Background: This study evaluates changes in the foveal avascular zone (FAZ) area and vessel density in patients with full-thickness macular hole (FTMH) before and after vitrectomy using optical coherence tomography–angiography (OCT-A). Methods: A prospective analysis was conducted on 39 patients diagnosed with FTMH who underwent pars plana vitrectomy. OCT-A imaging was performed preoperatively and at 1 and 3 months postoperatively. Parameters analyzed included FAZ area, superficial (SCP) and deep retinal vessel density (DCP), and central retinal thickness (CRT). Results: Preoperative OCT-A images showed a significant difference in the mean FAZ area between affected and healthy eyes (p < 0.01). However, a significant reduction in superficial capillary plexus (SCP) vessel density was noted after vitrectomy. Visual acuity improved significantly after surgery (p < 0.001), but no significant changes in FAZ or total vessel density were observed postoperatively. Postoperative distance visual acuity (DBCVA) correlated with preoperative macular hole size (p < 0.01). Conclusions: Vitrectomy for FTMH does not significantly alter the FAZ area or DCP vessel density, but does reduce SCP vessel density. OCT-A is a valuable tool for assessing retinal microvascular changes post-vitrectomy.

Valsalva retinopathy (VR) occurs when a sudden rise in pressure within the thoracic or abdominal cavity results in a pre-retinal hemorrhage. The elevated venous pressure leads to increased blood flow through the retinal vessels, causing the rupture of peripapillary capillaries. This rupture leads to unilateral or bilateral pre-retinal hemorrhage, with blood pooling beneath the inner limiting membrane (ILM). A 29-year-old patient presented to the Emergency Eye Care Unit of the Professor Kornel Gibiński University Hospital Center of the Silesian Medical University in Katowice due to deterioration of vision in the right eye over the past five days. On physical examination, the visual acuity (VA) in the right eye was 0.4, and the ocular pressure was 24 mmHg. In the left eye, the VA was 1.0, and the ocular pressure was 22 mmHg. A fundus examination showed a tear-shaped hemorrhage in the fovea. On admission, an optical coherence tomography (OCT) scan of the right eye was performed, confirming the presence of a hemorrhage under the ILM, measuring 524 μm × 246 μm. One month after the initial visit, the VA in the right eye improved to 1.0. The dimension of the hemorrhage, measured by OCT, had decreased to 153 μm × 62 μm. Effective management of VR includes close observation and the avoidance of strenuous physical activity, which gives the patient a chance to regain useful VA and avoid surgical treatment.

Introduction: Suprachoroidal hemorrhage (SCH) is a severe complication that can arise both during and after ophthalmic procedures. The occurrence rate during cataract phacoemulsification surgery ranges from 0.03% to 0.13%. This condition is caused by damage to the posterior long or short ciliary artery, leading to blood accumulation in the area between the choroid and sclera. Risk factors for SCH include intraocular surgeries, older age, glaucoma, and myopia. Materials and Methods: A 55-year-old female patient presented to the Ophthalmology Outpatient Clinic with SCH and hemorrhagic retinal detachment of the left eye (OS) resulting from phacoemulsification cataract surgery with high degenerative myopia. The visual acuity (VA) of the OS before vitrectomy (PPV) was at 0.001, and the intraocular pressure (IOP) in the OS was 20 mmHg. After the additional examinations, the patient was qualified for PPV. PPV was performed from a posterior access, mAndo iridotomy, decalin was administered, subretinal and subconjunctival blood was partially evacuated, retinal endolaser was performed, decalin was removed, and OS silicone oil endotamponade was performed. Results: At the first follow-up 7 days after PPV, the VA of the OS was 0.06, and the IOP value in the OS was 14 mmHg. B-projection ultrasound showed dense silicone oil echoes, and the retina appeared adherent. At follow-up after 1 and 3 months, VA was at 0.1 and 0.7 respectively, and IOP in the OS was 14 mmHg. Conclusions: Despite the difficulties associated with high myopia and extensive SCH, the PPV procedure proved to be extremely effective for achieving satisfactory visual acuity and restoring correct anatomical conditions.

Rationale: Large full-thickness macular holes (FTMH), defined by the International Vitreomacular Traction Study Group as defects of all retinal layers within the foveal region with an aperture size of 400 μm or more, remain a challenging condition with reduced anatomical closure rates using conventional techniques. We report a case managed with the temporal inverted internal limiting membrane (ILM) flap technique. Patient concerns: A 70-year-old female patient presented to the Outpatient Ophthalmology Clinic with decreased vision in the left eye. Diagnoses: Decimal Snellen best-corrected visual acuity was 0.3 (5/16) in oculus sinister (left eye) and 0.06 (3/50) in oculus dexter (right eye), and intraocular pressure was 16 mm Hg in both eyes. Optical coherence tomography (OCT) revealed an hourglass-shaped FTMH with cystic changes within the retina and rounded thickened edges, with a minimum aperture size of 500 μm. Fundus examination and OCT of the fellow (right) eye also revealed a full-thickness macular hole (MH), with a smaller aperture than the left eye. Interventions: The patient underwent 25G pars plana vitrectomy with the temporal inverted ILM flap technique, followed by fluid–air exchange and 25% sulfur hexafluoride gas endotamponade. Outcomes: Follow-up OCT at 33 and 45 days after the procedure demonstrated complete closure of the MH, with a small residual fluid pocket beneath the inverted ILM flap noted at day 33. Best-corrected visual acuity was 0.1 (5/50) in oculus dexter (right eye) and 0.5 (5/10) in oculus sinister, and intraocular pressure was 15 mm Hg in both eyes at the final follow-up. Lessons: In the presented patient, 25G vitrectomy using the temporal inverted ILM flap technique resulted in short-term anatomical closure of the MH and improvement in visual acuity, consistent with previous reports of this technique in the management of large FTMH.