Epiretinal implant of human amniotic membrane to treat highly myopic macular hole retinal detachments: A novel surgical technique.

PURPOSE: To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient. METHODS: A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days. RESULTS: Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up. CONCLUSIONS: Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.

Intraocular Temperature Distribution in Eyes Undergoing Different Types of Surgical Procedures during Vitreous Surgery.

Vitreous temperature has been reported to vary during intraocular surgery. We measured the temperature at three intraocular sites, just posterior to the crystalline lens (BL), mid-vitreous (MV), and just anterior to the optic disc (OD), and investigated temperature changes before and after different types of surgical procedures in 78 eyes. The mean temperature at the beginning was 30.1 ± 1.70 °C in the anterior chamber, 32.4 ± 1.41 °C at the BL, 33.8 ± 0.95 °C at the MV, and 34.7 ± 0.95 °C at the OD. It was lowest at the BL, and highest at the OD. The mean temperature after cataract surgery was slightly lower especially at an anterior location. Thus, the temperature gradient became slightly flatter. The mean temperature after core vitrectomy was even lower at all sites and a gradient of the temperature was not present. The mean temperature after membrane peeling was significantly higher than that after core vitrectomy, and there was no gradient. The mean temperature after fluid/air exchange was lower at the BL and higher at the MV and at the OD. Thus, a gradient of higher temperatures at the OD appeared. The intraocular temperature distribution is different depending on the surgical procedure which can then change the temperature gradient. The temperature changes at the different intraocular sites and the gradients should be further investigated because they may affect the physiology of the retina and the recovery process.

Outcomes of Vitrectomy with Fovea-Sparing and Inverted ILM Flap Technique for Myopic Foveoschisis.

Surgical treatment of myopic foveoschisis (MF) can result in a macular hole in 11−17% of patients that may lead to poor visual outcomes and progression to macular hole retinal detachment. We evaluated the benefit of vitrectomy to treat MF using the inverted internal limiting membrane (ILM) flap and fovea-sparing ILM techniques. We studied 20 eyes of 20 patients (7 men, 13 women) with high MF (mean axial length, 29.3 ± 1.7 mm). MF was classified by optical coherence tomography findings: retinoschisis (7 eyes) or foveal detachment (13 eyes). Between October 2013 and June 2021, we performed vitreous surgery in all 20 patients, employing both techniques. Air tamponade was used in 4 eyes, SF6 gas in 10 eyes, and C3F8 gas in 6 eyes. All patients stayed in the face-down position for one full day postoperatively. Visual acuity and foveal contour were analyzed using optical coherence tomography before surgery and at 3 and 6 months postoperatively. LogMAR visual acuity was 0.46 before surgery, with a significant improvement at 3 months (0.34) and at 6 months (0.2) postoperatively (p = 0.024, p < 0.001, respectively). In all patients, the foveal contour showed improvement without macular hole formation after surgery. These results show that vitrectomy, performed using the inverted ILM flap and fovea-sparing ILM technique, is effective for treating MF.

Case Report: Microincision Vitreous Surgery Induces Bleb Failure in Eyes With Functional Filtering Bleb.

Purpose: To investigate the effect of microincision vitreous surgery (MIVS) on intraocular pressure (IOP) control in glaucomatous eyes with functional filtering bleb. Methods: We enrolled 18 patients (15 males; median age, 73 years) who previously had filtering surgery and underwent MIVS with functional filtering bleb. Kaplan-Meier method was used to calculate the survival rate with defined the failure as when more number of preoperative antiglaucoma medication was started or additional glaucoma surgery including bleb revisions were performed, and IOP increase of 20% (criteria 1) and 30% (criteria 2) from preoperative levels after 2 weeks of MIVS. Results: The median follow-up duration was 970 days. Preoperative IOP was 13.3 ± 3.8 mmHg (mean ± SD). Postoperative IOP were 14.7 ± 4.9 (P=0.365), 15.2 ± 3.5 (P=0.137), 16.4 ± 5.6 (P = 0.073), 17.6 ± 6.1(P = 0.020), and 14.5 ± 4.0 (P = 0.402) mmHg at 3, 6, 12, and 15 months and final visit, respectively (compared to preoperative IOP). The number of antiglaucoma medications was a median of 1.0 (range 0-4) preoperatively and 0 (0-4) at the final visit (P = 0.238). The survival rates were 55%/61% at 3 months, 50%/61% at 6 months, and 38%/55% at 12 months with criteria 1 and 2, respectively. Four eyes (22%) received additional glaucoma surgery during follow-up. Conclusion: After several months of MIVS, IOP was likely to increase. We should focus on IOP control by conducting long-term follow-ups.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury.

AIM: To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.

Hemorrhagic choroidal detachment as the presenting sign of uveal melanoma.

PURPOSE: To describe two cases of medium-sized uveal melanoma presenting with hemorrhagic choroidal detachments. OBSERVATIONS: The first case is a 39-year-old man who presented with choroidal hemorrhage and angle closure glaucoma. The second case is a 42-year-old man who presented with choroidal hemorrhage and posterior scleritis. Vitrectomy with transvitreous fine needle aspiration biopsy was ultimately required to diagnose malignant uveal melanoma in each case. CONCLUSIONS AND IMPORTANCE: Intraocular hemorrhage is a rare presenting sign of uveal melanoma. When it does occur, it is typically associated with large tumors. Hemorrhagic choroidal detachments are particularly rare in uveal melanoma, and can limit the diagnostic utility of clinical exam, B-scan ultrasonography, and magnetic resonance imaging. Although it is uncommon, it is important to maintain a high index of suspicion for choroidal melanoma in any patient with unexplained choroidal hemorrhage.

Intraocular Temperature at Different Sites in Eye Measured at the Beginning of Vitreous Surgery.

The temperature of the vitreous has been reported to vary during cataract and vitreous surgery. We measured intraocular temperature at four intraocular sites; the anterior chamber (AC), just behind the crystalline lens, mid-vitreous, and just anterior to the optic disc (OD) at the beginning of vitrectomy with a thermoprobe in 48 eyes. The temperatures were compared in three groups; eyes that underwent vitrectomy for the first time (Group V, n = 30), eyes that had previous vitrectomy and the vitreous cavity had been filled with balanced salt solution (BSS; Group A, n = 12), and eyes that had previous vitrectomy and the vitreous cavity was filled with silicone oil (Group S, n = 6). There was a gradient in the temperature in all groups, i.e., it was lowest in the AC, and it increased at points closer to the retina. The intraocular temperature was significantly correlated with the type of fluid in the vitreous cavity. The mean intraocular temperatures were not significantly different in Groups V and A, but they were significantly higher in Group S. Clinicians should be aware of the differences in the temperature at the different intraocular sites because the temperatures may affect the physiology of the retina and the recovery process.

A Case of Presumed Dyskeratosis Congenita Causing Severe Retinal Vascular Occlusion.

Dyskeratosis congenita (DKC) is a rare, multisystem, bone marrow failure disease characterized by abnormalities such as in the skin, mucosa, nervous system, and lungs. Here we report a rare case of presumed DKC causing total retinal detachment in the right eye and severe peripheral retinal vascular occlusion in the left eye. A 3-year-old boy was presented with vitreous hemorrhage and total retinal detachment in the right eye and was scheduled to undergo vitreous surgery in the right eye and detailed ophthalmologic examination of the left eye under general anesthesia. Since a systemic examination revealed anemia and marked thrombocytopenia, he underwent a detailed pediatric examination. Although genetic testing revealed no significant pathologic mutations, the presence of shortened telomere length and other clinical findings suggested the possibility of DKC. His right eye had severe proliferative vitreoretinopathy, and retinal reattachment was not achieved with vitreous surgery, thus resulting in phthisis bulbi. The left eye showed a wide retinal avascular area in the temporal retina, retinal neovascularization, and hard exudates on fluorescein fundus angiography and was treated with laser photocoagulation using a binocular indirect ophthalmoscopic photocoagulator. Following laser surgery, the new blood vessels regressed, and the visual acuity was maintained at 1.0. The findings in this rare case indicate that DKC can cause severe retinal vascular occlusion, thus leading to vitreous hemorrhage and retinal detachment. Therefore, early detection with fundus examination and early treatment with photocoagulation are important.

Quality of view through extended depth of focus intraocular lens in a model eye.

PURPOSE: To compare the quality of images viewed through an extended depth of focus (EDF) intraocular lens (IOL) to that through multifocal or monofocal IOL. STUDY DESIGN: Experimental study METHODS: EDF IOL (Symfony®, ZXR00V, Johnson & Johnson Vision), diffractive multifocal (ZLB00, + 3.25D or ZMB00, + 4.0D), or monofocal (ZCB00V) IOL with a spherical power of + 20.0 diopter (D) was placed in a fluid-filled model eye with corneal aberrations similar to those of human eyes. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat contact lens, a 60D or 128D wide-angle non-contact lens (Resight®) or wide-angle contact lens (MiniQuad®). The contrast of the grating images recorded with the EDF and multifocal IOLs were compared to those through the monofocal IOL. RESULTS: The grating images viewed through the flat contact lens were slightly blurred when viewed through the EDF IOL but clearer than those through the multifocal IOLs with very blurred images in the periphery. The contrast of the images viewed through the EDF and multifocal IOLs through the flat contact lens was significantly lower than through the monofocal IOL (P < 0.02). The contrast of the images viewed through the EDF IOL with 60D or 128D wide-angle non-contact lens was significantly lower than through the monofocal IOL (P < 0.05) but not with wide-angle contact lens. CONCLUSION: Our results suggest that vitreous surgeons can accomplish a clearer view during vitrectomy in EDF IOL-implanted eyes with a wide-angle viewing contact lens and a flat contact lens than in multifocal IOL-implanted eyes.

Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery.

Pars plana vitrectomy (PPV) in uveitis is indicated for various diagnostic and therapeutic indications. With the advent of microincision vitreous surgery (MIVS), the use of PPV in uveitis has increased with a wider spectrum of indications due to shorter surgical time, less patient discomfort, less conjunctival scarring, and a decreased rate of complications as compared to standard 20G vitrectomy. Because of faster post-operative recovery in terms of visual improvement and reduction of inflammation, and reduced duration of systemic corticosteroids, MIVS has gained popularity in uveitis as an adjunctive therapy to the standard of care medical therapy. The safety and efficacy of MIVS is related to the emerging vitrectomy techniques with better and newer cutters, illuminating probes, and accessory instruments. Because of the instrumentation and fluidics of MIVS, PPV is emerging as a safe and useful alternative for diagnostic challenges in uveitis, aiding in earlier diagnosis and better outcome of inflammatory disease, even in the presence of severe and active inflammation, which was once considered a relative contraindication for performing vitreous surgery. However, for surgical interventions for therapeutic indications and complications of uveitis, it is advisable to achieve an optimum control of inflammation for best results. The increasing reports of the use of MIVS in uveitis have led to its wider acceptance among clinicians practicing uveitis.

The Evolving Treatment of Diabetic Retinopathy.

PURPOSE: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. METHODS: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. RESULTS: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. CONCLUSION: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and treatment burden are more constrained. Results with subthreshold laser appear promising but will require more rigorous study to establish its role as adjunctive therapy. Evidence to support an optimal integration of the various treatment options is lacking. Central to the widespread adoption of any therapeutic regimen for DR and DME is substantiation of safety, efficacy, and cost-effectiveness by a body of sound clinical trials.

Clinical Features of Vitreomacular Traction Syndrome with Peripheral Vitreoretinal Adhesion.

PURPOSE: To retrospectively review and analyze the clinical and imaging data of patients with vitreomacular traction syndrome (VMTS) with strong peripheral vitreoretinal adhesion. SUBJECTS AND METHODS: This retrospective case-series study involved 4 eyes of 4 VMTS patients with vitreoretinal adhesion in both the macular region and the periphery who underwent vitreous surgery. In all 4 cases, preoperative refraction, fundoscopic findings, optical coherence tomography (OCT) findings, and intraoperative findings were evaluated. RESULTS: The preoperative fundoscopy and OCT findings revealed fibrous membranes around the optic nerve head in 3 eyes. Thickened posterior vitreous membranes extending from the posterior pole to the periphery were observed in all eyes. Apparent VMTS or epimacular membrane was also found in the fellow eyes of 2 patients. The preoperative refractive errors ranged from +0.5 diopters (D) to +2.75 D (mean, +1.13 D). Intraoperatively, a thickened posterior vitreous membrane was found strongly adhered to the retina in the macula regions, optic nerve head, and periphery. In 2 eyes, when artificial posterior vitreous detachment (PVD) was created, an iatrogenic tear developed in the periphery. CONCLUSION: The features of VMTS that cause strong peripheral vitreoretinal adhesion include the preoperative presence of a thickened posterior vitreous membrane over a wide area, hypermetropia, and a short axial length.

Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy.

PURPOSE: To compare the outcomes of vitrectomy with fovea-sparing internal limiting membrane peeling (FSIP) and complete internal limiting membrane peeling (ILMP) for myopic traction maculopathy (MTM). STUDY DESIGN: A retrospective, observational study. PATIENTS AND METHODS: In this study, we included 22 eyes of 21 consecutive patients who underwent vitrectomy with FSIP or ILMP for MTM and were monitored for at least 6 months. Eleven eyes were treated with FSIP, and 11, with ILMP. RESULTS: With FSIP, the postoperative best-corrected visual acuity (BCVA) significantly improved from 0.61 (20/82) to 0.34 (20/44; P = .009) logarithm of the minimum angle of resolution (logMAR) units. With ILMP, the postoperative BCVA improved from 0.65 (20/89) to 0.52 (20/66) logMAR units, but was not significant (P = .106). The postoperative final central foveal thickness (CFT) reduced significantly after FSIP (from 557.6 to 128.8 µm, P = .003) and ILMP (from 547.3 to 130.3 µm, P = .008). The postoperative incidence of a macular hole was 0% (0/11 eyes) with FSIP and 27.3% (3/11 eyes) with ILMP. All patients with a macular hole had foveal detachment in association with a thin fovea preoperatively. With ILMP, postoperative BCVA with a macular hole worsened by -3.5 letters; in contrast, postoperative BCVA without a macular hole improved by +10.5 letters. With FSIP, postoperative BCVA without a macular hole significantly improved by +13.5 letters (P = .009). CONCLUSIONS: FSIP resulted in significant improvement in MTM and prevented postoperative macular hole development.

Addition Of D-Sorbitol Improves The Usability Of Ophthalmic Viscosurgical Devices.

PURPOSE: To evaluate the effects of D-sorbitol addition on changes in the extrusion force of ophthalmic viscosurgical devices (OVDs). METHODS: OVD formulations; the mixtures of 3% hyaluronic acid (HA) and 4% chondroitin sulfate (CS) containing 0%, 0.5%, or 1.0% D-sorbitol were prepared. Each prefilled syringe of OVD was stored at room temperature for 0, 15, 30, 60, or 120 mins after a small amount of viscoelastic agent was discharged from the needle. The extrusion force values (kgf) of these OVDs when reused after storage were measured with a texture analyzer. Moreover, 10 healthy adults (5 men and 5 women) used a pinch sensor to measure the extrusion force values for the HA/CS combination without D-sorbitol which was stored in the above manner, and used a 4-step scale to score the usability of OVD. RESULTS: For the HA/CS combination without D-sorbitol, the extrusion force value was increased from its initial value (storage duration, 0 min) as storage duration increased. However, for the HA/CS combination containing 0.5% or 1.0% D-sorbitol, this value remained almost unchanged over time. Likewise, the pinch sensor-determined extrusion force values of HA/CS combination without D-sorbitol increased, depending on storage duration. CONCLUSION: The addition of D-sorbitol to viscoelastic agent may suppress the needle clogging that occurs with OVD storage, and may improve the usability of OVDs during surgery.

The use of air from the infusion line to confirm infusion tip positioning in vitreous surgery for eyes with media opacities.

PURPOSE: To demonstrate the use of an air bubble in infusion to ascertain infusion tip (IT) positioning before commencing vitreoretinal surgery (VRS) in eyes with media opacities. METHODS: Twenty-four eyes were studied. An air bubble was introduced into the IT by manually expelling fluid from the distal end of the IT. Passage of this air bubble into the vitreous cavity immediately on opening the infusion line confirmed IT position and VRS was commenced only after this event. RESULTS: The air bubble was seen within the eye in 18/24 eyes immediately on opening the infusion line. In 6 eyes, the air bubble did not exit the infusion line, and VRS was commenced only after IT position was confirmed by other methods. In all 24 eyes, no untoward effect attributable to the air bubble was noticed during subsequent VRS. CONCLUSIONS: An air bubble introduced into the IT helps to quickly confirm IT position when direct visualization of the IT is difficult. There were no untoward events in eyes where the air bubble could not enter the vitreous cavity.

Changes of macular structure and retinal thickness in macular area after vitrectomy for idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:The repair of macular structure after 23G vitrectomy was performed in patients with idiopathic macular hole, and the changes of retinal thickness in vision and macular area were analyzed.<p>METHODS: A total of 85 patients(85 eyes)with monocular idiopathic macular hole who underwent elective surgery in our hospital from June 2016 to December 2017 were included in the study, of which 37 were male and 48 were female, with an average age of(64.7±10.1)years. All subjects underwent 23G vitrectomy were observed the closure of macular hole after operation, and the changes of retinal thickness in macular forea were observed preoperatively and postoperatively by optical coherence tomography(OCT). To observe the changes of the best corrected visual acuity(BCVA)in preoperative, 1mo, 3mo and 6mo after operation.<p>RESULTS: All subjects underwent postoperative examinations had good macular hole closure. The average BCVA of 3mo and 6mo after operation were significantly higher than that of preoperative and 1mo after operation(<i>P</i><0.05); the average BCVA in 6mo after operation was significantly higher than the average BCVA of 6mo after operation, with statistically significant differences(<i>t</i>=7.983, <i>P</i>=0.037). The macular central fovea thickness in 1mo after operation was significantly higher than preoperative and 3mo, 6mo after operation(<i>P</i><0.05); The retinal thickness of the macular fovea thickness in 3mo and 6mo after operation were significantly lower than that of preoperative.<p>CONCLUSION:The treatment of idiopathic macular hole with 23G vitrectomy had a high degree of successful closure rate of fracture hole and the visual acuity of patients was obviously improved.

Research status of glucocorticoid therapy for retinal detachment associated with choroidal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#Glucocorticoid as adjunctive drug before and after the surgery for retinal detachment associated with choroidal detachment. It has obvious effects in controlling inflammation and improving choroidal detachment, which creates favorable conditions for the operation. However, the ophthalmologists have different opinions on the effects of postoperative retinal reattachment rate and improvement of visual function. There has been controversy about whether to use hormones before surgery, the time of use and the way they are used. This article will review the relevant knowledge. In order to provide a more accurate and feasible reference for clinical treatment.

Influence of orientation of the external linear incision created by the 25-gauge trocar and related factors on sclerotomy closure: A clinical and optical coherence tomographic study.

PURPOSE: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). METHODS: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. RESULTS: Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ≥5 when circumferential sclerotomies were used. CONCLUSION: Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.

Visual recovery after surgical repair of chronic macular detachment associated with peripheral retinoschisis.

PURPOSE: To report 2 cases of chronic macular detachment associated with peripheral retinoschisis in which surgical repair resulted in significant visual recovery. OBSERVATIONS: A 44-year-old man and 60-year-old woman were evaluated for chronic macular detachment, with a duration of 5 years and 6 months, respectively. In each case, optical coherence tomography was used to establish a diagnosis of full-thickness macular detachment resulting from peripheral retinoschisis and to confirm or identify the pathogenic outer layer breaks. After surgical repair with pars plana vitrectomy, endolaser photocoagulation of outer layer breaks, and gas tamponade, both patients had significant improvement in vision. The best-corrected visual acuity improved from 20/50- to 20/20 at one year post-operatively in the first patient and from 20/1250 to 20/200 at 8 months post-operatively in the second. CONCLUSION AND IMPORTANCE: In cases of chronic schisis-detachment involving the macula, surgical intervention can sometimes result in unexpected levels of visual recovery.

Case Report of a Family Affected by Stickler Syndrome in Which Rhegmatogenous Retinal Detachment Occurred in Five Eyes of Three Siblings.

PURPOSE: Stickler syndrome is an autosomal dominant inherited disorder that is well known to be highly associated with the development of rhegmatogenous retinal detachment. In this study, we report the case of a family affected by Stickler syndrome in which rhegmatogenous retinal detachment developed in 5 eyes of 3 siblings. CASE SERIES: For treatment, we performed vitreous surgery on 1 eye of the eldest son, and bilateral scleral buckling surgery on the 2 younger children. A good postoperative outcome was obtained on the 4 eyes that underwent scleral buckling surgery, yet the prognosis was poor on the 1 eye that underwent vitrectomy due to redetachment of the retina and corneal complication. Since vitreous surgery was quite difficult due to strong vitreoretinal adhesion, we created an artificial posterior vitreous detachment via the bimanual technique combined with encircling. For the scleral buckling surgery, broad scleral extrusion was needed to seal multiple retinal breaks. CONCLUSIONS: The findings of this study showed a high prevalence of rhegmatogenous retinal detachment in a single family with Stickler syndrome. In these cases, scleral buckling surgery was effective for treating the detached retina, and some prophylactic treatment, such as laser photocoagulation to prevent the occurrence of rhegmatogenous retinal detachment, should be considered for such cases in the future.