Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis

Purpose

To evaluate the efficacy of vitrectomy including internal limiting membrane (ILM) peeling without gas tamponade for myopic foveoschisis (MF).

Method

In this retrospective study, 15 eyes of 13 consecutive patients with MF underwent pars plana vitrectomy and ILM peeling without gas tamponade. The main outcomes were measured using best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT).

Result

The mean refractive error was ?11.0?±?8.2 diopters and mean axial length was 30.8?±?2.6?mm. The mean BCVA increased from 0.78?±?0.53 to 0.61?±?0.75 logMAR unit (p?=?0.05), and the mean CMT decreased from 405?±?143?μm to 255?±?47?μm (p?=?0.002) during a follow-up of 11.8?months. OCT showed a complete resolution of the MF, with foveal reattachment in all eyes. Full-thickness macular hole developed in two eyes during follow-up.

Conclusion

ILM peeling without gas tamponade results in favorable anatomical and visual outcomes.     

Surgical treatment of lamellar macular hole secondary to epiretinal membrane

Background

To examine the surgical results of lamellar macular hole (LMH) secondary to epiretinal membrane (ERM).

Methods

A 3-year retrospective review was performed of patients with LMH secondary to ERM that underwent ERM and internal limiting membrane (ILM) peeling. The main outcome measures included best-corrected visual acuity (BCVA) and postoperative macular structure. The results were compared with cases of idiopathic ERM with similar baseline demographic characteristics.

Results

Thirty eyes in 30 patients were collected. The mean BCVA improvement was 3.4 Snellen lines after a mean follow-up period of 16.9 months. Optical coherence tomography (OCT) showed improved macular contour in 27 cases. Patients with intravitreal gas tamponade exhibited a higher percentage of restoration of macular contour than those without (P?=?0.016). Final BCVA was correlated with an intact photoreceptor inner segment–outer segment (IS–OS) junction (P?=?0.03). The degree of visual improvement is less than that observed in idiopathic ERM patients.

Conclusion

In LMH secondary to ERM with significant visual decrease, ERM and ILM peeling may improve BCVA. Postoperative gas tamponade is associated with better restoration of macular configuration. Final BCVA is related to an intact photoreceptor IS–OS junction rather than to the normalization of the macular contour.     

Funktionelle Ergebnisse nach anatomisch erfolgreicher Makulaforamen-Stadium-III/IV-Chirurgie

Purpose

To report the functional results after anatomically successful surgery for stage III/IV macular hole.

Methods

Follow-up examinations (ETDRS charts, Birkhäuser near visual acuity charts, OCT) were carried out in 29 patients 11±5 months after surgery for stage III/IV macular hole (hole size >400 µm); in all cases the foveal contour had been restored postoperatively . The surgery performed also included cataract surgery (n=26), vitrectomy, ICG-assisted ILM peeling (in which perfluorcarbon liquid was used to prevent ICG from coming in contact with the retinal pigment epithelium) and tamponade with intraocular gas (n=16) or silicone oil (n=13). Silicone oil had been removed by the time of the follow-up evaluation.

Results

Preoperative mean BCVA was 0.2 (0.64 logMAR±0.24) and postoperative BCVA, 0.5 (0.3 logMAR±0.19). None of the patients experienced any deterioration in sight; the average improvement in visual acuity was 3.5±2 lines. In 70% (n=20) of the patients the postoperative BCVA was ≥0.5. Visual acuity for near sight was 0.45±0.2. In 66% (n=19) a visual acuity of ≥0.4 was achieved for close work. The improvement in visual acuity was not related to the kind of endotamponade or to the size of the macular hole. Patients with macular hole diameters of 400–800 µm (n=20) gained 3.5±2.,4 lines, while in patients with macular hole diameters of 800–1135 µm the average gain was 3.6±1.3 lines.

Conclusions

Anatomically successful macular hole stage III/IV surgery with ICG-assisted ILM peeling and protection of the retinal pigment epithelium from contact with ICG by perfluorcarbon liquid can yield good functional results.     

Operative Therapie bei Makulaschichtforamen

Purpose

Vitrectomy and peeling in patients with lamellar macular hole was evaluated with regard to anatomical and functional outcome.

Patients and methods

In a retrospective study, 10 patients with lamellar macular hole underwent vitrectomy, membrane-peeling (epiretinal membrane [ERM] and internal limiting membrane [ILM]) and gas (n=9) or silicone oil (n=1) endotamponade. In most patients (n=9), cataract surgery was also performed. Pre- and postoperative ocular coherence tomography (OCT) findings, visual acuity (ETDRS), and Birkhäuser near visual acuity were evaluated.

Results

Mean follow-up was 15±11 months after surgery with a minimum follow-up of 6 months. Best corrected visual acuity (BCVA) improved in all patients; the average BCVA gain was 3±2 lines. Preoperative mean BCVA was 0.35 (0.45±0.23logMAR), and postoperative BCVA was 0.64 (0.19±0.21logMAR). Eight of ten patients had a postoperative BCVA ≥20/40, and six patients had a postoperative BCVA ≥20/25. Mean near visual acuity was 0.5±0.26 (range 0.2–0.9). Postoperative OCT revealed a closed lamellar macular hole in six patients, with restored foveal contour in three of them. The other four patients showed a persistent inner retinal defect with an intact photoreceptor layer.

Conclusion

Surgical treatment including vitrectomy, ERM-ILM-peeling and endotamponade appears to benefit patients with lamellar macular hole. All patients improved functionally. Surgical treatment can close the lamellar macular hole and restore foveal architecture.     

Foveola nonpeeling internal limiting membrane surgery to prevent inner retinal damages in early stage 2 idiopathic macula hole

Purpose

The purpose of this study was to investigate and present the results of a new vitrectomy technique to preserve the foveolar internal limiting membrane (ILM) during ILM peeling in early stage 2 macular holes (MH).

Methods

The medical records of 28 consecutive patients (28 eyes) with early stage 2 MH were retrospectively reviewed and randomly divided into two groups by the extent of ILM peeing. Group 1: foveolar ILM nonpeeling group (14 eyes), and group 2: total peeling of foveal ILM group (14 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm-diameter ILM over foveola in group 1.

Results

Smooth and symmetric umbo foveolar contour was restored without inner retinal dimpling in all eyes in group 1, but not in group 2. The final vision was better in group 1 (P?=?0.011). All eyes in group 1 (100 %) and seven of 14 eyes in group 2 (50 %)regained the inner segment/outer segment (IS/OS) line. Restoration of the umbo light reflex was found in 12 of 14 eyes in group 1 (86 %) but none in group 2 (0 %).

Conclusions

Nonpeeling of the foveolar ILM in early stage 2 idiopathic MH surgery prevented inner retinal damages, restored umbo light reflex, achieved better foveolar microstructures, and led to better final visual acuity.     

Retinal thickness in eyes with idiopathic macular hole after vitrectomy with internal limiting membrane peeling

Purpose

To compare the thickness of each retinal layer in the parafoveal and perifoveal regions of eyes after successful closure of a macular hole (MH) by pars plana vitrectomy with internal limiting membrane (ILM) peeling to the corresponding areas of the normal fellow eyes.

Methods

Twenty-two eyes of 22 patients with an idiopathic MH who underwent PPV with ILM peeling at the Matsumoto Dental University Hospital were studied. The retinal thickness was measured manually with the volume scan mode of the Spectralis HRA?+?OCT (Heidelberg Engineering, Germany).

Results

The average postoperative parafoveal thickness of the temporal sector was 314.8 μm, and that of the corresponding area of the fellow eyes was 325.0 μm (P?=?0.01). The parafoveal thickness of the nasal sector was 360.7 μm, and that of the fellow eyes was 339.6 μm (P?<?0.0001). Changes in the inner retinal layer thicknesses contributed to the decreased temporal and increased nasal sectors. The perifoveal retinal thickness was significantly increased in all sectors after PPV, probably due to an increase in the outer nuclear layer thickness.

Conclusions

PPV with ILM peeling for MHs can cause microstructural changes in wide areas of the macula region, suggesting a loss of longitudinal support of the Müller cells.     

Heavy silicone oil (Densiron-68) for the treatment of persistent macular holes

Purpose

To evaluate the efficacy and safety of the use of Densiron-68 as intraocular endotamponade for the treatment of persisting macular holes (persistent MHs).

Methods

Retrospective interventional case study on 23 consecutive eyes showing persistent MHs after unsuccessful primary surgery that underwent retreatment with pars plana vitrectomy and Densiron-68 filling. The main outcome measures were: anatomic closure evaluated with optical coherence tomography (OCT), final best-corrected visual acuity (BCVA), and postoperative complications.

Results

A total of 23 patients (52–88 years) were studied. Pre-operative OCT showed full-thickness MH (mean size 560 µm) in all patients. Densiron-68 was left in situ for 1.5–3 months. Final follow-up time was 12 months after the last surgery. Postoperative OCT showed the complete closure of the PMH in 20 of 23 eyes. Pre-operative BCVA ranged from 20/200 to 20/630 (1.50–1.00 logMAR, mean 1.14). Final postoperative BCVA ranged from 20/30 to 20/400 (0.18–1.30 logMAR, mean. 0.61). Nineteen eyes (82%) showed a significant increase in visual acuity by at least three lines: 11 (47%) patients gained at least four lines. Three eyes remained unchanged (13%). One case deteriorated by two lines (4%). No major complications were recorded.

Conclusions

Retreatment with Densiron-68 filling was safe and achieved encouraging anatomic and functional results.     

Comparisons of cone electroretinograms after indocyanine green-, brilliant blue G-, or triamcinolone acetonide-assisted macular hole surgery

Purpose

To compare the function of retinal ganglion cells (RGCs) using the photopic negative response (PhNR) in patients who had undergone indocyaine green (ICG)-assisted, brilliant blue G (BBG)-assisted, or triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling during macular hole (MH) surgery.

Methods

Forty-eight eyes of 48 patients with a macular hole were randomly divided into those undergoing ICG-assisted, BBG-assisted, or TA-assisted vitrectomy (n?=?16 for each group). Full-field cone ERGs were recorded before and 1, 3, 6, 9, and 12 months postoperatively. The amplitudes and implicit times of the a-waves and b-waves and the amplitudes of the oscillatory potentials (OPs) and PhNRs were measured. The mean deviations (MDs) of standard automated perimetry and the best-corrected visual acuity (BCVA) were measured. The circumferential retinal nerve fiber layer (RNFL) thickness was evaluated by SD-OCT.

Results

All macular holes were closed with a significant improvement of the BCVA and MD without differences among the groups. There was no significant difference between the preoperative and postoperative RNFL thickness. The implicit times of the a-waves and b-waves were significantly prolonged, and the ΣOPs amplitude was significantly decreased postoperatively in all groups. These ERG changes were not significantly different among the groups. The postoperative PhNR amplitudes were significantly lower in the ICG group than in the BBG or TA group.

Conclusions

The results indicate that the PhNR may detect subclinical impairments of RGCs caused by the possible toxic effect of ICG. This finding adds to the data that BBG and TA may be safer than ICG for use during MH surgery.     

Paracentral scotoma in glaucoma detected by 10-2 but not by 24-2 perimetry

Purpose

To describe, in glaucomatous patients, spectral-domain optical coherence tomography (SD-OCT) results predictive of paracentral visual field (VF) defects present on standard automated perimetry (SAP) 10-2, but not on SAP 24-2.

Methods

The SAP 10-2 test was repeated 3 times to determine whether paracentral VF defects were present. Spectralis? HRA + OCT was used to obtain speckle-noise-reduced macular B-scans. The macular scan protocol consisted of 19 vertical cross-sectional scan lines centered on the fovea (30° × 15° volume scan), each of which was the average of 50 scans. A 3D OCT-2000 was also used to determine macular layer thicknesses and to detect abnormally thin regions (below the 1 % confidence interval of the normative data).

Results

We identified 3 cases in which paracentral VF defects were detected on SAP 10-2, but not on SAP 24-2. Paracentral VF defects were detected on all of the SAP 10-2 tests repeated 3 times, and included absolute scotoma in 2 of the 3 SAP 10-2 results. Retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) damage was diminished on SD-OCT macular images; 2 patients had RNFL and GCL thinning within and central to the parafoveal region, where the GCL is generally thickest in healthy eyes, and 1 patient had evident RNFL and GCL thinning in the papillomacular bundle.

Conclusions

Macular SD-OCT scans may be useful in deciding whether SAP 10-2 should be performed.     

Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia

Purpose

To compare visual and anatomic outcomes in eyes with type 2 idiopathic macular telangiectasia (Mactel) treated with either intravitreal bevacizumab (IVB), observation, or pars plana vitrectomy (PPV) with internal limiting membrane removal.

Methods

Retrospective, consecutive, interventional case series of phakic patients with Mactel. Best-corrected Snellen visual acuity (BCVA) and complete ophthalmic exam was obtained prior to treatment and at subsequent 3-month intervals for a minimum of 6 months. Fluorescein angiographic and spectral-domain optical coherence tomography features were examined, and compared to BCVA at treatment initiation and follow-up.

Results

Fifty-six eyes of 28 patients were evaluated. Mean age was 65?±?12 years, and mean follow-up was 24?±?13 months. Patients were treated with either observation (n?=?33), IVB (n?=?15), or PPV (n?=?8). Mean number of treatments for the IVB group was 2.5?±?3.5 intravitreal injections. No significant differences in BCVA change were observed between treatment groups via one-way ANOVA (p?=?0.49). Presence of inner retinal cysts was not correlated to BCVA (p?>?0.05). Discontinuous outer nuclear layer was significantly related to worse initial and final vision, but not to BCVA change.

Conclusion

IVB and PPV with ILM removal appear ineffective in improving visual outcome in eyes with non-proliferative Mactel. SD-OCT evidence of disrupted foveal outer nuclear layer is related to decreased BCVA, but not related to BCVA change following treatment.     

Optical Coherence Tomography Before and After Vitrectomy with Internal Limiting Membrane Removal in a Child with Optic Disc Pit Maculopathy

Background

The pathogenesis of optic disc pit maculopathy is still unknown, although recent optical coherence tomographic (OCT) analyses have made a great contribution to clarifying its morphological appearance. The best treatment for this disease is also controversial.

Case

We report on a 7-year-old girl with optic disc pit maculopathy associated with a separation of the internal limiting membrane (ILM) near the optic disc.

Observations

The OCT images before treatment showed a conduit from the perineural space to the schisislike separation of the sensory retina with a dome-shaped separation of the ILM. A serous detachment (SD) in the macula, centered on the fovea, was also present. In OCT images after laser photocoagulation, the conduit appeared to be closed, but the SD was still present. Vitrectomy with ILM removal and gas tamponade resulted in a marked reduction of the SD in the macular area. Focal macular electroretinograms and visual acuity demonstrated a recovery of macular function.

Conclusion

The dome-shaped separation of the ILM suggested that the vitreous might be exerting a tractional force on the optic disc pit, and vitrectomy with ILM peeling released the traction on the optic disc pit. Jpn J Ophthalmol 2005;49:411–413 © Japanese Ophthalmological Society 2005     

Macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling: one-year results

PURPOSE: To report the 1-year results of macular hole surgery with triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling and to compare those with results of indocyanine green (ICG)-assisted ILM peeling. METHODS: In a nonrandomized, retrospective, interventional case series, 40 eyes of 39 consecutive patients with idiopathic full-thickness macular holes underwent macular hole surgery with TA-assisted ILM peeling. Surgical results 1 year after surgery, including changes in best-corrected visual acuity (BCVA) and macular hole closure, were evaluated. Moreover, we compared the results for these 40 eyes (TA group) with those for 27 eyes of 27 consecutive patients who had undergone macular hole surgery with 0.25% ICG-assisted ILM peeling (ICG group). RESULTS: In the TA group, macular holes were closed in 39 (98%) of 40 eyes. Mean BCVA +/- SD significantly improved from 0.78 +/- 0.31 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.20 +/- 0.30 logMAR (P < 0.001). BCVA improved by > or =0.2 logMAR in 37 eyes (93%). BCVA was 20/40 or better in 33 (83%) of 30 eyes. In the ICG group, macular holes were closed in all 27 eyes (100%), and mean BCVA +/- SD significantly improved from 0.81 +/- 0.4 logMAR preoperatively to 0.34 +/- 0.2 logMAR 1 year postoperatively (P < 0.001). BCVA improved by > or =0.2 logMAR in 22 eyes (81%). BCVA was 20/40 or better in 16 (59%) of 27 eyes. Significant differences between groups were seen in mean BCVA 1 year after surgery (P = 0.049) but not in BCVA of 20/40 or better (P = 0.17) or change in BCVA by > or =0.2 logMAR (P = 0.05). CONCLUSION: TA is useful as an adjuvant for ILM peeling in macular hole surgery, and BCVA 1 year after surgery might be more favorable when compared with ICG-assisted ILM peeling.     

Residual indocyanine green fluorescence pattern after vitrectomy for idiopathic macular hole with internal limiting membrane peeling

BACKGROUND: Internal limiting membrane (ILM) peeling with indocyanine green (ICG) staining is a commonly used procedure to treat idiopathic macular holes (MH). AIM: To report changes in the patterns of residual ICG fluorescence over time after vitrectomy using the Heidelberg Retina Angiograph 2 (HRA2, Heidelberg Engineering, Heidelberg, Germany). METHODS: 10 patients (10 eyes) who had undergone vitrectomy for MH with ILM peeling were included. 9 (90%) patients underwent ILM peeling with ICG, and 1 (10%) patient had it with triamcinolone acetonide (TA). We observed residual ICG using HRA2, postoperatively. Autofluorescence, optical coherence tomography images and best-corrected visual acuity (BCVA) measurements were also obtained. The minimal follow-up was 3 months. RESULTS: The MHs were closed postoperatively in all patients (100%). In eyes that underwent ILM peeling with ICG, the BCVA improved significantly (p<0.001) in 8 (89%) eyes and was unchanged in 1 (11%) eye. HRA2 showed the ICG fluorescence patterns but not TA postoperatively. The ICG hyperfluorescent signal was typically diffuse at the posterior retina and was hypofluorescent around the fovea. The hyperfluorescence then migrated towards the optic nerve disc presumably along the nerve fibre, and the area of ILM peeling was clearly identified. A large number of hyperfluorescent dots were observed instead of diffuse hyperfluorescence that was observed just after surgery. CONCLUSIONS: Patterns of residual ICG fluorescence were sequentially observed with HRA2 after vitrectomy for MH with ICG-assisted ILM peeling.     

Restoration of macular structure as the determining factor for macular hole surgery outcome

Objective

The aim of this work is to evaluate the preoperative and postoperative spectral domain optical coherence tomography (SD-OCT) findings as predictors of visual acuity for macular hole (MH) surgery.

Methods

Fifty eyes of 46 patients diagnosed with MH and that had undergone 25-g vitrectomy with internal limiting membrane peeling were included in this retrospective study. A complete clinical examination and SD-OCT were performed before and after surgery. Three groups were considered on the basis of the postoperative integrity of photoreceptor inner and outer segment (IS-OS) junction and the external limiting membrane (ELM): group A (11 eyes, both lines disrupted), group B (ten eyes, disrupted IS/OS line and complete ELM), and group C (29 eyes, both lines restored).

Results

LogMAR BCVA improved significantly after surgery from an average 0.60?±?0.29 to 0.19?±?0.19 (p?p≥0.18). Postoperative BCVA was significantly better in group C compared to groups A and B (p?≤?0.01). A significant correlation was found between ELM restoration and postoperative BCVA (r?=?–0.63, p?r?=?–0.55, p?Conclusions Outer retina restoration seems to be the best determining factor for a good visual rehabilitation after MH surgery.     

Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis

Background

To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prognostic factors in myopic macular hole (MMH) surgery.

Methods

In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > ?6.00 D) who underwent pars plana vitrectomy with internal limiting membrane peeling for MMH without foveoschisis. Statistical analysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI).

Results

Primary and final anatomical success rate were 83.3 % (35/42) and 90.5 % (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4 %) patients, worsened in 7/42 (16.7 %) and remained unchanged in 13/42 (30.9 %). Only MH minimum diameter (P?=?0.03) and HFF (P?=?0.02) correlated significantly with postoperative BCVA.

Conclusions

Minimum diameter and HFF are strongly correlated with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT.     

Long-term outcomes of 3 surgical adjuvants used for internal limiting membrane peeling in idiopathic macular hole surgery

Purpose

Indocyanine green (ICG), an adjuvant used for peeling of the internal limiting membrane (ILM) during vitreous surgery for idiopathic macular hole (MH), has been reported to be toxic, possibly affecting postoperative visual acuity. We compared the long-term outcomes (within 2 years) of brilliant blue G (BBG), ICG, and triamcinolone acetonide (TA).

Patients and methods

This study involved 97 eyes of 94 patients who underwent vitreous surgery for MH at the Yamagata University Hospital between June 2002 and November 2010. The surgical adjuvants used were BBG for 15 eyes, ICG for 61 eyes, and TA for 21 eyes. We compared the postoperative visual acuities, initial closure rates, final closure rates, and complications of the 3 groups.

Results

In all 3 groups, the visual acuity significantly improved after surgery. The magnitude of the improvement at 2 years after surgery was significantly better in the BBG group than in the ICG group (Mann–Whitney test, P = 0.020). The postoperative visual acuity did not significantly differ between the BBG and TA groups (P = 0.627) or between the ICG and TA groups (P =0 .137). Thus, the surgery using BBG resulted in a significantly better outcome in visual acuity than did the surgery using ICG. The 3 groups did not differ in initial or final closure rates or in incidence of complications.

Conclusion

Analysis of the long-term outcomes of vitreous surgeries provided evidence that BBG is a useful adjuvant for ILM peeling.     

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study

Purpose

To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs).

Design

Prospective, randomized, investigator-masked, controlled clinical study.

Methods

Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively.

Results

At month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups).

Conclusion

The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.     

Einfluss postoperativer oraler Steroidgabe auf die retinale Sensitivität bei Patienten nach Makulachirurgie

Background

The aim of this study was to evaluate the effect of postoperative systemic steroid treatment on retinal sensitivity in patients with epiretinal membrane (ERM) after successful surgery.

Patients and methods

A total of 28 patients with ERM, macular edema and visual loss were included in this study. All patients were treated with combined 23 gauge vitrectomy and peeling of the ERM and inner limiting membrane (ILM). After randomization the first group (n?=?14) was treated with postoperative systemic steroids (100 mg prednisolone per day for 5 days) and the second group (n?=?14) served as a control group. Follow-up examinations were performed up to 12 months.

Results

After 12 months a statistically significant increase in visual acuity with a gain of 17/10 letters in the steroid/control group as well as significant decrease of the central retinal thickness of 107/128 µm could be observed (p?<?0.05). In the steroid/control group mean retinal sensitivity increased from 14.0/14.3 dB after 12 months in comparison to 11.7/11.9 dB at baseline examination (p?<?0.05).

Conclusions

Postoperative oral steroid treatment does not seem to be beneficial in patients with macular pucker surgery.     

Comparison of fovea-sparing and non-internal limiting membrane peeling for retinoschisis with foveal detachment in highly myopic eyes

PurposeTo compare the visual and anatomical outcomes of two different treatment strategies (non-internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling) for retinoschisis with foveal detachment (FD) in highly myopic eyes.DesignA retrospective cohort study.MethodsNinety-five eyes from 92 highly myopic patients with retinoschisis with FD were divided into two groups, including 44 eyes from 43 patients who received 23-gauge, 3-port vitrectomy without ILM peeling (group A) and 51 eyes from 49 patients who received vitrectomy with fovea-sparing ILM peeling (group B). All eyes also underwent cataract surgery.ResultsThere were no significant differences between the two groups in terms of sex, age, diopters, axial length (AL), or central foveal thickness (CFT) before surgery (P > 0.05). One month after surgery, foveoschisis and FD were resolved in 74.47% of the eyes in group B and in only 12.50% of those in group A. Six months after surgery, foveoschisis and FD were resolved in 96.08% of the eyes in group B and in only 72.73% of those in group A (P < 0.05). There were no significant differences between the two groups in terms of BCVA 6 months after surgery. The postoperative complication was macular holes, which were found in seven eyes (15.90%) in group A and in one eye (1.96%) in group B (P < 0.05).ConclusionHighly myopic eyes with FD that underwent fovea-sparing ILM peeling appeared to obtain a better anatomical outcome than those that did not undergo non-ILM peeling. The two procedures obtained similar results in terms of visual function.Subject terms: Retinal diseases, Vision disorders

Myopic foveoschisis with foveal detachment had been treated by vitrectomy without ILM peeling as well as foveal sparing ILM peeling in an attempt to reduce the occurrence of postoperative complications. We performed this retrospective study to assess which is the best method for improving anatomical and functional outcomes, and to reduce the incidence of postoperative macular holes.

Myopic retinopathy is one of the most common causes of irreversible visual impairment and blindness due to the high incidence rate of high myopia [1]. Myopic foveoschisis (MF), a common finding in the macula of highly myopic eyes [2], is one of the major causes of poor vision in eyes with pathologic myopia. Based on optical coherence tomography (OCT) images of the macular region, MF can be divided into three stages: isolated retinoschisis, retinoschisis with foveal detachment (FD), and retinoschisis with a macular hole (MH) [3]. Patients with isolated retinoschisis may have stable vision for a long time. However, when retinoschisis progresses to FD or FD progresses to MH, the patient’s visual acuity drops sharply, and MH retinal detachment may easily develop [4]. Thus, stage II (retinoschisis with FD) is the best time to start surgical treatment.At present, the mainstream treatment for retinoschisis with FD is vitrectomy. Studies have shown that vitrectomy could result in good anatomical and visual outcomes in highly myopic eyes [5–15]. However, how to address the ILM remains controversial. Some studies proposed vitrectomy without ILM peeling and showed that the prevalence of postoperative MH was much lower than that in ILM peeling cases, but the recovery rate may not be satisfactory [12, 16]. In contrast, people who promote ILM peeling believe that it can increase the recovery rate but that postoperative MH may occur (8–18%) [17, 18] and result in poor postoperative VA. Recently, some researchers have proposed a fovea-sparing ILM technique to reduce the risk of iatrogenic MH formation [19–24]. Could fovea-sparing ILM peeling increase the anatomic resolution and reduce the incidence of postoperative MHs in FD patients at the same time? Comparing non-ILM peeling with fovea-sparing ILM peeling, which procedure is better? For these purposes, we designed this study. This study analyzed 95 eyes from 92 patients with MS and FD treated with PPV without ILM peeling or with ILM peeling that avoided the foveal area to determine which procedure is better for treating this disease.     

曲安奈德辅助玻璃体后脱离联合不染色剥除内界膜治疗Ⅱ、Ⅲ期特发性黄斑裂孔的临床观察

目的 评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法 对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果 手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.

Abstract：

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.