Disappearance of central confluent soft drusen following vitrectomy and ILM peeling

Abstract

ReferencesRegarding his comment, the axial length measurements for silicone oil-filled eyes using IOL master showed a high correlation with the postoperative axial length measurement, while the postoperative refractive outcomes varied. We illustrated the plot described by Bland and Altman 3 ( Figure 1) following his suggestion and found that few measurements were outside the 95% limits of agreement, resulting in a wide range of predictive postoperative refractive error ( À 2.74 to þ 2.33 D). But most measurements were in the range, resulting in high correlation (0.966) and a small mean predictive postoperative refractive error (0.60 ± 0.23 D). Conflict of interestThe author declares no conflict of interest. We report a long-term effective treatment for drusenoid pigment epithelial detachment. Case reportA 66-year-old woman presented with central confluent drusen, incipient cataract OU, and macular hole OD (Figure 1). BCVA was 20/200 OD and 20/30 OS. The patient underwent macular hole surgery including cataract surgery, vitrectomy, posterior vitreous detachment (PVD), peeling of epiretinal membrane plus internal limiting membrane (ILM) after ICG staining, and gas tamponade. Before ILM staining with ICG, the macular hole was covered with a small PFCL-bubble to avoid any contact of ICG with the RPE. Postoperatively, the macular hole was closed and the confluent drusen almost completely disappeared. Only few small drusen were present 12 months after surgery (BCVA 20/60).Comparison of pre-and postoperative photographs suggests that these drusen were newly formed.

Complications of Macular Peeling

“…Other possible applications of macular peeling are optic disk maculopathy [ 172 ], vitreomacular traction syndrome [ 173 ], Terson's syndrome [ 174 ], and prevention of ERM formation in retinal detachment surgery [ 175 , 176 ]. Dithmar also reports a case of soft confluent drusen absorption after ILM peeling [ 177 ].…”

Morphologic Changes in Patient with Drusen and Drusenoid Pigment Epithelial Detachment after Intravitreal Ranibizumab for Choroidal Neovascular Membrane : A Case Report

“…Possible mechanisms during and after intravitreal ranibizumab injection include mechanical and biochemical effects. Some stimulating factors have a common final pathway of reactive RPE changes resulting in phagocytosis of drusen material [ 8 , 9 ]. It may be speculated that nonspecific stimulating factors including mechanical (partial detachment of the posterior vitreous cortex, vitreoretinal traction), or biochemical (ranibizumab itself) factors.…”

“…Drusenoid pigment epithelial detachment (DPED) is defined as a fairly well-circumscribed, shallow elevation of the retinal pigment epithelium, formed by a confluence of soft drusen, often located in the central macula [ 1 ]. Disappearance of drusen or DPED has been shown after laser photocoagulation, verteporfin photodynamic therapy, haemorheopheresis and vitrectomy [ 2 - 9 ]. Ranibizumab (Lucentis, Genentech, South San Francisco, CA) as a treatment for exudative AMD inhibits a number of subtypes of vascular endothelial growth factor (VEGF).…”

Disappearance of soft drusen and subsequent development of choroidal neovascularization following macular hole surgery: a case report

“…In the present case, vitrectomy, ILM peeling, and gas tamponade were performed to close macular hole. ILM peeling may not be a significant factor associated with drusen regression; Holz et al did not attempt to peel ILM during his macular hole surgery, whereas Dithmar et al did, but both noted the disappearance of drusen after surgery [ 5 , 6 ]. Other surgical components such as induction of posterior hyaloid detachment, vitrectomy, and gas tamponade may somehow acted as exogenous stimuli to the exposed RPE and perhaps accelerated phagocytosis of multinucleated giant cells, resulting in degradation of drusen material around the macular hole.…”