Foveal Morphology of Normal Fellow Eyes of Patients with Unilateral Macular Hole.

PURPOSE: To determine the morphology of the fovea in the ophthalmoscopically and tomographically normal fellow eyes of patients with a unilateral idiopathic macular hole (MH) and determine the association between foveal morphological parameters and foveal outer nuclear layer (ONL) thickness. DESIGN: Retrospective observational study. PARTICIPANTS: Two hundred three normal fellow eyes of patients with a unilateral MH and 216 normal eyes of 216 healthy subjects. METHODS: All the eyes were examined using swept-source OCT. A built-in software was used to measure the average retinal and choroidal thickness in the center and in the inner 4 subfields defined in ETDRS. The total retinal thickness, thickness of 3 retinal layers at the fovea and parafovea (0.25 and 0.5 mm nasal and temporal from the fovea), and foveal floor width (FFW) were measured on a scan image of a horizontal line passing through the center of the fovea. We defined the thickness between the internal limiting membrane and outer plexiform layer as inner retinal thickness and the thickness between the external limiting membrane and retinal pigment epithelium as outer retinal thickness. Multiple regression analyses were performed with age, sex, axial length, and the presence of a posterior vitreous detachment as the dependent variables. MAIN OUTCOME MEASURES: OCT measurements and correlations between foveal parameters and foveal ONL thickness. RESULTS: The fellow eyes had a thinner central retinal subfield, thinner fovea, thinner ONL at all points except at 0.5 mm nasal, significantly thicker outer retina at all points, and a wider FFW (P = 0.040 to P < 0.0001). The foveal ONL thickness was significantly and positively correlated with the central subfield retinal thickness and foveal thickness and negatively correlated with the FFW (all P < 0.0001). CONCLUSIONS: The thinner and deeper fovea and the thinner ONL of the fellow eyes of patients with a unilateral MH make these eyes more susceptible to the formation of an MH.

Birth Year-Dependent Increase in Axial Length of Japanese Adult.

PURPOSE: To determine whether the correlations between the axial length and the aging-dependent and birth year-dependent age are significant. DESIGN: Retrospective cross-sectional study. METHODS: This study included Japanese patients ≥50 years who had undergone cataract surgery at numerous clinics from 2002 to 2020. Only 1 eye/patient was analyzed. The axial length was measured with the IOL Master. The age-dependent changes were determined by the significance of the correlation between the axial length and age by the birth year. The birth year-dependent changes were determined by the significance of the correlation between the axial length and birth year in the different age groups. The age refers to the age at the time of the cataract surgery. Spearman correlations were calculated. The turning points were identified by the LOESS, NLIN, and HPMIXED procedures. RESULTS: A total of 62,362 eyes (35,508 women, 26,854 men) were studied. The mean age was 72.9 ± 8.4 (standard deviation) years (range, 50-101 years), and the mean axial length was 23.90 ± 1.66 mm (standard deviation) (range, 19.20-37.07 mm). The birth year ranged from 1908 to 1970. Analyses of the birth year-dependent changes showed significant positive correlations in 48 of 81 (59.3%) groups for women and men. The increase in the axial length was birth year-dependent, and the turning point was 1939.4 for women and 1936.7 for men. CONCLUSIONS: The negative and significant correlation between the axial length and age is due to birth year-dependent changes. A birth year-dependent increase in axial length might have continued for several decades from the birth year of the late 1930s.

Removal of foveal hard exudates by subretinal balanced salt solution injection using 38-gauge needle in diabetic patients.

PURPOSE: To examine the anatomic and visual outcomes after removal of foveal hard exudates through a macular hole created by subretinal balanced salt solution (BSS) injection. METHODS: This was a retrospective, consecutive, case series. Six patients (7 eyes) underwent vitrectomy with removal of foveal hard exudates. All patients were women and the mean age was 65 years (range from 55 to 71). All patients had a history of panretinal photocoagulation. Previous treatments included intravitreal anti-vascular endothelial growth factor injection in one eye and vitrectomy in both eyes of one patient. The geometric mean preoperative decimal visual acuity was 0.11 (range from 0.08 to 0.3). The mean postoperative follow-up period was 12 months (range from 6 to 19). The status of lens was two phakic and five pseudophakic. Surgical procedures included simultaneous cataract surgery if phakic, creation of posterior vitreous detachment if not present, internal limiting membrane (ILM) peeling and a gas or air tamponade. Manual subretinal BSS injection using 38-gauge needle was performed at ILM-peeled area. Removal of foveal hard exudates was conducted by the water flow through the macular hole created during subretinal BSS injection. RESULTS: Foveal hard exudates decreased in all cases early after surgery. The geometric mean final decimal visual acuity was 0.31 (range from 0.1 to 0.9). Visual acuity improved more than 0.2 LogMAR units in six eyes and unchanged in one eye. There was no severe complication and recurrence of macular edema. CONCLUSION: This procedure may be effective for foveal hard exudates in diabetic patients.

Vitrectomy for macular edema due to retinal vein occlusion.

Purpose: To determine the long-term outcomes of vitrectomy for the macular edema associated with a retinal vein occlusion (RVO). Methods: This was a retrospective, consecutive, interventional case series. The intraoperative procedures included internal limiting membrane peeling, arteriovenous sheathotomy, radial optic neurotomy, and intravitreal triamcinolone acetonide injection at the end of the surgery. The main outcome was the best-corrected visual acuity (BCVA). Results: Eight hundred and fifty-four eyes of 854 patients were studied. The eyes consisted of 602 with branch RVO (BRVO), 74 with hemi-central RVO (hemi-CRVO), 87 with nonischemic central retinal vein occlusion (CRVO), and 91 with ischemic CRVO. The mean follow-up period was 68.6 months with a range of 12 to 262 months. The mean BCVA was significantly improved at the final visit (P<0.0001 to 0.0016). The final BCVA improved in 74.4% of the BRVO eyes, in 58.1% of the hemi-CRVO eyes, in 57.4% of the nonischemic CRVO eyes, and in 51.6% of the ischemic CRVO eyes. Multiple regression analysis showed there was no significant relationship between the intraoperative combined procedures and the final BCVA. Conclusions: The results indicate that the type of RVO is significantly associated with the final BCVA, and vitrectomy is a treatment option to improve and maintain BCVA for a long term.

Long-term outcomes of intravitreous bevacizumab or tissue plasminogen activator or vitrectomy for macular edema due to branch retinal vein occlusion.

PURPOSE: The purpose of this study was to determine the long-term outcomes of intravitreal bevacizumab (IVB) or intravitreal tissue plasminogen activator (tPA) or vitrectomy for macular edema associated with a branch retinal vein occlusion (BRVO). METHODS: This was a retrospective, interventional case series. Forty-one patients received a single 1.25 mg of IVB injection and followed by pro re nata protocol, 71 patients received a single intravitreal tPA, and 116 patients underwent phacovitrectomy with intraocular lens implantation. RESULTS: The baseline characteristics and follow-up periods were not significantly different among the three groups. The mean follow-up period was 55.5 months with a range of 12-160 months. Sixteen patients (39.0%) in the IVB group, 24 patients (33.8%) in the tPA group, and two patients (1.7%) in the vitrectomy group underwent additional surgeries during the follow-up period. The best-corrected visual acuity (BCVA) significantly improved in all groups at 1 year after the initial treatment (all, P<0.0001) and at the final visit (all, P<0.0001). The differences in the BCVA between the three groups were not significant at all times after the initial treatment. CONCLUSION: The three groups led to similar long-term good visual outcomes. However, additional surgeries were performed in more than 30% of patients in the IVB and tPA groups.

CENTRIPETAL MOVEMENT OF THE CAPILLARIES IN THE CENTRAL MACULAR REGION AFTER INTERNAL LIMITING MEMBRANE PEELING.

PURPOSE: To report a case that showed centripetal movements of the capillaries in the central macular region after vitrectomy with internal limiting membrane peeling. METHODS: A 57-year-old pseudophakic woman underwent successful vitrectomy with internal limiting membrane peeling and air tamponade for a vitreomacular traction. Optical coherence tomography angiographic images of the 3 mm × 3 mm inner retinal vascular plexus were examined preoperatively and at 3 months postoperatively. The changes in 93 corresponding bifurcations of the capillaries were assessed. RESULTS: The majority of the bifurcations were displaced towards the fovea at 3 months after the vitrectomy with internal limiting membrane peeling. CONCLUSION: Optical coherence tomography angiography was used to help visualize the centripetal movement of the inner retina around the fovea after the vitrectomy with internal limiting membrane peeling.

Early centripetal displacements of capillaries in macular region caused by internal limiting membrane peeling.

PURPOSE: The aim of this study was to determine whether the centripetal displacement of the capillaries in the macular region after vitrectomy is caused by internal limiting membrane (ILM) peeling. METHODS: Eighteen patients with different types of retinal diseases but with a normal or approximately normal foveal contour underwent successful vitrectomy with (n=12) or without (n=6) ILM peeling. Optical coherence tomography angiography (OCTA) images of the inner retinal vascular plexus in the macular region were analyzed pre- and postoperatively. Four concentric polygonal areas were marked in the OCTA images with the corners selected to be easily identified by vessel bifurcations. The areas of the postoperative foveal avascular zone (FAZ) and the four polygonal regions at about 1 month postoperatively were compared to the baseline areas. RESULTS: Vitrectomy was performed for eleven eyes with vitreomacular tractions, three with macular-on retinal detachments, and four with thin epiretinal membranes. A significant decrease in the FAZ area was observed postoperatively in only the ILM-peeled eyes (P=0.0002). The four polygonal areas in the ILM-peeled eyes decreased after surgery, and the decrease was fit by a linear regression line (R2=0.985-0.999; n=7). The time course of the postoperative decrease of the FAZ area was fit by a hyperbolic curve (R2=0.969-0.998; n=6). The average postoperative time required to reach one-half of the final FAZ area was 1.16 days (0.81-1.62 days). CONCLUSION: These findings suggest that ILM peeling causes an early centripetal displacement of the capillaries in the macular region.

FOVEAL AVASCULAR ZONE AREA AFTER INTERNAL LIMITING MEMBRANE PEELING FOR EPIRETINAL MEMBRANE AND MACULAR HOLE COMPARED WITH THAT OF FELLOW EYES AND HEALTHY CONTROLS.

PURPOSE: To measure the foveal avascular zone (FAZ) area after internal limiting membrane (ILM) peeling and to determine the factors significantly correlated with the FAZ area. METHODS: This was a retrospective, observational, and cross-sectional study. The affected and normal fellow eyes of 102 patients with unilateral macular diseases and 169 healthy subjects were studied. The patients underwent successful vitrectomy with internal limiting membrane peeling for an epiretinal membrane (n = 56) or a macular hole (n = 46). The superficial FAZ area and average foveal (within 1 mm) thickness were measured. The main outcome measures were the en face FAZ area measured in the optical coherence tomography angiographic images. RESULTS: The FAZ area in the epiretinal membrane group (0.148 ± 0.094 mm) and in the macular hole group (0.255 ± 0.111 mm) were significantly smaller than that in the healthy control group (0.358 ± 0.118 mm; all, P < 0.0001). Multiple regression analysis showed that a thicker fovea was significantly correlated with a smaller FAZ area in the epiretinal membrane group (r = -0.799, P < 0.0001), macular hole group (r = -0.473, P = 0.0042), and control group (r = -0.612, P < 0.0001). CONCLUSION: The FAZ area after internal limiting membrane peeling was smaller than that of the controls. A smaller FAZ area was correlated with a thicker fovea both in internal limiting membrane-peeled eyes and normal eyes.

Efficacy of 0.05% epinastine and 0.1% olopatadine for allergic conjunctivitis as seasonal and preseasonal treatment.

PURPOSE: To evaluate the efficacy and safety of 0.05% epinastine and 0.1% olopatadine eye drop preparations as seasonal and preseasonal treatments in patients with seasonal allergic conjunctivitis (SAC). SUBJECTS AND METHODS: This was a prospective, randomized, case-control study involving two institutions. The subjects were patients diagnosed with SAC at two institutions between February and March in 2014. To examine the clinical effects of seasonal treatment, 0.05% epinastine and 0.1% olopatadine were administered, and their effects were investigated every 2 weeks (Stage 1). To evaluate the clinical effects of preseasonal therapy, in January 2015, the same eye drop preparations as adopted in Stage 1 were administered to patients who had participated in Stage 1 and provided consent to participate in this study, and their effects were investigated every month (Stage 2). RESULTS: In Stage 1, the 0.05% epinastine group consisted of 43 patients, and the 0.1% olopatadine group consisted of 42 patients. There were significant improvements in the total symptom and objective finding scores at each time point after administration in comparison with those before its baseline, but there were no significant differences between the two groups. In Stage 2, the 0.05% epinastine group consisted of 15 patients, and the 0.1% olopatadine group consisted of 14 patients. The rate of change in the total symptom score in comparison with that at the baseline of preseasonal treatment was significantly higher in the 0.1% olopatadine group 1 month after the start of treatment, suggesting symptom deterioration (P=0.025). There was no significant difference in the rate of change in the total objective finding score between the two groups. CONCLUSION: Seasonal treatment with 0.05% epinastine or 0.1% olopatadine was equally effective for patients with allergic conjunctivitis. However, for preseasonal therapy, 0.05% epinastine was more effective than 0.1% olopatadine.

Increase in average foveal thickness after internal limiting membrane peeling.

PURPOSE: To report the findings in three cases in which the average foveal thickness was increased after a thin epiretinal membrane (ERM) was removed by vitrectomy with internal limiting membrane (ILM) peeling. METHODS: The foveal contour was normal preoperatively in all eyes. All cases underwent successful phacovitrectomy with ILM peeling for a thin ERM. The optical coherence tomography (OCT) images were examined before and after the surgery. The changes in the average foveal (1 mm) thickness and the foveal areas within 500 µm from the foveal center were measured. The postoperative changes in the inner and outer retinal areas determined from the cross-sectional OCT images were analyzed. RESULTS: The average foveal thickness and the inner and outer foveal areas increased significantly after the surgery in each of the three cases. The percentage increase in the average foveal thickness relative to the baseline thickness was 26% in Case 1, 29% in Case 2, and 31% in Case 3. The percentage increase in the foveal inner retinal area was 71% in Case 1, 113% in Case 2, and 110% in Case 3, and the percentage increase in foveal outer retinal area was 8% in Case 1, 13% in Case 2, and 18% in Case 3. CONCLUSION: The increase in the average foveal thickness and the inner and outer foveal areas suggests that a centripetal movement of the inner and outer retinal layers toward the foveal center probably occurred due to the ILM peeling.

Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study.

PURPOSE: To report a patient whose foveal avascular zone (FAZ) decreased after vitrectomy with internal limiting membrane (ILM) peeling. METHODS: A 58-year-old woman underwent successful phacovitrectomy with ILM peeling for a thin epiretinal membrane in an eye with a normal foveal contour. Optical coherence tomography angiographic en face images of the 3 mm×3 mm superficial and deep inner retinal vascular plexuses were examined preoperatively, and on days 1, 2, 9, and 37 postoperatively. The changes in the FAZ areas and the thicknesses of the parafoveal retinal layers at 500 µm from the foveal center were assessed in the vertical and horizontal B-scan images. RESULTS: The areas of the superficial and deep FAZ decreased after the surgery. The course of the postoperative decrease of the FAZ area in the superficial plexus can be fit by a hyperbolic curve (R2=0.993). An increase in the thicknesses of the retinal nerve fiber layer, ganglion cell-inner plexiform layer, and inner nuclear layer was observed at all times postoperatively. CONCLUSIONS: We observed one case that the FAZ area decreased and the parafoveal inner retinal thickness increased after the vitrectomy with ILM peeling. The decrease in the FAZ area suggests that a centripetal movement of the inner retinal layer is probably due to the ILM peeling.

Effect of vitreomacular separation on macular thickness determined by spectral-domain optical coherence tomography.

PURPOSE: To determine the effects of vitreomacular separation on macular thickness. METHODS: This was a retrospective, observational, cross-sectional study. Average foveal and central minimum thicknesses were measured by spectral-domain optical coherence tomography (SD-OCT) in 308 eyes of 308 healthy subjects (healthy group) and 298 normal fellow eyes of 298 patients with a unilateral macular hole (MH group). Multiple regression analyses were performed to determine the effects of various factors on the macular thickness. RESULTS: The mean age of the healthy group was 67.3 ± 9.6 years (range 40-88 years) and that of the MH group was 67.8 ± 7.0 years (range 43-91). SD-OCT images showed that 149 eyes (48.4 %) in the healthy group and 174 eyes (58.4 %) in the MH group had a vitreomacular separation. In the healthy group, the central minimum thickness of eyes with a vitreomacular separation (196 µm) was significantly thinner than those without a vitreomacular separation (205 µm; P < 0.001). In the MH group, the average foveal thickness (234 µm) and the central minimum thickness (177 µm) in eyes with a vitreomacular separation were thinner than those without it (247 and 199 µm, respectively; both P < 0.001). Multiple regression analyses showed that a vitreomacular separation was significantly correlated with thinner central minimum thicknesses in both groups (P < 0.001) and also with the average foveal thickness in the MH group (P < 0.001). CONCLUSIONS: A vitreomacular separation caused thinning of the central fovea in both the healthy eyes and the normal fellow eyes of unilateral MH patients; the extent of foveal thinning is greater in the MH group.

Effect of vitreomacular adhesion and vitreous gel on age-related reduction of macular thickness: a retrospective observational study.

OBJECTIVE: To investigate the effects of vitreomacular adhesion (VMA), vitreomacular separation (VMS) and absence of vitreous gel due to vitrectomy on macular thickness measured in the spectral domain optical coherence tomographic (SD-OCT) images. DESIGN: A longitudinal, retrospective, observational study. SETTING: Secondary multicentre study. PARTICIPANTS: 218 eyes of 218 healthy patients and 119 vitrectomised eyes of 119 patients were studied. The healthy individuals were classified into a VMA group (54 eyes) and a VMS group (164 eyes), while the vitrectomised patients were classified into an internal limiting membrane (ILM)-on group (26 eyes) and an ILM-off group (93 eyes). In all participants, 2 Cirrus HD-OCT recordings were made with an average interval of 36 months (range 24-60 months). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the rate of change in macular thickness in the central sector. The secondary outcomes were the rates of change in macular thickness in the inner 4 sectors. RESULTS: The annual rate of change in the macular thickness of the central sector was 0.76±1.8 µm/year in the VMA group, -0.58±2.3 µm/year in the VMS group, -1.57±1.9 µm/year in the ILM-on group and -0.86±3.1 µm/year in the ILM-off group. There was a significant difference between the rate of the central sector thickness change in the VMA and VMS groups (p=0.0001). The presence of VMA was a significant factor associated with an increase in the central sector thickness (p=0.0055). When the healthy and ILM-on groups were compared, the rate of decrease in the central sector thickness was faster in the ILM-on group (p=0.0043). Multiple regression analyses showed that not peeling the ILM during the vitrectomy was a significant factor associated with a decrease in the central sector thickness (p=0.044). CONCLUSIONS: The presence of a VMA and a vitreous gel may help restrain the macular thickness reduction.

Progressive Thinning of Regional Macular Thickness After Epiretinal Membrane Surgery.

PURPOSE: To determine the long-term changes in the regional macular thickness after idiopathic epiretinal membrane (ERM) excision and to determine whether there were correlations between the pre- and postoperative central macular thickness and the best-corrected visual acuity (BCVA). METHODS: This was a prospective, interventional case series study of 53 eyes of 53 patients that underwent ERM removal with internal limiting membrane (ILM) peeling. Examinations were performed before, 1, 2, 3, 6, 9, 12, 24, 36, 48, and 60 months after the surgery. The average macular thicknesses in nine sectors outlined by the Early Treatment Diabetic Retinopathy Study were measured by spectral-domain optical coherence tomography. The final macular thicknesses of nine sectors of the 35 patients were compared with that of the normal fellow eyes. RESULTS: All patients were followed for 36 months, and 21 patients were followed for 48 months. The thicknesses of all sectors progressively decreased for 48 months. The macula at 48 months was thinner than at 36 months (P < 0.0001-0.037) in all sectors. The final central and nasal sectors were significantly thicker than that of the fellow eyes. The final inner and outer temporal sectors were significantly thinner compared with the fellow eyes. There was no significant difference in the other sectors. The pre- and postoperative central macular thickness was significantly correlated with the postoperative BCVA at each examination. CONCLUSIONS: A progressive thinning of the macula occurs with regional differences for at least 48 months. The temporal sector becomes thinner than the normal thickness.

Clinical results of Trabectome surgery for open-angle glaucoma.

BACKGROUND: The purpose of this study was to determine outcomes when using Trabectome surgery and to evaluate factors associated with its effects in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). METHODS: This was a prospective, non-randomized, observational, comparative cohort study in which Trabectome surgery was used alone in patients with POAG or EXG. Trabectome surgery was considered to have failed when at least one of the following three criteria was fulfilled: intraocular pressure (IOP) ≥21 mmHg and a <20% reduction below the baseline IOP on two consecutive follow-up visits 3 months or more after surgery; need for additional glaucoma surgery; and an increase in number of medications compared with baseline. RESULTS: The subjects were 32 males (34 eyes) and 46 females (48 eyes). POAG was observed in 43 eyes and EXG in 39 eyes. IOP after Trabectome surgery decreased significantly from 22.3±6.8 mmHg at baseline to 14.0±3.9 mmHg (23.0% reduction) at month 24 in all cases (P<0.0000). The success rate at 2 years was 51.2% for all cases (POAG, 50.9%; EXG, 49.2%). There was no significant difference in success rate between POAG and EXG (P=0.91). Preoperative IOP (P=0.033) and number of medications (P=0.041) were significant factors for surgical success/failure in multivariate logistic regression. No serious complications were observed. CONCLUSION: Trabectome surgery achieved favorable IOP control and was equally effective in patients with POAG and those with EXG. Its effects were influenced by preoperative IOP and number of preoperative medications.

Plateau iris in Japanese patients with primary angle closure and primary angle closure glaucoma.

PURPOSE: To determine the prevalence of plateau iris in Japanese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and analyze the biometric parameters in patients with plateau iris using ultrasound biomicroscopy (UBM). METHODS: In this cross-sectional observational study, subjects aged >50 years with PAC and PACG who had previously undergone a patent laser peripheral iridotomy underwent UBM in one eye. UBM images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least two quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. A-scan biometry was used to measure anterior segment parameters. RESULTS: Ninety-one subjects with PAC (58 subjects) or PACG (33 subjects) and 68 normal controls were recruited. The mean (standard deviation) ages of PAC and PACG patients and normal controls were 73.5 (6.2) and 72.6 (7.3), respectively. Based on UBM criteria, plateau iris was found in 16 eyes (17.6%) of 91 eyes. In these 16 eyes, quadrant-wise analysis showed ten eyes (62.5%) had plateau iris in two quadrants; four eyes (25%) had plateau iris in three quadrants; and two eyes (12.5%) had plateau iris in four quadrants. Anterior chamber depth, lens thickness, axial length, lens position, and relative lens position were not statistically significant between the group having plateau iris and that not having plateau iris, respectively. CONCLUSION: Approximately 20% of Japanese subjects with PAC and PACG with a patent laser peripheral iridotomy were found to have plateau iris on UBM. No morphological difference was noted in the anterior segment of the eye between those with or without plateau iris.

EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON LONG-TERM VISUAL OUTCOMES FOR DIABETIC MACULAR EDEMA.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on the long-term visual outcomes in eyes with diffuse, nontractional diabetic macular edema. METHODS: One hundred and sixteen eyes of 58 patients with the same degree of diabetic macular edema in both eyes underwent pars plana vitrectomy with the creation of a posterior vitreous detachment in both eyes. Internal limiting membrane peeling was performed in one randomly selected eye (ILM-off group), and ILM peeling was not performed (ILM-on group) in the fellow eye. The postoperative follow-up period ranged from 12 months to 161 months (average, 80.4 months). RESULTS: In the ILM-off group, the mean best-corrected visual acuity in logMAR units (Snellen equivalent) increased from 0.55 ± 0.31 (20/71) before surgery to 0.35 ± 0.35 (20/45) at 1 year (P < 0.0001) and 0.46 ± 0.43 (20/59) at the final visit (P = 0.058). In the ILM-on group, the mean best-corrected visual acuity increased from 0.55 ± 0.41 (20/71) before surgery to 0.43 ± 0.38 (20/54) at 1 year (P = 0.010) and 0.44 ± 0.45 (20/56) at the final visit (P = 0.043). The differences in the best-corrected visual acuity between the two groups were not significant at any time point. CONCLUSION: Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling does not affect the postoperative best-corrected visual acuity significantly.

Peripheral iris thickness and association with iridotrabecular contact after laser peripheral iridotomy in patients with primary angle-closure and primary angle-closure glaucoma.

PURPOSE: To investigate the relation between the quantitative iris parameters and iridotrabecular contact (ITC) in patients with primary angle-closure (PAC) and PAC glaucoma (PACG). MATERIALS AND METHODS: PAC and PACG with laser peripheral iridotomy were recruited prospectively. Anterior-segment optical coherence tomography (ASOCT) was performed under light and dark conditions, and scans were taken along the vertical and horizontal axes. Iris thickness at 500 µm (IT500) and 750 µm (IT750) from the scleral spur, maximal iris thickness (MIT), and cross sections of the iris area (I-Area) were measured by using software. ITC was defined by the ASOCT as the contact between the peripheral iris and angle wall anterior to the scleral spur. The ITC(+) and ITC(-) groups were defined as eyes that had ITC in two or more quadrants and in no or one quadrant, respectively. RESULTS: A total of 79 eyes of 60 patients (consisting of 48 PAC and 31 PACG) were recruited. The prevalence of superior, inferior, temporal, and nasal ITC was 44 eyes (55.7%), 48 eyes (60.8%), 18 eyes (22.8%), and 16 eyes (20.2%), respectively. These iris parameters of the inferior quadrant, which had the highest prevalence of all the quadrants, were used for the analysis. After adjusting for age, sex, pupil size, and central anterior chamber depth, mean values of IT500 and IT750 were significantly greater in the ITC(+) group than the ITC(-) group (P<0.05). Multivariate-adjusted odds ratios of parameters for the ITC(+) group compared with the ITC(-) group were: IT500, 1.9 (P=0.029); IT750, 2.0 (P=0.011), MIT, 1.4 (P=0.244), and I-Area, 0.97 (P=0.406), respectively, per 0.1-unit increase. CONCLUSION: Peripheral iris thickness is associated with ITC in patients with angle closure.

Progressive changes of regional macular thickness after macular hole surgery with internal limiting membrane peeling.

PURPOSE: To determine the changes of regional macular thickness after successful macular hole surgery (MHS) with internal limiting membrane (ILM) peeling during a 24-month follow-up period. METHODS: In a prospective, interventional case study, the authors evaluated 24 eyes of 24 patients who underwent 23-gauge transconjunctival pars plana vitrectomy with triamcinolone-assisted ILM peeling to treat idiopathic macular hole. Examinations were performed before and 1, 2, 3, 6, 9, 12, and 24 months after surgery. Average regional macular thicknesses in the Early Treatment Diabetic Retinopathy Study sectors were measured by spectral-domain optical coherence tomography. RESULTS: The four inner sectors showed a significant reduction in the average retinal thickness at 1 month after surgery (P ≤ 0.0001-0.020), and the thickness continued to decrease for 24 months except in the nasal sector. The four outer sectors had a significant increase at postoperative 1 month (P = 0.0003-0.029) and then progressively decreased during the postoperative 24 months. The postoperative regional macular thinning was statistically significant even between 12 and 24 months (P = 0.0007-0.026) in all sectors except in the inner nasal sector (P = 0.13). The postoperative percent reduction rate was significantly different among four inner sectors after postoperative 3 months (P = 0.0029-0.039) in the order of temporal > superior > inferior > nasal sectors. CONCLUSIONS: These results suggest that a progressive macular thinning occurs for at least 2 years with different patterns of the changes in the macular regions after successful MHS with ILM peeling.

Foveal thickness in healthy fellow eyes of patients with unilateral macular holes.

PURPOSE: To compare the morphologic parameters of ophthalmoscopically and tomographically normal foveae of the fellow eyes of patients with a unilateral macular hole (MH), other unilateral retinal diseases, and healthy eyes. DESIGN: Observational, cross-sectional study. METHODS: Of the 849 subjects studied, 183 eyes were excluded because they had an abnormal vitreofoveal interface that might have affected the foveal thickness. The average regional retinal thicknesses of the Early Treatment Diabetic Retinopathy Study sectors determined by spectral-domain optical coherence tomography were compared among 160 patients with MH, 175 patients with epiretinal membrane, 145 patients with retinal vein occlusion, and 186 healthy subjects. The foveal depression was quantified as the foveal pit depth divided by the foveal pit diameter. RESULTS: The fovea (1 mm) and central fovea were significantly thinner in the MH group (243 and 192 µm) than in the other groups (P < .0001). There were no significant differences in the thickness of the fovea and central fovea among the eyes with epiretinal membrane (254 and 203 µm) or retinal vein occlusion (251 and 202 µm) or in the healthy group (254 and 201 µm). The foveal depression was significantly greater in the MH group (0.063) than in the retinal vein occlusion group (0.059) or in the healthy group (0.058; P = .014 and P = .0014, respectively). Multiple regression analyses showed that a thinner fovea and a deeper foveal depression were associated significantly with the presence of MH (P = .0054 to P < .0001). CONCLUSIONS: These results suggest that patients with MH have unique foveal morphologic features that predispose them to MH development.