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The following is a case of vitreoretinal lymphoma masquerading as central serous chorioretinopathy (CSCR). A 74-year-old man presented with blurred vision in the left eye with unilateral subretinal fluid in the setting of exogenous corticosteroid use, which was diagnosed as CSCR and resolved with corticosteroid cessation. He later experienced a similar self-limited episode in the right eye. Subsequently, he developed bilateral vitritis with yellow-white subretinal pigment epithelial infiltrates. Vitreous biopsy confirmed a diagnosis of large B-cell lymphoma. Vitreoretinal lymphoma can masquerade as a number of ocular pathologies, including CSCR. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:467-470.] .

This case report describes a 74-year-old woman who developed a crystalline retinopathy following intravitreal injection of clindamycin. The patient presented with ocular toxoplasmosis in the left eye but was allergic to sulfa medications, so she was treated with intravitreal clindamycin. Subsequently, fine refractile yellow-white crystals were observed on examination of the left macula. Optical coherence tomography localized the crystals to the posterior hyaloid. Intravitreal clindamycin should be considered in the differential diagnosis of crystalline retinopathy. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:168-170.] .

Purpose: Explantation of a dislocated capsular tension ring (CTR) from the vitreous cavity can be challenging, typically requiring a bimanual hand-shake technique or cutting the CTR into segments. We present three cases of dislocated intraocular lens (IOL)-CTR-capsule complexes in which CTRs were explanted efficiently and safely by using a CTR inserter (CTR-I) through a clear corneal incision., Methods: Retrospective case series., Results: Capsular tension rings were successfully explanted by freeing the eyelet of the CTR from the capsule, engaging it with the CTR-I hook and retracting the CTR into the device's shaft while maintaining the entire IOL-CTR-capsule complex in a safe position behind the iris plane. No complications of the procedure were observed in all three cases. All patients had subsequent uneventful IOL exchange through sutureless scleral fixation during the same surgery., Conclusion: The CTR inserter provides a simple and efficient approach to CTR removal from IOL-CTR-capsule complexes dislocated into the vitreous cavity. Greater awareness of this technique among providers is needed.

Background and Objective: Vancomycin and ceftazidime are commonly used intravitreal antibiotics for suspected bacterial endophthalmitis. Many retina surgical practices prepare aliquoted individual doses in syringes that are then stored frozen for future use, but this practice has not been well studied. This investigation aims to examine the stability of frozen vancomycin and ceftazidime., Materials and Methods: Samples of drugs were reconstituted monthly and placed in a -20°C freezer. At the end of 3 months and again at 6 months, a newly reconstituted drug constant was created and compared to a newly created reference sample. The frozen samples were compared to a freshly produced drug solution. Using high-performance liquid chromatography (HPLC), the peak heights were compared to evaluate stability., Results: The vancomycin reference sample was 100 ± 1.67%. Values over time were 97.4 ± 0.75%, 98.8 ± 0.44%, 102.1 ± 0.4%, 100.5 ± 0.12%, 101.8 ± 0.12, 101.5 ± 0.11, and 100.6 ± 1.87 for 1, 2, 3(A), 3(B), 4, 5, and 6 months, respectively. The ceftazidime reference sample was 100 ± 1.8%. Values over time were 100.7 ± 1.78%, 100.0 ± 1%, 102.3 ± 1.55%, 117.5 ± 11.6%, 112.8 ± 1.64%, 123 ± 2.8%, and 117 ± 2.5% for 1, 2, 3(A), 3(B), 4, 5, and 6 months, respectively., Conclusion: Both vancomycin and ceftazidime were stable over 6 months under frozen conditions at -20°C. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:281-283.] .

Background and Objective: Postoperative pain is frequently reported following scleral buckle (SB) surgery. This study assessed the efficacy of perioperative dexamethasone on postoperative pain and opioid use following SB., Materials and Methods: Forty-five patients with rhegmatogenous retinal detachments undergoing SB or SB and pars plana vitrectomy were randomly assigned to either standard care of postoperative oral acetaminophen and oxycodone/acetaminophen as needed or standard care plus 8 mg single-dose peri-operative intravenous dexamethasone. A questionnaire was administered on postoperative days 0, 1, and 7 to determine visual analog scale 0 to 10 pain score and number of opioid tablets consumed., Results: Mean visual analog scale score and opioid use were significantly lower in the dexamethasone group on postoperative day 0 compared with control (2.76 ± 1.96 vs 5.64 ± 3.40, P = 0.002; 0.41 ± 0.92 vs 1.34 ± 1.43, P = 0.016). The dexamethasone group also demonstrated significantly lower total opioid use (0.97 ± 1.88 vs 3.69 ± 5.32, P = 0.047). No significant differences in pain score or opioid use were observed on days 1 or 7 ( P = 0.078; P = 0.311; P = 0.326; P = 0.334)., Conclusion: Single-dose intravenous dexamethasone following SB can significantly reduce postoperative pain and opioid use. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:238-242.] .

Background and Objective: To report the outcomes of topical difluprednate 0.05% use in the closure of full-thickness macular holes., Patients and Methods: Retrospective chart review of 4 patients with full-thickness macular holes who received difluprednate drops 4 times daily for a minimum of 12 weeks. Main outcome measures were macular hole status assessed with optical coherence tomography, visual acuity, intraocular pressure, and complications of treatment., Results: All patients had macular hole closure within 12 weeks of difluprednate exposure. Mean time to macular hole closure was 5 weeks (range, 2-12 weeks). Visual acuity improved with macular hole closure. Average baseline visual acuity was 20/42. Average visual acuity after macular hole closure was 20/26 (P = 0.14). Two patients experienced increased intraocular pressure with topical steroid use., Conclusion: Exposure to difluprednate in this cohort of patients with full-thickness macular holes was associated with reduced macular edema, macular hole closure, and visual improvement.

Background and Objective: The purpose of this article is to describe a cluster of four cases of severe postoperative inflammation in eyes that received intraoperative indocyanine green (ICG) from the same lot., Patients and Methods: This was a retrospective chart review of patients from a single-center, retina-only group practice. The ICG lot associated with the inflammatory events was identified and analyzed with high-performance liquid chromatography with UV spectroscopy., Results: Four patients presented on postoperative day 1 with severe inflammation. The first patient was treated with aqueous biopsy and injection of intravitreal antibiotics, followed by topical steroid and antibiotic drops. The subsequent three patients were treated with topical steroid and antibiotic drops. All patients had resolution of inflammation by postoperative day 14 (range 10 to 14 days). High-performance liquid chromatography with UV spectroscopy failed to identify a contaminant., Conclusions: The use of intravitreal ICG dye as a surgical adjuvant may uncommonly be associated with severe postoperative inflammation. This inflammation may resolve within weeks after topical corticosteroid and antibiotic treatment. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53:148-151.] .

Background and Objective: To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery., Patients and Methods: Retrospective observational case series. Eyes that underwent SB removal between 2010 and 2016 with greater than 1 year of follow-up were included. Main outcome measures were post-SB removal complications and best-corrected visual acuity (BCVA)., Results: Fifty eyes that underwent SB removal met the inclusion criteria. Indications include exposed SB (54%), infection (26%), diplopia (16%), and recurrent retinal detachment (4%). Mean and median intervals between SB placement and removal were 65 months and 30 months. Complications include recurrent retinal detachment (12%), transient ocular hypertension (6%), and persistent diplopia (4%). There was no significant change in mean BCVA after SB removal ( P = .979)., Conclusions: Exposed SB, infection, and diplopia are the most common indications for SB removal. The single-surgery success rate is high and the risk for complications is relatively low. [ Ophthalmic Surg Lasers Imaging Retina. 2021;52:138-144.] .

Purpose: To evaluate the effect of cataract extraction (CE) by phacoemulsification on the vitreomacular interface (VMI) of eyes with preexisting vitreomacular traction (VMT)., Methods: Retrospective, observational case series. Patients with VMT who elected to proceed with CE, before any vitreoretinal intervention, were studied. Eyes with at least a 12-month follow-up period were included. The status of the vitreomacular adhesion at different time points was assessed using spectral-domain optical coherence tomography. The best-corrected visual acuity was recorded at different time points. Other macular and systemic comorbidities were documented., Results: Fifteen eyes from 15 phakic patients with symptomatic VMT were included. Six of them were male subjects. Seven patients had diabetes mellitus and two of them also had nonproliferative diabetic retinopathy. The preoperative macular comorbidities included macular hole in six eyes (Stage 1 in 3 eyes and Stage 2 or 3 in another 3 eyes), epiretinal membrane in five eyes, and cystoid macular edema in four eyes. After uncomplicated CE, the VMT was released in 5 eyes, whereas in 10 eyes, CE did not significantly change the status of the vitreomacular adhesion. Three of 3 eyes with preexisting full-thickness macular hole (Stage 2 or 3 macular hole) were found to have Stage 4 macular hole shortly after CE. In seven of seven patients with diabetes mellitus, the status of the vitreomacular interface did not change after CE. Eventually, 7 of 15 patients underwent additional pars plana vitrectomy. Compared with the baseline vision, and vision before other interventions, the visual acuity after CE improved in 5 patients, remained unchanged in 7 patients, and decreased in the 3 patients with Stage 2 or 3 macular hole. The mean preoperative and early postoperative visual acuity was 20/59 and 20/68, respectively (P > 0.05)., Conclusion: The effect of CE in phakic eyes with known VMT varies significantly. In the current case series, every eye with VMT and Stage 2 or 3 macular hole ended up with Stage 4 macular hole, although the VMT did not change significantly in the eyes of diabetic patients. Studies with larger sample size are needed to further elucidate the impact of elective CE on VMT.

Purpose: To present the 1-year results of a surgical technique for the sutureless intrascleral fixation of a 3-piece intraocular lens using a 30-gauge needle., Methods: A retrospective chart review of a consecutive series of 9 eyes of 8 patients who underwent sutureless intrascleral fixation of posterior chamber intraocular lens using a 30-gauge needle was performed. Patients were required to have at least 1 year of follow-up to be included in the analysis. Short-term data were collected 1 month after surgery, and long-term data were collected 1 year after surgery. Data collected included visual acuity, lens stability, intraocular pressure, and the development of complications., Results: Visual acuity improved from Snellen 20/309 preoperatively to Snellen 20/27 at postoperative Month 12 (P = 0.03). Short-term complications included increased intraocular pressure (n = 4) and corneal edema (n = 2). Long-term complications included exposed superior haptic (n = 1) and recurrent anterior chamber inflammation (n = 1)., Conclusion: The novel surgical technique for sutureless intrascleral fixation of a 3-piece intraocular lens is well tolerated 1 year after surgery.

Background and Objective: To evaluate disease characteristics and frequencies of genetic mutations in a cohort of patients with known or suspected retinal dystrophies., Patients and Methods: A cohort of 37 patients with known or suspected retinal dystrophies received genetic testing with a panel of 31 genes known to result in the development of retinal dystrophies. Disease characteristics identified during chart review were analyzed and related back to their associated genetic mutations in an attempt to link clinical features with genotypes., Results: Eighteen of 37 patients (48.6%) tested positive for a variant(s) in one or more of the 31 genes tested. Mutations were discovered in 14 of the 31 genes, with USH2A being the most frequently mutated gene. Both gene-positive and gene-negative patient groups had similar disease characteristics including reduced visual acuity, legal blindness, dyschromatopsia, nyctalopia, and reduced peripheral vision., Conclusions: This investigation demonstrates the utility of genetic testing in a cohort of patients who carry a clinical diagnosis of retinal dystrophy. In this cohort, a significant number of patients had a genetic mutation or variant identified. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:338-345.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To report the 1-year outcomes of a novel surgical technique for the fixation of a CZ70BD intraocular lens with Gore-Tex suture using cow-hitch knots., Methods: A retrospective chart review of 15 patients (13 men and 2 women) who underwent fixation of a posterior chamber intraocular lens with Gore-Tex suture was performed. Short- and long-term outcomes data were collected 1 month and 1 year after surgery, respectively., Results: Fourteen of the 15 patients met inclusion criteria and were included in the analysis. Mean visual acuity improved significantly from Snellen 20/491 preoperatively to Snellen 20/59 at postoperative month 12 (P = 0.002). The most common short-term complications included increased intraocular pressure (n = 6) and cystoid macular edema (n = 4). The most common long-term complications included increased intraocular pressure (n = 2) and iris capture of the intraocular lens (n = 2)., Conclusions: One-year outcome data suggest that this technique is a reasonable surgical option for secondary intraocular lens placement in patients who lack capsular support.

A mechanics-based mathematical model of retinal detachment due to the geometric changes of the eye associated with the evolution of myopia is developed. This includes deformation of the retina due to biological growth of the retina, as well as elastic deformation imposed on the retina by the myopic change in shape of the much stiffer choroid and sclera. The problem is formulated as a propagating boundary value problem in the calculus of variations, which yields self-consistent governing equations, boundary conditions, and transversality conditions that establish the location of the propagating boundaries that correspond to equilibrium configurations of the detaching ocular system. Axisymmetric conditions are considered, and exact, analytical solutions to the corresponding boundary value problem are obtained for detaching retinas with and without a tear. Based upon application of the model presented herein to the emmetropic retina, a value of the bond energy of the retina to retinal pigment epithelium interface is estimated using material properties found in the literature. Simulations based on the analytical solutions are performed for a detachment in the retina located at either the posterior or superior pole of the eye. The results support the clinical finding of an increased prevalence of retinal detachment in myopic eyes and provide insight into the potential causation for the increased prevalence.

Background and Objective: To investigate the variability in optical coherence tomography angiography (OCTA) image interpretation in a cohort of retina specialists., Patients and Methods: A survey consisting of a study set of images from 12 eyes examined by OCTA was created. Eight multiple-choice answers were provided as response options for each case. The survey was sent to 100 retina specialists, with instructions to complete the survey only if they had facility with the interpretation of OCTA images. Thirty-eight physicians completed the survey. Data generated were subsequently analyzed and interpreted., Results: Krippendorff's alpha coefficients of agreement and their associated 95% confidence intervals (CIs) were utilized for statistical analyses. For the overall data, the estimated alpha coefficient was 0.366 (95% CI, 0.31-0.47). Although the estimated alpha coefficient is significant, the level of significance is considered low, as it is far from unity (0.366). Therefore, although statistically significant, the overall data did not demonstrate either high reliability or agreement in interpretation. Additional analyses evaluating the influence of years and location of practice, and frequency of OCTA use did not demonstrate a significant effect on reliability measures., Conclusions: Significant variability exists in the interpretation of OCTA images in this cohort of retina specialists. The overall data did not demonstrate high reliability or agreement in interpretation of images, suggesting the need for additional study of this nascent technology. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:344-353.]., (Copyright 2019, SLACK Incorporated.)

Purpose: To describe a crystalline retinopathy observed in patients greater than 1 year after intravitreal injection of triamcinolone acetonide (IVTA)., Methods: A retrospective, interventional, noncomparative, single-center case series of patients who received IVTA and developed subsequent crystalline retinopathy lasting greater than 1 year after injection., Results: Eighteen eyes of 16 patients in which preretinal crystals were observed >1 year after IVTA were included in the study, with a mean follow-up (range) of 5.8 years (1.1-9.2) after IVTA. The crystals were refractile, not visible on fluorescein nor indocyanine green angiography, exhibited slow dissolution and movement, and were occasionally distributed in a circular fashion. Optical coherence tomography confirmed the preretinal and/or subhyaloid location of crystals., Conclusion: Macular crystals can persist for years after IVTA. The crystals localize to the preretinal or subhyaloid space, are angiographically silent, can exhibit slow dissolution and movement, may be distributed in a circular fashion reflecting the bursa premacularis, and appear nonpathologic.

Purpose: To report a case of relentless placoid chorioretinitis (ampiginous choroiditis) treated with intravitreal triamcinolone acetonide (IVTA)., Methods: Interventional case report., Results: A 34-year-old pregnant woman with a history of poor visual acuity in her left eye, secondary to an undetermined cause, developed an acute painless central scotoma and blurred vision in the right eye. The examination revealed decreased visual acuity, active inflammatory placoid choroidal lesions in the posterior pole, and mid-periphery with sharp disk margins and normal-appearing vasculature. A diagnosis of relentless placoid chorioretinitis was made, and the patient was treated biannually with 4 mg IVTA for 3 years with visual improvement to 20/25. Although she experienced a relapse at 12 months, the episode was adequately controlled with repeat IVTA. After the sixth IVTA treatment occurring at 30 months, the decision was made to stop IVTA, ultimately facilitating the preservation of 20/25 in the right eye at 63-month follow-up. The disease course was complicated by cataract progression that was successfully treated with a cataract extraction and episodic increases in intraocular pressure which were successfully treated with timolol ophthalmic solution., Conclusion: Intravitreal triamcinolone acetonide therapy represents an important alternative in the treatment of relentless placoid chorioretinitis. By avoiding the potentially significant side effects of long-term systemic corticosteroid and immunosuppressive therapies, IVTA can be an important alternative in the long-term management of this uncommon and complicated entity.

Background: To describe a case of corneal toxicity associated with the use of the epidermal growth factor receptor (EGFR) inhibitor ABT-414 in the treatment of glioblastoma multiforme., Case Presentation: Case report of a 56-year-old male with glioblastoma multiforme who developed mild painless blurred vision after systemic treatment with the investigational EGFR inhibitor ABT-414. The patient had best corrected visual acuity of 20/60 right eye and 20/50 left eye. Ophthalmic examination revealed corneal toxicity with whorl-like opacities in the inferior interpalpebral cornea. The patient was treated with topical fluoromethalone and lifitegrast, and his ocular symptoms as well as the corneal findings improved., Conclusions: The systemic use of EGFR inhibitor ABT-414 may be associated with corneal toxicity and the effects are reversible with treatment.

Background and Objective: To describe a new approach for in-office air-fluid exchange., Patients and Methods: This manuscript describes a procedural technique. A retrospective chart review of three patients on whom the procedure was performed is presented., Results: The authors have performed this novel procedure on three eyes of three patients. All patients were followed for at least 3 months after the procedure. No short-term complications occurred, and no secondary procedures were required to achieve a near-complete air-fluid exchange., Conclusion: This novel technique is a reliable and reproducible procedure that allows for in-office air-fluid exchange with good results in this small cohort of patients. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:799-801.]., (Copyright 2018, SLACK Incorporated.)

Background and Objective: Dexamethasone intravitreal implant (DEX) (Ozurdex; Allergan plc, Dublin, Ireland) is approved for the treatment of diabetic macular edema (DME). This study assessed the real-world effectiveness, safety, and reinjection interval of DEX in adult patients with DME., Patients and Methods: This was a phase 4, prospective, multicenter (18 U.S. sites), observational study., Results: The study population comprised 177 patients (180 eyes; 93.8% previously treated). Baseline mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were 54.4 letters and 424.6 μm, respectively. DEX was administered as monotherapy or with other DME therapy (55%/45%). The mean reinjection interval was 5.0 months. Mean maximum BCVA change from baseline after the first three DEX injections was +9.1 letters, +7.7 letters, and +7.0 letters, respectively (P < .001); 36.0% of eyes achieved 15-letter or greater BCVA improvement. Mean maximum CRT change from baseline was -137.7 μm (P < .001)., Conclusion: DEX used alone or with other DME therapy improved visual and anatomic outcomes in DME patients in clinical practice, with no new safety concerns. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:425-435.]., (© 2018 Singer, Dugel, Fine, et al.)

Purpose: To investigate predictors of success, visual outcomes, and complications of intravitreal ocriplasmin for the treatment of symptomatic vitreomacular adhesion in a clinical care setting., Methods: Retrospective chart review of 49 consecutive eyes of 47 patients who received intravitreal ocriplasmin. Spectral domain optical coherence tomography scans were examined for vitreomacular traction (VMT) release, full-thickness macular hole (FTMH) closure, and other changes in retinal anatomy., Results: Pharmacologic VMT release occurred in 41% of eyes; positive predictors included age ≤75 years (P = 0.001), phakic status (P = 0.016), VMT width ≤750 μm (P = 0.001), and absence of retinal comorbidities (P = 0.035). Pharmacologic FTMH closure occurred in 25% of cases; positive predictors included successful VMT release (P = 0.042), better preinjection best-corrected visual acuity (P = 0.036), and smaller FTMH aperture width (P = 0.033). Eyes that achieved VMT release and did not undergo surgery attained significant improvement in best-corrected visual acuity (P = 0.015). Complications included subfoveal lucency (33%), ellipsoid zone disruption (33%), and FTMH base enlargement (75%). Only FTMH base enlargement resulted in worse visual outcomes (P = 0.024). Subgroup analysis of 14 eyes with ideal characteristics (all positive predictors listed above) yielded a 93% VMT release rate., Conclusion: Proper case selection may facilitate successful pharmacologic vitreolysis with ocriplasmin, improve visual outcomes, and minimize potential complications.

Background and Objective: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids., Patients and Methods: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process., Results: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment., Conclusion: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:291-301.]., (© 2017 Regillo, Callanan, Do, et al.)

A mechanics based mathematical model for the behavior of an eye encircled by a scleral buckle, a procedure used by surgeons to correct retinal detachment, is developed. Closed form analytical solutions are obtained, and results of numerical simulations based on those solutions are presented. The effects of material and geometric parameters of the scleral buckle, as well as of the ocular pressure, on the deformation and volume change of the eye are studied. Critical behavior is identified, and correlations are drawn with regard to the properties of the buckle, the associated deformation of the eye, and the ocular pressure. The results indicate that a judicious choice of the buckle parameters is advisable for planning surgery. In particular, the initial (undeformed) radius of the buckle is seen to have the dominant influence with regard to deformation of the eye, while the thickness (height) and width, and hence the shape, of the buckle are seen to have minimal influence and may be chosen for other reasons, such as to maximize the comfort of the patient.

Background/Aims . To evaluate the impact of back-illuminated and nonilluminated electronic reading devices on reading speed and comfort in patients with decreased vision. Methods . A prospective study involving a convenience sample of 167 patients at a single retina practice from January 2011 to December 2012. Participants were asked to read five different excerpts on five different media in a randomly assigned order. Media included a printed book at 12-point font (12PF), iPad2 at 12PF, iPad2 at 18-point font (18PF), Kindle2 at 12PF, and Kindle2 at 18PF. Reading speed in words per minute (WPM) and medium preference were recorded and stratified by visual acuity (VA). Results . Mean reading speeds in WPM: iPad2 at 18PF (217.0), iPad2 at 12PF (209.1), Kindle2 at 18PF (183.3), Kindle2 at 12PF (177.7), and printed book at 12PF (176.8). Reading speed was faster on back-illuminated media compared to nonilluminated media. Text magnification minimized losses in reading performance with worsening patient VA. The majority of participants preferred reading on the iPad2 at 18PF. Conclusions . Back-illuminated devices may increase reading speed and comfort relative to nonilluminated devices and printed text, particularly in patients with decreased VA.

A mechanics-based mathematical model of an eye possessing a posterior retinal detachment is presented for the case where an encircling scleral buckle (a cerclage) is sutured around the equator of the eye. The mechanical behaviour of the retina and the globe, both before and after applying the cerclage, is studied. An energy formulation yields the self-consistent equations of equilibrium and boundary conditions of the ocular system, and analytical solutions are established for the scleral buckle, for the globe and for the detached segment of the retina. Results of numerical simulations based on the solutions unveil characteristic behaviour of the ocular system, and demonstrate the influence of the scleral buckle, as well as of the pressure difference between the vitreous cavity and the subretinal space, on the deformation of the eye and on closing the region of retinal detachment. The results indicate that a scleral buckle encircling the equator, normally used for closing retinal tears and associated retinal detachments in the immediate vicinity of the buckle, can have a marked influence on bringing the detached segment of neurosensory retina back into contact with the retinal pigment epithelium, even for detachments at the posterior of the eye., (© The authors 2015. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications. All rights reserved.)

Aims: To evaluate the presence of cognitive bias among retinal specialists when recommending treatment options for cystoid macular oedema (CMO) secondary to retinal vein occlusion (RVO)., Methods: Two randomly chosen samples of retina specialists were surveyed regarding their treatment and dosing regimen choices among three antivascular endothelial growth factor (anti-VEGF) biologics (aflibercept, bevacizumab and ranibizumab), intravitreal steroid, focal laser and observation for the treatment of CMO secondary to RVO. The first group was asked to make recommendations for two hypothetical patients: one with CMO secondary to branch RVO (BRVO) and the second with CMO secondary to central RVO (CRVO). The second group was asked to make recommendations as if they themselves were the hypothetical patient with the same disease processes., Results: The survey was completed by 492 respondents (20.1%). When comparing anti-VEGF agents for patients with BRVO, a majority of physicians recommended bevacizumab (60.5%) over ranibizumab (37.8%) and aflibercept (1.7%; p<0.0001). For themselves, physicians were more likely to recommend ranibizumab (44.9%) over bevacizumab (39.2%) and aflibercept (15.9%; p<0.0001). When comparing among the anti-VEGF agents chosen for patients with CRVO, a majority of physicians recommended bevacizumab (56.7%) over ranibizumab (28.2%) and aflibercept (15.1%; p<0.0001), but when choosing for themselves, retina specialists were equally divided among the three biologics (aflibercept 30.6%, bevacizumab 36.5% and ranibizumab 32.9%; p=0.559). The results were influenced by geographical location but not by the gender, the length of practice or the type of practice., Conclusions: Physicians should be aware that cognitive biases exist and take this into consideration when making treatment recommendations for their patients., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)