Closure rates and patterns after light silicone oil tamponade for persistent full-thickness macular holes.

PURPOSE: To report outcomes of re-vitrectomy using light silicone oil (SO) tamponade for persistent macular holes (MHs). METHODS: We reviewed cases of patients with full-thickness MHs that underwent pars plana vitrectomy (PPV) with air/gas and were re-vitrectomized using light SO tamponade after primary non-closure (persistent MHs). Outcome measures included anatomic closure rates and patterns confirmed by optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA). RESULTS: A total of 42 eyes of 41 patients with unsuccessful primary PPV with air/gas were included. After re-vitrectomy with light SO (1000-centistoke), 29 (69%) eyes demonstrated type 1 closure without neurosensory defects in OCT scans, whereas 9 eyes (21%) showed type 2 closure with persisting neurosensory defects. Available data (n = 21) showed a significant mean improvement of BCVA from 0.99 logMAR (SD 0.25, range 0.7-1.3) preoperatively to 0.74 logMAR (SD 0.42, range 0.2-1.5) postoperatively (p = 0.035). CONCLUSION: The treatment of persistent MHs with PPV and light SO tamponade resulted in high closure rates.

Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery.

PURPOSE: To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery. SETTING: Department of Ophthalmology Graz, Graz, Austria. DESIGN: Single-center, retrospective cohort study. METHODS: The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations. RESULTS: ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078). CONCLUSIONS: According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.

CHANGES OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PARAMETERS AFTER INTERNAL LIMITING MEMBRANE PEELING COMPARED WITH NONPEELING IN EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To prospectively compare microvascular changes of internal limiting membrane (ILM) peeled and nonpeeled eyes in patients with idiopathic epiretinal membranes using optical coherence tomography angiography. METHODS: Forty-two patients with epiretinal membranes underwent vitrectomy with (n = 22) or without ILM peeling (n = 20). The mean superficial capillary plexus foveal avascular zone area change between preoperative and three-month postoperative readings served as the main outcome measure. Secondary outcome parameters included mean changes in superficial capillary plexus parafoveal vessel density, central foveal thickness, retinal volume, and best-corrected visual acuity. RESULTS: Mean superficial capillary plexus foveal avascular zone area change (µm 2 ) was 59 ± 74 in the ILM nonpeeling group compared with -12 ± 86 in the ILM peeling group ( P = 0.007). Similarly, mean superficial capillary plexus parafoveal vessel density change (%) was higher in the ILM nonpeeling group (ILM nonpeeling 4 ± 4, ILM peeling -2 ± 6, P = 0.003). The mean retinal volume reduction was higher in the ILM peeling group, and this difference also reached statistical significance ( P = 0.036). There were no intergroup differences in mean central foveal thickness change and mean best-corrected visual acuity change ( P = 0.409 and P = 0.440, respectively). Epiretinal membrane/ILM separation was achieved in 23 of 51 patients. CONCLUSION: The macular microvasculature demonstrated more remodeling in the ILM nonpeeling group after three months.

Influence of combined phacovitrectomy without tamponade on intraocular lens displacement and postoperative refraction.

PURPOSE: To compare phacoemulsification versus phacovitrectomy regarding postoperative intraocular lens (IOL) shift and refraction. METHODS: This prospective bilateral comparison study included 40 eyes of 20 patients. Inclusion criteria were combined phacovitrectomy without gas/air tamponade in one eye and cataract surgery in the contralateral eye with implantation of the same IOL. Postoperative anterior chamber depth (ACD) was compared between both groups 1-5 hr, 1 day and 8 weeks after surgery. Postoperative refraction was compared after 8 weeks using the Holladay I, HofferQ, SRK/T, Haigis and Barrett formulae. RESULTS: There were no intergroup differences in ACD (8 weeks: 0.02 mm absolute difference, SD 0.22, range -0.36 to 0.65, p = 0.401), mean absolute refractive error (8 weeks: Holladay I p = 0.452; HofferQ p = 0.475; SRK/T p = 0.498; Haigis p = 0.869; and Barrett p = 0.352) or percentages within the 0.5 D and 1.0 D range at any time-point. All formulae were optimized for the phacovitrectomy and the cataract groups. There was no correlation of macular thickness change and refractive error (cataract group r2 = -0.13, p = 0.58; phacovitrectomy group r2 = -0.10, p = 0.68). CONCLUSION: Combined phacovitrectomy without air/ gas tamponade caused neither ACD displacement nor refractive shifts compared to phacoemulsification alone. Surgically induced macular thickness change had no significant influence on postoperative refraction in this study. All five IOL formulae showed comparable postoperative refractive outcomes.

In-depth analysis of risk factors for pseudophakic retinal detachments and retinal breaks.

PURPOSE: To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB). MATERIALS AND METHODS: We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional-hazard regression model was used to analyse risk factors for PRD and PRB. RESULTS: Sixty-five thousand six hundred and sixty-two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow-up (median 7.1 years, range 0-21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy. CONCLUSIONS: Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.

Vitrectomy for diabetic macular edema and the relevance of external limiting membrane.

PURPOSE: To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. METHODS: Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). RESULTS: Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 µm preoperatively and 327 ± 66.1 µm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 µm; ELM disruption: 334 ± 75.2, p = 0.31). CONCLUSIONS: PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.

Cotinine and cytokine levels in the vitreous body and blood serum of smokers and non-smokers - A pilot study.

Tobacco smoking is a risk factor for many ocular diseases. Of the multiple tobacco smoke compounds nicotine and its main metabolite cotinine are likely agents in disease modulation. The interaction of these compounds with exposed tissue is complex and ranges from proinflammatory to potentially neuroprotective properties. We aimed to determine cotinine and cytokines in the vitreous in smokers and non-smokers in this prospective, cross-sectional study at the Department of Ophthalmology, Medical University Graz, Austria. We included 10 smokers and 10 non-smokers. Vitreous and serum samples were analyzed for cotinine and cytokines. The cytokine analysis was performed with multiplex assay and cotinine was quantified with enzyme-linked immunosorbent assay. Cotinine was detectable in smokers only with a mean of 154.0 ng/ml ± 107.3 ng/ml in the vitreous and of 194.1 ng/ml ± 121.3 ng/ml in the serum. The difference between intraocular and systemic levels was statistically significant. There were no statistically significant differences between the cytokine levels of smokers and non-smokers. However, intravitreal VEGF-A was by trend elevated in smokers and correlated positively with intravitreal cotinine (r = 0.59, p = 0.073). In conclusion cotinine is detectable in the vitreous of smokers and is lower than the serum. There is a trend towards elevation of VEGF-A in the vitreous of smokers.

STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS IN A PATIENT WITH MACULAR TELANGIECTASIA TYPE 2.

PURPOSE: To present a case of unilateral stellate nonhereditary idiopathic foveomacular retinoschisis in a patient with macular telangiectasia (MacTel) Type 2. METHODS: Single-patient case report. RESULTS: A 61-year-old female white patient was referred to our clinic with metamorphopsia and reduction of visual acuity over a period of 2 months on her right eye. Ocular findings in her right eye included reduced best-corrected visual acuity of 20/63 Snellen, foveomacular retinoschisis with extension to the lower middle periphery, central elevation of the neurosensory retina, and macular telangiectasia (MacTel) Type 2. Other causes of foveomacular retinoschisis, such as glaucoma, myopic degeneration, optic or scleral pit, X-linked juvenile retinoschisis, degenerative retinoschisis, and vitreomacular traction, were ruled out. The patient had no history of niacin or taxane medication, which may cause rather similar appearing cases of cystoid macular edema without leakage in fluorescein angiography. Because of the unilateral presentation, uneventful medical history, female sex, and the absence of known hereditary diseases or retinal pathologies in the patient's family history, hereditary predisposition appears to be highly unlikely. CONCLUSION: To our knowledge, this is the first reported case of stellate nonhereditary idiopathic foveomacular retinoschisis in combination with MacTel Type 2. Whether or not MacTel Type 2 plays a role in the development of stellate nonhereditary idiopathic foveomacular retinoschisis or has an impact on its clinical course requires further investigation. Furthermore, we suggest a significant involvement of Henle fiber layer in the process of intraretinal expansion in optical coherence tomography, in accordance with the most recent published nomenclature.

Vitreous albumin redox state in open-angle glaucoma patients and controls: a pilot study.

PURPOSE: Numerous studies suggest that reactive oxygen species play a crucial role in the development of glaucoma. Since glaucoma patients exhibit posterior vitreous detachment earlier than controls, it has been suggested that reactive oxygen species-increased in glaucoma-also affect the vitreous. In the present study we evaluated the influence of open-angle glaucoma oxidative stress on the redox state of vitreous albumin. METHODS: Albumin redox states of the vitreous and plasma were evaluated in 22 subjects-11 open-angle glaucoma patients and 11 controls-matched for age, gender, and vitreous state. According to the redox state of cysteine-34, albumin can be separated into: human mercaptalbumin (the thiol form), human nonmercaptalbumin1 (a reversible modification due to mild oxidation), and human nonmercaptalbumin2 (an irreversible modification due to severe oxidation). RESULTS: Albumin of both, the open-angle glaucoma group and the control group, was more oxidized in the vitreous compared to plasma. Furthermore, significantly higher human nonmercaptalbumin1 fractions were found in the vitreous of open-angle glaucoma patients compared to controls. No significant differences were found in the plasma albumin fractions between the groups. CONCLUSION: Our results support the hypothesis that oxidative stress plays a crucial role in open-angle glaucoma and that reactive oxygen species in glaucomatous eyes may also affect the vitreous.

Gender differences in albumin and ascorbic acid in the vitreous antioxidant system.

Ascorbic acid is present at high concentrations in the vitreous and plays a central role in vitreous redox chemistry. Albumin is the main protein in the vitreous with antioxidant properties and occurs in different oxidation states, which can be used as redox indicators, but have not been studied in the vitreous. This study, therefore, addressed the vitreous redox state of cysteine-34 of albumin in relation to the ascorbic acid content, which has been suggested to exert a main function in detoxifying reactive oxygen in the vitreous. A total of 58 vitreous samples obtained from patients undergoing vitrectomy were analyzed for (i) human mercaptalbumin (HMA), the reduced thiol form; (ii) human non-mercaptalbumin1 (HNA1), a reversible oxidative modification with a disulfide at cysteine-34; and (iii) human non-mercaptalbumin2 (HNA2), a non-reversibly (highly) oxidized form of albumin; as well as (iv) ascorbic acid concentrations, to study possible relations. In addition, blood samples were taken to compare albumin redox state between plasma and the vitreous. Vitreous albumin showed greater variability in the redox state of cysteine-34 and a shift to the oxidized fractions compared to plasma albumin (P < 0.001). A strong positive relation was observed between the vitreous ascorbic acid concentrations and the reversibly oxidized form, HNA1 (P < 0.001), and a negative relation with the reduced form, HMA. Positive relations between ascorbic acid and HNA1 in the vitreous were stronger in men than in women. In contrast to HMA and HNA1, there was a distinct gender difference noted for the irreversibly oxidized form, HNA2. While males showed a positive relation between the vitreous ascorbic acid concentrations and HNA2, there was no correlation found with HNA2 in females. Our results support the view that ascorbic acid, by decreasing either directly or indirectly the concentrations of molecular oxygen, generates hydrogen peroxide, and that thiols, including HMA, are acting as antioxidants. This study for the first time provides evidence that vitreous albumin can be used as a marker molecule for the appearance of reactive oxygen species in the vitreous of patients undergoing vitrectomy. Moreover, it can be shown that there are gender differences in vitreous ascorbic acid and albumin concentrations as well as in oxidation state of vitreous albumin.

Role of the tissue-type plasminogen activator -7351C > T and plasminogen activator inhibitor 1 4G/5G gene polymorphisms in central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) is a common chorioretinal disease, characterized by choroidal hyperpermeability leading to neurosensory and/or retinal pigment epithelial detachments. Hypofibrinolysis due to higher plasma concentrations of plasminogen activator type 1 (PAI-1) or lower activity of tissue-type plasminogen activator (t-PA) has been implicated in the pathogenesis of CSC. Functional polymorphisms in the PAI-1 (SERPINE1) and t-Pa (PLAT) are thus potential risk factors for CSC. The aim of the present study was therefore to investigate a hypothesized association between the PAI-1 4G/5G and the t-PA -7351C > T gene variants and the presence of CSC. METHODS: The present study comprised 172 CSC patients and 313 control subjects. Genotypes of the PAI-1 4G/5G and the t-PA -7351C > T polymorphisms were determined by TaqManTM fluorogenic 5'-exonuclease assays. RESULTS: Allelic frequencies or genotype distributions of neither the PAI-1 4G/5G nor the t-PA -7531C > T polymorphisms were significantly different between patients with CSC and control subjects (PAI-1 4G/4G: 24.4% vs. 20.4, p = 0.36; t-PA -7351CC: 42.4% vs. 46.0%, p = 0.50). After adjusting for age and gender presence of the PAI-1 4G/4G genotype was associated with a non-significant odds ratio (OR) of 1.21 (95% confidence interval [95% CI]: 0.77-1.92, p = 0.41), while homozygosity for the t-PA -7351C allele yielded a non-significant OR of 0.91 (95% CI: 0.62-1.33, p = 0.62) for CSC. CONCLUSION: The present study suggests that both the t-PA -7351C > T and the PAI-1 4G/5G gene variants are unlikely major risk factors for CSC.

Effect of intravitreal C3F8 gas in patients with vitreomacular traction: A retrospective case series.

BACKGROUND: We aimed to assess the efficacy of a single intravitreal perfluoropropane (C3F8) gas injection for the treatment of vitreomacular traction with or without a macular hole. METHODS: In this retrospective case series, seven eyes of six patients with symptomatic vitreomacular traction documented on optical coherence tomography, one with a macular hole additionally, received a single intravitreal C3F8 gas injection of up to 0.3 ml. The primary endpoint was vitreomacular traction release at 1 month after injection. Secondary endpoints included resolution of vitreomacular adhesion within 6 months, nonsurgical closure of macular holes, and change in central foveal thickness and best-corrected visual acuity. RESULTS: Overall, on optical coherence tomography, six of seven eyes (85.7%) had release of vitreomacular traction during the entire study duration: three within 1 month of injection and the other three within 6 months. Of the latter group, two of the three eyes showed a concurrent epiretinal membrane and one concurrent diabetic retino- and maculopathy. The patient with a macular hole had resolution of vitreomacular traction within 1 month but had to undergo vitrectomy because of nonclosure of the macular hole. Associated adverse events were macular edema with a consequent lamellar hole after injection in one patient, and another patient developed retinal detachment. CONCLUSION: Intravitreal C3F8gas injection is an inexpensive and promising minimally invasive option for the treatment of symptomatic and persistent vitreomacular traction with or without a macular hole. Further larger studies, especially comparing C3F8 gas injection with other treatment options, are needed.

MACULAR CHOROIDAL VOLUME CHANGES AFTER INTRAVITREAL BEVACIZUMAB FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the effect of intravitreal bevacizumab on the macular choroidal volume and the subfoveal choroidal thickness in treatment naïve eyes with exudative age-related macular degeneration. METHODS: The macular choroidal volume and the subfoveal choroidal thickness were measured using enhanced depth imaging optical coherence tomography. After a screening examination, each patient received 3 monthly intravitreal injections of 1.25 mg bevacizumab. One month after the third injection was a final assessment. RESULTS: Forty-seven patients with a mean age of 80 ± 6.4 years were included. The macular choroidal volume decreased significantly from median 4.1 mm (interquartile range 3.4-5.9) to median 3.9 mm (interquartile range 3.1-5.6) between the baseline and final examination (difference -0.46 mm, 95% confidence interval: -0.57 to 0.35, P < 0.001). Similarly, subfoveal choroidal thickness had decreased from 157.0 µm (interquartile range 116.0-244.5) at baseline to 139.0 µm (interquartile range 102.5-212.0) at the final examination (P < 0.001). Both parameters macular choroidal volume at baseline and subfoveal choroidal thickness at baseline were not associated with the response to treatment. CONCLUSION: The macular choroidal volume and the subfoveal choroidal thickness decreased significantly after 3 monthly bevacizumab injections for exudative age-related macular degeneration.

CHANGE OF CHOROIDAL VOLUME IN UNTREATED CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: Choroidal hyperpermeability plays a central role in the pathophysiology of central serous chorioretinopathy (CSC). In active CSC undergoing treatment, choroidal thickness decreases if subretinal fluid (SRF) resolves. This study aimed to investigate the change in choroidal thickness and volume in eyes with untreated CSC. METHODS: The authors retrospectively analyzed 27 eyes with treatment-naïve CSC (25 patients), who had a follow-up of 4 to 6 weeks. Retinal and choroidal volume and SRF were segmented manually and calculated using the Spectralis OCT built-in software (Spectralis; Heidelberg Engineering). RESULTS: In treatment-naïve eyes with CSC, an increase in SRF was significantly associated with an increase in choroidal thickness and volume (rho = 0.93, P < 0.01). Eyes with greater baseline choroidal volume showed a significantly greater decrease in SRF during follow-up (rho = -0.47, P = 0.03). CONCLUSION: In this study, an increase in SRF was associated with an increase in both choroidal thickness and volume in eyes with treatment-naïve CSC. Eyes with thicker baseline choroidal volume showed a greater reduction in SRF.

Estimating Retinal Blood Flow Velocities by Optical Coherence Tomography.

IMPORTANCE: While optical coherence tomography (OCT) angiography has been considered to evaluate retinal capillary blood flow instead of fluorescein angiography, the reflectance pattern of blood vessels on structural OCT might also provide retinal capillary flow data in the absence of fluorescein angiography. This potential has been insufficiently explored, despite promising data concerning a possible relationship between the reflectance pattern of blood vessels and their perfusion velocity in a laboratory setting. OBJECTIVE: To evaluate the potential of retinal blood flow velocity estimation by structural OCT. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional observational study conducted from June to November 2015 at a tertiary clinical referral center. Sixty arteries (the superior and inferior temporal arteries) from 30 eyes of 30 patients (17 female, 13 male) were included in the study. MAIN OUTCOMES AND MEASURES: Based on the intraluminal contrast patterns of retinal arteries on OCT, 3 independent graders categorized the blood flow velocities as low, medium, or high. These results and the results from a software-based intraluminal contrast analysis were compared with the retinal blood flow velocities measured by video fluorescein angiography. RESULTS: Among the 30 eyes of 30 patients (mean [SD] age, 72.6 [12.3] years; 17 female, 13 male), 15 were controls without retinal occlusion, 6 had a branch retinal artery occlusion, and 9 had a central retinal artery occlusion. When discriminating between low flow velocities and medium or high flow velocities, the graders' sensitivity ranged from 88.2% to 100% (grader 1: 88.2%; 95% CI, 63.6%-98.5%; grader 2: 88.2%; 95% CI, 63.6%-98.5%; and grader 3: 100%; 95% CI, 69.8%-100%) and their specificity ranged from 97.6% to 100% (grader 1: 100%; 95% CI, 87.7%-100%; grader 2: 97.6%; 95% CI, 87.4%-99.9%; and grader 3: 100%; 95% CI, 87.7%-100%). The κ coefficients of the comparison between the 3 graders and the angiography were 0.77 (95% CI, 0.60-0.93; P < .001), 0.64 (95% CI, 0.44-0.83; P < .001), and 0.87 (95% CI, 0.74-0.99; P < .001). In the computer-based assessment, the contrast reduction of the intraluminal pattern could be numerically expressed in a specific coefficient in the model (I2, describing the angular change of the backscattering intensity in the model), which presented nonoverlapping intervals between low flow velocities and medium or high flow velocities (mean [SD] I2, 0.3 [5.3], 20.4 [6.4], and 21.7 [4.0], respectively). CONCLUSIONS AND RELEVANCE: This study suggests that a low retinal blood flow velocity reflects in a visually distinct contrast reduction of the intraluminal pattern of retinal vessels on OCT. Larger studies are required to assess the clinical benefits.

Correction: High-Density Lipoprotein Function in Exudative Age-Related Macular Degeneration.

[This corrects the article DOI: 10.1371/journal.pone.0154397.].