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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 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.]

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.

Background/aimsTo investigate the clinical effectiveness of adjunctive triamcinolone acetonide (TA) given at the time of vitreoretinal surgery following open globe trauma (OGT).MethodsA phase 3, multicentre, double-masked randomised controlled trial of patients undergoing vitrectomy following OGT comparing adjunctive TA (intravitreal and subtenons) against standard care (2014–2020). The primary outcome was the proportion of patients with at least 10 Early Treatment Diabetic Retinopathy Study (ETDRS) letter improvement in corrected visual acuity (VA) at 6 months. Secondary outcomes included: change in ETDRS, retinal detachment (RD) secondary to PVR, retinal reattachment, macular reattachment, tractional RD, number of operations, hypotony, elevated intraocular pressure and quality of life.Results280 patients were randomised over 75 months, of which 259 completed the study. 46.9% (n=61/130) of patients in the treatment group had a 10-letter improvement in VA compared with 43.4% (n=56/129) of the control group (difference 3.5% (95% CI −8.6% to 15.6%), OR=1.03 (95% CI 0.61 to 1.75), p=0.908)). Secondary outcome measures also failed to show any treatment benefit. For two of the secondary outcome measures, stable complete retinal and macular reattachment, outcomes were worse in the treatment group compared with controls, respectively, 51.6% (n=65/126) vs 64.2% (n=79/123), OR=0.59 (95% CI 0.36 to 0.99), and 54.0% (n=68/126) vs 66.7% (n=82/123), OR=0.59 (95% CI 0.35 to 0.98), for TA vs control.ConclusionThe use of combined intraocular and sub-Tenons capsule TA is not recommended as an adjunct to vitrectomy surgery following OGT.Trial registration number NCT02873026.

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 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.

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.

This case report describes a surgical technique using double-layer human amniotic membrane (hAM) grafting to repair a high myopic macular hole (MH)-related chronic retinal detachment (RD) with subretinal bands in a child with Knobloch syndrome. A 4-year-old boy diagnosed with Knobloch syndrome presented with macular atrophy in the right eye and chronic total RD with subretinal bands associated with a myopic MH in the left eye. The surgery involved an encircling band, pars plana vitrectomy, and subretinal band extraction through a retinotomy. The retinotomy and MH were sealed using hAM with a 5000 centistoke (cS) silicone oil (SO) tamponade. RD recurred two weeks postoperatively due to hAM contracture, leading to MH reopening. A second intervention included replacing the contracted graft with two larger hAM grafts; the first positioned under the MH and the second over the MH in a sandwich configuration, with 5000 cS SO tamponade. Eighteen months after SO removal, a flat retina, closed MH, and ambulatory vision were achieved. In conclusion, double-layer hAM grafting provides a strong seal for MH in high myopia-associated RD where conventional techniques fail. Keywords: Pediatric retinal detachment, human amniotic membrane, Knobloch syndrome, macular hole-related retinal detachment, pediatric high myopia

To compare postoperative changes in peripapillary retinal nerve fiber layer (pRNFL) thickness between macula-off and macula-on rhegmatogenous retinal detachment (RRD). Patients with RRD who had undergone a single, uncomplicated vitrectomy and been followed for ≥ 3 years postoperatively were included. Based on preoperative status, patients were categorized into a macula-on group (Group 1) and a macula-off group (Group 2). The baseline was established after complete gas dissipation from the vitreous cavity, followed by three additional examinations at 1-year intervals. In total, 62 eyes were analyzed: 30 in Group 1 and 32 in Group 2. Global pRNFL thicknesses in Group 1 were 100.0 ± 19.5, 99.4 ± 19.6, 98.4 ± 19.4, and 97.0 ± 20.3 μm at baseline, 1 year, 2 years, and 3 years, respectively ( P  = 0.001). In Group 2, the corresponding values were 99.6 ± 15.0, 96.2 ± 16.4, 95.4 ± 16.3, and 94.1 ± 17.6 μm ( P  < 0.001). Sectoral analysis showed statistically significant changes in the inferotemporal ( P  < 0.001) and inferonasal ( P  = 0.003) sectors in Group 2. The reduction rates of global pRNFL thickness were − 0.89 μm/y in Group 1 and − 1.81 μm/y in Group 2; these rates significantly differed between the groups ( P  = 0.026). Among RRD patients, pRNFL thickness gradually declined over time, with a more pronounced reduction in the macula-off group. A substantial decrease in inferior pRNFL thickness was observed in macula-off patients.

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.