Quantitative assessment of macular function after surgery for optic disc pit maculopathy: A case report.

RATIONALE: We describe a case of optic disc pit maculopathy (ODP-M) in which vitrectomy with juxtapapillary laser (JPL) treatment led to the reattachment of retinoschisis (RS) as well as serous retinal detachment (SRD). PATIENT CONCERNS: An 80-year-old man complained of distorted vision and decreased visual acuity (VA) in his left eye for 12 months. DIAGNOSIS: We conducted quantitative functional evaluation on the area of RS and SRD using the Humphrey visual field analyzer. Fundus examination and optical coherence tomography showed SRD and RS in connection with the optic disc. The best-corrected logarithm of the minimum angle of resolution (logMAR) VA was 0.7. INTERVENTIONS: The patient underwent JPL treatment combined with pars plana vitrectomy. During surgery, posterior vitreous detachment and tamponade were created with sulfur hexafluoride. OUTCOMES: After surgery, SRD (and subsequently RS) gradually reduced and had completely disappeared at 31 months. VA gradually improved and was 0.0 (logMAR) at 28 months. The analysis of the mean macular thickness of the central 3-mm diameter showed that the macula thickness recovered to 300 µm at 17 months postoperatively. Retinal sensitivity began to improve at 24 months postoperatively and had increased at 48 months postoperatively. LESSONS: In conclusion, vitrectomy with JPL treatment for ODP-M had a favorable anatomical outcome as well as a long-term functional outcome. These findings provide useful information for clinicians who are planning a therapeutic strategy, including the choice of surgical procedure for ODP-M.

Endoscopic Transethmosphenoid Optic Canal and Orbital Apex Decompression for Patients With Traumatic Orbital Apex Syndrome.

PURPOSE: The aim of this study was to evaluate the efficacy, feasibility, and safety of the endoscopic optic canal and orbital apex decompression for patients with traumatic orbital apex syndrome. DESIGN: Retrospective, noncomparative case series. METHOD: Thirty-one patients (31 eyes) with traumatic orbital apex syndrome underwent endoscopic transethmosphenoid optic canal and orbital apex decompression at the Eye Hospital of Wenzhou Medical University from May 1st, 2012 to May 1st, 2018. In each case, the indication of surgery was that patient with traumatic orbital apex syndrome failed to respond to corticosteroids. Patients were followed up to 6 months after surgery. Best corrected visual acuity, visual field, ptosis, ophthalmoplegia, hypoesthesia, and pupil before and after surgery were compared. RESULT: All patients presented visual decline (including 5 patients with no light perception), ptosis, ophthalmoplegia, diplopia, pupil dysfunction, and visual field defect, and 20 of them also presented hypoesthesia. Nineteen of 31 (61.3%) patients gained improvement of best-corrected visual acuity after surgery, 7 of them gained 20/20 BCVA, and visual field showed improvement in 20 patients. Ptosis and ophthalmoplegia of all patients recovered in various degree; diplopia also relieved relatively. The function of the pupil was also improved in most patients (27/31, 87.1%). The improvement of hypoesthesia was also observed in most patients. No serious complications occurred. CONCLUSION: Endoscopic transethmosphenoid optic canal and orbital apex decompression seems to be a feasible, efficient, and safe approach for traumatic orbital apex syndrome patients.

Anterior Lens Capsule Transplantation for Acquired Optic Disc Pit Maculopathy.

A patient with acquired optic disc pit (ODP) maculopathy underwent vitrectomy with anterior capsule transplantation to the ODP and gas tamponade. Structural changes were evaluated by enhanced depth imaging optical coherence (OCT) tomography. During vitrectomy, the eye was confirmed to have preexisting posterior vitreous detachment. Postoperative OCT showed complete closure of the optic pit resulting in rapid absorption of subretinal fluid. The authors' observations suggest that the anterior capsule is a useful material for achieving optic pit closure. To the authors' knowledge, this is the first report describing application of the anterior capsule to the treatment of ODP maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:649-652.].

Relationship between preoperative high intraocular pressure and retinal nerve fibre layer thinning after glaucoma surgery.

Recent reports show varying results regarding peripapillary retinal nerve fibre layer (RNFL) thickness after intraocular pressure (IOP)-lowering glaucoma surgery. We hypothesised that different levels of the preoperative IOP influence RNFL thickness. A total of 60 patients (60 eyes) with glaucoma, who underwent glaucoma surgery and had a stable postoperative mean IOP < 22 mmHg, were enrolled. The RNFL thickness was measured using spectral domain optical coherence tomography, before and at 3-6 months after surgery. The preoperative peak IOP, 37.4 ± 10.8 mmHg, decreased to a postoperative mean IOP of 14.8 ± 3.5 mmHg (p < 0.001). The average RNFL thickness was significantly reduced from 75.6 ± 17.7 µm to 70.2 ± 15.8 µm (p < 0.001). In subgroup analyses, only patients with a preoperative peak IOP ≥ median value (37 mmHg) exhibited significant RNFL thinning (9.7 ± 6.6 µm, p < 0.001) associated with a higher preoperative peak IOP (r = 0.475, p = 0.008). The RNFL thinning was evident for a few months after glaucoma surgery in patients with a higher preoperative peak IOP, although the postoperative IOP was stable.

[Congenital abnormalities of the optic disc]. / Anomalies congénitales de la papille.

Congenital abnormalities of the optic disc are not uncommon in clinical practice and should be recognized. Size abnormalities of the optic disc include optic disc aplasia, hypoplasia, megalopapilla, and optic disc cupping in prematurity. Among congenital excavations of the optic disc head, morning glory disc anomaly and optic disc pit can be complicated by serous retinal detachment; the papillorenal disc is an association of bilateral optic disc cupping and renal hypoplasia which should be ruled out; optic disc coloboma is caused by an abnormal closure of the embryonic fissure and can be complicated by choroidal neovascularization and retinal detachment. Other abnormalities that will be discussed are congenital tilted disc syndrome, duplicity of the optic disc head, congenital pigmentation of the optic disc head and myelinated retinal nerve fibers. All of these abnormalities can be associated with syndromes and neurological diseases, as well as other potentially blinding ophthalmological defects which can be secondarily complicated by amblyopia, strabismus and nystagmus. Thus, they should be recognized in order to plan for appropriate follow-up.

Retinal Nerve Fiber Layer Thickness Measurement for Predicting Visual Outcome after Transsphenoidal Surgery: Optic Disc Atrophy Is Not the Deciding Indicator.

BACKGROUND: Postoperative visual recovery is a major concern after transsphenoidal surgery. Optical coherence tomography (OCT) can visualize the anatomy of the retina, and retinal nerve fiber layer (RNFL) thinning reflects loss of optic nerve axons. Visual-evoked potential (VEP) is an electrophysiological response that confirms the nerve conductance. Therefore, these factors reflecting the optic nerve condition may be closely associated with the visual outcome after transsphenoidal surgery. METHODS: A total of 124 eyes in 62 patients with sellar tumor who underwent transsphenoidal surgery were included. The following variables were retrospectively analyzed: age, sex, tumor diameter, histology, symptom duration, history of rapid deterioration, optic disc atrophy on fundoscopy, peripapillary RNFL thickness on OCT, and latency and reproducibility of the VEP waveform. RESULTS: Four eyes were excluded for no visual disturbance in 3 and glaucoma aggravation in 1. Eighty-three eyes manifested visual improvement, 37 revealed no change, and none showed postoperative deterioration. Univariate analysis demonstrated that thick RNFL of the inferior and temporal quadrants, reproducible VEP waveform, short symptom duration, histologic diagnosis of pituitary adenoma, and small tumor diameter were associated with good visual recovery. Multivariate analysis showed RNFL thickness of the temporal quadrant had significant association with visual recovery (P = 0.03). CONCLUSIONS: OCT is a useful diagnostic modality to assess optic nerve condition, and RNFL thickness of the temporal quadrant is correlated with visual outcome after transsphenoidal surgery. Patients with severe visual disturbance may still achieve visual recovery, so surgery should be considered even if optic disc atrophy is evident.

Formation of an Intraretinal Fluid Barrier in Cavitary Optic Disc Maculopathy.

PURPOSE: Cavitary optic disc maculopathy develops when fluctuating pressure gradients along anomalous communications in the optic nerve head induce migration of fluid into the adjacent retinal tissue. We sought to determine whether carefully titrated laser photocoagulation combined with vitrectomy and gas tamponade can safely create an effective intraretinal barrier to fluid egress from the optic disc cavitation. DESIGN: Retrospective interventional case series. METHODS: We retrospectively evaluated medical records and imaging studies of 22 consecutive patients with cavitary disc maculopathy evaluated by a single surgeon between 1991 and 2014. Patients requiring surgery underwent carefully titrated juxtapapillary laser photocoagulation followed immediately by vitrectomy and gas tamponade. Main outcome measures were change in visual acuity, macular fluid resolution, and recurrence of maculopathy. RESULTS: Eleven patients (11 eyes) had undergone vitreous surgery and were included in the study. No preoperative evidence for vitreous traction on the optic disc or macula was seen in any eye. Nine patients underwent a single surgery and 2 patients required additional procedures to resolve the macular fluid. Mean length of follow-up after the last surgery was 48.2 months (range, 4-143 months). All 11 patients (100%) had complete resolution of macular fluid, with an average time to resolution of 8.5 months (range, 1-18 months). Only 1 of 11 patients (9%) had recurrence of macular fluid (14 months postoperatively). The average preoperative visual acuity of 20/125 (logMAR 0.81, standard deviation [SD] = 0.36) improved by nearly 4 lines to an average final visual acuity of 20/57 (logMAR 0.45, SD = 0.37) (P = .0072). A possible laser-induced central scotoma was suspected in only 1 patient who had undergone extensive prior laser treatments. CONCLUSIONS: An effective intraretinal barrier to fluid migration from cavitary optic disc anomalies can be safely achieved in most patients with carefully titrated juxtapapillary laser photocoagulation combined with vitrectomy and gas tamponade. Once achieved, the barrier facilitates resolution of macular fluid and long-term avoidance of recurrent maculopathy.

[Optic disc pit-associated maculopathy and iris-retinochoroidal-coloboma - a rare combination]. / Kranenburg-Syndrom und Iris-Netzhaut-Aderhaut-Kolobom ­ eine seltene Kombination.

Kranenburg's syndrome is defined as central serous detachment associated with an optic disc pit. We report the interesting and very seldom combination of Kranenburg's syndrome and iris-retinochoroidal-coloboma. Reattachment was achieved after vitrectomy, peeling of epiretinal membranes, laser coagulation adjacent and temporal to the optic disc and gas endotamponade. Coincidence of this syndrome with an iris-retinochoroidal-coloboma is extremely rare. Both coloboma and optic disc pit are based on closure defects during week 6 of embryogenesis.

Blood vessel extraction and optic disc removal using curvelet transform and kernel fuzzy c-means.

This paper proposes an automatic blood vessel extraction method on retinal images using matched filtering in an integrated system design platform that involves curvelet transform and kernel based fuzzy c-means. Since curvelet transform represents the lines, the edges and the curvatures very well and in compact form (by less number of coefficients) compared to other multi-resolution techniques, this paper uses curvelet transform for enhancement of the retinal vasculature. Matched filtering is then used to intensify the blood vessels' response which is further employed by kernel based fuzzy c-means algorithm that extracts the vessel silhouette from the background through non-linear mapping. For pathological images, in addition to matched filtering, Laplacian of Gaussian filter is also employed to distinguish the step and the ramp like signal from that of vessel structure. To test the efficacy of the proposed method, the algorithm has also been applied to images in presence of additive white Gaussian noise where the curvelet transform has been used for image denoising. Performance is evaluated on publicly available DRIVE, STARE and DIARETDB1 databases and is compared with the large number of existing blood vessel extraction methodologies. Simulation results demonstrate that the proposed method is very much efficient in detecting the long and the thick as well as the short and the thin vessels with an average accuracy of 96.16% for the DRIVE and 97.35% for the STARE database wherein the existing methods fail to extract the tiny and the thin vessels.

Retinal nerve fiber layer thickness analysis in cases of papilledema using optical coherence tomography ­ A case control study.

BACKGROUND: Papilledema is defined as an optic disk swelling that is secondary to elevated intracranial pressure. Early diagnosis of papilledema can help in early intervention thus preventing visual loss and even death. Optical coherence tomography (OCT) is a non-invasive imaging technique which can detect and quantify diffuse thickening of the retinal nerve fiber layer (RNFL) in eyes with optic disk edema. AIMS: To assess the difference in the RNFL thickness in patients with papilledema from controls using OCT and to correlate the RNFL thickness with the degree of papilledema. SETTING AND DESIGN: A case control study was conducted from August 2011 to July 2013 in a tertiary care medical college of south India. METHODS AND MATERIALS: All adult patients diagnosed or suspected to have papilledema were included in the study. Disk photographs were graded according to modified Frisen criteria. Fast RNFL protocol on time-domain OCT was used. Cases and controls were compared. STATISTICAL ANALYSIS: RNFL thickness was compared using an independent samples t-test. Correlation between RNFL thickness and modified Frisen scale of papilledema was done using Spearman correlation. GraphPad InStat 3 version was used. RESULTS: A total of 100 cases and 126 controls were studied. Statistically significant thickening of retinal nerve fiber layer (RNFL) was seen in all quadrants in patients with papilledema as compared to controls. A positive correlation was found between Frisen grading of papilledema RNFL thickness measurements. CONCLUSIONS: RNFL thickening was mainly in the inferior and superior peripapillary region and was greater in higher grades of papilledema. A strong positive correlation was found between RNFL thickness and the Frisen scale for grading of papilledema. OCT can be included as a routine non-invasive quantitative tool for detection of early papilledema.

Measurement of ocular torsion variation following superior oblique tenectomy / Medida da variação da torção ocular após a tenectomia do oblíquo superior

Purposes: To objectively evaluate the torsional effect of the superior oblique muscle-weakening surgery using the tenectomy technique proposed by Souza-Dias. Methods: The present prospective study included 10 patients (20 eyes) with horizontal strabismus, bilateral superior oblique overaction and A-pattern of 15 to 30 prism diopters who underwent superior oblique tenectomy. Objective assessment of ocular torsion was performed by retinography immediately before and one month after surgery. The amount of ocular torsion was determined by measuring the angle formed by a horizontal line drawn across the geometric center of the optic disc and a second line connecting this point to the fovea. Results: The median preoperative angle was 5.56° in the right eyes and -3.43° in the left eyes. The median postoperative angle was 1.84° in the right eyes and -3.12° in the left eyes. The angle variation was statistically significant in both eyes (p=0.012 and p=0.01, respectively). Conclusion: The present study suggests that superior oblique tenectomy has an extorter effect, decreasing the intorsion detected on overaction of this muscle. .

Objetivo: Avaliar, de forma objetiva, a torção ocular após a tenectomia do oblíquo superior, proposta por Souza-Dias. Métodos: Estudo prospectivo de dez pacientes (20 olhos) com estrabismo horizontal, hiperfunção bilateral dos oblíquos anisotropia em A de 15 a 30 dioptrias prismáticas, submetidos à tenectomia bilateral dos oblíquos superiores. A avaliação objetiva da torção foi realizada com a retinografia antes e após a cirurgia, determinando-se o ângulo de torção formado entre a linha horizontal que passa pelo centro do disco óptico e a linha que passa pelo centro da fóvea. Resultados: A mediana dos ângulos de torção pré-operatória foi de 5,56° nos olhos direitos e de 3,43° nos esquerdos. Após a cirurgia, o ângulo mediano foi de 1,84° nos olhos direitos e de -3,12° nos esquerdos. Em ambos os olhos, a variação absoluta foi estatisticamente significativa (p=0,012/p=0,01). Conclusões: O presente estudo demonstrou que a tenectomia do oblíquo superior tem ação extorsora, reduzindo de forma significante a intorção encontrada nos casos de hiperfunção deste músculo. .

Measurement of ocular torsion variation following superior oblique tenectomy.

PURPOSES: To objectively evaluate the torsional effect of the superior oblique muscle-weakening surgery using the tenectomy technique proposed by Souza-Dias. METHODS: The present prospective study included 10 patients (20 eyes) with horizontal strabismus, bilateral superior oblique overaction and A-pattern of 15 to 30 prism diopters who underwent superior oblique tenectomy. Objective assessment of ocular torsion was performed by retinography immediately before and one month after surgery. The amount of ocular torsion was determined by measuring the angle formed by a horizontal line drawn across the geometric center of the optic disc and a second line connecting this point to the fovea. RESULTS: The median preoperative angle was 5.56° in the right eyes and -3.43° in the left eyes. The median postoperative angle was 1.84° in the right eyes and -3.12° in the left eyes. The angle variation was statistically significant in both eyes (p=0.012 and p=0.01, respectively). CONCLUSION: The present study suggests that superior oblique tenectomy has an extorter effect, decreasing the intorsion detected on overaction of this muscle.

Macular slippage after macular hole surgery with internal limiting membrane peeling.

PURPOSE: To describe macular slippage toward the optic disc after macular hole surgery with internal limiting membrane (ILM) peeling. MATERIALS AND METHODS: A total of 27 eyes of 27 patients with idiopathic macular hole were included in this retrospective study. The fovea-to-disc distance (FDD) was measured from digital color fundus images before and at least six months after surgery. The position of the fovea was determined as the center of the macular hole before surgery and the center of the macular pigment area after surgery. The thickness of the nasal and temporal macula was measured using spectral-domain optical coherence tomography. The difference in thickness between the nasal and temporal macula was determined as the degree of parafoveal asymmetry (PFA). RESULTS: The postoperative FDD was significantly shorter than the preoperative FDD: 4.00 ± 0.33 mm and 3.82 ± 0.34 mm, respectively (p < 0.0001). The mean decreased ratio of FDD was 4.68% (range, 0.38-9.24%). The appearance of the dissociated optic nerve fiber layer (DONFL) was finally found in 21 eyes (78%). The decreased FDD ratio was significantly larger in eyes with the DONFL appearance than in those without it: 5.61 ± 1.74% and 1.44 ± 1.12%, respectively (p < 0.0001). The decreased ratio of FDD was correlated with the postoperative PFA (r = 0.63, p = 0.0004). CONCLUSION: A macula in which the ILM has peeled off would slip toward the optic disc after macular hole surgery. Macular slippage can be a reasonable cause for the macular alterations such as an appearance of DONFL and changes in asymmetrical parafoveal thickness.

The inner diameter of the optic disc pit decreases with pars plana vitrectomy.

To report a patient with optic disc pit who showed decreased inner diameter of the optic disc pit along with resolution of recurrent macular detachment after pars plana vitrectomy. Pneumatic retinopexy and peripapillary laser photocoagulation was performed in a 28-year-old female with optic disc pit and serous macular detachment. Two months after the initial therapy, serous macular detachment recurred. Then, pars plana vitrectomy with removal of the posterior hyaloid was performed, and intraocular perfluoro-octane (C3F8) tamponade was used. Fundus photography and ocular coherence tomography were obtained at each visit. The patient was followed up for 1 year. Visual acuity was 20/400 (Snellen) at first presentation, improved to 20/40 at 2 weeks after pneumatic retinopexy and peripapillary laser treatment. Then, 2 months later visual acuity decreased to 20/200, improved to 20/40 at 2 weeks after the vitreoretinal surgery, and stayed stable during the 1-year follow-up. It was also noticed on clinical examinations as well as fundus photographs that the inner diameter of the optic disc pit had decreased significantly. Vitreous traction plays an important role in the formation of serous macular detachments with optic disc pits. In these patients, pars plana vitrectomy and posterior hyaloid removal may be an effective treatment for reduction of the inner diameter of the optic pit and resolution of the serous macular detachments.

[Posterior approach for foreign body removal from optic nerve head. Case report].

A technique of foreign body removal from optic nerve head performing an external approach and optic nerve transection is described. After 3 months of follow-up cosmetic result is satisfactory and there are no surgery related complications.