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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis. BMC Ophthalmol 2024; 24:105. [PMID: 38443856 PMCID: PMC10913604 DOI: 10.1186/s12886-024-03374-0] [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: 12/26/2022] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico.
| | - Erick A Quiroz-Gonzalez
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico
- Institute of Ophthalmology, Chimalpopoca 14, 06800, Mexico City, Colonia Obrera, Mexico
| | - Miguel A Quiroz-Gonzalez
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Colonia Magdalena de Las Salinas, Av. Politecnico Nacional 5160, 07760, Mexico City, Mexico
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Zgolli H, Elzarrug HKH, Abdelhedi C, Mabrouk S, Fekih O, Malek I, Zghal I, Nacef L. Autologous retinal graft for the management of large macular holes associated with retinal detachment. Libyan J Med 2023; 18:2164451. [PMID: 36593646 DOI: 10.1080/19932820.2022.2164451] [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: 01/04/2023] Open
Abstract
To present the efficacy of autologous neurosensory retinal transplantation in macular holes surgery with rhegmatogenous retinal detachment. Eleven eyes of 11 patients with rhegmatogenous retinal detachment associated to a large macular hole were enrolled between January 2019 and January 2021 in the Department A of the Hedi Rais Institute of Ophthalmology (Tunis, Tunisia). All patients underwent a 23 G pars plana vitrectomy. An autologous neurosensory retinal patch was placed inside the macular hole. Long-acting silicone tamponade was carried out. Clinical features of the macular area, best-corrected visual acuity (BCVA), fundus examination, and SD-OCT were recorded before surgery, at 1- and 3-month follow-up after surgery. The mean age of our population was 56.6 ± 10.33 years old, ranged from 45 to 76 years old. Final retinal reattachment was achieved clinically in all eyes. The Spectral domain-Optical Coherence Tomography (SD-OCT) follow-up showed the macular hole closure. The retinal patch was demonstrated by OCT at each control. BCVA improved from 1.52 ± 0.23 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.89 ± 0.16 LogMAR 3 months after surgery (p= 0.014). No adverse events were registered during the study. Autologous neurosensory retinal transplantation has been efficient to treat macular hole associated to rhegmatogenous retinal detachment. Further multicentric studies with a large number of patients are needed to establish the results of this technique in complex cases.
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Affiliation(s)
- Hsouna Zgolli
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hamad K H Elzarrug
- Department of Ophthalmology, Faculty of Medicine, University of Benghazi, Benghazi, Lybia
| | - Chiraz Abdelhedi
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sonya Mabrouk
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Olfa Fekih
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ines Malek
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Imen Zghal
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Leila Nacef
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Kalur A, Muste J, Singh RP. A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes. Ophthalmic Surg Lasers Imaging Retina 2022; 53:52-61. [PMID: 34982003 DOI: 10.3928/23258160-20211210-03] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm. MATERIAL AND METHODS PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 μm. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole. RESULTS Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of -0.48 ± 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of -0.15 ± 0.17 and -0.14 ± 0.91 logMAR, respectively. CONCLUSION An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:52-61.].
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Da Mota SEH, Morales-Cantón V, Rojas-Juárez S, López-Bolaños A, Ramírez-Estudillo A, Macouzet LB. Autologous Retinal Transplant for Macular Hole. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We aim to review scientific literature concerning published studies on autologous retinal transplantation to treat macular hole patients. The following databases were searched: Medline and Medline Non-Indexed Items, Embase (1990–2020), Ovid Medline® (1990 to November 2020), Embase (1990 to November 2020), Ovid Medline® and Epub Ahead of Print, in-Process and Web of Science (all years). Search keywords included “autologous”, “retinal transplant”, “autologous neurosensory retinal free flap” “transplantation”, “macular hole”, and “macular hole surgery”. Eighteen case series and single case reports were reviewed.
Preoperative and final best-corrected visual acuity, microperimetry and multifocal electroretinogram findings, macular hole closure rate, preoperative and postoperative ellipsoid zone, and external limiting membrane defects were obtained and analyzed. Indications of autologous retinal transplantation for macular hole surgery included refractory macular holes, conventional techniques, and large macular holes. The number of cases included in the different case series ranged from 2 to 130 cases, and prior macular hole surgeries of the patients ranged from 0 to 3. Overall, the published case series of autologous retinal transplants have reported a macular hole closure rate of 66.7 to 100%, as well as a significant improvement in best-corrected visual acuity. The most frequently reported complications included considerable intraoperative bleeding and postoperative dislocation of the graft. The presence of functionality in the graft area has also been documented by microperimetry and multifocal electroretinogram.
In conclusion, the autologous retinal transplantation technique for macular hole patients has emerged as another surgical option, with a high macular hole closure rate and visual improvement.
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Abdul-Kadir MA, Lim LT. Update on surgical management of complex macular holes: a review. Int J Retina Vitreous 2021; 7:75. [PMID: 34930488 PMCID: PMC8686572 DOI: 10.1186/s40942-021-00350-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.
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Affiliation(s)
| | - Lik Thai Lim
- Department of Ophthalmology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
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Patel SN, Mahmoud TH, Kazahaya M, Todorich B. AUTOLOGOUS NEUROSENSORY RETINAL TRANSPLANTATION: Bridging the Gap. Retina 2021; 41:2417-2423. [PMID: 33990116 DOI: 10.1097/iae.0000000000003210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the autologous retinal transplantation surgical technique, indications, rationale, and current outcomes of data published to date. METHODS Review of surgical technique, preoperative and postoperative best-corrected visual acuity, and macular hole (MH) closure rate in studies with at least five eyes. RESULTS The weighted average macular hole closure rate is 88%, with a MH closure rate ranging from 66.7% to 100%. The weighted average best-corrected visual acuity improved from mean logarithm of the minimum angle of resolution 1.35 (Snellen equivalent of 20/450) preoperatively to mean logarithm of the minimum angle of resolution 1.02 (Snellen equivalent of 20/210) postoperatively. From the largest autologous retinal transplantation case series, 37% of patients gained 3 or more lines of visual acuity after autologous retinal transplantation for primary or refractory MHs and 74% gained 3 or more lines of visual acuity after autologous retinal transplantation for MH-retinal detachments. Functional improvement including negative Watzke-Allen sign and conversion from positive to negative scotoma was reported in large case series. CONCLUSION Autologous retinal transplantation is a promising technique for closure of large and refractory MHs otherwise difficult to repair with conventional techniques. This technique may allow for replacement of neural tissue in the macula through cell rehabilitation and regeneration through presumed ectopic synaptogenesis, retinal progenitor cell differentiation and integration, and/or retinal progenitor cell material transfer to host neurons.
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Affiliation(s)
- Saagar N Patel
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Tamer H Mahmoud
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan; and
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INTRAOPERATIVE AND POSTOPERATIVE MONITORING OF AUTOLOGOUS NEUROSENSORY RETINAL FLAP TRANSPLANTATION FOR A REFRACTORY MACULAR HOLE ASSOCIATED WITH HIGH MYOPIA. Retina 2021; 41:921-930. [PMID: 33079787 DOI: 10.1097/iae.0000000000003000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the intraoperative and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for a high myopia-related refractory macular hole (MH). METHODS This prospective interventional study enrolled five eyes of five patients (age range 54-84 years) with highly myopic refractory MHs who underwent ART. All cases were evaluated with intraoperative optical coherence tomography and postoperative optical coherence tomography, optical coherence tomography angiography, and microperimetry for at least 6 months postoperatively. RESULTS Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4 days to 6 days. Optical coherence tomography discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1,504 ± 684 µm preoperatively to 1,111 ± 356 µm postoperatively. The best-corrected visual acuity improved in two cases, was stable in two cases, and deteriorated in one case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In two eyes, choroidal neovascularization developed beneath the transplanted retinas. CONCLUSION Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Because choroidal neovascularization may develop, detailed monitoring is required.
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Hernández-Da Mota SE. Autologous Retinal Transplantation with the Use of Air Tamponade for the Treatment of a Primary Large Chronic Macular Hole. Case Rep Ophthalmol 2021; 12:124-128. [PMID: 33976668 PMCID: PMC8077463 DOI: 10.1159/000512388] [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: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 12/03/2022] Open
Abstract
The purpose of this case report is to describe a chandelier-assisted bimanual autologous retinal transplantation (ART) with air tamponade technique for the treatment of a large macular hole (MH). A patient with a primary chronic large MH, who underwent chandelier-assisted bimanual ART with the use of air tamponade is described. The MH diameter was 888 μm. Changes in best-corrected visual acuity (BCVA) were measured postoperatively; clinical pictures and optical coherence tomography were analyzed. Baseline preoperative BCVA was 20/400. Closure of the MH was achieved. At 7 months, post-surgery BCVA improved to 20/50. Optical coherence tomography examinations showed the integration of the autologous transplant with the adjacent macular tissue and continuity preservation of the ellipsoid layer. In conclusion, chandelier-assisted bimanual ART with air tamponade technique was effective in achieving complete MH closure and long-term visual improvement.
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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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Okonkwo ON, Hassan AO, Akanbi T. Autologous Neurosensory Retinal Transplantation: A Report of Three Cases. J Ophthalmic Vis Res 2021; 16:68-76. [PMID: 33520129 PMCID: PMC7841287 DOI: 10.18502/jovr.v16i1.8252] [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: 07/13/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To present the anatomical and functional outcomes of autologous surgical transplantation of a free neurosensory retinal graft in three cases of recurrent and chronic full thickness macular hole (MH). METHODS A retrospective case series, reporting the profile, preoperative presentation, surgical technique, and postoperative outcome of three consecutive eyes of three patients who had autologous retina transplantation (ART) surgery for recurrent and chronic MHs, and had a minimum of six months follow-up. The technique involved excision of a free neurosensory graft after laser demarcation of the harvest site. The graft was slid under perfluorocarbon liquid (PFCL) into the MH. A five-day tamponade with PFCL was used to secure the graft within the MH and then exchanged with air. RESULTS The patients were one female and two males aged 60, 44, and 67 years, respectively. All eyes had successful surgery. Postoperative vision improved from 6/36 to 6/18 in patient 1 and remained same as preoperative vision in the other two eyes. No eye lost vision postoperatively. The main complication of surgery was occurrence of retinal and vitreous hemorrhage in one eye (this did not appear to jeopardize the outcome) and retraction of graft tissue in two eyes. CONCLUSION ART appears to be a safe and effective treatment for difficult MHs. Our results are comparable to previous studies. Short-term use of PFCL can be useful to secure the graft within the MH. Methods of improving visual function should be the focus of further research in this promising area.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Eye Foundation Hospital, Apo. Abuja, Nigeria
- Eye Foundation Retina Institute, Ikeja. Lagos, Nigeria
| | - Adekunle Olobola Hassan
- Eye Foundation Hospital, Apo. Abuja, Nigeria
- Eye Foundation Retina Institute, Ikeja. Lagos, Nigeria
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Li Y, Li Z, Xu C, Liu Y, Kang X, Wu J. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes. Acta Ophthalmol 2020; 98:e983-e990. [PMID: 32323479 DOI: 10.1111/aos.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. METHODS Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best-corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula. RESULTS At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow-up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post-BCVA was significantly better than the pre-BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t-test). CONCLUSION Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea.
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Affiliation(s)
- Yanzi Li
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | | | | | - Yong Liu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Xueqin Kang
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Jianhua Wu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
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Rojas-Juárez S, Cisneros-Cortés J, Ramirez-Estudillo A, Velez-Montoya R. Autologous full-thickness retinal transplant for refractory large macular holes. Int J Retina Vitreous 2020; 6:60. [PMID: 33292851 PMCID: PMC7685585 DOI: 10.1186/s40942-020-00266-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Background Despite the constant refinement of techniques and surgical aids, extremely large and refractory macular holes continue to have poor surgical outcomes with the current standard of care. The objective of the present study is to assess the anatomical and functional outcomes, as well as the structural change through time, of the optical coherence tomography of patients with refractory macular holes treated with a full-thickness autologous retinal transplant. Methods Prospective, case series. We include patients with a clinical diagnosis of refractory macular holes with a minimum diameter of at least 500 µm. All the patients had a comprehensive ophthalmological examination, which included a best-corrected visual acuity assessment, fundus examination, and optical coherence analysis. All the patients underwent a 23-gauge pars plana vitrectomy with a full-thickness retinal transplant and silicone oil tamponade (5000 cs<). Follow-up was done at 1, 3, 6, and 12 months. Statistical analysis was done with a test for repeated measurements and Bonferroni correction, with an alpha value of 0.05 for statistical significance and a Mann-Whitney U test for nonparametric continuous variables. Results We enrolled 13 eyes from 13 patients (mean age: 67.15 years) with refractory macular holes, with a mean base diameter of 1615.38 ± 689.19 µm and a minimum diameter of 964.08 ± 709.77 µm. The closure rate after 12 months of follow-up was 76.92%. Six patients with a closed macular hole at the end of the follow-up had complete recovery of the myoid/ellipsoid layer. The remaining showed a 44.9% reduction of the initial gap. Most patients formed a pseudofovea and normalization of the internal retinal layers. Despite a positive trend toward visual recovery (p = 0.034), after the correction of the alpha value, the change lost its statistical significance. During follow-up, one patient developed mild proliferative vitreoretinopathy and epiretinal membrane without anatomical or functional consequences. Conclusions An autologous full-thickness retinal transplant may improve the anatomical and structural outcome of patients with refractory macular holes. The full safety profile of this new technique is still unknown. More studies are needed in order to assess functional changes through time.
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Affiliation(s)
- Sergio Rojas-Juárez
- Retina Department, Hospital de Nuestra Señora de La Luz, 06030, Mexico City, Mexico
| | | | | | - Raul Velez-Montoya
- Retina Department, Asociación para Evitar le Ceguera en México IAP, Vicente García Torres #46. Col: San Lucas Coyoacán, 04030, Mexico City, Mexico.
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Tabandeh H. Vascularization and Reperfusion of Autologous Retinal Transplant for Giant Macular Holes. JAMA Ophthalmol 2020; 138:305-309. [PMID: 31944234 DOI: 10.1001/jamaophthalmol.2019.5733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Autologous retinal transplant is a recently described treatment modality for myopic and other refractory macular holes (MH). Establishment of blood supply may influence survival of a transplanted tissue. However, there are currently no reports on the vascular status of a transplanted retinal graft. Objective To report on vascularization and reperfusion of autologous retinal graft after transplant for giant MHs demonstrated by multimodal imaging. Design, Setting, Participants Two patients with giant MH (basal diameter ≥2000 μm) who underwent autologous retinal transplant at Retina-Vitreous Associates Medical Group in Los Angeles, California, in June 2018 and February 2019, respectively, were included. Main Outcomes and Measures Status of MH, Snellen visual acuity, optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography findings. Results Two eyes of 2 female patients were included. The mean age was 68.5 years. Baseline visual acuity was counting fingers and 20/200, and MHs measured 3441 μm and 2387 μm, respectively. Six weeks postoperatively, MHs were closed and the superficial inner retina blood vessels within the graft appeared perfused. Optical coherence tomography and optical coherence tomography angiography demonstrated early integration of the graft into the surrounding retina and perfused graft vasculature in both patients. Fluorescein angiography confirmed perfusion of retinal graft. At the last follow-up, visual acuity was 20/200 and 20/150, respectively, the MH was closed, and the retinal grafts were perfused. Conclusions and Relevance Autologous neurosensory retinal transplant may be used for the treatment of giant MHs. Vascularization and reperfusion of the retinal graft is observed within 6 weeks of transplant. It is hypothesized that visual improvement occurs as a result of flattening of the MH rim, partial centripetal migration of MH edges during the early healing phase, and further centripetal migration in the later phase associated with the shrinkage of the retinal graft.
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Caporossi T, Pacini B, Bacherini D, Barca F, Faraldi F, Rizzo S. Human amniotic membrane plug to promote failed macular hole closure. Sci Rep 2020; 10:18264. [PMID: 33106542 PMCID: PMC7588413 DOI: 10.1038/s41598-020-75292-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/22/2020] [Indexed: 12/04/2022] Open
Abstract
The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries. While many surgical options have been proposed to manage it, none of these guarantee complete anatomical success and satisfactory visual recovery. We report postoperative outcomes on 36 patients affected by failed macular hole, treated with a human amniotic membrane plug transplant. Follow-ups were performed with a standard ophthalmological examination and with advanced multimodal diagnostic imaging. Anatomical closure was achieved at 3 months in all patients. Mean best-corrected visual acuity improved statistically significantly at 6 months (p < 0.05). Through microperimetric tests, we assessed a partial recovery of the macular sensitivity on the edges of the plug. Analyzing SD-OCT images, we reported a tissutal ingrowth above the plug, and its segmentation into layers, mimicking normal retinal architecture. OCT-Angiography images non invasively analysed the retinal parafoveal capillary microvasculature; the elaboration of Adaptive Optics images showed the presence of photoreceptors at the edges of the plug. This work demonstrates not only the complete anatomical success of our technique, but also remarkable functional results, and opens the door to a greater understanding of modifications induced by the presence of a human amniotic membrane plug.
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Affiliation(s)
- Tomaso Caporossi
- Department of NEUROFARBA, Ophthalmology, University of Florence, Largo Brambilla 3, Careggi, 50134, Florence, Italy.
| | - Bianca Pacini
- Department of NEUROFARBA, Ophthalmology, University of Florence, Largo Brambilla 3, Careggi, 50134, Florence, Italy
| | - Daniela Bacherini
- Department of NEUROFARBA, Ophthalmology, University of Florence, Largo Brambilla 3, Careggi, 50134, Florence, Italy
| | - Francesco Barca
- Department of NEUROFARBA, Ophthalmology, University of Florence, Largo Brambilla 3, Careggi, 50134, Florence, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00196, Rome, Italy.,Department of Ophthalmology, Catholic University of "Sacro Cuore", 00168, Rome, Italy
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15
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Sousa Neves F, Braga J, Sepúlveda P, Bilhoto M. Refractory Myopic Retinal Detachment and Macular Hole Closure with Autologous Neurosensory Retinal Free Flap. Case Rep Ophthalmol 2019; 10:160-164. [PMID: 31692566 PMCID: PMC6760359 DOI: 10.1159/000500275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/07/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this case report is to describe a modified technique involving the use of an autologous neurosensory retinal free flap for closure of a macular hole (MH) during retinal detachment (RD) surgery. A 50-year-old female presented with sudden vision loss (light perception only) and a recurrent myopic RD associated with an MH. An autologous neurosensory retinal free flap was obtained and moved toward the MH. Silicone oil was used as an endotamponade and removed after 6 months. Two months after oil removal visual acuity improved to 20/400 and remained stable thereafter; however, the patient developed central retinal atrophy. One year after surgery the MH was closed and the retina attached. This modified technique with the use of an autologous neurosensory retinal flap provides an alternative approach for recurrent MH in RD procedures.
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Affiliation(s)
- Filipe Sousa Neves
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Braga
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Sepúlveda
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Miguel Bilhoto
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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16
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Comparing the inverted internal limiting membrane flap with autologous blood technique to internal limiting membrane insertion for the repair of refractory macular hole. Int Ophthalmol 2019; 40:141-149. [DOI: 10.1007/s10792-019-01162-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
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17
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Frisina R, Tozzi L, Sabella P, Cacciatori M, Midena E. Surgically Induced Macular Detachment for Treatment of Refractory Full-Thickness Macular Hole: Anatomical and Functional Results. Ophthalmologica 2019; 242:98-105. [PMID: 31220838 DOI: 10.1159/000500573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/25/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the efficacy and safety of surgically induced macular detachment (MD) for the treatment of refractory full-thickness macular hole (FTMH). MATERIALS AND METHODS Clinical data were age, gender, lens status, and best corrected visual acuity (BCVA). Preoperative tomographic parameters were: FTMH morphology (intraretinal cyst and elevated or flat edges) and FTMH diameter. Postoperative FTMH closure and outer retinal layer (ORL) restoration were evaluated. Fundus autofluorescence (FAF), optical coherence tomography (OCT) findings, and BCVA were analyzed at the 1st, 3rd, and 6th postoperative month. The interval between the first surgery for idiopathic FTMH and the surgically induced MD for refractory FTMH was collected (intersurgical interval, days). RESULTS Ten eyes of 10 patients were included. The mean age was 68.8 ± 6.8 years. FTMH closure was obtained in 9 patients; in 8 patients, ORL restoration was detected. BCVA improved from 1.06 ± 0.1 (baseline) to 0.56 ± 0.2 (final) logMAR (p = 0.0001). A negative correlation between the intersurgical interval and postoperative visual gain was demonstrated (r = -0.3618). FAF and OCT showed a permanent retinal pigment epithelium (RPE) damage corresponding to the retinotomy points. CONCLUSION This study demonstrates the efficacy of this technique and highlights the risk of RPE damage, suggesting the need to perform the retinotomy points outside the macula.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Padova, Italy,
| | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
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18
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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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19
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Wu AL, Chuang LH, Wang NK, Chen KJ, Liu L, Yeung L, Chen TL, Hwang YS, Wu WC, Lai CC. Refractory macular hole repaired by autologous retinal graft and blood clot. BMC Ophthalmol 2018; 18:213. [PMID: 30157808 PMCID: PMC6114829 DOI: 10.1186/s12886-018-0898-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the surgical technique using autologous retinal graft (ARG) and autologous blood clot (ABC) for the management of refractory macular holes (MHs). Methods This study was a retrospective, consecutive, interventional case series. Six eyes of 6 patients who underwent vitrectomy combined with ARG and ABC for the treatment of refractory MH were reviewed. Visual and anatomic outcomes were evaluated. Results The mean age was 59.0 ± 9.9 years. All cases had multiple vitreoretinal procedures including vitrectomy and gas fluid exchange before patient presentation. The average numbers of vitrectomies were 2.3 ± 0.5, and those of gas fluid exchange were 3 ± 1.7. Closure of the macular hole was achieved in four (66.7%) cases at last follow-up. The mean follow-up time was 25.2 ± 15.6 months. The averaged BCVA before and after 12 months of the surgery improved from 20/591 to 20/244. Conclusions This surgical technique using ARG and ABC provide an option for the treatment of refractory MHs. Electronic supplementary material The online version of this article (10.1186/s12886-018-0898-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Lan-Hsin Chuang
- College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, 635 west, 165th street, New York, NY, 10032, USA
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.
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