Observational Study in Drusen Patients with Epiretinal Membrane after Vitrectomy and Membrane Peeling

Purpose@#To observe results in drusen patients with epiretinal membrane after a vitrectomy and membrane peeling. @*Methods@#This retrospective, observational study included drusen patients diagnosed with epiretinal membrane after vitrectomy with membrane peeling. Twenty eyes had epiretinal membrane with drusen (group 1) and 112 eyes had epiretinal membrane without drusen (group 2). At the 6 month follow-up, central foveal thickness and changes in best-corrected visual acuity (BCVA) were evaluated. In Group I, the results with drusen size 65 μm were compared. The largest drusen size change was measured and compared according to the existence of preoperative intraretinal cysts or ellipsoid zone disruption. @*Results@#Preoperatively and at 6 months postoperatively, the average size of the largest drusen was 198.23 ± 27.34 and 192.23 ± 26.12 μm, respectively, and there was no significant change during the follow-up period. Group I patients with intraretinal cysts and ellipsoid zone disruption experienced low BCVA during the preoperative period; the BCVA had improved postoperatively at 6 months, but with limitations. @*Conclusions@#Postoperatively at 6 months, no significant change was observed in the largest drusen size after vitrectomy and membrane peeling. Thus, drusen patients with epiretinal membrane, as well as intraretinal cysts or ellipsoid zone disruption can expect an extended recovery period and slow BCVA improvement.

Observational Study in Drusen Patients with Epiretinal Membrane after Vitrectomy and Membrane Peeling

Purpose@#To observe results in drusen patients with epiretinal membrane after a vitrectomy and membrane peeling. @*Methods@#This retrospective, observational study included drusen patients diagnosed with epiretinal membrane after vitrectomy with membrane peeling. Twenty eyes had epiretinal membrane with drusen (group 1) and 112 eyes had epiretinal membrane without drusen (group 2). At the 6 month follow-up, central foveal thickness and changes in best-corrected visual acuity (BCVA) were evaluated. In Group I, the results with drusen size 65 μm were compared. The largest drusen size change was measured and compared according to the existence of preoperative intraretinal cysts or ellipsoid zone disruption. @*Results@#Preoperatively and at 6 months postoperatively, the average size of the largest drusen was 198.23 ± 27.34 and 192.23 ± 26.12 μm, respectively, and there was no significant change during the follow-up period. Group I patients with intraretinal cysts and ellipsoid zone disruption experienced low BCVA during the preoperative period; the BCVA had improved postoperatively at 6 months, but with limitations. @*Conclusions@#Postoperatively at 6 months, no significant change was observed in the largest drusen size after vitrectomy and membrane peeling. Thus, drusen patients with epiretinal membrane, as well as intraretinal cysts or ellipsoid zone disruption can expect an extended recovery period and slow BCVA improvement.

Visual and Structural Differences in Idiopathic Epiretinal Membrane According to the Presence of Retinoschisis

PURPOSE: To present differences in visual acuity and macular structure before and after surgery in patients with idiopathic epiretinal membrane (ERM) according to the presence of retinoschisis. METHODS: This retrospective observational study included 324 eyes with idiopathic ERM, that underwent pars plana vitrectomy with ERM and internal limiting membrane peeling, and were followed for more than 6 months. Subjects were classified into two groups according to the presence of retinoschisis using preoperative optical coherence tomography (OCT; group 1, ERM with retinoschisis; group 2, ERM without retinoschisis). Preoperative and postoperative macular structure changes and surgical outcomes were compared. RESULTS: Group 1 included 61 eyes, and group 2 included 263 eyes. Group 1 had a significantly higher preoperative and final postoperative best-corrected visual acuity compared with group 2 (p = 0.01, p = 0.02). Preoperative disorganization of retinal inner layers (DRIL) was significantly less in group 1 than group 2 (p = 0.01). Preoperative central macular thickness was not significantly different between the two groups. However, postoperative central macular thickness was significantly lower in group 1 than group 2 (p = 0.02, p = 0.01, p < 0.01). The ratio of the inner or outer layer in the total retinal thickness before surgery was significantly smaller in group 1 than in group 2 (p = 0.02, p = 0.04). CONCLUSIONS: Preoperative visual acuity was better and the occurrence of DRIL was less in idiopathic ERM with retinoschisis than without retinoschisis. Postoperative visual and structural outcome was better in idiopathic ERM with retinoschisis than without retinoschisis. Retinoschisis may have played a role in reducing the tractional force given to the inner and outer retina.

Intraoperative Foveal Traction in Patients with Epiretinal Membrane

PURPOSE: To determine influences of intraoperative foveal traction during membrane peeling in idiopathic epiretinal membrane (ERM) surgery. METHODS: This retrospective observational study included 46 eyes of 46 patients with idiopathic ERM who underwent pars plana vitrectomy with ERM and internal limiting membrane peeling from February 2015 to September 2015. The presence of intraoperative foveal traction during membrane peeling was reviewed using video records. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT), foveal contour, and photoreceptor inner segment/outer segment junction disruption using optical coherence tomography at baseline and at 1, 3, 6, and 12 months after surgery. RESULTS: Group 1 (ERM with intraoperative foveal traction) included 22 eyes, and group 2 (ERM without intraoperative foveal traction) included 24 eyes. Preoperatively, convex pattern ERM was observed more often in group 1. Group 1 had a significantly thicker CFT and a lower BCVA compared to group 2 at baseline and during the first 6 months, but the final postoperative BCVA and CFT were not significantly different between the groups at 12 months. Among 22 eyes, 12 eyes (54.5%) were restored to flat or concave ERM patterns at an average of 5.4 months after surgery in group 1, and 18 out of 24 eyes (75%) recovered at 2.4 months (p < 0.01) in group 2. CONCLUSIONS: Preoperative thick CFT and convex pattern ERM indicated a high possibility of intraoperative foveal traction in idiopathic ERM surgery. There were no differences in long-term BCVA and restoration of foveal configuration according to foveal traction during membrane peeling.

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Change in Subfoveal Choroidal Thickness after Patterned Panretinal Photocoagulation in Patients with Diabetic Retinopathy

PURPOSE: To evaluate changes in subfoveal choroidal thickness (SFCT) after patterned panretinal photocoagulation (PRP) using pattern scan laser (PASCAL) in patients with diabetic retinopathy. METHODS: This study included 39 patients (50 eyes) treated with patterned PRP using PASCAL and who were followed for at least 3 months. Patients were classified into 2 groups according to severity: severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. SFCT was measured by enhanced depth imaging of spectral-domain optical coherence tomography. The change in SFCT was analyzed at 1 and 3 months after PRP. RESULTS: SFCT was 270.42 ± 61.44 µm before PRP, 264.52 ± 60.78 µm at 1 month, and 255.74 ± 56.89 µm at 3 months after PRP. Significant change of SFCT was found at 3 months after PRP. Central macular thickness was 275.56 ± 50.61 µm before PRP and increased to 295.18 ± 52.80 µm and 293.10 ± 57.24 µm at 1 and 3 months post-treatment, respectively. There were no significant differences between groups in SFCT at baseline or in the amount of change in SFCT after PRP. CONCLUSIONS: SFCT significantly decreased after patterned PRP using PASCAL.

Refractive Accommodative Esotropia: Duration between Wearing Hyperopic Glasses and Control of Esotropia within 8 PD

PURPOSE: To report clinical aspects of children diagnosed with refractive accommodative esotropia after wearing their first glasses to correct hyperopia accompanied with esodeviation. METHODS: The present study included 75 children followed up for at least 24 months. Age, spherical equivalent of refractive error, angle of deviation and presence of amblyopia were analyzed according to the duration between first wearing glasses and control of esotropia within 8 PD (2 months). RESULTS: The mean age was 4.48 +/- 2.08 years and mean follow-up was 50.17 months. Initial deviation angle without glasses was 25.43 +/- 10.07 PD at far, 27.72 +/- 11.45 PD at near, spherical equivalent was +4.86 +/- 2.41 D in right eyes, +5.05 +/- 1.06 D in left eyes and 8 of 75 patients (10.67%) had 2 months had less hyperopia (+4.02 D vs. 5.17 D), more severe esodeviation both at far (30.79 +/- 10.79 PD vs. 24.17 +/- 9.56 PD, p = 0.03) and at near distance (34.00 +/- 14.20 PD vs. 26.25 +/- 10.31 PD, p = 0.02) and higher initial amblyopia prevalence rates (71.5% vs. 47.5%). CONCLUSIONS: Several patients needed longer follow-up until esotropia was controlled within 8 PD after wearing hyperopic glasses considering the amount of hyperopia and angle of esodeviation.

Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate the short-term effect of intravitreal aflibercept (Eylea(R); Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) on the visual outcomes and retinal anatomic changes of patients with polypoidal choroidal vasculopathy (PCV). METHODS: Intravitreal Eylea(R) was injected into 16 eyes of 16 patients with PCV in this retrospective case study. After therapy, the patients were followed up for over 3 months. Changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) using optical coherence tomography (OCT) and abnormal vasculature on indocyanine green angiography (ICGA) were evaluated. RESULTS: The mean log MAR BCVA was 0.75 +/- 0.60 at baseline, 0.74 +/- 0.60 and 0.71 +/- 0.63 at 1 and 2 months, respectively (p > 0.05) and 0.57 +/- 0.53 at 3 months (p < 0.05) after treatment. The mean CFT was 379 +/- 130 microm at baseline, 281 +/- 92 microm, 247 +/- 54 microm, and 231 +/- 51 microm at 1, 2, and 3 months, respectively, after treatment (p < 0.05). Complete resolution was 43%, 55%, and 50% at 1, 2, and 3 months, respectively in pigment epithelial detachment (PED), 67%, 83%, and 92% at 1, 2, and 3 months, respectively in subretinal fluid (SRF) and 33%, 60%, and 60% at 1, 2, and 3 months, respectively in intraretinal fluid (IRF) using OCT. The polypoidal lesions in ICGA decreased in 12 of 14 eyes (86%). CONCLUSIONS: Intravitreal injection of Eylea(R) with PCV reduced CFT due to decreased retinal PED, SRF, IRF and occluded effectively the polypoidal lesion leaking. Compared with baseline, mean BCVA at the 3-month follow-up was significantly improved.

Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

PURPOSE: To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT). METHODS: This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome. RESULTS: The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 +/- 0.32 to log MAR 0.23 +/- 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting. CONCLUSIONS: The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.

ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

PURPOSE: To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery. METHODS: The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. 'Asymmetric elongation' was defined as non-uniform elongation of the foveal tissue in certain directions. RESULTS: Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 +/- 88.54 / 404.92 +/- 78.55 microm; group A, 421.33 +/- 109.97 / 404.14 +/- 120.9 microm; and C group, 389.25 +/- 48.75 / 400 +/- 52.23 microm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 +/- 65.64 / 103.92 +/- 73.37 microm; group A, 88.11 +/- 41.57 / 75.89 +/- 53.18 microm; and group C, 140.25 +/- 68.51 / 83.63 +/- 56.62 microm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups. CONCLUSIONS: Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.

The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

PURPOSE: To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT). METHODS: This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome. RESULTS: The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 +/- 0.32 to log MAR 0.23 +/- 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting. CONCLUSIONS: The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.

ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

PURPOSE: To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery. METHODS: The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. 'Asymmetric elongation' was defined as non-uniform elongation of the foveal tissue in certain directions. RESULTS: Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 +/- 88.54 / 404.92 +/- 78.55 microm; group A, 421.33 +/- 109.97 / 404.14 +/- 120.9 microm; and C group, 389.25 +/- 48.75 / 400 +/- 52.23 microm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 +/- 65.64 / 103.92 +/- 73.37 microm; group A, 88.11 +/- 41.57 / 75.89 +/- 53.18 microm; and group C, 140.25 +/- 68.51 / 83.63 +/- 56.62 microm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups. CONCLUSIONS: Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.

Analysis of Miscorrection after Implantation of the Toric Intraocular Lens

PURPOSE: To evaluate the efficacy and stability of AcrySof Toric intraocular lens (IOL) implants and to analyze the miscorrection that resulted after implantation. METHODS: This retrospective study included 422 eyes of 348 patients who underwent cataract surgery with implantation of the AcrySof toric IOL between December 2011 and June 2013. We evaluated uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry and refraction preoperatively and 3 months postoperatively. The axis of implanted AcrySof Toric IOL was measured using the KR-1W aberrometer before mydriasis. At 3 months postoperatively, patients with a residual cylindrical power of 0.50 diopters (D) or more, and having an IOL rotation of 10 degrees (degrees) or more were considered having miscorrection. RESULTS: UCVA (log MAR) improved from 0.58 +/- 0.35 to 0.18 +/- 0.26. Preoperative corneal astigmatism was 1.46 +/- 0.72 D and postoperative refractive cylindrical power was 0.45 +/- 0.30 D. The postoperative miscorrection was 50.5% in the T3 group, 35.7% in the T4 group, and 27.2% in the T5 group. The incidence of overcorrection was significantly higher in the T3 group than in the T4 and T5 group. In eyes with with-the-rule (WTR) astigmatism, overcorrection was found in 36.4% (32/88 eyes), while in eyes with against-the-rule (ATR) astigmatism, undercorrection was found in 37.6% of cases (44/117 eyes). There were five cases of IOL rotation at 3 months postoperatively. CONCLUSIONS: AcrySof Toric IOL was effective in correcting corneal astigmatism and had good rotational stability. However, the incidence of miscorrection, especially for overcorrection, was higher with lower power toric IOL. Patients with WTR astigmatism tend to have overcorrection, while those with ATR show a tendency toward undercorrection, suggesting that these changes considered at the time of cataract surgery.

The Effects of Overnight Orthokeratology Lens Wear on Ocular Scatter

PURPOSE: To evaluate the change of visual quality after wearing orthokeratology lenses overnight. METHODS: This study included 13 patients (24 eyes) who wore orthokeratology lenses for the first time. Visual quality was assessed with the optical quality analysis system (OQAS) using the double-pass technique. The value of modulation transfer function (MTF) cutoff, Strehl ratio, and objective scatter index (OSI) were measured at baseline and 4 weeks after wearing the lenses. RESULTS: The mean spherical equivalent decreased from -2.70 +/- 1.03 diopters (D) to 0.03 +/- 0.36 D after 4 weeks of wearing orthokeratology lenses and uncorrected visual acuity improved from log MAR 0.88 +/- 0.17 to log MAR 0.03 +/- 0.04. The MTF cutoff decreased from 38.20 +/- 11.01 to 34.79 +/- 10.30 and the Strehl ratio decreased from 0.24 +/- 0.07 to 0.21 +/- 0.07 but without statistical significance. The OSI significantly increased from 0.38 +/- 0.19 to 0.72 +/- 0.40 after wearing orthokeratology lenses. CONCLUSIONS: Orthokeratology lenses were effective for correction of myopia and astigmatism. The OSI increased after wearing the lenses, but MFT cutoff and Strehl ratios were not affected.

Objective Optical Quality Analysis in Dry Eye Syndrome

PURPOSE: To evaluate the efficacy of Optical Quality Analysis System (OQAS(R)) instrument for the assessment of dry eye syndrome. METHODS: Dynamic recording of double-pass (DP) retinal images was performed in 1 eye dry eye patients (20 eyes) and in healthy controls (20 eyes) for 20 seconds after eye blinking. RESULTS: The mean objective scatter Index (OSI) value was 4.53 in dry eyes, 0.67 in healthy eyes and the standard deviation of OSI was 1.20 in dry eyes and 1.18 in healthy eyes. The patients with dry eyes showed significantly higher mean OSI and standard deviation values. Ocular scatter increased over time and significant changes occurred 13.5 seconds after blinking. The difference in OSI value between 0 second and 20 seconds was significantly greater in dry eye patients (4.15) than in controls (0.32). CONCLUSIONS: Ocular scatter increased over time after blinking. The dry eye patients had larger and more variable ocular scatter index than the controls. OQAS(R) may be useful to detect and follow-up tear film-related patient complaints in dry eye syndrome.