Three cases of macular hole that occurred in inferior scleral staphyloma associated with tilted disc syndrome: a case series.

BACKGROUND: The objective is to examine the clinical characteristics of three patients with macular hole that occurred in inferior posterior staphyloma associated with tilted disc syndrome. CASE PRESENTATIONS: This study involved three eyes of three Japanese female patients (mean age 76.0 years, range 73-84 years) with macular hole occurring in inferior posterior staphyloma associated with tilted disc syndrome. One of the three eyes was slightly myopic, while the other two eyes were highly myopic. In all three eyes, the macular hole was found to be located in or near the margin of the inferior posterior staphyloma. In one eye, the extent of retinoschisis was rather broad in the margin of the macular hole, and another eye had a history of treatment for choroidal neovascularization. As surgical treatment, the internal limiting membrane in areas surrounding the macular hole was detached after producing artificial posterior vitreous detachment, and a gas tamponade was performed. It was found during surgery that the extensibility of the retina in the margin of the MH was decreased in the three eyes as compared with a usual macular hole. Although the macular hole was successfully closed in all three cases post surgery, the layer structure of the central retina was poorly repaired in all three cases and choroidal neovascularization remained in one case. In all three cases, corrected visual acuity remained at 0.3-0.5 post surgery. CONCLUSIONS: Our findings showed poor improvement of visual acuity in all three cases post surgery, even if closure of the macular hole is achieved, thus suggesting that in cases of macular hole associated with tilted disc syndrome and inferior posterior staphyloma, the presence of macular dysfunction existing prior to the onset of macular hole affects visual prognosis.

Involvement of the Retinal Pigment Epithelium in the Development of Retinal Lattice Degeneration.

Lattice degeneration involves thinning of the retina that occurs over time. Here we performed an immunohistological study of tissue sections of human peripheral retinal lattice degeneration to investigate if retinal pigment epithelium (RPE) cells are involved in the pathogenesis of this condition. In two cases of retinal detachment with a large tear that underwent vitreous surgery, retinal lattice degeneration tissue specimens were collected during surgery. In the obtained specimens, both whole mounts and horizontal section slices were prepared, and immunostaining was then performed with hematoxylin and antibodies against glial fibrillary acidic protein (GFAP), RPE-specific protein 65 kDa (RPE65), pan-cytokeratin (pan-CK), and CK18. Hematoxylin staining showed no nuclei in the center of the degenerative lesion, thus suggesting the possibility of the occurrence of apoptosis. In the degenerative lesion specimens, GFAP staining was observed in the center, RPE65 staining was observed in the slightly peripheral region, and pan-CK staining was observed in all areas. However, no obvious CK18 staining was observed. In a monkey retina used as the control specimen of a normal healthy retina, no RPE65 or pan-CK staining was observed in the neural retina. Our findings suggest that migration, proliferation, and differentiation of RPE cells might be involved in the repair of retinal lattice degeneration.

A case of tractional retinal detachment associated with congenital retinal vascular hypoplasia in the superotemporal quadrant treated by vitreous surgery.

BACKGROUND: Here we report a case of traction retinal detachment (TRD) associated with congenital retinal vascular hypoplasia localized in the superotemporal quadrant that was treated with vitrectomy. CASE PRESENTATIONS: A 58 year-old female presented with a gradual decrease of visual acuity (VA) and distorted vision in her left eye. She had a past history of amblyopia in her left eye from early childhood, and a previous examination performed at a nearby hospital revealed that the corrected visual acuity (VA) in that eye was 0.15. Upon initial examination, no abnormal findings were observed in her right eye, yet optic-disc traction and macular rotation with a folded TRD extending superotemporally from the macular region was observed in her left eye. Fluorescein fundus angiography showed a retinal nonperfused area localized in the superotemporal quadrant surrounded by a retinal avascular area. The optic disc in her left eye was smaller than that in her right eye. Vitrectomy was performed to remove the proliferative membrane and created an artificial posterior vitreous detachment (PVD). Following surgery, the patient's corrected VA improved from 0.04 to 0.1. CONCLUSIONS: The present case was likely to be TRD caused by PVD in the presence of localized congenital retinal vascular hypoplasia secondary to optic-disc hypoplasia.

Valsalva retinopathy induced by handstand: a case report.

BACKGROUND: Valsalva retinopathy is known to occur as a sudden preretinal or sub-internal limiting membrane hemorrhage induced by a rapid rise in venous pressure following increased intrathoracic or intraabdominal pressure. Here we report a case of Valsalva retinopathy that was probably induced by straining that occurred due to following a handstand. CASE PRESENTATION: A 15-year-old boy became aware of decreased visual acuity in his left eye immediately after doing a handstand for approximately 10 s during physical education class, and subsequently visited a local clinic on the same day. Upon examination, a vitreous hemorrhage (VH) in the posterior pole of the fundus was found in his left eye, and he was subsequently referred to our department 7 days later. Upon examination, the VH around the optic nerve head of the left eye appeared to be resolved, and an oval-shaped sub-internal limiting membrane (sub-ILM) hemorrhage was found in the superonasal side of the optic nerve head. No abnormalities were observed in the macular area. Four months later, the sub-ILM hemorrhage was found to have spontaneously resolved. Subsequent fluorescein angiography examinations revealed no abnormal findings at the lesion site. CONCLUSIONS: In this patient, we hypothesize that the Valsalva retinopathy was induced by straining that occurred due to a handstand, and that the resultant sub-ILM hemorrhage progressed to VH.

A Case of Fungal Endophthalmitis Caused by Paecilomyces lilacinus that Might Have Spread from the Sclera into the Intraocular Space.

The aim of this report was to describe a case of fungal endophthalmitis possibly caused by Paecilomyces lilacinus(PL) penetrating the sclera from a conjunctival abscess. This case study involved an 83-year-old male patient with a past history of scleral buckling, subtenon steroid injection, and cataract surgery. The vitreous opacity and a conjunctival abscess appeared in the inferonasal quadrant of his right eye at 5 months after cataract surgery. PL was isolated from a cultured conjunctival discharge specimen obtained from the patient's right eye. Although the treatment with antifungal agents relieved the conjunctival abscess, the vitreous opacity became worse. Thus, vitrectomy was subsequently performed. Intraoperative findings revealed severe vitreous opacity in the inferonasal quadrant, adjacent to the sclera at the site of the conjunctival abscess. Our findings indicate that fungal endophthalmitis appeared to have been caused by PL in the conjunctival abscess that may have penetrated the sclera and spread into the intraocular space.

Type III uveal effusion syndrome suspected to be related to pachychoroid spectrum disease: A case report.

INTRODUCTION: We report a case of type III uveal effusion syndrome (UES) suspected to be related to pachychoroid spectrum disease. PATIENT CONCERNS: A 42-year-old man became aware of visual field constriction and deterioration of visual acuity in his right eye. DIAGNOSIS: Upon examination, a bullous non-rhegmatogenous retinal detachment was observed in the inferior 2 quadrants of the right eye fundus, and the subretinal fluid moved with postural changes. The axial length in that eye was 22.36 mm, thus indicating no nanophthalmia. Preoperative indocyanine green angiography revealed dilated choroidal vessels in the posterior pole of the right eye and mild leakage in the late phase. Optical coherence tomography examination revealed choroidal thickening in both eyes. INTERVENTIONS: For treatment, we first performed sclerotomy, and the intraoperative findings showed no thickening of the sclera. Following surgery, reattachment of the retina was not achieved. OUTCOMES: Thus, we next performed vitrectomy, which led to successful reattachment of the retina. LESSONS: In this case, we theorize that pachychoroid spectrum disease might have been involved in the pathogenesis of type III UES.

Ciliary body suturing using intraocular irrigation for traumatic cyclodialysis: two case reports.

BACKGROUND: We report two cases (two eyes) of traumatic cyclodialysis with prolonged decrease of intraocular pressure that were successfully treated with surgery by ciliary body suturing using intraocular irrigation. CASE PRESENTATION: This study involved a 17-year-old Japanese boy (patient 1) and a 31-year-old Japanese man (patient 2) in whom cyclodialysis was sustained in one eye after blunt-force ocular trauma from a thrown ball. Because the hypotony maculopathy in both patients did not resolve after conservative treatment, ciliary body suturing was performed. Briefly, a 25-gauge trocar intraocular irrigation needle for vitrectomy was inserted into the vitreous cavity of the injured eye. A lamellar scleral flap was then made, and an incision was created on the sclera while maintaining intraocular pressure. Next, the detached ciliary body was sutured to the sclera under direct vision. The intraocular fluid at the site of cyclodialysis was then rapidly drained from the scleral wound because of elevated intraocular pressure in the vitreous cavity, and the ciliary body was visually recognized through the scleral wound under direct vision, thus allowing a stable suture fixation of the ciliary body to the sclera. Postoperatively, the treated eye in both cases showed improvement of intraocular pressure and visual function. CONCLUSIONS: The surgical method described in this report was found to be effective for draining intraocular fluid at the site of cyclodialysis and for performing a stable suture fixation of the ciliary body to the sclera through the scleral wound under direct vision, and it should be considered advantageous for avoiding intraoperative bleeding and suturing in a blinded manner.

Concurrent vitrectomy for persistent pupillary membrane complicated by severe myopia and vitreomacular traction syndrome: A case report.

INTRODUCTION: In cases of persistent pupillary membrane (PPM), the eye is usually slightly microphthalmic and emmetropia or hyperopia is often present, yet severe myopia is reportedly rare. Here we presented a case of PPM complicated by vitreomacular traction syndrome and posterior staphyloma due to severe myopia. PATIENT CONCERNS: This study involved a 63-year-old female patient who had been diagnosed with bilateral PPM at a local eye clinic and who was subsequently referred to our department for a more detailed examination due to a recent decrease of visual acuity. DIAGNOSES: Slit-lamp microscopy examination revealed bilateral PPM. The ocular fundus revealed peripapillary conus and myopic change in both eyes. Optical coherence tomography examination revealed no particular abnormalities in the right eye, yet did show findings indicative of vitreomacular traction syndrome in the left eye. INTERVENTIONS: In both eyes, we performed surgical removal of the PPM, phacoemulsification aspiration, and intraocular lens implantation, yet in the patient's left eye, vitrectomy was also performed. OUTCOMES: After surgery, the patient's visual acuity improved in both eyes. CONCLUSION: The findings in this case show that when required, vitrectomy should be considered based upon the preoperative Optical coherence tomography findings for PPM.

Two cases of diabetic macular edema complicated by an atypical macular hole.

BACKGROUND: Here we report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME). CASE PRESENTATIONS: Patient 1 was a 73-year-old male. Optical coherence tomography (OCT) revealed perifoveal retinoschisis (RS) in addition to cystoid macular edema and serous retinal detachment (SRD) in his left eye, and that an MH had developed during the clinical course. A convex surface was formed at the MH margin toward the vitreous cavity, and granular shadows were observed in the fluid cuff. Intraoperative findings revealed a thin epiretinal macular membrane (ERM) around the MH. Patient 2 was a 79-year-old male. Although the patient underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in both eyes, RS and a thin ERM in addition to SRD was observed in his left eye after surgery, and an MH developed during the clinical course. As in Patient 1, a convex surface was formed at the fluid cuff margin toward the vitreous cavity. CONCLUSIONS: Both patients had persistent DME, SRD, RS, and a thin ERM before the development of the MH. OCT revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form.

A Case of Pneumatic Displacement with Gas Tamponade Performed for Macular Subretinal Hemorrhage Complicating Vogt-Koyanagi-Harada Disease.

We experienced a case of subretinal hemorrhage (SRH) from choroidal neovascularization (CNV) complicating Vogt-Koyanagi-Harada disease (VKH) that underwent pneumatic displacement of hematoma by intravitreal gas injection. A 76-year-old male revealed VKH relapses and optical coherence tomography showed irregular retinal pigment epithelium in his right eye and serous retinal detachment and retinal pigment epithelial detachment in his left eye. Fluorescein angiography of the left eye showed hyperfluorescence possibly attributable to CNV. One month later, SRH occurred in the left eye, yet it was spontaneously absorbed. However, approximately 1 year later, the SRH recurred in the left eye affecting a wide area, including the macular region, and his visual acuity (VA) decreased to 0.06. When pneumatic displacement of the hematoma by intravitreal gas injection was performed, the SRH was inferiorly displaced, and his VA improved to 0.4. Pneumatic displacement with gas tamponade was effective for treating a case of SRH caused by persistent CNV complicating VKH.

Effects of an Aquaporin 4 Inhibitor, TGN-020, on Murine Diabetic Retina.

PURPOSE: To investigate the effect of a selective aquaporin 4 (AQP4) inhibitor, 2-(nicotinamide)-1,3,4-thiadiazole (TGN-020), on the expression of vascular endothelial growth factor (VEGF) and reactive oxygen species (ROS) production, as well as on the retinal edema in diabetic retina. METHODS: Intravitreal injections of bevacizumab, TGN-020, or phosphate-buffered saline (PBS) were performed on streptozotocin-induced diabetic rats. Retinal sections were immunostained for anti-glial fibrillary acidic protein (GFAP), anti-AQP4, and anti-VEGF. Protein levels of VEGF from collected retinas were determined by Western blot analysis. In addition, retinal vascular leakage of Evans Blue was observed in the flat-mounted retina from the diabetic rats in the presence or absence of TGN-020. Volumetric changes of rat retinal Müller cells (TR-MUL5; transgenic rat Müller cells) and intracellular levels of ROS were determined using flow cytometry analysis of ethidium fluorescence in the presence or absence of TGN-020 or bevacizumab under physiological and high glucose conditions. RESULTS: In the diabetic retina, the immunoreactivity and protein levels of VEGF were suppressed by TGN-020. AQP4 immunoreactivity was higher than in the control retinas and the expressions of AQP4 were co-localized with GFAP. Similarly to VEGF, AQP4 and GFAP were also suppressed by TGN-020. In the Evans Blue assay, TGN-020 decreased leakage in the diabetic retinas. In the cultured Müller cells, the increase in cell volumes and intracellular ROS production under high glucose condition were suppressed by exposure to TGN-020 as much as by exposure to bevacizumab. CONCLUSION: TGN-020 may have an inhibitory effect on diabetic retinal edema.

Clinical Features of Vitreomacular Traction Syndrome with Peripheral Vitreoretinal Adhesion.

PURPOSE: To retrospectively review and analyze the clinical and imaging data of patients with vitreomacular traction syndrome (VMTS) with strong peripheral vitreoretinal adhesion. SUBJECTS AND METHODS: This retrospective case-series study involved 4 eyes of 4 VMTS patients with vitreoretinal adhesion in both the macular region and the periphery who underwent vitreous surgery. In all 4 cases, preoperative refraction, fundoscopic findings, optical coherence tomography (OCT) findings, and intraoperative findings were evaluated. RESULTS: The preoperative fundoscopy and OCT findings revealed fibrous membranes around the optic nerve head in 3 eyes. Thickened posterior vitreous membranes extending from the posterior pole to the periphery were observed in all eyes. Apparent VMTS or epimacular membrane was also found in the fellow eyes of 2 patients. The preoperative refractive errors ranged from +0.5 diopters (D) to +2.75 D (mean, +1.13 D). Intraoperatively, a thickened posterior vitreous membrane was found strongly adhered to the retina in the macula regions, optic nerve head, and periphery. In 2 eyes, when artificial posterior vitreous detachment (PVD) was created, an iatrogenic tear developed in the periphery. CONCLUSION: The features of VMTS that cause strong peripheral vitreoretinal adhesion include the preoperative presence of a thickened posterior vitreous membrane over a wide area, hypermetropia, and a short axial length.

Spontaneous Closure of the Macular Hole in a Patient with Acquired Vitelliform Lesion.

In this paper, we report an extremely rare case of spontaneous closure of a macular hole (MH) that developed in a patient in whom acquired vitelliform lesion (AVL) occurred after vitrectomy for atopic retinal detachment (ARD). A 32-year-old male developed ARD in both eyes, and retinal reattachment was achieved after vitrectomy. Five years after surgery, optical coherence tomography showed localized serous retinal detachment (SRD) and a granular lesion with a higher brightness in the subretinal fluid, thus leading to the diagnosis of AVL. One month later, an MH developed, and a follow-up examination performed 6 weeks later revealed that the MH had spontaneously closed and the SRD decreased. In the fovea, fluorescein angiography revealed a window defect due to atrophy of the retinal pigment epithelium (RPE). These findings in this present case suggest the possibility that RPE dysfunction was involved in the development of AVL and MH.

Long-Term Follow-Up Changes of Central Choroidal Thickness Thinning after Repeated Anti-VEGF Therapy Injections in Patients with Central Retinal Vein Occlusion-Related Macular Edema with Systemic Hypertension.

PURPOSE: We investigated the thinning of central choroidal thickness (CCT) following intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs to treat central retinal vein occlusion (CRVO)-related macular edema in patients with and without systemic hypertension (HT) to assess the influence of repeated anti-VEGF therapy and HT on the choroid in CRVO eyes. METHODS: We conducted a retrospective study involving 27 patients with CRVO-related macular edema from January 2014 to July 2017, with follow-ups exceeding 18 months. Visual acuity (VA), central retinal thickness (CRT), and CCT were evaluated before and after initial anti-VEGF drug treatment during follow-up. RESULTS: The mean follow-up period was 35.2 months. Seventeen (63.0%) patients had HT. At 1 month after treatment, VA had improved in 21 (77.8%) patients, and CRT had decreased in 25 (92.6%). At the final visit, 22 (81.5%) showed improved VA, 19 (70.4%) had resolved macular edema, and the CCT had gradually become thinner with additional drug injections in all the patients. Furthermore, the mean CCT in HT patients (209.0 µm) was significantly lower than in non-HT patients (256.1 µm), and the mean injections were 7.8 and 5.3, respectively (p = 0.2067). CONCLUSION: The CCTs were thinner in eyes with HT than in eyes without HT both before and after the repeated anti-VEGF injections.

Scleral patch grafting for scleral wound thinning after pars plana phacoemulsification and aspiration: A case report.

RATIONALE: Here we report the case of a patient who required closure with an autologous scleral patch graft during reoperation after developing marked scleral thinning in the late stage after pars plana phacoemulsification and aspiration (PPPEA). To the best of our knowledge, this is the first reports of the procedure being used for the treatment of a thinned scleral section post PPPEA. PATIENT CONCERNS: This study involved a 73-year-old woman who had undergone vitreous surgery combined with PPPEA for retinal detachment in her right eye 8 years earlier and subsequently underwent intraocular lens (IOL) ciliary sulcus suture fixation. DIAGNOSES: She became aware of visual disturbance in her right eye and slit-lamp examination revealed the dislocation of the IOL. INTERVENTIONS: To remove the dislocated IOL and resuture the nasal loop back onto the ciliary sulcus of the patient's right eye, a 25-guage trocar was placed on the superior temporal side. OUTCOMES: Subsequent removal of the trocar from the patient's right eye left an approximately 3-mm-wide oval-shaped gap at the trocar insertion site due to extreme thinning of the sclera in that area; that is, the location where the PPPEA was performed. Since suture fixation failed to stop intraocular fluid leakage, an inferior free half-thickness scleral flap was created to patch the scleral wound. Postsurgery, the leakage in that eye stopped and the intraocular pressure was stable. No complications were observed during the 1-year-postoperative follow-up period. LESSONS: Since thermal injuries during PPPEA may lead to postoperative scleral thinning, surgeons should avoid the site of a prior PPPEA when constructing a scleral wound during reoperation.

Protein kinase C-mediated insulin receptor phosphorylation in diabetic rat retina.

PURPOSE: Diabetic retinopathy (DR) involves a proliferation of vascular endothelial cells and loss of pericytes. There is a link among the action of protein kinase C (PKC) and insulin signaling. Thus, we investigated the differences between these cells in insulin receptor (IR) phosphorylation in DR. METHODS: Retinas were removed from streptozotocin-induced diabetic or healthy rats, and IR expression levels were compared by immunoblot and immunohistochemistry. In vitro assays also were performed in order to determine the expressions of phosphorylated IR in both cells cultured under 5.5 or 25 mM glucose by immunoblot. Cell viability was determined in both cells cultured under different concentrations of phorbol myristate acetate (PMA), a PKC activator. To determine the involvement of the PI3 kinase pathway of IR, PMA with or without wortmannin-induced changes in Akt was also analyzed. RESULTS: Immunoreactivity to the IR was decreased in diabetic retina. High glucose (25 mM) increased phosphorylated IR levels in endothelial cells but not in pericytes. PMA (1 nM or higher) induced death of pericytes, while endothelial cells were increased. PMA increased phosphorylated Akt in endothelial cells and decreased in pericytes. Wortmannin suppressed the PMA-induced phosphorylation of Akt in endothelial cells. CONCLUSIONS: The different responses to 25 mM glucose and PMA were observed between retinal endothelial cells and pericytes. Thus, IR phosphorylation is likely important for retinal vascular cells to survive in diabetic retina.

Involvement of premacular mast cells in the pathogenesis of macular diseases.

We previously reported on the elevated intravitreal activities of tryptase and chymase in association with idiopathic epiretinal membrane (ERM) and idiopathic macular hole (MH). In this present study, we investigated the potential intraocular production of these serine proteases, and measured and compared tryptase and chymase activities in the vitreous body and serum in ERM, MH, proliferative diabetic retinopathy (PDR), and rhegmatogenous retinal detachment (RRD) patients. In addition, nuclear staining with hematoxylin and eosin (H&E) and mast-cell staining with toluidine blue were performed on samples of the vitreous core and bursa premacularis (BPM) of MH. We also performed immunostaining on the above two regions of vitreous samples for MH with anti-tryptase antibody, anti-chymase antibody, anti-podoplanin antibody, anti-lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) antibody, and anti-fibroblast antibody. Moreover, we performed immunostaining with anti-tryptase antibody and anti-chymase antibody on ERMs collected intraoperatively. Tryptase activity in the vitreous body was significantly higher in ERM and MH than in PDR. However, no significant differences were observed in the tryptase activity in the serum among these four diseases. Chymase activity in the vitreous body was significantly higher in MH than in the other three diseases, yet chymase activity in the serum was below detection limit in any of the diseases. Nuclear staining with H&E revealed an abundance of nuclei in the BPM region, but few in the surrounding area. Mast-cell staining with toluidine blue revealed that the BPM showed metachromatic staining. In immunostaining with anti-fibroblasts antibody, anti-tryptase antibody, anti-chymase antibody, anti-podoplanin antibody, and anti-LYVE-1 antibody, the BPM stained more strongly than the vitreous core. Tryptase and chymase-positive cells were also observed in ERM. These findings revealed that the presence of mast cells in the BPM potentially represent the source of these serine proteases. Moreover, the BPM, as a lymphatic tissue, may play an important role in the pathogenesis of macular disease.

Periocular injection of candesartan-PLGA microparticles inhibits laser-induced experimental choroidal neovascularization.

PURPOSE: Microparticle technology enables local administration of medication. The purpose of this study was to examine the inhibitory effect of locally administered candesartan (CAN)-encapsulated microparticles on experimental choroidal neovascularization (CNV). METHODS: Laser photocoagulation was used to induce CNV in Brown Norway rats. The rats were pretreated with subconjunctival injections of CAN (5.0 mg/eye) or phosphate buffer saline for 3 days before photocoagulation. The volume of CNV was evaluated 7 days after laser injury using the lectin staining technique. The infiltration of macrophages within the CNV lesion was determined using immunofluorescent staining with an anti-CD68 antibody. mRNA levels of MCP-1, IL1-ß and VEGF in the retinal pigment epithelium/choroid complex were determined using quantitative PCR (q-PCR). RESULTS: CNV volume was significantly suppressed by the treatment with CAN compared with that in vehicle-treated eyes (P<0.05, two-tailed Student's t-test). Subconjunctival injections of CAN decreased the numbers of CD68+ cells in the CNV lesion. The increased mRNA levels of MCP-1, IL1-ß, and VEGF induced by photocoagulation was significantly suppressed following the local administration of CAN (P<0.05, two-tailed Student's t-test). CONCLUSION: Local administration of CAN inhibited experimentally induced CNV possibly through anti-inflammatory effects.

Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery: Two case reports.

RATIONALE: We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases. PATIENT CONCERNS AND DIAGNOSES: Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history. INTERVENTIONS: In both cases, reattachment was achieved by performing vitrectomies. OUTCOMES: These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.

Investigation of scleral thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration using pig eyes.

PURPOSE: The purpose of this study was to investigate the thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration (PPPEA) using pig eyes. METHOD: Using a 20-gauge (G) vitrectomy system (Accurus®, Fragmatome; Alcon Laboratories) in both the 'open-tip' and 'closed-tip' techniques, PPPEA was performed in pig eyes and the subsequent thermal injuries generated around the scleral wound were measured by infrared thermal imaging (thermography). Post surgery, the state of the scleral wound was observed under a microscope, and a tissue slice containing the scleral wound was then prepared and observed under an optical microscope. RESULTS: Thermography measurements revealed a slight temperature rise around the scleral wound in the open-tip case, yet a marked temperature rise in the closed-tip case. The scleral wound incision produced by the open tip was linear, while that produced by the closed tip was expanded. Histological examination revealed mild degeneration of the sclera around the wound in the open-tip case, yet marked tissue degeneration by thermal injuries in the closed-tip case. CONCLUSION: Our findings showed that in PPPEA, the temperature of the tip of a 20G vitrectomy system rapidly increases due to the closed-tip technique, thus producing obvious thermal damage to the scleral wound. In order to prevent thermal injuries to the scleral wound during PPPEA, it is important to shorten the time of ultrasonic oscillation during surgery as much as possible while the tip is occluded with nuclear fragments.