Purpose: The study aimed to evaluate risk factors for macular atrophy (MA) associated with myopic choroidal neovascularization (mCNV) during long-term follow-up after intravitreal anti-vascular endothelial growth factor (VEGF) treatment in highly myopic eyes. Methods: The medical records of patients who received intravitreal injection of anti-VEGF agents as mCNV treatment and were followed-up for more than 36 months were retrospectively reviewed. The risk factors for the development of mCNV-MA, which is the fovea-involving patchy atrophy lesion adjacent to mCNV, were investigated using the Cox proportional hazard model. Results: A total of 82 eyes (74 patients) were included in the study. The mean age at anti-VEGF treatment was 56.3 ± 12.5 years (range, 26–77), and the mean follow-up period was 76.3 ± 33.5 months (range, 36–154). During follow-up, mCNV-MA developed in 27 eyes (32.9%), and its occurrence was estimated to be 24.5% at 3 years and 37.3% at 5 years after the first anti-VEGF treatment. Old age (hazard ratio [HR] = 1.054, 95% confidence interval [CI]: 1.018–1.091; P = 0.003) and greater CNV size at baseline (HR = 2.396, CI: 1.043–5.504; P = 0.040) were significant factors for mCNV-MA development. Eyes with a thinner subfoveal choroid were more likely to show faster enlargement of the mCNV-MA during follow-up. Conclusions: In mCNV eyes treated with intravitreal anti-VEGF agents, older age and greater mCNV size at baseline were risk factors for the development of MA during long-term follow-up, which was associated with a poor visual prognosis.

Purpose: To investigate the functional and anatomical parameters and their postoperative changes according to the ectopic inner foveal layer (EIFL) staging scheme for idiopathic epiretinal membrane (ERM). Methods: In this prospective study, patients with idiopathic ERM underwent pars plana vitrectomy and ERM removal, and were followed-up for 6 months. The associations of EIFL with pre- and postoperative functional and anatomical parameters were analyzed. Results: A total of 84 eyes (84 patients) were included: 39 (46.4%), 33 (39.3%), and 12 (14.3%) as EIFL stages 2, 3, and 4, respectively. At 6 months after surgery, the mean best-corrected visual acuity (BCVA) significantly improved in all EIFL stages (P ≤ 0.003); however, metamorphopsia improved only in eyes with EIFL stage 2 (P = 0.039) and 3 (P = 0.011). The aniseikonia and foveal avascular zone (FAZ) area showed no significant postoperative changes in any of the EIFL stages. Both preoperatively and during 6 months after surgery, the EIFL stage showed a significant correlation with BCVA (P ≤ 0.033), metamorphopsia (P ≤ 0.008), central macular thickness (P < 0.001), and FAZ parameters (P ≤ 0.016) at each time point, but not with aniseikonia. Significant correlations of EIFL thickness with BCVA (P = 0.028) and metamorphopsia (P = 0.006) before surgery were not persistent after surgery. Conclusion: Both pre- and postoperatively, the staging of EIFL, rather than its thickness, is a simple and adequate surrogate marker for visual acuity and metamorphopsia in eyes with idiopathic ERM.

This study investigated the long-term effects of epiretinal membrane (ERM) surgery on peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) images. We included 30 patients with idiopathic ERM who underwent a vitrectomy for ERM removal with internal limiting membrane peeling. The patients were followed up for 5 years after surgery, and their medical records were reviewed for best-corrected visual acuity (BCVA) and OCT parameters. The study population comprised 24 females (80.0%), and the mean age was 65.4 ± 7.2 years. The baseline BCVA significantly improved from 0.28 ± 0.24 to 0.12 ± 0.09 logMAR (p < 0.001) 1 year after surgery and continued to improve for 5 years after surgery. The peripapillary RNFL thickness initially increased after surgery and then gradually decreased. The peripapillary RNFL thicknesses of the global and temporal sectors showed significant reductions 2 years after surgery, whereas those of the nasal sectors did not significantly change. The peripapillary RNFL thickness was thinner in the global and temporal areas of the operated eyes than in those of the fellow eyes 4 and 5 years after surgery. In conclusion, peripapillary RNFL thicknesses decreased in the global and temporal areas after ERM surgery, whereas peripapillary RNFL thicknesses in the nasal sectors did not change significantly during the long-term follow-up.

This study aimed to investigate changes in choroidal thickness after pars plana vitrectomy (PPV) with and without air tamponade in patients with idiopathic epiretinal membrane (ERM). We retrospectively reviewed 61 patients with ERM who underwent a 25-gauge transconjunctival sutureless PPV. The patients were divided into two groups: the air tamponade group (30 eyes) and the nontamponade group (31 eyes). Subfoveal choroidal thickness (SFCT) was analyzed over 12 months. No significant differences were seen between the two groups at baseline. For all patients, the SFCT was significantly thicker at 1 month after surgery and significantly thinner at 6 and 12 months after surgery than preoperative values. In the subgroup analysis, there was no significant difference in SFCT 3 months after surgery compared with the preoperative values in both groups, but SFCT was significantly lower 6 months after surgery in both groups. In conclusion, our results showed that choroidal thickness temporarily increased after surgery and then gradually decreased until 12 months after the PPV for ERM.

Kelly and Wendel [1] first introduced vitrectomy to treat macular holes (MHs) in 1991, and Eckardt et al. [2] reported internal limiting membrane (ILM) peeling during MH surgery in 1997. Currently, the primary surgical treatments for MH are pars plana vitrectomy (PPV), ILM peeling, and gas tamponade. Although the primary hole closure rate reaches more than 90% with current methods, the failure rate is much higher in cases with high myopia, chronic MH, nonidiopathic condition or large MH, defined as a hole diameter bigger than 400 µm [3]. Recently, Ch'ng et al. [4] reported a closure rate of 76% in MHs >650 µm. Various secondary surgical options have been proposed for recurrent and persistent MHs, such as additional ILM peeling, ILM f laps, and lens capsule transplantation [3]. Chen and Yang [5] demonstrated lens capsular flap transplantation to treat refractory MH and showed hole closure and visual improvement. Herein, we report a case of refractory large MH successfully treated with anterior capsular flap transplantation after a failed primary surgery. Informed consent for the publication of this case report and relevant images was obtained from the patient. A 66-year-old female patient presented with metamorphopsia and decreased vision in her left eye for more than 1

Background/Objectives: We evaluated the clinical features and natural course of treatment-naïve non-exudative macular neovascularization (NE MNV) associated with age-related macular degeneration in Korean patients. Methods: This retrospective longitudinal study of 21 eyes of 21 patients with NE MNV involved a chart review of best corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCT angiography parameters. Results: This study included 13 men (13/21, 61.9%) and 8 women (8/21, 38.1%), with a mean age of 71.5 ± 9.1 years. The average follow-up period was 15.1 ± 11.8 (range 6.0–49.6) months, and 14 eyes (66.7%) demonstrated exudative changes on OCT scans. The baseline BCVA was 0.15 ± 0.18 logMAR. The initial central macular thickness (CMT), subfoveal choroidal thickness, and the outer retinal layer thickness were 265.3 ± 37.1, 245.2 ± 95.2, and 86.6 ± 5.3 μm, respectively. Cox proportional hazards analysis revealed that older age (hazard ratio [HR]: 1.096, 95% confidence interval [CI]: 1.002–1.200; p = 0.045), larger baseline CMT (HR: 1.025, 95% CI: 1.002–1.049; p = 0.035), and larger baseline MNV (HR: 1.618, 95% CI: 1.035–2.529; p = 0.035) were significant risk factors for exudative changes. Conclusions: We observed the clinical features and natural course of NE MNV in Korean patients and identified that significant risk factors for exudative changes in NE MNV included old age, initially thick CMT, and larger MNV size at baseline. For eyes with NE MNV that have risk factors of exudative conversion, more frequent observation is recommended to ensure the appropriate management.