AUTOLOGOUS RETINA TRANSPLANTATION FOR TREATMENT OF REFRACTORY DOUBLE FULL-THICKNESS MACULAR HOLE IN ALPORT SYNDROME.

PURPOSE: To report the structural and functional outcomes of autologous neurosensory retinal transplantation for closure of refractory double full-thickness macular hole in a patient diagnosed with Alport syndrome. METHODS: Patient with previous pars plana vitrectomy and a failed macular hole surgery (internal limiting membrane removal) underwent pars plana vitrectomy and autologous neurosensory retinal flap transplantation with silicone oil tamponade. Follow-up was performed after one year. The anatomic outcomes were evaluated mainly by fundus examination, optical coherence tomography (OCT), and microperimetry (MAIA). The functional changes were evaluated comparing best-corrected visual acuities preoperative and 1 year after surgery. RESULTS: A 35-year-old man with progressive visual loss of two years of evolution presented a double full-thickness macular hole in the left eye. After retinal flap transplantation, the macular hole appeared successfully closed during the entire follow-up. Integration of both retinal flaps into the surrounding retina and regeneration of the external retinal layers were observed in optical coherence tomography. Best-corrected visual acuities improved from 20/200 preoperatively to 20/80 one-year postoperatively. CONCLUSION: Pars plana vitrectomy combined with autologous neurosensory retinal flap transplantation is an effective option to achieve the anatomic closure of recurrent double full-thickness macular hole and significant visual recovery in Alport syndrome.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

Intraocular pressure after myopic laser refractive surgery measured with a new Goldmann convex prism: correlations with GAT and ORA.

BACKGROUND: The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). METHODS: Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. RESULTS: Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703-0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: - 0.185 - 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = - 0.266, 95% CI: - 3.896 - 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: - 0.332 - 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182). CONCLUSIONS: Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy.

Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma.

PURPOSE: To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). METHODS: Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. RESULTS: After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. CONCLUSION: We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences.

New applanation tonometer for myopic patients after laser refractive surgery.

This study assesses the agreement between intraocular pressure (IOP) measurements taken with the Goldmann applanation tonometer (GAT) and a new experimental applanation tonometer with a convexly shaped apex (CT) after laser myopic refractive surgery. Two different CT radii (CT1 and CT2) were designed with a finite element analyser, and a prospective double masked study on 102 eyes from 102 patients was carried out. A Bland-Altman plot and intra-class correlation coefficient (ICC) were calculated to assess the agreement between GAT measurements and the measurements of both CT1 and CT2 before and after myopic laser assisted in situ keratomileusis (LASIK; n = 73) and photorefractive keratectomy (PRK; n = 29). We evaluated a subset of two subgroups (n = 36 each) for intra and inter-observer (IA/IE) error. From the whole cohort, the best IOP agreement was observed between GATpre and CT1post surgery: 16.09 ± 2.92 vs 16.42 ± 2.87 (p < 0.001); ICC = 0.675 (95% CI: 0.554-0.768). In the analysis of LASIK vs PRK, GATpre and CT1post showed the highest agreement, although LASIK measurements were more accurate than PRK, as the ICC = 0.718 (95% CI: 0.594-0.812) and ICC = 0.578 (95% CI: 0.182-0.795) respectively. Excellent agreement was observed for IA/IE, and there was an ICC > 0.8 (95% CI) in all cases. CT1 proved more accurate in the LASIK subgroup. In conclusion, our new version of GAT could be used with post-surgery LASIK patients as a more accurate measurement device compared to the current reference tonometer.

Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series.

PURPOSE: Purpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage. SETTING: Barraquer Institute in Barcelona, Spain. DESIGN: Retrospective study of consecutive cases. METHODS: Study of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis. RESULTS: 345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79. CONCLUSIONS: Scleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.

Long-term visual outcomes and rehabilitation in Usher syndrome type II after retinal implant Argus II.

BACKGROUND: The aim of this article is to describe visual outcomes and posterior rehabilitation of the first Usher syndrome type II (USH2) patient receiving an Argus II (®) prosthesis. CASE PRESENTATION: We present a case of a USH2 patient who underwent Argus II prosthesis surgery at the age of 53. He had hearing loss from birth and presented a very poor visual field with good light perception. He communicated through sign language translated by his interpreter, who explained all the information regarding the surgical procedure and who assisted in the posterior visual therapy. Sixteen months after surgery, the patient communicates more fluently with sign language and is able to identify letters with high contrast over 6 cm and words up to four letters. CONCLUSIONS: This is the first case described in the literature of a USH2 patient receiving an Argus II prosthesis This is an alternative treatment for USH2 patients, whose interpreters are essential in the selection process and subsequent rehabilitation after surgery.

A RESCUE THERAPY FOR PERSISTENT OPTIC DISK PIT MACULOPATHY IN PREVIOUSLY VITRECTOMIZED EYES.

PURPOSE: To report the results of vitrectomy with platelet-rich plasma (PRP) application and gas tamponade as a rescue therapy in previously vitrectomized eyes with optic disk pit (ODP) maculopathy. METHODS: Three patients with visual loss due to persistent or recurrent ODP maculopathy who had undergone previous vitrectomy were offered application of PRP. Platelet-rich plasma was obtained by centrifugation of a blood sample from each patient. Surgery consisted of vitrectomy and internal limiting membrane peeling if the membrane had not been already removed (in two eyes). After fluid/air exchange, three drops of PRP were applied on the ODP followed by 8% C3F8 tamponade. Immediately after surgery, the patient remained supine for 30 minutes and then kept a face-down position for 2 weeks. RESULTS: Optic disk pit maculopathy improved as soon as two weeks after surgery and resolved in all eyes between six and eight months after PRP application. Patients were followed up for three years, with no recurrences. Visual acuity remained stable in one eye and improved in two eyes. CONCLUSION: Vitrectomy with PRP application may be useful as a rescue therapy in patients with refractory ODP maculopathy. Platelet-rich plasma may act by promoting the closure of the communication between the vitreous and the intraretinal/subretinal space at the pit. This treatment may avoid potentially harmful maneuvers that have been used to treat ODP maculopathy.

RESULTS OF RETINAL DETACHMENT SURGERY IN EYES WITH OSTEO-KERATOPROSTHESIS.

PURPOSE: To evaluate the anatomical and functional results of pars plana vitrectomy in eyes with osteo-keratoprosthesis, who have suffered retinal detachment. METHODS: An observational, retrospective study of 18 eyes which underwent pars plana vitrectomy for retinal detachment after an implantation of an osteo-keratoprosthesis, with a minimum of 1-year follow-up. A descriptive study and a Kaplan-Meier survival analysis for anatomical and functional success were performed. Anatomical success was defined as an attached retina at the end of vitreoretinal surgery with no redetachment during the follow-up. Functional success was defined as a postoperative visual acuity of more than or equal to 20/400. RESULTS: The overall rate of anatomical success was 56%, and the anatomical survival rates were 67% and 53% at 6 months and 12 months, respectively, maintaining this last value at 24 months after pars plana vitrectomy. The overall rate of functional success was 17%, and the functional survival rates were 83%, 39%, and 14% at 6 months, 12 months, and 24 months after pars plana vitrectomy, respectively. The most frequent complication after retinal surgery was retroprosthetic membrane (33%). CONCLUSION: Despite the reserved prognosis and the severe complications, vitrectomy represents a valid method for treating retinal detachment in patients with osteo-keratoprosthesis, with good anatomical results but poor visual acuity.

Macular edema is a rare finding in untreated vitreoretinal lymphoma: small case series and review of the literature.

BACKGROUND: To determine the occurrence of macular edema (ME) in vitreoretinal lymphoma (VRL). METHODS: Retrospective analysis of 17 patients (31 eyes) with VRL. A review of the literature was done as well. RESULTS: Nine patients (15 eyes) had fluorescein angiography and/or optical coherence tomography at presentation. In the ME group (six eyes of four patients), three patients (five eyes) had prior chemotherapy and radiation. Excluding eyes with radiation retinopathy (three eyes), rate of ME was 25% (3/12). When two unirradiated fellow eyes of eyes with radiation retinopathy were also excluded, ME rate was 10% (1/10). Excluding the eyes with intraocular surgery, the rate of ME was 0%. In the group without ME (nine eyes of six patients), one patient (one eye) was treated with chemotherapy and radiation and three patients (five eyes) with chemotherapy. Review of the literature showed that the ME was found between 2 and 60% of cases, but most of the cases with ME had prior interventions. CONCLUSIONS: Macular edema in VRL is not uncommon but usually related to prior interventions. Macular edema as an initial presentation of VRL is rare.

Internal limiting membrane translocation for refractory macular holes.

BACKGROUND/AIMS: Closure is more difficult to achieve in macular holes that remain open following a previous unsuccessful pars plana vitrectomy (PPV). We present our results with the internal limiting membrane (ILM) translocation technique that is used to optimise outcomes in refractory macular holes. METHODS: A prospective, interventional, case series was conducted. 12 eyes of 12 consecutive patients with incomplete sealing of the macular hole (open and type 2 closure) after a previous PPV with ILM peeling were included. Measured baseline parameters included best-corrected visual acuity (BCVA) and macular hole smallest diameter, base diameter and height. Surgeries were performed by harvesting a fragment of the ILM near the vascular arcades and subsequently placing it inside the hole. Postoperative measured outcomes included macular hole status, foveal contour, outer retina integrity, BCVA and surgery-related complications. RESULTS: Anatomic closure occurred in 11 of 12 eyes (91%). This technique elicited a statistically significant improvement in BCVA (p=0.008). Mean BCVA was 20/400 at study baseline and 20/160 at final follow-up. However, less than 16.7% of cases had a final BCVA of ≥20/63. CONCLUSION: The ILM translocation technique seems to facilitate persistent idiopathic macular hole closure, where primary surgery with PPV and ILM peeling failed.

USE OF FIBEROPTIC-GUIDED CO2 LASER IN THE TREATMENT OF UVEAL EFFUSION.

BACKGROUND/PURPOSE: To report a new technique for treating patients with uveal effusion syndrome by the fiberoptic-guided CO2 laser. METHODS: Interventional case report. A 74-year-old man presented with exudative detachment of the choroid secondary to uveal effusion syndrome. Partial-thickness sclerotomy and full-thickness sclerotomy were performed to treat the disease using a fiberoptic-guided CO2 laser. RESULTS: After the surgery, the patient's visual acuity improved and choroidal folds disappeared. CONCLUSION: This technique allows concomitant coagulation and cutting, thereby reducing the risk of bleeding and providing better depth control.

Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit.

PURPOSE: To evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP). METHODS: We performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid-air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation. RESULTS: Preoperatively, the median BCVA was 0.70 (range: 0.30-1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07-0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2-8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12-144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded. CONCLUSION: For macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results.

Scleral Fixation of Posteriorly Dislocated Intraocular Lenses by 23-Gauge Vitrectomy without Anterior Segment Approach.

Background. To evaluate visual outcomes, corneal changes, intraocular lens (IOL) stability, and complications after repositioning posteriorly dislocated IOLs and sulcus fixation with polyester sutures. Design. Prospective consecutive case series. Setting. Institut Universitari Barraquer. Participants. 25 eyes of 25 patients with posteriorly dislocated IOL. Methods. The patients underwent 23-gauge vitrectomy via the sulcus to rescue dislocated IOLs and fix them to the scleral wall with a previously looped nonabsorbable polyester suture. Main Outcome Measures. Best corrected visual acuity (BCVA) LogMAR, corneal astigmatism, endothelial cell count, IOL stability, and postoperative complications. Results. Mean follow-up time was 18.8 ± 10.9 months. Mean surgery time was 33 ± 2 minutes. Mean BCVA improved from 0.30 ± 0.48 before surgery to 0.18 ± 0.60 (p = 0.015) at 1 month, which persisted to 12 months (0.18 ± 0.60). Neither corneal astigmatism nor endothelial cell count showed alterations 1 year after surgery. Complications included IOL subluxation in 1 eye (4%), vitreous hemorrhage in 2 eyes (8%), transient hypotony in 2 eyes (8%), and cystic macular edema in 1 eye (4%). No patients presented retinal detachment. Conclusion. This surgical technique proved successful in the management of dislocated IOL. Functional results were good and the complications were easily resolved.

Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes.

BACKGROUND: Hypotony maculopathy (HM) changes may persist, and visual acuity remains poor, despite normalization of intraocular pressure (IOP). The aim of this study was to evaluate the visual and anatomical results of pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, and 20% SF6 gas tamponade in five myopic patients with HM. METHODS: This retrospective interventional study was conducted at the Barraquer Center of Ophthalmology, a tertiary care center in Barcelona, Spain, and included five eyes from five consecutive patients (aged 55.4±13.1 years) with HM caused by different conditions. All the patients were treated with 23-gauge PPV, ILM peeling, and 20% SF6 gas tamponade. Preoperative and postoperative evaluation was performed using anterior and posterior biomicroscopy and best corrected visual acuity (BCVA) by logMAR charts. RESULTS: Before surgery, median spherical equivalent was -13.1 (range -7, -19) diopters of myopia. Preoperatively, four cases presented IOP <6.5 mmHg for 3 (range 2-8) weeks. In three of these four cases, IOP >6.5 mmHg was achieved over 16 (range 16-28) weeks, without resolution of HM; increased IOP was not achieved in the remaining case treated 2 weeks after diagnosis of HM. One case presented IOP >6.5 mmHg with HM for 28 weeks before surgery. Preoperative BCVA was 0.7 (range 0.26-2.3) logMAR, and 0.6 (range 0.3-0.7) logMAR and 0.5 (range 0.2-1) logMAR, respectively, at 4 and 12 months after surgery. There was no statistically significant difference between preoperative and postoperative BCVA. Hyper-pigmentation lines in the macular area were observed in three cases with hypotony. These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases. CONCLUSION: PPV with ILM peeling followed by gas tamponade is a good alternative for the treatment of HM in myopic patients. However, persistent choroidal folds may compromise BCVA. We therefore recommend initiating treatment as early as possible.

Neovascular glaucoma treatment with extraction of anterior chamber fibrovascular tissue.

The use of antibody to vascular endothelial growth factor to treat neovascular glaucoma yields good anatomic results in most cases. However, this type of glaucoma can cause angle closure with decompensation of intraocular pressure secondary to fibrovascular tissue contraction in the anterior chamber. Our surgical technique treats the cause by removing the anterior chamber fibrous complex after administration of antibody to vascular endothelial growth factor, thus restoring the chamber angle.

Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to pars plana vitrectomy for proliferative diabetic retinopathy.

PURPOSE: To evaluate the results of surgery with pars plana vitrectomy (PPV), endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana as treatment of recurrent vitreous hemorrhage secondary to PPV for proliferative diabetic retinopathy (PDR). METHODS: Tertiary care center, Barraquer Center of Ophthalmology, Barcelona, Spain. Prospective interventional study of 14 eyes of 14 consecutive patients aged 20 years to 47 years with recurrent vitreous hemorrhage because of sclerotomy site neovascularization secondary to PPV for PDR. All patients were treated by cataract, or transparent lens, extraction with intraocular lens implantation plus 20-gauge PPV of the vitreous base, including incarcerated vitreous of the sclerotomy site, together with endodiathermy of sclerotomy site fibrovascular tissue and adjuvant photocoagulation to the pars plana. Preoperative evaluation was performed by 20-MHz, high-resolution, anterior-segment ultrasonography of the neovascularized sclerotomy sites, pre- and postoperative visual acuity (logarithm of the minimum angle of resolution), and postoperative rebleeding rates. RESULTS: Recurrent vitreous hemorrhage appeared 8 ± 4 months after the initial PPV for PDR. Ten (71%) patients had isolated vascularization of a single sclerotomy site and 4 (29%) had vascularization of 2 sclerotomy sites. Nine of the 18 vascularized sites (50%) corresponded to optical fiber sclerotomies, 7 (39%) to vitreotome, and 2 (11%) to infusion sclerotomies. All the neovascularized sclerotomies presented sentinel vessels in the anterior segment. No patient showed postoperative recurrent vitreous hemorrhage during follow-up of 23 ± 10 months; all showed improved visual acuity, from initial 2.23 (±1.13 standard deviation) to final 0.23 (±0.09 standard deviation). CONCLUSION: According to our study, the technique of choice for the treatment of recurrent vitreous hemorrhage secondary to PPV for PDR is endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana. This technique treats the etiology of the problem, improves final best-corrected visual acuity, and, most importantly, helps prevent recurrent bleeding.

Intraretinal cyst secondary to longstanding retinal detachment.

PURPOSE: To describe the diagnosis and management of an intraretinal cyst. CASE REPORT: A 34-year-old man with a history of retinal detachment presented sudden loss of vision in the left eye. Visual acuity was hand movement. Examination revealed hematic vitreous haze and ultrasound showed a rounded mobile object in the vitreous cavity. RESULTS: After differential diagnosis ruled out cysticercosis, pars plana vitrectomy revealed a neovascularized intraretinal macrocyst attached to a posterior flap of a 13-year-old retinal tear. Retinotomy and retinectomy were performed, removing this cyst located in the upper retina together with a portion of detached retina. At 1 year, the retina had adapted and the vitreous cavity was clear. Final visual acuity was 18/20. CONCLUSIONS: Intraretinal cysts are usually asymptomatic and associated with long-standing retinal detachment, as seen in our clinical case. Periodic fundus examination is essential for their detection. Surgical treatment of the underlying condition usually leads to complete resolution.

Vitrectomy without face-down posturing for idiopathic macular holes.

PURPOSE: To report the results of vitrectomy with internal limiting membrane peeling and C3F8 tamponade for macular hole without postoperative face-down posturing in 208 eyes. METHODS: The study included 208 eyes on an uncontrolled retrospective review, undergoing pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and C3F8 tamponade, without subsequent face-down posturing. All patients were followed-up at 1 day, 1 week, 3 months, and 12 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 1 day, 1 week, 3 months, and 12 months postoperatively. Pre- and postoperative visual acuity by Snellen chart was compared. RESULTS: In 208 eyes with idiopathic macular hole, preoperative mean visual acuity was 20/200 and final visual acuity was 20/40 (P = 0.00017). Anatomic macular hole closure rate was 81.3%. CONCLUSION: In agreement with published studies, combined phacovitrectomy without face-down posturing after macular hole surgery seems effective and safe, showing anatomical improvement and favorable best-corrected visual acuity. Isolating the macula from vitreous fluid with a large long-lasting gas-fill may render postoperative posturing unnecessary. Eliminating face-down posturing may increase patient acceptance and compliance.

Temporal branch retinal vein occlusion secondary to a racemose hemangioma.

PURPOSE: To describe a case of venous thrombosis secondary to unilateral racemose hemangioma (RH). METHODS: Biomicroscopic examination, fluorescein angiography, and optical coherence tomography were used. The patient was a 12-year-old girl who was seen for progressive loss of visual acuity in the left eye. RESULTS: Examination revealed venous thrombosis in the superior temporal vein area in the context of arteriovenous malformation (AVM). Treatment with intravitreal triamcinolone (4 mg) resulted in anatomic and functional improvement. CONCLUSION: This was an exceptional case of branch retinal vein occlusion secondary to RH in a girl without known risk factors for venous obstruction. The obstruction was attributable to the large-caliber superior temporal artery, which, on forming a loop in the region of the venous branch, produced an obstruction of venous branch blood flow.