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AimTo compare the efficacy of macular buckling (MB) and pars plana vitrectomy (PPV) for full-thickness macular holes (FTMH) and associated macular detachment (MD) in highly myopic eyes.MethodsProspective interventional case series of eyes undergoing PPV or MB for FTMH and MD.Main outcome measuresBest-corrected visual acuity (BCVA) at postoperative month 24. Other measured outcomes include the initial surgical success rate, macular hole closure rate and the progression of myopic maculopathy.ResultsA total of 53 eyes from 53 participants were included in this study (26 participants receiving MB and 27 participants receiving PPV), and finally 49 eyes from 49 participants (25 participants in the MB group and 24 participants in the PPV group) were analysed. At postoperative month 24, the BCVA had improved significantly in those that underwent either MB (p<0.001) or PPV (p=0.04). The difference between the groups was not significant (p=0.653). The surgical failure rate after the primary treatment was significantly higher in the PPV group than the MB group (25.00% vs 4.00%, respectively; p=0.04). The macular closure rate was higher in the MB group compared with the PPV group, but the difference was not statistically significant (64.00% vs 58.33%, respectively; p=0.45). Myopic maculopathy development may be more severe following PPV than following MB surgery.ConclusionPatients with high myopia obtained anatomical and functional improvements from either MB or PPV. However, MB achieved a significantly higher success rate in retinal reattachment compared with PPV.Trial registration number NCT03433547.

Background Patients who had successful rhegmatogenous retinal detachment (RRD) surgery often complained of metamorphopsia due to postoperative fovea displacement and alteration of the foveal microstructure. The papillo-foveal distance (PFD) is correlated bilaterally. Therefore, PFD from the fellow healthy eye could be used to determine the change of foveal position in eyes with successful RRD repair. Ultra-high-resolution optical coherence tomography (UHR-OCT) could explain incomplete visual recovery by demonstrating foveal misalignment and changes in foveal microstructure. The rationale of the study is to assess the changes in the foveal location and microstructural layers after successful retinal reattachment and correlate them with visual dysfunction. Patients and methods A prospective interventional cross-sectional controlled study included patients who had successful retinal reattachment and complained of defective vision or metamorphopsia. The primary outcome measure is to evaluate the post-operative foveal location. The secondary outcome measures are the assessment of metamorphopsia, the evaluation of the foveal microstructural changes, and the correlation between foveal shift, metamorphopsia, foveal microstructure, and visual function. We used a standard Amsler chart to detect subjective metamorphopsia and a modified Amsler chart to quantify metamorphopsia. We used the enhanced-depth imaging optical coherence tomography (EDI-OCT) to detect changes in PFD and the foveal microstructure. p  < 0.05. Results The study included 50 study eyes and 50 control eyes. The male gender constituted 70%. The mean age was 53 years. The mean baseline BCVA was 0.001. The incidence of foveal displacement was 70%. Disorganized retinal inner layers (DRIL) occurred in 56% of eyes, and disorganized retinal outer layers (DROL) occurred in 72% of eyes. The mean postoperative BCVA was 0.3. The subjective metamorphopsia was mild in 39%, moderate in 24%, severe in 33%, and very severe in 3% of eyes. The mean quantitative metamorphopsia was 587 mm. PVR correlated significantly with the foveal shift. DROL correlated significantly with subjective metamorphopsia. There was a statistically significant difference between subjective metamorphopsia and quantitative metamorphopsia. Conclusion Foveal displacement and metamorphopsia after successful retinal reattachment pose significant morbidity. UHR-OCT is pivotal in evaluating the anatomical outcome after successful retinal re-attachment surgery and its relation to visual function.

Purpose To compare the rate of re-detachment in patients with rhegmatogenous retinal detachment and Grade-C PVR following vitreoretinal surgery, with and without serial intravitreal injections of methotrexate. Methods It was a randomized control trial. Patients aged more than 18 years undergoing pars plana vitrectomy for rhegmatogenous retinal detachment with PVR grade C or more were included in the study. Patients treated with intravitreal injection of methotrexate were grouped as cases and those not injected served as controls. The cases received 3 intravitreal injections of methotrexate at monthly intervals. Patients were evaluated on Day 1, 1st month, 2nd month, 3rd month and 6th month in terms of BCVA, rate of re-attachment and grade of PVR. Results The case group had 23 patients and the control group had 20 patients. 2 patients in the case group were lost to follow-up after the first follow-up, so they were excluded. So 21 patients in case group and 20 patients in control group were followed up. Six months after surgery, 15 ‘cases’ had completely attached retina whereas 6 patients had partial detachment with macula on. There was no patient amongst the cases with macula-off retinal re-detachment. Out of 20 patients in the control group, 9 had a complete retinal attachment, 4 had partial detachment with macula-on and 7 had partial detachment with macula-off. There was statistically significant difference in macula off retinal detachment rates ( p -value- 0.003). Conclusion Serial intravitreal methotrexate injections reduce the incidence of re-detachment in patients undergoing PPV for RRD with PVR-C. Further investigation into this promising therapeutic approach is warranted. Key messages What is known Methotrexate is an anti-inflammatory agent which is safe for intravitreal use There are case series retrospective and prospective studies suggesting potential benefit of intravitreal methotrexate in preventing re-detachment due to PVR What is new First randomized control trial studying the efficacy of intravitreal methotrexate in preventing re-detachment due to PVR Our study showed statistically significant difference in macula off retinal detachment between the 2 groups at 6 months of follow up

BackgroundThis open-label extension study to the original VIPER trial investigated the long-term single surgery success after repair of an uncomplicated pseudophakic retinal detachment (PRD) by vitrectomy and gas with or without an encircling band (EB).MethodsExamination data from patients enrolled in the VIPER trial obtained after the 26-weeks’ follow-up period (26-weeks’ FU) of the original trial were analysed, and failures, given as indications for another reattachment procedure, were documented.ResultsFrom the original study population of 257 patients enrolled to the three treatment groups (20G vitrectomy+EB (E1), 20G vitrectomy alone (C) and 23/25G vitrectomy (E2)), follow-up data from 105 (41%) patients could be collected. The additional postoperative follow-up was 1.4 months up to 10.8 years. Of the 105 patients enrolled in this long-term analysis, 102 had an observation time greater than 2 years. Failures due to the reattachment procedure within the 26-week FU of the original trial were as follows: 17 in E1, 19 in C and 5 in E2. Additional late failures were found in seven cases: two in E1, three in C and two in E2, respectively.ConclusionsThe long-term observation of additional failures after primary vitrectomy with or without EB did not change the main result of the VIPER study. There is still no evidence that an additional EB would improve the primary surgical success of vitrectomy for uncomplicated PRD. In the cohort of 105 patients with a longer follow-up than 26 weeks, only seven additional failures were observed.Trial registration numberDKRS00023359.

AimTo assess the primary reattachment rate (PARR) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomised Trial (PIVOT) criteria with a single break in detached retina.MethodsA post hoc analysis of two clinical trials. To be included, patients with primary RRD had to meet PIVOT criteria but could have only one break in the detached retina. Patients with additional pathology in the attached retina were included in a secondary analysis. The primary outcome was PARR following PnR versus PPV at 1-year postoperatively.Results162 patients were included. 53% (86/162) underwent PnR and 47% (76/162) had a PPV. 99% (85/86) and 86.8% (66/76) completed the 1-year follow-up visits in the PnR and PPV groups, respectively. PARR was 88.2% (75/85) in the PnR group and 90.9% (60/66) in the PPV group (p=0.6) with a mean postoperative logMAR best-corrected visual acuity of 0.19±0.25 versus 0.34±0.37 (Snellen 20/30 vs 20/44) (p=0.01) each in the PnR and PPV groups, respectively.In an additional analysis of patients who were also allowed to have any pathology in the attached retina, the PARR was 85% (91/107) and 91.6% (66/72) in the PnR and PPV groups, respectively (p=0.18).ConclusionsPnR and PPV provide similar long-term PARR in a substantial proportion of patients meeting PIVOT criteria with only a single break in the detached retina. Therefore, in patients meeting these specific criteria, PnR is an appropriate first-line therapy as it offers superior functional outcomes without compromising PARR.

Background Cellophane membranes are an early stage of proliferative vitreoretinopathy (PVR) complicating retinal detachment surgery. Our aim was to assess whether a prolonged administration of systemic corticosteroids would attenuate early stages of PVR such as cellophane membranes. Design Prospective randomized placebo-controlled double-blind clinical trial. Patients and methods A total of 220 consecutive eyes (220 patients) were operated for primary rhegmatogenous retinal detachment (RD), mainly by scleral buckling procedures. Patients were randomized into two groups: 110 patients (steroid group) received prednisone for 15 days starting with 100 mg at the day of surgery and being tapered to 12.5 mg. The control group of 110 patients received placebo in a comparable manner. Follow-up examinations were performed at 1, 3 and 6 months postoperatively, and included visual acuity and assessment of retinal findings. Results Cellophane membranes occurred in 41.8%, 46.9%, and 39.1% in the placebo group and 26.7%, 23.6%, and 19.8% in the steroid group at 1, 3 and 6 months postoperatively ( p  < 0.05, = 0.0005, and <0.005 respectively). The application of five or more cryocoagulation spots was associated with more cases developing cellophane membranes in the placebo than the steroid group ( p  < 0.05). A complete reattachment of the retina was achieved in 95% steroid and 89% placebo group eyes, and a reattachment of the macula in 98% of both groups. There was no significant difference of the final visual outcome in both groups. Conclusion Early stages of PVR such as cellophane membranes after retinal detachment surgery can be reduced with corticosteroids in oral doses.

PurposeTo test if an encircling band improves outcomes in vitrectomy for pseudophakic retinal detachment (PRD) with inferior or with multiple (4 or more) breaks.MethodsSubgroup analysis of a prospective randomized controlled multicenter trial in patients with uncomplicated PRD assigned either to 20 G vitrectomy plus encircling band (group E1), or 20 G vitrectomy without any buckle (group C), or 23/25 G vitrectomy without any buckle (group E2). The primary endpoint was defined as no indication for any retina reattaching procedure during the review period of 6 months. One hundred out of 257 patients were identified with inferior breaks and 63 patients had 4 or more breaks.ResultsIn patients with retinal breaks between 5:00 and 7:00, treatment was successful in 77.4% (24/31, treatment arm E1) versus 57.1% (16/28, treatment arm C) (p = 0.301, odds ratio (OR) 1.83, 95% confidence interval (CI) 0.48 to 7.17). In patients with multiple breaks, success rates were 68.2% (15/22, E1) versus. 72.4% (21/29, C, p = 0.46, OR 0.52, CI 0.08–3.65).ConclusionCombining an encircling band with vitrectomy in patients with pseudophakic retinal detachment and inferior or multiple breaks does not significantly improve primary anatomical success in comparison to treatment with 20 G or 23/25 G vitrectomy alone.

Purpose To develop and evaluate an automated deep learning model to predict the anatomical outcome of rhegmatogenous retinal detachment (RRD) surgery.MethodsSix thousand six hundred and sixty-one digital images of RRD treated by vitrectomy and internal tamponade were collected from the British and Eire Association of Vitreoretinal Surgeons database. Each image was classified as a primary surgical success or a primary surgical failure. The synthetic minority over-sampling technique was used to address class imbalance. We adopted the state-of-the-art deep convolutional neural network architecture Inception v3 to train, validate, and test deep learning models to predict the anatomical outcome of RRD surgery. The area under the curve (AUC), sensitivity, and specificity for predicting the outcome of RRD surgery was calculated for the best predictive deep learning model.ResultsThe deep learning model was able to predict the anatomical outcome of RRD surgery with an AUC of 0.94, with a corresponding sensitivity of 73.3% and a specificity of 96%.ConclusionA deep learning model is capable of accurately predicting the anatomical outcome of RRD surgery. This fully automated model has potential application in surgical care of patients with RRD.

Background and Objective This study evaluated the use of a dual-delivery methotrexate (MTX) strategy for diabetic tractional retinal detachment (TRD). Diabetic retinopathy (DR) is a leading cause of blindness. Inflammation plays a key role in TRD, and MTX has anti-inflammatory properties. Patients and Methods This is a pilot study that included 60 patients with TRD. They were block randomized to either MTX with pars plana vitrectomy (PPV) (n = 30) or PPV alone (control, n = 30). MTX was added to the irrigation fluid during surgery and an intra-silicone injection at the end. One month after silicone oil removal, visual acuity (VA), multifocal electroretinography (mfERG), and spectral-domain optical coherence tomography (SD-OCT) were assessed. Results One month after silicone oil removal, VA and mfERG were significantly better with a lower prevalence of epiretinal membranes, disorganization of retinal inner layers, and cystic macular changes by SD-OCT in the MTX group. Conclusion This study found that dual-delivery MTX during PPV is a promising strategy to improve functional and anatomical results in diabetic TRD. [Ophthalmic Surg Lasers Imaging Retina 2025;56:XX–XX.]

BackgroundIt is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy.Methods257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months.ResultsSuccess was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average −0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of −1.0 D in group E1 compared with −0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1.ConclusionsVitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique.Trial registration numberDKRS 00003158, Results.