Is It Worth Reoperating on Macular Holes?

Objective: To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs. Design: Retrospective single-center case series. Participants: Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group). Methods: All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery. Main Outcome Measures: Anatomic and visual results. Results: All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; ±standard deviation [SD]) before the second surgery was 0.14±0.10 (range, 0.01-0.33) in the reopened group and 0.10±0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (±SD) in the reopened group was 0.42±0.31 (range, 0.05-1) and in the unclosed group was 0.19±0.14 (range, HM-0.66). Conclusions: Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation. © 2008 American Academy of Ophthalmology.link_to_subscribed_fulltex

Resolution of cystoid macular oedema after retinal detachment repair: Is intravitreal triamcinolone useful?

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Bilateral ischemic maculopathy in a patient with AIDS

PURPOSE. To describe ischemic maculopathy as a cause of sudden bilateral decreased vision in a patient with human immunodeficiency virus (HIV) infection. METHODS. A 44-year-old HIV-positive woman presented with bilateral decreased vision and normal examination, except for pale maculae and retinal vascular tortuosity. Fluorescein angiography showed bilateral enlargement of the foveal avascular zone with perifoveal dye leakage. CONCLUSIONS. Ischemic maculopathy is a potential cause of decreased vision in patients with acquired immunodeficiency syndrome, even in patients with immune sustained recovery. This condition can be almost totally reversible, in the absence of other concomitant ocular pathologies

Sub-macular surgery: Is still an option for age-related macular degeneration?

Purpose: This review summarizes the data reported in peer-reviewed literature on the effects of submacular surgery for age-related macular degeneration (AMD) associated with choriodal neovascularization (CNV). Methods: A review of the MEDLINE database has been performed in order to examine the therapeutic effects of submacular surgical treatments in patients affected by AMD. Results: The multicenter studies conducted by the Submacular Surgery Trials Research Group compare the removal of the CNV complex, both with (336) and without blood (454), with observation in patients affected by AMD. At a 1-year follow-up, no benefit in preventing visual loss had been shown. Furthermore, complications occurred in the surgery arm such as retinal detachment and lens opacification. No differences have been found between submacular surgery and laser photocoagulation in terms of visual acuity and quality of life. As yet, there are no randomized controlled trials concerning retinal pigment epithelium and choroid translocation or macular translocation, but only prospective, non-controlled case series with low quality of evidence. Conclusions: No evidence of potential benefit from submacular removal of the CNV complex due to AMD has been shown. Randomized clinical trails (RCT) concerning other submacular surgical approaches are not available. There are sufficient non-comparative data on retinal pigment epithelium (RPE) graft to warrant an RCT especially in patients with large subretinal haemorrhages, RPE rip or in Anti-VEGF non-responders. © 2010 Bentham Science Publishers Ltd.link_to_subscribed_fulltex

Heavy silicone oil (densiron) and supine position in the management of massive suprachoroidal hemorrhage: Use of heavy silicone for suprachoroidal hemorrhage

Purpose: To describe a case of massive suprachoroidal hemorrhage after a phacoemulsification managed with pars plana vitrectomy, heavy silicone oil (Densiron), and supine position. Methods: Report of a 69-year-old woman with systemic hypertension and under antiplatelet treatment who developed a massive suprachoroidal hemorrhage. Results: The patient underwent a pars plana vitrectomy and heavy oil endotamponade combined with 3 radial sclerotomies to drain the suprachoroidal blood. Two months after this surgery, the retina remains attached and visual acuity is 3/60 with aphakia and half of the vitreous cavity filled with Densiron. Conclusion: Pars plana vitrectomy and Densiron endotamponade with supine position can represent a good surgical option in such a dramatic case as a suprachoroidal hemorrhage. Long-term heavy silicone oil endotamponade cannot be advised in these cases. © 2012 Ophthalmic Communications Society, Inc.link_to_subscribed_fulltex