OBJECTIVETo identify the characteristics of and evaluate surgical impact on idiopathic macular hole (IMH) by using an optical coherence tomography (OCT) scanner.

METHODSSixty-five cases (70 eyes) experiencing IMH were examined using OCT, then graded by their clinical characteristics. Nineteen cases (19 eyes) were scanned and measured using OCT before and after surgery.

RESULTSOf the 70 eyes,the number of stage I-IV macular holes were 11, 12, 36 and 11, respectively. For stage I holes, the OCT images revealed flattened or nonexistent fovea and minimally reflective space within or beneath the neurosensory retina; stage II holes appeared to be full-sized with attached operculum and surrounding edema; stage III holes were also full-sized with surrounding edema; finally, stage IV holes were full-sized and completely separated the posterior hyaloid membrane from the retina. Through quantitative measurements, OCT determined that the values for mean hole diameter, mean halo diameter and mean thickness of the hole's edge were reduced from 570.95 +/- 265.59 to 337.05 +/- 335.95 microm, 1043.53 +/- 278.8 to 695.00 +/- 483.00 microm and 389.78 +/- 60.58 to 298.78 +/- 109.80 microm, respectively in 19 IMH cases after surgery. In 17 eyes, the holes or halos eventually closed or were reduced in size, or the edges of the holes thinned out. The anatomic successful rate of the surgery was 89%.

CONCLUSIONOCT can exhibit the characteristics of IMH and measure the diameter of holes quantitatively. This method can also judge the surgical impacts of IMH objectively, accurately and effectively.

Adult ; Aged ; Female ; Humans ; Macula Lutea ; pathology ; Male ; Middle Aged ; Retinal Perforations ; pathology ; surgery ; Tomography ; methods

PURPOSE: To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT. RESULTS: The mean duration of macular detachment was 15.5 +/- 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 +/- 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017). CONCLUSIONS: Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.
Adolescent ; Adult ; Female ; Fovea Centralis/*pathology/*surgery ; Humans ; Macula Lutea/pathology/surgery ; Male ; Middle Aged ; *Recovery of Function ; Retinal Detachment/*pathology/*surgery ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79+/-0.29 and postoperative BCVA (log MAR) at 3 months was 0.57+/-0.33. And improvement of visual acuity > or =2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22+/-76.83 micrometer (510-737 micrometer) and postoperative fovea thickness was 217.60+/-47.33 micrometer (164-285 micrometer). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.
Treatment Outcome ; Tomography, Optical Coherence ; Retrospective Studies ; Retinal Vein Occlusion/*complications/diagnosis/surgery ; Ophthalmologic Surgical Procedures/*methods ; Middle Aged ; Male ; Macular Edema, Cystoid/diagnosis/etiology/*surgery ; Macula Lutea/*surgery ; Humans ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Female

PURPOSE: To evaluate the effectiveness of laser photocoagulation as adjuvant therapy in the treatment of large macular holes. METHODS: A randomized clinical trial. Thirty-one eyes from 29 subjects with idiopathic macular holes of diameters larger than 400 micrometer were randomized into a laser group and a control group. All eyes underwent vitrectomy with peeling of the internal limiting membrane. Contrary to the control group eyes, the laser group eyes underwent laser photocoagulation at the center of the macular hole before vitrectomy. Visual acuity and anatomic outcomes assessed by optical coherence tomography (OCT) were analyzed 3 months after surgery. RESULTS: On postoperative OCT, closure of the macular hole was noted in 17 of the 18 (94.4%) laser group eyes and 10 of the 13 (76.9%) control group eyes. Hole closure without bare retinal pigment epithelium was observed in 16 eyes in the laser group and 6 eyes in the control group (P<0.05). The amount of improvement in logMAR visual acuity 3 months after surgery was 0.40+/-0.29 in the laser group, and 0.19+/-0.23 in the control group (P<0.05). CONCLUSIONS: Laser photocoagulation constitutes a potent adjuvant therapy that may improve anatomical and visual outcomes of surgery for macular holes larger than 400 micrometer.
*Vitrectomy ; Visual Acuity ; Treatment Outcome ; Tomography, Optical Coherence ; Time Factors ; Severity of Illness Index ; Retrospective Studies ; Retinal Perforations/pathology/*surgery ; Middle Aged ; Male ; Macula Lutea/pathology/surgery ; *Laser Coagulation ; Humans ; Follow-Up Studies ; Female ; Aged

INTRODUCTIONThis paper reports the 1-year results of the first 2 cases of macular translocation in Singapore.

CLINICAL PICTUREA 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman's condition was secondary to pathological myopia while the man's was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively.

TREATMENTBoth patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye.

OUTCOMEBoth patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively.

CONCLUSIONMacular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving.

Aged ; Choroidal Neovascularization ; diagnostic imaging ; etiology ; surgery ; Female ; Fluorescein Angiography ; Humans ; Laser Coagulation ; Macula Lutea ; transplantation ; Macular Degeneration ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Myopia, Degenerative ; complications ; Prognosis ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both. RESULTS: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 +/- 0.15, 0.36 +/- 0.18, 0.31 +/- 0.14, and 0.34 +/- 0.22, respectively. The mean CSTs were 433.3 +/- 77.9, 329.9 +/- 59.4, 307.2 +/- 60.2, and 310.1 +/- 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). CONCLUSIONS: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.
Aged ; Combined Modality Therapy ; Diabetic Retinopathy/*drug therapy/*surgery ; Female ; Humans ; Immunosuppressive Agents/administration & dosage ; Intravitreal Injections ; Light Coagulation/*methods ; Macula Lutea/drug effects/surgery ; Macular Edema/*drug therapy/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Triamcinolone Acetonide/*administration & dosage ; Vitrectomy/*methods

PURPOSE: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. METHODS: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. RESULTS: The average RNFL thickness had increased by 0.84 microm two months after and decreased by 0.4 microm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 microm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 microm (p = 0.11) at six months in the PASCAL group. CONCLUSIONS: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.
Adult ; Aged ; Aged, 80 and over ; Diabetic Retinopathy/physiopathology/*surgery ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Laser Coagulation/*methods ; Lasers, Solid-State/*therapeutic use ; Macula Lutea/*pathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Nerve/*pathology ; Prospective Studies ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence ; Visual Acuity/physiology