Partial-thickness macular hole in vitreomacular traction syndrome: a case report and review of the literature

Surgical Outcome of Vitreomacular Traction Associated With Macular Hole

Vitreomacular Interface pathology and its surgical treatment is an ever-evolving field in vitreoretinal surgery. Various treatments have been proposed for macular holes associated with vitreomacular traction including ocriplasmin injection, gas injection, and pars plana vitrectomy with posterior hyaloid face stripping with or without internal limiting membrane peeling. The time of intervention in patients with vitreomacular traction syndrome is also a point of contention among researchers. Here we present a case of an 83-year-old male patient who presented to the outpatient department with a history of grossly decreased visual acuity of counting fingers in the right eye. An altered foveal reflex was seen in an otherwise unremarkable ocular examination. The left eye revealed no pertinent findings. The patient was diagnosed with vitreomacular traction syndrome on spectral domain optical coherence tomography. There was an associated grade 1b macular hole according to the International Vitreomacular Traction Study classification. As the roof of the macular hole was intact, we decided to proceed with pars plana vitrectomy and careful stripping of the posterior hyaloid face. However, this resulted in a full-thickness macular hole and no change in visual acuity. A second surgery comprising internal limiting membrane peel using brilliant blue dye with perfluoropropane (C3F8) gas tamponade was done. Follow-up after six weeks showed a visual acuity improvement to 20/120 and restoration of foveal configuration. To the best of our knowledge, such a clinical case has not been reported in locally published literature.

Early prediction of complex midgut volvulus in neonates and infants

INTRODUCTION

Prognosis of midgut volvulus in neonates and infants younger than 1 year remains poor, as diagnostic findings may not be apparent until gut infarction had occurred. To characterize factors that help to predict complex midgut volvulus early was aim of this study.

METHODS

Institutionally approved retrospective analysis of all children younger than 1 year treated for midgut volvulus at the author's center from January 2002 to December 2011. Medical history, symptoms, laboratory and radiologic findings as well as sequelae of midgut volvulus were evaluated.

RESULTS

In 10 years, 37 children fulfilled the inclusion criteria. Of these, 43% developed complications, and mortality rate was 16%. In 30% of the patients, the only clinical sign was a sudden worsening of the general condition and abdominal distension (complex 19% vs. simple 38%). In one child with simple midgut volvulus, all clinical, laboratory and radiologic signs were negative. CART analysis identified a base excess below -1.70 and preterm birth (<36 weeks) as the best discriminators of complex and simple midgut volvulus. A score >1pt (comprised of these two factors) was found in all children with complex and in 14% of simple midgut volvulus (p < 0.001). A positive score (>1pt) offers a sensitivity of 100% (81.7-100%), specificity of 85.7% (71.8-85.7%), a PPV of 84.2% (68.8-84.2%) and NPV 100% (83.8-100%).

DISCUSSION

The study shows that midgut volvulus has a substantial morbidity and mortality. Unfortunately, not all affected children get picked up by history, laboratory and imaging. However, the proposed score helps to identify subject with increased risk of complications. It has the potential to facilitate and accelerate diagnosis of complex midgut volvulus; ultimately, it might help to reduce morbidity and mortality.

Bilateral vitreomacular traction resolved with a single intravitreal ocriplasmin injection

A 74-year-old woman was referred by her ophthalmologist for evaluation of blurred vision in both eyes over the course of several months, presenting with a best corrected visual acuity (BCVA) of 20/150 in the right eye and 20/50 in the left eye. Optical coherence tomography showed vitreomacular traction (VMT) bilaterally with a full-thickness macular hole in the right eye; a single intravitreal injection of 125 μg ocriplasmin was administered in the right eye. One week after the injection, BCVA in the right eye improved to 20/60 with release of VMT, and at 3 weeks bilateral release of VMT was observed.