Intraocular perfluorodecalin and silicone oil tamponade (double filling) in the management of complicated retinal detachment: functional and anatomical outcomes using small-gauge surgery.

PURPOSE: To describe the functional and anatomical results of complicated retinal detachment (RD) treated with small-gauge pars plana vitrectomy (PPV) and combined perfluorodecalin and polydimethylsiloxane tamponade (double filling, DF). METHODS: Retrospective analysis of consecutive patients with complex RD (severe proliferative vitreoretinopathy, inferior/posterior/giant retinal tears, and traumatic detachments) treated with small-gauge PPV, membrane peeling, and DF at the Department of Ophthalmology at San Gerardo Hospital, Monza, Italy. Main outcome measures included best-corrected visual acuity (BCVA), rates of retinal reattachment, and complications. RESULTS: This study included 15 patients with a median follow-up (FU) of 6 months (range 1-22). Three patients with early retinal redetachment under tamponade and FU shorter than 3 months were excluded from the final functional analysis, but they were considered anatomical failure. At the last examination, BCVA improved in 50% of patients and remained stable in 25% of patients and anatomical success was achieved in 73% of eyes, 64% of them without any endotamponade. Three eyes had retinal redetachment after perfluorodecalin/silicone oil exchange because of diffuse proliferative vitreoretinopathy (PVR) and required reoperation to achieve retinal attachment. In eyes with anatomical success, macular pucker was the most frequent long-term complication (27%). CONCLUSION: In the management of complex RD, small-gauge pars plana vitrectomy, and double filling endotamponade using wide-angle viewing systems was a well-tolerated and effective technique to preserve visual acuity and achieve anatomical success.

PREVALENCE AND RISK FACTORS OF ELLIPSOID ZONE DAMAGE AFTER PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To assess factors associated with external limiting membrane (ELM)/ellipsoid zone (EZ) damage after pars plana vitrectomy (PPV) for epiretinal membrane and evaluate ELM/EZ damage impact on functional and anatomical outcomes. METHODS: Patients who underwent PPV with epiretinal membrane ± inner limiting membrane peeling were retrospectively analyzed. Best-corrected visual acuity and central macular thickness were longitudinally collected based on the available follow-up. Demographic data, clinical data, and surgical details were included in logistic regression models having ELM/EZ damage as a binary outcome. RESULTS: Overall, 179 eyes (171 patients) were included; 93 had a 12-month follow-up. Thirty-four eyes (19%) had ELM/EZ damage after surgery; in nine eyes (5%), ELM/EZ damage persisted at 12 months. Phacoemulsification during PPV (odds ratio = 6.97; P = 0.007) and ELM/EZ damage before PPV (odds ratio = 6.91; P = 0.007) were risk factors for postoperative ELM/EZ disruption. Thicker outer nuclear layer (P = 0.002), thicker ectopic inner foveal layer (P < 0.001), and higher endoillumination power (P = 0.03) were associated with slower visual recovery. Inner limiting membrane peeling (P = 0.04) was associated with slower anatomical recovery. CONCLUSION: Cataract extraction and outer retinal damage before PPV are associated with higher risk of photoreceptor damage postoperatively. The rate of visual improvement varies as a function of retinal layers' distortion before surgery; additional retinal manipulation slows restoration of the macular anatomy.

The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation.

PURPOSE: To analyze the functional impact of ectopic inner foveal layers (EIFL), along with other clinical and optical coherence tomography biomarkers, on patients with epiretinal membrane (ERM) and preserved foveal layers' segmentation undergoing ERM removal. METHODS: Retrospective review of consecutive patients with ERM who underwent pars plana vitrectomy with ERM peeling from December 2018 to December 2019. Baseline factors including age, gender, lens status, phacoemulsification at the time of surgery, tamponade agent, dye used for ERM and internal limiting membrane (ILM) enhancement, ILM peeling, best-corrected visual acuity (BCVA) and central macular thickness (CMT), presence and thickness of EIFL, thickness of outer nuclear layer (ONL), presence of a cotton ball, subfoveal state of photoreceptors, and presence of cystoid macular edema were included in a multivariable model having the BCVA at 12 months as the main outcome. The changes in EIFL and ONL thickness over time were also analyzed. RESULTS: Fifty-one patients (58 eyes, 23 eyes in the no EIFL group, and 35 eyes in the EIFL group) were enrolled. The BCVA significantly improved over 12 months after surgery, regardless of the presence of EIFL (p < 0.001). Eyes with no EIFL had better BCVA at month 3 (p = 0.04), but this difference was no longer detectable at 6 and 12 months. The presence of EIFL was not associated with the final BCVA (p = 0.9), while the CMT at 12 months correlated with EIFL thickness (r = 0.8, p = 0.008). CONCLUSION: Patients with EIFL could reach optimal visual acuity in the absence of disorganization of the inner retinal layers but should be warned of potentially longer healing times. None of the morphologic signs included in this study precluded good visual recovery on long-term follow-up.

Bilateral Acute Macular Neuroretinopathy in a Young Patient: Imaging and Visual Field during Two-Year-Follow-Up.

Acute macular neuroretinopathy (AMN) is a rare disorder. We report a case of bilateral AMN in a young female patient, without any risk factors. She referred a positive scotoma in both eyes after flu-like symptoms. Fundus examination revealed parafoveal dark-reddish oval lesions in both eyes. Therefore, we performed visual field, optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG) at baseline and several times during the two years of follow-up. The infrared (IR) imaging showed one rounded hyporeflective lesion in the left eye and two similar lesions in the right eye. The OCT demonstrated the characteristic alterations in the outer retina. The visual field also demonstrated scotomas corresponding with these lesions. The OCT and IR features disappeared at the end of the follow-up except for the left eye, which continued to have hyperreflective spots in the outer plexiform layer. The patient complained about a residual scotoma only in the left eye after two years. Our case shows a difference in disease progression in the two eyes of the same patient, suggesting that several mechanisms can be implicated in the pathology of AMN.