Giacomo Boscia

Purpose To evaluate intraretinal inflammatory hyperreflective retinal foci (i-HRF) as predictive biomarkers for fluid resolution after dexamethasone implant (DEX-I) treatment in patients with retinal vein occlusions. Methods This retrospective study included 49 consecutive patients (28 central retinal vein occlusion [CRVO], 21 branch retinal vein occlusion [BRVO]) treated with DEX-I (Ozurdex, AbbVie Inc.) between 2019 and 2024. Optical coherence tomography (OCT) parameters were analysed pre- and post-treatment using artificial intelligence-assisted quantitative analysis: central retinal thickness (CRT), i-HRF count, intraretinal fluid (IRF) volume, subretinal fluid (SRF) volume, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity. Results Baseline i-HRF count significantly correlated with SRF volume reduction (r = 0.652, p < 0.001) and IRF volume reduction (r = 0.434, p = 0.003). SRF demonstrated superior resolution rates compared to IRF (92.3% vs 73.7%, p < 0.001). Patients with high i-HRF count ( ≥ 100) achieved 100% SRF resolution compared to 66.7% in low i-HRF group ( < 60), p = 0.024. Mean CRT reduction was 350.8 ± 198.7 μm with 17.2 ± 14.3 ETDRS letters visual acuity improvement. i-HRF count decreased from 77.4 ± 29.6 to 59.8 ± 28.2 (p < 0.001), confirming anti-inflammatory efficacy. Conclusions Baseline i-HRF count may serve as a potentially valuable biomarker of fluid resolution after DEX-I in retinal vein occlusions. Higher i-HRF counts may be associated with a greater likelihood of SRF resolution within a dexamethasone-treated cohort.

Purpose: To evaluate the anatomical and functional outcomes of an epiretinal cryopreserved human amniotic membrane (hAM) overlay technique for the management of recurrent retinal detachment (RD) associated with peripapillary breaks in highly myopic eyes. Methods: Retrospective interventional case series including five eyes with recurrent RD (mean axial length 30.70 ± 2.03 mm). Two eyes presented with recurrence under silicone oil (SO) tamponade, and three after prior SO removal. All eyes underwent 25-gauge pars plana vitrectomy with SO removal when present. A customized 8–9 mm hAM patch was positioned epiretinally and unrolled bimanually under perfluorocarbon liquid (PFCL). Final tamponade was achieved with SO 1000 cSt, followed by scheduled SO removal. Results: Complete retinal reattachment was achieved in all cases (100%) after a single procedure and remained stable throughout follow-up. Mean best-corrected visual acuity (BCVA) improved from 1.00 ± 0.60 to 0.68 ± 0.58 logMAR at 2 months after SO removal (p = 0.068). Optical coherence tomography demonstrated stable integration of the hAM as a hyperreflective layer over the peripapillary defects. No cases of graft dislocation, proliferative vitreoretinopathy, or significant inflammatory complications were observed. Conclusions: The epiretinal hAM overlay technique appears to be a safe and effective approach for sealing complex peripapillary breaks in highly myopic eyes with chorioretinal atrophy. By providing both mechanical support and a biological scaffold for tissue repair, this technique may represent a valuable surgical option in cases where conventional retinopexy is not feasible or has failed.

Purpose: The study aims to assess the outcomes of introducing tissue plasminogen activator (t-PA) for massive subretinal hemorrhage (SRH) during pars plana vitrectomy (PPV). Methods: This consecutive, retrospective, non-randomized study evaluated 11 eyes with massive SRH. The post-operative follow-up was assessed after 3- and 6 months from the surgery, evaluating the Best-corrected visual acuity (BCVA) and measured the central macular thickness (CMT). All eyes were undergoing a PPV in combination with t-PA introduction and retinal displacement, fluid-air exchange, and anti-VEGF injection. Results: 11 eyes were included. At baseline, the main BCVA before the surgery was very poor. At 3-month after the surgery 5 eyes (45.4%) gained two and three lines on the visual acuity chart (range 20/400–20/100), and it was remained stable at 6-month. Solely in 3 eyes the BCVA not improved in the follow-up time. Moreover, in 3 eyes (27.3%), the BCVA improved significantly ( p < 0.05). Pre-surgical CMT was 596,4 ± 143,2 μm. Postoperative CMT was 288,7 ± 77,6 μm at 3-months follow-up ( p < 0.05) and 263,3 ± 75,2 μm at 6-months follow-up ( p < 0.05). Hemorrhage was displaced away from the fovea in all eyes. SRH recurred in only one eye. Conclusion: We suggest that timely intervention in massive-sized SRH may play a crucial role in limiting the extent of damage and preventing poor visual outcomes. It is also important to note that prompt treatment may help preserve foveal anatomy and limit the structural damage associated with this condition.

Purpose: To describe a simple, reproducible marking technique to confirm correct epithelial orientation of human amniotic membrane (hAM) during subretinal implantation in complex vitreoretinal surgery for massive subretinal hemorrhage. Methods: A single-surgeon case report of a patient with massive subretinal hemorrhage managed by 23-gauge pars plana vitrectomy, retinal turnover, and subretinal hAM implantation. Prior to intraocular insertion, an “F” letter mark was applied to the epithelial surface of the graft using gentian violet dye, enabling unambiguous identification of membrane orientation throughout folding and intraocular delivery. Results: The gentian violet “F” mark remained clearly visible at each surgical step — forceps insertion and subretinal placement — enabling immediate confirmation of graft orientation and correct apposition of the stromal surface against the retinal pigment epithelium. No intraoperative complications related to the dye were observed. Postoperative optical coherence tomography (OCT) confirmed anatomically correct graft positioning, stable retinal reattachment, and progressive improvement in best-corrected visual acuity (BCVA). Conclusion: Gentian violet “F” marking of the hAM epithelial surface is a straightforward, safe, and reproducible adjunct for orientation verification in complex vitreoretinal surgery, where tissue transparency and repeated intraocular manipulation pose a significant risk of incorrect graft placement.

Purpose: To evaluate visual and anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD), and to assess outcomes according to the clinical indication for switching. Methods: Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7%), suboptimal response (n:159, 53.0%), or durability-driven reasons (n:67, 22.3%). Longitudinal data from the 6 months preceding the switch and post-switch visits at 3 and 6 months were analyzed. The primary outcome was change in best-corrected visual acuity (BCVA, ETDRS letters) from the switch visit to the 3-month post-switch visit. Secondary outcomes included changes in central subfield thickness (CST) and retinal fluid status. Results: During the pre-switch period, mean BCVA declined by − 1.9 ± 8.2 letters and CST increased. At 3 months after switching, BCVA improved by + 2.0 ± 9.2 letters (95% CI, + 0.8 to + 3.2; p < 0.01), with greater gains in eyes switched for non-response (+ 2.8 ± 12.6 letters). Mean CST decreased by − 45.3 ± 79.8 µm (95% CI, − 55.4 to − 35.2; p < 0.001), with corresponding reductions in retinal fluid. Anatomical improvements were more pronounced in eyes switched for non-response, whereas more modest but consistent changes were observed in suboptimal and durability-driven groups. Visual and anatomical outcomes were maintained at 6 months. Conclusions: In previously treated nAMD eyes, switching to aflibercept 8 mg was associated with reversal of pre-switch anatomical worsening, reduction in retinal fluid, and modest visual gains. Greater responses were observed in eyes with inadequate pre-switch disease control, supporting its role as a treatment escalation strategy in clinical practice.

Background: Graft-versus-host disease is the most common complication after allogeneic hematopoietic stem cell transplantation. While ocular graft-versus-host disease typically manifests as dry eye syndrome and anterior segment involvement, posterior segment complications are rare. Previously reported posterior segment complications in graft-versus-host disease have been limited to acute presentations with significant functional visual impairment. Methods: A 41-year-old man developed progressive retinal nerve fiber layer and ganglion cell layer loss four years after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. The patient had established chronic graft-versus-host disease with cutaneous involvement and ocular surface disease. Results: Despite preserved visual acuity and visual fields, and only subtle functional involvement on visual evoked potentials, optical coherence tomography revealed significant reduction in retinal nerve fiber layer thickness and ganglion cell layer. Magnetic resonance imaging showed no optic nerve or brain abnormalities. Conclusions: This case describes an uncommon presentation of chronic, subclinical posterior segment involvement in chronic GVHD and suggests that optical coherence tomography may detect progressive structural retinal changes in the absence of clinically evident visual impairment, supporting its potential role in longitudinal monitoring.

Purpose: To describe a surgical technique based on the creation of horizontal scleral incisions for sutureless fixation of the Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy) in eyes without adequate capsular support. Methods: This retrospective interventional case series included eyes undergoing secondary IOL implantation using a Carlevale IOL. The technique consisted of creating two opposite horizontal scleral incisions, aligned with the haptic orientation, allowing stable intrascleral fixation of the T-shaped plugs without sutures or scleral flaps. Functional and anatomical outcomes were evaluated over a 3-month follow-up. Results: Twelve eyes were included. Mean best-corrected visual acuity (BCVA) improved from 0.48 ± 0.21 logMAR preoperatively to 0.34 ± 0.18 logMAR at 3 months (p = 0.029). All IOLs remained well centered and stable. No cases of IOL dislocation or endophthalmitis were observed. One eye developed transient hypotony that resolved spontaneously. Conclusions: Horizontal scleral incisions represent a safe, reproducible, and effective modification for Carlevale IOL implantation, minimizing scleral manipulation and suture-related complications.

Purpose: To characterise the natural history of poor-responder neovascular age-related macular degeneration (AMD) by tracking structural evolution and visual decline over time. Methods: This retrospective longitudinal study analysed 70 eyes of 70 treatment-naive neovascular AMD patients who completed loading dose therapy, received ≥7 injections in the first year, and experienced ≥10 ETDRS letter visual acuity (BCVA) loss from post-loading baseline. Spectral-domain OCT imaging and BCVA were evaluated at three timepoints: baseline (post-loading), 10-letter loss, and worst visual outcome. Multivariate regression analysis identified independent predictors of visual acuity at each timepoint. Primary structural parameters assessed included macular atrophy, subretinal fibrosis, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, central retinal thickness (CRT), and fluid parameters. Results: Mean follow-up was 38.5 ± 22.8 months. Macular atrophy progression was dramatic (7.1% → 41.4% → 81.4%, p < 0.001) and subretinal fibrosis increased substantially (11.4% → 25.7% → 57.1%, p < 0.001). CRT showed paradoxical biphasic evolution (262.6 → 278.6 → 252.0 μm). Multivariate analysis revealed three distinct phases: no independent predictors at baseline, comprehensive multi-pathway model at 10-letter loss with subretinal fibrosis ( β = −0.536), hyperreflective material ( β = −0.350), and intraretinal fluid ( β = −0.223) as independent predictors (R² = 0.428), and fibrotic dominance at worst outcome where subretinal fibrosis emerged as the sole predictor ( β = −0.469, R² = 0.220). CRT showed no predictive value across all timepoints. Conclusions: Poor-responder neovascular AMD follows a three-phase evolutionary journey with subretinal fibrosis as the dominant independent predictor of visual decline. These findings demand a paradigmatic shift toward qualitative structural assessment focusing on fibrotic changes rather than thickness-based monitoring.

Purpose: To describe a surgical technique consisting of selective removal of exposed retinal pigment epithelium (RPE) in eyes with extensive retinal loss, aimed at reducing postoperative proliferative vitreoretinopathy (PVR). Methods: This retrospective interventional case series included eyes undergoing complex retinal detachment surgery characterized by large areas of retinal absence with exposed RPE, including giant retinal tears, retinectomies, and large retinal breaks. Following standard pars plana vitrectomy and retinal stabilization, exposed RPE was selectively removed using a Charles flute needle under active aspiration with a protective silicone tip. Silicone oil tamponade was used in all cases. Results: Ten eyes were included. Mean best-corrected visual acuity (BCVA) improved significantly from approximately 0.72 ± 0.12 logMAR preoperatively to 0.42 ± 0.19 logMAR at 3 months (p = 0.027) and further to 0.38 ± 0.13 logMAR at final follow-up (p = 0.009). No patient developed clinical signs of PVR at 6 months. One recurrence occurred at 6 months; however, no associated signs of PVR were observed. No intraoperative or postoperative complications related to RPE removal were observed. Conclusions: Selective removal of exposed RPE in areas of retinal absence may reduce the exposure of the cellular substrate responsible for PVR formation and represents a potentially effective adjunctive technique in high-risk retinal detachment surgery.