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Aim: Our aim is to report a case with bilateral Waldenström's macroglobulinemia (WM) associated maculopathy, assessed with multimodal imaging including swept source optical coherence tomography (SS-OCT) and OCT-Angiography (OCT-A)., Methods: Observational case report., Case Presentation: A 61-year-old diabetic woman with history of treated WM currently in remission, presented with progressive bilateral visual loss. Best-corrected visual acuity was 20/100 in the right eye (RE) and 20/200 in the left eye (LE). Fundus examination showed bilateral microaneurysms and retinal punctuate hemorrhages and a large macular serous detachment in the LE. There was no retinal ischemia on FA nor macular dye leakage. SS-OCT showed a significant schisis-like intraretinal fluid accumulation in the RE and a large prominent macular detachment with significant subretinal fluid accumulation in the LE. Retinal and choriocapillaris vascular densities were normal on OCT-A., Conclusion: Our case illustrated characteristic multimodal imaging findings in WM associated maculopathy such as schisis-like intraretinal fluid accumulation and angiographically silent serous macular detachment. OCT-A could non-invasively analyze macular vascular densities layer-by-layer, without noticing any vascular anomaly.

Purpose: To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks., Patients and Methods: Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed., Results: A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%)., Conclusion: RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.

Purpose: To evaluate the clinical characteristics and therapeutic challenges of retinal detachment in highly myopic eyes., Patients and Methods: We retrospectively reviewed the medical records of 83 eyes in 79 patients with high myopia (> 6.00 diopters or axial length > or = 26.00 mm) who underwent surgery for retinal detachment between 2001 and 2008. The surgical approaches depended on the type and location of the retinal break, the degree of myopia, and the grade of PVR., Results: The mean age of patients (48 men and 31 women) was 53.9 years. Refractive error ranged from - 10 D to - 25 D (mean was - 14.0 D). The mean follow-up was 19.4 months. Peripheral or equatorial retinal tears were present in 52 cases (62.6%), a macular hole in 14 cases (16.8%), a giant retinal tear in 6 cases (7.2%), and posterior paravascular retinal tears in 11 cases (13.2%). Single-surgery anatomic success was achieved in 65 cases (78.3%), with 17 cases after scleral buckle surgery and 46 cases after pars plana vitrectomy. Final anatomic success was achieved in 76 cases (91.5%). Per and postoperative hemorrhagic complications occurred in 16 cases (19.2%)., Conclusion: Retinal detachment is a serious complication of high myopia. It often occurs in young patients. Treatment is difficult due to anatomical and clinical conditions.

Purpose: To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with large retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD)., Design: Prospective, consecutive, observational case series., Methods: Seven eyes (five patients) with CNV associated with large PED in AMD were treated by IVTA (4 mg/ 0.1 ml), followed by a IVB (1.25 mg/0.05 ml) 1 week later. Patients were evaluated for best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at baseline, at 1 week and every 6 weeks. Fluorescein angiography (FA) and indocyanine green angiography (ICG) were performed at baseline and every 3 months afterwards. Indications for retreatment by combined injection were defined as persistent PED with subretinal and/or intraretinal fluid on OCT. Patients with flattening of the PED and activity leakage demonstrated by OCT underwent subsequent IVB., Results: The mean duration of follow-up was 11 months (range 9-14 months). BCVA at baseline averaged 20/125, and 20/80 at the end of follow-up. FA showed no leakage from the lesion in four eyes at the end of follow-up, and three eyes showed a decrease in leakage. Average central foveal thickness was (CFT) 325.7 microns at baseline and 209.2 microns at the end. The average size of the PED was 2.34 disk diameters (range 1.33-3.25) at baseline, and the PED disappeared in four eyes, while it decreased in size at the end in the remaining three. The subretinal fluid disappeared in all patients at the end. The combined treatment (IVTA with IVB 1 week later) was repeated in four eyes, and the number of IVB after combined injection ranged from one to three. No RPE tear appeared during follow-up. Two eyes developed glaucoma controlled by topical medication. There were no other ocular or systemic complications, Conclusion: Combined IVB and IVTA therapy seems to be an effective and safe procedure to treat CNV associated with large PED in AMD.

Purpose: To analyze the physiopathologic mechanism, therapeutic modalities, and prognosis of late recurrent retinal detachment., Methods: A retrospective study was conducted on late recurrent retinal detachment operated with episcleral surgery over a 15-year period. Ten patients were included in this study., Results: Late recurrent retinal detachments occurred in 0.39% of all retinal detachments repaired by episcleral surgery over 15 years. Redetachment occurred 3-7 years after surgery, with etiologies including new retinal breaks (seven cases), reopening of old breaks (three cases), and removal of scleral explant (one case). Proliferative vitreoretinopathy (PVR) grade B was seen in three cases, grade C in six cases, and grade D in one case. After reoperation, the retina was reattached in nine cases. Three eyes were treated with scleral buckle, the others underwent vitreoretinal surgery. Failure occurred in one patient who had a very high level of vitreoretinal proliferation., Conclusion: Late recurrent retinal detachments are rare and vitreous base traction seems to be an important factor, although the associated PVR was probably a secondary factor. Treatment depends on PVR, with vitreoretinal surgery necessary in some cases. They usually have a good prognosis.

Purpose: To determine the epidemiological and clinical factors involved in inferior rhegmatogenous retinal detachments and to propose a therapeutic plan., Patients and Methods: A retrospective case note review of 173 patients (175 eyes), 11-89 years old, who had been operated on for inferior retinal detachment over a 13-year period between 1990 and 2003., Results: The retinal reattachment rate after initial surgery was 79.5%, the final anatomical success rate was 81.5%. Scleral buckling surgery was used for the primary repair of rhegmatogenous retinal detachments in 111 cases and it was successful in 81 cases. Fifty-eight patients underwent vitrectomy with internal silicone oil tamponade. Anatomical success was obtained in 55 cases (94.8%) without recurrence. Endocular surgery allowed surgeons to find missed causal tear in 76% of cases. Mixed surgery was undertaken in four cases, with three good results. Visual acuity improved in 81% of cases, remained unchanged in 15% of cases, and deteriorated in 4% of cases. The mean final visual acuity ranged from 2.5 to 3/10, while it was only 1/20 before surgery. The mean improvement in visual acuity was 2.5 lines. The mean follow-up in our study was 13+/-11 months., Conclusion: Inferior retinal detachment usually occurred in young myopic or old pseudophakic subjects. These patients are characterized by the absence of tears. Vitrectomy in primary repair with inferior retinal detachment improves their anatomical and functional prognosis.

Purpose: To study the clinical characteristics and the therapeutic results of retinal detachment following neodymium YAG laser posterior capsulotomy., Material and Methods: A retrospective study of 28 patients (28 eyes) operated in department B of the Hédi Rais Institute of Ophthalmology (Tunis, Tunisia) between march 1993 and january 2005 for retinal detachment following neodymium YAG laser posterior capsulotomy. We study the preoperative clinical characteristics of the retinal detachment and the anatomic and functionnal results., Results: The mean age of the patients is 53.4 years. Fourteen patients are men and eleven have high myopia. Ten patients are aphakic and eighteen pseudophakic. The retinal detachment is total or subtotal in 19 eyes (67.9%). The macula is detached in 27 cases (96.4%). The retinal tears are posterior in 9 cases (paravascular retinal break or macular hole) and peripheral in fifteen cases. In 4 cases no tear is found. Vitreoretinal proliferation is advanced in 10 cases. Eleven patients underwent episcleral surgery and 17 endocular surgery. The final success rate is 89%. The postoperative visual acuity increases in 20 cases. It is superior to 1/10 in 14 cases. The minimum follow-up is 6 months., Conclusion: The retinal detachment after neodymium laser posterior capsulotomy is serious due to severe vitreoretinal proliferation wich influences the anatomic results.

Purpose: Simultaneous bilateral rhegmatogenous retinal detachments are rare. The purpose of our study was to examine the incidence, predictive factors, surgical results and prognosis of these retinal detachments., Patients and Methods: A retrospective analysis of the medical records of 468 consecutive patients, 7-89 years of age (mean, 45.7 years), undergoing surgery for rhegmatogenous retinal detachment between 1993 and 2000., Results: During this period, a total of 497 operations for rhegmatogenous retinal detachment were done. Thirty-two patients had bilateral rhegmatogenous retinal detachment. Simultaneous detachments were observed in seven patients (1.5%). In four cases, the diagnosis of retinal detachment was fortuitous. In fact, most patients presented with unilateral symptoms. The mean age (35 years) of patients suffering from simultaneous bilateral rhegmatogenous retinal detachment was younger than that of patients with unilateral or consecutive bilateral retinal detachments. Five patients were myopic. Multiple round retinal holes were the most frequent lesions responsible for retinal detachment. A preoperative proliferative vitreoretinopathy was found in 57% of cases. The retina was reattached in nine cases (81%)., Conclusion: Simultaneous bilateral rhegmatogenous retinal detachment is usually found in relatively young myopic patients with atrophic retinal holes. They are rare but severe because of their frequent association with preoperative proliferative vitreoretinopathy.

Unlabelled: To compare the success rate and the visual improvement of different surgical techniques for treating 21 retinal detachments due to macular hole in highly myopic eyes., Methods: Twelve patients were treated by gas tamponade alone, 5 patients underwent vitrectomy with gas tamponade, 4 patients underwent vitrectomy with epiretinal membrane pealing and gas or oil silicone tamponade., Results: Fifty eight % of patients were successfully treated after gas tamponade alone, and 75% after vitrectomy, epiretinal membrane pealing and gas or silicone oil tamponade. After retreatment in 7 patients, the final reattachment rate was 80%. Visual acuity was inchanged in 12 cases, improved to 1/20-1/10 in 8 case and reached 3/10 in 1 case., Conclusion: A therapeutic scheme is suggested according to the type of retinal detachment, macular vitreoretinal traction and pigment epithelium and chorioretinal degeneration condition.

Purpose To study macular involvement in non infectious intermediate, posterior and panuveitis. Methods The data of 201 eyes in 118 patients with diagnosed non infectious intermediate, posterior or panuveitis examined between January 2007 and June 2012 were retrospectively reviewed. All patients underwent complete ophthalmic examination with fluorescein angiography and optical coherence tomography (OCT) to assess macular involvement. Results Uveitis was due to behcet's disease in 62 eyes(30.8%), sarcoidosis in 22 eyes (10.9%), VKH in 24 eyes (11.9%), sympathetic ophthalmia in 1 eye (0.5%), birdshot chorioretinopathy in 2 eyes (1%), and multiple sclerosis in 2 eyes (1%). At initial examination, 54 eyes (27.2%) demonstrated macular involvement which consisted in macular edema (ME) in 32 eyes (15.9%), serous retinal detachment in 29 eyes(14.4%), epiretinal membrane (ERM) in 8 eyes (3.9%), macular atrophy in 2 eyes (1%), vitreo‐retinal traction in 1 eye (0.5%), macular hole in 1 eye (0.5%) , and active macular chorioretinitis in 1 eye (0.5%). During follow up, 16 eyes (8%) developed macular complications including ME in 6 eyes(3%), ERM in 5 eyes (2.5%), and macular atrophy in 5 eyes (2.5%). Conclusion Macular involvement,especially macular edema, is common in non infectious intermediate, posterior and panuveitis. It may lead to irreversible visual impairment. Thus, recognition of macular morphological characteristics by performing both OCT and fluorescein angiography in uveitic disease may facilitate earlier diagnosis and the initiation of specific treatment. [ABSTRACT FROM AUTHOR]