Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment / O impacto do descolamento macular seroso na recuperação visual no tratamento de oclusões de veias retinianas

ABSTRACT Purpose: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. Methods: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. Results: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. Conclusions: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

RESUMO Objetivo: Avaliar o efeito do descolamento macular seroso observado durante oclusões de veias retinianas nos resultados do tratamento. Métodos: Um total de 117 olhos de 115 pacientes que foram tratados com injeções intravítreas para edema macular secundário à oclusão de veia retiniana foram revistos retrospectivamente. A acuidade visual, tomografia de coerência óptica e os resultados da angiofluoresceinografia foram avaliados de acordo com a presença ou ausência de descolamento macular seroso. Resultados: No grupo com oclusão de um ramo da veia retiniana, foi detectado um aumento estatisticamente significativo na acuidade visual média em comparação com o valor inicial em cada consulta de acompanhamento do descolamento macular seroso, enquanto que o aumento na acuidade visual média só foi significativo nas consultas aos 3 e 6 meses na presença de descolamento macular seroso. No grupo com oclusão da veia central da retina, houve um aumento na acuidade visual média em comparação com a acuidade inicial em cada consulta na ausência de descolamento macular seroso, enquanto a acuidade visual média diminuiu em comparação com a acuidade inicial em todas as consultas, exceto na consulta aos 3 meses. O defeito da zona elipsoide era mais proeminente na presença de descolamento macular seroso nos olhos com oclusão de um ramo da veia retiniana, enquanto que não havia diferença significativa na zona elipsoide com a presença ou ausência de descolamento macular seroso em olhos com oclusão central da veia retiniana. Conclusões: No grupo com edema macular devido à oclusão de veias retinianas, o aumento médio inicial da acuidade visual observado no primeiro ano foi mantido nos casos sem descolamento macular seroso, mas não naqueles com presença de descolamento macular seroso. O descolamento macular seroso pode ser um fator negativo em olhos com oclusão de veias retinianas.

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience

Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia?associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow?up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow?up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full?thickness macular hole?related retinal detachment was present in nine cases. Swept?source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best?corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy

Hypertensive retinopathy is seen frequently in patients with systemic hypertension and is usually asymptomatic. An acute rise in blood pressure may lead to exudative changes in the form of macular edema, hemorrhages, and serous macular detachment that can lead to visual decline. The authors report prompt resolution of exudative changes in a case of hypertensive retinopathy following intravitreal bevacizumab.

Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment

PURPOSE: To investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD). METHODS: A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were macula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated. RESULTS: In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ± 0.55 log MAR, n = 16) (p = 0.008). CONCLUSIONS: After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.

Acute lymphoblastic leukemia presenting with bilateral serous macular detachment / Leucemia linfoblástica aguda com descolamento macular seroso bilateral

ABSTRACT Acute lymphoblastic leukemia is a malignant hematopoietic neoplasia, which is rare in adults. Although ocular fundus alterations may be commonly observed in the course of the disease, such alterations are rarely the presenting signs of the disease. Here we describe the case of a patient with painless and progressive loss of visual acuity (right eye, 2/10; left eye, 3/10) developing over two weeks, accompanied by fever and cervical lymphadenopathy. Fundus examination showed bilateral macular serous detachment, which was confirmed by optical coherence tomography. Fluorescein angiography revealed hyperfluorescent pinpoints in the posterior poles. The limits of the macular detachment were revealed in the late phase of the angiogram. The results of blood count analysis triggered a thorough, systematic patient examination. The diagnosis of acute lymphoblastic leukemia B (CD10+) was established, and intensive systemic chemotherapy was immediately initiated. One year after the diagnosis, the patient remains in complete remission without any ophthalmologic alterations.

RESUMO A leucemia linfoblástica aguda é uma neoplasia maligna das células hematopoiéticas, incomum em adultos. Apesar da maioria dos casos apresentar alterações no fundo ocular no decurso da doença, estas são raramente forma de apresentação da mesma. Descreve-se o caso de uma doente com diminuição progressiva e indolor da acuidade visual (OD 2/10 e OE 3/10), que apresentava concomitantemente febre e adenopatias cervicais, com duas semanas de evolução. À oftalmoscopia apresentava descolamento seroso macular bilateral, confirmado por tomografia de coerência ótica. A angiografia fluoresceínica revelou pequenas lesões hiperfluorescentes tipo pinpoints no polo posterior. Nos tempos médios e tardios do exame adivinham-se os limites da bolsa do descolamento do neuroepitélio. As alterações encontradas no hemograma suscitaram um estudo sistêmico extenso. O diagnóstico de leucemia linfoblástica aguda B (CD10+) foi efetuado, iniciando-se, de imediato, quimioterapia sistêmica intensiva. Um ano após o diagnóstico a doente continua em remissão e sem alterações oftalmológicas de novo.

Intravitreal bevacizumab therapy for idiophatic juxtafoveolar retinal telangiectasis associated with serous macular detachment / Tratamento com injeção intravítrea de bevacizumabe para telangiectasia justafoveolar idiopática associada a descolamento seroso macular

The authors describe a 50-year-old woman with group 2 juxtafoveolar retinal telangiectasis and macular detachment treated with a single-dose of intravitreous bevacizumab injection. There was an improvement in her visual acuity, with a decrease in retinal thickness showed by the optical coherence tomography and fluorescein leakage in the angiography on follow-up visits. No adverse events were observed as a result of the treatment used. After one year of follow-up, the vision remained stable and macular detachment did not recur.

Os autores descrevem uma paciente do sexo feminino com 50 anos de idade portadora de telangiectasia justafoveolar idiopática tipo 2, associada a descolamento macular e tratada com injeção intravítrea de bevacizumabe, dose única. Houve uma melhora da acuidade visual com diminuição da espessura retiniana documentada por tomografia de coerência óptica e angiografia fluoresceínica durante seu acompanhamento. Não observou-se efeitos adversos em consequência do tratamento. Após um ano de acompanhamento, sua visão permaneceu estável e o descolamento macular não recorreu.

A Case of Serous Macular Detachment Associated with Tractional Fibrous Tissue in an Optic Pit Patient

PURPOSE: To report a case of serous macular detachment associated with tractional fibrous tissue in an optic pit patient successfully treated by vitrectomy without laser photocoagulation. CASE SUMMARY: A 15-year-old female visited our hospital for visual disturbance of her left eye. The patient's best-corrected visual acuity was 0.5. After ophthalmic examinations, the patient was diagnosed with an optic pit associated serous macular detachment. Pars plana vitrectomy with complete posterior vitreous detachment was performed. A thick fibrous tissue within the optic disc cupping was found. During removal of the fibrous tissue, the tissue was observed to be attached to a tiny hole above the optic pit. The thick fibrous tissue was tugging at the margin of the hole and was removed using intraocular forceps to relieve the traction. Fluid-gas exchange was then performed and the operation was completed without laser photocoagulation around the optic disc. The fovea was reattached completely in 12 months and visual acuity was improved to 0.8.

Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment.

Aim: A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD). Materials and Methods: Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test. Results: The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001). Conclusions: The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.

A Case of Surgically Treated Serous Macular Detachment Associated With Optic Disc Pit

PURPOSE: To report the clinical results of a planned vitrectomy, laser photocoagulation and gas tamponade for the treatment of serous macular detachment associated with optic disc pit. However, laser photocoagulation was performed on a postoperative outpatient basis for subretinal fluid. CASE SUMMARY: A 13-year-old women presented with central visual disturbance in the left eye. Her best-corrected visual acuity (BCVA) was 0.16. On ophthalmic examination, the patient was diagnosed with optic disc pit combined with serous macular detachment. After 3 months, the serous macular detachment increased and visual acuity decreased to 0.1. Pars plana vitrectomy combined with complete posterior vitreous detachment was performed. After intravitreal injection of perfluorodecalin, internal drainage of the subretinal fluid using the back flush needle around the optic disc pit was performed, but the fluid was not drained. The planned intraoperative photocoagulation was not performed due to a large serous macular detachment. Gas tamponade was performed and a facedown position was maintained for 1 week followed by laser photocoagulation. The subretinal fluid was completely absorbed and visual acuity was improved. In addition, recurrence was not observed throughout the follow-up period.

Multifocal Electroretinography After Reattachment of Macula-Off Retinal Detachment

PURPOSE: To assess macular function by multifocal electroretinography after reattachment of macula-off retinal detachment and to evaluate relationship between duration of macular detachment (DMD) and functional recovery. METHODS: Nineteen patients (19 eyes) with macula-off rhegmatogenous retinal detachment underwent pneumatic retinopexy or scleral buckling. Retinal reattachment was obtained successfully in all patients. Duration of follow-up of all patients is at least more than 12 months. Eyes were divided into 2 groups, corresponding to the DMD : Group A (within 7 days, n=9 eyes), Group B (>7 days, n=10 eyes). The amplitudes and implicit times of N1-wave and P1-wave of mfERGs in Area 1 (Ring 1), Area 2 (Ring 1+2) were compared between Group A and B and between Group A and control group. RESULTS: The P1 amplitudes in Area 1 and 2 were significantly different between Group A and B (P0.05). There were no significant difference of all data between Group A and control in Area 1 and 2 (P>0.05) The implicit times of N1, P1 were not significantly different between Group A and B. CONCLUSIONS: The DMD plays a key role in recovery of visual function after reattachment. The mfERG is a useful tool to evaluate the recovery of macular function after reattachment of macula-off retinal detachments.

Effectiveness of ILM Peeling on Vitrectomy Patients with Diabetic Macular Edema

PURPOSE: To evaluate the effectiveness of a combined procedure of peeling the internal limiting membrane with vitrectomy in diabetic macular edema. METHODS: This study comprised 16 eyes of 16 patients hospitalized during a 1-year period. They were randomized to either a vitrectomy group (10 eyes in 10 patients) or to a combined procedure group (6 eyes in 6 patients). Preoperative and postoperative macular center thickness, best corrected visual acuity and postoperative complications 4 months postoperative were investigated. RESULTS: There were no statistically significant differences in the mean values of preoperative and postoperative best corrected visual acuity (logMAR) between the two groups. The mean values of preoperative and postoperative macular center thickness in the vitrectomy group were respectively 509.50+/-36.77 and 332.60+/-91.73; while in the combined procedure group, they were 516.17+/-55.43 and 333.83+/-51.64. Again, there were no statistically significant differences between the two groups. At the 4-month follow-up, decreased visual acuity was found in 3 eyes of the vitrectomy group and in 2 eyes of the combined procedure group. Vitreous hemorrhage (3 eyes) and tractional retinal detachment (1 eye) were found in the vitrectomy group and vitreous hemorrhage (2 eyes) was diagnosed in the combined group. CONCLUSIONS: In our study, vitrectomy with peeling of the internal limiting membrane was not more effective than vitrectomy alone in decreasing macular edema or in improving best corrected visual acuity. Additional studies of the combined procedure are needed to verify this result.

Factors Affecting the Visual Outcome after Scleral Buckle in Rhegmatogenous Retinal Detachment Involving Macula

PURPOSE: To investigate the factors affecting the visual outcome after a scleral buckle in a rhegmatogenous retinal detachment involving the macula. METHODS: A retrospective survey of 70 eyes was carried out. The preoperative factors examined in this study included the preoperative visual acuity, the patient's age, the duration of macular detachment, the extent of the detached retina, the location of the retinal hole, and the surgical procedure. The correlation between these factors and the postoperative visual outcome were investigated. RESULTS: The factors related to a favorable visual outcome were the preoperative visual acuity, age, the duration of macular detachment, surgical procedure, and the location of the retinal hole. A preoperative visual acuity of 0.1 or more, an age of 30 years or less, a detached retina of 2 quadrants or less, and duration of macular detachment of 7 days or less were factors that indicated a favorable visual outcome. The surgical procedure and the location of the retinal hole were not associated with the visual outcome. CONCLUSIONS: The factors related to a favorable visual outcome were a preoperative visual acuity of 0.2 or higher, an age of 30 or less, a detached retina of 2 quadrants or less, and duration of the macular detachment of 7 days or less. The location of the retinal hole, however, did not affect the visual outcome.

Factors Predisposing to Poor Visual Acuity after Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the predisposing factors of a visual acuity of less than 0.1 after vitrectomy in proliferative diabetic retinopathy. METHODS: The medical records of 310 eyes of 295 patients were reviewed, and the eyes were divided into 2 groups: postoperative visual acuity less than 0.1 (131 eyes, 42.2%), and more than 0.1 (179 eyes, 57.8%). RESULTS: Univariate analysis revealed that postoperative visual acuity of less than 0.1 was associated with preoperative retinal detachment, preoperative macular detachment, intraocular tamponade, absence of cataract operation, preoperative visual acuity of less than 0.02, and a treatment need for postoperative high intraocular pressure. Multivariate analysis revealed that postoperative visual acuity of less than 0.1 was associated with preoperative macular detachment and treatment for high postoperative intraocular pressure. CONCLUSIONS: This study showed that diabetic patients who have visual acuity less than 0.1 after vitrectomy are likely to have preoperative macular detachment or to need treatment for postoperative high intraocular pressure.

Surgical results of Vitrectomy for Diabetic Macular Heterotopia

PURPOSE: This study aimed to investigate visual prognosis and postoperative complications of vitrectomies for macular heterotopia, and compare it with that of tractional macular detachment. METHODS: Medical records of 10 eyes which had undergone pars plana vitrectomy for diabetic macular heterotopia and 21 eyes which for diabetic tractional macular detachment in the 202 patients who had been diagnosed as proliferative diabetic retinopathy at Pusan Paik hospital from January, 1995 to december, 1998 were reviewed to study their clinical features, complications, visual outcome. RESULTS: Final postoperative improved visual acuity was documented in 70% of patients with macular heterotopia and 38% of patients with tractional macular detachment (P>0.05). Postoperative vitreous hemorrhage and cataract developed in 20% and 10% of patients with macular heterotopia and 19% and 10% of patients with tractinal macular detachment. Patients with macular heterotopia experienced retinal detachment and macular hole. Patients with tractional macular detachment experienced increased IOP, neovascular glaucoma and phthisis. CONCLUSIONS: Although we could not revealed statistical significance, the surgical results of vitrectomy for diabetic macular heterotopia was better than that of diabetic tractional macular detachment and in the view of vision and complications, diabetic macular heterotopia was more favorable.

ecovery of Visual Acuity after Rhegmatogenous Retinal Detachment Involving the Macula

We retrospectively investigated long-term visual prognosis following successful retinal reattachment in eyes with rhegmatogenous retinal detach-ment involving the macula. We operated 852 eyes using scleral buckling technique between May 1983 and May 1995. Among them 20 patients with macular detachment had been followed for more than three years postoperatively. The age range of patients was between 13 and 37 years[mean 23.6 +/-8.0]. Among 10 eyes, the best-corrected visual acuity at 3 years after surgery improved by one line than best-corrected visual acuity at 3 months postoperatively[improved group]. Among the other 10 eyes, no interval change was found during the period[unimproved group]. Improvement of long-term postoperative visual acuity was found to be statistically correlated with shorter duration of macular detachment[< or =30 days]and the location of detachment[inferior][p<0.05]. According to this study, surgeon should be aware that the visual function of reattached retina may improve during the long postoperative peroid, especially in eyes with above features.

Factors Affecting the Visual Outcome after Successful Retinal Reattachment Surgery in Rhegmatogenous Retinal Detachment Involving the Macula

To investigate the factors affecting the visual outcome after otherwise successful retinal reattachment surgery in rhegmatogenous retinal detachment involving macula, we performed a retrospective surgvey on 170 eyes encountered properly for this study. Preoperative variables used in this series included age of patients, duration of macular detachment, preoperative visual acuity, extent of detached retina, distance between breaks, and number, shape and location of breaks. We achieved visual acuities of 20/50 or better in 49% (83 of 170 eyes) after retinal reattachment surgery. Factors related to the favorable visual outcome (20/50 or better) were macular detachment lasting less than one month, preoperative visual acuities of 20/200 or better, extent of retinal detachment of 3Q or less, and detachment with tears located at or anterior to the equator. There was no relationship between the visual outcome and the type and the number of the breaks. Of all these variables, preoperative visual acuity has the closest correlation with the final visual results after anatomically successful reattachment surgery.