Search Results (42)

Pathologic myopia has become a major global cause of blindness, making timely surgical management for myopic traction maculopathy (MTM) increasingly important. This study aimed to identify prognostic factors associated with functional and anatomical outcomes following surgery for MTM and to determine the optimal timing for intervention. This retrospective study included 33 eyes from 28 patients with MTM without full-thickness macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Better preoperative best-corrected visual acuity (BCVA) and lower foveal height were associated with better postoperative BCVA, whereas longer axial length, higher MTM, and higher Atrophy–Traction–Neovascularization (ATN) classification grade were correlated with thinner postoperative central foveal thickness. Foveal detachment (FD), ellipsoid zone (EZ) disruption, and advanced MTM grade were associated with poorer functional and anatomical outcomes. Postoperative visual outcomes should be interpreted with caution, as they may have been influenced by lens-related factors, including combined cataract surgery, post-vitrectomy cataract progression, and posterior capsule opacity. Nonetheless, consistent anatomical improvement was observed, supporting early surgical consideration in eyes with MTM showing progressive macular traction or EZ disruption, even in the absence of FD. These findings highlight the importance of serial OCT monitoring and individualized surgical timing based on preoperative assessments. Full article

Objectives: We aimed to visualize the interaction of intravitreal gas with the adjacent vitreomacular interface by using prone position (PP) SD-OCT and suggest possible mechanisms of action behind gas-induced posterior vitreous detachment (PVD) in pneumatic vitreolysis (PV). Methods: This was a descriptive–interpretative morphological study. Spectral domain OCT imaging in PP was carried out using a flexible scanning module (SD-OCT-Flex, Heidelberg Engineering) originally designed for bedside imaging. Routine imaging in sitting position was carried out using a regular SD-OCT-device (Heidelberg Engineering). Patients with symptomatic vitreomacular traction (VMT) scheduled for PV with perfluoropropane (C3F8, 0.3 mL) received both sitting and PP imaging immediately before and at regular follow-up visits during the first 3 post-procedural weeks, beginning 3 h after PV. Imaging was reviewed for positional changes of the gas bubble, posterior hyaloid membrane (PHM), VMT configuration, and retrohyaloidal fluid (RHF). Results: Three consecutive patients with VMT were included (age: 79, 80, 82 years). Before the procedure, no positional alterations were detected. After the intravitreal injection of gas, PP allowed for the precise discrimination of the PHM and the posterior border of the gas bubble. In contrast to regular SD-OCT in sitting position, PP imaging showed a flattened VMT by the gas bubble with consecutive displacement of RHF from the macular region to the midperiphery. Conclusions: This exploratory study describes PP imaging as a tool for the assessment of the morphologic dynamics between the posterior hyaloid membrane, retina, and gas bubble in pneumatic vitreolysis. PP in pneumatic vitreolysis causes the gas bubble to flatten the VMT and to push retrohyaloidal fluid to the midperiphery, possibly allowing for the release of persistent vitreoretinal adhesions and consequent PVD induction. Full article

Background: Evidence guiding secondary repair of persistent full-thickness macular holes (FTMHs) remains limited and heterogeneous. Temporal arcuate relaxing retinotomy has been described as a salvage maneuver intended to increase temporal retinal compliance, yet functional safety data are scarce. We report consecutive real-world outcomes of temporal arcuate relaxing retinotomy for persistent FTMHs after failed standard repair(s). Methods: Retrospective consecutive case series of patients with persistent FTMH after ≥1 pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, treated with repeat PPV and temporal arcuate relaxing retinotomy. Outcomes included OCT (Optical Coherence Tomography)-confirmed closure after gas absorption and best-corrected visual acuity (BCVA, logMAR), ellipsoid zone (EZ) status, retinotomy-site morphology on OCT/fundus autofluorescence (FAF), and safety/functional outcomes (systematic scotoma symptom inquiry; Humphrey visual field testing when feasible). Exact binomial 95% confidence intervals (CI) were calculated for proportions. Results: Nine eyes (median age 70 years; range 55–76) underwent temporal arcuate relaxing retinotomy for persistent FTMH. Minimum linear diameter ranged 412–1037 µm (median 613 µm). OCT-confirmed closure was achieved in 7/9 eyes (77.8%; 95% CI 40.0–97.2) at a mean follow-up of 5.9 months (range 2–12). BCVA improved in 8/9 eyes (88.9%; 95% CI 51.8–99.7); mean BCVA improved from 1.26 ± 0.51 logMAR pre-operatively to 0.61 ± 0.18 logMAR at last follow-up (mean change −0.64 logMAR; Wilcoxon signed-rank test p = 0.011). As a sensitivity analysis, the paired t-test yielded p = 0.008. Humphrey visual fields were obtained in 6/9 eyes; one patient reported a new paracentral nasal scotoma, which was subjectively well tolerated. Conclusions: In this small consecutive series, temporal arcuate relaxing retinotomy was associated with a 78% closure rate and mean BCVA improvement in eyes with persistent FTMH after failed standard repair(s), with limited symptomatic scotoma reporting in those assessed. Given the retrospective design, small cohort, and incomplete standardized functional testing, larger comparative studies with uniform functional endpoints (microperimetry, RNFL/GCL metrics, and systematic perimetry) are needed to define patient selection, reproducibility, and relative performance versus contemporary salvage options. Full article

Background/Objectives: The aim of the present study was to identify preoperative functional and anatomical parameters that better predict postoperative best corrected visual acuity (BCVA) after full-thickness macular hole (MH) surgery during long-term follow-up. Methodology: Initial visual outcomes, medical history, retinal imaging data, microperimetry and mfERG measurements were collected to characterise functional and morphological macular status. Results: Among the study subjects, 22 presented with a BCVA > 0.5, and 20 presented with a BCVA ≤ 0.5 at the final visit. Multivariate regression analysis revealed that a smaller minimum MH diameter (OR = 0.98; 95% CI = 0.87–0.99; p = 0.004) and a shorter disease duration (OR =0.11; 95% CI = 0.02–0.53; p = 0.005) were predictors of postoperative long-term BCVA > 0.5. Baseline P wave amplitudes in the central ring on mfERG were positively correlated with postoperative BCVA gain (Rs = +0.53, p = 0.001). Conclusions: Our findings corroborate the significance of hole diameter measurements for postoperative visual outcomes and support the rationale of early intervention. Full article

Background and Objective: To elucidate the clinical characteristics of full-thickness macular holes (FTMHs) with epiretinal proliferation (EP) without posterior vitreous detachment (PVD). Material and Methods: A retrospective and exploratory study reviewed clinical records of patients with FTMHs with EP without PVD (5 eyes: EP group) and FTMHs without EP without PVD (32 eyes: non-EP group). Swept-source OCT images were analyzed for macular structure. Statistical comparisons were made between clinical characteristics and surgical outcomes. Results: The EP group had two eyes with non-closure of macular holes (40%) (p = 0.01) and three eyes with ellipsoid zone defects (60%) (p = 0.01 compared with the non-EP group). Conclusions: Although limited by a small sample size, this pilot study suggests that the observed trends—such as a lower closure rate and more outer retinal disruption in the EP group—may indicate differences in pathogenesis and surgical outcomes compared to the non-EP group. However, these findings should be interpreted with caution due to statistical limitations. Further prospective studies with larger cohorts are needed to validate these preliminary findings and better understand the underlying pathogenesis. Full article

Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, incomplete ILM peeling, and post-operative noncompliance. Multiple surgical techniques exist, though comparative evidence remains limited. Current options include the inverted ILM flap technique, autologous ILM transplantation (free flap or plug), lens capsular flap transplantation (autologous or allogenic), preserved human amniotic membrane transplantation, macular subretinal fluid injection, macular fibrin plug with autologous platelet concentrates, and autologous retinal transplantation. Closure rates range from 57.1% to 100%, with selection depending on hole size, residual ILM, patient posturing ability, etc. For non-posturing patients, fibrin plugs are preferred. Residual ILM cases may benefit from extended peeling or flap techniques, while large holes often require scaffold-based (lens capsule, amniotic membrane) or fibrin plug approaches. Pseudophakic patients should avoid posterior capsular flaps due to lower success rates. Despite promising outcomes, the lack of randomized trials necessitates further research to establish evidence-based guidelines. Personalized surgical planning, considering anatomical and functional goals, remains crucial in optimizing visual recovery in rFTMHs. Full article

Background: Surgical management of large full-thickness macular holes (MHs) remains challenging, particularly when aiming for both rapid visual recovery and consistent anatomical closure without inducing retinal trauma. This retrospective single-center study evaluated the efficacy of activated conditioned plasma (ACP) as an intraoperative coadjuvant supporting ILM (internal limiting membrane) peeling and air tamponade in the treatment of idiopathic MHs measuring 400–800 µm, under real-time intraoperative optical coherence tomography (i-OCT) guidance. Methods: Seventy eyes from fifty patients underwent pars plana vitrectomy with intraoperative ACP application. ACP, a leukocyte-poor autologous platelet concentrate, was used intraoperatively as a coadjuvant to ILM peeling and air tamponade. It facilitated the formation of a transparent fibrin membrane over the retinal surface, supporting edge approximation and promoting retinal healing. Results: The primary outcome was complete MH closure confirmed by OCT; the secondary outcome was improvement in BCVA on postoperative day 7 and during a 12-month follow-up. Anatomical closure was achieved in 98.6% of cases. On day 7, 78.6% of eyes showed a ≥ three-line BCVA improvement, with mean BCVA increasing from 0.25 ± 0.21 to 0.69 ± 0.20 (p < 0.001). These outcomes remained stable throughout the follow-up. No significant intraoperative or postoperative complications were observed. Conclusions: The combination of ACP and i-OCT appears to be a safe and effective strategy for anatomical foveolar reconstruction, enabling early visual recovery while minimizing inflammation and fibrotic scarring associated with conventional techniques. Full article

This pilot study explored whether the ceruloplasmin (CP) and ferritin (FT) levels in ocular fluids could serve as biomarkers for early neurodegenerative diseases (Alzheimer’s, Parkinson’s, and other dementias). CP and FT are known to modulate neurodegenerative tissue responses. We analysed aqueous and vitreous samples from 26 patients (8M/18F, aged 60–85) who were undergoing elective vitreoretinal (VR) surgery. Of these, 14 had idiopathic epiretinal membranes (ERMs), 6 had idiopathic macular holes (MH), and 6 were patients with Alzheimer’s disease (AD) who presented with VR disorders (VRDs). CP, FT, and selected neuroinflammatory mediators such as interferon γ (IFN-γ), interleukin (IL-6), vascular endothelial growth factor (VEGF), nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) were quantified. Odds ratio analysis was applied to assess the CP/FT ratio’s association with subretinal drusen. We found distinct CP and FT profiles in VRD samples. In aqueous fluid, the CP increased and the FT decreased in early-stage ERM, which reduced the CP/FT ratio. Similar patterns were observed in vitreous fluid. The CP levels correlated with the VEGF (aqueous), IL-4 (vitreous), NGF, and BDNF levels; FT correlated with IL-6 and NGF. A higher CP/FT ratio was associated with increased risk for neurodegenerative conditions. Our findings support the quantification of CP and FT in ocular fluids as a promising approach for identifying early neurodegenerative changes and suggest that the CP/FT ratio may be linked to drusen imaging and clinical neurodegenerative history. Full article

Background: The vitreomacular interface (VMI) encompasses a group of retinal disorders that significantly impact vision, requiring accurate classification for effective management. This study aims to compare the effectiveness of an expert-designed custom deep learning (DL) model and a code free Auto Machine Learning (ML) model in classifying optical coherence tomography (OCT) images of VMI disorders. Materials and Methods: A balanced dataset of OCT images across five classes—normal, epiretinal membrane (ERM), idiopathic full-thickness macular hole (FTMH), lamellar macular hole (LMH), and vitreomacular traction (VMT)—was used. The expert-designed model combined ResNet-50 and EfficientNet-B0 architectures with Monte Carlo cross-validation. The AutoML model was created on Google Vertex AI, which handled data processing, model selection, and hyperparameter tuning automatically. Performance was evaluated using average precision, precision, and recall metrics. Results: The expert-designed model achieved an overall balanced accuracy of 95.97% and a Matthews Correlation Coefficient (MCC) of 94.65%. Both models attained 100% precision and recall for normal cases. For FTMH, the expert model reached perfect precision and recall, while the AutoML model scored 97.8% average precision, and 97.4% recall. In VMT detection, the AutoML model showed 99.5% average precision with a slightly lower recall of 94.7% compared to the expert model’s 95%. For ERM, the expert model achieved 95% recall, while the AutoML model had higher precision at 93.9% but a lower recall of 79.5%. In LMH classification, the expert model exhibited 95% precision, compared to 72.3% for the AutoML model, with similar recall for both (88% and 87.2%, respectively). Conclusions: While the AutoML model demonstrated strong performance, the expert-designed model achieved superior accuracy across certain classes. AutoML platforms, although accessible to healthcare professionals, may require further advancements to match the performance of expert-designed models in clinical applications. Full article

Background and Clinical Significance: Full-thickness macular hole (FTMH) is a common retinal condition that impairs detailed vision, with idiopathic causes being the most prevalent. Small macular holes (<250 µm) have the potential for spontaneous closure, whereas larger holes typically require surgical intervention to restore visual acuity (VA). The management of small macular holes remains controversial, as approximately 25% resolve spontaneously. Reporting cases of spontaneous closure may provide evidence to support a conservative, non-surgical approach in such cases. Case Presentation: We report the case of a 65-year-old female patient monitored using spectral domain optical coherence tomography (OCT). She initially presented with unilateral FTMH and subsequently developed an FTMH in the fellow eye during follow-up. Both macular holes closed spontaneously, leading to VA recovery. OCT imaging enabled the identification of vitreomacular traction as the underlying mechanism for hole formation and the bridging process responsible for spontaneous closure. Conclusions: This case highlights the potential for spontaneous anatomical and functional recovery in small-diameter macular holes (<250 µm). A conservative, observational approach may be appropriate in selected cases, potentially avoiding unnecessary surgical intervention. Full article

Background/Objectives: To propose a combined surgery of surgically induced macular detachment (MD) and autologous internal limiting membrane (ILM) transplantation to treat refractory full thickness macular holes (FTMHs). Methods: A series of patients affected by refractory FTMHs underwent a combined surgery. The following demographic and clinical data were collected: age, gender, eye, lens status, and best corrected visual acuity (BCVA). The tomographic pre- and post-operative parameters were the following: pre-operative FTMH diameter, refractory FTMH morphology (flat/with cuff), FTMH closure, foveal profile (regular/flat/inverted), flap displacement, and outer retinal layers restoration. Results: The study included a total of 14 pseudophakic eyes (14 patients). In all of the patients, surgical FTMH closure was reached. The mean BCVA improved after surgery from 1.1 ± 0.14 to 0.48 ± 03 logMAR (p < 0.0001). Statistical analysis demonstrated that the larger the FTMH, the poorer the post-operative gain in BCVA (p −0.5). The post-operative regular foveal profile was obtained in 50% of the eyes with a mean post-operative BCVA of 0.3 logMAR. A negative correlation between the time interval from diagnosis to surgery and post-operative BCVA gain was highlighted (p −0.8). Conclusions: The proposed combined surgical technique led to encouraging anatomical and functional results. Surgically induced MD increased the elasticity of the retina, and the free flap isolated the macular hole from the vitreous chamber favoring its closure. Full article

Background/Objectives: Spontaneous macular hole closure is a rare phenomenon, with lamellar hole epiretinal proliferation (LHEP) frequently implicated as a potential mechanism. This study aims to analyze the presence of LHEP in patients with full-thickness macular holes (FTMHs) or lamellar macular holes (LMHs) that closed spontaneously without intervention. Methods: A retrospective longitudinal analysis of optical coherence tomography (OCT) scans was conducted for 73 patients diagnosed with FTMH or LMH in a single institution. Patients with documented spontaneous hole closure were further analyzed for the presence of LHEP, other OCT findings, and clinical characteristics. Results: Of the 73 patients, eight (11%) exhibited spontaneous closure of their macular holes. LHEP was identified in all cases, regardless of hole type (FTMH or LMH). Associated OCT features on diagnosis included VMT in one eye (13%), partial or complete posterior vitreous detachment in seven eyes (88%) and epiretinal membrane in eight eyes (100%). During hole closure, an outer nuclear layer bridge was noted in six eyes (75%). Various extents of outer retinal recovery were noted following closure. After closure, five holes (63%) remained closed without further intervention, while three (38%) reopened and required surgical intervention. Conclusions: Spontaneous macular hole closure is strongly associated with the presence of LHEP, highlighting its potential role in retinal repair mechanisms. While in most patients the spontaneous closure is permanent, surgical intervention may be necessary in cases of hole recurrence. Full article

Background: This study evaluates changes in the foveal avascular zone (FAZ) area and vessel density in patients with full-thickness macular hole (FTMH) before and after vitrectomy using optical coherence tomography–angiography (OCT-A). Methods: A prospective analysis was conducted on 39 patients diagnosed with FTMH who underwent pars plana vitrectomy. OCT-A imaging was performed preoperatively and at 1 and 3 months postoperatively. Parameters analyzed included FAZ area, superficial (SCP) and deep retinal vessel density (DCP), and central retinal thickness (CRT). Results: Preoperative OCT-A images showed a significant difference in the mean FAZ area between affected and healthy eyes (p < 0.01). However, a significant reduction in superficial capillary plexus (SCP) vessel density was noted after vitrectomy. Visual acuity improved significantly after surgery (p < 0.001), but no significant changes in FAZ or total vessel density were observed postoperatively. Postoperative distance visual acuity (DBCVA) correlated with preoperative macular hole size (p < 0.01). Conclusions: Vitrectomy for FTMH does not significantly alter the FAZ area or DCP vessel density, but does reduce SCP vessel density. OCT-A is a valuable tool for assessing retinal microvascular changes post-vitrectomy. Full article

A macular hole is a defect of the neurosensory retina at the fovea. Post-traumatic holes can occur immediately after blunt trauma, causing severe non-penetrating retinal contusion or after sudden detachment of the vitreous from the retina. Post-traumatic macular holes can close spontaneously or may require vitreoretinal surgery. This paper aims to present the case of an 11-year-old boy with a macular hole following a ball injury. The child reported deterioration of visual acuity. Ophthalmic examination, ocular ultrasound, optical coherence tomography (OCT), perimetry, and a pattern visual evoked potential (VEP) test were performed. On the day of injury, the visual acuity of the right eye was 0.04 and intraocular pressure was 28 mmHg; the eyelid skin was reddened, and superficial conjunctival injection was observed. A fundus examination revealed oedema, pre-retinal haemorrhages, and a macular hole; peripheral retinal oedema in the superior temporal quadrant with pre-retinal haemorrhages was also seen. At the follow-up appointment scheduled 5 months following hospital discharge, visual acuity of the right eye was 0.3 and intraocular pressure was 20 mmHg. Follow-up OCT images of the OD macula were comparable to the findings obtained on the day of hospital discharge, i.e., 10 days after blunt trauma to the right eye. The left-eye OCT did not reveal any abnormalities. Full article

Objectives: The goal was to study the ellipsoid zone (EZ) as a structural biomarker for final visual outcomes after pharmacological intervention in center-involving diabetic macular edema (DME) and surgical intervention for full-thickness macular holes (FTMHs). Methods: This was a tertiary care center-based retrospective study. After sample size calculations, data from 64 consecutive cases were collected, with subjects aged between 40 and 60 years. Thirty-two cases of DME with anti-vascular endothelial growth factor (VEGF) therapy and 32 cases of FTMHs with successful macular hole surgery (MHS) were studied. Spectral-domain optical coherence tomography (SD-OCT) data were collected. Measurements of EZ defects documented at the time of presentation and 12 weeks after intervention were analyzed using the caliper function of the machine. EZ restoration was graded, and a Pearson correlation analysis was performed. Results: Mean logMAR VA decreased after intravitreal therapy (IVT) from 1.12 ± 0.22 pre-intervention to 0.81 ± 0.41 post-intervention and after MHS, from 1.05 + 0.25 to 0.62 + 0.11 (p < 0.001). EZ disruption reduced from 73.4% to 19.4% after IVT and from 67% to 19.3% after MHS. DME and MHS postoperative visual acuity and residual EZ defect were observed to have a statistically significant linear correlation (r = 0.794, p < 0.001 and r = 0.894, p < 0.001, respectively). The EZ was found to be an excellent structural biomarker for final BCVA (area under curve = 0.95 for DME and 1.00 for MHS). Conclusion: Notable EZ restoration results were obtained from pharmacological and surgical interventions. The EZ proves to be a critical structural biomarker for predicting visual outcomes in center-involving DME and MHS. Full article