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PubMed2003

Observation of idiopathic full-thickness macular hole closure in early postoperative period as evaluated by optical coherence tomography.

PURPOSE: To report the optical coherence tomography (OCT)-determined progressive changes in a macular hole (MH) following vitreous surgery with a gas tamponade. Observational case report. METHODS: A 60-year-old woman with an idiopathic full-thickness MH (Gass, Stage 2) in the left eye underwent vitreous surgery with a gas tamponade. The progressive closure of the MH was followed by OCT because an unplanned decrease of the gas tamponade made the macula accessible to OCT examination. RESULTS: On day 1, the tissue surrounding the MH extended into the center, and on day 2, the subretinal fluid and foveal cysts decreased and the retinal separation was reduced. On the third postoperative day, the MH was closed and the foveal contour was similar to that of normal retinas. CONCLUSION: These results demonstrated that a small MH appears to be closed by 3 days after vitrectomy with gas tamponade. Although we cannot generalize to all sizes of MH, our findings suggest that small MHs are closed much earlier than reported and that the duration of maintaining a prone position can be shortened.

Diagnostic Techniques, Ophthalmological↗
PubMed2003

Optical coherence tomography and focal macular electroretinogram in eyes with epiretinal membrane and macular pseudohole.

PURPOSE: To determine the morphology of macular pseudoholes (MPHs) and the relationship of morphology to macular function. DESIGN: Observational case series. METHODS: Optical coherence tomography (OCT) was performed on 42 eyes of 42 consecutive patients with an epiretinal membrane (ERM) and an MPH. The diameters of the MPH, and the thickness of the foveal and parafoveal retina were measured. Of these 42 eyes, focal macular electroretinograms (FMERGs) were recorded from 22 eyes of 22 patients with a 15 degree stimulus; FMERGs were also recorded with a 5 degree stimulus from 9 eyes of these 22 eyes. RESULTS: In 42 eyes, the mean +/- Standard deviation (SD) diameter (437.7 +/- 172.8 microm) and geometrical shape of the MPHs were not significantly correlated with the visual acuity. The MPHs were divided into 2 types from the OCT images at the base of MPHs; group A had normal thickness (100-199 microm; n = 29), and group B (n = 13) had thicknesses of >or= 200 microm, or thickness < 100 microm, or irregular base. The visual acuity in group A (logarithm of the minimum angle of resolution [log MAR] mean +/- SD:.083 +/-.144) was significantly better than group B (log MAR,.407 +/-.212, P <.0001). There was a significant reduction in the amplitude of all components of FMERGs elicited by the 15 degree stimulus in the affected eyes (mean +/- SE, A-wave: 1.26 +/-.12 microv, B-wave: 3.07 +/-.27 microv, oscillatory potentials: 1.23 +/-.25 microv) compared with the normal fellow eyes (A-wave: 1.58 +/-.13 microv, B-wave: 4.14 +/-.27 microv, oscillatory potentials: 2.35 +/-.29 microv). A significant correlation was found between the relative amplitudes of the B-wave elicited by the 5 degree stimulus and the visual acuity (r =.918, P =.0005). CONCLUSIONS: In eyes with an ERM and an MPH, the visual acuity is generally correlated with the OCT images. Macular function of eyes with an MPH resembles eyes with an ERM without an MPH. The effect of the ERM appears to be different on the base and parafovea of the MPHs.

Adult↗
PubMed2003

Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula.

PURPOSE: To evaluate the postoperative status of the macula after vitreous surgery with internal limiting membrane removal for macular hole related retinal detachment in patients with severe myopia. DESIGN: Interventional case series. METHODS: We prospectively examined 10 eyes with retinal detachment associated with a myopic macular hole from 10 consecutive patients, and performed pars plana vitrectomy with internal limiting membrane peeling. Macular buckling was performed in one eye during the initial treatment and in three eyes during subsequent operations. The main outcome measures were the anatomic reattachment rate and the postoperative status of the macular hole. We examined the macular area pre- and postoperatively with slit-lamp biomicroscopy and with a scanning laser ophthalmoscope. Cross-sectional imaging of the macular area was conducted with optical coherence tomography. RESULTS: Successful retinal reattachment was achieved in seven eyes (70%) after the initial surgery and in three eyes (30%) after additional procedures. Visual acuity remained unchanged in two eyes (20%), and improved by two or more logarithmic units of minimum angle of resolution (logMAR) measurement in eight eyes (80%). The macular hole was anatomically closed in only one eye (10%). Postoperative enlargement of the macular hole was observed in seven eyes. CONCLUSIONS: In highly myopic eyes with macular hole related retinal detachment, closure of the macular hole is difficult to attain despite the complete relief of tangential traction by internal limiting membrane peeling. Results indicate the presence of a possible imbalance between the retina and the choroid-sclera complex associated with axial elongation and posterior staphyloma in highly myopic eyes.

Adult↗
PubMed2003

Indocyanine green for successful repair of a long-standing macular hole.

PURPOSE: To report on the successful closure of a persistent chronic macular hole using indocyanine green (ICG) during the second surgical approach. DESIGN: Interventional case report. METHODS: A patient with a long standing macular hole (18 years) underwent pars plana vitrectomy with peeling of the internal limiting membrane (ILM). While no dye was used during the first operation, ICG (0.05%, Pulsion) was applied during the second procedure. The light source was turned off immediately after the ICG application until the dye was washed out after a period of 15 seconds. Tissue harvested during the second surgical approach was prepared for electron microscopy. RESULTS: After the failure of the first operation, areas of incomplete ILM peeling could be stained using ICG and a thorough ILM removal was achieved. Postoperatively, the macular hole was closed, as confirmed by optical coherence tomography. Visual acuity increased from 20/200 to 20/50. No visual field defects were seen postoperatively. There were only few cellular elements adherent to the retinal surface of the ILM as seen during electron microscopy. CONCLUSION: In cases where tractional forces due to incomplete ILM removal are considered responsible for the persistence of a macular hole, ICG is useful to identify areas of unpeeled ILM. Under certain safety precautions no adverse effect on functional outcome was seen.

Aged↗
PubMed2003

Intravitreal triamcinolone acetonide in eyes with cystoid macular edema associated with central retinal vein occlusion.

PURPOSE: To evaluate treatment of cystoid macular edema associated with central retinal vein occlusion with intravitreal triamcinolone acetonide. METHODS: This study included 10 eyes of nine patients with perfused central retinal vein occlusion with visual acuity of 20/50 or worse. Following baseline evaluation, including best-corrected visual acuity, intraocular pressure (IOP), fluorescein angiography, and volumetric optical coherence tomography (VOCT), triamcinolone acetonide (4 mg in 0.1 ml) was injected into the vitreous cavity. RESULTS: Mean duration from the time of diagnosis to the intravitreal injection was 15.4 months. All 10 eyes demonstrated biomicroscopic improvement in cystoid macular edema with corresponding improvement in VOCT measurements from a mean of 4.2 mm(3) preinjection to a mean of 2.6 mm(3) at last follow-up (P <.001). Mean best-corrected visual acuity improved from 58 letters (range, 37-72) at baseline to 78 letters (range, 50-100 letters) at last follow-up (average, 4.8 months). The visual acuity improvement was statistically significant (P =.01). Six eyes (60%) were > or =20/50. There were no significant complications. Three eyes (30%) without previous history of glaucoma required initiation of topical aqueous suppressant therapy for IOP elevation at last follow-up. One eye with a previous history of open-angle glaucoma required a trabeculectomy. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide appears to be effective in reducing cystoid macular edema associated with central retinal vein occlusion. This reduction often corresponded to an improvement in visual acuity. Further evaluation is warranted to assess its safety and efficacy in these eyes.

Adult↗
PubMed2003

Evaluating pulsatile ocular blood flow analysis in normal and treated glaucomatous eyes.

PURPOSE: To evaluate pulsatile ocular blood flow (POBF) analysis in normal subjects and glaucoma patients by comparison of POBF measurements with functional (as determined by visual field [VF]) and structural (as determined by optical coherence tomography [OCT]) measures. DESIGN: Prospective, cross-sectional study. METHODS: Forty-one eyes of 24 consecutive glaucoma patients and 20 eyes of 10 healthy subjects were studied; POBF analysis was performed on all subjects at the same visit as VF testing and OCT retinal nerve fiber layer (NFL) thickness measurement. The mean results of normal and glaucomatous eyes were compared for each method. Correlation between measurements obtained with each modality and the discriminating power using receiver operator characteristic curves was tested. RESULTS: The mean POBF (standard deviation [SD]) in the normal group was 1,010.4 (292.8) microl/min and 989.3 (305.5) microl/min in the glaucoma group (P =.90). Significant differences between groups were found for VF mean deviation and pattern standard deviation (P =.02, P =.004, respectively) and OCT mean NFL thickness (P <.0001). No correlation was found between POBF parameters and intraocular pressure, VF, or OCT variables except for intraocular pressure in glaucoma group (r = -.43, P =.003). The area under the receiver operator characteristic curves was higher for VF indexes and OCT mean NFL thickness than POBF parameters for distinguishing between normal and glaucomatous eyes. CONCLUSIONS: The wide range of normal values and the low discriminating power of POBF between normal and glaucomatous eyes limits the clinical use of the device for glaucoma patients.

Aged↗
PubMed2003

Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes.

PURPOSE: To report anatomic and visual improvement following vitrectomy with internal limiting membrane (ILM) peeling for two highly myopic patients with retinoschisis and/or retinal detachment without a macular hole. DESIGN: Two interventional case reports. METHODS: Two highly myopic patients who had retinoschisis and/or retinal detachment without a full-thickness macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherent tomography finding. RESULTS: Vitrectomy with ILM peeling results in biomicroscopic, functional, and tomographic improvement in both patients, for follow-up periods of 12 months and 8 months, respectively. CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade is an effective method for retinoschisis and/or retinal detachment without a macular hole in highly myopic patients.

Aged↗
PubMed2003

Intravitreal triamcinolone acetonide for idiopathic cystoid macular edema.

PURPOSE: To report intravitreal triamcinolone acetonide for idiopathic cystoid macular edema (ICME). DESIGN: Interventional case series. METHODS: Two patients with ICME were treated with intravitreal triamcinolone. RESULTS: In one patient, best-corrected acuity was 20/70 before treatment and 20/30 6 months posttreatment in both eyes. Foveal thickness was 606 microm before and 197 microm posttreatment in the right eye and 542 microm before and 190 microm posttreatment in the left eye. In another patient, best-corrected acuity was 20/200 before treatment and 20/50 5 months posttreatment; foveal thickness was 580 microm before and 208 microm posttreatment. Recurrence of macular edema responded to repeat intravitreal triamcinolone acetonide in both patients. CONCLUSIONS: Intravitreal triamcinolone may be associated with reduced edema and improved vision in patients with ICME; however, these changes may be transient.

Female↗
PubMed2003

Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes.

PURPOSE: Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN: Retrospective, nonrandomized, comparative study. PATIENTS: Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS: Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS: The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS: The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.

Aged↗
PubMed2003

Optical coherence tomography characteristics of a hemorrhagic detachment of the retinal pigment epithelium after blunt trauma.

PURPOSE: To report traumatic, hemorrhagic detachment of the retinal pigment epithelium that was detected by optical coherence tomography. DESIGN: Observational case report. METHODS: A 17-year-old boy with hemorrhagic fundus lesions caused by blunt ocular trauma was examined by optical coherence tomography and angiography. RESULTS: Initially, two dark red, mounded lesions were seen, with one in the macula and the other adjacent to the optic disk. The lesions blocked the fluorescence on fluorescein and indocyanine green angiography. Optical coherence tomography demonstrated dome-shaped elevations of the retinal pigment epithelium at each lesion. Four months later, the retinal pigment epithelium detachments disappeared in the tomography images, and no scarring was evident ophthalmoscopically. Small choroidal ruptures were detected in each lesion by angiography. CONCLUSIONS: Optical coherence tomography was useful in evaluating the site of the hemorrhage in the chorioretinal layers caused by blunt ocular trauma.

Adolescent↗
PubMed2003

Early macular holes with retinoschisis in highly myopic eyes.

PURPOSE: We present two cases with early macular holes (MH) complicated by retinoschisis and foveal detachment (RSFD). DESIGN: Case reports. CASE REPORT: A 46-year-old woman and a 70-year-old woman, both with high myopia, presented visual loss and a small MH associated with RSFD. Vitrectomy and gas tamponade were performed. However, both MHs enlarged postoperatively, resulting in progressive retinal detachment. Additional gas tamponade led to retinal reattachment. At the final visit, the MH was open in case 1 but closed in case 2. CONCLUSIONS: Although the benefit of vitrectomy is uncertain, RSFD and MHs can be associated in highly myopic eyes.

Aged↗
PubMed2003

Autologous retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: short-term follow-up.

PURPOSE: To evaluate the feasibilty of translocating autologous retinal pigment epithelium cells and choroid after the removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration. DESIGN: Interventional case series. METHODS: This was a prospective evaluation of six patients with a follow-up of 7 to 13 months. All patients had large (> 1 disk diameter) subfoveal choroidal membranes, five with subretinal hemorrhage. Preoperative visual acuity ranged from 20/400 to 20/200. After the extraction of the neovascular complex, an autologous peripheral full-thickness patch of retinal pigment epithelium, Bruch membrane, choriocapillary, and choroid was cut out from the midperiphery and repositioned under the macula. Functional tests included Early Treatment Diabetic Retinopathy Study vision testing, fixation testing on a optical coherence tomography monitor, fluorescein and indocyanine green angiography, and scanning laser ophthalmoscopy autofluorescence. RESULTS: The retinal pigment epithelium patch appeared flat and had a brown furry aspect in four patients. Fixation was on the patch in these four patients. Postoperative vision ranged from 20/200 to 20/64, with a 2-line increase in three patients. Revascularization was visible on fluorescein and indocyanide angiography in three patients examined in this manner. Normal retinal pigment epithelium autofluorescence was present over the patch in four patients. CONCLUSIONS: The translocation of a full-thickness patch with autologous peripheral retinal pigment epithelium to the macula after choroidal neovascular membrane extraction was feasible and may result in a surviving and functioning graft for more than 1 year. Longer follow-up to evaluate its long-term benefit is necessary, as well as refinement of the surgery.

Aged↗
PubMed2003

Potential pitfalls from variable optical coherence tomograph displays in managing diabetic macular edema.

PURPOSE: To describe potential pitfalls in the use of optical coherence tomography for management of diabetic macular edema. DESIGN: Prospective, noninterventional case series. METHODS: Review of optical coherence tomographs in 13 eyes with clinically significant diabetic macular edema from 11 consecutive patients in a private retina practice. RESULTS: Optical coherence tomography displays are based on 3.5-mm or 6-mm diameter circular grids that look very similar and have identical sector names but schematize different areas of the macula. The numeric outputs for the identically named sectors in the two displays do not differ significantly for retinal thickness but differ significantly in all sectors except the fovea for retinal volume because of the different areas represented by the sectors. CONCLUSIONS: Failure to explicitly note the scale of the optical coherence tomography display can potentially misdirect planned focal and grid laser treatment for diabetic macular edema. Failure to explicitly verify identical optical coherence tomography display scales in longitudinal studies of laser treatment for diabetic macular edema can potentially lead to errors in interpreting treatment efficacy.

Data Display↗
PubMed2003

Optical coherence tomographic findings in acute exudative polymorphous vitelliform maculopathy.

PURPOSE: To report two cases of acute exudative polymorphous vitelliform maculopathy. DESIGN: Observational case reports. METHODS: Fluorescein angiography, optical coherence tomography, and electrophysiology were performed. RESULTS: Both patients presented with sudden onset of blurred vision and bilaterally symmetric, central, and perimacular vitelliform lesions. Perimacular lesions were faintly hyperfluorescent early in the disease, but there was no abnormal fluorescence in the macular centers. Optical coherence tomography revealed anterior displacement of the photoreceptor layer by a hypereflective subretinal layer overlying a hyporeflective space above the retinal pigment epithelium-choriocapillaris complex under all lesions and no subretinal fluid. The electrooculogram was abnormal. Near complete resolution occurred over 4 to 8 months, with no improvement in the electrooculogram. CONCLUSIONS: Transient multifocal vitelliform lesions suggest a diagnosis of acute exudative polymorphous vitelliform maculopathy. Optical coherence tomography reveals characteristic anterior displacement of the photoreceptor layer by a subretinal hypereflective deposit similar to that seen in adult-onset foveomacular vitelliform dystrophy.

Acute Disease↗
PubMed2000

Tomographic assessment of vitreous surgery for diabetic macular edema.

PURPOSE: To evaluate the retinal structure before and after vitrectomy for diabetic macular edema and to assess the correlation between thickness of neurosensory retina and best-corrected visual acuity. METHODS: Tomographic features of 13 eyes (nine patients) with diabetic macular edema were prospectively evaluated with optical coherence tomography before and after vitrectomy. The foveal thickness (the distance between the inner retinal surface and the retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) were measured by optical coherence tomography preoperatively and postoperatively. The correlation of the best-corrected visual acuity with foveal and retinal thickness was determined. RESULTS: All 13 eyes had retinal swelling with low intraretinal reflectivity. In addition to retinal swelling, there were cystoid spaces in five (38%) of 13 eyes, a serous retinal detachment in three (23%), and both cystoid spaces and serous detachment in three (23%). Six months postoperatively, the mean foveal thickness significantly decreased from 630 +/- 170 to 350 +/- 120 microm (P <.01, paired t test) and the mean thickness of neurosensory retina decreased from 540 +/- 160 to 320 +/- 140 microm (P <.01, paired t test). A serous retinal detachment occurred transiently in 3 eyes. Compared with the preoperative level, the postoperative best-corrected visual acuity level improved by more than 2 lines in five of the 13 eyes (38%), remained the same in seven eyes (54%), and decreased in one eye (8%). The postoperative thickness of neurosensory retina at the fovea and best-corrected visual acuity level at the sixth postoperative month had a strong negative correlation (correlation coefficient, -0.76; P <.01, Spearmans rank test). CONCLUSIONS: Vitrectomy was generally effective in treatment of diabetic macular edema. Optical coherence tomography demonstrated the intraretinal changes of macular edema and the process of edema absorption. During the process of macular edema absorption, intraretinal fluid appeared to move into the subretinal space in some cases. Best-corrected visual acuity improvement was greater in eyes with less preoperative increase in thickness of neurosensory retina.

Aged↗