Surgical treatment of lamellar macular hole secondary to epiretinal membrane

Background

To examine the surgical results of lamellar macular hole (LMH) secondary to epiretinal membrane (ERM).

Methods

A 3-year retrospective review was performed of patients with LMH secondary to ERM that underwent ERM and internal limiting membrane (ILM) peeling. The main outcome measures included best-corrected visual acuity (BCVA) and postoperative macular structure. The results were compared with cases of idiopathic ERM with similar baseline demographic characteristics.

Results

Thirty eyes in 30 patients were collected. The mean BCVA improvement was 3.4 Snellen lines after a mean follow-up period of 16.9 months. Optical coherence tomography (OCT) showed improved macular contour in 27 cases. Patients with intravitreal gas tamponade exhibited a higher percentage of restoration of macular contour than those without (P?=?0.016). Final BCVA was correlated with an intact photoreceptor inner segment–outer segment (IS–OS) junction (P?=?0.03). The degree of visual improvement is less than that observed in idiopathic ERM patients.

Conclusion

In LMH secondary to ERM with significant visual decrease, ERM and ILM peeling may improve BCVA. Postoperative gas tamponade is associated with better restoration of macular configuration. Final BCVA is related to an intact photoreceptor IS–OS junction rather than to the normalization of the macular contour.     

Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia

Purpose

To compare visual and anatomic outcomes in eyes with type 2 idiopathic macular telangiectasia (Mactel) treated with either intravitreal bevacizumab (IVB), observation, or pars plana vitrectomy (PPV) with internal limiting membrane removal.

Methods

Retrospective, consecutive, interventional case series of phakic patients with Mactel. Best-corrected Snellen visual acuity (BCVA) and complete ophthalmic exam was obtained prior to treatment and at subsequent 3-month intervals for a minimum of 6 months. Fluorescein angiographic and spectral-domain optical coherence tomography features were examined, and compared to BCVA at treatment initiation and follow-up.

Results

Fifty-six eyes of 28 patients were evaluated. Mean age was 65?±?12 years, and mean follow-up was 24?±?13 months. Patients were treated with either observation (n?=?33), IVB (n?=?15), or PPV (n?=?8). Mean number of treatments for the IVB group was 2.5?±?3.5 intravitreal injections. No significant differences in BCVA change were observed between treatment groups via one-way ANOVA (p?=?0.49). Presence of inner retinal cysts was not correlated to BCVA (p?>?0.05). Discontinuous outer nuclear layer was significantly related to worse initial and final vision, but not to BCVA change.

Conclusion

IVB and PPV with ILM removal appear ineffective in improving visual outcome in eyes with non-proliferative Mactel. SD-OCT evidence of disrupted foveal outer nuclear layer is related to decreased BCVA, but not related to BCVA change following treatment.     

Subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage associated with ruptured retinal arterial macroaneurysm

Purpose

To evaluate the surgical outcomes of small-gauge vitrectomy with subretinal injection of recombinant tissue plasminogen activator (rt-PA) for a submacular hemorrhage caused by a ruptured retinal arterial macroaneurysm (RAM).

Methods

Non-comparative, consecutive case-series performed at two ophthalmological institutions. We examined 22 eyes of 22 patients with a submacular hemorrhage associated with a RAM but without a preretinal or sub-internal limiting membrane hemorrhage at the fovea. During 25-gauge vitrectomy, approximately 4000–8000 IU of rt-PA was injected subretinally, followed by the injection of air or 10 % sulfur hexafluoride as a tamponade. The patients maintained an upright position for 1 hour, then turned to a facedown position for 1 to 3 days. The best-corrected visual acuity (BCVA) and postoperative complications were evaluated.

Results

The average interval from the onset of symptoms to surgery was 8.4?±?7.6 days, and the average size of the subretinal hemorrhage was 3.4?±?1.0 disc diameters. The submacular hemorrhage was displaced from the foveal area in all eyes after 1 week. The mean baseline BCVA was 1.41?±?0.41 logMAR units, and it improved to 0.91?±?0.43 at 1 month and to 0.64?±?0.45 at the final visit (P?=?0.0001, P?<?0.0001 respectively). A macular hole was detected intraoperatively in two eyes and postoperatively in two eyes, and both were closed by internal limiting membrane peeling or a second vitrectomy.

Conclusions

Small-gauge vitrectomy with subretinal rt-PA injection and gas tamponade were effective in displacing a submacular hemorrhage associated with a RAM.

     

Equivalent tamponade by room air as compared with SF6 after macular hole surgery

Background

To evaluate the effect of tamponade by room air after vitrectomy for the treatment of idiopathic macular hole (MH).

Methods

There were 156 eyes of 151 patients studied. The patients’ ages ranged from 35 to 88 years old (mean:?65.1 years). After conventional pars plana vitrectomy with internal limiting membrane peeling, fluid air exchange was performed using 20% SF₆ (Gas group: 91 eyes) or room air (Air group: 65 eyes). Surgical outcomes were retrospectively analyzed.

Results

Mean preoperative hole diameter was 352?μm in the Gas group and 370?μm in the Air group (P =?0.558). The closure rate of all cases was 91.0% after first surgery and 98.7% at last follow-up. The primary closure rate was 90.1% in the Gas group after 7.44?±?1.66 (mean ± SD) days prone positioning period, and 92.3% in the Air group after 3.83?±?0.97 days of prone positioning. There was significant difference in prone positioning period (P?<?0.0001), but not in the first closure rate (P?=?0.132).

Conclusion

This study suggests that room air may have an equivalent tamponade effect, in spite of the shorter prone positioning period, than SF₆ after MH surgery.     

Retinal thickness in eyes with idiopathic macular hole after vitrectomy with internal limiting membrane peeling

Purpose

To compare the thickness of each retinal layer in the parafoveal and perifoveal regions of eyes after successful closure of a macular hole (MH) by pars plana vitrectomy with internal limiting membrane (ILM) peeling to the corresponding areas of the normal fellow eyes.

Methods

Twenty-two eyes of 22 patients with an idiopathic MH who underwent PPV with ILM peeling at the Matsumoto Dental University Hospital were studied. The retinal thickness was measured manually with the volume scan mode of the Spectralis HRA?+?OCT (Heidelberg Engineering, Germany).

Results

The average postoperative parafoveal thickness of the temporal sector was 314.8 μm, and that of the corresponding area of the fellow eyes was 325.0 μm (P?=?0.01). The parafoveal thickness of the nasal sector was 360.7 μm, and that of the fellow eyes was 339.6 μm (P?<?0.0001). Changes in the inner retinal layer thicknesses contributed to the decreased temporal and increased nasal sectors. The perifoveal retinal thickness was significantly increased in all sectors after PPV, probably due to an increase in the outer nuclear layer thickness.

Conclusions

PPV with ILM peeling for MHs can cause microstructural changes in wide areas of the macula region, suggesting a loss of longitudinal support of the Müller cells.     

Delayed onset inner nuclear layer cystic changes following internal limiting membrane removal for epimacular membrane

Purpose

To report the rare occurrence of new inner nuclear layer cystic spaces occurring in eyes treated with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal for idiopathic epimacular membrane (EMM).

Materials and methods

Consecutive patients with EMM without preoperative retinal cystic changes undergoing PPV with ILM peeling were retrospectively evaluated. Patients developing a characteristic inner nuclear layer cystic change were analyzed.

Results

Inner nuclear layer cystic changes appeared in eight of 768 (1.04 %) eyes at a mean postoperative time period of 3.2?±?0.89 months. No leakage or pooling was demonstrated on postoperative fluorescein angiography. Morphologic characteristics included vertically elongated hyporeflectant spaces within the inner nuclear layer on spectral domain optical coherence tomography (SD-OCT).

Conclusions

A minority of patients undergoing PPV with ILM peeling develop new, delayed onset, postoperative inner nuclear layer cystic spaces with a characteristic SD-OCT appearance and no evidence of angiographic leakage.     

Operative Therapie bei Makulaschichtforamen

Purpose

Vitrectomy and peeling in patients with lamellar macular hole was evaluated with regard to anatomical and functional outcome.

Patients and methods

In a retrospective study, 10 patients with lamellar macular hole underwent vitrectomy, membrane-peeling (epiretinal membrane [ERM] and internal limiting membrane [ILM]) and gas (n=9) or silicone oil (n=1) endotamponade. In most patients (n=9), cataract surgery was also performed. Pre- and postoperative ocular coherence tomography (OCT) findings, visual acuity (ETDRS), and Birkhäuser near visual acuity were evaluated.

Results

Mean follow-up was 15±11 months after surgery with a minimum follow-up of 6 months. Best corrected visual acuity (BCVA) improved in all patients; the average BCVA gain was 3±2 lines. Preoperative mean BCVA was 0.35 (0.45±0.23logMAR), and postoperative BCVA was 0.64 (0.19±0.21logMAR). Eight of ten patients had a postoperative BCVA ≥20/40, and six patients had a postoperative BCVA ≥20/25. Mean near visual acuity was 0.5±0.26 (range 0.2–0.9). Postoperative OCT revealed a closed lamellar macular hole in six patients, with restored foveal contour in three of them. The other four patients showed a persistent inner retinal defect with an intact photoreceptor layer.

Conclusion

Surgical treatment including vitrectomy, ERM-ILM-peeling and endotamponade appears to benefit patients with lamellar macular hole. All patients improved functionally. Surgical treatment can close the lamellar macular hole and restore foveal architecture.     

Morphometry of surgically removed internal limiting membrane during vitrectomy in diabetic macular edema

Background

Histopathologic and morphometric analysis of the internal limiting membrane (ILM) in diabetic eyes was performed. The thickness of the ILM was correlated with the level of glykosylated hemoglobin (HbA_1C) and other clinical factors.

Methods

The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63?±?7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in the standard way. The mean follow-up period was 8.7 months (range 3–19 months). The ILM was fixed immediately after peeling in 2.5% glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed at standard magnification (×5,000) with the scale of 1 µm in the shot.

Results

Morphometric analysis demonstrated a significant thickening of the ILM in all eyes, with a mean thickness of the ILM of 3.61?±?1.22 µm. It was found that a higher thickness of the ILM is related to elevated HbA_1C in both types of diabetes mellitus (DM) (p?=?0.040). We also found significant dependence of ILM thickness in relation to duration of DM by comparison of men and women (p?=?0.026), and a significant correlation between ILM thickness and the age of diabetic patients related to their gender (p?=?0.029).

Conclusions

We confirmed increased thickness of the surgically peeled ILM and statistically significant correlations to elevated HbA_1C in both types of DM, and to further clinical characteristics of case series. Morphometric and histopathologic analyses of the ILM contribute to more objective evaluation of the ultrastructure of the vitreomacular interface.     

Funktionelle Ergebnisse nach anatomisch erfolgreicher Makulaforamen-Stadium-III/IV-Chirurgie

Purpose

To report the functional results after anatomically successful surgery for stage III/IV macular hole.

Methods

Follow-up examinations (ETDRS charts, Birkhäuser near visual acuity charts, OCT) were carried out in 29 patients 11±5 months after surgery for stage III/IV macular hole (hole size >400 µm); in all cases the foveal contour had been restored postoperatively . The surgery performed also included cataract surgery (n=26), vitrectomy, ICG-assisted ILM peeling (in which perfluorcarbon liquid was used to prevent ICG from coming in contact with the retinal pigment epithelium) and tamponade with intraocular gas (n=16) or silicone oil (n=13). Silicone oil had been removed by the time of the follow-up evaluation.

Results

Preoperative mean BCVA was 0.2 (0.64 logMAR±0.24) and postoperative BCVA, 0.5 (0.3 logMAR±0.19). None of the patients experienced any deterioration in sight; the average improvement in visual acuity was 3.5±2 lines. In 70% (n=20) of the patients the postoperative BCVA was ≥0.5. Visual acuity for near sight was 0.45±0.2. In 66% (n=19) a visual acuity of ≥0.4 was achieved for close work. The improvement in visual acuity was not related to the kind of endotamponade or to the size of the macular hole. Patients with macular hole diameters of 400–800 µm (n=20) gained 3.5±2.,4 lines, while in patients with macular hole diameters of 800–1135 µm the average gain was 3.6±1.3 lines.

Conclusions

Anatomically successful macular hole stage III/IV surgery with ICG-assisted ILM peeling and protection of the retinal pigment epithelium from contact with ICG by perfluorcarbon liquid can yield good functional results.     

Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract

Background

Long-term outcomes of intraocular lens (IOL) implantation for congenital cataract in children under 2 years old are still undetermined.

Methods

We retrospectively reviewed all cases of bilateral congenital cataract who had undergone simultaneous bilateral cataract removal with posterior capsulotomy and central anterior vitrectomy between 1990 and 2010. Patients randomly underwent primary IOL implantation or secondary IOL implantation after a period of contact lens wear. The two groups were compared for visual outcome and complications during follow-up.

Results

Cataract removal and primary IOL implantation was performed in 30 eyes (15 patients; nine males, six females) at a mean age of 6.8?±?4.2 months. After 79.31?±?63.4 months, best-corrected visual acuity (BCVA) was 0.53?±?0.36 EDTRS LogMAR. In 36 eyes (18 patients, 11 males, seven females) the lens was removed at a mean age of 5.42?±?2.80 months, and after 32.0?±?6.1 months of contact lens utilization, secondary IOL implantation was performed. After 109.0?±?33.8 months, BCVA was 0.54?±?0.4 ETDRS LogMAR. The association between age at surgery and final visual acuity and the difference between the two groups concerning type of cataract at baseline, BCVA and refractive error at last visit, incidence of posterior capsular opacification, glaucoma, strabismus, and nystagmus during follow-up were not significant (p?>?0.05). Myopic shift was more frequent in eyes undergone primary IOL implantation (p?<?0.001).

Conclusions

Similar visual outcome and complications were observed during long-term follow-up after both primary and secondary IOL implantation following simultaneous bilateral congenital cataract removal with posterior capsulotomy and central anterior vitrectomy.     

Restoration of macular structure as the determining factor for macular hole surgery outcome

Objective

The aim of this work is to evaluate the preoperative and postoperative spectral domain optical coherence tomography (SD-OCT) findings as predictors of visual acuity for macular hole (MH) surgery.

Methods

Fifty eyes of 46 patients diagnosed with MH and that had undergone 25-g vitrectomy with internal limiting membrane peeling were included in this retrospective study. A complete clinical examination and SD-OCT were performed before and after surgery. Three groups were considered on the basis of the postoperative integrity of photoreceptor inner and outer segment (IS-OS) junction and the external limiting membrane (ELM): group A (11 eyes, both lines disrupted), group B (ten eyes, disrupted IS/OS line and complete ELM), and group C (29 eyes, both lines restored).

Results

LogMAR BCVA improved significantly after surgery from an average 0.60?±?0.29 to 0.19?±?0.19 (p?p≥0.18). Postoperative BCVA was significantly better in group C compared to groups A and B (p?≤?0.01). A significant correlation was found between ELM restoration and postoperative BCVA (r?=?–0.63, p?r?=?–0.55, p?Conclusions Outer retina restoration seems to be the best determining factor for a good visual rehabilitation after MH surgery.     

Long-term intraocular pressure changes after vitrectomy for epiretinal membrane and macular hole

Background

To investigate long-term intraocular pressure (IOP) changes after vitrectomy for epiretinal membrane (ERM) or macular hole (MH).

Methods

We retrospectively reviewed the medical records of 57 eyes with ERM and 61 eyes with MH that underwent vitrectomy. IOP levels and changes at 1, 3, 6, 12 months, and the final visit from baseline were evaluated in vitrectomized eyes and non-vitrectomized fellow eyes.

Results

In the ERM group, the mean follow-up period was 29.3 months; the mean preoperative IOP in the operated eyes was 12.9?±?2.5 mmHg and the final IOP was 13.2?±?2.9 mmHg. In the MH group, the mean follow-up period was 25.6 months; the mean preoperative IOP in the operated eyes was 13.3?±?2.5 mmHg and the final IOP was 14.0?±?3.2 mmHg. The mean final IOP of the fellow unoperated eyes was 13.0?±?2.5 mmHg in the ERM group and it was 12.9?±?3.2 mmHg in the MH group. A significant difference was found between the operated eyes and fellow eyes at the final visit in the MH group (P?<?0.01) but not in the ERM group (P?=?0.40). MH group was significantly at high risk of IOP increase after vitrectomy (P?<?0.01).

Conclusions

IOP increase after vitrectomy was found in some eyes with MH during long-term follow-up but it was unlikely in eyes with ERM.     

Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion

Purpose

To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute branch retinal vein occlusion (BRVO).

Methods

In this randomized clinical trial, 86 eyes with recent-onset (less than 12?weeks) BRVO were included. Participants were randomly assigned to two treatment groups: (1) IVB group (43 eyes), patients who received three monthly injections of 1.25?mg of IVB, and (2) IVT group (43 eyes), patients who received two injections of 2?mg IVT 2?months apart. Patients were examined at 1, 2, 3, 4, and 6?months after enrollment. Main outcome measure was change in best-corrected visual acuity (BCVA) at 6?months. Secondary outcome measures were central macular thickness (CMT) and intraocular pressure (IOP) changes at month 6.

Results

Mean BCVA improved significantly up to 6?months in both groups from 0.68?±?0.25 to 0.31?±?0.21 logMAR (logarithm of minimum angle of resolution) in the IVB group, and from 0.67?±?0.29 to 0.46?±?0.31 logMAR in the IVT group (P?P?=?0.013) and 6 (P?P?=?0.031) at final visit. Dividing the cases into ischemic and non-ischemic types, a significant difference was noted only in the ischemic cases regarding BCVA improvement and CMT reduction in favor of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits.

Conclusions

Both 3-times-monthly IVB injections and 2-times IVT injections with a 2-month interval could be effective for improving BCVA and CMT in cases with recent-onset BRVO up to 6?months. However, considering the better visual and anatomic outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The favorable responses were more pronounced in the ischemic types of BRVO in this trial; nevertheless, this should be confirmed in larger studies.     

Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up

Background

To report the 12-month anatomic and ETDRS best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin®) (1.25 mg or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the two different doses of intravitreal bevacizumab (IVB) utilized was made.

Methods

We reviewed the clinical records of 82 consecutive patients (101 eyes) with DDME in this interventional retrospective multicenter study. All patients with a minimum follow-up of 12 months (mean 57.6?±?8.4 weeks) were included in this analysis. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits.

Results

The mean age of our patients was 59.7?±?9.3 years. The mean number of IVB injections per eye was three (range: one to six injections) at a mean interval of 14.1?±?10.5 weeks. In the 1.25 mg group at 1 month BCVA improved from 20/190, logMAR?=?0.97 to 20/85, logMAR 0.62, a difference that was statistically significant (p?=?0.0001). This improvement was maintained throughout the 3-, 6-, and 12-month follow-up. The mean final BCVA at 12 months was 20/76, logMAR?=?0.58 (p?p?

Conclusions

Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 12 months. There seems to be no difference in our results between intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg. In addition, our results suggest the need for at least three injections a year to maintain the BCVA results.

     

Optical Coherence Tomography Before and After Vitrectomy with Internal Limiting Membrane Removal in a Child with Optic Disc Pit Maculopathy

Background

The pathogenesis of optic disc pit maculopathy is still unknown, although recent optical coherence tomographic (OCT) analyses have made a great contribution to clarifying its morphological appearance. The best treatment for this disease is also controversial.

Case

We report on a 7-year-old girl with optic disc pit maculopathy associated with a separation of the internal limiting membrane (ILM) near the optic disc.

Observations

The OCT images before treatment showed a conduit from the perineural space to the schisislike separation of the sensory retina with a dome-shaped separation of the ILM. A serous detachment (SD) in the macula, centered on the fovea, was also present. In OCT images after laser photocoagulation, the conduit appeared to be closed, but the SD was still present. Vitrectomy with ILM removal and gas tamponade resulted in a marked reduction of the SD in the macular area. Focal macular electroretinograms and visual acuity demonstrated a recovery of macular function.

Conclusion

The dome-shaped separation of the ILM suggested that the vitreous might be exerting a tractional force on the optic disc pit, and vitrectomy with ILM peeling released the traction on the optic disc pit. Jpn J Ophthalmol 2005;49:411–413 © Japanese Ophthalmological Society 2005     

Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy

Background

To study the surgically induced astigmatism (SIA) in combined phacoemulsification with 23-gauge transconjunctival sutureless vitrectomy (TSV) versus combined phacoemulsification with 20-gauge standard vitrectomy.

Methods

This is a prospective comparative study comprised of 40 eyes from 37 consecutive patients. Twenty eyes (19 patients) underwent combined phacoemulsification and 23-gauge TSV, and 20 eyes (18 patients) underwent combined phacoemulsification and 20-gauge standard vitrectomy. Corneal topography was obtained preoperatively and postoperatively at weeks 1, 4, 8, and 12. Main outcome measurement was SIA consisting of astigmatic amplitude and axis from cross cylinder form calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula.

Results

The mean SIA was 1.07?±?0.57 diopters (D) in the 23-gauge TSV group and 2.09?±?0.81 D in the 20-gauge group at postoperative week 1. SIA of both groups at weeks 4, 8, and 12 significantly decreased from the SIA at postoperative week 1 (p?<?0.0001 for all 3 weeks). SIA of the 23-gauge TSV group was significantly less than that of the 20-gauge standard vitrectomy group at each postoperative period (p?=?0.001). SIA of the gas tamponade group in the 23-gauge TSV was significantly greater than that of the non-gas tamponade group at postoperative week one (p?=?0.039). Shifts of axis to other meridians returned to preoperative meridian in 12 eyes (85.7%) for the 23-gauge group and seven eyes (43.8%) for the 20-gauge group.

Conclusion

Combined phacoemulsification and pars plana vitrectomy (23-gauge and 20-gauge) could induce significant SIA at postoperative week 1, and decrease over 3 months. However, 23-gauge TSV showed less SIA and early stabilization compared to the 20-gauge standard vitrectomy.     

Pars plana vitrectomy for the repair of primary, inferior rhegmatogenous retinal detachment associated to inferior breaks. A comparison of a 25-gauge versus a 20-gauge system

Background

To compare anatomical, functional outcomes and complications of high-speed 25-gauge (G) pars plana vitrectomy (PPV) versus 20-G PPV for the management of primary inferior rhegmatogenous retinal detachment (RRD) associated to inferior breaks/holes.

Methods

Eighty-five eyes from 85 patients with a minimum follow-up of 3 months were retrospectively evaluated. Forty-one patients underwent 25-G and 44 patients underwent 20-G PPV. All patients underwent PPV with fluid-air exchange, sulfur hexafluoride (SF6) 20 % gas tamponade and laser or cryo retinopexy.

Results

The mean follow-up interval was 6.51(±2.32) and 6.63 (±2.58) months in the 25-G and 20-G groups respectively. Single-operation success rate was 92.7 % for the 25-G group and 81.8 % for the 20-G group (P?=?0.24). Post-operative hypotony was observed in no case. Redetachment occurred in 3 eyes operated on with 25-G and in 8 eyes operated on with 20-G system. All retinas were attached at final follow-up. Logarithm of the minimum angle of resolution visual acuity significantly improved from 0.69?±?0.76 to 0.33?±?0.37 in the 25-G and from 0.47?±?0.59 to 0.21?±?0.28 in the 20-G group (P?=?0.0007 and P?<?0.0001 respectively).

Conclusions

High-speed PPV and SF6 gas tamponade using either 25-G or 20-G PPV system, yields similar single operation anatomical success rates for the repair of uncomplicated, primary inferior RRDs associated to inferior breaks.     

Paracentral retinal holes occurring after macular surgery: incidence, clinical features, and evolution

Aim

To describe the incidence, clinical features, and evolution of paracentral retinal holes occurring after macular surgery.

Methods

A retrospective non-randomized study of 909 patients operated on for either a macular hole (MH, n?=?400 patients) or an epiretinal membrane (ERM, n?=?509 patients) between 2004 and 2009. Six patients (0.6%) developed a paracentral macular hole after surgery. Their clinical, auto-fluorescence, and optical coherence tomography (OCT) characteristics as well as their visual outcomes were studied.

Results

The mean age of patients was 70?years. Paracentral holes occurred approximately 5?weeks after surgery (with a range of 2–12?weeks). All patients were asymptomatic. Five patients underwent ILM peeling during initial surgery. Paracentral retinal holes were located superiorly to the fovea in three cases and temporally in the other three cases. Mean pre-operative BCVA was 20/200 and mean post-operative BCVA was 20/40. The eye where the eccentric MHs were closest to the fovea (inferior to 1 optic disc area) had the poorest final visual acuity. Autofluorescence imaging showed a bright fluorescence in paramacular holes. On OCT images, they were shown to be flat full-thickness holes. No treatment was attempted. No rhegmatogenous complications or choroidal neovascularization occurred in any of the patients. Mean follow-up was 2?years.

Conclusions

In summary, paracentral MHs are uncommon complications which can occur at the site where ILM peeling has been initiated or completed. Except for the closest holes to fovea, they have good visual prognosis and do not require any treatment underlining the importance of initiating the ILM peeling as far as possible from the fovea.     

Retinal thickness changes following photodynamic therapy in chronic central serous chorioretinopathy

Objective

To evaluate changes in neural retina (NR) thickness and best-corrected visual acuity (BCVA) induced by treatment of chronic central serous chorioretinopathy (CSC) by photodynamic therapy (PDT).

Patients and methods

Retrospective study of 25 eyes of 25 patients with chronic CSC treated by “full-fluence” PDT. LogMAR BCVA and Stratus optical coherence tomography (OCT) were evaluated before treatment and 1?year after PDT. Twenty-four eyes from 24 patients with non-chronic, non-PDT-treated forms of CSC were evaluated as a control group.

Results

NR foveal thickness before PDT was 182?±?43.4?μm (range, 92–246) vs 148.1?±?30.9?μm (range, 101–220) 1?year after treatment (p?=?0.004; Student's t-test paired data). NR foveal thickness in the untreated eyes was 204.6?±?30.7?μ (range, 132–249) vs 192.5?±?26.4?μ (range, 123–235) after self-resolution (p?=?0.03; Student's t-test paired data). Basal NR thickness was statistically significant different between both groups (p?=?0.04; Student's t-test); this difference continued to be significant at the end of the follow-up (p?<?0.01; Student's t-test). All the patients with chronic CSC treated by PDT showed anatomic resolution, and BCVA improved from 0.38?±?0.35 to 0.23?±?0.29 (p?=?0.007; Student's t-test paired data). Final BCVA and basal and final NR thickness showed poor correlation (Pearson?=?0.2 and 0.1 respectively).

Conclusions

The use of PDT in chronic CSC induces NR thickness thinning. This change is not correlated with a decrease in BCVA. Spontaneous resolution of classic CCS also showed significant NR thinning.     

A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome

Purpose

To analyze the course of eyes with vitreomacular traction (VMT), and to find by optical coherence tomography (OCT) possible correlations between vitreomacular interface area changes and the chance of spontaneous VMT resolution.

Methods

Retrospective analysis of all consecutive patients presenting with VMT over a 24-month period. We introduced a novel OCT evaluation model to assess the vitreomacular interface area. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were also analyzed throughout follow-up.

Results

Twenty-six eyes of 18 symptomatic patients were followed for 12.9?±?4.8 months. Eyes were subdivided into groups according to their clinical course. Six eyes (23%) had a spontaneous resolution of the VMT (group A), and the interface area before its occurrence (39565?±?26409 μm²) was smaller than at study entry (99434?±?38819 μm²; p?=?0.03). The interface area did not significantly change throughout follow-up in the group that underwent surgery (group B, 11 eyes) and in the group that remained overall stable (group C, 9 eyes). At baseline, the interface area was smaller in group A compared to groups with non-resolved VMT (mean values of group B and C together) (785095?±?920721 μm²; p?=?0.002). CFT and BCVA did not significantly change in any of the studied groups. Vitreomacular interface area of 101002 μm² was identified as the threshold value separating the spontaneous VMT resolution group from the group with non-resolved VMT (p?Conclusions The more the vitreomacular interface area reduced over time, the higher was the chance of spontaneous VMT resolution. An area below 101002 μm² was the threshold value indicating a higher chance of spontaneous release of VMT.