Partial thickness sclerectomy to treat exudative retinal detachment secondary a submacular choroidal hemangioma in a Sturge-Weber syndrome.

PURPOSE: To demonstrate the safety and efficacy of partial thickness sclerectomies to treat exudative retinal detachment secondary to choroidal hemangioma, non-suitable with photodynamic therapy in a 5-year-old child with Sturge-Weber syndrome. METHODS: A 5 year-old child presented exudative retinal detachment secondary to choroidal subfoveal diffuse hemangioma. The child was non-compliant to undergo a photodynamic therapy. A partial thickness sclerectomy was made in each quadrant under general anesthesia. RESULTS: The retina was re-attached with improvement in vision from 20/400 to 20/80. Two years after primary surgery, the retinal detachment relapsed. Drainage of the subretinal fluid was obtained by the revision of the sclerectomies. After obtaining retinal reattachment, photodynamic therapy was applied to treat the hemangioma. No complications were reported after treatment. CONCLUSION: Sclerectomies may be considered an efficient and safe surgical option for the management of exudative retinal detachment secondary to choroidal hemangioma in patients non-suitable for photodynamic therapy, waiting for photodynamic therapy to be practicable directly on the hemangioma.

COMBINED AUTOLOGOUS TRANSPLANTATION OF NEUROSENSORY RETINA, RETINAL PIGMENT EPITHELIUM, AND CHOROID FREE GRAFTS.

PURPOSE: To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole. METHODS: During vitrectomy, an RPE-choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE-choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE-choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases. RESULTS: Mean follow-up was 7 ± 5.5 months (range 3-19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2-3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7-2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina-choroid-RPE free graft (n = 1). CONCLUSION: Combined autologous RPE-choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.

Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane.

BACKGROUND: To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PPV) with or without combined cataract surgery for the treatment of idiopathic epiretinal membrane (ERM). METHODS: Retrospective, non-comparative, interventional case series. Data included patient age, indication for surgery, and intra- and post-operative complications. The follow-up lasted 1 year. Best-corrected visual acuity (BCVA logMAR), central foveal thickness (CFT micron-µ) and the incidence of intra-retinal cysts were evaluated. CME was defined as post-operative observation of intra-retinal cysts at optical coherence tomography, preventing improvement or causing reduction of BCVA when compared to the pre-operative value. Statistical analysis was performed to identify the risk factors of CME. RESULTS: Two hundred and forty two eyes of 242 patients underwent PPV for the treatment of idiopathic ERM. Statistical analysis showed that the presence of preoperative intra-retinal cysts were associated with persistent CME following surgery (odds ratio 3.89; 95%CI: 1.63-9.28, P = 0.0004). However, postoperative CME occurred in 10 % of eyes that did not show preoperative CME. In addition, there was a significant correlation between the baseline value of CFT and the values of CFT at each time point during the follow up (p < 0.0001), with greater values of the pre-operative thickness correlating to greater values of post-operative thickness. CONCLUSIONS: Persistent or new CME following surgery for idiopathic ERM are frequently identified after PPV for ERM. The statistical results of the current study suggest that intraretinal cysts and increased preoperative CFT are associated with reduced visual acuity after surgery.