Spontaneous resolution of a full thickness idiopathic macular hole: fundus autofluorescence and OCT imaging.

BACKGROUND: To report on the spontaneous closure of a full thickness juxtafoveolar idiopathic macular hole (IMH) monitored with fundus autofluorescence (AF) as well as optical coherence tomography (OCT) imaging. METHODS: Observational case report. Fundus Autofluorescence with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT imaging were used to monitor the spontaneous evolution of a stage II IMH. RESULTS: A 70 year-old woman with unremarkable ocular history received a diagnosis of idiopathic macular hole in the left eye. Bright autofluorescence corresponding to the IMH was documented with the confocal SLO and OCT imaging could confirm the presence of an hour glass shaped full thickness juxtafoveolar IMH. Biomicroscopy revealed no posterior vitreous detachment (PVD). Few months later clinical examination demonstrated the presence of typical symptoms and signs of PVD (miodesopsias and Weiss ring). The bright autofluorescence corresponding to the IMH disappeared and OCT imaging documented a normal fovea in morphology and thickness. CONCLUSIONS: Spontaneous closure of full thickness juxtafoveolar IMH can occur and may be properly monitored with fundus AF as well as OCT imaging.

Peribulbar and retrobulbar combined anesthesia for vitreoretinal surgery using ropivacaine.

PURPOSE: To evaluate the efficacy and clinical effects of local retrobulbar anesthesia using ropivacaine in vitreoretinal surgery. METHODS: Prospective study. A total of 919 vitreoretinal operations were followed. The operations were divided into three groups, depending on the degree of anesthesia needed. Group A: Vitrectomies with episcleral procedures (208 vitrectomies for detached retina or perforating trauma). Group B: Episcleral procedures only (410 operations for detached retina without vitrectomy). Group C: Vitrectomies without episcleral surgery (301 operations for macular pucker or hole, proliferative diabetic retinopathy, or silicone oil removal). Anesthesia was administered using a 23-gauge Atkinson-type retrobulbar needle, after topical anesthesia. Six mL of the solution containing 7.5 mg ropivacaine/mL were injected into the peribulbar space, and the other 4 mL deeper, into the retrobulbar space. The degree of infiltration of the palpebral region, the motor block in the extrinsic ocular muscles, and pain felt were checked and rated. RESULTS: Swelling of lids was seen in 885 patients (96%); in 21 (2%) swelling was partial. In 13 patients (1%) there were no signs of infiltration. The motor block was total in 801 (87%) eyes, while 118 (12%) had reduced ocular movements. The degree of anesthesia was as follows, considering the three groups together: no pain = 855 (93%) patients; moderate pain = 44 (4%) patients; very strong pain = 20 (2%) patients. No adverse events or side effects were observed. CONCLUSIONS: Ropivacaine used for retrobulbar-peribulbar combined anesthesia in vitreoretinal surgery showed excellent clinical efficacy as regards analgesia and muscle akinesia.