1
|
McCabe GA, Zaidi SBH, O'Riordan MM, Kennelly KP. Surgery for idiopathic full-thickness macular holes within four months of symptom onset yields superior visual outcomes: Results from an Irish patient cohort. Ir J Med Sci 2024; 193:1665-1670. [PMID: 38114866 DOI: 10.1007/s11845-023-03592-3] [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: 10/18/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To describe the anatomical, visual, and safety results of full-thickness macular hole (FTMH) repair surgery and determine factors influencing outcomes. PATIENTS AND METHODS A retrospective chart review was performed on all patients who underwent primary FTMH repair surgery by a single surgeon over a 3-year period. For comparisons, Snellen visual acuity (VA) was converted to logMAR equivalent. Anatomical hole closure, visual improvement, and final VA of ≤ 0.30 logMAR were the primary outcome measures. RESULTS Twenty eyes of 19 patients were included. Mean patient age was 69 years (range 55 to 80 years) and 74% were female. Mean minimum linear diameter (MLD) was 440 μm (range 170 μm to 1200 μm). Mean duration of symptoms before surgery was 16 weeks (range 3 to 39 weeks). 100% of eyes achieved successful anatomical FTMH closure. Mean VA improved from 1.03 ± 0.43 logMAR (Snellen 6/60) preoperatively to 0.35 ± 0.22 logMAR (Snellen 6/15) postoperatively (p = 0.0001). Patients with worse preoperative VA gained more vision than those with better preoperative VA (p = 0.01). Eyes operated on within 4 months of symptom onset were more than twice as likely to achieve a postoperative VA of ≤ 0.30 logMAR (Snellen 6/12 or better) compared to eyes with a longer duration of symptoms (p = 0.03). CONCLUSION FTMH repair surgery was safe and effective, with outcomes comparing favourably with published international studies. All patients benefited from surgery regardless of symptom duration, presenting VA or FTMH size. However, surgery performed within 4 months of symptom-onset was particularly beneficial, highlighting the need for prompt referral and surgery.
Collapse
Affiliation(s)
- Grace A McCabe
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland.
| | | | - Matthew M O'Riordan
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
| | - Kevin P Kennelly
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
2
|
Li JQ, Hattenbach LO, Lommatzsch A, Priglinger SG, Krohne TU. [Macular hole: Differential diagnosis, treatment options and new guideline recommendations]. DIE OPHTHALMOLOGIE 2024; 121:462-469. [PMID: 38775987 DOI: 10.1007/s00347-024-02047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 06/19/2024]
Abstract
Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If diagnosed and treatment is initiated at an early stage, surgery has a high success rate with respect to both hole closure and improvement of visual acuity. Optical coherence tomography (OCT)-based staging and sizing enables an estimation of the surgical outcome. The differential diagnostic distinction from clinically similar disorders, such as lamellar macular holes, macular pseudoholes, and foveoschisis is clinically relevant as the pathogenesis, prognosis and treatment are significantly different. While vitrectomy with peeling of the inner limiting membrane (ILM) and gas tamponade is established as the standard treatment for FTMH, some aspects of treatment are handled differently between surgeons, such as the timing of surgery, the choice of endotamponade and the type and duration of postoperative positioning. For FTMH associated with vitreomacular traction, alternative treatment options in addition to vitrectomy include intravitreal ocriplasmin injection and pneumatic vitreolysis. The current clinical guidelines of the German ophthalmological societies summarize the evidence-based recommendations for diagnosis and treatment of FTMH.
Collapse
Affiliation(s)
- Jeany Q Li
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | | | | | | | - Tim U Krohne
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.
| |
Collapse
|
3
|
Lee SM, Lee JW, Lee JE, Choi HY, Lee JS, Byon I. Efficacy of inverted inner limiting membrane flap technique for macular holes of ≤400 μm: A systematic review and meta-analysis. PLoS One 2024; 19:e0302481. [PMID: 38683767 PMCID: PMC11057726 DOI: 10.1371/journal.pone.0302481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To evaluate the efficacy of inverted internal limiting membrane (ILM) flap technique in full-thickness macular holes (MHs) with a size of ≤400 μm compared to the ILM peeling technique. METHODS Related literatures that compared inverted ILM flap and ILM peeling in MHs ≤ 400 μm were reviewed by searching electronic databases including Pubmed, EMbase, ClinicalTrials.gov, and Cochrane Library up to April 2023. The primary outcome measure was hole closure rate, and the secondary outcome measures were the mean postoperative best-corrected visual acuity (BCVA), retinal sensitivity, and outer status of the retinal layers, including the external limiting membrane and ellipsoid zone. The quality of the articles was assessed according to the revised version of the Cochrane risk-of-bias tool for randomized trials or the Newcastle-Ottawa scale. In the case of heterogeneity, a sensitivity analysis was conducted, and publication bias was visually evaluated using a funnel plot. RESULTS This review included six studies with 610 eyes for the primary outcome and 385 eyes for the secondary outcomes, which were two randomized control trials and four retrospective studies. Pooled data revealed that the overall MH closure rate was 99.4% in the inverted ILM flap group and 96.2% in the ILM peeling group, without significant difference between the two groups (odds ratio = 3.91; 95% confidence interval, 0.82~18.69; P = 0.09). The inverted ILM flap technique did not have a favorable effect on the BCVA, retinal sensitivity, or recovery of the outer retinal layers. These results were consistent with those of the subgroup analysis of the different follow-up periods. No significant publication bias was observed. CONCLUSION In eyes with MHs of ≤400 μm, both techniques demonstrated excellent surgical outcomes without significant differences. Therefore, surgical techniques can be selected according to surgeon preferences.
Collapse
Affiliation(s)
- Seung Min Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Pusan National University School of Medicine, Yangsan, South Korea
| | - Ji Woong Lee
- Pusan National University School of Medicine, Yangsan, South Korea
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Pusan National University School of Medicine, Yangsan, South Korea
| | - Hee-young Choi
- Pusan National University School of Medicine, Yangsan, South Korea
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jong Soo Lee
- Pusan National University School of Medicine, Yangsan, South Korea
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Iksoo Byon
- Pusan National University School of Medicine, Yangsan, South Korea
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| |
Collapse
|
4
|
Sato M, Iwase T. Swept Source-Optical Coherence Tomography-Guided Facedown Posturing to Minimize Treatment Burden and Maximize Outcome after Macular Hole Surgery. J Clin Med 2023; 12:5282. [PMID: 37629324 PMCID: PMC10455272 DOI: 10.3390/jcm12165282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
We evaluated the closure of full-thickness macular holes (MHs) the day after surgery in minimizing the burden and maximizing patient outcomes. Herein, 25-gauge pars plana vitrectomy, internal limiting membrane peeling, and fluid-gas (20% sulfur hexafluoride) were performed for the treatment. Patients were instructed to remain in the facedown position until the confirmation of MH closure, and the position was discontinued in cases where the closure was confirmed. In total, 43 eyes of 43 patients, whose average age was 69.7 ± 8.6 years, were enrolled in this study. We used swept source (SS)-optical coherence tomography (OCT) for the confirmation of MH closure for gas-filled eyes and used spectral domain (SD)-OCT for the reconfirmation of MH closure after the gas volume was reduced to less than half of the vitreous cavity. MH closure was confirmed in 40 eyes (93%, the closure group) on the next day after surgery. The time from surgery to SS-OCT imaging was 24.7 h. Although facedown positioning was terminated in cases where MH closure was confirmed, there were no cases in which the MH was re-opened afterward. The basal and minimum MH size was significantly larger in the non-closure group than that in the closure group (p = 0.027, p = 0.043, respectively). Therefore, checking with SS-OCT the day after surgery and terminating facedown positioning in cases where MH closure was confirmed would be a useful method, removing a great burden for the elderly without sacrificing the MH closure rate.
Collapse
Affiliation(s)
| | - Takeshi Iwase
- Department of Ophthalmology, Akita University Graduate School of Medicine, Akita 010-8543, Japan;
| |
Collapse
|
5
|
Murphy DC, Al-Zubaidy M, Lois N, Scott N, Steel DH. The Effect of Macular Hole Duration on Surgical Outcomes: An Individual Participant Data Study of Randomized Controlled Trials. Ophthalmology 2023; 130:152-163. [PMID: 36058348 DOI: 10.1016/j.ophtha.2022.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023] Open
Abstract
TOPIC To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). CLINICAL RELEVANCE Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. METHODS A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. RESULTS Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. CONCLUSIONS Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
Collapse
Affiliation(s)
- Declan C Murphy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mo Al-Zubaidy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Noemi Lois
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom
| | - David H Steel
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom; Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, United Kingdom.
| | | |
Collapse
|
6
|
Ach T, Agostini H, Claessens D, Gehrig C, Hattenbach LO, Lommatzsch A, Ostrowski A, Schumann RG. [Macular hole and vitreomacular traction : S1 guideline of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 22 September 2022]. DIE OPHTHALMOLOGIE 2023; 120:1-14. [PMID: 36512120 DOI: 10.1007/s00347-022-01774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
|
7
|
Pradhan D, Agarwal L, Joshi I, Kushwaha A, Aditya K, Kumari A. Internal limiting membrane peeling in macular hole surgery. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc07. [PMID: 35813123 PMCID: PMC9204259 DOI: 10.3205/000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
Collapse
Affiliation(s)
- Deepti Pradhan
- Kirtipur Eye Hospital, Department of Vitreoretinal Services, Kirtipur, Nepal,*To whom correspondence should be addressed: Deepti Pradhan, Kirtipur Eye Hospital, Department of Vitreoretinal Services, Tahalcha, Tinkune, 44618 Kirtipur-10, Nepal, Phone: +977 9808119112, E-mail:
| | - Lalit Agarwal
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Ichhya Joshi
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Anamika Kushwaha
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | | | | |
Collapse
|
8
|
Dervenis N, Dervenis P, Sandinha T, Murphy DC, Steel DH. Intraocular Tamponade Choice with Vitrectomy and Internal Limiting Membrane Peeling for Idiopathic Macular Hole: A Systematic Review and Meta-analysis. Ophthalmol Retina 2022; 6:457-468. [PMID: 35144020 DOI: 10.1016/j.oret.2022.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
TOPIC A variety of different tamponade agents are used with vitrectomy combined with internal limiting membrane (ILM) peeling for the treatment of idiopathic macular holes. These agents include air, gas (sulfur hexafluoride [SF6], hexafluoroethane [C2F6], and perfluoropropane [C3F8]), and silicone oil. The optimal tamponade agent is uncertain, and we aimed to review the effect of tamponade choice on hole closure and visual outcomes. CLINICAL RELEVANCE Although most surgeons initially chose to use long-acting gas (C3F8), there has been a gradual change in practice to the increasing use of the medium- (C2F6) and short-acting gases (SF6) or even air. However, there is no consensus regarding their relative efficacies. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies comparing different tamponade agents in patients undergoing vitrectomy and ILM peeling for primary idiopathic macular holes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, whereas for nonrandomized studies, the Risk of Bias in Nonrandomized Studies of Interventions tool was used. RESULTS Thirteen publications, including 2 RCTs, were identified. Overall, there was no significant difference in the anatomic closure rates between studies using SF6 compared with either C3F8 or C2F6 (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.51-1.08). A subgroup analysis showed a significantly higher closure rate using SF6 (OR = 0.49; 95% CI = 0.30-0.79) in patients without postoperative posturing but not in those who were advised to posture facedown. The visual outcomes and adverse events were not significantly different. The comparisons of anatomic closure rates of patients treated with gas tamponade vs. silicone oil and with air vs. SF6 showed no significant differences. The included studies had a number of methodological limitations and heterogeneities, making conclusions imprecise, with low or very low certainty by the Grades of Recommendation, Assessment, Development and Evaluation approach. CONCLUSION The current evidence base for tamponade selection with vitrectomy and ILM peeling for full-thickness macular hole has several major limitations. Further appropriately designed studies are needed to guide tamponade selection.
Collapse
Affiliation(s)
- Nikolaos Dervenis
- 1st Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Clinical Directorate Professional Services, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Panagiotis Dervenis
- Laboratory of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
| | - Teresa Sandinha
- St Paul's Eye Department, Liverpool University Hospitals, Liverpool, United Kingdom; Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Declan C Murphy
- Sunderland Eye Infirmary, Sunderland, United Kingdom; Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - David H Steel
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom; Sunderland Eye Infirmary, Sunderland, United Kingdom; Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| |
Collapse
|
9
|
Sharpless M, Hogden M. Full-Thickness Macular Hole Closure Following a Single Intravitreal Injection of Aflibercept in an Eye With Diabetic Macular Edema. JOURNAL OF VITREORETINAL DISEASES 2022; 6:457-460. [PMID: 37009537 PMCID: PMC9954781 DOI: 10.1177/24741264221083415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aims to discuss the case of a 32-year-old man with diabetic macular edema (DME) who underwent successful treatment of a full-thickness macular hole (FTMH) with a single dose of aflibercept. Methods: A case report is presented. Results: A 32-year-old man with reduced vision and DME in the right eye was found to have a FTMH. The patient was scheduled for pars plana vitrectomy; however, following a single dose of intravitreal aflibercept, the FTMH closed and the patient avoided surgical intervention. Conclusions: FTMH formation in DME is a rare complication that typically requires surgical intervention. We present a case of FTMH closure after a single dose of intravitreal aflibercept, which to our knowledge is the first of its kind. This report highlights the importance of considering conservative treatment initially to avoid surgery.
Collapse
Affiliation(s)
- Michael Sharpless
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Hogden
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| |
Collapse
|
10
|
Cheng D, Tao JW, Yu XT, Chen YQ, Shen MX, Wu MH, Yu JF, Lian HL, Lu Z, Shen LJ. Characteristics of macular microvasculature before and after idiopathic macular hole surgery. Int J Ophthalmol 2022; 15:98-105. [PMID: 35047363 DOI: 10.18240/ijo.2022.01.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the macular microvasculature before and after surgery for idiopathic macular hole (MH) and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration. METHODS Twenty eyes from 20 patients with idiopathic MH were enrolled. Optical coherence tomography angiography (OCTA) images were obtained before, 2wk, 1, and 3mo after vitrectomy with internal limiting membrane peeling. Preoperative foveal avascular zone (FAZ) area and perimeter and regional vessel density (VD) in both layers were compared according to the 3-month best-corrected visual acuity (BCVA). RESULTS The BCVA improved from 0.98±0.59 (logMAR, Snellen 20/200) preoperatively to 0.30±0.25 (Snellen 20/40) at 3mo postoperatively. The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group (all P<0.05). A significant reduction was observed in FAZ parameters and all VDs 2wk postoperatively. Except for deep perifoveal VD, all VDs recovered only to their preoperative values. The postoperative FAZ parameters were lower during follow-up. Decreases in preoperative deep VDs were correlated with worse postoperative BCVA (Pearson's r=-0.667 and -0.619, respectively). A larger FAZ perimeter (Spearman's r=-0.524) and a lower deep perifoveal VD preoperatively (Pearson's r=0.486) were associated with lower healing stage. CONCLUSION The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH. Except for the deep perifoveal region, VD recovers only to preoperative levels.
Collapse
Affiliation(s)
- Dan Cheng
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Ji-Wei Tao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Xue-Ting Yu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Yi-Qi Chen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Mei-Xiao Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Min-Hui Wu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Jia-Feng Yu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Heng-Li Lian
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Zhe Lu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Li-Jun Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
| |
Collapse
|
11
|
Ahmed Khan S, Goldsmith C, Thandar So M. Aspiration of viscous plug in macular hole surgery: a case series. Ther Adv Ophthalmol 2022; 14:25158414211063288. [PMID: 35071982 PMCID: PMC8771736 DOI: 10.1177/25158414211063288] [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: 05/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Macular hole surgery has been revolutionized since the 1990s’ with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.
Collapse
Affiliation(s)
- Shaheryar Ahmed Khan
- Ophthalmology Department, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK
| | - Craig Goldsmith
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK
| | - Mya Thandar So
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK
| |
Collapse
|
12
|
Li K, Zhou Y, Yang W, Jiang Q, Xu X. Modified internal limiting membrane flap technique for large chronic macular hole: Two case reports. Medicine (Baltimore) 2022; 101:e28412. [PMID: 35029885 PMCID: PMC8735802 DOI: 10.1097/md.0000000000028412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Internal limiting membrane (ILM) peeling and gas tamponade are the standardized treatments for macular holes (MHs). However, the close rate is low, and postoperative vision is unsatisfactory in large, chronic MHs. Currently, various modifications of the ILM flap techniques are being gradually applied for large MHs in the hope of obtaining better postoperative effects. This study described 2 successful cases achieved by "Sandwich-type" modified ILM flap covering technique in patients with large, chronic MHs. PATIENT CONCERNS A 62-year-old woman presented with decreased vision and visual distortion of the left eye for 18 months. Optical coherence tomography (OCT) showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 742 μm and a base diameter of 1630 μm. A 57-year-old man experienced decreased visual acuity for 8 months. OCT showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 713 μm and a basal diameter of 939 μm. DIAGNOSES Two patients were diagnosed with large, chronic MH based on the OCT results and duration of the hole. INTERVENTIONS The 2 patients were treated with the "sandwich-type" modified ILM flap covering technique. OUTCOMES Large, chronic MH closure was observed using SD-OCT, and the BCVA improved. The patients were very satisfied with the postoperative results. LESSONS "Sandwich-type" modified ILM flap covering technique may be a safe, effective way for large, chronic MH.
Collapse
|
13
|
Abdul-Kadir MA, Lim LT. Update on surgical management of complex macular holes: a review. Int J Retina Vitreous 2021; 7:75. [PMID: 34930488 PMCID: PMC8686572 DOI: 10.1186/s40942-021-00350-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.
Collapse
Affiliation(s)
| | - Lik Thai Lim
- Department of Ophthalmology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
| |
Collapse
|
14
|
Factors Associated with Anatomic Failure and Hole Reopening after Macular Hole Surgery. J Ophthalmol 2021; 2021:7861180. [PMID: 34917414 PMCID: PMC8670966 DOI: 10.1155/2021/7861180] [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: 05/08/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
A macular hole (MH), particularly an idiopathic macular hole (IMH), is a common cause of central vision loss. Risk factors for nonidiopathic MH include high myopia, cystoid macular edema, inflammation, and trauma. MH is primarily diagnosed using slit-lamp microscopy and optical coherence tomography (OCT). Half of the patients with stage I MHs are treated conservatively and may show spontaneous resolution. The main treatment methods for MHs currently include vitrectomy and stripping of the internal limiting membrane (ILM). However, in some patients, surgery does not lead to anatomical closure. In this review, we summarize the factors influencing the anatomical closure of MHs and analyze the potential underlying mechanisms.
Collapse
|
15
|
Yuan A, Yang D, Olmos de Koo L. Current Trends in Macular Hole Repair. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Tsipursky MS, Byun M, Jager RD, Sheth VS. Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair. JOURNAL OF VITREORETINAL DISEASES 2021; 5:479-487. [PMID: 37007177 PMCID: PMC9976153 DOI: 10.1177/2474126420987145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.
Collapse
Affiliation(s)
| | - Matthew Byun
- University Retina and Macula Associates, Oak Forest, IL, USA
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | - Rama D. Jager
- University Retina and Macula Associates, Oak Forest, IL, USA
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | - Veeral S. Sheth
- University Retina and Macula Associates, Oak Forest, IL, USA
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
17
|
Karalezli A, Kaderli ST, Sul S. Macular microvasculature differences in patients with macular hole after vitrectomy with internal limiting membrane removal or single-layered temporal inverted flap technique. Eye (Lond) 2021; 35:2746-2753. [PMID: 33235343 PMCID: PMC8452644 DOI: 10.1038/s41433-020-01301-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/02/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare the macular microvasculature differences in cases with idiopathic macular hole (MH) after vitrectomy when using internal limiting membrane (ILM) removal or temporal inverted ILM flap technique (IFT). METHOD A total of 34 patients were included, of whom 20 were treated vitrectomy with ILM removal (group 1), and 14 were treated with IFT (group 2). The OCTA (RTVue; Optovue, Fremont, CA) parameters, including foveal avascular zone (FAZ), vessel density (VD) ratios in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were evaluated at baseline and 6 months follow-up. The VD measurements in DCP and inner retinal thickness (IRT) in temporal and nasal sectors were compared in subanalyses. RESULTS There was no significant difference in means of post-operative BCVA and FAZ between the two groups (p = 0.943, p = 0.760). The mean VDs of the DCP was significantly decreased at 6 months postoperatively in both groups (p < 0.001, p < 0.001). The mean post-operative temporal VDs of DCP were similar in the two groups, but the mean post-operative nasal VDs of the DCP was lower in group 1 than in group 2 (p = 0.005 and p = 0.03 for parafovea and perifovea, respectively). The mean temporal IRTs were similar in the two groups, but paranasal and perinasal IRTs were significantly thinner in group 1 than in group 2 (p < 0.001, p < 0.001). The mean post-operative VDs of parafoveal and perifoveal temporal and nasal quadrants in DCP significantly and positively correlated with the IRTs. CONCLUSION Single-layered temporal IFT causes fewer VD changes when compared to complete ILM removal, especially in the DCP.
Collapse
Affiliation(s)
- Aylin Karalezli
- grid.411861.b0000 0001 0703 3794Ophthalmology Department, Mugla Sitki Kocman University, Muğla, Turkey
| | - Sema Tamer Kaderli
- grid.411861.b0000 0001 0703 3794Ophthalmology Department, Mugla Sitki Kocman University Education and Training Hospital, Muğla, Turkey
| | - Sabahattin Sul
- grid.411861.b0000 0001 0703 3794Ophthalmology Department, Mugla Sitki Kocman University, Muğla, Turkey
| |
Collapse
|
18
|
Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmol Ther 2021; 10:1137-1153. [PMID: 34494236 PMCID: PMC8589910 DOI: 10.1007/s40123-021-00388-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
Primary surgery for macular hole (MH) closure has a high success rate with current methods of pars plana vitrectomy and internal limiting membrane (ILM) peeling. When primary surgery fails, there are several options available for secondary repair, including extension of the ILM peel, creation of an ILM flap, pedunculated ILM flap, lens capsule flap transplantation, autologous retinal transplantation, use of a human amniotic membrane plug, adjuvant autologous platelet concentrate, induction of macular detachments with subretinal blebs, and creation of retinal incisions. In this review, we discuss the practical approach to each of these surgical techniques for the management of recurrent or persistent MHs.
Collapse
|
19
|
Abstract
PURPOSE To analyze the outcomes of revision surgery for idiopathic full-thickness macular holes that have failed to close after primary surgery, and also to assess factors predicting success and to review the relative effect of adjunctive surgical techniques. METHODS A multicenter retrospective study. Anatomical closure rates and visual acuity change between pre and postrevision surgery were assessed. Hole size, age, symptom duration, surgical interval, and reduced hole size were analyzed as predictive factors for success. Effectiveness of adjunctive surgical techniques was reviewed. RESULTS Seventy-seven eyes were included in the study. Anatomical closure was achieved in 71% (55/77) cases. There was a median gain of 11 Early Treatment of Diabetic Retinopathy Score letters in all holes and 14 letters in closed holes. Full-thickness macular holes that increased in size by more than 10% following primary surgery had a closure rate of 50% compared with 80% in holes that reduced by 10% or stayed the same (P = 0.015). Increasing hole size is associated with a modest reduction in odds of closure (odds ratio = 0.99; P = 0.04). Surgical interval <2 months is not associated with better outcomes compared with >2 months (P = 0.14). CONCLUSION Revision surgery for full-thickness macular holes that have failed to close after primary surgery is associated with high closure rates and significant visual gains.
Collapse
|
20
|
Okada M, Chiu D, Yeoh J. Vitreomacular disorders: a review of the classification, pathogenesis and treatment paradigms including new surgical techniques. Clin Exp Optom 2021; 104:672-683. [PMID: 33899681 DOI: 10.1080/08164622.2021.1896946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This review explores how optical coherence tomography has guided our assessment of vitreomacular disorders. Vitreomacular disorders (VMD), such as macular holes and epiretinal membranes are common and potentially sight threatening. The introduction and widespread use of optical coherence tomography (OCT) imaging technology has transformed our ability to visualise the vitreoretinal interface. This review discusses the pathogenesis and updated classification scheme for VMD in the OCT era. Imaging biomarkers and the treatment algorithm, including the role of novel therapeutics, for managing patients with VMD are presented.
Collapse
Affiliation(s)
- Mali Okada
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Daniel Chiu
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jonathan Yeoh
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
FIRST FAILED MACULAR HOLE SURGERY OR REOPENING OF A PREVIOUSLY CLOSED HOLE: Do We Gain by Reoperating?-A Systematic Review and Meta-analysis. Retina 2021; 40:1-15. [PMID: 31335482 PMCID: PMC6924931 DOI: 10.1097/iae.0000000000002564] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Repeated idiopathic full-thickness macular hole surgery after primary failure or reopening of a previously closed hole seems beneficial both in terms of anatomical closure and improvement in best-corrected visual acuity. To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.
Collapse
|
23
|
HEMI-TEMPORAL INTERNAL LIMITING MEMBRANE PEELING IS AS EFFECTIVE AND SAFE AS CONVENTIONAL FULL PEELING FOR MACULAR HOLE SURGERY. Retina 2020; 39:1779-1785. [PMID: 29746406 PMCID: PMC6727914 DOI: 10.1097/iae.0000000000002215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate the efficacy of hemi-temporal internal limiting membrane (ILM) peeling for idiopathic macular hole. METHODS The medical records of patients with macular holes who had undergone vitrectomy with ILM peeling were studied. Forty-two eyes with macular hole were divided into 2 groups based on surgical procedure (hemi-temporal ILM peeling [hemi group]: 15 eyes; 360° ILM peeling [360° group]: 27 eyes). The closure rates and distances between the optic disc and the intersection of two retinal vessels most closely located nasally or temporally to the macular hole were compared. RESULTS The primary closure rates were not significantly different between the two groups (hemi group: 93.3%; 360° group: 92.5%, P = 0.92). The temporal retinal vessels in the hemi group were displaced 120.5 ± 102.0 µm toward the optic disc at 1 week postoperatively, which did not differ significantly from the 360° group (136.1 ± 106.1 µm) (P = 0.107). However, the nasal retinal vessels in the hemi group were displaced by 42.4 ± 42.9 µm at 1 week postoperatively, which was significantly less than the 90.1 ± 77.3 µm displacement seen in the 360° group (P = 0.040). CONCLUSION Hemi-temporal ILM peeling may be preferable to 360° ILM peeling because of less displacement of the retina and greater safety.
Collapse
|
24
|
Tao J, Chen H, Zhu L, Pan D, Fang J, Chen Y, Mao J, Shen L. Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome. BMC Ophthalmol 2020; 20:280. [PMID: 32652958 PMCID: PMC7353697 DOI: 10.1186/s12886-020-01541-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict the restoration of retinal microstructure and visual outcomes. Methods This retrospective case series study included 53 MH patients. One eye each was assessed with iOCT during vitrectomy after internal limiting membrane (ILM) peeling. The MHs were categorized into three groups according to the morphology of the hole edge. The Hole-Door group had vertical pillars of tissue that projected into the vitreous cavity after ILM peeling. The Foveal Flap group had a preoperative foveal flap that adhered to the hole edge after ILM peeling, and the Negative group had neither a hole-door nor a foveal flap. At 6 months after surgery, the retinal microstructure restoration and visual outcomes were compared among the groups. Results All eyes had MH closure, and the postoperative best corrected visual acuity (BCVA) was significantly improved compared with the preoperative BCVA (P < 0.001). The Hole-Door group (n = 15) and Foveal Flap group (n = 14) had significantly better final visual acuity and postoperative restoration of the external limiting membrane (ELM) than the Negative group (n = 24) (P = 0.002, P = 0.012). For the group in which the MH diameter (MHD) was ≤400 μm (n = 25), there were no significant differences in ELM restoration, ellipsoid zone (EZ) restoration, or BCVA among the three groups (P = 0.516, P = 0.179, and P = 0.179 respectively). For the MHD > 400-μm group (n = 28, the Hole-Door group and Foveal Flap group had significantly better final visual acuity and restoration of ELM than the Negative group (P = 0.013, P = 0.005). Conclusions The novel use of iOCT during MH surgery confirmed the presence of hole edges configured as door-holes, foveal flaps, or neither. The data acquired by iOCT can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcome of MH, especially large ones.
Collapse
Affiliation(s)
- Jiwei Tao
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Huan Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Lin Zhu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Deming Pan
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Jia Fang
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Yiqi Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Jianbo Mao
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Lijun Shen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
25
|
The Healing Process and Functional Recovery of Neuroretina after Idiopathic Macular Hole Surgery without Internal Limiting Membrane Reversal Tamponade. J Ophthalmol 2020; 2020:2478943. [PMID: 32454986 PMCID: PMC7222536 DOI: 10.1155/2020/2478943] [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: 11/12/2019] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors. Methods Thirty-six eyes of 31 patients with full-thickness idiopathic macular hole (IMH) were enrolled in this retrospective study. All of them were operated using 23-gauge or 25-gauge vitrectomy with inner limiting membrane peeling and air tamponade. Spectral-domain optical coherence tomography was performed before surgery and after surgery to observe the structural changes of neuroretina. Results Twenty eyes (55.56%) had the macular hole closed at 3 to 5 days after surgery (closed group), beginning from the inner retina based on OCT. Holes of 16 eyes (44.44%) remained unclosed and progressed to larger holes at 13 to 15 days (t = −2.811, P=0.013) after surgery (unclosed group). Compared with the eyes in the closed group, the eyes in the unclosed group had significantly larger hole diameter (t = −2.882, P=0.007). Postoperative BCVA was significantly improved in the closed group (t = 2.573, P=0.019) and not improved in the unclosed group (t = 0.606, P=0.554) at the 6-month follow-up. Conclusion Full-thickness IMHs could achieve anatomic closure 3 to 5 days after surgery with first-step inner retina tissue bridging. Otherwise, they were not able to achieve hole closure and opened to larger holes about 2 weeks postoperatively. Macular hole diameter was an important factor affecting the healing of the holes. The delayed restoration of fovea detachment and ellipsoid area deficiency were responsible for poor vision outcomes after surgery.
Collapse
|
26
|
Long-term improvement of retinal sensitivity after macular hole surgery over at least 9-year-old follow-up: a case series. Graefes Arch Clin Exp Ophthalmol 2020; 258:1655-1662. [PMID: 32363499 DOI: 10.1007/s00417-020-04719-3] [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: 02/19/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the correlations between anatomical and functional changes in idiopathic macular hole (IMH) surgery in long-term follow-up. METHODS This is a prospective, interventional single centre case series. The final sample is formed by 14 eyes of 14 patients who had undergone IMH surgery in our institution between 2005 and 2009 and were still followed up in 2019. Reported data were pre- and post-operative best-corrected visual acuity (BCVA), retinal sensitivity and fixation stability values on MP-1 and structural macular features on spectral domain optical coherence tomography. Optical coherence tomography angiography (OCTA) was utilized to assess microvascular characteristics at the final visit. Only patients with a successful MH closure were enrolled, excluding eyes affected by other relevant pathologies. RESULTS Mean BCVA improvement was significant after surgery (t test, p value < 0.001) and presented a slight, not statistically significant raise, between the post-operative and long-term follow-up. Differently, mean retinal sensibility (dB) showed a highly statistically significant difference between pre-operative and post-operative (t test, p value = .002) and post-operative and last follow-up (p value < 0.001). In the long-term follow-up, subjects having integrity of the inner segment/outer segment (IS/OS) layer showed no statistically significant difference in BCVA compared with subjects with IS/OS discontinuity (t test, p value = 0.72). OCTA parameters of the operated eye showed no statistical significance compared with the fellow eye. CONCLUSIONS In successfully closed MHs, retinal sensibility measured by microperimetry significatively increases after a long follow-up period even when BCVA remains stable or raises slightly. Vessel density organization tends to be quantitatively similar to fellow eye several years after surgery.
Collapse
|
27
|
Qi Y, Wang Z, Li SM, You Q, Liang X, Yu Y, Liu W. Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3. BMC Ophthalmol 2020; 20:140. [PMID: 32272972 PMCID: PMC7146999 DOI: 10.1186/s12886-020-01383-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the effect of internal limiting membrane (ILM) peeling surrounding macular holes (MH) for the function of retina by microperimetry-3(MP-3). Methods This is a prospective, cohort study which included patients with MHs who were treated by 23-gauge 3-port pars plana vitrectomy and ILM peeling with air tamponade. Color fundus photography, retinal optical coherence tomography and MP-3 were performed 1 week before, 1 and 4 months after the operation. In MP-3 examination, a customized follow-up pattern with 45 spots in the central 8° visual field was used. The spots corresponding to the retina surrounding macular holes were selected for comparison of pre- and post-operative function. Results We incuded 44 eyes of 44 patients with best corrected visual acuity (BCVA) of 1.06 ± 0.40 (logMAR). All eyes achieved an anatomical success at 4 months. BCVA significantly improved at 1 month (0.53 ± 0.30, P < 0.01) and 4 months (0.31 ± 0.24, P < 0.01), respectively. Mean retinal sensitivity (MRS, dB) of the retina surrounding macular hole was 23.46 ± 3.01 dB at baseline, and significantly increased at 1 month (26.25 ± 2.31 dB, u = − 4.88, P < 0.01) and 4 months (27.14 ± 2.45 dB, t = − 6.29, P < 0.01). Patients with increased MRS are significantly younger than those with deceased MRS (59.72 ± 3.22 years vs. 65.60 ± 8.19 years, P < 0.01). After ILM peeling, the increasing extent of MRS was significantly higher in inferior and nasal retina than in superior and temporal retina at 1 and 4 months (P < 0.05). Conclusion ILM peeling in normal retina will not decrease the retinal function in a short-term after surgery.
Collapse
Affiliation(s)
- Yue Qi
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Zengyi Wang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Shi-Ming Li
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Qisheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xida Liang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yanping Yu
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China
| | - Wu Liu
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
28
|
Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort. Eye (Lond) 2020; 35:316-325. [PMID: 32231259 DOI: 10.1038/s41433-020-0844-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/09/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery. DESIGN Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma. RESULTS A higher proportion of operations were performed in eyes from females (71.1%) who were 'on average' younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD. CONCLUSIONS Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.
Collapse
|
29
|
Schaub F, Gözlügöl N, von Goscinski C, Enders P, Heindl LM, Dahlke C. Outcome of autologous platelet concentrate and gas tamponade compared to heavy silicone oil tamponade in persistent macular hole surgery. Eur J Ophthalmol 2020; 31:664-672. [PMID: 32019342 DOI: 10.1177/1120672120903704] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Persistence represents the major reason for failure of primary macular hole repair. A variety of surgical approaches are available for treating persistent macular holes. To compare clinical outcome of re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% gas tamponade with heavy silicone oil in persistent macular hole. METHODS Records of 48 consecutive eyes with persistent macular holes which underwent re-pars plana vitrectomy with either heavy silicone oil (35 eyes, persistent macular-hole minimum linear diameter: 518.8 ± 171.1 µm) or autologous platelet concentrate and sulfur hexafluoride 20% (13 eyes, persistent macular hole-minimum linear diameter: 454.1 ± 211.3 µm) were reviewed retrospectively. All patients underwent measurements of anatomical persistent macular hole characteristics evaluated by optical coherence tomography and visual function. Cases in which anatomical success failed after first re-pars plana vitrectomy were treated with the other surgical techniques, comparable to a cross-over design. RESULTS Persistent macular hole closure rate was 57.1% with autologous platelet concentrate and sulfur hexafluoride 20% and 45.7% with heavy silicone oil (p = 0.102). Functional results were comparable when persistent macular hole closure was achieved (p ⩾ 0.741), but significantly better for the autologous platelet concentrate with sulfur hexafluoride 20% group when persistent macular hole closure failed (p = 0.019). CONCLUSION Re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% seems to achieve at least non-inferior persistent macular hole closure rates and comparable functional results when compared to heavy silicone oil, suggesting autologous platelet concentrate and sulfur hexafluoride 20% as a safe surgical alternative in persistent macular hole. Especially when persistent macular hole closure failed, autologous platelet concentrate with sulfur hexafluoride 20% seems to be superior regarding visual outcome.
Collapse
Affiliation(s)
- Friederike Schaub
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nasir Gözlügöl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Corinna von Goscinski
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philip Enders
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claudia Dahlke
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
30
|
Zhang L, Li X, Yang X, Shen Y, Wu M. Internal limiting membrane insertion technique combined with nerve growth factor injection for large macular hole. BMC Ophthalmol 2019; 19:247. [PMID: 31823798 PMCID: PMC6902465 DOI: 10.1186/s12886-019-1258-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was proposed to determine whether nerve growth factor (NGF) combined with an internal limiting membrane (ILM) insertion was effective in the large idiopathic full-thickness macular hole (iFTMH) therapy. METHODS A subset of 18 eyes (July 2015-October 2017) diagnosed as the large iFTMH were enrolled in this study. The subjects were treated using ILM insertion technique alone (ILM group) or ILM combined with NGF injection (NGF group) and the follow-up period was 6 months. Macular hole closure rates, best-corrected visual acuity (BCVA, improvements using ETDRS), and optical coherence tomography (OCT) findings were analyzed at 1st, 3rd, and 6th months postoperatively. RESULTS We found that macular holes in both groups fully closed. In comparison to ILM insertion group, the NGF group had better BCVA at the 3rd month (48.00 ± 2.392 vs 58.22 ± 2.957, 95% confidence interval (CI): 2.159 to 18.29). The mean external limiting membrane (ELM, 422.2 ± 96 vs 674.9 ± 103.6, 95% CI: - 47.26 to 552.8) and ellipsoid zone (EZ, 496.7 ± 101.6 vs 766.7 ± 111.8, 95% CI: - 50.29 to 590.4) defects were significantly smaller in the NGF group at the 6th month in the follow-up examination. Complete recovery of ELM and EZ was observed in the NGF group in one eye of a patient and two eyes of two patients, respectively. In comparison, one eye's ELM and another eye's EZ were completely recovered in the ILM insertion group. CONCLUSION Our results indicated that ILM insertion with NGF injection might be an effective technique for the initial surgical treatment of eyes with large MHs. The proposed approach yielded better recovery of the photoreceptor layers and consequently might have superior postoperative visual acuity. TRIAL REGISTRATION chiCTR1900021711. Retrospectively registered 5 March 2019.
Collapse
Affiliation(s)
- Luyi Zhang
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Xiaoxia Li
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Xiaoli Yang
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Yu Shen
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Miaoqin Wu
- Department of Ophthalmology. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
| |
Collapse
|
31
|
Goker YS, Demir G, Tekin K, Ucgul Atilgan C. Optical coherence tomography analysis of the recovery of the ellipsoid zone after macular hole surgery: 2-Year results. J Fr Ophtalmol 2019; 42:987-992. [PMID: 31202777 DOI: 10.1016/j.jfo.2019.05.007] [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: 01/26/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To present the two-year results of ellipsoid zone (EZ) recovery by Spectral Domain Optical Coherence Tomography (SD-OCT) after vitrectomy surgery in large full thickness macular holes (MHs). METHODS Thirty eyes of 30 patients were enrolled in this retrospective study. Inclusion criteria were large full thickness idiopathic MH (400 microns), a minimum follow-up period of 24 months and successful repair of the hole with the first surgery. The mean length of the EZ defect was calculated linearly via SD-OCT preoperatively and at postoperative 1st, 3rd, 6th, 12th, 18th and 24th months. The main outcome measures were diameter of the EZ defect and preoperative and postoperative best corrected visual acuities (BCVA). RESULTS The EZ defect was mostly recovered in the first month. The continuity of the EZ and total recovery of the EZ defect was achieved in 3.33 % of the participants at month 12; 10 % of the participants at month 18, and 33.3 % of the participants at month 24. The EZ defect was significantly correlated with BCVA preoperatively and at 6 months postoperatively (P=0.02 and P=0.01, respectively). CONCLUSIONS Ellipsoid zone recovery occurred mostly in the first month after vitreoretinal surgery, and this recovery process extended up to 2 years. At 24 months postoperatively, the EZ was fully recovered in only one third of the patients.
Collapse
Affiliation(s)
- Y S Goker
- M.D. Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - G Demir
- M.D. Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - K Tekin
- M.D. Van Erciş State Hospital, Ophthalmology Department, Van, Turkey
| | - C Ucgul Atilgan
- M.D. Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
32
|
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
|
33
|
Moreto R, De Lucca Perches ACB, Almeida F, Jorge R, Messias A, Gekeler K. Central mfERG amplitude ratio as a predictor for visual outcome of macular hole surgery. Doc Ophthalmol 2019; 140:23-30. [PMID: 31482394 DOI: 10.1007/s10633-019-09716-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate whether visual acuity improvement achieved after surgical treatment for macular hole (MH) can be predicted by preoperative multifocal ERG (mfERG) central/peripheral amplitude ratio. METHODS Thirty patients with unilateral MH were included. Evaluations with comprehensive ophthalmological examination including best-corrected visual acuity (BCVA) were performed at baseline and 1, 3, 8, 24 and 48 weeks after surgery, while mfERG (Diagnosys LLC; 61 hexagons-30°) and spectral-domain optic coherence tomography (sOCT-Heidelberg Engineering) were performed at baseline and 2 months after surgery. mfERG results are shown by means of the ratio between the amplitudes' average from rings 1 and 2 (central) and rings 4 and 5 (peripheral): the P1 ratio. mfERG data from 20 normally sighted age-matched subjects was used for comparison. A macular hole index (MH index) was defined as the quotient between hole height and base measured on OCT. RESULTS Twenty-six patients finished the 48-week follow-up. Mean ± SE (logMAR) preoperative BCVA was 0.93 ± 0.22 and improved in 0.25 ± 0.07 at 48 weeks. mfERG P1 ratio was reduced at baseline and increased significantly after surgery. A significant correlation was observed between preoperative P1 ratio and BCVA gain at week 8 (r = -0.42; P = 0.033). There was no significant correlation between preoperative MH index and postoperative BCVA (P > 0.05). CONCLUSION Retinal function assessed using the ratio between central and peripheral mfERG responses might be used as predictor of visual acuity outcome after macular surgery for MH.
Collapse
Affiliation(s)
- Renata Moreto
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil
| | - Ana Claudia Brancato De Lucca Perches
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil
| | - Felipe Almeida
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil
| | - André Messias
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil.
| | - Katrin Gekeler
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| |
Collapse
|
34
|
Yao Y, Qu J, Dong C, Li X, Liang J, Yin H, Huang L, Li Y, Liu P, Pan C, Ding X, Song D, Sadda SR, Zhao M. The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54-week randomized clinical trial. Acta Ophthalmol 2019; 97:303-312. [PMID: 30187641 PMCID: PMC6585771 DOI: 10.1111/aos.13853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/20/2018] [Indexed: 11/02/2022]
Abstract
PURPOSE To compare the anatomical outcomes of different extents of internal limiting membrane (ILM) peeling in idiopathic macular hole surgery. METHODS Prospective, parallel-group, randomized clinical trial. A total of 121 eyes of 121 patients with idiopathic macular hole underwent pars plana vitrectomy, and peeling of the ILM with a diameter of two disk diameters (DD) or 4DD based on randomization. The main outcome was the proportion of eyes with complete hole closure at 12 months. The second outcome was the hole closure grading stratified by macular hole closure index (MHCI) at each visit. RESULTS At 12 months, there was no significant difference in anatomical outcomes with complete closure achieved in 52 (82.5%) of 63 eyes in the 2DD group and 53 (91.4%) of 58 eyes in the 4DD group (p = 0.15). For subjects with MHCI ≤0.5 (n = 24), complete closure rate was significantly lower in the 2DD group compared to the 4DD group (p = 0.012; 18.2% versus 75.9%, respectively). Average BCVA was lower in 2DD group than 4DD group (p = 0.014). By contrast, when MHCI was >0.5, the complete closure rate between the two groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (p = 0.185). CONCLUSION In patients with idiopathic full-thickness macular hole and MHCI ≤0.5, a larger ILM peel of 4DD tends to achieve better anatomical outcomes than a more limited 2DD peel.
Collapse
Affiliation(s)
- Yuou Yao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Jinfeng Qu
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Chongya Dong
- Department of Biostatistics Peking University Clinical Research Institute Beijing China
| | - Xiaoxin Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Jianhong Liang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Hong Yin
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Lvzhen Huang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Yan Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Peipei Liu
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Chungting Pan
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Xue Ding
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Dan Song
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Srinivas R. Sadda
- Doheny Eye Institute Los Angeles California USA
- Department of Ophthalmology David Geffen School of Medicine at University of California‐Los Angeles Los Angeles California USA
| | - Mingwei Zhao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| |
Collapse
|
35
|
Sulfur Hexafluoride (SF 6) versus Perfluoropropane (C 3F 8) in the Intraoperative Management of Macular Holes: A Systematic Review and Meta-Analysis. J Ophthalmol 2019; 2019:1820850. [PMID: 30993017 PMCID: PMC6434271 DOI: 10.1155/2019/1820850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose A systematic literature search was conducted to identify and review studies comparing SF6 to C3F8 as a tamponade agent in the intraoperative management of macular holes. Methods Publications up to October 2018 that focused on macular hole surgery in terms of primary closure, complications, and clinical outcomes were included. Forest plots were created using a weighted summary of proportion meta-analysis. Analysis was performed separately for SF6 and C3F8. A random effects model was used, and corresponding I2 heterogeneity estimates were calculated. Results Nine pertinent publications studying a total of 4,715 patients were identified in 2000 to 2017, including two randomized studies (n=206), two prospective studies (n=170), and five retrospective or registry-based studies. Similar rates of closure between SF6 and C3F8 were reported in eight out of nine studies, regardless of subgroup analyses. All studies reporting visual outcomes showed similar results when comparing SF6 to C3F8 at one to six months of follow-up. Neither agent was clearly associated with increased risk of ocular hypertension, cataract formation, or other adverse events. Meta-analytic pooling of the closure rates in the SF6 group resulted in 91.73% (95% confidence interval: 88.40 to 94.55, I2: 38.03%), and for C3F8, the closure rate was 88.36% (95% confidence interval: 85.88 to 90.63, I2: 0.0%). Conclusions Both SF6 and C3F8 appear to have achieved similar visual outcomes and primary closure rates and neither was associated with an increased risk of adverse events. Considering the more rapid visual recovery with SF6, there appears to be no evidence to support C3F8 as the tamponade agent of choice for macular hole surgery.
Collapse
|
36
|
Sokol JT, Ferenchak K, Rosen DT, Schechet SA, Skondra D. Macular Hole Formation After Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e256-e262. [PMID: 30566711 DOI: 10.3928/23258160-20181203-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the incidence, clinical features, and outcomes of patients with macular hole (MH) formation after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD). PATIENTS AND METHODS We conducted a retrospective review of all cases of PPV for diabetic TRD performed by a surgeon (DS) at a large county hospital between November 2013 and August 2016. RESULTS Ninety consecutive eyes of 79 patients were included in this case series, of which four eyes developed MH, yielding an incidence of 4.4% (95% confidence interval [CI], 1.2%-11.0%). The mean interval between PPV for TRD and MH formation was 7.0 ± 5.5 (mean ± 1 standard deviation) months, and mean follow-up time was 29.6 months ± 6.9 months. Three of the four eyes that developed MH underwent intervention, and of the three that underwent intervention, all had successful hole closure. CONCLUSION In this case series, the incidence of MH after PPV for TRD is 4.4% (95% CI, 1.2%-11.0%). The mechanism of MH formation after diabetic TRD repair is not certain but may be related to a taut internal limiting membrane, epiretinal membrane formation, macular edema, or residual vitreous contraction. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e256-e262.].
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
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]
|
39
|
SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVEALS INTERNAL LIMITING MEMBRANE PEELING ALTERS DEEP RETINAL VASCULATURE. Retina 2018; 38 Suppl 1:S154-S160. [DOI: 10.1097/iae.0000000000002199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
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]
|
41
|
Bagger MM. Intraocular biopsy of uveal melanoma Risk assessment and identification of genetic prognostic markers. Acta Ophthalmol 2018; 96 Suppl A112:1-28. [PMID: 30133961 DOI: 10.1111/aos.13858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mette Marie Bagger
- Departments of Clinical Genetics and Ophthalmology; Rigshospitalet Blegdamsvej; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
42
|
A Review of Surgical Outcomes and Advances for Macular Holes. J Ophthalmol 2018; 2018:7389412. [PMID: 29850211 PMCID: PMC5932482 DOI: 10.1155/2018/7389412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/28/2018] [Accepted: 02/18/2018] [Indexed: 01/10/2023] Open
Abstract
The surgical outcomes of macular holes (MHs) have improved greatly in recent years. The closure rate is as high as 90-100%, but the outcomes of some special types of MHs remain unsatisfactory. Internal limiting membrane (ILM) peeling dramatically improves the anatomic success rate, but recent studies have found that it could also cause mechanical and subclinical traumatic changes to the retina. Dyes are widely used, and apart from indocyanine green (ICG), the toxicities of other dyes require further research. Face-down posturing is necessary for MHs larger than 400 μm, and the duration of this posture is determined by the type of tamponade and the case. The ellipsoid zone has been shown to be highly correlated with visual outcome and recovery. New surgical methods include the inverted ILM flap technique and the ILM abrasion technique. However, they require further research to determine their effectiveness.
Collapse
|
43
|
Autologous neurosensory retinal free patch transplantation for persistent full-thickness macular hole. Int Ophthalmol 2018; 39:1147-1150. [PMID: 29589232 DOI: 10.1007/s10792-018-0904-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate anatomical and functional outcomes after autologous neurosensory retinal free patch (ANRFP) transplantation for persistent idiopathic full-thickness macular hole (iFTMH). METHODS A 65-year-old woman with persistent macular hole in her right eye after previous 27-gauge pars plana vitrectomy with internal limiting membrane peeling and long-acting gas tamponade underwent ANRFP transplantation. Before surgery, best corrected visual acuity in her right eye was 20/800. Optical coherence tomography (OCT) showed a 715-micron-diameter FTMH. To treat the persistent FTMH, a small autologous neurosensory retinal patch was transplanted and placed inside the macular hole under perfluorocarbon liquids (PFCL). PFCL-air exchange was performed, and long-acting gas tamponade was carried out. Clinical features of the macular area, visual acuity (VA), fundus autofluorescence, microperimetry and OCT were recorded during the 10-month follow-up. RESULTS The macular hole appeared successfully closed with retinal patch stable and well plugged into the hole during the whole follow-up. VA improved to 20/100 and microperimetry revealed an increase in mean retinal sensitivity from 14.7 dB at 1 month to 15.6 dB at 10 months postoperatively. OCT showed a well-distinguishable retinal patch into the hole 1 month after surgery and a completely integrated retinal patch between the retinal layers 10 months postoperatively. No intra- and postoperative complications were noticed. CONCLUSIONS ANRFP transplantation may represent an innovative technique for persistent iFTMH treatment.
Collapse
|
44
|
Pieczynski J, Kuklo P, Grzybowski A. Pars plana vitrectomy with silicone oil tamponade for primary and secondary macular hole closure: Is it still a useful procedure? Eur J Ophthalmol 2018; 28:503-514. [DOI: 10.1177/1120672117752423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate usefulness of posterior vitrectomy with silicone oil tamponade for primary and secondary macular hole closure. Methods: We searched for publications on the surgical treatment of full-thickness idiopathic and recurrent macular hole. We divided reports into two groups: primary macular hole repair and recurrent macular hole repair with silicone oil tamponade. Results: In primary macular hole treatment, different authors confirmed effectiveness of silicone oil tamponade. They suggest that the most important factor for successful outcome was completeness of vitreous cavity filling with oil. Complications after this method were comparable to those after gas tamponade. However, even if good anatomical results are achieved in secondary macular hole closure, visual acuity is sometimes less rewarding. Conclusion: There are reports on good efficacy of silicone oil tamponade for primary and recurrent macular hole closure. Anatomical closure and visual acuity rates in pars plana vitrectomy with silicone oil and with gas filling are comparable. Gas tamponade seems to be safer and needs no more surgery. Postoperative complications in both methods are similar, but all patients with silicone oil filling need to undergo a reoperation to have the silicone removed. There are also other surgical techniques for primary macular hole closure as well as for unsuccessful primary macular hole procedures. We think that primary macular hole closure should be performed with gas tamponade, supported with different adjuvants, as a method of choice. Silicone oil tamponade could be still an alternative in cases, when there are no more efficient techniques or possibilities to treat with success recurrent macular hole.
Collapse
Affiliation(s)
- Janusz Pieczynski
- Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Voivodal Specialistic Hospital, Olsztyn, Poland
| | - Patrycja Kuklo
- Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Voivodal Specialistic Hospital, Olsztyn, Poland
| | - Andrzej Grzybowski
- Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Poznan, Poland
| |
Collapse
|
45
|
Song DH, Yeom MI, Park JM. The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Hun Song
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Myeong In Yeom
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Jung Min Park
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| |
Collapse
|
46
|
Abstract
PURPOSE To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. METHODS This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. RESULTS The average displacement was 57.2 μm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 μm) than in the outer ring (35.3 μm, P < 0.001), and larger in the temporal sectors than in the corresponding nasal sectors (P ≤ 0.008). Inferior and superior displacement was noted in the superior and inferior sectors, respectively. Multiple regression analysis revealed that basal horizontal macular hole diameter and size of internal limiting membrane removal were independent factors of displacement. CONCLUSION The macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.
Collapse
|
47
|
Correspondence. Retina 2017; 37:e103-e104. [PMID: 28820851 DOI: 10.1097/iae.0000000000001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
Lee JJ, Lee IH, Park KH, Pak KY, Park SW, Byon IS, Lee JE. Vascular Displacement in Idiopathic Macular Hole after Single-layered Inverted Internal Limiting Membrane Flap Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:336-342. [PMID: 28682018 PMCID: PMC5540989 DOI: 10.3341/kjo.2016.0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/09/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare vascular displacement in the macula after surgical closure of idiopathic macular hole (MH) after single-layered inverted internal limiting membrane (ILM) flap technique and conventional ILM removal. Methods This retrospective study included patients who underwent either vitrectomy and ILM removal only or vitrectomy with single-layered inverted ILM flap for idiopathic MH larger than 400 µm from 2012 to 2015. A customized program compared the positions of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of 6 × 6 mm optical coherence tomography volume scans were registered to calculate the scale. Retinal vessel displacement was measured as a vector value by comparing its location in 16 sectors of a grid partitioned into eight sectors in two rings (inner, 2 to 4 mm; outer, 4 to 6 mm). The distance and angle of displacement were calculated as an average vector and were compared between the two groups for whole sectors, inner ring, outer ring, and for each sector. Results Twenty patients were included in the ILM flap group and 22 in the ILM removal group. There were no statistical differences between the groups for baseline characteristics. The average displacement in the ILM flap group and the ILM removal group was 56.6 µm at −3.4° and 64.9 µm at −2.7°, respectively, for the whole sectors (p = 0.900), 76.1 µm at −1.1° and 87.3 µm at −0.9° for the inner ring (p = 0.980), and 37.4 µm at −8.2° and 42.7 µm at −6.3° for the outer ring (p = 0.314). There was no statistical difference in the displacement of each of the sectors. Conclusions Postoperative topographic changes showed no significant differences between the ILM flap and the ILM removal group for idiopathic MH. The single-layered ILM flap technique did not appear to cause additional displacement of the retinal vessels in the macula.
Collapse
Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Ho Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Keun Heung Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kang Yeun Pak
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| |
Collapse
|
50
|
Mohammed OA, Pai A. New Surgical Technique for Management of Recurrent Macular Hole. Middle East Afr J Ophthalmol 2017; 24:61-63. [PMID: 28546696 PMCID: PMC5433132 DOI: 10.4103/meajo.meajo_211_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Recurrence of macular hole (MH) following the standard approach of pars plana vitrectomy, posterior hyaloids removal, internal limiting membrane peeling, gas tamponade, and postoperative positioning is a common postoperative complication following MH surgery. We present a new surgical technique which involves induction of serous macular detachment around the MH, parafoveal retinal massage to bring its edges closer, gas tamponade, and face down positioning. The recurrent MHs had closed in all four consecutive patients with a parallel gain in visual acuity following this technique. All patients had Type 1 closure of the MH indicating its closure without any defect of the neurosensory retina. The MHs remained closed during the follow-up without any late reopening.
Collapse
Affiliation(s)
| | - Anant Pai
- Department of Surgery, Ophthalmology Section, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|