PREDICTIVE FACTORS OF SURGICAL SUCCESS WITH THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE.

PURPOSE: To present new morphologic features correlating with functional and anatomical outcomes of the inverted internal limiting membrane flap technique in full-thickness macular hole. METHODS: A retrospective study of 51 successful and 22 failed full-thickness macular hole surgeries. In all eyes, preoperative spectral domain optical coherence tomography (SD-OCT) or swept source optical coherence tomography (SS-OCT) were reviewed. The presence of supraretinal pigment epithelium granular deposits, presence of an epiretinal membrane or epiretinal proliferation, visibility of posterior hyaloid, continuity of the interdigitation zone or external limiting membrane, presence of cystoid spaces, irregular surface of the margins of full-thickness macular hole, visibility of the suprachoroidal space, and diameters of full-thickness macular hole were analyzed. RESULTS: In multivariate analysis, the success of the first surgery depended solely on the absence of epiretinal membrane ( P < 0.05).In univariate analysis, the success of the first surgery was correlated moreover with the absence of preoperative supraretinal pigment epithelium granular deposits ( P = 0.0010), the absence of an epiretinal proliferation ( P = 0.0060), and the absence of an irregular border of the hole ( P = 0.010). CONCLUSION: In multivariate analysis, epiretinal membranes were a negative prognostic factor for macular hole closure when the inverted internal limiting membrane flap technique was used. Worse final visual acuity was observed in patients with primary anatomical failure, even if the hole was successfully closed during the second intervention.

Fundus Autofluorescence Patterns in Subretinal Hemorrhages Associated with Neovascular Age-Related Macular Degeneration.

INTRODUCTION: Submacular hemorrhage (SMH) is a vision-threatening complication of neovascular age-related macular degeneration (AMD). The exact treatment scheme is not established yet. The aim of the current study was to describe surgical results and fundus autofluorescence (FAF) patterns after pars plana vitrectomy (ppV) + subretinal tissue plasminogen activator (tPA) + anti-vascular endothelial growth factor (VEGF) and intravitreal tPA + anti-VEGF + sulfur hexafluoride (SF6) tamponade and to compare them to intravitreal tPA + anti-VEGF + SF6 in the treatment of SMH in the course of AMD. MATERIALS AND METHODS: We performed FAF imaging in patients with a previous SMH in the course of AMD with a duration of <60 days treated with vitrectomy with subretinal anti-VEGF and tPA and intravitreal anti-VEGF, tPA, and SF6 administration (group 1) or intravitreal tPA + anti-VEGF + SF6 (group 2). In all eyes, a throughout ophthalmic examination, fluorescein angiography, and spectral domain optical coherence tomography (SD-OCT) were done for diagnosis. SD-OCT was performed monthly during treatment. RESULTS: Three FAF patterns were observed in both groups. Pattern one (normal autofluorescence) was observed in 5/18 in group one and 5/21 group two. Pattern two was observed in 6/18 in group one and 7/21 in group two. Pattern three was noted in 7/18 in group one and 5/21 in group two. Improvement in visual acuity was statistically significant for both groups: 0.01 Snellen (2.0 logMAR) to 0.11 Snellen (0.96 logMAR) in group one (p = 0.019) and 0.11 Snellen (0.96 logMAR) to 0.33 Snellen (0.48 logMAR) in group two (p = 0.0007). Central retinal thickness also decreased with statistical significance for both groups (p < 0.05). CONCLUSION: FAF patterns did not depend on the treatment used, but solely on the duration of SMH before treatment. SMH if not treated prompt enough might cause long-standing photoreceptor and retinal pigment epithelium defect, which is represented by hypo- and hyperautofluorescence. Performing a subretinal injection of tPA and anti-VEGF does not cause any defects associated with the injection site. That might be associated with previous local internal limiting membrane peeling, which reduces the injection pressure. Not only prompt treatment of SMH but also further continuation of anti-VEGF treatment is mandatory to maintain vision.

Vitrectomy with ILM peeling in diabetic macular edema in one eye vs. intravitreal anti-VEGF injections in the second eye: a comparative study.

PURPOSE: The aim of this study was to compare the results of vitrectomy performed in patients' worse eyes with diabetic macular edema to the results of continuous anti-VEGF treatment performed in patients' fellow eyes. METHODS: A retrospective interventional study of 14 patients with diabetic macular edema in both eyes. The better eye was always qualified for aflibercept injections (group 1), and the worse eye was scheduled for vitrectomy (group 2). The follow-up lasted 12 months. The following parameters were measured: visual acuity (V), central retinal thickness (CRT), maximum retinal thickness (MRT), central choroidal thickness (CCT), superficial fovea avascular zone (sFAZ) and deep fovea avascular zone (dFAZ), and vessel density at the level of superficial (sVD) and deep (dVD) retinal vessels. RESULTS: None of the analyzed factors differed between groups with statistical significance at any timepoint. The time of recovery of vision was identical in both eyes (F = 0.91, p = 0.449). The final sFAZ was significantly smaller for group 2 (median 196 µm) than for group 1 (median 375 µm; U = 101.0; p = 0.022; r = 0.44). CONCLUSION: Both techniques resulted in similar improvements in visual acuity and decreases in CRT after 1 year. sFAZ decreased in all eyes, with a higher extent after vitrectomy.

Spontaneous Closure of Full-Thickness Macular Holes.

PURPOSE: To describe retinal morphology and vision recovery after spontaneous closure of full-thickness macular hole (FTMH). MATERIALS AND METHODS: Retrospective, observational study. From a database containing 750 FTMH, we included 23 cases. All patients had a complete ophthalmic examination. Swept-source optical coherence tomography angiography was performed. RESULTS: Prior to spontaneous closure in 11 women and 12 men (mean age 67 years), the mean minimum FTMH diameter was 201 µm, and mean base FTMH diameter was 638 µm. Visual acuity improved from 0.29 Snellen to 0.47 Snellen (p = 0.001) after 6 months and showed no further improvement. Spontaneous closure of FTMH was associated with vitreous detachment in less than half of the cases. Irregularities in the deep vascular layer and hyporeflective areas in the choriocapillaris were noted. DISCUSSION: Equal sex distribution of spontaneous closures (1:1) differs from the high prevalence of females seen in the literature. Complete visual recovery is uncommon in cases of spontaneous closure of FTMH. It might be explained by prolonged defects of the choriocapillaris layer. These findings, along with the evolution of the various morphologies reported in the study, could possibly suggest that delaying vitrectomy while hoping for spontaneous closure might not be justified.

The analysis of macular thickness asymmetry in primary open angle glaucoma using Spectral- -Domain Optical Coherence Tomography.

PURPOSE: To analyze central retinal thickness asymmetry in patients with known and suspected primary open angle glaucoma. MATERIAL AND METHODS: A prospective analysis of 21 patients with known glaucoma and 53 patients with suspected glaucoma. A control group consisted of 25 healthy volunteers. Each enrolled patient had a spectral domain optical coherence tomography performed including a circumpapillary retinal nerve fiber layer and central retinal thickness measurements. A central 20 degree area was divided into 64 3° x 3° areas. The mean retinal thickness was measured in each small square and the value obtained in the upper half of every square was compared to the corresponding value in the lower half. A correlation between the mean circumpapillary retinal nerve fiber layer thickness and the central retinal thickness was assessed. RESULTS: The mean thickness of circumpapillary retinal nerve fiber layer was significantly lower in patients with known and suspected glaucoma (92.15 ±12.85 µm; 93.84 ± 11.45 µm vs. 97.82 ± 7.48 µm; P<0.05). The mean central retinal thickness did not differ significantly between the groups (291.05 ± 15.86 µm; 290.46 ± 13.60 µm vs. 293.94 ± 11.07 µm; P>0.05). Macular asymmetry was detected significantly more frequently in glaucomatous and glaucoma suspected eyes (78%; 66% vs. 32%; P<0.05). An association between the measured values was observed. CONCLUSIONS: The macular thickness measurements and macular asymmetry analysis may represent a novel strategy in glaucoma diagnosis.

The outer choroidoscleral boundary in full-thickness macular holes before and after surgery-a swept-source OCT study.

PURPOSE: To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swept-source OCT in patients with full-thickness macular holes (FTMH) before and after surgery. METHODS: Single center matched case-control study of 32 patients with FTMH (group 1), fellow eyes (group 2), and 32 eyes of 32 healthy controls (group 3). All eyes from group 1 had vitrectomy with a minimum follow-up of 3 months. Main outcome measures were the visibility and regularity of the outer choroidoscleral boundary (CSB), and additionally the eventual visibility of the suprachoroidal layer (SCL). RESULTS: Choroidal thickness was indifferent between groups. Choroidal thickness did not change after surgery (p = 0.1). CSB was visible in all cases. CSB was irregular in 59 % of eyes in group 1, in 40 % of eyes in group 2, and in any eye in group 3. SCL was visible in 34 % of eyes in group 1, and remained visible after surgery. In group 2, SCL was observed in 44 % of eyes, and in group 3 in one eye. CONCLUSIONS: Choroidal thickness does not differ between eyes with FTMH and their fellow eyes and healthy controls. CSB is more often irregular and SCL is more often visible in eyes with FTMH and their fellow eyes than in healthy controls. In fellow eyes of FTMH, the visibility of SCL was observed more often in eyes with partial vitreous detachment (p = 0.0). Three months after surgery, choroidal thickness does not change, the irregularities of CSB and SCL remain visible. More frequent changes of the outer choroidoscleral boundary in FTMH, and especially in their fellow eyes, may suggest a role of the choroid in the pathogenesis of FTMH.

Suprachoroidal layer and suprachoroidal space delineating the outer margin of the choroid in swept-source optical coherence tomography.

PURPOSE: To define the morphology of outer choroidal margins in swept-source optical coherence tomography. METHODS: This is a prospective observational study of 180 eyes: 20 eyes of healthy volunteers, 20 eyes of myopic patients, and 20 eyes from each of the following groups: macular hole, lamellar macular hole, epiretinal membranes, drusen, dry age-related macular degeneration (AMD), neovascular AMD, and vitreomacular traction. A single 12-mm wide swept-source optical coherence tomography image for each of the examined eyes consisting of 1,024 A-scans has been created. The main outcome measure selected was to estimate the presence of suprachoroidal layer, as well as to estimate the ability to delineate the outer choroidoscleral boundary using the software available (DRI-OCT) and to determine its shape. RESULTS: Suprachoroidal layer was observed in 5% of healthy emmetropic eyes, in 50% of eyes with full-thickness macular holes, and in 60% of eyes with vitreomacular traction syndrome. It was also present in 50% of eyes with dry AMD and in 20% of eyes with neovascular AMD. The outer margin of the choroid in all eyes of the healthy volunteers and in eyes with macular diseases has been delineated correctly. In all healthy and myopic eyes, we recognized the outer choroidoscleral boundary as having a regular shape following the natural oval contour of the globe. In eyes with epiretinal membranes, macular hole, vitreomacular traction, and AMD, the outer choroidoscleral boundary was irregular; the choroid varied in thickness from point to point. CONCLUSION: Swept-source optical coherence tomography enables exact visualization of the outer choroidoscleral boundary. Suprachoroidal layer consisting of two bands has been recognized, the upper of which is hyperreflective and the lower of which is hyporeflective. It may be supposed that the lower hyporeflective band corresponds to suprachoroidal space, which was not earlier visualized in vivo in eyes without choroidal effusion. Suprachoroidal layer in myopic and emmetropic healthy subjects has been rarely observed. We observed it more frequently in different macular diseases.

[Comparison of Heidelberg retinal tomography and spectral domain optical coherence tomography examinations for detection of glaucoma]. / Porównanie skaningowej laserowej oftalmoskopii i spektralnej optycznej koherentnej tomografii w diagnostyce jaskry.

PURPOSE: To compare the diagnostic ability of Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography Copernicus in detection of optic disc changes in glaucomatous patients. MATERIAL AND METHODS: Retrospective analysis of 24 eyes of 24 subjects with primary open angle glaucoma. All individuals had complete ophthalmic examination, Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography examinations performed. Measurements in Spectral Domain Optical Coherence Tomography were obtained both automatically (Spectral Domain Optical Coherence Tomography software) and manually. Following diameters were analyzed: disc area, cup area, cup volume, C to D ratio (C/D ratio) and circumpapillary retinal nerve fiber layer thickness. RESULTS: Disc area, cup area, cup volume were classified as within normal limits more often in Spectral Domain Optical Coherence Tomography printouts than in Heidelberg Retina Tomograph (75%, 63% and 83% in SD-OCT auto, 70%, 57% and 83% in SD-OCT manu vs. 58%, 37% and 33% in Heidelberg Retina Tomograph, respectively). C/D ratio was increased in 23 eyes (96%) in Heidelberg Retina Tomograph compared to 14 eyes (58%) in SD-OCT auto and 12 eyes (52%) in SD-OCT manu. Retinal nerve fiber layer thickness was significantly lower in Spectral Domain Optical Coherence Tomography (both auto and manu 96% vs. 58% in Heidelberg Retina Tomograph). According to the Moorfields Regresion Analysis classification from Heidelberg Retina Tomograph, 21 eyes were diagnosed as glaucomatous (88%). CONCLUSIONS: Although there was poor agreement in optic disc measurements between the two methods, both had high sensitivity in detection of glaucomatous optic disc changes (96% when retinal nerve fiber layer thickness measured by Spectral Domain Optical Coherence Tomography compared to 88% for Moorfield regresion analysis in Heidelberg Retina Tomograph). The sensitivity of diagnostic ability increases when both, Heidelberg Retina Tomograph and Spectral Domain Optical Coherence Tomography are performed.

Idiopathic epiretinal membranes: postoperative changes in morphology.

OBJECTIVE: To describe retinal morphology in idiopathic epiretinal membranes (ERMs) and to evaluate factors influencing function at different postoperative times up to 24 months. DESIGN: Retrospective study. PARTICIPANTS: A total of 121 eyes of 117 patients followed with spectral-domain optical coherence tomography for 24 months. METHODS: The following details were analyzed: type of ERM, central retinal thickness, and status of all retina layers in the fovea, especially the outer nuclear layer (ONL) and photoreceptor layer. We evaluated the presence of disorganization of retinal inner layers (DRIL), ectopic inner foveal layer (EIFL), elevation (stretching) of the ONL, cotton ball sign, and type connection between the retina and ERMs (complete adherence or multiple junction spots). RESULTS: The percentage of DRIL, EIFL, and stretched ONL decreased. Several factors negatively influenced visual acuity during the early postoperative controls: age, interdigitation zone defects; presence of cotton ball sign, DRIL, EIFL, and stretched ONL; and strong adhesion of the ERMs to the retina. Twenty-four months after surgery, only DRIL and strong adhesion between ERMs and the retina remained statistically significant. CONCLUSIONS: Younger patients (p < 0.001) and patients without DRIL (p < 0.001) experienced a faster recovery of function. The length of follow-up was associated with a decrease of factors influencing the final outcome. After 24 months, only the presence of DRIL and strong adhesion between the ERMs and the retina were significant. Assuming that DRIL appears in more advanced stages when compared with EIFL, this allows us to suggest that earlier surgery might be of more benefit in idiopathic ERMs.

Full-Thickness Macular Hole in Coats Disease Treated Using the Inverted Internal Limiting Flap Technique.

Purpose: To report vitrectomy with the inverted internal limiting membrane (ILM) flap technique in a patient with a full-thickness macular hole (FTMH) and Coats disease. Methods: A case and its long-term findings were analyzed. Results: A 27-year-old patient with Coats disease who was treated 5 years earlier with laser photocoagulation presented with an FTMH. Vitrectomy with the temporal inverted ILM flap technique was performed. The macular hole decreased in size on serial OCT scans but did completely close until 18 months postoperatively. The final visual acuity was 20/40 (0.3 logMAR). The patient's vision remained stable for the next 5 years. Conclusions: Although the healing process after vitrectomy with ILM peeling and the inverted flap technique in an FTMH coexisting with Coats disease is prolonged compared with an idiopathic FTMH, it is still possible to obtain satisfactory anatomic and functional results.

Dry eye parameters measured with an ocular surface analyzer in eyes after vitrectomy for vitreomacular interface disorders.

Purpose: Dry eye disease (DED) might be caused by multiple ocular surgical interventions. The aim of the study was to estimate the extent of DED in patients undergoing core vitrectomy for vitreoretinal interface disorders. Methods: In this prospective observational study, we included patients with 12 months of follow-up after vitrectomy. The following data were collected as controls: age, sex, best-corrected visual acuity before and after surgery, and phakic status. In OSA (ocular surface analysis), the following parameters were evaluated: NIBUT (non-invasive tear break-up time), sltDear (thickness of the lipid layer), Meibomian gland (MGD) loss, and the height of tear meniscus. Shapiro-Wilk test, Wilcoxon rank-sum test, and Mann-Whitney U tests were used for statistical analysis. Results: We evaluated 48 eyes of 24 patients (10 men, 14 women; 64.63 ± 14.10 years) 1 year after vitrectomy. From the analyzed ocular surface parameters, NIBUT was significantly lower in operated versus non-operated eyes (P = 0.048). The higher the level of difference in MGD loss between both eyes, the higher the level of difference in NIBUT between both eyes (rs = 0.47, P = 0.032). Conclusion: NIBUT levels were still decreased 12 months after vitrectomy. Patients with more pronounced MGD loss or decreased NIBUT levels in the fellow eye were more likely to experience such disorders. The tear meniscus height was lower in patients undergoing surgery for retinal detachment than in those with vitreoretinal disorders. This might allow the suggestion to include artificial tears in pre- and post-operative care in vitrectomized eyes.

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group.

BACKGROUND: The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making. METHODS: We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups. RESULTS: Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases. CONCLUSIONS: The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400-550 µm) and X-Large (550-800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.

Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Swept-Source Optical Coherence Tomography Angiography in Vitreomacular Traction Syndrome.

Purpose: A swept-source optical coherence tomography angiography (SS-OCTA) analysis of vasculature in vitreomacular traction (VMT) before and after surgery as well as 15 months' "watchful waiting" follow-up data. Methods: A retrospective analysis of 38 eyes. Patients were divided into group 1: untreated (20 eyes); group 2: untreated, spontaneous release of traction (4 eyes); and group 3: vitrectomy (14 eyes). Results: In all cases, SS-OCTA of the choriocapillaris revealed a hyporeflective area, which disappeared after traction release. In group 1, none of the analyzed factors significantly changed. In group 2, visual acuity (VA) improved from 0.3 logMAR to 0.1 logMAR. None of the following parameters significantly changed: central choroidal thickness, superficial fovea avascular zone (sFAZ), deep fovea avascular zone (dFAZ), and vessel densities. In 1 eye a lamellar macular hole formed. Factors increasing the chances of spontaneous release of traction were width of traction and central retinal thickness (P < .05). In group 3, VA improved from 0.27 Snellen (0.6 logMAR) to 0.44 Snellen (0.4 logMAR) (P < .05). Postoperative OCTA revealed significant decreases in central retinal thickness (P < .001), the parameters sFAZ, and dFAZ (P < .05). Conclusions: sFAZ and dFAZ decreased after vitrectomy but not after spontaneous release of traction. VA was better in eyes with spontaneous release of traction. The degree of improvement in VA was greater in the vitrectomy group. In all cases a hyporeflective area is visible in the choriocapillaris layer in SS-OCTA. It disappears when traction is released. Early treatment, at least in patients with lower VA, might be beneficial.

Vitrectomy for full thickness macular hole developed during the course of anti-VEGF treatment of type 1 neovascular AMD.

PURPOSE: To report a case of treatment of a full-thickness macular hole, which appeared after 10 months of anti-VEGF treatment in neovascular age related macular degeneration (nAMD). METHODS: The patient was diagnosed as type 1 nAMD. The coexisting vitreomacular traction caused a full thickness macular hole after 10 months of treatment. PATIENTS: A 68-year-old woman treated with anti VEGF. RESULTS: Vitrectomy with the temporal inverted ILM flap technique succeeded in closing the hole. Further anti-VEGF treatment followed. CONCLUSION: FTMH is a rare complication or coexistence in nAMD. Vitrectomy and continuous anti-VEGF treatment might result in satisfactory anatomical and functional results.

Vitrectomy in Diabetic Macular Edema:: A Swept-source OCT Angiography Study.

Purpose: The foveal avascular zone (FAZ) has been reported to decrease after anti-VEGF injections in diabetic macular edema (DME) in the long term. This study aimed to present the changes in swept-source OCT angiography after vitrectomy in patients with DME. Design: Retrospective interventional study. Participants: Thirty-five eyes were included (mean age: 62 years). Methods: Patients were followed for 12 months after vitrectomy with internal limiting membrane peeling for DME. Main Outcome Measures: The following parameters were measured: central retinal thickness (CRT), central choroidal thickness, superficial FAZ, deep FAZ (dFAZ), and vessel density in the superficial and deep retinal layers (dVD). Results: The CRT and superficial FAZ significantly decreased after surgery (401 µm-338 µm; P < 0.00, 401 µm-293 µm; P < 0.001, respectively). Initial visual acuity (VA) improved from 20/160 (0.97 logarithm of the minimum angle of resolution [LogMAR]) to 20/80 (0.62 LogMAR) (P < 0.001). The vessel density in the superficial retinal layers rate was 42.3% and decreased after surgery, reaching 41.6% at the end of the follow-up. The dVD rate 1 week after surgery was 28.9% and remained stable throughout the observation period. The most important prognostic factors for the final VA were preoperative VA and preoperative CRT, while the dFAZ and dVD at the time of edema resolution also correlated with the final VA. Conclusions: The superficial FAZ decreases after vitrectomy, which might indicate that vitrectomy has a protective effect on DME, similar to anti-VEGF injections. Prognostic factors for better final functional results are better initial VA and lower CRT before vitrectomy, in addition to a lower dFAZ diameter and a higher dVD at the moment of edema resolution. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study.

PURPOSE: To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. METHODS: Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. RESULTS: Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. CONCLUSION: Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.

Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery.

Purpose: To analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome. Methods: This is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters. Results: A total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF6 or C3F8, 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively. Conclusion: PPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.

Swept-Source OCT and Swept-Source OCT Angiography before and after Vitrectomy with Stuffing of the Optic Pit.

PURPOSE: To identify swept-source (SS) OCT and SS OCT angiography (OCTA) patterns predicting outcome in patients with optic disc pit-associated maculopathy and to present the results of a novel surgical technique, stuffing of the optic disc pit. DESIGN: Prospective, interventional study. PARTICIPANTS: Fifteen eyes. METHODS: Swept-source OCT before surgery and then 1 week and 1, 3, and 6 months after surgery, then up to 4 years later. Swept-source OCTA was performed from 2015 (9 patients). After core vitrectomy, internal limiting membrane (ILM) was peeled between the optic nerve and fovea and stuffed into the optic disc pit. Laser photocoagulation was performed at the temporal side of the optic disc pit. Fluid-air exchange followed. The following data were noted: visual acuity, central retinal thickness, distribution of fluid on SS OCT, and diameters and circuit of the foveal avascular zone on OCTA. MAIN OUTCOME MEASURES: Normalization of the fovea contour and visual acuity. RESULTS: We subdivided patients into 2 groups. On SS OCT, we observed subretinal fluid with elevation of the fovea (group 1) in 8 eyes. Group 2 comprised 7 eyes without subretinal fluid, but with intraretinal fluid. Five of these eyes additionally showed an outer lamellar macular hole. Anatomic success was achieved in all eyes. The decrease of central retinal thickness 1 week after surgery was more marked in group 1 (P = 0.002). The area of the foveal avascular zone in the superficial retinal vessel layer increased significantly after surgery for group 2 (P = 0.04), but not for group 1 (P = 0.4). Visual acuity improved without statistically significant differences between groups. CONCLUSIONS: Stuffing of the optic disc pit with the ILM results in improvement of anatomic and functional results. Prognosis depends on initial morphologic features. Central retinal thickness normalizes faster after surgery in eyes with subretinal fluid when compared with eyes with intraretinal fluid. Faster anatomic improvement does not correlate with improvement of vision. Postoperative increase in the size of the foveal avascular zone in the superficial retinal vessel layer, more pronounced in group 2, may be associated with the prolonged postoperative anatomic recovery in those eyes.

[Normal retinal layers in HRT II corneal module]. / Mozliwosci diagnostyczne modulu rogówkowego HRT II.

PURPOSE: The aim of this paper is to present corneal layers of healthy individuals with a confocal laser scanning ophthalmoscope (Heidelberg Retina Tomograph/ Restock Cornea Module). MATERIAL AND METHODS: We analyzed 40 corneas of 20 healthy individuals and measured corneal thickness and thickness of corneal layers. We also describe cell characteristics of each layer. RESULTS: In the outer endothelium 846 cells/mm2 were observed. In the medium endothelium 5000 cells/mm2 and in the inner endothelium about 9000 cells/mm2 were noted. 34 Langerhans cells/mm2 in the centre and 92 Langerhans cells/mm2 were present. The mean keratocyte nuclei count in the stroma was 355/mm2. In the endothelium we noted a mean of 2960 cells/mm2. Our data are similar to data obtained by histopathological findings. CONCLUSIONS: HRT II cornea module is a noninvasive, rapid and repeatable instrument that enables not only measurement of corneal thickness but also the exact cell count. It can be an important tool in diagnosis and evaluation of treatment of various corneal diseases.