Surgically Induced Macular Detachment for Treatment of Refractory Full-Thickness Macular Hole: Anatomical and Functional Results.

PURPOSE: The purpose of this study was to investigate the efficacy and safety of surgically induced macular detachment (MD) for the treatment of refractory full-thickness macular hole (FTMH). MATERIALS AND METHODS: Clinical data were age, gender, lens status, and best corrected visual acuity (BCVA). Preoperative tomographic parameters were: FTMH morphology (intraretinal cyst and elevated or flat edges) and FTMH diameter. Postoperative FTMH closure and outer retinal layer (ORL) restoration were evaluated. Fundus autofluorescence (FAF), optical coherence tomography (OCT) findings, and BCVA were analyzed at the 1st, 3rd, and 6th postoperative month. The interval between the first surgery for idiopathic FTMH and the surgically induced MD for refractory FTMH was collected (intersurgical interval, days). RESULTS: Ten eyes of 10 patients were included. The mean age was 68.8 ± 6.8 years. FTMH closure was obtained in 9 patients; in 8 patients, ORL restoration was detected. BCVA improved from 1.06 ± 0.1 (baseline) to 0.56 ± 0.2 (final) logMAR (p = 0.0001). A negative correlation between the intersurgical interval and postoperative visual gain was demonstrated (r = -0.3618). FAF and OCT showed a permanent retinal pigment epithelium (RPE) damage corresponding to the retinotomy points. CONCLUSION: This study demonstrates the efficacy of this technique and highlights the risk of RPE damage, suggesting the need to perform the retinotomy points outside the macula.

A novel quantitative analysis method for idiopathic epiretinal membrane.

PURPOSE: To introduce a novel method to quantitively analyse in three dimensions traction forces in a vast area of the ocular posterior pole. METHODS: Retrospective analysis of 14 eyes who underwent peeling surgery for idiopathic, symptomatic and progressive epiretinal membrane. The technique measures the shift in position of vascular crossings after surgery from a fixed point, which is the retinal pigmented epithelium. This shift is defined as the relaxation index (RI) and represents a measure of the postoperative movement of the retina due to released traction after surgery. RESULTS: Best-corrected visual acuity was significantly better than baseline at all follow ups while the RI had its maximum value at baseline. Moreover, we found a significant correlation between best-corrected visual acuity at 6 months and RI at baseline. CONCLUSION: While all previous published methods focused on bi-dimensional changes observed in a small region, this study introduces a three-dimensional assessment of tractional forces. Future integration of RI into built-in processing software will allow systematic three-dimensional measurement of intraretinal traction.

Combined panretinal photocoagulation and cataract surgery in a patient with diabetes mellitus.

A case is presented whereby a simple method of applying indirect laser during cataract surgery in the presence of retinal and iris neovascularization is described. The method involves placing an infusion cannula into the anterior chamber following standard phacoemulsification and soft lens matter removal. The main section is then sutured and indirect laser is delivered to the far retinal periphery with gentle manipulation of the eye. Successful delivery of indirect panretinal photocoagulation despite inadvertent vitreous loss in this case demonstrates the advantages of its use. Other advantages, including its use in previously vitrectomized eyes and allowing manipulation/indentation of the eye, control of bleeding, and better visualization, are discussed.

Surgical technique for anterior segment surgery in pediatric patients using 25-gauge instruments.

Many surgical techniques for the management of vitreous prolapse in the wound, secondary pupillary membrane, and congenital cataract in pediatric patients have been described. We report our experience using 25-gauge instruments and describe intraoperative and postoperative advantages.

Trypan blue to aid visualization of the vitreous during anterior segment surgery.

We describe the usefulness of intracameral injection of trypan blue to highlight vitreous in the anterior chamber. The technique was used in 3 eyes of 3 patients who had vitreous prolapse in the anterior chamber. Trypan blue 0.06% was injected in the anterior chamber under air to visualize and resect the prolapsed vitreous. Trypan blue stained the clear vitreous and improved visualization for a safe and atraumatic vitrectomy. No complications associated with the dye were found.

Corneal endothelial evaluation after phacoemulsification and silicone oil removal via an anterior approach.

PURPOSE: To determine the effect of simultaneous phacoemulsification and silicone oil removal via an anterior approach on the endothelial cell density (ECD). METHODS: In this prospective study, the authors measured the ECD before and 6 weeks after surgery using an automatic noncontact specular endothelial microscope. Nine patients underwent phacoemulsification and silicone oil removal via an anterior approach using a closed system and separation of irrigation/aspiration function. RESULTS: Of nine patients, four (five eyes) were diabetic and five (five eyes) were nondiabetic. The postoperative ECD of the entire population was statistically different (P<0.01) from baseline and the average endothelial cell loss was 6.7%. CONCLUSIONS: Combined phacoemulsification and silicone oil removal via an anterior approach using a close system and separation of irrigation/aspiration function is safe to the corneal endothelium.