Biogen Enters GA Treatment Market After Major Acquisition

Eyetube

Pharma giant Biogen announces its intention to acquire Apellis in a multi-billion dollar deal; a recently approved first-of-its-kind presbyopia drop is commercially launched; and Kodiak Sciences releases phase 3 data for its diabetic retinopathy drug candidate. Learn more about your ad choices. Visit megaphone.fm/adchoices

Refractive Lens Exchange in the Presbyopic Gray Zone

Optimizing outcomes through patient selection and expectation-setting.

Travis Parker, MD, and Greg Parkhurst, MD

Cataract and Refractive Surgery Today

Presbyopia is profoundly frustrating for patients. This age-related condition manifests as a progressive loss of accommodation that impairs their near and intermediate visual acuity. Patients may strain to read and may experience intermittently blurry distance vision due to accommodative spasm. They also find themselves increasingly reliant on optical aids and other work-arounds to perform everyday tasks—challenges that can substantially erode their quality of life. Refractive lens exchange (RLE) has emerged as a highly effective intervention for the majority of suitable presbyopic patients. The procedure can substantially reduce the spectacle dependence of appropriately selected candidates and enhance their visual function across all distances. In our practice, RLE consistently yields high patient satisfaction rates. The procedure not only corrects presbyopia, but it also preempts future cataract development, making RLE a comprehensive, long-term solution. There is, however, a presbyopic gray zone inhabited by patients who have excellent corrected distance visual acuity, no cataracts, and increasing difficulty with their near visual acuity. Achieving optimal outcomes in these individuals requires meticulous patient selection, a thorough preoperative evaluation, and precise expectation alignment.

Complex Myopic MHRD: Membranes and Transplants

In the last installment of this three-part series, we describe the latest techniques for managing challenging retinal detachments.

Carlos Mateo, MD, and Anniken Burés-Jelstrup, MD

Retina Today

MTM IN THREE PARTS Myopic traction maculopathy (MTM) is a complex condition that includes macular schisis with or without submacular fluid, as well as the more advanced stage of macular hole retinal detachment (MHRD). To help clinicians tackle the various complications of high myopia, I have organized a three-part series breaking down the timing and surgical options for MTM, macular buckling for MTM, and vitrectomy pearls for complex MHRD. Together, these articles are designed to provide you with a comprehensive perspective on the surgical management of this challenging condition. Below is part three, and you can find parts one and two here: Myopic Traction Maculopathy: Surgical Timing and Techniques Macular Buckling for Myopic Traction Maculopathy - Yusuke Oshima, MD, PhD Macular hole retinal detachments (MHRD) are a significant challenge in vitreoretinal surgery, with high myopia and the presence of a posterior staphyloma the predominant causes. In RDs originating from the posterior pole, retinal breaks other than the MH may be responsible, such as full-thickness tears along the vascular arcades or within areas of chorioretinal atrophy—particularly around the optic disc—which can be difficult to identify.  In addition to the macular buckling technique, several alternative surgical strategies have proven highly effective for achieving both MH closure and retinal reattachment. ILM DISSECTION AND INVERTED FLAP TECHNIQUE  First described in 2016 by Michalewska et al for large MHs, the inverted internal limiting membrane (ILM) flap technique has demonstrated a clear superiority over complete ILM removal in terms of MH closure rates and retinal reattachment in various series published in 2016 and 2017.1-5 Creating an inverted flap when the retina is detached can be cumbersome due to two main challenges: During staining, the dye tends to enter the subretinal space, impairing ILM visualization and increasing the risk of retinal pigment epithelium (RPE) toxicity. Performing the initial “pinch” maneuver to start the ILM peel on a detached, mobile retina can be technically difficult and traumatic.  To address these issues, a modified technique was described in 2023: Following pars plana vitrectomy (PPV), perfluorocarbon liquid (PFCL) is injected to displace the subretinal fluid peripherally. Using high magnification and a 41-gauge cannula, a partial drainage of subretinal fluid can be performed through the MH. Staining is then achieved by injecting dye with a soft-tip cannula between the retina and the PFCL, which allows almost instantaneous staining without subretinal dye migration. The inverted flap can then be prepared and positioned over the MH.