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At least 631 records · Page 35Linked to original sources
PubMed2006

Incidence of fellow eye retinal detachment resulting from macular hole.

PURPOSE: To determine the incidence of retinal detachment resulting from macular hole (MHRD) in fellow eyes. DESIGN: Observational case series. METHODS: The medical records of 59 normal fellow eyes of cases with MHRD diagnosed between 1994 and 2004 at Osaka Rosai Hospital were retrospectively reviewed. Thirty-nine of the 59 fellow eyes were highly myopic. The average follow-up period was 42 months with a range of seven to 132 months. The incidence of MHRD in fellow eyes, and the interval between the onset of MHRD in the first eye and the fellow eye were determined. The Kaplan-Meier method was used to estimate the probability of the fellow eye developing MHRD at 18 months and five years, and the probability of high myopia in the development of MHRD with log-rank test. RESULTS: Five eyes (8.5%) developed MHRD during the follow-up period. All affected eyes were highly myopic, and the incidence of MHRD among the highly myopic fellow eyes was 12.8%. The average interval was 51 months. The Kaplan-Meier estimated probability of the fellow eye developing MHRD was 3.7% (0% to 8.7% for 95% confidence interval [CI]) at 18 months and 8.0% (0% to 17.7% for 95% CI) at five years. The probability of the fellow eyes with high myopia developing MHRD was significantly higher than that of eyes without high myopia (P = .0304). CONCLUSIONS: The high incidence of MHRD developing in the fellow eye indicates that the fellow eyes should be examined and followed carefully.

Aged↗
PubMed2006

Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome.

PURPOSE: To determine the natural evolution and surgical indications of myopic foveoschisis (MF), which are still poorly documented, and the factors that predict poor prognosis. DESIGN: Retrospective observational case series. METHODS: Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis. RESULTS: Mean refraction was -14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly (P = .04, Wilcoxon test), but three eyes developed a macular hole. CONCLUSIONS: MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.

Adult↗
PubMed2006

Reopening of 2 macular holes after neodymium:YAG capsulotomy.

We report 2 cases of reopening of macular holes after successful neodymium:YAG (Nd:YAG) posterior capsulotomy. Both patients had surgery for closure of macular holes with recovery of visual acuity. To our knowledge, this is the first report of recurrent macular holes after Nd:YAG laser posterior capsulotomy treated successfully with surgery.

Aged↗
PubMed2004

A novel method for determining regional visual acuity in man and its application to a case of macular hole.

A novel method is described for measuring the regional visual acuity in the vicinity of the fovea. A letter is flashed for 100 ms in one of nine positions. The size of the letters is increased or decreased systematically until the size of a letter that can be identified correctly in 75% of cases is obtained for each of the nine positions. The method has been applied to the determination of the time course of development of the acuity changes associated with a macular hole in a single case. The relationship of these changes to other changes occurring in the retina or in perception is also described. With appropriate modification the method could be applied to other parts of the retina. Some even simpler tests are also described.

Fovea Centralis↗
PubMed2004

Results of macular hole surgery with and without epiretinal dissection or internal limiting membrane removal.

PURPOSE: To evaluate the results of idiopathic macular hole surgery with or without epiretinal dissection or peeling of the internal limiting membrane (ILM). DESIGN: Retrospective consecutive nonrandomized comparative interventional trial. PARTICIPANTS: One hundred seventy-two eyes of 162 patients with previously untreated idiopathic macular holes of <24 months duration. INTERVENTION: All eyes were treated with pars plana vitrectomy by 1 surgeon using 1 of 3 techniques: no epiretinal dissection (116 eyes), epiretinal dissection (27 eyes), or ILM peeling (29 eyes). MAIN OUTCOME MEASURES: Closure of the macular hole and visual acuity. RESULTS: The macular hole was closed with 1 surgery in 92.9% of 56 eyes with epiretinal dissection/ILM peeling versus 79.3% of 116 eyes without dissection (P = 0.03) and was closed with 1 surgery in 85.1% of 27 eyes in the epiretinal dissection group compared with 100% of 29 eyes in the ILM peeling group (P = 0.05). Visual acuity improved 3 or more lines in 57.1% of 56 eyes in the epiretinal dissection/ILM peeling group compared with 38.8% of 116 eyes in the no dissection group 3 months postoperatively (P = 0.03). Visual acuity improved 3 or more lines at 3 months in the no dissection group in 32.2% of 87 eyes placed faceup for 24 hours compared with 58.6% of 29 eyes placed immediately prone postoperatively (P = 0.02). The visual and anatomic results of the no dissection and epiretinal dissection/ILM peeling groups were similar when comparing eyes in the no dissection group placed immediately prone with the epiretinal dissection/ILM peeling eyes also placed immediately prone. Visual improvement of 3 or more lines at 3 months occurred in 79.2% of 24 eyes in the epiretinal dissection group versus 44.8% of 29 eyes in the ILM peeling group (P = 0.01) in eyes with successful macular hole closure. Visual acuity results were similar in all subgroups at the final examination after reoperations. CONCLUSIONS: The faceup position for 24 hours using adjuvants reduced the initial anatomic and visual outcomes of macular hole surgery. Internal limiting membrane peeling improved the likelihood of successful macular hole closure but reduced the amount of initial visual improvement at 3 months compared with epiretinal dissection alone. Final visual acuities were similar in all groups.

Aged↗
PubMed2004

Proposed mechanism for retinal tears after LASIK: an experimental model.

OBJECTIVE: To demonstrate axial length changes associated with anterior shift of the lens/iris diaphragm and anterior vitreous base in human cadaver eyes during suction ring application preceding Moria LASIK, and to propose that these changes may be associated with anterior retinal tears. DESIGN: Human eye study. MATERIALS: Eight human eye bank eyes ranging in age from 65 to 73 years. Two eyes had a history of intraocular surgery involving cataract extraction and intraocular lens implantation. INTERVENTION: Measurements of intraocular pressure via internal manometer and Tono-Pen, anterior chamber depth, and axial length before and after application of a Moria LASIK suction ring. MAIN OUTCOME MEASURES: Change in anterior chamber depth and axial length after Moria LASIK suction ring application. RESULTS: Axial length increases (mean change = 1.125 mm, P = 0.02) after application of the suction ring, whereas anterior chamber depth shows no significant difference (mean change = -0.01 mm, P = 0.98), suggesting anterior movement of the vitreous base resulting in traction on the anterior retina. CONCLUSION: Axial length increase with anterior displacement of the vitreous base during suction ring placement might predispose susceptible eyes to anterior retinal tears during and after LASIK.

Aged↗
PubMed2004

Retinal detachment associated with macular hole in high myopia: using the vitreous anatomy to optimize the surgical approach.

PURPOSE: To evaluate the efficacy of different surgical strategies on the postoperative outcomes of retinal detachments (RDs) associated with macular holes (MHs) in high myopia. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: The study included 120 phakic, highly myopic eyes (mean degree of myopia, -22.2+/-4.80 diopters) with RDs and MHs that underwent surgical repair. The patients were divided into 2 groups. Group 1 consisted of 60 eyes with a posterior vitreous detachment (PVD). Mean preoperative visual acuity (VA) was 20/200+/-20/500. Group 2 consisted of 60 eyes with posterior vitreous schisis (PVS). The mean preoperative VA was 20/152+/-20/333. The minimum follow-up was 6 months. INTERVENTION: The surgical approach was chosen on the basis of the clinical characteristics. Twenty-five eyes of group 1 underwent pneumoretinopexy (group 1A), whereas 35 eyes of group 1 were repaired with vitrectomy (group 1B). Forty-nine eyes of group 2 underwent pars plana vitrectomy (group 2A), whereas 11 eyes of group 2 underwent scleral buckling of the macula (group 2B). MAIN OUTCOME MEASURES: Anatomic attachment of the retina and VA. RESULTS: Retinal reattachment at 6 months was achieved in 23 of 25 (92%) eyes of group 1A, 31 of 35 (88.5%) eyes of group 1B, 45 of 49 (91.8%) eyes of group 2A, and 8 of 11 (72.7%) eyes of group 2B. A significant (P<0.01) improvement of postoperative VA with respect to the preoperative values was observed in all groups. The greatest percentage improvement in postoperative VA was observed in groups 1A and 1B eyes. CONCLUSIONS: Different surgical approaches can be used to repair myopic RD associated with an MH. The choice between different surgical techniques may depend on vitreoretinal relationships, the extent of chorioretinal atrophic areas, and presence of posterior staphyloma. In our study, eyes with a PVD had significantly better visual outcomes than detachments in eyes with PVS.

Adult↗
PubMed2004

High-resolution ultrasonic imaging of the posterior segment.

PURPOSE: Conventional ophthalmic ultrasonography is performed using 10-megahertz (MHz) transducers. Our aim was to explore the use of higher frequency ultrasound to provide improved resolution of the posterior pole. DESIGN: Prospective case series. PARTICIPANTS: One normal subject and 5 subjects with pathologies affecting the posterior coats, including nevii, small melanomas, and macular hole. METHODS: We modeled the frequency-dependent attenuation of ultrasound across the eye to develop an understanding of the range of frequencies that might be practically applied for imaging of the posterior pole. We compared images of the posterior coats made at 10, 15, and 20 MHz, and 20-MHz ultrasound images of pathologies with 10-MHz ultrasound and optical coherence tomography (OCT). MAIN OUTCOME MEASURES: Ability to resolve normal and pathologic structures affecting posterior coats of the eye. RESULTS: Modeling showed that frequencies of 20 to 25 MHz might be used for posterior pole imaging. Twenty-megahertz images allowed differentiation of the retina, choroid, and sclera. In addition, at 20 MHz the retina showed banding patterns suggesting an internal structure comparable in many respects to that seen in OCT and histology. Images of ocular pathology provided much improved detail relative to 10-MHz images and deeper penetration than OCT. CONCLUSIONS: Twenty-megahertz ultrasound can be practically employed for imaging of the posterior pole of the eye, providing a 2-fold improvement in resolution relative to conventional 10-MHz instruments. Although not providing the resolution of OCT, ultrasound can be used in the presence of optical opacities and allows evaluation of deeper tissue structures.

Adult↗
PubMed2004

Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy.

PURPOSE: Neovascular glaucoma is a frequent complication of vitrectomy performed to treat proliferative diabetic retinopathy (PDR). We assessed the level of vascular endothelial growth factor (VEGF) in the vitreous fluid obtained during vitrectomy and at postoperative fluid-air exchange. METHODS: We measured VEGF levels in vitreous samples from 17 eyes of 15 patients with PDR during vitrectomy and fluid samples obtained during fluid-air exchange 5 to 36 days postoperatively. Six of the 17 eyes had iris neovascularization after vitrectomy. Vascular endothelial growth factor levels also were measured in the vitreous fluid obtained from 8 eyes with a macular hole during vitrectomy and postoperative fluid-air exchange. We measured the plasma VEGF levels in all patients. RESULTS: The mean VEGF levels in 17 eyes with PDR were 1162.3+/-173.2 pg/ml in the vitreous samples and 1180.4+/-182.8 pg/ml in the postoperative fluid samples. The mean plasma VEGF level was 116.1+/-10.2 pg/ml in eyes with PDR, and the mean plasma VEGF level was 118.5+/-15.2 pg/ml in patients with a macular hole. The mean VEGF levels were 96.9+/-11.5 pg/ml in the vitreous samples and 73.9+/-12.3 pg/ml in the fluid samples in eyes with a macular hole. CONCLUSIONS: A high VEGF level was maintained in the vitreous cavity after vitrectomy for PDR. The VEGF level in eyes with PDR was 10 times higher than that in the plasma. The results suggest that there is persistent secretion of VEGF into the vitreous cavity even after vitrectomy for PDR.

Adult↗
PubMed2004

Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular hole pathology and repair.

PURPOSE: To compare ultrahigh-resolution optical coherence tomography (UHR-OCT) technology to a standard-resolution OCT instrument for the imaging of macular hole pathology and repair; to identify situations where UHR-OCT provides additional information on disease morphology, pathogenesis, and management; and to use UHR-OCT as a baseline for improving the interpretation of the standard-resolution images. DESIGN: Observational and interventional case series. PARTICIPANTS: Twenty-nine eyes of 24 patients clinically diagnosed with macular hole in at least one eye. METHODS: A UHR-OCT system has been developed and employed in a tertiary-care ophthalmology clinic. Using a femtosecond laser as the low-coherence light source, this new UHR-OCT system can achieve an unprecedented 3-mum axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR-OCT and standard 10-mum resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the population before and after macular hole surgery. MAIN OUTCOME MEASURES: Ultrahigh- and standard-resolution cross-sectional OCT images of macular hole pathologies. RESULTS: Both UHR-OCT and standard-resolution OCT exhibited comparable performance in differentiating various stages of macular holes. The UHR-OCT provided improved imaging of finer intraretinal structures, such as the external limiting membrane and photoreceptor inner segment (IS) and outer segment (OS), and identification of the anatomy of successful surgical repair. The improved resolution of UHR-OCT enabled imaging of previously unidentified changes in photoreceptor morphology associated with macular hole pathology and postoperative repair. Visualization of the junction between the photoreceptor IS and OS was found to be an important indicator of photoreceptor integrity for both standard-resolution and UHR-OCT images. CONCLUSIONS: Ultrahigh-resolution optical coherence tomography improves the visualization of the macular hole architectural morphology. The increased resolution of UHR-OCT enables the visualization of photoreceptor morphology associated with macular holes. This promises to lead to a better understanding of the pathogenesis of macular holes, the causes of visual loss secondary to macular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh-resolution optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR-OCT images. Comparisons of UHR-OCT images with standard-resolution OCT images can establish a baseline for the better interpretation of clinical standard-resolution OCT images. The ability to visualize photoreceptors and their integrity or impairment is an indicator of macular hole progression and surgical outcome.

Aged↗
PubMed2004

Stage 0 macular holes: observations by optical coherence tomography.

OBJECTIVE: To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patients with unilateral idiopathic macular holes, and to evaluate the subsequent risk of progression to a full-thickness macular hole. DESIGN: Retrospective observational case series. PARTICIPANTS: Ninety-four patients with a unilateral stage 2, 3, or 4 full-thickness macular hole. METHODS: The medical records of patients with a unilateral macular hole diagnosed between 1994 and 2000 at the New England Eye Center were reviewed. MAIN OUTCOME MEASURE: Development of a full-thickness macular hole in the fellow eye on biomicroscopic fundoscopy or optical coherence tomography (OCT). RESULTS: In 27 (28.7%) of 94 clinically normal fellow eyes, OCT detected an abnormality of the vitreoretinal interface but normal foveal anatomy. The vitreoretinal abnormalities were further subclassified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes) based on the intensity and morphology of the OCT signal. One of the 4 (25%) severe cases progressed to a full-thickness macular hole, 4 of the 8 (50%) moderate cases became full-thickness macular holes, and no (0%) mild cases progressed to a full-thickness macular hole. Severe and moderate eyes seemed to share characteristic features on OCT that increased their risk of macular hole development (stage 0 macular hole). The macular hole-free survival at 48 months was 94% for stage 0-negative patients, versus 54% for stage 0-positive patients. Univariate analysis revealed that the presence of a stage 0 macular hole was significantly associated with an almost 6-fold increase in the risk of macular hole formation (relative risk: 5.8, 95% confidence interval: 1.16-28.61, P = 0.03). CONCLUSIONS: A stage 0 macular hole has a normal biomicroscopic appearance clinically, but has salient features on OCT as a result of oblique vitreous traction. Optical coherence tomographic findings consist of a normal foveal contour and normal retinal thickness and must include the presence of a preretinal, minimally reflective, thin band inserting obliquely on at least one side of the fovea. The presence of a stage 0 macular hole in the fellow eye is a significant risk factor for the development of a second macular hole.

Adult↗