To report the incidence and clinical features of patients that experienced un-explained visual loss following silicone oil (SO) removal. Multicenter retrospective study of patients that underwent SO removal during 2000–2012. Visual loss of ≥2 lines was considered significant. A total of 324 eyes of 324 patients underwent SO removal during the study period. Forty two (13%) eyes suffered a significant visual loss following SO removal. Twenty three (7.1%) of these eyes lost vision secondary to known causes. In the remaining 19 (5.9%) eyes, the loss of vision was not explained by any other pathology. Eleven of these 19 patients (57.9%) were male. The mean age of this group was 49.2 ± 16.4 years. Eyes that had an un-explained visual loss had a mean IOP while the eye was filled with SO of 19.6 ± 6.9 mm Hg. The length of time that the eye was filled with SO was 14.8 ± 4.4 months. In comparison, eyes that did not experience visual loss had a mean IOP of 14 ± 7.3 mm Hg (p < 0.0002) and a mean tamponade duration of 9.3 ± 10.9 months (p < 0.0001). An un-explained visual loss after SO removal was observed in 5.9% of eyes. Factors associated with this phenomenon included a higher IOP and longer SO tamponade duration.

Giant retinal tears (GRTs) are full-thickness circumferential tears of more than 90 degrees of the retina that are associated with vitreous detachment. They are related to ocular trauma, high myopia, aphakia, pseudophakia, genetic mutations involving collagen and young age. GRTs comprise 1.5% of all rhegmatogenous retinal detachments and the average age of incidence is 42 years. GRTs are more common in males, as 72% of all cases occur in males. The incidence of GRTs in the general population is estimated to be 0.05 per 100,000 individuals. Common techniques used in the management of GRTs include fluid-air exchange, pneumatic retinopexy, scleral buckling, primary vitrectomy with gas or silicone oil tamponade, and combined scleral buckle-vitrectomies. However, management of GRTs poses a great challenge to physicians due to the high risk of intra- and post-operative complications and the many technical difficulties involved. The advent of perfluorocarbon liquids (PFCL) and the use of micro-incisional surgery for the treatment of GRTs has provided new opportunities for the management of GTRs. Today, retinal reattachment can be achieved in 94-100% of cases.

Complications from diabetic retinopathy such as diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) constitute leading causes of preventable vision loss in working-age patients. Since vascular endothelial growth factor (VEGF) plays a major role in the pathogenesis of these complications, VEGF inhibitors have been the cornerstone of their treatment. Anti-VEGF monotherapy is an effective but burdensome treatment for DME. However, due to the intensive and burdensome treatment, most patients in routine clinical practice are undertreated, and therefore, their outcomes are compromised. Even in adequately treated patients, persistent DME is reported anywhere from 30% to 60% depending on the drug used. PDR is currently treated by anti-VEGF, panretinal photocoagulation (PRP) or a combination of both. Similarly, a number of eyes, despite these treatments, continue to progress to tractional retinal detachment and vitreous hemorrhage. Clearly there are other molecular pathways other than VEGF involved in the pathogenesis of DME and PDR. One of these pathways is the angiopoietin–Tie signaling pathway. Angiopoietin 1 (Ang1) plays a major role in maintaining vascular quiescence and stability. It acts as a molecular brake against vascular destabilization and inflammation that is usually promoted by angiopoietin 2 (Ang2). Several pathological conditions including chronic hyperglycemia lead to Ang2 upregulation. Recent regulatory approval of the bi-specific antibody, faricimab, may improve long term outcomes in DME. It targets both the Ang/Tie and VEGF pathways. The YOSEMITE and RHINE were multicenter, double-masked, randomized non-inferiority phase 3 clinical trials that compared faricimab to aflibercept in eyes with center-involved DME. At 12 months of follow-up, faricimab demonstrated non-inferior vision gains, improved anatomic outcomes and a potential for extended dosing when compared to aflibercept. The 2-year results of the YOSEMITE and RHINE trials demonstrated that the anatomic and functional results obtained at the 1 year follow-up were maintained. Short term outcomes of previously treated and treatment-naive eyes with DME that were treated with faricimab during routine clinical practice suggest a beneficial effect of faricimab over other agents. Targeting of Ang2 has been reported by several other means including VE-PTP inhibitors, integrin binding peptide and surrobodies.

To report our experience using 27-gauge pars plana vitrectomy (PPV) system for treating patients with combined tractional and rhegmatogenous retinal detachments (CTRRD) involving the macula associated with proliferative diabetic retinopathy (PDR). Retrospective noncomparative interventional cases series of 12 patients with CTRRD associated with PDR who underwent 3-port, transconjunctival 27-gauge PPV by a single surgeon. Main outcome measures were change in Snellen best corrected visual acuity (BCVA) and occurrence of intra- and post-operative complications. Twelve eyes from 12 patients (9 men and 3 women) underwent 27-gauge PPV. Mean follow-up was 17 months (range 8–26 months). Preoperatively, BCVA of 20/400 or better was recorded in only 2 of 12 (16.7%) eyes. Postoperatively, BCVA improved to 20/400 or better in 11 of 12 (91.7%) eyes at 6 months (P = 0.001). At last follow-up, BCVA of 20/400 or better was recorded in 10 of 12 (83.3%), in comparison to 2 (16.7%) eyes at baseline (P = 0.004). The only intraoperative complication was an iatrogenic break in 1 eye (8.3%). Postoperative complications included vitreous hemorrhage in 4 eyes (33.3%) and transient ocular hypertension in 3 eyes (25.0%). At final follow-up anatomic success was confirmed in all eyes. The current study findings suggest that 27-gauge PPV is a safe and promising surgical technology for treating patients with CTRRD involving the macula associated with PDR. Smaller gauge instruments and higher cutting rates may facilitate the dissection and shaving of fibrovascular membranes, while minimizing intra- and post-operative complications.