Reappraisal of biomicroscopic classification of stages of development of a macular hole

Optical coherence tomography of macular holes.

Objective: To prospectively assess the risks and benefits of vitrectomy surgery for eyes with stage 3 or 4 macular holes. Design: A multicentered, controlled, randomized clinical trial. Setting: Community- and university-based ophthalmology clinics. Patients: One hundred twenty patients (129 eyes) with stage 3 or 4 macular holes. Interventions: Standardized macular hole surgery vs observation alone. Main Outcome Measures: Four measures of bestcorrected visual function, standardized photographic evaluation of the extent of hole closure, evaluation of lens opacification, and determination of adverse events. Outcomes were determined at 6 months after randomization. Results: Compared with observation alone, a significant benefit due to surgery was found in the rate of hole closure (4% vs 69%, P P =.02) and the Potential Acuity Meter ( P P =.05) Although the proportion of eyes achieving a change in visual acuity of 2 or more lines on the Early Treatment Diabetic Retinopathy Study chart was significantly greater for the surgery group vs the observed group (11 [19%] of 59 eyes vs 3[5%] of 58 eyes, adjusted P =.05), 20(34%) of 59 eyes randomized to surgery had a loss in visual acuity of 1 or more lines. Compared with the observation group, eyes randomized to surgery had higher nuclear sclerosis scores (2.4 vs 1.3, P Conclusions: Some visual benefit of vitrectomy surgery for macular holes exists, despite a notable incidence of adverse events. The large variability in visual acuity outcome in the surgical group may be because of complications or progressive cataract. A study of the longterm outcome after macular hole surgery is needed.

Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group.

Internal limiting membrane removal in the management of full-thickness macular holes

Endophthalmitis is a severe inflammation of the interior of the eye caused by the introduction of contaminating microorganisms following trauma, surgery, or hematogenous spread from a distant infection site. Despite appropriate therapeutic intervention, bacterial endophthalmitis frequently results in visual loss, if not loss of the eye itself. Although the pathogenicity of bacterial endophthalmitis has historically been linked with toxin production during infection, a paucity of information exists as to the exact mechanisms of retinal toxicity and the triggers for induction of the intraocular immune response. Recently, research has begun to examine the bacterial and host molecular and cellular events that contribute to ocular damage during endophthalmitis. This review focuses on the causative agents and therapeutic challenges of bacterial endophthalmitis and provides current data from the analysis of the role of bacterial virulence factors and host inflammatory interactions in the pathogenesis of eye infections. Based on these and related studies, a hypothetical model for the molecular pathogenesis of bacterial endophthalmitis is proposed. Identifying and understanding the basic mechanisms of these bacterium-host interactions will provide the foundation for which novel, information-based therapeutic agents are developed in order to prevent vision loss during endophthalmitis.

John T. Thompson

Papers

Infectious Endophthalmitis after Penetrating Injuries with Retained Intraocular Foreign Bodies

The Effect of Pars Plana Vitrectomy and Transforming Growth Factor-Beta 2 without Epiretinal Membrane Peeling on Full-thickness Macular Holes

Resolution of an absolute scotoma and improvement of relative scotomata after successful macular hole surgery

Retreatment of full-thickness macular holes persisting after prior vitrectomy. A pilot study.