Key Points Endogenous sVEGFR-3 that is expressed by the cornea binds and sequesters VEGF-C and is critical for corneal alymphaticity. sVEGFR-3 overexpression enhances murine corneal graft transplant survival 5-fold by blocking lymphangiogenesis and hemangiogenesis.

Background Non-paraneoplastic autoimmune retinopathy (npAIR) is a rare autoimmune disease that primarily affects retinal photoreceptor function and results in profound and often times permanent vision loss. Delay in diagnosis and treatment initiation may contribute to the poor visual prognosis. Methods A retrospective chart review of all patients diagnosed with autoimmune retinopathy at the University of Wisconsin-Madison Eye Clinics between January 2012 and January 2017 was performed. Twenty eyes of 15 patients had evidence of any form of autoimmune retinopathy through a combination of symptoms, ocular findings, visual fields, optical coherence tomography, fundus autofluorescence, full-field and multifocal electroretinography, and serum anti-retinal antibodies. Clinical records were also analyzed for demographic data, systemic comorbidities, visual acuity, treatment employed, and disease progression. Results We identified 18 eyes from 13 patients who fit the criteria for non-paraneoplastic autoimmune retinopathy. Sixty-nine percent of patients were female with a mean age of symptom onset of 56.9 ± 20.3 years. Sixty-seven percent of eyes had an associated autoimmune condition, most commonly hypothyroidism. Serum testing revealed a preponderance of antibodies against carbonic anhydrase II, while imaging revealed characteristic changes. Fundus autofluorescence most commonly showed hyperautofluorescence around the macula. The delayed diagnosis led to a larger reduction in the horizontal extent of ellipsoid zone in 1-mm perifoveal area on optical coherence tomography with resulting visual decline. There was no difference in the change of visual acuity when stratifying for patients with autoimmune conditions ( p = 0.52) or treatment status ( p = 0.50). None of the patients who received treatment developed contralateral eye involvement or experienced disease progression based on visual acuity or symptoms. Conclusion Non-paraneoplastic autoimmune retinopathy has a wide and often challenging to diagnose spectrum of clinical symptoms and imaging findings. Immunosuppressive therapy can be considered empiric in the face of a suggestive presentation and can be initiated after an evaluation of clinical findings and multimodal testing, though treatment does not appear to affect regeneration of the ellipsoid zone on OCT or impact visual acuity. Treatment should be primarily used to prevent disease progression and contralateral eye involvement. Trial registration N/A

In this retrospective multicenter study of 261 eyes (259), patients who underwent rhegmatogenous retinal detachment repair during the coronavirus disease 2019 (COVID-19) post-lockdown period experienced an additional 22-day delay leading to significantly more epiretinal membrane, proliferative vitreoretinopathy and lower single surgery anatomic success. During lockdown, perfluoropropane (C3F8) gas was utilized more commonly; and pneumatic retinopexy was used more commonly in COVID-19-positive patients.

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Importance: Trabeculectomy is very effective in lowering intraocular pressure for the treatment of glaucoma, but it carries with it possible complications and failure. The ExPress shunt (Alcon Laboratories, Fort Worth, TX, USA) is an adjunctive device that can be used at the time of trabeculectomy to create an external fistuliztion. An alternative established and highly efficacious technique is the implantation of a glaucoma drainage device for sustained intraocular pressure (IOP) lowering. Specifically, evidence has established the Baerveldt 101-350 glaucoma implant (BGI) to have the best sustained IOP lowering in long-term follow-up amongst the many options for glaucoma drainage devices. Objective: To compare outcomes in eyes that underwent Baerveldt 101-350 glaucoma implant (BGI) and trabeculectomy with ExPress shunt (Trab) in primary open angle glaucoma without any prior incisional glaucoma surgery. Design, Setting, and Participants: This was a retrospective study of outcomes in patients identified by CPT codes as having undergone glaucoma implantation or trabeculectomy (with ExPress shunt) for the treatment of Primary Open Angle Glaucoma between 2012 and 2015 at a single institution by 2 fellowship trained glaucoma surgeons. A total of 57 eyes that underwent Baerveldt 101-350 glaucoma implant and 38 eyes that underwent trabeculectomy cases with ExPress™ shunt were included in the study. All patients were diagnosed with primary open angle glaucoma. Cases were included into the study if the patient underwent BGI or trabeculectomy with ExPress shunt without any prior incisional glaucoma surgery. Main Outcomes and Measures: Main outcomes included IOP, medications, visual acuity (VA), and secondary glaucoma surgery, if any. Results: Survival rate at 12 months was 85% in the BGI group and 80% in trabeculectomy with ExPress Shunt. A statistically significant difference was not found in the survival distributions between surgery groups using the log-rank test. A total of 12 trabeculectomy and 9 BGI cases failed by our definition of success. These cases were included in the analysis of IOP, number of glaucoma medications, and VA. The mean IOP was reduced from 20.6 ± 5.6 mmHg to 12.4 ± 3.2 mmHg and from 20.7 ± 5.5 mmHg to 11.3 ± 4.8 mmHg at one year post-operation in the BGI group and the trabeculectomy with ExPress shunt group, respectively. On average, the BGI group showed an IOP reduction of 7.7 ± 6.1 mmHg, while trabeculectomy with ExPress shunt experienced a decrease of 7.9 ± 5.2 mmHg at one year post-operation. Medications were reduced from 3.5 ± 0.8 to 2.6 ± 1.3 at one year in the BGI group and from 3.7 ± 0.5 to 0.6 ± 1.8 in the trabeculectomy with ExPress shunt group. At one year post-operation, the BGI group had an average of 0.9 ± 1.1 medication reduction, while trabeculectomy with ExPress shunt cases had a reduction of 3.2 ± 1.3 medications. VA was compared in logMar. At baseline, the average for BGI logMar was 0.5 ± 0.7 and the average for trabeculectomy was 0.2 ± 0.3. At one year post-operation...

To describe the use of 27-gauge pars plana vitrectomy in the management of Coats' disease retinal detachment. Methods: Case report of a 10-year-old female presenting with exudative retinal detachment secondary to Coats' disease. A twoport, 27-gauge pars plana vitrectomy, with one cannula in the subretinal space, was used to drain subretinal fluid. After resolution of the retinal detachment, a laser was directed to vascular abnormalities, and intravitreal antivascular endothelial growth factor was administered. Results: At 1 year follow-up, her retinal detachment remained resolved, peripheral vision had improved, and visual acuity had stabilized. Conclusions: A 27-gauge vitrectomy can be used successfully in the treatment of exudative Coats' detachment. The use of valved trocars allows control of intraocular pressure and simultaneous controlled extrusion of subretinal fluid, decreasing the risk of retinal incarceration.

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We report a case of morning glory disc anomaly in a young patient with tractional retinal detachment successfully repaired with complex pars plana vitrectomy, membrane peel, laser, and oil tamponade. A 19-year-old female with a history of right morning glory disc anomaly associated with PAX6 gene mutation presented with floaters, photopsia, central scotoma, and visual acuity (VA) of 1/200. A complex macula-involving tractional retinal detachment centered around the optic nerve with a morning glory disc anomaly. Retinal detachment was treated with 25-gauge pars plana vitrectomy with difficult separation of the posterior hyaloid. Fibrous preretinal membranes were peeled, a temporal relaxing retinotomy was required, subretinal fluid was drained through a superonasal retinotomy during air-fluid exchange, endolaser was applied, and tamponade was achieved with 1,000-centistoke silicone oil. The retina remained attached at 1-year follow-up, with VA count fingers throughout. Morning glory disc is a rare congenital anomaly associated with PAX6 gene mutation that most often occurs unilaterally. It is rarely associated with tractional retinal detachment. Optimization of visual outcome is imperative despite a poor visual prognosis.