RESUMEN

BACKGROUND: Full-thickness macular holes, defined as full-thickness defects of the fovea, lead to central scotoma and deterioration of vision. Apart from peeling of the internal limiting membrane (ILM), ILM flap techniques have been reported to have potential in improving results in macular hole surgery. In addition, foveal-sparing ILM peeling gives a high macular hole closure rate and improvement in postoperative visual acuity. The aim of this study was to examine outcomes in a cohort of patients with full-thickness macular holes that underwent vitrectomy with foveal-sparing ILM peeling and transposition of an ILM flap over the macular hole. METHODS: This retrospective study included patients scheduled for pars plana vitrectomy with foveal-sparing ILM peeling, combined with ILM flap transposition over the macular hole, for macular hole repair. All patients received a gas tamponade with 20% sulphur hexafluoride and were encouraged to undergo postoperative face-down positioning for 48 hours after surgery. Optical coherence tomography (OCT) imaging of the macula and distance-corrected visual acuity (DCVA) were performed before and 3 months after surgery. RESULTS: In total, 42 eyes of 42 patients were included in this study. Leaving a broad area of residual ILM at the foveal rim led to a high risk of failure in macular hole closure, while leaving a narrow zone of residual ILM at the foveal rim resulted in high macular hole closure rates (97% type 1 closure and 3% type 2 closure), with a median improvement of DCVA of 4 lines [interquartile range (IQR): 3 to 6] among pseudophakic and 3.5 lines (IQR: 2 to 5) among phakic patients. CONCLUSIONS: A combination of foveal-sparing ILM peeling with ILM flap techniques was shown to be a safe and effective surgical option for patients with full-thickness macular holes, resulting in a high macular hole closure rate and improvement in visual acuity in the majority of patients.

Asunto(s)

Perforaciones de la Retina , Colgajos Quirúrgicos , Agudeza Visual , Vitrectomía , Humanos , Perforaciones de la Retina/cirugía , Masculino , Femenino , Vitrectomía/métodos , Colgajos Quirúrgicos/trasplante , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Fóvea Central/diagnóstico por imagen , Fóvea Central/cirugía , Membrana Basal/cirugía , Tomografía de Coherencia Óptica , Tratamientos Conservadores del Órgano/métodos

RESUMEN

PURPOSE: To investigate clinical factors contributing to metamorphopsia after 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD) to reveal whether the proximity of the preoperative retinal detachment to the fovea is associated with postoperative metamorphopsia. METHODS: We retrospectively reviewed medical records of 77 eyes of 77 patients after 27GPPV for RRD. Patients were subdivided into three groups using optical coherence tomography findings: Group A, patients with RRD outside the vascular arcade; Group B, patients whose condition was present within the vascular arcade, but without foveal detachment; and Group C, patients with foveal detachment. RESULTS: The average metamorphopsia score (°) assessed with M-charts 12 months after surgery was 0.01 ± 0.04 in Group A (24 eyes), 0.08 ± 0.18 in Group B (20 eyes), and 0.49 ± 0.48 in Group C (33 eyes) (p<0.001). Logistic regression analysis revealed that metamorphopsia at 12 months after surgery significantly correlated with the proximity of the retinal detachment to the fovea (p = 0.007). CONCLUSION: Metamorphopsia after 27GPPV for RRD correlated with the proximity of the preoperative retinal detachment to the fovea. Attention should be paid to the possibility of postoperative metamorphopsia development when retinal detachment is present within a vascular arcade even if the fovea is not involved.

Asunto(s)

Fóvea Central/patología , Complicaciones Posoperatorias/patología , Desprendimiento de Retina/cirugía , Trastornos de la Visión/patología , Vitrectomía/efectos adversos , Femenino , Fóvea Central/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Desprendimiento de Retina/patología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Trastornos de la Visión/etiología , Agudeza Visual

RESUMEN

PURPOSE: To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases, including macular hole (MH), epiretinal membrane, macular foveoschisis, myopic traction maculopathy, and the like. METHODS: PubMed, EMBASE, Cochrane, CNKI Databases, and the ClinicalTrials.gov website (PROSPERO number CRD42020187401) were searched. Controlled trials comparing fovea-sparing with complete ILM peeling were included. Postoperative changes in best-corrected visual acuity, central retinal thickness in vitreomacular interface diseases, the incidence of MH closure in MH cases, full-thickness macular hole development in non-MH cases, and retinal reattachment in retinoschisis cases were extracted. RESULTS: Fourteen studies (487 eyes) were eligible. Compared with complete ILM peeling, the fovea-sparing technique revealed significant improvement in best-corrected visual acuity ( logarithm of the minimum angle of resolution; weighted mean difference = -0.70; 95% confidence interval, -1.11 to -0.30), and a reduced incidence of full-thickness macular hole was noted in non-MH cases (risk ratios = 0.25; 95% confidence interval, 0.08-0.76). However, no significant differences in mean change in central retinal thickness, incidence of MH closure in MH cases, and retinal reattachment in retinoschisis cases were noted. CONCLUSION: Based on current evidence, fovea-sparing ILM peeling significantly improve visual outcomes and decrease complications of full-thickness macular hole development in vitreomacular interface diseases.

Asunto(s)

Membrana Basal/cirugía , Fóvea Central/cirugía , Enfermedades de la Retina/cirugía , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Vitrectomía/métodos , Fóvea Central/diagnóstico por imagen , Humanos , Enfermedades de la Retina/diagnóstico

RESUMEN

PURPOSE: To determine the effect of foveal vitreous cortex removal during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) on the prevention of postoperative epiretinal membrane (ERM) development without internal limiting membrane (ILM) peeling. DESIGN: Case-control study. PARTICIPANTS: A total of 105 consecutive eyes of 105 patients who underwent primary PPV for RRD between September 2018 and August 2019 and were followed for at least 6 months. METHODS: The presence of foveal vitreous cortex during PPV was determined by examining the images obtained by a widefield viewing system in 52 eyes (WF group) operated in the first half of the study period and obtained by a high-magnification floating lens in 53 eyes (FL group) operated in the latter half of the study period. Triamcinolone acetonide was used to make the vitreous cortex more visible during PPV. The foveal vitreous cortex was removed if detected by forceps with a high-magnification floating lens without ILM peeling or use of dye staining. The presence of postoperative ERM was examined by using OCT. MAIN OUTCOME MEASURES: The rate of detected and removed foveal vitreous cortex during PPV and the incidence of postoperative ERM of each group. RESULTS: The rate of detected and removed foveal vitreous cortex during PPV was significantly higher in the FL group than in the WF group (41.5% vs. 15.4%, P = 0.004). The incidence of postoperative ERM was significantly lower in the FL group than in the WF group (1.9% vs. 13.5%, P = 0.03). None of the eyes required additional surgery for the postoperative ERM during the follow-up period. The retinal reattachment rate was not significantly different (98.1% vs. 100%, P = 0.99), and the final retinal attachment rate was 100% in both groups. A dissociated optic nerve fiber layer appearance and a temporal macular thinning were not detected postoperatively in any of the eyes with removal of the foveal vitreous cortex during PPV. CONCLUSIONS: The detection and removal of foveal vitreous cortex with the high-magnification floating lens during PPV for RRD significantly reduce the incidence of postoperative ERM without adverse findings.

Asunto(s)

Membrana Basal/cirugía , Membrana Epirretinal/prevención & control , Fóvea Central/cirugía , Complicaciones Posoperatorias/prevención & control , Desprendimiento de Retina/cirugía , Agudeza Visual , Vitrectomía/efectos adversos , Membrana Basal/diagnóstico por imagen , Estudios de Casos y Controles , Membrana Epirretinal/epidemiología , Membrana Epirretinal/etiología , Femenino , Fóvea Central/diagnóstico por imagen , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tomografía de Coherencia Óptica/métodos

RESUMEN

PURPOSE: To describe a novel surgical technique to remove retained subfoveal perfluorocarbon liquid (PFCL). METHODS: After setting up for 23-G pars plana vitrectomy, a 38-G flexible-tip macular hydrodissection cannula connected to the automated viscous fluid infusion kit was used to create a small retinotomy approximately 700 µm to 800 µm inferior to the fovea and induce macular detachment involving the retained PFCL bubble. The flexible cannula was bent at its junction with the shaft and was carefully advanced through the same retinotomy into the subretinal space to access and directly aspirate the retained subfoveal PFCL bubble. Fluid-air exchange was then performed, and surgery was concluded. RESULTS: The retained subfoveal PFCL bubble was successfully removed with restoration of normal foveal architecture on optical coherence tomography and with objective and subjective improvement of central vision. CONCLUSION: We report a novel surgical technique combining macular detachment with direct aspiration of the retained subfoveal PFCL without direct perforation of the foveal center. This technique may provide an alternative approach to manage this difficult complication.

Asunto(s)

Drenaje , Fóvea Central , Procedimientos Quirúrgicos Oftalmológicos , Drenaje/métodos , Fluorocarburos , Fóvea Central/cirugía , Humanos , Procedimientos Quirúrgicos Oftalmológicos/métodos

RESUMEN

TOPIC: The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been understood fully. The present meta-analysis aimed to compare postoperative visual and anatomic outcomes between FS peeling and total peeling (TP) of ILM in pars plana vitrectomy for the treatment of MF. CLINICAL RELEVANCE: Postoperative macular hole (MH) development is not uncommon and is a serious complication after surgery for MF, with poor visual prognosis. Fovea-sparing peeling of ILM is expected to reduce the risk of postoperative MH; however, no statistically significant evidence exists to prove this hypothesis. In addition, its effect on postoperative visual acuity has not been clear. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were reviewed systematically, and studies that compared FS with total ILM peeling in MF surgery were retrieved. The protocol was registered in International Prospective Register of Systematic Reviews (identifier, CRD42020201675). Primary outcome measures were the postoperative best-corrected visual acuity (BCVA) and frequency of postoperative MH development. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: Eight studies with 300 eyes from 289 patients were included. All studies were nonrandomized and observational. The postoperative BCVA was significantly better in eyes treated with FS (mean difference [MD], -0.15 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.24 to -0.05 logMAR; P = 0.002). The risk of postoperative MH was significantly lower in the FS group (odds ratio, 0.19; 95% CI, 0.06-0.56; P = 0.003). No significant difference was found in postoperative central foveal thickness (MD, 12.59 µm; 95% CI, -2.8 to 28.0 µm; P = 0.11). The certainty of evidence regarding lower frequency of postoperative MH after FS peeling was considered moderate, whereas the certainty regarding better postoperative BCVA after FS peeling was judged to be low. DISCUSSION: Fovea-sparing peeling may contribute to better visual acuity outcome and lower risk of postoperative MH development in eyes with MF.

Asunto(s)

Membrana Basal/cirugía , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Fóvea Central/cirugía , Miopía/complicaciones , Retinosquisis/cirugía , Humanos , Retinosquisis/etiología

RESUMEN

This study aimed to investigate morphological differences between idiopathic epiretinal membrane (ERM) and secondary ERM due to peripheral break (SEPB) and to identify clinical characteristics in eyes with SEPB to facilitate peripheral retinal examination. The retrospective cross-sectional study involved 93 consecutive eyes in 91 patients who underwent ERM removal surgery. Eyes were divided into two groups: the macular pucker group and the idiopathic ERM group. En-face Optical Coherence Tomography (OCT) images, fundus photographs, severity of metamorphopsia (M-score) and clinical characteristics of each group were compared. ERM extent and eccentricity (ratio of the shortest and longest distances from the foveal center to the boundary) were obtained through en-face OCT imaging. Fundus photographs were used to judge whether the membrane was turbid or not. Patients with SEPB were younger than patients with idiopathic ERM (61.3 ± 7.5 vs. 66.6 ± 8.3 years; p < 0.05). Preoperative M-score and myopic refractive error, axial length were also significantly higher in the macular pucker group than in the idiopathic ERM group (all p < 0.05). There was no difference in ERM extent between the two groups. The incidence of ERM eccentricity was 23 of the 34 eyes (67.6%) in the SEPB group and 26 of the 59 eyes (44.1%) in the idiopathic ERM group (p < 0.05). The incidence of turbid ERM was 18 of the 34 eyes (52.9%) in the SEPB group and 10 of the 59 eyes (16.9%) in the idiopathic ERM group (p < 0.01). The SEPB group, compared with the idiopathic ERM group, tended to have eccentric, turbid ERM at a younger age and with more severe metamorphopsia and myopic refractive error.

Asunto(s)

Membrana Epirretinal/patología , Membrana Epirretinal/cirugía , Anciano , Estudios Transversales , Ojo/patología , Femenino , Fóvea Central/patología , Fóvea Central/cirugía , Humanos , Mácula Lútea/patología , Mácula Lútea/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Trastornos de la Visión/patología , Trastornos de la Visión/cirugía , Agudeza Visual/fisiología , Vitrectomía/métodos

RESUMEN

OBJECTIVE: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. METHODS: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). RESULTS: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. CONCLUSION: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.

Asunto(s)

Anestesia Local/efectos adversos , Ceguera/epidemiología , Complicaciones Intraoperatorias/epidemiología , Bloqueo Nervioso/efectos adversos , Facoemulsificación/efectos adversos , Vitrectomía/efectos adversos , Anestesia Local/métodos , Ceguera/etiología , Ceguera/psicología , Ceguera/rehabilitación , Potenciales Evocados Visuales , Estudios de Seguimiento , Fóvea Central/diagnóstico por imagen , Fóvea Central/cirugía , Humanos , Incidencia , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/psicología , Complicaciones Intraoperatorias/rehabilitación , Bloqueo Nervioso/métodos , Facoemulsificación/métodos , Periodo Posoperatorio , Factores Protectores , Perforaciones de la Retina/cirugía , Cápsula de Tenon/inervación , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Vitrectomía/métodos

RESUMEN

Silicone oil (SO) is widely used as a long-term intravitreal tamponading agent for rhegmatogenous retinal detachment (RRD) repair. This study investigated the structural changes of the foveal microvasculature using optical coherence tomography angiography (OCTA) in patients with RRD treated with vitrectomy and SO tamponade. Thirty-eight patients with unilateral RRD who were treated with vitrectomy and SO tamponade and were followed up for ≥3 months after SO removal were included. En face OCTA images were obtained and foveal avascular zone (FAZ) area and vascular density (VD) were compared between study eyes and unaffected contralateral eyes. The FAZ area in deep capillary plexus (DCP) was larger (P < 0.001) and the VD in DCP was lower (P = 0.022) in the study eyes than in the fellow eyes. The duration of SO tamponade was significantly correlated with the enlargement of FAZ area (P = 0.034) and reduction of VD in DCP (P = 0.015). These changes could reflect vascular insufficiency in eyes with SO tamponade and may represent a potential explanation for the pathogenesis of retinal thinning and unexplained visual loss.

Asunto(s)

Fóvea Central/cirugía , Retina/cirugía , Desprendimiento de Retina/cirugía , Aceites de Silicona/administración & dosificación , Tomografía de Coherencia Óptica , Adulto , Ojo/efectos de los fármacos , Ojo/patología , Ojo/ultraestructura , Femenino , Fóvea Central/efectos de los fármacos , Fóvea Central/patología , Fóvea Central/ultraestructura , Humanos , Mácula Lútea/irrigación sanguínea , Mácula Lútea/efectos de los fármacos , Mácula Lútea/patología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/métodos , Retina/diagnóstico por imagen , Retina/efectos de los fármacos , Retina/fisiopatología , Desprendimiento de Retina/diagnóstico por imagen , Desprendimiento de Retina/tratamiento farmacológico , Desprendimiento de Retina/fisiopatología , Vasos Retinianos/efectos de los fármacos , Vasos Retinianos/patología , Agudeza Visual/fisiología , Vitrectomía/métodos

RESUMEN

PURPOSE: To compare the functional and anatomical results of fovea-sparing internal limiting membrane peeling during vitrectomy with those of observation for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation. DESIGN: A prospective, randomized, comparative pilot study. METHODS: Thirty-six eyes were randomized to undergo surgery with foveal internal limiting membrane sparing (Group S) or observation only (Group C). The main outcome measures were foveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: After 6 months, a significant difference was found in foveal retinal sensitivity between Group S (12.8 ± 1.7 dB) and Group C (9.39 ± 1.8 dB; P < 0.001). Similarly, best-corrected visual acuity improved in Group S and remained stable in Group C (respectively, 0.17 ± 0.13 and 0.46 ± 0.21 logMAR; P < 0.001). A significant increase in central retinal thickness was observed in Group S, but not in Group C (272 ± 24 vs. 147 ± 20 µm, P < 0.001). CONCLUSION: Fovea-sparing internal limiting membrane peeling is a feasible treatment for degenerative lamellar macular hole with lamellar hole-associated epiretinal proliferation, yielding better improvements in best-corrected visual acuity and foveal retinal sensitivity than observation alone. Further studies are needed to optimize this new surgical approach.

Asunto(s)

Membrana Basal/cirugía , Fóvea Central/cirugía , Perforaciones de la Retina/cirugía , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Vitrectomía/métodos , Anciano , Femenino , Fóvea Central/diagnóstico por imagen , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Perforaciones de la Retina/diagnóstico

RESUMEN

PURPOSE: To investigate the effectiveness and safety of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis (MF) treatment. METHODS: We conducted a systematic review and meta-analysis. We evaluated the improvement of best-corrected visual acuity (BCVA) in logMAR unit, the percentage of patients with improved or stabled BCVA, benefit on axial length (AL), the retinal reattachment rate, the macular hole (MH) closure rate, as well as the complication rate. RESULTS: Fourteen studies (311 eyes) were included. Overall, patients' BCVA improved - 0.46 (95% confidence interval [CI] - 0.52, - 0.40) logMAR unit, with 80% (95%CI 74%, 85%) benefiting from BCVA improvement and 6% (95%CI 3%, 10%) suffering from BCVA loss. Patients' AL was shortened by - 1.74 (95%CI - 2.92, - 0.57) mm, and for patients whose AL was ≥ 30 mm, the average benefit reached - 3.68 (95%CI - 4.59, - 2.77) mm. Ninety-three percent (95%CI 89%, 96%) of the patients achieved retinal reattachment, and 65% (95%CI 47%, 80%) of the MH was closed. Patients' central foveal thickness decreased; the MD was - 187.32 (95%CI - 206.25, - 168.40) mm. The pooled complication rate was 9% (95%CI 8%, 19%), with extrusion, choroidal atrophy, and choroidal neovascularization being the most common complications. Subgroup analysis indicated no statistical difference in BCVA improvement, AL change, retinal reattachment rate, and complication rate between patients with or without MH. Subgroup analysis indicated no statistical difference in the above four outcomes between the primary and the recurrent patients either. There was no statistical difference in the above four outcomes no matter ILM peeling was combined or not. CONCLUSION: PSR combined with vitrectomy helps improve 80% MF patients' BCVA; the average benefit on BCVA is - 0.46 logMAR unit. The average change in AL is - 1.74 mm; patients with AL ≥ 30 mm benefit much more than the patients with AL < 30 mm. The retinal reattachment rate is up to 93%; the MH closure rate is 65%. About 9% patients will suffer from extrusion, choroidal atrophy, choroidal neovascularization, and other complications. The outcomes were not influenced by presence of MH, disease recurrence, or ILM peeling.

Asunto(s)

Fóvea Central/patología , Miopía Degenerativa/complicaciones , Retinosquisis/cirugía , Esclerótica/cirugía , Vitrectomía/métodos , Fóvea Central/cirugía , Humanos , Retinosquisis/diagnóstico , Retinosquisis/etiología , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual

RESUMEN

PURPOSE: To compare the anatomical and functional outcomes of vitrectomy involving complete internal limiting membrane peeling (CP) with those of vitrectomy involving fovea-sparing internal limiting membrane peeling (FSP) for the treatment of macular holes measuring >250 µm. METHODS: This prospective, randomized, comparative study included 46 eyes with a medium or large macular hole that was randomized to undergo complete (CP group) or fovea-sparing (FSP group) internal limiting membrane peeling during vitrectomy. The main outcome measures included the foveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: Both groups showed significantly improved foveal retinal sensitivity after surgery; the mean foveal retinal sensitivity change at 12 months after surgery was +2.8 ± 2.1 dB in the CP group and +7.2 ± 2.3 dB in the FSP group. The visual acuity also showed a significant improvement in both groups, with no significant differences in values at any time point. Regarding central retinal thickness, there was a significant decrease in the CP group and no change in the FSP group. Nicks or dimples in the inner retinal layers were visible in the fovea and perifovea of nine eyes in the CP group. CONCLUSION: Our findings suggest that both CP and FSP are safe and effective treatments leading to functional and anatomical improvements in patients with all size macular holes. However, the fovea-sparing technique may provide better functional outcomes because of a greater improvement in foveal retinal sensitivity.

Asunto(s)

Membrana Basal/cirugía , Fóvea Central/cirugía , Perforaciones de la Retina/cirugía , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Vitrectomía/métodos , Anciano , Endotaponamiento/métodos , Femenino , Fóvea Central/patología , Humanos , Masculino , Estudios Prospectivos , Perforaciones de la Retina/diagnóstico , Resultado del Tratamiento

RESUMEN

Differences in the pathogenesis and clinical characteristics between lamellar macular hole (LMH) with and without LMH-associated epiretinal proliferation (LHEP) can have surgical implications. This study investigated the effects of treating LHEP by foveolar internal limiting membrane (ILM) non-peeling and epiretinal proliferative (EP) tissue repositioning on visual acuity and foveolar architecture. Consecutive patients with LHEP treated at our institution were enrolled. The eyes were divided into a conventional total ILM peeling group (group 1, n = 11) and a foveolar ILM non-peeling group (group 2, n = 22). In group 2, a doughnut-shaped ILM was peeled, leaving a 400-µm-diameter ILM without elevated margin over the foveola after EP tissue repositioning. The EP tissue was elevated, trimmed, and inverted into the LMH. Postoperatively, the LMH was sealed in all eyes in group 2, with significantly better best-corrected visual acuity (-0.26 vs -0.10 logMAR; p = 0.002). A smaller retinal defect (p = 0.003), a more restored ellipsoid zone (p = 0.002), and a more smooth foveal depression (p < 0.001) were achieved in group 2. Foveolar ILM non-peeling and EP tissue repositioning sealed the LMH, released the tangential traction, and achieved better visual acuity. The presumed foveolar architecture may be reconstructed surgically. LMH with LHEP could have a combined degenerative and tractional mechanism.

Asunto(s)

Membrana Epirretinal , Fóvea Central , Perforaciones de la Retina , Tomografía de Coherencia Óptica , Agudeza Visual , Vitrectomía , Anciano , Proliferación Celular , Membrana Epirretinal/diagnóstico por imagen , Membrana Epirretinal/fisiopatología , Membrana Epirretinal/cirugía , Femenino , Fóvea Central/diagnóstico por imagen , Fóvea Central/fisiopatología , Fóvea Central/cirugía , Humanos , Masculino , Persona de Mediana Edad , Perforaciones de la Retina/diagnóstico por imagen , Perforaciones de la Retina/fisiopatología , Perforaciones de la Retina/cirugía , Estudios Retrospectivos

RESUMEN

PURPOSE: To determine the influence of residual submacular fluid (SMF) on the recovery of function and structure of the retina after successful rhegmatogenous retinal detachment (RRD) reattachment. METHODS: We reviewed the medical records of all patients who had undergone successful RRD repair by scleral buckling (SB) surgery or by pars plana vitrectomy (PPV) from March 2011 to August 2014. Spectral-domain optical coherence tomographic images of the macular regions were used at 1, 2, 3, 6, 9, and 12 months following the surgery. The best-corrected visual acuities (BCVA) were evaluated at the same times. RESULTS: The eyes with a macula-off RRD that were treated by SB surgery had a significant higher incidence of residual SMF (52%) than those treated by PPV (6.8%; P <0.001). Nevertheless, the postoperative BCVA was significantly improved in the eyes that had undergone SB surgery (P = 0.007). The postoperative BCVAs were not significantly different between the groups in which the SMF was absorbed (12 eyes) and not absorbed (13 eyes) within 1 month after the SB surgery. The photoreceptor outer segment length and the presence of a foveal bulge were not significantly different between these two groups at 12 months. Multiple regression analyses showed that the presence of a foveal bulge (ß = 0.531, P = 0.001) and the duration of the retinal detachment before surgery (ß = 0.465, P = 0.002) but not the duration of the SMF were independent factors significantly correlated with the final BCVA. CONCLUSIONS: These results suggest that the postoperative residual SMF does not significantly disrupt the functional and structural recovery of eyes with macula-off RRD treated by SB surgery.

Asunto(s)

Líquido Extracelular/metabolismo , Fóvea Central , Recuperación de la Función , Desprendimiento de Retina , Curvatura de la Esclerótica , Vitrectomía , Adulto , Anciano , Femenino , Fóvea Central/metabolismo , Fóvea Central/fisiopatología , Fóvea Central/cirugía , Humanos , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/metabolismo , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/cirugía

RESUMEN

Photocoagulation may still be a therapeutic choice for center-sparing diabetic macular edema. We compared the visual evolution after photocoagulation, in eyes with focal diabetic macular edema, stratified per the location of thickening with optical coherence tomography. We evaluated people with type 2 diabetes and focal diabetic macular edema, before and three weeks after focal photocoagulation. We divided the sample by edema location: central (group1); paracentral (group 2) and pericentral (group 3) and compared the proportions of eyes with baseline visual impairment, visual improvement, and visual deterioration between groups; central edema was evaluated with logistic regression, as an explaining variable of baseline visual impairment and visual improvement. The study included 160 eyes: 77 in group 1, 20 in group 2, 63 in group 3; baseline visual impairment was more frequent in groups 1 and 2 (52.6%) than in group 3 (28.6%, p = 0.002, OR 2.77) and as common in groups 1 (51.9%) and 2 (55.0%, p = 0.8). The proportions of visual improvement and visual deterioration did not differ between groups (p > 0.05). The outcome after focal photocoagulation was similar in paracentral (considered center-sparing) and central macular edema; the definition of center involvement, which needs intravitreal antiangiogenics, should expand to include paracentral thickening.

Asunto(s)

Coagulación con Láser , Edema Macular/cirugía , Adulto , Anciano , Femenino , Fóvea Central/cirugía , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Trastornos de la Visión/complicaciones

RESUMEN

PURPOSE: To identify prognostic factors that may predict the amount of long-term visual improvement after idiopathic epiretinal membrane removal. METHODS: A retrospective study of 114 patients who underwent epiretinal membrane removal was performed. The central foveal thickness, inner retinal layer thickness, inner retinal irregularity index, length of the cone outer segment tip line defect, and length of the ellipsoid zone defect were measured. The optical coherence tomography parameters that were associated with the amount of visual improvement were determined at 24 months postoperatively. RESULTS: Central foveal thickness and inner retinal irregularity index were not associated with best-corrected visual acuity at 24 months (P = 0.227 and P = 0.544, respectively), whereas the lengths of cone outer segment tip line defect and ellipsoid zone defect were associated with worse best-corrected visual acuity at 24 months (P = 0.015 and P < 0.001, respectively). Univariate regression analysis indicated that central foveal thickness and inner retinal irregularity index were associated with visual improvement (P = 0.011 and P < 0.001, respectively). Multivariate regression analysis indicated that inner retinal irregularity index, a marker of the inner retinal deformation, was associated with visual improvement after adjusting for age, gender, and other optical coherence tomography findings (P < 0.001). CONCLUSION: Patients with preoperative inner retinal deformation were found to have significantly improved long-term visual outcomes after epiretinal membrane removal.

Asunto(s)

Membrana Epirretinal/cirugía , Trastornos de la Visión/cirugía , Anciano , Anciano de 80 o más Años , Extracción de Catarata/estadística & datos numéricos , Membrana Epirretinal/diagnóstico por imagen , Femenino , Fóvea Central/diagnóstico por imagen , Fóvea Central/cirugía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico por imagen , Agudeza Visual/fisiología , Vitrectomía/métodos

RESUMEN

PURPOSE: To investigate the impact of preserving the foveal flap on surgical outcomes of full-thickness macular hole (MH) with foveal flaps. METHODS: We retrospectively reviewed patients with Stages 2 and 3 idiopathic MH, who underwent pars plana vitrectomy by a single surgeon at Asan Medical Center from November 2011 to November 2016. In the study group, we included eyes with MH and a foveal flap on preoperative spectral domain optical coherence tomography and successfully preserved the flap during surgery. The control group included eyes with MH and an operculum in the posterior vitreous plane on preoperative optical coherence tomography. We compared the anatomical and functional surgical outcomes between these groups. RESULTS: Postoperative mean best-corrected visual acuity at the last visit was 20/25 and 20/33 in the study (9 eyes) and control (23 eyes) groups, respectively. The study group showed a significantly better postoperative best-corrected visual acuity (P < 0.05). Restoration of both the external limiting membrane and ellipsoid zone, as assessed by spectral domain optical coherence tomography, was achieved in 9 (100%) and 15 (65.2%) eyes of the study and control groups, respectively. CONCLUSION: Preserving the foveal flap might improve both functional and anatomical outcomes of vitrectomy for MHs with a foveal flap.

Asunto(s)

Fóvea Central/cirugía , Perforaciones de la Retina/cirugía , Colgajos Quirúrgicos , Agudeza Visual , Vitrectomía/métodos , Anciano , Femenino , Humanos , Mácula Lútea/patología , Masculino , Persona de Mediana Edad , Perforaciones de la Retina/diagnóstico , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento

Asunto(s)

Inhibidores de la Angiogénesis/administración & dosificación , Retinopatía Diabética/terapia , Fóvea Central/cirugía , Edema Macular/terapia , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Femenino , Estudios de Seguimiento , Fóvea Central/diagnóstico por imagen , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento

RESUMEN

PURPOSE: To evaluate the functional and anatomical outcomes of 23-gauge or 25-gauge pars plana vitrectomy with internal limiting membrane peeling and air tamponade for the treatment of myopic foveoschisis. METHODS: Retrospective, noncomparative, interventional case series. The records of 29 patients (32 eyes), with myopic foveoschisis who were treated by 23-gauge or 25-gauge 3-port pars plana vitrectomy with internal limiting membrane peeling and air tamponade, were reviewed. At each visit, a complete ophthalmic examination, intraocular pressure, best-corrected visual acuity, and central foveal thickness measured using optical coherence tomography were assessed. RESULTS: Twenty-five eyes of 23 patients (M:F = 4:19) matched the inclusion criteria, whereas 7 eyes of 6 patients were excluded. The mean logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) was 0.62 (20/80) (SE: 0.061), and the mean preoperative central foveal thickness was 619.5 µm (SE: 16.38) at baseline. Visual acuity significantly improved of 5 Early Treatment Diabetic Retinopathy Study letters (45 letters) at the 1-month follow-up (P < 0.001), 2 lines (50 Early Treatment Diabetic Retinopathy Study letters) at the 6-month follow-up (P < 0.001), and it reached 55 Early Treatment Diabetic Retinopathy Study letters at the 1-year follow-up visit (P < 0.001). Central foveal thickness decreased to 292.4 µm (SE: 15.93), to 227.3 µm (SE: 14.05), and to 208.8 µm (SE: 12.86), respectively, at the 1-, 6-, and 12-month follow-ups (for each P < 0.001). There were no differences in best-corrected visual acuity or central foveal thickness changes between the foveal detachment group and the nonfoveal detachment group (P > 0.05). CONCLUSION: Small-gauge vitrectomy with internal limiting membrane peeling and air tamponade results in favorable anatomical and functional outcomes for patients affected by myopic macular foveoschisis.

Asunto(s)

Membrana Basal/cirugía , Endotaponamiento/métodos , Fluorocarburos , Fóvea Central/cirugía , Miopía Degenerativa/complicaciones , Retinosquisis/cirugía , Vitrectomía/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Miopía Degenerativa/diagnóstico , Retinosquisis/diagnóstico , Retinosquisis/etiología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual

RESUMEN

PURPOSE: To compare the retinal sensitivity after complete internal limiting membrane (ILM) peeling with that after foveal-sparing ILM peeling during vitrectomy for Type I epiretinal membrane. METHODS: This was a prospective, randomized, comparative study. Thirty-eight eyes were randomized to undergo complete peeling of the ILM (CP group) or peeling with foveal sparing (FS group). The main outcome measures were foveal and perifoveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS: Foveal retinal sensitivity showed a significant improvement in the FS group (2.82 ± 0.85 dB, P = 0.037) versus a slight drop in the CP group (-0.66 ± 0.48 dB, P = 1). Perifoveal retinal sensitivity slightly improved in both groups (0.47 ± 0.37 dB, P = 1 in the CP group and 0.79 ± 0.42 dB, P = 0.77 in the FS group), showing a similar trend without significant differences. Significant improvements were observed in both visual acuity and central retinal thickness in both groups. However, three cases in the FS group showed epiretinal membrane recurrence and required revision surgery with complete ILM removal. CONCLUSION: Internal limiting membrane peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas. However, the higher epiretinal membrane recurrence rate after the foveal-sparing technique limits the effectiveness of this procedure. Further studies must be conducted to determine if it is safe to leave a portion of the ILM in front of the fovea.

Asunto(s)

Membrana Basal/cirugía , Membrana Epirretinal/cirugía , Fóvea Central/cirugía , Agudeza Visual , Vitrectomía/métodos , Anciano , Membrana Epirretinal/diagnóstico , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento