Search Results (38)

Background: To compare tilt and decentration results of two scleral fixation intraocular lens (IOL) methods of four-point scleral fixation (Akreos AO60) and the Yamane technique (AcrySof MA60AC). Methods: Two groups were compared in terms of IOL decentration and tilt at day 30 and 2 years after surgery. Correlations between IOL tilt and decentration and previous pars plana vitrectomy (PPV), axial length (AL), refractive error (RE), astigmatism, and spherical equivalent (SE) were also analyzed. Results: This study included 50 eyes from 47 patients: four-point fixation in 25 eyes (group 1) and Yamane technique in 25 eyes (group 2). The mean horizontal tilt was 1.66° ± 1.45° in group 1 and 5.06° ± 4.65° in group 2. The horizontal tilt value was significantly higher (p < 0.05) in group 2. The mean vertical tilt for group 1 and group 2 at two year’s observation was 1.74° ± 2.16° and 3.09° ± 2.79° respectively (p = 0.02). The mean horizontal IOL decentration was 0.35 ± 0.32 mm in group 1 and 0.34 ± 0.26 mm in group 2 (p > 0.05). The mean vertical IOL decentration in group 1 was 0.34 ± 0.33 mm and in group 2 it was 0.27 ± 0.20 mm respectively (p = 0.45). No statistically significant changes in tilt and decentration time were demonstrated in both groups (p > 0.05). There was no statistically significant correlation between IOL tilt and decentration and previous PPV in both groups. Conclusions: Both techniques provide good centration and stability IOL in aphakic eyes in the absence of capsular support. Full article

Background/Objectives: Refractory macular holes (MHs) that persist after conventional internal limiting membrane (ILM) peeling pose a significant surgical challenge. In this study, we analyzed the anatomical and functional outcomes of epiretinal human amniotic membrane (hAM) transplantation in patients with MHs. Methods: This retrospective study included 10 eyes of 10 patients with refractory MHs. All patients underwent 25-gauge pars plana vitrectomy, epiretinal cryopreserved hAM transplantation, and C3F8 gas tamponade. The large hAM graft was placed over the macula with the stromal side facing the retina. Preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings, and MH dimensions were recorded. Results: The mean follow-up period was 7 months (range: 3–14 months). The mean preoperative minimum linear diameter and base diameter of the MHs were 715 ± 212 μm and 1114 ± 258 μm, respectively. Anatomical closure was achieved in all patients (100%). Postoperative OCT revealed rearrangement of the inner and other retinal layers in 7 out of 10 patients (70%), with partial restoration of the outer retinal layers. The mean logMAR BCVA improved significantly from 1.60 ± 0.37 preoperatively to 1.00 ± 0.45 postoperatively (p < 0.001). No graft dislocation, rejection, or other significant complications were observed. Conclusions: Our preliminary results suggest that epiretinal human amniotic membrane transplantation is a feasible and promising surgical technique for achieving anatomical closure and functional improvement in refractory macular holes in which conventional ILM peeling has failed. Full article

Background and Clinical Significance: Macular holes are rare in pediatric patients and most often result from blunt trauma, commonly from soccer-related injuries. These cases present unique challenges due to delayed presentation, tightly adherent hyaloid layers, and difficulties with postoperative positioning. Larger, chronic macular holes have low spontaneous closure rates and poorer surgical outcomes, necessitating advanced surgical approaches. Herein we report a case of chronic traumatic macular hole in a pediatric patient that closed with an internal limiting membrane (ILM) flap surgical technique with silicone oil tamponade. Case Presentation: A 15-year-old male patient presented with a history of blunt ocular trauma from a soccer ball one year prior, resulting in a large chronic macular hole. The decision was made to perform pars plana vitrectomy with an inverted ILM flap technique and silicone oil tamponade. To stabilize the ILM flap and prevent displacement, a novel technique involving the placement of a single drop of silicone oil on the retinal surface prior to complete silicone oil fill was employed. This “silicone oil drop” technique allowed for smoother propagation of the oil over the flap, effectively securing it without the need for additional manipulation or perfluorocarbon liquid. Postoperatively, the macular hole was closed, and the patient’s vision improved. Conclusions: This case highlights the potential benefits of the ILM flap technique in treating pediatric macular holes with utilization of silicone oil as not only a tamponade but as a method to stabilize the flap. Full article

Background/Objectives: Ocular graft-versus-host disease (oGVHD) is a chronic, immune-mediated complication of allogeneic hematopoietic stem cell transplantation that can progress to corneal ulceration or perforation. These cases are often refractory to standard therapy and present a high risk of graft failure after keratoplasty. We report a case of oGVHD-related corneal perforation successfully managed with a novel amniotic membrane-assisted “envelope” technique during corneal transplantation. Case Report: A 42-year-old man with chronic oGVHD and a full-thickness corneal perforation underwent urgent repair with a lamellar patch graft completely wrapped in cryopreserved amniotic membrane, followed by penetrating keratoplasty (PKP) using an amniotic membrane envelope surrounding the donor lenticule. Results: The amniotic membrane provided a 360° biological barrier that isolated graft antigens from the inflammatory environment while supporting epithelial healing and stromal remodeling. Despite recurrent inflammatory episodes and multiple procedures—including cataract extraction, pars plana vitrectomy, and multilayer amniotic membrane transplantation—the graft remained clear and stable at 12-month follow-up, achieving a best-corrected visual acuity of 20/40. Conclusions: The amniotic membrane envelope technique may represent a valuable adjunct in managing high-risk corneal perforations secondary to oGVHD. By combining immune modulation and regenerative support, this approach can enhance tectonic stability, reduce rejection risk, and promote durable surface recovery, potentially delaying or avoiding keratoprosthesis in refractory cases. Full article

Uveitis constitutes a heterogeneous group of intraocular inflammatory pathologies, including both infectious and non-infectious aetiologies, often leading to substantial morbidity and permanent loss of vision in up to 20% of the affected cases. Visual impairment is most prominent in intermediate, posterior, or panuveitis and is commonly associated with cystoid macular oedema, epiretinal membranes, macular holes, and retinal detachment. In the context of uveitis, these complications arise as a result of recurrent flare-ups or chronic inflammation, contributing to cumulative ocular damage. Pars plana vitrectomy (PPV) has an evolving role in the diagnostic and therapeutic approach to uveitis. Diagnostic PPV allows for the analysis of vitreous fluid and tissue using techniques such as PCR, flow cytometry, cytology, and cultures, providing further insights into intraocular immune responses. Therapeutic PPV can be employed for the management of structural complications associated with uveitis, in a wide spectrum of inflammatory clinical entities such as Adamantiades–Behçet disease, juvenile idiopathic arthritis, acute retinal necrosis, or ocular toxoplasmosis. Modern small-gauge and minimally invasive techniques improve visual outcomes, reduce intraocular inflammation, and may decrease reliance on systemic immunosuppression. Emerging technologies, including robot-assisted systems, are expected to enhance surgical precision and safety in the future. Despite these advances, PPV outcomes remain variable due to heterogeneity in indications, surgical techniques, and postoperative management. Prospective studies with standardized protocols, detailed subgroup analyses, and the integration of immunological profiling are needed to define which patients benefit most, optimize therapeutic strategies, and establish predictive biomarkers in uveitis management. Full article

Background: Submacular hemorrhage (SMH) is a vision-threatening condition most associated with neovascular age-related macular degeneration (nAMD), although it may also arise from polypoidal choroidal vasculopathy, pathological myopia, retinal vascular diseases, trauma, and systemic factors. Rapid management is essential because subretinal blood induces photoreceptor toxicity, clot organization, and fibroglial scarring, leading to irreversible visual loss. The choice and urgency of treatment depend on hemorrhage size, duration, and underlying pathology, and the patient’s surgical risk category, which can influence the invasiveness of the selected procedure. This review aims to provide an updated synthesis of recent advances in the surgical and pharmacological management of SMH, focusing on evidence from the past five years and comparing outcomes across major interventional approaches. Methods: A narrative review of 27 recent clinical and multicentre studies was conducted. The included literature evaluated pneumatic displacement (PD), pars plana vitrectomy (PPV), subretinal or intravitreal recombinant tissue plasminogen activator (rtPA), anti-VEGF therapy, and hybrid techniques. Studies were analyzed about indications, surgical methods, timing of intervention, anatomical and functional outcomes, and complication and patient risk stratification. Results: Outcomes varied depending on the size and duration of hemorrhage, as well as the activity of underlying macular neovascularization. PD with intravitreal rtPA was reported as effective for small and recent SMH. PPV combined with subretinal rtPA, filtered air, and anti-VEGF therapy demonstrated favorable displacement and visual outcomes in medium to large hemorrhages or those associated with active nAMD. Hybrid techniques further improved clot mobilization in selected cases. Across studies, delayed intervention beyond 14 days correlated with reduced visual recovery due to blood organization and photoreceptor loss. Potential risks, including recurrent bleeding and rtPA-associated toxicity, were reported but varied across studies. Conclusions: Management should be individualized, considering hemorrhage characteristics and surgical risk. Laser therapy, including PDT, may serve as an adjunct in the perioperative or postoperative period, particularly in PCV patients. Early, tailored intervention typically yields the best functional outcomes. Full article

Background/Objectives: The optimal surgical approach for treating myopic tractional maculopathy (MTM) with retinal detachment remains unclear, particularly owing to complications associated with standard internal limiting membrane (ILM) peeling techniques and macular buckling procedures. Although the flower-petal inverted ILM flap technique is promising for large macular holes, its effectiveness in MTM without macular holes is less understood. We evaluated visual acuity and anatomical recovery in patients who underwent the flower-petal fovea-sparing inverted ILM flap technique for MTM with retinal detachment for 12 months. Methods: We retrospectively analyzed clinical data on 22 eyes of 22 consecutive patients diagnosed with MTM involving retinal detachment (Stages 3a, 3b, 4a, and 4b) between May 2019 and May 2023. All patients underwent pars plana vitrectomy using the flower-petal fovea-sparing ILM flap technique. Air, C3F8 gas, or silicone oil tamponade was used. Best-corrected visual acuity (BCVA; logMAR), intraocular pressure, axial length, central retinal thickness (CRT), and foveal contour were assessed using optical coherence tomography preoperatively and at 3, 6, and 12 months postoperatively. Results: Mean BCVA (logMAR values) significantly improved (p < 0.021). Mean CRT values significantly decreased (p < 0.001) at 3, 6, and 12 months. No significant differences in surgical outcomes were observed among tamponade materials. One patient who received air tamponade developed a postoperative macular hole. Conclusions: Our findings suggest that the flower-petal fovea-sparing ILM flap technique improves visual function and anatomical outcomes in patients with MTM and retinal detachment. This approach is a promising surgical option for managing MTM with associated retinal detachment. Full article

To assess the outcomes of a modified surgical approach for the treatment of uveal melanoma involving endoresection with intentional residual tumor at the margins, combined with adjuvant ruthenium-106 brachytherapy. This technique aims to reduce surgical morbidity, while preserving visual function and maintaining effective local tumor control and survival. We conducted a retrospective observational study including 33 patients with choroidal melanoma treated between January 2017 and August 2024 at a single tertiary ocular oncology center in Spain. Patients underwent pars plana vitrectomy and endoresection leaving residual tumor followed by ruthenium-106 brachytherapy. Clinical, functional, and oncological outcomes were analyzed, including tumor recurrence, metastasis, visual acuity, complications, and cytogenetic findings. Kaplan–Meier analysis was used to estimate survival and recurrence rates. After a mean follow-up of 41.7 months, local tumor recurrence occurred in 2 patients (6.06%) and enucleation was performed in 1 patient (3.03%). Two patients (6.06%) developed metastases, with one disease-specific death, resulting in a 5-year survival rate of 97%. Visual acuity of 20/200 or better was preserved in 60.61% of patients. The most frequent complications were retinal detachment (36.36%) and macular edema (45.45%). Cytogenetic analysis showed a significant association between chromosome 1p loss and both recurrence and metastasis (p = 0.032). No cases of phthisis bulbi or severe hypotony were observed. This modified endoresection technique with intentional tumor residuals and adjuvant ruthenium-106 brachytherapy offers a safe and function-preserving option for selected patients with choroidal melanoma. It achieves good tumor control and visual outcomes, with a low rate of enucleation and metastasis. Further studies are required to validate its long-term efficacy. Full article

Background: Idiopathic macular holes (MHs) are typically treated with pars plana vitrectomy and internal limiting membrane (ILM) peeling. The inverted ILM flap (ILMF) technique has emerged for MHs, but long-term outcome data remain inadequately established. This study evaluates the long-term functional and anatomical outcomes of the ILMF in idiopathic MHs. Methods: We evaluated 71 consecutive eyes of patients with idiopathic MHs who underwent vitrectomy with the inverted ILMF. Follow-up duration was more than 12 months. Visual acuity was measured, and macular anatomy was monitored with optic coherence tomography (OCT). Long-term visual and anatomical outcomes were defined a priori and analyzed accordingly. Results: Final vision values showed significant improvement compared to preoperative ones, from 1.02 [Snellen Equivalent (SE), 19/200] ± 0.40 logarithm of the minimum angle of resolution (logMAR) to 0.47 (SE, 68/200) ± 0.39 logMAR (p < 0.001). The primary MH closure rates were 94.37% (67/71), while the secondary closure rate reached 97.18% (69/71). Factors associated with better final vision included smaller hole size, favorable hole stage, better preoperative vision, intact postoperative foveal microstructure and contour. The recovery of the external limiting membrane (ELM), inner and outer segment junction (IS/OS), and good foveal contour had improved to 73.4%, 40.3%, and 49.3% at one year and 80%, 71.4%, and 53.3% at three years postoperatively, respectively. Conclusions: In idiopathic MHs, the ILMF approach provides meaningful, long-term visual and microstructural recovery, especially with a favorable functional outcome and intact postoperative microstructure sustaining up to three years. Full article

Background: The hyoid bone is a key anatomical structure involved in the functional coordination of the stomatognathic system. Although its position may vary in response to masticatory patterns, its relationship with functional occlusion remains insufficiently studied in orthodontics. Objective: This pilot study aimed to explore the association between masticatory type and hyoid bone position and to assess the clinical utility of the Functional Masticatory Angle of Planas (AFMP) in classifying masticatory patterns. Materials and Methods: A descriptive, observational, cross-sectional study was conducted with 18 patients. Right and left AFMPs were measured using standardized intraoral photographs, and hyoid bone position was assessed via panoramic radiographs, classified as either aligned or displaced. Measurements were repeated to assess intraobserver reliability. Results: In most cases, hyoid bone elevation occurred on the same side as the smaller AFMP, suggesting a possible adaptive response to unilateral masticatory dominance. High intraobserver agreement was confirmed for both AFMP and hyoid measurements. Conclusions: The findings suggest a potential relationship between functional masticatory asymmetry and hyoid bone position. While further studies with larger samples are needed, the AFMP appears to be a promising tool for evaluating functional occlusion in relation to craniofacial dynamics. Full article

Background: Surgical management of large full-thickness macular holes (MHs) remains challenging, particularly when aiming for both rapid visual recovery and consistent anatomical closure without inducing retinal trauma. This retrospective single-center study evaluated the efficacy of activated conditioned plasma (ACP) as an intraoperative coadjuvant supporting ILM (internal limiting membrane) peeling and air tamponade in the treatment of idiopathic MHs measuring 400–800 µm, under real-time intraoperative optical coherence tomography (i-OCT) guidance. Methods: Seventy eyes from fifty patients underwent pars plana vitrectomy with intraoperative ACP application. ACP, a leukocyte-poor autologous platelet concentrate, was used intraoperatively as a coadjuvant to ILM peeling and air tamponade. It facilitated the formation of a transparent fibrin membrane over the retinal surface, supporting edge approximation and promoting retinal healing. Results: The primary outcome was complete MH closure confirmed by OCT; the secondary outcome was improvement in BCVA on postoperative day 7 and during a 12-month follow-up. Anatomical closure was achieved in 98.6% of cases. On day 7, 78.6% of eyes showed a ≥ three-line BCVA improvement, with mean BCVA increasing from 0.25 ± 0.21 to 0.69 ± 0.20 (p < 0.001). These outcomes remained stable throughout the follow-up. No significant intraoperative or postoperative complications were observed. Conclusions: The combination of ACP and i-OCT appears to be a safe and effective strategy for anatomical foveolar reconstruction, enabling early visual recovery while minimizing inflammation and fibrotic scarring associated with conventional techniques. Full article

Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In a retrospective single-center study, the perioperative data of 100 patients who consecutively received a scleral fixated Carlevale IOL combined with a 25 gauge (G) pars plana vitrectomy between September 2021 and June 2024 were investigated. The intraoperative and postoperative results were analyzed in terms of complication rates and refractive outcomes. Results: IOL dislocation was the most common surgical indication (50%) for sutureless Carlevale IOL implantation, followed by postoperative aphakia in 35 patients (35%). Nearly every fourth patient (24%) had a preoperative traumatic event, and 21% had pseudoexfoliation (PEX) syndrome. The average surgery time was 60.2 (±20.1) min. Intraoperative intraocular hemorrhage occurred in seven cases, and IOL haptic breakage in two patients. Temporary intraocular pressure fluctuations represented the most common postoperative complications (28%). Severe complications such as endophthalmitis or retinal detachment were not observed in our cohort. The mean refractive prediction error was determined in 67 patients and amounted to an average of −0.7 ± 2.0 diopters. The best corrected visual acuity (BCVA) at the last postoperative follow-up showed an improvement of 0.2 ± 0.5 logMAR (n = 76) compared to the preoperative BCVA (p = 0.0002). The postoperative examination was performed in 72% of the patients, and the mean follow-up period amounted to 7.2 ± 6.4 months. Conclusions: Overall, sutureless and scleral fixated implantation of the Carlevale IOL represents a valuable therapeutic option in the treatment of aphakia and lens as well as IOL dislocation in the absence of capsular bag support with minor postoperative complications and positive refractive outcomes. Full article

Objectives: Intraocular lens dislocation is a well-recognized complication of cataract surgery, necessitating secondary interventions such as retropupillary iris-claw IOL implantation. While effective, this procedure requires larger incisions that may induce significant astigmatism. This study aimed to (1) evaluate anterior chamber changes following retropupillary ICIOL implantation and (2) compare surgically induced astigmatism between corneal and scleral incision techniques. Methods: In this prospective cohort study, patients with IOL dislocation underwent 25-gauge pars plana vitrectomy with ICIOL implantation. Anterior chamber depth, volume, and angle configuration were measured across 12 meridians preoperatively, at 1–1.5 months (short-term), and 5–6 months (long-term). Surgically induced astigmatism was compared between the corneal and scleral incision groups. Statistical analysis included Shapiro–Wilk, Mann–Whitney U, and repeated-measures ANOVA tests. Results: This prospective study included 40 patients (22 females, 18 males) with a mean age of 76.3 ± 5.38 years (range 65–86). Significant reductions in ACD and ACV occurred postoperatively (p < 0.05), with partial recovery at long-term follow up. Surgically induced astigmatism was markedly higher with corneal incisions versus scleral approaches (p < 0.01 short term; p < 0.05 long term). Anterior chamber angle changes varied by meridian but stabilized by 6 months. Conclusions: Retropupillary ICIOL implantation induces predictable anterior segment remodeling, with scleral incisions offering superior refractive stability. Surgical planning should prioritize scleral techniques to minimize surgically induced astigmatism while maintaining anatomical efficacy. Future innovations in IOL design may further reduce incision-related complications. Full article

Recurrence of retinal detachment (RD) following pars plana vitrectomy (PPV) with silicone oil tamponade is a surgical challenge. This study proposes a novel approach utilizing segmental scleral buckle to manage early recurrences, especially in inferior quadrants. A retrospective case series of four patients with early recurrent inferior RD post-PPV with silicone oil tamponade was conducted. The segmental scleral buckle technique, with or without subretinal fluid drainage, was employed. Clinical and surgical data were collected, including visual outcomes and complications. No intraoperative or postoperative complications were observed during the 6-month follow-up period. Visual acuity remained stable, and retinal reattachment was achieved in 100% of cases after silicone oil removal. Segmental scleral buckle emerges as a promising technique for managing early recurrent inferior RD in silicone oil-filled eyes. The technique demonstrates favorable outcomes, including retinal reattachment and visual acuity stability, without significant complications. Further studies are warranted to validate its efficacy and establish standardized protocols. Full article

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings. Full article