Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis.

PURPOSE: To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS: Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES: Visual outcomes and postoperative complications after lens exchange. RESULTS: A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS: In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Evaluation of epiretinal membrane formation after scleral buckling for treating rhegmatogenous retinal detachment: En face optical coherence tomography image-based study.

PURPOSE: To assess epiretinal membrane (ERM) formation, severity, and the associated risk factors after scleral buckling using en face optical coherence tomography (OCT) images. METHODS: Medical records of 61 consecutive patients (66 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling were retrospectively reviewed. Posterior vitreous detachment (PVD) was determined based on B-scan OCT images. En face OCT images were used to visualize the ERM and retinal folds. ERM formation was identified by comparing en face images pre- and post-surgery. The maximum depth of the retinal folds (MDRF) was measured using en face imaging to objectively assess traction strength. RESULTS: ERM formation occurred in 15 (22.7%) eyes at the final visit; the foveal pit was preserved in all cases. Parafoveal retinal folds were present in 5 (7.6%) eyes, with a mean MDRF of 21.8 ± 12.6 µm. No significant difference was observed in best-corrected visual acuity (logarithm of the minimal angle of resolution) between the ERM formation (-0.019 ± 0.128) and non-ERM formation (-0.001 ± 0.213) groups at the final visit (P = 0.593; Mann-Whitney U test). Multivariate logistic regression analysis revealed that older age and the presence of PVD were significant risk factors for ERM formation (odds ratio 1.07, 95% confidence interval 1.01-1.14, P = 0.032; odds ratio 5.26, 95% confidence interval 1.06-26.10, P = 0.042; respectively). CONCLUSION: ERM occurred in 22.7% of cases but was mild and did not affect visual acuity. Older age and the presence of PVD are risk factors for ERM formation.

Internal limiting membrane flap with viscoelastic device for lamellar hole surgery with no postoperative positioning.

PURPOSE: To propose a novel technique of an internal limiting membrane (ILM) flap using ophthalmic viscoelastic device (OVD) with no requirement for postoperative head posture for the treatment of lamellar macular hole (LMH) repair. METHODS: A retrospective analysis of 16 consecutive eyes of LMH patients who underwent vitrectomy with ILM flap with OVD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), simultaneous cataract extraction, and ellipsoid zone disruption preoperatively and at the final follow-up were compared. RESULTS: The mean age was 73.19 ± 7.26 years, and ten patients (62%) were females. The mean follow-up was 5.06±1.43 months (range 3-6). For all patients, BCVA was significantly improved at the final visit, from 0.65±0.36 logMAR units to 0.42±0.29 (p < 0.001). None of the patients had visual loss. Six patients had epiretinal membrane (ERM) foveoschisis, and the rest had LMH with epiretinal proliferation. Both subgroups presented a significant improvement in their BCVA with a trend for better improvement in the latter (p=0.09). Ellipsoid zone disruption was seen in 7 patients including one patient with a macular scar. There was no significant effect of ellipsoid zone disruption on the final BCVA (p=0.33). Twelve eyes (75%) underwent simultaneous cataract extraction. Mean BCVA at the final postoperative visit improved regardless of whether the eyes underwent simultaneous cataract surgery (p=0.39). CMT was also significantly improved at the final visit, from 200.06±46.8 µm preoperatively to 305.00±85.5 µm (p<0.001). No full-thickness macular holes were developed postoperatively. No intraoperative or postoperative complications were observed. CONCLUSIONS: Treatment of LMH with ILM flap with OVD showed promising anatomical and functional results with no postoperative head position requirements.

SURGICAL OUTCOMES OF PARS PLANA VITRECTOMY FOR INTRAOCULAR COMPLICATIONS RELATED TO VASOPROLIFERATIVE TUMOR OF THE RETINA.

PURPOSE: To investigate the safety and efficacy of vitrectomy pars plana vitrectomy in managing intraocular complications relating to vasoproliferative tumors of the retina (VPL). METHODS: Retrospective study. 17 patients with VPL who underwent vitrectomy at Sheffield Teaching Hospital NHS Trust from 2005 to 2020 were included. Patient demographics, clinical characteristics, intraoperative data, and surgical outcomes were collected and evaluated. RESULTS: The mean age was 52 years. Indications for pars plana vitrectomy included epiretinal membrane (n = 7), vitreous hemorrhage (n = 5), retinal detachment (n = 3), diagnostic (n = 1), and others (n = 1). After pars plana vitrectomy, 14/17 (82.4%) have stabilized vision and 3/17 (17.6%) deteriorated. Subgroup analysis of epiretinal membrane peel had good outcomes with 6/7 (85.7%) noticing improvement or stabilization of symptoms and mean logarithm of minimal angle of resolution visual acuity improved from 0.719 [6/30] ± 0.267 [6/12] to 0.476 [6/19] ± 0.271 [6/12]. Patients undergoing surgery for vitreous hemorrhage also had good outcomes with resolution (and no recurrence) of the hemorrhage in 3/5 (60%) and 5/5 (100%) with one or more surgeries, respectively. Outcomes for retinal detachment surgery were logarithm of minimal angle of resolution 2.126 [HM] ± 0.301 [6/12] preoperatively and 1.185 [6/95] ± 0.522 [6/19] postoperatively, with one recurrence of retinal detachment. In the epiretinal membrane group, three patients had adjunctive treatment for VPL intraoperatively and four patients had none, and no difference found between the two groups in outcome or complications. Tumor with thickness of ≥2 mm exhibited inferior visual outcomes compared with <2 mm ( P < 0.05). CONCLUSION: This is one of the largest data sets in looking at outcomes of vitrectomy for complications of VPL. Pars plana vitrectomy is effective and safe in managing VPL-related intraocular complications with good outcomes and a low rate of complications, especially for patients with epiretinal membrane and vitreous hemorrhage.

COMPARISON OF THREE INTERNAL LIMITING MEMBRANE PEELING TECHNIQUES FOR MYOPIC TRACTION MACULOPATHY WITH HIGH RISK OF POSTOPERATIVE MACULAR HOLE DEVELOPMENT.

PURPOSE: To compare three different internal limiting membrane (ILM) peeling techniques, including standard ILM peeling, fovea-sparing ILM peeling, and inverted ILM flap (ILMF), in the treatment of myopic traction maculopathy with high risk of postoperative macular hole development. METHOD: This retrospective cohort study enrolled 101 eyes suffering from lamellar macular hole combined with myopic traction maculopathy in 98 consecutive patients who underwent vitrectomy with either standard ILM peeling, fovea-sparing ILM peeling, or ILMF from July 2017 to August 2020. All patients were followed up for at least 12 months after surgery. Best-corrected visual acuity, macular anatomical outcomes, and postoperative full-thickness macular hole (FTMH) formation were evaluated. RESULTS: No significant differences were found among the three surgical groups in baseline characteristics. 12 months after surgery, the mean best-corrected visual acuity was significantly improved ( P < 0.001) and showed no significant differences among groups ( P = 0.452). None of the eyes in the ILMF group, five eyes (15.6%) in the standard ILM peeling group, and six eyes (17.1%) in the fovea-sparing ILM peeling group developed a postoperative FTMH ( P = 0.026). Logistic regression showed that the ILM peeling technique was an independent influencing factor for FTMH formation (OR = 0.209, P = 0.014). CONCLUSION: Compared with the standard ILM peeling or fovea-sparing ILM peeling technique, the ILMF technique resulted in similar visual outcomes but a relatively low incidence of postoperative FTMH in the treatment of lamellar macular hole combined with myopic traction maculopathy. Inverted ILM flap is an effective technique for treating myopic traction maculopathy with high risk of postoperative FTMH development.

Characterization of Different Types of Epiretinal Proliferations by Synchrotron Radiation-Based Fourier Transform Infrared Micro-Spectroscopy.

Pathological tissue on the surface of the retina that can be of different etiology and pathogenesis can cause changes in the retina that have a direct consequence on vision. Tissues of different etiology and pathogenesis have different morphological structures and also different macromolecule compositions usually characteristic of specific diseases. In this study, we evaluated and compared biochemical differences among samples of three different types of epiretinal proliferations: idiopathic epiretinal membrane (ERMi), membranes in proliferative vitreoretinopathy (PVRm), and proliferative diabetic retinopathy (PDRm). The membranes were analyzed by using synchrotron radiation-based Fourier transform infrared micro-spectroscopy (SR-FTIR). We used the SR-FTIR micro-spectroscopy setup, where measurements were set to achieve a high resolution that was capable of showing clear biochemical spectra in biological tissue. We were able to identify differences between PVRm, PDRm, and ERMi in protein and lipid structure; collagen content and collagen maturity; differences in proteoglycan presence; protein phosphorylation; and DNA expression. Collagen showed the strongest expression in PDRm, lower expression in ERMi, and very low expression in PVRm. We also demonstrated the presence of silicone oil (SO) or polydimethylsiloxane in the structure of PVRm after SO endotamponade. This finding suggests that SO, in addition to its many benefits as an important tool in vitreoretinal surgery, could be involved in PVRm formation.

A Simple New Technique to Peel Epiretinal Membrane Without Removing Silicone Oil.

PURPOSE: To introduce a new surgical technique that can keep constant intraocular pressure of the eyeball during peeling epiretinal membrane under silicone oil status. METHODS: A viscoelastic agent was injected into the air pump of the constellation system via the metal tip. This procedure offers a buffer zone to keep constant pressure within the eyeball without disturbing the surgical field by an air bubble. RESULTS: Three cases were performed efficiently (15 ± 5 minutes) under this technique with improvement in anatomical feature and visual function after the surgery. CONCLUSION: Using this simple yet important technique can provide us the constant intraocular pressure without hypotony and avoid the traditional complicated procedures.

Surgical outcome and pathological findings in macular epiretinal membrane caused by neurofibromatosis type 2.

We present surgical outcomes in a 10-year-old Japanese girl with neurofibromatosis type 2 (NF2)-induced epiretinal membrane (ERM). Her right eye underwent lens-sparing 27-gauge microincision vitrectomy surgery (MIVS) with ERM peeling. Decimal best-corrected visual acuity increased from 0.3 to 0.4 postoperatively. However, abnormal thickening of the macula persisted for 3 years. Staining of the extracted ERM revealed many cells positive for glial fibrillary acidic protein and nestin. Although removal of NF2-induced ERM with MIVS can improve visual acuity, the potential surgical risks require careful consideration on a case-by-case basis.

Incidence and risk factors of progressive nasal inner nuclear layer thickening after surgical peeling of epiretinal membrane.

To assess incidence and risk factors of postoperative progressive nasal inner nuclear layer (INL) thickening after epiretinal membrane (ERM) surgery. Progressive nasal INL thickening was defined as 1.5-fold increase in thickness of nasal INL after ERM surgery compared to preoperative examination. Kaplan-Meier survival analysis was done to compare the cumulative risk ratio between groups stratified by presence of progressive nasal INL thickening. Logistic regression was performed to identify possible risk factors. Progressive nasal INL thickening occurred in 13.0% of ERM removal patients. Patients without progressive nasal INL thickening showed better visual acuity recovery compared to patients with nasal INL thickening (p = 0.029). Presence of cystoid space in inner retinal layer before surgery (odds ratio [OR] = 0.143, 95% confidence interval [CI] 0.028-0.736; p = 0.020), older age (OR = 0.896, 95% CI 0.817-0.982, p = 0.020), and thicker preoperative central macular thickness (OR = 0.994, 95% CI 0.988-1.000, p = 0.039) were correlated inversely with thickening of nasal INL. Correlation between nasal INL thickness and postoperative visual outcome was significant. Absence of cystoid space before ERM surgery, younger age, and thinner central macular thickness were risk factors for progressive postoperative nasal INL thickening. Progressive nasal INL thickening may serve as a new biomarker for worsened visual symptom after ERM surgery.

ASSOCIATED FACTORS AND SURGICAL OUTCOMES OF MICROCYSTOID MACULAR EDEMA AND CONE BOUQUET ABNORMALITIES IN EYES WITH EPIRETINAL MEMBRANE.

PURPOSE: To investigate the associated features and the surgical outcomes in eyes with microcystoid macular edema (MME) and cone bouquet abnormalities (CBA) undergoing epiretinal membrane peeling. METHODS: Retrospective study including patients who underwent pars plana vitrectomy for idiopathic epiretinal membrane. Factors associated with MME and CBA at baseline and their regression were identified with logistic regression models. Postoperative visual acuity was evaluated with linear mixed models from baseline to 12 months. Risk factors for new or worsened macular edema were explored with a Cox regression model. RESULTS: One hundred and eighty-seven eyes are included in this study; 30 eyes (16%) had MME and 53 eyes (28%) had CBA preoperatively. Microcystoid macular edema was associated with severe epiretinal membrane stage (odds ratio [95% confidence interval] = 3.6 [1.3-12.7], P = 0.02); CBA was inversely associated with ectopic inner foveal layer thickness (odds ratio [95% confidence interval] = 0.97 [0.97-0.99] for each 1- µ m EIFL increase, P = 0.006). Eyes with MME had worse visual acuity after epiretinal membrane peeling ( P = 0.01) and were at risk of macular edema worsening (hazard ratio [95% confidence interval] = 2.22 [1.01-5.16], P = 0.04). Older age was associated with MME persistence (odds ratio [95% confidence interval] = 2.46 [1.06-6.82] for each 10-year increase, P = 0.04). No significant associations were found for CBA. CONCLUSION: Although CBA had no prognostic consequences, MME was associated with suboptimal visual recovery and less efficient control of inflammation after surgery. Degeneration of Müller cells may have an alleged role, and further imaging and functional tests are warranted.

Natural History and Surgical Timing for Idiopathic Epiretinal Membrane.

PURPOSE: This study assessed the prevalence of progression to surgery on idiopathic epiretinal membrane (iERM) and compared the results with those of immediate surgery. DESIGN: Retrospective study with nested case-control comparison. SUBJECTS: Patients with mild iERM at initial presentation METHODS: A retrospective study with a nested case-control study was conducted to compare the outcomes of those who later progressed to surgery ("deferred surgery") with those of a control group that underwent surgery within 6 months of initial presentation ("immediate surgery"). MAIN OUTCOME MEASURES: The prevalence of performing vitrectomy with membrane peeling after initial deferral, features associated with deferred surgery, and the visual acuity (VA) outcomes of surgery compared with those with immediate surgery. RESULTS: A total of 413 patients were included in the base study cohort: 369 did not undergo iERM peeling, whereas 44 (10.7%) underwent deferred surgery at a mean duration of 18.1 months after initial presentation. The factor most associated with later progression to surgery, determined using a multivariate analysis, was symptoms at initial presentation (odds ratio [95% confidence interval], 8.75 [3.80-20.15]; P < 0.0001). The immediate surgical group (controls) had a poorer logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at presentation compared with the deferred surgery group (cases), but this decreased in the latter group to about the same preoperative level immediately before the deferred surgery (typically why they underwent surgery). The final logMAR BCVA was similar in the deferred and immediate surgical groups when only pseudophakic cases were analyzed. An analysis of the change from preoperative BCVA (instead of initial) to final BCVA showed no difference in the magnitude of change between the pseudophakic subgroups of the deferred and immediate surgery groups (median [interquartile range] preoperative VA of 0.52 [0.40-0.60] in the deferred surgery group and 0.44 [0.39-0.60] in the immediate surgery group [P = 0.7256]). Within the deferred and immediate surgery groups, the median change from preoperative BCVA to final BCVA in the pseudophakic subgroups was 0.22 (P = 0.0082) in the former and 0.21 (P = 0.0001) in the latter. CONCLUSIONS: The vast majority of eyes with iERM remain stable after initial presentation. The deferral of surgery in the minority of patients who progress does not have a disadvantageous final outcome compared with immediate surgery.

JUXTAPAPILLARY CAPILLARY RETINAL ANGIOMA AND EPIRETINAL MEMBRANE MANAGEMENT IN A MONOCULAR PATIENT WITH VON HIPPEL-LINDAU SYNDROME.

PURPOSE: To report a case of von Hippel-Lindau syndrome in a monocular patient with progressive vision loss due to a juxtapapillary capillary retinal angioma and an epiretinal membrane (ERM) formation. PATIENT: We describe a 37-year-old white male patient with von Hippel-Lindau syndrome who presented for retinal evaluation. The right eye was blind with no light perception vision. The left eye had a best-corrected visual acuity of 20/30 and exhibited a peripheral capillary hemangioblastoma at 12 o'clock and a juxtapapillary capillary hemangioma with an ERM covering the fovea. The patient underwent two sessions of fluorescein-potentiated argon laser treatment to the peripheral capillary hemangioblastoma with initial stabilization of vision. After 18 months of follow-up, the ERM contracted causing decline in vision to 20/50. Intravitreal injection of bevacizumab was given without improvement in vision or distortion. Twenty-five-gauge pars plana vitrectomy with ERM peeling and internal limiting membrane removal was performed with immediate improvement in vision and distortion. CONCLUSION: This case suggests that pars plana vitrectomy is a reasonable treatment option for vision loss due to a juxtapapillary capillary retinal angioma and ERM formation.

ASSOCIATION BETWEEN EPIRETINAL MEMBRANE, EPIRETINAL PROLIFERATION, AND PROGNOSIS OF FULL-THICKNESS MACULAR HOLE CLOSURE.

PURPOSE: To demonstrate the effects of epiretinal membrane (ERM) and epiretinal proliferation on surgical outcomes for full-thickness macular hole. METHODS: Nested case-control study with propensity score matching. Patients operated on for full-thickness macular hole between January 2011 and March 2020 were enrolled. The primary outcome was failure of the macular hole closure, and the secondary outcome was unfavorable hole closure (V or λ type closure) at 6 months after the surgery. RESULTS: Five hundred and thirty-four eyes of 534 patients met the inclusion criteria. After 1:1 propensity score matching (127 pairs), patients demonstrating ERM were more likely to have a failure of hole closure (adjusted odds ratio, 2.71; 95% confidence interval, 1.19-6.14) and unfavorable hole closure (adjusted odds ratio, 2.07; 95% confidence interval, 1.16-3.71). Epiretinal membrane spanning the hole margin (hole marginal ERM) greatly increased the likelihood of unfavorable hole closure (adjusted odds ratio, 2.13; 95% confidence interval, 1.12-4.07). Patients with hole marginal-ERM + epiretinal proliferation were more likely to have a failure of hole closure (38.4%) compared with those with no ERM (11.8%). CONCLUSION: Patients with ERM had a higher risk for adverse surgical outcomes for full-thickness macular hole closure. The location of the ERM relative to the macular hole and the presence of epiretinal proliferation might affect the surgical outcomes for full-thickness macular hole closure.

Photocoagulation-associated spontaneous release of epiretinal membrane secondary to retinal vascular tumor: case series of 8 cases.

To evaluate the secondary epiretinal membrane (ERM) response after photocoagulation in retinal vascular tumor. This retrospective interventional case series included 8 patients (8 eyes) who were diagnosed with retinal vascular tumor and secondary ERM. All eyes were treated with photocoagulation and underwent comprehensive ophthalmologic examinations at baseline and at each follow-up. Of the 8 eyes with retinal vascular tumor and associated ERM, 4 eyes (50%) were von Hippel and 4 eyes (50%) were vasoproliferative tumor of the retina. The mean follow-up time was 12.63 ± 14.64 (range, 4-51) months. The BCVA in the eyes at baseline was 1.16 ± 1.10 logMAR (range, HM to 20/40). ERM located in the macular region in 100% of the eyes and led to CME with a mean central foveal thickness of 497.6 ± 147.7 µm (range, 294-736 µm) at presentation. After photocoagulation, the ERM spontaneously peeled in 7 of 8 eyes (87.5%), among which one case required surgical treatment due to complicating tractional retinal detachment. After ERM peeling without complications, 6 eyes recovered normal macular structure, with an improved BCVA in 5 eyes and a stable BCVA in 1 eye. Laser photocoagulation is necessary and effective treatment for retinal vascular tumor. After laser photocoagulation, retinal vascular tumor-related ERM spontaneously released in 75% of the cases, without complication and surgical intervention.

Epiretinal Membrane Surgery after Retinal Detachment Repair: Visual Acuity Outcomes and OCT Analysis.

PURPOSE: To assess visual acuity (VA) outcomes of epiretinal membrane (ERM) surgery following primary rhegmatogenous retinal detachment (RD) repair and to identify OCT features predictive of visual outcomes. DESIGN: Retrospective, consecutive case series. SUBJECTS: Eyes undergoing pars plana vitrectomy (PPV) with membrane peel (MP) surgery for ERM following primary RD repair (PPV with or without scleral buckle (SB) and gas tamponade). METHODS: Retrospective chart review from 2015 to 2018. A previously described ERM grading scale was utilized for OCT structural analysis. MAIN OUTCOME MEASURES: Visual acuity (VA) and change in VA from pre- MP to 6 months and final follow-up. Secondary outcomes included RD and OCT features predictive of VA, as well as RD factors associated with need for subsequent MP surgery. RESULTS: 53 eyes of 53 patients underwent MP following RD repair. VA improved significantly from logMAR 1.00 ± 0.51 (Snellen 20/200) pre-MP to 0.45 ± 0.41 (20/56) at 6 months and 0.42 ± 0.41 (20/53) at final follow-up, (p<0.001) for each respectively. Macula on eyes had better 6 month [0.29 ± 0.18 (20/39) vs. 0.51 ± 0.46 (20/65), p=0.02] and final VA [0.29 ± 0.14 (20/39) vs. 0.46 ± 0.47 (20/58), p=0.04] after MP surgery. VA improved significantly from pre-MP to 6 months and final follow-up regardless of macula status. MP occurring ≤180 days from RD repair and IS/OS loss were associated with worse pre-MP VA [1.13 ± 0.09 (20/270) vs. 0.82 ± 0.07(20/132), p=0.01 and 1.21 ± 0.07 (20/324) vs. 0.74 ± 0.09 (20/110) p=0.0003, respectively]. IS/OS loss [adjusted means 0.54 ± 0.07 (20/69) vs. 0.25 ± 0.08 (20/36) at final visit, p=0.006] and RD repair with PPV/SB [0.53 ± 0.08 (20/68) vs. 0.31 ±0.07 (20/41) at final visit, p=0.03] were significantly associated with worse VA at both 6 months and final follow-up. CONCLUSIONS: Eyes undergoing MP after RD repair have significant visual acuity gains independent of macula-status at time of RD repair. Pre-operative IS/OS disruption was the OCT feature best predictive of visual acuity.

SECONDARY EPIRETINAL MEMBRANE AFTER LASER RETINOPEXY FOR RETINAL TEAR OR LOCALIZED RETINAL DETACHMENT: Surgical Outcomes and Optical Coherence Tomography Structural Analysis.

PURPOSE: To assess visual acuity and optical coherence tomography outcomes after repair of secondary epiretinal membrane (ERM) after prior laser retinopexy for retinal tear with or without localized retinal detachment. METHODS: Retrospective, consecutive series. A previously described optical coherence tomography grading scheme was used for imaging analysis. RESULTS: Forty-two eyes of 42 patients were included, of which 16 (38.1%) had a concurrent localized retinal detachment. Mean logMAR visual acuity prelaser retinopexy was 0.15 ± 0.13 (Snellen 20/28), which worsened to 0.56 ± 0.42 (Snellen 20/72) before ERM surgery (P < 0.001). The mean visual acuity improved to 0.36 ± 0.30 (Snellen 20/45, P < 0.001) 3 months postsurgery and to 0.31 ± 0.32 (Snellen = 20/40, P < 0.001) at the final follow-up. Most eyes exhibited advanced ERM characteristics (n = 19 [45.2%] Stage 3 and n = 15 [35.7%] Stage 4 characteristics). The presence of inner microcystic changes (P = 0.008) and ellipsoid zone disruption (P = 0.009) at postoperative Month 3 were associated with worse final visual acuity. Eyes undergoing ERM surgery ≤180 days from laser retinopexy (n = 16, 38.1%) were younger (P = 0.024) and more likely to have Stage 4 ERM characteristics (P = 0.001). CONCLUSION: Secondary ERM after laser retinopexy may occur rapidly (<180 days) and exhibit significant anatomic alterations. The presence of inner microcystic changes and ellipsoid zone disruption postoperatively were optical coherence tomography features associated with worse final visual acuity.

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Full-thickness macular hole formation in proliferative diabetic retinopathy.

Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.

Surgical Treatment of Epiretinal Membrane.

Epiretinal membrane (ERM) is a common retinal disease characterized by cellular proliferation and metaplasia that lead to the formation of a pathological fibrocellular membrane immediately superjacent to the inner retinal surface. The vast majority of ERMs are considered idiopathic. However, ERM formation can result from various primary intraocular diseases, including retinal breaks and detachment, retinal vascular diseases, and vitreoretinal inflammatory conditions. Although ERMs are generally asymptomatic or cause mild metamorphopsia and/or a modest decrease in visual acuity, some can cause severe macular distortion and macular edema, resulting in significantly impaired function. Surgical removal of ERM is the only treatment, and improvements in vitrectomy systems have enabled less invasive treatment. However, there are currently no standardized criteria for ERM surgery, and the indications for surgery are determined from the patient's subjective symptoms. Another problem with ERM surgery is that not all patients show satisfactory postoperative recovery of visual function. Thus, further research is needed to determine the criteria for ERM surgery and methods to improve the postoperative prognosis.

Activation of quiescent polypoidal choroidal vasculopathy after membrane peeling vitrectomy for epiretinal membrane: a case report.

BACKGROUND: Regular membrane peeling vitrectomy for epiretinal membrane (ERM) patients seldom causes large pigment epithelial detachment (PED). We presented an unusual case of the activation of quiescent polypoidal choroidal vasculopathy (PCV) after membrane peeling vitrectomy for ERM, with an uneven therapeutic process. CASE PRESENTATION: A 75-year-old female patient complained of metamorphopsia in her left eye for 2 years. Her best-corrected visual acuity was 20/160 with a moderate nuclear cataract. An irregular ERM and slight PED were shown in optical coherence tomography (OCT). No obvious orange-red lesion was detected. The patient underwent vitrectomy + ERM peeling + cataract surgery. After the operation, large PED emerged, and indocyanine green angiography (ICGA) confirmed PCV. Four monthly injections of intravitreal ranibizumab were administered, but PED persisted. After focal laser therapy targeted to the polyps combined with ranibizumab treatment, PED was absorbed. CONCLUSIONS: Careful evaluation for PCV before membrane peeling vitrectomy for ERM is important, as indolent PCV may be activated postoperatively. Anti-VEGF therapy accompanied by laser photocoagulation may be more effective for PCV polyps located away from the fovea.