Localized foveal detachment in a patient with central retinal artery occlusion with cilioretinal sparing.

PURPOSE: To report the optical coherence tomography (OCT) findings of acute central retinal artery occlusion (CRAO) with cilioretinal sparing. METHODS: Optical coherence tomography findings in a 45-year-old man with CRAO with cilioretinal sparing were evaluated. RESULTS: Optical coherence tomography disclosed diffuse thickening of the neurosensory retina in the perifoveolar area. Increased reflectivity was noted in the inner retinal layers. The hyporeflectivity is observed in the outer retina including the outer neurosensory retina. The photoreceptors are not seen because of the shadowing effect. A localized foveal detachment composed of a dome-shaped retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues was seen. CONCLUSIONS: The OCT findings showed that besides the usual OCT findings in acute CRAO, the presence of a cilioretinal artery might lead to the leakage of fluid into the subfoveal space leading to localized detachment.

Retinal sensitivity and fixation changes 1 year after triamcinolone acetonide assisted internal limiting membrane peeling for macular hole surgery--a MP-1 microperimetric study.

PURPOSE: To evaluate microperimetric changes 1year after macular hole surgery with triamcinolone acetonide assisted internal limiting membrane (ILM) peeling. METHODS: Twenty-two eyes of 22 patients with stage 3 and 4 idiopathic macular holes of <6months' duration underwent vitrectomy with triamcinolone acetonide assisted ILM peeling. Best corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution), and central retinal sensitivity were documented before and 1, 3, 6, and 12months after surgery. Macular sensitivity (mean sensitivity in decibels -dB), and stability and location of fixation (preferred retinal locus) were determined using MP-1 microperimetry (Nidek). The MP-1 microperimetry sensitivity map was overlaid onto infrared images recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the fixation location before surgery. Anatomical success was evaluated with optical coherence tomography (OCT). Optical coherence tomography scans were recorded on an OCT 3000 scanner. RESULTS: Anatomical success was achieved in all 22 eyes. All patients completed 1year follow-up. No recurrence of macular hole was seen in any patients in the follow-up period. The mean BCVA improved from 0.75±0.2 before surgery to 0.31±0.1 logMAR at the last visit (p<0.001). Mean sensitivity improved from 3.7±0.6 to 5.3±1.0dB at the last visit (p<0.001). Before surgery, the preferred retinal locus was located on the margin of the hole in all, in 18 eyes on its upper part and in four eyes to the side or on its lower part. Preoperatively, 12 eyes were stable and 10 were relatively unstable, but 12month after surgery, fixation stability had improved, and 20 eyes were stable and two were relatively unstable. CONCLUSIONS: MP-1 microperimetry sensitivity map overlaid onto an infrared image using dedicated MP-1 software can be used successfully to evaluate fixation location in patients with a macular hole before surgery. With microperimetry findings, we can also measure functional macular changes more precisely than using BCVA alone after macular hole surgery. Our results also showed that retinal sensitivity and fixation properties were improved after vitrectomy with triamcinolone acetonide assisted ILM peeling in patients with idiopathic macular hole.