FIVE-YEAR VISUAL OUTCOME OF TREATMENT FOR RETINOPATHY OF PREMATURITY IN INFANTS WEIGHING <500 G AT BIRTH: A Multicenter Cohort Study From J-CREST.

PURPOSE: To investigate the 5-year treatment outcomes of retinopathy of prematurity in infants <500 g birth weight and compare laser and anti-vascular endothelial growth factor therapies. METHODS: A multicenter retrospective study comprised 24 eyes of 13 patients treated for Type 1 retinopathy of prematurity, followed for 5 years. Initial treatment was laser and anti-vascular endothelial growth factor in 13 and 11 eyes, respectively. Data collected included sex, birth characteristics, retinopathy of prematurity characteristics at the time of treatment, best-corrected visual acuity (BCVA), spherical equivalent, and astigmatism at 5 years posttreatment. RESULTS: Median BCVA was 0.15 logarithm of the minimum angle of resolution (interquartile range, 0.0-0.5). Snellen BCVA was ≥20/40 in 73% and ≥20/20 in 27% of eyes. Median spherical equivalent was -2.37 (interquartile range, -6.1 to -0.1); 75% had myopia (≤-0.5 D), and 25% had high myopia (≤-6.0 D). Median astigmatism was 1.25 (interquartile range, 0.9-3.0); 46% had ≥1.5 D. Anti-vascular endothelial growth factor-treated eyes showed less myopia ( P < 0.009), with no BCVA or astigmatism difference ( P = 0.997, P = 0.271) compared with laser-treated eyes. CONCLUSION: One-quarter of the eyes exhibited good visual acuity (Snellen BCVA of ≥20/20) 5 years after retinopathy of prematurity treatment. Refractive errors were common. Anti-vascular endothelial growth factor therapy may be superior to laser therapy in myopic refractive error.

Internal Limiting Membrane Peeling and Inverted Flap Technique in Macular Hole: Postoperative Metamorphopsia and Optical Coherence Tomography.

INTRODUCTION: We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH). METHODS: This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed. RESULTS: At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively. DISCUSSION/CONCLUSION: The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.

Analysis of the sustained release ability of bevacizumab-loaded tetra-PEG gel.

Multiple intravitreal injections, which are painful and costly, are often required in the treatment of retinal disorders. Therefore, a novel drug delivery system using hydrogels is currently being evaluated as an alternative. This study aimed to evaluate the ability of tetra-armed polyethylene glycol (tetra-PEG) gel for sustained release in vitro. Bevacizumab-loaded tetra-PEG gel and 5-Carboxyfluorescein N-succinimidyl ester (FAM-NHS)-labeled IgG-loaded tetra-PEG gel were prepared by mixing tetra-PEG with thiol termini (tetra-PEG-SH) solution, maleimide termini (tetra-PEG-MA) solution, and bevacizumab or FAM-NHS labeled IgG. The gels were prepared with three different polymer concentrations of 1.5%, 5%, and 10%, then an in vitro release study performed to assess the sustained release ability of the drug-loaded tetra-PEG gels. High performance liquid chromatography (HPLC) was used to test the structural stability of the bevacizumab released from the tetra-PEG gel. The binding of bevacizumab to tetra-PEG-SH or MA was assessed using SDS-polyacrylamide gel electrophoresis (PAGE). The bioactivity of released bevacizumab was tested using KDR/NFAT-RE HEK293 cells. In addition, in vitro degradation and swelling studies were also performed. The in vitro release analysis showed that the release of bevacizumab was slower in the 5% and 10% tetra-PEG gels than that of 1.5% tetra-PEG gels. Similarly, the release of FAM-NHS-labeled IgG was slowest in the 1.5%, 5%, and 10% tetra-PEG gels, in that order. The 5% and 10% tetra-PEG gels released bevacizumab and FAM-NHS-labeled IgG over a period of 1-2 weeks. Both bevacizumab and FAM-NHS-labeled IgG were not fully released in 2 weeks. HPLC analysis showed that the retention time of the samples released from the bevacizumab-loaded tetra-PEG gel was similar to that of the bevacizumab standard. The SDS-PAGE analysis showed that bevacizumab binds to tetra-PEG-MA. The bioactivity assay test revealed no decrease in the bioactivity of the released bevacizumab. In vitro degradation and swelling studies revealed that 1.5%, 5%, and 10% tetra-PEG gels expanded by approximately 1.4-, 2-, and 3-fold, respectively. Based on the results of the release and swelling tests, 5% tetra-PEG gels are considered good candidates for controlled release systems for therapeutic antibodies such as bevacizumab. The binding of PEG to the therapeutic antibodies may reduce the availability of therapeutic antibodies that can be released.

Evaluation of postoperative visual function based on the preoperative inner layer structure in the epiretinal membrane.

PURPOSE: To evaluate the postoperative visual function using a preoperative epiretinal membrane (ERM) classification based on the status of the inner layer structure. METHODS: We assessed 62 eyes, one from each patient undergoing vitrectomy with internal limiting membrane (ILM) peeling for unilateral ERM. The inclusion criteria were as follows: (1) the presence of idiopathic ERM based on optical coherence tomography and a healthy contralateral eye, (2) successful surgery after 25- or 27-gauge transconjunctival 3-port pars plana vitrectomy with ILM peeling, and (3) a minimum follow-up period of 12 months. We included patients with preoperative ERM morphology with no disruption of the inner retinal layer in group A (37 eyes) and those with disruption in group B (25 eyes) and compared the visual acuity, central visual-field sensitivity (CVFS) measured using the Humphrey field analyzer 10-2 program, and detection rate of micro-scotoma (< 10 dB) at baseline and 12 months postoperatively between the groups. RESULTS: Visual acuity at 12 months showed greater improvement in group A than in group B (P = .03). There was no significant difference in CVFS at baseline; however, that of the nasal area was substantially lower after surgery in group B than in group A (P = .02). The 12-month postoperative detection rate of micro-scotoma was significantly higher in group B than in group A (P = .002). CONCLUSION: ERM that has preoperatively disrupted the inner layer poses the risks of CVFS reduction and micro-scotoma formation after vitrectomy. Evaluating the inner layer could be an important prognostic factor in determining retinal function in ERM.

Comparison of 5-year safety and efficacy of laser photocoagulation and intravitreal bevacizumab injection in retinopathy of prematurity.

PURPOSE: To compare laser photocoagulation and intravitreal injection of bevacizumab (IVB) treatment for retinopathy of prematurity (ROP). METHODS: The study included 52 eyes of 26 patients after ROP treatment who were observed up to 5 years of age. Twenty-eight eyes received laser photocoagulation as the initial treatment (laser group), and twenty-four eyes underwent IVB (IVB group). We collected data on gestational age, birth weight, 1- and 5-min Apgar scores, zone and stage at the time of treatment, recurrence of ROP and best-corrected visual acuity (BCVA) (logMAR), equivalent spherical value (SE), ocular complications, and developmental delay at the age of 5. RESULTS: More zone I low-stage eyes were treated with IVB than laser. There was no difference in BCVA (p = 0.836). Although the mean SE was not different between the groups (p = 0.280), the prevalence of myopia was significantly higher in the laser group (p = 0.020). Developmental delay was observed in 3 of 14 and 3 of 12 cases in the laser and IVB groups, respectively (p = 0.596). Retinal holes were observed in 2 eyes in the IVB group, with 1 developing localized retinal detachment. There were no significant differences between the groups in the other factors. CONCLUSIONS: Compared to laser for ROP, IVB was not inferior in neurodevelopment or visual outcome and was superior in refractive error. As cases in the IVB group showed retinal holes, long-term follow-up with fundus examination is recommended after IVB.

[Three Cases of No. 16 Lymph Node Metastasis-Positive Gastric Cancer Successfully Treated with Chemotherapy and Para-Aortic Lymph Node Dissection].

Chemotherapy is standard treatment for Stage Ⅳ advanced gastric cancer(AGC)positive for No. 16 lymph node(LN) metastasis, but the significance of conversion surgery remains unclear. S-1 plus CDDP(SP), primary lesion resection+ para-aortic LN dissection(PAND), and postoperative recurrence-free survival are reported. Case 1: A 70-year-old woman had AGC with para-aortic LN metastases(tub1, HER2 score 3+, cT3N2M1, cStage Ⅳ). Four courses of SP plus trastuzumab were administered, which shrank the primary tumor and metastatic LNs. She underwent distal gastrectomy with D2+PAND (No. 16a2 int-b1 int). Histopathology showed metastasis to No. 16 LN, with Grade 2 histological effect. She underwent adjuvant chemotherapy with S-1 and 4-year recurrence-free follow-up. Case 2: An 80-year-old man with AGC rand para- aortic LN metastases(por, cT3N2M1, cStage Ⅳ)underwent 4 courses of SP, which shrank the primary tumor and metastatic LNs. He underwent total gastrectomy with D2+PAND(No. 16a2 lat)dissection. Histopathology showed no residual tumor cells in LNs. Follow-up for 3 years has shown no recurrence without chemotherapy. Case 3: A 50-year-old woman with epigastric pain and anemia had AGC with para-aortic LN metastases(tub2, cT3N3M1, cStage Ⅳ). She underwent distal gastrectomy with D2+PAND(No. 16a2 int-b1 lat). After 1-year chemotherapy with SP, follow-up for 5 years showed no recurrence. In AGC with para-aortic LN metastases, long-term survival can be expected by combining selective PAND with SP therapy.

Preoperative aniseikonia is a prognostic factor for postoperative stereopsis in patients with unilateral epiretinal membrane.

PURPOSE: To investigate stereopsis and other visual functions in patients with unilateral epiretinal membrane (ERM) and to identify vision-related parameters affecting stereopsis. METHODS: This prospective study included 63 consecutive patients who were scheduled to undergo vitrectomy for unilateral idiopathic ERM. We examined stereopsis (Titmus Stereo Test, TST; TNO stereotest, TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, and degree of aniseikonia preoperatively and 6 months postoperatively. RESULTS: Preoperatively, we observed significant correlation between TST scores and other vision-related parameters except severity of metamorphopsia and between TNO score and all the vision-related parameters. Multiple regression analysis showed that preoperative TST and TNO scores were significantly associated with the degree of aniseikonia (both P < 0.01). ERM surgery significantly improved stereopsis, BCVA, contrast sensitivity, and metamorphopsia, but not aniseikonia. Postoperatively, TST was significantly associated with BCVA, and TNO showed association with BCVA and aniseikonia. Postoperative TST and TNO scores showed significant correlation with preoperative aniseikonia (P < 0.005 and P < 0.001, respectively). CONCLUSIONS: Impairment of stereopsis in patients with unilateral ERM was considered to be due to retinally induced aniseikonia. Aniseikonia did not improve by surgery, and preoperative aniseikonia can be a prognostic factor for postoperative stereopsis.

COMBINATION THERAPY OF INTRAVITREAL RANIBIZUMAB AND SUBTHRESHOLD MICROPULSE PHOTOCOAGULATION FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION: 6-MONTH RESULT.

PURPOSE: To determine the efficacy of the combination therapy of intravitreal ranibizumab (IVR) and 577-nm yellow laser subthreshold micropulse laser photocoagulation (SMLP) for macular edema secondary to branch retinal vein occlusion cystoid macular edema. METHODS: Retrospective, consecutive, case-control study. Forty-six eyes of 46 patients with treatment-naive branch retinal vein occlusion cystoid macular edema were enrolled. The IVR + SMLP group consisted of 22 patients who had undergone both SMLP and IVR. Intravitreal ranibizumab group consisted of 24 patients who had undergone IVR monotherapy. Intravitreal ranibizumab therapy was one initial injection and on a pro re nata in both groups, and SMLP was performed at 1 month after IVR in the IVR + SMLP group. Preoperatively and monthly, best-corrected visual acuity and central retinal thickness were evaluated using swept source optical coherence tomography. RESULTS: Best-corrected visual acuity and central retinal thickness significantly improved at 6 months in IVR + SMLP and IVR groups. Best-corrected visual acuity and central retinal thickness were not significantly different between the two groups at any time points. The number of IVR injections during initial 6 months in IVR group (2.3 ± 0.9) was significantly greater (P = 0.034) than that in IVR + SMLP group (1.9 ± 0.8). CONCLUSION: The combination therapy of IVR and SMLP can treat branch retinal vein occlusion cystoid macular edema effectively, by decreasing the frequency of IVR injections while maintaining good visual acuity.

TRAFFIC ACCIDENT-RELATED OPEN GLOBE INJURIES.

PURPOSE: To evaluate the clinical characteristics and visual outcomes of patients with traffic accident-related open globe injuries, and to examine preoperative factors influencing the visual prognosis after pars plana vitrectomy, as compared with common open globe injuries. METHODS: Patients with open globe injuries, who underwent pars plana vitrectomy, were identified. Patients' demographic and clinical data were entered into a computerized database for review and analysis; data included age, sex, initial visual acuity, duration between onset of injury and surgery, information about the type and cause of injury, wound location and length, presence of ocular complications, and final visual acuity. RESULTS: Of the 355 open globe injuries, 14 were sustained during a traffic-related accident; the average age was 50.4 years (range: 20-85) and most (78.6%) were men. Of these 14 patients, 9 (64.3%) presented with rupture and 5 (35.7%) with laceration. Injuries were caused while driving (6 eyes; 42.9%), riding a bicycle (5 eyes; 35.7%), involved in car accident while walking (2 eyes; 14.3%), and riding a motorbike (1 eye; 7.1%). Initial visual acuity was significantly related to final visual acuity (P = 0.003, R = 0.80). The final visual acuity in patients with traffic accident-related open globe injuries was significantly better than that of the total group (P = 0.01). CONCLUSION: Traffic accident-related open globe injuries had better visual outcomes than common open globe injuries. Visual outcomes in patients with traffic accident-related open globe injuries were related to the initial visual acuity. No eyes developed endophthalmitis in patients with traffic accident-related open globe injuries.

Patching retinal breaks with polyethylene glycol-based synthetic hydrogel sealant for retinal detachment in rabbits.

The purpose of this study was to evaluate absorbable polyethylene glycol (PEG)-based synthetic hydrogel as a sealant for retinal breaks in rhegmatogenous retinal detachment (RD). A three-port, 25-gauge vitrectomy was performed on nine Dutch pigmented rabbit eyes. Subsequently, RD was induced by creating a retinal break. The retina was then reattached by fluid-air exchange. In six of nine eyes (RD-PEG group), PEG sealant was applied to completely cover the retinal breaks, and then photopolymerized with light; thereafter, intravitreous air was replaced with balanced salt solution (BSS). In the remaining three eyes (RD group), PEG sealant was not applied, but the intravitreous air was replaced with BSS. Ophthalmological examinations and intraocular pressure measurements were conducted preoperatively, and at 1 and 7 days, and 1, 3, and 6 months postoperatively. Histological examinations of the eyes were performed after 6 postoperative months. At surgery, retinal reattachment with PEG sealant was achieved in all eyes in the RD-PEG group. Fundoscopic and optical coherence tomographic examinations revealed that the retina remained attached in all the eyes of the RD-PEG group throughout the 6-month observation period. Histological examination revealed no signs of damage in the retinal layers at the edges of the retinal breaks that were in contact with the sealant. In the RD group, the retinas detached in all eyes within 7 days postoperatively. The PEG sealant closed the retinal breaks and maintained retinal reattachment. Intraocular tamponade was not necessary.

Clinical characteristics and outcomes of fall-related open globe injuries in Japan.

PURPOSE: To investigate the clinical characteristics and visual outcomes in patients with fall-related open globe injuries and to evaluate differences between fall-related and non-fall-related open globe injuries in Japan. METHODS: A retrospective review of patients with open globe injury who presented to Japan-Clinical Research of Study (J-CREST) hospitals between 2005 and 2015 was enrolled. Clinical information including age, sex, initial visual acuity, final visual acuity, type of injury, status of the crystalline lens, zone of injury, wound length, presence of retinal detachment, proliferative vitreoretinopathy, expulsive hemorrhage, and endophthalmitis was recorded. RESULTS: A total of 374 eyes were enrolled, of which 120 (32.1%) suffered from fall-related injury with average age of 73.7 ± 15.9 years (range, 11-101 years). A majority of patients were female (55.8%). Of 120 patients with fall-related injury, 109 (90.8%) presented with rupture and 11 (9.2%) with laceration. A multiple regression analysis revealed that final visual acuity was significantly associated with initial visual acuity (r = 0.99, P < 0.001). Compared to non-fall-related open globe injuries, fall-related open globe injuries were associated with elderly age, female sex, poorer initial and final visual acuity, rupture, absence of the lens, larger wound size, retinal detachment, expulsive hemorrhage, and absence of endophthalmitis (P < 0.01). CONCLUSIONS: Fall-related open globe injuries were more frequent in elderly female and accompanied by larger wound lengths and severer ocular complications. Visual outcomes in patients with fall-related open globe injuries were related to initial visual acuity.

CHANGES IN METAMORPHOPSIA AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS AFTER SUCCESSFUL RETINAL DETACHMENT SURGERY.

PURPOSE: To investigate changes in metamorphopsia after rhegmatogenous retinal detachment surgery and to evaluate the relationship between metamorphopsia and retinal microstructures assessed with optical coherence tomography. METHODS: The study included 47 eyes of 47 patients undergoing retinal detachment surgery. We examined the severity of metamorphopsia using M-CHARTS, best-corrected visual acuity, and optical coherence tomography images. All data were recorded before and 3, 6, and 12 months after surgery, except for M-CHARTS which were recorded only postoperatively. RESULTS: Metamorphopsia scores at 3, 6, and 12 months postoperatively were 0.46 ± 0.51, 0.41 ± 0.44, and 0.28 ± 0.37, respectively, with significant improvement from 3 months to 12 months after surgery. Significant metamorphopsia (score ≥0.2) was present in 49% of patients at 12 months postoperatively. Multiple regression analysis revealed that metamorphopsia score at 12 months was significantly related to the status of macula and interdigitation zone. In patients with macula-off retinal detachment, improvement of metamorphopsia scores was associated with an increase in thickness of external limiting membrane-retinal pigment epithelium. CONCLUSION: After successful retinal detachment surgery, metamorphopsia gradually improved, but nearly half of the patients still exhibited metamorphopsia at 12 months postoperatively. Disruption of interdigitation zone and external limiting membrane-retinal pigment epithelium thickness was related to metamorphopsia.

TIME COURSE OF CHANGES IN METAMORPHOPSIA FOLLOWING INTRAVITREAL RANIBIZUMAB INJECTION FOR BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO) and to assess the relationship between retinal microstructure and metamorphopsia. METHODS: Subjects were 39 eyes of 39 patients with branch retinal vein occlusion. The severity of metamorphopsia was quantified using the M-CHARTS before and 1, 2, 3, 4, 5, and 6 months after treatment. Based on optical coherence tomography (OCT) images, we assessed central retinal thickness (CRT) and status of the external limiting membrane (ELM) and ellipsoid zone (EZ). The association between retinal microstructure and metamorphopsia was analyzed in 24 eyes with treatment-naïve branch retinal vein occlusion. RESULTS: Intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity (BCVA) and central retinal thickness (P < 0.0001, P < 0.0001, respectively), but metamorphopsia did not improve by treatment. Posttreatment metamorphopsia scores showed a significant correlation with duration of symptoms (P < 0.05) and pretreatment metamorphopsia scores (P < 0.01). Posttreatment metamorphopsia score was significantly worse in patients with disruption of external limiting membrane (P < 0.05). CONCLUSIONS: In patients with branch retinal vein occlusion, intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity and central retinal thickness, but not metamorphopsia. The severity of posttreatment metamorphopsia was significantly associated with duration of symptoms, degree of pretreatment metamorphopsia, and posttreatment integrity of external limiting membrane.

Safety and efficacy following 10-years of overnight orthokeratology for myopia control.

PURPOSE: To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10-year period in schoolchildren. METHODS: Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10-year period, were recorded. Estimated myopia progression was calculated as the sum of 'changes in prescription lens power during 10 years' and 'residual refractive errors at the 10-year visit,' and was compared between groups. We also compared the incidence of adverse events between groups over the 10-year study period. RESULTS: A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10-year period found in the OK and SCL groups were -1.26 ± 0.98 and -1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72). CONCLUSIONS: The results of this study supports the long-term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren.

Aniseikonia in various retinal disorders.

PURPOSE: The purpose was to quantify and compare the severity of aniseikonia in patients undergoing vitrectomy for various retinal disorders. METHODS: We studied 357 patients with retinal disorders including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch / central retinal vein occlusion (BRVO-CME / CRVO-CME), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD) as well as 31 normal controls. The amount of aniseikonia was measured using the New Aniseikonia Test preoperatively and at 6 months postoperatively. RESULTS: Of all patients, 59% presented aniseikonia. Preoperative and postoperative mean aniseikonia were 4.0 ± 4.1% and 3.0 ± 3.6%, respectively. In particular, 68% of patients with ERM had macropsia, and approximately half of MH, RVO-CME, DME, and M-off RD patients had micropsia. Preoperative aniseikonia was significantly severe in ERM than in other disorders. Vitrectomy improved aniseikonia only in MH, while visual acuity was improved in all disorders except CRVO-CME. CONCLUSION: More than half of the patients showed aniseikonia preoperatively. A majority of ERM patients exhibited macropsia, whereas MH, RVO-CME, DME, and macula-off RD patients presented micropsia. The aniseikonia score was greatest in ERM patients. In most retinal disorders, surgery significantly improved visual acuity, but not aniseikonia.

Morphometric assessment of normal human ciliary body using ultrasound biomicroscopy.

PURPOSE: To quantitatively assess the biometry of the ciliary body in normal human eyes using ultrasound biomicroscopy. METHODS: We evaluated 85 eyes of 85 normal subjects (35 men and 50 women), whose age ranged from 11 to 86 years (mean ± SD, 56.8 ± 20.4 years). The eyes were assessed along the 3-, 6-, 9-, and 12-o'clock meridians relative to the center of the cornea. Clinical data were collected, including age, axial length, ciliary body length (CBL), ciliary body thickness (CBT), anterior chamber depth, iris root thickness, trabecular-iris angle, and scleral-ciliary process angle. Axial length was measured using A-scan ultrasonography. RESULTS: CBL and CBT tended to be larger in the superior than in the inferior quadrant, but the differences among the four quadrants were not statistically significant. The average CBL showed a significant positive correlation with the average CBT (r = 0.40, P < 0.001). Average CBL and CBT were significantly correlated with axial length (r = 0.33, P = 0.031; r = 0.46, P < 0.01 respectively). In addition, the average CBL was significantly correlated with anterior chamber depth (r = 0.23, P < 0.05), trabecular-iris angle (r = 0.29, P = 0.01), and scleral-ciliary process angle (r = 0.40, P < 0.001). CONCLUSIONS: Ultrasound biomicroscopic imaging demonstrated that the ciliary body is similar in size in all circumferences, and eyes with longer axial length have an elongated and thicker ciliary body. The values obtained in the present study may serve as standard clinical references.

Effect of fluid-air exchange on reducing residual silicone oil after silicone oil removal.

PURPOSE: Our purpose was to determine the effect of fluid-air exchange on the amount of silicone oil (SO) droplets remaining in the vitreous cavity after removal of the main body of the SO. METHODS: This was a retrospective comparative study of 56 eyes of 56 patients that had undergone vitrectomy with SO tamponade. Fluid-air exchange was performed during surgery in 30 eyes [Air Ex(+) group] and was not done in 26 eyes [Air Ex(-) group]. All of the eyes were examined by ultrasonography, and the images were converted to binarized image. The amount of residual SO droplets/vitreal area in the images was expressed as the, "silicone oil index (SOI)". The correlations between SOI and clinical findings were determined. RESULTS: The SOI was significantly correlated with the axial length (AL, R = 0.444, P = 0.023). The SOI in the Air Ex(+) group was significantly higher (7.4 ± 2.6%) than in the Air Ex(-) group (4.9 ± 3.4%; P = 0.004). Multiple linear regression analyses showed that the SOI was independently and significantly correlated with the AL and the Air Ex(+) group (P = 0.003, P = 0.006, respectively). CONCLUSIONS: Fluid-air exchange during vitrectomy to remove residual SO is not effective. Our findings indicate that it may increase the amount of residual SO droplets.

RELATIONSHIP BETWEEN METAMORPHOPSIA AND INTRARETINAL CYSTS WITHIN THE FLUID CUFF AFTER SURGERY FOR IDIOPATHIC MACULAR HOLE.

PURPOSE: To quantify metamorphopsia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to investigate the relationship between metamorphopsia and foveal microstructure. METHODS: This is prospective, consecutive, interventional study. Fifty-one eyes of MH were included. Severity of metamorphopsia was quantified using the M-CHARTS and foveal microstructure was assessed with optical coherence tomography preoperatively and at 3 months, 6 months postoperatively. Based on the optical coherence tomography images, the authors quantified minimum and base diameters of MH, macular thickness, defect lengths of external limiting membrane, ellipsoid zone and interdigitation zone, and the area of intraretinal cysts within the fluid cuff. RESULTS: Mean metamorphopsia score was significantly improved from 0.82 to 0.44. Postoperative mean and horizontal metamorphopsia scores were correlated with preoperative base diameters of MH, defect lengths of external limiting membrane, and the area of cysts in fluid cuff. Multiple regression analysis revealed that postoperative mean and horizontal metamorphopsia scores were significantly positively relevant to the area of intraretinal cysts within the fluid cuff. Postoperative vertical metamorphopsia score was also correlated with the area of intraretinal cysts within the fluid cuff. CONCLUSION: Vitrectomy for MH improved metamorphopsia. Postoperative metamorphopsia was associated with the preoperative area of intraretinal cysts within the fluid cuff.

Aniseikonia and Foveal Microstructure in Patients with Idiopathic Macular Hole.

PURPOSE: To quantify the severity of aniseikonia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to examine any relationship between aniseikonia and the foveal microstructure. DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: We included 56 eyes of 56 patients who underwent vitrectomy to treat idiopathic MH. METHODS: We examined visual acuity, aniseikonia using the New Aniseikonia Test, and foveal structure using optical coherence tomography (OCT) before and 3, 6, and 12 months after surgery. Based on OCT images, minimum and base diameters of MH, height of MH, and defect lengths of the external limiting membrane (ELM), ellipsoid zone, and interdigitation zone were assessed. MAIN OUTCOME MEASURES: Degree of aniseikonia before and after surgery. RESULTS: The mean aniseikonia was -3.2±4.6%, ranging from -15.5% to +5.0%. Of the patients, 55% had micropsia, 7% had macropsia, and 38% had no aniseikonia. The mean absolute value of aniseikonia improved significantly from 3.8±4.1% before surgery to 1.0±1.5% at 12 months after surgery (P < 0.0001). The preoperative mean absolute value of aniseikonia showed a significant correlation with minimum diameters of MH (P < 0.01), base diameters of MH (P < 0.01), and the defect length of ELM (P < 0.05). In multivariate analysis, preoperative aniseikonia showed a significant correlation with the defect length of ELM (P < 0.05). In contrast, postoperative aniseikonia was not associated with any of the parameters. CONCLUSIONS: Approximately half of MH patients had micropsia. Vitrectomy for MH improved aniseikonia. Preoperative aniseikonia was associated with MH size and the defect length of ELM.

Relationship between metamorphopsia and foveal microstructure in patients with branch retinal vein occlusion and cystoid macular edema.

PURPOSE: We aimed to investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients with cystoid macular edema caused by branch retinal vein occlusion (BRVO-CME). METHODS: The study included 30 eyes of 30 patients with BRVO-CME. We examined visual acuity and the severity of metamorphopsia using M-CHARTS. Central foveal thickness, central retinal thickness at the fovea (CRT-1 mm), and macular volume were measured with SD-OCT software. The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated. RESULTS: The mean metamorphopsia score was 0.77 ± 0.50, with 28 of 30 patients (93 %) having metamorphopsia (metamorphopsia score ≥ 0.2). The vertical metamorphopsia score (0.89 ± 0.54) was significantly higher than the horizontal metamorphopsia score (0.64 ± 0.53) (p < 0.005). The status of EZ and ELM was significantly associated with visual acuity, but not with the mean metamorphopsia score. The mean metamorphopsia score was significantly related to CRT-1 mm (p < 0.05) and the presence of inner retinal cyst (p < 0.05). CONCLUSIONS: The severity of metamorphopsia was significantly associated with central retinal thickness and the presence of inner retinal cyst.