Macular Pathology Research Articles

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study

BackgroundDiffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling.MethodsThis is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE).ResultsMean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 μm with the ERM to 313.70 ± 36.98 μm after PPV. Mean SE after lensectomy was − 0.18 ± 0.38 D, which minimally changed to – 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV.ConclusionPPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

5xFAD mouse model develops visual dysfunction together with protein aggregation

AbstractPurposeDisturbed proteostasis and protein aggregation have a key role in Alzheimer´s disease and age‐related macular degeneration pathology. In this study, we assessed the electrophysiological and protein aggregation related biomarker changes in 5xFAD mouse model.MethodsScotopic and photopic electroretinograms (ERG) were recorded at 3, 6, 9 and 12‐ months old animals followed by optical coherent tomography (OCT) (WT; n = 12, 5xFAD; n = 12). The eyes of 3‐ and 6‐month‐old WT (n = 5) and 5xFAD (n = 5) were used in immunohistochemistry. The paraffin sections were immunostained with the key regulators of lysosomal and proteasomal clearance.Results5xFAD mice showed decreased scotopic and photopic ERG signaling over time compared to WT mice. However, there were no clear changes in OCT between groups. Immunohistochemistry results revealed that proteasomal clearance was disturbed in 6‐month‐old 5xFAD mice compared to WT. Interestingly, there were no changes in autophagy biomarkers.Conclusions5xFAD mouse is a good model to study visual function and protein aggregation mechanism in response to degenerative retina processes.

Remote patient monitoring of central retinal function with MACUSTAT®: A multi-modal macular function scan.

IntroductionThere is significant unmet need for patient-centric remote monitoring of visual function for chronic retinal diseases, as demonstrated by the COVID-19 pandemic. The Macustat® central retinal function scan is a novel cloud-based digital health application for remote monitoring. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations.Materials and methodsPatients with underlying macular pathology underwent office-based retinal and visual acuity examinations and OCT macula imaging followed by remote tele-monitoring assessment with the Macustat. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation.ResultsThe foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan.ConclusionThe Macustat demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.

Age- and gender-based morphometric variation of macula in indian population using optical coherence tomography

Introduction: Histological morphometric analysis of retinal layers has inherent limitations while processing the specimen. A new in vivo technique, optical coherence tomography (OCT), has been developed that can be used to analyze and differentiate normal and pathological retina. To do a morphometric analysis of normal macula in the adult population of India and study its variations on the grounds of sex and age. Material and Methods: One hundred (200 Eyes) healthy adult subjects (18–65 years) underwent macular cube scanning using Zeiss spectral-domain OCT (SD-OCT). Macular thickness from all nine regions of the Early Treatment Diabetic Retinopathy study map was documented for each subject. Their variations for age and sex were determined manually and automatically. Statistical analysis was done by entering into an MS Excel sheet using IBM SPSS Statistics for Windows,Version 25.0. Armonk, NY: IBM Corp. (2017). The data were also analyzed using an independent t-test and analysis of variance. Results: The mean age of the subjects was 34.2 ± 13 (range, 19–65) years. The mean Central Subfield Thickness (CST) measured automatically (foveal thickness) and manually was 239.52 ± 22.9 μm and 167.75 ± 21.94 μm, respectively, while mean macular thickness was 284.73 ± 15.7 μm and 276.76 ± 14.84 μm. Males were associated with greater foveal, central foveal thickness, and mean macular thickness than females (P < 0.0001). There was no significant correlation of CST, outer and inner ring, and mean macular thickness with increasing age (>30 years). However, with respect to gender in the inner ring (parafoveal region), all the quadrants except the inferior quadrant, CST was significantly (P < 0.0001) higher in males than females while in the outer ring (perifoveal region), it was the temporal quadrant that had statistically significant higher CST in males compared to females. Discussion and Conclusion: The results will add evidence and can serve as a normal database in morphometry of macula in Indians, created and found significantly different in already fed normal comparative data in SD-OCT machines. It will help analyze morphometry of macula and understand macular pathologies in Indian eyes.

Visual Outcome after Vitrectomy with Subretinal tPA Injection to Treat Submacular Hemorrhage Secondary to Age-Related Macular Degeneration or Macroaneurysm.

Purpose To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy, subretinal injection of tissue plasminogen activator using the EVA Surgical System, and pneumatic displacement with air to treat submacular hemorrhages. Methods Retrospective analysis of 93 eyes surgically treated for submacular hemorrhage caused by neovascular AMD or retinal macroaneurysms. Main Outcome Measures. Postoperative visual acuity and surgical complications. Results After surgery, visual acuity improved after 6 weeks but decreased again at the final postoperative visit at 8 months due to progression of the underlying disease. Complications consisted of 2 cases of retinal pigment epithelial tear, 7 vitreous hemorrhages, 4 hyphema, 6 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period. Conclusions This study suggests that a surgical approach with 23G vitrectomy, subretinal tPA injection, and pneumatic displacement using air may be an effective procedure for submacular hemorrhage displacement in patients with AMD and retinal macroaneurysms. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.

Visual outcomes and treatment adherence of patients with macular pathology using a mobile hyperacuity home-monitoring app: a matched-pair analysis

ObjectiveWe compared patients with neovascular age-related macular degeneration (nvAMD), diabetic macular oedema (DMO) and other macular pathologies testing their vision with the hyperacuity home-monitoring app Alleye to patients not performing...

Features of Phacoemulsification in Macular Pathology. Part 1. Diagnostic Aspects

Cataract is the most common cause of blindness worldwide. The standard treatment for cataracts is phacoemulsification with implantation of an intraocular lens (IOL). Removing cataracts can significantly improve vision and the quality of life associated with vision. The review considers the necessary biometric studies before phacoemulsification of patients with macular pathology, the long-term effects of phacoemulsification in patients with various macular pathologies, the features of implantation of mono- and multifocal IOLs in such patients, as well as possible complications after phacoemulsification in patients with macular pathology. The importance of examination of the macula before phacoemulsification of cataract has been shown. A review of changes in different eye’s parts after phacoemulsification in patients with various pathologies: with the progression of myotic traction, with combined cataract and glaucoma, in patients with diabetes, with an epiretinal membrane, and the features of implantation of multifocal lenses and IOLs with UV protection are considered. Not only the postoperative condition is assessed, but also the changes between the preoperative and postoperative conditions. In addition, the review demonstrates the dynamic healing processes and changes in macular parameters (after different times — from several days to several years) in order to obtain a rational analysis result.

Features of Phacosurgery in Macular Pathology. Part 2. Сapabilities of Optical Correction

Cataracts and age-related macular degeneration (AMD) are the leading causes of blindness worldwide. The main symptoms of AMD are: a gradual decrease in visual acuity to the hundredth, metamorphosis, the appearance of a central scotoma, which reduces the quality of life of the patients and leads to disability. Prosthetic and stationary means of optical rehabilitation, such as magnifiers for the visually impaired, glasses, video systems are cumbersome and poorly functional. An alternative correction option is intraocular vision devices that improve the patient’s quality of life. The review considers various types of intraocular implants, in particular, the intraocular telescope system (intraocular miniature telescope-IMT, IOL-VIP, IOL-AMD), Fresnel lens, Lipschitz lens, Scharioth macular lens (Scharioth macula lens, SML), EyeMax Mono, LENTIS ® MAX IOL LS-313 MF80. The use of high-tech devices for the correction of visual disturbances in AMD has opened a new direction in the rehabilitation of low vision. Further study and implementation of the latest generation of “macular” lenses will improve the quality of life of patients with advanced stages of AMD.

Charles Bonnet Syndrome in Patients with Open-Angle Glaucoma: Prevalence and Correlation to Visual Field Loss

To determine the prevalence and characteristics of Charles Bonnet Syndrome (CBS) and its relation to visual field loss (VFL) in patients with open-angle glaucoma (OAG). Prospective, cross-sectional study. Adult patients (n= 337) with manifest OAG with verified VFL and without significant macular disease or extraocular conditions known to cause visual hallucinations. Patients attending the glaucoma outpatient department of the Skåne University hospital, Malmö, Sweden, between April 1, 2018, and December 31, 2018, were consecutively evaluated for inclusion. Potentially eligible patients admitting to having complex visual hallucinations were interviewed to explore the characteristics of their hallucinatory experiences. Recent automated visual field examinations were available for all participants, and swept-source OCT was performed in participants with CBS to rule out previously undiagnosed macular pathology. The correlation between potential risk factors and CBS was evaluated with logistic regression analysis. Prevalence of CBS in patients with OAG. Charles Bonnet Syndrome was found in 7.1% (95% confidence interval [CI], 4.7-10.6) of patients with OAG. Participants with CBS were more likely to have at least 1 eye with a visual field index (VFI) of ≤30% compared with those without CBS (71% vs. 34.2%; P= 0.001). Although the best-corrected visual acuity (BCVA) in the worse eye was significantly lower in participants with CBS (decimal equivalent of Snellen BCVA: 0.25 vs. 0.6, P= 0.003), 33% of these participants had a BCVA of ≥0.5 in the worse eye. In multivariable analysis, CBS was correlated to the VFI of the better eye (odds ratio, 0.984; 95% CI, 0.969-0.998, P= 0.030) and the BCVA of the worse-seeing eye (odds ratio, 0.210; 95% CI, 0.046-0.952, P= 0.043). Charles Bonnet Syndrome was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, 1 of 3 patients with CBS hada BCVA of ≥0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms ofCBS in patients with glaucomatous VFL even when visual acuity is preserved.

Имплантация мультифокального хрусталика в хирургии катаракты у пациентов после витреоретинальной операции

Purpose. To study the results of cataract surgery with implantation of multifocal IOLs in patients with various retinal pathologies who underwent vitreoretinal surgery. Material and мethods. Fifteen patients who had previously undergone vitreoretinal interventions for macular hole (n=6), epiretinal membrane (n=4) and retinal detachment (n=5) were observed. The criterion for choosing in favor of multifocal lens implantation was high visual acuity (0.7 or more) after undergoing vitreoretinal surgery. All patients underwent cataract phacoemulsification with implantation of two types of multifocal lenses: I group – IOL with an extended near focus (EDOF) (n=8) and II group – with a multifocal three-focus lens (n=7 eyes), including, in 3 cases – with toric component. In 55% of cases, the operation was performed on both eyes. The age of the patients varied from 34 to 59 years (51.4 ± 6.1 years). Results. Long-distance uncorrected visual acuity varied from 0.7 to 1.0 (0.85±0.25), which did not depend on the type of intraocular lens and correlated with morphological changes in the macular region of the retina. The highest uncorrected visual acuity (0.8±0.14) at an intermediate and near distance (0.75±0.25) was achieved in I group of patients. Postoperative spherical equivalent after 1 month corresponded to the planned target refraction (Em±0.5 diopters) in 14 cases and remained stable during 12 months of observation. In general, subjective satisfaction with MIOL implantation was higher in patients in II group, which was explained by minimal changes in the macular region of the retina. Additional spectacle correction for near was required for a patient of I group with a history of macular rupture, who underwent bilateral multifocal IOL implantation with high uncorrected visual acuity in the distance (OD=1.0 \ OS=1.0) and near (OD=0.6 \ OS=0,5). Conclusion. Implantation of multifocal lenses in patients with a good anatomical and functional outcome of vitreoretinal surgery allows obtaining high and stable functional results. Bilateral implantation of a multifocal lens with an extended near focus in patients with operated macular pathology does not cause specific adaptive difficulties in binocular vision. The choice in favor of multifocal lens implantation in patients with vitreoretinal pathology requires an individual approach and careful selection. Key words: multifocal lens, cataract, macular hole, retinal detachment, epiretinal membrane.

Interpretation of Retinal OCT

With the recent advances in ophthalmic imaging, optical coherence tomography (OCT) has emerged as a non-invasive, very useful, and sensitive tool to produce high-resolution, cross-sectional images of the macula and the optic nerve head. OCT has been well absorbed in the clinical practice where it has been used to assess the different layers of the retina and to some extent choroid in the newer machines. This article helps us to understand the step-by-step interpretation of OCT in various macular and retinal pathologies, its diagnosis, follow-up, and management.

Utility of IOLMaster 700 Swept-Source Optical Coherence Tomography in Detecting Macular Disease for Preoperative Cataract Surgery Patients.

PurposeTo assess the efficacy of IOLMaster 700 (IOLM) biometer swept-source optical coherence tomography (SS-OCT) in detecting macular pathology before cataract surgery and to compare IOLM SS-OCT characteristics of foveal pathology with a widely used spectral-domain OCT (SD-OCT) system.Patients and MethodsRetrospective analysis of 1156 consecutive eyes with IOLMaster 700 SS-OCT undergoing cataract surgery from January to June 2017 was performed. Approximately a third of these eyes (327 eyes) also had a SD-OCT scan performed previously. A single reviewer assessed each SS-OCT scan and identified them as “normal” or “abnormal.” SS-OCT sensitivity and specificity in identifying foveal pathology was assessed using findings on Spectralis SD-OCT scans as the gold standard.ResultsOf 327 eyes with both IOLM SS-OCT and Spectralis SD-OCT scans, 121 eyes (37.0%) had abnormal SS-OCT scans. Of these 121 eyes, SD-OCT scans confirmed pathology in 104 eyes (86.0%). Of the remaining 206 eyes graded to have normal SS-OCT scans, 84 eyes (40.8%) had normal SD-OCT scans, and 122 eyes (59.2%) had pathologic findings on SD-OCT scans. For each pathologic condition, subtle but definitive differences existed in the appearance of the IOLM SS-OCT and SD-OCT images.ConclusionUsing a normal or abnormal Spectralis SD-OCT scan as confirmation of absence or presence of foveal pathology respectively, we found a high positive predictive value (86.0%) of an abnormal IOLM SS-OCT scan and a high specificity (83.2%) but low sensitivity (46.0%) and negative predictive value (40.8%) of a normal-appearing SS-OCT scan. These results suggest that an abnormal IOLM SS-OCT scan in an eye without known pathology is a strong indicator of an abnormal macula and should prompt further evaluation of the retina to identify pathology prior to cataract surgery. Importantly, IOLM SS-OCT scans do not detect all macular pathology and cannot be used as a screening test for identifying macular pathology.

Astigmatism Management with Astigmatism-Correcting Intraocular Lens Using Two Toric Calculators - A Comparative Case Series.

BackgroundTo compare refractive outcomes after phacoemulsification and toric IOL implantation using two different toric calculators for initial astigmatism assessment in a real-world setting.MethodsThis was a retrospective, comparative, interventional case series. Patients over 30-year-old who underwent phacoemulsification and toric IOL implantation (AcrySof® Toric IOL) by the same surgeon between 2017 and 2018 were included. Eyes with irregular astigmatism, previous corneal refractive surgery, intraocular surgery, corneal pathology, macular pathology and pupil abnormalities were excluded. IOL toricity was determined by using a calculator provided by the AcrySof Toric calculator before 2018 and Barrett Toric Calculator after 2018. Patient demographics, corneal topography, vector and preoperative and postoperative refraction were collected and analyzed at three months postoperative.ResultsThirty-two eyes of 32 patients were included in the final analysis. 0.1D for surgically induced astigmatism was used. Group 1 included 14 eyes assessed with the original (AcrySof) toric IOL calculator, and group 2 included 18 eyes assessed with the Barrett toric IOL calculator. In group 1, postoperative astigmatism less than −1.00D, −0.75 D, and −0.5D was achieved in 88.2%, 76.1% and 53.7% of eyes, respectively, while, in group 2, 89% eyes achieved postoperative residual astigmatism less than 0.5D and all eyes achieved postoperative residual astigmatism less than 0.75D. The proportion of patients with lower postoperative astigmatism was significantly higher in Group 2 (p< 0.05 by chi-square test), a pattern that still held when we divided patients into multiple groups. Vector analysis with the Alpins methods also supported better outcomes in the Barrett group (0.71 D vs 0.35 D).ConclusionThe Barrett Toric calculator resulted in better results in the prediction of residual astigmatism than original (AcrySof) toric calculators.

Разметка цветных фотографий глазного дна улучшает распознавание макулярной патологии с помощью глубокого обучения

Retinal diseases remain one of the leading causes of visual impairments in the world. The development of automated diagnostic methods can improve the efficiency and availability of the macular pathology mass screening programs. The objective of this work was to develop and validate deep learning algorithms detecting macular pathology (age-related macular degeneration, AMD) based on the analysis of color fundus photographs with and without data labeling. We used 1200 color fundus photographs from local databases, including 575 retinal images of AMD patients and 625 pictures of the retina of healthy people. The deep learning algorithm was deployed in the Faster RCNN neural network with ResNet50 for convolution. The process employed the transfer learning method. As a result, in the absence of labeling, the accuracy of the model was unsatisfactory (79%) because the neural network selected the areas of attention incorrectly. Data labeling improved the efficacy of the developed method: with the test dataset, the model determined the areas with informative features adequately, and the classification accuracy reached 96.6%. Thus, image data labeling significantly improves the accuracy of retinal color images recognition by a neural network and enables development and training of effective models with limited datasets.

Сравнительная оценка анатомического и функционального результата при применении технологии PRPв хирургии макулярного отверстия разного диаметра

Purpose. Compare the anatomical and functional results of using PRP technology in the surgery of macular holes of various diameters. Materials and methods. We observed 15 patients (15 eyes). After the vitrectomy, the internal border membrane was peeled. Platelet-rich autoplasm was injected intravitreally. The observation period was 1 month. Results. As a result of surgical treatment, we managed to close the opening in all cases, restore the anatomy of the fovea, and improve visual acuity in all patients. Conclusions. According to the assessment of the results obtained in the ongoing study, the use of this technology is an effective and promising method of treatment based on the stimulation of the tissues' own regenerative potential. Key words: мacular foramen, platelet-rich plasma, vitreomacular interface, macular pathology, vitrectomy, internal border membrane, posterior hyaloid membrane, retina, vitreoretinal surgery, foveolar fossa.

Simulating Visibility and Reading Performance in Low Vision.

PurposeLow vision reduces text visibility and causes difficulties in reading. A valid low-vision simulation could be used to evaluate the accessibility of digital text for readers with low vision. We examined the validity of a digital simulation for replicating the text visibility and reading performance of low-vision individuals.MethodsLow-vision visibility was modeled with contrast sensitivity functions (CSFs) with parameters to represent reduced acuity and contrast sensitivity. Digital filtering incorporating these CSFs were applied to digital versions of the Lighthouse Letter Acuity Chart and the Pelli-Robson Contrast Sensitivity Chart. Reading performance (reading acuity, critical print size, and maximum reading speed) was assessed with filtered versions of the MNREAD reading acuity Chart. Thirty-six normally sighted young adults completed chart testing under normal and simulated low-vision conditions. Fifty-eight low-vision subjects (thirty with macular pathology and twenty-eight with non-macular pathology) and fifteen normally sighted older subjects completed chart testing with their habitual viewing. We hypothesized that the performance of the normally sighted young adults under simulated low-vision conditions would match the corresponding performance of actual low-vision subjects.ResultsWhen simulating low-vision conditions with visual acuity better than 1.50 logMAR (Snellen 20/630) and contrast sensitivity better than 0.15 log unit, the simulation adequately reduced the acuity and contrast sensitivity in normally sighted young subjects to the desired low-vision levels. When performing the MNREAD test with simulated low vision, the normally sighted young adults had faster maximum reading speed than both the Non-macular and Macular groups, by an average of 0.07 and 0.12 log word per minute, respectively. However, they adequately replicated the reading acuity as well as the critical print size, up to 2.00 logMAR of both low-vision groups.ConclusionA low-vision simulation based on clinical measures of visual acuity and contrast sensitivity can provide good estimates of reading performance and the accessibility of digital text for a broad range of low-vision conditions.

English

BACKGROUND Optical Coherence Tomography (OCT) is a commonly used non invasive imaging instrument useful for the diagnosis and follow up of macular disorders, but it has its own share of drawbacks in the presence of media opacities like corneal oedema, dense cataract and vitreous haemorrhage. We wanted to study and interpret the various patterns of common macular diseases on optical coherence tomography. METHODS 100 patients having macular diseases with no other ocular pathology were selected by simple random sampling. The patients were studied and followed up from day 1 of OPD during the period from January 2019 to December 2019 in rural hospital at Latur. All patients suspected of any macular disorder by slit lamp bio-microscopy with 78D or 90D examination were subjected to OCT evaluation. RESULTS On observation, out of 100 cases of macular pathology, 44 % (44 patients) with age related macular degeneration(ARMD), diabetic macular oedema ( DME) 36 % (36 patients), central serous retinopathy (CSR) 10 % (10 patients), myopic maculopathy (MM) 7 % (7 patients), macular hole (MH) 3 % (3 patients) were found in our study. In ARMD patients our OCT findings were hard drusens in retinal pigment epithelium (RPE), detachment of neurosensory retina and retinal pigment epithelium whereas in patients of DME our OCT findings were cyst like hyporeflective spaces within the retina, with retinal thinning and loss of foveal depression. In patients of CSR our findings were separation of sensory retina from RP, in myopic maculopathy our OCT findings were presence of macular retinoschisis and in patients of MH our findings were showing attachment of the posterior hyaloids to the fovea, separation of a small portion of the sensory retina from RPE in the foveolar region and intraretinal cystic changes. CONCLUSIONS OCT plays a crucial role when added along with the clinical examination in the diagnosis and interpretation of common macular disorders. KEYWORDS Optical Coherence Tomography, Age Related Macular Degeneration, Macular Hole, Myopic Maculopathy

Macular Optical Coherence Tomography before Cataract Surgery.

Purpose:To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD-OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery.Methods:In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System.Results:Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age-related macular degeneration in four eyes (12.12%). Full-thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions (P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years (P = 0.025 and odds ratio [OR] =11.12), smoking history (P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%).Conclusions:Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.

A new optical coherence tomography method for subfoveal choroidal thickness measurement: A single-center observational study.

Several macular pathologies are associated with choroidal vascular supply and thus require choroidal thickness evaluation. However, there is no standard subfoveal choroidal thickness (SFCT) measurement method. This study investigated a new method of SFCT measurement, using optical coherence tomography.This is a single-center observational study. Eighty-two senior medical students participated as observers and independently measured the SFCT on 5 standard optical coherence tomography images of healthy adults in a tertiary care setting. They used 3 different methods: the observer's own method, the conventional method, perpendicular to the retinal pigment epithelium, and the new method, along a virtual line connecting the umbo with the most elevated point of the ellipsoid. Additionally, the SFCT angle—the angle between the measurement line and the vertical line of the image—was measured and compared between methods. The intraclass correlation coefficient was used to determine interpersonal variability.The intraclass correlation coefficients for SFCT, measured using methods 1, 2, and 3, were 0.853, 0.880, and 0.896, respectively (P < .001 for all). Method 3 was the highest. The intraclass correlation coefficients of the SFCT angles were 0.647, 0.842, and 0.307, respectively (P < .001 for all).The new method showed the lowest interpersonal variability and could therefore be a reliable standard for SFCT measurement, even in foveae with a steep slope on optical coherence tomography.Trial registration: Not applicable.

Surgical technique for removing vitreous cortex remnants using a diamond-dusted membrane scraper.

The purpose of this paper is to present a new surgical technique to remove vitreous cortex remnants. Non-consecutive retrospective interventional case series. When the posterior vitreous is split, its outermost layer may remain attached to the retina, developing vitreoschisis-induced vitreous cortex remnants (VCR). Their role in macular pathology etiopathogenesis has been well documented; however, recently, it has been proposed that VCR also play a crucial role in proliferative vitreoretinopathy and consequent retinal redetachment. The prevalence of VCR is underestimated because triamcinolone acetonide is not routinely used for vitreous staining. Vitreous cortex remnants (VCR) removal is challenging, and several surgical techniques have been proposed. However, they require sclerotomy enlargement, material that may not be readily available, and manual fashioning. Alternatively, a diamond-dusted membrane scraper (DDMS), already widely used in macular pathology treatment, can follow the contour of the retina, as it is a silicone tube, and remove VCR with its abrasive tip. A DDMS may also be introduced in the vitreous cavity through a standard trocar. Finally, the use of a DDMS provides predictable feedback, making the learning curve short. In this case series, 34 eyes affected by primary rhegmatogenous retinal detachment were enrolled. The retinal redetachment rate was 2.9% at six months of follow-up, below the average literature value of 21%. No adverse events were reported. A DDMS can be suitable for use in VCR removal, although further studies are warranted to understand the indications and extent of this surgical technique for improving the management of rhegmatogenous retinal detachment.