To describe the features and incidence of epiretinal traction and related retinal damage in degenerative myopia. Consecutive observational case series. We retrospectively reviewed medical records and optical coherence tomography findings of 218 eyes with high myopia of 121 consecutive patients to detect the incidence and features of epiretinal traction-related macular damage. The degree of myopia ranged from -8 to -26 spherical equivalent (mean +/- SD, -16.93 +/- 5.74). Mean +/- SD axial length was 29.75 +/- 2.12 mm. Excluding eyes with possibly confounding features, 125 eyes were analyzed. Detection of epiretinal traction and related macular damage. Epiretinal traction was found in 58 (46.4%) of 125 eyes and retinal damage, in 43 eyes (34.4%). Macular retinoschisis was the most frequent form of macular damage (25 eyes [58%]), followed by retinal thickening, lamellar hole, and shallow retinal detachment. Epiretinal traction is a frequent finding in degenerative myopia and, particularly if associated with the presence of staphyloma, can generate a form of macular damage unique to eyes with high myopia. This damage can affect up to one third of these eyes and should be considered as a separate cause of visual loss easily detected by optical coherence tomography at its early stages.

Research from JAMA Ophthalmology — Vitrectomy for Myopic Traction Maculopathy

Purpose. More than ten years after ETDRS, Optical Coherence Tomography (OCT) greatly enhanced our ability to detect macular thickening and has brought new insights on the morphology of edema and on the presence of vitreal traction. In this study we propose a new classification of macular edema based on OCT findings to better catalogue and follow this complex clinical entity. Methods. Since January 2000 we analysed with OCT 2 (Zeiss Inc.) more than one thousand and two hundred eyes with DME. Results. The classification takes into account five parameters: retinal thickness, diffusion, volume, morphology and presence of vitreous traction. Standard figures and numerical values for every parameter are given. Conclusion. Although ETDRS guidelines for laser treatment of DME still remain the only proven therapy for this condition, many other strategies are now on trial, and the vast majority of authors use OCT as the best indicator of therapeutic benefit. The amount of information given by OCT demonstrates that macular edema is a complex clinical entity with various morphology and gravity, and disclaimed the limitations of a simple "clinical" definition. As in many other examples such as macular holes and choroidal neovascularization, a uniform and precise definition of macular edema would increase the possibility to compare and judge the result of different therapeutic strategies. Aim of this classification is to implement the ETDRS clinical definition of DME with the precise and useful data given by OCT to better diagnose, catalogue and follow macular edema.

Dry eye syndrome is a common disease which can damage the corneal epithelium. It is treated with eye drops to stimulate tear production and hydrate the corneal surface. The most prescribed artificial tear remedies contain hyaluronic acid (HA), which enhances epithelial wound healing, improving tissue health. To the best of our knowledge, only a few recent studies have investigated cross-linked HA (HA-CL) in eye drops for human applications. This work consists in an in vitro evaluation of the re-epithelialization ability of two different preparations containing a recently synthetized HA cross-linked with urea: 0.02% (w/v) HA-CL (solution 1, S1), and 0.4% (w/v) HA-CL (solution 2, S2). The study was conducted on both 2D human corneal cells (HCEpiC) and 3D reconstructed tissues of human corneal epithelium (HCE). Viability by 3(4,5-dimethylthiazol-2)2,5-diphenyltetrazolium bromide (MTT) test, pro-inflammatory cytokine release (interleukin-8, IL-8) by ELISA, and morphology by hematoxylin and eosin (HE) staining were evaluated. In addition, to understand the molecular basis of the re-epithelialization properties, cyclin D1 levels were assessed by western blot. The results showed no cellular toxicity, a slight decrease in IL-8 release, and restoration of epithelium integrity when the wounded 3D model was treated with S1 and S2. In parallel, cyclin D1 levels increased in cells treated with both S1 and S2.

Purpose: To define the mean time of first recurrence of diabetic macular edema (DME) after a single injection of dexamethasone intravitreal implant (DEX-I), reducing the burden of monthly visits during a PRN regimen of treatment. Methods: Twenty phakic eyes with DME (12 eyes naïve and 8 eyes with edema persistent after previous treatments) were followed monthly after DEX-I injection until evidence of first recurrence of edema, defined as a change in visual acuity (VA) ≥5 letters and/or in foveal thickness (FT) ≥50 µm. Reaching this point, the eyes were re-treated. Monitored parameters were changes in VA, FT, intraocular pressure (IOP), and lens opacity. Results: Maximal efficacy was registered at month 1, when mean VA improved by 14 letters (19%), FT decreased by 325 µm (43.7%), and in 15 eyes (75%) edema was completely reabsorbed. The mean time of first recurrence was 5.1 months. No statistical difference was found between eyes with naïve or persistent DME. Five eyes needed topical medication for modest temporary IOP increase (21-24 mm Hg) between months 2 and 4. No increase in lens opacities was registered during follow-up. Conclusions: According to the results of this study, the first signs of DME recurrence after DEX-I injection appear at a mean time of 5 months, suggesting that an appropriate and prudent time schedule for a PRN regimen could be limited to monthly tonometry and a first complete examination not before 4 months.

Background: The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy.Methods: It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels.Results: A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated proliferative diabetic retinopathy, and 53 (7.5%) had laser-treated retinopathy. In the entire sample of 3657 subjects, a normal macula was present in 90.9% of cases, diabetic macular edema of any kind in 5.4%, and other maculopathies in 3.4%.Conclusion: In this large cohort study on patients undergoing cataract surgery, more than one-fourth were diabetics and more than one-fourth of these had diabetic macular edema. These high prevalences suggest the opportunity to plan an adequate preoperative assessment in all patients in order to reduce the risk of postoperative development or worsening of a sight-threatening complication such as chronic diabetic macular edema.