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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

BACKGROUND AND OBJECTIVE:To compare intravitreal bevacizumab versus ranibizumab as adjuvant treatment prior to pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR) with respect to parameters of surgical complexity. PATIENTS AND METHODS:Prospective, randomized, double-masked pilot study of patients requiring PPV for nonclearing vitreous hemorrhage or tractional retinal detachment (TRD) secondary to PDR. Patients were randomized to receive either intravitreal bevacizumab or ranibizumab at standard doses 1 week preoperatively. Measured parameters included total surgical time, presence of TRD, intraoperative bleeding, iatrogenic retinal breaks, and use of endolaser and endodiathermy or silicone oil. RESULTS:A total of 29 patients were recruited. For surgical parameters, there were no statistically significant differences between the groups in the univariate analyses. Multivariable analysis showed no statistically significant difference for total surgical time. CONCLUSION:This pilot study suggests that intravitreal bevacizumab and ranibizumab are equivalent as surgical adjuvants when used as pre-treatment in patients with PDR undergoing PPV.[Ophthalmic Surg Lasers Imaging Retina. 2014;45:521–524.]

Purpose To report the outcome of adjunctive intravitreal dexamethasone (Ozurdex) implantation in patients with proliferative diabetic retinopathy (PDR) and retinal detachment (RD) undergoing vitrectomy and silicone oil (SO) tamponade. Design A one-year, single-center, prospective, randomized controlled clinical trial. Methods A total of 30 people (34 eyes) with PDR and RD who need vitrectomy and silicone oil tamponade were randomly assigned as 1:1 to study group and control group. Eyes in study group were injected with Ozurdex after vitrectomy and just before silicone oil tamponade. Primary outcome was the changes of epiretinal proliferative membranes area from 1 month to 12 months after the first operation. Anatomical and functional outcomes were also assessed during follow-up. Results There was no significant difference in baseline characteristics between the two groups. The incidence of preretinal proliferation progression from 1-month to 12-months follow-up in the study group was significantly lower than that in the control group (23.5% vs. 88.2%, p=0.000). The area of preretinal proliferation in the study group was significantly smaller than that in the control group at 1-month, 3-months, 6-months, and 12-months follow-up and this difference increased with the prolongation of follow-up time. During the follow-up period, the incidence of macular epiretinal membrane in the study group (11.8%) was significantly lower than that in the control group (41.2%) (p=0.024). The mean best corrected visual acuity (BCVA) between the two groups only showed a significant difference at 12-months follow-up, with better BCVA in study group (0.61±0.70 logMAR) than in the control group (1.02±1.00 logMAR) (p=0.024). The mean central retinal thickness (CRT) of the study group at 1 and 6 months were 225.9 ± 106.9 µm and 223.0±118.9 µm respectively which was significantly lower than that of the control group (450.8 ± 301.4 µm and 275.5±131.9 µm, p=0.008 and 0.024, respectively). Conclusion In patients with proliferative diabetes retinopathy complicated with retinal detachment, the combination of vitrectomy with silicone oil tamponade and dexamethasone implantation can reduce the incidence of preretinal proliferative membrane and macular epiretinal membrane and improve the visual outcome during 1 year follow-up.

Background and Objective: Proliferative vitreoretinopathy (PVR) remains the leading cause of failed retinal detachment (RD) repair. This study evaluated anatomic and visual outcomes in complex Grade C PVR RDs by advanced vitreoretinal techniques with or without adjunctive intravitreal met hotrexate (MTX). Patients and Methods: This retrospective consecutive case series included eyes undergoing surgical repair at a single tertiary care center. Outcomes were compared in complex RDs repaired by advanced surgical maneuvers with or without adjunctive MTX. The primary endpoint was single-surgery retinal attachment, assessed at 3 to 5 months, 1 year, and final follow-up. Secondary endpoints included visual acuity (VA), outcomes after silicone oil removal, and corneal epitheliopathy. Results: There were no significant difference in single-surgery retinal reattachment rates (P = 1.00) or VA (P > 0.05) at any timepoint. The number of MTX injections was not associated with improved odds of single-surgery reattachment (OR = 1.02, P = 0.73). Mild corneal epitheliopathy was observed in 28.8% of MTX-treated eyes. Conclusion: Adding intravitreal MTX to advanced vitreoretinal repair techniques did not show significant improvement in the outcomes of complex Grade C PVR RDs. Additional refinement of treatment criteria is likely needed to identify which patients may benefit the most from this additional treatment.

PurposeIn this study we compared the anatomic and functional outcomes of two steroid treatments on rhegmatogenous retinal detachment (RRD) combined with choroidal detachment (CD), namely treatment with oral prednisolone (1 mg/kg daily) for 3–7 days before vitrectomy or a single periocular injection of methylprednisolone (40 mg) 1–3 days before vitrectomy. We also analyzed the outcomes of the eyes with subsided CD and the eyes with persistent CD that underwent drainage of suprachoroidal fluids during the vitrectomy.MethodsThis was a prospective randomized study. Seventy five eyes with RRD combined with CD were divided into 2 groups based on the two different treatment regimens as above. The eyes in each group were further divided into 2 subgroups (A: CD subsided eyes; B: CD persistent eyes) according to the response of CD to the treatment of steroids. Retinal reattachment rates were measured at 6 months after the removal of silicone oil.ResultsAt 6 months after silicone oil removal, the retinal reattachment rate was similar (p = 0.666) in the oral prednisolone group (91.7%, 33/36) and the periocular injection group (94.9%, 37/39). Similar retinal reattachment rates (p = 0.364) were also found in the CD subsided eyes (97.1%, 34/35) and the CD persistent eyes (90.0%, 36/40). The retinal reattachment rate was comparable among the subgroups (p = 0.395; oral prednisolone A group: 95.2%, 20/21; oral prednisolone B group: 86.7%, 13/15; periocular injection A group: 100%, 14/14; periocular injection B group: 92.0%, 23/25).ConclusionsFor RRD combined with CD, eyes treated with a single periocular injection of methylprednisolone (40 mg, 1–3 days before pars plana vitrectomy) combined with the drainage of suprachoroidal fluids during the surgery had similar anatomic and functional outcomes compared to the eyes treated with oral prednisolone for 3–7 days before vitrectomy.

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.]

This report highlights the successful management of a large submacular haemorrhage associated with idiopathic polypoidal choroidal vasculopathy in a woman in her late 50s who presented with sudden vision loss in her left eye. Multilayered haemorrhages involving the macula were confirmed through funduscopy and swept-source optical coherence tomography. The patient underwent pars plana vitrectomy with subretinal recombinant tissue plasminogen activator injection, fluid-gas exchange with sulphur hexafluoride, and intravitreal ranibizumab, followed by prone positioning postoperatively. At 1 week, significant resolution of subretinal haemorrhage and improvement in exudative retinal detachment were observed. By 3 months, best-corrected visual acuity improved to 20/60, with consolidation of the haemorrhage and shrinkage of the pigment epithelial detachment.

Summary statement Intravitreal high dose (2 mg) ranibizumab may lead to quicker resolution of choroidal neovascularization (CNV) and associated retinal pigment epithelial detachment in eyes with exudative age-related macular degeneration, although it may possibly correlate with RPE tears in certain cases. Purpose This prospective study compared the outcomes of 0.5 vs 2.0 mg intravitreal ranibizumab injections (RI) for treating vascularized pigment epithelial detachment (vPED) due to age-related macular degeneration. Methods Patients with vPED were randomized to receive 2.0 vs 0.5 mg RI monthly for 12 months or for 4 months and then repeated on a pro-re nata basis. Optical coherence tomography, fundus photography, and fluorescein and indocyanine-green angiography were obtained at baseline and subsequent specific intervals. Outcome measures were best-corrected standardized visual acuities, central 1-mm thickness, surface area (SA), greatest linear diameter (GLD), heights (PED and CNV), and amount of subretinal fluid (SRF) and cystoid macular edema (CME). Results Both groups yielded reductions of the central 1-mm thickness, PED and CNV SA and PED height and GLD, SRF, and CME. Vision improvement and reduction in SRF and PED height occurred earlier for eyes receiving the 2.0 mg dose. Cataract progression was similar but RPE tears developed more often with the 2.0 mg dose. Conclusions There were similar visual and anatomical outcomes at the end of the study; however, the higher dose yielded more rapid reductions and more complete resolution of the PED, although there was possible increased tendency for an RPE tear with the higher dose.

AimTo identify preoperative features associated with surgical failure following vitrectomy using data collected in a large, prospective randomised controlled trial. Outcomes of patients who redetached were then examined in more detail.Methods615 patients were analysed as part of an randomised controlled trial investigating the use of 5-fluorouracil and low-molecular-weight heparin. Treatment status had no effect on success rates and did not therefore form part of the analyses. Failure was defined as retinal redetachment within 6 months of primary vitrectomy. Univariate logistic regression analysis was used to assess association between failure and putative risk factors (age, pathological myopia, intraocular pressure, vitreous haemorrhage, previous lens extraction, uveitis, number of retinal quadrants detached, number and distribution of retinal breaks, and grade C proliferative vitreoretinopathy (PVR)). Additional characteristics of patients were then elucidated including number of operations required to achieve retinal reattachment, surgical techniques used and final logMAR visual acuity.Results96 patients (15.6%) redetached following surgery, and 37 failed due to PVR. Surgical failure was associated with number of retinal quadrants detached (OR per increase, 1.69 (1.33 to 2.15) p<0.001) and grade C PVR (OR 3.98 (1.47 to 10.73) p=0.006). Inferior breaks were not identified as a risk factor (p=0.602). Repeat retinal detachment surgery showed a trend towards reduced visual acuity at 6 months providing PVR did not develop. PVR resulted in a significant deterioration in visual acuity.ConclusionsThe extent of retinal detachment and preoperative PVR are risk factors for surgical failure following vitrectomy for primary retinal detachment. PVR was again confirmed as the major factor influencing visual outcomes.

We aimed to evaluate the neuroprotective efficacy of rasagiline in pseudophakic patients who had surgery for macula-off rhegmatogenous retinal detachment (RRD). This was a 6-month, prospective, randomized, double-blind, placebo-controlled pilot study. Patients presenting with acute macula-off RRD were recruited and randomized 1:1 to receive rasagiline 1 mg/day or placebo for 7 days. Best-corrected visual acuity (BCVA) and optical coherence tomography were acquired 1 day before as well as 2 days, 3 weeks, 3 months and 6 months after surgery. We screened 26 patients with RRD whereof 23 were eventually included and randomized. The primary outcome was final BCVA. Secondary outcomes included central retinal thickness (CRT) and adverse events (AE). We evaluated photoreceptor cells (prc) recovery through morphological measurements. The baseline characteristics were comparable between groups. BCVA significantly improved in both groups (letters gained: rasagiline 61.5 ± 18.1 vs placebo 55.3 ± 29.2, p = 0.56), but no significant inter-group difference was found at any visit. CRT was stable 3 weeks after surgery onwards, with no inter-group difference. No treatment-emergent AE occurred. Significant prc restoration was observed from 3 weeks to 6 months after surgery, without inter-group difference at either visit. Ellipsoid zone integrity (β = 0.517, p = 0.008) and foveal bulge (β = 0.387, p = 0.038) were significant predictors of good final BCVA. In conclusion, perioperative oral treatment with rasagiline 1 mg/day for 7 days did not show significant benefits on visual or anatomical outcomes in macula-off RRD patients.