Combined phacovitrectomy for macular hole: long-term results.

BACKGROUND AND OBJECTIVE: To present the long-term results of patients undergoing combined phacovitrectomy surgery for idiopathic macular hole at a single center. PATIENTS AND METHODS: A retrospective review of the records for 57 eyes of 53 consecutive patients who underwent combined phacovitrectomy for idiopathic macular hole during an 18-month period was completed at the Southampton Eye Unit. RESULTS: In 45 of 57 eyes (78.9%), the macular hole closed after one surgical procedure. Forty-seven patients had a follow-up period of more than 12 months (mean = 22.1 months). In this group, the mean visual acuity (standard deviation) improved by 0.37 (+/- 0.46) logarithm of the minimum angle of resolution units. Thirty-two (68%) cases had improved visual acuity of 2 or more Snellen lines. Hole closure rate at the final follow-up examination was 87.2%. CONCLUSION: Combining phacoemulsification and vitrectomy for an idiopathic macular hole has many benefits. It is a safe procedure and produces long-term results that are comparable to previously published series.

Lesion morphology in age-related macular degeneration and its therapeutic significance.

OBJECTIVES: To quantify and categorize the lesions of neovascular age-related macular degeneration on the basis of fluorescein angiographic morphology. METHODS: We retrospectively reviewed 3580 consecutive cases of neovascular age-related macular degeneration. The lesions were graded in terms of the location, size, and composition and categorized according to the lesion components. RESULTS: A comprehensive schema for lesion description and categorization is presented. There were 2642 subfoveal (73.8%), 658 juxtafoveal (18.4%), and 276 extrafoveal (7.7%) lesions. After disciform lesions were excluded, 1337 subfoveal (72.3%), 580 juxtafoveal (88.1%), and 242 extrafoveal lesions (87.7%) consisted of at least 50% choroidal neovascularization, most of which included a classic or an occult component but not both. Subfoveal lesions (mean size, 2.82 Macular Photocoagulation Study disc areas) were significantly larger than juxtafoveal (mean size, 0.89 Macular Photocoagulation Study disc areas) or extrafoveal lesions (mean size, 1.04 Macular Photocoagulation Study disc areas) (Kruskal-Wallis, P<.001), but overall the lesions were substantially smaller than those found in the major trials. It is estimated that photodynamic therapy or photocoagulation may be offered to one half to two thirds of all patients with nondisciform neovascular age-related macular degeneration. CONCLUSION: The smaller lesion size and low proportion of mixed choroidal neovascularization lesions suggest that treatment benefit and eligibility may be greater in the clinical setting than previously thought.

Cup-to-disc ratio, intraocular pressure, and primary open-angle glaucoma in retinal venous occlusion.

PURPOSE: To investigate the association of cup-to-disc ratio (CDR), intraocular pressure (IOP), and primary open-angle glaucoma (POAG) with the site of retinal venous occlusion (RVO) and optic nerve head swelling (ONHS). DESIGN: Prospective observational case series. PARTICIPANTS: Four hundred fifty consecutive cases from a single tertiary referral center. METHODS: Fundus photography of the retinopathy, 30 degrees stereo photography of the optic disc, and Goldmann applanation tonometry were the main parameters studied. The diagnosis of POAG was obtained from the referring ophthalmologist. MAIN OUTCOME MEASURES: The main outcome measures were the CDR, measured vertically through the center of the optic disc, and the site of RVO, identified as an arteriovenous (AV) crossing, optic cup, or optic nerve. Retinal venous occlusions occurring within the optic nerve were subdivided on the basis of the presence or absence of ONHS. RESULTS: There were poor correlations between CDR and IOP (r = 0.18; P = 0.000209) and CDR and age (r = 0.21; P = 0.000012). There were 197 AV crossing-sited RVOs (AV-RVOs) (43.8%) and 46 optic cup (OC)-sited RVOs (10.2%). The remainder occurred within the optic nerve; the ONHS group had 80 cases (17.8%) and the nonoptic nerve head swelling group (NONHS) had 127 cases (28.2%). The OC-RVO group tended to be the oldest of the four groups, whereas the ONHS group was the youngest (P < 0.000001). The mean CDR was significantly higher in the OC-RVO (0.65) compared with the rest of the groups (0.45-0.48). The proportion of cases with CDR > or = 0.7 was significantly higher in the OC-RVO group (39.1%) compared with the rest of the groups (0-6.3%). There was a trend (P = 0.000012) for IOP in the OC-RVO group (19.0 mmHg) and NONHS group (17.6 mmHg); the proportion of cases with IOP more than 21 mmHg was also higher in these cases (P = 0.00033). The prevalence of POAG was highest (P < 0.000001) in the OC-RVO group (39.1%) followed by the NONHS group (18.1%), ONHS group (8.8%), and AV-RVO (4.1%) group, respectively. CONCLUSIONS: Optic cup and optic nerve-sited RVO without ONHS are associated with raised IOP and may share a common management strategy aimed at controlling ocular pressure. Glaucomatous optic disc cupping, in contrast, seems to be important in the OC-sited RVO group only. Intraocular pressure, POAG, and glaucomatous optic disc cupping do not significantly seem to contribute to the development of RVO at an AV crossing or when the occlusion occurs within the optic nerve in association with ONHS.