Baseline thickness of macular ganglion cell complex predicts progression of visual field loss

Background

Previous studies reported that the thickness of the macular ganglion cell complex (mGCC) showed good diagnostic ability for detecting glaucoma. However, its impact on the progression of visual field loss in primary open angle glaucoma (POAG) is unknown. The purpose of this study was to assess whether baseline mGCC thickness is associated with the progression of visual field loss in POAG.

Methods

Fifty-six patients with POAG were included in the study. All patients were followed for more than 2 years after baseline optical coherence tomography (OCT) measurements. They had at least five reliable Humphrey visual field tests with 30–2 Swedish Interactive Threshold Algorithm standard tests during the follow-up period. The subjects were divided into two groups according to the slope of the mean deviation (MD): the fast progression group (MD slope < ?0.4 dB/y) and the slow progression group (MD slope ≥ ?0.4 dB/y). Factors compared between the groups were as follows: age, baseline intraocular pressure (IOP), mean IOP during the follow-up, refraction, baseline MD, pattern standard deviation (PSD), and baseline OCT measurements.

Results

There were no significant differences between the two groups in age, baseline IOP, mean IOP during the follow-up, refraction, baseline MD or PSD, average thickness of retinal nerve fiber layer (RNFL), or disc parameters. However, the baseline mGCC thickness (average and inferior hemifield) was significantly thinner in the fast progression group than in the slow progression group (74.0?±?7.2 μm vs. 80.3?±?8.6 μm; 68.0?±?6.6 μm vs. 78.2?±?11.6 μm, respectively). Moreover, global loss volume and focal loss volume, which are parameters of mGCC, showed significantly higher rates in the fast progression group than in the slow progression group. In multivariate analysis, only mGCC thickness of the inferior hemifield was associated with disease progression (P?=?0.007).

Conclusions

Baseline mGCC thickness can be predictive of progressive visual field loss in patients with POAG.     

Relationship between retinal nerve fiber layer and visual field sensitivity as measured by optical coherence tomography in chiasmal compression

PURPOSE: To investigate the spatial relationship between retinal nerve fiber layer (RNFL) thickness measured with optical coherence tomography (OCT) and visual field sensitivity (VFS) measured by standard automated perimetry (SAP) in chiasmal compression. METHODS: Twenty-six patients with chiasmal compression were enrolled. RNFL thickness was measured with the StratusOCT and VFS with SAP (Humphrey Field Analyzer; both from Carl Zeiss Meditec, Dublin, CA). Relationships between RNFL thickness (in clock hours, hemifields, and sectors) and VFS (zones were divided into hemifields, quadrants, and sectors based on a validated visual field map) expressed in a decibel scale and 1/lambert (L) were evaluated by linear and nonlinear regression. Coefficients of determination (R(2)) were calculated by using a multivariate model. RESULTS: Average RNFL thickness correlated strongly with pattern standard deviation (PSD; R = 0.622) and mean deviation (MD; R = 0.413). The four strongest correlations were between the 8 o'clock OCT position (temporal disc), with the temporal hemifield (R = -0.813), the superotemporal quadrant (R = -0.847), the inferotemporal quadrant (R = -0.855), and the field sector representing the papillomacular bundle (R = -0.809). Coefficients of determination improved significantly in all sectors when time since surgery was included in the regression model-most notably, average thickness and 1/L (R(2) = 0.35-0.49), the decibels (R(2) = 0.31-0.47), and the temporal sector (R(2) = 0.44-0.57). CONCLUSIONS: This is the first study to compare the structure-function correlation of RNFL measured by OCT with SAP in patients with chiasmal compression. RNFL is topographically related globally and sectorally to decreased SAP, with the temporal sectors showing the strongest correlations. The correlation between RNFL and VFS strengthens as the time from surgical intervention increases.     

Evaluation of the retinal nerve fibre layer and ganglion cell complex thickness in pituitary macroadenomas without optic chiasmal compression

Purpose

The aim of this prospective study was to measure the thickness of the circumpapillary retinal nerve fibre layer (cpRNFL) and the ganglion cell complex (GCC) using spectral domain optical coherence tomography (SD-OCT) in a cohort of consecutive de novo patients with pituitary macroadenomas without chiasmal compression.

Patients and methods

Twenty-two consecutive patients with pituitary macroadenoma without chiasmal compression (16 men, 6 women, aged 45.2±14.6 years, 43 eyes) entered the study between September 2011 and June 2013. Among them, 31.8% harboured a growth hormone-secreting pituitary adenoma, 27.3% a prolactin-secreting pituitary adenoma, 27.3% a corticotrophin-secreting pituitary adenoma, and 13.6% a non-secreting pituitary tumour. Eighteen subjects (nine females, nine males, mean age 36.47±6.37 years; 33 eyes) without pituitary adenoma, with normal ophthalmic examination, served as controls. In both patients and controls, cpRNFL and GCC thicknesses were measured by SD-OCT.

Results

Patients were significantly older (P=0.02) than controls. Best corrected visual acuity, intraocular pressure, colour fundus photography, and automatic perimetry test were within the normal range in patients and controls. Conversely, cpRNFL (P=0.009) and GCC (P<0.0001) were significantly thinner in patients than in controls. The average GCC (r=0.306, P=0.046) significantly correlated with the presence of arterial hypertension. OCT parameters did not differ significantly between patients with a tumour volume above the median and those with a tumour volume below the median.

Conclusion

Pituitary macroadenomas, even in the absence of chiasmal compression, may induce GCC and retinal nerve fibre layer thinning. SD-OCT may have a role in the early diagnosis and management of patients with pituitary tumours.     

视网膜黄斑区神经节细胞复合体厚度与眼轴长度的相关性研究

目的分析研究视网膜黄斑区神经节复合体(GCC)的厚度与眼轴长度的相关关系,以期指导临床应用。方法前瞻性病例分析研究。选取2014年5月至2014年10月期间在山东省眼科医院屈光中心就诊的患者连续性病例共93例(184只眼)。根据眼轴长度分为A组(眼轴22~24 mm),15例(29只眼);B组(眼轴>24~26 mm),50例(100只眼);C组(眼轴>26 mm),28例(55只眼)。眼部检查指标包括:眼轴长度、平均GCC厚度(Avg.GCC)、上方GCC厚度(Sup.GCC)、下方GCC厚度(Ing.GCC)、局部丢失容积(FLV)及总体丢失容积(GLV)。分析3组间GCC厚度的差异及眼轴长度与GCC厚度的相关关系。对数据进行单因素方差分析和Pearson相关性分析。结果 3组受试者眼轴长度分别为A组(23.31±0.53)mm,B组(25.20±0.49)mm,C组(26.91±0.99)mm;A组、B组、C组Avg.GCC分别为(97.19±5.09)μm、(92.74±5.50)μm、(92.84±5.74)μm,3组比较差异有统计学意义(P=0.001);3组Sup.GCC与Ing.GCC分别为(97.56±5.06)μm、(93.37±6.18)μm、(93.22±5.99)μm(P=0.002)和(96.83±5.51)μm、(92.11±5.80)μm、(92.47±5.96)μm(P=0.001),3组间比较二者差异均有统计学意义;GLV分别为(5.56±4.19)%、(8.28±5.46)%、(8.61±5.13)%,3组间比较差异有统计学意义(P=0.026)。此外,3组间FLV(%)比较无统计学意义(F=0.659,P=0.518)。Pearson分析结果显示:GCC厚度值参数与眼轴长度呈显著负相关(P<0.05)。结论 GCC厚度与眼轴长度呈负相关,随着眼轴变长,GCC厚度逐渐变薄。     

Bitemporal visual field defects mimicking chiasmal compression in eyes with tilted disc syndrome

BackgroundTilted disc syndrome (TDS) is a congenital optic nerve coloboma occurring from embryonic dysgenesis. Several features characterize TDS, including an inferiorly located conus, situs inversus of the major retinal vessels, and an anomalous disc shape. Commensurate with axonal dysgenesis, visual field defects may often occur from TDS, the most common of which involve the temporal and superior temporal visual field. These visual field defects can mimic those seen in chiasmal compression from a mass lesion.CasesFive patients from New South Wales, Australia, with distinct TDS and bitemporal visual field defects on frequency doubling threshold perimetry seemingly respecting the vertical hemianopic line are presented. Neuroimaging and medical evaluation of each failed to show intracranial chiasmal pathology in any patient.ConclusionsTDS can present with visual field loss resembling that seen in chiasmal disease. Although most cases of temporal visual field loss from TDS do not respect the vertical hemianopic line and are not true quadrantanopsias, there are instances in which this does occur, likely caused by the testing modality used. It is essential that patients with suspected intracranial pathology undergo immediate neuroimaging, even in the face of TDS.     

视盘参数与视野损害程度的关系

目的分析各项视盘参数与视野检查中视野平均光敏感度(mean sensibility,MS)和平均缺损(mean defect,MD)之间的关系。方法对2周之内完成海德堡视网膜断层扫描仪(Heidelberg retina tomography,HRT)和视野检查的201例(402眼)患者进行筛选,其中视野MD超过2dB,且屈光度及眼底表现不符合排除标准的103例患者(161眼)数据纳入分析。HRT检查参数包括视盘面积、盘沿面积、杯盘比、视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度及RNFL断层面积等。视野检查为中央30°,包括MS和MD。结果反映视野功能的指标为平均光敏感度(20.34±5.79)dB、视野平均缺损(6.94±5.47)dB;反映视盘参数的各项指标为视杯面积(1.02±0.59)mm2、视杯容积(0.29±0.25)mm3、平均视杯深度(0.29±0.13)mm、最高视杯深度(0.71±0.25)mm、视杯视盘面积比0.40±0.20、水平杯盘比0.64±0.18、垂直杯盘比0.54±0.25、平均RNFL厚度(0.23±0.10)mm和RNFL断层面积(1.29±0.61)mm2。MS与视杯面积(r=-0.413,P<0.001)和视杯容积(r=-0.267,P=0.001)显著相关,视野MD亦与视杯面积(r=0.405,P<0.001)和视杯容积(r=0.279,P<0.001)显著相关,但是MS、MD和平均、最高视杯深度的相关性均无统计学意义(均为P>0.05)。MS、MD与视杯视盘面积比、水平、垂直杯盘比均显著相关(均为P<0.01)。MS和MD与平均RNFL厚度和RNFL断层面积亦均显著相关(均为P<0.01)。MS与视盘面积的相关性无统计学意义(r=-0.124,P=0.117),与盘沿面积显著负相关(r=-0.383,P<0.001)。类似,MD与视盘面积的相关性无统计学意义(r=0.127,P=0.108),与盘沿面积显著负相关(r=-0.370,P<0.001)。结论对视野丢失患者而言,视杯的面积大小比视杯的深度对临床更有意义。盘沿面积、视杯视盘面积比、水平/垂直杯盘比、RNFL厚度和断层面积等均与视野丢失有相应关系。     

mGCC和pRNFL厚度及视野对新生血管性青光眼的诊断价值

目的:分析黄斑区节细胞复合体(mGCC)和视乳头周围视网膜神经纤维层(pRNFL)厚度及视野对新生血管性青光眼(NVG)的诊断价值。方法:回顾性研究。收集2018-01/2021-10本院收治的NVG患者92例100眼,按病理分期分为新生血管性青光眼前期患者31例32眼、开角型青光眼期患者31例36眼及闭角型青光眼期患者30例32眼。选择同期于我院接受健康体检者50例100眼者作为对照组。采用Pearson相关性分析mGCC、pRNFL厚度与MD的相关性,以受试者工作特征(ROC)曲线研究各指标诊断效能。结果:新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期mGCC-平均(a)、mGCC-上方(s)、mGCC-下方(i)厚度均低于对照组(均P<0.001),新生血管性青光眼前期、开角型青光眼期mGCC-a、mGCC-s、mGCC-i均高于闭角型青光眼期(均P<0.001),新生血管性青光眼前期mGCC-a、mGCC-s、mGCC-i均高于开角型青光眼期(均P<0.001)。新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期pRNFL-a、pRNFL-颞侧(t)、...     

睡眠呼吸障碍患者黄斑区神经节细胞复合体厚度研究

目的:比较不同程度睡眠呼吸障碍患者黄斑区神经节细胞复合体(GCC)的厚度变化。方法:采用横断面研究,收集2015-06/2018-06间于我校附属医院诊断为阻塞性睡眠呼吸障碍综合征的患者和健康体检者,将呼吸暂停低通气指数(AHI)≥5的58例患者纳入睡眠呼吸障碍组,根据AHI值将其分为轻、中、重度三个亚组,将AHI<5的50例健康体检者纳入对照组。采用RTVUE 100-2型相干光断层扫描检查仪对黄斑区视网膜进行扫描,测量黄斑区GCC总体平均厚度(GCC-Avg)、上方平均厚度(GCC-Sup)、下方平均厚度(GCC-Inf)、局部丢失容积(FLV)与整体丢失容积(GLV)。分析比较各组间GCC厚度的差异。结果:不同程度睡眠呼吸障碍组各区GCC厚度均较对照组变薄(P<0.05),但FLV和GLV均较对照组增加(P<0.05),不同程度睡眠呼吸障碍组组间FLV比较无差异(P>0.05),不同程度睡眠呼吸障碍组组间GLV比较有差异(P<0.05)。结论:随着睡眠呼吸障碍程度的加重黄斑区GCC厚度变薄。     

A comparison between Humphrey and frequency doubling perimetry for chiasmal visual field defects

PURPOSE: To evaluate and compare the diagnostic ability of frequency doubling technology perimetry (FDT) with standard automated perimetry (SAP) using Humphrey Field Analyser for the detection of visual field defects produced by chiasmal lesions. METHODS: Fifteen patients with documented chiasmal disease and previously diagnosed of bitemporal hemianopia with Humphrey perimetry were prospectively evaluated. All of them underwent a new SAP (SITA 24-2) followed by FDT tests (C-20 threshold). Diagnostic criteria for hemianopia were established according to the total deviation plot and the threshold values of FDT. A patient was diagnosed with hemianopia if one or both criteria were met. Based on these criteria, FDT sensitivity was calculated. Testing time and global indexes for both perimetric strategies were compared. RESULTS: The sensitivity of FDT was 75.0% (18 out of 24 eyes); the criterion based on threshold values was met more often (70.83%) than the criterion based on the total deviation plot (50.0%). Linear correlation was better for the external column than for the internal column of the visual field. Testing time with FDT was 122.16 seconds shorter than with SAP (p<0.001). The mean value for mean deviation (MD) was -13.62 dB (SD 6.88) for SAP and -8.83 dB (SD 5.94) for FDT (p<0.001). CONCLUSIONS: Compared with standard automatic perimetry, FDT has a low sensitivity for detecting temporal hemianopias and also has more difficulty in defining the vertical limits of the defects. Therefore, it does not appear to be an adequate method for the detection of chiasmal visual field defects.     

原发性青光眼早期视盘参数与视野缺损的关系

目的 探讨应用海德堡视网膜断层扫描仪(HRT-Ⅱ)检测原发性青光眼患者视盘参数改变及其与Humphrey 750检测视野改变间的关系.方法 49例原发性青光眼患者和30例对照个体分别行Humphrey 750视野与HRT-Ⅱ检查,每例患者的双眼间视盘损害与视野缺损间的对应关系彼此独立,双眼均被纳入研究.比较对照个体、慢性闭角型青光眼(CACG)、开角型青光眼(POAG)和正常眼压性青光眼(NTC)患者视乳头参数的差异,分析视乳头各项参数分别与各自视野指数(MD)间的相关性.将对照个体与原发性青光眼患者的视盘参数进行逐步判别分析,建立判别函数,筛选出诊断青光眼的敏感参数.结果 HRT-Ⅱ和Humphrey 750检测对照组、CACG组、POAC组和NTG组四组间视野平均缺损(1VID)、视杯面积(CA)、视盘面积(DA)、盘沿面积(RA)、视杯容积(CV)、盘沿容积(RV)、杯盘面积比(CDAR)、线性杯盘比(LCDR)、平均视杯深度(MCD)、最大视杯深度(max CD)、视杯形态(CSM)、视杯高度变异轮廓(HVC)、平均视网膜神经纤维层厚度(MRNFLT)、视神经纤维层横截面积(RCSA)等差异具有显著统计学意义(P<0.01).对照组中LCDR和MD呈直线线性相关,POAG组中DA、CA和MD呈直线线性相关,NTG组中CA、RA、CV、CDAR、HVC和MD呈直线线性相关.经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,得出回归方程MD=4.475×CV+5.338×HVC-0.480.诊断敏感的视盘参数为RA、RV、MRNFLT、CSM、HVC,判别函数式为D=2.767+0.312×RA +3.731×RV+4.294×MRNFLT-3.668×CSM-4.024×HVC.结论 临床上应用HRT-Ⅱ检测视盘参数与Humphrey750检测视野结果结合对照分析有助于原发性青光眼的早期诊断.     

Cystoid macular edema: a correlation between macular volumetric parameters and visual acuity

Objective

To study in patients with cystoid macular edema (CME) the correlation between macular volumetric parameters on ocular coherence tomography (OCT) and visual acuity (VA).

Design

A retrospective consecutive cohort design was used.

Participants

The sample included 167 examinations of 92 consecutive patients (130 eyes).

Methods

Patients underwent spectral-domain OCT for CME from the years 2008 to 2010 at a tertiary medical centre. Background and VA data were recorded from the files. The custom-developed Cystometer software was used to calculate volumetric parameters from the OCT videos.

Results

In univariate analyses, VA correlated best with cystoid macular volume (CMVol; R² = 8.57) and total macular volume (TMV; R² = 7.46). By underlying disease, the strongest correlation was found with CMVol (R² = 8.47) in patients with diabetic CME (n = 91) and with TMV (R² = 22.18) in patients with branch retinal vein occlusion (n = 46). In multiple regression analyses, TMV, age, and CMVol/TMV accounted for 17.57% of the variation in VA. In the diabetic CME group, CMVol/TMV and age accounted for 15.34% of the variation; in the branch retinal vein occlusion group, TMV accounted for 22.18% of the variation.

Conclusions

Macular volumetric parameters measured by OCT and Cystometer software significantly correlate with VA in patients with CME, with variations by underlying CME causative factor.     

小鼠视网膜胆碱能无长突细胞和方向选择性神经节细胞树突野发育的相关性研究

目的探讨小鼠视网膜方向选择性神经节细胞(DSGC)树突野(DF)的发育及其与胆碱能细胞阵列的关系。 方法选用中国科学院生物物理研究所实验动物中心繁殖的清洁级YFP(H)品系的转基因小鼠(种鼠来源于The Jackson实验室)共36只,0～1月龄,雌雄不限。对出生后不同发育时期(P8、P13及成年)的小鼠视网膜中ON/OFF DSGC及OFF DSGC的DF范围内包含的胆碱能细胞的数目采用单因素方差分析进行比较,当差异有统计学意义时,进一步两两比较。 结果ON/OFF DSGC作为经典的方向选择性神经节细胞,其树突具有两层树突结构,分别分布在视网膜内网状层的ON和OFF亚层中,其树突弯曲度和树突分支之间的夹角比较大,分支多向胞体方向返回呈半环状,显著的特点是同一细胞的树突不会发生交叉。P8时,D2亚类神经节细胞(即ON/OFF DSGC)DF范围中分别包含(25.6±4.8)个内核层(INL)的胆碱能无长突细胞和(28.4±5.7)个视网膜神经节细胞(GCL)的胆碱能无长突细胞(n＝7);P13时,D2亚类神经节细胞DF范围中分别包含(30.8±9.5)个INL的胆碱能无长突细胞和(35.2±10.4)个GCL的胆碱能无长突细胞(n＝10);成年时,D2亚类神经节细胞DF范围中分别包含(33.7±7.4)个INL的胆碱能无长突细胞和(32.1±5.6)个GCL的胆碱能无长突细胞(n＝9),三个时期的胆碱能无长突细胞的数目差异均无统计学意义(F＝2.16,1.55;P>0.05)。而视网膜中另外一种方向选择性神经节细胞OFF DSGC的DF范围内无长突细胞的数目从P8到P13先增多,然后从P13到成年又减少。P8时,该类细胞DF范围内位于GCL的无长突细胞数目为(20.0±2.5,n＝8)个,明显少于P13时的(32.0±7.1,n＝6)个;成年时,数目又减少到(23.7±7.5,n＝14)个。,三个时期的胆碱能无长突细胞的数目差异均无统计学意义(F＝6.19,1.55;P<0.05)。 结论小鼠视网膜ON/OFF DSGC的DF在出生后早期就已经发育成熟,并和胆碱能细胞形成稳定的联系,不再受后期双极细胞及光刺激的影响,而OFF DSGC的DF发育可能包含不同的分子和细胞机制。     

球内异物伤玻璃体切割术后黄斑形态改变与视力的相关性研究

目的 从黄斑形态改变方面探讨球内异物伤玻璃体切割术后低视力的可能原因.方法 观察行玻璃体切割手术的20只眼球内异物伤病例,术后3月行验光和黄斑OCT检查,测量黄斑中央小凹神经上皮层厚度(MNT),分析MNT及黄斑形态改变与预后视力的相关性.结果 球内异物伤玻璃体切割术后3月,黄斑前膜的发生率为50%,黄斑前膜组和正常形态组之间视力存在显著性差异;MNT值与视力之间存在相关性:MNT值越大,视力越差.结论 球内异物伤玻璃体切割术后黄斑形态异常以黄斑前膜的发生率最高,对视力有严重影响;黄斑中央小凹神经上皮层厚度越大,视力越差.     

Leber遗传性视神经病变视神经纤维层厚度及黄斑区神经节细胞复合体相关参数分析

目的观察Leber遗传性视神经病变（LHON）不同病变期患者的视网膜神经纤维层（RNFL）厚度和黄斑神经节细胞复合体（GCC）相关参数的变化特征。方法回顾性病例对照研究。纳入经线粒体基因检测确诊的LHON患者32例（64眼）,根据病变程度分为早期组18眼,进展期组22眼,晚期组24眼。选取眼部检查正常的健康志愿者60例（60眼）作为正常对照组。采用傅里叶频域光学相干断层扫描对所有受检者的视盘和黄斑区进行扫描,测量视盘平均、上方、下方、颞上、颞下、鼻上、鼻下、颞侧偏上、颞侧偏下、鼻侧偏上、鼻侧偏下象限的RNFL厚度等参数以及黄斑平均GCC、上方GCC、下方GCC厚度和局部丢失体积（FLV）、整体丢失体积（GLV）值。组间比较采用单因素方差分析。结果LHON早期组颞上、颞侧偏上、颞侧偏下、颞下、鼻下、上方、下方及平均RNFL厚度较正常对照组厚（P<0.05）;进展期组颞侧偏上、颞侧偏下、鼻侧偏下较正常对照组薄（P<0.05）;晚期组各象限RNFL厚度分别较正常对照组、早期组、进展组明显薄（P<0.05）。与正常对照组比较,LHON各期组平均GCC厚度、上方GCC厚度及下方GCC厚度均明显较薄（F=61.7、39.5、61.5,P<0.01）,FLV、GLV值均增大（F=29.6、40.8,P<0.01）。结论LHON发病早期,RNFL增厚,黄斑GCC明显变薄;病情进展期,颞侧和下方RNFL变薄,黄斑GCC进一步变薄;晚期各象限RNFL及黄斑GCC显著变薄。LHON发病存在慢性潜在性损害,且表现为急性发作的特征。     

Prevention of visual field defects after macular hole surgery

BACKGROUND/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. METHODS: 102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. RESULTS: In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. CONCLUSION: The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to differ from eyes in which a complete posterior vitreous detachment has been effected during surgery.