Nonarteritic Anterior Ischemic Optic Neuropathy with an Atypical Visual Field Defect

PURPOSE@#To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) with an atypical visual field defect after intraocular surgery.CASE SUMMARY: A 61-year-old male presented with a visual field defect in his right eye 1 day after uneventful cataract surgery with pars plana vitrectomy for epiretinal membrane. His best-corrected visual acuity (BCVA) in the right eye was 20/400 with a relative afferent pupillary defect. A color vision test revealed failure only in the right eye. A slit-lamp examination revealed no abnormality in the anterior part of the eyes. A fundoscopic examination also revealed no abnormality in the posterior part of the eyes, including the optic disc. The Humphrey visual field test revealed a nasal vertical defect in the right eye. Orbital and brain magnetic resonance imaging were normal. After 14 days from the initial symptom, fundus photography and optical coherence tomography revealed an optic disc swelling and splinter hemorrhage. Fluorescein angiography revealed a delayed filling on the temporal half of the optic disc and inferotemporal peripapillary choroid. A diagnosis of NA-AION was made. The patient was treated with oral steroids and aspirin. After 3 months, the BCVA was 20/125. The visual field defect was maintained and segmental atrophy developed on the superior and inferior sides of the right optic disc.@*CONCLUSIONS@#AION may present as vertical hemianopsia. With the risk factors of ischemic optic neuropathy, the possibility of AION should be considered in the differential diagnoses of postoperative visual impairments or field defects after intraocular surgery.

Analysis of Choroidal Thickness and Vascular Density Using Optical Coherence Tomography Angiography after Laser Photocoagulation

PURPOSE: To evaluate the changes in choroidal thickness and superficial vascular density of the macula and optic disc using optical coherence tomography angiography after laser photocoagulation. METHODS: We conducted a retrospective chart review of 25 eyes of diabetic retinopathy patients who underwent panretinal photocoagulation. The macula and optic disc were divided into nine areas, and the vascular density of each area was quantitatively measured using optical coherence tomography angiography. The changes in vascular density and choroidal thickness were analyzed before laser photocoagulation and at 1 week after, 1 month after, and 3 months after treatment. RESULTS: In the panretinal photocoagulation group, the average vascular densities of the macula were 13.5 ± 3.6 mm⁻¹ before treatment, and 14.7 ± 3.1 mm⁻¹ after 1 week, 13.7 ± 2.6 mm⁻¹ after 1 month, and 12.8 ± 3.8 mm⁻¹ after 3 months of treatment. The average vascular densities of the optic disc were 14.7 ± 5.2 mm⁻¹ before treatment, and 14.1 ± 4.7 mm⁻¹ after 1 week, 14.8 ± 5.3 mm⁻¹ after 1 month, and 15.0 ± 4.7 mm⁻¹ after 3 months of treatment. The average subfoveal choroidal thicknesses were 327.5 ± 57.9 µm before treatment, and 334.4 ± 52.5 µm after 1 week, 291.2 ± 52.9 µm after 1 month, and 286.3 ± 44.4 µm after 3 months of treatment. CONCLUSIONS: The vascular density of the macula increased temporarily after 1 week of treatment but decreased afterwards. The vascular density of the optic disc decreased after 1 week of laser treatment but increased over time. The subfoveal choroidal thickness increased after 1 week of laser treatment but decreased afterwards.

The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique

PURPOSE: To describe a multi-layered inverted internal limiting membrane (ILM) flap technique and to evaluate the surgical outcomes of this surgery in patients with macular holes > 800 µm in base diameter. METHODS: The medical records of patients who received a multi-layered ILM flap technique were retrospectively studied and patients with macular holes > 800 µm were included in the analyses. Best-corrected visual acuity (BCVA) before and after surgery, preoperative hole size, hole base size, vertical size, and hole closure after surgery were checked using spectral domain optical coherence tomography. Pars plana vitrectomy was performed and the ILM was stained using indocyanine green and peeled with the base attached at the hole margin. The ILM flap was inverted over the macular hole with 2~3 layers, and gas injection was performed. RESULTS: The mean age of 12 patients was 65.2 ± 12.3 years. The mean BCVA (logMAR) was 1.27 ± 0.61. The mean hole size was 563.6 ± 221.9 µm, the mean vertical size was 418.8 ± 80.9 µm, and the mean hole base size was 1,182.8 ± 298.5 µm. The mean follow-up period was 174.4 ± 143.3 days. Nine macular holes were closed after surgery but three macular holes were not closed. The postoperative mean BCVA (logMAR) was 0.21 ± 0.51. Eight eyes showed visual improvement while three eyes did not show visual improvement after macular hole surgery. CONCLUSIONS: The macular hole was closed successfully and the visual acuity improved after the multi-layered, inverted ILM flap technique. The multi-layered, inverted ILM flap technique is therefore considered the treatment of choice for large macular holes.