Intraocular lymphomas represent a diverse group of malignant lymphoid neoplasms, characterized by their heterogeneity. These neoplasms can be classified into two main categories: (1) those originating from the vitreoretinal tissue and (2) those that emerge within the uveal tract [1], [2]. The lymphomas affecting the retina and/or vitreous are considered primary tumors and are often associated with central nervous system (CNS) disorders [1], [2]. Primary vitreoretinal lymphomas (PVRLs) were previously referred to as primary intraocular lymphomas (PIOLs). PVRL predominantly involves the retina, vitreous body, and retinal pigment epithelium, whereas PIOL encompasses a broader range of intraocular structures, including the retina, vitreous body, choroid, and optic nerve, and can manifest as either vitreoretinal lymphoma or uveal/choroidal lymphoma. Both conditions share similar clinical presentations but differ in their specific intraocular involvement [1], [2]. Although rare, PVRLs constitute the most prevalent form of intraocular lymphoma. The estimated annual incidence is 0.46 per 100 000 individuals [1], [3]. This aggressive high-grade non-Hodgkin lymphoma is strongly associated with primary CNS lymphoma (PCNSL). According to the current World Health Organization (WHO) lymphoma classification, the majority of PVRL cases are categorized as diffuse large B-cell lymphomas [4]. Approximately 80% of PVRL patients will ultimately develop PCNSL, while 20% of PCNSL cases initially present with PVRL. Consequently, PVRL is typically fatal due to its eventual correlation with the CNS [5]. Despite its rarity, PVRL poses significant challenges in terms of diagnosis and treatment. The lack of effective therapeutic options and delays in diagnosis can contribute to a poor prognosis [1], [2].

PURPOSE:This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up, and therapeutic approach of uveitic epiretinal membranes (ERM). METHODS:A thorough investigation of the literature was conducted using the PubMed database. Additionally, a complementary search was carried out on Google Scholar to ensure the inclusion of all relevant items in the collection. RESULTS:ERM is an abnormal layer at the vitreoretinal interface, resulting from myofibroblastic cell proliferation along the inner surface of the central retina, causing visual impairment. Known by various names, ERM has diverse causes, including idiopathic or secondary factors, with ophthalmic imaging techniques like OCT improving detection. In uveitis, ERM occurrence is common, and surgical intervention involves pars plana vitrectomy with ERM peeling, although debates persist on optimal approaches. CONCLUSIONS:Histopathological studies and OCT advancements improved ERM understanding, revealing a diverse group of diseases without a unified model. Consensus supports surgery for uveitic ERM in progressive cases, but variability requires careful consideration and effective inflammation management. OCT biomarkers, deep learning, and surgical advances may enhance outcomes, and medical interventions and robotics show promise for early ERM intervention.

Endophthalmitis refers to an infection, either bacterial or fungal, occurring within the eye and involving the vitreous and/or aqueous humor [1]. Exogenous endophthalmitis is the more common form, where microorganisms are introduced into the eye through trauma, surgical procedures, or an infected cornea. On the other hand, endogenous endophthalmitis occurs when the eye becomes seeded with microorganisms via the bloodstream. Patients often exhibit symptoms related to their underlying systemic infection, although some may present solely with eye symptoms [1]. It is important to note that endophthalmitis does not act as a source of bacteremia or fungemia; the infection remains localized within the eye. However, if left untreated or inadequately treated, it progresses to panophthalmitis, spreading beyond the globe to the surrounding soft tissues of the orbit. Acute presentation is typical for most endophthalmitis cases, with symptoms emerging within hours to a few days. Due to the potential for irreversible vision loss, prompt treatment is imperative, making these cases medical emergencies [1].

Matrix metalloproteinase-9 (MMP9) and total amyloid-beta (Aβ) are prospective biomarkers of ocular ageing and retinopathy. These were quantified by ELISA in the vitreous and blood from controls (n = 55) and in a subset of age-related macular degeneration (AMD) patients (n = 12) for insights and possible additional links between the ocular and systemic compartments. Vitreous MMP9 levels in control and AMD groups were 932.5 ± 240.9 pg/mL and 813.7 ± 157.6 pg/mL, whilst serum levels were 2228 ± 193 pg/mL and 2386.8 ± 449.4 pg/mL, respectively. Vitreous Aβ in control and AMD groups were 1173.5 ± 117.1 pg/mL and 1275.6 ± 332.9 pg/mL, whilst plasma Aβ were 574.3 ± 104.8 pg/mL and 542.2 ± 139.9 pg/mL, respectively. MMP9 and Aβ showed variable levels across the lifecourse, indicating no correlation to each other or with age nor AMD status, though the smaller AMD cohort was a limiting factor. Aβ and MMP9 levels in the vitreous and blood were unrelated to mean arterial pressure. Smoking, another modifiable risk, showed no association with vitreous Aβ. However, smoking may be linked with vitreous (p = 0.004) and serum (p = 0.005) MMP9 levels in control and AMD groups, though this did not reach our elevated (p = 0.001) significance. A bioinformatics analysis revealed promising MMP9 and APP/Aβ partners for further scrutiny, many of which are already linked with retinopathy.

Purpose: To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. Methods: This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. Results: There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p < 0.05), 0.91 at 6 months (p < 0.05), and 1.07 at 1 year (p < 0.05). Mean best corrected visual acuity in control group at baseline was 1.22LogMAR with no significant improvement at any time points: 1 month (1.27), 6 months (1.35), and 12 months (1.36). Complications included retinal detachment 5%, vitreous hemorrhage 7.5%, and cataract 19%. Conclusion: Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.

Background: Cataract formation is the most frequent complication associated with pars plana vitrectomy (PPV). A growing trend has emerged for surgeons to perform combined phacovitrectomy rather than a two-step approach, even in the absence of cataract. We performed a financial analysis of combined phacovitrectomy for epiretinal membrane (ERM). Methods: Patients who underwent phacovitrectomy for ERM over a three-year period were included in the study. Operating time and cost of theatre time per minute was assessed. Univariate sensitivity analysis was performed to examine the sensitivity of our findings to changes in case duration. Results: Combined phacovitrectomy was performed on 55 eyes. Theatre cost per minute was £14.91 (in addition to £197.49 surgical pack prices). The mean operating time for phacovitrectomy was 48 minutes (range 23–77 minutes) and mean theatre cost was £909 (range 540-1346). The average income for the hospital per combined phacovitrectomy was £914. The conclusion that combined phacovitrectomy represented the more lean approach was robust in our sensitivity analysis. Conclusion: Our findings suggest that phacovitrectomy costs less to healthcare commissioners, yet still leads to a higher income for the hospital due to its higher tariff. Combined phacovitrectomy is the lean approach compared to two-step surgery and should be recommended for all phakic patients with ERM.

Journal of Cataract & Refractive Surgery 42(12):p 1843-1844, December 2016. | DOI: 10.1016/j.jcrs.2016.11.001