Tomoyuki Hiraoka

Correlation between Length of Foveal Cone Outer Segment Tips Line Defect and Visual Acuity after Macular Hole Closure

PURPOSE To determine whether the postoperative length of the photoreceptor cone outer segment tips (COST) line defect is significantly correlated with best-corrected visual acuity (BCVA) after macular hole closure. DESIGN Retrospective, consecutive, observational case series. PARTICIPANTS Fifty-one eyes of 51 patients with a surgically closed macular hole were studied. METHODS Spectral-domain optical coherence tomography (SD-OCT) was used to obtain images of the foveal area, and the lengths of the COST line defect were measured in the images obtained 1, 3, 6, 9, and 12 months after macular hole surgery. The correlation between the length of COST line defect and the BCVA was determined. MAIN OUTCOME MEASURES The lengths of the COST line defect, the inner segment/outer segment (IS/OS) junction defect, the external limiting membrane (ELM) line defect in the SD-OCT images, and the BCVA. RESULTS The COST line defect was gradually restored centripetally 1 to 12 months postoperatively. The length of the COST line defect was significantly correlated with the BCVA at 1, 3, 6, 9, and 12 months postoperatively (P < 0.001). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of the COST line defect (P < 0.001) but not with that of the IS/OS junction and ELM line defects after 6 months. The preoperative length of the COST line defect was significantly correlated with postoperative BCVA at 12 months (P = 0.020), but the length of the IS/OS junction and ELM line defects was not. The preoperative length of the COST line defect was significantly longer than the fluid cuff diameter of the macular hole (P = 0.020), indicating that the influence of the elevated neurosensory retina at the fluid cuff on the SD-OCT signals of the COST line was probably minimal. The postoperative BCVA at 12 months can be calculated by the following regression equation: BCVA = 0.00020 × (length of preoperative COST line defect [μm]) - 0.23 (F value = 15.4; P < 0.001). CONCLUSIONS The recovery of the foveal COST line defect is related to visual recovery after macular hole closure. The length of the preoperative COST line defect may predict the BCVA after macular hole surgery.

Vitrectomy without Laser Treatment or Gas Tamponade for Macular Detachment Associated with an Optic Disc Pit

PURPOSE To evaluate the clinical outcomes after vitrectomy, without gas tamponade or laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with optic disc pits and to characterize retinal manifestations during treatment of optic pit maculopathy using optical coherence tomography (OCT). DESIGN Noncomparative, retrospective, interventional case series. PARTICIPANTS Eight consecutive patients (8 to 56 years of age) with unilateral macular detachment associated with optic disc pit. INTERVENTION Pars plana vitrectomy with induction of a posterior vitreous detachment (PVD) was performed in all eyes. No laser or gas injection was performed in any eye during the original surgery. Patients were followed up for 10 to 46 months (mean, 26 months) after surgery. MAIN OUTCOME MEASURES Anatomic outcome as determined by OCT and postoperative visual acuities were the main outcome parameters. Fundus autofluorescence (FAF) images were obtained in 4 eyes to document anatomic changes in the macula. RESULTS Although complete retinal reattachment was achieved in 7 of 8 eyes, up to about 1 year was necessary for the retinal detachment to resolve fully. The 1 eye in which macular detachment failed to resolve completely underwent revision of vitrectomy with a gas tamponade and laser photocoagulation in the peripapillary area. In the early postoperative period, despite persistent macular detachment, the visual acuities improved in 7 eyes. These improved acuities corresponded with remodeling of the photoreceptor outer segments on OCT and the appearance of granular hyperfluorescence on FAF imaging. CONCLUSIONS Vitrectomy with induction of a PVD at the optic disc without gas tamponade or laser photocoagulation seems to be an effective method of managing macular detachment resulting from optic disc pits. The OCT scanning before and after surgery suggests that peripapillary vitreous traction with the passage of fluid into the retina through the pit is the cause of the schisis-like separation seen in optic disc pit maculopathy.

Significant Correlation Between Visual Acuity and Recovery of Foveal Cone Microstructures After Macular Hole Surgery

PURPOSE To determine whether a recovery of the microstructures of the foveal photoreceptors after macular hole closure is correlated with best-corrected visual acuity (BCVA). DESIGN Retrospective, consecutive, observational case series. METHODS SETTING Single-center academic practice. STUDY POPULATION Forty-one eyes of 41 patients with surgically closed macular holes. OBSERVATIONAL PROCEDURES: The presence and intactness of the cone outer segment tips (COST) line were determined by spectral-domain optical coherence tomography and compared with the presence of the inner segment/outer segment (IS/OS) junction and the external limiting membrane (ELM) at 1, 3, 6, 9, and 12 months after the macular hole surgery. MAIN OUTCOME MEASURE The correlation between the integrity of the foveal photoreceptor microstructures and the BCVA. RESULTS A distinct COST line was first seen at 6 months after the surgery. A distinct or irregular COST line was observed only in eyes with an intact IS/OS junction and ELM. Eyes with a distinct or irregular COST line had significantly better BCVA than those with a disrupted COST line in eyes with an intact IS/OS junction and ELM at 12 months (P = .030). The BCVA was ≥20/25 at 12 months in 91% of the eyes with a distinct or irregular COST line but in only 44% of the eyes without a COST line (P = .015). CONCLUSIONS The significant correlation between the BCVA and a distinct or irregular COST line after successful macular hole surgery indicates that the recovery of foveal cone microstructure is associated with good postoperative BCVA.

Ability to determine postoperative status of macular hole in gas-filled eyes by spectral-domain optical coherence tomography.

Background:  To determine whether the status of a macular hole can be determined by spectral‐domain optical coherence tomography in gas‐filled eyes.

Infrared and fundus autofluorescence imaging in eyes with optic disc pit maculopathy

Background:  To characterize the infrared (IR) and fundus autofluorescence (FAF) images of eyes with optic disc pit maculopathy.

Increased choroidal thickness in patient with high-altitude retinopathy.

We report a case of high-altitude retinopathy with increased choroidal thickness detected by spectral-domain optical coherence tomography (SD-OCT). A 36-year-old Japanese man developed an acute vision decrease in his left eye after he had trekked at an altitude of 4600 m in Tibet for 1 week. His visual acuity was 20/20 OD and 20/200 OS with refractive errors of − 0.25 diopters (D) OD and − 0.50 D OS 3 weeks after the onset of the visual decrease. Funduscopic examinations revealed multiple intraretinal hemorrhages bilaterally and a macular hemorrhage in the left eye. SD-OCT showed that the thickness of choroidal layer at the fovea was 530 μm OD and 490 μm OS which is thicker than that in normal subjects of approximately 300 μm. We suggest that the increase in the retinal blood flow under hypoxic conditions may be associated with an increase in the choroidal blood flow resulting in an increase in choroidal thickness.

Bilateral exudative retinal detachment due to retinal pigment epithelial tears successfully treated by vitrectomy and scleral window surgery

Dear Editor, R etinal pigment epithelial (RPE) tears develop by an excessive stretching of the RPE layer (Gass 1984). Exudative retinal detachments (RDs) may rarely be associated with RPE tears (Serels et al. 1991; Laidlaw & Poynter 1998). We report the findings of a patient who developed bilateral exudative RD causing angleclosure glaucoma associated with spontaneous multiple RPE tears. Vitrectomy, endolaser photocoagulation and silicone oil tamponade with ⁄without scleral window were used to treat this complicated RD. A 68-year-old man complained of blurred vision in his left eye. He had had prophylactic laser iridotomy and persistent pleuritis of unknown origin, but had not had steroid therapy. He also did not have renal dysfunction. His visual acuity was 20 ⁄ 40 OD and 20 ⁄ 200 OS. Ophthalmoscopy of the left eye showed an inferior bullous RD involving the macula without a retinal break, but with large RPE tears (Fig. 1A). An old retinal branch vein occlusion was found in the superior temporal arcade of the right eye. Fluorescein angiography showed hyperfluorescence in the areas of the RPE tears and leakage from the RPE tears in the left eye (Fig. 1B). The axial length was 21 OD and 22 mm OS. Although we expected a spontaneous resolution of the RD, 1 month later, a total bullous RD developed pushing the lens anteriorly causing angle-closure glaucoma in the left eye (Fig. 1C). At this time, many RPE tears and a RD were found in the right eye (Fig. 1D). The patient underwent lensectomy with preservation of the posterior lens capsule, external drainage of the subretinal fluid (SRF) and vitrectomy in the left eye. Multiple RPE tears were noted under the RD. The RPE tears were photocoagulated by endolaser, and silicone oil was injected as a tamponade. A reduction in the RD was achieved, but exudation gradually increased leading to an increase in the intraocular pressure (IOP). The patient underwent a second vitrectomy with removal of the posterior lens capsule, additional photocoagulation and silicone oil tamponade in the left eye. Postoperatively, the IOP was