Surgical treatment in macular diseases, criteria for indication by new modulity for examinations, and evaluation on outcome of treatment.

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In some of frequently occurred and severe macular diseases, pathophysiology, clinical features, criteria for diagnosis, indication for treatment, clinical course, and outcome were eveluated.1. Multifocal posterior pigment epitheliopathy (MPPE) This is a severe variant of central serous chorioretinopathy and its manifestation is bullous retinal detachment. Primary involvement of MPPE is in hyperpermeability of the choriocapillaris, and the retinal pigment epithelium is secondarily damaged, then lead to subretinal leakage from the choroid. Laser photocoagulation to the leakage sites is effecitve treatment.2. Uveal effusion syndrome Manifestation is a combination of bullous retinal detachment and annural choroidal detachment. There is no subretinal leakage. The sclera is thick and rigid. In the sclera, collagen fiber bundles are irragularly arranged, and proteoglycans are deposited in the matrix. Transscleral outflow of the intraocular fluid is impaired due to scleral abnormality. We conf … More irmed abnormality of the selera by CT, MRI, ultrasound, length of ocular axis. Subscleral sclerectomy is successful treatment. Among 19 eyes for 10 years, 6 eyes in type 1 ; nanophthalmic eye, 11 eyes in type 2 ; normal sized, abnormal sclera eye, 2 eyes in type 3 ; normal sized, normal sclera eyes.3. The second eye in unilateral exudative age-related macular degeneration. 170 eyes of the second eyes followed, choroidal neovascularizations (CNV) were developed in 12 eyes (7%), and accumulation of incidence were 0.6% by 1 year, 5.6% by 3 years, and 12.3% by 5 years with Kaplan-Meier life table analysis. Predisposing findings were mostly from serous RPE detachment, not from soft drusen.4. Polypoidal choroidal vasculopathy.Serous and hemorrhagic detachment of the retina and/or RPE in the posterior pole are common manifestation. ICG angiography revealed branching vascular network with polypoidal and aneurysmal dilatations. 35 eyes for 4 years were eveluated, and suggested as a variant of choroidal neovascularization beneath the RPE. Less