No abstract

The ILM insertion technique may be as effective as the inverted ILM flap technique for the closure of large MHs. However, the latter technique results in better recovery of photoreceptor layers and, consequently, better postoperative visual acuity.

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

PurposeTo investigate fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy (PCV).MethodsThis phase IV, prospective, single-arm, interventional case series was conducted in eight centers. Forty treatment-naïve PCV patients were administered three monthly doses of intravitreal aflibercept (2.0 mg) and an injection every 2 months thereafter. Best-corrected visual acuity (BCVA) and central subfield macular thickness (CSMT) were measured at each visit. Fluorescein and indocyanine green angiography (ICGA) were performed at baseline, 3 and 12 months. The primary outcome measure was the proportion of patients who maintained BCVA (<15 letters loss) at 12 months. Changes in BCVA, macular appearance, and polypoidal lesion appearance were also examined.ResultsThirty-five eyes (87.5 %) had maintained BCVA at 12 months. Average BCVA was significantly higher at 12 months (20/53, 64.2 letters) than at baseline (20/80, 55.1 letters, 9-letter gain; P < .001). Mean CSMT was significantly lower at 12 months (253.6 μm) than at baseline (365.2 μm, P < .001). The macula was dry in 32 (76.2 %), 27 (64.3 %), and 24 eyes (60.0 %) at 3, 6, and 12 months respectively. Fourteen eyes (33.3 %) had a fluid recurrence or increase at 6 months, and they had a significantly lower vision gain (P = .005) than other patients at 12 months. Complete polyp regression occurred in 26 eyes (66.7 %) at 12 months.ConclusionsFixed-dosing aflibercept showed favorable outcomes in PCV patients at 12 months. However, some patients had worse outcomes because of fluid recurrence during maintenance dosing, and these patients would require additional treatments.

Purpose To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). Conclusions In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358.

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.

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.

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.