Angulation of the inner nuclear layer as an indicator of the severity of macular pseudohole.

PURPOSE: To investigate foveal morphologic parameters related to visual acuity and the stages classified in this study reflect the severity of the macular pseudohole (MPH). METHODS: Seventy-eight eyes of 78 consecutive patients diagnosed with MPH were studied. Quantitative optical coherence tomography (OCT) parameters including central foveal thickness, parafoveal thickness, parafoveal inner and outer retinal thickness (PIRT and PORT), pseudohole depth, pseudohole diameter, and inner nuclear layer (INL) angulation were measured and the morphologic features of the inner retina (disorganization of retinal inner layers (DRIL)) and the photoreceptor layer (external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and cotton ball sign) were determined. Associations between OCT parameters and best-corrected visual acuity (BCVA) were analyzed. Based on the location of the inner margin of INL, all patients were divided into three stages and the mean comparison between the three stages was analyzed. RESULTS: PIRT (r = 0.6489; p < 0.0001) and pseudohole depth (r = 0.5266; p < 0.0001) had a statistically significant correlation with BCVA. Statistically significant visual acuity differences were found in eyes with DRIL (p < 0.001) and IZ disruption (p = 0.018), but not in ELM disruption (p = 0.916), EZ disruption (p = 0.581), and cotton ball sign (p = 0.075). According to the univariate and multivariate regression analyses, PIRT was associated with BCVA in both univariate (p < 0.001) and multivariate (p = 0.002) regression analyses. Defect diameters of both ELM (p = 0.025) and IZ (p = 0.006) were associated with BCVA in univariate regression analysis, but not in multivariate regression analysis. INL angulation and the ratio of the IZ disruption was significantly different in the three groups. Stage 3 (95.8%) had significantly higher disrupted IZ ratio than stage 1 (40%) and stage 2 (65.5%). The BCVA of stages 1, 2, and 3 were identified as 0.06 ± 0.07 (20/23 Snellen equivalent), 0.23 ± 0.17 (20/34 Snellen equivalent), and 0.48 ± 0.23 (20/60 Snellen equivalent), respectively, and the differences in BCVA between the three groups were significant (p < 0.0001). CONCLUSION: The parameters related to visual acuity were PIRT, pseudohole depth, DRIL, and IZ. The stage classification proposed in this study included morphologic changes of the inner retina and photoreceptor layer and is likely to be clinically useful for showing the severity of the MPH.

RESIDUAL VITREOUS CORTEX AT THE FOVEA DURING VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

PURPOSE: To investigate the frequency of residual cortex and the effectiveness of removal of residual cortex in the fovea during vitrectomy for primary rhegmatogenous retinal detachment repair. METHODS: We retrospectively reviewed the charts and the operative videos of the 80 patients (80 eyes) who underwent vitrectomy for repair and who were observed for more than 6 months. After triamcinolone acetonide injection, we observed residual cortex on the surface of the retina. Residual cortex was removed with a diamond-dusted scraper. After surgery, we watched for the occurrence of epiretinal membrane (ERM) for at least 6 months. We graded ERM according to the postoperative visual acuity (thin membranes that did not affect vision vs. thick membranes that reduced vision). RESULTS: Of the 80 eyes, 60 eyes (75%) showed macular residual cortex, which we removed with a scraper, and 20 eyes (25%) did not have visible cortical remnants. Postoperative ERM occurred in 30% of eyes (24/80). The rate of postoperative ERM was 35% (21/60) in eyes with residual cortex and 15% (3/20) in eyes without residual cortex (P = 0.091). In the 60 eyes with residual cortex during vitrectomy, a thin membrane occurred in 18 eyes (30%) and a thick membrane occurred in 3 eyes (5%). In the 20 eyes without residual cortex, however, a thin membrane occurred in 3 eyes (15%) and no thick membrane was found. CONCLUSION: Eyes with residual cortex have a higher rate of ERM than eyes with no residual cortex after vitrectomy for primary repair. It is uncertain whether removing the cortex reduces the rate of postoperative ERM. The residual cortex may have already started the pathogenesis of ERM, or surgical trauma may have played a role.

Change of eye position in patients with orthophoria and horizontal strabismus under general anesthesia.

We studied the relationship between eye position in the awakened state and in the surgical plane of anesthesia in orthophoric and horizontal strabismus patients. We classified 105 orthophoric and horizontal strabismus patients into 5 groups, measured the eye position at the primary position by photographic measurement of the corneal reflex positions and undertook a quantitative study of eye position. Under general anesthesia, the mean divergence was 39.7+/-8 PD for the esotropia group, 36.6+/-11.7 PD for exophoria, 27.4+/-8.1 PD for orthophoria, and 11.1+/-10.2 PD for exotropia I (< or =30 PD). Therefore, the esotropia group had the largest amount of divergence among the groups, but the eye position of the exotropia II (>30 PD) group was rather convergent at 11.0+/-6.5 PD. According to the eye position of the fixating and nonfixating eyes in the esotropia group, both eyes converged with an angle deviation of 14.4+/-4.8 PD divergent and 14.1+/-4.8 PD divergent, respectively (P=.71). In the exotropia groups (I, II), the fixating eye diverged but the nonfixating eye rather converged. Therefore, the angle deviation was 19.0+/-2.1 PD divergent for the fixating eye and 18.2+/-6.4 PD divergent for the nonfixating eye (P=.68). In conclusion, under general anesthesia, eye positions in the awakened state and in the surgical plane of anesthesia were convergent or divergent, and showed a tendency to converge into the position of 25-35 PD divergent. Therefore, we could not distinguish fixating eye from nonfixating eye under general anesthesia.