Purpose: Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS).Design: Retrospective cross- sectional study. Methods: Postope...Purpose: Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS).Design: Retrospective cross- sectional study. Methods: PostoperativeOCT scans were analyzed in 34 eyes of 30 patients. Raw files of horizontal and vertical OCT scans were exported to Adobe Photoshop 7.0. Measured parameters included central foveal thickness, photoreceptor thickness, photoreceptor reflectivity, and relative reflectivity of photoreceptor to retinal pigment epithelium in the foveal area. Foveal configuration was subjectively graded. Results: OCT scans were obtained at a median of 2 years (1 month to 10 years) postoperatively. The median visual acuity was 20/80 (20/50 to 8/200) preoperatively and 20/50 (20/20 to5/200) postoperatively. The median foveal thickness was 198.5 μ (148 to 283). The mean (SD) photoreceptor layer thickness was 16.5 (8) μ in the 500 μ area and 17.5 (8) μ in the 1000 μ area. Mean (SD) of relative reflectivity of the photoreceptor layer was 0.60 (0.10) in both 500 μ and 1000 μ area. Postoperative VA did not correlate with foveal thickness or foveal configuration. Central (500 μ and 1000 μ ) photoreceptor thicknesswas significantly correlated with final VA(r=.38, P=.026, each). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 500 μ area was correlated with postoperative VA at a borderline significance (r=.32, P=.07). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 1000 μ area was not significantly correlated with postoperative VA (r=.27, P=.12). Conclusion: Specific retinal features can be assessed from OCT images. Morphology and thickness of the foveal photoreceptor layer correlate well with macular function after successful MHS. Outer retinal features appear to be more important to determine postoperative visual function. Inner retinal features may be more relevant for the ophthalmoscopic appearance of anatomic closure.展开更多
Objective: To review the results of 2 different surgical approaches in the management of primary rhegmatogenousretinal detachments (RDs) with undetected retinal breaks. Design: Retrospective, consecutive, intervention...Objective: To review the results of 2 different surgical approaches in the management of primary rhegmatogenousretinal detachments (RDs) with undetected retinal breaks. Design: Retrospective, consecutive, interventional case series. Participants: Medical records of 44 patients with uncomplicated macula-involving primary rhegmatogenous-appearing RDs, but without retinal breaks detected preoperatively or intraoperatively, were reviewed. Methods: All study patients were operated by the same surgeon between 1989 and 2004 using 2 approaches: 26 (59% ) patients underwent a scleral buckling procedure (SBP) with or without subretinal fluid drainage, whereas 18 (41% ) patients underwent scleral buckling combined with pars plana vitrectomy (PPV), fluid-gas exchange, and broad application of endolaser. Main Outcome Measures: Single operation and final postoperative anatomic success, and 2- month postoperative and final best-corrected visual acuity (VA) (negative logarithm of the minimum angle of resolution LogMAR). Results: Mean preoperative VAs were 1.73 log-MAR units (median, 1.60; range, 0.48- 2.60) in the combined surgery group and 1.52 logMAR units (median, 1.30; range, 0.30- 2.60) in the scleral buckling group. Neither preoperative (P=0.33), 2- month postoperative (P=0.53), best-corrected (P = 0.98), nor final (P=0.46) mean VA showed any statistically significant differences between the 2 treatment groups. A single operation reattachment rate of 72% (13/18 cases) was achieved in the combined surgery group, compared with 61.5% (16/26 cases) in the scleral buckling group (P=0.17, log rank test). Immediate anatomic success rates were 89% after combined treatment and 38.5% after scleral buckling alone (P=0.002). At the final visit, the retina was attached in 15 (83.3% ) patients who received the combined treatment and in 22 (84.6% ) patients who underwent scleral buckling (P=0.900). Intraoperative subretinal hemorrhage occurred in 1 (5.6% ) patient from the combined surgery group and in 2 (7.7% ) patients from the scleral buckling group. Retinal incarceration in the drainage sclerotomy occurred in 1 (3.8% ) case during the SBP. Proliferative vitreoretinopathy sufficient to require reoperation developed in 1 (5.6% ) eye of the combined surgery group and in 3 (11.5% ) eyes of the scleral buckling group. Conclusions: Scleral buckling is as effective in the management of uncomplicated rhegmatogenous RDs with undetected breaks as is surgery combining scleral buckling and PPV.展开更多
文摘Purpose: Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS).Design: Retrospective cross- sectional study. Methods: PostoperativeOCT scans were analyzed in 34 eyes of 30 patients. Raw files of horizontal and vertical OCT scans were exported to Adobe Photoshop 7.0. Measured parameters included central foveal thickness, photoreceptor thickness, photoreceptor reflectivity, and relative reflectivity of photoreceptor to retinal pigment epithelium in the foveal area. Foveal configuration was subjectively graded. Results: OCT scans were obtained at a median of 2 years (1 month to 10 years) postoperatively. The median visual acuity was 20/80 (20/50 to 8/200) preoperatively and 20/50 (20/20 to5/200) postoperatively. The median foveal thickness was 198.5 μ (148 to 283). The mean (SD) photoreceptor layer thickness was 16.5 (8) μ in the 500 μ area and 17.5 (8) μ in the 1000 μ area. Mean (SD) of relative reflectivity of the photoreceptor layer was 0.60 (0.10) in both 500 μ and 1000 μ area. Postoperative VA did not correlate with foveal thickness or foveal configuration. Central (500 μ and 1000 μ ) photoreceptor thicknesswas significantly correlated with final VA(r=.38, P=.026, each). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 500 μ area was correlated with postoperative VA at a borderline significance (r=.32, P=.07). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 1000 μ area was not significantly correlated with postoperative VA (r=.27, P=.12). Conclusion: Specific retinal features can be assessed from OCT images. Morphology and thickness of the foveal photoreceptor layer correlate well with macular function after successful MHS. Outer retinal features appear to be more important to determine postoperative visual function. Inner retinal features may be more relevant for the ophthalmoscopic appearance of anatomic closure.
文摘Objective: To review the results of 2 different surgical approaches in the management of primary rhegmatogenousretinal detachments (RDs) with undetected retinal breaks. Design: Retrospective, consecutive, interventional case series. Participants: Medical records of 44 patients with uncomplicated macula-involving primary rhegmatogenous-appearing RDs, but without retinal breaks detected preoperatively or intraoperatively, were reviewed. Methods: All study patients were operated by the same surgeon between 1989 and 2004 using 2 approaches: 26 (59% ) patients underwent a scleral buckling procedure (SBP) with or without subretinal fluid drainage, whereas 18 (41% ) patients underwent scleral buckling combined with pars plana vitrectomy (PPV), fluid-gas exchange, and broad application of endolaser. Main Outcome Measures: Single operation and final postoperative anatomic success, and 2- month postoperative and final best-corrected visual acuity (VA) (negative logarithm of the minimum angle of resolution LogMAR). Results: Mean preoperative VAs were 1.73 log-MAR units (median, 1.60; range, 0.48- 2.60) in the combined surgery group and 1.52 logMAR units (median, 1.30; range, 0.30- 2.60) in the scleral buckling group. Neither preoperative (P=0.33), 2- month postoperative (P=0.53), best-corrected (P = 0.98), nor final (P=0.46) mean VA showed any statistically significant differences between the 2 treatment groups. A single operation reattachment rate of 72% (13/18 cases) was achieved in the combined surgery group, compared with 61.5% (16/26 cases) in the scleral buckling group (P=0.17, log rank test). Immediate anatomic success rates were 89% after combined treatment and 38.5% after scleral buckling alone (P=0.002). At the final visit, the retina was attached in 15 (83.3% ) patients who received the combined treatment and in 22 (84.6% ) patients who underwent scleral buckling (P=0.900). Intraoperative subretinal hemorrhage occurred in 1 (5.6% ) patient from the combined surgery group and in 2 (7.7% ) patients from the scleral buckling group. Retinal incarceration in the drainage sclerotomy occurred in 1 (3.8% ) case during the SBP. Proliferative vitreoretinopathy sufficient to require reoperation developed in 1 (5.6% ) eye of the combined surgery group and in 3 (11.5% ) eyes of the scleral buckling group. Conclusions: Scleral buckling is as effective in the management of uncomplicated rhegmatogenous RDs with undetected breaks as is surgery combining scleral buckling and PPV.
