A case of OCT evidence of retinal breaks in a myopic patient woman at 38 weeks of gestation

Background: An eye examination of a pregnant woman is a mandatory phase of her preparation for delivery, with a special attention given to ophthalmic symptoms and relevant recommendations for delivery management. Purpose: To examine spectral domain ocular coherence tomography (SD-OCT) changes in retinal periphery and to provide grounds for the tactics of preparing a pregnant woman for delivery by performing preventive peripheral laser photocoagulation (PPLP). Material and Methods: A 35-year-old myopic woman at 38 weeks of gestation underwent a routine eye examination (visual acuity assessment, refractometry, tonometry, perimetry, biomicroscopy, and ophthalmoscopy), ultrasound biometry and SD-OCT (Heidelberg Engineering). Results: The patient was diagnosed with mild myopia along with peripheral lattice degeneration and peripheral cystic degeneration of the retina in both eyes and local retinal detachment with atrophic retinal breaks in the right eye. The peripheral vitreoretinal lattice degeneration was arrested and the local retinal detachment was limited by laser-induced chorioretinal adhesions. Conclusion: Spectral domain ocular coherence tomography provides an objective picture of the state of both the macular and the periphery of the retina, and, along with biomicroscopy and ophthalmoscopy, provides grounds for the tactics of care for pregnant women for preventing retinal detachment. The outcome of timely preventive laser treatment allowed us to conclude that the patient had no ocular contraindications to vaginal delivery

Retinal function as assessed by multifocal electroretinography and central perimetry before and after vitrectomy with conventional versus fovea-sparing internal limiting membrane peeling for idiopathic macular hole

Purpose: To perform multifocal electroretinography (mfERG)- and central perimetry-based evaluation of the function of the macula before and after vitrectomy with conventional internal limiting membrane (ILM) peeling versus fovea-sparing ILM peeling for idiopathic macular hole (IMH). Material and Methods: This study included 70 patients (71 eyes) who received 25-G vitrectomy with conventional or fovea-sparing ILM peeling and gas tamponade with 20% SF6 or 15% С3F8 for stage-2 to stage-4 holes as per the classification by Gass. Eyes of study patients underwent optical coherence tomography angiography (OCTA) evaluation of IMH diameter and choriocapillaris perfusion density, ten-degree static perimetry and 20-degree 5-ring mfERG before and 1 month after surgery. Results: Before surgery, eyes with IMH showed significantly reduced foveal light sensitivity and overall parafoveal sensitivity, increased Pattern Standard Deviation (PSD), and reduced retinal response density in mfERG rings 1 and 2 compared to fellow eyes. The foveal threshold sensitivity in the affected eyes was found to be correlated with minimal diameter of IMH (r = -0.77; р < 0.05) and the postoperative BCVA (r = 0.66; р < 0.05), whereas the overall retinal sensitivity, with the maximal diameter of IMH (r = -0.56), preoperative BCVA (r = 0.6) and postoperative BCVA (r = 0.7). MfERG retinal response density in ring 1 was significantly reduced (р = 0.00001) and correlated with the preoperative foveal threshold sensitivity (r = 0.6) and choriocapillaris perfusion density (r = 0.39). After macular hole closure, median BCVA (interquartile range) in the fovea-sparing ILM peeling group and the conventional ILM peeling group improved to 0.55 (0.35–0.7) and 0.43 (0.35–0.6), respectively. In addition, the foveal threshold sensitivity within 10-degree area in the former and latter groups improved, but was 13.6% (р = 0.009) and 15% (р = 0.0001), respectively, lower than in the fellow eyes (34.5 ± 2.9 dB). The overall retinal sensitivity in the fovea-sparing ILM peeling group improved more substantially, to 509.6 ± 13.9 dB, and almost reached the fellow-eye value (528.0 ± 25.8 dB). Moreover, the retinal response density in the conventional ILM peeling group improved in rings 1-5, whereas that in the fovea-sparing ILM peeling group, in rings 2-4, but not in ring 1. Conclusion: In eyes with IMH, retinal photoreceptor function as assessed by perimetry and mfERG was found to be impaired at baseline and improved after macular hole closure. In the fovea-sparing ILM peeling group, the overall retinal sensitivity in the affected eyes improved more substantially than in the conventional ILM peeling group