Search Results (121)

Background: Secondary epiretinal membrane (ERM) is a common complication of diabetic retinopathy, but data on surgical outcome is limited. The aim of this study was to evaluate anatomical and functional outcomes after pars plana vitrectomy with ERM peeling in eyes with diabetic retinopathy. Methods: A retrospective analysis was conducted on 87 eyes of 87 consecutive patients with diabetic retinopathy who underwent ERM peeling over a ten-year period (04/2013–11/2022). Collected data included demographics, best-corrected visual acuity (BCVA), stage of diabetic retinopathy, and optical coherence tomography parameters such as central subfield retinal thickness (CSRT), macular volume (MV), and presence of hyperreflective foci, subretinal fluid, and intraretinal fluid. Statistical analyses were performed using a paired t-test and the Wilcoxon test. Results: The majority of patients had type 2 diabetes (96.6%), and 69.0% presented with diabetic macular edema (DME). The mean follow-up was 2.2 ± 2.0 years. Significant postoperative reductions were observed in CSRT (from 377.20 ± 99.28 µm to 337.99 ± 113.834 µm; p = 0.008) and MV (from 10.11 ± 1.46 mm³ to 99.28 ± 1.07 mm³; p < 0.001). No significant changes in BCVA were observed across the entire study cohort. ERM recurrence was rare (2.3%), and no major complications occurred. Conclusions: ERM peeling in diabetic eyes leads to significant anatomical improvement, especially in advanced diabetic retinopathy and DME, but with limited functional gains. The surgical indication should be carefully considered. Full article

Background: Epiretinal membrane (ERM) and proliferative diabetic retinopathy (PDR) belong to the group of vitreoretinal diseases, characterized by impairments at both the retina and the vitreous. The non-diabetic and diabetic forms of ERM (no-dERM and dERM) as well as the PDR are caused by microvascular disorder, which frequently occurs in association with inflammation and oxidative stress. To better characterize no-dERM, dERM, and PDR at the biomolecular level, we compared the expression of inflammatory, oxidative, lipidic peroxidation products, and complement receptors. Methods: Twenty-seven ocular fluids from patients who underwent phaco-vitrectomy were categorized as no-dERM (9, 4M/5F; 70.4 ± 6.4), dERM (6, 3M/3F; 73.2 ± 4.9), and PDR (6, 5M/1F; 63.7 ± 7.4). Six cataracts (CTR; 3M/3F; 77.7 ± 9.0) were collected for internal control of aqueous cells. Results: In aqueous cells, p65NFkB, iNOS, Nox1/Nox4, and Nrf2 were significantly upregulated, and Keap1 was downregulated in dERM compared with PDR and no-dERM. In aqueous cells, a significant upregulation for C3aR1mRNA, C5aR1mRNA, and CFHmRNA were observed in dERM. In vitreous, C3a, C5b9, and MDA levels were significantly increased in dERM compared with PDR and no-dERM. Conclusions: Inflammatory and ROS products, as well as C3aR1/C5aR1 and soluble MDA, appear of great interest, as their expression in aqueous and vitreous might have potential prognostic and therapeutic values. Full article

This pilot study explored whether the ceruloplasmin (CP) and ferritin (FT) levels in ocular fluids could serve as biomarkers for early neurodegenerative diseases (Alzheimer’s, Parkinson’s, and other dementias). CP and FT are known to modulate neurodegenerative tissue responses. We analysed aqueous and vitreous samples from 26 patients (8M/18F, aged 60–85) who were undergoing elective vitreoretinal (VR) surgery. Of these, 14 had idiopathic epiretinal membranes (ERMs), 6 had idiopathic macular holes (MH), and 6 were patients with Alzheimer’s disease (AD) who presented with VR disorders (VRDs). CP, FT, and selected neuroinflammatory mediators such as interferon γ (IFN-γ), interleukin (IL-6), vascular endothelial growth factor (VEGF), nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) were quantified. Odds ratio analysis was applied to assess the CP/FT ratio’s association with subretinal drusen. We found distinct CP and FT profiles in VRD samples. In aqueous fluid, the CP increased and the FT decreased in early-stage ERM, which reduced the CP/FT ratio. Similar patterns were observed in vitreous fluid. The CP levels correlated with the VEGF (aqueous), IL-4 (vitreous), NGF, and BDNF levels; FT correlated with IL-6 and NGF. A higher CP/FT ratio was associated with increased risk for neurodegenerative conditions. Our findings support the quantification of CP and FT in ocular fluids as a promising approach for identifying early neurodegenerative changes and suggest that the CP/FT ratio may be linked to drusen imaging and clinical neurodegenerative history. Full article

Background/Objectives: Inherited retinal diseases (IRDs) are a heterogeneous group of rare eye disorders characterized by progressive photoreceptor degeneration, leading to severe visual impairment or even blindness. This study aims to investigate the prevalence, types, and clinical significance of ophthalmic comorbidities in Portuguese patients with IRDs. Methods: This nationwide Portuguese population-based retrospective study was based on the IRD-PT registry (retina.com.pt). Statistical analysis was conducted using Microsoft^® Excel^® for Microsoft 365 and IBM SPSS Statistics version 29.0.2.0. Informed consent was obtained from all participants. Results: A total of 1531 patients (1254 families) from six centers were enrolled. The cohort consisted of 51% males, with a mean age of 45.8 ± 19.3 years and a mean age at diagnosis of 39.4 ± 19.5 years. Overall, ocular comorbidities were reported in 644 patients (42.1%). In 176 individuals (11.5%), multiple concurrent comorbidities were found. Cataract was the most common comorbidity (21.3%), followed by amblyopia (6.3%) and high myopia (5.9%). Statistically significant associations with ocular comorbidities were observed in isolated progressive IRDs. Specifically, AR RP was associated with cataract (p < 0.001), and gene analysis revealed several significant associations. CRB1 was statistically linked to epiretinal membrane (ERM) (p = 0.003), EYS with cataract (p = 0.001), PROM1 with choroidal neovascularization (CNV) (p = 0.0026), and USH2A with macular hole (p = 0.01). Patients with the RPE65 mutation in Leber congenital amaurosis were associated with ERM (p = 0.019). There was also a significant association between X-linked RP and high myopia (p < 0.001) and CNV in Best disease (p < 0.001); in syndromic IRDs, cataract, cystoid macular edema, and ERM were observed in Usher syndrome, p = 0.002, p = 0.002, and p = 0.005, respectively, and the MYO7A gene was linked to cataract (p = 0.041) and strabismus (p = 0.013); pseudoxanthoma elasticum was significantly associated with CNV (p = 0.002); and foveal hypoplasia was associated with anterior segment dysgenesis (p < 0.001). Conclusions: This study enhances the current understanding of ocular comorbidities in IRDs in Portuguese patients. Common findings were cataract, refractive error, and CME. Stationary IRDs and pattern dystrophies showed fewer concomitant comorbidities, supporting their classification as non-progressive or benign conditions. The significance of registries like IRD-PT cannot be overstated, particularly in the context of rare diseases. These databases serve multiple crucial functions in enabling detailed documentation of disease characteristics and long-term monitoring of disease progression. Full article

Background/Objectives: The role of the vitreous in the effective lens position (ELP) is controversial in patients undergoing phacovitrectomy. The aim of this study was to compare the change in aqueous depth (AD), a surrogate of the ELP, in non-vitrectomized and vitrectomized fellow eyes. Methods: Post-hoc analysis of a prospective study conducted in OMIQ facilities (Barcelona, Spain) between 2021 and 2023. Patients with bilateral cataracts and a unilateral grade 2/3 epiretinal membrane underwent phacoemulsification in one eye and phacovitrectomy without endotamponade in the fellow eye. All eyes were implanted with an extended depth-of-focus intraocular lens after power calculation using the same biometer, technicians, formula, and surgeon. We compared the change in AD (mm and percentage) from baseline, and the role of vitrectomy without endotamponade on AD with a mixed-effects models. Results: We included 40 eyes (20 patients) with a mean age of 71.6 years, with 55% females. The mean change in AD was +1.51 (vitrectomized) and +1.42 mm (non-vitrectomized eyes), p = 0.33. The percent of change in AD was not different between groups (p ≥ 0.38) and phacovitrectomy had no effect on the change in AD on mixed-effects models (p > 0.10). Conclusions: The absence of the vitreous had a minimal influence on AD in these patients undergoing standard phacoemulsification or phacovitrectomy. Full article

Background/Objectives: Uncontrolled or long-standing diabetes can lead to proliferative diabetic retinopathy (PDR), a condition that significantly impairs vision. A subset of patients does not respond adequately to conventional therapies, such as intravitreal injections of anti-vascular endothelial growth factor (VEGF) or laser treatment. This study aims to identify potential biomarkers for alternative treatment pathways in the vitreous and blood of patients with severe PDR. Methods: Vitreous samples were collected from PDR patients (n = 3) undergoing vitrectomy for vitreous hemorrhage and from control patients (n = 9) undergoing ocular surgery for epiretinal membrane or macular holes. Blood samples were collected from a separate group of PDR patients (n = 13) and non-diabetic control patients without retinopathy (n = 13). Medical histories were obtained. Two-stage real-time quantitative polymerase chain reaction (qPCR) was used to evaluate mRNA expression levels of genes potentially implicated in PDR, including HIF2A, PAI-1, TIE1, TIE2, ANGPT2, and VEGFA. Molecular and statistical analyses were performed to compare PDR and control vitreous and blood samples. Results: The PDR vitrectomy group included two females and one male, aged 71–77 years (mean 74 years). All participants had undergone pan-retinal photocoagulation and two had received anti-VEGF injections before vitrectomy. These participants had elevated HbA1c levels. Targeted vitreous gene analysis revealed varying levels of increased expression of all genes examined as compared to the control group. A trend for increased median expression was demonstrated for all examined genes: HIF2A by 1.44-fold (PDR = 2.50, control = 1.74, p = 0.21), PAI-1 by 1.56-fold (PDR = 3.00, control = 1.93, p = 0.37), TIE1 by 1.36-fold (PDR = 2.33, control = 1.72, p = 0.66), TIE2 by 2.06-fold (PDR = 2.81, control = 1.36, p = 0.51), ANGPT2 by 2.93-fold (PDR = 6.32, control = 2.16, p = 0.1), and VEGFA by 3.53-fold (PDR = 3.51, control = 0.99, p = 0.08). PDR blood sample analysis as compared to controls showed a trend for increased expression of VEGFA by 1.2-fold (PDR = 0.88, control = 0.74, p = 0.57), whereas the other examined genes showed a trend of reduced expression; HIF2A decreased by 0.50-fold (PDR = 0.38, control = 0.75, p = 0.07), PAI by 0.51-fold (PDR = 0.35, control = 0.69, p = 0.09), TIE-1 by 0.79-fold (PDR = 0.79, control = 1.00, p = 0.54), TIE-2 by 0.70-fold (PDR = 0.58, control = 0.82, p = 0.34), and ANGPT2 by 0.45-fold (PDR = 0.51, control = 1.15, p = 0.11). Conclusions: Vitreous sample analysis revealed a trend of increased mRNA expression of ANGPT2 and VEGFA in patients with PDR. Blood sample analysis did not show a significant increase of VEGFA mRNA expression but a decreased trend of HIF2A, PAI-1, and ANGPT2 mRNA expression. These trends warrant validation in a larger cohort to explore alternative pathways for targeted treatment. Full article

Background: The vitreomacular interface (VMI) encompasses a group of retinal disorders that significantly impact vision, requiring accurate classification for effective management. This study aims to compare the effectiveness of an expert-designed custom deep learning (DL) model and a code free Auto Machine Learning (ML) model in classifying optical coherence tomography (OCT) images of VMI disorders. Materials and Methods: A balanced dataset of OCT images across five classes—normal, epiretinal membrane (ERM), idiopathic full-thickness macular hole (FTMH), lamellar macular hole (LMH), and vitreomacular traction (VMT)—was used. The expert-designed model combined ResNet-50 and EfficientNet-B0 architectures with Monte Carlo cross-validation. The AutoML model was created on Google Vertex AI, which handled data processing, model selection, and hyperparameter tuning automatically. Performance was evaluated using average precision, precision, and recall metrics. Results: The expert-designed model achieved an overall balanced accuracy of 95.97% and a Matthews Correlation Coefficient (MCC) of 94.65%. Both models attained 100% precision and recall for normal cases. For FTMH, the expert model reached perfect precision and recall, while the AutoML model scored 97.8% average precision, and 97.4% recall. In VMT detection, the AutoML model showed 99.5% average precision with a slightly lower recall of 94.7% compared to the expert model’s 95%. For ERM, the expert model achieved 95% recall, while the AutoML model had higher precision at 93.9% but a lower recall of 79.5%. In LMH classification, the expert model exhibited 95% precision, compared to 72.3% for the AutoML model, with similar recall for both (88% and 87.2%, respectively). Conclusions: While the AutoML model demonstrated strong performance, the expert-designed model achieved superior accuracy across certain classes. AutoML platforms, although accessible to healthcare professionals, may require further advancements to match the performance of expert-designed models in clinical applications. Full article

Background/Objectives: To evaluate the clinical efficacy and safety of combined phacoemulsification, extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and epiretinal membrane (ERM) peeling during vitrectomy surgery for treating patients with ERM, cataracts, and presbyopia. Methods: Patients with preexisting low-grade ERM who underwent cataract surgery with the implantation of an EDOF IOL were included. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), autorefraction and keratometry, manifest refraction, and central foveal thickness (CFT) were measured before surgery and at postoperative months 3 and 6. A monocular defocus curve was measured 6 months postoperatively. Furthermore, patients were instructed to report symptoms of photic phenomena at each visit. Results: In total, 16 eyes of 16 patients (median age, 59.5 years) were included in this study. Compared with those at baseline, the CDVA, UDVA, UIVA, UNVA, and CFT significantly improved at 3 and 6 months postoperatively. The defocus curve revealed that a visual acuity of 0.12 logarithm of the minimal angle of resolution or better was maintained from +0.5 to –1.5 diopters. No patients reported visual disturbances suggestive of photic phenomena, such as glare or halo. Conclusions: EDOF IOL implantation had excellent outcomes, including improved distance and intermediate visual acuity, functional near visual acuity, and absence of visual symptoms in patients who received phacovitrectomy to treat low-grade ERM. Full article

Objectives: This study aimed to investigate the possible relationship between aortic stenosis (AS) occupancy and the incidence of subsequent macular diseases. Methods: A retrospective cohort study was conducted using the TriNetX database, and participants with AS were enrolled and matched to non-AS participants. A total of 421,860 and 421,860 participants were evenly divided into the AS and non-AS groups, respectively. The major outcomes of the present study include the development of age-related macular degeneration (AMD), retinal vascular occlusion (RVO), epiretinal membrane (ERM), and central serous chorioretinopathy (CSC). Cox proportional hazard regression was utilized for statistical analysis. Results: There were 4426 and 3013 AMD events; 7315 and 4753 RVO events; 2780 and 1910 ERM events; and 113 and 64 CSC events in the AS and non-AS groups, respectively. According to the results of Cox proportional hazard regression analysis, the AS group demonstrated significantly higher incidences of all macular diseases, including AMD, RVO, ERM, and CSC, compared to the non-AS group (all p < 0.05). The cumulative probabilities of all macular diseases were significantly higher in the AS group than in the non-AS group (all p < 0.05). In the sensitivity analysis, the developmental risks of AMD were significantly higher in the AS group than in the non-AS group with all traits. Conclusions: This study determined that AS occupancy is related to a higher risk of developing macular diseases, which positively correlated to the disease time of AS. Full article

Background/Objectives: Spontaneous macular hole closure is a rare phenomenon, with lamellar hole epiretinal proliferation (LHEP) frequently implicated as a potential mechanism. This study aims to analyze the presence of LHEP in patients with full-thickness macular holes (FTMHs) or lamellar macular holes (LMHs) that closed spontaneously without intervention. Methods: A retrospective longitudinal analysis of optical coherence tomography (OCT) scans was conducted for 73 patients diagnosed with FTMH or LMH in a single institution. Patients with documented spontaneous hole closure were further analyzed for the presence of LHEP, other OCT findings, and clinical characteristics. Results: Of the 73 patients, eight (11%) exhibited spontaneous closure of their macular holes. LHEP was identified in all cases, regardless of hole type (FTMH or LMH). Associated OCT features on diagnosis included VMT in one eye (13%), partial or complete posterior vitreous detachment in seven eyes (88%) and epiretinal membrane in eight eyes (100%). During hole closure, an outer nuclear layer bridge was noted in six eyes (75%). Various extents of outer retinal recovery were noted following closure. After closure, five holes (63%) remained closed without further intervention, while three (38%) reopened and required surgical intervention. Conclusions: Spontaneous macular hole closure is strongly associated with the presence of LHEP, highlighting its potential role in retinal repair mechanisms. While in most patients the spontaneous closure is permanent, surgical intervention may be necessary in cases of hole recurrence. Full article

Background: Rhegmatogenous retinal detachment (RRD) is an ophthalmological emergency that can lead to vision loss if left untreated. Pars plana vitrectomy (PPV) is the preferred procedure for most complex RRD cases with a high success rate. However, certain parameters related to the patient, disease history, or ocular presentation may influence surgical outcomes. Methods: A systematic review of studies from 2010 to 2023 was conducted using PubMed/Medline (National Library of Medicine, Bethesda, MD, USA) and Scopus (Elsevier, Netherlands). The main objective of this review is to present the most significant data published in the scientific literature over the last 10 years, focusing on the latest implications of prognostic factors affecting the success of PPV in RRD. The search included terms such as “prognostic factors”, “visual outcome”, “functional outcome”, and “rhegmatogenous retinal detachment”. The database search returned 3489 studies. The included studies had to involve participants with RRD treated mainly by PPV, a minimum of 10 participants, and at least a 6-month follow-up period. Studies were excluded if they involved patients with previous PPV treatment or trauma. After reviewing their abstracts, titles, and applying the exclusion criteria, 19 articles were selected. Because it is an ample and interesting topic, many authors explored the connection between prognostic factors involved in the management of RRD and the final visual and functional outcomes. Methodological quality was assessed using PRISMA guidelines. Results: various factors have been studied, ranging from classic ophthalmological parameters, such as refractive error, axial length, lens status, visual acuity, duration of symptoms, description of the RRD, and retinal tears, to more complex findings on optical coherence tomography. Conclusions: The factors that significantly influenced postoperative prognosis in RRD included preoperative best-corrected visual acuity (BCVA), duration of symptoms, macular status (on/off), extent of retinal detachment, presence of macular hole, and proliferative vitreoretinopathy (PVR). Disruption of the ellipsoid zone (EZ), presence of epiretinal membrane (ERM), and lack of external limiting membrane (ELM) integrity were associated with poorer outcomes following RRD surgery. Full article

(1) Background: The process of epiretinal membrane peeling (MP) requires precise intraoperative visualization to achieve optimal surgical outcomes. This study investigates the integration of preoperative Optical Coherence Tomography (OCT) images into real-time surgical video feeds, providing a dynamic overlay that enhances the decision-making process during surgery. (2) Methods: Five MP surgeries were analyzed, where preoperative OCT images were first manually aligned with the initial frame of the surgical video by selecting five pairs of corresponding points. A homography transformation was then computed to overlay the OCT onto that first frame. Subsequently, for consecutive frames, feature point extraction (the Shi–Tomasi method) and optical flow computation (the Lucas–Kanade algorithm) were used to calculate frame-by-frame transformations, which were applied to the OCT image to maintain alignment in near real time. (3) Results: The method achieved a 92.7% success rate in optical flow detection and maintained an average processing speed of 7.56 frames per second (FPS), demonstrating the feasibility of near real-time application. (4) Conclusions: The developed approach facilitates enhanced intraoperative visualization, providing surgeons with easier retinal structure identification which results in more comprehensive data-driven decisions. By improving surgical precision while potentially reducing complications, this technique benefits both surgeons and patients. Furthermore, the integration of OCT overlays holds promise for advancing robot-assisted surgery and surgical training protocols. This pilot study establishes the feasibility of real-time OCT integration in MP and opens avenues for broader applications in vitreoretinal procedures. Full article

Background: We aimed to develop a tablet-based written examination system (Implementing digitization in assessment for metamorphopsia: IDAM) to quantify metamorphopsia severity and monitor changes after treatment in patients with epiretinal membrane (ERM) and central serous chorioretinopathy (CSC). Methods: This prospective study included 33 eyes from 31 patients with ERM or CSC. Patients used a tablet and stylus to illustrate perceived line distortions with IDAM. IDAM displayed a grid at a size of 20° × 20° (771 × 771 pixels), and patients depicted any distortions that they perceived in the presented lines. Metamorphopsia scores were calculated by summing the line deviation distances. Scores and distortion areas were compared before and three months after treatment. Results: Thirty eyes had baseline metamorphopsia on IDAM. The average pretreatment IDAM scores were 196,598 pixels (ERM) and 98,414 pixels (CSC). IDAM and M-charts scores were correlated (r = 0.38, p = 0.03). IDAM scores improved post-treatment in both groups (both p < 0.001). Distortion areas decreased from 6.6 to 4.2 (p = 0.0049). Conclusions: IDAM allowed quantitative metamorphopsia evaluation and detected treatment responses. This tablet-based system could facilitate at-home monitoring in macular disorders. Full article

Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition involving retinal detachment and the accumulation of fluid in the subretinal space. Proliferative vitreoretinopathy (PVR) is a pathologic complication that develops after RRD surgery, and approximately 5–10% of RRD cases develop post-operative PVR. Prolonged inflammation in the wound healing process, epithelial–mesenchymal transition (EMT), retinal pigment epithelial (RPE) cell migration and proliferation, and epiretinal, intraretinal, and subretinal fibrosis are typical in the formation of PVR. RPE cells undergo EMT and become fibroblast-like cells that migrate to the retina and vitreous, promoting PVR formation. Fibroblasts transform into myofibroblasts, which promote fibrosis by overproducing the extracellular matrix (ECM). RPE cells, fibroblasts, glial cells, macrophages, T lymphocytes, and increased ECM production form contractile epiretinal membranes. Cytokine release, complement activation, RPE cells, glial cells, and endothelial cells are all involved in retinal immune responses. Normally, wounds heal within 4 to 6 weeks, including hemostasis, inflammation, proliferation, and remodeling phases. Properly initiated inflammation, complement activation, and the function of neutrophils and glial cells heal the wound in the first stage. In a retinal wound, glial cells proliferate and fill the injured area. Gliosis tries to protect the neurons and prevent damage, but it becomes harmful when it causes scarring. If healing is complicated, prolonged inflammation leads to pathological fibrosis. Currently, there is no preventive treatment for the formation of PVR, and it is worth studying in the future. Full article

Background: In this study, we evaluated the incidence of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for different retinal pathologies and assessed the role of optical coherence tomography (OCT) biomarkers in guiding treatment decisions in post-surgical CME patients who were refractory to medical therapy over a follow-up period of 12 months. Methods: Medical records of consecutive pseudophakic patients, who underwent PPV for different retinal pathologies, were retrospectively evaluated in this single-center, uncontrolled study. The incidence of post-PPV CME was assessed. Eyes with post-PPV CME in the first 2 months after surgery, with available clinical and OCT data for 12 months after surgery, were included in the evaluation. The mean best-corrected visual acuity (BCVA; logMAR), mean central macular thickness (CMT; μm) change, and response to different treatments [medical therapy and intravitreal dexamethasone (DEX) implant] were evaluated 1, 3, 6, 9, and 12 months after PPV. The impact of OCT biomarkers on the exposure to DEX implants was assessed. Adverse events, potentially related to the treatment, were investigated as well. Results: Of the 346 pseudophakic patients (352 eyes) who participated in this study, 54 (54 eyes) developed CME within the first 2 months after PPV (incidence of 15.3%). Among them, 48 patients were deemed eligible for the 12-month analysis. Preoperative mean BCVA (1.44 ± 0.99 logMAR) significantly improved to 0.32 ± 0.37 logMAR after 12 months (p < 0.001). The mean baseline CMT of 347 (±123.5) μm significantly decreased to 290 μm (±80.4; p = 0.003) by the end of the follow-up. Twenty-five eyes (52%) required one or more DEX implants for CME, due to being refractory to topical therapy. Significant correlations were found between the mean CMT values at various time points. Additionally, patients who required DEX implants at months 3 and 9 were more likely to present intraretinal fluid (IRF), disorganization of inner retinal layers (DRIL), disorganization of outer retinal layers (DROL), and hyper-reflective foci (HRF) at 1-month OCT. Five patients experienced a slight increase in intraocular pressure (IOP), which was successfully managed with topical medication. Conclusions: Topical therapy alone can be a valuable option for post-PPV CME in approximately 50% of patients. Significant visual recovery and macular thickness reduction at 12 months demonstrated that DEX implants can be a safe and effective second-line treatment for pseudophakic patients with post-PPV CME and who are refractory to medical therapy. Early post-surgical OCT biomarkers may indicate a more severe CME that might benefit from the steroid implant. Full article