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Starr MR, Hinkle JC, Patel LG, Ammar MJ, Soares RR, Patel SN, Cohen MN, Hsu J, Yonekawa Y, Ho AC, Regillo CD, Gupta OP. RANDOMIZED TRIAL COMPARING MICROSERRATED VERSUS CONVENTIONAL INTERNAL LIMITING MEMBRANE FORCEPS FOR INTERNAL LIMITING MEMBRANE PEELING. Retina 2024; 44:1323-1328. [PMID: 39047125 DOI: 10.1097/iae.0000000000004138] [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: 07/27/2024]
Abstract
PURPOSE To evaluate anatomic outcomes and surgeon response following the use of microserrated (Sharkskin, Alcon, Forth Worth, TX) internal limiting membrane (ILM) forceps compared with conventional (Grieshaber; Alcon) ILM forceps for peeling of the ILM. METHODS Patients were prospectively assigned in a 1:1 randomized fashion to undergo ILM peeling using microserrated forceps or conventional forceps. Rates of retinal hemorrhages, deep retinal grasps, ILM regrasping, time to ILM removal, and surgeon questionnaire comparing the use of microserrated and conventional ILM forceps were analyzed. RESULTS A total of 90 eyes of 90 patients were included in this study. The mean number of deep retinal grasps was higher in the conventional forceps group (1.51 ± 1.70 vs. 0.33 ± 0.56, respectively [P < 0.0001]). The mean number of failed ILM grasps was higher with conventional forceps (6.62 ± 3.51 vs. 5.18 ± 2.06 [P = 0.019]). Microserrated forceps provided more comfortability (lower number) in initiating the ILM flap (2.16 ± 0.85 vs. 1.56 ± 0.76, P < 0.001), comfortability in regrasping the ILM flap (2.51 ± 1.01 vs. 1.98 ± 0.89, P = 0.01), and comfortability in completing the ILM flap (2.42 ± 1.03 vs. 1.84 ± 1.02, P = 0.01). CONCLUSION Surgeons utilizing the microserrated forceps experienced fewer deep retina grasps and fewer failed ILM grasps compared with conventional ILM forceps. The microserrated forceps was also a more favorable experience subjectively among the surgeons.
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Affiliation(s)
- Matthew R Starr
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; and
| | - John C Hinkle
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Luv G Patel
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael J Ammar
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca R Soares
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Samir N Patel
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael N Cohen
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carl D Regillo
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omesh P Gupta
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Cakir Y, Sassine AG, Amine R, Matar K, Talcott KE, Srivastava SK, Reese JL, Ehlers JP. Analysis of retinal alterations utilizing intraoperative OCT following surgical interventions with novel ILM forceps in the DISCOVER study. Sci Rep 2024; 14:16959. [PMID: 39043729 PMCID: PMC11266399 DOI: 10.1038/s41598-024-67700-8] [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: 05/03/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
This study aimed to assess retinal alterations following membrane peeling procedures using novel ILM Forceps with laser ablated surface with the help of intraoperative optical coherence tomography (iOCT). A post-hoc analysis was performed to evaluate iOCT findings in eyes that underwent membrane peeling procedures with the novel ILM Forceps. Pre-peel and post-peel iOCT videos and images were evaluated for each eye to assess for post-peel anatomic alterations. Surgical video/iOCT scan correlation was conducted to evaluate the etiology of anatomic alterations. Thirty-two eyes were included in the analysis. Three eyes (9%) had focal full thickness retinal elevations identified on iOCT following tissue-instrument interaction with the ILM Forceps. Two eyes (6%) had focal inner retinal elevations and one eye (3%) had a full-thickness retinal elevation that were not related to direct tissue-instrument interaction but rather indirect peeling forces. iOCT-identified architectural alterations related to direct-tissue instrument interaction were relatively infrequent (< 10%) with similar frequency to previously reported alterations with other surgical instruments.
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Affiliation(s)
- Yavuz Cakir
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Antoine G Sassine
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Reem Amine
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Karen Matar
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Jamie L Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH, 44195, USA.
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Yamamoto A, Miyata M, Tsujikawa A. Ophthalmologists' assessment of the handling characteristics of the novel Finesse Reflex Handle in comparison to those of a conventional handle. Sci Rep 2024; 14:5736. [PMID: 38459107 PMCID: PMC10923932 DOI: 10.1038/s41598-024-56501-8] [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: 01/30/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024] Open
Abstract
Internal limiting membrane (ILM) peeling requires a delicate handling technique. It is also important that ophthalmologists can use the ILM forceps handle of their preference. This study objectively and subjectively evaluated the handling of the novel Finesse Reflex Handle (Reflex) in comparison with that of a conventional handle. The force required to close the forceps tips, evaluated using a digital force gauge, was significantly lesser for Reflex than for the conventional handle (3.14 ± 0.09 N vs. 3.84 ± 0.06 N, P < 0.001). Twenty-one ophthalmologists with various levels of experience answered a questionnaire after using both handles, and the total questionnaire score for Reflex was higher than that for the conventional handle (35.0 ± 3.7 vs. 30.0 ± 6.9, P = 0.01). Furthermore, the duration of experience as an ophthalmologist was negatively correlated with the vertical motion, assessed by video analysis, for the conventional handle (P = 0.02, r = - 0.50) but not for Reflex (P = 0.26). In conclusion, objective and subjective analyses revealed that compared with the conventional handle, the novel Reflex handle had more favourable handling characteristics. Most ophthalmologists preferred the handling of Reflex. Reflex may compensate for a lack of surgical experience.
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Affiliation(s)
- Akinari Yamamoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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Ye X, Xu J, He S, Wang J, Yang J, Tao J, Chen Y, Shen L. Quantitative evaluation of dissociated optic nerve fibre layer (DONFL) following idiopathic macular hole surgery. Eye (Lond) 2023; 37:1451-1457. [PMID: 35778607 PMCID: PMC10170160 DOI: 10.1038/s41433-022-02150-y] [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: 12/24/2021] [Revised: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To quantitatively evaluate concentric macular dark spots (CMDS) on spectral-domain optical coherence tomography (SD-OCT) to determine the morphological characteristics of dissociated optic nerve fibre layer (DONFL) following the performance of internal limiting membrane (ILM) peeling in patients with full-thickness idiopathic macular hole (IMH) closure. METHODS Retrospective study on patients who underwent a vitrectomy with ILM peeling procedure. BCVA, cross-sectional OCT scans, and three-dimensional reconstructions of en face OCT scans were analysed preoperatively, at 2, 6, 12 months post-operatively. A novel image analysis technique was used to automatically measure DONFL logical properties through the radius, area, the nerve fibre layer dissociation index (NFLDI), and depth of the CMDS. RESULTS 53 eyes of 51 patients were included, and the mean follow-up was 11.53 ± 6.26 months. CMDS was found in 46 (86.79%) eyes within 2 months after ILM peeling and 50 (94.34%) eyes within 6 months after ILM peeling. CMDS concentrated on the temporal side of the macula in all 50 eyes (100%) at first detection. The area, NFLDI, and depth of CMDS in four quadrants developed significantly during the postoperative 6 months (p < 0.05), and then these changes slowed down and remained unchanged 12 months post-operatively. The morphological changes in the temporal quadrant were significantly greater than those in other quadrants at 2, 6, 12 months (all p < 0.05) post-operatively. CONCLUSIONS CMDS mostly appeared and concentrated on the temporal side of the macula in IMHs within two months after ILM peeling and progressed within 6 months and remained unchanged after 12 months.
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Affiliation(s)
- Xin Ye
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jiahao Xu
- Department of Ophthalmology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang, 312000, China
| | - Shucheng He
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jun Wang
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jinglei Yang
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jiwei Tao
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China
| | - Yiqi Chen
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China.
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, China.
| | - Lijun Shen
- School of Ophthalmology and Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, China.
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, China.
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Ehrhardt A, Delpuech M, Luc A, Zessler A, Pastor G, Angioi-Duprez K, Berrod JP, Thilly N, Conart JB. Dissociated Optic Nerve Fiber Layer Appearance after Macular Hole Surgery: A Randomized Controlled Trial Comparing the Temporal Inverted Internal Limiting Membrane Flap Technique with Conventional Peeling. Ophthalmol Retina 2023; 7:227-235. [PMID: 36109006 DOI: 10.1016/j.oret.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the effect of the temporal inverted internal limiting membrane (ILM) flap technique compared with that of conventional ILM peeling on the extent of the dissociated optic nerve fiber layer (DONFL) and retinal sensitivity in patients undergoing macular hole (MH) surgery. DESIGN Single-center, prospective, open-label, randomized controlled clinical trial. PARTICIPANTS Patients requiring vitrectomy for MHs sized > 250 μm. METHODS Patients were randomly assigned (1:1) to 1 of the following 2 groups: (1) the control group undergoing standard ILM peeling and (2) the experimental group (flap group) undergoing the temporal inverted ILM flap technique. MAIN OUTCOME MEASURES The primary outcome measure was the total DONFL score at 3 months after surgery. Important secondary outcomes were microperimetry results, primary MH closure rate, external limiting membrane (ELM) and ellipsoid zone (EZ) recovery rates, and best-corrected visual acuity (BCVA). RESULTS Sixty-five patients were recruited between February 2018 and July 2020; primary outcome data were available for 60 patients. The median DONFL score was 7.0 (3.0-12.5) in the control group and 5.0 (1.5-8.5) in the flap group at 3 months after surgery (P = 0.145). The focal depressions characteristic of the DONFL were limited to the temporal side of the fovea in the flap group, whereas they were found all around the fovea in the control group on spectral-domain OCT images. The MH closure rate (P = 1), EZ and ELM recovery rates (P = 0.252), and BCVA (P = 0.450) were similar between the 2 groups. The 3-month overall median retinal sensitivity (MRS) (P = 0.142) and MRS improvement (P = 0.916) in the control group were comparable with those observed in the flap group. In addition, there was no significant difference between the 2 techniques when considering the temporal area (P = 0.105) or the nasal area (P = 0.468). CONCLUSIONS The temporal inverted ILM flap technique reduced the extent of the DONFL by preserving the nasal part of the fovea. However, the overall DONFL score was similar between the 2 techniques. In addition, the MRS and BCVA did not differ from those obtained after complete ILM peeling. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Alix Ehrhardt
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France.
| | - Marion Delpuech
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Amandine Luc
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
| | | | - Geoffrey Pastor
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | | | - Jean-Paul Berrod
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Nathalie Thilly
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
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Caporossi T, Picardi SM, Gambini G, Baldascino A, Carlà MM, Molle A, Scampoli A, Governatori L, Rizzo S. Dynamics of Epiretinal Membrane Peeling under Perfluorocarbon Liquid Evaluated by Intraoperative OCT. Life (Basel) 2023; 13:life13020253. [PMID: 36836611 PMCID: PMC9965307 DOI: 10.3390/life13020253] [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: 12/10/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS). METHODS This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6. RESULTS The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups (p < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, p = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups (p < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups (p = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group. CONCLUSION We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness.
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Affiliation(s)
- Tomaso Caporossi
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, 00186 Rome, Italy
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
| | - Stefano Maria Picardi
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Gloria Gambini
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Molle
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandra Scampoli
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, 00186 Rome, Italy
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
| | - Lorenzo Governatori
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, 00186 Rome, Italy
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, 56124 Pisa, Italy
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Tyagi M, Sahoo NK, Belenje AS, Desai A. Fovea sparing internal limiting membrane peeling for idiopathic macular holes—Report of unfavourable outcomes of a surgical technique. Eur J Ophthalmol 2022; 33:1467-1472. [PMID: 36524252 DOI: 10.1177/11206721221145052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To describe the outcomes of fovea-sparing internal limiting membrane peeling for idiopathic macular holes. Method This was a prospective, interventional case series in patients with idiopathic macular holes. Patients underwent fovea-sparing internal limiting membrane (ILM) peeling with the help of a finesse loop. The primary outcome measure was successful anatomical closure. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) or any surgical complications. Results The study included 22 eyes of 22 patients (median age of 61 (IQR 58 to 66) years). The median basal diameter of the holes was 1054 (IQR 961.5 to 1278) microns, while the median minimal linear diameter was 697 (IQR 461.5 to 786) microns. Successful anatomic closure was achieved in nine cases out of 22 (40.9%). BCVA improved from 20/125 preoperatively to 20/80 at the end of the follow-up. There was no difference in baseline parameters between eyes with closure, versus eyes with an open hole. One eye had an iatrogenic break in an attempt to reinitiate peeling and create a fovea-sparing flap. One of the eyes had an ERM formation at end of 3 months. Conclusion Our outcomes of fovea-sparing ILM peeling in idiopathic macular holes were unfavourable. The residual ILM could be causing tangential traction resulting in non-closure.
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Affiliation(s)
- Mudit Tyagi
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Niroj Kumar Sahoo
- Department of Retina and Vitreous, LV Prasad Eye Institute, Vijayawada, India
| | - Akash S Belenje
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Arjun Desai
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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8
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A randomised controlled trial evaluating internal limiting membrane peeling forceps in macular hole surgery. Graefes Arch Clin Exp Ophthalmol 2022; 261:1553-1562. [DOI: 10.1007/s00417-022-05932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/18/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Purpose
To assess study design and a range of anatomical and functional changes after internal limiting membrane (ILM) peeling using forceps developed for atraumatic ILM pick-up compared to standard forceps.
Methods
We conducted a masked proof-of concept randomised controlled trial (RCT) on 65 patients who underwent ILM peeling for idiopathic full-thickness macular hole (FTMH) using etched-tip forceps (etched-tip group, 33 eyes) compared to standard ILM forceps (smooth-tip group, 32 eyes). Patients were assessed preoperatively, 3 weeks, 3 and 6 months postoperatively.
Results
The primary closure rate was 95.4%. There was no statistically significant difference between the groups in terms of final visual acuity (66.9 vs 70.9 ETDRS letters, p = 0.13), difference of visual field mean deviation (1.32 vs 1.14 decibels), and number of eyes with pick-up-related retinal haemorrhages (16% vs 16%, p = 0.96), swelling of arcuate nerve fibre layer lesions (63% vs 55%, p = 0.54), number of dissociated optic nerve fibre layer lesions (31.4 vs 41.0, p = 0.16), nor inner retina defects (37% vs 22%, p = 0.17). Similar changes in inner retinal volumes were detected in all 9 sectors of an ETDRS grid except for a trend (p = 0.06) towards a lower reduction in the inferior inner sector in the etched-tip group.
Conclusions
The study was successfully completed with masking maintained and a low risk of bias. Multiple endpoints relating to ILM peeling were assessed, and estimates were provided that can be used for future studies. Although the study was not powered to assess any specific endpoint, the anatomical and functional outcomes assessed did not significantly differ.
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9
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Ashurov A, Chronopoulos A, Heim J, Schutz JS, Arndt C, Hattenbach LO. Real-Time (iOCT) Guided Epiretinal Membrane Surgery Using a Novel Forceps with Laser-Ablated Microstructure Tip Surface. Clin Pract 2022; 12:818-825. [PMID: 36286072 PMCID: PMC9599977 DOI: 10.3390/clinpract12050086] [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] [Received: 08/21/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose: We investigated intraoperative OCT (iOCT)—guided epiretinal membrane (ERM) and internal limiting membrane (ILM) removal using a novel forceps with a laser-ablated tip surface; it was designed to help prevent indentation force, shear stress, or tractional trauma when grasping very fine membranes. Patients and Methods: This retrospective study included patients who underwent 23- and 25-gauge pars plana vitrectomy (PPV) for vitreoretinal interface disorders. ERM and ILM peeling was performed under guidance with microscope-integrated iOCT using novel ILM forceps with laser-ablated tip surfaces. These forceps were engineered to enhance friction when grasping tissue. Evaluation of ERM/ILM manipulation included postoperative slow-motion video analysis of the number of grasping attempts, initial ILM mobilization, and observed damage to retinal tissue. Results: ERM/ILM removal was successfully performed in all patients, with an average of four grasp actions to initial membrane mobilization (91%). Additional use of a diamond-dusted membrane scraper was used in two cases (9%). Mean best-recorded visual acuity (BRVA) logMAR improved from 0.5 ± 0.34 to 0.33 ± 0.36 (p = 0.05) and mean central retinal thickness (CRT) improved from 462 ± 146 µm to 359 ± 78 µm (p = 0.002). Postoperative iOCT video analysis demonstrated hyper-reflectivity of the inner retinal layers associated with retinal hemorrhage in five eyes (22%), but no grasping-related retinal breaks. Conclusions: The texturized surface on the tips of the ILM forceps were found to be helpful for mobilizing ILM edges from the retinal surface. iOCT-guided ERM surgery also allowed for improved intraoperative tissue visualization. We believe that these two technologies helped reduce both unnecessary surgical maneuvers and retinal damage.
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Affiliation(s)
- Agharza Ashurov
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz and Medical Faculty of the University of Mannheim, 67063 Ludwigshafen, Germany
- Correspondence: ; Tel.: +49-0621-503-3058; Fax: +49-0621-503-770030
| | - Argyrios Chronopoulos
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz and Medical Faculty of the University of Mannheim, 67063 Ludwigshafen, Germany
| | - Julia Heim
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz and Medical Faculty of the University of Mannheim, 67063 Ludwigshafen, Germany
| | - James Scott Schutz
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz and Medical Faculty of the University of Mannheim, 67063 Ludwigshafen, Germany
| | - Carl Arndt
- Department of Ophthalmology, University Hospital of Reims, 51100 Reims, France
| | - Lars-Olof Hattenbach
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz and Medical Faculty of the University of Mannheim, 67063 Ludwigshafen, Germany
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Pradhan D, Agarwal L, Joshi I, Kushwaha A, Aditya K, Kumari A. Internal limiting membrane peeling in macular hole surgery. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc07. [PMID: 35813123 PMCID: PMC9204259 DOI: 10.3205/000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
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Affiliation(s)
- Deepti Pradhan
- Kirtipur Eye Hospital, Department of Vitreoretinal Services, Kirtipur, Nepal,*To whom correspondence should be addressed: Deepti Pradhan, Kirtipur Eye Hospital, Department of Vitreoretinal Services, Tahalcha, Tinkune, 44618 Kirtipur-10, Nepal, Phone: +977 9808119112, E-mail:
| | - Lalit Agarwal
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Ichhya Joshi
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Anamika Kushwaha
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
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Caporossi T, Carlà MM, Gambini G, De Vico U, Baldascino A, Rizzo S. Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives. Clin Ophthalmol 2022; 16:1069-1084. [PMID: 35418741 PMCID: PMC8995173 DOI: 10.2147/opth.s284620] [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] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Pars plana vitrectomy has become the standard procedure for primary macular holes (MHs) repair, including the removal of the posterior cortical vitreous, the stripping of eventual epiretinal membranes, and finally an intraocular gas tamponade. During this procedure, peeling the internal limiting membrane (ILM) has been proven to increase closure rates and avoid postoperative reopening in several researches. In fact, even in large MHs more than 400 µm, the advantage of peeling off the ILM was highlighted by better anatomical closure rates. Nevertheless, some authors suggested that ILM peeling is not always essential, because it generates various side effects in retinal structure and function. Furthermore, the ideal amount of ILM peeling and the most effective strategies for removing the ILM are still subject of research. Different surgical modifications have been reported as alternatives to traditional peeling in certain clinical settings, including ILM flaps, ILM scraping, and foveal sparing ILM peeling. As regards large MHs, the introduction of ILM inverted flap appeared as a game changer, offering a significantly higher >90% closure rate when compared to traditional ILM peeling. Modifications to inverted ILM flap procedures have been claimed in recent years, in order to define the best area and direction of ILM peeling and its correlation with functional outcomes. Moreover, several innovations saw the light in the setting of recurrent MHs, such as ILM free flap transposition, inverted ILM flap combined autologous blood clot technique, neurosensory retinal flap, and human amniotic membrane (HAM) plug, claiming higher anatomical success rate also in those complex settings. In conclusion, the aim of this review is to report how the success rate of contemporary macular surgery has grown since the turn of the century, especially for big and chronic MHs, analyzing in which way ILM management became a crucial point of this kind of surgery.
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Affiliation(s)
- Tomaso Caporossi
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Gloria Gambini
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
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Tuifua TS, Sood AB, Abraham JR, Srivastava SK, Kaiser PK, Sharma S, Rachitskaya A, Singh RP, Reese J, Ehlers JP. Epiretinal Membrane Surgery Using Intraoperative OCT-Guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal. Ophthalmol Retina 2021; 5:1254-1262. [PMID: 33647472 DOI: 10.1016/j.oret.2021.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/09/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel. DESIGN Case-control retrospective, comparative assessment. PARTICIPANTS Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT. METHODS Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel. MAIN OUTCOME MEASURES Visual acuity and ERM recurrence. RESULTS A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P < 0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P > 0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P = 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort. CONCLUSIONS Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.
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Affiliation(s)
- Tisileli S Tuifua
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Arjun B Sood
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph R Abraham
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter K Kaiser
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Sharma
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aleksandra Rachitskaya
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P Singh
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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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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Abdullah ME, Moharram HEM, Abdelhalim AS, Mourad KM, Abdelkader MF. Evaluation of primary internal limiting membrane peeling in cases with rhegmatogenous retinal detachment. Int J Retina Vitreous 2020; 6:8. [PMID: 32411388 PMCID: PMC7204288 DOI: 10.1186/s40942-020-00213-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Epiretinal membranes (ERMs) have been reported after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Peeling of the internal limiting membrane (ILM) can prevent post-PPV ERM formation but has a potential negative impact on macular structure and function. Purpose To investigate the anatomical and functional outcomes of ILM peeling during PPV for primary RRD. Methods This was a prospective nonrandomized study that included 60 eyes of 60 patients with a primary macula-off RRD and less than grade C proliferative vitreoretinopathy (PVR). Eyes were allocated into 2 groups; Group A underwent PPV without ILM peeling and Group B had ILM peeling. At postoperative month 6, all patients underwent retinal imaging using spectral domain optical coherence tomography (OCT) and OCT angiography and macular function was assessed using multifocal electroretinogram (mfERG). Baseline characteristics and postoperative anatomical and visual outcomes were recorded and statistically analyzed. Results We enrolled 30 eyes of 30 patients in each group. In Group A, mean age was 44.6 years, while the mean age of Group B patients was 49.9 years. Postoperative LogMAR visual acuity was significantly better in Group A than in Group B (p < 0.001). ERMs were demonstrated on OCT in 13.3% of Group A and none of Group B patients (p = 0.04). Retinal dimples were found in 53.3% of Group B and none of Group A eyes (p < 0.001). OCTA showed a greater vessel density of the superficial capillary plexus (SCP) in Group A compared to Group B eyes (p = 0.046), while no difference was found regarding deep capillary vessel density (p = 0.7). Mean amplitude of mfERG P1 wave was significantly higher in Group A eyes than in Group B (p = 0.002). Both the SCP vessel density and P1 amplitude were positively correlated with visual acuity (p < 0.001). Conclusion This study suggests that ILM peeling prevents ERM development in eyes undergoing PPV for uncomplicated macula-off RRD, but potential damage to macular structure and function were found. Trial registration Retrospectively registered on 09/24/2019 on ClinicalTrials.gov with an ID of NCT04139811.
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Affiliation(s)
- Mohamed Esmail Abdullah
- 1Faculty of Medicine, Minia University, Minia, Egypt.,2Department of Ophthalmology, Minia University Hospital, Minia, 61111 Egypt
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15
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Shimada Y. Unintentional retinal artery amputation during macular peeling. GMS OPHTHALMOLOGY CASES 2020; 10:Doc13. [PMID: 32269911 PMCID: PMC7114637 DOI: 10.3205/oc000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of unintentional retina artery amputation during macular peeling. Methods: Observational case report Results: A 73-year-old female underwent surgery to treat epiretinal membrane (ERM) associated with severe staphyloma in her left eye. While the ERM/posterior hyaloid membrane visually enhanced with triamcinolone (TA) was peeled, a movement of the forceps unintentionally involved the inferior temporal branch artery near the inner edge of the staphyloma. The artery was avulsed and amputated. Oozing from the retinal cleft that had once enfolded the artery and microscopic bleeding from the amputation stump were observed. The vitreous hemorrhage obscured a view of the fundus more than 4 weeks after the surgery. After 8 weeks, postoperative visual acuity was improved; however, the superior nasal visual field was lost, and the patient was aware of the broken vessel as a floater in her vision. Conclusions: Macular peeling is technically challenging, so meticulous attention must be paid to avoid any damage on vessels. The retina tissue was stretched in a staphyloma and vessels were bulged into the vitreous space especially at the inner edge of the staphyloma. High levels of TA dye here buried the texture of the retina. Excessive TA should be removed prior to macular peeling.
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Affiliation(s)
- Yoshiaki Shimada
- Department of Ophthalmology, Fujita Health University Bantane Hospital, Aichi, Japan
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16
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Saurabh K, Roy R, Thomas NR. Multicolor Imaging Characteristics of Best's Vitelliform Macular Dystrophy. Middle East Afr J Ophthalmol 2019; 26:178-180. [PMID: 31619909 PMCID: PMC6788318 DOI: 10.4103/meajo.meajo_303_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/17/2018] [Accepted: 09/15/2019] [Indexed: 11/30/2022] Open
Abstract
A 40-year-old woman presented with vitellieruptive stage of Best's vitelliform macular dystrophy (BVMD) in the right eye and pseudohypopyon stage in the left eye. She underwent comprehensive ophthalmic examination and fundus imaging using multicolor (MC) imaging technology of Spectralis (Heidelberg Engineering, Heidelberg, Germany) spectral-domain-optical coherence tomography system. Composite MC imaging revealed larger area of retinal pigment epithelium atrophy in vitellierruptive stage of the disease in the right eye compared to color fundus photograph. Retinal elevation in the pseudohypopyon stage was better delineated on composite MC and blue reflectance images in the left eye. Subretinal lipofuscin was best seen in green reflectance and short-wave autofluorescence images. The present case reports the MC imaging features of BVMD.
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Affiliation(s)
- Kumar Saurabh
- Retina Services, Kamalnayan Bajaj Sankara Nethralaya, Kolkata, West Bengal, India
| | - Rupak Roy
- Retina Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Nicey Roy Thomas
- Sri Bhagwan Mahavir Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Jeancolas AL, Foveau P, Leroy B, Berrod JP, Conart JB. [Anatomical and functional results of macular hole surgery using a temporal inverted internal limiting membrane flap. Experience with 24 cases]. J Fr Ophtalmol 2018; 41:939-944. [PMID: 30442489 DOI: 10.1016/j.jfo.2018.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/18/2018] [Accepted: 02/28/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the anatomical and functional outcomes of macular hole (MH) surgery with a temporal inverted internal limiting membrane (ILM) flap technique. METHODS Monocentric retrospective study of 24 patients who were operated on for macular hole between March 2014 and April 2017 at Nancy University Hospital. All patients underwent pars plana vitrectomy with the inverted ILM flap technique. ILM peeling was restricted to the temporal side of the fovea, and the macular hole was then covered with the ILM flap, followed by SF6 tamponnade and first day face-down positioning. The main outcome measures included macular hole closure rate and visual acuity at 1 month postoperatively. RESULTS Eight men and 16 women of mean age 67.0±5.4 years were included. The mean axial length was 23.5±1.2mm. The mean diameter of the MH was 362±123μm. Closure of the MH was achieved in 23 of 24 eyes (95.8%) after one surgery. The mean BVCA improved significantly from 0.71±0.20 logMar to 0.29±0.22 logMar (P<0.001) at 1 month postoperatively, for a gain of 0.42±0.24 logMar. CONCLUSION Macular hole surgery with the inverted ILM flap technique results in good anatomical and functional outcomes, comparable to those obtained with the classic technique with complete ILM peeling.
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Affiliation(s)
- A-L Jeancolas
- CHRU Brabois, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France.
| | - P Foveau
- CHRU Brabois, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France
| | - B Leroy
- CHRU Brabois, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France
| | - J-P Berrod
- CHRU Brabois, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France
| | - J-B Conart
- CHRU Brabois, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France
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Essex RW, Hunyor AP, Moreno-Betancur M, Yek JT, Kingston ZS, Campbell WG, Connell PP, McAllister IL, Allen P, Ambler J, Bourke R, Branley M, Buttery R, Campbell W, Chang A, Chauhan D, Chen F, Chen S, Clark B, Donaldson M, Downie J, Essex R, Evans K, Fabinyi D, Fleming B, Fung A, Gilhotra J, Gorbatov M, Groenveld E, Guest S, Hadden P, Hall AB, Heriot W, Ho IV, Hunyor A, Isaacs T, Jones A, Kwan T, Kang HK, Lake S, Lee L, Luckie A, McAllister I, McCombe M, McKay D, O’Rourke M, Park J, Phillips R, Reddie I, Roufail E, Saha N, Subramaniam D, Tsanaktsidis G, Vandeleur K, Vilacorta-Sandez, Welch S, Wong H, Yellachich D. The Visual Outcomes of Macular Hole Surgery: A Registry-Based Study by the Australian and New Zealand Society of Retinal Specialists. ACTA ACUST UNITED AC 2018; 2:1143-1151. [DOI: 10.1016/j.oret.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
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FACTORS ASSOCIATED WITH DEVELOPMENT OF DISSOCIATED OPTIC NERVE FIBER LAYER APPEARANCE IN THE PIONEER INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY STUDY. Retina 2018; 38 Suppl 1:S103-S109. [PMID: 29346239 DOI: 10.1097/iae.0000000000002017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the relationship of dissociated optic nerve fiber layer (DONFL) and intraoperative membrane-peeling dynamics as visualized using intraoperative optical coherence tomography (OCT), and to evaluate the functional implications of DONFL. METHODS This was a post hoc analysis of eyes undergoing membrane peeling for vitreomacular interface disorders in the prospective PIONEER intraoperative OCT study. Retinal layer measurements in preincision and postpeel intraoperative OCT images were obtained. The primary outcome was development of DONFL appearance on spectral domain OCT at 6-month follow-up. Secondary outcomes included correlation of DONFL with surgical technique, surgical indication, intraoperative OCT findings, and retinal sensitivity. RESULTS Ninety-five eyes were included. The prevalence of DONFL at 6 months was 36%. Increased inner retinal layer thickness on intraoperative OCT immediately after membrane peeling was associated with development of DONFL (P < 0.01). Macular hole repair was significantly associated with DONFL appearance. Peel technique (forceps vs. diamond-dusted membrane scraper) was not associated with DONFL. There was no difference in retinal sensitivity or visual acuity between eyes with or without DONFL. CONCLUSION Acute postpeel increase in inner retinal thickness and macular hole repair were associated with development of DONFL appearance. However, it is unclear whether the surgical indication (e.g., macular hole) or the surgical manipulations performed (e.g., internal limiting membrane peeling) is the major factor that has an impact on DONFL appearance. Overall, these findings suggest that one mechanism in the development of DONFL appearance may be intraoperative trauma to the inner retina, potentially during internal limiting membrane peeling (e.g., macular hole repair).
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INTERNAL LIMITING MEMBRANE PEELING-DEPENDENT RETINAL STRUCTURAL CHANGES AFTER VITRECTOMY IN RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2018; 38:471-479. [PMID: 28234805 DOI: 10.1097/iae.0000000000001558] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine retinal changes after vitrectomy with internal limiting membrane (ILM) peeling, we used 3-dimensional optical coherence tomography (3D-OCT) in rhegmatogenous retinal detachment cases. METHODS The 68 eyes from 67 patients with rhegmatogenous retinal detachment were studied, including 35 detached macula cases (51%) and 33 attached macula cases. Internal limiting membrane peeling was performed with fine forceps after brilliant blue G staining. The 3D-OCT images were obtained with volume-rendering technologies from cross-sectional OCT images. RESULTS The 3D-OCT detected 45 eyes (66%) with ILM peeling-dependent retinal changes, including dissociated optic nerve fiber layer appearance, dimple sign, temporal macular thinning, ILM peeling area thinning, or forceps-related retinal thinning. The ILM peeled area was detectable in only 9 eyes with 3D-OCT, whereas it was undetectable in other 59 eyes. The dissociated optic nerve fiber layer appearance was detected in 8 of the total cases (12%), and dimple signs were observed in 14 cases (21%). Forceps-related thinning was also noted in eight cases (24%) of attached macula cases and in four cases (11%) of detached macula cases. No postoperative macular pucker was noted in the observational period. CONCLUSION The 3D-OCT clearly revealed spatial and time-dependent retinal changes after ILM peeling. The changes occurred in 2 months and remained thereafter.
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INCOMPLETE REPAIR OF RETINAL STRUCTURE AFTER VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING. Retina 2018; 37:1523-1528. [PMID: 27828909 DOI: 10.1097/iae.0000000000001388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine retinal changes after vitrectomy with internal limiting membrane (ILM) peeling, we used a cynomolgus monkey model and focused on surgical damages of ILM peeling for long observational period of 3 years. METHODS Vitrectomy was performed followed by ILM peeling similar to clinical settings in humans. Ultrastructural changes of the retina were investigated by light, transmission, and scanning electron microscopy at 3 months and 3 years after ILM peeling. RESULTS Ultrastructural study showed that the ILM peeled area was still clearly recognized after 3 years. The Müller cell processes covered most of the retina; however, the nerve fiber layer was partly uncovered and exposed to the vitreous space. The arcuate linear nerve fiber bundles were observed as comparable with dissociated optic nerve fiber layer appearance. Small round retinal surface defects were also observed around macula, resembling the dimple sign. Forceps-related retinal thinning was also found on the edge of ILM peeling, where we started peeling with fine forceps. CONCLUSION The ultrastructural studies showed that most of ILM peeling area was covered with glial cells during wound healing processes. Retinal changes were found comparable with dissociated optic nerve fiber layer appearance or dimple sign, which were clinically observed with optical coherence tomography.
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Uchida A, Srivastava SK, Ehlers JP. Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study. Invest Ophthalmol Vis Sci 2017; 58:3440-3444. [PMID: 28692739 PMCID: PMC5505120 DOI: 10.1167/iovs.17-21584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigate acute retinal alterations identified on intraoperative optical coherence tomography (iOCT) immediately following surgical intervention with the Finesse Flex Loop for vitreoretinal interface disorders. Methods The Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualization during En face Retinal and ophthalmic surgery (DISCOVER) study is a prospective multisurgeon intraoperative OCT clinical study. Subjects who had participated in the DISCOVER study and had undergone macular surgery with the membrane flex loop from August 2014 to July 2016 were identified. iOCT images and video sequences were evaluated at various surgical time points. Subjects were excluded if iOCT images were not obtained over the area of membrane peeling performed with the membrane flex loop. Qualitative characteristics of intraoperative changes in retinal images were analyzed, with particular focus on the retinal layers within the bed of membrane peeling performed specifically with the membrane flex loop. Results We studied 34 eyes of 34 patients, with a mean age of 72.7 (± 6.4) years, 25 of whom were women. The intraoperative diagnosis was full thickness macular hole in 21 eyes (62%) and epiretinal membrane in 13 (38%). All eyes had successful indocyanine green–assisted inner limiting membrane (ILM) flap initiation using the membrane loop. Intraoperative OCT demonstrated expansion of the ellipsoid zone-to-RPE distance in 3 eyes (9%), definitive subretinal fluid accumulation in 1 eye (3%), and hyperreflectivity of the inner retinal layers associated with retinal hemorrhage in 10 eyes (29%). Retinal breaks were not observed in any eye. Conclusions Acute retinal alterations after ILM peeling with the membrane flex loop were visualized at a frequency of less than 10%. Additional research is needed to understand the clinical impact, if any, of these architectural alterations.
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Affiliation(s)
- Atsuro Uchida
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Sunil K Srivastava
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Rivera-De La Parra D, Perez-Peralta L, Toldi J, Levine J, Fikhman M, Graue-Hernandez EO. MULTICOLOR SCANNING LASER IMAGING IN LIPEMIA RETINALIS. Retin Cases Brief Rep 2017; 11 Suppl 1:S132-S135. [PMID: 27828900 DOI: 10.1097/icb.0000000000000469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To describe multicolor scanning laser imaging (MSLI) and conventional fundus photography findings in lipemia retinalis (LR). METHODS We report two LR cases. The first case is a 47-year-old diabetic woman with LR secondary to familial hypertriglyceridemia examined with MSLI, conventional fundus photography, and optical coherence tomography (OCT). The second case is a 39-year-old diabetic man with hypertriglyceridemia and LR. He was followed over time with conventional fundus photography of his retina until metabolic control was achieved. RESULTS In the first case, MSLI showed retinal arteries with an intense yellow and retinal veins with a pale yellow color. Fundus photography disclosed only mild pale red vessels. Optical coherence tomography detected macular edema and hyperreflective changes of retinal vessels. In the second case, fundus photography showed vessels with a pale red appearance that normalized after metabolic control of triglycerides. CONCLUSION We described the retinal findings in patients with LR using different image modalities. Specifically, we report the findings with MSLI not previously described. While regular fundus photography may show mild changes in LR, the MSLI modality may show more significant findings assisting in the diagnosis and follow-up of this disease.
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Affiliation(s)
- David Rivera-De La Parra
- *Centro de atención integral del paciente con diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; †Instituto de Oftalmología "Fundación Conde de Valenciana" I.A.P., Mexico City, Mexico; ‡Florida State University College of Medicine, Bonita Springs, Florida; §Arizona Eye Consultants, Tucson, Arizona; and ¶Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California
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Steel DHW, Dinah C, White K, Avery PJ. The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane. Acta Ophthalmol 2017; 95:153-157. [PMID: 27572851 DOI: 10.1111/aos.13195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE A dissociated optic nerve fibre layer (DONFL) is a characteristic change noted in inner retinal morphology after internal limiting membrane (ILM) peeling. It is thought to be due to trauma to Muller cells as the ILM is peeled from their attached end plates. In this study, we aimed to determine the extent and size of Muller cell debris on the retinal side of excised ILM and assess whether this correlated with the extent of DONFL observed postoperatively. METHOD Prospective single centre study of a consecutive series of patients undergoing macular hole surgery. Transmission electron microscopy of the ILM was used to assess Muller cell debris and postoperative spectral domain optical coherence tomography (SD-OCT) to assess the extent of DONFL. A variety of other pre- and postoperative features was also included. RESULTS Thirty-nine patients were analysed. There were retinal dimples characteristic of DONFL detected on SD-OCT in all 39 eyes. The portion of the retinal side of the ILM specimen covered by cellular debris ranged from 12% to 49%, with a median of 28%. Using linear regression, the percentage of retinal debris, the size of the debris and the postoperative visual acuity were significantly positively associated with the DONFL score. The total R squared for the model was 63.9%. CONCLUSION The extent of DONFL observed postoperatively can be partly explained by the amount of retinal side cellular debris on the retinal side of the peeled ILM. Surgical strategies which minimize this material could reduce the extent of DONFL.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary; Sunderland UK
- Institute of Genetic Medicine; Newcastle University; Newcastle Upon Tyne UK
| | | | - Kathryn White
- EM Research Services; Newcastle University; Newcastle Upon Tyne UK
| | - Peter J. Avery
- School of Mathematics and Statistics; Newcastle University; Newcastle Upon Tyne UK
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Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol 2017; 62:58-69. [DOI: 10.1016/j.survophthal.2016.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 02/02/2023]
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Park SH, Kim YJ, Lee SJ. Reply. Retina 2016; 36:e65. [DOI: 10.1097/iae.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Correspondence. Retina 2016; 36:e64-5. [DOI: 10.1097/iae.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Belyy YA, Tereshchenko AV, Shkvorchenko DO, Erokhina EV, Shilov NM. [Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes]. Vestn Oftalmol 2016; 132:23-30. [PMID: 27030430 DOI: 10.17116/oftalma2016132123-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to develop a surgical procedure for large idiopathic macular holes (MH) that would involve creation of an original internal limiting membrane (ILM) flap to close the hole with. MATERIAL AND METHODS Nineteen patients aged from 59 to 71 years with stage 3 idiopathic MH (by J. Gass) were enrolled. Besides standard ophthalmic examination, spectral optical coherence tomography and microperimetry were performed in all cases. The patients were followed up 2 weeks and then 1 and 3 months after surgery. Surgical procedure was notable for an original ILM flap created in a way that resembles removing petals from a flower. The new method implies that the ILM is peeled off all the way round the MH except for the foveolar area and one particular ILM fragment, which is only partially separated from the retina, from the periphery towards the MH, stopping at some 0.1-0.2 mm from its margin. This last fragment is then inverted to cover the MH. RESULTS All surgeries were completed without complications. Visual acuity has gradually increased over the follow-up period in all patients: from 0.1-0.4 to 0.3-0.7 (0.39±0.15 on the average; Sivtsev-Golovin chart). Foveal anatomy has also improved: complete closure of the MH was achieved in 8 patients, partial - in 11. Moreover, all patients demonstrated a shift of the retinal fixation point towards the center of the fovea for 153-369 mm, at that, their fixation has stabilized and absolute central scotomas disappeared. CONCLUSION The method developed is a promising treatment for large idiopathic macular holes. Further studies are required.
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Affiliation(s)
- Yu A Belyy
- Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007
| | - A V Tereshchenko
- Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007
| | - D O Shkvorchenko
- Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 59a Beskudnikovskiy bulvar, Moscow, Russian Federation, 127486
| | - E V Erokhina
- Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007
| | - N M Shilov
- Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007
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Ehlers JP, Han J, Petkovsek D, Kaiser PK, Singh RP, Srivastava SK. Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study. Invest Ophthalmol Vis Sci 2016; 56:7324-30. [PMID: 26559478 DOI: 10.1167/iovs.15-17526] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess retinal architectural alterations that occur following membrane peeling procedures and the impact of peel technique on these alterations utilizing intraoperative optical coherence tomography (iOCT). METHODS This is a subanalysis of the prospective PIONEER iOCT study of eyes undergoing a membrane peeling for a vitreomacular interface (VMI) disorder. Intraoperative scanning was performed with a microscope-mounted OCT system. Macroarchitectural alterations (e.g., full-thickness retinal elevations) and microarchitectural alterations (e.g., relative layer thickness alterations) were analyzed. Video/iOCT correlation was performed to identify instrument-tissue manipulations resulting in macroarchitectural alterations. RESULTS One hundred sixty-three eyes were included in the macroarchitectural analysis. Instrumentation utilized for membrane peeling included forceps alone for 73 eyes (45%), combined diamond-dusted membrane scraper (DDMS) and forceps for 87 eyes (53%), and other techniques in three eyes (2%). Focal retinal elevations were identified in 45 of 163 eyes (28%). Video/iOCT correlation identified 69% of alterations involved forceps compared to 26% due to DDMS. Sixteen percent of retinal alterations persisted 1 month following surgery. The microarchitectural analysis included 134 eyes. Immediately following membrane peeling, there was a significant increase in the ellipsoid zone to retinal pigment epithelium height (+20%, P < 0.00001) and the cone outer segment tips to retinal pigment epithelium height (+18%, P < 0.00001). CONCLUSIONS Significant subclinical retinal architectural changes occur during membrane peeling for VMI conditions. Differences in surgical instruments may impact these architectural alterations.
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Affiliation(s)
- Justis P Ehlers
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Jaehong Han
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Daniel Petkovsek
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Peter K Kaiser
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Rishi P Singh
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Sunil K Srivastava
- Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Paravascular abnormalities in eyes with idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2016; 254:1723-9. [PMID: 26803488 DOI: 10.1007/s00417-016-3276-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The purpose was to investigate the paravascular abnormalities (PVA) around the retinal vascular arcades and their post-operative evolution in eyes with epiretinal membranes (ERM). METHODS This is an observational case series. Fifty-seven eyes of 55 patients with concurrent PVA and ERM were studied (study group). Forty-one eyes in 41 patients with ERM but no PVA served as controls. Multiple optical coherence tomography (OCT) scans were made along the upper and lower arcades and across the fovea in each patient. Serial fundus photography and OCT scans were performed in eyes receiving an operation. All surgeries were performed by one surgeon. The incidence and location of paravascular retinal cysts, deep cystic spaces underneath the vessels, and paravascular retinal defects, as well as vitreoretinal interface changes, were determined and correlated with macular thickness. RESULTS In the study group, paravascular retinal cysts were detected in 57 eyes (100 %), deep cystic spaces in nine eyes (15.8 %), and paravascular lamellar holes in 31 eyes (54.4 %). No case had a full-thickness hole. ERM adhesion to the PVA was noted in 16 eyes (28.1 %) and internal limiting membrane (ILM) changes over the PVA in 22 eyes (38.6 %). Compared with the control, the study group had significantly increased macular thickness. PVA, except lamellar holes, disappeared or decrease in severity after ERM and ILM removal surgery. CONCLUSION Different types of PVA are relatively common in eyes with ERM. Our findings suggest that PVA may develop secondary to ERM-induced macular thickening. Except for lamellar holes, most lesions decrease following an operation.
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Abstract
This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.
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Affiliation(s)
- Haifa A Madi
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK
| | - Ibrahim Masri
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK; Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK
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Comparison of the Effectiveness of Pars Plana Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Retinal Membrane Removal: A Meta-Analysis. J Ophthalmol 2015; 2015:974568. [PMID: 26693348 PMCID: PMC4674606 DOI: 10.1155/2015/974568] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/22/2015] [Accepted: 11/02/2015] [Indexed: 01/22/2023] Open
Abstract
We conducted a meta-analysis of published retrospective studies and compared the effectiveness of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IERM). The results revealed that patients in the IERM+ILM peeling group had better BCVA after surgery within 12 months than those in IERM peeling group. But patients in the IERM peeling group showed better BCVA in the 18th month. More retrospective studies or randomized controlled trials are required to investigate and compare the long-term effect of IERM removal with and without ILM peeling.
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Manousaridis K, Peter S, Mennel S. 20 g PPV with indocyanine green-assisted ILM peeling versus 23 g PPV with brilliant blue G-assisted ILM peeling for epiretinal membrane. Int Ophthalmol 2015; 36:407-12. [PMID: 26499510 DOI: 10.1007/s10792-015-0148-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/17/2015] [Indexed: 11/29/2022]
Abstract
To compare the anatomical and visual outcomes of 20 gauge (g) pars plana vitrectomy (PPV) with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling and 23 g PPV with brilliant blue G (BBG)-assisted ILM peeling for idiopathic epiretinal membrane (ERM). 38 eyes of 38 patients with idiopathic ERM were included. They were divided in two groups: group 1 (18 eyes) underwent 20 g PPV with ICG-assisted ILM peeling and group 2 (20 eyes) 23 g PPV with BBG-assisted ILM peeling. Postoperative best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared. Average BCVA in group 1 improved significantly from 0.60 logarithm of the minimal angle of resolution (log MAR) at baseline to 0.3 log MAR postoperatively. Average BCVA in group 2 improved significantly from 0.60 log MAR at baseline to 0.3 log MAR postoperatively. Mean CMT reduced significantly from 473 to 375 μm in group 1 and from 486 to 396 μm in group 2. There were no significant differences in the BCVA and CMT between the groups. Both surgical methods appeared to be safe and provided similar anatomical and visual outcomes.
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Affiliation(s)
- Kleanthis Manousaridis
- Ophthalmology Department, State Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Silvia Peter
- Ophthalmology Department, State Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Stefan Mennel
- Ophthalmology Department, State Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
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Abstract
Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications.
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