Limits...
Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes.

Nadal J, Carreras E, Canut MI, Barraquer RI - Clin Ophthalmol (2015)

Bottom Line: There was no statistically significant difference between preoperative and postoperative BCVA.These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases.We therefore recommend initiating treatment as early as possible.

View Article: PubMed Central - PubMed

Affiliation: Centro de Oftalmologia Barraquer, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain ; Instituto Barraquer, Barcelona, Spain.

ABSTRACT

Background: Hypotony maculopathy (HM) changes may persist, and visual acuity remains poor, despite normalization of intraocular pressure (IOP). The aim of this study was to evaluate the visual and anatomical results of pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, and 20% SF6 gas tamponade in five myopic patients with HM.

Methods: This retrospective interventional study was conducted at the Barraquer Center of Ophthalmology, a tertiary care center in Barcelona, Spain, and included five eyes from five consecutive patients (aged 55.4±13.1 years) with HM caused by different conditions. All the patients were treated with 23-gauge PPV, ILM peeling, and 20% SF6 gas tamponade. Preoperative and postoperative evaluation was performed using anterior and posterior biomicroscopy and best corrected visual acuity (BCVA) by logMAR charts.

Results: Before surgery, median spherical equivalent was -13.1 (range -7, -19) diopters of myopia. Preoperatively, four cases presented IOP <6.5 mmHg for 3 (range 2-8) weeks. In three of these four cases, IOP >6.5 mmHg was achieved over 16 (range 16-28) weeks, without resolution of HM; increased IOP was not achieved in the remaining case treated 2 weeks after diagnosis of HM. One case presented IOP >6.5 mmHg with HM for 28 weeks before surgery. Preoperative BCVA was 0.7 (range 0.26-2.3) logMAR, and 0.6 (range 0.3-0.7) logMAR and 0.5 (range 0.2-1) logMAR, respectively, at 4 and 12 months after surgery. There was no statistically significant difference between preoperative and postoperative BCVA. Hyper-pigmentation lines in the macular area were observed in three cases with hypotony. These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases.

Conclusion: PPV with ILM peeling followed by gas tamponade is a good alternative for the treatment of HM in myopic patients. However, persistent choroidal folds may compromise BCVA. We therefore recommend initiating treatment as early as possible.

No MeSH data available.


Related in: MedlinePlus

(A) Preoperative hypotony maculopathy shown by posterior pole biomicroscopy (A1) and by optical coherence tomography (A2) in case 1. (B) Biomicroscopy (B1) and optical coherence tomography obtained one year after vitreoretinal surgery (B2) in case 1. Note the increase of hyperpigmentation (B1) despite resolution of the retinal folds, but not the choroidal folds (B2) in case 1.
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f1-opth-9-859: (A) Preoperative hypotony maculopathy shown by posterior pole biomicroscopy (A1) and by optical coherence tomography (A2) in case 1. (B) Biomicroscopy (B1) and optical coherence tomography obtained one year after vitreoretinal surgery (B2) in case 1. Note the increase of hyperpigmentation (B1) despite resolution of the retinal folds, but not the choroidal folds (B2) in case 1.

Mentions: Hyperpigmentation lines were observed in the troughs of folds in the macular area in 3 cases at 30, 32, and 56 weeks after diagnosis of hypotony, corresponding to patients with the most prolonged clinical and statistical hypotony (24–28 weeks). Hyperpigmentation lines in the postoperative period progressed despite resolution of retinal folds, because choroidal folds persisted (Figure 1). This progression occurred in parallel with decreasing BCVA in two cases, while in the remaining patient BCVA remained stable.


Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes.

Nadal J, Carreras E, Canut MI, Barraquer RI - Clin Ophthalmol (2015)

(A) Preoperative hypotony maculopathy shown by posterior pole biomicroscopy (A1) and by optical coherence tomography (A2) in case 1. (B) Biomicroscopy (B1) and optical coherence tomography obtained one year after vitreoretinal surgery (B2) in case 1. Note the increase of hyperpigmentation (B1) despite resolution of the retinal folds, but not the choroidal folds (B2) in case 1.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440434&req=5

f1-opth-9-859: (A) Preoperative hypotony maculopathy shown by posterior pole biomicroscopy (A1) and by optical coherence tomography (A2) in case 1. (B) Biomicroscopy (B1) and optical coherence tomography obtained one year after vitreoretinal surgery (B2) in case 1. Note the increase of hyperpigmentation (B1) despite resolution of the retinal folds, but not the choroidal folds (B2) in case 1.
Mentions: Hyperpigmentation lines were observed in the troughs of folds in the macular area in 3 cases at 30, 32, and 56 weeks after diagnosis of hypotony, corresponding to patients with the most prolonged clinical and statistical hypotony (24–28 weeks). Hyperpigmentation lines in the postoperative period progressed despite resolution of retinal folds, because choroidal folds persisted (Figure 1). This progression occurred in parallel with decreasing BCVA in two cases, while in the remaining patient BCVA remained stable.

Bottom Line: There was no statistically significant difference between preoperative and postoperative BCVA.These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases.We therefore recommend initiating treatment as early as possible.

View Article: PubMed Central - PubMed

Affiliation: Centro de Oftalmologia Barraquer, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain ; Instituto Barraquer, Barcelona, Spain.

ABSTRACT

Background: Hypotony maculopathy (HM) changes may persist, and visual acuity remains poor, despite normalization of intraocular pressure (IOP). The aim of this study was to evaluate the visual and anatomical results of pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, and 20% SF6 gas tamponade in five myopic patients with HM.

Methods: This retrospective interventional study was conducted at the Barraquer Center of Ophthalmology, a tertiary care center in Barcelona, Spain, and included five eyes from five consecutive patients (aged 55.4±13.1 years) with HM caused by different conditions. All the patients were treated with 23-gauge PPV, ILM peeling, and 20% SF6 gas tamponade. Preoperative and postoperative evaluation was performed using anterior and posterior biomicroscopy and best corrected visual acuity (BCVA) by logMAR charts.

Results: Before surgery, median spherical equivalent was -13.1 (range -7, -19) diopters of myopia. Preoperatively, four cases presented IOP <6.5 mmHg for 3 (range 2-8) weeks. In three of these four cases, IOP >6.5 mmHg was achieved over 16 (range 16-28) weeks, without resolution of HM; increased IOP was not achieved in the remaining case treated 2 weeks after diagnosis of HM. One case presented IOP >6.5 mmHg with HM for 28 weeks before surgery. Preoperative BCVA was 0.7 (range 0.26-2.3) logMAR, and 0.6 (range 0.3-0.7) logMAR and 0.5 (range 0.2-1) logMAR, respectively, at 4 and 12 months after surgery. There was no statistically significant difference between preoperative and postoperative BCVA. Hyper-pigmentation lines in the macular area were observed in three cases with hypotony. These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases.

Conclusion: PPV with ILM peeling followed by gas tamponade is a good alternative for the treatment of HM in myopic patients. However, persistent choroidal folds may compromise BCVA. We therefore recommend initiating treatment as early as possible.

No MeSH data available.


Related in: MedlinePlus