Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon

PURPOSE: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. METHODS: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. RESULTS: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. CONCLUSIONS: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.

Macular Hole as a Risk Factor of Choroidal Detachment in Rhegmatogenous Retinal Detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.

Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante / Perfluoroctane liquid as a short-term vitreous-retinal tamponade in the postoperative period in patients with retinal detachment due to giant tears

OBJETIVOS: Relatar os resultados de vitrectomia via pars plana com utilização de perfluocarbono líquido (Perfluoroctano-Ophtalmos®), como tamponante vítreo-retiniano de curta duração, no pós-operatório de portadores de descolamento de retina, por ruptura gigante. MÉTODOS: Estudaram-se dez desses pacientes. Todos os casos eram complicados por vitreorretinopatia proliferativa grau B ou pior com rupturas que variavam em extensão de 90° a 210°. O perfluorocarbono líquido foi introduzido, por via pars plana, com o volume necessário para ultrapassar o limite posterior da ruptura, permanecendo no pós-operatório por cinco dias, estando os pacientes em decúbito dorsal. Após esse período submetiam-se a segunda intervenção para troca do perfluorocarbono líquido para gás ou óleo de silicone. RESULTADOS: Após período de acompanhamento médio de 16,2 ± 12,4 meses (2 a 43 meses), 80 por cento das retinas estavam aplicadas, sendo necessária a repetição desta técnica em 1 caso (10 por cento) caso e em 2 casos (20 por cento) não houve reaplicação da retina por vitreorretinopatia avançada. Houve melhora da acuidade visual em 5 casos (50 por cento). CONCLUSÃO: Observaram-se bons resultados quanto à aplicação da retina (80 por cento) e melhora da acuidade visual (50 por cento) quando do uso do perfluorocarbono líquido como tamponante vitreorretiniano de curta duração no pós-operatório de cirurgias de descolamento de retina por rupturas gigantes.

PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90° to 210° were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80 percent) after a mean follow-up of 16.2 ± 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10 percent) case, and there was no attachment of the retina in two (20 percent) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50 percent) cases. CONCLUSION: Good results (80 percent) and improvement of the visual acuity (50 percent) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

A Phacovitrectomy with a Clear Corneal Incision for a Full-Thickness Macular Hole

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p<0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808+/-0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Choroidal melanoma with macular hole.

A rare case of choroidal melanoma with exudative retinal detachment and a full-thickness macular hole is reported in an Indian patient.

Effect of Internal Limiting Membrane Removal in Treatment of Retinal Detachment Caused by Myopic Macular Hole

The purpose of this study was to evaluate the anatomical outcomes of vitrectomy with internal limiting membrane removal in highly myopic eyes with retinal detachment caused by a macular hole. Nineteen, consecutive, highly myopic eyes with full thickness macular hole with retinal detachment were treated by vitrectomy with internal limiting membrane removal, endolaser photocoagulation on the center of the hole and fluid gas exchange. In five eyes with other peripheral breaks, scleral buckling (3 cases), encircling (1 case) and barrier laser (1 case) were combined. In 15 eyes (79.0%) the macular hole was closed after the initial surgery. In 4 eyes (21%) the macular hole was reopened, but these were successfully treated with fluid gas exchange (1 case) or macular buckling (3 cases). The visual acuity was improved in 15 eyes (79.0%). In conclusion, these results suggest that the removal of the perifoveal internal limiting membrane may be an important adjuvant in the treatment of the myopic macular hole with retinal detachment.

Electroretinographic studies in rhegmatogenous retinal detachment before and after reattachment surgery

Changes in the scotopic electroretinogram (ERG) and oscillatory potentials (Ops) were examined in patients who had rhegmatogenous retinal detachment within 3 days before and also at regular intervals after a successful reattachment operation. Electroretinograms were recorded in 38 patients (age 10 to 62 years) for the recent 5 year period. The amplitudes of the scotopic a-wave and b-wave in the detached eye were significantly decreased compared to the fellow normal eye preoperatively. Statistically significant differences were found between the preoperative and the postoperative recordings of the diseased eye. However, postoperative interocular differences in the amplitude of the a-wave between the reattached and normal fellow eye were not statistically significant. The amplitudes of the a-wave and b-wave were inversely related to the extent of the retinal detachment area, the duration of the detachment, and the extent of the buckles that were applied. Significant interocular differences in the b/a wave amplitude ratio and the Ops amplitude were observed. These results strongly suggest that the retinal function, even after successful reattachment surgery, might be compromised mainly by an inner retinal malfunction rather than from a photoreceptor dysfunction.

Retinal detachment with macular hole.

Retinal detachment with macular hole was treated by different methods. Intravitreal SF6 injection was helpful to seal the macular hole and reattach the retina. In cases of retinal detachment with macular hole and peripheral retinal tear, the retinal reattachment could be achieved by scleral buckling procedure. When vitreous traction adjacent to the macular hole or proliferative vitreoretinopathy was present, vitrectomy combined with internal temponade by SF6 gas injection was indicated. Failure of the operation was caused by inadequate removal of the vitreous traction and post-operative vitreoretinopathy. In a successful operation, visual acuity of 6/60 or better was found in eight of thirty-one patients. (25.8%)

Spontaneous reattachment of retinal detachment with macular hole in nonmyopic patients

The occurrence of a retinal detachment in a patient with a macular hole is quite rare unless the patient is a high myope or has experienced ocular trauma. The incidence of spontaneous reattachment of retinal detachment with a macular hole is not uncommon in the highly myopic patients. However, data on nonmyopic cases are lacking. I herein describe two nonmyopic cases of retinal detachment with a macular hole, of which retinas reattached spontaneously.

Utilizaçäo do implante de silicone sólido em forma de cunha em cirurgias do descolamento da retina associado à presença de "boca de peixe" / The use of solid silicone implant in wedge shaped in retinal detachment surgeries associated with the presence of the fishmouth phenomenon

Este trabalho descreve a utilizaçäo do implante de silicone sólido em forma de cunha - wedge implant - num grupo de 37 pacientes operados por descolamento regmatogênico da retina, causado por grandes rupturas em ferradura, onde uma complicaçäo transoperatória conhecida como o fenômeno da "boca de peixe" pôde ser suspeitada. Os resultados positivos de reaplicaçäo retiniana alcançado nesta série ficaram na ordem de 86,5% sem que nenhuma complicaçäo trans ou pós-operatoria pudesse ter sido atribuída ao implante utilizado

Descolamento de retina por rotura gigante: tratamento simplificado em casos selecionados / Retinal detachment with giant breaks

Os autores citam técnica e fazem comentários a respeito para o tratamento de casos selecionados de descolamento de retina, provocado por rotura gigante. Enfatizam que, algumas vezes, a rapidez no tratamento é täo importante quanto a utilizaçäo de aparelhagem sofisticada