Role of the vitreous in idiopathic preretinal macular fibrosis

Of 250 eyes with idiopathic preretinal macular fibrosis, 56 had no posterior vitreous detachment (Group 1), ten had partial posterior vitreous detachments without vitreous traction to the macula (Group 2), 29 had partial posterior vitreous detachments with vitreous traction to the macula (Group 3), and 155 had complete posterior vitreous detachments (Group 4). There were significantly more eyes with visual acuities of 20/60 or worse, cystoid macular changes, or macular fluorescein leakage in Group 3 than in Group 1 or Group 4. Thus, the presence of vitreous traction to the macula was associated with worse anatomic and functional findings.     

Two cases of idiopathic preretinal macular fibrosis in children

We report herein the findings in two patients less than 15 years old with the diagnosis of idiopathic preretinal macular fibrosis, a disorder found primarily in the older population. Only a few reports have discussed idiopathic preretinal macular fibrosis in children and its pathogenesis is still unknown. One is a 10-year-old boy and the other is a 14-year-old girl who visited our hospital with a chief complaint of blurred vision in their right eyes. Epiretinal membranes were recognized on the macular region of their right eyes. Since there was no causative factors, a diagnosis of idiopathic preretinal macular fibrosis was made. They were conservatively followed up. The vision of the boy once worsened but improved spontaneously and remained stable for three years. Because the vision of the girl worsened rapidly, vitreous surgery was performed to remove the epiretinal membrane, resulting in poor vision. It was suggested that this disorder in children should be followed up conservatively and the indication of vitreous surgery should be carefully determined.     

Prognostic factors in idiopathic preretinal macular fibrosis

We retrospectively studied 124 eyes with idiopathic preretinal macular fibrosis to assess the value of fluorescein angiography and vitreous examination for predicting the visual prognosis. During a mean follow-up period of 43 months (range, 12–14 months), the visual acuity of 33 eyes (27%) declined two or more lines from the initial value, although the appearance of the fibrosis remained unchanged in 114 cases (92%). At initial examination, 38 eyes (31%) showed fluorescein leakage into the macula; these eyes were more prone to further visual deterioration than were those without leakage (P< 0.05). Of 14 eyes with partial vitreous detachment and vitreous traction to the fibrosis, 6 (43%) had a final visual acuity of 20/200 or worse; this proportion was significantly higher than that found either in eyes with no detachment or in those with complete vitreous detachment (P< 0.05). The presence of fluorescein leakage and/or vitreous traction to the fibrosis may predict worse functional prognosis in eyes with idiopathic preretinal macular fibrosis.J. Akiba and A. Yoshida were on leave from the Department of Ophthalmology, Asahikawa Medical College, Japan     

Idiopathic preretinal macular fibrosis. Study of correlation between morphologic changes and visual acuity

Idiopathic preretinal macular fibrosis is an affection characterized by the development of preretinal membranes, macular distortion and, sometimes, macular edema. These changes as well as the consequent reduction of the visual acuity may vary very widely from one case to another. In this study, the degree of correlation among the various retinal morphological changes and among them and the visual acuity was investigated. This study shows that the importance of retinal distortion is strictly dependent on the appearance of the preretinal membranes that the appearance of the preretinal membrane and the importance of the retinal distortion are equally valid predictors of visual acuity, that the macular edema (defined as fluorescein leakage) depends mainly on the degree of contraction of the preretinal membrane and that such leakage does not represent the best parameter in order to predict the visual acuity.     

Spontaneous detachment of the preretinal membrane in preretinal macular fibrosis

Preretinal macular fibrosis is one of the most frequently encountered conditions of the macula; it is based on the formation of a transparent or white-gray preretinal membrane. Usually these changes do not progress and persist without change for many years. In rare cases it may come to a spontaneous detachment of the preretinal membrane connected usually with an improvement of the visual acuity. Presented are 2 patients with preretinal macular fibrosis in whom--after a various duration of the disease--it came to a spontaneous detachment of the preretinal membrane.     

Nd-YAG laser treatment in preretinal macular fibrosis

Three eyes with preretinal macular fibrosis (PMF) were treated with the Q-switched Nd-YAG laser. The PMF was idiopathic in two eyes and associated with a vitreous hemorrhage, due to ocular trauma, in the third eye. The three eyes had in common a partial posterior vitreous detachment with vitreous traction on the macula. The Nd-YAG laser beam was focused on the detached posterior hyaloid in front of the macular region. Some holes were made in this membrane or in the adjacent collapsed vitreous cortex. Treatment increased the visual acuity in the three eyes; the vitreous remained partially detached in the two eyes with idiopathic PMF and detached completely in the eye with the secondary PMF. The disentanglement of the fovelar area was revealed by the unfolded appearance of the retinal vessels on fluoangiography.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986This work was supported by the Belgian National Foundation for Scientific Research     

The incidence of idiopathic preretinal macular gliosis

A series of 1,000 consecutive routine eye examinations performed on patients over the age of 50 was evaluated with particular reference to the presence of idiopathic preretinal macular gliosis (IPMG). In this group, there were 64 patients with IPMG (6.4%), 13 (20%) of whom had bilateral IPMG. The large majority of cases (63%), however, had only minor visual disability as a result of this disorder.     

特发性黄斑视网膜前膜的眼底分析

探讨特发性黄斑视网膜前膜的眼底改变特性及其视力预后。方法采用眼底彩照和荧光血管造影对６５例患者进行检查,其中１５例,作了眼底形态和视力的随访观察。结果依据患者的眼底及ＦＦＡ改变特征将其分为Ⅰ、Ⅱ、Ⅲ期;６８．３％的患眼视力≥０．５。所有随访患超的视均保持稳定。结论因病程不同,眼底可有多种改变,但大部分患眼的视力预后良好。     

特发性黄斑裂孔玻璃体切割术后视力恢复及黄斑解剖愈合的相关因素分析

目的 探讨特发性黄斑裂孔玻璃体切割术后影响视力恢复及黄斑解剖愈合的相关因素.方法 49例49眼特发性黄斑裂孔行玻璃体切割联合内界膜剥离术的患者纳入本研究.行最佳矫正视力(best corrected visual acuity,BCVA) (logMAR)检查、裂隙灯显微镜及间接检眼镜等检查,同时采用光学相干断层扫描检测黄斑裂孔基底直径、裂孔边缘高度及裂孔最小径,计算黄斑裂孔指数(macular hole index,MHI)、黄斑裂孔牵拉指数(tractional hole index,THI),对黄斑裂孔愈合情况分类.观察术后6个月时视力恢复及黄斑裂孔愈合情况,并与年龄、病程、术前BCVA、裂孔基底直径、裂孔高度、裂孔最小径、MHI、THI等进行相关性分析.结果 术后BCVA为(0.45±0.29) logMAR,与术前BCVA(0.89±0.34) logMAR相比差异具有统计学意义(t=34.2,P=0.000).术后裂孔基底直径为(432.1±90.7) μm,裂孔边缘高度为(214.0±81.3) μm,裂孔最小径为(195.3 ±86.2)μm,均较术前明显减小,差异均有统计学意义(均为P=0.000);术后49眼中,裂孔完全愈合者31眼(63.3％),部分愈合者14眼(28.6％),未愈合者4眼(8.2％).相关性分析结果表明,术后BCVA (logMAR)与年龄、病程、术前BCVA (logMAR)均无相关性(均为P ＞0.05),而与MHI、THI显著相关(r=0.763,P=0.000;r =0.814,P=0.000);黄斑裂孔愈合类型与裂孔基底直径、裂孔边缘高度、裂孔最小径、MHI、THI均显著相关(均为P＜0.05),而与术前BCVA、病程、年龄无相关性(均为P＞0.05).结论 MHI、THI可作为预测术后视力恢复及黄斑裂孔愈合的指标.     

The state of the vitreous in idiopathic macular holes

We examined the vitreous of 37 eyes of 31 patients with macular holes of various stages. There was no posterior vitreous detachment (PVD) in 18 of 18 impending and 19 of 20 newly formed macular holes. In newly formed macular holes, the operculum was located either at the level of or immediately anterior to the retinal surface. The gel component of the vitreous was always separated from the posterior fundus by intervening liquefied lacuna, simulating PVD. However, the cortical vitreous was located posterior to the liquefied lacuna and remained attached to the retina. PVD failed to develop in all of 15 eyes during the follow-up period of 3 months after formation of a macular hole. The incidence of PVD increased in the eyes with macular holes lasting for 1 year or longer. In our present series, PVD in its classical sense did not contribute to the pathogenesis of macular holes as it developed after formation of the latter. Instead, a subtle anterior displacement of vitreous cortex strictly confined to the area of the fovea seemed to trigger the development of idiopathic macular holes.     

Micropsia and visual acuity in macular edema

Summary Relative micropsia was measured by a matching technique in patients with unilateral, benign, macular edema. Quantitative assessment of foveolar micropsia appeared to be a sensitive indicator of receptor displacement in this disorder, and may be a useful tool both for diagnosing and for monitoring macular edema.Parallel measurements of grating acuity showed a close proportionality between acuity and micropsia parameters. This result validates a new quantitative theory for the neuro-retinal basis of visual acuity. The theory allows prediction of the proportion of working visual neurons in patients with impaired acuity due to diseases that produce a diffuse loss, or disconnection, of macular cones. Our results indicate that so-called normal visual acuity (1.0, or 20/20) requires no more than 44% of the normal quantity of foveolar, neuro-retinal channels.     

Improvement of visual acuity one-year after vitreous surgery in eyes with residual triamcinolone acetonide at the macular hole

PURPOSE: To investigate whether triamcinolone acetonide in the macular hole after surgery interferes with anatomic macular hole repair or visual acuity improvement. DESIGN: Prospective, interventional case series with historical comparison. METHODS: Pars plana vitrectomy and triamcinolone acetonide-assisted internal limiting membrane peeling were performed in 26 eyes (24 patients) with stage 3 or 4 idiopathic macular hole. The visual acuities one-year after surgery were compared between eyes with and without residual triamcinolone acetonide after surgery. RESULTS: The macular holes were closed successfully in all 26 eyes. Nine eyes (35%) had residual triamcinolone acetonide in the macular hole at the end of the surgery and in the fovea on day 3 after surgery. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity +/- standard deviation was 0.73 +/- 0.36 and improved significantly to 0.20 +/- 0.29 one-year after surgery (P = .010). In the nine eyes with residual triamcinolone acetonide, the preoperative mean logMAR triamcinolone acetonide was 0.81 +/- 0.33, which improved to 0.20 +/- 0.19 one-year after surgery (P = .013). In the remaining 17 eyes, the mean visual acuity also improved from 0.71 +/- 0.38 before surgery to 0.21 +/- 0.28 after surgery (P = .001). No significant difference was found between the groups in preoperative and postoperative logMAR visual acuities. CONCLUSIONS: Residual triamcinolone acetonide in the macular hole does not interfere with anatomic or visual improvement.     

Role of the vitreous in age-related macular degeneration

PURPOSE: To investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD). METHODS: The condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls. RESULTS: There was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD. CONCLUSIONS: PVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.     

特发性黄斑前膜手术前后光学相干断层扫描形态变化与视力的关系

目的 评估特发性黄斑前膜手术前后光学相干断层扫描形态变化与视力的关系.方法 回顾性分析在我院行玻璃体切割术+内界膜剥除术的特发性黄斑前膜患者32例(32眼)的临床资料,分析术前、术后光学相干断层扫描图像中黄斑中心凹的形态、中心凹厚度与最佳矫正视力的关系.结果 29例患者视力提高,3例患者视力无提高,最佳矫正视力由术前0.25±0.12提高至术后的0.49±0.28(P ＜0.05),所有患者黄斑中心凹厚度均有所下降,由术前的(385±115) μm降至术后的(241±64) μm(P ＜0.05).最佳矫正视力与黄斑中心凹厚度相关性分析呈负相关性,即黄斑中心凹越厚,视力越差.结论 特发性黄斑前膜手术前后黄斑中心凹形态变化与视力有密切关系,光学相干断层扫描可用于术前评估及术后追踪其转归.     

Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane

The aim of this study was to analyze macular function by measuring the sensitivity of the macula with fundus-related microperimetry and to compare the results with the best corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT) in patients with idiopathic epimacular membrane. We prospectively reviewed 66 eyes with idiopathic epimacular membrane and 35 normal healthy eyes in patients who had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The mean retinal sensitivities in the central 10° (central microperimetry, cMP-1) and in the paracentral 10–20° (paracentral microperimetry, pMP-1) areas were determined and correlated with the BCVA and OCT-measured foveal thickness. Eyes with epimacular membranes showed significantly lower log MAR BCVA (P < 0.001) and cMP-1 microperimetry sensitivity (P < 0.001) and significantly higher OCT foveal thickness (P < 0.001) than control eyes. There was a significant correlation between the BCVA and mean retinal sensitivity in the cMP-1 (r ² = 0.26, P < 0.001) and the pMP-1 (r ² = 0.07, P = 0.008) areas. A significant negative correlation was observed between the foveal thickness and the mean retinal sensitivity in the cMP-1 (r ² = 0.13, P < 0.001) area. Retinal sensitivity in the central macular area determined by MP-1 microperimetry was significantly correlated with BCVA and with foveal thickness. The combination of OCT and microperimetry may help a better evaluation of the patients with idiopathic epimacular membrane.     

Eccentric visual acuity in patients with macular disease

A series of cards each containing a two dimensional array of identical Snellen "E's" was used to determine best eccentric visual acuity in patients with macular disease having Snellen visual acuity of 20/70 or worse. Each "full field E" card simultaneously presents the same letter to foveal and parafoveal areas. This test can therefore determine quickly if potentially useful vision is present in any area of the central visual field. In our study of 37 eyes, 70% demonstrated potential visual acuity at least two times better than visual acuity measured by conventional methods, and 20% demonstrated at least a fourfold improvement. This suggests that most patients with macular disease do not spontaneously employ their best remaining area of retina for fixation.