Importance of subfoveal fluid height on visual outcome in macula-off retinal detachments.

AIMS: To investigate the effect of subfoveal fluid height (SFFH) on visual outcome after macula-off retinal detachment (RD) repair. METHODS: Prospective interventional case series of consecutive patients undergoing pars plana vitrectomy with gas tamponade (PPV) for primary macula-off RD with duration of symptomatic loss of central vision (LCV) of ≤1 week. Preoperative SFFH was measured on two occasions an hour apart using optical coherence tomography (OCT) by two independent observers. Postoperative best corrected visual acuity (BCVA) was measured at 3 months. RESULTS: Sixty-one patients were included. All patients were pseudophakic after RD repair. The mean preoperative and postoperative BCVA (logarithm of the minimum angle of resolution) at 3 months was 1.41 (±0.71) and 0.15 (±0.12, range 0.00-0.70). Twenty-six patients with SFFH of ≤1500 µm were available for repeat OCT measurements. The variation in SFFH was proportional to the SFFH and showed a logarithmic (base 2) association (r=0.50, p=0.01). Patients were therefore grouped according to their SFFH as group 1: 1-100 µm, group 2: 101-300 µm, group 3: 301-700 µm, group 4: 701-1500 µm and group 5: 1501-3100 µm. BCVA at 3 months significantly reduced with increasing SFFH from 0.04 (±0.03) in group 1 to 0.28 (±0.15) in group 5 (p<0.001) but was not associated with age (p=0.77), preoperative BCVA (p=0.39), duration of LCV (p=0.63) or use of perfluorocarbon liquids (p=0.88). Forty-five patients had SFFH ≤1500 µm and achieved 0.10 (±0.07, range 0.00-0.30) logMAR. CONCLUSION: Visual acuity following PPV for macula-off RD is related to preoperative SFFH regardless of the duration of symptomatic LCV within the first week.

Defining a Cutoff for Progression of Macular Holes.

Purpose: The purpose of this study was to determine a cutoff for progression of idiopathic full-thickness macular hole (MH) size. Methods: Retrospective analysis of consecutive patients waiting 4 weeks for MH surgery. Two observers performed 3 repeat sets of MH size measurements on optical coherence tomography (OCT) high-density radial scans taken at first presentation and 4 weeks later before surgery. Primary outcome was the definition of a cutoff for true enlargement of MH size versus measurement error. Secondary outcomes were risk factors for change in minimum linear diameter (MLD) size and best-corrected visual acuity (BCVA). Results: Fifty-one patients were included with a mean MH size of 334 µm (±179 µm; range 39 to 793 µm). The cutoff for an increase in MLD size calculated as the outer confidence limit for the 99.73% limits of agreement was 31 µm. This was independent of MH size. Using this cutoff, MLD size increased in 9/34 (26.5%) of patients without and in 14 of 17 (82.4%) of patients with vitreomacular traction (VMT; P < 0.001). Mean BCVA deteriorated in patients in whom the MH had progressed from 0.62 (±0.23) logMAR to 0.82 (±0.29; P < 0.001), whereas there was no significant change in BCVA in patients without MH progression (P = 0.25). In 31% (16/51) of patients, classification of their MHs (small ≤250 µm, medium 251-400 µm, and large >400 µm) changed over the 4-week period. Conclusions: Using a cutoff discriminates change from measurement error. A significant proportion of MHs progressed by 4 weeks, particularly in the presence of VMT. Translational Relevance: The established cutoff enables clinicians to differentiate true MH enlargement from measurement error.

Repeatability and Reproducibility of Macular Hole Size Measurements Using Optical Coherence Tomography.

The purpose of this study was to assess the repeatability and reproducibility of measuring the minimum linear diameter (MLD) of macular holes (MHs) using horizontal linear and radial scan modes in optical coherence tomography (OCT). Patients with concurrent sets of radial and horizontal linear OCT volume scans were included. The MLD was measured twice in both scan modes by six raters of three different experience levels (groups). Outcome measures were the reliability and repeatability of MLD measurements. Fifty patients were included. Mean MLD was 317.21(±170.63) µm in horizontal linear and 364.52 (±161.71) µm in radial mode, a difference of 47.31 (±26.48) µm (p < 0.001). In the radial scan mode, MLD was identified within 15° of the horizontal meridian in 27% and within 15° of the vertical meridian in 26.7%, with the remainder (46.3%) in oblique meridians. The intra-group coefficients of repeatability (CR) for horizontal linear mode were 23 µm, 33 µm and 45 µm, and for radial mode 25 µm, 44 µm and 57 µm for groups 1, 2 and 3, respectively. The inter-group CR, taking group 1 as reference standard for groups 2 and 3, were 74 µm and 71 µm for the linear mode, and 62 µm and 78 µm for radial mode. The radial mode provides good repeatability and reliability for measurement of MLD. In a majority of cases the MLD does not lie in the horizontal meridian and would be underestimated using a horizontal OCT mode.

Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris-Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT).

INTRODUCTION: While proven to be an effective treatment for cystoid macular edema (CME) and diabetic macular edema, intravitreal steroid implants (IVSI) may cause undesirable side effects, including steroid-related glaucoma or migration into the anterior chamber in the case of iris-lens diaphragm disruption. Here we present a new surgical technique that allows for the easy implantation and subsequent fixation of the fluocinolone acetonide intravitreal implant without the risk of migration as a feasible and possibly reversible approach in the treatment of persistent CME in severely damaged eyes. METHODS: In this single-center, prospective off-label, proof of principle, scleral fixation of the fluocinolone implant was performed in two eyes with disrupted anterior-posterior segment border and persistent CME. Both eyes were then followed monthly in accordance to a detailed protocol. RESULTS: The procedure was overall well tolerated without severe side effects. There was no migration of the implant in the anterior chamber in either eye. CONCLUSION: Scleral fixation of the fluocinolone implant proved to be a safe and feasible approach in eyes with persistent CME and disrupted anterior-posterior segment border. This new technique also allows for the possible removal of the implant and may therefore be suitable even for eyes at higher risk for side effects, such as glaucoma.