The Journal of Retina

PATIENTS WEARING FACE MASKS DURING INTRAVITREAL INJECTIONS MAY BE AT A HIGHER RISK OF ENDOPHTHALMITIS

Hadayer, Amir; Zahavi, Alon; Livny, Eitan; More

Purpose: 

To investigate the safety of face masks worn by patients during intravitreal injections.

Methods: 

A prospective, qualitative, interventional study performed in a tertiary university hospital. Healthy volunteers were asked to wear three different professional surgical face masks while air leaks around the eyes were monitored. Three types of masks were investigated as follows: 1) surgical face mask with four tying strips, 2) surgical face mask with elastic ear loops and 3) 2200 N95 tuberculosis particulate face mask. For each session the periocular area was inspected for air leak during normal respiration, speech, and deep respiration. Detection of air leak was performed using the following two professional thermal cameras: FLIR A310—thermal camera and EyeCGas 2.0—super sensitive infrared camera used for detection of minute fugitive emissions of industrial gases.

Results: 

Ten healthy volunteers were enrolled in this study. The experiment was repeated 45 times for each camera; 3 times for each of 3 mask types, on 5 volunteers, for a total of 90 trials. Air jets were detected originating from the superior edges of the masks radiating toward the eyes in 81% (73/90) of cases in total; 71% (32/45) with the FLIR camera and 91% (41/45) with the OPGAL camera. Air leaks were detected with all investigated mask types.

Conclusion: 

Patients wearing face masks during intravitreal injections may be at a higher risk of endophthalmitis. Until further data are available, we recommend verifying proper face mask fitting and either taping the upper edges of the face masks with a medical adhesive tape or using an adhesive surgical drape around the injected eye.

SMOKING STATUS AND TREATMENT OUTCOMES OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Vittorio, Alexander F.; Nguyen, Vuong; Barthelmes, Daniel; More

Purpose: 

To assess whether smoking status affects 1-year visual outcomes in eyes treated with vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration.

Methods: 

Retrospective analysis of data from a prospectively designed, multicenter, observational database. Nine hundred and eighty seven treatment-naive eyes of patients with neovascular age-related macular degeneration were tracked by the Fight Retinal Blindness! outcome registry in Australia, New Zealand, Singapore, and Switzerland who had documented smoking status at baseline and commenced vascular endothelial growth factor inhibitor therapy from January 2006 to December 2016. Generalized additive models were used to display visual acuity results.

Results: 

There was a significant difference in mean improvement in visual acuity at 12 months between nonsmokers, ex-smokers, and current smokers (7.7 vs. 6.1 vs. 3.5 letters of change; P = ۰.۰۴۶) among patients who completed 12 months of treatment when adjusted for age, baseline visual acuity, and choroidal neovascular membrane lesion type and nested for practice. There was no significant difference in the median number of injections over 12 months of treatment by smoking status. Current smokers were a mean of 6.2 years younger than nonsmokers when they started treatment (P < 0.001).

Conclusion: 

This study found inferior 12-month visual outcomes in patients who continued to smoke while receiving vascular endothelial growth factor inhibitor therapy for neovascular age-related macular degeneration.

GENETIC RISK FACTORS IN SEVERE, NONSEVERE AND ACUTE PHENOTYPES OF CENTRAL SEROUS CHORIORETINOPATHY

Mohabati, Danial; Schellevis, Rosa L.; van Dijk, Elon H. C.; More

Purpose:

To study genetic predispositions and differences between severe chronic central serous chorioretinopathy (cCSC), nonsevere cCSC, and acute central serous chorioretinopathy (aCSC).

Methods:

One hundred seventy-three severe cCSC patients, 272 nonsevere cCSC patients, 135 aCSC patients, and 1,385 control individuals were included. Eight single-nucleotide polymorphisms were genotyped in the ARMS2 (rs10490924), CFH (rs800292, rs1061170, rs1065489, rs1329428, rs2284664, rs3753394), and NR3C2 (rs2070951). Additionally, C4B gene copy numbers were analyzed.

Results:

A significant association in 5 single-nucleotide polymorphisms in the CFH gene could be reproduced among severe cCSC patients, including rs800292 (P = ۰.۰۰۱۴; odds ratio [OR] = 1.93; 95% confidence interval [CI] = 1.51–۲.۴۷), rs1065489 (P = ۲.۲۲ × ۱۰−۴; OR = 0.49; 95% CI = 0.34–۰.۷۲), rs1329428 (P = ۰.۰۰۱; OR = 1.89; 95% CI = 1.49–۲.۴۰), rs2284664 (P = ۱.۲۱× ۱۰−۴; OR = 1.65; 95% CI = 1.28–۲.۱۳), and rs3753394 (P = ۶.۱۰× ۱۰−۴; OR = 0.61; 95% CI = 0.46–۰.۸۱). Carrying three C4B copies was protective for severe cCSC (P = ۰.۰۰۱; OR = 0.29; 95% CI = 0.14–۰.۶۱). No significant differences in allele frequencies could be found among the CSC phenotypes.

Conclusion:

Acute CSC, nonsevere cCSC, and severe cCSC all showed a similar association with the CFH and C4B genes, and the three phenotypes could not be distinguished based on the genetics. This shows that despite the differences in clinical presentation and severity, there is an overlap in the genetic predisposition of different CSC phenotypes. Nongenetic factors may play a more important role in determining the clinical course of CSC.

AUTOLOGOUS BLOOD CLOT COVERING INSTEAD OF GAS TAMPONADE FOR MACULAR HOLES

Zhu, Dongqing; Ma, Bo; Zhang, Jing; More

Purpose: 

This study evaluates the efficacy and usefulness of vitrectomy with internal limiting membrane peeling and autologous blood clot covering without gas tamponade in the treatment of macular holes (MHs).

Methods: 

All patients with a full-thickness MH with a minimum diameter of <600 µm and a base diameter of <1,200 µm underwent pars plana vitrectomy and internal limiting membrane peeling with autologous blood covering the MH at the end of the surgery. No fluid–air exchange or gas tamponade was performed. Postoperatively, all patients were instructed to adopt supine position overnight and thereafter any comfortable posture.

Results: 

A total of 18 eyes of 18 consecutive patients were included. The mean age of the patients (12 women and 6 men) was 59.06 ± ۱۴.۳۱ years (range, 21–۸۱ years). The MHs composed of 13 idiopathic MHs, 2 MHs with high myopia (axial length > 26.5 mm), 2 traumatic MHs, and 1 MH associated with diabetic macular edema. Among them were five large MHs (minimum diameter > 400 µm). Complete MH closure was achieved in all eyes at the end of the follow-up period (range, 3–۱۴ months). Visual acuity was significantly improved from preoperative 0.89 ± ۰.۴۱ logarithm of the minimum angle of resolution (20/155 Snellen) to 0.42 ± ۰.۳۳ logarithm of the minimum angle of resolution (20/53 Snellen) at the final visit (P < 0.001).

Conclusion: 

The novel surgical protocol using vitrectomy, internal limiting membrane peeling, and autologous blood clot covering at the end of the MH surgery with limited diameters achieved highly effective closure and visual improvement and eliminated the gas tamponade and thus the associated adverse effects and the need for postoperative face-down positioning.

VASOPROLIFERATIVE TUMORS IN INTERMEDIATE UVEITIS

Pichi, Francesco; Neri, Piergorgio; Agarwal, Aniruddha; More

Purpose: 

To describe patients with intermediate uveitis complicated by vasoproliferative tumors (VPTs).

Methods: 

Data were collected at seven Uveitis/Ocular Oncology centers on demographic, ophthalmic findings at baseline and at follow-up, and on imaging. The therapeutic intervention, final visual acuity, and duration of follow-up were recorded.

Results: 

A total of 36 eyes from 34 patients (12 men, 22 women; mean age 35.3 ± ۱۴.۲ years) were included in this study. Visual acuity at presentation ranged from 20/40 to counting fingers. At the time of VPT diagnosis, intermediate uveitis was active in all eyes. The mean VPT thickness was 3.06 ± ۰.۸۶ mm. Local treatment to the VPT was provide in 22 eyes (61.1%) and no local treatment to the VPT in 14 eyes (38.9%). After the VPT was detected, systemic or local treatment for the inflammation was initiated and on follow-up FAs 94.4% of the eyes showed resolution of the vascular leakage. During follow-up of 35.8 months, the 22 VPTs treated locally had a reduction in the tumor thickness to 1.25 mm, whereas the 14 VPTs untreated remained stable (final mean tumor thickness 2.65 mm).

Conclusion: 

The presence of active intermediate uveitis accompanied by VPTs suggests the need for an aggressive uveitis treatment.