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Purpose: To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH). Methods: A consecutive 99 eyes of 99 patients were enrolled {45 – conventional group and 54 – inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed. Results: At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group. Conclusion: The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.

Purpose: This study aimed at establishing the normative data for the thickness of macular layers on Spectralis Spectral-domain optical coherence tomography (SD-OCT) in healthy Indian eyes and testing the effects of age, gender, central corneal thickness (CCT), and intraocular pressure (IOP) on such values. Methods: This cross-sectional study was done on 308 eyes of 159 healthy subjects. OCT scans were obtained using the posterior pole asymmetry scan protocol. From the thickness map, data were grouped into nine Early Treatment Diabetic Retinopathy Study (ETDRS) macular sectors. Correlation between retinal thickness and age/IOP/CCT was done using Pearson correlation. Correcting for age as a covariate, multivariate regression analysis was done to know which retinal layers showed significant differences in thickness between males and females. Results: The mean age was 46.06 ± 13.06 years (range: 20–75 years). Significant central subfield (CSF) thickening with age was noted in retinal nerve fiber layer (RNFL), inner nuclear layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL) (P < 0.04). The average thickness of the outer ring reduced with age in the ganglion cell layer (GCL)/IPL/INL (P = 0.001). Women had thinner inner and outer retinal thickness than men in all ETDRS rings (P < 0.001). There was no interocular asymmetry (P > 0.05) and no correlation between IOP/CCT and retinal layer thickness. Conclusion: In CSF, age-related thickening was noted in RNFL, IPL, INL, OPL, and ONL. The average inner ring thickness decreased with age in GCL and IPL and increased in the RPE layer. The average outer ring thickness decreased with age in GCL, IPL, and INL layers and increased in OPL. The average IR and OR thickness was significantly less in women compared to men in all sub-fields. There was no correlation between IOP/CCT and retinal layer thickness.

The most challenging step in sutureless scleral fixation of intraocular lens (SFIOL) is exteriorization of haptics. The conventional handshake technique has a learning curve since it involves intraocular handing over of haptics from one forceps to another. Here, we describe “extraocular needle-guided haptic insertion technique” (X-NIT), a novel technique of exteriorizing haptics that totally eliminates intraocular manipulations. This method involves sequential introduction of two bent 26-gauge needles through the sclera (pars plicata zone) into the eye which are brought out through a sclerocorneal wound. The intraocular lens haptics are threaded through these needles and exteriorized. Nineteen consecutive patients underwent surgery by this technique. There were no intraoperative complications. The mean best-corrected visual acuity (BCVA) of these patients at 1-month follow-up was 0.5 ± 0.3 (logarithm of the minimum angle of resolution) with 18 of 19 eyes showing one or more lines of improvement in BCVA. X-NIT is a safe, easy, cost-effective, and highly reproducible technique, especially for beginners.

Purpose: Hyperreflective spots (HRS) are considered as spectral domain optical coherence tomography biomarkers in predicting response to intravitreal therapy (IVT) in diabetic macular edema (DME). We aimed to determine if there was a quantitative reduction in HRS following IVT in DME, if the response to antivascular endothelial growth factor (anti-VEGF) drugs was different from steroids, and if HRS-response was associated with improvement in visual acuity (VA) or reduction in central macular thickness (CMT). Methods: PubMed/MEDLINE, Scopus, ProQuest, CINAHL, Wiley online, and Web of Science were searched (between January 1, 2011 and July 1, 2020). Publication bias and heterogeneity were assessed. Meta-analysis was done using the random-effects model. Results: Totally, 1168 eyes from 19 studies were eligible for inclusion. IVT was associated with a reduction in quantitative HRS (z = -6.3, P < 0.0001). Studies, however, showed heterogeneity (I2 = 93.2%). There was no difference between anti-VEGF and steroid therapies (P = 0.23). The evidence on predicting VA and CMT outcomes were limited by the number of analyzable studies, owing to the wide variation in individual study designs, and lack of randomized controlled trials. Conclusion: We could conclude that there is a definite reduction in quantitative HRS following either form of IVT. We highlight the lacunae in the existing literature on HRS in DME and propose goals for future studies to harness the advantage of this promising biomarker. [ABSTRACT FROM AUTHOR]