Posterior polar annular choroidal dystrophy association with cystoid macular edema.

Posterior polar annular choroidal dystrophy (PPACD) is an uncommon retinal dystrophy causing nyctalopia. PPACD has been characteristically described as a foveal sparing dystrophy. We report the first case with cystoid macular edema association.

Sub-hyaloid and sub-internal limiting membrane macular hemorrhage after laser exposure at music festival: a case report.

PURPOSE: To describe the first case of a combined sub-hyaloid and sub-internal limiting membrane macular hemorrhage after recreational laser exposure. METHODS: A 23-year-old patient presented with an acute loss of vision in his right eye (OD) immediately after a brief exposure to a laser beam at a music festival. Color photography, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinogram (mfERG) were performed for diagnosis and follow-up. RESULTS: On presentation, visual acuity was 20/400 in the OD and 20/20 in the left eye. Posterior segment examination of his OD revealed a preretinal hemorrhage at the macula. SD-OCT images exposed a combined sub-hyaloid and sub-internal limiting membrane localization. Successful VPP with ILM peeling was carried out. Although sequential mfERG displayed almost complete restoration of the P1 amplitude 6 months posterior to VPP, SD-OCT demonstrated permanent damage to outer retinal layers. Final BCVA on OD was 20/30. CONCLUSION: The expanding and unregulated use of lasers in everyday life has created an increasing amount of cases of laser-induced retinopathy in recent years. Much more attention should be addressed in laser safety and awareness to prevent future ocular injuries. In acute phases of sub-hyaloid hemorrhages blocking direct visualization of the posterior pole, mfERG is a valuable tool to address initial macular pathology.

Anatomical Changes of Full-Thickness Macular Hole Documented by Microscope-Integrated Spectral-Domain Optical Coherence Tomography.

BACKGROUND AND OBJECTIVE: To evaluate anatomical changes of idiopathic macular hole (MH) after internal limiting membrane removal and after passive suction at the hole's borders using microscope-integrated intraoperative optical coherence tomography (iOCT). PATIENTS AND METHODS: Five eyes of five subjects with full-thickness idiopathic MH underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy, and internal limiting membrane (ILM) removal. iOCT was performed after ILM removal and after passive suction at the hole's borders. RESULTS: iOCT showed decreased MH diameter after ILM removal in all cases. Passive suction achieved complete apposition of borders. All cases presented successful postsurgical closure. CONCLUSIONS: iOCT provides anatomical information during MH surgery that may impact surgical decision-making by allowing a real-time evaluation of structures. iOCT with preservative-free triamcinolone acetonide enhanced ILM visualization. Its use is superior to iOCT alone for the identification of vitreomacular interface structures. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e105-e111.].

Inverted ILM flap, free ILM flap and conventional ILM peeling for large macular holes.

BACKGROUND: To assess closure rate after a single surgery of large macular holes and their visual recovery in the short term with three different surgical techniques. METHODS: Prospective multicenter randomized controlled trial. We included treatment-naïve patients with diagnosis of large macular hole (minimum diameter of > 400 µm). All patients underwent a comprehensive ophthalmological examination. Before surgery, the patients were randomized into three groups: group A: conventional internal limiting membrane peeling, group B: inverted-flap technique and group C: free-flap technique. All study measurements were repeated within the period of 1 and 3 months after surgery. Continuous variables were assessed with a Kruskal-Wallis test, change in visual acuity was assessed with analysis of variance for repeated measurements with a Bonferroni correction for statistical significance. RESULTS: Thirty-eight patients were enrolled (group A: 12, group B: 12, group C: 14). The closure rate was in group A and B: 91.6%; 95% CI 61.52-99.79%. In group C: 85.71%; 95% CI 57.19-98.22%. There were no differences in the macular hole closure rate between groups (p = 0.85). All groups improved ≈ 0.2 logMAR, but only group B reached statistical significance (p < 0.007). CONCLUSIONS: Despite all techniques displayed a trend toward visual improvement, the inverted-flap technique seems to induce a faster and more significant recovery in the short term.

Single-Spot Yellow Laser Versus Conventional Green Laser on Panretinal Photocoagulation: Patient Pain Scores and Preferences.

BACKGROUND AND OBJECTIVE: Panretinal photocoagulation (PRP) is the mainstay therapy for proliferative diabetic retinopathy. Pain during and after its application is a complication that affects patients' therapeutic adherence. This study aimed to compare pain perception and patient preference for the 577-nm yellow laser (YL-577) (LIGHTL as 577; LIGHTMED, San Clemente, CA) and the conventional 532-nm green laser (GL-532) (Purepoint Laser; Alcon, Fort Worth, TX) with PRP. PATIENTS AND METHODS: A total of 92 patient eyes with proliferative diabetic retinopathy treated with PRP were randomly assigned to receive both GL-532 and YL-577 (184 eyes) - one on each eye, with the order of application randomized, as well. Afterward, verbal rapid answer and visual analogue scale (VAS) scores for pain perception and patient preference were evaluated. RESULTS: VAS score was 7 ± 2 for the GL-532 group compared to 5 ± 3 in the YL-577 group (P = .001). Overall, 75% of the patients preferred YL-577 therapy if they were to receive a second PRP session. CONCLUSION: The use of YL-577 as an alternative approach for PRP reduces pain perception and is preferred by patients. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:902-905.].

Amaurosis congénita de Leber RPE-65, seguimiento a 7 años.

Leber congenital amaurosis is a retinal dystrophy with several forms of presentation due to its genetic variability. Case of a female girl followed up from 4 to 11 years old is presented, with positive clinical data of nyctalopia, myopia and choroid ocular fundus. Electroretinogram was not measurable in all phases but diagnostic was confirmed by RPE65 mutation genetic study. RPE65 Leber congenital amaurosis is particularly important as it has been researched for a gene therapy treatment with good functional outcomes up to now, awaiting to offer hope and a better quality of life to people with this disease.

[Intraoperative use of coherence tomography in vitreoretinal surgery]. / Utilidad transquirúrgica de la tomografía de coherencia óptica en cirugía vítreo-retiniana.

BACKGROUND: Optical coherence tomography is a useful tool in several diseases. Its intraoperative use with the intention of improving anatomical results has recently been described. PURPOSE: To determine the usefulness and safety of optical coherence tomography during pars plana vitrectomy for several vitreo-retinal diseases. MATERIAL AND METHODS: A prospective case series is reported, in which the decision that influenced the use of the optical coherence tomography imaging during pars plana vitrectomy is evaluated. A RESCAN 700 microscope that includes a spectral domain tomography was used to obtain the images. At the end of each procedure the surgeons completed a questionnaire to determine if the tomographic image had an influence when making decisions during the surgery, or change the decision during the procedure. RESULTS: Thirteen patients with pars plana vitrectomy were included, with cataract surgery also performed in 6 patients. The surgeon considered that the intraoperative image influenced the decision during the procedure in 8 cases. CONCLUSION: Intraoperative optical coherence tomography is helpful for a safe patient diagnosis. It does not affect the surgery time, and in some cases it is useful for optimising the procedure in vitreous-retinal surgery.

[Risk factors for recurrent retinal detachment]. / Desprendimiento recidivante de retina. Factores de riesgo.

OBJECTIVE: To determine the risk factors associated with recurrent retinal detachment in patients vitrectomized. METHODS: Case-control study nested in a cohort. We included patients with a diagnosis of rhegmatogenous retinal detachment treated with vitrectomy for one year, with a six months follow-up. We monitored the presence of incident event in the emergency department, and the examination room. Statistical analysis was performed by descriptive statistics (median, minimum and maximum) and inferential statistics (chi-squared test, Cox regression, Kaplan-Meier). RESULTS: A population of 94 patients with a median age of 55 years (21-83) was analyzed. The silicone was the most widely used type of tamponade in 62 patients (66 %) and recurrent retinal detachment occurred in 19 cases (20 %). In the relation between the non-relapse group and the relapse group, the statistically significant variable was the use of silicone (p = 0.05, OR = 0.03, 0.013-0.98), wich had a lower probability of recurrent detachment compared with the use of sulfur hexafluoride (SF6 gas) (p = 0.012). CONCLUSIONS: The use of silicone compared with the use of SF6 gas has shown to be a protective factor for recurrent retinal detachment; however, the choice of method of tamponade should be individualized for each patient.

OBJETIVO: determinar los factores de riesgo quirúrgico relacionados con el desprendimiento de retina recidivante en pacientes que habían sido tratados con vitrectomía. MÉTODOS: estudio de casos y controles anidado en una cohorte recolectada durante un año. Se incluyeron pacientes con diagnóstico de desprendimiento regmatógeno de retina tratados con vitrectomía, con un seguimiento de seis meses. Se monitorizó la presencia del evento incidente en el servicio de urgencias y en la consulta. El análisis de los datos se realizó mediante estadística descriptiva (medianas, mínimos y máximos) e inferencial (chi-squared, regresión de Cox y método de Kaplan-Meier). RESULTADOS: se analizaron 94 pacientes con mediana de edad de 55 años (rango de 21 a 83 años). La silicona fue el material de taponamiento utilizado en 62 pacientes (66 %) y la recidiva se presentó en 19 (20 %). En la relación entre el grupo sin recidiva y el grupo con recidiva, la variable estadísticamente significativa fue el uso de silicona (p = 0.05, OR = 0.03, 0.013-0.98), el cual tuvo menor probabilidad de redesprendimiento comparado con el del hexafluoruro de azufre (p = 0.012). CONCLUSIONES: el uso de silicona comparado con el del gas SF6 mostró ser un factor protector para el desarrollo de redesprendimiento de retina, sin embargo, la decisión de que elemento emplear para el taponamiento debe individualizarse.