The effect of phacoemulsification performed with vitrectomy on choroidal vascularity index in eyes with vitreomacular diseases

Comparison of choroidal vascularity index in rhegmatogenous retinal detachment: impact of silicone-oil vs. gas tamponade following pars plana vitrectomy

PURPOSE

This study aimed to evaluate the impact of silicone oil (SO) and perfluoropropane gas (C3F8) tamponade on the choroidal vascularity index (CVI) in patients undergoing pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).

METHODS

This retrospective study included 106 patients (212 eyes) with macula-off RRD who underwent PPV with either SO (n = 60) or C3F8 gas (n = 46) tamponade. CVI and other choroidal parameters, including luminal area (LA), stromal area (SA), total choroidal area (TCA), and subfoveal choroidal thickness (SFCT), were evaluated using swept-source optical coherence tomography (SS-OCT) and compared between operated and fellow healthy eyes at postoperative months 1 and 3. In addition, direct comparisons were made between SO- and gas-treated eyes to assess the differential impact of tamponade type on choroidal metrics. Multiple linear regression analyses were conducted to investigate associations between CVI and clinical variables such as preoperative best-corrected visual acuity (BCVA), age, sex, surgical type, and tamponade type.

RESULTS

No significant differences in CVI, LA, SA, or TCA were observed between operated and fellow eyes in either the SO or gas groups. Likewise, CVI values did not differ significantly between postoperative months 1 and 3 or between tamponade groups (p > 0.05). However, LA, SA, and TCA were significantly higher in SO-treated eyes than in gas-treated eyes at both follow-up visits (p < 0.05). SFCT significantly increased at month 1 in gas-treated eyes compared to fellow eyes (p < 0.001), but this difference was not significant by month 3. Conversely, SFCT was significantly lower in SO-treated eyes than in fellow eyes at both time points and continued to decrease following SO removal. The multiple linear regression analyses revealed no statistically significant associations between CVI values and preoperative BCVA, age, sex, surgical type, or tamponade type at either postoperative month 1 or month 3 (p > 0.05).

CONCLUSION

CVI values did not significantly differ between eyes treated with SO and gas tamponade, nor did they correlate significantly with postoperative visual outcomes. Although CVI provides valuable insights into choroidal health, it may not serve as a strong predictor of visual recovery in the early postoperative period. Larger, prospective studies are needed to further explore the long-term effects of different tamponade agents on choroidal vascularity and visual outcomes.

CLINICAL TRIAL NUMBER

Not applicable.

Insights into the pattern of choroidal vascularity index changes in idiopathic macular hole

This retrospective study aimed to investigate the changes in choroidal vascularity index (CVI) before and after surgery for idiopathic macular hole (MH). Enhanced depth imaging optical coherence tomography (EDI-OCT) images were analyzed at baseline and at 1-week, 1-month, and 3-month postoperative visits. A total of 97 patients (97 eyes) were included in the study. At baseline, overall CVI and macular CVI showed negative correlation with axial length (AL) and positive correlation with central corneal thickness (CCT). There were no significant differences in macular CVI or overall CVI between affected and healthy eyes, as well as in subgroup analysis of different stages of macular CVI. Following surgery, there was a significant decrease in CVI at 1 week postoperatively, followed by a gradual recovery to baseline levels over time. The observed changes in CVI may be attributed to factors such as air tamponade, pressure changes, and photoreceptor metabolism. This study provides insights into the pattern of CVI changes associated with MH surgery. The findings suggest that stage 4 MH is associated with decreased macular CVI in affected eyes. These results contribute to a better understanding of the effects of surgery on choroidal blood flow in MH patients.

Choroidal Vascularity Index Fluctuations in Epiretinal Membranes in Vitreoretinal Surgery: Comparison Between Idiopathic and Diabetic Ones

Purpose

The aim of the study was to analyze choroidal vascularity index (CVI) fluctuations in patients with epiretinal membrane after vitreoretinal surgery, comparing idiopathic and secondary diabetic ones.

Methods

Thirty eyes suffering from idiopathic ERMs (I-ERMS; n = 15) and diabetic ERMs (D-ERMS; n = 15) were analyzed in this observational prospective study. Anatomical (central macular thickness) and functional (best-corrected visual acuity) parameters were analyzed preoperatively and at 1 and 3 months after vitrectomy. Perfusion findings regarding CVI and luminal area were also calculated.

Results

At 1 month after surgery, the luminal area and CVI significantly decreased in the I-ERMS group, whereas they were increased in the D-ERMS group. At the 3-month follow-up, the CVI tended to return to baseline values in I-ERMS and to reduce in D-ERMS, but without any statistical differences.

Conclusions

The significant change in the CVI after surgery seems to imply that the choroidal layer is affected by vitreomacular disease and can become a novel potential biomarker of predictiveness in vitreoretinal surgery.

Translational Relevance

The aim of the study was to focus on the early choroidal changes to better understand initial predictive elements of long-term functional postoperative outcomes.

Choroidal vascularity index changes in different treatments for vitreomacular traction

INTRODUCTION

The aim of this study was to examine if choroidal vascularity index (CVI) is different in eyes with unilateral vitreomacular traction (VMT) from their healthy fellow eyes; and whether different treatments affect the CVI.

METHODS

The baseline and 8-week post treatment CVIs of 56 unilateral VMT patients that underwent spontaneous resolution (n = 30), vitreoretinal surgery (n = 16) or pneumatic vitreolysis (n = 10) were compared with fellow eyes using paired samples t-test. Partial correlation analyses correcting age and gender was used for calculations between treatment groups. P values < 0.05 were considered statistically significant.

RESULTS

The mean baseline CVI for VMT and control eyes had no statistically significant difference (p = 0.81, r= -0.38). The post traction release follow-up CVI of VMT eyes and contralateral eyes had no significant difference (p = 0.12, r = 0.49). In spontaneous resolution group, vitreoretinal surgery group and pneumatic vitreolysis group the baseline and follow up CVIs of VMT eyes were statistically similar (p = 0.72, p = 0.32 and p = 0.79 respectively).Spontaneous detachment patients' CVIs showed a 0.57±5.81% increase, vitreoretinal surgery group had a reduction of 1.098±4.76%, and the pneumatic vitreolysis patients showed a CVI reduction of 0.307±4.24%. However, none of these changes was found to be statistically significant when compared between the groups (p = 0.21, r = 0.02).

DISCUSSION

Previous studies have argued that vitreomacular traction might have a role on the choroidal changes seen in the vitreoretinal interface disorders. This study has shown that VMT alone does not cause any significant changes in choroidal vascular index pre or post traction release.

Changes in choriocapillaris structure occurring in idiopathic macular hole before and after vitrectomy

PURPOSE

The aim of this study was to analyze the anatomical choroidal vascular layers and the changes in idiopathic macular hole (IMH) eyes over time after vitrectomy.

METHODS

This is a retrospective observational case-control study. Fifteen eyes from 15 patients who received vitrectomy for IMH and age-matched 15 eyes from 15 healthy controls were enrolled in this study. Retinal and choroidal structures were quantitatively analyzed before vitrectomy and 1 and 2 months after surgery using spectral domain-optical coherence tomography. Each choroidal vascular layer was divided into the choriocapillaris, Sattler's layer, and Haller's layer, and then, the choroidal area (CA), luminal area (LA), stromal area (SA), and central choroidal thickness (CCT) were calculated using binarization techniques. The ratio of LA to CA was defined as the L/C ratio.

RESULTS

The CA, LA, and L/C ratios were 36.9 ± 6.2, 23.4 ± 5.0, and 63.1 ± 7.2 in the choriocapillaris of IMH and were 47.3 ± 6.6, 38.3 ± 5.6, and 80.9 ± 4.1 in that of control eyes, respectively. Those values were significantly lower in IMH eyes than in control eyes (each P < 0.01), whereas there was no significant difference in total choroid, Sattler's layer, and Haller's layer or CCT. The ellipsoid zone defect length showed a significant negative correlation with the L/C ratio in total choroid and with CA and LA in the choriocapillaris of IMH (R =  - 0.61, P < 0.05, R =  - 0.77, P < 0.01, and R =  - 0.71, P < 0.01, respectively). In the choriocapillaris, the LA were 23.4 ± 5.0, 27.7 ± 3.8, and 30.9 ± 4.4, and the L/C ratios were 63.1 ± 7.2, 74.3 ± 6.4, and 76.6 ± 5.4 at baseline, 1 month, and 2 months after vitrectomy, respectively. Those values showed a significant increase over time after surgery (each P < 0.05), whereas the other choroidal layers did not alter consistently with respect to changes in choroidal structure.

CONCLUSIONS

The current OCT-based study demonstrated that the choriocapillaris was exclusively disrupted between choroidal vascular structures in IMH, which may correlate with the ellipsoid zone defect. Furthermore, the L/C ratio of choriocapillaris recovered after IMH repair, suggesting an improved balance between supply and demand of oxygen that has collapsed due to temporary loss of central retinal function by IMH.

Short-term postoperative changes in the choroidal vascularity index in patients with a unilateral epiretinal membrane

BACKGROUND

To investigate short-term choroidal structural and vascular changes after epiretinal membrane (ERM) surgery.

METHODS

In this retrospective study, 65 patients with unilateral ERM underwent pars plana vitrectomy combined with cataract surgery and were examined one day before surgery and one week, one month, and three months after surgery. Choroidal thickness (CT) and choroidal vascular index (CVI) were evaluated using horizontal enhanced depth imaging optical coherence tomography (EDI-OCT) scans and were further calculated using semi-automatic algorithms using MATLAB R2017a.

RESULTS

Preoperatively, CVI was higher in eyes with ERM (61.70 ± 5.17%) than in fellow eyes (59.99 ± 5.26%). CVI increased significantly at one week after surgery (62.14 ± 5.02%) and decreased at 1 and 3 months after surgery (60.76 ± 4.97% and 60.4 ± 4.83%, respectively). The change was pronounced in the nasal region (p < 0.001) and central region (p < 0.05). CT in the temporal macula increased at 1 week (239.65 ± 72.98 μm) after surgery and decreased at 1 and 3 months after surgery (222.15 ± 71.91 μm and 222.33 ± 65.72 μm, respectively; p < 0.01).

CONCLUSIONS

Short-term postoperative variations in the choroid have been demonstrated in eyes with ERM. This may be related to the release of macular traction. CVI assessment using EDI-OCT may be a useful tool for investigating choroidal structural changes accompanying ERM and postoperative period.

Choroidal structural changes following vitrectomy performed with phacoemulsification in unilateral idiopathic epiretinal membrane

BACKGROUND

This study aims to determine the influence of vitrectomy combined with macular epiretinal membrane dissection and internal limiting membrane (ILM) peeling and phacoemulsification on choroidal vasculature in patients with unilateral idiopathic epiretinal membrane (IERM) and concurrent cataract using optical coherence tomography (OCT).

METHODS

This retrospective study included 26 eyes of 26 patients (8 males and 18 females) with unilateral IERM without vitreomacular traction (VMT) (group 1) and the patients' fellow eyes (n = 26, group 2). Three-port 25-G pars plana vitrectomy (PPV) combined with macular epiretinal membrane dissection and ILM peeling and phacoemulsification was performed on all patients. The comprehensive ophthalmologic examinations of all patients involved OCT measurements at every visit before and after surgery, and the choroidal thickness (CT), central macular thickness (CMT) and choroidal vascularity index (CVI) were calculated.

RESULTS

The mean age of the IERM patients was 66.58 ± 7.06 years. Postoperatively, best corrected visual acuity (BCVA) was significantly greater than baseline (P = 0.023). The CVI of the IERM eyes was significantly lower (P < 0.01) than that of the fellow eyes at baseline. The subfoveal CT in the IERM eyes was lower than that in the fellow eyes (P = 0.023), but there was, no significant difference in the average CT between the two groups at baseline (P = 0.071). In eyes with IERM, the CVI significantly increased at 1 week, 1 month (P < 0.001), and 3 months (P = 0.049) postoperatively, the subfoveal CT was markedly thickened 1 month after surgery (P = 0.001), the temporal 3 mm and nasal CT significantly increased at 1 week and 1 month postoperatively (P = 0.041, P = 0.022 for temporal 3 mm; P < 0.001, P = 0.047 for nasal 1.5 mm; P = 0.01, P = 0.001 for nasal 3 mm), and only the temporal 3 mm CT increased significantly at 3 months postoperatively (P = 0.017). The baseline CMT of the IERM eyes was significantly thicker than that of the fellow eyes (P < 0.001). CMT significantly decreased at 3 months postoperatively in IERM eyes(P = 0.033).

CONCLUSIONS

The increase in the CVI in the IERM eyes without VMT after combined PPV with ILM peeling and phacoemulsification persists for at least 3 months.

Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders

Purpose

Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH).

Methods

Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared.

Results

Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16).

Conclusion

There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.

Comparison Between L-312 Hydrophobic-Hydrophilic Acrylate and US-860 UV Hydrophilic Acrylate IOL Opacification Characteristic

Objective

To compare opacity characteristics of US-860 UV and L-312 IOL, and report the phenomenon of glistenings in hydrophobic-hydrophilic acrylic IOLs.

Setting

Qingdao Eye Hospital.

Design

Experimental study.

Methods

Four medical records (4 eyes) of patients with L-312 or US-860 UV IOL opacification reporting decreased or lost vision who underwent IOL explanation between 2019 and 2021 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at Qingdao Eye Hospital and Qingdao university of science and technology.

Results

The 4 explanted IOLs were represented by 2 hydrophilic acrylic designs. The preoperative mean corrected distance visual acuity changed from 1.84 ± 1.09 logarithm of the minimum angle of resolution (log MAR) to 0.20 ± 0.03 log MAR postoperatively except case 3. The mean interval of the L-312 IOL was 56.67 ± 14.19 months (range 44 to 72 months), and the interval of the US-860 UV IOL was 27 months. Morphological findings were surface, subsurface calcifications of the US-860 UV IOL material, and the optical region of L-312 IOLs are teeming with a great number of vacuoles by light microscope, scanning electron microscope and Energy Dispersive X-ray Spectral.

Conclusion

The cause of US-860 UV opacification was primary calcification, and vacuoles resulted in L-312 IOL opacification.