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Chen SN, Chen SJ, Wu TT, Wu WC, Yang CH, Yang CM. Refining vitrectomy for proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3659-3670. [PMID: 37314522 PMCID: PMC10667443 DOI: 10.1007/s00417-023-06134-w] [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: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Pars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.
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Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Tien Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- School of Medicine, National Taiwan University, Taipei, Taiwan.
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Tsui MC, Yang CM, Wang LC. Characteristics and outcomes of full-thickness macular holes created during vitrectomy for proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:3479-3490. [PMID: 37277662 DOI: 10.1007/s10792-023-02753-8] [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: 05/06/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the clinical features, management, and prognosis of full-thickness macular holes (FTMHs) inadvertently created during vitrectomy for eyes with proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP). METHODS Eyes with PDR and FVP that had intraoperatively created FTMHs were retrospectively collected as the study group, and age- and sex-matched subjects with PDR and FVP who did not have intraoperative FTMHs were selected as the control group. Fundus abnormalities, optical coherence tomography (OCT) features, and anatomical and functional outcomes were compared between the two groups. RESULTS Eleven eyes of 11 patients (5 male and 6 female) were identified as the study group. Follow-up duration was 36.8 ± 47.2 months. FTMHs were managed by ILM peeling or the inverted ILM flap technique. Anatomical success and MH closure were achieved in 100% of eyes in the study group. In comparison to the control group, the study group had a higher proportion of condensed prefoveal tissue (63.6% vs. 22.7%, p = 0.028), and a higher ratio of silicone oil tamponade (63.6% vs. 18.2%, p = 0.014), whereas there were no differences in preoperative and final BCVA, and the severity, activity, and locations of FVP between the two groups. CONCLUSION Condensed prefoveal tissue was a risk factor of FTMHs created during operation for eyes with PDR and FVP. The ILM peeling or the inverted ILM flap technique may be beneficial for the treatment with favorable anatomical and functional outcomes.
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Affiliation(s)
- Mei-Chi Tsui
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu-Chun Wang
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou, Yunlin, Taiwan.
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Secondary Full-thickness Macular Holes after Diabetic Vitrectomy: Clinical Manifestations and Rational Approaches to the Treatment. J Ophthalmol 2022; 2022:3156642. [PMID: 35685904 PMCID: PMC9173914 DOI: 10.1155/2022/3156642] [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: 11/17/2021] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of the study is to present the clinical characteristics and surgical treatment of secondary full-thickness macular hole (MH) after diabetic vitrectomy (DV) in patients with proliferative diabetic retinopathy (PDR). Methods. In this retrospective, observational, and longitudinal study, we enrolled consecutive patients with PDR who developed MH after DV. The macular structure was evaluated using optical coherence tomography. The clinical characteristics, surgical techniques, and outcomes were also recorded. Results. Three patients developed MH within 6 weeks, which was associated with foveal thinning, residual fibrovascular proliferation, or anterior proliferative vitreoretinopathy. Six patients developed MH originating from the epiretinal membrane (ERM) with lamellar MH (LMH) after a median interval of 16.5 months. Three of them were complicated with retinal detachment (RD). Various surgical procedures were performed according to the clinical scenarios, including internal limiting membrane (ILM) peeling, inverted ILM flap insertion, temporal inverted ILM flap, lens posterior capsular flap insertion, and neurosensory retinal free flap insertion. All patients achieved MH closure after surgery, and 5 patients exhibited improved visual acuity. Conclusions. MH may develop after successful DV, with a high rate of associated RD. Rapid MH formation was attributed to unreleased tractional force and weakened foveal structure. The development of ERM and LMH also led to MH. Various surgical techniques could be used for MH closure.
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Silva N, Ferreira A, Nawrocka (vel Michalewska) ZA, Meireles A. Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes? Clin Ophthalmol 2021; 15:3295-3303. [PMID: 34408388 PMCID: PMC8360769 DOI: 10.2147/opth.s284614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment is generally necessary to repair full-thickness macular holes (FTMH). Although vitrectomy with or without internal limiting membrane (ILM) peeling remains the standard surgical technique, the inverted ILM flap procedure has increasingly assumed a role in the primary surgical repair of FTMHs. Some vitreoretinal surgeons reserve this technique to treat large or myopic holes, whereas others use it routinely in all cases. This paper is a comprehensive review of the current scientific evidence on the anatomical and functional outcomes of the inverted ILM flap technique in the repair of macular holes, following the International Vitreomacular Traction Study (IVTS) group classification.
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Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - André Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal
| | | | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
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Ikeda M, Baba T, Aikawa Y, Yotsukura J, Yokouchi H, Yamamoto S. Case of Macular Hole Secondary to Ocular Toxoplasmosis Treated Successfully by Vitrectomy with Inverted Internal Limiting Membrane Flap. Case Rep Ophthalmol 2021; 12:363-368. [PMID: 34054485 PMCID: PMC8136329 DOI: 10.1159/000514910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
We report a case of ocular toxoplasmosis that developed a full-thickness macular hole (FTMH) which was successfully treated by pars plana vitrectomy combined with an inverted internal limiting membrane (ILM) flap. A 49-years-old Japanese man was aware of blurred vision in his right eye. Slit-lamp biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT) of the right eye showed that there was a grayish-white subretinal lesion at the macula accompanied by retinal exudation and mild vitreous flare and iritis. An increase in the level of serum IgM for toxoplasma led to a diagnosis of ocular toxoplasmosis. He developed a FTMH adjacent to the lesion 2 weeks after administering sulfamethoxazole/trimethoprim, and his decimal visual acuity was 0.15. Because the FTMH remained 3 months after the resolution of inflammation and his metamorphopsia persisted, vitrectomy with an inverted ILM flap was performed. After the surgery, the visual acuity improved to 0.2 with the closure of the FTMH confirmed by OCT. A FTMH in an eye with ocular toxoplasmosis was successfully closed by vitrectomy with an inverted ILM flap.
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Affiliation(s)
- Mizuki Ikeda
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuri Aikawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jiro Yotsukura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hirotaka Yokouchi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Karimov M, Akhundova L, Aliyeva T. Pars Plana Vitrectomy for Full-Thickness Macular Holes in Patients with Proliferative Diabetic Retinopathy and Active Fibrovascular Proliferation. Clin Ophthalmol 2020; 14:4125-4133. [PMID: 33293785 PMCID: PMC7718992 DOI: 10.2147/opth.s280654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose of the Study To study preoperative and postoperative optical coherence tomography features and the outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for full-thickness macular holes (MHs) associated with proliferative diabetic retinopathy. Methods The data from 14 eyes of 11 patients with full-thickness macular holes and active diabetic fibrovascular proliferation (FVP) with/without tractional retinal detachment who underwent pars plana vitrectomy and standard ILM peeling at Zarifa Aliyeva National Ophthalmology Centre in Baku were analysed. Bilateral surgery for diabetic MHs was performed in 27.3% of patients. The minimum follow-up duration was 6 months. Results All eyes (100%) achieved type 1 macular hole closure, with residual macular subretinal fluid (SRF) present in 13 cases after surgery (92.9%). The SRF resolved gradually without any interventions. The incidence of SRF was 92.9% at 1 month, 85.7% at 3 months, 50% at 6 months, and 14.3% at 9 months (Cochran's Q test, χ2 (4) =37.44, p<0.001). Visual acuity improved after surgery in 13 cases (92.9%), with a mean difference of 0.75 ±0.71 LogMAR between the preoperative and final values, rs=0.608, 95% BCa CI [0.037-0.969], p=0.021. Conclusion The standard ILM peeling technique for full-thickness MHs in eyes with active diabetic fibrovascular proliferation can help restore the anatomy and function of the macula in diabetic patients. Close follow-up is important for unilateral cases. Residual SRF in the perifoveal area is detectable by OCT after surgery in patients with macular holes associated with diabetic tractional retinal detachment, and it usually resorbs gradually without any interventions.
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Affiliation(s)
- Mushfig Karimov
- Department of Diabetic Eye Diseases, National Centre of Ophthalmology Named After Acad. Zarifa Aliyeva, Baku, Azerbaijan
| | - Lala Akhundova
- Department of Diabetic Eye Diseases, National Centre of Ophthalmology Named After Acad. Zarifa Aliyeva, Baku, Azerbaijan
| | - Tarlan Aliyeva
- Department of Diabetic Eye Diseases, National Centre of Ophthalmology Named After Acad. Zarifa Aliyeva, Baku, Azerbaijan
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Silicone oil removal after extended tamponade in proliferative diabetic retinopathy-a long range of follow-up. Eye (Lond) 2020; 34:2307-2314. [PMID: 32071404 DOI: 10.1038/s41433-020-0815-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/30/2020] [Accepted: 02/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To investigate the anatomical and functional results of silicone oil (SO) removal after an extended period of SO tamponade in eyes having received vitrectomy for proliferative diabetic retinopathy (PDR). METHODS From May 2009 to August 2017, clinical records of patients who had vitrectomy for PDR and underwent SO removal were retrospectively reviewed. SO was in principle left in the eye for an extended period of time and would be removed promptly when complications relevant to SO rose, or at the same setting when other intraocular surgeries were performed. Main outcome measures include anatomical outcome, functional outcome, and postoperative complications. RESULTS Seventy-four eyes of 64 patients (31 males and 33 females) were analysed. The mean follow-up duration was 35.6 months (ranging from 6 to 99 months, median 32 months). The duration of SO tamponade ranged from 3 to 116 months (mean 26.89 months, median 16 months). Anatomical success was achieved in 95.9% at the last follow-up with best-corrected visual acuity (BCVA) becoming better or unchanged in 81.1%. Postoperative complications included ocular hypertension (>25 mmHg; > 4 weeks) in three eyes (4.1%), macular hole in two eyes (2.7%), transient choroidal detachment in one eye (1.4%), vitreous haemorrhage in four eyes (5.4%) and hyphaema in two eyes (2.7%). CONCLUSIONS The rate of retinal redetachment after an extended period of SO tamponade and removal was low and the majority of eyes obtained final visual acuity improvement. SO removal after an extended period of tamponade in PDR seems to be safe under proper indications and case selection.
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