DEVELOPMENT OF FOCAL CHOROIDAL EXCAVATION AFTER ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: The purpose of this study was to describe a case of polypoidal choroidal vasculopathy, showing a newly developed focal choroidal excavation during a 4-year follow-up period with multiple intravitreal antivascular endothelial growth factor injections. METHODS: This study was a case report. RESULTS: A 64-year-old man was referred for treatment of age-related macular degeneration in his left eye. His corrected visual acuity at initial presentation was 20/20 in both the right and left eye. Optical coherence tomography of the left eye revealed a steep retinal pigment epithelial detachment and subretinal fluid, and indocyanine green angiography confirmed a polypoidal lesion, leading to the diagnosis of polypoidal choroidal vasculopathy with pachychoroid features. Thereafter, antivascular endothelial growth factor intravitreal injections were continued on a pro re nata basis. Two years after the initial presentation, the sharp pigment epithelial detachment began to shrink, and a novel focal choroidal excavation gradually emerged surrounding the pigment epithelial detachment with an inner choroidal layer attenuation. CONCLUSION: Multiple antivascular endothelial growth factor injections for polypoidal choroidal vasculopathy resulted in atrophy of the polypoidal lesion and a decrease in the blood flow in the adjacent inner choroidal vasculature, leading to the formation of a novel focal choroidal excavation.

CLINICAL CHARACTERISTICS AND SURGICAL OUTCOMES IN STAGE 4 MACULAR HOLE WITH EPIRETINAL PROLIFERATION.

PURPOSE: To investigate the clinical characteristics and surgical outcomes of Stage 4 macular holes (MHs) with epiretinal proliferation (EP) and explore the pathogenesis of MH formation. METHODS: This retrospective study included consecutive patients who underwent pars plana vitrectomy for Stage 4 MH. Patients were divided into two groups based on the presence or absence of EP. Baseline characteristics, optical coherence tomography features of MHs, and surgical outcomes were compared between the groups. RESULTS: EP was detected in 31 of 102 eyes with Stage 4 MH (30%). Patients with EP were older ( P = 0.044), predominantly male ( P = 0.047), had a greater axial length ( P = 0.008), and had better preoperative visual acuity ( P < 0.001) than those without EP. On optical coherence tomography, eyes with EP had more epiretinal membrane and intraretinal splitting ( P = 0.002 and P < 0.001, respectively) than those without EP. The hole closure rate after primary surgery was comparable, and visual acuity at 6 months after surgery was significantly better in eyes with EP than those without EP ( P = 0.036). In 9 eyes with EP, the medical record documented the presence of complete posterior vitreous detachment before MH development. CONCLUSION: Patients of Stage 4 MH with EP were older, predominantly male, and had better preoperative and postoperative visual acuity compared with those without EP. The differences in demographic characteristics and optical coherence tomography findings suggest that the pathogenesis of Stage 4 MH with EP is different from that of Stage 4 MH without EP.

FULL-THICKNESS MACULAR HOLE WITH PERSISTENT BROAD VITREOMACULAR ATTACHMENT: Clinical Characteristics and Surgical Outcomes.

PURPOSE: To describe the characteristics and surgical outcomes of full-thickness macular holes (FTMHs) with persistent broad vitreomacular attachment. METHODS: This was a retrospective, observational case series. Consecutive patients undergoing pars plana vitrectomy for FTMHs with persistent broad vitreomacular attachment (study group) were reviewed. Clinical charts, optical coherence tomography (OCT) features of macular holes, and surgical outcomes were reviewed and compared with those with typical FTMH with focal vitreomacular traction (control group). RESULTS: A total of 15 eyes of 14 consecutive patients (eight males and six females with a mean age of 60.6 years) were included in the study group. OCT showed a zone of at least 1,500 µm all around the circumference of the fovea where the vitreous was attached. On OCT, epiretinal membrane and epiretinal proliferation were observed in 73% and 87% of cases, respectively. Compared with the control group, the study group was younger (P = 0.027) and had better preoperative visual acuity (P = 0.007). All FTMHs closed after one surgery in both groups, and the postoperative visual acuity of the study group was better than that of the control group (P = 0.002). CONCLUSION: Full-thickness macular holes may have developed under the condition that the vitreous cortex was broadly attached around the hole. These FTMHs were associated with younger age, better baseline visual acuity, and a higher incidence of epiretinal membranes and epiretinal proliferations compared with macular hole with focal vitreomacular traction. The surgical outcome was favorable, but the pathogenesis of FTMH development remains unclear.

Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic.

BACKGROUND/AIMS: To determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period. METHODS: This was a retrospective multicentre study including 31 ophthalmological institutions of the Japanese Retina and Vitreous Society or Japan-Clinical Retina Study group. Patients who had undergone vitrectomy during 2019, the pre-COVID-19 period, and from July 2020 to June 2021, the COVID-mask period, were studied. The results of cataract surgery were used as a control. The total number of vitrectomies and the total number of postoperative endophthalmitis were determined. Then, the differences in the incidence of postoperative endophthalmitis between the pre-COVID-19 period and the COVID-mask period, and the type of pathogens causing the endophthalmitis were studied. RESULTS: The incidence of postvitrectomy endophthalmitis was significantly lower in the pre-COVID-19 period with 16 568 surgeries and 18 endophthalmitis cases (0.11%) than in the COVID-mask period of 14 929 surgeries and 31 endophthalmitis cases (0.21%; p=0.031, OR=1.913, 95% CI 1.078 to 3.394). In the pre-COVID-19 period, 4 of the 18 eyes were culture positive, and all were of the Staphylococcus family. In the COVID-mask period, 9 of the 31 eyes were culture positive, and 4 cases were related to oral commensals including Streptococcus spp, which are reportedly very rare in endophthalmitis after vitrectomy. CONCLUSIONS: It is necessary for physicians to be aware of the higher incidence of postvitrectomy endophthalmitis during the COVID-mask period, and to treat their patients appropriately.

AIR VERSUS SULFUR HEXAFLUORIDE GAS TAMPONADE IN VITRECTOMY FOR UNCOMPLICATED RETINAL DETACHMENT WITH INFERIOR BREAKS.

PURPOSE: To compare surgical outcomes of filtered air and sulfur hexafluoride (SF6) as an internal tamponade in patients undergoing primary 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment with inferior breaks. METHODS: Patients with uncomplicated rhegmatogenous retinal detachment associated with inferior breaks (between 4 and 8 o'clock positions) who were undergoing primary pars plana vitrectomy were enrolled. All eyes underwent pars plana vitrectomy and complete drainage of subretinal fluid, followed by filtered air or 20% SF6 tamponade. The main outcome measures included single-surgery anatomical success rates and final visual recovery. RESULTS: Overall, 116 eyes of 116 patients (81 men and 35 women with a mean age of 55.2 years) were assessed. Air was used in 52 eyes (air group) and gas in 64 eyes (gas group). Single-surgery anatomical success was achieved in 50 (96.2%) and 60 (93.8%) eyes in the air and gas groups, respectively (P = 0.69), and final anatomical success was achieved in all eyes. The mean final Snellen visual acuity was similar in the air (20/23) and gas groups (20/21; P = 0.13). CONCLUSION: No significant differences were observed in single-surgery anatomical success rates and final visual recovery when comparing air with SF6 gas tamponade in pars plana vitrectomy for primary uncomplicated rhegmatogenous retinal detachment with inferior breaks.

Macular holes following vitrectomy for rhegmatogenous retinal detachment: epiretinal proliferation and spontaneous closure of macular holes.

PURPOSE: To describe the characteristics and management of full-thickness macular holes (MHs) that develop after pars plana vitrectomy for rhegmatogenous retinal detachment (RD). METHODS: Retrospective, interventional, consecutive case series. Patients who developed secondary full-thickness MHs after prior pars plana vitrectomy for RD over a 6-year period were included. The main outcome measures included optical coherence tomography (OCT) findings and the clinical course of full-thickness MHs. RESULTS: A total of 11 eyes of 11 consecutive patients were included in the study. The mean age of the patients was 58.8 years (range, 47-70 years). The median time between RD repair and MH diagnosis was 36 months (range, 1 month-11 years). The fovea was attached to 10 eyes (91%) at the time of RD repair. OCT demonstrated epiretinal proliferation (EP) at the hole margin in 10 eyes (91%). MH spontaneously closed in 7 eyes (63%) but reopened in 5 eyes. A total of 7 eyes (63%) required a vitrectomy to repair the MHs. All MHs were closed at the last follow-up visit. CONCLUSION: Full-thickness MHs after pars plana vitrectomy for RD have features that are distinct from that of typical idiopathic MH. The presence of EPs is common, and MHs are prone to spontaneous closure and reopening. These findings suggest that EP may be associated with spontaneous hole closure and that long-term follow-up is necessary even if the MHs close spontaneously.

Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study.

PURPOSE: To report a patient whose foveal avascular zone (FAZ) decreased after vitrectomy with internal limiting membrane (ILM) peeling. METHODS: A 58-year-old woman underwent successful phacovitrectomy with ILM peeling for a thin epiretinal membrane in an eye with a normal foveal contour. Optical coherence tomography angiographic en face images of the 3 mm×3 mm superficial and deep inner retinal vascular plexuses were examined preoperatively, and on days 1, 2, 9, and 37 postoperatively. The changes in the FAZ areas and the thicknesses of the parafoveal retinal layers at 500 µm from the foveal center were assessed in the vertical and horizontal B-scan images. RESULTS: The areas of the superficial and deep FAZ decreased after the surgery. The course of the postoperative decrease of the FAZ area in the superficial plexus can be fit by a hyperbolic curve (R2=0.993). An increase in the thicknesses of the retinal nerve fiber layer, ganglion cell-inner plexiform layer, and inner nuclear layer was observed at all times postoperatively. CONCLUSIONS: We observed one case that the FAZ area decreased and the parafoveal inner retinal thickness increased after the vitrectomy with ILM peeling. The decrease in the FAZ area suggests that a centripetal movement of the inner retinal layer is probably due to the ILM peeling.

Effect of vitreomacular separation on macular thickness determined by spectral-domain optical coherence tomography.

PURPOSE: To determine the effects of vitreomacular separation on macular thickness. METHODS: This was a retrospective, observational, cross-sectional study. Average foveal and central minimum thicknesses were measured by spectral-domain optical coherence tomography (SD-OCT) in 308 eyes of 308 healthy subjects (healthy group) and 298 normal fellow eyes of 298 patients with a unilateral macular hole (MH group). Multiple regression analyses were performed to determine the effects of various factors on the macular thickness. RESULTS: The mean age of the healthy group was 67.3 ± 9.6 years (range 40-88 years) and that of the MH group was 67.8 ± 7.0 years (range 43-91). SD-OCT images showed that 149 eyes (48.4 %) in the healthy group and 174 eyes (58.4 %) in the MH group had a vitreomacular separation. In the healthy group, the central minimum thickness of eyes with a vitreomacular separation (196 µm) was significantly thinner than those without a vitreomacular separation (205 µm; P < 0.001). In the MH group, the average foveal thickness (234 µm) and the central minimum thickness (177 µm) in eyes with a vitreomacular separation were thinner than those without it (247 and 199 µm, respectively; both P < 0.001). Multiple regression analyses showed that a vitreomacular separation was significantly correlated with thinner central minimum thicknesses in both groups (P < 0.001) and also with the average foveal thickness in the MH group (P < 0.001). CONCLUSIONS: A vitreomacular separation caused thinning of the central fovea in both the healthy eyes and the normal fellow eyes of unilateral MH patients; the extent of foveal thinning is greater in the MH group.

Changes in visual field defects during 10-year follow-up for indocyanine green-assisted macular hole surgery.

PURPOSE: To determine whether the visual field defects detected within 3 months of indocyanine green (ICG)-assisted inner-limiting membrane (ILM) peeling continue to worsen over longer periods. METHODS: This was a retrospective observational case series. Four eyes with visual field defects that developed within 3 years of ICG-assisted ILM peeling for a macular hole (MH) were examined yearly for 10 years. The main outcome measures were the degree of mean deviation (MD) determined by Humphrey perimetry with the 30-2 SITA-Fast program and the best-corrected visual acuity (BCVA). RESULTS: Four patients were examined yearly for more than 10 years, with a mean duration of follow-up of 139.5 months (11.6 years) and a range of follow-up of 137-156 months (11.4-13 years). The mean (±standard deviation) preoperative MD value was -4.99 ± 3.26 dB, and the mean postoperative MD values were -12.9 ± 1.29 dB after 1 year, -14.1 ± 0.75 dB after 3 years, and -12.73 ± 2.65 dB after 10 years. The mean preoperative BCVA was 0.65 ± 0.26 logarithm of the minimal angle of resolution (logMAR) units, and the postoperative BCVA was 0.21 ± 0.07 logMAR units at 1 year, 0.28 ± 0.21 logMAR units at 3 years, and 0.14 ± 0.06 dB logMAR units at 10 years. CONCLUSIONS: The visual field defects detected soon after ICG-assisted ILM peeling continued to worsen for 3 years, but not thereafter.

Long-term observation of the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes.

PURPOSE: To describe long-term changes in the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes (MHs). METHODS: This is a retrospective, observational case series. The medical records of patients who underwent surgery for idiopathic MHs between May 2000 and December 2010 were reviewed. Patients who had clinically normal fellow eyes and underwent 12 months or more of follow-up were included. The vitreomacular relationship in the fellow eyes was evaluated using optical coherence tomography (OCT) and slit-lamp biomicroscopy. RESULTS: The study included 153 patients with a mean age of 65.5 years and a mean follow-up of 33.5 months (range, 12-121). The incidence of vitreomacular attachments evaluated by OCT was 52% (80 eyes) at initial examination, which decreased to 41, 37 and 23% at 1, 2 and 3 years after the initial examination, respectively. Of the 80 eyes with vitreomacular attachments at initial examination, 40 (50%) still had vitreomacular attachments at the final visit. Of the remaining 40 eyes in which vitreomacular separation occurred during follow-up, 11 (28%) developed an MH, with a mean interval of 45 months. None of the eyes with vitreomacular separation at presentation developed an MH. CONCLUSION: This largest series of fellow eyes of MHs followed by OCT shows that, at presentation, about half of the patients already have premacular vitreous detachment and therefore no risk of MH, and that second MH develops in about 30% in the process of vitreomacular separation, which evolves over a prolonged period.

Vitreomacular interface and outer foveal microstructure in fellow eyes of patients with unilateral macular holes.

PURPOSE: To investigate the relationship between the vitreomacular interface and the integrity of the photoreceptor microstructures in the normal fellow eyes of patients with unilateral macular holes. METHODS: Retrospective observational case series. Fifty-five normal fellow eyes of 55 patients with unilateral macular holes were enrolled in the study. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, fundus photography, and spectral domain optical coherence tomography at initial and follow-up visits. The features of the vitreomacular interface were graded based on spectral domain optical coherence tomography findings. RESULTS: At the initial visit, 28 of 55 eyes (51%) had vitreomacular attachments with or without perifoveal posterior vitreous detachment. On their initial visit, a triangular elevation of the cone outer segment tips line was identified in 11 of 18 eyes (61%) with perifoveal posterior vitreous detachment across all quadrants with persistent attachment to the fovea. Conversely, none of the remaining 37 eyes with the other stages of posterior vitreous detachment showed any abnormalities. Over a mean follow-up period of 18 months (range, 12-24 months), the elevation of the cone outer segment tips line resolved after spontaneous vitreomacular separation without macular holes in 3 eyes, remained unchanged in 6 eyes, and showed progression to a full-thickness macular hole in 2 eyes. CONCLUSION: These findings suggest that an elevation of the cone outer segment tips line in the normal fellow eyes of patients with macular holes is caused by the focal traction of the vitreous at the foveal center. This is considered to be an important primary change observed in the macular tissue in full-thickness macular hole formation.

Long-term intraocular pressure changes after combined phacoemulsification, intraocular lens implantation, and vitrectomy.

PURPOSE: To observe long-term changes in intraocular pressure (IOP) after a combined phacoemulsification, intraocular lens implantation, and vitrectomy procedure. METHODS: This was a retrospective case series at a single hospital. Of 105 consecutive cases that received combined phacoemulsification, intraocular lens implantation, and vitrectomy for macular hole or epiretinal membrane, 85 eyes (patients) were followed up for 1 year or longer. The IOP of both eyes in the subjects who had surgery in one eye was measured at baseline and at 1, 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The IOP of the treated eye was compared with the fellow eye and with the baseline value at each follow-up visit. RESULTS: Intraocular pressure in the operated eyes at 3 months after surgery was significantly lower than that at baseline and than that in the respectively fellow eyes (P < 0.001, paired-t test with Bonferroni correction). The IOP subsequently returned to the baseline value or was the same as that of the fellow eye within 3 months of the observation time point. Only two treated eyes had elevated IOP exceeding 21 mmHg after 6 months postoperatively. CONCLUSIONS: The change in the IOP after phacovitrectomy may be limited, and care when using this procedure because some eyes show increased IOP compared to the fellow eye after a long period.

Incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases.

PURPOSE: To assess the incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases and to compare it with 20-gauge vitrectomy. METHODS: Retrospective, comparative, interventional case series. We compared the incidence of iatrogenic peripheral retinal breaks in 176 eyes undergoing 23-gauge vitrectomy between January 2007 and November 2009 (23-gauge group) and 153 eyes undergoing 20-gauge vitrectomy between January 2004 and June 2006 (20-gauge group) for either idiopathic macular holes or idiopathic epiretinal membranes. All surgeries were performed by one surgeon at a single hospital. Main outcome measure was the incidence rate of iatrogenic peripheral retinal breaks discovered intraoperatively and postoperatively. RESULTS: Iatrogenic peripheral retinal breaks occurred in 1 eye in the 23-gauge group and in 11 eyes in the 20-gauge group during surgery. Additional iatrogenic retinal breaks were found in 1 eye in the 23-gauge group and in 2 eyes in the 20-gauge group within 1 month after surgery. The overall incidence of iatrogenic peripheral retinal breaks was 1.1% (2 of 176) in the 23-gauge group and 8.5% (13 of 153) in the 20-gauge group. The difference was statistically significant (P = 0.0023). CONCLUSION: The incidence of iatrogenic peripheral retinal breaks during vitrectomy for macular diseases is significantly lower in 23-gauge vitrectomy than in 20-gauge vitrectomy.

Atypical presentation of acute macular neuroretinopathy with tiny parafoveal reddish-brown lesions.

PURPOSE: To report two cases of acute macular neuroretinopathy with unusually small parafoveal lesions, which showed later recurrent lesions either in the same eye or the fellow eye. METHODS: Observational case series. PATIENTS: In case 1, a 48-year-old woman developed a sudden onset of a tiny paracentral scotoma associated with a small reddish-brown paracentral lesion. A new paracentral lesion with a corresponding scotoma developed 1 year later. In case 2, a 39-year-old man with diabetes type 1 developed a paracentral scotoma OS with a corresponding small reddish-brown lesion. Two months later, a similar lesion with a corresponding scotoma developed in the fellow eye. CONCLUSIONS: Acute macular neuroretinopathy may present with tiny paracentral lesions difficult to detect with fundus examination, and may be associated with recurrent lesions either in the same eye or the fellow eye.

Incidence of outer foveal defect after macular hole surgery.

PURPOSE: To determine the incidence of outer foveal defects after macular hole surgery and to evaluate the relationship between the defect and visual outcome. DESIGN: Retrospective, observational case series. METHODS: A retrospective analysis was performed on 50 eyes from 50 patients who underwent macular hole surgery with a follow-up period of 12 months or more. We evaluated the presence of outer foveal defects using time-domain optical coherence tomography and best-corrected visual acuity at several postoperative time points. The main outcome measures are the incidence of an outer foveal defect and the best-corrected visual acuity. RESULTS: The incidence of an outer foveal defect at 1, 3, 6, and 12 months after surgery was 49%, 50%, 47%, and 31%, respectively. There were no statistical differences in the postoperative visual acuity between eyes with and without an outer foveal defect at each postoperative time point. CONCLUSIONS: Outer foveal defects after successful macular hole surgery were observed in approximately half of the eyes during the early postoperative period and one third of the eyes at 12 months postoperatively, suggesting that it takes longer than expected to recover the normal foveal anatomy after surgery. The presence of outer foveal defects did not significantly correlate with the visual outcome.

Vitrectomy for exudative age-related macular degeneration with vitreous hemorrhage.

PURPOSE: The purpose of this study was to study the effect of pars plana vitrectomy (PPV) for age-related macular degeneration with vitreous hemorrhage on choroidal neo-vascularization (CNV). METHODS: A retrospective interventional case series in which 92 eyes with age-related macular degeneration with vitreous hemorrhage that received PPV were studied. Among them, 60 eyes without pre- or posttreatment other than PPV were selected. Choroidal neovascularization was expressed as the incidence of bleeding 6 months before and after PPV. The status of CNV after PPV was compared and classified as worsened, remained, regressed, disappeared, or unclassified. The influence of posterior vitreous detachment was examined. RESULTS: The incidence of bleeding was reduced dramatically after PPV (1.11 +/- 0.44 in preoperative 6 months vs. 0.03 +/- 0.18 in postoperative 6 months, P < 0.0001). The status of CNV improved in most cases; 40 of 54 classifiable eyes (74.1%) were categorized as "regressed" or "disappeared." Postoperative visual acuity was significantly better than preoperative visual acuity (P < 0.0001). The status of CNV subsided more in those eyes without posterior vitreous detachment than in those with posterior vitreous detachment (odds ratio, 1.02; 95% confidence interval, -0.01-2.08; P = 0.054). CONCLUSION: The activity of CNV was reduced after PPV in eyes with age-related macular degeneration with vitreous hemorrhage. Visual acuity significantly improved, with only rare severe complications. The involvement of vitreomacular traction in the patho-physiology of CNV in age-related macular degeneration is possible.

Surgical outcomes for patients who develop macular holes after pars plana vitrectomy.

PURPOSE: To characterize outcomes for patients who develop full-thickness macular holes after pars plana vitrectomy. METHODS: We retrospectively analyzed data for 47 consecutive patients (47 eyes) who developed full-thickness macular holes after initial pars plana vitrectomy for a variety of indications. All patients underwent a second vitrectomy and gas tamponade with or without internal limiting membrane peeling. RESULTS: Indications for initial vitrectomy included idiopathic epiretinal membranes (11 eyes), epiretinal membranes with a pseudohole (nine eyes), macular edema resulting from various conditions (nine eyes), proliferative diabetic retinopathy (nine eyes), rhegmatogenous retinal detachment (five eyes), and miscellaneous causes (four eyes). Mean interval from initial vitrectomy to macular hole formation was 20.4 months. Mean visual acuity (VA) in the affected eye was 0.13 (20/155, Snellen equivalent). The hole was closed in 32 eyes (68%) after a single procedure. With a mean follow-up of 53 months, mean final VA improved to 0.26 (20/77); 26 (55%) eyes improved, 18 (38%) were stable, and three (6%) worsened. No severe complications occurred except one macular hole that reopened after successful closure. CONCLUSIONS: Macular holes may develop after pars plana vitrectomy. Although additional vitrectomy can successfully close the hole and improve vision in most patients, postsurgical outcome seems to depend on the underlying condition.

Intraoperative characteristics of the posterior vitreous cortex in patients with epiretinal membrane.

BACKGROUND: The aim of the study was to investigate the intraoperative characteristics of the posterior vitreous cortex in patients with epiretinal membranes. METHOD: Fifteen eyes of 15 patients with an idiopathic epiretinal membrane that had no posterior vitreous detachment (PVD) on both slit-lamp biomicroscopy and B-scan ultrasound examination were enrolled in this study. During vitrectomy, the relationship between the posterior vitreous cortex and the epiretinal membrane was observed when PVD was created using triamcinolone acetonide. RESULTS: Three patterns were observed: (A) seven eyes (47%) showed a round defect in the posterior vitreous cortex after surgical PVD, leaving an epiretinal membrane on the macula, (B) three eyes (20%) showed a complete detachment of the vitreous cortex along with the epiretinal membrane, and (C) five eyes (33%) showed a detachment of the posterior vitreous cortex without a round defect, leaving an epiretinal membrane on the macula. Four of five eyes in group C had a discrete linear signal over the macular area on optical coherence tomography before surgery. CONCLUSION: The finding that during surgery the posterior vitreous cortex can split into lamellae supports the hypothesis that epiretinal membranes are the result of anomalous PVD with vitreoschisis, leaving the outermost layer of posterior vitreous cortex attached to the macula.

Long-term outcomes of visual field defects after indocyanine green-assisted macular hole surgery.

PURPOSE: To evaluate the long-term course of visual field defects after intravitreal injection of indocyanine green (ICG) during vitrectomy. METHODS: Retrospective observational case series. The medical records of seven eyes of seven patients with visual field defects after the adjunctive use of ICG during macular hole surgery were studied. All of the surgeries were performed between February 2001 and January 2002. Humphrey static perimetry and best-corrected visual acuity were examined periodically, and the main outcome measure was the mean deviation (MD) determined by the Humphrey (30-2) SITA-Fast program. RESULTS: All patients were observed for more than 4.5 years, for a mean of 60.7 months and a range of 54 to 66 months. The preoperative MD was -3.5 +/- 3.1 dB (mean +/- SD), and the postoperative MD was -13.3 +/- 4.9 dB at 1 year, -13.4 +/- 4.6 dB at 2 years, -16.2 +/- 5.1 dB at 3 years, and -15.6 +/- 5.1 dB at 4 years. The decrease in the mean MD between 1 and 3 years after surgery was significant (P < 0.05). Optic disk pallor in five eyes showed a decrease in the MD between 1 year and 3 years after the surgery. There was no significant difference in the postoperative best-corrected visual acuity at any time. CONCLUSIONS: The visual field defect in eyes that had undergone vitrectomy with staining of the internal limiting membrane with ICG can continue to deteriorate for at least 3 years. Eyes receiving intravitreal ICG during vitrectomy should be followed for a longer period to determine the long-term effect of ICG.

Long-term outcomes of macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling.

PURPOSE: To report long-term anatomical and functional results after pars plana vitrectomy with internal limiting membrane (ILM) peeling using triamcinolone acetonide (TA) for idiopathic macular holes. DESIGN: Prospective, consecutive, interventional case series. METHODS: Ninety-six eyes of 94 patients who underwent macular hole surgery with TA-assisted ILM peeling were included in the study. Patients with <12 months of follow-up were excluded. On 82 phakic eyes, simultaneous phacoemulsification with intraocular lens implantation was performed. Follow-up examinations included clinical examination, determination of best-corrected visual acuity, intraocular pressure measurement, optical coherence tomography, Goldmann perimetry, and static perimetry using the Humphrey visual field analyzer. The main outcome measures were postoperative visual acuity, macular hole status, and postoperative complications. RESULTS: The mean follow-up period was 17 months (range, 12-30 months). TA improved visualization of the ILM, and the peeled area was seen as an area lacking white specks. All macular holes successfully closed after primary surgery. Mean visual acuity improved from 0.26 to 1.0 at the final visit (P < 0.0001), with 90 eyes (94%) having improvement of visual acuity. Postoperative complications included retinal detachment in one patient and transient intraocular pressure elevation in five patients. CONCLUSIONS: Although transient intraocular pressure elevation was observed in a few patients, the use of TA in macular hole surgery may be an effective and safe technique to facilitate visualization of the ILM and can lead to good long-term anatomical and functional results.