Purpose: To examine the characteristics of eyes with high-risk lattice degeneration treated with laser retinopexy and determine the indications, safety, and outcomes of the treatment. Methods: This interventional single-surgeon consecutive retrospective study was conducted at Wills Eye Hospital between 2014 and 2021. The series included eyes with lattice degeneration with high-risk lesions. Documented characteristics and outcomes of these eyes and fellow eyes were documented. Results: The study comprised 167 eyes of 143 patients (53.3% women; mean age [±SD], 50 ± 17 years). Complications after laser treatment included new posterior vitreous detachment (PVD) (n = 21), epiretinal membrane (ERM) (n = 13), retinal detachment (RD) (n = 5), and additional laser required (n = 22). Eyes that developed ERMs were more likely to develop PVDs (odds ratio, 5.39; 95% CI, 1.57-18.47). Patents who developed ERMs were older (mean, 60 ± 7 years vs 49 ± 17 years; P = .016), as were those developing PVDs (mean, 59 ± 8 years vs 48 ± 17; P = .005). No eye with a new ERM required surgery (n = 13). Four eyes with a new RD required laser retinopexy alone; 1 eye was treated surgically. No eye had an RD at the most recent evaluation. Conclusions: Despite high-risk lesions in areas of lattice degeneration, few eyes developed RDs after prophylactic laser retinopexy. Older patients may have a higher risk for ERM or PVD after laser treatment. Eyes with post-laser PVD were more likely to develop an ERM.

UNASSIGNED: Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS.
UNASSIGNED: Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test.
UNASSIGNED: RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08).
UNASSIGNED: Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP.
UNASSIGNED: RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety of an intravitreal dexamethasone (DEX) implant for the treatment of macular edema (ME) following pars plana vitrectomy (PPV) and removal of the primary epiretinal membrane (ERM) and to assess the impact of the integrity of the ellipsoid zone (EZ) and disorganization of the retinal inner layer (DRIL) grade on visual and anatomical outcomes.
METHODS: Forty-two pseudophakic patients who developed ME following PPV and removal of the primary stage 2-3 ERM were included. Patients were divided into two groups when ME was diagnosed via spectral domain optic coherence tomography (SD-OCT). In the DEX group (n = 22), DEX was implanted for the treatment of ME. In the control group (n = 20), only observation was conducted, without any treatment. The best-corrected visual acuity (BCVA) and macular thickness (MT) of the two groups were compared at baseline and 1, 6, and 12 months after DEX implantation. The effects of OCT parameters such as EZ integrity and DRIL grade were also evaluated in terms of decreases in MT and increases in VA in the treatment of ME with DEX implantation. Intraocular pressure (IOP), number of DEX implantations and adverse effects were also recorded.
RESULTS: While a statistically significant increase in the mean BCVA was observed in the DEX group (p < 0.001 at months 1, 6, and 12, respectively), no such increase was detected in the control group (p = 0.169, p = 0.065, and p = 0.058 at months 1, 6 and 12, respectively) compared with the baseline. A statistically significant decrease in the mean MT was observed in the DEX group (p  < 0.001 at months 1, 6, and 12); however, no significant difference was observed in the control group (p  = 0.081, p  = 0.065, and p  = 0.054 at months 1, 6 and 12, respectively) compared with the baseline. Significant differences were found between the two groups in terms of the increase in BCVA (p  < 0.01) and decrease in MT (p  < 0.01) at all visits, with the outcomes being more favorable in the DEX group. A statistically significant relationship was found between the increase in VA and EZ integrity and DRIL grade in both groups. Ten patients (45.4%) received two injections of DEX during the follow-up. An increase in IOP was observed in five patients (22.7%) who were treated with topical antiglaucomatous drops. No significant side effects were observed.
CONCLUSIONS: DEX implantation was found to be effective and safe for the treatment of ME following PPV and primary ERM removal, although some eyes may require repeated injections to achieve visual and anatomical success. Additionally, a relationship was found between EZ integrity, DRIL grade and visual-anatomical outcomes.

UNASSIGNED: In this study, we aimed to evaluate cellular alterations in the foveal neuroglia of eyes with idiopathic epiretinal membrane (ERM) and examine their correlation with visual function. We also aimed to identify prognostic markers for visual outcomes postvitrectomy.
UNASSIGNED: A prospective longitudinal study.
UNASSIGNED: The study comprised 84 subjects, including 50 eyes diagnosed with idiopathic ERM and 34 healthy eyes serving as controls.
UNASSIGNED: The foveal neuroglial changes in eyes with idiopathic ERM were determined using adaptive optics OCT (AO-OCT) by comparing them with healthy eyes. For patients with ERM, the ERM and inner limiting membrane were removed during vitrectomy in all eyes.
UNASSIGNED: Foveal microstructures on AO-OCT images, best-corrected visual acuity (BCVA) and M-CHARTS scores, evaluated preoperatively and at 1, 3, and 6 months postoperatively, and associations between foveal neuroglial changes and these parameters.
UNASSIGNED: Adaptive optics OCT revealed discernible differences in the foveal cones of the eyes with ERM and their healthy counterparts. The thickness of the ellipsoid zone (EZ) band was augmented in eyes with ERM. The alignment of the Müller cells was more vertical and the density of the foveal cone cell nuclei was higher in eyes with ERM than in healthy eyes. Within the AO-OCT parameters, the higher cone nuclei count correlated with worse M-CHARTS scores, both preoperatively and 6 months postoperatively (P = 0.004, 0.010, respectively). Greater EZ thickness was significantly associated with poorer 6-month postoperative BCVA (P = 0.005).
UNASSIGNED: Adaptive optics OCT can be used to precisely identify cellular alterations in eyes with ERM that are closely related to visual function impairments. These cellular insights enhance our understanding of ERM pathology and offer promising prognostic indicators of visual outcome after vitrectomy.

Previous studies reported the expression of toll-like receptors (TLRs), merely TLR2 and TLR4, and complement fragments (C3a, C5b9) in vitreoretinal disorders. Other than pathogens, TLRs can recognize endogenous products of tissue remodeling as damage-associated molecular pattern (DAMPs). The aim of this study was to confirm the expression of TLR2 and TLR4 in the fibrocellular membranes and vitreal fluids (soluble TLRs) of patients suffering of epiretinal membranes (ERMs) and assess their association with disease severity, complement fragments and inflammatory profiles. Twenty (n = 20) ERMs and twelve (n = 12) vitreous samples were collected at the time of the vitrectomy. Different severity-staged ERMs were processed for: immunolocalization (IF), transcriptomic (RT-PCR) and proteomics (ELISA, IP/WB, Protein Chip Array) analysis. The investigation of targets included TLR2, TLR4, C3a, C5b9, a few selected inflammatory biomarkers (Eotaxin-2, Rantes, Vascular Endothelial Growth Factor (VEGFA), Vascular Endothelial Growth Factor receptor (VEGFR2), Interferon-γ (IFNγ), Interleukin (IL1β, IL12p40/p70)) and a restricted panel of matrix enzymes (Matrix metalloproteinases (MMPs)/Tissue Inhibitor of Metallo-Proteinases (TIMPs)). A reduced cellularity was observed as function of ERM severity. TLR2, TLR4 and myD88 transcripts/proteins were detected in membranes and decreased upon disease severity. The levels of soluble TLR2 and TLR4, as well as C3a, C5b9, Eotaxin-2, Rantes, VEGFA, VEGFR2, IFNγ, IL1β, IL12p40/p70, MMP7 and TIMP2 levels were changed in vitreal samples. Significant correlations were observed between TLRs and complement fragments and between TLRs and some inflammatory mediators. Our findings pointed at TLR2 and TLR4 over-expression at early stages of ERM formation, suggesting the participation of the local immune response in the severity of disease. These activations at the early-stage of ERM formation suggest a potential persistence of innate immune response in the early phases of fibrocellular membrane formation.

BACKGROUND: Fovea plana is indicative of an immature inner retina, yet its association with epimacular membrane (ERM) remains unexplored. This study aims to investigate the prevalence of fovea plana in the contralateral eye of patients diagnosed with ERM.
METHODS: A retrospective analysis was conducted on consecutive patients in a monocentric tertiary ophthalmic department between January and April 2021. The study included all patients referred for ERM, with dense optical coherence tomography (OCT) B-scans utilized to assess the incidence of fovea plana in the contralateral eye. Patients with bilateral ERM were excluded from the analysis.
RESULTS: Out of 181 patients, 26 exhibited fovea plana in the contralateral eye, resulting in an incidence rate of 14.3%. Demographic characteristics, OCT patterns, and indications for surgery did not differ significantly between patients with and without fovea plana.
CONCLUSIONS: The prevalence of fovea plana in patients with ERM did not exhibit a statistically significant increase compared to the reported incidence in patients undergoing preoperative cataract surgery.
CONCLUSIONS: In our cohort, the incidence of fovea plana in patients with ERM was determined to be 14.3%.

OBJECTIVE: To measure the coronal and sagittal retinal displacement before and after surgery for epiretinal membranes in InfraRed horizontal foveal sections and optical coherence tomography scans and describe displacement tridimensionality, vision loss, and metamorphopsia.
METHODS: Retrospective series with greater than 6-month average follow-up before and after surgery. The record included best-corrected visual acuity, optical coherence tomography, M-charts, and InfraRed retinography. Overall, pre- and postoperative coronal and sagittal retinal displacement across the entire field, concentric circles at 0.5-, 1.5-, and 4.5-mm radii, and the central horizontal and vertical meridian were calculated as the optical flow of consecutive images.
RESULTS: This study comprised 10 patients (4 men, 6 women), with 22.7 ± 25.2 months follow-up before surgery and 16.2 ± 7.3 months after. Best-corrected visual acuity reduced before surgery (0.15 ± 0.67 logarithm of minimum angle of resolution to 0.38 ± 0.85 logarithm of minimum angle of resolution; P < 0.05) and increased afterward (0.086 ± 0.61 logarithm of minimum angle of resolution; P = 0.003). Preoperative coronal displacement was 30.1 ± 29.1 µm versus 67.0 ± 23.4 µm after (P = 0.002). Sagittal retinal displacement was 140.9 ± 84.6 µm before surgery, 339.7 ± 172.5 µm after (P = 0.017), and 357.6 ± 320.8 µm across the entire follow-up. Preoperative best-corrected visual acuity decreases correlated with the foveal coronal displacement. Vertical metamorphopsia correlated with the average coronal displacement within a 4.5-mm radius. Pre- and postoperative sagittal displacement correlated with horizontal metamorphopsia (P = 0.006 and P = 0.026). Postoperative sagittal displacement correlated with postoperative best-corrected visual acuity (P = 0.026) and foveal thickness (P = 0.009).
CONCLUSIONS: This study confirms that postoperative displacement is greater than preoperative and that sagittal displacement is greater than coronal and correlates with best-corrected visual acuity and metamorphopsia changes.

OBJECTIVE: To evaluate anatomic outcomes and surgeon response following the use of microserrated (Sharkskin, Alcon, Forth Worth, TX) internal limiting membrane (ILM) forceps compared with conventional (Grieshaber; Alcon) ILM forceps for peeling of the ILM.
METHODS: Patients were prospectively assigned in a 1:1 randomized fashion to undergo ILM peeling using microserrated forceps or conventional forceps. Rates of retinal hemorrhages, deep retinal grasps, ILM regrasping, time to ILM removal, and surgeon questionnaire comparing the use of microserrated and conventional ILM forceps were analyzed.
RESULTS: A total of 90 eyes of 90 patients were included in this study. The mean number of deep retinal grasps was higher in the conventional forceps group (1.51 ± 1.70 vs. 0.33 ± 0.56, respectively [P < 0.0001]). The mean number of failed ILM grasps was higher with conventional forceps (6.62 ± 3.51 vs. 5.18 ± 2.06 [P = 0.019]). Microserrated forceps provided more comfortability (lower number) in initiating the ILM flap (2.16 ± 0.85 vs. 1.56 ± 0.76, P < 0.001), comfortability in regrasping the ILM flap (2.51 ± 1.01 vs. 1.98 ± 0.89, P = 0.01), and comfortability in completing the ILM flap (2.42 ± 1.03 vs. 1.84 ± 1.02, P = 0.01).
CONCLUSIONS: Surgeons utilizing the microserrated forceps experienced fewer deep retina grasps and fewer failed ILM grasps compared with conventional ILM forceps. The microserrated forceps was also a more favorable experience subjectively among the surgeons.

This study aimed to assess retinal alterations following membrane peeling procedures using novel ILM Forceps with laser ablated surface with the help of intraoperative optical coherence tomography (iOCT). A post-hoc analysis was performed to evaluate iOCT findings in eyes that underwent membrane peeling procedures with the novel ILM Forceps. Pre-peel and post-peel iOCT videos and images were evaluated for each eye to assess for post-peel anatomic alterations. Surgical video/iOCT scan correlation was conducted to evaluate the etiology of anatomic alterations. Thirty-two eyes were included in the analysis. Three eyes (9%) had focal full thickness retinal elevations identified on iOCT following tissue-instrument interaction with the ILM Forceps. Two eyes (6%) had focal inner retinal elevations and one eye (3%) had a full-thickness retinal elevation that were not related to direct tissue-instrument interaction but rather indirect peeling forces. iOCT-identified architectural alterations related to direct-tissue instrument interaction were relatively infrequent (< 10%) with similar frequency to previously reported alterations with other surgical instruments.

BACKGROUND: The purpose of this study was to develop a model that can predict the postoperative visual acuity in eyes that had undergone vitrectomy for an epiretinal membrane (ERM). The Light Gradient Boosting Machine (LightGBM) was used to evaluate the accuracy of the prediction and the contribution of the explanatory variables. Two models were designed to predict the postoperative visual acuity in 67 ERM patients. Model 1 used the age, sex, affected eye, axial length, preoperative visual acuity, Govetto\'s classification stage, and OCT-derived vector information as features to predict the visual acuity at 1, 3, and 6 months postoperatively. Model 2 incorporated the early postoperative visual acuity as an additional variable to predict the visual acuity at 3, and 6 months postoperatively. LightGBM with 100 iterations of 5-fold cross-validation was used to tune the hyperparameters and train the model. This involved addressing multicollinearity and selecting the explanatory variables. The generalized performance of these models was evaluated using the root mean squared error (RMSE) in a 5-fold cross-validation, and the contributions of the explanatory variables were visualized using the average Shapley Additive exPlanations (SHAP) values.
RESULTS: The RMSEs for the predicted visual acuity of Model 1 were 0.14 ± 0.02 logMAR units at 1 month, 0.12 ± 0.03 logMAR units at 3 months, and 0.13 ± 0.04 logMAR units at 6 months. High SHAP values were observed for the preoperative visual acuity and the ectopic inner foveal layer (EIFL) area with significant and positive correlations across all models. Model 2 that incorporated the postoperative visual acuity was used to predict the visual acuity at 3 and 6 months, and it had superior accuracy with RMSEs of 0.10 ± 0.02 logMAR units at 3 months and 0.10 ± 0.04 logMAR units at 6 months. High SHAP values were observed for the postoperative visual acuity in Model 2.
CONCLUSIONS: Predicting the postoperative visual acuity in ERM patients is possible using the preoperative clinical data and OCT images with LightGBM. The contribution of the explanatory variables can be visualized using the SHAP values, and the accuracy of the prediction models improved when the postoperative visual acuity is included as an explanatory variable. Our data-driven machine learning models reveal that preoperative visual acuity and the size of the EIFL significantly influence postoperative visual acuity. Early intervention may be crucial for achieving favorable visual outcomes in eyes with an ERM.