To evaluate visual outcomes after vitrectomy based on preoperative visual acuity (VA) in eyes with myopic traction maculopathy (MTM) and explore the optimal timing for surgery. Patients who underwent vitrectomy for MTM were categorized into four groups: preoperative vision of 20/25 or better (V1), worse than 20/25 to 20/50 (V2), 20/60 to 20/200 (V3), and worse than 20/200 (V4). The primary outcome was the postoperative VA at 12 months. We included 193 eyes: V1 (12 eyes), V2 (77 eyes), V3 (83 eyes), and V4 (21 eyes). Postoperative VA significantly correlated with preoperative VA (R2 = 0.400, P < 0.001). Postoperative logarithm of the minimum angle of resolution VA was the best in V1 and worst in V4 (V1, 0.10 ± 0.26; V2, 0.19 ± 0.26; V3, 0.54 ± 0.44; and V4, 0.92 ± 0.54; P < 0.001). Visual improvement was highest in V4 and lowest in V1 (V1, 0.04 ± 0.26; V2, -0.12 ± 0.25; V3, -0.18 ± 0.41; and V4, -0.36 ± 0.44; P = 0.001). At 12 months, 83.3

PURPOSE:To evaluate the efficacy of internal limiting membrane (ILM) peeling on the anatomic and visual outcomes of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR). DESIGN:Multicenter, interventional, clinical cohort study. SUBJECTS:Consecutive patients who underwent PPV for grade C PVR with a minimum of 6-month follow-up. METHODS:We compared the anatomic and visual outcomes of grade C PVR surgery after vitrectomy with PVR membrane peeling plus, or without, ILM peeling, in patients treated at 6 institutions between January 2015 and January 2022. Internal limiting membrane peeling was performed within the macula, arcade to arcade, or beyond the arcades (extended ILM peeling). MAIN OUTCOME MEASURES:Single surgery anatomic success at 3 months and 6 months with versus without ILM peeling. RESULTS:We included a total of 370 eyes (370 patients); 157 eyes (42.4%) treated with ILM peeling were compared with 213 eyes (57.6%) treated without ILM peeling. Mean follow-up was 23.2 ± 13.9 months. No differences were noted in baseline characteristics or surgical techniques. Single surgery anatomic success was significantly higher in the ILM peeling group (86.6% vs. 73.2% at 3 months [P = 0.002] and 75.2% vs. 65.3% at 6 months [P = 0.041], respectively). The retinal reattachment rate under fluid without tamponade was significantly higher in the ILM peeling group at 6 months (68.8% vs. 51.6%, P < 0.001). Both groups showed visual improvement after surgery (both P < 0.001). However, the ILM peeling group showed significantly better visual acuity and visual improvement (1.11 ± 0.70 vs. 1.29 ± 0.80 [P = 0.020] and 0.48 ± 0.77 vs. 0.24 ± 0.90 [P = 0.018], respectively). The ILM peeling group had significantly fewer subsequent vitreoretinal surgeries (P = 0.002), including subsequent epiretinal membrane surgeries (8.9% vs. 17.8%, P = 0.015). No ILM peeling was associated with more posterior breaks when the retina redetached (P = 0.045). Multivariable regression analysis showed that extended ILM peeling was significantly associated with higher likelihood of retinal reattachment without tamponade (under fluid) at 6 months and better final visual acuity (P = 0.040 and 0.031, respectively). CONCLUSIONS:Internal limiting membrane peeling, particularly extended ILM peeling, for RRD with grade C PVR resulted in superior anatomic and visual outcomes compared with vitrectomy without ILM peeling in this study. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The authors report a multicenter pilot study examining the use of 27-G vitrectomy and instrumentation in pediatric patients, ranging from premature infants with retinopathy of prematurity, to older children with traumatic macular hole and endophthalmitis. Purpose: To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients. Methods: This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications. Results: The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery. Conclusion: Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

Purpose: To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). Design: Multicenter, interventional, retrospective case series. Subjects: Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up.Methods: We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery.Main Outcome Measures: Incidence, risk factors, and anatomic and visual outcomes of postoperative MH.Results: We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for post-operative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Post-operative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 +/- 0.43 vs. 0.68 +/- 0.46; P = 0.002).Conclusions: Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in favorable anatomic closure but unfavorable visual outcomes.

PURPOSE: To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrec-tomy for myopic traction maculopathy (MTM). DESIGN: Multicenter, retrospective clinical cohort study. METHODS: Consecutive eyes that underwent vitrec-tomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or with-out tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postop-erative visual acuity (VA) at 12 months in eyes with vs without tamponade. RESULTS: We included a total of 193 eyes (193 pa-tients) in this study; 136 eyes (70%) treated with tam-ponade were compared with 57 eyes (30%) treated with-out tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and vi-sual improvement at 12 months were significantly bet-ter ( P = .003 and P = .028, respectively) in eyes with -out tamponade, although the MTM in these eyes with-out tamponade took longer to resolve ( P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade ( P < .001 and P = .001, respec-tively). Complications such as macular holes did not dif-fer between the groups. A novel imaging finding of "schi-sis bending (accordioning)" was identified during MTM resolution.CONCLUSIONS: Vitrectomy either with or without tam-ponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.

To evaluate the surgical outcomes of the 27-gauge (G) vitrectomy system for the treatment of primary rhegmatogenous retinal detachment (RRD). This retrospective consecutive series multicenter study involved a total of 410 eyes of 406 patients who underwent 3-port transconjunctival 27G pars plana vitrectomy (PPV) for RRD between November 2014 and December 2016 and who were followed for a minimum of 3 months postoperative. The main outcome measure was primary reattachment, with the secondary outcome measures being final reattachment, improvement of visual acuity (VA), intraocular pressure (IOP), intraoperative and postoperative complications, and surgery time. Of the 410 treated eyes, primary reattachment was achieved in 392 (95.6%) and final reattachment was achieved in 410 (100%). In 226 eyes (55.1%) with macula-on RRD, the mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.16 ± 0.51 pre-surgery to 0.02 ± 0.14 post-surgery (P = 0.11). In 184 eyes (44.9%) with macula-off RRD, logMAR VA improved from 1.06 ± 0.77 pre-surgery to 0.26 ± 0.35 post-surgery (P < 0.001). Following surgery, the mean IOP was highest at 1 day (15.7 ± 7.0 mmHg) postoperative. In all eyes, surgery was concluded without the use of sutures or the need of conversion to a larger-gauge instrument. Although hypotony was observed in 14 (3.4%) of the 410 treated eyes at 1 day postoperative, it spontaneously resolved within 1 week without additional surgical intervention. No postoperative complications such as infectious endophthalmitis were observed throughout the follow-up period. Our findings show that 27G PPV is both safe and effective for the treatment of primary RRD.

Purpose: To evaluate the safety and efficacy of 27-gauge vitrectomy for various vitreoretinal disorders. Methods: In this retrospective comparative study, 163 consecutive eyes with various diseases that underwent 27-gauge pars plana vitrectomy with or without ultraspeed transformer by a single surgeon from June 2012 through December 2014 were analyzed in regard to best-corrected visual acuity, intraocular pressure, intraoperative and postoperative complications, and surgery time. Results: In 2 eyes (1.2%), peripheral retina breaks were encountered intraoperatively, yet no other complications were found in those eyes. No cases required larger-gauge vitrectomy. Mean best-corrected visual acuity improved from 20/58 (logarithm of the minimum angle of resolution, 0.46 ± 0.64) preoperatively to 20/32 (logarithm of the minimum angle of resolution, 0.20 ± 0.40) postoperatively ( P < 0.001). Mean follow-up was 16.7 months (range, 6–33 months). Intraocular pressure remained stable throughout the postoperative course. Hypotony was seen in 15 eyes (9.2%) at 1-day postoperative, yet that spontaneously improved within 1 week. No case of retinal detachment or endophthalmitis was recorded. In macular surgeries, such as idiopathic epiretinal membrane and macular hole combined with cataract surgery, the mean surgery time was 32.1 ± 6.9 minutes with ultraspeed transformer (n = 38) and 37.1 ± 7.7 minutes without ultraspeed transformer (n = 40) ( P = 0.004). Conclusion: The 27-gauge pars plana vitrectomy was found to be safe and effective for treating various vitreoretinal disorders.

Background/aims To compare the functional and anatomic outcomes of pars plana vitrectomy (PPV) with juxtapapillary laser photocoagulation (JLP) versus vitrectomy without JLP in optic disc pit maculopathy.Methods This was a multicentre, retrospective study of 46 consecutive patients with optic disc pit maculopathy presenting at tertiary eye centres between 1992 and 2012. Indications for surgery included distorted or decreased vision. Surgical intervention included PPV, posterior vitreous detachment, with or without gas tamponade. Twenty-four patients received laser photocoagulation at the temporal edge of the optic disc pit (group A) and 22 patients had no laser (group B). Postoperative best-corrected visual acuity (BCVA) and optical coherence tomography findings were the main outcome measures.Results Mean follow-up was 44 months (range 1298 months). BCVA in group A improved significantly from 0.7 logMAR (20/100) preoperatively to 0.5 logMAR (20/60) postoperatively (p=0.017). In group B, BCVA improved from 0.7 logMAR (20/100) preoperatively to 0.4 logMAR (20/40) postoperatively (p=0.014). The difference in final BCVA between groups was not statistically significant (p=0.693). The mean central macular thickness (CMT) in group A improved significantly from 750 mu m preoperatively to 309 mu m at last follow-up (p<0.0001). The mean CMT in group B improved from 616 mu m preoperatively to 291 mu m at last follow-up (p=0.028). The difference in final CMT between groups was not statistically significant (p=0.747).Conclusions PPV with JLP for optic disc pit maculopathy had similar functional and anatomic outcomes compared with vitrectomy without JLP.

Ten years or more have passed since the current concept of 25-gauge transconjunctival sutureless vitrectomy with a trocar-cannula system emerged. There is no doubt that current microincision vitrectomy surgery with 25- or 23-gauge instrumentation has simplified the vitrectomy procedure and has provided numerous potential advantages over traditional 20-gauge surgery. The established theory regarding surgical wounds is that 'much smaller is better'. Along with the development of new-generation vitrectomy machines with ergonomic instruments, surgeons have been shifting dramatically from 20-gauge systems to 23- and 25-gauge systems over the last years. Thanks to recent innovations and improvements in high-end multifunctional vitrectomy machines and ultrahigh-speed cutters, the development of powerful light sources, and wide-angle viewing systems, several new techniques have also encouraged us to launch the development of a 27-gauge vitrectomy system over the past several years. Similar to the recent evolution in 23- and 25-gauge systems, further development and refinement of the functionality of instruments with a gauge of 27 or more are under way and will continue over the coming years, which in the future will allow us to establish this system for ultra-minimally invasive surgery for the full spectrum of vitreoretinal pathologies.

This paper proposes a method for adaptively controlling the admission of interference to users for our previously proposed layered partially non-orthogonal block diagonalization (BD) precoding method for downlink multiuser multiple-input multiple-output (MIMO) transmission that employs cooperation among multiple base stations (BS). The proposed method is applicable when some of the instantaneous channel state information (CSI) feedback between the user equipment and the respective BSs is missing if the path loss between the user equipment and BS is higher than a predetermined threshold. The proposed method alleviates the loss in the transmitter diversity (beam forming) gain caused by the perfect nulling of inter-user interference in BD. By allowing the inter-user interference from a link that has a high average path loss, the overall throughput performance of simple BD is enhanced. We show that the combination of layered transmission that restricts the set of BSs used for the signal transmission and adaptive control of interference admission significantly increases the throughput of BS cooperative multiuser MIMO with partial CSI feedback.

PURPOSE:We developed a new artificial image enhancement system and evaluated its usefulness in controlling intraoperative reflection and enhancing of Brilliant Blue G (BBG) staining.METHODS:The system was composed of three kinds of filters (a polarizing filter, a blue-enhancing filter, and a sharp-cut filter Y) and attached to the inferior surface of the operating microscope. Twenty-seven post-mortem extracted porcine eyes were used for a series of examinations. We performed surgery using the 23G-vitrectomy system with a halogen light and xenon lights and compared the reduction of intraoperative reflection under air condition and visibility and BBG contrast with and without this system. The evaluation of images was calculated in CIE 1976 (L*, a*, b*) color space (CIELAB) carried out by ImageJ software. The transmission of each filter and absorbance of BBG was measured by a spectrophotometer. We measured spectral irradiance at each wavelength about each filter from each light source with a spectroradiometer.RESULTS:Under both light sources, intraoperative reflection was controlled using a polarizing (PL) filter or combination of filters under air condition. Evaluation of the value of L* within the cutter surface was changed by 37.8 % under the halogen light, and 61.6 % (averaged) under the xenon light with inserted filters versus no filter. The BBG intensity difference was obtained with sharp-cut Y filter under both light source and PL with blue enhancing filter under the halogen light using each L*, a*, b* parameter with statistically significant (p < 0.01, 0.05). However, there was a relative decrease in the observation illuminance when the filter inserted according to the attenuation total spectral irradiance.CONCLUSIONS:This system can reduce intraoperative reflections under the air condition and obtain an excellent BBG staining intensity induced by various light sources.