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Garcin T, Gaudric A, Sikorav A, Tadayoni R, Couturier A. Internal Limiting Membrane Peeling for Large Macular Holes Induces Only Structural Remodeling without Functional Impairment Over 12 Years. Ophthalmol Retina 2024:S2468-6530(24)00429-9. [PMID: 39276867 DOI: 10.1016/j.oret.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE To evaluate the very long-term functional and structural outcomes of internal limiting membrane (ILM) peeling for full-thickness macular holes (FTMH). DESIGN Observational case series nested within a multicenter, randomized, controlled clinical trial (RCT) (ClinicalTrials.gov: NCT00190190). SUBJECTS Patients who underwent vitrectomy with or without ILM peeling for an idiopathic large FTMH in a tertiary ophthalmology center, with a minimum follow-up of 10 years after surgery. METHODS Review of charts, spectral-domain OCT (SD-OCT) scans, OCT angiography (OCTA) scans, and microperimetry of patients originally enrolled in the RCT. MAIN OUTCOME MEASURES Primary outcome was functional assessment in both groups (ILM peeling or not) including the retinal sensitivity (RS), distance and near best-corrected visual acuity (BCVA), and number of eyes achieving ≥0.3 logarithm of the minimum angle of resolution >10 years after surgery. Secondary outcomes were structural assessment in the entire 3 × 3-mm and 6 × 6-mm areas, and regionally in the different areas of the ETDRS grid: OCT and OCTA biomarkers in both groups and fellow eyes. RESULTS Thirteen eyes of 13 patients with a mean follow-up of 12 ± 0.73 years were included. The mean RS and BCVA, or visual improvement did not differ between ILM peeling (n = 8) and no peeling (n = 5) (all P > 0.05). The dissociated optic nerve fiber layers on en face OCT were only observed in eyes with ILM peeling, predominantly in temporal parafoveal (20%) and perifoveal (19%) rings. The mean total retinal thickness and inner retinal thickness in the parafoveal ring were significantly lower in peeled eyes (309 ± 11 μm and 94 ± 9 μm respectively) versus nonpeeled eyes (330 ± 21 μm and 108 ± 11 μm respectively; P = 0.037 and P = 0.040), without significant difference in ganglion cell or retinal nerve fiber layers. Accordingly, the mean superficial capillary plexus density in the parafoveal ring was significantly lower in eyes with peeling versus without (39.65 ± 3.76 % versus 47.22 ± 4.00; P = 0.005). The mean foveal avascular zone area was smaller in eyes with peeling versus without (0.24 ± 0.05 mm2 vs. 0.42 ± 0.13 mm2, respectively, P = 0.005). CONCLUSIONS Despite persistent structural changes especially in the parafoveal ring, ILM peeling for idiopathic large FTMH did not seem to impact long-term RS or BCVA over 12 years. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thibaud Garcin
- Ophthalmology Department, Hospital Lariboisiere and Fernand-Widal, Paris, France; Ophthalmology Department 5, National Hospital 15-20, Paris, France; University Jean Monnet, Saint-Etienne, France.
| | - Alain Gaudric
- Ophthalmology Department, Hospital Lariboisiere and Fernand-Widal, Paris, France
| | - Anne Sikorav
- Ophthalmology Department, Hospital Lariboisiere and Fernand-Widal, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, Hospital Lariboisiere and Fernand-Widal, Paris, France
| | - Aude Couturier
- Ophthalmology Department, Hospital Lariboisiere and Fernand-Widal, Paris, France
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Steinkerchner MS, Sharma N, Russell MW, Maatouk C, Talcott KE, Singh RP. Long-term Visual Outcomes in Patients With Idiopathic Macular Hole Surgery. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 39254499 DOI: 10.3928/23258160-20240805-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND AND OBJECTIVE This study assesses long-term outcomes following surgical repair of idiopathic full-thickness macular holes (FTMHs) in patients with at least 5 years of postoperative follow-up. PATIENTS AND METHODS A retrospective study evaluated patients diagnosed with idiopathic FTMH who received surgical repair at a single tertiary center with at least 5 years of postoperative follow-up. Data collection included demographic and preoperative characteristics along with macular hole structural integrity as determined by spectral-domain optical coherence tomography (OCT). Functional and structural improvement were assessed by collection of visual acuity and findings on OCT at determined time points until 9 years of follow-up. RESULTS The study comprised 90 eyes of 80 patients with a mean age of 67.2 ± 6.8 years, with an average postoperative follow-up of 80.8 ± 17.4 months (range 54 to 130 months). The mean macular hole diameter was 239.7 µm ± 92.2. Macular hole reoperation occurred in four eyes (4%) at a mean duration of 5.5 ± 6 months (range 0.3 to 13 months). Over the study duration, ellipsoid zone (EZ) integrity was maintained in 67.8% of eyes, with an absence of intraretinal fluid (IRF) in 96% on final OCT. The preoperative mean Early Treatment Diabetic Retinopathy Study (ETDRS) best visual acuity (BVA) of 51 improved to a mean BVA of 76 at 5 years postoperatively, with an average gain of 24 letters at one year that remained stable over 5 years (P < 0.05). Eight years after surgical repair, more than 80% of patients achieved a BVA > 65. CONCLUSIONS Vitreoretinal surgery for idiopathic FTMH resulted in successful hole closure and sustained visual acuity improvement over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Liang KH, Tsai HR, Peng PL, Chen CH, Huang YT, Lu JW, Chen TL. Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e252-e259. [PMID: 37253430 DOI: 10.1016/j.jcjo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/12/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the best-corrected visual acuity (BCVA) change, idiopathic macular (IMH) closure, and complications in IMH patients receiving combined phacovitrectomy and sequential surgery (vitrectomy followed by phacoemulsification). DESIGN Systematic review and meta-analysis. METHODS PubMed, Ovid EMBASE, and Cochrane Library databases were searched from their inception through February 2022. Randomized, controlled trials and observational studies that presented results of BCVA change, IMH closure, and surgery-related complications were included. A random-effects meta-analysis was conducted to calculate effect estimates with 95% CIs. RESULTS One randomized, controlled trials and 7 cohort studies with 585 patients were included. Overall, the meta-analyses of BCVA change (mean difference, -0.03; 95% CI, -0.10-0.04) and IMH closure (risk ratio = 1.04; 95% CI, 0.96-1.13) revealed no significant differences between combined phacovitrectomy and sequential surgery. The pooled risk ratios for various surgical complications such as postoperative retinal detachment, inflammation, and intraocular pressure elevation showed no significant differences between the 2 groups. CONCLUSIONS Similar visual gain and IMH closure rates were achieved after both combined phacovitrectomy and sequential surgery, with similar complication risks. The anatomic and functional outcomes of combined surgery were not better than those of sequential surgery. These results could serve as a reference for future trials.
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Affiliation(s)
- Kai-Hsiang Liang
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hou-Ren Tsai
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Po-Lin Peng
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ting Huang
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jing-Wun Lu
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tai-Li Chen
- Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
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Xia H, Yang J, Ding Y, Wang X, Liao Y, Shi Y, Dou H, Li X. Predictive value of ellipsoid zone-related angle parameters in primary surgery of large macular hole: a case control study. BMC Ophthalmol 2023; 23:467. [PMID: 37978355 PMCID: PMC10655441 DOI: 10.1186/s12886-023-03187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To explore the predictive value of Ellipsoid Zone (EZ) -related angle parameters for the outcome of primary macular hole surgery. METHODS This was a retrospective study. Patients diagnosed with large macular hole (MH) (minimum diameter > 500 μm) between 2018 and 2021 were enrolled. All patients underwent 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling and air tamponade. Spectral-domain OCT (SD-OCT) and best corrected visual acuity (BCVA) were measured in preoperative and 2-week post-operative. Classic and angle related parameters were measured via ImageJ. Angle regularity (AR) were defined as the standard deviation of the angle parameters in vertical and horizontal direction. RESULTS Seventy-six eyes were included for analysis; 24 eyes showed an unclosed macular hole at the 2-week postoperative and 52 eyes showed a closed hole. Preoperatively, MLD (P < 0.001), BD (P = 0.009) and diameter of EZ/ELM disruption (P = 0.002 and 0.025) in patients failed to close the hole after primary surgery were significantly larger than those succeeded. EZ-MH (P = 0.018), EZ-NFL (P = 0.006), EZ-GCL (P = 0.004), EZ-INL (P = 0.002), EZ-OPL (P = 0.009) and EZ-ONL (P = 0.011) angles were smaller in patients with unclosed hole. AR of the EZ-NFL (P = 0.009), EZ-GCL (P = 0.009), EZ-OPL (P = 0.023), EZ-ONL (P = 0.048) and Basal-NFL (P = 0.030) angles among the unclosed patients were significantly larger than those of the closed group. EZ-NFL (P = 0.015), EZ-GCL (P = 0.004), EZ-INL (P < 0.001), EZ-OPL (P < 0.001), EZ-ONL (P < 0.001), Basal (P = 0.023) and Basal-NFL (P < 0.001) angles of hole-unclosed patients enlarged significantly after the surgery. CONCLUSIONS Patients with large macular holes and an increased EZ-related angle and angle AR are more likely to experience unsuccessful outcomes following primary MH surgery. Therefore, EZ-related angles hold potential as valuable parameters for predicting the surgical outcome.
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Affiliation(s)
- Huaqin Xia
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yi Ding
- Medical Oncology College, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yanfeng Liao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yiwen Shi
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Hongliang Dou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
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Qi B, Zhang K, Yang X, Wu X, Wang X, Liu W. Comparison of Different Internal Limiting Membrane Peeling Sizes for Idiopathic Macular Holes: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:1071-1084. [PMID: 37586342 PMCID: PMC10614454 DOI: 10.1159/000531510] [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: 04/12/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Although internal limiting membrane (ILM) peeling facilitates macular hole (MH) closure and reduces late hole reopening, it brings some detrimental consequences to the retinal microstructure and functional outcomes. So far, previous studies have not reached a consensus on the optimal ILM peeling size. OBJECTIVES The objective of this study was to evaluate the outcomes of different ILM peeling sizes for idiopathic MHs. METHODS PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WANFANG were searched until April 10, 2022. Studies in English or Chinese that compare the effects of two ILM peeling sizes (>2 disk diameters [DDs] vs. ≤2DD) for idiopathic MHs were included. The overall closure rate, postoperative best-corrected visual acuity (BCVA), type 1 closure, and adverse events were extracted. BCVA was converted to logarithm of the minimum angle of resolution (LogMAR). RESULTS Seven eligible studies (560 eyes) including 3 randomized clinical trials, 3 prospective trials, and one retrospective cohort were included. Pooled results showed a significantly better postoperative BCVA (mean difference = -0.16; 95% confidence interval [CI]: -0.27 to -0.04; LogMAR) and higher type 1 closure rate (risk ratio [RR] = 1.24; 95% CI: 1.08-1.43) in eyes with ILM peeling >2DD than those with peeling ≤2DD. No significant difference was found in overall closure rate and adverse events between the two groups. Subgroup analysis indicated that in MHs >400 μm, peeling >2DD helped obtain a better postoperative BCVA (mean difference = -0.17; 95% CI: -0.29 to -0.04; LogMAR) and higher frequency of type 1 closure (RR = 1.25; 95% CI: 1.03-1.51). CONCLUSIONS Peeling >2DD shares similar safety level with peeling ≤2DD and has a superiority of facilitating visual recovery. Larger ILM peeling may be more beneficial for large MHs.
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Affiliation(s)
- Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xijin Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xinbo Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Liu X, Shao Y, Lin H, Liu C, Shen J, Zhang L, Bi Y. Corneal densitometry: an innovative method to quantitatively evaluate corneal changes after phacovitrectomy. BMC Ophthalmol 2023; 23:87. [PMID: 36879221 PMCID: PMC9987054 DOI: 10.1186/s12886-023-02818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND To quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy. METHODS Thirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy. RESULTS ECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0-2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2-6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0-2 mm zone was positively correlated with CCT. Posterior CD in the 0-2 mm zone was negatively correlated with ECD and HEX. CONCLUSIONS CD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair. TRIAL REGISTRATION This study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554).
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Affiliation(s)
- Xin Liu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China.,Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yuting Shao
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China
| | - Hui Lin
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China
| | - Chunyu Liu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China
| | - Jiaqi Shen
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China
| | - Li Zhang
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China.
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200000, China. .,Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China.
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Trends and Hotspots Concerning Macular Hole between 2002 and 2021: A 20-Year Bibliometric Study. J Pers Med 2022; 13:jpm13010075. [PMID: 36675736 PMCID: PMC9860867 DOI: 10.3390/jpm13010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/10/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Macular hole (MH) can severely impair central vision. Although it can be treated with vitrectomy surgery, avoiding recurrence and improving visual acuity are still priorities to be addressed. This study aims to reveal the trends and hotspots about MH. METHODS The Web of Science Core Collection (WOSCC) was used to perform a bibliometric analysis investigating trends of MH research from 2002 to 2021. We evaluated the details of associated regions, institutions, authors, and journals. To construct and overlay network visualizations, VOSviewer software was used. RESULTS In total, 1518 publications were collected. Our analysis showed that MH research is becoming increasingly relevant, with Japan achieving the largest number of publications (291), largest number of citations (7745 in total), and highest h-index value (48). Retina published the most publications on this topic, totaling more than the next two journals combined. An analysis of keyword co-occurrence was evaluated, highlighting several novel keywords of interest, such as flap technique, transplantation, epiretinal proliferation (EP), foveal microstructure, and retinal sensitivity. CONCLUSIONS Details on MH research were uncovered by comprehensively analyzing the global trends and hotspots over the past two decades, presenting valuable information for future MH research. Japan, the USA, and China hold leading positions in research on this topic. Amendable surgical methods are a potential focus for improving prognosis.
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Caporossi T, Carlà MM, Gambini G, De Vico U, Baldascino A, Rizzo S. Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives. Clin Ophthalmol 2022; 16:1069-1084. [PMID: 35418741 PMCID: PMC8995173 DOI: 10.2147/opth.s284620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Pars plana vitrectomy has become the standard procedure for primary macular holes (MHs) repair, including the removal of the posterior cortical vitreous, the stripping of eventual epiretinal membranes, and finally an intraocular gas tamponade. During this procedure, peeling the internal limiting membrane (ILM) has been proven to increase closure rates and avoid postoperative reopening in several researches. In fact, even in large MHs more than 400 µm, the advantage of peeling off the ILM was highlighted by better anatomical closure rates. Nevertheless, some authors suggested that ILM peeling is not always essential, because it generates various side effects in retinal structure and function. Furthermore, the ideal amount of ILM peeling and the most effective strategies for removing the ILM are still subject of research. Different surgical modifications have been reported as alternatives to traditional peeling in certain clinical settings, including ILM flaps, ILM scraping, and foveal sparing ILM peeling. As regards large MHs, the introduction of ILM inverted flap appeared as a game changer, offering a significantly higher >90% closure rate when compared to traditional ILM peeling. Modifications to inverted ILM flap procedures have been claimed in recent years, in order to define the best area and direction of ILM peeling and its correlation with functional outcomes. Moreover, several innovations saw the light in the setting of recurrent MHs, such as ILM free flap transposition, inverted ILM flap combined autologous blood clot technique, neurosensory retinal flap, and human amniotic membrane (HAM) plug, claiming higher anatomical success rate also in those complex settings. In conclusion, the aim of this review is to report how the success rate of contemporary macular surgery has grown since the turn of the century, especially for big and chronic MHs, analyzing in which way ILM management became a crucial point of this kind of surgery.
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Affiliation(s)
- Tomaso Caporossi
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Gloria Gambini
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, “Fondazione Policlinico Universitario A. Gemelli, IRCCS”, Rome, 00168, Italy
- Ophthalmology Department, Catholic University “Sacro Cuore”, Rome, Italy
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Padidam S, Skopis G, Lai MM. Prevalence of Cystoid Macular Edema After Cataract Surgery in Eyes with Previous Macular Surgery. Clin Ophthalmol 2022; 16:423-427. [PMID: 35210747 PMCID: PMC8859272 DOI: 10.2147/opth.s333754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the prevalence and risk factors for cystoid macular edema (CME) after cataract surgery in eyes that have previously undergone macular surgery. Study Design and Methods Retrospective consecutive interventional case series. Patient medical records and Spectral Domain Optical Coherence Tomography (SD-OCT) were reviewed for eyes that underwent vitrectomy for full thickness macular hole (FTMH), lamellar macular hole (LMH) or epiretinal membrane (ERM) and subsequent cataract surgery at a large private retina practice between 2016 and 2018. Results Around 9.1% of eyes (22/243) developed CME post cataract surgery. The mean time from macular surgery to cataract surgery was 273 days (range: 87–797) in eyes with CME and 289 days (range: 22–897) in eyes without CME (p = 0.67). There was no difference in final visual acuity between eyes with CME (20/40, logMAR 0.312) and without CME (20/30, logMAR 0.206) (p = 0.101). Compared with patients with FTMH or LMH, patients with epiretinal membrane were more likely to develop post cataract CME (OR = 2.97, p = 0.031, Chi square test). Conclusion In eyes with history of macular surgery, the prevalence of post cataract surgery CME was around 9.1%. The development of CME is not dependent on timing of cataract surgery but is more common in eyes with history of epiretinal membrane.
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Affiliation(s)
- Sneha Padidam
- The Retina Group of Washington, Chevy Chase, MD, USA
- Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USA
| | - George Skopis
- Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Michael M Lai
- The Retina Group of Washington, Chevy Chase, MD, USA
- Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USA
- Correspondence: Michael M Lai, Tel +301-656-8100, Email
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Yang J, Xia H, Liu Y, Wang X, Yuan H, Hou Q, Ge Y, Ding Y, Wang Y, Wang C, Li X. Ellipsoid Zone and External Limiting Membrane-Related Parameters on Spectral Domain-Optical Coherence Tomography and Their Relationships With Visual Prognosis After Successful Macular Hole Surgery. Front Med (Lausanne) 2021; 8:779602. [PMID: 34859022 PMCID: PMC8631427 DOI: 10.3389/fmed.2021.779602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare structural diameters of the ellipsoid zone (EZ) and external limiting membrane (ELM) bands on spectral domain-optical coherence tomography (SD-OCT) images between vision-improved (group A) and vision-unimproved (group B) patients, and investigate the connection between these parameters and visual prognosis. Materials and Methods: Forty-five eyes of 43 patients with idiopathic full-thickness macular hole closed after vitrectomy were retrospectively reviewed. Best-corrected visual acuity (BCVA) and SD-OCT were conducted preoperatively and at 1 week, 1 month and 6 months postoperatively. Structural and functional parameters were then measured using ImageJ software. Results: Among structural and functional parameters, the relative reflectivity of EZ and the ratio of continuous ELM and EZ in group A were significantly higher than in group B from the 1-month postoperative visit. At the 6-month follow-up, the diameter of EZ disruption in group A was significantly smaller than in group B, and the relative reflectivity of ELM/EZ was significantly higher than group B. At 6-months, BCVA was statistically significantly correlated with baseline BCVA, basal diameter (BD), macular hole index (MHI), and diameter of ELM/EZ disruption. Change in BCVA from baseline was found to be significantly correlated with axial length and diameter hole index (DHI). Conclusions: Postoperative BCVA outcome was significantly correlated with integrity, thickness and reflectivity of the EZ band. Patients with smaller diameter of EZ disruption and higher reflectivity of EZ band tended to have better visual outcomes. Given that the EZ band reflects the recovery of mitochondria in photoreceptors, it is a promising parameter for their functional evaluation.
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Affiliation(s)
- Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Huaqin Xia
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yushi Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Hao Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Qingyi Hou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yimeng Ge
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yi Ding
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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11
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EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY. Retina 2021; 40:1955-1963. [PMID: 31834129 DOI: 10.1097/iae.0000000000002707] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the role of an internal limiting membrane (ILM) flap in macular hole (MH) surgery on closure rate, visual acuity, and integrity of the outer retinal layers. METHODS Retrospective, nonrandomized interventional analysis in which 117 eyes of 117 patients were included who had undergone pars-plana vitrectomy (PPV) and gas tamponade for primary idiopathic MH >400 µm with either conventional ILM peeling or with inverted ILM flap technique at The Royal Liverpool University Hospital between January 2016 and April 2018. Main outcome measures were closure of MH, best-corrected visual acuity (BCVA) at 3, 6, and 12 months, and restoration of external limiting membrane and ellipsoid zone (EZ) using optical coherence tomography. RESULTS Macular hole closure rate was significantly higher in patients with an ILM flap (67/68; 98.53%) than in those with conventional ILM peeling (43/49; 87.76%) (P = 0.02). Both groups showed significant improvements in their preoperative to postoperative BCVA at 3 months from 1.07 (0.43) logarithm of the minimum angle of resolution (logMAR) (20/235 Snellen) to 0.71 (0.34) logMAR (20/103 Snellen) (P <0.001), but there was no significant difference between the two groups (P = 0.45, P = 0.71). We found significant associations between postoperative BCVA and preoperative BCVA (P < 0.01) and the integrity of the EZ (P < 0.01). In 35 patients who had follow-up to 12 months, there was a significant improvement in BCVA between 3, 6, and 12 months from 0.73 (0.45) logMAR (20/107 Snellen) to 0.53 (0.24) logMAR (20/68 Snellen) and to 0.35 (0.18) logMAR (20/45 Snellen), respectively (P < 0.01). There was no significant difference at these time periods between the two groups (P = 0.62, P = 0.21, P = 0.31). The integrity of the EZ also improved significantly between 3, 6, and 12 months (P = 0.01), irrespective of the presence of an ILM flap (P = 0.58), but with a trend toward delay in restoration in those patients with an ILM flap. The improvement in BCVA at 12 months, taking into account the age of the patient, size and duration of the MH, presence of an ILM flap, and preoperative BCVA was dependent on the state of the EZ (P = 0.01). CONCLUSION In patients undergoing primary pars-plana vitrectomy for MH >400 µm, the presence of an inverted ILM flap was associated with a significantly higher closure rate than a conventional ILM peeling. Best-corrected visual acuity showed a strong correlation with the integrity of the EZ and both improved significantly between 3, 6, and 12 months, irrespective of the presence of an ILM flap.
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12
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Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery. Sci Rep 2021; 11:11351. [PMID: 34059759 PMCID: PMC8167100 DOI: 10.1038/s41598-021-90955-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 12/04/2022] Open
Abstract
To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.
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13
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Ferreira MA, Maia A, Machado AJ, Ferreira REA, Hagemann LF, Júnior PHER, Rezende FA. Human amniotic membrane for the treatment of large and refractory macular holes: a retrospective, multicentric, interventional study. Int J Retina Vitreous 2021; 7:38. [PMID: 33964971 PMCID: PMC8105940 DOI: 10.1186/s40942-021-00308-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful. Methods Retrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values < 0.05 were considered statistically significant. Results Nineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80–2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4–3.0) approximately 20/200 (p < 0.0001) with median of three lines of visual improvement. Conclusion The use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.
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Affiliation(s)
- Magno A Ferreira
- Universidade Federal de Uberlândia UFU - Federal University of Uberlândia, Uberlândia, Brazil. .,Uberlândia Eye Hospital (HOLHOS), Av. Pará, 1720-Umuarama, Uberlândia, MG, 38405-320, Brazil.
| | - André Maia
- Departamento de Retina e Vítreo - Retina and Vitreous Department of the Universidade Federal de São Paulo (UNIFESP)-(Federal University of São Paulo), São Paulo, Brazil.,Retina Clinic, São Paulo, Brazil
| | - André J Machado
- Universidade Federal Do Ceará (UFC) - Federal University of Ceará and President of CLDO, Fortaleza, Brazil
| | - Raquel E A Ferreira
- Uberlândia Eye Hospital (HOLHOS), Av. Pará, 1720-Umuarama, Uberlândia, MG, 38405-320, Brazil
| | | | | | - Flávio A Rezende
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Canada
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14
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Grajewski L, Grajewski O, Carstens J, Krause L. Incidence of Retinal Detachment after Macular Surgery. Klin Monbl Augenheilkd 2021; 238:580-583. [PMID: 33607691 DOI: 10.1055/a-1353-5436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Macular surgery has become an increasingly atraumatic procedure for the eye with the surgical methods that have been further developed in recent years. The most common complications include cystoid macular oedema and retinal detachment, more rarely endophthalmitis. The aim of this retrospective study is to record the number of retinal detachments following elective macular surgery. In this study we included all patients who underwent pars plana vitrectomy (ppV, 20 or 25 gauge) in the years 2009 - 2016. We then identified the patients who were hospitalised again because of retinal detachment. For the affected patients, the rate of retinal detachment, functional outcomes and possible risk factors were recorded. A total of 904 eyes were identified, of which 667 had surgery for epiretinal membrane, 188 for macular hole, and 49 for vitreomacular traction with a 20 or 25 gauge ppV. Of these 904, retinal detachment occurred in 17 (1.88%) cases. The mean time between first ppV and second ppV with retinal detachment was 248 days (3 - 1837 days). Two of the 17 patients had at least one retinal break before or during surgery. The retinal break was located inferior in six cases, superior in four; in four cases PVR retinal detachment and in three cases the foramina were distributed. Mean visual acuity was 0.27 (decimal) before macular surgery and 0.28 at the time of last presentation. Modern vitrectomy techniques reduce the complications in elective macular surgery, but do not replace the surgeon's experience.
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Affiliation(s)
- Luise Grajewski
- Klinik für Augenheilkunde, Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Dessau, Deutschland
| | | | - Jens Carstens
- Klinik für Augenheilkunde, Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Dessau, Deutschland
| | - Lothar Krause
- Klinik für Augenheilkunde, Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Dessau, Deutschland
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15
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Hu Y, Xiao Y, Quan W, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Fang Y, Hu Y, Feng S, Yuan L, Li T, Cai H, Yu H. A multi-center study of prediction of macular hole status after vitrectomy and internal limiting membrane peeling by a deep learning model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:51. [PMID: 33553344 PMCID: PMC7859800 DOI: 10.21037/atm-20-1789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background To develop a deep learning (DL) model for prediction of idiopathic macular hole (MH) status after vitrectomy and internal limiting membrane peeling (VILMP) based on optical coherence tomography (OCT) images from four ophthalmic centers. Methods Eyes followed up at 1 month after VILMP for full-thickness MH were included. In the internal training set, 920 preoperative macular OCT images (as the input) and post-operative status of MH (closed or open, as the output) of 256 eyes from two ophthalmic centers were used to train the DL model using VGG16 algorithm. In the external validation set, 72 preoperative macular OCT images of 36 MH eyes treated by VILMP from another two ophthalmic centers were used to validate the prediction accuracy of the DL model. Results In internal training, the mean of overall accuracy for prediction of MH status after VILMP was 84.6% with a mean area under the receiver operating characteristic (ROC) curve (AUC) of 91.04% (sensitivity 85.37% and specificity 81.99%). In external validation, the overall accuracy of predicting MH status after VILMP was 84.7% with an AUC of 89.32% (sensitivity 83.33% and specificity 87.50%). The heatmaps showed that the area critical for prediction was at the central macula, mainly at the MH and its adjacent retina. Conclusions The DL model trained by preoperative macular OCT images can be used to predict postoperative MH status after VILMP. The prediction accuracy of our DL model has been validated by multiple ophthalmic centers.
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Affiliation(s)
- Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Hu
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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16
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Wu A, Ling K, Chuang L, Chen K, Chen Y, Yeung L, Wang N, Liu L, Chen T, Hwang Y, Wu W, Lai C. Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three-year results. Acta Ophthalmol 2020; 98:e839-e847. [PMID: 32243725 DOI: 10.1111/aos.14418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. METHODS Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications. RESULTS The mean patient age was 61.0 ± 11.4 years. The follow-up was 45.2 ± 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 ± 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and pre-existing disease of glaucoma (p = 0.006). CONCLUSIONS A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.
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Affiliation(s)
- An‐Lun Wu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- Department of Ophthalmology Mackay Memorial Hospital Hsinchu Taiwan
| | - Kiet‐Phang Ling
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- Department of Ophthalmology Sultanah Aminah Hospital Johor Malaysia
| | - Lan‐Hsin Chuang
- Department of Ophthalmology Chang Gung Memorial Hospital Keelung Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Kuan‐Jen Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yen‐Po Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Ling Yeung
- Department of Ophthalmology Chang Gung Memorial Hospital Keelung Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Nan‐Kai Wang
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
- Edward S. Harkness Eye Institute Department of Ophthalmology Columbia University New York NY USA
| | - Laura Liu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Tun‐Lu Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yih‐Shiou Hwang
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Wei‐Chi Wu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Chi‐Chun Lai
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
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17
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Combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco for phakic patients with full-thickness macular hole (FTMH) and no significant cataract at baseline: 1-year outcomes of a randomized trial combined PPV/phaco vs PPV/deferred phaco for MH. Graefes Arch Clin Exp Ophthalmol 2020; 259:29-36. [PMID: 32761473 DOI: 10.1007/s00417-020-04731-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/09/2020] [Accepted: 04/29/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare functional and anatomic outcomes of combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco in patients with full-thickness macular hole (FTMH) and no significant cataract. METHODS Thirty-four patients were randomized to group 1 (combined PPV/phaco) and 34 to group 2 (PPV/deferred phaco). Group 2 patients could undergo phaco any time after FTMH surgery if significant cataract developed. RESULTS Sixty-five patients (33 group 1 and 32 group 2) completed the 12-month visit. Mean ± SEM logMAR best-corrected visual acuity (BCVA) was 0.92 ± 0.04 and 0.90 ± 0.04 at baseline and improved significantly to 0.60 ± 0.05 and 0.58 ± 0.05 at month 12 (p < 0.0001) in groups 1 and 2, respectively. There was no significant difference between the groups in mean BCVA at baseline or at month 12. Mean macular sensitivity (dB) was 18.22 ± 0.93 and 16.72 ± 0.93 at baseline and increased to 21.13 ± 0.86 and 21.07 ± 0.85 in groups 1 and 2, respectively (p < 0.05) with no significant difference between the groups (p = 0.449) at month 12. FTMH closure rate was 73% and 75% in groups 1 and 2, respectively (p = 0.834). CONCLUSION Among patients with FTMH and no significant cataract at baseline, combined PPV/phaco was associated with similar BCVA, microperimetry, and FTMH closure outcomes at 1-year compared with PPV/deferred phaco. TRIAL REGISTRATION ( clinicaltrials.gov.br ): Ensaios clínicos brasileiros: RBR-3wmd9s; UTN number: U1111-1190-5013; Plataforma Brasil CAAE number: 50455415.3.0000.5440; IRB number: 1.433.000.
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18
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Tang YF, Chang A, Campbell WG, Connell PP, Hunyor AP, McAllister IL, Essex RW. SURGICAL MANAGEMENT OF TRAUMATIC MACULAR HOLE: Optical Coherence Tomography Features and Outcomes. Retina 2020; 40:290-298. [PMID: 31972799 DOI: 10.1097/iae.0000000000002382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the outcomes of eyes receiving surgical management for traumatic macular holes. To describe the preoperative and postoperative optical coherence tomography features of traumatic macular holes and to explore associations between preoperative clinical and optical coherence tomography features, and visual outcome. METHODS Retrospective study of patients undergoing vitrectomy for traumatic macular hole and entered into the Australian and New Zealand Society of Retinal Specialists surgical registry. Preoperative clinical data, surgical details, and 3-month postoperative outcomes were recorded prospectively. Longer-term outcomes at 12 months were requested retrospectively, as were preoperative and postoperative optical coherence tomography scans. RESULTS Hole closure was achieved in 91% (21/23) of patients with a single procedure. The average preoperative visual acuity was 20/120. At 3 months postoperatively, the mean visual acuity had improved to 20/70 (P < 0.001), 11/23 (48%) of eyes improved ≥15 letters, and the number of eyes with 20/40 acuity or better increased from 1/23 to 7/23. Eyes with worse visual outcomes (visual acuity < 20/80) had larger holes, worse preoperative acuity, and a greater extent of preoperative ellipsoid band attenuation than those with better postoperative visual acuity. CONCLUSION Eyes receiving surgical management for traumatic macular hole achieved good anatomical results and approximately half had a substantial improvement in acuity. Ellipsoid band attenuation on preoperative optical coherence tomography and worse preoperative acuity were associated with poorer visual outcomes.
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Affiliation(s)
- Yi Fan Tang
- Department of Ophthalmology, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Andrew Chang
- Vitreoretinal Unit, Sydney Eye Hospital, Sydney, New AU1 South Wales, Australia
| | - William G Campbell
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Paul P Connell
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alex P Hunyor
- Vitreoretinal Unit, Sydney Eye Hospital, Sydney, New AU1 South Wales, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University ofWestern Australia, Perth, Western Australia, Australia; and
| | - Rohan W Essex
- Department of Ophthalmology, Canberra Hospital, Garran, Australian Capital Territory, Australia
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Academic Unit of Ophthalmology, Australian National University, Acton, Australian
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19
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Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology 2019; 127:P184-P222. [PMID: 31757499 DOI: 10.1016/j.ophtha.2019.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
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20
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An Internal Limiting Membrane Plug and Gas Endotamponade for Recurrent or Persistent Macular Hole. J Ophthalmol 2019; 2019:6051724. [PMID: 30956814 PMCID: PMC6431435 DOI: 10.1155/2019/6051724] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/03/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.
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Ma Q, Fan F, Zhao Z, Jia Z. Combined phacoemulsification, 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for patients with coexisting idiopathic macular hole and age-associated cataract. Exp Ther Med 2019; 17:525-530. [PMID: 30651832 DOI: 10.3892/etm.2018.6963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/19/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to assess the curative effect of combined phacoemulsification, 23-gauge pars plana vitrectomy with Brilliant blue G-assisted limiting membrane peeling and gas tamponade in patients with coexisting idiopathic macular hole (IMH) and age-associated cataract. A total of 21 consecutive patients (21 eyes) with coexisting IMH and age-associated cataract were enrolled in the study. All patients were treated by 23-gauge microincision vitrectomy with internal limiting membrane peeling, gas tamponade and combined phacoemulsification. The pre-operative MH diameter, MH index and best-corrected visual acuity (BCVA), as well as events of post-operative MH closure and complications were recorded and analyzed. Anatomic closure of the MH was achieved in 19 eyes (90.4%) with a single surgery. The LogMAR BCVA value at 1 month after surgery and the final follow-up visit was significantly lower than the baseline value (P=0.0036 and P=0.0015, respectively). A significant correlation was identified between the MH index and the post-operative LogMAR BCVA (r=0.869; P<0.001). The combined technique applied in the present study produced favorable anatomic and functional results for patients with coexisting IMH and age-associated cataracts. The pre-operative MH size measured by optical coherence tomography may serve as a predictive factor for the LogMAR BCVA value following MH surgery.
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Affiliation(s)
- Qingmin Ma
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Fang Fan
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhihua Zhao
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhiyang Jia
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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A Combination of Surgical Techniques to Repair a Giant Traumatic Macular Hole. Case Rep Ophthalmol Med 2019; 2018:7595873. [PMID: 30627468 PMCID: PMC6304587 DOI: 10.1155/2018/7595873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
A 38-year-old man with a traumatic full-thickness macular hole (FTMH) presented to our eye casualty department with a sudden deterioration of his right eye vision to hand movements over the past one week. The suspected traumatic FTMH was present since he was 13 years old from a direct impact of a golf ball in his right eye and his best-corrected visual acuity (BCVA) has always remained at 1/60 Snellen vision. On examination, he had a very large FTMH measuring 1635 µm with central foveal retinal detachment. Pars plana vitrectomy combined with large inverted internal limiting membrane (ILM) peel flap, 5000 Cs silicone oil tamponade, and autologous platelets implantation was performed. Follow-up visits revealed that the FTMH was closed under silicone oil. The silicone oil was removed six months after the surgery and the FTMH remained close with the retina remaining attached. His BCVA was restored to his previous baseline level of 1/60 Snellen vision. With the advent of multiple techniques to repair FTMH such as the ILM flaps, we have combined this technique with older proven techniques such as silicone oil tamponade and autologous platelets implantation to close the giant traumatic FTMH. This case study demonstrates that combining techniques can help close a FMTH that is otherwise deemed impossible in the past.
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Bennis A, Chraibi F, Abdellaoui M, Benatiya AI, Lenoble P. [Prognostic factors for idiopathic macular hole surgery: Report of 107 eyes (Approach by univariate statistical analysis)]. J Fr Ophtalmol 2018; 42:153-158. [PMID: 30594417 DOI: 10.1016/j.jfo.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To identify prognostic factors influencing the success of idiopathic macular hole surgery, including initial visual acuity, hole size and stage, and type of gas used for tamponade. PATIENTS AND METHODS Retrospective single-center descriptive analysis of all patients with an idiopathic macular hole operated by the same surgeon, treated in the ophthalmology department of Mulhouse hospital, between January 2004 and July 2014. Patients whose functional and anatomical results could be confounded by the coexistence of other ocular pathologies and patients with secondary macular holes were excluded. RESULTS We included and followed 107 eyes of 104 patients for at least 6 months. Initial closure after the first surgery was obtained in 92 eyes (85.98 %), allowing 2 groups to be defined, the cases of success and failure. Initial visual acuity, hole size, stage according to Gass, Gaudric and IVTS classifications, and presence or absence of a PVD, were statistically significant prognostic factors (P<0.05) CONCLUSION: Our univariate statistical analysis identified multiple prognostic factors. These factors may predict success and the choice of surgical technique, including whether to peel the internal limiting membrane, the choice of gas for tamponade, and postoperative positioning.
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Affiliation(s)
- A Bennis
- Service d'ophtalmologie, hôpital Émile-Muller, GHR Mulhouse Sud Alsace, 68100 Mulhouse, France; Service d'ophtalmologie, hôpital Omar-Drissi, CHU Hassan II, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
| | - F Chraibi
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU Hassan II, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU Hassan II, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - A I Benatiya
- Service d'ophtalmologie, hôpital Omar-Drissi, CHU Hassan II, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - P Lenoble
- Service d'ophtalmologie, hôpital Émile-Muller, GHR Mulhouse Sud Alsace, 68100 Mulhouse, France
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The Manchester Large Macular Hole Study: Is it Time to Reclassify Large Macular Holes? Am J Ophthalmol 2018; 195:36-42. [PMID: 30071212 DOI: 10.1016/j.ajo.2018.07.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate anatomic and functional outcomes of full-thickness macular holes (FTMH) larger than 400 μm following vitrectomy, internal limiting membrane peel, gas tamponade, and face-down posturing. DESIGN A retrospective interventional case series. METHODS A total of 258 consecutive eyes with FTMH larger than 400 μm were enrolled at the Manchester Royal Eye Hospital study over a 5-year period from 2012 to 2017. All eyes underwent pars plana vitrectomy, ILM peel, and gas tamponade. Anatomic success rates were measured. A correlation between macular hole size and closure was evaluated. RESULTS A total of 258 eyes were analyzed. The anatomic closure rate was 89.92%. When divided into quartiles, the closure rate of FTMH was 98% (64/65) in the 400-477 μm quartile, 91% (59/65) in the 478-558 μm quartile, 94% (60/64) in the 559-649 μm quartile, and 76% (49/64) in the 650-1416 μm quartile. Using receiver operating characteristic and area under the curve analysis, the maximum sensitivity and specificity was obtained with a cutoff ≤ 630 μm (sensitivity 76.7%, specificity 69.2%) giving a Youden index (J) of 0.46. One hundred and forty-six eyes (56.6%) improved by 0.3 logMAR units from their preoperative best-corrected visual acuity at 3 months following surgery. CONCLUSION This study shows that standard FTMH surgical repair has very high success rate up to 650 μm. It may suggest that there is a need for a reclassification of large FTMH, and new surgical techniques such as internal limiting membrane flaps should be reserved for macular holes larger than 650 μm.
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Essex RW, Hunyor AP, Moreno-Betancur M, Yek JT, Kingston ZS, Campbell WG, Connell PP, McAllister IL, Allen P, Ambler J, Bourke R, Branley M, Buttery R, Campbell W, Chang A, Chauhan D, Chen F, Chen S, Clark B, Donaldson M, Downie J, Essex R, Evans K, Fabinyi D, Fleming B, Fung A, Gilhotra J, Gorbatov M, Groenveld E, Guest S, Hadden P, Hall AB, Heriot W, Ho IV, Hunyor A, Isaacs T, Jones A, Kwan T, Kang HK, Lake S, Lee L, Luckie A, McAllister I, McCombe M, McKay D, O’Rourke M, Park J, Phillips R, Reddie I, Roufail E, Saha N, Subramaniam D, Tsanaktsidis G, Vandeleur K, Vilacorta-Sandez, Welch S, Wong H, Yellachich D. The Visual Outcomes of Macular Hole Surgery: A Registry-Based Study by the Australian and New Zealand Society of Retinal Specialists. ACTA ACUST UNITED AC 2018; 2:1143-1151. [DOI: 10.1016/j.oret.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
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Yek JT, Hunyor AP, Campbell WG, McAllister IL, Essex RW, Luckie A, Hunyor A, Chang A, Kwan A, Clark B, Fleming B, Fabinyi D, Chauhan D, Roufail E, Chen F, Wong HC, Kang HK, McAllister I, Reddie I, Gilhotra J, Ambler J, Downie J, Evans K, Lee L, McCombe M, Branley M, Saha N, Allen P, Hadden P, Bourke R, Buttery R, Essex R, Phillips R, Chen S, Lake S, Campbell W, Heriot W. Outcomes of Eyes with Failed Primary Surgery for Idiopathic Macular Hole. ACTA ACUST UNITED AC 2018; 2:757-764. [DOI: 10.1016/j.oret.2017.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
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Papastefanou VP, Dooley I, Zambarakji H. Management of macular edema in vitrectomized patients with diabetes. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1465819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Vasilios P. Papastefanou
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
| | - Ian Dooley
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
| | - Hadi Zambarakji
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
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Wang W, He M, Zhong X. Sex-Dependent Choroidal Thickness Differences in Healthy Adults: A Study Based on Original and Synthesized Data. Curr Eye Res 2018; 43:796-803. [PMID: 29451995 DOI: 10.1080/02713683.2018.1428995] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to determine the influence of sex on choroidal thickness (CT) in healthy adults. METHODS Healthy Chinese adults were recruited and complete ophthalmic examinations were performed. The choroid was imaged by swept-source optical coherence tomography and the macular CT in Early Treatment Diabetic Retinopathy Study grids was obtained by the intrinsic automated segmentation software. CT in males and females was compared after controlling other factors. All of the published studies in PubMed were systemically tracked, and a syntheses analysis of the combined data of the present study and previous studies was performed to address this issue further. RESULTS A total of 104 healthy adults were included, of whom 38 (37%) were male and 66 (63%) were female. Older age and longer axial length (AL) each were significantly associated with thinner CT. After controlling for age and AL, the foveal CT and average macular CT were 25.5 μm (95% CI: 0.5-50.4 μm) and 22.1 μm (95% CI: 2.7-41.4 μm) thicker in men than in women, respectively. Significant differences in CT between males and females were also observed in inner and outer rings after controlling for age and AL (P < 0.05). After strict screening, 15 previously reported studies were determined to be eligible for inclusion. The combination of data collected from 2821 males and 3389 females provided further evidence that the choroid is thicker in males, with a pooled mean difference of 19.5 μm (95% CI: 11.4 to 27.6) for foveal CT and 14.7 μm (95% CI: 6.8 to 22.6) for average CT. CONCLUSION Our study of Chinese subjects, along with the syntheses analysis, strengthens the evidence that CT is greater in males than in females, based on OCT measurements. This observation may be pertinent for the sex disparities in some clinical conditions related to CT.
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Affiliation(s)
- Wei Wang
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
| | - Miao He
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
| | - Xingwu Zhong
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
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Jenisch TM, Zeman F, Koller M, Märker DA, Helbig H, Herrmann WA. Macular hole surgery: an analysis of risk factors for the anatomical and functional outcomes with a special emphasis on the experience of the surgeon. Clin Ophthalmol 2017; 11:1127-1134. [PMID: 28652700 PMCID: PMC5476441 DOI: 10.2147/opth.s125561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate risk factors for the anatomical and functional outcomes of macular hole (MH) surgery with special emphasis on the experience of the surgeon. Methods A total of 225 surgeries on idiopathic MHs (IMHs) performed by 6 surgeons with a mean follow-up period of 20.5 months were reviewed in this retrospective study. Outcome parameters focused on IMH closure, complications and visual acuity improvement. The results of MH surgeries performed by experienced surgeons were compared to those of surgeons in training. Results The average MH size was 381 µm (standard deviation [SD]=168). Brilliant blue G (BBG) for internal limiting membrane (ILM) staining was used in 109 (48%) eyes and indocyanine green (ICG) in 116 (52%) eyes. As endotamponade, 20% SF6 was used in 38 (17%) cases, 16% C2F6 in 33 (15%) cases and 16% C3F8 in 154 (68%) cases. IMH closure was achieved in 194 eyes (86%). Mean preoperative visual acuity was 0.84 logarithm of the minimum angle of resolution (log MAR; SD=0.29, range: 0.3–1.5); surgery led to a mean improvement of 0.40 (SD=0.37) log MAR. Although the MH closure rate was the same using BBG or ICG for ILM peeling, visual acuity improvement was better in eyes peeled with BBG compared to eyes peeled with ICG (log MAR: BBG: 0.38 [95% CI: 0.32, 0.44] vs ICG: 0.48 [95% CI: 0.42, 0.54], P=0.029). Surgeons with previous experience in vitreoretinal surgery of ≥6 years achieved better visual outcomes compared to surgeons with 0–3 years of experience, regardless of the MH size, preoperative visual acuity, time to follow-up or dye used for ILM peeling (0–3 years [0.27, Δlog MAR] vs ≥6 years [0.43, Δlog MAR], P=0.009). Conclusion Our results indicate that vitrectomy with ILM peeling performed by non-experienced surgeons is a safe procedure leading to good anatomical and functional results. Very experienced surgeons may achieve even better functional outcomes.
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Affiliation(s)
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg
| | | | | | - Wolfgang A Herrmann
- Department of Ophthalmology.,Department of Ophthalmology, St John of God Hospital, Regensburg, Germany
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Outcome of 2 cc pure sulfur hexafluoride gas tamponade for macular hole surgery. BMC Ophthalmol 2016; 16:73. [PMID: 27255461 PMCID: PMC4891936 DOI: 10.1186/s12886-016-0254-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/24/2016] [Indexed: 11/28/2022] Open
Abstract
Background Isoexpansile concentrations of intraocular gases are typically used as tamponading agent in macular hole surgery. Using a small volume of the pure form of these gases may achieve the same result without increasing the incidence of postoperative complications. The purpose of this study was to evaluate the anatomical and visual outcomes following macular hole surgery with 2 cc pure (100 %) sulfur hexafluoride (SF6) gas tamponade. Methods A retrospective study of eyes with idiopathic macular holes that underwent 23-gauge pars plana vitrectomy with 2 cc pure SF6 gas tamponade. Macular hole surgery was performed alone or in combination with phacoemulsification in eyes with cataract. Preoperative and postoperative data including best corrected visual acuity recorded in LogMAR units, slit-lamp biomicroscopy, and optical coherence tomography were analysed. Surgical complications were also recorded. Results Seventy six eyes of seventy five patients were analysed. A closure rate of 100 % was achieved with reoperation in 4 eyes. There was a significant improvement in best-corrected visual acuity from a mean of 0.65 LogMAR preoperatively to 0.36 at 6 months (p value 0.004). Forty five (59 %) eyes gained at least 2 lines on the Snellen visual acuity chart. Postoperative elevation in intraocular pressure (≥30 mmHg) was documented in 3 eyes (4 %). Conclusion Macular hole surgery with 2 cc pure SF6 gas tamponade achieved a high success rate with a low incidence of complications. The smaller volume of gas required makes it a cheaper technique. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0254-9) contains supplementary material, which is available to authorized users.
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Abstract
PURPOSE To report a case of full-thickness macular hole in a patient with X-linked retinoschisis and the outcome after surgical repair. METHODS A 15-year-old boy with a history of X-linked retinoschisis presented to his ophthalmologist for routine follow-up and was found to have a Stage-3 macular hole in his left eye. His vision was 20/200. The patient underwent pars plana vitrectomy and internal limiting membrane peeling, and he received long-acting gas. Color fundus photography and spectral domain optical coherence tomography (Cirrus; Carl Zeiss Meditech Inc, Dublin, CA) recorded images at office visits, before and after surgical repair. RESULTS The initial spectral domain optical coherence tomography of the left eye showed a full-thickness macular hole of 1,370 μm in diameter as well as schisis cavities in the macula. After pars plana vitrectomy and repeat fluid-gas exchange, the hole was closed at the sixth-week follow-up visit. The patient noted a subjective decrease in the size of a central scotoma. Best-corrected visual acuity returned to the baseline of 20/80. CONCLUSION A large full-thickness macular hole can develop in X-linked retinoschisis, and pars plana vitrectomy with internal limiting membrane peeling may be helpful for successful surgical closure.
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Abstract
This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.
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Affiliation(s)
- Haifa A Madi
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK
| | - Ibrahim Masri
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, Newcastle University, International Centre for Life, Newcastle, UK; Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK
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Vaziri K, Schwartz SG, Kishor KS, Fortun JA, Moshfeghi AA, Smiddy WE, Flynn HW. Rates of Reoperation and Retinal Detachment after Macular Hole Surgery. Ophthalmology 2015; 123:26-31. [PMID: 26505804 DOI: 10.1016/j.ophtha.2015.09.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/04/2015] [Accepted: 09/13/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate rates of reoperation and retinal detachment (RD) after macular hole surgery. DESIGN Retrospective cross-sectional study. PARTICIPANTS Patients in the insurance claim-based MarketScan databases from 2007 through 2013 with a record of macular hole surgery. METHODS Patients with macular hole surgery were identified. Cases of definite (the same eye was coded both times) and presumed (the eye laterality was not coded) macular hole reoperations within 2, 3, and 12 months were queried. In addition, cases of postoperative RD within 2, 3, and 12 months were captured. MAIN OUTCOME MEASURES Rates of macular hole reoperation and postoperative RD, including subgroup analysis based on presence or absence of internal limiting membrane (ILM) peeling. RESULTS Records of 23465 macular hole surgeries among 20 764 patients were analyzed. Among presumed reoperations, the rates of reoperation were 4.3% (4.1% after ILM peeling and 5.0% after no ILM peeling; P = 0.01) within 2 months of surgery, 5.5% (5.3% after ILM peeling and 6.2% after no ILM peeling; P = 0.03) within 3 months of surgery, and 9.5% (9.0% after ILM peeling and 11.0% after no ILM peeling; P = 0.01) within 12 months of surgery. The rates for definite reoperations were 1.3% (1.2% after ILM peeling and 1.8% after no ILM peeling; P = 0.04) at 2 months, 1.7% (1.6% after ILM peeling and 2.5% after no ILM peeling; P = 0.004) at 3 months, and 4.1% (3.3% after ILM peeling and 7.5% after no ILM peeling; P < 0.001) at 12 months. The cumulative rate of postoperative RD was 1.81±0.09% to 2.18±0.5% after 2 months, 2.27±0.10% to 3.18±0.67% after 3 months, and 3.92±0.16% to 5.70±1.1% after 12 months. Internal limiting membrane peeling was associated negatively with postoperative RD at 2 months (2.3% vs. 1.7%; P = 0.007), 3 months (2.8% vs. 2.1%; P = 0.004), and 12 months (4.7% vs. 3.3%; P < 0.001). CONCLUSIONS In this sample, reoperations for macular hole were performed at low rates. Internal limiting membrane peeling was associated with lower rates of reoperation and RD.
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Affiliation(s)
- Kamyar Vaziri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - Krishna S Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew A Moshfeghi
- Department of Ophthalmology, USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Dihowm F, MacCumber M. Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole. Int J Retina Vitreous 2015; 1:6. [PMID: 27847599 PMCID: PMC5066517 DOI: 10.1186/s40942-015-0007-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/26/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice. Methods In this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy. Results The MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\126 (20 gauge), 20\100 (23 gauge), and 20\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\60 (20 gauge), 20\69 (23 gauge), and 20\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053). Conclusion Based on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.
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Affiliation(s)
- Fatma Dihowm
- grid.240684.c0000000107053621Graduate College, Rush University Medical Center, Chicago, IL USA
| | - Mathew MacCumber
- grid.240684.c0000000107053621Department of Ophthalmology, Rush University Medical Center, Chicago, IL USA
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Amoaku W, Cackett P, Tyagi A, Mahmood U, Nosek J, Mennie G, Rumney N. Redesigning services for the management of vitreomacular traction and macular hole. Eye (Lond) 2015; 28 Suppl 1:S1-10. [PMID: 25008433 PMCID: PMC4097190 DOI: 10.1038/eye.2014.125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey—from initial referral to treatment—taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.
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Affiliation(s)
- W Amoaku
- Faculty of Medicine and Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - P Cackett
- Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - A Tyagi
- Birmingham and Midlands Eye Centre and Sandwell General Hospital, Birmingham, UK
| | - U Mahmood
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - J Nosek
- Wolverhampton Eye Infirmary, Wolverhampton, UK
| | - G Mennie
- Gloucestershire Clinical Commissioning Group, Brockworth, UK
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Abstract
PURPOSE An uncommon late complication after successful initial surgical closure of a full-thickness macular hole is reopening. METHODS A retrospective interventional case report. RESULTS A 58-year-old pseudophakic woman presented with 6 weeks of decreased vision in her right eye. She was found to have a full-thickness macular hole, which was successfully repaired through pars plana vitrectomy, epiretinal membrane peeling, gas-fluid exchange with 25% SF6, and 7 days of face-down positioning. Twelve years later, she presented with new metamorphopsia and visual acuity of 20/50 in the right eye. Examination revealed reopening of the macular hole. CONCLUSION Despite high rates of surgical success, the reopening of initially closed macular holes can occur at any time postoperatively but has been reported more frequently in the first few months, though late reopenings have been observed. This is the latest reopening of a macular hole reported in the literature, occurring 12 years after initial successful surgical closure. This case highlights the importance of long-term follow-up and raises questions about why macular holes can reopen so late after initial successful closure.
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Spontaneous closure of an idiopathic macular hole 9 months after unsuccessful vitreoretinal surgery. Retin Cases Brief Rep 2014; 8:157-60. [PMID: 25372427 DOI: 10.1097/icb.0000000000000030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report spontaneous closure of a persistent idiopathic macular hole (MH) 9 months after cataract and vitreoretinal surgery, and subsequent gas reinjection. METHODS Baseline and follow-up examinations after surgery included slit-lamp biomicroscopy, best-corrected distance visual acuity and near visual acuity, spectral domain optical coherence tomography, and microperimetry. RESULTS Spectral domain optical coherence tomography scans showed a persistent MH after surgery until 5 months of follow-up, with an increasing base diameter of the MH and decreasing best-corrected visual acuity. Nine months after surgery, spontaneous closure of the MH with an improvement in best-corrected visual acuity was observed. These findings remained stable at 15 months of follow-up, with an additional increase in retinal sensitivity. CONCLUSION Spontaneous closure of a persistent Stage 3 full-thickness MH after primary surgery is possible. We recommend follow-up examinations including spectral domain optical coherence tomography for several months before scheduling a reoperation.
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Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond) 2014; 27 Suppl 1:S1-21. [PMID: 24108069 PMCID: PMC3797995 DOI: 10.1038/eye.2013.212] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.
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Che X, He F, Lu L, Zhu D, Xu X, Song X, Fan X, Wang Z. Evaluation of secondary surgery to enlarge the peeling of the internal limiting membrane following the failed surgery of idiopathic macular holes. Exp Ther Med 2014; 7:742-746. [PMID: 24520279 PMCID: PMC3919896 DOI: 10.3892/etm.2014.1477] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 12/23/2013] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to evaluate the clinical results of pars plana vitrectomy (PPV) combined with the surgical enlargement of internal limiting membrane (ILM) peeling in patients who had previously undergone failed idiopathic macular hole (IMH) surgery. In the study, 134 eyes from 130 IMH patients who had received PPV combined with ILM peeling surgery (2 disk diameters) were analyzed. Within this cohort, 14 eyes had IMHs that were not closed, of which 13 eyes underwent a second surgery involving enlargement of the ILM peeling. The extent of the ILM peeling was increased to the vascular arcades of the posterior fundus in the secondary surgery. Of the 13 eyes that underwent secondary surgery, five were in stage III and nine were in stage IV. The second surgery successfully achieved IMH closure in 61.5% (8/13) of the eyes. The IMH was completely closed following surgery and the logMAR vision increased from 0.98 to 0.84 (P=0.013) in the 8 successfully treated cases. The surgical enlargement of ILM peeling closed the IMHs and improved vision in the majority of patients. In addition, the procedures were safe. Therefore, the results of the present study indicate that enlargement of ILM peeling may be an effective therapy for patients who have previously undergone the failed surgical correction of an IMH.
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Affiliation(s)
- Xin Che
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China ; Key Laboratory of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Fanglin He
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Linna Lu
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Dongqing Zhu
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Xiaofang Xu
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Xin Song
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Xianqun Fan
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
| | - Zhiliang Wang
- Department of Ophthamology, Ninth People's Hospital Affliated with Shanghai Jiaotong University, Shanghai 200011, P.R. China
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Wu CM, Yeh PT, Yang CH, Chen MS, Yang CM. Comparison of triamcinolone and VisCoat in indocyanine-green-assisted internal-limiting-membrane peeling in macular hole surgery. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes. Eye (Lond) 2012; 27:72-7. [PMID: 23154500 DOI: 10.1038/eye.2012.227] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess and compare the complications and long-term visual and anatomical outcomes of 20- and 23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair. METHODS A retrospective, consecutive, interventional case series of 72 eyes with idiopathic macular holes were managed with 20-gauge PVT (n=36) or 23-gauge PVT (n=36). All patients underwent a posterior-chamber intra-ocular lens implantation and internal-limiting-membrane peel with the aid of either trypan blue or brilliant blue G(250) dyes. RESULTS The macular hole closure rate was 97% with 20-gauge PVT and 100% with 23-gauge PVT. Mean follow-up was 24.06 (±12.83) months with 20-gauge PVT and 17.47 (±5.79) with 23-gauge PVT. Mean visual acuity improvement in LogMar was 0.41 (±0.32) with 20-gauge PVT and 0.52 (±0.25) with 23-gauge PVT (P=0.135). The incidence of retinal breaks was higher with the 20-gauge PVT compared with the 23-gauge PVT, occurring in 13 (36.1%) and 4 (11.1%) cases, respectively (P=0.025). There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day 1, was significantly higher with 20-gauge PVT at 24.77 (±12.68) mm Hg compared with 17.20 (±6.95) mm Hg in 23-gauge PVT (P=0.0028). Operating times were longer in 20-gauge PVT at 89.36 (±15.26) min compared with the 23-gauge PVT at 79.33 (±23.82) min (P=0.04). CONCLUSION The 20-gauge PVT compared with 23-gauge PVT for macular hole repair is a slightly longer procedure and was associated with an increased incidence of retinal breaks and short-term elevated IOP. Both techniques have comparable visual and anatomical outcomes, but the 23-gauge PVT has advantages with regard to safety profile and operating time.
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Effect of preoperative retinal sensitivity and fixation on long-term prognosis for idiopathic macular holes. Graefes Arch Clin Exp Ophthalmol 2012; 250:1587-96. [DOI: 10.1007/s00417-012-1997-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/15/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022] Open
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Bezatis A, Laufenböck C, Zehetner C, Kieselbach G, Kralinger M. Makulaforamenchirurgie: Funktionelles und anatomisches Outcome. SPEKTRUM DER AUGENHEILKUNDE 2011. [DOI: 10.1007/s00717-011-0035-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanisoglu H, Sevim MS, Aktas B, Sevim S, Nohutcu A. Outcomes of 23-gauge pars plana vitrectomy and internal limiting membrane peeling with brilliant blue in macular hole. Clin Ophthalmol 2011; 5:1177-83. [PMID: 21887101 PMCID: PMC3162299 DOI: 10.2147/opth.s22381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose: The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV). Materials and methods: Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients. Results: The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed. Conclusion: PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.
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Affiliation(s)
- Huseyin Sanisoglu
- Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology
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Le Rouic JF, Becquet F, Ducournau D. DOES 23-GAUGE SUTURELESS VITRECTOMY MODIFY THE RISK OF POSTOPERATIVE RETINAL DETACHMENT AFTER MACULAR SURGERY? Retina 2011; 31:902-8. [DOI: 10.1097/iae.0b013e3182069aa4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muselier A, Dugas B, Burelle X, Passemard M, Hubert I, Mathieu B, Berrod JP, Bron AM, Creuzot-Garcher C. Macular hole surgery and cataract extraction: combined vs consecutive surgery. Am J Ophthalmol 2010; 150:387-91. [PMID: 20615492 DOI: 10.1016/j.ajo.2010.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/11/2010] [Accepted: 04/12/2010] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare the functional and the anatomic outcomes of a combined surgery and consecutive surgery for macular hole and cataract extraction. DESIGN Multicenter, retrospective, comparative case series. PATIENTS One hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 64) and consecutive surgery (n = 56) were performed between 2006 and 2007. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity at 6 and 12 months, and the rate of closure of macular hole evaluated with optical coherence tomography. RESULTS After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). However the improvement of far visual acuity was not significant in the consecutive surgery group at 6 months (P = .06) while such an improvement was observed in the combined surgery group (P < .0001). The rates of closure, 100% and 96% in the combined and the consecutive groups respectively, and the complications did not differ significantly between groups. CONCLUSION Both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract with equivalent functional and anatomic results in both procedures. However, combined surgery shortened the delay for visual recovery.
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