The aim of the present study was to determine the efficacy and safety of intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) in the real-world setting. The REBA study (real-world experience with brolucizumab in wet AMD) was a retrospective, observational, multicentric study that included 78 consecutive patients (105 eyes), with neovascular AMD, who received brolucizumab therapy. Both treatment-naive and switch-therapy patients were included. Switch therapy was based either on fluid recurrence, fluid recalcitrance, or inability to extend beyond q4/q6. All relevant data were collected. The primary outcome measure was change in best-corrected visual acuity (BCVA) over time. Secondary outcome measures included determination of change in central subfield thickness (CST) and complications. The mean baseline BCVA was 49.4 ± 5.4 letters and 40 ± 3.2 letters, and corresponding mean BCVA gain was +11.9 ± 3.9 letters (p = 0.011) and +10.4 ± 4.8 letters (p = 0.014) in the treatment-naive and switch-therapy groups, respectively. The change in CST was significantly decreased in the treatment-naive (p = 0.021) and the switch-therapy (p = 0.013) groups. The mean follow-up was 10.4 months in both groups. One patient in the switch-therapy group developed vascular occlusion and another a macular hole after the fifth brolucizumab injection. Both patients recovered uneventfully. In conclusion, patients showed a very good anatomical and functional response to brolucizumab therapy in the real world, regardless of prior treatment status, until the end of the follow-up period. Two significant untoward events were noted.

Purpose: To report a case of spontaneous closure of simultaneous full-thickness macular hole. Methods: Case report and literature review. Results: A 67-year-old woman with small-diameter simultaneous macular holes was observed for a period of 5 months, and progression was documented with spectral-domain optical coherence tomography. Closure of right full-thickness macular hole was evidenced by 1 month and left full-thickness macular hole by 5 months. Conclusion: This case demonstrates possible spontaneous resolution of a condition that is usually treated surgically. A period of observation with serial imaging studies may be advised in cases of small macular holes.

Hintergrund Eine phototoxische Makulopathie kann nach längerer Bestrahlung der Augen mit hellem Licht wie beispielsweise Sonnenlicht oder Strahlung aus Bogenschweißgeräten, Operationsmikroskopen oder Halogenlampen entstehen. Der Stellenwert des multifokalen ERGs für die Identifizierung der Funktionsausfälle war bislang nicht beschrieben worden. Kasuistik Es wird der Fall eines 38 Jahre alten Patienten beschrieben, der sich bei seinem Augenarzt mit beidseitigem schmerzhaftem akutem Sehverlust vorstellte, nachdem er für zwei Stunden am Lichtbogenschweißgerät gearbeitet hatte. Im Bereich der Makula zeigte sich ein ovales, rötlich gefärbtes Narbenareal, das für die beidseitige Verminderung der Sehschärfe verantwortlich war. Nach neun Monaten stellte sich der Patient in der Universitätsaugenklinik Tübingen zur Begutachtung der Minderung der Erwerbsfähigkeit vor. Mit Hilfe der automatischen Schwellenperimetrie konnte der Funktionsausfall auf beiden Seiten gut dargestellt werden. Im multifokalen ERG mit einem zentralen Element von 2° Durchmesser konnte am rechten Auge ein zentraler Defekt gefunden werden. Schlußfolgerungen In seltenen Fällen kann eine phototoxische Makulopathie als Folge einer beruflichen Tätigkeit am Lichtbogenschweißgerät entstehen. Sie kann in den ersten Tagen durch eine phototoxische Keratitis maskiert sein. Die Funktionsausfälle können mit Hilfe der Schwellenperimetrie und des multifokalen ERGs detektiert werden. Background Phototoxic maculopathy most likely results from longer exposure to light from sources such as the sun, welding arcs, tungsten halogen lamp filaments or operation microscopes. The value of the multifocal ERG for the evaluation of functional defects in this rare entity has not been described to date. Cases We describe the case of a 38-year-old male patient who presented to his local ophthalmologist with bilateral loss of vision and acute ocular pain after having worked for two hours at an electric welding arc. A foveal lesion was found in both eyes, resulting in a bilateral reduction of visual acuity. Nine months later, the patient underwent examination and further investigations at the university eye clinic in Tübingen. Visual field defects on both sides could be detected with automatic threshold perimetry. Using the multifocal ERG with a central element of 2° diameter, a central defect was detected only for the right eye. Conclusions In rare cases, a photic maculopathy can result from exposure to light during arc welding. It can be masked in the first days by a phototoxic keratitis. Multifocal ERG and automatic perimetry are useful tools for the detection and quantification of the functional defects.

This is a prospective clinical assay that included six patients who were diagnosed with penetrating corneal injury, traumatic cataract, and posterior segment intraocular foreign body (IOFB). Following anterior segment repair and extraction of traumatic cataract by clear cornea phacoemulsification, a standard 25-gauge transconjunctival pars plana vitrectomy was performed to find and release the IOFB. With active suction using a 25-gauge silicone tipped cannula, the foreign body was retrieved and safely placed in the anterior chamber. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction through the main phaco incision was easily performed, followed by placement of an intraocular lens. Of the six patients, 66.6% showed a significant improvement of visual acuity. No complications associated directly with the surgical procedure occurred. Our surgical technique is a safe alternative for handling and removing a posterior IOFB. There was no need for a scleral incision.

BACKGROUND AND OBJECTIVE: To evaluate anatomical changes of idiopathic macular hole (MH) after internal limiting membrane removal and after passive suction at the hole's borders using microscope-integrated intraoperative optical coherence tomography (iOCT). PATIENTS AND METHODS: Five eyes of five subjects with full-thickness idiopathic MH underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy, and internal limiting membrane (ILM) removal. iOCT was performed after ILM removal and after passive suction at the hole's borders. RESULTS: iOCT showed decreased MH diameter after ILM removal in all cases. Passive suction achieved complete apposition of borders. All cases presented successful postsurgical closure. CONCLUSIONS: iOCT provides anatomical information during MH surgery that may impact surgical decision-making by allowing a real-time evaluation of structures. iOCT with preservative-free triamcinolone acetonide enhanced ILM visualization. Its use is superior to iOCT alone for the identification of vitreomacular interface structures. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e105–e111.]