Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction.

To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair.

BACKGROUND: To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH). METHODS: We retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications. RESULTS: Neither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001). CONCLUSIONS: Combined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only. TRIAL REGISTRATION: The study was approved on 30th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033 ).

Long-term outcome of macular shift after retinal detachment repair.

BACKGROUND: This study aimed to evaluate the long-term change of postoperative retinal shift after pars plana vitrectomy for macular off retinal detachment. METHODS: In this retrospective study, patients with retinal shift after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment (RRD) were examined at 3 weeks and 12 months postoperatively. Fundus autofluorescence images were obtained to visualize retinal rotation. Best-corrected visual acuity was measured and metamorphopsia assessed using the Amsler grid. RESULTS: Nine patients with postoperative retinal shift were included in the study. Retinal shift decreased significantly in these patients, on average by 1.07° (range 0.52-1.62, p = 0.002) after 12 months. However, more patients complained of distorted vision after 12 months (odds ratio for change = 3.0, 95% CI: 0.24 to 157.49). The main reason was the new formation of an epiretinal membrane (odds ratio for change = infinity, 95% CI: 0.41 to infinity). There was no change in visual acuity observed (p = 0.16). CONCLUSION: Postoperative retinal shift after RRD repair decreases over a 1-year span. While retinal shift is the main cause for metamorphopsia in the early postoperative period, formation of an ERM is the main reason for distorted vision long term.

Predictive Risk Factors for Retinal Redetachment Following Uncomplicated Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment.

PURPOSE: To investigate clinical and surgical factors influencing the outcome after primary rhegmatogenous retinal detachment surgery. METHODS: A retrospective, single-centre, case-control study of 1017 eyes of 1017 consecutive patients with primary rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV), were included in the study. Analysed surgical factors were: combined procedure with phacoemulsification, type of retinopexy (cryocoagulation, endolaser, combined), type of tamponade (gas, silicone oil), and anatomical factors: primary proliferative vitreoretinopathy (PVR) and macular detachment at the time of surgery. RESULTS: Overall retinal re-detachment rate was 10.1%. The main reason for re-detachment was an insufficient retinopexy in 53.6%, followed by PVR (37.3%), and retinal detachment occurred at a different location caused by another break in 9.1%. No significant difference in the rate of re-detachment was found if a phacoemulsification with simultaneous IOL implantation was performed (p = 0.641). No significant difference between the various retinopexy techniques was found (p = 0.309). Risk factors re-detachment were primary PVR (p = 0.0003), silicone oil as initial tamponade (p = 0.0001) as well as macula off detachments (p = 0.034). CONCLUSIONS: The present study showed no significant difference between the types of retinopexy and if additional phacoemulsification was performed or not. Factors associated with a higher risk for re-detachment were detached macula at surgery, primary PVR and primary oil-filling.

Correction to: Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

The original article can be found online.

Successful Treatment of Peripheral Proliferative Vitreoretinopathy with Cryocoagulation During Retinal Detachment Repair - A New Surgical Technique.

PURPOSE: To evaluate the effect of extrascleral cryocoagulation for the treatment of proliferative vitreoretinopathy (PVR) during retinal detachment repair. METHODS: Patients with a rhegmatogenous retinal detachment associated with peripheral PVR Grade C star-folds were included in this study and analysed retrospectively. In all patients, PVR star-folds were treated by extrascleral cryocoagulation. RESULTS: A total of six patients with a rhegmatogenous retinal detachment associated with at least one peripheral PVR star-fold were included in this study. Reattachment of the retina was successfully achieved in all patients. CONCLUSION: This novel and simple technique for the treatment of localized PVR using extrascleral cryocoagulation appears to be a safe and effective approach with favourable surgical success rates.

Multimodal imaging for detecting metamorphopsia after successful retinal detachment repair.

PURPOSE: To investigate the etiologies of metamorphopsia after successful retinal detachment repair. METHODS: In this retrospective study, we included patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD). Patients were reviewed after 3 to 6 weeks. Best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, spectral-domain optical coherence tomography (SD-OCT), and fundus autofluorescence images (FAF) were obtained from all patients to visualize abnormalities in retinal layers and retinal rotation. RESULTS: A total of 50 eyes from 49 consecutive patients were included, of whom 12 (24%) complained of postoperative metamorphopsia. The main cause of metamorphopsia was retinal shift after RRD repair (p < 0.001). CONCLUSION: Distorted vision after macula-off RRD is a common and retinal shift was found to be the main reason patients experience metamorphopsia after a successful macula-off RRD repair.

Combined pars plana vitrectomy with phacoemulsification for rhegmatogenous retinal detachment repair.

PURPOSE: To investigate the outcome after combined phaco-vitrectomy in rhegmatogenous retinal detachment (RRD) repair. PATIENTS AND METHODS: In this retrospective study, we included all patients who underwent pars plana vitrectomy (PPV) for RRD between January 2013 and December 2017. The main outcome measure was the retinal re-detachment rate after combined phaco-vitrectomy. RESULTS: Overall, 1017 eyes with RRD were included. All eyes received PPV, while in 516 eyes additional phacoemulsification was performed. A retinal re-detachment occurred in 103 patients (10.1%). No significant difference in the rate of re-detachment was found if additional phacoemulsification was performed (p=0.641). Subgroup calculations showed a significant higher rate of re-detachment in patients with a PVR (p=0.0003) and in patients where silicone oil was used as primary tamponade (p=0.0001) as well as in macula off RRDs (p=0.034). CONCLUSION: Additional phacoemulsification during vitrectomy for RRD is not associated with higher rate of retinal re-detachment.

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

INTRODUCTION: To evaluate the effect of postoperative posture on the retinal shift after retinal detachment repair. METHODS: Patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD) were included prospectively in the current study. Patients were randomized into two groups: group A included patients who did a log roll postoperatively, and group B included patients who had to lie flat on their backs for 6 h postoperatively before moving into the end position. Patients in group A and patients in group B were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence images (FAF) were obtained to visualize the retinal rotation. RESULTS: The sample included 50 eyes from 49 patients. Retinal shift occurred after RRD repair in 17 patients (34%). There was no statistically significant difference between the two groups (p = 0.94). Postoperative macular shift occurred significantly less often (p = 0.049) in participants in whom heavy fluid was used in the procedure. Metamorphopsia was reported postoperatively by 10 of 17 patients with retinal shift (p < 0.001). CONCLUSION: In our study, postoperative posture did not significantly influence postoperative macular slippage after RRD repair. The use of intraoperative heavy liquid appears to be associated with a lower occurrence of retinal shift.

How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair: A Prospective, Randomized Study.

PURPOSE: To evaluate the effect of intraoperative use of heavy liquid on retinal shift after retinal detachment repair. DESIGN: Prospective, randomized study. PARTICIPANTS: Patients who underwent pars plana vitrectomy for macula-off rhegmatogenous retinal detachment were included in the current study. METHODS: Patients were randomized into 2 groups: group A included patients in whom heavy liquid was used during the procedure and group B included patients in whom no heavy liquid was used. Group A and B patients were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence (FAF) images were obtained to visualize the retinal rotation. MAIN OUTCOME MEASURE: Postoperative macular shift, visualized with FAF. RESULTS: A total of 50 eyes from 49 patients were included. Overall, retinal shift was observed in 17 patients (34%). Patients in whom heavy liquid was used during the procedure showed significantly less macular shift after surgery (P = 0.049). There was a strong association between retinal shift and postoperative symptoms of metamorphopsia. Ten of 17 patients with retinal shift reported distorted vision (P < 0.001). CONCLUSIONS: The use of intraoperative heavy liquid seems to be associated with lower occurrence of retinal shift after retinal detachment repair.

Comparative study of endolaser versus cryocoagulation in vitrectomy for rhegmatogenous retinal detachment.

BACKGROUND: To investigate the influence of different types of retinopexy on the outcome of rhegmatogenous retinal detachment (RRD) repair. METHOD: All patients with RRD who underwent pars plana vitrectomy (PPV) between January 2013 and December 2017 were included. Analysed surgical factors were types of retinopexy (cryocoagulation, endolaser, combined). Subgroup analysis was performed in patients with primary proliferative vitreoretinopathy (PVR), and/or the necessity of a primary silicone oil fill. RESULTS: A total of 1017 eyes with retinal detachment were included. The predominant type of retinopexy used during PPV was cryocoagulation in 492 eyes, followed by a combined cryocogulation/endolaser in 306 eyes and laserretinopexy in only 219 eyes. Overall, the re-detachment rate was 10.1%. In most of the cases (53.6%) the main reason for re-detachment was insufficient retinopexy, followed by a PVR-reaction in 37.3%, and new site break in 9.1%. No significant difference in the rate of re-detachment was found between the different types of retinopexy (p = 0.309). However, subgroup analysis showed a significantly higher rate of re-detachment in patients with a primary PVR (p = 0.0003), and in the group with silicone oil as the primary tamponade (p = 0.0001). CONCLUSION: The data suggests that the type of retinopexy has little relevance for the surgical outcome of PPV for the primary RRD. However, patients with primary PVR and primary silicone oil fills were at a significantly increased risk for re-detachment.

Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling.

INTRODUCTION: The aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity. METHODS: The patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery. RESULTS: A total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant. CONCLUSIONS: No difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.

First experience with Oasis Collagen SOFT SHIELD® for epithelial defect after corneal cross-linking.

BACKGROUND: To investigate response of dissolving collagen contact lenses as an alternative for bandage contact lenses, for the post-interventional care of epithelial defects after corneal cross-linking (CXL) treatment for keratoconus. PATIENTS AND METHODS: Follow-up visits were performed at day 1, 4 and 1 month after the intervention. We reviewed notes for re-epithelialization, comfort/pain and any untoward effects of Collagen SOFT SHIELD®. Assessment included visual acuity (VA), refraction (SE); corneal haze, epithelial erosion and pain status were assessed subjectively on a 4-point scale, from 0 (none) to 3 (severe). RESULTS: Thirty consecutive CXL patients with collagen shield application after CXL were included. Mean age was 28 years (range from 16 to 51 years old). Pre-CXL VA was 0.7 logMAR IQR 0.4-1.0; post-CXL VA at day 4 and month 1 was 0.6 logMAR IQR 0.4-0.9. Post-operative mean SE was 5.5D ± 4.1D. In all patients, the Collagen SOFT SHIELD® was completely dissolved at the 4-day follow-up visit. In most cases, epithelial defect was closed at day 4, on average 0.8 ± 0.5 days post-intervention; all epithelial defects were closed by month 1. Haze was minimal (mean haze score 1.4 ± 0.7 at day 4 and 1.0 ± 0.6 at 1 month). No adverse effects such as infection were observed. CONCLUSIONS: This study indicates that Oasis Collagen SOFT SHIELD® is valuable and safe alternative to standard bandage contact lens for the treatment of epithelial defects. This outcome may be of particular interest in patients where the contact lens removal is likely to be problematic.

Microstructural retinal regeneration after internal limiting membrane flap surgery for repair of large macular holes: a 1-year follow-up study.

PURPOSE: To evaluate long-term change in functional and structural outcomes after successful repair of large macular holes (MH) with internal limiting membrane (ILM) flap techniques. METHODS: Eleven consecutive patients were reviewed over a 1-year time period after the successful repair of large MH with ILM flap techniques. SD-optical coherence tomography (SD-OCT) images were taken to assess the anatomical outcome after surgery, while the best-corrected visual acuity (BCVA) was tested using Snellen charts to evaluate the functional outcome. Each patient was evaluated at 1, 6 and 12 months after surgery, respectively. RESULTS: All cases achieved complete anatomical closure. All patients showed a microstructural regeneration of the retina with a decrease in ellipsoid zone defects over the 1-year follow-up. Functionally, as compared to baseline, all of the patients showed improvements in best-corrected visual acuity of 1-4 lines at the final examination after 12 months post-operatively. CONCLUSIONS: Long-term results show further improvement in the best-corrected visual acuity as well as further microstructural regeneration of the retina and decrease in ellipsoid zone defects over time. The exact mechanism, which promotes closure of the macular hole and reconstruction of the ellipsoid zone after internal Limiting Membrane autograft surgery, still remains unknown.

[Long-term Outcome after Autologous Free Internal Limiting Membrane Flap for the Treatment of Refractory Macular Holes]. / Langzeitergebnis nach autologer Membrana-limitans-interna-Lappenplastik bei nicht verschlossenem Makulaloch.

PURPOSE: To evaluate the technique and the long-term outcomes after autologous internal limiting membrane flap surgery for refractory macular holes. METHODS: The free ILM flap technique was used as a secondary procedure for non-closing macular holes after failed initial standard procedure. SD-OCT images were taken to assess the anatomical outcome of surgery while best corrected visual acuity (BCVA) was used to evaluate the functional outcome during a one-year follow-up. RESULTS: A total of five eyes were included. All patients underwent successful intended manipulation of the ILM flap. All cases achieved complete anatomical closure. Partial microstructural reconstruction was demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone and was observed in all cases. Functionally, as compared to baseline, most of the patients showed improvements in BCVA of 1 to 2 lines. CONCLUSION: This technique appears to be a safe and effective approach with favourable anatomical and functional results.

Surgical Outcome after Lamellar Macular Hole Associated with Epiretinal Membrane.

PURPOSE: To evaluate functional and anatomical outcomes after pars plana vitrectomy (PPV) in patients with epiretinal membrane associated with lamellar hole (LH). PATIENTS AND METHODS: All patients who underwent PPV with epiretinal membrane peeling associated with an LH from January 2016 to December 2017 were included. Each patient received a complete ophthalmological examination including best-corrected visual acuity using Snellen charts (in decimal form; converted to logMAR) and spectral domain optical coherence tomography (SD-OCT) before surgery as well as 3 months after surgery. In all patients, the contour of the LH was postoperatively graded using SD-OCT images. RESULTS: A total of 36 consecutive patients (36 eyes) with LH associated with epiretinal membrane were reviewed. Most of the patients had normalization or at least an improvement of the LH contour postoperatively (p < 0.001). Median logMAR improved significantly after surgery from 0.3 to 0.2 (p < 0.001). CONCLUSIONS: PPV with epiretinal membrane peeling in symptomatic patients with LH caused by epiretinal membrane is a safe treatment with favorable functional and anatomical short-term outcomes.

[Congenital Simple Hamartoma of the Retinal Pigment Epithelium]. / Kongenitales einfaches Hamartom des retinalen Pigmentepithels.

BACKGROUND: Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is an uncommon benign lesion with characteristic clinical features. Ophthalmoscopically it appears as a small localized, well circumscribed, pigmented tumor in the foveal region. In contrast to the more common flat congenital hypertrophy of the RPE the CSHRPE has an elevated nodular appearance. PATIENTS AND METHODS: Retrospective case series of three patients with CSHRPE. Clinical morphological features using different imaging techniques are presented. RESULTS: A typical dark lesion was incidentally noted in the macula of two patients. Optical coherence tomography (OCT) demonstrated a nodular preretinal hyperreflectivity with shadowing of deeper structures. In one patient the CSHRPE was hypofluorescent throughout the angiogram. The third patient presented with a reduced visual acuity of 0.3. A characteristic lesion was found at the foveal center. OCT revealed a hyperreflective preretinal lesion with associated moderate disruption of the foveal architecture. Amblyopia treatment slightly improved visual acuity in this case. The lesions remained stationary in two patients (follow-up 8 - 14 months). CONCLUSIONS: CSHRPE are usually detected as an incidental finding. Given its benign character and typically asymptomatic presentation an observational treatment approach is generally recommended. The lesions generally remain stationary and are not known to grow. In cases with visual impairment due to foveal involvement amblyopia treatment should be initiated.