Sung Who Park

Perfluoro-n-octane–assisted Single-layered Inverted Internal Limiting Membrane Flap Technique for Macular Hole Surgery

Vitrectomy became the standard treatment of macular hole after its introduction by Kelly and Wendel.1 Although progression of surgical techniques and diagnostic tools have improved the anatomical outcomes of macular hole surgery, postoperative visual recovery is usually limited.2–4 Furthermore, surg

Regional Choroidal Thickness Changes in Branch Retinal Vein Occlusion with Macular Edema

Purpose: To investigate regional changes in choroidal thickness in branch retinal vein occlusion (BRVO) patients with macular edema. Methods: Choroidal thickness in the subfoveal, occlusive, and nonocclusive areas in BRVO eyes was measured using enhanced depth imaging by spectral domain optical coherence tomography. The choroidal thickness was compared with the corresponding values both in the fellow eye and in normal controls at baseline. Regional changes in choroidal thickness were then evaluated in the BRVO eyes after intravitreal bevacizumab (IVB) injections. Results: Regional choroidal thickness was measured in 57 eyes at baseline. The mean choroidal thickness of the occlusive area was significantly higher than that of the nonocclusive, subfoveal, and corresponding areas in the fellow eyes and normal controls (p < 0.001). The choroidal thickness in the occlusive area correlated with the retinal thickness in both the central and occlusive areas (rho = 0.590, p < 0.001, and rho = 0.351, p = 0.011, respectively), but not with visual acuity. After IVB, the choroidal thickness in the occlusive area had decreased significantly (p = 0.004), but remained higher than that of other areas (p < 0.001 and p = 0.026). Conclusion: In acute BRVO eyes, the choroid is thicker in the occlusive area. This difference is correlated with the severity of macular edema, but not with visual acuity. Bevacizumab reduces choroidal thickness, but does not restore normal values.

Perfluoro-n-octane Assisted Free Internal Limiting Membrane Flap Technique for Recurrent Macular Hole.

Perfluoro-n-octane Assisted Free Internal Limiting Membrane Flap Technique for Recurrent Macular Hole Vitrectomy combined with removal of the internal limiting membrane (ILM) and gas tamponade is considered a standard procedure for macular hole. Hole closure is not sufficient for the recovery of vision but is necessary to ensure good visual acuity and prevent further vision loss. It is challenging to achieve hole closure in cases of chronic large macular holes or in highly myopic eyes. Recently, various surgical techniques using the ILM have been introduced to improve the surgical outcomes in such cases. The inverted ILM flap technique, first described by Michalewska et al, has shown improved functional and anatomical outcomes. Our group has reported a similar technique, whereby the macular hole is covered with a singlelayered ILM flap using perfluoro-n-octane (PFO) to stabilize the flap during fluid–air exchange. However, these procedures are not feasible in cases where the ILM around the macular hole has already been removed, such as cases of recurrent macular hole or failed surgery. Herein, the authors describe a modified technique for covering a recurrent macular hole with a free flap of the ILM with the assistance of PFO.

TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

Purpose: To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. Methods: This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2–4 mm and outer; 4–6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. Results: The average displacement was 57.2 &mgr;m at an angle of −3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 &mgr;m) than in the outer ring (35.3 &mgr;m, P < 0.001), and larger in the temporal sectors than in the corresponding nasal sectors (P ⩽ 0.008). Inferior and superior displacement was noted in the superior and inferior sectors, respectively. Multiple regression analysis revealed that basal horizontal macular hole diameter and size of internal limiting membrane removal were independent factors of displacement. Conclusion: The macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

Natural History of Idiopathic Epiretinal Membrane in Eyes with Good Vision Assessed by Spectral-Domain Optical Coherence Tomography

Purpose: To investigate the natural history of idiopathic epiretinal membrane (ERM) in eyes with good visual function using optical coherence tomography (OCT). Methods: Sixty-two eyes of 58 patients with idiopathic ERM, visual acuity of 20/40 or better, and no significant metamorphopsia were included. The best corrected visual acuity (BCVA), central macular thickness (CMT), membrane configuration, and ellipsoid zone signal data over 24 months were retrospectively analyzed. Based on OCT findings, ERM configurations were categorized as global attachment (GA), partial attachment (PA), pseudohole, and vitreomacular traction (VMT). Results: The mean BCVA and CMT did not change significantly between baseline and 24 months. GA, PA, pseudohole, and VMT types were observed in 33, 19, 9, and 1 eye at baseline, and in 20, 22, 10, and 1 eye at 24 months, respectively. A membrane configuration change was noted in 24 eyes (38.7%) during follow-up, and the distribution shifted from GA to the other types (p < 0.001). Six eyes had visual loss due to membrane progression, and 4 eyes had spontaneous membrane separation. Of the 10 eyes with progression or separation, 6 were of the PA type. Conclusions: Although the BCVA remains stable over 2 years in most idiopathic ERM eyes with good visual function at baseline, the membrane configuration may change, affecting visual acuity. The GA type would be an early stage, and the PA type is prone to changes in visual acuity.

Reduced-Fluence Photodynamic Therapy in Polypoidal Choroidal Vasculopathy Nonresponsive to Ranibizumab

BACKGROUND AND OBJECTIVE To evaluate the effect of reduced-fluence photodynamic therapy (PDT) on polypoidal choroidal vasculopathy (PCV) unresponsive to intravitreal ranibizumab. PATIENTS AND METHODS Patients with PCV unresponsive to ranibizumab administered 3 months consecutively who then received reduced-fluence PDT were retrospectively surveyed. Nonresponders were defined as patients having no reduction in intraretinal and/or subretinal fluid after 3 consecutive treatments. RESULTS In total, 22 of 104 eyes (21.2%) were non-responders, and 16 of 22 nonresponders received reduced-fluence PDT. Nine eyes achieved complete fluid resolution, and six had reduced but persistent fluid. In one eye, fluid persisted at 6 months despite an additional anti-vascular endothelial growth factor (anti-VEGF) injection after reduced-fluence PDT. Mean macular thickness decreased significantly at 3 and 6 months after PDT, but the mean visual acuity was worse than baseline. CONCLUSION Reduced-fluence PDT in nonresponders gradually decreased intraretinal and/or subretinal fluid over several months but did not maintain visual acuity.

Optic perineuritis secondary to acute retinal necrosis.

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ASSOCIATION BETWEEN TANGENTIAL CONTRACTION AND EARLY VISION LOSS IN IDIOPATHIC EPIRETINAL MEMBRANE.

Purpose: To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane. Methods: Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk–fovea–vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography. Results: We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P < 0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (&rgr; = 0.657; P = 0.008) and traction index of membrane (&rgr; = −0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P < 0.001, both). Conclusion: Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Purpose: The aim of this study was to evaluate the efficacy of the perfluoro-n-octane-assisted single-layered inverted internal limiting membrane (ILM) flap for large macular holes (MHs). Methods: We reviewed idiopathic MHs >400 μm. The patients were divided into ILM peeling (group P, 51 eyes) and ILM flap (group F, 41 eyes). Closure of MHs, best-corrected visual acuity (BCVA), and postoperative optical coherence tomography findings were analyzed. Results: MH closure was achieved in 88.2% in group P and in 100% in group F (p = 0.032). SF6 and air was used most frequently in groups P and F, respectively. Both had a significant improvement in BCVA, which was better in group F until 3 months, but not at 6 months. At 6 months, the ellipsoid zone and external limiting membrane were restored with no significant difference. Conclusion: The single-layered inverted ILM flap was better for the closure of large MHs than ILM peeling, without using long-acting gas that prevents early rehabilitation.

Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy

ABSTRACT Purpose: To investigate the topographic relationship between polypoidal choroidal vasculopathy (PCV) growth and choroidal watershed zones (CWZ) by using indocyanine green angiography (ICGA). Materials and Methods: We evaluated PCV lesions smaller than the CWZ at baseline and followed up more than 6 months. The CWZ was traced in the early phase ICGA at baseline. The vascular lesion of PCV was traced in baseline and follow-up ICGA. These traces were overlapped and topographic relationships between CWZs and PCV growth were evaluated. Results: Among 31 eyes of 31 patients, enlargement of a PCV lesion was observed in 20 patients (64.5%) at mean follow-up of 30.4 months (6–68 months). A topographical relationship between the CWZ and PCV growth was demonstrated in 14 eyes (70.0%), as the shape of the PCV lesion conformed to the boundary of the CWZ, and/or the growth of the branching vascular network was aligned to the direction of the CWZ extension to the periphery. Growth beyond the boundary of the CWZ was noted in 9 eyes (45.0%), however growth area was greater inside the CWZ than outside in all eyes. Of 15 eyes of extrafoveal lesion at baseline, 8 eyes in which the vascular lesion progressed to the fovea had the CWZ involving the fovea, whereas PCV in three eyes with an extrafoveal CWZ remained as a non-subfoveal disease after mean follow-up of 17.0 months (p = 0.019). Conclusions: A subfoveal CWZ was related to PCV growth to the fovea. Topographical relationships between PCV growth and the CWZ suggest that choroidal circulation is a predisposition for PCV growth.