, prognostic significance, and potential role as biomarkers in a wide range of retinal disorders.

Advances in cross-sectional and en face optical coherence tomography have revealed a spectrum of subtle inner retinal changes that occur in both surgical and non-surgical conditions. Among these, inner retinal dimples (IRDs), also referred to as dissociated optic nerve fiber layer (DONFL) appearance, concentric macular dark spots (CMDS), and transient swollen arcuate nerve fiber layer (SANFL) have been described in eyes undergoing internal limiting membrane (ILM) peeling, most commonly for macular hole or epiretinal membrane while paravascular inner retinal defects (PIRD), micro-holes, and clefts have been reported in highly myopic eyes and tractional conditions even without prior surgery. The multiplicity of terms, some modality-dependent, others descriptive of etiology has obscured the relationships among these entities, causing confusion in clinical interpretation and research communication. Herein, we propose a hypothesis-driven conceptual and terminological framework intended to reconcile these disparate observations within a coherent schema grounded in anatomy and imaging phenotype while recognizing that the available evidence remains predominantly retrospective and heterogeneous. By reviewing multimodal imaging studies we clarify that postoperative IRDs, DONFL, CMDS, and SANFL may reflect a remodeling response of the inner retina (largely due to ILM removal/peeling, either surgical or spontaneous) whereas PIRD and its variants stem from chronic biomechanical or tractional stress. The review examines their morphological characteristics, temporal evolution, and available data on structure-function correlations. Standardizing nomenclature and interpretation will enhance clarity in both surgical outcomes assessment and clinical management of myopic or tractional retinal disease.

PURPOSE:To report a case of vitreoretinal lymphoma (VRL) presenting with a distinctive placoid-like pattern of macular hyperautofluorescence, initially misdiagnosed as autoimmune retinopathy. METHODS:We conducted a single case report employing multimodal imaging, including fundus autofluorescence, optical coherence tomography, and angiographic imaging, complemented by multiparametric liquid biopsy analysis of vitreous, aqueous, and cerebrospinal fluid. RESULTS:A 68-year-old Caucasian man presented with bilateral placoid hyperautofluorescent lesions at the posterior pole, stellate keratic precipitates, and subretinal deposits. Despite bilateral vitrectomy samples showing negative lymphomatous cytological findings, cerebrospinal fluid (CSF) analysis revealed a MYD88 L265P mutation and an elevated IL-10/IL-6 ratio, providing strong molecular evidence supporting a diagnosis of VRL. A five-year standing brain lesion had remained stable until vitreoretinal manifestations' onset. The patient was successfully treated with intravitreal methotrexate and systemic chemotherapy followed by consolidative low-dose radiotherapy. CONCLUSIONS:VRL can present with a placoid-like macular phenotype that closely mimics autoimmune retinopathy, representing an unusual imaging presentation that has yet to be well characterized in the literature. Extended latency periods between central nervous system involvement and ocular manifestations are possible, potentially longer than previously reported. CSF analysis for MYD88 mutation and IL-10/IL-6 ratio provides crucial diagnostic value when vitreous sampling is inconclusive, emphasizing the importance of multi-parametric liquid biopsy approaches in challenging VRL cases.

To test the applicability of a mixed reality headset in cataract surgery. Patients scheduled for phacoemulsification and intraocular lens implantation surgery were enrolled in our prospective interventional study. All patients underwent complete baseline ophthalmological examination and multimodal imaging analysis before surgery, which was scheduled and performed with the aid of the mixed reality headset. Primary outcomes were: surgical safety, efficacy and intraoperative parameters (Time lag, and surgical time duration). Secondary outcome was the occurrence of self-reported surgeon strain (SRSS), measured in a range from 0 to 5 and ergonomics, measured through the rapid upper limb assessment scale, RULA. A total of 100 phacoemulsification surgeries were performed. Surgical success was recorded in all cases (100

Purpose:The purpose of this study was to determine the prevalence and imaging characteristics of thin and thick idiopathic epiretinal membranes (ERMs) using high-resolution (HR) optical coherence tomography (OCT) and to identify clinical factors associated with ERM thickness phenotype. Methods:All patients underwent comprehensive ophthalmologic examination and multimodal imaging, including HR-OCT. ERM morphology was evaluated on fovea-centered OCT scans and classified as thin or thick based on preretinal reflectivity patterns. Multivariable generalized estimating equations (GEEs) were used to identify factors independently associated with ERM type while accounting for inter-eye correlation. Results:Fifty-four eyes included in this analysis and 28 (51.9%) were classified as thin ERM, whereas 26 (48.1%) were thick ERM. Patients with thick ERM were significantly older than those with thin ERM (81.6 ± 6.2 vs. 75.7 ± 10.8 years, P = 0.039). Pseudophakia was more prevalent in the thick ERM group (84.6% vs. 60.7%, P < 0.001), as was the presence of AMD (69.2% vs. 28.6%, P = 0.003). Mean central macular thickness (CMT) and best-corrected visual acuity (BCVA) did not differ significantly between thin and thick ERM groups (P > 0.05). In multivariable analysis, pseudophakia (odds ratio [OR] = 10.33, 95% confidence interval [CI] = 1.29-83.10, P = 0.028) and age-related macular degeneration (AMD; OR = 4.12, 95% CI = 1.01-16.87, P = 0.049) were independently associated with thick ERM. Conclusions:HR-OCT enables in vivo differentiation of thin and thick idiopathic ERMs. Thick ERM is independently associated with pseudophakia and AMD but not with greater CMT or worse BCVA, suggesting that ERM thickness phenotype may reflect differences in factors other than vitreoretinal interface biology alone.

Purpose: To investigate the impact of epiretinal membrane (ERM) on the structural characteristics of acquired vitelliform lesions (AVLs) in eyes with intermediate age-related macular degeneration (iAMD). Design: Cross-sectional study. Participants: Eyes of patients with iAMD-associated AVLs were identified from a tertiary referral center database. Methods: Multimodal imaging, including spectral-domain OCT, was reviewed. Eyes were stratified according to the presence (ERM + AVL) or absence (AVL-only) of ERM. Quantitative OCT parameters, including apical AVL height and width, and qualitative structural features such as intraretinal hyperreflective foci (IHRF), ellipsoid zone (EZ), and external limiting membrane (ELM) disruption, and AVL location relative to drusen, were assessed by masked graders. Effect sizes were calculated using Hedges' g. Group comparisons were performed using appropriate parametric or nonparametric tests. Main Outcome Measures: Differences in AVL structural characteristics between eyes with and without ERM. Results: A total of 234 eyes with age-related macular degeneration (AMD)-associated AVLs were included, of which 17 eyes had concomitant ERM. Eyes with ERM demonstrated significantly greater apical AVL height compared with AVL-only eyes (169.9 ± 52.5 μm vs. 134.8 ± 55.0 μm; P = 0.016). Acquired vitelliform lesion width was greater in the ERM + AVL group, although this difference did not reach statistical significance (811.1 ± 251.0 μm vs. 676.8 ± 416.0 μm; P = 0.057). The prevalence of IHRF, EZ disruption, ELM disruption, and AVL location over drusen did not differ significantly between groups. Effect size analysis demonstrated a moderate positive effect for apical AVL height (Hedges' g ≈ 0.65; 95% confidence interval [CI] ∼0.15 to 1.10), whereas AVL width showed a small-to-moderate effect size with CIs crossing 0. Conclusions: In eyes with AMD-associated AVLs, the presence of ERM is associated with increased AVL height without corresponding differences in other outer retinal structural features. These findings suggest that vitreomacular traction may selectively influence AVL configuration. Longitudinal studies are needed to determine whether traction-related modulation of AVL morphology impacts AMD disease progression and AVL collapse. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose:To evaluate the effects of 0. 001% glycerophosphoinositol in 0.2% hyaluronate (GPI/HA) vehicle eye drops in patients with glaucoma therapy related-ocular surface disease (GTOSD). Methods:Forty patients diagnosed with GTOSD and receiving GPI/HA or HA 0.2%, underwent ocular surface disease index (OSDI), Symptom Assessment iN Dry Eye (SANDE), National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 questionnaires, and tear matrix metalloproteinase-9 (MMP-9), break-up time (BUT), corneal fluorescein staining (CFS), Schirmer test I (STI), and bulbar conjunctival hyperemia (BCH) determination. Results:After 1 month, GPI/HA eyedrops increased BUT [6 (4-7.25) to 7 (6-8)] and STI [11.5 (8-17.5) to 13.5 (10-18.5)], whereas decreased BCH [2.2 (2.1-2.3) to 2.1 (1.3-2.2)] and CFS [3 (2-4) to 2 (2-3)] (p < 0.001). Questionnaire scores improved from 35 (24.36-46.25) to 33 (20.75-40.52), for SANDE and from 31.5 (20-45) to 28.5 (17.75-40.5), for OSDI (p < 0.001). HA 0.2% eyedrops reduced BCH from 2.75 (2.15-3.20) to 2.25 (1.90-2.30) and CFS from 3.5 (2.75-5) to 2.5 (2-4) (p = 0.014), and increased BUT (p = 0.036). Questionnaire scores improved from 28.95 (20.9-47.6) to 26.86 (19.90-36.41) (p = 0.009) for SANDE, and from 40 (19.5-49) to 29 (19.75-42) (p = 0.005) for OSDI. There were not significant modifications in the MMP-9 immunoassay positivity in either treatment group. Follow-up inter-group comparisons showed better BCH values in GPI/HA, and better NEI VFQ-25 scores in HA 0.2%. Conclusion:Both treatments proved valuable in managing GTOSD, supporting the use of lubricants in this condition. GPI/HA showed a broader pattern of improvement, which should be interpreted cautiously given the observational design and limited inter-group differences.

INTRODUCTION:The aim of the study was to evaluate functional and anatomical changes at the 44-week follow-up in patients with naïve neovascular age-related macular degeneration (nAMD) treated with faricimab intravitreal injections (IVIs). METHODS:Fifty-four eyes of 54 patients with naïve active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University "G. d'Annunzio," Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI. Each patient underwent complete ophthalmic examination including best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts and optical coherence tomography. All measurements were evaluated at baseline, at week 20 and then according to fixed retreatment interval up to week 44. Fluorescein angiography and indocyanine green angiography were also performed at baseline. Main outcome measures were changes in BCVA, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), intraretinal fluid presence, subfoveal subretinal fluid presence and thickness, the presence of pigment epithelial detachments (PEDs), and its maximum height (PED-MH). RESULTS:BCVA improved and CMT reduced significantly from baseline to week 44 (p = 0.002 and p = 0.020, respectively) in the overall sample with a higher significant improvement from baseline to week 20 (p < 0.001 for both parameters) and no additional significant improvement from week 20 to week 44 in the overall sample (p = 0.348 and p = 0.146, respectively). At week 20, 72.3% of patients were in the Q12/Q16 interval. Patients in the Q8 interval showed significant improvement in BCVA (p < 0.001) and significant reduction of CMT (p = 0.008) from baseline to week 44, respectively. PED-MH as well showed a significant reduction from baseline to week 44 (p < 0.001). Patients in the Q12 interval showed significant improvement in BCVA (p = 0.030) and significant reduction of CMT, SFCT, and PED-MH from baseline to week 36 (p < 0.001). Patients in the Q16 interval showed significant reduction of BCVA during follow-up (p = 0.026). CMT, SFCT, and PED-MH were significantly reduced from baseline to week 44 (p < 0.001). CONCLUSION:Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of many anatomical and functional parameters at 44 weeks, allowing the maintenance of a treatment regimen for most patients equal to or greater than 12 weeks.

To develop an innovative preclinical full-thickness macular hole (FTMH) model using porcine eyes and to evaluate the feasibility of decellularized human corneal lenticule (hCL) as a novel bio-graft for macular hole closure. Twenty-five eyes (n = 25) were obtained from pigs euthanized for food consumption and transported to the laboratory within 3 h. Surgical procedures were performed by the same experienced vitreoretinal surgeon using a Leica Proveo microscope (Proveo 8, Leica Microsystems Inc.) with integrated intraoperative optical coherence tomography (iOCT) technology. After core vitrectomy and posterior vitreous detachment, FTMH was induced using diathermy and a vitrectomy probe. hCLs (thickness 100–120 µm), collected from refractive surgery patients, were decellularized and introduced into the vitreous cavity. With the aid of a viscoelastic agent for stability, hCLs were positioned into the FTMH using microsurgical forceps. Placement and integration were evaluated by iOCT and immunofluorescence (IF) analysis. OCT images and IF analysis confirmed the successful creation of FTMHs ex vivo in porcine eyes, demonstrating the feasibility of hole induction in an ex vivo model. Preliminary OCT and IF analyses showed the successful implantation of decellularized hCLs at the FTMH site, which were correctly positioned in the subretinal space between the choroid and the retinal pigment epithelium. Our preliminary results suggest that decellularized hCLs can be successfully implanted to close FTMHs in our preclinical ex vivo model of study, paving the way for future research into bioengineered hCLs for therapeutic purposes. Video available for this article.

Peripapillary pachychoroid syndrome (PPS) is a recently recognized member of the pachychoroid disease spectrum characterized by peripapillary choroidal thickening, pachyvessels, intra- and subretinal fluid and associated serous pigment epithelial detachment. We summarize current knowledge on its clinical presentation, multimodal imaging features, differential diagnosis, and available treatment strategies, with emphasis on reported outcomes. PPS predominantly affects older, hyperopic men with short axial lengths and may coexist with other pachychoroid entities, focal choroidal excavation, chorioretinal folds, or secondary choroidal neovascularization (CNV). Multimodal imaging, particularly enhanced-depth imaging optical coherence tomography and indocyanine green angiography, is essential for distinguishing PPS from optic disc pit maculopathy, tractional macular schisis, and inflammatory or neovascular disorders. Anti-vascular endothelial growth factor therapy has shown limited benefit in the absence of CNV, whereas photodynamic therapy appears to achieve anatomical improvement in a substantial proportion of persistent or refractory cases, albeit with variable functional gains. PPS exhibits a variable natural history, and treatment outcomes remain heterogeneous. Well-designed prospective studies are required to refine therapeutic algorithms and identify imaging biomarkers predictive of response, enabling more tailored management of this emerging chorioretinal disorder.

PURPOSE:to describe an early migration of Sulfur Hexafluoride (SF6) gas through the optic nerve sheath after air/gas exchange for silicone oil removal surgery. METHODS:An 85-year-old male with glaucoma and high myopia underwent removal of 1000cS silicone oil via pars plana. Intraoperatively, we observed a localised retinal detachment which was treated with a subretinal fluid drainage under air, endophotocoagulation and sulfur hexafluoride (SF6) at the concentration of 20%. On the day after surgery, the patient had a Snellen visual acuity of 20/250, intraocular pressure of 18 mmHg, and a gas-filled vitreous chamber. RESULTS:Five days postoperatively, the patient came back with severe proptosis, palpebral edema, absent anterior chamber, and a dislocated intraocular lens, with an unexplorable fundus. Urgent CT imaging revealed SF6 gas migration into the optic nerve head sheath, compressing the nerve and causing pneumoencephalus without neurological symptoms. Urgent vitrectomy with gas removal was performed. The proptosis regressed in one week, with light perception as the final visual acuity. CONCLUSION:Early post-operative gas migration can result in severe and irreversible anatomical and functional outcomes, therefore it is required an urgent gas removal to reduce the possibility of irreversible complications. Unfortunately our case resulted in blindness in the affected eye.

To provide expert-driven, practical guidelines for the optimal use of optical coherence tomography angiography (OCTA) in the clinical management of age-related macular degeneration (AMD). Given the heterogeneity of AMD and the versatility of OCTA, clinicians require scenario-specific recommendations to navigate imaging strategies effectively across various stages and phenotypes of the disease. An expert panel from the European Young Retinal Imaging and Retina Study Group conducted a consensus-based review integrating the latest evidence and extensive clinical experience. The panel focused on developing OCTA-based protocols tailored to distinct clinical scenarios in AMD, including neovascular subtypes, geographic atrophy, non-exudative neovascularization, and ambiguous fluid accumulations. Recommendations emphasize appropriate scan sizes, slab selections, and strategies for interpreting flow signals across disease presentations. The expert panel delineated structured OCTA protocols for a range of AMD phenotypes to enhance diagnostic accuracy and clinical decision-making. In neovascular AMD, OCTA enables detailed characterization of macular neovascularization (MNV) subtypes—types 1, 2, and 3—through high-resolution, depth-resolved imaging. Recommendations include the use of cross-sectional OCTA to localize flow and appropriate selection of en face slabs to optimize lesion visualization. In geographic atrophy (GA), while structural OCT remains the primary modality, OCTA may assist in identifying subclinical or complicating MNV and in assessing choriocapillaris perfusion in the peri-atrophic zone, which may have prognostic implications. In cases of early and intermediate AMD, OCTA plays a critical role in detecting non-exudative MNV—particularly type 1 and type 3 lesions—providing valuable prognostic information given the risk of exudative conversion. Additionally, OCTA contributes to the differential diagnosis of pseudovitelliform lesions, detection of deep retinal age-related microvascular anomalies (DRAMAs), and exclusion of neovascularization in cases presenting with atypical intraretinal or subretinal fluid. This expert consensus offers a pragmatic framework for applying OCTA in AMD clinics, advocating for individualized imaging approaches based on lesion type and anatomical complexity. By enhancing diagnostic precision and enabling tailored monitoring strategies, OCTA integration into clinical workflows may significantly improve patient outcomes across the AMD spectrum.

Purpose:To describe the clinical and multimodal imaging features of a novel form of macular neovascularization (MNV), designated Type 4 MNV, defined by mixed Type 1 and Type 2 neovascularization (NV), extensive intraretinal anastomotic NV, and central posterior hyaloid fibrosis.Methods:This multicenter retrospective observational case series included patients with neovascular age-related macular degeneration exhibiting both Type 1 and 2 MNV and an overlying anastomotic intraretinal NV network. This was confirmed with optical coherence tomography (OCT) and OCT angiography (OCTA). Demographics, baseline visual acuity (VA), and OCT imaging biomarkers including the hyperreflective oblique band sign, central posterior hyaloid fibrosis, epiretinal membrane, and OCTA NV subtype were assessed.Results:Eleven eyes from 11 patients (mean age: 76.9 years; 36.4% female) met inclusion criteria. Baseline VA was logMAR 1.56 +/- 0.45 (approximate to 20/630) and 90.9% of subjects presented with severe visual loss. All eyes showed the hyperreflective oblique band sign. Central posterior hyaloid fibrosis was observed in 81.8% (9/11 subjects). Epiretinal membrane with radial traction was present in 81.8%. OCT angiography illustrated mixed Type 1 and 2 MNV with a prominent overlying intraretinal anastomotic network extending into the preretinal space.Conclusion:Type 4 MNV represents a distinct age-related macular degeneration phenotype with aggressive anatomical features including mixed Type 1 and 2 MNV, inner retinal and preretinal proliferation and anastomosis and retinal disorganization. The visual prognosis is invariably poor with recalcitrance to anti-vascular endothelial growth factor therapy. The recognition of this signature NV lesion subtype further refines the MNV classification system and can affect therapeutic strategies for neovascular age-related macular degeneration.

PURPOSE: To report the benefits of a newly defined tele-mentoring surgical model in vitreoretinal surgery based on a mixed reality headset (MRH) to enhance ophthalmic surgical education. METHODS: A two-step approach was used to define and test the efficacy of the tele-mentoring model designed for surgical teaching. First, the application of the innovative MRH in intraocular surgery was validated for safety and efficacy by an expert surgeon. Secondly, a board of vitreoretinal surgeons designed the tele-mentoring model for surgical teaching, entailing a pre-operative training and the execution of vitreoretinal procedures by a fellow supervised by the mentor through the connection offered by the device. Intraoperative parameters and a satisfaction questionnaire were used to assess surgical safety, efficacy and level of satisfaction for the tele-mentoring teaching method. Outcomes in the model validation were: Surgical safety, defined by (i) the absence of intraoperative complications (ii) the absence of early and (iii) late post-operative complications and surgical efficacy. In addition, in the model application MRH wearability and practicability, the all in one system, impact in the procedure and safety and confidence were investigated. In all cases, time lag and surgery duration were measured. RESULTS: A total of 40 vitreoretinal surgical procedures were performed by an experienced vitreoretinal surgeon with the aid of the MRH. No intraoperative nor early or late postoperative complications were recorded, and time lag and surgical duration were acceptable. A total of 40 surgical procedures were successfully performed by a fellow with the MRH, with no recorded complications and acceptable time-lag and intraoperative time. The tele-mentoring experience was found to be safe and effective, with overall fellows satisfaction in the surgical teaching method. CONCLUSIONS: Reshaping the mentor-fellow relation in a tele-mentoring dimension boosts the fellow self-confidence and training, preserving patient safety and surgical efficacy and representing a promising tool for surgical education in ophthalmology.