Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at 18 months

Sixty-five eyes with giant retinal tears previously reviewed at 6 months after vitrectomy and fluid/silicone-oil exchange were again reviewed 18 months after surgery. The retina remained attached in 54 eyes (83%), and of these 32 (57%) had visual acuities of 6/60 or better. Poor acuities were attributed in most cases to cataract associated with silicone-oil contact or macular damage from preoperative macular detachment. Glaucoma occurred chiefly in those eyes which were aphakic prior to surgery, or were rendered aphakic at surgery, but did not influence the visual outcome at this stage. Encouraging results of surgery after 6 months were confirmed after 18 months, although the level of vision had fallen in some cases due to the development of lens opacities.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up

A series of 64 eyes, in 64 patients with giant retinal tears, treated by vitrectomy and fluid/silicone-oil exchange, has been reviewed after 5 years. Anatomical success was achieved in 73% of cases and visual function in successful cases ranged from 6/6 to NPL; 66% achieved acuities of 6/60 or better and 32% had vision of 6/18 or better. These results compare favourably with those in a previous series reported after 6 months and 18 months. Epiretinal membrane proliferation and shortening accounted for the majority of retinal redetachments while macular abnormalities, especially pucker, were responsible for a poor visual outcome. Glaucoma is the most serious long-term complication of the surgical method and occurs most frequently in aphakic eyes. Retention of the crystalline lens, whenever possible, the creation of a 6 o'clock iridectomy in aphakic eyes, early removal of silicone oil and a conservative approach to the use of scleral buckles are recommended.Presented at the XVIth Meeting of the Club Jules Gonin, Bruges, 4–8 September 1988     

特发性黄斑裂孔手术前后矫正视力及多焦视网膜电图比较

目的 观察特发性黄斑裂孔(IMH)玻璃体切割手术(PPV)联合吲哚青绿(ICG)辅助内界膜剥除治疗前后的矫正视力及多焦视网膜电图(mfERG)的改变.方法 回顾分析我科接受PPV联合0.25%ICG辅助内界膜剥除治疗的特发性黄斑裂孔患者19例19只眼的临床资料.所有患眼手术前裂孔情况和手术后2个月裂孔闭合情况均以OCT检查为依据.采用VERIS Science 4.9视觉诱发反应图像系统观察手术前及手术后2、6、12个月患者mfERG6个环形视网膜区域mfERG的P1波振幅密度,同时分析比较手术前后最佳矫正视力的改变情况.结果 手术后2个月,OCT检查显示16例16只眼黄斑裂孔闭合,占84.21%;3例3只眼黄斑裂孔未闭合,占15.79%.手术后最佳矫正视力较手术前提高,其中以手术后2个月提高幅度最大(F=6.389,P=0.045).手术后2、6、12个月mfERG各环P1波振幅较手术前均明显降低,其差异均有统计学意义(t=6.140,P＜0.05).结论 IMH患者手术后最佳矫正视力提高;手术后P1波振幅较手术前降低.     

Outcomes of bilateral macular hole surgery

BACKGROUND AND OBJECTIVE: Characteristics and outcomes in patients undergoing macular hole surgery in both eyes are studied. MATERIALS AND METHODS: Demographic and clinical data were abstracted from patients' medical records for a retrospective study of 31 consecutive patients (62 eyes) who underwent macular hole surgery in both eyes between 1992-1998. Outcome measures included best corrected Snellen visual acuity and status of the macular hole 3 months after surgery. RESULTS: The duration of symptoms was 5.5 months at the time of surgery in the first eye and 9.8 months in the second operated eye (P= 0.063). The macular hole was closed after surgery in both eyes (17), only in the first eye (6), only in the second eye (6), and not closed in either eye (2) (P = 0.9) (46/62, 74% eyes overall). With reoperation 55/62 (89%) were closed. In eyes with a closed macular hole, the visual acuity improved 2 or more lines in 20 (88%) first eyes and 12 (52%) of the second eyes (P = 0.02). Cataract surgery was performed in 12 (41%) first eyes and 13 (45%) second eyes within 1 year of the initial macular hole surgery. The occurrence of cataract surgery in the second eye correlated with the first eye (P= 0.017). CONCLUSION: Macular hole surgery is usually successful in one or both eyes. Surgical results in the second eye do not appear to correlate with the results in the first eye.     

Retinal detachment associated with macular hole surgery: characteristics, mechanism, and outcomes.

OBJECTIVE: To study the frequency, features, and outcomes of retinal detachment (RD) occurring after macular hole surgery. METHODS: Retrospective review of all cases of macular hole surgery. Cases with postoperative RD were identified for study. Outcome measures included baseline demographic and ocular characteristics, RD features, surgical procedure, macular hole status, and final visual and anatomic outcomes. RESULTS: Retinal detachment occurred in 8 (1.8%) of 438 eyes undergoing macular hole surgery. The rate of RD was 3.5% early in the course of the surgeon's experience (first 200 cases) and 0.4% later in the surgeon's experience (after 200 cases) (P = 0.026). Two of the eight eyes with RD had undergone previous macular hole surgery. All six primary cases occurred after repair of stage 3 macular holes, which had involved peeling of the posterior cortical face. The RD involved the inferior quadrants in seven eyes and the macula in two eyes. The pathogenic retinal break was in the equatorial region in four eyes, was anterior to the equator in two eyes, and remained undetermined in two eyes. The retina was attached and the macular hole was closed in all cases at the final follow-up examination (mean 30 months). The macular hole reopened 2 years following successful reattachment of the RD in one eye. Final visual acuity was > or =20/60 in four eyes and <20/200 in one eye. CONCLUSION: Retinal detachment after macular hole surgery is uncommon, and may be related to posterior cortical vitreous stripping. Early detection of RD minimizes adverse visual and anatomic outcomes.     

The behavior of surgically repaired idiopathic macular holes in the setting of subsequent cystoid macular edema

PURPOSE: To report findings for eyes with surgically repaired idiopathic macular hole that subsequently developed cystoid macular edema (CME). METHODS: This study was a retrospective chart review of six eyes of six consecutive patients evaluated between January 1997 and October 2000 who had successful macular hole repair and subsequently developed CME. Patient demographic data, cause and time course of CME, treatment, and outcomes, including macular hole reopening, were recorded. RESULTS: CME developed after cataract extraction in five eyes and after macular hole surgery alone in one eye. Average time from macular hole surgery to diagnosis of CME was 11.2 months (range, 2.5-23.0 months). Average duration of CME was 5.5 months (range, 1.5-17.0 months). Five (83%) of 6 eyes had sustained closure of the macular hole throughout a mean follow-up period of 31.8 months (range, 9.5-62.0 months). Patients were treated with topical antiinflammatory therapy, and all had resolution of CME. CONCLUSIONS: CME developing in eyes with surgically repaired idiopathic macular holes responds well to conventional topical antiinflammatory therapy and is not associated with a high incidence of macular hole reopening. These results suggest that in most eyes the reparative mechanisms involved in macular hole closure confer sufficient strength to withstand the tensile forces associated with CME.     

Frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide

PURPOSE: To evaluate the frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide in elderly patients. METHODS: This clinical interventional case series study included 144 phakic eyes that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide for diffuse diabetic macular edema (n=42 eyes), exudative age-related macular degeneration (n=98), and branch retinal vein occlusion (n=4). Mean age was 72.3-/+8.9 years. Mean follow-up was 11.0-/+6.8 months (median, 8.8 months; range, 3 to 35.5 months). Reinjections were carried out in 12 (8.3%) eyes. RESULTS: Cataract surgery was performed in 20 (13.9%) eyes 17.4-/+9.1 months (median, 12.7 months; range, 8.0 to 35.5 months) after the first intravitreal injection. Out of the 20 eyes undergoing cataract surgery, 19 (95%) eyes had received one intravitreal injection, and 1 (5%) eye had received two previous injections. CONCLUSIONS: In the elderly population of patients with exudative age-related macular degeneration, diffuse diabetic macular edema, or branch retinal vein occlusion, intravitreal high-dosage injection of triamcinolone acetonide leads to clinically significant cataract with eventual cataract surgery in about 15% to 20% of eyes within about 1 year after the intravitreal injection.     

Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia

PURPOSE: To report the results of limited macular translocation in subfoveal choroidal neovascularization resulting from age-related macular degeneration or degenerative myopia. METHODS: The first consecutive 32 patients (23 age-related macular degeneration eyes and nine myopic eyes) were operated on with the limited macular translocation technique described by de Juan. Before and after surgery, a complete examination included fluorescein and indocyanine-green angiographies and optical coherence tomography. Mean follow-up was 9 months in the age-related macular degeneration group (range, 6 to 14 months) and 10 months in the myopic group (range, 6 to 15 months). RESULTS: The improvement in visual acuity was better in the myopic group than in the age-related macular degeneration group and was correlated with younger age in the myopic group (P <.05). At the end of follow-up, visual acuity improved by 2 lines or more in seven age-related macular degeneration eyes (30%), including four eyes (13%) with an improvement of 6 lines or more, and in six myopic eyes (67%), including two eyes (22%) with an improvement of 6 lines or more. Final visual acuity was unchanged in four age-related macular degeneration eyes (17%) and three myopic eyes (33%), and decreased in 12 age-related macular degeneration eyes (52%). Conversely, the mean foveal displacement was greater in age-related macular degeneration than in myopia (1,105 microm and 685 microm, respectively; P <.05). Main complications were retinal detachment (six eyes), neovascularization at the injection site (two eyes), and recurrence of neovascularization (43% of the age-related macular degeneration group and 11% of the myopic group). CONCLUSIONS: Limited macular translocation allowed a significant improvement in visual acuity in some eyes with subfoveal neovascularization and resulted in a moderate rate of complications. Longer follow-up and additional studies are required to confirm these findings.     

Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia

AMS: To describe the characteristics and surgical outcomes of full thickness macular hole surgery after laser assisted in situ keratomileusis (LASIK) for the correction of myopia. METHODS: 13 patients (14 eyes) who developed a macular hole after bilateral LASIK for the correction of myopia participated in the study. RESULTS: Macular hole formed 1-83 months after LASIK (mean 13 months). 11 out of 13 (84.6%) patients were female. Mean age was 45.5 years old (25-65). All eyes were myopic (range -0.50 to -19.75 dioptres (D); mean -8.4 D). Posterior vitreous detachment (PVD) was not present before and was documented after LASIK on 42.8% of eyes. Most macular hole were unilateral, stage 4 macular hole, had no yellow deposits on the retinal pigment epithelium, had no associated epiretinal membrane, were centric, and had subretinal fluid. The mean diameter of the hole was 385.3 microm (range 200--750 microm). A vitrectomy closed the macular hole on all eyes with an improvement on final best corrected visual acuity (VA) on 13 out of 14 (92.8%) patients. CONCLUSIONS: This study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with a macular hole after LASIK.     

Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling

PURPOSE: To determine the pathogenesis of macular hole recurrence after vitreous surgery and to evaluate internal limiting membrane (ILM) peeling to prevent recurrence. METHODS: We conducted a retrospective, nonrandomized, comparative trial in which we performed pars plana vitrectomy with intravitreal gas injection on 161 consecutive eyes with macular holes without ILM peeling between September 1993 and June 1996 and on 150 consecutive eyes with ILM peeling between July 1999 and January 2003. Closure and reopening rates with and without ILM peeling were compared, and the evolution of recurrence was evaluated. RESULTS: The macular holes closed in 85% of eyes without ILM peeling and in 94% of eyes with ILM peeling during the initial surgery. During mean follow-ups of 25 months and 30 months with and without ILM peeling, respectively, macular holes reopened in 6 eyes (4%) without ILM peeling; the macular holes did not reopen in any eye in which the ILM was peeled. Reopening first occurred 6 months to 48 months after the initial surgery and was associated with an epiretinal membrane (ERM) around the macular hole. The macular holes in four eyes closed permanently after repeated removal of a perifoveal ERM. The holes in the remaining two eyes closed permanently after ILM peeling after reopening occurred six and three times. CONCLUSIONS: Macular holes reopen because of tangential contraction of the ERM postoperatively. ILM peeling prevents macular hole reopening by inhibiting recurrence of the ERM.     

Anatomical and visual outcomes of idiopathic macular hole surgery with internal limiting membrane removal using low-concentration indocyanine green

PURPOSE: To report the anatomical, visual, and optical coherence tomography (OCT) results of using a brief application of a low concentration of indocyanine green (ICG) to assist the removal of internal limiting membrane (ILM) during idiopathic macular hole repair. METHODS: Retrospective, interventional, noncomparative case series of 59 eyes of 57 patients with stage 2, 3, or 4 idiopathic macular holes who underwent pars plana vitrectomy with removal of ILM assisted by a brief (<30 seconds) intravitreal application of 0.125% (1.25 mg/mL) ICG. RESULTS: The median follow-up period was 13 months (range, 2-40 months). Anatomical closure of the macular hole was achieved in 58 eyes (98%) with a single surgery. Visual acuity improved from a preoperative mean of 20/100 to 20/60 postoperatively (P < 0.0001). Twenty-nine eyes (49%) had postoperative visual acuity of 20/50 or better. Visual acuity improved by > or =2 lines in 43 eyes (73%) and between 0 and 2 lines in 13 eyes (22%) and decreased in 3 eyes (5%). Postoperative OCT showed closure of macular hole with normal foveal depression in 49 (89%) of 55 eyes. CONCLUSION: A brief application of ICG at a low concentration appears to provide a safe and effective way of assisting ILM peeling during idiopathic macular hole surgery.     

Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study

PURPOSE: To investigate the findings in optical coherence tomography (OCT) in eyes with metamorphopsia after scleral buckling surgery for macula-off retinal detachment. METHODS: A total of 46 patients (46 eyes) with macula-off retinal detachment were prospectively studied 2 months after successful scleral buckling surgery. Patients were examined with the Amsler grid, fundus biomicroscopy and OCT. RESULTS: At the 2 month follow-up, 31/46 (67%) patients had metamorphopsia; 24/31 (77%) of these patients had an abnormal macular structure on OCT and 7/31 (23%) showed a normal macula. However, of the 15 patients in the non-metamorphopsia group, 4/15 (27%) had an abnormal macula and 11/15 (73%) had a normal macula (p = 0.0015). The most common finding on OCT was neurosensory retinal detachment. CONCLUSIONS: Metamorphopsia after scleral buckling surgery in macula-off detachment is more common in patients in whom abnormal macular structure is seen on the OCT scan compared to those showing a normal macular structure. Neurosensory retinal detachment is the most common pathology in these patients.     

Inzidenz und Ausprägung von postoperativem Makulaödem nach Makulaforamenoperation mit und ohne kombinierte Kataraktoperation

PURPOSE. In the majority of patients with full-thickness macular hole, closure can be achieved with vitreoretinal surgery techniques. However, postoperative function is variable and the prognostic determinants for visual acuity are incompletely understood. We evaluated the incidence and extent of macular edema after macular foramen surgery with and without combined cataract-surgery. METHODS. Between October 1997 and March 2001 macular foramen surgery was performed in 125 eyes from 116 patients. Fluorescein angiograms with sufficient quality were obtained from 59 eyes using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph, HRA, Heidelberg Engineering, Heidelberg) and were evaluated by two independent observers. RESULTS. Angiographic macular edema was noted on average 4.2 months after the operation in 47 out of 59 (79.7%) eyes. The incidence of macular edema was 87% in eyes after a combined cataract operation compared to 66.7 % in eyes with no simultaneous operation ( p=0.735). Mean postoperative visual acuity was 0.4 (min 0.1-max 1.2) with no significant difference between eyes with (4.1 lines) and without macular edema (3.5 lines) with regard to visual improvement from baseline. CONCLUSIONS. The results indicate a high incidence of macular edema in eyes after macular hole surgery with subsequent anatomical success. Apparently, the presence of macular edema is not associated with short term visual impairment. Furthermore it seems that a combined cataract operation compared to a consecutive procedure is not associated with disadvantages regarding the functional outcome.     

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.     

Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema

PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edema refractory to laser photocoagulation. DESIGN: Prospective, consecutive, interventional case series. METHODS: Diabetic patients with biomicroscopic, angiographic, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for inclusion. Patients with biomicroscopic evidence of epiretinal membrane or taut posterior hyaloid, previous vitreoretinal surgery, or active proliferative diabetic retinopathy were excluded. The main outcome measures were macular thickness, as measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS: PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six women; mean age = 58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20% in eight of 11 eyes (mean preoperative thickness of 421 mum compared with mean postoperative thickness of 188 mum; P = .007). Mean VA improved from 20/352 to 20/94 at 6 months (P = .002). By the most recent visit (range = 6-20 months postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in some eyes with chronic diabetic macular edema unresponsive or unamenable to additional laser photocoagulation.     

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.     

Surgical management of exudative maculopathies: preliminary report.

A new surgical approach to the management of exudative maculopathies has been developed including the transvitreal route. As a result of surgery the subretinal spaces are drained and their viscous content removed. A special tool was designed for this operation. The method has been clinically tested on 32 patients (32 eyes) with different forms of age-related macular degeneration in the phase of complicated pigment epithelium detachment and on six patients (six eyes) with myopic exudative maculopathy. The follow-up ranged from 6 to 32 months. No fluid reappeared in the macular zone in patients with age-related macular degeneration, except one; visual function improved in 26 out of 32 cases (81.3%). Similar results were obtained in all six patients with myopic exudative maculopathy.     

Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery

Purpose

To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).

Methods

We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.

Results

Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.

Conclusions

The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.     

Surgical treatment of macular holes with multiple recurrences

PURPOSE: To evaluate the results of a third macular hole surgery in eyes with recurrent macular holes and two prior macular hole surgeries. DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Sixteen eyes of sixteen patients with two prior macular hole surgeries with recurrent macular hole. INTERVENTION: A third vitreous surgery was performed in each eye using a long-acting gas bubble. MAIN OUTCOME MEASURE: Closure of the macular hole and change in visual acuity. RESULTS: The macular hole was closed in 12 of 16 eyes (75%) at 3 months after the third surgery. Visual acuity improved 2 or more Snellen lines in 9 of 16 eyes (56%), and 5 of 16 eyes (31%) achieved 20/40 or better vision. Six eyes (37.5%) had cataract surgery after the third macular hole surgery, and visual acuity results were similar in eyes with or without cataract surgery. Successful closure of the macular hole improved the visual acuity from 20/80 -1 to 20/50 +1 (P < 0.001). Eyes in which one of the previous surgeries had been temporarily successful in closing the macular hole improved from a mean of 20/80 to 20/40 (P = 0.003). Eyes in which both prior macular hole surgeries had been primary failures had minimal benefit with a preoperative visual acuity of 20/100 +1 and a postoperative visual acuity of 20/100 +2 (P = 0.67). CONCLUSIONS: Repeat macular hole surgery should be considered in eyes with recurrent macular holes and two prior surgeries when the macular hole was temporarily closed by at least one of the two previous surgeries. Successful closure of a macular hole in such cases usually results in significant visual acuity improvement.     

Changes in focal macular ERGs after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To evaluate the short- and long-term changes of focal macular electroretinograms (fmERGs) after macular translocation with 360 degrees retinotomy. METHODS: This was a retrospective study. fmERGs were recorded in 19 eyes of 19 consecutive patients who underwent macular translocation with 360 degrees retinotomy for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD; 17 eyes) or polypoidal choroidal vasculopathy (2 eyes). The changes in the fmERGs, recorded before, shortly after (6-12 months; mean 8.3 months), and more than 18 months (18-30 months; mean 22.4 months) after surgery from 12 eyes, were analyzed. A 15 degrees stimulus centered on the fovea was used to elicit the fmERGs. RESULTS: The mean logarithm of minimum angle of resolution (logMAR) was 1.06 +/- 0.07 (20/230) before surgery, 0.78 +/- 0.08 (20/121) early after surgery (n = 19), and 0.64 +/- 0.07 (20/87) late after surgery (n = 12). These improvements in visual acuity were significant (P = 0.0074, P = 0.0050, respectively). Before surgery, the amplitudes of all components of the fmERGs were markedly reduced in all eyes. The mean b-wave amplitude in 17 AMD eyes recorded early after surgery was significantly larger (P = 0.0262), and the mean a-wave amplitude was also increased but not significantly (P = 0.1180). The mean amplitudes of the a- and b-waves in 10 AMD eyes recorded after 18 months were significantly larger than those before the surgery (P = 0.0218, and P = 0.0284). The mean implicit time of the b-wave in 17 AMD eyes decreased early after surgery, and a further decrease was detected at the later testing time. CONCLUSIONS: These results indicate that macular function is partially recoverable after macular translocation in some patients.