Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study. Wang Xianggui,Zhou Xuezhi,Zhu Ying,Xu Huizhuo BMC ophthalmology BACKGROUND:To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients. METHODS:We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated. RESULTS:There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5-3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy. CONCLUSION:Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients. 10.1186/s12886-021-01973-9

Optical coherence tomography features of neovascularization in proliferative diabetic retinopathy: a systematic review. International journal of retina and vitreous BACKGROUND:Diabetic retinopathy (DR) is a leading cause of blindness due to diabetic macular edema (DME) or complications of proliferative diabetic retinopathy (PDR). Optical coherence tomography (OCT) is a noninvasive imaging technique well established for DME but less used to assess neovascularization in PDR. Developments in OCT imaging and the introduction of OCT angiography (OCTA) have shown significant potential in PDR. OBJECTIVES:To describe the tomographic features of PDR, namely of neovascularization, both of the optic disc (NVD) and elsewhere (NVE), intraretinal microvascular abnormalities (IRMA), retinal nonperfusion areas (NPA), status of the posterior vitreous, vitreoschisis and vitreous and subhyaloid/sub-ILM hemorrhages. DATA SOURCES:Electronic database search on PubMed and EMBASE, last run on December 19th 2019. STUDY ELIGIBILITY CRITERIA PARTICIPANTS AND INTERVENTIONS:Publications assessing OCT and/or OCTA findings in PDR patients. All study designs were allowed except for case-reports, conference proceedings and letters. STUDY APPRAISAL:Newcastle-Ottawa Scale for observational studies was used for purposes of risk of bias assessment. RESULTS:From the 1300 studies identified, 283 proceeded to full-text assessment and 60 were included in this comprehensive review. OCT was useful in detecting NVD and NVE, such as in characterizing disease activity and response to laser and/or anti-VEGF therapies. The absence of posterior vitreous detachment seemed determinant for neovascular growth, with the posterior hyaloid acting as a scaffold. OCTA allowed a more detailed characterization of the neovascular complexes, associated NPA and disease activity, allowing the quantification of neovessel area and flow index. However, changes in OCTA blood flow signal following local therapies did not necessarily correlate with structural regression. Widefield and ultra-widefield OCTA were highly sensitive in the detection of PDR, adding value to disease staging and monitoring. Compared to fluorescein angiography, OCTA was more sensitive in detecting microvascular changes indicating disease progression. LIMITATIONS:Publication languages were restricted. Most included studies were observational and non-comparative. Risk of bias regarding case representativeness. CONCLUSIONS:OCT-based retinal imaging technologies are advancing rapidly and the trend is to be noninvasive and wide-field. OCT has proven invaluable in diagnosing, staging and management of proliferative diabetic disease with daily application in clinical and surgical practices. 10.1186/s40942-020-00230-3

Ocular blood flow velocities in patients with proliferative diabetic retinopathy before and after scatter photocoagulation: a prospective study. European journal of ophthalmology INTRODUCTION:Color Doppler imaging allows for simultaneous two-dimensional anatomical imaging and Doppler measurement of blood flow velocity. Chemicals are released during the development of a thermal lesion caused by photocoagulation. METHODS:A prospective study compared ocular blood flow velocities (ophthalmic artery, posterior ciliary arteries, central retinal artery, central retinal vein and vortex veins) before and 30 minutes after the first episode of scatter photocoagulation (650, 0.1 s, 500 microns argon laser) in 25 patients with proliferative diabetic retinopathy, using a color Doppler imaging unit (Toshiba Sonolayer SSA-270 A with a 5.0 MHz PLF-503 ST phased-array scanning head). RESULTS:Systolic, diastolic and mean arterial blood flow velocities were higher after photo-coagulation than before. There was a significant difference in the ophthalmic artery; diastolic (P < 0.01), mean velocity (P < 0.05), posterior ciliary arteries; systolic (P < 0.01), diastolic (P < 0.001), mean velocity (P < 0.05), central retinal artery; mean velocity (P < 0.05), central retinal vein; systolic (P < 0.001) and vortex veins; systolic (P < 0.01), diastolic (P < 0.01). Ophthalmic artery systolic and end-diastolic velocities declined with age in diabetic patients before scatter photocoagulation; these changes were not significant (systolic: r = -0.33, diastolic: r = -0.30). DISCUSSION:During and after thermal lesion caused by photocoagulation, there is a dynamic inflammatory and an autoregulatory response of the retinal circulation, causing changes in the ocular circulation. 10.1177/112067219500500411

Effect of panretinal photocoagulation on macular vasculature using optical coherence tomography angiography. European journal of ophthalmology BACKGROUND:To evaluate the changes of macular vascular density in the superficial capillary (SCP) and the deep capillary plexus (DCP), foveal avascular area (FAZ), choroidal flow, and macular thickness after pan-retinal photocoagulation (PRP). METHODS:In this prospective interventional non-comparative case series, patients with very severe nonproliferative (NPDR) and early proliferative diabetic retinopathy (PDR) and no significant macular edema who were candidates for pan-retinal photocoagulation underwent measurement of corrected distance visual acuity (CDVA), optical coherence tomography (OCT), Optical coherence tomography angiography (OCTA) at the baseline, 1, and 6 months following completion of PRP treatment. RESULTS:Thirty-nine eyes from 21 patients with diabetes were enrolled. Superficial and deep capillary plexus densities in the foveal and parafoveal area didn't change significantly 1 and 6 months post-PRP ( > 0.1 in all of them). The FAZ area constricted 6 months following PRP ( = 0.075). Based on the calculated circularity index, the FAZ became significantly more circular after 6 months of follow-up ( = 0.047). Although the choroidal flow area increased after PRP this increase wasn't statically significant neither at 1 month nor at 6 months post-PRP ( = 0.31 and 0.23, respectively). CONCLUSION:Although OCTA parameters were not significantly affected by PRP at both short-term (1 month) and long-term (6 months) follow-ups, the FAZ area became significantly circular after PRP may be due to redistribution of blood flow in hypoperfused foveal capillary plexus. 10.1177/1120672120952642

A randomized clinical trial evaluating choroidal blood flow and morphology after conventional and pattern scan laser panretinal photocoagulation. Mikoshiba Yuji,Iwase Takeshi,Ueno Yoshitaka,Yamamoto Kentaro,Ra Eimei,Terasaki Hiroko Scientific reports We prospectively investigated the changes in choroidal blood flow and morphology after panretinal photocoagulation (PRP) in 39 eyes with severe nonproliferative diabetic retinopathy (S-NPDR). Seventeen eyes underwent PRP by conventional laser and 22 eyes underwent pattern scan laser (PASCAL). The choroidal blood flow was assessed by laser speckle flowgraphy, and the subfoveal choroidal thickness (SFCT) was measured with optical coherence tomography before and 1, 4, 8, and 12 weeks after the two types of PRP treatments. The choroidal mean blur rate (MBR) at the macular region was significantly reduced to 86.4% of the baseline level in the conventional laser group and 85.7% in the PASCAL group at Week 12 (P = 0.001, P < 0.001, respectively). The SFCT was significantly increased at 1 week following PRP but it was significantly reduced at Week 8 (P = 0.001, P < 0.001, respectively) in both groups. The differences in the ratio of the MBR and the SFCT was not significant between the conventional laser and PASCAL groups at any time after PRP. The results suggest that appropriate PRP treatments even by the PASCAL method will reduce the choroidal blood flow and the choroidal morphological components. 10.1038/s41598-018-32487-y