Ocular syphilis masquerading as refractory retinal diseases.

PURPOSE: To report two cases of syphilis masquerading as chronic refractory macular diseases. CASE DESCRIPTIONS: Two patients had been diagnosed with neovascular age-related macular degeneration (neovascular AMD) and diabetic macular edema (DME), respectively. The disease worsened despite repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) and also surgical treatment (in suspected case of DME). Systemic evaluations were positive for syphilis. Intravenous penicillin was started, and the macular diseases improved. The lesions were well controlled afterward. CONCLUSIONS: The current two cases demonstrated that ocular syphilis can masquerade as refractory chronic retinal diseases such as DME and neovascular AMD. Laboratory evaluations for syphilis may be needed, not only for uveitis but also for refractory retinal diseases. Indocyanine green angiography may be helpful to reveal occult syphilis.

Case series of neuroretinitis in Korea.

BACKGROUND: To present the clinical characteristics of neuroretinitis in Korea. METHODS: Twelve patients with neuroretinitis between January 2009 and September 2020 were retrospectively reviewed. Neuroretinitis was diagnosed based on fundus findings, optical coherence tomography, and fluorescein angiography. The serological findings of each patient were reviewed. RESULTS: Fifteen eyes of 12 patients (9 male and 3 female), with a mean age of 46.0 ± 10.7 years were included. Of the nine patients who underwent serological testing for Toxocara antibodies, six (66.6%) were positive. One patient had high titers of Toxoplasma immunoglobulins M and G. One patient diagnosed with dengue fever was suspected to have neuroretinitis in both eyes. There were no related abnormalities in the serological findings in four patients (33.3%) out of 12 patients. There were no suspected cases of cat-scratch disease. The six patients who were positive for Toxocara antibodies were older (mean age: 54.5 ± 9.1 years) than the others (mean age: 37.5 ± 4.4 years, p = 0.004). The four patients without any abnormal serological findings were relatively younger (mean age: 35.7 ± 3.0 years) than the other 8 patients (mean age: 51.1 ± 10.1 years, p = 0.008). CONCLUSIONS: Two-thirds of neuroretinitis patients were seropositive for Toxocara in the current cohort from Koreans. Causative factors in cases of neuroretinitis may vary according to age and region.

Diagnosis of posterior staphyloma using the radius of steepest curvature among retinal pigment epithelium segmentation line measured by optic coherent tomography.

PURPOSE: To investigate a novel marker to diagnose posterior staphylomas by measuring the radius of the steepest curvature on the retinal pigment epithelium (RPE) segmentation line using optical coherence tomography (OCT). STUDY DESIGN: Retrospective Cross-sectional Study. METHODS: The authors developed a prototype software to measure the radius of curvature on the RPE segmentation line of OCT. Twelve images of 9-mm radial OCT scans were used. The radius of curvature was measured at the steepest area of the RPE segmentation line, and the macular curvature (MC) index was calculated based on its reciprocal. Based on the wide-field fundus findings, the study sample was divided into three groups: definite posterior staphyloma, no posterior staphyloma, and undetermined. The differences of MC index among the groups and the correlation between the MC index, age, and axial length were analyzed. RESULTS: The present study analyzed 268 eyes, with 54 (20.1%) with definite posterior staphyloma, 202 (75.4%) with no posterior staphyloma, and 12 (4.5%) with undetermined disease status. A maximum MC index of 37.5 was observed in the group with no posterior staphyloma, which was less than the minimum MC index of 42.7 observed in the group with definite posterior staphyloma. The MC index had strong correlations with the axial length and age in eyes with high myopia. CONCLUSIONS: Eyes with posterior staphyloma have a steeper curvature than those with radius 8.44 mm, while eyes without posterior staphyloma do not. MC index 40 (radius 8.44 mm) might act as a reference to distinguish between those with and those without posterior staphyloma.

Case series of branch retinal vein occlusion secondary to rhegmatogenous retinal detachment and its surgical management.

BACKGROUND: To review cases of branch retinal vein occlusion (BRVO) secondary to rhegmatogenous retinal detachment (RRD) and its surgical management and presume their mechanism. METHODS: Medical records of patients who underwent surgery for RRD between 2015 and 2019 at a single tertiary care center were retrospectively reviewed. New BRVO secondary to RRD or its surgical procedure was diagnosed based on the fundus examination and its clinical course. RESULTS: A total of 734 RRD surgeries were performed for five years, and six cases of new BRVOs were noticed in the first year after surgery (incidence was 0.68%: six cases of BRVO / 734 cases of surgical RRD); five cases occurred after vitrectomy, and one occurred after scleral buckling. In three cases, retinal veins were presumed to already be partially occluded related due to a kink of the retinal vein seen before surgery. In the other three cases, the retinal veins were presumed to have incurred damage during vitrectomy. CONCLUSION: In the present cohort, RRD or its related procedures caused BRVO within a year of surgery at an incidence of 0.68%. The proposed mechanisms are kinks of the retinal vein on the detached retina and damage to the retinal vein during vitrectomy.

SQUARE GRID DEFORMATION ANALYSIS OF THE MACULA AND POSTOPERATIVE METAMORPHOPSIA AFTER MACULAR HOLE SURGERY.

PURPOSE: To investigate the correlation between postoperative metamorphopsia and macular deformation after macular hole surgery. METHODS: This study included 28 eyes of 28 patients who underwent vitrectomy and internal limiting membrane removal for an idiopathic macular hole. The retinal vasculatures were compared between preoperative and postoperative photographs, and postoperative deformation of the macula was assessed as deformation of the square grid. The displacement of each node was measured, and deformation of the grid was calculated as differences in the coordinates of the adjacent nodes. These parameters were analyzed to find correlation with metamorphopsia measured using the M-charts after 6 postoperative months. RESULTS: The average deformations in the vertical and horizontal lines of the grid were 94.29 µm and 49.72 µm, respectively. Perifoveal deformation was significantly greater than parafoveal deformation (P = 0.001∼0.019). The multiple regression analysis demonstrated that the vertical M-score correlated with superior perifoveal deformation of the vertical line on the fovea (P = 0.036), and the horizontal M-score correlated with temporal perifoveal deformation of the horizontal line on the fovea (P = 0.032). CONCLUSION: The parafoveal tissue was displaced with the fovea concurrently after internal limiting membrane removal in macular hole surgery causing perifoveal deformation, which correlated with postoperative metamorphopsia.

Perioperative intraretinal fluid observed using optical coherence tomography in the epiretinal membrane.

BACKGROUND: Postoperative intraretinal fluid (IRF) is reportedly associated with visual outcomes after epiretinal membrane (ERM) surgery. However, preoperative IRF is common, and persistent IRF would have different impact on visual function from postoperative newly developed IRF. Therefore, we aimed to investigate the incidence rate and clinical implications of perioperative IRF in ERM. METHODS: Medical records of patients who underwent vitrectomy for idiopathic ERM between January 2014 and January 2017 were reviewed retrospectively. The incidence of IRF was analyzed using optical coherence tomography preoperatively and 1, 3, and 6 months postoperatively. On the basis of the presence or absence and the time of detection of IRF, patients were divided into three groups, namely preoperative IRF group, New IRF group, and IRF(-) group. Correlations of various parameters including age, sex, baseline visual acuity (VA), central subfield macular thickness, lens status, and surgical factors with IRF, along with the effect of IRF on VA, were evaluated. RESULTS: This study included 155 eyes from 155 patients. Thirty-six (23.2%) and 49 (31.6%) eyes demonstrated preoperative and newly developed IRF, respectively. Seventy eyes (45.2%), which did not exhibit IRF during the study period, were assigned to the IRF(-) group. At baseline, the IRF(-) group showed a better VA than the other two groups. Postoperatively, VA improved significantly in all three groups. There was no difference in VA between the IRF(-) and new IRF groups at 6 months; however, the preoperative IRF group had significantly lower VA than the other two groups. CONCLUSION: IRF associated with ERM was frequently observed preoperatively and postoperatively, but it did not prevent postoperative vision improvement. Preoperative IRF was related to lower postoperative vision improvement.

Enlargement of polypoidal choroidal vasculopathy lesion without exudative findings assessed in en face optical coherence tomography images.

PURPOSE: This study aimed to investigate growth of polypoidal choroidal vasculopathy (PCV) without exudative findings assessed in en face optical coherence tomography (OCT) images and its clinical implications. METHODS: Fifty patients who were diagnosed with PCV and had no disease activity after treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) were included. Patients were followed up for at least 12 months. Measurement of best-corrected visual acuity and volume scan using swept-source OCT was performed at each visit. The neovascular area of PCV was assessed using en face OCT. Growth group comprised patients who showed increase in neovascular area in the en face images without exudative findings. The main outcome measure was relationship between growth of PCV and recurrence. RESULTS: Among 50 eyes of 50 patients with average age of 68.5 ± 8.6 years, 25 (50%) eyes were included in the growth group. Exudative recurrence was noted more frequently in the growth group (18 eyes, 72%) than in the non-growth group (6 eyes, 24%, P = .002, odds ratio = 8.143). More injections were performed in the growth group (4.7 ± 2.1 vs. 1.9 ± 2.4, P = .002), but there was no difference in visual acuity at 1 year. After an exudative recurrence following the lesion growth, more frequent injections were required than before the recurrence to achieve no disease activity (P = .002). CONCLUSION: PCV lesion growth without fluid preceded exudative recurrence and worsening of response to anti-VEGF treatment.

INSTRUMENTAL DIFFERENCE IN ASSESSING CHOROIDAL HYPERPERMEABILITY AND PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To investigate the difference in choroidal hyperpermeability (CH) assessed using digital fundus camera (DFC) and scanning laser ophthalmoscope (SLO) and its effect on photodynamic therapy (PDT) outcomes in chronic central serous chorioretinopathy. METHODS: Midphase indocyanine green angiography (ICGA) images were acquired using both DFC and SLO in 38 consecutive eyes with chronic central serous chorioretinopathy in this retrospective study. Scanning laser ophthalmoscope-ICGA was taken immediately after DFC-ICGA. Photodynamic therapy was applied to the area of CH associated with subretinal fluid (CH-SRF). The main outcome measures included the areas of CH in the macula and CH-SRF, resolution of SRF, and change in the best-corrected visual acuity. RESULTS: Areas of CH (5.187 ± 2.625 mm vs. 3.170 ± 1.661 mm, P < 0.001) and CH-SRF (2.315 ± 1.111 mm vs. 1.465 ± 0.709 mm, P < 0.001) were greater in DFC than in SLO. Sixteen eyes underwent DFC ICGA-guided PDT (DFC-PDT group) and 22 underwent SLO ICGA-guided PDT (SLO-PDT group). Subretinal fluid resolution at 12 months was 100.0% and 90.9% in the DFC-PDT and SLO-PDT groups, respectively, without statistical differences. The improvement of best-corrected visual acuity was earlier in the SLO-PDT group than in the DFC-PDT group (3 months, P = 0.002 vs. 6 months, P = 0.003), but the final best-corrected visual acuity showed no difference. CONCLUSION: In chronic central serous chorioretinopathy, larger areas of CH and CH-SRF were observed with DFC than with SLO, which caused the ophthalmologists performing ICGA-guided PDT to determine a larger laser spot. This seemed to affect the time of visual recovery, but not the final outcome.

ASSOCIATION BETWEEN TANGENTIAL CONTRACTION AND EARLY VISION LOSS IN IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane. METHODS: Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk-fovea-vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography. RESULTS: We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P < 0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (ρ = 0.657; P = 0.008) and traction index of membrane (ρ = -0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P < 0.001, both). CONCLUSION: Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.

TREAT-AND-EXTEND REGIMEN USING RANIBIZUMAB FOR POLYPOIDAL CHOROIDAL VASCULOPATHY: One-Year Results.

PURPOSE: To investigate the efficacy of a treat-and-extend regimen (TER) using ranibizumab to treat polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively reviewed the medical records of 29 patients with PCV, who had been treated with a TER for 1 year. The primary outcome was the proportion of eyes that did not lose ≥3 best-corrected visual acuity (BCVA) lines. The number of intravitreal injections and recurrences as well as the maximum treatment interval without recurrence were analyzed. RESULTS: The mean BCVA improved from 0.64 ± 0.42 logMAR (median, 20/80) at baseline to 0.30 ± 0.31 logMAR (median, 20/30) at 12 months (P < 0.001). The mean central subfield macular thickness improved from 307.0 ± 70.2 µm to 237.5 ± 64.4 µm (P < 0.001). None of the subjects lost ≥3 lines, and 15 (51.7%) gained ≥3 lines. The mean number of injections was 7.0. The mean maximum treatment interval without recurrence was 10.0 weeks. After the loading phase, 12 eyes (41.4%) showed no recurrence. Seven eyes (24.1%) demonstrated disease activity at 12 months, and 4 (13.8%) of them were never dry during the entire 12-month follow-up duration. CONCLUSION: The TER effectively improved visual acuity in PCV while reducing the number of injections.

TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

PURPOSE: To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. METHODS: This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. RESULTS: The average displacement was 57.2 µm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 µm) than in the outer ring (35.3 µm, P < 0.001), and larger in the temporal sectors than in the corresponding nasal sectors (P ≤ 0.008). Inferior and superior displacement was noted in the superior and inferior sectors, respectively. Multiple regression analysis revealed that basal horizontal macular hole diameter and size of internal limiting membrane removal were independent factors of displacement. CONCLUSION: The macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes.

PURPOSE: The aim of this study was to evaluate the efficacy of the perfluoro-n-octane-assisted single-layered inverted internal limiting membrane (ILM) flap for large macular holes (MHs). METHODS: We reviewed idiopathic MHs >400 µm. The patients were divided into ILM peeling (group P, 51 eyes) and ILM flap (group F, 41 eyes). Closure of MHs, best-corrected visual acuity (BCVA), and postoperative optical coherence tomography findings were analyzed. RESULTS: MH closure was achieved in 88.2% in group P and in 100% in group F (p = 0.032). SF6 and air was used most frequently in groups P and F, respectively. Both had a significant improvement in BCVA, which was better in group F until 3 months, but not at 6 months. At 6 months, the ellipsoid zone and external limiting membrane were restored with no significant difference. CONCLUSION: The single-layered inverted ILM flap was better for the closure of large MHs than ILM peeling, without using long-acting gas that prevents early rehabilitation.

Ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer: a case report.

BACKGROUND: This report details ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer. CASE PRESENTATION: The patient presented with scleritis, which did not improve with systemic steroid. Intraocular pressure was elevated, and well demarcated hyper-reflective round lesion were noted in both eyes. He had a history of general ache and concurrent onset of ocular symptoms the day after eating raw meat. Systemic work-ups revealed no remarkable abnormalities except antibody for toxocara. Oral albendazole and steroid were prescribed. The inflammation and swellings resolved without recurrence. In the current case, scleritis with suspect granuloma in the nerve fiber layer seems to be caused by toxocara. CONCLUSION: Ocular toxocariasis can be presented as atypical features. Serologic exams for toxocariasis would be considered not only in typical features but also in other uveitis or scleritis, particularly when the patient has a related history.

Comparison of the most common isolates of postoperative endophthalmitis in South Korea; Enterococcus species vs coagulase-negative staphylococci.

BACKGROUND: To compare the related factors or manifestations of the two most common isolates of post-operative endophthalmitis, which were Enterococcus spp. and coagulase-negative staphylococci (CNS) in South Korea. METHODS: Medical records were reviewed for cases of post-operative endophthalmitis caused by Enterococcus spp. and CNS at eight institutions between January 2004 and July 2010. Various factors including age, sex, residence, systemic diseases, smoking and drinking history, and best corrected visual acuity, and length of time between causative intraocular surgery and symptom development were compared between the two groups. RESULTS: The total number of post-operative endophthalmitis cases was 128 and in 116 cases, microbiological culture tests from the aqueous humor or vitreous were performed. Among these cases, 67 (57.8%) were culture proven. Among these 67 cases, 19 (28.4%) were caused by Enterococcus spp., 14 (20.9%) were caused by Staphylococcus epidermidis endophthalmitis, and 5 (7.5%) were caused by other CNS spp. Age, sex, causative procedure, past medical history, social history, and laterality were not different in the two groups. Mean initial and final visual acuity were significantly worse in the Enterococcus spp. endophthalmitis group than in the CNS group (p = 0.049, 0.042, respectively). Length of time between the causative procedure and symptom development was significantly shorter in cases of Enterococcus spp. endophthalmitis (p = 0.004). CONCLUSIONS: Enterococcus spp. induce more severe and rapid-onset postoperative endophthalmitis than CNS. Infectious endophthalmitis developed within 2 days after cataract operation could be caused by Enterococcus spp. and have chance to be poor prognosis in South Korea.

The effects of vascular endothelial growth factor (VEGF) on human orbital preadipocyte.

PURPOSE: To investigate the presence of the Vascular Endothelial Growth Factor (VEGF) and its receptor (VEGFR) in human orbital preadipocytes, and to evaluate the effect of VEGF on human orbital preadipocyte differentiation and adipogenesis in vitro. RESULTS: Four isoforms of VEGF (VEGF121, 155, 189, and 206), VEGFR-1, VEGF-2, and neuropilin-1 were expressed in human orbital preadipocytes. Treatment with 100 ng/ml VEGF induced higher expressions of C/EBPα and LPL than the non-treated control (p = 0.03 and p = 0.01) or treatment with 50ng/ml (p = 0.04 for both). At both concentrations VEGF enhanced the accumulation of intra-cytoplasmic lipid versus the control, and treatment with 100 ng/ml VEGF induced more lipid accumulation than treatment with 50 ng/ml VEGF (p = 0.03). CONCLUSIONS: VEGF and VEGFR were observed in human orbital preadipocytes, and exogenous VEGF enhanced adipogenesis in these cells. These results suggest that VEGF plays a role as an autocrine or paracrine growth factor during human orbital preadipocyte differentiation.

Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study.

BACKGROUND: To investigate clinical features of infectious endophthalmitis over five years in a South Korean population. METHODS: Medical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed. RESULTS: A total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006~2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only. CONCLUSIONS: Our study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery.

PURPOSE: To investigate the correlation of visual acuity with the ganglion cell layer and the photoreceptor layer using spectral-domain optical coherence tomography after surgery for idiopathic epiretinal membrane (ERM). METHODS: The medical records of 58 eyes were reviewed retrospectively to collect data on visual acuity (VA), ganglion cell complex thickness (GT) and photoreceptor reflectivity (PR) at baseline, 3 months, and 6 months after surgery. The GT was adjusted to compensate for tractional thickening by calculating the proportional thickness to the macular thickness (MT). The PR was adjusted to compensate for the shadowing effects from the inner retina, which was achieved by calculating the ratio to the retinal pigment epithelium reflectivity (RR). The relative GT (RGT = GT/MT) and relative PR (RPR = PR/RR) were analyzed to determine their correlation with visual acuity. RESULTS: The GT was segmented correctly in 13 eyes at baseline, and in all eyes after surgery. The RGT and RPR were significantly lower than the normal eye. Thinner RGT correlated with poorer VA at 3 months (R = -0.352, p = 0.007) and 6 months (R = -0.324, p = 0.013), but the RPR had correlation with visual acuity only at 6 months (R = -0.377, p = 0.004). The area under the receiver operating characteristic curve was significant for VA ≥ 20/30 in both the RGT and RPR, and this significance was present for visual acuity ≥ 0/25 only in the RGT. CONCLUSIONS: The postoperative ganglion cell layer was found to be correlated to postoperative VA more consistently than the photoreceptor layer after ERM surgery. The outer retinal damage was a determining factor in the poor VA group.

Comparison of scleral buckling and vitrectomy using wide angle viewing system for rhegmatogenous retinal detachment in patients older than 35 years.

BACKGROUND: To compare scleral buckling (SB) and pars plana vitrectomy (PPV) using a wide angle viewing system (WAVS) for uncomplicated phakic rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated phakic RRD were retrospectively reviewed. Eyes with pseudophakic or attached fovea were excluded. Patients treated with SB were classified as group B, and PPV using WAVS as group V. Primary success rate, visual acuity (VA), macular complications, and sustained subretinal fluid (SRF) were compared between groups. RESULTS: Seventy-two eyes were included in group B and 57 eyes in group V. Group B had better preoperative VA (1.38 ± 0.87 vs 1.84 ± 0.97 in LogMAR, P = 0.010), but worse final VA (0.51 ± 0.48 vs 0.30 ± 0.23, P = 0.012) than group V. The primary success rate of 94.7 % in group V was higher than 77.8 % in group B (P = 0.010). Final success rate was 100 % in both groups. There was no significant difference in macular complications between groups (P = 0.087). Sustained SRF was found in 22 eyes in group B (38.6 %), while only two eyes in group V exhibited sustained SRF (2.8 %, P < 0.001). CONCLUSIONS: Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Changes in Visual Acuity after Idiopathic Epiretinal Membrane Removal: Good versus Poor Preoperative Visual Acuity.

PURPOSE: To investigate postoperative visual acuity changes following idiopathic epiretinal membrane (ERM) surgery as well as investigate the relationship between outcome and baseline visual acuity. METHODS: The medical records of 159 consecutive eyes were retrospectively reviewed for best corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and the ellipsoid zone (EZ) signal of the photoreceptor layer at baseline and 1, 3, and 6 months after surgery. Patients were divided into two groups: group A, with good vision of 20/50 or better, and group B, with poor visual acuity worse than 20/50. RESULTS: Seventy-nine eyes were included in group A and 80 eyes in group B. Mean baseline BCVA was 0.28 and 0.65 logarithm of the minimum angle of resolution (logMAR), and the mean baseline CSMT was 423.7 and 505.6 µm in group A and group B, respectively. In group A, BCVA worsened to 0.39 logMAR at 1 month (p < 0.001) and gradually improved to 0.25 logMAR at 6 months, which was not different from baseline BCVA. In group B, BCVA and CSMT improved at 1, 3, and 6 months (p < 0.05). The EZ signal improved in group B (p = 0.003) but not in group A. The area under the receiver operating characteristic curve for the improvement in BCVA of ≥ 2 lines was significant for preoperative BCVA (0.717, 95% confidence interval 0.638-0.797; p < 0.001). The cutoff value was 0.35 on the logMAR scale. CONCLUSION: After ERM surgery, patients with good vision maintained visual acuity after temporary worsening of vision, and patients with poor vision achieved significant BCVA improvement.

Regional Choroidal Thickness Changes in Branch Retinal Vein Occlusion with Macular Edema.

PURPOSE: To investigate regional changes in choroidal thickness in branch retinal vein occlusion (BRVO) patients with macular edema. METHODS: Choroidal thickness in the subfoveal, occlusive, and nonocclusive areas in BRVO eyes was measured using enhanced depth imaging by spectral domain optical coherence tomography. The choroidal thickness was compared with the corresponding values both in the fellow eye and in normal controls at baseline. Regional changes in choroidal thickness were then evaluated in the BRVO eyes after intravitreal bevacizumab (IVB) injections. RESULTS: Regional choroidal thickness was measured in 57 eyes at baseline. The mean choroidal thickness of the occlusive area was significantly higher than that of the nonocclusive, subfoveal, and corresponding areas in the fellow eyes and normal controls (p < 0.001). The choroidal thickness in the occlusive area correlated with the retinal thickness in both the central and occlusive areas (rho = 0.590, p < 0.001, and rho = 0.351, p = 0.011, respectively), but not with visual acuity. After IVB, the choroidal thickness in the occlusive area had decreased significantly (p = 0.004), but remained higher than that of other areas (p < 0.001 and p = 0.026). CONCLUSION: In acute BRVO eyes, the choroid is thicker in the occlusive area. This difference is correlated with the severity of macular edema, but not with visual acuity. Bevacizumab reduces choroidal thickness, but does not restore normal values.