Foveal Contour Research Articles

Symptomatic Foveal Impingement following Posterior Vitreous Detachment Formation

A-57-year old visually asymptomatic healthy woman was examined by us first in 2016. On optical coherence tomographic (OCT) examination left foveal contour appeared as normal at that time (Figure A). In 2020, there was the evidence of vitreomacular adhesion despite the normal foveal contour in the left eye (Figure B). However, we noticed the left foveal inpingement related to detached posterior vitreous on OCT when she was reexamined with the complaint of left metamorphosia in 2024 (Figure C). Posterior vitreous detachment (PVD) is the vitreous gel liquefaction,and extracellular matrix changes at the vitreoretinal interface characterized with the detachment of posterior vitreous cortex from the internal limiting membrane due to ongoing aging process.1 Gel liquefaction that exceeds the degree of vitreoretinal dehiscence may end up with anomalous PVD. We propose the term of ‘foveal inpingement’ to describe the subtle foveal contour change described above and believe that this term can gain recognition among the retinal physicians.

Optical Coherence Tomography Characteristics for Differentiating Scars in Type 1 (Polypoidal Choroidal Vasculopathy (PCV)) and Type 2 (Classical) Macular Neovascularization (MNV) in Age-Related Macular Degeneration (AMD).

This study aimed to assess the optical coherence tomography (OCT) characteristics for differentiating scars in the scarred stages of macular neovascularization (MNV) in age-related macular degeneration (AMD). Medical records of 20 patients, 10 in each group with type 1 and type 2 MNV, were selected for the study. Participants chosen were above 50 years of age and underwent comprehensive eye examination alongside indocyanine green angiography (ICGA), fundus fluorescence angiography (FFA), and Spectralis optical coherence tomography (SOCT) (Heidelberg Engineering, Germany), respectively. The qualitative and quantitative OCT measurements, such as the frequency of outer retinal tubulations, presence of cystoid spaces, scar area, choroid thickness, retinal thickness, presence of disorganization in retinal layers (DRIL), foveal contour, and involvement of retinal layers in the scar, were meticulously evaluated and compared between the two groups. Significant disparities between type 1 MNV and type 2 MNV in choroidal thickness were identified in the nasal and superior quadrants within 1 mm, in the superior quadrant within 3 mm, and in all quadrants except the inferior quadrant within 6 mm. Overall, type 2 MNV showed thinner choroid than type 1 MNV. Although there are several overlapping features noticed between the groups, the OCT was able to pick up characteristic features that aid in differentiating type 1 (polypoidal choroidal vasculopathy (PCV)) and type 2 (classic) MNV in AMD. This precise differentiation has the potential to assist ophthalmologists in making well-informed decisions, thereby enhancing patient care.

Spontaneous peeling of an epiretinal membrane in an eye with treated proliferative diabetic retinopathy

An epiretinal membrane (ERM) usually occurs in eyes that have had a posterior vitreous detachment (PVD). Primary causes are typically unknown, but several secondary causes are known, such as retinal vascular disease. The presence of an ERM can exert traction on the neurosensory retina and can also contribute to the development of cystoid macular edema (CME). Rare ERM cases have shown spontaneous separation from the inner retinal surface, often leading to improved visual symptoms. We present a diabetic patient with proliferative diabetic retinopathy treated with panretinal laser photocoagulation who developed a marked ERM. Over a 5 year period, there was liquefaction and separation of the posterior hyaloid along with progressive and spontaneous release of the ERM, leading to improved foveal contour. This case demonstrates the self-peeling of a secondary ERM following PVD formation in an eye with treated proliferative diabetic retinopathy.

Delayed manifestation of a full-thickness traumatic macular hole: Probable causes and consequences – A case report

A 23-year-old male experienced a cricket ball injury to his right eye 1 day ago. Right eye visual acuity was counting fingers close to face. He presented with anterior uveitis, commotio retinae, and vitreous hemorrhage. Steroids and cycloplegics were given. Fundus showed resolved vitreous hemorrhage, a healthy optic disc, patchy epiretinal membrane, choroidal ruptures, peripapillary scarring, and 20/80 vision on follow-up. Patient developed a full-thickness macular hole 11 months after trauma, decreasing vision to 20/120. Exam and optical coherence tomography showed no abnormal posterior vitreous detachment. Macular hole surgery closed the hole with a normal foveal contour without improving vision. At the last follow-up 6 months after surgery, the hole was closed and vision improved to 20/120. A delayed traumatic macular hole unrelated to vitreomacular traction or cystoid macular edema deroofing has not been reported in literature. Traumatic macular hole development may be delayed by secondary epiretinal membrane contraction, ocular movements, or expansion of choroidal rupture.

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment

PurposeTo analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity.Patients and methodsRetrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative.ResultsThere was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal.ConclusionThinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

SURGICAL DRAINAGE METHODS DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Systematic Review and Meta-Analysis.

To assess efficacy and safety outcomes of subretinal fluid drainage methods during pars plana vitrectomy for rhegmatogenous retinal detachment. A systematic search strategy was conducted for studies published between January 2000 and October 2022. Included studies reported on either the safety or efficacy of two or more drainage methods during pars plana vitrectomy for patients with rhegmatogenous retinal detachment. Two randomized and five observational studies consisting of 1,524 eyes were included. Best-corrected visual acuity at the last study observation and primary reattachment rates were similar across groups. A significantly lower risk of epiretinal membrane formation was associated with draining subretinal fluid through preexisting retinal breaks (risk ratio = 0.70, 95% confidence interval = [0.60, 0.83], P = <0.01, I 2 = 0%) or with perfluorocarbon liquid (risk ratios = 0.70, 95% confidence interval = [0.59, 0.83], P = <0.01, I 2 = 0%) compared with posterior retinotomy. The risk of an abnormal foveal contour was significantly greater in perfluorocarbon liquid-treated eyes relative to posterior retinotomy (risk ratios = 1.56, 95% confidence interval = [1.13, 2.17], P = <0.01, I 2 = 0%). No significant differences were observed in the final best-corrected visual acuity at the last study observation and primary reattachment rates across different drainage methods. There remains limited information on the topic, so future research is warranted.

Platelet rich plasma for primary macular hole: A case series.

To evaluate the anatomical and functional macular results and rate of complications following surgical treatment of primary macular hole (MH) with autologous platelet rich plasma (a-PRP) use. retrospective, interventional, non-randomized case series. A cohort of 9 consecutive patients from January 1, 2019 to August 31, 2021 who underwent vitrectomy with a-PRP use for primary MH were included. Anatomical results based on spectral domain- optical coherence tomography (SD-OCT) and visual acuity were analyzed. 10 pseudophakic eye of 9 patients were enrolled. Six patients were female and three patients were male. The mean age was 69.9 years ± 1.48. The baseline MH minimum diameter was 486.1 μm ± 37.1, and mean pre operative best-corrected visual acuity (BCVA) was 0.91 ± 0.03 logMAR (Snellen equivalent 20/160). Mean 1 month post operative BCVA was 0.81 ± 0.57 logMAR (Snellen equivalent 20/130; p = 1.000); mean 3 month post operative BCVA was 0.66 ± 0.04 logMAR (Snellen equivalent 20/90; p = 0.006); mean 6 month post operative BCVA was 0.6 ± 0.04 logMAR (Snellen equivalent 20/80; p < 0.001). In all eyes, 10/10 (100%), there was a complete MH closure at 6 months follow up: 5 eyes (50%) with a U-type closure pattern, 4 eyes (40%) with a V-type pattern and 1 eye (10%) with an irregular foveal contour closure at 6 month follow-up. No ocular and systemic complications were reported. The a-PRP use is a successful and promising vitreoretinal surgical technique option for primary MH.

Effects of internal limiting membrane peeling versus non-internal limiting membrane peeling during vitrectomy for diabetic tractional retinal detachment on postoperative macular thickness, foveal contour, and formation of epiretinal membranes

Aim To investigate the impact of internal limiting membrane (ILM) peeling during vitrectomy for diabetic tractional retinal detachment (TRD) on postoperative central macular thickness, foveal contour, and creation or reformation of epiretinal membranes. Methods In a randomized trial, patients aged 40–65 years old with TRD were recruited from the outpatient clinic in Suez Canal University Hospital from August 2020 to February 2022. Patients were randomized into two groups: group 1 did vitrectomy with ILM peeling, while group 2 did vitrectomy without ILM peeling. At 1, 3, and 6 months after surgery, optical coherence tomography (OCT) was carried out to investigate the central macular thickness (CMT), foveal contour, and epiretinal membrane’s presence. For categorical variables, the Chi-squared test or Fisher’s exact test was performed, while the Student’s t-test was used to assess differences in continuous data. Results Thirty-two patients (16 in each group) completed the required follow-up. There was no significant difference between both groups concerning the affected eye (P=1.00). There was no statistically significant difference regarding the CMT recorded via optical coherence tomography at any point of follow-up in the two groups (P=0.289). Also, there was no statistically significant difference regarding the presence of foveal depression at any point of follow-up in the two groups (P=0.680). On the other hand, the percentage of patients who showed no presence of epiretinal membranes in the ILM peeling group was statistically significant when compared with the non-ILM peeling group (P&lt;0.001). Conclusions ILM peeling decreases the incidence of epiretinal membrane proliferation following diabetic vitrectomy.

Gender- and age-related differences in foveal pit morphology.

To measure the foveal pit morphology parameters and evaluate their correlations with age and sex. A retrospective cross-sectional matched comparison study in a tertiary center. Forty men and 40 age-matched women who had normal macular structures and foveal contours were enrolled. Foveal pit parameters including top width, base width, nasal width, temporal width, minimal thickness, nasal thickness, temporal thickness, nasal height, temporal height, nasal slope, and temporal slope were measured on horizontal B-scan macular optical coherence tomography and compared between men and women. Paired t-tests and Pearson's correlation analysis. The average patient age was 51.4 ± 17.5 (21-84) years. Women had a wider base width (313.1 ± 68.0 μm vs 266.8 ± 70.9 μm, P = 0.006), wider temporal width (1043.1 ± 245.6 μm vs 968.9 ± 261.0 μm, P = 0.006), thinner nasal thickness (345.6 ± 36.2 μm vs 359.7 ± 35.8 μm, P = 0.048), and flatter temporal slope (11.60 ± 2.52° vs 12.98 ± 2.68°, P = 0.016) than men. With age, the base width (r = 0.35, P = 0.025) and temporal width (r = 0.54, P = 0.0003) tended to be wider and the temporal slope was flatter (r = -0.45, P = 0.003) in women but not men. The minimal thickness tended to be thinner in the elderly group (r = 0.038, P = 0.015). Women had a significantly wider base width, wider temporal width, thinner nasal thickness, and flatter temporal slope of the foveal pit than age-matched men. The base width and temporal width were wider and the temporal slope was flatter with age in women but not men.

Macular Imaging Characteristics in Children with Myelinated Retinal Nerve Fiber and High Myopia Syndrome.

To investigate the macular imaging features in patients with unilateral myelinated retinal nerve fiber (MRNF) and high myopia syndrome. Six patients with unilateral MRNF and high myopia syndrome and 13 myopic controls were enrolled in this study. Spectral domain (SD) optical coherence tomography (OCT), SD enhanced depth imaging OCT, and OCT angiography (OCTA) imaging results of MRNF-affected eyes were compared with the fellow eyes and myopic controls. All patients had abnormal foveal reflex and/or ectopia. No significant difference in retinal thickness parameters were noted between the groups. In OCT scans, posterior vitreous detachment (PVD) was observed in 4 out of the 6 MRNF-affected eyes. Regarding OCTA parameters, only a significant increase in acircularity index was noted in myelinated eyes (p=0.01). All patients demonstrated normal foveal contours, macular structure, and OCTA features except for a higher acircularity index. The incidence of PVD was notably increased in the myelinated eyes.

Unilateral macular branch retinal vein occlusion in a healthy Indian woman following coronavirus disease vaccination: a case report and comprehensive literature review

Background: The coronavirus disease (COVID-19) vaccines exert ocular adverse effects, including episcleritis, scleritis, anterior and recurrent uveitis, acute macular neuroretinopathy, paracentral acute middle maculopathy, ophthalmic vein thrombosis, Graves’ disease, arteritic anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, Vogt-Koyanagi-Harada disease, multifocal choroiditis, cranial nerve palsies such as facial or abducens nerve palsy, acute zonal occult outer retinopathy, acute zoster ophthalmicus following re-activation of the varicella-zoster virus, acute retinal necrosis, and multiple evanescent white dot syndrome. In this case report, we explored the possibility of macular branch retinal vein occlusion and its association with COVID-19 vaccination. Case Presentation: A 44-year-old healthy woman presented with unilateral nonprogressive blurring of vision in the right eye (OD). Her best-corrected distance visual acuity (BCDVA) in OD was 20 / 40. The anterior-segment evaluation was normal. Fundus evaluation of the OD revealed macular branch vein occlusion. She had a history of COVID-19 vaccination within 1 month. The interleukin-6 level was elevated six folds to 30.5 pg / mL. However, COVID-19 immunoglobulin G (IgG) antibodies were negative. Infective etiologies, such as tuberculosis and dengue, were ruled out. Spectral-domain optical coherence tomography (SD-OCT) of the OD showed hyperreflective dots in the posterior vitreous, inner retinal swelling, and cystoid changes in the macula. The maximum central macular thickness was 486 mm. A single dose of bevacizumab was administered at OD intravitreally. At the final follow-up 2.5 months later, her BCDVA had improved to 20 / 20 OD. Fundus evaluation revealed fewer retinal hemorrhages and cotton wool spots. SD-OCT of the OD showed a normal foveal contour and absence of cystoid spaces. Her maximum central macular thickness was 236 mm. Conclusions: A temporal effect of vein occlusion secondary to COVISHIELD™ vaccination may occur in the absence of systemic risk factors. The interleukin-6 level was elevated, and the remaining blood test results were within normal limits. Since this is a case report, it is limited by the absence of strong evidence to prove this causal relationship between macular branch retinal vein occlusion and the specific brand of COVID-19 vaccination.

Bergmeister papilla: A unilateral case report

To described enhanced imaging for visualization of anatomic features and microstructures of Bergmeister papilla within the optic nerve in asymptomatic patient.Primary measure is to see any change in the morphological characteristic in asymptomatic patient with Bergmeister papillae.Secondary outcome measures is to see any effect on parameters of OCT in asymptomatic patient with Bergmeister papillae. Carl Zeiss Cirrus HD 21 Line Raster OCT Model 5000 scanning protocol of the optic nerve and the optic disc cube 200×200 program obtains ONH images through a 3.46-mm diameter circle, and the algorithm automatically detects the circle and positions around the ONH and in the macular region were obtained in the both Eye. Fundus photo performed with Zeiss Fundus visucam 500.Clinical examination was carried out with Carl Zeiss Cirrus HD 21 Line Raster OCT Model 5000 scanning protocol of the optic nerve and the optic disc cube 200×200 program obtains ONH images through a 3.46-mm diameter circle was obtained in the both eye. Zeiss Cirrus HD 21 Line Raster OCT showed hyperreflectivity overlying traction on the right optic nerve with normal Foveal Contour while in the left eye (OS) optic nerve and macula were normal. Fundoscopic examination showed in the right eye(OD), a overlying traction was identified in the optic nerve supero-nasal region, while in the left eye(OS), the fundus was normal. Optical coherence tomography helps in identification of Bergmeister papilla with peripapillary vitreous thickening is beneficial in monitoring vitreo-retinal alterations that may cause future vision impairment.

Perfluoro-n-octane-assisted Superior Inverted ILM Flap without Using the Peeling-off Technique for Large Macular Holes

Purpose: To evaluate the surgical outcomes of a perfluoro-n-octane (PFO)-assisted superior inverted internal limiting membrane (ILM) flap without the peeling-off technique for the treatment of a large macular hole (MH).Methods: This retrospective interventional case series examined 13 eyes with a MH ≥ 400 μm. All eyes underwent 25-gauge pars plana vitrectomy. An ILM flap stained with 0.025% brilliant blue G was made in the superior area of the hole. The ILM in the temporal, nasal, and inferior areas around the hole was not peeled off. The hole was gently covered using the inverted ILM flap, which was stabilized using a small amount of PFO. Fluidair exchange was performed slowly. The small amount of residual PFO was removed by evaporation. The patients were instructed to maintain a facedown position for 1 day postoperatively. Anatomical closure of the hole and visual acuity were assessed postoperatively.Results: The average hole size was 605.08 ± 102.41 μm. Nine eyes had an idiopathic MH, two exhibited age-related macular degeneration, and one each had high myopia and a traumatic MH. All eyes achieved type I closure. The foveal contour improved gradually during follow-up: 92.3% of eyes had a U-shaped fovea, and 61.5% exhibited complete recovery of the ellipsoid zone. The visual acuity improved from 0.91 to 0.55 logarithm of the minimum angle of resolution (&lt;i&gt;p&lt;/i&gt; = 0.003).Conclusions: The PFO-assisted superior inverted ILM flap without peeling-off was effective for stabilizing the flap over the hole and consequently achieving good anatomical and visual outcomes in large MHs.

Long-term Follow-up Results of Idiopathic Epiretinal Membrane Removal in the Eyes with Ectopic Inner Foveal Retinal Layers.

The purpose of this study was to evaluate pre- and perioperative factors related to time for the evolution of ectopic inner foveal layers (EIFL) following pars plana vitrectomy (PPV) for epiretinal membrane (ERM) peeling. This retrospective study included 81 consecutive eyes with idiopathic ERM that underwent vitrectomy surgery. Standard PPV + internal limiting membrane peeling was performed in all cases. A comprehensive ophthalmic examination was performed for all patients before and 1, 3, 6, and 12 months, and the last follow-up after surgery. We observed the postoperative improvement in EIFL severity in the short-term and longest follow-up and evaluated anatomical and functional improvement. Several parameters were assessed using the multivariate COX proportional hazard analysis. Eighty patients (81 eyes) with a mean age of 70.33 ± 7.75 years were followed for a mean of 34.37 ± 23.61 months, and 55.5% of eyes (45 eyes) with EIFL ERM showed improvement of foveal contour to a better stage at the last follow-up. The median estimated time for evolving to a better stage was 29.73 months for stage 2, 49.68 months for stage 3, and 38.67 months for stage 4 (P = 0.001, log-rank test). The severity of EIFL was the only significant factor for time to evolution of EIFL ERM to a better stage, where the eyes with stage 4 EIFL ERM showed faster foveal contour improvement compared to those with stage 3 EIFL ERM (hazard ratio: 0.317, 95% confidence interval = 0.164-0.615, P = 0.001). On assessing preoperative factors, the preoperative EIFL stage emerged as the sole significant factor for EIFL ERM improvement to a better disease stage. This study reports some of the longest follow-up durations for patients undergoing PPV for EIFL ERM, and both functional and anatomical improvements were observed across all stages of EIFL, including in the advanced stage 4 EIFL ERM.

EPIRETINAL MEMBRANE WITH FOVEAL HERNIATION: Visual and Surgical Outcomes.

Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. This study describes the visual symptoms and spectral domain optical coherence tomography findings associated with foveal herniation and evaluates the postoperative visual, anatomical, and surgical outcomes. A multicenter retrospective review of patients diagnosed with epiretinal membrane identified 59 patients with preoperative foveal herniation on spectral domain optical coherence tomography. Data regarding visual symptoms, preoperative and postoperative best-corrected visual acuity (BCVA), central retinal thickness, macular volume, and size of foveal herniation were collected, and statistical analysis was performed. A total of 58 of the 59 patients with foveal herniation underwent surgical epiretinal membrane peeling, with foveal contour restored in 53.5% of patients after surgery. Average BCVA improved from 20/80 to 20/40 Snellen equivalent at most-recent postoperative visit (P < 0.0001). The average central retinal thickness decreased from 632 µm to 432 µm (P < 0.0001) and the average macular volume decreased from 11.3 mm3 to 9.5 mm3 (P < 0.0001) at 3 months postoperatively. Preoperatively, greater herniation height was associated with worse BCVA (P = 0.008), greater central retinal thickness (P = 0.01), retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone abnormality, and external limiting membrane abnormalities (P < 0.05). Postoperatively, there was a decrease in retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone, and external limiting membrane abnormality (P < 0.05) on spectral domain optical coherence tomography. Patients with larger foveal herniation height had greater preoperative central retinal thickness, worse preoperative and postoperative BCVA, and more intraretinal abnormalities on spectral domain optical coherence tomography. Surgical epiretinal membrane peeling in patients with foveal herniation resulted in a significant improvement in patients' BCVA and microstructural abnormalities.

Foveal Contour: Presence versus Complete Absence as a Prognostic Factor in Epiretinal Membrane Surgery

Introduction: The study explains the presence versus complete absence of the foveal contour on optical coherence tomography (OCT) image as predictor of improvement in visual acuity (VA) following epiretinal membrane removal surgery. Methods: We conducted a retrospective observational study in which 100 eyes that underwent vitrectomy for epiretinal membrane, with preoperative and postoperative VA and OCT, were analyzed. The study population was categorized into four groups based on the preoperational presence of a foveal contour and an intraocular lens implantation. Results: The most significant improvement in VA was found among eyes lacking a foveal contour. Pseudo-phakic eyes demonstrated greater improvement than phakic. The smallest improvement was documented in pseudo-phakic eyes with a foveal contour. Phakic eyes that had a foveal contour showed deterioration in VA. Among eyes that lacked foveal contour, the fraction of eyes with improved VA was only slightly larger than among pseudo-phakic eyes during midterm follow-up and no difference was observed at long-term follow-up. Among eyes with foveal contour, the fraction with improved VA was significantly larger among pseudo-phakic eyes. This difference became more prominent over long-term follow-up. Regardless of the presence of foveal contour, the fraction of patients whose VA worsened was greater among those with phakic versus pseudo-phakic eyes, and this difference increased during long-term follow-up. No correlation was found between the central macular thickness and the VA. Conclusion: Complete lack of foveal contour is positively correlated with greater improvement in postoperative VA. The presence of an intraocular lens contributes to improvement in VA, especially among patients with foveal contour.

360-degree pedicled inverted internal limiting membrane flap technique without face-down posturing for large idiopathic macular holes: a retrospective case series.

This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible.

Novel optical coherence tomography angiography biomarkers in the diagnosis and assessment of diabetic macular edema and diabetic macular ischemia in patients with non-proliferative diabetic retinopathy.

The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non-proliferative diabetic retinopathy (NPDR). In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT-1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ-CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ-CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.

Swept source optical coherence tomography and optical coherence tomography angiography for diagnosis and follow‐up of type 2 macular telangiectasia

AbstractPurpose: To report the contribution of swept source optical coherence tomography (SS‐OCT) and OCT‐angiography (OCTA) imaging findings in the diagnosis and the follow‐up of type 2 macular telangiectasia (MacTel 2).Methods: A retrospective study of eight eyes (five patients) with various stages of MacTel2. Clinical staging of MacTel 2 was performed based on SS‐OCT and OCTA.Results: The average age was 63 years old. The mean follow up was 33.6 months. A very early non‐proliferative stage was found in three eyes, an early non‐proliferative stage in three eyes and a late proliferative stage in two eyes. The most common findings on SS‐OCT were disruption of the inner segment‐outer segment (IS/OS) layer in all eyes, parafoveal hyporeflective retinal cavities in four eyes and superficial retinal crystals in three eyes. Two eyes showed irregularity of foveal contour and internal limiting membrane draping associated with retinal vascular channels connecting the superficial and deep retinal layers and forming retinal‐choroidal anastomosis. OCTA findings included capillary telangiectatic changes and enlargement of intercapillary spaces predominantly in deep capillary plexus (DCP) in comparison with superficial capillary plexus (SCP) in all eyes. Irregularity of capillary size in the perifoveal region of the DCP and SCP, predominantly temporal to the fovea, was found in five eyes. Circumferential capillary distortions and subretinal neovascularization at the level of the outer retina and choriocapillaris were detectable in two eyes. At the mean period of follow‐up, lesions were stable in two eyes, an extension of IS/OS disruption was noted in four eyes, parafoveal cavities' appearance and/or extension was found in two eyes and neovascular proliferation appeared in one eye.Conclusions: SS‐OCT and OCTA imaging features facilitate the diagnosis, staging and long‐term follow‐ up of MacTel 2. Further prospective studies are need to characterize the progressive and sequential nature of structural changes in this disease.

Tomographic prognostic factors for visual improvement after pars plana vitrectomy for epiretinal membrane

AbstractPurpose: To evaluate postoperative changes and investigate tomographic prognostic factors of visual impairment after vitrectomy for epiretinal membrane (ERM).Methods: A retrospective observational study on patients who underwent pars plana vitrectomy for ERM by a single experimented surgeon. Best corrected visual acuity (BCVA) on the logMAR chart and optical coherence tomography (OCT) features were recorded before surgery and at the last visit. Tomographic parameters analysed were: central foveal thickness (CFT), foveal contour morphology, external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IZ) integrity, the presence of intraretinal fluid (IRF), subretinal fluid, disorganization of retinal inner layers (DRIL) and subfoveal deposits. Student's t‐test and Pearson's correlation coefficients were used for statistical analysis. p Values &lt;0.05 were considered statistically significant.Results: Forty‐seven eyes of 43 patients were included. The mean age was 61.7 years (range 13–87). The ERM was idiopathic in 49% and secondary in 51%. The mean BCVA was 1.02 before and 0.5 after surgery and improved significantly (p &lt; 0.001) with a mean gain of 5.2 lines. The postoperative BCVA correlated strongly with the preoperative one (R2 = 0,764, p &lt; 0.001). Tomographic factors associated with worse final BCVA were higher baseline CFT (p = 0.004), abnormal foveal profile (p = 0.02), the presence of IRF (p &lt; 0.001), DRIL (p = 0.01) and subfoveal deposits (p = 0.04). The disruption of ELM, EZ and IZ were as well associated with a poorer visual outcome (p &lt; 0.001, p = 0.03 and p &lt; 0.001 respectively).Conclusions: ERM surgery provides functional and anatomical improvement. Preoperative OCT is an essential tool to evaluate morphological retinal changes and identify prognostic factors for visual recovery.