Internal Limiting Membrane Removal Research Articles

Paravascular abnormalities in eyes with idiopathic epiretinal membrane.

The purpose was to investigate the paravascular abnormalities (PVA) around the retinal vascular arcades and their post-operative evolution in eyes with epiretinal membranes (ERM). This is an observational case series. Fifty-seven eyes of 55 patients with concurrent PVA and ERM were studied (study group). Forty-one eyes in 41 patients with ERM but no PVA served as controls. Multiple optical coherence tomography (OCT) scans were made along the upper and lower arcades and across the fovea in each patient. Serial fundus photography and OCT scans were performed in eyes receiving an operation. All surgeries were performed by one surgeon. The incidence and location of paravascular retinal cysts, deep cystic spaces underneath the vessels, and paravascular retinal defects, as well as vitreoretinal interface changes, were determined and correlated with macular thickness. In the study group, paravascular retinal cysts were detected in 57 eyes (100%), deep cystic spaces in nine eyes (15.8%), and paravascular lamellar holes in 31 eyes (54.4%). No case had a full-thickness hole. ERM adhesion to the PVA was noted in 16 eyes (28.1%) and internal limiting membrane (ILM) changes over the PVA in 22 eyes (38.6%). Compared with the control, the study group had significantly increased macular thickness. PVA, except lamellar holes, disappeared or decrease in severity after ERM and ILM removal surgery. Different types of PVA are relatively common in eyes with ERM. Our findings suggest that PVA may develop secondary to ERM-induced macular thickening. Except for lamellar holes, most lesions decrease following an operation.

HIGH-RESOLUTION MULTIMODAL IMAGING AFTER IDIOPATHIC EPIRETINAL MEMBRANE SURGERY.

To investigate the changes of the vitreomacular interface during a 1-year follow-up after idiopathic epiretinal membrane (iERM) surgery. Six patients affected by fovea-attached iERM were recruited in this pilot study. Pars plana vitrectomy associated with epiretinal membrane peeling was performed uneventfully in all cases. In four cases, the inner limiting membrane was removed using Brilliant blue G. En face high-resolution adaptive optics and cross-sectional spectral domain optical coherence tomography retinal imaging were performed before and at 1, 3, 6, and 12 months after surgery. The microstructures of vitreomacular interface in high-resolution adaptive optics images were correlated to the cross-sectional spectral domain optical coherence tomography data. Preoperatively, adaptive optics images showed multiple abnormalities of the vitreomacular interface, such as macrofolds, microfolds, and hyperreflective microstructures. We identified two subtypes of iERM according to the distribution of microfolds over the foveal area, which included the radial-type and the grid-type iERM. After surgery, the morphology of the vitreomacular interface changed compared with the preoperative state. The number of both macrofolds and microfolds was reduced in all cases. The hyperreflective structures were still resolvable in all cases, however presenting different shape and morphology than preoperatively. In addition, they showed marked differences between eyes that had internal limiting membrane removal and eyes that did not. Adaptive optics imaging gives new insight into the changes of vitreomacular interface after iERM surgery. Enhanced multimodal imaging of the vitreomacular interface and retinal structures can be valuable to monitor treatment outcome of iERM.

Comparison of refractive error in phacovitrectomy for epiretinal membrane using ultrasound and partial coherence interferometry.

To compare the postoperative refractive error (RE) using A-scan ultrasound (US) and partial coherence interferometry (PCI) after phacovitrectomy for idiopathic epiretinal membrane (iERM) and cataract. Eighty-eight participants (88 eyes) with iERM and cataracts underwent phacovitrectomies with internal limiting membrane removal. Postoperative RE was the main outcome measured, calculated by subtracting intended spherical equivalent (SE) from 6-month postoperative SE. Secondary outcomes included axial length (AL) measured by 2 methods, change in best-corrected visual acuity (BCVA), and change in central subfield thickness (CSFT). Mean postoperative RE using US showed greater myopic shift compared with that using PCI (-0.569 ± 0.571 D vs -0.169 ± 0.415 D, respectively, p<0.001). The 6-month postoperative RE was within ±0.50 D in 43.2% (38/88) using US vs 84.1% (74/88) using PCI and within ±1.00 D in 84.1% (74/88) using US vs 96.6% (85/88) using PCI. Mean AL measured by US was shorter than that measured by PCI (23.50 ± 1.27 mm vs 23.58 ± 1.30 mm, respectively, p<0.001). Postsurgery, BCVA improved from 0.374 ± 0.264 logMAR to 0.144 ± 0.124 logMAR (p<0.001), and CSFT decreased from 449.2 ± 78.5 µm to 378.2 ± 47.0 µm (p<0.001). The BCVA improvement significantly correlated with decreased CSFT (R = 0.268, p = 0.011). Estimation of intraocular lens power for phacovitrectomies for iERM and cataracts is more accurate when assessed by PCI than by US.

Correlation between foveal interdigitation zone band defect and visual acuity after surgery for macular pseudohole.

To determine the correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for a macular pseudohole. Thirty-one eyes of 31 patients with a macular pseudohole underwent vitrectomy with internal limiting membrane removal. The foveal area was examined by spectral domain optical coherence tomography preoperatively and postoperatively. The correlations between the BCVA and the lengths of the photoreceptor interdigitation zone (IZ), the ellipsoid zone, and the external limiting membrane band defects, and central foveal thickness were determined. The BCVA improved significantly and the length of the IZ band defect decreased significantly after the surgery. Simple linear regression analyses showed that the BCVA was significantly correlated with the length of the IZ band defect preoperatively and also at 1 to 12 months postoperatively (P < 0.001 for all). The BCVA was not significantly correlated with the length of the ellipsoid zone, external limiting membrane band defect, and the central foveal thickness. The significant correlation between the length of the foveal IZ band defect and the BCVA preoperatively and postoperatively indicates that the foveal IZ band is related to the visual recovery in patients with macular pseudohole.

Retinal Damage Induced by Internal Limiting Membrane Removal.

The internal limiting membrane (ILM), the basement membrane of the Müller cells, serves as the interface between the vitreous body and the retinal nerve fiber layer. It has a fundamental role in the development, structure, and function of the retina, although it also is a pathologic component in the various vitreoretinal disorders, most notably in macular holes. It was not until understanding of the evolution of idiopathic macular holes and the advent of idiopathic macular hole surgery that the idea of adjuvant ILM peeling in the treatment of tractional maculopathies was explored. Today intentional ILM peeling is a commonly applied surgical technique among vitreoretinal surgeons as it has been found to increase the rate of successful macular hole closure and improve surgical outcomes in other vitreoretinal diseases. Though ILM peeling has refined surgery for tractional maculopathies, like all surgical procedures it is not immune to perioperative risk. The essential role of the ILM to the integrity of the retina and risk of trauma to retinal tissue spurs suspicion with regard to its routine removal. Several authors have investigated the retinal damage induced by ILM peeling and these complications have been manifested across many different diagnostic studies.

Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective, randomized comparative study.

Background:The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema.Materials and Methods:This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis.Results:In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group.Conclusion:Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.

Evaluation of the dual staining technique for complete removal of idiopathic epimacular membranes

Purpose This study tries to evaluate the usefulness of the dual staining first with Triamcinolone acetonide (TA) to effectively visualize and remove the fibrous component of idiopathic epimacular membrane (EMM) and then with brilliant blue G (BBG) to selectively remove the internal limiting membrane (ILM). The primary outcome was the visual acuity improvement and the concomitant decrease in the central macular thickness (CMT) after surgery, and the secondary outcome was the condition of the ILM after this dual staining. Subjects and Methods A prospective, non-randomized, observational cohort study including 15 eyes .The inclusion criterion was a clinically detectable idiopathic EMM diagnosed by fundus examination or optical coherence tomography (OCT), causing a decrease of visual acuity. The exclusion criteria included prior intravitreal injection of TA or antivascular endothelial growth factor, ocular inflammation or prior trauma. During a standard 23 G vitrectomy, peeling the EMM was carried out after administration of TA, BBG (0.25 mg /mL) was injected onto the retinal surface utilizing the ''dry method'' or the ''air-filled technique''. Both stains will be completely washed out immediately. Then the surgeon recorded the characteristics of the underlying ILM before peeling. Postoperatively the patients were followed up at 1 day, 1 week, 1 month and at 6 months. Primary and secondary outcomes were recorded. Results Our patients included 8 (53.3%) females and 7 males (46.7%). A single surgeon performed all surgeries. TA was used to identify the posterior hyaloid in all 14 cases (93.3%) with no prior vitreous surgery and to effectively visualize and remove the idiopathic EMM in all 15 cases. Three (20%) of the cases had EMM remnants after BBG staining. When this dye was used to stain the ILM during surgery, the unstained EMM clearly stood out against the ILM, which was stained blue. After EMM peeling, all of the eyes had residual ILM except one (6.3%). In all eyes, the surgeon was unable to determine the status of the ILM before BBG staining. The ILM was present and damaged in 8 eyes (53.3%), while it was present and undamaged in 6 (40%). The mean preoperative CMT in eyes were the ILM was found to be damaged on table was 565.3 ± 79.9 μm, while the mean preoperative CMT in eyes were the ILM was undamaged was 446.6 ± 34.4 microns, this was statistically significant (P = 0.005). At 6 months, decimal BCVA improved from 0.18 ± 0.06 at baseline to 0.53 ± 0.11 (P = 0.005). Again at 6 months, the CMT also improved from 506.2 ± 90.03 ΅m at baseline to 365.8 ± 53.3 μm (P Conclusions In conclusion, dual staining starting with TA effectively led to adequate visualization and removal of the posterior hyaloid as well as the fibrous component of the idiopathic EMM. The subsequent BBG administration in an air filled vitreous (the dry technique) helped selective removal of the ILM with no deleterious effects on the functional or the anatomical outcomes of the procedure as demonstrated by the significant improvement in both the BCVA and the CMT 6 months after surgery.

Surgical results of idiopathic and secondary epiretinal membrane.

The aim of the study is to compare the surgical results of patients with an idiopathic and secondary epiretinal membrane (ERM) after pars plana vitrectomy and membranectomy. The medical records of 51 consecutive patients with ERM who underwent pars plana vitrectomy and membranectomy with a follow-up >1 year were reviewed retrospectively. Age, sex, best-corrected visual acuity (BCVA, logMAR), lens status, presence of additional removal of internal limiting membrane (ILM), and recurrence rate within 1 year after the operation were compared in the idiopathic and secondary ERM groups. Forty-one eyes had idiopathic ERM and 10 eyes had secondary ERM. Preoperative average BCVA values in the two groups were 0.47 and 0.70, respectively, and the postoperative average BCVA values were 0.28 and 0.18, respectively, with significant improvement postoperatively in both groups (p < 0.01, p < 0.01). The recurrence rate within 1 year after surgery in the idiopathic group was 4.88 % and that in the secondary group was 20 % (p = 0.03). The recurrence rate was 4.3 % in the idiopathic group with ILM removal and it was 5.9 % without ILM removal (p = 0.03). No case recurred within 1 year in the secondary group with ILM removal but the recurrence rate was 33.3 % in the group without ILM removal (p = 0.01). Although patients with secondary ERM gained better visual acuity improvement postoperatively, the recurrence rate was higher within 1 year than that of patients with idiopathic ERM. Removal of the ILM may lower recurrence rates.

Evaluating Dissociated Optic Nerve Fiber Layer Appearance Using En Face Layer Imaging Produced by Optical Coherence Tomography

Purpose: To investigate the incidence of and risk factors for a dissociated optic nerve fiber layer (DONFL) appearance after pars plana vitrectomy (PPV). Methods: We retrospectively reviewed 189 eyes that underwent PPV with internal limiting membrane removal and judged the presence/absence of an apparent DONFL based on en face layer images produced by spectral-domain optical coherence tomography (SD-OCT). Results: An apparent DONFL was observed in 47 (24.9%) eyes. The incidence of an apparent DONFL was significantly higher in the macular hole (MH) group (76.5%) than in the non-MH group (epiretinal membrane, diabetic macular edema, retinal vein occlusion, and others; 4.9%; p < 0.001). In the logistic regression analysis, surgical indication for MH was identified as the most significant DONFL risk factor (odds ratio 63.7; p = 1.05 × 10^-8). Conclusion: Postoperative OCT en face layer imaging clarified that MH eyes are liable to have an apparent DONFL following PPV.

Comparative analysis of vitreofoveolar traction syndrome surgical treatment

This article focuses on the surgical treatment of the vitreomacular traction ( VMT) syndrome comparing vitrectomy with and without internal limiting membrane (ILM) removal. Patients were randomly divided into 2 groups. In the 1st group, the procedure was performed without the ILM removal. In the 2nd group, the surgery was performed with perifoveolar ILM removal. A comparative analysis revealed that an anatomical result was reached in both groups, but in the 1st group, the development of epiretinal fibrosis was observed in 35 % of the cases in the late postoperative period; and this was not observed in the 2nd group. Visual function recovery was faster in the 1st group, but at 1 year visit, data from both groups were comparable. Thus, the treatment method with surgical ILM removal is preferable, due to more stable anatomical result.

VITRECTOMY FOR MYOPIC FOVEOSCHISIS WITH INTERNAL LIMITING MEMBRANE PEELING AND NO GAS TAMPONADE

To evaluate the outcome of vitrectomy with internal limiting membrane peeling and no gas tamponade in the treatment of eyes with myopic foveoschisis. Medical records of 10 eyes of 9 consecutive patients with myopic foveoschisis without macular hole treated by vitrectomy were reviewed. The patients' refractive error was -4.00 diopters to -34.00 diopters, and axial length was 28.38 mm to 35.90 mm. Six eyes had foveal retinal detachment with retinoschisis. All cases were treated by vitrectomy with internal limiting membrane removal without gas tamponade. The mean preoperative best-corrected visual acuity was 0.61 ± 0.42 in logarithm of the minimum angle of resolution units (Snellen equivalent of 20/82). Myopic foveoschisis was reduced in 8 eyes (80%) with a single surgery. Two eyes without improvement developed a postoperative macular hole and were treated by additional vitreoretinal surgery. All 10 eyes showed anatomical repair, and 5 eyes showed improvement in best-corrected visual acuity to 0.47 ± 0.48 (Snellen equivalent of 20/60), by 17 months after the initial surgery. Vitrectomy with internal limiting membrane peeling and no gas tamponade can effectively treat some cases of myopic foveoschisis, suggesting that tractional forces at the vitreoretinal interface may contribute to the pathogenesis of myopic foveoschisis, thereby avoiding gas tamponade.

Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Holes

To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes. Prospective, interventional case series. Ten eyes of 10 consecutive patients who underwent autologous transplantation of the ILM for the treatment of refractory macular holes were studied. The primary diseases in these patients were large idiopathic macular holes that had existed for more than 1 year (4 eyes), a traumatic macular hole (1 eye), myopic foveoschisis (2 eyes), foveoschisis resulting from pit-macular syndrome (2 eyes), and proliferative diabetic retinopathy (1 eye). Apart from the 5 eyes with idiopathic or traumatic macular holes, macular holes developed in the other 5 eyes after initial vitrectomies with ILM removal. In all eyes, regular macular hole surgery failed to achieve closure. The main outcome measures used in this study were macular hole closure and best-corrected visual acuity (BCVA). Macular holes were closed successfully in 9 eyes (90%) after autologous transplantation of the ILM. The postoperative BCVAs were significantly better than the preoperative BCVAs (P = .007, paired t test). Postoperative BCVAs improved by more than 0.2 logarithm of the minimal angle of resolution units in 8 eyes (80%) and were unchanged in 2 eyes (20%). Although this is a pilot study, the results suggest that autologous transplantation of the ILM may contribute to improved anatomic and visual outcomes in the treatment of refractory macular holes and may warrant further investigation.

Assessment of Visual Function in Patients with Retinal Detachment after Vitrectomy with and without ILM Peeling

Purpose: To determine the influence of peeling the internal limiting membrane (ILM) on visual acuity, M-Charts, visual field and OCT in patients with retinal detachment.Methods: We have analyzed 63 patients in three groups. The first group (group B) consisted of 26 patients who underwent vitrectomy with ILM peeling performed after staining with Brilliant Peel. The second group (group G) consisted of 23 patients, in whom ILM peeling was performed after staining with indocyanine green. The third group (group Z) consisted of 14 patients in whom ILM peeling had not been performed. Ocular examination involved the assessment of visual acuity for distance and near vision, visual field testing, metamorphopsia quantification, dilated fundus exam and OCT.Results: There was a statistically significant improvement in the postoperative best corrected visual acuity for distance vision in groups B (p=0.00007), G (p=0.0002) and Z (p=0.003). There were statistically significant differences in the prevalence of ellipsoid layer photoreceptors abnormalities between the groups (p=0.004), with more abnormalities in group Z (64%) as compared to groups B (20%) and G (17%). Statistical analysis also revealed significant differences in the epiretinal membrane (ERM) incidence between the three groups (p=0.02), with ERM occurring more frequently in group Z (29%) as compared to groups B (4%) and G (4%).Conclusions: ILM peeling does not adversely or positively affect the distance and near vision, visual field and MCharts. Therefore ILM removal could be considered in only selected cases of “macula-off” retinal detachment.

Intraoperative Grasp Site Correlation With Morphologic Changes in Retinal Nerve Fiber Layer After Internal Limiting Membrane Peeling

Recent reports have demonstrated inner retinal changes after internal limiting membrane (ILM) peeling, but the mechanism responsible for these findings remains poorly understood. The purpose of this report is to establish a correlation between ILM removal and postoperative morphologic changes. Prospective, observational case series of eight consecutive patients undergoing pars plana vitrectomy with ILM peeling for macular hole or epimacular membrane. Intraoperatively, all grasp sites were recorded and subsequently superimposed on postoperative infrared and spectral-domain optical coherence tomography (SD-OCT) images. Repeat examination and imaging were performed at regular postoperative intervals. Infrared fundus photography revealed well-defined, hyporeflective arcuate striations in all patients during the early postoperative period. These defects followed the course of axonal pathways from the grasp site to the optic nerve. SD-OCT images on all patients revealed early focal nerve fiber layer swelling directly corresponding to grasp sites, with eventual atrophy. A dynamic process takes place within the inner retina following surgical removal of ILM. Inadvertent surgical trauma induced by ILM forceps may be the mechanism responsible for nerve fiber layer morphologic changes after ILM peeling.

INTERNAL LIMITING MEMBRANE CONTRAST AFTER STAINING WITH INDOCYANINE GREEN AND BRILLIANT BLUE G DURING MACULAR SURGERY

To evaluate the difference in color contrast by performing a color contrast ratio (CR) analysis and resulting visibility of the internal limiting membrane (ILM) when stained with indocyanine green and brilliant blue G (BBG) during macular surgery by performing a color CR analysis. The authors analyzed 40 consecutive cases in which vitrectomy with ILM removal was performed to treat a macular hole or an epiretinal membrane. The surgical procedure was performed in 21 patients (21 eyes) after staining with indocyanine green and in 19 patients (19 eyes) after staining with BBG. The color CRs were estimated based on digital analysis of the red, green, and blue data of the digital images captured, and the CRs obtained with the two dyes were compared. Color contrast analysis was performed in all 40 eyes, in which the ILM was removed after staining with indocyanine green or BBG, and the CRs were estimated in every eye. The CR (mean ± SD) obtained with indocyanine green and BBG was 4.3 ± 0.3 and 2.4 ± 0.1, respectively. Indocyanine green provided a significantly higher CR than BBG (P = 0.015). Digital color contrast analysis can be used to evaluate the visibility of digital images, and it may be useful when choosing the dye to use for staining the ILM better.

The Effect of Autologous Serum on Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole

We sought to evaluate the effects of intraoperative adjunctive autologous serum in idiopathic full-thickness macular hole surgeries, and to compare the surgical outcomes with a no-serum control group. In this retrospective, case-control study, 38 consecutive eyes received vitrectomy with internal limiting membrane removal for idiopathic full-thickness macular holes. Two groups were created according to the use of autologous serum. Outcome measures were visual acuity (VA), closure of the macular hole confirmed by optical coherence tomography, and surgical complications. Anatomical closure of the macular hole was achieved in 18 of 19 eyes (94.7%) in the vitrectomy with the autologous serum group, and in 18 of 19 eyes (94.7%) in the control group. The closure rates did not differ significantly between 2 groups (P=1.000; the Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in both groups (SD, standard deviation) [from 1.08 (0.21) to 0.47 (0.21) in vitrectomy with the serum group and from 1.01 (0.32) to 0.44 (0.30) in the control group (both P<0.001; 2 tailed, paired t test)]. There was no significant difference between these 2 groups in terms of visual outcomes (P=0.738; 2-tailed t test). There were no surgical complications, such as retinal detachment and endophthalmitis. The outcome of macular hole surgery did not differ both anatomically and functionally regardless of the use of adjuvant autologous serum. There seemed to be no additive effect with autologous serum.

Delayed onset inner nuclear layer cystic changes following internal limiting membrane removal for epimacular membrane

To report the rare occurrence of new inner nuclear layer cystic spaces occurring in eyes treated with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal for idiopathic epimacular membrane (EMM). Consecutive patients with EMM without preoperative retinal cystic changes undergoing PPV with ILM peeling were retrospectively evaluated. Patients developing a characteristic inner nuclear layer cystic change were analyzed. Inner nuclear layer cystic changes appeared in eight of 768 (1.04%) eyes at a mean postoperative time period of 3.2 ± 0.89months. No leakage or pooling was demonstrated on postoperative fluorescein angiography. Morphologic characteristics included vertically elongated hyporeflectant spaces within the inner nuclear layer on spectral domain optical coherence tomography (SD-OCT). A minority of patients undergoing PPV with ILM peeling develop new, delayed onset, postoperative inner nuclear layer cystic spaces with a characteristic SD-OCT appearance and no evidence of angiographic leakage.

POSTERIOR HYALOID DETACHMENT AND INTERNAL LIMITING MEMBRANE PEELING ASSISTED BY ANTHOCYANINS FROM ACAI FRUIT (EUTERPE OLERACEA) AND 10 OTHER NATURAL VITAL DYES

The purpose of this study was to determine whether natural dyes facilitate posterior hyaloid detachment (posterior vitreous detachment [PVD]) and retinal internal limiting membrane (ILM) peeling in human eyes. Open-sky vitrectomy with posterior hyaloid and ILM removal was performed in 86 human cadaveric eyes. After core vitrectomy, 11 different dyes were injected into the vitreous cavity to aid hyaloid detachment and ILM removal. The dyes were allowed to settle on the macula for 5 minutes after PVD and were removed by mechanical aspiration. Intraocular forceps were used for ILM peeling, which was confirmed by light microscopy of the peeled tissue. Acai fruit (Euterpe oleracea) extract and 10 additional dyes from plants or animal sources were tested: pomegranate (Punica granatum), logwood (Haematoxylum campechianum), chlorophyll extract from alfalfa (Medicago sativa), cochineal (Dactylopius coccus), hibiscus (Hibiscus rosa-sinensis), indigo (Indigofera tinctoria), paprika (Capiscum annuum), turmeric (Curcuma longa), old fustic (Maclura tinctoria), and grape (Vitis vinifera). The dyes facilitated PVD and ILM peeling. Acai fruit (E. oleracea) extract, logwood (H. campechianum), cochineal (D. coccus), and old fustic (M. tinctoria) facilitated PVD in all cases; dye-assisted PVD was compared with triamcinolone-assisted PVD performed previously in a comparative model. Acai fruit (E. oleracea) extract, cochineal (D. coccus), and chlorophyll extract from alfalfa (M. sativa) showed the best capability for ILM staining; dye-assisted ILM removal was compared with the ILM peeling guided by indocyanine green staining performed previously in a comparative model. Light microscopy confirmed the ILM removal in all cases. Anthocyanin dye of the acai fruit (E. oleracea) and the dyes from cochineal (D. coccus) and chlorophyll extract from alfalfa (M. sativa) resulted in the best capability for posterior hyaloid and ILM staining in human cadaveric eyes and may be a useful tool for vitreoretinal surgery.

Idiopathic Macular Hole Vitrectomy Without Postoperative Face-Down Positioning Performed by Different Surgeons.

To evaluate the efficacy of vitrectomy with internal limiting membrane peeling and sulfur hexafluoride gas tamponade without postoperative face-down positioning for macular holes (MHs) when performed by 3 surgeons at 2 centers. A retrospective, consecutive, observational case series. Fifty-seven eyes operated on by 1 of 3 surgeons and followed for 12 months after surgery were studied. Exclusion criteria included cases with MH duration longer than 6 months, secondary MH, and clear lenses. The surgical procedure involved cataract extraction and intraocular lens implantation in all phakic eyes before vitrectomy. Internal limiting membrane removal and 20% sulfur hexafluoride gas tamponade without postoperative face-down positioning were performed in all cases. Preoperative factors [age at surgery, sex, symptom duration, visual acuity (VA), MH size, and MH stage], initial and final hole-closure rates and VA at 1, 3, 6, and 12 months after surgery, were evaluated. Mean patient age was 65.3 years. Of the 57 eyes, 40 were in women, and 17 were in men. Macular hole (mean size, 0.30 disc diameter) was present for a mean of 2.37 months. Eight eyes had stage 2, 37 had stage 3, and 12 had stage 4 MH. Fifty-four holes (94.7%) initially closed. Final closure rate was 100%. Mean VA significantly improved from 0.65 to 0.41 at 1 month, 0.35 at 3 months, 0.28 at 6 months, and 0.21 at 12 months after surgery. Vitrectomy without face-down positioning for MHs produced favorable anatomic and functional results, regardless of which surgeon performed the procedure.

Pars plana vitrectomy with internal limiting membrane removal in type 2 idiopathic macular telangiectasia.

To report the anatomical and visual outcomes in a series of patients with type 2 idiopathic macular telangiectasia (mactel) and cystic foveal changes treated with pars plana vitrectomy and internal limiting membrane removal. Five eyes of 3 patients with mactel were treated with 25-gauge sutureless transconjunctival pars plana vitrectomy and internal limiting membrane peeling. Complete clinical examination, including serial spectral-domain optical coherence tomography, was performed preoperatively and postoperatively. Two of 5 eyes had stable vision at 2-year follow-up with continued evidence of foveal cystic spaces on spectral-domain optical coherence tomography. Two eyes experienced significant visual improvement despite continued evidence of foveal anatomical disruption. One eye experienced slight visual decline and full-thickness macular hole formation. Surgical intervention involving pars plana vitrectomy with internal limiting membrane peeling may be a treatment option for select cases of mactel. Pars plana vitrectomy does not seem to alter the underlying disease process in mactel but may stabilize visual decline or lead to improved vision in some patients.