Secondary Macular Holes Post Pars Plana Vitrectomy.

Purpose: To report incidence, clinical presentation, and treatment outcome of full-thickness macular hole (FTMHs) diagnosed post pars plana vitrectomy. Methods: We retrospectively reviewed the demographics, best-corrected visual acuity (BCVA), indication for the primary vitrectomy, time to diagnose the secondary FTMH, optical coherence tomographic (OCT) appearance, and treatment outcome of FTMHs, occurring after vitrectomy performed between January 2019 and December 2020. Results: Six of 523 vitrectomized eyes developed FTMHs, an incidence of 1.1%. There were five females and one male, mean age of 56.5 years (range 37-85). The indication for primary vitrectomy was rhegmatogenous retinal detachment (RRD) in three eyes, one eye each for sub internal limiting membrane hemorrhage from a ruptured macroaneurysm, vitreous hemorrhage from polypoidal choroidal vasculopathy (PCV), and pre-insertion of Ahmed glaucoma drainage device (GDD). FTMHs occurred within one week to three months after vitrectomy (time from primary vitrectomy to the identification of the secondary MH was a mean of 1.03 months). Mean BCVA in all six MH eyes was log MAR 0.9 (Snellen: 6/54). Anatomical closure was achieved after one surgery in three eyes, two surgeries in 1 eye, after photodynamic therapy (PDT) in the PCV eye, and one patient declined surgery. The mean BCVA in the four surgically closed MH eyes improved marginally from log MAR 0.82 (Snellen: 6/38) to log MAR 0.72 (Snellen: 6/30), mean follow-up 7.6 months. Conclusion: Post-vitrectomy FTMH is rare, and RRD was the commonest indication for initial vitrectomy. We observed that all secondary MHs were closed successfully using the inverted internal limiting membrane (ILM) flap technique with limited improvement in vision. The visual outcome of these secondary MHs trails behind that of idiopathic MHs.

Burden and Presentation of Age-Related Macular Degeneration among Nigerians.

PURPOSE: Age-related macular degeneration (AMD) is a leading cause of visual impairment worldwide, and its prevalence may also be on the increase in Nigeria. The purpose of this study is to ascertain the burden and pattern of presentation of AMD in a developing country. METHODS: We conducted a multicenter, prospective study from January to December 2018. Biodata and history of systemic disease were obtained from consecutive patients presenting at four collaborating retina clinics and diagnosed with a retina disease after dilated fundus examination and ocular investigations such as fundus photography, fluorescein angiography, and optical coherence tomography. All eyes diagnosed to have wet and dry AMD were used for the study analysis. RESULTS: Out of 8614 patients, 156 eyes of 78 patients were diagnosed with AMD. The hospital-based prevalence for AMD was 0.91%. The mean age at presentation was 67.9 ± 9.2 years, ranging from 44 to 95 years. A majority (75.6%) of patients were between 60 and 79 years, 53.8% were females. Thirty-two eyes (20.5%) had wet AMD, while 124 eyes (79.5%) had dry AMD. Sixty-one eyes (39.1%) had moderate visual impairment (<6/18-6/60); 58 eyes (37.2%) had normal vision (6/18 and better); while 27 eyes (17.3%) were blind, and ten eyes (6.4%) had severe visual impairment. CONCLUSION: AMD contributes to the burden of visual impairment and blindness in the elderly Nigerian. In Nigeria, AMD occurs more in females and most common between the ages of 60 and 79. Dry AMD is four times more common than wet AMD. About 24% of eyes have severe visual impairment or blindness, while about a third each have a moderate visual impairment and normal vision. Increasing awareness of AMD among the at-risk population will be beneficial in achieving early diagnosis and treatment.

Outer retina reconstruction following inverted internal limiting membrane flap technique for large macular holes.

PURPOSE: The aim of this study is to investigate the outer retina reconstruction using postoperative spectral domain optical coherence tomography (SD OCT) in large diameter macular holes (MHs) treated with the inverted internal limiting membrane (ILM) flap technique. METHODS: A retrospective study of 14 consecutive eyes that had vitrectomy and inverted ILM flap technique for MHs with a base diameter of 400 µ or greater. Preoperative and postoperative SD OCT images were assessed for MH closure and for outer retina presence; represented by the external limiting membrane (ELM) and ellipsoid zone (EZ), in the subfoveal and parafoveal areas. RESULTS: The average MH base diameter was 963 µ. Postoperative SD-OCT revealed an absence of the outer retina in six eyes, a continuous (regular) presence of the outer retina in four eyes, and a discontinuous (interrupted) presence in four eyes. There was an inverse relationship between MH size and presence or absence of ELM and EZ. A larger MH base diameter size was associated with a higher probability of an absent ELM and EZ (P = 0.04). Eyes in which an outer retina was present postoperatively achieved 6/18 and better vision compared to eyes without (P = 0.08). CONCLUSION: The outer retina in some large MHs treated with ILM flap technique can undergo reconstitution and remodeling which improves over time. The average size for MHs with complete reconstitution was 652 µ, 855 µ for those with interrupted reconstitution, and 1242 µ for eyes with no outer retina reconstruction. This suggests that MHs having a size within the limit of the no outer retina reconstitution MH group may be candidates for other surgical techniques in which postoperative outer retina presence is expected.

Case Series and Literature Review of Ophthalmologic Disorders Seen in a Specialist Rheumatology Clinic in Lagos, Nigeria.

Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.

Inverted Internal Limiting Membrane Technique Maintains Macular Hole Closure in Retinal Detachment Following Macular Hole Repair.

Recent advances in macular hole surgery have significantly improved the rates of anatomical success. One important advance is the dye-assisted peeling of the internal limiting membrane (ILM) around the hole. In large holes (<400 µ), sometimes, ILM peeling alone is not enough to achieve closure, and this may be improved by inverting part of the peeled membrane and using it to cover the macular hole or inverting and tucking the ILM flap into the hole. In this case report, a patient with large full-thickness macular hole underwent a hole repair with an inverted ILM flap technique. The eye developed a subsequent retinal detachment with large collection of subretinal fluid beneath the repaired hole, but the hole remained intact, suggesting that the adhesive forces binding an inverted flap to the edges of a repaired macular hole appear to be strong enough to maintain structural integrity of the closed hole even in the presence of a macula-involving retinal detachment with large subretinal fluid collection.