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Purpose: To evaluate contrast sensitivity (CS) in patients with epiretinal membrane (ERM) following vitrectomy and to investigate the relationship between CS and foveal microstructures with spectral-domain optical coherence tomography (SD-OCT)., Methods: Thirty-one eyes of 31 patients with ERM were included. We examined CS with a CSV-1000E chart, a logMAR best-corrected visual acuity (BCVA), and foveal microstructure by using SD-OCT before and at 6 months after surgery. From the CS data, the area under the log contrast sensitivity function (AULCSF) was calculated. Based on the OCT images, we quantified the mean thickness of the ganglion cell layer (GCL), the inner nuclear layer (INL), and the outer retinal layer (outer nuclear layer and outer plexiform layer [ONL+OPL]). The status of the photoreceptor inner and outer segment junction (IS/OS) and external limiting membrane (ELM) was also evaluated., Results: Vitrectomy significantly improved logMAR BCVA and AULCSF. Even in patients with poor improvement of visual acuity (changes in logMAR BCVA by surgery was ≤0.2), postoperative AULCSF significantly increased by treatment (P < 0.05). Postoperative AULCSF showed a significant correlation with preoperative (P < 0.05) and postoperative (P < 0.05) ONL+OPL thickness, whereas other parameters were not relevant. Postoperative logMAR BCVA significantly correlated with postoperative status of IS/OS (P < 0.05) and preoperative ONL+OPL thickness (P < 0.05)., Conclusions: In patients with ERM, CS improved even though their visual acuity did not recover significantly by vitrectomy. CS was associated with the thickness of outer retinal layer., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: To quantify aniseikonia in patients undergoing vitrectomy for epiretinal membrane (ERM) and to investigate the relationship between the aniseikonia and the foveal microstructure by spectral-domain (SD) optical coherence tomography (OCT)., Design: Prospective, consecutive, interventional case series., Subjects: This study included 44 eyes of 44 patients undergoing vitrectomy for idiopathic ERM., Methods: We examined visual acuity and aniseikonia using the New Aniseikonia Test and SD-OCT before and 3 and 6 months after surgery. On the basis of the obtained OCT image, we divided the 1.0 × 1.0-mm area centered on the fovea into 9 sections at 0.25-mm intervals and quantified the following parameters using an image-processing program: central foveal thickness and mean thickness of the ganglion cell layer, inner nuclear layer (INL), and outer retinal layer (outer nuclear layer + outer plexiform layer). The status of the photoreceptor inner segment/outer segment junction, external limiting membrane, and cone outer segment tips also was evaluated., Main Outcome Measures: Amount of aniseikonia 6 months after surgery., Results: Of 44 patients, 39 (89%) had macropsia, 1 (2%) had micropsia, and 4 (9%) had no aniseikonia preoperatively. Mean preoperative aniseikonia was 6.2% ± 4.5%. Vitrectomy significantly improved visual acuity in patients with ERM but did not change the amount of aniseikonia. Multiple regression analysis revealed that preoperative aniseikonia at 6 months was significantly related to preoperative INL thickness, whereas postoperative aniseikonia at 6 months was associated with postoperative INL thickness at 6 months. Preoperative INL thickness was found to be of significant prognostic value for postoperative aniseikonia at 6 months., Conclusions: Most of the patients with ERM had macropsia. Aniseikonia was not reduced after surgery. The amount of aniseikonia was associated with INL thickness., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Indocyanine green (ICG), an adjuvant used for peeling of the internal limiting membrane (ILM) during vitreous surgery for idiopathic macular hole (MH), has been reported to be toxic, possibly affecting postoperative visual acuity. We compared the long-term outcomes (within 2 years) of brilliant blue G (BBG), ICG, and triamcinolone acetonide (TA)., Patients and Methods: This study involved 97 eyes of 94 patients who underwent vitreous surgery for MH at the Yamagata University Hospital between June 2002 and November 2010. The surgical adjuvants used were BBG for 15 eyes, ICG for 61 eyes, and TA for 21 eyes. We compared the postoperative visual acuities, initial closure rates, final closure rates, and complications of the 3 groups., Results: In all 3 groups, the visual acuity significantly improved after surgery. The magnitude of the improvement at 2 years after surgery was significantly better in the BBG group than in the ICG group (Mann-Whitney test, P = 0.020). The postoperative visual acuity did not significantly differ between the BBG and TA groups (P = 0.627) or between the ICG and TA groups (P =0 .137). Thus, the surgery using BBG resulted in a significantly better outcome in visual acuity than did the surgery using ICG. The 3 groups did not differ in initial or final closure rates or in incidence of complications., Conclusion: Analysis of the long-term outcomes of vitreous surgeries provided evidence that BBG is a useful adjuvant for ILM peeling.

The authors present the case of an idiopathic epiretinal membrane (ERM) secondary to an acute self-repaired macular microhole documented by optical coherence tomography (OCT). A 65-year-old phakic woman presenting with acute onset of light flashes, myodesopsia, and central negative scotoma in the right eye was diagnosed with age-related posterior vitreous detachment. Spectral-domain OCT showed a tiny defect of the outer retina, consistent with the diagnosis of macular microhole, which spontaneously closed after 4 weeks. Six months later, the patient developed a contracting ERM, and her visual acuity significantly worsened. This case represents the first in vivo documentation of retinal pigment epithelium cell migration through a macular microhole, highlighting the importance of OCT in understanding idiopathic ERM pathogenesis., (Copyright 2014, SLACK Incorporated.)

Purpose: To describe the anatomical and visual outcomes in a series of patients undergoing two-port pars plana vitrectomy reoperation under silicone oil for recurrent retinal detachment (RD) due to proliferative vitreoretinopathy or epimacular membrane (EMM) after RD repair., Methods: This study is a prospective, consecutive, interventional case series of patients presenting with recurrent RD or EMM under silicone oil. Two-port 25-gauge pars plana vitrectomy reoperation without an infusion port was performed in all cases., Results: Thirty-nine patients were included. Reoperation pathology included recurrent RD with proliferative vitreoretinopathy (n = 33) and EMM alone (n = 6). The mean number of previous retinal surgeries was 2.4 ± 1.1 (range, 1-5). The mean overall follow-up was 24 ± 3.7 months. The mean visual acuity change from baseline at final follow-up was an improvement of 0.74 ± 0.63. Macular reattachment was achieved in 29 of 33 patients with RD, and EMMs were successfully removed in all patients., Conclusion: Two-port pars plana vitrectomy reoperation is an efficacious method for repair of consecutive RD due to proliferative vitreoretinopathy or EMM in patients with previous RD repair with silicone oil. Significant visual improvement with a low complication rate may be achieved in patients with advanced proliferative vitreoretinopathy or EMM under silicone oil.

Purpose: To investigate the prevalence, characteristics, and visual acuity of spontaneous idiopathic epiretinal membrane (ERM) separations using spectral domain optical coherence tomography., Methods: In a series of 1,248 consecutive eyes with idiopathic ERM, Group I with preexisting posterior vitreous detachment included 1,091 eyes (87.4%) and Group II without preexisting posterior vitreous detachment included 157 eyes (12.6%). Groups IA and IIA included self-resolution cases of ERM from Groups I and II, respectively., Results: The ERM self-separation occurred in 37 eyes (3.0%) for 32.6 ± 11.7 months, with 16 eyes (1.5%) in Group IA and 21 eyes (13.4%) in Group IIA. The mean best-corrected visual acuity (logMAR) improved in Groups IA and IIA by 0.1 (P = 0.013) and 0.06 (P = 0.078), respectively. From tomographic analyses, dominant undulation and retinal nerve fiber layer defects were more frequent in Group IA than Group IIA (P < 0.001 and P = 0.024, respectively). However, the completeness of ERM separation, inner segment/outer segment junction defects, and ERM recurrence were more frequent in Group IIA than Group IA (P = 0.039, P = 0.023 and P = 0.041, respectively). Multivariate analysis for factors related to visual improvement revealed only inner segment/outer segment junction defects as significantly associated (P = 0.025)., Conclusion: Different mechanisms underlying the self-resolution of idiopathic ERM lead to distinct tomographic characteristics and may affect the postseparation visual function.

Objective: To determine the relation between the recovery of the cone outer segment tips (COST) line and the best-corrected visual acuity (BCVA) after epiretinal membrane (ERM) surgery., Design: Retrospective, consecutive, interventional case series., Participants: Sixty-one eyes of 56 patients with an idiopathic ERM were studied. All participants underwent a complete ophthalmic examination including spectral-domain optical coherence tomography before and after ERM removal surgery., Methods: The integrities of the photoreceptor layer including the external limiting membrane line, photoreceptor inner segment/outer segment (IS/OS) line, and COST line in the spectral-domain optical coherence tomography images at the fovea were determined. The associations of these morphological parameters to the BCVA were determined., Results: Better BCVAs were found more frequently in eyes with an intact COST line than in eyes with a disrupted or absent COST line at 1 (p < 0.001), 6 (p = 0.003), and 12 months (p < 0.001). Among the external limiting membrane, IS/OS, and COST line parameters, the IS/OS line had higher correlations with the BCVA by multivariate analysis. No significant difference was observed in central retinal thickness between eyes with intact and nonintact COST lines. Eight (30.8%) of 26 eyes with BCVA ≥ 20/20 had nonintact COST lines at 12 months after the ERM surgery., Conclusions: Eyes with an intact COST line had better BCVA after ERM surgery. However, even at 12 months after ERM surgery, COST lines remained disrupted in many eyes with good BCVA., (Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate postoperative macular ganglion cell-inner plexiform layer (GCIPL) thickness, determine the factors related to GCIPL thickness, and evaluate the association of GCIPL thickness with postoperative visual outcomes in patients with idiopathic epiretinal membrane (ERM)., Design: Retrospective, cohort study., Participants: Sixty-two patients with unilateral idiopathic ERM who were followed for ≥ 6 months after surgery., Methods: Ophthalmologic evaluations included best-corrected visual acuity (BCVA) assessment, spectral-domain optical coherence tomography, and macular visual field (VF) mean sensitivity (MS) as measured by Humphrey VF test. Macular GCIPL thickness in eyes with ERM was compared with that of the normal contralateral eyes 6 months after surgery. The correlation between the interocular difference in GCIPL thickness and postoperative visual outcome was evaluated., Main Outcome Measures: Postoperative macular GCIPL thickness, factors related to the interocular differences in GCIPL thickness, and correlations of GCIPL thickness with BCVA and macular VF MS 6 months after surgery., Results: Macular GCIPL thickness was significantly lower in eyes with ERM 6 months after surgery (71.77 ± 10.21 μm) than in the unaffected contralateral eyes (81.69 ± 5.33 μm; P<0.001). Thirty-three subjects were followed for 1 year after surgery, and the macular GCIPL thickness in eyes with ERM did not significantly change between 6 and 12 months after surgery (71.77 ± 10.21 vs 70.64 ± 9.57 μm; P = 0.179). Preoperative central foveal thickness was the only factor significantly correlated with interocular differences in macular GCIPL thickness (r = 0.3677; P = 0.0033). Among patients with intact photoreceptor layers, a greater decrease in GCIPL thickness was correlated with a worse postoperative BCVA (r = 0.5209; P<0.0001) and a greater decrease in macular VF MS (r = -0.2845; P = 0.0390)., Conclusions: Macular GCIPL thickness decreased after vitrectomy to remove an idiopathic ERM. The decrease in GCIPL thickness was significantly correlated with postoperative visual outcomes in patients with intact photoreceptor layers., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate epiretinal membrane (ERM) response after cryotherapy for retinal vasoproliferative tumors (VPTs)., Method: Retrospective interventional case series., Results: Of 16 eyes with VPT and ERM, the tumor was classified as primary in 12 (75%) eyes or secondary in 4 (25%) eyes. The median patient age was 44 years (mean, 43 years; range, 9-70 years). The tumor was located in extramacular zone (n = 16, 100%) and inferotemporal quadrant (n = 12, 75%). The mean tumor base was 6 mm, and thickness was 3 mm. The ERM involved the macula in 12 (75%) eyes and extramacular zone in 4 (25%) eyes, with best-corrected visual acuity of 20/40 or better in 6 (38%) eyes. Associated features included cystoid macular edema (n = 8, 50%), subretinal fluid (n = 10, 63%), vitreous cells (n = 9, 56%), and vitreous hemorrhage (n = 7, 44%). Single-session cryotherapy (double freeze-thaw) to the VPT was performed in each case. Over mean follow-up of 68 months (median, 54 months; range, 8-252 months), tumor regression was documented in 16 (100%) cases, with ERM release in 10 (63%) cases. After ERM release, the foveal anatomy was normal in 12 (75%) eyes. Final visual acuity improved (n = 5, 31%), remained stable (n = 9, 56%), or worsened (n = 2, 13%). Posttreatment best-corrected visual acuity was 20/40 or better in 10 (63%) eyes., Conclusion: Cryotherapy is remarkably effective for VPT of 6 mm or less in basal dimension. After cryotherapy, VPT-related ERM spontaneously released in 63% of the cases, without the need for surgical intervention.

We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p < 0.001). For patients with phakic eyes, the combination of vitrectomy and cataract surgery resulted in a slightly better, but insignificant increase in visual acuity than for patients with primary pseudophakia (Δ = 0.05, p = 0.46). On average, central foveal thickness regressed by 94 μm (SD 129 μm). Linear regression showed a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity (R (2) = 0.16, B = 0.71, p = 0.004). A decrease in foveal thickness by 100 μm resulted in an increase in visual acuity by 0.71 lines. Visual improvement did not significantly differ between the group of patients with intact outer retinal layers before surgery and the group of patients with preoperative defects of the retina (p = 0.085). We found a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity for patients undergoing surgery for ERM. However, the preoperative OCT status (intact vs. broken) of the outer retinal layers did not correlate with the change in visual acuity.

This study investigated whether the presence of vitreomacular interface abnormalities (VMIAs) affects the improvement in visual acuity and edema of patients with diabetic macular edema (DME) who received three anti-vascular endothelial growth factor (VEGF) injections. Fifteen eyes of 11 patients with clinically significant macular edema were retrospectively divided into either the control group (only DME) or the experimental group (DME and VMIA) based on optical coherence tomography images. We defined VMIA patterns as epiretinal membrane and/or anomalous vitreomacular adhesion. Changes in central macular thickness (CMT), total macular volume (TMV), and best-corrected visual acuity (BCVA) from the baseline to post third injection were compared between the two groups. After the third injection, the decreases in CMT and TMV were not statistically different between the two groups. The improvement in BCVA was larger in the control group (0.1742 ± 0.0508 logMAR) than in the experimental group (0.0766 ± 0.0562 logMAR; p < 0.01). Our study showed that after the third anti-VEGF injection, the BCVA of patients with both DME and VMIAs improved significantly less than that of patients with only DME. Our results suggest that VMIAs may play a crucial role in reducing the therapeutic effects of anti-VEGF agents.

Purpose: To compare the macular morphology of pediatric versus adult eyes with epiretinal membrane (ERM) using spectral domain optical coherence tomography and identify characteristics associated with postoperative visual acuity., Methods: This retrospective study analyzed spectral domain optical coherence tomography from pediatric subjects and a randomly selected cohort of adult subjects with ERM. Morphologic retinal and ERM features were graded by two masked spectral domain optical coherence tomography readers and compared with a postoperative change in visual acuity., Results: Pediatric ERMs (age, 0.3-16.5 years) were more confluently attached to the retina than adult ERMs (age, 40-88 years; P = 0.009) and had less fibrillary appearance of the inner retina when separation was present (P = 0.044). Pediatric ERMs were associated with more vessel dragging (P = 0.019) and less external limiting membrane (P = 0.001) and inner segment band visibility (P = 0.010), with a trend toward foveal sparing by ERM (P = 0.051) and "taco" retinal folds (P = 0.052) compared with adult eyes. Visual acuity improvement was associated with intact (P = 0.048) and smooth (P = 0.055, trend) inner segment band in children and with smooth inner segment band (P = 0.083, trend) and visible external limiting membrane (P = 0.098, trend) in adults., Conclusion: We identified morphologic differences between pediatric and adult ERM on spectral domain optical coherence tomography. Similar to adults, photoreceptor integrity with pediatric ERM seems to predict better visual acuity changes after surgical ERM removal.

Purpose: To report the efficacy of laser photocoagulation in treating idiopathic (primary) retinal vasoproliferative tumors., Design: Retrospective noncomparative interventional case series., Patients and Method: Thirty eyes of 30 patients (22 women and 8 men) with retinal vasoproliferative tumors. Main outcome measures were best-corrected visual acuity (BCVA), presence of retinal hard exudates, retinal detachment (RD), cystoid macular edema (CME), and epiretinal membrane (ERM). Laser photocoagulation was performed at the slit lamp or during pars plana vitrectomy for telangiectasia visible at the retinal vasoproliferative tumors surface., Results: Fifteen eyes were treated with slit-lamp laser. Mean follow-up was 36.5 months (range 7 months to 11 years). Mean BCVA increased from 20/40 to 20/32 at the end of the follow-up. Hard exudates and CME regressed completely in 15 of 15 and 5 of 6 eyes, respectively. Fifteen eyes underwent vitrectomy owing to the presence of ERM (10 eyes), large exudative RD (4 eyes), or vitreous hemorrhage (1 eye). Mean follow-up was 24 months (9 months to 3.5 years). Mean BCVA increased from 20/125 to 20/40 at the end of the follow-up. No vision loss occurred. The retina reattached in all cases. Hard exudates regressed completely in 14 of 15 eyes and decreased significantly in 1. Postoperative complications were rhegmatogenous RD in 2 eyes, successfully reattached after additional surgery., Conclusion: Selective laser photocoagulation of retinal telangiectasia at the retinal vasoproliferative tumors' surface induced the regression of retinal exudation. Slit-lamp laser photocoagulation was sufficient in half of the cases. In more severe conditions, direct endolaser photocoagulation of the telangiectasia was required., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: We have developed a technique for the treatment of cataract and epiretinal membrane using a 25-gauge vitrectomy system through corneal ports., Design: Randomized, prospective study, Toyama Prefectural Central Hospital, Toyama, Japan., Participants: Twenty eyes of equal patients scheduled for cataract surgery combined with vitrectomy., Methods: Twenty eyes with cataract and epiretinal membrane were received treatment with our newly developed system (clear corneal vitrectomy) or the standard 25-gauge pars plana vitrectomy with corneal incision cataract surgery. The newly developed system uses 0.5-mm wide corneal side ports located at the superonasal, superotemporal and inferotemporal positions. After phacoemulsification using corneal incision, an infusion cannula was inserted from the inferotemporal port. Then core 25-gauge vitrectomy was performed using the corneal three port. After the epiretinal membrane was removed using forceps, an intraocular lens was implanted into the capsular bag. Finally, all corneal incision wounds were hydrated., Main Outcome Measurement: Visual acuity, intraocular pressure, corneal thickness, corneal endothelial cell and ocular inflammation were examined., Results: All procedures were uncomplicated in both groups. There was no leakage of aqueous humour from the corneal wounds in the developed system. There were no significant differences in visual acuity, corneal thickness and endothelial cell density loss., Conclusions: Clear corneal vitrectomy would be a good option for selected cases with cataract and vitreoretinal diseases., (© 2013 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose:   To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels., Methods:   We performed a prospective consecutive interventional case series of 20 eyes of 20 patients with macular hole or epiretinal membrane. We performed automatic retinal oximetry (Oxymap Inc., Reykjavik, Iceland) in each patient 24 hr prior to and 45 days (range 42-49) after PPV (classic 20G or sutureless 23G). We analysed oxygen saturations in retinal arteries and veins. Vessel segments of first or second degree were selected. The same segment was analysed before and after PPV. Oximetry data were compared by paired two-tailed t-test., Results:   Pars plana vitrectomy did not alter arterial haemoglobin saturation with oxygen (98±2% prior to the surgery and 98±3% after the procedure, p=0.549). The mean venous haemoglobin saturation with oxygen increased after vitrectomy from 63±10% to 66±8% (p=0.012)., Conclusions:   Oxygen saturation is higher in retinal veins after pars plana vitrectomy. Further studies are needed to unveil the mechanism of how vitrectomy affects oxygen metabolism in the retina., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the correlation of foveal photoreceptor integrity with visual outcome in patients undergoing idiopathic epiretinal membrane (ERM) surgery using spectral domain optical coherence tomography (SD-OCT)., Materials and Methods: Forty-three eyes of 43 patients were examined by SD-OCT before and at 1 and 6 months after vitrectomy for idiopathic ERM. Patients were divided into two groups based on the preoperative integrity of photoreceptor inner and outer segment junction (IS/OS) - Group I, intact IS/OS and Group D, disrupted IS/OS. Where present, disrupted length of IS/OS was measured, and the association between disrupted length of IS/OS and foveal thickness with best corrected visual acuity (BCVA) was evaluated., Results: There were 27 eyes with an intact IS/OS (Group I) and 16 eyes with a disrupted IS/OS (Group D). Patients in Group I had significantly better postoperative BCVA and greater improvement than those in Group D at 6 months after surgery (p = 0.001 and p = 0.030, respectively). By 6 months after surgery, the disrupted length of IS/OS observed preoperatively in Group D had decreased significantly (p = 0.007). The disrupted length of IS/OS before and at 6 months after the surgery in Group D showed a positive correlation with BCVA (r = 0.632 and p = 0.009; r = 0.658 and p = 0.006, respectively). Foveal thickness did not correlate significantly with preoperative and postoperative BCVA., Conclusions: Preoperative disruption of foveal photoreceptors can be restored after ERM surgery. The preoperative integrity of foveal photoreceptors may be a clinically significant prognostic factor for visual recovery in patients with idiopathic ERM.

Idiopathic epiretinal membrane is a result of a complex biomechanical interaction of the retina and vitreous. This paper discusses classification problems, epidemiological data of multicenter studies, and current hypotheses of epiretinal membrane pathogenesis.

Purpose: To evaluate the effects of epiretinal membranes on the response of uveitic macular edema to therapy and on visual acuity outcomes., Design: Retrospective case series., Methods: One hundred four eyes of 77 patients with uveitic macular edema were identified at a tertiary care center. Epiretinal membranes were diagnosed when identified by 2 investigators' grading of spectral-domain optical coherence tomography and scored for the presence or absence of surface wrinkling. Outcomes included best-corrected visual acuity, central subfield thickness, and rates of macular edema improvement (>20% reduction in central subfield thickness) and resolution (reduction of central subfield thickness to <315 μm) at 3 and 6 months follow-up., Results: Seventy-two eyes of 59 patients had an epiretinal membrane on presentation. Eyes without epiretinal membranes and with epiretinal membranes without surface wrinkling were not significantly different at presentation or at 3 and 6 months follow-up. Conversely, eyes with an epiretinal membrane with retinal surface wrinkling had a greater proportion of eyes with 20/200 or worse visual acuity at presentation, and had worse mean acuities at 3 months (20/94 vs 20/35 for eyes without an epiretinal membrane, P = .002) and at 6 months follow-up (20/110 vs 20/36 for eyes without an epiretinal membrane, P = .02). At 6 months of follow-up the mean central subfield thicknesses were: eyes without an epiretinal membrane, 338 ± 23 μm; and eyes with an epiretinal membrane and surface wrinkling, 405 ± 22 μm (P = .05)., Conclusions: In eyes with epiretinal membranes and retinal surface wrinkling, uveitic macular edema had a poorer visual acuity response to medical therapy and thicker maculae at 6 months., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To examine the retinal displacement following successful macular hole (MH) surgery with internal limiting membrane (ILM) peeling and gas tamponade, and to determine the correlation between the extent of displacement and the basal MH size., Design: Retrospective, interventional, observational case series., Methods: The medical records of consecutive patients with an idiopathic MH that had undergone vitrectomy with ILM peeling and gas tamponade were studied. The distances between the optic disc and the intersection of 2 retinal vessels located nasal or temporal to the fovea were measured manually preoperatively (A), and 2 weeks and 1, 3, 6, and 12 months postoperatively (B), on the fundus autofluorescence or near-infrared images. The basal and minimum diameters of the MHs were measured in the spectral-domain optical coherence tomographic images. The correlations between the ratio of the retinal displacement (A - B/A) and basal diameters of the MHs were determined., Results: Twenty-one eyes of 21 patients (9 men, mean age: 64.6 ± 8.4 years) were studied. Ten eyes (47.6%) had stage 2 MH, 9 eyes (42.9%) had stage 3 MH, and 2 eyes (9.5%) had stage 4 MH. The temporal retinal vessels were displaced 260.8 ± 145.8 μm toward the optic disc at 2 weeks postoperatively, which was significantly greater than the 91.1 ± 89.7 μm of the nasal retinal vessels (paired t test, P < .001). The ratio of retinal displacement in the temporal field at 2 weeks was significantly correlated with the basal diameter of the MH (Spearman's rank correlation coeffieient = -0.476, P = .033., Conclusions: The greater displacement of the temporal retina than the nasal retina toward the optic disc postoperatively suggests that the temporal retina is more flexible and can be retracted toward the optic disc during the MH closure., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: We aimed to quantify the displacement of macular capillaries using infrared fundus photographs and image processing software (ImageJ) in patients with idiopathic epiretinal membrane (ERM) who have undergone vitrectomy and to analyze the correlation between vessel displacement and retinal thickness., Methods: This prospective study included 16 patients who underwent vitrectomy for idiopathic ERM. Ophthalmic examination and optical coherence tomography (OCT) were performed before and 3 months after surgery. The length of radial vessel segment included in each area (VLA) and the length from the foveola to the vessel branching point (FBL) depending on the superior, inferior, nasal, and temporal areas of the macula were measured using infrared fundus images and image processing software (ImageJ). Preoperative and postoperative parameters were compared and correlations between VLA, FBL, macular thickness, and visual acuity were assessed., Results: The VLA of superior, inferior, and temporal areas showed a significant postoperative reduction. VLA differences showed a positive correlation with differences in macular thickness, which corresponded to the superior, inferior, and temporal areas; however, no correlation was observed in the nasal area. The FBL of the superior and inferior areas was significantly increased postoperatively. A positive correlation was observed between FBL differences and macular thickness differences in the superior area. Postoperative change in VLA and FBL did not show a significant correlation with postoperative best corrected visual acuity (BCVA) and BCVA differences., Conclusions: Infrared fundus photographs and image processing software can be useful for quantifying progressive changes in retinal surface distortion after surgical removal of ERM. Macular edema and vascular distortion showed significant improvement after surgery. Furthermore, a correlation was observed between topographic and tomographic changes.

Purpose: To evaluate the morphologic restoration of retinal anatomy after surgery for epiretinal membrane (ERM) peeling using spectral domain optical coherence tomography. Correlation of retinal structure with visual outcome., Design: Retrospective consecutive case series., Methods: Thirty-four consecutive eyes with ERM underwent surgery with 1 year follow-up examination. Spectral domain optical coherence tomography scans were analyzed preoperatively and 1, 3, 6, 9, and 12 months postoperative. Best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study charts was measured at each visit., Results: All eyes showed a significant improvement of BCVA after ERM peeling (P = 0.002). The time point of BCVA and retinal restoration seen on spectral domain optical coherence tomography occurred simultaneously and varied between individuals (occurrence of BCVA: mean, 4.82 months; retinal restoration: mean, 4.24 months). At 3 months, the retinal anatomical restoration rate was 70% and 88% at 6 months., Conclusion: Restoration of the retinal anatomical structure predominantly occurs within the first 3 months post-ERM peeling. An improvement of BCVA and anatomical retinal restoration after ERM removal varies in individuals. If retinal layers fully restore in their anatomical structure, BCVA improves at the same time point.

Purpose: To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes., Design: Prospective, interventional case series., Patient and Methods: Ten eyes of 10 consecutive patients who underwent autologous transplantation of the ILM for the treatment of refractory macular holes were studied. The primary diseases in these patients were large idiopathic macular holes that had existed for more than 1 year (4 eyes), a traumatic macular hole (1 eye), myopic foveoschisis (2 eyes), foveoschisis resulting from pit-macular syndrome (2 eyes), and proliferative diabetic retinopathy (1 eye). Apart from the 5 eyes with idiopathic or traumatic macular holes, macular holes developed in the other 5 eyes after initial vitrectomies with ILM removal. In all eyes, regular macular hole surgery failed to achieve closure. The main outcome measures used in this study were macular hole closure and best-corrected visual acuity (BCVA)., Results: Macular holes were closed successfully in 9 eyes (90%) after autologous transplantation of the ILM. The postoperative BCVAs were significantly better than the preoperative BCVAs (P = .007, paired t test). Postoperative BCVAs improved by more than 0.2 logarithm of the minimal angle of resolution units in 8 eyes (80%) and were unchanged in 2 eyes (20%)., Conclusions: Although this is a pilot study, the results suggest that autologous transplantation of the ILM may contribute to improved anatomic and visual outcomes in the treatment of refractory macular holes and may warrant further investigation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background and Objective: Vitrectomy markedly alters the intraocular milieu, which can then affect the physiology of the retina and choroid. This study investigates whether vitrectomy also alters ocular blood flow as determined by laser speckle flowgraphy (LSFG)., Patients and Methods: Twenty eyes of 20 patients that underwent vitrectomy for idiopathic macular hole or epiretinal membrane were studied. Standard 23-gauge microincision vitreous surgery was performed. Ocular blood flow of the optic nerve head, retinal vessels, and choroid was determined by LSGF before, during, and 2 weeks and 1 month after vitrectomy., Results: Postoperative blood flow of the optic nerve head, retinal vessels, and choroid did not differ significantly from preoperative values. Intraoperative blood flow of the optic nerve head and retinal vessels decreased significantly from baseline with increasing infusion pressure from 20 mm Hg to 40 mm Hg (P < .01), and choroidal blood flow decreased significantly when the infusion pressure increased from 8 mm Hg to 20 mm Hg and from 20 mm Hg to 40 mm Hg (both P < .01)., Conclusion: Blood flow did not differ significantly postoperatively versus preoperatively, but it was significantly reduced during vitrectomy with increasing infusion pressure. Careful attention should be paid to infusion pressure during vitrectomy., (Copyright 2014, SLACK Incorporated.)

Purpose: To investigate postoperative thickness changes in the retinal layers in eyes with epiretinal membrane (ERM). Correlations between these changes and visual outcomes were also examined., Methods: Retrospective review of 25 eyes (24 patients) that had undergone pars plana vitrectomy for ERM and had a postoperative follow-up period ≥6 months. Optical coherence tomography (6 × 6 mm macular thickness map) was used to measure mean thickness of the inner and outer retinal layers 1 week and 1, 3, and 6 months following surgery. Photoreceptor outer segment (PROS) length was evaluated manually, and used to assess the association between best-corrected visual acuity (BCVA) and retinal layer thickness at the fovea., Results: At 1 week and 1, 3, and 6 months, retinal layer thickness was 388, 377, 362, and 352 μm for the whole layer; 133, 115, 107, and 101 μm for the inner layer; 138, 145, 147, and 148 μm for the outer layer; and 28, 35, 36, and 40 μm for the PROS length, respectively. In comparison to 1-week data, the inner layers were significantly thinner at 1 month and later, as was the thickness of the entire retina. Outer layer thickness and PROS length were also significantly thicker at these time points. Six months following surgery, BCVA was significantly correlated with an elongated PROS length (R = 0.49, P = 0.01)., Conclusion: Retinal outer layer thickness significantly increased following pars plana vitrectomy for ERM. Visual improvement was positively correlated with PROS length recovery.

Purpose: To study the potential association between fundus autofluorescence, spectral-domain optical coherence tomography, and visual acuity in patients undergoing surgery because of epiretinal membranes., Methods: Prospective, interventional case series including 26 patients submitted to vitrectomy because of symptomatic epiretinal membranes. Preoperative evaluation consisted of a complete ophthalmologic examination, autofluorescence, and spectral-domain optical coherence tomography. Studied variables included foveal autofluorescence (fov.AF), photoreceptor inner segment/outer segment (IS/OS) junction line integrity, external limiting membrane integrity, central foveal thickness, and foveal morphology. All examinations were repeated at the first, third, and sixth postoperative months. The main outcome measures were logarithm of minimal angle resolution visual acuity, fov.AF integrity, and IS/OS integrity., Results: All cases showing a continuous IS/OS line had an intact fov.AF, whereas patients with IS/OS disruption could have either an increased area of foveal hypoautofluorescence or an intact fov.AF, with the latter being associated with IS/OS integrity recovery in follow-up spectral-domain optical coherence tomography imaging. The only preoperative variables presenting a significant correlation with final visual acuity were baseline visual acuity (P = 0.047) and fov.AF grade (P = 0.023)., Conclusion: Recovery of IS/OS line integrity after surgery, in patients with preoperative IS/OS disruption and normal fov.AF, can be explained by the presence of a functional retinal pigment epithelium-photoreceptor complex, supporting normal photoreceptor activity. Autofluorescence imaging provides a functional component to the study of epiretinal membranes, complementing the structural information obtained with optical coherence tomography.

Introduction: Acetazolamide reduces intraocular pressure and stimulates absorption of subretinal fluid by the retinal pigment epithelium. Recording the intraocular pressure response to systemic acetazolamide might enable an indirect evaluation of retinal pigment epithelial carbonic anhydrase., Methods: The intraocular pressure response to a standardized dose of intravenous acetazolamide (5mg/kg) was evaluated in a "case" group of 15 patients undergoing retinal detachment (RD) surgery and in a control group of 15 patients undergoing epiretinal membrane peeling. Intraocular pressure was measured with a handheld Perkins tonometer in a supine position before (t-2 min) and after the intravenous administration of acetazolamide (t+2 min, t+6 min, t+10 min and t+30 min). The mean variation of the intraocular pressure was compared between the two groups in the non-operated eye at each time point., Results: A significant reduction of the intraocular pressure was observed in both groups at 2, 6 and 10 minutes (P<0.01) after the injection of acetazolamide (5mg/kg). The reduction was significantly lower in the group of patients who underwent retinal detachment surgery when compared with the group of patients in whom epiretinal membrane peeling had been performed. This difference remained significant up to 10 minutes (P<0.01 at t=2, 6 and 10 min). At t=30 min, the intraocular pressure reduction was comparable in both groups., Discussion: The vitreous plays a fundamental role in the pathogenesis of retinal detachment via peripheral traction. However, since not all tears lead inevitably to retinal detachment, there must also be adherence factors which can prevent the latter. The response to acetazolamide differs significantly in patients undergoing retinal detachment surgery compared with patients treated with epiretinal membrane peeling. In the occurrence of retinal detachment, deficient photoreceptor adherence to the retinal pigment epithelium has been hypothesized. Further research should aim to correlate the tonometric response to acetazolamide with photoreceptor adherence., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Purpose: Pars plana vitrectomy (PPV) is commonly used to remove the epiretinal membrane (ERM), but the timing of surgical intervention guided by visual acuity (VA) performance at presentation is uncertain., Patients and Methods: Prospectively entered clinical data of 237 patients on an electronic patient record from 2001 to 2011 were analysed to determine visual outcomes, in particular in relation to pre-operative VA., Results: The mean age of the patients was 68.8 years and 54.4% were female. Median follow-up was 0.55 years. The median pre-operative logMAR VA was 0.60 (SD 0.48-0.78, Snellen equivalent 6/36) and post-operative VA was 0.30 (SD 0.18-0.60, 6/12, P<0.005). Pre-operative VA correlated with post-operative VA (linear R(2)=0.22, P<0.0001). In all, 69.6% of patients showed an improvement in VA, 15.2% showed no change, and the condition of 15.2% worsened. The number of patients with an improvement in logMAR VA of more than 0.3 was greatest in those who had a pre-operative VA of 1.0 (6/60) or worse, followed by those in the range of 0.6-0.9 and then those with pre-operative VA of 0.5 or better (P<0.001). The proportion of patients with visual improvement of logMAR VA of more than 0.3 increased statistically with progressing years (P=0.019)., Conclusion: In conclusion, this study shows improvement in VA after PPV and ERM removal. Patients with better initial VA achieve higher levels of visual outcome but those with poorer pre-operative VA show a greater change in VA following ERM surgery. Results of surgery improved over the time period of the study.

Objective: To develop a novel grading system for posterior staphyloma imaged by spectral-domain optical coherence tomography (SD-OCT) and to correlate the incidence of macular disease (vitreomacular traction, epiretinal membrane, macular schisis, lamellar macular hole, and full-thickness macular hole) with each grade., Design: Retrospective chart review., Participants: A total of 150 eyes from 89 patients with posterior staphylomas were examined at Jules Stein Eye Institute, University of California Los Angeles., Methods: Retrospective analysis of the Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, Calif.) database at a large institution (Jules Stein Eye Institute) was performed and eyes with a posterior staphyloma involving the macula were evaluated for the presence of macular pathology. The radius of each circle was measured and graded, and the incidence of macular pathology was correlated with each staphyloma grade. Statistical analysis was done using Fisher exact and Kruskal-Wallis tests., Results: The overall incidence rate of macular disease was 50.6% (76/150 eyes). The incidence rate of macular schisis was 17.3% (26/150) and was significantly greater with steeper (grade 3 [25.0%] and grade 4 [30.3%] staphyloma) versus shallower grade (grade 1 [5.6%]) staphyloma (p = 0.016)., Conclusions: Imaging of staphyloma via SD-OCT is a valuable tool for determining the severity of posterior staphyloma and for determining risk stratification for various macular diseases., (Published by Elsevier Inc.)

Purpose: As part of a clinical trial, an investigational epiretinal implant (IMI Intelligent Medical Implant) was implanted in a retinitis pigmentosa patient. The prosthesis was wirelessly controlled by a visual interface containing a microcamera, providing wireless data and energy transmission. Forty-nine (49) electrodes were used for pattern recognition. This study examined the changes of perceptual thresholds over time and its relation to long-term stimulation. The goal of the study was to introduce stimulus-related depression of perceptual threshold (StirDepth) measurements as a method to gain further insight into the safety profile of electrical stimulation., Methods: The perceptual threshold was defined as the level of stimulation intensity at which a phosphene perception with a probability of 50% was detected using the Best-PEST method. StirDepth was measured by comparing the threshold changes immediately before and after a stimulation session of using three active electrodes and one passive electrode, which served as control., Results: The initial threshold of the day remained stable over the observed period. In StirDepth measurement all thresholds raised significantly after the stimulation sessions. The threshold increase of the active electrodes never exceeded that of the inactive control electrode., Conclusions: StirDepth measurement is feasible in epiretinal implants. The prolonged stimulation raised no safety concerns in the patient. The threshold increase of both the active electrodes and the control electrode leads one to hypothesise that cognitive or neurophysiological effects are the cause rather than the desensitizing of the retinal network or incipient retinal damage., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To determine whether there is a significant correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for epiretinal membrane (ERM) removal., Methods: This was a retrospective, interventional case series. Forty-six eyes of 45 patients with an ERM underwent vitrectomy. The foveal area was examined by spectral-domain-optical coherence tomography (SD-OCT) preoperatively and postoperatively. The correlation between the length of the photoreceptor cone outer segment tips (COST) line defect, the inner segment/outer segment junction (IS/OS) line defect, the external limiting membrane (ELM) line defect, and the BCVA was determined., Results: The length of the COST line defect was significantly correlated with the BCVA at postoperative 1, 3, 6, 9, and 12 months (P < 0.001 for all). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of COST line defect (P < 0.001) but not with the IS/OS line and ELM line defects for up to 6 months. The preoperative length of the COST line defect was significantly correlated with the postoperative BCVA at 12 months (P = 0.005), but the lengths of the IS/OS line defect and ELM line defect were not. The factor that best predicted the postoperative BCVA was the length of the preoperative COST line defect (P = 0.04) but not the preoperative BCVA (P = 0.69)., Conclusions: The recovery of the foveal COST line defect is correlated with the BCVA after ERM surgery. The length of the preoperative COST line defect can predict the potential foveal function. (ClinicalTrials.gov number, NCT01549249.).

Background: Lack of clinical tests to quantify spatial components of distortion in patients with full thickness macular holes (FTMH) and epiretinal membranes (ERM)., Aim: To develop a test for subjective evaluation of visual distortion in the central visual field around fixation in patients with unilateral FTMH or ERM., Settings and Design: Prospective case-control study carried out at tertiary referral center., Materials and Methods: Twenty-five patients with unilateral macular disease (13 macular epiretinal membranes, 12 full-thickness macular holes), and nine controls (without ocular pathology) underwent ophthalmological examination with logMAR ETDRS visual acuity, near vision and contrast sensitivity assessed. Macular optical coherence tomography and metamorphopsia assessment using Morphision test was also carried out. This test consists of a set of modified Amsler charts for detection, identification, and subjective quantification of visual distortion in the central visual field around fixation. Morphision test content and construct validity, and reliability (test-retest method) were evaluated. Sixteen patients completed an unstructured survey on test performance and preference., Results: Every patient with unilateral FTMH or ERM identified a particular chart using Morphision test (content validity). None of the normal subjects without symptoms of metamorphopsia identified any distortion (construct validity). Test-retest showed a 100% consistency for frequency and 67% for amplitude. The mean amplitude difference between measurements was 0.02 degrees (SD = 0.038). The coefficient of repeatability was 0.075. There was a correlation between Morphision amplitude score and visual acuity and contrast sensitivity, individually., Conclusions: Morphision test allowed detection and subjective quantification of metamorphopsia in the clinical setting in our patients with unilateral macular epiretinal membranes and full thickness macular holes.

Background: To obtain a de novo map of outer photoreceptor layer (OPRL) thickness using a semiautomatic segmentation method for commercial spectral-domain optical coherence tomography (SD-OCT) and analyze the features of the resulting OPRL map in normal eyes and eyes with various inactive macular diseases., Methods: Forty normal eyes and 50 eyes with various inactive macular diseases such as resolved central serous chorioretinopathy (20 eyes), surgically-repaired macular hole (10 eyes), epiretinal membrane (10 eyes), and reattached rhegmatogenous retinal detachment (10 eyes) were screened. All subjects underwent a 12 radial scan protocol in SD-OCT. The segmentation lines defining the OPRL were modified using built-in software. The diseased eyes were subdivided into two groups (good vision, or intermediate to poor vision) based on a visual acuity better or worse than 20/40. The map of the OPRL thickness was obtained automatically by the embedded software and was presented as the Early Treatment Diabetic Retinopathy Study (ETDRS) style., Results: The mean OPRL thickness in normal eyes in all subfields was 40.37 ± 4.35 μm. The central subfield area showed the greatest mean OPRL thickness in normal eyes. The mean OPRL thickness of diseased eyes with good vision in the central subfield was greater than that of eyes with intermediate to poor vision. The OPRL thickness map showed various patterns according to the type of macular diseases., Conclusions: We suggest that our semiautomated segmentation method using a 12 radial scan protocol is simple, fast, and suitable for producing a reliable OPRL map with ETDRS. This quantitative data could be useful in clinical practice or research of various macular diseases.

Purpose: To evaluate the incidence, risk factors, outcomes, and visual prognosis in patients with bilateral macular holes repaired surgically with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling in our population., Design: Retrospective, multisurgeon, nonrandomized, noncomparative case series., Participants: Eighty-two patients were identified who underwent bilateral macular hole surgery with ILM peeling without other vision-limiting pathologic features., Methods: All patients underwent bilateral macular hole surgery at a single-site, multisurgeon center with preoperative and postoperative optical coherence tomography (OCT) characterization and ICG-assisted ILM peeling during surgery with intraocular gas tamponade., Main Outcome Measures: Comparison of the closure and reopening rate, prognosis, change in visual acuity, and family history for patients undergoing bilateral surgery., Results: Eight-two patients met the inclusion criteria (164 eyes). Nineteen patients (22.6%) had asymptomatic vitreomacular adhesion by OCT in the fellow eye at the time of presentation of macular hole in the first eye. There was a mean interval of 19.4 months between the first and fellow eye macular holes and a male-to-female ratio of 1:2.42. Surgical closure rate was 89% with the first macular hole surgery and 98.8% with the second surgery. Sex, family history, and duration of hole symptom were not found to be associated with risk of macular hole recurrence. Symptom duration of less than 1 year and earlier macular hole stage yielded the best visual acuity after successful surgical repair., Conclusions: Patients with bilateral macular holes may consider undergoing bilateral macular hole surgery to improve visual acuity. Successful closure rates of bilateral macular holes with ILM peeling in this series are better than those reported previously without consistent ILM peeling., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: To quantify changes in metamorphopsia and retinal contraction in eyes with idiopathic epiretinal membrane (ERM) before and after a spontaneous separation of ERM., Methods: Among 92 eyes of 92 patients with idiopathic ERM who were followed up at our hospital, 5 eyes of 5 patients had experienced a spontaneous separation of ERM during the follow-up period. Patient's metamorphopsia was assessed horizontally and vertically by a metamorphopsia chart developed by our group, M-CHARTS, to obtain the horizontal (MH) and vertical (MV) metamorphopsia scores. Difference in the scores before and after the membrane separation represents change in patient's metamorphopsia. Changes in retinal contraction were also evaluated horizontally and vertically with our original software for fundus image analysis. The difference between M-CHARTS scores and distances of retinal vessel movements with before and after membrane separation were measured., Results: All five subjects showed a decrease in the retinal contraction. Improved visual acuity was observed in three subjects, and no change was seen in the other two. Four subjects obtained better metamorphopsia scores after the membrane separation, while the other one was not detected with metamorphopsia by M-CHARTS either before or after the separation. In subjects with an improved MV, horizontal retinal movement was seen larger than the vertical movement. Similarly, the subjects with an improved MH indicated a larger vertical retinal movement than the horizontal movement., Conclusions: The direction of patient's metamorphopsia closely associated with the direction of retinal contraction before and after a spontaneous separation of ERM.

Purpose: To evaluate the outcomes of epiretinal membrane (ERM) surgery in highly myopic eyes without traction maculopathy, and to compare them with those from non-highly myopic eyes., Design: Retrospective nested case-control study from a cohort of 509 consecutive patients (509 eyes) who underwent pars plana vitrectomy with ERM removal., Methods: Thirty-two highly myopic eyes (with a refractive error of more than -6.00 diopters [D]), which underwent surgery for isolated ERM, were included in the study. For each case studied, we selected from the same cohort 2 age-matched controls who had ERM surgery (n = 64 non-highly myopic eyes). The best-corrected visual acuity (BCVA), the central macular thickness (CMT), and the surgical complications were analyzed., Results: The mean follow-up duration was 3.2 ± 1.5 years for the study cases and 3.4 ± 1.6 years for the control group (P = .608). At the final follow-up examination, the mean logMAR BCVA had improved significantly, from 0.56 to 0.26 (P < .001) for the case group and from 0.54 to 0.22 (P < .001) for the control group. At the final optical coherence tomography (OCT), the mean CMT had improved significantly, from 433 to 314 μm (P < .001) for the case group and from 428 to 303 μm (P < .001) for the control group. There was no significant difference between the 2 groups as regards visual or CMT improvement (P = .526 and P = .483, respectively). The incidence of surgical complications was not significant between the 2 groups., Conclusions: The results of ERM surgery were not different in terms of anatomic and visual outcomes and surgical complication between highly myopic and non-highly myopic eyes., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: Patients with epiretinal membrane sometimes complain of impaired central visual function, despite good best corrected visual acuity (BCVA), as measured by visual acuity (VA) charts. Here, we evaluate early epiretinal membrane-induced changes in central VA., Methods: Subjects were 72 eyes of 36 patients with epiretinal membrane in only one eye and a BCVA in each eye better than 1.0, as measured by conventional Landolt C chart, at the Retina Division Clinic of the Department of Ophthalmology, Keio University Hospital, between December 2010 and November 2011. The conventional Landolt VA, functional VA (FVA) and contrast VA measurements were taken after a general eye examination. For the FVA, Landolt optotypes were sequentially displayed every 2 seconds, which size was changed according to the correctness of the answer. To exclude the influence of other diseases, a standard Schirmer test was performed to diagnose dry eye, and corneal and lens densities were evaluated., Results: Average BCVA measured by Landolt C chart was not changed between affected and unaffected fellow eyes. However, the affected eyes showed a poorer FVA score (0.21 ± 0.12, affected; 0.09 ± 0.12, fellow) and visual maintenance ratio (VMR) (0.90 ± 0.04, affected; 0.94 ± 0.04, fellow), measured by the FVA system, and contrast VA score (0.35 ± 0.11, affected; 0.25 ± 0.14, fellow) than fellow eyes. The FVA and contrast VA values were correlated with the presence of epiretinal membrane, but not with the presence of dry eye, cataract and corneal densities., Conclusion: FVA and contrast VA results reflected early changes in central visual function caused by epiretinal membrane, which were not detected by conventional Landolt BCVA., (© 2013 The Authors. Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by Blackwell Publishing Ltd.)

Objective: To study the displacement of the retina and its change after vitrectomy in idiopathic epiretinal membrane (ERM)., Design: Prospective, interventional case series., Methods: Fifty-six eyes of 53 consecutive patients with ERM underwent vitrectomy with ERM removal and internal limiting membrane peeling. Fundus autofluorescence (FAF) imaging was examined before and at 1, 3, 6, and 12 months after vitrectomy. Main outcome measures were the proportion of eyes with retinal displacement for ERM detected by FAF imaging and the recovery rate of retinal displacement after vitrectomy., Results: Before surgery, FAF photography demonstrated hyperautofluorescent lines within the vascular arcade in 37 (66.1%) of the 56 eyes. The lines seemed to be consistent with the location of the retinal vessels before their displacement. These hyperautofluorescent lines appeared significantly more frequently among patients in whom the disease duration was 3 years or less. In 23 (62.2%) of these 37 eyes, within the first postoperative month, the hyperautofluorescent lines disappeared. The disappearance of the hyperautofluorescent line was thought to be the result of the return of the retinal vessel to its original position. Greater visual improvements (logarithm of the minimal angle of resolution, ≥0.3) were statistically significantly obtained in patients in whom the hyperautofluorescent lines had become indistinct at 1 month after surgery (P < .05)., Conclusions: Hyperautofluorescent lines indicating retinal displacement were found by FAF in 66.1% of patients before surgery for ERM. In addition, retinal displacement was significantly more common among patients who had experienced subjective symptoms for 3 years or less. Fundus autofluorescence is useful for predicting postoperative visual acuity improvement., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the stability of axis rotation, astigmatism correction, and improvement in uncorrected distance visual acuity (UDVA) up to 6 months postoperatively using an astigmatism-correcting intraocular lens (IOL) in a 25-gauge transconjunctival sutureless vitrectomy combined with cataract surgery., Setting: Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan., Design: Prospective nonrandomized interventional study., Method: Eyes with a preoperative corneal cylinder of more than 0.75 diopter (D) had a triple procedure for idiopathic epiretinal membrane (ERM) using an Acrysof IQ toric IOL. Outcome measures were the amount of IOL axis rotation up to 3 months postoperatively, UDVA, corrected distance visual acuity, and corneal and refractive astigmatism up to 6 months postoperatively. A comparison was performed between patients with a target postoperative spherical refraction of emmetropia (toric emmetropic group) and patients who previously had a triple procedure for idiopathic ERM using a nontoric IOL (control group)., Results: The mean IOL axis rotation from the end of surgery until 3 months postoperatively was 3.67 degrees ± 3.13 (SD). Six months postoperatively, the mean corneal and refractive cylinders were 1.32 ± 0.61 D and 0.51 ± 0.31 D, respectively, showing a significant difference (P<.0001, paired t test). In addition, the mean UDVA was significantly improved 6 months postoperatively in the control and toric emmetropic group (0.57 logMAR versus 0.35 logMAR) (P=.028), although the toric group was more improved than the control group., Conclusion: In vitrectomy (triple procedure) for idiopathic ERM with a toric IOL, postoperative IOL axis stability was similar to that reported for cataract surgery alone. Furthermore, the UDVA was better than with implantation of a spherical IOL., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Objective: To study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery., Methods: A total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study. An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period., Results: An improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=.001), and also between preoperative and postoperative central foveal thickness (P=.004), but not between BCVA and foveal thickness., Conclusions: There is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness., (Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

Purpose: The purpose of this study was to evaluate the safety and efficacy of 2-port 20-gauge pars plana vitrectomy with a slit-lamp illumination system in different vitreoretinal pathologies., Design: : Retrospective, consecutive, interventional case series., Methods: One hundred and ninety-five consecutive eyes of 195 patients underwent 20-gauge 2-port pars plana vitrectomy with a combination of slit-lamp illumination and a plano-concave contact lens, at the San Paolo Ophthalmology Center, from September 2005 through November 2007. Postoperative visual acuity at baseline and at 1, 3, and 6 months; intraoperative and postoperative complication rate; and surgical time were evaluated., Results: All patients completed 6 months of follow-up. The mean overall visual acuity was 0.74 ± 0.03 (mean ± SD) at baseline, improving to 0.56 ± 0.03 (P < 0.0001), 0.48 ± 0.03 (P < 0.0001), and 0.43 ± 0.03 (P < 0.0001) at 1, 3, and 6 months, respectively. No intraoperative complications occurred. Postoperative complications included retinal detachment in three patients, epiretinal membrane recurrence in three eyes, persistent macular hole in four eyes, and phthisis in one eye. Cataract formation was observed in 25 eyes. The total mean surgical time was 28.3 ± 10.1 minutes. No one had hypotony after the surgical procedure, and no cases of endophthalmitis were observed. Conversion to standard three-port vitrectomy was not necessary in any of the cases., Conclusion: Two-port 20-gauge pars plana vitrectomy with slit-lamp illumination is a safe and effective procedure for posterior segment surgeries.

Background: To evaluate the changes in visual acuity, metamorphopsia, and thickness of retinal layers after epiretinal membrane (ERM) removal and to investigate factors associated with visual function., Methods: This prospective study included 52 eyes of 52 patients who underwent surgery for idiopathic ERM. Changes in visual acuity, metamorphopsia score (M-score) using M-chart, and parafoveal thickness of each retinal layer were evaluated preoperatively and at 2-month and 6-month postoperative follow-up visits. Factors associated with visual acuity and M-score were investigated., Results: Although continuous improvement in visual acuity and decrease in the thickness of parafoveal retinal layers following ERM removal was observed, relatively slow improvement in M-score was noted with values of 0.32 ± 0.27, 0.44 ± 0.46, and 0.23 ± 0.23, respectively at the defined time points. A preoperative increase in the thickness of parafoveal retina was mainly caused by increased thickness of inner retinal layers. Preoperative thickness of inner nuclear layer (INL) were closely associated with preoperative, postoperative visual acuity, and preoperative M-score (p = 0.001, 0.012, and 0.027, respectively)., Conclusions: Compared with the postoperative improvement in visual acuity, the postoperative improvement in metamorphopsia was a rather slow process. Parafoveal INL thickness was found to be a significant structural factor for visual acuity and metamorphopsia in ERM.

We report the case of a 67-year-old woman who underwent epiretinal membrane surgery with internal limiting membrane peeling via a 23-gauge vitrectomy. Postoperative OCT and fundus photography revealed two forms of cicatrization: a dissociation of the retinal nerve fiber layer (DONFL) over the entire area of internal limiting membrane peeling, and an arcuate zone of retinal nerve fiber layer swelling (SANFL) at the site where the peeling had been initiated. Functionally, the patient demonstrated improved postoperative near acuity and a decrease in metamorphopsia. Mean retinal sensitivity measured by MP1 microperimetry at 3months was reduced by more than 30%. Microscotomata are more marked in the zone of inititation of peeling., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the relationship between the morphology of the fovea and visual acuity in patients with an untreated idiopathic epiretinal membrane (ERM)., Methods: We examined 52 eyes of 45 patients diagnosed with an ERM. The morphology of the foveal area was determined by spectral-domain optical coherence tomography. The relationships between the best-corrected visual acuity (BCVA) and 8 optical coherence tomography features, central retinal thickness, cone outer segment tip (COST) line, photoreceptor inner/outer segment (IS/OS) junction line, foveal bulge of the IS/OS line, external limiting membrane, inner limiting membrane, foveal pit, and ERM over the foveal center, were evaluated., Results: Multiple regression analysis showed that intact COST line, IS/OS junction line, and external limiting membrane independently and significantly contributed to the BCVA. The standardized partial regression coefficient β was 0.415 for the COST line, 0.287 for the IS/OS junction line, and 0.247 for the external limiting membrane. However, the other features, eg, foveal bulge, inner limiting membrane, foveal pit, and ERM, were not significantly associated with the BCVA. The central retinal thickness was significantly correlated with the BCVA (r2=0.274; P< .01)., Conclusions: At an early stage of an ERM, only the photoreceptor structures are significantly associated with the BCVA, and the appearance of the COST line was most highly associated. Detailed examinations of the photoreceptor structures using optical coherence tomography may help find photoreceptor dysfunction in cases of idiopathic ERM.

Purpose: To evaluate whether the status of the external limiting membrane (ELM) or inner segment/outer segment junction (IS/OS) improves after intravitreal injection of ranibizumab for age-related macular degeneration (AMD). We also evaluated whether the pre-operative values of these parameters are associated with the visual prognosis., Methods: This was a hospital-based, cross-sectional study. Seventy-six eyes of 76 treatment-naive AMD patients who received three monthly intravitreal injections of ranibizumab followed for more than 6 months with additional as-needed injections were investigated. Spectral domain OCT was used to evaluate the length of ELM, IS/OS, and foveal thickness pre- and post-operatively. Changes of ELM and IS/OS length were evaluated postoperatively. Correlation coefficients between pre-operative parameters and post-operative visual acuity were also analyzed., Results: Significant changes were noted in mean logMAR (0.66 to 0.53), foveal thickness (231.1 to 151.1 μm), and IS/OS length (514.9 to 832.3 μm) after the treatment. ELM length did not improve significantly (1,312.4 to 1,376.7 μm). Restoration of IS/OS occurred where ELM is retained. Although pre-operative ELM length, IS/OS length, and foveal thickness showed correlation with post-operative logMAR (R = -0.51, -0.39, and 0.46, respectively), the most powerful predictive factor for visual prognosis was pre-operative logMAR (R = 0.77, p < 0.001)., Conclusions: IS/OS status improves in response to anti-VEGF therapy but ELM seems to have less plasticity. The status of IS/OS and ELM can be used as prognostic factors but the predictive power is inferior to that of baseline visual acuity.

Background and Objective: To evaluate the clinical outcome and complications of intravitreal injections of triamcinolone acetonide as adjuvant to reduce postoperative macular edema in patients undergoing pars plana vitrectomy for epiretinal membranes., Patients and Methods: This retrospective comparative study included 22 patients (22 eyes) who underwent pars plana vitrectomy with membrane peeling for the treatment of idiopathic epiretinal membrane. Fifteen eyes (15 patients) received an intravitreal injection of 4 mg (0.1 cc) of triamcinolone acetonide at the end of surgery, and no injection was performed for 7 eyes (7 patients). Main outcome measures were visual acuity and intraocular pressure. Minimum follow-up was 3 months., Results: Twenty-two eyes of 22 patients were included in the study. The follow-up ranged from 3 to 12 months. Visual acuity improved in both groups at 3 months: logarithm of the minimum angle of resolution -0.26 ± 0.19 in the triamcinolone acetonide group (P = .001) and -0.26 ± 0.13 in the control group (P = .002). However, there was no statistically significant difference in visual acuity improvement 1, 3, and 12 months postoperatively in the triamcinolone acetonide group compared with the control group (P = .79, = .94, and = .21, respectively). There was no significant difference in intraocular pressure change between the two groups during the follow-up period (P > .05)., Conclusion: The current pilot study suggests that postoperative intravitreal injection of triamcinolone acetonide does not lead to better visual outcomes in patients undergoing pars plana vitrectomy for the treatment of idiopathic epiretinal membranes., (Copyright 2013, SLACK Incorporated.)

Purpose: To document changes in metamorphopsia via preferential hyperacuity perimeter and to identify prognostic factors related to favorable metamorphopsia outcome after idiopathic epiretinal membrane surgery., Design: Prospective, consecutive, interventional case series., Methods: We prospectively included 29 eyes of 27 patients who underwent successful vitrectomy for idiopathic epiretinal membrane. All eyes underwent examinations before surgery and at 2 weeks and 1, 3, and 6 months after surgery. Metamorphopsia was assessed by using a preferential hyperacuity perimeter. Several clinical factors were analyzed to reveal relationships with final metamorphopsia outcome, including the duration of symptoms, best-corrected visual acuity, and spectral-domain optical coherence tomography findings. Spectral-domain optical coherence tomography findings included assessment of central foveal thickness, and the integrity of the photoreceptor inner segment and outer segment (IS/OS) junction., Results: At baseline, preferential hyperacuity perimeter detected areas of distortion in 15 eyes (51.7%). At 6 months after surgery, there was significant reduction in metamorphopsia (P = .001), which was paralleled with significant improvement of best-corrected visual acuity and reduction of central foveal thickness (P < .001). At 6 months after surgery, the degree of metamorphopsia was related significantly to the severity of preoperative metamorphopsia and central foveal thickness at baseline (ρ = 0.856; P < .001; ρ = 0.412; P = .027; respectively). Eyes with broadly disrupted IS/OS junction of more than 200 μm before surgery revealed significantly poorer postoperative metamorphopsia than those with intact or narrowly disrupted IS/OS junction (P = .001). However, duration of symptoms and baseline best-corrected visual acuity were not correlated with final metamorphopsia (P = .625 and P = .052, respectively)., Conclusions: Significant reduction of metamorphopsia paralleled the improvement of best-corrected visual acuity and central foveal thickness until 6 months after idiopathic epiretinal membrane surgery. The significant predictors for postoperative metamorphopsia outcome were the degree of preoperative metamorphopsia, central foveal thickness, and the photoreceptor IS/OS junction integrity at baseline., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The goal of the study was to determine vitrectomy effect on ocular hydrodynamics. Patients were divided into 2 groups: patients with diabetes mellitus (DM) were enrolled in the 1st group, indications for vitrectomy were vitreous hemorrhage or diabetic macula edema. The 2nd group included patients without DM, indications for vitrectomy were macula hole, epiretinal fibrosis. Electronic tonography was used to measure the main ocular hydrodynamic parameters before and 2-12 months after the surgery. Though intraocular pressure (IOP) increased after vitrectomy in all patients, the true IOP was normal in the majority of them (60%) and did not require medical correction. In the rest of cases IOP increase required medical treatment: in 23% during 1 month, in 11% during 6-12 months. In subsequent follow-up during 2 years no glaucoma signs were revealed.

Purpose: To correlate the uveitic epiretinal membrane (ERM) features using spectral-domain optical coherence tomography (SD-OCT) with visual acuity (VA)., Methods: Forty-one eyes of 32 patients were included in this retrospective study. SD-OCT was performed in all patients and data were collected at the time of ERM diagnosis and at the final visit. Both best corrected visual acuity (BCVA) and ERM thickness were correlated with the morphological and clinical features., Results: Final BCVA was positively correlated with male sex (P = 0.0055) and the focal pattern of ERM attachment (P = 0.031) and negatively correlated with IS/OS photoreceptor junction disruption (P = 0.042). BVCA change showed a positive correlation with the age of ERM onset (P = 0.056) but a negative correlation with IS/OS photoreceptor disruption at the ERM diagnosis (P = 0.029) and the increase of central subfield thickness (CST) (P = 0.95). Final ERM thickness correlated with the duration of uveitis (P = 0.0023) and the duration of ERM (P = 1.15  e-05). During the follow-up, ERM thickening correlated with male sex (P = 0.042), posterior uveitis (P = 0.036), uveitis duration (P = 0.026), and broad attachment pattern (P = 0.052)., Conclusions: In the uveitic ERM, VA negatively correlates with IS/OS photoreceptor junction disruption and the increase of CST. ERM thickness is influenced by longer duration of both uveitis and ERM.