Miyuki Arai

Correlation of visual recovery and presence of photoreceptor inner/outer segment junction in optical coherence images after successful macular hole repair.

Purpose: To determine the relationship between the postoperative visual acuity (VA) and the presence of a photoreceptor inner segment (IS) and outer segment (OS) junction (IS/OS) in optical coherence tomographic (OCT) images after macular hole (MH) surgery. Methods: Twenty-three eyes of 23 cases of idiopathic MH treated by vitrectomy were studied. The postoperative VA and OCT3 images of the fovea at 1, 3, and 6 months were examined. The relationship between the presence of the IS/OS junction and the visual acuity was studied. Results: All MHs were successfully closed. The IS/OS junction appeared as a distinct, highly reflective line just vitread to the retinal pigment epithelial layer in the postoperative OCT3 images. A normal IS/OS junction was detected postoperatively in one eye at 1 month, three eyes at 3 months, and seven eyes at 6 months. The VA was significantly better in eyes in which a normal IS/OS junction was detected than in those not detected at 3 and 6 months postoperatively (P = 0.046 and P = 0.040, respectively). Conclusion: The normal IS/OS junction observed in OCT3 images is associated with good visual recovery after MH closure. The presence of normal IS/OS junction may be important for visual recovery after MH repair.

Comparison of Vitrectomy with Brilliant Blue G or Indocyanine Green on Retinal Microstructure and Function of Eyes with Macular Hole

PURPOSE To evaluate the microstructure of the inner and outer retina and the visual function after macular hole (MH) surgery using brilliant blue G (BBG) or indocyanine green (ICG) to make the internal limiting membrane (ILM) more visible. DESIGN Comparative, retrospective, interventional case series. PARTICIPANTS Sixty-three eyes of 63 consecutive cases with MH were studied. Thirty-five eyes of 35 cases were treated with BBG between January and August 2011. Twenty-eight eyes of 28 MH cases were treated with ICG from April 2009 through April 2010. METHODS Vitrectomy was performed with a 23-gauge system and 0.25 mg/ml BBG or with 0.125% ICG. MAIN OUTCOME MEASURES The best-corrected visual acuity (BCVA) and the microperimetry-determined retinal sensitivity were measured at baseline and at 3 and 6 months after surgery. The length of the defect of the photoreceptor inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM), the central foveal thickness (CFT), and the thickness of the ganglion cell complex (GCC) were measured in the spectral-domain optical coherence tomographic images. RESULTS The average BCVA was significantly better in the BBG group than in the ICG group at 3 months (P = 0.021) and 6 months (P = 0.045) after surgery. The mean retinal sensitivity in the BBG group was improved significantly in the central 2° at 3 and 6 months (P = 0.001 and P = 0.030, respectively), but was not significantly improved in the adjacent 10°. The length of IS/OS junction defect was significantly shorter in the BBG group at 3 months (P = 0.048), but was not significantly different at 6 months (P = 0.135). The length of ELM defect and the GCC thickness were not significantly different between the 2 groups at 3 and 6 months. The CFT was significantly thinner in the ICG group than in the BBG group at 3 and 6 months (P = 0.013 and P = 0.001, respectively). CONCLUSIONS The postoperative BCVA and retinal sensitivity in the central 2° were better in eyes after BBG-assisted vitrectomy. The restoration of IS/OS junction was faster in the BBG group, and the CFT was significantly thinner in eyes after ICG. Brilliant blue G may be a better agent than ICG to make the ILM more visible. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Efficacy of Vitrectomy and Internal Limiting Membrane Removal for Macular Edema Associated with Branch Retinal Vein Occlusion

Aim: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling to that without ILM peeling for macular edema associated with branch retinal vein occlusion (BRVO). Methods: The medical records of 47 eyes of 47 patients with BRVO-associated macular edema were examined. To treat the macular edema, a posterior vitreous detachment (PVD) was created, and the ILM was removed in 13 eyes (ILM-removed group), whereas a PVD was created and the ILM was not removed in 34 eyes (ILM-preserved group). The best-corrected visual acuity (BCVA) and the optical-coherence-tomography-determined foveal thickness were obtained preoperatively and at 6 months postoperatively. Results: The mean postoperative BCVA was significantly better than the preoperative BCVA in both the ILM-removed and in the ILM-preserved groups (p = 0.0017 and p = 0.0002, respectively). The fovea was significantly thinner at 1 month after surgery in both groups (p = 0.0007 and p < 0.0001, respectively). The postoperative improvement of the mean BCVA and the foveal thickness were not significantly different for the two groups at any postoperative period. Conclusions: Because there was no significant difference in the improvement of BCVA between the two groups at 6 months postoperatively, there may be no additional benefit in removing the ILM for BRVO-associated macular edema.

Long-term therapeutic efficacy of the subthreshold micropulse diode laser photocoagulation for diabetic macular edema

PurposeTo investigate the long-term efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP) on diabetic macular edema (DME).MethodsThe effects of SMDLP (810 nm) were studied on 56 eyes of 44 patients with DME. Optical coherence tomography-determined foveal thickness and best-corrected visual acuity (BCVA) were evaluated at 1, 3, 6, and 12 months after the SMDLP.ResultsThe mean foveal thickness was 504 μm before the SMDLP, and it was significantly reduced to 439 μm at 1 month (P = 0.001), 409 μm at 3 months (P < 0.0001), 358 μm at 6 months (P < 0.0001), and 320 μm at 12 months (P < 0.0001). The mean BCVA at baseline was 0.47 logarithm of the minimal angle of resolution (logMAR) units, and it was not changed significantly at all of the postoperative examinations. Among the 56 eyes, 10 (17.8%) had an improvement of BCVA of >0.2 logMAR units, 36 (64.2%) remained the same, and 10 eyes (17.8%) had a reduction of >0.2 logMAR units at 12 months postoperatively.ConclusionOur results indicate that SMDLP has a beneficial effect on DME. However, prospective studies are needed to evaluate this technique in more detail.

Early postoperative macular morphology and functional outcomes after successful macular hole surgery.

Purpose: To investigate the relationship between early postoperative macular morphology and postoperative visual acuity in eyes that had undergone successful macular hole (MH) surgery. Methods: Pars plana vitrectomy and internal limiting membrane peeling were performed during surgery for idiopathic MHs on 25 eyes. The macular configuration was determined by optical coherence tomography, and best-corrected VA (BCVA) was measured postoperatively. Results: Eleven eyes had nearly normal foveal morphology (normal group) and 14 eyes had subretinal fluid or intraretinal cysts (abnormal group) at 1 month. Among the 14 eyes in the abnormal morphology group, normal foveal morphology was confirmed in 9 eyes 3 months and in the remaining 5 eyes 6 months after surgery. Mean BCVA improved significantly from the preoperative values in both groups 6 months after surgery. Conclusions: The morphology of the macular area was abnormal in more than one half of eyes that had successful MH surgery 1 month after surgery. However, by 6 months, all eyes had normal macular configuration, and BCVA was not significantly different in the two groups. We conclude that an abnormal morphologic appearance of the macular area in the early postoperative period does not predict the final visual outcome.

Risk Factors for Refractory Diabetic Macular Oedema after Sub-Tenon's Capsule Triamcinolone Acetonide Injection.

The purpose of this study is to identify the risk factors for a recurrence or persistence of diabetic macular oedema (DME) after a sub-Tenons capsule triamcinolone acetonide (STTA) injection. The medical records of 124 patients (124 eyes) treated by STTA were reviewed. The age, sex, HbA1c level, best-corrected visual acuity, central macular thickness, insulin use, pioglitazone use, systemic hypertension, serous retinal detachment, proteinuria, panretinal photocoagulation, microaneurysm photocoagulation (MAPC), subthreshold micropulse diode laser photocoagulation (SMDLP), cataract surgery, and history of vitrectomy were examined by logistic regression analysis. Procedures of MAPC and SMDLP were significantly associated with DME treated with STTA (P = 0.0315, P = 0.04, resp.). However, a history of vitrectomy was found to have significantly fewer recurrences or persistent DME after STTA (P = 0.0464). In conclusion, patients who required combined MAPC or SMDLP with a STTA injection had significantly higher refractoriness to STTA, but postvitrectomy may prevent the recurrence or persistence of DME after STTA injection.

Comparisons of Efficacy of Intravitreal Aflibercept and Ranibizumab in Eyes with Diabetic Macular Edema

We compared the efficacy of intravitreal aflibercept (IVA) to intravitreal ranibizumab (IVR) injections in eyes with diabetic macular edema (DME). The medical records of 49 eyes of 36 patients who were diagnosed with DME and had received IVR and 46 eyes of 40 patients who had received IVA treatment were reviewed. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured at the baseline and at 1, 3, and 6 months after the IVR or IVA. The mean number of injections of IVR was 2.6 ± 1.1 and of IVA was 2.7 ± 1.4. At 6 months, the CMT was significantly thinner than the baseline after IVR and after IVA. The mean BCVA was significantly better than the baseline after IVR only at 1 and 3 months and after IVA at 1 and 6 months. The BCVA of eyes with serous retinal detachment (SRD) was significantly better at 1 month after the IVR and at 1 month and 6 months after the IVA. The BCVAs improved more significantly in the SRD+ group than in the SRD− group. The effects of IVA persist longer than that of IVR. The effectiveness of both IVR and IVA was not dependent on the presence of SRD (IRB#2107).

Efficacy of One-Year Treatment with Aflibercept for Diabetic Macular Edema with Practical Protocol

The purpose of this study was to determine the efficacy of one-year treatment of diabetic macular edema (DME) with intravitreal aflibercept (IVA) injections on a practical protocol. The medical records of 51 eyes of 43 patients who were diagnosed with DME and had received IVA treatments were reviewed. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of IVA injections was 3.8 ± 2.4. The mean BCVA was significantly better and the CMT was thinner after the IVA at all follow-up times (P < 0.05). The BCVA was better in eyes with a serous retinal detachment (SRD) than without a SRD (P < 0.01). There was a significant correlation between the photoreceptor outer segment (PROS) length and BCVA at the baseline and at 12 months after the IVA (P < 0.05). A fewer number of IVA injections significantly improved the BCVA and the CMT in eyes with DME after one-year treatment. IVA was more effective in the SRD+ group than in the SRD− group. The PROS length may be a predictive marker for visual outcomes after one-year treatment with IVA for DME (IRB#2272).

Effects of sub-Tenon's capsule triamcinolone acetonide injection combined with microa- neurysm photocoagulation on diabetic macular edema

PURPOSE To compare the effects of sub-Tenons capsule triamcinolone acetonide (STTA) injection to that of STTA injection combined with microaneurysm photocoagulation (MAPC; STTA + MAPC) on eyes with diabetic macular edema (DME). PATIENTS AND METHODS The medical records of 138 eyes of 138 patients with DME treated by either STTA or STTA + MAPC were reviewed. The degree of DME was determined by the optical coherence tomographic features: patients with serous retinal detachment (SRD+; 38 eyes) and patients without SRD (non-SRD; 100 eyes). The central macular thickness (CMT) and the best-corrected visual acuity (BCVA) were measured periodically for 6 months after the treatments. RESULTS The BCVA was significantly improved in the non-SRD group after STTA + MAPC. The CMT was significantly improved in all groups and improved considerably more in the non-SRD group than in the SRD+ group after STTA + MAPC. CONCLUSION Our findings indicate that MAPC has an additive effect in the non-SRD type.

The effect of posterior sub-Tenon's capsule triamcinolone acetonide injection to that of pars plana vitrectomy for diabetic macular edema.

Purpose To compare the effect of posterior sub-Tenon’s capsule triamcinolone acetonide (STTA) injection to that of pars plana vitrectomy (PPV) for diabetic macular edema (DME). Patients and methods The medical records of 50 patients (52 eyes) with DME were reviewed. Twenty-six eyes underwent STTA (20 mg) and the other 26 eyes underwent vitrectomy combined with cataract surgery. The central macular thickness (CMT), measured by optical coherence tomography, and best-corrected visual acuity (BCVA) were determined before and 1, 3, and 6 months after treatment. Results The differences in the BCVA and the CMT between the STTA group and the PPV group were not significant before or at any time after the treatment. In both the STTA and PPV groups, there were significant differences between the pre-treatment CMT and BCVA at any time after treatment. Conclusion We recommend STTA injection for the treatment of DME.