Pound-shape Silicone Oil Retention Suture in Aphakic Eyes With Intact Iris.

PURPOSE: To introduce a surgical technique, "pound-shape silicone oil retention suture in aphakic eye with intact iris." METHODS: A retrospective analysis of medical records was performed. Each patient had an aphakic eye with intact iris and received the pound-shape silicone oil retention suture during vitrectomy combined with silicone oil injection. RESULTS: In the four patients who received the pound-shape silicone oil retention suture, the silicone oil was confined behind the suture for 3 months to 7 months without prolapse into the anterior chamber. Increased intraocular pressure was not observed in any patient, although peripheral iridectomy was not performed. CONCLUSION: Pound-shape silicone oil retention suture is a simple and effective surgical technique to prevent silicone oil prolapse into the anterior chamber.

Retinal Pigment Epithelium Tears after Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this study was to assess the visual prognostic factors of retinal pigment epithelium (RPE) tears and describe their clinical features. METHODS: The medical records of treatment-naive neovascular age-related macular degeneration patients who received intravitreal anti-vascular endothelial growth factor (VEGF) injections were retrospectively reviewed. RESULTS: The incidence of RPE tears was 1.36% (10 out of 733 eyes). The type of anti-VEGF agent administered did not affect the incidence (p = 0.985). The median best-corrected visual acuity (BCVA) of 10 patients decreased after an RPE tear (0.4-0.6 logarithm of the minimum angle of resolution [logMAR]); however, subsequent injections restored the BCVA to a level similar to that before the RPE tear (0.4 logMAR, p = 0.436). Central macular thickness improved significantly during the study (794.4-491.9 µm, p = 0.013). The final BCVA was positively correlated with the BCVA before and immediately after the RPE tear (p = 0.025 and 0.002, respectively) and was weakly correlated with foveal involvement of the RPE tear (p = 0.061). CONCLUSION: The incidence of RPE tears did not differ according to the type of anti-VEGF agent. The final BCVA was proportional to the BCVA before and after RPE tears. Continuous treatment with anti-VEGF after the occurrence of RPE tears can benefit the final visual acuity and macular anatomy.

INTRAOCULAR LENS MALPOSITION AFTER SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENS.

PURPOSE: To introduce cases of intraocular lens (IOL) malposition after sutureless intrascleral fixation. METHODS: We retrospectively analyzed the medical records of patients who underwent sutureless intrascleral fixation. Cases with postoperative IOL requiring reoperation were analyzed further. RESULTS: Of the 48 eyes that underwent sutureless intrascleral fixation of their IOL, seven eyes had postoperative IOL malposition and underwent reoperation (14.6%). There was no difference in the clinical results between the intravitreal (33 eyes) and intracameral (15 eyes) techniques, but IOL malposition requiring reoperation was more frequent in the latter (2 cases [6.1%] vs. 5 cases [33.3%], P = 0.024). In the 7 eyes that required reoperation, the visual acuity before reoperation was 0.9 ± 0.6 logMAR (20/159), whereas astigmatism was -4.8 ± 3.2 diopters. The visual acuity and cylindrical error improved to 0.1 ± 0.2 logMAR (20/25) and -2.4 ± 2.3 diopters, respectively, at 6 months after the secondary operation. CONCLUSION: In 14.6% of the patients who underwent sutureless intrascleral fixation of the IOL, IOL malposition developed and reoperation was performed. With the intravitreal technique, which uses a wider space than the intracameral technique, the frequency of postoperative IOL malposition could be reduced.

Clinical Characteristics Associated with the Development of Cystoid Macular Edema in Patients with Cytomegalovirus Retinitis.

We evaluated the incidence and characteristics of eyes with cytomegalovirus (CMV) retinitis according to the occurrence of cystoid macular edema (CME) and identified the risk factors of its occurrence. Patients diagnosed with CMV retinitis and examined using optical coherence tomography were classified according to the development of CME. The CME group was further divided according to the presence of active retinitis at the time of CME development. The demographics, serologic findings, ophthalmic presentations, ocular treatments, and visual prognosis were compared. CME was identified in 25 eyes (17 eyes with active retinitis and 8 eyes with inactive retinitis) out of the 67 eyes with CMV retinitis. Visual acuity was worse in the CME group than in the non-CME group. The CME group had longer CMV viremia duration, zone 1 involvement, and larger extent of CMV retinitis. While CME with concurrent active retinitis developed in eyes with direct foveal involvement of retinitis in the acute phase and required more ganciclovir injections after CME development, CME without active retinitis developed in eyes with larger extents of involvement and more intravitreal ganciclovir injections before CME development. Zone 1 involvement and longer CMV viremia duration were independently associated with the occurrence of CME. CME, which caused visual deterioration, developed in considerable patients with CMV retinitis and had different characteristics according to the presence of active retinitis.

Comparison of the effect of air tamponade versus no tamponade after pars plana vitrectomy for idiopathic epiretinal membrane.

This study aimed to compare the surgical outcomes of pars plana vitrectomy (PPV) with and without air tamponade in patients with idiopathic epiretinal membrane (iERM). We prospectively enrolled 145 patients with iERM who underwent a 25-gauge transconjunctival sutureless PPV. Patients were assigned to either the air tamponade (air) group (79 eyes) or balanced salt solution (BSS; no tamponade) group (66 eyes). The central macular thickness (CMT), peripapillary retinal nerve fiber layer (pRNFL) thickness, and best-corrected visual acuity (BCVA) were compared for two years. At baseline, there were no significant differences between the two groups. CMT and BCVA were not significantly different between the groups for 2 years. However, the air group had a significantly lower thickness in the superior temporal pRNFL sector at 1 month (p = 0.01) and in the inferior temporal and superior temporal pRNFL sectors at 3 months (p = 0.02 for both). There were no significant differences between both groups in all the pRNFL sectors from 6 months to 2 years. The outcomes of PPV with air tamponade and that with no tamponade appear to be equivalent. This shows that air tamponade may not be an imperative procedure for iERM surgery and has no additional benefit.

COMPARISON OF SCLERAL FIXATION OF INTRAOCULAR LENS: Sutureless Intrascleral Fixation Versus Conventional Sutured Scleral Fixation.

PURPOSE: To compare the clinical outcomes of sutured scleral and sutureless intrascleral fixations of the intraocular lens. METHODS: Medical records of patients who underwent sutureless intrascleral fixation (sutureless group) and the conventional sutured scleral fixation (sutured group) were retrospectively reviewed. Patient demographics and the clinical outcomes of the two techniques were compared before and 1, 3, and 6 months after surgery. RESULTS: Seventy patients were followed up for 6 months after the surgery: 25 patients in the sutureless group (25 eyes) and 45 in the sutured group (45 eyes). Surgery time was shorter in the sutureless group than that in the sutured group (73.00 ± 15.68 vs. 107.39 ± 25.30 minutes, P < 0.001). The visual acuity gradually improved throughout the postoperative period in both groups, and a faster visual acuity recovery was observed in the sutureless group. The cylindrical error at 6 months after the surgery was significantly lower in the sutureless group than that in the sutured group (-1.33 ± 0.55 vs. -2.29 ± 1.19 diopter, P < 0.001). CONCLUSION: Sutureless intrascleral fixation is an effective and reliable surgical technique that provides more favorable visual and refractive outcomes than the conventional sutured scleral fixation method.

Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation.

PURPOSE: To investigate and compare the clinical features of cytomegalovirus (CMV) retinitis after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and to determine the poor prognostic factors. METHODS: Patients consulted to the ophthalmology department for CMV viremia after transplantation between March 2008 and February 2018 and followed for more than 6 months were analyzed. Medical records regarding demographic, serologic, and ocular characteristics were compared between the SOT and HSCT groups. Factors associated with poor visual outcomes were determined with logistic regression. RESULTS: CMV retinitis developed in 11.3% of patients with CMV viremia following transplantation. In the SOT group (25 eyes/18 patients) and the HSCT group (33 eyes/21 patients), CMV retinitis occurred at 5.8 months and 3.7 months post-transplantation, respectively. Mortality was significantly higher in the HSCT group (52.4% vs. 5.6%, P < 0.001). During the mean 11.7 months of follow-up, visual acuity tended to be aggravated (P = 0.087) despite antiviral treatment, which was especially notable in the SOT group (P = 0.028). Six eyes (10.3%) underwent vitrectomy due to retinal detachment, most of which (5 eyes) were in the SOT group. Multivariate logistic regression analysis showed that the presence of concurrent CMV disease (OR = 14.11, P = 0.009) and foveal involvement (OR = 114.85, P = 0.001) were poor prognostic factors. CONCLUSION: Clinical manifestations of CMV retinitis differed between the HSCT and SOT group. Concurrent CMV diseases and foveal involvement were associated with poor visual outcomes in CMV retinitis following transplantation.

COMBINED VITRECTOMY WITH INTRAVITREAL DEXAMETHASONE IMPLANT FOR REFRACTORY MACULAR EDEMA SECONDARY TO DIABETIC RETINOPATHY, RETINAL VEIN OCCLUSION, AND NONINFECTIOUS POSTERIOR UVEITIS.

PURPOSE: To compare the efficacy of intraoperative intravitreal dexamethasone implant for macular edema secondary to diabetic retinopathy (DME), retinal vein occlusion (RVO), and noninfectious posterior uveitis. METHODS: A retrospective review of 62 patients (29 men and 33 women; mean age 51.19 ± 14.41 years; 65 eyes) was performed. Best-corrected visual acuity (in logarithm of the minimal angle of resolution), central foveal thickness, intraocular pressure, and postoperative edema-free period were postoperatively assessed up to 1 year. The preoperative and postoperative numbers of other intravitreal injections needed were compared. RESULTS: Best-corrected visual acuity gradually improved in the DME group (from 0.87 to 0.51) but failed to improve from Month 3 onward in the RVO and uveitis groups. Central foveal thickness decreased in all groups, especially in the DME group (from 550.93 to 338.10 µm). Edema-free period was longest in the DME group (19.34 ± 15.12 months), followed by the uveitis (12.91 ± 7.85 months) and RVO (8.50 ± 8.76 months) groups. Subjects in the uveitis group used more intraocular pressure-lowering agents (1.00 ± 1.27) than those in the DME (0.13 ± 0.49) and RVO (0.36 ± 0.79) groups. Increased intraocular pressure events were most frequent in postoperative Week 1, especially in the uveitis group. CONCLUSION: Vitrectomy combined with intravitreal dexamethasone implant for DME, RVO, and noninfectious posterior uveitis had a favorable clinical outcome.

Epiretinal Proliferation Associated with Lamellar Hole or Macular Hole: Origin and Surgical Prognosis.

PURPOSE: To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after vitrectomy. METHODS: This is a retrospective observational case review of 17 eyes with EP that underwent vitrectomy, EP dissection, and internal limiting membrane peeling between January 2013 and December 2016. Surgical specimens of EP tissue were successfully obtained from 5 cases and they were analyzed after immunohistochemical staining. Postoperative outcomes, including best-corrected visual acuity (BCVA) and macular configuration in spectral domain-optical coherence tomography, were reviewed. RESULTS: Mean BCVA improved from 0.54 ± 0.36 logarithms of the minimum angle of resolution preoperatively to 0.32 ± 0.38 logarithms of the minimum angle of resolution postoperatively (p = 0.002). BCVA improved in 13 eyes and remained unchanged in four eyes. No cases experienced vision decline after surgery. All 17 patients' lamellar hole or macular hole were successfully closed. Despite hole closure, ellipsoid zone defects were not corrected in 11 of the 17 patients. In immunohistochemical analyses, anti-glial fibrillary acidic protein and pan-keratin (AE1/AE3) were positive, but synaptophysin, anti-α-smooth muscle actin, and anti-CD68 were negative. CONCLUSIONS: The epiretinal proliferative membrane seems to originate from Müller cells, not from the vitreous. It is unclear whether retinal pigment epithelia also contribute to EP formation. Gentle handling and preservation of the epiretinal proliferative tissue is crucial for successful surgical outcomes.

Possible Risk Factors and Clinical Effects of Opaque Bubble Layer in Small Incision Lenticule Extraction (SMILE).

PURPOSE: To report the development of an opaque bubble layer (OBL) during small incision lenticule extraction (SMILE) and analyze its potential risk factors and the clinical outcome. METHODS: A retrospective review of medical records was performed. The patients were divided into two groups in terms of OBL area following a posterior lenticule cut: OBL less than 5% of cornea and OBL greater than 5% of cornea. Preoperative parameters and clinical outcomes were compared. The association between amount of OBL and the various parameters was determined using a correlation analysis. RESULTS: The study included 208 myopic eyes (106 patients). The incidence of OBL was 51.82% (108 eyes) and mean OBL area was 3.06% ± 4.62%. The OBL greater than 5% group (48 eyes, 23.08%) had a thicker cornea, a thinner lenticule, and a longer operation time than the OBL less than 5% group (160 eyes, 72.92%). Visual acuity, efficacy, and safety were similar between groups except for a slightly lower predictability value for the OBL greater than 5% group. The amount of OBL area presented a quantitative association with corneal thickness, lenticule thickness, and the relative vertical position of the posterior lenticular surface. Flap tear was observed in 8 eyes (3.84%), at which an extensive amount of OBL (9.76% ± 7.02%) developed. CONCLUSIONS: Eyes with a thicker cornea or a thinner lenticule are more likely to develop OBL during SMILE. The OBL does not affect the overall clinical outcome. In eyes with extensive OBL, there is a higher incidence of flap tear and a lower predictability value. [J Refract Surg. 2017;33(1):24-29.].