Matteo Fallico

Purpose: To investigate visual outcomes after surgery for small idiopathic full‐thickness macular holes (FTMHs) exploring associated clinical variables. Methods: Multicentre, retrospective study including eyes with FTMH ≤250 μm treated with anatomically successful vitrectomy with a 12‐month follow‐up. The primary outcome was the incidence rate of normal vision outcome, defined as a postoperative best‐corrected visual acuity (BCVA) ≤0.1 logMAR and to explore clinical variables associated with it. Rates of suboptimal visual outcome (final BCVA >0.3 logMAR) and intermediate visual outcome (final BCVA >0.1 and ≤0.3 logMAR) were considered as secondary outcomes along with associated clinical variables. Results: Of 539 included eyes, 219 eyes (40.6%) achieved a normal vision outcome. An intermediate visual outcome was shown in 205 eyes (38%) and a suboptimal visual outcome in 115 eyes (21.3%). Vitrectomy with conventional internal limiting membrane (ILM) peeling was performed in 308 eyes (57%), while an inverted flap technique was used in 193 eyes (36%). Thirty‐eight eyes (7%) underwent vitrectomy without ILM peeling. Clinical variables associated with normal vision were a better preoperative BCVA and conventional ILM peeling. No ILM peeling vitrectomy proved to be a factor associated with normal vision. Inverted flap technique and a worse preoperative BCVA were associated with suboptimal visual outcome. Conclusion: Surgical treatment of small FTMHs has to be recommended since an excellent final visual outcome has been shown in 40% of cases. Vitrectomy with conventional ILM peeling should be considered the treatment of choice, while the inverted flap technique would not be advisable. Further studies are needed to confirm the role of vitrectomy without ILM peeling.

Purpose: To evaluate macular and peripapillary microvascular changes after proton beam radiotherapy for iris melanoma using optical coherence tomography angiography (OCT-A). Methods: Patients treated with proton beam radiotherapy for iris melanoma were included in the iris melanoma group. Fellow eyes were used as controls. Vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula, radial peripapillary capillary plexus (RPCP) and foveal avascular zone (FAZ) were evaluated using OCT-A. Central macular thickness (CMT) and nerve fiber layer thickness (RNFL) were also investigated. Results: A total of 11 patients were included. Vessel density in the whole SCP was comparable between treated eyes and untreated fellow eyes ( p = 0.32). Vessel density in the whole DCP was lower in the iris melanoma group compared with untreated fellow eyes: 39% [standard deviation (SD) 1.9] versus 49% (SD 4.1), respectively ( p < 0.001). Vessel density of the whole RPCP was lower in the iris melanoma group compared with untreated fellow eyes: 44% (SD 3.5) versus 48% (SD 2.2), respectively ( p = 0.02). No differences between treated eyes and untreated fellow eyes were noted when evaluating FAZ, CMT and RNFL thickness. Conclusion: Irradiation of the iris may determine vascular damage in the uveal tract, which, consequently, can affect the retinal vascular network. Changes in OCT-A parameters detected in DCP and RPCP may be early signs of microvascular impairment in these patients.

Purpose: To compare vitrectomy with and without internal limiting membrane (ILM) peeling in small idiopathic macular holes.Methods: Retrospective multicentre study including consecutive eyes with ≤250 μm idiopathic macular hole treated with vitrectomy. The primary outcome was hole closure rate. Best‐corrected visual acuity (BCVA) change, closure patterns on optical coherence tomography, rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery, and rate of complications were also investigated.Results: In total, 693 eyes were included. Hole closure rate was 98% in the peeling and 85% in the no‐peeling group (p < 0.001). At 12 months, mean BCVA change was 0.38 ± 0.22 logMAR in the peeling and 0.45 ± 0.21 logMAR in the no‐peeling group (p = 0.02); 66% versus 80% of eyes had a U‐shaped morphology, respectively; EZ recovery rate was 75% and 93%, respectively (p = 0.02). In the no‐peeling group, eyes with a vitreomacular traction (VMT) showed a 96% closure rate, comparable to the peeling group (p = 0.40). The incidence of adverse events was similar except for dissociated optic nerve fibre layer (55% in the peeling vs. 9% in the no‐peeling group, p < 0.001).Conclusions: In small idiopathic macular holes, ILM peeling provides a higher closure rate compared to no‐peeling; however, if a VMT is present closure rates are comparable. In closed macular holes, the no‐peeling technique provides advantages in terms of visual outcome and anatomical recovery.

Purpose: This paper explores the application of Apple Vision Pro in ophthalmic surgery, assessing its potential benefits in providing real-time imaging overlay, surgical guidance, and collaborative opportunities. Materials and method: The device was worn by 10 ophthalmic surgeons during eyelid malposition surgery. All surgeons performed the entire surgery while wearing the visor. At the end of procedure, all operators had to rate Apple Vision Pro visor according to 10 specific item and system usability scale (SUS) questionnaire. Results: The surgeons used the Apple Vision Pro during the entire procedure, and the results were positive, with high ratings for practicality, freedom of movement, integration into workflow, and learning. All surgeons rated the Apple Vision Pro above 85/100 in the SUS. Conclusion: The incorporation of Apple Vision Pro in oculoplastic surgery offers several advantages, including improved visualization, enhanced precision, and streamlined communication among surgical teams. According to our preliminary results Apple Vision Pro could represents a valuable tool in ophthalmic surgery, with implications for enhancing surgical techniques and advancing XR research in the surgical field.

Purpose: To assess the associations between visual acuity (VA) and retinal thickness in age-related macular degeneration (AMD) eyes treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods: Sixty-eight patients with neovascular AMD (68 eyes) undergoing anti-VEGF therapy with two years of follow-up imaging data after the initiation of treatment were retrospectively included. Linear and nonlinear regression analyses with curve fitting estimation were performed to explore the relationship between visual acuity and OCT-based parameters at the 3-month and 24-month follow-up visits. Regression analyses were also performed between visual acuity and the retinal thickness deviation which was calculated as the absolute value of the difference between measured and normative retinal thickness values. Results: The VA was not associated with either foveal (R²= 0.011 and p = .401 at 3 months; R²= 0.032 and p = .142 at 24 months) or parafoveal (R²= 0.045 and p = .081 at 3 months; R²= 0.050 and p = .055 at 24 months) retinal thicknesses. Compared with the linear models, a quadratic function yielded a relative increase in the R² coefficients. Conversely, the VA was linearly associated with foveal retinal thickness deviation (R²= 0.041 and p = .037 at 24 months) and parafoveal retinal thickness deviation (R²= 0.062 and p = .040 at 3 months; R²= 0.088 and p = .014 at 24 months) values. Conclusions: Although there was no linear relationship between retinal thickness and VA, a weak but statistically significant linear relationship could be observed when a retinal thickness deviation was considered. This suggests that deviation-based parameters may be beneficial for structure-function correlations in the context of anti-VEGF therapy for neovascular AMD.

Objectives: This study compared long-term surgical outcomes of the scleral flap versus scleral pocket technique for sutureless intrascleral one-piece intraocular lens (IOL) fixation. Methods: A retrospective comparative study was conducted at a single center, involving consecutive patients undergoing sutureless intrascleral one-piece IOL implantation, between January 2020 and May 2022. Eyes were divided into two groups based on the surgical technique: group 1 underwent scleral flap (n = 64), and group 2 received scleral pocket technique (n = 59). Visual acuity, refractive outcomes, and complications were assessed over a minimum 24-month follow-up period. Results: Both groups showed improvements in best-corrected visual acuity (BCVA), increasing from 0.84 ± 0.56 logMAR at baseline to 0.39 ± 0.23 logMAR (p = 0.042) at 24 months in group 1 and from 0.91 ± 0.63 logMAR at baseline to 0.45 ± 0.38 logMAR (p = 0.039) at 24 months in group 2. No significant differences in BCVA were observed between the groups at baseline (p = 0.991), 12 (p = 0.496) and 24 months (p = 0.557). Mean spherical equivalent (−0.73 ± 1.32 D in group 1 and −0.92 ± 0.99 D in group 2, p = 0.447), refractive prediction error (−0.21 ± 1.1 D in group 1 and −0.35 ± 1.8 D in group 2, p = 0.377), and surgically induced astigmatism (0.74 ± 0.89 D in group 1 and 0.85 ± 0.76 in group 2, p = 0.651) were comparable between the two groups. An IOL tilt of 5.5 ± 1.8 and 5.8 ± 2.0 degrees (p = 0.867) and an IOL decentration of 0.41 ± 0.21 mm and 0.29 ± 0.11 mm (p = 0.955) were obtained, respectively, in group 1 and group 2 at 24 months. Mean endothelial cell density remained stable at 24 months in both groups (p = 0.832 in group 1 and p = 0.443 in group 2), and it was 1747.20 ± 588.03 cells/mm² in group 1 and 1883.71 ± 621.29 cells/mm² in group 2 (p = 0.327) at baseline, 1545.36 ± 442.3 cells/mm² in group 1 and 1417.44 ± 623.40 cells/mm² in group 2 (p = 0.483) at 24 months. No cases of endophthalmitis were observed. Conclusions: The scleral pocket technique for sutureless intrascleral one-piece IOL fixation is comparable to the traditional scleral flap technique in terms of long-term visual outcomes and safety. The scleral pocket technique offers a simplified approach and a viable option even for less experienced surgeons.

Background: Idiopathic epiretinal membrane (ERM) often leads to visual symptoms such as metamorphopsia and decreased central vision. This study aimed to evaluate functional, structural, and microvascular characteristics in patients with different stages of idiopathic ERM who were candidates for surgery, with a focus on identifying potential indicators for surgical timing. Methods: A retrospective cohort study was conducted on consecutive patients with unilateral idiopathic ERM who were candidates for surgery. Patients underwent comprehensive ophthalmological assessments, including OCT grading, reading performance evaluation, and OCT angiography. Data analysis included comparisons between different ERM stages for functional, structural, and microvascular parameters. Results: A total of 44 eyes were included, classified into four ERM stages according to the Govetto grading system. Functional parameters, including distance and near visual acuity, worsened significantly with higher ERM stages, particularly in the transition from Stage 3 to Stage 4. Structural assessments revealed significant increases in central macular thickness (CMT) from Stage 3 to Stage 4. No significant differences were observed in microvascular features across different ERM stages. Conclusions: This study highlights the significant functional and anatomical impact of OCT staging in idiopathic ERM, particularly during the transition from Stage 3 to Stage 4, characterized by notable reductions in visual acuity and increases in CMT. These findings underscore the importance of considering both functional and structural parameters in surgical decision-making for ERM management. However, further research with larger cohorts is needed to confirm these observations and inform clinical practice.

Purpose: To describe and validate a 3D-printed adapter tool which could be used with either a slit lamp or a condensing lens, interchangeable between devices through magnetic fastening, in order to provide physicians a quick, easy and effective method of obtaining clinical photos. Materials and Methods: Three specialists, with at least 4-year experience in ophthalmology, gave a rate of image quality obtained by our device and the diagnostic confidence grade. The 3 specialists conducted each 13 or 14 examinations with the smartphone and magnetic adapter. At the end of evaluation, they rated with the Likert scale the ease of use of the device in obtaining clinical images of the anterior segment and ocular fundus respectively. Results: Data of quality perception and confidence demonstrated high values not dissimilar to the “de visu” eye examination. Moreover the instrument we designed turned out to be very user friendly. Conclusion: Our adapter coupled with a modern smartphone was able to obtain 4k images and videos of anterior segment, central and peripheral fundus, in an easy and inexpensive way.

(1) Purpose: To determine the “retinal thickness deviation” (RTD) in diabetic macular edema (DME) eyes treated with intravitreal therapy and to establish associations between RTD and best-corrected visual acuity (BCVA). (2) Methods: We conducted a retrospective study, including consecutive patients with DME eyes undergoing intravitreal therapy with two years of follow-up. BCVA and central subfield thickness (CST) were collected at baseline and at 12 months and 24 months of follow-up. RTD was calculated as the absolute difference between measured and normative CST values at each time point. Linear regression analyses were performed between RTD and BCVA and between CST and BCVA. (3) Results: One hundred and four eyes were included in the analysis. The RTD was 177.0 (117.2) μm at baseline, 97.0 (99.7) μm at 12 months and 89.9 (75.3) μm at 24 months of follow-up (p < 0.001). RTD showed a moderate association with BCVA at baseline (R² = 0.134, p < 0.001) and 12 months (R² = 0.197, p < 0.001) and a substantial association at 24 months (R² = 0.272, p < 0.001). The CST showed a moderate association with BCVA at baseline (R² = 0.132, p < 0.001) and 12 months (R² = 0.136, p < 0.001), while the association was weak at 24 months (R² = 0.065, p = 0.009). (4) Conclusions: RTD showed a good association with visual outcome in patients with DME eyes undergoing intravitreal treatment.