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Ma X, Sun J, Liang Q, Kong Y, Yang H, Huang X. Comparative analysis of internal limiting membrane peeling versus internal limiting membrane flap insertion for treating idiopathic macular holes. Photodiagnosis Photodyn Ther 2024; 49:104311. [PMID: 39154923 DOI: 10.1016/j.pdpdt.2024.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To evaluate the clinical efficacy of internal limiting membrane (ILM) peeling combined with perimacular hole massage versus ILM flap insertion in the management of patients with idiopathic macular holes was conducted. METHODS 35 patients (total of 35 eyes) with idiopathic macular holes (with hole diameters ranging from 366 to 1430 μm) were divided into two groups-Group A consisted of 20 eyes that underwent pars plana vitrectomy (PPV) combined with ILM peeling and perimacular hole massage, while Group B comprised 15 eyes that underwent PPV combined with ILM flap insertion. Subsequent follow-up examinations were performed at 1 week, 1 month, and 3 months post-surgery. The study also involved a comparison of best corrected visual acuity (BCVA) and optical coherence tomography (OCT) classifications between both the patient groups. RESULTS The macular hole closure rates in Group A were 60 %, while in Group B, the closure rate was 93 %. There was significant difference in hiatus healing rate between the two groups (t = 4.843, p = 0.048). The difference in BCVA at 3 months post-operation between the two groups was statistically significant (t = 3.221, p = 0.003). Three months post-operatively, the BCVA in Group B demonstrated improvement compared to the pre-operative BCVA, with a statistically significant difference (p > 0.05). Three months post-operatively, the BCVA in Group A demonstrated improvement compared to the pre-operative BCVA, but this difference was not statistically significant (p > 0.05). CONCLUSION The combination of PPV with ILM flap insertion demonstrates favorable therapeutic efficacy in the treatment of idiopathic macular holes, leading to improved visual acuity.
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Affiliation(s)
- Xueying Ma
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China.
| | - Jie Sun
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China
| | - Qiaohong Liang
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China
| | - Yuerong Kong
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China
| | - Hong Yang
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China
| | - Xiaogang Huang
- Department of Retina diseases, Lanzhou Prey Eye and Vision Hospital, Lanzhou 730030, Gansu Province,China
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Features of a well-timed macular hole closure related retinal regmatogenous detachment complicated by macular hole. OPHTHALMOLOGY JOURNAL 2023. [DOI: 10.17816/ov109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The literature review deals with the analysis of the timing and surgical techniques of macular hole closure in patients with retinal detachment complicated by macular hole. Modern concepts of treatment tactics for this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.
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3
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Malyugin BE, Shkvorchenko DO, Khurdaeva AG. [Long-term outcomes of treating rhegmatogenous retinal detachment with macular hole using platelet-rich blood plasma]. Vestn Oftalmol 2023; 139:6-10. [PMID: 37067926 DOI: 10.17116/oftalma20231390216] [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: 04/18/2023]
Abstract
Currently there is no specific algorithm for treating rhegmatogenous retinal detachment complicated by macular hole. PURPOSE The study analyzed the long-term outcomes of surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by macular hole (MH) using platelet-rich plasma (PRP) and local staining of the internal limiting membrane (ILM). MATERIAL AND METHODS This prospective open-label study included 27 patients (15 females and 12 males) aged 57 to 65 (59.2±7.2) years. In all studied cases, RRD complicated by MH was determined. The best corrected visual acuity (BCVA) before surgery was 0.05±0.01 (from 0.02 to 0.08). The average MH diameter measured with OCT was 576.3±150.4 μm (409 μm to 944 μm). After vitrectomy, a perfluororganic compound (PFOC) was injected into the MH area in amount of 2-3 optic nerve head diameters to prevent the ingress of dye under the retina, then the internal limiting membrane (ILM) was stained and removed. After sequential PFOC/air replacement, PRP was injected into the macular hole site. RESULTS AND DISCUSSION An increase in BCVA from 0.05±0.01 to 0.09±0.03 was observed in the preoperative period one month after surgery, with a further increase to 0.35±0.11 at the maximum follow-up time (two years). The MH was blocked and a glial scar was present in all cases according to OCT data. 1-2 years after the operation, all patients showed a favorable anatomical effect according to OCT data. According to computer microperimetry data, mean macular photosensitivity was 23.8±1.3 dB two years after the surgery. CONCLUSIONS This study shows a favorable anatomical and functional effect in patients with RRD and MH within a 2-year follow-up. A comparative study involving a larger cohort of patients is required to clarify the indications and contraindications for the use of the studied technique.
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Affiliation(s)
- B E Malyugin
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - D O Shkvorchenko
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A G Khurdaeva
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
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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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Xu C, Feng C, Han M, He J, Zhang R, Yan T, Li X, Liu Y, Li Y, Wu J. Inverted internal limiting membrane flap technique for retinal detachment due to macular holes in high myopia with axial length ≥ 30 mm. Sci Rep 2022; 12:4258. [PMID: 35277581 PMCID: PMC8917174 DOI: 10.1038/s41598-022-08277-y] [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: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
To compare the efficacy of internal limiting membrane (ILM) flap covering to that of ILM flap insertion for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes with axial length (AL) ≥ 30 mm. We retrospectively analysed the medical records of 48 MHRD patients with high myopia (AL ≥ 30 mm). According to different surgical methods, the patients were divided into a covering group (23 eyes) and an insertion group (25 eyes). The rate of retinal reattachment and MH closure were compared between the two groups, and the related factors affecting the initial anatomical results were analysed. After primary vitrectomy and single silicone oil removal, there were 18 eyes (78.3%) in the covering group, and 20 eyes (80.0%) in the insertion group had retinal reattachment (P = 1.000). Moreover, 16 eyes (69.6%) in the covering group and 17 eyes (68.0%) in the insertion group had their MHs sealed (P = 0.907). The best-corrected visual acuity (BCVA) at 12 months and the improvement in BCVA postoperatively in the two groups were not statistically significant (P = 0.543, 0.955). Logistic regression analysis showed that elongated AL (OR = 1.844, 95% CI 1.037–3.280, P = 0.037) and higher choroidal atrophy (OR = 2.986, 95% CI 1.011–8.821, P = 0.048) were risk factors affecting initial anatomical success. For extremely high-myopia MHRD with AL ≥ 30 mm, ILM flap covering and insertion can both effectively seal the MH and promote retinal reattachment, but the visual function improvement may still be limited. The longer the AL and the higher the choroidal atrophy, the greater is the risk of initial anatomical failure.
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Affiliation(s)
- Changzhong Xu
- Department of Ophthalmology, The Second Xiangya Hospital, School of Ophthalmology, Central South University, Changsha, China
| | - Chao Feng
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Mengyao Han
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Junwen He
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Rui Zhang
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Tao Yan
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Xiangyun Li
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Yong Liu
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Yanzi Li
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Jianhua Wu
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China.
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Garcin T, Gain P, Thuret G. Epiretinal large disc of blue-stained lyophilized amniotic membrane to treat complex macular holes: a 1-year follow-up. Acta Ophthalmol 2022; 100:e598-e608. [PMID: 33998147 DOI: 10.1111/aos.14909] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/11/2021] [Accepted: 04/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To report the long-term outcomes of large diameter epiretinal lyophilized amniotic membranes (lAMs) in recurrent or persistent macular holes (MHs) with or without rhegmatogenous retinal detachment (RRD), in a prospective interventional case series. METHODS Ten eyes of 10 patients underwent pars plana vitrectomy for MH-associated RRD (n = 5) or persistent MH without RRD (n = 5), in a university Hospital. A 3 or 4 mm diameter disc of lAM, stained with 0.06% trypan blue, was inserted with a catheter through a sclerotomy and positioned over the MH. Gas or silicone-oil tamponade was used. At 1 year, the main outcome was anatomic success defined as complete MH closure. Secondary outcomes were best corrected visual acuity (BCVA) recovery, changes in ellipsoid zone (EZ) and external limiting membrane (ELM) defects, complications. Mean follow-up was 13.8 ± 2.9 months (range, 12-18). RESULTS Mean baseline data were minimum and maximum diameters, respectively, 945 ± 330 and 1507 ± 717 μm; axial length 26.58 ± 3.38 mm; and number of prior surgeries 1.4 ± 0.96. At 1 year, anatomic success was achieved in eight eyes (80%), and two had reduced diameter of MH. All RRDs were reattached without recurrence. Mean logMAR BCVA improved from 1.92 ± 0.58 to 1.17 ± 0.57 (p < 0.001), with nine eyes (90%) achieving ≥0.3 logMAR improvement. Mean EZ and ELM defects decreased (p = 0.004, p = 0.003, respectively). Postoperative complications were RRD (n = 1) reattached by subsequent surgery, lAM slightly retracted under silicone (n = 1), foveal atrophy after early lAM displacement (n = 1). CONCLUSION A 1-year follow-up highlighted that epiretinal large discs of blue-stained lAM can help safely close refractory MHs, and provide satisfactory visual recovery.
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Affiliation(s)
- Thibaud Garcin
- Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC EA2521 Federative Institute of Research in Sciences and Health Engineering Faculty of Medicine Jean Monnet University Saint‐Etienne France
- Ophthalmology Department University Hospital Saint‐Etienne France
| | - Philippe Gain
- Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC EA2521 Federative Institute of Research in Sciences and Health Engineering Faculty of Medicine Jean Monnet University Saint‐Etienne France
- Ophthalmology Department University Hospital Saint‐Etienne France
| | - Gilles Thuret
- Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC EA2521 Federative Institute of Research in Sciences and Health Engineering Faculty of Medicine Jean Monnet University Saint‐Etienne France
- Ophthalmology Department University Hospital Saint‐Etienne France
- Institut Universitaire de France Boulevard Saint‐Michel Paris France
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7
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Li K, Zhou Y, Yang W, Jiang Q, Xu X. Modified internal limiting membrane flap technique for large chronic macular hole: Two case reports. Medicine (Baltimore) 2022; 101:e28412. [PMID: 35029885 PMCID: PMC8735802 DOI: 10.1097/md.0000000000028412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Internal limiting membrane (ILM) peeling and gas tamponade are the standardized treatments for macular holes (MHs). However, the close rate is low, and postoperative vision is unsatisfactory in large, chronic MHs. Currently, various modifications of the ILM flap techniques are being gradually applied for large MHs in the hope of obtaining better postoperative effects. This study described 2 successful cases achieved by "Sandwich-type" modified ILM flap covering technique in patients with large, chronic MHs. PATIENT CONCERNS A 62-year-old woman presented with decreased vision and visual distortion of the left eye for 18 months. Optical coherence tomography (OCT) showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 742 μm and a base diameter of 1630 μm. A 57-year-old man experienced decreased visual acuity for 8 months. OCT showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 713 μm and a basal diameter of 939 μm. DIAGNOSES Two patients were diagnosed with large, chronic MH based on the OCT results and duration of the hole. INTERVENTIONS The 2 patients were treated with the "sandwich-type" modified ILM flap covering technique. OUTCOMES Large, chronic MH closure was observed using SD-OCT, and the BCVA improved. The patients were very satisfied with the postoperative results. LESSONS "Sandwich-type" modified ILM flap covering technique may be a safe, effective way for large, chronic MH.
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Garcin T, Thuret G. Three-dimensional imaging of a gas bubble in a persistent macular hole closed with an epiretinal lyophilized amniotic membrane disc. J Fr Ophtalmol 2021; 45:e141-e143. [PMID: 34930646 DOI: 10.1016/j.jfo.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- T Garcin
- Service d'ophtalmologie, CHU, avenue Albert-Raimond, 42000 Saint-Étienne, France; Biologie, ingénierie et imagerie de la greffe de cornée, BiiGC, EA2521, faculté de médecine, université Jean-Monnet, Saint-Étienne, France.
| | - G Thuret
- Service d'ophtalmologie, CHU, avenue Albert-Raimond, 42000 Saint-Étienne, France; Biologie, ingénierie et imagerie de la greffe de cornée, BiiGC, EA2521, faculté de médecine, université Jean-Monnet, Saint-Étienne, France; Institut universitaire de France, 103, boulevard Saint-Michel, Paris, France
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9
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The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services-Experiences from the Tongren eye center in Beijing. PLoS One 2021; 16:e0254751. [PMID: 34411135 PMCID: PMC8375993 DOI: 10.1371/journal.pone.0254751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose To investigate the impact on services for rhegmatogenous retinal detachment (RRD) patients during the COVID-19 (2019coronal virus disease) pandemic in one tertiary center in Beijing. Methods A retrospective cohort study. Two reviewed consecutive RRD patients cohorts of the same length were treated during two different periods: the COVID-19 pandemic and the pre-COVID-19 group. The characteristics of patients, surgery, anesthesia methods, length of hospital stay, and the latest follow-up were recorded and analyzed. Results There were 79 patients in the COVID-19 pandemic group with a 55.9% reduction (179). Compared to patients in the pre-COVID-19, patients in the COVID-19 pandemic had a longer presurgical waiting times (28days, 3days, p<0.001), a higher percentage of patients with presurgical poor (less than 0.02) visual acuity (55.7%, 32.4%, p = 0.009), and a higher percentage of patients with presurgical choroidal detachment (34.2%, 19.6%, p = 0.01). There was no significant difference in the severity of presurgical proliferative vitreoretinopathy between the two groups (p = 0.64). Surgeries on pathological myopia patients with macular hole retinal detachment were postponed in the COVID-19 pandemic. There was a lower percentage of scleral buckling (27.8%, 41.3%, p = 0.02) and a lower rate of subretinal fluid drainage (45.4%, 75.7%, p = 0.01) in the COVID-19 pandemic. There was no significant difference in either postoperative visual acuity (p = 0.73) or the rate of single-surgery retinal attachment (p = 1) between the two groups. Patients in the COVID-19 pandemic had a shorter length of hospital stay (3hours, 35 hours, p<0.001), and a lower percentage of patients received general anesthesia (48.1%, 83.2%, p<0.001). None was infected with COVID-19 disease during the pandemic. Conclusion The COVID-19 pandemic lockdown caused prolonged presurgical waiting times, shorter hospital stays, less general anesthesia, and a significant reduction of RRD surgeries. The RD were more complicated, the surgeons were more conservative on procedures and patients selection, while the surgery outcomes were comparable.
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Wang X, Zhou X, Zhu Y, Xu H. Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study. BMC Ophthalmol 2021; 21:217. [PMID: 34001054 PMCID: PMC8127268 DOI: 10.1186/s12886-021-01973-9] [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: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients. METHODS We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated. RESULTS There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5-3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy. CONCLUSION Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients.
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Affiliation(s)
- Xianggui Wang
- Eye Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China
| | - Xuezhi Zhou
- Eye Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China
| | - Ying Zhu
- Eye Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China
| | - Huizhuo Xu
- Eye Center of Xiangya Hospital, Central South University, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Ophthalmology, No. 87 Xiangya Road, KaiFu District, Changsha, 410008, Hunan, China.
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Ghoraba HH, Leila M, Shebl M, Abdelhafez MA, Abdelfattah HM. Long-Term Outcome After Silicone Oil Removal in Eyes with Myopic Retinal Detachment Associated with Macular Hole. Clin Ophthalmol 2021; 15:1003-1011. [PMID: 33727783 PMCID: PMC7953888 DOI: 10.2147/opth.s298565] [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: 12/22/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the efficacy of pars plana vitrectomy (PPV) and silicone oil tamponade for management of myopic retinal detachment associated with macular hole (MRDMH) and to assess the anatomical and functional outcomes of this technique and its long-term validity after silicone oil removal. Methods Retrospective interventional non-comparative case series including consecutive patients who had PPV and silicone oil tamponade for MRDMH. All patients had an axial length ≥26 mm. Main outcome measures were retinal re-attachment and macular hole closure after silicone oil removal, improvement of best-corrected visual acuity (BCVA), and complications secondary to surgery. Chi square/Fisher’s exact test was used to analyze categorical variables, while One-way ANOVA/Kruskal–Wallis test was used to compare variables across the closure type and complications. Correlations between numerical variables were tested using Spearman correlation. Kaplan–Meier method was used to estimate the event-free survival. P value is significant at 0.05. Results The study included 26 eyes of 26 patients. Retinal re-attachment rate after primary and secondary surgeries was 88.4% and 100%, respectively. W-type macular hole closure occurred in 58% of eyes. Vision improved in 58% of eyes. Mean final BCVA was 0.05 decimal units, p = 0.004. Cataract and glaucoma developed in 42% and 15% of eyes, respectively. Initial BCVA, axial length and duration of silicone oil tamponade did not correlate significantly with either the type of macular hole closure or the final BCVA. Conclusion PPV and silicone oil tamponade technique promotes successful anatomical and functional outcome in MRDMH. Long-term success is maintained after silicone oil removal. High incidence of silicone oil-induced complications mandate its removal from eyes with successful retinal re-attachment.
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Affiliation(s)
- Hammouda Hamdy Ghoraba
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Magrabi Eye Hospital, Tanta, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Mohamed Shebl
- Vitreoretinal Consultant, Magrabi Eye Hospital, Tanta, Egypt
| | | | - Haithem Maamoun Abdelfattah
- Vitreoretinal Consultant, Magrabi Eye Hospital, Tanta, Egypt.,Vitreoretinal Associate Consultant, Benha Teaching Hospital, Benha, Egypt
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12
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Ghoraba HH, Mansour HO, Elsayed MAA, Zaky AG, Heikal MA, Abdelfattah HM, Elgouhary SM. Risk Factors for Recurrent Myopic Macular Hole Retinal Detachment after Silicone Oil Removal in Patients with Open Flat Macular Hole. Ophthalmologica 2021; 244:118-126. [PMID: 33461189 DOI: 10.1159/000514495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the risks that might be associated with recurrent macular hole retinal detachment (MHRD) after silicone oil (S.O) removal in myopic patients with open flat macular hole (MH). METHODS In this retrospective series, we assessed the different factors that might be associated with recurrent MHRD after S.O removal in 48 eyes with open flat MH that underwent S.O removal after successful MHRD repair. We divided the enrolled eyes into 2 groups: group 1 included 38 eyes with flat open MH and flat retina after S.O removal, and group 2 included 10 eyes with flat open MH and recurrent MHRD after S.O removal. RESULTS Ten of 48 eyes (20.8%) with open flat MH developed recurrent MHRD after S.O removal. Univariate logistic regression analysis revealed that MH at the apex of PS, MH minimum diameter, hole form factor (HFF), and MH index (MHI) were significant risk factors for recurrent MHRD after S.O removal in myopic patients with open flat MH. CONCLUSIONS If there is a "flat open" MH that is large, located at the apex of PS, or with an HHF or MHI <0.9-0.5, there is a high chance of recurrent MHRD after S.O removal.
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Affiliation(s)
- Hamouda Hamdy Ghoraba
- Department of Ophthalmology, Tanta University, Tanta, Egypt.,Maghrabi Eye Hospital, Tanta, Egypt
| | - Hosam Othman Mansour
- Maghrabi Eye Hospital, Tanta, Egypt.,Department of Ophthalmology, Al Azhar University, Damietta, Egypt
| | | | - Adel Galal Zaky
- Maghrabi Eye Hospital, Tanta, Egypt.,Department of Ophthalmology, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed Amin Heikal
- Department of Ophthalmology, Benha University, Benha, Egypt.,Magrabi Eye Hospital, Eastern Province, Khober City, Saudi Arabia
| | | | - Sameh Mohamed Elgouhary
- Maghrabi Eye Hospital, Tanta, Egypt, .,Department of Ophthalmology, Menoufia University, Shebin El-Kom, Egypt,
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13
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Li Y, Li Z, Xu C, Liu Y, Kang X, Wu J. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes. Acta Ophthalmol 2020; 98:e983-e990. [PMID: 32323479 DOI: 10.1111/aos.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. METHODS Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best-corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula. RESULTS At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow-up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post-BCVA was significantly better than the pre-BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t-test). CONCLUSION Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea.
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Affiliation(s)
- Yanzi Li
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | | | | | - Yong Liu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Xueqin Kang
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Jianhua Wu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
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Successful Technique for Closure of Macular Hole Retinal Detachment Using Autologous Retinal Transplant. Case Rep Ophthalmol Med 2020. [DOI: 10.1155/2020/8830985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Macular hole retinal detachment (MHRD) for the most part develops in highly myopic eyes. Several surgical methods have been introduced to treat MHRD. We describe our experience with the autologous retinal transplant in patient with MHRD. A 49-year-old female presented with a 2-week history of a sudden decrease in the central vision in the right eye (RE). A 3-port, 25-gauge pars plana vitrectomy was performed with the ILM dye staining and peeling. Endodiathermy was applied around a 1.5-disc diameter neurosensory donor site in the supertemporal retina. The graft was cut with standard 25-gauge curved scissors. Perfluoro-n-octane (PFO) was instilled. The free graft was gently handled until its packing into the macular hole. Two months following the initial PPV, the macular hole was closed, and vision improved from 0.05 to 0.25 logMAR.
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MORPHOLOGIC CHARACTERISTICS OF MACULAR HOLE AND MACULAR HOLE RETINAL DETACHMENT ASSOCIATED WITH EXTREME MYOPIA. Retina 2020; 39:1312-1318. [PMID: 29554077 DOI: 10.1097/iae.0000000000002155] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the surgical results and morphologic characteristics of macular hole (MH) and macular hole retinal detachment (MHRD) associated with extreme myopia. METHODS We retrospectively reviewed consecutive cases with axial length ≥28 mm who were treated with pars plana vitrectomy for MH or MHRD. The choroidal and scleral thickness at the fovea, presence of dome-shaped macula, and the height of posterior staphyloma 3 mm from the fovea were measured from postoperative optical coherence tomography images. RESULTS Significant improvement in visual acuity was obtained postoperatively in both MH (16 eyes; 15 patients) and MHRD (19 eyes; 18 patients) groups (P < 0.05). Final MH closure rate was not significantly different between the groups (MH: 15/16, MHRD: 14/19, P = 0.19). Axial length was not significantly different between the groups (MH: 30.5 ± 1.5 mm, MHRD: 29.6 ± 1.3 mm, P = 0.098). Eyes with MH had significantly greater choroidal thickness (MH: 61.9 ± 66.0 μm, MHRD: 24.1 ± 19.8 μm, P = 0.045), greater scleral thickness (MH: 294 ± 77 μm, MHRD: 232 ± 89 μm, P = 0.008), higher frequency of dome-shaped macula (MH: 6/16, MHRD: 1/19, P = 0.032), and lower staphyloma height (MH: 190 ± 113 μm, MHRD: 401 ± 156 μm, P < 0.001). CONCLUSION Surgical outcomes were generally favorable. The pathogenetic differences between the two conditions may be attributable to differences with respect to eye morphology.
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Zhao X, Ma W, Lian P, Tanumiharjo S, Lin Y, Ding X, Stewart JM, Liu B, Lu L. Three-year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes. Acta Ophthalmol 2020; 98:e470-e478. [PMID: 31742899 PMCID: PMC7318260 DOI: 10.1111/aos.14305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/31/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND To assess the functional and structural outcomes of macular buckling using a silicone sponge-titanium exoplant for the treatment of foveoschisis (FS) and full-thickness macular holes (FTMHs) in highly myopic eyes. METHODS Forty-nine consecutive patients with high myopia who underwent macular buckling for the treatment of FS and FTMHs were included. The outcomes measured included the anatomical success rate with FS resolution, retinal reattachment, MH closure, best corrected visual acuity (BCVA), axial length (AL) and complications of surgery. Moreover, the correlations between the BCVA at year three and series of factors, including age, duration of symptoms, baseline BCVA, AL, surgical type, preoperative macular status and severity of myopic maculopathy, were analysed. RESULTS This study involved 28 patients (28 eyes) with FS and 21 patients (21 eyes) with FTMHs with macular detachment. Retinal reattachment was achieved in 100% of cases, while MH closure was achieved in 76.19% of cases. The BCVA significantly improved one year after macular buckling in the FS cases and two years after macular buckling in the FTMH cases, and it remained stable throughout the rest of the follow-up period. The mean AL decreased by 2.09 mm postoperatively. No major perioperative complications were observed, although one patient needed to explant the buckling device due to intolerable diplopia. CONCLUSION Macular buckling with a silicone sponge-titanium exoplant may represent a safe and effective surgical option for the treatment of FS and FTMH in highly myopic eyes. Macular buckling showed a high closure rate and virtually no tendency to recur.
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Affiliation(s)
- Xiujuan Zhao
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Wei Ma
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Ping Lian
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Silvia Tanumiharjo
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Ying Lin
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Xiaoyan Ding
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Jay M. Stewart
- Department of OphthalmologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Bingqian Liu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
| | - Lin Lu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen UniversityGuangzhouChina
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17
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Nebbioso M, Lambiase A, Gharbiya M, Bruscolini A, Alisi L, Bonfiglio V. High myopic patients with and without foveoschisis: morphological and functional characteristics. Doc Ophthalmol 2020; 141:227-236. [PMID: 32323040 DOI: 10.1007/s10633-020-09767-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Myopic foveoschisis (MF) is characterized by the splitting of the retinal layers in the fovea of patients with high myopia (HM). MF may progress into foveal detachment or macular hole formation with consequent loss of central vision. The aim of this study is to investigate morphological and functional changes of the macular region in myopic subjects with and without foveoschisis. DESIGN Observational, cross-sectional, comparative study. METHODS Forty-eight patients with HM and 24 healthy controls were evaluated by spectral domain-optical coherence tomography (SD-OCT), multifocal electroretinography (mfERG) and microperimetry (MP-1) tests to assess macular thickness, functionality and sensitivity values, respectively. The results of the diagnostic examinations were compared between three groups: HM patients with MF (N = 24), HM patients without MF (N = 24) and control group (CG) (N = 24). All statistical analyses were performed with STATA 14.0 (Collage Station, Texas, USA). One-way analysis of variance (ANOVA) followed by Tukey's post hoc test was used to analyze differences between groups unless specified; p values < 0.05 were considered as statistically significant. Gender distribution was compared by the Chi square test. RESULTS The statistical analysis with one-way ANOVA followed by Tukey's post hoc test showed a significant increase in macular thickness in HM patients with MF when compared to both HM patients without MF and CG. Morphological changes were associated with functional impairment as demonstrated by the significant decrease in amplitude of the P1 wave and MP-1 sensitivity (p < 0.05), according to the anatomical landmarks. CONCLUSIONS This study showed that the morphological changes observed in the central retina of HM patients with MF are associated with functional alterations. High-tech diagnostic tests such as SD-OCT, mfERG and MP-1 could be useful for management in complications of MF.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy.
| | - Magda Gharbiya
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Alice Bruscolini
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Ludovico Alisi
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Vincenza Bonfiglio
- Department of Ophthalmology, University of Catania, Via S. Sofia 76, 95100, Catania, Italy
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Xin W, Cai X, Xiao Y, Ji L, Gu Y, Lv W, Jiang J. Surgical treatment for type II macular hole retinal detachment in pathologic myopia. Medicine (Baltimore) 2020; 99:e19531. [PMID: 32332602 PMCID: PMC7220656 DOI: 10.1097/md.0000000000019531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To observe the effectiveness and complications of inverted internal limiting membrane insertion through 25-G minimally invasive vitrectomy assisted with autologous blood adhesion fixation and combined with gas tamponade type-II macular hole retinal detachment in pathologic myopia.This was a retrospective study. The best-corrected visual acuity, intraocular pressure, macular hole closure, retinal reattachment, and systemic and ocular adverse events were observed.Twenty-three eyes were operated. Best-corrected visual acuity before surgery and at 3 and 6 months were 2.25 ± 0.47, 1.85 ± 0.32, and 1.32 ± 0.36 LogMAR (P < .001). On days 2 to 5, all the retinas reattached, and the macular holes closed. On days 5 to 9, 5 eyes showed increased intraocular pressure. At 2 and 4 months, 2 eyes showed retinal detachment recurrence. No serious systemic or ocular adverse events were observed.This surgical technique showed clinical benefits and no significant complications. Clinical trials are necessary to confirm efficacy and safety.
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Xiang W, Wei Y, Chi W, Zhang Z, Zhong L, Liu R, Zhang S. Effect of silicone oil on macular capillary vessel density and thickness. Exp Ther Med 2019; 19:729-734. [PMID: 31897107 DOI: 10.3892/etm.2019.8243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/19/2019] [Indexed: 11/06/2022] Open
Abstract
The present study assessed changes in macular capillary vessel density and thickness associated with ocular silicone oil tamponade (SOT) following complex vitreoretinal surgery. A total of 23 patients who underwent pars plana vitrectomy combined with intravitreal SOT were retrospectively enrolled, and a single eye was assessed in each participant. Furthermore, 20 patients who required silicone oil removal (SOR) were included. The macular capillary vessel density and the foveal avascular zone (FAZ) area were analyzed using optical coherence tomography angiography (OCTA) and retinal thickness was assessed by OCT. The results demonstrated that the macular capillary vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the FAZ area and full retinal thickness were retained at a stable level following SOT (P>0.05), and also following SOR (P>0.05). Furthermore, the parafoveal (P=0.008), superior-hemi (P=0.007), temporal (P=0.015), superior (P=0.028) and nasal (P=0.002) inner retinal thickness decreased in the SOT group, whereas the inner retinal thickness was unaltered after SOR vs. baseline (P>0.05). In conclusion, silicone oil has no significant effect on macular capillary vessel density within a 6-month period but may compress and reduce the thickness of the inner retina.
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Affiliation(s)
- Wu Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Liting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Rongjiao Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
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Sousa Neves F, Braga J, Sepúlveda P, Bilhoto M. Refractory Myopic Retinal Detachment and Macular Hole Closure with Autologous Neurosensory Retinal Free Flap. Case Rep Ophthalmol 2019; 10:160-164. [PMID: 31692566 PMCID: PMC6760359 DOI: 10.1159/000500275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/07/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this case report is to describe a modified technique involving the use of an autologous neurosensory retinal free flap for closure of a macular hole (MH) during retinal detachment (RD) surgery. A 50-year-old female presented with sudden vision loss (light perception only) and a recurrent myopic RD associated with an MH. An autologous neurosensory retinal free flap was obtained and moved toward the MH. Silicone oil was used as an endotamponade and removed after 6 months. Two months after oil removal visual acuity improved to 20/400 and remained stable thereafter; however, the patient developed central retinal atrophy. One year after surgery the MH was closed and the retina attached. This modified technique with the use of an autologous neurosensory retinal flap provides an alternative approach for recurrent MH in RD procedures.
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Affiliation(s)
- Filipe Sousa Neves
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Braga
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Sepúlveda
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Miguel Bilhoto
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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21
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Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res 2019; 69:80-115. [PMID: 30391362 DOI: 10.1016/j.preteyeres.2018.10.005] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.
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Affiliation(s)
- Jorge Ruiz-Medrano
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Javier A Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain
| | | | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Alfredo García-Layana
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Ruiz-Moreno
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain.
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POSTERIOR SCLERAL CONTRACTION TO TREAT RECURRENT OR PERSISTENT MACULAR DETACHMENT AFTER PREVIOUS VITRECTOMY IN HIGHLY MYOPIC EYES. Retina 2019; 39:193-201. [DOI: 10.1097/iae.0000000000002217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR TREATMENT OF MACULAR HOLE RETINAL DETACHMENT IN HIGHLY MYOPIC EYES. Retina 2018; 38:2317-2326. [DOI: 10.1097/iae.0000000000001898] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Zheng Y, Kang M, Wang H, Liu H, Sun T, Sun X, Wang F. Inverted internal limiting membrane insertion combined with air tamponade in the treatment of macular hole retinal detachment in high myopia: study protocol for a randomized controlled clinical trial. Trials 2018; 19:469. [PMID: 30165894 PMCID: PMC6117933 DOI: 10.1186/s13063-018-2833-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
Abstract
Background Macular hole retinal detachment (MHRD) occurs most commonly in high myopia and causes severe visual impairment and greatly reduces the quality of life. The aim of this study is to evaluate the efficacy and safety of inverted internal limiting membrane insertion combined with air tamponade in the treatment of MHRD in high myopia, and also to compare the treatment efficacy with that of the conventional “vitrectomy plus internal limiting membrane peeling plus silicone oil tamponade” method for high myopia-associated MHRD. Methods/design In this clinical trial, 38 patients with MHRD in high myopia will be randomly assigned to two groups (Group 1: standard 3-port 23-gauge pars plana vitrectomy plus internal limiting membrane peeling plus air-fluid exchange plus silicone oil infusion; Group 2: standard 3-port 23-gauge pars plana vitrectomy plus internal limiting membrane peeling plus inverted internal limiting membrane insertion plus air-fluid exchange). The primary outcome is macular hole closure rate in 3 months after the initial surgery. The secondary outcomes are best corrected visual acuity (BCVA), reattachment rate of retinal detachment, and postoperative complication rate. Discussion The study results may help to evaluate the efficacy and safety of inverted internal limiting membrane insertion combined with air tamponade in the treatment of MHRD in high myopia, and also compare the efficacy of the new treatment with the conventional “vitrectomy plus internal limiting membrane peeling plus silicone oil tamponade” method. This trial may provide a novel surgical treatment for MHRD in high myopia with more effectiveness and less pain. Trial registration ClinicalTrials.gov, NCT03383731. Registered on 19 December 2017. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13063-018-2833-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China
| | - Mei Kang
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China
| | - Tao Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Building 1, No.100, Haining Road, Shanghai, 200080, China.
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Abstract
PURPOSE To evaluate the current surgical options available for the management of large (>400 μm), recurrent, or persistent macular holes (MHs). METHODS A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and surgical treatments of large, recurrent, or persistent MHs. Based on this review, a comprehensive overview was provided regarding the topic of large, recurrent, or persistent MHs and focused on recent surgical management updates. RESULTS For large MHs, variations of the inverted internal limiting membrane flap technique demonstrated promising rates of primary hole closure and significant visual acuity improvements. For recurrent or recalcitrant MHs, early repeat vitrectomy with extension of the internal limiting membrane peel remains the most straightforward and optimal surgical technique to achieve secondary closure. Regardless of the surgical approach, the goal of each technique described is to induce or aid in stimulating gliosis within the MH to maximize closure. CONCLUSION Despite the high success rate of modern MH surgery, large, recurrent, or persistent MHs remain a challenge for retinal surgeons. This review provides a detailed summary on the rationality and efficacy of current surgical options.
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26
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Laviers H, Li JPO, Grabowska A, Charles SJ, Charteris D, Haynes RJ, Laidlaw DAH, Steel DH, Yorston D, Williamson TH, Zambarakji H. The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study. Eye (Lond) 2018; 32:1743-1751. [PMID: 30013156 DOI: 10.1038/s41433-018-0166-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To study UK practice patterns for the management of retinal detachment secondary to macular hole (MHRD) and macular retinoschisis (MRS) in pathological myopia (PM). To review the anatomical and visual outcomes of the surgically managed cases. METHODS A prospective observational case series for the management of MHRD was undertaken in association with the British Ophthalmological Surveillance Unit (BOSU). The results were combined with retrospective data, collected by the COllaboration of British RetinAl Surgeons (COBRA), on the management of both MHRD and MRS in PM in the UK. A total of 20 cases of MHRD and 53 cases of MRS (27 surgical cases and 26 cases managed conservatively) are reported in this combined study. RESULTS MHRD: Mean baseline best corrected visual acuity (BCVA) was 1.60 logMAR. All cases underwent pars plana vitrectomy (PPV). Mean post-operative BCVA was 1.49 logMAR (p = 0.674). The macular hole was closed in 5/20 (25%) cases, open/flat in 10/20 (50%) cases and open/elevated in 4/20 cases (20%). MRS: Mean baseline BCVA was 0.87 logMAR in the surgical group and 0.45 logMAR in the conservatively managed group (p = 0.002). All eyes that had surgical intervention underwent PPV. Mean post-operative BCVA was 0.68 logMAR (p = 0.183). Anatomical outcomes demonstrated a persistent MRS in 2/27 (7.4%) cases, partial resolution in 7/27 (25.9%) cases and complete resolution in 16/27 (59.2%) cases. CONCLUSIONS PPV is the only surgical procedure performed for the management of MHRD and MRS amongst the study participants. Success rates and visual outcomes are limited for MHRD and consistent with the current literature for MRS.
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Affiliation(s)
- Heidi Laviers
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | | | - Anna Grabowska
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Stephen J Charles
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Richard J Haynes
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - David H Steel
- Sunderland Eye Infirmary, NHS Trust, Sunderland, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - David Yorston
- Tennent Institute of Ophthalmology, Gartnavel Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tom H Williamson
- Ophthalmology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hadi Zambarakji
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK.
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Zhu SQ, Pan AP, Zheng LY, Wu Y, Xue AQ. Posterior scleral reinforcement using genipin-cross-linked sclera for macular hole retinal detachment in highly myopic eyes. Br J Ophthalmol 2018. [DOI: 10.1136/bjophthalmol-2017-311340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background/aimsTo investigate the surgical outcomes of posterior scleral reinforcement (PSR) using genipin-cross-linked sclera to treat macular hole retinal detachment (MHRD) in highly myopic eyes.MethodsNineteen patients with high myopia (19 eyes) with MHRD were treated sequentially with genipin-cross-linked PSR and were followed at least for 1 year after the surgery. The best corrected visual acuity (BCVA), axial length (AL), optical coherence tomography (OCT) outcomes and the complications were evaluated.ResultsMacular hole was closed in 73.7% of the eyes, foveal reattachment rate was 100%. The mean logMAR BCVA improved from 1.27±0.55 preoperatively to 0.88±0.55 postoperatively. The preoperative AL (29.88±1.97 mm) was decreased (27.73±1.84 mm) after the operation (p<0.001).ConclusionsFor at least a 1-year period of follow-up, PSR with genipin-cross-linked sclera should be considered as a preferred surgical approach to treat MHRD in highly myopic eyes, especially when foveal retinoschisis is also documented.
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Abstract
PURPOSE To evaluate a new application of an expanded polytetrafluoroethylene (Gore-Tex) vascular graft for use in macular buckling surgery for treatment of highly myopic eyes. METHODS The Gore-Tex vascular graft was used as a macular buckling material in eight consecutive cases of myopic macular diseases which included fovea detachment, foveoschisis, or macular hole retinal detachment. RESULTS Retinal reattachment was achieved in all cases except one which had partial resolution (88%). The postoperative best-corrected visual acuity ranged from 20/2000 to 20/100 depending on the degree preexisting macular degeneration, and significant better than the preoperative best-corrected visual acuity (P = 0.048, paired t-test). During the follow-up period, which ranged from 8 months to 3 years, no eye developed buckle-related complications such as infection or dislocation. CONCLUSION The initial pilot results from this series using a Gore-Tex graft for macular buckling is promising. Throughout the follow-up period, the Gore-Tex was well tolerated in the highly myopic eyes. Large scale and long-term follow-up is warranted.
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Gologorsky D, Williams BK, Flynn HW. Posterior Pole Retinal Detachment Due to a Macular Hole in a Patient with a Boston Keratoprosthesis. Am J Ophthalmol Case Rep 2017; 5:56-58. [PMID: 28944307 PMCID: PMC5607640 DOI: 10.1016/j.ajoc.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the clinical course of a patient with a Boston Keratoprosthesis type I who developed a localized posterior pole retinal detachment secondary to a macular hole. OBSERVATIONS A 73-year-old patient with a Boston Keratoprosthesis developed a localized posterior pole retinal detachment secondary to a macular hole. The retinal detachment was repaired with a 23-gauge pars plana vitrectomy, membrane peel, fluid-air exchange and 18% C3F8. Retinal reattachment was achieved but the macular hole remained open. CONCLUSIONS AND IMPORTANCE A posterior pole retinal detachment secondary to a macular hole can be repaired using standard techniques despite the limited view through a Boston Keratoprosthesis.
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Affiliation(s)
- Daniel Gologorsky
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Clinical Investigation of the Posterior scleral contraction to Treat Macular Traction Maculopathy in Highly Myopic Eyes. Sci Rep 2017; 7:43256. [PMID: 28220890 PMCID: PMC5318876 DOI: 10.1038/srep43256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/20/2017] [Indexed: 11/26/2022] Open
Abstract
Myopic traction maculopathy (MTM) can cause vision disabilities in highly myopic eyes. This retrospective case series investigated the clinical outcomes of posterior scleral contraction (PSC) using genipin-cross-linked sclera as the material to treat MTM in highly myopic eyes. In total, 32 eyes from 29 highly myopic patients who underwent PSC for MTM were recruited. The changes in best-corrected visual acuity (BCVA) and axial length were evaluated, macular reattachment and macular hole (MH) closure was assessed by optical coherence tomography, and complications were evaluated. At the final follow-up, the retina was completely reattached in 25 eyes (78.1%), essentially reattached in 4 eyes (12.5%), and partially reattached in 3 eyes (9.4%). The logMAR BCVA improved significantly from 1.18 ± 0.45 preoperatively to 0.87 ± 0.45 postoperatively (P < 0.001). The 32 eyes were further divided into the MH group (16 eyes) and the non-MH group (16 eyes) for comparison. The MH was closed in 9 eyes (56.3%). The retinal reattachment rate was 75.0% in the MH group and 81.25% in the non-MH group, and the logMAR BCVA improved significantly in both groups. The PSC using genipin-cross-linked sclera as the material can effectively treat MTM in highly myopic eyes, and significant visual improvement can be achieved with minimal complications.
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Abstract
Myopia is not a simple refractive error, but an eyesight-threatening disease. There is a high prevalence of myopia, 80% to 90%, in young adults in East Asia; myopia has become the leading cause of blindness in this area. As the myopic population increases globally, the severity of its impact is predicted. Approximately one fifth of the myopic population has high myopia (≥-6 diopters), which results in irreversible vision loss such as retinal detachment, choroidal neovascularization, cataracts, glaucoma, and macular atrophy. The increasing prevalence of school myopia in the past few decades may be a result of gene-environment interactions. However, earlier school myopia onset would accompany faster myopia progression and greater risk of high myopia later in life. Recently, there have been effective interventions to delay the onset of myopia, such as outdoor activity and decreasing the duration of near work. Hyperopia (≤0.5 diopters) is a predictor of myopia. Pharmacological agents and optic interventions such as low-concentration atropine and orthokeratology may slow progression in myopic children. Novel surgeries and anti-vascular endothelial growth factor drugs could deal with some myopic complications. From available evidence, the prevention, control, and treatment of myopia seem to be promising. However, to reduce the impact of myopia in future decades, more work and effort are still needed, including that by governments and intercountry eye health organizations.
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Affiliation(s)
- Pei-Chang Wu
- From the Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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Ando Y, Hirakata A, Ohara A, Yokota R, Orihara T, Hirota K, Koto T, Inoue M. Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment. Graefes Arch Clin Exp Ophthalmol 2016; 255:673-680. [PMID: 27832339 PMCID: PMC5364242 DOI: 10.1007/s00417-016-3523-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose To determine the outcomes of vitrectomy with scleral imbrication in highly myopic eyes with either myopic traction maculopathy (MTM) or macular hole retinal detachment (MHRD). Methods The medical records of 17 patients who had undergone vitrectomy with internal limiting membrane (ILM) peeling and scleral imbrication for MTM or MHRD were reviewed. The best-corrected visual acuities (BCVAs), the axial length, the macular hole (MH) closure rate, and the shape of the posterior segment determined by optical coherence tomography were evaluated. Three-dimensional magnetic resonance imaging (3D-MRI) was also performed on five eyes. Results The postoperative BCVA improved significantly from 0.76 ± 0.39 logarithm of the minimum angle of resolution (logMAR) units to 0.53 ± 0.35 logMAR units (P = 0.0004). The axial length decreased from 29.42 ± 1.81 mm to 27.97 ± 1.71 mm at 1 month. The MTM was resolved or decreased in all eyes. The MH was closed in 44 % of the MHRD eyes, and the retina was reattached in all of the MHRD eyes. The horizontal distance between the optic disc and the bottom of the posterior staphyloma was significantly decreased at 1 month (P = 0.012) but not at later times. The 3D-MRI images showed a reduction in the distance between the bottom of the posterior staphyloma and the center of the eye (P = 0.029) and a flattening of the posterior staphyloma (P = 0.010). Conclusions Vitrectomy with ILM peeling and scleral imbrication may be helpful in treating MTM and MHRD by reducing the degree of curvature of the posterior staphyloma.
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Affiliation(s)
- Yoshimasa Ando
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Akito Hirakata
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan.
| | - Arisa Ohara
- Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Reiji Yokota
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadashi Orihara
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazunari Hirota
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Koto
- 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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Grabowska A, Li JPO, Mateo C, da Cruz L. Myopic traction maculopathies and their treatments. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1226803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dealings between Cataract and Retinal Reattachment Surgery in PVR. J Ophthalmol 2016; 2016:2384312. [PMID: 27034821 PMCID: PMC4789506 DOI: 10.1155/2016/2384312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction. To evaluate the impact of the eye lens status and oil side effects on the outcome of vitreoretinal surgery in retinal detachment with proliferative vitreoretinopathy (PVR) and a temporary silicone oil tamponade (SOT). Methods. 101 eyes were analyzed retrospectively and 103 eyes prospectively in regard to their retinal reattachment success rate and key factors for the outcome. Subgroup analysis of 27 eyes with Scheimpflug lens photography (SLP) before and after retinal reattachment service with SOT was performed. For SLP (65% phakic eyes) a Pentacam densitometry reference body with 3 mm diameter was chosen and 3 segments (anterior/mid/posterior) were evaluated separately after a quality check. Results. The retinal reattachment rate was highest in the prospective pseudophakic group (p = 0.039). Lens transparency loss occurred earlier in middle aged patients than in younger patients. Besides the nucleus, layers posterior and anterior to it showed specific transparency changes. The emulsification rate was higher when eyes had been operated on in the anterior chamber before retinal reattachment service. Conclusions. Retinal reattachment surgery seems to benefit from preoperative cataract removal. We found significant lens changes in the nucleus as well as in the layers anterior and posterior to it. This corresponds to the histology of the lens epithelium published before.
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Hong N, Huang BS, Tong JP. Primary silicone oil tamponade and internal limiting membrane peeling for retinal detachment due to macular hole in highly myopic eyes with chorioretinal atrophy. BMC Ophthalmol 2015; 15:165. [PMID: 26560878 PMCID: PMC4642637 DOI: 10.1186/s12886-015-0154-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/04/2015] [Indexed: 01/14/2023] Open
Abstract
Background Retinal detachment (RD) secondary to macular hole (MH) is a common complication in highly myopic eyes, usually leading to a poor visual prognosis. The purpose of this study was to evaluate the surgical outcome of silicone oil (SO) tamponade and internal limiting membrane (ILM) peeling in the treatment of RD caused by MH (MHRD) in highly myopic eyes with chorioretinal atrophy, and to identify clinical factors associated with the anatomical outcomes. Methods We retrospectively reviewed 21 eyes of 21 highly myopic patients affected by RD secondary to MH and chorioretinal atrophy. All eyes were treated with pars plana vitrectomy (PPV) with ILM peeling and SO tamponade. Anatomical success was defined as reattachment of the retina with the closure of the MH, as assessed by optical coherence tomography (OCT), after SO removal. Logistic regression was performed to determine the clinical factors influencing anatomical success. Results The mean patient age was 59.95 years [standard deviation (SD), 10.39; range, 34–77 years] and the mean axial length was 30.58 mm (SD, 1.52; range, 27.99–34.51 mm). After the first surgical procedure, the anatomical success rate was 61.9 % (13 eyes in 21 eyes), with initial retinal attachment of16 eyes (76.2 %). A second surgical approach was performed for the five eyes with persistent or recurrent RD, and the final retinal reattachment rate was 100 % (21/21). Logistic regression analysis showed that no specific factors were significantly associated with anatomical success. Conclusions Primary silicone oil tamponade and ILM peeling can be a practical treatment for repairing MHRD in highly myopic eyes with chorioretinal atrophy.
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Affiliation(s)
- Nan Hong
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
| | - Bai-shuang Huang
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
| | - Jian-ping Tong
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
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Autofluorescence and axial length as prognostic factors for outcomes of macular hole retinal detachment surgery in high myopia. Retina 2015; 35:423-8. [PMID: 25170859 DOI: 10.1097/iae.0000000000000335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the results of fundus autofluorescence and axial length as prognostic factors for surgical outcome of macular hole retinal detachment in high myopic patients. METHODS This is a retrospective, interventional, nonrandomized study. Patients were treated with posterior vitrectomy, internal limiting membrane peeling, and silicone oil tamponade. Best-corrected visual acuity, axial length, fundus autofluorescence, and spectral domain optical coherence tomography images were obtained. RESULTS Fifteen eyes from 15 patients (mean age, 69.4 years) were evaluated. The mean refractive error was -19 diopters, and the mean axial length was 29.9 mm. The mean best-corrected visual acuity (logMAR) improved from 2.17 to 1.42 (P = 0.02) after a mean follow-up of 19.3 months. Spectral domain optical coherence tomography scans showed retinal detachment resolution in 13 eyes (86.6%) and macular hole closure in 9 eyes (60%). Fundus autofluorescence showed macular hypoautofluorescence with foveal involvement (mean area of 9.7 mm2) in 10 eyes (66.6%). Postoperative best-corrected visual acuity was significantly worse in these eyes (P = 0.009). Axial length >30 mm was found in the 2 cases with recurrent retinal detachment and in 4 of the 6 cases without macular hole closure (66.6%). CONCLUSION Macular hole retinal detachment in high myopic patients can be successfully treated with vitrectomy, internal limiting membrane peeling, and silicone oil. Axial length >30 mm and macular hypoautofluorescence with foveal involvement seem to be prognostic factors for a worse anatomical and visual outcome.
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Re: Scleral imbrication combined with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia. Retina 2015; 35:e34-5. [PMID: 26057394 DOI: 10.1097/iae.0000000000000637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SCLERAL IMBRICATION COMBINED WITH VITRECTOMY AND GAS TAMPONADE FOR REFRACTORY MACULAR HOLE RETINAL DETACHMENT ASSOCIATED WITH HIGH MYOPIA. Retina 2014; 34:2451-7. [DOI: 10.1097/iae.0000000000000246] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tamponade or filling effect: changes of forces in myopic eyes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:618382. [PMID: 25101290 PMCID: PMC4101978 DOI: 10.1155/2014/618382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/22/2014] [Indexed: 02/05/2023]
Abstract
Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye.
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Silicone oil: different physical proprieties and clinical applications. BIOMED RESEARCH INTERNATIONAL 2014; 2014:502143. [PMID: 25013785 PMCID: PMC4071776 DOI: 10.1155/2014/502143] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/18/2014] [Indexed: 01/31/2023]
Abstract
Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium. To understand this capability, it is important to know the silicone oil characteristics. Herein, we report first on the main chemical-physical proprieties and then we review the clinical applications of the current silicone oil which is lighter than water with particular reference to their indications with small gauge vitrectomy. Finally, we describe the surgical techniques to inject and remove this type of silicone oil. In the summary of this paper, we explain why silicone oils are today increasingly used and why their introduction has improved the prognosis of several retinal diseases. In fact, having different types of silicone oils allows us to choose the appropriate endotamponade for every single case.
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Chen ZQ, Lin JJ, Ye PP, Zhang L, Fang XY. Co-existent choroidal neovascular membrane and macular hole in pathologic myopia: a long follow-up clinical outcome and literature review. Int J Ophthalmol 2014; 6:884-7. [PMID: 24392342 DOI: 10.3980/j.issn.2222-3959.2013.06.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 09/09/2013] [Indexed: 11/02/2022] Open
Abstract
Choroidal neovascularization (CNV) is an uncommon complication associated with a macular hole. In this case report of a rare condition, we present a pathologic myopia patient with a co-existent macular hole and choroidal neovascular membrane. The patient was treated with photodynamic therapy for CNV, and then vitreous surgery for the retinal detachment and macular hole. At the end of 4 years follow-up, her visual acuity was improved to 0.1 while the macular hole remained open. Optical coherence tomography is a useful inspection method of the diagnosis of CNV and macular hole.
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Affiliation(s)
- Zhi-Qing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ji-Jian Lin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Pan-Pan Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Yun Fang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol 2013; 252:571-81. [PMID: 24158373 DOI: 10.1007/s00417-013-2497-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/02/2013] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes. METHODS In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula. RESULTS Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them. CONCLUSIONS Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.
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Lim LS, Tsai A, Wong D, Wong E, Yeo I, Loh BK, Ang CL, Ong SG, Lee SY. Prognostic factor analysis of vitrectomy for retinal detachment associated with myopic macular holes. Ophthalmology 2013; 121:305-310. [PMID: 24139155 DOI: 10.1016/j.ophtha.2013.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To describe the anatomic and functional outcomes in a cohort of subjects undergoing vitrectomy for retinal detachment (RD) resulting from myopic macular hole (MH) and to analyze the prognostic and surgical factors predicting retinal reattachment and MH closure. DESIGN Retrospective case series. PARTICIPANTS All patients who underwent vitrectomy for RD resulting from myopic MH between 2000 and 2009 at our center. METHODS Case records were reviewed at 6 months after surgery. Retinal reattachment and complete anatomic success, defined as retinal reattachment with MH closure, were assessed. Multivariate logistic regression models, including age, gender, duration of symptoms, spherical equivalent refraction (SE), internal limiting membrane peeling, tamponade choice, and concurrent scleral buckling, were constructed to assess associations with covariates. MAIN OUTCOME MEASURES Retinal reattachment and complete anatomic success (retinal reattachment with MH closure). RESULTS In total, 114 subjects were analyzed. Most were women (n = 79 [69.3%]), and the mean age was 57.5±13.3 years. The mean SE was -9.88±6.37 diopters. At 6 months, 98 subjects (86.0%) demonstrated retinal reattachment, of whom 93 subjects required only 1 operation. Complete anatomic success was achieved in 61 subjects (53.5%), of whom 55 needed only 1 operation. Subjects with retinal reattachment had better best-corrected visual acuity (BCVA; mean BCVA, 1.22±0.81 logarithm of the minimum angle of resolution [logMAR] units) than those without (mean BCVA, 1.98±1.26 logMAR units; P < 0.001), and subjects with complete anatomic success had better BCVA (mean BCVA, 1.05±0.87 logMAR units) than those without (mean BCVA, 1.62±0.87 logMAR units; P < 0.001). In multivariate analyses, increasing age and the use of perfluoropropane (C3F8) tamponade were predictive of anatomic success (per 1-year increase: odds ratio [OR], 1.049; 95% confidence interval [CI], 1.002-1.099; P = 0.04; and for tamponade: OR, 10.71; 95% CI, 1.08-106.29; P = 0.04). CONCLUSIONS Vitrectomy is effective in the repair of RD resulting from MH in myopic eyes, with retinal reattachment achieved more frequently than MH closure. Retinal reattachment and MH closure are important for improving visual outcomes. Greater age at presentation and use of C3F8 are associated with a greater likelihood of anatomic success.
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Affiliation(s)
- Laurence Shen Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Tsai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Doric Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Edmund Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ian Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Boon Kwang Loh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Chong Lye Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sze Guan Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore.
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Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 2013; 156:125-131.e1. [PMID: 23622567 DOI: 10.1016/j.ajo.2013.02.014] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the effect of pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap technique for macular hole with or without retinal detachment in highly myopic eyes. DESIGN Retrospective, interventional case series. METHODS Ten eyes of 10 patients with macular hole with (4 eyes) or without (6 eyes) retinal detachment in high myopia (axial length more than 26.5 mm) were treated by PPV with inverted ILM flap technique. RESULTS Macular hole closure was observed in 8 eyes (80%) following the initial surgery (in 5 eyes without retinal detachment and in 3 eyes with retinal detachment). In 4 eyes with retinal detachment caused by macular hole, retinas of 3 eyes were reattached by the initial surgery. Postoperative best-corrected visual acuity improved by more than 2 lines in 5 eyes (50%), was unchanged in 4 eyes (40%), and worsened by more than 2 lines in 1 eye (10%). CONCLUSIONS Inverted ILM flap technique might contribute to a high closure rate of macular hole and be a preferable adjuvant to the treatment of macular hole in high myopia with or without retinal detachment.
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