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Wu TT, Hou TY, Peng KL, Kung YH. Inverted flap technique versus internal limiting membrane insertion for macular hole in eyes with extremely high myopia. BMC Ophthalmol 2024; 24:286. [PMID: 39009984 PMCID: PMC11251341 DOI: 10.1186/s12886-024-03566-8] [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: 12/05/2023] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND To compare the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique and ILM insertion for macular hole (MH) without retinal detachment in eyes with extremely high myopia. METHODS In this retrospective study, we analyzed 22 eyes with an axial length ≥ 30.0 mm that had underwent MH surgery between April 2015 and August 2021. The surgical procedures involved either an inverted ILM flap or ILM insertion. The outcomes were compared between the two techniques. Closure of the MH was confirmed by optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) was measured before and after surgery. Associated complications were documented. RESULTS The median of axial length was 30.64 mm (range, 30.0-34.42). The MH closed in 100% (22/22) eyes and did not recur with a median follow-up of 12.5 months. For the inverted ILM flap technique, the median BCVA improved significantly from 0.80 logarithm of the minimum angle of resolution (logMAR) (range, 0.40-2.00) before surgery to 0.70 logMAR (range, 0.09-1.52) after surgery (p = 0.002). In addition, the median of final BCVA was better for the inverted ILM flap than ILM insertion (0.7 logMAR V.S. 1.00 logMAR; p = 0.016). CONCLUSIONS In eyes with extremely high myopia, despite comparable effects on MH closure for both ILM insertion and the inverted ILM flap, the later technique achieved significantly better visual outcomes.
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Affiliation(s)
- Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Tzu-Yu Hou
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Kai-Ling Peng
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, R.O.C
| | - Ya-Hsin Kung
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C..
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COMPARISON OF AIR VERSUS PERFLUOROPROPANE INTRAOCULAR TAMPONADE COMBINED WITH VITRECTOMY FOR THE TREATMENT OF MACULAR HOLE IN HIGH MYOPIA. Retina 2023; 43:42-48. [PMID: 36228145 DOI: 10.1097/iae.0000000000003642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare the efficacy of air and perfluoropropane (C3F8) with pars plana vitrectomy (PPV) in highly myopic macular holes (HMMHs) and explore the factors related to surgical prognosis. METHODS A retrospective comparison of a consecutive series of HMMHs undergone vitrectomy and internal limiting membrane peeling. According to tamponade type, they were divided into air group and C3F8 group, which were further divided into subgroups based on hole diameter or axial length (AXL). Anatomical and functional outcomes were compared between tamponades. Related factors of initial closure rate and postoperative best-corrected visual acuity (BCVA) were analyzed by logistic regression. RESULTS The baseline characteristics in air group (n = 63) and C3F8 group (n = 37) were similar except the age of air was older ( P = 0.019). The mean follow-up period was 17.16 ± 17.97 months. After surgery, the initial closure rate of air group was 85.7% and that of C3F8 group was 83.7% ( P = 0.780). And the initial closure rate showed no difference between tamponades in the same subgroup classified by hole diameter or AXL (all P > 0.05). Postoperative BCVA improved significantly in both groups ( P < 0.001), but no difference between them ( P = 0.793). Logistic regression showed that age, minimum linear diameter, and AXL were risk factors of initial closure rate, and preoperative BCVA was the only factor associated with postoperative BCVA (all P < 0.05). CONCLUSION With a long-term follow-up of HMMH, we found air had a similar tamponade effect anatomically and functionally compared with C3F8. Air may also be a good choice for patients with HMMH.
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Xiao Y, Hu Y, Quan W, Yang Y, Lai W, Wang X, Zhang X, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Lin Z, Fang Y, Hu Y, Feng S, Yuan L, Cai H, Li T, Lin H, Yu H. Development and validation of a deep learning system to classify aetiology and predict anatomical outcomes of macular hole. Br J Ophthalmol 2023; 107:109-115. [PMID: 34348922 PMCID: PMC9763201 DOI: 10.1136/bjophthalmol-2021-318844] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/23/2021] [Indexed: 11/03/2022]
Abstract
AIMS To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP). METHODS In this multicentre retrospective cohort study, a total of 330 MH eyes with 1082 optical coherence tomography (OCT) images and 3300 clinical data enrolled from four ophthalmic centres were used to train, validate and externally test the DL and MDFN models. 266 eyes from three centres were randomly split by eye-level into a training set (80%) and a validation set (20%). In the external testing dataset, 64 eyes were included from the remaining centre. All eyes underwent macular OCT scanning at baseline and 1 month after VILMP. The area under the receiver operated characteristic curve (AUC), accuracy, specificity and sensitivity were used to evaluate the performance of the models. RESULTS In the external testing set, the AUC, accuracy, specificity and sensitivity of the MH aetiology classification model were 0.965, 0.950, 0.870 and 0.938, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative MH status prediction model were 0.904, 0.825, 0.977 and 0.766, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative idiopathic MH status prediction model were 0.947, 0.875, 0.815 and 0.979, respectively. CONCLUSION Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH.
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Affiliation(s)
- Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yijun Hu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhanjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Hu
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China .,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China .,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Wei L, Cheng K, He W, Zhu X, Lu Y. Application of total keratometry in ten intraocular lens power calculation formulas in highly myopic eyes. EYE AND VISION 2022; 9:21. [PMID: 35676698 PMCID: PMC9178866 DOI: 10.1186/s40662-022-00293-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The accuracy of using total keratometry (TK) value in recent IOL power calculation formulas in highly myopic eyes remained unknown.
Methods
Highly myopic patients who underwent uneventful cataract surgery were prospectively enrolled in this prospective comparative study. At one month postoperatively, standard deviation (SD) of the prediction errors (PEs), mean and median absolute error (MedAE) of 103 highly myopic eyes were back-calculated and compared among ten formulas, including XGboost, RBF 3.0, Kane, Barrett Universal II, Emmetropia Verifying Optical 2.0, Cooke K6, Haigis, SRK/T, and Wang-Koch modifications of Haigis and SRK/T formulas, using either TK or standard keratometry (K) value.
Results
In highly myopic eyes, despite good agreement between TK and K (P > 0.05), larger differences between the two were associated with smaller central corneal thickness (P < 0.05). As to the refractive errors, TK method showed no differences compared to K method. The XGBoost, RBF 3.0 and Kane ranked top three when considering SDs of PEs. Using TK value, the XGboost calculator was comparable with the RBF 3.0 formula (P > 0.05), which both presented smaller MedAEs than others (all P < 0.05). As for the percentage of eyes within ± 0.50 D or ± 0.75 D of PE, the XGBoost TK showed comparable percentages with the RBF 3.0 TK formula (74.76% vs. 66.99%, or 90.29% vs. 87.38%, P > 0.05), and statistically larger percentages than the other eight formulas (P < 0.05).
Conclusions
Highly myopic eyes with thinner corneas tend to have larger differences between TK and K. The XGboost enhancement calculator and RBF 3.0 formula using TK showed the most promising outcomes in highly myopic eyes.
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Caporossi T, Governatori L, Gambini G, Baldascino A, De Vico U, Ripa M, Scampoli A, Carlà MM, Rizzo C, Kilian R, Rizzo S. Treatment of recurrent high myopic macular hole associated with retinal detachment using a human amniotic membrane. Jpn J Ophthalmol 2022; 66:518-526. [PMID: 36301445 DOI: 10.1007/s10384-022-00953-w] [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: 02/28/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the efficacy of using a human amniotic membrane to close macular hole retinal detachment in highly myopic eyes. STUDY DESIGN Prospective, consecutive, nonrandomized interventional study. METHODS We included 19 high myopic eyes from 19 patients affected by macular hole retinal detachment who had already undergone vitrectomy with internal limiting membrane peeling. The patients underwent vitrectomy with amniotic membrane transplant. RESULTS Primary success was achieved after 3 months in 89.5% (17 of 19 eyes) and final macular hole closure was obtained in 94.7% (18 of 19 eyes) of the patients. The final retinal reattachment rate was 100%. The final 12-month mean BCVA improved from 20/2000 (2 logMAR) to 20/250 (1.1 logMAR). OCT-angiography revealed a high correlation between the superficial and deep capillary plexus and the final BCVA. CONCLUSION Human amniotic membrane patches can effectively repair macular hole retinal detachment in high myopic eyes in terms of anatomic results and BCVA recovery.
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Affiliation(s)
- Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Lorenzo Governatori
- Department of Neurofarba, Ophthalmology, University of Florence, Florence, Italy.
| | - Gloria Gambini
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Scampoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Yamada K, Oishi A, Kusano M, Kinoshita H, Tsuiki E, Kitaoka T. Effect of inverted internal limiting membrane flap technique on small-medium size macular holes. Sci Rep 2022; 12:731. [PMID: 35031664 PMCID: PMC8760271 DOI: 10.1038/s41598-021-04739-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/24/2021] [Indexed: 11/09/2022] Open
Abstract
Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for small-medium size MH. We recruited patients who underwent vitrectomy for small-medium size (< 400 μm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score, 21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. We compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for small-medium size MHs and may delay recovery of retinal integrity.
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Affiliation(s)
- Kanako Yamada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan.
| | - Mao Kusano
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Hirofumi Kinoshita
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
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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.
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Caporossi T, Governatori L, Verdina T, Rizzo S. Human amniotic membrane for failed macular hole. A case of initial unsuccessful outcome that resolved after amniotic membrane exchange. Eur J Ophthalmol 2021; 32:11206721211058996. [PMID: 34779681 DOI: 10.1177/11206721211058996] [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: 11/16/2022]
Abstract
INTRODUCTION We described a case of initial unsuccessful outcome of failed macular hole treated with amniotic membrane, that resolved after amniotic membrane exchange and silicone oil injection. CASE DESCRIPTION a woman affected by a high myopic macular hole that had failed to close after multiple surgeries, had been treated using an amniotic membrane graft and 20% sulfur hexafluoride but, after the gas reabsorption, the macular hole was still open, and the amnioticmembrane. A second surgery with a second amniotic membrane patch and silicone oil was carried out. Two weeks after the procedure the macular hole closed, and the final visual acuity improved from 20/400 to 20/100. CONCLUSIONS In this case, a second surgery, using a new amniotic membrane graft and a longer-lasting endotamponade, closed the hole and improved the visual acuity.
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Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, 96983Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy
| | - Lorenzo Governatori
- Department of Neurofarba, Ophthalmology, 9300University of Florence, Florence, Italy
| | - Tommaso Verdina
- Institute of Ophthalmology, 9306University of Modena and Reggio Emilia, Modena, Italy
| | - Stanislao Rizzo
- Department of Ophthalmology, 96983Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy
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HUMAN AMNIOTIC MEMBRANE TO CLOSE RECURRENT, HIGH MYOPIC MACULAR HOLES IN PATHOLOGIC MYOPIA WITH AXIAL LENGTH OF ≥30 mm. Retina 2021; 40:1946-1954. [PMID: 31868775 DOI: 10.1097/iae.0000000000002699] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of the human amniotic membrane plug for recurrent high myopic macular hole (MH) that already underwent pars plana vitrectomy with internal limiting membrane peeling and gas endotamponade. METHODS Sixteen eyes of 16 patients with recurrent high myopic MH were enrolled. A 23-gauge pars plana vitrectomy was performed. Human amniotic membrane plugs were implanted under the neuroretina inside the MH. Twenty percent sulfur hexafluoride or air was used as endotamponades. The patients were instructed to maintain facedown position for 5 days after surgery. RESULTS Optical coherence tomography examinations showed that the MHs closed in 15 of the 16 patients (93.75%) 2 weeks after one surgical intervention, and in 100% of patients after second intervention. Mean best-corrected visual acuity improved from 1 logarithm of the minimum angle of resolution (20/200) to 0.67 logarithm of the minimum angle of resolution (20/100) 6 months after surgery. Best-corrected visual acuity remained stable during the 12-month follow-up. One patient had human amniotic membrane plug dislocation after gas absorption that needed a second intervention with new AM plug implantation. No adverse events were reported during the 12-month follow-up. CONCLUSION The first case series of recurrent high myopic MH was reported, assessing the effectiveness of the human amniotic membrane plug to close recurrent MHs in pathologic myopia. All the cases were successful with encouraging best-corrected visual acuity recovery.
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Marlow ED, Mahmoud TH. Current management strategies for atypical macular holes. Taiwan J Ophthalmol 2021; 11:221-231. [PMID: 34703737 PMCID: PMC8493981 DOI: 10.4103/tjo.tjo_26_20] [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: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Abstract
This review evaluates the current surgical management options for refractory and atypical macular holes (MH) and proposes a treatment paradigm for approaching complex cases. A review of literature was performed to deliver a thorough discussion of the epidemiology and pathophysiology of MH as well as the historic evolution of surgical management strategies. With this context established, an update on recent surgical advances for management of large, chronic, and highly myopic MH is provided. New small MH may be adequately treated with pars plana vitrectomy, while those ≥300 μm should undergo internal limiting membrane (ILM) peel. For MH ≥400 μm with risk factors for failure, primary intervention should involve creation of an ILM flap and various methods of flap creation are discussed. For very large MH ≥700 μm or in refractory cases, autologous retinal transplants and other recently proposed procedures should be considered. While typical MHs enjoy high initial surgical success rates, atypical and refractory MH require additional intraoperative and postoperative considerations to maximize surgical success and optimize vision. With many techniques at the surgeon's disposal, patient selection becomes critical to improving outcomes.
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Affiliation(s)
| | - Tamer H. Mahmoud
- Associated Retinal Consultants, P.C., Royal Oak, MI, USA
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Therapeutic Efficacy of Autologous Platelet Concentrate Injection on Macular Holes with High Myopia, Large Macular Holes, or Recurrent Macular Holes: A Multicenter Randomized Controlled Trial. J Clin Med 2021; 10:jcm10122727. [PMID: 34205522 PMCID: PMC8235760 DOI: 10.3390/jcm10122727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
We aimed to evaluate the anatomical and functional outcomes of pars-plana vitrectomy (PPV) with or without autologous platelet concentrate (APC) injection in patients with recurrent macular holes (MHs), large MHs, or MHs with high myopia. This multicenter, prospective, interventional randomized controlled trial was conducted from March 2017 to April 2020. Participants were randomly allocated to a PPV group or a PPV+APC group. All participants underwent standard 25-gauge PPV, and eyes in the PPV+APC group underwent PPV with intravitreal APC injection before air-gas exchange. A total of 117 patients were enrolled (PPV group: n = 59, PPV+APC group: n = 58). Hole closure was achieved in 47 participants (79.7%) in the PPV group and 52 participants (89.7%) in the PPV+APC group. There were no between-group differences in the anatomical closure rate or functional outcomes including best-corrected visual acuity, metamorphopsia, pattern-reversal visual evoked potential, or Visual Function Questionnaire-25 score. The use of APC injection does not improve the anatomical and functional outcomes of surgery for large MHs, recurrent MHs, or MHs with high myopia. The adjunctive use of APC can be considered in selected cases because it is not inferior to conventional MH surgery, is relatively simple to perform, and is not affected by the surgeon’s skill.
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Marques RE, Sousa DC, Leal I, Faria MY, Marques-Neves C. Complete ILM Peeling Versus Inverted Flap Technique for Macular Hole Surgery: A Meta-Analysis. Ophthalmic Surg Lasers Imaging Retina 2021; 51:187-A2. [PMID: 32211909 DOI: 10.3928/23258160-20200228-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare complete internal limiting membrane (ILM) peeling with the inverted flap technique for macular hole (MH) surgery. PATIENTS AND METHODS An electronic database search on PubMed, CENTRAL, and ClinicalTrials.gov was performed. Inclusion criteria were comparative prospective/retrospective studies including patients with MH of any size with at least 6 months of follow-up. The primary outcome was MH closure rate. Secondary outcomes were best-corrected visual acuity improvement and surgery-related adverse events. RESULTS Sixteen papers enrolling 1,403 eyes were included (733 ILM peeling, 670 inverted flap). MH mean minimum diameter and time of symptomatic evolution were higher in the inverted flap group (531.1 μm ± 188.8 μm vs. 602.8 μm ± 223.8 μm; 10.4 ± 20.2 months vs. 12.0 ± 18.4 months; P < .01). Overall, MH closure rate was superior with the inverted flap technique (risk-ratio [RR]: 1.25; 95% confidence interval [CI], 1.14-1.38; P < .0001), as well as in all subgroups: idiopathic large MH (n = 362; RR: 1.12; 95% CI, 1.05-1.20; P < .001), myopic MH without retinal detachment (n = 133; RR: 1.35; 95% CI, 1.14-1.59; P < .001), and MH retinal detachment (n = 198; RR: 1.89; 95% CI, 1.31-2.73; P < .001). CONCLUSION This meta-analysis suggests the inverted flap technique is more effective in achieving MH closure. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:187-195.].
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Chatziralli I, Machairoudia G, Kazantzis D, Theodossiadis G, Theodossiadis P. Inverted internal limiting membrane flap technique for myopic macular hole: A meta-analysis. Surv Ophthalmol 2021; 66:771-780. [PMID: 33652002 DOI: 10.1016/j.survophthal.2021.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
A macular hole (MH) may be a significant complication in patients with high myopia. The recently reported inverted internal limiting membrane (ILM) flap technique is a promising alternative to treat myopic MHs. We performed a meta-analysis of the published anatomical and functional results of the "inverted ILM flap" technique for the treatment of myopic MH with or without retinal detachment (RD). Our results showed that the inverted ILM flap technique, either covering or insertion, is an effective method for treating myopic MH with or without RD and provides high MH closure, ranging from 91.8% to 97.1%. Despite the high MH closure rate, the pooled visual acuity improvement rate was 77.3% and 66.2% in patients with myopic MH without RD, while it was 95% and 80.3% in patients with myopic MHRD, using "covering" and "insertion" ILM flap technique, respectively. Potential complications included reopening or persistence of MH, development of RD, choroidal detachment, ocular hypertension, and chorioretinal atrophy.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece.
| | - Genovefa Machairoudia
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
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Tabandeh H, Morozov A, Rezaei KA, Boyer DS. Superior Wide-Base Internal Limiting Membrane Flap Transposition for Macular Holes: Flap Status and Outcomes. Ophthalmol Retina 2020; 5:317-323. [PMID: 33316462 DOI: 10.1016/j.oret.2020.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Internal limiting membrane (ILM) flap techniques are used for the management of macular holes (MHs). Status of the flap after surgery often is uncertain. The current study evaluated the status of the ILM flap after MH surgery with superior wide-base ILM flap transposition (SWIFT). DESIGN Retrospective consecutive case series. PARTICIPANTS Eyes undergoing SWIFT for MH. METHODS Data were collected on demographic characteristics, preoperative and postoperative visual acuity (VA), and MH status. OCT and indocyanine green (ICG) fluorescence were used to evaluate the MH and the ILM flap status. MAIN OUTCOME MEASURES Status of MH, ILM flap position, and ILM flap integrity. RESULTS Seventeen eyes of 17 patients with a mean age of 65.3 years and mean follow-up of 11.6 months were included in the study. Thirteen eyes had 1 or more high-risk characteristics. Four eyes (24%) were highly myopic, 6 eyes (35%) had chronic MH, and 3 eyes (18%) had a history of prior MH surgery and ILM removal. The mean MH basal diameter was 899.4 μm and the mean inner diameter was 516.1 μm. In 6 eyes, the MH inner diameter was 650 μm. The baseline mean VA equivalent was 0.88 logarithm of the minimum angle of resolution (logMAR). The MH closed in 16 eyes (94%). Indocyanine green fluorescence imaging demonstrated complete coverage of the MH by the ILM flap in 14 eyes (82%), partial coverage in 1 eye (6%), and no coverage in 2 eyes (12%). In the 2 eyes without ILM flap coverage, the MH was closed in 1 eye and remained open in 1 eye. Non-center-involving folding of the ILM flap was present in 4 eyes (24%). At the last follow-up visit, the mean VA equivalent was 0.54 logMAR. CONCLUSIONS Superior wide-base ILM flap transposition is a useful technique for the management of high-risk MHs, including persistent MHs with previously removed ILM. After surgery, the ILM flap may be visualized by ICG fluorescence imaging. After SWIFT, ICG imaging indicates that the ILM flap is intact and in a good position in most cases.
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Affiliation(s)
| | - Andy Morozov
- Retina-Vitreous Associates Medical Group, Los Angeles, California
| | | | - David S Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California
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Xu Q, Luan J. Internal limiting membrane flap technique in macular hole surgery. Int J Ophthalmol 2020; 13:822-831. [PMID: 32420232 PMCID: PMC7201361 DOI: 10.18240/ijo.2020.05.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Abstract
Vitrectomy combined with internal limiting membrane (ILM) peeling is popular for the treatment of macular hole (MH). However, the improvements of MH closure rate and postoperative visual acuity are not satisfactory especially in large and refractory MHs. Currently, the ILM flap technique has gradually been applied for the treatment of MH and achieved high MH closure rate. The ILM flap technique has many variations, including the difference of the size, shape, number, and manner in which the flaps put on the MHs. The ILM flap technique also has some auxiliary means including perfluoro-n-octane (PFO), dye, autologous blood and adhesive viscoelastics. There is controversy about the effects between several technique variations of ILM flap, and it needs to be explored in the future.
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Affiliation(s)
- Qian Xu
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Jie Luan
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
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Iwasaki M, Miyamoto H, Imaizumi H. Effects of inverted internal limiting membrane technique and insertion technique on outer retinal restoration associated with glial proliferation in large macular holes. Graefes Arch Clin Exp Ophthalmol 2020; 258:1841-1849. [PMID: 32248409 DOI: 10.1007/s00417-020-04655-2] [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] [Received: 12/26/2019] [Revised: 02/28/2020] [Accepted: 03/21/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the effects of inverted internal limiting membrane (ILM) flap technique and ILM insertion technique for large macular hole (MH) on glial proliferation, retinal outer layer restoration, and visual function. METHODS This retrospective, observational study included 25 eyes with large MH (minimum diameter, ≥ 400 μm) treated using the inverted ILM flap or insertion technique. The inverted flap group was defined as flipping the ILM upside down on the MH (13 eyes) and the insertion group as inserting multiple ILM layers into the MH (12 eyes). RESULTS Glial proliferation in the photoreceptor layer at 1 month and the final visit was significantly less frequent in the inverted flap group than in the insertion group (61.5% vs. 100%, p = 0.039; 23.1% vs. 100%, p = 0.001). The mean postoperative external limiting membrane defect was 140.4 ± 286.2 μm in the inverted flap group, significantly narrower than that in the insertion group (364.6 ± 181.6 μm; p = 0.016). The mean postoperative ellipsoid zone defect was 235.3 ± 214.2 μm in the inverted flap group, which was almost significantly narrower than that in the insertion group (496.3 ± 445.6 μm; p = 0.068). The change in the best-corrected visual acuity was significantly better in the inverted flap group than that in the insertion group (+ 18.5 vs. + 9.0 letters). CONCLUSION Compared with patients treated with the insertion technique, those treated with the inverted ILM flap technique had significantly less glial proliferation at the photoreceptor space, more preferable outer retinal formation, and better visual improvement.
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Affiliation(s)
- Masanori Iwasaki
- Department of Ophthalmology, Sapporo City General Hospital, 1-1, Kita 11-jo Nishi 13-chome, Chuo-ku, Sapporo, 060-8604, Japan.
| | - Hirotomo Miyamoto
- Department of Ophthalmology, Sapporo City General Hospital, 1-1, Kita 11-jo Nishi 13-chome, Chuo-ku, Sapporo, 060-8604, Japan
| | - Hiroko Imaizumi
- Department of Ophthalmology, Sapporo City General Hospital, 1-1, Kita 11-jo Nishi 13-chome, Chuo-ku, Sapporo, 060-8604, Japan
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Infracyanine Green vs. Brilliant Blue G in Inverted Flap Surgery for Large Macular Holes: A Long-Term Swept-Source OCT Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56010043. [PMID: 31968622 PMCID: PMC7022749 DOI: 10.3390/medicina56010043] [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: 12/08/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives: To compare the long-term toxicity of infracyanine green (IFCG) to brilliant blue G (BBG) in inverted internal limiting membrane flap surgery (I-ILMFS) for large, full-thickness macular holes (FTMHs). Materials and Methods: Prospective randomized study including 39 eyes with ≥ 400 µm idiopathic FTMH who underwent I-ILMFS with either IFCG or BBG. Postoperative 6- and 12-month corrected distance visual acuity (CDVA), closure rate, and swept-source optical coherence tomography parameters, including ellipsoid zone (EZ) and external limiting membrane (ELM) mean defect length, central foveal thicknesses (CFT), parafoveal macular thickness (MT), ganglion cells and inner plexiform layer (GCL++) thickness, and peripapillary nerve fiber layer (pRNFL) thickness, were compared. Results: Nineteen eyes were included in the IFCG group and 20 eyes in the BBG group. In all cases a FTMH closure was found. CDVA improved at 6 and 12 months in both groups (p < 0.0005); the increase at 12 months was greater in the BBG group (p = 0.036). EZ and ELM defects did not differ between groups at either follow-up time. CFT at 12 months was greater in the BBG group (p = 0.041). A 12-months compared to 6-months MT decrease was present in both groups (p < 0.01). The GCL++ superior inner sector was thicker in the BBG group at 12 months (p = 0.036), as were the superior outer sector (p = 0.039 and p = 0.027 at 6 and 12 months, respectively) and inferior outer sector (p = 0.011 and p = 0.009 at 6 and 12 months, respectively). Conclusion: In our study BBG in I-ILMFS exhibits better long-term CDVA and retinal thickness than does IFCG, suggesting a lesser toxicity from BBG. These findings support the use of BBG over IFCG in I-ILMFS.
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Wu YJ, Rao J, Wu KR, Wu N, Cheng Y, Xu XX, Yan L, Shao Y, Tian Y, Wu XR. Vitrectomy with internal limiting membrane peeling versus its flap insertion for macular hole in high myopia: a Meta-analysis. Int J Ophthalmol 2020; 13:141-148. [PMID: 31956583 DOI: 10.18240/ijo.2020.01.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/23/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the anatomic and functional outcomes between vitrectomy with internal limiting membrane (ILM) peeling and internal ILM flap insertion technique for high myopia macular hole (MH). METHODS PubMed, Cochrane Library, EMBASE, and CNKI were systematically searched, and all studies involved MH were included. The closure rate of MH and the postoperative best-corrected visual acuity (BCVA) at 6mo after the initial surgery were the primary measures. All statistical tests were performed in Review Manager 5.3. RESULTS Five studies that included 151 eyes of 151 patients were finally included, all of which were retrospectively comparative studies. Between the pars plana vitrectomy (PPV) with ILM peeling surgery and the ILM insertion technique, the latter had significantly better efficacy with respect to the closure rate of MH (OR=21.32, 95%CI=7.25-62.67, P<0.001); However, regarding BCVA at 6mo after the initial surgery in MH, there was no statistical significance between the groups (OR=-0.04, 95%CI=-0.22-0.14, P=0.66). In addition, regarding the rate of retinal reattachment after the initial surgery, the two different methods were not significantly different (OR=2.22, 95%CI=0.34-14.32, P=0.4). CONCLUSION Both ILM peeling and ILM insertion technique could significantly improve anatomic outcomes of MH in high myopia with or without retinal detachment (RD), and anatomic outcomes are more effective. However, there is no statistical significance in BCVA at 6mo after the initial surgery in MH, or in the rate of retinal reattachment after the first surgery, between the two methods.
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Affiliation(s)
- Ya-Jun Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jie Rao
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Kang-Rui Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Na Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Xuan Xu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Li Yan
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Shao
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yu Tian
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xiao-Rong Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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Hu XT, Pan QT, Zheng JW, Zhang ZD. Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique. Br J Ophthalmol 2018; 103:1495-1502. [DOI: 10.1136/bjophthalmol-2018-313311] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 11/04/2022]
Abstract
PurposeThe aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH.MethodsPars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared.ResultsThe anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001).ConclusionsThese findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.
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Chantarasorn Y, Wang JC, Roh M, Eliott D. Closure of Macular Hole Associated With Extreme High Myopia After Conventional Vitrectomy With ILM Peeling. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e99-e101. [PMID: 30222827 DOI: 10.3928/23258160-20180907-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
Macular hole associated with high myopia (MH-HM) and macular hole-associated retinal detachment (MH-RD) are two conditions found in eyes with pathologic myopia that often have poor postoperative outcomes. A discrepancy in size between the stretched retina and the posteriorly expanded sclera is a major factor in the pathogenesis. The authors report a case comprising both types of maculopathy, one in each eye. The eye with the MH-HM (right eye) represents the longest axial length ever reported to have successful macular hole closure by any technique. The authors conclude that traditional surgery can be an adequate treatment for such a challenging condition. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e99-e101.].
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