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Purpose:To evaluate the long-term visual results of vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) removal for idiopathic ERM in eyes with a preoperative visual acuity (VA) of 20/50 or better. Methods:This retrospective review of a consecutive case series comprised 337 patients. Of these, 36 eyes of 36 patients had ERM and ILM removal from 2017 to 2018. Inclusion criteria included a subjective decrease in VA, a preoperative VA of 20/50 or better, vitrectomy with ERM and ILM removal for ERM, and a minimum 6-month follow-up. Paired ttests were used to determine the statistical significance (P< .05) of VA changes postoperatively. Results:The mean (±SD) best-corrected logMAR VA improved to a maximum of 0.125 ± 0.09 (Snellen equivalent 20/26.4) at a mean of 11.1 months postoperatively (P< .001). The VA continued to significantly improve over the long term (mean, 41.6 months; range, 6-63; P< .001). Overall long-term data trended heavily toward VA improvement (25/36 patients [69.4%]) and stability (10/36 patients [27.7%)] after ERM and ILM removal, with only 1 patient (2.8%) having worse VA. There were no intraoperative or postoperative complications related to ERM and ILM removal. Conclusions:Surgery to remove idiopathic ERM and ILM for patients with significant symptoms and good preoperative VA may result in excellent long-term visual results.

Purpose:To report a case of painless posterior scleritis presenting as a choroidal nodule in a patient with history of a tumor being treated with pembrolizumab. Methods:A case and its findings were analyzed, and a relevant literature review was performed. Results: A 20-year-old woman with a history of ependymoma presented with painless blurred vision in the right eye after being started on pembrolizumab for a tumor recurrence. Fundoscopy showed a solitary amelanotic choroidal lesion with surrounding subretinal fluid in the affected eye. Ultrasonography showed moderate internal reflectivity and fluid in Tenon capsule consistent with nodular posterior scleritis. After a course of systemic steroids and discontinuation of the pembrolizumab, the choroidal lesion completely resolved. Conclusions: Clinicians should be aware of posterior scleritis as an ocular complication of this class of medications.

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Hyperreflective foci (HRF) are OCT biomarkers for the progression of nonneovascular age-related macular degeneration (AMD) attributed to anteriorly migrated retinal pigment epithelial cells. We examined associations between rod- and cone-mediated vision and HRF plus smaller hyperreflective specks (HRS); we identified a histologic candidate for HRS.

BACKGROUND AND OBJECTIVE:Patients with hemorrhagic posterior vitreous detachments (HPVDs) have a high rate of retinal tears and often develop retinal detachments (RDs). This study aims to compare outcomes of 25-gauge pars plana vitrectomy (PPV) for HPVD versus an observational group.PATIENTS AND METHODS:Retrospective cohort study of 109 consecutive eyes of 105 patients diagnosed with HPVD; 66 eyes underwent PPV and 43 eyes were observed.RESULTS:Twenty-four eyes (36.4%) in the surgical group were found to have tears intraoperatively not seen preoperatively. The median time to vitreous hemorrhage (VH) resolution was significantly shorter for the PPV group, 14 days (interquartile range [IQR]: 7 days to 35 days), compared to those who were observed, 58.5 days (IQR: 30 days to 91 days) (Twenty-four eyes (36.4%) in the surgical group were found to have tears intraoperatively not seen preoperatively. The median time to vitreous hemorrhage (VH) resolution was significantly shorter for the PPV group, 14 days (interquartile range [IQR]: 7 days to 35 days), compared to those who were observed, 58.5 days (IQR: 30 days to 91 days) (P< .0001). RDs occurred more frequently among observational patients (11.63%) compared to 1.52% of surgical patients (P= .0344).CONCLUSION:Twenty-five-gauge PPV for HPVD resulted in less RDs, diagnosis of occult retinal breaks intraoperatively, and shorter time to VH resolution.[[Ophthalmic Surg Lasers Imaging Retina.2019;50:e288–e293.]

Purpose:To compare the long-term outcomes of standard panretinal photocoagulation (PRP) performed in the operating room (OR) with peripheral PRP performed in the clinic in treatment-naïve patients with proliferative diabetic retinopathy (PDR). Methods:Consecutive cases from 2017 to 2022 were retrospectively reviewed. Exclusion criteria included previous PRP, pars plana vitrectomy performed at the time of the initial PRP, PRP performed in another setting within 3 months of the initial treatment, a documented plan for future PRP at the time of the initial treatment, and less than 3 years of follow-up. Negative binomial regressions were used to compare the number of subsequent interventions between the 2 groups and ttests to compare the visual acuity (VA) outcomes. Results:Of the 961 eyes of 679 patients screened, 82 eyes of 53 patients met the inclusion criteria. The initial PRP was performed in the OR (OR cohort) in 57 eyes of 38 patients and in the clinic in 25 eyes of 15 patients (clinic cohort). The OR cohort had a mean of 0.4 subsequent surgeries and 0.8 subsequent PRP treatments and the clinic cohort, 0.8 subsequent surgeries (P< .05) and 1.8 subsequent PRP treatments (P< .05). No significant between-group difference was found in the VA outcomes over the long-term follow-up (mean, 44.2 months). Conclusions:Peripheral PRP performed in the OR resulted in fewer subsequent interventions than standard PRP in the clinic and may afford better control of PDR.

OCT has revealed many details of retinal disease that were not available with older imaging technologies. In eyes of adults older than 60 years with healthy maculas as determined by color fundus photography (CFP) and a validated grading system, we screened for pathologic features using OCT. We also tested visual function to assess potential impact of the observed pathologic features on patients.

To evaluate the outcomes of choroidal melanoma 25-gauge vitrectomy needle biopsy and iodine 125 (125I) brachytherapy performed by supervised fellows compared with experienced faculty.

Pneumatic vitreolysis with C3F8gas is effective in releasing focal vitreomacular traction in a high percentage of eyes with few adverse events, especially with limited vitreomacular traction (within 1 disk area), lack of thick cellophane membranes, no diabetes mellitus, younger age (mean age of 69.1 years vs. 78.1 years), better baseline best spectacle–corrected visual acuity (mean of 20/50 vs. 20/66), small Stage 2 macular hole, and female gender.

Purpose: To examine the difference in pain control and systemic pain medication usage with sub-Tenon’s bupivacaine versus bupivacaine liposome injectable suspension (BLIS) following radioactive plaque placement for choroidal and ciliary body melanomas.Methods: Retrospective chart review reporting postoperative nurse and physician pain scores, postoperative systemic pain medication usage, and telephone pain survey conducted at a single university institution from January 2016 to October 2016.Results: There were 9 (9 eyes) patients studied who underwent sub-Tenon’s bupivacaine injection and 9 (9 eyes) patients who underwent sub-Tenon’s BLIS. There were no statistically significant differences on postoperative days 1 to 3 between nurse pain scores, physician pain scores, vision, and average intraocular pressure. The difference in postoperative days 1 and 2 hydrocodone/acetaminophen usage was statistically significant (average pills per day on postoperative day 1 for bupivacaine only 0.22 versus 2.33 for BLIS, Pvalue .0032; and postoperative day 2 for bupivacaine only 0.00 versus 1.00 for BLIS, Pvalue .0289). There were no other statistically significant differences in postoperative systemic pain medication usage. There were no statistically significant differences in telephone pain survey.Conclusion: There was no clinically meaningful difference in postoperative nurse and physician pain scores, postoperative systemic pain medication usage, and telephone pain survey between sub-Tenon’s bupivacaine versus BLIS following radioactive plaque placement for choroidal and ciliary body melanomas.

Cytotoxic T-lymphocyte-associated antigen is a naturally occurring inhibitor of T-cell costimulation. Monoclonal antibody inhibition of cytotoxic T-lymphocyte-associated antigen with ipilimumab blocks this negative regulator of costimulation, promoting T-cell activation and survival, and leads to melanoma regression. Findings of the Vogt-Koyanagi-Harada (VKH) syndrome, an uveomeningitic syndrome that features neurological, auditory, ophthalmologic, and cutaneous involvement because of autoimmune targeting of melanocytic antigen, have rarely been described in association with melanoma immunotherapy. We describe a case of VKH-like syndrome in a 45-year-old HLA-A02-positive patient with metastatic melanoma treated with ipilimumab. Disruption of immune tolerance by ipilimumab led to melanoma remission while also inciting systemic and ophthalmic autoimmunity toward melanocytic antigen. These observations provide insight into the pathophysiology of the VKH syndrome, and the balance between tumor-associated tolerance and autoimmunity.

To demonstrate the diagnostic difficulties in cases of retinal necrosis in immunocompromised patients including the potential for false-negative anterior segment sampling and also to emphasize the utility of diagnostic vitrectomy with histopathologic examination.