2018 AAO Retina Subday: Vitreoretinal Surgery
Jonathan Prenner, MD NJ Retina RETINA Roundup Editor The Retina Society program committee reserved a number of superb presentations for the closing half-day of what has been an outstanding scientific conference. Highlights of the morning included the following presentations: Dr. Gupta Omesh Gupta from Mid Atlantic Retina and Wills Eye Hospital reported on the risk factors and outcomes of rhegmatogenous retinal detachment following intravitreal injections of anti-VEGF therapy. The study cohort demonstrated 24 patients of the 125,790 injections that were performed on 12,383 patients (0.019%). Patients received an average of 19 injections prior to detachment (range 1-62 injections), which developed an average of 32 days after injection (range 6-70 days). Average visual acuity prior to detachment was 20/160, decreasing to 20/400 3 months post-repair, which was stable at final follow-up (average 16.8 months). No risk factors were identified including quadrant of injection or the use of calipers. Dr. Gupta concluded that retinal detachment following intravitreal injection is uncommon but results in an average loss of 4 lines of visual acuity and is an issue that should remain in our thought processes when treating patients with intravitreal injections. Dr. Borkar Durga Borkar, a superb fellow from Wills Eye Hospital, gave an important talk for practitioners who perform simultaneous bilateral intravitreal injection. Dr. Borkar evaluated bilateral same day intravitreal anti-VEGF injections to determine the rate of post-injection endophthalmitis. The study cohort included 101,932 bilateral same day intravitreal anti-VEGF injections were performed over 50,966 office visits for 5,890 patients. Twenty-eight cases of endophthalmitis (0.027% of total injections) occurred during the study period. There were no cases of bilateral endophthalmitis, and no patients had more than one occurrence of endophthalmitis. The overall rate of endophthalmitis was low and comparable to prior studies of unilateral injections. Dr. Jeng-Miller Finally, Karen Jeng-Miller, a star third year resident at the Massachusetts Eye and Ear Infirmary presented her work on fellow eye findings in Coats’ disease. She performed a multicenter cross-sectional retrospective study of patients with Coats’ disease who had widefield fluorescein angiography performed. Angiograms were examined for the presence of telangiectasias, aneurysms, segmental non-perfusion, and leakage. Fellow eyes of ninety-three patients with Coats’ disease were included. Importantly, twenty-nine percent (27/93) of fellow eyes demonstrated vascular abnormalities: 11% demonstrated telangiectasias, 4% demonstrated aneurysms, 14% had nonperfusion, 7.5% demonstrated leakage, and 7.5% of eyes demonstrated significant tortuosity. There was no significant correlation between fellow eye vascular abnormalities and severity of Coats’ disease staging (r = -0.205, P = 0.696). Importantly, these lesions did not progress over time. The study demonstrates that a significant proportion of fellow eyes in Coats’ patients have vascular abnormalities. The meeting came to a spirited close with great enthusiasm for the upcoming 2019 gathering of the Retina Society in London.