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Objective: To determine the efficacy of vitrectomy in eyes with treatment-naïve diabetic macular edema (DME)., Methods: Consecutive patients with treatment-naïve DME who underwent pars plana vitrectomy with internal limiting membrane peeling at a single institution were identified from the electronic medical records. Morphologic and visual acuity changes from baseline were analyzed at both the primary temporal endpoint (6 months) and the final examination with the investigators. The primary outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT)., Results: Forty-four eyes of 44 patients were included in this retrospective study. The mean BCVA improved significantly from baseline until the 6-month primary endpoint (1.35 logMAR vs 0.83 logMAR, p < 0.001) and stabilized through the final examination (0.77 logMAR). The BCVA improved by at least 0.1, 0.3, and 0.6 logMAR in 26 (60%), 24 (55%), and 14 (32%) of eyes, respectively, whereas it worsened by 0.3 logMAR in only 1 (2%) eye. Final BCVA correlated inversely with duration of diabetes (p = 0.01), presence of an epiretinal membrane (p = 0.02), and initial visual acuity (p = 0.03). Mean CRT decreased significantly from baseline through 6 months (595 µm vs 266 µm; p < 0.001), and edema recurred in only 3 eyes (6%), one of which was subsequently treated with intravitreal bevacizumab., Conclusions: Pars plana vitrectomy significantly improves macular edema and visual acuity in eyes with treatment-naïve DME. Prospective randomized trials are needed to better determine the efficacy of early vitrectomy., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this article is to report on retinal and choroidal morphology in choroidal nevi documented with Swept Source optical coherence tomography (SS-OCT)., Design: This is a retrospective, observational study., Participants: We included 27 consecutive patients with choroidal nevi. Mean age was 66.3 years (21-95 years)., Methods: The SS-OCT scanning protocol consisted of a single line scan through the centre of the nevi with a resolution of 3 µm, built from 1024 A-scans, with a length of 12 mm. We attempted to visualize the outer choroidoscleral boundary and suprachoroidal layer (SCL) below the choroidal nevus and to observe any other defects of retinal or choroidal morphology., Results: In all cases, we observed that the inner margin of benign tumours was separated from the retinal pigment epithelium with a hyporeflective band. Melanotic nevi cast partial (41%) or complete shadow (41%) on the underlying structures. The outer choroidoscleral boundary was visible under the tumour in 8 eyes (25%). SCL and suprachoroidal space were noted in 40% of eyes in close proximity to the lesion, but in no case were these lines visible directly below the lesion. Thinning of the choriocapillaries was observed in 8 eyes (25%) and thinning of the choroid in 5 eyes (15.6%)., Conclusions: Using SS-OCT, we observed that the inner border of benign choroidal lesions was always situated below a hyporeflective band, possibly corresponding to the choriocapillaries. A new finding was that we observed the SCL in 40% of cases. This was always visible in close proximity to the nevus, never directly below it., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to report on the efficacy of 1 dose of aflibercept in bevacizumab nonresponders., Design: This was a retrospective, single-centre, interventional, noncomparative study., Participants: This study retrospectively analyzed 23 patients with persistent intraretinal or subretinal fluid treated with 6 or more monthly bevacizumab injections., Methods: Patients were switched to 1 dose of aflibercept and afterward continued their therapy with bevacizumab for at least another 6 months. We performed spectral domain optical coherence tomography monthly and evaluated visual acuity, central retinal thickness, and photoreceptor defects. The main outcome measures were visual and anatomic outcome 1 and 6 months after administering aflibercept., Results: Visual acuity significantly improved (p = 0.01) after the switch to aflibercept (from 0.39 to 0.49 Snellen). This improvement was stable for the remaining 6 months of the study (final visual acuity, 0.46 Snellen); 47% of patients experienced an improvement of at least 5 letters from baseline on a chart of the ETDRS type (Early Treatment Diabetic Retinopathy Study). Central retinal thickness decreased from 521 µm to 446 µm (p = 0.01) and remained stable for the next 6 months (452 µm). Complete resolution of intraretinal and subretinal fluid was observed in 30% of eyes., Conclusions: In bevacizumab nonresponders, switching to a single dose of aflibercept before continuing the therapy with bevacizumab improves visual outcome and anatomic results., (Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the frequency and characteristic spectral-domain optical coherence tomography (SD-OCT) features preceding new-onset choroidal neovascularization (CNV) in the fellow eye of neovascular age-related macular degeneration (AMD) with SD-OCT., Design: A prospective, observational study., Participants: Sixty-eight fellow eyes of patients with unilateral CNV., Methods: SD-OCT was performed at baseline and then monthly. The main outcome measure is the description of retinal morphology 1 month before new onset of neovascularization., Results: During the 48-month observation period, new-onset CNV was observed in 27 fellow eyes. Several morphologic features characterized SD-OCT images ≥1 months before new onset of CNV. These included new retinal pigment epithelium defects (2 eyes), new photoreceptor defects (7 eyes), drusen touching the photoreceptor layer and the external limiting membrane (13 eyes), and new drusen (4 eyes) hyperreflective spots probably representing new growing vessels (5 eyes)., Conclusions: Monthly SD-OCT screening of fellow eyes of patients treated with anti-vascular endothelial growth factor enables identification of morphologic changes that may predispose or precede CNV formation. Rapid identification of CNV formation enhances treatment immediacy., (Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)