Gregg T. Kokame

Purpose: Peripapillary and macular retinoschisis can occur without visible optic pits or advanced glaucomatous optic atrophy, a condition referred to as no optic pit retinoschisis (NOPIR). This study sought to further define the clinical features of NOPIR in a single-center case series. Methods: A retrospective study of consecutive cases of NOPIR was performed at The University of Osaka Hospital in Japan. The clinical characteristics and treatment history of patients were reviewed. Results: In total, 13 eyes of 12 patients with NOPIR were included. At baseline, the mean (±SD) age was 65.8 ± 10.3 years, mean intraocular pressure was 14.9 ± 3.9 mm Hg, and mean refractive error was −2.12 ± 2.4 diopters. Two eyes had moderate glaucoma at baseline. Ten eyes (91%) did not have glaucoma at baseline; however, glaucoma developed later after the initial diagnosis. The mean time from baseline to glaucoma diagnosis was 31.6 ± 15.2 months. Of the 13 eyes, retinoschisis associated with NOPIR was treated with vitrectomy in 6 eyes and with observation in 7 eyes. The time to resolution of retinoschisis was shorter in the surgery group (mean ± SD 14.7 ± 7.6 months) than in the observation group (52.4 ± 21.4 months) ( P = .005). The time to diagnosis of glaucoma was also shorter in the surgery group (9.5 ± 12.8 months) than in the observation group (35.6 ± 16.1 months) ( P = .02). Conclusions: Eyes with NOPIR can have glaucoma present at the time of diagnosis, but it more commonly develops later thereafter. Screening for glaucoma and visual field testing should be considered in eyes with NOPIR.

Purpose: To report a case of myopic macular retinoschisis and full-thickness macular hole (FTMH) that both resolved with topical medical therapy alone. Methods: A retrospective chart review was performed. Results: A patient with myopic retinoschisis with an FTMH and increased symptoms of metamorphopsia was treated with topical medical therapy consisting of 1% prednisolone, 4 times daily, and 0.07% bromfenac, daily. Anatomic changes at 6 weeks included drawing together of the inner retinal edges around the MH and its subsequent closure with marked resolution of the myopic retinoschisis. Conclusions: Severe myopic macular retinoschisis and an FTMH both resolved with topical therapy consisting of steroidal and nonsteroidal anti-inflammatory medications. This rapid resolution contradicts current theories of the pathogenesis of myopic macular retinoschisis.

We evaluated the response to faricimab in a retrospective series of neovascular age-related macular degeneration (nAMD) eyes with persistent edema or subretinal fluid on other existing anti-VEGF drugs. Inclusion criteria were at least 3 faricimab injections with 6 months follow-up. We also determined the subtypes of nAMD such as polypoidal choroidal vasculopathy (PCV) or non-PCV. Intervals between injections were extended as long as the macula remained dry. Thirteen eyes of thirteen patients were included. Mean age was 77.1 ± 9.3 years. Six were males and seven were females. All eyes had type 1 choroidal neovascularization (CNV) (CNV below the retinal pigment epithelium (RPE), and ten had PCV and three had occult CNV (non-PCV). Faricimab resolved the macula edema in 69.2% of anti-VEGF resistant eyes after three injections. Neither central retinal thickness nor visual acuity significantly changed 6 months after faricimab injections were started. The mean interval of injections before and after faricimab therapy did not change and was 5.3 ± 1.5 and 5.4 ± 0.8 weeks. Central retinal thickness, visual acuity, and the interval of injections were not significantly different between PCV and non-PCV subtypes of exudative AMD.

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.

Purpose: To describe a case of successful resolution of severe hypotony and choroidal detachments following nonfiltering glaucoma surgery with an intravitreal injection of C₃F₈ gas after a poor response to topical steroids and cycloplegia. Methods: Retrospective chart review of a case report. Results: 89 year-old male presented with a central retinal vein occlusion, hyphema, vitreous hemorrhage and neovascular glaucoma. After initial intravitreal injection of aflibercept he was treated with pars plana vitrectomy with panretinal photocoagulation and endocyclophotocoagulation to the ciliary body, but he continued to have elevated intraocular pressure. Subsequent external cyclophotocoagulation was performed but severe hypotony with inflammation, choroidal detachments, and corneal edema developed one week later without response to cycloplegic and steroid medications. A therapeutic injection of perfluorpropane (C3F8) gas led to resolution of the hypotony and choroid detachment and long-term maintenance of intraocular pressure. Discussion/Conclusion: An intravitreal gas bubble can be a very useful outpatient procedure to immediately reverse hypotony, resolve choroidal detachment, and decrease associated inflammation. When hypotony does not respond to medical therapy with cycloplegic drops and steroid medications, then an intravitreal gas bubble can rapidly resolve these complications and result in stabilization of intraocular pressure long-term.