We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.
Epiretinal Membrane/diagnosis/*surgery ; Female ; Humans ; *Postoperative Complications ; Retinal Perforations/diagnosis/etiology/*surgery ; Tomography, Optical Coherence ; Vitrectomy/*adverse effects ; Young Adult

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.
Epiretinal Membrane/diagnosis/*surgery ; Female ; Humans ; *Postoperative Complications ; Retinal Perforations/diagnosis/etiology/*surgery ; Tomography, Optical Coherence ; Vitrectomy/*adverse effects ; Young Adult

No abstract available.
Aged ; Cataract Extraction ; Choroidal Neovascularization/diagnosis/*etiology ; Epiretinal Membrane/*surgery ; Female ; Fluorescein Angiography ; Humans ; Iatrogenic Disease ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy/*adverse effects

PURPOSE: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. METHODS: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. RESULTS: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. CONCLUSIONS: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
Aged ; Epiretinal Membrane/*diagnosis/etiology/surgery ; Female ; Follow-Up Studies ; Fovea Centralis/*diagnostic imaging ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Retinal Perforations/complications/*diagnosis/surgery ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; *Vitrectomy

PURPOSE: To assess the clinical outcomes in idiopathic epiretinal membrane (ERM) patients after vitrectomy and ERM removal with or without additional indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling. METHODS: The medical records of 43 patients with an idiopathic ERM that underwent vitrectomy and ERM removal between July 2007 and April 2010 were reviewed. The patients were divided into two groups: triamcinolone-assisted simple ERM peeling only (group A, n = 23) and triamcinolone-assisted ERM peeling followed by ICG staining and peeling of the remaining internal ILM (group B, n = 20). RESULTS: No difference was found between the two groups in terms of visual acuity, macular thickness, P1 amplitude or implicit time on multifocal-electroretinogram (mfERG) at six and 12 months postoperatively. In group B, ICG staining after ERM peeling demonstrated that the ILM had been removed together with the ERM in 12 eyes (60%), and all 12 eyes showed punctate retinal hemorrhages during ERM peeling. There was no recurrence of an ERM in either group. CONCLUSIONS: Additional procedures involving ICG staining and ILM peeling during ERM surgery do not appear to have an additive effect on the clinical outcomes in terms of visual acuity, retinal function based on mfERG, or recurrence rate.
Aged ; Coloring Agents/diagnostic use ; Epiretinal Membrane/*surgery ; Female ; Follow-Up Studies ; Humans ; Indocyanine Green/*diagnostic use ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Retinal Hemorrhage/diagnosis ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; *Vitrectomy