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At least 721 records · Page 40Linked to original sources

PubMed2002

Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation.

PURPOSE: To report the ultrastructure of the internal limiting membrane (ILM) after macular hole surgery with indocyanine green (ICG) staining and to investigate an association with the postoperative functional outcome. DESIGN: Retrospective, noncomparative analysis of a consecutive case series. METHODS: Twenty eyes of 20 patients after macular hole surgery with ICG staining were included. Visual acuity and Goldmann perimetry were obtained before and after surgery. The ILM was obtained during three-port pars plana vitrectomy for idiopathic macular hole. Twenty-five milligrams of sterile ICG powder was dissolved in 5 ml of sterile water as recommended by the manufacturer and then diluted in balanced salt solution. The ultrastructure of the ILM was analyzed using light and transmission electron microscopy. Osmolarity and pH of the ICG solution were measured preoperatively. RESULTS: There was no statistically significant improvement of postoperative visual acuity after ICG-assisted peeling (P =.755). In seven patients, postoperative visual field defects occurred. Indocyanine green-stained specimens revealed cellular elements resembling the plasma membrane of Müller cells and other undetermined retinal structures adherent to the retinal side of the ILM. Histologic findings disclosed no difference between patients with and without visual field defects after the use of ICG. The osmolarity of the ICG solution applied was 275 mOsm; pH was 7.5. CONCLUSIONS: Intravitreal application of ICG may cause retinal damage by altering the cleavage plane to the innermost retinal layers. That may result in less improvement of visual acuity and unexpected visual field defects. The underlying mechanisms of action remain unclear and are the subject of ongoing investigations.

Aged↗

PubMed2002

Pathologic myopia: where are we now?.

PURPOSE: To describe current concepts and available treatments for pathologic myopia. DESIGN: Review of experimental and clinical studies. METHODS: The demography, natural history, medical and surgical treatments for choroidal neovascular membrane, vitreoretinal interface disorders and future strategies for pathologic myopia are reviewed. RESULTS: Several medical and surgical modalities are currently available to treat various complications of pathologic myopia. Macular translocation appears to stabilize or improve visual function in many eyes with choroidal neovascularization. CONCLUSION: Newer strategies are emerging to better ameliorate or prevent the complications of pathologic myopia.

Animals↗

PubMed2003

Iatrogenic punctate chorioretinopathy after internal limiting membrane peeling.

PURPOSE: To define the chorioretinal lesions created unintentionally during grasping the internal limiting membrane (ILM) with end-gripping forceps. DESIGN: Interventional case series. METHODS: A prospective review of a consecutive series of 15 patients (15 eyes) who underwent macular hole repair was performed. All patients underwent a three-port pars plana vitrectomy with ILM peeling. Fundus photographs, fluorescein angiography, and indocyanine green angiography were performed in all patients before and after surgery. RESULTS: In all eyes, small punctate barely seen chorioretinal lesions in the macular region were detected after surgery. These punctate lesions corresponded to the area where ILM was grasped with forceps. The lesions ranged from 100 to 400 microm in diameter. Their number ranged between 8 and 15 (mean, 12.6). In the early phase of fluorescein angiography, the lesions appeared hypofluorescent; in the late phase, there was slight staining of the margin of the lesions extending from the adjacent choriocapillaris, causing indistinct borders. In the early phase of indocyanine green angiogram, the lesions were hypofluorescent and in some larger lesions choroidal vessels were visible due to the thinning and atrophy of the retinal pigment epithelium and choriocapillaris. In the late phase, the homogenous hypofluorescent areas had well-delineated margins and were usually round or oval. This angiographic finding was independent of the age of the lesion, and neither enlargement of the lesions nor development of choroidal neovascularization were noted during follow-up. CONCLUSIONS: Iatrogenic punctate chorioretinopathy is the chorioretinal lesion created unintentionally during grasping the ILM with end-gripping forceps. It must be reported as one of the complications of ILM peeling. These small punctate lesions did not appear to affect the surgical outcome. However, the lesions should be followed to detect any long-term complication such as choroidal neovascularization.

Adult↗

PubMed2003

Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia.

PURPOSE: To report the prevalence of foveal retinal detachment without macular hole in a large number of highly myopic eyes using optical coherence tomography (OCT), and to clarify the demographic characteristics associated with foveal retinal detachment in these eyes. DESIGN: A consecutive, prospective, observational case series. METHODS: In 134 eyes of 78 consecutive patients with high myopia (refractive error of -8 diopters or more), we performed complete ophthalmic examinations and studied cross-sectional images of the macula with OCT. The patients were divided into two groups according to the presence (group 1, n = 78 eyes of 45 patients) or absence (group 2, n = 56 eyes of 33 patients) of posterior staphyloma. Slit-lamp examination with a Goldmann three-mirror lens indicated that none of the eyes had a macular hole. RESULTS: In seven of 78 eyes (9.0%) with posterior staphyloma (group 1), OCT revealed foveal retinal detachment. Two of the seven eyes had foveal retinoschisis. Optical coherence tomography revealed no retinal detachment or retinoschisis in any eye without posterior staphyloma (group 2). Visual acuity of the seven eyes with foveal retinal detachment ranged from 20/40 to 20/200. Two of the seven eyes had visual acuity 20/50 or better. No patients complained of recent, progressive visual impairment. All seven eyes with foveal retinal detachment had severe myopic fundus changes (focal chorioretinal atrophy or bare sclera). CONCLUSIONS: In highly myopic eyes with posterior staphyloma, the prevalence of foveal retinal detachment without macular hole was 9.0%. In eyes with this type of retinal detachment, visual acuity varies and foveal retinal detachment tends to be missed on routine examination. Periodic examination using OCT is recommended for highly myopic eyes with severe myopic degenerative changes and posterior staphyloma.

Adolescent↗

PubMed2003

Mapping posterior vitreous detachment by optical coherence tomography in eyes with idiopathic macular hole.

PURPOSE: To determine the relationship between posterior vitreous detachment and idiopathic macular hole. DESIGN: Observational case series. METHODS: In a prospective study, the posterior hyaloid face was scanned from the posterior pole to the far periphery by optical coherence tomography in 25 eyes (22 patients) with an idiopathic macular hole (stage 1 = 1, stage 2 = 7, stage 3 = 10, and stage 4 = 7), and a map of the posterior vitreous detachment was constructed. RESULTS: One eye with a stage 1 macular hole had a posterior vitreous detachment confined to the vascular arcade, but attached to the fovea. In all seven eyes at stage 2, the detached posterior hyaloid enlarged upward beyond the superior vascular arcade, but stopped at the margin of inferior vascular arcade. In two cases, the posterior vitreous detachment also extended temporally and superonasally. In all cases, the vitreous face remained attached to the fovea. Six of the 10 eyes at stage 3 had larger partial posterior vitreous detachment that extended not only upward, but also beyond the inferior vascular arcade, while in the other four eyes, the size and position of the posterior vitreous detachment was similar to stage 2 macular holes. However, unlike stage 2, the posterior vitreous detachment included the fovea in all eyes. All seven eyes with a stage 4 macular hole had complete posterior vitreous detachment that extended to the far periphery in all directions. CONCLUSION: There is a close correlation between the stage of the macular hole and the degree of posterior vitreous detachment. This close correlation suggests that progression of idiopathic macular hole is related to enlargement of the posterior vitreous detachment.

Aged↗

PubMed2003

Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery.

PURPOSE: To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery. DESIGN: Prospective consecutive series. METHODS: A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point. RESULTS: Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P <.01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P <.01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P >.05). CONCLUSIONS: Visual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery.

Aged↗

PubMed2003

Optical coherence tomographic evaluation of a surgically treated traumatic macular hole secondary to Nd:YAG laser injury.

PURPOSE: To report the importance of optical coherence tomographic (OCT) evaluation of a macular hole caused by neodymium:yttrium-aluminum-garnet (Nd:YAG) laser injury. DESIGN: Observational case report. METHODS: A 33-year-old man presented with an accidental Nd:YAG laser-induced macular hole in his right eye. After observing the course of the macular hole by OCT, the macular hole was treated by standard pars plana vitrectomy. The appearance of the macular hole was also followed up postoperatively. RESULTS: Seven days after the injury, OCT showed a full-thickness macular hole without a fluid-cuff or swelling of the surrounding retina. Twenty-one days after the injury, however, OCT disclosed that the retina around the macular hole was swollen. After vitrectomy, OCT showed that the macular hole was closed, and the visual acuity improved from 20/30 to 20/20. CONCLUSIONS: Surgical treatment can improve the visual function of eyes with a Nd:YAG laser-induced macular hole. Optical coherence tomography is valuable in providing precise information about the condition of the macula.

Adult↗

PubMed2003

Macular hole formation following ruptured retinal arterial macroaneurysm.

PURPOSE: To report four cases of macular hole formation following ruptured retinal arterial macroaneurysm. DESIGN: Case-control study. METHODS: Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm. Macroaneurysms were confirmed using either fluorescein angiography or indocyanine green angiography or both that indicated a telangiectatic retinal vascular change. Clinical data of patients with macroaneurysm with and without macular hole (MH) formation were compared retrospectively. RESULTS: Of 75 eyes, four (5.3%; four patients) with macroaneurysm had a macular hole. In one of the four eyes, a macular hole was detected 2 days after the rupture. The distance from the macroaneurysm to the center of the fovea was significantly closer in the four eyes with a macular hole (MH group, 1.1 +/- 0.4 (mean +/- standard deviation [SD]) disk diameter) than in the 71 eyes without a macular hole (non-MH group, 1.9 +/- 0.9 disk diameter) (P =.0196). The incidence of subretinal hemorrhage in the macula was significantly greater in the MH group (100%) than in the non-MH group (35.2%) (P =.0195). CONCLUSIONS: Macular hole formation associated with ruptured macroaneurysm is not as uncommon as previously thought. We suggest that there might be early onset of macular hole formation following ruptured macroaneurysm. Macroaneurysms with early-onset macular hole are present near the center of the macula and are accompanied by subretinal hemorrhage in the macula.

Aged↗

PubMed2003

Retinal tear and detachment after transpupillary thermotherapy for choroidal melanoma.

PURPOSE: To report a side effect of transpupillary thermotherapy for choroidal melanoma. DESIGN: Small case series. METHODS: Review of clinical charts and photographs in a private retina practice. RESULTS: Retinal tears developed in two patients after transpupillary thermotherapy for choroidal melanoma. In one patient a secondary rhegmatogenous retinal detachment developed. CONCLUSIONS: Transpupillary thermotherapy can result in vitreous traction on the retina over the choroidal tumor, which can lead to a retinal tear and to retinal detachment. Patients should be warned about this possibility and advised to be examined should photopsias or new floaters develop after treatment.

Aged↗

PubMed2003

Internal limiting membrane staining with various concentrations of indocyanine green dye under air in macular surgeries.

PURPOSE: To determine the effective minimal concentration of indocyanine green (ICG) for staining the internal limiting membrane (ILM) under air in macular surgeries and to report the clinical outcome of these patients. DESIGN: Prospective, randomized clinical trial. METHODS: Consecutive cases of macular hole (17 cases) and epiretinal membrane (ERM) (11 cases) undergoing primary surgery with ICG-stained ILM peeling were randomized to receive one of the three concentrations (mg/ml) of ICG (1): 0.25, (2) 0.5, and (3) 1.25. The number of ICG injections, visual quality of the stained ILM, and time used for ILM peeling were recorded. Internal limiting membrane specimens were subsequently examined under electron microscopy. Preoperative and postoperative clinical data with fluorescein angiography were recorded. RESULTS: There was a significantly smaller number of eyes with poor ILM staining in the 1.25-mg/ml group compared with the 0.25- to 0.5-mg/ml group (Fisher exact test, P =.04). The mean time required for ILM peeling was 4.2 minutes (range, 2.0-8.1 minutes). There was no significant difference in the time required for ILM peeling among the three concentration groups (one-way analysis of variance, P =.18) or between the macular hole and ERM group (two-tailed t test, P =.34). No ICG toxicity was found clinically or angiographically, except in one suspected case with ERM formation at the edge of ILM peeling. Electron microscopy of ILM specimens did not reveal any retinal elements. CONCLUSIONS: 1.25-mg/ml ICG under air stains the macular ILM consistently well for its removal in macular surgeries. The safety of ICG-stained ILM peeling needs further evaluation.

Adult↗

PubMed2003

Removal of the internal limiting membrane under perfluorocarbon liquid to treat macular-hole-associated retinal detachment.

PURPOSE: To demonstrate the advantages and efficacy of internal limiting membrane removal under perfluorocarbon liquid in macular-hole-associated retinal detachment. DESIGN: Interventional case series. METHOD: Four patients with macular-hole-associated retinal detachment underwent pars plana vitrectomy, retinal reattachment with endodrainage through the macular hole, perfluoro-n-octane injection to seal the macular hole, indocyanine green injection under the perfluoro-n-octane bubble and removal of the indocyanine green-stained internal limiting membrane. Visual acuity and anatomic results were recorded, with a mean follow-up period of 18 months. RESULTS: Postoperatively, the retina was reattached in all four patients and closure of the macular hole was achieved in three eyes. Visual acuity improved in all eyes. CONCLUSIONS: In retinal detachment resulting from macular hole, staining of the internal limiting membrane with indocyanine green injected under perfluoro-n-octane can facilitate peeling of the membrane without exertion of excessive retinal traction and may prevent passage of indocyanine green into the subretinal space.

Aged↗

PubMed2003

Ruptured retinal arterial macroaneurysm associated with a stage IV macular hole.

PURPOSE: To report a case of stage IV macular hole associated with ruptured retinal arterial macroaneurysm. DESIGN: Observational case report. METHOD: The patient's clinical, angiographic, and ophthalmic coherent tomography data were reviewed. RESULTS: A stage IV macular hole was observed in association with a ruptured retinal arterial macroaneurysm in a 79-year-old patient. After vitrectomy surgery, the macular hole closed and vision improved from counting fingers to 20/100. CONCLUSIONS: Macular hole associated with ruptured retinal macroaneurysm can be closed successfully to result in improved vision.

Aged↗

PubMed2003

Trypan blue-assisted peeling of the internal limiting membrane during macular hole surgery.

PURPOSE: To evaluate the outcome of surgeries for macular holes using trypan blue to facilitate delamination of the internal limiting membrane. DESIGN: A retrospective series of 18 patients. METHOD: All patients underwent a three-port pars plana vitrectomy with internal limiting membrane delamination using trypan blue 0.06% to assist visualization. The main outcome measures were postoperative visual acuity and clinically evident retinal pigment epithelial changes. RESULTS: The median preoperative visual acuity was 20/200, and the median postoperative visual acuity was 20/70. All but one macular hole were closed after surgery (94%). At the last recorded follow-up, 10 patients (56%) had improved visual acuity of at least two chart lines. No adverse reaction related to trypan blue was observed up to 1 year postsurgery. CONCLUSIONS: Trypan blue staining of internal limiting membrane may accomplish more complete dissections of the internal limiting membrane and better surgical and visual outcomes.

Adolescent↗

PubMed2003

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery.

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.

Aged↗

PubMed2003

Spontaneous closure of stage 2 macular hole observed with optical coherence tomography.

PURPOSE: To report the clinical course and images of optical coherence tomography of an eye with a stage 2 macular hole which closed spontaneously. DESIGN: Observational case report. METHODS: Serial optical coherence tomographic images were obtained. RESULTS: A 67-year-old woman received a diagnosis of stage 2 idiopathic macular hole in her right eye. The diagnosis was made with a tomographic image of a full-thickness dehiscence of the neurosensory retina at the fovea. The posterior hyaloid membrane was adhering to the edge of the dehiscence. Four weeks later, the closure of the macular hole was ascertained with optical coherence tomography. The posterior hyaloid membrane was fully separated from the fovea. CONCLUSION: A stage 2 macular hole may close spontaneously with the separation of the hyaloid membrane.

Aged↗

PubMed2003

Retention of dye after indocyanine Green-assisted internal limiting membrane peeling.

PURPOSE: To describe the long-term retention of indocyanine green (ICG) in the fundus after ICG-assisted internal limiting membrane peeling. DESIGN: Case report. Two patients underwent vitrectomy including ICG-assisted internal limiting membrane peeling. The fundus was examined with a 780-nm infrared illumination of a scanning laser ophthalmoscope after surgery. RESULTS: No ICG staining of the fundus was visible ophthalmoscopically. Examination with a scanning laser ophthalmoscope, however, detected fluorescence from residual ICG until 6 months after surgery in case 1 and 9 months in case 2. No complication related to the residual ICG was observed. CONCLUSIONS: The results suggested that ICG remains in the fundus for a long period after surgery. Clearance of the dye from the diabetic retina may be prolonged.

Aged↗

PubMed2003

Persistent indocyanine green fluorescence after vitrectomy for macular hole.

PURPOSE: To evaluate the persistence of indocyanine green (ICG) autofluorescence after ICG-assisted internal limiting membrane peeling for macular hole surgery. DESIGN: Interventional case series. METHODS: Retrospective institutional study. Four eyes of four patients who underwent pars plana vitrectomy with ICG-assisted internal limiting membrane peeling for macular hole repair were imaged for ICG autofluorescence at 795 nm with a scanning laser ophthalmoscope. The main outcome measure was persistence of ICG autofluorescence. RESULTS: All four patients demonstrated persistent ICG fluorescence in the central macula up to 8 months postsurgery. CONCLUSIONS: Persistent ICG signal was noted in the macula months after vitrectomy for macular hole surgery. The persistence of ICG autofluorescence could be responsible for delayed photochemical damage to the retinal pigment epithelium. Further studies must quantify the risk of retinal pigment epithelium injury when ICG-assisted internal limiting membrane peeling is used in macular hole surgery.

Aged↗

PubMed2003

Observation of idiopathic full-thickness macular hole closure in early postoperative period as evaluated by optical coherence tomography.

PURPOSE: To report the optical coherence tomography (OCT)-determined progressive changes in a macular hole (MH) following vitreous surgery with a gas tamponade. Observational case report. METHODS: A 60-year-old woman with an idiopathic full-thickness MH (Gass, Stage 2) in the left eye underwent vitreous surgery with a gas tamponade. The progressive closure of the MH was followed by OCT because an unplanned decrease of the gas tamponade made the macula accessible to OCT examination. RESULTS: On day 1, the tissue surrounding the MH extended into the center, and on day 2, the subretinal fluid and foveal cysts decreased and the retinal separation was reduced. On the third postoperative day, the MH was closed and the foveal contour was similar to that of normal retinas. CONCLUSION: These results demonstrated that a small MH appears to be closed by 3 days after vitrectomy with gas tamponade. Although we cannot generalize to all sizes of MH, our findings suggest that small MHs are closed much earlier than reported and that the duration of maintaining a prone position can be shortened.

Diagnostic Techniques, Ophthalmological↗