Masato Fujikawa

Scleral imbrication combined with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia.

Purpose: To evaluate scleral imbrication with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia. Methods: We retrospectively reviewed the medical records of eight eyes with macular hole retinal detachment and high myopia treated with temporal scleral imbrication, pars plana vitrectomy, and gas tamponade for refractory macular hole retinal detachment with history of pars plana vitrectomy. Retinal reattachment and macular hole closure were assessed. Postoperative changes in axial length and surgically induced astigmatism were evaluated. Results: The retinas were reattached in all eyes and the macular holes closed in 6 (75%) eyes. The mean baseline logarithm of the minimum angle of resolution best-corrected visual acuity of 1.43 ± 0.48 significantly (P < 0.01) improved to 0.87 ± 0.34 at the final visit (889 ± 173 postoperative days). The mean baseline axial length of 29.5 ± 1.3 mm decreased significantly (P < 0.01) to 27.1 ± 1.9 mm 1 month after scleral imbrication and 28.1 ± 1.7 mm at the final visit (P < 0.05 vs. baseline, P = 0.13 vs. 1 month). The mean 1-month surgically induced astigmatism of 3.6 ± 1.4 diopters (D) after scleral imbrication significantly (P < 0.05) decreased to 2.4 ± 1.5 D at the final visit. Conclusion: Scleral imbrication with vitrectomy and gas tamponade resulted in high reattachment and macular hole closure rates for treating refractory macular hole retinal detachment.

Comparison of pneumatic displacement for submacular hemorrhages with gas alone and gas plus tissue plasminogen activator.

Purpose: To retrospectively evaluate efficacy, safety, and visual outcomes of pneumatic displacement for submacular hemorrhages (SMHs) with or without tissue plasminogen activator (tPA). Methods: Sixty-eight eyes with fresh SMHs underwent pneumatic displacement. Thirty eyes received intravitreal injection of pure C3F8 gas alone and 38 eyes received gas with tPA (25 &mgr;g). The visual analog scale was used to evaluate displacement. The main outcome measures were the visual analog scale score and best-corrected visual acuity 1 month after treatment. The efficacy and safety of tPA were evaluated. Results: The visual analog scale score was 4.9 ± 2.5 in the gas group and 5.9 ± 2.9 in the gas plus tPA group. Sixteen eyes (53.3%) in the gas group and 15 eyes (39.5%) in the gas plus tPA group had best-corrected visual acuity improvements. In the gas group, complications included retinal detachment (n = 1, 3.3%), vitreous opacity (n = 7, 23.3%), and rebleeding (n = 1, 3.3%). In the gas plus tPA group, vitreous opacity (n = 6, 15.8%) was the only complication. Overall, both groups had similar displacement of SMH, visual improvement, and complication rates at 1 month. Conclusion: Intravitreal injection of pure C3F8 gas displaced SMHs and improved best-corrected visual acuity in eyes with SMHs. No adjuvant effect or adverse reactions of tPA were found.

PHOTORECEPTOR OUTER SEGMENT LENGTH AND OUTER FOVEAL THICKNESS AS FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER VITRECTOMY FOR VITREOMACULAR TRACTION SYNDROME.

Purpose: To investigate the predictive factors for postoperative best-corrected visual acuity (BCVA) in patients with vitreomacular traction syndrome treated with vitrectomy. Methods: The records of 21 patients with 21 eyes that underwent vitrectomy for vitreomacular traction syndrome and followed for at least 12 months were retrospectively reviewed. The BCVA and spectral domain optical coherence tomography findings were investigated preoperatively and at 1, 3, 6, and 12 months postoperatively. Axial length was measured preoperatively. The correlations between 12-month postoperative BCVA and preoperative parameters, including BCVA, age, axial length, central foveal thickness, outer foveal thickness, and photoreceptor outer segment length, were evaluated. Results: Twelve-month postoperative BCVA was significantly negatively correlated with preoperative outer foveal thickness and photoreceptor outer segment length (outer foveal thickness: P = 0.029, r = −0.501; photoreceptor outer segment length: P = 0.022, r = −0.523, respectively) but not correlated with age, axial length, preoperative BCVA, and preoperative central foveal thickness (age: P = 0.346, r = 0.216; axial length: P = 0.333, r = 0.242; BCVA: P = 0.202, r = 0.290; central foveal thickness: P = 0.065, r = −0.410, respectively). Conclusion: Preoperative outer foveal thickness and photoreceptor outer segment length could be good predictive factors of postoperative BCVA in patients with vitreomacular traction syndrome.

Correlation between vascular endothelial growth factor and nonperfused areas in macular edema secondary to branch retinal vein occlusion

Purpose To determine the role of vascular endothelial growth factor (VEGF) in macular edema secondary to branch retinal vein occlusion (BRVO). Patients and methods Aqueous humor samples were collected from 52 eyes with macular edema secondary to BRVO before intravitreal drug injections and from 62 control eyes with cataract. VEGF was measured using an enzyme-linked immunosorbent assay. Fluorescein angiography showed capillary nonperfused areas (NPAs). Macular edema was evaluated by optical coherence tomography as the central retinal thickness. Results The mean aqueous VEGF levels in eyes with BRVO and control eyes with cataract were, respectively, 290.5 pg/mL ± 294.9 pg/mL (range 81.9 pg/mL–1567.3 pg/mL) and 118.0 pg/mL ± 50.1 pg/mL (range 24.6 pg/mL–241.1 pg/mL), which differed significantly (P < 0.0001). The mean VEGF level in eyes with BRVO without apparent NPA was 171.4 pg/mL ± 52.5 pg/mL (range 90.9 pg/mL–299.9 pg/mL), which was significantly higher than controls (P = 0.001). VEGF levels were correlated positively with the size of NPA (P = 0.0002) but not with the central retinal thickness. Conclusion The aqueous VEGF concentration in patients with macular edema secondary to BRVO increased significantly and was correlated significantly with the size of NPA. Aqueous VEGF increased even in eyes without apparent NPA.

Contrast Sensitivity after Pars Plana Vitrectomy: Comparison between Macula-On and Macula-Off Rhegmatogenous Retinal Detachment.

Purpose: To evaluate the contrast sensitivity (CS) of eyes successfully repaired by vitrectomy for rhegmatogenous retinal detachment (RRD) with or without preoperative macular involvement. Methods: In this retrospective, consecutive, interventional case series, 109 eyes received primary vitrectomy for RRD, of which 36 with at least 12 months of follow-up and a best-corrected visual acuity (BCVA) ≥1 at 12 months postoperatively were investigated. The main outcome measurements were BCVA and CS at 12 months postoperatively. Patients with macula-on RRD preoperatively were included in the macula-on group, and patients with macula-off RRD preoperatively were included in the macula-off group. The between-group difference in CS under evening vision conditions was measured with a Takagi glare tester CGT-2000 at 6 visual angles and 13 contrast levels with and without glare. Results: CS was significantly lower in the macula-off group for targets with visual angles of 1.6, 1.0, and 0.64° with glare (p < 0.05) and for the target with a visual angle of 0.64° without glare (p < 0.05). Conclusions: CS in the higher spatial frequency range (especially with glare) is reduced in macula-off RRD patients with good postoperative BCVA compared to macula-on RRD patients with good postoperative BCVA.

Evaluation of clinical validity of the Rabin cone contrast test in normal phakic or pseudophakic eyes and severely dichromatic eyes

To evaluate the clinical validity of the Rabin cone contrast test (RCCT; Innova Systems, Inc.) in patients with normal phakic/pseudophakic eyes and severe dichromatic colour vision deficiency (CVD).

Changes in Retinal Thickness after Vitrectomy for Epiretinal Membrane with and without Internal Limiting Membrane Peeling

Purpose: To investigate anatomic changes in retinal thickness (RT) and functional changes after vitrectomy for idiopathic epiretinal membranes (ERMs) with and without internal limiting membrane (ILM) peeling. Methods: The medical records of 100 eyes of 96 patients with ERM who underwent vitrectomy and ERM removal were reviewed retrospectively. The RT was measured by optical coherence tomography, and the area was divided into 9 sections. The best-corrected visual acuity (BCVA), 9 RT areas, and incidence rates of recurrent ERM were compared between the groups with and without ILM peeling before the operation and 12 months postoperatively. Results: Thirty-nine eyes that underwent vitrectomy with ILM peeling and 61 eyes that underwent vitrectomy without ILM peeling met the inclusion criteria. There were no significant differences between the groups in the BCVA and any of the RTs before the operation and 12 months postoperatively. The ERMs recurred in 8 (20.5%) of 39 eyes and 26 (42.6%) of 61 eyes in the groups with and without ILM peeling, respectively, with a difference that reached significance (p = 0.02) 12 months postoperatively. Conclusions: Vitrectomy for ERM affects the BCVA or the RTs 12 months postoperatively. Additional ILM peeling does not affect them, but it might reduce the ERM recurrence rate.

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography

ABSTRACT A 79-year-old woman suffered ocular trauma from an umbrella. Exotropia of the left eye was observed, and the left eye could not adduct to the midline. Both edges of the lacerated medial rectus were sutured together with the aid of preoperative computed tomography (CT), which showed posterior muscle belly widening due to posterior slippage toward the equator. The alignment and ocular movement were improved postoperatively. Repairing a lacerated medial rectus is difficult because its edge slips into the muscle cone posteriorly. Preoperative CT was useful in identifying the posterior portion of the lacerated muscle, enabling successful repair.