Ophthalmology

Ultra-widefield imaging has become an important component of a thorough eye exam and is taking on a larger role in retina and comprehensive ophthalmology.

A recently released ultra-widefield fundus camera takes images in true color and captures high-resolution imagess rom the macula to the far periphery.

Study results provide new information about the risk and strategies for preventing tractional retinal detachment (TRD) development or progression in eyes with severe proliferative diabetic retinopathy (PDR) receiving intravitreal bevacizumab (Avastin, Genentech) prior to vitrectomy.

Glucose entrapment in the retinal pigment epithelium is responsible for central vision loss in retinitis pigmentosa. Injecting wild-type rods into the eye to restore glucose transportation or injecting glucose into the subretinal space can facilitate cone regeneration.

Achieving the best visual outcomes in challenging cases is a high priority in surgical retina. However, meeting that goal involves a high level of creativity, especially in complex cases associated with other ocular comorbidities.

Intraoperative optical coherence tomography (OCT) is becoming widely available, and its adoption is increasing, but improvements in the technology are needed to maximize its readiness for prime time, according to Justis P. Ehlers, MD.

Suprachorodial hemorrhage can be managed effectively with a conservative approach, but if surgical intervention becomes necessary, timing is critical for optimizing the outcome and minimally invasive techniques can be considered, said John W. Kitchens, MD.

Anti-vascular endothelial growth factor (VEGF) therapy is highly successful, but as Raj Maturi, MD, pointed out, also has some limitations.

Another adverse effect associated with the compounding process of bevacizumab (Avastin, Genentech)-i.e., the presence of silicone oil droplets in the vitreous cavity-has surfaced within the past year and seems to be related to the preloading of the drug in insulin syringes.

Subretinal hyperreflective material (SHRM) is a morphologic component seen on optical coherence tomography (OCT) images as hyperreflective material that is external to the retina and internal to the retinal pigment epithelium (RPE), said Jaya B. Kumar, MD.

Carol. L. Shields, MD, highlighted the results of collaborative efforts among four Philadelphia institutions: Wills Eye Hospital, Thomas Jefferson Hospital, the Genetics Department of the University of Pennsylvania, and the Wistar Instituate. The findings were published in Ophthalmology (Shields et al. 2017; published online May 7, 2017).

A surgical innovation is defined as a quantum improvement in the treatment of a particular disease or group of diseases, and it usually is developed by an individual or a small group working together, said John Thompson, MD.

“There is a compelling need to explore gene therapy in the eye,” according to Paul A. Sieving, MD, PhD.

A dye made from the açai fruit (Euterpe oleracea) is safe for use in human eyes and effective for identifying the posterior hyaloid and internal limiting membrane (ILM) during vitreoretinal surgery, according to phase I preliminary study results.

Recognition of this problem resulted in an innovative approach for closing persistent macular holes after the primary surgery has failed by creating a separate paracentral retinotomy in the nasal macula. Michael S. Tsipursky, MD, described the rationale for trying this treatment approach. “

In the current era where pharmacologic therapy is the preferred treatment for macular edema secondary to retinal vein occlusion (RVO), there is still a role for laser, according to Francesco Bandello, MD.

Optical coherence tomography angiography (OCTA) is a promising new approach for visualizing retinal vascular pathology in eyes with diabetic eye disease that can be expected to have even greater utility in the future pending further enhancements.

Scleral buckles and vitrectomy are the two main procedures used today to treat retinal detachments, with many surgeons performing a combination of the two.

Findings from preclinical studies show that a novel intravitreal depot of an anti-angiogenic drug releases the medication over a period of at least 6 months, is well-tolerated, and prevents VEGF-induced retinal vascular leakage.

Ongoing research for the treatment of uveal melanoma is providing hope that the future may bring new approaches for improving the safety of local therapy–along with modalities that will increase survival by reducing metastatic risk.

In complicated retinal detachment cases where the retina fails to reattach after completing the usual steps, retinectomy is a better technique than relaxing retinotomy–and the retinectomy is best done incrementally under air, said Steve Charles, MD.

The dry form of age-related macular degeneration (AMD) is the most common type of the disease, but successful treatments have been elusive in patients, resulting in disease progress and visual loss.

Idiopathic macular telangiectasia (MacTel) is bilateral condition characterised by ectatic capillaries of the macula and atrophy of the neurosensory retina. Familiarity with the distinctive intraretinal cavitation on SD-OCT in type 2, the most common type, is key for correct diagnosis.

The presence of vitreomacular adhesion (VMA) is associated with poorer, short-term anatomic, and functional outcomes in eyes with diabetic macular edema (DME) receiving anti-VEGF therapy, according to Márcio B. Nehemy, MD, PhD.

Future increases in imaging speed will improve performance and functionality for OCT and OCT angiography (OCTA), said James Fujimoto, PhD.

Findings from studies investigating intravitreal corticosteroids for treatment of diabetic macular edema (DME) provide information about their efficacy and safety, including some understanding of how they compare with anti-VEGF therapy.

Wide-field retinal imaging can be performed using a commercially available swept-source optical coherence tomography (SS-OCT) platform (DRI OCT Triton, Topcon) and only the internal fixation light for patient navigation provided detailed images of both normal and pathologic peripheral retinal findings.

A new hypersonic liquefaction vitrectomy system, called Vitesse PPVX (Bausch + Lomb), offers several advantages over currently available vitrector technology. The device received FDA 510k approval in April 2017.

Adaptive optics could allow clinicians to monitor the progression of retinal diseases cell-by-cell, according to Jacque Duncan, MD.