Evaluations of bridging sutures in preventing iris capture in eyes with intrascleral fixation of implanted intraocular lens.

PURPOSE: The study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL). METHODS: We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10-0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position. RESULTS: None of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis. CONCLUSION: Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL.

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment.

BACKGROUND: To determine the incidence and characteristics of the multiple subretinal particles (SRPs) present after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). METHODS: The medical records of 224 eyes of 224 patients that underwent PPV for RRD were reviewed. The presence of SRPs in the subretinal fluid blebs and the presence of subretinal deposits were determined by optical coherence tomography (OCT) and fundus autofluorescence (FAF). The characteristics of the FAF and infrared reflectance (IR) images of a scanning laser ophthalmoscope in eyes with SRPs (SRPs group) were compared to that of eyes without SRPs (control group). RESULTS: SRPs were observed in 27 eyes (12%), and they were completely resolved in 20 eyes (74%) after 6 months. The incidence of macula-off RRD (85%) and preoperative precipitates (41%) were significantly higher in the SRPs group than that in the control group (64%, P = 0.046; 12%, P = 0.002). The axial length was significantly shorter in the SRPs group than that in the control group (25.04 ± 1.54 mm, 26.00 ± 1.78 mm, P = 0.012). The preoperative and postoperative best-corrected visual acuity were not significantly different between the two groups (P = 0.702, P = 0.337). The subretinal fluid bleb determined by OCT were hyperfluorescent in the FAF images in 24 eyes (89%), and the subretinal deposits were hypofluorescent with solid appearance by OCT other than fluid in 3 eyes (11%). The hypofluorescent subretinal deposits in the FAF images were bright in the IR images in 2 eyes. CONCLUSIONS: The SRPs consist of lipofuscin-related hyperfluorescent subretinal fluid and the subretinal deposits containing bright IR melanin particles of proliferating retinal pigment epithelial cells.

Comparisons of Flow Dynamics of Dual-Blade to Single-Blade Beveled-Tip Vitreous Cutters.

INTRODUCTION: The aim of this study was to compare the flow dynamics of the dual-blade to the single-blade beveled-tip vitreous cutters. METHODS: The aspiration rates of balanced salt solution (BSS) and swine vitreous were measured for the 25-gauge and 27-gauge dual- and single-blade beveled-tip vitreous cutters. The flow dynamics of BSS and diluted vitreous mixed with fluorescent polymer at the maximal cutting rates and the reflux of BSS were measured in images obtained by a high-speed camera. The distal end of the cutter was defined as the head end. RESULTS: The aspiration rates of BSS and vitreous by the 25- and 27-gauge dual-blade cutters were significantly higher than those of both single-blade cutters at the maximal cutting rate (all p ≤ 0.01). The mean aspiration flow of BSS in front of the port from a lateral view was significantly faster for both dual-blade cutters than for both single-blade cutters (p = 0.003, p = 0.019). The angle of the mean flow of BSS of both dual-blade cutters was from the distal end (p < 0.001, p < 0.001) but that of the single-blade cutters was from the proximal end. The velocity and angle of the mean reflux flow of both types of cutters were not significantly different. The mean aspiration flow of diluted vitreous was significantly faster for 25-gauge dual-blade cutters with the angle more from the proximal end and 27-gauge dual-blade cutters more from the distal end than both single-blade cutters (p = 0.018, p = 0.048). CONCLUSION: The dual-blade beveled-tip vitreous cutters improve the efficiency of the vitrectomy procedures and maintain the distal aspirating flow by the beveled tip.

Circulating Vitreous microRNA as Possible Biomarker in High Myopic Eyes with Macular Hole.

High myopia is a major cause of irreversible visual impairment globally. In the present study, we investigated the microRNA (miRNA) profile in the vitreous of macular hole (MH) and high myopic MH. We performed miRNA analysis using TaqMan® Low Density Arrays (Thermo Fisher Scientific, Waltham, MA, USA) to investigate the circulating vitreous miRNA profile from patients with MH (axial length < 26.5 mm, n = 11) and high myopic MH (axial length ≥ 26.5 mm, n = 11) who underwent pars plana vitrectomy. The vitreous inflammatory cytokine signature was examined in high myopic MH eyes using a multiplex assay. A miRNA-Array analysis revealed that let-7c was significantly up-regulated and miR-200a was significantly down-regulated in high myopic MH eyes compared to those in MH eyes. The bioinformatics analysis for up-regulated miRNA targeted gene identified 23 pathways including mitogen-activated protein kinase (MAPK) and several inflammatory signaling pathways, whereas the bioinformatics analysis for down-regulated miRNA targeted genes showed 32 enriched pathways including phosphoinositide 3-kinase/protein kinase B (PI3K/AKT). The levels of inflammatory cytokines including IP-10, IFN-γ, and MCP-1 were significantly higher in the vitreous of high myopic MH eyes. These results suggest that specific miRNAs expressed in the vitreous may be associated with the pathological condition of high myopic MH and the above mentioned miRNAs may contribute to the development of inflammatory status in the vitreous of high myopic eyes.

Intraoperative optical coherence tomography-assisted displacement of prepapillary membrane in eyes with optic disc pit maculopathy.

PURPOSE: To determine the efficacy of displacing a prepapillary membrane during vitrectomy assisted by intraoperative optical coherence tomography (OCT) to treat eyes with optic disc pit maculopathy. METHOD: Pars plana vitrectomy was performed with 27-gauge instruments on 4 eyes of 4 consecutive patients for optic disc pit maculopathy with retinoschisis and foveal detachment. After creating a posterior vitreous detachment, the prepapillary membrane was made visible by brilliant blue G staining. The membrane was peeled from the central retinal vessel and inverted and placed over intraretinal clefts or stuffed into the optic disc pit. These procedures were guided by intraoperative OCT. A gas tamponade and peripapillary laser was not used. The preoperative and postoperative OCT images and surgical outcomes were evaluated. RESULT: Intraretinal clefts connected to an inner retinoschisis were detected at the edge of the optic disc pit in 3 eyes with intraoperative OCT and 2 eyes with preoperative OCT. The foveal detachment and retinoschisis were resolved completely in all 4 eyes at postoperative 13 to 15 months. The postoperative vision improved from 20/25 to 20/18 at the final examination in all eyes. CONCLUSION: Intraoperative OCT can detect intraretinal clefts at the edge of the optic disc pit, and the OCT images are helpful in guiding the peeling and placement of the prepapillary membrane to achieve anatomical and visual recovery.

FLOW DYNAMICS OF BEVELED-TIP AND FLAT-TIP VITREOUS CUTTERS.

PURPOSE: To compare the flow dynamics of beveled-tip to that of flat-tip vitreous cutters. METHOD: The aspiration rates of balanced salt solution and swine vitreous were measured for 25-gauge and 27-gauge beveled-tip and flat-tip vitreous cutters. Fluorescent polymer microspheres were mixed with balanced salt solution to make the flow visible. The flow dynamics at maximal cutting rates and reflux of balanced salt solution were measured with video images of a high-speed camera. RESULTS: The aspiration rates of balanced salt solution of the 25-gauge and 27-gauge beveled-tip cutters were significantly higher than that of the flat-tip cutters at 7,500 cut/min (P = 0.0001, P = 0.038, respectively). The aspiration rate of swine vitreous by the 25-gauge beveled-tip cutter was significantly higher than that of the flat-tip cutters (P = 0.006). The mean aspiration flow in front of the cutter was significantly faster for both beveled-tip than flat-tip cutters (P = 0.003, P = 0.023). The angle of the mean aspiration flow of both beveled-tip cutters was turned to the proximal side (P = 0.004, P = 0.003). The mean reflux flow of both beveled-tip cutters was significantly faster than that of the flat-tip cutters (P = 0.006, P = 0.006). CONCLUSION: The beveled-tip cutters have a greater velocity of aspirating frontal and proximal flow resulting in higher aspiration rates and greater reflux flow velocity.

SIX MONTHS PRIMARY SUCCESS RATE FOR RETINAL DETACHMENT BETWEEN VITRECTOMY AND SCLERAL BUCKLING.

PURPOSE: To compare clinical outcomes between pars plana vitrectomy (PPV), scleral buckling (SB), and PPV+SB for rhegmatogenous retinal detachment in the Japan-RD Registry. METHODS: This is a nation-wide, multicenter, observational study based on the registry data between 2016 and 2017. The failure levels were defined as Level 1 (a failure of retinal detachment repair), Level 2 (remaining silicone oil), and Level 3 (multiple surgeries to achieve reattachment). We compared cases treated by SB or PPV in the subgroup of simple rhegmatogenous retinal detachment using multivariate Cox proportional hazard models. RESULTS: A total of 2,775 cases were included. Overall, 6 months any levels of failure in total, SB, PPV, and PPV+SB were 9.2% (n = 256), 6.9% (n = 48), 8.2% (n = 157), and 21.3% (n = 51), respectively. Poor visual acuity at baseline in SB and inferior rhegmatogenous retinal detachment and larger retinal tear in PPV were associated with a higher risk of failure. Pars plana vitrectomy was associated with a higher chance of achieving primary success in cases with simple RRD, especially for cases with superior RRD (adjusted hazard ratio 3.61, 95% confidence interval 2.22-5.94, P < 0.001). CONCLUSION: In this nationwide study, surgical anatomic outcomes were equally successful in either SB or PPV. There were different baseline characteristics associated with primary success between SB and PPV.

MACULAR DEHISCENCE-ASSOCIATED EPIRETINAL PROLIFERATION IN EYES WITH FULL-THICKNESS MACULAR HOLE.

PURPOSE: To determine the characteristics of the macular dehiscence-associated epiretinal proliferations (EPs) in eyes with full-thickness macular holes (MHs). METHODS: The presence of EPs and the integrity of the retinal microstructures in eyes with MHs were determined by spectral domain optical coherence tomography in 390 eyes of 379 patients (29-89 years). The clinical findings, closure of the MH, the preoperative and postoperative best-corrected visual acuity, and the microstructural changes were compared between eyes with and without EPs. RESULTS: Epiretinal proliferations were detected in 31 of 390 eyes (7.9%). The preoperative best-corrected visual acuity and duration of reduced vision were not significantly different in the group with and without EPs (P = 0.09, P = 0.28). The axial lengths were significantly longer (P = 0.001), MH stage more advanced (P = 0.006), and the incidence of epiretinal membranes (P < 0.001) and intraretinal splitting (P < 0.001) were higher in eyes with EP. The EP was significantly correlated with the length of the ellipsoid zone defects (P < 0.001) and medium-reflective bridging tissue over the closed MH (P < 0.001). The closure rates and postoperative best-corrected visual acuities were not significantly different between the two groups (P > 0.99, P = 0.99). CONCLUSION: The presence of EP was correlated with retinal microstructural changes and may support postoperative visual improvements with medium-reflective bridging tissue over the closed MH.

Vascular Density of the Anterior Segment of the Eye Determined by Optical Coherence Tomography Angiography and Slit-Lamp Photography.

OBJECTIVE: To determine the vascular density of the anterior segment (AS) of the eye from optical coherence tomography angiography (OCTA) images and slit-lamp photographs. METHODS: A swept-source OCTA (Plex Elite 9000; Carl Zeiss) device modified with a +10-diopter lens was used to record the vasculature of the AS. Twenty eyes, including 4 eyes of 4 healthy subjects and 16 eyes of 12 patients scheduled for cataract surgery or combined vitrectomy and cataract surgery, were studied. The slit-lamp photographs of the AS were acquired concurrently with the AS-OCTA images. The vascular density was measured preoperatively and postoperatively in the nasal, temporal, superior, and inferior quadrants after binarization with ImageJ software. RESULTS: Acceptable AS-OCTA images were obtained of 65% (superior), 80% (nasal), 70% (inferior), and 80% (temporal) of the eyes. The percentage of acceptable images was significantly lower in the superior quadrant among the AS-OCTA images than among the AS photographs (100%; p = 0.004). The vascular density determined by AS-OCTA was higher than that determined in the AS photographs in all quadrants (p = 0.011 to <0.001). The AS-OCTA B-mode images showed that vascular flow was identified mainly between the conjunctiva and sclera but not in the ciliary body. The vascular density increased significantly after cataract surgery in the superior quadrant, which was significantly correlated with the location of the surgical incision (p = 0.03). CONCLUSION: AS-OCTA can obtain images with higher vascular density of the conjunctiva and sclera than slit-lamp photographs, and AS-OCTA images can show a postoperative increase in vascular density.

POSTERIOR STAPHYLOMAS IN EYES WITH RETINITIS PIGMENTOSA WITHOUT HIGH MYOPIA.

PURPOSE: To describe features of posterior staphylomas in nonhighly myopic eyes with retinitis pigmentosa (RP). METHODS: The retrospective observational case series study included patients with RP and an axial length of <26.5 mm and searched for eyes with posterior staphylomas. All study participants underwent fundus photography and optical coherence tomography. RESULTS: The study identified 13 eyes of 7 patients with a narrow macular staphyloma. Mean age was 40.9 ± 17.9 years (range 9-62 years) and mean axial length was 24.90 ± 0.69 mm. The staphyloma edges corresponded to the margin between the retinal atrophic area in the fundus midperiphery and the relatively unaffected fundus center. On vertically orientated optical coherence tomography images, the staphyloma edges showed a slight inward protrusion of the sclera and a ring-like localized choroidal thinning with choroidal rethickening in direction toward the fovea and toward the periphery of the fundus. The upper and lower staphyloma edges did not differ in steepness. The thickness of the subfoveal choroid (138.6 m ± 50.1 µm) was thinner than the normal range after adjusting for age and axial length in all eyes. Two eyes with advanced RP in the macula showed a subfoveal choroidal thickness of 95 µm and 88 µm. CONCLUSION: Narrow macular staphylomas can occur in nonhighly myopic eyes with RP and, in contrast to staphylomas in highly myopic eyes, show a less marked thinning of the subfoveal choroid. The occurrence of posterior staphylomas in nonhighly myopic eyes with RP may provide hints to unravel the etiology of posterior staphyloma formation.

Quantitative comparisons of ultra-widefield images of model eye obtained with Optos® 200Tx and Optos® California.

BACKGROUND: To compare the quality of the ultra-widefield images acquired by Optos® 200Tx to those acquired by Optos® California. METHODS: Images of the posterior surface of a Gullstrand's model eye obtained by Optos® 200Tx were compared to those obtained by Optos® California in terms of the angular field of view and the symmetry of the image, i.e., vertical and horizontal aspect ratios at the center (0°) and at the periphery (40° and 80°) in each direction. In addition, we compared the enlargement of the image on the posterior surface as the square ratio, and the differences in the contrasts. RESULTS: No significant differences were detected in the angular field of view between the two instruments. The aspect ratios showed that the Optos® California had more symmetrical images than the Optos® 200Tx at the center (0.98 vs 0.89, P < 0.01) and at the 40° periphery (0.93-1.04, △0.11 vs 0.79-1.01, △0.22) and 80° periphery (0.81-1.25, △0.44 vs 0.42-1.12, △0.70) in each direction. The amplitude of the square ratio of the Optos® California was smaller at 40° periphery (1.16-1.28, △0.12 vs 1.06-1.37, △0.31) and 80° periphery (2.12-2.46, △0.34 vs 1.14-3.29, △2.15). The contrast of the Optos® California images was significantly higher in the posterior pole (0.09 vs 0.12, P < 0.01), upper (0.07 vs 0.03, P < 0.01), and right (0.12 vs 0.07, P < 0.01) peripheries. CONCLUSION: Optos® California can record equal angular widefield images to Optos® 200Tx and more symmetrical images with higher contrast in the posterior pole, upper and right peripheries.

Alterations of Foveal Architecture during Vitrectomy for Myopic Retinoschisis Identified by Intraoperative Optical Coherence Tomography.

PURPOSE: To determine the changes in the foveal architecture before and after internal limiting membrane (ILM) peeling with and without fovea-sparing ILM peeling (FSIP) during vitrectomy for high myopic retinoschisis by intraoperative optical coherence tomography (iOCT). METHODS: Qualitative assessments were made of the alterations of the retinal architecture imaged by iOCT following complete ILM peeling (peeled group) or fovea-sparing ILM peeling (FSIP group). A microscope-integrated real-time iOCT device was used to analyze the retinal architectures. The alterations included a worsening of the retinoschisis, development of a foveal detachment, and development of a full thickness macular hole. The changes in the retinal architecture, clinical characteristics, and outcomes were compared between the 2 groups. RESULTS: The medical records of 15 eyes of 15 patients were studied. Complete ILM peeling was performed on 9 of 15 eyes, and 8 of the 9 eyes (89%) showed a worsening of the retinal architectures following the ILM peeling. FSIP was performed on 6 of the 15 eyes, and none of these eyes developed any retinal architectural changes in the iOCT images. The mean postoperative best-corrected visual acuity (BCVA) in eyes that underwent FSIP (20/38) was significantly better than that of preoperative BCVA (20/128; p < 0.05), although the differences in the preoperative BCVA (20/87) and postoperative BCVA (20/55) in the cases that underwent complete ILM peeling were not significant. CONCLUSIONS: The lack of alterations of the foveal architecture and significant improvements in the BCVA after FSIP indicate that FSIP peeling should be considered for eyes with retinoschisis. We recommend that iOCT be used to monitor the retinal architecture during intraocular surgery involving the retina.

Optical coherence tomography angiography findings of an optic disc melanocytoma in a glaucoma eye.

PURPOSE: To determine the optical coherence tomography angiography (OCTA) characteristics of a case of optic disc melanocytoma (ODM) associated with glaucomatous visual field and retinal nerve fiber layer (RNFL) defects in normal tension glaucoma. METHODS: The left eye of a 37-year-old female patient followed for a stable ODM for 10 years was investigated with OCT, OCTA, fluorescein (FA), and indocyanine green (ICGA) angiography. The ODM was unchanged, but a previously unknown inferotemporal neuroretinal rim loss and inferotemporal and superotemporal wedge shape glaucomatous RNFL thinning were seen with corresponding glaucomatous visual field defects. The intraocular pressure was 12 mmHg without treatment. RESULTS: In the area of the ODM, FA showed minimal vasculature, and week staining in the late phase, while ICGA showed no signal. In contrast, OCTA showed a dense vasculature in both the superficial and deep layers of the melanocytoma, which was clearly separated from the capillaries of the peripapillary retina. OCTA also showed reduced peripapillary perfusion in the areas of the glaucomatous RNFL bundle defects. CONCLUSIONS: In the presented case of a stable ODM and newly detected normal tension glaucoma, OCTA provided more information on perfusion than FA and ICGA which are limited by the heavy pigmentation of the ODM. OCTA also showed a similarly decreased capillary perfusion in both RNFL bundle defects suggesting that the structural damage was related to glaucoma and not compression by ODM. These results suggest that OCTA may be a method preferred over conventional angiography in ODM cases.

Circumpapillary microperimetry to detect glaucoma: a pilot study for sector-based comparison to circumpapillary retinal nerve fiber layer measurement.

PURPOSE: To evaluate and compare the diagnostic performance of circumpapillary microperimetry (MP) sensitivity and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measured with optical coherence tomography (OCT) for detection of early to moderate open-angle glaucoma. METHODS: Eleven eyes (11 patients) with early or moderate open-angle glaucoma and seven normal eyes (7 subjects) underwent MP (MP-3 microperimeter, NIDEK, Japan) and cpRNFLT measurement (RS-3000 Advance OCT, NIDEK, Japan) using an identical circumpapillary circle and similar measurement sectors. The structure-function relationship and the area under the receiver-operating characteristics curve (AUROC) were investigated for each sector, respectively. RESULTS: Significant differences (P < 0.05) between glaucoma and normal eyes were found for five of the 12 OCT sectors and seven of the 24 MP sectors. High correlation between cpRNFLT and MP sensitivity was found in the inferotemporal area (OCT sector 5) and superotemporal area (OCT sector 1) (r = 0.818, P < 0.001, and r = 0.796, P < 0.001, respectively). The AUROC values in these sectors ranged 0.890-1.000 for cpRNFLT and 0.825-0.981 for MP sensitivity. Overall, the AUROC ranged 0.506-1.000 for sector cpRNFLT and 0.591-0.981 for sector MP sensitivity. CONCLUSIONS: In this pilot study, circumpapillary MP sensitivity and cpRNFLT showed similar diagnostic power. The structure-function relationship was strong for the superotemporal and inferotemporal circumpapillary areas. Our results suggest that circumpapillary MP represents a new aspect of microperimetry in glaucoma. Further studies on larger populations are necessary to clarify whether the current results are confirmed in clinical practice.

Increased Microcirculation on Optic Nerve Head by Laser Speckle Flowgraphy at Early Stage of Leber Hereditary Optic Neuropathy.

Leber hereditary optic neuropathy (LHON) is a mitochondrial disorder predominantly affecting young men. Characteristic features of an early stage of LHON are peripapillary telangiectatic microangiopathy with optic disc hyperaemia and swelling of the retinal nerve fibre layers. We evaluated the microcirculation of the optic nerve head (ONH) by laser speckle flowgraphy (LSFG) in a 79-year-old man and a 36-year-old woman with LHON. The ONH microcirculation of the tissue area was markedly increased in the early stage in both patients. LSFG may be a useful noninvasive method to suspect individuals to have an early stage of LHON.

INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR TREATMENT OF MACULAR HOLE RETINAL DETACHMENT IN HIGHLY MYOPIC EYES.

PURPOSE: To compare the efficacy of vitrectomy with inverted internal limiting membrane (ILM) flap to complete removal of the ILM for the treatment of macular hole (MH) retinal detachment in highly myopic eyes. METHODS: Pars plana vitrectomy with inverted ILM flap technique (16 eyes; inverted group) or with the complete removal of the ILM (16 eyes; removed group) was performed in patients with high myopia with MH retinal detachment. The rate of retinal reattachment and MH closure, the best-corrected visual acuities, and the integrity of the foveal microstructures in the optical coherence tomographic images were compared. RESULTS: Thirteen eyes (81%) in the inverted group and 15 eyes (93%) in the removed group had retinal reattachment after the initial surgery (P = 0.30). The MH was closed significantly more often in the inverted group (75%) than in the removed group (25%; P = 0.006). The postoperative best-corrected visual acuity was significantly better in the inverted group (P = 0.04). The number of eyes with outer nuclear layer, external limiting membrane, and ellipsoid zone lines at the closed MH was not significantly different in the two groups. CONCLUSION: The inverted ILM flap technique with the presence of bridging tissue over the MH is effective in closing the MH and improving the postoperative best-corrected visual acuity in eyes with MH retinal detachment by bridging tissue over the MH.

Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment.

PURPOSE: To determine the outcomes of vitrectomy with scleral imbrication in highly myopic eyes with either myopic traction maculopathy (MTM) or macular hole retinal detachment (MHRD). METHODS: The medical records of 17 patients who had undergone vitrectomy with internal limiting membrane (ILM) peeling and scleral imbrication for MTM or MHRD were reviewed. The best-corrected visual acuities (BCVAs), the axial length, the macular hole (MH) closure rate, and the shape of the posterior segment determined by optical coherence tomography were evaluated. Three-dimensional magnetic resonance imaging (3D-MRI) was also performed on five eyes. RESULTS: The postoperative BCVA improved significantly from 0.76 ± 0.39 logarithm of the minimum angle of resolution (logMAR) units to 0.53 ± 0.35 logMAR units (P = 0.0004). The axial length decreased from 29.42 ± 1.81 mm to 27.97 ± 1.71 mm at 1 month. The MTM was resolved or decreased in all eyes. The MH was closed in 44 % of the MHRD eyes, and the retina was reattached in all of the MHRD eyes. The horizontal distance between the optic disc and the bottom of the posterior staphyloma was significantly decreased at 1 month (P = 0.012) but not at later times. The 3D-MRI images showed a reduction in the distance between the bottom of the posterior staphyloma and the center of the eye (P = 0.029) and a flattening of the posterior staphyloma (P = 0.010). CONCLUSIONS: Vitrectomy with ILM peeling and scleral imbrication may be helpful in treating MTM and MHRD by reducing the degree of curvature of the posterior staphyloma.

DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning. METHODS: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeon's decision (conventional group). The MH closure rate and duration of the prone positioning were compared. RESULTS: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001). CONCLUSION: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

Ultra-widefield fundus imaging in gas-filled eyes after vitrectomy.

BACKGROUND: To evaluate the quality of the images obtained by an ultra-widefield device in gas-filled eyes after vitrectomy for a retinal detachment. METHODS: Retrospective case series. The ultra-widefield scanning laser ophthalmoscopic images (Optos 200Tx imaging system) of 40 eyes that were gas-filled with 40 to 90% of the vitreous cavity after vitrectomy for a rhegmatogenous retinal detachment were studied. The rates of detecting the rates of reattachments and the causative retinal tears that were treated and were in the superior or inferior areas in eyes with intravitreal gas of ≥60% were compared to that to eyes with intravitreal gas of <60% of the vitreous cavity. The widefield images recorded with 532 nm (green) or 633 nm (red) wavelength laser lights were compared to determine which wavelength had clearer images in 20 eyes of retinal detachment with superior retinal tears and were more than 50% gas-filled. RESULTS: The ultra-widefield images showed a retinal reattachment in all eyes on postoperative days 1 to 40 (mean; 8.7 ± 7.5 days). A superior retinal break was not visible in 5 of 26 eyes due to a reflection from the intravitreal gas bubbles when the gas was <60%. However, the superior retinal breaks were visible when the patients were requested to gaze downward to reduce the reflection of the gas bubble. The retinal breaks treated with laser burns and the retinal vasculature were imaged better with green laser than red laser light, and the choroidal vasculature was seen better with red laser light. CONCLUSIONS: Ultra-widefield fundus images can be used to evaluate and document the retinal breaks and retinal reattachments in gas-filled eyes. The green and red laser lights can image different depths of the retina and choroid in gas-filled eyes.

Effects of optical diameter of intraocular lenses with intrascleral fixation on higher-order aberrations.

BACKGROUND: Intrascleral fixation of an intraocular lens (IOL) is used in eyes that lack capsular support. The aim of the study is to determine whether a larger optical diameter IOL will decrease the higher-order aberrations (HOAs) when the haptics are extended for intrascleral fixation than a smaller diameter IOL. METHODS: Three-piece acrylic IOLs with 6.0 mm optics (X-60, VA-60BBR) and 7.0 mm optics (X-70, VA-70 AD) were fixed at lengths of 13, 14, 15, 16, or 17 mm. A wavefront analyzer was used to measure the HOAs within the central 3.0 and 5.2 mm optic diameter. RESULTS: The astigmatic aberration within the central 5.2 mm was greater than that within the central 3.0 mm for all IOLs. The HOAs increased significantly with an extension of the IOLs with both optical diameters (P < 0.001). The coma aberration within the central 5.2 mm was greater than that within the central 3.0 mm but it did not increase with an extension of the haptics. The astigmatic aberration of the X-60 IOL was significantly greater than that of the X-70 only at an extension of 17 mm. The astigmatic aberration of the VA-70 AD was not significantly different from that of the VA-60BBR. The cylindrical power changed from 0.047 D in the X-60 to 0.118 D in the VA-70 AD when the IOLs were extended from 13 to 17 mm. CONCLUSION: When three-piece IOLs are highly extended for intrascleral fixation, the astigmatic aberration increases significantly. However, IOLs with 7 mm optics do not have less astigmatic and coma aberrations than IOLs with 6 mm optics.