Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review.

PURPOSE: It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. METHODS: A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. RESULTS: A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. CONCLUSIONS: The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

Papillary vitreous detachment as a possible accomplice in non-arteritic anterior ischaemic optic neuropathy.

AIM: To evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal individuals. METHODS: This study included 22 acute NAION patients (25 eyes), 21 non-acute NAION patients (23 eyes) and 23 normal individuals (34 eyes). All study participants underwent swept-source optical coherence tomography to assess the vitreopapillary interface, peripapillary wrinkles and peripapillary superficial vessel protrusion. The statistical correlations between peripapillary superficial vessel protrusion measurements and NAION were analysed. Two NAION patients underwent standard pars plana vitrectomy. RESULTS: Incomplete papillary vitreous detachment was noted in all acute NAION patients. The prevalence of peripapillary wrinkles was 68% (17/25), 30% (7/23) and 0% (0/34), and the prevalence of peripapillary superficial vessel protrusion was 44% (11/25), 91% (21/23) and 0% (0/34) in the acute, non-acute NAION and control groups, respectively. The prevalence of peripapillary superficial vessel protrusion was 88.9% in the eyes without retinal nerve fibre layer thinning. Furthermore, the number of peripapillary superficial vessel protrusions in the superior quadrant was significantly higher than that in the other quadrants in eyes with NAION, consistent with the more damaged visual field defect regions. Peripapillary wrinkles and visual field defects in two patients with NAION were significantly attenuated within 1 week and 1 month after the release of vitreous connections, respectively. CONCLUSION: Peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment-related traction in NAION. Papillary vitreous detachment may play an important role in NAION pathogenesis.

[Role of vitreous in the pathogenesis of neovascular age-related macular degeneration]. / Die Rolle des Glaskörpers in der Pathogenese der exsudativen altersabhängigen Makuladegeneration.

Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA.

Impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction.

Purpose: To investigate the impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction (VMT) with or without macular holes. Methods: A retrospective search of the medical records was conducted to identify patients with VMT who underwent cataract surgery at Mass Eye and Ear from 2016 to 2021. Patient demographics, ocular comorbidities, and clinical characteristics were extracted from the record, and optical coherence tomography images were assessed to confirm VMT and the presence of a lamellar or full-thickness macular hole (FMTH). Patients who underwent vitrectomy prior to cataract surgery were excluded. Results: A total of 22 patients (15 women [68%]) met inclusion criteria (average age, 71 years). Fifteen eyes had an associated epiretinal membrane (63%), 7 had a lamellar hole (29%), and 8 had an FTMH (33%). Epiretinal membrane was present in 3 of 7 eyes with lamellar holes (43%) and 4 of 8 with a FTMH (50%). No eyes developed a complete posterior vitreous detachment following phacoemulsification. In 2 cases, there was progression of the macular hole stage following phacoemulsification. Ten eyes underwent subsequent pars plana vitrectomy (PPV). There was no statistically significant difference in visual acuity between eyes pre- and post-phacoemulsification; however, there was a statistically significant improvement in visual acuity pre- and post-PPV. Conclusions: Unlike other studies, in this case series of 24 eyes with VMT or VMT with holes, no cases of full posterior vitreous detachment occurred following unremarkable phacoemulsification or YAG capsulotomy.

SPONTANEOUS CLOSURE OF MYOPIC MACULAR HOLE TWICE WITHOUT POSTERIOR VITREOUS DETACHMENT.

PURPOSE: To present a case of a myopic macular hole that spontaneously closed twice in the presence of a broadly adherent posterior hyaloid membrane. METHODS: Case report. RESULTS: A 49-year-old man with high myopia and pseudophakia had a full-thickness macular hole in the left eye. The hole spontaneously closed in all retinal layers before the elective surgery, but the macular hole recurred one month later. The hole started sealing again spontaneously after one month, leaving a defect in the outer retinal layers. Four months later, the outer layer defect sealed and a lamellar macular hole developed. Throughout the course, the posterior hyaloid membrane remained parallel to the macular surface. The macular morphology and the patient's vision remained stationary at the 2-year follow-up. CONCLUSION: This case demonstrated that myopic macular holes can form and seal repeatedly with a broadly adherent posterior hyaloid membrane. Although bridging phenomenon was the common sign indicating the initiation of the two hole closures, different patterns of tissue regeneration ensued.

EVALUATION OF PARAVASCULAR INNER RETINAL DEFECTS USING EN FACE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To evaluate the prevalence and risk factors for development of paravascular inner retinal defects (PIRDs) using en face optical coherence tomography. METHODS: This is a retrospective cross-sectional study. En face and cross-sectional optical coherence tomography images were reviewed (9 × 9 mm or 12 × 12 mm). Paravascular inner retinal defects were classified as either Grade 1 (i.e., paravascular inner retinal cysts) when the lesion was confined within the nerve fiber layer without any communication to the vitreous cavity or Grade 2 (i.e., paravascular lamellar hole) when the defects communicated to the vitreous. Paravascular inner retinal defect grading was correlated with presence of high myopia, stage of posterior vitreous detachment, and presence of epiretinal membrane and retinoschisis. RESULTS: Of 1,074 patients (2,148 eyes), PIRDs were detected in 261 eyes with a prevalence of 261 per 2,148 eyes (12.2%) and 176 per 1,074 patients (16.4%). A total of 116 eyes (44.4%) displayed Grade 2 PIRDs while 145 eyes (55.6%) were Grade 1. In the multivariate logistic regression model, the presence of partial/complete posterior vitreous detachment, retinoschisis, and epiretinal membrane was significantly correlated with PIRDs (OR = 2.78 [1.7-4.4], P < 0.001; OR = 2.93 [1.7-5], P < 0.001; and OR = 25.9 [2.8-242.5], P < 0.001, respectively). The presence of partial/complete posterior vitreous detachment and epiretinal membrane was also significantly associated with Grade 2 PIRDs versus Grade 1 PIRDs ( P = 0.03 and P < 0.001). CONCLUSION: Our results indicate that wide-field en face optical coherence tomography facilitates the identification of PIRDs over a large area of retina with a single capture. The presence of PIRDs was significantly associated with posterior vitreous detachment, epiretinal membrane, and retinoschisis, confirming the role of vitreoretinal traction in the pathogenesis of PIRDs.

Risk Factors for the Development of Fellow Eye Horseshoe Retinal Tears Following Horseshoe Retinal Tear in the Presenting Eye.

BACKGROUND: This study investigated factors associated with fellow eye horseshoe retinal tear (HST) development in consecutive patients with a presenting eye HST. MATERIALS AND METHODS: Medical records were reviewed for patients with initial HSTs between 2015 and 2017 and 24 factors were analyzed. Logistic regression was used to assess factors associated with fellow eye HST development. RESULTS: In total, 242 patients with an HST were identified with mean follow-up of 68.3 months. Four associations with fellow eye HST development were identified: (1) presence of fellow eye lattice degeneration, (2) subsequent presenting eye HSTs, (3) fellow eye vitreous hemorrhage at presenting eye HST occurrence, (4) OCT-determined stage 3 fellow eye posterior vitreous detachment at presenting eye HST occurrence. CONCLUSION: Four clinical findings associated with fellow eye HST development following presenting eye HST were identified. These factors may be important considerations during management patients with HST. [Ophthalmic Surg Lasers Imaging Retina 2023;54:338-345.].

Presentations to eye emergency departments with flashes and floaters differ dependent on incident solar radiation.

AIM: The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye emergency department of a tertiary referral hospital (the Mater Misericordiae University Hospital) over a 3-year period. The diagnostic and clinical outcomes of F/F presentations were also analysed. METHODS: This retrospective study assessed eye casualty attendances between January 2018 and December 2020. Solar irradiation (j/cm2) at ground level was retrieved from the records of Met Eireann (Irish National Meteorological Service) via their open access records. A review of electronic patient medical records using the in-house database patient centre was carried out of all patients who attended EED of during the study timeline on the 5 'brightest' and 5 'darkest' days of each year. RESULTS: Seven hundred forty patient presentations were analysed in total. Overall, 16% (n = 119) of all patients that attended EED during the timeframe of the study presented with F/F. One hundred six patients (89%) presented with floaters, 40 patients (34%) presented with flashing lights/photopsia, and 35 patients (29%) presented with both F/F. More patients presented to EED with F/F on bright days when compared with dark days (74 vs 45, p < 0.05). Eighty-nine percent of all patients with F/F presented with monocular floaters. There were more floater presentations during bright when compared with dark days (70 vs 36, p < 0.05). More patients were diagnosed with PVD on bright days when compared with those diagnosed with PVD on dark days (43vs 15, p < 0.05). More RDs were diagnosed on dark days compared with bright days (7 vs 3, p < 0.05). CONCLUSION: This study established that F/F presentations were more likely to present during bright days when compared with dark days. The diagnosis of PVD was more common during bright days, and RDs were diagnosed significantly more frequently on dark days. Although incident solar radiation was correlated with greater floaters/PVD presentation, causation is unlikely, and the duration of PVD may have been longer in patients presenting on bright days (i.e. pseudo-sudden symptoms).

Vitreous hemorrhage - Causes, diagnosis, and management.

Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Relationship Between Paravascular Abnormalities and Choroidal Thickness in Young Highly Myopic Adults.

Purpose: The purpose of this study was to investigate the clinical characteristics of paravascular abnormalities (PVAs) and retinoschisis, and their associations with choroidal thickness (ChT) in young highly myopic (HM) adults. Methods: A total number of 645 eyes were included. Paravascular microfolds (PMs), paravascular cystoid spaces (PCs), paravascular lamellar holes (PLHs), and retinoschisis were detected using swept-source optical coherence tomography. Their associations with macular ChT and risk factors were analyzed. Results: PMs, PCs, and PLHs were detected in 203 (31.5%), 141 (21.9%), and 30 (4.7%) eyes, respectively. Retinoschisis was found in 50 (7.8%) eyes, 43 (86.0%) of which were located around the retinal vessels surrounding the optic disc. A decreasing trend of macular ChT (P < 0.001) was observed in the eyes with PMs only, with both PCs and PMs, and with PLHs, PCs, and PMs. After adjustments for age, sex, and axial length (AL), the presence of PCs, PLHs, or retinoschisis around the optic disc was negatively associated with macular ChT (all P < 0.05). Eyes with longer AL, incomplete posterior vitreous detachment (PVD), and myopic atrophic maculopathy (MAM) were more likely to have PCs (all P < 0.01) and retinoschisis around the optic disc (all P < 0.05). Conclusions: PVAs were observed in approximately one third of the young HM adults in this study. The presence of PCs, PLHs, or retinoschisis around the optic disc was associated with thinner macular ChT. Eyes with longer AL, incomplete PVD, and MAM may be at risk of developing PVAs and retinoschisis around the optic disc. Translational Relevance: PCs, PLHs, and retinoschisis around the optic disc could serve as early indicators for myopia progression.

Complications of Acute Posterior Vitreous Detachment.

PURPOSE: To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria. METHODS: The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination. MAIN OUTCOME MEASURES: Presence of RT or RRD at initial presentation or within 1 year thereafter. RESULTS: Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR, 1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR, 0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r = 0.4). CONCLUSIONS: This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD.

Evaluation of the vitreolenticular interface with intraoperative OCT.

PURPOSE: To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens (BIL) cataract cases and possibly to identify risk factors for its presence. SETTING: University Hospital of Antwerp, Belgium. DESIGN: Prospective cross-sectional study. METHODS: Patients having routine BIL cataract surgery were included. Patients with traumatic cataract, previous intraocular surgeries, YAG laser treatment, intravitreal injection, or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients' records, and their surgical videos/photographs/optical coherence tomography were evaluated. RESULTS: 99 eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between men and women was not statistically significant ( P = .55, Pearson χ 2 test). The Mann-Whitney U test for axial length was not statistically significant ( P = .38). However, it was statistically significant for age ( P < .005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ 2 (1) = 8.246, P < .005). CONCLUSIONS: The prevalence of AVD in a routine cataract population was 63%. Age was identified as a risk factor. This study model determined that the odds for AVD increase 5.3% with each year of patient age. These data allowed for better preoperative and postoperative assessment of complications. The BIL, by its mandatory primary posterior continuous curvilinear capsulorhexis, did not increase the risk for postoperative ocular complications in the posterior segment of the eye.

[Acute onset of floaters, even without flashes, is an urgent ophthalmic warning sign]. / Plotse toename van mouches volantes is een alarmsymptoom, ook zónder lichtflitsen.

Acute onset of floaters is most likely caused by a posterior vitreous detachment (PVD). A PVD can lead to a retinal tear and subsequently to a retinal detachment with permanent vision loss if left untreated. A patient who presents to a primary care physician with acute onset of floaters, in the absence flashes or visual field loss, is often referred to an ophthalmologist without urgency. In the current Dutch general practitioners standard, acute onset or increase of floaters, without flashes or visual loss, is not included as a reason for urgent referral to an ophthalmologist. Patients who present with acute onset of floaters without flashes have a 14-23% risk of having a retinal tear. Risk factors for developing a retinal tear are high myopia, trauma, cataract surgery, or a retinal tear or retinal detachment in the past medical or family history. Patients with acute onset of floaters should be triaged for urgent ophthalmologic assessment.

OCT Assistance in Identifying Retinal Breaks in Symptomatic Posterior Vitreous Detachments.

BACKGROUND AND OBJECTIVE: Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks. PATIENTS AND METHODS: Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs. RESULTS: Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively. CONCLUSION: In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.].

[Rhegmatogenous retinal detachment in young adults: Clinical characteristics and surgical outcomes]. / Décollement de rétine rhegmatogène chez l'adulte jeune : caractéristiques cliniques et résultats chirurgicaux.

PURPOSE: To report the causes, clinical features and surgical outcomes of retinal detachment (RD) in young adults. METHODS: Retrospective study of 111 eyes of 99 patients aged between 18 and 40 years, who underwent primary RD surgery between January 2011 and January 2019. All patients underwent either scleral buckling or pars plana vitrectomy. We analyzed the demographic data, characteristics of the RD, primary and final anatomic success rate and best-corrected visual acuity (BCVA) at the conclusion of follow-up. RESULTS: The mean age of the patients was 30.3±6.5 years. RD was more frequent in males, with a gender ratio of 1.8. The breaks were atrophic round holes or retinal dialysis in 49 (44.2%) cases and were associated with posterior vitreous detachment in 62 (55.8%) cases. The main etiologies were high myopia (45.0%) and trauma (9.0%). Retinal reattachment was achieved in 74 (66.5%) eyes overall with a single procedure and in 108 (97.2%) eyes with two or more procedures. The primary success rates were 69.6% (46/66 eyes) with scleral buckling and 62.2% (28/45 eyes) with vitrectomy. High myopia was a risk factor for surgical failure (P<0.01). The mean BCVA improved from 0.71±0.64 logMAR to 0.41±0.35 logMAR (P<0.01) CONCLUSION: RD in young adults differs from that in older adults in clinical features and etiology. The main causes are trauma and high myopia. The anatomic outcomes appear less favorable, with a primary reattachment rate of 66.5%. However, the functional prognosis remains satisfactory with an improvement of 3 lines of visual acuity.

Anterior vitreous detachment: risk factor for intraoperative complications during phacoemulsification.

PURPOSE: To confirm the presence of incomplete vitreolenticular adhesion via microscope-integrated intraoperative optical coherence tomography (iOCT) during cataract surgery and via diagnostic spectral-domain OCT (SD-OCT) postoperatively. SETTING: S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia. DESIGN: Prospective noninterventional single-center study. METHODS: Clinical characteristics and surgical videos of 27 patients (28 eyes) who had cataract surgery were documented. Real-time iOCT integrated into the surgical microscope was directed to view the retrolenticular anatomy at the end of the surgery. Postoperatively, SD-OCT was also performed. RESULTS: This study comprised 28 eyes of 27 patients. Berger space was identified in 21 cases (75%) intraoperatively via iOCT and in 23 cases (82%) postoperatively via stationary OCT. Depth dimensions varied from 33.5 ± 87.0 µm to 383.1 ± 226.3 µm. Hyperreflective dots and particles of different shapes and sizes were documented within Berger space in 16 cases (57%) intraoperatively and in 9 cases (32%) postoperatively. Capsular rupture occurred in 1 case due to excessive posterior capsular movement anteriorly. The posterior capsular rupture was converted into a posterior capsulorhexis, leaving the anterior hyaloid membrane intact. CONCLUSIONS: iOCT confirmed the penetration of crystalline lens microfragments, cellular material, or medical suspension (triamcinolone) into the space between the posterior lens capsule and the anterior hyaloid membrane. This occurs due to discontinuity of both lenticular zonules and Wieger ligament attachment. A Wieger ligament rupture can also allow excessive Berger space hydration during phacoemulsification leading to anterior displacement of the posterior lens capsule increasing the risk of instrument touch and posterior capsule rupture.

EPIRETINAL MEMBRANE IN EYES WITH VITREOMACULAR TRACTION.

PURPOSE: To describe the occurrence of epiretinal membrane (ERM) in eyes with vitreomacular traction and to correlate the presence of ERM with retinal structural alterations detected using spectral domain optical coherence tomography. METHODS: In this retrospective observational cross-sectional study, we collected data from 502 eyes (307 patients) with diagnosis of vitreomacular traction. The presence of ERM and retinal lesions (cystoid cavities, neuroepithelial detachment, external limiting membrane, and ellipsoid zone discontinuity) was determined by standardized grading of macular spectral domain optical coherence tomography scans. RESULTS: The occurrence of ERM in eyes with vitreomacular traction was 37.5%. The mean ± SD central foveal thickness was 411 ± 60 µm in eyes with ERM and 380 ± 148 µm in eyes without ERM (P < 0.05). The occurrence of cystoid cavities (38.3% vs. 23.2%, P < 0.05), neuroepithelial detachment (24.5% vs. 9.9%, P < 0.0001), external limiting membrane discontinuity (16.5% vs. 5.1%, P < 0.0001), and ellipsoid zone discontinuity (13.3% vs. 6.7%, P < 0.05) was higher in eyes with ERM. The mean ± SD best-corrected visual acuity was 0.45 ± 0.16 logarithm of the minimum angle of resolution (Snellen equivalent of approximately 20/50) in eyes with ERM and 0.37 ± 0.09 in eyes without ERM (Snellen equivalent of approximately 20/40, P < 0.0001). Symptoms of metamorphopsia were present in 55 of 188 eyes with ERM (29.3%) and 40 of 314 eyes without ERM (12.7%, P < 0.0001). CONCLUSION: This study reported the occurrence of ERM in eyes with vitreomacular traction and demonstrated that ERM is significantly associated with an increased occurrence of other structural changes of the neuroretina and a negative effect on quantity and quality of vision.

Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery: Two case reports.

RATIONALE: We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases. PATIENT CONCERNS AND DIAGNOSES: Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history. INTERVENTIONS: In both cases, reattachment was achieved by performing vitrectomies. OUTCOMES: These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.

THE OASIS MP-1 SUBSTUDY: Characterization of the Effect of Ocriplasmin on Microperimetry Parameters.

PURPOSE: To evaluate the effects of ocriplasmin and symptomatic vitreomacular adhesion resolution on visual fixation and macular sensitivity using microperimetry. METHODS: MP-1 parameters were analyzed from 3 OASIS sites after the use of standardized instruments and testing procedures over 24 months. RESULTS: A total of 27 patients (19 ocriplasmin, 8 sham) were evaluated. Mean distance of the preferred fixation locus to the anatomical center was farther in the sham group at baseline and farther in the sham versus ocriplasmin group throughout the study. Retinal sensitivity values were consistently higher in the ocriplasmin versus sham group after Month 3. Fewer patients in the ocriplasmin group had predominantly eccentric fixation at study end compared with the sham group, which also had an increased number of patients with unstable fixation. Patients with vitreomacular adhesion resolution had lower bivariate contour area, fewer relative scotomas, and higher retinal sensitivity parameters at baseline than those with unresolved vitreomacular adhesion. CONCLUSION: Substudy results suggest that fixation and sensitivity parameters tended to be better in the ocriplasmin group than in the sham group over time. The substudy identified parameters that were distinct between patients with and without vitreomacular adhesion resolution, suggesting that microperimetry warrants further study as a relevant biomarker for visual function.

LINCOFF RULES ARE NOT FOLLOWED IN RETINAL DETACHMENT WITH POSTERIOR BREAKS AND ATTACHED CORTICAL VITREOUS.

PURPOSE: 1) To evaluate factors governing flow of subretinal fluid and validate Lincoff rules (LRs) in cases of rhegmatogenous retinal detachment. 2) To identify cases of rhegmatogenous retinal detachment where LRs are not followed. METHOD: This was a retrospective study where 253 patients of rhegmatogenous retinal detachment were identified through surgery records. Two hundred and twenty-nine case sheets with complete record of ocular examination and surgical findings were analyzed. Seventy-five of the 229 patients, having subtotal rhegmatogenous retinal detachment where LR could be applied were included for analysis. Validity of LR was analyzed about location of break, lattice degeneration, posterior vitreous detachment (PVD), proliferative vitreoretinopathy, lens status, myopia, and trauma. RESULT: The mean age of the patients was 40.12 years. Sixty-one were men. Lincoff rule was validated in 59 of the 75 patients. Anterior breaks (P < 0.008) and PVD (P < 0.001) were found to have a significant association with validity of LR. Other attributes did not have a statistically significant association with validity of LR. CONCLUSION: Presence of posterior retinal breaks and absent PVD is associated with unusual flow of subretinal fluid. Lincoff rules are valid in most of the clinical scenarios.