Folding the internal limiting membrane flap under perfluorocarbon liquid in large, chronic and myopic macular holes

RETINAL DISPLACEMENT AFTER IDIOPATHIC MACULAR HOLE SURGERY: Layer by Layer Analysis

PURPOSE

To measure the displacement of retinal vascular plexi and choriocapillaris after pars plana vitrectomy for idiopathic macular hole, using optical coherence tomography angiography, and correlate it with clinical data.

METHODS

Retrospective series with a 6-month follow-up. Records included Best Corrected Visual Acuity, M-charts, structural optical coherence tomography, and optical coherence tomography angiography. Coronal displacement was calculated comparing consecutive images across the 6.4 mm × 6.4 mm field and concentric circular regions of 0.5, 1.5, and 3.0 mm radii . Each circular region was further divided in four quadrants indicated as follows: SuperoTemporal; SuperNasal; InferoTemporal; InferoNasal.

RESULTS

The study comprised 33 patients (11 men and 22 women) with 68.9 ± 10.2 years mean age, similar among sexes. Macular hole closed in 31/33 (93.9%) of cases and Best Corrected Visual Acuity improved from mean 20/62 (0.50 ± 0.62 logarithm of Minimum Angle of Resolution) to 20/47 (0.23 ± 0.63 logarithm of Minimum Angle of Resolution; P = 0.0064). Vertical and horizontal metamorphopsia decreased from 0.98 ± 0.68 to 0.51 ± 0.59° ( P = 0.0028) and 0.84 ± 0.63 to 0.29 ± 0.45° ( P < 0.001), respectively. The average retinal displacement was 81.2 ± 44.1 µ m for the superficial plexus and 79.4 ± 45.7 µ m for the deep one, both greater than the choriocapillaris displacement (60.9 ± 20.2 µ m; P < 0.05). The temporal and superior quadrants displaced more than the others ( P < 0.05). Macular hole size correlated to retinal displacement within the central 0.5-mm radius area at all layers ( P < 0.05 in all cases).

CONCLUSION

Macular hole closure is associated with significant retinal displacement of all retinal layers and choriocapillaris remodeling. Surgical peeling removes the constraining effect of the internal limiting membrane and promotes a multilayered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the retinal nerve fiber layer.

Biological ultrathin amniotic membrane flap to close refractory macular holes associated with high myopia

PURPOSE

To propose an ultrathin biological amniotic membrane (btAM) thinner than 10 μm as the graft to treat highly myopic macular holes (MH).

METHODS

This pilot study included 14 patients affected by refractory macular holes associated with high myopia. btAM was used as a bandage covering the holes. The best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography (OCT) before and after surgery were compared.

RESULTS

The mean MH size was 865.93 ± 371.72 μm and all the MHs achieved anatomical closure. The btAM located centrally and fully on MHs from fundus photography yet no obvious visual masking was complained. The average BCVA 1 month, 3, and 6 months after surgery were 0.95 ± 0.24, 0.92 ± 0.23, 0.92 ± 0.23 logMAR, respectively, improved significantly compared to pre-operative BCVA (1.24 ± 0.42 logMAR, all P < 0.05). Ten out of 14 (71.4%) exhibited 2C closure patterns (formally closed and no bare RPE) on OCT.

CONCLUSION

The btAM thinner showed a favorable anatomical success with less risk of parafoveal atrophy or iatrogenic injuries and shortened the dissolving time.

Dynamics of Epiretinal Membrane Peeling under Perfluorocarbon Liquid Evaluated by Intraoperative OCT

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.