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Purpose To quantitatively and qualitatively evaluate the microvascular and structural abnormalities associated with inner retinal dimpling after internal limiting membrane peeling for full-thickness macular holes using sequential en face optical coherence tomography (OCT) and OCT angiography. Methods Thirteen eyes of 13 patients with idiopathic full-thickness macular holes were enrolled in the study. Patients were treated with pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. Subjects were evaluated preoperatively and at postoperative Months 1, 3, and 6. At each visit, patients underwent a comprehensive ophthalmologic examination, en face OCT and OCT angiography. The morphology and number and proportionate area of inner retinal dimples were analyzed. Vessel density of the superficial vascular complex at all visits was also measured. Results Inner retinal dimples were identified 1 month after surgery in all cases. The number and proportionate area of inner retinal dimples significantly increased over the follow-up period (P = 0.05). Preoperative vessel density of the superficial vascular complex was 17.9 ± 1.9 and did not change significantly over the follow-up period (P = 0.15). Conclusion Inner retinal dimples are identified with en face OCT as early as the first month after internal limiting membrane peeling for idiopathic full-thickness macular holes and progressively increase in number and proportionate area in the subsequent 3 to 6 months after surgery. This may be the result of progressive deturgescence of the nerve fiber layer in the postoperative period.

Purpose To report the case of a patient with peripapillary pachychoroid syndrome and recurrent and spontaneous resolving peripapillary neurosensory retinal detachments associated with pulmonary arterial hypertension. Methods Case report imaged with spectral-domain optical coherence tomography, swept-source optical coherence tomography angiography, fundus autofluorescence, and fluorescein and indocyanine green angiography. Results A 47-year-old woman presented with unilateral blurred vision and metamorphopsia in her left eye and was diagnosed with peripapillary serous retinal detachments associated with peripapillary pachychoroid syndrome. Cardiologic examination was remarkable for heart failure secondary to severe pulmonary arterial hypertension. Neurosensory detachments spontaneously resolved after 1 day but recurred again three days from baseline. Fluorescein and indocyanine green angiography illustrated choroidal hyperpermeability associated with pachyvessels, whereas optical coherence tomography angiography displayed numerous areas of choriocapillaris nonperfusion, more severe in the left eye of the patient. Conclusion In pulmonary arterial hypertension, hemodynamic changes caused by increased central venous pressure and endothelin-1 may explain the development of exudative retinal detachment and choroidal ischemia. The pathophysiological mechanisms explaining the peripapilary location of the fluid and the thick choroid, as with the peripapillary pachychoroid syndrome, are explored and discussed.

Author(s): Figueroa, Marta S; Govetto, Andrea; Steel, David H; Sebag, J; Virgili, Gianni; Hubschman, Jean Pierre | Abstract: PurposeFunctional and anatomical outcomes of vitrectomy with membrane peeling were compared in tractional lamellar macular holes (LMH)/macular pseudoholes (MPH) versus degenerative LMH.MethodsThis multicenter retrospective study enrolled patients with a minimum follow-up of 6 months. The association of spectral domain optical coherence tomography parameters with preoperative and postoperative best-corrected visual acuity was analyzed.ResultsSeventy-seven (74.8%) tractional LMH/MPH and 26 (25.2%) degenerative LMH were included. Preoperative best-corrected visual acuity was better in tractional LMH/MPH (0.39 ± 0.2 logarithm of the minimal angle of resolution, 20/50 Snellen equivalent) than degenerative LMH (0.56 ± 0.2 logarithm of the minimal angle of resolution, 20/66 Snellen equivalent; P l 0.001). Premacular membranes were found in all tractional LMH/MPH, whereas LMH-associated epiretinal proliferation (LHEP) was present in all degenerative LMH. Primary anatomical success was achieved in 97/103 eyes (94.2%), with foveal restoration occurring earlier in degenerative LMH (1.6 ± 2.3 vs. 3.3 ± 3.6 months; P = 0.025). Best-corrected visual acuity improved in both tractional LMH/MPH and degenerative LMH (P l 0.001 and P = 0.012, respectively) but was better in tractional LMH/MPH (P = 0.001).ConclusionThe presence of premacular membranes and absence of LMH-associated epiretinal proliferation in all tractional LMH/MPH further distinguishes this from degenerative LMH. Best-corrected visual acuity improved in both subgroups but more so in tractional LMH/MPH. Complete anatomical restoration of foveal microanatomy was rare in degenerative LMH, reflecting significant morphological and pathophysiological differences between the two lesions.

PURPOSE –: The aim of this study was to evaluate semi-automated surgical procedures for lens extraction by using the OCT-integrated Intraocular Robotic Interventional Surgical System (IRISS). SETTING –: A collaboration between the Stein Eye Institute and the Department of Mechanical and Aerospace Engineering at the University of California, Los Angeles. DESIGN –: Semi-automated lens extraction was performed on 30 post-mortem pig eyes using a robotic platform integrated with an optical coherence tomography (OCT) imaging system. The lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomical modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by providing real-time OCT image feedback to the surgeon via a graphical user interface (GUI). METHODS –: Manual preparation of the pig eye models, including corneal incision and capsulorhexis, was performed by a trained cataract surgeon prior to the semi-automated procedures for lens extraction. A scoring system was used to assess surgical complications in postoperative evaluation. RESULTS –: The semi-automated lens extraction procedures were performed on 30 post-mortem pig eyes. Complete lens extraction was achieved on 25 of 30 eyes. For the remaining five eyes, small (≤ 1 mm(3)) pieces of lens were postoperatively detected near the lens equator where the transpupillary OCT was unable to image. No posterior capsule rupture or corneal leakage was reported. The mean surgical duration was 277±42 s. Based on a 3-point scale (with 0 representing no damage), damage to the iris was 0.33±0.20, damage to the cornea was 1.47±0.20 (due to tissue dehydration), and stress at the incision was 0.97±0.11. CONCLUSION –: The efficacy of performing semi-automated lens extraction procedures in animal models was evaluated with post-mortem pig eyes. No posterior capsule rupture was reported and complete lens removal was achieved in 25 trials without significant surgical complications. Further refinements to the procedures will be required before fully automated lens extraction can be realized.

Pars plana vitrectomy has been reported to increase the risk of ocular hypertension and open-angle glaucoma. The authors conducted a systematic review of randomized and nonrandomized studies to compare the incidence of open-angle glaucoma and ocular hypertension in vitrectomized versus nonvitrectomized eyes.A literature search was performed using MEDLINE and EMBASE until August 2016. Data on ocular hypertension and open-angle glaucoma incidence and mean intraocular pressure after at least 1 year were pooled using random-effects metaanalysis models. Because only nonrandomized studies were retrieved, ROBINS-I tool was used to assess risk of bias in the review.Seven included studies had a paired design to compare the outcomes of vitrectomized versus fellow eyes, with mean follow-up of least 12 months. Four studies (851 patients) provided data on open-angle glaucoma: incidence in vitrectomized versus non-vitrectomized eyes was 7.8% and 4.8%, respectively, yielding a metaanalytic odds ratio of 1.67 (95% CI: 1.08-2.57). Six studies (1,060 patients) reported on the occurrence of ocular hypertension, which was 5.8% in vitrectomized eyes versus 3.1% in fellow eyes (odds ratio: 2.03, 95% CI: 0.97-4.22), without significant differences in the mean postoperative intraocular pressure (mean difference 0.31 mmHg, 95% CI: -0.26 to 0.89).Although the review found increased risk of open-angle glaucoma with pars plana vitrectomy, the studies were heterogenous or inconsistent regarding ocular hypertension and intraocular pressure increase. Larger studies should be conducted in homogenous cohorts of patients undergoing macular surgery, excluding complex conditions such as retinal detachment or diabetic retinopathy.

To assess the frequency of pseudoexfoliation syndrome (PXF) in patients scheduled for cataract surgery and to evaluate its association with pupil dilation, lens nucleus hardness, intraocular pressure (IOP), glaucoma, age, and sex.Ourense University Hospital, Ourense, Spain.Cross-sectional study.This study evaluated eyes scheduled for cataract surgery between January 2013 and July 2013. Pseudoexfoliation was diagnosed in phakic eyes that showed central and/or peripheral white deposits on the lens surface, pupillary margin, or both. Dilated pupils were evaluated with a portable pupil chart. Nucleus hardness was assessed according to the Lens Opacities Classification System III. Diagnosis of glaucoma was based on International Society Geographical and Epidemiological Ophthalmology criteria.Of the 1763 eyes (1093 patients) evaluated, 381 (21.6%) were diagnosed with PXF. The frequency of PXF increased with age from 6.0% in people between 50 year and 60 years to 31.66% in those older than 80 years. In PXF eyes, nuclear cataracts were significantly harder than in non-PXF eyes (P.001). The mean IOP was significantly higher in PXF eyes than in non-PXF eyes (P = .002). The frequency of glaucoma was higher in PXF eyes (17.4%) than in non-PXF eyes (9.4%), with a statistically significant difference (P.001). In PXF eyes, the pupil was significantly smaller than in non-PXF eyes (P.001).The frequency of PXF was high in the study population and increased with age. Eyes with PXF were associated with significantly harder nuclear cataracts, smaller pupils, and glaucoma.No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE Primarily to assess and compare the prevalence of open-angle glaucoma (OAG) in previously vitrectomized and nonvitrectomized eyes at our institution. Secondarily to assess and compare the prevalence of OAG in eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy. METHODS A cross-sectional prevalence study was designed. Patients who underwent pars plana vitrectomy at our institution from January 2006 to December 2011 and had not been diagnosed with OAG before the surgical procedure were contacted by phone. Those patients who agreed to participate were invited to the University Hospital of Ourense (Spain) for a comprehensive ophthalmic assessment, including Perkins tonometry, gonioscopy, examination of the optic disk, and a spectral-domain optical coherence tomography scan of the optic nerve head. The definition of OAG was based on standardized criteria, modified versions of the Rotterdam Study, and those published by Foster et al. RESULTS Among 472 eligible patients, 182 responded and agreed to participate in our study. Of these, 26 were excluded. Finally, 312 eyes of 156 patients were included in the analysis. Fifteen vitrectomized (8.9%) and 3 nonvitrectomized (2%) eyes were diagnosed with OAG. This difference was statistically significant (P = 0.02, chi-square test). Differences in the prevalence of OAG between eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy were not statistically significant (P = 0.48, chi-square test). CONCLUSION Our study supports the hypothesis of an increased risk of OAG after vitrectomy. Prevalence of OAG in vitrectomized eyes was significantly higher compared with nonvitrectomized ones. However, we were not able to demonstrate significant difference in the prevalence of OAG between eyes those were phakic or aphakic/pseudophakic at the time of vitrectomy.