Fellow eyes in idiopathic macular hole cases.

The fellow eyes in 84 cases of unilateral idiopathic macular hole were studied retrospectively to determine prognoses and risk factors for this disorder. On initial examination, 15 of 84 eyes (18%) had a macular cystic lesion (group 1), 23 (27%) had a yellow spot in the fovea (group 2), and 46 (55%) had a normal macula (group 3). Of the 84 eyes, 58 (69%) had posterior vitreous attachment. During a mean follow up of 39 months, macular hole developed in 8 of 15 eyes (53%) in group 1, and in 6 of 23 eyes (26%) in group 2. However, a macular hole did not develop in eyes with posterior vitreous separation or a normal macula. Although the risk of developing a macular hole may have been overestimated in our study, posterior vitreous attachment and macular abnormalities may be important in predicting macular hole formation in the fellow eyes in idiopathic macular hole cases.

Comparative study of vitreoretinal relationships using biomicroscopy and ultrasound.

We prospectively studied 29 consecutive eyes with proliferative diabetic retinopathy that showed media clear enough to enable characterization of vitreoretinal relationships by biomicroscopy. Vitreoretinal relationships were also determined by contact B-scan ultrasound. With both techniques, these relationships were documented by photographs and drawings. Biomicroscopy showed complete posterior vitreous detachment (PVD) in 4 eyes (14%), partial PVD in 18 (62%), and no PVD in 7 (24%). Ultrasound examination revealed complete PVD in 4 eyes (14%), partial PVD in 19 (66%), and no PVD in 6 (21%). The results we obtained using ultrasound agreed significantly with those obtained by biomicroscopy [Cohen's kappa = 0.93, 95% confidence interval = (0.80, 1.06)]. Ultrasound detected vitreous changes more easily than biomicroscopy when mild media opacities were present and when the equatorial areas of the globe were examined. Results suggest that ultrasound is adequate to determine vitreoretinal relationships in eyes with clear media and that it is a good alternative to biomicroscopy in eyes with significant media opacities.

Posterior vitreous detachment and neovascularization in diabetic retinopathy.

The authors evaluated the effect of posterior vitreous detachment (PVD) in 172 eyes (114 patients) with nonproliferative diabetic retinopathy on the development of retinal or optic disc neovascularization. Patients were followed for more than 6 months after the initial vitreous examination (mean, 32 months). None of the patients 39 years of age or younger had PVD, but this condition became more prevalent thereafter with age. In 124 eyes of patients 40 years of age or older, neovascularization developed eventually in 20 (22%) of 93 eyes without PVD but in only 1 (3%) of 29 eyes with complete PVD (P less than 0.05). A vitreous examination was invaluable in predicting the development of retinal or optic disc neovascularization in diabetic patients 40 years of age or older.