To report the clinical cases of PRESERFLO MicroShunt swelling following exposure to petrolatum-based ophthalmic ointment and to experimentally identify the cause and composition of the swollen MicroShunt. A retrospective case series and an in vitro experimental study were conducted. The clinical series included three glaucoma patients with swollen MicroShunts after ointment exposure and four patients whose explanted MicroShunts showed no swelling without ointment exposure. In vitro experiments were performed using unused MicroShunts incubated in 0.3

PURPOSE:This study evaluated the clinical outcomes and aqueous humor cytokine levels in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept to ranibizumab biosimilar (BS). STUDY DESIGN:Prospective observational study. METHODS:Thirty-eight eyes of 38 patients with nAMD who received aflibercept under a treat-and-extend (TAE) regimen were prospectively switched to ranibizumab BS. Eight eyes with cataracts undergoing surgery served as controls for aqueous humor cytokine analysis. Best-corrected visual acuity (BCVA) and anatomical outcomes were assessed over one year. The aqueous humor levels of vascular endothelial growth factor (VEGF)-A, angiopoietin-2 (Ang-2), and placental growth factor (PlGF) were measured before and after switching in eyes with nAMD and at surgery in controls. RESULTS:Disease activity remained controlled in 94.3% of patients with nAMD for over one year. No significant changes were observed in the BCVA (P=0.65) after one year. Ang-2 levels remained unchanged (P=0.66) and were not significantly different between eyes with nAMD and controls both before (P=0.64) and after switching (P=0.30). PlGF levels also remained stable (P=0.12) but were significantly higher in eyes with nAMD than in controls both before (P<0.01) and after switching (P=0.03). VEGF-A levels significantly increased after switching (P<0.01) but remained lower than in the controls both before (P<0.01) and after switching (P=0.02). CONCLUSION:Switching from aflibercept to ranibizumab BS effectively maintained disease stability and cytokine balance in eyes with nAMD. These findings support ranibizumab BS as a viable and cost-effective alternative for long-term treatment.

Background/Objectives: Submacular hemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD) can lead to significant vision loss, and the optimal management strategy remains uncertain. This study aimed to evaluate the efficacy and safety of pneumatic displacement (PD) without tissue plasminogen activator (t-PA) for SMH secondary to nAMD. Methods: A retrospective analysis was conducted on 22 eyes with SMH secondary to nAMD treated with PD without t-PA. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of intravitreal injections, and postoperative complications were assessed at baseline and follow-up. Multiple logistic regression analyses were used to identify factors associated with visual outcomes. Results: In the 22 eyes that completed the 6-month follow-up, BCVA (logMAR) was 0.88 ± 0.46 at baseline and 0.76 ± 0.63 at 6 months (p = 0.24). In the 15 eyes with 12-month follow-up, BCVA improved significantly from 0.92 ± 0.47 at baseline to 0.56 ± 0.51 at 12 months (p = 0.01). CRT significantly decreased at 3 months (p < 0.01). During this period, patients received an average of 8.13 ± 2.90 intravitreal anti-vascular endothelial growth factor (VEGF) injections. A shorter duration from symptom onset to treatment was associated with better visual outcomes (p = 0.02). Postoperative vitreous hemorrhage occurred in 31.8% of cases. Conclusions: PD without t-PA, in combination with anti-VEGF therapy, improved visual outcomes over 12 months. Early intervention and continuous anti-VEGF administration appear to be key factors in optimizing treatment outcomes. Further studies are needed to establish standardized treatment protocols for SMH associated with nAMD.

Objective:Artificial intelligence-powered large language models (LLMs) are increasingly applied in health care. However, studies in ophthalmology assessing whether LLMs can improve the accuracy of complex differential diagnoses in clinical cases, or which levels of clinical experience benefit most from their use, remain lacking. This study assessed the effectiveness of ChatGPT-4o, an LLM-driven chatbot, in enhancing ophthalmologists' clinical reasoning using original scenarios. Design:Prospective study. Subjects:Ten original ophthalmic clinical scenarios with open-ended questions were developed, covering the following subspecialties: oculoplastic and orbital disease, glaucoma, inherited retinal disease, macular disease, neuro-ophthalmology, ocular surface, pediatric ophthalmology, retinal vascular disease, strabismus, and uveitis. Methods:Responses to each clinical scenario were collected from 20 ophthalmologists (10 residents and 10 board-certified ophthalmologists) and ChatGPT-4o. Ophthalmologists subsequently revised their answers with assistance from ChatGPT-4o. All responses were anonymized and independently evaluated by 3 attending ophthalmologists based on 4 metrics: coherency, factuality, comprehensiveness, and safety (each on a 5-point scale). Main Outcome Measures:The median total scores for each group in coherency, factuality, comprehensiveness, and safety (maximum of 15 points each). Results:Assistance from ChatGPT-4o significantly improved evaluation scores for coherency, comprehensiveness, and safety among both residents and board-certified ophthalmologists (all, P < 0.001). However, factuality scores showed no significant improvements (P = 0.114 and 0.839, respectively). Although ChatGPT-4o assistance increased citation frequency (residents: 0.24-0.98 per response, board-certified ophthalmologists: 0.12-0.68 per response, both P < 0.05), approximately 44% of these additional citations were identified as hallucinated references, nonexistent, or incorrect citations. Notably, ChatGPT-4o assistance led to a significant increase in variability for factuality and safety scores in both groups (Brown-Forsythe test, all P < 0.05), whereas it decreased variability for coherency and comprehensiveness, with the reduction statistically significant among residents (P = 0.008 and P = 0.006, respectively). Conclusions:ChatGPT-4o effectively enhanced diagnostic reasoning and response quality, particularly among ophthalmology residents. However, successful integration into clinical education and practice requires careful management of increased variability in factuality and safety. This issue could be addressed by implementing strategies such as advanced retrieval-augmented generation systems to ensure the provision of accurate and safe clinical information. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To evaluate the clinical outcomes of pneumatic retinopexy (PnR) for a recurrent rhegmatogenous retinal detachment (RRD) due to superior retinal breaks following initial vitrectomy for a RRD. STUDY DESIGN:Clinical investigations. METHODS:A retrospective study of 82 eyes of 82 patients who underwent vitrectomy by a single surgeon between November 2021 and March 2023. PnR was performed on 4 (4.9%) of 11 eyes that developed a recurrent RD. The PnR procedure involved injecting sulfur hexafluoride gas into the vitreous cavity while the patient was in the lateral or in the supine position. The patient was placed in the prone position after the injection, and then laser photocoagulation was performed. RESULTS:A retinal reattachment was achieved in all four eyes that underwent rescue PnR. The gas infusion volume during the PnR was 4.3 to 5.6 ml for cases in which PnR was performed in the lateral position and 1.0 ml for a case in the supine position. The duration of the gas tamponade was 15 to 21 days for patients who had PnR in the lateral position and 11 days for patients who had PnR in the supine position. The best-corrected visual acuity after the treatment improved in all patients. No serious complications were associated with the PnR. CONCLUSION:The results indicate that rescue PnR may be an effective treatment for a recurrent RRD due to superior retinal breaks after vitrectomy for a RRD to achieve retinal reattachment without reoperation or hospitalization.

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the Kyorin Eye Center from June 2021 to August 2023 and were followed for ≥3 months were studied retrospectively. The surgical outcomes of the 10,000 cut/min (cpm) 25G vitrectomy (25G group, 25 eyes) to that of the 20,000 cpm 27G vitrectomy (27G group, 58 eyes) were compared. Results: The preoperative PDR status, surgical procedures, and postoperative outcomes were assessed relative to the surgical success. The 25G group had significantly more eyes with severe PDR (p = 0.010), no prior laser photocoagulation (p = 0.027), macular detachment (p = 0.006), and the use of bimanual technique (p = 0.005). However, the operative times and incidence of iatrogenic breaks were not significantly different. The visual acuity improved significantly in both groups at 3 months postoperatively. The primary anatomical success was 88% in the 25G and 97% in the 27G groups (p > 0.05). The risk factors for a postoperative retinal detachment were significantly associated with the grade (p = 0.042) and type of PDR (p = 0.041), the use of perfluorocarbon liquid (p = 0.028), and bimanual techniques (p = 0.017). Conclusions: The high anatomical success for both groups for TRD secondary to PDR indicates that both can be used to treat eyes with PDR. The 27G vitrectomy may reduce the need for bimanual techniques.

Recognizing the characteristic vertically oriented atrophy, pseudodrusen distribution, and retinal pigment epithelium-Bruch's membrane separation is critical for distinguishing extensive macular atrophy with a pseudodrusen-like appearance (EMAP) from age-related macular degeneration (AMD). Early identification of neovascular complications and prompt anti-vascular endothelial growth factor therapy can stabilize macular neovascularization (MNV) and help preserve residual vision in this rare retinal disorder. To the best of our knowledge, this is the first reported case of EMAP with MNV in an Asian patient. This report aims to describe the clinical presentation, imaging features, genetic findings, and therapeutic response in a Japanese woman with EMAP complicated by MNV, which is rarely reported in Asia. A 63-year-old woman presented with decades-long nyctalopia and progressive visual loss. Fundus examination and fundus autofluorescence showed vertically oriented macular atrophy, widespread pseudodrusen, and peripheral paving-stone degeneration. Optical coherence tomography (OCT) demonstrated diffuse separation of the retinal pigment epithelium from Bruch's membrane. These findings lead to the diagnosis of EMAP. Fluorescein angiography, indocyanine green angiography, and OCT angiography revealed type 1 MNV in the left eye. Whole-exome sequencing detected no pathogenic variants associated with inherited retinal disease or AMD. The neovascular lesion was treated with intravitreal aflibercept on a treat-and-extend regimen; after seven injections, the MNV became inactive.

PurposeTo evaluate subjective and objective macular retinal function and morphology in eyes after autologous retinal transplantation (ART).MethodsWe conducted the study in three patients with large macular holes (MHs) who underwent ART. The examination modalities included optical coherence tomography (OCT), microperimetry (MP-3), and focal macular electroretinography (FMERG) with 10-degree and 5-degree stimulus spots under infrared camera monitoring centered on the treated MHs after ART.ResultsAll three patients showed improved visual acuity after the ART; MP-3 showed relatively good sensitivity around the fixation point with a dense scotoma at the center of the graft. All MHs were closed with autologous grafts and the size of MHs was decreased. OCT revealed clearly visible ellipsoid zones of the host retina around the grafted retina, however one transplanted eye showed disorganized outer layer of the host retina near the border of graft-host retina. FMERGs with the 10-degree stimulus were recorded successfully in all three treated eyes with more than half of a- and b-wave amplitudes of the fellow eyes. FMERGs with the 5-degree stimulus were recorded successfully in two of the treated and their fellow eyes.ConclusionsThe FMERGs showed well-maintained macular retinal function after ART. The electrophysiologic and anatomic outcomes suggested that the host retina around the transplanted retina may play an important role in the postoperative macular retinal function with the mechanical support by the graft.

To compare the clarity of images displayed on a 3D local dimming technology (LDT) monitor (LMD-XH550MT) to that on a conventional 3D monitor (LMD-X550MT) integrated into the Artevo 800® system. Laboratory investigation Six vitreoretinal surgeons evaluated the clarity of the surgical field on photographs displayed simultaneously on 2 monitors during cataract and vitreous surgery by the Artevo 800® system. The visibility scores were made on a 5-point scale for images recorded during anterior capsulotomy, phacoemulsification, cortex aspiration, core vitrectomy, and peeling an epiretinal membrane or an internal limiting membrane (ILM). The skewness and kurtosis of the images during anterior and posterior segment surgery were evaluated. The mean visibility scores were significantly higher with the LDT monitor at 4.7±0.1 than with the conventional monitor at 2.9±0.1 (P<0.001). The visibility scores for anterior capsulotomy (P=0.034), phacoemulsification (P=0.036), cortex aspiration (P=0.036), core vitrectomy (P=0.035), peeling of epiretinal membrane (P=0.036), and ILM (P=0.036) were significantly higher with the LDT monitor than with the conventional monitor. The absolute value of skewness during anterior segment surgery was significantly lower with the LDT monitor (0.20±0.05) than with the conventional monitor (-0.44±0.06, P=0.03). Higher contrast with the LDT monitor was attained by adjusting the backlight brightness according to the brightness of the images, which provided better image clarity for 3D heads-up cataract and vitreous surgery.

To identify predictors for visual outcomes of eyes with submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD). Retrospective observational study. Clinical data from patients diagnosed with SMH secondary to nAMD and treated with pneumatic displacement were collected. SMH thickness was measured by optical coherence tomography (OCT) at baseline and 1 week. Possible factors associated with best-corrected visual acuity (BCVA) gain at 3 months were analyzed. Fifty-six eyes of 56 patients (18 female/38 male; mean age, 77.8 ± 10.1 years) were analyzed; 34 were treatment-naïve and 22 were previously treated with anti-vascular endothelial growth factor agents. Multivariable analysis showed that greater BCVA gain more than 0.3 logMAR at 3 months post-treatment was associated with being treatment-naïve (odds ratio [OR], 34.30; 95

Purpose: To present a surgical technique that combines an inverted internal limiting membrane (ILM) flap and subretinal injection of balanced salt solution for the closure of chronic macular holes (MHs). Methods: Two cases were evaluated. Results: A 74-year-old man and a 63-year-old woman presented with decreased visual acuity (VA) of 20/600 and 20/200, respectively, resulting from a chronic MH. Both patients had vitrectomy, during which the ILM flap was inverted and a 38-gauge subretinal needle was used to inject balanced salt solution near the vascular arcade, creating a retinal bleb. Injection of the balanced salt solution into the MH with a backflush needle completed the detachment. The MH was then closed by a gas tamponade with improvements in VA in both patients to 20/50 and 20/40, respectively. Conclusions: The combined inverted ILM flap and subretinal injection of balanced salt solution into the MH, extending the detachment, led to the successful closure of a chronic MH.

The purpose of this study was to determine the effectiveness of image-sharpening algorithms in detecting the severity of diabetic retinopathy (DR) in ultra-widefield (UWF) fundus photographs. This was a retrospective observational study of 100 UWF fundus photographs of 100 diabetic patients. The Optos UWF photographs of eyes with DR were enhanced using medical image enhancement software, and 3 masked retinal specialists evaluated the severity of DR according to the International Clinical Diabetic Retinopathy (ICDR) Disease Severity Scale. This scale is a five-stage classification system for DR. The skewness and kurtosis were measured to assess the image contrast. The results showed that the severity of the DR in the original and enhanced images did not agree in 14 of the 100 eyes. Eleven eyes were classified to have more severe retinopathy in the enhanced images than in the regular images. Twenty intraretinal retinal hemorrhages were detected in each of the four quadrants, definite venous beading in two quadrants, and prominent intraretinal microvascular abnormalities. These lesions were detected significantly more often in the enhanced images (P = 0.03). The skewness and kurtosis were significantly improved in the enhanced images (P < 0.001, P < 0.001, respectively). We conclude that the image-sharpening algorithms can improve the detection of lesions in the Optos UWF images, and improve the accuracy of the severity index in DR. These improvements make the image-sharpening algorithm a valuable tool for assessing the severity of DR.

Background: Chorioretinal folds are observed after vitrectomy due to ocular collapse caused by low intraocular pressure. The purpose of this study is to investigate the relationship between the postoperative hypotony, chorioretinal folds, and the fundus autofluorescence (FAF) findings. Methods: Two-hundred-and-seventy consecutive eyes that had undergone 25- or 27-gauge vitrectomy were examined. The associations between the arch-shaped hypo-autofluorescent lesions in the FAF images and the postoperative hypotony with intraocular pressure (IOP) ≤ 4 mmHg were determined on the day after the surgery. Results: Arch-shaped hypo-autofluorescent lesions were seen in 4 of the 270 eyes (1.5%), and hypo-autofluorescence was observed in 3 of 14 hypotonic eyes (18.5%). This was significantly more frequent than in the non-hypotony group (0.4%, p = 0.0004). Optical coherence tomography showed a loss of the ellipsoid zone and retinal pigment epithelial layer in the region of the arch-shaped lesions. None of the arch-shaped hypo-autofluorescent lesions involved the fovea, and the vision recovered in all cases. The hypo-autofluorescent lesions did not disappear during the 4 to 16 month observation period. Conclusions: The postoperative arch-shaped hypo-autofluorescent lesions were associated with postoperative hypotony and RPE damage due to chorioretinal folds. These findings remained even when the IOP was normalized and chorioretinal folds disappeared.

To assess the feasibility of swept-source optical coherence tomography angiography (SS-OCTA) to differentiate macular diseases, including nonpolypoidal macular neovascularization (MNV), polypoidal choroidal vasculopathy (PCV), type 3 MNV, and chronic central serous chorioretinopathy (CSC) without indocyanine green angiography (ICGA). Retrospective observational study. This study examined 63 eyes of 63 patients with treatment-naive neovascular age-related macular degeneration (AMD), including 23 eyes with nonpolypoidal MNV, 17 eyes with PCV, and 1 eye with type 3 MNV and 22 eyes with chronic CSC. Two independent retina specialists, blinded to the clinical diagnosis, assessed each case of neovascular AMD and chronic CSC using only B-scan and en face images of SS-OCTA without referring to other examination outcomes. By SS-OCTA alone, 19 eyes were diagnosed with nonpolypoidal MNV, 17 eyes with PCV, 2 eyes with type 3 MNV, and 22 eyes with chronic CSC, indicating high sensitivity (82.6

Purpose:To examine the changes in aqueous humor cytokine levels and clinical outcomes of switching from aflibercept to faricimab in eyes with neovascular age-related macular degeneration (nAMD). Methods:Fifty-four eyes of 54 patients with AMD undergoing treatment with aflibercept under a treat-and-extend (TAE) regimen were switched to faricimab and studied prospectively. Best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative status were analyzed using optical coherence tomography. Aqueous humor was collected before and after the switch, and angiopoietin-2 (Ang-2), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) A levels were measured. Results:After switching from aflibercept to faricimab, exudative changes improved in 28 eyes (52%), remained stable in eight eyes (15%), and worsened in 18 eyes (33%). BCVA changed from 0.27 ± 0.31 to 0.26 ± 0.29 (P = 0.46), CRT decreased from 306.2 ± 147.5 µm to 278.6 ± 100.4 µm (P = 0.11), and CCT changed from 189.5 ± 92.8 µm to 186.8 ± 93.9 µm (P = 0.21). VEGF-A levels were below the detection sensitivity in many cases throughout the pre- and post-switching periods. Ang-2 significantly decreased from 23.8 ± 23.5 pg/mL to 16.4 ± 21.9 pg/mL (P < 0.001), and PlGF significantly increased from 0.86 ± 0.85 pg/mL to 1.72 ± 1.39 pg/mL (P < 0.001). Conclusions:Switching from aflibercept to faricimab in patients with nAMD may not only suppress VEGF-A but also Ang-2 and reduce exudative changes.

This study evaluated the long-term outcomes of eyes with neovascular age-related macular degeneration (nAMD) treated with aflibercept according to a treat-and-extend (T E) regimen for up to 5 years. Methods This retrospective study included 112 eyes of 111 patients with nAMD who received aflibercept according to the T E regimen. The patients received 3 monthly injections of aflibercept followed by a T E regimen for at least 12 months. Data, including best-corrected visual acuity (BCVA), treatment interval, presence of exudation, central retinal thickness, and central choroidal thickness were analyzed. Of the 112 consecutive eyes, 66 completed the 5-year follow-up. After 5 years of treatment, BCVA (logMAR) was significantly better than baseline (0.29 ± 0.31 at baseline and 0.18 ± 0.23 at 5 years, P < 0.01). A mean of 7.0 ± 1.5 injections in the first year and 4.9 ± 2.2 injections per year thereafter were required. In eyes with subretinal hyperreflective material (SHRM) at baseline, BCVA at baseline and 5 years were significantly worse than in eyes without SHRM at baseline and 5 years. However, the eyes with SHRM required fewer injections and exhibited greater BCVA improvement. This retrospective study demonstrated the effectiveness of the T E regimen with aflibercept in managing nAMD over a 5-year period, maintaining significant improvements in BCVA.

This Japanese retrospective multicenter study included 1,351 eyes with nAMD treated with brolucizumab. Cumulative incidence of IOI 1 year after the first injection was 12.2%. History of inflammation and/or retinal vascular occlusion and female sex were significant risk factors. Purpose:To investigate the incidence of intraocular inflammation (IOI) and its risk factors following intravitreal injections of brolucizumab for neovascular age-related macular degeneration in Japan.Methods:A total of 1,351 Japanese consecutive patients with neovascular age-related macular degeneration who were treated with brolucizumab from May 2020 to May 2022 at 14 institutions were examined. The variables analyzed were the number of brolucizumab injections, time to onset of IOI, and risk factors.Results:Intraocular inflammation developed in 152 eyes (11.3%). Retinal vasculitis and/or retinal occlusion occurred in 53 eyes (3.9%). Ninety-four patients received bilaterally, bilateral IOI occurred in five patients (5.3%). Sixteen eyes (1.2%) had irreversible visual acuity loss and nine eyes (0.67%) had visual loss of three lines or more due to retinal vasculitis and/or retinal occlusion. The cumulative IOI incidence was 4.5%, 10.3%, and 12.2% at 30, 180, and 365 days (1-year), respectively. History of IOI (including retinal vasculitis) and/or retinal occlusion (odds ratio [OR], 5.41; P = 0.0075) and female sex (OR, 1.99; P = 0.0004) were significantly associated with IOI onset.Conclusion:The 1-year cumulative incidence of IOI in Japanese neovascular age-related macular degeneration patients treated with brolucizumab was 12.2%. History of IOI (including retinal vasculitis) and/or retinal occlusion and female sex were significant risk factors.

This study aimed to evaluate the changes in cytokine levels in the aqueous humor and factors of treatment resistance following intravitreal faricimab injection in treatment-na & iuml;ve patients with neovascular age-related macular degeneration. A total of 32 eyes were analyzed before and after a single faricimab injection. Although the best-corrected visual acuity (BCVA) showed no significant improvement, the mean central retinal thickness decreased significantly by 73.7% (P < 0.01), and more than 90% of the eyes showed improvement in exudative changes 1 month after faricimab injection. Moreover, the aqueous humor concentrations of vascular endothelial growth factor (VEGF)-A, angiopoietin (Ang)-2, and placental growth factor considerably decreased 1 month after faricimab injection. Multivariate analyses adjusted for age, sex, BCVA, central choroidal thickness, and aqueous humor cytokines revealed that higher Ang-2 levels in the aqueous humor at baseline were associated with better treatment response to faricimab injection. These findings suggest that the dual inhibition of VEGF-A and Ang-2 by faricimab is effective in reducing exudative changes and that Ang-2 may serve as a potential biomarker for predicting faricimab treatment response.

Coronary arteries are a critical part of the vascular system and provide nourishment to the heart. In humans, even minor defects in coronary arteries can be lethal, emphasizing their importance for survival. However, some teleosts survive without coronary arteries, suggesting that there may have been some evolutionary changes in the morphology and function of coronary arteries in the tetrapod lineage. Here, we propose that the true ventricular coronary arteries were newly established during amniote evolution through remodeling of the ancestral coronary vasculature. In mouse (Mus musculus) and Japanese quail (Coturnix japonica) embryos, the coronary arteries unique to amniotes are established by the reconstitution of transient vascular plexuses: aortic subepicardial vessels (ASVs) in the outflow tract and the primitive coronary plexus on the ventricle. In contrast, amphibians (Hyla japonica, Lithobates catesbeianus, Xenopus laevis, and Cynops pyrrhogaster) retain the ASV-like vasculature as truncal coronary arteries throughout their lives and have no primitive coronary plexus. The anatomy and development of zebrafish (Danio rerio) and chondrichthyans suggest that their hypobranchial arteries are ASV-like structures serving as the root of the coronary vasculature throughout their lives. Thus, the ventricular coronary artery of adult amniotes is a novel structure that has acquired a new remodeling process, while the ASVs, which occur transiently during embryonic development, are remnants of the ancestral coronary vessels. This evolutionary change may be related to the modification of branchial arteries, indicating considerable morphological changes underlying the physiological transition during amniote evolution.

PURPOSE:To discuss a case of a macular hole formation after vitrectomy for myopic retinoschisis with foveal detachment and spontaneous closure, during long-term follow-up.METHODS:Case report.RESULTS:A 71-year-old man with myopic retinoschisis with foveal detachment had a vitrectomy with internal limiting membrane peeling combined with cataract surgery in the left eye. The preoperative best-corrected visual acuity was 8/20, and the axial length was 27.11 mm. A macular hole with foveal detachment was observed 1 month after surgery. However, the macular hole closed spontaneously with foveal detachment at 4 months of follow-up. Foveal detachment resolved, and the best-corrected visual acuity improved to 20/20 at nine months of follow-up.CONCLUSION:This case suggests that the macular hole formed after vitrectomy for myopic retinoschisis with foveal detachment with internal limiting membrane peeling can close spontaneously.