Macular hole development in fellow eyes of patients with unilateral macular hole

Analysis of the progression rate of idiopathic macular holes and the optimal cut-off for baseline minimum linear diameter and base diameter

PURPOSE

To determine the cut-off points of minimum linear diameter (MLD) and base diameter (BD) at which the progression rate of idiopathic full-thickness macular holes (MHs) decreases before vitrectomy.

STUDY DESIGN

A retrospective study.

METHODS

We investigated the differences in MLD and BD between baseline and operation days in patients with stages 2, 3, and 4 MHs using optical coherence tomography (OCT). Each difference in OCT parameters was divided by the time interval to calculate the MH progression rates and the cut-off points of MLD and BD.

RESULTS

Overall, 269 patients (282 eyes) were included. It took an average of 36.02 ± 24.69 (7-197) days from baseline to operation. MLD and BD progressed faster in stages 2 and 3 without posterior vitreous detachment (PVD) than in stage 4 with PVD (MLD: p < 0.001 and p = 0.007; BD: p < 0.001 and p = 0.019, respectively). Simple linear regression showed the relationship between baseline MLD and BD, and the progression rate; the progression rate decreased as baseline MLD (p = 0.004) and BD increased ( p < 0.001). For baseline MLD and BD, the cut-off points where the progression rate decreased were 306.0 and 470.0 μm, respectively.

CONCLUSION

The group without PVD progressed faster than the group with PVD. Moreover, the progression rates were faster in MHs with MLD < 306.0 μm and BD < 470.0 μm. In these patients, vitrectomy without delay is expected to improve the visual prognosis.

Anatomical and functional results after vitrectomy with conventional ILM peeling versus inverted ILM flap technique in large full-thickness macular holes

BACKGROUND

Aim of the study was to compare success rate and functional outcome following pars plana vitrectomy (PPV) with conventional internal limiting membrane (ILM) peeling versus ILM flap technique for full-thickness idiopathic macular holes (FTMH).

METHODS

Retrospective analysis of consecutive eyes with FTMH having undergone vitrectomy with sulfur hexafluoride (SF6) endotamponade 25% at the University Medical Center Rostock, Germany (2009-2020). Eyes were divided according to applied surgical technique (ILM peeling [group P] versus ILM flap [group F]). Inclusion criteria were macular hole base diameters (MH-BD) ≥ 400 μm plus axial length ≤ 26.0 mm. Each group was divided into two subgroups based on macular hole minimum linear diameter (MH-MLD): ≤ 400 μm and > 400 μm. Exclusion criteria were FTMH with MH-BD < 400 μm, trauma, myopia with axial length > 26.0 mm or macular schisis. Demographic, functional, and anatomical data were obtained pre- and postoperatively. Preoperative MH-BD and MH-MLD were measured using optical coherence tomography (OCT; Spectralis®, Heidelberg Engineering GmbH, Heidelberg, Germany). Main outcome parameter were: primary closure rate, best-corrected visual acuity (BCVA), and re-surgery rate.

RESULTS

Overall 117 eyes of 117 patients with FTMH could be included, thereof 52 eyes underwent conventional ILM peeling (group P) and 65 additional ILM flap (group F) technique. Macular hole closure was achieved in 31 eyes (59.6%) in group P and in 59 eyes (90.8%) in group F (p < 0.001). Secondary PPV was required in 21 eyes (40.4%) in group P and in 6 eyes (9.2%) in group F. Postoperative BCVA at first follow-up in eyes with surgical closure showed no significant difference for both groups (MH-MLD ≤ 400 μm: p = 0.740); MH-MLD > 400 μm: p = 0.241).

CONCLUSION

Anatomical results and surgical closure rate following ILM flap technique seems to be superior to conventional ILM peeling for treatment of FTMH.

Choriocapillary regional characteristics in idiopathic macular holes using optical coherence tomography angiography

PURPOSE

To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by optical coherence tomography angiography (OCTA).

METHODS

A retrospective cases series study involving 20 unilateral eyes (20 patients) with IMH, the unaffected fellow eyes (n = 20) and 20 health controls, with age- and sex-matched, was conducted in Shanxi Eye Hospital from January 2019 to December 2021. VD of the retinal capillary plexuses measurements were obtained by OCTA.

RESULTS

Four quadrants of superficial capillary plexuses (SCP) in IMH eyes were not significant compared with that in the unaffected fellow eyes (all P > 0.05). The four quadrants of deep capillary plexuses (DCP) in IMH eyes were lower than that in the unaffected fellow eyes (all P < 0.05). Different regions retinal thickness in the IMH eyes was higher than that in the unaffected fellow eyes (all P < 0.05). a significant negative correlation between deep vessel density and retinal thickness in different quadrants among IMH eyes (all P < 0.05). Additionally, the correlation between the vascular density of SCP and retinal thickness was significant in macular fovea area (= 0.519, P = 0.019). <0.001.

CONCLUSIONS

The morphology of retina and choroid in idiopathic macular hole is different from that in fellow eye. The thickness of choroid in the fovea area of the unaffected eye also showed a decreasing trend. Taken together, the mechanism of macular hole may be further understood, that is, the decrease of choroid thickness may occur before the macular hole formation. It was verified again that the choroidal blood flow area in macular fovea of IMH patients was significantly lower than that in fellow eyes and healthy eyes.

Optical coherence tomography features and risk of macular hole formation in the fellow eye

Background

To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that precede MH formation in the fellow eye.

Methods

A retrospective review of 229 patients treated for primary MH at Stavanger University Hospital, Norway, from January 2008 through December 2018. The patients were categorised into two groups according to subsequent development of MH in the fellow eye. The OCT findings of the two groups were compared, and associated risk factors for MH formation assessed.

Results

Twenty cases of bilateral MH were identified. The overall bilateral disease risk was 8.8% (95% CI, 5.8–13.2%). Two patients were previously operated in the fellow eye, six patients presented with bilateral MH, and 12 patients subsequently developed MH in the fellow eye. The risk of subsequent MH development was 5.7% (95% CI, 3.3–9.8%). Although the extent of posterior vitreous detachment (PVD) tended to be more progressed in the bilateral group compared with the unilateral group, the difference was not statistically significant. In the bilateral group, 41.7% had outer retinal defects vs 6.6% in the unilateral group (p = 0.001), and 33.3% in the bilateral group had intraretinal pseudocysts vs 10.2% in the unilateral group (p = 0.036, not significant after multiple testing correction).

Conclusion

Outer retinal defects and intraretinal pseudocysts are associated with an increased risk of MH formation in the fellow eye, and complete PVD indicates a decreased risk of MH formation.

[Profile of macular holes in Cotonou]

PURPOSE

To establish the epidemiological and tomographic profile of macular holes in the Beninese subject.

PATIENTS AND METHODS

This cross-sectional study included consecutive patients seen for macular testing during the period from January 2016 to August 2017 at the St. Anthony of Padua Retinal Testing Center in Cotonou (Benin). All patients who had a macular hole and macular OCT were included. To define macular hole types, we used the 2013 DUKER New Classification and analyzed for each case: age sex, history, involved eye, fellow eye, visual acuity, hole type, hole diameter, status of the vitreous cortex, edge edema, mean macular thickness, presence of vitreomacular traction, epimacular membrane, and retrofoveal choroidal thickness. Patients with a pseudo-macular hole or lamellar hole were excluded.

RESULTS

During this study period, 401 patients underwent a macular OCT procedure at the Retinal Testing Center, with 22 patients having a macular hole, of which 15 women and 07 men for a sex ratio of 2.14 women to men. The mean age of the patients was 61±10 years, with a median age of 63 years. The mean diameter of the holes was 705μm±232μm. No small holes were found. The mean central macular thickness was 272μm±39μm. In 52.4% of cases, the condition of the felloweye indicated the presence of vitreomacular traction. The etiological profile of the macular hole found in 72.7% a primary origin, and a secondary origin (diabetic and traumatic) in 13.6% and 9.09% respectively.

DISCUSSION

The majority of the macular holes observed were large macular holes, which could be explained by the progressive course of these macular holes as well as late detection. Over half of the fellow eyes showed vitreomacular traction, reflecting the potential risk of bilateralization.

CONCLUSION

Macular hole is a pathology of the vitreomacular interface, tending to be large in our geographic context. On OCT, the data found remain comparable those reported in the literature.

DEVELOPMENT OF IDIOPATHIC MACULAR HOLE IN FELLOW EYES: Spectral Domain Optical Coherence Tomography Features

PURPOSE

To investigate the long-term incidence and risk factors of macular hole (MH) development in the fellow eyes of patients with unilateral idiopathic MH.

METHODS

The retrospective case-control study involved the fellow eyes of 215 consecutive patients with idiopathic MH. The patients were classified into two groups according to the presence or development of MH in the fellow eye. The spectral domain optical coherence tomography features and clinical characteristics of each group were compared.

RESULTS

Twelve (5.6%) patients presented with bilateral MH at the initial visit, whereas 20 (9.3%) initially unilateral patients developed MH in the fellow eye over a median interval of 44 months. Vitreomacular traction and inner foveal cyst were noted more frequently in the baseline spectral domain optical coherence tomography scans of fellow eyes of the bilateral group (P < 0.01). An outer foveal defect was found in five patients (35.7%) of the bilateral MH group (P < 0.01).

CONCLUSION

The incidence of MH in fellow eyes was approximately 10%. The presence of outer foveal defect, inner foveal cyst, and vitreomacular adhesion or traction on spectral domain optical coherence tomography in the fellow eye was the risk factor for MH.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

Purpose

To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole.

Methods

The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months.

Results

Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade.

Conclusions

Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

The effects of aging on the mechanical properties of the vitreous

The vitreous body is a viscoelastic gel-like network that fills the space between the lens and the retina in the eye. With aging, the vitreous undergoes a liquefaction process in which liquid pockets form in the gel network, thereby motivating the detachment of the vitreous from the retina in a process known as posterior vitreous detachment (PVD). The PVD process may lead to the formation of floaters and even result in partial or complete loss of vision. Experiments show that the liquefaction and the PVD processes alter the mechanical properties of the vitreous. In this work, we propose a microscopically motivated model that characterizes the changes in the mechanical properties of the vitreous due to aging. To this end, we distinguish between four vitreous states: a homogeneous vitreous, a liquefied vitreous, a vitreous that undergoes partial PVD, and a vitreous with full PVD. The model predicts the time-dependent and the steady-state response of the vitreous in each of the four states. The proposed framework is validated through a comparison with various experimental findings and captures the softening of the vitreous due to aging. We illustrate the importance of the age at which the PVD process begins and of the rate of the detachment process. In addition, we introduce a quantifiable parameter that describes the stage of PVD in the eye. Lastly, we employ our model to investigate the possibility of restoring the mechanical properties of a vitreous that has undergone PVD through the addition of reinforcing fibers to the gel. This work provides insight into the consequences of the age-related changes in the microstructure of the eye and serves as a motivation for new therapeutic measures.

A multifocal electroretinography study to evaluate risk of developing macular hole in the fellow eye of patients suffering with unilateral macular hole

Background

Visual outcome of eyes has often been found to be unsatisfactory even after successful closure of a macular hole, owing to factors like persistent metamorphopsia, scotoma, and reduced sensitivity. Therefore, it becomes critical to evaluate and study the probability and risk of developing a macular hole in the fellow eyes of the patient. This study analyzed the multifocal electroretinographic responses to help predict the risk of macular hole development in fellow eyes.

Methods

In total 26 fellow eyes, 26 eyes with macular hole, and 50 eyes of 25 controls were enrolled prospectively. The retinal responses from the different rings were compared in the three groups. Optical coherence tomography was done to rule out macular pathology or vitreomacular traction in the fellow eyes.

Results

All the fellow eyes under observation showed significantly reduced mean amplitudes of retinal response densities, in all rings as compared with controls (31.45 ± 10.38 versus 48.87 ± 7.55, p = 0.00). Three of the fellow eyes developed a macular hole during the 24 months observation period. The prevalence of fellow eye involvement was 11.5%. Relative risk of developing macular hole in the fellow eye ranged from 25 to 75.

Conclusion

All the fellow eyes, including those that did not develop a macular hole, showed significantly reduced responses on multifocal electroretinogram. This indicates that macular hole may not be a focal disease. It may have widespread functional deficit which is bilateral in nature and suggestive of a degenerative or ischemic insult.

Traumatic macular hole study: a multicenter comparative study between immediate vitrectomy and six-month observation for spontaneous closure

Background

Closure of traumatic macular hole (TMH) can be achieved spontaneously or by surgical intervention. Thus far, there exist no prospective comparative studies that have analyzed the difference between the two modalities. This study aimed to compare the anatomical and visual recovery of eyes with TMH following either an immediate vitrectomy or six-month observation.

Methods

This was a multicenter prospective comparative study. Eight centers participated in the study. Patient data from 40 eyes with a recent history of blunt ocular trauma and newly formed full-thickness TMH were recruited in this study. The participating patients selected between an early vitrectomy or a six-month observation after a doctor explained the potential benefits and risks of both strategies in an unbiased manner. Twenty-five patients underwent an immediate vitrectomy, and 15 patients received six-month observation. Patients were assessed by spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA).

Results

Closure rates were 66.7% for the observational group, and 100% for the surgical group (P=0.002). There were no vision-threatening ocular complications in both groups. For the observational group, the mean closure time was 2.5±1.6 months, and 80% of the hole closure occurred within 3 months; cystic edema on the edge of the hole at baseline was significantly more frequent in the non-closed subgroup than in the closed subgroup (P=0.03). There were no significant differences in the foveal microstructure and in the final visual outcome between the spontaneously closed cases and the surgically closed cases.

Conclusions

TMH had a moderately high incidence of spontaneous closure, but an immediate vitrectomy achieved an even higher closure rate. Vitrectomy was effective and safe to treat TMH, while a 3-month observation for spontaneous closure may be an alternative modality for TMH management. Cystic edema on the edge of the hole may be an unfavorable factor for the spontaneous closure of TMH.

[Morphology of the vitreoretinal interface in fellow eyes of patients with full thickness macular holes]

PURPOSE

We performed a retrospective, observational clinical study to evaluate the vitreoretinal interface (VRI) in fellow eyes of patients with full thickness macular holes (FTMH) based on spectral domain optical coherence tomography (SD-OCT) examinations.

METHODS

The VRI in fellow eyes of 38 patients with idiopathic FTMH, 6 of which had concomitant vitreomacular traction (VMT) and the VRI of 32 patients with FTMH with complete resolution of VMT were examined by SD-OCT for the presence of vitreomacular adhesion (VMA), VMT and the formation of FTMH, lamellar macular holes (LMH), macular pseudoholes (MPH) or epiretinal membranes (ERM). Patients underwent complete ophthalmic evaluation, including SD-OCT at baseline and follow-up visits. To classify the morphology of the VRI, we used the international vitreomacular traction study classification system by Duker et al. (Ophthalmology 2013), evaluating the baseline SD-OCT data for significant classification parameters, including size of VMA, macular thickness and volume and structural changes of retinal layers.

RESULTS

Of the 38 eyes with FTMH, 2 (5.3%) fellow eyes also showed evidence of FTMH, 5 (13.2%) had isolated VMT while 5 (13.2%) showed formation of ERM, of which 2 demonstrated MPH. In 5 patients (13.2%) showing evidence of VMA and 17 patients (44.7%) with an unremarkable VRI, 22 fellow eyes (57.9%) showed no pathological morphology. Altogether, 16 fellow eyes (42.1%) of patients with FTMH showed pathological changes of the vitreoretinal interface.

CONCLUSION

This high-resolution SD-OCT-based retrospective study showed that fellow eyes of patients with VMT or FTMH were at increased risk of demonstrating pathological changes in the morphology of the VRI.

Incidence of Macular Holes in the Fellow Eye without Vitreomacular Detachment at Baseline

PURPOSE

To determine the rate of macular holes (MH) occurring in the fellow eyes of eyes with MH depending on the vitreomacular interface at baseline.

METHODS

This was a retrospective study of patients operated on for idiopathic MH, with persistent vitreofoveal attachment in the fellow eye assessed by spectral-domain optical coherence tomography (SD-OCT). Follow-up lasted 6 months or more, and the main outcome was the occurrence of an MH.

RESULTS

The 77 fellow eyes included had a mean follow-up of 34.11 ± 22.3 months (6-78.4). At baseline, 31 eyes had vitreomacular traction (VMT), 35 vitreomacular adhesion, and 11 no posterior vitreous detachment. MH occurred in 19.5% of the cases (15/77). The rate of MH was significantly higher among the eyes with VMT than among the eyes without VMT at baseline (35.5 vs. 8.7%; p = 0.009).

CONCLUSION

One-third of eyes with VMT at baseline identified by SD-OCT will develop an MH in the following 5 years.

Epidemiology and morphology of full-thickness macular holes

PURPOSE

To investigate the incidence of full-thickness macular holes (FTMHs) and their morphological features according to the International Vitreomacular Traction Study (IVTS) classification.

METHODS

The clinical records of all new patients with FTMH, referred between 2008 and 2014, were reviewed for demographics, cause of the FTMH, age at diagnosis, symptom duration, laterality, visual acuity (VA), axial length and lens status. A detailed analysis of the patients' spectral domain optical coherence tomography (SD-OCT) images was performed, and the primary FTMHs were classified in clinical stages according to the IVTS classification. From the SD-OCT, accurate macula drawings were made by means of a computer-drawing software. By merging these drawings and displaying them as colour-coded maps, the morphology and shape of the FTMH were visualized.

RESULTS

The study included 177 eyes (152 primary and 25 secondary FTMH) in 166 patients. In primary FTMH, the male-to-female ratio was 1:2.2. The age- and gender-adjusted annual incidences of primary FTMH were 7.9 eyes and 7.4 individuals per 100 000 inhabitants. Mean primary FTMH minimum linear diameter (MLD) and basal diameter (BD) were 435 μm and 872 μm, respectively, and 13% were classified as small, 31% as medium and 55% as large. Vitreomacular traction (VMT) and epiretinal membrane (ERM) were present in 34% and 36% of the eyes, respectively.

CONCLUSION

This study provides data on the incidence rates of FTMH adjusted to different standard populations. The morphological analysis and novel computational visualization technique offer new insight into the structural complexity of FTMH and how VMT and ERM significantly influence FTMH configuration.

Tasmanian macular hole study: whole population-based incidence of full thickness macular hole

PURPOSE

To determine the incidence of full thickness macular hole in the Tasmanian population.

DESIGN

A whole population retrospective case series in Tasmania, Australia.

METHODS

Patients diagnosed with full thickness macular hole (confirmed by optical coherence tomography (OCT) imaging) of both idiopathic and secondary causes were identified from April 2005 to April 2011 by a sole vitreoretinal surgeon servicing Tasmania. Baseline characteristics were recorded. The six-year incidence rate was calculated, based on the 2006 and 2011 Tasmanian census data. Incidence rates were age and sex standardized.

PARTICIPANTS

One hundred forty-seven eyes of 136 patients.

MAIN OUTCOME MEASURES

To determine the incidence (age and sex standardized) of full thickness macular holes in Tasmania, Australia.

RESULTS

Idiopathic macular holes comprised 128 (87.1%). There were 116 cases of idiopathic Full Thickness Macular Hole in one or both eyes between 1 April 2005 and 31 April 2011. The six-year incidence of idiopathic full-thickness macular holes was 24.3 per 100 000 people, 4.05 per 100 000 per year, with the highest six-year incidence observed among women aged 70-79 years.

CONCLUSION

This is the first global study to report OCT confirmed incidence rates of full thickness macular holes in a relatively static Australian population sub-group.

Optimal management of idiopathic macular holes

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.

Focal vitreomacular traction: a prospective study of the evolution to macular hole: the mathematical approach

PURPORSE: To determine the associated balance of forces of the vitreofoveal interface in focal vitreomacular traction evolving to full-thickness macular hole (FTMH) and to link/explain the observed changes in the context of mathematical and physics models.

PATIENTS AND METHODS

This is a multicenter, prospective, and observational case series conducted at the Vitreoretinal Department of three different referral centers. Fellow eyes of patients with unilateral idiopathic FTMH were included. Eighty-nine patients were included in the analysis. The fellow normal eye of the study patients was imaged with spectral-domain optical coherence tomography. The main outcome measure was the optical-coherence-tomography-defined characteristics of the vitreofoveal interface and their analysis with mathematical and physics models at the end of follow-up period.

RESULTS

Of the included 89 patients (66 women and 23 men; mean age±SD, 68.5 years±9.8), 10 (11.2%) developed FTMH at the fellow eye at the end of the follow-up period. We observed two types of vitreofoveal attachment. A V-shaped (cord-like) configuration and a U-shaped configuration. The eyes with the V-shaped attachment demonstrated initial structural changes in the outer foveal layers and the eyes with the U-shaped attachment showed inner morphological changes.

CONCLUSION

We hypothesize that the type (V- or U-shaped) of the vitreofoveal attachment may affect the type and location of the initial structural change leading to the formation of FTMH from the stage of the focal vitreomacular traction.

Long-term observation of the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes

PURPOSE

To describe long-term changes in the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes (MHs).

METHODS

This is a retrospective, observational case series. The medical records of patients who underwent surgery for idiopathic MHs between May 2000 and December 2010 were reviewed. Patients who had clinically normal fellow eyes and underwent 12 months or more of follow-up were included. The vitreomacular relationship in the fellow eyes was evaluated using optical coherence tomography (OCT) and slit-lamp biomicroscopy.

RESULTS

The study included 153 patients with a mean age of 65.5 years and a mean follow-up of 33.5 months (range, 12-121). The incidence of vitreomacular attachments evaluated by OCT was 52% (80 eyes) at initial examination, which decreased to 41, 37 and 23% at 1, 2 and 3 years after the initial examination, respectively. Of the 80 eyes with vitreomacular attachments at initial examination, 40 (50%) still had vitreomacular attachments at the final visit. Of the remaining 40 eyes in which vitreomacular separation occurred during follow-up, 11 (28%) developed an MH, with a mean interval of 45 months. None of the eyes with vitreomacular separation at presentation developed an MH.

CONCLUSION

This largest series of fellow eyes of MHs followed by OCT shows that, at presentation, about half of the patients already have premacular vitreous detachment and therefore no risk of MH, and that second MH develops in about 30% in the process of vitreomacular separation, which evolves over a prolonged period.

Spectral-domain optical coherence tomography features in fellow eyes of patients with idiopathic macular hole

PURPOSE

To describe the vitreomacular interface and foveal structural changes in fellow eyes of patients with idiopathic macular holes using spectral-domain optical coherence tomography (SD-OCT).

METHODS

Retrospective analysis of consecutive medical records and SD-OCT images of the fellow eyes of patients with macular hole was done. Changes of the vitreoretinal interface and foveal structures on SD-OCT scan of the 101 fellow eyes of 101 subjects with full-thickness macular hole were studied and compared with 101 eyes of 101 age-matched healthy subjects.

RESULTS

Sixty-four patients (57.65%) were female. Mean age at presentation was 60.44 ± 12.17 years. The best-corrected visual acuity (BCVA) in eyes with macular hole was 0.86 logMAR units and in fellow eyes was 0.41 logMAR units. Seven eyes had macular hole in the fellow eye at the time of presentation. The majority of the fellow eyes (87/101, 78.37%) were phakic. The average base diameter of macular hole was 1105 ± 451.63 µm. Incidence of vitreomacular traction, epiretinal membrane, lamellar hole, and inner foveal split was more common (<0.05) in fellow eyes in comparison to healthy eyes. In contrast, posterior vitreous detachment (PVD) and perifoveal PVD was more common in age-matched control eyes. There was no statistically significant correlation between foveal abnormalities of fellow eyes with base diameter of eyes with macular hole, BCVA, and duration of symptoms.

CONCLUSIONS

Fellow eyes of patients with idiopathic macular hole have a high frequency of abnormal vitreoretinal interface and foveal abnormalities, which predisposes to formation of macular hole.

Vitreo-retinal interface changes on optical coherence tomography in the fellow eyes of patients with macular hole

AIM

To study the vitreo-retinal interface and macular changes on optical coherence tomography (OCT) in the fellow eyes of patients with macular hole.

METHODS

Patients with idiopathic macular hole in one or both eyes presented to our institute between January 2003 and December 2009 were evaluated retrospectively. Demographic details, best-corrected visual acuity and vitreo-retinal interface, and macular changes of the fellow eye on OCT were studied.

RESULTS

Seventy patients underwent OCT of both eyes during the study period. The average age group was 61.96 years and 35 (50%) were females. Among the fellow eyes, normal foveal contour was noted in 36 (51.4%) eyes and 34 (48.6%) eyes were observed to have vitreo-retinal interface changes. Of them, 13 (18.6%) eyes had some stage of full thickness macular hole and 21 (30.0%) eyes had interface changes. There was no statistical correlation between involved eye lesions (P=0.64) or visual acuity (P=0.55) as predictors of development of either fellow eye lesions or poor visual acuity.

CONCLUSION

There is a significant chance of having vitreo-retinal interface findings in the fellow eyes of patients presenting with macular hole. OCT should be considered in both eyes of patients with macular hole to detect early changes in the fellow eyes, which may require an early intervention.

Idiopathic full-thickness macular holes and the vitreomacular interface: a high-resolution spectral-domain optical coherence tomography study

PURPOSE

To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography.

DESIGN

Prospective cross-sectional case series.

METHODS

Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed.

RESULTS

Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum.

CONCLUSIONS

The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).

Spectral domain optical coherence tomography in the diagnosis and management of vitreoretinal interface pathologies

The introduction of spectral domain optical coherence tomography (SD-OCT) has enhanced Vitreoretinal Interface (VRI) imaging considerably and facilitated the diagnosis, followup, prognosis determination, and management of VRI-associated pathologies. HR-OCT became a common practical tool seen in almost every ophthalmology practice. Knowledge of SD-OCT image interpretation and recognition of pathologies are required for all ophthalmologists. This paper methodically reviews the normal aging process of the VRI and discusses several commonly encountered VRI pathologies. The role of SD-OCT imaging in VRI-associated disorders such as posterior vitreous detachment, vitreomacular traction syndrome, idiopathic epiretinal membranes, lamellar holes, pseudoholes, and full thickness macular holes is portrayed. Future perspectives of new OCT technologies based on SD-OCT are discussed.

Macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment of patients with a unilateral macular hole

PURPOSE

To estimate the rate of macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment (PVD) and early stage 1 intrafoveal lesions in patients with a unilateral idiopathic full-thickness macular hole (MH) using optical coherence tomography (OCT).

DESIGN

Retrospective observational case series.

METHODS

Fellow eyes of consecutive patients with a unilateral full-thickness MH were examined on OCT. A subset of fellow eyes with a perifoveal PVD had been followed to investigate the rates of macular hole formation in fellow eyes with early stage 1 intrafoveal lesions.

RESULTS

Of 176 patients with a unilateral full-thickness MH, 42 fellow eyes (42 patients) with a perifoveal PVD were identified. During follow-up, a foveolar detachment was seen in 16 eyes, and 4 eyes had a foveal pseudocyst alone. In the 16 eyes with a foveolar detachment, 9 eyes had concurrent inner foveal splits. Within another 2 years of follow-up, OCT showed that 5 of 16 fellow eyes (31%) with a foveolar detachment developed a second full-thickness MH and 5 of 9 fellow eyes with a foveolar detachment and inner foveal splits developed a second full-thickness MH. Two of 4 eyes with a foveal pseudocyst alone developed vitreofoveal separation without hole formation. The remaining 2 eyes with a foveal pseudocyst alone remained stable at the last follow-up visit.

CONCLUSIONS

Fellow eyes with a foveolar detachment and a perifoveal PVD may be at high risk, and fellow eyes with a foveolar detachment and inner foveal splits might be at higher risk for progression to macular hole formation.

Clarifying the mechanism of idiopathic macular hole development in fellow eyes using spectral-domain optical coherence tomography

Background

To clarify the mechanism of idiopathic macular hole development, we evaluated the vitreoretinal relationship in fellow eyes of those with a macular hole and normal eyes using spectral-domain optical coherence tomography. Thirty-one fellow eyes and 34 normal volunteer eyes without a posterior vitreous detachment (PVD) were included.

Results

We classified six vitreomacular relationships: type 1, no PVD, five fellow eyes (16.1%) and nine control eyes (26.5%); type 2, shallow PVD with perifoveal vitreous attachment, seven fellow eyes (22.6%) and 19 control eyes (55.9%); type 3, shallow PVD with pinpoint foveal vitreous traction, seven fellow eyes (22.6%) and no control eyes (0%), type 4a; shallow PVD with a round defect in the posterior vitreous cortex over the perifoveal area with vitreous attachment to the perifoveal area, two fellow eyes (6.5%) and one control eye (2.9%); type 4b, shallow PVD with a round defect in the posterior vitreous cortex over the perifoveal area without vitreous attachment to the perifoveal area, no fellow eyes (0%) and one control eye (2.9%); type 5a, shallow PVD with no pseudo-operculum, no fellow eyes (0%) and four control eyes (11.8%); type 5b, shallow PVD with a pseudo-operculum, four fellow eyes (12.9%) and no control eyes (0%); and type 6, biomicroscopically relevant PVD, six fellow eyes (19.4%).

Conclusion

Types 3 and 5b developed only in fellow eyes. Type 2 developed most often in normal eyes and seemed to cause less foveal stress. Type 3 may show the basic pathogenesis of macular holes. Progression of type 5b after type 3 induces abortion of developing macular holes.

Posterior vitreous detachment: evolution and complications of its early stages

PURPOSE

To summarize emerging concepts regarding the onset and progression, traction effects, and complications of the early stages of age-related posterior vitreous detachment (PVD).

DESIGN

Interpretive essay.

METHODS

Review and synthesis of selected literature, with clinical illustrations, interpretation, and perspective.

RESULTS

Imaging of the vitreoretinal interface with optical coherence tomography has shown that PVD begins in the perifoveal macula. Recent longitudinal studies have demonstrated conclusively that early PVD stages persist chronically and progress slowly over months to years. Vitreous traction forces resulting from perifoveal PVD with a small vitreofoveolar adhesion (500 microm or less) may cause localized cystoid foveal thickening or one of several macular hole conditions. Traction associated with larger adhesion zones may cause or exacerbate a separate group of macular disorders. Ultrastructural studies suggest that epiretinal membrane develops from cortical vitreous remnants left on the retinal surface after PVD and plays an important role in traction vitreomaculopathies.

CONCLUSIONS

Age-related PVD is an insidious, chronic event that begins in the perifoveal macula and evolves over a prolonged period before vitreopapillary separation. Although asymptomatic in most individuals, its early stages may be complicated by a variety of macular and optic disc pathologic features, determined in part by the size and strength of the residual vitreoretinal adhesion.

A study of macular hole formation by serial spectral optical coherence tomography

BACKGROUND

The purpose of this paper is to evaluate changes of the vitreoretinal interface in fellow eyes of eyes with a macular hole and to study early stages of macular hole formation by spectral optical coherence tomography (SOCT).

METHODS

A prospective study of 131 consecutive patients with history of macular hole. Serial SOCT examinations were performed on the fellow eyes four times during a 6-month observation period. Progression of foveal changes and formation of macular hole in the fellow eyes were studied.

RESULTS

Seven distinct abnormalities in the foveal region were noted in 70 of the fellow eyes (53.4%). Additionally in 18 patients (13.6%) other defects typical for the older population were noted. Gradual evolution to full-thickness macular holes during the 6-month observation period was noted in five eyes. One of these eyes had a previously detected cyst, and four eyes had elevation of the photoreceptor layer.

CONCLUSIONS

The high prevalence of macular abnormalities in the fellow eyes particularly epiretinal membranes and vitreous traction with schizis as well as the evolution of these abnormalities over time suggest that diseases of the vitreomacular interface may have similar pathogenesis. Macular hole formation often starts as a triangular elevation of the photoreceptor layer. In some cases, a cyst in the inner retinal layers can be an early step in macular hole formation.

Population-based incidence of macular holes

PURPOSE

To determine the incidence of full-thickness macular holes in Olmsted County, Minnesota.

DESIGN

Population-based retrospective chart review (cross-sectional study).

PARTICIPANTS

Ninety-four eyes of 85 patients who were residents of Olmsted County, Minnesota.

METHODS

A population-based retrospective chart review was performed for all diagnoses of macular hole between 1992 and 2002 among residents of Olmsted County, Minnesota. Yearly incidence rates for each given age and sex group were determined by dividing the number of cases within that group by the estimated total Olmsted County resident population of the group for that given year.

MAIN OUTCOME MEASURES

Documented clinical diagnosis of a macular hole.

RESULTS

Idiopathic macular holes occur at an age- and sex-adjusted incidence in 7.8 persons and 8.69 eyes per 100,000 population per year in Olmsted County, Minnesota. The female-to-male ratio was determined to be 3.3 to 1, and bilateral idiopathic macular holes occurred in 11.7% of patients and accounted for 20.9% of the affected eyes.

CONCLUSIONS

This study uniquely determined the incidence of macular holes in a predominantly Caucasian population.

[Reasons for readmission to hospital after vitreoretinal surgery: 5-year retrospective follow-up]

INTRODUCTION

To study the etiologies and occurrence rate of readmissions after vitreoretinal surgery.

PATIENTS AND METHODS

One hundred fifty-three eyes requiring vitreoretinal surgery in 2000 at the Besançon (France) University Hospital were retrospectively studied. The occurrence rate and etiologies of these readmissions and the time between surgery and readmission were analyzed from the patient files.

RESULTS

The main indications for vitreoretinal surgery were retinal detachment, epiretinal membrane surgery, idiopathic macular holes, neovascular retrovascular membranes, and intravitreal hemorrhage. A total of 40.5% of the patients were readmitted. The major causes were redetachment and cataract for retinal detachment surgery and cataract for epiretinal membrane and macular hole surgeries.

CONCLUSION

The results highlight the possibly iatrogenic association between anterior and posterior eye segment surgeries, in agreement with the literature.

Is It Worth Reoperating on Macular Holes?

OBJECTIVE

To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs.

DESIGN

Retrospective single-center case series.

PARTICIPANTS

Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group).

METHODS

All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery.

MAIN OUTCOME MEASURES

Anatomic and visual results.

RESULTS

All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; +/-standard deviation [SD]) before the second surgery was 0.14+/-0.10 (range, 0.01-0.33) in the reopened group and 0.10+/-0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (+/-SD) in the reopened group was 0.42+/-0.31 (range, 0.05-1) and in the unclosed group was 0.19+/-0.14 (range, HM-0.66).

CONCLUSIONS

Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation.

Associations between subjective and objective visual function in patients with unilateral macular holes

Forty-six patients with uniocular macular holes and unaffected, fellow eyes were studied to evaluate inter- and intraocular associations between various objective tests of visual function and perceived visual ability. The affected eye had significant associations between visual acuity (VA) and the fovea threshold test, but for the fellow eye only VA and low-contrast VA 10% were associated. The reduction in visual acuity under low-contrast conditions relative to high-contrast did not differ between the affected eye and the healthy eye. Subjective visual ability seems to depend more on the visual acuity of the affected eye than the healthy eye.

Optical Coherence Tomography Use in Evaluation of the Vitreoretinal Interface: A Review

Optical coherence tomography (OCT) is a valuable tool for assessment of the vitreoretinal interface. This article reviews the normal process of age-related posterior vitreous detachment as viewed by OCT. Abnormalities of the vitreoretinal interface as imaged by OCT are described including vitreomacular traction syndrome, cystoid macular edema/ diabetic macular edema, epiretinal membranes, full thickness macular holes, lamellar holes, pseudoholes, microholes, and schisis from myopia or optic pits/colobomas. This tool has given us new insights into the pathogenesis of these retinal abnormalities.

Retinal assessment using optical coherence tomography

Over the 15 years since the original description, optical coherence tomography (OCT) has become one of the key diagnostic technologies in the ophthalmic subspecialty areas of retinal diseases and glaucoma. The reason for the widespread adoption of this technology originates from at least two properties of the OCT results: on the one hand, the results are accessible to the non-specialist where microscopic retinal abnormalities are grossly and easily noticeable; on the other hand, results are reproducible and exceedingly quantitative in the hands of the specialist. However, as in any other imaging technique in ophthalmology, some artifacts are expected to occur. Understanding of the basic principles of image acquisition and data processing as well as recognition of OCT limitations are crucial issues to using this equipment with cleverness. Herein, we took a brief look in the past of OCT and have explained the key basic physical principles of this imaging technology. In addition, each of the several steps encompassing a third generation OCT evaluation of retinal tissues has been addressed in details. A comprehensive explanation about next generation OCT systems has also been provided and, to conclude, we have commented on the future directions of this exceptional technique.