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PubMed2006

Penetration of topically applied levofloxacin 0.5% and ofloxacin 0.3% into the vitreous of the non-inflamed human eye.

BACKGROUND: The aim of the study was to evaluate the vitreous penetration of two commercially available ophthalmic fluoroquinolones: ofloxacin and levofloxacin. METHODS: This prospective, double-blind, randomized clinical trial comprised 16 patients scheduled for vitrectomy surgery of one eye for macular hole or macular pucker. The patients were randomly assigned to receive topical ofloxacin 0.3% (n=9) or levofloxacin 0.5% (n=7) the day before, one drop at noon, 4 p.m., 8 p.m. and midnight. The next morning, patients were given their assigned masked antibiotic every 5 min for four doses starting 1 h before surgery. The vitreous humour samples, at least 0.3 ml each, were collected 1 h after the administration of the last dose, at the beginning of the pars plana vitrectomy with infusion disconnected. Samples were assayed for ofloxacin and levofloxacin concentrations by a method using high-performance liquid chromatography (HPLC) coupled with single mass spectrometry with electrospray ionization RESULTS: Equal topical administration of levofloxacin yielded 2.5 times higher vitreal concentration than ofloxacin. The mean vitreous concentrations of ofloxacin and levofloxacin were 5.30+/-3.04 (SD) ng/ml and 13.09+/-5.24 ng/ml, respectively (P=0.002). CONCLUSIONS: Equal dosing with topical administration of levofloxacin 0.5% and ofloxacin 0.3% allows better penetration into the vitreous for levofloxacin, but the levels of mean concentrations of each drug did not exceed the MIC(90) or MIC(50) for most ocular pathogenic bacteria in terms of conventional endophthalmitis therapy.

Administration, Topical↗

PubMed2006

Nonarteritic anterior ischemic optic neuropathy and 'visual field defects' following vitrectomy: could they be related?

BACKGROUND: Visual field defects after uncomplicated vitrectomy have been reported but poorly explained. We describe two cases of nonarteritic anterior ischemic optic neuropathy (NAION) observed following vitrectomy. We also reviewed the literature for cases of post-vitrectomy visual field defects for evidence of optic nerve damage. METHODS: Two patients developed optic disc edema and features of an optic neuropathy after uncomplicated vitrectomy for macular hole and epiretinal membrane. A systematic literature search was conducted to obtain prior reports of visual field defects or ischemic optic neuropathy following vitrectomy. Additional studies were identified from the bibliographies of the retrieved articles. RESULTS: The incidence of visual field defects following vitrectomy has varied from 1-71% across all studies. Overall, we found 160 (14.5%) cases of unexplained visual field defects following vitrectomy out of 1,104 patients. Of these, 31 eyes (19.4%) have shown some sign of optic nerve damage following vitrectomy, including pallor in 29 eyes, relative afferent pupillary defect in eight eyes, and intrapapillary hemorrhage in two eyes. CONCLUSIONS: NAION may develop following vitrectomy. "Visual field defects" following vitrectomy are common and many of the involved eyes demonstrate evidence of optic nerve damage, some of which may have represented NAION.

Aged↗

PubMed2006

Macular hole surgery complicated by accidental massive subretinal indocyanine green, and retinal tear.

BACKGROUND: To report a case of macular hole (MH) surgery complicated by accidental massive subretinal indocyanine green (ICG), and a retinal tear through the papillomacular bundle. METHODS: A 64-year-old woman complained of one-year history of poor vision in her left eye (LE) and of one month in her right (RE). Dilated fundus examination, fluorescein angiography, and optical coherence tomography (OCT) demonstrated a bilateral full-thickness MH with cystic changes and no posterior vitreous detachment RE and a full-thickness hole with significant surrounding retinal edema and cystic changes LE. RESULTS: A vitrectomy and posterior vitreous mechanical detachment were performed to close the MH RE. Approximately 0.3 ml of 0.5% ICG was applied to stain the internal limiting membrane (ILM). The assistant surgical nurse at the beginning of the instillation pushed the ICG syringe's embolus with too much force into the vitreous cavity with a 20-gauge cannula. Subretinal ICG was accidentally introduced through the macular hole, and an iatrogenic macular retinal tear though the papillomacular bundle was created. Infusion was resumed immediately, and ICG was removed from the vitreous cavity, and the ILM was removed in a circular fashion in the usual manner. The eye was left with 14% perfluoropropane gas. Fundus examination and OCT performed after the intraocular gas was reabsorbed one month after the surgery revealed that the macular hole was completely closed with choroidal hypereflectivity due to RPE and choriocapillaris atrophy. Best-corrected visual acuity was 20/150 with a closed macular hole and ICG still present in the subretinal space seven months after surgery. CONCLUSION: Our anatomic and functional results were poor with retinal and retinal pigment epithelium (RPE) atrophy, and a visual acuity of 20/150. Subretinal ICG and contact of ICG with the RPE should be avoided, and precautions should be taken when using intravitreous ICG to stain the ILM. Further studies are necessary to determine ICG safety in vitreoretinal surgery.

Atrophy↗

PubMed2000

Visual and anatomical success with short-term macular tamponade and autologous platelet concentrate.

BACKGROUND: This study aimed to determine whether, in eyes treated for macular hole by vitrectomy and autologous platelet injection, short-term tamponade with SF6 gas was as effective as longer tamponade with C3F8 gas. METHODS: Patients in group 1 (n=31) had vitrectomy, injection of platelet concentrate, and 16% C3F8 gas/air exchange. Patients in group 2 (n=31) were similarly treated, except that 23% SF6 gas was used. Group 1 patients were required to posture prone for 2-4 weeks, group 2 for 6 days. RESULTS: All patients had 3 months' follow-up. Postoperatively, visual acuity improved faster in group 2. However, the final mean improvement in logMAR acuity was similar in both groups. Intraocular pressure (IOP) spikes occurred in 12 patients in group 2 and in 17 patients in group 1. Posterior subcapsular cataract (PSCC) occurred in 55% of cases in group 1 and in just 37% in group 2. The rate of anatomical success in group 1 was 96.7%, and in group 2, 93.5% (P=1.0). CONCLUSIONS: The combination of SF6 gas, platelet concentrate, and short-term prone posturing gave a degree of anatomical and visual success comparable to that of the group which had longer tamponade. Although no differences were statistically significant, several trends did emerge; in group 2, patients recovered visual acuity faster, had fewer IOP spikes, and there were fewer cases of PSCC formation.

Aged↗

PubMed2000

Retinal pigment epithelial tear and extensive exudative retinal detachment following blunt trauma.

BACKGROUND: A peripheral retinal pigment epithelial tear and an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane are extremely rare. A peripheral retinal pigment epithelial tear has not been reported in an eye with retinochoroidal folds after blunt ocular trauma. METHODS: Case report. RESULTS: The course of a large nasal peripheral retinal pigment epithelial tear that occurred after blunt ocular trauma in a patient with retinochoroidal folds was followed. The inferior retinal detachment caused by leakage from the denuded Bruch's membrane following the development of the tear gradually worsened. Initial treatment with cryotherapy was ineffective, but the retinal detachment eventually resolved after the patient underwent sclerectomy and sclerostomy. CONCLUSION: A large peripheral retinal pigment epithelial tear can occur in patients with retinochoroidal folds following blunt ocular trauma, and extensive retinal detachment can be induced. Sclerectomy and sclerostomy can be beneficial in patients with an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane.

Adult↗

PubMed2000

Morphological changes of retinal pigment epithelial and glial cells at the site of experimental retinal holes.

PURPOSE: To investigate morphological changes of retinal pigment epithelial (RPE) cells and glial cells in the immediate and early phases of restoration at the site of experimental retinal holes. METHODS: We made 0.2-disc-diameter retinal holes with a vitreous cutter in albino rabbit eyes. To assess very early changes of RPE cells, the eyes were enucleated at 0,1,3, and 5 h postoperatively and observed by scanning electron microscopy (SEM). At 1,5, and 7 days after surgery, eyes were enucleated and prepared in thin and ultra-thin sections for observation by light and transmission electron microscopy (TEM). RESULTS: SEM showed the surface of the RPE cells lifting a few hours after surgery at the site of the retinal holes. The tissue filling the retinal hole was amorphous and homogeneous, as viewed by light microscopy. TEM revealed that this tissue consisted of glial cell processes containing many organelles. In addition, the cytoplasm of the cells was relatively dark, while the surface of the filling tissue continued smoothly to the internal limiting membrane. These findings suggested that these cell processes were parts of Müller cells. CONCLUSION: RPE cells and glial cells assembling at the site of the retinal hole may play an important role in retinal hole closure in this experimental model. In addition, RPE cells were morphologically changed in an immediate phase of restoration.

Animals↗

PubMed2001

Autosomal dominant peripheral cystic retinal patches and non-cystic retinal tufts associated with peripapillary crescents, retinal breaks and uveitis.

PURPOSE: To characterise an Irish kindred with apparent autosomal dominant peripheral retinal lesions and peripapillary crescents associated with retinal breaks and uveitis and assess whether these findings were associated with altered homocysteine metabolism. METHODS: Family members were followed prospectively and regularly examined. Molecular genetic analysis was performed on family members to detect cystathionine beta-synthase (CBS) 307G-S and 5,10-methylenetetrahydrofolate (MTHFR) 677C-T mutations. RESULTS: Over 11 years, 25 family members in four generations were examined, none of whom had significant refractive errors. Fifteen affected individuals had peripheral cystic retinal patches and in some cases non-cystic retinal tufts, associated with peripapillary pigmentation. Mean age at first examination of affected and non-affected individuals was the same. During follow-up the fundal findings remained unchanged in the affected group and no clinical characteristics developed in the unaffected individuals. Two affected siblings had associated uveitis and rhegmatogenous retinal detachment, which were successfully treated, while a third affected individual had a pigmented retinal break not requiring treatment. Heterozygosity for the CBS 307G-S mutation did not segregate with affected individuals while the MTHFR 677C-T mutation was not detected. CONCLUSIONS: This family has previously undescribed fundal findings inherited in an apparent autosomal dominant pattern associated with retinal breaks and uveitis. There is no associated inherited alteration of homocysteine metabolism.

Adolescent↗

PubMed2000

The process of closure of experimental retinal holes in rabbit eyes.

BACKGROUND: To investigate the healing process of retinal holes, including the identification of the cell types which play an important role in the process, we created experimental retinal holes with minimal damage to retinal pigment epithelium (RPE) in rabbit eyes. METHODS: Pars plana vitrectomy was performed in the rabbit eye. A dome-shaped retinal detachment (bleb; diameter 1.5 mm) was made by injecting balanced salt solution into the subretinal space, followed by making a retinal hole (diameter 0.5 mm) in the center of the bleb with a silicone-tipped extrusion needle. In one group of rabbits, fluid-air exchange was performed and sulfur hexafluoride gas was injected into the vitreous cavity postoperatively. In another group, gas tamponade was not performed. The operated eyes were examined ophthalmoscopically and enucleated at 1, 4, 7, 14, 30, and 90 days after surgery. Tissues were prepared in 5-microm sections for hematoxylin-eosin staining and immunohistochemistry with antibodies to cytokeratin 18 and glial fibrillary acidic protein (GFAP) and examined by light microscopy. RESULTS: In the gas-injected eyes, the retinal holes were ophthalmoscopically closed by 7 days after the surgery. Microscopic examination revealed that the sensory retina around the retinal hole was reattached, and the area of retinal defect was covered with cells which were positive for cytokeratin 18 and GFAP by 7 days after the surgery. In the eyes without gas tamponade, the retinal holes did not close during the observation period. CONCLUSIONS: These findings suggest that early attachment between the sensory retina and RPE could be essential for closure of a retinal hole, where glial and RPE cells might play an important role. This model seems to be useful to investigate the process of closure of retinal holes.

Animals↗

PubMed1998

Exchange of perfluorodecalin for gas or oil: a model for avoiding slippage.

BACKGROUND: The introduction of liquid perfluorocarbons as an intraoperative tool has greatly facilitated retinal re-apposition in giant retinal tears (GRT) and relieving retinotomies (RR). Slippage of the retina can occur during the exchange of heavy liquids for oil or gas, especially if the fill of perfluorocarbons is subtotal. METHODS: We have used a model eye chamber to study the surface interactions of perfluorodecalin (PFD) with silicone oil and air to evaluate possible mechanisms of slippage. RESULTS: The results demonstrate that it is possible during a PFD/air exchange to trap a wedge of aqueous which is displaced laterally and forced posteriorly during removal of the PFD, whereas during a PFD/silicone oil exchange the remaining aqueous is displaced laterally and upwards and thus trapped above the silicone oil/PFD interface. CONCLUSIONS: We believe that during PFD/air exchange the displacement of the aqueous posteriorly can cause slippage and that this could be avoided by performing a direct PFD/silicone oil exchange.

Air↗

PubMed1998

Ultrastructure of epiretinal membranes associated with macular holes.

BACKGROUND: The role of tangential traction exerted by epiretinal membranes in the pathogenesis of macular holes is not fully understood. Furthermore, the role of glial cells in the formation and/or closure of macular holes remains to be elucidated. METHODS: To better understand the pathogenesis of macular hole formation and to compare the ultrastructural features of epiretinal membranes associated with macular holes of primary and secondary etiology, we harvested 23 translucent epiretinal membranes associated with macular holes stages III-IV at the time of pars plana vitrectomy and examined them electron microscopically. Eighteen membranes were obtained from patients with idiopathic macular holes. 3 membranes from patients with myopic macular holes and 2 epiretinal membranes were associated with macular holes which had developed after retinal detachment surgery. RESULTS: Eighteen membranes contained a continuous undulating piece of inner limiting lamina (ILL). Sixteen of 18 epiretinal membranes at the margins of idiopathic macular holes, 2 of 3 membranes in myopic macular holes and both membranes associated with a macular hole after retinal detachment surgery demonstrated mono- or multilayers of fibrous astrocytes with single macrophage- or fibrocyte-like cells. Vitreous and newly formed collagen occupied the space between the ILL and the glial cells. Three macular holes were surrounded by rather firmly attached acellular ILL. CONCLUSIONS: Glial cells and newly formed collagen may play an important role in macular hole formation by exerting tangential traction regardless of the underlying disease process. Glial cells, however, may also be involved in healing of the retinal defect and pars plana vitrectomy with peeling of an epiretinal membrane, and/or the ILL may induce directed glial cell proliferation and migration. The similar ultrastructure of epiretinal membranes associated with macular holes and "simple epiretinal membranes" as described by Foos [8] suggests a common pathogenesis for macular holes and macular pucker.

Adult↗

PubMed1998

Anomaloscope examination in macular gliosis, macular holes and central serous choroidopathy.

BACKGROUND: Surgery for macular gliosis and macular holes has become increasingly successful with regard to anatomical outcome. Assessment of the damage to the receptors by these processes is still difficult, but is important in predicting functional outcome. METHODS: Examination with the Nagel II or the Neitz OT anomaloscope was performed in 36 patients with macular gliosis, 23 patients with full-thickness macular holes and 47 patients with central serous choroidopathy. The anomaloscope matches were expressed as the quotient of anomaly. RESULTS: In macular gliosis the mid-matching point is usually 1.0; there is no pseudoprotanomaly. In macular holes the mid-matching point is 1.0 when visual acuity is 0.3 or greater; in eyes with lower visual acuity there may be signs of diminished red sensitivity, but anomaloscope examination becomes difficult. In central serous choroidopathy the mid-matching point is shifted towards red, and pseudoprotanomaly is present, even when visual acuity is normal. CONCLUSIONS: Diseases of the inner retina, in early stages, do not alter colour vision substantially, whereas diseases of the outer retina give rise to early colour vision deficiency. In macular gliosis and macular holes, anomaloscope examination enables estimation of macular receptor misalignment.

Adolescent↗

PubMed1998

Prophylactic argon laser coagulation for rhegmatogenous retinal detachment in AIDS patients with cytomegalovirus retinitis.

BACKGROUND: The incidence of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) reaches 20-45%. Despite aggressive medical treatment, rhegmatogenous retinal detachments develop in up to 30% of the affected eyes. Surgical repair is often difficult due to multiple large and hardly visible retinal holes with vitreal traction. Pars plana vitrectomy with instillation of silicone oil is the procedure of choice, giving limited functional results with anatomical reattachment. METHODS: We performed prophylactic laser coagulation in AIDS patients with medically treated CMV retinitis to prevent a progressive retinal detachment. Twenty-two quiescent CMV lesions in 22 eyes of 20 patients were treated with argon green laser coagulation. Each CMV lesion was completely surrounded with a double or triple row of laser spots (500-600 mumols; 0.2 s; gray-white lesions). RESULTS: The duration of follow-up was 2-24 months. Histopathologic evaluation was possible in two eyes of one patient. Reactivated or smoldering CMV retinitis crossed the laser scars in 11 eyes, making additional laser coagulation necessary. In four eyes retinal holes in the CMV scar tissue led to retinal detachment, which stopped at the laser scar. In three eyes the detachment is still controlled by the laser scar. In one eye, the detachment stopped at the laser scar for 6.5 months and then slowly progressed across it. There were no complications associated with our laser treatment. CONCLUSION: Prophylactic argon laser coagulation in quiescent CMV retinitis seems to reduce the rate of progressive retinal detachment with no need for vitrectomy and silicone oil tamponade.

AIDS-Related Opportunistic Infections↗

PubMed1998

Radiating retinal folds detected by scanning laser ophthalmoscopy using a diode laser in a dark-field mode in idiopathic macular holes.

BACKGROUND: The pathogenesis of idiopathic macular hole is unclear. We studied the morphologic features of idiopathic macular holes using a modification of the scanning laser ophthalmoscope (SLO). METHODS: Seventy-two eyes of 57 patients with macular hole (40 women, 17 men; age 66.1 +/- 6.4 years, mean +/- SD) were included in this study. The macular holes were classified according to the Gass classification (1988). The changes around the macular holes were recorded by SLO using both a confocal aperture with a helium-neon laser (633 nm) and a ring aperture (dark-field mode) with a diode laser (780 nm) to detect fine morphologic features. RESULTS: We successfully observed minute retinal wrinkling, i.e., radiating striae (fold type) and a dome configuration (dome type), around the macular holes using the SLO dark-field mode with a diode laser, which provides a deeper retinal image because of the longer wave-length laser and the indirect mode. A helium-neon laser with a confocal aperture sometimes failed to disclose the fine retinal wrinkles. Most of the stage 2 macular holes were of the fold type. The smaller the hole, the higher the prevalence of the fold type. As the holes progressed in size, the prevalence of the dome type increased. The radiating retinal folds disappeared after successful vitreous surgery. CONCLUSION: The SLO dark-field mode with a diode laser might be useful for clear observation of fine retinal features around macular holes. The retinal folds probably indicate the presence of traction on the macula and hence may be good markers for macular repair after vitreous surgery.

Aged↗

PubMed1998

Comparative study of incomplete posterior vitreous detachment as a risk factor for proliferative vitreoretinopathy.

BACKGROUND: Abnormal vitreoretinal relationships have recently been implicated in many vitreoretinal disorders. Sites of abnormal vitreoretinal adherences are likely to exist in eyes predisposed to rhegmatogenous retinal detachment (RD), causing either retinal tears or incomplete posterior vitreous detachment (PVD). The present study was designed in two parts to identify the risk for preoperative and postoperative proliferative vitreoretinopathy (PVR) due to incomplete PVD. METHODS: We prospectively evaluated the vitreoretinal relationships using high-resolution kinetic echography in 102 consecutive eyes of 100 patients with rhegmatogenous RD. In the first part, a case-control study was conducted to compare the vitreous status in patients with preoperative PVR (cases) with that in patients with non-PVR-complicated RD (controls). During the second part, patients with noncomplicated RD (65 eyes) who were operated on by a simple retinal attachment procedure were followed up for a mean period of 6.6 months to compare the recurrence of RD due to postoperative PVR according to their vitreous status. RESULTS: Patients with PVR on study entry had a higher prevalence of partial PVD (28 of 32 eyes, 87%) than did controls (25 of 70 eyes, 35%). The statistical significance of this difference was independent of all other variables studied. After a mean follow-up period of 6.6 months, the incidence of recurrence of RD associated with postoperative PVR was 33% in the eyes with incomplete PVD, compared with 4.9% in the eyes without incomplete PVD. CONCLUSIONS: Our results support the notion that the occurrence of incomplete PVD in RD is a significant risk factor for preoperative and postoperative PVR.

Case-Control Studies↗

PubMed1998

Temporary vitreous gas tamponade by perfluoromethylcyclopentane.

Using perfluoromethylcyclopentane (FMCP; US patent no. 5,441,989, granted 1995) we have developed a new vitreous gas tamponade in a rabbit model that allows complete filling of the vitreous cavity without vitrectomy and without a significant increase in intraocular pressure. In humans this procedure would allow the blockage of inferior and posterior retinal holes without special positioning of the patient. Perfluoromethylcyclopentane (FMCP), a liquid perfluorocarbon with a boiling point slightly above body temperature, is injected in minute volumes into the vitreous cavity, where it vaporizes, thereby filling a gas volume approximately 500 times its liquid volume. FMCP was injected into the midvitreous in six rabbits (six eyes). After 2-3 days a complete gas tamponade was achieved in three eyes. Two eyes showed 75-90% filling, and one eye was filled only 50% with gas. Intraocular pressure was highest in the completely filled eyes, ranging from 26.6 to 38.8 mmHg. In all eyes the maximum expansion of the gas bubble lasted 2 weeks. One eye developed a retinal detachment. All eyes showed transient subcapsular cataracts. The results of this study showed that intravitreal injection of FMCP, a new perfluorocarbon liquid, results in a complete gas tamponade of the vitreous cavity which lasts 2 weeks without severe intraocular pressure rise and without vitrectomy. This procedure will be especially useful for eyes that have retinal detachment from inferior or posterior retinal holes. Injection of a conventional gas such as SF6 or C3F8 usually does not block retinal holes in inferior or posterior locations without tedious positioning and risk of (transient) glaucoma. Since the mechanism of transition of FMCP from liquid to gas in the vitreous is poorly understood, we are currently studying FMCP vaporization in an in vitro eye model.

Animals↗

PubMed1999

Correlation of quantitative three-dimensional measurements of macular hole size with visual acuity after vitrectomy.

OBJECTIVE: The purpose of the study was to study the relationship of postoperative visual outcome with anatomical parameters of macular holes using confocal scanning laser tomography and to predict the postoperative visual results. DESIGN: Cohort study. INTERVENTION AND PARTICIPANTS: We evaluated the eyes of 44 patients undergoing macular hole surgery (10 men and 34 women aged 40-76 years, mean 59.1 years). All patients showed idiopathic full-thickness stage 3 macular holes. The duration of symptoms was 1-4 months (mean 2.7 months). MAIN OUTCOME MEASURES: The area, volume, mean depth, and maximum depth of the macular holes and the areas of cuff and retinal striae were measured using the Heidelberg Retina Tomograph preoperatively. RESULTS: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. Postoperative visual acuity was significantly correlated with the area (r = 0.822, P<0.0001), volume (r = 0.840, P<0.0001), mean depth (r = 0.842, P<0.0001), and maximum depth (r = 0.831, P<0.0001) of the macular holes, area of cuff (r = 0.625, P<0.0001), and area of retinal striae (r = 0.648, P<0.0001). Multiple regression analysis showed that the combination of the preoperative mean depth of macular holes and logarithm of preoperative visual acuity was the strongest predictor of the postoperative visual acuity. CONCLUSIONS: Postoperative visual results vary significantly with the size of macular holes in patients with stage 3 macular holes of duration 1-4 months. The use of the confocal scanning laser tomography may facilitate the evaluation of macular holes before surgery. Ability to predict the postoperative visual results would be helpful in treating patients with macular holes.

Adult↗

PubMed1999

Predictive value of pattern VEP, pattern ERG and hole size in macular hole surgery.

OBJECTIVE: To describe pattern-reversal visual evoked response (PRVEP) and pattern electroretinogram (PERG) parameters in eyes with macular hole and their value for predicting postoperative visual outcome. METHODS: Prospectively we studied 27 eyes (27 patients) with a full-thickness macular hole. Preoperatively the hole and rim were measured and the PRVEP and PERG were recorded. The preoperative parameters were correlated with postoperative visual outcome. RESULTS: The macular hole was closed in 26 of 27 eyes. Sixteen eyes (59%) had an increase in visual acuity (VA) of two lines or more, 10 eyes (37%) remained within one line of preoperative VA and 1 eye (4%) had a decrease in VA of two lines. Duration of symptoms was negatively correlated with preoperative VA (R=-0.547, P=0.0038) and postoperative VA (R=-0.519, P=0.0065) and positively correlated with hole area (R=0.533, P=0.0061) and rim area R=0.633, P=0.0009). Only the PRVEP P100 latency of the 10' check size and the PERG N35 latency were significantly associated with visual outcome (P=0.022 and P=0.042 respectively). CONCLUSIONS: There was no association of either hole or rim size with postoperative visual outcome. Preoperative electrophysiology, however, is useful as a prognostic tool. Utilization is limited to the use of latency parameters of the response and is dependent on the check size of the stimulus.

Aged↗

PubMed1999

The residual epiretinal membrane after vitrectomy for macular hole.

BACKGROUND: We retrospectively observed idiopathic macular holes in 63 eyes using a scanning laser ophthalmoscope, in order to study the relation between postoperative epiretinal membranes and closure of macular holes following vitrectomy. METHODS: The eyes were classified into three groups based on the degree of the postoperative epiretinal membranes. Group I consisted of 23 eyes with no epiretinal membrane remaining on the retina after vitrectomy. Group II consisted of 20 eyes in which epiretinal membranes were observed on the retina, but separate from the edge of the macular hole. Group III consisted of 20 eyes in which epiretinal membranes were observed at the edge of the macular hole. Using these three groups, we studied how postoperative epiretinal membranes were related to the closure of macular holes. RESULTS: All macular holes (100%) in groups I and II were closed following vitrectomy. In group III, 5 (25.0%) of 20 eyes had complete closure and 13 eyes (65.0%) had incomplete closure of the macular hole, while 2 eyes (10.0%) had re-opening of initially closed macular holes several months after vitrectomy. CONCLUSION: Residual postoperative epiretinal membranes at the edge of macular hole are responsible for primary failure of vitrectomy. Removal of epiretinal tissues around the macular hole is important for macular hole to be closed following vitrectomy.

Epiretinal Membrane↗