Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report.

BACKGROUND: Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure. CASE PRESENTATION: A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later. CONCLUSION: Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.

A Case of Dellen Formation following 27-Gauge Vitrectomy with Rapid Improvement by Scleral and Conjunctival Sutures.

Introduction: Dellen is a corneal disease characterized by shallow, saucer-like excavations at the corneal margin. Herein, we presented a case of dellen formation that developed following a 27-gauge pars plana vitrectomy (PPV) and was rapidly resolved using scleral and conjunctival sutures. Case Presentation: A 73-year-old woman underwent a 27-gauge PPV for the epiretinal membrane of the right eye. Intraoperatively, owing to coexisting diabetic retinopathy, the peripheral vitreous was shaved, and retinal photocoagulation was performed on the peripheral retina. The intraocular pressure (IOP) was 15 mm Hg on 1 day after the PPV and on postoperative day 4; however, on day 14, the IOP decreased to 10 mm Hg, and conjunctival bleb formation was observed. By day 18, the bleb height remained unchanged, and dellen formation was noted at the corneal periphery. Because of marked corneal thinning, conjunctival and scleral sutures were placed 20 days following the PPV. Intraoperative findings revealed leakage from the scleral wound at the trocar puncture site. The IOP increased to 20 mm Hg at 19 h following the suture, resulting in the disappearance of the bleb and dellen. Since then, the bleb or dellen did not recur. Conclusion: We encountered a case of late-onset scleral wound cleavage 2 weeks following microincision vitreous surgery, resulting in bleb and dellen formation, which was immediately managed by the scleral and conjunctiva suturing.

A rigid gas permeable contact lens discovered embedded in the upper eyelid 7 years after trauma: A case report.

INTRODUCTION: Rigid gas permeable (RGP) contact lenses implanted in the upper eyelid may remain asymptomatic. It is important to evert the upper eyelid even in the absence of definite pain. PRESENTATION OF CASE: A 74-year-old woman with a history of rheumatoid arthritis visited a local clinic because of right eye discomfort that had persisted for 5 months. Eversion of the upper eyelid revealed an embedded foreign body, and she was referred to our hospital. A transparent and smooth-surfaced foreign body was found embedded at the center of the upper eyelid conjunctiva. Additionally, fatty tissues were found behind the foreign body. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a foreign body rich in water at the same site. The foreign body was a spherical object with a diameter of 9 mm reaching as deep as the tarsus. On removal, the foreign body was identified as an RGP contact lens. On further questioning, it was discovered that the patient had lost an RGP contact lens 7 years earlier. The symptoms disappeared after removal of the foreign body. DISCUSSION: RGP contact lenses are not detected on MRI scans, but cysts around the lenses are detected, which may result in multiple detections. CT cannot differentiate a foreign body from granulation tissue. The foreign body itself or a reactive granuloma can be seen when the eyelid is everted. CONCLUSION: A contact lens embedded in the eyelid without symptoms is rare but can be detected via a detailed interview, visual examination, and diagnostic imaging.

Relationship Between Deep Retinal Macular Vessel Density and Bipolar Cell Function in Glaucomatous Eyes.

Purpose: To evaluate the correlation between macular retinal function and the changes in the macular retinal vascular structure in glaucomatous eyes. Methods: The study included patients with glaucoma who visited Saitama Medical University and underwent optical coherence tomography angiography, and multifocal electroretinographic examinations at the same time between February 2020 and April 2021. Correlations among the ocular parameters, macular vessel density, and multifocal electroretinographic parameters were evaluated using a mixed model. Results: Forty-one eyes (mean deviation, -12.4 ± 7.8 dB) of 24 subjects (mean age, 75.2 ± 8.3 years) were included in the analysis. There were no significant correlations for macular vessel density in the superficial retinal layer. However, macular vessel density in the deep retinal layer showed a significant positive correlation with P1-N1 amplitude (coefficient = 0.724; P = 0.001). There were no significant correlations between the optical coherence tomography parameters and any of the multifocal electroretinographic parameters. Conclusions: A decrease in N1-P1 amplitude was observed in glaucomatous eyes in relation to a reduction in macular vessel density in the deep retinal layer, which suggests that ischemia-induced bipolar cell dysfunction may be involved in the intermediate retinal dysfunction associated with glaucoma. Translational Relevance: Intermediate retinal dysfunction in glaucoma is related to the changes in deep retinal microvasculature.