The Role of Internal Limiting Membrane as a Biomarker in the Evolution of Myopic Traction Maculopathy

Purpose: To describe the longitudinal structural changes of myopic traction maculopathy (MTM) based on optical coherence tomography (OCT) and to detect biomarkers in the evolution of MTM.Methods: A retrospective study was conducted on patients with MTM as defined by OCT. A minimum follow-up of 6 months was necessary for study inclusion. The effects of comprehensive OCT-based structure on the evolution of MTM, the progression rates, and resolution rates of MTM were evaluated.Results: A total of 120 eyes (120 patients) were included with an average follow-up of 15.4 months. During the follow-up, MTM progressed in 32 eyes (26.67%). The most common pattern of progression observed was the increased extent of retinoschisis in 12 eyes. The multivariate analysis showed that the presence of MTM progression had a significant correlation with internal limiting membrane (ILM) detachment and retinoschisis involved the entire macula at baseline. Five eyes (4.17%) experienced MTM resolution, of which 2 eyes developed disruptions of detached ILM, two eyes developed disruptions of epiretinal membrane, and one eye developed partial posterior vitreous detachment. Eyes with foveal detachment showed the highest progression rate (41.67%) and highest resolution rate (16.67%) compared to the eyes with other foveal complications.Conclusion: ILM detachment is a risk factor for MTM progression and MTM resolution can occur after ILM disruption. These suggest that ILM may play an important role as a biomarker in the evolution of MTM.

Vitrectomy With Peeling the Internal Limiting Membrane for the Treatment of Macular Hole Following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Background: This study aimed to report a case of vitrectomy with peeling the internal limiting membrane for the treatment of macular hole (MH) following ruptured retinal arterial macroaneurysm (RAMA).Case Presentation: A 65-year-old woman noticed a sudden decrease in vision in the left eye. She had no other ocular problems apart from a mild cataract in both eyes before. Her best-corrected visual acuity (BCVA) was 20/33 in the right eye, and 6/100 in the left eye. Fluorescein angiography (FFA) showed a retinal arterial macroaneurysm with telangiectatic retinal vascular changes in the inferior temporal macular region. Optical coherence tomography (OCT) examination demonstrated the presence of subretinal hemorrhage extending into the foveal area and incomplete posterior vitreous detachment. Because of the presence of submacular hemorrhage, some medicine was administrated and the patient was followed up. Then, 5 months later, the hemorrhage was absorbed. OCT examination exhibited a full-thickness MH with a macular epiretinal membrane. The size of the MH was 722 μm in diameter. She was then given a standard three-port pars plana vitrectomy (PPV), along with peeling of the internal limiting membrane (ILM) and filling the vitreous cavity with air. Anatomic closure of the MH was achieved after 4 weeks of the surgery by the examination of OCT. The BCVA was improved to 15/100.Conclusions: This case expanded our knowledge of the association of MH secondary to ruptured RAMA. We reported a case with successful surgical closure of the MH and improvement of BCVA.

Ocular ultrasonography for detection of posterior segment pathology in adult patients presenting with blurred vision

Background and objective: Ocular posterior segment lesions can affect individuals of both sexes at all ages. Such lesions can lead to serious manifestations such as retinal detachment and retinal hemorrhage, leading to permanent loss of eyesight. This study aimed to determine the association between age and gender and changes in ocular posterior segment based on ultrasonography findings. Methods: This prospective cross-sectional study included 50 patients with blurry vision who had been referred from ophthalmology outpatient clinics to the radiology department of Rizgary Teaching Hospital in Erbil, Kurdistan region in Iraq. Required data were collected using a researcher-designed questionnaire, and the patients were examined using a high resolution 7.5-10 MHz linear array ultrasound transducer. Results: The most frequent complications associated with ocular posterior segment pathologies were old vitreous hemorrhage (72%), posterior vitreous detachment (36%), and retinal detachment (34%). Diabetes and hypertension were the most frequent diseases associated with ocular posterior segment pathology. A significant association was seen between the patients' age with old vitreous hemorrhage (P = 0.003). A significant association was seen between the patients’ medical conditions with old vitreous hemorrhage and retinal detachment. There was no significant correlation between the patients’ gender and the studied ocular posterior segment pathologies. Conclusion: Age has a strong correlation with old vitreous hemorrhage, chronic medical conditions such as diabetes, and hypertension correlated with old vitreous hemorrhage and retinal detachment. Keywords: Ocular ultrasonography; Posterior segment pathology; Blurred vision; Age; Gender.

Influence of vitreomacular interface score on treatment outcomes of anti-VEGF therapy for neovascular age-related macular degeneration

Background To quantitatively evaluate the vitreomacular interface of eyes with neovascular age-related macular degeneration (AMD) and to investigate its association with the 1-year treatment outcome following intravitreal injections of aflibercept (IVA). Methods This prospective observational case series included 59 eyes of 59 consecutive patients with treatment-naïve neovascular AMD who were treated with three monthly IVA and subsequent four bi-monthly IVA and were followed up for 1 year. We estimated posterior vitreous detachment at 1, 9, and 25 macular points within an area of 6 × 6 mm2 at the center of the fovea using the built-in enhanced vitreous visualization mode of swept-source optical coherence tomography. One year after the initial IVA, we classified the eyes into either wet or dry groups. Results The wet and dry groups included 12 and 47 eyes, respectively. The resistance rate against IVA was 20.3%. The 25-point interface score was higher in the wet group than in the dry group (23.0 ± 4.3 vs. 18.6 ± 9.8, P = 0.03), whereas there were no significant between-group differences in the 9-point and 1-point scores (P = 0.21, and 0.47, respectively) or in the other studied parameters. Multivariable analysis revealed that the 25-point vitreomacular interface score was strongly correlated with subfoveal choroidal thickness (P = 0.02, β = − 0.31). Conclusions Our findings suggest that wide-ranged separation of the posterior vitreous membrane from the retina induces poor response to IVA.

Acute retinal necrosis with exudative retinal detachment in a child

Acute retinal necrosis (ARN) is a rare ocular emergency caused mainly by viral entities. ARN may be caused by Herpes zoster virus (HZV) and Herpes simplex virus (HSV), both HSV-1 and HSV-2. ARN mostly present in 20–60 years old immunocompetent adults. A 7-year-old girl presented to the eye clinic with complaints of left eye redness noted by her mother for 2–3 days. On examination with indirect ophthalmoscopy, no hypopyon was seen in either eye. In the left eye fundus view was hazy. Ultrasound B-scan performed showed exudative retinal detachment. PCR of ocular fluid was positive for HSV-1 DNA. The patient was started on topical steroids and antibiotics and systemic antivirals. In addition, she also received intravitreal ganciclovir 4 mg/0.1 mL three times under general anaesthesia. At her last follow-up, 3 years from her presentation, her right eye examination was within normal limits, and left eye showed thick vitreous bands with a posterior vitreous detachment, and left inferotemporal retinal scarring.

Inverted ILM flap technique in Optic Disc Pit Maculopathy: An Iranian experience with review of the literature

Purpose To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with inverted internal limiting membrane (ILM) flap over the optic disc. Methods This prospective case series included three patients with ODPM who underwent pars plana vitrectomy with posterior vitreous detachment induction, followed by inverted ILM flap over the optic disc and gas tamponade. Patients were followed for 7-16 weeks as regards their functional and anatomical findings. A narrative review is also provided about Pathology, Pathogenesis, and surgical techniques in the treatment of ODPM Results Three adult patients (25–39 years old) were evaluated, with a mean duration of decreased visual acuity of 7.33 ± 2.40 months (4-12 months). Postoperatively, BCVA improved dramatically in one patient from 2/200 to 20/25. BCVA in the other two improved two and three lines, to 20/50 and 20/30, respectively. Significant anatomic improvement was achieved in all patients. Conclusion Vitrectomy with inverted ILM flap insertion over the optic disc can yield favorable anatomical improvement in patients with ODPM.

Long-term outcomes of administration of intravitreal triamcinolone acetonide after posterior vitreous detachment during pars plana vitrectomy for proliferative diabetic retinopathy

AimTo evaluate the long-term outcomes of intravitreal triamcinolone acetonide (TA) administration after posterior vitreous detachment (PVD) during pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR).MethodsA total of 189 eyes (152 patients) who underwent PPV for severe PDR were reviewed. Intravitreal injection of TA (IVTA) was administered during PPV in 118 eyes (PPV+IVTA group), and 71 eyes did not receive IVTA (PPV group). Immediately after PVD, when most of the vitreous and proliferative membranes were removed, 0.1 mL TA (40 mg/mL) was injected into the vitreous cavity in the PPV+IVTA group. All patients were followed-up for least 12 months. Visual outcomes and postoperative complications were recorded and compared between the two groups.ResultsIVTA was helpful for proliferative membrane peeling and haemostasis during PPV. In the PPV+IVTA group, best-corrected visual acuity had significantly improved and the intraocular pressure was controlled well during the follow-up. The incidence of early recurrent vitreous haemorrhage after PPV was significantly lower in the PPV+IVTA group (1.7%) than in the PPV group (9.9%) (p=0.028).ConclusionThe administration of IVTA after PVD during PPV can effectively improve the final visual outcomes and prevent postoperative complications in patients with severe PDR.

POSTERIOR SEGMENT PATHOLOGIES IN DENSE LENS CHANGES

INTRODUCTION : B scan makes use of high frequency ultrasound waves which are reected back and are converted to electric signals. The data which is not available from the clinical examination can be visualised by using the ultrasound B-scan. It is of immense visual prognostic value to modify the surgical plan in eyes who have hazy media. AIM : Evaluation of posterior segment using ultrasound B scan(US-B) in patients with dense lens changes Co relation of the type of dense lens changes with different posterior segment pathologies. METHODOLOGY : Study sample : 100 Study period : 1st July 2019 to 31st June 2020 Study duration :12 months Study area :All the patients presenting to Ophthalmology OPD at Meenakshi medical college and research institute , Kanchipuram ,Tamil Nadu. RESULTS : Majority of the B-scans turned out to be normal in dense lens changes. Posterior vitreous detachment, Asteroid hyalosis and Retinal detachment are the common abnormalities seen in the decreasing order of their occurrence.

Intravitreal Tissue Plasminogen Activator Injection for Treatment-Resistant Diabetic Macular Edema of the Vitrectomized Eye

Diabetic macular edema (DME) is the main cause of visual loss in patients with diabetic retinopathy. DME has been treated using intravitreal anti-vascular endothelial growth factor (VEGF) drugs, steroids, laser photocoagulation, vitreoretinal surgery, and their combinations. These modalities are generally effective in preserving vision, but they sometimes produce only limited responses in patients with persistent or refractory DME. The levels of various inflammatory factors, including cytokines, chemokines, and extracellular matrices, as well as VEGF in the vitreous fluid, are increased in patients with DME. Excessive fibrinogen/fibrin levels in the vitreous fluid or fibrin deposition in the retina also contribute to DME pathogenesis. Tissue plasminogen activator (t-PA) promotes the degradation of fibrinogen or fibrin. Intravitreal t-PA injection is a commonly used treatment for subretinal hemorrhage secondary to age-related macular degeneration. Intravitreal t-PA injections have previously been used to restore vision by inducing posterior vitreous detachment in patients with DME. Herein, we describe the visual outcomes of intravitreal t-PA injection in a 78-year-old woman with treatment-resistant DME in her vitrectomized eye after several previous treatments. Before the injection, her best-corrected visual acuity (BCVA) was 0.7 logMAR and central foveal retinal thickness (CRT) was 735 μm. At 1 month after the injection, her BCVA was 0.8 logMAR and CRT was 558 μm, and 3 months later, her BCVA was 0.8 logMAR and CRT was 207 μm. Her BCVA was sustained, and CRT showed gradual improvements. These findings suggested the effectiveness of intravitreal t-PA injections for DME in the vitrectomized eye.