Re-operation of idiopathic full-thickness macular holes after initial surgery with internal limiting membrane peel

Background/aims: A retrospective consecutive case series to evaluate the efficacy of re-operation in patients with persistent or recurrent idiopathic full-thickness macular hole after initial surgery with internal limiting membrane peel (ILM). Methods: 491 patients underwent surgery for fullthickness macular hole from January 2004 to November 2007. Fifty-five patients either did not close or reopened during the follow-up period. Thirty patients with initial ILM peel underwent repeat surgery involving vitrectomy, enlargement of ILM rhexis and gas tamponade. Results: Anatomical closure rate was 88.8% for primary surgery and 46.7% (14/30) for re-operation. There was a statistically significant improvement in overall best corrected visual acuity (BCVA) from re-operation baseline BCVA (p=0.02) within 1 year. For holes that did not close after the second surgery, visual acuity did not worsen. Conclusion: Re-operation has a reduced success rate of anatomical closure. However, BCVA is statistically significantly improved from re-operation baseline, so even though we cannot return vision to pre-pathological baseline, re-operation can improve on this new baseline.Link_to_subscribed_fulltex

High-Resolution Optical Coherence Tomography Retinal Imaging: A Case Series Illustrating Potential and Limitations

Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence

Worldwide Argus II implantation: recommendations to optimize patient outcomes

Abstract Background A position paper based on the collective experiences of Argus II Retinal Prosthesis System investigators to review strategies to optimize outcomes in patients with retinitis pigmentosa undergoing retinal prosthesis implantation. Methods Retinal surgeons, device programmers, and rehabilitation specialists from Europe, Canada, Middle East, and the United States were convened to the first international Argus II Investigator Meeting held in Ann Arbor, MI in March 2015. The recommendations from the collective experiences were collected. Factors associated with successful outcomes were determined. Results Factors leading to successful outcomes begin with appropriate patient selection, expectation counseling, and preoperative retinal assessment. Challenges to surgical implantation include presence of staphyloma and inadequate Tenon’s capsule or conjunctiva. Modified surgical technique may reduce risks of complications such as hypotony and conjunctival erosion. Rehabilitation efforts and correlation with validated outcome measures following implantation are critical. Conclusions Bringing together Argus II investigators allowed the identification of strategies to optimize patient outcomes. Establishing an on-line collaborative network will foster coordinated research efforts to advance outcome assessment and rehabilitation strategies.http://deepblue.lib.umich.edu/bitstream/2027.42/134581/1/12886_2016_Article_225.pd

Evaluating the safety of air travel for patients with scleral buckles and small volumes of intraocular gas

Aim: To evaluate the effect of scleral buckling on intraocular pressure (IOP) change during atmospheric decompression for eyes with small volumes of intravitreal gas. Methods: 12 eyes of 12 patients, including 6 with and 6 without scleral buckles, were evaluated in a hypobaric chamber simulating air travel approximately 1 month post pars plana vitrectomy with 15% C 3F8 gas fluid exchange. The chamber was decompressed with an ascent rate of 300 feet/min to a peak altitude of 8000 feet. After 15 min of cruising, descent was undertaken at 300 feet/min. IOP was measured at baseline and then every 5 min using slit-lamp mounted Goldmann applanation tonometry. The data were entered onto a spreadsheet and comparative statistics were done. Results: During ascent, IOP steadily rose from an average of 13±3 mm Hg to a peak of 26±9 mm Hg at 8000 feet. Patients with scleral buckles had significantly lower peak IOPs compared with those without buckles (20±5 mm Hg vs 32±8 mm Hg, p=0.013, t test) representing lower absolute increases in IOP (7±1 mm Hg vs 19±7 mm Hg, p=0.001, t test) and lower percentage increases in IOP from baseline (62±25% vs 140±40%, respectively). Conclusions: Eyes with small volumes of intravitreal gas demonstrate significant IOP changes during atmospheric decompression in simulated flight. The presence of a scleral buckle significantly limits the magnitude of IOP change, suggesting that such patients can likely tolerate typical air travel without undue risk of dangerous IOP elevation.Link_to_subscribed_fulltex

Photobiomodulation reduces drusen volume and improves visual acuity and contrast sensitivity in dry age-related macular degeneration.

PURPOSE To evaluate the efficacy of photobiomodulation (PBM) treatment for patients with dry age-related macular degeneration (AMD). METHODS Assessments on 42 eyes with dry AMD (age related eye disease study (AREDS) 2-4) were conducted. Multiwavelength light emitting diode (LED) light comprising of yellow (590 nm), red (670 nm) and near-infrared (790 nm) bandwidths was applied to subjects' eyes for a treatment course of 3 weeks. Outcome measures were changes in best-corrected visual acuity (BCVA), contrast sensitivity (CS), drusen volume and central drusen thickness. RESULTS Significant improvement in mean BCVA of 5.90 letters (p < 0.001) was seen on completion of the 3-week treatment and 5.14 letters (p < 0.001) after 3 months. Contrast sensitivity improved significantly (log unit improvement of 0.11 (p = 0.02) at 3 weeks and 3 months (log unit improvement of 0.16 (p = 0.02) at three cycles per degree. Drusen volume decreased by 0.024 mm(3) (p < 0.001) and central drusen thickness was significantly reduced by a mean of 3.78 μm (p < 0.001), while overall central retinal thickness and retinal volume remained stable. CONCLUSION This is the first study demonstrating improvements in functional and anatomical outcomes in dry AMD subjects with PBM therapy. These findings corroborate an earlier pilot study that looked at functional outcome measures. The addition of anatomical evidence contributes to the basis for further development of a non-invasive PBM treatment for dry AMD

Understanding macular holes that develop after repair of retinal detachment

Objective: To present the characteristics and outcomes of macular holes (MHs) that arise in eyes that have been treated for retinal detachment (RD). Design: Retrospective, interventional, consecutive case series. Participants: We studied 18 eyes that developed a MH following RD repair. Methods: We report the demographic and clinical characteristics, MH closure rates, and best corrected visual acuity (BCVA) following MH repair. Results: We detected 18 full-thickness MHs in 985 eyes. In 14 of 18, the original RD involved the macula, and in 16 of 18, the BCVA was 20/200 or worse. Of the RDs, 8 of 18 required multiple procedures to achieve reattachment. Post-RD BCVA was 20/200 or worse in 15 of 18 patients. The median time to MH diagnosis after RD repair was 1 month (range, 2 days to 53 months), and from MH diagnosis to MH repair, the median time was 1.75 months (range, 3 weeks to 8 months). Of 16 eyes (89%) that underwent surgical repair of the MH, 14 achieved MH closure, 1 requiring multiple pars plana vitrectomy, and 11 saw at least 1 Snellen line of improvement (median, 1; range, 1 to 6); 2 lost vision (1 and 2 Snellen lines, respectively); and 3 remained unchanged at a median follow-up of 3 months (range, 1 month to 25 months). Of the 18 patients, 6 had at least 20/80 BCVA at last follow-up. Conclusions: MHs following RDs (incidence 1.9%) are likely to be macula-off RDs requiring multiple interventions for RD repair. Post-MH-repair closure rates are similar to the rates for idiopathic MHs. BCVA outcomes are moderate and are dependent on impairment post-RD repair. The findings suggest other pathogenic mechanisms besides vitreofoveal traction may be leading to these MHs. © 2012 Canadian Ophthalmological Society.Link_to_subscribed_fulltex

Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration

Background: The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract. Methods: The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores. Results: The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye. Interpretation: An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract.Link_to_subscribed_fulltex