Search Results (16)

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: The aim of this study was to evaluate the outcome of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in patients with diabetic macular edema (DME) refractory to intravitreal injections (IVIs) and without vitreomacular traction. Methods: In this retrospective consecutive case series, we included patients that underwent PPV with ILM peeling for refractory DME. Examination was performed at baseline, and at the 1- and 6-month follow-up. Primary endpoints were best-corrected distance visual acuity (BCVA) and central macular thickness (CMT). Results: A total of 15 eyes were included, and BCVA improved from 0.69 ± 0.27 logMAR preoperatively to 0.48 ± 0.28 logMAR at the 1-month (p = 0.013) follow-up and 0.42 ± 0.29 logMAR at the 6-month (p < 0.001) follow-up. At the 6-month follow-up, 10 eyes (66.6%) gained at least two lines of vision. The BCVA of pseudophakic eyes (nine eyes) improved from 0.64 ± 0.21 logMAR at baseline to 0.40 ± 0.26 logMAR at the 6-month follow-up (p = 0.02). CMT decreased from 457 ± 114 µm preoperatively to 336 ± 112 µm at the 1-month (p = 0.035) follow-up and 302 ± 68 µm at the 6-month (p = 0.001) follow-up. During follow-up, only two eyes received IVIs: one following vitreous hemorrhage and one for persistent DME. Conclusion: PPV with ILM peeling improves BCVA and reduces CMT in eyes with DME refractory to IVIs up to the 6-month follow-up. Full article

Since its introduction, optical coherence tomography (OCT) has significantly progressed in addressing its limitations. By integrating artificial intelligence and multimodal imaging, OCT enhances both speed and image quality while reducing its size. OCT continues to advance, offering new possibilities beyond the in-office setting, including intraoperative applications. This review will explore the different types of home OCT and intraoperative OCT, as well as the uses of each device and their future potential in ophthalmology. 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: There is a lack of research on the clinical characteristics of vitreomacular traction (VMT) in the Central Asian population, which evaluates the visual recovery and macular hole closure outcomes of pars plana vitrectomy (PPV) with membrane peel in this population. Methods: This long-term prospective cohort study, conducted at the Kazakh Eye Research Institute from June 2015 to December 2021 with a follow-up period until December 2022, included 1574 patients (1784 eyes) with VMT syndrome. Among the eyes, 724 (40.58%) had VMT, 620 (34.75%) had a lamellar macular hole (LMH), and 440 (24.66%) had a full-thickness macular hole (FTMH). Results: The FTMH group consisted of small (≤250 μm) holes in 14 (3.2%) eyes, medium (250–400 μm) holes in 79 (17.9%) eyes, and large (>400 μm) holes in 347 (78.9%) eyes. Significant improvements in visual acuity, retinal thickness reduction, and macular hole closure were observed in 98.79% of patients with LMH and 81.14% of patients with FTMH at 1.5 months after surgery. PPV with membrane peel resulted in improved clinical outcomes, including enhanced visual acuity and macular structure. Conclusions: These findings support the existing research indicating the efficacy and relative safety of this surgical approach for VMT, despite the potential risks of postoperative complications. Full article

Objectives: Our objective was to investigate the prevalence of macular complications detected by spectral-domain optical coherence tomography (SD-OCT) in a large Caucasian cohort of RP patients, highlight the major alterations in chorioretinal structure, and compare the macular structural changes in eyes affected by retinal dystrophies with those in healthy controls. Methods: This was an observational, retrospective, and cross-sectional study. Three hundred and seven patients with RP were consecutively enrolled and underwent clinical assessment. In particular, SD-OCT images were used to ascertain the morphology of the posterior pole of patients with RP by evaluating the residual ellipsoid zone (EZ), the volume and thickness of the outer nuclear layer (ONLT), and subfoveal choroid thickness (SCT). At the same time, the pathological finding that the patients’ vision was reduced under treatment was analyzed. Results: A total of 436 eyes of 218 patients with RP were studied. Considering all of the eyes studied, 103 had cystoid macular edema (CME) (23.62%), 123 (28.21%) had vitreomacular traction (VMT), and 199 (45.75%) had epiretinal membranes (ERMs). There were also 12 (2.75%) cases of lamellar macular holes (LMHs), of which 3 (1.38% of all patients) cases were bilateral. Only 137 eyes (31.42%) did not have the above-mentioned alterations. SCT was significantly reduced compared to that of the control group (193.03 µm ± 67.90 SD vs. 295 µm ± 69.04 SD), while the foveal central macular thickness (FCMT) was greater (270.91 μm ± 74.04 SD vs. 221 µm ± 37.25 SD). Conclusions: This research highlights the high incidence of macular complications. The results of our study indicate the importance of regular monitoring of RP patients and early intervention to avoid further complications in this group of subjects with severe visual field impairment to avoid further central vision loss. Full article

Modern mediation analysis techniques supplement the primary intention-to-treat analysis with the aim to shed light onto the treatment mechanism. We investigate to what extent the anatomic marker vitreomacular adhesion resolution (VMAR) mediates vision benefits, comparing ocriplasmin vs. a sham regimen. A causal mediation analysis is applied to randomized trial data including 218 participants with vitreomacular traction. Logistic regression models are used to estimate the total treatment effect (TTE) on binary outcomes. Outcomes, assessed at month 24, included visual acuity improvement (VA-I): ≥2-line increase in VA; visual function questionnaire improvement (VFQ-I): ≥5-point increase in the 25-item visual function questionnaire composite score (VFQ-25cs); visual function improvement (VF-I): defined as either a VA-I or a clinically meaningful improvement in the VFQ-25cs. Quantity of interest is the breakdown of TTE into an indirect (through VMAR) and direct effect to estimate the extent to which the TTE is transmitted through the mediating variable (VMAR) vs. other pathways. Causal effects are expressed as risk differences. Indirect effects for VFQ-I, VA-I, and VF-I are 5.7%, 11.8%, and 5.2%, respectively, representing the increase in the probability of a vision improvement if VMAR status were changed for each participant to the extent that it is affected by ocriplasmin. The direct effects are 8.3%, 12.1%, and 24.1% respectively, capturing the effect of treatment on the probability of a vision improvement if ocriplasmin left each participant’s VMAR status unchanged. The relative treatment effect of ocriplasmin on the functional outcome VA-I is to a large extent the result of its effect on VMAR, while an improvement in the patient-reported outcomes VFQ-I or VF-I was only partially mediated by VMAR. Full article

Purpose: To describe the feasibility of intraoperative digital visualization and its contribution to the enhancement of macular pigmentation visualization in a prospective series of macular surgery interventions. Materials and Methods: A prospective, single-center, single-surgeon study was performed on a series of 21 consecutive cases of vitrectomy for various types of macular surgery using a 3D visualization system. Two optimized filters were applied to enhance the visualization of the macular pigment (MP). For filter 1, cyan, yellow, and magenta color saturations were increased. Filter 2 differed from filter 1 only in having a lower level of magenta saturation for the green-magenta color channel. Results: Optimized digital filters enhanced the visualization of the MP and the pigmented epiretinal tissue associated with the lamellar and macular holes. In vitreomacular traction surgery, the filters facilitated the assessment of MP integrity at the end of surgery. Filter 1 enhanced MP visualization most strongly, with the MP appearing green and slightly fluorescent. Filter 2 enhanced MP visualization less effectively but gave a clearer image of the retinal surface, facilitating safe macular peeling. Conclusion: Optimized digital filters could be used to enhance MP and pigmented epiretinal tissue visualization during macular surgery. These filters open new horizons for future research and should be evaluated in larger series and correlated with intraoperative OCT. Full article

Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively. Full article

There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of vitreomacular interface disorders is notoriously poor in differentiating these conditions. These conditions were initially described with slit-lamp biomicroscopy, and the main goal was to distinguish an FTMH from the others. The introduction of optical coherence tomography (OCT) has revolutionized our understanding of the foveal microstructural anatomy and has facilitated differentiating these conditions from an FTMH. However, the definitions of the other conditions, particularly LMH, has evolved over the past two decades. Initially the term LMH encompassed a wide spectrum of clinical conditions. As OCT became more widely used and observations became more refined, two different phenotypes of LMH became apparent, raising the question of different pathogenic mechanisms for each phenotype. Tractional and degenerative pathological mechanisms were proposed. Epiretinal membranes (ERMs) associated with each phenotype were identified. Typical ERMs were associated with a tractional mechanism, whereas an epiretinal proliferation was associated with a degenerative mechanism. Epiretinal proliferation represents Müller cell proliferation as a reactive process to retinal injury. These two types of ERM were differentiated by their characteristics on SD-OCT. The latest consensus definitions take into account this phenotypic differentiation and classifies these entities into LMH, MPH and ERM foveoschisis. The initial event in both ERM foveoschisis and LMH is a tractional event that disrupts the Müller cell cone in the foveola or the foveal walls. Depending on the extent of Müller cell disruption, either a LMH or an ERM foveoschisis may develop. Although surgical intervention for LMH remains controversial and no clear guidelines exist for pars plana vitrectomy (PPV), eyes with symptomatic, progressive ERM foveoschisis and LMH may benefit from surgical intervention. Full article

Macular telangiectasia Type 2 (MacTel) is a bilateral acquired retinal disease characterized by both vascular changes and atrophy of the retina. The purpose of this case series is to highlight the use of optical coherence tomography angiography (OCTA) as a non-invasive imaging modality to distinguish atypical MacTel from other macular conditions with similar presentations. We performed a retrospective review of patients referred to our academic retinal practice with unconfirmed or misdiagnosed MacTel between July 2017 and July 2021. Patients’ OCTA imaging findings were reviewed to guide the appropriate diagnosis and management of atypical MacTel. Fifteen eyes from eight patients were included in this study. Six patients were referred with previous diagnoses of either full-thickness macular hole, lamellar hole, vitreomacular traction (VMT), postoperative cystoid macular edema (CME), or diabetic macular edema (DME). Two patients were referred to us to confirm the diagnosis of MacTel. OCTA revealed telangiectatic vessels in the temporal parafovea of all 15 eyes. OCTA also highlighted previously undiagnosed subretinal neovascularization (SRNV) in seven eyes. OCTA imaging is a valuable imaging modality to distinguish MacTel from other macular conditions, whose treatment courses vary substantially. Due to its ease of use, it holds immense potential in the future as treatments for non-proliferative MacTel emerge. Full article

Vitreomacular interface plays an important role in the pathogenesis and progression of proliferative diabetic retinopathy (PDR). This study investigated the prevalence and risk factors of vitreomacular interface disorders (VMID) in PDR. The macular optical coherence tomography (OCT) scans of 493 eyes from 378 PDR patients were retrospectively reviewed to detect VMID, including vitreomacular adhesion (VMA), vitreomacular traction (VMT), epiretinal membrane (ERM), lamellar hole–associated epiretinal proliferation (LHEP), and macular hole (MH). The associations between VMID and baseline factors, intraretinal structure, and visual acuity were analyzed. The prevalence was 78.9% for ERM, 13.4% for VMT, 4.8% for MH, 2.2% for LHEP, and 2.0% for VMA, respectively. On multivariable analyses (odds ratio, 95% confidence interval), fibrovascular proliferation (FVP) was positively associated with MH (8.029, 1.873–34.420), VMT (3.774, 1.827–7.798), and ERM (2.305, 1.460–3.640). High-risk PDR was another risk factor of ERM (1.846, 1.101–3.090). Female gender was positively associated with MH (3.836, 1.132–13.006), while vitreous hemorrhage was negatively associated with MH (0.344, 0.133–0.890). Eyes with all VMID subtypes showed more frequent macular cysts and tractional retinal detachment with poorer visual acuity (p ≤ 0.001). Therefore, the prevalence of VMID was considerably high, indicating that this distinct entity should be considered in interventions for PDR. Full article

This paper proposes an efficient segmentation of the preretinal area between the inner limiting membrane (ILM) and posterior cortical vitreous (PCV) of the human eye in an image obtained with the use of optical coherence tomography (OCT). The research was carried out using a database of three-dimensional OCT imaging scans obtained with the Optovue RTVue XR Avanti device. Various types of neural networks (UNet, Attention UNet, ReLayNet, LFUNet) were tested for semantic segmentation, their effectiveness was assessed using the Dice coefficient and compared to the graph theory techniques. Improvement in segmentation efficiency was achieved through the use of relative distance maps. We also show that selecting a larger kernel size for convolutional layers can improve segmentation quality depending on the neural network model. In the case of PVC, we obtain the effectiveness reaching up to $96.35\%$. The proposed solution can be widely used to diagnose vitreomacular traction changes, which is not yet available in scientific or commercial OCT imaging solutions. Full article

In this retrospective study, we compared the anatomical and functional changes in patients with vitreomacular traction associated with macular holes between the following groups: (1) Patients who were treated with a single intravitreal injection of ocriplasmin (the OCRIALONE group); (2) those who failed the ocriplasmin treatment and underwent vitrectomy one month later (the OCRIVIT group); and (3) patients who directly underwent par plana vitrectomy (VITREALONE group). A total of 38 patients, 19 in the OCRIALONE group + OCRIVIT group (seven and 12 patients, respectively) and 19 in the VITREALONE group with focal vitreomacular adhesion associated with macular holes were evaluated with spectral domain optical coherence tomography. Functional examinations included best-corrected visual acuity (BCVA) and microperimetry analysis. Visual function changes were compared between the OCRIALONE group + OCRIVIT group and VITREALONE group up to three months. Furthermore, a subgroup analysis compared the OCRIVIT group and the VITREALONE group. BCVA values and the mean retinal sensitivity showed statistically significant improvement in all groups (p < 0.001). Specifically, the retinal sensitivity values at the end of the follow-up were significantly higher in the OCRIALONE group + OCRIVIT group than in the VITREALONE group. These functional findings were also confirmed when the statistical analysis was conducted between the OCRIVIT group and the VITREALONE group. Although the OCRIALONE group + OCRIVIT group exhibited faster retinal thinning than the VITREALONE group (p = 0.006), the analysis of the OCRIVIT group versus the VITREALONE group did not show any statistically significant difference. The better functional results and similar anatomical findings suggest that ocriplasmin can be used as a first-line treatment, and that prompt pars plana vitrectomy as primary surgery does not provide better outcomes in comparison with pars plana vitrectomy after ocriplasmin injection. Full article