| PURPOSE: To describe the use of intravitreal indocyanine green as an aid to identifying epiretinal membranes and internal-limiting membranes during surgery for a retinal detachment resulting from a macular hole. methods: A 62-year-old man who had a retinal detachment resulting from a macular hole underwent vitrectomy. During the surgery, intravitreal indocyanine green was injected intravitreally. RESULTS: The internal-limiting membrane was stained green, but the epiretinal membrane was unstained. Because the epiretinal membrane and internal-limiting membrane were clearly identified, they could be completely removed. The clinical observations of the epiretinal membrane and internal-limiting membrane excised were confirmed by electron microscopy. Successful reattachment was obtained without damage to the retina. CONCLUSION: Removal of epiretinal membrane and internal-limiting membrane can be facilitated by using intravitreal indocyanine green during vitrectomy. We recommend further studies to confirm the benefit of this technique. ( info) |
12/71. Microbubble retention and failed macular hole surgery. This case reports a possible new cause of failed macular hole surgery. Standard macular hole surgery with removal of epiretinal membranes, 16% C3F8, and strict postoperative prone positioning was performed on a patient with stage 4 macular hole. Macular hole surgery failed with retention of a microbubble of C3F8 within the macular hole during the follow-up period. Retention of a microbubble within a macular hole may prevent closure of the hole and be a previously unrecognized cause of failed macular hole surgery. ( info) |
13/71. Persistent indocyanine green (ICG) fluorescence 6 weeks after intraocular ICG administration for macular hole surgery. BACKGROUND: Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of epiretinal membranes and the ILM is an obstacle to successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. methods: In a case of stage IV macular hole, epiretinal membranes and ILM were intraoperatively stained with three drops of 1:9 diluted ICG. After 1 min incubation the vitreous cavity was rinsed with Ringer's lactate solution, and the membranes were peeled. Autologous thrombocytes were applied to the macular hole, and the eye was endotamponaded with 20% SF6 gas. Six weeks postoperatively, visual acuity was measured and fundus photographs and autofluorescence images, as well as a multifocal ERG, were obtained. RESULTS: Intraoperatively, the ILM could be nicely visualized by ICG, which allowed immediate peeling. Six weeks after surgery, the visual acuity had improved from 0.1 to 0.7 and the macular hole was closed. Autofluorescence imaging at 795 nm revealed a strong signal. Multifocal ERG recording showed regular amplitudes. CONCLUSION: ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We did not observe any negative effect on retinal function; however, we were surprised to identify traces of ICG in retinal fluorescein angiography images 6 weeks postoperatively. ( info) |
| PURPOSE: To evaluate the surgical efficacy of pars plana vitrectomy on eyes with diabetic macular edema in the presence or absence of a complete posterior vitreous detachment and with or without an epimacular membrane. methods: Pars plana vitrectomy was performed on 30 eyes of 29 cases with diabetic macular edema. visual acuity was measured, and retinal thickness was determined by optical coherence tomography before and after vitrectomy. To evaluate the relationship between the effects of vitrectomy and the presence or absence of posterior vitreous detachment and/or epimacular membrane, all eyes were placed into one of four groups: group A, eyes with posterior vitreous detachment and epimacular membrane; B, eyes with posterior vitreous detachment and without epimacular membrane; C, eyes without posterior vitreous detachment and with epimacular membrane; and D, eyes without posterior vitreous detachment and without epimacular membrane. The expression of vascular endothelial growth factor and interleukin-6 was investigated immunohistochemically in epimacular membrane specimens obtained from seven eyes with diffuse diabetic macular edema. RESULTS: The postoperative mean visual acuity (0.653 /- 0.350: mean /- SD logarithm of minimal angle of resolution [logMAR]) was significantly better than the mean preoperative visual acuity (0.891 /- 0.319 logMAR; Wilcoxon signed-rank test, P =.0007). The postoperative foveal thickness (264.5 /- 118.6 microm) was significantly thinner than the preoperative foveal thickness (477.8 /- 147.7 microm; Wilcoxon signed-rank test, P <.0001). There were no significant differences in the improvement of visual acuity and decrease of foveal thickness between the four groups (Kruskal-Wallis test, P =.13, P =.65, respectively). All of the epimacular membranes obtained at surgery expressed vascular endothelial growth factor and interleukin-6. CONCLUSIONS: These results demonstrated that vitrectomy with removal of epimacular membrane is generally an effective procedure in reducing diabetic macular edema, and the outcome does not depend on the presence absence of posterior vitreous detachment and epimacular membrane. ( info) |
| PURPOSE: To report the outcome of epiretinal membrane (ERM) surgery in young patients. DESIGN: Interventional case series study. METHOD: A retrospective review of 20 young patients who had undergone vitrectomy and epiretinal membrane removal. All patients had a preoperative examination, including fundus biomicroscopy, red free photographs, and fluorescein angiography. RESULTS: Nine patients were males and 11 females (age: 7-26 years; mean: 16.3 years). Follow up ranged from 4-96 months (mean: 21.2 months). The 20 patients comprised 13 cases of idiopathic ERM, six cases in which ERM was associated with ocular inflammation and one case of combined hamartoma of the retina and retinal pigment epithelium (RPE). In 13 cases, the ERM was especially white, thick, and opaque, with localized constriction and severe retinal distortion. Final best-corrected visual acuity (VA) was significantly better than preoperatively (20/50 vs. 20/112), (P = 0.0002). Mean improvement in VA was 4.25 lines and 17 patients gained two or more lines. This improvement was better in secondary than idiopathic ERM (6 lines vs. 3.3). During follow up, five cases of recurrence were observed (25%). In another case, postoperative persistent ocular hypertension required filtering surgery. CONCLUSION: The characteristics of ERM in young patients are quite different in many cases from those in adults in terms of thickness and adherence. Removal of ERM in young patients is feasible and safe although the membrane may focally adhere strongly to retinal vessels. VA usually improves significantly after surgery, but recurrences are more frequent than in adults. ( info) |
16/71. Vitreous surgery combined with internal limiting membrane peeling for traumatic macular hole with severe retinal folds. PURPOSE: To report a case of a traumatic macular hole with severe retinal folds in which vitreous surgery combined with internal limiting membrane (ILM) peeling was beneficial. To demonstrate that the area from which the ILM was peeled can be clearly differentiated by scanning laser ophthalmoscopy. methods: A posterior hyaloid detachment was created during vitreous surgery on a 34 year old man with a traumatic macular hole. The remaining vitreous was resected and the ILM was peeled. The fundus was examined through a scanning laser ophthalmoscope before and after the surgery. RESULTS: The retinal folds disappeared concurrently with the detachment of the ILM, resulting in closure of the macular hole. The area from which the ILM was peeled was clearly observed through the scanning laser ophthalmoscope. CONCLUSION: In this patient, it was helpful to perform not only posterior hyaloid detachment but also ILM peeling. The scanning laser ophthalmoscope was highly useful for observing the area from which the ILM was peeled. ( info) |
17/71. Visual field defect caused by nerve fiber layer damage associated with an internal limiting lamina defect after uneventful epiretinal membrane surgery. PURPOSE: To report a case of visual field defect caused by damage of the nerve fiber layer associated with an internal limiting lamina defect after uneventful epiretinal membrane peeling. DESIGN: Interventional case report. methods: In the right eye, a 43-year-old male patient developed a nasal step and mild inferior arcuate scotoma after uneventful epiretinal membrane surgery without any associated glaucoma. Transmission electron microscopy was performed on the epiretinal membrane specimens. RESULTS: An epiretinal membrane specimen showed adhesion between epiretinal membrane and axons of nerve fiber layer in the area of the internal limiting lamina defect. CONCLUSION: Adhesion between epiretinal membrane and retinal tissue in the area of the internal limiting lamina defect may cause damage of the nerve fiber layer and visual field defect after epiretinal membrane peeling. ( info) |
18/71. The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema: a report of two cases. PURPOSE: To describe the effect of internal limiting membrane peeling in chronic recalcitrant pseudophakic cystoid macular edema. DESIGN: Two interventional case reports. methods: Two consecutive patients with chronic pseudophakic cystoid macular edema of 11-22 months duration, after uncomplicated cataract surgery, unresponsive to previous treatment, were enrolled. The surgical technique consisted of pars plana vitrectomy and internal limiting membrane peeling. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and perifoveal leakage on fluorescein angiography. Optical coherence tomography scans were performed postoperatively. RESULTS: Pars plana vitrectomy with internal limiting membrane peeling resulted in anatomical, angiographic, and functional improvement in both patients, for total follow-up periods of 8 and 11 months, respectively. CONCLUSION: To our knowledge, this is the first report of chronic pseudophakic cystoid macular edema that favorably responded to pars plana vitrectomy with internal limiting membrane peeling, as concluded after a medline search. ( info) |
19/71. Paramacular Von Hippel angioma with tractional macular detachment. A rare case of paramacular angioma with tractional macular detachment that was managed successfully with laser, followed by surgical intervention with good visual outcome, is presented. A 23-year-old female patient with paramacular Von Hippel angioma was treated with argon laser photocoagulation. Three-months following photocoagulation, vitrectomy with epiretinal tractional membrane removal was attempted successfully. visual acuity improved from a preoperative level of 20/200 to 20/50 at the 6 months postoperative period. No recurrence of epiretinal membrane or exudation was observed during the follow-up period. Photocoagulation, followed by surgical intervention for removal of epiretinal traction membranes, resulted in relieving the tractional macular detachment and recovering useful visual acuity in paramacular Von Hippel angioma. ( info) |
20/71. Massive vascular endothelium growth factor (VEGF) expression in Eales' disease. BACKGROUND: Eales' disease is an idiopathic retinal vasculitic and vaso-occlusive process complicated by extensive retinal neovascularisation and vitreous hemorrhages. The great propensity to produce retinal neovessels is one of the particular aspects of the disease that deserves to be further investigated. We report a case of Eales' disease having evolved over more than three decades, with a typical clinical presentation in one eye, while the other eye had to be enucleated because of a terminal neovascular glaucoma, thus allowing pathological examination. methods: The functional right eye was treated by vitrectomy, cerclage, cryocoagulation and endolaser. The non-functional phthitic left eye was enucleated and submitted for histopathological and immunohistochemical examination using antibodies against vascular endothelial growth factor, T-cells, B-cells and Muller cells. RESULTS: Evolution was favourable in the operated right eye, following management of the inflammatory reaction. The histopathological examination of the left eye revealed an occlusion of the anterior chamber angle by rubeosis iridis, tractional retinal detachments, pre-, intra- and sub-retinal neovascular membranes, and vitrous hemorrhages. Diffuse positive anti-VEGF immunostaining was found at the level of the retinal neovascular membranes. The retina exhibited prominent Muller cell immunostaining, indicating extensive gliosis, and predominantly B cell infiltrates were found in the eye. CONCLUSION: The present study indicates a close relationship between the prominent neovascular proliferation in Eales' disease and the intense expression of VEGF. The increased expression of VEGF, when compared to other conditions inducing neovascularisation, might explain the severity of neovascular growth and the propensity of repeated vitrous hemorrhages in Eales' disease. ( info) |