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Purpose: To identify factors for meeting prespecified criteria for switching from bevacizumab to aflibercept in eyes with center-involved diabetic macular edema (CI-DME) and moderate vision loss initially treated with bevacizumab in DRCR Retina Network protocol AC., Design: Post hoc analysis of data from a randomized clinical trial., Participants: Two hundred seventy participants with one or both eyes harboring CI-DME with visual acuity (VA) letter score of 69 to 24 (Snellen equivalent, 20/50-20/320)., Methods: Eligible eyes were assigned to receive intravitreal aflibercept monotherapy (n = 158) or bevacizumab followed by aflibercept if prespecified criteria for switching were met between 12 weeks and 2 years (n = 154)., Main Outcome Measures: Meeting switching criteria: (1) at any time, (2) at 12 weeks, and (3) after 12 weeks. Associations between meeting the criteria for switching and factors measured at baseline and 12 weeks were evaluated in univariable analyses. Stepwise procedures were used to select variables for multivariable models., Results: In the group receiving bevacizumab first, older participants showed a higher risk of meeting the switching criteria at any time, with a hazard ratio (HR) for a 10-year increase in age of 1.32 (95% confidence interval [CI], 1.11-1.58). Male participants or eyes with worse baseline VA were more likely to switch at 12 weeks (for male vs. female: odds ratio [OR], 4.84 [95% CI, 1.32-17.81]; 5-letter lower baseline VA: OR, 1.30 [95% CI, 1.03-1.63]). Worse 12-week central subfield thickness (CST; 10-μm greater: HR, 1.06 [95% CI, 1.04-1.07]) was associated with increased risk of switching after 12 weeks. The mean ± standard deviation improvement in visual acuity after completing the switch to aflibercept was 3.7 ± 4.9 letters compared with the day of switching., Conclusions: The identified factors can be used to refine expectations regarding the likelihood that an eye will meet protocol criteria to switch to aflibercept when treatment is initiated with bevacizumab. Older patients are more likely to be switched. At 12 weeks, thicker CST was predictive of eyes most likely to be switched in the future., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To review the anatomical and functional outcomes of eyes that underwent 360° retinectomy for a variety of indications and compare them with previously published results., Methods: Retrospective case series. We reviewed the data of 40 patients (41 eyes) who underwent pars plana vitrectomy and 360° retinectomy. The principal indication for surgery in this series was retinal detachment after penetrating trauma (26 of 41 eyes [63%]). Anatomical success was defined as complete retinal reattachment or attachment posterior to the scleral buckle, if present., Results: Thirty of the 41 eyes (73%) had follow-up of at least 6 months after 360° retinectomy, and of these, 11 eyes (37%) had recurrent retinal detachment. Seven of the latter eyes underwent repeat pars plana vitrectomy with anatomical success in 6 eyes (86%). Overall, anatomical success was achieved in 25 of 30 eyes (83%) with follow-up of ≥ 6 months after ≥ 1 operations (including 360° retinectomy). Visual results were limited with only 4 of 35 eyes (11%) in which visual acuity could be tested achieving ambulatory vision, which may reflect the preponderance of posttraumatic retinal detachments in this series., Conclusion: The anatomical results of this series are comparable with those in the reported literature and indicate that vitrectomy with 360° retinectomy can be beneficial in the management of complex retinal detachments in otherwise unsalvageable eyes.

Diabetic macular edema is a major cause of visual impairment. The pathogenesis of macular edema appears to be multifactorial. Laser photocoagulation is the standard of care for macular edema. However, there are cases that are not responsive to laser therapy. Several therapeutic options have been proposed for the treatment of this condition. In this review we discuss several factors and mechanisms implicated in the etiology of macular edema (vasoactive factors, biochemical pathways, anatomical abnormalities). It seems that combined pharmacologic and surgical therapy may be the best approach for the management of macular edema in diabetic patients.

Purpose: To report a case of sympathetic ophthalmia (SO) resembling multiple evanescent white dot syndrome (MEWDS)., Methods: Retrospective chart review., Results: A 17-year-old girl with a ruptured globe in the right eye underwent prompt primary repair and vitrectomy, scleral buckling, and silicone oil infusion 3 weeks later. Eight weeks after injury, she presented with visual loss in the left eye. Fundus examination in the left eye disclosed optic disk swelling and well-circumscribed, 100 to 500 microm diameter gray-white lesions at the level of the retinal pigment epithelium (RPE) posterior to the equator, sparing the fovea. On fluorescein angiography, the lesions appeared as areas of blocked choroidal fluorescence in the arterial phase and were associated with dye leakage in a wreathlike pattern during venous filling. Dye leakage occurred at the optic disk. Visual field testing showed depressed central sensitivity and an enlarged blind spot in the left eye. The patient was treated with prednisone and underwent diagnostic enucleation of the right eye. Histopathology showed rare choroidal granulomata and pigment phagocytosis. Vision improved to 20/20 in the left eye, and the window defects persisted. Visual field testing 6 months later was normal. One month after discontinuing prednisone, new areas of RPE hypopigmentation developed. Two weeks later, choroidal inflammation recurred and periphlebitis developed., Conclusion: This case indicates that SO can mimic MEWDS.

Improvement in surgical techniques has led to improved anatomic and functional success rates following surgery for severe complications of proliferative diabetic retinopathy (PDR). We compared the anatomic and functional outcomes of surgery in a non-randomized, consecutive case series of patients with severe PDR. We found that viscodissection using Healon provides outcomes comparable to conventional pick and scissors dissection. We also found that adjunctive use of silicone oil can salvage selected cases with particularly severe manifestations of PDR (e.g., the fibrinoid syndrome). With proper selection of patients and techniques, the anatomic success rate can exceed 80% even in the most severe cases. The goal of this paper is to show the applicability of using viscodissection and silicone oil infusion during vitrectomy in eyes with severe PDR.

Aims: To compare conventional methods of epiretinal membrane peeling with viscodissection., Methods: 154 eyes with proliferative diabetic retinopathy (PDR) that underwent pars plana vitrectomy with membrane dissection (89 traditional, 65 viscodissection) were studied retrospectively. Incidence of retinal breaks (RBs), length of time under anaesthesia, postoperative intraocular pressure, retinal reattachment rate, and final visual acuity (VA) were measured., Results: To compare cases of similar complexity, a "complexity score" was defined. The average complexity score for cases done with and without viscodissection was 4.7 and 3.2, respectively. The mean frequency of RBs in eyes undergoing viscodissection was 0.43 (SD 0.5) v 0.14 (0.35) RBs/eye without viscodissection. In complex cases, the frequency of posterior/peripheral RBs was 0.31 (0.47)/0.13 (0.34) RBs/eye, respectively, with viscodissection v 0.12 (0.33)/0.23 (0.43) RBs/eye without viscodissection. None of these differences were statistically significant. The average preoperative/postoperative VA (logMAR) in the viscodissection cohort was 1.7/1.3 (range 0.3 to >1.9/0.1 to >1.9) v 1.4/1 (range 0.48 to >1.9/0.1 to >1.9) in the non-viscodissection cohort, among eyes with 6 months of follow up. Anaesthesia duration was significantly shorter for cases done without viscodissection (p=0.03), but cases done with viscodissection were significantly more complex than cases done without viscodissection (p<0.0001)., Conclusion: Viscodissection appears to be a safe and effective alternative technique in eyes with PDR. Owing to the retrospective nature of the study, additional studies are warranted.

Effects of Arzni effervescent mineral baths (EMB) on brain tissue metabolism were studied on white rats (normal controls and those with transitory cerebral ischemia). It was found that EMB prevent ischemia-related disorders of phospholipid and adeninnucleotide pools, promote an increase in vasoactive prostaglandins in brain tissue, shifts in catecholamines concentrations in the hemispheres and hypothalamus, inhibit the activity of monoaminoxidase and absorption of 3H-noradrenaline by brains sections. Mechanisms of neuroprotective action of Arzni EMB in cerebral ischemia are considered.

Close morpho-functional relationships of the cerebellum and vestibular system at all stages of phylogenesis of vertebrates suggest that cerebellum can be regarded as an important center of gravireceptive function. Direct examination of electrical activity of the labyrinth in cats during transient (1-2 sec) state of weightlessness produced by free fall has shown that there was an almost two fold increase in both the rate and amplitude of electrical activity in the vestibular ganglion. It is commonly accepted at present time that the conditions of orbital flight around Earth closely connect with weightlessness that usually manifests itself as undesirable factor of flight. It is known, that vestibular, proprioceptive, visual and other sensory modalities are converted on the cerebellum, which would indicate that this information is used for motor coordination and spatial orientation. Undoubtedly, origin of many vestibulo-motor disturbances during flight and in postflight period to a considerable degree depends on weightlessness. On the whole the visual illusions, motor discoordination, and space sickness, including vomiting are referred to the "space adaptation syndrome." But nature of these disturbances still is not well understood. This investigation was dedicated to study of vestibular and motor reactions of cats and monkey in short-term microgravity.

The paper deals with the pathophysiological validation and assessment of the efficiency of a new low-traumatic operation aimed at decreasing the degree of injured extremity ischemia in patients with atherosclerosis obliterans and decompensation of peripheral circulation. The essence of the operation is to remove arteriovenous shunting into the shin. Eighteen patients were operated on, out of them only 5 underwent a subsequent amputation. It is concluded that this intervention is promising and indications for it are defined in this paper.

Ultrasonic scanning was used in 115 patients with suspected occlusion of vena cava inferior. Details of ultrasonic diagnosis of non-occlusive and occlusive thrombosis of vena cava inferior and vena cava compression from the outside, monitoring of the thrombosed vena cava and the antiembolic cava filter are discussed.

It is believed by the investigators of recurrent venous varicosity of lower limbs that phlebography aids to detect errors of the performed operative procedure and to reveal what caused the recurrence. The authors' experience comprise 48 distal, ascending, vertical phlebographies, and 47 pelvic and retrograde femoral ones in 60 patients, both explorations being utilized for 28 lower limbs. Distal phlebography in 44 of 48 examined patients indicated insufficiency of perforated veins that caused the recurrent crural varices. It is considered that in surgical therapy for venous varicosity a due consideration should be given for both a liquidation of recognized errors of the preceding surgery and a correction of pathological changes in deep veins of the lower extremities.