[Small gauge vitrectomy in macular surgery for myopic complications].

PURPOSE: To investigate the results of small gauge vitrectomy for myopic macular complications. METHODS: We reviewed 68 eyes which underwent vitrectomy with various needles (20 G, 27 eyes; sutureless 23 G, 15 eyes; sutured 23 G, 15 eyes; and 25 G, 11 eyes) for myopic macular pathologies. Surgical results and complications were compared. RESULTS: Mean logMAR after 3 months was 0.85 for 20 G, 0.78 for sutureless 23 G, 0.43 for sutured 23 G, and 0.46 for 25 G (p < 0.05). However, there was no significant difference in visual acuity change between the groups 3 months after surgery (p = 0.21). Mean intraocular pressure 1 day after surgery was significantly different (20 G, 15.0 mmHg; sutureless 23 G, 11.4 mmHg; sutured 23 G, 18.7 mmHg; and 25 G, 14.2 mmHg, p < 0.05), but that significance was lost 7 days after surgery. CONCLUSION: The small gauge system produces favorable results in vitrectomy for myopic macular complications, similar to the conventional 20 G system.

[Prognosis for branch retinal vein occlusion].

PURPOSE: To evaluate the visual outcomes of various kinds of treatment for branch retinal vein occlusion (BRVO). METHODS: The medical records of 222 BRVO eyes without any previous treatment were reviewed. One-year visual acuity (VA) and 1-year visual gains (VG) were analyzed for each treatment. RESULTS: The one-year VA correlated with the initial VA and 1-year VG negatively correlated with the initial VA. The initial and 1-year VA of the observation group (17.6%) were 0.6 and 0.8, respectively. No difference in the 1-year VA was found among the various treatments and the average 1-year VG was 1.1 lines. The one-year VA of the single treatment group (36.0%) was 0.62 on average, without any difference between the various treatments, while only the PPV group had better 1-year VG (4.4 lines). The multiple treatment group (46.4%)showed worse initial VA (0.33), 1-year VA (0.39) and 1-year VG (0.7 line). CONCLUSIONS: Patients with better initial VA can be observed without any treatment. As a whole, the 1-year VG is about one line and some significant visual improvement can be expected regardless of the treatments. The PPV group showed larger visual gain for eyes with worse initial visual acuity. Approximately half of the patients could not achieve any improvement by a single treatment and had a poor visual prognosis.

En Face Optical Coherence Tomography Imaging of the Choroid in a Case with Central Serous Chorioretinopathy during the Course of Vogt-Koyanagi-Harada Disease: A Case Report.

Vogt-Koyanagi-Harada (VKH) disease and central serous chorioretinopathy (CSC) develop serous retinal detachment; however, the treatment of each disease is totally different. Steroids treat VKH but worsen CSC; therefore, it is important to distinguish these diseases. Here, we report a case with CSC which was diagnosed by en face optical coherence tomography (OCT) imaging during the course of VKH disease. A 50-year-old man was referred with blurring of vision in his right eye. Fundus examination showed bilateral optic disc swelling and macular fluid in the right eye. OCT showed thick choroid, and en face OCT images depicted blurry choroid without clear delineation of choroidal vessels. Combined with angiography findings, this patient was diagnosed with VKH disease and treated with steroids. Promptly, fundus abnormalities resolved with the reduction of the choroidal thickness and the choroidal vessels became visible on the en face images. During the tapering of the steroid, serous macular detachment in the right eye recurred several times. Steroid treatment was effective at first; however, at the fourth appearance of submacular fluid, the patient did not respond. At that time, the choroidal vessels on the en face OCT images were clear, which significantly differed from the images at the time of recurrence of VKH. Angiography also suggested CSC-like leakage. The tapering of the steroids was effective in resolving the fluid. Secondary CSC may develop in the eye with VKH after steroid treatment. En face OCT observation of the choroid may be helpful to distinguish each condition.

Axial length estimation error caused by hidden double-peak on partial coherence interferometry in an eye with epiretinal membrane: a case report.

Here we report a patient in whom there was a myopic shift after combined cataract surgery and pars plana vitrectomy against the epiretinal membrane, related to axial measurement estimation error caused by a hidden double-peak appearance on partial coherence interferometry measurement. A 52-year-old female presented with epiretinal membrane and underwent combined cataract surgery and pars plana vitrectomy. Axial length was measured with partial coherence interferometry. Although the signal curve in the summary display showed a single peak, a 1.6 diopter myopic shift occurred. Viewed retrospectively, six of 20 individual signal curves showed a double peak. Most of them showed a higher anterior peak, with only one having a higher posterior peak. The other 14 curves showed a single peak at a similar distance to an anterior peak. The anterior peak appeared to be derived from the epiretinal membrane. The possibility of a double peak should always be considered in patients with epiretinal membrane even if the summary display of the partial coherence interferometry measurement shows a single peak. Checking all signal curves would reduce the risk of missing a hidden double peak.

Relationship between grades of macular perfusion and foveal thickness in branch retinal vein occlusion.

BACKGROUND: To study the relationship between retinal perfusion around the macula and the foveal thickness in branch retinal vein occlusion (BRVO). METHODS: Seventy-four eyes of 74 consecutive patients with BRVO were enrolled. We developed a new grading system to evaluate the status of retinal perfusion around the macula in three grades: full perfusion area (FPA), partial perfusion area (PPA), and nonperfusion area (NPA), using fluorescein angiography. The correlation was assessed between these grades and the central foveal thickness (CFT) measured by optical coherence tomography. We also determined the area with the closest correlation between the perfusion status and the foveal thickness by comparing the correlation coefficient in areas of 1-, 2-, and 3-disc diameter (DD) horizontal hemicircles centered at the fovea. The correlation was determined between the extent of each perfusion grade and CFT. RESULTS: We found a significant negative correlation between the CFT and the FPA (r = 0.31, P = 0.006) and a significant positive correlation between the CFT and the PPA (r = 0.45, P < 0.001) in the three areas. The most significant correlations were found in the 2-DD area. Interestingly, the NPA has not correlated with the foveal thickness in any areas. CONCLUSION: The areas of partial but not complete capillary loss seem to be responsible for the macular edema associated with BRVO. Treatments targeting leakage from the dilated capillaries in the PPA should be investigated.