Ultrastructural details of epiretinal membrane foveoschisis.

INTRODUCTION: To describe differences in the vitreomacular interface (VMI) in idiopathic epiretinal membrane (ERM) foveoschisis compared to macular pseudohole (MPH) and lamellar macular hole (LMH). METHODS: We analysed surgically excised epiretinal material and internal limiting membrane (ILM) specimens obtained from 16 eyes of 16 patients with ERM foveoschisis (6 eyes), MPH (5 eyes) and LMH (5 eyes) during standard pars plana vitrectomy (PPV) with membrane peeling. The three entities were classified according to the newly introduced optical coherence tomography (OCT) terminology. Transmission electron microscopy (TEM) was used to describe the ultrastructural features. RESULTS: We found fibrocellular epiretinal tissue in all samples analysed. However, the cell and collagen composition of the VMI differed between groups. Eyes with ERM foveoschisis were characterised by a higher number of cells, multi-layered membranes and thick strands of vitreous collagen embedding the major cell types of myofibroblasts compared to MPH. Eyes with MPH also showed a predominance of myofibroblasts, but these were located directly on the ILM with no collagen between the cells and the ILM. Eyes with LMH showed a thick, multi-layered epiretinal proliferation consisting mainly of non-tractional glial cells, corresponding to hypodense epiretinal proliferation on OCT. Eyes with ERM foveoschisis and MPH were more likely to have incomplete PVD compared to LMH in terms of posterior hyaloid status. DISCUSSION/CONCLUSION: Tractional ERMs in eyes with ERM foveoschisis and MPH differ in their ultrastructure. The main difference is in the amount and topographical distribution of vitreous collagen. Although the epiretinal cell types are predominantly myofibroblasts in both entities. This highlights the importance of distinguishing ERM foveoschisis from both MPH and LMH in terms of pathogenesis and surgical peeling procedures.

Correction: Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy.

PURPOSE: To evaluate the effectiveness of steroid-pulse therapy and three-wall orbital decompression in patients with dysthyroid optic neuropathy (DON). METHODS: Twenty-five patients (46 eyes) with a diagnosis of DON between 2008 and 2015 were included in the study. The first group (7 patients, 16 eyes) consisted of patients with a steroid-pulse treatment only and the second group (18 patients, 30 eyes) included patients with medical and surgical decompression. RESULTS: Twenty patients were female; five patients were male. After the diagnosis of DON, all patients were treated with steroid-pulse treatment (intravenous 500 mg prednisolon twice/week for 4 weeks, 250 mg twice/week for 2 weeks) as a first-line treatment (medical decompression). In 30 eyes (18 patients) out of 46 eyes, (25 patients) an orbital decompression was needed to preserve the optic nerve function. In those therapy-resistant cases (surgical decompression group), the orbital decompression led to statistically significant improvements in best-corrected visual acuity (BCVA), protan and tritan value of the color vision (p = 0.007, p < 0.0001, p = 0.019, respectively, comparison of first visit to last visit). CONCLUSION: According to our data, the mild cases of DON with better initial visual acuity (in our case series mean: 0.3 logMAR) seem to respond well to steroid treatment. However, therapy-resistant cases with an impaired initial BCVA (in our case series, mean: 0.6 logMAR) seem to need the surgery to preserve the optic nerve function. In conclusion, this retrospective study confirms the effectiveness of surgical decompression in therapy-resistant cases of DON.

Comparison of different devices to measure the intraocular pressure in thyroid-associated orbitopathy.

PURPOSE: To evaluate the correlation of the intraocular pressure measurements (IOP) with non-contact tonometer Corvis Scheimpflug technology (Corvis ST), Goldmann applanation tonometry (GAT), ocular response analyzer (ORA), and iCARE rebound tonometer in patients with thyroid-associated orbitopathy (TAO) and eye-healthy subjects (control group). METHODS: Twenty-nine consecutive patients with TAO (79% female) and 30 eye-healthy subjects (60% female) were included in this prospective, age- and sex-matched study. The IOP measurement with Corvis, ORA, GAT, iCARE, and central corneal thickness (CCT) with Corvis was obtained from all study participants. RESULTS: The mean age of the patients was 51 ± 10 years in patients with TAO and 56 ± 13 years in the control group. The mean IOP measurements with GAT, Corvis, ORA, and iCARE were 15.93 ± 4.42 mmHg, 18.10 ± 7.54 mmHg, 18.40 ± 7.93 mmHg, and 16.61 ± 7.96 mmHg in patients with TAO and 14.52 ± 3.02 mmHg, 14.48 ± 3.38 mmHg, 15.29 ± 4.64 mmHg, and 14.13 ± 3.85 mmHg in the control group (P = 0.157, P = 0.004, P = 0.017, and P = 0.176 respectively). The mean CCT was 547.5 ± 39.2 µm in patients with TAO and 560.8 ± 49.8 µm in the control group ( P= 0.261). CONCLUSIONS: The data collected shows an agreement between the iCARE and GAT IOP measurements in TAO patients and in eye-healthy patients. However, the mean value of IOP measurements with Corvis and ORA was significantly higher in patients with TAO in comparison with the control group (P = 0.044 and P = 0.029 respectively).