Macular Hole Surgery Research Articles

Supervised machine learning statistical models for visual outcome prediction in macular hole surgery: a single-surgeon, standardized surgery study

PurposeTo evaluate the predictive accuracy of various machine learning (ML) statistical models in forecasting postoperative visual acuity (VA) outcomes following macular hole (MH) surgery using preoperative optical coherence tomography (OCT) parameters.MethodsThis retrospective study included 158 eyes (151 patients) with full-thickness MHs treated between 2017 and 2023 by the same surgeon and using the same intraoperative surgical technique. Data from electronic medical records and OCT scans were extracted, with OCT-derived qualitative and quantitative MH characteristics recorded. Six supervised ML models—ANCOVA, Random Forest (RF) regression, K-Nearest Neighbor, Support Vector Machine, Extreme Gradient Boosting, and Lasso regression—were trained using an 80:20 training-to-testing split. Model performance was evaluated on an independent testing dataset using the XLSTAT software. In total, the ML statistical models were trained and tested on 14,652 OCT data points from 1332 OCT images.ResultsOverall, 91% achieved MH closure post-surgery, with a median VA gain of -0.3 logMAR units. The RF regression model outperformed other ML models, achieving the lowest mean square error (MSE = 0.038) on internal validation. The most significant predictors of VA were postoperative MH closure status (variable importance = 43.078) and MH area index (21.328). The model accurately predicted the post-operative VA within 0.1, 0.2 and 0.3 logMAR units in 61%, 78%, and 87% of OCT images, respectively.ConclusionThe RF regression model demonstrated superior predictive accuracy for forecasting postoperative VA, suggesting ML-driven approaches may improve surgical planning and patient counselling by providing reliable insights into expected visual outcomes based on pre-operative OCT features.Clinical trial registration numberNot applicable.

The Ellipsoid Zone Is a Structural Biomarker for Visual Outcomes in Diabetic Macular Edema and Macular Hole Management

Objectives: The goal was to study the ellipsoid zone (EZ) as a structural biomarker for final visual outcomes after pharmacological intervention in center-involving diabetic macular edema (DME) and surgical intervention for full-thickness macular holes (FTMHs). Methods: This was a tertiary care center-based retrospective study. After sample size calculations, data from 64 consecutive cases were collected, with subjects aged between 40 and 60 years. Thirty-two cases of DME with anti-vascular endothelial growth factor (VEGF) therapy and 32 cases of FTMHs with successful macular hole surgery (MHS) were studied. Spectral-domain optical coherence tomography (SD-OCT) data were collected. Measurements of EZ defects documented at the time of presentation and 12 weeks after intervention were analyzed using the caliper function of the machine. EZ restoration was graded, and a Pearson correlation analysis was performed. Results: Mean logMAR VA decreased after intravitreal therapy (IVT) from 1.12 ± 0.22 pre-intervention to 0.81 ± 0.41 post-intervention and after MHS, from 1.05 + 0.25 to 0.62 + 0.11 (p < 0.001). EZ disruption reduced from 73.4% to 19.4% after IVT and from 67% to 19.3% after MHS. DME and MHS postoperative visual acuity and residual EZ defect were observed to have a statistically significant linear correlation (r = 0.794, p < 0.001 and r = 0.894, p < 0.001, respectively). The EZ was found to be an excellent structural biomarker for final BCVA (area under curve = 0.95 for DME and 1.00 for MHS). Conclusion: Notable EZ restoration results were obtained from pharmacological and surgical interventions. The EZ proves to be a critical structural biomarker for predicting visual outcomes in center-involving DME and MHS.

MACULAR HOLE SURGERY AND RETINAL TECTONICS: The Impact of Internal Limiting Membrane Peeling Size on Tangential Retinal Displacement.

To evaluate the tangential retinal displacement occurring following macular hole (MH) surgery and to assess the impact of the internal limiting membrane (ILM) peeling size on the extent of the retinal movement. This retrospective study included patients with full-thickness MH undergoing 25-gauge pars plana vitrectomy with ILM peeling. Patients received either a small ILM peeling with a size of two-disk diameters or a large peeling extended up to the vascular arcades. Near-infrared retinal imaging was performed with the Spectral is (Heidelberg Engineering, Carlsbad, Germany) before and 6 months after the surgery. The tangential retinal displacement was evaluated comparing the optical flow of near-infrared images with a custom digital image analysis algorithm. Forty-four eyes of 44 patients undergoing vitrectomy with small (n = 24) or large (n = 20) ILM peeling were included. An average overall displacement of 31.3 ± 22.8 µ m toward the optic disk was observed after the surgery. Large ILM peeling was associated with a significantly higher overall displacement ( P = 0.009), displacement in the central 4-mm circle ( P < 0.001), and displacement in outer 8-mm ring ( P = 0.001). Macular holes closure was achieved in 100% and 83.3% of patients in the large and small peeling group, respectively ( P = 0.055). Pars plana vitrectomy with ILM peeling for MH results in a tangential retinal displacement toward the optic disk. A larger extent of the ILM peeling leads to a greater tangential movement, possibly improving the MH closure rate.

Predicting macular hole surgery outcomes: Integrating preoperative OCT features with supervised machine learning statistical models.

To evaluate various supervised machine learning (ML) statistical models to predict anatomical outcomes after macular hole (MH) surgery using preoperative optical coherence tomography (OCT) features. This retrospective study analyzed OCT data from idiopathic MH eyes at baseline and at 1-month post-surgery. The dataset was split 80:20 between training and testing. XLSTAT® statistical software (Lumivero, USA) was used to train different ML models on 10°CT parameters: prefoveal posterior cortical vitreous status, epiretinal membrane, intraretinal cysts, foveal retinal pigment epithelium hyperreflectivity, MH basal diameter, MH area (MHA), hole-forming factor, MH index, tractional hole index, and diameter hole index. The most effective statistical model was identified and was further assessed for accuracy, sensitivity, and specificity on a separate testing dataset. Six ML statistical models were trained on 33,260°CT data points from 3326°CT images of 308 operated MH (300 patients) eyes. Following training and internal validation, the random forest (RF) model achieved the highest accuracy (0.92), precision (0.94), recall (0.97), and F-score (0.96), and lowest misclassification rate. RF model identified the MHA index as the best predictor of post-surgical anatomical success. Following external testing, the RF model confirmed the highest accuracy and lowest misclassification rate (8.8%). ML-based statistical models can be used to predict MH status after surgery. The RF model was the most accurate ML model, and the MHA index was the best predictor of postoperative hole closure after surgery based on preoperative OCT parameters. These predictions may help with future surgical planning for MH patients.

Uncertainty-aware regression model to predict post-operative visual acuity in patients with macular holes

Full-thickness macular holes are a relatively common and visually disabling condition with a prevalence of approximately 0.5% in the over-40-year-old age group. If left untreated, the hole typically enlarges, reducing visual acuity (VA) below the definition of blindness in the eye affected. They are now routinely treated with surgery, which can close the hole and improve vision in most cases. The extent of improvement, however, is variable and dependent on the size of the hole and other features which can be discerned in spectral-domain optical coherence tomography imaging, which is now routinely available in eye clinics globally. Artificial intelligence (AI) models have been developed to enable surgical decision-making and have achieved relatively high predictive performance. However, their black-box behaviour is opaque to users and uncertainty associated with their predictions is not typically stated, leading to a lack of trust among clinicians and patients. In this paper, we describe an uncertainty-aware regression model (U-ARM) for predicting VA for people undergoing macular hole surgery using preoperative spectral-domain optical coherence tomography images, achieving an MAE of 6.07, RMSE of 9.11 and R2 of 0.47 in internal tests, and an MAE of 6.49, RMSE of 9.49, and R2 of 0.42 in external tests. In addition to predicting VA following surgery, U-ARM displays its associated uncertainty, a p-value of ¡0.005 in internal and external tests, showing the predictions are not due to random chance. We then qualitatively evaluated the performance of U-ARM. Lastly, we demonstrate out-of-sample data performance, generalising well to data outside the training distribution, low-quality images, and unseen instances not encountered during training. The results show that U-ARM outperforms commonly used methods in terms of prediction and reliability. U-ARM is thus a promising approach for clinical settings and can improve the reliability of AI models in predicting VA.

Retinal Displacement after Idiopathic Macular Hole Surgery: Layer by Layer Analysis.

To measure the displacement of retinal vascular plexi and choriocapillaris after Pars Plana Vitrectomy (PPV) for idiopathic Macular Hole (MH), using Optical Coherence Tomography Angiography (OCTA) and correlate it with clinical data. Retrospective series with 6-month follow-up. Records included best-corrected visual acuity (BCVA), M-charts, structural OCT and OCTA. Coronal displacement was calculated comparing consecutive images across the 6.4 mm x 6.4 mm field and concentric circular regions of 0.5, 1.5 and 3.0mm radii. Each circular region was further divided in four quadrans indicated as follows: ST=SuperoTemporal; SN=SuperNasal; IT=InferoTemporal; IN=InferoNasal. The study comprised 33 patients (11 males and 22 females) with 68.9 ± 10.2 years mean age, similar among sexes. MH closed in 31/33 (93.9%) of cases and BCVA improved from mean 20/62 (0.50±0.62 logMAR) to 20/47 (0.23±0.63 logMAR; p=0.0064). Vertical and horizontal metamorphopsia decreased from 0.98±0.68 to 0.51±0.59 degrees (p=0.0028) and 0.84±0.63 to 0.29±0.45 degrees (p<0.001), respectively. The average retinal displacement was 81.2±44.1 μm for the superficial plexus and 79.4±45.7 μm for the deep one, both greater than the choriocapillaris displacement (60.9±20.2 μm; p<0.05). The temporal and superior quadrants displaced more than the others (p<0.05). MH size correlated to retinal displacement within the central 0.5 mm radius area at all layers (p<0.05 in all cases). MH closure is associated with significant retinal displacement of all retinal layers as well as choriocapillaris remodelling. Surgical peeling removes the constraining effect of the Internal Limiting Membrane and promotes a multi-layered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the Retinal Nerve Fiber Layer.

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap.

To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.

Factors affecting the duration of air tamponade following vitreoretinal surgery.

Air as a tamponade in pars plana vitrectomy (PPV) is increasingly preferred due to its quick rehabilitation time. We aim to examine the factors affecting the absorption time of air tamponade. The study included 82 eyes from 78 patients who underwent PPV with air used as the tamponade. All patients underwent detailed ophthalmic examinations preoperatively and on the first and third postoperative days. The study evaluated demographic and clinical characteristics, surgical indications, and whether concurrent phacoemulsification surgery was performed. A single surgeon conducted all surgeries and examinations. The intraocular air percentage and volume in milliliters were determined. Patients were divided into two groups based on whether the intraocular air volume was reduced by more or less than 1.5ml from the first to the third day. Concurrent cataract surgery was performed in 35.4% of the eyes. All 82 eyes were pseudophakic at the end of the surgery. The mean air percentage in the eyes was 68.90% on the first day and 47.29% on the third day. Only the concurrent cataract surgery significantly shortened the air elimination time (p = 0.005). Other factors, such as diabetic retinopathy, glaucoma, and concurrent anti-VEGF therapy, did not show a significant impact. The study concluded that concurrent cataract surgery notably reduces air tamponade duration after PPV. We think these findings are crucial for patient selection and surgical planning, especially in cases where maintaining a longer tamponade duration is critical, such as in retinal detachment or macular hole surgeries. What is known The use of air as tamponade is becoming increasingly widespread in vitreoretinal surgery. What is new Compared to performing the surgeries separately, air tamponade shows faster absorption in concurrent cataract and vitreoretinal surgery. Factors such as diabetic retinopathy, glaucoma, and concurrent anti-VEGF therapy do not significantly affect the absorption time of intraocular air after vitreoretinal surgery.

Effects of Autologous Platelet Concentrate Injection on Persistent Macular Hole

Purpose: To evaluate the effects of secondary pars plana vitrectomy (PPV) with autologous platelet concentrate (APC) injection in patients with a persistent macular hole that failed to close after the primary surgery.Methods: This study included 10 eyes of 10 patients who required secondary PPV and APC injection due to unsuccessful hole closure following primary macular hole surgery between February 2021 and July 2023. We measured the minimum and base diameters of the holes before primary and secondary PPV, respectively. Furthermore, we evaluated the anatomical closure of the holes and changes in best corrected visual acuity (BCVA) for 6 months following secondary PPV.Results: The mean age of the 10 patients was 61.6 ± 9.5 years. Prior to the primary PPV, the mean BCVA (LogMAR) was 1.6 ± 0.7, the mean minimum diameter of the hole was 654.4 ± 98.9 μm, and the mean base diameter of the hole was 1,135.4 ± 276.5 μm. Prior to the secondary PPV with APC injection, the mean BCVA (LogMAR) was 1.3 ± 0.7, the mean minimum diameter of the hole was 666.8 ± 270.2 μm and the mean base diameter of the hole was 845.4 ± 292.4 μm. Following secondary surgery, all holes were successfully closed, the mean BCVA (LogMAR) was 0.9 ± 0.6 and the BCVA was significantly improved (&lt;i&gt;p&lt;/i&gt; = 0.007).Conclusions: PPV with APC injection can be an effective therapeutic option for persistent macular hole that failed to close following primary surgery both in terms of anatomical and functional outcomes.

Macular Hole Surgery Without Postoperative Head Positioning: A Technique of Viscoelastic Device Injection Covering the Temporal Internal Limiting Membrane Flap.

The purpose of this study was to describe a technique in which a dispersive viscoelastic device is injected under air onto and around the inverted temporal internal limiting membrane (ILM) flap to close the macular hole (MH) without the need for any postoperative head positioning. A temporal ILM flap was created in the patients. The created ILM flap was inverted over the MH using perfluorocarbon (PCFL) injection. Then, after a fluid-air exchange, careful PFCL-air exchange was performed. Under air, two- to three-disc diameters of viscoelastic device were injected over and around the inverted flap. No postoperative head position was recommended to any patient. In all 16 eyes treated with this approach, the MH was closed with a single procedure, and there were no intraoperative or postoperative complications. Injection of a viscoelastic device over the inverted ILM flap in MH surgery is an innovative approach that does not require any special postoperative head positioning. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Preoperative Widefield Swept-Source Optical Coherence Tomography Versus Intraoperative Findings in Detecting Posterior Vitreous Detachment.

To assess the accuracy of swept-source optical coherence tomography (SS-OCT) in detecting complete posterior vitreous detachment (PVD) in comparison with intraoperative findings. The retrospective study included 145 eyes of 145 consecutive patients who underwent surgery for epiretinal membranes or macular holes. Within a week prior to surgery, PVD status was evaluated by SS-OCT with a depth of field of 3mm and a capture window of 16 × 8mm. Complete PVD was identified when the hyaloid condensation was visible clearly on any B-scan or when the vitreous cortex reflectivity was not visible on all 33 B-scans. Sensitivity, specificity, positive predictive value, and negative predictive value of SS-OCT for detection of complete PVD were then compared with those evaluated during a triamcinolone acetonide-assisted vitrectomy. Of the 101 eyes diagnosed as complete PVD by SS-OCT preoperatively, 97 eyes were found to have complete PVD and four eyes were found to have attached vitreous intraoperatively. Of the 44 eyes categorized as attached vitreous by SS-OCT preoperatively, 43 eyes were graded as attached vitreous and one eye was graded as complete PVD during surgery. The sensitivity of SS-OCT for detecting complete PVD was 99.0% and the specificity was 91.5%. The positive predictive value and the negative predictive value were 96.0% and 97.7%, respectively. Widefield (16 × 8mm) SS-OCT showed high accuracy for the diagnosis of complete PVD in patients with epiretinal membranes or macular holes. Widefield SS-OCT has great potential to evaluate PVD status preoperatively and explore the mechanisms of vitreoretinal diseases.

Influence of foveal glial tissue after macular hole surgery on outer retinal restoration and visual acuity.

To investigate the impact of foveal glial tissue on the anatomical and functional results after macular hole (MH) surgery. This study included 141 consecutive eyes that underwent successful vitrectomy for full-thickness MH between January 2015 and December 2022. The best-corrected visual acuity (BCVA) and the length of outer retinal defects were evaluated preoperatively and at 6 months postoperatively. MH with retinal detachment, recurrent MH, and traumatic MH were excluded. Multiple regression analyses were conducted on outer retinal restoration and visual acuity using foveal glial tissue size, surgical technique of internal limiting membrane (ILM) peeling or inverted ILM flap, and high myopia as explanatory variables. Analyses revealed that the foveal glial tissue significantly limited the outer nuclear layer (ONL), external limiting membrane (ELM) restoration, and ellipsoid zone (EZ) restoration as well as BCVA improvement (r = -0.380, p < 0.001; r = -0.314, p = 0.035; r = -0.530, p = 0.015; r = -0.00027, p = 0.001; respectively). Meanwhile, the surgical technique and high myopia did not significantly affect the restoration of ONL, ELM, EZ, and BCVA after surgery. Foveal glial tissue after MH surgery attenuated ONL, ELM, and EZ restoration as well as BCVA improvement.

Функциональное восстановление фовеа после хирургического лечения сквозных макулярных разрывов: роль отдельных изменений морфологии и перфузии сетчатки в послеоперационном периоде

Purpose. To evaluate the relationship between changes in functional and structural indicators, indicators of retinal perfusion in the fovea after surgery of full-thickness macular holes (FTMH). Material and methods. A prospective study was conducted on 62 patients (62 eyes) with FTMH stages 1–4 who underwent surgical treatment. We studied BCVA, retinal sensitivity (RS) at fixation point (FP), the fixation zone area, the amplitude and implicit time of P1 at FP, the thickness of the macular complex of ganglion cells (mcGC), the ellipsoid zone (EZ) defect area, the foveal avascular zone (FAZ) area and vessel density in the superficial and deep capillary plexuses (SCP and DCP). The correlation of indicator changes in the period from the preoperative examination to 6 months after treatment and in the period from 1 to 6 months after treatment was studied. Results. Changes in BCVA in the period from the preoperative examination to 6 months after surgery significantly correlated with changes in mcGC thickness (R=0.39, p=0.004), EZ defect area (R= –029, p=0.001) and SCP and DCP vessel density (R=0.35 and R=0.29, p=0.002); RS changes at FP correlated with the changes in EZ defect area (R= –0.31, p=0.001), and P1 amplitude with the change in the EZ defect area (R= –0.34, p=0.001) and vessel density in DCP (R= –0.29, p=0.001). In the period from 1 to 6 months after closure of the FTMH, a more significant correlation of changes in BCVA, RS and P1 amplitude of mentioned above indicators was observed. Conclusion. Processes of functional restoration of the fovea after surgery of FTMH for at least 6 months is influenced by changes in such indicators as the mcGC thickness, the EZ defect area, and vessel density of SCP and DCP. In the late postoperative period, the importance of postoperative changes in retinal perfusion increases. Key words: Full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit.

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm. Retrospective, monocentric, consecutive case series. Patients with primary MH operated at Lariboisière Hospital, Paris, France. Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed. Postoperative MH closure rate and visual acuity. 74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameterwas 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR. MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

Long-term Visual Outcomes in Patients With Idiopathic Macular Hole Surgery.

This study assesses long-term outcomes following surgical repair of idiopathic full-thickness macular holes (FTMHs) in patients with at least 5 years of postoperative follow-up. A retrospective study evaluated patients diagnosed with idiopathic FTMH who received surgical repair at a single tertiary center with at least 5 years of postoperative follow-up. Data collection included demographic and preoperative characteristics along with macular hole structural integrity as determined by spectral-domain optical coherence tomography (OCT). Functional and structural improvement were assessed by collection of visual acuity and findings on OCT at determined time points until 9 years of follow-up. The study comprised 90 eyes of 80 patients with a mean age of 67.2 ± 6.8 years, with an average postoperative follow-up of 80.8 ± 17.4 months (range 54 to 130 months). The mean macular hole diameter was 239.7 µm ± 92.2. Macular hole reoperation occurred in four eyes (4%) at a mean duration of 5.5 ± 6 months (range 0.3 to 13 months). Over the study duration, ellipsoid zone (EZ) integrity was maintained in 67.8% of eyes, with an absence of intraretinal fluid (IRF) in 96% on final OCT. The preoperative mean Early Treatment Diabetic Retinopathy Study (ETDRS) best visual acuity (BVA) of 51 improved to a mean BVA of 76 at 5 years postoperatively, with an average gain of 24 letters at one year that remained stable over 5 years (P < 0.05). Eight years after surgical repair, more than 80% of patients achieved a BVA > 65. Vitreoretinal surgery for idiopathic FTMH resulted in successful hole closure and sustained visual acuity improvement over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Update on Retinal Drug Safety: Proceedings of the ASRS ReST Committee Webinar Part 1.

Purpose: To review the first Research and Safety in Therapeutics (ReST) Committee webinar and summarize the most current recommendations regarding diagnosis and management. Methods: The ReST Committee is comprised of members of the American Society of Retina Surgeons (ASRS). At regular internal meetings, safety issue reports from the website are reviewed. A webinar series was started in 2021 to update members on multiple relevant potential safety events. Results: Topics reviewed in the webinar included pentosan polysulfate sodium (Elmiron) maculopathy, intraocular pressure elevation reported with the aflibercept prefilled syringe (PFS), and brolucizumab-associated inflammation with occlusive retinal vasculitis. Retinal toxicity related to intraoperative medications was reviewed, including hemorrhagic occlusive retinal vasculitis after intraocular vancomycin, dilution errors with intravitreal aminoglycosides, inadvertent overdoses of cefuroxime after cataract surgery, and toxic posterior segment syndrome after dropless cataract surgery using compounded triamcinolone-moxifloxacin. Indocyanine green toxicity has been reported after its use as an adjuvant during macular hole surgery. Conclusions: The past decade has seen advances in retinal pharmaceuticals and drug-delivery devices. The ASRS ReST Committee collects data from its website reporting system to inform members about up-to-date pharmaceutical and device safety concerns. Recently, a webinar was used to inform members of pigmentary maculopathy associated with pentosan polysulfate sodium, safety regarding the aflibercept PFS, intraocular inflammation and occlusive retinal vasculitis secondary to brolucizumab, and retinal toxicity from intraoperative ocular medications.

Retinal displacement after surgery for idiopathic macular hole.

To review and summarize the mechanism hypothesis, influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole (IMH) surgery. PubMed and Web of Science database was searched for studies published before April 2023 on "Retinal displacement", "Idiopathic macular holes", and "Macular displacement". Recently, more academics have begun to focus on retinal displacement following idiopathic macular holes. They found that internal limiting membrane (ILM) peeling was the main cause of inducing postoperative position shift in the macular region. Moreover, several studies have revealed that the macular hole itself, as well as ILM peeling method, will have an impact on the result. In addition, this phenomenon is related to postoperative changes in macular retinal thickness, cone outer segment tips line recovery, the occurrence of dissociated optic nerve fiber layer (DONFL) and the degree of metamorphopsia. As a subclinical phenomenon, the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.

Topographic analysis of retinal and choroidal vascular displacements after macular hole surgery

It has been reported that the retinal vessel and macular region of the retina are displaced after macular hole (MH) surgery. However, there is no detailed information for correlations between retinal and choroidal displacements. We obtained optical coherence tomography angiography (OCTA) and en-face optical coherence tomography (OCT) images from 24 eyes to measure the retinal and choroidal vascular displacement before and after surgery. These images were merged into infrared images using blood vessel patterns. The same vascular bifurcation points were automatically selected for each follow-up image, and the displacements of the bifurcation points were analyzed as a vector unit for prespecified grid regions in a semi-automated fashion. The results showed displacements of the choroidal intermediate vessels and retinal vessels following MH surgery (p = 0.002, p < 0.001). The topographic changes showed inferior, nasal, and centripetal displacement of the retina and inferiorly displaced choroid. The ILM peeling size and basal MH size were significantly associated with the retinal displacement (p < 0.001 and p = 0.010). Additionally, changes in the amount of the choroidal displacement were significantly correlated with that of the retinal displacements (p = 0.002). Clinicians should keep in mind that there might be topographic discrepancies of the displacement between retina and choroid when analyzing them following surgery.

Retinal photoreceptor ellipsoid zone is a structural biomarker for visual outcome after successful macular hole surgery: A novel grading system-based study.

To develop a novel external limiting membrane (ELM) and ellipsoid zone (EZ) restoration-based grading system after successful macular hole surgery (MHS) and to evaluate EZ as a structural biomarker for the final visual outcome. In a tertiary care center-based retrospective study, 34 consecutive cases of successful MHS for full-thickness macular holes (FTMHs) were included. Spectral domain optical coherence tomography (SD-OCT) cross-sectional analysis was performed on preoperative and postoperative data of weeks 1, 4, 12, and 24, respectively. Sequential measurements of FTMH size, ELM and EZ defect were performed using the caliper function of SD-OCT. MHS was uniquely graded as grade 0: persistence of ELM and EZ defect; grade 1: partial or complete restoration of ELM with shortening of EZ defect; and grade 2: complete restoration of ELM and EZ. Data were statistically analyzed on Statistical Package for the Social Sciences software-version 24. MHS was graded as grade 0 (n = 8), grade 1 (n = 15), and grade 2 (n = 11). Best corrected visual activity (BCVA) was found to be 1.13 ± 0.19 in grade 0, 0.59 ± 0.09 in grade 1, and 0.26 ± 0.06 in grade 2. One-way analysis of variance showed improvement in final BCVA among the three grades (P < 0.001) Postoperative visual acuity and residual EZ defect had a statistically significant linear correlation (r = 0.899, P < 0.001). EZ was found to be an excellent structural biomarker for final BCVA (area under the curve = 0.99). Successful MHS is associated with better visual outcomes in eyes with restored EZ. ELM restoration preceded EZ regeneration. MHS novel grading system is physician friendly, incorporates pathoanatomic aspects, and correlates well with visual outcomes.

PUNCTATE INNER CHOROIDOPATHY FOLLOWING PARS PLANA VITRECTOMY FOR HIGH MYOPIC FULL THICKNESS MACULAR HOLE.

To describe a case of punctate inner choroidopathy (PIC) and secondary or epiphenomenon multiple evanescent white dot syndrome (EpiMEWDS) following surgery for high myopic full-thickness macular hole (FTMH). Case report. A 57-year-old high myopic female was diagnosed with cataract and FTMH in the left eye. Her initial best-corrected visual acuity (BCVA) was 20/20 in her right eye and 20/80 in the left eye. She underwent routine combined phacoemulsification and 25-gauge pars plana vitrectomy (PPV) with the inverted internal limiting membrane (ILM) technique and twice-repeated epiretinal membrane (ERM) and ILM staining in the left eye. Two weeks postoperatively, the patient reported significant visual decline and photopsia in her left eye. BCVA decreased to counting fingers. Anterior segment examination was unremarkable. Ophthalmoscopic examination showed multiple whitish-yellow lesions in the macular region compatible with PIC lesions in the left eye. Optical coherence tomography (OCT), blue-light fundus autofluorescence (BAF), fluorescein angiography, and indocyanine green angiography were performed and confirmed the diagnosis. The patient underwent oral steroid therapy for PIC treatment. One week after treatment initiation, BAF showed the occurrence of EpiMEWDS. After one month, all lesions resolved and BCVA improved to 20/100. We report a rare case of PIC and EpiMEWDS development following surgery for FTMH. We hypothesize that several causes, including individual susceptibility (high myopia and female gender), post-surgical inflammation, and/or dye toxicity due to repeated staining could have amplified this inflammatory chorioretinal response. Larger studies are needed to better understand the potential triggers of PIC development after surgery.