Although previously published studies demonstrated a significant risk of corneal decompensation after angle or pars plana tube implantation, our clinical experience suggests that ciliary sulcus tube implantation in eyes with a posterior chamber intraocular lens is a safe and effective procedure even in eyes with high risk of corneal decompensation.

Purpose: Epiretinal proliferation is a distinct clinical entity from epiretinal membrane that is classically associated with lamellar macular holes, but its prevalence and association with full-thickness macular holes (FTMH) have not been well described. We characterize MHEP macular hole associated epiretinal proliferation (MHEP) and its effects on long-term surgical outcomes. Design: Multi-center, interventional, retrospective case control study. Subjects: Consecutive eyes that underwent surgery for FTMH with a minimum of 12-months follow-up. Methods: All eyes underwent pars plana vitrectomy, removal of any epiretinal membranes, and gas tamponade, with or without internal limiting membrane peeling. Spectral domain optical coherence tomography imaging was obtained pre- and post-operatively. Main Outcome Measures: Improvement in visual acuity and single surgery hole closure rates in eyes with, versus without, MHEP at 12 months. Results: 725 charts were analyzed, and 113 patients met inclusion criteria. Of 113 eyes with FTMH, 30 (26.5%) had MHEP. Patients with FTMH and MHEP were older (P < 0.002), more often male (P = 0.001), and with more advanced macular hole stages than those without MHEP (P = 0.010). A full posterior vitreous detachment was more common in eyes with MHEP (P < 0.004). FTMH with MHEP had significantly less improvement in visual acuity 12-months postoperatively (P = 0.019) with higher rates of ellipsoid and external limiting membrane defects (P < 0.05) and with a higher rate of failure to close with one surgery compared to FTMH without MHEP (26.7% versus 4.8% [P = 0.002]). Peeling the internal limiting membrane was associated with improved rates of hole closure in FTMH with MHEP (P < 0.001). Multivariable testing confirmed that the presence of MHEP was an independent risk factor for less visual improvement (P = 0.031), single-surgery non-closure (P = 0.009), and that ILM peeling improved single-surgery closure rates (P = 0.026). Conclusions: We found that FTMH with MHEP has poorer anatomic and visual outcomes after vitrectomy compared to FTMH without MHEP. ILM peeling was associated with improved closure rates and should be considered when MHEP is detected preoperatively.

Background While teleophthalmology is not a novel technique or method of care, its application is set to undergo a transformation due to the implementation of artificial intelligence (AI). The field of AI has recently experienced significant advancements in image recognition due to a technique called deep learning, and is increasingly being investigated in ophthalmic image segmentation, analysis, and clinical decision making [1-5].

Purpose: To create a highly balanced comparison of ab interno trabeculectomy (Trabectome, AIT) and trabecular bypass stenting (iStent, TBS).Setting: Eye and Ear Institute, Pittsburgh, Ross Eye Institute, Buffalo, and Glaucoma Associates of Texas, Dallas, USA.Design: Retrospective Exact Matching analysis.Methods: AIT and TBS patients were included from three large glaucoma practices. The primary outcome measure was the unmedicated IOP &le; 21 mmHg at 2-year follow-up visit. A secondary measure was unmedicated IOP reduction &ge; 20% at 2 years. Patients were matched by baseline IOP, the number of glaucoma medications and glaucoma type using Exact Matching and by age using Nearest Neighbor matching. Patients without a close match were excluded. All surgeries were combined with phacoemulsification. Results: 154 AIT and 110 TBS eyes were analyzed. 48 AIT patients were exactly matched to 48 TBS patients. Both groups had a baseline IOP of 15.3&plusmn;3.1 mmHg. At 24 months, the mean IOP was 13.9&plusmn;3.3 for AIT versus 16.8&plusmn;2.8 mmHg for TBS (p=0.04), while the number of medications was 0.7&plusmn;1.0 for AIT versus 1.7&plusmn;1.2 for TBS (p=0.04). The proportion of subjects achieving IOP &le; 21 mmHg without medications at 24 months was 53% in AIT versus 16.6% in TBS (P &lt; 0.05). At 24-month follow up 17.6% of patients in AIT had &ge; 20% IOP reduction without medication versus no patient in TBS. Conclusions: An Exact Matching comparison of AIT and TBS demonstrated greater IOP reduction with fewer medications in AIT.