RETINA

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A PILOT CLINICAL STUDY OF TREATING RHEGMATOGENOUS RETINAL DETACHMENT BY SILICONE RUBBER BALLOON SCLERAL BUCKLING

imagePurpose:
To evaluate the efficacy and primary safety of treating rhegmatogenous retinal detachment (RRD) using foldable capsular vitreous body scleral buckling.
Methods:
Five patients with simple RRD were treated with foldable capsular vitreous body scleral buckling. B-ultrasound and fundus photography examining of retina reattachment were used to evaluate the postsurgery efficacy. The safety of the treatment was evaluated based on the occurrence of infection, eye pain, diplopia, elevated intraocular pressure, and other serious postoperative complications after surgery. The observation time after the operation was at least 12 weeks.
Results:
The simple RRD of all five patients was successfully reattached before being evaluating by B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in two patients who were macularly affected. One patient had temporary diplopia and eye movement limitation after surgery. No other complications were recorded.
Conclusion:
This pilot study determined that foldable capsular vitreous body scleral buckling can be efficacious and safe for simple RRD. The results indicate that this surgery may be a novel alternative to the current extraocular procedures for simple RRD.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/A_PILOT_CLINICAL_STUDY_OF_TREATING_RHEGMATOGENOUS.8.aspx

THICKNESSES OF SCLERA AND LAMINA CRIBROSA IN PATIENTS WITH CENTRAL RETINAL VEIN OCCLUSION

imagePurpose:
To evaluate thicknesses of sclera and lamina cribrosa (LC) in central retinal vein occlusion (CRVO).
Method:
Thirty-two patients with CRVO (mean age 62.2 ± 11.6 years, women/men 18/14) and 35 age- and sex-matched healthy volunteers were included into the study. Scleral thickness was measured at scleral spur and at 1 to 3 mm from scleral spur in four quadrants (temporal, nasal, super, and inferior) using anterior segment optical coherence tomography. Lamina cribrosa was measured using optic disk enhanced depth imaging optical coherence tomography.
Results:
The sclera was thicker in affected eyes of the CRVO group than healthy subjects at scleral spur in four quadrants (738.7 ± 30.9 µm vs. 702 ± 30.8 µm in temporal, 700.4 ± 19.7 µm vs. 673 ± 13.7 µm in superior, 693 ± 19.3 µm vs. 665.3 ± 24.2 µm in nasal, 810.7 ± 28.9 µm vs. 784.5 ± 23.7 µm in inferior quadrants, respectively; P ˂ 0.05 for all). Lamina cribrosa thickness in affected eyes of the CRVO group was significantly higher than that of healthy subjects (285.2 ± 12.7 µm vs. 266.4 ± 10.7 µm, respectively; P ˂ 0.01). The correlation between scleral thickness and LC thickness was moderate at scleral spur of temporal and superior quadrants of affected eyes (r = 0.510 and r = 0.420, respectively).
Conclusion:
Thicknesses of sclera and LC are increased in the CRVO, which may play a role in the pathogenesis of the disease.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/THICKNESSES_OF_SCLERA_AND_LAMINA_CRIBROSA_IN.24.aspx

FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY: Findings After Surgical Reattachment of Macula-Off Rhegmatogenous Retinal Detachment

imagePurpose:
The purpose of this study was to investigate fluorescence lifetime imaging ophthalmoscopy lifetimes after macula-off rhegmatogenous retinal detachment (RRD) repair.
Methods:
Fifty-eight patients with successful macula-off RRD reattachment surgery were included. Retinal autofluorescence was excited with 470 nm, and amplitude-weighted mean fluorescence lifetimes (Tm) were measured in a short spectral channel (SSC, 498–560 nm) and a long spectral channel (LSC, 560–720 nm). Tm were obtained within a standardized Early Treatment Diabetic Retinopathy Study grid and correlated with Tm. The unaffected fellow eye served as control.
Results:
Fifty-eight patients (age: 65 ± 1.6 years, 11 women) were imaged at median 1.5 months postoperatively. Tm were significantly prolongxxxed within areas of previously detached retina in the long spectral channel and particularly in the central subfield in the short spectral channel. Short lifetimes in the center of the Early Treatment Diabetic Retinopathy Study grid correlated with better visual acuity (short spectral channel; r2 = 0.18, P = 0.001, long spectral channel; r2 = 0.08, P = 0.03). Areas of residual subretinal fluid pockets in four RRD eyes displayed short fluorescence lifetimes.
Conclusion:
Areas of previously detached retina exhibit significant fluorescence lifetime changes. We found a significant correlation of fluorescence lifetimes within the fovea with visual acuity after successful RRD repair. Our data suggests that the prolongation of fluorescence lifetimes in the fovea is mainly driven by loss of macular pigment. Therefore, fluorescence lifetime imaging ophthalmoscopy may be useful in the prediction of long-term functional outcomes after macula-off RRD surgery.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/FLUORESCENCE_LIFETIME_IMAGING_OPHTHALMOSCOPY_.9.aspx

A NOVEL FINDING OF HYPERREFLECTIVE MATERIAL IN THE SILICONE-RETINA INTERFACE: An Optical Coherence Tomographic and Histopathological Study

imagePurpose:
To describe novel findings of hyperreflective material in the silicone-retina interphase on spectral domain optical coherence tomography (SD-OCT) imaging in eyes with silicone oil tamponade.
Methods:
Retrospective observational clinical study of consecutive patients who underwent primary pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. Repeat clinical examination and spectral domain optical coherence tomography macular imaging performed 3 months after surgery were evaluated to identify any macular pathologies, including formation of epiretinal membranes, intraretinal changes, subretinal fluid, and edema before scheduled secondary vitrectomy for silicone oil removal.
Results:
Eighty-two patients (mean age 54 years, range 22–89) were included. Twelve eyes (14%) showed discrete preretinal hyperreflective organized coarse material in the silicone-retina interphase on spectral domain optical coherence tomography. The material was scattered in the posterior pole, with several foci showing additional hyperreflectivity of the inner retinal layers beneath. These findings did not resemble silicone oil emulsification in size, shape, or reflectivity.
Conclusion:
This is the first report on hyperreflective material detected by spectral domain optical coherence tomography in the silicone-retina interphase in eyes with silicone oil tamponade. These findings may represent an inflammatory response to silicone oil exposure that may be the initial manifestation of a future proliferative process, warranting a rigorous follow-up protocol for affected patients.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/A_NOVEL_FINDING_OF_HYPERREFLECTIVE_MATERIAL_IN_THE.25.aspx

AUTOLOGOUS RETINAL TRANSPLANTATION AS A PRIMARY TREATMENT FOR LARGE CHRONIC MACULAR HOLES

imagePurpose:
To report the outcomes of autologous neurosensory retinal transplant as a primary treatment for patients with large chronic macular holes and evaluate the safety and feasibility of the procedure.
Design:
Retrospective study, consecutive case series.
Methods:
We reviewed seven patients with a primary chronic large macular hole, who underwent autologous neurosensory retinal transplant. Mean preoperative minimum and maximum hole diameters were 643 µm and 1214 µm, respectively. Changes in visual acuity were measured postsurgery, and optical coherence tomography, fluorescein angiography, and microperimetry-3 were analyzed after the procedure.
Results:
Closure of the macular hole was achieved in all seven eyes in the study. At 1 year post-surgery, there was significant improvement in mean visual acuity (LogMAR 1.10 vs. 0.68, P = 0.001). Optical coherence tomography showed that all grafts had formed attachments to the retinal epithelial cells of the recipient retina. Mean preoperative ellipsoid zone defect was 1,089 ± 403.8 µm (range, 918–1,329 µm) which further decreased to 921 ± 129.1 µm (range, 670–1,201 µm) at final follow up (P = 0.09). Microperimetry-3 testing indicated retinal sensitivity in the graft in five eyes.
Conclusion:
Autologous retinal transplantation may help rebuild the macular structure resulting in functional improvement for eyes with primary chronic large macular hole.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/AUTOLOGOUS_RETINAL_TRANSPLANTATION_AS_A_PRIMARY.10.aspx

Diagnostic and Therapeutic Challenges

imageNo abstract available

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/Diagnostic_and_Therapeutic_Challenges.26.aspx

HUMAN AMNIOTIC MEMBRANE TO CLOSE RECURRENT, HIGH MYOPIC MACULAR HOLES IN PATHOLOGIC MYOPIA WITH AXIAL LENGTH OF ≥30 mm

imagePurpose:
To assess the effectiveness of the human amniotic membrane plug for recurrent high myopic macular hole (MH) that already underwent pars plana vitrectomy with internal limiting membrane peeling and gas endotamponade.
Methods:
Sixteen eyes of 16 patients with recurrent high myopic MH were enrolled. A 23-gauge pars plana vitrectomy was performed. Human amniotic membrane plugs were implanted under the neuroretina inside the MH. Twenty percent sulfur hexafluoride or air was used as endotamponades. The patients were instructed to maintain facedown position for 5 days after surgery.
Results:
Optical coherence tomography examinations showed that the MHs closed in 15 of the 16 patients (93.75%) 2 weeks after one surgical intervention, and in 100% of patients after second intervention. Mean best-corrected visual acuity improved from 1 logarithm of the minimum angle of resolution (20/200) to 0.67 logarithm of the minimum angle of resolution (20/100) 6 months after surgery. Best-corrected visual acuity remained stable during the 12-month follow-up. One patient had human amniotic membrane plug dislocation after gas absorption that needed a second intervention with new AM plug implantation. No adverse events were reported during the 12-month follow-up.
Conclusion:
The first case series of recurrent high myopic MH was reported, assessing the effectiveness of the human amniotic membrane plug to close recurrent MHs in pathologic myopia. All the cases were successful with encouraging best-corrected visual acuity recovery.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/HUMAN_AMNIOTIC_MEMBRANE_TO_CLOSE_RECURRENT,_HIGH.11.aspx

EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY

imagePurpose:
To investigate the role of an internal limiting membrane (ILM) flap in macular hole (MH) surgery on closure rate, visual acuity, and integrity of the outer retinal layers.
Methods:
Retrospective, nonrandomized interventional analysis in which 117 eyes of 117 patients were included who had undergone pars-plana vitrectomy (PPV) and gas tamponade for primary idiopathic MH >400 µm with either conventional ILM peeling or with inverted ILM flap technique at The Royal Liverpool University Hospital between January 2016 and April 2018. Main outcome measures were closure of MH, best-corrected visual acuity (BCVA) at 3, 6, and 12 months, and restoration of external limiting membrane and ellipsoid zone (EZ) using optical coherence tomography.
Results:
Macular hole closure rate was significantly higher in patients with an ILM flap (67/68; 98.53%) than in those with conventional ILM peeling (43/49; 87.76%) (P = 0.02). Both groups showed significant improvements in their preoperative to postoperative BCVA at 3 months from 1.07 (0.43) logarithm of the minimum angle of resolution (logMAR) (20/235 Snellen) to 0.71 (0.34) logMAR (20/103 Snellen) (P <0.001), but there was no significant difference between the two groups (P = 0.45, P = 0.71). We found significant associations between postoperative BCVA and preoperative BCVA (P < 0.01) and the integrity of the EZ (P < 0.01). In 35 patients who had follow-up to 12 months, there was a significant improvement in BCVA between 3, 6, and 12 months from 0.73 (0.45) logMAR (20/107 Snellen) to 0.53 (0.24) logMAR (20/68 Snellen) and to 0.35 (0.18) logMAR (20/45 Snellen), respectively (P < 0.01). There was no significant difference at these time periods between the two groups (P = 0.62, P = 0.21, P = 0.31). The integrity of the EZ also improved significantly between 3, 6, and 12 months (P = 0.01), irrespective of the presence of an ILM flap (P = 0.58), but with a trend toward delay in restoration in those patients with an ILM flap. The improvement in BCVA at 12 months, taking into account the age of the patient, size and duration of the MH, presence of an ILM flap, and preoperative BCVA was dependent on the state of the EZ (P = 0.01).
Conclusion:
In patients undergoing primary pars-plana vitrectomy for MH >400 µm, the presence of an inverted ILM flap was associated with a significantly higher closure rate than a conventional ILM peeling. Best-corrected visual acuity showed a strong correlation with the integrity of the EZ and both improved significantly between 3, 6, and 12 months, irrespective of the presence of an ILM flap.

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https://journals.lww.com/retinajournal/Fulltext/2020/10000/EFFECT_OF_INVERTED_INTERNAL_LIMITING_MEMBRANE_FLAP.12.aspx

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