Efficacy of vitrectomy and internal limiting membrane removal for macular edema associated with branch retinal vein occlusion.

AIM: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling to that without ILM peeling for macular edema associated with branch retinal vein occlusion (BRVO). METHODS: The medical records of 47 eyes of 47 patients with BRVO-associated macular edema were examined. To treat the macular edema, a posterior vitreous detachment (PVD) was created, and the ILM was removed in 13 eyes (ILM-removed group), whereas a PVD was created and the ILM was not removed in 34 eyes (ILM-preserved group). The best-corrected visual acuity (BCVA) and the optical-coherence-tomography-determined foveal thickness were obtained preoperatively and at 6 months postoperatively. RESULTS: The mean postoperative BCVA was significantly better than the preoperative BCVA in both the ILM-removed and in the ILM-preserved groups (p = 0.0017 and p = 0.0002, respectively). The fovea was significantly thinner at 1 month after surgery in both groups (p = 0.0007 and p < 0.0001, respectively). The postoperative improvement of the mean BCVA and the foveal thickness were not significantly different for the two groups at any postoperative period. CONCLUSIONS: Because there was no significant difference in the improvement of BCVA between the two groups at 6 months postoperatively, there may be no additional benefit in removing the ILM for BRVO-associated macular edema.

Vitrectomy alone versus vitrectomy with simultaneous intravitreal injection of triamcinolone for macular edema associated with branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of vitrectomy with simultaneous intravitreal injection of triamcinolone acetonide for macular edema associated with branch retinal vein occlusion. PATIENTS AND METHODS: A retrospective study of 45 eyes with macular edema associated with branch retinal vein occlusion. A posterior vitreous detachment was created and the vitreous cortex was completely removed, after which 23 eyes immediately had an intravitreal injection of triamcinolone acetonide (triamcinolone acetonide group) and 22 eyes did not (no triamcinolone acetonide group). Visual acuity, fluorescein angiograms, and foveal thickness determined by optical coherence tomography were examined preoperatively and postoperatively. RESULTS: Mean postoperative visual acuity at 12 months was significantly better than the preoperative visual acuity in both groups. The fovea was significantly thinner 1 month postoperatively in both groups. Foveal thickness gradually decreased until 12 months in the no triamcinolone acetonide group; however, foveal thickness increased for 12 months in the triamcinolone acetonide group. A recurrence of macular edema was more frequent in the triamcinolone acetonide group than in the no triamcinolone acetonide group (P = .006). CONCLUSIONS: Because there was no significant difference in the improvement of best-corrected visual acuity between the groups 12 months postoperatively, there may be no benefit in the use of intraoperative intravitreal triamcinolone acetonide.

Central retinal artery occlusion after radial optic neurotomy in a patient with central retinal vein occlusion.

PURPOSE: To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. DESIGN: Interventional case report. METHODS: A 70-year-old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. RESULTS: Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. CONCLUSIONS: Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy, which is an unproven surgical procedure with a questionable pathophysiologic mechanism.

Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion.

PURPOSE: compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. RESULTS: The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups (P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. CONCLUSIONS: Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

Correlation of visual recovery and presence of photoreceptor inner/outer segment junction in optical coherence images after successful macular hole repair.

PURPOSE: To determine the relationship between the postoperative visual acuity (VA) and the presence of a photoreceptor inner segment (IS) and outer segment (OS) junction (IS/OS) in optical coherence tomographic (OCT) images after macular hole (MH) surgery. METHODS: Twenty-three eyes of 23 cases of idiopathic MH treated by vitrectomy were studied. The postoperative VA and OCT3 images of the fovea at 1, 3, and 6 months were examined. The relationship between the presence of the IS/OS junction and the visual acuity was studied. RESULTS: All MHs were successfully closed. The IS/OS junction appeared as a distinct, highly reflective line just vitread to the retinal pigment epithelial layer in the postoperative OCT3 images. A normal IS/OS junction was detected postoperatively in one eye at 1 month, three eyes at 3 months, and seven eyes at 6 months. The VA was significantly better in eyes in which a normal IS/OS junction was detected than in those not detected at 3 and 6 months postoperatively (P = 0.046 and P = 0.040, respectively). CONCLUSION: The normal IS/OS junction observed in OCT3 images is associated with good visual recovery after MH closure. The presence of normal IS/OS junction may be important for visual recovery after MH repair.

Changes of electroretinogram without improvement of retinal circulation after radial optic neurotomy for central retinal vein occlusion. ERG changes after RON for CRVO.

PURPOSE: To evaluate the efficacy of radial optic neurotomy (RON) on retinal function in patients with central retinal vein occlusion (CRVO). METHODS: Ten eyes of 10 patients with CRVO underwent pars plana vitrectomy and RON. Standardized combined electroretinograms (ERGs) to full-field bright-flash stimuli were recorded preoperatively and, 3 months postoperatively. The best-corrected visual acuity and foveal thickness were also determined, before and 3 months postoperatively. RESULTS: The mean best-corrected visual acuity and mean foveal thickness were both significantly improved after vitrectomy and RON. The mean amplitudes of a- and b-waves did not change significantly, but the mean b/a wave ratio was increased significantly after vitrectomy and RON. An improvement of the b/a ratio was observed in six eyes, however, an improvement of retinal circulation was confirmed on postoperative fluorescein angiograms in two of these six eyes. CONCLUSIONS: Significant improvements were observed in the b/a wave ratio of the standard combined ERGs after surgery in eyes with CRVO. The improvement of retinal function was most likely due to improved oxygenation of retina caused by vitrectomy and not by RON.

Changes in multifocal oscillatory potentials after internal limiting membrane removal for macular hole: multifocal OPs after ILM removal.

PURPOSE: To determine whether removal of the internal limiting membrane (ILM) during macular hole (MH) surgery alters the retinal function. METHODS: Multifocal electroretinograms (mfERGs) were recorded preoperatively and 3 months after surgery from 11 eyes of 10 patients with an idiopathic MH treated successfully by pars plana vitrectomy accompanied by ILM removal. A low frequency (9.4 Hz) pseudorandom binary m-sequence stimulus was used to elicit the mfERGs from different retinal loci. The bandpass of the amplifier was set at 10-300 Hz to record the mfERGs and at 100-300 Hz to record the oscillatory potentials (OPs). RESULTS: An anatomical closure of the MH was achieved in all patients, and the mean visual acuity was significantly improved postoperatively. No significant difference was observed in both the amplitudes and implicit times of the negative and positive waves of the mfERGs and the OPs recorded preoperatively to those recorded postoperatively. CONCLUSIONS: MH surgery with ILM removal does not alter the electrophysiological function of both the outer and inner retina of the posterior pole where the ILM was removed.

Early postoperative macular morphology and functional outcomes after successful macular hole surgery.

PURPOSE: To investigate the relationship between early postoperative macular morphology and postoperative visual acuity in eyes that had undergone successful macular hole (MH) surgery. METHODS: Pars plana vitrectomy and internal limiting membrane peeling were performed during surgery for idiopathic MHs on 25 eyes. The macular configuration was determined by optical coherence tomography, and best-corrected VA (BCVA) was measured postoperatively. RESULTS: Eleven eyes had nearly normal foveal morphology (normal group) and 14 eyes had subretinal fluid or intraretinal cysts (abnormal group) at 1 month. Among the 14 eyes in the abnormal morphology group, normal foveal morphology was confirmed in 9 eyes 3 months and in the remaining 5 eyes 6 months after surgery. Mean BCVA improved significantly from the preoperative values in both groups 6 months after surgery. CONCLUSIONS: The morphology of the macular area was abnormal in more than one half of eyes that had successful MH surgery 1 month after surgery. However, by 6 months, all eyes had normal macular configuration, and BCVA was not significantly different in the two groups. We conclude that an abnormal morphologic appearance of the macular area in the early postoperative period does not predict the final visual outcome.

Morphological and functional changes of the macula after vitrectomy and creation of posterior vitreous detachment in eyes with diabetic macular edema.

The purpose of this study was to determine the morphological and functional changes in the macula after pars plana vitrectomy with the creation of a posterior vitreous detachment in eyes with diabetic macular edema (DME). A simple posterior vitreous detachment was created during pars plana vitrectomy accompanied by simultaneous cataract surgery in 19 eyes of 17 patients with DME. The visual acuity (log MAR units), multifocal electroretinograms (mfERGs), and optical coherence tomographically (OCT)-determined foveal thickness were determined preoperatively and at 6 months postoperatively. The median preoperative log MAR visual acuity was 0.7 (20/100; range, 0.3-1.1), and it improved significantly to 0.4 (20/50; range, 0.15-1.0) postoperatively (p = 0.016). The median foveal thickness was 510 (range, 194-800) microm preoperatively and was significantly reduced to 201 (range, 60-631) microm postoperatively (p =0.0002). The median of response density of the mfERGs in the macular area was 6.3 nV/ deg2 (range, 2.8-14.8) preoperatively, and 6.1 nV/deg2 (range, 2.4-14.3) postoperatively, a non-significant change (p = 0.27). The median of peak latency of the macular response was 30.0 ms (range, 25.0-44.2) preoperatively and it decreased significantly to 28.3 ms (range, 26.7-35.0) postoperatively (p = 0.003). In conclusion, vitrectomy with the creation of a PVD in eyes with DME improved the visual acuity and foveal thickness significantly. In addition, a decrease of the peak latency of the macular mfERGs suggested an improvement of the physiological function of the macula although the amplitude of the mfERGs was not changed significantly.