Retina Institute of Hawaii

Purpose: Peripapillary and macular retinoschisis can occur without visible optic pits or advanced glaucomatous optic atrophy, a condition referred to as no optic pit retinoschisis (NOPIR). This study sought to further define the clinical features of NOPIR in a single-center case series. Methods: A retrospective study of consecutive cases of NOPIR was performed at The University of Osaka Hospital in Japan. The clinical characteristics and treatment history of patients were reviewed. Results: In total, 13 eyes of 12 patients with NOPIR were included. At baseline, the mean (±SD) age was 65.8 ± 10.3 years, mean intraocular pressure was 14.9 ± 3.9 mm Hg, and mean refractive error was -2.12 ± 2.4 diopters. Two eyes had moderate glaucoma at baseline. Ten eyes (91%) did not have glaucoma at baseline; however, glaucoma developed later after the initial diagnosis. The mean time from baseline to glaucoma diagnosis was 31.6 ± 15.2 months. Of the 13 eyes, retinoschisis associated with NOPIR was treated with vitrectomy in 6 eyes and with observation in 7 eyes. The time to resolution of retinoschisis was shorter in the surgery group (mean ± SD 14.7 ± 7.6 months) than in the observation group (52.4 ± 21.4 months) (P = .005). The time to diagnosis of glaucoma was also shorter in the surgery group (9.5 ± 12.8 months) than in the observation group (35.6 ± 16.1 months) (P = .02). Conclusions: Eyes with NOPIR can have glaucoma present at the time of diagnosis, but it more commonly develops later thereafter. Screening for glaucoma and visual field testing should be considered in eyes with NOPIR.

To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients. This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications. The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery. Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.

Determine sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis with structural en face optical coherence tomography (OCT) and OCT angiography (OCTA). Retrospective review of the medical records of eyes diagnosed with PCV by indocyanine green angiography with review of diagnostic testing with structural en face OCT and OCTA by a trained reader. Structural en face OCT, cross-sectional OCT angiograms alone, and OCTA in its entirety were reviewed blinded to the findings of indocyanine green angiography and each other to determine if they could demonstrate the PCV complex. Sensitivity and specificity of PCV diagnosis was determined for each imaging technique using indocyanine green angiography as the ground truth. Sensitivity and specificity of structural en face OCT were 30.0% and 85.7%, of OCT angiograms alone were 26.8% and 96.8%, and of the entire OCTA were 43.9% and 87.1%, respectively. Sensitivity and specificity were improved for OCT angiograms and OCTA when looking at images taken within 1 month of PCV diagnosis. Sensitivity of detecting PCV was low using structural en face OCT and OCTA but specificity was high. Indocyanine green angiography remains the gold standard for PCV detection.

To report patients who demonstrated an alteration in the clinical and optical coherence tomography features of neovascular age-related macular degeneration after resolution of endophthalmitis. Retrospective case series of the subsequent changes in the macula and need for anti-vascular endothelial growth factor therapy in patients with neovascular age-related macular degeneration who developed endophthalmitis after intravitreal injection. The study included seven eyes of seven patients with follow-up ranging between 3 months and 11 years. The vitreous cultures (n = 7) before intravitreal antibiotic injection were the following: culture-negative (4) and coagulase-negative Staphylococcus (3). Initial treatment included vitreous tap and injection (4) and pars plana vitrectomy (3). In 5/7 eyes, the optical coherence tomography showed resolution of subretinal fluid and serous pigment epithelial detachment, and there was no additional anti-vascular endothelial growth factor treatment administered. After successful treatment of endophthalmitis in patients with neovascular age-related macular degeneration, there was relative involution of the maculopathy and reduced anti-vascular endothelial growth factor treatment burden in this series.

To evaluate the safety and efficacy of epimacular brachytherapy for the treatment of chronic, active neovascular age-related macular degeneration. A prospective, multicenter, interventional noncontrolled clinical trial recruited 53 participants with previously treated neovascular age-related macular degeneration. Participants underwent pars plana vitrectomy with a single 24 Gray dose of epimacular brachytherapy, delivered using an intraocular cannula containing a Strontium 90/Yttrium 90 source that was positioned over the active lesion. Participants were retreated with ranibizumab, administered monthly as needed, using predefined retreatment criteria. Coprimary outcomes at 24 months were the proportion of participants losing <15 Early Treatment of Diabetic Retinopathy Study letters and mean number of ranibizumab retreatments. Over 24 months, 68.1% lost <15 letters with a mean of 8.7 ranibizumab retreatments. Mean change in visual acuity was -6.3 (standard deviation, 18.9) letters. There was one case of nonproliferative radiation retinopathy. The apparent reduction in ranibizumab retreatment was less evident in Year 2 than Year 1, with the moderate reduction in visual acuity extending into the second year. Although radiation retinopathy occurred in one case, it was not vision threatening and safety remained acceptable.

The treatment of choroidal neovascularization (CNV) due to myopic degeneration can include laser photocoagulation, photodynamic therapy, corticosteroids, and subretinal surgery. We report a case of a young patient with myopic CNV refractive to laser photocoagulation, photodynamic therapy, and intravitreal triamcinolone acetonide treated with intravitreal pegaptanib injections. Interventional case report. The medical chart of a 36-year-old female treated with intravitreal pegaptanib injections was reviewed for changes in visual acuity on the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, CNV leakage on fluorescein angiography, and adverse events reported. ETDRS visual acuity improved from counting fingers (CF) to 20/40 in the right eye after five, 6-weekly pegaptanib injections. This is the sentinel case of US Food and Drug Administration (FDA) approved pegaptanib usage for non-wet macular degeneration via an Investigational New Drug application (Title 21, Code of Federal Regulations part 132). Pegaptanib appears to be effective in treating myopic CNV refractive to laser photocoagulation, photodynamic therapy, and intravitreal triamcinolone acetonide.