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Jia Q, Zhang K, Qi B, Yang X, Wu X, Wang X, Feng X, Liu W. VITRECTOMY COMBINED WITH INVERTED INTERNAL LIMITING MEMBRANE FLAP INSERTION OR SINGLE-LAYERED FLAP COVERING TECHNIQUE FOR HIGHLY MYOPIC MACULAR HOLES WITH MACULAR RETINOSCHISIS. Retina 2025; 45:222-230. [PMID: 39383442 DOI: 10.1097/iae.0000000000004288] [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: 10/11/2024]
Abstract
PURPOSE To investigate the anatomical and visual outcomes of inverted internal limiting membrane flap insertion versus single-layered i-internal limiting membrane flap covering in highly myopic macular holes associated with macular retinoschisis. METHODS A retrospective study compared 23 G vitrectomy with inverted-internal limiting membrane flap insertion (30 eyes) or covering (31 eyes) in highly myopic macular holes patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA. RESULTS The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group ( P = 0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group ( P = 0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared with the insertion group (1/28) finally ( P = 0.026). Final BCVA improved significantly in both groups ( P < 0.001); the BCVA was better in closed highly myopic macular holes in the covering group ( P = 0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β = 0.386, P = 0.001) and Macular hole schisis stage (β = 0.309, P = 0.004) were independent predictive factors for the final BCVA. CONCLUSION The single-layered inverted-internal limiting membrane flap covering favored foveal structure recovery and provided a better visual prognosis in closed highly myopic macular holes compared with insertion. The preoperative BCVA and macular hole schisis stage were independent predictors of visual outcomes in patients with highly myopic macular holes.
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Affiliation(s)
- Qinlang Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China ; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xijin Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xinbo Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiao Feng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Lu X, Yokoi T, Kataoka K, Inoue M. Inverted internal limiting membrane flap combined with subretinal viscoelastic injection for large or chronic macular holes. Am J Ophthalmol Case Rep 2024; 36:102100. [PMID: 39070182 PMCID: PMC11279773 DOI: 10.1016/j.ajoc.2024.102100] [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: 03/04/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To report two cases with a large or chronic macular hole (MH) that was closed by combining the inverted internal limiting membrane (ILM) flap technique with the injection of ophthalmic viscoelastic device (OVD) into the subretinal space through the MH. Observations A 76-year-old woman was referred to our clinic for surgery of a MH with a maximum diameter of 1089 μm as determined by optical coherence tomography (OCT). Her visual acuity was 20/50 in the left eye after vitrectomy was performed at a local clinic to remove vitreous opacities. For our surgery, the ILM was peeled and the ILM flap was inverted and placed over the MH. Then, cohesive OVD was injected into the subretinal space through the MH to create a retinal detachment around the MH. The MH was closed by a gas tamponade, and the vision improved to 20/40. The second patient was a 62-year-old man whose vision had been decreasing for 3 years, and he was referred to our clinic. His vision was 20/40 in the left eye and OCT detected a MH with a maximum diameter of 853 μm. After core vitrectomy, the ILM was peeled, inverted, and placed over the MH. Then, dispersive and cohesive OVD was injected through the MH. During this procedure, the MH appeared to enlarge and elevate. Then a yellowish arch-shaped lesion appeared at the temporal edge of the macular detachment. The intraoperative OCT showed that the curled-up retinal pigment epithelium (RPE) within the temporal arch-shaped lesion was adherent to the outer retinal layer. Following gas tamponade, the MH was closed but the patient noticed a paracentric scotoma on the nasal side. The fundus autofluorescence (FAF) images showed a hypo-autofluorescent lesion corresponding to the RPE defect. At postoperative 4 months, his visual acuity had improved to 20/22 and the OCT image showed that the MH was closed with a recovery of the ellipsoid zone of the photoreceptors. The subjective paracentric scotoma disappeared, however the hypo-autofluorescent lesion persisted. Conclusions and importance A combination of the inverted ILM flap and the subretinal injection of OVD can close a large or chronic MH. An RPE detachment caused by injecting OVD into the subretinal space should be avoided.
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Affiliation(s)
- Xien Lu
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadashi Yokoi
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Keiko Kataoka
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Makoto Inoue
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
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Bencheqroun M, Couturier A, Chehaibou I, Tadayoni R, Philippakis E. Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit. Eye (Lond) 2024; 38:3341-3346. [PMID: 39251889 PMCID: PMC11584870 DOI: 10.1038/s41433-024-03302-y] [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: 11/10/2023] [Revised: 07/19/2024] [Accepted: 08/08/2024] [Indexed: 09/11/2024] Open
Abstract
PURPOSE To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm. DESIGN Retrospective, monocentric, consecutive case series. PARTICIPANTS Patients with primary MH operated at Lariboisière Hospital, Paris, France. METHODS Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed. MAIN OUTCOME MEASURES Postoperative MH closure rate and visual acuity. RESULTS 74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameter was 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR. CONCLUSION MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.
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Affiliation(s)
- Mehdi Bencheqroun
- Ophthalmology Department, Université Paris Cité, AP-HP Hôpital Lariboisière, Paris, France
| | - Aude Couturier
- Ophthalmology Department, Université Paris Cité, AP-HP Hôpital Lariboisière, Paris, France
| | - Ismael Chehaibou
- Retina Division, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, Université Paris Cité, AP-HP Hôpital Lariboisière, Paris, France
- Retina Division, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Elise Philippakis
- Ophthalmology Department, Université Paris Cité, AP-HP Hôpital Lariboisière, Paris, France.
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Fallico M, Caselgrandi P, Marolo P, Parisi G, Borrelli E, Ricardi F, Gelormini F, Ceroni L, Reibaldi M. Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap. Eye (Lond) 2024; 38:3334-3340. [PMID: 39181967 PMCID: PMC11584726 DOI: 10.1038/s41433-024-03301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/12/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. METHODS Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. RESULTS A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). CONCLUSIONS The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Federico Ricardi
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Francesco Gelormini
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy
| | - Luca Ceroni
- Department of Psychology, University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy.
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Bertolani Y, Arnaiz-Camacho A, Fernández-Engroba J, García-Arumí J, Zapata MÁ. Successful use of PRGF-endoret® and ILM peeling for full thickness macular hole in MacTel type 2: A case report and review of literature. Eur J Ophthalmol 2024:11206721241301933. [PMID: 39588577 DOI: 10.1177/11206721241301933] [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: 11/27/2024]
Abstract
PURPOSE To describe the successful use of plasma rich in growth factors (PRGF-Endoret®) and internal limiting membrane peeling for full thickness macular hole in Macular Telangiectasia type 2. CASE PRESENTATION A case report of a full thickness macular hole (FTMH) associated with Macular Telangiectasia (MacTel) type 2 is described. 25-G vitrectomy with internal limiting membrane (ILM) peeling and use of (PRGF-Endoret®) was performed. Several ophthalmological visits were conducted and multiple diagnostic tests were carried out including optical coherence tomography (OCT) and fluorescein angiography. A 72-year-old man under follow-up for MacTel type 2 presented with worsening vision in his left eye, with a best visual corrected acuity (BVCA) of 20/80. OCT demonstrated a FTMH in the left eye measuring 264 µm. A 25-gauge pars plana vitrectomy surgery was performed with ILM peeling, use of PRGF-Endoret® and tamponade with 20% sulfur hexafluoride (SF6). Three weeks after surgery, complete anatomical closure was observed with a BVCA of 20/40, which improved to 20/25 one year after the surgery. CONCLUSIONS The use of PRGF associated with ILM peeling may be a useful tool in the treatment of macular holes associated with MacTel Type 2 with excellent anatomical and functional outcomes.
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Affiliation(s)
- Yann Bertolani
- Ophthalmology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jose García-Arumí
- Ophthalmology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Hu Y, Meng Y, Liang Y, Zhang Y, Chen B, Qiu J, Meng Z, Luo J. Machine Learning and Optical-Coherence-Tomography-Derived Radiomics Analysis to Predict the Postoperative Anatomical Outcome of Full-Thickness Macular Hole. Bioengineering (Basel) 2024; 11:949. [PMID: 39329691 PMCID: PMC11428902 DOI: 10.3390/bioengineering11090949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/18/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
Full-thickness macular hole (FTMH) leads to central vision loss. It is essential to identify patients with FTMH at high risk of postoperative failure accurately to achieve anatomical closure. This study aimed to construct a predictive model for the anatomical outcome of FTMH after surgery. A retrospective study was performed, analyzing 200 eyes from 197 patients diagnosed with FTMH. Radiomics features were extracted from optical coherence tomography (OCT) images. Logistic regression, support vector machine (SVM), and backpropagation neural network (BPNN) classifiers were trained and evaluated. Decision curve analysis and survival analysis were performed to assess the clinical implications. Sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC) were calculated to assess the model effectiveness. In the training set, the AUC values were 0.998, 0.988, and 0.995, respectively. In the test set, the AUC values were 0.941, 0.943, and 0.968, respectively. The OCT-omics scores were significantly higher in the "Open" group than in the "Closed" group and were positively correlated with the minimum diameter (MIN) and base diameter (BASE) of FTMH. Therefore, in this study, we developed a model with robust discriminative ability to predict the postoperative anatomical outcome of FTMH.
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Affiliation(s)
| | | | | | | | | | | | - Zhishang Meng
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (Y.H.); (Y.M.); (Y.L.); (Y.Z.); (B.C.); (J.Q.)
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (Y.H.); (Y.M.); (Y.L.); (Y.Z.); (B.C.); (J.Q.)
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Macchi I, Huelin FJ, Young-Zvandasara T, Di Simplicio S, Kadhim MR, Chawla H, Hillier RJ. PEDICLE TRANSPOSITION FLAP, INVERTED FLAP, FREE FLAP, AND STANDARD PEEL FOR LARGE FULL-THICKNESS MACULAR HOLES: A Comparative Study. Retina 2024; 44:1552-1559. [PMID: 39073100 DOI: 10.1097/iae.0000000000004142] [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: 07/30/2024]
Abstract
PURPOSE To compare anatomical and functional outcomes of four different techniques for the treatment of large idiopathic full-thickness macular holes. METHODS This single-center retrospective study included 129 eyes of 126 patients with large (>500 µ m) full-thickness macular holes who presented between January 2018 and October 2022. All patients underwent 23/25 G vitrectomy and gas with standard internal limiting membrane (ILM) peel, pedicle transposition, inverted, or free flap technique. Postoperative optical coherence tomography images were assessed by two independent masked graders. RESULTS Mean age was 73.2 years (SD 8.4) with a median F/U of 5 months (IQR 8). The overall anatomical success rate was 81%; it was significantly lower (59%) for the standard ILM peel ( P < 0.0001). The pedicle transposition flap showed superior visual recovery compared with the free flap (+27 vs. +12 ETDRS letters, P = 0.02). At 3 months, restoration of the external limiting membrane was significantly better for the pedicle transposition flap compared with free flap and standard ILM peel ( P = 0.008 and P = 0.03) and superior to all the other techniques at 6 months ( P = 0.02, P = 0.04, and P = 0.006). CONCLUSION Standard ILM peel alone offers inferior outcomes for the management of large full-thickness macular holes. Of the alternative ILM techniques, despite similar closure rates, foveal microstructural recovery is most complete following the pedicle transposition flap and least complete following the free flap.
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Affiliation(s)
- Iacopo Macchi
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
| | - Fernando J Huelin
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
| | | | - Sandro Di Simplicio
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
| | - Mustafa R Kadhim
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
| | - Harshika Chawla
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Alghamdi SA, Aljahdali FF, Sharif RK, Homsi JJ, Alzahrani AA, Alomari LK, Abukhashabah A. Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials. Int J Retina Vitreous 2024; 10:50. [PMID: 39049133 PMCID: PMC11271051 DOI: 10.1186/s40942-024-00567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs. METHODS We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS Four RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: -0.16, 0.23; P = 0.70 and SMD: -0.167; 95%CI: -1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups' EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27). CONCLUSION Macular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.
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Affiliation(s)
- Sarah A Alghamdi
- Ophthalmology Residency Training Program in Western Region, Jeddah, Saudi Arabia
| | - Faisal F Aljahdali
- Department of Ophthalmology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Rahaf K Sharif
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jumanah J Homsi
- Ophthalmology Residency Training Program in Western Region, Jeddah, Saudi Arabia
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Asma A Alzahrani
- Ophthalmology Residency Training Program in Western Region, Jeddah, Saudi Arabia
| | - Lugean K Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amro Abukhashabah
- Medical Collage of Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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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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10
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Giansanti F, Nicolosi C, Giorgio D, Sodi A, Mucciolo DP, Pavese L, Pollazzi L, Virgili G, Vicini G, Passerini I, Pelo E, Murro V. Myopic Macular Hole and Detachment after Gene Therapy in Atypical RPE65 Retinal Dystrophy: A Case Report. Genes (Basel) 2024; 15:879. [PMID: 39062658 PMCID: PMC11276487 DOI: 10.3390/genes15070879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To report a case of macular hole and detachment occurring after the subretinal injection of Voretigene Neparvovec (VN) in a patient affected by atypical RPE65 retinal dystrophy with high myopia and its successful surgical management. CASE DESCRIPTION We report a case of a 70-year-old man treated with VN in both eyes. The best corrected visual acuity (BCVA) was 0.7 LogMar in the right eye (RE) and 0.92 LogMar in the left eye (LE). Axial length was 29.60 mm in the RE and 30.28 mm in the LE. Both eyes were pseudophakic. In both eyes, fundus examination revealed high myopia, posterior staphyloma, and extended retinal atrophy areas at the posterior pole, circumscribing a central island of surviving retina. Both eyes were treated with VN subretinal injection, but a full-thickness macular hole and retinal detachment occurred in the LE three weeks after surgery. The patient underwent 23-gauge vitrectomy with internal limiting membrane (ILM) peeling and the inverted flap technique with sulfur hexafluoride (SF6) 20% tamponade. Postoperative follow-up showed that the macular hole was closed and the BCVA was maintained. CONCLUSIONS Our experience suggests that patients with atypical RPE65 retinal dystrophy and high myopia undergoing VN subretinal injection require careful management to minimize the risk of macular hole and detachment occurrence and promptly detect and address these potential complications.
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Affiliation(s)
- Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
| | - Dario Giorgio
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
- Azienda USL Toscana Nordovest, 56121 Pisa, Italy
| | - Andrea Sodi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
| | - Dario Pasquale Mucciolo
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
| | - Laura Pavese
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
| | - Liliana Pollazzi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
| | - Gianni Virgili
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
- Azienda USL Toscana Nordovest, 56121 Pisa, Italy
| | - Ilaria Passerini
- SODc Diagnostica Genetica, Careggi University Hospital, 50134 Florence, Italy; (I.P.); (E.P.)
| | - Elisabetta Pelo
- SODc Diagnostica Genetica, Careggi University Hospital, 50134 Florence, Italy; (I.P.); (E.P.)
| | - Vittoria Murro
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (D.P.M.); (L.P.); (G.V.); (V.M.)
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy; (D.G.); (L.P.); (G.V.)
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Richards K, Kadakia A, Wykoff CC, Major JC, Wong TP, Chen E, Schefler AC, Patel SB, Kim RY, Henry CR, Fish RH, Brown DM, Benz MS, Pearce W, Shah AR. MANAGEMENT OF LARGE FULL-THICKNESS MACULAR HOLES: Long-Term Outcomes of Internal Limiting Membrane Flaps and Internal Limiting Membrane Peels. Retina 2024; 44:1165-1170. [PMID: 38900578 DOI: 10.1097/iae.0000000000004099] [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: 06/22/2024]
Abstract
BACKGROUND/PURPOSE To determine and compare the efficacy of a surgical internal limiting membrane (ILM) flap technique with the traditional ILM peel on long-term visual and anatomical outcomes for large (>400 µm) full-thickness macular holes. METHODS From October 2016 to July 2022, patients undergoing initial full-thickness macular hole repair with the ILM flap or ILM peel technique were reviewed. Final outcomes were recorded and based on size in microns: 401 to 800, 801 to 1,200, and >1,200. RESULTS Patients treated with ILM flap (n = 52, 94.2% closure rate) or ILM peel (n = 407, 93.6% closure rate) were followed with a mean follow-up time of 15.0 ± 10.2 and 20.0 ± 13.4 months, respectively. Success rates for ILM flaps and ILM peels were compared for full-thickness macular holes of 401 to 800 (100%, 95.8%, P = 0.39), 801 to 1,200 (95%, 93%, P = 0.74), and >1,200 (86.7%, 86.7%, P = 1.0) µm. Mean best-recorded logarithm of the minimal angle of resolution visual acuity for ILM flaps and ILM peels, respectively, was 1.02 ± 0.46 and 0.87 ± 0.47 preoperatively, with follow-up acuity of 0.48 ± 0.32 (P < 0.03) and 0.39 ± 0.42 (P < 0.01) at Year 3. CONCLUSION Both techniques provide a similar anatomical closure rate and functional improvement in vision. Comparisons should be cautiously made based on difference in preoperative hole size.
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Affiliation(s)
- Kaitlyn Richards
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Ankit Kadakia
- McGovern School of Medicine, Department of Ophthalmology, Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - James C Major
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Tien P Wong
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Eric Chen
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Amy C Schefler
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Sagar B Patel
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Rosa Y Kim
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Christopher R Henry
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Richard H Fish
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - David M Brown
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Matthew S Benz
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - William Pearce
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
| | - Ankoor R Shah
- Retina Consultants of Texas, Department of Ophthalmology, Houston, Texas, and Retina Consultants of America, Department of Ophthalmology, Southlake, Texas; and
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12
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Riding G, Teh BL, Yorston D, Steel DH. Comparison of the use of internal limiting membrane flaps versus conventional ILM peeling on post-operative anatomical and visual outcomes in large macular holes. Eye (Lond) 2024; 38:1876-1881. [PMID: 38493269 PMCID: PMC11226651 DOI: 10.1038/s41433-024-03024-1] [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: 05/22/2023] [Revised: 02/11/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Idiopathic full-thickness macular hole (iFTMH) closure rates following conventional vitrectomy, gas tamponade and internal limiting membrane (ILM) peeling decrease when the minimum linear diameter (MLD) ≥ 500 microns. ILM flap creation has been proposed to improve closure in larger holes. This study evaluated the anatomical and functional impact of ILM flap introduction to routine practice in iFTMH ≥500 microns. METHODS Retrospective, interventional analysis of prospectively collected data of 191 eyes from consecutive surgeries for primary iFTMH ≥500 microns performed by two surgeons between June 2018 and June 2022, during which both surgeons replaced ILM peeling with ILM flap creation. Post-operative best-corrected visual acuity (BCVA) and anatomical closure were compared between Group 1 (ILM peel) and Group 2 (ILM flap) in an intention-to-treat analysis. RESULTS Rates of iFTMH closure were greater in the ILM flap group (77/80; 96.3%) than the ILM peel group (94/110; 85.5%) (OR = 4.37, 95% CI = 1.23-15.55, p = 0.023). A non-significant increase in post-operative BCVA improvement was observed in the ILM flap group (p = 0.084). There was no statistically significant difference in final BCVA (p = 0.83). Multivariate logistic regression found only MLD (OR = 0.993, 95% CI = 0.989-0.997, p = 0.001) and ILM flap group (OR = 5.795, 95% CI = 1.313-25.570, p = 0.020) predicted primary closure. CONCLUSION ILM flap creation improves closure rates in larger holes and should be considered routinely in iFTMH ≥500 microns. Whether ILM flaps affect post-operative visual function remains uncertain.
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Affiliation(s)
| | - Boon Lin Teh
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK
| | | | - David H Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK.
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, NE1 3BZ, UK.
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13
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Suarez MK, Wang SK, Hayes B, Greven MA, Shah RE, Greven C, Russell G, Ong SS. VISUAL OUTCOMES AFTER INTERNAL LIMITING MEMBRANE PEELING VERSUS FLAP IN THE CLOSURE OF FULL-THICKNESS MACULAR HOLES. Retina 2024; 44:1171-1179. [PMID: 38437847 DOI: 10.1097/iae.0000000000004084] [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: 03/06/2024]
Abstract
PURPOSE To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full-thickness macular holes. METHODS Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close full-thickness macular hole at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow-up. Main outcome measures were type 1 primary full-thickness macular hole closure and postoperative best-corrected visual acuity in mean logMAR. RESULTS One hundred thirty and 30 eyes underwent ILMP and ILMF, respectively. There were no significant differences in baseline characteristics between the groups. Ninety-six percent of ILMP eyes and 90% of ILMF eyes achieved primary hole closure ( P = 0.29). Among all eyes with primary hole closure, best-corrected visual acuity at 1 year was not different between the groups, but when stratified by lens status, it was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean best-corrected visual acuity (Snellen equivalent) (95% confidence interval) was 0.42 (20/50) (0.34, 0.49) in the ILMP group and 0.71 (20/100) (0.50, 0.92) in the ILMF group. CONCLUSION Internal limiting membrane peeling and ILMF techniques yielded similarly high full-thickness macular hole closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse best-corrected visual acuity at 1 year.
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Affiliation(s)
- Mallory K Suarez
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Sean K Wang
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Bartlett Hayes
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Rajiv E Shah
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Craig Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Greg Russell
- Department of Biostatistics and Data Science, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Sally S Ong
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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14
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Rueda-Latorre D, Sosa-Lockward JA, Abreu-Arbaje N. Presence of subfoveal hyperreflective dots as an anatomic and functional prognostic biomarker in macular holes. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:232-236. [PMID: 38663716 DOI: 10.1016/j.oftale.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/12/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To evaluate the presence of subfoveal hyperreflective dots (SfHD) using optical coherence tomography (OCT) in macular holes (MH) and establish whether there is a relationship with postoperative anatomical and functional outcomes. METHODS An observational cross-sectional study was conducted at the Dr. Elías Santana Hospital. Sixty-eight eyes of 67 patients with a tomographic diagnosis of full-thickness MH who underwent pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling were included. Preoperative and postoperative measurements were obtained using radial macular scans and HD raster scans with Optovue and Cirrus 5000 (Zeiss) OCT machines. The main outcome measures were anatomical closure by OCT and functional outcome through best-corrected visual acuity (BCVA). RESULTS The anatomical closure rate in our study was 63%. MHs that failed to achieve anatomical closure exhibited a higher number of hyperreflective dots and worse postoperative BCVA. A statistically significant association was found between exposed retinal pigment epithelium (RPE) in microns and the number of SfHD (P = .001). CONCLUSION SfHD is a common tomographic finding in MH, and the presence of a higher number of these points is associated with poorer anatomical and functional outcomes. This imaging finding is a potential prognostic biomarker in this pathology.
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Affiliation(s)
- D Rueda-Latorre
- Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo, República Dominicana; Servicio de Oftalmología, Centro Cristiano de Servicios Médicos, Hospital Dr. Elías Santana, Santo Domingo, República Dominicana.
| | - J A Sosa-Lockward
- Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo, República Dominicana; Servicio de Oftalmología, Centro Cristiano de Servicios Médicos, Hospital Dr. Elías Santana, Santo Domingo, República Dominicana; Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, República Dominicana
| | - N Abreu-Arbaje
- Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo, República Dominicana; Servicio de Oftalmología, Centro Cristiano de Servicios Médicos, Hospital Dr. Elías Santana, Santo Domingo, República Dominicana; Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, República Dominicana
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15
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Pellegrini F, Barosco G, Trento B, Rapizzi E, Zemella N. Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole. JOURNAL OF VITREORETINAL DISEASES 2024; 8:312-316. [PMID: 38770064 PMCID: PMC11102733 DOI: 10.1177/24741264241238910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). Methods: This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. Results: The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. Conclusions: An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.
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Affiliation(s)
| | - Guido Barosco
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Barbara Trento
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Emilio Rapizzi
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Nicola Zemella
- Department of Ophthalmology, AULSS2 Marca Trevigiana, Conegliano, Italy
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16
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Iwasaki M, Nakashizuka H, Tanaka K, Wakatsuki Y, Onoe H, Sakakibara T, Nakagawa N, Fujimiya T, Koutari S, Kitagawa Y, Takayuki H, Mori R, Shimada H. A COMPARATIVE STUDY OF MEDIUM-SIZED MACULAR HOLE SURGERY WITH INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS CONVENTIONAL PEELING. Retina 2024; 44:635-641. [PMID: 38091587 DOI: 10.1097/iae.0000000000004022] [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: 03/28/2024]
Abstract
PURPOSE To investigate surgical results for medium-sized (251-400 µ m) macular holes (MHs). METHODS This retrospective observational study involved 266 eyes of 262 consecutive patients who underwent internal limiting membrane (ILM) peeling (147 eyes in the ILM peeling group) or inverted ILM flap cover technique (119 eyes in the inverted flap group) for primary medium-sized full-thickness MHs. Macular hole associated with retinal detachment, recurrent MH, and traumatic MH were excluded. RESULTS The primary closure rate for overall medium-sized MHs was 100% (119 of 119 eyes) in the inverted flap group, which was significantly higher than that (94.6% [139/147 eyes]; P = 0.010) in the ILM peeling group. Notably, even after adjusting for the minimum MH diameter, presence of high myopia, or preexisting posterior vitreous detachment, the primary closure rate was significantly better in the inverted flap group than in the ILM peeling group (Cochran-Mantel-Haenszel test, overall adjusted P = 0.006, 0.009, 0.005, respectively). The preoperative and postoperative restoration of the outer retinal layers and visual acuity were comparable between the inverted ILM flap and ILM peeling techniques. CONCLUSION Primary closure for medium-sized MHs was significantly superior in the inverted flap group than in the ILM peeling group.
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Affiliation(s)
- Masanori Iwasaki
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Koji Tanaka
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Yu Wakatsuki
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Hajime Onoe
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Sakakibara
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Nakagawa
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Taishi Fujimiya
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Sawako Koutari
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Yorihisa Kitagawa
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
- Kobari General Hospital
| | - Hattori Takayuki
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
- Kasukabe Medical Center; and
| | - Ryusaburo Mori
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Shimada
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
- Miyahara Eye Clinic
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17
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Nawrocka ZA, Nawrocki J. PREDICTIVE FACTORS OF SURGICAL SUCCESS WITH THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE. Retina 2024; 44:400-405. [PMID: 37948738 DOI: 10.1097/iae.0000000000003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To present new morphologic features correlating with functional and anatomical outcomes of the inverted internal limiting membrane flap technique in full-thickness macular hole. METHODS A retrospective study of 51 successful and 22 failed full-thickness macular hole surgeries. In all eyes, preoperative spectral domain optical coherence tomography (SD-OCT) or swept source optical coherence tomography (SS-OCT) were reviewed. The presence of supraretinal pigment epithelium granular deposits, presence of an epiretinal membrane or epiretinal proliferation, visibility of posterior hyaloid, continuity of the interdigitation zone or external limiting membrane, presence of cystoid spaces, irregular surface of the margins of full-thickness macular hole, visibility of the suprachoroidal space, and diameters of full-thickness macular hole were analyzed. RESULTS In multivariate analysis, the success of the first surgery depended solely on the absence of epiretinal membrane ( P < 0.05).In univariate analysis, the success of the first surgery was correlated moreover with the absence of preoperative supraretinal pigment epithelium granular deposits ( P = 0.0010), the absence of an epiretinal proliferation ( P = 0.0060), and the absence of an irregular border of the hole ( P = 0.010). CONCLUSION In multivariate analysis, epiretinal membranes were a negative prognostic factor for macular hole closure when the inverted internal limiting membrane flap technique was used. Worse final visual acuity was observed in patients with primary anatomical failure, even if the hole was successfully closed during the second intervention.
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Murakami T, Okamoto F, Sugiura Y, Izumi I, Iioka A, Morikawa S, Hiraoka T, Oshika T. Internal Limiting Membrane Peeling and Inverted Flap Technique in Macular Hole: Postoperative Metamorphopsia and Optical Coherence Tomography. Ophthalmologica 2024; 247:107-117. [PMID: 38408439 DOI: 10.1159/000537846] [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: 12/09/2022] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH). METHODS This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed. RESULTS At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively. DISCUSSION/CONCLUSION The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.
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Affiliation(s)
- Tomoya Murakami
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Iori Izumi
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aoi Iioka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Morikawa S, Okamoto F, Murakami T, Sugiura Y, Oshika T. Comparison of stereopsis and foveal microstructure after internal limiting membrane peeling and inverted internal limiting membrane flap techniques in patients with macular hole. PLoS One 2024; 19:e0297134. [PMID: 38335184 PMCID: PMC10857606 DOI: 10.1371/journal.pone.0297134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To compare stereopsis and foveal microstructure after internal limiting membrane peeling and inverted internal limiting membrane flap technique in patients with macular hole. DESIGN Retrospective observational study. METHODS Sixty-six patients with macular hole were included, of whom 41 underwent 25-gauge pars-plana vitrectomy with complete internal limiting membrane peeling (Peeling group) and 25 with the inverted flap technique (Inverted group). We evaluated stereopsis using the Titmus Stereo Test and the TNO stereo test, best-corrected visual acuity, macular hole closure rate, and foveal microstructure with optical coherence tomography before and at 3, 6, and 12 months after surgery. MAIN OUTCOME MEASURES Stereopsis and foveal microstructure. RESULTS Preoperatively, no difference was observed in the base and minimum diameters of macular hole, Titmus Stereo Test score, TNO stereo test score, and best-corrected visual acuity between the Peeling and Inverted groups. The macular hole closure rate in the Peeling and Inverted groups were 97.6% and 100%, respectively, with no significant difference between groups. At 12 months postoperatively, Titmus Stereo Test score (2.1 ± 0.4 in the peeling and 2.2 ± 0.4 in the inverted groups), TNO stereo test score (2.3 ± 0.4 and 2.2± 0.5), and best-corrected visual acuity (0.20 ± 0.18 and 0.24 ± 0.25) were not significantly different between groups (p = 0.596, 0.332, respectively). The defect of the external limiting membrane was more common in the Inverted group than in the Peeling group at 6 months after surgery (5.4 vs. 28.0%; p < 0.05). No statistically significant inter-group differences were noted in the ellipsoid zone defect ratio throughout the follow-up period. CONCLUSIONS There was no difference in postoperative stereopsis nor foveal microstructure between the internal limiting membrane peeling group and the inverted group in patients with macular hole.
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Affiliation(s)
- Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoya Murakami
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Baskaran P, Sindal MD, Ganne P, Madanagopalan VG, Krishnappa NC, Rajendran A, Dhoble P, Ratna B, Ghondale H, Mani I. Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes - A randomized controlled trial (InFlap Study). Indian J Ophthalmol 2024; 72:S75-S83. [PMID: 38131546 PMCID: PMC10833171 DOI: 10.4103/ijo.ijo_484_23] [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: 02/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH). METHODS A consecutive 99 eyes of 99 patients were enrolled {45 - conventional group and 54 - inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed. RESULTS At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group. CONCLUSION The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.
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Affiliation(s)
- Prabu Baskaran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Manavi D Sindal
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Pratyusha Ganne
- Department of Retina, All India Institute of Medical Science, Mangalagiri, Andhra Pradesh, India
| | | | | | - Anand Rajendran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Pankaja Dhoble
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Bholesh Ratna
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | | | - Iswarya Mani
- Department of Statistics, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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21
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Baumann C, Maier M, Johannigmann-Malek N, Gabka K, Schwer L, Kaye SB. VERTICAL AND HORIZONTAL METAMORPHOPSIA ONE YEAR AFTER SURGERY FOR MACULAR HOLES ≤ 500 µ m WITH AND WITHOUT INVERTED INTERNAL LIMITING MEMBRANE FLAP. Retina 2024; 44:95-101. [PMID: 37751574 DOI: 10.1097/iae.0000000000003941] [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: 09/28/2023]
Abstract
PURPOSE To investigate the effect of an inverted internal limiting membrane flap (IF) and other factors on metamorphopsia after macular hole surgery. METHODS Prospective case series of patients undergoing pars plana vitrectomy with gas tamponade, with either conventional internal limiting membrane peeling (CP) or an IF, for primary idiopathic macular holes ≤ 500 µ m. Vertical and horizontal metamorphopsia were measured as M-scores (degrees) using M-charts preoperatively and at 2, 6, and 12 months postoperatively. RESULTS Fifty-three eyes of 53 patients were included of whom 27 underwent CP and 26 were treated with an IF. After macular hole surgery, all patients were pseudophakic. Vertical and horizontal metamorphopsia improved from 1.08 (±0.51) and 0.98 (±0.70) preoperatively to 0.58 (±0.37) and 0.45 (±0.36) at 2 months ( P < 0.01), with no further significant improvement at 6 months (0.39 [±0.31], P = 0.07 and 0.31 [±0.28], P = 0.18) or at 12 months (0.37 [±0.30], P = 0.72 and 0.28 [±0.28], P = 0.99). There was no significant difference in the mean vertical and horizontal metamorphopsia between patients with CP and with an IF at 2 months ( P = 0.063, P = 0.10), 6 months ( P = 0.25, P = 0.16), or 12 months ( P = 0.62, P = 0.22). Preoperative vertical M-score improved at 12 months after macular hole surgery by 61% and 64% in the CP and IF groups, respectively ( P = 0.84), and the horizontal M-score by 65% and 71%, respectively ( P = 0.98). CONCLUSION The use of an IF has no evident bearing on the degree of postoperative metamorphopsia 12 months after surgical repair of macular holes ≤ 500 µ m.
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Affiliation(s)
- Carmen Baumann
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Mathias Maier
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Navid Johannigmann-Malek
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Katharina Gabka
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Lydia Schwer
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Stephen B Kaye
- William Henry Duncan Building, University of Liverpool, Liverpool, United Kingdom
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22
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Lamas-Francis D, Rodríguez-Fernández CA, Bande M, Blanco-Teijeiro MJ. Foveal microvascular features following inverted flap technique for closure of large macular holes. Eur J Ophthalmol 2024; 34:260-266. [PMID: 37122260 DOI: 10.1177/11206721231173004] [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] [Indexed: 05/02/2023]
Abstract
PURPOSE To describe the anatomical and functional outcomes following use of the inverted flap technique (IFT) to close idiopathic macular holes (MH) of diameter greater than 400 μm. To compare the changes in the macular microvascularization following surgery in operated and healthy fellow eyes. METHODS Retrospective study of 24 patients who underwent vitrectomy and IFT for large MH closure. The main variables were closure pattern, best corrected visual acuity (BCVA) and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). Foveal avascular zones (FAZ) and vessel and perfusion densities, obtained by OCT angiography scans, were compared with those in healthy fellow eyes. RESULTS Complete MH closure was achieved in 95.8% (23/24) of patients 6 months after surgery. There was a significant improvement in postoperative BCVA, from 1.0 to 0.4 logMAR (p < 0.001). The most frequent closure pattern was 1a (62.5%, 15/24), followed by 2c (12.5%, 3/24). The closure pattern was not correlated with height, minimum or maximum diameters or macular hole index (MHI) (p > 0.05). ELM and EZ recovery occurred in 87.5% and 83.3% of cases, respectively. FAZ were smaller in operated eyes than in the fellow eyes (p = 0.012). There were no differences in the vessel or perfusion densities between the operated and fellow eyes (p > 0.05). CONCLUSIONS Use of the inverted flap technique for large MH closure provides a high rate of functional and anatomical recovery. We observed a reduction in the FAZ following surgery, with no differences in the macular microvascularization parameters, suggesting that the technique is safe.
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Affiliation(s)
- David Lamas-Francis
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Manuel Bande
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Blanco-Teijeiro
- Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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Teng Y, Zhang X. Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction. J Int Med Res 2024; 52:3000605231223635. [PMID: 38235655 PMCID: PMC10798096 DOI: 10.1177/03000605231223635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To examine the effects of the temporal inverted internal limiting membrane (ILM) flap technique for foveal reconstruction in patients with highly myopic macular hole-associated retinal detachment (MHRD). METHODS A retrospective case series analysis of four patients (four eyes) with MHRD was conducted. The foveal optical coherence tomography changes following treatment using the temporal inverted ILM flap technique were evaluated. RESULTS In Patient 1, the ILM bridged the macular hole and residual subretinal fluid on postoperative day 6, and complete retinal reattachment was achieved at 19 months. Patient 2 exhibited reduced retinal detachment, with visible ILM inversion and macular hole closure after 14 days. In Patient 3, macular hole closure and fovea formation had occurred by day 25, and the ILM flap was visible. At 2 months, the outer collagenous layer connection in the central fovea and recovery of the external limiting membrane and ellipsoid zone were observed. Patient 4 had a "white hole" MHRD, with macular hole closure achieved on postoperative day 20, albeit with a suboptimal foveal shape. CONCLUSION The temporal inverted ILM flap technique in conjunction with vitrectomy facilitates foveal reconstruction in patients with successful treatment of MHRD, and this reconstruction process can be observed by optical coherence tomography.
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Affiliation(s)
- Yan Teng
- Department of Ophthalmology, Harbin Bright Eye Hospital, Harbin, China
| | - Xiaoyu Zhang
- Department of Ophthalmology, Harbin Bright Eye Hospital, Harbin, China
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24
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Chou HD, Shiah SG, Chuang LH, Wu WC, Hwang YS, Chen KJ, Kang EYC, Yeung L, Nien CY, Lai CC. MicroRNA-152-3p and MicroRNA-196a-5p Are Downregulated When Müller Cells Are Promoted by Components of the Internal Limiting Membrane: Implications for Macular Hole Healing. Int J Mol Sci 2023; 24:17188. [PMID: 38139016 PMCID: PMC10743628 DOI: 10.3390/ijms242417188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Müller cells play a critical role in the closure of macular holes, and their proliferation and migration are facilitated by the internal limiting membrane (ILM). Despite the importance of this process, the underlying molecular mechanism remains underexplored. This study investigated the effects of ILM components on the microRNA (miRNA) profile of Müller cells. Rat Müller cells (rMC-1) were cultured with a culture insert and varying concentrations of ILM component coatings, namely, collagen IV, laminin, and fibronectin, and cell migration was assessed by measuring cell-free areas in successive photographs following insert removal. MiRNAs were then extracted from these cells and analyzed. Mimics and inhibitors of miRNA candidates were transfected into Müller cells, and a cell migration assay and additional cell viability assays were performed. The results revealed that the ILM components promoted Müller cell migration (p < 0.01). Among the miRNA candidates, miR-194-3p was upregulated, whereas miR-125b-1-3p, miR-132-3p, miR-146b-5p, miR-152-3p, miR-196a-5p, miR-542-5p, miR-871-3p, miR-1839-5p, and miR-3573-3p were significantly downregulated (p < 0.05; fold change > 1.5). Moreover, miR-152-3p and miR-196a-5p reduced cell migration (p < 0.05) and proliferation (p < 0.001), and their suppressive effects were reversed by their respective inhibitors. In conclusion, miRNAs were regulated in ILM component-activated Müller cells, with miR-152-3p and miR-196a-5p regulating Müller cell migration and proliferation. These results serve as a basis for understanding the molecular healing process of macular holes and identifying potential new target genes in future research.
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Affiliation(s)
- Hung-Da Chou
- Department of Life Sciences, National Central University, Taoyuan 32001, Taiwan; (H.-D.C.); (S.-G.S.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
- National Institute of Cancer Research, National Health Research Institutes, Miaoli 35053, Taiwan
| | - Shine-Gwo Shiah
- Department of Life Sciences, National Central University, Taoyuan 32001, Taiwan; (H.-D.C.); (S.-G.S.)
- National Institute of Cancer Research, National Health Research Institutes, Miaoli 35053, Taiwan
| | - Lan-Hsin Chuang
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chung-Yi Nien
- Department of Life Sciences, National Central University, Taoyuan 32001, Taiwan; (H.-D.C.); (S.-G.S.)
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (W.-C.W.); (Y.-S.H.); (K.-J.C.); (E.Y.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; (L.-H.C.); (L.Y.)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
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Liu Y, Jiang F, Chen F, Liu Y, Zhang W, Zhang S, He Z, Cheng X, Xie Z. Minimal Posterior Pole Vitrectomy and Fixing the Inverted Internal Limiting Membrane Flap with DisCoVisc for Macular Hole: No Gas or Air Tamponade. Retina 2023; 43:2208-2214. [PMID: 37832156 DOI: 10.1097/iae.0000000000003919] [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: 10/15/2023]
Abstract
PURPOSE To investigate an alternative surgical method for macular hole repair without fluid-air exchange, gas tamponade, and prone positioning. METHODS Eighteen eyes of 17 patients with macular holes underwent minimal posterior pole vitrectomy with an inverted internal limiting membrane flap technique. Ophthalmic viscosurgical device was used to fix the inverted internal limiting membrane flap in the balanced salt solution. No fluid-air exchange, gas tamponade, or prone positioning was needed. Follow-ups were performed at 1 day, 1 week, and the last visit (ranging from 3 to 6 months) after surgery. Optical coherence tomography examination, intraocular pressure, and best-corrected visual acuity measurements were performed preoperatively and at every follow-up, postoperatively. RESULTS Primary closure of the macular hole was observed in all 18 eyes (100%). Optical coherence tomography showed U-type closure in 12 eyes, V-type closure in five eyes, and W-type closure in one eye. Preoperative, postoperative 1 week, and last follow-up best-corrected visual acuity were 0.90 (Snellen equivalent 20/159) ± 0.31 LogMAR, 0.72 (Snellen equivalent 20/105) ± 0.33 LogMAR, and 0.48 (Snellen equivalent 20/60) ± 0.32 LogMAR, respectively. Postoperative visual acuity was significantly improved compared with preoperative values ( F = 19.250, P = 0.000). No significant difference in intraocular pressure was found compared with preoperative values ( F = 1.933, P = 0.168). No significant complications were observed. CONCLUSION This surgical method can effectively close macular holes, improve visual acuity, enhance surgical efficiency, reduce surgical complications, and improve patients' postoperative experience without the need for fluid-air exchange, gas tamponade, or prone positioning.
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Affiliation(s)
- Yajun Liu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Feng Jiang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Feifei Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Yuanyuan Liu
- Department of Ophthalmology, Gaoyou Hospital of Traditional Chinese Medicine, Gaoyou, China
| | - Wenwen Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Si Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Zifang He
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Xinxuan Cheng
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
| | - Zhenggao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; and
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Alagoz C, Bektasoglu D, Alagoz N, Erdogdu E, Artunay Ö. Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure. Klin Monbl Augenheilkd 2023; 240:1413-1420. [PMID: 36827999 DOI: 10.1055/a-1946-5448] [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: 02/26/2023]
Abstract
PURPOSE We aimed to report our surgical experience with repeat surgery as the next step after an unsuccessful hole closure with the primary single-layered temporal inverted flap technique (IFT). METHODS We identified cases with persistent macular holes by reviewing the records of eyes that underwent IFT between October 2018 and October 2021. These cases were evaluated for hole features, anatomical closure, and visual improvement before and after the first and second surgeries. In addition, the technique applied in repeat surgery was recorded. Optical coherence tomography (OCT) images at follow-up were used to evaluate the flap position. RESULTS A persistent hole was identified in 11 (6.4%) of 172 patients who underwent IFT. An inferotemporal displacement was observed in seven eyes, while no flap could be identified in the OCT images of the other four eyes. In the second surgery, the old flap was reinverted in one eye, and a new flap was created from the superior region in five eyes and the nasal region in the other five eyes and was stabilized under perfluorocarbon liquid. A gas tamponade (C3F8/SF6) was used in all patients at the end of surgery. The minimum hole diameter was > 400 µm in all eyes and 100% closure was achieved after the second surgery. Visual acuity gain of ≥ 3 lines was observed in 9 of the 11 eyes (81.8%). The mean visual acuity increase at the last follow-up was significant (p = 0.008). CONCLUSION With single-layer temporal IFT in the primary surgery of macular holes, unsuccessful results may be observed due to the flap displacement in the early period. In our series, IFT was applied again with the use of the old flap or the creation of a new flap in the second surgery of the persistent holes, and successful results were obtained.
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Affiliation(s)
- Cengiz Alagoz
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Damla Bektasoglu
- Department of Ophthalmology, Igdir State Hospital, Igdir, Turkey
| | - Nese Alagoz
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Erdem Erdogdu
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Özgür Artunay
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Dera AU, Stoll D, Schoeneberger V, Walckling M, Brockmann C, Fuchsluger TA, Schaub F. Anatomical and functional results after vitrectomy with conventional ILM peeling versus inverted ILM flap technique in large full-thickness macular holes. Int J Retina Vitreous 2023; 9:68. [PMID: 37964333 PMCID: PMC10644592 DOI: 10.1186/s40942-023-00509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Aim of the study was to compare success rate and functional outcome following pars plana vitrectomy (PPV) with conventional internal limiting membrane (ILM) peeling versus ILM flap technique for full-thickness idiopathic macular holes (FTMH). METHODS Retrospective analysis of consecutive eyes with FTMH having undergone vitrectomy with sulfur hexafluoride (SF6) endotamponade 25% at the University Medical Center Rostock, Germany (2009-2020). Eyes were divided according to applied surgical technique (ILM peeling [group P] versus ILM flap [group F]). Inclusion criteria were macular hole base diameters (MH-BD) ≥ 400 μm plus axial length ≤ 26.0 mm. Each group was divided into two subgroups based on macular hole minimum linear diameter (MH-MLD): ≤ 400 μm and > 400 μm. Exclusion criteria were FTMH with MH-BD < 400 μm, trauma, myopia with axial length > 26.0 mm or macular schisis. Demographic, functional, and anatomical data were obtained pre- and postoperatively. Preoperative MH-BD and MH-MLD were measured using optical coherence tomography (OCT; Spectralis®, Heidelberg Engineering GmbH, Heidelberg, Germany). Main outcome parameter were: primary closure rate, best-corrected visual acuity (BCVA), and re-surgery rate. RESULTS Overall 117 eyes of 117 patients with FTMH could be included, thereof 52 eyes underwent conventional ILM peeling (group P) and 65 additional ILM flap (group F) technique. Macular hole closure was achieved in 31 eyes (59.6%) in group P and in 59 eyes (90.8%) in group F (p < 0.001). Secondary PPV was required in 21 eyes (40.4%) in group P and in 6 eyes (9.2%) in group F. Postoperative BCVA at first follow-up in eyes with surgical closure showed no significant difference for both groups (MH-MLD ≤ 400 μm: p = 0.740); MH-MLD > 400 μm: p = 0.241). CONCLUSION Anatomical results and surgical closure rate following ILM flap technique seems to be superior to conventional ILM peeling for treatment of FTMH.
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Affiliation(s)
- Adrianna U Dera
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Doerte Stoll
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Verena Schoeneberger
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Marcus Walckling
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Claudia Brockmann
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Thomas A Fuchsluger
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany.
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Carballés MJC, Sastre-Ibáñez M, Cura MPD, Hoz RD, Garcia-Saenz MC. Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery. Eur J Ophthalmol 2023; 33:2275-2284. [PMID: 36922754 DOI: 10.1177/11206721231163616] [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: 03/18/2023]
Abstract
AIM To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). METHODS Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. RESULTS A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). CONCLUSIONS The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.
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Affiliation(s)
| | - M Sastre-Ibáñez
- Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M Prieto Del Cura
- Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R De Hoz
- Instituto Investigaciones Oftalmológicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - M C Garcia-Saenz
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Zgolli H, Abdelhedi C, Mabrouk S, Fekih O, Zghal I, Malek I, Nacef L. Prognostic factors for visual recovery after successful large macular hole surgery using the inverted flap technique. J Fr Ophtalmol 2023; 46:1069-1078. [PMID: 37648549 DOI: 10.1016/j.jfo.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 02/14/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The goal of our study is to describe the functional results and preoperative factors predicting visual recovery after successful inverted flap technique and closure of large full-thickness macular holes (FTMH) and to evaluate the correlations between microstructural foveal changes and final visual acuity. METHODS Retrospective, descriptive, analytical study including 80 eyes of 78 patients with large FTMH; operated by inverted flap technique with successful closure of the macular hole after surgery. All eyes underwent a full preoperative ophthalmic examination and macular B-scan SD-OCT. We performed the classic inverted flap technique for all patients. Postoperatively, all patients were examined at 7 days, 1, 3, 6, 9 and 12 months after surgery. SD-OCT was performed for all patients on each follow-up. Preoperatively, best-corrected visual acuity (BCVA), FTMH size and basal hole diameter were the main outcome measures. Postoperatively, BCVA, macular thickness, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) were recorded. RESULTS Mean age was 62±8.42 years with female predominance. Mean size of the FTMH was 692.59μm, and mean basal hole diameter was 1436.06μm. Mean BCVA improved from 1.06±0.491 LogMAR preoperatively to 0.52±0.32 at 9 months following surgery (P<0.001). At 9 months, the ELM was absent, partial or fully restored in 6.67, 10 and 83.33% respectively. The EZ was absent, partial or fully restored in 6.67, 33 and 63.33% respectively. ELM regeneration always preceded EZ regeneration at every point of follow-up. Final BCVA was statistically correlated with initial hole size (P=0.006, OR=1.056; CI [1.016-1.098]) and mean symptom duration prior to surgery (P=0.001. OR=0.987; CI [0.976-0.998]). Analysis of the ROC curve demonstrated that a hole diameter>478.5μm and symptom duration>5 weeks were correlated with non-improvement of visual acuity, with 81.3% sensibility and 18.7% specificity. CONCLUSION We report tomographic microstructural foveal changes and functional results following successful large idiopathic FTMH surgery using the classic inverted flap technique. Preoperative parameters such as initial FTMH diameter and mean symptom duration prior to surgery are crucial prognostic factors influencing final visual results.
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Affiliation(s)
- H Zgolli
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - C Abdelhedi
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia.
| | - S Mabrouk
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - O Fekih
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - I Zghal
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - I Malek
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - L Nacef
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
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Alagoz C, Erdogdu E, Alagoz N, Pehlivanoglu S, Artunay O. Single Layered Free ILM Graft Technique in Large Macular Holes with Associated ERM. Semin Ophthalmol 2023; 38:737-743. [PMID: 37083504 DOI: 10.1080/08820538.2023.2204925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE We aimed to describe single layered free ILM graft technique (FIGT) and present results of this technique in the primary surgery of large macular holes (MHs). METHODS In this retrospective study, we identified MHs with a minimum hole diameter >400 μm that underwent FIGT by a single surgeon. Nineteen eyes were found to have an associated epiretinal membrane (ERM) and four eyes demonstrated a patchy ILM staining intraoperatively. A single layered FIGT was performed first by peeling the ILM around the hole and then creating a free ILM flap and transplanting it to cover the hole. All cases were evaluated for anatomical closure and visual improvement. RESULTS Twenty-three eyes of 22 patients (mean age 68.7 ± 7.4 years) were included in the study. The mean follow-up was 9.6 ± 4.9 months. Flap closure was observed in two eyes (8.6%) at week 1, while all eyes (100%) showed a complete closure at month 1. Mean preoperative visual acuity of 1.42 ± 0.66 LogMAR increased to 1.11 ± 0.51, 0.99 ± 0.34, 0.92 ± 0.38, 0.74 ± 0.37, 0.52 ± 0.28, 0.64 ± 0.39 respectively at week 1, month 1, month 3, month 6, year 1 and final follow-up postoperatively (p < .05 for all). In none of the eyes ERM recurred, nor flap contraction developed. CONCLUSION The study showed encouraging results using free ILM graft in the primary surgery of large MHs. This technique might be considered in large MHs that are associated with ERM or demonstrate patchy ILM staining. Further studies are needed to prove the effectiveness also in the long-term.
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Affiliation(s)
- Cengiz Alagoz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdem Erdogdu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nese Alagoz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seren Pehlivanoglu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Artunay
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Li S, Zhang L, Yu JG. Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Insertion Technique for Large Macular Holes: A Meta-Analysis. Semin Ophthalmol 2023; 38:752-760. [PMID: 37129523 DOI: 10.1080/08820538.2023.2209167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Abstract
PURPOSES This meta-analysis aimed to compare and evaluate the morphological and functional outcomes between the inverted internal limiting membrane (ILM) flap and ILM insertion techniques in the treatment of large macular holes (MHs). METHODS The PubMed, Embase, and Cochrane Library databases were searched for relevant studies comparing the two techniques for the treatment of large MHs. The primary outcome measures included the MH closure rate, preoperative and postoperative best-corrected visual acuity (BCVA), MH closure patterns, and external limiting membrane (ELM) and ellipsoid zone (EZ) recovery. Statistical analyses were performed using RevMan 5.3 software. RESULTS Two randomized controlled trials and four retrospective studies were included in this meta-analysis. The MH closure rate did not significantly differ between the two groups (P = .93). Postoperative BCVA was not significantly different between the two groups at 3 months (P = .20) or 6 months (P = .51). ELM and EZ recovery were also similar between the two groups. However, the results for postoperative BCVA and outer retinal structure recovery tended to favor the ILM flap group based on the forest plot. There was no significant difference between the two groups for the U-shape (P = .26), V-shape (P = .65), and W-shape closure types (P = .38). CONCLUSIONS Our meta-analysis provides evidence that the MH closure rate and visual function outcomes are similar between the ILM flap and ILM insertion techniques in large MHs. However, based on the forest plot, postoperative BCVA and outer retinal layer reconstruction tended to favor the ILM flap technique. Further studies with larger sample sizes are required to confirm the superiority of the ILM flap to the ILM insertion technique.
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Affiliation(s)
- Shuang Li
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Zhang
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji-Guo Yu
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu L, Wang Z, Yu Y, Yang X, Qi B, Zhang K, Liu W. Microstructural and microperimetric comparison of internal limiting membrane peeling and insertion in large idiopathic macular hole. BMC Ophthalmol 2023; 23:274. [PMID: 37316769 DOI: 10.1186/s12886-023-03006-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion. METHODS This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively. RESULTS For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group. CONCLUSION For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.
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Affiliation(s)
- Lingzi Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China.
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
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Sharma A, Wu L, Bloom S, Stanga P, Nehemy MB, Veloso CE, Nawrocka ZAA, Nawrocki J, Özdek Ş, Zeydanlı EÖ, Rezaei KA. RWC Update: Vitrectomy Surgery in a Pre-Phthisical Eye; Update on the Surgical Management of Macular Holes: The Inverted ILM Flap Technique and How It Revolutionized Macular Hole Surgery; Retinal Arteriovenous Malformation. Ophthalmic Surg Lasers Imaging Retina 2023; 54:321-328. [PMID: 37352400 DOI: 10.3928/23258160-20230516-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
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Kwak JJ, Byeon SH. Comparison of long-term visual and anatomical outcomes between internal limiting membrane flap and peeling techniques for macular holes with a propensity score analysis. Eye (Lond) 2023; 37:1207-1213. [PMID: 35585135 PMCID: PMC10102159 DOI: 10.1038/s41433-022-02103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To compare visual and anatomical outcomes between internal limiting membrane (ILM) flap (IF) and peeling (IP) techniques for full-thickness macular holes (FTMHs). METHODS A retrospective case series with propensity-score matching (PSM). Patients with a minimum 12 months follow-up were divided into IF and IP groups and matched based on FTMH size and preoperative best-corrected visual acuity (BCVA). BCVA and optical coherence tomography (OCT) findings were obtained to assess outer retinal layer integrity, foveal thickness, and foveal displacement. RESULTS Twenty-six eyes were included in each group after PSM. The IF group showed significantly greater BCVA after 1 month, its corresponding change from preoperative BCVA, proportions of eyes with ellipsoid zone defects <250 μm after 1 month, and interdigitation zone restoration after 6 and 12 months (P = 0.007, 0.038, 0.048, 0.025, and 0.023, respectively), as well as less foveal gliosis after 1, 3, 6, and 12 months (P = 0.020, 0.017, 0.050, and 0.024, respectively). In the IP group, the mean outer nuclear layer thickness significantly decreased at 3 (P = 0.019) and 12 months (P = 0.016) compared to 1 month, and the foveal displacement toward the optic disc was significant after 1, 3, 6, and 12 months (P = 0.049, 0.006, 0.001, and <0.001, respectively). CONCLUSIONS Compared to IP, IF promoted faster recovery of BCVA and outer retinal layers and was more protective against postoperative foveal thinning and displacement; hence, it should be considered for small and large FTMHs.
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Affiliation(s)
- Jay Jiyong Kwak
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Ehrhardt A, Delpuech M, Luc A, Zessler A, Pastor G, Angioi-Duprez K, Berrod JP, Thilly N, Conart JB. Dissociated Optic Nerve Fiber Layer Appearance after Macular Hole Surgery: A Randomized Controlled Trial Comparing the Temporal Inverted Internal Limiting Membrane Flap Technique with Conventional Peeling. Ophthalmol Retina 2023; 7:227-235. [PMID: 36109006 DOI: 10.1016/j.oret.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the effect of the temporal inverted internal limiting membrane (ILM) flap technique compared with that of conventional ILM peeling on the extent of the dissociated optic nerve fiber layer (DONFL) and retinal sensitivity in patients undergoing macular hole (MH) surgery. DESIGN Single-center, prospective, open-label, randomized controlled clinical trial. PARTICIPANTS Patients requiring vitrectomy for MHs sized > 250 μm. METHODS Patients were randomly assigned (1:1) to 1 of the following 2 groups: (1) the control group undergoing standard ILM peeling and (2) the experimental group (flap group) undergoing the temporal inverted ILM flap technique. MAIN OUTCOME MEASURES The primary outcome measure was the total DONFL score at 3 months after surgery. Important secondary outcomes were microperimetry results, primary MH closure rate, external limiting membrane (ELM) and ellipsoid zone (EZ) recovery rates, and best-corrected visual acuity (BCVA). RESULTS Sixty-five patients were recruited between February 2018 and July 2020; primary outcome data were available for 60 patients. The median DONFL score was 7.0 (3.0-12.5) in the control group and 5.0 (1.5-8.5) in the flap group at 3 months after surgery (P = 0.145). The focal depressions characteristic of the DONFL were limited to the temporal side of the fovea in the flap group, whereas they were found all around the fovea in the control group on spectral-domain OCT images. The MH closure rate (P = 1), EZ and ELM recovery rates (P = 0.252), and BCVA (P = 0.450) were similar between the 2 groups. The 3-month overall median retinal sensitivity (MRS) (P = 0.142) and MRS improvement (P = 0.916) in the control group were comparable with those observed in the flap group. In addition, there was no significant difference between the 2 techniques when considering the temporal area (P = 0.105) or the nasal area (P = 0.468). CONCLUSIONS The temporal inverted ILM flap technique reduced the extent of the DONFL by preserving the nasal part of the fovea. However, the overall DONFL score was similar between the 2 techniques. In addition, the MRS and BCVA did not differ from those obtained after complete ILM peeling. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Alix Ehrhardt
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France.
| | - Marion Delpuech
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Amandine Luc
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
| | | | - Geoffrey Pastor
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | | | - Jean-Paul Berrod
- Department of Ophthalmology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Nathalie Thilly
- Department of Methodology, Promotion and Investigation, CHRU-Nancy, Université de Lorraine, Nancy, France
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Chen Y, Xu Y, Ye X, Yu J, Wang C, Zhang Z, Mao J, Shen L. The effect comparison of ILM flap and traditional ILM peeling in iMH. Front Med (Lausanne) 2023; 10:1103593. [PMID: 36844205 PMCID: PMC9947532 DOI: 10.3389/fmed.2023.1103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose To compare the changes in anatomical structure and visual function after idiopathic macular hole (iMH) treatment with internal limiting membrane (ILM) peeling and inverted ILM flap and determine the value of the inverted ILM flap for the treatment of iMH. Methods Forty-nine patients with iMH (49 eyes) were included in this study and followed up for 1 year (12 months) after treatment with inverted ILM flap and ILM peeling respectively. The main foveal parameters assessed included the preoperative minimum diameter (MD), intraoperative residual fragments, and postoperative ELM reconstruction. Visual function was assessed using best-corrected visual acuity. Results The hole closure rate was 100% for 49 patients; 15 patients were treated with the inverted ILM flap, and 34 patients underwent ILM peeling. There were no differences between the postoperative best-corrected visual acuities and the rates of ELM reconstruction for the flap and peeling groups with different MDs. In the flap group, ELM reconstruction was associated with the preoperative MD, presence of an ILM flap, and hyperreflective changes in the inner retina 1 month after surgery. In the peeling group, ELM reconstruction was associated with the preoperative MD, intraoperative residual fragments at the hole edge, and hyperreflective changes in the inner retina. Conclusion The inverted ILM flap and the ILM Peeling were both able to obtain high closure rate. However, the inverted ILM flap showed no obvious advantages related to anatomical morphology and visual function over ILM peeling.
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Affiliation(s)
- Yiqi Chen
- Department of Ophthalmology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yijun Xu
- Daxing Teaching Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xin Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiafeng Yu
- Department of Ophthalmology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
| | - Chenxi Wang
- Department of Ophthalmology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
| | - Zhengxi Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianbo Mao
- Department of Ophthalmology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,*Correspondence: Jianbo Mao,
| | - Lijun Shen
- Department of Ophthalmology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,Lijun Shen,
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DIFFERENCES IN ANATOMICAL AND VISUAL OUTCOMES AMONG THREE INTERNAL LIMITING MEMBRANE TECHNIQUES TREATING EXTRA-LARGE IDIOPATHIC MACULAR HOLES. Retina 2023; 43:222-229. [PMID: 36695794 DOI: 10.1097/iae.0000000000003672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare the anatomical and visual outcomes of extra-large idiopathic macular holes treated with internal limiting membrane peeling and two inverted internal limiting membrane flap techniques, namely insertion and cover technique. METHODS Patients with idiopathic macular holes (minimum linear diameter ≥ 650 µm) were divided into peeling group, insertion group, and cover group. The initial closure rate, final length of external limiting membrane and ellipsoid zone recovery, and best-corrected visual acuity were evaluated. RESULTS A total of 124 eyes were included, and the average follow-up was 7.2 months. All the baseline characteristics were comparable among the three groups. Initial closure rate of the peeling group, the insertion group, and the cover group was 65.0% (26/40), 97.6% (41/42), and 90.5% (38/42), respectively (P < 0.001). In closed idiopathic macular holes, the peeling group and the cover group exhibited significantly longer length of external limiting membrane recovery than the insertion group (P < 0.001), and the peeling group exhibited significantly longer length of ellipsoid zone recovery than the other two groups (P = 0.021). The peeling group and the cover group exhibited significantly better best-corrected visual acuity improvement than the insertion group (P = 0.009). CONCLUSION For extra-large idiopathic macular holes, cover technique surpasses internal limiting membrane peeling technique in closure rate and outperforms insertion technique in anatomical and functional recovery, whereas insertion technique may adversely affect the recovery of foveal microstructure and best-corrected visual acuity.
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Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, Bacherini D, Rodrigues EB, Meyer CH, Caporossi T, Mahmoud TH, Rizzo S, Johnson MW, Duker JS. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous 2023; 9:4. [PMID: 36717928 PMCID: PMC9885593 DOI: 10.1186/s40942-022-00439-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making. METHODS We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups. RESULTS Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases. CONCLUSIONS The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400-550 µm) and X-Large (550-800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.
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Affiliation(s)
- Flavio A. Rezende
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Bruna G. Ferreira
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Emmanouil Rampakakis
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - David H. Steel
- grid.1006.70000 0001 0462 7212Sunderland Eye Infirmary, Sunderland, and Newcastle University, Newcastle-Upon-Tyne, UK
| | - Michael J. Koss
- Augenzentrum Nymphenburger Höfe/Augenklinik Herzog Carl Theodor, Munich, Germany
| | | | - Daniela Bacherini
- grid.8404.80000 0004 1757 2304Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, Florence, Italy
| | - Eduardo B. Rodrigues
- grid.262962.b0000 0004 1936 9342Department of Ophthalmology, St. Louis University, St. Louis, MO USA
| | | | - Tomaso Caporossi
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Tamer H. Mahmoud
- grid.261277.70000 0001 2219 916XAssociated Retinal Consultants, Beaumont Neuroscience Center, Oakland University William Beaumont School of Medicine, Royal Oak, MI USA
| | - Stanislao Rizzo
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Mark W. Johnson
- grid.214458.e0000000086837370Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI USA
| | - Jay S. Duker
- grid.67033.310000 0000 8934 4045New England Eye Center, Tufts Medical Center, Boston, MA USA ,grid.67033.310000 0000 8934 4045Department of Ophthalmology, Tufts Medical Center, Boston, MA USA
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Macular Surgery: Classification, Management and Surgical Techniques. J Ophthalmol 2023; 2023:9891345. [PMID: 36700117 PMCID: PMC9870682 DOI: 10.1155/2023/9891345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023] Open
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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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Ventre L, Fallico M, Longo A, Parisi G, Russo A, Bonfiglio V, Marolo P, Caselgrandi P, Avitabile T, Borrelli E, Reibaldi M. CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP FOR SMALL-TO-MEDIUM IDIOPATHIC MACULAR HOLE: A Randomized Trial. Retina 2022; 42:2251-2257. [PMID: 36084331 PMCID: PMC9665942 DOI: 10.1097/iae.0000000000003622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole. METHODS Eyes with ≤400 μ m idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month follow-up was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best-corrected visual acuity change, closure rate, anatomical findings on optical coherence tomography such as U-shape foveal contour, restoration of external limiting membrane, and ellipsoid zone. RESULTS In both groups, MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6 ± 2.3 dB versus 14.9 ± 2.9 dB, respectively ( P = 0.026). In both groups best-corrected visual acuity improved throughout the follow-up, with a final best-corrected visual acuity of 0.19 ± 0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22 ± 0.11 logMar (20/33 Snellen) in the inverted flap group ( P = 0.398). Anatomical hole closure was achieved in all cases. No difference in optical coherence tomography findings was shown between the two groups. CONCLUSION A better final MS was found in eyes undergoing conventional ILM peeling. Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.
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Affiliation(s)
- Luca Ventre
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy; and
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | | | | | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
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El Rayes EN, Leila M, Stavrakas P. Multi-layer internal limiting membrane plug technique for management of large full-thickness macular holes. Int J Retina Vitreous 2022; 8:80. [PMID: 36376951 PMCID: PMC9661779 DOI: 10.1186/s40942-022-00428-7] [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: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the efficacy of the multi-layer internal limiting membrane plug (MIP) technique in promoting the closure of large full-thickness macular holes (FTMH) and improvement of visual function. Methods A prospective interventional non-comparative consecutive case series including patients with surgically naïve large FTMH whether primary or secondary. All macular holes were > 400 µm. All patients had 23-gauge pars plana vitrectomy (PPV), MIP technique, and sulfur hexafluoride (SF6) 20% gas tamponade. The main outcome measures were the closure of the hole, improvement of best-corrected visual acuity (BCVA), and detection of complications that might develop due to surgery. Results The study included 15 eyes of 15 patients. The mean age was 44 years (range 10–68; SD 21.5). Primary FTMH constituted 53% of cases. The mean pre-operative minimum linear diameter (MLD) was 702 µm (range 401–1068 µm; SD 154). The mean duration of the macular hole was 6 months (range 1–24; SD 6). The mean pre-operative BCVA was 0.06 decimal units (range 0.01–0.1; SD 0.03). Post-operatively, the macular hole was closed in all patients. U- and V- type closure developed in 93% and 7% of patients, respectively. None of the patients developed W-type closure. Post-operatively, the mean post-operative BCVA was 0.2 decimal units (range 0.05–0.5; SD 0.1). The mean improvement was 5 lines of vision. The mean postoperative follow-up period was 4 months (range 1–10; SD 2.5). None of the patients developed complications attributed to the surgical technique described. Conclusion MIP technique is effective in promoting macular hole closure and improvement of visual function in large FTMH. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-022-00428-7.
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Kakehi S, Mizuguchi T, Tanikawa A, Horiguchi M. Modified inverted internal limiting membrane flap technique for macular hole closure. Jpn J Ophthalmol 2022; 66:543-548. [PMID: 36346555 DOI: 10.1007/s10384-022-00950-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate the efficacy of modified internal limiting membrane (ILM) flap technique combined with vitreous surgery for treating macular holes and examine the outcomes in visual function and anatomic macular hole closure. STUDY DESIGN Retrospective, observational. METHODS Between July 1, 2015, and October 1, 2019, the modified inverted ILM flap technique combined with vitreous surgery was used to treat idiopathic macular holes, postoperative progression was then followed for at least 6 months in 96 participants (98 eyes). We modified the method by removing the lower half of the ILM while peeling and inverting the upper half. The mean age of the participants was 65.9 ± 11.9 years (41 men (42.7%) and 55 women (57.3%)). Retrospective evaluations of macular hole diameter, corrected visual acuity, and macular hole closure rates were performed using data from medical records. RESULTS The mean macular hole diameter was 623.6 ± 207.4 μm. The mean corrected visual acuity (logMAR) was 0.79 ± 0.27 before surgery and 0.46 ± 0.35 at 1, 0.35 ± 0.39 at 3, and 0.31 ± 0.36 at 6 months Post surgery, showing significant differences before and after surgery (p = 2.30 × 10- 2). The macular hole closure rate was 98%. CONCLUSION The modified inverted ILM flap technique combined with vitreous surgery was an effective method for treating macular holes, resulting in improvement in closure and visual acuity.
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Affiliation(s)
| | - Tadashi Mizuguchi
- Department of Ophthalmology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, 470-1192, Toyoake, Aichi, Japan.
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, 470-1192, Toyoake, Aichi, Japan
| | - Masayuki Horiguchi
- Department of Ophthalmology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, 470-1192, Toyoake, Aichi, Japan
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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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Ruban A, Petrovski BÉ, Petrovski G, Lytvynchuk LM. Internal Limiting Membrane Peeling and Gas Tamponade For Full-Thickness Macular Holes of Different Etiology - Is It Still Relevant? Clin Ophthalmol 2022; 16:3391-3404. [PMID: 36249443 PMCID: PMC9555881 DOI: 10.2147/opth.s373675] [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: 05/27/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the abundance of novel surgical approaches proposed for full thickness macular hole (FTMH) treatment, the choice of the optimal technique remains debatable Vitrectomy with «classic» internal limiting membrane peeling and gas tamponade remains the standard of FTMH surgery in many cases, but there are still very limited recent publications on the outcomes of such surgery. Purpose To investigate the anatomical and functional result and to analyze the significance of outcome-related risk factors of the classic 25-gauge pars plana vitrectomy (PPV) with ILM peeling and gas tamponade (GT) for treatment of FTMH of different etiology. Patients and methods Thirty-eight eyes of thirty-seven patients with FTMH who underwent 25-gauge PPV, ILM peeling and GT were recruited for this retrospective, consecutive, interventional study. Four eyes with persistent holes underwent a re-operation. Outcome-related factors were discussed. Results The primary closure rate was 89.5% (34/38). All eyes that underwent the repeated surgery (4 cases) obtained final closure. A hole size of >500 μm has a statistically significant effect on the primary macular hole closure (F = 0.048; φ = 0.38; p ˂ 0.05). In the general group (N = 38), the duration of symptoms directly correlated with age (ρ = 0.34; p = 0.04), size of the hole (ρ = 0.66; p ˂ 0.001) and BCVA before surgery (ρ = 0.59; p ˂ 0.001), after 1 month (ρ = 0.36; p = 0.03), and after 3 months (ρ = 0.35; p = 0.03). Preoperative BCVA was better in initially closed cases (Group 1) (U = 26.0; p = 0.05). In the Group 2 with primary unclosed holes, 75% of the eyes (3/4) had an axial length (AL) >26 mm, while in Group 1 such eyes were 12.5 times less (2/34) 5.9% (F = 0.004; φ = 0.63; р ˂ 0.01). The ELM recovery rate at 3 months was 92% (35/38 eyes) and the restoration of EZ at 3 months was 47% (18/38 eyes). Best-corrected visual acuity of all individuals improved significantly from 0.72 ± 0.35 (logMAR) (Me = 0.7; IQR: 0.5-0.8) to 0.25±0.14 (logMAR) (Me = 0.2; IQR: 0.2 - 0.3) at 1 month and 0.17 ± 0.13 (logMAR) (Me = 0.2; IQR: 0.1 - 0.2) at 3 months after surgery (P = 0.0001). Conclusion 25G PPV with ILM and GT for FTMH of different etiology provide satisfactory morphologic and functional outcomes. Elongated AL, large diameter of MH and long duration of symptoms are the risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.
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Affiliation(s)
| | - Beáta Éva Petrovski
- Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway,Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
| | - Lyubomyr M Lytvynchuk
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Giessen, Germany,Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria,Correspondence: Lyubomyr M Lytvynchuk, Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, Giessen, 35392, Germany, Tel +49 64198543820, Fax +49 64198543809, Email
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Comparative Study of Conventional Inverted ILM Flap Covering and ILM Flap Filling Technique in Idiopathic Macular Hole Treatment: A Meta-Analysis and Systematic Review. J Ophthalmol 2022; 2022:4922616. [PMID: 36237559 PMCID: PMC9553370 DOI: 10.1155/2022/4922616] [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: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This meta-analysis was performed to evaluate the anatomical efficacy and functional improvement of the conventional inverted internal limiting membrane (ILM), flap covering technique, and ILM flap filling technique for patients with idiopathic macular hole (MH). Methods Literature from Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were comprehensively retrieved. The primary outcomes included the MH closure rate and postoperative best-corrected visual acuity (BCVA). The secondary outcomes were the proportion of external limiting membrane (ELM) and ellipsoid zone (EZ) defect recovery. Pooled odds ratios (ORs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated using STATA 17.0 software. Results 7 studies that contained 139 eyes in the inverted ILM flap covering group and 121 eyes in the ILM flap filling group were selected. Pooled data suggested that the surgical treatment resulted in an overall MH closure rate of up to 97.12% (135/139 eyes) in the inverted ILM flap covering group and 99.17% (120/121 eyes) in the filling group, with no significant difference between the 2 groups (OR = 1.98, 95% CI: 0.55 to 7.09, and P=0.29). Similarly, the 2 techniques demonstrated equal effectiveness on the anatomical closure in MH with the average diameter smaller than 650 μm (OR = 2.17, 95% CI: 0.48 to 9.77, and P=0.31) and larger than 650 μm (OR = 1.58, 95% CI: 0.14 to 17.37, and P=0.71). However, compared with the filling technique, the inverted ILM flap covering technique was superior in postoperative BCVA (WMD = 0.11, 95% CI: 0.04 to 0.18, and P=0.0017) and presented a significantly higher proportion of reconstitution of ELM (OR = 0.02, 95% CI: 0.00 to 0.08, and P < 0.0001) and EZ (OR = 0.11, 95% CI: 0.04 to 0.32, and P=0.0001). Conclusion The inverted ILM flap covering technique was associated with the superior reconstitution of outer layers of the retina, including ELM and EZ, and more improvement in postoperative BCVA than the ILM flap filling technique.
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Predictive value of macular hole indices for vitrectomy with ILM peeling combined with ILM flap transposition over the macular hole on macular hole closure. SPEKTRUM DER AUGENHEILKUNDE 2022. [DOI: 10.1007/s00717-022-00530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Marlow ED, Bakhsh SR, Reddy DN, Farley ND, Williams GA, Mahmoud TH. Combined epiretinal and internal limiting membrane retracting door flaps for large macular holes associated with epiretinal membranes. Graefes Arch Clin Exp Ophthalmol 2022; 260:2433-2436. [PMID: 35230476 DOI: 10.1007/s00417-022-05608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess the closure rate of large full-thickness macular holes (FTMH) associated with epiretinal membrane (ERM) with a combined epiretinal and internal limiting membrane retracting door flap. METHODS Retrospective chart review of patients treated at a single tertiary retina practice between January 2017 and November 2019. Individuals with FTMH larger than 400 μm and co-diagnosis of ERM who underwent surgical repair with an ERM flap were included. Patients underwent pars plana vitrectomy with peeling of ERM that was positioned as a retracting door flap to cover the FTMH. Primary outcome was closure rate at 6 months following surgery. Final surgical success rate and visual acuity were secondary outcomes. RESULTS Among 7 eyes of 7 patients, 6 eyes achieved primary surgical success and final surgical success rate was achieved in all 7 eyes with a large FTMH repaired with ERM flap. The mean minimum linear diameter of the FTMH was 681 μm ± 295. All patients had follow-up greater than 6 months, with a mean duration of 17 months (range 14-23 months). Visual acuity improved from a mean of 0.9 ± 0.3 logMar (20/160) before surgery to 0.3 ± 0.5 logMar (Snellen 20/40), postoperatively. CONCLUSION Large FTMH with concurrent ERM that are managed with an ERM flap have high single-surgery success rate.
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Affiliation(s)
- Elizabeth D Marlow
- Associated Retinal Consultants, Royal Oak, MI, USA.,Bay Area Retina Associates, Walnut Creek, CA, USA
| | - Saaquib R Bakhsh
- William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | - Devasis N Reddy
- William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | | | - George A Williams
- Associated Retinal Consultants, Royal Oak, MI, USA.,William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | - Tamer H Mahmoud
- Associated Retinal Consultants, Royal Oak, MI, USA. .,William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA.
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Surgical Techniques for Refractory Macular Holes. Int Ophthalmol Clin 2022; 62:103-117. [PMID: 35752889 DOI: 10.1097/iio.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kastl G, Heidenkummer P. ILM Flap Repositioning for Persistent Macular Hole. Case Rep Ophthalmol 2022; 13:499-503. [PMID: 35950016 PMCID: PMC9294932 DOI: 10.1159/000525303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
We present a case of a persistent macular hole which was initially treated by pars plana vitrectomy with the inverted ILM flap technique. In a second procedure, the internal limiting membrane (ILM) flap was mobilized from its perifoveal adherence to the retina and peeled back to its adherence at the foveal ring. The eye was filled with 25% C2F6 gas. Three weeks after the second procedure, closure of the hole was observed. Best corrected visual acuity increased from 20/400 to 20/50. We assume that contractile elements within the ILM may cause perifoveal adhesion and centrifugal effects preventing macular hole closure. If macular hole closure does not occur after surgery with an inverted ILM flap, it is worth to peel back the existing flap again towards the foveal edge in order to induce hole closure and preserve the benefits of flap surgery. If the flap is only attached to the foveal ring, centripetal contraction could lead to annular closure of the macular hole. If the flap is lost, alternative surgical methods for refractory MHs should be considered.
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Affiliation(s)
- Gregor Kastl
- Dr. Koss und Kollegen, Munich, Germany
- *Gregor Kastl,
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