Naoto Sato, MD
Suzuki Eye Group, Tokyo, Japan
On Sunday afternoon, the Macular Surgery 2 session was moderated by Drs. Kazuaki Kadonosono and Thomas J. Wolfensberger.
Dr. Eric Nudleman from Shiley Eye Institute, U.S.A. started with a presentation on cellular and molecular mechanisms of retinal fibrosis.
First, it was emphasized that there is a clear distinction between gliosis and fibrosis. Dr. Nudleman examined fibrosis in the brain and found that it occurs due to perivascular fibroblasts. They also developed a new retinal scarring model termed as Long Oxygen Induced Retinopathy (LOIR), which was used to assess the process of retinal fibrosis. He concluded that fibrosis-producing cells are not RPE or glia but in fact pericytes. Therefore, inhibition of pericyte specific mitogens may be able to prevent fibrosis in various retinal pathologies.
Next, a rotational internal limiting membrane flap technique for macular hole repair was presented by Dr. Peiquan Zhao of Xinhua Hospital, China.
Although ILM flap techniques are useful for treating refractory macular holes, patients often ends up with suboptimal visual recovery. He speculated that it is due to the tractional force created by proliferation beneath the inverted ILM flap postoperatively. They introduced a new technique whereby the macular hole is covered without inverting the flap to minimize proliferation, which may lead to better visual outcomes.
Dr. Takashi Iwase from Akita University also gave us new insights about macular hole repair.
They looked at the relationship between preoperative morphology and the recovery of vision and outer retinal structures. Based on OCT findings at the edge of the macular hole, they classified macular holes into two groups: Smooth type and bumpy type. They noted that OCT findings observed in bumpy types may suggest irreversible photoreceptor damage, which could negatively impact functional and anatomical recovery.
Dr. Yoshihiro Yonekawa from Wills Eye Hospital, U.S.A., then presented an effective method for treating macular edema after vitrectomy.
Topical steroids and NSAIDS drops are widely used to treat macular edema in vitrectomized eyes, but in some cases, they only have a suboptimal effect. Although intravitreal dexamethasone implant is commonly used for treatment-resistant macular edema, it carries a risk of striking the retina and anterior chamber migration, especially in the vitrectomzed eye.
Dr. Yonekawa examined patients receiving suprachoroidal triamcinolone treatment for macular edema after vitrectomy and found that central foveal thickness and visual acuity improved after the treatment, though patients still need to be monitored for IOP elevation, especially those with a history of glaucoma.
Dr. Thomas J. Wolfensberger from The University of Lausanne, Switzerland investigated the relationship between choroidal thickness (CT) and retinal detachment.
The investigators looked at choroidal changes not only of the subfoveal area but also of the entire submacular choroid in retinal detachment cases. There was a significant increase in CT in the treated eye with peripheral macula-on RD compared to fellow eyes. Additionally, peripheral macula-on RD showed a thinner CT compared to the average reported in the literature. He speculated whether eyes with peripheral macula-on RD are at lower risk of large extension due to thinner baseline CT.
Finally, Dr. Taku Wakabayashi from Wakabayashi Eye Clinic, Japan, presented his multicenter study comparing the incidence of postoperative epiretinal membrane between eyes with myopic traction maculopathy that underwent fovea-sparing ILM peeling and eyes that received standard ILM peeling.
Fovea-sparing ILM peeling is an effective strategy for preventing macular hole and subsequent visual impairment in patients with myopic traction maculopathy (MTM). However, according to Dr. Wakabayashi’s study, the incidence of postoperative ERM at 12 months was significantly higher after fovea-sparing ILM peeling (14%) compared to standard ILM peeling (4.2%). Nevertheless, postoperative ERMs were mostly mild, and they did not cause significant vision loss. Based on these results, they concluded that although postoperative ERMs are more likely to occur after the fovea-sparing technique, the benefit of preventing MH outweighs the risk for postoperative ERM in patients with MTM.