ABSTRACT
Objectives: To investigate choriocapillaris flow voids (FV) with a new optical coherence tomography angiography (OCTA) image processing strategy that can eliminate artifacts caused by vitreous opacities, sub-retinal pigment epithelium fluid and deposits, and subretinal fluid (SRF) by thresholding the en-face OCT image of the outer retina. Materials and Methods: We retrospectively reviewed medical records of patients with drusen and patients with active central serous chorioretinopathy (CSC). FV number (FVn), average area (FVav), and maximum area (FVmax) and the percentage of nonperfused choriocapillaris area (PNPCA) obtained using the proposed strategy were compared with those obtained by removing only artifacts caused by the superficial capillary plexus (SCP). Results: The SRF group included 21 eyes with active CSC and the drusen group included 29 eyes with nonexudative age-related macular degeneration. FVav, FVmax, FVn, and PNPCA obtained using the algorithm were significantly lower than those obtained by removing only SCP-related artefacts in both groups (all p<0.05). The algorithm was also able to remove 96.9% of artifacts secondary to vitreous opacities and all artifacts secondary to serous pigment epithelial detachments. Conclusion: Choriocapillaris nonperfusion areas on OCTA images may be overestimated in eyes with RPE abnormalities and SRF due to artifacts. These artifact areas on choriocapillaris OCTA images can be removed using thresholded images of the outer retina en-face OCT scans. Our new artifact-removal strategy is useful in the assessment of choriocapillaris FV in eyes with SRF, drusen, drusen-like deposits, and pigment epithelial detachment.
Subject(s)
Artifacts , Retinal Detachment , Humans , Retrospective Studies , Choroid , Retina , Retinal Detachment/diagnosisABSTRACT
PURPOSE: To report clinical and multimodal imaging features of Best disease in patients presenting with subretinal pigment epithelium hyperreflective lesions. DESIGN: Retrospective study. METHODS: Clinical examination findings and multimodal imaging features, including color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, fluorescein and indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCTA) images were evaluated retrospectively. RESULTS: We assessed 27 eyes of 16 patients with the diagnosis of Best disease. Only patients presenting with serous macular detachment and subretinal pigment epithelium hyperreflective lesion in one or both eyes were included in this study. In 17 of 27 eyes (63%), fibrosis was identified by multimodal imaging techniques. Although there was no sign of active neovascularization on fundus examination or SD-OCT, a vascular network could be identified in 7 eyes (26%) (in 1 eye with OCTA only and in 6 eyes with both OCTA and ICGA). Active neovascularization was seen in 3 eyes (11%). Treatment was recommended for eyes with active neovascularization, and follow-up was scheduled for eyes with quiescent neovascularization and fibrosis. CONCLUSION: Eyes with Best disease with subretinal pigment epithelium hyperreflective lesion and serous macular detachment may show fibrosis, quiescent neovascularization, or active neovascularization. Multimodal imaging techniques are very important for differentiation of these lesions.
Subject(s)
Retinal Detachment , Vitelliform Macular Dystrophy , Epithelium/pathology , Fibrosis , Fluorescein Angiography/methods , Humans , Multimodal Imaging , Retinal Detachment/diagnosis , Retinal Detachment/pathology , Retinal Pigment Epithelium/pathology , Retrospective Studies , Tomography, Optical Coherence/methods , Visual Acuity , Vitelliform Macular Dystrophy/pathologyABSTRACT
Objectives: To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales' disease. Materials and Methods: In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales' disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included. Results: The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p<0.001). After surgery, BCVA was stable in 4 eyes (18.2%), increased in 16 eyes (72.7%), and decreased in 2 eyes (9.1%). Although the mean BCVA was better in the VH group (0.3±0.34 logMAR) than the TRD group (0.9±1.1 logMAR), the difference was not statistically significant (p=0.1). Multivariable linear regression analyses revealed that final BCVA was negatively associated with preoperative or postoperative proliferative vitreoretinopathy grade C (PVR-C), preoperative retinal detachment involving the macula, postoperative neovascular glaucoma, and long preoperative duration of disease, and positively associated with preoperative BCVA. Final BCVA was not associated with preoperative retinal and disc neovascularization, rubeosis iridis, total posterior hyaloid detachment, preoperative retinal laser photocoagulation, indication of surgery, diameter of sclerotomy (20 or 23 gauge), preoperative lens status, preoperative or postoperative epimacular membrane, peroperative iatrogenic retinal breaks, postoperative hypotony, cystoid macular edema, and new or recurrent retinal detachment. The primary anatomic success rate was 81.8% and the final anatomic success rate was 90.9%. Conclusion: In Eales' disease, good visual results can be obtained with vitreoretinal surgery if the detachment area does not involve the macula and PVR-C does not develop pre- or postoperatively.
Subject(s)
Neovascularization, Pathologic/complications , Retinal Detachment/surgery , Retinal Vasculitis/complications , Visual Acuity , Vitrectomy/methods , Vitreous Hemorrhage/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neovascularization, Pathologic/surgery , Retinal Detachment/etiology , Retinal Vasculitis/surgery , Retrospective Studies , Time Factors , Treatment Outcome , Vitreous Hemorrhage/etiology , Young AdultABSTRACT
PURPOSE: To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR). METHODS: Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated. RESULTS: Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 (p < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA (p = 0.02), previous vitrectomy with gas tamponade (p = 0.007), and was negatively correlated with number of previous RD operations (p = 0.01), larger extent of RD (p = 0.02) and more extensive retinotomy/retinectomy (p = 0.04). CONCLUSIONS: An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.
ABSTRACT
PURPOSE: To report characteristics of patients developing full-thickness macular hole (MH) after rhegmatogenous retinal detachment (RRD) repair surgery. We also compared patients developing MH with and without accompanying RRD recurrence regarding anatomical and visual outcomes of MH repair. DESIGN: Retrospective study. METHODS: Medical records of patients who developed MH after RRD repair between January 2002 and January 2018 were reviewed. RESULTS: We performed 1661 primary RRD operations during the study period and 14 of these developed MH, an incidence of 0.8%. Nine patients had their primary RRD repair surgery in another clinic and were referred to our clinic after development of MH. In total 23 patients with MH secondary to RRD repair were included in the study. The type of RRD repair surgery was scleral buckling only in 4 patients (17%), pars plana vitrectomy (PPV) only in 14 patients (61%), and sequential scleral buckling and PPV in 5 patients (22%). Nineteen patients (83%) had macula-off RRD. In 12 patients (52%), MH developed within 3 months after RRD repair. Surgery for MH repair was performed in 18 patients. Postoperative best corrected visual acuity (BCVA) was better than preoperative BCVA in the group with RRD recurrence as well as in the group without RRD recurrence (both P < 0.05). There wasn't a significant difference between these groups regarding postoperative visual gain and anatomical success (P > 0.05). CONCLUSION: MH can develop after various surgical methods of RRD repair. Anatomic closure and visual acuity gain can be achieved even if patients have accompanying RRD recurrence.
Subject(s)
Retinal Detachment , Retinal Perforations , Humans , Neoplasm Recurrence, Local , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Retinal Detachment/surgery , Retinal Perforations/diagnosis , Retinal Perforations/etiology , Retinal Perforations/surgery , Retrospective Studies , Scleral Buckling , VitrectomyABSTRACT
PURPOSE: To report first case of sequential development of pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) after repeated intravitreal dexamethasone implantations for diabetic macular edema treatment. METHODS: We present a case of a 54-year-old man having intravitreal dexamethasone implant for bilateral diabetic macular edema. RESULTS: We observed development of pachychoroid pigment epitheliopathy, seen as a small pigment epithelial detachment on optical coherence tomography after a fourth dexamethasone implantation. A fifth implantation caused transformation of pachychoroid pigment epitheliopathy to central serous chorioretinopathy. CONCLUSION: Consecutive administration of dexamethasone implants may have a cumulative effect on retinal pigment epithelium, Bruch membrane, and choroid.
Subject(s)
Central Serous Chorioretinopathy , Dexamethasone , Retinal Pigment Epithelium , Central Serous Chorioretinopathy/chemically induced , Dexamethasone/adverse effects , Diabetic Retinopathy/drug therapy , Humans , Macular Edema/drug therapy , Male , Middle Aged , Retinal Pigment Epithelium/drug effects , Tomography, Optical CoherenceABSTRACT
PURPOSE: To describe transcorneal sutureless silicone oil removal using 23-gauge trocars as an alternative surgical technique in an aphakic eye. METHODS: We retrospectively evaluated the management of a 50-year-old male patient who had a history of bilateral congenital cataract removal at the age of 5 and developed rhegmatogenous retinal detachment. A 3-port 23-gauge pars plana vitrectomy, removal of the vitreous up to the vitreous base, 60° temporal retinotomy, and anterior flap retinectomy were performed. Silicone oil (1,000 cSt) was selected as a tamponading agent. The patients underwent active silicone oil removal at subsequent surgery 2 months after the initial vitrectomy. RESULTS: The silicone oil was successfully extracted from the aphakic eye by using transcorneal 23-gauge trocars. No suture was needed at the corneal wound sites. There were no intraoperative or postoperative complications. CONCLUSION: Transcorneal silicone oil removal using 23-gauge trocars can be performed easily with today's modern vitreoretinal surgery systems as an alternative treatment modality.
Subject(s)
Aphakia, Postcataract/complications , Drainage/instrumentation , Endotamponade , Retinal Detachment/surgery , Silicone Oils , Surgical Instruments , Humans , Intraoperative Complications , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Sutureless Surgical Procedures , VitrectomyABSTRACT
PURPOSE: To investigate, using optical coherence tomography angiography, the foveal avascular zone (FAZar), the FAZ perimeter (FAZp), the acircularity index of the FAZ (FAZai), and the density of vessels surrounding the FAZ (FAZvd) before and after idiopathic epiretinal membrane surgery, and associations of these parameters with postoperative best-corrected visual acuity, letter score gain, and central foveal thickness. METHODS: We retrospectively reviewed preoperative and postoperative (sixth month) medical records of 28 eyes of 28 patients who undergone epiretinal membrane surgery and had an intact ellipsoid zone. RESULTS: There were significant increases in best-corrected visual acuity, FAZar, and FAZp and decreases in central foveal thickness and FAZai (all P < 0.05). Postoperative best-corrected visual acuity was not significantly correlated with any preoperative parameters. Postoperative letter score gain and central foveal thickness correlated negatively with preoperative FAZar and preoperative FAZp (all P < 0.05). Multivariable linear regression analysis revealed that preoperative FAZp was independently associated with postoperative letter score gain (P < 0.05). CONCLUSION: The FAZ enlarges and becomes more circular after epiretinal membrane surgery. Postoperative best-corrected visual acuity is not associated with any FAZ parameters. In eyes with an intact foveal ellipsoid zone, especially a smaller preoperative FAZp is associated with more postoperative letter score gain.
Subject(s)
Fluorescein Angiography/methods , Fovea Centralis/blood supply , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Visual Acuity , Vitrectomy/methods , Aged , Female , Fundus Oculi , Humans , Male , Middle Aged , Postoperative Period , Retrospective StudiesABSTRACT
PURPOSE: To compare neovascular membrane features of pachychoroid neovasculopathy (PNV) and type 1 neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). DESIGN: Retrospective study. METHODS: We assessed 34 treatment-naïve eyes with a diagnosis of PNV and 36 treatment-naïve eyes with a diagnosis of type 1 nAMD. Morphological patterns of neovascular membranes were categorized, and lesion sizes and flow areas were calculated by using en face images on the AngioVue (Optovue) OCTA system. RESULTS: Statistically significant differences were found between groups in age (P=0.001), baseline best corrected visual acuity (P=0.005), and baseline subfoveal choroidal thickness (P<0.001). However, there were no statistically significant differences in membrane morphology (P=0.86), lesion size (P=0.80), or flow area (P=0.96). All membranes that could be detected by OCTA could also be detected by indocyanine green angiography (ICGA). However, OCTA could not identify the neovascularization in 11.8% of the eyes with PNV and 16.7% of the eyes with nAMD, which could be identified on ICGA images. CONCLUSIONS: PNV is seen in younger patients and in patients with thicker choroids, but in terms of morphological characteristics and vessel density, membranes detected by OCTA are not different from those of nAMD. Dye angiography remains the gold standard for identifying neovascularization, especially in treatment-naïve patients, owing to blockage of fluid and hemorrhage and scattering of OCTA signals.
Subject(s)
Choroidal Neovascularization/diagnosis , Wet Macular Degeneration/diagnosis , Aged , Aged, 80 and over , Choroid/blood supply , Choroidal Neovascularization/physiopathology , Ciliary Arteries/physiopathology , Coloring Agents/administration & dosage , Female , Fluorescein Angiography , Humans , Indocyanine Green/administration & dosage , Male , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Wet Macular Degeneration/physiopathologyABSTRACT
PURPOSE: To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings. METHODS: We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT. RESULTS: The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P = 0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001). CONCLUSIONS: Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.
Subject(s)
Diabetic Retinopathy/classification , Macular Edema/classification , Tomography, Optical Coherence/classification , Adult , Aged , Aged, 80 and over , Diabetic Retinopathy/diagnostic imaging , Diabetic Retinopathy/physiopathology , Exudates and Transudates , Female , Fluorescein Angiography , Humans , Macula Lutea/pathology , Macular Edema/diagnostic imaging , Macular Edema/physiopathology , Male , Middle Aged , Photoreceptor Cells, Vertebrate/pathology , Retinal Detachment/diagnosis , Retinal Detachment/physiopathology , Retrospective Studies , Visual Acuity/physiology , Vitreous Body/pathology , Young AdultABSTRACT
PURPOSE: The purpose of this study was to investigate the foveal avascular zone area and its perimeter, the acircularity index of the foveal avascular zone, the vessel density surrounding the foveal avascular zone, and the vessel density in the foveal, parafoveal, and perifoveal areas and their associations with best-corrected visual acuity, central foveal average thickness, and volume of ellipsoid zone-retinal pigment epithelium in patients with macular telangiectasia Type 2 (MacTel 2). METHODS: We retrospectively reviewed medical records of 22 eyes of 22 patients with MacTel 2 and 24 eyes of 24 healthy controls. Eyes with MacTel 2 were graded according to optical coherence tomography angiography: 1) vascular anomalies temporal to the fovea; 2) vascular anomalies temporal and nasal to the fovea; 3) markedly diffuse circumferential vascular anomalies; and 4) neovascularization in the outer retina. RESULTS: Acircularity index was higher and superficial-parafoveal vessel density was lower, in MacTel 2 group (all P < 0.05). Acircularity index was associated with the severity of the disease and had strong correlations with best-corrected visual acuity, ellipsoid zone-retinal pigment epithelium thickness, and ellipsoid zone-retinal pigment epithelium volume (all P < 0.05). CONCLUSION: In conclusion, the increase in acircularity index is correlated with the severity of the disease, the decrease in ellipsoid zone-retinal pigment epithelium thickness and volume, and the decrease in best-corrected visual acuity. It may be used to monitor patients with MacTel 2.
Subject(s)
Fluorescein Angiography/methods , Fovea Centralis/diagnostic imaging , Retinal Telangiectasis/diagnosis , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Visual Acuity , Female , Fundus Oculi , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration. Materials and Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The "short-term monthly injections" protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the "short-term treat-and-extend (TREX)" protocol. The "extended TREX" protocol was for patients with high-risk lesions and low fellow-eye visual acuity. Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year. Conclusion: The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.
Subject(s)
Algorithms , Disease Management , Ranibizumab/administration & dosage , Risk Assessment/methods , Visual Acuity , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Macula Lutea/pathology , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Vascular Endothelial Growth Factor A , Wet Macular Degeneration/diagnosisABSTRACT
Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.
Subject(s)
Artificial Lens Implant Migration/surgery , Device Removal/methods , Iris/surgery , Lenses, Intraocular , Visual Acuity , Vitrectomy , Artificial Lens Implant Migration/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Design , Reoperation , Retrospective Studies , Time FactorsABSTRACT
PURPOSE: To investigate the associations between macular complications and demographic, clinical, and optical coherence tomography characteristics (OCT) of highly myopic eyes with a dome-shaped macula (DSM). METHODS: We retrospectively analyzed the findings of 90 patients (167 eyes) with DSM who had vertical and horizontal OCT scans between January 2011 and June 2018. Demographic data, clinical characteristics, and OCT-derived morphologic parameters were determined, and the associations of these parameters with macular complications were evaluated. RESULTS: Among 167 eyes, the following patterns were observed: horizontally oriented DSM (71%), symmetric DSM (27%), and vertically oriented DSM (2%). Complications or abnormalities involving the macular area were detected by OCT in 63% (106/167) of the eyes. Specific complications were as follows: choroidal neovascularization (CNV) (37.1%), macular retinoschisis (9.0%), serous retinal detachment (RD) (7.8%), epiretinal membrane (4.2%), lamellar macular hole (3.0%), and macular hole (2.4%). The eyes with CNV had thinner choroid (P < 0.001) and lower macular bulge height (P = 0.04). The eyes with serous RD had thicker choroid (P < 0.001) and higher macular bulge height (P < 0.001). Serous RD was significantly more common when the macular height was greater than 250 µm (P = 0.001) and if the DSM pattern was vertical (P < 0.001). CONCLUSIONS: A greater bulge height and thicker choroid in highly myopic eyes with DSM may be protective against the development of myopic CNV. A thicker choroid, a higher macular bulge (> 250 µm), and a vertical DSM pattern are associated with a risk of developing serous RD.
Subject(s)
Macula Lutea/pathology , Myopia/diagnosis , Refraction, Ocular/physiology , Retinal Diseases/etiology , Tomography, Optical Coherence/methods , Visual Acuity , Adult , Aged , Female , Fluorescein Angiography/methods , Fundus Oculi , Humans , Male , Middle Aged , Myopia/complications , Myopia/physiopathology , Prognosis , Retinal Diseases/diagnosis , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: To evaluate morphologic patterns of choroidal neovascular membranes using optical coherence tomography angiography (OCTA) in patients with treatment-naive, continuously treated, and previously treated exudative age-related macular degeneration (AMD). SUBJECTS: We assessed retrospectively 184 eyes of 153 patients diagnosed with type 1, type 2, and mixed-type neovascularization associated with AMD. The type of neovascularization and clinical activity were assessed by clinical examination and spectral domain optical coherence tomography (SD-OCT). Morphological patterns of neovascular membranes were categorized using en face images on the AngioVue (Optovue) OCTA system. RESULTS: The mean age of patients was 77.9 ± 8.6 years (range, 52-96 years). The most frequently identified type of membrane morphology was well-defined in the treatment-naive group (69% of the eyes) and in eyes receiving ongoing anti-VEGF treatments (77% of the eyes). Long-filamentous morphology was the most frequent type in the previously treated group (53%), in which only 33% had a well-defined membrane. All clinically active cases had a well-defined pattern, such as a medusa or sea-fan shaped pattern, or an ill-defined pattern, and none had a long-filamentous neovascular network. Almost half of the clinically inactive cases (47%) had well- or ill-defined, identifiable membrane morphology on OCTA. A long-filamentous membrane pattern, which was consistent with chronicity of lesion, was seen only in eyes with inactive neovascularization. CONCLUSIONS: The membrane morphology on OCTA was not associated with clinical activity, except that the presence of long dilated filamentous linear vessels was associated with chronicity and lesion inactivity.
Subject(s)
Choroid/pathology , Choroidal Neovascularization/diagnosis , Fluorescein Angiography/methods , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Female , Fundus Oculi , Humans , Male , Middle Aged , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To describe double arcuate relaxing retinotomy as an alternative surgical technique in a case with a secondary large macular hole. METHODS: The management of a patient who developed a large macular hole and macular tractional rhegmatogenous retinal detachment after pars plana vitrectomy for proliferative diabetic retinopathy was retrospectively assessed. Despite surgical procedures, such as dissection of a preretinal membrane from the retina and peeling of the retinal internal limiting membrane, the macular hole could not be closed. In the absence of an alternative method, superior and inferior posterior arcuate, 120° relaxing retinotomies were performed. RESULTS: At the follow-up, the macular hole closure was confirmed by clinical examination and optical coherence tomography imaging, and visual acuity improved. There were no intraoperative or postoperative complications. CONCLUSION: In cases of large macular holes, double arcuate relaxing retinotomy can reduce traction, leading to hole closure.
Subject(s)
Ophthalmologic Surgical Procedures/methods , Retinal Perforations/surgery , Diabetic Retinopathy/complications , Female , Humans , Retinal Detachment/surgery , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To compare the outcomes of phakic and pseudophakic uncomplicated rhegmatogenous retinal detachment (RRD) treated with primary pars plana vitrectomy (PPV) and short-term silicone oil (SO) tamponade. METHODS: A retrospective chart review of 201 eyes (185 patients) with uncomplicated RRD treated with primary 23-gauge PPV and short-term SO tamponade. Anatomical success was defined as a reattached retina for at least 6 months after SO removal. RESULTS: The analysis consisted of 111 phakic eyes and 90 pseudophakic eyes. The mean duration of SO tamponade in phakic eyes was 8.5 ± 1.9 and in pseudophakic eyes was 8.3 ± 1.9 weeks [corrected] (P = 0.39). The primary reattachment rate was 93% in the phakic group and 98% in the pseudophakic group (P = 0.19). The mean Snellen VA equivalent at the final visit was 20/30 in both groups. Final VA ≥ 20/40 was achieved in 81% of phakic and 86% of pseudophakic eyes (P = 0.69). Postoperative complications included cataract in the phakic group (100%), transient elevation of intraocular pressure (IOP) (29%), epiretinal membrane (8%), proliferative vitreoretinopathy (7%), cystoid macular edema (3%), secondary macular hole (2%), persistent elevation of IOP (1.5%), and persistent hypotony (1%). CONCLUSIONS: The success rates and functional outcomes of primary 23-gauge PPV with short-term SO tamponade did not differ significantly between the two groups, suggesting that lens status is not the single most important factor influencing the final results. The use of short-term SO was not associated with keratopathy, visual loss without any apparent reason and high rates of chronic elevation of IOP or redetachment following SO removal.
Subject(s)
Endotamponade/methods , Retinal Detachment/surgery , Silicone Oils/pharmacology , Vitrectomy/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retinal Detachment/diagnosis , Retrospective Studies , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
PURPOSE: To estimate the outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy and silicone oil tamponade. METHODS: A retrospective chart review of 10 eyes (10 patients) who underwent pars plana vitrectomy for retinal detachment with chorioretinal coloboma. RESULTS: The average age at the time of the surgery was 29.8 ± 19.7 years. The mean follow-up period was 28.8 ± 28.4 months. The mean silicone oil tamponade duration was 9.8 ± 3.5 weeks. Of 10 eyes, 4 (40%) had retinal breaks outside the coloboma, 4 (40%) had breaks inside the coloboma, 1 (10%) had breaks inside and outside the coloboma, and in 1 eye (10%); the causative retinal break was not localized. Preoperatively, the mean visual acuity was 20/2,500 (n = 9), and 1 (10%) was recorded as "Not CSM." At the final examination, the mean visual acuity for the patients with measurable visual acuity was 20/200 (P = 0.06), and in the remaining eye was recorded as light perception. The retina was finally reattached in nine eyes (90%). Postoperative complications included cataract in three (30%), persistent elevated intraocular pressure in one (10%), band keratopathy in one (10%), and proliferative vitreoretinopathy in one (10%). CONCLUSION: Complete pars plana vitrectomy with or without lensectomy, laser photocoagulation around the peripheral retina, around all the peripheral breaks and around the colobomatous area, and silicone oil tamponade is effective for retinal detachment in eyes with chorioretinal coloboma. Silicone oil removal as early as possible did not increase the risk of redetachment and seems to reduce the incidence of oil-related complications in such cases.
Subject(s)
Choroid/abnormalities , Coloboma/complications , Endotamponade , Retina/abnormalities , Retinal Detachment/surgery , Silicone Oils/administration & dosage , Vitrectomy , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Postoperative Complications , Retinal Detachment/diagnosis , Retinal Detachment/physiopathology , Retrospective Studies , Treatment Outcome , Visual Acuity/physiologyABSTRACT
AIMS: To determine the demographic and morphological characteristics of patients with central serous chorioretinopathy (CSC) and describe risk factors for CSC. METHODS: We retrospectively reviewed medical records of 811 patients with CSC and 816 healthy controls referred from 2002 to 2018. RESULTS: The female/male ratio of patients with CSC was 1/2.7. Mean age of onset was 45.2 years. The peak prevalence for men occurred at 45-49 years. Women had two prevalence peaks, the higher at 55-59 years and the other at 45-49 years. Of these patients, 56.8% had unilateral disease, 42.1% had bilateral disease and 1.1% had only one eye. 671 (82.7%) patients had spectral domain optical coherence tomography (SD-OCT) images and 598 (73.7%) had enhanced depth choroidal images. Pigment epithelial detachment (PED) was detected in 763 (80.7%) of 945 eyes with SD-OCT images. Chronic cases were more likely to be bilateral and multifocal and to have PED (all p<0.001). Subfoveal choroidal thickness (SFCT) did not differ between chronic and classic cases (p=0.74), but SFCT was greater in multifocal cases than unifocal cases (p<0.001). In multivariate regression analyses, older age of onset, longer duration of disease and hyperopia were positively associated with having chronic disease rather than classic disease, and myopia and thyroid hormone replacement were negatively associated. Steroid use, antidepressant or anxiolytic drug use, smoking, pregnancy and hyperopia were risk factors, and myopia was a protective factor for CSC. CONCLUSION: This is the largest case-control study of CSC to evaluate demographic morphological characteristics and risk factors. Multiple factors are associated with CSC.