Preoperative Spectral-domain Optical Coherence Research Articles

Refining glaucoma diagnosis and treatment in cataract surgery candidates: contribution of preoperative OCT retinal nerve fiber layer.

To evaluate the clinical significance of preoperative spectral domain optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) thickness in identifying glaucoma and better managing patients scheduled for routine cataract surgery. Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. Retrospective cohort study. Consecutive patients scheduled for cataract surgery were enrolled from February 2022 to August 2022. Participants underwent routine OCT RNFL studies which were evaluated by a glaucoma specialist. Findings were compared with those of preoperative fundus biomicroscopic examinations conducted by the referring ophthalmologist. The main outcomes were the incidence of newly detected glaucoma based on OCT RNFL findings and the consequent changes in patient management. In total, 486 patients met the inclusion criteria of whom 112 (23%) had abnormal RNFL. 31 patients (6.4%) had abnormal OCT RNFL findings attributed to comorbidities other than glaucoma, and 81 patients (16.7%) were suspected to have glaucoma based on their OCT RNFL findings, from which 44 patients (9%) were newly diagnosed with glaucoma or as glaucoma suspects, resulting in management modifications that included routine glaucoma follow-up (25 patients, 5.1%), initiation of intraocular pressure-lowering treatment (12 patients, 2.5%), and conversion to combined cataract-glaucoma surgery (7 patients, 1.4%). OCT RNFL for cataract surgery candidates proved valuable in detecting glaucoma that had not been revealed by standard fundus biomicroscopic examination. The additional information provided by OCT RNFL can potentially enhance patient management and optimize outcomes.

Tandem Mass Tag LC-MS/MS of Aqueous Humor From Individuals With Type 2 Diabetes Without Retinopathy Reveals Early Dysregulation of Synaptic Proteins.

An early neurodegenerative component of diabetic retinal disease (DRD) that precedes the vascular findings of clinically diagnosed diabetic retinopathy (DR) is increasingly being recognized. However, the relevant molecular mechanisms and biomarkers for early DRD are poorly defined. The purpose of this study was to uncover novel potential mediators of early diabetic retinal neuronal dysfunction through analysis of the aqueous fluid proteome in preclinical DR. Aqueous fluid was collected from subjects with type 2 diabetes mellitus (DM) but no clinical DR and from nondiabetic controls undergoing routine cataract surgery. Preoperative spectral-domain optical coherence tomography of the macula was obtained. Tandem mass tag LC-MS/MS was performed to identify proteins differentially present in diabetic and control aqueous fluid, and proteins with >50% change and P < 0.05 were considered significant. Selected results were validated with western blot of human aqueous fluid samples. We identified decreased levels of proteins implicated in neuronal synapse formation and increased levels of inflammatory proteins in the aqueous fluid from patients with type 2 DM but no DR compared with controls. Of the differentially present synaptic proteins that we identified and confirmed with western blot, the majority have not previously been linked with DRD. The proteomic profile of aqueous fluid from individuals with type 2 DM but no DR suggests that retinal neuronal dysfunction and inflammation represent very early events in the pathophysiology of DRD. These findings support the concept that diabetic retinal neurodegeneration precedes vascular pathology and reveal novel potential mediators and/or biomarkers warranting further investigation.

Optical biopsy – Optical coherence tomography guided excision of ocular surface squamous neoplasia

: To report the role of optical biopsy where the preoperative spectral domain optical coherence tomography (SD OCT) features were used for surgical margin clearance in ocular surface squamous neoplasia (OSSN) excision.In this prospectiveinterventional studypatients with clinically diagnosed OSSNundergopreoperative SD OCT and mass was excised with 3mm clearance with respect to the extent on OCT. Corneal, conjunctival margins and lamellar sclera was evaluated histopathologically. Twelve eyes of 11 patients with mean age of 59.2 ± 12.2 were studied. Hyper reflective epithelium, increased thickness, abrupt transition of corneal epithelium and increase back shadow were the features of OSSN noted. The mean functional epithelial thickness and epithelial thickness were 137.5± 60.6µm and 58.5±10.8 µm respectively. The histopathology confirmed as squamous cell carcinoma (SCC) (n=4, 33.3%), carcinoma in situ (CIN) (n=8, 66.6%). In CIN 2 eyes were severe dysplasia and 6 were moderate dysplasia. Corneal clearance was noted as 100 %. Of 36 conjunctival margins, the positive margin noted in 6 eyes (50%). Nasal margin (n=3) and temporal (n=3) were the common margins. There was no difference in clearance between CIN (50%) or SCC (50%) on conjunctival side. Two eyes with recurrence required and revision excision subsequent topical chemotherapyOptical biopsy by SD OCT though is an effective method for OSSN removal. Corneal margins showed better margin clearance than conjunctival.

Parameters affecting the anatomical and functional success of macular hole surgery

Aim: To evaluate the effect of preoperative Spectral Domain Optical Coherence Tomography (SD-OCT) parameters on macular hole surgery (MHS) and their predictive value for postoperative best corrected visual acuity (BCVA).&#x0D; Materials and Methods: This retrospective study included 30 eyes of 30 patients with macular hole (MH). All patients underwent pars plana 23-gauge vitrectomy. A detailed macular analysis including MH minimum diameter (MD), base diameter (BD), opening diameter (OD), height, nasal arm (NA), temporal arm (TA), macular hole index (MHI), diameter hole index (DHI), tractional hole index (THI), hole form factor (HHF), macular hole area (MHA), and macular hole volume (MHV) were performed preoperatively. Presence of inner segment–outer segment (IS/OS) line, external limiting membrane (ELM), and cyst was noted postoperatively. Relationships between these parameters and postoperative BCVA were evaluated.&#x0D; Results: The study group comprised 25 (83.3%) women. Mean pre and postoperative BCVA values were 0.924±0.320 and 0.487±0.287 logMAR, respectively. BCVA improved significantly after MHS (p

Role of intraretinal cysts in the prediction of postoperative closure and photoreceptor damages of the idiopathic full-thickness macular hole

BackgroundTo determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is present.MethodsCase-control study. Patients with idiopathic FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were retrospectively reviewed. Preoperative spectral-domain optical coherence tomography was undertaken in all patients. The new parameter, macular hole closing factor (MHCF) was defined as the base diameter - (arm length + IRC height) by adding IRC to the existing parameter. After surgery, patients were classified and analyzed according to the type of hole closure and the damage of photoreceptor.ResultsOf the 35 patients, 28 (80.00%) had type 1 closure and seven (20.00%) had type 2 closure. There was a significant difference in postoperative BCVA (P < 0.01), base diameter (P = 0.037), arm length (P = 0.045), and IRC height (P = 0.011) between the two groups. In the type 1 closure, they were further divided into two subgroups according to photoreceptor damage, and it was confirmed that there were significant differences in postoperative BCVA (P = 0.045), hole height (P = 0.048), and IRC height (P = 0.046) in the two subgroups. As for the new parameters, a significant difference between the three groups was confirmed (P < 0.01).ConclusionIRC may help predict hole closure along with the known horizontal parameters. Therefore, the new parameter containing both two factors can help predict not only hole closure but also damage to photoreceptors that affects postoperative visual prognosis.

Use of ellipsoid zone width for predicting visual prognosis after cataract surgery in patients with retinitis pigmentosa

ObjectiveTo predict the visual prognosis of cataract surgery in patients with retinitis pigmentosa by measuring ellipsoid zone (EZ) width using spectral-domain optical coherence tomography.MethodsThis retrospective study included patients with retinitis pigmentosa who underwent uncomplicated cataract surgery between December 2017 and June 2020. Preoperative best-corrected visual acuity (BCVA) and the best postoperative BCVA during follow-up were collected. EZ width was measured on preoperative cross-sectional optical coherence tomography images along the horizontal/vertical meridian through the fovea.ResultsThirty-eight eyes of 38 patients (22 female; mean [±standard deviation] age, 62.1 ± 11.8 years) were included. The median preoperative logarithm of the minimum angle of resolution BCVA of 0.52 (range, 0.00–3.00) significantly improved to 0.07 (range, −0.18–3.00) after surgery (P < 0.001). On preoperative spectral-domain optical coherence tomography images, the median horizontal, vertical, and average EZ widths were 783 (range, 0–9837), 761 (range, 0–10 250), and 769 (range, 0–10 043) μm, respectively. Postoperative BCVA significantly correlated with the horizontal (r = −0.784, P < 0.001), vertical (r = −0.777, P < 0.001), and average EZ widths (r = −0.777, P < 0.001). The area under the receiver operating characteristic curve for the ability of the horizontal, vertical, and average EZ widths to discriminate eyes with and without postoperative BCVA ≤ 0.3 was 0.971, 0.960, and 0.963, respectively, with best cut-off values of 513, 608, and 515 μm, respectively.ConclusionsEZ width measurement can help predict the visual prognosis of cataract surgery in patients with retinitis pigmentosa. A preferable visual acuity prognosis can be expected in patients with an EZ width of approximately 600 μm.

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.

Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography.

To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD). This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021. Among 406 eyes, baseline visual acuity (β = 0.184, P = .001) and time to surgery (β = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment. Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].

Evaluación de la distancia al recto medio en la exotropía consecutiva mediante tomografía de coherencia óptica y medida intraoperatoria

PurposeTo assess the agreement between the intraoperative measurements of the distance from the medial rectus muscles insertion to the limbus and preoperative spectral-domain optical coherence tomography (SD-OCT) in consecutive exotropia (cXT). MethodsAn analysis was performed on total of 14 medial rectus (MR) muscles of 14 patients who underwent surgery for the treatment of cXT. The limbus-insertion distance of the MR muscles was measured using preoperative SD-OCT and intraoperatively using a calliper. The intraclass correlation coefficient (ICC) and Bland Altman plots were calculated to determine the agreement between the two methods, as well as the correlation. ResultsMean age was 36.3±16.0 years (range 13-60), with 60% being women. Mean preoperative deviation was 38.7±16.9 prismatic dioptres (PD) (range 16 to 65), being +1.3±6.3 PD (range -12 to +10 PD) after surgery. Intraoperatively the MR insertion was found at 8.7±2.1mm (range 5.5 - 12.0) and by OCT at 7.7±1.2mm (range 5.3 - 10.0). The ICC showed a moderate to good agreement (0.659; 95% confidence interval: 0.157-0.885; P<.001), with a correlation of R=0.792 (P=.011). A better agreement was observed in those MR that were less retro-inserted. ConclusionsSD-OCT is able to measure the insertion to the limbus distance of the medial rectus muscles that have been previously operated on, showing moderate to good agreement with intraoperative measurements. However, the agreement was poor in muscles with a large retro-insertion.

Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular optical coherence tomography.

To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery. Shaare-Zedek Medical Center, Jerusalem, Israel. Retrospective case series. Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning before cataract surgery. The scans were reviewed by a retinal specialist for macular pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed. Four hundred fifty-three eyes of 453 patients were enrolled in the study; 42 eyes (9.2%) were excluded because of noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 eyes (40.6%), including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 patients (26.0%) was modified because of macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopic examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes [17.8%]) and referral to a retinal specialist for consultation (34 eyes [8.3%]). Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopic examination. The added information could improve patient management.

Are There Funduscopic and Optical Coherence Tomography Preoperative Characteristics to Predict Surgical Difficulty of Epiretinal Membrane Removal?

ABSTRACT Purpose To identify the correlation between preoperative funduscopic and optical coherence tomography characteristics of epiretinal membranes and the difficulty of surgical removal. Methods Fifty eyes of 50 patients with an idiopathic epiretinal membrane (ERM) scheduled for pars plana vitrectomy (PPV) and ERM peeling were included. Surgical videos were analyzed and the difficulty of ERM removal (easy or difficult) determined subjectively by an independent surgeon. Furthermore, the peeling time and amount of grasping were measured on the videos to provide an objective factor of surgery difficulty. Preoperative spectral-domain optical coherence tomography (OCT) images and color fundus photos were analyzed to identify predictive factors for membrane removal difficulty. Results The subjective surgical difficulty of ERM removal was strongly associated with fibrillary changes between the ERM and retinal nerve fiber layer (RNFL), severe retinal vascular tortuosity and severe glinting fundus reflex. Higher fundus pigmentation was associated with fewer and cystoid spaces with more attempts of grasping ERM. No other preoperative signs were found to be associated with the duration of the peeling time. Conclusion The presence of fibrillary changes between the ERM and RNFL, severe retinal vascular tortuosity and severe glinting reflex are preoperative findings that have a strong association with the difficulty in ERM peeling.

PRESERVATION OF THE FOVEAL FLAP IN MACULAR HOLE SURGERY.

To investigate the impact of preserving the foveal flap on surgical outcomes of full-thickness macular hole (MH) with foveal flaps. We retrospectively reviewed patients with Stages 2 and 3 idiopathic MH, who underwent pars plana vitrectomy by a single surgeon at Asan Medical Center from November 2011 to November 2016. In the study group, we included eyes with MH and a foveal flap on preoperative spectral domain optical coherence tomography and successfully preserved the flap during surgery. The control group included eyes with MH and an operculum in the posterior vitreous plane on preoperative optical coherence tomography. We compared the anatomical and functional surgical outcomes between these groups. Postoperative mean best-corrected visual acuity at the last visit was 20/25 and 20/33 in the study (9 eyes) and control (23 eyes) groups, respectively. The study group showed a significantly better postoperative best-corrected visual acuity (P < 0.05). Restoration of both the external limiting membrane and ellipsoid zone, as assessed by spectral domain optical coherence tomography, was achieved in 9 (100%) and 15 (65.2%) eyes of the study and control groups, respectively. Preserving the foveal flap might improve both functional and anatomical outcomes of vitrectomy for MHs with a foveal flap.

IDENTIFICATION OF FACTORS RELATED TO SUBFOVEAL DETACHMENT SECONDARY TO EPIRETINAL MEMBRANE.

To demonstrate factors related to the presence of subfoveal detachment (SD) secondary to epiretinal membrane (ERM) and to characterize the predictors for the resolution of SD after membrane peeling. A retrospective chart review was conducted for the patients who underwent pars plana vitrectomy for the idiopathic ERM peeling. Preoperative spectral domain optical coherence tomography characteristics of the eyes including central foveal thickness, foveal center point thickness, presence of intraretinal cyst, continuity of the membrane, area of the membrane within fovea (1 mm), and entire macula (6 mm) were evaluated to find the best predictors for the presence of SD. These predictors as well as perioperative parameters including use of internal tamponade and volume of SD were considered for time of resolution of SD. Of 158 included eyes, 20.2% eyes (32 eyes) had SD, and the presence of SD was significantly related to involvement of the membrane within the macula. After surgery, SD completely resolved in 90.6% of eyes (29 eyes) at a median of 2.97 months (range: 0.03-12.0 months). The area of the membrane within fovea was the only significant predictor for time to resolution of SD (hazard ratio = 1.20, 95% confidence interval = 1.100-1.324, P = 0.021). A small percent of eyes showed some further changes including fluctuation (6.2%) or persistence (3.1%) of fluid. A larger extension of ERM over the macula is related to higher likelihood of the presence of SD. Time for resolution of subfoveal detachment does not seem to be affected by the preoperative and perioperative factors except the extent of membrane within 1,000 μm of the fovea.

Preoperative spectral-domain optical coherence tomography in patients having cataract surgery

To evaluate the role and cost-effectiveness of preoperative spectral-domain optical coherence tomography (SD-OCT) in patients having cataract surgery. Fondation Opthalmologique Adolphe de Rothschild, Paris, France. Retrospective case series. All patients who had cataract surgery had macular and retinal nerve fiber layer SD-OCT preoperatively. A complete ophthalmologic examination was performed, including corrected near (CNVA) and corrected distance visual acuities, intraocular pressure (IOP), and a fundus examination. The study comprised 245 patients (401 eyes) with amean age of 73.5years±9.81 and a mean IOP of 15.6±3.04mm Hg. Of 107 eyes (26.7%) with abnormal macular SD-OCT, 70 eyes were judged normal on fundus examination. The most frequent anomalies were age-related macular degeneration and epiretinal membrane. Age over 70years and CNVA worse than Parinaud 2 were associated with higher rate of abnormal macular SD-OCT (odds ratio, 2.76 and 2.28, respectively). Fifty-seven eyes (14.2%) had abnormal retinal nerve fiber layer SD-OCT, 30% of them with no history of glaucoma and no detected anomaly on fundus examination. Age over 70years and a history of glaucoma were associated with a higher rate of retinal nerve fiber layer anomalies. Preoperative SD-OCT scanning was significantly more effective in detecting anomalies in patients having cataract surgery than fundus examination. Older age and CNVA worse than Parinaud 2 were associated with higher rates of abnormal macular SD-OCT. Older age and a history of glaucoma were associated with higher abnormal retinal nerve fiber layer anomaly rates.

Efficacy of non-fovea-sparing ILM peeling for symptomatic myopic foveoschisis with and without macular hole

AimTo study anatomical and visual outcomes of pars plana vitrectomy (PPV) with non-fovea-sparing (entire) internal limiting membrane (ILM) peeling in eyes with myopic foveoschisis (MF).MethodsProspective interventional case series of eyes...

The role of membrane-inner retina adherence in predicting simultaneous internal limiting membrane peeling during idiopathic epiretinal membrane surgery.

PurposeTo correlate the frequency and extent of simultaneous inadvertent internal limiting membrane (ILM) peeling during idiopathic epiretinal membrane (ERM) removal with characteristics of ERM adherence demonstrated on pre-operative spectral domain optical coherence tomography (SD-OCT).Patients and methodsThis is a prospective, observational, case series of patients undergoing pars plana vitrectomy for idiopathic ERM. Inner retina-ERM adhesion was categorized as focal, broad or complete in five anatomic locations at macular area based on preoperative SD-OCT findings. The extent of spontaneous ILM peeling was quantified on a scale 0-100% in each of the aforementioned anatomic locations by the operating surgeons who were masked to the OCT characteristics. All operations were recorded with a high definition recording system and the area of simultaneous ILM peel was quantified by a second masked observer. The final extent of spontaneous ILM peel was calculated as the average of the two scores.ResultsThirty consecutive subjects who underwent surgery for idiopathic ERM were included in the study. Evidence of simultaneous ILM peeling was identified in 80.3% of individuals. With regards to the type of ERM-macula adhesion, inadvertent ILM peel was observed in 70% of the patients who pre-operatively showed complete adhesion, in 43% with broad adhesion and in only 21% with focal adhesion (P<0.001). The extent of the spontaneous ILM peel during removal of ERM was also significantly dependent on the type of ERM-inner retina adhesion. Total simultaneous ILM peel was observed in 59% of locations with complete ERM-macula adhesion but only in 22% and 7% of locations with broad and focal adhesion respectively (P<0.001).ConclusionsSimultaneous ILM peel is a frequent occurrence during ERM surgery, especially when there is complete or broad ERM adherence to the macula. The type of ERM-inner retina adhesion represents a valid predictor of the extent of simultaneous ILM peel during removal of ERM. Thorough evaluation of preoperative OCT may be a useful tool in determining a safer, more simplistic strategy in ERM surgery.

Surgical outcomes of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation.

To report the clinical findings and surgical outcomes of lamellar macular holes (LMHs) with and without lamellar hole-associated epiretinal proliferation (LHEP). A retrospective review was performed of 73 eyes of 73 patients who underwent vitrectomy for LMH. Patients were grouped according to the presence of LHEP on preoperative spectral-domain optical coherence tomography (SD-OCT). Postoperative best-corrected visual acuity (BCVA) and OCT features were compared between LMH patients with and without LHEP. Lamellar hole-associated epiretinal proliferation (LHEP) was found in 15 of 73 eyes with LMHs (20.5%). The mean age was 65.0years. The mean follow-up duration was 21.5months. Preoperatively, eyes with LHEP were characterized by a greater hole diameter (p=0.007), thinner fovea (p=0.002) and greater incidence of outer retinal disruption (p<0.001). Best-corrected visual acuity (BCVA) significantly improved after surgery in eyes without LHEP (p<0.001), but showed no change in eyes with LHEP (p=0.185). Initial BCVA was not different between the two groups; however, final BCVA was better in eyes without LHEP (logarithm of the minimum angle of resolution (logMAR) BCVA, 0.10±0.10 versus 0.33±0.40, p=0.003). OCT evaluations of postoperative foveal configurations showed no difference between the two groups (p=0.171). No case developed a full-thickness macular hole after surgery. There was no visual benefit after surgery in LMH patients with LHEP. Different surgical indications for LMHs may be warranted based on the presence of LHEP-associated pathology.

Vitrectomy for center-involved diabetic macular edema.

PurposeTo determine the effect of vitrectomy for center-involved diabetic macular edema (CI-DME).MethodsThis was a retrospective study of 53 eyes of 45 patients who had vitrectomy for CI-DME and were followed up for at least 12 months. Charts were reviewed for visual acuity (VA), central subfield mean thickness measured by optical coherence tomography, presurgical and postsurgical interventions for CI-DME, and number of office visits in the first 12 months after surgery. Preoperative spectral domain optical coherence tomography was performed on 38 patients, and they were graded for ellipsoid zone (EZ) intactness by three independent graders with assessment of agreement between graders using intraclass correlation coefficients and Bland–Altman analysis.ResultsThe median VA improved from 20/100 (interquartile range [IQR], 20/63–20/200) at baseline to 20/63 (IQR, 20/32–20/125) at 12 months. The median central subfield mean thickness improved from 505 μm (IQR, 389–597 μm) at baseline to 279 μm (IQR, 246–339 μm) at 12 months. Intergrader agreement for EZ intactness was moderate (intraclass correlation coefficients 0.4294–0.6356). There was no relationship between preoperative intactness of the EZ and the 12-month change in VA.ConclusionVitrectomy consistently thins the macula in CI-DME and, on average, leads to clinically significant improvement in VA comparable in size to that reported with serial intravitreal anti-vascular endothelial growth factor injections. A large, comparative, prospective, randomized clinical trial of these two treatments is needed to determine which is more effective and cost-effective.

INTRAOPERATIVE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING AFTER INTERNAL LIMITING MEMBRANE PEELING IN IDIOPATHIC EPIRETINAL MEMBRANE WITH CONNECTING STRANDS.

To report the intraoperative optical coherence tomography findings in idiopathic epiretinal membrane (ERM) with connecting strands and to describe the postoperative outcomes. A retrospective, case series study within a prospective observational intraoperative optical coherence tomography imaging study was performed. Epiretinal membranes with connecting strands were characterized on preoperative spectral domain optical coherence tomography images and assessed against corresponding intraoperative (after internal limiting membrane [ILM] peeling) and postoperative spectral domain optical coherence tomography images. Eleven locations of the connecting strands in 7 eyes were studied. The connecting strands had visible connections from the inner retinal surface to the ERM in all locations, and the reflectivity was moderate in 8 locations and high in 3 locations. After ERM and ILM peeling, disconnected strands were identified in all of the intraoperative optical coherence tomography images. The reflectivity of the remaining intraoperative strands was higher than that of the preoperative lesions and appeared as "finger-like" and branching projections. The remaining disconnected lesions were contiguous with the inner retinal layers. Postoperatively, the intraoperative lesions disappeared completely in all locations, and recurrent formation of ERM was not identified in any eyes. In ERM eyes with connecting strands, intraoperative spectral domain optical coherence tomography imaging showed moderately to highly reflective sub-ILM finger-like lesions that persist immediately after membrane and ILM peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously without localized nerve fiber layer loss. The sub-ILM connecting strands may represent glial retinal attachments.

Layer cake-silicone oil under the internal limiting membrane in an optic pit eye.

To describe a case of sub-internal limiting membrane (ILM) silicone oil dislocation in a patient with optic pit of the disk pathology. Interventional case report. The patient had been previously subjected to silicone oil surgery because of pit of the disk-associated retinal detachment. After silicone oil removal, persistent oil emulsifications were diagnosed within the posterior pole. Both the spatial location within the retina and the interpretation of preoperative spectral-domain optical coherence tomography images were impaired because of posterior capsule opacification. Upon explorative revitrectomy, mobile silicone oil appeared underneath a clear membrane. Internal limiting membrane peeling led to silicone oil ascension into the vitreous cavity. The macular area appeared atrophic after oil removal. Previously described formation of internal limiting membrane ridges in optic pit with subsequent emergence of sub-internal limiting membrane cavities may have facilitated silicone oil dislocation into sub-internal limiting membrane space through the optic pit. Our findings add to the features of possible spatial fluid dislocations in patients with pit of the disk pathology. Complete internal limiting membrane removal and careful evaluation of tamponade use, are desirable in surgical treatment of optic pit cases.