Search

Purpose: To present effects of the inverted internal limiting membrane flap technique in full-thickness macular holes coexisting with dry age-related macular degeneration., Methods: Our database was retrospectively reviewed in order to spot patients with the simultaneous diagnosis of dry age-related macular degeneration and full-thickness macular hole. Vitrectomy with the inverted internal limiting membrane flap technique was performed. Inclusion criteria were full-thickness macular hole, drusen, vitrectomy performed, and spectral domain optical coherence tomography (Copernicus HR, Optopol, Poland) or swept source optical coherence tomography (Triton, Topcon, Japan) before surgery, then 1 week (±3 days), 1 month (±1 week), 3 months (±1 month), 6 months (±1 month), 12 months (±2 months), and 18 months to 12 years after surgery., Main Outcome Measures: Closure of macular hole and visual acuity at the final control., Results: A total of 18 eyes of 12 patients (mean age: 68 years) were included. Mean minimum macular hole diameter was 493 μm. Mean maximum macular hole diameter was 1072 μm. Macular hole was closed in 16 eyes after first surgery and in all eyes after second surgery. Improvement of visual acuity was statistically significant ( P  = 0.05), but there was no statistical significant correlation observed between initial macular hole diameters and final visual acuity ( P  > 0.1)., Conclusion: The inverted internal limiting membrane flap technique improves anatomical and functional results in eyes with coexisting dry age-related macular degeneration and full-thickness macular holes. Final development of choroidal neovascularization or geographic atrophy is possible in rare cases.

Purpose: This work presents the effects of vitrectomy with an inverted internal limiting membrane flap in full-thickness macular holes (FTMHs) in eyes with diabetic retinopathy (DR)., Methods: Vitrectomy with the inverted and temporal inverted internal limiting membrane flap technique was performed in all cases. Inclusion criteria were FTMH, diabetes treated with oral drugs or with insulin for at least 5 years, spectral-domain or swept-source optical coherence tomography performed before surgery then 1 week, 1, 3, 6, 12, and 18 to 36 months after surgery., Results: FTMH with nonproliferative DR (NPDR) was noted in 20 eyes and with proliferative DR (PDR) in 5 eyes. In PDR the margins of the macular holes (MHs) were always detached, and the MHs tended to be larger than in NPDR. The minimum diameter-to-base diameter ratio was 1:2 in NPDR and 1:10 in PDR. Postoperatively central retinal thickness and visual acuity (VA) were significantly lower for PDR. Twenty-one of 25 FTMHs were closed after the first surgery, and all were closed after the second surgery. VA improved, final results did not depend on FTMH diameter. Photoreceptor defects decreased in size but were present in all cases 12 months after surgery., Conclusions: Morphology of MHs in NPDR and PDR was varied. FTMH in NPDR resembled idiopathic cases; morphology of FTMH with PDR was different. In PDR, FTMHs were larger and the fovea was usually detached; retina thinning was also observed. Final VA depended on initial VA and the severity of the disease (NPDR vs PDR)., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Purpose: To identify swept-source (SS) OCT and SS OCT angiography (OCTA) patterns predicting outcome in patients with optic disc pit-associated maculopathy and to present the results of a novel surgical technique, stuffing of the optic disc pit., Design: Prospective, interventional study., Participants: Fifteen eyes., Methods: Swept-source OCT before surgery and then 1 week and 1, 3, and 6 months after surgery, then up to 4 years later. Swept-source OCTA was performed from 2015 (9 patients). After core vitrectomy, internal limiting membrane (ILM) was peeled between the optic nerve and fovea and stuffed into the optic disc pit. Laser photocoagulation was performed at the temporal side of the optic disc pit. Fluid-air exchange followed. The following data were noted: visual acuity, central retinal thickness, distribution of fluid on SS OCT, and diameters and circuit of the foveal avascular zone on OCTA., Main Outcome Measures: Normalization of the fovea contour and visual acuity., Results: We subdivided patients into 2 groups. On SS OCT, we observed subretinal fluid with elevation of the fovea (group 1) in 8 eyes. Group 2 comprised 7 eyes without subretinal fluid, but with intraretinal fluid. Five of these eyes additionally showed an outer lamellar macular hole. Anatomic success was achieved in all eyes. The decrease of central retinal thickness 1 week after surgery was more marked in group 1 (P = 0.002). The area of the foveal avascular zone in the superficial retinal vessel layer increased significantly after surgery for group 2 (P = 0.04), but not for group 1 (P = 0.4). Visual acuity improved without statistically significant differences between groups., Conclusions: Stuffing of the optic disc pit with the ILM results in improvement of anatomic and functional results. Prognosis depends on initial morphologic features. Central retinal thickness normalizes faster after surgery in eyes with subretinal fluid when compared with eyes with intraretinal fluid. Faster anatomic improvement does not correlate with improvement of vision. Postoperative increase in the size of the foveal avascular zone in the superficial retinal vessel layer, more pronounced in group 2, may be associated with the prolonged postoperative anatomic recovery in those eyes., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report a cohort with optic disk pit maculopathy (ODPM) presenting with neurosensory macular detachment that were initially misdiagnosed and mistreated; and to describe structural features on spectral domain optical coherence tomography in misdiagnosed and all other consecutive cases of ODPM., Methods: Multicenter international retrospective cohort study., Participants: 59 eyes from 59 patients with ODPM., Main Outcome Measures: 1) Proportion of patients with ODPM initially misdiagnosed, inaccurate diagnosis and treatment. 2) Morphologic features on spectral domain optical coherence tomography: other causes of subretinal and/or intraretinal fluid, inner/outer retinoschisis, communication with optic disk pit, and retinal pigment epithelium alterations. 3) Visual and anatomical outcomes 6 months after proper treatment., Results: Fifteen patients (25.4%) with ODPM were correctly diagnosed initially and those were significantly younger than misdiagnosed cases (age 33.8 ± 15.2 vs. 58.7 ± 15.8 years, P < 0.0001). Forty of forty-four misdiagnosed eyes (90.9%) were treated for their presumed diagnosis before referral. Eyes with initial misdiagnosis had significantly more outer retinoschisis at baseline (88.4 vs. 40.0%, P = 0.0002) and more retinal pigment epithelium alterations (90.0 vs. 27.3%, P < 0.0001) 6 months after proper treatment., Conclusion: Optic disk pit maculopathy is an underdiagnosed entity and can mimic other causes for subretinal fluid. Awareness and identification of pertinent spectral domain optical coherence tomography features can help avoid inappropriate and delayed treatment.

Purpose: This article studies visual outcome and frequency of antivascular endothelial growth factor (anti-VEGF) injections continued in patients with neovascular age-related macular degeneration (AMD) who had an earlier vitrectomy for postinjection endophthalmitis., Methods: A retrospective interventional study was conducted reviewing our database for patients with a diagnosis of endophthalmitis in the course of anti-VEGF injections. Endophthalmitis diagnosis was made on clinical examination of pain, rapid decrease in visual acuity (VA), conjunctival hyperemia, hypopyon, and vitritis. In all eyes, core vitrectomy with intravitreal antibiotics was performed. Spectral-domain optical coherence tomography was performed monthly before and after surgery during follow-up. Anti-VEGF injections were continued after surgery in all cases., Results: Eight eyes with postinjection endophthalmitis were included. Mean VA immediately before endophthalmitis was 20/50 Snellen with a mean of 19 intravitreal anti-VEGF injections ( P = .45). At time of endophthalmitis diagnosis, mean VA was 20/1000 (range, 20/2000-20/200). Mean time from injection to when the patient noted first symptoms was 4.3 days (range, 1-8 days). Mean time from first symptoms to surgery was 12 hours (range, 2.5-26 hours). Final mean VA at the end of follow-up (range, 12-84 months) did not statistically differ from VA at the visit immediately before endophthalmitis diagnosis ( P = .69). Mean frequency of injections after vitrectomy did not significantly differ from the presurgical course of treatment ( P =.97)., Conclusions: Anti-VEGF treatment might be continued after vitrectomy for endophthalmitis and results in satisfactory anatomical and visual outcome. Surgery did not influence the frequency of anti-VEGF injections for neovascular AMD., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Purpose: To study the practice patterns for the management of acute postoperative and postinjection endophthalmitis., Design: Retrospective, interventional, nonrandomized, multicenter study., Participants: Data on 237 eyes diagnosed with acute endophthalmitis occurring after intraocular surgery or procedures provided by 57 retina specialists from 28 countries., Main Outcome Measures: Rates of pars plana vitrectomy (PPV), repeat intravitreal injection, and adjunctive therapeutic regimens (local and systemic antibiotics and steroids)., Results: Of 237 analyzed eyes, acute endophthalmitis secondary to cataract surgery or secondary lens implantation represented 64.6% of cases (153 eyes), whereas the remaining were secondary to intravitreal injections (35 eyes [14.8%]), PPV (29 eyes [12.2%]), and other intraocular surgeries (20 eyes [8.4%]). All eyes received intravitreal antibiotics on the same day of diagnosis. Overall, early PPV was used within the first week of presentation in 176 eyes (74.3%). There was no statistical difference in the proportion of eyes requiring a second intravitreal injection of antibiotics whether the eye was managed primarily with intravitreal antibiotics alone versus early PPV plus intravitreal antibiotics (29.5% [18 eyes] vs. 25.0% [44 eyes], respectively). Adjunctive therapies in the form of intravitreal steroids, systemic steroids, and systemic antibiotics were used in 25.3%, 21.9%, and 66.6% of eyes, respectively. The absence of disc or macular view and absence of endophthalmitis after cataract surgery were associated with an increased likelihood for early PPV (odds ratios 4.1 and 5.1, respectively)., Conclusions: Pars plana vitrectomy was frequently performed regardless of the presenting vision in eyes with endophthalmitis after cataract surgery and intravitreal injections. Increased vitreous opacification was associated with a higher probability for performing PPV., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Recent studies described that in approximately 14% to 16% of cases of macular holes treated with the inverted internal limiting membrane flap technique, the hole was closed only by a thin layer of inverted internal limiting membrane-"flap closure." The aim of this article was to describe the functional and anatomical results in flap closure macular holes and also the mechanism of flap closure., Methods: A retrospective observational study of 149 eyes of 139 patients treated with vitrectomy using the inverted internal limiting membrane flap technique was reviewed to aggregate eyes with flap closure. Complete ophthalmic examination was performed preoperatively and at 7 days, 1, 3, 6, and 12 months after surgery., Results: Flap closure (Group 1) was noted in 24 eyes and other closure types in 125 eyes (Group 2). The mean minimal and base diameters of the macular holes in the flap closure group were greater than those in Group 2 (P < 0.001). The mean postoperative best-corrected visual acuity in the flap closure group (20/100) was lower than that in Group 2 (20/50) (P < 0.001)., Conclusion: Flap closure probably enables closure of large macular holes with a higher probability of remaining open without the use of the inverted internal limiting membrane flap technique. Foveal architecture continuously improved.

Purpose: To describe morphology of retinal and choroidal vessels in swept-source optical coherence tomography angiography before and after vitrectomy with the temporal inverted internal limiting membrane (ILM) flap technique for full-thickness macular holes., Methods: Prospective, observational study of 36 eyes of 33 patients with full-thickness macular holes swept-source optical coherence tomography angiography was performed in patients before and 1 month after vitrectomy. Vitrectomy with the temporal inverted ILM flap technique was performed. In this method, ILM is peeled only at one side of the fovea. An ILM flap is created to cover the macular hole. Comparison of retina vasculature in the areas of ILM peeling vs. no ILM peeling at 1 and 3 months after successful vitrectomy was performed., Results: The study demonstrated lower density of vessels in the deep retinal plexus in the area where ILM was peeled as compared to the rest of the fovea. Visual acuity and central retinal thickness 1 month after surgery correlates with fovea avascular zone diameter in deep retinal layers at the same time point (P = 0.001)., Conclusion: This study confirmed that ILM peeling might alter blood flow in deep retinal vessels below the peeling area in the early postoperative period. The area of the fovea avascular zone corresponds to functional results at the same time point.

Background and Objective: Effects of repeat surgery in failed primary full-thickness macular hole (FTMH) closure with the inverted internal limiting membrane (ILM) flap technique., Patients and Methods: Retrospective analysis of patients operated with the inverted ILM flap technique. Optical coherence tomography was performed before initial and secondary surgeries and then at up to 12 months post-surgery., Results: During the second surgery, the inverted ILM flap created at the first attempt had returned to its original position, instead of covering the FTMH. FTMH was closed in 29 eyes after second surgery (89%) and in all eyes after third surgery. Visual acuity improved in 28 of 32 cases (87.5%). The tamponade used (either silicone oil or air) did not influence final visual results (P = .06)., Conclusions: Repeat surgery with the inverted ILM flap technique is an effective method of treatment. Silicone oil improved anatomical outcome after second surgery but did not influence visual results. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:611-618.]., (Copyright 2018, SLACK Incorporated.)

Objective: To determine the efficacy of vitrectomy in eyes with treatment-naïve diabetic macular edema (DME)., Methods: Consecutive patients with treatment-naïve DME who underwent pars plana vitrectomy with internal limiting membrane peeling at a single institution were identified from the electronic medical records. Morphologic and visual acuity changes from baseline were analyzed at both the primary temporal endpoint (6 months) and the final examination with the investigators. The primary outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT)., Results: Forty-four eyes of 44 patients were included in this retrospective study. The mean BCVA improved significantly from baseline until the 6-month primary endpoint (1.35 logMAR vs 0.83 logMAR, p < 0.001) and stabilized through the final examination (0.77 logMAR). The BCVA improved by at least 0.1, 0.3, and 0.6 logMAR in 26 (60%), 24 (55%), and 14 (32%) of eyes, respectively, whereas it worsened by 0.3 logMAR in only 1 (2%) eye. Final BCVA correlated inversely with duration of diabetes (p = 0.01), presence of an epiretinal membrane (p = 0.02), and initial visual acuity (p = 0.03). Mean CRT decreased significantly from baseline through 6 months (595 µm vs 266 µm; p < 0.001), and edema recurred in only 3 eyes (6%), one of which was subsequently treated with intravitreal bevacizumab., Conclusions: Pars plana vitrectomy significantly improves macular edema and visual acuity in eyes with treatment-naïve DME. Prospective randomized trials are needed to better determine the efficacy of early vitrectomy., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background and Objective: To evaluate swept-source optical coherence tomography angiography (SS-OCTA) images in full-thickness macular holes (FTMHs)., Patients and Methods: SS-OCTA of FTMHs was performed before or after surgery. Vitrectomy with the temporal inverted internal limiting membrane flap technique was used. The authors measured the diameter and area of the foveal avascular zone (FAZ) in superficial and deep retina vasculature., Results: In 88 patients, two artifact types were observed. First, a hyperreflective circle in the center corresponding to a segmentation failure, as in these cases the segmentation line automatically relocated below the retinal pigment epithelium. Second, in macular holes with cystic spaces around the fovea, detection of blood flow was only partially possible, showing artifacts in the perifoveal vasculature., Conclusion: The authors present artifacts occurring during visualization of FTMHs with SS-OCTA and the means to correct them. Eyes with decreased postoperative central retinal thickness have an increased FAZ in the deep retinal layer plexus. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:111-121.]., (Copyright 2018, SLACK Incorporated.)

The idiopathic uveal effusion syndrome is a rare disease characterized by serous choroidal detachment. The pathogenesis of idiopathic effusion syndrome has not been conclusively determined yet. One hypothesis postulates compression of the vortex veins and abnormal diffusion of extravascular proteins. A possible complication of the disease is retinal detachment. We present a case of 59-year-old woman with idiopathic uveal effusion in the left eye. The uncorrected visual acuity was 5/5 in both eyes. Ultrasonography, ultrasound biomicroscopy, spectral optical coherence tomography and magnetic resonance imaging were performed, which excluded secondary causes of the disease. Spontaneous resolution was observed over a two-week period, without the recurrence in one-year follow up. The diagnosis was based on the clinical exam findings. The uveal effusion syndrome may be idiopathic, although in the majority of patients it is secondary to other ocular conditions, such as hypotony or inflammation.

Purpose: To analyze central retinal thickness asymmetry in patients with known and suspected primary open angle glaucoma., Material and Methods: A prospective analysis of 21 patients with known glaucoma and 53 patients with suspected glaucoma. A control group consisted of 25 healthy volunteers. Each enrolled patient had a spectral domain optical coherence tomography performed including a circumpapillary retinal nerve fiber layer and central retinal thickness measurements. A central 20 degree area was divided into 64 3⁰ x 3⁰ areas. The mean retinal thickness was measured in each small square and the value obtained in the upper half of every square was compared to the corresponding value in the lower half. A correlation between the mean circumpapillary retinal nerve fiber layer thickness and the central retinal thickness was assessed., Results: The mean thickness of circumpapillary retinal nerve fiber layer was significantly lower in patients with known and suspected glaucoma (92.15 ±12.85 μm; 93.84 ± 11.45 μm vs. 97.82 ± 7.48 μm; P<0.05). The mean central retinal thickness did not differ significantly between the groups (291.05 ± 15.86 μm; 290.46 ± 13.60 μm vs. 293.94 ± 11.07 μm; P>0.05). Macular asymmetry was detected significantly more frequently in glaucomatous and glaucoma suspected eyes (78%; 66% vs. 32%; P<0.05). An association between the measured values was observed., Conclusions: The macular thickness measurements and macular asymmetry analysis may represent a novel strategy in glaucoma diagnosis.

Purpose: To evaluate the refractive outcome after combined surgery of silicone oil removal with phacoemulsification and intraocular lens implantation. We calculated ocular lens implantation power with optical low-coherence reflectometry (Lenstar LS900; Haag Streit, Koniz, Switzerland) in silicone oil-filled eyes., Methods: Prospective, comparative study. The intraocular lens power of 35 silicone oil-filled eyes of 35 patients was calculated with a Lenstar LS900 laser biometer. In all cases we performed a combined procedure of pars plana vitrectomy with silicone oil removal and phacoemulsification with intraocular lens implantation. We analyzed the spherical equivalent of predicted and postoperative refractive error. A control group consisted of 25 cases of cataract extraction and intraocular lens implantation in non-vitrectomized eyes., Results: The mean deviation of the final refraction was -0.03 ± 1.06 diopters and did not differ significantly from non-vitrectomized eyes (P < 0.05). 68.6% eyes had a deviation of ±1 diopter. There were no differences between high myopic and emmetropic silicone oil-filled eyes (-0.05 ±1.33 diopters vs. -0.03 ± 1.00 diopters; P < 0.05)., Conclusions: Optical low-coherence reflectometry enables accurate intraocular lens power calculations in silicone oil-filled eyes. The refractive outcome is as accurate as in non-vitrectomized eyes.

Objective: The aim of this article is to report on retinal and choroidal morphology in choroidal nevi documented with Swept Source optical coherence tomography (SS-OCT)., Design: This is a retrospective, observational study., Participants: We included 27 consecutive patients with choroidal nevi. Mean age was 66.3 years (21-95 years)., Methods: The SS-OCT scanning protocol consisted of a single line scan through the centre of the nevi with a resolution of 3 µm, built from 1024 A-scans, with a length of 12 mm. We attempted to visualize the outer choroidoscleral boundary and suprachoroidal layer (SCL) below the choroidal nevus and to observe any other defects of retinal or choroidal morphology., Results: In all cases, we observed that the inner margin of benign tumours was separated from the retinal pigment epithelium with a hyporeflective band. Melanotic nevi cast partial (41%) or complete shadow (41%) on the underlying structures. The outer choroidoscleral boundary was visible under the tumour in 8 eyes (25%). SCL and suprachoroidal space were noted in 40% of eyes in close proximity to the lesion, but in no case were these lines visible directly below the lesion. Thinning of the choriocapillaries was observed in 8 eyes (25%) and thinning of the choroid in 5 eyes (15.6%)., Conclusions: Using SS-OCT, we observed that the inner border of benign choroidal lesions was always situated below a hyporeflective band, possibly corresponding to the choriocapillaries. A new finding was that we observed the SCL in 40% of cases. This was always visible in close proximity to the nevus, never directly below it., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe retinal and choroidal morphology before and after surgery for epiretinal membranes (ERM) in swept-source OCT (SS-OCT). Additionally, to evaluate factors responsible for visibility of the suprachoroidal layer (SCL) and suprachoroidal space (SCS)., Design: Prospective consecutive case series., Methods: Twenty-nine eyes of 29 patients with symptomatic, idiopathic ERM were included. Pars plana vitrectomy with ERM removal and ILM peeling was performed. We examined patients with SS-OCT twice preoperatively (9-12 months and 1 week before surgery), then postoperatively at 1 week and 6 and 12 months., Results: Twelve months after surgery visual acuity improved to 20/50 (0.48 logMAR), statistically significantly higher as compared to 1 week preoperatively (P < .001). Preoperative loss of visual acuity was commonly associated with progression of deformation of the plexiform layers, as central retinal thickness (CRT) did not decrease in this period, nor did photoreceptor defects increase. Choroidal thickness decreased 6 months after surgery (P = .02) and remained stable until 12 months postoperatively (P = .2). The outer choroidoscleral boundary was irregular in 16 eyes preoperatively but only in 4 eyes 12 months post surgery. SCS and SCL were visible in 15 eyes., Conclusion: During the natural course of idiopathic ERM, deformation of the outer plexiform layer progresses and is associated with decreased visual acuity. Eyes with an initially irregular outer choroidoscleral boundary (CSB) recover visual acuity faster after vitrectomy with ILM peeling for ERM. Three factors are independently associated with the visibility of the SCS: disarrangement of plexiform layers, CRT, and multiple adhesion points between retina and ERM., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background and Objective: To report on details of the choroid in dry age-related macular degeneration imaged with Swept Source Optical Coherence Tomography., Material and Methods: Swept Source Optical Coherence Tomography was performed in 28 eyes with dry age-related macular degeneration (Group 1), who were age and refractive error-matched with 28 eyes of 28 healthy controls (Group 2). The visibility and contour of the outer choroidoscleral boundary and suprachoroidal layer was estimated., Results: Choroidoscleral boundary was visible in all eyes, irregular in 78% in Group 1 and in 18% in Group 2. Suprachoroidal layer was visible in 36% eyes in Group 1 and in 7% eyes in Group 2. Mean choroidal thickness did not differ between groups (p=.11)., Conclusions: The outer choroidoscleral boundary is irregular in most cases of age-related macular degeneration. Suprachoroidal layer and suprachoroidal space are more often visible in dry age-related macular degeneration than in healthy controls.

Purpose: To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swept-source OCT in patients with full-thickness macular holes (FTMH) before and after surgery., Methods: Single center matched case-control study of 32 patients with FTMH (group 1), fellow eyes (group 2), and 32 eyes of 32 healthy controls (group 3). All eyes from group 1 had vitrectomy with a minimum follow-up of 3 months. Main outcome measures were the visibility and regularity of the outer choroidoscleral boundary (CSB), and additionally the eventual visibility of the suprachoroidal layer (SCL)., Results: Choroidal thickness was indifferent between groups. Choroidal thickness did not change after surgery (p = 0.1). CSB was visible in all cases. CSB was irregular in 59 % of eyes in group 1, in 40 % of eyes in group 2, and in any eye in group 3. SCL was visible in 34 % of eyes in group 1, and remained visible after surgery. In group 2, SCL was observed in 44 % of eyes, and in group 3 in one eye., Conclusions: Choroidal thickness does not differ between eyes with FTMH and their fellow eyes and healthy controls. CSB is more often irregular and SCL is more often visible in eyes with FTMH and their fellow eyes than in healthy controls. In fellow eyes of FTMH, the visibility of SCL was observed more often in eyes with partial vitreous detachment (p = 0.0). Three months after surgery, choroidal thickness does not change, the irregularities of CSB and SCL remain visible. More frequent changes of the outer choroidoscleral boundary in FTMH, and especially in their fellow eyes, may suggest a role of the choroid in the pathogenesis of FTMH.

Purpose: To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM flap technique results in satisfactory outcomes for the repair of large Stage IV idiopathic macular holes., Methods: Prospective comparative interventional study of 87 consecutive eyes. Participants were randomized into two treatment groups. In Group A, the classic inverted ILM flap technique was performed. In Group B, a modification of this procedure, the temporal inverted ILM flap technique, was performed. In the modified inverted ILM flap technique, peeling of the ILM was restricted to the temporal side of the fovea only--the macular hole was then covered with the temporal ILM flap., Results: There was no significant difference in initial and final visual acuities between Groups A and B. In both groups, defects in photoreceptors and the external limiting membrane decreased with time. Successive postoperative examinations revealed an increasing number of patients with the dissociated optic nerve fiber layer appearance, although this was less frequent in Group B (modified ILM flap) than in Group A., Conclusion: The study results indicate that the temporal inverted ILM flap technique is as effective as the classic inverted ILM flap technique for the repair of large Stage IV macular holes.

Purpose: In eyes with epiretinal membranes (ERMs), retinal arteries become dilated and tortuous. This may correlate with the hemodynamics of the affected areas and possibly with choroidal thickness. The aim of this study was to estimate choroidal thickness before and after vitrectomy for idiopathic ERM in the operated eye and in the unaffected fellow eye., Methods: A prospective study of 21 patients with idiopathic ERMs. We obtained swept source optical coherence tomography images that simultaneously evaluated the vitreous, retina, and choroid. We performed choroidal thickness measurements before pars plana vitrectomy with ERM removal and internal limiting membrane peeling. We took subsequent images 10 days and then 3 months after surgery. We compared the images with patients' fellow eyes. In each eye, we performed 256 horizontal scans, 12 mm in length and centered on the fovea. We manually calculated choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroidoscleral boundary with the built-in caliper and additionally measured it automatically using DRI-OCT mapping software. We evaluated the outer choroidoscleral boundary and performed statistical analysis., Results: We observed an ERM in 50% of fellow eyes. Mean choroidal thickness did not differ between study and fellow eyes (P = 0.67). Choroidal thickness decreased from 200 μm to 173 μm (P = 0.034) 3 months after vitrectomy and internal limiting membrane peeling. In all but two cases, the outer choroidoscleral boundary was irregular. Additionally, we observed that the suprachoroidal layer consists of two bands in four cases, an inner hyperreflective band and an outer hyporeflective one. We speculate the latter correlates with the suprachoroidal space., Conclusion: Normalization of choroidal thickness after surgery suggests that there is some relationship between choroidal thickness and structure and the presence of idiopathic ERMs.

Purpose: To define the morphology of outer choroidal margins in swept-source optical coherence tomography., Methods: This is a prospective observational study of 180 eyes: 20 eyes of healthy volunteers, 20 eyes of myopic patients, and 20 eyes from each of the following groups: macular hole, lamellar macular hole, epiretinal membranes, drusen, dry age-related macular degeneration (AMD), neovascular AMD, and vitreomacular traction. A single 12-mm wide swept-source optical coherence tomography image for each of the examined eyes consisting of 1,024 A-scans has been created. The main outcome measure selected was to estimate the presence of suprachoroidal layer, as well as to estimate the ability to delineate the outer choroidoscleral boundary using the software available (DRI-OCT) and to determine its shape., Results: Suprachoroidal layer was observed in 5% of healthy emmetropic eyes, in 50% of eyes with full-thickness macular holes, and in 60% of eyes with vitreomacular traction syndrome. It was also present in 50% of eyes with dry AMD and in 20% of eyes with neovascular AMD. The outer margin of the choroid in all eyes of the healthy volunteers and in eyes with macular diseases has been delineated correctly. In all healthy and myopic eyes, we recognized the outer choroidoscleral boundary as having a regular shape following the natural oval contour of the globe. In eyes with epiretinal membranes, macular hole, vitreomacular traction, and AMD, the outer choroidoscleral boundary was irregular; the choroid varied in thickness from point to point., Conclusion: Swept-source optical coherence tomography enables exact visualization of the outer choroidoscleral boundary. Suprachoroidal layer consisting of two bands has been recognized, the upper of which is hyperreflective and the lower of which is hyporeflective. It may be supposed that the lower hyporeflective band corresponds to suprachoroidal space, which was not earlier visualized in vivo in eyes without choroidal effusion. Suprachoroidal layer in myopic and emmetropic healthy subjects has been rarely observed. We observed it more frequently in different macular diseases.