Vitreomacular Interface Abnormalities in Myopic Foveoschisis: Correlation With Morphological Features and Outcome of Vitrectomy

Purpose: To compare the morphologic characteristics and response to surgery of myopic foveoschisis (MF) with different patterns of vitreomacular interface abnormalities (VMIAs).Methods: In this observational case series, 158 eyes of 121 MF patients with epiretinal membrane (ERM) or vitreomacular traction (VMT) based on optical coherence tomography (OCT) were enrolled. All the eyes were divided into two groups by the pattern of VMIAs: ERM and VMT group. Sixty-one eyes underwent pars plana vitrectomy (PPV) and were followed up for at least 6 months. The morphologic characteristics based on OCT and the surgical outcome were evaluated.Outcome: ERM and VMT were found in 47.47 and 52.53% of the cases, respectively. A higher rate of foveal detachment (61.4 vs. 26.7%; p < 0.001) and a higher rate of outer lamellar macular hole (45.8 vs. 21.3%; p = 0.001) were detected in the eyes with VMT compared with those with ERM. In contrast, a lower rate of inner lamellar macular hole (28.9 vs. 60.0%; p = 0.001) was detected in the eyes with VMT compared with those with ERM. The disruption of the external limiting membrane (ELM) was more common in the eyes with VMT than in those with ERM (45.8 vs. 21.3%; p = 0.001). PPV was performed in 61 eyes with a mean follow-up time of 23.55 ± 19.92 months. After surgery, anatomical resolution was achieved in 51 eyes (83.6%). At the final visit, the mean central foveal thickness (CFT) decreased significantly from 547.83 to 118.74 μm, and the mean LogMAR BCVA improved significantly from 0.92 to 0.57. The VMT group was associated with a higher proportion of eyes with visual acuity improvement postoperatively (p = 0.02) and had more a decrease of CFT (P = 0.007) compared with the ERM group.Conclusion: In the eyes with MF, outer retinal lesions occurred more frequently in the eyes with VMT, whereas inner retinal lesions occurred more frequently in the eyes with ERM. Tangential force generated by ERM may act as a causative factor for the inner retinal lesions in MF, and inward-directed force resulting from VMT may act as a causative factor for outer retinal lesions in MF.

Influence of vitreomacular interface score on treatment outcomes of anti-VEGF therapy for neovascular age-related macular degeneration

Background To quantitatively evaluate the vitreomacular interface of eyes with neovascular age-related macular degeneration (AMD) and to investigate its association with the 1-year treatment outcome following intravitreal injections of aflibercept (IVA). Methods This prospective observational case series included 59 eyes of 59 consecutive patients with treatment-naïve neovascular AMD who were treated with three monthly IVA and subsequent four bi-monthly IVA and were followed up for 1 year. We estimated posterior vitreous detachment at 1, 9, and 25 macular points within an area of 6 × 6 mm2 at the center of the fovea using the built-in enhanced vitreous visualization mode of swept-source optical coherence tomography. One year after the initial IVA, we classified the eyes into either wet or dry groups. Results The wet and dry groups included 12 and 47 eyes, respectively. The resistance rate against IVA was 20.3%. The 25-point interface score was higher in the wet group than in the dry group (23.0 ± 4.3 vs. 18.6 ± 9.8, P = 0.03), whereas there were no significant between-group differences in the 9-point and 1-point scores (P = 0.21, and 0.47, respectively) or in the other studied parameters. Multivariable analysis revealed that the 25-point vitreomacular interface score was strongly correlated with subfoveal choroidal thickness (P = 0.02, β = − 0.31). Conclusions Our findings suggest that wide-ranged separation of the posterior vitreous membrane from the retina induces poor response to IVA.

ILM removal in vitreomacular interface disorders: for or against?

Purpose. To provide data on efficacy and safety of internal limiting membrane (ILM) removal in various pathologies of the vitreomacular interface. Material and methods. To perform the review, literature sources were searched through the PubMed and Scopus databases up to year 2021 using the keywords "internal limiting membrane peeling", "macular hole", "epiretinal membrane". A total of 38 articles relevant to the topic of the review were selected. Results. Numerous studies have confirmed the efficacy of internal limiting peeling in improving anatomical and functional outcomes of treatment of various pathologies. However, even a flawlessly performed peeling can cause both anatomical and functional effects on the retina. Various studies have demonstrated that the anatomical complications of ILM peeling did not correlate with the functional outcomes of surgery. Conclusion. Available evidence supports ILM peeling as an intervention that improves anatomical and functional results of treatment and reduces rate of reoperation. However, in order to evaluate the safety of this procedure, further studies with an assessment of the visual function with a long follow-up period are required. Key words: internal limiting membrane, peeling, macular hole, epiretinal membrane

Latent Diabetic Macular Edema in Chinese Diabetic Retinopathy Patients

Purpose: To compare the detection rates of optical coherence tomography (OCT) and fluorescein angiography (FA) in a diabetic macular edema (DME) and the severity of diabetic retinopathy in both color fundus images (CFI) and FA, and to investigate the predictive factors in macular leakages in FA.Methods: This was a retrospective study, and a total of 132 eyes of 77 patients with diabetic retinopathy were enrolled. Macular OCT, FA, and CFI were reviewed and measured. Central foveal thickness was also measured.Results: The severity of diabetic retinopathy in FA was significantly higher than that in CFI (p < 0.001). OCT detected 26 eyes with DMEs, which included the following: 13 eyes with cystoid macular edemas; 13 eyes with serous retinal detachments; 11 eyes with diffuse retinal thickening; 4 eyes with vitreomacular interface abnormalities. In contrast, 72 out of 132 eyes (54.5%) showed macular leakages in FA, which was significantly higher than that detected by OCT (p < 0.001). Compared with FA, the sensitivity and the specificity of OCT in detecting DMEs were 30.6 and 93.3%, respectively. However, central foveal thickness was not significantly different between the patients with non-clinically significant macular edema (CSME, 253.1 ± 26.95 μm) and slight CSME (270.9 ± 37.11 μm, p = 0.204). The mean central foveal thickness in diabetic macular edema (FA) eyes was 271.8 ± 66.02 μm, which was significantly higher than that (253. ± 25.21 μm) in non-DME (FA) eyes (p = 0.039). The central foveal thickness in DME (FA) eyes was significantly lower than that in eyes with DME (OCT) (p = 0.014). After adjusting for age and sex, a logistic regression analysis showed that the classification of diabetic retinopathy in FA was positively associated with macular leakage in FA (p < 0.001).Conclusions: The severity of diabetic retinopathy is underestimated in CFI compared with that in FA. FA can detect latent DMEs, which appeared normal on OCT. The central foveal thickness is not a sensitive parameter for detecting latent DMEs.

The role of the macular interface in the diagnosis of retinopathy of prematurity and diabetic angioretinopathy

Vitreomacular interface is an important part of the diagnosis from retinopathy of prematurity (ROP) to retinal diseases in adults. It is required to develop a method for macula localization to determine 3 stable points for photographic measurements of a 3D eye model. Purpose. To minimize the risk of mistakes in the diagnosis and choice of treatment for ROP and diabetic angioretinopathy (DARP) by improving the quality and analysis of modeled wide-field images on the Key to Diagnosis I and II platforms. Material and methods. 1278 RetCam and fundus images of 402 patients. 3 clinical groups: 1 – ROP 272 (544 eyes): 1A – I stage 152(304 eyes), 1B – II stage 45 (90 eyes), 1C – III stage 8 (12 eyes), 1D – posterior aggressive ROP 7 (14 eyes), 1E-retinal immaturity 60 (120 eyes); 2 – DARP 120 (240 eyes): 2A – non-proliferative 13 (17 eyes), 2B – preproliferative 47 (55 eyes), 2C – proliferative 27 (33 eyes), 2D – terminal 33 (37 eyes), 3 – control 10 (20 eyes). A standard clinical examination, analysis of modeled wide-field images, localization of the macula and traction index of the macular region (Tm) were performed. Results. Platform modules have been developed for automatic wide-field images modeling and macular localization, which is a reference point for assessing the extent of pathological changes. In ROP there was significant negative correlation of the Tm value with a stage: 1А – 0,8±0,03, 1B – 0,75±0,04, 1C – 0,74±0,13, 1D – 0,99±0,01, 1E – 0,91±0,09. For groups 2A – 2B, there was no correlation between Tm and the DARP severity. Conclusion. Tm reflects the severity of traction processes at the periphery of the retina and can be used as a marker in case of diagnostic defects in ROP. The localization of the macula determines the stable points for automatic morphometry. Key words: retinopathy of prematurity, pediatric retinal camera RetCam-Shuttle, telemedicine, diabetic angioretinopathy, vitreomacular interface.

On the creation of a new unified classification of the vitreomacular interface surgical pathology

The progress of modern methods the vitreomacular interface (VMI) visualization, clinical and histopathological studies are constantly expanding our understanding of the course of the macular pathological process. At the same time, the diagnostic and classification schemes we use may lose their relevance without reflecting the pathogenesis of the disease, complicating the choice of treatment tactics, and also complicating professional communication when we using various classification approaches. Aim. To offer our views on the possibility of creating a unified clinical classification of primary surgical pathology of VMI. Material and methods. Research papers related to the surgical pathology of VMI were analyzed. Results. The main role in the development of VMI pathology belongs to the vitreous body and the changes that occur in it, leading to posterior vitreous detachment (PVD). Pathological PVD is a variant of vitreomacular adhesion: vitreoschisis or separation of the entire thickness of the posterior cortex with the presence of local vitreoretinal fixation. In the first case, an epiretinal membrane (ERM) develops, which can progress to an ERM with macular pseudohole or to an ERM with foveoschisis. In the second case, pathological PVD is realized in vitreomacular traction (VMT). Depending on various factors, VMT can resolve both asymptomatically and with the formation of a defect in the retinal tissue, leading to outer lamellar macular hole (outer LMH) and the subsequent formation of a full-thickness macular hole (FTMH). If the traction does not cause strong changes, then it, disrupting the architectonics of the retina, triggers the processes leading to the LMH (which was previously called degenerative LMH), and it, in turn, in rare cases, can also become FTMH. Conclusions. We proposed the combined clinical classification scheme of VMI primary surgical pathology, which more fully reflects modern ideas about pathogenesis and allows, based on OCT data, to more clearly differentiate macular changes requiring a various surgical approach. Key words: PPV, vitreomacular interface, classification, VMT, epiretinal membrane, ERM, pseudohole, macular hole.

Comparative assessment of anatomical and functional results when using PRP technology in surgery of macular holes of different diameters

Purpose. Compare the anatomical and functional results of using PRP technology in the surgery of macular holes of various diameters. Materials and methods. We observed 15 patients (15 eyes). After the vitrectomy, the internal border membrane was peeled. Platelet-rich autoplasm was injected intravitreally. The observation period was 1 month. Results. As a result of surgical treatment, we managed to close the opening in all cases, restore the anatomy of the fovea, and improve visual acuity in all patients. Conclusions. According to the assessment of the results obtained in the ongoing study, the use of this technology is an effective and promising method of treatment based on the stimulation of the tissues' own regenerative potential. Key words: мacular foramen, platelet-rich plasma, vitreomacular interface, macular pathology, vitrectomy, internal border membrane, posterior hyaloid membrane, retina, vitreoretinal surgery, foveolar fossa.

Sensitivity of spectral domain optical coherence tomography in the diagnosis of posterior vitreous detachment in vitreomacular interface disorders: A prospective cohort study

Purpose: To evaluate the sensitivity of Spectral Domain Optical Coherence Tomography (SD-OCT) regarding the diagnosis of posterior vitreous detachment (PVD) in vitreomacular interface disorders (VID). Methods: A total of 48 eyes of 48 patients were included in this prospective cohort study. PVD in eyes with VID was investigated. We determined the status of posterior vitreous cortex using slit lamp (SL) biomicroscopy and SD-OCT preoperatively, during vitrectomy and on the intraoperative video recording. Sensitivity and specificity of the examining methods were analysed. Four masked independent examiners participated in this study. Results: PVD was diagnosed in 16 eyes (33.3%) on SD-OCT, 20 eyes (41.7%) on SL examination and 28 eyes (58.3%) during vitrectomy. Sensitivity and specificity for diagnosis of PVD was 37.5% and 31.3% using SD-OCT, 90% and 64.3% on the SL examination, 92.9% and 90% on the video recording respectively, compared to the intraoperative PVD diagnosis. Conclusion: SD-OCT shows a relatively low detection sensitivity of PVD in VID. Thorough OCT investigation is necessary to establish an appropriate diagnosis of PVD and treatment in VID.

Vitreomacular interface after anti-VEGF injections in diabetic macular edema

Background The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome. Methods This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release. Results The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7 % were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473 μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9 %), ranibizumab (37.9 %) and bevacizumab (21.2 %). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3 %) developed VMA release following a mean of 5.7 injections (range: 3–13). Sixteen eyes (72.7 %) with focal VMA and 6 eyes (27.3 %) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm). Conclusions VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.

Long-term follow-up of retinal sensitivity assessed by microperimetry in patients with internal limiting membrane peeling

Purpose: To evaluate anatomical and functional changes in patients with vitreomacular interface disease after internal limiting membrane (ILM) peeling, using microperimetry along with usual clinical and multimodal retinal imaging. Methods: Patients with vitreomacular interface disease requiring vitrectomy underwent multimodal retinal evaluation, including visual acuity assessment, fundus color photograph, Spectral-Domain Optical Coherence Tomography, Optical Coherence Tomography-Angiography, and microperimetry. They were examined at baseline (M0), 6 months (M6) and 18 months (M18) after surgery. Retinal sensitivity was subdivided into three concentric polygons: Large, Medium, Small. Results: Eleven eyes of 11 patients were analyzed, including 10 epiretinal membranes (ERMs). Best-corrected visual acuity (BCVA) improved in all patients from 0.51 logarithm of the minimal angle of resolution (logMAR) to 0.067 ( p = 0.0074). Retinal sensitivity improved between M0 and M6 in all polygons and continued to improve between M6 and M18 for polygons Medium (M) and Small (S) with no statistical significance. At M18, BCVA and retinal sensitivity were similar in the operated eye compared with the fellow eye for all patients. Dissociated optic nerve fiber layer appearance was observed in 8 patients at M18. It was not correlated with either retinal sensitivity or BCVA or microscotomas. No recurrence of ERM or macular hole occurred during follow-up. Conclusion: After surgery, the retinal sensitivity assessed by microperimetry gradually improved until the 18th month and was not different from the values of the fellow eye. These results seemed to confirm that ILM peeling can be an effective and safe technique to treat patients with vitreomacular interface disease.