Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy.

PURPOSE: To compare the outcomes of vitrectomy with fovea-sparing internal limiting membrane peeling (FSIP) and complete internal limiting membrane peeling (ILMP) for myopic traction maculopathy (MTM). STUDY DESIGN: A retrospective, observational study. PATIENTS AND METHODS: In this study, we included 22 eyes of 21 consecutive patients who underwent vitrectomy with FSIP or ILMP for MTM and were monitored for at least 6 months. Eleven eyes were treated with FSIP, and 11, with ILMP. RESULTS: With FSIP, the postoperative best-corrected visual acuity (BCVA) significantly improved from 0.61 (20/82) to 0.34 (20/44; P = .009) logarithm of the minimum angle of resolution (logMAR) units. With ILMP, the postoperative BCVA improved from 0.65 (20/89) to 0.52 (20/66) logMAR units, but was not significant (P = .106). The postoperative final central foveal thickness (CFT) reduced significantly after FSIP (from 557.6 to 128.8 µm, P = .003) and ILMP (from 547.3 to 130.3 µm, P = .008). The postoperative incidence of a macular hole was 0% (0/11 eyes) with FSIP and 27.3% (3/11 eyes) with ILMP. All patients with a macular hole had foveal detachment in association with a thin fovea preoperatively. With ILMP, postoperative BCVA with a macular hole worsened by -3.5 letters; in contrast, postoperative BCVA without a macular hole improved by +10.5 letters. With FSIP, postoperative BCVA without a macular hole significantly improved by +13.5 letters (P = .009). CONCLUSIONS: FSIP resulted in significant improvement in MTM and prevented postoperative macular hole development.

Changes in metamorphopsia in daily life after successful epiretinal membrane surgery and correlation with M-CHARTS score.

PURPOSE: To determine the correlation between the changes in metamorphopsia in daily life environment and the M-CHARTS scores after epiretinal membrane (ERM) removal, and to determine the criterion for determining whether clinically significant changes in the metamorphopsia score have occurred in M-CHARTS. METHODS: We studied 65 eyes undergoing vitrectomy for unilateral ERM. Self-administered questionnaires were used to examine the metamorphopsia in their daily life. The degree of metamorphopsia was determined by M-CHARTS. The receiver operating characteristic curve was used to determine the best predictor of the changes in metamorphopsia in daily life. To determine the reproducibility of the M-CHARTS score, another set of 56 eyes with ERM was tested twice on two different days. RESULTS: The postoperative changes in the logarithm of the M-CHARTS score was defined as M2-value. The area under the receiver operating characteristic curve for the M2-value as a predictor of the changes in metamorphopsia in daily life was larger than area under the receiver operating characteristic curve obtained for any other parameter. The optimal cutoff value was -0.4. The 95% limits of agreement between test and retest measurements had a reproducibility of ±0.3 logarithm of the M-CHARTS score. Taking into account not only the reproducibility but also the consistency with the subjective changes, we determined the criterion for clinically significant changes in the M-CHARTS scores as a change of the M2-value by ≥0.4. CONCLUSION: Evaluating the changes in the M-CHARTS scores in logarithmic form is favorable not only theoretically but also from the perspective of consistency with the subjective changes.

[Clinical findings and macular lesions in basal laminar drusen].

PURPOSE: To investigate the clinical characteristics and accompanying macular lesions in Japanese patients with basal laminar drusen (BLD). DESIGN: Retrospective cross-sectional study. PATIENTS AND METHODS: Fifty four eyes of 27 Japanese patients with BLD were examined for the clinical characteristics of BLD and accompanying macular lesions using retro-mode imaging (Scanning Laser Ophthalmoscope F-10, Nidek) in addition to current methods such as fluorescein angiography (FA), indocyanine green angiography (IA), fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT). RESULTS: 1)BLD was more clearly identified using retro-mode imaging than any of the other current imaging methods, and was divided into two types: a crater type (relatively sparsely distributed BLD with many soft drusens) and a mesh type (uniformly distributed BLD). 2) BLD in both eyes was more common in female patients, and had the same type, distribution and similar macular lesions in both eyes. 3) Among the macular lesions, we observed macular atrophy, retinal angiomatous proliferation and vitelliform detachment in many patients, in contrast to few cases of choroidal neovascularization and no polypoidal choroidal vasculopathy. CONCLUSIONS: BLD may be regarded as a disease that is different from age-related macular degeneration (AMD).

[Detection for retinal pigment epithelial lesions in fellow eye of age-related macular degeneration by retro-mode].

PURPOSE: Using the Retro-mode (RM), to detect drusen and other minute lesions of the retinal pigment epithelium (RPE) invisible in current imaging methods in the fellow eye of Japanese patients with exudative age-related macular degeneration(AMD). DESIGN: A retrospective cross-sectional study. PATIENTS AND METHODS: The fellow eyes of nineteen Japanese patients with unilateral exudative AMD were examined using RM imaging (F-10 fundus camera, Nidek), in contrast with fluorescein angiography, indocyanine green angiography, and optic coherence tomography (3D OCT-1000, Topcon Co). We were able to identify the type of drusen and minute granular lesions (MGLs) in the RPE. RESULTS: In all patients, RM imaging gave easier to identify images of all types of drusen than other current imaging methods. Moreover, MGLs of the RPE either adjacent to drusen or without drusen, invisible in other current methods, were detected by RM imaging. CONCLUSIONS: The RM provides clearer imaging of all kind of drusen, and MGLs of the RPE invisible with current methods. These MGLs are possible precursors of drusen.

Time course of changes in metamorphopsia, visual acuity, and OCT parameters after successful epiretinal membrane surgery.

PURPOSE: To follow the changes in the metamorphopsia, visual acuity, and OCT parameters after epiretinal membrane (ERM) removal. METHODS: The study included 49 eyes of 49 patients with an ERM who underwent vitrectomy and membrane peeling. The changes in the best-corrected visual acuity (BCVA), metamorphopsia, and central foveal thickness (CFT) were evaluated at baseline and 1, 3, 6, 9, and 12 months postoperatively. M-CHARTS were used to quantify metamorphopsia. RESULTS: The mean BCVA, metamorphopsia scores for horizontal lines (MH) and vertical lines (MV), and CFT improved significantly at 12 months after surgery (P < 0.001). The baseline BCVA, MH score, and MV score were significantly correlated with the corresponding BCVA, MH score, and MV score at 12 months after surgery (P < 0.01). The MH and MV scores at 12 months was significantly correlated with the BCVA at 12 months (P < 0.01), and the baseline MV score was significantly correlated with the BCVA at 12 months (P < 0.05). The MH score but not the MV score was significantly correlated with the CFT at baseline and 12 months (P < 0.05). CONCLUSIONS: The preoperative BCVA, MH score, and MV score were prognostic factors for the corresponding postoperative BCVA, MH score, and MV score. These results suggest that surgery for ERM should be considered before severe reduction in the BCVA or the degree of metamorphopsia. In addition, the preoperative MV score was a prognostic factor for postoperative BCVA. The MH score but not the MV score was correlated with the CFT preoperatively and postoperatively.

[Clinical features of vitreous hemorrhage after photodynamic therapy for age-related macular degeneration].

PURPOSE: To study the clinical features of vitreous hemorrhage (VH) after photodynamic therapy (PDT) for age-related macular degeneration(AMD). MATERIALS AND METHODS: Twelve patients (12 eyes: 1.7% of the 718 eyes on which PDT was performed) who had vitrectomy due to massive VH after PDT for AMD were studied. Their medical records were reviewed and courses and characteristics were studied. RESULTS: Eight eyes (67%) were diagnosed as polypoidal choroidal vasculopathy and 7 eyes showed multiple clusters of grape-like lesions. Average greatest linear dimension (GLD) was 4533 microm, larger than common AMD. After vitrectomy, some cases retained choroidal neovascularization. Five eyes had another PDT and 3 eyes had a second vitrectomy due to recurrent vitreous hemorrhage. CONCLUSIONS: Both PCV and a large GLD are risk factors for a massive vitreous hemorrhage after PDT therapy for AMD. As many cases retain choroidal neovascularization many patients require additional treatment. Continued observation after vitrectomy is essential.

[Visualization of the posterior vitreous membrane in diabetic macular edema patients using three-dimensional optical coherence tomography].

PURPOSE: To study the visualization of the vitreoretinal interface in diabetic macular edema patients using three-dimensional optical coherence tomography (3 D-OCT) and to compare it to surgical findings. METHODS: We prospectively examined the medical records of 25 patients (30 eyes) with diabetic macular edema measured by 3 D-OCT (optic disc and macular lesions) who received vitrectomy between August 2006 and February 2007. We compared the findings of 3 D-OCT to the findings during surgery using triamcinolone acetonide. RESULTS: Posterior vitreous membrane was found in 18 eyes using 3 D-OCT. The findings in all cases corresponded to operative findings. Six cases were characterized by posterior vitreous membrane attached to the optic disc and macular area. Twelve cases were characterized by posterior vitreous membrane diffusely attached to the posterior pole. CONCLUSIONS: Vitreoretinal interfaces were visualized using 3D-OCT and confirmed by operative findings. 3 D-OCT is an effective tool to determine the pathogenesis of diabetic macular edema.

[Multifocal choroiditis associated with serpiginous choroiditis and choroidal neovascularization: a case report].

BACKGROUND: We treated a patient with multifocal choroiditis (MFC) associated with serpiginous choroiditis and choroidal neovascularization (CNV). CASE: In a 27-year-old woman whose left eye showed serpiginous choroiditis near the optic disc and multiple irregular chorioretinal scars and exudates in peripheral and near-peripheral zones, fluorescein angiography demonstrated diffusely scattered hyperfluorescent dots and late leakage from retinal vessels. The lesion near the optic disc showed hypofluorescence in the early venous phase, and hyperfluorescence in the late phase. Sub-Tenon injection of triamcinolone acetonide did not effectively treat the CNV secondary to serpiginous choroiditis, but direct laser photocoagulation was successful, achieving improved visual acuity. CONCLUSIONS: We suggest that this patient's MFC and serpiginous choroiditis represented a single process rather than independent events. With lesions at the posterior pole, CNV developed secondarily. In this case, direct laser photocoagulation proved useful.

[Vitrectomy for chronic macular edema associated with branch retinal vein occlusion].

PURPOSE: To study the outcome after vitrectomy for chronic and acute macular edema associated with branch retinal vein occlusion (BRVO). MATERIALS AND METHODS: Medical charts of fifty-five patients (55 eyes) who underwent vitrectomy for macular edema associated with BRVO were reviewed retrospectively. Patients were followed up for more than one year after the vitrectomy. We compared the visual and structural outcome between an early group (i. e., edema lasting less than one year) and a late group (i.e., edema lasting more than one year). RESULTS: The mean visual acuity improved significantly from 0.088 to 0.163 in the early group and from 0.147 to 0.132 in the late group. Seventy percent of the cases improved in angiographic findings and eighty percent of the cases improved in optical coherence tomography findings. CONCLUSIONS: Vitrectomy for chronic macular edema even lasting more than one year after BRVO seems to be effective, depending on the case.

Photodynamic therapy for age-related macular degeneration in Japanese patients: results after one year.

PURPOSE: To evaluate the effects of photodynamic therapy (PDT) with verteporfin 1 year after treatment in Japanese patients with age-related macular degeneration (AMD) and subfoveal choroidal neovascularization. METHODS: Between May 2004 and March 2005, PDT was performed on 102 eyes of 98 patients (60 men and 38 women) with AMD and subfoveal choroidal neovascularization. Patients were followed for at least 12 months after PDT. RESULTS: The mean visual acuities in logarithm of the minimum angle of resolution (logMAR) units were 0.978 at baseline, 0.919 at 3 months, 0.895 at 6 months, 0.892 at 9 months, and 0.874 at 12 months. After PDT, the logMAR visual acuity improved by >0.3 logMAR units or more in 28 eyes (27%) and deteriorated by >0.3 logMAR units or more in 13 eyes (13%). Stable or improved vision was achieved in 93% of patients with polypoidal choroidal vasculopathy (PCV). CONCLUSIONS: The visual outcome in our patients was similar to that of an earlier major Japanese study, and similar to or better than outcomes in Western studies. Differences between Caucasians and Japanese might influence the characteristics of PCV. It is possible that PDT is more effective for AMD patients with PCV than for other AMD patients. Further observations and longer follow-up are necessary.

[Study of the causes of poor visual prognosis in photodynamic therapy for age-related macular degeneration].

PURPOSE: To study the factors for poor visual outcome in photodynamic therapy(PDT) for age-related macular degeneration (AMD) patients with subfoveal choroidal neovascularization. MATERIALS AND METHODS: Medical charts of eighty-five patients (88 eyes) who had AMD with subfoveal choroidal neovascularization were reviewed in the study. All patients were followed up by visual acuity assessment, angiography, and optical coherence tomography at least 6 months after PDT. RESULTS: Out of 11 cases of poor visual outcome, 7 cases showed cystoid macular edema (CME) before treatment and 4 cases showed massive subretinal hemorrhage and/or vitreous hemorrhage after treatment. Some cases with CME had a worse visual outcome than cases without CME. CONCLUSIONS: Some of the factors for poor visual outcome after PDT for AMD are the existence of CME before treatment and polypoidal choroidal vasculopathy (PCV). In some cases, PCV caused massive subretinal hemorrhage and/or vitreous hemorrhage after treatment.

Macular hole formation following ruptured retinal arterial macroaneurysm.

PURPOSE: To report four cases of macular hole formation following ruptured retinal arterial macroaneurysm. DESIGN: Case-control study. METHODS: Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm. Macroaneurysms were confirmed using either fluorescein angiography or indocyanine green angiography or both that indicated a telangiectatic retinal vascular change. Clinical data of patients with macroaneurysm with and without macular hole (MH) formation were compared retrospectively. RESULTS: Of 75 eyes, four (5.3%; four patients) with macroaneurysm had a macular hole. In one of the four eyes, a macular hole was detected 2 days after the rupture. The distance from the macroaneurysm to the center of the fovea was significantly closer in the four eyes with a macular hole (MH group, 1.1 +/- 0.4 (mean +/- standard deviation [SD]) disk diameter) than in the 71 eyes without a macular hole (non-MH group, 1.9 +/- 0.9 disk diameter) (P =.0196). The incidence of subretinal hemorrhage in the macula was significantly greater in the MH group (100%) than in the non-MH group (35.2%) (P =.0195). CONCLUSIONS: Macular hole formation associated with ruptured macroaneurysm is not as uncommon as previously thought. We suggest that there might be early onset of macular hole formation following ruptured macroaneurysm. Macroaneurysms with early-onset macular hole are present near the center of the macula and are accompanied by subretinal hemorrhage in the macula.