scholarly journals Early Vascular and Functional Changes after Vitreoretinal Surgery: A Comparison between the Macular Hole and Epiretinal Membrane

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1031
Author(s):  
Rossella D’Aloisio ◽  
Paolo Carpineto ◽  
Agbéanda Aharrh-Gnama ◽  
Carla Iafigliola ◽  
Luca Cerino ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Epiretinal Membrane ◽  
Vitreoretinal Surgery ◽  
Macular Area ◽  
Functional Changes ◽  
Corrected Visual Acuity ◽  
Capillary Plexus ◽  
Best Corrected Visual Acuity ◽  
25 Gauge Vitrectomy

(1) Background: The aim of this observational comparative study was to investigate early retinal vascular and functional changes in patients undergoing vitreoretinal surgery for idiopathic epiretinal membrane (iERM) or macular hole (MH) using a widefield swept-source optical coherence tomography angiography (WSS-OCTA). (2) Methods: Forty one diseased eyes were enrolled in the study. Twenty three eyes with iERM diagnosis (ERM group) underwent 25-gauge vitrectomy with inner limiting membrane (ILM) and MER peeling, while eighteen eyes with MH (MH group) underwent 25-gauge vitrectomy with inverted flap technique. Functional and anatomical/perfusion parameters were evaluated pre- and postoperatively in all eyes by means of WSS-OCTA system, microperimetry (MP3), best corrected visual acuity assessment, central macular thickness (CMT) and MH diameter calculation. For each eye, 12 × 12 mm OCTA volume scans were acquired by a retinal specialist and a semi-automated algorithm was used for a quantitative vessel analysis of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC). In detail, perfusion density (PD) of the SCP, DCP and CC was evaluated in four circles (one central in the macular area of 5 mm diameter; three midperiphery circles (temporal, superior and inferior) of 3 mm). In addition, the vessel length density (VLD) of the SCP and DCP for the same circles was quantified. (3) Results: In the MH group, PD of the SCP significantly increased in the macular area (p = 0.018) and in the superior ring (p = 0.016); PD of the DCP significantly increased in the macular area (p = 0.015) and in the superior and inferior ring (p = 0.016) 3 months after surgery. In the ERM group, PD of the SCP and DCP significantly increased in the macular area and superior ring, respectively (p = 0.001; p = 0.032), 3 months after surgery. During follow-up there was a significant improvement in terms of functional (Best corrected visual acuity, p = 0.007 and p = 0.029; microperimetry ((MP3) 10°, p = 0.003 and p = 0.004; MP3 2°, p = 0.028 and p = 0.003 in MH group and ERM group respectively) and anatomical parameters (CMT, p = 0.049 in ERM group; hole complete closure in MH group). (4) Conclusions: After vitreoretinal surgery, early retinal vascular and functional changes can be promptly observed and quantified to monitor and potentially predict surgery outcomes. Widefield OCTA devices allow for a detailed microvasculature analysis of retina and choriocapillaris in the macular area and in the periphery, showing a different behaviour of retinal sectors in two distinct vitreoretinal disorders.

scholarly journals Optic coherence tomography angiography follow-up in a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome

2019 ◽  
Vol 30 (3) ◽  
pp. NP14-NP17 ◽  
Author(s):  
Juan Francisco Santamaría Álvarez ◽  
Anna Serret Camps ◽  
Javier Aguayo Alvarez ◽  
Olga García García
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Hemolytic Uremic Syndrome ◽  
Optical Coherence Tomography Angiography ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Capillary Plexus ◽  
Uremic Syndrome ◽  
Best Corrected Visual Acuity

Purpose: To report a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome and the changes seen in the optical coherence tomography angiography before and after treatment with eculizumab. Case description: A 22-year-old man with an unremarkable medical history presented with acute, bilateral blurred vision and headache of 1-week duration. Best corrected visual acuity of 20/50 and 20/40, respectively, in the patient’s right eye and left eye. Funduscopy revealed multiple cotton-wool spots associated with intrarretinal fluid. Swept source optical coherence tomography revealed multifocal retinal detachments with increased choroidal thickness. Optical coherence tomography angiography showed areas of ischemia in both capillary plexus. Due to concurrent symptoms and laboratory analysis, he was diagnosed with atypical hemolytic uremic syndrome and secondary Purtscher-like retinopathy; therefore, treatment with eculizumab was initiated. After 2 months revascularization of the previous ischemic areas was seen in the optical coherence tomography angiography that were correlated with best corrected visual acuity improvement. Conclusion: Our findings suggest that evaluation of the macular capillary plexus revascularization by optical coherence tomography angiography during the disease could help to predict an improvement of best corrected visual acuity in these patients and the measurement of choroidal thickness could give us information about the resolution of the pathologic process.

Surgical management of a case of contractile peripapillary staphyloma with retinal detachment and macular hole

2020 ◽  
pp. 112067212092022
Author(s):  
Sofía H Vidal ◽  
Diego Bueso Ponce ◽  
Juan Esteban Unigarro ◽  
Sergio Arrascue Limo ◽  
Carlos Abdala Caballero
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Hole ◽  
Retinal Pigment ◽  
Silicon Oil ◽  
Corrected Visual Acuity ◽  
Intraocular Gas ◽  
Best Corrected Visual Acuity ◽  
Peripapillary Staphyloma

A healthy 4-year-old male presented a fundus examination with a unilateral contractile peripapillary staphyloma surrounded by redundant retina and retinal pigment epithelium atrophy. Five years later, best-corrected visual acuity decreased to hand motion due to a retinal detachment with macular hole. One month after first vitrectomy, scleral buckle and intraocular gas, retina re-detached. Second surgery was performed with silicon oil tamponade and lensectomy without intraocular lens (IOL). Subretinal silicon oil was detected at the third month of follow-up when vitrectomy, inferior retinectomy, and laser photocoagulation of temporal border of staphyloma with silicon oil tamponade were performed. The retina remained attached and best-corrected visual acuity was 20/600 with intraocular silicon oil. A fourth surgery was performed for emulsified silicon oil extraction replaced with intraocular gas. At 6 months of follow-up, the retina re-detached again. This is a challenging vitreoretinal surgery in which re-detachments were due to retinal folds around the contractile staphyloma that raised macular hole. This is the first report of the combined presentation of contractile peripapillary staphyloma, retinal detachment and macular hole with a long-time follow-up period of years.

scholarly journals Rapid progression of chorioretinal atrophy in punctate inner choroiditis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuka Kasuya ◽  
Yuji Inoue ◽  
Satoru Inoda ◽  
Yusuke Arai ◽  
Hidenori Takahashi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Epiretinal Membrane ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Japanese Woman ◽  
Rapid Progression ◽  
Chorioretinal Atrophy ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Abstract Background The chorioretinal inflammatory lesions occurring in punctate inner choroiditis evolve into punched-out atrophic scars. Typically, the progression is gradual. We report a case of highly myopic punctate inner choroiditis with rapid progression of chorioretinal atrophy. Case presentation A 48-year-old Japanese woman with high myopia presented with decreased visual acuity. Best-corrected visual acuity was 20/28 in the right eye and 20/16 in the left eye; axial length was 29.0 mm and 28.7 mm, respectively. Fundoscopy revealed an epiretinal membrane in the left eye. Three years later, the best-corrected visual acuity in the left eye had decreased to 20/33; at this time, the patient underwent vitrectomy with epiretinal membrane and internal limiting membrane peeling in this eye. Six months later, the best-corrected visual acuity in the left eye decreased suddenly to 20/100. Optical coherence tomography showed a nodule-like lesion in the outer retina with disruption of the retinal pigment epithelium and a focally thickened choroid, compatible with PIC. One month later, the choroidal thickness had decreased. The central chorioretinal atrophy expanded rapidly at a rate of 0.45 mm2/year over the next 3 years, and new areas of patchy focal chorioretinal atrophy developed in the perifovea. Conclusions Rapid progression of chorioretinal atrophy was observed in a patient with punctate inner choroiditis. Because punctate inner choroiditis is often associated with degenerative myopia, the retina is fragile and may be susceptible to mechanical damage. This case report alerts clinicians to the need for careful management of patients with punctate inner choroiditis, especially after vitrectomy.

scholarly journals Evaluation of vision-related quality of life with autologous internal limiting membrane transplantation for refractory macular hole.

2019 ◽  
Author(s):  
dongqing yuan ◽  
Weiwei Zhang ◽  
Songtao Yuan ◽  
Ping Xie ◽  
Qinghuai Liu
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Corrected Visual Acuity ◽  
Hole Index ◽  
Related Quality ◽  
Best Corrected Visual Acuity

Abstract Background: To evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane(ILM) transplantation for refractory macular hole． Methods: A prospective and nonrandomized clinical study was carried out. There were fourty eyes with refractory macular hole included and all eyes received 23G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded, including best corrected visual acuity (BCVA), intraocular pressure, central retinal thickness (CRT) measurement by Optical coherence tomography (OCT) examination, macular hole index (MHI) and operative complications. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the visual related quality of life of patients after operation. The correlation between the quality of life and the postoperative visual acuity and the size of the macular hole before operation was tested by Spearman rank correlation test. Results: All patients were followed up for three months after surgery, and 38 patients achieved anatomical closure. The mean postoperative logMAR BCVA was 1.09±0.33, which has significantly improved than that before operation (P=0.000). The vision-related quality of life of patients after surgery was closely related to the macular hole index (r=0.375, P=0.017), but was negatively correlated with the best corrected visual acuity before and after surgery (r=-0.495, P=0.001; r=-0.760，P=0.000). It was also found that the vision-related quality of life of patients positively correlated with the postoperative CRT ( r=0.414，P=0.008). Conclusions: The anatomical structure of refractory macular hole patients with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of the patients improved significantly. Meanwhile, the vision-related quality of life was significantly improved after surgery. Trial Registration: ChiCTR-INR-16008660, date of registration: 2016/06/17

Implantation of multifocal lens in cataract surgery in patients after vitreoretinal surgery

2021 ◽  
pp. 10-12
Author(s):  
U.R. Altynbaev ◽  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Cataract Surgery ◽  
Macular Hole ◽  
Epiretinal Membrane ◽  
Vitreoretinal Surgery ◽  
Long Distance ◽  
Uncorrected Visual Acuity ◽  
Lens Implantation ◽  
Multifocal Lens

Purpose. To study the results of cataract surgery with implantation of multifocal IOLs in patients with various retinal pathologies who underwent vitreoretinal surgery. Material and мethods. Fifteen patients who had previously undergone vitreoretinal interventions for macular hole (n=6), epiretinal membrane (n=4) and retinal detachment (n=5) were observed. The criterion for choosing in favor of multifocal lens implantation was high visual acuity (0.7 or more) after undergoing vitreoretinal surgery. All patients underwent cataract phacoemulsification with implantation of two types of multifocal lenses: I group – IOL with an extended near focus (EDOF) (n=8) and II group – with a multifocal three-focus lens (n=7 eyes), including, in 3 cases – with toric component. In 55% of cases, the operation was performed on both eyes. The age of the patients varied from 34 to 59 years (51.4 ± 6.1 years). Results. Long-distance uncorrected visual acuity varied from 0.7 to 1.0 (0.85±0.25), which did not depend on the type of intraocular lens and correlated with morphological changes in the macular region of the retina. The highest uncorrected visual acuity (0.8±0.14) at an intermediate and near distance (0.75±0.25) was achieved in I group of patients. Postoperative spherical equivalent after 1 month corresponded to the planned target refraction (Em±0.5 diopters) in 14 cases and remained stable during 12 months of observation. In general, subjective satisfaction with MIOL implantation was higher in patients in II group, which was explained by minimal changes in the macular region of the retina. Additional spectacle correction for near was required for a patient of I group with a history of macular rupture, who underwent bilateral multifocal IOL implantation with high uncorrected visual acuity in the distance (OD=1.0 \ OS=1.0) and near (OD=0.6 \ OS=0,5). Conclusion. Implantation of multifocal lenses in patients with a good anatomical and functional outcome of vitreoretinal surgery allows obtaining high and stable functional results. Bilateral implantation of a multifocal lens with an extended near focus in patients with operated macular pathology does not cause specific adaptive difficulties in binocular vision. The choice in favor of multifocal lens implantation in patients with vitreoretinal pathology requires an individual approach and careful selection. Key words: multifocal lens, cataract, macular hole, retinal detachment, epiretinal membrane.

scholarly journals Macular Hole Progression following Ocriplasmin Intravitreal Injection

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Edward Casswell ◽  
Guillermo Fernandez-Sanz ◽  
Danny Mitry ◽  
Sheila Luk ◽  
Rahila Zakir
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Intravitreal Injection ◽  
Macular Hole ◽  
Optical Coherence ◽  
Vitreomacular Adhesion ◽  
Blurred Vision ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Ocriplasmin is a protease which has been approved for the treatment of symptomatic vitreomacular adhesion (VMA). A 63-year-old presented with blurred vision in the left eye and a best corrected visual acuity of 6/18. Optical coherence tomography revealed VMA with an underlying macular hole and she subsequently underwent a left intravitreal ocriplasmin injection. One week after the injection, VMA had been released but with enlargement of the macular hole and a drop in her BCVA to 6/60. This persisted at 1 month after the injection. It is important to warn patients that ocriplasmin may lead to an enlargement of their macular hole with resultant loss in visual acuity.

Lamellar macular hole in diabetic retinopathy

2019 ◽  
pp. 112067211987966
Author(s):  
Bo-I Kuo ◽  
Chung-May Yang ◽  
Yi-Ting Hsieh
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Macular Hole ◽  
Surgical Outcomes ◽  
Lamellar Macular Hole ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Anatomical Outcomes ◽  
Best Corrected Visual Acuity

Purpose: To describe the clinical features and surgical outcomes of diabetic retinopathy–associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole. Methods: A total of 17 eyes with diabetic retinopathy–associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups. Results: Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy–associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both). Conclusion: Compared with idiopathic group, diabetic retinopathy–associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.

scholarly journals Perifoveal exudative vascular anomalous complex in a highly myopic eye

2020 ◽  
Vol 12 ◽  
pp. 251584142094793
Author(s):  
Riccardo Sacconi ◽  
Enrico Borrelli ◽  
Francesco Bandello ◽  
Giuseppe Querques
Keyword(s):  
Visual Acuity ◽  
Fundus Examination ◽  
Corrected Visual Acuity ◽  
Capillary Plexus ◽  
The Right ◽  
Superficial Capillary Plexus ◽  
Best Corrected Visual Acuity ◽  
Past Conditions ◽  
Chorioretinal Degeneration

‘Perifoveal Exudative Vascular Anomalous Complex’ (PEVAC) is a perifoveal, unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. Here, we report a case of PEVAC in a highly myopic eye of a 86-year-old woman affected by a visual decline in the right eye (best-corrected visual acuity of 20/100). She had no other relevant past conditions and/or ocular impairment. Fundus examination in the right eye showed myopic chorioretinal degeneration with a concomitant PEVAC. Structural optical coherence tomography (OCT) showed a round lesion with a hyperreflective wall associated with intraretinal cystic spaces. OCT-angiography nicely disclosed an isolated large aneurysmal retinal dilation featuring the PEVAC with detectable flow in superficial capillary plexus, deep capillary plexus, and avascular slab. This case highlights the importance of discerning between different vascular disorders of the macula, in order to be able to offer the right treatment and/or follow-up to the patient.

scholarly journals A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for the Treatment of Idiopathic Macular Hole with Air or C3F8 Intraocular Tamponade

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Xiang Chen ◽  
Yi Yao ◽  
Xiaolu Hao ◽  
Xiaocui Liu ◽  
Tiecheng Liu
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Macular Hole ◽  
Idiopathic Macular Hole ◽  
The Third ◽  
Corrected Visual Acuity ◽  
Intraocular Tamponade ◽  
The Face ◽  
Best Corrected Visual Acuity

Purpose. The treatment of idiopathic macular holes has been basically modeled, and vitreoretinal surgery is recognized as an effective treatment. However, the postoperative tamponade of gas will still make the patient uncomfortable and may have related complications. The purpose of this study is to investigate whether air as an intraocular tamponade is equivalent to gas and what advantages may exist. Methods. A retrospective study was performed in one hundred and ninety-eight patients from 2013 to 2017; 112 received gas tamponade and 86 received air tamponade. After receiving retinal surgery, the outcomes of best corrected visual acuity, intraocular pressure, slit lamp examination, fundus examination, and imaging of the macula by spectral-domain optical coherence tomography were analyzed. Results. Before operation, there was no statistically significant difference in age, sex, macular hole diameter, or visual acuity between groups. The median follow-up period for the C3F8 group was 26 months, and the median follow-up for the air group was 25 months. After the operation, the best corrected visual acuity and macular hole closure rate were not significantly different between the two groups. The face-down time after the operation, the incidence of lens opacity on the third postoperative day, the intraocular pressure on the third postoperative day, and the operation time were significantly different between the two groups. Conclusions. In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material can be similar to that of C3F8 but has fewer complications. In particular, it is a better choice for patients for whom the face-down position is not suitable.

scholarly journals Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes

2019 ◽  
Vol 35 (2) ◽  
Author(s):  
Haroon Tayyab ◽  
Asad Aslam Khan ◽  
Sana Jahangir
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Creative Commons ◽  
Corrected Visual Acuity ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
Best Corrected Visual Acuity ◽  
Hole Closure ◽  
Sd Oct

Objective: To evaluate the effectiveness of inverted internal limiting membrane flap in large idiopathic macular holes. Methods: Twelve patients diagnosed with idiopathic macular holes larger than 400um underwent 23 gauge Pars Plana Vitrectomy (PPV) with inverted internal limiting flap and gas tamponade at Al-Ehsan Eye Welfare Eye Hospital, Lahore from February 2017 to February 2018. All cases were diagnosed on Spectral Domain Optical Coherence Tomography (SD-OCT) and were followed up for 6 months. At every follow-up, best corrected visual acuity and SD-OCT was done. Results: We achieved macular hole closure in 91.6% (11/12) patients with idiopathic macular holes larger than 400um. Five out of 12 patients underwent combined phacoemulsification and PPV. One patient has flat hole closure which was considered failure. One patient was excluded from the study due to per-operative flap loss. This patient was not included in final data analysis of 12 patients. There was statistically significant gain in best corrected visual acuity after successful macular hole closure. We did not report any untoward events during or in the post-operative period. Conclusion: Inverted internal limiting flap is an effective method for repairing large macular holes. How to cite this:Tayyab H, Khan AA, Jahangir S. Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.689 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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