Eye Microsurgery Institute

To evaluate long-term anatomical and functional outcomes of autologous retinal transplantation (ART) in refractory highly myopic macular holes (HMMHs). Retrospective interventional analysis of 9 eyes with refractory HMMH undergoing ART. Best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT) were performed at baseline and each follow-up visit (1, 3, 6, 12, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, central macular thickness (CMT), external limiting membrane (ELM)/ellipsoid zone (EZ) visibility, macular edema (ME) and retinal pigmented epithelium (RPE) atrophy were evaluated. Mean follow-up duration was 46.0 ± 19.6 months. Anatomical success was reached in 7/9 eyes (78%). Median BCVA went from 0.05 (IQR 0.065) at baseline to 0.075 (IQR 0.069) at final follow-up (p = 0.25). Only one eye showed a 2-lines improvement, while BCVA was stable in 4/9 (44%) and worsened in 1 eye (12%). CMT progressively thickened in the first 6 months (177 ± 68 μm), but then decreased to 122 ± 50 μm at final follow-up. Graft merging with the surrounding retina was visible in two eyes, showing partial ELM/EZ recovery and good outcomes. Microcystic-like refractory ME (33%) and long-term RPE atrophy (22%) were reported, while delayed displacement of the graft was seen in one case 6 months after first surgery. ART offered acceptable anatomical success but no visual improvement in our cohort. Lack of graft merging with the surrounding retina, persistent microcystic-like ME, RPE atrophy and hole recurrence were the most frequent shortfalls.

The article presents information about the 12th Annual Symposium of the Robotic Microsurgery and Endoscopy Society (RAMSES) held in Singapore in Autumn 2024.

Purpose After 15 years of accumulated experience in the Descemet Membrane Endothelial Keratoplasty (DMEK) technique, this surgical method has demonstrated a high reproducibility and success rate. However, certain ocular conditions such as aphakia and previously vitrectomized eyes remain challenging. We describe a novel technique designed to improve surgical time and postoperative outcomes in these specific scenarios. Methods Following delivery of the Descemet membrane graft into the anterior chamber (AC), a small air bubble was injected beneath the graft. One edge of the graft was grasped using the forceps. Subsequently, the external corneal surface was tapped, until the graft was unrolled. Results In our experience, this technique has consistently led to a reduced surgical time and excellent anatomical outcomes, achieving complete membrane attachment. Conclusions The technique developed and described herein provides a valuable surgical alternative for achieving successful DMEK outcomes in complex cases.

This chapter explores the impact of different cap thicknesses in small incision lenticule extraction (SMILE) procedures, a minimally invasive corneal lenticule extraction technique using femtosecond laser technology.

Corneal haze, a consequence of pathological wound healing, manifests as opacity and sometimes irregularity impairing vision. This condition arises from breaches in the epithelial barrier, triggering an inflammatory cascade culminating in myofibroblasts formation. Surgical procedures such as photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and corneal cross-linking (CXL) are major contributors, alongside non-surgical causes like trauma and infections. Research has extensively explored post-surgical corneal haze, focusing on the transforming growth factor beta (TGFβ) pathway, inflammation management, and extracellular matrix remodeling. Losartan, traditionally an antihypertensive, has gained attention in ophthalmology for its anti-fibrotic and anti-inflammatory properties. Studies have supported its efficacy in reducing corneal fibrosis post-descemetorhexis, alkali burn, and PRK injuries in animal models, and human case reports. This review aims to examine the topical use of losartan 0.08% in ophthalmology, assessing its effectiveness against post-surgical corneal haze and exploring its pharmacological profile and potential future applications. We provide a systematic review of all published in-human studies of the use of topical losartan in corneal disease.

Objective: This study aimed to evaluate the initial clinical outcomes of and patient satisfaction with the newly introduced extended monofocal Evolux™ intraocular lens following cataract surgery. Methods: A retrospective study was conducted, involving 18 patients (36 eyes) who received Evolux™ lenses bilaterally. The inclusion criteria comprised individuals over 40 years old with no active eye diseases, excluding cataracts, and no postoperative complications. Various parameters were evaluated, including distance, intermediate, and near visual acuity; refraction; defocus curves; dependency on spectacles; and patient satisfaction. Patient satisfaction and visual quality of life were measured using the Catquest-9SF and QOV questionnaires. Results: The average age of the patients was 72.7 years, with the majority being women (77.8%). The results demonstrated excellent postoperative visual acuity at different distances. The mean logMAR values for uncorrected visual acuity were −0.04 for distance vision, 0.15 for intermediate vision, and 0.35 for near vision. The defocus curve indicated good tolerance, with visual acuity exceeding 20/20 in significant defocus ranges. Most patients expressed high satisfaction with their vision without spectacles, particularly for distance and intermediate vision. The need for spectacles for near vision was notably reduced. Furthermore, there was a low incidence of photic phenomena like halos and glare, contributing to the overall high patient satisfaction. Conclusions: Evolux™ lenses were found to be an effective choice for cataract surgery, providing excellent visual acuity at various distances and high patient satisfaction.

Purpose To determine predictive factors of higher levels of best-corrected visual acuity (BCVA) in the long-term after primary Descemet’s membrane endothelial keratoplasty (DMEK). Methods Retrospective, single-surgeon case series of 129 successful primary DMEK eyes without graft failure and with a minimum postoperative follow-up of 12 months. Mixed effect model for repeated measurements (MMRM) analysis was performed to determine recipient, donor, surgical and postoperative factors associated with BCVA ≤ 0.10 logMAR (≥ 20/25 Snellen). Results After primary DMEK, there was a statistically significant improvement in BCVA with a global reduction in logMAR BCVA (p < 0.00001). There was also a global tendency towards increasing proportion of eyes with BCVA ≤ 0.10 logMAR at all time points (p < 0.00001), from 1.6% before DMEK to 64.4% in eyes with more than 5 years of F-U. Absence of retinal disease was associated with a decrease of 0.10 logMAR in postoperative BCVA after primary DMEK, maintaining constant the rest of variables (p < 0.001). The variables age (OR 0.960), postoperative time (OR 1.083), preoperative BCVA ≥ 0.375 logMAR (OR 0.162) and indication for DMEK (OR 5.412) were included in the predictive MMRM model of BCVA ≤ 0.10 logMAR. Conclusion Primary DMEK is associated with statistically and clinically significant improvement in BCVA that occur early in the postoperative period and are continuous over time. Eyes with retinal comorbidities have increased risk of worse postoperative BCVA after DMEK. Younger recipient age, Fuchs’ dystrophy eyes and eyes with better preoperative BCVA are more likely to achieve postoperative BCVA ≤ 0.10 logMAR.

Purpose To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS). Methods Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12 months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RTNAS and RTTEM), peri-HMMH nasal and temporal O-RS height (O-RSNAS and O-RSTEM). The ratios O-RSNAS/ RTNAS and O-RSTEM/RTTEM were defined as %O-RSNAS and %O-RSTEM. Postoperatively, we distinguished classic HMMH closure (n = 14) from a newly described “delayed” closure pattern (n = 5). Results Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up (p = 0.009 and p = 0.001, respectively). At every follow-up, “classic” vs. “delayed closure” did not influence BCVA (all p > 0.05). Baseline O-RSNAS (p = 0.026), O-RSTEM (p = 0.04), %O-RSNAS (p = 0.04) and %O-RSTEM (0.004), were significantly associated with the “flap closure” pattern, differently from MLD and BD. In the “delayed closure” subgroup we reported a 100% closure rate, but 65.8 ± 64.4 days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RSNAS and O-RSTEM progressively reduced until HMMH closure. Conclusion Inverted flap is useful to close HMMH with O-RS. In case of “delayed closure” pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA. Key messages What is knownInverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is newHMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or “delayed closure” pattern. In cases of delayed closure, it took a variable range of 30–179 days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing “delayed” and “classic” closure subgroups.

Purpose We report a case of retinal toxicity induced by SBP-101, a polyamine inhibitor for the treatment of metastatic pancreatic adenocarcinoma, presenting as rapidly progressive bilateral central retinal pigmented epithelium (RPE) atrophy in a patient with a silent ocular history. Observations A 69-year-old female patient with a metastatic pancreatic adenocarcinoma visited our retina clinic referring a 6-months history of blurred vision and progressive visual field loss. One year before, she started administration of SBP-101 combined with nab-paclitaxel and gemcitabine to treat her malignancy. Baseline ophthalmological examination showed bilateral healthy retina an 20/20 visual acuity (VA). After the second monthly cycle of SBP-101, the patient experienced significant visual loss in both eyes, with VA decreasing to 20/50 in right eye (RE) and to 20/40 in left eye (LE). In the suspect of a cancer associated retinopathy (CAR), the patient underwent bilateral injection of intravitreal slow-releasing dexamethasone, with poor clinical outcomes. Concomitant testing for anti-enolase and anti-recoverin antibodies gave negative results, while electroretinography showed borderline but within the limit values in both eyes. At 6 months, VA was 20/5000 in RE and 20/4000 in LE and the patient referred significant limitations in everyday life. Ultra-wide field fundus photography showed a bilateral, roundish area of irregular pigment loss involving the entire macula and extending beyond the arcades. Ultra-wide autofluorescence showed a central area of hypo-autofluorescence surrounded by a ring of alternating hyper- and hypo-autofluorescence areas. Optical coherence tomography showed bilateral atrophy of the subfoveal RPE and disruption of the ellipsoid zone. Optic disc examination was within the limits. No treatment was possible. Conclusion and Importance In conclusion, ophthalmologists should be aware of the existence of a sight-threatening side effect of SPB-101 administration, since we highlighted a massive bilateral RPE atrophy rapidly developing after the second drug injection.

This chapter provides a comprehensive overview of macular surgery in highly myopic eyes, focusing on anatomical features and surgical management techniques. Anatomical considerations include posterior staphyloma, vitreous gel characteristics, and the internal limiting membrane in highly myopic eyes. Surgical management covers various conditions such as myopic traction maculopathy, including retinoschisis and lamellar macular hole, as well as full-thickness macular hole with and without retinoschisis. Additionally, it discusses surgical techniques for retinal detachment secondary to full-thickness macular hole, including pars plana vitrectomy and macular buckling. The chapter delves into important points to consider and surgical techniques specific to each condition, highlighting the nuances and challenges associated with macular surgery in highly myopic eyes.

Purpose: To determine risk factors for intraocular lens opacification (IOLop) after Descemet membrane endothelial keratoplasty (DMEK) and to analyze clinical outcomes after IOL exchange. Methods: Cross-Sectional Study: Analysis of all cases of IOL exchange because of post-DMEK IOLop with a minimum of 6- month postoperative follow-up observed in clinic between November 2021 and April 2022. Main outcomes analyzed at the study visit were change in logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity after IOL exchange, endothelial cell loss (ECL), and graft survival. An historical cohort of 232 pseudophakic DMEK eyes was retrospectively analyzed to determine risk factors for post-DMEK IOLop. Results: Cross-Sectional Study: Four eyes were observed (median follow-up = 45 (35.5–86.8) months). IOL materials were hydrophilic acrylic IOLs in 2 eyes and hydrophobic–hydrophilic in the other 2. At the study visit, improvement in median best-corrected visual acuity after IOL exchange was statistically significant (0.25 (0.19– 0.41) logMAR to 0.00 (0–0.10) logMAR; P = 0.041). ECL ranged between 57.7% and 85.3%, without cases of graft failure. In the historical cohort, 21 eyes (9.05%) had some IOLop. In multivariate logistic regression model (105 eyes where IOL material data was available), IOLs with high water content material (odds ratio = 65.5, P = 0.0005) and rebubbling (odds ratio = 9.51, P = 0.0138) were independent risk factors for post-DMEK IOLop. Conclusions: Post-DMEK IOLop is infrequent, but a non-neglectable proportion of cases may require IOL explantation. IOL exchange is safe and effective in these eyes but may pose a risk for increased ECL. This study confirms that IOL material and number of rebubblings are major risk factors for post-DMEK IOLop. Key Words: Descemet membrane, endothelial keratoplasty, intra-ocular lens opacification, risk factors

The aim of our work was to study the syntopy and pathomorphology of excised volar ganglia. The study design involved two groups: an experimental group and a control group. The experimental group consisted of 20 patients with volar ganglion of the wrist joint who underwent treatment at the Microsurgery Research Institute clinic from October 2022 to January 2023. All patients underwent open excision of the volar ganglion under the control of 3× optical magnification. During the operation, the syntopy of the ganglion was studied in all patients, and a sample of the wrist joint capsule was taken for morphological examination, where the ganglion pedicle and the ganglion itself were attached. Anatomical material (7 specimens) served as a control a similar area of the wrist joint capsule taken from patients without wrist pathology, obtained from the pathological anatomy office. To determine the syntopy of the ganglion pedicle, intraoperative radiographic examination of the wrist joint was performed. The ganglion and the excised capsule segment were fixed in 10% neutral buffered formalin, then subjected to histological examination with hematoxylin and eosin staining. The pathomorphological picture of the excised joint capsule segment, adjacent to the ganglion pedicle, showed that the visually unchanged joint capsule consisted of coarse fibrous connective tissue with hyalinosis and areas of focal myxomatosis, with an increased number of fibrocytes and fibroblasts, as well as a small number of mononuclear elements. The assessment of the pathomorphology of the volar ganglion itself showed that it was similar to the capsule, represented by coarse fibrous connective tissue with areas of hyalinosis. The epithelial lining was absent. Numerous areas of myxomatosis with uneven mononuclear infiltration and foci with a large number of fibroblastic and histiocytoid elements were present. The capsule and the volar ganglion itself had identical histological structures.

The problems with bone healing still exist, despite the significant development of treatment methods in traumatology and orthopedics. There is a standard treatment approach with expected consolidation times of up to 6 months for diaphyseal femoral fractures. However, there are no algorithms for cases when the time for consolidation exceeds 1 year. In this article is presented the experience of treating a patient with a diaphyseal femoral fracture that had delayed consolidation.

The objective of this paper was to determine how different types of posterior staphyloma (PS) may affect the appearance and degree of myopic maculopathy. A cross-sectional study was conducted, in which 467 eyes from 246 highly myopic patients [axial length (AL) ≥ 26 mm] were studied. A complete ophthalmic exploration was carried out on all patients, including imaging tests. The presence of macular PS was established as the main comparison variable between groups (macular PS vs. non-macular PS vs. non-PS). The variables analyzed included age, AL, decimal best-corrected visual acuity (BCVA), Atrophy (A)/Traction (T)/Neovascularization (N) components according to the ATN grading system, and the presence of severe pathologic myopia (PM). Out of the total, 179 eyes (38.3%) presented macular PS, 146 eyes presented non-macular PS (31.2%), and 142 eyes showed no PS (30.4%). The group without PS was significantly younger than macular PS and non-macular PS groups (53.85 vs. 66.57 vs. 65.20 years; p < 0.001 each, respectively). There were no age differences between PS groups. Eyes with macular PS (31.47 ± 2.30 mm) were significantly longer than those with non-macular PS (28.68 ± 1.78 mm, p < 0.001) and those without PS (27.47 ± 1.34 mm, p < 0.001). BCVA was significantly better in the non-PS group (0.75 ± 0.27) compared to the non-macular PS (0.56 ± 0.31) and macular PS groups (0.43 ± 0.33), with p < 0.001 each. Eyes without PS showed significantly lower A and T components (1.31 ± 0.96 and 0.30 ± 0.53, respectively) than non-macular PS (2.21 ± 0.75 and 0.71 ± 0.99, respectively, p < 0.001 each) and macular PS eyes (2.83 ± 0.64 and 1.11 ± 1.10, respectively, p < 0.001 each). The N component was lower in non-PS eyes vs. non-macular PS eyes (0.20 ± 0.59 vs. 0.47 ± 0.83, p < 0.001) and as compared to the macular PS group (0.68 ± 0.90, p < 0.01). Additionally, the N component was significantly lower in the non-macular PS group than in the macular PS one (p < 0.05). The prevalence of severe PM was different between groups (p < 0.001). It was higher among macular PS eyes (138/179) when compared to other groups (p < 0.001, each), followed by the non-macular PS eyes (40/146) and being the lowest in the non-PS group (20/142). To conclude, macular PS is associated with a more advanced maculopathy, worse vision, and higher rates of severe PM.

Purpose: to assess the state of the wavefront in children with myopia, who have various manifestations of digital eye strain and symptoms of ocular surface disorders, and to evaluate the diagnostic significance of wavefront criteria for assessing the state of the ocular surface. Patients and methods. The study involved 76 children (152 eyes) with myopia aged 8 to 18 years who used gadgets and computers for more than 2 hours a day. All patients used glasses as a method of optical correction and were constantly worn. The patients were divided into 2 groups: 1st with symptoms of ocular surface disorder, 2nd — comparison group. Subjective signs were studied using the online questionnaire “State of the ocular surface”. Using the “Keratograph 5M Oculus” the following parameters were assessed: non­invasive tear film breakup time (NTBR), including the first tear film breakup time, average tear film breakup time, breakup time gradient and maximum tear film breakup zone, the same device was used to perform infrared meibography and study of the lipid layer of the tear film. All patients underwent wavefront aberrometry in a darkened room without cycloplegia. Results. It was found that in the group of patients with the presence of subjective phenomena of disturbance of the state of the ocular surface, identified using the online questionnaire “State of the ocular surface”, rotor aberrations were statistically significantly higher than in the comparison group. At the same time, the indicators of higher­order corneal aberrations have comparable values. Correlation analysis between indicators of the state of the ocular surface and parameters of the wavefront in the group of children with disturbances of the state of the ocular surface showed that a higher level of corneal aberrations corresponds to a higher number of points on the questionnaire of disturbances of the ocular surface and the state of visual comfort, in turn, when comparing data on non­invasive tear film breakup time, a negative correlation was established, which means that with a higher number of points on the questionnaire, and therefore, with a more significant degree of impairment of the ocular surface, the tear film breakup time was shorter. Conclusion. The structure of the wavefront in children with myopia against the background of a disorder of the ocular surface in combination with CVS and digital eye strain is significantly different from the structure of the wavefront in the comparison group.