Search Results (34)

Background/Objectives: Posterior vitreous detachment (PVD), which is closely related to epiretinal membrane (ERM) formation, can affect macular microstructure and function through persistent tractional forces. The aim of this study was to evaluate whether PVD status influences preoperative characteristics and long-term functional and morphological retinal outcomes after ERM surgery. Methods: Ninety patients who underwent idiopathic ERM removal were included and divided into two groups on the basis of intraoperative vitreous status: incomplete or complete PVD. Visual function, retinal imaging, microperimetry, and multifocal electroretinography (mfERG) data were assessed preoperatively and at 1, 4, and 12 months postoperatively. Results: At baseline, compared with the incomplete PVD group, the complete PVD group demonstrated greater fixation stability and lower variability, along with smaller foveal avascular zone (FAZ) areas in both superficial and deep vascular complexes. In terms of absolute postoperative values, the complete PVD group exhibited superior functional outcomes, including higher macular sensitivity and improved fixation variability parameters at 12 months. Morphologically, the incomplete PVD group showed consistently larger FAZ areas in both superficial and deep vascular complexes. In terms of changes from baseline, best-corrected visual acuity (BCVA) gain was greater in the complete PVD group at 1 and 4 months, with no difference at 12 months, whereas no significant between-group differences were observed for other functional or morphological parameters at any time point. Conclusions: Complete PVD is associated with faster visual recovery. Incomplete PVD may induce alterations at the retinal microcirculation level that persist postoperatively and influence microperimetric scores. Full article

Background and Clinical Significance: To describe two cases within the spectrum of non-myopic foveomacular retinoschisis, including stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR) and central anomalous retinoschisis with mid-peripheral traction (CARPET), and to highlight the role of multimodal imaging in identifying vitreoretinal traction in their pathogenesis and management. Case Presentation:First Case Report: A 57-year-old man presenting with bilateral visual decline. Multimodal imaging, including spectral-domain and en face optical coherence tomography (OCT), demonstrated characteristic features of SNIFR, with schisis at the Henle fibre layer and outer plexiform layer and persistent posterior hyaloid adhesion. Medical treatment was ineffective. Over two years, complete posterior vitreous detachment occurred, followed by spontaneous anatomical resolution of the schisis and full visual recovery. Second Case Report: A 63-year-old man with severe unilateral visual loss. Imaging revealed marked mid-peripheral vitreoretinal traction extending toward the posterior pole; associated with foveoschisis, central neurosensory detachment, and an outer lamellar macular hole, consistent with CARPET syndrome. The patient underwent pars plana vitrectomy with traction release. Postoperatively, complete anatomical resolution of both macular and peripheral schisis was achieved, with partial visual recovery. Conclusions: These cases support vitreoretinal traction as an important pathogenic mechanism in selected forms of non-myopic foveomacular retinoschisis. SNIFR may resolve spontaneously following posterior vitreous detachment, whereas CARPET represents a more severe tractional phenotype that may require surgical intervention. Careful multimodal imaging assessment of the vitreoretinal interface is essential for accurate diagnosis and management. These findings further characterise CARPET and expand the clinical spectrum of traction-related non-myopic foveomacular retinoschisis. Full article

Retinal detachments following blunt ocular trauma are challenging to predict due to the complex and transient biomechanical responses of the globe. This study combines an in vitro weight-drop experiment and finite element analysis (FEA) to evaluate the mechanical pathways leading to traumatic retinal detachment and to predict the spatial likelihood of injury. In the in vitro model, a cylindrical weight was impacted onto freshly enucleated mouse eyes (16 weeks old) supported on a rigid metal plate. Following impact, the eyes were sectioned and stained using hematoxylin and eosin (H&E) for histological assessment. A finite element model of a mouse eye, including the cornea, sclera, lens, zonule, vitreous body, aqueous humor, and retina, was reconstructed from the histological section and used to simulate the whole sequence of compression and rebound following the blunt impact. The simulation demonstrated that the lens retained a high momentum. It generated an alternating compressive (up to −6.57 × 10⁻³ MPa) and tensile (up to 1.62 × 10⁻³ MPa) radial stress at the posterior pole and sustained compressive stress at the peripheral region (up to −3.12 × 10⁻³ MPa) and tensile-compressive stress variation at the equatorial region of the retina. In addition, the regions experiencing tensile stress overlapped with the region exhibiting retinal detachment in the in vitro experiment. These findings highlight the spatiotemporal mapping of biomechanical stress to predict traumatic retinal detachment following blunt impact and provide an understanding of early biomechanical response following ocular trauma. Full article

Objectives: We aimed to visualize the interaction of intravitreal gas with the adjacent vitreomacular interface by using prone position (PP) SD-OCT and suggest possible mechanisms of action behind gas-induced posterior vitreous detachment (PVD) in pneumatic vitreolysis (PV). Methods: This was a descriptive–interpretative morphological study. Spectral domain OCT imaging in PP was carried out using a flexible scanning module (SD-OCT-Flex, Heidelberg Engineering) originally designed for bedside imaging. Routine imaging in sitting position was carried out using a regular SD-OCT-device (Heidelberg Engineering). Patients with symptomatic vitreomacular traction (VMT) scheduled for PV with perfluoropropane (C3F8, 0.3 mL) received both sitting and PP imaging immediately before and at regular follow-up visits during the first 3 post-procedural weeks, beginning 3 h after PV. Imaging was reviewed for positional changes of the gas bubble, posterior hyaloid membrane (PHM), VMT configuration, and retrohyaloidal fluid (RHF). Results: Three consecutive patients with VMT were included (age: 79, 80, 82 years). Before the procedure, no positional alterations were detected. After the intravitreal injection of gas, PP allowed for the precise discrimination of the PHM and the posterior border of the gas bubble. In contrast to regular SD-OCT in sitting position, PP imaging showed a flattened VMT by the gas bubble with consecutive displacement of RHF from the macular region to the midperiphery. Conclusions: This exploratory study describes PP imaging as a tool for the assessment of the morphologic dynamics between the posterior hyaloid membrane, retina, and gas bubble in pneumatic vitreolysis. PP in pneumatic vitreolysis causes the gas bubble to flatten the VMT and to push retrohyaloidal fluid to the midperiphery, possibly allowing for the release of persistent vitreoretinal adhesions and consequent PVD induction. Full article

Uveitis constitutes a heterogeneous group of intraocular inflammatory pathologies, including both infectious and non-infectious aetiologies, often leading to substantial morbidity and permanent loss of vision in up to 20% of the affected cases. Visual impairment is most prominent in intermediate, posterior, or panuveitis and is commonly associated with cystoid macular oedema, epiretinal membranes, macular holes, and retinal detachment. In the context of uveitis, these complications arise as a result of recurrent flare-ups or chronic inflammation, contributing to cumulative ocular damage. Pars plana vitrectomy (PPV) has an evolving role in the diagnostic and therapeutic approach to uveitis. Diagnostic PPV allows for the analysis of vitreous fluid and tissue using techniques such as PCR, flow cytometry, cytology, and cultures, providing further insights into intraocular immune responses. Therapeutic PPV can be employed for the management of structural complications associated with uveitis, in a wide spectrum of inflammatory clinical entities such as Adamantiades–Behçet disease, juvenile idiopathic arthritis, acute retinal necrosis, or ocular toxoplasmosis. Modern small-gauge and minimally invasive techniques improve visual outcomes, reduce intraocular inflammation, and may decrease reliance on systemic immunosuppression. Emerging technologies, including robot-assisted systems, are expected to enhance surgical precision and safety in the future. Despite these advances, PPV outcomes remain variable due to heterogeneity in indications, surgical techniques, and postoperative management. Prospective studies with standardized protocols, detailed subgroup analyses, and the integration of immunological profiling are needed to define which patients benefit most, optimize therapeutic strategies, and establish predictive biomarkers in uveitis management. Full article

Background/Objectives: The influence of the vitreoretinal interface on neovascular age-related macular degeneration (nAMD) remains poorly characterized. Most previous studies relied solely on macular optical coherence tomography (OCT), which provides limited information about global posterior vitreous detachment (PVD). This study evaluated (1) whether ultrasonography-defined PVD status differs between nAMD eyes and healthy controls, and (2) whether baseline PVD influences macular neovascularization (MNV) phenotype and functional outcomes following anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: In this prospective longitudinal study, treatment-naïve nAMD eyes and population-based healthy controls underwent dynamic B-scan ultrasonography and spectral-domain OCT. PVD was categorized as absent, partial, or complete. nAMD eyes received intravitreal aflibercept according to a treat-and-extend protocol and were followed for 12 months. Structural parameters—including subretinal fluid (SRF), intraretinal fluid (IRF), and central foveal thickness—along with best-corrected visual acuity (BCVA) were recorded. A multivariable linear regression model was performed to assess whether PVD independently predicted BCVA gain after adjusting for age, baseline BCVA, MNV subtype, SRF, atrophy, and number of injections. Results: Absence of PVD was significantly more frequent in nAMD eyes than in controls (p < 0.001), whereas complete PVD prevalence was comparable. In nAMD, absence of PVD was associated with a higher prevalence of MNV type 2 (p = 0.032), while partial/complete PVD correlated with type 1 lesions. After 12 months, eyes without PVD achieved the greatest visual improvement (mean BCVA gain +0.34 ± 0.26), outperforming eyes with complete PVD (p = 0.026). A multivariable model confirmed that absence of PVD was an independent predictor of greater BCVA gain (β = −0.27; 95% CI −0.42 to −0.12; p = 0.0008). Eyes with complete PVD required more injections (p = 0.046). SRF and foveal-thickness reductions occurred across groups, whereas IRF changes were similar. Conclusions: Ultrasonography-defined PVD status differs markedly between nAMD and healthy eyes and independently influences neovascular phenotype and functional response to anti-VEGF therapy. These findings underscore the physiological importance of the vitreoretinal interface and support the use of ocular ultrasonography as an adjunct tool for assessing global vitreous status in selected nAMD settings. Full article

Background: Scleral fixation of intraocular lenses (IOLs) is a valuable option in cases of aphakia or inadequate capsular support, yet conventional sutured and sutureless approaches can pose technical challenges and complication risks. The needle-guided scleral fixation technique offers a simplified, single-suture solution that enhances safety and reproducibility. Methods: In this retrospective interventional case series, 30 eyes with insufficient capsular support underwent IOL implantation using Meduri’s needle-guided single-suture technique at the G. Martino University Hospital, Messina. The surgical method employs a 24-gauge needle to guide a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation. Outcomes were assessed over 24 months, including best-corrected visual acuity (BCVA), IOL centration, intraocular pressure (IOP), and postoperative complications. Results: Mean BCVA improved from X to Y LogMAR at two years (p < 0.05). All IOLs remained well-centered without tilt or decentration. Mild conjunctival hyperemia occurred in 70% of cases, resolving spontaneously. No suture erosion, vitreous hemorrhage, or retinal detachment was observed. Conclusions: The needle-guided single-suture technique provides a stable, efficient, and reproducible method for posterior chamber IOL fixation in aphakic eyes lacking capsular support. Its minimal learning curve and reduced surgical complexity make it an attractive alternative to both traditional sutured and modern sutureless methods, particularly in centers without vitreoretinal expertise. Full article

Background/Objectives: Posterior vitreous detachment (PVD) is an age-related physiological process, yet the clinical and biometric factors influencing its progression remain incompletely characterized in adults undergoing routine ophthalmic evaluation at a tertiary center. Characterizing expected vitreous patterns is essential for interpreting vitreoretinal interface changes in disease. This study aimed to identify independent clinical and biometric factors associated with more advanced PVD stages in adults without macular pathology. Methods: In this cross-sectional observational study, 340 eyes from 198 consecutive adults undergoing routine ophthalmological evaluation at a tertiary hospital (March 2022–April 2023) were analyzed. Eyes with current or past macular disease were excluded. Demographic variables, systemic comorbidities and ocular history were recorded. Axial length was measured using optical biometry IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Vitreous status was assessed with 10-MHz B-scan ultrasonography and classified as no PVD, partial PVD or complete PVD. Analyses were performed at the eye level. Given its cross-sectional design, this study evaluates associations and cannot establish causal relationships. Bivariate comparisons examined associations between clinical variables and PVD grade. Multivariable modeling was conducted using a clustered generalized estimating equations (GEE) ordinal logit model as the primary analysis, and a secondary independent-eye ordinal logistic regression model was used to evaluate the proportional-odds assumption and model robustness. Results: Mean age was 55.6 ± 18.3 years, and 68.5% of eyes were from female participants. No PVD, partial PVD and complete PVD were present in 30.9%, 43.5% and 25.6% of eyes, respectively. In the primary GEE model, axial length (OR 1.35; p < 0.001), systemic hypertension (OR 7.13; p < 0.001), and prior cataract surgery (OR 2.13; p = 0.020) were independently associated with more advanced PVD stages. Age showed a modest but significant association with increasing PVD severity (OR 1.03; p = 0.012). Sex and diabetes mellitus were not associated with PVD grade. The independent-eye ordinal model yielded consistent effect directions. Conclusions: In adults without macular disease, more advanced PVD stages are independently associated with axial elongation, systemic hypertension, and previous cataract surgery, while age shows a mild but significant association. These findings provide clinically useful contextual reference information for interpreting vitreoretinal interface changes in health and disease. These associations should not be interpreted as causal due to the cross-sectional nature of the study. Full article

Background and Objective: To elucidate the clinical characteristics of full-thickness macular holes (FTMHs) with epiretinal proliferation (EP) without posterior vitreous detachment (PVD). Material and Methods: A retrospective and exploratory study reviewed clinical records of patients with FTMHs with EP without PVD (5 eyes: EP group) and FTMHs without EP without PVD (32 eyes: non-EP group). Swept-source OCT images were analyzed for macular structure. Statistical comparisons were made between clinical characteristics and surgical outcomes. Results: The EP group had two eyes with non-closure of macular holes (40%) (p = 0.01) and three eyes with ellipsoid zone defects (60%) (p = 0.01 compared with the non-EP group). Conclusions: Although limited by a small sample size, this pilot study suggests that the observed trends—such as a lower closure rate and more outer retinal disruption in the EP group—may indicate differences in pathogenesis and surgical outcomes compared to the non-EP group. However, these findings should be interpreted with caution due to statistical limitations. Further prospective studies with larger cohorts are needed to validate these preliminary findings and better understand the underlying pathogenesis. Full article

Background: Idiopathic epiretinal membrane (iERM) is a common retinal pathology in elderly patients, thought to originate primarily from an anomalous process of posterior vitreous detachment. The standard treatment is pars plana vitrectomy (PPV) with membrane peeling. No consensus exists regarding the optimal timing of surgery, nor is it clear which patients are most likely to benefit. Given that iERM profoundly affects retinal vascular morphology and function, optical coherence tomography angiography (OCTA) has emerged as a valuable tool for identifying potential biomarkers. This systematic review aimed to synthesize the available evidence on OCTA-derived biomarkers and their correlations with visual function before and/or after surgical intervention in iERM, with a particular focus on their prognostic value for postoperative outcomes. Methods: A systematic search of PubMed/MEDLINE and Scopus was conducted on the 20th of May 2025 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included patients with iERM undergoing vitreoretinal surgery, used OCTA for pre- and/or postoperative assessment, investigated structure–function correlations, and were designed as clinical trials, observational studies, or case series with more than 10 patients. Exclusion criteria were studies with ≤10 cases, absence of separate iERM analysis, lack of surgical intervention, or non-English language. Data extraction covered study design, demographics, surgical approach, OCTA device, follow-up, OCTA biomarkers, and structure–function outcomes. Risk of bias in observational studies was assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The search yielded 1053 records, of which 71 underwent full-text review and 43 met eligibility criteria. All included studies were observational, encompassing 1958 eyes from 1953 patients. The most frequently investigated biomarkers were the foveal avascular zone (FAZ) area and related parameters, vessel density (VD), and foveal density 300 (FD-300). Additional studies evaluated average vessel length (VL), blood flow area, vessel length density (VLD), vessel tortuosity (VT), fractal dimension (FD), and perfusion capacity (PC). Conclusions: By consolidating current evidence, this systematic review provides a comprehensive overview of structure–function correlations in iERM and highlights the potential of OCTA-derived metrics as biomarkers of disease severity and surgical prognosis. These findings help clarify underlying mechanisms of visual decline and establish the context for further research. Nonetheless, interpretation is limited by the observational design of all included studies and by heterogeneity in OCTA methodology and nomenclature, underscoring the need for standardization to improve comparability and foster greater coherence across studies. No funding was provided for this review. Full article

Background/Objectives: A vasoproliferative retinal tumor (VPT) is a rare, benign, vascular tumor that is found in the peripheral retina. We retrospectively investigated the clinical characteristics and the outcomes of pars plana vitrectomy (PPV) on idiopathic VPTs. Methods: The medical records of 13 eyes of 12 patients who underwent PPV for an idiopathic VPT were reviewed. The chief complaint of the patients, the location and size of the tumor, the presence of concomitant retinal disorders, the treatment procedures, and the best-corrected visual acuity (BCVA) were evaluated. Results: The mean age was 51.2 years, with 4 men and 8 women. The chief complaints at the initial visit were metamorphopsia in 6 eyes, decreased vision in 6 eyes, and blurry vision in 1 eye. A hemangioma was detected in the inferior-temporal quadrant in 11 eyes and in the superior-temporal quadrant in 2 eyes. An epiretinal membrane was present in all 13 eyes with tractional and exudative retinal detachment in 4 eyes, macular hole in 2 eyes, and vitreous hemorrhage in 3 eyes. During the vitrectomy, a posterior vitreous detachment was created in 10 eyes (77%), photocoagulation was performed for the hemangioma in all 13 eyes, cryotherapy in 4 eyes, and direct diathermy in 2 eyes. The visual acuity improved significantly from 0.51 ± 0.66 logMAR units at the baseline to 0.05 ± 0.21 logMAR units at the final examination (p = 0.002). Conclusions: Vitrectomy for idiopathic VPTs is effective in improving the visual acuity. Idiopathic VPTs are often associated with epiretinal membranes, and patients present with various types of visual disorders. Full article

Introduction: This study aimed to determine the frequency of posterior vitreous detachment (PVD) in dry and wet age-related macular degeneration (AMD) patients compared with healthy eyes via ultrawide field optical coherence tomography (UWF–OCT). Additionally, the retinal thicknesses in the central and peripheral zones of AMD patients and the control group were compared. Methods: We included 123 eyes from 83 participants with dry AMD, 123 from 87 participants with wet AMD, and 85 from 53 healthy controls. All three study groups were compared according to age, sex, best corrected visual acuity (BCVA), PVD stage, axial length, and retinal thickness in the central, perifoveal, and peripheral zones. Additional analyses included correlations between the BCVA and PVD stage and between retinal thickness and the PVD stage. Results: Complete separation of the vitreous from the macula was significantly more common in AMD patients than in the control group, as noted in 47 eyes (55.29%) in the control group, 92 eyes (74.80%) in the wet AMD group, and 93 eyes (75.61%) in the dry AMD group. The PVD stage did not significantly influence retinal thickness. BCVA in AMD patients did not correlate with the PVD stage. Conclusions: Complete PVD is more common in AMD patients than in healthy controls, as evaluated by UWF–OCT. No relationship between the PVD stage and AMD type or BCVA was observed. Full article

Background/Objectives: Spontaneous macular hole closure is a rare phenomenon, with lamellar hole epiretinal proliferation (LHEP) frequently implicated as a potential mechanism. This study aims to analyze the presence of LHEP in patients with full-thickness macular holes (FTMHs) or lamellar macular holes (LMHs) that closed spontaneously without intervention. Methods: A retrospective longitudinal analysis of optical coherence tomography (OCT) scans was conducted for 73 patients diagnosed with FTMH or LMH in a single institution. Patients with documented spontaneous hole closure were further analyzed for the presence of LHEP, other OCT findings, and clinical characteristics. Results: Of the 73 patients, eight (11%) exhibited spontaneous closure of their macular holes. LHEP was identified in all cases, regardless of hole type (FTMH or LMH). Associated OCT features on diagnosis included VMT in one eye (13%), partial or complete posterior vitreous detachment in seven eyes (88%) and epiretinal membrane in eight eyes (100%). During hole closure, an outer nuclear layer bridge was noted in six eyes (75%). Various extents of outer retinal recovery were noted following closure. After closure, five holes (63%) remained closed without further intervention, while three (38%) reopened and required surgical intervention. Conclusions: Spontaneous macular hole closure is strongly associated with the presence of LHEP, highlighting its potential role in retinal repair mechanisms. While in most patients the spontaneous closure is permanent, surgical intervention may be necessary in cases of hole recurrence. Full article

In this study, we describe a case of graft dislocation into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK), and review the risk factors and complications of posterior dislocation. A 70-year-old female with disruption of the iris–lens diaphragm experienced DSAEK graft dislocation into the vitreous cavity during air re-bubbling at 1 week postoperatively. The corneal opacity hindered adequate visualization of the vitreous cavity for the immediate retrieval of the graft. Five days after re-bubbling, vitrectomy and corneal tissue removal was performed using a temporary Eckardt keratoprosthesis, and penetrating keratoplasty was subsequently performed. Two weeks after graft removal, a retinal detachment occurred. Silicon oil was used as a tamponade to reattach the retina. Three months after the last procedure, the retina was attached, and the cornea was clear. Posterior dislocation of DSAEK graft is a rare complication. A disrupted iris–lens diaphragm and previous vitrectomy are the main risk factors. Severe vision loss is more likely to occur when corneal tissue removal is delayed. In cases of delayed removal, it is advisable to take precautions to prevent possible retinal detachment. Full article

Proliferative diabetic retinopathy (PDR) is the most severe complication of chronic hyperglycaemi stimulates oxidative stress that changes the retinal basement membrane function and provokes neovascularization, macular edema and retinal detachment. But an oxidative–antioxidant biomarker assessment in ocular matrices, such as aqueous humor (AH) and vitreous, might show the oxidative stress (OS) status in the posterior segment. Here, we show a cross-sectional analytical study of 39 patients who had a vitrectomy and assess the levels of different oxidative–antioxidant biomarkers in blood, aqueous and vitreous humor in three groups: diabetes mellitus 2 (DM2) with PDR [DM(+)PDR(+)] (n =13), DM2 without PDR [DM(+)PDR(−)] (n = 13) and non-DM2 non-PDR [DM(−)PDR(−)] as the control group (n = 13). Our finding suggests the presence of oxidative stress in diabetic retinopathy, as evidenced by increased levels of 8-isoprostanes and decreased levels of total antioxidant capacity from stages before the development of diabetic retinopathy. Our results reveal a notable increment in catalase levels in the DM(+)PDR(+) group in blood and vitreous humor. Likewise, we identified that the DM(+)PDR(−) group presents significant levels in 8-IP and SOD in vitreous humor and blood versus aqueous humor. These finding suggest the role of antioxidant enzymes in compensating oxidative stress mechanisms in PDR development. Full article