Exhibiting Residual Subretinal Fluid after High Myopic Macular Hole Retinal Detachment Surgery

Purpose: To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1.Conclusions: In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.

A novel design silicone oil removal cannula

Background: Silicone oil, which is one of the most commonly used endotamponades in vitreoretinal surgery, is removed after a certain period of time in most cases. In this study, we present our results with a unique cannula that provides effective and safe silicone oil removal. Aims and Objectives: To assess the aids and success of silicone oil removal with a novel 23-gauge cannula for the patients who underwent pars plana vitrectomy and silicone oil injection before. Materials and Methods: 72 eyes of 64 patients who operated by the same surgeon (FA) between May 2017 and May 2019 were involved in the study. The primary indications were proliferative diabetic retinopathy in 46 (63.9%) eyes and retinal detachment in 26 (36.1%) eyes. Phacoemulsification and intraocular lens implantation (23 eyes), membrane peeling (23 eyes), internal limiting membrane peeling (5 eyes), and argon laser endo-photocoagulation (37 eyes) performed in the same session. Furthermore, perfluorocarbon remnants aspirated in 9 eyes and 17 eyes needed suturing. Descriptive statistical analyses achieved by SPSS 10.5 statistical software. Results: The mean follow-up time was 11.7 + 2.5 months (between 3 and 23 months), and the mean age was 61.4 + 8.52 years (between 44 and 69 years). 1000 centistokes (cSt) silicone oil was removed from 61 (84.7%) eyes, and 5000 cSt silicone oil was removed from 11 (15.3%) eyes. The mean removal time was 2.04 + 0.1 min for 1000 cSt silicone oil and 5.11 + 0.3 min for 5000 cSt silicone oil. 4 re-detachment and 3 vitreous hemorrhage observed in follow-up period. Post-operative silicone oil remnants were not detected in any patient. Conclusion: The unique 23-gauge cannula provides silicone oil removal without any conjunctival cut-down and sclerotomy enlargement. Thus, it reduces the duration of surgery and post-operative recovery period.

Effect of Air Tamponade among Patients with Epiretinal Membranes and Intraretinal Cystoid Changes Undergoing Vitrectomy with Membrane Peeling – A Prospective Randomized Trial

Background The effect of air tamponade among patients undergoing vitrectomy with membrane peeling for removal of epiretinal membranes (ERM) is controversially discussed. The aim of the present study was to analyze differences in outcomes between air tamponade and balanced salt solution (BSS) in a study population with preoperative intraretinal cystoid changes. Patients and Methods This randomized study included patients scheduled for pars plana vitrectomy with membrane peeling owing to ERM and intraretinal cystoid changes. Air tamponade or BSS at the end of surgery was applied according to preoperative randomization. Optical coherence tomography and best-corrected distance visual acuity (DCVA) measurements were performed before surgery, 5 days after surgery, and 3 months after surgery. Results From 96 patients included, 85 eyes had full follow-up and could be included for analysis. Median improvement of DCVA was + 16 EDTRS letters (IQR: 8 to 22) among patients with BSS, while it was + 13 EDTRS letters (IQR: 8 to 17) among patients with air tamponade. There was a trend for better improvement of DCVA when BSS was left at the end of surgery, compared to air tamponade, but not reaching statistical significance. Conclusions There were no statistically significant differences concerning resorption of preoperative intraretinal cystoid changes, improvement of visual acuity, and final DVCA between air tamponade and BSS.

ILM removal in vitreomacular interface disorders: for or against?

Purpose. To provide data on efficacy and safety of internal limiting membrane (ILM) removal in various pathologies of the vitreomacular interface. Material and methods. To perform the review, literature sources were searched through the PubMed and Scopus databases up to year 2021 using the keywords "internal limiting membrane peeling", "macular hole", "epiretinal membrane". A total of 38 articles relevant to the topic of the review were selected. Results. Numerous studies have confirmed the efficacy of internal limiting peeling in improving anatomical and functional outcomes of treatment of various pathologies. However, even a flawlessly performed peeling can cause both anatomical and functional effects on the retina. Various studies have demonstrated that the anatomical complications of ILM peeling did not correlate with the functional outcomes of surgery. Conclusion. Available evidence supports ILM peeling as an intervention that improves anatomical and functional results of treatment and reduces rate of reoperation. However, in order to evaluate the safety of this procedure, further studies with an assessment of the visual function with a long follow-up period are required. Key words: internal limiting membrane, peeling, macular hole, epiretinal membrane