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Background: To report a case with bilateral Terson syndrome presented with a unique mushroom-like mass lesion on the optic disc along with proliferative vitreoretinopathy and tractional retinal detachment., Case Presentation: A 33-year-old man was injured during a traffic accident and had diffuse brain swelling and intraocular hemorrhage. Poor vision in both eyes was noted after the patient regained consciousness. B-scan ultrasonography showed extensive vitreous opacity with a posterior vitreous detachment and without obvious retinal detachment. Vitrectomy was performed in both eyes five months after the accident. After clearing up the vitreous opacity, a peculiar pigmented mushroom-like mass lesion was noted in the posterior pole and had severe adhesion to the underneath optic disc. Extensive multilayered peripapillary epiretinal membrane was found covering the posterior pole and led to tractional retinal detachment around the macula. The mass was presumed to be an organized vitreous hemorrhage originated from the optic disc. The extensive and adherent epiretinal membrane together with the mass lesion were removed as much as possible and silicon oil was injected for tamponade. However, in the right eye, the retina redetached under silicon oil, whereas in the left eye, his vision improved to 20/100., Conclusions: Terson syndrome usually has a favorable prognosis but may be complicated by proliferative vitreoretinopathy and tractional retinal detachment. Careful monitoring is warranted and early vitrectomy should be considered in cases suspecting additional pathologies., (© 2024. The Author(s).)

Introduction: Retinal cysts are rare lesions of the fundus that are essentially fluid-filled cavities located or originating in the retina, with a diameter larger than the normal retinal thickness. To date, there have been few case reports of giant retinal cyst hemorrhage with retinoschisis., Case Presentation: A 32-year-old woman with no other medical history complained of decreased vision for 3 days after a severe cough. The best-corrected visual acuity in the right eye was 0.5. A comprehensive ophthalmological examination including slit-lamp fundoscopy, ultrasound scan of the eye, optical coherence tomography scan, and orbital magnetic resonance imaging was performed. Ophthalmological examination revealed grade III anterior chamber blood cells and grade III vitreous hemorrhage in the right eye and a large herpetic cyst on the nasal side of the retina. The cyst projected into the vitreous, with a large amount of hemorrhage vaguely visible within it. The cyst was clearly visible, and a superficial retinal limiting detachment was observed around it. Ultrasound showed a retinal cyst with retinal detachment in the right eye. Laboratory test results were unremarkable. After 3 months of conservative treatment, the patient's intracystic hemorrhage was significantly absorbed, but the size of the cyst cavity did not show any significant change. Scleral buckling with external compression combined with external drainage of the intracystic fluid was performed, the patient's visual acuity was gradually restored to a normal 1.0 after the operation, and the retina appeared flattened. The patient was finally diagnosed with a giant retinal cyst with retinoschisis in the right eye. The presumed cause was heavy coughing leading to rupture and hemorrhage of the retinal cyst, similar to the mechanism of rupture of an arterial dissection. To the best of our knowledge, this case of retinal cyst rupture and hemorrhage caused by heavy coughing with good recovery after external surgical treatment has never been reported before., Conclusions: Giant cystic retinal hemorrhage with retinoschisis is very rare. Orbital magnetic resonance imaging and ocular B-scan ultrasound are essential for its diagnosis, and the selection of an appropriate surgical procedure is necessary to maximize the benefit for affected patients., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To investigate the use of intraocular fibrin glue to lower the risk of vitreous hemorrhage (VH) after pars plana vitrectomy (PPV) in eyes with diabetic VH or traction retinal detachment., Methods: A matched, case-control, single-surgeon, pilot study of patients undergoing PPV for diabetic VH or traction retinal detachment with versus without fibrin glue was performed., Results: Thirty-nine patients (13 glue and 26 control patients) were included. In the glue group, mean (SD) logarithm of the minimum angle of resolution visual acuity (Snellen) significantly improved from 1.53 (0.6) (20/678) to 0.99 (0.9) (20/195) at postoperative month 6 ( P = 0.03). In the control group, mean logarithm of the minimum angle of resolution visual acuity also improved from 1.45 (0.8) (20/564) to 1.17 (0.9) (20/296) at postoperative Month 6 ( P = 0.3). Persistent post-PPV VH was similar between the 2 groups (15.4% in both groups, P > 0.99). However, early recurrent VH (<3 months post-PPV) was seen in 34.6% in the control group and none in the glue group ( P = 0.02). No intraocular inflammatory events were seen in the glue group., Conclusion: Intraocular fibrin glue may be a safe adjuvant in diabetic vitrectomy and may reduce the rate of early recurrent postoperative VH.

Purpose: To investigate the safety and efficacy of vitrectomy pars plana vitrectomy in managing intraocular complications relating to vasoproliferative tumors of the retina (VPL)., Methods: Retrospective study. 17 patients with VPL who underwent vitrectomy at Sheffield Teaching Hospital NHS Trust from 2005 to 2020 were included. Patient demographics, clinical characteristics, intraoperative data, and surgical outcomes were collected and evaluated., Results: The mean age was 52 years. Indications for pars plana vitrectomy included epiretinal membrane (n = 7), vitreous hemorrhage (n = 5), retinal detachment (n = 3), diagnostic (n = 1), and others (n = 1). After pars plana vitrectomy, 14/17 (82.4%) have stabilized vision and 3/17 (17.6%) deteriorated. Subgroup analysis of epiretinal membrane peel had good outcomes with 6/7 (85.7%) noticing improvement or stabilization of symptoms and mean logarithm of minimal angle of resolution visual acuity improved from 0.719 [6/30] ± 0.267 [6/12] to 0.476 [6/19] ± 0.271 [6/12]. Patients undergoing surgery for vitreous hemorrhage also had good outcomes with resolution (and no recurrence) of the hemorrhage in 3/5 (60%) and 5/5 (100%) with one or more surgeries, respectively. Outcomes for retinal detachment surgery were logarithm of minimal angle of resolution 2.126 [HM] ± 0.301 [6/12] preoperatively and 1.185 [6/95] ± 0.522 [6/19] postoperatively, with one recurrence of retinal detachment. In the epiretinal membrane group, three patients had adjunctive treatment for VPL intraoperatively and four patients had none, and no difference found between the two groups in outcome or complications. Tumor with thickness of ≥2 mm exhibited inferior visual outcomes compared with <2 mm ( P < 0.05)., Conclusion: This is one of the largest data sets in looking at outcomes of vitrectomy for complications of VPL. Pars plana vitrectomy is effective and safe in managing VPL-related intraocular complications with good outcomes and a low rate of complications, especially for patients with epiretinal membrane and vitreous hemorrhage.

Purpose: To report the outcomes of pars plana vitrectomy for vitreous hemorrhage (VH) associated with retinal vein occlusion and to identify prognostic indicators., Methods: Interventional, retrospective consecutive case series between 2015 and 2021., Results: The study included 138 eyes of 138 patients (64 female and 74 male); 81 patients had branch retinal vein occlusion and 57 had central retinal vein occlusion. The mean age was 69.8 years. The mean duration between the diagnosis of VH and surgery was 79.6 ± 115.3 (range, 1-572) days. The mean follow-up was 27.2 months. The logarithm of the minimum angle of resolution visual acuity significantly improved from 1.95 ± 0.72 (Snellen equivalent, 20/1782) to 0.99 ± 0.87 (20/195) at 6 months and to 1.06 ± 0.96 (20/230) at the final visit (both P < 0.001). The visual acuity at 6 months improved by three or more lines in 103 eyes (75%). Postoperative complications during follow-up included recurrent VH in 16 eyes (12%) (of which 8 eyes underwent reoperations), rhegmatogenous retinal detachment in six eyes (4%), and new neovascular glaucoma in three eyes (2%). Worse final visual acuity was significantly associated with older age ( P = 0.007), concurrent neovascular glaucoma ( P < 0.001), central retinal vein occlusion ( P < 0.001), worse preoperative visual acuity ( P < 0.001), postoperative new neovascular glaucoma ( P = 0.021), and postoperative retinal detachment ( P < 0.001). The duration of VH was not associated with visual outcomes ( P = 0.684). Preoperative antivascular endothelial growth factor injections and tamponade did not prevent postoperative recurrent VH., Conclusion: Pars plana vitrectomy is effective for VH associated with retinal vein occlusion, regardless of the duration of hemorrhage. However, pre-existing risk factors and postoperative sequelae may limit visual recovery.

Background/purpose: To describe diagnostic characteristics and management of exudative macular detachment, a rare complication of pars plana vitrectomy and endolaser for diabetic vitreous hemorrhage., Methods: Case report including multimodal imaging., Results: Forty-seven-year-old man with diabetes mellitus Type 2 and proliferative diabetic retinopathy underwent uncomplicated 23-gauge pars plana vitrectomy, Triesence-assisted hyaloid peeling, fill-in endolaser, and intravitreal bevacizumab injection in the left eye for nonclearing visually significant vitreous hemorrhage. On the first postoperative day, patient developed significant macular subretinal fluid. Multimodal imaging revealed numerous pigment epithelial detachments around optic nerve, and subretinal fluid throughout the macula on optical coherence tomography in the absence of retinal breaks on widefield raster, late deep leakage on fluorescein angiography, and corresponding hyperautofluorescence in the same region. Diagnosed with macular exudative retinal detachment, patient was treated with topical and systemic corticosteroids, with gradual resolution of subretinal fluid and visual acuity improvement., Discussion: Exudative retinal detachment following diabetic pars plana vitrectomy with endolaser has been described in as many as 8.78% of cases, however may be missed in the early postoperative period. Multimodal imaging including multiple pigment epithelial detachments on optical coherence tomography, hyperautofluorescence, and late deep leakage on fluorescein angiography can help differentiate this condition from rhegmatogenous retinal detachment and central serous chorioretinopathy, and guide management to include corticosteroids.

Objective: To determine the timing of delayed retinal pathology in eyes presenting with acute posterior vitreous detachment (PVD)., Design: Retrospective database study., Subjects: Patients in the Intelligent Research in Sight (IRIS) registry found to have acute PVD based on the International Classification of Diseases, Ninth and Tenth Revision, codes were followed., Methods: Patients coded to have a PVD from 2013 to 2018 along with common procedural technology coding of extended ophthalmoscopy were included. Ocular baseline characteristics included visual acuity, lens status, presence or absence of vitreous hemorrhage, myopia, lattice degeneration, and subspecialty training of the treating physician., Main Outcome Measures: Timing (days) to delayed retinal break or detachment RESULTS: A total of 434 046 eyes met inclusion/exclusion criteria, and 10 518 eyes (2.42%) presented with a delayed retinal break or detachment after initial PVD. The median time to retinal break and detachment after initial PVD was 42 (range, 1-365) days and 51 (range, 1-365) days, respectively. Eyes with vitreous hemorrhage (hazard ratio [HR], 9.30; 95% confidence interval [CI], 8.50-10.2), history of retinal break/retinal detachment in the fellow eye (HR, 3.91; 95% CI, 3.64-4.20), lattice degeneration (HR, 2.61; 95% CI, 2.35-2.90), and myopia (HR, 1.42; 95% CI, 1.33-1.53) were found to be at a higher risk of developing delayed break or detachment., Conclusions: Follow-up examination after initial PVD is necessary to diagnose delayed or missed retinal pathology. In eyes with no initial pathology, providers should consider repeat examination at least once within 6 weeks, and sooner for eyes with higher-risk features., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment., Design: International, multicenter, noncomparative retrospective case series., Participants: We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP., Methods: Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared., Main Outcome Measures: Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP., Results: A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P = 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement., Conclusions: Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Polypoidal choroidal vasculopathy (PCV) with hemorrhagic complications is at higher risk for breakthrough vitreous hemorrhage (VH). This study aimed to evaluate the clinical features and outcomes of breakthrough VH secondary to PCV. Data of patients receiving pars plana vitrectomy for breakthrough VH secondary to PCV (VH group) were evaluated retrospectively and compared statistically to data of age and sex-matched PCV patients without breakthrough VH (control group). Among PCV patients, 36 eyes with breakthrough VH and 62 eyes without VH were included. Compared with baseline, best corrected visual acuity (BCVA) was worse in the VH group (P < 0.001), and improved postoperatively (P < 0.001). Percentages of pigmented epithelial detachment (PED), hemorrhagic PED, massive subretinal hemorrhage, hemorrhagic retinal detachment (RD), and hemorrhagic choroidal detachment (CD) (P = 0.007) were higher in the VH group (P < 0.001). Incidence of choroidal vascular hyperpermeability (P < 0.001), massive subretinal hemorrhage (P = 0.001), hemorrhagic retinal detachment (P = 0.001) and hemorrhagic type PCV (P = 0.001) was higher in patients with pachychoroid PCV, while fibrovascular type had lower incidence (P < 0.001). Better initial BCVA (P < 0.001), higher frequency of anti-VEGF treatment (P = 0.009), and previous photodynamic therapy (P = 0.017) showed better visual outcomes. Breakthrough VH risk is higher in PCV patients with massive subretinal hemorrhage, hemorrhagic PED and hemorrhagic RD. BCVA and hemorrhagic complications improve significantly postoperatively. Higher frequency of anti-VEGF treatment and previous photodynamic therapy are associated with better visual prognosis in PCV patients with breakthrough VH., Competing Interests: The authors declare no competing interests., (Copyright: © 2022 Li, Tsen. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objective: To describe an under-recognized complication in the surgical management of dense, nonclearing vitreous hemorrhage, specifically, the development of iatrogenic retinal breaks as a result of cutter-associated traction., Study Design/patients and Methods: Review of surgical cases with cutter-associated traction from chronic vitreous hemorrhage (CATCH)., Results: Cutter-associated traction from chronic vitreous hemorrhage is a commonly encountered surgical entity that may result in complications such as iatrogenic retinal breaks, including giant retinal tears. These complications can be minimized or potentially avoided through the use of open sclerotomies or potentially mixed-gauge vitrectomy., Conclusion: Careful surgical planning in cases of dense or chronic vitreous hemorrhage is required to prevent cutter-associated tractional retinal breaks. [ Ophthalmic Surg Lasers Imaging Retina 2022;53:584-585.] .

Purpose: To evaluate clinical features and manifestations of Eales disease and the efficacy of different interventions., Methods: The databases PubMed, EMBASE, and Ovid from inception until February 2021 were searched. Pooled analyses included 1) presenting features, 2) symptoms and signs, and 3) postoperative vision outcomes and complications. Statistical analyses were conducted with R software version 3.6.3., Results: Forty-seven studies involving 3,557 patients and 4,959 eyes were included. The pooling results showed that Eales disease was male dominated (94%), bilateral involvement (64%), and mainly occurred in adolescents. Approximately 83% of patients were positive in Mantoux test, and 31% of patients have vitreous tap polymerase chain reaction positive for tuberculosis genome. More than half of the patients had decreased vision at the first clinic visit. The common signs of Eales disease included sclerotic vessels (83%), neovascularization of retina elsewhere (64%) and periphlebitis (51%). Macular changes could be detected in 24% of patients. The most common complication was vitreous hemorrhage, followed by cataracts and retinal detachment. Photocoagulation was directed at nonperfusion or neovascularization areas, with a decrease in the incidence of later pars plana vitrectomy (19%). Anti-vascular endothelial growth factor treatment was suggested for vitreous hemorrhage, which could achieve high visual acuity improvement rate (82%) while increasing the possibility of retinal detachment (18%). Pars plana vitrectomy was indicated in cases with persistent vitreous hemorrhage or retinal detachment, with 56% of patients obtaining visual improvement. Still, 17% of patients needed a second pars plana vitrectomy, mainly because of recurrent vitreous hemorrhage or retinal detachment., Conclusion: Eales disease most commonly affects young men. It has diverse clinical features, and management should be based on the progression of the disease.

Purpose: This is the first case series of two instances of retinal tears due to an injury sustained while playing pickleball., Methods: Case series., Results: A 66-year old white man presented with a symptomatic retinal tear, localized retinal detachment, and mild vitreous hemorrhage nine days after he was hit in his left eye while playing pickleball. The patient was not wearing eye protection while playing. The patient was treated with cryotherapy, and after three weeks, the vitreous hemorrhage and retinal detachment resolved. In addition, a 60-year-old woman presented with a posterior vitreous detachment and a symptomatic retinal tear 1 month after blunt trauma to her left eye from a pickleball injury. She underwent successful laser retinopexy treatment., Conclusion: Proper eye protection should be strongly considered while playing pickleball, especially in the elderly population or in individuals who are at higher risk for retinal detachment.

Purpose: To compare pars plana vitrectomy (PPV) with combined PPV and scleral buckle (PPV/SB) for repair of primary rhegmatogenous retinal detachment (RRD) with associated vitreous hemorrhage (VH)., Design: Retrospective, observational study., Participants: Patients with RRD and associated VH who underwent PPV or PPV/SB from January 1, 2010, through August 31, 2020, were analyzed., Method: We performed a single-institution, retrospective, observational study of 224 eyes with RRD and VH at the time of detachment. We excluded eyes with <6 months of follow-up, a prior history of retinal detachment (RD) repair with vitrectomy or SB, VH that resolved before surgical intervention, and tractional or combined tractional and rhegmatogenous detachments., Main Outcome Measures: Single-surgery anatomic success (SSAS) at 6 months, defined as no recurrent RD requiring surgical intervention., Results: Pars plana vitrectomy and PPV/SB were performed on 138 eyes (62%) and 85 eyes (38%), respectively. The mean age of the PPV and PPV/SB patients was 61.9 and 60.2 years, respectively. Single-surgery anatomic success was achieved in 107 of 138 eyes (77.5%) that underwent PPV and 78 of 85 eyes (91.7%) that underwent PPV/SB. The difference in SSAS between types of treatment was significant (P = 0.006). Mean visual acuity improvement in the PPV/SB group was 0.54 logMAR units greater than that in the PPV group (P = 0.126). The incidence of postoperative proliferative vitreoretinopathy in the PPV/SB group (11.7%) was lower than that in the PPV group (19.5%; P = 0.128). The rate of repeat PPV for non-RD reasons was similar for both the groups (P = 0.437). Final reattachment status was achieved in 137 of the 138 and 84 of the 85 eyes in the PPV and PPV/SB groups, respectively. Final visual acuity improvement was significantly better in eyes with PPV/SB than in eyes with PPV alone (logMAR 2.12 vs. 1.26, respectively; P = 0.011)., Conclusions: In patients with RRD and VH, SSAS was superior in patients treated with PPV/SB compared with those treated with PPV alone. Although not significantly different, the PPV/SB group had better visual outcomes and a lower postoperative proliferative vitreoretinopathy rate., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting., Design: Retrospective cohort study., Participants: A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria., Methods: The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination., Main Outcome Measures: Presence of RT or RRD at initial presentation or within 1 year thereafter., Results: Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR, 1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR, 0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r = 0.4)., Conclusions: This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Competing Interests: None

Purpose: To establish a scoring system to triage patients presenting with symptoms of flashes and floaters to allow safe differentiation between those with retinal tears and detachments, versus uncomplicated posterior vitreous detachments (PVDs)., Methods: Prospective and retrospective audits of 153 patients presenting to eye casualty and vitreoretinal clinics to ascertain the clinical features most likely to be associated with retinal pathology, rather than simple PVD. We then developed a scoring system, which was applied to 160 patients in a further prospective audit., Results: The significant risk factors, symptoms and signs were identified then given a number related to their importance: male sex 1, myopia 1, blurred vision 2, shadow 2, vitreous haemorrhage 3, tobacco dust 4. The scores were summed and a total score > 3 was more likely to be a complicated PVD. Sensitivity of the scoring system was 90% (confidence interval (CI) 68.3-98.8%), specificity 80% (CI 73.2-86.9%), positive predictive value 40% (CI 25.7-55.7%), and negative predictive value 98.26% (CI 93.9-99.8%)., Conclusions: The BElfast Retinal Tear and detachment Score is an easy to apply scoring system, which has a high sensitivity and negative predictive value i.e. nearly all retinal tears or detachments are detected by the scoring system.

Objectives: To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales' disease., Materials and Methods: In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales' disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included., Results: The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p<0.001). After surgery, BCVA was stable in 4 eyes (18.2%), increased in 16 eyes (72.7%), and decreased in 2 eyes (9.1%). Although the mean BCVA was better in the VH group (0.3±0.34 logMAR) than the TRD group (0.9±1.1 logMAR), the difference was not statistically significant (p=0.1). Multivariable linear regression analyses revealed that final BCVA was negatively associated with preoperative or postoperative proliferative vitreoretinopathy grade C (PVR-C), preoperative retinal detachment involving the macula, postoperative neovascular glaucoma, and long preoperative duration of disease, and positively associated with preoperative BCVA. Final BCVA was not associated with preoperative retinal and disc neovascularization, rubeosis iridis, total posterior hyaloid detachment, preoperative retinal laser photocoagulation, indication of surgery, diameter of sclerotomy (20 or 23 gauge), preoperative lens status, preoperative or postoperative epimacular membrane, peroperative iatrogenic retinal breaks, postoperative hypotony, cystoid macular edema, and new or recurrent retinal detachment. The primary anatomic success rate was 81.8% and the final anatomic success rate was 90.9%., Conclusion: In Eales' disease, good visual results can be obtained with vitreoretinal surgery if the detachment area does not involve the macula and PVR-C does not develop pre- or postoperatively.

Purpose: When the International Classification of Diseases 9th Revision (ICD-9) transitioned to the International Classification of Diseases 10th Revision (ICD-10), there was a marked increase in the complexity of International Classification of Diseases (ICD) codes with potential for improved specificity in clinical database research. The purpose of this study was to characterize the accuracy of coding for stage of diabetic retinopathy (DR) and DR-related complications (including vitreous hemorrhage, retinal detachment, and neovascular glaucoma) during this transition., Design: Retrospective chart review of 3 time periods corresponding to the use of ICD-9: 2014-2015; "early" use of ICD-10, 2015-2016; and "late" use of ICD-10, 2018-2019., Participants: Patients aged 18 years or older with a diagnosis of DR at a multispecialty academic institution., Methods: Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and kappa (κ) statistics were generated for each diagnosis. Generalized estimating equation (GEE) models were used to assess the significance of the variables., Main Outcome Measure: The main outcome was the proportion of agreement between the ICD code and the documented chart standard for stage of DR and DR-related complications., Results: A total of 600 patients were included in the study (average age, 61 years; range, 25-93 years). Overall, there was substantial agreement between the ICD codes for stage of DR and the documented standard (κ = 0.66). The proportion of ICD codes in agreement with the documented standard diagnosis increased with time: 66.5%, 78.5%, and 83.3% for ICD-9, "early" ICD-10, and "late" ICD-10, respectively. The odds of agreement were 2.67 (95% confidence interval [CI], 1.49-4.76, P < 0.001) and 3.96 (95% CI, 2.34-6.69, P < 0.0001) times greater for "early" and "late" ICD-10 codes compared with ICD-9 codes, respectively. For specific codes, the overall PPV, NPV, sensitivity, and specificity for nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excellent (>90%). The odds of agreement were 19.70 (95% CI, 11.54-33.64, P < 0.0001) times greater for PDR than NPDR. Compared with the stage of DR, DR-related diagnoses were overall less accurately coded (κ = 0.61, 0.48, and 0.52 for vitreous hemorrhage, retinal detachment, and neovascular glaucoma, respectively)., Conclusions: Coding in ICD-10 is more accurate than in ICD-9, particularly for PDR compared with NPDR. The increased accuracy emphasizes the potential for ICD-10 coding to be used effectively in database research., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To compare surgical outcomes between 27 and 25-gauge vitrectomy in proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD)., Methods: This retrospective study was conducted to compare the intraoperative status, operation time, use of instruments, endotamponade substance, wound suture number, and iatrogenic break, between 27 and 25-gauge vitrectomy in 43 eyes afflicted by PDR with TRD. The post-surgical results, best-corrected visual acuity, intraocular pressure, recurrent vitreous haemorrhage, and re-operation rate were regularly followed up for 6 months., Results: Patients in the 25 and the 27-gauge groups did not differ significantly in terms of pre-surgical conditions, such as age, gender, pre-existing glaucoma, best-corrected visual acuity (BCVA) and the severity of their TRD. The mean operation time was 56.7 minutes in the 27-gauge group and 63.7 minutes in the 25-gauge group (p = 0.94). There is significantly less use of micro forceps in the 27-gauge group (p = 0.004). No difference between micro scissors and chandelier usage were noted; neither was their difference in iatrogenic retinal breaks. Significantly fewer wound sutures were noted in the 27-gauge group (p < 0.001). The post-operative results revealed no significant difference in ocular hypertension, hypotony, BCVA improvement, recurrent vitreous haemorrhage and re-operation rate., Conclusions: The 27-gauge vitrectomy system offers comparable surgical outcomes in PDR with TRD. The 27-gauge vitrectomy system is suitable for complicated retinal surgery., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To determine clinical characteristics and identify factors associated with better visual outcomes in patients who had vitrectomy for vitreous haemorrhage (VH) associated with Terson syndrome (TS)., Methods: The records of 48 patients (54 corresponding eyes) who underwent vitrectomy for VH associated with TS from January 2008 to December 2017 were retrospectively reviewed. The main outcome measure was the final postoperative visual acuity., Results: At the last visit, 34 eyes (63.0%) achieved a BCVA of 0.3 or better. Eyes associated with traumatic brain injury had a better visual outcome than those with primary intracerebral haemorrhage (P = 0.042). In the primary intracerebral haemorrhage group, patients with hypertension-induced intracranial haemorrhage (IH) showed poorer final visual acuities than the ruptured intracranial aneurysm group (P = 0.023). In the delayed vitrectomy group, epiretinal membrane and peripheral retina changes were more common (P < 0.05). However, the difference in final visual acuity between the early and delayed vitrectomy groups was not significant (P = 0.69)., Conclusion: Most of the patients obtained visual recovery after vitrectomy for TS. VH associated with ruptured intracranial aneurysm or traumatic brain injury or eyes without retinal haemorrhage are predictive of better prognosis. Although the timing of vitrectomy was not related to the final postoperative visual outcome, early vitrectomy by three months seems to suggest less epiretinal membrane formation, retinal tears, and retinal detachments.

Rationale: To report a rare case of severe atypical hemolytic-uremic syndrome (HUS) in a patient who presented with vitreous hemorrhage and tractional retinal detachment (TRD) in both eyes. To our knowledge, this is the first reported case of atypical HUS complicated with bilateral TRD in the literature., Patient Concerns: A 20-year-old man with atypical HUS demonstrated bilateral visual acuity of hand motion at 30 cm., Diagnoses: Dilated fundus examination revealed diffuse intraretinal hemorrhage with vascular engorgement, neovascularization of the disc, and neovascularization elsewhere bilaterally. Fluorescein angiography revealed bilateral proliferative retinopathy, retinal hemorrhage, and a large nonperfusion area with extensive neovascularization. Intravitreal antivascular endothelial growth factor (ranibizumab) injection was administered in both eyes, but his ophthalmic condition did not improve, and TRD developed bilaterally. Therefore atypical HUS complicated with bilateral TRD was diagnosed., Interventions: Pars plana vitrectomy was performed with panretinal photocoagulation and silicone oil tamponade in the right eye., Outcomes: After the pars plana vitrectomy of right eye, the retina was well-attached after surgery, but visual acuity remained poor. Visual evoked potential examination showed poor waveforms bilaterally, which suggested ischemic optic neuropathy., Lessons: Atypical HUS can cause systemic thrombotic microangiopathy, resulting in ischemic retinal changes. These ischemic retinal changes can then cause hypoxia, which triggers production of angiogenic factors and subsequently causes retinal vascular hyperpermeability, retinal and vitreous neovascularization, fibrovascular proliferation, vitreous hemorrhage, and TRD, in a manner similar to that of other ischemia-induced proliferative retinopathies. Despite successful surgery in the right eye, our patient's visual acuity did not improve, possibly because of severe and generalized ischemia of intraocular tissue, which resulted in ischemic optic neuropathy.

Purpose: To evaluate the use of live volumetric (4D) intraoperative swept-source microscope-integrated optical coherence tomography in vitrectomy for proliferative diabetic retinopathy complications., Methods: In this prospective study, we analyzed a subgroup of patients with proliferative diabetic retinopathy complications who required vitrectomy and who were imaged by the research swept-source microscope-integrated optical coherence tomography system. In near real time, images were displayed in stereo heads-up display facilitating intraoperative surgeon feedback. Postoperative review included scoring image quality, identifying different diabetic retinopathy-associated pathologies and reviewing the intraoperatively documented surgeon feedback., Results: Twenty eyes were included. Indications for vitrectomy were tractional retinal detachment (16 eyes), combined tractional-rhegmatogenous retinal detachment (2 eyes), and vitreous hemorrhage (2 eyes). Useful, good-quality 2D (B-scans) and 4D images were obtained in 16/20 eyes (80%). In these eyes, multiple diabetic retinopathy complications could be imaged. Swept-source microscope-integrated optical coherence tomography provided surgical guidance, e.g., in identifying dissection planes under fibrovascular membranes, and in determining residual membranes and traction that would benefit from additional peeling. In 4/20 eyes (20%), acceptable images were captured, but they were not useful due to high tractional retinal detachment elevation which was challenging for imaging., Conclusion: Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different complications and facilitation of intraoperative decision making.

A 13-year-old female presented with diminution of vision in both eyes for 3 months following snakebite. Best-corrected visual acuities were hand movement in both eyes. Fundoscopy showed vitreous hemorrhage, and B-scan ultrasonography revealed an underlying tractional retinal detachment (TRD) involving the macula in both eyes. Patient underwent 25-gauge pars plana vitrectomy in conjunction with belt buckling, endolaser, and silicone oil tamponade in the left eye. At 6 weeks postoperatively, best-corrected visual acuity of the left eye was noted to be 20/200 with settled TRD and attached retina. Bilateral proliferative retinopathy with TRD is a hitherto unreported complication of snake bite.

X-linked juvenile retinoschisis is a hereditary disorder which usually occurs in boys rather than in girls, who are rarely affected. First clinical manifestations usually appear during the first decade. It is responsible for variable severity and slowly progressive vision loss. This progression can be characterized by vitreous hemorrhages and recurrent retinal detachments. We report the case of a 17-year old patient with stellar bilateral microcistic macular rearrangement of the eye-ground, centered on the foveola, associated with peripheral schisis with retinal detachment and unilateral tearing of internal and external layers.

Purpose: To describe the treatment and natural history of a patient with complicated congenital retinoschisis., Methods: A retrospective case report. A 10-month-old boy with congenital retinoschisis presented with tractional retinal detachments and foveal schisis in both eyes., Results: On presentation, vision was decreased in both eyes with presumed amblyopia of the left eye. Funduscopic examination revealed bilateral foveal schisis and tractional retinal detachment involving the macula. Follow-up examination revealed superior retinal dragging and peripheral ischemia on fluorescein angiogram in both eyes. Nine months after presentation, combined rhegmatogenous and tractional retinal detachment developed in the right eye and was treated by scleral buckle. After vitrectomy for nonclearing vitreous hemorrhage in the left eye, a combined rhegmatogenous and tractional retinal detachment developed. Vitrectomy and lensectomy with silicone oil was performed. At 6 years of follow-up, both retinas were attached and foveal schisis had resolved., Conclusion: Sight threatening complications of congenital retinoschisis include retinal detachment and vitreous hemorrhage. Vitrectomy and/or scleral buckling may prevent progression of vision loss and promote resolution of schisis.

Purpose: The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD)., Methods: Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding., Results: Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09)., Conclusion: This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.

Objective: To determine the outcomes of vitreoretinal surgery after choroidal tumor biopsy., Design: Retrospective, single-center, consecutive case series., Participants: A total of 739 consecutive patients undergoing choroidal tumor biopsy., Methods: All subjects who underwent transretinal or transscleral choroidal tumor biopsy for diagnostic or prognostic purposes between May 1993 and May 2013 were identified in our database. We then reviewed patients who subsequently required secondary vitreoretinal surgery for complications arising from such biopsies., Main Outcome Measures: Reason for vitreoretinal surgery, association with biopsy procedure, best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]), intraocular or extrascleral tumor dissemination, resolution of vitreous hemorrhage, reattachment of the retina with a single vitreoretinal procedure, number of additional vitrectomies undertaken, and number of enucleations., Results: A total of 20 of 739 eyes (2.7%) underwent vitreoretinal surgery for complications arising from choroidal tumor biopsy. The tumors consisted of choroidal melanoma in all 20 eyes. The reasons for the secondary surgery included persistent vitreous hemorrhage in 1.9% (14/739), rhegmatogenous retinal detachment in 0.7% (5/739), and endophthalmitis in 0.14% (1/739). Median BCVA improved from 2.0 logMAR (mean, 1.92 logMAR; range, 0.8-2.7 logMAR) before vitrectomy to 0.72 logMAR (mean, 0.88 logMAR; range, -0.14 to 2.7 logMAR) after vitrectomy and 0.76 logMAR (mean, 1.14 logMAR; range, 0.1-3.0 logMAR) at the final visit (P < 0.0001, t test). Permanent resolution of vitreous hemorrhage was achieved in 6 of 14 patients, and reattachment of the retina was achieved in 2 of 5 patients after the first vitrectomy. A median of 1 (mean, 1.5; range, 1-3) additional vitrectomy was performed. Enucleation was necessary in 3 of 20 eyes (15%). There were no cases of intraocular invasion or extrascleral extension after vitrectomy., Conclusions: Vitrectomy for complications of choroidal tumor biopsy is rare. Such corrective surgery is complex and is best undertaken by specialized ocular oncologists or vitreoretinal surgeons with experience in managing this problem., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the clinical manifestations of a case of chorioretinitis sclopetaria., Methods: Observational case report., Results: A 30-year-old prison inmate sustained a traumatic injury to his left eye. Fundus examination showed a large chorioretinal detachment revealing bare sclera, vitreous hemorrhage, and commotio retinae., Conclusion: The patient was diagnosed with chorioretinitis sclopetaria. Given the mechanism of injury, retinal detachment is rare. Observation is appropriate as initial management.

Purpose: The purpose of this study is to evaluate the efficacy of preoperative intravitreal bevacizumab (IVB) for improving outcomes in vitrectomy for diabetic retinopathy-related non-clearing vitreous haemorrhage and/or tractional retinal detachment., Methods: Medical record from patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) were retrospectively analysed (2003-2011). From 2007, IVB (1.25 mg 2-4 days before operating) was used on all eyes. Eyes receiving IVB were compared with those that did not receive IVB. Intraoperative complications, reoperation rates, and final visual acuity were the core outcome measures., Results: Data were analysed for 88 patients (101 eyes). In all, 41 (41%) patients had received IVB, whereas 60 (59%) patients had not. Significant intraoperative haemorrhage occurred in six eyes (10%) in the non-IVB group and in one (2.4%) IVB eyes (P=0.24). Silicon oil was used in 29 (48%) non-IVB eyes and in 11 (27%) IVB eyes (P=0.03). The non-IVB eyes underwent significantly more vitreoretinal reoperations (P=0.01) and were significantly more likely to lose two or more lines of vision at the final follow-up (P=0.03). The numbers needed to treat (NNT) blindness (<3/60) was four for non-IVB eyes and two for the IVB group., Conclusions: IVB reduces surgical complications, the use of silicon oil, and the need for further retinal surgery. The NNT to restore useful vision (≥3/60) to a blind eye were significantly lower in the IVB group. Vitreoretinal surgery for the complications of PDR is effective in an East African context, and IVB should be considered a valuable adjunct.

Purpose: To report an association of congenital optic nerve anomalies with peripheral retina nonperfusion and to describe the clinical manifestations and treatment., Design: Retrospective, observational case series., Participants: Fifteen patients with congenital optic nerve anomalies referred for pediatric retina consultation were studied. Sixteen eyes of 9 patients with optic nerve hypoplasia and 8 eyes of 6 patients with other congenital optic nerve anomalies, including optic nerve coloboma, morning glory disc, and peripapillary staphyloma, were included., Methods: All patients underwent examinations under anesthesia. Wide-angle retina photographs and fluorescein angiograms were reviewed. The severity of nonperfusion was graded. The presence of fibrovascular proliferation (FP), vitreous hemorrhage (VH), and tractional retinal detachment (TRD) were documented. Anatomic outcome after treatment was recorded., Main Outcome Measures: Severity of nonperfusion, occurrence of secondary complications, and the anatomic outcome of patients who underwent laser treatment., Results: In patients with optic nerve hypoplasia, 12 of 16 eyes (75%) had severe peripheral nonperfusion, 12 of 16 eyes (75%) had FP, 3 of 16 eyes (19%) had VH, and 10 of 16 eyes (63%) had TRD. Six of these eyes with severe nonperfusion received laser photocoagulation to the nonperfused retina; laser-treated retinas remained attached in all 6 eyes. In patients with the other optic nerve anomalies, 7 of 8 eyes (88%) had mild to moderate nonperfusion, 2 of 8 eyes (25%) had FP, 1 of 8 eyes (12%) had VH, and 2 of 8 eyes (25%) had TRD. Six of 9 patients (67%) with optic nerve hypoplasia and 1 of 6 patients (17%) with other anomalies had a coexisting congenital brain disease., Conclusions: Congenital optic nerve anomalies may be associated with peripheral retina nonperfusion and the secondary complications of FP, VH, and TRD. In this select group of patients, the nonperfusion associated with optic nerve hypoplasia seemed to be more severe and associated more frequently with secondary complications. Peripheral retina examination in eyes with optic nerve anomalies may identify nonperfusion or FP. Laser treatment of the avascular retina may have helped prevent complications from proliferative retinopathy in eyes clinically observed to have progressed or considered at risk for progression to proliferative retinopathy., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Aims: To investigate whether pseudophakic and phakic rhegmatogenous retinal detachment (RRD) patterns differ., Methods: Retrospective review of electronic database of patients, aged 50 years or over, presenting to our vitreoretinal service. Data included baseline characteristics, digital drawings, and outcomes. Retinal drawings were analysed in a masked fashion for site, size, and number of retinal breaks. Comparisons were made between the following groups and subgroups: pseudophakic eyes, phakic eyes, phakic eyes with cataract, and phakic eyes without cataract., Results: Of 500 eyes included, 146 were pseudophakic; 177 of the phakic eyes had cataract. The following were significant by univariate analysis: pseudophakic patients were older than phakic patients in general, but the same age as patients with cataract; in the pseudophakic group, there were lower proportions of females and of patients presenting with vitreous haemorrhage or with large or superotemporal breaks; higher proportions of pseudophakic eyes had small breaks and inferonasal breaks. Some differences remained significant when comparing pseudophakia eyes with cataract. Multivariate analysis comparing pseudophakia with phakia confirmed a lower chance in pseudophakia of large breaks, vitreous haemorrhage and superotemporal breaks, but higher chance of detached inferior breaks. Some variables were age dependent., Conclusion: Differences were found between pseudophakic and phakic RRD patterns. These suggest special pathogenetic mechanisms in pseudophakic retinal detachment, which could help explain increased incidences of RRD after cataract surgery.

Objective: To compare the rate of serious ocular and systemic adverse effects of intravitreal bevacizumab and ranibizumab in the treatment of a variety of eye diseases., Design: Retrospective chart review., Participants: Consecutive series of intravitreal injections of bevacizumab (n = 693) and ranibizumab (n = 891)., Methods: Medical records of all patients receiving injections in the series were retrieved. We considered the rate of both serious ocular adverse effects (e.g., acute intraocular inflammation, infectious endophthalmitis, retinal detachment, vitreous hemorrhage) and of arterial thromboembolic events that occurred within 1 month of injection., Results: Subjects who received bevacizumab were 12 times more likely to develop severe intraocular inflammation following each injection than were those who received ranibizumab (OR = 11.71; 95% CI 1.5-93). The 1 case of acute intraocular inflammation following ranibizumab injection was mild and not associated with vision loss. No other serious ocular complications were noted. A trend was also noted toward an increased risk for arterial thromboembolic events in patients receiving bevacizumab, although the confidence interval was wide (OR = 4.26; 95% CI 0.44-41)., Conclusions: Significant concern still exists regarding the safety of off-label use of intravitreal bevacizumab. Patients receiving bevacizumab should be counselled regarding a possible increased risk for serious adverse events., (Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: To report the occurrence of secondary rhegmatogenous retinal detachment (RRD) after intravitreal bevacizumab injection in patients with Eales' disease., Methods: This is a retrospective, non-controlled, comparative case series. We reviewed 14 eyes of 14 patients with Eales' disease who had received pretreatment with intravitreal bevacizumab (1.25 mg/0.05 ml) and subsequently undergone a pars plana vitrectomy for non-resolving vitreous hemorrhage and/or tractional retinal detachment. Clinical records were reviewed. The primary outcome measure was the occurrence of secondary RRD after intravitreal bevacizumab injection., Results: Four patients had developed secondary RRD, with retinal breaks that were localized to the base of tractional retinal bands, within 1 week of receiving intravitreal bevacizumab. On comparative analysis, median age of patients who had developed secondary RRD was 26.5 years, significantly less than the median age of 33.5 years in the rest (P = 0.022). Median post-operative best-corrected visual acuity (BCVA) in patients who developed secondary RRD was logMAR 0.7 (0.3-0.8), significantly worse than the BCVA of logMAR 0.3 (0.0-0.5) in the rest (P = 0.015). None of the patients who developed secondary RRD had a complete posterior vitreous detachment (PVD) at presentation., Conclusion: Intravitreal bevacizumab injections may be associated with the serious complication of secondary RRD in patients of Eales' disease within 7 days of injection.

Purpose: To evaluate the results and complications of combined 23-gauge sutureless vitrectomy, clear corneal phacoemulsification, and intraocular lens implantation in patients with proliferative diabetic retinopathy., Methods: This was a retrospective, consecutive, noncomparative, interventional case series of 136 eyes of 108 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the complications of proliferative diabetic retinopathy. The main outcome measures were visual outcomes and surgical complications., Results: Main indications for the combined surgery were vitreous hemorrhage (78 eyes, 57.4%) and tractional retinal detachment (36 eyes, 28.7%). The logarithm of the minimum angle of resolution visual acuity (mean ± SD) improved from 0.86 ± 0.59 preoperatively to 0.39 ± 0.52 six months postoperatively (P < 0.0001). Intraoperative retinal tear occurred in 7 eyes (5.1%) and postoperative vitreous hemorrhage in 10 eyes (7.5%). Even in the absence of suturing of sclerotomy sites, only 1 eye (0.7%) had postoperative hypotony (<6 mmHg). During the 6 months after surgery, only 1 eye (0.7%) developed neovascular glaucoma and 6 eyes (4.4%) required a repeat vitrectomy (3 for retinal detachment and 3 for vitreous hemorrhage)., Conclusion: Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification in patients with proliferative diabetic retinopathy was safe and effective. It may have not only the known advantages of conventional combined surgery but also additionally those such as faster visual rehabilitation and less conjunctival fibrosis.

Purpose: To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment., Methods: Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center., Results: In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2-34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy., Conclusion: Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.

This study examined the clinical features of complications of congenital retinoschisis and the clinical efficacy of vitreoretinal surgery in the treatment of these complications. The clinical efficacy of surgical treatments was retrospectively analyzed in 10 patients with congenital retinoschisis (10 eyes) complicated with rhegmatogenous retinal detachment (n=5), vitreous hemorrhage (n=2) and macula- involving schisis (n=1). All the patients suffered foveal and peripheral schisis. They were treated with scleral buckling (n=1) or vitrectomy (n=9). After the surgical treatment, the retina was reattached in patients with rhegmatogenous retinal detachment; the refractive media became transparent in those with vitreous hemorrhage; the visual acuity in 80% of patients was improved; no remarkable progression of schisis was found; no severe operative complications occurred. It was concluded that vitreoretinal surgery in the treatment of complications of congenital retinoschisis is safe and effective, and helps improve and maintain the visual function.

A variety of airbag-associated ocular injuries have been reported in children sitting in the front passenger seat during automobile collisions. These injuries range from corneal abrasions to traumatic hyphema with secondary glaucoma and cataract. We report the case of a 5-year-old boy who experienced retinal dialysis and detachment associated with airbag deployment. The patient recovered 20/20 visual acuity after cryopexy and placement of a radial sponge., (Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: To compare the anatomic and visual results and complications of 25-gauge transconjunctival sutureless vitrectomy versus conventional 20-gauge vitrectomy for the management of primary rhegmatogenous retinal detachment., Methods: A retrospective comparative analysis of 125 consecutive eyes from 125 patients with a minimum of 3 months follow-up was performed. All patients underwent primary vitrectomy with complete fluid air exchange, gas tamponade, and laser retinopexy. Excluded were eyes with prior retinal or vitreous surgery, and patients with inadequate follow-up. Sixty-four patients underwent 25-gauge transconjunctival sutureless vitrectomy and 61 patients underwent 20-gauge pars plana vitrectomy from September 2004 to April 2007. Primary endpoints included one surgery retinal reattachment success rate, visual outcomes, postoperative intraocular pressures and complications as determined by standard clinical evaluation., Results: Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The mean follow-up interval was 305.4 days for the 25-gauge group and 452.4 days for the 20-gauge group. The single operation success rate with one procedure was 58/64 (90.6%) for 25-gauge cases and 56/61 (91.8%) for 20-gauge cases, Fisher Exact Test (P = 0.801). All cases were attached at final follow-up and the anatomic success rate was 100% for each of the two cohorts. Preoperative best-corrected visual acuity (BCVA) was 20/125 and 20/169 for 25-gauge and 20-gauge cases, respectively (P > 0.5). The final follow-up mean BCVA was 20/34 and 20/36 for the 25-gauge and 20-gauge groups, respectively (P > 0.6). In the 25-gauge group two cases were complicated by hypotony that resolved uneventfully and one case developed postoperative choroidal and vitreous hemorrhage. In the 20-gauge group there was one case of sterile endophthalmitis and one case of vitreous hemorrhage., Conclusion: There was no significant difference between 25-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachments.

Objective: To observe the tolerance of repeated intravitreous injections over the short and long term and to analyze their complications., Patients and Methods: The clinical records of consecutive patients having one or several intravitreous injections between 2002 and 2007 were evaluated, for all indications except the treatment of endophthalmitis., Results: 2028 intravitreous injections were performed, mainly for age-related macular degeneration (n=1 192) or macular edema secondary to diabetes mellitus or retinal vein occlusion (n=41). The injected drug was triamcinolone acetonide 4 mg (339 injections), pegaptanib sodium 0.3 mg (1179 injections), and ranibizumab 0.3 (497 injections). The patients received 1-27 intravitreous injections per eye. The main complications were endophthalmitis (two after triamcinolone, 0.1% of the total group), pseudoendophthalmitis (two after triamcinolone, 0.1% of the total group), hypertony (7.69% of the total group, 13.78% after triamcinolone, 3.56% after pegaptanib, 1.21% after ranibizumab), including five cases of acute hypertony with transient light perception loss after ranibizumab, cataract (0.44% of total group), and macular hole (one patient after triamcinolone). No case of retinal detachment nor systemic complication was observed., Discussion: Most of the complications were observed with the use of nonfiltered triamcinolone. The incidence of endophtalmitis was considerably lower with increased experience and the use of a dedicated room for the injections. Repeated injections were locally well tolerated., Conclusion: With the strict respect of asepsis rules, intravitreous injection seems well tolerated over the short and long term.

Aim: To present and analyse the anatomical and functional outcomes for vitrectomy in Eales' disease., Methods: This retrospective case series enrolled 63 patients (71 eyes) who underwent pars plana vitrectomy (PPV) for the complications of Eales' disease. Indications included nonclearing vitreous haemorrhage (VH) with/without epiretinal membranes in 49 (69%) eyes, and retinal detachments (RD) involving/threatening macula in 22 (31%). Additional procedures (scleral buckling; gas/oil tamponade) were performed at surgeon's discretion. Minimum follow-up was 6 months. The primary outcome measures were change in best-corrected visual acuity (BCVA) and posterior segment status., Results: The mean age of the patients was 29.6 years (range: 15-70 years); 60 were male (95%). Preoperatively, posterior vitreous detachment (PVD) existed in 28 (39.4%) eyes. Forty (56.3%) eyes underwent only PPV; the rest required additional surgical procedures (q.v.). The mean baseline BCVA (1/60) improved to 6/24 postoperatively (P<0.0001). Fifty-four eyes of 50 patients (76%) showed an improvement of > or =2 equivalent Snellen lines; six eyes (four patients) remained stable (+/-1 line); visual acuity worsened in 11 eyes (nine patients). The mean final BCVA was similar in eyes operated for VH and RD (P=0.08); but the magnitude of change from baseline was greater in the VH group (P=0.009). PVD had a borderline association with final BCVA (P=0.056); but did not influence the functional/anatomical improvement. Thirteen eyes required repeat interventions; 11 (15.49%) eyes experienced surgical failure., Conclusions: Although surgical outcomes in Eales' disease depend on preoperative PVD/RD to some extent; good results are possible in the presence of incomplete PVD and tractional sequelae.

Purpose: To elucidate the relationship between the severity of vitreous haemorrhage (VH) and visual outcome in primary rhegmatogenous retinal detachment (RRD) without previous vitreoretinal surgery., Methods: We carried out a retrospective review of patients presenting with RRD and VH between January 1993 and December 2002. Diabetic retinopathy, retinal vessel occlusion and open-globe injury patients were excluded. Study patients were separated into group 1 (eyes with mild to moderate VH) and group 2 (eyes with severe VH)., Results: Our sample included 71 eyes of 71 patients (mean age 48.0 years, range 7-78 years) (median follow-up period 19 months, range 12-140 months), of which 21 had mild, 17 had moderate and 33 had severe VH. The mean visual acuity (VA) in logMAR (logarithm of minimum angle of resolution) of the 38 eyes in group 1 improved from 1.90 (Snellen equivalent [SE] 20/1589) to 0.68 (SE 20/96). In the 33 eyes in group 2, mean logMAR VA improved from 2.42 (SE 20/5261) to 1.63 (SE 20/853). Group 2 patients were significantly older (p = 0.002), had longer duration of preoperative haemorrhage (p = 0.004), lower presenting VA (p < 0.001), worse final VA (p < 0.001), and a higher incidence of severe (grade C) proliferative vitreoretinopathy (PVR) (p = 0.002). More eyes in group 2 required silicone oil tamponade, although this was not statistically significant (p = 0.133). The overall recurrence rate of retinal detachment after primary surgery was around 21% in both groups., Conclusions: Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. Close follow-up and aggressive surgical interventions are suggested in these patients.

Background: Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder caused by defective collagen synthesis and categorized into 11 types based on genetic mutations and clinical features.(1) Its principal clinical characteristics include hyperelasticity and vulnerability of the skin and joints to laxity, and fragility of blood vessels., Case: We recently performed vitreous surgery with introduction of an artificial cornea and corneal allograft transplantation in a boy with EDS type VI, whose visual acuity had decreased rapidly because of vitreous hemorrhage., Observations: An ultrasound examination revealed posterior vitreous detachment with fresh vitreous hemorrhage. After vitrectomy with introduction of an artificial cornea and cornea allograft transplant were carried out, visual acuity improved to 0.05 and was maintained for at least 22 months., Conclusions: Abnormal collagen synthesis is thought to lead to systemic disorders such as hyperelasticity, vulnerability to skin and joint laxity, and fragile blood vessels in patients with Ehlers-Danlos syndrome., ((c) Japanese Ophthalmological Society 2007)

Purpose: To review the surgical outcome of autologous plasmin enzyme-assisted vitreoretinal surgery in managing complications associated with congenital X-linked retinoschisis (CXLRS)., Methods: Medical records of 20 patients (22 eyes) with CXLRS complications, treated with autologous plasmin enzyme-assisted vitreoretinal surgery, were reviewed. Surgical techniques were adapted according to a new CXLRS classification., Results: Median age of the cohort was 3.5 years. Indications for surgical intervention included 8 eyes with schisis involving or threatening the macula, 7 eyes with rhegmatogenous retinal detachment, 4 eyes with tractional retinal detachment, 1 eye with vitreous and intraschisis hemorrhage, 1 eye with obstruction of the macula by an overhanging bullous schisis cavity, and 1 eye with macular pucker. Ninety-one percent (20/22) of eyes had retinal attachment postoperatively after an average of 1.3 procedures per eye. Of the eyes in which visual acuity was measured, 53% (8/15) improved, 33% (5/15) had no change, and 13% (2/15) lost vision., Conclusion: Plasmin enzyme-assisted vitreoretinal surgery is a safe and effective method for managing the complications associated with CXLRS. Most patients had improved or stable postoperative visions.