Cryotherapy is implicated for inducing or aggravating proliferative vitreoretinopathy (PVR) by releasing retinal pigment epithelial (RPE) cells. These are based on the fact that PVR rarely occurs in a non-operated eye, and many of the PVR patients have received cryotherapy during surgery. Nonetheless, eyes with diathermy also developed PVR, and although there have been many experiments, the effect of cryotherapy on inducing PVR has not been proven experimentally in the living eye. We made retinal tears in living rabbit eyes, and applied cryotherapy on one eye of each rabbit. The result was compared histologically with the contralateral noncryothermized control eye. There was no statistically significant difference between the two groups concerning the migration of RPE, and the proliferation of RPE. Although the formation of an epiretinal membrane was more obvious in the cryothermized group, the difference was not statistically significant.
Animals ; Cell Division ; *Cryosurgery/adverse effects ; Rabbits ; Retinal Detachment/*pathology ; Retinal Perforations/*pathology ; Vitreous Body/*pathology/surgery

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 evaluate the effects of laser photocoagulation on reopened macular holes. METHODS: This study involved 9 eyes from 9 patients who underwent laser photocoagulation coupled with fluid-gas exchange for reopened macular holes. The photocoagulation was performed at the center of the macular hole. Closure of the reopened hole was categorized by optical coherence tomography (OCT) according to the presence (type 1 closure) or absence (type 2 closure) of continuity in the foveal tissue. Best corrected visual acuity (BCVA), closure types, and complications were assessed. RESULTS: Upon final examination, all macular holes were found to have closed. Six eyes were classified as type 1 closure, and three were classified as type 2 closure. The mean BCVAs, before and after laser photocoagulation, were 0.11 and 0.31, respectively (P< .05). The eyes with type 1 closure were associated with shorter symptom durations and greater visual improvement than those with type 2 closure (P< .05). CONCLUSIONS: The combination of laser photocoagulation and fluid-gas exchange appears to be a safe and effective treatment for reopened macular holes. Early intervention should be encouraged to ensure complete hole closure and improved visual outcomes.
*Tomography, Optical Coherence ; Retinal Perforations/*pathology/*surgery ; Recurrence ; Middle Aged ; Male ; *Laser Coagulation ; Humans ; Female ; Aged

A 42-year-old man was admitted to our clinic complaining of visual distortion in his left eye two months after bilateral myopic photorefractive keratectomy (PRK). Macular optical coherence tomography (OCT) showed a stage II macular hole in the left eye. Simultaneous OCT in the right eye showed vitreous traction and distortion of the outer retina. One month later, the patient underwent vitrectomy for the left eye, and the macular hole was closed. Two months after that, the patient complained of visual distortion in the right eye, and OCT revealed increased traction and accentuated outer retinal distortion indicating a stage IB macular hole. Traction attenuated later without any intervention. The short interval between PRK and hole formation, bilateral involvement, and the moderate refractive error in this case highlight the possible role of PRK in aggravating vitreoretinal interface abnormalities. We recommend the addition of PRK to the list of procedures that may be associated with the formation of a macular hole.
Adult ; Humans ; Male ; Myopia/*surgery ; Photorefractive Keratectomy/*adverse effects ; Retina/*pathology ; Retinal Perforations/diagnosis/*etiology ; Tomography, Optical Coherence ; *Visual Acuity

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

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p<0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808+/-0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.
Vitrectomy/*methods ; Visual Acuity ; Treatment Outcome ; Severity of Illness Index ; Retinal Perforations/complications/pathology/*surgery ; Phacoemulsification/*methods ; Middle Aged ; Male ; Lens Implantation, Intraocular/methods ; Humans ; Follow-Up Studies ; Female ; Cornea/*surgery ; Cataract/*complications ; Aged, 80 and over ; Aged ; Adult

PURPOSE: To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). METHODS: Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (V(postop), logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced. RESULTS: V(postop) was determined to be significantly correlated with the preoperative visual acuity (V(preop)) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of V(postop) was derived from the most accurate regression analysis: V(postop)=0.248xV(preop)+1.1x10(-6)xA(2)-0.121xD+0.19. CONCLUSIONS: The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.
Cell Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Photoreceptor Cells, Vertebrate/*pathology ; Prognosis ; Retinal Perforations/*pathology/physiopathology/surgery ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity/*physiology ; Vitrectomy/methods