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Purpose. We compared the incidences of iatrogenic retinal breaks and postoperative retinal detachment between eyes that underwent 20-gauge vitrectomy and those that underwent 25-gauge vitrectomy for idiopathic macular hole repair. Methods. This retrospective nonrandomized consecutive observational case series included 185 eyes of 183 patients (130 eyes of 129 patients and 55 eyes of 54 patients in the 20- and 25-gauge groups, respectively). We assessed the relationship between the incidence of retinal breaks and postoperative retinal detachment and related this to posterior vitreous detachment and lattice degeneration. Results. The incidences of iatrogenic retinal breaks were 36.9% and 12.7% in the 20-gauge and 25-gauge groups, respectively. These groups did not differ in their respective frequencies of posterior vitreous detachment (the 20-gauge group: 31.5% and the 25-gauge group: 27.3%) and lattice degeneration (the 20-gauge group: 14.6% and the 25-gauge group: 7.3%). Among eyes without lattice degeneration, the 20-gauge group showed a higher incidence of iatrogenic retinal breaks than the 25-gauge group. However, among the eyes with lattice degeneration, the frequency of retinal breaks did not differ between the two surgery types, and four cases of postoperative retinal detachment were reported in both groups. Conclusions. The incidence of retinal breaks related to idiopathic macular hole surgery is higher among patients undergoing 20-gauge vitrectomy than among those undergoing 25-gauge vitrectomy. Posterior vitreous detachment and lattice degeneration are associated with considerably increased incidences of retinal break.

Purpose. We evaluated the association between optic nerve head (ONH) microcirculation and macular ganglion cell complex (mGCC) thickness in patients with untreated normal tension glaucoma (NTG) and a hemifield defect. Methods. The medical records of 47 patients with untreated NTG were retrospectively reviewed. Laser speckle flowgraphy was used to obtain mean blur rate (MBR), a relative measure of blood flow. Average total deviation (TD), mGCC, and the circumpapillary retinal nerve fiber layer (cpRNFL) thickness were also analyzed. Results. All parameters corresponding to the defective hemifield were significantly lower than those corresponding to the normal hemifield. In the defective hemifield, MBR was correlated with TD, mGCC, and cpRNFL thickness. In the normal hemifield, MBR was only correlated with mGCC thickness, and multiple regression analysis showed that mGCC thickness was a significant contributing factor of the MBR. Conclusion. MBR was well correlated with mGCC thickness in eyes with untreated NTG and a hemifield defect. In the normal hemifield, mGCC thickness was a contributing factor of the MBR indicating that ONH circulatory dysfunction may be associated with retinal structural changes in the early stages of glaucoma. A reduction in ONH microcirculation may be an early indicator of the presence and progression of glaucoma.

When internal carotid artery stenosis is accompanied by ocular ischemic syndrome, intervention is recommended to prevent irreversible visual loss. In this study, we used laser speckle flowgraphy to measure the ocular microcirculation in the optic nerve head before and after carotid artery stenting (CAS) of 40 advanced internal carotid stenosis lesions from 37 patients. The aim was to investigate the relationship between ocular microcirculation and the direction of ophthalmic artery blood flow obtained by angiography. We found that there was a significant increase in blood flow after CAS (P=0.003). Peak systolic velocity as an indicator of the rate of stenosis was also significantly higher in the group with retrograde/undetected flow of the ophthalmic artery than in the group with antegrade flow (P=0.002). In all cases where retrograde flow of the ophthalmic artery was observed before stenting, the flow changed to antegrade after stenting. Through the use of laser speckle flowgraphy, this study found that CAS can improve ocular microcirculation. Furthermore, while patients displaying retrograde flow of the ophthalmic artery before stenting have a poor prognosis, CAS corrected the flow to antegrade, suggesting that visual loss can be prevented by improving the ocular microcirculation.

Purpose. To evaluate the relationships among the optic nerve head (ONH) area, macular ganglion cell complex (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field defects in patients with primary open angle glaucoma (POAG). Methods. This retrospective study included 90 eyes of 90 patients with POAG. The ONH area, rim area, mGCC thickness, and cpRNFL thickness were measured using optical coherence tomography. Mean deviation (MD) was measured using standard automated perimetry. The relationships among clinical factors including age, refraction, the ONH area, the rim area, the mGCC thickness, the cpRNFL thickness, and MD were evaluated using correlation coefficients and multiple regression analyses. Results. The significant correlation of the ONH area with refraction (r=0.362, P

Purpose. To evaluate the outcome of combined vitrectomy with phacoemulsification without postoperative face-down positioning for idiopathic macular holes (MHs). Design. Retrospective, observational case series. Participants. Forty-two eyes of 42 patients with MH. Methods. We studied 42 eyes of 42 cases followed up for 6 months postoperatively. MH closure rate and preoperative and postoperative visual acuity (VA) were evaluated. Main Outcome Measures. MH closure rate and VA were evaluated after combined vitrectomy with phacoemulsification without postoperative face-down positioning. Results. Of the 42 holes, 40 (95.2%) were initially closed, and the final closure rate was 100%. Compared with preoperative VA, the mean VA was significantly improved at 1 month and the improvement was maintained for at least 6 months postoperatively. Conclusions. Combined vitrectomy with phacoemulsification without postoperative face-down positioning produced favorable anatomic and functional results for MH repair. Improvement in VA can be expected for up to at least 6 months postoperatively.

Abstract Purpose  To evaluate the efficacy of vitrectomy with internal limiting membrane (ILM) peeling and SF6 gas tamponade for macular holes without face-down positioning. Methods  Twenty-one eyes of 21 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and 20% SF6 gas tamponade without face-down positioning were included in this study. Biomicroscopy and optical coherence tomography were used to assess macular hole closure. Pre- and postoperative visual acuities (VAs) were compared. Results  Among the 21 eyes, five (23.8%) had stage 2, 11 (52.4%) stage 3, and five (23.8%) stage 4 macular holes. Mean macular hole size was 0.35 disc diameters. The macular holes had been present for an average of 2.3 months. Twenty eyes (95.2%) were phakic, and one (4.8%) was pseudophakic. Nineteen of the 21 holes (90.5%) initially closed. The final closure rate was 100%, and no eyes showed reopening. Preoperative mean VA (logMAR) was 0.65, and mean VA had significantly improved to 0.46 at 1 month and to 0.42 at 3 months after surgery (P Conclusion  Vitrectomy with ILM peeling and SF6 gas tamponade for macular holes without face-down positioning achieved favorable anatomical and functional results. [ABSTRACT FROM AUTHOR]

Abstract Purpose  Results of vitreous surgery alone in patients with diabetic macular edema (Vit group) were compared with results of surgery combined with peeling of the internal limiting membrane (ILM group), and surgery combined with removal of the residual vitreous cortex after its visualization using triamcinolone acetonide (TA) and a postoperative intravitreal TA injection (TA group). Visual acuities after the operation, degree of improvement in visual acuity (VA), and intra- and postoperative complications were evaluated. Methods  The study included 141 consecutive patients (168 eyes) who could be followed up for at least 12 months after the operation. The Vit group consisted of 66 eyes, the ILM group of 62 eyes, and the TA group of 40 eyes. Patient background factors, and visual acuities 6 and 12 months after operation were evaluated first, and at the final examination, the degree of improvement in VA, the incidences of intra- and postoperative complications, and the incidence of intraocular pressure ≥25 mmHg were studied. Results  Preoperative VA was compared with the 6- and 12-month postoperative VA and the VA at the final examination. The preoperative to 6 months postoperative improvements and those between the 12-month postoperative and final examination did not differ among the three groups. However, the degree of improvement in VA between 6 and 12 months after the operation was significantly smaller in the TA group than in the other two groups. The incidences of intra- and postoperative complications did not differ among the three groups, but the incidence of intraocular pressure ≥25 mmHg was slightly higher in the TA group. Conclusion  Surgical results did not differ among the three operative techniques examined in this study. [ABSTRACT FROM AUTHOR]