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Oman Journal of Ophthalmology 2024Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case...
Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case of a 75-year-old female who came with decreased vision in the left eye (LE) following cataract surgery under peribulbar block. Her visual acuity in the right eye (RE) was 6/24 and LE was 6/75. Fundus examination of LE showed vitreous hemorrhage with localized subretinal hemorrhage along the inferotemporal arcade suggestive of globe perforation. Optical coherence tomography (OCT, Spectralis. Heidelberg imaging, Germany) scan across the perforation site showed subretinal hemorrhage and full-thickness retinal tear. On follow-up, two more focal points of retinal whitening were noted in the inferotemporal equatorial region. The patient was kept under close monitoring, and 4 weeks later, vision improved to 6/9 and barrage laser was done around the perforation sites. Serial OCT scans and close follow-up in iatrogenic globe perforation can result in good visual outcomes.
PubMed: 38524350
DOI: 10.4103/ojo.ojo_38_22 -
Scientific Reports Mar 2024This study aims to propose a generative deep learning model (GDLM) based on a variational autoencoder that predicts macular optical coherence tomography (OCT) images...
This study aims to propose a generative deep learning model (GDLM) based on a variational autoencoder that predicts macular optical coherence tomography (OCT) images following full-thickness macular hole (FTMH) surgery and evaluate its clinical accuracy. Preoperative and 6-month postoperative swept-source OCT data were collected from 150 patients with successfully closed FTMH using 6 × 6 mm macular volume scan datasets. Randomly selected and augmented 120,000 training and 5000 validation pairs of OCT images were used to train the GDLM. We assessed the accuracy and F1 score of concordance for neurosensory retinal areas, performed Bland-Altman analysis of foveolar height (FH) and mean foveal thickness (MFT), and predicted postoperative external limiting membrane (ELM) and ellipsoid zone (EZ) restoration accuracy between artificial intelligence (AI)-OCT and ground truth (GT)-OCT images. Accuracy and F1 scores were 94.7% and 0.891, respectively. Average FH (228.2 vs. 233.4 μm, P = 0.587) and MFT (271.4 vs. 273.3 μm, P = 0.819) were similar between AI- and GT-OCT images, within 30.0% differences of 95% limits of agreement. ELM and EZ recovery prediction accuracy was 88.0% and 92.0%, respectively. The proposed GDLM accurately predicted macular OCT images following FTMH surgery, aiding patient and surgeon understanding of postoperative macular features.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Artificial Intelligence; Deep Learning; Retina; Retrospective Studies
PubMed: 38519532
DOI: 10.1038/s41598-024-57562-5 -
International Ophthalmology Mar 2024It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This...
PURPOSE
It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments.
METHODS
A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager.
RESULTS
A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length.
CONCLUSIONS
The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.
Topics: Humans; Vitreous Detachment; Phacoemulsification; Prospective Studies; Vitreous Body; Retinal Perforations; Retinal Detachment
PubMed: 38512501
DOI: 10.1007/s10792-024-03091-z -
Retina (Philadelphia, Pa.) Jul 2024To report a technique consisting of inverted internal limiting membrane (ILM) flap coverage with autologous blood after air-fluid exchange and silicone oil tamponade in...
Inverted Internal Limiting Membrane Flap Coverage With Autologous Blood Technique After Air-Fluid Exchange and Silicone Oil Tamponade for Extensive Macular Hole Retinal Detachment in Highly Myopic Eyes.
PURPOSE
To report a technique consisting of inverted internal limiting membrane (ILM) flap coverage with autologous blood after air-fluid exchange and silicone oil tamponade in treating extensive retinal detachment secondary to a myopic macular hole (MH).
METHODS
This was a retrospective case series. 18 eyes with MHRD extending beyond the equator were included in this study with a minimum follow-up of 6 months. The procedures for pars plan vitrectomy (PPV) included the following: 1) The ILM was peeled to the superior and inferior arcade margins and, except for the ILM in the temporal region, was hinged toward the edge of the MH. 2) Air-fluid exchange was then performed to drain the subretinal fluid through the MH with a flute needle, ensuring that a small amount of subretinal fluid remained to facilitate ILM flap inversion. 3) The ILM flap was used to cover the MH with the assistance of autologous blood.
RESULTS
Six months after surgery, the MH was successfully anatomically closed, and retinal reattachment was observed in all 18 eyes of 18 patients. The mean best-corrected visual acuity logarithm of the minimum angle of resolution (logMAR) improved from 2.03 ± 0.61 (ranging from hand motion [2.6] to finger counting [2.3]) to 1.23 ± 0.63 (ranging from hand motion [2.6] to 20/28 [0.15]) ( P < 0.01) at 6 months.
CONCLUSION
This surgical technique using an inverted ILM flap combined with autologous blood provides an option for the treatment of extensive MHRD.
Topics: Humans; Retrospective Studies; Retinal Perforations; Retinal Detachment; Male; Endotamponade; Female; Surgical Flaps; Vitrectomy; Visual Acuity; Middle Aged; Basement Membrane; Silicone Oils; Tomography, Optical Coherence; Aged; Myopia, Degenerative; Blood Transfusion, Autologous; Follow-Up Studies
PubMed: 38502928
DOI: 10.1097/IAE.0000000000004068 -
Ophthalmology. Retina Jun 2024
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Descemet Membrane; Visual Acuity; Male; Female; Aged; Vitrectomy
PubMed: 38494116
DOI: 10.1016/j.oret.2024.03.011 -
Klinische Monatsblatter Fur... Apr 2024The goals of this study are to evaluate potential long-term visual deterioration associated with retinal pigment epithelial (RPE) tears in patients with neovascular...
BACKGROUND
The goals of this study are to evaluate potential long-term visual deterioration associated with retinal pigment epithelial (RPE) tears in patients with neovascular age-related macular degeneration (nAMD) and to find treatment-related and morphological factors that might influence the outcomes.
PATIENTS AND METHODS
This retrospective study enrolled 21 eyes of 21 patients from the database of Vista Eye Clinic Binningen, Switzerland, diagnosed with RPE tears, as confirmed by spectral domain optical coherence tomography (SD-OCT), with a minimum follow-up period of 12 months. Treatment history before and after RPE rupture with anti-VEGF therapy, visual acuity, and imaging (SD-OCT) were analyzed and statistically evaluated for possible correlations.
RESULTS
Mean patient age was 80.5 ± 6.2 years. The mean length of total follow-up was 39.7 ± 13.9 months. The mean pigment epithelial detachment (PED) height increased by 363.8 ± 355.5 µm from the first consultation to 562.8 ± 251.5 µm at the last consultation prior to rupture. Therefore, a higher risk of RPE rupture is implied as a result of an increase in PED height (p = 0.004, n = 14). The mean visual acuity before rupture was 66.2 ± 16.0 letters. Mean visual acuity deteriorated to 60.8 ± 18.6 letters at the first consultation after rupture (p = 0.052, n = 21). A statistically nonsignificant decrease in vision was noted in the follow-up period. After 2 years, the mean BCVA decreased by 10.5 ± 23.7 ETDRS letters (p = 0.23, n = 19). PED characteristics before rupture and amount of anti-VEGF injections after rupture did not affect the visual outcome. None of the 21 patients included in our study showed a visual improvement in the long-term follow-up. RPE atrophy increased significantly from 3.35 ± 2.94 mm (baseline) to 6.81 ± 6.25 mm over the course of 2 years (p = 0.000 013, n = 20).
CONCLUSIONS
The overall mean vision decrease after rupture was without statistical significance. There was no significant change in BCVA at the 2-year follow-up, independent of the amount of anti-VEGF injections provided. In this study, there was a significant increase in RPE defect over a follow-up of 2 years, implying progression of contraction of RPE and/or macular atrophy.
Topics: Humans; Female; Male; Retinal Pigment Epithelium; Follow-Up Studies; Aged, 80 and over; Retrospective Studies; Aged; Retinal Perforations; Wet Macular Degeneration; Visual Acuity; Tomography, Optical Coherence; Regeneration; Longitudinal Studies; Treatment Outcome; Vision Disorders; Angiogenesis Inhibitors
PubMed: 38484787
DOI: 10.1055/a-2248-9986 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024To analyze the changes in optical coherence tomography angiography(OCTA)-related parameters before and after idiopathic macular hole (IMH) internal limiting membrane...
To analyze the changes in optical coherence tomography angiography(OCTA)-related parameters before and after idiopathic macular hole (IMH) internal limiting membrane (ILM) flap inversion surgery and assess their impact on retinal sensitivity. A retrospective case series study was conducted, collecting clinical data of 30 patients (30 eyes) diagnosed with IMH who underwent vitrectomy combined with ILM flap inversion surgery at Shanxi Eye Hospital, affiliated with Shanxi Medical University, between January 2020 and December 2021. Visual acuity and best-corrected visual acuity were examined preoperatively and at 1, 3, and 6 months postoperatively. Microperimetry measured retinal sensitivity (RS), and OCTA measured retinal thickness (RT) as well as vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Statistical analysis was performed using t-tests, repeated measures analysis of variance, and Pearson correlation analysis. Thirty patients with IMH (30 eyes) were included, with 3 males (3 eyes) and 27 females (27 eyes). The mean age was (62.5±3.0) years, and the follow-up time was (96.3±1.3) days, with a 100% closure rate of macular holes postoperatively. RT in the macular was significantly lower at 1, 3, and 6 months postoperatively compared to preoperative values (=46.21, <0.001). The RT in the upper macular region showed statistically significant differences at different time points (<0.001). VD in the SCP layer showed no significant differences between the upper and lower macular regions at various time points (=3.21, =0.601). VD in the upper region of the DCP layer increased at 1, 3, and 6 months postoperatively (<0.001). RS in the macular was higher at 1, 3, and 6 months postoperatively compared to preoperative values (=52.01, <0.001). RS in the lower macular region increased at 3 and 6 months postoperatively (<0.001), while in the upper region, it increased only at 6 months postoperatively (<0.001). There was a positive correlation between RS and RT at 1 and 3 months postoperatively, but not at 6 months postoperatively in the upper macular region (=0.40, =0.071). In the lower macular region, there was a positive correlation between RS and RT at 1 and 3 months postoperatively (<0.001). There was no correlation between RS in the upper macular region at 6 months postoperatively and preoperative RT (=0.43, =0.072), but there was a positive correlation with RT at 3 months postoperatively (=0.58, =0.041). After idiopathic macular hole internal limiting membrane flap inversion surgery, the OCTA-related parameters have changed. There are transient changes in deep vascular parameters and thinning of the retinal layers at the ILM inversion site, leading to decreased sensitivity.
Topics: Male; Female; Humans; Middle Aged; Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Retina; Vitrectomy
PubMed: 38462373
DOI: 10.3760/cma.j.cn112142-20230926-00115 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024To utilize a Python-based fluorescence area detection system to observe and quantitatively analyze the intraocular distribution characteristics and metabolic patterns...
[Clinical observation of the intraocular distribution characteristics of indocyanine green after epiretinal membrane peeling using a fluorescence detection system developed in Python].
To utilize a Python-based fluorescence area detection system to observe and quantitatively analyze the intraocular distribution characteristics and metabolic patterns of Indocyanine Green (ICG) following epiretinal membrane peeling. A prospective case series study was conducted on patients with idiopathic epiretinal membrane undergoing vitrectomy at West China Hospital of Sichuan University from March 2019 to March 2021. ICG staining was applied during surgery for peeling the epiretinal membrane and internal limiting membrane. Patients were followed up at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively, with assessments including best-corrected visual acuity, intraocular pressure, fundus photography, near-infrared fundus fluorescence imaging (NIR-FF), and optical coherence tomography (OCT). A Python-based ICG intraocular metabolism detection system was developed to measure the residual area of ICG fluorescence on NIR-FF, predict the ICG metabolic pattern equation, and correlate it with postoperative visual acuity and peripapillary retinal nerve fiber layer thickness. A total of 64 patients (64 eyes) were included, with an average age of 64.6±8.4 years, including 25 males (39.1%) and 39 females (60.9%). Preoperative NIR-FF images showed no ICG strong fluorescence. At 1 week postoperatively, diffuse ICG strong fluorescence appeared in the posterior pole, and the internal limiting membrane removal area exhibited a ring-like weak fluorescence. Over time, ICG strong fluorescence was observed along the vascular arch and nerve fiber trajectory, gradually diminishing toward the optic disc, with residual ICG fluorescence still visible at the optic disc at 1 year. The Python-based ICG fluorescence area detection system effectively measured intraocular residual ICG area. A predictive equation for the 12-month residual ICG area was constructed through linear regression analysis (Residual ICG area=0.22 × Residual ICG area at 6 months, =16%, =0.002). Except for a negative correlation between the ICG residual area at 1 month and postoperative visual acuity (=0.017, =-0.195), no correlation was found between intraocular ICG fluorescence residual area and postoperative visual acuity or peripapillary retinal nerve fiber layer thickness at other follow-up times (all >0.05). In patients with idiopathic epiretinal membrane undergoing ICG staining for internal limiting membrane peeling, ICG exhibits characteristic metabolic processes in the eye, with strong fluorescence along the vascular arch and nerve fiber trajectory, gradually converging toward the optic disc over time. The Python-based ICG fluorescence area detection system provides a clear display of the intraocular distribution characteristics of ICG after epiretinal membrane peeling and serves as a tool for predicting the metabolic patterns of ICG in the eye.
Topics: Male; Female; Humans; Middle Aged; Aged; Indocyanine Green; Epiretinal Membrane; Coloring Agents; Retina; Fundus Oculi; Vitrectomy; Tomography, Optical Coherence; Retrospective Studies; Retinal Perforations; Basement Membrane
PubMed: 38462372
DOI: 10.3760/cma.j.cn112142-20231211-00282 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied...
[Analysis of the therapeutic efficacy of pars plana vitrectomy without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis and central foveal detachment].
To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using -tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (=6.11, <0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (=13.47, <0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 0.79±0.40, =0.85, =0.403; (148.3±63.8)(164.3±137.2)um,=0.48, =0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (=0.433, <0.001). Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.
Topics: Humans; Male; Female; Middle Aged; Aged; Vitrectomy; Myopia, Degenerative; Retrospective Studies; Retinoschisis; Tomography, Optical Coherence; Basement Membrane; Visual Acuity; Retinal Detachment; Retinal Perforations
PubMed: 38462371
DOI: 10.3760/cma.j.cn112142-20231019-00155 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024Internal limiting membrane (ILM) peeling is a critical step in the process of macular hole surgery, giving rise to various modified techniques such as ILM flip-over...
Internal limiting membrane (ILM) peeling is a critical step in the process of macular hole surgery, giving rise to various modified techniques such as ILM flip-over coverage, ILM and other tissue tamponade procedures, and foveal-sparing ILM peeling. All these approaches aim to improve the postoperative closure rate of macular holes. The goal of macular hole surgery is to better preserve the integrity of the foveal center structure, with the aim of achieving functional recovery on the basis of anatomical restoration. However, in clinical practice, there is a tendency to excessively choose certain surgical methods solely to pursue the closure rate of the hole, which may not be beneficial for the visual function recovery of the patients. This article discusses how to correctly select the internal limiting membrane and its derivative procedures in macular hole surgery, combining clinical practice and relevant domestic and international research literature. It aims to provide insights for colleagues performing macular hole surgery as a reference regarding this clinical focus issue.
Topics: Humans; Retinal Perforations; Vitrectomy; Epiretinal Membrane; Treatment Outcome; Retrospective Studies; Basement Membrane
PubMed: 38462369
DOI: 10.3760/cma.j.cn112142-20231225-00307