Macular Hole Closure Without Endotamponade Application.

PURPOSE: We describe an alternative vitreoretinal technique that allows for the macular hole closure without filling the vitreous cavity with gas. METHODS: A prospective interventional one-center case series from March 2019 to January 2020. The patients underwent the formation of viscoelastic-assisted temporal internal limiting membrane flap without any gas endotamponade. Preoperative and postoperative visual acuity and foveal structure in optical coherence tomography images were evaluated. RESULTS: Macular hole closure was achieved with a single procedure in 11 of 12 eyes with no endotamponade application. Preoperative, mean best-corrected visual acuity was 1.11 (Snellen equivalent 20/258) ± 0.28 logarithm of the minimal angle of resolution (range 1.398-0.523). We were able to assess visual acuity as early as on the first postoperative day in all patients. It ranged from 1.398 to 0.523 logarithm of the minimal angle of resolution (Snellen equivalent 20/500-20/67) with a mean of 0.97 (20/186) ± 0.29. Final best-corrected visual acuity was 0.31 (Snellen equivalent 20/40) ± 0.18 (range 0.699-0.1) at the end of the 3-month follow-up. CONCLUSION: This technique avoids the application of any tamponade, does not require positioning, and seems to provide macular hole closure rates similar to those of traditional vitrectomy with gas.

Immediate effects of smoking on optic nerve and macular perfusion measured by optical coherence tomography angiography.

The aim of this study was the assessment of the relationship between cigarette smoking and optic nerve and macular vessel density measured by optical coherence tomography angiography. We examined 30 eyes from 30 healthy habitual smokers. The examination was performed using a high-speed and high-resolution spectral-domain optical coherence tomography RTVue XR Avanti with AngioVue (Optovue, Fremont, CA, USA) with a split-spectrum amplitude-decorrelation angiography algorithm. Blood pressure, heart rate, vascular density in the area of the optic nerve head (4.5*4.5 mm) and vascular density with the foveal avascular zone in the central macula (3.0*3.0 mm) were measured and analyzed before, immediately after and 30 minutes after cigarette smoking. Quantitative measurements were carried out by AngioAnalytics Phase 7 software. Immediately after smoking both heart rate and blood pressure increased significantly (p < 0.001) compared to values before smoking and then significantly decreased after 30 minutes comparing to values obtained right after smoking (p < 0.001). The mean area of the foveal avascular zone, parafoveal vessel density, and peripapillary vessel density did not change significantly. Our results show no immediate influence of smoking on vessel density parameters measured by specific OCTA machine in healthy habitual smokers.

IMAGING AND MEASUREMENT OF THE PRERETINAL SPACE IN VITREOMACULAR ADHESION AND VITREOMACULAR TRACTION BY A NEW SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANALYSIS.

PURPOSE: To evaluate a new method for volumetric imaging of the preretinal space (also known as the subhyaloid, subcortical, or retrocortical space) and investigate differences in preretinal space volume in vitreomacular adhesion (VMA) and vitreomacular traction (VMT). METHODS: Nine patients with VMA and 13 with VMT were prospectively evaluated. Automatic inner limiting membrane line segmentation, which exploits graph search theory implementation, and posterior cortical vitreous line segmentation were performed on 141 horizontal spectral domain optical coherence tomography B-scans per patient. Vertical distances (depths) between the posterior cortical vitreous and inner limiting membrane lines were calculated for each optical coherence tomography B-scan acquired. The derived distances were merged and visualized as a color depth map that represented the preretinal space between the posterior surface of the hyaloid and the anterior surface of the retina. The early treatment d retinopathy study macular map was overlaid onto final virtual maps, and preretinal space volumes were calculated for each early treatment diabetic retinopathy study map sector. RESULTS: Volumetric maps representing preretinal space volumes were created for each patient in the VMA and VMT groups. Preretinal space volumes were larger in all early treatment diabetic retinopathy study map macular regions in the VMT group compared with those in the VMA group. The differences reached statistical significance in all early treatment diabetic retinopathy study sectors, except for the superior outer macula and temporal outer macula where significance values were P = 0.05 and P = 0.08, respectively. Overall, the relative differences in preretinal space volumes between the VMT and VMA groups varied from 2.7 to 4.3 in inner regions and 1.8 to 2.9 in outer regions. CONCLUSION: Our study provides evidence of significant differences in preretinal space volume between eyes with VMA and those with VMT. This may be useful not only in the investigation of preretinal space properties in VMA and VMT, but also in other conditions, such as age-related macular degeneration, diabetic retinopathy, and central retinal vein occlusion.

Comparison of anatomic and functional results after retinotomy for retinal detachment in pediatric and adult patients.

PURPOSE: We investigated characteristics and treatment outcomes of pediatric vs adult retinal detachment managed by retinotomy and retinectomy.
 METHODS: This was a retrospective, nonrandomized, interventional study involving 20 pediatric patients and 25 adult patients operated with vitrectomy and retinectomy due to retinal detachment. Outcome measures included preoperative and postoperative visual acuity at 6 months and at final visit, postoperative proliferative vitreoretinopathy, silicone oil removal, final intraocular pressure (IOP), and final anatomic success, defined as complete retinal reattachment.
 RESULTS: Reattachment was observed in 60% (12/20) of pediatric patients and 88% (22/25) of adults at final visit (p=0.041). Statistically significant improvement in visual acuity was observed in adults (p<0.001) but not in children (p=0.360) due to large proportion of anatomic failure. Children required a higher number of further reoperations (p=0.008). Postoperative proliferative vitreoretinopathy was significantly more frequent in pediatric eyes (p=0.003). 
 CONCLUSIONS: The clinical features and prognosis for pediatric retinotomies and retinectomies are different from those for adults. When a decision to perform retinotomy in children is made, we can anticipate significantly lower anatomic success than in adults. Even though the overall visual acuity was worse in children than in adults, 25% of pediatric eyes achieved 5/50 or better vision.

A pedicled autologous choroid RPE patch: a technique to preserve perfusion.

The aim of the study is to report a technique of a pedicled autologous choroid retinal pigment epithelium (RPE) patch that aims to preserve perfusion of the transplanted tissue. A case report of a patient with sudden vision deterioration due to submacular hemorrhage in age-related macular degeneration. The surgery involved a 180-degree peripheral retinectomy and the creation of a pedicled graft instead of an isolated one. Outcome measures included preoperative and postoperative visual acuity and optical coherence tomography scans at 1, 3, 6, 12 months and patch vascularization on postoperative indocyanine green angiography. Postoperatively the patch was positioned under the fovea with an intact pedicle. Indocyanine green angiography showed perfusion through the pedicle and patch vasculature on the third postoperative day. Best corrected visual acuity improved from 0.5/50 to 5/50 at 1 month and remained stable over 1 year follow-up. No choroidal neovascularization recurrence was observed. This case report demonstrates the feasibility of a pedicled RPE-choroid graft that is an alternative to a free isolated graft. Our modification of patch surgery, by demonstrating early perfusion, offers an advantage, similar to macular translocation, when photoreceptors are embedded in RPE and choroid with blood circulation immediately after the surgery.

[The disturbances of the eye position and motility in patients after scleral buckling surgery due to retinal detachment]. / Ustawienie i ruchomosc galek ocznych u pacjentów po chirurgii konwencjonalnej z powodu odwarstwienia siatkówki.

PURPOSE: The aim of the study was the evaluation of the frequency and intensity of the disturbances of the eye position and motility in patients after scleral buckling surgery due to retinal detachment, treated in Ophthalmology Clinic in Poznar. Additionally the aim was to diagnose the reason for muscles damage by means of the Hess screen. MATERIAL AND METHODS: Seventy patients were treated with this method between 2007-2009 and the study group was built by 40 patients, treated in average 15 months before the examination, at the age 12-79 years (mean age 55 years and 8 months). The correlation between the location of retinal holes treated with cryotherapy, the type of surgery and the changes in eye position and motility or diplopia in clinical evaluation and on the Hess screen, were evaluated. RESULTS: The disturbances of eye motility in clinical evaluation was diagnosed in 10 eyes (25% cases), and on the Hess screen in 16 eyes (40% cases). We noted, that the damaged muscle (overacting or weakened), was localized always on the site of cryotherapy or in the area at three o'clock from the retinal hole. CONCLUSIONS: (1) Patients during visual rehabilitation after scleral buckling surgery should be controlled for eye motility disturbances and diplopia. (2) The percentage of eye motility disturbances in our study group was comparable to this presented in literature, but higher in evaluation by means of Hess screen. (3) Accidental cryotherapy of the muscle, causing its weakening or overaction, seems to be a particular risk factor of extraocular muscles function disturbances.

[Choroidal melanoma treatment by endoresection]. / Leczenie czerniaka naczyniówki metoda endoresekcji.

PURPOSE: To report choroidal melanoma treatment by endoresection. MATERIAL AND METHODS: A retrospective review of a series of 2 patients with choroidal melanoma that did not meet the criteria for brachytherapy. Both patients were treated by tumor endoresection supported by brachytherapy. Outcome measures included preoperative and postoperative visual acuity at 1, 3, 6 months. Preoperative evaluation included tumor measurements in ultrasound. Systemic evaluation (liver function test, chest x ray, abdominal ultrasound), was carried out to monitor possible metastases in the observation period. RESULTS: The two operated patients were followed-up for 6 months. Visual acuity deteriorated from 5/16 (0.51 logMAR) preoperatively to 5/25 (0.7 logMAR) postoperatively in patient 1, and improved from 3/50 (1.22 logMAR) do 5/25 (0.7 logMAR) in patient 2. This corresponded to deterioration by 0.19 logMAR and improvement by 0.52 logMAR respectively. Neither tumor recurrence nor metastases were detected in the follow-up period. CONCLUSIONS: Endoresection is a treatment option, alternative to enucleation, that can conserve the eye It sometimes can be performed in eyes that are not eligible for trans-scleral resection. Further larger studies are needed to establish the efficacy of this still controversial surgery.

[Autologous choroidal RPE patch transplantation for submacular hemorrhage in age-related macular degeneration]. / Autologiczny przeszczep naczyniówki i nablonka barwnikowego siatkówki w leczeniu krwotoku podsiatkówkowego w przebiegu zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: To report autologous choroidal RPE patch transplantation for treatment of submacular hemorrhage in a patients with age related macular degeneration. MATERIAL AND METHODS: A case report of a patient with sudden vision deterioration due to submacular hemorrhage in AMD. The visual acuity was 5/5 in the right eye and 0.5/50 in the left eye. He was treated with autologous choroidal RPE patch transplantation. Outcome measures included preoperative and postoperative visual acuity at 1, 3, 6 months, duration of hemorrhage, hemorrhage size on preoperative fluorescein angiography and thickness of the subretinal hemorrhagic complex on preoperative and postoperative OCT scans. RESULTS: Visual acuity improved from 0.5/50 to 5/50 in 6 months follow-up. No major intraoperative and postoperative complications were observed. The perfusion of the graft was confirmed in ICG angiography. CONCLUSIONS: Autologous choroidal RPE patch transplantation is an effective option for submacular hemorrhage treatment in AMD. Unlike macular translocation, the surgery can be performed even in patients with excellent visual acuity in the fellow eye.

[The evaluation of macular thickness in patients with retinal detachment treated with conventional surgery--preliminary report]. / Ocena grubosci siatkówki w plamce u chorych operowanych metoda konwencjonalna z powodu odwarstwienia siatkówki--doniesienie wstepne.

The aim of the study was to evaluate retinal thickness in macular area (before and after surgery), and its correlation with visual acuity in patients with retinal detachment treated conventional surgery. Twenty eyes of 20 patients, treated in our clinic and eyes of 20 healthy subjects without any ocular pathology were evaluated. Retinal thickness in macular area (obtained with retinal thickness analyzer RTA - TALIA Technology) and visual acuity achieved after surgery compared with ocular pathology before and after surgery were analyzed. The correlation between visual acuity changes after successful surgery and macular thickness was evaluated. Retinal thickening in macula in patients with detached retina (even if macula was attached), and immediately after successful surgery in comparison to control group was observed. In selected cases, withdrawal of subclinical macular edema correlated with improvement of visual acuity. RTA allows for quantitative evaluation of retinal thickness in macula and its correlation with visual rehabilitation in patients with retinal detachment treated conventional surgery. Therefore RTA can be a useful tool in monitoring and determining visual acuity improvement.

[Ocular complication in children with Stevens-Johnson syndrome]. / Powiklania oczne u dzieci i mlodziezy w ciezkich postaciach zespolu Stevensa-Johnsona.

PURPOSE: Presentation of serious cases of Stevens-Johnson syndrome (SJS) with acute and chronic ocular manifestations and methods of their treatment. MATERIAL AND METHODS: 3 children aged between 6 to 12 years. Follow-up time was from 5, months up to 6 years. CONSERVATIVE TREATMENT WAS: Symblepharon massage, topical antibiotics, steroids, artificial tears. In chronic stage mitomycin C as eye drops was use in one case. Surgical treatment--intubation of lacrimal ducts and removal of eye lashes were performed in 2 cases. RESULTS: In 2 cases, in which ophthalmological therapy was introduced very early, the results of treatment were very good. In one case with corneal neovascularization and posterior lid margin keratinization, the results of treatment were not satisfactory. CONCLUSIONS: 1. The children with SJS should be treated by ophthalmologists as soon as possible. 2. Some pathological changes of conjunctiva, cornea and lacrimal ducts disappeared after few weeks of intensive topical therapy often. 3. The results of treatment of cicatrical changes of lids, conjunctiva and neovascularization of the cornea were not satisfactory.