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PURPOSE: To report contributory factors and clinical outcomes of central posterior hyaloid fibrosis (CPHF) associated with neovascular age-related macular degeneration (nAMD). METHODS: In this retrospective, single-center study, patients with CPHF and nAMD were included. Demographic and imaging characteristics, as well as the anatomical and functional outcomes, of these patients were analysed. RESULTS: We identified 530 eyes in 273 patients with chronic predominantly scarred macular neovascularisation (MNV), and 32 eyes in 29 patients revealed CPHF, representing a prevalence of 6%. Patients had a mean age of 72.76 years. Before and during the development of CPHF, Type 2 MNV was observed in all eyes. At the time of MNV diagnosis, mean logMAR visual acuity was 1.308 ± 0.559 (20/407). The average time to develop CPHF was 27.3 months since the diagnosis of MNV. At the time of CPHF identification, the mean logMAR visual acuity was 1.498 ± 0.374 (20/630). RPE tear was observed in 6% (n = 2) of CPHF eyes. The average number of intravitreal anti-VEGF injections administered prior to the diagnosis of CPHF was 2.4 and after the onset of CPHF was 0.9. The final visual acuity was not significantly different at the final follow-up visit [1.304 ± 0.42 (20/402); p = 0.646]. CONCLUSION: Rarely observed in eyes with predominantly scarred subfoveal type 2 MNVs and extensive subretinal fibrosis, CPHF is associated with poor visual outcomes. Its presence could possibly suggest a profibrotic effect of MNV on the posterior hyaloid. TRIAL REGISTRATION NUMBER: Not applicable.

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PURPOSE: To describe and evaluate the effectiveness of the Kaminari Kagura technique as a posterior hyaloid detachment treatment. STUDY DESIGN: This was a prospective, consecutive, randomized interventional study. METHODS: This study examined 30 eyes from 30 patients divided into two groups: (1) a Kaminari Kagura group (15 eyes) and (2) a control group (15 eyes) scheduled for vitrectomy with an optical coherence tomography (OCT)-based diagnosis of adherent posterior hyaloid. RESULTS: The mean time for posterior vitreous detachment (PVD) induction in the Kaminari Kagura group was 58 ± 6.6 s, and that in the control group was 69 ± 9 s (p < 0.005). No intra- or post-operative complications were reported. CONCLUSIONS: The Kaminari Kagura technique results in effective posterior hyaloid detachment in less time than that required for posterior vitreous cortex engagement.

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Retinal detachment (RD) is one of the most common, sight-threatening ocular conditions requiring emergency intervention. Posterior vitreous detachment (PVD) occurs in the majority of an aging population whereby the vitreous body separates from the retina. It is well established that PVD is the common precursor to the most common forms of RD; however, it remains unknown why in most individuals PVD will cause no/few complications (physiological PVD) but in a small percentage will cause retinal tears and detachment (pathological PVD). Despite over 100 years of scientific research, the anatomical definitions of PVD and its pathogenesis remain controversial. Recent research has identified a novel cell population (laminocyte), present at significantly higher numbers in pathological PVD when compared to physiological PVD. We review and summarise the seven distinct clinical sub-groups of retinal breaks and focus on the role of the laminocyte in those secondary to PVD and the transcriptomic profile of this unique cell. Provisional whole transcriptome analysis using bulk RNA-Seq shows marked differentially expressed genes when comparing physiological PVD with PVD associated with RD. The limitations of bulk RNA-Seq are considered and the potential to address these using spatial transcriptomics are discussed. Understanding the pathogenesis of PVD-related retinal tears will provide a baseline for the development of novel therapeutic targets and prophylactic treatments.

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PURPOSE: This study aimed to investigate the clinical features and treatment outcomes of idiopathic full-thickness macular hole (FTMH) without vitreomacular separation (VMS). METHODS: Consecutive cases of idiopathic FTMH at one tertiary center from January 2013 to April 2020 were retrospectively recruited. They were separated into two groups according to the findings in optical coherence tomography (OCT): FTMH with VMS and FTMH without VMS. Ophthalmic examinations and OCT were performed pre- and postoperatively. The clinical findings were compared between the two groups. RESULTS: Of the total 124 cases, 15 (12.1%) were noted as FTMH without VMS with the presence of an attached posterior hyaloid (PH) at macula. The macular hole (MH) size was smaller (276.06 ± 170.10 µm) compared to those with VMS (492.83 ± 209.31 µm) (p < 0.001). The incidence of lamellar hole-associated epiretinal proliferation (LHEP) was much higher in this group (13/15, 86.7%) compared to FTMH with VMS (11/109, 10.1%) (p < 0.001). A higher rate of spontaneous closure of MH (13.3%) was also noted in FMTH without VMS (13.3% vs. 0.9% in FTMH with VMS, p = 0.040). After operation, the MH closure rate was 93.3%. The postoperative best-corrected visual acuity was not significantly different between the two groups (p = 0.098). CONCLUSIONS: A small percentage (12.1% in this series) of idiopathic FTMH had no VMS. The completely attached PH along with the high incidence of LHEP implied a tangential traction in FTMH without VMS. The MH size was usually small, and the postoperative outcomes were similar to those of conventional FTMH with VMS.

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BACKGROUND: To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. METHODS: This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. RESULTS: The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. CONCLUSIONS: We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.

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PURPOSE: To compare the specificity of diagnosing posterior vitreous detachment (PVD) using preoperative optical coherence tomography (OCT) versus intraoperative triamcinolone acetonide (TA) staining in patients undergoing vitrectomy. PATIENTS AND METHODS: This retrospective cohort study included patients undergoing pars plana vitrectomy for diverse retinal pathologies. Intraoperatively, surgeons evaluated the posterior hyaloid status with TA staining and compared it with preoperative OCT findings. RESULTS: One hundred six patients underwent intraoperative assessments of posterior hyaloid status, with 72% (76/106) of the eyes showing positive staining. Sixty-two patients had also undergone preoperative OCT. Of the patients diagnosed with PVD on preoperative OCT, 50% (15/30) showed positive TA staining intraoperatively. The sensitivity of preoperative OCT assessment was 83.3%, and its specificity was 65.9%. CONCLUSION: Preoperative OCT imaging is associated with lower sensitivity and specificity for diagnosing PVD when compared to intraoperative TA staining.

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Intravitreal injection is the most widely used injection technique for ocular gene delivery. However, vector diffusion is attenuated by physical barriers and neutralizing antibodies in the vitreous. The 13-lined ground squirrel (13-LGS), as in humans, has a larger relative vitreous body volume than the more common rodent models such as rats and mice, which would further reduce transduction efficiency with the intravitreal injection route. We report here a "pre-retinal" injection approach that leads to detachment of the posterior hyaloid membrane and delivers vector into the space between vitreous and inner retina. Vectors carrying a ubiquitously expressing mCherry reporter were injected into the deep vitreous or pre-retinal space in adult wild-type 13-LGSs. Then, adeno-associated virus (AAV)-mediated mCherry expression was evaluated with non-invasive imaging, immunofluorescence, and flow cytometry. Compared to deep vitreous delivery, pre-retinal administration achieved pan-retinal gene expression with a lower vector dose volume and significantly increased the number of transduced cone photoreceptors. These results suggest that pre-retinal injection is a promising tool in the development of gene therapy strategies in animal models and is a potential approach for use in human research, particularly in younger individuals with an intact posterior hyaloid membrane and stable vitreous.

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BACKGROUND: To report two cases with idiopathic unilateral diffuse opacification of the posterior hyaloid membrane (PHM) completely separated from the retina, the mechanism of which is possibly due to glial cell proliferation and migration. CASE PRESENTATION: Two Japanese women at age 75 and 84 with no systemic or ocular history developed diffuse opacification in one eye resembling a ground glass sheet almost all over the surface of the PHM, but not within the vitreous gel or fluid. The retinas were funduscopically normal; however, optical coherence tomography demonstrated hyperreflective icicle-like anterior protrusions from the surface of the fovea. The patients received pars plana vitrectomy, resulting in visual improvement. Cell block preparations of the vitreous in one case revealed a cluster of cells immunoreactive for glial fibrillary acidic protein in consistence with gliosis, while denying vitreoretinal lymphoma from lack of atypical cells and vitreous amyloidosis due to no staining for Congo red or direct fast scarlet. The lesions did not recur during follow-up with no new funduscopic abnormalities. CONCLUSIONS: To our knowledge, this is the first to demonstrate such peculiar cases of vitreous opacity with idiopathic and unilateral onset. Histological assessments revealed the possible pathogenesis of gliotic opaque PHM separation to cause its ground-glass-sheet appearance.

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Many eyes with macular pucker are characterized by a centripetal displacement of the inner foveal layers which may result in a disappearance of the foveal pit. In this retrospective case series of 90 eyes with macular pucker of 90 patients, we describe using spectral-domain optical coherence tomography different foveal configurations with ectopic inner foveal layers, document the relationship between posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) formation and spontaneous and postoperative morphological alterations of the fovea, and propose an active role of Müller cells in the development of foveal herniation. We found that ERM were formed during or after partial perifoveal PVD, or after foveal deformations caused by tissue edema. The ERM-mediated centripetal displacement of the inner foveal layers and in various eyes anterior hyaloidal traction caused a disappearance of the foveal pit and an anterior stretching of the foveola with a thickening of the central outer nuclear layer (ONL). After the edges of the thickened inner layers of the foveal walls moved together, continuous centripetal displacement of the inner foveal layers generated a bulge of the fovea towards the vitreous (foveal herniation). Macular pseudoholes with a herniation of the inner foveal layers show that the outer layer of the protruding foveal walls is the outer plexiform layer (OPL). If the ERM covered the foveal walls and parafova, but not the foveola, the inner layers of the foveal walls were not fully centripetally displaced and the foveal pit was present. The visual acuity of eyes with ectopic inner foveal layers was inversely correlated with the thickness of the foveal center. Spontaneous morphological alterations after disappearance of the foveal pit may include the development of cystoid macular edema or additional thickening of the foveal tissue and foveal herniation. The foveal configuration with ectopic inner layers of the foveal walls and a thick central ONL persisted over longer postoperative time periods. The data show that the centripetal displacement of the inner foveal layers in eyes with macular pucker, which results in a disappearance of the foveal pit, may also generate foveal herniation which is suggested to be caused by contraction of Müller cell processes in the OPL. The centripetal displacement of the inner foveal layers and the formation of foveal herniation are suggested to reverse the foveal pit formation during development.

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PURPOSE: To characterize preretinal neovascularizations (NV) and their corresponding branching routes in proliferative diabetic retinopathy (PDR) with optical coherence tomography angiography (OCTA) and compare the findings with fluorescein angiography (FA). METHODS: In patients with PDR, angiograms were acquired with spectral-domain OCTA (CIRRUS 5000, OCTA AngioPlexTMCarl Zeiss Meditec, Inc.) and FA (Zeiss FF450PlusIR fundus camera or Spectralis HRA-OCT SLO, Heidelberg Engineering Inc.) and were consecutively evaluated. Neovascularization of the disc (NVD) and neovascularization elsewhere (NVE) were analyzed with 6 × 6 and 8 × 8 mm OCTA flow images and B-scans with flow registration. Segmentations of the vitreoretinal interface (VRI) and superficial retina were performed for analysis. Two independent investigators examined OCTA findings and compared them to corresponding FA. RESULTS: Forty-two eyes of 30 patients with PDR were analyzed. A total of 76 NV with their corresponding proliferation routes were visualized and characterized, with 55 (72.4%) proliferating along the posterior hyaloid membrane (PHM), 14 (18.4%) along the epiretinal membrane, and 7 (9.2%) along the fibrovascular membrane. The posterior vitreous was partially detached in 37 of 42 eyes (88.1%), completely detached in 1 of 42 eyes (2.4%), and adherent in 1 of 42 eyes (2.4%). In 38 of 42 cases, OCTA was superior (n = 23) or equivalent (n = 15) to FA in detecting NV and provided a more detailed information of the neovascular vessels. In 4 of 42 study eyes, OCTA was inferior to FA. CONCLUSIONS: OCTA is a useful tool to detect NV in PDR. In comparison to FA, OCTA has the advantages that it is noninvasive and the image capture takes only seconds. We were able to identify all NV and characterize their corresponding proliferation routes in the VRI, the superficial retina slab, or the B-scan with flow registration. Through evading the masking effect of dye leakage in FA, OCTA is capable of better visualization of NV. FA, however, remains essential for the detection of all NV, since OCTA supplies a smaller detection field. Additionally, we identified the PHM as the main proliferating route of diabetic NV (72.4%), marking it as an important structure for sprouting vessels in neoangiogenesis in PDR.

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Purpose: This study aimed to evaluate the optic coherence tomography (OCT) findings in patients with toxoplasmic retinochoroiditis (TRC). Methods: A total of 12 eyes of 12 patients with active TRC were included in the study. At baseline, at the first-month follow-up, at the sixth-month follow-up and at the 1-year follow-up, the TRC lesion OCT and macula OCT were evaluated. Results: Hyperreflectivity of the inner retinal layers and an increase in retinal thickness were observed on the OCT examinations of all the patients with an active TRC lesion. The retinal thickness decreased and the reflectivity of retinal layers was disorganized in the OCT images obtained in the follow-up period. Partial posterior hyaloid detachment (PHD) and no PHD were detected in 11 cases and 1 case, respectively. Epiretinal membrane (ERM) had developed in the adjacent region of the scar in 7 patients. With the regression of the lesion, the disruption of the ellipsoid zone (EZ), retinal pigment epithelium (RPE) and external limiting membrane (ELM) improved in the adjacent areas. In all the eyes, ERM and the PHD configuration did progress during the follow-up period. Vitreoschisis was found in 4 of the 11 patients with partial PHD. It was observed that ERM developed in all the patients with vitreoschisis. Conclusion: ERM and partial PHD were common in the TRC patients, and there was no progression during the follow-up period. Regeneration of the EZ, RPE and ELM was observed in the follow-up period.

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BACKGROUND: To estimate the prevalence of posterior segment eye lesions and to identify their ocular and systemic associations within the Gutenberg Health Study (GHS) in Germany. METHODS: Assessment and grading of fundus images as well as physical examination and history taking were performed in the cross-sectional analysis of 15,010 subjects (aged 35-74 years) using standardised procedures to determine the prevalence and associations of various posterior segment eye lesions. RESULTS: Fundus photographs of both eyes were available for 12,782 (85.2%; 50% female) subjects. The prevalence weighted to the region of Mainz and Mainz-Bingen in Germany was for choroidal nevi 2.4%, drusen of the optic nerve head 0.2%, tilted discs 1.5%, chorioretinal scars suggestive of toxoplasmosis 0.2%, retinitis pigmentosa 0.04% and persistent hyaloid artery 0.02%. Choroidal nevi were positively associated with a history of myocardial infarction (OR = 2.7, 95% confidence interval 1.2-6.2, p value = 0.017). Tilted discs were positively associated with increased intraocular pressure (OR = 1.09 per mm Hg (1.02-1.16), p = 0.011) and negatively associated with smoking (OR 0.4 (0.3-0.7), p = 0.0022). Participants with tilted discs had a mean spherical equivalent of - 3.6 dioptres (standard deviation 4.0) compared with - 0.4 dioptres (2.4) to those without. CONCLUSION: Our study is-to the best of our knowledge-the first to determine the prevalence of drusen of optic nerve head among Caucasians, to show a positive association between tilted discs and increased intraocular pressure and questions a possible link between choroidal nevi and myocardial infarction. It also showed that participants with tilted discs had a lower mean spherical equivalent than those without.

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PURPOSE: To test the applicability of the acai dye at a 25% concentration for identifying the posterior hyaloids and internal limiting membranes (ILMs) during pars plana vitrectomy (PPV) in human eyes with macular holes (MHs). METHODS: This study included 25 patients with chronic idiopathic MHs. The exclusion criteria included glaucoma, previous significant ocular conditions, and previous ocular surgeries except uncomplicated cataract. Ten surgeons performed 23-gauge four-port PPV, phacoemulsification, posterior hyaloid detachment, ILM peeling guided by dye staining, and perfluoropropane injection. The patients remained prone for 5 days postoperatively. The patients were evaluated postoperatively after 1, 30, and 180 days. The surgeons completed a questionnaire regarding the dye's staining abilities. RESULTS: The posterior hyaloids and ILMs stained purple in all eyes. The final best-corrected visual acuity improved significantly (p < 0.001) from preoperatively (1.37 ± 0.29) to 180 days postoperatively (1.05 ± 0.43). The MHs closed in 76% of eyes. CONCLUSION: The acai dye at a 25% concentration identified posterior hyaloids and ILMs during PPVs in humans. Dye toxicity was unlikely.

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PURPOSE: Our aim is to present in this online supplementa ry video (see www.karger.com/doi/10.1159/000486348) an easy new surgical technique using blue dye to dissect the posterior hyaloid when performing pars plana vitrectomy. PROCEDURES: Dual-Blue stain is injected in vitreous cavity just after central vitrectomy is performed. The distribution of the blue stain will allow us to know if there is a posterior vitreous detachment or not ("blue lake fashion" or "blue jelly fashion," respectively) and as an excellent visualization of the vitreous fibers is accomplished, dissection of the posterior hyaloid can be performed without difficulty. RESULTS: This procedure allows a much more simple, fast, and safe dissection of posterior hyaloid even for an inexperienced vitreoretinal surgeon. The cleavage plane between the retina and the posterior hyaloid is easily differentiated. CONCLUSIONS: A more controlled and easy dissection of posterior hyaloid during vitrectomy is accomplished with this simple technique without adding any extra cost. Message of the paper: An easy technique that allows a much easier dissection of the posterior hyaloid during vitrectomy improving visualization and decreasing risks. No extra cost, nor time is needed.

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PURPOSE: To evaluate using Doppler ultrasonography (DUS) how pars plana vitrectomy (PPV) affects orbital circulation in diffuse diabetic macular edema (DME) associated with either the epiretinal membrane (ERM) or taut posterior hyaloid (TPH). METHODS: The sample included 46 eyes of 42 patients with DME associated with the ERM (n = 22, Group 1) or TPH (n = 24, Group 2). All participants received panretinal laser photocoagulation and antivascular endothelial growth factor injections preoperatively and underwent 23-gauge PPV combined with ERM or TPH removal and internal limiting membrane (ILM) peeling. Pre- and postoperative peak systolic velocity (PSV), end-diastolic velocity (EDV), and the resistivity index (RI) of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary artery (PCA), and central retinal vein were measured with DUS. RESULTS: Statistically significant decreases in the PSV and EDV of the OA, CRA, and PCA were detected in all groups. In Group 1, the PSV of the OA and CRA as well as the EDV and PSV of the PCA declined significantly. In Group 2, the EDV of the OA and both the PSV and EDV of the CRA and PCA decreased. Postoperatively, the CRA's PSV and EDV were lower in Group 2, while the preoperative and postoperative RI of the CRA and preoperative RI of the PCA were greater in Group 2 than in Group 1. Changes in the CRA's RI, PSV, and EDV were greater in Group 2 after surgery. CONCLUSIONS: 23-Gauge PPV combined with ERM or TPH removal and ILM peeling in DME reduces blood flow rates of both choroidal and retinal vessels. In eyes with TPH, the RIs of the CRA and PCA were significantly greater preoperatively and the changes in the CRA's RI, PSV, and EDV were greater postoperatively. The removal of the TPH may play a role in regulating blood flow.

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BACKGROUND: Vitreous degeneration begins soon after birth and accelerates throughout life. Vitreous liquefaction with a slowly progressive separation of the posterior hyaloid from the peripheral macula usually leads to complete posterior vitreous detachment. The purpose of this study is to measure the age-related prevalence of partial vitreous separation and the length of residual vitreous adhesion in an ophthalmology clinic population. METHODS: Patients examined by the senior author (MWS) during a 6-month period were included in a retrospective chart review. Demographic data and spectral domain optical coherence tomography scan results were gathered. Data analysis with descriptive statistics focused on the prevalence and extent of partial vitreous separation. RESULTS: The mean age of the study patients was 69.9 years, and 62% were phakic. The highest prevalence of partial posterior hyaloid separation from the internal limiting membrane (71.2%) was seen in the 50- to 54-year age group. This prevalence rate steadily decreased to 5.6% in the 95- to 99-year age group. The prevalence of complete vitreous detachment as determined by slit-lamp biomicroscopy increased from 1.7% in the <50-year age group to a maximum of 29.2% in the 75- to 79-year group. The length of vitreomacular adhesion averaged 4.6 mm in the 50- to 54-year age group and steadily decreased to 2.1 mm in the 90- to 95-year group. CONCLUSION: Vitreomacular separation affects the majority of eyes in the sixth decade of life. The prevalence of partial vitreous separation decreases with advancing age, probably because an increasing number of these patients progress to complete posterior vitreous detachment.

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PURPOSE: To evaluate the relationship between visual outcomes and the determinants detected by spectral domain optical coherence tomography (OCT) in eyes with epiretinal membrane (ERM) and/or taut posterior hyaloid (TPH) that underwent pars plana vitrectomy (PPV). MATERIALS AND METHODS: A total of 30 participants with diabetic ERM and TPH were included in the study. All study participants underwent PPV. Preoperative and postoperative best corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer (RNFL), macular RNFL, ganglion cell layer, inner plexiform layer, and ganglion cell complex thicknesses were measured in each participant. Linear regression analyses were performed to determine the association between the OCT parameters and the visual acuity measured at the time of the OCT measurement. RESULTS: The postoperative BCVA logarithm of the minimum angle of resolution (logMAR) values were statistically higher than the preoperative values in the ERM group and TPH group (P=0.001 and P<0.001, respectively). The postoperative BCVA logMAR value was negatively correlated with average RNFL, inferior RNFL thicknesses, and image quality (P=0.002, P=0.004, and P=0.006, respectively). The preoperative and postoperative BCVA logMAR value difference was not correlated with age and all of the OCT parameters measured (P>0.05). CONCLUSION: This study shows that achievement of better peripapillary RNFL thickness results in better visual outcome after PPV and ERM/TPH removal.

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Adequate visualization and identification of the posterior hyaloid, epiretinal membranes and the internal limiting membrane are of paramount importance in modern vitreoretinal surgery. "Chromovitrectomy" is a term used for describing the vital dyes use in order to stain these transparent tissues and facilitate their manipulation during vitreous surgery. This article reviews the indications, applications and characteristics of vital dyes in vitreoretinal surgery. Various dyes are currently being used in routine clinical procedures, however the ideal staining agent has not yet been found. Any dye which is injected intravitreally has the potential to become toxic. Triamcinolone acetonide is used to highlight the vitreous and is particularly beneficial in determining the attachment of the posterior hyaloid to the underlying retina. Trypan blue stains epiretinal membranes and facilitates their complete removal. Both indocyanine green and brilliant blue G stain the internal limiting membrane properly, however concerns over indocyanine green toxicity have made surgeons switch to brillliant blue G as a safer alternative.

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BACKGROUND: The purpose of this study was to evaluate the efficacy of pars plana vitrectomy for the treatment of optic disc pit-associated maculopathy with or without preoperative posterior vitreous detachment. METHODS: We reviewed the clinical records of four consecutive patients who underwent pars plana vitrectomy in one eye for the treatment of optic disc pit-associated maculopathy, with an emphasis on the preoperative condition of the posterior hyaloid membrane. RESULTS: Two of four eyes were confirmed to have an attached posterior hyaloid membrane, which was subsequently removed during surgery. Following vitrectomy, these two eyes experienced an improvement in visual acuity with complete retinal attachment of the macula. However, the other two eyes, which already had a posterior vitreous detachment at the time of surgery, showed a decrease in visual acuity with persistent maculopathy postoperatively. CONCLUSION: Pars plana vitrectomy for optic disc pit-associated maculopathy was beneficial for improving visual acuity in two eyes without preoperative posterior vitreous detachment but not in two eyes with preoperative posterior vitreous detachment. Our study suggests that preoperative assessment of a posterior hyaloid membrane is clinically important in predicting the surgical outcome of optic disc pit-associated maculopathy.

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Total vitrectomy and removal of the posterior hyaloid membrane were done in 7 patients who were diagnosed as macular hole with specific causative factors. The causative factor of 2 patients is high myopia and of remainers is trauma. Of the 7 patients treated by removal of the posterior hyaloid membrane during total vitrectomy, 3 patients showed anatomical and functional success, 2 patients only the anatomical success, and 2 patients failure. The postoperative complications included phthisis bulbi, proliferative vitreoreinopathy, optic atrophy, and macular degeneration, and iatrogenic rhegmatogenous retinal detachment. Two patients of the 3 success cases complained of mild diplopia after operation.

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