RETINAL DETACHMENT ASSOCIATED WITH PERIPAPILLARY STAPHYLOMA IMAGED WITH SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To examine a rhegmatogenous retinal detachment (RRD) associated with a peripapillary staphyloma with swept source optical coherence tomography (SS-OCT) before and after vitrectomy and circumferential photocoagulation. METHODS: The SS-OCT images including the montage images of two patients with a RRD associated with peripapillary staphylomas were analyzed. A 34-year-old woman (Case 1) and a 70-year-old woman (Case 2) both noticed temporal visual field defects in their left eyes. Ophthalmoscopy showed a retinal detachment in the nasal quadrant without any peripheral breaks in both patients. The best-corrected visual acuity was 20/20 with -8.5 diopters in Case 1 and 20/25 with -7.0 diopters and moderate cataract in Case 2. SS-OT was used to follow the clinical course of the RRD. RESULTS: Preoperatively, retinal tears were detected nasal to the optic disk within the excavated staphyloma in the SS-OCT images. A posterior vitreous detachment was not present in Case 1 but was present in Case 2. The glial tissue at the edge of the excavated staphyloma was removed from both eyes, and the subretinal fluid was drained internally through the retinal breaks. Hemicircumferential photocoagulation was performed at the nasal edge of the staphyloma, and the retina was reattached in both eyes. Postoperative SS-OCT montage images showed retinal reattachment but a detachment was still present within the staphyloma. CONCLUSION: Vitreous surgery was effective for an RRD associated with a peripapillary staphyloma. Examinations by SS-OCT can follow the changes in the RRD and the excavated lesion of a peripapillary staphyloma.

Effects of optical diameter of intraocular lenses with intrascleral fixation on higher-order aberrations.

BACKGROUND: Intrascleral fixation of an intraocular lens (IOL) is used in eyes that lack capsular support. The aim of the study is to determine whether a larger optical diameter IOL will decrease the higher-order aberrations (HOAs) when the haptics are extended for intrascleral fixation than a smaller diameter IOL. METHODS: Three-piece acrylic IOLs with 6.0 mm optics (X-60, VA-60BBR) and 7.0 mm optics (X-70, VA-70 AD) were fixed at lengths of 13, 14, 15, 16, or 17 mm. A wavefront analyzer was used to measure the HOAs within the central 3.0 and 5.2 mm optic diameter. RESULTS: The astigmatic aberration within the central 5.2 mm was greater than that within the central 3.0 mm for all IOLs. The HOAs increased significantly with an extension of the IOLs with both optical diameters (P < 0.001). The coma aberration within the central 5.2 mm was greater than that within the central 3.0 mm but it did not increase with an extension of the haptics. The astigmatic aberration of the X-60 IOL was significantly greater than that of the X-70 only at an extension of 17 mm. The astigmatic aberration of the VA-70 AD was not significantly different from that of the VA-60BBR. The cylindrical power changed from 0.047 D in the X-60 to 0.118 D in the VA-70 AD when the IOLs were extended from 13 to 17 mm. CONCLUSION: When three-piece IOLs are highly extended for intrascleral fixation, the astigmatic aberration increases significantly. However, IOLs with 7 mm optics do not have less astigmatic and coma aberrations than IOLs with 6 mm optics.

[Clinical Characteristics of Rhegmatogenous Retinal Detachment in Highly Myopic and Phakic Eyes].

PURPOSE: To evaluate clinical characteristics of rhegmatogenous retinal detachment in high myopic and phakic eyes. SUBJECTS AND METHOD: The subjects were 1174 eyes of phakic rhegmatogenous retinal detachment detected in 1199 eyes that underwent initial vitreoretinal surgery between April 2006 and March 2011. Eyes with macular hole retinal detachment or secondary retinal detachment were excluded. The 486 eyes with high myopia (spherical equivalent ≤ -6.0 D or axial length ≥ 26.5 mm) and the 688 eyes with non-high myopia were compared. RESULTS: The mean age was significantly younger in the high myopia group (42.7 ± 14.2 years old, p < 0.001) with a single peak of higher incidence in 40 years old. The retinal detachment caused by retinal hole was significantly frequent in the high myopia group (p < 0.001) and that caused by retinal tear was less frequent (p = 0.021). The initial retinal attachment rate and the final attachment rate were not significant. In the fellow eye of the high myopia group, the incidence of retinal detachment and lattice degeneration were more frequent (16.7%, 20.4%, respectively). CONCLUSIONS: The incidences of the retinal detachment in younger age and those caused by retinal holes were higher in the high myopia group. Higher incidence of retinal detachment and lattice degeneration in the fellow eyes of the high myopia group indicated that careful observation also in the fellow eyes was recommended.

[Comparison of Retinal Detachment Associated with Atopic Dermatitis with that of a Blunt Trauma].

PURPOSE: Retinal detachment associated with atopic dermatitis has been reported to have several similarities to retinal detachment with blunt trauma both in location and types of retinal breaks. To clarify the difference between these two types of retinal detachment, the clinical features of retinal detachment associated with atopic dermatitis to those with blunt trauma were compared. METHOD: Among phakic eyes of rhegmatogenous retinal detachment which underwent surgery in our clinic between 2006 and 2011, 51 eyes of 41 cases of retinal detachment associated with atopic dermatitis (Atopy group) and 53 eyes of 51 cases of retinal detachment with blunt trauma (Trauma group) were compared. RESULTS: In the Atopy group, the patients were younger, and the incidence of cataracts and bilateral detachment were more frequent. In the Trauma group, the occurence was more frequent in men and associated vitreous hemorrhage and iritis were more frequent. Shallow retinal detachments and ciliary breaks located at the superotemporal quadrant were more frequent in the Atopy group and bullous detachments and retinal breaks located at the superonasal quadrant were more frequent in the trauma group. Oral dialysis and ciliary breaks were frequent in both groups. The initial retinal reattachment rates were similar between both groups but the final reattachment rate was worse in the trauma group. CONCLUSIONS: Retinal detachment associated with atopic dermatitis had many similarities to the detachment with blunt trauma in types of retinal breaks. However, it was distinct in featuring higher incidence of bilateral retinal detachment, cataracts, and ciliary breaks at the superotemporal quadrant.

Macular retinoschisis associated with glaucomatous optic neuropathy in eyes with normal intraocular pressure.

PURPOSE: The purpose of this study was to evaluate the clinical features, optical coherence tomography (OCT) findings, and surgical outcomes of eyes with macular retinoschisis associated with glaucomatous optic neuropathy and normal intraocular pressure (IOP). METHODS: In this retrospective interventional observational study, 11 eyes of 11 patients who underwent pars plana vitrectomy for macular retinoschisis and glaucomatous optic neuropathy were studied. All eyes had a vertical cup-to-disc ratio of ≥ 0.7 and retinal nerve fiber layer (RNFL) defects. Intraocular pressure (IOP) was <21 mmHg in all eyes, and there was no presence of congenital optic disc pits or high myopia in any eyes. The best-corrected visual acuity (BCVA) and the appearance of the fundus and OCT images were evaluated. RESULTS: The retinoschisis extended from the optic disc to the macula in all 11 eyes, and foveal detachment was present in 10 eyes. OCT showed vitreous adhesions near the RNFL defects and over the retinal vessels. The retinoschisis in the RNFL resolved immediately after the vitrectomy, and the BCVA improved significantly (p = 0.004). Macular retinoschisis resolved or decreased in all cases, although it required an average of 11 ± 3 months. The optic disc cup and RNFL defects were more clearly visible after resolution of the retinoschisis. CONCLUSIONS: Macular retinoschisis can develop from vitreous traction near the RNFL defect in eyes with glaucomatous optic neuropathy and normal IOP. We suggest that the traction on the structurally fragile RNFL contributed to the retinoschisis.

Two-year outcomes of pro re nata ranibizumab monotherapy for exudative age-related macular degeneration in Japanese patients.

PURPOSE: To describe outcomes of intravitreal ranibizumab using a pro re nata regimen for treatment-naive exudative age-related macular degeneration (AMD), in Japanese patients over the first 2 years. METHODS: Clinical records were retrospectively reviewed of 48 eyes of 48 patients with treatment-naive exudative AMD who underwent intravitreal ranibizumab therapy. After three monthly injections (induction), patients were examined monthly, and subsequent injections were performed as needed (pro re nata) for any residual activity, by fundus biomicroscopy and imaging studies, regardless of severity. RESULTS: Twenty-nine (60%) of the patients were men, and 19 (40%) were women; the mean age was 76.1 years. Of the 48 eyes evaluated, 17 (35%) had findings consistent with polypoidal choroidal vasculopathy, and five (10%) with retinal angiomatous proliferation. A mean of 6.0 ranibizumab injections were given in the first year, 3.5 in the second year, and 9.5 over the 2-year period. The best-corrected visual acuity (logarithm of minimum angle of resolution) improved significantly, from 0.35 at baseline to 0.21 at 12 months (P < 0.01), and remained stable at 0.21 at 24 months (P < 0.01). The mean central macular thickness decreased significantly, from 355.4 µm at baseline to 237.9 µm at 12 months (P < 0.01) and 247.7 µm at 24 months (P < 0.01). CONCLUSION: Improved visual acuity and decreased central macular thickness were observed and maintained over a 2-year period, in a Japanese population receiving 3 monthly induction injections followed by a pro re nata regimen of ranibizumab for exudative AMD.

Ability to determine postoperative status of macular hole in gas-filled eyes by spectral-domain optical coherence tomography.

BACKGROUND: To determine whether the status of a macular hole can be determined by spectral-domain optical coherence tomography in gas-filled eyes. DESIGN: Prospective study, university hospital setting. PARTICIPANTS: Twenty-six eyes with a macular hole, seven eyes with a macular hole retinal detachment and four eyes with a macular hole and myopic traction maculopathy underwent vitreous surgery. METHODS: The macular area was examined by spectral-domain optical coherence tomography (OCT-4000) on postoperative days 1, 3, 7 and 30. MAIN OUTCOME MEASURES: Detection of macular hole closure. RESULTS: The status of macular hole was able to be assessed in 24 eyes (92%) on postoperative day 1 and 23 were closed. The condition of the macular hole could not be determined in the other two eyes with a lower volume of gas (≤60%). The macular hole of seven eyes could be seen only when the patients looked upward or downward (P = 0.009). The 11 eyes with a macular hole retinal detachment or a myopic traction maculopathy had a posterior staphyloma, and the macular hole was visible in four eyes on day 1 (P = 0.001). When a closure of the macular hole was detected on day 1, the macular hole remained closed in all of these eyes on day 30. CONCLUSIONS: The status of a macular hole can be determined by spectral-domain optical coherence tomography on postoperative day 1 even in gas-filled eyes. The visibility depends on the volume of intravitreal gas and the absence of a posterior staphyloma.

[Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors].

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.