[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.

[Complications in posterior segment after transscleral suturing of the posterior chamber in intraocular lens implantation].

PURPOSE: To investigate complications in the posterior segment after transscleral suturing of the posterior chamber in intraocular lens (PC-IOL) implantation. METHODS: Preoperative clinical characteristics and clinical course were analyzed in 13 eyes of 13 patients who underwent vitreous surgery for either suprachoroidal hemorrhage or rhegmatogenous retinal detachment after transscleral suturing in PC-IOL implantation. RESULTS: Preoperative low intraocular pressure (IOP) was found in 3 of 6 eyes with suprachoroidal hemorrhage (50%) and longer axial length in 3 eyes (50%). Retinal reattachment was achieved in 4 eyes (67%) and final vision was more than 0.1 in 3 eyes (50%). In 7 eyes of retinal detachment, retinal tear was undetected preoperatively in 3 eyes (43%), and retinal breaks were located in the superior quadrant in 5 eyes (71%), similar to the characteristics of aphakic retinal detachment. The retina was reattached in all eyes and vision improved to more than 2 Snellen lines in 6 eyes(86%). CONCLUSION: Low IOP caused by leakage from the scleral wound was a potential risk for developing suprachoroidal hemorrhage after transscleral suturing in PC-IOL implantation. A complete closure of the wounds may prevent suprachoroidal hemorrhage. Collapse and incarceration of the peripheral vitreous may cause retinal detachment and complete removal of the peripheral vitreous may prevent retinal detachment.

Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit.

PURPOSE: To evaluate the clinical outcomes after vitrectomy, without gas tamponade or laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with optic disc pits and to characterize retinal manifestations during treatment of optic pit maculopathy using optical coherence tomography (OCT). DESIGN: Noncomparative, retrospective, interventional case series. PARTICIPANTS: Eight consecutive patients (8 to 56 years of age) with unilateral macular detachment associated with optic disc pit. INTERVENTION: Pars plana vitrectomy with induction of a posterior vitreous detachment (PVD) was performed in all eyes. No laser or gas injection was performed in any eye during the original surgery. Patients were followed up for 10 to 46 months (mean, 26 months) after surgery. MAIN OUTCOME MEASURES: Anatomic outcome as determined by OCT and postoperative visual acuities were the main outcome parameters. Fundus autofluorescence (FAF) images were obtained in 4 eyes to document anatomic changes in the macula. RESULTS: Although complete retinal reattachment was achieved in 7 of 8 eyes, up to about 1 year was necessary for the retinal detachment to resolve fully. The 1 eye in which macular detachment failed to resolve completely underwent revision of vitrectomy with a gas tamponade and laser photocoagulation in the peripapillary area. In the early postoperative period, despite persistent macular detachment, the visual acuities improved in 7 eyes. These improved acuities corresponded with remodeling of the photoreceptor outer segments on OCT and the appearance of granular hyperfluorescence on FAF imaging. CONCLUSIONS: Vitrectomy with induction of a PVD at the optic disc without gas tamponade or laser photocoagulation seems to be an effective method of managing macular detachment resulting from optic disc pits. The OCT scanning before and after surgery suggests that peripapillary vitreous traction with the passage of fluid into the retina through the pit is the cause of the schisis-like separation seen in optic disc pit maculopathy.

Correlation between length of foveal cone outer segment tips line defect and visual acuity after macular hole closure.

PURPOSE: To determine whether the postoperative length of the photoreceptor cone outer segment tips (COST) line defect is significantly correlated with best-corrected visual acuity (BCVA) after macular hole closure. DESIGN: Retrospective, consecutive, observational case series. PARTICIPANTS: Fifty-one eyes of 51 patients with a surgically closed macular hole were studied. METHODS: Spectral-domain optical coherence tomography (SD-OCT) was used to obtain images of the foveal area, and the lengths of the COST line defect were measured in the images obtained 1, 3, 6, 9, and 12 months after macular hole surgery. The correlation between the length of COST line defect and the BCVA was determined. MAIN OUTCOME MEASURES: The lengths of the COST line defect, the inner segment/outer segment (IS/OS) junction defect, the external limiting membrane (ELM) line defect in the SD-OCT images, and the BCVA. RESULTS: The COST line defect was gradually restored centripetally 1 to 12 months postoperatively. The length of the COST line defect was significantly correlated with the BCVA at 1, 3, 6, 9, and 12 months postoperatively (P < 0.001). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of the COST line defect (P < 0.001) but not with that of the IS/OS junction and ELM line defects after 6 months. The preoperative length of the COST line defect was significantly correlated with postoperative BCVA at 12 months (P = 0.020), but the length of the IS/OS junction and ELM line defects was not. The preoperative length of the COST line defect was significantly longer than the fluid cuff diameter of the macular hole (P = 0.020), indicating that the influence of the elevated neurosensory retina at the fluid cuff on the SD-OCT signals of the COST line was probably minimal. The postoperative BCVA at 12 months can be calculated by the following regression equation: BCVA = 0.00020 × (length of preoperative COST line defect [µm]) - 0.23 (F value = 15.4; P < 0.001). CONCLUSIONS: The recovery of the foveal COST line defect is related to visual recovery after macular hole closure. The length of the preoperative COST line defect may predict the BCVA after macular hole surgery.

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.

Infrared and fundus autofluorescence imaging in eyes with optic disc pit maculopathy.

BACKGROUND: To characterize the infrared (IR) and fundus autofluorescence (FAF) images of eyes with optic disc pit maculopathy. METHODS: A retrospective non-comparative study of three patients with optic disc pit maculopathy who were followed by optical coherence tomography (OCT) and retinal angiography (Heidelberg retina angiograph 2) before and after vitreous surgery without laser photocoagulation. RESULTS: The areas of serous retinal detachment and inner retinal schisis were dark in the IR and FAF images preoperatively; and they changed to brighter areas following reattachment of the retina. There was an increase in the granular hyperfluorescence in the FAF images accompanied by an increase in the number of subretinal precipitates. OCT showed a thickening of the photoreceptor outer segments. The outer retinal layer defect initially appeared bright in the IR images and hypofluorescent or hyperfluorescent in the FAF images. The outer retinal layer defect became larger with a reduction of the outer retinal schisis and increased retinal detachment, but then became smaller with the resolution of the retinal detachment. All cases had a resolution or reduction of the retinal detachment and retinal schisis after the vitrectomy. CONCLUSION: The IR and FAF images in eyes with optic disc pit maculopathy reflect the changes in the inner and outer retinal layers corresponding with the stage of recovery of the disease.

[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.

[Recent outcomes of vitreous surgery for diabetic retinopathy].

PURPOSE: To investigate background, surgical method, complications, prognosis, and prognostic factors in patients undergoing vitrectomy for diabetic retinopathy. SUBJECTS AND METHODS: Three hundred and forty eyes of 261 patients undergoing vitrectomy for diabetic retinopathy in five recent years were studied regarding background, surgical method, complications, and visual prognosis. Factors influencing postoperative visual acuity and complications were also examined using univariate and multivariate analyses. RESULTS: Final postoperative visual acuity (FPVA) improved in 226 eyes (66%). FPVA of 0.1 or better and 0.5 or better was achieved in 80% and 45% of all patients, respectively. Postoperative complications occurred in 89 eyes(26%). In the vitreous hemorrhage group, FPVA improved in 86%, and FPVA of 0.5 or better was achieved in 60%. Postoperative complications were most common in the traction detachment group and the percentage was 40%. Factors influencing FPVA were preoperative visual acuity, postoperative complications, indications for surgery, and preoperative severity. Factors influencing postoperative complications were patient background, preoperative visual acuity, preoperative severity, and iatrogenic breaks. CONCLUSIONS: Vitrectomy is a useful method for diabetic retinopathy but postoperative complications must be managed.

Increased choroidal thickness in patient with high-altitude retinopathy.

We report a case of high-altitude retinopathy with increased choroidal thickness detected by spectral-domain optical coherence tomography (SD-OCT). A 36-year-old Japanese man developed an acute vision decrease in his left eye after he had trekked at an altitude of 4600 m in Tibet for 1 week. His visual acuity was 20/20 OD and 20/200 OS with refractive errors of - 0.25 diopters (D) OD and - 0.50 D OS 3 weeks after the onset of the visual decrease. Funduscopic examinations revealed multiple intraretinal hemorrhages bilaterally and a macular hemorrhage in the left eye. SD-OCT showed that the thickness of choroidal layer at the fovea was 530 µm OD and 490 µm OS which is thicker than that in normal subjects of approximately 300 µm. We suggest that the increase in the retinal blood flow under hypoxic conditions may be associated with an increase in the choroidal blood flow resulting in an increase in choroidal thickness.

Significant correlation between visual acuity and recovery of foveal cone microstructures after macular hole surgery.

PURPOSE: To determine whether a recovery of the microstructures of the foveal photoreceptors after macular hole closure is correlated with best-corrected visual acuity (BCVA). DESIGN: Retrospective, consecutive, observational case series. SETTING: Single-center academic practice. STUDY POPULATION: Forty-one eyes of 41 patients with surgically closed macular holes. OBSERVATIONAL PROCEDURES: The presence and intactness of the cone outer segment tips (COST) line were determined by spectral-domain optical coherence tomography and compared with the presence of the inner segment/outer segment (IS/OS) junction and the external limiting membrane (ELM) at 1, 3, 6, 9, and 12 months after the macular hole surgery. MAIN OUTCOME MEASURE: The correlation between the integrity of the foveal photoreceptor microstructures and the BCVA. RESULTS: A distinct COST line was first seen at 6 months after the surgery. A distinct or irregular COST line was observed only in eyes with an intact IS/OS junction and ELM. Eyes with a distinct or irregular COST line had significantly better BCVA than those with a disrupted COST line in eyes with an intact IS/OS junction and ELM at 12 months (P = .030). The BCVA was ≥20/25 at 12 months in 91% of the eyes with a distinct or irregular COST line but in only 44% of the eyes without a COST line (P = .015). CONCLUSIONS: The significant correlation between the BCVA and a distinct or irregular COST line after successful macular hole surgery indicates that the recovery of foveal cone microstructure is associated with good postoperative BCVA.