1/46. Surgical removal of subfoveal choroidal neovascular membranes in high myopia.BACKGROUND: A study was carried out to elucidate the anatomical and functional outcome after surgical excision of subfoveal choroidal neovascular membranes in high myopia. methods: Sixty-five patients with high myopia (> or =6 diopters), well-defined subfoveal neovascular membranes on fluorescein angiography and preoperative visual acuity < or =20/100 were selected for surgery. A standardized surgical technique was used in all cases, by a single surgeon. The main outcomes assessed were Snellen visual acuity, surgical retinal pigment epithelium defect and postoperative perfusion of the choriocapillaris. Multifactor analysis of variance and chi-square/Fisher's exact test statistics were used to assess the association between patients' pre- and postoperative characteristics and outcome measures. RESULTS: Follow-up ranged from 6 to 48 months (mean 16 months). Mean postoperative visual acuity (0.18) was significantly better than mean preoperative visual acuity (0.09). visual acuity improved by at least two lines in 29 eyes (45%) and was unchanged in 24 (37%). overall, 43 eyes (66%) had visual acuity of 20/200 or better and 15 (23%), 20/60 or better. Predictive factors with a significant effect on final visual acuity were mean visual acuity, preoperative status of retinal pigment epithelium and postoperative perfusion of the choriocapillaris. Postoperative perfusion was detected in 31 (48%) of the total 65 eyes and in 12 (67%) of the 18 eyes with normal retinal pigment epithelium at baseline. The mean postoperative retinal pigment epithelium defect was 4.6 times larger than the original neovascular membrane. In selected patients, SLO macular scotometry showed areas of retained retinal sensitivity within the atrophic scar. CONCLUSION: The natural history of subfoveal neovascularization in high myopia is rarely visually restorative. By contrast, surgical excision of the membranes is feasible and may restore visual acuity in selected patients. This therapeutic approach merits a formal multicenter clinical trial.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/46. persistent hyperplastic primary vitreous with myopia: a case study.BACKGROUND: persistent hyperplastic primary vitreous (PHPV) is a congenital disorder that manifests a range of ocular anomalies, including leukocoria, microphthalmia, cataract, and a retrolental fibrovascular membrane. In general, the prognosis for visual acuity with PHPV has been poor. A recent report on six patients who have myopia associated with PHPV showed that these patients were not microphthalmic, did not manifest leukocoria, and showed a mean visual acuity at final followup of 20/160. CASE REPORT: The case of a 3-year-old boy with myopic PHPV of the left eye is presented. Full-time wear of the cycloplegic refraction, combined with patching of the non-amblyopic eye, resulted in an improvement in visual acuity. RESULTS: PHPV with myopia may constitute a distinct subtype of PHPV. patients with myopic PHPV tend to seek treatment later than patients with anterior or posterior PHPV as a result of the lack of microphthalmia and leukocoria. These individuals do not show the long-term complications, such as secondary glaucoma and intraocular hemorrhages, associated with PHPV. CONCLUSION: The acuity improvement in this case of myopic PHPV suggests that a more conservative approach to its surgical management may be appropriate while pursuing refractive correction and amblyopia therapy to attain the best acuity possible.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
3/46. Visual function after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy.PURPOSE: To assess functional and anatomical outcomes after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. methods: Foveal translocation with 360-degree retinotomy was performed in 11 eyes of 11 patients with myopic neovascular maculopathy. Ten eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Silicone oil removal with or without intraocular lens implantation was performed 2 to 8 weeks after the primary procedure. visual acuity, binocular function, and degree of cyclotorsion were assessed preoperatively and postoperatively. Angles of retinal and globe rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS: With a mean postoperative follow-up of 6.2 months (range, 3 to 13 months), vision improved (greater than 0.2 logarithm of minimal angle of resolution [logMAR] units) in eight eyes, was unchanged in two eyes, and worsened (greater than 0.2 logMAR units) in 1 eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better. Five patients developed or maintained binocular fusion, four patients continued to have suppression, and two patients developed diplopia that was managed by spectacles with Fresnel prisms. Subjective cyclotorsion was less than 8 degrees in 10 eyes. Mean retinal and globe rotations were 23.4 degrees and 19.8 degrees, respectively. Average size of the choroidal neovascular membrane was 0.8 disk diameter, whereas the average distance of foveal shift was 1.5 disk diameter. After the primary procedure, three eyes developed retinal detachment, one eye macular hole, and one eye proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION: Foveal translocation with 360-degree retinotomy is effective in restoring vision in some patients with myopic neovascular maculopathy. Although the development of torsional diplopia is generally obviated by simultaneous extraocular muscle surgery, a relatively high incidence of surgical complications should be taken into account with this procedure.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
4/46. indocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment.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.- - - - - - - - - - ranking = 1.75keywords = membrane (Clic here for more details about this article) |
5/46. Foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy.PURPOSE: To report our surgical results of foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy. DESIGN: Noncomparative, interventional, consecutive case series. methods: Ten eyes of 10 myopic patients with subfoveal neovascular membranes that had undergone foveal translocation with scleral imbrication were recruited for this retrospective study. Inclusion criteria were myopia 6.0 diopters or greater in refractive error (or axial length 26.5 mm or longer), subfoveal choroidal neovascularization, and preoperative best-corrected visual acuity of 20/100 or worse. None of these eyes had undergone prior laser photocoagulation or submacular surgery. The main outcome measures were surgical complications and postoperative visual function. RESULTS: Postoperatively, visual acuity had improved more than 3 lines in the logarithm of minimum angle of resolution (logMAR) measurement in all eyes. The mean preoperative, postoperative best, and final visual acuity were 0.12, 0.59, and 0.51, respectively. Of the 10 eyes, six achieved a postoperative final visual acuity of 20/40 or better. The mean postoperative foveal displacement was 0.78 disk diameter (range, 0.3--1.3 disk diameter). Two patients underwent a reoperation because of insufficient foveal displacement. Furthermore, one of these two patients required a third operation to reduce an excessive retinal fold involving the fovea induced by the second surgery. Of the 10 patients, two noted transient diplopia. This complaint, however, resolved over time as suppression developed. Although unintentional iatrogenic retinal tears formed intraoperatively in two eyes, these were successfully treated without serious complications. Postoperatively, mild retinal pigment epithelial changes were observed in all cases, but none led to significant deterioration of visual acuity during the follow-up period. All patients but one were followed for a minimum of 6 months. CONCLUSIONS: In eyes with myopic neovascular maculopathy, foveal translocation with scleral imbrication may be useful in improving visual acuity. Further refinements in surgical technique and assessment of the long-term complications will be needed to make this procedure safer and more useful.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
6/46. Surgical removal of subfoveal choroidal neovascularization without removal of posterior hyaloid: a consecutive series in younger patients.PURPOSE: Subfoveal choroidal neovascularization (CNV) remains a common and important cause of visual loss. Previous studies have suggested that submacular surgery may improve or maintain visual acuity, particularly in younger patients. The majority of reported cases included removal of the posterior hyaloid during vitrectomy. The authors present a consecutive series of patients age 55 or younger with subfoveal CNV removal without posterior hyaloid removal. methods: Seventeen patients without age-related macular degeneration (ARMD), with subfoveal CNV from choroiditis, presumed ocular histoplasmosis syndrome, myopia, or idiopathic causes, underwent a small retinotomy technique to extract the membranes after vitrectomy without posterior hyaloid removal. RESULTS: Median improvement in visual acuity was from 20/320 to 20/50. Eleven patients (65%) experienced an improvement of three or more lines of Snellen acuity (average 7.5), 4 (23%) were within two lines of preoperative acuity, and 2 (12%) had decreased acuity, with an average follow-up of 12 months (range 3-31). Choroidal neovascularization recurred in six patients (35%). Postoperative retinal detachment, epiretinal proliferation, or macular hole did not occur. CONCLUSIONS: In this series of younger patients with subfoveal CNV not from ARMD, visual acuity was improved in the majority after submacular membrane removal. Omission of removal of the posterior hyaloid did not adversely affect outcome.- - - - - - - - - - ranking = 0.25keywords = membrane (Clic here for more details about this article) |
7/46. Optical coherence tomography of choroidal neovascularization in high myopia.AIM: To investigate morphologic changes in the eye with choroidal neovascularization (CNV) in high myopia using optical coherence tomography (OCT). methods: Optical coherence tomography was performed in 35 patients (42 eyes) with myopic CNV. Myopic CNV was divided into active, scar, or atrophic stages based on funduscopic and fluorescein angiographic findings. The characteristics of OCT findings in each stage were identified. RESULTS: In the active stage (11 eyes), OCT clearly displayed a neovascular membrane as a highly reflective dome-like elevation above the retinal pigment epithelium (RPE). No apparent subretinal fluid accumulation around the CNV was identified. In the scar stage (12 eyes), only the surface of the CNV showed high reflectivity, which was markedly attenuated below the surface. In the atrophic stage (19 eyes), the CNV had become totally flat and chorioretinal atrophy around the regressed CNV showed high reflectivity. CONCLUSIONS: Optical coherence tomography demonstrated characteristic features at each stage of myopic CNV. Optical coherence tomography appears to be useful in evaluating the stage and activity of myopic CNV.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
8/46. Severe hypotony after macular translocation surgery with 360-degree retinotomy.PURPOSE: To report a case of severe hypotony after macular translocation with 360-degree retinotomy. DESIGN: Interventional case report. methods: A 50-year-old woman with myopic neovascular maculopathy underwent macular translocation with 360-degree retinotomy in her left eye. RESULTS: After the second procedure of silicone oil removal, severe hypotony developed. No clear sign of leakage was found. Pure perfluoropropane gas tamponade was then performed, which resulted in temporal resolution of severe hypotony, but the hypotony recurred as the gas bubble was absorbed. Ten weeks after the second surgery, the hypotonous eye was refilled with silicone oil. No apparent cyclitic membrane was observed intraoperatively. After this procedure, the choroidal and retinal folds regressed; intraocular pressure has been between 5 and 7 mm Hg for more than 4 months thereafter. CONCLUSION: Severe hypotony can occur as a complication of otherwise uneventful macular translocation with 360-degree retinotomy.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
9/46. Pathologic myopia: where are we now?.PURPOSE: To describe current concepts and available treatments for pathologic myopia. DESIGN: review of experimental and clinical studies. methods: The demography, natural history, medical and surgical treatments for choroidal neovascular membrane, vitreoretinal interface disorders and future strategies for pathologic myopia are reviewed. RESULTS: Several medical and surgical modalities are currently available to treat various complications of pathologic myopia. Macular translocation appears to stabilize or improve visual function in many eyes with choroidal neovascularization. CONCLUSION: Newer strategies are emerging to better ameliorate or prevent the complications of pathologic myopia.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
10/46. Macular hole in a myopic eye after laser in situ keratomileusis.PURPOSE: To analyze the characteristics of a macular hole in a myopic patient after laser in situ keratomileusis (LASIK). methods: A macular hole with sharp margins and small yellow deposits on the surface of the retinal pigment epithelium appeared in the left eye of a female patient, 53 years old, 12 months after LASIK for the correction of -6.75 D of myopia (follow-up after LASIK, 22 months). Best spectacle-corrected visual acuity (BSCVA) before LASIK was 20/25. BSCVA after LASIK was 20/20 (spherical equivalent refraction -1.00 D). After the macular hole appearance, BSCVA was 20/100. The macular hole was treated by vitrectomy with internal-limiting membrane peeling. Final BSCVA was 20/50. CONCLUSION: The role of LASIK in the pathogenesis of macular hole remains unclear.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
| | Next -> |