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Recent developments in scanning laser ophthalmoscopy, S. Wolf Multifocal ERG recording by the VERIS technique and its clinical applications, U. Kretschmann et al Advances in the management of vitreomacular traction syndrome and macular hole, F. Koerner, J. Garweg Use of autologous platelet concentrate in macular hole surgery - report of 77 cases, A. Gaudric et al Autologous platelet concentrate in the surgical management of macular holes, M. Minihan, P.E. Cleary Haemorrhagic macular cysts in Terson's syndrome and its implications for macular surgery, R. Morris et al Complications in the removal of the posterior vitreous cortex, G. Ripandelli et al Epiretinal macular membranes - pathogenesis and treatment, B. Miller Local therapy of CMV retinitis - a new therapeutical approach, A.V. Fuchs et al A retained catheter for retrobulbar administration of interferon for age-related macular degeneration, H. Lincoff et al Experimental therapies for age-related macular degeneration, G. Soubrane, G. Coscas Evaluation of macular therapy, R.K. Blach.

The case for and against ICG assisted macular surgery The concept of retinal vital staining is not new.1–3 There has however been renewed interest in the subject since indocyanine green (ICG) was introduced as a vital stain to highlight the internal limiting membrane (ILM) during macular surgery. ICG’s well known role in cardiac and choroidal angiography exploits its properties as a fluorophore, but its role as a macular vital stain relies on its properties as a chromophore or biological stain. Biological stains such as ICG have specific atomic groupings that impart colour (C = S, C = N, N = N, N = O, and NO2). ICG is therefore able to stain the thin, optically clear ILM, assisting maculorhexis in much the same way that trypan blue assists capsulorhexis. ICG has more recently been used to help remove epiretinal membranes.4 Initial reports were favourable.5–7 Subsequently, some of the most prominent exponents of ICG reported possible toxicity,8 and enthusiasm waned. More recently there have again been papers showing a favourable outcome,9,10 and the debate continues. The article by Hillenkamp et al in this issue of the BJO (p 437) supports the continued use of ICG, but it should not be read in isolation. This editorial presents the case for and against ICG macular vital staining, considering the clinical and experimental evidence in turn. Hillenkamp’s study suggests that ICG vital staining is both safe and effective. It reports a retrospective analysis of two consecutive series of patients undergoing removal of epiretinal membranes, with and without the aid of ICG. The strength of this study lies in its …

We describe a case of maculopathy consisting of macular retinoschisis and serous macular detachment occurring in a patient with an acquired enlarged optic disc cup, similar to the maculopathy observed in congenital optic nerve abnormalities, mainly optic nerve pits and colobomas, without vitreomacular traction nor angiographic leak. Pars plana vitrectomy with argon laser endophotocoagulation and gas tamponade was found to be useful. Traction from membranes covering deep optic disc cups may create small retinal dehiscences, as described in congenital optic nerve abnormalities, which will enable the liquefied vitreous to pass, leading to retinoschisis with or without associated neurosensory detachment. Vitrectomy, photocoagulation, and gas tamponade may be a useful therapy for this entity.

Papers p 11 Age related macular degeneration may be recognised in its early stages by the appearance of drusen and pigment change within the retina, but it produces few symptoms. Progression of age related macular degeneration can result in irreversible visual loss and is the commonest cause of blindness in the Western world. New treatments such as photodynamic therapy and macular surgery may limit the extent of visual loss and in a few cases even restore sight.1 But in contrast with cataract surgery, outcomes are unpredictable and the treatment is burdensome for patients and carries massive resource implications for healthcare providers. The prospect of prevention is thus very appealing from the public health perspective, not to mention that of the patient who may be at risk of losing the ability to recognise faces, read a newspaper, or to live independently. Increasing evidence suggests that cumulative oxidative damage increases risk of age related macular degeneration.2 But evidence from trials and reviews suggests that the antioxidant vitamin E, used alone, does not seem to have a protective effect against age related macular degeneration. …

We read with interest the article by Tan et al .1 We congratulate the authors for emphasising the need for meticulous examination of the peripheral retina to look for retinal breaks after pars plana vitrectomy (PPV). We would like to add some comments to augment this fine study. 1. We did not completely understand what the authors mean by ‘intensified search strategy’ and ‘enhanced 360° internal search’. Are they proposing any new technique which is different …

PURPOSE: To describe the incidence and characteristics of iatrogenic retinal breaks in 25-gauge macular surgery. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: We included 177 consecutive operations in 171 patients who underwent 25,gauge vitrectomy for idiopathic macular pucker or idiopathic macular hole. Main outcome measures were the incidence of breaks related to the sclerotomies, the incidence of breaks occurring elsewhere, the incidence of lesions suspicious for traction, the location of identified breaks, and intraoperative induction of posterior vitreous detachment (PVD). RESULTS: Retinal breaks occurred in 15.8% of operations. In 6.2%, breaks were related to the sclerotomies, and in 10.7%, breaks were found elsewhere. In 8.5% of eyes, only lesions suspicious for traction were detected. Breaks or suspicious lesions were treated with external cryocoagulation in a total of 24.3% of cases. A statistically significant relation between PVD induction and presence of breaks elsewhere was identified. No correlation with lens status, initial diagnosis, or preoperative refraction was found. Retinal detachment occurred in 1.7% of cases. CONCLUSIONS: We report an incidence of retinal breaks that is higher than previously found for 20- or 25-gauge surgery. Despite the high incidence of breaks, the incidence of postoperative retinal detachment was low. A specific characteristic was the relatively high incidence of breaks elsewhere and their relation to PVD induction. Our findings underscore the importance of scrupulous full 360-degree internal search at the end of each procedure to identify and treat all breaks and suspicious lesions optimally. (Am J Ophthalmol 2009; 148:427-430. (C) 2009 by Elsevier Inc. All rights reserved.)

We read with interest the article by Li and colleagues about trypan blue staining of the vitreomacular interface during vitrectomy.1 We congratulate the authors on their work. In particular, we appreciate their critical approach of testing trypan blue for staining of the internal limiting membrane (ILM) and epiretinal membrane (ERM) as well as their comments on potential untoward effects of indocyanine green (ICG) in macular surgery. We would like to comment on two remarks concerning the ultrastructural findings on the retinal side of the ILM following ILM removal with and without the use of ICG. We agree with Li and colleagues that fragments of glial cells are commonly found in ILM specimens. Ultrastructurally, they appear as tiny fragments of Muller cell membranes adherent to and enclosed within the undulations of the retinal side of the ILM. These glial structures had been described in detail by Eckhardt and colleagues, and are in accordance with previous work of our group, in an investigation of the ultrastructure of the vitreomacular interface …

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.; Purpose : The aim of the present study was to describe pre and postoperative anatomical and Optical Coherence Tomography (OCT) features of patients who underwent macular hole surgery in a single academic center. The secondary objective was to investigate the association between preoperative parameters and post-operative visual acuity. Methods : This was a retrospective study of 54 patients who underwent macular hole surgery for the first time and who had no other ocular medical or surgical past history. The procedure was performed by four surgeons between July 2012 and August 2014. The clinical parameters such as gender, age, side, duration of symptoms, preoperative visual acuity in logMAR and lens status were collected. The macular holes were graded in agreement with the International Study Group Vitreomacular Traction classification. A Spectral-Domain Optical Coherence Tomography was carried out before every surgery. The OCT features were screened by a trained investigator. The size of the macular hole, the height, the right and left arm lengths, the basal diameter and the defect of the ellipsoid line and the COST line length were collected. We calculated OCT indexes (the Macular Hole Index, the Tractional Hole Index and the Hole Form Factor). The postoperative visual acuities at 1, 6 and 12 months were collected in logMAR. A cataract surgery when needed was also recorded. Results : The median [IQR] age was 66 [63-76]. There were 39 primary and 15 secondary macular holes (high myopia and post-traumatic). The median preoperative visual acuity was 0.70 [0.6-1.0] logMAR and the size of macular holes was 385 [252-533] µm. The closure rate was 89% with one surgery. Among the thirty-six phakic patients, 21 underwent cataract extraction within 8 [4-11] months after macular hole surgery. Postoperative visual acuity at 12 months was significantly associated with baseline visual acuity, r = 0.73, p