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Objectives: To investigate choriocapillaris flow voids (FV) with a new optical coherence tomography angiography (OCTA) image processing strategy that can eliminate artifacts caused by vitreous opacities, sub-retinal pigment epithelium fluid and deposits, and subretinal fluid (SRF) by thresholding the en-face OCT image of the outer retina. Materials and methods: We retrospectively reviewed medical records of patients with drusen and patients with active central serous chorioretinopathy (CSC). FV number (FVn), average area (FVav), and maximum area (FVmax) and the percentage of nonperfused choriocapillaris area (PNPCA) obtained using the proposed strategy were compared with those obtained by removing only artifacts caused by the superficial capillary plexus (SCP). Results: The SRF group included 21 eyes with active CSC and the drusen group included 29 eyes with nonexudative age-related macular degeneration. FVav, FVmax, FVn, and PNPCA obtained using the algorithm were significantly lower than those obtained by removing only SCP-related artefacts in both groups (all p

Purpose To report first case of sequential development of pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) after repeated intravitreal dexamethasone implantations for diabetic macular edema treatment. Methods We present a case of a 54-year-old man having intravitreal dexamethasone implant for bilateral diabetic macular edema. Results We observed development of pachychoroid pigment epitheliopathy, seen as a small pigment epithelial detachment on optical coherence tomography after a fourth dexamethasone implantation. A fifth implantation caused transformation of pachychoroid pigment epitheliopathy to central serous chorioretinopathy. Conclusion Consecutive administration of dexamethasone implants may have a cumulative effect on retinal pigment epithelium, Bruch membrane, and choroid.

To report characteristics of patients developing full-thickness macular hole (MH) after rhegmatogenous retinal detachment (RRD) repair surgery. We also compared patients developing MH with and without accompanying RRD recurrence regarding anatomical and visual outcomes of MH repair.Retrospective study.Medical records of patients who developed MH after RRD repair between January 2002 and January 2018 were reviewed.We performed 1661 primary RRD operations during the study period and 14 of these developed MH, an incidence of 0.8%. Nine patients had their primary RRD repair surgery in another clinic and were referred to our clinic after development of MH. In total 23 patients with MH secondary to RRD repair were included in the study. The type of RRD repair surgery was scleral buckling only in 4 patients (17%), pars plana vitrectomy (PPV) only in 14 patients (61%), and sequential scleral buckling and PPV in 5 patients (22%). Nineteen patients (83%) had macula-off RRD. In 12 patients (52%), MH developed within 3 months after RRD repair. Surgery for MH repair was performed in 18 patients. Postoperative best corrected visual acuity (BCVA) was better than preoperative BCVA in the group with RRD recurrence as well as in the group without RRD recurrence (both P 0.05). There wasn't a significant difference between these groups regarding postoperative visual gain and anatomical success (P 0.05).MH can develop after various surgical methods of RRD repair. Anatomic closure and visual acuity gain can be achieved even if patients have accompanying RRD recurrence.

To compare neovascular membrane features of pachychoroid neovasculopathy (PNV) and type 1 neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). Retrospective study. We assessed 34 treatment-naive eyes with a diagnosis of PNV and 36 treatment-naive eyes with a diagnosis of type 1 nAMD. Morphological patterns of neovascular membranes were categorized, and lesion sizes and flow areas were calculated by using en face images on the AngioVue (Optovue) OCTA system. Statistically significant differences were found between groups in age (P=0.001), baseline best corrected visual acuity (P=0.005), and baseline subfoveal choroidal thickness (P

Objectives: To evaluate the outcomes of 23-gauge pars plana vitrectomy (PPV) under air compared with standard PPV for idiopathic macular hole (MH). Materials and Methods: In this prospective, comparative, interventional case series, 42 eyes of 42 patients with idiopathic MH were enrolled. Twenty-one eyes had vitrectomy with an air-infused technique and 21 eyes underwent vitrectomy with a traditional balanced salt solution-infused technique as a control group. Effective vitrectomy time, total surgery time, microperimetry (MP1), and anatomical and functional results were evaluated. Results: The mean effective vitrectomy time was significantly lower in the air group than in the control group (7.5±0.3 min and 13.3±0.5 min, respectively, P

PURPOSE To describe transcorneal sutureless silicone oil removal using 23-gauge trocars as an alternative surgical technique in an aphakic eye. METHODS We retrospectively evaluated the management of a 50-year-old male patient who had a history of bilateral congenital cataract removal at the age of 5 and developed rhegmatogenous retinal detachment. A 3-port 23-gauge pars plana vitrectomy, removal of the vitreous up to the vitreous base, 60° temporal retinotomy, and anterior flap retinectomy were performed. Silicone oil (1,000 cSt) was selected as a tamponading agent. The patients underwent active silicone oil removal at subsequent surgery 2 months after the initial vitrectomy. RESULTS The silicone oil was successfully extracted from the aphakic eye by using transcorneal 23-gauge trocars. No suture was needed at the corneal wound sites. There were no intraoperative or postoperative complications. CONCLUSION Transcorneal silicone oil removal using 23-gauge trocars can be performed easily with today's modern vitreoretinal surgery systems as an alternative treatment modality.

PurposeTo report clinical and multimodal imaging features of Best disease in patients presenting with subretinal pigment epithelium hyperreflective lesion.DesignRetrospective study.MethodsClinical examination findings and multimodal imaging features, including color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, fluorescein and indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCTA) images were evaluated retrospectively. ResultsWe assessed 27 eyes of 16 patients with the diagnosis of Best disease. Only patients presenting with serous macular detachment and subretinal pigment epithelium hyperreflective lesion in one or both eyes were included in this study. In 17 of 27 eyes (63%), fibrosis was identified by multimodal imaging techniques. Although there was no sign of active neovascularization on fundus examination or SD-OCT, a vascular network could be identified in 7 eyes (26%) (in 1 eye with OCTA only and in 6 with both OCTA and ICGA). Active neovascularization was seen in 3 eyes (11%). Treatment was recommended for eyes with active neovascularization, and follow-up was scheduled for eyes with quiescent neovascularization and fibrosis.ConclusionEyes with Best disease with subretinal pigment epithelium hyperreflective lesion and serous macular detachment may show fibrosis, quiescent neovascularization, or active neovascularization. Multimodal imaging techniques are very important for differentiation of these lesions.

Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.

To investigate the associations between macular complications and demographic, clinical, and optical coherence tomography characteristics (OCT) of highly myopic eyes with a dome-shaped macula (DSM).We retrospectively analyzed the findings of 90 patients (167 eyes) with DSM who had vertical and horizontal OCT scans between January 2011 and June 2018. Demographic data, clinical characteristics, and OCT-derived morphologic parameters were determined, and the associations of these parameters with macular complications were evaluated.Among 167 eyes, the following patterns were observed: horizontally oriented DSM (71%), symmetric DSM (27%), and vertically oriented DSM (2%). Complications or abnormalities involving the macular area were detected by OCT in 63% (106/167) of the eyes. Specific complications were as follows: choroidal neovascularization (CNV) (37.1%), macular retinoschisis (9.0%), serous retinal detachment (RD) (7.8%), epiretinal membrane (4.2%), lamellar macular hole (3.0%), and macular hole (2.4%). The eyes with CNV had thinner choroid (P 0.001) and lower macular bulge height (P = 0.04). The eyes with serous RD had thicker choroid (P 0.001) and higher macular bulge height (P 0.001). Serous RD was significantly more common when the macular height was greater than 250 μm (P = 0.001) and if the DSM pattern was vertical (P 0.001).A greater bulge height and thicker choroid in highly myopic eyes with DSM may be protective against the development of myopic CNV. A thicker choroid, a higher macular bulge ( 250 μm), and a vertical DSM pattern are associated with a risk of developing serous RD.

BACKGROUND: To evaluate morphologic patterns of choroidal neovascular membranes using optical coherence tomography angiography (OCTA) in patients with treatment-naive, continuously treated, and previously treated exudative age-related macular degeneration (AMD). SUBJECTS: We assessed retrospectively 184 eyes of 153 patients diagnosed with type 1, type 2, and mixed-type neovascularization associated with AMD. The type of neovascularization and clinical activity were assessed by clinical examination and spectral domain optical coherence tomography (SD-OCT). Morphological patterns of neovascular membranes were categorized using en face images on the AngioVue (Optovue) OCTA system. RESULTS: The mean age of patients was 77.9 ± 8.6 years (range, 52–96 years). The most frequently identified type of membrane morphology was well-defined in the treatment-naive group (69% of the eyes) and in eyes receiving ongoing anti-VEGF treatments (77% of the eyes). Long-filamentous morphology was the most frequent type in the previously treated group (53%), in which only 33% had a well-defined membrane. All clinically active cases had a well-defined pattern, such as a medusa or sea-fan shaped pattern, or an ill-defined pattern, and none had a long-filamentous neovascular network. Almost half of the clinically inactive cases (47%) had well- or ill-defined, identifiable membrane morphology on OCTA. A long-filamentous membrane pattern, which was consistent with chronicity of lesion, was seen only in eyes with inactive neovascularization. CONCLUSIONS: The membrane morphology on OCTA was not associated with clinical activity, except that the presence of long dilated filamentous linear vessels was associated with chronicity and lesion inactivity.

PURPOSE To describe double arcuate relaxing retinotomy as an alternative surgical technique in a case with a secondary large macular hole. METHODS The management of a patient who developed a large macular hole and macular tractional rhegmatogenous retinal detachment after pars plana vitrectomy for proliferative diabetic retinopathy was retrospectively assessed. Despite surgical procedures, such as dissection of a preretinal membrane from the retina and peeling of the retinal internal limiting membrane, the macular hole could not be closed. In the absence of an alternative method, superior and inferior posterior arcuate, 120° relaxing retinotomies were performed. RESULTS At the follow-up, the macular hole closure was confirmed by clinical examination and optical coherence tomography imaging, and visual acuity improved. There were no intraoperative or postoperative complications. CONCLUSION In cases of large macular holes, double arcuate relaxing retinotomy can reduce traction, leading to hole closure.

BACKGROUND AND OBJECTIVE: To evaluate early treatment outcomes of half-time photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC). PATIENTS AND METHODS: The anatomical and functional results were assessed for 24 eyes of 23 patients with CSC treated with half-time PDT in this prospective case series. Central foveal thickness (CFT) and subfoveal choroidal thickness (SCT) were evaluated by spectral-domain optical coherence tomography (SD-OCT), and mean retinal sensitivities and fixation characteristics were evaluated by MP-1 microperimetry at baseline and 1 day, 3 days, 1 week, 1 month, and 3 months after treatment. RESULTS: Observations 1 day after treatment revealed an increase in both SCT and CFT and a decrease in retinal sensitivity ( P = .013; P = .02; and P = .02, respectively). The CFT significantly resolved 1 month after treatment ( P = .002), and the SCT significantly resolved 7 days after treatment ( P = .011). Although an immediate decrease in retinal sensitivity was observed at post-treatment day 1 ( P = .02), the greatest reduction in retinal sensitivity was observed 3 days after treatment( P = .009), and then a tendency to increase was seen at subsequent visits. CONCLUSIONS: Despite early anatomical and functional impairments, such as an increase in CFT and SCT and a decrease in retinal sensitivity immediately after half-time PDT, best-corrected visual acuity and retinal sensitivity improved significantly 3 months after treatment. Half-time PDT is associated with early transient deterioration, but not with permanent adverse effect in patients with CSC. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:932–940.]

Objectives: To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales’ disease. Materials and Methods: In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales’ disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included. Results: The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p

Purpose: To investigate choriocapillaris flow voids (FV) with a new optical coherence tomography angiography (OCTA) image processing strategy to exclude artifacts due to vitreous opacities, subretinal pigment epithelium (sub-RPE) fluid and deposits, and subretinal fluid (SRF) by thresholding the en-face OCT image of the outer retina.Methods: This retrospective study included 15 eyes with drusen and 15 eyes with SRF. Number (FVn), average area (FVav), and maximum area (FVmax) of FV and the percentage of the nonperfused choriocapillaris area (PNPCA) obtained using the proposed strategy were compared with those obtained by removing only artifacts due to superficial capillary plexus (SCP).Results: There were three eyes with autosomal dominant drusen and 12 eyes with drusen secondary to non-exudative AMD in the drusen group. SRF group included 15 eyes with active central serous chorioretinopathy. PNPCA, FVav, FVmax, and FVn obtained using the algorithm were significantly lower than those obtained by removing only SCP in both groups (all p< 0.05). The algorithm was able to remove 94.7% of artifacts secondary to vitreous opacities and all artifacts secondary to serous pigment epithelial detachments. Conclusion: Nonperfusion areas of choriocapillaris may be overestimated in eyes with RPE abnormalities and SRF. These areas can be removed using thresholded images of the outer retina en-face OCT scans.

PURPOSE To investigate, using optical coherence tomography angiography, the foveal avascular zone (FAZar), the FAZ perimeter (FAZp), the acircularity index of the FAZ (FAZai), and the density of vessels surrounding the FAZ (FAZvd) before and after idiopathic epiretinal membrane surgery, and associations of these parameters with postoperative best-corrected visual acuity, letter score gain, and central foveal thickness. METHODS We retrospectively reviewed preoperative and postoperative (sixth month) medical records of 28 eyes of 28 patients who undergone epiretinal membrane surgery and had an intact ellipsoid zone. RESULTS There were significant increases in best-corrected visual acuity, FAZar, and FAZp and decreases in central foveal thickness and FAZai (all P < 0.05). Postoperative best-corrected visual acuity was not significantly correlated with any preoperative parameters. Postoperative letter score gain and central foveal thickness correlated negatively with preoperative FAZar and preoperative FAZp (all P < 0.05). Multivariable linear regression analysis revealed that preoperative FAZp was independently associated with postoperative letter score gain (P < 0.05). CONCLUSION The FAZ enlarges and becomes more circular after epiretinal membrane surgery. Postoperative best-corrected visual acuity is not associated with any FAZ parameters. In eyes with an intact foveal ellipsoid zone, especially a smaller preoperative FAZp is associated with more postoperative letter score gain.

To investigate conversion of pachychoroid pigment epitheliopathy (PPE) lesions and the development of other pachychoroid spectrum diseases in patients with PPE during follow-up. We retrospectively reviewed medical records of 46 eyes of 44 patients who had a diagnosis of PPE and were followed up for at least 3 years. Eyes with PPE (17.4%) developed central serous chorioretinopathy (CSC), and none developed pachychoroid neovasculopathy or polypoidal choroidal vasculopathy. Of 74 initial PPE lesions, 21.6% were retinal pigment epithelium (RPE) thickening, 36.5% were pigment epithelium detachment (PED), and 41.9% were RPE elevation with microbreak appearance (REwM). Five (62.5%) of the eight initial PPE lesions progressing to CSC were REwM. Two developed directly from the REwM and three REwMs transformed to PED first, and then progressed to CSC. Three initial PEDs progressed to CSC. REwMs can also transform to PED and RPE thickening. No initial PEDs or RPE thickenings transformed to a REwM. Of the new PPE lesions, 60% were REwM, 26.7% were PEDs, and 13.3% were RPE thickening. The smallest PPE lesion that can be detected is a REwM of RPE. It may be the precursor lesion for pachychoroid spectrum disease, but further large-scale prospective studies are required.

To compare choroidal hyperpermeability and vessel density between eyes with central serous chorioretinopathy (CSC), those with pachychoroid pigment epitheliopathy (PPE) and those with uncomplicated pachychoroid (UCP).We retrospectively reviewed indocyanine green angiography images of 60 patients with unilateral active CSC who had PPE (36 eyes) or UCP (24 eyes) in their fellow eyes. We used color thresholding of indocyanine green angiography images to determine choroidal vessel density.The mean choroidal thickness of eyes with CSC was greater than that of eyes with PPE or UCP, but this difference was not statistically significant (P = 0.46). There was no significant difference between the PPE (92%) and CSC (93%) groups regarding choroidal hyperpermeability (P = 0.76), but both of these groups had higher choroidal permeability than the UCP group (50%) (both P0.001). In 30 (90%) of 33 eyes with PPE who had choroidal hyperpermeability, retinal pigment epithelium alterations were in the region of hyperpermeability. Choroidal vessel density did not differ between the PPE and UCP groups (P = 0.57).Pachychoroid pigment epitheliopathy is forme fruste of CSC. There is no difference between complicated and UCP regarding subfoveal choroidal thickness and choroidal vessel density. The main difference between these groups is choroidal hyperpermeability.

AimsTo determine the demographic and morphological characteristics of patients with central serous chorioretinopathy (CSC) and describe risk factors for CSC.MethodsWe retrospectively reviewed medical records of 811 patients with CSC and 816 healthy controls referred from 2002 to 2018.ResultsThe female/male ratio of patients with CSC was 1/2.7. Mean age of onset was 45.2 years. The peak prevalence for men occurred at 45–49 years. Women had two prevalence peaks, the higher at 55–59 years and the other at 45–49 years. Of these patients, 56.8% had unilateral disease, 42.1% had bilateral disease and 1.1% had only one eye. 671 (82.7%) patients had spectral domain optical coherence tomography (SD-OCT) images and 598 (73.7%) had enhanced depth choroidal images. Pigment epithelial detachment (PED) was detected in 763 (80.7%) of 945 eyes with SD-OCT images. Chronic cases were more likely to be bilateral and multifocal and to have PED (all pConclusionThis is the largest case-control study of CSC to evaluate demographic morphological characteristics and risk factors. Multiple factors are associated with CSC.

To evaluate macular features and fixation pattern in patients with retinitis pigmentosa (RP) compared with healthy controls, using spectral-domain optical coherence tomography and MP-1 microperimetry.Eighty-one eyes of 81 patients with RP and 90 eyes of 90 healthy subjects were assessed. The central foveal thickness, subfoveal choroidal thickness, ellipsoid zone length, and the mean retinal sensitivities and fixation characteristics were evaluated by spectral-domain optical coherence tomography and MP-1 microperimetry.Compared with healthy subjects, patients with central macular thinning had lower best corrected visual acuity, central foveal thickness, ellipsoid zone length, retinal sensitivity, and visual field than patients with cystoid macular edema or no macular change (all P0.001). Correlations between fixation characteristics and best corrected visual acuity, central foveal thickness, ellipsoid zone length, retinal sensitivity, and visual field were statistically significant (all P0.001). Patients with no macular change had more centralized and stabilized fixation than patients with central foveal thinning and cystoid macular edema.The spectrum of macular features from the nearly normal retina to complete chorioretinal atrophy can be seen in RP patients without associations with age or duration of symptoms. Unlike other macular degenerations, most patients with RP obtained at least a central 2° of visual field, with foveal and stable fixation.

Purpose To report visualization of a case of retinal deep capillary plexus ischemia with antiphospholipid syndrome. Methods A 53-year-old woman was referred with a 1-week history of sudden onset of decreased vision in the right eye. Her symptoms were evaluated by clinical examination, infrared reflectance, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography, microperimetry, and multifocal electroretinography. Results The patient's visual acuity on presentation was 0.4 (Snellen) in the right eye and 0.7 in the left eye. Spectral-domain optical coherence tomography showed increased reflectivity of inner nuclear and inner plexiform layers of the right eye. Laboratory evaluation revealed abnormal titers of lupus anticoagulant antibodies. After 6 months, her visual acuity was finger counting at 1 m in the right eye and 0.4 in the left eye. Spectral-domain optical coherence tomographic image demonstrated a diffuse thinning of those retinal layers in the right eye. These findings are consistent with the clinical characteristics of retinal deep capillary ischemia in association with antiphospholipid syndrome. Conclusion Deep capillary ischemia has some characteristic findings, and on spectral-domain optical coherence tomography, outcomes in conjunction with multimodal imaging are helpful for the diagnosis of the acute and the chronic stages of retinal deep capillary plexus ischemia.

Our purpose was to assess anatomical and functional outcomes of vitrectomy in pediatric cases of Terson syndrome. A total of 11 eyes of seven children diagnosed with Terson syndrome secondary to traumatic brain injury and 17 eyes of 12 children diagnosed with Terson syndrome secondary to nontraumatic brain hemorrhage who had 20-gauge or 23-gauge pars plana or pars plicata vitrectomy were included in this retrospective study. The primary outcome was the change in visual acuity from the preoperative examination to postoperative final follow-up. Secondary outcomes were anatomic surgical success and postoperative complications. The mean time between diagnosis and surgery was 62 ± 35 days (range, 30–150), and the average age at the time of the surgery was 4.5 ± 6.4 years (range, 3 months to 17 years). The mean preoperative logarithm of the minimum angle of resolution (logMAR) (Snellen) best corrected visual acuity (BCVA) was 2.6 ± 0.7 (20/7260) (n = 9) and in the remaining 19 eyes it was recorded as noncentral, unsteady, nonmaintained fixation. The mean follow-up period was 50 ± 54 months (range, 12–192 months). At the last follow-up visit, the mean logMAR BCVA was 0.46 ± 0.6 (20/60) (n = 19) and in eight eyes it was recorded as fix-and-follow. One eye developed a retinal detachment 14 months after the first operation, and one eye developed an epiretinal membrane after 2 years. Anatomical success was recorded in all patients at the final visit. In children with massive vitreous hemorrhage secondary to Terson syndrome, vitrectomy is an effective procedure and offers a rapid visual improvement. Earlier surgical treatment prevents amblyopia and blood-related potential complications.

Purpose To assess the long-term anatomical and functional results of vitreoretinal surgery in patients with advanced Coats disease. Methods Retrospective analysis of 23 patients who underwent 23-gauge pars plana vitrectomy combined with transscleral cryotherapy, laser photocoagulation, and intraocular tamponade between 2005 and 2014 and had a follow-up of at least 1 year. The primary outcomes were mean visual acuity and anatomical success. Results The average age at the time of surgery was 8.7 ± 1.3 years (range, 2-18 years). The mean follow-up period was 55.2 ± 31 months (range, 12-120 months). In 16 eyes (70%), further treatment was not necessary. In the remaining 7 patients (30%), revision surgery with silicone oil tamponade was required. In 20 eyes (87%), the retina was reattached. At the final visit, 8 eyes (35%) had improved mean Snellen visual acuity from 20/1,000 at initial presentation to 20/160, 3 eyes (13%) showed stabilization, and 6 eyes (26%) had decline in visual acuity. No enucleation was necessary, and no progression to neovascular glaucoma was observed. Conclusion Pars plana vitrectomy combined with cryotherapy, laser photocoagulation, and intraocular tamponade could be an effective treatment option for advanced Coats disease. Despite surgery, disease-related complications remained high, but the main aim of management in these young patients is functional and anatomical stability.

Various eye conditions cause tears in the retinal pigment epithelium (RPE). The most common cause of a RPE tear is vascularized retinal pigment epithelial detachment (PED) in patients with exudative age-related macular degeneration. Although RPE tears can develop spontaneously in vascularized PEDs, most recent cases have been associated with anti-vascular endothelial growth factor (VEGF) injections. The subretinal fluid within the PED applies hydrostatic pressure to the RPE and stretches it. The PED enlarges as the hydrostatic pressure increases. Contraction of the choroidal neovascular membrane adds tractional forces to the RPE monolayer. Especially in larger PEDs, the risk of a RPE tear increases after anti-VEGF therapy owing to increasing contraction of the choroidal neovascular membrane. The risk factors and predictors defined by retinal imaging can contribute to prevention of RPE tears, and modified therapies can be used for patients at most risk; however, there is no proven method for prevention of RPE tears. After tear formation, in the presence of an active choroidal neovascular membrane, anti-VEGF should be repeated until the underlying disease has been suppressed. When the subretinal fluid is present for more than 6 months, the denuded area is covered with thickened fibrotic tissue. We review the literature to describe the classification, epidemiology, mechanisms of development, and repair of RPE tears, diagnosis, risk factors and predictors, prevention, and management.

PURPOSE To evaluate the long-term outcomes of radial optic neurotomy (RON) in patients with optic disk pit maculopathy and to compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with temporal side single RON versus PPV without RON. METHODS This retrospective study included 15 eyes of 15 consecutive patients who had surgery for optic disk pit maculopathy. Patients were followed for 12 to 115 months after surgery. Anatomical and functional results were evaluated with optical coherence tomography, MP-1 microperimetry in the central 20°, and measurement of best-corrected visual acuity. Descriptive statistical methods, Friedman chi-square test, post hoc Dunn test, Mann-Whitney test, Wilcoxon signed-rank test, and Fisher's exact test were used to determine the best-corrected visual acuity and MP-1 microperimetry differences between time points and to compare the results between the two treatment groups. RESULTS Two male and 5 female patients with a mean age 23.3 ± 8.7 (±standard error) years at presentation had PPV and silicone oil or gas tamponade with RON. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 6 (86%) eyes (3 ± 2 lines). After surgery, complete resolution of fluid in the central macula was observed in 6 (86%) eyes. Five male and 3 female patients with a mean age 28.2 ± 8.2 years at presentation had PPV, posterior vitreous detachment, with or without juxtapapillary laser treatment, and silicone oil or gas tamponade. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 5 (62.5%) eyes (2 ± 0.7 lines). After surgery, fluid in the central macula resolved completely in 4 (50%) eyes. CONCLUSION Pars plana vitrectomy with temporal side, single RON seems to be an effective method of managing optic disk pit maculopathy. The anatomical and functional improvements, without additional treatment or complication during the follow-up period, indicate that RON might be an alternative treatment approach to PPV alone for optic disk pit maculopathy.

PURPOSE The purpose of this study was to investigate the foveal avascular zone area and its perimeter, the acircularity index of the foveal avascular zone, the vessel density surrounding the foveal avascular zone, and the vessel density in the foveal, parafoveal, and perifoveal areas and their associations with best-corrected visual acuity, central foveal average thickness, and volume of ellipsoid zone-retinal pigment epithelium in patients with macular telangiectasia Type 2 (MacTel 2). METHODS We retrospectively reviewed medical records of 22 eyes of 22 patients with MacTel 2 and 24 eyes of 24 healthy controls. Eyes with MacTel 2 were graded according to optical coherence tomography angiography: 1) vascular anomalies temporal to the fovea; 2) vascular anomalies temporal and nasal to the fovea; 3) markedly diffuse circumferential vascular anomalies; and 4) neovascularization in the outer retina. RESULTS Acircularity index was higher and superficial-parafoveal vessel density was lower, in MacTel 2 group (all P < 0.05). Acircularity index was associated with the severity of the disease and had strong correlations with best-corrected visual acuity, ellipsoid zone-retinal pigment epithelium thickness, and ellipsoid zone-retinal pigment epithelium volume (all P < 0.05). CONCLUSION In conclusion, the increase in acircularity index is correlated with the severity of the disease, the decrease in ellipsoid zone-retinal pigment epithelium thickness and volume, and the decrease in best-corrected visual acuity. It may be used to monitor patients with MacTel 2.

Purpose To assess long-term functional results after vitrectomy for stages 4 and 5 retinopathy of prematurity (ROP). Methods Retrospective analysis of data from eyes that underwent lens-sparing vitrectomy (LSV) or combined lensectomy and vitrectomy (LV) and had a follow-up of at least 5 years. Results Eighty-eight eyes of 65 infants who underwent LSV or LV for stage 4 or 5 ROP were included in the study. The mean follow-up was 6.9 years. The anatomic success rate was 89% (17/19) for stage 4A, 63% (24/38) for stage 4B, and 42% (13/31) for stage 5. Forty-five eyes (51%) had measurable visual acuity (VA). The approximate Snellen VA equivalent was 20/550 for stage 4A, 20/1600 for stage 4B, and 20/4000 for stage 5. The remaining 39% (34/88) had light perception or no light perception. Owing to neurological conditions, VA in nine eyes (10%) could not be measured. Anatomic and visual outcomes were not associated with surgical technique. Conclusions Surgery for stage 4A ROP has better visual success. Acceptable vision for stage 4B and poor for stage 5 ROP, despite retinal reattachment, is thought to be secondary to irreversible injury to either the retina or visual nervous pathways, or both.

Purpose To evaluate the outcomes of transscleral diode laser photocoagulation in the eyes of children with a history of threshold retinopathy of prematurity (ROP) and compare them with the eyes of children with no or subthreshold ROP and normal term infants by spectral-domain optical coherence tomography (SD-OCT). Methods Three groups of children aged 4 to 10 years were included as follows: 45 patients with regressed ROP who had not received any treatment (group 1), 48 patients with a history of zone 2 threshold ROP who had been treated with transscleral diode laser (group 2), and 56 age-matched healthy full-term children (group 3). Visual acuity, refractive error, and measurement of retinal and choroidal thickness by SD-OCT were compared between groups retrospectively. Results The mean gestational age (GA) and birthweight (BW) were 31 weeks and 1,409 grams in group 1, 28.7 weeks and 1,274.5 grams in group 2, and 38.4 weeks and 3,285 grams in group 3, respectively. There were 6 significant differences in the laser group: GA, BW, macular thickness, foveal depression, spherical equivalent, and visual acuity. In contrast, there were no significant differences among any of the choroidal parameters in all of the groups. Neither macular nor choroidal thickness correlated with visual acuity. Conclusions Although retinal structural changes were observed in patients with a history of ROP, especially in patients treated with laser, no significant difference was found in choroidal thickness between groups. These structural abnormalities may be related to both severity of ROP and laser treatment.

Laser devices are widely used for medical, military, industrial and entertainment purposes. This extensive and unregulated use of lasers can cause a variety of maculopathies that can result in permanent vision loss. Uncontrolled and inappropriate use of laser instruments should be prevented with strict rules. We strongly emphasize the importance of changing the general misperception that lasers are safe to use for entertainment purposes. In this study we aim to report the clinical features of three patients with a history of maculopathy caused by exposure to laser light in an entertainment venue.

Purpose To evaluate the outcomes of pars plana vitrectomy with silicone oil tamponade in the management of retinal detachment associated with giant retinal tears. Methods We reviewed 45 eyes of 42 patients with primary retinal detachment associated with giant retinal tears over 10 years at a tertiary referral centre. Patients underwent 23-gauge vitrectomy without adjuvant scleral buckling by a single surgeon and had follow-up at least 6 months after silicone oil removal. Results Mean follow-up was 37 ± 35 months. Seven eyes (16%) had grade C proliferative vitreoretinopathy, and 16 (36%) had a giant retinal tear ≥180° at baseline. The primary reattachment rate was 84%, and the overall final anatomical success rate was 98%. The mean Snellen visual acuity equivalent at the final visit was 20/58. Final visual acuity ≥20/40 was achieved in 64%. The mean duration of silicone oil tamponade was 10.5 ± 4 weeks. By the final visit, silicone oil had been removed from 44 eyes (98%). Conclusion The high rates of anatomical and functional success support management of giant retinal tears-associated retinal detachment with vitrectomy without adjuvant scleral buckling. Removal of silicone oil at the earliest possible time helps to avoid complications such as keratopathy, glaucoma and visual loss without apparent reason.

Purpose To estimate the outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy and silicone oil tamponade. Methods A retrospective chart review of 10 eyes (10 patients) who underwent pars plana vitrectomy for retinal detachment with chorioretinal coloboma. Results The average age at the time of the surgery was 29.8 ± 19.7 years. The mean follow-up period was 28.8 ± 28.4 months. The mean silicone oil tamponade duration was 9.8 ± 3.5 weeks. Of 10 eyes, 4 (40%) had retinal breaks outside the coloboma, 4 (40%) had breaks inside the coloboma, 1 (10%) had breaks inside and outside the coloboma, and in 1 eye (10%); the causative retinal break was not localized. Preoperatively, the mean visual acuity was 20/2,500 (n = 9), and 1 (10%) was recorded as "Not CSM." At the final examination, the mean visual acuity for the patients with measurable visual acuity was 20/200 (P = 0.06), and in the remaining eye was recorded as light perception. The retina was finally reattached in nine eyes (90%). Postoperative complications included cataract in three (30%), persistent elevated intraocular pressure in one (10%), band keratopathy in one (10%), and proliferative vitreoretinopathy in one (10%). Conclusion Complete pars plana vitrectomy with or without lensectomy, laser photocoagulation around the peripheral retina, around all the peripheral breaks and around the colobomatous area, and silicone oil tamponade is effective for retinal detachment in eyes with chorioretinal coloboma. Silicone oil removal as early as possible did not increase the risk of redetachment and seems to reduce the incidence of oil-related complications in such cases.

BACKGROUND AND OBJECTIVE: To report anatomical and functional outcomes of surgery in each of the eyes in cases of bilateral macular hole (MH). PATIENTS AND METHODS: The anatomical and functional results for 42 patients with bilateral idiopathic MH were evaluated retrospectively. First-operated and fellow eyes were compared at various time points for preoperative characteristics and postoperative outcomes. RESULTS: Anatomical success was achieved in all patients after a single operation, and no reopening of an initially closed MH was observed during the follow-up period. There was a statistically significant difference between the first and fellow eyes in mean postoperative logMAR visual acuity (VA) ( P = .048). Fellow eyes had better postoperative VA, lower rates of ellipsoid zone, and interdigitation zone disruption, and none of the fellow eyes had external limiting membrane disruption at any time after surgery. CONCLUSIONS: Although anatomical success can be achieved in both eyes after successful surgery, early detection and treatment of fellow eyes is associated with better postoperative VA. The reason for a better outcome in the fellow eye is related to the lower photoreceptor impairment rate because of the earlier stage of the hole. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:571–578. ]

AimsTo investigate the prevalence of pachychoroid pigment epitheliopathy (PPE) in fellow eyes of patients with unilateral central serous chorioretinopathy (CSC) and to determine differences between patients with PPE, uncomplicated pachychoroid (UCP) and normal fellow eyes.MethodsWe retrospectively reviewed 536 patients with CSC. Demographic and medical data, spectral domain optical coherence tomography scans with enhanced depth imaging mode, infrared reflectance images and fundus autofluorescence images were obtained from the patients’ medical records.Results254 (47.4%) of 536 patients had bilateral CSC. The female to male ratio was 1/2.8 in all patients with CSC. In patients with unilateral CSC (282 patients), 61% of fellow eyes had PPE, 30.8% had UCP and 8.2% were normal. There were no significant differences between patients with PPE, UCP and normal eyes in age, duration of disease, sex, presence of systemic hypertension, steroid use, psychopharmacological medication use, refractive error or central foveal thickness. Eyes with PPE and UCP did not differ regarding subfoveal choroidal thickness. In eyes with PPE (172 eyes), 77.3% had retinal pigment epithelium (RPE) bumps and 43% had pigment epithelium detachment.ConclusionPPE is common in fellow eyes of patients with CSC. There is no difference between PPE and UCP regarding demographic characteristics and medical features.

PURPOSE To compare the average thicknesses of central inner retinal layers in eyes with pachychoroid pigment epitheliopathy (PPE), with uncomplicated pachychoroid (UCP), and of healthy subjects. METHODS Medical records of patients with PPE and UCP were retrospectively reviewed. Twenty-nine eyes with foveal PPE, 30 eyes with UCP, and 29 eyes of healthy subjects were included. Spectral-domain optical coherence tomography with enhanced depth imaging was used for all optical coherence tomography scans. Mean central inner retinal layer thicknesses were measured in 1-mm-diameter circle with Spectralis automated segmentation software and compared between groups. RESULTS The outer nuclear layer (ONL) and the sum of the outer plexiform layer and ONL were significantly thinner in the PPE group than the UCP and control groups (ONL: P < 0.001, P < 0.001; outer plexiform layer + ONL: P = 0.002, P = 0.002, respectively). There was no significant difference between groups regarding thickness of the outer plexiform layer and other inner retinal layers. Eyes with UCP and normal eyes did not differ. CONCLUSION The ONL is thinner in eyes with PPE. The degenerative process of pachychoroid spectrum diseases may begin with retinal pigment epithelium alterations before subretinal fluid accumulation. The PPE lesions, commonly seen above pachyvessels, may be an indicator of photoreceptor apoptosis.

PURPOSE To evaluate the anatomical and functional outcomes after endoresection of complex retinal capillary hemangioblastoma (RCH). METHODS Retrospective case series of 12 patients (13 eyes), all treated with pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH and silicone oil injection. RESULTS The mean age at the time of surgery was 32.5 ± 15.9 years. The mean follow-up duration after initial surgery was 50.5 ± 49.4 months. Indications for surgery included RCH with associated complications such as tractional retinal detachment in five eyes (38%), exudative retinal detachment in four eyes (31%), and combination of tractional retinal detachment and exudative retinal detachment in four eyes (31%). The dimensions of the resected RCHs were as follows: >3.0 mm in seven eyes (54%), >3.5 mm in three eyes (23%), and >4.0 mm in three eyes (23%). No tumor was located closer than 10 mm to the optic nerve or fovea. Anatomical success after initial surgery was 92%. One eye had a second vitreoretinal procedure owing to recurrent RD. The mean preoperative Snellen visual acuity was 20/303. The mean Snellen visual acuity at the final visit was 20/73. At the final visit, visual acuity had improved in seven eyes (54%), and six eyes (46%) were stable. Short-term complications included recurrent proliferative vitreoretinopathy in one eye (8%), transient ocular hypertension requiring topical antiglaucoma treatment in four eyes (31%), and long-term complications included progression of cataract in seven eyes (54%). CONCLUSION Combined pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH, and silicone oil injection may be an effective treatment option for complex RCH, achieving high anatomical success and stable or even improved visual acuity, acceptable rates of disease- and treatment-related complications, and minimal need for retreatment.

Pachychoroid pigment epitheliopathy (PPE) is considered to be a forme fruste of central serous chorioretinopathy. Tamoxifen (Soltamax; Midatech Pharma, Raleigh, NC) has an anti-estrogenic effect on cytoplasmic estrogen receptors. Serum total testosterone, cortisol, and cortisone levels increase during tamoxifen therapy. Tamoxifen may cause hormone disturbance leading to the development of disorders in the pachychoroid spectrum. The authors present two cases of PPE associated with tamoxifen therapy. A 65-year-old woman (Patient 1) and a 52-year-old woman (Patient 2) had a recent history of tamoxifen therapy. PPE lesions were seen in both eyes of Patient 1 and in the right eye of Patient 2. [ Ophthalmic Surg Lasers Imaging Retina . 2017;48:838–842.]

To assess correlation between preoperative and postoperative findings and surgical factors, and postoperative functional outcomes after successful repair of acute macula-off rhegmatogenous retinal detachment (RRD). Forty-four eyes of 44 patients with recent-onset macula-off RRD who had primary pars plana vitrectomy were included in this retrospective study. Best-corrected visual acuity (BCVA) and retinal and choroidal changes on spectral-domain optical coherence tomography (SD-OCT) were evaluated before and after surgery. Correlation between preoperative and postoperative variables such as demographic and clinical data, SD-OCT findings and surgical factors, and postoperative functional outcomes were assessed. Eighteen women and 26 men, whose mean age at the onset of RRD was 51.7 ± 14.4 years, were evaluated. The mean preoperative and postoperative logMAR BCVA were 1.1 ± 0.5 (20/250) and 0.14 ± 0.1 (20/30), respectively, after a mean of 16.7 ± 7.2 months. Although all factors were evaluated as prognostic factors for functional outcome after surgical treatment of recent-onset macula-off RRD, epiretinal membrane formation was found as the only factor affecting postoperative visual acuity. Satisfactory visual recovery can be achieved after a successful surgery in patients with acute RRD without any association with morphological changes such as increased subretinal fluid, central foveal thickness, subfoveal choroidal thickness, cystic spaces in the inner nuclear layer and/or outer nuclear layer, undulation of separated outer retina, and disruption of the photoreceptor layer. Epiretinal membrane formation may affect visual outcome in these patients.

The purpose of the study was to evaluate the effect of reduced-fluence photodynamic therapy (RFPDT) for chronic central serous chorioretinopathy (CSC) associated with serous retinal detachment (SRD) and fovea-involving pigment epithelial detachment (PED). Ten eyes of ten patients with chronic CSC associated with combined SRD and PED involving the fovea were included. RFPDT was applied to the hyperfluorescent area identified at the mid-to-late phase of indocyanine green angiography, which indicated the area of leakage. We evaluated the changes in best-corrected visual acuity (BCVA) and optical coherence tomography at month 1 and final follow-up visit. The mean age of the participants was 47.4 ± 7 years. The mean follow-up duration was 6.3 ± 4 months. At month 3, the SRD had resolved completely in all ten eyes (100 %), and PED had resolved in seven eyes (70 %). The initial mean BCVA improved from 20/50 at baseline to 20/32 at the last visit (P > 0.05). The mean central retinal thickness was reduced from 534 ± 279 µm at baseline to 194 ± 46 µm at the last examination (P

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Purpose To compare the outcomes for patients with rhegmatogenous retinal detachment (RRD) and patients with retinal detachment (RD) following penetrating injury after combined 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced proliferative vitreoretinopathy (PVR). Design Retrospective, comparative, interventional case series. Methods Twenty-four eyes (60%) of 24 patients diagnosed with RRD and 16 eyes (40%) of 16 patients diagnosed with RD after penetrating injury whose surgery involved 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced PVR (grade D) were included in the analysis. The primary outcome was anatomic surgical success. Secondary outcomes were change in visual acuity (VA) and postoperative complications. Results The mean number of previous interventions in the RRD and trauma groups were 1.04 and 1.31, respectively ( P = .13). After 51.5 (± 52.7) months of mean follow-up, the complete retinal reattachment rates for the RRD and trauma groups were 79% (19/24) and 75% (12/16), respectively ( P > .99). The final mean VA was 2.2 logMAR (20/2000) in both groups, with improvement in the RRD group ( P = .04). The most common postoperative complications in the RRD and trauma groups, respectively, were persistent hypotony in 6 eyes (25%) and 5 eyes (31%) ( P = .73), corneal damage in 8 eyes (29%) and 6 eyes (38%) ( P = .34), and epiretinal membrane in 5 eyes (20.8%) and 4 eyes (25%) ( P > .99). Conclusions Only 25% of the eyes (10/40) had VA of 20/200 or better. The aim of peripheral 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy is to obtain retinal reattachment, which is otherwise unachievable.

BACKGROUND AND OBJECTIVE: To evaluate ultrasonography outcomes in eyes with stage 5 retinopathy of prematurity (ROP). PATIENTS AND METHODS: Patients with bilateral stage 5 ROP were evaluated retrospectively. Ultrasonography examination was performed in all cases. Patients’ demographic features and ultrasonography findings such as axial eye length, funnel configuration, subretinal hemorrhage, anterior loop traction, retinal cyst, and calcification were assessed, and correlations between variables were analyzed. RESULTS: Three hundred eyes of 150 patients were included. Sixty-one patients (40.7%) were female. The mean gestational age was 28.8 weeks ± 2.6 weeks, and the mean birth weight was 1,277 g ± 360 g. The mean axial eye length was 14.7 mm ± 1.8 mm. Two hundred forty-five eyes (81.7%) had closed-closed retinal detachment configuration, 32 (10.7%) had open-closed retinal detachment configuration, 17 (5.7%) had open-open retinal detachment configuration, and six (2%) had closed-open retinal detachment configuration. Subretinal hemorrhage (25.7%), anterior loop traction (24%), retinal cyst (2.3%), and calcification (1.3%) were also observed. CONCLUSION: Closed-closed funnel configuration, reduced axial diameter, and subretinal hemorrhage are associated with poor prognosis, and ocular ultrasonography examination for ascertaining these parameters is very important in cases with stage 5 ROP. In the present study, closed-closed retinal detachment configuration was noted in almost 80% of the cases with stage 5 ROP, which is probably the reason for the surgical failure in these end-stage cases. [ Ophthalmic Surg Imaging Lasers Retina. 2015;46:1035–1040.]

Occult macular dystrophy is an inherited macular dystrophy characterized by a progressive decline of bilateral visual acuity with normal fundus appearance, fluorescein angiogram and full-field electroretinogram. This case report presents a 20-year-old female patient with bilateral progressive decline of visual acuity for six years. Her visual acuity was 3-4/10 in both eyes. Anterior segment and fundus examination, fluorescein angiogram and full-field electroretinogram were normal. She could read all Ishihara pseudoisochromatic plates. Fundus autofluorescence imaging was normal. There was a mild central hyporeflectance on fundus infrared reflectance imaging in both eyes. Reduced foveal thickness and alterations of the photoreceptor inner and outer segment junction were observed by optical coherence tomography in both eyes. Central scotoma was also found by microperimetry and reduced central response was revealed by multifocal electroretinogram in both eyes. These findings are consistent with the clinical characteristics of occult macular dystrophy.