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Allen A, Zheng Y, Lee T, Joseph S, Zhang X, Feng HL, Fekrat S. Risk Factors for Progression of Vitreomacular Traction to Macular Hole. JOURNAL OF VITREORETINAL DISEASES 2024; 8:524-532. [PMID: 39381333 PMCID: PMC11457020 DOI: 10.1177/24741264241264937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Purpose: To evaluate the clinical and optical coherence tomography (OCT) characteristics associated with progression of vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) and lamellar macular hole (LMH). Methods: A retrospective cohort study of patients with an OCT-confirmed diagnosis of idiopathic VMT and 6 or more months of follow-up was performed. Clinical data included age, sex, race, systemic comorbidities, hormone replacement therapy, corrected visual acuity (VA), subjective visual symptoms, OCT signs, and the presence of or progression to FTMH or LMH. Results: Of the 287 eyes with VMT, 48 (16.7%) progressed to MH. Twelve eyes (4.2%) progressed to LMH, and 36 eyes (12.5%) progressed to FTMH. Female sex (P = .02), myopic refractive status in phakic eyes (P = .02), subjective decreased VA (P = .01), and the presence of an inner segment-outer segment junction disruption on OCT (P = .003) were risk factors for progression from VMT to FTMH. Subjective metamorphopsia was a risk factor for progression to FTMH (P = .001) and LMH (P = .01). In a subgroup analysis, patients who had an FTMH in the fellow eye were significantly more likely to have VMT progress to FTMH in the study eye (24.0% vs 8.7%; P = .04). Having an LMH in the fellow eye was not a risk factor for progression to LMH in the study eye (P = .47). Conclusions: Risk factors were found for the progression of VMT to MH that may be clinically relevant for risk-stratifying patients presenting with VMT.
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Affiliation(s)
- Ariana Allen
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Yuxi Zheng
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Terry Lee
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Suzanna Joseph
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | | | - Henry L. Feng
- Illinois Retina Associates, Chicago, IL, USA
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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Hanai M, Amaral DC, Jacometti R, Aguiar EHC, Gomes FC, Cyrino LG, Alves MR, Monteiro MLR, Fuganti RM, Casella AMB, Louzada RN. Large macular hole and autologous retinal transplantation: a systematic review and meta-analysis. Int J Retina Vitreous 2024; 10:56. [PMID: 39175026 PMCID: PMC11340077 DOI: 10.1186/s40942-024-00573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes. METHODS We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software. RESULTS We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I2 = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I2 = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I2 = 59%). CONCLUSION ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.
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Affiliation(s)
- Mário Hanai
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Dillan Cunha Amaral
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raiza Jacometti
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Laura Goldfarb Cyrino
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Milton Ruiz Alves
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Mário Luiz Ribeiro Monteiro
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Noguera Louzada
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
- Instituto de Olhos São Sebastião, Largo do Machado 54, 1208, Rio de Janeiro, RJ, 22221-020, Brazil.
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Yue H, Liu C, Zhang Y, Zhang L, Gao Z, Ma T, Zhang X. Etiologies and clinical characteristics of macular hole: An 8-year, single-center, retrospective study. Medicine (Baltimore) 2024; 103:e37878. [PMID: 39121247 PMCID: PMC11315493 DOI: 10.1097/md.0000000000037878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/21/2024] [Indexed: 08/11/2024] Open
Abstract
To investigate the etiologies and clinical characteristics of full-thickness macular hole (FTMH) cases at Shanxi Eye Hospital in North China. Patients diagnosed with FTMH who underwent surgery from 2012 to 2020 were included, and the etiologies and clinical features of MH types were analyzed in an 8-year, cross-sectional, retrospective study. A total of 752 cases (776 eyes) were analyzed. The top 3 subtypes of MH were idiopathic (IMH, 64.4%), myopic (MMH, 21.1%) and traumatic (TMH, 3.7%) MH. Among these, there were significant differences in sex, age, and baseline best-corrected visual acuity (BCVA) distributions. Females predominated in the IMH and MMH groups, while males predominated in the TMH group. The IMH onset age was older than the MMH and TMH onset ages. Baseline BCVA in the IMH (Z = 8.9, P < .001) and the other group (Z = 4.0, P < .001) was significantly better than that in the MMH group. In the IMH group, females were younger, had a shorter axial length (AL), and had a worse baseline BCVA than males, while in the MMH group, there were no significant sex differences. Multivariate correlation analysis showed that a smaller hole diameter in IMH, no retinal detachment in MMH, and a younger age in TMH may result in better baseline BCVA. The most common MH etiologies were IMH, MMH and TMH, which contributed to differences in clinical features. Females predominated in the IMH and MMH groups, and the onset of MMH occurred 6.5 years earlier than the onset of IMH. Therefore, early fundus monitoring in females and high myopia patients is helpful for the early detection and treatment of MH.
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Affiliation(s)
| | - Chenyu Liu
- Shanxi Medical University, Taiyuan, China
| | | | | | - Zhao Gao
- Shanxi Eye Hospital, Taiyuan, China
| | - Tao Ma
- Shanxi Eye Hospital, Taiyuan, China
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4
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Choi J, Kim SJ, Kang SW, Son KY, Hwang S. Macular hole with epiretinal proliferation: diagnostic value of en-face optical coherence tomography and clinical characteristics. Graefes Arch Clin Exp Ophthalmol 2024; 262:2461-2470. [PMID: 38499794 DOI: 10.1007/s00417-024-06446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To elucidate the clinical features and surgical outcomes of full-thickness macular hole (FTMH) with epiretinal proliferation (EP) diagnosed by both en-face and B-mode optical coherence tomography (OCT). METHOD This retrospective cohort study classified idiopathic FTMHs into two groups, based on B-scan and en-face OCT imaging: FTMH with EP (EP group) and without EP (non-EP group). The preoperative features, as well as postoperative outcomes up to 12 months, were compared between the two groups. RESULT Among 318 eyes of idiopathic FTMH that met the inclusion criteria, 59 eyes (18.6%) were in the EP group, and others were in the non-EP group. In 9 eyes (15.3%) out of the EP group, EP was not detected in the preoperative B-mode OCT but was identified through the en-face OCT. Baseline features showed a higher male proportion (47.5% vs. 27.8%, P = 0.005) and a lower incidence of vitreofoveal traction (P < 0.001) in the EP group than in the non-EP group. The EP group showed worse visual recovery than the non-EP group (- 0.23 vs. - 0.41 logarithm of the minimum angle of the resolution at 12 months, P = 0.001). CONCLUSION The en-face OCT enhances diagnostic accuracy of EP in FTMH eyes, especially in the case with smaller extent of EP. Eyes with FTMH with EP showed a worse visual recovery than FTMH without EP.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medial Center, Kyung Hee University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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5
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Suarez MK, Wang SK, Hayes B, Greven MA, Shah RE, Greven C, Russell G, Ong SS. VISUAL OUTCOMES AFTER INTERNAL LIMITING MEMBRANE PEELING VERSUS FLAP IN THE CLOSURE OF FULL-THICKNESS MACULAR HOLES. Retina 2024; 44:1171-1179. [PMID: 38437847 DOI: 10.1097/iae.0000000000004084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full-thickness macular holes. METHODS Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close full-thickness macular hole at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow-up. Main outcome measures were type 1 primary full-thickness macular hole closure and postoperative best-corrected visual acuity in mean logMAR. RESULTS One hundred thirty and 30 eyes underwent ILMP and ILMF, respectively. There were no significant differences in baseline characteristics between the groups. Ninety-six percent of ILMP eyes and 90% of ILMF eyes achieved primary hole closure ( P = 0.29). Among all eyes with primary hole closure, best-corrected visual acuity at 1 year was not different between the groups, but when stratified by lens status, it was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean best-corrected visual acuity (Snellen equivalent) (95% confidence interval) was 0.42 (20/50) (0.34, 0.49) in the ILMP group and 0.71 (20/100) (0.50, 0.92) in the ILMF group. CONCLUSION Internal limiting membrane peeling and ILMF techniques yielded similarly high full-thickness macular hole closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse best-corrected visual acuity at 1 year.
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Affiliation(s)
- Mallory K Suarez
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Sean K Wang
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Bartlett Hayes
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Rajiv E Shah
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Craig Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Greg Russell
- Department of Biostatistics and Data Science, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Sally S Ong
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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6
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Ueoka K, Mizuguchi T, Horiguchi M, Ito Y. Vitreoretinal interface abnormalities in fellow eyes of patients with a macular hole. FUJITA MEDICAL JOURNAL 2024; 10:64-68. [PMID: 38708076 PMCID: PMC11063577 DOI: 10.20407/fmj.2023-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/15/2023] [Indexed: 05/07/2024]
Abstract
Objectives This study aimed to determine the incidence of bilateral macular holes (MHs), and to investigate the incidence and characteristics of retinal abnormalities in the fellow eyes, using high-definition optical coherence tomography (OCT). Methods Medical records from 724 consecutive patients diagnosed with full-thickness MHs, who underwent surgery at Fujita Health University Hospital from May 2015 to March 2022, were retrospectively reviewed. Based on the exclusion criteria, 658 patients with idiopathic MHs were included. B-scan OCT images of the fellow eyes were used to identify vitreoretinal interface abnormalities, such as MHs, epiretinal membranes (ERMs), vitreomacular traction syndrome (VMTS) and lamellar macular holes (LMHs). Results The mean age of the patients was 65.9±9.0 years. There were 292 males (44.4%) and 366 females (55.6%). There were 39 fellow eyes with MHs (5.9%), 77 with ERMs (11.7%), 32 with VMTS (4.9%) and 11 with LMHs (1.7%). Thirty-four fellow eyes (5.2%) could not be classified and 469 fellow eyes were normal (71.3%). Furthermore, the 39 bilateral MHs were divided into four stages according to the Gass classification, as follows: stage 1, 32 eyes (82.1%); stage 2, none (0%); stage 3, 5 eyes (12.8%); and stage 4, 2 eyes (5.1%). Conclusions Vitreoretinal interface abnormalities, such as MHs, ERMs, VMTS and LMHs, are more common in the fellow eyes of patients with MHs than in the healthy population. The fellow eyes of patients with MHs should be carefully followed using OCT.
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Affiliation(s)
- Koji Ueoka
- Department of Ophthalmology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
- Department of Ophthalmology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tadashi Mizuguchi
- Department of Ophthalmology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Masayuki Horiguchi
- Department of Ophthalmology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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7
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Choi J, Kim SJ, Kang SW, Hwang S, Son KY. Outcomes of epiretinal proliferation embedding technique in the surgery for full-thickness macular hole. Sci Rep 2024; 14:8170. [PMID: 38589441 PMCID: PMC11001908 DOI: 10.1038/s41598-024-58449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea
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8
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Valentim CCS, Wu AK, Yu S, Manivannan N, Zhang Q, Cao J, Song W, Wang V, Kang H, Kalur A, Iyer AI, Conti T, Singh RP, Talcott KE. Deep learning-based algorithm for the detection of idiopathic full thickness macular holes in spectral domain optical coherence tomography. Int J Retina Vitreous 2024; 10:9. [PMID: 38263402 PMCID: PMC10804727 DOI: 10.1186/s40942-024-00526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Automated identification of spectral domain optical coherence tomography (SD-OCT) features can improve retina clinic workflow efficiency as they are able to detect pathologic findings. The purpose of this study was to test a deep learning (DL)-based algorithm for the identification of Idiopathic Full Thickness Macular Hole (IFTMH) features and stages of severity in SD-OCT B-scans. METHODS In this cross-sectional study, subjects solely diagnosed with either IFTMH or Posterior Vitreous Detachment (PVD) were identified excluding secondary causes of macular holes, any concurrent maculopathies, or incomplete records. SD-OCT scans (512 × 128) from all subjects were acquired with CIRRUS™ HD-OCT (ZEISS, Dublin, CA) and reviewed for quality. In order to establish a ground truth classification, each SD-OCT B-scan was labeled by two trained graders and adjudicated by a retina specialist when applicable. Two test sets were built based on different gold-standard classification methods. The sensitivity, specificity and accuracy of the algorithm to identify IFTMH features in SD-OCT B-scans were determined. Spearman's correlation was run to examine if the algorithm's probability score was associated with the severity stages of IFTMH. RESULTS Six hundred and one SD-OCT cube scans from 601 subjects (299 with IFTMH and 302 with PVD) were used. A total of 76,928 individual SD-OCT B-scans were labeled gradable by the algorithm and yielded an accuracy of 88.5% (test set 1, 33,024 B-scans) and 91.4% (test set 2, 43,904 B-scans) in identifying SD-OCT features of IFTMHs. A Spearman's correlation coefficient of 0.15 was achieved between the algorithm's probability score and the stages of the 299 (47 [15.7%] stage 2, 56 [18.7%] stage 3 and 196 [65.6%] stage 4) IFTMHs cubes studied. CONCLUSIONS The DL-based algorithm was able to accurately detect IFTMHs features on individual SD-OCT B-scans in both test sets. However, there was a low correlation between the algorithm's probability score and IFTMH severity stages. The algorithm may serve as a clinical decision support tool that assists with the identification of IFTMHs. Further training is necessary for the algorithm to identify stages of IFTMHs.
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Affiliation(s)
- Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Anna K Wu
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sophia Yu
- Carl Zeiss Meditec, Inc, Dublin, CA, USA
| | | | | | - Jessica Cao
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Weilin Song
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Victoria Wang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hannah Kang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Aneesha Kalur
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Amogh I Iyer
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Thais Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA.
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Hui M, Gunzenhauser R, Dillon A, Tsui I. Unexpected Vision Loss following Six Intravitreal Injections for Neovascular Age-Related Macular Degeneration. Case Rep Ophthalmol 2024; 15:525-531. [PMID: 39015241 PMCID: PMC11250276 DOI: 10.1159/000537777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/03/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction We present a case of a patient with preceding vitreomacular traction (VMT) who developed a full-thickness macular hole (FTMH) following his sixth intravitreal aflibercept injection for the treatment of age-related macular degeneration and review the literature on risk factors and pathogenesis of this adverse event. Case Presentation FTMH can occur after an extended number of repeat intravitreal injections in the setting of worsening vitreomacular adhesion or VMT. This patient's FTMH was successfully treated surgically in a timely manner, and additional injections were resumed safely. Conclusions Patients with an unexpected decrease in vision after intravitreal injections should be reevaluated with optical coherence tomography to rule out alternative pathology including vitreomacular interface abnormalities. FTMH, if present, should be treated promptly to allow for resumption of therapy as needed and visual optimization.
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Affiliation(s)
- Maggie Hui
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Robert Gunzenhauser
- West Los Angeles Veterans Affairs Hospital, Los Angeles, CA, USA
- Stein Eye Institute, Department of Ophthalmology, UCLA, Los Angeles, CA, USA
| | - Alexander Dillon
- Stein Eye Institute, Department of Ophthalmology, UCLA, Los Angeles, CA, USA
| | - Irena Tsui
- West Los Angeles Veterans Affairs Hospital, Los Angeles, CA, USA
- Stein Eye Institute, Department of Ophthalmology, UCLA, Los Angeles, CA, USA
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10
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Chalam KV, Akanda M, Subramanian M. Successful closure of a refractory giant (15 sq mm) macular hole with amniotic membrane graft. J Surg Case Rep 2024; 2024:rjae013. [PMID: 38304310 PMCID: PMC10832604 DOI: 10.1093/jscr/rjae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
The management of macular hole defects has undergone a significant transformation with the advent of advanced diagnostic tools and surgical techniques. These developments have enabled the effective treatment of macular holes that were previously considered untreatable. Although the majority of patients exhibit a positive response to initial treatment, a subset of patients may develop refractory macular holes that necessitate multiple surgeries for closure. In these instances, the utilization of amniotic membrane grafts to aid in the closure of large retinal holes presents a promising alternative. This report details the successful closure of a refractory giant macular hole (15 sq. mm) in a patient using an amniotic membrane graft, with improvement in visual acuity.
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Affiliation(s)
- Kakarla Venkata Chalam
- Department of Ophthalmology, Loma Linda University School of Medicine, 11370 Anderson St., Suite 1800, Loma Linda, CA 92354, United States
| | - Marib Akanda
- Department of Ophthalmology, Loma Linda University School of Medicine, 11370 Anderson St., Suite 1800, Loma Linda, CA 92354, United States
| | - Meenakshi Subramanian
- Department of Ophthalmology, Loma Linda University School of Medicine, 11370 Anderson St., Suite 1800, Loma Linda, CA 92354, United States
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11
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Cundy O, Lange CA, Bunce C, Bainbridge JW, Solebo AL. Face-down positioning or posturing after macular hole surgery. Cochrane Database Syst Rev 2023; 11:CD008228. [PMID: 37987517 PMCID: PMC10661040 DOI: 10.1002/14651858.cd008228.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Macular holes cause severe impairment of sight. With the aim of improving the outcome of surgery for macular holes, particularly larger macular holes (those measuring over 400 μm), a variable period of face-down positioning may be advised. This review is an update of a Cochrane Review published in 2011. OBJECTIVES To evaluate the effect of postoperative face-down positioning on the outcome of surgery for macular hole. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 5), which contains the Cochrane Eyes and Vision Trials Register, Ovid MEDLINE, Ovid Embase, the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which postoperative face-down positioning was compared to no face-down positioning following surgery for macular holes. The primary outcome of interest was closure of the macular hole. Other outcomes of interest included visual outcomes, quality of life outcomes, and the occurrence of adverse events. Pairs of review authors independently selected studies for inclusion, extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We analysed dichotomous data as risk ratios (RRs), and continuous data as mean differences (MDs), with 95% confidence intervals (CI). The unit of analysis was eyes. MAIN RESULTS We included eight studies allocating a total of 709 eyes (699 participants). There was heterogeneity in study design, including the control group treatment (from no positioning to strict maintenance of other 'face-forward' postures) and surgical procedures (with or without inner limiting membrane peeling, with or without cataract surgery). There were also different durations of positioning, with two studies using 3 days, two studies using 5 days, and three studies using 10 days of face-down positioning. Whilst the overall risk of bias was low, all included studies were judged to be at high or unclear risk of bias due to absence of assessment of adherence to the 'prescribed' intervention of face-down positioning or posturing. The primary outcome of successful anatomical hole closure at one to six months following surgery was reported in 95 of every 100 eyes of participants advised to position face-down for at least three days after surgery, and in 85 of every 100 eyes of participants not advised to position face-down (RR 1.05, 95% CI 0.99 to 1.12, 709 eyes, 8 studies, I² = 44%). Amongst the 327 eyes of participants with macular holes of at least 400 μm, hole closure was noted in 94 of every 100 eyes of participants advised to position face-down, and in 84 of every 100 eyes of participants not advised to position face-down (RR 1.08, 95% CI 0.93 to 1.26, 5 studies, I² = 62%). Amongst the 129 eyes of participants with macular holes of less than 400 μm, hole closure was noted in 100 of every 100 eyes of participants advised to position face-down, and in 96 of every 100 eyes of participants not advised to position face-down (RR 1.03, CI 0.97 to 1.11, 4 studies, I² = 0%). The certainty of the evidence was low, downgraded for imprecision (CIs including no effect) and study design limitations (with different durations of face-down posturing used in the absence of a dose-response gradient, and limitations in measuring the exposure). Meta-analysis of visual acuity data was challenging given the use of different definitions of postoperative visual outcome across studies. Three studies reported findings by gain in Early Treatment Diabetic Retinopathy Study (ETDRS) letters (MD 2.04, 95% CI -0.01 to 4.09, very low-certainty evidence). Meta-analyses of quality of life data were not possible because of inconsistency in outcome metrics across studies. One study reported no difference between groups in quality of life, as reported on a validated quality of life metric scale (the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25), between face-down positioning for five days and non-face-down positioning (median NEI VFQ-25 score was 89 (interquartile range (IQR) 76 to 94) in the face-down group versus 87 (IQR 73 to 93) in the non-face-down group (adjusted mean difference on a logistic scale 0.02, 95% CI -0.03 to 0.07, P = 0.41)). Two studies reported increased ease of positioning and less pain in non-face-down positioning groups on non-validated 0-to-10-point visual analogue scores. On an ease-of-positioning score running from 0 (very difficult) to 10 (very easy), there were consistent reports of the discomfort associated with face-down positioning: the median participant-reported ease-of-positioning score was 6 (IQR 4 to 8) in those undergoing 5 days of face-down positioning versus 9 (IQR 7 to 10) in the comparator group (P = 0.01). On a pain score with 0 being pain-free and 10 being in severe pain, mean pain score was 6.52 ± 2.48 in the face-down positioning group versus 2.53 ± 2.6 in the non-face-down positioning group. The adverse event of postoperative nerve compression occurred in less than 1 in every 100 (3 per 1000) participants advised to position face-down, and 0 in every 100 participants not advised to position face-down (699 participants, 8 studies, moderate-certainty evidence). AUTHORS' CONCLUSIONS We identified eight RCTs evaluating face-down positioning following surgery for macular hole. The included studies were not all directly comparable due to differences in the surgical techniques used and the durations of postoperative positioning advised. Low-certainty evidence suggests that face-down positioning may have little or no effect on macular hole closure after surgery. Face-down positioning is a low-risk intervention, with serious adverse events affecting fewer than 1 in 300 people. We suggest that any future trials focus on patients with larger macular holes, with interventions and outcome measures used in previous trials (i.e. with inner limiting membrane peeling, positioning durations of three to five days, and validated quality of life metrics) to allow future meta-analyses to determine any effect with greater precision and confidence.
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Affiliation(s)
- Olivia Cundy
- Ophthalmology , Imperial College Hospital, London, UK
| | - Clemens Ak Lange
- Eye Center, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- Augenzentrum am St. Franziskus-Hospital, Münster, Germany
| | - Catey Bunce
- NIHR Biomedical Reseach Centre, The Royal Marsden NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - James W Bainbridge
- UCL Institute of Ophthalmology, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London , UK
| | - Ameenat Lola Solebo
- Vision and Eyes Group , Population, Policy and Practice Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
- Ophthalmology and Rheumatology , Great Ormond Street Hospital , London , UK
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12
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Ye X, He S, Zhong X, Yu J, Yang S, Shen Y, Chen Y, Wang Y, Huang X, Shen L. OIMHS: An Optical Coherence Tomography Image Dataset Based on Macular Hole Manual Segmentation. Sci Data 2023; 10:769. [PMID: 37932307 PMCID: PMC10628143 DOI: 10.1038/s41597-023-02675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
Macular holes, one of the most common macular diseases, require timely treatment. The morphological changes on optical coherence tomography (OCT) images provided an opportunity for direct observation of the disease, and accurate segmentation was needed to identify and quantify the lesions. Developments of such algorithms had been obstructed by a lack of high-quality datasets (the OCT images and the corresponding gold standard macular hole segmentation labels), especially for supervised learning-based segmentation algorithms. In such context, we established a large OCT image macular hole segmentation (OIMHS) dataset with 3859 B-scan images of 119 patients, and each image provided four segmentation labels: retina, macular hole, intraretinal cysts, and choroid. This dataset offered an excellent opportunity for investigating the accuracy and reliability of different segmentation algorithms for macular holes and a new research insight into the further development of clinical research for macular diseases, which included the retina, lesions, and choroid in quantitative analyses.
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Affiliation(s)
- Xin Ye
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shucheng He
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xiaxing Zhong
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiafeng Yu
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | | | - Yingjiao Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yiqi Chen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Xingru Huang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK.
| | - Lijun Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
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13
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M Mansour A, Parodi M, H Uwaydat S, Charbaji S, Ascaso J, A Mansour H, Tripathy K, Marcelo Barbante Casella A. Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review. J Ophthalmic Vis Res 2023; 18:424-432. [PMID: 38250231 PMCID: PMC10794794 DOI: 10.18502/jovr.v18i4.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 01/23/2024] Open
Abstract
Our purpose is to review the closure time and optical coherence tomography (OCT) biomarkers that result in the non-surgical repair of idiopathic full-thickness macular holes (IFTMH). Our methodology consisted of a comprehensive literature review of the nonsurgical resolution of IFTMH followed by the calculation of the estimated closure time using the structural equation model. Forty-nine studies were found eligible yielding 181 eyes with IFTMH: 81.1% being small holes (< 250 µm) with a median diameter of 166 µm. Final vision (mean 20/41) was related to initial vision (mean 20/65) and mean age (67 years). The hole diameter was correlated with initial vision and closure time (mean 3.9 months). Closure time was related to hole diameter and initial vision in the following algorithm: Closure time (month)= - 0.057 + 0.008 diameter (µm) + 0.021 age (year) + 2.153 initial vision (logMAR). Biomarkers by OCT for self-closure included in decreasing frequency: pointed edge, de-turgescence of cystic macular edema (CME) with reversal of bascule bridge, and vitreomacular traction (VMT) release. The crucial function of Muller cell bridging in sealing the hole attests to its exceptional capacity for regeneration. After the hole has begun to close; however in less than 5%, a delayed restoration of the ellipsoid layer or a persistent outer foveal defect may prevent visual recovery and reopening of the hole is possible. In conclusion, eyes with small-size IFTMH and good baseline vision can have the additional option of close OCT monitoring for biomarkers of self-sealing biomarkers. When rehabilitative activity seems to be lacking, surgery is therefore mandatory.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Maurizio Parodi
- Department of Ophthalmology, University Vita-Salute Milan, Milan, Italy
| | - Sami H Uwaydat
- Jones Eye Institute, University of Arkansas Medical School, Little Rock, Arkansas, USA
| | | | - Javier Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
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14
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Tieger MG, Kim LA, Vavvas DG. SPONTANEOUS CLOSURE AND RECURRENT OPENING TIMES TWO OF A MACULAR HOLE IN A SURGICALLY NAIVE EYE. Retin Cases Brief Rep 2023; 17:581-583. [PMID: 37643046 DOI: 10.1097/icb.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To report a case of an idiopathic macular hole with recurrent opening and spontaneous closure in a surgically naive eye. METHODS A retrospective review of medical records was performed in addition to a review of the current literature. RESULTS An 82-year-old man was referred for the management of a full-thickness macular hole in the right eye. Visual acuity was 20/60, and dilated fundus examination was notable for a posterior vitreous detachment, macular hole, and mild epiretinal membrane. Optical coherence tomography confirmed the presence of a full-thickness macular hole. The patient declined surgical intervention and elected to observe. Five weeks later, optical coherence tomography confirmed spontaneous closure. One year later, a recurrent partial thickness outer retinal hole was noted on dilated fundus examination and optical coherence tomography that subsequently spontaneously closed for the second time. The following year, the patient represented with a new scotoma and metamorphopsia and was found to have a full-thickness macular hole. This time the patient was elected for surgical intervention (25-gauge pars plana vitrectomy, epiretinal membrane peel, and 14% C3F8), resulting in closure of the macular hole and improvement in visual acuity to 20/25+1. CONCLUSION This case highlights a rare presentation of a see-saw pattern of opening and closing of a macular hole in a treatment-naive eye. The presence of a posterior vitreous detachment and epiretinal membrane suggests that other factors than anterior-posterior and tangential traction may be a contributing in the formation and closure of idiopathic macular holes.
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Affiliation(s)
- Marisa G Tieger
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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15
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Ghoraba H, Rittiphairoj T, Akhavanrezayat A, Karaca I, Matsumiya W, Pham B, Mishra K, Yasar C, Mobasserian A, Abdelkarem AA, Nguyen QD. Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole. Cochrane Database Syst Rev 2023; 8:CD015031. [PMID: 37548231 PMCID: PMC10558045 DOI: 10.1002/14651858.cd015031.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Macular hole (MH) is a full-thickness defect in the central portion of the retina that causes loss of central vision. According to the usual definition, a large MH has a diameter greater than 400 µm at the narrowest point. For closure of MH, there is evidence that pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling achieves better anatomical outcomes than standard PPV. PPV with ILM peeling is currently the standard of care for MH management; however, the failure rate of this technique is higher for large MHs than for smaller MHs. Some studies have shown that the inverted ILM flap technique is superior to conventional ILM peeling for the management of large MHs. OBJECTIVES To evaluate the clinical effectiveness and safety of pars plana vitrectomy with the inverted internal limiting membrane flap technique versus pars plana vitrectomy with conventional internal limiting membrane peeling for treating large macular holes, including idiopathic, traumatic, and myopic macular holes. SEARCH METHODS The Cochrane Eyes and Vision Information Specialist searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries on 12 December 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated PPV with ILM peeling versus PPV with inverted ILM flap for treatment of large MHs (with a basal diameter greater than 400 µm at the narrowest point measured by optical coherence tomography) of any type (idiopathic, traumatic, or myopic). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane and assessed the certainty of the body of evidence using GRADE. MAIN RESULTS We included four RCTs (285 eyes of 275 participants; range per study 24 to 91 eyes). Most participants were women (63%), and of older age (range of means 59.4 to 66 years). Three RCTs were single-center trials, and the same surgeon performed all surgeries in two RCTs (the third single-center RCT did not report the number of surgeons). One RCT was a multicenter trial (three sites), and four surgeons performed all surgeries. Two RCTs took place in India, one in Poland, and one in Mexico. Maximum follow-up ranged from three months (2 RCTs) to 12 months (1 RCT). No RCTs reported conflicts of interest or disclosed financial support. All four RCTs enrolled people with large idiopathic MHs and compared conventional PPV with ILM peeling versus PPV with inverted ILM flap techniques. Variations in technique across the four RCTs were minimal. There was some heterogeneity in interventions: in two RCTs, all participants underwent combined cataract-PPV surgery, whereas in one RCT, some participants underwent cataract surgery after PPV (the fourth RCT did not mention cataract surgery). The critical outcomes for this review were mean best-corrected visual acuity (BCVA) and MH closure rates. All four RCTs provided data for meta-analyses of both critical outcomes. We assessed the risk of bias for both outcomes using the Cochrane risk of bias tool (RoB 2); there were some concerns for risk of bias associated with lack of masking of outcome assessors and selective reporting of outcomes in all RCTs. All RCTs reported postoperative BCVA values; only one RCT reported the change in BCVA from baseline. Based on evidence from the four RCTs, it is unclear if the inverted ILM flap technique compared with ILM peeling reduces (improves) postoperative BCVA measured on a logarithm of the minimum angle of resolution (logMAR) chart at one month (mean difference [MD] -0.08 logMAR, 95% confidence interval [CI] -0.20 to 0.05; P = 0.23, I2 = 65%; 4 studies, 254 eyes; very low-certainty evidence), but it may improve BCVA at three months or more (MD -0.17 logMAR, 95% CI -0.23 to -0.10; P < 0.001, I2 = 0%; 4 studies, 276 eyes; low-certainty evidence). PPV with an inverted ILM flap compared to PPV with ILM peeling probably increases the proportion of eyes achieving MH closure (risk ratio [RR] 1.10, 95% CI 1.02 to 1.18; P = 0.01, I2 = 0%; 4 studies, 276 eyes; moderate-certainty evidence) and type 1 MH closure (RR 1.31, 95% CI 1.03 to 1.66; P = 0.03, I² = 69%; 4 studies, 276 eyes; moderate-certainty evidence). One study reported that none of the 38 participants experienced postoperative retinal detachment. AUTHORS' CONCLUSIONS We found low-certainty evidence from four small RCTs that PPV with the inverted ILM flap technique is superior to PPV with ILM peeling with respect to BCVA gains at three or more months after surgery. We also found moderate-certainty evidence that the inverted ILM flap technique achieves more overall and type 1 MH closures. There is a need for high-quality multicenter RCTs to ascertain whether the inverted ILM flap technique is superior to ILM peeling with regard to anatomical and functional outcomes. Investigators should use the standard logMAR charts when measuring BCVA to facilitate comparison across trials.
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Affiliation(s)
- Hashem Ghoraba
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Thanitsara Rittiphairoj
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | | | - Irmak Karaca
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Brandon Pham
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Kapil Mishra
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Amira Ahmed Abdelkarem
- Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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16
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Murphy DC, Al-Zubaidy M, Lois N, Scott N, Steel DH. The Effect of Macular Hole Duration on Surgical Outcomes: An Individual Participant Data Study of Randomized Controlled Trials. Ophthalmology 2023; 130:152-163. [PMID: 36058348 DOI: 10.1016/j.ophtha.2022.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023] Open
Abstract
TOPIC To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). CLINICAL RELEVANCE Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. METHODS A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. RESULTS Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. CONCLUSIONS Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
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Affiliation(s)
- Declan C Murphy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mo Al-Zubaidy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Noemi Lois
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom
| | - David H Steel
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom; Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, United Kingdom.
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17
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Xiao Y, Hu Y, Quan W, Yang Y, Lai W, Wang X, Zhang X, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Lin Z, Fang Y, Hu Y, Feng S, Yuan L, Cai H, Li T, Lin H, Yu H. Development and validation of a deep learning system to classify aetiology and predict anatomical outcomes of macular hole. Br J Ophthalmol 2023; 107:109-115. [PMID: 34348922 PMCID: PMC9763201 DOI: 10.1136/bjophthalmol-2021-318844] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/23/2021] [Indexed: 11/03/2022]
Abstract
AIMS To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP). METHODS In this multicentre retrospective cohort study, a total of 330 MH eyes with 1082 optical coherence tomography (OCT) images and 3300 clinical data enrolled from four ophthalmic centres were used to train, validate and externally test the DL and MDFN models. 266 eyes from three centres were randomly split by eye-level into a training set (80%) and a validation set (20%). In the external testing dataset, 64 eyes were included from the remaining centre. All eyes underwent macular OCT scanning at baseline and 1 month after VILMP. The area under the receiver operated characteristic curve (AUC), accuracy, specificity and sensitivity were used to evaluate the performance of the models. RESULTS In the external testing set, the AUC, accuracy, specificity and sensitivity of the MH aetiology classification model were 0.965, 0.950, 0.870 and 0.938, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative MH status prediction model were 0.904, 0.825, 0.977 and 0.766, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative idiopathic MH status prediction model were 0.947, 0.875, 0.815 and 0.979, respectively. CONCLUSION Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH.
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Affiliation(s)
- Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yijun Hu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhanjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Hu
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China .,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China .,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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18
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Hwang S, Kang SW, Kim SJ, Choi J, Son KY, Lim DH, Shin DW, Choi D, Chang Y, Ryu S, Cho J. Risk factors for the development of idiopathic macular hole: a nationwide population-based cohort study. Sci Rep 2022; 12:21778. [PMID: 36526695 PMCID: PMC9758209 DOI: 10.1038/s41598-022-25791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
This nationwide population-based cohort study searched for demographic, comorbid, behavioral, and reproductive risk factors for idiopathic macular hole (MH) development using data provided by the Korean National Health Insurance Service. A total of 4,496,867 individuals aged 50-79 years who participated in the Korean National Health Screening Program in 2013 or 2014 were included. Participants were followed up until December 2018, and incident cases of idiopathic MH were identified. Prospective associations between incident idiopathic MH and various covariates were investigated using multivariable-adjusted Cox proportional hazard models. During an average follow-up period of 4.91 years, 3054 patients were newly diagnosed with idiopathic MHs. Women showed greater risk (hazard ratio of 1.71) and earlier presentation of idiopathic MH than men. Compared to the normal body mass index group, the obese group (≥ 25 kg/m2) showed a significantly lower risk of idiopathic MH. Among postmenopausal women, those with two or more children showed a greater risk of idiopathic MH than those who had not been pregnant, with a hazard ratio of 1.80. In conclusion, idiopathic MH occurred earlier and greater in women. Childbirth were associated with an increased risk of MH development, and obesity was associated with a lower risk of MH.
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Affiliation(s)
- Sungsoon Hwang
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Woong Kang
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Kim
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaehwan Choi
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Young Son
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Wook Shin
- grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - DooSeok Choi
- grid.264381.a0000 0001 2181 989XDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XCenter for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XCenter for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- grid.264381.a0000 0001 2181 989XDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea ,grid.414964.a0000 0001 0640 5613Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea ,grid.21107.350000 0001 2171 9311Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
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Impact of Race and Ethnicity on Presentation and Surgical Outcomes of Idiopathic Macular Holes. J Pers Med 2022; 12:jpm12091518. [PMID: 36143303 PMCID: PMC9506218 DOI: 10.3390/jpm12091518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
There is limited data on the presentation and surgical outcomes of idiopathic macular holes (IMH) for different ethnic and racial groups. Recognition of distinct, clinically-relevant patient subgroups may provide opportunities to identify specific unmet needs including possible barriers to optimal healthcare delivery. Medical records of patients who underwent surgery for IMH (between 2016 and 2022) at a large, urban retina practice were reviewed and self-reported ethnicity (Hispanic and non-Hispanic) and race (Asian, Black, White, and Other) were captured. The primary variables included (1) mean minimum linear diameter (MLD) at presentation and (2) surgical outcome (IMH closure status). Overall, mean MLD for all study eyes (515) was 366.1 μm, and surgical success was achieved in 489 (95.0%) eyes. Hispanic eyes presented with larger mean MLD (p = 0.002) compared to non-Hispanic eyes. Asian, Black, and Other eyes presented with larger mean MLD (p = 0.033, p < 0.001, p < 0.001) when compared to White eyes. The presentation of IMH varied in severity among different ethnic and racial groups. Hispanic patients were found to have worse preoperative visual acuity (VA), longer time to surgery, and larger mean MLD and BD compared to non-Hispanic participants. Black and Other patients were found to have worse VA, time to surgery, and larger mean MLD and BD when compared to White participants.
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Valentim CCS, Iyer AI, Xu C, Muste JC, Li A, Singh RP. Influence of Race, Ethnicity, and Socioeconomic Factors in Idiopathic Macular Hole Presentation and Surgical Outcomes. Ophthalmic Surg Lasers Imaging Retina 2022; 53:333-344. [PMID: 35724368 DOI: 10.3928/23258160-20220602-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To characterize the influence of race, ethnicity, and socioeconomic factors on idiopathic macular hole (IMH) presentation and surgical outcomes. PATIENTS AND METHODS This retrospective cohort study of patients diagnosed with IMH who underwent surgical repair collected IMH data from optical coherence tomography scans as well as demographic information. Univariate and multivariate regression models interrogated relevant relationships. RESULTS Of 292 eyes analyzed, 223 (76.4%) patients were White and 53 (18.2%) were Black. Mean income was $57,076.9 ± 17,794.7. Black patients presented with 0.05 mm2 larger IMH area (95% CI, 0.01 to 0.09; P = .01) and 69.07 µm wider minimum linear diameter (95% CI, 15.05 to 123.10; P = .01). Patients with higher income presented with 3.76 µm narrower base diameter (95% CI, -6.42 to -1.09; P = .006). CONCLUSIONS Black patients were associated with larger IMH at presentation, and higher income patients were associated with smaller IMH. [Ophthalmic Surg Lasers Imaging Retina 2022;53(6): 333-344.].
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Chiquet C, Tadjine M, Bouisse M, François P, Dufournet J, Robert P, Creuzot C, Boussat B. Analysis of vitreoretinal surgery activity in metropolitan France in 2016: impact on training capacities. Acta Ophthalmol 2022; 100:e1617-e1623. [PMID: 35415895 DOI: 10.1111/aos.15143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to describe vitreoretinal surgery activity and vitreoretinal surgeons in private or public practice in metropolitan France over the year 2016 to anticipate surgical training needs. METHODS Patients aged ≥20 years who had undergone vitreoretinal surgery, alone or combined with cataract surgery were included using the French National Healthcare system database. For surgery performed by ophthalmologists carrying out ≥50 procedures during the year, the incidence per 100 000 of population ≥ 20 years of age, the number and mean age of surgeons and the number of surgeons aged >55 years were calculated. RESULTS Overall, 57 947 posterior segment surgical procedures were included, 40% in the public sector and 49% in the private sector for private surgeons and/or public centres performing ≥50 procedures/year. The remaining 11% of procedures were from private surgeons and/or public centres performing <50 procedures/year. The analysis included 356 surgeons with a mean age of 41 ± 10 years (39% female) in the public sector and 47 ± 10 years (14% female) in the private sector. The majority of urgent surgery was for retinal detachment (n = 30 290 [52% of total surgical procedures]). Scheduled surgery involved surgery for macular holes and epiretinal membranes (n = 16 454 [28% of total surgical procedures]). Combined vitrectomy-phacoemulsification surgery (n = 10 120) represented 17% of all vitreoretinal surgery. University regions with the fewest surgeons and regions with surgeons >55 years of age were identified, to anticipate the training need for new surgeons. CONCLUSION This study demonstrated disparities in the geographic distribution of vitreoretinal surgery in France and identified regions that need increased training capacities to ensure a sufficient number of surgeons.
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Affiliation(s)
- Christophe Chiquet
- Department of Ophthalmology University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
- French Council of University Ophthalmogists (COUF) Paris France
| | - Mehdi Tadjine
- Department of Ophthalmology University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
- French Council of University Ophthalmogists (COUF) Paris France
| | - Magali Bouisse
- Department of Epidemiology and Quality of care University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
| | - Patrice François
- Department of Epidemiology and Quality of care University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
- TIMC UMR 5525 CNRS, Computational and Mathematical Biology Team Grenoble Alpes University Grenoble France
| | - Julie Dufournet
- Department of Ophthalmology University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
- French Council of University Ophthalmogists (COUF) Paris France
| | - Pierre‐Yves Robert
- French Council of University Ophthalmogists (COUF) Paris France
- Department of Ophthalmology University Hospital CHU Dupuytren, Limoges University Limoges France
| | - Catherine Creuzot
- French Council of University Ophthalmogists (COUF) Paris France
- Department of Ophthalmology University Hospital, Bourgogne University Dijon France
| | - Bastien Boussat
- Department of Epidemiology and Quality of care University Hospital of Grenoble Alpes, Grenoble Alpes University Grenoble France
- TIMC UMR 5525 CNRS, Computational and Mathematical Biology Team Grenoble Alpes University Grenoble France
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
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22
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O'Fee JR, Rayess N, Pan CK, Toy BC. Factors Affecting Ophthalmology Trainees to Pursue Vitreoretinal Surgery Fellowship. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0041-1741461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective The aim of this study was to understand the factors that ophthalmology trainees consider in pursuing vitreoretinal surgery (VRS) fellowship training.
Methods This is a prospective observational survey study. Survey invitations were disseminated to postgraduate year 4 (PGY)-4 ophthalmology residents at Accreditation Council for Graduate Medical Education-accredited residency programs and surgical retina fellows at Association of University Professors of Ophthalmology Fellowship Compliance Committee-compliant fellowship programs in the United States. Survey questions on factors related to VRS were administered employing a 5-point Likert scale. Responses from ophthalmology residents pursuing surgical retina were combined with surgical retina fellows' responses and compared with responses from PGY-4 residents not pursuing vitreoretinal surgery.
Results Eighty-one resident surveys were completed. Forty-three fellow surveys were completed. Fifty-seven out of eighty-one (70.4%) residents were not pursuing surgical retina, and a total of 67 trainees (24 residents, 43 fellows) were pursuing surgical retina. The following factors were associated with pursuing VRS training: male gender (p = 0.031); having performed retina research during residency (p ≤ 0.001); enjoying surgical retina procedures (p ≤ 0.001), enjoying surgical retina patient outcomes (p ≤ 0.001), and working with vitreoretinal surgeons (p ≤ 0.001); finding surgical retina prestigious (p ≤ 0.001); perceiving their residency having a strong record of matching surgical retina (p = 0.039); liking the potential financial income from surgical retina (p ≤ 0.001); and having vitreoretinal mentors during residency (p = 0.014). A majority of trainees (31/57, 54.4%) not pursuing surgical retina disagreed or strongly disagreed with enjoying the patient outcomes in surgical retina. A third of female residents not pursuing surgical retina felt having a female surgical retina mentor would have made them more likely to pursue the field.
Conclusion Longer retina rotations, encouraging resident participation in retina research, and increasing mentorship opportunities of female trainees from female retina specialists may increase resident interest in pursuing surgical retina fellowship.
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Affiliation(s)
- John R. O'Fee
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nadim Rayess
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Carolyn K. Pan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Brian C. Toy
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California
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23
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Singh VK, Kucukgoz B, Murphy DC, Xiong X, Steel DH, Obara B. Benchmarking automated detection of the retinal external limiting membrane in a 3D spectral domain optical coherence tomography image dataset of full thickness macular holes. Comput Biol Med 2022; 140:105070. [PMID: 34875408 DOI: 10.1016/j.compbiomed.2021.105070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
In this article, we present a new benchmark for the segmentation of the retinal external limiting membrane (ELM) using an image dataset of spectral domain optical coherence tomography (OCT) scans in a patient population with idiopathic full-thickness macular holes. Specifically, the dataset used contains OCT images from one eye of 107 patients with an idiopathic full-thickness macular hole. In total, the dataset contains 5243 individual 2-dimensional (2-D) OCT image slices, with each patient contributing 49 individual spectral-domain OCT tagged image slices. We display precise image-wise binary annotations to segment the ELM line. The OCT images present high variations in image contrast, motion, brightness, and speckle noise which can affect the robustness of applied algorithms, so we performed an extensive OCT imaging and annotation data quality analysis. Imaging data quality control included noise, blurriness and contrast scores, motion estimation, darkness and average pixel scores, and anomaly detection. Annotation quality was measured using gradient mapping of ELM line annotation confidence, and idiopathic full-thickness macular hole detection. Finally, we compared qualitative and quantitative results with seven state-of-the-art machine learning-based segmentation methods to identify the ELM line with an automated system.
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Affiliation(s)
| | - Burak Kucukgoz
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Declan C Murphy
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Xiaofan Xiong
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - David H Steel
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Boguslaw Obara
- School of Computing, Newcastle University, Newcastle upon Tyne, UK; Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK.
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24
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Lindtjørn B, Krohn J, Forsaa VA. Optical coherence tomography features and risk of macular hole formation in the fellow eye. BMC Ophthalmol 2021; 21:351. [PMID: 34587925 PMCID: PMC8482611 DOI: 10.1186/s12886-021-02111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that precede MH formation in the fellow eye. Methods A retrospective review of 229 patients treated for primary MH at Stavanger University Hospital, Norway, from January 2008 through December 2018. The patients were categorised into two groups according to subsequent development of MH in the fellow eye. The OCT findings of the two groups were compared, and associated risk factors for MH formation assessed. Results Twenty cases of bilateral MH were identified. The overall bilateral disease risk was 8.8% (95% CI, 5.8–13.2%). Two patients were previously operated in the fellow eye, six patients presented with bilateral MH, and 12 patients subsequently developed MH in the fellow eye. The risk of subsequent MH development was 5.7% (95% CI, 3.3–9.8%). Although the extent of posterior vitreous detachment (PVD) tended to be more progressed in the bilateral group compared with the unilateral group, the difference was not statistically significant. In the bilateral group, 41.7% had outer retinal defects vs 6.6% in the unilateral group (p = 0.001), and 33.3% in the bilateral group had intraretinal pseudocysts vs 10.2% in the unilateral group (p = 0.036, not significant after multiple testing correction). Conclusion Outer retinal defects and intraretinal pseudocysts are associated with an increased risk of MH formation in the fellow eye, and complete PVD indicates a decreased risk of MH formation.
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Affiliation(s)
- Birger Lindtjørn
- Department of Ophthalmology, Stavanger University Hospital, box 8100, N-4068, Stavanger, PO, Norway. .,Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.
| | - Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.,Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Vegard A Forsaa
- Department of Ophthalmology, Stavanger University Hospital, box 8100, N-4068, Stavanger, PO, Norway.,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
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HUMAN AMNIOTIC MEMBRANE TO CLOSE RECURRENT, HIGH MYOPIC MACULAR HOLES IN PATHOLOGIC MYOPIA WITH AXIAL LENGTH OF ≥30 mm. Retina 2021; 40:1946-1954. [PMID: 31868775 DOI: 10.1097/iae.0000000000002699] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of the human amniotic membrane plug for recurrent high myopic macular hole (MH) that already underwent pars plana vitrectomy with internal limiting membrane peeling and gas endotamponade. METHODS Sixteen eyes of 16 patients with recurrent high myopic MH were enrolled. A 23-gauge pars plana vitrectomy was performed. Human amniotic membrane plugs were implanted under the neuroretina inside the MH. Twenty percent sulfur hexafluoride or air was used as endotamponades. The patients were instructed to maintain facedown position for 5 days after surgery. RESULTS Optical coherence tomography examinations showed that the MHs closed in 15 of the 16 patients (93.75%) 2 weeks after one surgical intervention, and in 100% of patients after second intervention. Mean best-corrected visual acuity improved from 1 logarithm of the minimum angle of resolution (20/200) to 0.67 logarithm of the minimum angle of resolution (20/100) 6 months after surgery. Best-corrected visual acuity remained stable during the 12-month follow-up. One patient had human amniotic membrane plug dislocation after gas absorption that needed a second intervention with new AM plug implantation. No adverse events were reported during the 12-month follow-up. CONCLUSION The first case series of recurrent high myopic MH was reported, assessing the effectiveness of the human amniotic membrane plug to close recurrent MHs in pathologic myopia. All the cases were successful with encouraging best-corrected visual acuity recovery.
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26
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Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmol Ther 2021; 10:1137-1153. [PMID: 34494236 PMCID: PMC8589910 DOI: 10.1007/s40123-021-00388-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
Primary surgery for macular hole (MH) closure has a high success rate with current methods of pars plana vitrectomy and internal limiting membrane (ILM) peeling. When primary surgery fails, there are several options available for secondary repair, including extension of the ILM peel, creation of an ILM flap, pedunculated ILM flap, lens capsule flap transplantation, autologous retinal transplantation, use of a human amniotic membrane plug, adjuvant autologous platelet concentrate, induction of macular detachments with subretinal blebs, and creation of retinal incisions. In this review, we discuss the practical approach to each of these surgical techniques for the management of recurrent or persistent MHs.
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27
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Yüksel M, Özdemir HB, Hasanreisoğlu M. Spontaneous Closure of Large Full-Thickness Macular Hole in a Patient with Degenerative Myopia: Case Report. Turk J Ophthalmol 2021; 51:184-187. [PMID: 34187155 PMCID: PMC8251669 DOI: 10.4274/tjo.galenos.2020.83530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Macular hole is characterized by a full-thickness defect of the retinal layers in the center of the fovea and is an important cause of central vision loss. Spontaneous closure of a macular hole is rare, most often occurring in traumatic and idiopathic macular holes. In this case report, we present a 51-year-old woman with a myopic macular hole that closed spontaneously. The patient had degenerative myopia and a history of clear lens surgery and multiple laser retinopexy procedures due to retinal tear in both eyes. A macular hole was detected in her right eye, but she declined surgery and was followed up. At 66 months after presentation, bridge formation and spontaneous closure of the macular hole were observed. Spontaneous closure is extremely rare in cases of myopic macular hole, but may be seen in patients who are followed for a long time.
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Affiliation(s)
- Murat Yüksel
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | | | - Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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28
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MANAGEMENT OF LARGE OR RECURRENT MACULAR HOLES. CURRENT OPHTHALMOLOGY REPORTS 2021; 8:62-68. [PMID: 33585076 DOI: 10.1007/s40135-020-00231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose of Review To review and critically appraise the recent literature about new surgical techniques for the management of large or recurrent macular holes. Recent Findings A variety of surgical approaches have recently been developed ranging from autologous retinal grafts to amniotic membrane transplant with varying levels of anatomical and visual success. Summary More data is needed to determine if one technique is superior to others. However, with a variety of grafts, adhesives, and tamponades at their disposal, vitreoretinal surgeons have an extensive array of options to approach complex macular holes.
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29
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Mehta N, Lavinsky F, Larochelle R, Rebhun C, Mehta NB, Yanovsky RL, Cohen MN, Lee GD, Dedania V, Ishikawa H, Wollstein G, Schuman JS, Waheed N, Modi Y. ASSESSING THE ABILITY OF PREOPERATIVE QUANTITATIVE SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS TO PREDICT VISUAL OUTCOME IN IDIOPATHIC MACULAR HOLE SURGERY. Retina 2021; 41:29-36. [PMID: 32251240 PMCID: PMC7529763 DOI: 10.1097/iae.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine which spectral domain optical coherence tomography biomarkers of idiopathic macular hole (MH) correlate with the postoperative best-corrected visual acuity (BCVA) in anatomically closed MH. METHODS Retrospective analysis of spectral domain optical coherence tomography scans of 44 patients presenting with MH followed for a mean of 17 months. Widths of MH aperture, base, and ellipsoid zone disruption were calculated from presenting foveal spectral domain optical coherence tomography B-scans. Macular hole base area and ellipsoid zone disruption area were calculated through the custom in-house software. RESULTS Poorer postoperative BCVA correlated with increased preoperative choroidal hypertransmission (r = 0.503, P = 0.0005), minimum diameter (r = 0.491, P = 0.0007), and base diameter (r = 0.319, P = 0.0348), but not with preoperative ellipsoid zone width (r = 0.199, P = 0.2001). Applying en-face analysis, the BCVA correlated weakly with preoperative ellipsoid zone loss area (r = 0.380, P = 0.013), but not with preoperative MH base area (r = 0.253, P = 0.1058). CONCLUSION Increased MH minimum diameter, base diameter, base area, and choroidal hypertransmission are correlated with a poorer postoperative BCVA. Ellipsoid zone loss measurements were not consistently correlated with a BCVA. Choroidal hypertransmission width may be an easy-to-visualize predictive imaging biomarker in MH surgery.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Fabio Lavinsky
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Ryan Larochelle
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Carl Rebhun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nihaal B Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Michael N Cohen
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Gregory D Lee
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Vaidehi Dedania
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
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30
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Hashimoto Y, Michihata N, Matsui H, Ishimaru M, Fushimi K, Yasunaga H, Aihara M, Takao M, Obata R. Recent trends in vitreoretinal surgery: a nationwide database study in Japan, 2010-2017. Jpn J Ophthalmol 2020; 65:54-62. [PMID: 33111254 DOI: 10.1007/s10384-020-00777-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We clarified recent trends in vitreoretinal surgery in Japan, which is a rapidly aging country. STUDY DESIGN Retrospective cohort study. METHODS We used the Diagnostic Procedure Combination database (2010-2017), a national inpatient database in Japan. Patients undergoing vitreoretinal surgery were included. We measured the number of surgeries stratified by procedures, diagnoses, age categories, and combined cases of cataract surgery per fiscal year. We also considered changes in the Japanese population. RESULTS From 2010 to 2017, the total number of vitreoretinal surgeries per fiscal year increased by 7.8% (from 36,988 to 39,873). Among the diagnoses categories, epiretinal membrane (ERM) increased by 71%, rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV) by 50%, and macular hole (MH) by 12% throughout the observed period. Diabetic retinopathy (DR) decreased by 20%, RRD with scleral buckling (SB) by 40%, and vitreous hemorrhage (VH) by 10%. We observed remarkable increases in ERM among patients in their 60s and 70s, in MH in their 70s and 80s, and in RRD with PPV in their 50s and 60s. We observed remarkable decreases in RRD with SB in patients in their 20s-70s, in DR in their 60s, and in VH in their 60s and 70s. These findings did not change greatly when population changes were considered. All age groups from the 30 to 80s showed significant increases in the proportions of combined vitreoretinal and cataract surgery. CONCLUSION The total number of cases of vitreoretinal surgery per fiscal year increased throughout the period. The increases in ERM and RRD with PPV and the decreases in DR and RRD with SB were remarkable.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Muneyuki Takao
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Wang J, Yu Y, Liang X, Wang Z, Qi B, Liu W. Pre- and post-operative differences between genders in idiopathic macular holes. BMC Ophthalmol 2020; 20:365. [PMID: 32912182 PMCID: PMC7488443 DOI: 10.1186/s12886-020-01633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare idiopathic macular holes (IMHs) between male and female before and after surgery. METHODS Patients with IMHs of stage 3 and stage 4 who underwent 23-gauge vitrectomy were retrospectively enrolled. Pre-operative clinical features like age of onset, and best-corrected visual acuity (BCVA) were reviewed. Optical coherence tomography parameters including minimum linear diameter (MLD), central macular thickness and some other indexes were measured and calculated. Main surgical outcomes included the primary closure rate, the highest BCVA during follow-up, and the recovery duration. All the metrics mentioned above were compared between genders with appropriate statistical methods. RESULTS A total of 298 eyes from 280 patients (male: 51; female: 229) were enrolled. Compared with men, women demonstrated a significantly higher ratio of stage3/stage4 (P = 0.045), larger horizontal MLD (P = 0.009), but similar surgical outcomes except for a relatively longer recovery duration (P = 0.024). For stage 3 IMHs, women exhibited significantly younger age of onset (P = 0.023), larger MLD (P = 0.003), and smaller height of the hole (P = 0.029). However, for stage 4 IMHs, all the pre- and post-operative metrics showed no differences between genders. CONCLUSIONS Female IMHs seem to demonstrate an earlier age of onset and larger size of hole, especially in IMHs of stage 3. However, these differences, which may owe to normal gender-related variations, have limited influence on the surgical outcomes.
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Affiliation(s)
- Jing Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Xida Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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32
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Scharf JM, Hilely A, Preti RC, Grondin C, Chehaibou I, Greaves G, Tran K, Wang D, Ip MS, Hubschman JP, Gaudric A, Sarraf D. Hyperreflective Stress Lines and Macular Holes. Invest Ophthalmol Vis Sci 2020; 61:50. [PMID: 32347919 PMCID: PMC7401923 DOI: 10.1167/iovs.61.4.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the prevalence of a central hyperreflective line in eyes with full-thickness macular holes (FTMH) and lamellar macular holes (LMH) and to elucidate the pathoanatomic importance of this optical coherence tomography (OCT) sign. Methods This retrospective analysis evaluated patients with FTMH and LMH at the Stein Eye Institute. Clinical data was collected and SD-OCT volume scans were analyzed for the presence of a central vertical hyperreflective line in 3 separate cohorts: patients with SD-OCT preceding FTMH development, patients with SD-OCT after pars plana vitrectomy (PPVT) treatment for FTMH, and patients with SD-OCT of LMH. Results In total, 93 eyes with FTMH and 88 eyes with LMH were identified. Of the 93 FTMH eyes, SD-OCT volume scans were available before development of the FTMH in 12 eyes. Of these, 6 (50%) displayed a vertical hyperreflective line preceding the development of the FTMH. Fifty-one eyes underwent PPVT with resolution of the FTMH, and 26 displayed a hyperreflective line after resolution (51%). Of the 88 eyes with LMH, 22 displayed a hyperreflective line (25%). All hyperreflective lines were noted at the central fovea. Conclusions SD-OCT illustrated the presence of a central vertical hyperreflective line preceding FTMH and after resolution of FTMH after PPVT in approximately one-half of cases, and concurrent with LMH in 25% of cases. This vertical hyperreflective line may represent an early SD-OCT marker for the development of FTMH, and may be a sign of central foveal dehiscence owing to disruption of the Muller cell cone.
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Ittarat M, Somkijrungroj T, Chansangpetch S, Pongsachareonnont P. Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole. Clin Ophthalmol 2020; 14:2171-2183. [PMID: 32801628 PMCID: PMC7398756 DOI: 10.2147/opth.s262877] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To summarize current surgical techniques for treating primary macular holes (MHs). Methods We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of >90%, even in large MH up to 650 µm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.
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Affiliation(s)
- Mantapond Ittarat
- Surin Hospital and Surin Medical Education Center, Department of Ophthalmology, Suranaree University of Technology, Surin, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thanapong Somkijrungroj
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Vitreoretinal Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Glaucoma Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pear Pongsachareonnont
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Vitreoretinal Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Tsuboi K, Fukutomi A, Sasajima H, Ishida Y, Kusaba K, Kataoka T, Kamei M. Visual Acuity Recovery After Macular Hole Closure Associated With Foveal Avascular Zone Change. Transl Vis Sci Technol 2020; 9:20. [PMID: 32855867 PMCID: PMC7422767 DOI: 10.1167/tvst.9.8.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm2 at the preoperative visit, 0.25 ± 0.091 mm2 at the first postoperative visit and 0.31 ± 0.11 mm2 at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.
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Affiliation(s)
- Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Akira Fukutomi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Hirofumi Sasajima
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Yuichiro Ishida
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Kiichiro Kusaba
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Takuya Kataoka
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
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MACULAR HOLE HYDRODISSECTION: Surgical Technique for the Treatment of Persistent, Chronic, and Large Macular Holes. Retina 2020; 39:743-752. [PMID: 29303907 DOI: 10.1097/iae.0000000000002013] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors. METHODS A retrospective review of all consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400 μm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together. RESULTS Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47 μm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days. CONCLUSION The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.
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Quinn NB, Steel DH, Chakravarthy U, Peto T, Hamill B, Muldrew A, Graham K, Elliott D, Hennessy R, Cruise S, McGuinness B, Young IS, Kee F, Hogg RE. Assessment of the Vitreomacular Interface Using High-Resolution OCT in a Population-Based Cohort Study of Older Adults. Ophthalmol Retina 2020; 4:801-813. [PMID: 32335034 DOI: 10.1016/j.oret.2020.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the prevalence of vitreomacular interface (VMI) features and their associated risk factors in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) Study. DESIGN Cross-sectional population-based study. PARTICIPANTS Noninstitutionalized Northern Irish adults 40 years of age or older. METHODS Using geographic stratification, a representative sample of people in Northern Ireland was invited to participate in the NICOLA Study. SD OCT images of participants were graded for vitreomacular traction (VMT), macular hole (MH), and epiretinal membrane (ERM) according to the International Vitreomacular Traction Study Group. A subsample was graded in more detail to estimate the prevalence of VMA and VMA area detailing size and location of VMA. Descriptive analysis and risk factors for each VMI feature were determined using generalized estimating equations. Results were standardized to the Northern Ireland population census (2011). MAIN OUTCOME MEASURES Cohort profile, standardized prevalence, and risk factor associations of each VMI feature. RESULTS Three thousand three hundred fifty-one NICOLA participants had gradable SD OCT images available for at least 1 eye. The prevalence of VMT was 0.5% (CI, 0.31%-0.70%), that for MH was 0.3% (CI, 0.23%-0.52%), and that for ERM was 7.6% (CI, 7.0%-8.3%). A detailed VMA analysis was performed on a subsample consisting of the first 1481 participants. The prevalence of VMA was 22.6% (CI, 21.1-24.2), and VMA area ranged from 0.25 to 42.7 mm2 (mean, 12.53 mm2; standard deviation, 6.90 mm2). In multivariate analyses, increased age was associated with an increased odds ratio (OR) of VMT, MH, and ERM. VMA area was positively associated with younger age and normal blood pressure. ERM and MH were present more often in more myopic eyes, associated with an increase in levels of high-density lipoprotein (HDL) cholesterol and triglycerides. CONCLUSIONS The epidemiologic characteristics of VMI features indicated that VMI interactions throughout life are age dependent. Vitreous separation reduced to a greater extent in the horizontal meridians compared with the vertical, differing from previous studies. Future longitudinal studies of the evolution of these VMI changes over time would be of great interest.
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Affiliation(s)
- Nicola B Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom, and Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Barbra Hamill
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Alyson Muldrew
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Katie Graham
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - David Elliott
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Riona Hennessy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Sharon Cruise
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
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Sokol JT, Ferenchak K, Rosen DT, Schechet SA, Skondra D. Macular Hole Formation After Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e256-e262. [PMID: 30566711 DOI: 10.3928/23258160-20181203-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the incidence, clinical features, and outcomes of patients with macular hole (MH) formation after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD). PATIENTS AND METHODS We conducted a retrospective review of all cases of PPV for diabetic TRD performed by a surgeon (DS) at a large county hospital between November 2013 and August 2016. RESULTS Ninety consecutive eyes of 79 patients were included in this case series, of which four eyes developed MH, yielding an incidence of 4.4% (95% confidence interval [CI], 1.2%-11.0%). The mean interval between PPV for TRD and MH formation was 7.0 ± 5.5 (mean ± 1 standard deviation) months, and mean follow-up time was 29.6 months ± 6.9 months. Three of the four eyes that developed MH underwent intervention, and of the three that underwent intervention, all had successful hole closure. CONCLUSION In this case series, the incidence of MH after PPV for TRD is 4.4% (95% CI, 1.2%-11.0%). The mechanism of MH formation after diabetic TRD repair is not certain but may be related to a taut internal limiting membrane, epiretinal membrane formation, macular edema, or residual vitreous contraction. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e256-e262.].
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Chantarasorn Y, Thamsriswadi P. Closure of Large Chronic Macular Hole by Scleral Imbrication and Retinal Expansion. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e57-e64. [PMID: 30222820 DOI: 10.3928/23258160-20180907-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to describe a new technique for the treatment of large, chronic macular hole (MH) using scleral imbrication and retinal expansion and to report the outcomes of MH closure. PATIENTS AND METHODS This retrospective study demonstrates a procedure for correcting the disproportion between an area of stiff neurosensory retina and the inner scleral wall. Baseline MH parameters were collected. MH closure rate, visual outcomes, and biometry were reported at 6-month follow-up. RESULTS MH closure was achieved in six out of seven patients (85.7%). Mean minimal hole diameter, base hole diameter, and MH index were 712 μm ± 136.8 μm, 1,440 μm ± 444 μm, and 0.27 μm ± 0.08 μm, respectively. At 6-month follow-up, median logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity significantly improved from 1.2 (interquartile range [IQR] = 1.0 to 1.6) preoperatively to 0.7 (IQR = 0.58 to 0.8) postoperatively (P = .018; Wilcoxon signed-rank test). CONCLUSION This technique provided both satisfactory hole closure rates and acceptable structural outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e57-e64.].
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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Cho SC, Park SJ, Byun SJ, Woo SJ, Park KH. Five-year nationwide incidence of macular hole requiring surgery in Korea. Br J Ophthalmol 2019; 103:1619-1623. [DOI: 10.1136/bjophthalmol-2018-313237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/18/2018] [Accepted: 12/26/2018] [Indexed: 11/03/2022]
Abstract
Background/aimsTo estimate the incidence and demographics of macular hole (MH) requiring surgery in Korea.MethodsPatients who underwent surgery for MH in Korea from 2011 to 2015 with the diagnostic code for MH and the surgical code for vitrectomy were retrospectively identified using the Korean national health claims database. The average incidence rate of MH during the 5-year study period was estimated by applying the direct method of standardisation using the 2015 census data as a reference population.ResultsA total of 7301 patients with MH requiring surgery were identified. The average incidence of MH requiring surgery was 3.14 (95 % CI, 3.07 to 3.21) per 100 000 person-years . The incidence in women (4.29 per 100 000 person-years; 95% CI, 4.17 to 4.40) was significantly higher than that in men (2.00 per 100 000 person-years; 95% CI, 1.92 to 2.07; p<0.001). The incidence rate of MH increased exponentially with increasing age between the ages of 35 years and 69 years and was highest among patients aged 65–69 years. The female-to-male ratio for the incidence of MH was 2.15:1.ConclusionsThis study represents the largest nationwide population-based investigation of the incidence of MH, using a database that covers the entire population of South Korea. MH is the disease of elderly peaked 70 years old and more common in women.
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Abstract
BACKGROUND Several new instruments and techniques for pars plana vitrectomy (PPV) have been widely used in recent years, but information about the related characteristics of PPV in China is limited. To investigate the trends in the characteristics of PPV in Eastern China, an 8-year retrospective study was conducted. PATIENTS AND METHODS We collected data from patients who underwent PPV at the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China, in November 2007, November 2011, and November 2015. Cases of trauma-related retinopathy were excluded. Data on the patient demographics, surgical procedures, and the prophylactic use of IOP-lowering medications were collected and analyzed. RESULTS In 2015, most PPVs were conducted with a 23-gauge system, whereas all PPVs in 2007 and 2011 were conducted with a 20-gauge system. The proportions of macular disease in the population in 2007, 2011, and 2015 were 9.1%, 10.7%, and 21.5%, respectively (P<0.001). The proportion of PPV that was combined with lens extraction and intraocular lens (IOL) implantation increased significantly from 12.81% in 2007 to 25.95% by 2015 (P<0.001). The proportions of patients treated with IOP-lowering drugs in 2007, 2011, and 2015 were 27.40%, 38.20%, and 12.60%, respectively (P<0.001). In 2007, systemic carbonic anhydrase inhibitors (CAI-Ss) and beta blockers (BBs) were the two main types of prophylactic IOP-lowering drugs administered, but their use had decreased in 2015 (P<0.001). The preventive use of adrenergic agonists (AAs), topical carbonic anhydrase inhibitors (CAI-Ts), and prostaglandin analogs (PGAs) became increasingly frequent from 2007 to 2015 (P<0.05). CONCLUSION The 23-gauge system, rather than the 20-gauge system, had become the mainstream PPV instrument by 2015. The proportion of macular disease patients requiring PPV in China clearly increased, and the rate of prophylactic IOP-lowering drug use decreased by 2015.
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Affiliation(s)
- Yuan Fang
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China,
| | - Hsiangyu Ku
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China,
| | - Yiwen Liu
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China,
| | - Dekang Gan
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China,
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China,
- Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China,
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Zhang P, Zhu M, Zhao Y, Qian J, Dufresne C, Turner R, Semba RD, Solomon SD. A proteomic approach to understanding the pathogenesis of idiopathic macular hole formation. Clin Proteomics 2017; 14:37. [PMID: 29176938 PMCID: PMC5688700 DOI: 10.1186/s12014-017-9172-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022] Open
Abstract
Idiopathic macular holes (IMH) are full-thickness defects of retinal tissue that cause severe vision loss due to disruption of the anatomic fovea. Abnormal vitreous traction is involved in the formation of macular holes. Both glial cells and hyalocytes contribute to epiretinal membrane formation in IMH. In order to gain further insight into the pathophysiology of IMH, we conducted a discovery phase investigation of the vitreous proteome in four patients with macular holes and six controls using one-dimensional gel fractionation and liquid chromatography-tandem mass spectrometry analyses on an Orbitrap Elite mass spectrometer. Of a total of 5912 vitreous proteins, 32 proteins had increased and 39 proteins had decreased expression in IMH compared with controls, using a false discovery rate approach with p value < 0.001 and q value < 0.05. IMH was associated with increased expression of proteins in the complement pathway, α-2-macroglobulin, a major inducer of Müller glial cell migration, fibrinogen, and extracellular matrix proteins, and decreased expression of proteins involved in protein folding and actin filament binding. A proteomic approach revealed proteins and biological pathways that may be involved in the pathogenesis of IMH and could be targeted for future studies.
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Affiliation(s)
- Pingbo Zhang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Min Zhu
- National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - Yuming Zhao
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jiang Qian
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | - Randi Turner
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Richard D. Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sharon D. Solomon
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
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