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Moussa G, Jalil A, Patton N, Sabatino F, Jasani K, Dhawahir-Scala F, Sousa DC, Ivanova T. PREDICTION OF MACULAR HOLE SIZE PROGRESSION BASED ON BASELINE OPTICAL COHERENCE TOMOGRAPHY FINDINGS. Retina 2023; 43:464-471. [PMID: 36730582 DOI: 10.1097/iae.0000000000003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To quantify the rate of idiopathic macular hole progression from presentation and identify factors that may influence stratification and urgency for surgical listing based on the initial optical coherence tomography scans. METHODS The minimal linear diameter (MLD), base diameter (BD), and hole height on nasal and temporal sides of idiopathic macular hole were measured on spectral domain optical coherence tomographies, on initial presentation and just before surgery. Mean hole height, hole height asymmetry (absolute difference between nasal and temporal height), MLD/BD, and MLD change per day (MLD/day) were calculated for each patient. Multivariable linear regression analysis with MLD/day as the dependent variable was performed to identify significant risk factors for MLD progression. Minimal linear diameter was grouped to quintiles: 1: ≤290 µ m, 2: >290 µ m and ≤385 µ m, 3: >385 µ m and ≤490 µ m, 4: >490 µ m and ≤623 µ m, and 5: >623 µ m. RESULTS In 161 eyes (157 patients), we report significant associations with MLD/day: 1) MLD/BD ( P = 0.039) (i.e., wide BD relative to MLD lead to faster progression of MLD), 2) hole height asymmetry ( P = 0.006) (larger absolute difference between nasal and temporal hole height lead to faster progression), and 3) days between scans ( P < 0.001) (longer duration between scans had reduced MLD/day, indicating more rapid increase initially then plateaux), and relative to MLD Quintile 1, MLD Quintile 3 ( P = 0.002) and MLD Quintile 4 ( P = 0,008), and MLD Quintile 5 ( P < 0.001) all lead to a reduced MLD/day rate on multivariable regression. CONCLUSION In addition to finding that the previously reported initial smaller MLD is a risk factor for rapid MLD progression, we report two novel findings, large hole height asymmetry and a low MLD/BD (wide base relative to MLD), that represent significant risk factors. These factors should be taken into consideration on presentation to stratify timing of surgery.
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Affiliation(s)
- George Moussa
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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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.
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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.
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Macular Hole Detection Using a New Hybrid Method: Using Multilevel Thresholding and Derivation on Optical Coherence Tomographic Images. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2021:6904217. [PMID: 34976042 PMCID: PMC8716210 DOI: 10.1155/2021/6904217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging test. OCT imaging is analogous to ultrasound imaging, except that it uses light instead of sound. In this type of image, microscopic quality intratissue images are provided. In addition, fast and direct imaging of tissue morphology and reproducibility of results are the advantages of this imaging. Macular holes are a common eye disease that leads to visual impairment. The macular perforation is a rupture in the central part of the retina that, if left untreated, can lead to vision loss. A novel method for detecting macular holes using OCT images based on multilevel thresholding and derivation is proposed in this paper. This is a multistep method, which consists of segmentation, feature extraction, and feature selection. A combination of thresholding and derivation is used to diagnose the macular hole. After feature extraction, the features with useful information are selected and finally the output image of the macular hole is obtained. An open-access data set of 200 images with the size of 224 × 224 pixels from Sankara Nethralaya (SN) Eye Hospital, Chennai, India, is used in the experiments. Experimental results show better-diagnosing results than some recent diagnosing methods.
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Bertelmann T, Berndzen L, Raber T, Pfeiffer S, Leha A, Paul C, Feltgen N, Bemme S. Predicting the individual probability of macular hole closure following intravitreal ocriplasmin injections for vitreomacular traction release using baseline characteristics. Sci Rep 2021; 11:24096. [PMID: 34916576 PMCID: PMC8677762 DOI: 10.1038/s41598-021-03509-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023] Open
Abstract
The primary objective was to create and establish a new formula that predicts the individual probability of macular hole closure for eyes with full thickness macular holes (FTMH) accompanied by vitreomacular traction (VMT) which received enzymatic vitreolysis using intravitreally administered ocriplasmin. The secondary objective was to evaluate the forecast reliability of a previously published formula for VMT resolution in VMT-only eyes (OddsIVO-Success = eIntercept × ORyears × ORln(µm); ProbabilityIVO-Success = OddsIVO-Success/(OddsIVO-Success + 1)) on VMT resolution using the current dataset of eyes with FTMH accompanied by VMT. Retrospective analysis of the OASIS, ORBIT, and INJECT-studies. Patients with FTMH and VMT with complete information (n = 213) were included. The effect of gender, age, FTMH diameter, lens status and the presence of epiretinal membranes (ERM) on FTMH closure was assessed using separate univariate logistic regression analyses. With regard to VMT release separate univariate regression analyses were carried out and results were compared with formerly published data of VMT resolution in eyes with VMT only. Overall, 126 eyes (63%) experienced VMT resolution within 28 days. Younger age (p < 0.0001) and VMT diameter (p = 0.041) had a significant impact on VMT release. Overall, 81 eyes (38%) treated with ocriplasmin showed FTMH closure within 28 days. Univariate analysis of the different predictors analyzed revealed that FTMH diameter < 250 µm had a significant impact on treatment success (p = 0.0495). It was not possible to calculate and establish a new multivariate formula that can predict the individual FTMH closure probability for eyes with FTMHs and VMT. However, the results of VMT release prediction in eyes with FTMHs accompanied by VMT matched the prediction of VMT release in eyes with VMT only when using the previously published formula. All in all, predictors for calculating the individual probability of VMT resolution on the one hand and FTMH closure on the other hand are different suggesting diverse pathophysiological mechanisms.
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Affiliation(s)
- Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Lars Berndzen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | - Sebastian Pfeiffer
- UMG Study Center, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas Leha
- Department of Medical Biometry and Statistical Bioinformatics, University Medical Center Goettingen, Goettingen, Germany
| | - Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
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Khanani AM, Constantine RN, Blot KH, Lescrauwaet B, Szurman P. Effectiveness of ocriplasmin in real-world settings: A systematic literature review, meta-analysis, and comparison with randomized trials. Acta Ophthalmol 2021; 99:e823-e836. [PMID: 33369248 PMCID: PMC8518696 DOI: 10.1111/aos.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
Purpose Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta‐analysis of ocriplasmin studies conducted in real‐world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs). Methods We included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end‐points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta‐regression on pooled results to evaluate effects of baseline covariates and study design on outcomes. Results Thirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18–2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08–0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression. Conclusions Ocriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.
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Affiliation(s)
| | | | | | | | - Peter Szurman
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
- Klaus Heimann Eye Research Institute (KHERI) Sulzbach Germany
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Joondeph BC, Willems P, Raber T, Duchateau L, Markoff J. Prognostic Factors Associated with Ocriplasmin Efficacy for the Treatment of Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies. J Ophthalmic Vis Res 2021; 16:42-55. [PMID: 33520127 PMCID: PMC7841271 DOI: 10.18502/jovr.v16i1.8250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of patient baseline characteristics on the efficacy of ocriplasmin treatment for symptomatic vitreomacular adhesion (VMA) with full-thickness macular hole (FTMH) from phase 3/4 studies. Methods Patients with symptomatic VMA and FTMH at baseline and receiving ocriplasmin treatment 125 μg were pooled from the MIVI-TRUST, OASIS, and ORBIT studies. Multivariable logistic regression analysis was used to evaluate whether patient baseline characteristics were predictors of having VMA resolution by Day 28 and FTMH closure by Month 6. Results Two hundred and seventy-four patients receiving ocriplasmin treatment were assessed. Overall, 22.6% (62/274) of the patients experienced both VMA resolution by Day 28 and non-surgical FTMH closure by Month 6. Patients with FTMH ≤250 µm at baseline had a significantly higher success rate compared to those with FTMH >400 µm (29.9% [41/137] vs 2.2% [1/48]; P = 0.009). In patients with VMA resolution by Day 28, both small FTMH size (P = 0.001) and FTMH width at RPE (P = 0.012) were significantly associated with a higher FTMH closure rate. Patients with VMA resolution had higher rates of FTMH closure. Previously identified baseline predictive factors, including age, lens status, or presence of epiretinal membrane (ERM) were not found to be predictive of both VMA release and FTMH closure. Conclusion The analysis revealed that FMTH ≤250 µm was the only factor predictive for achieving both pharmacological VMA resolution by Day 28 and nonsurgical FTMH closure by Month 6; neither lens status or presence of ERM, previously identified baseline characteristics favoring VMA resolution, showed statistically significant predictive power for both outcomes.
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Affiliation(s)
| | | | | | - Luc Duchateau
- Biometrics Research Group, Ghent University, Gent, Belgium
| | - Joseph Markoff
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Steel DHW, Patton N, Stappler T, Karia N, Hoerauf H, Patel N, Wachtlin J, Raber T, Kozma-Wiebe P. OCRIPLASMIN FOR VITREOMACULAR TRACTION IN CLINICAL PRACTICE: The INJECT Study. Retina 2021; 41:266-276. [PMID: 32496343 PMCID: PMC7819525 DOI: 10.1097/iae.0000000000002862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole (MH). The INJECT study prospectively evaluated ocriplasmin in the setting of clinical practice. METHODS INJECT was a Phase 4, multicenter, prospective observational study. Patients were followed up for 12 months. Assessments included nonsurgical VMT resolution, nonsurgical MH closure, best-corrected visual acuity, occurrence of vitrectomy, and adverse events. RESULTS The efficacy population (N = 395) received an ocriplasmin injection and had optical coherence tomography-confirmed VMT at baseline. At Day 28, the rate of nonsurgical VMT resolution was 40.7% in the overall group, and the rate of nonsurgical MH closure was 36.0% in the VMT with MH group. At Month 12, the rate of ≥2-line best-corrected visual acuity gain (irrespective of vitrectomy) was 36.8% in the overall group and 59.6% in the VMT with MH group. The percentage of patients who underwent vitrectomy in the study eye was 29.1% in the overall group and 55.6% in the VMT with MH group. Photopsia (9.8%) and vitreous floaters (6.8%) were the most frequent adverse events. CONCLUSION The INJECT study showed that ocriplasmin is effective in a clinical setting in patients with VMT, with or without MH. No new safety signals were identified from this large and surgeon-selected patient group, although the significant limitations of the study design without an image reading center and scheduled study visit timings should be noted.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Theodor Stappler
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
| | - Niral Karia
- Southend University Hospital, Westcliff-on-Sea, United Kingdom
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Germany
| | - Nishal Patel
- Department of Ophthalmology, Kent and Canterbury Hospital, East Kent Hospitals University, Canterbury, United Kingdom
| | - Joachim Wachtlin
- Augenheilkunde, Sankt Gertrauden-Krankenhaus GmbH, Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany; and
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Chen Y, Nasrulloh AV, Wilson I, Geenen C, Habib M, Obara B, Steel DHW. Macular hole morphology and measurement using an automated three-dimensional image segmentation algorithm. BMJ Open Ophthalmol 2020; 5:e000404. [PMID: 32844119 PMCID: PMC7430427 DOI: 10.1136/bmjophth-2019-000404] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/21/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Full-thickness macular holes (MH) are classified principally by size, which is one of the strongest predictors of anatomical and visual success. Using a three-dimensional (3D) automated image processing algorithm, we analysed optical coherence tomography (OCT) images of 104 MH of patients, comparing MH dimensions and morphology with clinician-acquired two-dimensional measurements. Methods and Analysis All patients underwent a high-density central horizontal scanning OCT protocol. Two independent clinicians measured the minimum linear diameter (MLD) and maximum base diameter. OCT images were also analysed using an automated 3D segmentation algorithm which produced key parameters including the respective maximum and minimum diameter of the minimum area (MA) of the MH, as well as volume and surface area. Results Using the algorithm-derived values, MH were found to have significant asymmetry in all dimensions. The minima of the MA were typically approximately 90° to the horizontal, and differed from their maxima by 55 μm. The minima of the MA differed from the human-measured MLD by a mean of nearly 50 μm, with significant interobserver variability. The resultant differences led to reclassification using the International Vitreomacular Traction Study Group classification in a quarter of the patients (p=0.07). Conclusion MH are complex shapes with significant asymmetry in all dimensions. We have shown how 3D automated analysis of MH describes their dimensions more accurately and repeatably than human assessment. This could be used in future studies investigating hole progression and outcome to help guide optimum treatments.
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Affiliation(s)
- Yunzi Chen
- Sunderland Eye Infirmary, Sunderland, UK
| | - Amar V Nasrulloh
- Department of Computer Science, Durham University, Durham, Durham, UK
| | - Ian Wilson
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Boguslaw Obara
- Department of Computer Science, Durham University, Durham, Durham, UK
| | - David H W Steel
- Sunderland Eye Infirmary, Sunderland, UK.,Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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Tosi GM, Bacci T, Tarantello A, Marigliani D, Calmanti G, Polito MS, Neri G, Fusco F, Cevenini G, Virgili G. Vitreomacular interface alterations following peripheral laser retinopexy: Interface changes after laser. Eur J Ophthalmol 2019; 30:941-947. [PMID: 31538489 DOI: 10.1177/1120672119876547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR). METHODS Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group). RESULTS In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05). CONCLUSION These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.
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Affiliation(s)
- Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Antonio Tarantello
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Davide Marigliani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Giacomo Calmanti
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Maria Sole Polito
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Giovanni Neri
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Fiorella Fusco
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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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.
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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
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[Microstructural retinal changes after pharmacological vitreolysis with ocriplasmin-an SD-OCT supported analysis]. Ophthalmologe 2019; 117:260-266. [PMID: 31346704 DOI: 10.1007/s00347-019-0944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Ocriplasmin (Jetrea®) is a therapeutic option for patients with focal vitreomacular traction (VMT) with or without small full thickness macular holes (FTMH) < 400 µm. Retinal alterations after injection with ocriplasmin have been described. The purpose of this essay was to determine Ocriplasmin-associated side-effects and changes in the retinal microstructure. METHODS We included 70 patients with ocriplasmin treatment in our study. On all patients SD-OCT (spectral-domain optical coherence tomography) scans were performed prior to injection with Ocriplasmin. If present, adverse events were registered. The OCT scans were then evaluated taking the following into account: macular hole (MH) size, macular edema, subretinal fluid (SRF), changes in the ellipsoid zone (EZ) and the external limiting membrane (ELM). RESULTS Twenty of the 70 examined patients showed a preoperative FTMH. One week after ocriplasmin IVI (intravitreal injection) 8 of the 20 FTMHs were already closed. Overall 12 patients showed a FTMH closure and 4 patients developed a FTMH after ocriplasmin IVI. Twelve of the 24 MH (macular hole) patients still required an operative closure of the FTMH. We noticed a resolution of the VMT on 51 patients. Three patients developed a retinal detachment. Furthermore, after ocriplasmin IVI we detected changes in the EZ and ELM on 8 patients. CONCLUSIONS Ocriplasmin is a substantial minimal invasive option in the therapy of VMT with or without small FTMH. Nevertheless, there seem to be some specific ocriplasmin-associated risks, although usually transient. Severe complications like retinal detachment are rare but exist. Therefore, every indication of ocriplasmin should be considered carefully.
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Grinton M, Steel DH. Cochrane Corner: Ocriplasmin-why isn't it being used more? Eye (Lond) 2019; 33:1195-1197. [PMID: 30940886 DOI: 10.1038/s41433-019-0407-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Grinton
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK.
| | - David H Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
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13
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Treatment of primary full-thickness macular hole by intravitreal injection of expansile gas. Eye (Lond) 2018; 33:136-143. [PMID: 30185833 DOI: 10.1038/s41433-018-0098-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH). METHODS Prospective interventional case series. Twenty-six eyes of 26 patients in Peking Union Medical College Hospital with primary FTMH underwent IVI of perfluoropropane (C3F8) 0.2 ml, followed by 7-14 days' face-down positioning. The macular hole closure rate, post-operative visual acuity, and the incidence of surgical complications were observed. The correlation between the patients' age, macular hole diameter, pre-operative best-corrected visual acuity (BCVA), status of the vitreous, and the macular hole closure rates were analyzed. RESULTS A total of 17 cases (65.4%) had hole closure after IVI of C3F8 alone. The closure rate of small, medium, and large FTMH was 85.7, 80, and 33.3%, respectively. Pre-operative OCT examination showed that 10 cases (37%) had vitreomacular traction (VMT), and all of them achieved vitreous-macula separation after IVI of the gas. The diameters of the hole (P = 0.024) and the status of the vitreous (P = 0.038) had a significance difference for hole closure. The mean pre-operative and post-operative BCVA was 0.84 ± 0.29 and 0.49 ± 0.36 (logMAR), respectively (P < 0.01). One myope with persistent hole developed rhegmatogenous retinal detachment (RRD) 2 months after the surgery. Another myope with hole closure developed RRD 10 months after the surgery. They achieved hole closure and retinal reattachment after vitrectomy and scleral buckling, respectively. CONCLUSION Intravitreal injection of C3F8 gas alone was an effective treatment for small-sized and medium-sized primary FTMH, but further large prospective studies are needed.
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Paul C, Krug P, Müller HH, Wachtlin J, Mennel S, Müller S, Schmitz-Valckenberg S, Bertelmann T, Schumann RG. Comparison of the horizontal diameter to a modeled area of traction in eyes with vitreomacular traction: is the diameter close enough to the truth? Graefes Arch Clin Exp Ophthalmol 2018; 256:1817-1822. [PMID: 29955972 DOI: 10.1007/s00417-018-4055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT. METHODS A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (Ameasured). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (Acircular). RESULTS Thirty-seven eyes of 37 patients with pure VMT were included. Patients' mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44-991 μm). While there was no difference between mean areas of traction for Acircular and Ameasured (P = 0.93), the individual difference (|Acircular - Ameasured|) was 0.042 (± 0.044) mm2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of Ameasured to Acircular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively. CONCLUSION Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - P Krug
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - H H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - J Wachtlin
- Department of Ophthalmology, Sankt Gertrauden-Krankenhaus, Berlin, Germany.,The Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - S Mennel
- Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria
| | - S Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - T Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.,ARTEMIS Eye Clinic, Dillenburg, Germany
| | - R G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
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15
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Forsaa VA, Lindtjørn B, Kvaløy JT, Frøystein T, Krohn J. Epidemiology and morphology of full-thickness macular holes. Acta Ophthalmol 2018; 96:397-404. [PMID: 29197164 DOI: 10.1111/aos.13618] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/02/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the incidence of full-thickness macular holes (FTMHs) and their morphological features according to the International Vitreomacular Traction Study (IVTS) classification. METHODS The clinical records of all new patients with FTMH, referred between 2008 and 2014, were reviewed for demographics, cause of the FTMH, age at diagnosis, symptom duration, laterality, visual acuity (VA), axial length and lens status. A detailed analysis of the patients' spectral domain optical coherence tomography (SD-OCT) images was performed, and the primary FTMHs were classified in clinical stages according to the IVTS classification. From the SD-OCT, accurate macula drawings were made by means of a computer-drawing software. By merging these drawings and displaying them as colour-coded maps, the morphology and shape of the FTMH were visualized. RESULTS The study included 177 eyes (152 primary and 25 secondary FTMH) in 166 patients. In primary FTMH, the male-to-female ratio was 1:2.2. The age- and gender-adjusted annual incidences of primary FTMH were 7.9 eyes and 7.4 individuals per 100 000 inhabitants. Mean primary FTMH minimum linear diameter (MLD) and basal diameter (BD) were 435 μm and 872 μm, respectively, and 13% were classified as small, 31% as medium and 55% as large. Vitreomacular traction (VMT) and epiretinal membrane (ERM) were present in 34% and 36% of the eyes, respectively. CONCLUSION This study provides data on the incidence rates of FTMH adjusted to different standard populations. The morphological analysis and novel computational visualization technique offer new insight into the structural complexity of FTMH and how VMT and ERM significantly influence FTMH configuration.
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Affiliation(s)
- Vegard Asgeir Forsaa
- Department of Ophthalmology; Stavanger University Hospital; Stavanger Norway
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
| | - Birger Lindtjørn
- Department of Ophthalmology; Stavanger University Hospital; Stavanger Norway
| | - Jan Terje Kvaløy
- Department of Research; Stavanger University Hospital; Stavanger Norway
- Department of Mathematics and Natural Sciences; University of Stavanger; Stavanger Norway
| | - Torbjørn Frøystein
- Department of Oncology and Medical Physics; Haukeland University Hospital; Bergen Norway
| | - Jørgen Krohn
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
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17
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Nasrulloh AV, Willcocks CG, Jackson PTG, Geenen C, Habib MS, Steel DHW, Obara B. Multi-Scale Segmentation and Surface Fitting for Measuring 3-D Macular Holes. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:580-589. [PMID: 29408786 DOI: 10.1109/tmi.2017.2767908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Macular holes are blinding conditions, where a hole develops in the central part of retina, resulting in reduced central vision. The prognosis and treatment options are related to a number of variables, including the macular hole size and shape. High-resolution spectral domain optical coherence tomography allows precise imaging of the macular hole geometry in three dimensions, but the measurement of these by human observers is time-consuming and prone to high inter- and intra-observer variability, being characteristically measured in 2-D rather than 3-D. We introduce several novel techniques to automatically retrieve accurate 3-D measurements of the macular hole, including: surface area, base area, base diameter, top area, top diameter, height, and minimum diameter. Specifically, we introduce a multi-scale 3-D level set segmentation approach based on a state-of-the-art level set method, and we introduce novel curvature-based cutting and 3-D measurement procedures. The algorithm is fully automatic, and we validate our extracted measurements both qualitatively and quantitatively, where our results show the method to be robust across a variety of scenarios. Our automated processes are considered a significant contribution for clinical applications.
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Geng XY, Wu HQ, Jiang JH, Jiang K, Zhu J, Xu Y, Dong JC, Yan ZZ. Area and volume ratios for prediction of visual outcome in idiopathic macular hole. Int J Ophthalmol 2017; 10:1255-1260. [PMID: 28861352 DOI: 10.18240/ijo.2017.08.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/26/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To predict the visual outcome in patients undergoing macular hole surgery by two novel three-dimensional morphological parameters on optical coherence tomography (OCT): area ratio factor (ARF) and volume ratio factor (VRF). METHODS A clinical case series was conducted, including 54 eyes of 54 patients with an idiopathic macular hole (IMH). Each patient had an OCT examination before and after surgery. Morphological parameters of the macular hole, such as minimum diameter, base diameter, and height were measured. Then, the macular hole index (MHI), tractional hole index (THI), and hole form factor (HFF) were calculated. Meanwhile, novel postoperative macular hole (MH) factors, ARF and VRF were calculated by three-dimensional morphology. Bivariate correlations were performed to acquire asymptotic significance values between the steady best corrected visual acuity (BCVA) after surgery and 2D/3D arguments of MH by the Pearson method with two-tailed test. All significant factors were analyzed by the receiver operating characteristic (ROC) curve analysis of SPSS software which were responsible for vision recovery. ROC curves analyses were performed to further discuss the different parameters on the prediction of visual outcome. RESULTS The mean and standard deviation values of patients' age, symptoms duration, and follow-up time were 64.8±8.9y (range: 28-81), 18.6±11.5d (range: 2-60), and 11.4±0.4mo (range: 6-24), respectively. Steady-post-BCVA analyzed with bivariate correlations was found to be significantly correlated with base diameter (r=0.521, P<0.001), minimum diameter (r=0.514, P<0.001), MHI (r=-0.531, P<0.001), THI (r=-0.386, P=0.004), HFF (r=-0.508, P<0.001), and ARF (r=-0.532, P<0.001). Other characteristic parameters such as age, duration of surgery, height, diameter hole index, and VRF were not statistically significant with steady-post-BCVA. According to area under the curve (AUC) values, values of ARF, MHI, HFF, minimum diameter, THI, and base diameter are 0.806, 0.772, 0.750, 0.705, 0.690, and 0.686, respectively. However, Steady-post-BCVA analysis with bivariate correlations for VRF was no statistical significance. Results of ROC curve analysis indicated that the MHI value, HFF, and ARF was greater than 0.427, 1.027 and 1.558 respectively which could correlate with better visual acuity. CONCLUSION Compared with MHI and HFF, ARF could effectively express three-dimensional characteristics of macular hole and achieve better sensitivity and specificity. Thus, ARF could be the most effective parameter to predict the visual outcome in macular hole surgery.
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Affiliation(s)
- Xing-Yun Geng
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China.,Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Qun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jie-Hui Jiang
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jun Zhu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yi Xu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jian-Cheng Dong
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhuang-Zhi Yan
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China
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Manousaridis K, Peter-Reichart S, Mennel S. Ocriplasmin treatment for vitreomacular traction in real life: can the indication spectrum be expanded? Graefes Arch Clin Exp Ophthalmol 2017; 255:1907-1916. [PMID: 28681138 DOI: 10.1007/s00417-017-3731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. METHODS The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. RESULTS Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. CONCLUSIONS Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.
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Affiliation(s)
- Kleanthis Manousaridis
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Silvia Peter-Reichart
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Stefan Mennel
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
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New insights into the pathoanatomy of macular holes based on features of optical coherence tomography. Surv Ophthalmol 2017; 62:506-521. [PMID: 28300548 DOI: 10.1016/j.survophthal.2017.03.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 11/20/2022]
Abstract
Various important findings related to the development and progression of idiopathic macular holes (MHs) have been described using optical coherence tomography since Gass first staged MH development using biomicroscopy in 1988 and 1995. We believe that a system for classifying and staging MHs should reflect the degree of disease status and its progression and have value not only from a practical point of view (by predicting the chance of closure or visual recovery), but also provide researchers and clinicians with insights into the pathogenesis and disease progression of MH. These data pave the way for the development of more effective strategies. In this review, we integrate the morphologic features of MHs observed by optical coherence tomography with Gass's biomicroscopic classification and anatomic interpretations. As a result, we propose a conceptual model of a modified classification system for MHs: (1) there are 2 types of MHs starting from the earliest developmental phases of the condition; (2) differences between the types of MHs result from the peculiar characteristics of Müller cells in the fovea; and (3) this classification system, which is based on the degree of preoperative tissue defects, determines closure patterns as well as visual outcomes after an MH is surgically repaired.
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21
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Khan MA, Haller JA. Ocriplasmin for Treatment of Vitreomacular Traction: An Update. Ophthalmol Ther 2016; 5:147-159. [PMID: 27619226 PMCID: PMC5125123 DOI: 10.1007/s40123-016-0062-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Indexed: 11/28/2022] Open
Abstract
Pharmacologic vitreolysis with ocriplasmin, a 27 kilodalton serine protease, is an effective nonsurgical treatment option for vitreomacular traction (VMT). Data from phase III clinical studies, including the Microplasmin for Intravitreal Injection-Traction Release without Surgical Treatment (MIVI-TRUST) and Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) studies, have demonstrated the treatment efficacy of ocriplasmin for VMT and full-thickness macular hole (FTMH). Subgroup analysis of these clinical trials as well as post-marketing clinical series have aided in patient selection by identifying features associated with successful pharmacologic release of VMT with ocriplasmin, including adhesion diameter ≤1500 μm, absence of epiretinal membrane, phakic status, and age younger than 65. As a first-in-class therapeutic, ocriplasmin and its side effects have been carefully monitored by the vitreoretinal community. The following categories of related or possibly related adverse events have been identified: acute reduction in visual acuity, ERG changes, dyschromatopsia, retinal tear or detachment, lens subluxation or phacodonesis, abnormal pupillary reflex, retinal vascular changes, and OCT ellipsoid zone alterations. Adverse events have almost all been transient with restoration of visual acuity; however, in select patients, alterations may persist.
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Affiliation(s)
- Mohammed Ali Khan
- Retina Division, Department of Ophthalmology, Doheny Eye Center UCLA, Pasadena, CA, USA.,Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Julia A Haller
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA.
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22
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Steel DHW, Wong D. Ocriplasmin — variable efficacy? Graefes Arch Clin Exp Ophthalmol 2016; 254:1245-6. [PMID: 27262728 DOI: 10.1007/s00417-016-3404-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- David H W Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK.
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
| | - David Wong
- St. Paul's Eye Unit, Royal Liverpool University Hospital Trust, Liverpool, UK
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