Internal Limiting Membrane Flap in the Management of Retinal Detachment due to Paracentral Retinal Breaks

Lyophilised amniotic membrane patches are a safe and effective treatment for rhegmatogenous lesions in combined tractional and rhegmatogenous retinal detachment: a prospective interventional study

OBJECTIVES

This study was performed to evaluate the safety and effectiveness of a lyophilised amniotic membrane (LAM) as a patch for the treatment of retinal breaks and to describe the structural changes at the implantation site.

DESIGN

Prospective, interventional case series study. Patients with diabetic retinopathy and combined tractional and rhegmatogenous retinal detachment.

METHODS

Patients were organised into 3 groups according to the number of rhegmatogenous lesions: those in group A had a single break, those in group B had two breaks, and those in group C had three or more breaks. The location of the break was also evaluated as either superior or inferior. Structural outcomes were assessed using SD-OCT during a 3-month follow-up period.

RESULTS

Of a total of 23 eyes of 23 patients, 22 (95.6%) achieved retinal repair without associated complications. Patients with 2 or fewer rhegmatogenous lesions located in the superior sector had a better anatomical result as they achieved 100% surgical success. The structural changes observed by SD-OCT over the follow-up period showed adequate adaptation of the lyophilised patch and complete closure of the rhegmatogenous lesion with no alterations in the adjacent tissue.

CONCLUSIONS

The LAM patch seems to be safe and effective, as it promotes therapeutic closure of rhegmatogenous lesions without damaging the retinal architecture adjacent to the implantation site.

Relationship between visual function and macular microstructure in highly myopic patients undergoing surgery for rhegmatogenous retinal detachment

OBJECTIVE

To analyze the relationship between visual function and macular microstructure in highly myopic patients undergoing surgery for rhegmatogenous retinal detachment (RRD).

METHODS

Fifty-eight highly myopic patients treated in the Baoding No. 1 Central Hospital between December 2021 and September 2023 were selected as the research participants for retrospective analysis. All patients were complicated with RRD and underwent retinal reattachment surgery at Baoding No. 1 Central Hospital after diagnosis. Best-corrected visual acuity (BCVA) examinations were performed before and 3 months after surgery, and visual field mean sensitivity (MS) and fixation stability (FS) were measured by microperimetry. Additionally, changes in postoperative macular microstructure and micro blood flow were determined by optical coherence tomography (OCT), and their correlations with visual function were analyzed.

RESULTS

Patients showed reduced BCVA, MS, and FS after surgery (all P<0.05), with 70.69% of them presenting with macular microstructural changes, mainly ellipsoid zone disruption and external limiting membrane disruption. Patients with macular microstructural changes exhibited significantly decreased BCVA, MS, and FS than those without (all P<0.05). In terms of micro blood flow, the BCVA, FS, and MS of patients with macular microstructural changes were negatively correlated with the foveal avascular zone (FAZ) area but were positively related to FAZ morphological index, PSCP, and VSCP (all P<0.05).

CONCLUSIONS

Changes in patients' visual function after surgery for RRD can be effectively evaluated by observing the macular ellipsoid, the integrity of the external limiting membrane, and the alterations in micro-blood flow, enabling the formulation of early and targeted interventions.

Human amniotic membrane grafts for retinal breaks in diabetic tractional retinal detachment and combined tractional and rhegmatogenous retinal detachment

To describe the surgical outcomes of using human amniotic membrane (hAM) grafts in the management of retinal breaks in diabetic tractional detachment (TRD) and combined tractional and rhegmatogenous retinal detachment (CTRRD). A retrospective case series of 10 eyes with TRD or CTRRD receiving pars plana vitrectomy with hAM grafts implantation, compared with 13 controls receiving the same surgery without hAM grafts. Best-corrected visual acuity (BCVA) and re-detachment rate were compared between two groups. Postoperatively, all eyes in the hAM group had retina attachment without recurrence, while 9 eyes in the control group had retina re-detachment and required additional surgery (0% vs 69.2%, p = 0.003). The BCVA significantly improved in the hAM group (from 1.96 ± 0.95 to 1.44 ± 0.77 in log MAR, p = 0.03), but not improved in control group (p = 0.20). Postoperative optical coherence tomography of the eyes receiving hAM grafts demonstrated glial tissue regeneration and restoration of ellipsoid zone. In diabetic TRD or CTRRD, hAM grafts could be an effective method, with promising outcome. Compared to standard surgery, it could result in higher retina reattachment rate and significant visual improvement. Moreover, it may offer the adjunctive benefit in tissue regeneration and fasten ellipsoid zone restoration.