CLINICAL CHARACTERISTICS AND SURGICAL OUTCOMES IN STAGE 4 MACULAR HOLE WITH EPIRETINAL PROLIFERATION.

PURPOSE: To investigate the clinical characteristics and surgical outcomes of Stage 4 macular holes (MHs) with epiretinal proliferation (EP) and explore the pathogenesis of MH formation. METHODS: This retrospective study included consecutive patients who underwent pars plana vitrectomy for Stage 4 MH. Patients were divided into two groups based on the presence or absence of EP. Baseline characteristics, optical coherence tomography features of MHs, and surgical outcomes were compared between the groups. RESULTS: EP was detected in 31 of 102 eyes with Stage 4 MH (30%). Patients with EP were older ( P = 0.044), predominantly male ( P = 0.047), had a greater axial length ( P = 0.008), and had better preoperative visual acuity ( P < 0.001) than those without EP. On optical coherence tomography, eyes with EP had more epiretinal membrane and intraretinal splitting ( P = 0.002 and P < 0.001, respectively) than those without EP. The hole closure rate after primary surgery was comparable, and visual acuity at 6 months after surgery was significantly better in eyes with EP than those without EP ( P = 0.036). In 9 eyes with EP, the medical record documented the presence of complete posterior vitreous detachment before MH development. CONCLUSION: Patients of Stage 4 MH with EP were older, predominantly male, and had better preoperative and postoperative visual acuity compared with those without EP. The differences in demographic characteristics and optical coherence tomography findings suggest that the pathogenesis of Stage 4 MH with EP is different from that of Stage 4 MH without EP.

FULL-THICKNESS MACULAR HOLE WITH PERSISTENT BROAD VITREOMACULAR ATTACHMENT: Clinical Characteristics and Surgical Outcomes.

PURPOSE: To describe the characteristics and surgical outcomes of full-thickness macular holes (FTMHs) with persistent broad vitreomacular attachment. METHODS: This was a retrospective, observational case series. Consecutive patients undergoing pars plana vitrectomy for FTMHs with persistent broad vitreomacular attachment (study group) were reviewed. Clinical charts, optical coherence tomography (OCT) features of macular holes, and surgical outcomes were reviewed and compared with those with typical FTMH with focal vitreomacular traction (control group). RESULTS: A total of 15 eyes of 14 consecutive patients (eight males and six females with a mean age of 60.6 years) were included in the study group. OCT showed a zone of at least 1,500 µm all around the circumference of the fovea where the vitreous was attached. On OCT, epiretinal membrane and epiretinal proliferation were observed in 73% and 87% of cases, respectively. Compared with the control group, the study group was younger (P = 0.027) and had better preoperative visual acuity (P = 0.007). All FTMHs closed after one surgery in both groups, and the postoperative visual acuity of the study group was better than that of the control group (P = 0.002). CONCLUSION: Full-thickness macular holes may have developed under the condition that the vitreous cortex was broadly attached around the hole. These FTMHs were associated with younger age, better baseline visual acuity, and a higher incidence of epiretinal membranes and epiretinal proliferations compared with macular hole with focal vitreomacular traction. The surgical outcome was favorable, but the pathogenesis of FTMH development remains unclear.

AIR VERSUS SULFUR HEXAFLUORIDE GAS TAMPONADE IN VITRECTOMY FOR UNCOMPLICATED RETINAL DETACHMENT WITH INFERIOR BREAKS.

PURPOSE: To compare surgical outcomes of filtered air and sulfur hexafluoride (SF6) as an internal tamponade in patients undergoing primary 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment with inferior breaks. METHODS: Patients with uncomplicated rhegmatogenous retinal detachment associated with inferior breaks (between 4 and 8 o'clock positions) who were undergoing primary pars plana vitrectomy were enrolled. All eyes underwent pars plana vitrectomy and complete drainage of subretinal fluid, followed by filtered air or 20% SF6 tamponade. The main outcome measures included single-surgery anatomical success rates and final visual recovery. RESULTS: Overall, 116 eyes of 116 patients (81 men and 35 women with a mean age of 55.2 years) were assessed. Air was used in 52 eyes (air group) and gas in 64 eyes (gas group). Single-surgery anatomical success was achieved in 50 (96.2%) and 60 (93.8%) eyes in the air and gas groups, respectively (P = 0.69), and final anatomical success was achieved in all eyes. The mean final Snellen visual acuity was similar in the air (20/23) and gas groups (20/21; P = 0.13). CONCLUSION: No significant differences were observed in single-surgery anatomical success rates and final visual recovery when comparing air with SF6 gas tamponade in pars plana vitrectomy for primary uncomplicated rhegmatogenous retinal detachment with inferior breaks.

Macular holes following vitrectomy for rhegmatogenous retinal detachment: epiretinal proliferation and spontaneous closure of macular holes.

PURPOSE: To describe the characteristics and management of full-thickness macular holes (MHs) that develop after pars plana vitrectomy for rhegmatogenous retinal detachment (RD). METHODS: Retrospective, interventional, consecutive case series. Patients who developed secondary full-thickness MHs after prior pars plana vitrectomy for RD over a 6-year period were included. The main outcome measures included optical coherence tomography (OCT) findings and the clinical course of full-thickness MHs. RESULTS: A total of 11 eyes of 11 consecutive patients were included in the study. The mean age of the patients was 58.8 years (range, 47-70 years). The median time between RD repair and MH diagnosis was 36 months (range, 1 month-11 years). The fovea was attached to 10 eyes (91%) at the time of RD repair. OCT demonstrated epiretinal proliferation (EP) at the hole margin in 10 eyes (91%). MH spontaneously closed in 7 eyes (63%) but reopened in 5 eyes. A total of 7 eyes (63%) required a vitrectomy to repair the MHs. All MHs were closed at the last follow-up visit. CONCLUSION: Full-thickness MHs after pars plana vitrectomy for RD have features that are distinct from that of typical idiopathic MH. The presence of EPs is common, and MHs are prone to spontaneous closure and reopening. These findings suggest that EP may be associated with spontaneous hole closure and that long-term follow-up is necessary even if the MHs close spontaneously.

Vitreomacular interface and outer foveal microstructure in fellow eyes of patients with unilateral macular holes.

PURPOSE: To investigate the relationship between the vitreomacular interface and the integrity of the photoreceptor microstructures in the normal fellow eyes of patients with unilateral macular holes. METHODS: Retrospective observational case series. Fifty-five normal fellow eyes of 55 patients with unilateral macular holes were enrolled in the study. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, fundus photography, and spectral domain optical coherence tomography at initial and follow-up visits. The features of the vitreomacular interface were graded based on spectral domain optical coherence tomography findings. RESULTS: At the initial visit, 28 of 55 eyes (51%) had vitreomacular attachments with or without perifoveal posterior vitreous detachment. On their initial visit, a triangular elevation of the cone outer segment tips line was identified in 11 of 18 eyes (61%) with perifoveal posterior vitreous detachment across all quadrants with persistent attachment to the fovea. Conversely, none of the remaining 37 eyes with the other stages of posterior vitreous detachment showed any abnormalities. Over a mean follow-up period of 18 months (range, 12-24 months), the elevation of the cone outer segment tips line resolved after spontaneous vitreomacular separation without macular holes in 3 eyes, remained unchanged in 6 eyes, and showed progression to a full-thickness macular hole in 2 eyes. CONCLUSION: These findings suggest that an elevation of the cone outer segment tips line in the normal fellow eyes of patients with macular holes is caused by the focal traction of the vitreous at the foveal center. This is considered to be an important primary change observed in the macular tissue in full-thickness macular hole formation.

Long-term observation of the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes.

PURPOSE: To describe long-term changes in the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes (MHs). METHODS: This is a retrospective, observational case series. The medical records of patients who underwent surgery for idiopathic MHs between May 2000 and December 2010 were reviewed. Patients who had clinically normal fellow eyes and underwent 12 months or more of follow-up were included. The vitreomacular relationship in the fellow eyes was evaluated using optical coherence tomography (OCT) and slit-lamp biomicroscopy. RESULTS: The study included 153 patients with a mean age of 65.5 years and a mean follow-up of 33.5 months (range, 12-121). The incidence of vitreomacular attachments evaluated by OCT was 52% (80 eyes) at initial examination, which decreased to 41, 37 and 23% at 1, 2 and 3 years after the initial examination, respectively. Of the 80 eyes with vitreomacular attachments at initial examination, 40 (50%) still had vitreomacular attachments at the final visit. Of the remaining 40 eyes in which vitreomacular separation occurred during follow-up, 11 (28%) developed an MH, with a mean interval of 45 months. None of the eyes with vitreomacular separation at presentation developed an MH. CONCLUSION: This largest series of fellow eyes of MHs followed by OCT shows that, at presentation, about half of the patients already have premacular vitreous detachment and therefore no risk of MH, and that second MH develops in about 30% in the process of vitreomacular separation, which evolves over a prolonged period.

DEVELOPMENT OF FOCAL CHOROIDAL EXCAVATION AFTER ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: The purpose of this study was to describe a case of polypoidal choroidal vasculopathy, showing a newly developed focal choroidal excavation during a 4-year follow-up period with multiple intravitreal antivascular endothelial growth factor injections. METHODS: This study was a case report. RESULTS: A 64-year-old man was referred for treatment of age-related macular degeneration in his left eye. His corrected visual acuity at initial presentation was 20/20 in both the right and left eye. Optical coherence tomography of the left eye revealed a steep retinal pigment epithelial detachment and subretinal fluid, and indocyanine green angiography confirmed a polypoidal lesion, leading to the diagnosis of polypoidal choroidal vasculopathy with pachychoroid features. Thereafter, antivascular endothelial growth factor intravitreal injections were continued on a pro re nata basis. Two years after the initial presentation, the sharp pigment epithelial detachment began to shrink, and a novel focal choroidal excavation gradually emerged surrounding the pigment epithelial detachment with an inner choroidal layer attenuation. CONCLUSION: Multiple antivascular endothelial growth factor injections for polypoidal choroidal vasculopathy resulted in atrophy of the polypoidal lesion and a decrease in the blood flow in the adjacent inner choroidal vasculature, leading to the formation of a novel focal choroidal excavation.

Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic.

BACKGROUND/AIMS: To determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period. METHODS: This was a retrospective multicentre study including 31 ophthalmological institutions of the Japanese Retina and Vitreous Society or Japan-Clinical Retina Study group. Patients who had undergone vitrectomy during 2019, the pre-COVID-19 period, and from July 2020 to June 2021, the COVID-mask period, were studied. The results of cataract surgery were used as a control. The total number of vitrectomies and the total number of postoperative endophthalmitis were determined. Then, the differences in the incidence of postoperative endophthalmitis between the pre-COVID-19 period and the COVID-mask period, and the type of pathogens causing the endophthalmitis were studied. RESULTS: The incidence of postvitrectomy endophthalmitis was significantly lower in the pre-COVID-19 period with 16 568 surgeries and 18 endophthalmitis cases (0.11%) than in the COVID-mask period of 14 929 surgeries and 31 endophthalmitis cases (0.21%; p=0.031, OR=1.913, 95% CI 1.078 to 3.394). In the pre-COVID-19 period, 4 of the 18 eyes were culture positive, and all were of the Staphylococcus family. In the COVID-mask period, 9 of the 31 eyes were culture positive, and 4 cases were related to oral commensals including Streptococcus spp, which are reportedly very rare in endophthalmitis after vitrectomy. CONCLUSIONS: It is necessary for physicians to be aware of the higher incidence of postvitrectomy endophthalmitis during the COVID-mask period, and to treat their patients appropriately.

Incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases.

PURPOSE: To assess the incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases and to compare it with 20-gauge vitrectomy. METHODS: Retrospective, comparative, interventional case series. We compared the incidence of iatrogenic peripheral retinal breaks in 176 eyes undergoing 23-gauge vitrectomy between January 2007 and November 2009 (23-gauge group) and 153 eyes undergoing 20-gauge vitrectomy between January 2004 and June 2006 (20-gauge group) for either idiopathic macular holes or idiopathic epiretinal membranes. All surgeries were performed by one surgeon at a single hospital. Main outcome measure was the incidence rate of iatrogenic peripheral retinal breaks discovered intraoperatively and postoperatively. RESULTS: Iatrogenic peripheral retinal breaks occurred in 1 eye in the 23-gauge group and in 11 eyes in the 20-gauge group during surgery. Additional iatrogenic retinal breaks were found in 1 eye in the 23-gauge group and in 2 eyes in the 20-gauge group within 1 month after surgery. The overall incidence of iatrogenic peripheral retinal breaks was 1.1% (2 of 176) in the 23-gauge group and 8.5% (13 of 153) in the 20-gauge group. The difference was statistically significant (P = 0.0023). CONCLUSION: The incidence of iatrogenic peripheral retinal breaks during vitrectomy for macular diseases is significantly lower in 23-gauge vitrectomy than in 20-gauge vitrectomy.

Vitrectomy for exudative age-related macular degeneration with vitreous hemorrhage.

PURPOSE: The purpose of this study was to study the effect of pars plana vitrectomy (PPV) for age-related macular degeneration with vitreous hemorrhage on choroidal neo-vascularization (CNV). METHODS: A retrospective interventional case series in which 92 eyes with age-related macular degeneration with vitreous hemorrhage that received PPV were studied. Among them, 60 eyes without pre- or posttreatment other than PPV were selected. Choroidal neovascularization was expressed as the incidence of bleeding 6 months before and after PPV. The status of CNV after PPV was compared and classified as worsened, remained, regressed, disappeared, or unclassified. The influence of posterior vitreous detachment was examined. RESULTS: The incidence of bleeding was reduced dramatically after PPV (1.11 +/- 0.44 in preoperative 6 months vs. 0.03 +/- 0.18 in postoperative 6 months, P < 0.0001). The status of CNV improved in most cases; 40 of 54 classifiable eyes (74.1%) were categorized as "regressed" or "disappeared." Postoperative visual acuity was significantly better than preoperative visual acuity (P < 0.0001). The status of CNV subsided more in those eyes without posterior vitreous detachment than in those with posterior vitreous detachment (odds ratio, 1.02; 95% confidence interval, -0.01-2.08; P = 0.054). CONCLUSION: The activity of CNV was reduced after PPV in eyes with age-related macular degeneration with vitreous hemorrhage. Visual acuity significantly improved, with only rare severe complications. The involvement of vitreomacular traction in the patho-physiology of CNV in age-related macular degeneration is possible.

Surgical outcomes for patients who develop macular holes after pars plana vitrectomy.

PURPOSE: To characterize outcomes for patients who develop full-thickness macular holes after pars plana vitrectomy. METHODS: We retrospectively analyzed data for 47 consecutive patients (47 eyes) who developed full-thickness macular holes after initial pars plana vitrectomy for a variety of indications. All patients underwent a second vitrectomy and gas tamponade with or without internal limiting membrane peeling. RESULTS: Indications for initial vitrectomy included idiopathic epiretinal membranes (11 eyes), epiretinal membranes with a pseudohole (nine eyes), macular edema resulting from various conditions (nine eyes), proliferative diabetic retinopathy (nine eyes), rhegmatogenous retinal detachment (five eyes), and miscellaneous causes (four eyes). Mean interval from initial vitrectomy to macular hole formation was 20.4 months. Mean visual acuity (VA) in the affected eye was 0.13 (20/155, Snellen equivalent). The hole was closed in 32 eyes (68%) after a single procedure. With a mean follow-up of 53 months, mean final VA improved to 0.26 (20/77); 26 (55%) eyes improved, 18 (38%) were stable, and three (6%) worsened. No severe complications occurred except one macular hole that reopened after successful closure. CONCLUSIONS: Macular holes may develop after pars plana vitrectomy. Although additional vitrectomy can successfully close the hole and improve vision in most patients, postsurgical outcome seems to depend on the underlying condition.

Long-term outcomes of visual field defects after indocyanine green-assisted macular hole surgery.

PURPOSE: To evaluate the long-term course of visual field defects after intravitreal injection of indocyanine green (ICG) during vitrectomy. METHODS: Retrospective observational case series. The medical records of seven eyes of seven patients with visual field defects after the adjunctive use of ICG during macular hole surgery were studied. All of the surgeries were performed between February 2001 and January 2002. Humphrey static perimetry and best-corrected visual acuity were examined periodically, and the main outcome measure was the mean deviation (MD) determined by the Humphrey (30-2) SITA-Fast program. RESULTS: All patients were observed for more than 4.5 years, for a mean of 60.7 months and a range of 54 to 66 months. The preoperative MD was -3.5 +/- 3.1 dB (mean +/- SD), and the postoperative MD was -13.3 +/- 4.9 dB at 1 year, -13.4 +/- 4.6 dB at 2 years, -16.2 +/- 5.1 dB at 3 years, and -15.6 +/- 5.1 dB at 4 years. The decrease in the mean MD between 1 and 3 years after surgery was significant (P < 0.05). Optic disk pallor in five eyes showed a decrease in the MD between 1 year and 3 years after the surgery. There was no significant difference in the postoperative best-corrected visual acuity at any time. CONCLUSIONS: The visual field defect in eyes that had undergone vitrectomy with staining of the internal limiting membrane with ICG can continue to deteriorate for at least 3 years. Eyes receiving intravitreal ICG during vitrectomy should be followed for a longer period to determine the long-term effect of ICG.

Intraocular pressure after intravitreal injection of triamcinolone acetonide following vitrectomy for macular edema.

PURPOSE: To evaluate long-term intraocular pressure (IOP) response after intravitreal injections of different doses of triamcinolone acetonide (TA) upon completion of pars plana vitrectomy (PPV) for macular edema secondary to diabetic retinopathy or retinal vein occlusion. PATIENTS AND METHODS: Retrospective, consecutive, comparative, interventional case series. Twenty-seven eyes of 25 consecutive patients with macular edema associated with diabetic retinopathy (n=18) or retinal vein occlusion (n=9), who underwent PPV for the treatment of macular edema between January 2003 and December 2003, were included. Upon completion of vitrectomy, different doses of TA were injected into the vitreous cavity: 14 eyes with 5 mg of TA (group 1) and 13 eyes with 10 mg of TA (group 2). The main outcome measure was IOP. RESULTS: All patients were followed up for at least 12 months. Preoperative IOP was 12.6+/-2.6 mm Hg (mean+/-standard deviation) in group 1 and 13.2+/-2.1 mm Hg in group 2. Postoperatively, IOP increased to a mean maximum of 20.6+/-5.5 mm Hg in group 1 and 31.5+/-3.5 mm Hg in group 2 (P<0.01 for both groups). The difference between groups was also significant (P<0.05). Five of 14 eyes (36%) in group 1 and 10 of 13 eyes (77%) in group 2 had an elevation of IOP exceeding 21 mm Hg (P=0.03). The median interval from surgery to reach maximal IOP was 7 days in both groups. The significant IOP elevation lasted for 3 months in group 1 and 6 months in group 2. CONCLUSIONS: After injecting of TA into the vitreous cavity upon completion of PPV for macular edema, a dose-dependent IOP elevation was observed, starting from early postoperative days and returning to normal values after several months. These results show that intravitreal TA injection in the vitrectomized eyes might have different IOP changes from in the nonvitrectomized eyes.

Results of visual acuity and foveal thickness in diabetic macular edema after vitrectomy.

PURPOSE: To report results of an investigation of visual acuity (VA) and foveal thickness in diabetic macular edema (DME) patients after vitrectomy. METHODS: A retrospective study was performed of the records of 47 patients (61 eyes) who received pars plana vitrectomy (PPV) for DME. All eyes were followed up for over 6 months (mean, 24.8 months; range, 6-60 months). VA and foveal thickness evaluated by optical coherence tomography were reviewed preoperatively and postoperatively. RESULTS: Twenty-four-month follow-up data were available for 46 of the 61 eyes (75%). VA at the final examination had improved by 0.2 log units or more in 34 of the 61 eyes (56%), remained unchanged in 21 eyes (34%), and worsened in six eyes (10%). Mean foveal thickness decreased by more than 20% of the preoperative value in 50 of the 61 eyes (82%), remained unchanged in ten eyes (16%), and increased by more than 20% in one eye (2%) at the final examination. Postoperative best-corrected visual acuity (BCVA) at both 12 and 24 months was significantly better than preoperative BCVA (P < 0.0001). Foveal thickness at 3 months or later significantly decreased from the preoperative value (P < 0.0001), but remained unchanged in comparison with postoperative 12 months and 24 months values (P = 0.19). Preoperative VA and presence of cystoid macular edema (CME) were independently associated with final visual acuity (P = 0.001). CONCLUSIONS: PPV for DME effectively improved VA and reduced foveal thickness for a longer postoperative period. Better preoperative VA was associated with better final postoperative VA. The eyes without CME tended to have better final postoperative VA.

Recurrence of diabetic macular edema after intravitreous injection of triamcinolone following vitrectomy.

PURPOSE: To evaluate the effects of intravitreous triamcinolone acetonide (TA) after pars plana vitrectomy (PPV) for diabetic macular edema (DME). METHODS: We studied a prospective interventional case series. TA was injected intravitreously after PPV in 28 eyes (PPV+TA group). Eyes with DME that met the same criteria and had been treated with PPV alone (29 eyes) were used as controls. The best-corrected visual acuity (VA) and foveal thickness determined by optical coherence tomography were followed up for over 12 months in both groups. Chronological changes of VA and foveal thickness between the groups were evaluated. RESULTS: In the PPV+TA group, VA had improved at 1 month, but worsened after 3 months. Improvement of foveal thickness was found until 3 months, but not after 6 months. In controls, both VA and foveal thickness continued to improve. The VA of the PPV+TA group was significantly better than that of the controls at 1 and 3 months (P = 0.007 and 0.015, respectively). The foveal thickness of the PPV+TA group was significantly less than that of controls at 1 month (P = 0.0004). These differences became insignificant thereafter, and foveal thickness became significantly worse in the PPV+TA group than in the controls at 12 months (P = 0.0002). CONCLUSION: Although adjunctive use of TA after PPV for DME improved VA and foveal thickness, the effect was transient and foveal thickness increased significantly compared with the PPV alone group at 12 months postoperatively.

Effect of vitreomacular separation on macular thickness determined by spectral-domain optical coherence tomography.

PURPOSE: To determine the effects of vitreomacular separation on macular thickness. METHODS: This was a retrospective, observational, cross-sectional study. Average foveal and central minimum thicknesses were measured by spectral-domain optical coherence tomography (SD-OCT) in 308 eyes of 308 healthy subjects (healthy group) and 298 normal fellow eyes of 298 patients with a unilateral macular hole (MH group). Multiple regression analyses were performed to determine the effects of various factors on the macular thickness. RESULTS: The mean age of the healthy group was 67.3 ± 9.6 years (range 40-88 years) and that of the MH group was 67.8 ± 7.0 years (range 43-91). SD-OCT images showed that 149 eyes (48.4 %) in the healthy group and 174 eyes (58.4 %) in the MH group had a vitreomacular separation. In the healthy group, the central minimum thickness of eyes with a vitreomacular separation (196 µm) was significantly thinner than those without a vitreomacular separation (205 µm; P < 0.001). In the MH group, the average foveal thickness (234 µm) and the central minimum thickness (177 µm) in eyes with a vitreomacular separation were thinner than those without it (247 and 199 µm, respectively; both P < 0.001). Multiple regression analyses showed that a vitreomacular separation was significantly correlated with thinner central minimum thicknesses in both groups (P < 0.001) and also with the average foveal thickness in the MH group (P < 0.001). CONCLUSIONS: A vitreomacular separation caused thinning of the central fovea in both the healthy eyes and the normal fellow eyes of unilateral MH patients; the extent of foveal thinning is greater in the MH group.

Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study.

PURPOSE: To report a patient whose foveal avascular zone (FAZ) decreased after vitrectomy with internal limiting membrane (ILM) peeling. METHODS: A 58-year-old woman underwent successful phacovitrectomy with ILM peeling for a thin epiretinal membrane in an eye with a normal foveal contour. Optical coherence tomography angiographic en face images of the 3 mm×3 mm superficial and deep inner retinal vascular plexuses were examined preoperatively, and on days 1, 2, 9, and 37 postoperatively. The changes in the FAZ areas and the thicknesses of the parafoveal retinal layers at 500 µm from the foveal center were assessed in the vertical and horizontal B-scan images. RESULTS: The areas of the superficial and deep FAZ decreased after the surgery. The course of the postoperative decrease of the FAZ area in the superficial plexus can be fit by a hyperbolic curve (R2=0.993). An increase in the thicknesses of the retinal nerve fiber layer, ganglion cell-inner plexiform layer, and inner nuclear layer was observed at all times postoperatively. CONCLUSIONS: We observed one case that the FAZ area decreased and the parafoveal inner retinal thickness increased after the vitrectomy with ILM peeling. The decrease in the FAZ area suggests that a centripetal movement of the inner retinal layer is probably due to the ILM peeling.

Analysis of the retinal nerve fiber layer after indocyanine green-assisted vitrectomy for idiopathic macular holes.

PURPOSE: To analyze retinal nerve fiber layer (RNFL) thickness in eyes with or without visual field (VF) defects after indocyanine green-assisted vitrectomy for idiopathic macular holes using optical coherence tomography (OCT) and to investigate the relationship between postoperative VF defects and RNFL damage. DESIGN: Retrospective interventional case series. PARTICIPANTS: Thirty-four eyes of 32 patients with idiopathic macular holes that underwent vitrectomy between January 2001 and March 2003 were included in this study. Eyes were divided into 3 groups according to the occurrence of postoperative VF defects and the use of indocyanine green for internal limiting membrane peeling during surgery: 11 eyes with VF defects after indocyanine green-assisted vitrectomy (group 1), 9 eyes without VF defects despite the use of indocyanine green (group 2), and 14 eyes without VF defects that underwent vitrectomy without indocyanine green (group 3). METHODS: Retinal nerve fiber layer thickness in each of 4 quadrants (superior, inferior, nasal, temporal) was measured with OCT. MAIN OUTCOME MEASURE: Retinal nerve fiber layer thickness around the optic disc. RESULTS: The mean RNFL thickness in 3 of 4 quadrants (superior, nasal, inferior) in group 1 was significantly less than that in the corresponding quadrant in groups 2 and 3 (P<0.01). In the temporal quadrant, there was a significant difference between groups 1 and 3 (P = 0.02), but not between groups 1 and 2. The RNFL thickness in group 1 was significantly less in 3 quadrants in operated eyes than in fellow eyes (P<0.05). CONCLUSIONS: The RNFL thickness was reduced in eyes with VF defects after indocyanine green-assisted vitrectomy for macular holes, suggesting that the postoperative VF defects may have been caused by RNFL damage relating to the use of indocyanine green.

Changes in visual field defects during 10-year follow-up for indocyanine green-assisted macular hole surgery.

PURPOSE: To determine whether the visual field defects detected within 3 months of indocyanine green (ICG)-assisted inner-limiting membrane (ILM) peeling continue to worsen over longer periods. METHODS: This was a retrospective observational case series. Four eyes with visual field defects that developed within 3 years of ICG-assisted ILM peeling for a macular hole (MH) were examined yearly for 10 years. The main outcome measures were the degree of mean deviation (MD) determined by Humphrey perimetry with the 30-2 SITA-Fast program and the best-corrected visual acuity (BCVA). RESULTS: Four patients were examined yearly for more than 10 years, with a mean duration of follow-up of 139.5 months (11.6 years) and a range of follow-up of 137-156 months (11.4-13 years). The mean (±standard deviation) preoperative MD value was -4.99 ± 3.26 dB, and the mean postoperative MD values were -12.9 ± 1.29 dB after 1 year, -14.1 ± 0.75 dB after 3 years, and -12.73 ± 2.65 dB after 10 years. The mean preoperative BCVA was 0.65 ± 0.26 logarithm of the minimal angle of resolution (logMAR) units, and the postoperative BCVA was 0.21 ± 0.07 logMAR units at 1 year, 0.28 ± 0.21 logMAR units at 3 years, and 0.14 ± 0.06 dB logMAR units at 10 years. CONCLUSIONS: The visual field defects detected soon after ICG-assisted ILM peeling continued to worsen for 3 years, but not thereafter.

Pulsatile blood flow in the polypoidal choroidal vasculopathy.

OBJECTIVE: To describe patients with pulsatile polypoidal vessels in polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective, observational case series. PARTICIPANTS: Eighty-four eyes of 74 patients with PCV. METHODS: The medical records of patients diagnosed with PCV between 1998 and 2004 at Kagoshima University Hospital were reviewed. MAIN OUTCOME MEASURES: A pulsatile polypoidal vessel (PV) on indocyanine green angiography (ICGA). RESULTS: Seven of 74 patients (9.5%) had PVs in the macula. Four eyes revealed pulsatile PVs on the day the diagnosis of PCV was first made, and PVs in the other 3 eyes showed pulsatile movement during the follow-up period. Two patterns of pulsatile movement were observed on ICGA: (1) a rhythmic variation in the caliber of a choroidal vessel (caliber variation pattern) and (2) a pulsatile blood flow in a tortuous and relatively narrow choroidal vessel (pulsatile blood flow pattern). Both patterns of pulsatile PVs appeared in the early frames of the ICGA, and some of them were observable even during the first 15 minutes after the ICG dye injection. The pulsatile movement disappeared spontaneously without treatment in some patients, and the period in which pulsatile PVs was detectable on ICGA was limited in each patient. CONCLUSIONS: We report the features of pulsatile PV in PCV. It is a unique and important characteristic that has not been reported with any other chorioretinal diseases and may provide a clue to understanding the pathogenesis of PCV.