LONG-TERM OUTCOMES OF 23-GAUGE PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND GAS TAMPONADE FOR MYOPIC TRACTION MACULOPATHY: A Prospective Study.

PURPOSE: To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy. METHODS: A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded. RESULTS: Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test). CONCLUSION: Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.

Macular choroidal neovascularization in myopic eyes after phakic intraocular lens implantation.

PURPOSE: To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs). METHODS: This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization. RESULTS: Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955). CONCLUSIONS: Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.

Retinal detachment in myopic eyes after phakic intraocular lens implantation.

PURPOSE: To analyze the risk of retinal detachment in highly myopic patients who underwent implantation of phakic intraocular lenses (PIOLs). METHODS: In a retrospective, non-comparative, interventional case series, the occurrence of retinal detachment was analyzed in 522 consecutive highly myopic eyes (323 patients) that underwent PIOL implantation. Treatment and results were reviewed. Parameters evaluated were best corrected visual acuity before and after retinal detachment surgery and time between refractive surgery and retinal detachment. RESULTS: Fifteen (2.87%) eyes presented with retinal detachment after PIOL implantation, with a mean time between surgery and detachment of 24.4 +/- 24.4 months (range: 1 to 92 months). The risk of retinal detachment in patients with high myopia corrected by PIOL implantation was 0.57% at 3 months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months (Kaplan-Meier analysis). A comparative study between the group of patients with retinal detachment and the remaining patients without retinal detachment was performed. Differences were found in axial length (30.65 +/- 1.97 vs 29.51 +/- 2.02; P=.028, one factor-analysis of variance test). CONCLUSIONS: The risk of retinal detachment in eyes implanted with phakic lenses for the correction of high myopia is higher in eyes with axial length >30.24 mm.

Macular atrophy after photocoagulation of soft drusen.

PURPOSE: To analyze the appearance and characteristics of macular atrophy after photocoagulation of soft drusen. PATIENTS AND METHODS: The authors studied the development of macular atrophy in 52 consecutive eyes (52 patients) that underwent green argon laser photocoagulation for the treatment of soft drusen. The mean age was 71.4 +/- 5.1 years (range, 61-85 years). Twelve eyes (23%) were in men and 40 (77%) were in women. Follow-up averaged 50.1 +/- 21.3 months (range, 6-96 months). RESULTS: Macular atrophy occurred in nine eyes (17.7%), including five (56%) women and four (44%) men. The time interval between photocoagulation and macular atrophy averaged 37.2 +/- 21.2 months (range, 7-75 months). The mean age of patients with macular atrophy was 68.1 +/- 4.6 years (range, 61-75 years). Mean best-corrected visual acuity (BCVA) after soft drusen photocoagulation and before macular atrophy development was 20/55 (range, 20/28-20/200). After the appearance of macular atrophy, mean BCVA was 20/126 (range, 20/50-20/900). Differences between BCVA before and after macular atrophy were statistically significant (P = 0.02, student's paired t-test). CONCLUSIONS: Macular atrophy can occur after photocoagulation of soft drusen, as applied according to our treatment protocol. The development of macular atrophy was associated with a significant decrease in BCVA.

Choroidal neovascularization in phakic eyes with anterior chamber intraocular lenses to correct high myopia.

PURPOSE: To analyze the appearance, incidence, and characteristics of choroidal neovascularization (CNV) in patients with high myopia corrected by implantation of a phakic anterior chamber intraocular lens (PACL). SETTING: University Miguel Hernández, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: The CNV observed in 294 consecutive eyes (181 patients) implanted with a PACL for the correction of high myopia (-7.0 to -38.0 diopters) was studied. The mean follow-up was 50.6 months +/- 32.8 (SD) (range 6 to 120 months). RESULTS: Choroidal neovascularization occurred in 5 eyes (1.70%); 3 eyes were in women, and 2 were in men. The interval between PACL implantation and CNV was 63.2 +/- 27.3 months (range 18 to 87 months). The CNV was subfoveal in 4 eyes and juxtafoveal in 1 case. The mean best spectacle-corrected visual acuity (BSCVA) after PACL implantation and before the appearance of CNV was 0.53 +/- 0.18 (range 0.4 [20/50] to 0.8 [20/25]); after CNV appeared, it was 0.26 +/- 0.18 (range 0.05 [20/400] to 0.5 [20/40]), a statistically significant difference (P =.001, paired Student t test). In 2 cases, the CNV was treated with photodynamic therapy (PDT); in the other 3 cases, PDT was rejected. The cumulative risk for CNV (Kaplan-Meier survival analysis) in highly myopic patients corrected by PACL implantation was 0.43% at 18 months and 5.4% at 87 months. CONCLUSIONS: Implantation of a PACL to correct high myopia was followed by a small incidence of CNV (cumulative risk of 5.4% at 87 months). The appearance of CNV was followed by a significant decrease in BSCVA.

Situación marital y emocional de un grupo de mujeres gestantes de alto riesgo / Marital and emotional aspects of a group of high risk pregnancy women

El presente estudio fue diseñado para determinar si en un embarazo de alto riesgo los aspectos emocionales se incrementan y de qué manera la satisfacción marital se ve modificada tomando en cuenta los factores de alto riesgo, por lo cual se trabajó sobre la base de medición de los aspectos emocionales y la satisfacción marital. El cuestionario general de salud, la escala de satisfacción marital y el cuestionario de alternativa, fueron aplicados a dos grupos de pacientes obstétricas del Instituto Nacional de Perinatología, uno con embarazo de alto riesgo y otro con embarazo normal, mismo que funcionó como grupo control, obteniéndose los niveles precisos que caracterizan a cada uno. Los resultados obtenidos presentan diferencias significativas en la problemática emocional (X = 8.98), en las variables de depresión (X = .42), inadecuaci-on social (X = .42); y en la escala de satisfacción marital, interación conyugal (factor I) X = 2.10; Interación con los aspectos emocionales (Factor II) X = 2.10; así como diferencias en los factores II y III del cuestionario de alternativa, relaciones familiares (Factor II) X = .51 y Comunicación y Cooperación (Factor III X = .33, con puntajes por encima del grupo de mujeres con embarazo de curso normal. El conocimiento de la situación emocional y marital de la mujer embarazada, permite optimizar y facilitar el nivel de asistencia al contar con parámetros objetivos en el manejo terapéutico de la paciente.