Vitreoretinal interface abnormalities in fellow eyes of patients with a macular hole.

Objectives: This study aimed to determine the incidence of bilateral macular holes (MHs), and to investigate the incidence and characteristics of retinal abnormalities in the fellow eyes, using high-definition optical coherence tomography (OCT). Methods: Medical records from 724 consecutive patients diagnosed with full-thickness MHs, who underwent surgery at Fujita Health University Hospital from May 2015 to March 2022, were retrospectively reviewed. Based on the exclusion criteria, 658 patients with idiopathic MHs were included. B-scan OCT images of the fellow eyes were used to identify vitreoretinal interface abnormalities, such as MHs, epiretinal membranes (ERMs), vitreomacular traction syndrome (VMTS) and lamellar macular holes (LMHs). Results: The mean age of the patients was 65.9±9.0 years. There were 292 males (44.4%) and 366 females (55.6%). There were 39 fellow eyes with MHs (5.9%), 77 with ERMs (11.7%), 32 with VMTS (4.9%) and 11 with LMHs (1.7%). Thirty-four fellow eyes (5.2%) could not be classified and 469 fellow eyes were normal (71.3%). Furthermore, the 39 bilateral MHs were divided into four stages according to the Gass classification, as follows: stage 1, 32 eyes (82.1%); stage 2, none (0%); stage 3, 5 eyes (12.8%); and stage 4, 2 eyes (5.1%). Conclusions: Vitreoretinal interface abnormalities, such as MHs, ERMs, VMTS and LMHs, are more common in the fellow eyes of patients with MHs than in the healthy population. The fellow eyes of patients with MHs should be carefully followed using OCT.

Comparison of ocular morphological measurement by wide-angle echography and magnetic resonance imaging.

Objectives: To compare the eye axial length (AL), equatorial horizontal diameter (HD), and equatorial vertical diameter (VD) of normal eyes using a novel wide-angle, arc-scanning, ultrasound diagnostic device for wide-angle B-mode echography. Methods: In this cross-sectional study, wide-angle B-mode echography and magnetic resonance imaging (MRI) were conducted on 22 normal eyes; the AL, HD, and VD were measured. Results: The mean ALs were as follows: wide-angle B-mode echography, 25.22±1.47 mm and MRI, 25.24±1.46 mm; a significant correlation was observed between the two measurements (ß=0.995 [0.976, 1.013]; p<0.001; 95% R2=1.00). The mean HDs were as follows: wide-angle B-mode echography, 22.33±0.84 mm and MRI, 22.55±0.90 mm; a significant correlation was observed between the two measurements (ß=0.902 [0.750, 1.179]; p<0.001; 95% R2=0.81). The mean VDs were as follows: wide-angle B-mode echography, 22.77±0.91 mm; and MRI, 22.88±0.92 mm; a significant correlation was observed between the two measurements (ß=0.966 [0.853, 1.097]; p<0.001; 95% R2=0.93). Conclusions: There were no significant differences in the measurements for each parameter by wide-angle B-mode echography and MRI. Therefore, wide-angle B-mode echography permits accurate visualization of ocular morphology.

MACULAR MORPHOLOGY AFTER MACULAR HOLE SURGERY USING THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE.

PURPOSE: To investigate the influence of an excess inverted internal limiting membrane (ILM) flap that covers the fovea in idiopathic macular hole surgery on postoperative visual acuity and macular morphology. METHODS: This retrospective study included 66 patients with an idiopathic macular hole who underwent vitrectomy using the inverted ILM flap technique. They were divided into three groups: normal morphology (N), detached ILM (D), or ILM proliferation (P) in the parafoveal area. They were followed up for at least 6 months, and their best-corrected visual acuity, central retinal thickness, and parafoveal retinal thickness were measured. RESULTS: There were no significant differences in preoperative or postoperative mean best-corrected visual acuities or postoperative CRTs among the groups. The postoperative inferior parafoveal retinal thicknesses were 319.2 ± 38.0, 377.1 ± 60.6, and 373.1 ± 67.3 µ m in the N, D, and P groups, respectively (P vs. D group, P = 0.963; P vs. N group, P = 0.008; N vs. D group, P = 0.004). CONCLUSION: Regardless of the postoperative morphology of the inverted ILM flap, there was no effect on postoperative best-corrected visual acuity or CRT.

Modified inverted internal limiting membrane flap technique for macular hole closure.

PURPOSE: To investigate the efficacy of modified internal limiting membrane (ILM) flap technique combined with vitreous surgery for treating macular holes and examine the outcomes in visual function and anatomic macular hole closure. STUDY DESIGN: Retrospective, observational. METHODS: Between July 1, 2015, and October 1, 2019, the modified inverted ILM flap technique combined with vitreous surgery was used to treat idiopathic macular holes, postoperative progression was then followed for at least 6 months in 96 participants (98 eyes). We modified the method by removing the lower half of the ILM while peeling and inverting the upper half. The mean age of the participants was 65.9 ± 11.9 years (41 men (42.7%) and 55 women (57.3%)). Retrospective evaluations of macular hole diameter, corrected visual acuity, and macular hole closure rates were performed using data from medical records. RESULTS: The mean macular hole diameter was 623.6 ± 207.4 µm. The mean corrected visual acuity (logMAR) was 0.79 ± 0.27 before surgery and 0.46 ± 0.35 at 1, 0.35 ± 0.39 at 3, and 0.31 ± 0.36 at 6 months Post surgery, showing significant differences before and after surgery (p = 2.30 × 10- 2). The macular hole closure rate was 98%. CONCLUSION: The modified inverted ILM flap technique combined with vitreous surgery was an effective method for treating macular holes, resulting in improvement in closure and visual acuity.

Risk factors for epiretinal membrane surgery after initial pars plana vitrectomy for rhegmatogenous retinal detachment.

OBJECTIVES: The purpose of this study was to examine the incidence of, and risk factors for, epiretinal membrane (ERM) surgery after an initial pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). METHODS: The records of consecutive patients (3,495 eyes of 3,387 patients) who underwent RRD repair at Fujita Health University Hospital between January 1, 2008, and February 28, 2019, were retrospectively reviewed. A total of 1,736 eyes without an ERM in preoperative optical coherence tomography were included in this study. RESULTS: The incidence of ERM surgery after RRD repair was 2.4%. The mean time from RRD repair to ERM surgery was 19.5±27.2 months. The odds ratios after adjusting for age and sex were as follows: the preoperative visual acuity (logarithm of the minimum angle of resolution, logMAR), 2.17 (p=0.02; 95% confidence interval [CI], 1.11-5.16); axial length, 1.38 (p=0.002; 95% CI, 1.12-1.72); 20-gauge vitreous surgery instruments, 3.82 (p<0.0001; 95% CI, 2.02-7.16); internal limiting membrane (ILM) peeling, 0.28 (p=0.033; 95% CI, 0.05-0.92). ERM surgery improved visual acuity from 0.36 to 0.01 logMAR, even at ≥1.5 years after RRD repair. CONCLUSIONS: Careful follow-up is required in the following cases: long axial length before RRD repair, low visual acuity, use of 20-gauge vitreous surgery instruments, and a lack of ILM peeling.

Asymmetric extent of distortion measured using the Watzke-Allen Test in patients with macular hole.

Visual dysfunction in patients with macular hole is believed to occur because of cone cell displacement, often measured by the Watzke-Allen test (WAT). However, it is unknown if the horizontal and vertical measurements recorded by WAT reflect the true extent of photoreceptor displacement. This study aimed to measure the extent of photoreceptor displacement in patients with macular hole using WAT and compare the displacement value with the hole diameter measured by optical coherence tomography (OCT). This prospective, observational study at a single tertiary referral center included 43 patients with macular hole. WAT thresholds were assessed for their ability to detect macular hole. The slit was presented vertically and horizontally, and the brightness of the monitor screen was 180 cd/m2. Horizontal and vertical WAT thresholds for distortion were measured. Correlations and performance evaluations were assessed by Pearson's correlation analysis and Wilcoxon rank-sum test, respectively, between WAT threshold values and hole diameters. Horizontal and vertical WAT thresholds and diameters were compared using paired t-tests. The mean vertical WAT threshold (1.95° ± 0.87°) was significantly higher than the mean horizontal threshold (1.71° ± 0.73°; P < 0.0001). The mean minimum horizontal hole diameter (303.42 ± 111.16 mm; visual angle, 1.01°) was significantly greater than the mean minimum vertical diameter (264.12 ± 107.88 mm; visual angle, 0.88°; P = 0.0149). The minimum vertical and horizontal macular hole diameters were positively correlated with the vertical and horizontal WAT threshold values (r = 0.514, P < 0.01; r = 0.447, P < 0.01, respectively). The WAT threshold values were greater than the respective minimum macular hole diameters, indicative of cone cells displacement over an area larger than that of the hole. The difference in the extent of vertical and horizontal distortions suggests asymmetric hole formation. Hence, WAT threshold values may help evaluate visual function in patients with macular hole.

Comparison of microscopic illumination between a three-dimensional heads-up system and eyepiece in cataract surgery.

INTRODUCTION: The ability to reduce illumination levels is generally accepted as one of the main benefits of a three-dimensional heads-up system (3D system: Ngenuity®; Alcon, CA, USA). Some studies have focused on illumination reduction in vitreoretinal procedures; however, information regarding illumination reduction in cataract surgery has not been published. PURPOSE: This study aimed to compare the illumination of the operational field with a 3D system and a standard microscope eyepiece during cataract surgery. SUBJECT AND METHODS: We retrospectively evaluated 91 eyes of 84 consecutive patients who were undergoing cataract surgery at our hospital. We used the 3D system and the eyepiece on alternative days. We determined the minimum light intensity required for safe surgery using the foot switch of the microscope (OMS800; Topcon, Tokyo, Japan). Illuminance on the ocular surface and the minimum illuminance required for the operation were calculated from the minimum light intensity. RESULTS: The 3D system was used in 45 eyes (3D group), and the eyepiece was used in 46 eyes (eyepiece group). The values of minimum illuminance in the 3D group were significantly lower than those in the eyepiece group (3D: 5500 ± 2000 lux, eyepiece: 11,900 ± 1800 lux; p < 0.001*). In addition, the illuminance of the operational field was reduced by 60.4% on average using the 3D system. CONCLUSION: With real-time digital processing and automated brightness control, the 3D system reduced ocular surface illumination by 50% or more. Hence, the 3D system may contribute to reducing the risk of retinal phototoxicity and patient photophobia.

The influence of mild cataract on ISCEV standard electroretinogram recorded from mydriatic eyes.

PURPOSE: To investigate the effect of mild cataract and its surgery on the ISCEV standard electroretinogram (ERG) by comparing pre- and postoperative ERGs elicited from fully dilated eyes. METHODS: Twenty-two patients participated. Each eye had cataract of grade 2 according to Emery-Little classification. None had complications during and after phacoemulsification and intraocular lens implantation. According to the ISCEV standard, pre- and 1-week postoperative full-field ERGs, dark adapted (DA) 0.01, DA 3, DA 3 oscillatory potentials (OPs), DA 10, and light adapted (LA) 3, and LA 3 flicker, were elicited from fully dilated eyes using skin electrodes. Photopic negative response (PhNR) 1 amplitude was measured from the baseline to the trough before the i-wave in the LA 3 ERG waveform. Statistical analysis was performed using SigmaPlot version 11.0 (Systat Software, Inc., San Jose, CA, USA). Pre- and postoperative data were compared using a paired t-test. Non-normally distributed data were evaluated using the Wilcoxon signed rank test. RESULTS: The pre- and 1-week postoperative amplitudes in each component were as follows: DA 0.01: 48.4 ± 19.5 µV and 57.1 ± 20.0 µV (p = 0.002), a-wave of DA3: 51.5 ± 14.8 µV and 58.3 ± 17.3 µV (p = 0.003), b-wave of DA3: 88.3 ± 27.5 µV and 101.5 ± 29.7 µV (p = 0.003), DA 3 ΣOPs (sum of DA 3 OP1, OP2, and OP3 amplitude): 30.7 ± 16.3 µV and 37.1 ± 21.9 µV (p < 0.001), a-wave of DA 10: 65.5 ± 18.8 µV and 74.2 ± 19.5 µV (p < 0.001), b-wave of DA 10: 95.5 ± 29.6 µV and 111.1 ± 29.9 µV (p < 0.001), a-wave of LA 3: 7.2 ± 2.6 µV and 8.2 ± 2.2 µV (p = 0.025), b-wave of LA 3: 30.6 ± 12.9 µV and 35.3 ± 12.7 µV (p = 0.003), PhNR1: 5.8 ± 2.5 µV and 5.5 ± 2.6 µV (p = 0.562), and LA 3 flicker: 25.4 ± 8.9 µV and 27.8 ± 8.6 µV (p = 0.039), respectively. The implicit time of all the components did not reveal significant differences before and after surgery. CONCLUSIONS: Cataractous lens removal and intraocular lens implantation may influence ISCEV standard ERGs, even if the cataract is relatively mild.

Comparison of analgesia and akinesia between sub-Tenon's capsule anesthesia and trans-Tenon's capsule retrobulbar anesthesia in vitrectomy.

OBJECTIVES: We compared the effects of sub-Tenon's capsule anesthesia (STA) and trans-Tenon's capsule retrobulbar anesthesia (TTRBA) in 68 patients with epiretinal membrane. METHODS: Either STA or TTRBA was induced with 3 mL of lidocaine (2%) before vitrectomy combined with phacoemulsification and aspiration (phacovitrectomy). Akinesia was evaluated by range of eye movement (ROEM) in upward, downward, nasal, and temporal directions at 4, 10, and 30 minutes after injection. Analgesia was evaluated with a visual analogue pain score, which ranged from 0 to 10. RESULTS: The mean cumulative ROEMs were 1.44±1.02 corneal diameters (CDs) at 4 minutes, 0.55±0.76 CDs at 10 minutes, and 0.26±0.33 CDs at 30 minutes in patients who received STA; these values were 0.39±0.35 CDs at 4 minutes, 0.22±0.30 CDs at 10 minutes, and 0.13±0.29 CDs at 30 minutes in patients who received TTRBA. At both 4 and 10 minutes, the cumulative ROEMs in all directions, as well as the temporal ROEMs, were significantly larger in patients who received STA than in patients who received TTRBA. Pain scores did not significantly differ between groups at any time point. CONCLUSIONS: STA and TTRBA produced identical degrees of analgesia, but akinesia was slower in patients who received STA. TTRBA might be preferable for patients undergoing brief vitrectomy.

The effect of age on full-field electroretinograms recorded with skin electrodes.

OBJECTIVES: The aim of this study was to determine whether age correlates with amplitude and latency, when full-field electroretinography (ERG) is performed using skin electrodes. The ability of pulse reference power line noise reduction (PURE) to dampen the noise associated with the use of skin electrodes, was also investigated. METHODS: ERG was performed on 77 eyes in 77 healthy subjects (mean age: 55.6±19.0 years; age range: 9 to 86 years). Subjects with -5D or higher myopia, Emery-Little grade III or higher cataracts, retinal disease, uveitis, glaucoma, ≤5 mm mydriasis, or a history of intraocular surgery other than cataract surgery, were excluded. The active, reference, and ground electrodes were placed on the lower eyelid, outer canthus, and earlobe, respectively. Responses were averaged 10 times for dark-adapted (DA) ERGs, and 32 to 64 times for light-adapted (LA) ERGs. Noise was removed using the PURE method. RESULTS: The DA ERGs without PURE were so noisy that the amplitude or latency could not be determined, whereas those with PURE were comparatively quieter. ERG with PURE demonstrated a significant negative correlation between age and amplitude and a significant positive correlation between age and latency. CONCLUSIONS: We could record the measurable ERG waveforms with skin electrodes by using the PURE method, especially in fewer averaged conditions. It is suggested that skin electrode with PURE is suitable to examine the pathological ERGs, and other types of electrodes. It is recommended that the aging effect should be taken into consideration when pathological ERGs are evaluated.

Visualization of the posterior surface of the lens nucleus with triamcinolone acetonide in phacoemulsification.

PURPOSE: We report a novel technique for visualizing the posterior surface of the lens nucleus during phacoemulsification. SURGICAL TECHNIQUE: Hydro-dissection was performed using a solution of 20 mg triamcinolone acetonide powder without preservatives mixed with 3 ml BSS-plus, and triamcinolone acetonide was clearly identifiable underneath the posterior surface of the lens nucleus. Using a phaco-tip, the nucleus was shaved to the level of the triamcinolone acetonide and could be easily divided. The remnant triamcinolone acetonide was aspirated as much as possible from the lens cortex with an infusion/aspiration tip. SUBJECTS AND EVALUATION TECHNIQUE: Twenty-eight eyes in 28 patients with cataracts were enrolled in this study. Triamcinolone acetonide-assisted phacoemulsification was performed in 13 eyes in 13 patients (triamcinolone acetonide-phacoemulsification group), and normal phacoemulsification was performed in 15 eyes in 15 patients (phacoemulsification group). Intraocular pressure was measured in all patients pre-operatively, 1 day after, and 1 week after surgery. Corneal endothelial cell density was measured pre-operatively and 1 month after surgery. The time of surgical phacoemulsification (surgical phaco time) was measured from the video of the surgery. RESULTS: Surgery was successively performed in all eyes. Pre-operative and post-operative intraocular pressures and cell densities did not significantly differ between the two groups. Surgical phaco time was shorter in the triamcinolone acetonide-phacoemulsification group than in the phacoemulsification group (157.1 ± 51.7 s vs 225.3 ± 45.1 s; p = 0.006). CONCLUSION: The triamcinolone acetonide-assisted phacoemulsification procedure is safe and useful for visualizing the posterior surface of the lens nucleus and facilitates removal of the lens nucleus by phacoemulsification.

Measurement of the volume of the vitrectomized space during vitrectomy in myopic patients with retinal detachment.

PURPOSE: We present a novel technique for measuring volume of space replaced by air during fluid-air exchange in vitrectomy (vitrectomized space) for intravitreal gas injection. To confirm the feasibility of this technique, we assessed postoperative intraocular pressure (IOP) and the duration of injected gas. Using this technique, we found remarkable differences in volume between high myopic eyes with retinal detachment caused by peripheral break (PB-RD group) and those with macular hole retinal detachment (MH-RD group). We studied the relationships between the volume and biometric values, axial length (AL) and corneal curvature radius (CCR) in both PB-RD and MH-RD group. STUDY DESIGN: Retrospective study. METHODS: During fluid-air exchange, the aspirated fluid accumulates in the measuring cup between the infusion needle and vitrectomy instrument. Vitrectomized space volume is obtained by subtracting the volume of the tube between the infusion needle and the 3-way stopcock from the aspirated fluid volume. We performed phaco-vitrectomies by measuring the vitrectomized space volume and then injected pure SF6 at 15% of the volume into the vitreous cavity in 156 myopic eyes (AL > 26 mm) with RD consisting of 144 eyes in PB-RD group and 12 in MH-group. RESULTS: The IOP (mean ± SD) was 13.5 ± 3.4 mmHg preoperatively, 23.4 ± 10.4 mmHg on day 1, 18.2 ± 7.4 mmHg on day 2, and 16.1 ± 4.5 on day 7. The gas disappeared in 16.1 ± 1.9 days. Axial length was longer in the MH-RD group but the volume of vitrectomized space was larger in the PB-RD group. AL and volume were significantly correlated in both groups (P < 0.01), but the fitting lines differed. The CCR and volume significantly correlated in the PB-RD group (P < 0.01) but not in the MH-RD group. CONCLUSION: Our novel technique for measuring the volume of vitrectomized space can achieve target gas concentration in the vitreous cavity. The difference in the shape of eyeballs may explain discrepancies in relationship between volume and the biometric factors.

Adherence to face-down and non-supine positioning after macular hole surgery.

BACKGROUND: This study aimed to investigate patient adherence to face-down positioning (FDP) and non-supine positioning (NSP) following vitrectomy with gas tamponade for treating macular holes (MHs). METHODS: Nursing records of 92 patients who underwent vitrectomy with gas tamponade for small-diameter (diameter < 400 µm) MHs during April 2016-June 2017 were examined. Forty-seven and 45 patients were instructed to maintain FDP and NSP (FDP and NSP groups), respectively. Patient adherence was evaluated seven times a day for 3 days, and the adherence rate was calculated. RESULTS: The mean adherence rate was significantly higher in the NSP group (99.3% ± 2.7%) than in the FDP group (93.7% ± 13.3%; P < 0.001, Mann-Whitney U test). Forty-one patients (91.1%) in the NSP group had an adherence rate of 100%, which was significantly higher than that in the 24 patients in the FDP group (51.1%; P < 0.001, chi-squared test). No statistically significant difference was observed between the patients in the two groups regarding sex, age, MH diameter, and pre- and postoperative visual acuities. MH closure was achieved in all patients. CONCLUSIONS: Almost half of the patients in the FDP group did not obtain 100% adherence rate, suggesting that patient adherence was largely compromised. Patient adherence was better in the NSP group as patient compliance to NSP was better, however, 8.9% of patients were found in face-up positioning at least once. Incompleteness of patient adherence was common, although to differing degrees.

Adherence to the face-down positioning after vitrectomy and gas tamponade: a time series analysis.

OBJECTIVE: To determine the adherence to the face-down positioning (FDP) in 296 patients who had undergone vitrectomy and gas tamponade. RESULTS: We studied 119 female and 177 male patients who had undergone primary vitrectomy and gas tamponade for a macular hole (MH) or for rhegmatogenous retinal detachments (RRDs). Adherence was assessed and recorded four times per day for 3 days postsurgery. The mean ± standard deviation adherence rate was 88.3 ± 11.7 (range 50.0-100.0). Female patients (90.8 ± 10.0) had significantly better adherence than male patients (86.7 ± 13.3; P < 0.02, U test). The adherence was significantly better after MH surgery (90.8 ± 11.7) than after RRD surgery (87.5 ± 12.5; P < 0.02). There were diurnal variations in adherence, being highest in the evening and significantly lower at midnight, and we evidenced a decline in adherence over time, with it being significantly low on the last follow-up day. Adherence to the FDP varied considerably among patients. Adherence was higher in female than in male patients, and higher in patients with MH than in those with RRD. We found patients age had no effect on adherence. Adherence also varied with time, being worst at midnight and declining over time.

Patient adherence to the face-down positioning after macular hole surgery.

PURPOSE: To determine adherence to face-down positioning (FDP) among patients who underwent vitrectomy and gas tamponade for macular hole (MH) repair. METHOD: A total of 69 patients (37 females and 32 males) who underwent primary vitrectomy for MH repair were studied. Nurses recorded whether the patient complied with FDP each time they examined the patient. FDP score was obtained from the nursing records; patients were given a score of 1 if they complied with the FDP and 0 if they did not. The score was recorded four times per day for the first 3 postoperative days. A perfect FDP score was 12. RESULTS: The mean ± standard deviation of the FDP scores was 10.6±1.8 (range: 4-12). Overall, 32 (46.4%) patients scored a perfect 12, and 7 (10.1%) patients scored <8. Failure of the MH closure was observed in only one patient (1.4%), who showed the poorest adherence to FDP (score =4). Consequently, the closure rate in patients with FDP score <7 (2/3, 66.7%) was significantly lower than in patients with an FDP score ≥7 (66/66, 100%) (P<0.05, Fisher's exact probability test). CONCLUSION: While adherence to FDP after MH surgery was better than that observed after vitrectomy for rhegmatogenous retinal detachments in our previous study, the percentage of patients with FDP scores <8 did not differ. Statistically, the poor adherence to FDP can negatively impact the effectiveness of the surgery for MH repair.

The Effect of an Inverted Internal Limiting Membrane Flap on Retinal Function after Macular Hole Surgery.

PURPOSE: To study the effect of an inverted internal limiting membrane (ILM) flap on the retina. DESIGN: Prospective case series. PARTICIPANTS: Twenty-nine patients with large (>400 µm) unilateral macular holes underwent surgery using a modified inverted ILM flap technique. METHODS: The macular ILM was peeled, and a large (2-3 disc diameter) ILM flap was made on the superior side of the hole, and then the flap was inverted on the inferior side. MAIN OUTCOME MEASURES: In all patients, multifocal electroretinograms (mfERGs) were recorded from operated eyes and normal fellow eyes. The peak time and amplitude of N1, P1, and N2 in the focal ERG from the upper retina without the ILM flap and those from the lower retina with the ILM flap were evaluated. In 14 patients, microperimetry was also performed in both eyes, and the averaged sensitivity was measured from the upper and lower areas. RESULTS: The peak times of P1 and N2 from the upper and lower retina were significantly longer in operated eyes than in the fellow eyes (P1 upper and lower: P < 0.04, N2 upper: P < 0.01, and N2 lower: P < 0.04), although we could not identify a significant difference in peak time and amplitude of N1, P1, and N2 between the upper retina and lower retina in both eyes (fellow eye-N1 amplitude: P > 0.2, N1 peak time: P > 0.5, P1 amplitude: P > 0.9, P1 peak time: P > 0.4, N2 amplitude: P > 0.9, N2 peak time: P > 0.9; operated eye-N1 amplitude: P > 0.8, N1 peak time: P > 0.4, P1 amplitude: P > 0.6, P1 peak time: P > 0.4, N2 amplitude: P > 0.9, N2 peak time: P > 0.9). We could not observe a significant difference in sensitivity between the upper and lower retinas in both eyes (fellow eye: P = 0.28, operated eye: P = 0.66). CONCLUSIONS: The results of this study revealed no significant difference between the upper retina without the ILM flap and the lower retina with the ILM flap, suggesting that an inverted ILM flap has little effect on retinal function.

Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report.

BACKGROUND: Iridocorneal endothelial (ICE) syndrome occurs mainly in young and middle-aged women and typically presents as a unilateral disease characterized by abnormalities of the iris and corneal endothelium. While the ICE syndrome is known to be associated with glaucoma and bullous keratopathy, to our knowledge, only two cases of ICE syndrome complicated with cystoid macular edema (CME) have been reported to date. In this paper, we report a case of ICE syndrome complicated with CME treated at our institution. CASE PRESENTATION: The subject was a 51-year-old woman. In October 2013, she was examined by a primary care physician for blurred vision in her left eye. Dyscoria and abnormality of the corneal endothelium were observed, and the patient was diagnosed with ICE syndrome. In November of the same year, she was referred to our institution with a decrease in visual acuity and CME, both in her left eye. At initial examination, her best corrected decimal visual acuity was 1.0 (Snellen equivalent: 20/20) in the right eye and 0.5 (20/40) in the left eye. Intraocular pressure was 12 mmHg in both eyes. She was diagnosed with Cogan-Reese syndrome based on marked ectropion uveae, peripheral anterior synechia, and abnormalities of the corneal endothelium. Marked CME was observed on ophthalmoscopy and optical coherence tomography. A topical non-steroidal anti-inflammatory drug (nepafenac 0.1 %) was applied to the left eye four times daily from January 2014. Four weeks later, the CME had resolved and her visual acuity was 1.0 (20/20). CONCLUSION: While non-steroidal anti-inflammatory drugs and steroids did not appear to be effective in two previously reported cases of ICE syndrome complicated with CME, topical nepafenac was effective in this case. However, more such cases are needed before concluding that topical nepafenac is effective in this situation.

COMPLIANCE WITH THE FACE-DOWN POSITIONING AFTER VITRECTOMY AND GAS TAMPONADE FOR RHEGMATOGENOUS RETINAL DETACHMENTS.

PURPOSE: To determine the compliance with the face-down positioning (FDP) of the patients who had undergone vitrectomy and gas tamponade. METHODS: One hundred and twenty-seven patients, 45 females and 82 males, who had undergone primary vitrectomy and gas tamponade for rhegmatogenous retinal detachments were studied. The FDP score was determined as 4 per day for 3 days after the surgery. The patient was given a score of one if the nurse found that the patient was in the FDP and zero if not in the FDP. A perfect FDP score was 12. RESULTS: The mean ± SD FDP score was 10.2 ± 1.8 with a range of 3 to 12. Females (10.7 ± 1.2) scored significantly higher than males (9.9 ± 2.1) (Mann-Whitney U test: P < 0.05). Patients who scored a perfect 12 were 38 (29.9%; female, 14:31.1%; male 24:29.3%). Low scorers <8 were all males (12:14.6%) and no females (0:0.0%). Age did not seem to be related. Only 1 patient failed to achieve retinal attachment, although she had scored a perfect 12. CONCLUSION: The compliance was considerably varied among patients. Some patients failed nearly or more than half times, and they were mostly males. The significance of the FDP to treat rhegmatogenous retinal detachment needs to be examined in a further investigation.