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Purpose of Review: Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 ▪▪ ] . The objective of this review is to review management options for symptomatic vitreous floaters., Recent Findings: Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 ▪▪ ,3,4] ., Summary: This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal individuals., Methods: This study included 22 acute NAION patients (25 eyes), 21 non-acute NAION patients (23 eyes) and 23 normal individuals (34 eyes). All study participants underwent swept-source optical coherence tomography to assess the vitreopapillary interface, peripapillary wrinkles and peripapillary superficial vessel protrusion. The statistical correlations between peripapillary superficial vessel protrusion measurements and NAION were analysed. Two NAION patients underwent standard pars plana vitrectomy., Results: Incomplete papillary vitreous detachment was noted in all acute NAION patients. The prevalence of peripapillary wrinkles was 68% (17/25), 30% (7/23) and 0% (0/34), and the prevalence of peripapillary superficial vessel protrusion was 44% (11/25), 91% (21/23) and 0% (0/34) in the acute, non-acute NAION and control groups, respectively. The prevalence of peripapillary superficial vessel protrusion was 88.9% in the eyes without retinal nerve fibre layer thinning. Furthermore, the number of peripapillary superficial vessel protrusions in the superior quadrant was significantly higher than that in the other quadrants in eyes with NAION, consistent with the more damaged visual field defect regions. Peripapillary wrinkles and visual field defects in two patients with NAION were significantly attenuated within 1 week and 1 month after the release of vitreous connections, respectively., Conclusion: Peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment-related traction in NAION. Papillary vitreous detachment may play an important role in NAION pathogenesis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To explore the characteristics of vitreoretinal lymphoma (VRL) in B-scan ultrasonography., Design: Single-center case-control study., Participants: A total of 106 eyes of 56 patients with biopsy-proven VRL and 86 eyes of 59 patients with uveitis were included., Methods: B-scan ultrasonography of the included eyes was performed. Evaluated were the ultrasonographic signs as well as a special pattern termed centrifugal condensation, which refers to the peripherally hyperreflective appearance of the vitreous haze in ultrasonography., Main Outcome Measures: Posterior vitreous detachment, vitreoretinal adhesion, location of vitreous haze, thickening or occupying lesions of the retina, retinal detachment, and centrifugal condensation pattern of vitreous haze were evaluated through B-scan ultrasonography. The incidences of these signs were compared between the 2 groups; odds ratios (ORs) were calculated., Results: The incidence of vitreoretinal adhesion in patients with VRL (6/106) was lower than in patients with uveitis (20/86; P = 0.001; OR: 0.195; 95% confidence interval [CI]: 0.073-0.522). The incidence of retinal thickening or occupying lesions in patients with VRL (21/106) was higher than that in patients with uveitis (1/86; P = 0.005; OR: 19.068; 95% CI: 2.455-148.265). The incidences of posterior vitreous detachment and retinal detachment were not significantly different between the 2 groups (P = 0.453 and P = 0.310, respectively). The centrifugal condensation pattern was more likely to be observed in patients with VRL (49/106) than in patients with uveitis (13/86; P < 0.001; OR: 4.831; 95% CI: 2.416-9.660)., Conclusions: B-scan ultrasonography might help to provide clues for the suspicion of VRL. Thickening or occupying lesions of the retina and centrifugal condensation pattern of vitreous haze might be suggestive of VRL., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Currently, no consensus exists on the role of optical coherence tomography (OCT) imaging in the setting of acute posterior vitreous detachment (PVD). The authors outline the clinical utility of OCT in the management of acute PVD and its complications., Methods: Literature review of OCT findings in association with acute PVD and report of illustrative cases., Results: Optical coherence tomography imaging in the setting of acute PVD can provide details of vitreoretinal interface that are difficult to appreciate on biomicroscopy alone including partial PVDs, focal vitreoretinal adhesions and traction, and subclinical macular changes. The presence of vitreous hyperreflective dots on OCT in the premacular space, especially if severe, is highly correlated with the presence of peripheral retinal breaks and development of epiretinal membrane. Advancements in OCT technology, including enhanced vitreous imaging OCT, swept-source OCT, wide-angle OCT, and widefield OCT, allow for increased resolution and expanded field of imaging of the vitreoretinal interface., Conclusion: Optical coherence tomography imaging is an emerging standard of care in the setting of patients presenting with new flashes and floaters. The authors highlight the benefits of OCT imaging in patients with acute PVD, which includes recognition of the status of the vitreoretinal interface, assistance in identifying high-risk PVDs, and performance of risk assessment that predict future macular pathologic condition.

There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen fibrils into dense bundles (syneresis). Progressive age-related degradation leads to posterior vitreous detachment (PVD). At present many classifications of PVD exist, in which authors relied either on the morphological features, or on the differences in pathogenesis before and after widespread use of OCT. The course of PVD can be either normal or anomalous. Physiological PVD induced by age-related vitreous changes progresses in specific stages. The review emphasizes that PVD can occur initially not only in the central zone of the retina, but also on the periphery with further spread to the posterior pole. Anomalous PVD can lead to various negative effects on the retina, as well as on the vitreous as a result of traction in the area of vitreoretinal interface.

Purpose: This study aimed to assess the clinical usefulness of widefield swept source optical coherence tomography angiography (WF SS-OCTA) for detecting microvasculature lesions in diabetic retinopathy (DR) by comparing it with ultra-widefield fluorescein angiography (UWFFA) and to investigate the effect of panretinal photocoagulation (PRP) on posterior vitreous detachment (PVD) status., Methods: Patients with severe non-proliferative DR (NPDR) or proliferative DR (PDR) who were initially treated with PRP were enrolled. They underwent WF SS-OCTA with a 12×12-mm scan pattern of five visual fixations at baseline and at least a 3-month follow-up after PRP treatment. Patients with no contraindications underwent imaging with UWFFA within a week. Images were evaluated using two methods for the areas of the visible field of view (FOV), non-perfusion area (NPA), presence of neovascularization of the disc (NVD), neovascularization elsewhere (NVE), and PVD status., Results: In total, 44 eyes of 28 patients with DR that were initially treated with PRP were analyzed. The FOV of the UWFFA was significantly wider than that of the WF SS-OCTA. The quantitative measurement of the NPAs was consistent between the two methods. NPAs more than 5DA outside the panoramic OCTA imaging area were detected in 1 eye with NPDR (8.3%) and in 10 eyes with PDR (47.8%). WF SS-OCTA had high detection rates for NVDs and NVEs, with a low rate of false positives. After PRP treatment, no eyes indicated progression in the PVD stages around the macula, optical disc, or NVEs at the short follow-up., Conclusion: WF SS-OCTA is clinically useful for evaluating NPAs and neovascularization in DR. PRP treatment does not induce PVD development in the short term., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gong, Hu, Wang, Shao and Li.)

Purpose: To investigate the impact of baseline vitreomacular interface status on treatment outcomes in patients treated with three different anti-vascular endothelial growth factors for diabetic macular edema., Methods: Post hoc analysis from patients enrolled in the DRCR.net Protocol T study. Optical coherence tomography images were analyzed at baseline and at the end of follow-up to identify the presence of complete vitreomacular adhesion, partial vitreomacular adhesion, vitreomacular traction syndrome, and complete posterior vitreous detachment., Results: Six hundred and twenty-nine eyes were eligible for the study based on the study criteria. Complete adhesion eyes gained on average +3.7 more ETDRS letters compared with the complete posterior vitreous detachment group at the end of the 12 months follow-up ( P < 0.001). Baseline vitreomacular interface status had no significant influence on central subfield thickness at 12 months ( P = 0.144). There was no difference between the treatment arms based on effect of baseline vitreomacular interface status on best-corrected visual acuity gain., Conclusion: This study provides evidence that vitreomacular interface status affects functional outcomes in diabetic macular edema patients treated with anti-vascular endothelial growth factor injections. The presence of complete or partial vitreomacular adhesion at baseline may be associated with a larger treatment benefit than those with complete posterior vitreous detachment.

Purpose: To compare pneumatic vitreolysis and pars plana vitrectomy in the management of focal symptomatic vitreomacular traction (VMT)., Method: Patients aged 18 years or older, with idiopathic focal symptomatic VMT and best-corrected visual acuity <20/40, without any other retinal pathology were randomized to undergo pneumatic vitreolysis (Group 1) or pars plana vitrectomy (Group 2). The primary outcome measure was resolution of traction confirmed with optical coherence tomography at 3 months. Secondary outcome measures were to compare changes in best-corrected visual acuity, central foveal thickness, and complications if any., Results: A total of 30 eyes of 30 patients were included with 15 eyes in each group. Vitreomacular traction resolved successfully in 12 of 15 (80%) eyes in Group 1 and in all (100%) eyes in Group 2 (P = 0.224). The mean visual acuity improved from 0.80 ± 0.26 (20/126 Snellen's equivalent) to 0.70 ± 0.46 logMAR (20/100 Snellen's equivalent) in Group 1 (P = 0.71) and from 0.904 ± 0.44 (20/160 Snellen's equivalent) to 0.47 ± 0.26 logMAR (20/59 Snellen's equivalent) in Group 2 (P = 0.0016). Although 4 of 15 (26.66%) eyes in Group 1 had formation of full-thickness macular hole and 7 eyes required resurgery (4 for full-thickness macular hole and 3 for unresolved VMT), none in the pars plana vitrectomy group had any complications requiring resurgery (P = 0.0063). Two eyes in the pars plana vitrectomy group had intraoperative deroofing of the fovea leading to full-thickness macular hole., Conclusion: Pars plana vitrectomy is better than pneumatic vitreolysis as a single intervention in the management of focal symptomatic VMT.

Background: Coats disease is a retinal vascular disorder characterized by aneurysms and telangiectasias. Macular fibrosis is a complication of Coats disease that results in vision loss. Macular fibrosis rarely develops in the natural course and often occurs after treatment with intravitreal bevacizumab, photocoagulation, or cryotherapy. Here, we have described an unusual case of spontaneous peeling of preretinal macular fibrosis in a patient with untreated Coats disease., Case Presentation: A 10-year-old Japanese boy presented with vision loss in his left eye. The patient's left visual acuity was 20/28. Fundus examination of his left eye revealed thick preretinal macular fibrosis around the optic disc and macula. In addition, retinal telangiectasis, microaneurysms, hard exudates, and retinal hemorrhages were observed in the left peripheral temporal retina. We diagnosed his condition as Coats disease with preretinal macular fibrosis. Two months later, optical coherence tomography revealed preretinal macular fibrosis detachment at the foveal lesion without any treatment. During follow-up, preretinal macular fibrosis at the macular lesion was completely detached. Further, posterior vitreous detachment was observed and the shape of the macula and the patient's left visual acuity had improved., Conclusions: In our case, both formation and spontaneous peeling of preretinal macular fibrosis occurred without any treatment for Coats disease, which is an unusual finding. Vitreous changes might have occurred during the natural clinical course, causing subsequent posterior vitreous detachment and resulting in spontaneous peeling of fibrosis., (© 2022. The Author(s).)

Background/aims: To assess the effect of partial posterior vitreous detachment (pPVD) on spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fibre layer thickness (RNFL) measurements., Methods: Spectral-domain OCT RNFL thickness measurements were obtained from 684 consecutive patients who were seen in the Massachusetts Eye and Ear Glaucoma Service. Of these patients, we compared RNFL thickness measurements between 101 eyes of 101 glaucoma suspects who met inclusion criteria (55 eyes with and 46 eyes without pPVD)., Results: Among all 684 patients, 253 (37%) had pPVD in at least one eye. Among a subset of 101 eyes of 101 glaucoma suspects, average RNFL thickness was greater in eyes with compared to eyes without pPVD (p=0.02). Measurements were significantly greater in the inferior (p=0.004) and superior quadrants (p=0.008), but not in the nasal (p=0.10) and temporal quadrants (p=0.25). The difference in average RNFL thickness remained significant (p=0.05) even when corrected for expected age-related decline in RNFL thickness., Conclusion: Over a third of patients were found on peripapillary spectral-domain OCT to have a pPVD, which was associated with greater RNFL thickness measurements. Judicious clinical interpretation of this finding on spectral-domain OCT RNFL thickness scans should be factored into the assessment of glaucoma suspects., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success., Methods: The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed., Results: Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0-100) to 65 ± 37 (0-100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air., Conclusion: Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.

Our purpose was to evaluate the concentrations of vitreous cytokines in patients with rhegmatogenous retinal detachment (RRD). We hypothesized that patients with macula on RRD have lower levels of cytokines compared to patients with macula off RRD and proliferative vitreoretinopathy (PVR). Vitreous fluids were collected during 23G pars plana vitrectomy from 58 eyes of 58 patients. Indication for vitrectomy included macula off and macula on RRD, PVR, and idiopathic epiretinal membrane (ERM). A multiplex chemiluminescent immunoassay was performed to measure the concentrations of 48 cytokines, chemokines, and growth factors. Levels of HGF, IL-6, IL-8, IL-16, IFN-gamma, MCP-1, and MIF were significantly higher in all groups of retinal detachment compared to ERM. Levels of CTACK, eotaxin, G-CSF, IP-10, MIG, SCF, SCGF-beta, SDF-1alpha were significantly higher in PVR compared to macula on RRD and ERM. Levels of IL-1ra, IL-5, IL-9, M-CSF, MIP-1alpha, and TRIAL were significantly higher in PVR compared to macula on RRD. Our results indicate that the position of macula lutea and the presence of PVR significantly influence vitreous cytokine expression. The detected proteins may serve as biomarkers to estimate the possibility of PVR formation and may help to invent personalized therapeutic strategies to slow down or prevent PVR., Competing Interests: The authors have declared that no competing interests exist.

Background: Stickler syndrome is a collagenopathy caused by mutations in the genes COL2A1 (STL1) or COL11A1 (STL2). Affected patients manifest ocular, auditory, articular, and craniofacial manifestations in varying degrees. Ocular symptoms include myopia, retinal detachment, cataract, and glaucoma. The aim of this systematic review was to evaluate the prevalence of ocular manifestations and the outcome of prophylactic treatment on reducing the risk of retinal detachment., Method: A systematic literature search was performed in the PubMed database. Information on the cross-study prevalence of myopia, retinal detachment, cataract, glaucoma, visual impairment, severity and age of onset of myopia and retinal detachments. Studies that reported on the outcome of prophylactic treatment against a control group were explored., Results: 37 articles with 2324 individual patients were included. Myopia was found in 83% of patients, mostly of a moderate to severe degree. Retinal detachments occurred in 45% of patients. Generally, the first detachment occurred in the second decade of life in STL1 patients and later in STL2. Cataracts were more common in STL2 patients, 59% versus 36% in STL1. Glaucoma (10%) and visual impairment (blind: 6%; vision loss in one eye: 10%) were rare. Three studies reported on the effect of prophylactic treatment being protective., Conclusion: Ocular manifestations are common in Stickler patients, but the comparison between studies was difficult because of inconsistencies in diagnostic and inclusion criteria by different studies. Sight-threatening complications such as retinal detachments are common but although prophylactic therapy is reported to be effective in retrospective studies, evidence from randomized trials is missing.

Purpose: We aimed to determine the prevalence of characteristics and pathologies of the vitreo-macular interface within the general population., Methods: The Gutenberg Health Study is a population-based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo-macular interface were graded on volume scans including visibility of an epiretinal membrane, full-thickness macular hole, lamellar hole and pseudohole. Overall and age-specific prevalences including 95% confidence intervals [95%-CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression., Results: A total of 1890 people aged 40-80 years were included in the study. Of these, 4.7% (95%-CI: 3.8%-5.8%) had an epiretinal membrane in at least one eye, 0.1% a full-thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure., Conclusions: Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy., (© 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the association between different stages of posterior vitreous detachment (PVD) and macular microvasculature in the elderly., Methods: Swept-source optical coherence tomography (OCT), OCT angiography, and color fundus images of 490 eyes without retinal pathologies of 322 participants aged ≥65 years were evaluated. PVD was classified using enhanced vitreous visualization mode as no apparent PVD (stage 0/1), vitreous adhesions at the fovea and optic disc (stage 2), adhesion at the optic disc (stage 3), or complete PVD (stage 4). Microvascular parameters, including foveal avascular zone (FAZ) and vessel density (VD), were analyzed for their associations with complete PVD. Additionally, the association between PVD and central retinal thickness (CRT) was also addressed., Results: Overall, 80, 31, 31, and 349 eyes were categorized into stages 0/1, 2, 3, and 4, respectively. Using multivariate mixed-effects model, the mean superficial FAZ area was smaller in stage 4 compared with stages 0-3 (0.29 vs. 0.32 mm2; P = 0.014), and the mean superficial VD was lower in stage 4 compared with stages 0-3 (34.96% vs. 35.24%; P = 0.0089). However, PVD was not significantly associated with deep macular microvascular parameters or CRT., Conclusions: Complete PVD was associated with smaller FAZ area and lower VD in superficial macular microvasculature, while it was not associated with central retinal thickness., Competing Interests: Topcon (www.topcon.co.jp), supported our condut of the present research, which does not alter our adherence to PLOS ONE policies on sharing data and materials.

Pontocerebellar hypoplasia type 9 (PCH9) is an autosomal recessive neurodevelopmental disorder caused by pathogenic variants in the AMPD2 gene. We evaluated the son of a consanguineous couple who presented with profound hypotonia and global developmental delay. Other features included sensorineural hearing loss, asymmetric astigmatism, and high myopia. Clinical whole-exome sequence analysis identified a homozygous missense variant in AMPD2 (NM&#95;001257360.1:c.2201C > T, p.[Pro734Leu]) that has not been previously reported. Given the strong phenotypic overlap with PCH9, including the identification of the typical "Figure 8" appearance of the brainstem on neuroimaging, we suspect this variant was causative of the neurodevelopmental disability in this individual. An additional homozygous nonsense variant in COL11A1 (NM&#95;001854.4:c.1168G > T, p.[Glu390Ter]) was identified. Variants in this alternatively spliced region of COL11A1 have been identified to cause an autosomal recessive form of Stickler syndrome type 2 characterized by sensorineural hearing loss and eye abnormalities, but without musculoskeletal abnormalities. The COL11A1 variant likely also contributed to the individual's phenotype, suggesting two potentially relevant genetic findings. This challenging case highlights the importance of detailed phenotypic characterization when interpreting whole exome data., (© 2019 Wiley Periodicals, Inc.)

The purpose of the study is to evaluate retinal involvement in a cohort of patients affected by Myotonic Dystrophy type 1 (DM1). Both eyes of 30 patients and one eye of a 31st patient with genetically proven diagnosis of DM1 and both eyes of 20 healthy age- and gender-matched subjects were enrolled. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, fundoscopy, fundus autofluorescence, infrared imaging and spectral-domain optical coherence tomography with central macular thickness measurement. DM1 patients showed statistically significant higher central macular thickness values than controls. In the DM1 group, butterfly (14.8%) and reticular (13.1%) pigment abnormalities were found with corresponding drusenoid deposit and focal disruption of photoreceptor and retinal pigment epithelium layers. Compared with the controls, DM1 group had higher prevalence of epiretinal membrane. In the DM1 group, the prevalence of epiretinal membrane and retinal pigment epithelium alterations were directly correlated with age, whereas no correlation was found with disease duration, CTG expansion and MIRS score. In conclusion, in addition to the typical retinal pigment epithelium changes, DM1 is also associated with abnormalities of the vitreoretinal interface, particularly epiretinal membrane, resulting in central macular thickness increase. Both inner and outer retinal alterations were associated with increasing age, suggesting that DM1 may cause a premature aging of the retina., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: There have been several reports of spontaneous closure and reopening of a macular hole, however, in most of those cases, it was observed in eyes post vitrectomy. Here, we report a case of multiple episodes of spontaneous disappearance and recurrence of impending macular hole (stage 1B macular hole) with no history of previous surgery., Case Presentation: A 76-year-old Japanese man presented with a primary complaint of reduced visual acuity in his right eye. On initial examination, the visual acuity in his right and left eye was 0.4 and 0.01, respectively. He had previously been diagnosed as having macular degeneration of unknown origin in his left eye. Optical coherence tomography imaging confirmed vitreomacular traction and impending macular hole in his right eye. After a 1-week follow-up period, posterior vitreous detachment was detected, and the impending macular hole appeared to be resolved. Two months later, the impending macular hole had completely disappeared and his visual acuity had improved to 0.9. Six months later, he again noticed decreased vision in his right eye. An examination revealed that his visual acuity had dropped to 0.4, and there was a recurrence of impending macular hole. An optical coherence tomography examination showed no definitive findings of vitreous traction, and, 1 month later, spontaneous disappearance was observed again and his visual acuity improved to 0.7., Conclusions: In this case, both the initial onset and the recurrence involved impending macular hole, however, the optical coherence tomography findings differed at each examination. These findings suggest that some causes other than vitreous traction were responsible for both the spontaneous disappearance and recurrence of the impending macular hole in this present case.

Background and Objective: To evaluate the vitreomacular interface and its relation to treatment burden for diabetic macular edema (DME) in patients without overt vitreomacular traction (VMT)., Patients and Methods: A retrospective cohort study of 494 eyes from 274 patients who had macular spectral-domain optical coherence tomography (SD-OCT) and did not have proliferative diabetic retinopathy, DME, or VMT at the initial visit. Posterior vitreous detachment (PVD) was categorized at the initial visit into five stages (0-4) using SD-OCT parameters alone., Results: Two of 34 eyes (6.9%) presenting with a complete PVD required DME treatment during follow-up, whereas 144 of 460 eyes (31.3%) without a complete PVD at baseline required treatment (P = .001, Chi-squared). After adjusting for age, ethnicity, gender, and HbA1c, complete PVD at baseline was associated with a significant reduction in risk of DME therapy (hazard ratio: 0.18; 95% confidence interval, 0.05-0.73; P = .02)., Conclusion: Complete PVD is independently associated with a reduced need for DME treatment. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e266-e273.]., (Copyright 2019, SLACK Incorporated.)

Purpose: To evaluate ophthalmic ultrasonographic findings associated with active ocular toxoplasmosis., Methods: Forty-seven eyes with active ocular toxoplasmosis in 47 patients were subjected to ocular ultrasonography using the transpalpebral technique (10-MHz transducer) and fundus photography. Patient medical records were retrospectively reviewed., Results: Ocular ultrasonography revealed vitritis, posterior vitreous detachment, retinal wall thickening, and non-rhegmatogenous retinal detachment in 47 (100%), 36 [76.6%; partial in 12 (25.5%) and total in 23 (48.9%)], 12 (25.5%), and 5 eyes (10.6%). Thirty-five of the 36 eyes with posterior vitreous detachment (97.2%) exhibited posterior hyaloid thickening; moreover, adhesion to the exudative lesion and vitreoschisis were observed in 4 (11.1%) and 12 eyes (25.5%), respectively. Ultrasonography detected the location of the exudative focus in 12 eyes (25.5%)., Conclusion: Ultrasonography is helpful for detecting important intraocular findings of acute ocular toxoplasmosis that can be hindered by medial opacity or posterior synechiae.

Purpose: To compare the difference in the progression of posterior vitreous detachment (PVD) between men and women in relation to age., Design: Observational cross-sectional study., Participants: One hundred eyes of 100 male patients and 100 eyes of 100 female patients in 4 age groups: 40 to 49 years of age, 50 to 59 years of age, 60 to 69 years of age, and 70 years of age or older., Methods: Using swept-source (SS) OCT, PVD was classified into 5 stages: 0, no PVD; 1, paramacular PVD; 2, perifoveal PVD; 3, vitreofoveal separation; and 4, complete PVD. The PVD stage distribution was compared between men and women in the 4 age groups and among the age groups., Main Outcome Measures: Stage of PVD determined using SS OCT., Results: In both male and female eyes, the stage of PVD progressed significantly in association with the age group (P < 0.0001). The distribution of the PVD stage did not differ significantly between men and women in the 40- to 49- and the 50- to 59-year age groups. The distribution of the PVD stage was significantly more progressed in women than in men, however, in those 60 to 69 years of age and those 70 years of age and older (P ≤ 0.0292). At 40 to 49 years of age, no PVD (stage 0) and paramacular PVD (stage 1) were detected in 92 (92.0%) female eyes and 93 (93.0%) male eyes. At 70 years of age or older, vitreofoveal separation (stage 3) and complete PVD (stage 4) were detected in 93 (93.0%) female eyes and 78 (78.0%) male eyes., Conclusions: Posterior vitreous detachment significantly progresses with age in both genders, specifically between 40 years of age and 70 years of age or older. Posterior vitreous detachment progression occurs significantly faster in female eyes than in male eyes at 60 years of age or older, suggesting that the macular pathologic features associated with PVD occur at a younger age in women., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report a case of macular telangiectasia Type 2 that showed a resolution of a foveal cystic change accompanying the release of vitreomacular attachment., Methods: Retrospective chart review., Report of the Case: A 75-year-old man presented with a bilateral decrease in visual acuity and metamorphopsia. At the initial visit, the left eye demonstrated a hyporeflective foveal cyst and a perifoveal vitreous detachment on optical coherence tomography. The characteristic clinical findings were consistent with the diagnosis of macular telangiectasia Type 2. Fifteen months later, the patient returned with a remission of the metamorphopsia in the left eye. The left eye had a vitreous detachment from the macula, and the hyporeflective foveal cyst was completely resolved., Conclusion: At least in some cases, vitreous traction or attachment may play a role in the morphologic changes seen in macular telangiectasia Type 2.

Background: Extracellular matrix molecular components, previously linked to multisystem syndromes include collagens, fibrillins and laminins. Recently, we described a novel multisystem syndrome caused by the c.9418G>A p.(V3140M) mutation in the laminin alpha-5 (LAMA5) gene, which affects connective tissues of all organs and apparatus in a three generation family. In the same family, we have also reported a myopic trait, which, however, was linked to the Prolyl 4-hydroxylase subunit alpha-2 (P4HA2) gene. Results of investigation on vitreous changes and their pathogenesis are reported in the present study., Materials and Methods: Nineteen family individuals underwent complete ophthalmic examination including best-corrected visual acuity (BCVA), fundus examination, fundus photography, intraocular pressure measurement, axial length measurement using ocular biometry, Goldmann visual field examination, standard electroretinogram, SD-OCT. Segregation analysis of LAMA5 and P4HA2 mutations was performed in enrolled members., Results: The vitreous alterations fully segregated with LAMA5 mutation in both young and adult family members. Slight reduction of retinal thickness and peripheral retinal degeneration in only two patients were reported., Conclusions: In this work we showed that PVD is a common trait of LAMA5 multisystem syndrome, therefore occurring as an age-unrelated trait. We hypothesize that the p.(V3140M) mutation results in a reduction of retinal inner limiting membrane (ILM) stability, leading to a derangement in the macromolecular structure of the vitreous gel, and PVD. Further investigations will be necessary to elucidate the role of wild type and mutated LAMA5 in the pathogenesis of PVD.

Purpose: We aimed to assess the relationship of repeated intravitreal injection of anti-vascular endothelial growth factor, the main treatment for exudative age-related macular degeneration, with changes in vitreous ultrasonographic findings in patients with age-related macular degeneration., Methods: We retrospectively collected data from 41 patients (41 age-related macular degeneration eyes, 41 control eyes) on age, sex, number of injections, and type of anti-vascular endothelial growth factor (ranibizumab, aflibercept). Ocular ultrasonography was performed with open eyelids, under topical anesthesia, and using carbomers as ultrasonographic gel. Topographic, quantitative, and kinetic ultrasonography was performed in all eye quadrants using a 10-MHz posterior pole probe, and vitreous reflectivity was assessed., Results: The mean age of patients was 79 (range: 59-94) years, with a mean of five intravitreal anti-vascular endothelial growth factor injections (range: 1-13). No significant ultrasonographic differences were found relative to the incidence of partial or complete posterior vitreous detachment. Vitreous hyperechogenicity increased in the treated eye (P < 0.001), and the vitreous reflectivity range increased with the number of injections (P = 0.041, R = 0.214). However, the type of anti-vascular endothelial growth factor used and the time elapsed since the last intravitreal injection was not significant (P > 0.05)., Conclusion: These preliminary results indicate a proportional increase in ultrasonographic reflectivity of vitreous gel with the number of injections.

Purpose: To determine the prevalence and factors influencing vitreomacular adhesion (VMA) or vitreomacular traction (VMT) in subjects without maculopathy older than age 40 years., Methods: In a prospective cross-sectional study, 1,950 eyes in 1,090 participants aged 40 to 89 years representing various ethnic groups from 14 centers in the United States underwent a comprehensive eye examination, including spectral domain optical coherence tomography. A team of independent, masked readers classified the presence or absence of VMA/VMT on spectral domain optical coherence tomography based on the International Vitreomacular Traction Study Group rubric., Results: Across all eyes, the prevalence of VMA or VMT was 39% or 1%, respectively. For every 1-year increase in age, there was a statistically significant 7% decreased odds of having VMA or VMT (95% confidence interval [CI]: 0.89-0.96; P < 0.001), whereas African Americans had 55% significantly reduced odds of having VMA or VMT when than whites (95% CI: 0.23-0.90; P = 0.025). Vitreomacular adhesion >1,500 μm was significantly more likely than VMA <1,500 μm in younger adults (95% CI: 0.70-0.86; P < 0.001), hyperopes versus emmetropes (95% CI: 1.49-35.9; P = 0.01), primary eye care versus tertiary practices (95% CI: 0.03-0.92; P = 0.04), and patients without hyperlipidemia (95% CI: 0.04-0.83; P = 0.03)., Conclusion: Vitreomacular adhesion is highly prevalent among middle-aged adults. Diagnostic screening with spectral domain optical coherence tomography may help to accurately detect VMA or VMT, prompting routine monitoring and timely therapeutic intervention.

Purpose: In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT., Methods: A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (A measured ). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (A circular )., Results: Thirty-seven eyes of 37 patients with pure VMT were included. Patients' mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44-991 μm). While there was no difference between mean areas of traction for A circular and A measured (P = 0.93), the individual difference (|A circular  - A measured |) was 0.042 (± 0.044) mm 2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of A measured to A circular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively., Conclusion: Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.

An 81-year-old man with bilateral progressively blurry vision and optic disc swelling was referred for evaluation. Examination and ancillary testing confirmed a diagnosis of bilateral vitreopapillary traction accompanied by unilateral tractional retinoschisis in the right eye. Pars plana vitrectomy was performed to release the traction in both the eyes. Visual acuity improved in the right eye and stabilized in the left eye. Retinoschisis in the right eye resolved. The visual field improved in both the eyes although the left eye demonstrated a persistent hemifield defect likely attributable to a prior optic neuropathy. Distinguishing vitreopapillary traction optic neuropathy from nonarteritic anterior ischemic optic neuropathy is discussed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To evaluate baseline features and morphologic changes of vitreoretinal adhesion and outer retinal layers outside the macula after intravitreal ocriplasmin injection. To study the relation between vitreous detachment and attenuation of retinal outer segments signal., Methods: Retrospective cases series of 15 eyes. Each eye was scanned with the 55° wide-field optical coherence tomography lens in 6 different locations, three horizontal B-scan (central, temporal, and nasal) and three vertical B-scan (central, superior, and inferior) at baseline, 1 week, 1 month, 3 months, and 6 months after injection., Results: After ocriplasmin injection, vitreomacular traction (VMT) resolved in 12 patients (80%), 3 of them presenting a complete posterior vitreous detachment. Eight patients (53%) showed a panretinal attenuation of photoreceptors outer segment signal, 7 with VMT resolution and 1 with non-posterior vitreous detachment and no VMT resolution. In three patients after VMT resolution the attenuation involved also areas with no posterior vitreous detachment. The attenuation resolved during follow-up in 7/8 eyes (87.5%)., Conclusion: Intravitreal ocriplasmin injection induced resolution of VMT in most cases and more rarely a release of vitreopapillary adhesion and a complete posterior vitreous detachment. An acute panretinopathy was visible in more than half of the patients and was not related to vitreous detachment.

Rationale: To report a case of familial exudative vitreoretinopathy (FEVR) complicated with full-thickness macular hole (FTMH)., Patient Concerns: A 39-year-old male presented after becoming aware of metamorphopsia in his left eye., Diagnoses: Fundus examination showed a retinal avascular area, retinal vascular abnormality, and yellow exudation at the peripheral retina in both eyes. Optical coherence tomography findings revealed impending MH (IMH) due to posterior vitreous detachment (PVD) in his left eye. Despite of the occurrence of spontaneous complete PVD, an FTMH developed at 4 months after the onset of IMH., Interventions: To treat the FTMH, vitreous surgery was performed. Intraoperative findings revealed that the thick posterior vitreous membrane (PVM) had no adhesions with the edge of the FTMH. However, a thin epiretinal membrane (ERM) was observed around the MH., Outcomes: Postoperatively, the FTMH was closed, and the patient's corrected visual acuity improved from (0.4) to (0.8)., Lessons: In this present case, an IMH developed via traction by a thick PVM, characteristic of FEVR, with FTMH then developing via traction by a thin ERM. Our findings reveal that it is vital to fully understand these anatomical features before performing vitreous surgery for FTMH complicated with FEVR.

Purpose: To assess the 10-year incidence and progression of epiretinal membranes (ERMs)., Methods: The population-based longitudinal Beijing Eye Study, which included 4439 subjects (age:40+years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). The study participants underwent a detailed ophthalmic examination, including retinal photography. Assessing fundus photograohs, ERMs were classified as cellophane macular reflex (CMR) without retinal folds, or as preretinal macular fibrosis (PMF) without or with retinal folds., Results: Fundus photographs were available for 2476 subjects with a mean age of 69.0±7.8 years (range:51-93 years) and mean axial length of 23.3±0.9 mm (range:19.92-26.33mm). The 10-year incidence of ERMs was 8.4% (208/2476 participants; 95% confidence interval (CI):7.4,9.5). ERMs developed bilaterally in 50 (24%) individuals and unilaterally in 158 (76%) persons. The incidence of PMFs with 2.5% (95% CI: 1.9, 3.1) was lower than the incidence of CMRs with 5.9% (95% CI: 5.0, 6.9). Higher 10-year incidence of ERMs was associated with older age (P<0.001; odds ratio (OR): 1.06; 95%CI:1.04,1.09), previous cataract surgery (P = 0.003;OR:3.32;95%CI:1.51,7.29) and presence of a complete posterior vitreous detachment (P = 0.02;OR:1.84;95%CI:1.12,3.02). In the age groups of <60 years, 60-69 years, 70-79 years and 80+years, incidence of ERMs was 3.1%, 10.0%, 14.4% and 10.9%, respectively, with no significant gender difference., Conclusions: In Chinese aged 40+ years, the 10-year incidence of ERMs (8.4%) increased with older age, previous cataract surgery and complete posterior vitreous detachment. The ten-year incidence was lower for PMFs (2.5%) than for CMRs (5.9%).

Purpose: To quantify the changes in vitreomacular interactions that occur with aging in diabetic eyes in comparison with age-matched control eyes., Methods: Spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering) foveal scans of diabetic patients, without evidence of cystoid macular edema, were included. Twenty-five raster foveal scans were performed on every subject. Area of vitreomacular adhesion was delineated using the Spectralis drawing tool and calculated in square millimeter. Data collected included gender, race, best-corrected visual acuity, and posterior vitreous detachment status. Subjects were divided into age groups according to decade of life., Results: Spectral-domain optical coherence tomography scans from 141 diabetic patients were analyzed. Area of vitreomacular adhesion (mm) showed a hyperbolic decline in diabetic patients (35.5 ± 0, 35.0 ± 3, 34.0 ± 3, 33.9 ± 5, 33.7 ± 6, 29.0 ± 11, 23 ± 15, 13 ± 15). With aging, incidence of posterior vitreous detachment increased and incidence of complete attachment decreased., Conclusion: Diabetes affects the magnitude of attachment of the vitreous gel to the macula that results in stronger and longer lasting attachment of the gel throughout life. Gender differences were not noticed in diabetic patients, suggesting that vitreomacular adhesion remains robust in both genders in diabetes despite aging.

Purpose: To investigate the structure of vitreomacular traction (VMT), specifically, if a correlation exists between 1) the VMT type/grade and the central foveal thickness (CFT) and subfoveal and adjacent choroidal thickness, 2) the vitreomacular/foveal angle (VMFA) and the CFT and subfoveal and adjacent choroidal thickness, and 3) the diameter of vitreomacular adhesion (VMA) and CFT and subfoveal and adjacent choroidal thickness., Materials and Methods: Retrospective, multicenter image analysis study. We analyzed raster scans of the macula taken with spectral-domain optical coherence tomography (SD-OCT) of 61 eyes of 55 patients with VMT. Conventional scans of the vitreoretinal interface were analyzed to measure CFT and the degree of VMFA. Enhanced depth imaging (EDI) scans were analyzed to measure the choroidal thickness in the macula. The multivariate test of means and the t-test were used for statistical comparisons., Results: There was no statistically significant difference in CFT between focal vs broad and concurrent vs isolated type VMT. Central (p = 0.009), nasal (p = 0.004), and temporal (p = 0.007) subfoveal choroidal thickness was significantly higher in broad VMT compared to focal VMT. There was difference in both CFT (p = 0.035) and central (p = 0.005), nasal (p = 0.01), and temporal (p = 0.001) choroidal thickness between moderate and severe VMT. There was a correlation between VMFA and CFT, where a wider angle was associated with increased CFT (p = 0.026). The broader VMA was associated with increased central subfoveal (p = 0.032), nasal (p = 0.05), and temporal (p = 0.01) choroidal thickness., Conclusions: Eyes with broad VMT have thicker choroid than eyes with focal VMT, which have a more open vitreomacular angle. The angle of VMT is related to distinct CFTs.

Background: To evaluate the resolution rate in patients with symptomatic vitreomacular traction (VMT) ≤ 1500 μm with or without macular holes ≤ 400 μm after therapy with intravitreal ocriplasmin (Jetrea®) injections in a clinical setting in comparison to transconjunctival vitrectomy., Materials and Methods: We examined 21 eyes of 21 consecutive patients with vitreomacular traction with or without macular holes who underwent intravitreal injection of 0.1 ml ocriplasmin and we retrospectively reviewed 18 eyes of 18 patients with VMT with or without FTMH who underwent 23-gauge vitrectomy., Results: Vitreomacular traction resolved in 15 of 21 eyes treated with ocriplasmin after 6 month (71 %) compared to 100 % of eyes treated by vitrectomy. Of the 5 eyes that initially presented FTMH with VMT in the ocriplasmin group, 2 were closed 1 month after ocriplasmin treatment. The remaining 3 had vitrectomy and closed thereafter. Best corrected visual acuity was 0.38 ± 0.23 LogMAR at baseline, improving to 0.34 ± 0.24 LogMAR at 6 months after ocriplasmin treatment. Best corrected visual acuity in the vitrectomy group improved from 0.55 ± 0.29 LogMAR before operation to 0.53 ± 0.51 LogMAR 6 months postoperatively. Foveal thickness was 355.95 ± 114.53 μm at baseline, reducing to 277.77 ± 40.26 μm at 6 months after ocriplasmin treatment. Foveal thickness of eyes that underwent vitrectomy was 494.61 ± 126.02 μm at baseline, decreasing to 330.2 ± 88.85 μm 6 months postoperatively., Conclusion: When traction is ≤ 1500 μm, enzymatic vitreolysis with ocriplasmin is a therapeutic option. In the presence of VMT >1500 μm or ERM, surgical treatment with vitrectomy is associated with better outcomes. In small macular holes with VMT and in the absence of ERM, enzymatic vitreolysis with ocriplasmin is an option. In cases of holes >400 μm, or in the absence of evident VMT, or in the presence of ERM, vitrectomy is the first choice.

Purpose: To describe the natural history, optical coherence tomography characteristics, and proposed biomechanics of macular pseudohole (MPH) evolution and spontaneous resolution., Methods: Clinical case report, with longitudinal follow-up documented by fundus photographs and spectral domain optical coherence tomography., Results: A 26-year-old woman presented with visual disturbance secondary to an idiopathic epiretinal membrane. Subsequent formation of an MPH was observed. Spontaneous peeling of the epiretinal membrane occurred in conjunction with posterior vitreous detachment 6.5 years after initial presentation. The MPH resolved, and the patient's vision improved., Conclusion: Spontaneous epiretinal membrane peeling represents a potential mechanism for visual and anatomical improvement in eyes with MPH. This is the first published observation of MPH resolution documented by spectral domain optical coherence tomography.

Purpose: To report two cases where the primary visual complaints were central visual phenomena, with normal fundus biomicroscopy., Methods: History and clinical examination, fundus autofluorescence, and spectral domain-optical coherence tomography., Results: The authors report 2 patients, a 66-year-old woman and a 77-year-old woman, who complained of a central visual disturbance in one eye. Best-corrected visual acuity was normal. Ophthalmoscopy in the first case was unremarkable and showed minimal retinal pigment epithelial mottling in Case 2. Spectral domain-optical coherence tomography revealed vitreomacular traction with foveal distortion in both eyes, associated with small cysts in the inner retinal layers and in one patient disruption of photoreceptors., Conclusion: Central visual phenomena are important clues for central vitreomacular traction, even in the presence of a normal fundus examination. The authors highlight the importance of performing spectral domain-optical coherence tomography evaluation in this setting before considering neurologic or systemic causes.

Introduction: Stickler syndrome is a connective tissue disorder characterized by orofacial, ocular, skeletal and auditory symptoms. The orofacial phenotype mainly consists of midfacial hypoplasia, micrognathia and cleft palate. Large phenotypic variability is evident though. Few studies have tried to substantiate the typical facial appearance in Stickler syndrome patients., Methods: Molecularly confirmed Stickler patients were invited to undergo cephalometric analysis based on a lateral radiograph in standardized conditions. Angular and linear measurements were performed according to Steiner's and Sassouni's analysis and compared with age- and gender-matched reference values., Results: Thirteen patients aged 10-62y were included, twelve of whom had type 1 Stickler syndrome (COL2A1 mutation) and one type 2 Stickler syndrome (COL11A1 mutation). The position of maxilla and mandible relative to the cranial base was not significantly different from the reference population (S-N-A: p = 0.73, S-N-B: p = 0.43). The mandibular plane and y-axis showed an elevated angle with the cranial base in most patients, although not significant for the total group (S-N to Go-Me: p = 0.20, S-N to S-Gn: p = 0.18). Dental analysis was normal, except for a higher overjet value (p = 0.006) and a higher angle between occlusal plane and Frankfort plane (p = 0.022)., Conclusion: Cephalometric analysis was not able to thoroughly prove the abnormal facial appearance in Stickler syndrome. The majority of patients had normal dentofacial proportions. The most frequently observed anomaly in our series is a rather short and posteriorly rotated mandible, but clinical variability is high., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of the current pilot study is to investigate the efficacy of a novel enhanced vitreous imaging (EVI) in primary macular holes (MHs) using a spectral-domain optical coherence tomography (SD-OCT). Thirty-four eyes of 32 consecutive patients with a MH were examined in one time cross-sectional study. The vitreomacular interface was assessed using SD-OCT with conventional and EVI technique. Twenty-three of the 34 eyes did not show a Weiss ring, and in 22 of those, we observed a MH with an open roof or operculum and a detached posterior vitreous cortex with conventional vitreous imaging. Using EVI-OCT, we visualized the reflection of the posterior vitreous with a vitreopapillary attachment. One of the 23 eyes without a Weiss ring had a central round retinal defect without an operculum, and the conventional SD-OCT showed an empty vitreous, suggesting a complete posterior vitreous detachment. However, the EVI-OCT revealed the reflection of the posterior vitreous, and the cortex appeared to still be completely attached. In all the 23 eyes without a Weiss ring, EVI-OCT detected the reflection of the posterior vitreous and vitreopapillary attachment. In all 11 eyes with a Weiss ring (stage 4 hole), EVI-OCT showed an optically empty space in the posterior vitreous cavity without a vitreopapillary attachment. EVI-OCT may be a new reliable method for preoperative evaluations to determine the presence or absence of a complete posterior vitreous detachment in macular diseases with an indistinct Weiss ring.

Background: The purpose of this study was to evaluate the extension and traction effects of posterior vitreous detachment (PVD) complicated with retinal tears using spectral domain optical coherence tomography (OCT) and B-scan ultrasonography., Methods: Complete ophthalmological examination, B-scan ultrasonography and spectral domain OCT were performed in patients with acute PVD and retinal tears. Vitreous detachment was classified as complete or incomplete, based on extent of posterior pole or peripheral vitreous detachment. Retinal tear location and persistent traction on the retinal flap was evaluated with B-scan ultrasonography and OCT. Categorical data were evaluated with Fisher's exact test. Statistical significance was considered as P < 0.05., Results: Twenty-six eyes of 25 patients were assessed. Four eyes (15 %) presented complete PVD with detachment at the posterior pole and periphery. 22 eyes (85 %) presented incomplete PVD with detachment in the periphery. Twenty eyes presented retinal tears in the superior quadrants with respect to only 6 in the inferior quadrants (p = 0.006). There was a higher incidence of retinal tears in the pre with respect to post-equatorial areas (19 vs 7 eyes, p = 0.019). B-scan ultrasonography and OCT revealed persistent traction on the retinal tear flap in 19 and 15 eyes, respectively., Conclusions: In acute PVD, retinal tears are prevalently associated with peripheral vitreous detachment. The impact of complete or incomplete PVD can be of clinical value when evaluating patients with retinal tears.

Treatment is usually indicated for symptomatic vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) and without spontaneous resolution. Ultrastructural parameters are evaluated by SD-OCT, in order to classify the vitreoretinal interface and to estimate the success rate of treatment. The resolution rate after therapy with intravitreal Jetrea® (Ocriplasmin) is high (up to 70 %) in patients with symptomatic focal vitreomacular traction (≤ 1500 µm) with or without a macular hole (≤ 250 µm) and with no epiretinal membrane (ERM), but depends on the exact baseline analysis. All other patients with idiopathic traction retinopathy should be treated by minimal invasive pars plana vitrectomy (MIVI). Vitreoretinal surgery effectively removes traction and gives a high closure rate of a full thickness macular hole (FTMH, 90 to 100 %). It is now a very safe procedure with few side effects. Despite a low risk profile (cataract, retinal tear etc.) the indication for surgery needs to take the safety profile into account. Therefore vitrectomy is only indicated in symptomatic patients complaining of blurred vision, VA reduction and metamorphopsia. Vitrectomy is also indicated in patients whose treatment by pharmacologic vitreolysis has failed., (Georg Thieme Verlag KG Stuttgart · New York.)

This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

Aim: Posterior vitreous detachment (PVD) is a physiological phenomenon due to aging characterized by separation of the vitreous cortex from the retina and may induce a variety of pathological events at the vitreoretinal junction. The aim of this study is to highlight in vivo anatomical and functional changes in early stages of PVD allowing the correct treatment., Material and Methods: Non-consecutive case series; optical coherence tomography (OCT) relies on analyzing the reflectivity of coherent light from different anatomical interfaces within posterior vitreous and retinal histological layers, thus acquiring transverse sections through vitreoretinal interface, sensory retina, retinal pigment epithelium and choroid. Modern techniques using Fourier spectral analysis of the reflected light enhance axial resolution to 5-10 μm, almost matching classic histological sections. Integrating these sections, OCT can reconstruct three-dimensional tissue anatomy. Full-field electroretinogram (ERG) evaluates the function of the entire retina evoked by a flash light., Results: Imaging of the vitreoretinal interface with OCT allowed staging PVD and correctly diagnosing its secondary pathologies: cystoid macular edema, vitreomacular traction syndrome, epiretinal membrane, macular pucker, macular hole, macular pseudohole, lamellar macular hole. The cone response of full-field ERG is a marker of retinal damage in macular pathology due to PVD., Conclusions: Correct understanding of vitreoretinal anatomic and functional changes due to posterior vitreous detachment is essential for a proper diagnosis and treatment.

Background: The inner retinal complex is a well-defined layer in spectral-domain OCT scans of the retina. The central edge of this layer at the fovea provides anatomical landmarks that can be observed in serial OCT scans of developing full-thickness macular holes (FTMH). Measurement of the movement of these points may clarify the mechanism of FTMH formation., Method: This is a retrospective study of primary FTMH that had a sequence of two OCT scans showing progression of the hole. Measurements were made of the dimensions of the hole, including measurements using the central edge of the inner retinal complex (CEIRC) as markers. The inner retinal separation (distance between the CEIRC across the centre of the fovea) and the Height-IRS (average height of CEIRC above the retinal pigment epithelium) were measured., Results: Eighteen cases were identified in 17 patients. The average increase in the base diameter (368 microns) and the average increase in minimum linear dimension (187 microns) were much larger than the average increase in the inner retinal separation (73 microns). The average increase in Height-IRS was 103 microns., Conclusion: The tangential separation of the outer retina to produce the macular hole is much larger than the tangential separation of the inner retinal layers. A model based on the histology of the Muller cells at the fovea is proposed to explain the findings of this study.

Purpose: To evaluate the resolution rate in patients with symptomatic vitreomacular traction (≤ 1500 μm) with or without macular holes (≤ 400 μm) after therapy with intravitreal ocriplasmin (Jetrea®) injection in a clinical setting., Methods: Until now we have prospectively examined 21 eyes of 21 consecutive patients with symptomatic vitreomacular traction with or without macular holes who underwent intravitreal operative injection of 0.1 ml ocriplasmin. The best corrected visual acuity and high-resolution optical coherence tomography (SD-OCT) ultrastructural parameters were measured before injection and again 1, 3 and 4 months after treatment. The numbers of resolved vitreomacular traction and closed macular holes were documented., Results: Vitreomacular traction was resolved in 15 out of 21 (71 %) eyes. Of the five eyes which initially presented with vitreomacular traction with macular holes, all showed resolution of vitreomacular traction but only two of the macular holes were closed. The average best corrected visual acuity was 0.38 logMAR (± 0.23) at baseline and 0.43 logMAR (± 0.28), 0.38 logMAR (± 0.27) and 0.36 logMAR (± 0.24) 1, 3 and 4 months after injection, respectively. The average foveal thickness was 355.95 μm (± 114.53 μm) at baseline, reducing to 304.61 μm (± 100.91 μm), 308.00 μm (±76.17 μm) and 277.50 μm (± 26.24 μm) after 1, 3 and 4 months, respectively., Conclusion: In this ongoing study there was a high percentage of resolution of vitreomacular traction (71 %) 1 month after intravitreal operative injection of Jetrea® and closure of two out of five macular holes. This was further associated with stabilization of visual acuity and reduction of foveal thickness. Further investigations are necessary to document the effectiveness of the pharmacological vitreolysis in a clinical setting.

Purpose: The aim of this study was to evaluate the relationship between oxidative stress and human vitreous degeneration, using the presence of an evident posterior vitreous detachment (PVD) as a clinical sign and thiobarbituric acid-reactive substances (TBARS) and nitrite as oxidative biomarkers., Methods: We collected 42 vitreous samples from patients undergoing pars plana vitrectomy for two groups of vitreoretinal diseases (macular holes and epimacular membranes). TBARS and nitrite were assessed spectrophotometrically and compared to the presence of an evident PVD, considering other clinical features potentially related to the oxidative stress in the vitreous: diabetes, plasma fibrinogen, type of intraocular lens (IOL), and the vitreoretinal disease requiring the surgery., Results: Vitreous TBARS levels were significantly higher in patients with artificial IOLs compared to those with natural lenses and cataracts (1.39±0.64 versus 0.75±0.45; p=0.003). Furthermore, patients with PVD had a significant increase in vitreous TBARS compared to those without PVD (1.45±0.54 versus 0.53±0.38; p=0.001). The plasma fibrinogen levels explained 17% of the TBARS variance, with a significant correlation between these two markers (p=0.011). No significant differences were observed when nitrites were used as biomarkers., Conclusions: Current IOLs, even with ultraviolet (UV) absorber, do not ensure the same photoprotection offered by natural lenses affected by corticonuclear cataracts. Furthermore, we observed a relevant correlation between the increased presence of peroxidation products in the vitreous and an evident PVD, but the nature of this relationship requires further study.

Purpose: The purpose of this study was to demonstrate the efficacy of the digital fluoroscopy system (DFS) for the in vivo assessment of pharmacologically induced posterior vitreous detachment (PVD) and vitreous liquefaction in a rabbit model., Methods: Twenty eyes from 10 New Zealand white rabbits were divided into 5 groups. In each group, one rabbit received an intravitreal injection of 2.0 U plasmin in the right eye and 0.5 U plasmin in the left eye. Intravitreal injection of 0.1 mL balanced salt solution (BSS) was given in the right eye, and no injection was given in the left eye of another rabbit used as a control. Intraocular fluid dynamics were assessed by the DFS, using a contrast agent in each group at different time intervals (6 hours, 12 hours, 1 day, 3 days, and 7 days). After rabbits were killed, both eyes were enucleated. Scanning electron microscopy was used to confirm the morphological alterations of the vitreoretinal interface as observed in the DFS., Results: Complete PVD was observed after 12 hours with 2.0 U plasmin injection, whereas complete PVD was observed only after 3 days in eyes injected with 0.5 U plasmin. Eyes that received BSS injection or did not receive an injection failed to show complete PVD even after 7 days. Complete vitreous liquefaction was observed after 7 days with 2.0 U plasmin injection, but no eyes with 0.5 U plasmin or BSS injection showed complete liquefaction. We could clearly confirm the presence of PVD and the degree of vitreous liquefaction by using DFS., Conclusions: Digital fluoroscopy system appears to be a useful tool for the evaluation of pharmacological vitreolysis in rabbits with clear in vivo visualization of PVD and vitreous liquefaction.

The postmortem retinal fold has been previously documented, but its mechanism of formation is not known. All previous studies of the fold involved invasive techniques and the postmortem ocular fundus has yet to be non-invasively examined. Our study used the non-invasive techniques of monocular indirect ophthalmoscopy and ocular echography to examine 79 postmortem eyes of 42 bodies. We examined whether the postmortem retinal fold was associated with postmortem time, position, and/or age. Age was significantly associated with postmortem retinal fold formation (Mann-Whitney U test, P = 0.013), which led us to examine the effect of posterior vitreous detachment (PVD) on retinal folds. The absence of a PVD was statistically associated with the presence of a retinal fold (Fisher's exact test, P < 0.0001). Interestingly, the presence of a PVD was also significantly correlated with retinal fold height (Mann-Whitney U test, P < 0.0001). Therefore, we hypothesized that retinal folds result from postmortem vitreoretinal traction caused by eyeball flaccidity. We also believe that the loss of retinochoroidal hydrostatic pressure plays a role. It is important that forensic pathologists not confuse a postmortem retinal fold with traumatic retinal detachment or perimacular retinal folds caused by child abuse. When child abuse is suspected, forensic pathologists should perform enucleation and a subsequent histological examination for confirmation., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: The introduction and approval of Ocriplasmin as an intravitreally applicable drug in the pharmocological treatment of vitreomacular traction represents a new therapeutic approach possibly avoiding vitreoretinal surgery. With our article we report our first experience wih Ocriplasmin in clinical practice., Methods: The indication for intravitreal therapy with Ocriplasmin was provided for symptomatic VMT or macular hole with VMT in 20 patients since March 2013. Surgery was planned in cases with remaining symptoms. Before IVI we performed SD-OCT. Best visual acuity (BCVA) was evaluated preoperatively, 7 and 28 days after treatment and finally every month in 14 treated eyes. SD-OCT images were analysed before treatment and later on with every follow-up examination. In addition to functional and morphological changes we analysed all side effects., Results: The mean BCVA at the beginning of treatment was 0.3 and 0.4 before injection. The indications for treatment were as follows: symptomatic VMT in 10 patients and 4 patients suffering from full thickness macular hole stage 2. In 3 patients spontaneous regression of VMT could be observed with increasing of vision from 0.3 to 0.5. In one patient his macular hole was closed and BCVA increased from 0.2 to 0.6 within 7 days. Two patients showed significant enlargement of their macular holes after 7 days and finally underwent surgery. A massive cystoid macular oedema occurred in one patient. No change in the SD-OCT image could be observed 28 days after treatment. The mean visual acuity improved to 0.6 during a follow-up period of 90 days. Photopsia and disturbing vitreous opacities up to 28 days post injection could be regarded as minor side effects., Conclusion: Our first clinical experience with intravitreous injection of Ocriplasmin were performed to confirm the presumed therapeutic effect in patients suffering from VMT. Small macular holes could frequently be closed. The possibility of special side effects must be taken in consideration just as the possibility of spanteous improvement before performing IVI with Ocriplasmin. Further prospective studies must be recommended to be right about Ocriplasmin injections., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To find the reliability of ocular ultrasonography (USG) for pre-surgical evaluation in various vitreo-retinal conditions., Method: In a retrospective study, a chart review of patients who underwent preoperative USG for various vitreoretinal conditions was done. We correlated findings of preoperative USG with intraoperative findings., Results: 131 of 130 patients were included. Various ocular pathologies included trauma, diabetic vitreous hemorrhage, endophthalmitis, and other causes of vitreous hemorrhage. We found overall sensitivity and specificity of 92.31% and 98.31% for identification of rhegmatogenous retinal detachment, and 96.2% and 100% for posterior vitreous detachment, respectively, whereas it was 100% for vitreous hemorrhage, preretinal bleed, and vitreous exudates. In eyes with trauma, sensitivity and specificity of USG for identifying the status of retina was least (90.9% and 97.7%)., Conclusion: Our study highlighted that the reliability of USG findings was least in cases of trauma, hence requiring special care while reporting.