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Aim: To describe the incidence, clinical features, and evolution of paracentral retinal holes occurring after macular surgery. Methods: A retrospective non-randomized study of 909 patients operated on for either a macular hole (MH, n = 400 patients) or an epiretinal membrane (ERM, n = 509 patients) between 2004 and 2009. Six patients (0.6%) developed a paracentral macular hole after surgery. Their clinical, auto-fluorescence, and optical coherence tomography (OCT) characteristics as well as their visual outcomes were studied. Results: The mean age of patients was 70 years. Paracentral holes occurred approximately 5 weeks after surgery (with a range of 2-12 weeks). All patients were asymptomatic. Five patients underwent ILM peeling during initial surgery. Paracentral retinal holes were located superiorly to the fovea in three cases and temporally in the other three cases. Mean pre-operative BCVA was 20/200 and mean post-operative BCVA was 20/40. The eye where the eccentric MHs were closest to the fovea (inferior to 1 optic disc area) had the poorest final visual acuity. Autofluorescence imaging showed a bright fluorescence in paramacular holes. On OCT images, they were shown to be flat full-thickness holes. No treatment was attempted. No rhegmatogenous complications or choroidal neovascularization occurred in any of the patients. Mean follow-up was 2 years. Conclusions: In summary, paracentral MHs are uncommon complications which can occur at the site where ILM peeling has been initiated or completed. Except for the closest holes to fovea, they have good visual prognosis and do not require any treatment underlining the importance of initiating the ILM peeling as far as possible from the fovea. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and functional outcomes of 25-gauge and 23-gauge (G) micro-incision vitrectomy surgery (MIVS) instrumentation with the standard 20-G vitrectomy system in the treatment of epiretinal membranes (ERM). Methods: A retrospective comparative study of 553 consecutive cases with epiretinal membrane who underwent pars plana vitrectomy. Twenty-gauge, 25-gauge and 23-gauge vitrectomy was performed respectively in 347, 91, and 115 eyes. Surgery duration, visual acuity improvement, intraocular pressure variation, intraoperative and postoperative complications were analyzed. Results: The mean surgical time in the 23-G group and in the 25-G group was shorter than in the 20-G group ( P < 0.001). Visual improvement was higher 8 days postoperatively in the 25-G group than in the 20-G and 23-G groups ( P = 0.035), but not at 6 weeks postoperatively ( P = 0.186). In the 20-G group, the IOP increased significantly on the first day postoperatively ( P < 0.001), while in the 23-G group, the IOP decreased on the first day postoperatively ( P = 0.073). In the 25-G group, the IOP did not change significantly ( P = 0.807). The incidence of complications was not statistically significant between the three groups. Retinal breaks were significantly related to the induction of posterior vitreous detachment, independent of the system gauge. Conclusion: In ERM surgery, 23-G and 25-G (MIVS) systems are as safe and effective as the 20-G system, and significantly reduce surgical time. Although the 25-G system provides an earlier visual improvement, the 23- and 25- gauge systems are comparable, and the selection will depend on the surgeon's preference. [ABSTRACT FROM AUTHOR]

The article describes aspects of increased stromal reaction observed in 4 eyes of 3 melanoderm patients who underwent corneal collagen cross-linking (CXL) for evolutive keratoconus. Topics covered include aspect of thick spindle-shaped structures observed in some melanoderm patients who had CXL at the third postoperative month, the tendency of patients to form scar tissue following tissue injury, and increased failure rates of trabeculectomy in pigmented patients.