Introduction: Metastatic iris tumors from lung cancer are uncommon and challenging to diagnose. As lung cancer treatments improve, life expectancy increases, potentially leading to more cases of metastasis. These tumors often cause neovascular glaucoma, making intraocular pressure (IOP) management crucial, especially in terminal-stage patients. Case Presentation: A 65-year-old man with small cell lung carcinoma (SCLC) presented with right ocular pain and blurred vision. His right IOP was 55 mm Hg, and examination revealed anterior chamber cells, multiple grayish-white iris masses, and right iris neovascularization. Anterior chamber fluid cytology confirmed the diagnosis of metastatic iris tumors from SCLC. Despite treatment with topical eye drops, oral acetazolamide, and intravenous hypertonic mannitol, the IOP remained poorly controlled. Intravitreal aflibercept was subsequently administered into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but IOP did not improve. However, intravenous infusion of hypertonic mannitol was no longer required, and the complaints of nausea associated with IOP decreased. Although this patient died 4 months after the initial visit due to multiple metastases of SCLC, the intravitreal aflibercept was effective in shrinking the iris tumor size and lowering IOP in the terminal phase of the disease. Conclusion: This is the first reported use of intravitreal aflibercept for SCLC metastases to the iris. While the prognosis of patients with metastatic iris tumors remains poor, intravitreal aflibercept injections show potential in reducing iris tumor size and lowering IOP. Although not curative, this therapeutic approach may play a significant role in the symptom management of these patients.

Background/Objectives: To investigate and compare the clinical characteristics of epiretinal membrane (ERM) and associated diseases: macular pseudohole (MPH), ERM foveoschisis (ERM-FS), and lamellar macular hole (LMH). Methods: We retrospectively reviewed of all patients who underwent vitrectomy with at least 6 months follow-up, all eyes were classified into four groups: ERM, MPH, ERM-FS, and LMH. Age, gender, presence of glaucoma, preoperative spherical equivalent, axial length (AL), preoperative and postoperative best-corrected visual acuity (BCVA), metamorphopsia using M-CHARTS^®, and frequency of overlapping associated diseases were investigated. The association between pre- and postoperative BCVA and these clinical factors was analyzed. Results: After enrolling 718 eyes of 662 patients, eyes were classified as ERM (592 eyes), MPH (76 eyes), ERM-FS (63 eyes), and LMH (42 eyes). Overlapping cases included MPH+ERM-FS (17 eyes), ERM-FS+LMH (14 eyes), MPH+LMH (18 eyes), and MPH+ERM-FS+LMH (3 eyes). The AL was significantly longer (p < 0.05) in MPH, ERM-FS, and LMH versus ERM. In all groups, BCVA significantly improved after vitrectomy. Although preoperative BCVA was not significantly different among the four groups, postoperative BCVA was significantly worse for LMH versus ERM (p < 0.001). Preoperative metamorphopsia was significantly more severe in ERM (0.52 ± 0.51) versus MPH (0.34 ± 0.29) (p < 0.05). Postoperative BCVA correlated with preoperative BCVA and age in all groups except LMH. Conclusions: Associated diseases often overlap and were more myopic than ERM. Postoperative BCVA was worse in LMH, while preoperative metamorphopsia was severe in ERM. These results highlight the importance of both clinical and functional evaluations in determining surgical indications and predicting visual outcomes.

This study aimed to evaluate the changes in visual outcomes and optical coherence tomography (OCT) findings in patients with lamellar macular hole (LMH) following vitrectomy. Consecutive patients diagnosed with LMH based on OCT findings who underwent vitrectomy between April 2020 and December 2023 were included. Forty-two patients (male, n = 21; female, n = 21; mean age, 71.3 ± 8.2 years) were included in the study. Preoperative and postoperative best-corrected visual acuity (BCVA) and OCT parameters, including the presence of inner and outer retinal cysts, epiretinal proliferation (EP), and ellipsoid zone disruption (EZ), were analyzed. Postoperative BCVA was assessed at 6 months after surgery, and postoperative OCT findings were evaluated at 1, 3, and 6 months using all available data. Mean BCVA significantly improved from 0.36 ± 0.33 logarithm of the minimal angle of resolution preoperatively to 0.15 ± 0.26 at 6 months postoperatively (p < 0.001). The frequency of eyes with inner retinal cysts was 21.4% preoperatively, which gradually decreased to 8.0% at 6 months postoperatively. The frequency of outer retinal cysts was 54.8% preoperatively, which significantly decreased to 12.0% at 6 months postoperatively (p = 0.00937). The presence of EP was significantly correlated with worse postoperative BCVA (p < 0.05). Both preoperative and postoperative EZ disruptions significantly correlated with worse postoperative BCVA (p < 0.05). Vitrectomy for LMH improves visual acuity and reduces most intraretinal cysts within 6 months. EP, EZ disruption, and poor preoperative visual acuity were identified as factors associated with poor visual outcomes in patients with LMH.

Anatomic restoration after vitrectomy for lamellar macular hole (LMH) is not always achieved. However, the impact of unresolved LMH on visual outcomes remains unclear. We evaluated postoperative outcomes in eyes with unresolved LMH and postoperative full-thickness macular hole (FTMH) to reassess the meaning of anatomic success after LMH surgery. Multicenter, retrospective cohort study. One hundred sixty-six consecutive eyes of 166 patients who underwent vitrectomy for LMH. Anatomic success was defined as restoration of foveal configuration, whereby the postoperative OCT findings no longer met the diagnostic criteria for LMH. Postoperative anatomic outcomes were classified as anatomic success, unresolved LMH (including both persistent or recurrent LMH), or postoperative FTMH. Incidence and risk factors of unresolved LMH and postoperative FTMH, and best-corrected visual acuity (BCVA). Anatomic success was achieved in 141 eyes (84.9%), whereas 14 eyes (8.4%) had unresolved LMH and 11 eyes (6.6%) progressed to FTMH during follow-up (mean 17.8 months). At 12 months, BCVA was significantly worse in eyes with unresolved LMH than in those with anatomic success (0.24 ± 0.24 vs. 0.09 ± 0.19 logarithm of the minimum angle of resolution [logMAR]; P=0.041). Internal limiting membrane (ILM) peeling was significantly associated with a reduced risk of unresolved LMH (odds ratio [OR], 0.011; 95% CI, 0.002-0.062; P<0.001). Postoperative FTMH was significantly associated with epiretinal proliferation (P=0.018), thinner preoperative central foveal thickness (P=0.017), and no ILM peeling (P=0.001). Multivariable analysis confirmed that ILM peeling was an independent factor preventing postoperative FTMH (OR, 0.080; 95% CI, 0.010-0.620; P=0.001). Postoperative FTMH achieved closure in 9 eyes (82%) with additional treatment or observation, while the final BCVA was significantly worse in eyes that developed FTMH than in those with anatomic success (0.50 ± 0.32 vs. 0.12 ± 0.20 logMAR; P<0.001). While most eyes achieved anatomic success after vitrectomy for LMH, approximately 15% developed unresolved LMH or postoperative FTMH, both of which were associated with the absence of ILM peeling. Because anatomic failure was associated with poorer visual outcomes, foveal restoration on OCT may represent a more clinically meaningful anatomic endpoint after LMH surgery.

Purpose: To evaluate clinical features and visual outcomes in macular pseudohole (MPH) and to investigate associations between visual acuity and optical coherence tomography (OCT) parameters in patients with MPH. Methods: We retrospectively reviewed consecutive patients with MPH who underwent vitrectomy and were followed for at least 6 months after surgery. MPH was diagnosed based on spectral-domain OCT findings. Analysed factors included axial length, spherical equivalent, overlapping cases of epiretinal membrane foveoschisis (ERM-FS) and lamellar macular hole (LMH), presence of glaucoma, preoperative and postoperative best-corrected visual acuity (BCVA), presence of inner and outer retinal cysts, epiretinal proliferation (EP) and ellipsoid zone (EZ) disruption. Results: This study enrolled 76 eyes of 75 patients, with overlapping cases that included MPH+ERM FS (17 eyes), MPH+LMH (18 eyes) and MPH+ERM FS + LMH (3 eyes). BCVA significantly improved from 0.29±0.25 preoperatively to 0.06±0.17 postoperatively (p<0.001). Preoperative BCVA and the presence of EP exhibited significant associations with worse postoperative BCVA (p<0.0005 and p<0.05, respectively). Presence of EZ disruption at 3 and 6 months postoperatively was associated with worse postoperative BCVA (p<0.001 and p<0.01, respectively). Conclusion: There was significant improvement in patients with MPH after undergoing surgery. Current results suggest preoperative poor visual acuity, preoperative presence of EP and postoperative EZ disruption are negative prognostic factors for visual outcomes.

Background: Axial elongation may influence the structural characteristics and surgical prognosis of epiretinal membrane (ERM), but its impact across different axial length (AL) categories remains unclear. Methods: We retrospectively analyzed 557 eyes from 515 patients with ERM who underwent vitrectomy and were followed for at least 6 months. Eyes were stratified by AL into normal to mild myopia (NM; <26 mm), high myopia (HM; ≥26 to <28 mm), and extreme high myopia (EHM; ≥28 mm). Clinical variables included age, AL, and pre- and postoperative best-corrected visual acuity (BCVA). OCT parameters assessed included inner and outer retinal cystoid lesions, epiretinal proliferation (EP), and ellipsoid zone (EZ) disruption. Results: Postoperative BCVA significantly improved in the NM and HM groups (p < 0.001) but not in the EHM group (p = 0.091). Although preoperative BCVA was comparable among groups, postoperative BCVA was significantly better in the HM group (−0.02 ± 0.17 logMAR) compared with the NM (0.03 ± 0.20 logMAR) and EHM (0.21 ± 0.43 logMAR) groups (p < 0.05). Outer retinal cystoid lesions were significantly more frequent in the EHM group (p < 0.05), whereas the prevalence of EZ disruption, inner retinal cystoid lesions, and EP did not differ significantly among groups. Conclusions: Eyes with ERM and extreme high myopia exhibited limited postoperative visual improvement and a higher prevalence of outer retinal cystoid lesions, suggesting that axial elongation may adversely affect surgical prognosis.