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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Effect of internal limiting membrane surgical techniques on the idiopathic and refractory management of macular holes: a systematic review and meta-analysis. Int J Retina Vitreous 2024; 10:44. [PMID: 38907361 PMCID: PMC11193206 DOI: 10.1186/s40942-024-00564-2] [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: 05/13/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- The Retina Department, Oftalmologia Integral ABC (Medical and Surgical Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Paseo de Las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Institute of Ophthalmology. (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- The Retina Department, Oftalmologia Integral ABC (Medical and Surgical Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Paseo de Las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de Las Salinas, 07760, Mexico, Mexico
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Kim JY, Kim RY, Kim M, Park YG, Yim HW, Park YH. Analysis of the progression rate of idiopathic macular holes and the optimal cut-off for baseline minimum linear diameter and base diameter. Jpn J Ophthalmol 2024; 68:96-104. [PMID: 38334871 DOI: 10.1007/s10384-023-01044-0] [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: 06/28/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine the cut-off points of minimum linear diameter (MLD) and base diameter (BD) at which the progression rate of idiopathic full-thickness macular holes (MHs) decreases before vitrectomy. STUDY DESIGN A retrospective study. METHODS We investigated the differences in MLD and BD between baseline and operation days in patients with stages 2, 3, and 4 MHs using optical coherence tomography (OCT). Each difference in OCT parameters was divided by the time interval to calculate the MH progression rates and the cut-off points of MLD and BD. RESULTS Overall, 269 patients (282 eyes) were included. It took an average of 36.02 ± 24.69 (7-197) days from baseline to operation. MLD and BD progressed faster in stages 2 and 3 without posterior vitreous detachment (PVD) than in stage 4 with PVD (MLD: p < 0.001 and p = 0.007; BD: p < 0.001 and p = 0.019, respectively). Simple linear regression showed the relationship between baseline MLD and BD, and the progression rate; the progression rate decreased as baseline MLD (p = 0.004) and BD increased ( p < 0.001). For baseline MLD and BD, the cut-off points where the progression rate decreased were 306.0 and 470.0 μm, respectively. CONCLUSION The group without PVD progressed faster than the group with PVD. Moreover, the progression rates were faster in MHs with MLD < 306.0 μm and BD < 470.0 μm. In these patients, vitrectomy without delay is expected to improve the visual prognosis.
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Affiliation(s)
- Joo Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Gun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Mariotti C, Mangoni L, Iorio S, Lombardo V, Fruttini D, Rizzo C, Chhablani J, Midena E, Lupidi M. Novel Artificial Intelligence-Based Assessment of Imaging Biomarkers in Full-Thickness Macular Holes: Preliminary Data from a Pivotal Trial. J Clin Med 2024; 13:628. [PMID: 38276134 PMCID: PMC10816123 DOI: 10.3390/jcm13020628] [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: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Artificial intelligence (AI)- and deep learning (DL)-based systems have shown significant progress in the field of macular disorders, demonstrating high performance in detecting retinal fluid and assessing anatomical changes during disease progression. This study aimed to validate an AI algorithm for identifying and quantifying prognostic factors in visual recovery after macular hole (MH) surgery by analyzing major optical coherence tomography (OCT) biomarkers. This study included 20 patients who underwent vitrectomy for a full-thickness macular hole (FTMH). The mean diameter of the FTMH was measured at 285.36 ± 97.4 μm. The preoperative best-corrected visual acuity (BCVA) was 0.76 ± 0.06 logMAR, improving to 0.38 ± 0.16 postoperatively, with a statistically significant difference (p = 0.001). AI software was utilized to assess biomarkers, such as intraretinal fluid (IRF) and subretinal fluid (SRF) volume, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, and retinal hyperreflective foci (HRF). The AI analysis showed a significant decrease in IRF volume, from 0.08 ± 0.12 mm3 preoperatively to 0.01 ± 0.01 mm3 postoperatively. ELM interruption improved from 79% ± 18% to 34% ± 37% after surgery (p = 0.006), whereas EZ interruption improved from 80% ± 22% to 40% ± 36% (p = 0.007) postoperatively. Additionally, the study revealed a negative correlation between preoperative IRF volume and postoperative BCVA recovery, suggesting that greater preoperative fluid volumes may hinder visual improvement. The integrity of the ELM and EZ was found to be essential for postoperative visual acuity improvement, with their disruption negatively impacting visual recovery. The study highlights the potential of AI in quantifying OCT biomarkers for managing MHs and improving patient care.
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Affiliation(s)
- Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Lorenzo Mangoni
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Silvia Iorio
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Veronica Lombardo
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Daniela Fruttini
- Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, 06123 Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy;
- IRCCS—Fondazione Bietti, 00198 Rome, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
- Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, 16132 Genova, Italy
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Zgolli H, Abdelhedi C, Mabrouk S, Fekih O, Zghal I, Malek I, Nacef L. Prognostic factors for visual recovery after successful large macular hole surgery using the inverted flap technique. J Fr Ophtalmol 2023; 46:1069-1078. [PMID: 37648549 DOI: 10.1016/j.jfo.2023.02.019] [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: 10/13/2022] [Revised: 12/19/2022] [Accepted: 02/14/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The goal of our study is to describe the functional results and preoperative factors predicting visual recovery after successful inverted flap technique and closure of large full-thickness macular holes (FTMH) and to evaluate the correlations between microstructural foveal changes and final visual acuity. METHODS Retrospective, descriptive, analytical study including 80 eyes of 78 patients with large FTMH; operated by inverted flap technique with successful closure of the macular hole after surgery. All eyes underwent a full preoperative ophthalmic examination and macular B-scan SD-OCT. We performed the classic inverted flap technique for all patients. Postoperatively, all patients were examined at 7 days, 1, 3, 6, 9 and 12 months after surgery. SD-OCT was performed for all patients on each follow-up. Preoperatively, best-corrected visual acuity (BCVA), FTMH size and basal hole diameter were the main outcome measures. Postoperatively, BCVA, macular thickness, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) were recorded. RESULTS Mean age was 62±8.42 years with female predominance. Mean size of the FTMH was 692.59μm, and mean basal hole diameter was 1436.06μm. Mean BCVA improved from 1.06±0.491 LogMAR preoperatively to 0.52±0.32 at 9 months following surgery (P<0.001). At 9 months, the ELM was absent, partial or fully restored in 6.67, 10 and 83.33% respectively. The EZ was absent, partial or fully restored in 6.67, 33 and 63.33% respectively. ELM regeneration always preceded EZ regeneration at every point of follow-up. Final BCVA was statistically correlated with initial hole size (P=0.006, OR=1.056; CI [1.016-1.098]) and mean symptom duration prior to surgery (P=0.001. OR=0.987; CI [0.976-0.998]). Analysis of the ROC curve demonstrated that a hole diameter>478.5μm and symptom duration>5 weeks were correlated with non-improvement of visual acuity, with 81.3% sensibility and 18.7% specificity. CONCLUSION We report tomographic microstructural foveal changes and functional results following successful large idiopathic FTMH surgery using the classic inverted flap technique. Preoperative parameters such as initial FTMH diameter and mean symptom duration prior to surgery are crucial prognostic factors influencing final visual results.
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Affiliation(s)
- H Zgolli
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - C Abdelhedi
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia.
| | - S Mabrouk
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - O Fekih
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - I Zghal
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - I Malek
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
| | - L Nacef
- Department A, Faculty of Medicine, Hedi-Raies Institute of Ophthalmology, Tunis, Tunisia
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Kim JY, Kim RY, Kim M, Park YG, Park Y. Progression rate analysis of idiopathic macular hole using optical coherence tomography before vitrectomy: short-term results. Acta Ophthalmol 2022; 100:919-926. [PMID: 35332991 DOI: 10.1111/aos.15129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/02/2022] [Accepted: 03/12/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE While the postoperative closure rate of idiopathic macular holes (IMH) is quite high, its success rate and visual prognosis differ depending on macular hole (MH) characteristics. This study investigated the IMH progression rate before vitrectomy. METHODS This retrospective study compared optical coherence tomography (OCT) taken at baseline and on operation day for patients with stage 2, 3 and 4 IMH to determine the changes in minimum linear diameter (MLD), base diameter (BD), height and MH index (MHI). The IMH progression rate was calculated by dividing each difference in OCT parameters by the time interval. RESULTS A total of 224 eyes of 216 patients were included. The average time interval from baseline to operation was 35.59 ± 23.43 (7-137) days. Final visual acuity was related to preoperative MLD, BD, best-corrected visual acuity and time interval between baseline and operation (p = 0.005, p = 0.003, p <0.001 and p = 0.005 respectively). Between baseline and operation, the average MLD and BD increased significantly (all p <0.001). The average progression rates of MLD and BD assessed by simple regression analysis were 0.698 μm/day (R2 = 0.066, p <0.001) and 1.368 μm/day (R2 = 0.097, p <0.001) respectively. When patients were classified according to the MH stage, the progression rates of MLD and BD in those with stage 2 MH were significantly faster than those with stage 3 or 4 MH. CONCLUSION The relatively smaller MHs in stage 2 progress faster than those in stages 3 and 4. Therefore, it would ultimately be beneficial to perform vitrectomy without delay in patients with stage 2 MH.
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Affiliation(s)
- Joo Young Kim
- Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul South Korea
- Catholic Institute for Visual Science, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul South Korea
- Catholic Institute for Visual Science, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul South Korea
- Catholic Institute for Visual Science, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Young Gun Park
- Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul South Korea
- Catholic Institute for Visual Science, College of Medicine The Catholic University of Korea Seoul South Korea
| | - Young‐Hoon Park
- Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul South Korea
- Catholic Institute for Visual Science, College of Medicine The Catholic University of Korea Seoul South Korea
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Srivastava M, Singh VK, Singh A, Singh BK. A study of post-operative clinico-imaging status and visual outcome after idiopathic macular hole surgery with amniotic membrane plug. Rom J Ophthalmol 2022; 66:271-276. [PMID: 36349167 PMCID: PMC9585495 DOI: 10.22336/rjo.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of this study was to determine the efficacy of hAM plug in the treatment of idiopathic macular hole and to see its post-operative visual improvement and anatomical apposition. Material and methods: 10 eyes of 10 patients who had idiopathic MH underwent a pars plana vitrectomy (PPV) with the hAM plug implanted in MH. The patients were followed up on 2nd day, 1st week, 3rd week, 6th week and 3rd month. Results: Final anatomical closure of MH was achieved in all the cases. BCVA improved from 0.91±0.11 logMAR to 0.28±0.06 logMAR after 3 months. No adverse event was documented in the specified period. Conclusion: hAM plug is an efficient method to treat and manage idiopathic MH with encouraging results both in terms of anatomical closure and visual acuity gain. Abbreviations: MH = Macular Hole, IOP = Intra Ocular Pressure, ILM = Internal Limiting Membrane, BCVA = Best Corrected Visual Acuity, OCT = Optical Coherence Tomography, LogMAR = Logarithm of Minimum Angle of Resolution, hAM = Human Amniotic Membrane, RPE = Retinal Pigment Epithelium.
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Affiliation(s)
- Mayank Srivastava
- Department of Ophthalmology, RIO, M.L.N Medical College, Prayagraj, India
| | - Vinod Kumar Singh
- Department of Ophthalmology, RIO, M.L.N Medical College, Prayagraj, India
| | - Ankita Singh
- Department of Ophthalmology, RIO, M.L.N Medical College, Prayagraj, India
| | - Basant Kuma Singh
- Department of Ophthalmology, RIO, M.L.N Medical College, Prayagraj, India
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Bertelmann T, Berndzen L, Raber T, Pfeiffer S, Leha A, Paul C, Feltgen N, Bemme S. Predicting the individual probability of macular hole closure following intravitreal ocriplasmin injections for vitreomacular traction release using baseline characteristics. Sci Rep 2021; 11:24096. [PMID: 34916576 PMCID: PMC8677762 DOI: 10.1038/s41598-021-03509-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023] Open
Abstract
The primary objective was to create and establish a new formula that predicts the individual probability of macular hole closure for eyes with full thickness macular holes (FTMH) accompanied by vitreomacular traction (VMT) which received enzymatic vitreolysis using intravitreally administered ocriplasmin. The secondary objective was to evaluate the forecast reliability of a previously published formula for VMT resolution in VMT-only eyes (OddsIVO-Success = eIntercept × ORyears × ORln(µm); ProbabilityIVO-Success = OddsIVO-Success/(OddsIVO-Success + 1)) on VMT resolution using the current dataset of eyes with FTMH accompanied by VMT. Retrospective analysis of the OASIS, ORBIT, and INJECT-studies. Patients with FTMH and VMT with complete information (n = 213) were included. The effect of gender, age, FTMH diameter, lens status and the presence of epiretinal membranes (ERM) on FTMH closure was assessed using separate univariate logistic regression analyses. With regard to VMT release separate univariate regression analyses were carried out and results were compared with formerly published data of VMT resolution in eyes with VMT only. Overall, 126 eyes (63%) experienced VMT resolution within 28 days. Younger age (p < 0.0001) and VMT diameter (p = 0.041) had a significant impact on VMT release. Overall, 81 eyes (38%) treated with ocriplasmin showed FTMH closure within 28 days. Univariate analysis of the different predictors analyzed revealed that FTMH diameter < 250 µm had a significant impact on treatment success (p = 0.0495). It was not possible to calculate and establish a new multivariate formula that can predict the individual FTMH closure probability for eyes with FTMHs and VMT. However, the results of VMT release prediction in eyes with FTMHs accompanied by VMT matched the prediction of VMT release in eyes with VMT only when using the previously published formula. All in all, predictors for calculating the individual probability of VMT resolution on the one hand and FTMH closure on the other hand are different suggesting diverse pathophysiological mechanisms.
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Affiliation(s)
- Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Lars Berndzen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | - Sebastian Pfeiffer
- UMG Study Center, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas Leha
- Department of Medical Biometry and Statistical Bioinformatics, University Medical Center Goettingen, Goettingen, Germany
| | - Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
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Tayyab H, Siddiqui R, Jahangir S, Hashmi S. Optical Coherence Tomography based indices in predicting functional outcome of macular hole surgery: A retrospective chart review. Pak J Med Sci 2021; 37:1504-1508. [PMID: 34475938 PMCID: PMC8377905 DOI: 10.12669/pjms.37.5.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/15/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: The objective of this study was to assess the utility of novel macular hole indices of Optical Coherence Tomography (OCT) and predicting the functional outcome of surgery. Methods: This was a retrospective chart review of 28 eyes who underwent surgery for idiopathic Full Thickness Macular Hole (FTMH) at The Aga Khan University Hospital (AKUH), Karachi from January 2016 to March 2020. Data of preoperative OCTs were recovered from data server of OCT machine. Measurements of the pre-operative OCTs were calculated using caliper function of OCT software by two independent technicians. Parameters included Macular Hole Index (MHI), Traction Hole Index (THI), Hole Form Factor (HFF) and Diameter Hole Index (DHI) were recorded. Receiver operating characteristic (ROC) curve was used to evaluate the performance of DHI, THI, HFF and MHI for improved BCVA after surgery, by looking at sensitivity, specificity and area under curve (AUC). P-value of <0.05 was considered significant. Results: Out of 30 eyes, final data analysis was done for 28 eyes. Mean age was 61.5 ± 6.2 years. Mean pre-operative and 6 months post-operative LogMAR best corrected visual acuity (BCVA) was 0.84 ± 0.23 and 0.32 ± 0.30 (p-value <0.001). Area under the curve with 95% confidence interval estimated for DHI, THI, HFF, and MHI was [0.750 (0.559 to 0.889)], [0.827 (0.637 to 0.943)], [0.846 (0.660 to 0.954)], [0.827 (0.637 to 0.943)]. Cut off values for predicting good functional outcome (post-op BCVA equal or better that 0.4) for DHI, THI, HFF and MHI were 0.454, 1.086, 0.856 and 0.501 respectively. All ROC value of less than 0.5 were considered unlikely to predict functional outcomes with macular hole indices. Conclusion: Novel macular hole indices can be used as a tool to predict the functional outcomes of macular hole surgery. Larger studies may be required to assess their wider effectiveness.
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Affiliation(s)
- Haroon Tayyab
- Dr. Haroon Tayyab, FCPS (Ophth), FCPS (VRO), FRCS (Glasg), FRCSEd Section of Ophthalmology, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Rehman Siddiqui
- Dr. Rehman Siddiqui, MRCOphth, FRCOphth Section of Ophthalmology, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Sana Jahangir
- Dr. Sana Jahangir, MD, FCPS Department of Ophthalmology, Allama Iqbal Medical College, Jinnah Hospital, Lahore
| | - Shiraz Hashmi
- Dr. Shiraz Hashmi, MBBS, M.Sc Section of Ophthalmology, Department of Surgery, The Aga Khan University, Karachi, Pakistan
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VEGF-Independent Activation of Müller Cells by the Vitreous from Proliferative Diabetic Retinopathy Patients. Int J Mol Sci 2021; 22:ijms22042179. [PMID: 33671690 PMCID: PMC7926720 DOI: 10.3390/ijms22042179] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Proliferative diabetic retinopathy (PDR), a major complication of diabetes mellitus, results from an inflammation-sustained interplay among endothelial cells, neurons, and glia. Even though anti-vascular endothelial growth factor (VEGF) interventions represent the therapeutic option for PDR, they are only partially efficacious. In PDR, Müller cells undergo reactive gliosis, produce inflammatory cytokines/chemokines, and contribute to scar formation and retinal neovascularization. However, the impact of anti-VEGF interventions on Müller cell activation has not been fully elucidated. Here, we show that treatment of MIO-M1 Müller cells with vitreous obtained from PDR patients stimulates cell proliferation and motility, and activates various intracellular signaling pathways. This leads to cytokine/chemokine upregulation, a response that was not mimicked by treatment with recombinant VEGF nor inhibited by the anti-VEGF drug ranibizumab. In contrast, fibroblast growth factor-2 (FGF2) induced a significant overexpression of various cytokines/chemokines in MIO-M1 cells. In addition, the FGF receptor tyrosine kinase inhibitor BGJ398, the pan-FGF trap NSC12, the heparin-binding protein antagonist N-tert-butyloxycarbonyl-Phe-Leu-Phe-Leu-Phe Boc2, and the anti-inflammatory hydrocortisone all inhibited Müller cell activation mediated by PDR vitreous. These findings point to a role for various modulators beside VEGF in Müller cell activation and pave the way to the search for novel therapeutic strategies in PDR.
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Shiihara H, Terasaki H, Sonoda S, Kakiuchi N, Yamaji H, Yamaoka S, Uno T, Watanabe M, Sakamoto T. Association of foveal avascular zone with the metamorphopsia in epiretinal membrane. Sci Rep 2020; 10:17092. [PMID: 33051514 PMCID: PMC7555497 DOI: 10.1038/s41598-020-74190-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson's correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = - 0.491, P < 0.001; circularity R = - 0.385, P = 0.004; eigenvalue ratio R = - 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (β - 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.
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Affiliation(s)
- Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoko Kakiuchi
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Shinnosuke Yamaoka
- Graduate School of Science and Engineering, Kagoshima University, Kagoshima, Japan
| | | | - Mutsumi Watanabe
- Graduate School of Science and Engineering, Kagoshima University, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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11
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Sborgia G, Niro A, Tritto T, Albano V, Sborgia L, Sborgia A, Donghia R, Giancipoli E, Coassin M, Pastore V, Giuliani G, Lorenzi U, Romano MR, Boscia F, Alessio G. Microperimetric Biofeedback Training after Successful Inverted Flap Technique for Large Macular Hole. J Clin Med 2020; 9:jcm9020556. [PMID: 32085592 PMCID: PMC7074367 DOI: 10.3390/jcm9020556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the high closure rate of large macular hole (LMH) after surgery, visual recovery is often worse than expected. Microperimetric biofeedback can improve visual function in macular pathologies. We evaluated the efficacy of biofeedback on macular function after successful inverted flap technique for LMH. Methods: In this prospective comparative study, 26 patients after LMH surgical closure were enrolled. The whole sample was equally divided into two groups. In Group 1 (trained), patients underwent a double cycle of microperimetric biofeedback, using structured light stimulus plus acoustic tone; in Group 2 (control), patients underwent scheduled visits. We analyzed visual acuity, retinal sensitivity at central 12° (macular sensitivity, MS) and 4° (central macular sensitivity, CMS), and fixation stability over twelve months. Results: Visual acuity improved mainly in the trained group, without any significant differences between the groups (p > 0.05). Only after training did MS significantly improve (p = 0.01). CMS more significantly improved in the trained (p < 0.001) than the control group (p < 0.01) (Group 1 vs. 2, p = 0.004). Only in the trained group did fixation significantly improve (3 months, p ≤ 0.03; 12 months, p ≤ 0.01). An equality test on matched data confirmed a greater significant improvement of CMS (p ≤ 0.02) at all follow-up and fixation (p ≤ 0.02) at last follow-up after training. Conclusions: Microperimetric biofeedback consolidates and increases the improvement of retinal sensitivity and fixation gained after successful inverted flap technique.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Alfredo Niro
- Eye Clinic, Hospital “S. G. MOSCATI”, A.S.L. Taranto, 74010 Statte, Taranto, Italy;
- Correspondence: ; Tel.: +39-0994585017; Fax: +39-0994585742
| | - Tiziana Tritto
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Valeria Albano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Luigi Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Alessandra Sborgia
- Eye Clinic, Hospital “S. G. MOSCATI”, A.S.L. Taranto, 74010 Statte, Taranto, Italy;
| | - Rossella Donghia
- National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Bari, Italy;
| | | | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128 Roma, Italy;
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Umberto Lorenzi
- Department of Ophthalmology, University Hospital of Rouen, 76000 Rouen, France;
| | - Mario R. Romano
- Department of Ophthalmology, Humanitas University, 20090 Pieve Emanuele, Milan, Italy;
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
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Li SS, You R, Li M, Guo XX, Zhao L, Wang YL, Chen X. Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis. Int J Ophthalmol 2019; 12:1917-1928. [PMID: 31850178 DOI: 10.18240/ijo.2019.12.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/22/2019] [Indexed: 01/11/2023] Open
Abstract
AIM To evaluate the effect of internal limiting membrane (ILM) peeling with indocyanine green (ICG), brilliant blue G (BBG), triamcinolone acetonide (TA), trypan blue (TB), or without dye for the treatment of idiopathic macular hole (IMH). METHODS A search was conducted using PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.
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Affiliation(s)
- Shan-Shan Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ran You
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Min Li
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Xiao-Xiao Guo
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yan-Ling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xi Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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