Patients Underwent Pars Plana Vitrectomy Research Articles

Гравитационная дислокация субмакулярных кровоизлияний у пациентов с возрастной макулярной дегенерацией

Purpose. To study the effectiveness and anatomical results of gravitational dislocation of submacular hemorrhages in patients with age-related macular degeneration. Material and methods. We examined 4 patients (4 eyes) with the diagnosis of submacular hemorrhages. The average age of the subjects was 71.45 ± 5.15 years. The duration of the disease was 7determined from the onset of characteristic symptoms to surgical treatment and averaged 7.5 ± 4 days. The maximum corrected acuity averaged 0.02 ± 0.05. According to the data of optical coherence tomography, a high central detachment of the neuro- and pigment epithelium with hemorrhagic contents was determined in patients. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. All patients underwent pars plana vitrectomy combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were advised to take supine position postoperatively in order t-PA to liquefy the haemorrhage, for 1 h; after which they were positioned upright or lying down on the temporal side of the affected eye, for 3 days. Results. In the early surgical period, there was a tendency to increase the maximum corrected visual acuity (MCI): on the 7th day after the first stage of treatment, it was 0.23 ± 0.06 (p < 0.05 compared with the indicators before treatment). The displacement of the blood clot from the central area of the retina, with the correct positioning of the patient, occurred within 5.87 ± 1.9 days. Lysis of the submacular clot was observed for 14 ± 1.53 days. After 3 loading injections carried out within 1.2 and 3 months after the operation, the MCI increased to 0.4 ± 0.2. Conclusion. Microinvasive subtotal vitrectomy with subretinal injection of Prourokinase, with proper positioning of the patient, help gravitational dislocation of submacular hemorrhages and is an effective treatment method in patients with age-related macular degeneration. Keyword: submacular hemorrhage, age-related macular degeneration, dislocation, optical coherence tomography

Etiological Factors and Visual Outcomes of Dense Vitreous Hemorrhage in Patients Aged 80 years and above over the Past Decade in a Tertiary General Hospital.

This study aimed to investigate the main etiological factors and visual outcomes in patients with dense vitreous hemorrhage (DVH) aged ≥80 years. We retrospectively included patients with DVH aged ≥80 years who were admitted to our ophthalmology department between January 1, 2010, and December 31, 2019. All patients underwent pars plana vitrectomy (PPV). Data regarding demographic characteristics; preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ophthalmic B-scan ultrasonography findings; intraoperative conditions; and postoperative complications were collected and analyzed. A total of 44 patients (44 eyes) were enrolled, with a median age of 82 years; among them, 25 patients (56.82%) were men. The median preoperative BCVA was 2.3 (1.1-3.0). The main etiological factors included retinal vein occlusion (RVO) (20 eyes, 45.45%), polypoidal choroidal vasculopathy (PCV) (15 eyes, 34.09%), proliferative diabetic retinopathy (PDR) (7 eyes, 15.90%), retinal arterial macroaneurysm (RAM) (1 eye, 2.27%), and posterior vitreous detachment (PVD) (1 eye, 2.27%). The median final BCVA was 1.92 (0.5-2.6). There was a significant postoperative improvement in the BCVA; moreover, branch RVO (BRVO) had a better postoperative visual prognosis than central RVO (CRVO), PCV, and PDR (P < 0.05). The final postoperative BCVA was significantly better when the initial BCVA was above hand motion (HM) than when it was HM or lower (P < 0.05). Our findings indicate that RVO, PCV, and PDR were the main causes of DVH. Microinvasive PPV is a safe and effective method that can clarify diagnosis and improve BCVA. Patients with BRVO and preoperative BCVA > HM may have a relatively good visual prognosis. For patients aged ≥80 years who have an appropriate general condition, PPV can be timely performed to treat DVH.

Gene Therapy with Voretigene Neparvovec Improves Vision and Partially Restores Electrophysiological Function in Pre-School Children with Leber Congenital Amaurosis.

Leber congenital amaurosis caused by mutations in the RPE65 gene belongs to the most severe early-onset hereditary childhood retinopathies naturally progressing to legal blindness. The novel gene therapy voretigene neparvovec is the first approved causative treatment option for this devastating eye disease and is specifically designed to treat RPE65-mediated retinal dystrophies. Herein, we present a follow-up of the youngest treated patients in Germany so far, including four pre-school children who received treatment with voretigene neparvovec at a single treatment center between January 2020 and May 2022. All patients underwent pars plana vitrectomy with circumferential peeling of the internal limiting membrane at the injection site and subretinal injection of voretigene neparvovec. Pre- and postoperative diagnostics included imaging (spectral domain optical coherence tomography, fundus autofluorescence, fundus wide-angle imaging), electrophysiologic examination (ERG), retinal light sensitivity measurements (FST) and visual acuity testing. Behavioral changes were assessed using a questionnaire and by observing the children's vision-guided behavior in different levels of illumination. All children showed marked increase in vision-guided behavior shortly after therapy, as well as marked increase in visual acuity in the postoperative course up to full visual acuity in one child. Two eyes showed partial electrophysiological recovery of an ERG that was undetectable before treatment-a finding that has not been described in humans before.

Endophthalmitis Caused by Pseudomonas aeruginosa: Clinical Characteristics, Outcomes, and Antibiotics Sensitivities.

Purpose The aim of this study is to report the clinical characteristics, visual outcomes, and antibiotic susceptibilities of patients with Pseudomonas aeruginosa endophthalmitis. Methods The medical records of patients with culture-proven Pseudomonas aeruginosa endophthalmitis treated from June 2013 to December 2019 were reviewed. Results This study included 36 eyes of 36 patients. The clinical settings included ocular trauma (15/36), corneal ulcer (9/36), postoperative endophthalmitis (5/36), endogenous (3/36), and unknown (4/36). Sixteen patients underwent evisceration, 13 patients underwent pars plana vitrectomy (PPV), 2 patients were treated with only intravitreal antibiotics, and 5 patients did not undergo surgery. Only one patient achieved a visual acuity of 20/400, and the others had all counting fingers or below. The cultured Pseudomonas aeruginosa was 100% sensitive to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin and, approximately 95% sensitive to meropenem, imipenem, and aztreonam. Conclusion The visual outcomes of Pseudomonas aeruginosa endophthalmitis were very poor, and the evisceration rate remained high. Pseudomonas aeruginosa has good susceptibility to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin.

Myopic Foveoschisis Completely Resolves within 12 Months after Vitrectomy

To assess the sequence of anatomical resolution of myopic foveoschisis (MFS) after vitrectomy. Monocentric retrospective observational case series. The files of consecutive patients with MFS who underwent vitreoretinal surgery and were followed postoperatively for at least 6 months were reviewed. Patients underwent pars plana vitrectomy for MFS. The central foveal thickness (CFT) was measured. The presence of a foveal involvement, and/or outer retinoschisis (ORS), with or without inner retinoschisis (IRS), and foveal detachment (FD) were analyzed. Anatomical success was defined as the resolution of foveal ORS and FD. The main outcome was the time to resolution of the different morphologic features of MFS after surgery. Thirty-nine eyes of 36 patients were included in the analysis. The mean follow-up was 14.8 ± 12.9 months (range, 6-84 months). Anatomical success was achieved in 82% of cases at the end of the follow-up and in > 80% of cases during the first year. The CFT was significantly decreased in 79% of cases at 3 months. Inner retinoschisis, present in 18 eyes (46%), resolved in all cases after a median time of 1 month. Foveal ORS, present in all cases, resolved in 82% of cases after a median time of 3 months. The FD, present in 23 eyes (59%), resolved in 91% of cases after a median time of 6 months. Extrafoveal ORS resolved in 59% of cases after a median time of 12 months. The mean best-corrected visual acuity significantly improved from 0.80 ± 0.64 logarithm of the minimum angle of resolution (logMAR) (Snellen Eq 20/148) to 0.48 ± 0.52 logMAR (Snellen Eq 20/70). Most MFS (80%) are completely resolved during the first year. The decrease in CFT and early resolution of IRS could be used as early biomarkers of surgical success.

Autologous Iris transplant as plug for macular hole retinal detachment in highly myopic eyes.

To describe the anatomic and visual outcomes of eyes undergoing autologous iris transplantation for macular hole retinal detachment. Seven consecutive patients with macular hole retinal detachment were enrolled in a single-arm prospective study. All patients underwent pars plana vitrectomy with autologous iris transplantation placed in the subretinal space as a plug to close the macular hole; in one case, a posterior retinal break was also closed with the same technique. Seven patients (2 males and 5 females) with a mean age of 69.14 ± 7.79 years (range 58-80 years) were followed up for a period of six months. The best-corrected visual acuity improved from 2.44 ± 0.48 logMAR (20/2000) preoperatively to 1.90 ± 0.26 logMAR (20/800) 6 months after surgery. Optical coherence tomography analysis showed retinal adhesion around the iris plug, and the retina remained dry in the follow-up period. In this series of macular hole retinal detachments, autologous iris transplantation placed as a plug over the retinal pigment epithelium facing the macular hole opening or directly over the bare sclera achieved anatomical success with improvement in visual function.

Diamond Dust Particles Seen on Intraoperative Oct

A 68-year-old female with a full-thickness macular hole in the right eye was referred for surgical repair. The patient underwent pars plana vitrectomy with internal limiting membrane (ILM) peeling and intraocular gas injection. During the surgery, the ILM was stained using Brilliant Blue G solution, elevated using a diamond-dusted membrane scraper, and removed using vitreoretinal forceps. After ILM removal, white refractile particles (arrow) likely corresponding to diamond dust particles were noted on the retinal surface (panel A), and appeared hyperreflective on intraoperative optical coherence tomography (iOCT; panel B). Attempts at aspirating these particles were unsuccessful.

Silicone sponge intrusion after scleral buckling surgery followed by vitrectomy for retinal detachment

Background: This study reports a case of silicone sponge intrusion as a late complication of scleral buckling surgery. Case presentation: A 57-year-old man underwent a silicone sponge scleral buckling surgery 19 years ago due to retinal detachment of his left eye. Visual acuity impairment of his left eye was noted. His best-corrected visual acuity (BCVA) was 20/80 (logMAR 0.6). Intraocular lens-capsular bag-capsular tension ring luxation with implant extrusion was observed in the inferior nasal quadrant. The patient underwent pars plana vitrectomy with retropupillary iris-claw lens implantation. His BCVA improved to 20/20. Conclusion: Although silicone sponge intrusion is a rare complication of scleral buckling procedures, it may lead to serious complications. The intruding sponge may be left intact unless there is a significant threat to the integrity of ocular structures. Manipulation of the encircling band or buckle does not necessarily alter the visual acuity or the status of the retina.

Combined epiretinal and internal limiting membrane retracting door flaps for large macular holes associated with epiretinal membranes.

To assess the closure rate of large full-thickness macular holes (FTMH) associated with epiretinal membrane (ERM) with a combined epiretinal and internal limiting membrane retracting door flap. Retrospective chart review of patients treated at a single tertiary retina practice between January 2017 and November 2019. Individuals with FTMH larger than 400μm and co-diagnosis of ERM who underwent surgical repair with an ERM flap were included. Patients underwent pars plana vitrectomy with peeling of ERM that was positioned as a retracting door flap to cover the FTMH. Primary outcome was closure rate at 6months following surgery. Final surgical success rate and visual acuity were secondary outcomes. Among 7 eyes of 7 patients, 6 eyes achieved primary surgical success and final surgical success rate was achieved in all 7 eyes with a large FTMH repaired with ERM flap. The mean minimum linear diameter of the FTMH was 681μm ± 295. All patients had follow-up greater than 6months, with a mean duration of 17months (range 14-23months). Visual acuity improved from a mean of 0.9 ± 0.3 logMar (20/160) before surgery to 0.3 ± 0.5 logMar (Snellen 20/40), postoperatively. Large FTMH with concurrent ERM that are managed with an ERM flap have high single-surgery success rate.

Late onset endophthalmitis with rare fungus Exophiala dermatitidis

<br>The authors report a case of a 64-year-old diabetic male patient with late-onset fulminant fungal endophthalmitis occurring 6 weeks following complicated cataract surgery. A pigmented, dimorphic fungus known as <i>Exophiala dermatitidis</i> was isolated from aqueous and vitreous samples of the patient. The patient underwent pars plana vitrectomy, followed by daily injections of intravitreal voriconazole, and eventually had marked improvement in the best-corrected visual acuity to 6/9. So far, eight cases of <i>Exophiala</i> endophthalmitis have been reported in the literature, of which six have had a poor visual outcome. This case report demonstrates a successful outcome in a case of <i>E. dermatitidis</i> endophthalmitis, tackled with an aggressive medical and surgical approach.<br>

Outcomes for Successfully Repaired Macula-Off Diabetic Tractional Retinal Detachment

All patients underwent pars plana vitrectomy and successfully surgical resolution of tractional retinal detachment forming only one surgery group and more than one surgery group in cases of recurrent diabetic TRD. Structural, perfused and functional postoperative findings were statistical analized.

Inner retinal fenestration for paediatric optic disc pit maculopathy: a case series.

To evaluate the efficacy of inner retinal fenestration as a surgical technique for the treatment of optic disc pit maculopathy (ODPM) in the paediatric population. This is a retrospective, interventional case series of paediatric patients with ODPM treated at two tertiary hospitals in London by a single surgeon (SCW). All patients underwent pars plana vitrectomy with the creation of two inner retinal fenestrations and endogas tamponade. The partial-thickness retinotomies were made radial to the optic disc pit using a 25-gauge MVR blade. Anatomic and visual outcomes were determined by optical coherence tomography central retinal thickness and best-corrected visual acuity (BCVA), respectively. A total of six eyes were included. Average patient age was 12.0 ± 3.5 years. Preoperatively all eyes demonstrated intraretinal fluid and/or serous detachment of the central macula. Patients were followed for a mean of 22.7 ± 16.1 months after surgery. Mean preoperative BCVA was logMAR 0.71 ± 0.29 (20/100). Mean postoperative BCVA was 0.49 ± 0.30 (20/63) at 2 weeks, 0.35 ± 0.33 (20/45) at 3 months and 0.16 ± 0.29 (20/32) at 1 year. Progressive resolution of intraretinal and subretinal fluid (SRF) was observed in all eyes, with central retinal thickness significantly improved by 2 weeks postoperatively (637.83 ± 209.09 µm preoperatively and 465.40 ± 169.86 µm postoperatively, p = 0.04). Recurrence of subretinal or intraretinal fluid was not observed. Dual inner retinal fenestration is an effective technique that resolves fluid and restores vision in paediatric patients with ODPM. These results support the hypothesis that enabling egress of fluid into the vitreous cavity can achieve long-lasting amelioration of ODPM.

PARS PLANA VITRECTOMY FOR VITREOUS HEMORRHAGE IN CIPTOMANGUNKUSUMO HOSPITAL

Introduction: Vitreous hemorrhage is the presence of blood in the vitreous cavity. This condition could impair the visual function and hindered the clinician’s ability to examine the posterior segment of the eye. Pars plana vitrectomy (PPV) not only act as a surgical treatment of choice but also diagnostic procedure. Immediate PPV has the advantage to optimalize visual acuity&#x0D; Methods: Retrospective descriptive study of vitreous hemorrhage patients underwent pars plana vitrectomy in Ciptomangunkusumo Hospital, Indonesia from January to December 2018&#x0D; Result: There were 160 cases of vitreous hemorrhage cases undergoes pars plana vitrectomy in 2018. Most frequent etiology was proliferative diabetic retinopathy (49.4%). Rebleeding was found only in 8 cases within the period of three months follow up. Final visual acuity was improved in majority of the cases and found to be related to timing of the surgery.&#x0D; Conclusion: Early vitrectomy along with systemic control of underlying factors lead to improvement of visual acuity in vitreous hemorrhage.&#x0D;

A case of air pollution-induced Valsalva retinopathy

This is a case of Valsalva retinopathy during the season of annual transboundary haze pollution in Sarawak. A 22-year-old man with no known medical illness developed sudden onset of painless visual acuity loss preceded by persistent cough. Left eye fundus showed dense preretinal haemorrhage covering optic disc extendinginferiorly with breakthrough vitreous haemorrhage. The patient underwent pars plana vitrectomy, endolaser, and fluid gas exchange in view of persistent dense vitreous haemorrhage after a month of conservative management. In conclusion, pars plana vitrectomy can be considered as a safe and effective treatment option for patients with Valsalva retinopathy developing extensive premacular haemorrhage.

Epiretinal large disc of blue-stained lyophilized amniotic membrane to treat complex macular holes: a 1-year follow-up.

To report the long-term outcomes of large diameter epiretinal lyophilized amniotic membranes (lAMs) in recurrent or persistent macular holes (MHs) with or without rhegmatogenous retinal detachment (RRD), in a prospective interventional case series. Ten eyes of 10 patients underwent pars plana vitrectomy for MH-associated RRD (n = 5) or persistent MH without RRD (n = 5), in a university Hospital. A 3 or 4 mm diameter disc of lAM, stained with 0.06% trypan blue, was inserted with a catheter through a sclerotomy and positioned over the MH. Gas or silicone-oil tamponade was used. At 1 year, the main outcome was anatomic success defined as complete MH closure. Secondary outcomes were best corrected visual acuity (BCVA) recovery, changes in ellipsoid zone (EZ) and external limiting membrane (ELM) defects, complications. Mean follow-up was 13.8 ± 2.9 months (range, 12-18). Mean baseline data were minimum and maximum diameters, respectively, 945 ± 330 and 1507 ± 717 μm; axial length 26.58 ± 3.38 mm; and number of prior surgeries 1.4 ± 0.96. At 1 year, anatomic success was achieved in eight eyes (80%), and two had reduced diameter of MH. All RRDs were reattached without recurrence. Mean logMAR BCVA improved from 1.92 ± 0.58 to 1.17 ± 0.57 (p < 0.001), with nine eyes (90%) achieving ≥0.3 logMAR improvement. Mean EZ and ELM defects decreased (p = 0.004, p = 0.003, respectively). Postoperative complications were RRD (n = 1) reattached by subsequent surgery, lAM slightly retracted under silicone (n = 1), foveal atrophy after early lAM displacement (n = 1). A 1-year follow-up highlighted that epiretinal large discs of blue-stained lAM can help safely close refractory MHs, and provide satisfactory visual recovery.

Autologous Retinal Transplantation for Primary and Refractory Macular Holes and Macular Hole Retinal Detachments: The Global Consortium

To report the anatomic and functional outcomes of autologous retinal transplantation (ART). Multicenter, retrospective, interventional, consecutive case series. One hundred thirty eyes of 130 patients undergoing ART for the repair of primary and refractory macular holes (MHs), as well as combined MH-rhegmatogenous retinal detachment (MH-RRD), between January 2017 and December2019. All patients underwent pars plana vitrectomy and ART, with surgeon modification of intraoperative variables. A large array of preoperative, intraoperative, and postoperative data was collected. Two masked reviewers graded OCT images. Multivariate statistical analysis and subgroup analysis were performed. Macular hole closure rate, visual acuity (VA), external limiting membrane and ellipsoid zone (EZ) band integrity, and alignment of neurosensory layers (ANL) on OCT. One hundred thirty ART surgeries were performed by 33 vitreoretinal surgeons worldwide. Patient demographics were: mean age of 63 ± 6.3 years, 58% female, 41% White, 23% Black, 19% Asian, and 17% Latino. Preoperative VA was 1.37 ± 0.12 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/500), which improved significantly to 1.05 ± 0.09 logMAR (Snellen equivalent, approximately 20/225; P < 0.001) after surgery (mean follow-up, 8.6 ± 0.8 months). Autologous retinal transplantation was performed for primary MH repair in 27% of patients (n= 35), for refractory MH in 58% of patients (n= 76; mean number of previous surgeries, 1.6 ± 0.2), and for MH-RRD in 15% of patients (n= 19). Mean maximum MH diameter was 1470 ± 160 μm, mean minimum diameter was 840 ± 94 μm, and mean axial length was 24.6 ± 3.2 mm. Overall, 89% of MHs closed (78.5% complete; 10% small eccentric defect), with a 95% closure rate in MH-RRD (68.4% complete; 26.3% small eccentric defect). Visual acuity improved by at least 3 lines in 43% of eyes and by at least 5 lines in 29% of eyes. Reconstitution of the EZ (P= 0.02) and ANL (P= 0.01) on OCT were associated with better final VA. Five cases of ART graft dislocation (3.8%), 5 cases of postoperative retinal detachment (3.8%), and 1 case of endophthalmitis (0.77%) occurred. In this global experience, patients undergoing ART for large primary and refractory MHs and MH-RRDs achieved good anatomic and functional outcomes, with low complication rates despite complex surgical pathologic features.

Pars Plana Vitrectomy in Posttraumatic Endophthalmitis in Cipto Mangunkusumo Hospital Indonesia

Introduction: Endophthalmitis is an inflammation of the intraocular tissues and fluid, and an emergency in ophthalmology. One of the most common causes of endophthalmitis is post-traumatic endophthalmitis. Post-traumatic endophthalmitis has a poorer prognosis than post-cataract surgery endophthalmitis. The immediate pars plana vitrectomy (PPV) surgery in post-traumatic endophthalmitis is beneficial for optimizing of final visual.&#x0D; Methods: A retrospective descriptive study of post-traumatic endophthalmitis patients underwent pars plana vitrectomy in the Ciptomangunkusumo Hospital, Indonesia from January 2017 – June 2017.&#x0D; Result: There were twelve cases of post-traumatic endophthalmitis undergoes pars plana vitrectomy within the period of January 2017-June 2017. The most frequently identified causative organism was Staphylococcus (33,3%). There was an improvement of final visual acuity after the procedure of pars plana vitrectomy in 58.3% post-traumatic endophthalmitis patients.&#x0D; Conclusion: Early PPV leads to vision improvement and maintains visual acuity in post-traumatic endophthalmitis.&#x0D; Keywords: Pars Plana Vitrectomy, Endophthalmitis, Post-traumatic

Posterior Retinotomy vs Perfluorocarbon Liquid to Aid Drainage of Subretinal Fluid During Primary Rhegmatogenous Retinal Detachment Repair (PRO Study Report No. 10).

This work compares posterior retinotomy vs perfluorocarbon liquid (PFCL) for subretinal fluid (SRF) drainage during pars plana vitrectomy for primary rhegmatogenous retinal detachment (RRD). In this large, multicenter, retrospective comparative study, 2620 patients underwent pars plana vitrectomy (with or without scleral buckle) for uncomplicated RRD. Patients for whom SRF was drained via the primary break without retinotomy or PFCL were excluded; those who required both retinotomy and PFCL were similarly excluded. Remaining patients were separated into "retinotomy" and "PFCL" cohorts. Subgroup analysis was conducted for macula-on and macula-off subgroups. Postoperative outcomes were analyzed and compared. A total of 760 eyes (82.7%) had retinotomy and 159 eyes (17.3%) had PFCL for drainage of SRF, and baseline characteristics between the 2 groups were similar. Postoperative analysis showed similar outcomes between the retinotomy and PFCL cohorts, including final visual acuity (P = .19), redetachment rate (P = .30), anatomic success (P = .28), presence of postoperative epiretinal membrane (P = .75), and other macular pathologies (P > .99). Subgroup analysis yielded similar outcomes for macula-on and macula-off subgroups. Postoperative presence of retained PFCL was 2.4%, possibly a factor in the slightly higher number of subsequent surgical procedures (P = .03) in the PFCL cohort. Postoperative outcomes for retinotomy vs PFCL during RRD repair are comparable, aside from slightly greater number of subsequent surgical procedures needed in the PFCL cohort. Our analysis suggests both techniques are reasonable tools in the repair of macula-on or macula-off RRD.

Spontaneous full thickness macular hole development and closure in a patient with nucleus dislocation due to hypermature cataract: a case report

Spontaneous posterior capsule rupture with lens-nucleus dislocation is a very rare entity, as is the development and spontaneous closure of a full thickness macular hole (FTMH) after vitrectomy. The occurrence of these two entities in one eye has not been previously described. A 79-year-old woman was referred because of the right eye intermittent pain and progressive visual loss. Best corrected visual acuity (BCVA) with correction for aphakia was 20/20. Intraocular pressure was normal with therapy. The cornea, anterior chamber, and vitreous were clear. Gonioscopy was normal. The capsular bag was clear, with rolled-up anterior and posterior lens capsule, and the nucleus dislocated in the vitreous. As surgery waiting time was prolonged due to administrative problems, the patient’s intraocular pressure (IOP) increased and cystoid macular edema (CME) with lamellar macular hole developed. The patient underwent pars plana vitrectomy with endophacofragmentation and epiretinal membrane peeling. Postoperative optical coherence tomography was normal, BCVA was 20/40, and IOP was normal with topical therapy. One month after surgery, the eye was without signs of inflammation and IOP started rising in spite of maximum therapy. CME reoccurred and progressed to a FTMH, which started closing spontaneously in one month. One year after surgery, IOP normalized and FTMH closed completely. A dislocated crystalline lens in a quiet eye with normal BCVA, which rapidly developed into intractable glaucoma and FTMH, is an unusual finding. The deterioration was followed by spontaneous IOP normalization and macular hole closure. Such unexpected disease course, suggesting a possible autoimmune reaction, has not yet been described.

Two cases of diabetic macular edema complicated by an atypical macular hole

BackgroundHere we report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME).Case presentationsPatient 1 was a 73-year-old male. Optical coherence tomography (OCT) revealed perifoveal retinoschisis (RS) in addition to cystoid macular edema and serous retinal detachment (SRD) in his left eye, and that an MH had developed during the clinical course. A convex surface was formed at the MH margin toward the vitreous cavity, and granular shadows were observed in the fluid cuff. Intraoperative findings revealed a thin epiretinal macular membrane (ERM) around the MH. Patient 2 was a 79-year-old male. Although the patient underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in both eyes, RS and a thin ERM in addition to SRD was observed in his left eye after surgery, and an MH developed during the clinical course. As in Patient 1, a convex surface was formed at the fluid cuff margin toward the vitreous cavity.ConclusionsBoth patients had persistent DME, SRD, RS, and a thin ERM before the development of the MH. OCT revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form.