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Purpose: To analyze the presence of hyperreflective foci in Type 1 and Type 2 diabetic patients, separately, without clinically significant diabetic macular edema and visual impairment. Methods: Noninvasive, observational prospective study. Seventeen and 19 consecutive Type 1 and Type 2 diabetic patients (33 and 38 eyes), respectively, were recruited. All patients had no clinically significant diabetic macular edema or visual impairment. Two age-and sex-matched control groups were also included. Patients underwent an ophthalmologic examination including spectral domain optical coherence tomography. Hyperreflective foci were counted considering horizontal B-scan passing through the fovea. Results: On spectral domain optical coherence tomography, patients affected by Type 1 and Type 2 diabetes had a mean of 7.5 +/- 4.6 and 9.9 +/- 4.5 hyperreflective foci, respectively. Subjects of control groups had a mean of 0.9 +/- 0.8 and 1.7 +/- 1.5 hyperreflective foci, respectively. Hyperreflective foci amount was statistically different between Type 1 and Type 2 diabetic groups (P = 0.032) and significantly higher in diabetic patients than in controls (P < 0.001). Hyperreflective foci amount was significantly higher in diabetic patients with a poor quality glycometabolic control (P < 0.001 and P = 0.016) or affected by hypertension (P = 0.008). Conclusion: We reported the presence of hyperreflective foci in diabetic patients without diabetic macular edema and visual impairment. This spectral domain optical coherence tomography finding might be a useful marker for the diagnosis and the follow-up in the early stage of diabetic retinopathy.

Purpose To evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT). Methods APE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated. Results Thirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51 +/- 0.37 LogMAR at baseline, improving to 0.23 +/- 0.14 LogMAR at 6 months (P = 0.002). Foveal thickness was 464 +/- 180 mu m at baseline, reducing to 246 +/- 59 mu m at 6 months (P < 0.001). Hyaloid was intraoperatively judged 'partially detached' in seven cases and 'totally detached' in one case. Hyaloid peeling was evaluated 'easy' in six eyes and 'very easy' in two eyes. Conclusions In the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients. Eye (2013) 27, 22-27; doi:10.1038/eye.2012.248; published online 14 December 2012 Purpose To evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT). Methods APE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated. Results Thirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51 +/- 0.37 LogMAR at baseline, improving to 0.23 +/- 0.14 LogMAR at 6 months (P = 0.002). Foveal thickness was 464 +/- 180 mu m at baseline, reducing to 246 +/- 59 mu m at 6 months (P < 0.001). Hyaloid was intraoperatively judged 'partially detached' in seven cases and 'totally detached' in one case. Hyaloid peeling was evaluated 'easy' in six eyes and 'very easy' in two eyes. Conclusions In the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients. Eye (2013) 27, 22-27; doi:10.1038/eye.2012.248; published online 14 December 2012

Purpose: To investigate the relationship between type of intraocular tamponade and unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment. Methods: Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment underwent 3-port pars plana vitrectomy with gas (C3F8) or silicone oil (polydimethylsiloxane) tamponade. Ophthalmologic examination and fundus autofluorescence were performed before surgery (baseline) and at the 7-day, 1-month, and 3-month postoperative visits. Macula sparing rhegmatogenous retinal detachment underwent fixation test (with microperimetry) at baseline and at the 7-day and 1-month follow-up examinations. Results: Fundus autofluorescence revealed postoperative retinal displacement in 12 of the 23 eyes (52.2%). Occurrence of retinal displacement was higher in eyes with gas tamponade (10 of 14 eyes; 71.4%) compared with eyes with silicone oil (2 of 9 eyes; 22.2%) (P = 0.036). Retina shifted downward in all eyes with C3F8 and upward in all eyes with polydimethylsiloxane. Baseline and follow-up macular fixation was tested in 10 macula-on cases. In all cases, a shift of mean fixation point was present at the 7-day postoperative examination, with a partial return toward the baseline mean fixation point at the 1-month follow-up examination. Conclusion: In eyes with rhegmatogenous retinal detachment treated with vitrectomy and gas or silicone oil tamponade, retinal displacement may occur despite successful reattachment. Type of intraocular tamponade seems to influence the occurrence of retinal dislocation and its direction. RETINA 33:349-355, 2013 OI Codenotti, Marco/0000-0002-7221-7941; Fogliato, Giovanni/0000-0001-5627-8210; Iuliano, Lorenzo/0000-0001-6664-1327 Purpose: To investigate the relationship between type of intraocular tamponade and unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment. Methods: Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment underwent 3-port pars plana vitrectomy with gas (C3F8) or silicone oil (polydimethylsiloxane) tamponade. Ophthalmologic examination and fundus autofluorescence were performed before surgery (baseline) and at the 7-day, 1-month, and 3-month postoperative visits. Macula sparing rhegmatogenous retinal detachment underwent fixation test (with microperimetry) at baseline and at the 7-day and 1-month follow-up examinations. Results: Fundus autofluorescence revealed postoperative retinal displacement in 12 of the 23 eyes (52.2%). Occurrence of retinal displacement was higher in eyes with gas tamponade (10 of 14 eyes; 71.4%) compared with eyes with silicone oil (2 of 9 eyes; 22.2%) (P = 0.036). Retina shifted downward in all eyes with C3F8 and upward in all eyes with polydimethylsiloxane. Baseline and follow-up macular fixation was tested in 10 macula-on cases. In all cases, a shift of mean fixation point was present at the 7-day postoperative examination, with a partial return toward the baseline mean fixation point at the 1-month follow-up examination. Conclusion: In eyes with rhegmatogenous retinal detachment treated with vitrectomy and gas or silicone oil tamponade, retinal displacement may occur despite successful reattachment. Type of intraocular tamponade seems to influence the occurrence of retinal dislocation and its direction. RETINA 33:349-355, 2013

Purpose. To report a case of scleral dislocation mimicking glaucoma progression. Methods. Interventional case report. Results. A 71-year-old man was referred for glaucoma surgery in his right eye because of perimetry defect progression and uncontrolled intraocular pressure despite maximal medical therapy. A scleral buckling procedure in his right eye was previously performed for rhegmatogenous retinal detachment. At the time of presentation, a visible protruded sponge buckle element was noted at ocular inspection, without any sign of infection. The buckle element was posteriorly in contact with the optic nerve and anteriorly protruding under intact conjunctiva. We eventually managed for its removal via upper eyelid orbitotomy. Visual field lesions were unchanged on every follow-up visit. Conclusions. This case report describes severe permanent optic nerve damage due to previous misdiagnosis of a rare complication of scleral buckling surgery. Our surgical solution appears to be a safe and successful approach for this ocular disorder, also able to stabilize visual function and interrupt disease progression.

Prepapillary arterial loops are rare benign congenital vascular anomalies that may be complicated by vitreous hemorrhage and branch retinal artery occlusion (BRAO). We describe the first case in the literature of simultaneous occurrence of both these complications in the same eye of a patient with a bilateral prepapillary arterial loop, successfully treated with vitrectomy. (C) 2013 Elsevier Masson SAS. All rights reserved.

Purpose: To study retinal function in asymptomatic Type 1 and Type 2 diabetic patients with nonproliferative diabetic retinopathy (NPDR) and no clinical signs of diabetic macular edema. Methods: Thirty-six consecutive Type 1 and Type 2 diabetic patients with nonproliferative diabetic retinopathy and no diabetic macular edema and 28 healthy controls underwent a complete ophthalmologic examination, including spectral domain optical coherence tomography and microperimetry. Results: Seventy-one eyes (17 patients with Type 1 and 19 with Type 2 diabetes) were tested, and data from 36 (17 Type 1 and 19 Type 2) eyes were analyzed. Mean best-corrected visual acuity was 0.00 +/- 0.01 logMAR and 0.00 +/- 0.02 logMAR for Type 1 and Type 2 diabetic patients, respectively (P = 0.075). Mean central foveal thickness was 234.5 +/- 13.7 mm and 256.3 +/- 12.7 mm for Type 1 and Type 2 diabetic patients, respectively (P = 0.04); the central foveal thickness was statistically different compared with the control groups (P = 0.04 and P = 0.01, respectively). Mean retinal sensitivity was 18.9 +/- 0.5 dB and 17.7 +/- 0.4 dB for Type 1 and Type 2 diabetic patients, respectively; it was statistically different compared with control groups (P < 0.0001 and P < 0.0001, respectively). Conclusion: We demonstrated a significantly reduced sensitivity in both nonproliferative diabetic retinopathy groups without diabetic macular edema compared with healthy controls; this reduction was greater in Type 2 diabetic patients. Central foveal thickness was increased in all diabetic patients compared with healthy controls, despite the absence of diabetic macular edema. Purpose: To study retinal function in asymptomatic Type 1 and Type 2 diabetic patients with nonproliferative diabetic retinopathy (NPDR) and no clinical signs of diabetic macular edema. Methods: Thirty-six consecutive Type 1 and Type 2 diabetic patients with nonproliferative diabetic retinopathy and no diabetic macular edema and 28 healthy controls underwent a complete ophthalmologic examination, including spectral domain optical coherence tomography and microperimetry. Results: Seventy-one eyes (17 patients with Type 1 and 19 with Type 2 diabetes) were tested, and data from 36 (17 Type 1 and 19 Type 2) eyes were analyzed. Mean best-corrected visual acuity was 0.00 +/- 0.01 logMAR and 0.00 +/- 0.02 logMAR for Type 1 and Type 2 diabetic patients, respectively (P = 0.075). Mean central foveal thickness was 234.5 +/- 13.7 mm and 256.3 +/- 12.7 mm for Type 1 and Type 2 diabetic patients, respectively (P = 0.04); the central foveal thickness was statistically different compared with the control groups (P = 0.04 and P = 0.01, respectively). Mean retinal sensitivity was 18.9 +/- 0.5 dB and 17.7 +/- 0.4 dB for Type 1 and Type 2 diabetic patients, respectively; it was statistically different compared with control groups (P < 0.0001 and P < 0.0001, respectively). Conclusion: We demonstrated a significantly reduced sensitivity in both nonproliferative diabetic retinopathy groups without diabetic macular edema compared with healthy controls; this reduction was greater in Type 2 diabetic patients. Central foveal thickness was increased in all diabetic patients compared with healthy controls, despite the absence of diabetic macular edema.

Background: To report the morphological macular findings detected by spectral domain optical coherence tomography (SD-OCT) and to determine their prevalence in patients with retinitis pigmentosa (RP). Methods: SD-OCT scans of 176 eyes from 90 patients affected by RP were reviewed. A careful evaluation was carried out on photoreceptor inner/outer segment (IS/OS) junction, external limiting membrane (ELM), inner limiting membrane thickening (ILMT), epiretinal membranes (ERMs), retinal micropseudocysts (MPCs), cystoid macular edema (CME), macular holes (MHs) and choroidal neovascularization (CNV). Results: The photoreceptor IS/OS junction was absent in the foveal region of 24 eyes (13.6%) and disrupted in 84 eyes (47.7%). The ELM was absent in 24 eyes (13.6%), whereas the ILMT was found in 118 eyes (67%). The presence of an ERM was detected in 48 eyes (27.3%). Some sort of vitreomacular alteration (ILMT and/or ERM) was identifiable in a total of 94.3% of eyes with RP. The presence of MPCs was detected in 32 eyes (18.2%). An evident CME was found in 22 eyes (12.5%). We also found MHs in 8 eyes (4.5%) and CNV in 3 eyes (1.7%). Conclusions: Our data indicate that RP is associated with alterations of many retinal layers. In particular, the vitreoretinal interface is affected in 94% of patients, and MPC can be identified in 18% of eyes. SD-OCT may contribute to the understanding of the pathophysiological mechanism involved in RP.

Purpose: To assess the effects of intravitreal bevacizumab injections in the treatment of juxtafoveal choroidal neovascularization associated with multifocal choroiditis. Methods: Prospective interventional case series. Fourteen patients (14 eyes) affected by juxtafoveal choroidal neovascularization secondary to multifocal choroiditis were examined. All patients underwent a complete ophthalmologic examination, including measurement of best-corrected visual acuity using Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. The protocol treatment included a first injection, followed by repeated intravitreal bevacizumab injections over a 12-month follow-up period on the basis of optical coherence tomography parameters and angiographic features. Results: Mean best-corrected visual acuity changed from 0.41 logarithm of the minimum angle of resolution (approximately corresponding to 20/51 Snellen equivalent), at baseline, to 0.16 +/- 0.13 logarithm of the minimum angle of resolution (approximately corresponding to 20/28 Snellen equivalent), at the 12-month examination (P < 0.002). A functional improvement of at least 3 Early Treatment Diabetic Retinopathy Study lines was achieved by 6 eyes (43%) at the 12-month examination. Mean central macular thickness at baseline was 318 mm, reducing to 239 mm at the 12-month examination (P < 0.001). No eye showed choroidal neovascularization extension to the fovea. Conclusion: Intravitreal bevacizumab is a beneficial treatment for juxtafoveal choroidal neovascularization associated with multifocal choroiditis. Further studies are warranted to confirm these preliminary results. RETINA 33: 953-956, 2013

Purpose: To report the effects of intravitreal bevacizumab injection (IVBI) in a patient affected by retinal neo-vascularizations (RNVs) associated with myelinated nerve fibers (MNF) and complicated by vitreous hemorrhage. Methods: A 23-year-old female was referred because of sudden visual acuity deterioration in the left eye. Nine years earlier, the subject underwent retinal laser photocoagulation for recurrent vitreous hemorrhages related to the development of RNV associated with MNF. The ophthalmological evaluation revealed a new recurrence of vitreous hemorrhage associated with fluorescein leakage from RNV. After careful discussion, the patient underwent IVBI. Results: One month after the injection, the best corrected visual acuity (BCVA) improved from 20/400 to 20/100, with a vitreous hemorrhage resolution, and cessation of fluorescein leakage. Over the 24-month follow-up, 2 additional IVBIs were administered due to further vitreous hemorrhage associated with fluorescein leakage from RNV, achieving a final BCVA of 20/80. Conclusions: IVBI may temporarily counteract the vascular hyperpermeability typical of RNV associated with MNF, leading to the cessation of fluorescein leakage, but does not result in RNV regression.

Purpose: Spectral-domain optical coherence tomography (SD-OCT) enables high-resolution analysis of retinal layers and previously unseen hyperreflective dots (HRD). HRD morphological characteristics, evolution, possible origin and prognostic value are discussed. Methods: We conducted a prospective study of 100 patients with exudative age-related macular degeneration (AMD), who were treated and followed up with monthly imaging examinations. Statistical correlations between visual acuity (VA) and pre-/post- treatment HRD characteristics were evaluated. Results: HRD were present in all cases, mainly in the outer retinal layers but also elsewhere. After treatment, HRD regressed in a few days, 1 month (p < 0.04) and 3 months (p < 0.01). Regression was evident in all VA and morphological subsets. Resolution was associated with better final VA (p < 0.001). Conclusions: Presence of initial/recurrent HRD, rapid treatment response and the growing role that early biological inflammatory reaction plays in AMD suggests HRD are activated microglia cells. The correlation between VA and HRD could make HRD a clinical marker for early decisions about treatment and retreatment.

Purpose: To describe two cases of extrafoveal choroidal neovascularization (CNV) after ocular trauma successfully treated with intravitreal bevacizumab injection. Methods: A 41-year-old man presented for progressive visual impairment in the left eye (LE). The patient had a positive history for pseudoxanthoma elasticum and suffered a blunt trauma in the LE 1 year before. Best-corrected visual acuity (BCVA) in the affected eye was 20/100. Fundus examination of the LE revealed angioid streaks and a choroidal rupture with retinal hemorrhages. Fluorescein angiography (FA) revealed an extrafoveal CNV and optical coherence tomography (OCT) findings demonstrated the presence of intraretinal fluid extending to the fovea. The second patient was a 61-year-old man complaining of blurred vision in the LE. Fundus examination of the LE revealed retinal pigment epithelium (RPE) changes, while FA showed the presence of an extrafoveal CNV close to the area of RPE attenuation. Intraretinal fluid extending to the fovea was detectable on OCT examination. An intravitreal injection of bevacizumab was proposed in both cases. Results: In the first patient, treatment with one intravitreal bevacizumab injection was successful in contrasting CNV activity, as OCT findings showed a resolution of intraretinal fluid accumulation. BCVA remained unchanged (20/100) over the 12-month follow-up period, most probably due to permanent alteration of the photoreceptors. In the second case, BCVA improved from 20/40 to 20/20 with complete resolution of leakage on FA and fluid on OCT 1 month after a single intravitreal injection of bevacizumab. Visual function remained stable over the 14-month follow-up. Conclusions: Our results indicate that intravitreal bevacizumab is effective in the management of extrafoveal CNV secondary to ocular trauma.

PURPOSE. Nephrotic syndrome is a kidney disorder characterized by loss of different plasmatic proteins resulting in different peripheral tissue edemas. No ocular complications have been reported in nephrotic syndrome secondary to primary glomerular disease. METHODS. A 24-year-old woman was referred to emergency service for acute generalized edema,. associated with bilateral visual impairment and metamorphopsia. A diagnosis of nephrotic syndrome was made. The patient was treated with diuretic therapy. RESULTS. At first ophthalmologic evaluation, the woman presented best-corrected visual acuity of 20/32 in the right eye and 20/40 in the left eye and a dome-shaped bilateral neurosensorial retinal detachment and macular edema studied with spectral-domain optical coherence tomography. The patient underwent furosemide treatment. At follow-up evaluation 6 days later, best-corrected visual acuity improved to 20/20 in both eyes and restoration of normal retinal anatomy was demonstrated. CONCLUSIONS. Sequestration of interstitial fluids, which leads to classic generalized edema in nephrotic syndrome, could be the origin of interstitial accumulation of fluids in the retinal layers.

We present a case of a patient with bilateral posterior uveitis HLA-A29 positive, masquerading intraocular lymphoma. A 43 year-old woman presented with bilateral vitritis and chorioretinal lesions compatible with "birdshot lesions". The patient was initially diagnosed with birdshot retinochoroidopathy and later on, during follow up, the occurrence of neurologic involvement and the lack of response to systemic immunosuppression led us to re-evaluate the diagnosis. A definite diagnosis of intraocular lymphoma with central nervous system involvement was made. This case is presented to highlight the importance of careful follow-up of patients with chronic uveitis and re-evaluation of systemic symptoms and signs, in particular when ocular findings are highly suggestive for masquerade syndrome.

Primitive retinal vascular abnormalities are benign conditions of the retinal circulation that comprise vascular tumors and telangiectasias. The principal vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, racemose hemangiomatosis of the retina and retinal vasoproliferative tumor, while primary retinal telangiectasias include Coats' disease, Leber's miliary aneurysms and idiopathic juxtafoveal telangiectasias. In most cases, these alterations result in significant visual impairment due to exudation determined by the structural abnormalities of the retinal vasculature. The aim of this review is to assess the different clinical and diagnostic features of the single pathological entities and to discuss the available treatment modalities including the onset of intravitreal antivascular endothelial growth factor therapy. Copyright (C) 2012 S. Karger AG, Basel OI Knutsson, Karl Anders/0000-0002-9615-2839 Primitive retinal vascular abnormalities are benign conditions of the retinal circulation that comprise vascular tumors and telangiectasias. The principal vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, racemose hemangiomatosis of the retina and retinal vasoproliferative tumor, while primary retinal telangiectasias include Coats' disease, Leber's miliary aneurysms and idiopathic juxtafoveal telangiectasias. In most cases, these alterations result in significant visual impairment due to exudation determined by the structural abnormalities of the retinal vasculature. The aim of this review is to assess the different clinical and diagnostic features of the single pathological entities and to discuss the available treatment modalities including the onset of intravitreal antivascular endothelial growth factor therapy. Copyright (C) 2012 S. Karger AG, Basel

Purpose To describe a case of ABCA4 gene mutation (G1961E) associated with bilateral choroidal neovascularization (CNV) treated with intravitreal ranibizumab injections. Methods A 52-year-old man with bilateral CNV associated with ABCA4 gene mutation underwent complete ophthalmologic examination over a 30-month follow-up and was treated with intravitreal ranibizumab injections on an as-needed basis. Results Baseline best-corrected visual acuity (BCVA) was 20/32 in the right eye (RE) and 20/63 in the left eye (LE). Two small CNVs with juxtafoveal location were detectable in the RE, whereas a single subfoveal CNV was visible in the LE. Overall, 6 and 9 intravitreal ranibizumab injections were administered in RE and LE, respectively, during the 30-month follow-up. At the end of the follow-up, BCVA was 20/100 in the RE and 20/200 in the LE. Conclusions This case report reveals that ABCA4 gene mutation may be complicated by multiple and bilateral CNVs. Intravitreal injection of ranibizumab can achieve temporary CNV stabilization, but cannot guarantee complete quiescence over a long-term follow-up. Other therapeutic approaches could be necessary to accomplish visual acuity preservation.

Purpose: To describe a case of juxtafoveal choroidal neovascularization (CNV) occurring in a patient affected by retinitis pigmentosa (RP), treated with intravitreal bevacizumab over a 12-month follow-up. Methods: A 66 year-old woman referred to our center for visual acuity deterioration was diagnosed as having classic juxtafoveal CNV associated with RP. The patient was treated with intravitreal bevacizumab, and was regularly monitored every month. Results: At the end of the 12-month follow-up, best corrected visual acuity changed from 20/200 to 20/100 in the affected eye. Five intravitreal bevacizumab injections were required to obtain the stabilization of the CNV. Conclusions: Intravitreal bevacizumab is effective in producing juxtafoveal CNV stabilization and visual acuity improvement in a patient affected by RP, over a 12-month follow-up. Future studies are required to ascertain the best therapeutic approach for CNV complicating RP.

Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, plays a major role in vision loss related to diabetic retinopathy. This article presents an in-depth analysis of therapeutic perspectives on DME by means of an approach based on combination therapy with steroids. Corticosteroid drugs have been demonstrated to both inhibit the expression of vascular endothelial growth factor (VEGF) and the VEGF gene, and to have antiinflammatory properties. A treatment algorithm is provided regarding the management of DME. While grid laser photocoagulation remains the first-line therapy for focal vasogenic DME, diffuse DME can be effectively treated by means of intravitreal injections of corticosteroids. Recalcitrant DME can also be managed beneficially with intravitreal steroids. The management of DME is complex, and often multiple treatment approaches are needed. Each form of DME should be properly classified and specifically treated. The combination treatment has still an important role in the combined treatment options for DME. Copyright (C) 2010 S. Karger AG, Basel

PURPOSE. To report the spectral domain (SD) findings in a retinal fold secondary to vitrectomy surgery. METHODS. A 57-year-old man presented 1 month after vitrectomy surgery with gas injection (C(3)F(8) 6%) in his left eye for treatment of a macula-on retinal detachment and was noted to have a retinal fold in the superior aspect of the macula. Complete ocular examination, fundus photography, fluorescein angiography, autofluorescence, and SD optical coherence tomography (OCT) were performed. RESULTS. Spectral domain OCT revealed a slightly hyperreflective lesion in the outer retina, which occupied a discontinuity in the inner segment-outer segment junction and extended superiorly with apparent indentation of the overlying retinal layers. CONCLUSIONS. This case illustrates how SD OCT may be useful in describing the morphologic substrate of retinal fold after retinal surgery.

Purpose:To investigate the relation between type of intraocular tamponade and unintentional retinal displacement (URD) after standard vitrectomy. Methods:Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment (RRD) underwent three-port pars plana vitrectomy (TPPV) with gas (perfluoropropane) or silicone oil tamponade, according to specific clinical conditions. All patients underwent complete ocular examination, including fundus autofluorescence (FAF) (Topcon TRC-50DX), spatial and quantitative assessment of fixation (Nidek MP-1 microperimetry) before surgery and on 7-day, 1-month, 3-month and 6-month post-operatory visits. Results:URD was noted on FAF in 12 of the 23 eyes (52.2%). Retinal displacement rate was greater in gas-injected eyes (10/14, 71.4%) compared with eyes with silicone oil (2/9, 22.2%) (Fisher’s exact test, p=0.036). Retina shifted downward in all gas-injected eyes and upward in all eyes with silicone oil. Preoperative and follow-up macular function assessment was reliably performed only in macula-on cases (7). In this subgroup a fixation shift was noted on the first post-operative visit, with a maximum value on the 7-day post-operative examination and decreasing throughout the follow-up examinations. Conclusions:In eyes with RRD treated with vitrectomy and gas or silicone oil injection, URD may occur despite successful retinal reattachment. The type of intraocular tamponade seems to influence retinal dislocation rate and direction.