Retinal Detachment Research Articles

Spontaneous closure of full-thickness macular hole after pars plana vitrectomy for retinal detachment: evidence of ellipsoid zone restoration.

To describe a case of full-thickness macular hole (FTMH) occurred after pars plana vitrectomy (PPV) for a macula-sparing rhegmatogenous retinal detachment (RRD), which showed a spontaneous closure associated with outer retinal layers restoration. Case report. A pseudophakic 69-year-old man underwent PPV for a macula-sparing superior RRD in the right eye (RE). Best corrected visual acuity (BCVA) was 20/20 before surgery. Three weeks after treatment the patient complained about visual impairment, and a FTMH was detected at fundus examination as well as confirmed by optical coherence tomography (OCT) scan. The patient was scheduled for a repeated surgery, but FTMH spontaneously closed eighteen days after its occurrence as demonstrated at OCT showing only a point break of the ellipsoid zone (EZ) and Verhoeff membrane. The subsequent macular OCT scan showed a point-like irregularity at the Verhoeff membrane and regeneration of EZ, associated with a progressive improvement in BCVA. Forty-days after the FTMH occurrence, all the retinal layers were completely restored with a complete clinical recovery. FTMH formation and closure after macula-sparing RRD repair is a rare event that could be characterized by spontaneous and gradual anatomical restoration of the EZ associated with visual acuity improvement, underlying the retinal physiology recovery.

X-linked juvenile retinoschisis associated with an RS1 in-frame deletion and bilateral central serous chorioretinopathy.

To report the case of a patient with X-linked juvenile retinoschisis (XLRS), caused by an in-frame deletion of the RS1 gene, who presented visual loss due to bilateral central serous chorioretinopathy (CSC).Methods: Observational case report. A 34-year-old man, with type-A personality, presented with a one-month history of decreased visual acuity and metamorphopsia in his right eye. Funduscopic examination showed a dome-like foveal elevation in both eyes (OU), as well as subtle pigmentary changes of the retinal pigment epithelium with a tapetal reflex in the fovea. Spectral-domain optical coherence tomography revealed intraretinal cystic foveal changes and serous retinal detachment in OU. Fundus fluorescein angiography of OU showed a focal area of intense hyperfluorescence with leakage in late phases. Electroretinogram revealed a markedly attenuated b-wave and a diminished a-wave in photopic and scotopic phases. Genetic testing revealed a hemizygous c.282_284delCTT deletion in the RS1 gene, predicting a p.Ser95del change at the protein level. The patient was diagnosed with XLRS and central serous chorioretinopathy as a coexisting condition. Patient was observed during a 3-month period but showed no improvement. Therefore, subthreshold micropulse laser was applied, achieving complete resolution of signs and symptoms of CSC. CSC can be a cause of acute or subacute visual loss in patients with XLRS when other complications such as vitreous hemorrhage and retinal detachment have been excluded.

Retropupillary sulcus gas migration after retinal detachment repair surgery.

To elucidate etiology and management of retropupillary sulcus migration of intravitreal gas after uneventful retinal detachment repair surgery. 70 year old Caucasian man presented with a temporal macula-off rhegmatogenous retinal detachment. 25-gauge (25G) pars plana vitrectomy was performed with cryopexy to retinal tear and 12% C3F8 gas tamponade under sub-Tenon's anaesthesia. At one week review, there was an elevated IOP of 28mmHg with migration of gas to the retropupillary space. Superiorly, iris was displaced anteriorly causing iridocorneal touch. There was no phacodonesis nor subluxation and retina was attached with a cryopexy scar under a 80% vitreous cavity gas fill. On treatment with topical IOP-lowering agents until two-week review, IOP had normalised to 18mmHg with persistent 50% gas fill in the retropupillary sulcus and superior iridocorneal touch.Retropupillary gas resorbed at week four with normalisation of IOP, a localised superior anterior subcapsular cataract with associated posterior synechiae, and no iridocorneal touch. Best-corrected visual acuity was 6/12 Snellen following resorption of vitreous cavity gas. Medical management may be adequate if there is no complete pupil block and adequate posterior gas fill. With complete pupil block, refractory IOP elevation, or inadequate posterior tamponade resulting in failure of retinal attachment, surgical intervention would be required.

Characterization of pediatric low vision and socioeconomic determinants of health at an academic center: a 5-year analysis

PurposeTo investigate the demographics, eye surgeries, and social determinants of health in pediatric patients with low vision in one or both eyes. MethodsThis is a cross-sectional study of children 3-18 years of age examined at an academic eye center from 2014 to 2019. Low vision was present if one eye had a distance best-corrected visual acuity (BCVA) of <20/70. ZIP code was used to estimate patient income via a public third-party database. ResultsOf 47,571 children examined during the study period, 882 had at least one eye with low vision. Of the 882, 88 (10%) had BCVA of <20/400 in at least one eye, and 228 patients (26%) had bilateral low vision. The most common cause of low vision was refractive/strabismic amblyopia (n = 304). The severest forms of vision loss (BCVA<20/200) were predominantly due to retinal dystrophies or detachment (n = 91). Three hundred patients (34%) had undergone at least one ophthalmic surgery—predominantly extraocular muscle procedures in eyes with mild visual loss and vitreoretinal surgeries in those with more severe loss. The severity of vision loss was significantly associated with a higher likelihood and number of surgeries (P < 0.0001). Income and insurance coverage did not have a significant association with BCVA or the likelihood of surgery. ConclusionsRefractive and strabismic amblyopia are the predominant causes of reduced worse-eye vision in children, and retinal diseases commonly caused severe vision loss. The type and number of surgeries correlate with the severity of vision loss. We did not find any association of income and insurance type with studied outcomes.

Nondiabetic Vitreous Hemorrhage: A Review of Management Strategy and Outcomes.

Vitreous hemorrhage involves blood leakage into or around the vitreous cavity, which presents complex management decisions. Treatment options for nondiabetic vitreous hemorrhage (NDVH) traditionally include observation or early vitrectomy. Traditional guidelines have long emphasized an initial period of cautious observation. This systematic review shows that a significant portion (∼62% to 75%) of NDVH patients present a retinal tear and/or detachment upon initial presentation. B-scan ultrasonography, the primary diagnostic tool, exhibits variable sensitivities and may miss approximately half (46.4%) of underlying tears or detachments. Only 25% of observed NDVH cases clear spontaneously, while the remaining will ultimately require vitrectomy due to nonclearance (45%) or sight-threatening complications (30%). Patients under observation experience visual deficits as hemorrhage clears slowly, challenging the efficacy of traditional guidelines favoring observation. While there is no clear guideline concerning the management of NDVH, our findings suggest that early vitrectomy for severe NDVH may be the safest and most appropriate approach, provided the patient accepts procedural risks like cataract development. [Ophthalmic Surg Lasers Imaging Retina 2024;55:660-667.].

Waxing and waning pattern of choroidal detachment post scleral buckle.

Description of evolving and resolving pattern of choroidal mounds at different quadrants post scleral buckle surgery in a myopic patient. A 48-year-old male with axial length of 32mm underwent scleral buckling for subtotal fresh retinal detachment with 360-degree multiple lattices with superior horse shoe tear. A posterior buckle was placed superiorly traversing 180-degree, 14 mm beyond muscle insertion. Uneventful drainage of sub-retinal fluid was performed intra-operatively. Post-operative day 1 depicted two choroidal detachment (CD) mounds in the ST quadrant with an adequate break buckle relationship. Post-operative day 2 depicted an additional CD mound in the inferonasal with an additional mound supero-nasally on day 4. Spontaneous resolution of the mounds was observed from day 7 with complete resolution by one month. Fragility of the choroidal vasculature in axial myopia can aggravate venous congestion when associated with one or two vortex vein obstruction after scleral buckle. Choroidal vasculature remodeling occurs after vortex vein obstruction leading to formation of new venous drainage routes.

Detection of vitrector shavings on OCT.

To describe multiple retained intraocular foreign bodies felt to be from a vitrectomy instrument. Observational case report. A 66-year-old male with history of rhegmatogenous retinal detachment repaired with PPV, scleral buckle, endolaser, and fluid-air exchange presented with dyschromatopsia OD. OCT demonstrated metallic vitrector shavings detected on OCT above the optic nerve head and macula. Repeat OCT 9 months later demonstrated movement of the vitrector shavings throughout the vitreous. We demonstrate retained intraocular foreign body shavings which are rarely seen following vitrectomy. These can be confirmed using OCT.

Comparison of Vessel Density and Retinal Sensitivity After Scleral Buckling and Phacovitrectomy in the Management of Macula-on Primary Rhegmatogenous Retinal Detachment.

The choice of surgical method for rhegmatogenous retinal detachment (RRD) may have a significant impact on the retina. In this study, we aimed to compare retinal function and structure after scleral buckling (SB) and phacovitrectomy (phaco-PPV) for macula-on RRD. This cross-sectional study included patients who underwent anatomically successful repair of macula-on RRD managed with SB (n=35) and phaco-PPV (n=35) between 2019-2023. All participants were examined within 6-20 months of surgery to evaluate the retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best-corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess the retinal function. Analysis of the microvascular network with OCTA between eyes after surgery and healthy eyes showed a decrease in VD. Significant changes in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were observed only in eyes after SB surgery (p <0.001 and p=0.02, respectively). Analysis of retinal function assessed by MP showed a significant decrease (p<0.05) in retinal sensitivity after phaco-PPV (24.81±2.25 dB) and SB (24.18±2.14 dB) operations compared to the healthy control group (25.97 ± 1.51 dB), whereas postoperative BCVA showed no differences (p>0.05). Changes in retinal sensitivity were accompanied by impairment of the microvascular network in the eyes after SB and phaco-PPV surgeries due to macula-on RRD. Disorders were more pronounced in eyes following SB surgery, possibly secondary to mechanical stress.

An Unknown Pregnancy Presenting as Vision Loss: A case report

Hypertensive retinopathy (HTR) secondary to preeclampsia can present similarly to non-pregnancy related HTR. Here, we report a case of a patient who presented to our eye clinic for decreased vision bilaterally. Ocular exam and imaging revealed large serous retinal detachments affecting the central macula along with massive intraretinal edema. Due to concern for systemic pathology, the patient was referred to the emergency department (ED), where her blood pressure was found to be 200/110 mmHg. The patient was discovered to be pregnant and diagnosed with preeclampsia with severe features in the third trimester. After delivery of the fetus, the patient had complete resolution of visual symptoms. Since pregnancy-related ophthalmic manifestations are generally mild and reversible, ophthalmologists do not usually consider pregnancy-related disease in patients who are not known to be pregnant. However, it is important to keep these complications on the differential with women of child-bearing age.

Posterior vitreous membrane findings on OCT related to collagen type IV abnormalities.

The pathological mechanisms of abnormal collagen type IV predisposing to macular hole formation in Alport syndrome are hypothesized to be related to defective Bruch's membrane leading to ruptured intraretinal cysts. However, abnormal collagen type IV may also predispose to macular hole formation due to vitreous cortex abnormalities. An observational case series of Optical Coherence Tomography (OCT) findings in three patients. In two patients diagnosed with Alport syndrome and in one patient with a possibly pathogenic genetic variant in COL4A3 we observed a remarkable posterior vitreous cortex with a vitreoschisis-like appearance on OCT. Two of these patients developed a rhegmatogenous retinal detachment, of which one was caused by a giant retinal tear, and one patient developed a macular hole. During surgery, a firmly adherent vitreous cortex was observed centrally in the left eye and in the midperiphery in the right eye in one patient with a macular hole and giant retinal tear, respectively. These new vitreous cortex findings in patients with Alport syndrome are possibly related to pathogenic genetic variants affecting type IV collagen. Abnormal type IV collagen may cause pathological vitreoretinal traction, potentially leading to an increased risk of macular holes and rhegmatogenous retinal detachments.

Fovea-Sparing Internal Limiting Membrane (ILM) Peeling and ILM Plug: A Novel Approach for Managing Optic Disc Pit Maculopathy.

To evaluate the efficacy of fovea-sparing internal limiting membrane (ILM) peeling combined with ILM plug placement in patients with optic disc pit maculopathy (ODP-M). This retrospective study included seven eyes from seven patients diagnosed with ODP-M, treated with fovea-sparing ILM peeling and ILM plug placement. All patients underwent pars plana vitrectomy (PPV), with either SF6 gas or silicone oil used as tamponade. Outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), retinal reattachment, and resolution of retinoschitic lesions (RL). Data were collected at baseline and during follow-ups at 1, 3, 6, and 12 months. The mean age of the study patients was 31 (± 13.14) years, with a marginal male preponderance (M: F = 4:3). All patients achieved complete retinal reattachment, with a significant reduction in CMT from 503.57 (± 154.74) µm preoperatively to 286.29 (± 22.43) µm at 12 months (P=0.02). BCVA improved in 85.7% of patients, from a mean of 0.77 (± 0.19) logMAR to 0.5 (± 0.25) logMAR by 12 months, though this was not statistically significant (P=0.27). Complete resolution of RL was observed in 71.4% of eyes, while 2 eyes showed partial resolution. One patient developed retinal detachment postoperatively, which was successfully managed with additional surgery. Fovea-sparing ILM peeling combined with ILM plug placement resulted in favorable anatomical and functional outcomes for ODP-M patients, with a 100% retinal reattachment rate and significant CMT reduction. This technique offers a viable alternative to conventional approaches, preserving foveal architecture while providing a mechanical barrier to fluid accumulation.

Intraocular lens tilt and decentration after primary and delayed implantation in phacovitrectomy for macula-off rhegmatogenous retinal detachment repair.

To evaluate the tilt and decentration of intraocular lenses (IOLs) in eyes that underwent phacovitrectomy for macula-off rhegmatogenous retinal detachment (RRD) repair. In this retrospective cohort study, 63 patients with macula-off RRD who underwent phacovitrectomy were enrolled and divided into a primary implantation group (group A) and a delayed implantation group (group B) according to the time of IOL implantation. Routine ocular examinations, including optometry, were performed, and the IOL tilt and decentration were measured. Postoperative refractive prediction error and IOL tilt and decentration were compared between the two groups, and the relevant factors of IOL positions were analyzed. The mean spherical refractive prediction error (MSE) was - 0.53 ± 0.39 D in group A and - 0.09 ± 0.55 in group B. The mean absolute spherical refractive prediction error (MASE) was 0.61 ± 0.23 D in group A and 0.50 ± 0.22 D in group B. The difference in MSE ( t = -3.623, P < 0.05) but not in MASE (t = 1.866, P = 0.067) between the two groups was significant. The mean IOL tilt and mean decentration were 8.54° ±3.65° and 0.55 ± 0.18 mm in group A and 10.62° ±3.29° and 0.66 ± 0.14 mm, respectively, in Group B. Differences in tilt ( t = -2.373, P < 0.05) and decentration ( t = -2.698, P < 0.05) between the two groups were both significant. In group B, the mean time interval between phacovitrectomy and IOL implantation (T V-I ) was 25.2 ± 6.9 weeks, and the absolute values of both IOL tilt and decentration were positively correlated with T V-I . In phacovitrectomy for macula-off RRD repair, primary IOL implantation leads to a postoperative myopic shift, while delayed IOL implantation may cause greater IOL tilt and decentration.

Unilateral retinal neovascularization associated with recurrent vitreous hemorrhage in a patient with gyrate atrophy.

To describe the first case of unilateral peripheral retinal neovasularization associated with recurrent vitreous hemorrhage and localised tractional retinal detachment in a patient with gyrate atrophy (GA). Interventional case report. A 23-year-old man with confirmed diagnosis of gyrate atrophy presented with vitreous hemorrhage and history of stable peripheral inferior tractional retinal detachment in the left eye. After three months, the vitreous hemorrhage partially reabsorbed and peripheral retinal vascular abnormalities with focal neovascularization were detected with associated tractional retinal detachment and confirmed on fluorescein angiography. Cryotherapy was performed to prevent any further bleeding. Twelve months later, the left eye remained stable and no further vitreous bleeding occurred. The combination of peripheral retinal neovascularization, localised tractional retinal detachment and recurrent vitreous hemorrhage can be a unilateral complication of gyrate atrophy. In similar cases, cryotherapy may represent a valuable therapeutic option to prevent recurrent bleeding.

Accuracy of Axial Length Measurements by Two Swept-Source Optical Coherence Tomography Biometers in Macula-off Rhegmatogenous Retinal Detachment Eyes.

To assess the accuracy of axial length (AXL) measurements using two swept-source optical coherence biometers, IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany) and ARGOS (Alcon, Inc. Fort Worth, TX), for macula-off rhegmatogenous retinal detachment (RRD). This retrospective study included 100 eyes with phakic primary macula-off RRD. Preoperative AXL measurements were performed using different methods: applanation A-scan ultrasound (U/S) biometry, combined applanation vector A/B-scan biometry, and optical biometry measurements were obtained using IOLMaster 700 (Carl Zeiss, Meditec, Jena, Germany) and ARGOS (Alcon, Inc. Fort Worth, TX). All patients underwent pars plana phacovitrectomy. At 8-10weeks postoperatively, optical biometry was performed to record AXL. Mean preoperative AXL measured using vector-A/B-scan ultrasonography was higher than that of postoperative AXL measured using IOLMaster (p < 0.05). Mean AXL measured by the standard mode of the ARGOS optical biometer was lower than mean AXL measured by both enhanced retina visualization (ERV) mode and user-adjusted method (p < 0.05). Mean same-eye AXL measured using IOLMaster was lower than that measured using ARGOS (p < 0.05). The least difference was observed with combined vector-A/B-scan ultrasound (on the positive side), followed by fellow eye AXL measured using IOLMaster optical biometry (on the negative side). Optical biometry of fellow eye in macula-off RRD was noted to be highly correlating with postoperative optical biometry of same eye using IOL Master 700 in eyes without anisometropia. IOLMaster 700 showed less accuracy in the AXL measurements for same eye. The ARGOS optical biometer may have a good potential for measuring same eye AXL. Using ERV mode or a user-adjusted method for the ARGOS optical biometer may improve accuracy of AXL measurements. Most accurate method for measuring AXL in same eye was vector-A/B-scan ultrasound.

Fellow Eye Risk of Rhegmatogenous Retinal Detachment in the United States: IRIS Registry (Intelligent Research in Sight) Analysis.

This study aimed to investigate the rate of rhegmatogenous retinal detachment (RRD) in the fellow eye of patients after developing an RRD in one eye. This is a retrospective cohort study of patients with a new RRD diagnosis in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) from 2016 to 2020. The association between risk factors of RRD and fellow-eye RRD was evaluated using Cox regression. Among the 201,622 patients who developed a new RRD in at least one eye, 6,740 (3.34%) developed an RRD in the fellow eye at a mean time of 406.02 days (SD = 373.74) from the first eye diagnosis. Of those 6,740 eyes, 1,889 (28.03%) had lattice degeneration, 3,938 (58.43%) had PVD, 588 (8.72%) had cataract surgery, and 38 (0.56%) had complex cataract surgery. Adjusted regression modeling showed that male sex (HR 1.73, [95% confidence interval (CI) 1.64 to 1.83]; P < 0.001), younger age at first eye RRD diagnosis (HR 1.02, [95% CI 1.01 to 1.02]; P < 0.001), active smoking (HR 1.13, [95% CI 1.05 to 1.22]; P = 0.002), and cataract surgery (HR 1.33, [95% CI 1.23 to 1.45]; P < 0.001) were associated with increased risk of a fellow eye RRD. On the other hand, fellow eye PVD was associated with a lower risk of RRD (HR 0.80, [95% CI 0.76 to 0.84]; P < 0.001). Among patients with an RRD in one eye, male sex, younger age of first eye RRD diagnosis, active smoking, and cataract surgery were associated with a higher risk of developing a fellow eye RRD, whereas fellow eye PVD was associated with a lower risk of fellow eye RRD. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Submacular hemorrhage: My personal journey to the goal.

Acute submacular hemorrhage (SMH) can be caused by various diseases including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and retinal arterial microaneurysm (RAM). The natural course of submacular hemorrhage is generally poor. Animal studies have suggested that the removal of subretinal hemorrhage may effectively reduce retinal damage caused by hemorrhage in humans and removal of submacular hemorrhage have been performed with limited visual outcomes. Pneumatic displacement involving intravitreal expansile gas with or without adjunctive intravitreal injection of tissue plasminogen activator (tPA) has demonstrated effective displacement of SMH and improvement in visual acuity in the majority of cases. Although tPA may not be indispensable, its use may facilitate displacement. Combining pneumatic displacement with vitrectomy and subretinal injection of tPA may achieve superior displacement of SMH compared to pneumatic displacement of SMH, implying that pneumatic displacement of SMH with vitrectomy and subretinal injection may offer enhanced effectiveness in SMH displacement,while noobvious different was found in visual outcomes between the two treatments.Complications associated with these procedures encompass breakthrough hemorrhage, retinal detachment and macular hole formation. Breakthrough hemorrhage is more commonly observed following pneumatic displacement whereas retinal detachment appears to be more prevalent following vitrectomy. Macular hole formation subsequent to vitrectomy represents a significant complication, particularly in eyes with SMH attributed to ruptured retinal arterial microaneurysm. Both pneumatic displacement and vitrectomy present advantages and disadvantages, and the superiority between the two remains undetermined. Sequential strategy for the treatment of submacular hemorrhage is another option. As the initial step, pneumatic displacement of SMH should be attempted, and if displacement is insufficient, pneumatic displacement following vitrectomy with subretinal injection of tPA may be pursued. Further investigations are warranted to ascertain optimal management strategies for SMH leading to improved outcomes. KEY MESSAGES: What is known • Pneumatic displacement with/without intravitreal tPA injection, and vitrectomy with subretinal tPA injection and gas are the two major treatments for submacular hemorrhage. What is new • No obvious different was found in visual outcomes between vitrectomy, subretinal tPA injection and gas, and intravitreal tPA injection and gas while vitrectomy with subretinal tPA injection and gas may achieve better displacement of submacular hemorrhage. • Macular hole formation is a specific complication for submacular hemorrhage due to ruptured retinal arterial macroaneurysm.

Bilateral exudative retinal detachment with subretinal light-chain protein in a patient with multiple myeloma -case report-

BackgroundExudative retinal detachment in patients with multiple myeloma is exceedingly rare. Only two Cases are known to us. We successfully identified light-chain proteins in subretinal fluid, allowing for a more precise understanding of the pathogenesis of this complication.Case presentationA 68-year-old patient presented with bilateral exudative retinal detachment. The visual impairment was reported one day after stem cell mobilization by granulocyte-colony stimulating factor (G-CSF) and the additional administration of Plerixafor. The symptoms began during stem cell apheresis. The patient underwent surgical treatment for both eyes through vitrectomy and silicone oil tamponade. Light-chain proteins were detected in the collected subretinal fluid through electrophoresis in one eye.ConclusionsWe successfully identified light-chain proteins in subretinal fluid, allowing for a more precise understanding of the pathogenesis of this complication. The pathomechanism likely involves damage to the outer blood-retina barrier due to the deposition of light-chain proteins. Whether mobilization of bone marrow cells with Plerixafor led to a breakdown of the outer blood-retina barrier in these patients is a topic for discussion and has to be considered in the use of Plerixafor.

Automated segmentation of retinal layers in optical coherence tomography images using Xception70 feature extraction

Optical coherence tomography (OCT) imaging plays a critical role in evaluating retinal layer thickness, serving as a pivotal diagnostic tool for numerous retinal conditions. However, challenges such as speckle noise, poor image contrast, and ambiguous retinal detachments, like drusen, often hinder accurate segmentation of retinal layers. To address these challenges and enhance diagnostic precision, we introduce the Retinal Segmentation Network, or "Ret-Seg Net," a deep neural network-based approach. Leveraging the advanced Xception70 feature extractor, Ret-Seg Net extracts and comprehends the intricate properties of retinal layers. By integrating acquired feature maps from Xception70 into the atrous spatial pyramid-pooling module, Ret-Seg Net extracts multiscale feature information. The encoder-decoder module of Ret-Seg Net achieves automated segmentation of retinal layers in OCT images by reconstructing distinct retinal layer borders. This advanced module accurately recognizes and differentiates retinal layer boundaries, providing precise and reliable segmentation. Validation of our approach using real-time images and the Duke dataset, comprising 310 volumes with 40 B-scans each, demonstrates outstanding performance. Mean intersection over union (MIoU) and sensitivity (Se) metrics achieved remarkable values of 94.52 % and 96.25 % respectively. Furthermore, our approach offers a versatile segmentation framework applicable to various tissues and cell types in clinical settings. Automating segmentation of retinal layers enhances precision in disease identification and monitoring while significantly improving labor efficiency by reducing the need for manual segmentation.

Frequency, Causes and Medico-Legal Aspects of Grievous Injury to the Eye after Physical Assault

Aims: A medicolegal report is prepared by the medicolegal officer in conjunction with an ophthalmologist in cases of physical assault claiming vision loss. The objective was to report the frequency and cause of grievous injury to the eye after a physical assault. Methods: This was a descriptive cross-sectional study, conducted in the Department of Ophthalmology of a tertiary care hospital in Pakistan from October 2019 to August 2022. A total of 378 medicolegal cases were reported in the ophthalmology outpatient. Among them, 285 patients of physical assault were included with consecutive sampling technique. Results: The mean age of the patients was 33.93±12.96 years. The mean reporting time to an ophthalmologist was 4.1±8.2 days. Simple and grievous injuries were found in 278 (97.5%) and 7 (2.4%) cases, respectively. Among the grievous injuries, 4 (57.2%) were close globe injuries and 3 (42.8%) were open globe injuries. Thirteen (4.5%) were malingers. Domestic violence was observed in 82 (28.8%) study subjects. Conclusion: The frequency of grievous injury to the eye is very low (2.4%) in patients with physical assault. The patients of assault-related grievous injury were mostly males, young age, low level of education, and doing manual jobs. Vitrolage with corneal melting, and firearm injury caused the grievous injury in open globe patterns. Vitreous hemorrhage, retinal detachment, macular hole, and secondary glaucoma were seen among close globe patterns. J Bangladesh Coll Phys Surg 2024; 42: 336-341

Ultrastructural investigation of the posterior hyaloid membrane in posterior vitreous detachment.

Separation of the posterior hyaloid membrane (PHM) from the retina in posterior vitreous detachment (PVD) is a fundamental, but poorly understood, process underlying vitreoretinal disorders including retinal detachment and macular hole. We performed electron microscopy studies of the PHM after PVD to investigate its ultrastructure, associated cellular structures and relationship to the internal limiting membrane (ILM). Post-mortem human eyes were collected from recently deceased patients over 70 years of age. A posterior scleral button was trephined to identify PVD status, and the PHM and vitreous prepared for analysis with transmission and scanning electron microscopy. Twelve eyes from six patients were collected. Seven eyes had PVD; five eyes had attached vitreous. PHM was isolated from seven of seven eyes with PVD. The PHM in eyes with PVD is a laminar lacy sheet, distinct from the disorganised fibres of vitreous gel. Eyes without PVD had vitreous encased in internal limiting membrane which had separated en bloc from the retina. Cells embedded in the PHM (laminocytes) were identified in five of seven eyes with PVD, with strands stretching into the membrane. PHM isolated from eyes with PVD is distinct from artefactual separation of the ILM from the retina during dissection. PHM is ultrastructurally distinct from vitreous gel and is a separate entity. The en face appearance of PHM is similar to that of ILM, suggesting that in PVD, PHM forms from separation of an inner layer of ILM. Laminocytes may play a role in the pathogenesis of vitreoretinal disease.