Kazunari Hirota

Correlation Between Foveal Cone Outer Segment Tips Line and Visual Recovery After Epiretinal Membrane Surgery

PURPOSE To determine whether there is a significant correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for epiretinal membrane (ERM) removal. METHODS This was a retrospective, interventional case series. Forty-six eyes of 45 patients with an ERM underwent vitrectomy. The foveal area was examined by spectral-domain-optical coherence tomography (SD-OCT) preoperatively and postoperatively. The correlation between the length of the photoreceptor cone outer segment tips (COST) line defect, the inner segment/outer segment junction (IS/OS) line defect, the external limiting membrane (ELM) line defect, and the BCVA was determined. RESULTS The length of the COST line defect was significantly correlated with the BCVA at postoperative 1, 3, 6, 9, and 12 months (P < 0.001 for all). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of COST line defect (P < 0.001) but not with the IS/OS line and ELM line defects for up to 6 months. The preoperative length of the COST line defect was significantly correlated with the postoperative BCVA at 12 months (P = 0.005), but the lengths of the IS/OS line defect and ELM line defect were not. The factor that best predicted the postoperative BCVA was the length of the preoperative COST line defect (P = 0.04) but not the preoperative BCVA (P = 0.69). CONCLUSIONS The recovery of the foveal COST line defect is correlated with the BCVA after ERM surgery. The length of the preoperative COST line defect can predict the potential foveal function. (ClinicalTrials.gov number, NCT01549249.).

Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy.

Purpose: To evaluate the effect of vitrectomy on the best-corrected visual acuity (BCVA) and postoperative complications in highly myopic eyes with myopic traction maculopathy. Methods: The medical records of 71 eyes of 64 patients with myopic traction maculopathy and high myopia (⩽−8.0 diopters and axial length, ≥26.0 mm) were reviewed. Twenty-six eyes had only macular retinoschisis, 30 eyes had foveal detachment, and 15 eyes had macular hole. The BCVA and complications were studied in eyes that underwent vitrectomy with or without internal limiting membrane (ILM) peeling. Results: The postoperative BCVA at the final visit significantly improved in the macular retinoschisis and the foveal detachment groups (P = 0.003 and P = 0.010, respectively) but not in the macular hole group (P = 0.069). The BCVA in the macular retinoschisis group and the foveal detachment group with ILM peeling significantly improved at the final visit (P = 0.003 and P = 0.010, respectively). The BCVA at the final visit significantly correlated with age (P = 0.026) and ILM peeling (P = 0.034). A recurrence of tractional macular detachment developed more frequently in eyes without ILM peeling (P = 0.018). Conclusion: These results indicate that vitrectomy with ILM peeling can lead to improvement in vision in patients with macular retinoschisis or foveal detachment with visual impairments.

Outer retinal morphological changes and visual function after removal of epiretinal membrane

OBJECTIVE To determine the relation between the recovery of the cone outer segment tips (COST) line and the best-corrected visual acuity (BCVA) after epiretinal membrane (ERM) surgery. DESIGN Retrospective, consecutive, interventional case series. PARTICIPANTS Sixty-one eyes of 56 patients with an idiopathic ERM were studied. All participants underwent a complete ophthalmic examination including spectral-domain optical coherence tomography before and after ERM removal surgery. METHODS The integrities of the photoreceptor layer including the external limiting membrane line, photoreceptor inner segment/outer segment (IS/OS) line, and COST line in the spectral-domain optical coherence tomography images at the fovea were determined. The associations of these morphological parameters to the BCVA were determined. RESULTS Better BCVAs were found more frequently in eyes with an intact COST line than in eyes with a disrupted or absent COST line at 1 (p < 0.001), 6 (p = 0.003), and 12 months (p < 0.001). Among the external limiting membrane, IS/OS, and COST line parameters, the IS/OS line had higher correlations with the BCVA by multivariate analysis. No significant difference was observed in central retinal thickness between eyes with intact and nonintact COST lines. Eight (30.8%) of 26 eyes with BCVA ≥ 20/20 had nonintact COST lines at 12 months after the ERM surgery. CONCLUSIONS Eyes with an intact COST line had better BCVA after ERM surgery. However, even at 12 months after ERM surgery, COST lines remained disrupted in many eyes with good BCVA.

Correlation between foveal interdigitation zone band defect and visual acuity after surgery for macular pseudohole.

Purpose: To determine the correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for a macular pseudohole. Methods: Thirty-one eyes of 31 patients with a macular pseudohole underwent vitrectomy with internal limiting membrane removal. The foveal area was examined by spectral domain optical coherence tomography preoperatively and postoperatively. The correlations between the BCVA and the lengths of the photoreceptor interdigitation zone (IZ), the ellipsoid zone, and the external limiting membrane band defects, and central foveal thickness were determined. Results: The BCVA improved significantly and the length of the IZ band defect decreased significantly after the surgery. Simple linear regression analyses showed that the BCVA was significantly correlated with the length of the IZ band defect preoperatively and also at 1 to 12 months postoperatively (P < 0.001 for all). The BCVA was not significantly correlated with the length of the ellipsoid zone, external limiting membrane band defect, and the central foveal thickness. Conclusion: The significant correlation between the length of the foveal IZ band defect and the BCVA preoperatively and postoperatively indicates that the foveal IZ band is related to the visual recovery in patients with macular pseudohole.

Inverted Internal Limiting Membrane Flap Technique For Treatment Of Macular Hole Retinal Detachment In Highly Myopic Eyes

Purpose: To compare the efficacy of vitrectomy with inverted internal limiting membrane (ILM) flap to complete removal of the ILM for the treatment of macular hole (MH) retinal detachment in highly myopic eyes. Methods: Pars plana vitrectomy with inverted ILM flap technique (16 eyes; inverted group) or with the complete removal of the ILM (16 eyes; removed group) was performed in patients with high myopia with MH retinal detachment. The rate of retinal reattachment and MH closure, the best-corrected visual acuities, and the integrity of the foveal microstructures in the optical coherence tomographic images were compared. Results: Thirteen eyes (81%) in the inverted group and 15 eyes (93%) in the removed group had retinal reattachment after the initial surgery (P = 0.30). The MH was closed significantly more often in the inverted group (75%) than in the removed group (25%; P = 0.006). The postoperative best-corrected visual acuity was significantly better in the inverted group (P = 0.04). The number of eyes with outer nuclear layer, external limiting membrane, and ellipsoid zone lines at the closed MH was not significantly different in the two groups. Conclusion: The inverted ILM flap technique with the presence of bridging tissue over the MH is effective in closing the MH and improving the postoperative best-corrected visual acuity in eyes with MH retinal detachment by bridging tissue over the MH.

Dehiscence of detached internal limiting membrane in eyes with myopic traction maculopathy with spontaneous resolution

BackgroundTo report the optical coherence tomographic (OCT) findings in 4 eyes before and after a spontaneous resolution of a myopic traction maculopathy (MTM).MethodRetrospective review of medical records including history, examination findings, fundus details, and finding of spectral-domain OCT (Cirrus HD-OCT, Carl Zeiss Meditec, Spectralis, Heidelberg Engineering, Heidelberg) findings in 4 eyes with a spontaneous resolution of MTM.ResultsA release of the vitreofoveal traction was detected by OCT in 3 eyes before the resolution of the MTM. A vitreofoveal separation in one eye and an increase in the length of a vitreous strand from the macula in two eyes indicated a reduction in the traction. In 2 eyes, an internal limiting membrane (ILM) detachment was seen by OCT as a membrane above the wrinkled inner retina at the perifoveal lesion, and a flattening of the ILM and inner retina was detected after the resolution. The detached ILM was shifted centrifugally on the macula and disappeared with the flattening of the adjacent retina which suggests that the release of tangential traction was caused by the dehiscence of ILM possibly at the proximal edges of the ILM detachment.ConclusionReleasing a vitreofoveal traction and flattening of the detached ILM may be signs of spontaneous resolution of a MTM. Vitrectomy is not required when these signs are detected.

Spontaneous resolution of peripapillary retinoschisis associated with glaucomatous optic neuropathy

Editor, O ptic disc pits are congenital anomalies of the optic nerve head and are commonly associated with retinoschisis and serous retinal detachment. Macular or peripapillary retinoschisis can develop after an acute increase of intraocular pressure (IOP) in eyes with enlarged optic disc cups but without congenital optic disc pits (Hollander et al. 2005; Kahook et al. 2007). We report an eye with peripapillary retinoschisis associated with glaucomatous optic neuropathy and normal IOP. A 53-year-old woman visited a local clinic for visual field defect in her right eye associated with headaches and periorbital pain. She was referred to our clinic on September 2008. She was diagnosed with borderline glaucoma earlier. Her visual acuity was 20/20 in

DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY

Purpose: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning. Methods: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeons decision (conventional group). The MH closure rate and duration of the prone positioning were compared. Results: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001). Conclusion: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

Efficacy of higher cutting rates during microincision vitrectomy for proliferative diabetic retinopathy

Purpose To compare the outcomes of 25-G vitrectomy using a vitreous cutter with a higher cutting rate to that of conventional 25-G vitrectomy with a lower cutting rate on eyes with severe proliferative diabetic retinopathy (PDR). Methods The medical records of 393 eyes of 326 patients with severe PDR were reviewed. A higher cutting rate dual-pneumatic 25-G vitrectomy probe (5,000 cuts/min, Constellation) was used on 219 eyes (group C) and a conventional 25-G pneumatic vitrectomy probe with lower cutting rate was used on 174 eyes (2,500 or 1,500 cuts/min, Acurrus) (group A). The visual and anatomical outcomes and the incidences of intraoperative and postoperative complications were compared. Results The incidence of combined cataract surgery was significantly higher in group C (p<0.001). The number of eyes in which scissors were used was significantly lower in group C (p<0.001), and the use of perfluorocarbon liquid was higher in group C (p = 0.015). The incidence of intraoperative iatrogenic tears, postoperative retinal detachments, and neovascular glaucoma was not significantly different between the 2 groups, but the incidence of postoperative vitreous hemorrhage was significantly lower in group C eyes (p<0.001). Preoperative and postoperative vision were not significantly different between the 2 groups. Conclusions The higher vitreous cutting rates during 25-G vitrectomy make it easier to dissect fibrovascular membranes with only the vitreous cutter, and achieved equivalent anatomical and visual outcomes after 25-G vitrectomy for PDR.

Thickened retinal ganglion cell complex in patient with severe Takayasu retinopathy at early stage.

PURPOSE Takayasu arteritis is caused by an autoimmune process that results in chronic granulomatous inflammation. We describe the optical coherence tomographic findings in a case of Stage 4 Takayasu retinopathy. METHODS Case report and evaluation by optical coherence tomography. PATIENT A 31-year-old woman visited our clinic because of bilateral blurred vision that began 1 month earlier. Examination showed that her visual acuities were 20/33 in the right and 20/100 in the left. The anterior segments were normal but retinal arteriovenous anastomosis shunts were detected on the optic disk of the both eyes, and vitreous hemorrhage was found in the left eye. RESULTS Spectral domain optical coherence tomography showed a thickening of the retinal ganglion cell complex and inner plexiform layer around the optic disk with dilated retinal arteriovenous shunts near the nerve fiber layer. Irregular hyperreflectivity was also seen between the outer plexiform layer and the outer nuclear layer especially at the temporal raphe. Steroid pulse therapy was begun with 500 mg/day intravenous methylprednisolone for 3 days, followed by oral prednisolone and antiplatelet agents. After 2 months, the retinal arteriovenous shunts on the optic disk of the right eye had a fibrovascular membrane-like appearance, and fluorescein angiography showed a progression of the retinal anastomosis and capillary nonperfusion especially in the temporal area. The thickened retinal ganglion cell complex around the optic disk remained but the irregular hyperreflectivity between the outer plexiform layer and the outer nuclear layer at the temporal raphe became smoother in both eyes. CONCLUSION Optical coherence tomography can be useful in detecting retinal ischemia and the degree of inflammation in Takayasu retinopathy especially at the early stage.