Retinal circulation and its role in macular disorders in patients without systemic disease

AIM: To determine whether retinal circulatory changes play a role in the pathogenesis of macular disorders in patients who are otherwise healthy. METHODS: Patients with macular disorders that required angiographic imaging were included in this prospective case series. After a complete ocular exam,fluorescein angiography was performed using a standardized technique on the HRA-II(Heidelberg Engineering, Heidelberg, Germany) with special focus on the posterior pole. Only patients with good quality images were included in the analysis. Circulatory parameters recorded included the arm-choroid time,choroid-retinal artery, and finally the retinal artery-vein time. Zonal asymmetry(between the upper and lower zones divided by a line passing through the centre of the fovea) in transit times, if any was also noted. Appropriate statistical analysis was done. Circulation times were compared with age matched historical controls. Changes in retinal dye transit times relative to historical age matched controls, if any, were noted and compared between various disorders.RESULTS: A total of 156 eyes of 156 patients(120 males)were included in the study. Mean age: 49.14 ±14.93 y.Macular disorders studied were age related degeneration,polypoidal vasculopathy, central serous chorioretinopathy(CSCR) and parafoveal telangiectasia. Delayed circulation time was noted in CSCR patients only.CONCLUSION: CSCR patients appear to have delayed arterial filling, retinal circulatory disturbances do not seem to contribute to the pathogenesis of other macular disorders.

Vitreo-retinal interface changes on optical coherence tomography in the fellow eyes of patients with macular hole

AIM:To study the vitreo-retinal interface and macular changes on optical coherence tomography(OCT) in the fellow eyes of patients with macular hole.·METHODS:Patients with idiopathic macular hole in one or both eyes presented to our institute between January 2003 and December 2009 were evaluated retrospectively.Demographic details,best-corrected visual acuity and vitreo-retinal interface,and macular changes of the fellow eye on OCT were studied.·RESULTS:Seventy patients underwent OCT of both eyes during the study period.The average age group was 61.96 years and 35(50%) were females.Among the fellow eyes,normal foveal contour was noted in 36(51.4%) eyes and 34(48.6%) eyes were observed to have vitreo-retinal interface changes.Of them,13(18.6%) eyes had some stage of full thickness macular hole and 21(30.0%) eyes had interface changes.There was no statistical correlation between involved eye lesions(P =0.64) or visual acuity(P =0.55) as predictors of development of either fellow eye lesions or poor visual acuity.·CONCLUSION:There is a significant chance of having vitreo-retinal interface findings in the fellow eyes of patients presenting with macular hole.OCT should be considered in both eyes of patients with macular hole to detect early changes in the fellow eyes,which may require an early intervention.

Neurodegeneration in branch retinal vein occlusion

One of the most common forms of visual impairment and reduction in overall visual acuity is branch retinal vein occlu- sion （BRVO）, second only to diabetic retinopathy （Rogers et al., 2010; Sun et al., 2013）. Unlike central retinal vein occlusion （CRVO） which is a similar macular disease, BRVO is extremely more prevalent and generally only affects a smaller portion of the retina （Osborne et al., 2004） due to the nature of the dis- ease.

Inverted internal limiting membrane flap technique for very large macular hole

AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.