Clinical characteristics of full thickness macular holes that closed without surgery.

PURPOSE: To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH). METHODS: Retrospective collaborative study of FTMH that closed without surgical intervention. RESULTS: A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 µm in size and 24.7 for more than 200 µm. CONCLUSION: Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 µm.

Successful Treatment of a Retinal Detachment Secondary to Multiple Eccentric Macular Holes With Autologous Lens Capsular Flap Transplantation.

The authors report a case of a retinal detachment secondary to multiple eccentric macular holes (MEMHs) following an uneventful pars plana vitrectomy and epiretinal membrane peel, successfully treated by autologous lens capsule graft. Anatomical and functional changes were also evaluated. Autologous lens capsule graft is a safe and effective treatment for MEMHs that may improve anatomical and functional results. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:901-903.].

Visual outcome and complications of cataract extraction after pars plana vitrectomy.

PURPOSE: To evaluate the visual outcomes and complications of phacoemulsification in previously vitrectomized eyes. PATIENTS AND METHODS: A retrospective analysis of 87 consecutive vitrectomized eyes (87 patients) which had undergone phacoemulsification with intraocular lens implantation between 2013 and 2016. RESULTS: The mean interval from pars plana vitrectomy (PPV) to cataract surgery (CS) was 18.8 months. Mean age at CS was 61.5 years. Intraoperative complications included anterior rhexis tear (1 eye) and hyphema (1 eye). Postoperative complications included macular edema (17.2%, mean 42 days), posterior capsule opacification (13.8%, mean 14 months), ocular hypertension (11.5%), and anterior uveitis (1.1%). Preoperative mean best-corrected visual acuity improved from 20/50 to 20/25. Ninety-one percent of the eyes gained 2 or more lines, and 95% achieved visual acuity ≥20/40 after CS. Preoperative mean spherical equivalent improved from -4.35 to -0.17. Eyes with clear lens prior to the PPV had later CS (clear lens 27.1 vs no clear lens 9.7 months; p=0.016). Patients >55 years with clear lens at PPV (n=21) had earlier CS than younger ones with clear lens (n=24) (11.8 vs 40.5 months; p=0.033). Mean follow-up was 14.5 months. CONCLUSION: Phacoemulsification is a safe procedure in vitrectomized eyes, with substantial gains in vision in most cases. Patients of advanced age and eyes without clear lens prior to the PPV had earlier CS.