Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Vitreoretinal interface in central serous choroidopathy: a retrospective case-control study.

PURPOSE: To investigate the frequency and patterns of vitreoretinal adherence in central serous choroidopathy (CSC) using spectral domain optical coherence tomography (SD-OCT) imaging and compare them with normal subject. METHODS: A descriptive observational analytical retrospective case-control study. The study patients were split into non-chronic and chronic CSC groups and compared with an age- and gender-matched control group composed of healthy individuals without CSC. Five patterns of vitreoretinal adherence were defined: lacunae, partial posterior vitreous detachment (partial-PVD), epiretinal membrane (ERM), focal vitreomacular adherence (VMA) and no recognizable pattern. Statistical analysis was performed. RESULTS: One hundred and four eyes of 52 patients were included in this study. Forty-eight eyes of 24 patients had chronic CSC and 56 eyes of 28 patients had non-chronic CSC. The control group for chronic CSC included 96 normal eyes of 48 subjects, and the control group for non-chronic CSC included one hundred and twelve normal eyes of 56 subjects. We found a recognizable pattern of the vitreoretinal interface (lacuna, partial-PPV, VMA or ERM) more often in non-chronic CSC (p = 0.0001, OR = 6.51 and CI = 2.71-15.62) and in chronic CSC patients (p = 0.001, OR = 4.05, CI: 1.77-9.57) than in normal subjects. CONCLUSION: The proportion of patterns of vitreoretinal adherence and interface found in CSC changes with age and manifests differently compared with normal eyes. The results indicate early changes in CSC patients younger than 40 years of old bilaterally.

A patient with pantothenate kinase-associated neurodegeneration and supranuclear gaze palsy.

Pantothenate kinase-associated neurodegeneration (PKAN) is a genetic disease with childhood onset characterized clinically by dystonia, parkinsonism, pyramidal signs, visual failure and mental retardation. Progression is usually relentless culminating in severe disability and death within 15 years of onset. Eye movement abnormalities have been described in patients with PKAN including slowed vertical saccades and saccadic vertical pursuit. We here report a patient with PKAN and supranuclear gaze palsy broadening the phenotypic spectrum of the disease.

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment.

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. METHODS: A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. RESULTS: The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). CONCLUSION: Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.