1
|
Wu TT, Hou TY, Peng KL, Kung YH. Inverted flap technique versus internal limiting membrane insertion for macular hole in eyes with extremely high myopia. BMC Ophthalmol 2024; 24:286. [PMID: 39009984 PMCID: PMC11251341 DOI: 10.1186/s12886-024-03566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND To compare the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique and ILM insertion for macular hole (MH) without retinal detachment in eyes with extremely high myopia. METHODS In this retrospective study, we analyzed 22 eyes with an axial length ≥ 30.0 mm that had underwent MH surgery between April 2015 and August 2021. The surgical procedures involved either an inverted ILM flap or ILM insertion. The outcomes were compared between the two techniques. Closure of the MH was confirmed by optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) was measured before and after surgery. Associated complications were documented. RESULTS The median of axial length was 30.64 mm (range, 30.0-34.42). The MH closed in 100% (22/22) eyes and did not recur with a median follow-up of 12.5 months. For the inverted ILM flap technique, the median BCVA improved significantly from 0.80 logarithm of the minimum angle of resolution (logMAR) (range, 0.40-2.00) before surgery to 0.70 logMAR (range, 0.09-1.52) after surgery (p = 0.002). In addition, the median of final BCVA was better for the inverted ILM flap than ILM insertion (0.7 logMAR V.S. 1.00 logMAR; p = 0.016). CONCLUSIONS In eyes with extremely high myopia, despite comparable effects on MH closure for both ILM insertion and the inverted ILM flap, the later technique achieved significantly better visual outcomes.
Collapse
Affiliation(s)
- Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Tzu-Yu Hou
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Kai-Ling Peng
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan
- Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, R.O.C
| | - Ya-Hsin Kung
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C..
| |
Collapse
|
2
|
Teixeira A, Salaroli C, Fuganti RM, Casella AMB. The Cosine Law to Choose the Correct Forceps Shaft Length for Macular Surgery in Highly Myopic Eyes. Retina 2023; 43:2166-2169. [PMID: 36729566 DOI: 10.1097/iae.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To demonstrate a mathematical analogy between the Pythagorean theorem using the axial a-scan measurement, i.e., the distance between the central cornea and the sclerotomy, and the lengths of the forceps in eyes of patients with all axial lengths. METHODS We used the Pythagorean equation (c 2 = a 2 + b 2 ) to calculate the adequate shaft length of the forceps to use in macular surgery, especially in highly myopic eyes, where c 2 represents the axial length (hypotenuse); b 2 the sum of the corneal ray and distance between the corneal limbus and the sclerotomy (base side); and a 2 the distance between the sclerotomy and the fovea (perpendicular side). RESULTS We reproduced the cosine law to estimate the distance between the sclerotomy and the fovea. The distance between the sclerotomy and the foveal area is shorter than the axial length and can become smaller based on the distance from the sclerotomy to the corneal limbus. CONCLUSION This simple mathematical formula is useful when performing surgery in highly myopic eyes, in which there can be difficulties reaching the macular area.
Collapse
Affiliation(s)
- Anderson Teixeira
- Medical School, Catholic University of Brasília, Brasília, DF, Brazil
| | | | | | | |
Collapse
|
3
|
Bergamo VC, Caiado RR, Maia A, Magalhães O, Moraes NSB, Rodrigues EB, Farah ME, Maia M. Role of Vital Dyes in Chromovitrectomy. Asia Pac J Ophthalmol (Phila) 2020; 10:26-38. [PMID: 33252365 DOI: 10.1097/apo.0000000000000344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Chromovitrectomy, the intraocular application of dyes to assist visualization of preretinal tissues during vitreoretinal surgery, was introduced to avoid ocular complications related to internal limiting membrane peeling, inadequate removal of the vitreous, and incomplete removal of epiretinal membranes. Since 2000, chromovitrectomy has become a popular approach among vitreoretinal specialists. The first vital dye used in chromovitrectomy, indocyanine green, facilitated identification of the fine and transparent internal limiting membrane. Following indocyanine green, trypan blue was introduced to identify epiretinal membranes, and triamcinolone acetonide stained the vitreous well. Recently, additional natural dyes such as lutein and anthocyanin from the açaí fruit have been proposed for intraocular application during vitrectomy. The main goal of this review was to study the role of vital stains in chromovitrectomy and report the latest findings in the literature.
Collapse
Affiliation(s)
- Vinicius C Bergamo
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Rafael R Caiado
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - André Maia
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Octaviano Magalhães
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Nilva S B Moraes
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Eduardo B Rodrigues
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, SSM Health Saint Louis University Hospital, Saint Louis University, St. Louis, Missouri, United States
| | - Michel E Farah
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Retina Division, Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
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: 7] [Impact Index Per Article: 1.8] [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.
Collapse
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
| |
Collapse
|
5
|
Bové Álvarez M, Sabaté S, Gómez-Resa M, García-Arumí J. ANATOMICAL AND VISUAL OUTCOMES OF INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS INTERNAL LIMITING MEMBRANE PEELING IN MYOPIC MACULAR HOLE WITHOUT RETINAL DETACHMENT: A Preliminary Retrospective Study. Retina 2020; 40:233-240. [PMID: 31972792 DOI: 10.1097/iae.0000000000002368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap for treating myopic macular hole without retinal detachment. METHODS Twenty-eight eyes of 28 patients undergoing vitrectomy with either ILM peeling (n = 16) or inverted ILM flap technique (n = 12) were included. Outcomes were myopic macular hole closure by optical coherence tomography and visual acuity at 6 months and at the end of follow-up. RESULTS Closure of myopic macular hole was achieved in 13 eyes (81.2%) of the ILM peeling group and in 11 eyes (91.7%) of the inverted ILM flap group. The median length of follow-up was 18 months in the peeling group and 10.3 in the inverted group. There were not statistically significant differences between restoration of the external limiting membrane, external limiting membrane and ellipsoid zone, and none of both layers between the two groups. The median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.25 (20/35 Snellen) in the peeling group and 0.4 (20/50) in the inverted group (P = 0.027). CONCLUSION Both techniques were associated with high closure rates of myopic macular hole but the small sample size and the retrospective design prevents any claims of superiority of one technique over the other.
Collapse
Affiliation(s)
| | - Sergi Sabaté
- Service of Anesthesiology, Fundació Puigvert, Barcelona, Spain
| | - María Gómez-Resa
- Service of Ophthalmology, Hospital Universitario Son Espases, Palma de Mallorca, Spain; and
| | - José García-Arumí
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
- Service of Ophthalmology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique. J Ophthalmol 2019; 2019:6723824. [PMID: 31205783 PMCID: PMC6530104 DOI: 10.1155/2019/6723824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the results of vitrectomy with those of internal limiting membrane (ILM) peeling or inverted ILM flap for treating myopic or idiopathic macular hole. Methods Thirty-nine eyes of 39 patients undergoing vitrectomy with ILM peeling for macular hole (25 idiopathic and 14 myopic) and 27 eyes of 27 patients undergoing vitrectomy with inverted ILM flap (15 idiopathic and 12 myopic) were included. Outcome measures were macular hole closure by optical coherence tomography and visual acuity at 6 months. Results Closure was achieved in 25 (100%) idiopathic and 12 (86%) myopic macular holes in the ILM peeling group and in 14 (93%) idiopathic and 11 (91.77%) macular holes in the inverted ILM flap group. There were no statistically significant differences in restoration of the external limiting membrane and ellipsoid zone between the groups. Median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.22 (20/32 Snellen) in idiopathic and 0.4 (20/50) in myopic (P=0.042) patients in the ILM peeling group and 0.4 (20/50) in idiopathic and 0.4 (20/50) in myopic (P=0.652) patients in the inverted ILM flap group. Conclusion Both techniques were associated with high closure rates in myopic and idiopathic macular holes, with somewhat better visual outcomes in idiopathic cases. The small sample size may have provided insufficient power to support the superiority of one technique over the other in the two groups.
Collapse
|
7
|
SURGICAL OUTCOMES IN EYES WITH EXTREMELY HIGH MYOPIA FOR MACULAR HOLE WITHOUT RETINAL DETACHMENT. Retina 2019; 38:2051-2055. [PMID: 28796147 DOI: 10.1097/iae.0000000000001806] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The authors evaluated surgical outcomes in eyes with extremely high myopia for macular hole (MH) without retinal detachment. METHODS In this retrospective study, 14 eyes with axial lengths of ≥30.0 mm underwent vitrectomy and internal limiting membrane (ILM) peeling with or without inverted ILM flap insertion for MH without retinal detachment (October 2009-June 2016). Outcome measures were MH closure confirmed by optical coherence tomography, best-corrected visual acuity, and complications. RESULTS The mean axial length was 30.69 ± 0.76 mm. The overall final closure rate was 85.7% (12/14 eyes); the mean follow-up was 17.29 (±20.20) months. Primary anatomical MH closure after 1 operation was achieved in three of eight eyes (37.5%) without an inverted ILM flap and was achieved in six of six eyes (100%) with inverted ILM flap insertion (P = 0.031). There was no reopening of MH during follow-up. Mean visual acuity improved significantly from 1.10 ± 0.43 logarithm of the minimum angle of resolution (Snellen equivalent, 20/254) to 0.84 ± 0.50 logarithm of the minimum angle of resolution (Snellen equivalent, 20/138) (P = 0.046; 2-tailed, paired t-test). Only 1 eye developed an MH-associated retinal detachment 4.5 years after previously failed MH surgery; reattachment was achieved after a second operation. CONCLUSION Patients with extremely high myopia obtained anatomical and functional improvements from MH surgery; inverted ILM flap insertion achieved significantly higher primary success rates in MH closure.
Collapse
|
8
|
Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal. J Ophthalmol 2019; 2019:1314989. [PMID: 31275628 PMCID: PMC6589202 DOI: 10.1155/2019/1314989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the microstructural changes after successful myopic macular hole (MMH) surgery, comparing inverted ILM flap and complete ILM removal techniques, and their association with visual function. Methods Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate both external limiting membrane (ELM) and ellipsoid zone (EZ) recovery in 40 eyes of 39 patients who underwent pars plana vitrectomy with either inverted internal limiting membrane flap technique (n=27) or complete ILM removal (n=13) to achieve MH closure. The association between ELM and EZ recovery and visual acuity was also investigated. The patients were followed up at 1 year. Results ELM and EZ was recovered in 72% and 62% of cases, respectively, regardless of the surgical techniques 1 year after surgery. A strong positive association between the ELM and EZ recovery and the mean BCVA was found: regardless of the surgical technique, this was statistically significant at each time point (p < 0.05). None of the baseline variables were found to act as predictive factors for either ELM or EZ. Conclusion The inverted ILM flap technique did not affect the MMH healing processes compared to complete ILM removal. Thus, the presence of the ILM plug did not interfere with the restoration of both ELM and EZ, which correlated with functional recovery.
Collapse
|
9
|
Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
Collapse
|
10
|
Hu XT, Pan QT, Zheng JW, Zhang ZD. Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique. Br J Ophthalmol 2018; 103:1495-1502. [DOI: 10.1136/bjophthalmol-2018-313311] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 11/04/2022]
Abstract
PurposeThe aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH.MethodsPars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared.ResultsThe anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001).ConclusionsThese findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.
Collapse
|
11
|
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.
Collapse
|
12
|
Floating flap of internal limiting membrane in myopic macular hole surgery. Graefes Arch Clin Exp Ophthalmol 2018; 256:693-698. [PMID: 29453727 DOI: 10.1007/s00417-018-3936-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the surgical results of macular hole (MH) in patients with high myopia treated with pars plana vitrectomy (PPV) leaving the internal limiting membrane (ILM) flap floating in vitreous fluid at the edge of the MH. METHODS Nine highly myopic eyes with MH of nine consecutive patients who underwent PPV were retrospectively evaluated. Three eyes were accompanied by retinal detachment (RD). ILM peeling was performed around the MH and some part of the ILM flap was left attached to the edge of the MH. Further manipulation of the ILM flap to cover the MH was not performed. Fluid-gas exchange was performed to the retinal vessel arcade level. Patients maintained a face down position for 3 to 7 days postoperatively. RESULTS Complete MH closure was confirmed using optical coherence tomography in all eyes and three eyes with RD showed reattachment of the retina after the initial surgery. Visual acuity significantly improved (P = 0.02) and no eyes experienced MH reopening or RD occurrence during the follow-up period of 8.33 ± 3.61 months after the surgery. CONCLUSIONS MH with or without RD in highly myopic eyes could be successfully treated with PPV leaving ILM flap floating in vitreous fluid at the edge of the MH. After the ILM peeling, further manipulation of the ILM flap to cover the MH would not be necessary for the treatment of MH in high myopia.
Collapse
|
13
|
Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes. Acta Ophthalmol 2018; 96:e46-e53. [PMID: 28677833 DOI: 10.1111/aos.13514] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 05/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated the surgical results of macular hole retinal detachment (MHRD) with a modified C-shaped temporal inverted internal limiting membrane (ILM) flap to reconstruct the foveolar architecture in highly myopic eyes. METHODS Eighteen highly myopic eyes with MHRD in 17 patients who underwent a vitrectomy with a modified C-shaped temporal inverted ILM flap were followed for 12 months. Anatomic outcomes were evaluated by fundus examinations and optical coherence tomography. The preoperative and postoperative best-corrected visual acuities (BCVAs) were compared as functional outcomes. RESULTS Women accounted for 88% of the MHRD patients. The mean age was 60.2 ± 8.2 years. The mean axial length was 29.25 ± 2.10 mm. Type 1 and type 2 MHRD was present in four eyes and 14 eyes, respectively. After a single surgery, the hole was closed in 18 eyes (100%). Retinal attachment was achieved in 95%. Persistent shallow subretinal fluid (SRF) was noted in one case, which was resolved at follow-up. The surgery significantly improved BCVAs (from 1.7 ± 0.6 to 0.72 ± 0.4 logarithm of the minimum angle of resolution units [p < 0.001]) at the last visit. In total, 94.4% of the eyes had restored foveolar architecture. Ellipsoid zone recovery within the foveola was found in 77.8% of the eyes. CONCLUSION A vitrectomy and modified C-shaped inverted temporal ILM flap is effective for closing MHs, reattaching the retina, restoring the foveolar architecture and significantly improving the postoperative BCVA in MHRD patients. This technique is feasible, and we propose 'presumed' Müller cell cone repair in MHRD surgery.
Collapse
Affiliation(s)
- Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Allen Ho
- School of Medicine, Chang-Gung University, Taoyuan City, Taiwan
| | - Muh-Shy Chen
- Department of Ophthalmology, Cardinal Tien Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
14
|
Kumar A, Kakkar P, Ravani RD, Markan A. Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment. BMJ Case Rep 2017; 2017:bcr-2016-217671. [PMID: 28710187 DOI: 10.1136/bcr-2016-217671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).1â€"3 Shimada et al4 described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction.5 6 Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.
Collapse
Affiliation(s)
- Atul Kumar
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kakkar
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Dinesh Ravani
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Ohno-Matsui K, Lai TY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res 2016; 52:156-87. [DOI: 10.1016/j.preteyeres.2015.12.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
|
16
|
Chen SN, Yang CM. Inverted Internal Limiting Membrane Insertion for Macular Hole-Associated Retinal Detachment in High Myopia. Am J Ophthalmol 2016; 162:99-106.e1. [PMID: 26582311 DOI: 10.1016/j.ajo.2015.11.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/01/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the surgical outcomes of inverted internal limiting membrane (ILM) insertion in macular hole (MH)-associated retinal detachment (RD) in high myopia. DESIGN Retrospective, interventional, consecutive case series. METHODS This study was conducted at 2 medical centers. Consecutive cases of highly myopic eyes with MH-associated RD were included. Forty eyes were divided into 2 groups: Group 1 (20 eyes) received vitrectomy, ILM peeling within the arcade area, and air-fluid exchange, and Group 2 (20 eyes) received vitrectomy, inverted ILM inserted into the macular hole, and air-fluid exchange. Optical coherence tomography was used to observe the closure of the macular hole. Corrected visual acuity (VA) was also recorded. Two-sample t test and Mann-Whitney U test were used for statistical analysis to compare differences between the 2 groups. RESULTS MH was closed in 35% of the eyes in Group 1 and in all eyes in Group 2 (P < .001). Significant improvement in VA in logarithm of minimal angle of resolution (logMAR) was achieved in both groups. There was no difference in the initial, final, or improvement of logMAR VA in the 2 groups. CONCLUSION Inverted ILM insertion into a macular hole effectively helps close the macular hole in MH-associated RD in high myopia. This may prevent the possible re-detachment from the MH. A prospective study with a larger number of cases and longer follow-up may help validate our findings.
Collapse
|
17
|
Abstract
Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications.
Collapse
|
18
|
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.
Collapse
|
19
|
Lin CW, Ho TC, Yang CM. The development and evolution of full thickness macular hole in highly myopic eyes. Eye (Lond) 2015; 29:388-96. [PMID: 25572579 DOI: 10.1038/eye.2014.312] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/28/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes. PATIENTS AND METHODS Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes. RESULTS Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection. CONCLUSION The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.
Collapse
Affiliation(s)
- C-W Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - T-C Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-M Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
20
|
MACULAR HOLE REPAIR BY VITRECTOMY AND INTERNAL LIMITING MEMBRANE PEELING IN HIGHLY MYOPIC EYES. Retina 2014; 34:2021-7. [DOI: 10.1097/iae.0000000000000183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
21
|
Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment. Retina 2014; 34:670-8. [PMID: 24013260 DOI: 10.1097/iae.0b013e3182a487ea] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the effect of 360° scleral band in combination with pars plana vitrectomy (PPV) and silicone oil tamponade on the anatomical success and on the closure of macular hole (MH) in cases of myopic macular hole retinal detachment. METHODS A retrospective consecutive interventional study from medical records on patients who had pars plana vitrectomy and silicone oil. with or without 360° scleral band for the treatment of retinal detachment associated with MH. The cases were operated in the period from February 2006 to May 2012. The included cases were classified into two groups: the first group with scleral band and the second group without scleral band. The primary anatomical success and optical coherence tomography patterns of MH closure were the main outcomes. RESULTS After the first procedure, the overall success rate was 90.6% (in both groups). In 9.4%, there was recurrent retinal detachment. In the first group the success rate was 89.5%, and in 10.5% there was recurrent retinal detachment. In the second group 92.5% was success and 7.5% was recurrent retinal detachment. After the second interference, the success rate was 98.4% in both groups. Closure of MH was achieved in 45.2% in both groups. In the first group, there was closure of MH in 43.5%, while in 47.8% the hole remained open flat, in 4.3% the hole closed partially and in 4.3% there was macular scar. In the second group, MH closure was achieved in 47.4%, whereas in 52.6% the hole was open flat. CONCLUSION The use of 360° band in combination with pars plana vitrectomy and silicone oil offered no additional effect on either the anatomical success or the rate of MH closure in the management of myopic macular hole retinal detachment. Four patterns of MH were reported closed MH, partial thickness MH, open flat MH, and macular scar.
Collapse
|
22
|
Abstract
PURPOSE To present the anatomical and functional results of vitrectomy with the "inverted internal limiting membrane flap technique" in myopic macular holes without retinal detachment. METHODS A prospective interventional study of 19 myopic eyes with a spherical equivalent >-6 diopters with macular holes in 18 consecutive patients. Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measure was visual outcome and macular hole closure rate. RESULTS Mean visual acuity improved from 1.2 logMAR to 0.56 logMAR. We confirmed the closure of the macular hole with spectral domain optical coherence tomography in all cases. The closure of the macular hole began in the inner retinal layers, and the architecture gradually filled with tissue. Photoreceptor and external limiting membrane defects improved during the first 12 months after surgery. CONCLUSION Vitrectomy with the inverted internal limiting membrane flap technique may be an effective addition to surgical options for treating myopic macular holes. Spectral domain optical coherence tomography images confirm that the process of foveal architectural repair after this surgery continues over at least a 12-month period.
Collapse
|
23
|
Conart JB, Selton J, Hubert I, Trechot F, El Adssi H, Creuzot-Garcher C, Berrod JP. Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes: a case-control study. Ophthalmology 2014; 121:1263-8. [PMID: 24480709 DOI: 10.1016/j.ophtha.2013.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/28/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the outcomes of macular hole (MH) surgery with 3-day prone positioning in highly myopic eyes and to compare them with those from non-highly myopic eyes. DESIGN Retrospective nested case-control study from a cohort of 496 consecutive patients (496 eyes) who underwent surgery for MH. PARTICIPANTS Forty-seven highly myopic eyes (with axial length >26 mm) were included in the study group and were matched for MH size and duration of symptoms with 47 non-highly myopic control eyes selected from the same cohort. METHODS All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and 17% hexafluoroethane gas filling. Patients then were advised to maintain strict face-down positioning for 3 days only and to avoid the supine position during the night for a minimum of 1 week. MAIN OUTCOME MEASURES The MH closure rate, the relationship between axial length and closure rate, the best-corrected visual acuity (BCVA), and the surgical complications were analyzed. RESULTS The mean axial length was 28.5±2.2 mm in highly myopic eyes and 23.3±1.1 mm in controls (P < 0.001). Closure of the MH was achieved in 39 of 47 eyes (83%) in the study group and in 45 of 47 eyes (95.7%) in the control group (P = 0.045). Anatomic outcomes tended to decrease when axial length increased (P = 0.066). Mean BCVA improved in both groups (0.41±0.39 logarithm of the minimal angle of resolution [logMAR] vs. 0.68±0.34 logMAR) but was significantly lower in highly myopic eyes (P < 0.001). Retinal detachment occurred in 8.5% of highly myopic patients versus 2.1% of controls, but the difference was not significant. CONCLUSIONS Macular hole surgery with 3-day postoperative positioning in highly myopic eyes resulted in satisfactory anatomic and functional outcomes. However, the MH closure rate and mean improvement of visual acuity were less favorable than those in control eyes. Longer axial length may increase the risk of anatomic failure.
Collapse
Affiliation(s)
| | - Jérôme Selton
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Isabelle Hubert
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Fanny Trechot
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| | - Haritina El Adssi
- Clinical Epidemiology and Evaluation, Nancy University Hospital, Nancy, France
| | | | - Jean-Paul Berrod
- Department of Ophthalmology, Nancy University Hospital, Nancy, France
| |
Collapse
|
24
|
Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment: a review. Graefes Arch Clin Exp Ophthalmol 2014; 252:191-9. [DOI: 10.1007/s00417-013-2555-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023] Open
|
25
|
Chen SN, Li KH, Hwang JF. Myopic macular hole-associated retinal detachment with proliferative vitreoretinopathy. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
26
|
|
27
|
Gao X, Ikuno Y, Fujimoto S, Nishida K. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol 2013; 155:1021-1027.e1. [PMID: 23522356 DOI: 10.1016/j.ajo.2013.01.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify risk factors for development of secondary full-thickness macular holes after pars plana vitrectomy with internal limiting membrane (ILM) peeling for myopic foveoschisis. DESIGN Retrospective, interventional case series. METHODS We retrospectively reviewed the records of 42 eyes (42 patients) treated with pars plana vitrectomy (vitreous separation, internal limiting membrane peeling, and gas tamponade) for myopic foveoschisis with and without a retinal detachment but without a macular hole from January 2002 through June 2012. Cataract surgery was performed in all phakic eyes. Patients were followed up for 6 months after the initial surgery, and optical coherence tomography images were obtained at every visit. The factors associated with development of postoperative full-thickness macular holes were investigated. RESULTS A postoperative macular hole developed in 8 (19.0%) eyes. No significant correlations of age (P = .369), axial length (P = .113), visual acuity (P = .859), foveal status (P = .331), posterior staphyloma (P = 1.000), or chorioretinal atrophy (P = .837) were found between patients with and without secondary macular holes. Among the characteristics seen on the optical coherence tomography images, the percentage of eyes with an inner segment/outer segment junction defect was significantly (P = .013, Fisher exact test) higher in patients with a macular hole than in those without a macular hole. Logistic regression analysis showed that only an inner segment/outer segment junction defect (P = .018) was a significant risk factor for development of secondary macular holes. CONCLUSIONS Secondary macular holes can develop in myopic foveoschisis after pars plana vitrectomy with internal limiting membrane peeling. A preoperative inner segment/outer segment junction defect can be a risk factor for development of a macular hole.
Collapse
|
28
|
|
29
|
Minarcik JR, von Fricken MA. Virtual retinectomy: indocyanine green-assisted internal limiting membrane peeling as a surgical adjunct in repair of recurrent rhegmatogenous retinal detachment due to PVR. Clin Ophthalmol 2012; 6:631-6. [PMID: 22570543 PMCID: PMC3346193 DOI: 10.2147/opth.s29654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to describe and evaluate a surgical approach, known as internal limiting membrane (ILM) peeling, as an adjunct to repair of recurrent retinal detachment due to proliferative vitreoretinopathy (PVR). Methods This was a retrospective case series. All eyes underwent repair of recurrent PVR-related rhegmatogenous retinal detachment incorporating macular indocyanine green-assisted ILM peeling. Patients with primary detachments, diabetes, staphyloma, or macular holes were excluded. The main outcome measure was the anatomic success of single surgery. The characteristics of the group were studied, including the number and types of previous detachment repair attempts, as well as the subsequent surgeries. Results Fourteen eyes from 14 patients were included. Anatomic success with single surgery was achieved in 11 of 14 (79%) of the operated eyes using this technique, and eventual success was achieved in all eyes (100%). Among the failed repairs prior to ILM peeling, 8/14 eyes had scleral buckles, 7/14 had silicone oil tamponade, and two had inferior retinectomies. There was no subsequent development of epiretinal membranes after ILM peeling. Conclusion ILM peeling in conjunction with vitrectomy and peeling of peripheral membranes is an effective technique with a high anatomic success rate in the challenging scenario of PVR-related recurrent detachments. We describe the technique as an alternative to the traditional retinectomy.
Collapse
Affiliation(s)
- John R Minarcik
- Ophthalmology, Georgetown/Washington Hospital Center, Retina Group of Washington, Fairfax, VA, USA
| | | |
Collapse
|
30
|
Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2011; 250:327-31. [DOI: 10.1007/s00417-011-1821-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/29/2011] [Accepted: 09/02/2011] [Indexed: 02/03/2023] Open
|
31
|
Yu J, Wang F, Cao H, Fan Y, Zhang X. Combination of Internal Limiting Membrane Peeling and Endophotocoagulation for Retinal Detachment Related to High Myopia in Patients with Macular Hole. Ophthalmic Surg Lasers Imaging Retina 2010; 41:215-21. [DOI: 10.3928/15428877-20100303-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2009] [Indexed: 11/20/2022]
|
32
|
Thompson JT, Haritoglu C, Kampik A, Langhals H. Should Indocyanine green should be used to facilitate removal of the internal limiting membrane in macular hole surgery. Surv Ophthalmol 2009; 54:135-8. [PMID: 19171215 DOI: 10.1016/j.survophthal.2008.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Indocyanine green (ICG) is one of several vital dyes that are used in vitreoretinal surgery to aid visualization of diaphanous collagenous tissues in what has been called chromovitrectomy. As shown herein, much has been written about the use and rather narrow safety profile of ICG. The discussion surrounding its applications would have ended long ago were it not for the occasional patient who keeps returning to the office with permanent central scotomas after ICG-assisted macular hole surgery. The purpose of this Viewpoint is to reemphasize potential methods of proper use and clarify safety issues of this particular vital dye that enhances surgical technique but not necessarily visual outcome.
Collapse
|
33
|
|
34
|
Georgalas I, Ezra E. Delayed closure after surgery for a full-thickness macular hole in a highly myopic eye. Can J Ophthalmol 2007. [DOI: 10.3129/can.j.ophthalmol.i07-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
35
|
INDOCYANINE GREEN–ASSISTED INTERNAL LIMITING MEMBRANE PEELING FOR MACULAR HOLES. Retina 2006. [DOI: 10.1097/01.iae.0000226602.34867.f9] [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]
|
36
|
Mavrofrides E, Smiddy WE, Kitchens JW, Salicone A, Feuer W. INDOCYANINE GREEN???ASSISTED INTERNAL LIMITING MEMBRANE PEELING FOR MACULAR HOLES. Retina 2006; 26:637-44. [PMID: 16829805 DOI: 10.1097/00006982-200607000-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Indocyanine green (ICG) staining facilitates definitive internal limiting membrane (ILM) peeling during macular hole surgery (MHS), but might cause toxicity. PURPOSE To determine if ICG to assist in ILM peeling has an effect on anatomic or visual results in MHS with ILM peeling. METHODS Retrospective, comparative review including primary analysis of 173 cases undergoing MHS. Visual acuity >or=20/50, <or=20/200, three-line visual acuity improvement, and anatomic success rates were analyzed as endpoints. RESULTS The single operation hole closure rate was 87% with ICG versus 83% without ICG (P = 0.52). Postoperative median best-corrected visual acuity was 20/70 and 20/80 in the ICG and no ICG groups with median follow-up intervals of 8 and 9 months. The use of ICG was associated with a higher rate of <or=20/200, but ILM peeling and ICG use was not associated with better anatomic success, visual improvement, or >or=20/50 visual acuity. CONCLUSIONS ICG usage during macular hole surgery was not associated with worse visual outcomes, suggesting possible toxic effects reported are not clinically significant. If the ILM cannot be peeled effectively, ICG should be considered a safe option.
Collapse
Affiliation(s)
- Elias Mavrofrides
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA
| | | | | | | | | |
Collapse
|
37
|
Kwok AKH, Lai TYY, Yip WWK. Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis. Br J Ophthalmol 2005; 89:1180-3. [PMID: 16113377 PMCID: PMC1772841 DOI: 10.1136/bjo.2005.069427] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the clinical and anatomical outcomes of pars plana vitrectomy and gas tamponade without internal limiting membrane (ILM) peeling in symptomatic patients caused by myopic foveoschisis. METHODS Nine eyes in eight highly myopic patients who had myopic foveoschisis with foveal detachment underwent vitrectomy without ILM peeling followed by gas tamponade. Main outcome measures include change in best corrected visual acuity (BCVA) and changes in height of the foveal detachment and resolution of the myopic foveoschisis measured by optical coherence tomography (OCT). RESULTS After surgery, BCVA improved in eight eyes with the median BCVA improved from 20/80 to 20/50 (p=0.012). The mean line of visual improvement was 3.6 lines. OCT showed complete resolution of myopic foveoschisis with complete foveal reattachment in seven (77.8%) eyes with partial resolution in two (22.2%) eyes. The mean height of foveal detachment decreased from 505 mum preoperatively to 21 mum postoperatively (p<0.001). CONCLUSIONS Vitrectomy without ILM peeling followed by gas tamponade appeared to result in favourable visual and anatomical outcomes for treating myopic foveoschisis in highly myopic eyes. The results are comparable with studies in which ILM removal was performed. Further controlled study will be useful to determine the role of ILM peeling in these patients.
Collapse
Affiliation(s)
- A K H Kwok
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, People's Republic of China
| | | | | |
Collapse
|
38
|
Jackson TL, Griffin L, Vote B, Hillenkamp J, Marshall J. An experimental method for testing novel retinal vital stains. Exp Eye Res 2005; 81:446-54. [PMID: 15923004 DOI: 10.1016/j.exer.2005.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 02/24/2005] [Accepted: 03/07/2005] [Indexed: 10/25/2022]
Abstract
There is uncertainty surrounding the safety of the vital stains currently used to assist macular surgery, and there may be other agents that are more suitable. This study aimed to validate a method of screening retinal vital stains for their potential surgical utility. Bovine retina was exposed to test agents at a range of concentrations. Masked observers determined the minimum dye concentration that reliably stained the retina, defined as the minimum visible concentration (MVC). Computer image analysis (CIE94 colour difference equation) was used to estimate the magnitude of the colour difference between stained and unstained retina. Agents that had favourable staining characteristics underwent safety testing using a retinal pigment epithelium and glial cell culture model. Cells were exposed to each agent and viability was assessed with a mitochondrial enzyme (MTT) assay, and fluorescent live-dead probe (ethidium homodimer-1/calcein-AM). Frozen sections were used to determine which retinal layers were stained. Techniques were tested on the following agents: alcian blue; diethyloxadicarbocyanine; Evan's blue; fast green; fluorescein; Janus green; methylene blue; naphthol green; neutral red; procian (reactive) yellow; rose bengal; and trypan blue. For most dyes, the results of image analysis showed that colour differences increased linearly with dye concentration, although some displayed a more exponential relationship. Five agents showed favourable staining characteristics: Evan's blue, rose bengal, naphthol green, neutral red, and trypan blue (MVC 0.02, 0.01, 0.1, 0.002, 0.01%, respectively). Safety testing of these five agents did not show toxicity, except in glial cells exposed to rose bengal. Relative to the negative control (saline), these showed a 48% reduction in viability using the MTT assay (p<0.001; t=4.71; CI 30-75%), and qualitative damage on fluorescence microscopy. Frozen sections showed that some agents produced diffuse staining of all retinal layers, others produced selective inner retinal staining. There are thousands of biological stains available and many of these may be more effective or safer than those currently used for retinal surgery. This study provides a means of screening potentially useful vital stains.
Collapse
Affiliation(s)
- Timothy L Jackson
- Academic Department of Ophthalmology, The Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
| | | | | | | | | |
Collapse
|
39
|
Rodrigues EB, Meyer CH, Farah ME, Kroll P. Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes. Ophthalmologica 2005; 219:251-62. [PMID: 16123549 DOI: 10.1159/000086107] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 12/09/2004] [Indexed: 02/03/2023]
Abstract
Surgical management of macular holes consists of pars plana vitrectomy, removal of the posterior hyaloid facia, and peeling of the epiretinal membranes (ERM). Additionally, removal of the internal limiting membrane (ILM) may enable an increase in the anatomic and functional success rates. However, recognition of fine ILM is difficult thus increasing the time that the macula is exposed to intraoperative light. Staining the ILM with indocyanine green (ICG) dye during vitrectomy facilitates recognition of the ILM and assures that all adjacent ERM are removed. Therefore, ICG-assisted ILM peeling has gained worldwide popularity among vitreoretinal surgeons. However, there are some concerns about the intravitreal ICG application. Reports in the literature described a variety of application techniques using different concentrations. The postoperative outcomes were controversial reporting heterogeneous anatomical and functional outcomes after ICG application, as well as descriptions of adverse effects related to the dye. We discuss the indications, techniques, surgical results, and complications after intravitreal ICG injection for the treatment of macular holes.
Collapse
|
40
|
Kwok AK, Lai TY, Yuen KS. Epiretinal membrane surgery with or without internal limiting membrane peeling. Clin Exp Ophthalmol 2005; 33:379-85. [PMID: 16033350 DOI: 10.1111/j.1442-9071.2005.01015.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of the present paper was to evaluate the visual outcome and recurrence rate of epiretinal membrane (ERM) formation following vitreoretinal surgery with and without internal limiting membrane (ILM) peel. METHODS The medical records of 42 consecutive patients who underwent surgery for macular ERM by a single surgeon were reviewed. All patients underwent pars plana vitrectomy and ERM removal with a subset undergoing ILM peel. Recurrence of macular ERM within 18 months and the final visual outcome after surgery were compared between patients with and without ILM removal. RESULTS Twenty-five patients (59.5%) underwent ERM surgery with ILM peeling and 17 patients (40.5%) underwent ERM surgery without ILM peeling. The mean preoperative logMAR visual acuity was 0.77 and 0.96 for the ILM peeling and non-ILM peeling groups, respectively. Visual acuity improved significantly in both the ILM and non-ILM peeling groups after ERM surgery (P < 0.001 and P = 0.003, respectively). Eighteen months after surgery, 3/17 eyes without ILM peeling (17.6%) developed recurrent macular ERM, compared with none of the 25 eyes with ILM peeling (log-rank test, P = 0.030). CONCLUSIONS Internal limiting membrane removal during macular ERM surgery may minimize the recurrence of ERM, without adverse visual outcome. Further controlled prospective studies are needed to determine the role of ILM peeling in ERM surgery.
Collapse
Affiliation(s)
- Alvin Kh Kwok
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | | | | |
Collapse
|
41
|
Da Mata AP, Riemann CD, Nehemy MB, Foster RE, Petersen MR, Burk SE. Indocyanine Green–Assisted Internal Limiting Membrane Peeling for Macular Holes To Stain or Not To Stain? Retina 2005; 25:395-404. [PMID: 15933584 DOI: 10.1097/00006982-200506000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
42
|
Kwok AKH, Lai TYY, Li WWY, Yew DTW, Wong VWY. Trypan blue- and indocyanine green-assisted epiretinal membrane surgery: clinical and histopathological studies. Eye (Lond) 2004; 18:882-8. [PMID: 15002012 DOI: 10.1038/sj.eye.6701359] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the clinical outcome and electron microscopic findings of trypan blue (Tb) and indocyanine green (ICG) assisted epiretinal membrane (ERM) surgery. METHODS This is a prospective consecutive noncomparative interventional case series. After pars plana vitrectomy, 0.1 ml of 0.6 mg/ml Tb solution was applied for 1 min under air for ERM staining. After ERM removal, internal limiting membrane (ILM) was further peeled after staining with 0.2 ml of 1 mg/ml ICG solution. Intraoperative specimens were sent for electron microscopy. Tb was considered useful if the edge of ERM was stained where peeling could be initiated with a clearer visualisation of the overall extent of the ERM. RESULTS In all, 16 eyes from 16 patients were recruited. There were nine grade 1 ERMs, five grade 2 ERMs, and two grade 3 ERMs. Tb was useful in six (67%) of the nine eyes with grade 1 ERMs and in all eyes with grade 2 or 3 ERMs. The three remaining grade 1 ERMs were removed together with surrounding ILM that was stained by ICG. The mean line of improvement was 1.3 lines with the median BCVA improved from 6/12 to 6/9. All 16 eyes had symptomatic improvement and none developed ERM recurrence. No complication related to Tb or ICG was observed clinically or angiographically. Electron microscopy of the Tb-stained ERM specimens showed fragments of ILM in all specimens. CONCLUSIONS Tb and ICG are useful intraoperatively to improve the visualisation and facilitate complete removal of ERM and ILM in macular ERM surgery.
Collapse
Affiliation(s)
- A K H Kwok
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, People's Republic of China.
| | | | | | | | | |
Collapse
|
43
|
Da Mata AP, Burk SE, Foster RE, Riemann CD, Petersen MR, Nehemy MÁB, Augsburger JJ. Long-term follow-up of indocyanine green–assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair. Ophthalmology 2004; 111:2246-53. [PMID: 15582081 DOI: 10.1016/j.ophtha.2004.05.037] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 05/01/2004] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine the long-term efficacy of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. DESIGN Retrospective, interventional, noncomparative case series. PARTICIPANTS One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003. INTERVENTION All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. MAIN OUTCOME MEASURES Long-term postoperative anatomic results, visual acuity (VA), and complications. RESULTS Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by > or =2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0-14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. CONCLUSIONS Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.
Collapse
|
44
|
Jaycock PD, Bunce C, Xing W, Thomas D, Poon W, Gazzard G, Williamson TH, Laidlaw DAH. Outcomes of macular hole surgery: implications for surgical management and clinical governance. Eye (Lond) 2004; 19:879-84. [PMID: 15389276 DOI: 10.1038/sj.eye.6701679] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The optimal method and timing of the surgical treatment for idiopathic macular holes remains unknown. The aim of this retrospective study was to identify factors associated with anatomical and visual success in macular hole surgery. METHODS Case records of 55 patients undergoing macular hole surgery at three units in the 2-year period up to July 2002 were reviewed to identify factors associated with anatomical and visual success. The following potential prognosticators were evaluated: patient age, hole stage, hole latency prior to surgery, preoperative acuity, simultaneous phacoemulsification, and intraocular lens implantation, internal limiting membrane peeling with and/or without indocyanine green, and postoperative posturing. RESULTS The duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperative visual acuity of 6/12 or better. DISCUSSION The closure rate in patients undergoing surgery within 1 year of onset was 94.0%, and in those waiting 1 year or more it was 47.4%. Clinical governance and quality issues should dictate that NHS macular hole surgery is available to all within 1 year of onset. This study showed no adverse effect of ICG dye retinal staining. The results support the use of a 'patient-friendly' approach of simultaneous cataract surgery with no prone postoperative posturing.
Collapse
Affiliation(s)
- P D Jaycock
- Department of Ophthalmology, St Thomas' Hospital, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Kwok AKH, Lai TYY, Li WWY, Woo DCF, Chan NR. Indocyanine green-assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study. Am J Ophthalmol 2004; 138:194-9. [PMID: 15289126 DOI: 10.1016/j.ajo.2004.03.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the clinical outcome and quantify histologically the amount of microscopic internal limiting membrane (ILM) and epiretinal membrane (ERM) present in ILM and ERM specimens obtained from ERM surgery. DESIGN Interventional consecutive case series. METHODS Patients scheduled for ERM surgery were recruited prospectively. Pars plana vitrectomy, removal of ERM, and ILM peeling with indocyanine green (ICG) staining were performed in all patients. Epiretinal membrane and ILM specimens were sent for histologic examination. The amount of ERM present in ILM specimens and the amount of ILM present in ERM specimens were quantified by manual counting. Outcome measures include change in best-corrected visual acuity (BCVA), proportion of cases with 2 or more lines of visual improvement, anatomic outcome, proportions of microscopic ERM within ILM, and microscopic ILM within ERM. RESULTS Eighteen eyes in 18 patients were operated with a mean follow-up of 19.3 months. There were 13 primary ERMs and five secondary ERMs. The mean logMAR BCVA improved from 0.83 preoperatively to 0.49 postoperatively (P <.001). The mean lines of improvement in BCVA was 3.3 lines with 14 patients (77.8%) who had 2 or more lines of BCVA improvement. Histologic evaluation of the specimens showed no significant correlation with the final BCVA of 20/50 or better. Eleven (61.1%) of the ILM specimens showed various amount of microscopic ERM and 16 (88.9%) of the ERM specimens showed various amount of ILM fragments. The mean proportion of ERM within ILM specimens was 4.69% and that of ILM within ERM specimens was 51.5%. No significant recurrence of ERM was found. CONCLUSION Recurrence of ERM may be minimized by removing residual microscopic ERM present on the ILM. Indocyanine green-assisted ILM peeling in ERM surgery appears to have favorable visual and anatomic outcomes.
Collapse
Affiliation(s)
- Alvin K H Kwok
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.
| | | | | | | | | |
Collapse
|
46
|
Lai TY, Kwok AK. Internal limiting membrane staining with various concentrations of indocyanine green dye under air in macular surgeries: Author Reply. Am J Ophthalmol 2004. [DOI: 10.1016/j.ajo.2003.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|