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To evaluate retrospectively if scleral buckling combined or not to cryopexy reduces fellow-eye retinal detachment (RD) in Stickler syndrome patients who lost their first eye due to RD.Retrospective review of 52 Stickler syndrome patients who received a 6-mm wide, 360° encircling scleral buckling. Thirty-nine (75%; Cryo + Group) also received cryo treatment, whereas the reminder 13/52 (25% Cryo - Group) did not.Average follow-up was 15.6 ± 2.41 years. Five patients (5/52; 9.6%) developed a retinal detachment 2.6 ± 0.55 years after prophylactic treatment, respectively, 0/39 patients in the Cryo + Group and 5/13 in the Cryo - Group (P0.001). All five RD eyes were successfully reattached through revised episcleral surgery and adjunctive cryo treatment. Postop refraction changed an average -1.9 ± 0.74 diopters and best corrected visual acuity at the end of follow-up was 20/25 (0.1 ± 0.07 logarithm of the minimum angle of resolution), not significantly different from the rest of sample population who did not develop RD in their fellow eye.Cryopexy significantly reduced the risk of RD in Stickler syndrome patients undergoing scleral buckling. If RD ensues, the presence of scleral buckling may ease surgical repair and improve final outcome.

To determine whether improvements in microperimetry testing are associated with anatomic resolution after ocriplasmin treatment in patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction and relatively preserved baseline best-corrected visual acuity (BCVA). Patients with vitreomacular traction received a single 125-μg intravitreal ocriplasmin injection and were followed longitudinally for 6 months with optical coherence tomography, BCVA testing, and microperimetry. Visual function changes were compared between eyes with and without VMA resolution on optical coherence tomography. Eleven of 16 eyes (68.8%) achieved VMA resolution after treatment. Mean baseline BCVA was relatively good (79 ± 3 Early Treatment Diabetic Retinopathy Study letters; 20/52); no patients had a ≥2-line improvement in BCVA over the 6-month follow-up period. In the group with VMA resolution, mean retinal sensitivity significantly increased in the central 4° (15.2 ± 1.9 dB vs. 18.9 ± 0.7 dB, P < 0.001) when comparing baseline and final follow-up microperimetry testing. No change in mean retinal sensitivity was found in the group without VMA resolution. Microperimetry demonstrates a significant gain in retinal sensitivity, particularly in the central 4° area, in eyes with anatomic resolution after treatment of vitreomacular traction with intravitreal ocriplasmin injection, even when no significant gain in BCVA is seen.

Purpose: To investigate the changes of the vitreomacular interface during a 1-year follow-up after idiopathic epiretinal membrane (iERM) surgery. Methods: Six patients affected by fovea-attached iERM were recruited in this pilot study. Pars plana vitrectomy associated with epiretinal membrane peeling was performed uneventfully in all cases. In four cases, the inner limiting membrane was removed using Brilliant blue G. En face high-resolution adaptive optics and cross-sectional spectral domain optical coherence tomography retinal imaging were performed before and at 1, 3, 6, and 12 months after surgery. The microstructures of vitreomacular interface in high-resolution adaptive optics images were correlated to the cross-sectional spectral domain optical coherence tomography data. Results: Preoperatively, adaptive optics images showed multiple abnormalities of the vitreomacular interface, such as macrofolds, microfolds, and hyperreflective microstructures. We identified two subtypes of iERM according to the distribution of microfolds over the foveal area, which included the radial-type and the grid-type iERM. After surgery, the morphology of the vitreomacular interface changed compared with the preoperative state. The number of both macrofolds and microfolds was reduced in all cases. The hyperreflective structures were still resolvable in all cases, however presenting different shape and morphology than preoperatively. In addition, they showed marked differences between eyes that had internal limiting membrane removal and eyes that did not. Conclusion: Adaptive optics imaging gives new insight into the changes of vitreomacular interface after iERM surgery. Enhanced multimodal imaging of the vitreomacular interface and retinal structures can be valuable to monitor treatment outcome of iERM.

Purpose: To report on the use of scleral buckling (SB) alone or associated to pars plana vitrectomy (PPV) for the treatment of recurrent retinal detachment in highly myopic eyes with axial length >26.5 mm. Methods: Single-surgeon, retrospective consecutive operative series consisting of 255 eyes of 237 highly myopic patients suffering recurrent retinal detachment after primary SB (40%), primary PPV (40%), and multiple surgery (20%). Included eyes underwent either a 6-mm encircling band associated to a 6-mm inferior buckle wedge-shaped or 2.5 mm band and 15 mm inferior buckle. Results: Overall 88% of sample population had an attached retina after 1 surgery (90% in the post-SB group, 90% in the post-PPV group, and 85% in the post–multiple surgery group). Visual acuity results were less encouraging with a mean 20/60 visual acuity in the post-SB group and 20/200 in both post-PPV and post–multiple surgery groups. Conclusion: Encircling SB explants with extensive inferior indentation can be a valuable adjunct to PPV, membrane peeling, and silicone oil tamponade in the treatment of recurrent retinal detachment in highly myopic eyes. Although anatomical success rate is increasingly high, vision is often disappointing.

To investigate the efficacy and safety of intraoperative slow-release dexamethasone implant and 25-gauge (G) vitrectomy plus epiretinal membrane removal in patients affected by idiopathic macular pucker.In this randomized, clinical, multicenter study, 60 eyes of 60 pseudophakic eyes having idiopathic macular pucker were enrolled. Thirty eyes underwent 25-G pars plana vitrectomy and internal limiting membrane peeling ("Control group"), whereas 30 eyes underwent 25-G pars plana vitrectomy and internal limiting membrane peeling combined with dexamethasone implant ("DEX group"). Best-corrected visual acuity was investigated using Snellen visual acuity ratio. Anatomical outcomes (foveal thickness and total macular volume) were analyzed with spectral domain optical coherence tomography.After 6-month follow-up, best-corrected visual acuity significantly increased in each group (P0.05), but there were no significant differences between groups (P = 0.60). Foveal thickness showed a significant decrease in both groups (P0.05), but no differences were seen between groups (P = 0.80). Finally, also total macular volume decreased significantly in both groups at the last follow-up visit (P0.05), but both groups a showed similar trend (P = 0.12).Intraoperative sustained-release dexamethasone implant, a powerful antiinflammatory agent with significant efficacy in vitrectomized eyes, did not result in a significant change in macular thickness and volume compared with the vitrectomy alone without dexamethasone implant at 6-month follow-up. These data support the hypothesis that its etiology does not seem to be mainly related to an inflammatory process.

PURPOSE:: To investigate the variation and symmetry of cone density distribution along the nasal and temporal retina of fellow eyes. METHODS:: An adaptive optics retinal camera (rtx1; Imagine Eyes) was used to obtain images of the parafoveal cone mosaic in 20 healthy subjects. Cone density was estimated at 250, 420, 760, and 1,300 ?m eccentricity from the fovea along the nasal and temporal retina of both eyes in each subject. The coefficient of variation and the intraclass correlation coefficient were used to calculate the variation and absolute agreement of cone density between the same retinal eccentricity locations of fellow eyes, respectively. RESULTS:: A considerable variation of cone density between subjects was found at all eccentricities along the nasal and temporal retina (intersubject coefficient of variation >= 11%, P < 0.001). The intrasubject variation of cone density was, however, moderate (coefficient of variation = 0.86, P < 0.001). CONCLUSION:: Cone density follows a symmetrical distribution between fellow eyes. A systematic distribution of parafoveal cones between fellow eyes may provide an anatomical basis for the involvement of the photoreceptor layer in the first step of binocular spatial sampling. © by Ophthalmic Communications Society, Inc.

PURPOSE To assess functional and structural outcome after adjustable macular buckling for the treatment of foveoschisis (FS), associated with full-thickness macular hole (FTMH) in highly myopic eyes. METHODS Eighteen consecutive patients who underwent adjustable macular buckling for FS associated with FTMH were included in this prospective study. Three cases were not included in the analysis due to short follow-up period (less than 3 months). Outcome measures included anatomical success rate with FS resolution and FTMH closure, best-corrected visual acuity, mean retinal sensitivity, central retinal thickness, and fixation site and stability. RESULTS Foveoschisis resolution and FTMH closure were observed in all cases between 1 month to 3 months after surgery. At 24 months of follow-up visit visual acuity improved in 13/15 eyes (86.7%) and remained stable in 2 (13.3%). Mean retinal sensitivity showed significant improvement from baseline 5.69 ± 3.52 dB to final 8.35 ± 3.86 dB; P < 0.001. Fixation stability inside central 4° improved from baseline 58.5 ± 17.8% to final 73.7 ± 23.0%; P = 0.009. Central retinal thickness did not change significantly throughout follow-up. No FTMH or FS recurrence occurred and no surgical complications arose. CONCLUSION Adjustable macular buckling exoplant may represent an effective surgical option for the treatment of FS associated with FTMH in highly myopic eyes. Adjustable macular buckling showed high closure rate and virtually no tendency to recur. Functional results and safety are also interesting because vision improved and retinal thickness did not reduce significantly at 24 months of follow-up.

Purpose To identity anatomic risk factors involved in the onset of retinal complications causing decrease of visual acuity (VA) in the fellow eyes of highly myopic patients operated for retinal detachment with macular hole (RDMH). Design Cohort study. Participants Ninety-eight patients (mean age, 51.5±8.0 years) with bilateral high myopia (mean myopia of the fellow eye, 20.4±5.5 diopters) affected by RDMH in the other eye at baseline. Methods Evaluation of the anatomic features at baseline and during 84±2.7 months of follow-up by biomicroscopic examination, indirect binocular ophthalmoscopy, B-scan ultrasonography, and optical coherence tomography. Main Outcome Measures Detection of anatomic features associated with onset of retinal complications causing decrease of VA during the follow-up period. Results The fellow eyes were divided into 2 groups according to the clinical features of the RDMH eyes: Group 1, presence of posterior vitreous detachment (PVD); and Group 2, presence of posterior vitreous schisis (PVS). At baseline, the incidence of PVD in group 1 was 31 of 47 eyes (65.9%) and the incidence of PVS in Group 2 was 42 of 51 eyes (82.3%). At the end of follow-up, group 1 eyes had a lower incidence of retinal complications causing visual decrease than group 2 eyes (group 1, 2/47 eyes; group 2, 9/51 eyes). Conclusions Fellow eyes of RDMH cases with higher degree of myopia and peculiar vitreoretinal features including PVS, posterior epiretinal membrane, severe posterior staphyloma, and chorioretinal atrophy are more likely to develop retinal complications causing decrease of VA. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.

Objective: To evaluate possible changes of vitreous status in emmetropic eyes after uneventful phacoemulsification surgery, and possible related complications such as the onset of retinal detachment (RD). Design: Retrospective case series. Participants: Four hundred fifty-three emmetropic eyes from 453 patients (mean age, 62.035.57 years) subjected to uneventful phacoemulsification with intraocular lens implantation in the capsular bag were considered in the study. They had a refractive error within 0.5 diopters (mean, 0.210.08). Eyes with peripheral retinal lattice degeneration were included only if asymptomatic and only if the degeneration involved one retinal quadrant. After cataract surgery, the 453 eyes were evaluated preoperatively at days 1, 15, and 30 and months 3, 6, 12, 18, 24, 36, 48, and 60. The whole period of follow-up was 5 years. Methods: Evaluation of vitreous status by biomicroscopic examination, indirect binocular ophthalmoscopy, and B-scan ultrasonography. Main Outcome Measures: Postoperative onset of posterior vitreous detachment (PVD) and RD. Results: After cataract surgery, a PVD occurred in 107 of 141 (75.88%) eyes without preoperative PVD or lattice degeneration. Posterior vitreous detachment occurred in 41 of 47 eyes (87.23%) with preoperative lattice degeneration and no PVD. Eyes with preoperative lattice degeneration and postoperative PVD showed a higher incidence of RD after cataract surgery (21.27%) than eyes without preoperative PVD or lattice degeneration (0.70%). In all patients with lattice degeneration, RD originated from horseshoe retinal tears on lattice areas located on the superior quadrants. No correlation was observed between the development of RD and age. Conclusions: Our results suggest that the onset of postoperative PVD should be considered an important risk factor for the development of RD after cataract surgery, particularly in eyes with lattice areas. Ophthalmology 2007;114:692–697 © 2007 by the American Academy of Ophthalmology.

PURPOSE To evaluate macular function before and after surgical peeling of idiopathic epimacular membrane (EMM). METHODS Logarithm of the minimal angle of resolution visual acuity and results of focal (central 9 x 9 degrees) electroretinogram (fERG), pattern electroretinogram (pERG), and optical coherence tomography (OCT) assessment of macular volume were evaluated for 22 eyes of 22 patients (mean age +/- SD, 63.20 +/- 10.0 years) with EMM preoperatively (baseline) and 6 months after surgical peeling. Preoperative visual acuity and fERG and pERG amplitudes observed in EMM eyes were compared with those in 15 age-matched control eyes. RESULTS In the preoperative evaluation, EMM eyes had a significant (P < 0.01; one-way analysis of variance) reduction in visual acuity and fERG and pERG amplitudes and an increase in OCT macular volume when compared with controls. In EMM eyes, the decrease in visual acuity was significantly correlated (P < 0.01, Pearson test) to the reduction in fERG and pERG amplitudes. At the postoperative evaluation, EMM eyes had a correlated significant (P < 0.01) increase in visual acuity, fERG amplitude, and pERG amplitude with respect to the preoperative values. All EMM eyes had a significant (P

To compare functional and anatomical outcomes after idiopathic macular pucker removal between eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not.In this multicentric, randomized clinical trial, 60 eyes of 60 patients affected with idiopathic macular pucker were enrolled. Thirty eyes underwent 23-gauge pars plana vitrectomy associated with ILM peeling ("ILM peeling group"), whereas 30 eyes did not undergo ILM peeling ("ILM not peeling group"). Retinal sensitivity, frequency of microscotomas, and all the other microperimetric parameters were tested by MP1 microperimetry. Best-corrected visual acuity was investigated with the Early Treatment Diabetic Retinopathy Study chart. Anatomical outcomes were analyzed with spectral domain optical coherence tomography.After a 12-month follow-up, the mean retinal sensitivity in the 4° central area showed a greater and faster recovery in the ILM not peeling group than in the ILM peeling group (P = 0.041). The number of absolute microscotomas (0 dB) within the 12° central retinal area was significantly higher in the ILM peeling group than in the ILM not peeling group (P = 0.044).The ILM not peeling group seems to show better outcomes than the ILM peeling group as measured by mean retinal sensitivity and number of microscotomas after a 12-month follow-up.

Objective To evaluate the presence of macular holes (MHs) in very highly myopic eyes in the absence of visual symptoms. Design Retrospective case series. Participants Three hundred eighty-three eyes from 383 patients (mean age, 51.70±12.73 years) affected by very high myopia (between −14 and −32 diopters [D]), with no visual disturbance such as metamorphopsia and with visual acuity (VA) of >0.2 logarithm of the minimum angle of resolution, were considered in the study. They were evaluated at baseline and every 6 months during a mean total period of 30.2±0.5 months (range, 28.3–32.1). Methods Evaluation of macular morphology by optical coherence tomography (OCT). Main Outcome Measures Changes in OCT macular morphology ascribed to the presence of an MH. Results Macular holes were detected by OCT in 24 of 383 (6.26%) myopic eyes. These MHs were defined as asymptomatic (AMHs). The presence of AMHs was more prevalent (although not significantly when compared with the overall study population) in myopic patients younger than 50 years and with concomitant myopia of >−20 D. Posterior vitreous schisis was the most frequent vitreous modification associated with AMH (18/24 eyes [75.0%]). During follow-up, a decrease in VA was observed in 5 of 24 (20.8%) AMH eyes due to the enlargement of the lesion or to posterior retinal detachment, leading to the development of a symptomatic MH. Greater degree of myopia and younger age were associated with the evolution of the macular disease, consisting of an enlargement of the MH and/or the onset of a macular detachment. Conclusions A small percentage (6.26%) of highly myopic eyes may develop an MH in the absence of visual symptoms. The absence of symptoms could be related to the localization of the hole in a juxtafoveal area. Its evolution in a symptomatic MH seems to be related to the presence of epiretinal tissue, younger age, and the degree of myopia.

Purpose To evaluate the efficacy of different surgical strategies on the postoperative outcomes of retinal detachments (RDs) associated with macular holes (MHs) in high myopia. Design Prospective, noncomparative case series. Participants The study included 120 phakic, highly myopic eyes (mean degree of myopia, −22.2±4.80 diopters) with RDs and MHs that underwent surgical repair. The patients were divided into 2 groups. Group 1 consisted of 60 eyes with a posterior vitreous detachment (PVD). Mean preoperative visual acuity (VA) was 20/200±20/500. Group 2 consisted of 60 eyes with posterior vitreous schisis (PVS). The mean preoperative VA was 20/152±20/333. The minimum follow-up was 6 months. Intervention The surgical approach was chosen on the basis of the clinical characteristics. Twenty-five eyes of group 1 underwent pneumoretinopexy (group 1A), whereas 35 eyes of group 1 were repaired with vitrectomy (group 1B). Forty-nine eyes of group 2 underwent pars plana vitrectomy (group 2A), whereas 11 eyes of group 2 underwent scleral buckling of the macula (group 2B). Main outcome measures Anatomic attachment of the retina and VA. Results Retinal reattachment at 6 months was achieved in 23 of 25 (92%) eyes of group 1A, 31 of 35 (88.5%) eyes of group 1B, 45 of 49 (91.8%) eyes of group 2A, and 8 of 11 (72.7%) eyes of group 2B. A significant ( P Conclusions Different surgical approaches can be used to repair myopic RD associated with an MH. The choice between different surgical techniques may depend on vitreoretinal relationships, the extent of chorioretinal atrophic areas, and presence of posterior staphyloma. In our study, eyes with a PVD had significantly better visual outcomes than detachments in eyes with PVS.

Several ophthalmologists, during these past 20 years, supported by the great improvement in the surgical techniques of cataract extraction, proposed again the surgical procedure of clear lens extraction (CLE) to correct high axial myopia. However, we have to remember that vitreous and retinal changes in high myopic eyes can lead to retinal detachment (RD), in some cases with a poor visual outcome even after successful surgery. Moreover, it is well known that cataract extraction is a major cause of later RD with a further significant increase of the incidence of RD after Nd:YAG laser capsulotomy. The increased risk rates of RD for high myopia and cataract extraction are probably to be additive; therefore, high myopic eyes are significantly more exposed to postoperative complications. The greater incidence of RD in these eyes can be explained considering the anomalous vitreous changes occurring in high myopia, precipitated by the molecular and structural changes of the vitreous following cataract surgery. There are anomalous vitreo-retinal separation that are most frequently observed in very high myopic eyes: anomalous posterior vitreous detachment (PVD) and posterior vitreous schisis (PVS), the latter generally observed in association with a prominent posterior stafiloma. Intraoperative observations and recent studies of the macular area by means of optical coherence tomography (OCT) allowed the detection in these eyes of a thin layer of epiretinal tissue strictly adherent to the retina involved by the staphyloma; in these cases tractional retinal detachment, macular schisis or holes can occur. There are only few reports on the vitreo-retinal complications of CLE; for this reason, most conclusions have been derived from studies on RD occurred after cataract extraction in high myopic eyes. These data suggest that the risk/benefit ratio for this operation is probably too high to be recommended.

To evaluate the incidence of retinal detachment (RD) after cataract surgery performed by phacoemulsification in very highly myopic eyes.Retrospective, paired-eye, case-control trial.We assessed the development of RD in 930 eyes from 930 subjects (mean age = 62.5 +/- 8.5 years) affected by very high myopia (between -15 and -30 diopters) undergoing cataract surgery after uncomplicated phacoemulsification (cataract-subjected [CS] eyes). Fellow eyes served as controls. Follow-up was 36 months.Detachment of the retina.Retinal detachment was observed in 8.0% of CS eyes compared with 1.2% of control eyes (P0.01, chi-square test). In CS eyes, posterior RD was most common (52.7% of eyes with RD). In control eyes, peripheral detachments with or without macular involvement were most common (47.3% of eyes with RD).Cataract surgery, despite the use of a safe technique such as phacoemulsification, increases the risk of RD development in very highly myopic eyes.

The optical coherence tomograph is a new, noninvasive technical device that can obtain cross-sectional, high-resolution images-optical coherence tomographs (OCT)-of the retina. This instrument permits an accurate evaluation of various macular and chorioretinal pathologies and the early detection of glaucomatous damage. Images of the retina are obtained similar to ultrasound B-scan, with 10-microm longitudinal resolution. Because the OCT operates with a near-infrared wavelength (about 840 nm), the examination is of minimal discomfort for the patient. OCT examination is indicated in cases of macular pathologies such as vitreoretinal interface syndrome, in the early detection and quantitative assessment of macular edema, and in the evaluation of a glaucomatous damage by measuring the retinal nerve fiber layer thickness. The future role of this instrument and its applications for clinical diagnosis depend on the future improvement and updating of the software.

BACKGROUND Retinotomies and retinectomies are surgical procedures mainly devoted to the peripheral retina that require optimal visibility and adequate magnification to make the surgeon's task easy, quick, and safe. The purpose of present study was to estimate to what extent the introduction of wide-angle viewing systems can help the surgeon perform safer and more effective retinotomy procedures. MATERIALS AND METHODS The authors retrospectively analyzed the records of patients undergoing retinotomy procedures between 1993 and 1995 and divided them into two groups according to the viewing system used during the retinotomy procedures. Group 1 included 86 eyes that underwent surgery between July 1991 and June 1993 with Lander's plano-concave and prismatic lenses (Optikon, Rome, Italy), and group 2 included 96 eyes that underwent surgery between July 1993 and June 1995 with the Advanced Vitreoretinal Instruments system (New York, NY). Outcome measures were divided into preoperative (diagnosis at baseline, anterior proliferative vitreoretinopathy grade and extension, and visual acuity), intraoperative (size of retinotomy, number of laser spots, need for scleral depression, lensectomy, intraocular lens and capsule removal, and duration of treatment) and postoperative (anatomic success rates, visual acuity, postoperative intraocular pressure, and need for postoperative laser treatment and follow-up treatment). RESULTS Among preoperative parameters, there were no significant differences between the two groups. For intraoperative parameters, eyes in group 2 underwent significantly shorter surgical procedures, had less of a need for scleral depression, and, as a group, had a higher average number of laser spots. For postoperative parameters, eyes in group 2 had a significantly lower need for laser treatment at the edge of retinotomy after surgery. CONCLUSION Our results suggest that the use of a panoramic viewing system significantly decreases the time required for intervention, allowing more complete laser treatment along the edge of the retinotomy and lowering the need for scleral depression. The need for completion of laser treatment along the edge of the retinotomy after surgery also is reduced significantly, possibly increasing patient comfort because, especially in the early postoperative days, postoperative laser treatment can be extremely uncomfortable for the patient and difficult to perform for the surgeon. No prognostic benefit has been proven for any of the two groups because anatomic and visual results were overlapped.

Purpose: To evaluate the parafoveal cone density in patients with Type 1 diabetes mellitus (DM1). Methods: Adaptive optics retinal images of the photoreceptor mosaic were acquired from 11 DM1 patients (study group) and 11 age-matched healthy subjects (control group). Cone density was analyzed, along the horizontal and vertical meridian, at 230-um, 350-um, and 460-um eccentricity from the fovea. Central retinal thickness was measured using a Spectralis spectral-domain optical coherence tomography. A multiple regression model was performed to determine the relationships between the explanatory variables (age, glycohemoglobin level, presence of diabetic retinopathy, duration of diabetes, and central retinal thickness) and cone density. Results: Patients had a diagnosis of DM1 in the past 9 years to 21 years. Of these, five patients had a diagnosis of no diabetic retinopathy and six had mild nonproliferative diabetic retinopathy. On average, cone density was 10%lower in the study than in the control group at each retinal eccentricity along the horizontal and vertical meridians (analysis of variance, P

Purpose Clear lens extraction is a surgical procedure to correct high axial myopia. The authors explain how this technique may lead to serious vitreoretinal complications. Methods The study included 41 eyes of 39 patients aged 25 to 58 years (mean, 37.5 years) with high axial myopia (14-29 diopters; mean, 19.5 diopters) operated on for retinal detachment after clear lens extraction. Retinal detachment occurred 1 month to 4 years after lens extraction, except for two eyes that also had intraoperative choroidal hemorrhages. Results Twenty-six of the 41 eyes had undergone 360 degree prophylactic retinopexy on preequatorial areas; in four eyes, the retinal breaks occurred along the edge of the prior circumferential photocoagulation. Seventeen eyes exhibited proliferative vitreoretinopathy of various grades. The retina was reattached in 36 eyes. Only nine eyes achieved final visual acuity of 20/60 or better. Conclusions Although the authors do not report the actual incidence of retinal detachment after clear lens extraction, they indicate that potentially blinding complications can occur after this surgical procedure, despite prophylactic treatments.

To review prevalence, long-term progression, and prognosis of vitreoretinal interface modifications in pathologic myopia with posterior staphyloma and investigate foveal sensitivity and fixation stability.Retrospective single-institution series of 214 eyes (116 patients) with pathologic myopia, axial length30 mm, and posterior staphyloma. Exclusion criteria included follow-up less than five years, incomplete records, and/or less than three optical coherence tomography or microperimetry. Patients were divided into 5 groups according to optical coherence tomography: 1) epiretinal membrane without schisis (ERM); 2) macular retinal schisis (Schisis); 3) partial thickness macular hole (PTMH); 4) full-thickness macular hole (FTMH); and 5) posterior retinal detachment (PRD) with or without macular hole. Disease progression was defined as a visual acuity decrease of two or more lines associated to objective worsening of the optical coherence tomography and/or microperimetry.Vitreoretinal abnormalities at baseline were present in 116 of 204 patients (56.8%) and 214 of 408 eyes (52.4%); 98 of 116 patients (84.4%) showed bilateral involvement. Baseline visual acuity and foveal sensitivity varied significantly with ERM performing better and PRD worse than others; PTMH and FTMH did not differ. During the 66 months of average follow-up, 33 of 214 eyes (15.4%) required surgery and 13 of 33 eyes (39.3%) needed reintervention. Surgery rate significantly differed among groups: 2% for ERM, 20% to 25% for Schisis, PTMH, and FTMH, and up to 50% for PRD. Progression rate of Schisis and FTMH was the same, regardless of symptoms, while macula-off PRD always required surgery. Decrease of fixation stability and foveal sensitivity correlated to need for surgery, while baseline foveal sensitivity and fixation did not.Vitreoretinal interface pathology in pathologic myopia with posterior staphyloma encompasses a spectrum of conditions whose baseline functionality, prognosis, rate, and amount of progression vary significantly. Customized treatment for each different condition should be considered.

PURPOSE To analyze the effects of femtosecond laser pulses on the posterior human corneal stroma with atomic force microscopy (AFM) and environmental scanning electron microscopy (ESEM). METHODS A femtosecond laser (IntraLase iFS, Abbott, USA) was programmed to create a full posterior lamellar dissection in 9 human corneal tissues, using 3 different pulse energies (1.00 µJ, 0.75 µJ, and 0.50 µJ). Three corneal tissues were prepared in a similar fashion using a mechanical microkeratome (Moria Evolution 3, Moria, France). Six corneal tissues received an 8.00-mm diameter full cylindrical resection using either the femtosecond laser or the Barron trephine (Katena Products Inc., USA). The posterior corneal lenticules were first examined at AFM (Autoprobe CP, Veeco, USA). Both the posterior lenticules and the trephined corneal samples were scanned by ESEM (FEI Quanta 400, USA). RESULTS Granules and crater-like features were observed on the stromal interface of all the laser dissected tissues, likely due to a secondary thermal effect of femtosecond laser dissection. Collagen fibers were seen only on samples treated with the 0.50 µJ pulse energy. Images of an even stromal surface were observed on the posterior stroma of mechanically dissected corneal samples. CONCLUSIONS Mechanical and thermal effects, induced by femtosecond laser pulses on the human corneal stroma, were seen with AFM. Surface regularity of the photodisrupted stroma was inversely and non-linearly related to the pulse energy. The femtosecond laser provided high surface quality for lamellar resection of the posterior stroma comparable to those provided by mechanical devices.

To evaluate the efficacy of different surgical strategies on the postoperative outcomes of retinal detachments (RDs) associated with macular holes (MHs) in high myopia.Prospective, noncomparative case series.The study included 120 phakic, highly myopic eyes (mean degree of myopia, -22.2+/-4.80 diopters) with RDs and MHs that underwent surgical repair. The patients were divided into 2 groups. Group 1 consisted of 60 eyes with a posterior vitreous detachment (PVD). Mean preoperative visual acuity (VA) was 20/200+/-20/500. Group 2 consisted of 60 eyes with posterior vitreous schisis (PVS). The mean preoperative VA was 20/152+/-20/333. The minimum follow-up was 6 months.The surgical approach was chosen on the basis of the clinical characteristics. Twenty-five eyes of group 1 underwent pneumoretinopexy (group 1A), whereas 35 eyes of group 1 were repaired with vitrectomy (group 1B). Forty-nine eyes of group 2 underwent pars plana vitrectomy (group 2A), whereas 11 eyes of group 2 underwent scleral buckling of the macula (group 2B).Anatomic attachment of the retina and VA.Retinal reattachment at 6 months was achieved in 23 of 25 (92%) eyes of group 1A, 31 of 35 (88.5%) eyes of group 1B, 45 of 49 (91.8%) eyes of group 2A, and 8 of 11 (72.7%) eyes of group 2B. A significant (P0.01) improvement of postoperative VA with respect to the preoperative values was observed in all groups. The greatest percentage improvement in postoperative VA was observed in groups 1A and 1B eyes.Different surgical approaches can be used to repair myopic RD associated with an MH. The choice between different surgical techniques may depend on vitreoretinal relationships, the extent of chorioretinal atrophic areas, and presence of posterior staphyloma. In our study, eyes with a PVD had significantly better visual outcomes than detachments in eyes with PVS.

Purpose To evaluate postoperative outcomes between pars plana vitrectomy (PPV) and posterior episcleral buckle procedure (PEBP) in myopic eyes with retinal detachment (RD) and macular hole (MH). Design Retrospective nonrandomized comparative interventional trial. Participants and intervention The study included 30 phakic, highly myopic eyes (from 19–30 negative diopters) of 30 patients with an RD and MH. The patients were divided into two groups: They were assigned to PPV (15 eyes, group A) or to PEBP (15 eyes, group B). No significant ( P > 0.01) differences in preoperative visual acuity (VA) between group A and group B eyes were found. Follow-up was 12 months. Main outcome measures Anatomic attachment of the retina was determined, and VA was measured. Results Retinal reattachment was obtained on 11 of 15 (73.3%) eyes of group A and on 14 of 15 (93.3%) eyes of group B. In group A eyes the VA was substantially unmodified after surgical treatment, whereas in group B eyes the VA observed after surgical treatment increased significantly ( P Conclusions PEBP resulted in better postoperative anatomic and functional results compared with PPV in eyes with extreme degrees of myopia, pronounced posterior staphyloma, and posterior vitreous schisis affected with RD caused by MH.

Hereditary predisposition to lipomas is observed in familial multiple lipomatosis (OMIM 151900) and benign cervical lipomatosis (OMIM 151800) and can also be associated with mutations in the MEN1 and PTEN genes (OMIM 131100 and 153480, respectively). In addition, a recent report indicates that a few patients with hereditary retinoblastoma also have lipomas. Here we report on an extended family segregating a splice site mutation in the RB1 gene. Almost all adult carriers of this mutation had multiple lipomas while penetrance for retinoblastoma was incomplete. In an unrelated pedigree, which was reported previously, the identical mutation was only associated with low-penetrance retinoblastoma but not lipomas. Our data indicate that lipoma predisposition in hereditary retinoblastoma is not associated with specific RB1 gene mutations but is influenced by modifying factors linked to this gene.

• Background: The authors report a case of posterior internal ophthalmomyiasis causing vitreous haemorrhage and retinal detachment after uncomplicated cataract extration. • Case report: The patient suffered an abrupt vitreous haemorrhage 9 days after ECCE and posterior chamber IOL implantation. After 2 months the haemorrhage did not clear up and a retinal detachment arose. The patient underwent encircling scleral buckle, pars plana vitrectomy and fluid-gas exchange. In course of intervention the surgeon removed from the vitreous chamber a 14-mm-long round worm subsequently identified as a dipterous larva of the Sarcophagidae family. • Discussion: The patient showed no sign of subretinal tracking or retinal breaks or holes. The sclerocorneal surgical wound seems the most likely site of entrance of the parasite, and this would then be the first reported case of myiasis with no RPE tracking.

We operated on four highly myopic eyes with recurrent retinal detachment due to macular holes. A thin layer of epiretinal tissue was present over the posterior retina in each eye, probably causing tangential traction on the retina and accounting for the recurrent detachment. Biopsy of the tissue from one case showed mainly acellular material resembling cortical vitreous. Recognizing this clinical condition may permit successful treatment of certain cases with recurrent retinal detachment in highly myopic eyes with macular holes.

Transvitreal diathermy was combined with vitrectomy, scleral buckling, and silicone oil injection to treat 28 eyes with severe proliferative vitreoretinopathy and fore-shortened peripheral retina. A special gold tip on the diathermy probe prevented adhesions to the retina. The probe can be used for coaxial bipolar diathermy or for internal-external bipolar diathermy when combined with an electrode on the external scleral surface. Nineteen (68%) of 28 eyes treated with these methods achieved anatomic success and 10 eyes obtained final visual acuity ranging from 5/200 to 20/70.

According to the observations of Machemer, “attraction forces” created by a continuous absorption of fluid by the pigmented epithelium keep the retina attached to the underlying planes. Following this observation, Machemer and Gonvers showed that a relaxing of any vitreo-retinal traction by vitrectomy makes possible the reattachment of a detached retina with macular hole. By relaxing traction on the retina, posterior scleral buckles and cryo or laser treatment can be avoided. Without scar adhesions, however, any tangential traction on the retina, even if it is not near the macular hole, can cause a new subretinal infiltration of fluid through the re-opened central hole.

The total number of cataract operations performed annually in the United States is not known with certainty, but it is estimated that 75% of cataract operations performed in the United States are associated with implantation of an intraocular lens (IOL) (1). As lens designs and surgical techniques improve, fewer IOL-related complications are being encountered. By way of this communication we discuss the surgical management of selected intraocular lens complications.

The biggest problem in the surgery of advanced proliferative diabetic retinopathy with tractional retinal detachment concerns the removal of the fibrovascular membranes at the apex of the vitreal cone that exerts traction on the retina. These membranes can at times be very limited; this happens when there has been a precocious posterior vitreous detachment. In this case, after the vitreal cone has been removed and the point of the adhesion between the vitreous cortex and the membrane is cut, the retina returns to a flattened position. Sometimes, however, the epiretinal proliferations are very extensive and very closely attached to the underlying retina. This happens in cases in which there has been no posterior vitreous detachment or when such a posterior vitreous detachment has occured later and to a more limited degree (1,2). In these cases, the epicenter of the proliferation is usually in the optic disc or between the paramacular vascular arcades. In the latter cases, fibrovascular proliferations can extend bridge-like between the two arcades or remain attached to the central part of the retina (1,2,3). In these areas, if the detachment is not too old, the retina is sufficiently resistent. A new adhesion of the retina can be obtained by dividing the epiretinal tissues into small islands corresponding to the original fibrovascular stem (segmentation technique), (1,2,4,5), or by removing the epiretinal tissues completely.

Rubeosis iridis, with or without ocular hypertension, is a frequent complication in vascular diseases of the retina.

Silicone oil is injected into the vitreous chamber at the end of surgery for retinal detachment with PVR if the condition is severe enough to convince the surgeon that success is not sufficiently guaranteed. The purpose of the injection of silicone oil into the vitreous chamber is to maintain a tamponade for a prolonged period of time. As a matter of fact, silicone oil cannot inhibit the proliferative process but it is apt to condition its progress in some way.

Development of Vitreous Surgery (G.B. Bietti memorial lecture).- Development of Vitreous Surgery (G.B. Bietti memorial lecture).- Training For Vitreous Surgery: Animal Surgery.- Training For Vitreous Surgery: Animal Surgery.- Instrumentation.- Instrumentation for Vitreoretinal Surgery.- How Automatic Infusion and Suction have Changed During the Last Five Years.- "Le System": A Unified Microsurgical Center.- The Phacoexcavator: A New Approach to Lentectomy.- Pneumatic Forceps for the Removal of Epiretinal Membranes.- Mechanical Systems for Irrigation and Suction of High Viscosity Silicone Oil.- Preoperative evaluation and patient preparation.- Pre-Vitrectomy Assessment by Ultrasound.- Preparation of the Patient for Vitrectomy Surgery.- Anterior segment vitrectomy.- Vitrectomy Techniques for the Anterior Segment Surgeon.- The Cornea and Vitreous Surgery.- Management of Complicated Cataracts Using Vitrectomy Instruments.- Pars Plana Lensectomy.- Lens and Vitreous Complications.- Management of Epithelial Cysts and Ingrowth.- Vitrectomy in the Management of Dislocated Crystalline Lenses.- Viscomicrosurgery: The Use of a New Fraction of the Sodium Salt of Hyaluronate.- Use of the Neodynium Yag Laser for the Anterior Segment Surgeon.- Surgical Management of Selected Intraocular Lens Complications.- Closed Vitreous Surgery for Complications of Intraocular Lens Implantation I. Indications.- Closed Vitreous Surgery for Complications of Intraocular Lens Implantation II. Techniques.- Closed Vitreous Surgery for Complications of Intraocular Lens Implantation III. Results and Complications.- Vitrectomy in the Management of Posteriorly Dislocated Intraocular Lenses.- Pseudophakia: Incidence of Cystoid Macular Edema.- Pseudophakic Retinal Detachments.- IOL and Vitreo-Retinal Complications.- Vitreal hemorrhage and opacities.- Pars Plana Vitrectomy for the Treatment of Vitreal Hemorrhage.- Pars Plana Vitrectomy in Chronic Uveitis.- Retinal detachment A. Giant retinal tears.- Giant Retinal Tears.- Giant Retinal Tear.- Management of Giant Retinal Tears using Vitrectomy and Fluid/Silicone-Oil Exchange.- Retinal detachment B. Macular hole.- Macular Hole and Retinal Detachment.- Treatment of Myopic Macular Holes and Detachment with Liquid Vitreous - Intravitreal Gas Exchange.- Retinal Detachment with Macular Hole.- Vitrectomy Fluid-Gas Exchange in the Treatment of Macular Hole.- Vitreo-retinal proliferation.- Complications of Retinal Detachment.- Proliferative Vitreoretinopathy and Surgical Approach.- Validity of Scleral Surgery for the Treatment of Vitreo-Retinal Tractions and Proliferations.- Subretinal Proliferation.- The use of Silicone Oil Following Failed Vitrectomy for Retinal Detachment with Advanced Proliferative Vitreoretinopathy.- Behaviour of Retinal Proliferation after Silicone Oil Injection.- Vitreo-retinal proliferation / Macular pucker.- Surgical Treatment of Macular Pucker.- Diabetes.- Preoperative Iris Angiography: a Prognostic Tool for Diabetic Patients.- Prognostic Values of Preoperative Findings for Diabetic Vitrectomy.- Lens Influence on Iris Neovascularization and Glaucoma.- Diabetic Traction Detachment.- Vitreous Surgery for Proliferative Diabetic Retinopathy.- Removal of Fibrovascular Diabetic Membranes.- Argon Laser Endophotocoagulation.- Cataract with Rubeosis Iridis: Its Treatment.- Long Term Diabetic Retinopathy Vitrectomy Results: 10 Years Follow-Up.- Management of Postvitrectomy Diabetic Vitreous Hemorrhage.- Retrolental fibroplasia.- Retrolental Fibroplasia: Pathogenesis of Late Stages.- Retrolental Fibroplasia: Surgical Therapy.- Ocular trauma.- Indications and Timing of Vitrectomy in Trauma.- Penetrating Injuries.- Treatment of Double Perforating Injuries.- Progress in Foreign Body Extractors.- Removal of Intraocular Foreign Bodies.- Exdophthalmitis.- Vitrectomy in the Management of Infectious Endophthalmitis.- Complications of vitrectomy.- Complications of Vitreous Surgery.- Internal tamponade.- Fluid/Gas Exchange in Vitreous Surgery.- Silicone Oil: Results in 300 Cases.- Laser Treatment of Retinal Detachment With P.V.R. After Vitrectomy in the Presence of Silicone Oil.- Internal Tamponade With Silicone Oil: Echographic Evaluation.- Complications of Silicone oil.- Endothelial Cell Density in Patients With Intravitreal Silicone oil Injection.- Vitrectomy and Silicone Oil Infusion: Pattern of Ocular Hydrodynamics.- Intraocular Silicone oil: an Experimental Study.- Mesical therapy.- Inhibition of Experimental Intraocular Proliferation and Retinal Detachment by Various Drugs.- Ocular Effects and Clearance of Intravitreal 5-Fluorouracil.

To illustrate a noninvasive method to analyze the retinal capillary lumen caliber in patients with Type 1 diabetes.Adaptive optics imaging of the retinal capillaries were acquired in two parafoveal regions of interest in eyes with nonproliferative diabetic retinopathy and unaffected controls. Measures of the retinal capillary lumen caliber were quantified using an algorithm written in Matlab by an independent observer in a masked manner. Comparison of the adaptive optics images with red-free and color wide fundus retinography images was also assessed.Eight eyes with nonproliferative diabetic retinopathy (eight patients, study group), no macular edema, and preserved visual acuity and eight control eyes (eight healthy volunteers; control group) were analyzed. The repeatability of capillary lumen caliber measurements was 0.22 μm (3.5%) with the 95% confidence interval between 0.12 and 0.31 μm in the study group. It was 0.30 μm (4.1%) with the 95% confidence interval between 0.16 and 0.43 μm in the control group. The average capillary lumen caliber was significantly narrower in eyes with nonproliferative diabetic retinopathy (6.27 ± 1.63 μm) than in the control eyes (7.31 ± 1.59 μm, P = 0.002).The authors demonstrated a noninvasive method to analyze, with micrometric scale of resolution, the lumen of retinal capillaries. The parafoveal capillaries were narrower in patients with Type 1 diabetes and nonproliferative diabetic retinopathy than in healthy subjects, showing the potential capability of adaptive optics imaging to detect pathologic variations of the retinal microvascular structures in vaso-occlusive diseases.

PURPOSE To assess the efficacy of optical coherence tomography (OCT) for the morphological evaluation of idiopathic full-thickness macular holes and for detecting any morphological changes with time. METHODS Serial sagittal tomographs through the macula were taken by OCT in a consecutive series of 34 eyes of 34 patients with diagnosis of idiopathic full-thickness macular hole. The patients were divided into two groups on the basis of "recent" (group 1, 25 patients) or "not-recent" (group 2, 9 patients) onset of symptoms related to the macular hole. Fourteen of the 25 patients in group 1 and all nine in group 2 underwent vitrectomy. The 11 in group 1 who refused surgery were observed by OCT examination with follow-up from 6 to 13 months. RESULTS In most eyes OCT scans revealed two different anatomical features of macular holes depending on the time of onset of symptoms. Eleven of the 14 "recent-onset" holes that underwent surgery showed "sharp", undermining edges at preoperative OCT; the other three had "rounded" edges. Seven of the nine eyes operated for long-standing full-thickness macular holes had preoperative "rounded" edges, while the edges in the remaining two eyes were "sharp". OCT of eight of the 11 non-operated eyes in group 1 showed a morphological evolution of the macular hole edges from a "sharp" to a "rounded" contour and an increase in the diameter of the hole. CONCLUSIONS OCT can help in the morphological evaluation of idiopathic full-thickness macular holes and in the detection of morphological changes with time.

BACKGROUND: The purpose of this study was to estimate if and to what extent scanning laser ophthalmoscopy can help in the early diagnosis and follow-up management of the vitreoretinal interface syndrome, which includes disorders such as cellophane maculopathy, pseudomacular hole, macular pucker, and macular hole. METHODS: The 35 fellow eyes of 35 patients with vitreoretinal interface syndromes in the first eye underwent scanning laser ophthalmoscopy microperimetry and argon, helium-neon, and infrared scanning laser ophthalmoscopy. Fellow eyes were defined as clinically positive or negative for vitreoretinal interface syndrome. Fellow eyes then were classified based on scanning laser ophthalmoscopy techniques. Patients were observed for an average of 18 months (range, 10-26 months). RESULTS: Thirty-two of the 35 fellow eyes were classified as clinically negative, and three of the 35 were classified as clinically positive. Fifteen of the 32 clinically negative fellow eyes were redefined as positive on scanning laser ophthalmoscopy. None of the clinically positive eyes proved to be negative on scanning laser ophthalmoscopy. During the average follow-up period (18 months), the condition of five of 18 fellow eyes that were positive on scanning laser ophthalmoscopy worsened. None of the 17 eyes that were negative on scanning laser ophthalmoscopy worsened. CONCLUSION: Scanning laser ophthalmoscopy can produce beautifully clear images of structures that are otherwise difficult to see and document, such as posterior hyaloid and the inner retinal layers. Despite a relatively limited number of cases and the short duration of the follow-up period, the present study suggests that scanning laser ophthalmoscopy has good sensitivity and specificity for the early diagnosis of vitreoretinal interface syndromes.

Scientific object The epidemic diffusion of diabetes mellitus has raised serious concerns about the deleterious effects of its complications. Diabetic retinopathy (DR) is a severe progressive ocular pathology and the leading cause of blindness in adults. There is a significant limitation in specific biomarkers for DR, thus, implying that DR diagnosis occur when vision is already compromised. Poor glycemic control, with elevated hemoglobin A1c (HbA1c), and hypertension are recognized risk factors, however the implication of inflammatory processes in DR pathogenesis has prompt interest in the identification of biomarkers of disease within the immune system.