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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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Teng Y, Zhang X. Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction. J Int Med Res 2024; 52:3000605231223635. [PMID: 38235655 PMCID: PMC10798096 DOI: 10.1177/03000605231223635] [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: 04/13/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To examine the effects of the temporal inverted internal limiting membrane (ILM) flap technique for foveal reconstruction in patients with highly myopic macular hole-associated retinal detachment (MHRD). METHODS A retrospective case series analysis of four patients (four eyes) with MHRD was conducted. The foveal optical coherence tomography changes following treatment using the temporal inverted ILM flap technique were evaluated. RESULTS In Patient 1, the ILM bridged the macular hole and residual subretinal fluid on postoperative day 6, and complete retinal reattachment was achieved at 19 months. Patient 2 exhibited reduced retinal detachment, with visible ILM inversion and macular hole closure after 14 days. In Patient 3, macular hole closure and fovea formation had occurred by day 25, and the ILM flap was visible. At 2 months, the outer collagenous layer connection in the central fovea and recovery of the external limiting membrane and ellipsoid zone were observed. Patient 4 had a "white hole" MHRD, with macular hole closure achieved on postoperative day 20, albeit with a suboptimal foveal shape. CONCLUSION The temporal inverted ILM flap technique in conjunction with vitrectomy facilitates foveal reconstruction in patients with successful treatment of MHRD, and this reconstruction process can be observed by optical coherence tomography.
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Affiliation(s)
- Yan Teng
- Department of Ophthalmology, Harbin Bright Eye Hospital, Harbin, China
| | - Xiaoyu Zhang
- Department of Ophthalmology, Harbin Bright Eye Hospital, Harbin, China
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Carballés MJC, Sastre-Ibáñez M, Cura MPD, Hoz RD, Garcia-Saenz MC. Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery. Eur J Ophthalmol 2023; 33:2275-2284. [PMID: 36922754 DOI: 10.1177/11206721231163616] [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: 03/18/2023]
Abstract
AIM To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). METHODS Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. RESULTS A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). CONCLUSIONS The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.
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Affiliation(s)
| | - M Sastre-Ibáñez
- Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M Prieto Del Cura
- Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R De Hoz
- Instituto Investigaciones Oftalmológicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - M C Garcia-Saenz
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Alagoz C, Erdogdu E, Alagoz N, Pehlivanoglu S, Artunay O. Single Layered Free ILM Graft Technique in Large Macular Holes with Associated ERM. Semin Ophthalmol 2023; 38:737-743. [PMID: 37083504 DOI: 10.1080/08820538.2023.2204925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE We aimed to describe single layered free ILM graft technique (FIGT) and present results of this technique in the primary surgery of large macular holes (MHs). METHODS In this retrospective study, we identified MHs with a minimum hole diameter >400 μm that underwent FIGT by a single surgeon. Nineteen eyes were found to have an associated epiretinal membrane (ERM) and four eyes demonstrated a patchy ILM staining intraoperatively. A single layered FIGT was performed first by peeling the ILM around the hole and then creating a free ILM flap and transplanting it to cover the hole. All cases were evaluated for anatomical closure and visual improvement. RESULTS Twenty-three eyes of 22 patients (mean age 68.7 ± 7.4 years) were included in the study. The mean follow-up was 9.6 ± 4.9 months. Flap closure was observed in two eyes (8.6%) at week 1, while all eyes (100%) showed a complete closure at month 1. Mean preoperative visual acuity of 1.42 ± 0.66 LogMAR increased to 1.11 ± 0.51, 0.99 ± 0.34, 0.92 ± 0.38, 0.74 ± 0.37, 0.52 ± 0.28, 0.64 ± 0.39 respectively at week 1, month 1, month 3, month 6, year 1 and final follow-up postoperatively (p < .05 for all). In none of the eyes ERM recurred, nor flap contraction developed. CONCLUSION The study showed encouraging results using free ILM graft in the primary surgery of large MHs. This technique might be considered in large MHs that are associated with ERM or demonstrate patchy ILM staining. Further studies are needed to prove the effectiveness also in the long-term.
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Affiliation(s)
- Cengiz Alagoz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdem Erdogdu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nese Alagoz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seren Pehlivanoglu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Artunay
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Kalas T, Newman A, Whyte J, Sharma A. Clinical utilization of microperimetry in ophthalmic surgery: A narrative review. Surv Ophthalmol 2023:S0039-6257(23)00142-X. [PMID: 37918576 DOI: 10.1016/j.survophthal.2023.10.011] [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: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.
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Affiliation(s)
- Timothy Kalas
- Department of Ophthalmology, Queensland Children's Hospital, Queensland, Australia.
| | - Alexander Newman
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jonathan Whyte
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Abhishek Sharma
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland Eye Institute, South Brisbane, Queensland, Australia
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Yu X, Wu L, Mao Z, Fan H, Dong W, You Z. Internal limiting membrane peeling combined with mouse nerve growth factor injection for idiopathic macular hole. BMC Ophthalmol 2023; 23:339. [PMID: 37525098 PMCID: PMC10391844 DOI: 10.1186/s12886-023-03066-1] [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: 10/18/2022] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The study was intended to confirm whether Pars Plana Vitrectomy (PPV) with Internal Limiting Membrane (ILM) peeling and intravitreal injection mouse Nerve Growth Factor(mNGF) was effective for the treatment of Idiopathic Macular Hole(IMH) by Optical Coherence Tomography Angiography(OCTA) and microperimetry. METHODS A retrospective study was performed in adults' patients. A total of 44 eyes (March 2021-October 2021) with IMH who received surgical treatment in the Affiliated Eye Hospital of Nanchang University in Nanchang City, Jiangxi Province were selected. The subjects were treated using PPV combined with ILM peeling and intravitreal mNGF (combined group) or PPV combined with ILM peeling (placebo group). The Best Corrected Visual Acuity (BCVA), Optical Coherence Tomography Angiography (OCTA) and MP-3 microperimetry were carried out and observed at baseline, 1 week(1W), 1,3 and 6 months (1 M,3 M,6 M) postoperatively. RESULTS The minimum diameter of MH were (568.650 ± 215.862)μm and (533.348 ± 228.836)μm in the Placebo and Combine group pre-operative. During the observation, the macular hole closure rate in the placebo group and combined group were 90% and 95.8% respectively and the difference was not statistically significant(p = 0.583). Compared to pre-surgery, the perimeter and circularity of Foveal Avascular Zone (FAZ) in the placebo group decreased at 1,3,6 M (p = 0.001, < 0.001, < 0.001) and 1W,1,6 M (p = 0.045,0.010, < 0.001) post-surgery respectively. And the perimeter and circularity of FAZ showed significant reduction in the combined group at 1,3,6 M (p = 0.005,0.004, < 0.001) and at each follow-up time point (all values of p < 0.001). The vascular density of SCP increased at 1W(p = 0.031) and 6 M(p = 0.007), the perfusion density of SCP was significantly improved at each follow-up time point (p = 0.028, 0.011, 0.046, 0.004) in the combined group. The BCVA in the combined group was more obvious than that in the placebo group at 1 M, 3 M and 6 M after operation (t1 = 2.248, p1 = 0.030; t3 = 3.546, p3 = 0.001; t6 = 3.054, p6 = 0.004). The changes of BCVA in the combined group was more conspicuous than that in the placebo group at each follow-up time point, and the difference was statistically significant (t1 = 2.206,p1 = 0.033;t2 = 2.54,p2 = 0.015;t3 = 3.546,p3 = 0.001;t6 = 3.124,p6 = 0.003).At 1 M, 3 M and 6 M, the MRS of 2° and 4° in the combined group was better than that in the placebo group(t = -2.429,-2.650,-3.510,-2.134,-2.820,-3.099 p = 0.020,0.011,0.001,0.039,0.007,0.004). During various time points, the MRS of 12°in the combined group was better than that in the placebo group, the difference was statistically significant (t = -3.151, -3.912, -4.521, -4.948, p1 = 0.003, < 0.001, < 0.001 < 0.001). The integrity of External Limiting Membrane (ELM) in combination group was better than that in placebo group at 6 M postoperative(p = 0.022) and that of Ellipsoid Zone(EZ) was preferable in the combined group at 3 M and 6 M after surgery(p = 0.012,0.004). Correlation analysis showed that the integrity of EZ was correlated with 12°MRS at 1 M, 3 M and 6 M after surgery(r = -0.318, -0.343,-0.322;p = 0.023,0.033, < 0.001). There was no correlation between postoperative ELM integrity and postoperative BCVA and 12°MRS(p > 0.05). CONCLUSIONS Our results manifested that PPV combined with ILM peeling and intravitreal injection mNGF might be more effective for initial IMH. This method increased the blood flow, MRS and promoted the recovery of ELM and EZ in the macular and might improve the visual function of patients postoperatively.
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Affiliation(s)
- Xiao Yu
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China
| | - Lingyao Wu
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China
| | - Ziqing Mao
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China
| | - Huimin Fan
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China
| | - Wenjia Dong
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China
| | - Zhipeng You
- The Affiliated Eye Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Jiangxi Institute of Ophthalmology and Vision Science, Jiangxi Provincial Key Laboratory of Ophthalmology, 330006, Nanchang, China.
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Bleidißel N, Friedrich J, Feucht N, Klaas J, Maier M. Visual improvement and regeneration of retinal layers in eyes with small, medium, and large idiopathic full-thickness macular holes treated with the inverted internal limiting membrane flap technique over a period of 12 months. Graefes Arch Clin Exp Ophthalmol 2022; 260:3161-3171. [PMID: 35475915 PMCID: PMC9477954 DOI: 10.1007/s00417-022-05676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid zone (EZ) in small ([Formula: see text] 250 μm), medium ([Formula: see text] 250 μm), and large ([Formula: see text] 400 μm) full-thickness macular holes (FTMH) treated with inverted internal limiting membrane (I-ILM) flap technique over a follow-up period of 12 months. METHODS Ninety-one eyes of 87 patients were enrolled in this retrospective study. BCVA and spectral-domain optical coherence tomography (SD-OCT) were conducted preoperatively as well as after 1, 3, 6, 9, and 12 months postoperatively. The defect length of the ELM and the EZ was measured using the caliper tool at each follow-up time point. RESULTS BCVA improved significantly in the group of small, medium, and large FTMH over the time of 12 months, whereby the improvement did not depend on FTMH size over 9 months. Only after 12 months, large FTMH showed significantly higher BCVA improvement compared to small and medium FTMH. The closure rate was 100% (91/91). The defect length of ELM and EZ reduced continuously over the period of 12 months. There was a significant correlation between defect length of ELM and EZ with postoperative BCVA. CONCLUSION The I-ILM flap technique has very good morphological and functional outcomes in small, medium, and large FTMH over a long-time period, indicating that it can be considered as a treatment option in small and medium FTMH. The defect length of ELM and EZ is directly connected to postoperative BCVA.
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Affiliation(s)
- Nathalie Bleidißel
- Department of Ophthalmology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaningerstraße 22, 81675, Munich, Germany.
| | - Julia Friedrich
- Department of Ophthalmology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaningerstraße 22, 81675, Munich, Germany
| | - Nikolaus Feucht
- Smile Eyes Augenklinik Airport, Terminalstraße Mitte 18, 85356, Munich, Germany
| | - Julian Klaas
- Department of Ophthalmology, University Hospital Munich (LMU), Mathildenstraße 8, 80336, Munich, Germany
| | - Mathias Maier
- Department of Ophthalmology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaningerstraße 22, 81675, Munich, Germany
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