Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes: a case-control study.

PURPOSE: To evaluate the outcomes of macular hole (MH) surgery with 3-day prone positioning in highly myopic eyes and to compare them with those from non-highly myopic eyes. DESIGN: Retrospective nested case-control study from a cohort of 496 consecutive patients (496 eyes) who underwent surgery for MH. PARTICIPANTS: Forty-seven highly myopic eyes (with axial length >26 mm) were included in the study group and were matched for MH size and duration of symptoms with 47 non-highly myopic control eyes selected from the same cohort. METHODS: All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and 17% hexafluoroethane gas filling. Patients then were advised to maintain strict face-down positioning for 3 days only and to avoid the supine position during the night for a minimum of 1 week. MAIN OUTCOME MEASURES: The MH closure rate, the relationship between axial length and closure rate, the best-corrected visual acuity (BCVA), and the surgical complications were analyzed. RESULTS: The mean axial length was 28.5±2.2 mm in highly myopic eyes and 23.3±1.1 mm in controls (P < 0.001). Closure of the MH was achieved in 39 of 47 eyes (83%) in the study group and in 45 of 47 eyes (95.7%) in the control group (P = 0.045). Anatomic outcomes tended to decrease when axial length increased (P = 0.066). Mean BCVA improved in both groups (0.41±0.39 logarithm of the minimal angle of resolution [logMAR] vs. 0.68±0.34 logMAR) but was significantly lower in highly myopic eyes (P < 0.001). Retinal detachment occurred in 8.5% of highly myopic patients versus 2.1% of controls, but the difference was not significant. CONCLUSIONS: Macular hole surgery with 3-day postoperative positioning in highly myopic eyes resulted in satisfactory anatomic and functional outcomes. However, the MH closure rate and mean improvement of visual acuity were less favorable than those in control eyes. Longer axial length may increase the risk of anatomic failure.

Bilateral optic neuropathy related to severe anemia in a patient with alcoholic cirrhosis: a case report and review of the literature.

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.

Outcomes of epiretinal membrane surgery in highly myopic eyes: a case-control study.

AIMS: To evaluate the outcomes of epiretinal membrane (ERM) surgery in highly myopic eyes and to compare them with those from non-highly myopic eyes. METHODS: Retrospective nested case-control study from a cohort of 1776 consecutive patients (1776 eyes) who underwent surgery for ERM. Fifty-seven highly myopic eyes (with axial length longer than 26 mm) were included in the study group and were matched for preoperative visual acuity and duration of symptoms with 57 non-highly myopic control eyes selected from the same cohort. The best-corrected visual acuity (BCVA), the relationship between axial length and visual improvement, the central macular thickness (CMT) and the surgical complications were analysed. RESULTS: The mean axial length was 27.3±1.1 mm in highly myopic eyes and 23.1±1 mm in controls (p<0.001). At the 1-year final examination, the mean BCVA significantly improved from 0.62±0.23 logarithm of minimal angle of resolution (logMAR) to 0.27±0.21 logMAR in the study group (p<0.001) and from 0.61±0.22 logMAR to 0.25±0.15 logMAR in the control group (p<0.001). Similarly, the mean CMT significantly decreased in both groups (p<0.001). The two groups did not differ statistically in terms of visual and anatomical changes as well as surgical complications. There was no significant correlation between axial length and visual recovery. CONCLUSIONS: ERM surgery resulted in similar anatomical and functional outcomes in both groups. Longer axial length does not seem to affect visual improvement and the complication rate.

Iliopsoas hematoma in Gaucher's disease.

Gaucher's disease is an autosomal recessive inherited disease characterized by oraganomegaly, cytopenia and bone destruction. Clotting disorders and platelet dysfunctions are described. We report the case of a 22-year-old man who presented subacute groin pain due to spontaneous iliopsoas hematoma. Laboratory investigations found moderate thrombocytopenia, normal coagulation factor activities and unspecific platelet function test disturbances. His spleen was moderately enlarged and no significant bone lesions were found. Iliopsoas hematoma is a rare complication in Gaucher's disease and should be included in the differential diagnosis of pain localized to the groin-hip area, which could rather evoke hip osteonecrosis in this context.