Vitreoretinal Interface Diseases Research Articles

Lamellar macular holes-In the center of vitreomacular interface diseases : Pathophysiology, spontaneous courses and treatment concepts

A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.

Ultrawidefield Fluorescein Angiography and OCT Findings in Children and Young Adults with Autosomal Dominant Neovascular Inflammatory Vitreoretinopathy

PurposeAutosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV) is a rare genetic (CAPN5) autoimmune condition typically diagnosed in adulthood and characterized by a triad of inflammation, retinal degeneration and neovascularization. We report novel multimodal imaging findings in children and young adults with ADNIV and early treatment response to short-duration local and/or systemic corticosteroids. DesignRetrospective consecutive case series. ParticipantsTen patients under the age of 25 with ADNIV and available multimodal imaging. MethodsThe medical records of patients under the age of 25 with a diagnosis of ADNIV with ultra-widefield fluorescein angiography (UWFFA) and optical coherence tomography (OCT) data were reviewed. Main Outcome MeasuresUWFFA and OCT findings at baseline and following local corticosteroids. ResultsMedian age at presentation was 14 years (range 9-24 years). OCT on presentation demonstrated CME in 8/20 eyes and symptomatic vitreoretinal interface disease in 2/20 eyes. Initial UWFFA demonstrated retinal vascular leakage (20/20 eyes, 100%), peripheral non-perfusion (13/20 eyes, 65%), and retinal neovascularization (6/20 eyes, 30%). Retinal vascular leakage improved with local corticosteroids and neovascularization regressed with anti-VEGF therapy. ConclusionsUWFFA findings of prefibrotic ADNIV reported in adults were also present in children and young adults. Early testing for a pathogenic CAPN5 variant in at-risk children and regularly scheduled screening for uveitis and retinal vasculitis with UWFFA and OCT may prompt earlier intervention. Short duration local steroids are effective at treating retinal vascular leakage and macular edema but are not durable suggesting a potential role for steroid-sparing immunosuppressive therapy. Early treatment may alter the natural history of disease.

Quantification of retinal vein and artery trajectories using second-order polynomial equation in eyes with vitreomacular traction

BackgroundsTo measure the degree of curvature of the retinal artery trajectory (RAT) and retinal vein trajectory (RVT) in the eyes of patients with vitreomacular traction (VMT) and compare them with their healthy fellow eyes. MethodsThis was a retrospective, cross-sectional, case-control study of 58 eyes of 29 patients with unilateral VMT. The participants were divided into two groups. Group 1 VMT was defined as having only morphological changes, while group 2 VMT was defined as morphological changes accompanied by the presence of a cyst or hole to quantify the severity of the disease. The RATs and RVTs were assessed from the color fundus photographs using the ImageJ program. The fundus photographs were rotated 90°. The course of the retinal arteries and veins were marked on a color fundus photograph and fitted to a second-degree polynomial curve (axe[x]/100+bx+c). The coefficient ‘‘a’’ was the width and steepness of the trajectories. The comparison between the RAT and RVT of VMT and healthy fellow eyes was investigated and the association between the RAT and RVT and the severity of disease were determined using the Image J program. ResultsEleven subjects were male, and 18 subjects were female. The mean ± SD age was 70.6 ± 7.6 years. Eighteen of the eyes had VMT in the right and 11 of the eyes had VMT in the left eye. Eleven eyes were in group 1 and 18 eyes were in group 2. Axial length (AL) was similar between the two groups (22.63 ± 1.20 mm vs 22.45 ± 1.45 mm p = 0.83) (Table 1). The mean RAT was 0.60 ± 0.18 in eyes with VMT and 0.51 ± 0.17in healthy eyes (p = 0.063). The mean RVT was 0.74 ± 0.24 in eyes with VMT and 0.62 ± 0.25 in healthy eyes for the whole group (p = 0.02). In group 1, the mean RVT of the eyes with VMT was statistically significantly higher than the healthy eyes (p = 0.014). There was not any statistically significant difference for the other parameters evaluated between eyes with VMT and healthy eyes according to the groups and the whole group. (Tables 2–4) ConclusionUnlike other vitreoretinal interface diseases such as epiretinal membrane and macular hole, VMT may be characterized by a narrower RVT, which is characterized by a larger “a” value.

ODP246 The Content of Blood Chemokine Fractalkine in Patients with Type 2 Diabetes and Diabetic Macular Edema Depending on The Type of Glucose Lowering Therapy

Abstract Relevance. Diabetic macular edema (DME) remains one of the most widespread diabetic complications. Complications associated with DME include microglial activation, dysfunction of neurons, their dystrophy and apoptosis. One of the important modern chemokines involved in the functioning of the eye neurovascular unit is fractalkine (CX3CL1). The current literature has demonstrated a positive and significant relationship between fraktalkine aqueous humor levels and central macular thickness after intravitreal injection of aflibercept in patients with DME [Rodolfo Mastropasqua et al., 2018]. Goal. To evaluate the content of blood plasmachemokine fractalkine in patients with type 2 diabetes (T2D) and DME depending on the type of glucose lowering therapy (GLT). Material and methods. This study was conducted in 82 patients (male and female) with T2D and DME. The average age of patients was 65.25 ± 10.85 years (±SD), the average duration of diabetes was 14. 0 ± 7. 05 years(±SD), the average level of HbA1c was 8.40 ± 1.58% (±SD). The inclusion criteria in this open study were voluntary informed consent, age 18 years old and more, the presence of DME according to the classification of American Academy of Ophthalmology (2014) and non-proliferative diabetic retinopathy (DR) according to the simplified version of the ETDRS. Exclusion criteria were others endocrine diseases, acute infectious diseases, cancer, decompensation of comorbid pathology, mental disorders, proteinuria, T1D, were vitreo-retinal interface diseases, damage of the optic nerve, inflammatory eye diseases, glaucoma and mature cataracts, retinal vascular diseases. Plasma fractalkine concentration was determined by «RayBio®Human Fractalkine ELISA Kit Protocol» (USA). All patients enrolled in this study were diagnosed assessing DR using color fundus photography, fluorescein angiography, spectral optical coherence tomography and were evaluated with a comprehensive ophthalmologic examination. 43 patients received oral glucose lowering drugs (OGLD), 39– metformin plus insulin. Statistical analysis of the results of the current study included one-way ANOVA analysis. Results A study of content of blood plasma fractalkine showed its dependence from the type of GLT. So comparison of mean values of blood plasma fractalkine in patients with DME revealed the following differences: OGLD 1,81±0,09ng/ml [95%CІ 1.67 - 1,94ng/ml], insulin therapy 2,11±0,08ng/ml [95%CІ 1,98-2,23 ng/ml] (р=0,02). Discussion An increase in the concentration of fractalkine in blood plasma for a certain time can serve as an indicator of an active nonspecific inflammatory process in the neuroglia, the presence of edema and a harbinger of the death of ganglion cells and vision loss. That is why fractalkine, apparently, has a promising prognostic potential for its use in evaluating the effectiveness of treatment of DME and T2D in patients receiving various types of GLT. Conclusion In patients undergoing insulin therapy, the content of fractalkine in blood plasma is statistically significantly (p = 0. 02) higher than in patients receiving OGLD. Presentation: No date and time listed

OCT ANGIOGRAPHY IN DISEASES OF THE VITREORETINAL INTERFACE.

Present the use of Optical Coherence Tomography Angiography (OCTA) in vitreoretinal interface diseases and results of macular capillary network evaluation before and after idiopathic macular hole surgery (IMD). Prospective evaluation of functional results, anatomical and OCTA findings before and after IMD surgery. The group consists of 8 eyes of eight patients. Preoperatively and 1, 3 and 6 months after surgery, the best corrected visual acuity (BCVA) was examined, fundus photography was performed, examination of the macula by spectral-domain optical coherence tomography (SD OCT), determination of the stage of IMD according to Gases and also OCTA examination. The area of the foveal avascular zone (FAZ) and vascular density (VD) were evaluated by using of the OCTA. The operation was performed in all cases by transconjunctival suture 25G vitrectomy by one surgeon, always peeling the inner limiting membrane. An expansive gas, 7x 20% SF6, 1x 15% C3F8, was used for vitreous tamponade. In all 8 cases, the primary closure of the IMD occurred after the operation. The mean BCVA improved statistically significantly from 0.74 to 0.48 logMAR (p = 0.0023). The average FAZ area decreased from 0.345 mm² to 0.25 mm² after surgery (p = 0.0458). The mean VD increased from 7.93 mm-1 to 8.38 mm-1 (p = 0.2959). Assessment of the macular capillary network in patients with diseases of the vitreoretinal interface offers new findings and important details that can lead to prognostic information and a better understanding of the pathogenesis of the disease. We demonstrated a statistically significant reduction in FAZ in the eyes after successful IMD surgery and an indirect relationship between the improvement of BCVA and the change in FAZ area in our cohort.

Clinical Characteristics of Eyes Showing a Discrete Margin of Different Retinal Reflectivity.

To evaluate the clinical characteristics of discrete margins of different retinal reflectivity (DMDRR) in ultra-widefield fundus photography. This DMDRR comprises a discrete border, with differing patterns of reflectivity on either side. Spectral-domain optical coherence tomography was performed on both the macula and the margin. The incidences of epiretinal membrane (ERM) and peripheral retinal pathologies of patients with a DMDRR (n = 36) were compared with a control group (n = 41). An ellipsoid zone (EZ) defect at the DMDRR was detected in 34 eyes (92.2%), and vitreous traction was detected in 20 eyes (55.6%). A significantly higher proportion of eyes in the DMDRR group had an ERM, retinal hole, and cystic retinal tuft compared with the control group (P = .022, P = .010, and P < .001, respectively). The DMDRR indicates EZ disruption that may originate from vitreous traction. Meticulous observation for vitreoretinal interface diseases is mandatory for these patients. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:273-280.].

Test-Retest-Reliability of Computer-Based Metamorphopsia Measurement in Macular Diseases.

In this study, the test-retest-reliability as one aspect of reliability of metamorphopsia measurements using a computer-based measuring method was determined in patients with macular diseases. Metamorphopsia amplitude, position, and area were quantified using AMD - A Metamorphopsia Detector software (app4eyes GmbH & Co. KG, Germany) in patients with diabetic, myopic, or uveitic macular edema, intermediate or neovascular age-associated macular degeneration, epiretinal membrane, vitelliform maculopathy, Irvine-Gass syndrome, or macular edema due to venous retinal occlusion. The intraclass correlation coefficient (ICC) was calculated in order to determine the repeatability of two repeated measurements and was used as an indicator of the reliability of the measurements. In this study, metamorphopsia measurements were conducted on 36 eyes with macular diseases. Metamorphopsia measurements made using AMD - A Metamorphopsia Detector software were highly reliable and repeatable in patients with maculopathies. The intraclass correlation coefficient of all indices was excellent (0.95 - 0.97). For diseases of the vitreoretinal interface or macular diseases with intra- or subretinal edema, this metamorphopsia measurement represents a supplement for visual function testing in the clinic, as well as in clinical studies.

Why Miss the Chance? Incidental Findings while Telescreening for Diabetic Retinopathy

ABSTRACT Purpose To report on incidental pathological findings met while screening for Diabetic Retinopathy (DR) in Diabetes Clinics (DC) by ophthalmologist-graded digital fundus imaging. Methods At the DC of Pescara (central Italy), for 3,859 eyes of 1,930 consecutive patients having not undergone fundus examination in the last year, two mydriatic fundus digital images, taken with a CenterVue DRS Digital Retinal Camera, were sent along with Best Corrected Visual Acuity, on a “store-and-forward” basis, to an ophthalmologist trained in DR screening, and graded according to the UK Diabetic Eye Screening Programme. Incidental fundus abnormalities other than DR were reported. Results No adverse event to mydriasis was reported. One hundred and eighty eyes (4.66%) were ungradable. Among the 3,679 gradable ones, 1,105 (30.04%) showed different degrees of DR (R1 to R3), and 126 (3.42%) maculopathy (M1). Any Age-Related Macular Degeneration was present in 387 eyes (10.52%), any optic disc and parapapillary area features suspect for glaucoma in 562 eyes (15.27%), any hypertensive retinopathy in 1,263 eyes (34.33%), vitreoretinal interface disease in 252 eyes (6.84%), myopic choroidopathy in 92 eyes (2.50%), disc pallor in 31 eyes (0.84%). Mean time was 5 min for screening, 2 min for grading. Conclusion Teleretinography is a well-established, cost-effective procedure in DR screening. Along with increased attendance, locating a digital camera in a DC with a retina-specialist grader results in finding fundus pathologies also beyond DR, very similarly to fundus examination in an outpatient ophthalmic setting.

Systems pathology analysis identifies neurodegenerative nature of age-related vitreoretinal interface diseases.

Aging is a phenomenon that is associated with profound medical implications. Idiopathic epiretinal membrane (iEMR) and macular hole (MH) are the major vision‐threatening vitreoretinal diseases affecting millions of aging people globally, making these conditions an important public health issue. iERM is characterized by fibrous tissue developing on the surface of the macula, which leads to biomechanical and biochemical macular damage. MH is a small breakage in the macula and is associated with many ocular conditions. Although several individual factors and pathways are suggested, a systems pathology level understanding of the molecular mechanisms underlying these disorders is lacking. Therefore, we performed mass spectrometry‐based label‐free quantitative proteomics analysis of the vitreous proteomes from patients with iERM and MH to identify the key proteins, as well as the multiple interconnected biochemical pathways, contributing to the development of these diseases. We identified a total of 1,014 unique proteins, many of which are linked to inflammation and the complement cascade, revealing the inflammation processes in retinal diseases. Additionally, we detected a profound difference in the proteomes of iEMR and MH compared to those of diabetic retinopathy with macular edema and rhegmatogenous retinal detachment. A large number of neuronal proteins were present at higher levels in the iERM and MH vitreous, including neuronal adhesion molecules, nervous system development proteins, and signaling molecules, pointing toward the important role of neurodegenerative component in the pathogenesis of age‐related vitreoretinal diseases. Despite them having marked similarities, several unique vitreous proteins were identified in both iERM and MH, from which candidate targets for new diagnostic and therapeutic approaches can be provided.

Vital Dyes in Vitreoretinal Surgery

It is essential to visualize posterior hyaloid, epiretinal proliferation, and internal limiting membrane during vitreoretinal surgery especially in surgeries for vitreoretinal interface diseases. Even though indirect signs and reflections may help their identification, these signs are not as reliable and effective as direct visualization of these structures in preventing traumatic surgery. Dyes that are used to stain living tissues are called vital dyes. Vitreoretinal surgery using these dyes is called chromovitrectomy. Diagnosis of vitreoretinal interface diseases was diversified, indications were widened and the number of patients was increased over the last fifteen years with the widespread use of optical coherence tomography. Vital dyes became a sine qua non in today's vitreoretinal surgeries for vitreoretinal interface diseases. This article discusses the properties and the place of widely used dyes such as triamcinolone, trypan blue, brilliant blue G, and indocyanine green.

The Pathophysiology of Vitreomacular Interface Disease

Anomalous posterior vitreous detachment is an important step in the pathogenesis of vitreoretinal interface diseases. In order to understand the pathophysiology of vitreoretinal interface diseases, the structure and biochemistry of the vitreous body, and its relation with the retina should be investigated. Having a clear understanding of the pathophysiology of these diseases may help to develop new pharmacologic or surgical treatment modalities.

Pharmacological Vitreolysis and Pneumatic Vitreolysis

Treatment of vitreoretinal interface diseases can be successfully performed with surgical methods, but serious complications could be seen in this method. As an alternative to surgery, pharmacologic vitreolysis has been developed. In this method, the vitreous structure is chemically altered without any need for surgery, thus vitreous can be effectively and safely separated from the retina. Ocriplasmin has been detected as the most successful agent in the literature. Pneumatic vitreolysis is another treatment method used in the treatment of vitreoretinal interface diseases. Pneumatic vitreolysis is an intravitreal injection of an expansile gas bubble that can be used to massage the vitreomacular interface thereby yielding traction release. In this study, recent studies evaluating pharmacologic vitreolysis and pneumatic vitreolysis methods were evaluated.

Statin use and vitreoretinal surgery: Findings from a Finnish population-based cohort study.

Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy. Our historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008-2014, covering 6.5years. Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication. The primary end-point event was revitrectomy during a postoperative follow-up period of 1year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole. Rhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18-0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53-0.97), but not in absolute scale (incidence rate difference -0.58, 95% CI -4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups. Use of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted.

The predictability of ocriplasmin treatment effects: is there consensus among retinal experts? Results from the EXPORT study.

To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria. Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success. Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16. These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.

Factors associated with corneal epithelial defects after pars plana vitrectomy

To investigate the risk factors associated with corneal epithelial defects (CED) and delayed healing (exceeding 1week) following pars plana vitrectomy (PPV). This retrospective study enrolled patients who underwent PPV at a single center in Taiwan between 2011 and 2012. Medical records were reviewed, including demographic, underlying disease, surgical indication, operation parameters, and existence of CED. These data were statistically analyzed. All patients were evaluated during follow-ups at day 1 and week 1 after PPV. Patients with persistent CED 1week after PPV were diagnosed with delayed healing. A total of 255 patients were included in the study, consisting of 139 men and 116 women, with a mean age of 56.9years. PPV was performed under the indications of rhegmatogenous retinal detachment (RRD), diabetic retinopathy, or vitreoretinal interface disease. Out of 255 eyes, 59 developed CED 1day after surgery (23.1%), and CED was associated with younger age, diabetes mellitus (DM), RRD, longer duration of surgery, and silicon oil use during surgery. Among them, seven patients (11.9%) demonstrated delayed healing, which was associated with a higher rate of DM (p=0.085), compared to patients who healed within 1week. Patients with RRD, longer duration of surgery, and DM may be at risk of developing CED after PPV. In addition, patients with DM demonstrated a higher incidence of delayed corneal healing.

An Assessment of Vitreous Degeneration in Eyes with Vitreomacular Traction and Macular Holes.

Purpose. To compare the stages of vitreous degeneration in patients with vitreomacular traction (VMT) and macular holes (MH). Methods. A retrospective study was performed analyzing stages of vitreous degeneration of eyes with VMT or MH using swept-source optical coherence tomography (SS-OCT) and spectral-domain optical coherence tomography (SD-OCT). An analogous review was performed on a control group of eyes with contralateral posterior vitreous detachments. Thirty-four eyes with VMT/MH and 39 control eyes were reviewed. Results. Twenty-seven VMT/MH eyes and 31 control eyes were included. Eyes with VMT/MH demonstrated significantly earlier stages of vitreous degeneration when compared to the control group (p = 0.048) despite significantly greater age (p = 0.032). Conclusions. Vitreoretinal interface disease is more often associated with a formed vitreous and an intact premacular bursa. This is contrary to previous assumptions implicating degeneration of vitreous as a precipitating factor of interface disease when in conjunction with abnormal vitreomacular separation.

Vitreous anatomy and the vitreomacular correlation.

The presence of a posterior precortical vitreous pocket, referred to as a precortical pocket, implies that the vitreous cortex is formed into a collagen sheet separated from the gel in the macula. Along with strong vitreoretinal attachment at the fovea, the precortical pocket plays a role in perifoveal posterior vitreous detachments, which may lead to macular holes, premacular membranes, and ring-shaped proliferation in diabetic retinopathy. I and my colleagues published pioneer studies of the vitreous in postmortem eyes. Here, the role of the precortical pocket in various vitreoretinal interface diseases is discussed. Swept-source optical coherence tomography showed development of the precortical pocket, the connecting channel, and Cloquet's canal during early childhood. These findings raised the possibility that aqueous humor may drain into the precortical pocket. The physiologic role of the drainage route is also discussed. Crosstalk between the anterior chamber and macula is an attractive hypothesis and remains to be elucidated.

Partial posterior vitreous detachment as a classification criterion of epiretinal membrane.

Dear editor I read with great interest the article “Relationship between variations in posterior vitreous detachment and visual prognosis in idiopathic epiretinal membranes” by Ota et al.1 The authors have compared visual prognosis of epiretinal membrane (ERM) patients according to type of vitreous detachment. Partial posterior vitreous detachment (P-PVD) was found to be related with poor visual acuity and prognosis. I appreciate the authors for this well-organized study. Position of vitreous is very important in some retinal diseases. Vitreoretinal traction and adhesion affects prognosis of vitreoretinal interface diseases, macular hole, diabetic retinopathy, and age-related macular degeneration.2 Existence of vitreous detachment is a criterion of macular hole. Because of its importance in prognosis, I think vitreous detachment also should be a criterion for classification of ERMs. As stated in this study, P-PVD may cause a rapid worsening of clinical table by impairing structure of retinal composition and accelerating progression of ERM. Thus, revising classification of ERM according to existence of P-PVD may provide a better clinical approach to this disease.

DETECTION OF MICROVASCULAR CHANGES IN EYES OF PATIENTS WITH DIABETES BUT NOT CLINICAL DIABETIC RETINOPATHY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

To evaluate the ability of optical coherence tomography angiography to detect early microvascular changes in eyes of diabetic individuals without clinical retinopathy. Prospective observational study of 61 eyes of 39 patients with diabetes mellitus and 28 control eyes of 22 age-matched healthy subjects that received imaging using optical coherence tomography angiography between August 2014 and March 2015. Eyes with concomitant retinal, optic nerve, and vitreoretinal interface diseases and/or poor-quality images were excluded. Foveal avascular zone size and irregularity, vessel beading and tortuosity, capillary nonperfusion, and microaneurysm were evaluated. Foveal avascular zone size measured 0.348 mm² (0.1085-0.671) in diabetic eyes and 0.288 mm² (0.07-0.434) in control eyes (P = 0.04). Foveal avascular zone remodeling was seen more often in diabetic than control eyes (36% and 11%, respectively; P = 0.01). Capillary nonperfusion was noted in 21% of diabetic eyes and 4% of control eyes (P = 0.03). Microaneurysms and venous beading were noted in less than 10% of both diabetic and control eyes. Both diabetic and healthy control eyes demonstrated tortuous vessels in 21% and 25% of eyes, respectively. Optical coherence tomography angiography was able to image foveal microvascular changes that were not detected by clinical examination in diabetic eyes. Changes to the foveal avascular zone and capillary nonperfusion were more prevalent in diabetic eyes, whereas vessel tortuosity was observed with a similar frequency in normal and diabetic eyes. Optical coherence tomography angiography may be able to detect diabetic eyes at risk of developing retinopathy and to screen for diabetes quickly and noninvasively before the systemic diagnosis is made.

Vitreoretinal traction syndrome

SummaryIndividualized from the other vitreoretinal interface diseases in the 80’, the vitreoretinal traction syndrome has really been thoroughly described with the advances in OCT imaging.We'll present the proposed new international classification. By evaluating physiologic and pathological features, it allows to choose between different therapeutic options: watchful waiting, vitreolysis and vitrectomy.The new treatment using vitreolysis may in some cases avoid surgery in selected cases highlighted by this classification. We'll show some real life cases illustrating what we may really achieve with this non surgical therapy.