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Klaas JE, Lommatzsch A, Krohne TU, Hattenbach LO, Priglinger S. [Lamellar macular holes-In the center of vitreomacular interface diseases : Pathophysiology, spontaneous courses and treatment concepts]. DIE OPHTHALMOLOGIE 2024; 121:452-461. [PMID: 38842556 DOI: 10.1007/s00347-024-02054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. PURPOSE Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. METHODS Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. RESULTS The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. CONCLUSION The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.
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Affiliation(s)
- Julian E Klaas
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | | | - Tim U Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Deutschland
| | - Lars-Olof Hattenbach
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
| | - Siegfried Priglinger
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
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Paez-Escamilla M, Alabek ML, Beale O, Prensky CJ, Lejoyeux R, Friberg TR, Sahel JA, Rosin B. An Optical Coherence Tomography-Based Measure as an Independent Estimate of Retinal Function in Retinitis Pigmentosa. Diagnostics (Basel) 2023; 13:3521. [PMID: 38066762 PMCID: PMC10706660 DOI: 10.3390/diagnostics13233521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND With the clinical advances in the field of gene therapy, the development of objective measures of visual function of patients with inherited retinal dystrophies (IRDs) is of utmost importance. Here, we propose one such measure. METHODS We retrospectively analyzed data from a cohort of 194 eyes of 97 genetically diagnosed patients with retinitis pigmentosa (RP), the most common IRD, followed at the UPMC Vision Institute. The analyzed data included the reflectivity ratio (RR) of the retinal nerve fiber layer (RNFL) to that of the entire retina, visual acuity (VA) and the thickness of the retinal outer nuclear layer (ONL) and the RNFL. RESULTS There was a strong positive correlation between the RR and VA. Both VA and the RR were negatively correlated with disease duration; VA, but not the RR, was negatively correlated with age. The RR correlated with the ONL but not with the RNFL thickness or the intraocular pressure. Age, RR, disease duration and ONL thickness were found to be independent predictors of VA by multivariate analysis. CONCLUSION The OCT RR could serve as an independent predictor of visual acuity, and by extension of retinal function, in genetically diagnosed RP patients. Such objective measures can be of great value in patient selection for therapeutic trials.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Department of Ophthalmology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Michelle L. Alabek
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Oliver Beale
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Colin J. Prensky
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Raphael Lejoyeux
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Rothschild Foundation Hospital, 75019 Paris, France
- Institut Oeil Paupiere, Viry-Chatillon, 91170 Paris, France
| | - Thomas R. Friberg
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Jose-Alain Sahel
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Boris Rosin
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
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Jain M, Narayanan R, Gopal L, Padhi TR, Behera UC, Panda KG, Tabasum R, Banjare NK. Post-vitrectomy secondary macular holes: Risk factors, clinical features, and multivariate analysis of outcome predictors. Indian J Ophthalmol 2023; 71:2053-2060. [PMID: 37203080 PMCID: PMC10391407 DOI: 10.4103/ijo.ijo_1749_22] [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: 05/20/2023] Open
Abstract
Purpose We report clinical characteristics, risk factors, treatment outcomes, and prognostic predictors of post-vitrectomy secondary macular holes (MHs). Methods This was a retrospective observational case series from November 2014 to December 2020. Eyes that developed secondary MH, two weeks and beyond after primary vitrectomy for non-MH indications, were enrolled. Pre- and intraoperative records were screened to exclude pre-existence of MH. Eyes with multiple vitreoretinal surgeries prior to MH detection and tractional myopic maculopathy were excluded. Results A total of 29 eyes of 29 patients with a mean age of 52 years developed secondary MH post-vitrectomy. The most common indications for primary vitrectomy were rhegmatogenous retinal detachment (RRD, 48.2%) and tractional retinal detachment (TRD, 24.1%). Time to MH detection after primary vitrectomy was 91.5 ± 117.6 days. The mean minimum hole diameter was 530 ± 298 microns. Epi-retinal membrane and cystoid degeneration was noted in 6 (20.7%) and 12 (41.3%) eyes, respectively (p = 0.088). The mean time from MH detection to MH repair was 34 ± 42 days. The surgical intervention included internal limiting membrane peeling with tamponade in 25 eyes. Overall, 80% showed anatomic hole closure, 90.9% versus 57.1% in the RRD and TRD (p = 0.092), respectively. The mean best-corrected visual acuity (BCVA) at the final visit was 0.71 logarithm of the minimum angle of resolution. Thirteen eyes (52%) had a BCVA of 20/100 or better. Minimal hole diameter (p = 0.029) only predicted final visual acuity. The interval between MH diagnosis and repair did not affect hole closure significantly (p = 0.064). Conclusion Secondary MH post-vitrectomy closed successfully with limited visual improvement and trails behind idiopathic MH.
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Affiliation(s)
- Mukesh Jain
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Raja Narayanan
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha; Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), Hyderabad, Telangana, India
| | - Lingam Gopal
- Sankara Nethralaya, Sri Bhagavan Mahavir Vitreoretina Services, Chennai, Tamil Nadu, India
| | - Tapas R Padhi
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Umesh C Behera
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Krushna G Panda
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Runa Tabasum
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Nadeem K Banjare
- Anant Baja Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Staropoli PC, Moolani HV, Elhusseiny AM, Flynn Jr HW, Smiddy WE. Rates of Fellow Eye Macular Hole Development During Long Term Follow-Up. Clin Ophthalmol 2023; 17:47-52. [PMID: 36636620 PMCID: PMC9830953 DOI: 10.2147/opth.s394933] [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: 11/08/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Identify the long-term rate of fellow eye full-thickness macular hole (FTMH) development. Patients and Methods In this single site, single provider retrospective consecutive case series, idiopathic FTMH patients who underwent surgery from 2003 to 2014 who also had at least 5 years of follow-up information within our electronic medical record (EMR) which was started in 2014 were identified. Cases with secondary causes (ie, trauma), high myopia, bilateral FTMH on presentation, previous retinal surgery, retinal breaks, or intraocular inflammation were excluded. Demographics, medical and ocular history, refractive error, phakic status, best corrected visual acuity, follow-up duration, surgical technique, single operation anatomic success, and reoperations were recorded. Results The rate of fellow eye FTMH was 2.6% (2/77) at 1 year, 5.2% (4/77) at 3 years, 9.1% (6/66) at 6 years, and 9.1% (7/77) as of final follow up. There were 2 cases by year 1, 2 additional cases by year 3, 2 additional cases by year 6, and 1 additional case reported thereafter. The average follow up was 11.1 ± 4.5 years. There was no significant difference in visual outcomes between primary eyes and fellow eyes. There was no significant difference in gender, age, ocular comorbidities, refractive error, phakic status, and visual acuity between the unilateral and bilateral groups. Conclusion The rate of FTMH in the fellow eye was low but significant, increased during long-term follow up, and may stabilize after 6 years.
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Affiliation(s)
- Patrick C Staropoli
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harsh V Moolani
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Harry W Flynn Jr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,Correspondence: William E Smiddy, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1 305-302-2704, Fax +1 305-326-6114, Email
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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Lindtjørn B, Krohn J, Forsaa VA. Optical coherence tomography features and risk of macular hole formation in the fellow eye. BMC Ophthalmol 2021; 21:351. [PMID: 34587925 PMCID: PMC8482611 DOI: 10.1186/s12886-021-02111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that precede MH formation in the fellow eye. Methods A retrospective review of 229 patients treated for primary MH at Stavanger University Hospital, Norway, from January 2008 through December 2018. The patients were categorised into two groups according to subsequent development of MH in the fellow eye. The OCT findings of the two groups were compared, and associated risk factors for MH formation assessed. Results Twenty cases of bilateral MH were identified. The overall bilateral disease risk was 8.8% (95% CI, 5.8–13.2%). Two patients were previously operated in the fellow eye, six patients presented with bilateral MH, and 12 patients subsequently developed MH in the fellow eye. The risk of subsequent MH development was 5.7% (95% CI, 3.3–9.8%). Although the extent of posterior vitreous detachment (PVD) tended to be more progressed in the bilateral group compared with the unilateral group, the difference was not statistically significant. In the bilateral group, 41.7% had outer retinal defects vs 6.6% in the unilateral group (p = 0.001), and 33.3% in the bilateral group had intraretinal pseudocysts vs 10.2% in the unilateral group (p = 0.036, not significant after multiple testing correction). Conclusion Outer retinal defects and intraretinal pseudocysts are associated with an increased risk of MH formation in the fellow eye, and complete PVD indicates a decreased risk of MH formation.
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Affiliation(s)
- Birger Lindtjørn
- Department of Ophthalmology, Stavanger University Hospital, box 8100, N-4068, Stavanger, PO, Norway. .,Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.
| | - Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.,Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Vegard A Forsaa
- Department of Ophthalmology, Stavanger University Hospital, box 8100, N-4068, Stavanger, PO, Norway.,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
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