Purpose: To define the natural course of extensive submacular hemorrhage in age-related macular degeneration (AMD). Patients and Methods: The clinical charts of 54 patients (60 eyes) older than 55 years with subretinal hemorrhage larger than 1 disk diameter and extending beneath the fovea were retrospectively reviewed. The age of the patient, the use of antihypertensive or anticoagulant medication, visual acuity, biomicroscopic and fluorescein and indocyanine green (in 33 cases) angiographic data were recorded at presentation and during follow-up. Results: At the initial examination, average visual acuity was 20/240 (range from 20/70 to light perception). During follow-up (mean 24 months) visual acuity worsened in 80% of the eyes with a mean final visual acuity of 20/1,250 (range from 20/100 to light perception). The initial size and thickness of hemorrhage were correlated with initial and final visual acuity. Recurrence of hemorrhage resulted in an important impact on final visual acuity. Anatomic outcome showed fibrous tissue proliferation in 23 eyes (38.3%), atrophic scar in 15 eyes (25%) and occurrence of a retinal pigment epithelium tear in 13 eyes (21.6%). Conclusion: The visual outcome in eyes with submacular hemorrhages due to AMD is very poor. Size and thickness of the hemorrhage influenced negatively the natural prognosis. A surgical approach can be considered although it has not yet a widespread use.

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PURPOSE. The purpose of this study was to study the incidence and factors influencing retinal displacement in eyes treated for rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV) and gas or silicone oil.METHODS. This was a prospective observational case series. One hundred twenty-five eyes with macula-off RRD from 125 patients underwent 25-gauge PPV at two vitreoretinal institutional practices. Eyes without proliferative vitreoretinopathy (PVR) or PVR grade A were tamponated with sulfur hexafluoride (SF6) gas, whereas eyes with PVR grade B received 1000 centistokes silicone oil (SO). The patients postured face-down immediately after surgery. Blue-fundus autofluorescence (B-FAF) pictures were obtained at each follow-up examination. Main outcome measures were incidence and direction of retinal displacement.RESULTS. Ninety-seven eyes (77.6%) were tamponated with SF6 and 28 eyes (22.4%) with SO. After retinal reattachment, displacement was observed in 44 of 125 (35.2%) eyes (40 eyes in the SF6 group and 4 eyes in the SO group, respectively). The type of tamponade, specifically gas, was the only significant predictor of retinal displacement (P ¼ 0.007). The displacement was downward in 39 (88.6%) eyes (36 tamponated with SF6 and 3 with SO) and upward in 5 (11.4%) eyes (4 tamponated with SF6 and 1 with SO).CONCLUSIONS. Displacement of the retina after repair of macula-off RRD with PPV is observed using either SF6 gas or SO. Downward and upward displacements may occur with both tamponades, but downward dislocation is more common. Of the factors potentially implicated in favoring displacement that were studied, only the type of tamponade, specifically the gas, was significant.Keywords: blue fundus autofluorescence, retinal vessel printings, retinal detachment, pars plana vitrectomy, retinal displacement T here has recently been a trend toward pars plana vitrectomy (PPV) as the preferred method for treatment for rhegmatogenous retinal detachment (RRD). The reasons behind this trend include the advent of outpatient ambulatory surgery and improvements in technology, instrumentation, and viewing systems. [1][2][3][4][5] When PPV is chosen for the treatment of RRD, it is typically accompanied with a postoperative intraocular tamponade agent-most commonly gases or silicone oils (SOs). Many surgeons prefer to use SO for complicated RRD or if postoperative airplane or high elevation travel is planned. However, a recent prospective study has shown that PPV with SO injection is also a safe and efficient surgical approach for treatment of primary uncomplicated RRD. 6 The use of both gas and SO in conjunction with PPV for repair of RRD may be associated with unintentional displacement of the retina. [7][8][9][10][11][12] Blue fundus autofluorescence (B-FAF) elegantly depicts this shift via lines of increased autofluorescence, which closely reflect the caliber and orientation of the adjacent retinal vessels. These lines indicate the original location of the retinal vessels, which have been displaced along with t...

. Purpose:  To evaluate the efficacy and safety of intravitreal bevacizumab in proliferative diabetic retinopathy (PDR) patients. Methods:  This interventional case series study included 15 eyes of 10 patients with bilateral PDR: 13 eyes with severe PDR and active new vessels (NV) and two eyes with recurrent vitreous haemorrhages. Study eyes received a single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. All eyes were followed up for 3 months, and eight of them for 9 months. Reinjection was performed in three eyes 4–6 months after the first injection. Study eyes were evaluated by fluorescein angiography at baseline, 1, 3 and 9 months. Quantitative planimetric analysis (QPA) of NV area was measured before and after treatment. All eyes received or completed panretinal photocoagulation (PRP) 1 month after the first injection. Results:  As early as at 1 month, all study eyes had a regression (paired t‐test, P = 0.01) of QPA‐estimated NV area. The eyes with recurrent vitreous haemorrhages had clearing of bleeding. These early effects were maintained at 3 months for all eyes and tended to be stable at 9 months. The fast and measurable efficacy of bevacizumab allowed a subsequent complete and safe PRP. Conclusion:  Intravitreal bevacizumab did not reveal any side‐effects and was effective in the regression of NV areas and the resolution of vitreous haemorrhages. This approach is potentially useful in allowing (within a planned temporal window) a safe and efficient PRP to be performed while minimizing the risk of its complications.

PurposeTo develop a predictive model and nomogram for maculopathy occurrence at 3 years after 106Ru/106Rh plaque brachytherapy in uveal melanoma.Material and methodsClinical records of patients affected by choroidal melanoma and treated with 106Ru/106Rh plaque from December 2006 to December 2014 were retrospectively reviewed. Inclusion criteria were: dome-shaped melanoma, distance to the fovea > 1.5 mm, tumor thickness > 2 mm, and follow-up > 4 months. The delivered dose to the tumor apex was 100 Gy. Primary endpoint of this investigation was the occurrence of radiation maculopathy at 3 years. Analyzed factors were as follows: gender, age, diabetes, tumor size (volume, area, largest basal diameter and apical height), type of plaque, distance to the fovea, presence of exudative detachment, drusen, orange pigment, radiation dose to the fovea and sclera. Univariate and multivariate Cox proportional hazards analyses were used to define the impact of baseline patient factors on the occurrence of maculopathy. Kaplan-Meier curves were used to estimate freedom from the occurrence of the maculopathy. The model performance was evaluated through internal validation using area under the ROC curve (AUC), and calibration with Gronnesby and Borgan tests.ResultsOne hundred ninety-seven patients were considered for the final analysis. Radiation-related maculopathy at 3 years was observed in 41 patients. The proposed nomogram can predict maculopathy at 3 years with an AUC of 0.75. Distance to fovea appeared to be the main prognostic factor of the predictive model (hazard ratio of 0.83 [0.76-0.90], p < 0.01). Diabetes (hazard radio of 2.92 [1.38-6.20], p < 0.01), and tumor volume (hazard radio of 21.6 [1.66-281.14], p = 0.02) were significantly predictive for maculopathy occurrence. The calibration showed no statistical difference between actual and predicted maculopathy (p = 1).ConclusionsOur predictive model, together with its nomogram, could be a useful tool to predict the occurrence of radiation maculopathy at 3 years after the treatment.

PDT may represent an effective and safe modality of treatment for VPRTs because of its selectivity. Our study supports the application of a light dose of 100 J/cm, although further studies with larger numbers of cases and longer follow-ups are required.

PurposeTo report the case of a 13-year-old girl with torpedo maculopathy, evaluated with multimodal morpho-functional retinal imaging, including fundus photography, infra-red and blue fundus autofluorescence, swept-source optical coherence tomography (OCT), en face OCT, OCT angiography and microperimetry (MP).ObservationsOn fundus examination, a torpedo-like hypopigmented lesion was observed temporal to the fovea in the left eye. OCT showed disruption of outer retinal layers and the presence of a subretinal cleft. On OCTA, a diffuse attenuation of signal from choriocapillaris was observed along the lesion. Functional analysis with MP revealed a reduction of retinal sensitivity over the lesion.Conclusionsand importance: On OCTA, torpedo maculopathy is characterized by vascular alterations of the choriocapillaris along the lesion.

Improvement of macular sensitivity and fixation stability 1 year after intravitreal bevacizumab for myopic choroidal neovascularization suggest a stable and progressive macular function recovery. The mean treatment session was 1.53, with 53.3% of patients needing only a single intravitreal bevacizumab injection, supporting a potential long-lasting efficacy of intravitreal bevacizumab treatment.