Posterior Hyaloid Research Articles

Cirurgia de vitrectomia com equipamento de 27 gauge

In the following video, we will show two pars plana vitrectomies using a 27-gauge system. The equipment used was the constellation® (Alcon, USA). These are the first two surgeries performed using this system in Brazil. They were undertaken at the Parana Eye Hospital (Hospital dos Olhos do Parana) in Curitiba, Parana State, and at the Brazilian Vision Center (Centro Brasileiro de Visao) in Brasilia, Distrito Federal. The 27-gauge system is thinner and more delicate compared with other such systems. It allows making incisions as small as 0.4 mm. Previously, the thinnest system available was the 25gague system, allowing 0.55-mm incisions. Smaller incisions induce less inflammation, do not require suturing, and allow faster recovery. The first case presented is that of a patient with vitreous hemorrhage due to proliferative diabetic retinopathy, an operation which was completed using only the new 27-gauge system. Contrary to what is expected, dense vitreous opacities can be removed with an instrument with a smaller-diameter opening. To do so, we simply follow Poiseuille's law that states that the flow velocity of a fluid in a system is directly related to the pressure exerted for its withdrawal and has an inverse correlation with the viscosity of the material. The new 27-gauge systems exhibit a high suction pressure, reaching up to 600 mmHg. In addition, their cutting speed is up to 7500 cuts per minute, i.e., if we perform the vitrectomy using these systems, we can achieve a flow rate similar to that achieved with devices with larger diameters, such as the 25- or 23gauge systems. It is the cutting speed on the vitreous that allows dense vitreous to be removed quickly. Note that the surgery is in real time and all bleeding is aspirated at a constant rate; this is similar to previously used systems. Although the 27-gauge system is more delicate, it allows performing peripheral vitrectomy without bending the tip of the device. Experienced surgeons will have no difficulty performing this procedure. In addition to the thinner cutter tip, the 27-gauge system comes with all accessories with the same diameter, including the laser that is used at the end of the procedure. In the second case, we show the surgery on a patient with a macular hole. With the high vacuum pressure exerted on the vitreous, the posterior hyaloid membrane is removed easily and safely. Once the posterior hyaloid is removed, the inner limiting membrane is stained with brilliant blue so that it may be removed using suitable forceps. At the end of the surgery, fluid–gas exchange is performed.

Evaluation of the Posterior Hyaloid Changes Following Intravitreal Injection of Ranibizumab for Diabetic Macular Edema

Purpose The aim of this work was to evaluate the posterior hyaloid changes and the effect on the vitreomacular relationship following intravitreal injection of ranibizumab (lucentis) for DME in diabetic patients attending the outpatient clinic of the Ophthalmology Department in Alexandria Main University Hospital. Patients and methods The study included 40 eyes. All of them received a baseline injection of 0.5 mg of intravitreal ranibizumab under sterile conditions. The injection was performed under topical anesthesia, with or without sedation. Further injections were administered Pro Re Nata (PRN ‘as required’) as decided in each subsequent follow-up visit if central retinal thickness remained 300 μm or greater or if there was a decrease in best-corrected visual acuity due to DME progression, confirmed with clinical evaluation and/or optical coherence tomography or other anatomic and clinical assessments. Results There were 12 male (54.2%) and 10 female patients (45.5%) between 45 and 71 years of age, with a mean value of 63.2 ± 12.6. There were five patients (22.7%) with type I and 17 patients (77.3%) with type II DM. The duration of DM was less than 10 years in six patients (27.3%) and more than 10 years in 16 patients (72.7%); it ranged between 9.5 and 20 years, with a mean value of 15.11 ± 7.98 years. HbA1c ranged from 7.11 to 8.25, with a mean value of 7.72 ± 0.892, and baseline visual acuity (TTDRS) ranged from 7.11 to 8.25, with a mean value of 53.13 ± 12.22. Baseline central macular thickness ranged from 301.0 to 525.0, with a mean value of 413.0 ± 107.0. No vitreous separation (category 1) was observed in 19 cases (47.5%), partial vitreomacular separation (VMS) (category 2) was observed in 12 cases (30%), vitreofoveal attachment with no traction (category 3) in seven cases (17.5%), and finally vitreofoveal attachment with traction (dome-shaped profile) (category 4) was observed in two cases (5%). No changes in vitreomacular relationship was seen in 16 cases (40%), partial VMS was seen in six cases (15%), vitreofoveal attachment with no traction was seen in eight cases (20%), vitreofoveal attachment with traction (dome-shaped profile) in three cases (7.5%), and complete VMS was seen in seven cases (17.5%). There was a statistically significant difference with regard to number of changes in VMR, partial VMS, vitreofoveal attachment with no traction, and vitreofoveal attachment with traction (dome-shaped profile). There was a statistically significant difference with regard to partial VMS, vitreofoveal attachment with no traction, and vitreofoveal attachment with traction (dome-shaped profile). There was a statistically significant relation between the number of injections and the outcome; the higher the number of injections, the better is the outcome.

SINGLE ACQUISITION OF THE VITREOUS, RETINA AND CHOROID WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IN ACUTE TOXOPLASMOSIS

To report the swept-source optical coherence tomography (SS-OCT) findings in a case of acute toxoplasmosis chorioretinitis. A 35-year-old male presented with acute blurry vision and floaters in his left eye. Ophthalmic examination, color photographs, spectral-domain OCT (SD-OCT), enhanced depth imaging OCT (EDI-OCT), SS-OCT and wide-field fluorescein angiography images were obtained to diagnose and follow the subsequent changes of toxoplasmosis chorioretinitis over a 2-month period. Initial imaging with different modalities of SD- and EDI-OCT including radial vitreous scans and horizontal high-speed B-scan raster lines demonstrated thickening of the posterior hyaloid and acute vitreous cells emanating from the retinal blood vessels, thickening and disorganization of the retinal layers within the chorioretinal lesion, and increased sub-lesional choroidal thickness, respectively. SS-OCT demonstrated all of these same findings in a single 12-mm B-scan. Topical steroids were initiated and imaging over the next 2 months showed separation of the posterior hyaloid, decrease in vitreous cell, and atrophy of the chorioretinal lesion. We report the first SS-OCT images of an acute case of toxoplasmosis chorioretinitis. SS-OCT can visualize the choroidal, retinal, and vitreous changes in a single scan, compared with the different imaging algorithms required with SD-OCT.

Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes

The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity.

Iatrogenic retinal breaks in ultrahigh-speed 25-gauge vitrectomy: a prospective study of elective cases

Background/AimsTo evaluate the incidence of intraoperative retinal breaks in the ultrahigh-speed (UHS) 25-gauge vitrectomy system in elective vitreous-retina surgery cases.MethodsA prospective series of 1676 eyes of 1306 consecutive patients. All...

Relationship between variations in posterior vitreous detachment and visual prognosis in idiopathic epiretinal membranes.

PurposeTo clarify the relationship between variations in posterior vitreous detachments (PVDs) and visual prognoses in idiopathic epiretinal membranes (ERMs).MethodsIn this retrospective, observational, and consecutive case series, we observed variations in PVDs in 37 patients (mean age, 65.7±11.0 years) with ERMs and followed them for 2 years. Three PVD types were found biomicroscopically: no PVD, complete PVD with collapse (C-PVD with collapse), and partial PVD without shrinkage, with persistent vitreous attachment to the macula through the premacular hole of the posterior hyaloid membrane (P-PVD without shrinkage [M]). The best-corrected visual acuity (BCVA) was measured and converted to the logarithm of the minimum angle of resolution (logMAR) BCVA at the first visit and 2 years later.ResultsNo PVD was observed in 16 of the 37 eyes (mean age, 61.3±11.3 years), C-PVD with collapse in 11 of the 37 eyes (mean age, 69.1±9.9 years), and P-PVD without shrinkage (M) in 10 of the 37 eyes (mean age, 69.3±10.9 years). The logMAR BCVA at the first visit was the worst in the P-PVD without shrinkage (M) group (0.22±0.35) compared with the no-PVD group (−0.019±0.07; P<0.01) and the C-PVD group (0.029±0.08; P<0.05). The logMAR BCVA 2 years later was also worst in the P-PVD without shrinkage (M) group (0.39±0.35) compared with the no-PVD group (0.04±0.13) and the C-PVD with collapse group (0.03±0.09; P<0.05 for both comparisons). The change in the logMAR BCVA over the 2-year follow-up period was worst in the P-PVD without shrinkage (M) group (0.17±0.23) compared with the no-PVD group (0.06±0.14) and the C-PVD with collapse group (0.0009±0.09; P<0.05 for both comparisons).ConclusionCases with an ERM with a P-PVD without shrinkage (M) had a worse visual prognosis than those with an ERM with no PVD and C-PVD with collapse.

Ultrasound findings in ocular trauma

ObjectiveTo evaluate the frequencies of various eye and/or orbital disorders by ultrasound examination in patients with ocular trauma. Materials and methodsThis prospective and descriptive study was conducted on 100 patients with ocular trauma treated in the Conde de Valenciana Institute from March to November 2014. Ultrasound examination was performed primarily using ultrasound B mode, with standardized A mode only used as correlation method. Age, gender, type of trauma, and various ultrasound findings were recorded. ResultsOcular trauma was more frequent in men (83%) compared to women (17%). The left eye was affected in 55%, and right eye in 45%, with 55% being open traumas and 45% blunt traumas. Most cases were young patients with a mean age of 33.7 years, with the group between 41 and 50 years being the most affected. Among the most frequent injuries found was the vitreous hemorrhage (45%) and posterior hyaloid detachment (38%), followed by retinal detachment (32%), and choroidal detachment (18%). ConclusionUltrasound remains as the investigation method of choice in patients with ocular trauma, since it is a simple, cheap and non-invasive study, and can be very useful in providing diagnostic and prognostic information. This study demonstrated that trauma is more common in young men, with vitreous hemorrhage as the most common finding.

INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY DURING VITREORETINAL SURGERY FOR DENSE VITREOUS HEMORRHAGE IN THE PIONEER STUDY.

To evaluate the feasibility and utility of intraoperative optical coherence tomography (OCT) during pars plana vitrectomy surgery for dense vitreous hemorrhage. The Prospective Assessment of Intraoperative and Perioperative OCT for Ophthalmic Surgery study examined the utility of intraoperative OCT in ophthalmic surgery. Intraoperative scanning was performed with a microscope-mounted spectral domain OCT system. This report is a case series of those eyes undergoing pars plana vitrectomy for dense central vitreous hemorrhage that precluded preoperative OCT assessment. Intraoperative OCT images were qualitatively evaluated for retinal abnormalities that might impact intraoperative or perioperative management. Clinical variables were collected and assessed. Surgeon assessment of intraoperative OCT utility was also evaluated. Twenty-three eyes were identified and included. The etiology for the vitreous hemorrhage was proliferative diabetic retinopathy (19 eyes, 82.6%), horseshoe retinal tear (1 eye, 4.3%), retinal vein occlusion with neovascularization (1 eye, 4.3%), presumed polypoid choroidal vasculopathy (1 eye, 4.3%), and presumed retinal arterial macroaneurysm (1 eye, 4.3%). Intraoperative OCT revealed epiretinal membrane (14 eyes, 60.9%), macular edema (14 eyes, 60.9%), posterior hyaloid traction (1 eye, 4.3%), and retinal detachment (1 eye, 4.3%). Surgeon feedback suggested that intraoperative OCT impacted surgical decision making in eyes where membrane peeling was performed. Intraoperative OCT during pars plana vitrectomy for vitreous hemorrhage may provide physicians with clinically relevant information that may impact surgical management, perioperative management, and patient outcomes.

Laser and ranibuzumab combination for retinal vasoproliferative tumor's management

Case reportA 34 year-old man presented with progressive visual loss in his right eye. Ocular fundus showed a vasoproliferative tumor in the peripheral retina with an associated epiretinal macular membrane. Angiography showed a rapid filling of tumor vessels. The treatment consisted of laser photocoagulation and a single injection of intravitreal ranibizumab. After 8 weeks, there was a residual area of fibrosis, the posterior hyaloid was detached, and the epiretinal membrane disappeared. Visual acuity returned to 20/25. DiscussionLaser photocoagulation and intravitreal ranibizumab combination could be useful for vasoproliferative tumors.

Three-Dimensional Enhanced Imaging of Vitreoretinal Interface in Diabetic Retinopathy Using Swept-Source Optical Coherence Tomography

To analyze the vitreoretinal interface in diabetic eyes using 3-dimensional wide-field volumes acquired using high-speed, long-wavelength swept-source optical coherence tomography (SSOCT). Prospective cross-sectional study. Fifty-six diabetic patients (88 eyes) and 11 healthy nondiabetic controls (22 eyes) were recruited. Up to 8 SSOCT volumes were acquired for each eye. A registration algorithm removed motion artifacts and merged multiple SSOCT volumes to improve signal. Vitreous visualization was enhanced using vitreous windowing method. Of 88 diabetic eyes, 20 eyes had no retinopathy, 21 eyes had nonproliferative diabetic retinopathy (NPDR) without macular edema, 20 eyes had proliferative diabetic retinopathy (PDR) without macular edema, and 27 eyes had diabetic macular edema (DME) with either NPDR or PDR. Thick posterior hyaloid relative to healthy nondiabetic controls was observed in 0 of 20 (0%) diabetic eyes without retinopathy, 4 of 21 (19%) eyes with NPDR, 11 of 20 (55%) eyes with PDR, and 11 of 27 (41%) eyes with DME (P= .0001). Vitreoschisis was observed in 6 of 22 (27%) healthy nondiabetic eyes, 9 of 20 (45%) diabetic eyes without retinopathy, 10 of 21 (48%) eyes with NPDR, 13 of 20 (65%) eyes with PDR, and 17 of 27 (63%) eyes with DME (P= .007). While no healthy nondiabetic controls and diabetic eyes without retinopathy had adhesions/pegs between detached posterior hyaloid and retina, 1 of 21 (4%), 11 of 20 (55%), and 11 of 27 (41%) eyes with NPDR, PDR, and DME, respectively, demonstrated this feature (P=.0001). SSOCT with motion-correction and vitreous windowing provides wide-field 3-dimensional information of vitreoretinal interface in diabetic eyes. This may be useful in assessing progression of retinopathy, planning diabetic vitreous surgery, and predicting treatment outcomes.

Hallazgos ecográficos en trauma ocular

ObjectiveTo evaluate the frequencies of various eye and/or orbital disorders by ultrasound examination in patients with ocular trauma. Materials and methodsThis prospective and descriptive study was conducted on 100 patients with ocular trauma treated in the Conde de Valenciana Institute from March to November 2014. Ultrasound examination was performed primarily using ultrasound B mode, with standardised A mode only used as correlation method. Age, gender, type of trauma, and various ultrasound findings were recorded. ResultsOcular trauma was more frequent in men (83%) compared to women (17%). The left eye was affected in 55%, and right eye in 45%, with 55% being open traumas and 45% blunt traumas. Most cases were young patients with a mean age of 33.7 years, with the group between 41 to 50 years being the most affected. Among the most frequent injuries found was the vitreous haemorrhage (45%) and posterior hyaloid detachment (38%), followed by retinal detachment (32%), and choroidal detachment (18%). ConclusionUltrasound remains as the investigation method of choice in patients with ocular trauma, since it is a simple, cheap and non-invasive study, and can be very useful in providing diagnostic and prognostic information. This study demonstrated that trauma is more common in young men, with vitreous haemorrhage as the most common finding.

Swept source optical coherence tomography of a vitreal pocket entrapped in myelinated retinal nerve fibers

A 53-year-old women, 20/20 visual acuity in both eyes, showed after dilated fundus examination myelinated retinal nerve fibers (MRNF) on 360 around optic disk in left eye, sparing the macula (A). Swept source optical coherence tomography (SS-OCT) scanning line centered on the optic nerve head (B), showed two vitreous pockets (*) entrapped between highly hyperreflective MRNF and posterior hyaloid; posterior hyaloid appears thickened by hyperreflective tissue that can be interpreted as residual of innermost layer of myelin remained attached after posterior hyaloid separation.

THE INFLUENCE OF VITREOMACULAR ADHESION ON OUTCOMES AFTER AFLIBERCEPT THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

To evaluate the influence of vitreomacular attachment on outcomes after intravitreal aflibercept for neovascular age-related macular degeneration. In a prospective case series, eyes with neovascular age-related macular degeneration were treated with intravitreal aflibercept, given as 3 consecutive monthly injections, followed by further injection every 2 months. Spectral domain optical coherence tomography images were reviewed at each visit to determine the attachment of the posterior hyaloid. Best-corrected visual acuity and retinal thickness were also recorded. Outcomes at Months 2 and 6 were compared between the eyes with persistent vitreomacular attachment (Stage 1) and those with posterior vitreous detachment (Stages 2 or 3 PVD) at baseline. At baseline, 30 eyes had Stage 1 PVD and 63 eyes had either Stage 2 or 3 PVD. Although there was a trend for both greater visual acuity gains and reductions in retinal thickness for the eyes with Stages 2 or 3 PVD, this failed to reach significance. Baseline visual acuity and age were negatively associated with visual acuity change, and baseline retinal thickness alone was associated with retinal thickness change. Visual acuity, retinal thickness, and age at the baseline examination, but not PVD status, are associated with functional and anatomical outcomes after intravitreal aflibercept for neovascular age-related macular degeneration.

Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit.

PurposeTo evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP).MethodsWe performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid–air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation.ResultsPreoperatively, the median BCVA was 0.70 (range: 0.30–1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07–0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2–8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12–144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded.ConclusionFor macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results.

Diabetic maculopathy

SummaryVitreoretinal macular interface plays an important role in the formation and progression of diabetic macular edema. Main vitreoretinal diseases as epiretinal membrane, vitreous traction and macular holes may occur in this condition. They are due to abnormal mechanical and biochemical interactions between posterior hyaloid and retinal surface. OCT has changed our understanding of the contribution of vitreoretinal interface disorders on the course of macular edema. Tractional elements contribution seems to be more obvious compared to untractional elements as epiretinal membranes. The management of vitreoretinal retinal disorders associated to diabetic macular edema will be discussed. Specific surgical approach will be detailled and compared to same conditions occuring in non diabetic patients.

Optic nerve head hemorrhage and vitreous traction

PurposeDuring posterior vitreous detachment (PVD) the posterior hyaloid remains, for a certain period, attached to the optic disc. It can exert traction with development of optic nerve head hemorrhages (ONHH). ONHH are known to be associated with glaucomatous progression and retinal nerve fiber layer (RNFL) defects. Therefore this study aims at investigating the relationship between PVD formation and ONHH in open angle glaucoma patients.MethodsPatients presenting with an ONHH, from November 2014 on, were included. They underwent a comprehensive ophthalmological investigation, automated visual field test, confocal scanner (HRT III), OCT (HRT‐Spectralis) scan and stereographic photos of the optic nerve head. This study is part of a larger, clinicaltrial.gov (NCT02290795) registered, study investigating vitreopapillary traction (VPT).ResultsEighteen eyes of 18 patients (11 normal tension, 6 primary open angle and 1 secondary open angle glaucoma) were included. Seven out of 18 (38.9%) eyes had concomitant VPT and 7 had a complete PVD. Seven ONHH were located infero‐, 5 supero‐ and 6 temporal. In the non‐VPT subgroup 5 out of 11 (45.5%) eyes showed matching retinal nerve fiber layer defects, with 2 out of 7 (28.6%) in the VPT subgroup.ConclusionsVPT could be a confounding factor in glaucoma assessment and ONHH development.

The use of intraoperative spectral domain optic coherence tomography in vitreoretinal surgery: The evaluation of efficacy

PurposeTo evaluate the feasibility of intraoperative spectral domain optic coherence tomography (iSD‐OCT) in challenging cases during pars plana vitrectomy (PPV).MethodsIntraoperative imaging was performed using the first commercially available iSD‐OCT system Rescan 700, fully integrated into the surgical microscope OPMI Lumera 700 (Zeiss, Oberkochen, Germany). The feasibility of iSD‐OCT was assessed during three 23‐gauge PPV cases: large macular hole (MH) with inverted internal limiting membrane (ILM) flap technique (Case #1), vitrectomy for asteroid hyalosis with age‐related macular degeneration (Case #2), vitrectomy for morning glory syndrome with retinoschisis and exudative retinal detachment (Case #3).ResultsCase #1. The use of iSD‐OCT facilitated to safely initiate ILM flap, to form inverted flap, to invert the flap into the MH, to control position of the forceps concerning retinal layers, and to confirm the MH covering with the ILM remnants at the end of the surgery. Case #2. Standard OCT was not available before the surgery due to opaque vitreous. Intraoperative SD‐OCT imaging assisted to reveal epiretinal membrane (ERM), retinal pigment epithelium detachment, intraretinal fluid and drusen. These findings required additional surgical steps: ERM removal and injection of anti‐VEGF at the end of the surgery. Case #3. In the case of morning glory syndrome iSD‐OCT facilitated to remove the strongly adherent posterior hyaloid, to control ILM flap initiation, to perform the peeling over the detached retina, to aspirate residual fluid after fluid/air exchange.ConclusionsThe use of iSD‐OCT facilitates real‐time simultaneous to surgical workflow visualisation of tissue behaviour and surgical manoeuvres during pars plans vitrectomy. The obtained information can improve surgical technique and influence the decision making in difficult cases.

The use of intraoperative spectral domain optic coherence tomography in vitreoretinal surgery: The evaluation of efficacy

PurposeTo evaluate the feasibility of intraoperative spectral domain optic coherence tomography (iSD‐OCT) in challenging cases during pars plana vitrectomy (PPV).MethodsIntraoperative imaging was performed using the first commercially available iSD‐OCT system Rescan 700, fully integrated into the surgical microscope OPMI Lumera 700 (Zeiss, Oberkochen, Germany). The feasibility of iSD‐OCT was assessed during three 23‐gauge PPV cases: large macular hole (MH) with inverted internal limiting membrane (ILM) flap technique (Case #1), vitrectomy for asteroid hyalosis with age‐related macular degeneration (Case #2), vitrectomy for morning glory syndrome with retinoschisis and exudative retinal detachment (Case #3).ResultsCase #1. The use of iSD‐OCT facilitated to safely initiate ILM flap, to form inverted flap, to invert the flap into the MH, to control position of the forceps concerning retinal layers, and to confirm the MH covering with the ILM remnants at the end of the surgery. Case #2. Standard OCT was not available before the surgery due to opaque vitreous. Intraoperative SD‐OCT imaging assisted to reveal epiretinal membrane (ERM), retinal pigment epithelium detachment, intraretinal fluid and drusen. These findings required additional surgical steps: ERM removal and injection of anti‐VEGF at the end of the surgery. Case #3. In the case of morning glory syndrome iSD‐OCT facilitated to remove the strongly adherent posterior hyaloid, to control ILM flap initiation, to perform the peeling over the detached retina, to aspirate residual fluid after fluid/air exchange.ConclusionsThe use of iSD‐OCT facilitates real‐time simultaneous to surgical workflow visualisation of tissue behaviour and surgical manoeuvres during pars plans vitrectomy. The obtained information can improve surgical technique and influence the decision making in difficult cases.

Combinación de láser y ranibizumab en el manejo del tumor retiniano vasoproliferativo

Case reportA 34 year-old man presented with progressive visual loss in his right eye. Ocular fundus showed a vasoproliferative tumor in the peripheral retina with an associated epiretinal macular membrane. Angiography showed a rapid filling of tumor vessels. The treatment consisted of laser photocoagulation and a single injection of intravitreal ranibizumab. After 8 weeks, there was a residual area of fibrosis, the posterior hyaloid was detached, and the epiretinal membrane disappeared. Visual acuity returned to 20/25. DiscussionLaser photocoagulation and intravitreal ranibizumab combination could be useful for vasoproliferative tumors.

The correlation between visual acuity outcomes and optical coherence tomography parameters following surgery for diabetic epiretinal membrane and taut posterior hyaloid.

PurposeTo evaluate the relationship between visual outcomes and the determinants detected by spectral domain optical coherence tomography (OCT) in eyes with epiretinal membrane (ERM) and/or taut posterior hyaloid (TPH) that underwent pars plana vitrectomy (PPV).Materials and methodsA total of 30 participants with diabetic ERM and TPH were included in the study. All study participants underwent PPV. Preoperative and postoperative best corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer (RNFL), macular RNFL, ganglion cell layer, inner plexiform layer, and ganglion cell complex thicknesses were measured in each participant. Linear regression analyses were performed to determine the association between the OCT parameters and the visual acuity measured at the time of the OCT measurement.ResultsThe postoperative BCVA logarithm of the minimum angle of resolution (logMAR) values were statistically higher than the preoperative values in the ERM group and TPH group (P=0.001 and P<0.001, respectively). The postoperative BCVA logMAR value was negatively correlated with average RNFL, inferior RNFL thicknesses, and image quality (P=0.002, P=0.004, and P=0.006, respectively). The preoperative and postoperative BCVA logMAR value difference was not correlated with age and all of the OCT parameters measured (P>0.05).ConclusionThis study shows that achievement of better peripapillary RNFL thickness results in better visual outcome after PPV and ERM/TPH removal.