Flow pattern and perforating vessels in three different phases of myopic choroidal neovascularization seen by swept-source optical coherence tomography angiography.

PURPOSE: To compare the choroidal neovascularization (CNV) flow patterns and the relationship between perforating vessels (PVs) and CNV in the three different stages of networks in myopic CNV (mCNV) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: This retrospective study included 28 eyes with mCNV that was divided into three phases (active, scar, and atrophic) and observed by SS-OCTA. SS-OCTA findings, with special focus on the relationship between the PVs and CNV, were compared among the three phases. RESULTS: Overall, the CNV signal was detected in 31 of the 34 areas of CNV (91%); in the active, scar, and atrophic phases, respectively, CNV signals were detected in eight of eight areas of CNV (100%), 10 of 11 areas of CNV (91%), and 13 of 15 areas of CNV (86%). Two signal patterns were observed in each phase, i.e., dense and loop; in the atrophic phase, seven eyes were unclassifiable. The ratio between the dense and loop patterns did not differ significantly among the phases. In 30 of 34 areas of CNV for which clear images were obtained, the PVs and CNV were connected directly or indirectly in 19 area of CNV, and in five areas of CNV, trunk-like vessels were connected to the PVs within the CNV. The numbers of foveal or parafoveal CNVs accompanied by PVs were significantly (p=0.0048) greater than those of the extrafoveal CNV. CONCLUSIONS: OCTA provides detailed observation of mCNV and the relationship between CNV and PVs. Although the CNV signal pattern does not differ depending on the degree of atrophy, there are cases in which only the trunk-like vessels connect to the PVs within the CNV in the atrophic phase without CNV flow signal.

Effect of intravitreal injection of aflibercept or ranibizumab on chorioretinal atrophy in myopic choroidal neovascularization.

PURPOSE: To compare chorioretinal atrophy (CRA) progression in myopic choroidal neovascularization (mCNV) between intravitreal injections of ranibizumab (IVR) and aflibercept (IVA) in the eyes with mCNV. METHODS: Thirty eyes (28 patients) with treatment-naïve mCNV were included in this study. IVR or IVA was administered for up to 1 year. The best-corrected visual acuity (BCVA) was measured, and fundus photographs and fundus autofluorescence were obtained before and 1, 3, 6, and 12 months after the initial treatment. The clinical characteristics including the macular choroidal thickness in various areas and CRA progression were compared between the drugs. The clinical characteristics and macular choroidal thicknesses were compared between eyes with and without CRA progression. RESULTS: The BCVA improved significantly (p < 0.05 for all comparisons) from 0.44 to 0.26, 0.19, 0.20, and 0.17 after 1, 3, 6, and 12 months, respectively. CRA progressed in 12 (40%) eyes over 1 year. The CRA progression did not differ significantly between aflibercept and ranibizumab. The foveal choroid was significantly (p = 0.0043) thinner in aflibercept-treated eyes compared with ranibizumab-treated eyes at 1 year. Subfoveal CNV tended to cause CRA progression more frequently at 1 year, although this did not reach significance. CONCLUSIONS: IVA to treat mCNV caused more severe thinning of the foveal choroid than ranibizumab; however, no significant difference was seen in CRA progression between the drugs and the choroidal thickness should not be associated with CRA progression. The CNV location may predict CRA progression after anti-vascular endothelial growth factor therapy for mCNV.

MORPHOLOGIC CHARACTERISTICS OF MACULAR HOLE AND MACULAR HOLE RETINAL DETACHMENT ASSOCIATED WITH EXTREME MYOPIA.

PURPOSE: To investigate the surgical results and morphologic characteristics of macular hole (MH) and macular hole retinal detachment (MHRD) associated with extreme myopia. METHODS: We retrospectively reviewed consecutive cases with axial length ≥28 mm who were treated with pars plana vitrectomy for MH or MHRD. The choroidal and scleral thickness at the fovea, presence of dome-shaped macula, and the height of posterior staphyloma 3 mm from the fovea were measured from postoperative optical coherence tomography images. RESULTS: Significant improvement in visual acuity was obtained postoperatively in both MH (16 eyes; 15 patients) and MHRD (19 eyes; 18 patients) groups (P < 0.05). Final MH closure rate was not significantly different between the groups (MH: 15/16, MHRD: 14/19, P = 0.19). Axial length was not significantly different between the groups (MH: 30.5 ± 1.5 mm, MHRD: 29.6 ± 1.3 mm, P = 0.098). Eyes with MH had significantly greater choroidal thickness (MH: 61.9 ± 66.0 µm, MHRD: 24.1 ± 19.8 µm, P = 0.045), greater scleral thickness (MH: 294 ± 77 µm, MHRD: 232 ± 89 µm, P = 0.008), higher frequency of dome-shaped macula (MH: 6/16, MHRD: 1/19, P = 0.032), and lower staphyloma height (MH: 190 ± 113 µm, MHRD: 401 ± 156 µm, P < 0.001). CONCLUSION: Surgical outcomes were generally favorable. The pathogenetic differences between the two conditions may be attributable to differences with respect to eye morphology.

Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study.

PURPOSE: The aim of this study was to investigate the efficacy of pars plana vitrectomy with inverted internal limiting membrane (ILM) insertion for macular hole retinal detachment (MHRD) in high myopia. METHODS: We studied 49 eyes of 49 consecutive patients who underwent vitrectomy for MHRD and were followed for more than 12 months postoperatively. Eyes that underwent vitrectomy with inverted ILM insertion from October 2013 to August 2015 were compared with eyes that underwent standard ILM peeling from October 2006 to September 2013. Macular hole closure rate, retinal reattachment, and postoperative visual acuity (VA) at 6 and12 months were retrospectively evaluated. RESULTS: This series included 13 eyes in the inverted ILM insertion group and 36 eyes in the standard ILM peeling group. The MH closure rate was significantly better in the inverted ILM group (92 vs 39%) (P = 0.003). The initial and final retinal reattachment rates (92% vs. 86%, and 100% in both groups, respectively) did not differ significantly between groups. Although the mean preoperative VA did not differ significantly between the groups, postoperative VA tended to be better in the inverted ILM group at 12 months (P = 0.059). The rate of visual improvement of three or more lines in the inverted ILM insertion group (85%) was higher than that in the standard ILM peeling group (47%) at 12 months (P = 0.045). CONCLUSION: Compared to conventional ILM peeling, inverted ILM insertion has a higher MH closure rate and tendency of better postoperative VA in patients with MHRD.

OVERVIEW OF THE COMPLICATIONS OF HIGH MYOPIA.

High myopia is very common and one of the major causes of social blindness, especially in East Asian countries. It is characterized by axial length elongation, and induces various specific complications, including cataract formation, retinal detachment from peripheral retinal tears, myopic foveoschisis, macular hole with or without retinal detachment, peripapillary deformation, dome-shaped macula, choroidal/scleral thinning, myopic choroidal neovascularization, and glaucoma. This article will review these complications and discuss the current concepts relating to these complications and their treatments. CONCLUSION: This information will be helpful for the daily practice of treating myopic eyes.

Understanding the Pathology and Current Treatment Strategy of Highly Myopic Complications.

The population of high myopia in Japan is large and increasing. It is a high risk factor not only for its specific macular complications but also as a precursor for cataracts and glaucoma. Myopic foveoschisis and the consequent macular hole with retinal detachment (MHRD) are caused by inner retinal traction which may include the vitreous cortex, epiretinal membrane, internal limiting membrane and posterior staphyloma formation. Vitrectomy is the 1st choice of treatment, and releasing the retina from traction is the goal. MHRD has poor anatomical success rates, and, therefore, inverted internal limiting membrane is a common treatment procedure to enhance MH closure. Myopic choroidal neovascularization occurs predominantly in highly myopic eyes, and anti-vascular endothelial growth factor therapy is the 1st line treatment. Normally the patient's eyes respond well, however, recurrence is an important issue. Conventional optical coherence tomography (OCT) and fluorescein angiography are the major diagnostic tools. At the same time, advanced technologies such as OCT-angiography and Polarization-sensitive OCT may enable an early and more accurate diagnosis. High myopia is a high risk factor for glaucoma and its mechanism is still uncertain. Studies using OCT thus far have shown variety of abnormalities occurring in highly myopic eyes inside and around the optic nerve head. High myopia has uncommon progression patterns such as preceding the papillo-macular bundle damage, especially in younger patients. Future studies are needed.

A meta-analysis of vitrectomy with or without internal limiting membrane peeling for macular hole retinal detachment in the highly myopic eyes.

BACKGROUND: To evaluate the anatomical and visual outcomes by par plana vitrectomy with or without internal limiting membrane (ILM) peeling in highly myopic eyes with macular hole retinal detachment (MHRD). METHODS: MEDLINE (Ovid, PubMed) and EMBASE were used for data collection up to September 30, 2015. The parameters of anatomical success, macular hole closure and improved best corrected visual acuity (BCVA) at or beyond 6 months after operation were assessed as the primary outcome measurement. The meta-analysis was performed with the fixed-effects model. RESULTS: Seven comparative analyses involving a total of 373 patients were included in the present meta-analysis. Statistically the pooled data showed significant relative risk (RR) in terms of primary reattachment between ILM peeling and non-peeling groups (RR, 1.19; 95 % CI, 1.04 to 1.36; P = 0.012). An effect favoring ILM peeling with regard to macular hole closure was also detected (RR, 1.71; 95 % CI, 1.20 to 2.43; P = 0.003). However, no statistically significant difference was found in the improved BCVA (logarithm of the minimum angle of resolution) at 6 months or more (95 % CI, -0.31 to 0.44; P = 0.738). CONCLUSIONS: There is no proved benefit of postoperative visual improvement. However, the available evidences from this study suggested a superiority of ILM peeling over no peeling for myopic patients with MHRD.

Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization: The MYRROR Study.

PURPOSE: To evaluate intravitreal aflibercept 2 mg in patients with myopic choroidal neovascularization (CNV). DESIGN: An international, phase III, multicenter, randomized, double-masked, sham-controlled study. PARTICIPANTS: Patients aged ≥ 18 years with high myopia (≤-6.0 diopters or axial length of ≥ 26.5 mm), active myopic CNV, and best-corrected visual acuity (BCVA) of 73-35 Early Treatment Diabetic Retinopathy Study letters in the study eye were included. METHODS: Patients were randomized 3:1 to intravitreal aflibercept or sham. In the intravitreal aflibercept arm, patients received 1 injection at baseline. Additional injections were performed in case of CNV persistence or recurrence at monthly visits through week 44. In the sham arm, patients received sham injections through week 20. At week 24, after assessment of the primary efficacy end point, sham patients received a mandatory intravitreal aflibercept injection followed by intravitreal aflibercept (if disease persisted/recurred) or sham injection every 4 weeks. MAIN OUTCOME MEASURES: Mean change in BCVA from baseline to week 24. RESULTS: A total of 122 patients were randomized to intravitreal aflibercept (n = 91) or sham (n = 31). Baseline demographics were similar across groups. At week 24, patients in the intravitreal aflibercept and sham groups gained 12.1 and lost 2 letters, respectively (P < 0.0001). By week 48, patients in the intravitreal aflibercept and sham/intravitreal aflibercept groups gained 13.5 and 3.9 letters. Patients in the intravitreal aflibercept group received 2 injections (median) in the first study quarter (week 0-8). Median number of injections in quarters 2 to 4 was 0. Patients in the "sham/intravitreal aflibercept" group received 2 and 1 (median) intravitreal aflibercept injections in quarters 3 and 4. Central retinal thickness improved in parallel with visual gains. Incidence of ocular adverse events was similar in both groups through week 48 (37.4% vs. 38.7); most were assessed by investigators as mild. No deaths occurred. CONCLUSIONS: Intravitreal aflibercept 2 mg was effective for treatment of myopic CNV with clinically important visual and anatomic benefits achieved with a limited number of injections given in the first 8 weeks of treatment. No new safety concerns occurred with treatment. Intravitreal aflibercept should be considered as a treatment option for myopic CNV.

Analysis of choroidal folds in acute Vogt-Koyanagi-Harada disease using high-penetration optical coherence tomography.

PURPOSE: To characterize patients with Vogt-Koyanagi-Harada (VKH) disease with choroidal folds (CFs) and determine how the foveal choroidal thickness changes after initial treatment using high-penetration optical coherence tomography (HP-OCT). METHODS: In this retrospective observational study, we analyzed 42 eyes of 21 patients with new-onset VKH disease to determine the demographic and clinical differences between patients with and without CFs. RESULTS: Twenty-four eyes (57.1 %) of 13 patients with VKH disease had CFs. The mean age (p = 0.0009) of patients with CFs was significantly higher than that of those without CFs (49.1 vs 39.4 years respectively). The frequency of disc swelling (p = 0.0001) was significantly higher in eyes with CFs than in those without CFs (95.8 % vs 38.9 %). The choroidal thickness at the first visit (p = 0.0011) was significantly greater in eyes with CFs than in those without CFs (794 ± 144 µm vs 649 ± 113 µm). The choroid 6 months after the initial treatment (p = 0.0118) was significantly thinner in eyes with CFs than in those without CFs (270 ± 92 µm vs 340 ± 80 µm). The frequency of sunset glow fundus at 6 months (p = 0.0334) in eyes with CFs was significantly higher than in those without CFs (62.5 % vs 27.8 %). CONCLUSION: The development of CFs in patients with VKH disease was significantly correlated with age, disc swelling, and choroidal thickness. The eyes with CFs frequently developed a sunset glow fundus. The findings suggested that patients with CFs might have severe and longstanding inflammation of the choroidal tissues.

Comparison of visual prognoses between natural course of simple hemorrhage and choroidal neovascularization treated with intravitreal bevacizumab in highly myopic eyes: a 1-year follow-up.

PURPOSE: To compare the long-term outcomes of simple hemorrhage (SH) without any treatments and myopic choroidal neovascularization (mCNV) treated with intravitreal bevacizumab in highly myopic eyes. METHODS: Twenty eyes (17 patients) with SH and 28 eyes (27 patients) with mCNV were included. We retrospectively evaluated the refractive error, axial length, age, best-corrected visual acuity, and the integrity of photoreceptor inner segment/outer segment junction and compared the two groups. RESULTS: The mean patient age was 41.6 ± 11.2 years, the mean refractive error -12.7 ± 3.57 diopters, and the mean axial length was 29.64 ± 1.42 mm. Patients in the SH group were significantly (P < 0.001) younger than those in the mCNV group (34.8 vs. 46.5 years, respectively). There were no significant differences in other parameters between the groups. Compared with baseline, the best-corrected visual acuity improved significantly (P < 0.01) at 12 months in both groups. The change in vision at 12 months in the SH group was significantly (P < 0.05) better than that in the mCNV group, although there were no significant differences at 3 months or 6 months. The final integrity of photoreceptor inner segment/outer segment junction was significantly associated with the final best-corrected visual acuity (P < 0.05). CONCLUSION: Eyes with SH had a more favorable visual prognosis compared with eyes with mCNV treated with intravitreal bevacizumab. The differential diagnosis of these pathologies is important.

Comparison of spectral-domain and high-penetration OCT for observing morphologic changes in age-related macular degeneration and polypoidal choroidal vasculopathy.

BACKGROUND: We compared the visibility of retinal and choroidal pathologies using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source (1,050 nm) and conventional spectral-domain OCT (SD-OCT) in age-related macular degeneration (AMD). METHODS: One hundred and forty-six eyes were included: 63 eyes with AMD, 79 eyes with polypoidal choroidal vasculopathy (PCV), and four eyes with retinal angiomatous proliferation. The SD-OCT and HP-OCT images were compared using the grading criteria to grade the visibility of the retinal changes, the line corresponding to the retinal pigment epithelium (RPE), and the chorioscleral interface (CSI). In 132 eyes with a pigment epithelial detachment (PED), we graded the structures inside the PED, Bruch's line, and the CSI. We compared the visibility of those changes in eyes with subretinal hyperreflective changes due to a subretinal hemorrhage (SRH) (n = 17) or a hemorrhage inside the PED (HPED) (n = 12). RESULTS: HP-OCT provided superior visibility of the following structures compared to SD-OCT (P < 0.01): the CSI, structures inside the PED, Bruch's line inside the PED, the CSI inside the PED, SRH, type 1 CNV, polyps, and HPED. There were no significant differences between the two OCT devices in the scores for the RPE line, retinal morphology, or type 2 CNV and/or fibrin. CONCLUSION: HP-OCT visualizes morphologies beneath the RPE better than SD-OCT, and is equivalent to SD-OCT for visualizing morphologies above the RPE.

Choroidal thickness changes after diabetes type 2 and blood pressure control in a hospitalized situation.

PURPOSE: To investigate the effect of acute diabetic control on choroidal thickness in patients with Type 2 diabetes. METHODS: Seventeen eyes of 17 patients with Type 2 diabetes were included in this prospective observational study. The patients with Type 2 diabetes who were scheduled to undergo a program of intensive diabetic control underwent prototype high-penetration optical coherence tomography before and 2 weeks after the start of treatment. The choroidal thickness changes 2 weeks after the protocol of intensive diabetic control were assessed, and associated ophthalmologic and general parameters were explored. Seventeen eyes of 17 healthy volunteers were included to compare diabetic patients. The choroidal thickness also was measured in this group at baseline and after 2 weeks. And the intraobserver and interobserver reproducibility were verified using this control group. RESULTS: The intraobserver (intraclass coefficient, 0.992) and interobserver reproducibility (0.982) in our subfoveal choroidal thickness measurement were high. The mean subfoveal choroidal thickness after 2 weeks (226 ± 56 µm) was significantly greater than at baseline (215 ± 52 µm, P < 0.05); there was no difference between the baseline and 2-week values in the control group (baseline, 312 ± 113 vs. 2-week value, 307 ± 103 µm; P = 0.17). The changes in refractive error (P < 0.001), axial length (P < 0.01), and diastolic blood pressure (P < 0.01) were associated significantly with changes in choroidal thickness 2 weeks after the intensive control. The pretreatment body mass index (P < 0.05) and hemoglobin A1c (P < 0.005) also were associated significantly with increased choroidal thickness. CONCLUSION: Diabetic patients showed a significant increase of choroidal thickness after the intensive control. Various ophthalmologic and systemic parameters seem to affect the choroidal thickness changes. This may be related to the progression of retinopathy after acute glycemic control.

Choroidal thickness in eyes with tilted disk syndrome.

PURPOSE: To investigate the choroidal thickness in eyes with tilted disk syndrome within/without posterior staphyloma. METHODS: Twenty-one eyes examined in 16 patients with tilted disk syndrome were included. The thicknesses of the choriocapillaris, the medium-to-large choroidal vessels, and total choroids found 1 mm and 3 mm superior and inferior to the fovea and in the area with the thinnest choroid were measured using enhanced-depth imaging optical coherence tomography or high-penetration optical coherence tomography. The results were compared with the findings on indocyanine green angiography. RESULTS: The mean thicknesses of total choroid found 3 mm and 1 mm inferior (114.3 µm ± 77.8 µm, 145.0 µm ± 85.9 µm) to the fovea were significantly thinner than those found superior (174.5 µm ± 89.7 µm, 145.0 µm ± 85.9 µm) to it. The minimal choroidal thickness of 80.5 µm ± 67.1 µm was obtained at a mean 1.04 mm below the fovea at the upper edge of the posterior staphyloma. The thickness of the layer of choriocapillaris was not significantly different according to the regions but the layer of medium-to-large choroidal vessels found 3 mm and 1 mm inferior to the fovea was significantly thinner than that found superior to the fovea. The ratio of choriocapillaris to medium-to-large vessels found 1 mm superior also was significantly smaller than those found inferior. The diameter of medium-to-large choroidal vessels on ICGA was not significantly different in the areas although less number of vessels were seen around the area inferior to the fovea. CONCLUSION: In the eyes of patients with tilted disk syndrome, the choroid is thinnest at approximately 1 mm inferior to the fovea at the upper edge of the posterior staphyloma rather than at the bottom of the posterior staphyloma. Thinning of the layer of medium-to-large choroidal vessels seems to be associated with the thinning of choroid thickness.

Choroidal observations in posterior scleritis using high-penetration optical coherence tomography.

To investigate the choroidal morphologic changes in two patients with posterior scleritis. We used high-penetration optical coherence tomography (HP-OCT) in vivo with a long-wavelength light source (1,060 nm) to view the choroidal changes. In patient 1 with unilateral scleritis, the subfoveal choroidal thickness of the right eye was 418 µm with a serous retinal detachment (SRD) at the initial visit. The treatment regimen was prednisolone 30 mg/day, and the posterior scleritis resolved. Follow-up HP-OCT showed the following choroidal thicknesses-266 µm on day 27 with no SRD, 245 µm on day 69, and 200 µm on day 216. In patient 2 with bilateral scleritis, the subfoveal choroidal thickness of the left eye was 279 µm at the initial visit. The inflammation was more severe in the left eye compared to the right eye on day 99. The choroidal thickness again increased markedly with recurrent disease in the left eye despite treatment. The posterior scleritis resolved with treatment. Follow-up HP-OCT showed the following choroidal thicknesses of the left eye--321 µm on day 99, 257 µm on day 176, and 228 µm on day 358. Significant choroidal changes underlie posterior scleritis. HP-OCT can show these deep choroidal pathologies in patients with posterior uveitis. The choroidal thickness recovers following treatment.

Choroidal thickness in central serous chorioretinopathy.

PURPOSE: To study the choroidal thickness profile using high-penetration optical coherence tomography in central serous chorioretinopathy (CSC). METHODS: Thirty-five eyes of 27 subjects with CSC and 35 healthy, age-matched control eyes were included. We observed the choroid using the prototype high-penetration optical coherence tomography. Fluorescein angiography and indocyanine green angiography were performed to identify the CSC location and activity. The choroidal thicknesses was measured manually in various conditions or locations, and the choroidal thickness maps were obtained from cube scans and calculating software and composed of nine sectors in the Early Diabetic Retinopathy Study chart. RESULTS: The subfoveal choroidal thicknesses in all eyes with CSC were significantly (P < 0.01) greater than that in the control eyes. The choroidal thickness at the fovea and the fluorescein points of leakage were significantly (P < 0.01 for both comparisons) greater in eyes with CSC than the corresponding locations in the fellow eyes in patients with unilateral disease. Dilatation of the choroidal large vessels was significantly (P < 0.01) more common in CSC. The foveal choroidal thickness was significantly greater in eyes with venous dilatation (P < 0.01) than those without. The mean choroidal thickness was significantly (P < 0.05) greater in all sectors of the Early Diabetic Retinopathy Study chart except for the inner (P = 0.087) and outer (P = 0.053) inferior sectors. The percent mean choroidal thicknesses compared with the normal controls in the nasal sector were significantly (P < 0.05 and P < 0.01, respectively) greater in the inner and outer circles than in the superior, temporal, and inferior sectors. CONCLUSION: The choroid is diffusely thickened in CSC likely because of the choroidal vascular dilatation. The nasal macula undergoes the greatest alterations in choroidal thickness compared with the other areas.

3-D choroidal thickness maps from EDI-OCT in highly myopic eyes.

PURPOSE: Myopic chorioretinal atrophy is a debilitating condition that causes severe loss of primary vision. However, its mechanisms and pathologic course are not well understood. We performed volumetric measurements of the posterior choroid via three-dimensional analysis of the choroid in patients with high myopia to understand its structure, and we compared the measurements with those of normal subjects. METHODS: Twenty-five highly myopic but otherwise normal eyes and 25 nonmyopic eyes were evaluated. Enhanced depth imaging optical coherence tomography (EDI-OCT) was performed using 20 × 20-degree raster scans consisting of 25 high-speed line scans. Three-dimensional retinal and choroidal thickness maps were produced from the EDI-OCT data. For the quantitative analyses, the macula was divided into nine regions, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) layout, and the mean retinal and choroidal thicknesses of each region were obtained. RESULTS: The choroidal thicknesses at all regions in the high-myopia group were significantly smaller than those in the normal refractive group (p < 0.0001). The foveal choroidal thickness was the greatest in the normal group but not in the high-myopia group. In the high-myopia group, the choroidal thickness at the fovea was significantly greater than that at the outer nasal quadrants (p < 0.0001) but significantly smaller than that at the outer superior (p < 0.0001) quadrants. CONCLUSIONS: Three-dimensional choroidal thickness maps obtained via EDI-OCT are useful for quantifying choroid thickness in subjects with high myopia more accurately.

Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2.

PURPOSE: To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). DESIGN: Multicenter, interventional, retrospective case series. SUBJECTS: Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up. METHODS: We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery. MAIN OUTCOME MEASURES: Incidence, risk factors, and anatomic and visual outcomes of postoperative MH. RESULTS: We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P = 0.002). CONCLUSIONS: Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Efficacy of Vitrectomy With Tamponade Versus No Tamponade for Myopic Traction Maculopathy: A Multicenter Study (SCHISIS Report No.1).

PURPOSE: To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM). DESIGN: Multicenter, retrospective clinical cohort study. METHODS: Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade. RESULTS: We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution. CONCLUSIONS: Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.

Choroidal observations in Vogt-Koyanagi-Harada disease using high-penetration optical coherence tomography.

BACKGROUND: The aim of this work was to investigate the choroidal morphologic changes of Vogt-Koyanagi-Harada (VKH) disease in vivo using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source (1,060 nm). METHODS: Fourteen patients with VKH disease were included in this study: 12 eyes of six patients with treatment-naive acute VKH in the first 6-12 months after diagnosis and 16 eyes of eight patients in the convalescent phase with a sunset glow fundus appearance. A prototype HP-OCT instrument was used to observe the deep choroid and sclera. The choroidal thickness was measured for more than 6 months in eyes with acute disease. The choroidal thickness in patients with a sunset glow fundus appearance for 2-9 years after the onset was also examined. RESULTS: In 12 eyes with acute VKH disease, the baseline choroidal thickness was significantly (p < 0.0001) greater than in controls. After treatment, the choroidal thickness decreased over time. However, the choroidal thickness increased markedly again in four eyes with recurrent disease. The mean thickness at 12 months was significantly less than the normal value (p < 0.0001). In 16 eyes with a sunset glow fundus appearance, the choroidal thickness was significantly (p < 0.0001) thinner compared to the controls. CONCLUSIONS: Significant choroidal thickness changes underlie VKH disease, which progress over time. Objective measurement of the choroidal thickness using HP-OCT may be useful for longitudinal evaluation of VKH activity.