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.

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.

Cystoid macular edema after vitrectomy and after phacovitrectomy for epiretinal membrane.

OBJECTIVE: To compare the incidence of cystoid macular edema (CME) after vitrectomy and CME after phacovitrectomy in patients requiring epiretinal membrane (ERM) removal. DESIGN: A retrospective, comparative, interventional study. METHODS: Medical records of patients who had undergone vitrectomy or phacovitrectomy for ERM removal by a single surgeon were retrospectively reviewed. Phacovitrectomy was performed in all phakic eyes and vitrectomy was performed in all pseudophakic eyes. Increased macular thickness (IMT) was defined as an increase in macular thickness by more than 10% at the postoperative week 4 visit compared to the measurements at baseline. RESULTS: There were 214 and 53 eyes in the Phacovitrectomy group and the Vitrectomy group, respectively. IMT occurred in 15.4% of the Phacovitrectomy group, which was higher than the incidence of 3.8% in the Vitrectomy group (p=0.023). CONCLUSIONS: IMT, that is suspected to be a type of CME, was not uncommon (15.4%) after phacovitrectomy in phakic eyes but was uncommon (3.8%) after vitrectomy alone in pseudophakic eyes. Irvine-Gass syndrome appears to be triggered by crystalline lens removal itself rather than intraocular surgery or surgical trauma alone.

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.

Evaluation of the safety of anterior capsule staining with trypan blue under air: a retrospective analysis.

AIM: To evaluate the safety of using 0.03% trypan blue under air for anterior capsule staining in cataract surgery. METHODS: The current study involved a retrospective analysis of the medical records of 86 patients with vitreous hemorrhage, who underwent pars plana vitrectomy and cataract surgery. The patients were classified into two groups. The trypan blue group (n=45) comprised patients who underwent anterior capsule staining with 0.03% trypan blue under an air bubble. The control group (n=41) comprised of patients who underwent intracameral illuminator-assisted capsulorhexis. The status of endothelial cell density (ECD) in both the groups was analyzed. RESULTS: The trypan blue group displayed significant decline in ECD at 1mo (7.91% loss, P<0.001) and 3mo (9.65% loss, P<0.001) after the surgery, whereas no significant changes were observed in the control group. Moreover, the number of patients who did not display a postoperative decline in ECD was significantly higher in the control group (43.9%; 18 patients) than in the trypan blue group (17.1%; 7 patients, P=0.004). CONCLUSION: Anterior capsule staining with trypan blue under the air bubble would not be as safe as the intracameral illuminator. The ECD loss might be attributed to the air bubble rather than to the deleterious effects of 0.03% trypan blue. Further studies are required to clarify this.

Corneal endothelial cell damage after scleral fixation of intraocular lens surgery.

PURPOSE: To analyze corneal endothelial cell damage after scleral fixation of intraocular lens (SFIOL) surgery. STUDY DESIGN: Retrospective study. METHODS: Medical records of consecutive eyes undergoing SFIOL surgery performed by a single surgeon were reviewed between January 2011 and June 2019. The patients were classified into three groups according to surgical methods: Group I, re-fixating the existing intraocular lens (IOL) or fixating a new IOL in an aphakic eye; Group II, removing the existing IOL and fixating a new IOL; and Group III, phacoemulsification and fixating a new IOL simultaneously. Preoperative and postoperative specular microscopy (SM) status were compared. Changes in SM were compared among the three groups. RESULTS: Ninety-four eyes were included. Thirty-four eyes in Group I, 39 in Group II, and 21 in Group III. The endothelial cell density (ECD) loss in Group I was 1.5%, less than the ECD loss of 14.3% (p < 0.001) in Group II and 15.4% (p = 0.005), in Group III. In no eye was there an ECD decrease to < 1000/mm2 following the surgical procedure. CONCLUSIONS: ECD loss was related to IOL removal or phacoemulsification rather than SFIOL surgery. SFIOL using the existing IOL should be considered preferential in eyes with low ECD and dislocated IOL.

Association between capillary congestion and macular edema recurrence in chronic branch retinal vein occlusion through quantitative analysis of OCT angiography.

This study aims to quantitatively investigate the optical coherence tomographic angiography (OCTA) findings of capillary congestion and its association with macular edema (ME) recurrence in chronic branch retinal vein occlusion (BRVO). We retrospectively reviewed the medical records of 115 consecutive patients with major ischemic BRVO who reached stable macula (without ME for two consecutive visits) at baseline (the first visit within the stable period). All patients were classified into a recurrence or non-recurrence groups depending on ME recurrence. Capillary congestion of deep capillary plexuses (DCP-C) and other abnormal capillary lesions were segmented, and their areas, vascular densities, and mean retinal thicknesses (MRT) were calculated. The main outcomes were differences between the two groups and risk factors for recurrence among baseline and OCTA parameters. A total of 76 eyes were included, of which 22 (28.9%) recurred. DCP-C existed in all eyes at baseline. MRT of DCP-C (p = 0.006) was greater in the recurrence group. Greater MRT of DCP-C (OR: 1.044; p = 0.002) and more frequent intravitreal injections (OR: 1.803; p < 0.001) were associated with a higher risk of relapsing ME. DCP-C may contribute to the anatomical stability of chronic BRVO and simultaneously be the source of ME.

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G.

PURPOSE: To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. METHODS: The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. RESULTS: Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. CONCLUSIONS: Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

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.

Comparison of refractive deviations after phacovitrectomy according to the intraocular lens insertion method.

PURPOSE: This study aimed to compare refractive deviations between in-the-bag insertion, trans-scleral ciliary sulcus fixation, ciliary sulcus insertion, and ciliary sulcus insertion with optic capture after phacovitrectomy. STUDY DESIGN: Single-unit, single-surgeon, retrospective study. METHODS: Consecutive patients who underwent phacovitrectomy and intraocular lens (IOL) out-of-the-bag insertion simultaneously were retrospectively reviewed. Patients who underwent phacovitrectomy with IOL in-the-bag insertion were also included for comparison with those who underwent phacovitrectomy with out-of-the-bag insertion. Patients were classified into four groups based on the IOL insertion method. The average difference from the target spherical equivalent (SE) to postoperative SE was defined as the refractive deviation. Refractive deviations of the groups were compared. RESULTS: The refractive deviation for the in-the-bag insertion (43 eyes) was -0.18 ± 0.50 Df, -0.84 ± 0.81 D for the trans-scleral ciliary sulcus fixation (43 eyes), -0.93 ± 0.68 D for the ciliary sulcus insertion (25 eyes), and -0.27 ± 0.50 D for the ciliary sulcus insertion with optic capture group (24 eyes). The trans-scleral ciliary sulcus fixation and ciliary sulcus insertion groups had significantly different deviations than the in-the-bag group (p < 0.001). There was no significant difference between the ciliary sulcus insertion with optic capture and the in-the-bag insertion groups (p = 0.100). CONCLUSION: Refractive deviation was significantly different between the eyes that underwent trans-scleral ciliary sulcus fixation or ciliary sulcus insertion and the eyes that underwent in-the-bag insertion. However, there was no significant deviation among the eyes that underwent ciliary sulcus insertion with optic capture.

Emerging Enterococcus isolates in postoperative endophthalmitis by selection pressure of fluoroquinolones: an 11-year multicenter and experimental study.

Postoperative endophthalmitis (PE) is the devastating complication that frequently results in vision loss. Recently, enterococcus have emerged as a major cause of PE in several countries and resulted in poor visual outcome. However, the reason remains elusive. We investigate whether selection pressure of fluoroquinolone exerts effects on microorganism profiles isolated from PE. Medical records of patients who were diagnosed with PE at eight resident training institutions between January 2004 and December 2015 were reviewed. The most common isolate was Enterococcus faecalis (28.0%), followed by Staphylococcus epidermidis (18.6%) and other coagulase negative Staphylococci (7.6%). However, the rates of E. faecalis isolated from conjunctival microbes were 6.2% (16/257) and their resistance to fluoroquinolones was higher than those of S. epidermidis. In vitro and in vivo co-culture models of E. faecalis and S. epidermidis were established for survival assays after administration of fourth-generation fluoroquinolone. In in vitro co-culture model, the survival assay of E. faecalis and S. epidermidis against the treatment of moxifloxacin showed that E. faecalis survived significantly better than S. epidermidis in the presence of moxifloxacin 1 µg/mL and more. In in vivo co-culture model, E. faecalis survived significantly better than S. epidermidis after topical treatment of moxifloxacin (5 mg/mL). E. faecalis has been the most common causative strain of PE in Korea. We suggest that the increase of E. faecalis in PE could be associated with the selection pressure of fourth-generation fluoroquinolone. Summary: Enterococcus spp. have emerged as a leading causative strain of postoperative endophthalmitis in 11-year clinical data. We suggest that the increase of Enterococcus spp. is associated with the selection pressure of fourth-generation fluoroquinolone.

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.

Duration of room air tamponade after vitrectomy.

PURPOSE: To evaluate the duration of room air tamponade and its associated factors. STUDY DESIGN: Retrospective cohort study METHODS: The present study reviewed the medical records of patients who received room air tamponade after vitrectomy between Jun 2015 and Dec 2016. The room air duration was assessed by patient interviews 2 weeks after surgery. Relationships between the variables and tamponade duration were determined using logistic regression analysis. The remaining air level was determined from medical records. RESULTS: The room air tamponade had dissipated by 11.1 ± 1.3 days after surgery. The duration was 11.2 ± 1.3 days for eyes with a spared posterior capsule, longer than the duration in other eyes (10.1 ± 0.9 days). Increased axial length was correlated with increased duration. Axial length and a spared posterior capsule were significantly correlated with tamponade duration. Its half-life was presumed about 3.3 days. The room air seems to be absorbed at a constant rate. CONCLUSION: The data suggest that room air tamponade remains in the vitreous cavity for an average of 11.1 days. Axial length and posterior capsule status were associated with duration.

Displacement of the Foveal Retinal Layers After Macular Hole Surgery Assessed Using En Face Optical Coherence Tomography Images.

BACKGROUND AND OBJECTIVE: To investigate the displacement of foveal retinal layers in surgically closed macular holes (MHs) after removal of the internal limiting membrane (ILM). PATIENTS AND METHODS: Medical records of 26 consecutive patients who underwent vitrectomy and removal of the ILM for idiopathic MH were retrospectively reviewed. En face optical coherence tomography images were exported at the level of the choroid, ellipsoid zone (EZ), and inner plexiform layer (IPL) at baseline and at 1, 3, and 6 months. The foveal center of the EZ and IPL was marked in the choroid en face image. The choroidal images were overlapped to match the vasculature in each patient, and the postoperative displacement of the foveal center was compared to baseline. RESULTS: The center of the EZ and IPL was displaced significantly toward the disc during the first 3 months. The mean horizontal displacement at 1, 3, and 6 months was 52.7 µm, 112.5 µm, and 115.4 µm, respectively, for the EZ and 75.2 µm, 117.1 µm, and 136.5 µm, respectively, for the IPL. The location of the foveal center was significantly correlated between the EZ and the IPL (P ≤ .016). CONCLUSIONS: The fovea was displaced nasally and slightly inferiorly after removal of the ILM. The displacement of the photoreceptor and inner retinal layers was concurrent. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:414-422.].

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.

Comparison between refractive outcomes between macula-on and macula-off retinal detachments after phaco-vitrectomy.

PURPOSE: To evaluate axial length (AL) measurements and refractive outcomes in vitrectomy combined with cataract operation for rhegmatogenous retinal detachment (RRD) with wholly detached macula. STUDY DESIGN: Retrospective, consecutive, comparative, clinical study. METHODS: We reviewed the data of patients treated by vitrectomy combined with cataract operation for RRD. The group "Attach" (n=31) consisted of eyes in which retina was not detached within 1.5 disc diameters from the foveal center, and the group "Detach" (n=33) consisted of eyes in which that area was detached entirely. Only those eyes inthe group "Detach", only the eyes (n=20) which AL were measured similar to those fellow eyes were compared to the group "Attach" (n=31). Refractive shift (RS) was defined as the average of the difference between postoperative spherical equivalent (SE) and predicted SE. RESULTS: AL was well measured by A-scan ultrasonography (A-scan) in all 31 eyes of the group "Attach" and their RS was ‒0.57 diopters (D). AL was measured by A-scan similar to the fellow eye in 20 of 33 eyes (60.6%) of the group "Detach", and the RS was ‒0.09 D. The AL difference as much as central subfield macular thickness (about 300um) can make this difference of RS (0.48 D, P=0.025) CONCLUSION: When AL can be measured by A-scan similar to its fellow eye in RRD with wholly detached macula, RS would be smaller than that of the wholly attached macula after phacovitrectomy. It assumed that AL was measured from the RPE under the detached macula in RRD with wholly detached macula.

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.

Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique.

BACKGROUND: To determine whether the internal limiting membrane (ILM) insertion technique is as effective as the inverted ILM flap technique for the initial surgical treatment of eyes with large idiopathic macular holes (MHs). METHODS: This retrospective, non-randomised, comparative clinical study included 41 eyes with large MHs (minimum diameter >500 µm) that were treated using the ILM insertion technique or the inverted ILM flap technique. The hole closure rate, postoperative best corrected visual acuity (BCVA) and swept source optical coherence tomography findings were analysed at 6 months after surgery. RESULTS: There were 15 and 26 eyes in the insertion and inverted flap groups, respectively. Hole closure was achieved in all eyes. The mean final BCVA was better in the inverted flap group than in the insertion group (0.527 vs 0.773, p=0.006), although significant postoperative improvements were observed in both groups (p<0.001). Postoperative foveal discolouration was more common in the insertion group than in the inverted flap group (86.7% vs 7.7%, p<0.001). Complete resolution of ellipsoid zone and external limiting membrane defects was observed in 7 and 18 eyes, respectively, in the inverted flap group; in contrast, complete resolution was not observed in any of the eyes in the insertion group (p=0.035 and p<0.001, respectively). CONCLUSION: The ILM insertion technique may be as effective as the inverted ILM flap technique for the closure of large MHs. However, the latter technique results in better recovery of photoreceptor layers and, consequently, better postoperative visual acuity.