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Thi Ha Chau Tran,1 Ali Erginay,2 Stephane Verdun,3 Eric Fourmaux,4 Jean-François Le Rouic,5 Joel Uzzan,6 Solange Milazzo7 ,† Stephanie Baillif,8 Laurent Kodjikian9 1Service d’Ophtalmologie, Université Catholique de Lille, Faculté de Médecine et Maieutique, INSERM U1171, Lille, France; 2Service d’Ophtalmologie, Hôpital Lariboisière APHP, Universite de Paris, Paris, France; 3Département de Recherche Médicale, Groupement des Hôpitaux Catholiques de Lille, Lille, France; 4Centre Rétine Gallien, Bordeaux, France; 5Institut Ophtalmologique de l’Ouest Jules Verne, Ophtalliance, Nantes, France; 6Clinique Mathilde, Rouen, France; 7Service d’Ophtalmologie, Centre Hospitalier Universitaire d’Amiens Picardie, Université de Picardie Jules Verne, Amiens, France; 8Service d’Ophtalmologie, Centre Hospitalier Université Côte d’Azur, Université Côte d’Azur, Nice, France; 9Service d’Ophtalmologie, Croix Rousse Hospital, Hospice Cilvils de Lyon 1, Université de Lyon 1, Lyon, France†Solange Milazzo passed away on March 23, 2019Correspondence: Thi Ha Chau TranService d’Ophtalmologie, Université Catholique de Lille, Faculté de Médecine et Maieutique, INSERM U1171, Boulevard de Belfort, BP387, Lille, Cedex, 59021, FranceTel +33 3 20 87 74 42Fax + 33 20 87 75 58Email tran.hachau@ghicl.netAim: To evaluate the efficacy of intravitreal Aflibercept injection (IAI) for vitrectomized eyes with diabetic macular edema (DME) at one year.Methods: This is a prospective, non-comparative, multicenter observational study including diabetic patients whose HbA1c is < 9%, with visual acuity between 20/400 to 20/40 due to DME, who have undergone vitrectomy since at least 3 months before the first aflibercept injection. Treatment protocol included 5 monthly aflibercept injection followed by a ProReNata regimen during the first year. Visual acuity, OCT findings and number of IAI were assessed at 6 months and one year.Results: Forty-six eyes were included. Indications for vitrectomy were epiretinal membrane (58.7%), intravitreal hemorrhage (26.1%), and vitreomacular traction (8.7%), retinal detachment (4.3%), and other cause (4.3%). Median duration of macular edema was 3 years. Median interval between vitrectomy and first visit was 9 months. Thirty eyes were non-naïve and received previously thermal laser (44.3%), intravitreal injection of triamcinolone (26.7%), of ranibizumab (70%), of dexamethasone implant (36.7%), or bevacizumab (6.7%). Data was available for 35 eyes at 1 year. Visual gain was significant, +6 letters (p < 0.001) and central subfield thickness (CST) decreased significantly (− 108μm, p < 0.001) at 1 year. Mean number of injections was 9.3 and mean interval injection was 5.8 weeks.Conclusion: These results suggest that IAI may be beneficial in vitrectomized eyes with refractory DME which require frequent injections to obtain visual and anatomical improvement.Clinical Trial Registration: http://www.clinicaltrials.gov, registration Number NCT02874859.Keywords: aflibercept, diabetic macular edema, DME, vitrectomy, anti-VEGF

Thi Ha Chau Tran,1 Stephane Verdun,2 Jean François Le Rouic,3 Joel Uzzan,4 Solange Milazzo5 ,† Laurent Kodjikian,6 Ali Erginay7 1Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, INSERM, U1172, Lille, France; 2Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille, France; 3Institut d’Ophtalmologie de l’Ouest, Nantes, France; 4Clinique Mathilde, Rouen, France; 5Ophthalmology Department, Picardie Jules Verne University, Amiens, France; 6Ophthalmology Department, Hospice Civils de Lyon, Lyon 1 University, UMR-CNRS 5510, Lyon, France; 7Ophthalmology Department, Lariboisière Hospital, Paris University, Paris, France†Solange Milazzo passed away on March 23, 2019Correspondence: Thi Ha Chau Tran, Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, INSERM, Boulevard de Belfort – BP387. 59020 Lille Cedex, U1171, France, Tel +33 3 20 87 74 42, Fax +33 20 87 75 58, Email tran.hachau@ghicl.netPurpose: To evaluate the efficacy of intravitreal aflibercept injection (IAI) for vitrectomized eyes with diabetic macular edema (DME) at two years.Methods: This is a prospective, non-comparative, multicenter observational study including diabetic patients with visual acuity between 20/400 to 20/40 due to DME, who have undergone vitrectomy at least 3 months before the first aflibercept injection. Treatment protocol included 5 monthly aflibercept injection followed by a ProReNata regimen during the first year. Participants were managed at clinicians’ discretion using Treat and Extend or Observe and Plan regimen during the second year. Visual acuity, OCT findings and number of IAI were assessed at two years.Results: Available data for 28 eyes with DME previously vitrectomized treated with aflibercept intravitreal injection during at least 2 years were collected. Visual gain was +5.4 letters (p = 0.01), and central macular thickness decreased significantly − 62μm, p < 0.001) at 2 years. Resolution of macular edema allowing discontinuation of aflibercept was observed in 7 eyes (15%). Mean number of injections was 14.6, and mean interval injection was 6.4 weeks for 2 years.Conclusion: These results suggest that IAI is beneficial in vitrectomized eyes leading to improvement of visual and anatomical outcome which was maintained for 2 years.Keywords: aflibercept, diabetic macular edema, vitrectomy, anti-VEGF

A step-by-step description of a surgical technique for episcleral Miragel buckle removal is reported. After dissection of the conjunctiva and the capsule surrounding the Miragel element, the extremity of the buckle is pulled out with a cryoprobe. The removal of Miragel episcleral buckle with the cryoprobe is a safe and effective technique with a low fragmentation rate and a reduction of the surgical risk related to the use of sharp forceps near a possibly weakened sclera. Procedure time seems also to be reduced.