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Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium. To understand this capability, it is important to know the silicone oil characteristics. Herein, we report first on the main chemical-physical proprieties and then we review the clinical applications of the current silicone oil which is lighter than water with particular reference to their indications with small gauge vitrectomy. Finally, we describe the surgical techniques to inject and remove this type of silicone oil. In the summary of this paper, we explain why silicone oils are today increasingly used and why their introduction has improved the prognosis of several retinal diseases. In fact, having different types of silicone oils allows us to choose the appropriate endotamponade for every single case.

PurposeTo review a series of highly myopic eyes with retinal detachment undergoing pars plana vitrectomy with autologous internal limiting membrane (ILM) flap placed over posterior retinal breaks located in areas of choroidal atrophy.MethodsRetrospective review of 13 consecutive patients receiving pars plana vitrectomy with ILM flap over causative breaks, compared with 19 controls receiving the same surgery with ILM peeling but no ILM flap. Main outcome measures included anatomical success rate, visual acuity, number of surgeries and the rate of silicone oil removal.ResultsPatients in the ILM group required 2.08±0.37 interventions versus 2.58±0.75 in the control group (p=0.037). One (1/13; 7.6%) patient in the ILM group required additional unplanned surgery versus 8/19 (42.10%) in the control group (p=0.038). Final anatomical success rate defined as attached retina after silicone oil (SiO) removal was 13/13 in the I-ILM group and 14/19 (73.6%) in the control group (p=0.052). No patients (0/13) in the I-ILM group retained SiO at the end of follow-up versus 4/19 (21.1%) patients in the control group (p=0.061). Best-corrected visual acuity at the end of follow-up was logMAR 0.65±0.36 (20/91 Snellen) in the ILM group and logMAR 0.89±0.44 (20/158 Snellen) in the control group (p=0.20).ConclusionAutologous ILM may help seal posterior retinal breaks and improve the surgical prognosis of retinal detachment due to breaks located over areas of choroidal atrophy within the myopic staphyloma.

Background. The aim of this observational study is to assess pre- and postoperative retinochoroidal vascular changes in patients undergoing epiretinal macular membrane (ERM) surgery by using optical coherence tomography angiography (OCTA). Materials and Methods. 23 eyes affected by ERM and those which underwent phacovitrectomy associated with ERM peeling were enrolled. They were evaluated using structural OCT and OCTA before surgery and at 1, 3, and 6 months postoperatively. Results. We found a statistically significant (p < 0.05) increase in the superficial capillary plexus vessel density (VD) from baseline to the 6-month follow-up. We observed a large increase in both the perfusion density (PD) and the VD of the deep capillary plexus between baseline and the 6-month follow-up (p < 0.001). A significant decrease in the VD and PD of the choriocapillaris (CC) from baseline to the 1st month and a significant increase in CC perfusion density at the 6-month follow-up compared to the preoperative value were revealed. The FAZ area and perimeter after surgery significantly increased during the follow-up (p < 0.001) at baseline retinal and choroidal plexi with a lower PD or VD correlated with worse visual acuity (p < 0.05 for all plexi). At baseline and at the 1-month follow-up, a significant correlation was found with the FAZ area and the FAZ perimeter: a smaller FAZ area or a smaller FAZ perimeter was correlated to a lower visual acuity. Before surgery, negative correlations (p < 0.05) were found between the Govetto ERM stages and perfusion density of the SCP and the DCP and between the Govetto stages and vessel density of the DCP. Conclusions. In our study, OCTA detected vascular alterations induced by the presence of the ERM, allowing several correlations with functional data. In these patients, OCTA may be useful to add new potential surgical prognostic factors.

Introduction. Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods. This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results. The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion. In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.

Purpose. To compare the vitrectomy time, clinical outcomes, and complications between 27-gauge (27-G) and 25-gauge (25-G) vitrectomy in patients with primary rhegmatogenous retinal detachment (PRRD). Methods. Prospective, nonrandomized, comparative, interventional study. Forty consecutive patients with PRRD were recruited. Twenty patients underwent the 27-gauge procedure and twenty patients had the 25-gauge procedure. The main outcome measure of the study was the actual vitrectomy time. Results. The mean duration of vitreous removal was 23.2 min (SD 6.5) with 27-G vitrectomy and 19.6 min (SD 7.3) with 25-G vitrectomy, resulting in a difference of 3.6 min (95% confidence interval (95%CI): −8.0 to 0.8 mins, p=0.11). Mean logMAR visual acuity improved from 1.70 ± 1.18 preoperatively to 0.12 ± 0.14 at final postoperative visit (p<0.001) in the 27-G group and from 1.52 ± 1.15 preoperatively to 0.22 ± 0.30 at final postoperative visit (p<0.001) in the 25-G group. The anatomical success rate after a single operation was 90.0% and 85.0% in the 27-G and in the 25-G groups (p=0.63), respectively. Intraoperative iatrogenic retinal breaks (IRBs) occurred in 2 eyes in the 27-G group and 1 eye in the 25-G group. Conclusions. Twenty-seven-gauge vitrectomy may be a safe and effective surgery for the treatment of PRRD.

The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries. While many surgical options have been proposed to manage it, none of these guarantee complete anatomical success and satisfactory visual recovery. We report postoperative outcomes on 36 patients affected by failed macular hole, treated with a human amniotic membrane plug transplant. Follow-ups were performed with a standard ophthalmological examination and with advanced multimodal diagnostic imaging. Anatomical closure was achieved at 3 months in all patients. Mean best-corrected visual acuity improved statistically significantly at 6 months ( p  < 0.05). Through microperimetric tests, we assessed a partial recovery of the macular sensitivity on the edges of the plug. Analyzing SD-OCT images, we reported a tissutal ingrowth above the plug, and its segmentation into layers, mimicking normal retinal architecture. OCT-Angiography images non invasively analysed the retinal parafoveal capillary microvasculature; the elaboration of Adaptive Optics images showed the presence of photoreceptors at the edges of the plug. This work demonstrates not only the complete anatomical success of our technique, but also remarkable functional results, and opens the door to a greater understanding of modifications induced by the presence of a human amniotic membrane plug.

Background/AimsTo evaluate the incidence of intraoperative retinal breaks in the ultrahigh-speed (UHS) 25-gauge vitrectomy system in elective vitreous-retina surgery cases.MethodsA prospective series of 1676 eyes of 1306 consecutive patients. All eyes underwent an UHS 25-gauge transconjunctival sutureless pars plana vitrectomy for elective cases such as idiopathic epiretinal membrane (586 cases), floaters (153), macular hole (385), vitreous macular traction syndrome (119), dropped nucleus or intraocular lens (84) and vitreous bleeding (82). Patients were followed up for a minimum of 6 months.ResultsThere were 1409 eyes involved in this study. Iatrogenic retinal breaks were found in 25 eyes (1.8%) during surgery. The majority were detected in cases where posterior vitreous detachment was induced during surgery (21 eyes; 2.8% of the patients), and in only four eyes (0.6%) with an already detached vitreous. In nine cases, rhegmatogenous retinal detachment developed during the follow-up. Patients who showed intraoperative retinal breaks were not in this group. Other complications during the follow-up included two cases of vitreous haemorrhage (0.1%), two cases of dislocated intraocular lens (0.1%), and 23 eyes with hypotony without any further complications.ConclusionsUHS 25-gauge transconjunctival sutureless vitrectomy is a safe procedure for treatment of elective vitreous-retina cases. The risk of developing iatrogenic breaks seems to be correlated with adhesion of the posterior vitreous hyaloid. Other complications, such as rhegmatogenous retinal detachment or hypotony, were similar to previous reports. No correlation was found between iatrogenic retina breaks and other complications.

Purpose: To evaluate safety and clinical outcomes of the sutureless intrascleral one-piece intraocular lens (SSF IOL) fixation in patients with Marfan syndrome (MFS) presenting with ectopia lentis. Methods: This retrospective, longitudinal, non-comparative case series was a multicenter study involving Ophthalmology Departments at three tertiary care centers in Italy. Fifteen eyes from 10 patients (4 males, 6 females; mean age 29.13 ± 16.96 years) diagnosed as having Marfan syndrome underwent lensectomy and implantation of the SSF one-piece IOL (FIL SSF; Soleko). Patients were followed up for 12 months postoperatively. Primary outcomes included corrected distance visual acuity (CDVA), IOL tilt (35-MHz ultrasound biomicroscopy), and endothelial cell density (ECD). Intraoperative and postoperative complications were recorded. Results: All surgeries were performed uneventfully, and no intraoperative complications occurred. CDVA improved significantly from 0.50 to 0.09 logarithm of the minimum angle of resolution (logMAR) (P = .0001). At 12 months postoperatively, the mean IOL tilt was 2.89 ± 0.91 degrees, indicating good centration and stability. No cases of IOL dislocation were reported. ECD showed a statistically significant mean reduction of 257.4 ± 138.2 cells/mm2 (P < .0001), although no corneal decompensation was observed. The postoperative complications included one case of macular edema with subsequent development of an epiretinal membrane and one case of haptic exposure. Conclusions: The SSF implantation of a single-piece IOL appears to be a viable and reproducible option for the successful surgical management of ectopia lentis in patients with MFS.

Purpose To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance. Methods This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO). Results The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group (P = .02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group (P = .13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group (P = .02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 (P = .11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group (P = .01). Conclusions The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [J Refract Surg. 2024;40(12):e926–e933.]

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of visual impairment in the elderly and is characterized by a multifactorial etiology. Emerging evidence points to the potential involvement of the gut–retina axis in AMD pathogenesis, prompting exploration into novel therapeutic strategies. This study aims to investigate the effects of some micronutrients (such as lutein and zeaxanthin) and saffron (as a supplement)—known for their anti-inflammatory properties—on ophthalmological and microbial parameters in neovascular AMD (nAMD) patients. Methods: Thirty naive nAMD patients were randomized to receive daily micronutrient supplementation alongside anti-VEGF (vascular endothelial growth factor) therapy, or anti-VEGF treatment alone, over a 6-month period, with comparisons made to a healthy control (HC) group (N = 15). Ophthalmological assessments, biochemical measurements, and stool samples were obtained before and after treatment. Gut microbiota (GM) characterization was performed using 16S rRNA sequencing, while short-chain fatty acids (SCFAs), medium-chain fatty acids (MCFAs), and long-chain fatty acids (LCFAs) were analyzed with a gas chromatography–mass spectrometry protocol. Results: Compared to HC, nAMD patients exhibited reduced GM alpha diversity, altered taxonomic composition, and decreased total SCFA levels, in addition to elevated levels of proinflammatory octanoic and nonanoic acids. Micronutrient supplementation was associated with improved visual acuity relative to the group treated with anti-VEGF alone, along with a decrease in the total amount of MCFAs, which are metabolites known to have adverse ocular effects. Conclusions: In conclusion, despite certain limitations—such as the limited sample size and the low taxonomic resolution of 16S rRNA sequencing—this study highlights compositional and functional imbalances in the GM of nAMD patients and demonstrates that micronutrient supplementation may help restore the gut–retina axis. These findings suggest the therapeutic potential of micronutrients in enhancing ocular outcomes for nAMD patients, underscoring the complex interaction between GM and ocular health.