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Introduction: Tafenoquine has been recently registered for the prevention of relapse in Plasmodium vivax malaria., Objective: This study assessed the pharmacodynamic effects of 300-mg single-dose tafenoquine on the retina., Methods: This phase I, prospective, multicenter, randomized, single-masked, placebo-controlled, parallel-group study was conducted between 2 February 2016 and 14 September 2017 at three US study centers. Adult healthy volunteers were randomized (2:1) to receive either a single 300-mg oral dose of tafenoquine or matched placebo on day 1. Ophthalmic assessments, including spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF), were conducted at baseline and day 90 and evaluated for pre-determined endpoints by an independent, masked reading center., Results: One subject in each group met the composite primary endpoint for retinal changes identified with SD-OCT or FAF, i.e., one out of 306 (0.3%) with tafenoquine, one out of 161 (0.6%) with placebo. Both cases had unilateral focal ellipsoid zone disruption at day 90 with no effect on best-corrected visual acuity. The tafenoquine-treated subject had this abnormality at baseline, and was enrolled in error. There was no difference in ophthalmic safety between tafenoquine and placebo., Conclusion: There was no evidence of any pharmacodynamic effect of 300-mg single-dose tafenoquine on the retina or any short-term clinically relevant effects on ophthalmic safety. This clinical trial is registered with ClinicalTrials.gov (identifier: NCT02658435).

A 45-year-old woman underwent pars plana vitrectomy for vitreous hemorrhage in the right eye 20 years prior to presentation. She also had prior phacoemulsification and intraocular lens implantation and subsequent laser capsulotomy in the right eye. Multiple preretinal metallic fragments were visible on the retinal surface and were presumed to be stainless steel fragments from the vitrectomy instrument. The fragments were documented by color photography, fluorescein angiography, optical coherence tomography, and echography. Visual acuity was 20/30, electrophysiologic testing was normal, and no signs of toxicity were present. No surgical intervention was planned.

Purpose: To evaluate whether vitreous surgery is successful in closing full-thickness traumatic macular holes and whether there is subsequent improvement in visual acuity., Methods: Twelve eyes from 12 consecutive patients with traumatic macular holes underwent vitrectomy, fluid-gas exchange and instillation of bovine or recombinant transforming growth factor (TGF)-beta-2. Three of four eyes underwent repeat vitrectomy with TGF-beta-2 after the initial procedure failed to close the macular hole., Results: Eleven (92%) of 12 eyes had closure of the macular hole. Follow-up ranged from 3 to 33 months. Visual acuity improved by 2 or more lines in 8 (67%) of 12 eyes. Six (50%) of 12 eyes improved to 20/40 or better. All 3 eyes that underwent reoperation had successful closure of the macular hole and achieved 2 or more lines of visual improvement., Conclusion: Treatment of full-thickness traumatic macular holes with vitrectomy, fluid-gas exchange, and TGF-beta-2 may result in successful anatomic closure and visual improvement.

Background: The fluorescein angiographic characteristics in eyes with pseudoholes of the macula associated with epiretinal membranes have not been studied extensively., Methods: Stereo photographs and fluorescein angiograms from 83 consecutive eyes of 80 patients with pseudoholes of the macula were evaluated by two independent graders for epiretinal membrane opacity, fluorescence in the base of the pseudohole, and late perifoveal pooling of dye., Results: Hyperfluorescence in synchrony with choroidal fluorescence appeared within the base of the pseudohole in 52 (63%) of the 83 eyes studied. The hyperfluorescence was smaller than the pseudohole in 37 (45%) eyes. Diffuse hyperfluorescence filled the pseudohole in 15 (18%) eyes. No fluorescence was seen in 20 (24%) eyes. Eleven (13%) eyes could not be graded due to coexistent macular disease or media opacity. Fluorescence within the area of pseudohole was less common in eyes with opaque epiretinal membranes than in eyes with visible or transparent epiretinal membranes (P = 0.002). Fluorescence within the area of the pseudohole was also less common in eyes with evidence of macular edema on fluorescein angiography (P < 0.001). The mean visual acuity was better for eyes with hyperfluorescence within the area of the pseudohole than for eyes without hyperfluorescence (P < 0.01)., Conclusion: A common fluorescein angiographic characteristic associated with pseudoholes of the macula is early hyperfluorescence within the area of the pseudohole. This hyperfluorescence coincides with choroidal filling and appears to be a form of transmission defect rather than a blocking of surrounding choroidal fluorescence by the epiretinal membrane. This central hyperfluorescence may result in misdiagnosis of the macular pseudohole as a full-thickness macular hole.

Previous studies of treatment of full-thickness macular holes have effected resolution of the surrounding subretinal fluid cuff in 58%-71% of cases. An initial report has found 330 ng and 1,330 ng transforming growth factor-beta 2 to be successful in effecting resolution of the surrounding subretinal fluid cuff in 100% of cases. A randomized, masked, controlled, prospective, multicenter study of 90 patients with full-thickness macular holes was performed to assess the efficacy of the local application of TGF-beta 2 at the time of vitrectomy surgery. Eligibility criteria included: (1) best corrected visual acuity of 20/80 or worse; (2) duration of macular hole for less than 1 year; and (3) absence of other ocular disorders that might interfere with vision. Patients were evenly randomized to receive placebo, 660 ng transforming growth factor-beta 2, or 1,330 ng transforming growth factor-beta 2. The treatment assignment was unmasked at the examination 3 months after treatment only if the macular hole failed to close. If the initial treatment had been placebo, patients were offered crossover to 1,330 ng transforming growth factor-beta 2 during a reoperation. It can be deduced that resolution of the subretinal fluid cuff occurred in 16 of 30 placebo-treated eyes, 53 of 58 eyes treated with transforming growth factor-beta 2, and in 9 of 13 cases (69%) initially treated with placebo that subsequently underwent repeat surgery under the crossover option.(ABSTRACT TRUNCATED AT 250 WORDS)

The current two-dimensional (2D) retinal drawing chart is an azimuth equidistant representation of the retina. The distortion produced by this chart was analyzed and compared to other 2D projections, such as stereographic, equal area, and orthographic maps of the retina. Circumferential distortion was calculated for lesions at varying distances from the macula using the azimuth equidistant retinal map and was found to increase exponentially as a function of the distance from the macula. Circumferential distortion was 57.1% at the equator, 88.5% 3 mm anterior to the equator, and 137.8% 6 mm anterior to the equator. A three-dimensional (3D) model of the retinal surface was created using 3D computer assisted design (CAD) software. This 3D model was able to represent retinal lesions such that their true size, shape, location, and orientation were all conserved. Retinal lesions could be viewed from multiple angles and examined in cross section. The use of 3D CAD software coupled with ultrasound or magnetic resonance imaging data has the potential to represent retinal lesions more accurately than current methods.

Epiretinal membranes exert a perpendicular force on the retina that is directed toward the center of the vitreous cavity and tends to elevate the retina from the retinal pigment epithelium. A scleral buckle changes the eye wall from concave to convex and reverses the direction of the vector force oriented perpendicular to the eye wall. Therefore, when a scleral buckle is used, the force from an epiretinal membrane pulls the retina toward the retinal pigment epithelium instead of causing retinal detachment.