PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.
Depression ; Epiretinal Membrane* ; Humans ; Medical Records ; Membranes ; Retrospective Studies ; Tomography, Optical Coherence ; Vision Disorders ; Visual Acuity* ; Vitrectomy

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.
Depression ; Epiretinal Membrane* ; Humans ; Medical Records ; Membranes ; Retrospective Studies ; Tomography, Optical Coherence ; Vision Disorders ; Visual Acuity* ; Vitrectomy

PURPOSE: To report the incidence of intraocular pressure (IOP) elevation and identify the risk factors of IOP elevation after intravitreal dexamethasone 0.7 mg (Ozurdex®, Allergan, Irvine, CA, USA) implant. METHODS: A total of 86 eyes of 79 patients who underwent intravitreal dexamethasone implantation and who were followed for ≥ 3 months were included in the present study. IOP elevation was defined as a pressure > 21 mm Hg at some time during follow-up. RESULTS: Twenty-nine eyes (33.7%) had an IOP > 21 mm Hg after dexamethasone intravitreal implant. The incidence of IOP elevation increased rapidly at 2–3 months after dexamethasone intravitreal implant. The Kaplan-Meier estimated incidence of IOP elevation was 25.6 ± 4.7% (mean ± standard error) at 81 days. Cox multivariate analysis showed the significant risk factors of IOP elevation to be age < 55 years (p = 0.045), baseline IOP ≥ 15 mm Hg (p < 0.001), and history of intraocular surgery (p = 0.039). CONCLUSIONS: This study demonstrates the incidence of IOP elevation to be 33.7% and describes the risk factors associated with IOP elevation. Clinicians should be cautious regarding the possibility of IOP elevation after intravitreal dexamethasone implant, especially in the presence of identified risk factors.
Dexamethasone* ; Follow-Up Studies ; Humans ; Incidence* ; Intraocular Pressure* ; Multivariate Analysis ; Risk Factors*

PURPOSE: To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole. METHODS: Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 microm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography. RESULTS: A total of 5 eyes were included in the present study. The mean age was 65.0 +/- 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 +/- 0.27. The mean refractive error was -2.0 +/- 2.2 diopter, mean horizontal size of hole was 701.4 +/- 129.4 microm, mean vertical size was 630.2 +/- 202.8 microm, mean hole base size was 1,043.4 +/- 225.0 microm and hole height was 464.4 +/- 218.9 microm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery. CONCLUSIONS: Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.
Autografts* ; Follow-Up Studies ; Humans ; Membranes* ; Refractive Errors ; Retinal Perforations* ; Tomography, Optical Coherence ; Transplantation, Autologous* ; Visual Acuity ; Vitrectomy

PURPOSE: To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid. METHODS: Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intraocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, location and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed. RESULTS: Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular surgery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92). CONCLUSIONS: When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without proliferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.
Follow-Up Studies ; Humans ; Intraocular Pressure ; Myopia ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative

PURPOSE: To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, and gas tamponade. CASE SUMMARY: A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was 20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 microm in diameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membrane peeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased in size to 378 microm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to 311 microm, 252 microm and 156 microm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edema at 9 months. However, the visual acuity of 20/100 remained unchanged. CONCLUSIONS: Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery.
Aged ; Cataract ; Female ; Humans ; Macular Edema ; Membranes* ; Retinal Perforations* ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy* ; Vitreous Detachment

PURPOSE: To evaluate the effect of posterior sub-Tenon triamcinolone acetonide injection combined with vitrectomy for idiopathic epiretinal membrane (ERM). METHODS: This study included 40 eyes of 40 patients who underwent vitrectomy and membrane peeling for idiopathic ERM. Triamcinolone acetonide (40 mg) was injected into the posterior sub-Tenon space following vitrectomy in 20 eyes of the injected group. The other 20 eyes that did not receive the injection were selected as the control group to match preoperative visual acuity and central macular thickness with the injected group. Pre- and postoperative best-corrected visual acuity, central macular thickness, intraocular pressure, and complications were compared between the 2 groups. RESULTS: The average visual acuity in the injected group improved from 0.56 +/- 0.23 (log MAR) at baseline to 0.52 +/- 0.36 at 1 month, 0.44 +/- 0.39 at 3 months, and 0.38 +/- 0.41 at 6 months postoperatively. Central macular thickness decreased from 456.2 +/- 86.2 to 399.0 +/- 60.1 at 1 month, 377.1 +/- 71.5 at 3 months, and 353.1 +/- 57.4 at 6 months postoperatively. In the control group, average visual acuity improved from 0.56 +/- 0.23 at baseline to 0.53 +/- 0.25 at 1 month, 0.41 +/- 0.20 at 3 months, and 0.37 +/- 0.24 at 6 months postoperatively. Central macular thickness decreased from 456.4 +/- 74.8 to 394.9 +/- 63.5 at 1 month, 377.2 +/- 56.8 at 3 months, and 358.0 +/- 57.2 at 6 months postoperatively. Significant differences in visual acuity and central macular thickness were not observed between the 2 groups before surgery and during the follow-up period. Intraocular pressure and complications were similar. CONCLUSIONS: Posterior sub-Tenon injection of triamcinolone acetonide combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative anatomical and functional outcomes.
Epiretinal Membrane* ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Membranes ; Triamcinolone Acetonide ; Triamcinolone* ; Visual Acuity ; Vitrectomy*

PURPOSE: To evaluate visual acuity changes over 3 years following surgical reattachment of macular hole retinal detachment (MHRD) developed in high myopia.METHODS: A retrospective analysis was performed using the medical records of patients with highly myopic eyes who underwent pars plana vitrectomy with internal limiting membrane peeling or the internal limiting membrane flap technique for MHRD. Changes in best-corrected visual acuity (BCVA) were measured at baseline, 6 months, 1 year, 2 years, and 3 years.RESULTS: Of the 22 eyes analyzed, macular hole was closed in 13 and unclosed in nine. BCVA significantly improved from 1.61 ± 0.39 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.17 ± 0.43 logMAR at 6 months and 1.33 ± 0.48 logMAR at 2 years after MHRD surgery. At 3 years, BCVA significantly decreased compared with that at 6 months, and visual improvement from baseline was not significant. BCVA and proportion of vision loss ≥0.3 logMAR were not different between the closed and unclosed macular hole groups.CONCLUSIONS: Visual improvement after surgical reattachment of MHRD in high myopia was not maintained, and favorable macular hole closure effects were not observed at 3-year follow-up.
Follow-Up Studies ; Humans ; Medical Records ; Membranes ; Myopia ; Myopia, Degenerative ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retrospective Studies ; Visual Acuity ; Vitrectomy

Purpose: To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female.Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment. Conclusions Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.

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.