COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM AT PEDIATRIC AGE: Surgical Versus Conservative Approach.

PURPOSE: To report outcomes of pediatric patients with combined hamartoma of the retina and the retina pigment epithelium followed up conservatively or after pars plana vitrectomy. METHODS: This retrospective multicenter study included 62 eyes of 59 pediatric patients with combined hamartoma of the retina and the retina pigment epithelium from 13 different international centers with an average age of 7.7 ± 4.7 (0.3-17) years at the time of the diagnosis and having undergone pars plana vitrectomy or followed conservatively. At baseline and each visit, visual acuity values, optical coherence tomography for features and central foveal thickness, and tumor location were noted. Lesions were called as Zone 1, if it involves the macular and peripapillary areas, and the others were called as Zone 2 lesions. RESULTS: Twenty-one eyes of 20 patients in the intervention group and 41 eyes of 39 patients in the conservative group were followed for a mean of 36.2 ± 40.4 (6-182) months. Best-corrected visual acuity improved in 11 (68.8%) of 16 eyes in the intervention group and 4 (12.9%) of 31 eyes in the conservative group ( P < 0.001). The mean central foveal thickness decreased from 602.0 ± 164.9 µ m to 451.2 ± 184.3 µ m in the intervention group, while it increased from 709.5 ± 344.2 µ m to 791.0 ± 452.1 µ m in Zone 1 eyes of the conservative group. Posterior location of tumor, irregular configuration of the foveal contour and ellipsoid Zone defect in optical coherence tomography, subretinal exudate and prominent vascular tortuosity were associated with poor visual acuity. CONCLUSION: Vitreoretinal surgery is safe and effective in improving vision and reducing retinal distortion in Zone 1 combined hamartoma of the retina and the retina pigment epithelium in children.

QUANTITATIVE ASSESSMENT OF THE FOVEAL AVASCULAR ZONE USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER SURGERY FOR IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To investigate, using optical coherence tomography angiography, the foveal avascular zone (FAZar), the FAZ perimeter (FAZp), the acircularity index of the FAZ (FAZai), and the density of vessels surrounding the FAZ (FAZvd) before and after idiopathic epiretinal membrane surgery, and associations of these parameters with postoperative best-corrected visual acuity, letter score gain, and central foveal thickness. METHODS: We retrospectively reviewed preoperative and postoperative (sixth month) medical records of 28 eyes of 28 patients who undergone epiretinal membrane surgery and had an intact ellipsoid zone. RESULTS: There were significant increases in best-corrected visual acuity, FAZar, and FAZp and decreases in central foveal thickness and FAZai (all P < 0.05). Postoperative best-corrected visual acuity was not significantly correlated with any preoperative parameters. Postoperative letter score gain and central foveal thickness correlated negatively with preoperative FAZar and preoperative FAZp (all P < 0.05). Multivariable linear regression analysis revealed that preoperative FAZp was independently associated with postoperative letter score gain (P < 0.05). CONCLUSION: The FAZ enlarges and becomes more circular after epiretinal membrane surgery. Postoperative best-corrected visual acuity is not associated with any FAZ parameters. In eyes with an intact foveal ellipsoid zone, especially a smaller preoperative FAZp is associated with more postoperative letter score gain.

Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice.

PURPOSE: To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings. METHODS: We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT. RESULTS: The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P = 0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001). CONCLUSIONS: Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.

MACULAR TELANGIECTASIA TYPE 2: Acircularity Index and Quantitative Assessment of Foveal Avascular Zone Using Optical Coherence Tomography Angiography.

PURPOSE: The purpose of this study was to investigate the foveal avascular zone area and its perimeter, the acircularity index of the foveal avascular zone, the vessel density surrounding the foveal avascular zone, and the vessel density in the foveal, parafoveal, and perifoveal areas and their associations with best-corrected visual acuity, central foveal average thickness, and volume of ellipsoid zone-retinal pigment epithelium in patients with macular telangiectasia Type 2 (MacTel 2). METHODS: We retrospectively reviewed medical records of 22 eyes of 22 patients with MacTel 2 and 24 eyes of 24 healthy controls. Eyes with MacTel 2 were graded according to optical coherence tomography angiography: 1) vascular anomalies temporal to the fovea; 2) vascular anomalies temporal and nasal to the fovea; 3) markedly diffuse circumferential vascular anomalies; and 4) neovascularization in the outer retina. RESULTS: Acircularity index was higher and superficial-parafoveal vessel density was lower, in MacTel 2 group (all P < 0.05). Acircularity index was associated with the severity of the disease and had strong correlations with best-corrected visual acuity, ellipsoid zone-retinal pigment epithelium thickness, and ellipsoid zone-retinal pigment epithelium volume (all P < 0.05). CONCLUSION: In conclusion, the increase in acircularity index is correlated with the severity of the disease, the decrease in ellipsoid zone-retinal pigment epithelium thickness and volume, and the decrease in best-corrected visual acuity. It may be used to monitor patients with MacTel 2.

Factors associated with macular complications in highly myopic eyes with dome-shaped macular configuration.

PURPOSE: To investigate the associations between macular complications and demographic, clinical, and optical coherence tomography characteristics (OCT) of highly myopic eyes with a dome-shaped macula (DSM). METHODS: We retrospectively analyzed the findings of 90 patients (167 eyes) with DSM who had vertical and horizontal OCT scans between January 2011 and June 2018. Demographic data, clinical characteristics, and OCT-derived morphologic parameters were determined, and the associations of these parameters with macular complications were evaluated. RESULTS: Among 167 eyes, the following patterns were observed: horizontally oriented DSM (71%), symmetric DSM (27%), and vertically oriented DSM (2%). Complications or abnormalities involving the macular area were detected by OCT in 63% (106/167) of the eyes. Specific complications were as follows: choroidal neovascularization (CNV) (37.1%), macular retinoschisis (9.0%), serous retinal detachment (RD) (7.8%), epiretinal membrane (4.2%), lamellar macular hole (3.0%), and macular hole (2.4%). The eyes with CNV had thinner choroid (P < 0.001) and lower macular bulge height (P = 0.04). The eyes with serous RD had thicker choroid (P < 0.001) and higher macular bulge height (P < 0.001). Serous RD was significantly more common when the macular height was greater than 250 µm (P = 0.001) and if the DSM pattern was vertical (P < 0.001). CONCLUSIONS: A greater bulge height and thicker choroid in highly myopic eyes with DSM may be protective against the development of myopic CNV. A thicker choroid, a higher macular bulge (> 250 µm), and a vertical DSM pattern are associated with a risk of developing serous RD.

OUTCOMES OF VITRECTOMY WITH SILICONE OIL TAMPONADE FOR MANAGEMENT OF RETINAL DETACHMENT IN EYES WITH CHORIORETINAL COLOBOMA.

PURPOSE: To estimate the outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy and silicone oil tamponade. METHODS: A retrospective chart review of 10 eyes (10 patients) who underwent pars plana vitrectomy for retinal detachment with chorioretinal coloboma. RESULTS: The average age at the time of the surgery was 29.8 ± 19.7 years. The mean follow-up period was 28.8 ± 28.4 months. The mean silicone oil tamponade duration was 9.8 ± 3.5 weeks. Of 10 eyes, 4 (40%) had retinal breaks outside the coloboma, 4 (40%) had breaks inside the coloboma, 1 (10%) had breaks inside and outside the coloboma, and in 1 eye (10%); the causative retinal break was not localized. Preoperatively, the mean visual acuity was 20/2,500 (n = 9), and 1 (10%) was recorded as "Not CSM." At the final examination, the mean visual acuity for the patients with measurable visual acuity was 20/200 (P = 0.06), and in the remaining eye was recorded as light perception. The retina was finally reattached in nine eyes (90%). Postoperative complications included cataract in three (30%), persistent elevated intraocular pressure in one (10%), band keratopathy in one (10%), and proliferative vitreoretinopathy in one (10%). CONCLUSION: Complete pars plana vitrectomy with or without lensectomy, laser photocoagulation around the peripheral retina, around all the peripheral breaks and around the colobomatous area, and silicone oil tamponade is effective for retinal detachment in eyes with chorioretinal coloboma. Silicone oil removal as early as possible did not increase the risk of redetachment and seems to reduce the incidence of oil-related complications in such cases.

Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment.

PURPOSE: To compare the outcomes of phakic and pseudophakic uncomplicated rhegmatogenous retinal detachment (RRD) treated with primary pars plana vitrectomy (PPV) and short-term silicone oil (SO) tamponade. METHODS: A retrospective chart review of 201 eyes (185 patients) with uncomplicated RRD treated with primary 23-gauge PPV and short-term SO tamponade. Anatomical success was defined as a reattached retina for at least 6 months after SO removal. RESULTS: The analysis consisted of 111 phakic eyes and 90 pseudophakic eyes. The mean duration of SO tamponade in phakic eyes was 8.5 ± 1.9 and in pseudophakic eyes was 8.3 ± 1.9 weeks [corrected] (P = 0.39). The primary reattachment rate was 93% in the phakic group and 98% in the pseudophakic group (P = 0.19). The mean Snellen VA equivalent at the final visit was 20/30 in both groups. Final VA ≥ 20/40 was achieved in 81% of phakic and 86% of pseudophakic eyes (P = 0.69). Postoperative complications included cataract in the phakic group (100%), transient elevation of intraocular pressure (IOP) (29%), epiretinal membrane (8%), proliferative vitreoretinopathy (7%), cystoid macular edema (3%), secondary macular hole (2%), persistent elevation of IOP (1.5%), and persistent hypotony (1%). CONCLUSIONS: The success rates and functional outcomes of primary 23-gauge PPV with short-term SO tamponade did not differ significantly between the two groups, suggesting that lens status is not the single most important factor influencing the final results. The use of short-term SO was not associated with keratopathy, visual loss without any apparent reason and high rates of chronic elevation of IOP or redetachment following SO removal.

Correction to: Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment.

Dear editor and readers, this letter is written to make you aware that the original version of this article unfortunately contained a mistake.

Long-term follow-up of pachychoroid pigment epitheliopathy and lesion characteristics.

AIMS: To investigate conversion of pachychoroid pigment epitheliopathy (PPE) lesions and the development of other pachychoroid spectrum diseases in patients with PPE during follow-up. METHODS: We retrospectively reviewed medical records of 46 eyes of 44 patients who had a diagnosis of PPE and were followed up for at least 3 years. RESULTS: Eyes with PPE (17.4%) developed central serous chorioretinopathy (CSC), and none developed pachychoroid neovasculopathy or polypoidal choroidal vasculopathy. Of 74 initial PPE lesions, 21.6% were retinal pigment epithelium (RPE) thickening, 36.5% were pigment epithelium detachment (PED), and 41.9% were RPE elevation with microbreak appearance (REwM). Five (62.5%) of the eight initial PPE lesions progressing to CSC were REwM. Two developed directly from the REwM and three REwMs transformed to PED first, and then progressed to CSC. Three initial PEDs progressed to CSC. REwMs can also transform to PED and RPE thickening. No initial PEDs or RPE thickenings transformed to a REwM. Of the new PPE lesions, 60% were REwM, 26.7% were PEDs, and 13.3% were RPE thickening. CONCLUSION: The smallest PPE lesion that can be detected is a REwM of RPE. It may be the precursor lesion for pachychoroid spectrum disease, but further large-scale prospective studies are required.

Anatomical and functional outcomes following vitrectomy for dense vitreous hemorrhage related to Terson syndrome in children.

PURPOSE: Our purpose was to assess anatomical and functional outcomes of vitrectomy in pediatric cases of Terson syndrome. METHODS: A total of 11 eyes of seven children diagnosed with Terson syndrome secondary to traumatic brain injury and 17 eyes of 12 children diagnosed with Terson syndrome secondary to nontraumatic brain hemorrhage who had 20-gauge or 23-gauge pars plana or pars plicata vitrectomy were included in this retrospective study. The primary outcome was the change in visual acuity from the preoperative examination to postoperative final follow-up. Secondary outcomes were anatomic surgical success and postoperative complications. RESULTS: The mean time between diagnosis and surgery was 62 ± 35 days (range, 30-150), and the average age at the time of the surgery was 4.5 ± 6.4 years (range, 3 months to 17 years). The mean preoperative logarithm of the minimum angle of resolution (logMAR) (Snellen) best corrected visual acuity (BCVA) was 2.6 ± 0.7 (20/7260) (n = 9) and in the remaining 19 eyes it was recorded as noncentral, unsteady, nonmaintained fixation. The mean follow-up period was 50 ± 54 months (range, 12-192 months). At the last follow-up visit, the mean logMAR BCVA was 0.46 ± 0.6 (20/60) (n = 19) and in eight eyes it was recorded as fix-and-follow. One eye developed a retinal detachment 14 months after the first operation, and one eye developed an epiretinal membrane after 2 years. Anatomical success was recorded in all patients at the final visit. CONCLUSIONS: In children with massive vitreous hemorrhage secondary to Terson syndrome, vitrectomy is an effective procedure and offers a rapid visual improvement. Earlier surgical treatment prevents amblyopia and blood-related potential complications.

Functional and anatomical outcomes following surgical management of persistent fetal vasculature: a single-center experience of 44 cases.

PURPOSE: To investigate the functional and anatomical outcomes following surgical management of persistent fetal vasculature (PFV). METHODS: Single-center, retrospective, interventional consecutive case series of 41 patients (44 eyes) who underwent vitrectomy with or without lensectomy through a limbal or pars plana/plicata approach with diagnosis of anterior, posterior, or combined anterior and posterior segment PFV were included. RESULTS: The median age at the time of surgery was 3 months (range, 1-36 months), and the mean follow-up period was 37.2 ± 38.1 months (range, 12-164 months). Of the 44 eyes, 5 (11%) had clinical and ultrasonographic findings of anterior PFV, 5 (11%) had posterior PFV, and 34 (78%) had components of both anterior and posterior disease. At the last visit, 38 eyes (87%) were aphakic, 5 eyes (11%) were phakic, and 1 eye (2%) was pseudophakic. The mean Snellen equivalent VA at the final visit for the 14 (32%) eyes with measurable VA was 20/283. Nine (20%) eyes had final VA of only light perception or no light perception. The remaining 21 (48%) eyes behaved consistently with form vision, but the patients were not able to report VA. CONCLUSIONS: Most of the eyes achieved at least form vision, with acceptable postoperative complication rates. Functional and anatomical outcomes are not strictly dependent on axial length, and microphthalmic eyes with mild posterior segment involvement have the potential for good visual results. Outcomes after surgery for posterior PFV associated with tractional retinal detachment are limited. Anatomical success does not always equate to functional improvement.

OUTER NUCLEAR LAYER THINNING IN PACHYCHOROID PIGMENT EPITHELIOPATHY.

PURPOSE: To compare the average thicknesses of central inner retinal layers in eyes with pachychoroid pigment epitheliopathy (PPE), with uncomplicated pachychoroid (UCP), and of healthy subjects. METHODS: Medical records of patients with PPE and UCP were retrospectively reviewed. Twenty-nine eyes with foveal PPE, 30 eyes with UCP, and 29 eyes of healthy subjects were included. Spectral-domain optical coherence tomography with enhanced depth imaging was used for all optical coherence tomography scans. Mean central inner retinal layer thicknesses were measured in 1-mm-diameter circle with Spectralis automated segmentation software and compared between groups. RESULTS: The outer nuclear layer (ONL) and the sum of the outer plexiform layer and ONL were significantly thinner in the PPE group than the UCP and control groups (ONL: P < 0.001, P < 0.001; outer plexiform layer + ONL: P = 0.002, P = 0.002, respectively). There was no significant difference between groups regarding thickness of the outer plexiform layer and other inner retinal layers. Eyes with UCP and normal eyes did not differ. CONCLUSION: The ONL is thinner in eyes with PPE. The degenerative process of pachychoroid spectrum diseases may begin with retinal pigment epithelium alterations before subretinal fluid accumulation. The PPE lesions, commonly seen above pachyvessels, may be an indicator of photoreceptor apoptosis.

FEATURES OF THE MACULA AND CENTRAL VISUAL FIELD AND FIXATION PATTERN IN PATIENTS WITH RETINITIS PIGMENTOSA.

PURPOSE: To evaluate macular features and fixation pattern in patients with retinitis pigmentosa (RP) compared with healthy controls, using spectral-domain optical coherence tomography and MP-1 microperimetry. METHODS: Eighty-one eyes of 81 patients with RP and 90 eyes of 90 healthy subjects were assessed. The central foveal thickness, subfoveal choroidal thickness, ellipsoid zone length, and the mean retinal sensitivities and fixation characteristics were evaluated by spectral-domain optical coherence tomography and MP-1 microperimetry. RESULTS: Compared with healthy subjects, patients with central macular thinning had lower best corrected visual acuity, central foveal thickness, ellipsoid zone length, retinal sensitivity, and visual field than patients with cystoid macular edema or no macular change (all P < 0.001). Correlations between fixation characteristics and best corrected visual acuity, central foveal thickness, ellipsoid zone length, retinal sensitivity, and visual field were statistically significant (all P < 0.001). Patients with no macular change had more centralized and stabilized fixation than patients with central foveal thinning and cystoid macular edema. CONCLUSION: The spectrum of macular features from the nearly normal retina to complete chorioretinal atrophy can be seen in RP patients without associations with age or duration of symptoms. Unlike other macular degenerations, most patients with RP obtained at least a central 2° of visual field, with foveal and stable fixation.

INDOCYANINE GREEN ANGIOGRAPHY OF PACHYCHOROID PIGMENT EPITHELIOPATHY.

PURPOSE: To compare choroidal hyperpermeability and vessel density between eyes with central serous chorioretinopathy (CSC), those with pachychoroid pigment epitheliopathy (PPE) and those with uncomplicated pachychoroid (UCP). METHODS: We retrospectively reviewed indocyanine green angiography images of 60 patients with unilateral active CSC who had PPE (36 eyes) or UCP (24 eyes) in their fellow eyes. We used color thresholding of indocyanine green angiography images to determine choroidal vessel density. RESULTS: The mean choroidal thickness of eyes with CSC was greater than that of eyes with PPE or UCP, but this difference was not statistically significant (P = 0.46). There was no significant difference between the PPE (92%) and CSC (93%) groups regarding choroidal hyperpermeability (P = 0.76), but both of these groups had higher choroidal permeability than the UCP group (50%) (both P < 0.001). In 30 (90%) of 33 eyes with PPE who had choroidal hyperpermeability, retinal pigment epithelium alterations were in the region of hyperpermeability. Choroidal vessel density did not differ between the PPE and UCP groups (P = 0.57). CONCLUSION: Pachychoroid pigment epitheliopathy is forme fruste of CSC. There is no difference between complicated and UCP regarding subfoveal choroidal thickness and choroidal vessel density. The main difference between these groups is choroidal hyperpermeability.

THERAPEUTIC OUTCOMES AFTER ENDORESECTION OF COMPLEX RETINAL CAPILLARY HEMANGIOBLASTOMA.

PURPOSE: To evaluate the anatomical and functional outcomes after endoresection of complex retinal capillary hemangioblastoma (RCH). METHODS: Retrospective case series of 12 patients (13 eyes), all treated with pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH and silicone oil injection. RESULTS: The mean age at the time of surgery was 32.5 ± 15.9 years. The mean follow-up duration after initial surgery was 50.5 ± 49.4 months. Indications for surgery included RCH with associated complications such as tractional retinal detachment in five eyes (38%), exudative retinal detachment in four eyes (31%), and combination of tractional retinal detachment and exudative retinal detachment in four eyes (31%). The dimensions of the resected RCHs were as follows: >3.0 mm in seven eyes (54%), >3.5 mm in three eyes (23%), and >4.0 mm in three eyes (23%). No tumor was located closer than 10 mm to the optic nerve or fovea. Anatomical success after initial surgery was 92%. One eye had a second vitreoretinal procedure owing to recurrent RD. The mean preoperative Snellen visual acuity was 20/303. The mean Snellen visual acuity at the final visit was 20/73. At the final visit, visual acuity had improved in seven eyes (54%), and six eyes (46%) were stable. Short-term complications included recurrent proliferative vitreoretinopathy in one eye (8%), transient ocular hypertension requiring topical antiglaucoma treatment in four eyes (31%), and long-term complications included progression of cataract in seven eyes (54%). CONCLUSION: Combined pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH, and silicone oil injection may be an effective treatment option for complex RCH, achieving high anatomical success and stable or even improved visual acuity, acceptable rates of disease- and treatment-related complications, and minimal need for retreatment.

Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment.

PURPOSE: To assess correlation between preoperative and postoperative findings and surgical factors, and postoperative functional outcomes after successful repair of acute macula-off rhegmatogenous retinal detachment (RRD). METHODS: Forty-four eyes of 44 patients with recent-onset macula-off RRD who had primary pars plana vitrectomy were included in this retrospective study. Best-corrected visual acuity (BCVA) and retinal and choroidal changes on spectral-domain optical coherence tomography (SD-OCT) were evaluated before and after surgery. Correlation between preoperative and postoperative variables such as demographic and clinical data, SD-OCT findings and surgical factors, and postoperative functional outcomes were assessed. RESULTS: Eighteen women and 26 men, whose mean age at the onset of RRD was 51.7 ± 14.4 years, were evaluated. The mean preoperative and postoperative logMAR BCVA were 1.1 ± 0.5 (20/250) and 0.14 ± 0.1 (20/30), respectively, after a mean of 16.7 ± 7.2 months. Although all factors were evaluated as prognostic factors for functional outcome after surgical treatment of recent-onset macula-off RRD, epiretinal membrane formation was found as the only factor affecting postoperative visual acuity. CONCLUSION: Satisfactory visual recovery can be achieved after a successful surgery in patients with acute RRD without any association with morphological changes such as increased subretinal fluid, central foveal thickness, subfoveal choroidal thickness, cystic spaces in the inner nuclear layer and/or outer nuclear layer, undulation of separated outer retina, and disruption of the photoreceptor layer. Epiretinal membrane formation may affect visual outcome in these patients.

Choroidal thickness in chronic rhegmatogenous retinal detachment before and after surgery, and comparison with acute cases.

PURPOSE: To evaluate subfoveal choroidal thickness (SCT) in cases with chronic rhegmatogenous retinal detachment (RRD), before and after pars plana vitrectomy, and cases with acute RRD using optical coherence tomography. METHODS: This retrospective study included 24 eyes with chronic RRD and 26 eyes with recent-onset RRD. Best corrected visual acuity, intraocular pressure, and SCT were measured and compared between the two groups. Of 24 eyes with chronic RRD, 11 had primary pars plana vitrectomy. Measurements of operated and fellow eyes were also compared before surgery and 1 week, 1 and 3 months after surgery. RESULTS: The preoperative mean SCT in eyes with chronic RRD was 342.6 ± 111.7 µm and in fellow eyes 342.4 ± 116.7 µm (P = 0.83) and in eyes with acute RRD was 346.2 ± 51 µm and in fellow eyes 262.7 ± 46.8 µm (P < 0.001). There was also no significant change in SCT between baseline before surgery and 3 months after surgery in eyes with chronic RRD (P = 0.20). CONCLUSION: No significant difference was found in the mean SCT between affected and fellow eyes in chronic RRD. This may be related to intraocular inflammation, which is more limited in chronic than in acute RRD. There was also no significant difference in the SCT in eyes with chronic RRD between the operated and fellow eyes after surgery. It may be concluded that vitrectomy does not affect choroidal thickness.

LONG-TERM ANATOMICAL AND FUNCTIONAL OUTCOMES FOLLOWING VITRECTOMY FOR ADVANCED COATS DISEASE.

PURPOSE: To assess the long-term anatomical and functional results of vitreoretinal surgery in patients with advanced Coats disease. METHODS: Retrospective analysis of 23 patients who underwent 23-gauge pars plana vitrectomy combined with transscleral cryotherapy, laser photocoagulation, and intraocular tamponade between 2005 and 2014 and had a follow-up of at least 1 year. The primary outcomes were mean visual acuity and anatomical success. RESULTS: The average age at the time of surgery was 8.7 ± 1.3 years (range, 2-18 years). The mean follow-up period was 55.2 ± 31 months (range, 12-120 months). In 16 eyes (70%), further treatment was not necessary. In the remaining 7 patients (30%), revision surgery with silicone oil tamponade was required. In 20 eyes (87%), the retina was reattached. At the final visit, 8 eyes (35%) had improved mean Snellen visual acuity from 20/1,000 at initial presentation to 20/160, 3 eyes (13%) showed stabilization, and 6 eyes (26%) had decline in visual acuity. No enucleation was necessary, and no progression to neovascular glaucoma was observed. CONCLUSION: Pars plana vitrectomy combined with cryotherapy, laser photocoagulation, and intraocular tamponade could be an effective treatment option for advanced Coats disease. Despite surgery, disease-related complications remained high, but the main aim of management in these young patients is functional and anatomical stability.

LONG-TERM RESULTS OF TOTAL RETINECTOMY IN CASES WITH ADVANCED PROLIFERATIVE VITREORETINOPATHY.

PURPOSE: To evaluate the long-term results of total retinectomy in patients with rhegmatogenous retinal detachment and severe proliferative vitreoretinopathy. METHODS: Seven eyes of 7 patients had pars plana vitrectomy, with or without pars plana lensectomy, and total retinectomy, with or without silicone oil tamponade, for the management of rhegmatogenous retinal detachment and proliferative vitreoretinopathy (Grade D1-3) after previous complex vitreoretinal surgery procedures. Visual acuity, intraocular pressure, details of previous operations, and development of complications were evaluated retrospectively. RESULTS: Five eyes had a history of penetrating eye trauma, one had persistent fetal vasculature, and one had Coats disease. Patients were all male, with a mean age of 15 ± 11 years (range, 2-31). The mean follow-up was 49.7 ± 50.2 months (range, 12-132). In 3 eyes (42%), enucleation and evisceration were avoided over a mean 100 ± 30.2 month follow-up. All 7 eyes had corneal opacity and band keratopathy after a mean 4.4 ± 3.2 months. Four eyes had phthisis bulbi after a mean 7 ± 4.2 months. No patients developed rubeosis iridis related to the total retinectomy. CONCLUSION: Total retinectomy may be a last option to preserve the eyeball in cases with massive fibrosis and rhegmatogenous retinal detachment, despite previous complex surgical treatments.

Efficacy of reduced-fluence photodynamic therapy for central serous chorioretinopathy associated with combined serous retinal detachment and fovea-involving pigment epithelial detachment.

The purpose of the study was to evaluate the effect of reduced-fluence photodynamic therapy (RFPDT) for chronic central serous chorioretinopathy (CSC) associated with serous retinal detachment (SRD) and fovea-involving pigment epithelial detachment (PED). Ten eyes of ten patients with chronic CSC associated with combined SRD and PED involving the fovea were included. RFPDT was applied to the hyperfluorescent area identified at the mid-to-late phase of indocyanine green angiography, which indicated the area of leakage. We evaluated the changes in best-corrected visual acuity (BCVA) and optical coherence tomography at month 1 and final follow-up visit. The mean age of the participants was 47.4 ± 7 years. The mean follow-up duration was 6.3 ± 4 months. At month 3, the SRD had resolved completely in all ten eyes (100 %), and PED had resolved in seven eyes (70 %). The initial mean BCVA improved from 20/50 at baseline to 20/32 at the last visit (P > 0.05). The mean central retinal thickness was reduced from 534 ± 279 µm at baseline to 194 ± 46 µm at the last examination (P < 0.001). The mean subfoveal choroidal thickness decreased from 461 ± 57 at baseline to 369 ± 75 at the final visit (P < 0.001). Reduced-fluence PDT appears as an effective treatment for chronic CSC cases associated with SRD and fovea-involving PED.