AAO 2017 Retina Subspecialty Day: The Great Debates
The session kicked off with Dr. Sengul Ozdek describing the long term anatomical and functional results of surgery for retinal detachment associated with stage 4 ROP. She noted in her study of 125 eyes of 86 infants that the results were encouraging. Better outcomes were observed in patients with prior laser/anti-VEGF treatment and surgically induced posterior hyaloid detachment, as well as performance of lens-sparing vitrectomy.
After this, Dr. Guillermo Salcedo-Villanueva described the value of ultra-widefield imaging in screening and diagnosing ROP using Optos photos. His study suggested that evaluation based on photos has considerable intergrader agreement. This was followed by a talk by Dr. J. Peter Campbell who described a deep learning algorithm which had been created using images from 5225 clinical examinations of 1692 eyes of 871 babies. His results showed that there may be potential to diagnose plus disease, monitor disease progression, identify patients at risk for development of type I ROP, and monitor response to treatment with a deep learning algorithm for ROP.
The second half of the session began with a talk by Dr. Swati Agarwal-Sinha describing the FA findings after bevacizumab monotherapy for ROP. Next, Dr. Lejla Vajzovic described the successful use of a table top OCT-A unit in the OR to image retinal microvasculature in infants. She noted that serial imaging could provide a basis for assessing foveal development and pathophysiology.
Dr. Camila Ventura then described a series of ten eyes of five infants infected with Zika virus. Retinal abnormalities were noted in thirty percent of the eyes and vasculature changes were observed in twenty percent. She noted that these changes are best identified using both high magnification fundus photography and FA imaging.
Dr. Aaron Nagiel presented the results of his study investigating surgical indications, outcomes, and complications of pediatric endoscopic vitrectomy in 285 surgical cases. The indication for surgery in two-thirds of the cases was retinal detachment with proliferative vitreoretinopathy. The reattachment rate for retinal detachment cases was 65%, and this was significantly lower for cases of persistent fetal vasculature. The most common complications seen postoperatively were band keratopathy, hypotony, cataract, and elevated intraocular pressure.
Dr. Audina Berrocal talked about treatment of retinoschisis in Coats’ Disease. She described a large series of 138 patients at the Bascom Palmer Eye Institute. She posited that retinoschisis in Coats’ Disease is exudative, tractional, and ischemic. Early vitrectomy with oil may be indicated in the setting of a rapidly progressive schisis cavity.
The presentations were followed by a lively and informative discussion.