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Gelormini F, D'antico S, Ricardi F, Parisi G, Borrelli E, Marolo P, Conte F, Salafia M, Reibaldi M. Platelet concentrates in macular hole surgery. A journey through the labyrinth of terminology, preparation, and application: a comprehensive review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2365-2388. [PMID: 38270630 PMCID: PMC11271331 DOI: 10.1007/s00417-023-06365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
The surgical management of macular holes is undergoing continuous evolution, with recent focus on the utilization of platelet concentrates as a promising adjunctive intervention. Currently, they present a valid surgical approach for achieving anatomical and functional success with a non-inferiority comparably to the alternative surgical techniques. Nonetheless, the utilization of varied platelet concentrates terminologies, coupled with the lack of standardization in their preparation methodologies, engenders both lexical confusion and challenges in comparing scientific studies published up until now. In this review, we summarized the published evidence concerning the application of platelet concentrates in macular holes surgery, aiming to clarify the terminology and methodologies employed and to establish a common consensus facilitating further development and diffusion of this promising technique.
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Affiliation(s)
- Francesco Gelormini
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Sergio D'antico
- Blood Bank, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Federico Ricardi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy.
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Fabio Conte
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Marika Salafia
- Blood Bank, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
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Lai TT, Hsia Y, Yang CM. Lamellar macular hole in highly myopic eyes and insights into its development, evolution, and treatment: a mini-review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2713-2724. [PMID: 38407591 DOI: 10.1007/s00417-024-06419-8] [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: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024] Open
Abstract
Lamellar macular holes (LMHs) are a manifestation of myopic tractional maculopathy (MTM). Owing to the complex and multidirectional traction force in the elongated eyeball, the clinical features, development, evolution, and treatment algorithms of LMH in highly myopic eyes may differ from those of idiopathic LMH or MTM in general. This review aimed to specifically explore the LMHs in highly myopic eyes. Several developmental processes of LMH and their association with macular retinoschisis have been demonstrated, with the tractional component identified in all processes. Epiretinal proliferation was more prevalent and more extensive in LMHs in highly myopic eyes than in idiopathic LMHs. LMHs in highly myopic eyes may remain stable or progress to foveal detachment and full-thickness macular hole with or without retinal detachment. The predictive factors associated with disease progression were summarized to facilitate monitoring and guide surgical intervention. The treatment of LMHs in highly myopic eyes was based on an algorithm for treating myopic tractional maculopathy, including gas tamponade, pars plana vitrectomy, macular buckling, and a combination of vitrectomy and macular buckling. New internal limiting membrane (ILM) manipulation techniques such as fovea-sparing ILM peeling or fovea-sparing ILM peeling combined with ILM flap insertion could reduce the risk of developing iatrogenic full-thickness macular holes postoperatively. Further research should focus on the treatment of LMH in highly myopic eyes.
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Affiliation(s)
- Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei City, Taiwan
| | - Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei City, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei City, Taiwan.
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Tang Z, Wang X, Ran AR, Yang D, Ling A, Yam JC, Zhang X, Szeto SKH, Chan J, Wong CYK, Hui VWK, Chan CKM, Wong TY, Cheng CY, Sabanayagam C, Tham YC, Liew G, Anantharaman G, Raman R, Cai Y, Che H, Luo L, Liu Q, Wong YL, Ngai AKY, Yuen VL, Kei N, Lai TYY, Chen H, Tham CC, Heng PA, Cheung CY. Deep learning-based image quality assessment for optical coherence tomography macular scans: a multicentre study. Br J Ophthalmol 2024:bjo-2023-323871. [PMID: 39033014 DOI: 10.1136/bjo-2023-323871] [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: 05/04/2023] [Accepted: 11/05/2023] [Indexed: 07/23/2024]
Abstract
AIMS To develop and externally test deep learning (DL) models for assessing the image quality of three-dimensional (3D) macular scans from Cirrus and Spectralis optical coherence tomography devices. METHODS We retrospectively collected two data sets including 2277 Cirrus 3D scans and 1557 Spectralis 3D scans, respectively, for training (70%), fine-tuning (10%) and internal validation (20%) from electronic medical and research records at The Chinese University of Hong Kong Eye Centre and the Hong Kong Eye Hospital. Scans with various eye diseases (eg, diabetic macular oedema, age-related macular degeneration, polypoidal choroidal vasculopathy and pathological myopia), and scans of normal eyes from adults and children were included. Two graders labelled each 3D scan as gradable or ungradable, according to standardised criteria. We used a 3D version of the residual network (ResNet)-18 for Cirrus 3D scans and a multiple-instance learning pipline with ResNet-18 for Spectralis 3D scans. Two deep learning (DL) models were further tested via three unseen Cirrus data sets from Singapore and five unseen Spectralis data sets from India, Australia and Hong Kong, respectively. RESULTS In the internal validation, the models achieved the area under curves (AUCs) of 0.930 (0.885-0.976) and 0.906 (0.863-0.948) for assessing the Cirrus 3D scans and Spectralis 3D scans, respectively. In the external testing, the models showed robust performance with AUCs ranging from 0.832 (0.730-0.934) to 0.930 (0.906-0.953) and 0.891 (0.836-0.945) to 0.962 (0.918-1.000), respectively. CONCLUSIONS Our models could be used for filtering out ungradable 3D scans and further incorporated with a disease-detection DL model, allowing a fully automated eye disease detection workflow.
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Affiliation(s)
- Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xi Wang
- Zhejiang Lab, Hangzhou, Zhejiang, China
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anni Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Xiujuan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Cherie Y K Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Vivian W K Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Centre for Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Centre for Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Liew
- Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Yu Cai
- Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Luyang Luo
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Quande Liu
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yiu Lun Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Amanda K Y Ngai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nelson Kei
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Medical Intelligence and XR, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Polat Gültekin B, Kalaycı D. Evaluation of Optical Coherence Tomography Angiography in Degenerative and Tractional Lamellar Macular Hole. J Ophthalmol 2024; 2024:4146294. [PMID: 39070303 PMCID: PMC11281851 DOI: 10.1155/2024/4146294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/11/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024] Open
Abstract
Background This study aims to evaluate the optical coherence tomography angiography (OCTA) findings in cases with degenerative and tractional lamellar macular holes (LMH). Methods Two subtypes of LMH cases were included. Seventeen patients had the degenerative subtype, whereas 18 patients had the tractional subtype of LMH. Twenty healthy individuals were enrolled as the control group. The foveal avascular zone (FAZ) and retinal vascular densities in the superficial, deep capillary, and choriocapillary plexuses were analyzed and compared with fellow eyes and healthy controls using OCTA. Results The mean FAZ area was wider in the degenerative subtype (0.33 ± 0.14 mm2) compared to the tractional subtype (0.24 ± 0.10 mm2) (p=0.04) and control eyes (0.26 ± 0.10 mm2) (p=0.03). Foveal vessel densities in the superficial and deep capillary plexuses were lower in the degenerative group than in the tractional group, (21.7 ± 9.8% vs. 26.8 ± 6.9%, p=0.01 and 28.5 ± 5.1% vs. 36.9 ± 6.2%, p=0.01). Choriocapillary vascular density in the parafoveal area was also lower in degenerative lamellar macular holes compared to the tractional group (60.4 ± 4.7% vs. 63.7 ± 3.9%, p=0.03). Compared to control eyes, eyes with degenerative and tractional LMH showed lower vessel densities in the parafoveal and perifoveal areas of the SCP, DCP, and all layers of CC (p < 0.05). In the foveal area, the LMH groups showed higher foveal vascular density (FVD) in the SCP than control eyes, while in the DCP, FVD was lower in the degenerative LMH eyes relative to the other groups. Conclusion The finding of microvascular changes between degenerative and tractional LMH subtypes highlights their distinct pathologies and supports recent changes in the classification and terminology of this macular condition.
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Affiliation(s)
| | - Defne Kalaycı
- Bilkent City HospitalDepartment of Ophthalmology, Ankara, Türkiye
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5
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Lippera M, Moussa G, Ivanova T, Ferrara M, Spiess K, Ally N, Jasani K, Dhawahir-Scala F, Patton N, Jalil A. Volumetric Biomarkers of Visual Outcome after Surgical Repair in Lamellar Macular Holes. J Pers Med 2024; 14:755. [PMID: 39064009 PMCID: PMC11278409 DOI: 10.3390/jpm14070755] [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: 06/21/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND We investigate novel OCT parameters, based on the volumetric analysis of lamellar macular holes (LMHs), as prognostic indicators for visual outcomes after surgery. METHODS LMHs were divided into degenerative LMHs (D-LMHs) and ERM-foveoschisis (ERM-FS). Pre-operative clinical, OCT linear and volumetric parameters were collected. Volumes were obtained using the OCT automatic segmentation, such as central retinal volume (CRV) and outer nuclear layer (ONL) volume, or using a novel method to calculate volumes of specific LMH entities like epiretinal proliferation (ERP), foveal cavity (FC) in D-LMH and schitic volume (SV) in ERM-FS. Univariate and multivariate linear regression analysis evaluated the factors predictive for post-operative best-corrected visual acuity (BCVA). RESULTS We included 31 eyes of 31 patients (14 D-LMH,17 ERM-FS). A pre-operative BCVA ≤ 0.48 logMAR was a predictor for achieving ≤0.30 logMAR at final follow-up. A lower pre-operative BCVA (p = 0.008) and the presence of ERP (p = 0.002) were associated with worse visual outcomes post-surgery. Moreover, novel pre-operative OCT parameters significantly associated with worse post-operative BCVA, such as increased FC volume (p = 0.032) and lower CRV (p = 0.034) in the D-LMH subtype and lower CRV (p < 0.001) and ERP volume (p < 0.001), higher SV (p < 0.001) and foveal ONL volume (p < 0.001) in the ERM-FS subtype. CONCLUSIONS Novel volumetric OCT parameters can be prognostic indicators of visual outcome following surgery in LMHs.
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Affiliation(s)
- Myrta Lippera
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - George Moussa
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Mariantonia Ferrara
- School of Medicine, University of Malaga, 29071 Malaga, Spain
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 25123 Brescia, Italy
| | - Karina Spiess
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Naseer Ally
- Division of Ophthalmology, Department of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Kirti Jasani
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Felipe Dhawahir-Scala
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK (K.S.); (K.J.)
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6
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Holzwarth J, Krohne TU, Lommatzsch A, Priglinger SG, Hattenbach LO. [Epiretinal membrane: diagnostics, indications and surgical treatment]. DIE OPHTHALMOLOGIE 2024; 121:443-451. [PMID: 38831204 DOI: 10.1007/s00347-024-02055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024]
Abstract
An epiretinal membrane (ERM) is a frequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. A distinction is made between an idiopathic form caused by age-related changes of the vitreous body and a secondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays a major role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or a reduction of metamorphopsia can be achieved, with a number of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.
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Affiliation(s)
- Jakob Holzwarth
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland
| | - Tim U Krohne
- Augenzentrum, St. Franziskus Hospital, Münster, Deutschland
| | - Albrecht Lommatzsch
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | | | - Lars-Olof Hattenbach
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland.
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7
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Klaas JE, Lommatzsch A, Krohne TU, Hattenbach LO, Priglinger S. [Lamellar macular holes-In the center of vitreomacular interface diseases : Pathophysiology, spontaneous courses and treatment concepts]. DIE OPHTHALMOLOGIE 2024; 121:452-461. [PMID: 38842556 DOI: 10.1007/s00347-024-02054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. PURPOSE Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. METHODS Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. RESULTS The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. CONCLUSION The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.
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Affiliation(s)
- Julian E Klaas
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | | | - Tim U Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Deutschland
| | - Lars-Olof Hattenbach
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
| | - Siegfried Priglinger
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
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Abousy M, Drew-Bear LE, Gibbons A, Pan-Doh N, Li X, Handa JT. In-Depth Analysis of Preoperative OCT Markers as Prognostic Factors for Lamellar Macular Holes and Epiretinal Membrane Foveoschisis. Ophthalmol Retina 2024; 8:465-472. [PMID: 37972892 PMCID: PMC11070309 DOI: 10.1016/j.oret.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To identify preoperative OCT markers that correlate with postoperative visual acuity (VA) changes in eyes with lamellar macular hole (LMH) and epiretinal membrane foveoschisis (ERMF) after pars plana vitrectomy (PPV). DESIGN Cross-sectional retrospective study. SUBJECTS Patients seen at the Wilmer Eye Institute between 2011 and 2021 with an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for "macular hole" that underwent PPV, and demonstrated all OCT criteria present for either LMH or ERMF based on the Hubschman et al (2020) classification. METHODS OCT markers including hole dimensions, retinal layer continuity, and ellipsoid zone (EZ) convexity and pixelated intensity were quantified. Visual acuity immediately before PPV and at the last follow-up date available were both recorded. MAIN OUTCOME MEASURES Preoperative OCT variables that are correlated with postoperative changes in VA. RESULTS Forty-two eyes from 42 patients with LMH (n = 11) and ERMF (n = 31) that underwent PPV were identified. Visual acuity in the ERMF cohort significantly improved at last follow-up compared with preoperative VA (P < 0.001), whereas VA in the LMH cohort did not (P = 0.14). In the LMH cohort, retinal layer continuity at the hole edge was positively correlated with change in VA at final follow-up, whereas hole height was negatively correlated with VA. In the ERMF cohort, preoperative VA was negatively correlated with change in VA at final follow-up. CONCLUSIONS Retinal layer continuity at the hole and hole height are novel preoperative markers that predict postoperative VA change in LMH. After identifying the type of macular lesion, surgeons should consider using these preoperative OCT markers when counseling patients on potential postoperative VA outcomes and when managing patient expectations. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mya Abousy
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura E Drew-Bear
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Missouri-Kansas City Department of Ophthalmology, Kansas City, Missouri
| | - Alison Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Pan-Doh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ximin Li
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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9
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Englmaier VA, Storp JJ, Dierse S, Eter N, Al-Nawaiseh S. Idiopathic Epiretinal Membranes - Pathophysiology, Classifications and OCT-Biomarkers. Klin Monbl Augenheilkd 2024; 241:666-674. [PMID: 36849107 DOI: 10.1055/a-2043-4662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Epiretinal membranes (ERMs) are a common finding in patients with increasing age. Diagnosis and treatment of ERMs have changed dramatically in recent years due to technological advances in ophthalmological care. In recent years, tomographic imaging has allowed for accurate visualization of ERMs and contributed to the growing understanding of the pathophysiology of this condition. The literature review conducted here summarizes recent innovations in diagnosis, classification, and treatment of idiopathic ERMs and specifically addresses novel optical coherence tomography (OCT) biomarkers that allow for the generation of prognoses regarding the clinical postoperative outcome.
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Affiliation(s)
| | - Jens Julian Storp
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Sebastian Dierse
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Sami Al-Nawaiseh
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
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10
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Choi J, Kim SJ, Kang SW, Hwang S, Son KY. Outcomes of epiretinal proliferation embedding technique in the surgery for full-thickness macular hole. Sci Rep 2024; 14:8170. [PMID: 38589441 PMCID: PMC11001908 DOI: 10.1038/s41598-024-58449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea
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11
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Mohammed TK, Thompson JT. Outcomes of Pars Plana Vitrectomy With Membrane Peel for Lamellar Macular Holes and Related Conditions Using a New Optical Coherence Tomography Consensus Definition. JOURNAL OF VITREORETINAL DISEASES 2024; 8:125-130. [PMID: 38465354 PMCID: PMC10924591 DOI: 10.1177/24741264231218054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To characterize the change in visual acuity (VA) in eyes treated with vitrectomy using the 2020 international consensus-based optical coherence tomography (OCT) definition of lamellar macular hole (LMH), macular pseudohole (MPH), and epiretinal membrane with foveoschisis (ERMF). Methods: A retrospective chart review was performed from 2000 to 2022 of patients who had vitrectomy for symptomatic decreased VA from LMH, MPH, or ERMF performed by the same surgeon at a community hospital. Preoperative spectral domain (SD-OCT) was reviewed to classify patients using the consensus guidelines. Primary outcomes were the mean change in best-corrected VA at 3 months, 1 year, and the final postoperative examination. Results: Fifty-one patients were included, 30 with LMH, 14 with MPH, and 7 with ERMF. The VA was 20/63 at baseline, 20/62 (P = .79) 3 months postoperatively, 20/40 (P = .003) at 1 year, and 20/52 (P = .10) at the final examination for LMH; 20/64, 20/50 (P = .16), 20/40 (P = .040), and 20/40 (P = .02), respectively, for MPH; and 20/53, 20/50 (P = .42), 20/30 (P = .03), and 20/38 (P = .04), respectively, for ERMF. Subgroup analysis showed that eyes with LMH without ellipsoid zone (EZ) disruption on SD-OCT improved from 20/57 at baseline to 20/39 (P = .01) at the final examination. Conclusions: There was no significant improvement in VA at the final postvitrectomy examination in eyes with LMH, while there was significant improvement in eyes with MPH and ERMF. This supports surgery in selected eyes with MPH and ERMF but possibly not in eyes with LMH, unless OCT shows no EZ disruption.
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Affiliation(s)
- Taariq K. Mohammed
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John T. Thompson
- Retina Specialists, Greater Baltimore Medical Center, Baltimore, MD, USA
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12
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Pandya BU, Grinton M, Mandelcorn ED, Felfeli T. RETINAL OPTICAL COHERENCE TOMOGRAPHY IMAGING BIOMARKERS: A Review of the Literature. Retina 2024; 44:369-380. [PMID: 37903455 PMCID: PMC10885864 DOI: 10.1097/iae.0000000000003974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE The aim of this literature review was to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically. METHODS The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features. RESULTS Thirty-seven OCT terminologies were identified. The vitreomacular interface disorder group included the four stages of epiretinal membrane, macular pseudohole, tractional lamellar hole (LH), degenerative LH, cotton ball sign, and foveal crack sign. The age-related macular degeneration group included outer retinal tubulation, multilayered pigment epithelial detachment, prechoroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete retinal pigment epithelium and outer retinal atrophy, and reticular pseudodrusen. The uveitic disorder group consisted of bacillary layer detachment, syphilis placoid, rain-cloud sign, and pitchfork sign. The disorders relating to the toxicity group included flying saucer sign and mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy. The disorders associated with the systemic condition group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorder group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, inner nuclear layer microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω). CONCLUSIONS Thirty-seven OCT terminologies were summarized, and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential because of their predictive and prognostic value.
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Affiliation(s)
- Bhadra U. Pandya
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Grinton
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
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13
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Chehaibou I, Tadayoni R, Hubschman JP, Bottoni F, Caputo G, Chang S, Dell'Omo R, Figueroa MS, Gaudric A, Haritoglou C, Kadonosono K, Leisser C, Maier M, Priglinger S, Rizzo S, Schumann RG, Sebag J, Stamenkovic M, Veckeneer M, Steel DH. Natural History and Surgical Outcomes of Lamellar Macular Holes. Ophthalmol Retina 2024; 8:210-222. [PMID: 37743020 DOI: 10.1016/j.oret.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To assess the natural history and surgical outcomes of lamellar macular holes (LMHs). DESIGN Retrospective and consecutive case series. SUBJECTS Patients with LMHs from multiple tertiary care centers. METHODS Clinical charts and OCT scans were reviewed. MAIN OUTCOME MEASURES The visual acuity (VA) changes and the occurrence rate of full-thickness macular hole (FTMH) were studied in both groups. Within the operated group, factors associated with 6-month VA and development of FTMH were explored. RESULTS One hundred seventy-eight eyes were included, of which 89 were monitored and 89 underwent surgery. In the observation group, the mean VA decreased from 0.25 ± 0.18 to 0.28 ± 0.18 logarithm of the minimum angle of resolution (logMAR; P = 0.13), with 14 eyes (15.7%) that lost ≥ 0.2 logMAR VA, after 45.7 ± 33.3 months. Nine eyes (10.1%) spontaneously developed an FTMH. In the operated group, the mean VA increased from 0.47 ± 0.23 to 0.35 ± 0.25 logMAR at 6 months (P < 0.001) and 0.36 ± 0.28 logMAR (P = 0.001) after 24.1 ± 30.1 months. By multivariate analysis, better baseline VA (P < 0.001), the presence of an epiretinal membrane (P = 0.03), and the peeling of the internal limiting membrane (ILM; P = 0.02), with a greater effect of ILM perihole sparing, were associated with a greater 6-month VA. Perihole epiretinal proliferation sparing was associated with a better postoperative VA by univariate analysis (P = 0.03), but this was not significant by multivariate analysis. Eight eyes (9.0%) developed a postoperative FTMH. Using Cox proportional hazard ratios [HRs], pseudophakia at baseline (HR, 0.06; 95% confidence interval [CI], 0.00-0.75; P = 0.03) and peeling of the ILM (HR, 0.05; 95% CI, 0.01-0.39; P = 0.004) were protective factors, while ellipsoid zone disruption (HR, 10.5; 95% CI, 1.04-105; P = 0.05) was associated with an increased risk of FTMH. CONCLUSION Observed eyes with LMH experienced, on average, progressive VA loss. Patients with LMH and altered vision may benefit from surgery. Internal limiting membrane peeling, with perihole ILM sparing, represents a crucial step of the surgery associated with a greater VA and a lower risk of postoperative FTMH. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Ismael Chehaibou
- Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France; Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jean-Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Ferdinando Bottoni
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Georges Caputo
- Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Stanley Chang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Roberto Dell'Omo
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Marta S Figueroa
- Clinica Baviera, Department of Ophthalmology, Ramon y Cajal University Hospital, University of Alcala de Henares, Madrid, Spain
| | - Alain Gaudric
- Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology and micro-technology, Yokohama City University Medical School, Yokohama, Japan
| | - Christoph Leisser
- VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Vienna, Austria
| | - Mathias Maier
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Munich, Germany
| | | | - Stanislao Rizzo
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy; Istituto di Neuroscienze, Consiglio Nazionale della Ricerca, Pisa, Italy
| | - Ricarda G Schumann
- Eye and Vascular Medicine Center, Ludwig-Maximilians-University, Munich, Germany
| | - Jerry Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California; Doheny Eye Institute, UCLA, Pasadena, California; Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | | | - Marc Veckeneer
- Department of Ophthalmology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - David H Steel
- Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom; Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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14
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Kanzaki Y, Matoba R, Ishihara K, Morita T, Muraoka Y, Kimura S, Koto T, Kawasaki R, Baba T, Okamoto F, Inoue M, Sakamoto T, Tsujikawa A, Morizane Y. Japan-epiretinal membrane (J-ERM) registry: A prospective cohort study protocol investigating the surgical outcome of epiretinal membrane. PLoS One 2024; 19:e0297347. [PMID: 38329968 PMCID: PMC10852224 DOI: 10.1371/journal.pone.0297347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Epiretinal membrane (ERM) causes visual impairment such as reduction in visual acuity and metamorphopsia due to retinal traction. With the improvement of optical coherence tomography (OCT) and microincision vitrectomy surgery (MIVS), the surgery of ERM has significantly advanced. However, there have been no large-scale studies on the following: (1) how to evaluate visual impairment in ERM, (2) the relationship between OCT findings and visual function, (3) when is the optimal timing of surgery, and (4) the relationship between the surgical instruments as well as techniques and prognosis. The purpose of this study was to obtain evidence regarding these ERM surgeries. METHODS AND DESIGN This is a prospective, multicenter cohort study of ERM surgery in Japan from March 1, 2023, to March 31, 2027 (UMIN000048472, R-3468-2). Patients who underwent ERM surgery during the study period and agreed to participate in this study will be included. The goal is to have a total of 5,000 eyes surgically treated for ERM. The following data will be collected: age, gender, medical history, subjective symptoms, visual function before and 6 and 12 months after surgery, clinical findings, OCT data, surgical technique, instruments used in surgery, and complications. DISCUSSION The results of this study will support the surgical decisions and procedures in ERM practices.
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Affiliation(s)
- Yuki Kanzaki
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Ryo Matoba
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Tetsuro Morita
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Takashi Koto
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Makoto Inoue
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Kagoshima, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
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15
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Catania F, Romano MR, Crincoli E, Allegrini D, Miere A, Chehaibou I, Abdelmassih Y, Beaumont W, Chapron T, Souied EH, Caputo G. Phenomenology of spontaneous closure in degenerative and mixed type lamellar macular hole. Eye (Lond) 2024; 38:315-320. [PMID: 37524832 PMCID: PMC10810871 DOI: 10.1038/s41433-023-02681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE To the describe OCT imaging characteristics of a cohort of patients showing spontaneously closing degenerative or mixed type lamellar macular holes (LMH) and to compare them to the ones of a sex and age matched group showing stable lesions. METHODS Patients diagnosed with degenerative and mixed type LMHs showing OCT-documented spontaneous anatomical closure were retrospectively selected from 3 specialized retina centres. An equal number of age and sex matching subjects were randomly selected among patients with anatomically stable lesions. RESULTS Eleven (11) spontaneously closing (SC group) and 11 stable (ST group) degenerative LMH with a mean follow up of 4 years were recruited. Hyperreflective inner border (HIB) and linear hyperreflectivity in the outer plexiform layer (LHOP) at baseline were significantly more prevalent in SC group in processed images (respectively p = 0.007 and p = 0.003). A borderline significance in lamellar hole associated epiretinal proliferation (LHEP) at last follow up was detected (p = 0.085). As for mixed type LMH, 10 patients for SC group and 10 for ST group were recruited. LHOP at baseline in processed images was significantly more prevalent in SC group (p = 0.005). CONCLUSIONS Spontaneously closing LMHs show higher prevalence of HIB and LHOP at the beginning of the closing process, a difference which is enhanced by image processing. These signs might be a signal of microglial and Muller cells coordinated activation.
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Affiliation(s)
- Fiammetta Catania
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
| | - Mario R Romano
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Department of Ophthalmology, Humanitas Gavazzeni - Castelli, Via Giuseppe Mazzini 11, 24128, Bergamo, Italy
| | - Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France.
| | - Davide Allegrini
- Department of Ophthalmology, Humanitas Gavazzeni - Castelli, Via Giuseppe Mazzini 11, 24128, Bergamo, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France
| | - Ismael Chehaibou
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Youssef Abdelmassih
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - William Beaumont
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Thibaut Chapron
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France
| | - Georges Caputo
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
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16
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [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: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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17
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Garg A, Wahab C, Yan P. Surgical Management of Full-Thickness Macular Holes Spontaneously Arising From Lamellar Macular Holes. JOURNAL OF VITREORETINAL DISEASES 2024; 8:29-33. [PMID: 38223778 PMCID: PMC10786080 DOI: 10.1177/24741264231208493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Introduction: To review the literature regarding surgical management of full-thickness macular holes (FTMHs) spontaneously arising from lamellar MHs (LMHs). Methods: The literature on surgically managed FTMHs arising from LMHs was reviewed via Ovid MEDLINE and Embase through June 5, 2022. Results: Seventy-six eyes from 16 articles were included. Forty eyes had internal limiting membrane (ILM) peeling, 32 inverted ILM flap techniques, and 4 an unclear surgical technique. The FTMH closure rate was not significantly different between ILM peeling (34/40 [85%]) and the inverted ILM flap techniques (28/32 [88%]) (P = .761). The mean (±SD) logMAR visual acuity improved from 0.64 ± 0.46 to 0.25 ± 0.22 (Snellen 20/87 to 20/36) with ILM peeling (n = 30); similar data were not available for inverted ILM flap techniques. Conclusions: Foveal tissue loss, flat hole edges, and limited retinal hydration may result in inverted ILM flap techniques having outcomes similar to those of ILM peeling in repairing FTMHs from LMHs. Future studies are needed to compare techniques.
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Affiliation(s)
- Anubhav Garg
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada
| | - Charbel Wahab
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
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18
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Fukushima M, Hayashi A, Kusaka S, Kamei M, Tsuboi K. Use of a Backflush Needle with a Silicone Tip Cannula to Embed Lamellar Hole-Associated Epiretinal Proliferation. Retina 2023; 43:2204-2207. [PMID: 37490924 PMCID: PMC10659254 DOI: 10.1097/iae.0000000000003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE For the treatment of lamellar macular hole, the recent development of a lamellar hole-associated epiretinal proliferation (LHEP) embedding technique is likely to improve functional and anatomical results. However, the peeling of LHEP is often technically challenging. We have developed a new technique using a backflush needle with a silicone tip cannula that seems safer and more effective for use in LHEP embedding. METHODS A 25-gauge vitrectomy system with an enhancing visual acuity system (D.O.R.C., Zuidland, Netherlands) was used in all cases. After core vitrectomy, triamcinolone acetonide (Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) was used to visualize the membrane. A 25-gauge backflush needle with a silicone tip cannula was used to remove the thin preretinal membrane centripetally, leaving an LHEP on the edge of the hole. Brilliant Blue G (internal limiting membrane Blue; D.O.R.C.) was then used to stain the internal limiting membrane. RESULTS This technique was used in six eyes with lamellar macular holes. In all cases, peeling and embedding of the LHEP was effectively performed without damaging the internal limiting membrane or causing retinal hemorrhage. No other intraoperative or postoperative complications were experienced. CONCLUSION Using a silicone-tipped backflush needle with passive aspiration was a simple and effective technique for peeling and embedding of LHEPs in this small series.
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19
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Berco E, Arnon R, Kozlov Y, Shad JL, Shoham-Hazon N, Tuli R, Hilely A. Internal limiting membrane flap with viscoelastic device for lamellar hole surgery with no postoperative positioning. Graefes Arch Clin Exp Ophthalmol 2023; 261:3395-3401. [PMID: 37542557 DOI: 10.1007/s00417-023-06196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023] Open
Abstract
PURPOSE To propose a novel technique of an internal limiting membrane (ILM) flap using ophthalmic viscoelastic device (OVD) with no requirement for postoperative head posture for the treatment of lamellar macular hole (LMH) repair. METHODS A retrospective analysis of 16 consecutive eyes of LMH patients who underwent vitrectomy with ILM flap with OVD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), simultaneous cataract extraction, and ellipsoid zone disruption preoperatively and at the final follow-up were compared. RESULTS The mean age was 73.19 ± 7.26 years, and ten patients (62%) were females. The mean follow-up was 5.06±1.43 months (range 3-6). For all patients, BCVA was significantly improved at the final visit, from 0.65±0.36 logMAR units to 0.42±0.29 (p < 0.001). None of the patients had visual loss. Six patients had epiretinal membrane (ERM) foveoschisis, and the rest had LMH with epiretinal proliferation. Both subgroups presented a significant improvement in their BCVA with a trend for better improvement in the latter (p=0.09). Ellipsoid zone disruption was seen in 7 patients including one patient with a macular scar. There was no significant effect of ellipsoid zone disruption on the final BCVA (p=0.33). Twelve eyes (75%) underwent simultaneous cataract extraction. Mean BCVA at the final postoperative visit improved regardless of whether the eyes underwent simultaneous cataract surgery (p=0.39). CMT was also significantly improved at the final visit, from 200.06±46.8 μm preoperatively to 305.00±85.5 μm (p<0.001). No full-thickness macular holes were developed postoperatively. No intraoperative or postoperative complications were observed. CONCLUSIONS Treatment of LMH with ILM flap with OVD showed promising anatomical and functional results with no postoperative head position requirements.
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Affiliation(s)
- Efraim Berco
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roee Arnon
- Dan-Petah-Tiqwa District, Clalit Health Services, 13th David Ben Gurion, Bnei Brak, Israel.
| | - Yuval Kozlov
- Department of Military Medicine and "Tzameret", Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Nir Shoham-Hazon
- Dalhousie University Nova Scotia, Eye NB Centre of Excellence, Miramichi, New Brunswick, Canada
| | - Raman Tuli
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Assaf Hilely
- Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Govetto A, Radice P, Lucchini S, Bacherini D, Rizzo S, Savastano A. Recovery of bacillary layer detachment associated with macula-off rhegmatogenous retinal detachment: Evidence of foveation mechanisms? Am J Ophthalmol Case Rep 2023; 32:101923. [PMID: 37693691 PMCID: PMC10482997 DOI: 10.1016/j.ajoc.2023.101923] [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: 04/17/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To describe the mechanisms of postoperative foveal restoration in three patients with bacillary layer detachment (BALAD) associated with macula-off rhegmatogenous retinal detachment. Observations BALAD associated with macula-off rhegmatogenous retinal detachment presented with two different morphologies: with an intact foveal roof (case 1) and lamellar, with an open foveal roof (cases 2 and 3). In case 1 visual acuity significantly improved and foveal morphology completely restored at postoperative month 6, with a marked increase in foveal thickness. Case 2 presented with a lamellar BALAD in a long-standing retinal detachment, and it was treated with scleral buckling with an unfavourable evolution into a full-thickness hole in the early postoperative period. It was then addressed with internal limiting membrane peeling and inverted flap, which resulted in the resolution of the lesion, but with limited postoperative visual and anatomical recovery. Case 3 lamellar BALAD was directly addressed with pars plana vitrectomy, ILM peeling and inverted flap, with a remarkable foveal anatomical restoration and visual acuity improvement over the follow-up period. Conclusions and importance The process of foveation may play a key role in the healing process of BALAD associated with rhegmatogenous retinal detachment. Lamellar BALAD should be considered and treated as a FTMH associated with retinal detachment. The two BALAD subtypes may represent different clinical stages of the BALAD spectrum.
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Affiliation(s)
- Andrea Govetto
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Paolo Radice
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Sara Lucchini
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Daniela Bacherini
- Ophthalmology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, Pisa, Italy
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Liu J, Zhang Q, Zhao P. AN EIGHT-YEAR RETROSPECTIVE STUDY OF THE ETIOLOGIES, CLINICAL CHARACTERISTICS, AND VISUAL OUTCOMES OF PEDIATRIC LAMELLAR MACULAR HOLE. Retina 2023; 43:2010-2018. [PMID: 37870909 DOI: 10.1097/iae.0000000000003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE To explore the etiologies, characteristics, and prognosis of lamellar macular hole (LMH) in pediatric patients. METHODS A consecutive series of 59 patients (62 eyes) aged <16 years with MHs (lamellar and full-thickness) treated from 2013 to 2021 in a tertiary center was reviewed. Data collected included demographic and clinical characteristics, management, and outcomes of patients presenting with LMH. RESULTS Twelve eyes (19.4%) of 11 children had LMH. Seven patients were male, with an average age of 6.9 years. The primary pathologies included X-linked retinoschisis in six eyes (50%); familial exudative vitreoretinopathy in two (16.7%); and ocular toxocariasis, Coats disease, persistent hyperplastic primary vitreous, and idiopathic LMH with associated lenticonus in one eye (8.3%) each. Four eyes (36.4%) showed tractional appearance and seven (63.6%) degenerative. All degenerative LMH showed ellipsoidal zone defect, significantly higher than that in the tractional group (25%, 1/4) ( P = 0.024). Five eyes achieved closed LMH and limited visual gain, four underwent surgery, and one closed spontaneously. CONCLUSION X-linked retinoschisis was the most frequent primary cause in pediatric LMH. Two types of LMH can be classified: tractional and degenerative. The latter showed a higher rate of ellipsoidal zone defect. Vision improved after LMH closed, regardless of surgery or spontaneous closure.
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Affiliation(s)
- Jingjing Liu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Komi Y, Katsumoto T, Yoshikawa Y, Shibuya M, Shoji T, Makita J, Shinoda K. Case of Spontaneous Closure and Recurrence of Macular Hole in Vitrectomized Eye. Int Med Case Rep J 2023; 16:641-645. [PMID: 37808920 PMCID: PMC10557958 DOI: 10.2147/imcrj.s429577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Rationale Development and spontaneous closure of a macular hole (MH) in a vitrectomized eye is relatively rare. We report our findings in a case in which vitrectomy was performed successfully to treat a vitreous hemorrhage (VH), but a MH developed eight months later. The MH spontaneously closed 2 weeks later, but then reopened. A second vitrectomy was performed with insertion of the internal limiting membrane flap into the MH which led to the successful closure of the MH. The purpose of this article is to present an explanation of how MH developed in this eye without vitreous traction. Patient A 64-year-old woman visited an eye clinic with vision reduction in her right eye of 3 days duration. A VH was detected in the right eye and pars plana vitrectomy (PPV) was performed. A retinal tear was detected which was the origin of the VH. The vision was restored to a decimal visual acuity of 1.2. Eight months later, the patient noticed that her vision was distorted and was referred to our hospital. Diagnosis Optical coherence tomographic (OCT) images showed a thin epiretinal membrane on the macula, cystoid changes in the macular area, and a full-thickness MH. Interventions The MH closed spontaneously in two weeks, however a lamellar MH with an epiretinal proliferation (EP) developed 11 months later. Two months later, OCT showed cyst-like changes in the retina and a full-thickness MH. A second PPV was performed with the insertion of the ILM flap and EP into the MH to close the MH. Her visual acuity improved, and distorted vision was not present. Lessons Clinicians should be aware that a MH can develop in a vitrectomized eye without vitreous traction but can close spontaneously. We conclude that careful follow-up examinations are necessary even in vitrectomized eyes.
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Affiliation(s)
- Yuki Komi
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Takeshi Katsumoto
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Yuji Yoshikawa
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Masayuki Shibuya
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Takuhei Shoji
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
- Koedo Eye Institute, Kawagoe, Saitama, Japan
| | - Jun Makita
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Kei Shinoda
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
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Mino M, Matoba R, Kanzaki Y, Kimura S, Hosokawa MM, Shiode Y, Morita T, Morizane Y. Quantitative Analyses of Retinal Traction Force and Metamorphopsia in Lamellar Macular Hole and Related Diseases. OPHTHALMOLOGY SCIENCE 2023; 3:100305. [PMID: 37214763 PMCID: PMC10199245 DOI: 10.1016/j.xops.2023.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
Purpose To investigate the involvement of retinal traction in the pathogenesis of lamellar macular hole (LMH) and related diseases based on OCT-based consensus definition. Design Retrospective, observational study. Participants Seventy-two eyes with LMH, epiretinal membrane foveoschisis (ERM-FS), or macular pseudohole (MPH). Methods To quantitatively evaluate the involvement and strength of retinal traction in their pathogenesis, retinal folds were visualized with en face OCT imaging, and the maximum depth of the parafoveal retinal folds (MDRF) was measured. Metamorphopsia was quantified by measuring the minimum visual angle of dotted lines needed to cause it to disappear using M-CHARTS (Inami). Main Outcome Measures Maximum depth of retinal folds and M-CHARTS scores. Results Of the 72 eyes, 26 were classified as having LMH, 25 as having ERM-FS, and 21 as having MPH. Parafoveal retinal folds were observed in 7 (26.9%) eyes with LMH, 25 (100%) with ERM-FS, and 21 (100%) with MPH. The MDRF (7.5 ± 17.6 μm) was significantly smaller in LMH than in ERM-FS (86.3 ± 31.4 μm) and MPH (74.5 ± 24.6 μm) (both P < 0.001), whereas no significant difference in MDRF between MPH and ERM-FS was observed (P = 0.43). A significant positive correlation between MDRF and M-CHARTS scores was observed in ERM-FS and MPH (P = 0.008 and 0.040, respectively) but not in LMH (P = 0.073). Conclusions Retinal traction was significantly weaker in the LMH group than in the ERM-FS and MPH groups. The MDRF was significantly associated with the degree of metamorphopsia in the ERM-FS and MPH groups. These results provide insights into the diseases' pathophysiology and treatment strategy.
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Affiliation(s)
| | - Ryo Matoba
- Correspondence: Ryo Matoba, MD, PhD, Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan.
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Uzel AGT, Neubauer J, Gelisken F. Lamellar Macular Hole-Associated Epiretinal Proliferation with Cystoid Changes: Long-term Follow-up. Klin Monbl Augenheilkd 2023. [PMID: 37343583 DOI: 10.1055/a-2114-4953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
| | - Jonas Neubauer
- Ophthalmology, Eberhard-Karls-University Tübingen, Medical Faculty, Tübingen, Germany
| | - Faik Gelisken
- Ophthalmology, Eberhard-Karls-University Tübingen, Medical Faculty, Tübingen, Germany
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Sasaki T, Matsui Y, Kato K, Chujo S, Maeda S, Ozaki A, Ikesugi K, Sugimoto M, Matsubara H, Kondo M. Comparisons of Clinical Characteristics and Surgical Outcomes of Epiretinal Membrane Foveoschisis to Typical Epiretinal Membrane. J Clin Med 2023; 12:4009. [PMID: 37373702 DOI: 10.3390/jcm12124009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Epiretinal membrane (ERM) foveoschisis is a recently proposed clinical entity. The purpose of this study was to compare the clinical characteristics and surgical outcomes of eyes with ERM foveoschisis to those of typical ERM. The medical records of all patients with ERM-related disorders examined between 2011 and 2020 were reviewed. ERM foveoschisis was defined by the clinical criteria proposed by an international panel of experts on ERMs. The background factors, clinical characteristics, and surgical outcomes of ERM foveoschisis were compared to those of typical ERM. Forty eyes with ERM foveoschisis were compared to 333 eyes with typical ERM. The percentage of women was significantly higher in the ERM foveoschisis group (92.5%) than in the typical ERM group (48.9%, p < 0.001). The central macular thickness (CMT) was significantly thinner in the ERM foveoschisis group (340 ± 110 μm) than in the typical ERM groups (476 ± 111 μm, p < 0.01). The degree of improvement in the best-corrected visual acuity (BCVA) three months after the surgery did not differ between the two groups (p = 0.59). These results suggest that the ERM foveoschisis is more likely to occur in women and that the prognosis after surgery is comparable to typical ERM.
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Affiliation(s)
- Taku Sasaki
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yoshitsugu Matsui
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Kumiko Kato
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Shinichiro Chujo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Satoshi Maeda
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Atsuta Ozaki
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Kengo Ikesugi
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata 990-8585, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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Hsia Y, Hsieh YT. Associations between macular retinal vasculature and severity of idiopathic epiretinal membrane. BMC Ophthalmol 2023; 23:200. [PMID: 37147577 PMCID: PMC10161494 DOI: 10.1186/s12886-023-02945-x] [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: 09/18/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To demonstrate the associations between the morphology of macular retinal vasculature and disease severity of idiopathic epiretinal membrane (ERM). METHODS Macular structures were assessed using optical coherence tomography (OCT), and were classified as "with pseudohole" or "without pseudohole". The 3 × 3 mm macular OCT angiography images were analyzed using the Fiji software to obtain the vessel density, skeleton density, average vessel diameter, vessel tortuosity, fractal dimension, and foveal avascular zone (FAZ)-related parameters. The correlations between these parameters and ERM grading as well as visual acuity were analyzed. RESULTS For ERM with or without a pseudohole, increased average vessel diameter, decreased skeleton density, and decreased vessel tortuosity were all associated with inner retinal folding and thickened inner nuclear layer, indicating more severe ERM. In 191 eyes without a pseudohole, the average vessel diameter increased, fractal dimension decreased and vessel tortuosity decreased with increasing ERM severity. The FAZ was not associated with ERM severity. Decreased skeleton density (r = -0.37), vessel tortuosity (r = -0.35), and increased average vessel diameter (r = 0.42) were correlated with worse visual acuity (All P < 0.001). In 58 eyes with pseudoholes, a larger FAZ was associated with a smaller average vessel diameter (r = -0.43, P = 0.015), higher skeleton density (r = 0.49, P < 0.001), and vessel tortuosity (r = 0.32, P = 0.015). However, none of the retinal vasculature parameters correlated with visual acuity and central foveal thickness. CONCLUSION Increased average vessel diameter, decreased skeleton density, decreased fractal dimension and decreased vessel tortuosity were good indicators of ERM severity and associated visual impairment.
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Affiliation(s)
- Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd, Taipei, 100, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
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Su YT, Yang CM, Lai TT. Multimodel Imaging Evidence of Traction Component in Lamellar Macular Hole with Epiretinal Proliferation. Ophthalmic Res 2023; 66:835-845. [PMID: 37040723 PMCID: PMC10308544 DOI: 10.1159/000530529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the association of epiretinal traction in idiopathic lamellar macular hole (LMH) with or without lamellar hole-associated epiretinal proliferation (LHEP). METHODS A retrospective consecutive case series included 108 eyes diagnosed with LMH in a single tertiary referral center. Epiretinal traction was determined by the presence of epiretinal membrane (ERM), attached posterior hyaloid, or vascular traction with multimodal imaging studies and intraoperative findings in those received surgical interventions. RESULTS The 53 LMHs with LHEP had similar age, refraction, initial, and final visual acuity to the 55 LMHs without LHEP. Both groups exhibited high incidences of vascular traction (with and without LHEP: 92% and 84%, p = 0.36, respectively) and ERM and/or attached posterior hyaloid (both 100%, p = 1.00). The vision improved 10.5 and 14 ETDRS letters (p = 0.60) in the 30 eyes with and 19 eyes without LHEP that underwent vitrectomy. Vascular tractions released postoperatively in 88% and 100% of LMHs with and without LHEP, respectively (p = 0.27). The LMH, ERM foveoschisis, and mixed subtypes exhibited epiretinal traction in 100% of cases in all subtypes (p = 1.00). CONCLUSION Our findings indicated that epiretinal traction, evaluated by multimodal imaging, is the norm rather than the exception in LMHs showing LHEP. The presence of tractional forces should be taken into consideration when treatment was planned in LMHs.
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Affiliation(s)
- Yu-Ting Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Hsia Y, Lee CY, Ho TC, Yang CH, Yang CM. The development and evolution of lamellar macular hole in highly myopic eyes. Eye (Lond) 2023; 37:1170-1177. [PMID: 35562550 PMCID: PMC10102228 DOI: 10.1038/s41433-022-02086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To study the development, evolution, outcomes, and prognostic factors of lamellar macular hole (LMH) in highly myopic (HM) patients. METHODS Fifty eyes from 47 HM patients with LMHs were retrospectively enrolled. Relevant pre- and post-LMH optical coherence tomography findings and visual acuity were collected. Structural progression was defined as an increase in the height of retinoschisis, and the development of foveal detachment, full-thickness macular hole, or retinal detachment. RESULTS Four traction-related developmental processes were identified. Type 1 LMHs (8, 16%) developed from foveal avulsion caused by vitreomacular traction. Type 2 (32, 64%) and type 3 LMHs (5, 10%) formed from ruptured parafoveal and central foveal cysts, respectively. Progressive foveal thinning caused by epiretinal membranes (ERMs) without cystic changes led to type 4 LMHs (5, 10%). Retinoschisis developed before (9 eyes), after (10 eyes), or simultaneously with (6 eyes) the LMH formation. Structural progression was noted in 50%, 53%, 0%, 100% of patients with type 1-4 LMHs, respectively. Multivariable Cox proportional hazard model showed that greater residual foveal thickness (P = 0.001, adjusted odds ratio = 0.22, 95% confidence interval [CI], 0.08 ~ 0.56), and the absence of retinoschisis were protective against structural progression. Multivariable linear regression showed that poor baseline visual acuity (P < 0.001, β = 0.74, 95% CI 0.41 ~ 1.07) and type 4 LMH predicted worse visual outcomes. CONCLUSIONS Four traction-related LMH developmental processes were observed in HM eyes and exhibited different evolution and outcomes. LMHs with foveal thinning induced by ERMs had the worst outcomes.
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Affiliation(s)
- Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Cheng-Yung Lee
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Hagenau F, Osterode EV, Klaas JE, Vogt D, Keidel LF, Schworm B, Siedlecki J, Mayer WJ, Kreutzer TC, Priglinger SG. Long-Term Results of Adjunct Autologous Platelet-Rich Plasma in Lamellar Macular Hole Surgery Showing Lasting Restoration of Foveal Anatomy. Int J Mol Sci 2023; 24:ijms24054589. [PMID: 36902019 PMCID: PMC10002568 DOI: 10.3390/ijms24054589] [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: 12/03/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
The aim of this study was to evaluate the long-time results of highly concentrated autologous platelet-rich plasma (PRP) used as an adjunct in lamellar macular hole (LMH) surgery. Nineteen eyes of nineteen patients with progressive LMH were enrolled in this interventional case series, on which 23/25-gauge pars plana vitrectomy was performed and 0.1 mL of highly concentrated autologous platelet-rich plasma was applied under air tamponade. Posterior vitreous detachment was induced, and the peeling of tractive epiretinal membranes, whenever present, was performed. In cases of phakic lens status, combined surgery was carried out. Postoperatively, all patients were instructed to remain in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, and spectral domain optical coherence tomography (SD-OCT) were carried out preoperatively and at minimum 6 months (in median 12 months) postoperatively. Foveal configuration was postoperatively restored in 19 of 19 patients. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (p = 0.028, Wilcoxon signed-rank test). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p = 0.67). No patients experienced vision loss after surgery, and no significant intra- or postoperative complications were observed. Using PRP as an adjunct in macular hole surgery significantly improves morphological and functional outcomes. Additionally, it might be an effective prophylaxis to further progression and also the formation of a secondary full-thickness macular hole. The results of this study might contribute to a paradigm shift in macular hole surgery towards early intervention.
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Affiliation(s)
- Felix Hagenau
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Correspondence:
| | - Elisa V. Osterode
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Julian E. Klaas
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Denise Vogt
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Leonie F. Keidel
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Jakob Siedlecki
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Wolfgang J. Mayer
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Thomas C. Kreutzer
- Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
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Ishida Y, Tsuboi K, Wakabayashi T, Baba K, Kamei M. En Face OCT Detects Preretinal Abnormal Tissues Before and After Internal Limiting Membrane Peeling in Eyes with Macular Hole. Ophthalmol Retina 2023; 7:153-163. [PMID: 35987293 DOI: 10.1016/j.oret.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess preretinal abnormal tissue (PAT) using en face OCT in eyes with idiopathic macular holes (MHs). DESIGN Retrospective, observational study. PARTICIPANTS Patients with MH who received 6 × 6-mm spectral-domain-OCT scans. METHODS Preretinal abnormal tissue was detected by en face OCT images with a custom slab, defined with an anterior boundary of 6 μm anterior to the internal limiting membrane (ILM) and a posterior boundary at 3 μm posterior to the ILM. The PAT was defined as any abnormal tissues observed in en face OCT. MAIN OUTCOME MEASURES Characteristics of preoperative and postoperative PAT. RESULTS Sixty eyes with MH from 60 patients were included. Fifty-one eyes underwent preoperative analysis, and 46 eyes underwent postoperative examination. Before surgery, 48 (94%) eyes had a mean (standard deviation [SD]) PAT of 6.6 (9.8) mm2. The corresponding cross-sectional OCT showed PAT consisting of epiretinal proliferation, epivascular glia, and a preretinal hyperreflective band. Preretinal abnormal tissue was contiguous to the hole (peri-MH PAT) in 12 eyes (24%), whereas others (36 eyes, 76%) had a scattered distribution (extrafoveal PAT). The area of PAT was greater in eyes with a peri-MH PAT than in eyes with an extrafoveal PAT (P < 0.0001). Compared to the eyes with the extrafoveal PAT, the eyes with the peri-MH PAT were associated with men (P = 0.0059) and worse baseline visual acuity (VA) (P = 0.0002). In eyes with ILM peeling (42 eyes), postoperative PAT proliferation was observed from the edge of the ILM peeling toward the periphery over a 1-year follow-up. The mean (SD) area of PAT at 2 weeks after surgery was 3.4 (3.6) mm2 and increased to 12.1 (6.4) mm2 at 12 months (P < 0.0001). However, no PAT increase was observed in 4 eyes that underwent vitrectomy without ILM peeling. The postoperative PAT size was not associated with the postoperative VA. CONCLUSIONS En face OCT revealed PAT in most eyes with MHs. Peri-MH PAT was associated with worse VA and was seen more frequently in male patients. Postoperative PAT proliferation may be triggered by ILM peeling, but it is not associated with worse VA.
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Affiliation(s)
- Yuichiro Ishida
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
| | - Taku Wakabayashi
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keita Baba
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
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VOLUMETRIC ANALYSIS OF LAMELLAR MACULAR HOLE: An Optical Coherence Tomography Study. Retina 2023; 43:209-214. [PMID: 36695792 DOI: 10.1097/iae.0000000000003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND To investigate the cavity of lamellar macular holes (LMH-CV) by using volumetric analysis of optical coherence tomography images. METHODS Single-center, retrospective, observational case series. The volume of the LMH-CV and epiretinal proliferation was determined. Best-corrected visual acuity, central macular thickness, maximum horizontal diameter and minimum horizontal diameter, and the presence of foveal bump and ellipsoid zone defect were noted. RESULTS Forty-nine eyes of 46 patients (20 women) were included in the baseline analysis. The natural course group consisted of 25 patients (27 eyes) with a mean follow-up of 19.2 ± 15.7 months. The volume of LMH-CV was found to be a predictive factor for baseline best-corrected visual acuity (P = 0.038, ß-coefficient = 0.338, 95% CI: 0.275-8.893). Whereas no significant change at the last visit was observed in central macular thickness, minimum horizontal diameter, and maximum horizontal diameter, the LMH-CV and epiretinal proliferation volume increased significantly (P = 0.036, P < 0.001, respectively). Eyes with foveal bump had larger minimum horizontal diameter, maximum horizontal diameter, and LMH-CV volume (P = 0.008, P < 0.001, P = 0.024, respectively). Eyes with ellipsoid zone defect showed larger LMH-CV and epiretinal proliferation volume, but thinner central macular thickness (P = 0.038, P = 0.004, P = 0.012, respectively). CONCLUSION Volumetric analysis of LMH-CV detects changes in the natural course of lamellar macular hole earlier than the measurement of horizontal diameters. Further studies will clarify whether volumetric analysis of the lamellar macular hole is useful as an additional biomarker in the management of lamellar macular hole.
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Yang X, Wu X, Yu Y, Zhang K, Qi B, Wang X, Liu W. Morphological Characteristics of Foveal Pit Base and Its Impact on Visual Acuity in Macular Pseudoholes. Ophthalmic Res 2023; 66:529-537. [PMID: 36716725 DOI: 10.1159/000529058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION To investigate the characteristics of macular pseudoholes (MPHs) with different foveal profiles and their impact on preoperative and postoperative visual acuity (VA). METHODS A retrospective review of 47 eyes from 46 consecutive patients with MPH who had undergone vitrectomy was conducted. The MPHs were classified into u-shape and v-shape according to the morphological description of the foveola base. The best-corrected visual acuity (BCVA), central foveal point thickness, parafoveal thickness, parafoveal inner and outer retinal thickness, stretched lamellar cleavage, microcystic macular edema (MME), disorganization of retinal inner layers (DRIL), and the integrity of outer retinal layers were recorded. RESULTS The eyes in the v-shaped group (n = 31) had lower BCVA, thicker retinal thickness, more intraretinal cleavage, MME, and DRIL than the u-shaped (n = 16) group (all p < 0.05). Multiple regression analysis revealed that the morphology of the foveola base was significantly related to the preoperative BCVA (p = 0.025). The VA was significantly improved in both groups, and the improvement was greater in the v-shaped group (p = 0.024). No significant difference was found in the postoperative BCVA between the two groups (all p > 0.05). CONCLUSION The v-shape, reflecting the stretch in the foveola, had a significant impact on preoperative BCVA. However, the VA was improved after surgery whatever their initial foveal profile.
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Affiliation(s)
- Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Xijin Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Xinbo Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
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Kanai M, Sakimoto S, Takahashi S, Nishida K, Maruyama K, Sato S, Sakaguchi H, Nishida K. Embedding Technique versus Conventional Internal Limiting Membrane Peeling for Lamellar Macular Holes with Epiretinal Proliferation. Ophthalmol Retina 2023; 7:44-51. [PMID: 35933107 DOI: 10.1016/j.oret.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To examine the outcomes of pars plana vitrectomy (PPV) with lamellar hole-associated epiretinal proliferation (LHEP) embedding and conventional internal limiting membrane (ILM) peeling for lamellar macular holes (LMHs) with LHEP. DESIGN Retrospective observational study. SUBJECTS Forty eyes of 39 consecutive patients with LMHs and LHEP who underwent 3-port PPV with a minimum follow-up of 3 months. METHODS We compared the results of eyes that underwent PPV with LHEP embedding and ILM peeling (group E) with those of eyes that underwent PPV with ILM peeling only (group I) from September 2010 to September 2021. We confirmed whether the LHEP was embedded using postoperative OCT in all the cases. MAIN OUTCOME MEASURES Postoperative best-corrected visual acuity (BCVA) and the development of macular holes (MHs) were assessed. RESULTS The mean patient age was 73.3 years. The mean follow-up duration was 23.1 months. There were 23 and 17 eyes in groups E and I, respectively. Preoperative BCVA (P = 0.774) and central retinal thickness (CRT) (P = 0.800) did not differ significantly between the 2 groups. The final BCVA in group E was better than that in group I (P = 0.059). The final CRT in group E was thicker than that in group I (P < 0.001). Postoperatively, a significant improvement in BCVA was observed in group E at 3 months (P = 0.001) and at the final visit (P < 0.001). None of the eyes in group E developed postoperative MHs, whereas 5 eyes in group I developed postoperative MHs. CONCLUSIONS Pars plana vitrectomy using the LHEP embedding technique improved visual acuity significantly and yielded better anatomic outcomes than those with PPV using conventional ILM peeling; MH formation did not occur. Embedding LHEP is more effective than conventional surgical procedures for LMHs.
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Affiliation(s)
- Masanori Kanai
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan.
| | - Shizuka Takahashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Kentaro Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Pertile G, Iacovello D, Maraone G, Bottega E, Guerriero M, Maggio E. Lamellar macular defects: are degenerative lamellar macular holes truly degenerative? Front Med (Lausanne) 2023; 10:1156410. [PMID: 37138761 PMCID: PMC10149835 DOI: 10.3389/fmed.2023.1156410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose To investigate morpho-functional changes after surgical treatment for ERM foveoschisis or lamellar macular hole (LMH), and to evaluate whether the two entities are associated with different healing processes and long-term outcomes. Design Retrospective interventional case series. Methods A total of 56 eyes, treated for lamellar macular defects and followed up for 24 months, were enrolled. The eyes were divided into two groups: 34 with ERM foveoschisis and 22 with LMH. Changes in the following features were evaluated and compared between the two groups: best-corrected visual acuity (BCVA), external limiting membrane (ELM) and ellipsoid zone (EZ) defects, central foveal thickness (CFT), and autofluorescence (FAF) diameter and area. Results After surgery, progressive BCVA improvement was observed with no significant difference between the two groups (p-value: 0.06). An increased number of eyes with intact outer-retinal layers was found both in the ERM foveoschisis and LMH groups. FAF diameter and area decreased significantly throughout the FU with no significant difference between the two groups (p-value: 0.2). Conclusion In the present study, significant functional and microstructural improvements were observed after surgery for both ERM foveoschisis and LMH, demonstrating considerable repair potential in both types of lamellar defects. These findings question the true "degenerative" nature of LMH.
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Affiliation(s)
- Grazia Pertile
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
- *Correspondence: Grazia Pertile,
| | - Daniela Iacovello
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Giorgia Maraone
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Elisa Bottega
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Massimo Guerriero
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Emilia Maggio
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
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Ach T, Agostini H, Claessens D, Gehrig C, Hattenbach LO, Lommatzsch A, Ostrowski A, Schumann RG. [Macular hole and vitreomacular traction : S1 guideline of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 22 September 2022]. DIE OPHTHALMOLOGIE 2023; 120:1-14. [PMID: 36512120 DOI: 10.1007/s00347-022-01774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
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Hetzel A, Neubauer J, Gelisken F. Clinical characteristics of patients with epiretinal membrane-Foveoschisis. Graefes Arch Clin Exp Ophthalmol 2022; 261:1579-1585. [PMID: 36576570 DOI: 10.1007/s00417-022-05940-y] [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: 08/08/2022] [Revised: 11/23/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the clinical and morphological characteristics of epiretinal membrane (ERM)-Foveoschisis. METHODS Medical charts of 2088 patients diagnosed with idiopathic ERM were screened and eyes with ERM-Foveoschisis were included. All eyes underwent a complete ophthalmological examination including spectral domain optical coherence tomography (SD-OCT). OCT features and best corrected visual acuity (BCVA) were analysed. ERM-Foveoschisis was defined as open, closed, elevated or flat based on the OCT features. Ellipsoidal zone (EZ) abnormality, intraretinal cystoid spaces, central foveal thickness (CFT), posterior vitreous detachment (PVD) and lens status were assessed. RESULTS One hundred-sixty-six patients (175 eyes) (72% female, mean age 70.46 years) were included. Incidence of ERM-Foveoschisis was 6.7%. Open type was seen in 86.8% and had a significantly better mean BCVA than closed type (p = 0.01). No statistically significant difference of mean BCVA was noted between the elevated and flat types. Mean BCVA was significantly lower in eyes with EZ abnormality (p = 0.03) and eyes with intraretinal cystoid spaces (p = 0.02). Patients with 'closed' ERM-Foveoschisis showed a significant higher median CFT than 'open' ERM-Foveoschisis (respectively, 364 µm and 176 µm, p < 0.001). A total of 81.9% eyes had PVD. CONCLUSION We differentiated four morphological types of ERM-Foveoschisis based on the OCT examination. Closed ERM-Foveoschisis presented with a higher CFT and lower BCVA than the open type. ERM-Foveoschisis with cystoid intraretinal spaces presented with a lower BCVA. The impact of the morphological types of the ERM-Foveoschisis on the clinical course and for therapy decision requires further long-term studies.
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Affiliation(s)
- Annegret Hetzel
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Jonas Neubauer
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Faik Gelisken
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
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Kilian R, Crincoli E, Rizzo C, Ripa M, Faraldi F, Lavia C, Tartaro R, Ceruti P, Casini G, Rizzo S, Savastano A. Refractive error after combined phaco-vitrectomy: A multicentric study. Eur J Ophthalmol 2022; 33:11206721221143165. [PMID: 36503334 DOI: 10.1177/11206721221143165] [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: 02/17/2024]
Abstract
PURPOSE To study the post-operative refractive error (RE) of patients undergoing combined phaco-vitrectomy and to find out which intraocular lens (IOL)-power formula had the best refractive outcomes. METHODS In this retrospective multicentric study we compared the preoperative expected target with the postoperative RE of patients undergoing combined phaco-vitrectomy due to vitreomacular traction, macular pucker, full thickness macular hole or lamellar macular hole. A multinomial logistic regression was performed to compare the postoperative REs and the differences between expected and postoperative REs among the SRK-T, Olsen's and Holladay-2 formulas. The correlation between the difference in REs and IOL-power was also studied. RESULTS Sixty-seven eyes with a mean axial length of 23.73 ± 1.21 mm were included. Forty-two (63%), 14 (21%) and 11 (16%) eyes were implanted with an IOL that was calculated respectively with SRK-T, Olsen's and the Holladay-2 formula. The mean preoperative expected- and post-operative REs were -0.16 ± 0.12D and -0.48 ± 0.17, respectively (p = 0.045). SRK-T and Holladay-2 formulas led to a significant myopic shift whereas Olsen's caused a significant hyperopic error, independently from the IOL power. CONCLUSION Independently from the IOL power, none of the analyzed formulas is precise at calculating the post-operative RE.
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Affiliation(s)
- Raphael Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Ripa
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | | | - Carlo Lavia
- Surgical Department, Ophthalmology Service, Azienda Sanitaria Locale TO5, Chieri, Italy
| | - Ruggero Tartaro
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy
| | - Piero Ceruti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giamberto Casini
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Emergency, University of Pisa, Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
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Nakamura K, Inoue T, Nagura K, Tanaka Y, Arasaki R, Asaoka R, Yanagi Y, Maruyama-Inoue M, Kadonosono K. Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole. Eye (Lond) 2022; 36:2247-2252. [PMID: 34799707 PMCID: PMC9674578 DOI: 10.1038/s41433-021-01818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions. METHOD In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated. RESULTS Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE. CONCLUSION Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.
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Affiliation(s)
- Kentaro Nakamura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan.
| | - Koichi Nagura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Yui Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Rei Arasaki
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- Seirei Christopher University, Shizuoka, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
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Sharma A, Wu L, Bloom S, Stanga P, Rezaei KA. RWC Update: Lamellar Macular Holes: A State of Confusion!; Peripapillary Pachychoroid Syndrome with Unilateral Diffuse Uveal Melanocytic Proliferation. Ophthalmic Surg Lasers Imaging Retina 2022; 53:654-658. [PMID: 36547955 DOI: 10.3928/23258160-20221129-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lee CY, Hsia Y, Yang CM. Formation and evolution of idiopathic lamellar macular hole-a pilot study. BMC Ophthalmol 2022; 22:432. [PMID: 36376819 PMCID: PMC9664695 DOI: 10.1186/s12886-022-02669-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background The developmental pathways and subsequent evolutional processes of idiopathic lamellar macular hole (LMH) were studied with spectrum domain optical coherence tomography (SD-OCT). Methods Twenty-seven eyes of 26 patients of idiopathic LMH with pre-LMH SD-OCT available were retrospectively reviewed. Relevant OCT parameters and best-corrected visual acuity (BCVA) were collected and analyzed. Results Four types of developmental pathways of idiopathic LMH were noted. Type 1 (5 cases), involved disruption of a foveal cyst from vitreomacular traction. Type 2 (10 cases), demonstrated rupture of parafoveal cysts or schisis mainly from epiretinal membrane (ERM). In type 3 pathway (5 cases), a central intraretinal cyst formed under tight ERM with subsequent cyst roof dehiscence. Type 4 (7 cases), showed gradual loss of foveal tissue without cystic lesions from ERM traction. There was no statistically significant change in BCVA during LMH formations or subsequent evolutional processes in any types of the developmental pathways. Three cases developed epiretinal proliferation (EP) during evolution, which showed tendency of decrease in BCVA. Among the three cases, one later developed the degenerative configuration. Conclusions In summary, four types of tractional developmental pathways of idiopathic LMH were identified. BCVA was relatively stable during LMH formation and follow-up. Deterioration of visual acuity were found in cases that developed EP during evolution. Transformation into degenerative configuration might be possible after LMH formation.
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Ferrara M, Zheng Y, Romano V. Editorial: Imaging in Ophthalmology. J Clin Med 2022; 11:jcm11185433. [PMID: 36143079 PMCID: PMC9503085 DOI: 10.3390/jcm11185433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...]
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Affiliation(s)
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L69 3BX, UK
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy
- ASST Civil Hospital of Brescia, 25123 Brescia, Italy
- Correspondence:
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Lumi X, Petrovski BE, Petrovski G. Simple new technique for macular pucker peel without forceps. Front Med (Lausanne) 2022; 9:947578. [PMID: 36177324 PMCID: PMC9513118 DOI: 10.3389/fmed.2022.947578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to describe the effectiveness and evaluate the anatomical and functional results of surgery for macular pucker (MP) peel using a 25-gauge pars plana vitrectomy (PPV) cutter without forceps. Methods This study assessed a prospective consecutive case series of 14 eyes of 14 patients who underwent 25-gauge PPV for MP. The surgical procedure was performed using the new peeling technique. The edge of the membrane was engaged at the opening of the cutter by gradually increasing the vacuum. The peeling process was finished by holding a stable vacuum or regrasping the membrane in the same manner. Results The study included six women and eight men patients with a mean age of 72.3 (range 59–84) years. MP peel was achieved in all cases without the need for microforceps. Patients were followed for at least 6 months. Visual acuity and retinal thickness were obtained 6 months after the surgery. Best corrected visual acuity improved from a mean pre-operative 0.6 on a logMAR scale to post-operative 0.23 (P < 0.001). Mean pre-operative Central Retinal Thickness was significantly reduced from 489.7 to 377.6 μm post-operatively (P < 0.001). There were no intra- or post-operative complications. Conclusion MP peel with a 25-gauge vitrectomy probe could be an alternative simple and safe technique. The technique does not require extra instrumentation. It results in anatomic and functional improvement in all cases.
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Affiliation(s)
- Xhevat Lumi
- Eye Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- *Correspondence: Xhevat Lumi
| | - Beáta Eva Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Center, Split, Croatia
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Hwang S, Kang SW. The clinical and pathogenic significance of atypical epiretinal tissue in macular hole. Graefes Arch Clin Exp Ophthalmol 2022; 260:2791-2798. [PMID: 35838804 DOI: 10.1007/s00417-022-05750-2] [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: 02/28/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023] Open
Abstract
With the recent advent of high-resolution optical coherence tomography (OCT), atypical epiretinal tissue (AET), also known as epiretinal proliferation, has been frequently noted in various pathologies. AET presents as premacular tissue with homogenous medium reflectivity over the internal limiting membrane on OCT. Although AET is most frequently associated with a lamellar hole (LH), some cases of macular hole (MH) also accompany AET at the edge of the hole. MH with AET has been reported to have worse clinical and surgical outcomes than MH without AET. The imaging and histopathological findings of AET imply that the development of MH with AET may not have been driven by vitreofoveal traction. Instead, MH with AET might have evolved from LH with AET. This mini-review encompassed relevant studies on MH with AET published to date and explained the clinical, prognostic, and pathogenic significance of AET in MH in detail.
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Affiliation(s)
- Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Primary Lamellar Macular Holes: To Vit or Not to Vit. J Clin Med 2022; 11:jcm11175046. [PMID: 36078977 PMCID: PMC9457236 DOI: 10.3390/jcm11175046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of vitreomacular interface disorders is notoriously poor in differentiating these conditions. These conditions were initially described with slit-lamp biomicroscopy, and the main goal was to distinguish an FTMH from the others. The introduction of optical coherence tomography (OCT) has revolutionized our understanding of the foveal microstructural anatomy and has facilitated differentiating these conditions from an FTMH. However, the definitions of the other conditions, particularly LMH, has evolved over the past two decades. Initially the term LMH encompassed a wide spectrum of clinical conditions. As OCT became more widely used and observations became more refined, two different phenotypes of LMH became apparent, raising the question of different pathogenic mechanisms for each phenotype. Tractional and degenerative pathological mechanisms were proposed. Epiretinal membranes (ERMs) associated with each phenotype were identified. Typical ERMs were associated with a tractional mechanism, whereas an epiretinal proliferation was associated with a degenerative mechanism. Epiretinal proliferation represents Müller cell proliferation as a reactive process to retinal injury. These two types of ERM were differentiated by their characteristics on SD-OCT. The latest consensus definitions take into account this phenotypic differentiation and classifies these entities into LMH, MPH and ERM foveoschisis. The initial event in both ERM foveoschisis and LMH is a tractional event that disrupts the Müller cell cone in the foveola or the foveal walls. Depending on the extent of Müller cell disruption, either a LMH or an ERM foveoschisis may develop. Although surgical intervention for LMH remains controversial and no clear guidelines exist for pars plana vitrectomy (PPV), eyes with symptomatic, progressive ERM foveoschisis and LMH may benefit from surgical intervention.
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Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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Chehaibou I, Manoharan N, Govetto A, Tsui I, Hubschman JP. SPONTANEOUS LAMELLAR MACULAR HOLES CLOSURE. Retin Cases Brief Rep 2022; 16:397-400. [PMID: 32910024 DOI: 10.1097/icb.0000000000001029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report two cases of spontaneous closure of lamellar macular holes with epiretinal proliferation (ERP). METHODS Observational cases report. RESULTS Two patients affected with lamellar macular hole showed progressive and spontaneous closure of the hole associated with ERP development. At presentation, both patients presented with irregular foveal contour, and foveal cavitation with apparent loss of retinal tissue. In both cases, ERP, also called "lamellar hole-associated epiretinal proliferation", was present and increased in size over time. This proliferation progressively developed across the hole with apparent restoration of the foveal contour and preservation of visual acuity. CONCLUSION This report describes two cases of lamellar macular hole in which ERP increased over time, resulting in lamellar macular hole closure. Such observations may suggest a spontaneous healing process driven by glial cell proliferation.
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Affiliation(s)
- Ismael Chehaibou
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France; and
| | - Niranjan Manoharan
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Irena Tsui
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Jean-Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
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Haave H, Petrovski BÉ, Zając M, Lumi X, Melekidou W, Lytvynchuk L, Ruban A, Znaor L, Nawrocki J, Nawrocka ZA, Petrovski G. Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery. Clin Ophthalmol 2022; 16:1847-1860. [PMID: 35702686 PMCID: PMC9188806 DOI: 10.2147/opth.s351932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome. Methods This is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters. Results A total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF6 or C3F8, 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively. Conclusion PPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.
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Affiliation(s)
- Hanna Haave
- Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Beáta Éva Petrovski
- Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Xhevat Lumi
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Wassiliki Melekidou
- Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Lyubomyr Lytvynchuk
- Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
| | | | - Ljubo Znaor
- Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
- Department of Ophthalmology, University Hospital Centre, Split, Croatia
| | | | | | - Goran Petrovski
- Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Correspondence: Goran Petrovski, Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, Oslo, 0450, Norway, Tel +47 2301 5163, Email
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Embedding and sparing of lamellar hole-associated epiretinal proliferation in the treatment of lamellar macular holes. Eye (Lond) 2022; 36:1308-1313. [PMID: 34155368 PMCID: PMC9151660 DOI: 10.1038/s41433-021-01631-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Compare the outcomes of two surgical techniques, lamellar hole-associated epiretinal proliferation (LHEP) embedding and LHEP sparing, in treating idiopathic lamellar macular holes (LMHs). METHODS Retrospective consecutive case series with 34 LMHs with LHEP that underwent operation. LHEP-sparing technique was used before July 2015 and LHEP-embedding after July 2015. Morphological features in optical coherence tomography (OCT) images were identified, including the presence of LHEP, ellipsoid zone (EZ) defects, and types of LMH closure, along with best-corrected visual acuity (BCVA) before and after surgery. RESULTS No baseline differences were observed between the embedding (17 patients) and sparing (17 patients) groups in LMH size, retinal defect depth, or preoperative BCVA. The two groups' mean postoperative BCVAs were similar (embedding vs sparing: 0.388 ± 0.337 vs 0.465 ± 0.418 [Snellen: 20/49 and 20/58], P = 0.812). Postoperatively, a U-type closure was observed in 77 and 65% of patients in the embedding and sparing groups, respectively. Both groups exhibited V-type and T-type closures in half of the remaining patients (P = 0.753). Older age, postoperative external limiting membrane defect, postoperative EZ disruption, and non-U-type closure were associated with worse final BCVA. CONCLUSIONS Both the LHEP-embedding and LHEP-sparing techniques significantly improved vision in patients with LMHs and produced similar visual and anatomical outcomes. Most patients achieved a normal U-type closure with either technique. Preservation of LHEP during surgery is vital and could facilitates successful surgery.
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Macular Holes: Main Clinical Presentations, Diagnosis, and Therapies. J Ophthalmol 2022; 2022:2270861. [PMID: 35450323 PMCID: PMC9017549 DOI: 10.1155/2022/2270861] [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: 12/30/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Macular holes are a spectrum of retinal diseases that comprehends full-thickness macular holes (FTMHs), refractory/recurrent macular holes, lamellar macular holes (LMHs), myopic macular holes (MMHs), traumatic macular holes, and macular holes secondary to other retinal pathologies or injuries. There are various classifications of the subtypes of macular hole, and only in recent times researchers defined a common nomenclature, especially thanks to the evolution in retinal imaging, offered by new instruments like the swept-source OCT. The proposed therapies for macular holes are different and range from a “wait-and-see” approach to the vitrectomy, with different results in each subtype of macular hole. This narrative review has the purpose to investigate the available evidence in literature to give a summary of the knowledge about these retinal pathologies.
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Stino H, Wassermann L, Ristl R, Abela‐Formanek C, Georgopoulos M, Sacu S, Schmidt‐Erfurth U, Pollreisz A. Evaluation of neuroretinal integrity in optical coherence tomography-graded eyes with partial-thickness macular holes. Acta Ophthalmol 2022; 100:e1280-e1286. [PMID: 35403361 DOI: 10.1111/aos.15156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate neuroretinal integrity in different subtypes of optical coherence tomography (OCT)-graded partial-thickness macular holes. METHODS Fovea-centred SD-OCT images (Cirrus, Carl Zeiss Meditec AG; Spectralis, Heidelberg Engineering GmbH) and visual acuity (VA) acquired at every visit were analysed by two retina specialists retrospectively in 71 eyes of 65 patients. Partial-thickness macular holes were classified as lamellar macular hole (LMH), epiretinal membrane foveoschisis (ERMF) or macular pseudohole (MPH). RESULTS Lamellar macular hole, ERMF and MPH were diagnosed in 33 (47%), 31 (43%) and 7 (10%) eyes with a VA of 0.18 ± 0.25, 0.15 ± 0.2, and 0.06 ± 0.08 (p = 0.323), respectively. Median follow-up time was 11 (interquartile range 4-32.5), 10 (interquartile range 5-18) and 19 (interquartile range 8-24) months in LMH, ERMF and MPH. In all subgroups, VA remained stable during the follow-up (p = 0.652, p = 0.915 and p = 1.000). Epiretinal proliferations (EP) were present in 12 LMH and 3 ERMF. At baseline, eyes with EP had significantly worse VA (p < 0.001), wider foveal cavities (p = 0.007) and thinner foveal floors (p < 0.001) compared with eyes without EP. Twelve out of 15 eyes with EP showed exudative cystoid spaces. Among all 71 eyes, 51 remained morphologically and functionally stable during follow-up. CONCLUSION In our study cohort, EP are associated with worse VA and advanced neuroretinal tissue loss presenting with wider foveal cavities and thinner foveal floors. During the follow-up period, VA remained stable in all entities of partial-thickness macular holes.
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Affiliation(s)
- Heiko Stino
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna Vienna Austria
| | | | - Michael Georgopoulos
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | | | - Andreas Pollreisz
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
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