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Ercan ZE, Akca Bayar S, Kurt RA, Akkoyun I, Yilmaz G. Macular hole surgery follow-up with spectral domain-optical coherence tomography-guided facedown posturing. Int Ophthalmol 2024; 44:180. [PMID: 38625598 DOI: 10.1007/s10792-024-03110-z] [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: 06/29/2023] [Accepted: 03/24/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP. METHODS Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded. RESULTS Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260-max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed. CONCLUSIONS OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.
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Affiliation(s)
- Zeynep Eylul Ercan
- Department of Ophthalmology, Yıldırım Beyazıt University Yenimahalle Education and Training Hospital, Ankara, 06900, Turkey.
| | | | | | - Imren Akkoyun
- Department of Ophthalmology, Baskent University, Ankara, Turkey
| | - Gursel Yilmaz
- Department of Ophthalmology, Baskent University, Ankara, Turkey
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Baumann C, Maier M, Johannigmann-Malek N, Gabka K, Schwer L, Kaye SB. VERTICAL AND HORIZONTAL METAMORPHOPSIA ONE YEAR AFTER SURGERY FOR MACULAR HOLES ≤ 500 µ m WITH AND WITHOUT INVERTED INTERNAL LIMITING MEMBRANE FLAP. Retina 2024; 44:95-101. [PMID: 37751574 DOI: 10.1097/iae.0000000000003941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE To investigate the effect of an inverted internal limiting membrane flap (IF) and other factors on metamorphopsia after macular hole surgery. METHODS Prospective case series of patients undergoing pars plana vitrectomy with gas tamponade, with either conventional internal limiting membrane peeling (CP) or an IF, for primary idiopathic macular holes ≤ 500 µ m. Vertical and horizontal metamorphopsia were measured as M-scores (degrees) using M-charts preoperatively and at 2, 6, and 12 months postoperatively. RESULTS Fifty-three eyes of 53 patients were included of whom 27 underwent CP and 26 were treated with an IF. After macular hole surgery, all patients were pseudophakic. Vertical and horizontal metamorphopsia improved from 1.08 (±0.51) and 0.98 (±0.70) preoperatively to 0.58 (±0.37) and 0.45 (±0.36) at 2 months ( P < 0.01), with no further significant improvement at 6 months (0.39 [±0.31], P = 0.07 and 0.31 [±0.28], P = 0.18) or at 12 months (0.37 [±0.30], P = 0.72 and 0.28 [±0.28], P = 0.99). There was no significant difference in the mean vertical and horizontal metamorphopsia between patients with CP and with an IF at 2 months ( P = 0.063, P = 0.10), 6 months ( P = 0.25, P = 0.16), or 12 months ( P = 0.62, P = 0.22). Preoperative vertical M-score improved at 12 months after macular hole surgery by 61% and 64% in the CP and IF groups, respectively ( P = 0.84), and the horizontal M-score by 65% and 71%, respectively ( P = 0.98). CONCLUSION The use of an IF has no evident bearing on the degree of postoperative metamorphopsia 12 months after surgical repair of macular holes ≤ 500 µ m.
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Affiliation(s)
- Carmen Baumann
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Mathias Maier
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Navid Johannigmann-Malek
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Katharina Gabka
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Lydia Schwer
- Department of Ophthalmology, Hospital Rechts der Isar, Technical University of Munich (TUM), Munich, Germany; and
| | - Stephen B Kaye
- William Henry Duncan Building, University of Liverpool, Liverpool, United Kingdom
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Rahman R, Sarfraz MW, El-Wardani M. Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in Nonposturing Surgery. JOURNAL OF VITREORETINAL DISEASES 2022; 6:9-13. [PMID: 37007718 PMCID: PMC9976215 DOI: 10.1177/24741264211022212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study compared anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique with complete ILM peeling (ILMP) in nonposturing surgery for large, full-thickness macular holes (MHs). Methods: This was a retrospective, comparative, single-surgeon study. Eyes with idiopathic large full-thickness MHs (minimum diameter > 400 μm) were included. A total of 46 patients including 22 ILMF cases and 24 ILMP cases were analyzed. No positioning instructions were advised postoperatively. Results: Primary hole closure was achieved in all patients (100%) in both groups. Mean logMAR visual acuity (VA) improved significantly in both groups compared with the preoperative values (ILMF: 0.60 [SD, 0.26] postoperatively, vs 0.93 [SD, 0.3] preoperatively, P = .032; ILMP: 0.43 [SD, 0.22] postoperatively vs 0.83 [SD, 0.16] preoperatively, P < .01). However, ILMP showed a statistically significant improvement in VA compared with ILMF ( P = .02). Conclusions: All MHs in both groups closed after surgery (100%). There was a statistically significant improvement of VA in the ILMP group compared with the ILMF group ( P = .02). Not posturing after surgery did not compromise surgical success in both groups.
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Affiliation(s)
- Rubina Rahman
- Calderdale Royal Hospital, Salterhebble Hill, Halifax, UK
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Lorusso M, Micelli Ferrari L, Cicinelli MV, Nikolopoulou E, Zito R, Bandello F, Querques G, Micelli Ferrari T. Feasibility and Safety of Intraoperative Optical Coherence Tomography-Guided Short-Term Posturing Prescription after Macular Hole Surgery. Ophthalmic Res 2019; 63:18-24. [PMID: 31430744 DOI: 10.1159/000501561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess closure rate and visual outcome of a court of patients with macular hole (MH) who underwent surgical repair with intraoperative optical coherence tomography (iOCT)-confirmed MH closure and short-term postoperative face-down posturing (FDP). Secondary aim was to assess the correlation between iOCT and postoperative OCT at day 1. METHODS Retrospective clinical study conducted in the Miulli Hospital Acquaviva delle Fonti (Italy), enrolling patients with idiopathic MH who underwent 25-G pars plana vitrectomy plus internal limiting membrane peeling. During surgery, closure of MH was confirmed by iOCT and short-term FDP (12-24 h, until day-1 visit) was prescribed. All patients had measurement of best-corrected visual acuity (BCVA) and spectral domain-OCT before the surgery and during follow-up (at 1 day, 1 month, 3 months). RESULTS Twenty-nine eyes of 29 patients (14 males, 62.1%) were enrolled in the study. MH mean size was 451.7 ± 139.7 µm and baseline BCVA was 0.77 ± 0.26 logarithm of the minimum angle of resolution (LogMAR). MH was confirmed to be closed in 100% of patients intraoperatively (iOCT) and at OCT during early follow-up (1-3 days). Mean time of FDP was 18 ± 2.6 h. At 3 months, MH closure rate was 93%; 2 eyes -underwent secondary MH repair surgery. Final BCVA was 0.39 ± 0.22 LogMAR (p < 0.0001). CONCLUSION iOCT-based confirmation of MH closure could be a safe and useful tool for prescribing short-term FDP after surgery, with high closure rate and no additional complication. The execution of an OCT in the immediate postoperative days could be potentially unnecessary.
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Affiliation(s)
- Massimo Lorusso
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Luisa Micelli Ferrari
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Eleni Nikolopoulou
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Roberta Zito
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy,
| | - Tommaso Micelli Ferrari
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Bari, Italy
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Brill DA, Fields TS, Badami AU, Kuley AJ, Kumar N, Desai UR. Bilateral pulmonary emboli following macular hole surgery with postoperative prone positioning. Am J Ophthalmol Case Rep 2019; 15:100478. [PMID: 31211284 PMCID: PMC6562177 DOI: 10.1016/j.ajoc.2019.100478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/25/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a rare case of bilateral pulmonary emboli following pars plana vitrectomy with postoperative prone positioning. Observations A 60 year-old female presented with a fourmonth history of unilateral distorted vision. Ocular coherence tomography revealed a full thickness macular hole. Two weeks later, the patient underwent a 23-gauge pars plana vitrectomy with internal limiting membrane peeling and 12% perfluoropropane gas tamponade. Postoperatively, she completed two weeks of prone positioning. Five days later, she presented with a two day history of abdominal pain and shortness of breath. Computed tomography angiography revealed bilateral pulmonary emboli. The patient received six months of anticoagulation to prevent further thromboembolic events. Conclusions Life threatening blood clots can form due to prolonged immobilization from prone positioning. Patients should be educated to perform light exercise postoperatively to prevent complications of blood stasis.
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Affiliation(s)
- Daniel A Brill
- Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, USA
| | - Taylor S Fields
- Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, USA
| | - Anjali U Badami
- Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, USA
| | | | - Nitin Kumar
- Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, USA
| | - Uday R Desai
- Henry Ford Hospital, Department of Ophthalmology, Detroit, MI, USA
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Morimoto E, Shimada Y, Sugimoto M, Mizuguchi T, Tanikawa A, Horiguchi M. Adherence to face-down and non-supine positioning after macular hole surgery. BMC Ophthalmol 2018; 18:322. [PMID: 30547840 PMCID: PMC6295062 DOI: 10.1186/s12886-018-0979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate patient adherence to face-down positioning (FDP) and non-supine positioning (NSP) following vitrectomy with gas tamponade for treating macular holes (MHs). METHODS Nursing records of 92 patients who underwent vitrectomy with gas tamponade for small-diameter (diameter < 400 μm) MHs during April 2016-June 2017 were examined. Forty-seven and 45 patients were instructed to maintain FDP and NSP (FDP and NSP groups), respectively. Patient adherence was evaluated seven times a day for 3 days, and the adherence rate was calculated. RESULTS The mean adherence rate was significantly higher in the NSP group (99.3% ± 2.7%) than in the FDP group (93.7% ± 13.3%; P < 0.001, Mann-Whitney U test). Forty-one patients (91.1%) in the NSP group had an adherence rate of 100%, which was significantly higher than that in the 24 patients in the FDP group (51.1%; P < 0.001, chi-squared test). No statistically significant difference was observed between the patients in the two groups regarding sex, age, MH diameter, and pre- and postoperative visual acuities. MH closure was achieved in all patients. CONCLUSIONS Almost half of the patients in the FDP group did not obtain 100% adherence rate, suggesting that patient adherence was largely compromised. Patient adherence was better in the NSP group as patient compliance to NSP was better, however, 8.9% of patients were found in face-up positioning at least once. Incompleteness of patient adherence was common, although to differing degrees.
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Affiliation(s)
- Emi Morimoto
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Yoshiaki Shimada
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Mitsuo Sugimoto
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Tadashi Mizuguchi
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Masayuki Horiguchi
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
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A Review of Surgical Outcomes and Advances for Macular Holes. J Ophthalmol 2018; 2018:7389412. [PMID: 29850211 PMCID: PMC5932482 DOI: 10.1155/2018/7389412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/28/2018] [Accepted: 02/18/2018] [Indexed: 01/10/2023] Open
Abstract
The surgical outcomes of macular holes (MHs) have improved greatly in recent years. The closure rate is as high as 90-100%, but the outcomes of some special types of MHs remain unsatisfactory. Internal limiting membrane (ILM) peeling dramatically improves the anatomic success rate, but recent studies have found that it could also cause mechanical and subclinical traumatic changes to the retina. Dyes are widely used, and apart from indocyanine green (ICG), the toxicities of other dyes require further research. Face-down posturing is necessary for MHs larger than 400 μm, and the duration of this posture is determined by the type of tamponade and the case. The ellipsoid zone has been shown to be highly correlated with visual outcome and recovery. New surgical methods include the inverted ILM flap technique and the ILM abrasion technique. However, they require further research to determine their effectiveness.
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Suzuki K, Shimada Y, Seno Y, Mizuguchi T, Tanikawa A, Horiguchi M. Adherence to the face-down positioning after vitrectomy and gas tamponade: a time series analysis. BMC Res Notes 2018; 11:142. [PMID: 29463317 PMCID: PMC5819221 DOI: 10.1186/s13104-018-3257-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/14/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the adherence to the face-down positioning (FDP) in 296 patients who had undergone vitrectomy and gas tamponade. Results We studied 119 female and 177 male patients who had undergone primary vitrectomy and gas tamponade for a macular hole (MH) or for rhegmatogenous retinal detachments (RRDs). Adherence was assessed and recorded four times per day for 3 days postsurgery. The mean ± standard deviation adherence rate was 88.3 ± 11.7 (range 50.0–100.0). Female patients (90.8 ± 10.0) had significantly better adherence than male patients (86.7 ± 13.3; P < 0.02, U test). The adherence was significantly better after MH surgery (90.8 ± 11.7) than after RRD surgery (87.5 ± 12.5; P < 0.02). There were diurnal variations in adherence, being highest in the evening and significantly lower at midnight, and we evidenced a decline in adherence over time, with it being significantly low on the last follow-up day. Adherence to the FDP varied considerably among patients. Adherence was higher in female than in male patients, and higher in patients with MH than in those with RRD. We found patients age had no effect on adherence. Adherence also varied with time, being worst at midnight and declining over time. Electronic supplementary material The online version of this article (10.1186/s13104-018-3257-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keita Suzuki
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiaki Shimada
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Yui Seno
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tadashi Mizuguchi
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masayuki Horiguchi
- Department of Ophthalmology, Fujita Health University School of Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2017; 37:1483-1491. [DOI: 10.1097/iae.0000000000001394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shimada Y, Seno Y, Mizuguchi T, Tanikawa A, Horiguchi M. Patient adherence to the face-down positioning after macular hole surgery. Clin Ophthalmol 2017; 11:1099-1104. [PMID: 28652695 PMCID: PMC5472416 DOI: 10.2147/opth.s135144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine adherence to face-down positioning (FDP) among patients who underwent vitrectomy and gas tamponade for macular hole (MH) repair. Method A total of 69 patients (37 females and 32 males) who underwent primary vitrectomy for MH repair were studied. Nurses recorded whether the patient complied with FDP each time they examined the patient. FDP score was obtained from the nursing records; patients were given a score of 1 if they complied with the FDP and 0 if they did not. The score was recorded four times per day for the first 3 postoperative days. A perfect FDP score was 12. Results The mean ± standard deviation of the FDP scores was 10.6±1.8 (range: 4–12). Overall, 32 (46.4%) patients scored a perfect 12, and 7 (10.1%) patients scored <8. Failure of the MH closure was observed in only one patient (1.4%), who showed the poorest adherence to FDP (score =4). Consequently, the closure rate in patients with FDP score <7 (2/3, 66.7%) was significantly lower than in patients with an FDP score ≥7 (66/66, 100%) (P<0.05, Fisher’s exact probability test). Conclusion While adherence to FDP after MH surgery was better than that observed after vitrectomy for rhegmatogenous retinal detachments in our previous study, the percentage of patients with FDP scores <8 did not differ. Statistically, the poor adherence to FDP can negatively impact the effectiveness of the surgery for MH repair.
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Affiliation(s)
- Yoshiaki Shimada
- Department of Ophthalmology, Fujita Health University Hospital, Aichi, Japan
| | - Yui Seno
- Department of Ophthalmology, Fujita Health University Hospital, Aichi, Japan
| | - Tadashi Mizuguchi
- Department of Ophthalmology, Fujita Health University Hospital, Aichi, Japan
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, Fujita Health University Hospital, Aichi, Japan
| | - Masayuki Horiguchi
- Department of Ophthalmology, Fujita Health University Hospital, Aichi, Japan
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Ethnic variation in primary idiopathic macular hole surgery. Eye (Lond) 2017; 31:708-712. [PMID: 28085145 DOI: 10.1038/eye.2016.296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 11/23/2016] [Indexed: 01/08/2023] Open
Abstract
PurposeThe purpose of the study was to investigate the role of ethnicity on idiopathic macular holes (IMH) structure and surgical outcome. This was a retrospective review.Patients and methodsConsecutive patients undergoing primary IMH surgery at two surgical sites of Moorfields Eye Hospital (London, UK) between April 2012 and June 2013. The main outcome measure was post surgical anatomical closure of IMH.ResultsTwo hundred and twenty two primary IMH surgeries were undertaken. A standard procedure including pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade was undertaken for all cases. 61.3% of patients were Caucasian, 21.2% were South Asian, and 16% were Afro-Caribbean. The mean minimum linear diameter (MLD) for our cohort was 434.6 mcm. Mean MLD was 395.3 mcm in Caucasian patients, 490.0 mcm in South Asians (P=0.006), and 491.4 mcm in Afro-Caribbeans (P=0.007). Regression analysis demonstrated that MLD and Afro-Caribbean ethnicity were independent significant risk factors for surgical failure (OR: 1.01, P<0.001 and OR: 5.73, P=0.008, respectively).ConclusionSouth Asian and Afro-Caribbean patients present with larger IMH than Caucasians. In addition to IMH diameter, Afro-Caribbean ethnicity is an independent risk factor for surgical failure.
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12
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MIRRORED-PRISM SPECTACLES FOR FACEDOWN POSTURING AFTER VITREORETINAL SURGERY WITH GAS TAMPONADE. Retina 2015; 36:846-8. [PMID: 26689270 DOI: 10.1097/iae.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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COMPLIANCE WITH THE FACE-DOWN POSITIONING AFTER VITRECTOMY AND GAS TAMPONADE FOR RHEGMATOGENOUS RETINAL DETACHMENTS. Retina 2015; 35:1436-40. [PMID: 25748281 DOI: 10.1097/iae.0000000000000479] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the compliance with the face-down positioning (FDP) of the patients who had undergone vitrectomy and gas tamponade. METHODS One hundred and twenty-seven patients, 45 females and 82 males, who had undergone primary vitrectomy and gas tamponade for rhegmatogenous retinal detachments were studied. The FDP score was determined as 4 per day for 3 days after the surgery. The patient was given a score of one if the nurse found that the patient was in the FDP and zero if not in the FDP. A perfect FDP score was 12. RESULTS The mean ± SD FDP score was 10.2 ± 1.8 with a range of 3 to 12. Females (10.7 ± 1.2) scored significantly higher than males (9.9 ± 2.1) (Mann-Whitney U test: P < 0.05). Patients who scored a perfect 12 were 38 (29.9%; female, 14:31.1%; male 24:29.3%). Low scorers <8 were all males (12:14.6%) and no females (0:0.0%). Age did not seem to be related. Only 1 patient failed to achieve retinal attachment, although she had scored a perfect 12. CONCLUSION The compliance was considerably varied among patients. Some patients failed nearly or more than half times, and they were mostly males. The significance of the FDP to treat rhegmatogenous retinal detachment needs to be examined in a further investigation.
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Alberti M, la Cour M. Face-down positioning versus non-supine positioning in macular hole surgery. Br J Ophthalmol 2014; 99:236-9. [DOI: 10.1136/bjophthalmol-2014-305569] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ehlers JP, Xu D, Kaiser PK, Singh RP, Srivastava SK. Intrasurgical dynamics of macular hole surgery: an assessment of surgery-induced ultrastructural alterations with intraoperative optical coherence tomography. Retina 2014; 34:213-21. [PMID: 23860560 DOI: 10.1097/iae.0b013e318297daf3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the intrasurgical retinal architectural and macular hole (MH) geometric alterations that occur during surgical MH repair using intraoperative optical coherence tomography. METHODS A retrospective, multisurgeon, single-center, consecutive case series of 21 eyes undergoing surgical repair for MH with concurrent intraoperative optical coherence tomography using a custom microscope-mounted optical coherence tomography system was performed. All patients underwent surgical repair with pars plana vitrectomy, membrane peel, and gas tamponade. A novel three-dimensional segmentation algorithm was used for volumetric analysis of intrasurgical changes of MH geometry after surgical repair. Intraoperative optical coherence tomographic characteristics analyzed included MH volume, minimum diameter, base area, and hole height. Outer retinal architecture changes were analyzed both quantitatively and qualitatively. RESULTS All 21 eyes were successfully imaged with intraoperative optical coherence tomography. Nineteen of 21 eyes had images of sufficient signal strength to allow for quantitative analysis. Significant changes were noted in MH geometry after internal limiting membrane peeling including increased MH volume, increased base area, and decreased top area (all P < 0.03). Additionally, increased subretinal hyporeflectance was noted by expansion of the height between the inner segment/outer segment and retinal pigment epithelium bands (P = 0.008). Peeling methods and surgeon experience did not correlate with the magnitude of architectural alterations. Macular hole algorithm measurements and alterations were associated with visual outcome and MH closure. CONCLUSION Significant alterations occur in MH geometry and outer retinal structure after internal limiting membrane peeling. These changes are subclinical and unable to be appreciated with en face surgical microscope viewing and require intraoperative optical coherence tomography for visualization. Preliminary analysis of these measurements identified an association with visual outcome and successful MH closure. The functional significance of these changes deserves further study.
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Affiliation(s)
- Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Levison AL, Kaiser PK. Vitreomacular interface diseases: Diagnosis and management. Taiwan J Ophthalmol 2014. [DOI: 10.1016/j.tjo.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Purpose To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery. Methods The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1) or outpatient (group 2) surgery, and a comparison of several parameters between these two groups was performed. Results Of the 80 subjects in this study, the average age of group 1 (50 patients) was 49.7 years, and that of group 2 (30 patients) was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant. Conclusion Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.
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Affiliation(s)
- Jin Cheol Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
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Leitritz MA, Ziemssen F, Voykov B, Bartz-Schmidt KU. Usability of a gravity- and tilt-compensated sensor with data logging function to measure posturing compliance in patients after macular hole surgery: a pilot study. Graefes Arch Clin Exp Ophthalmol 2013; 252:739-44. [PMID: 24292701 DOI: 10.1007/s00417-013-2517-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To investigate the use of a small gravity- and tilt-compensated, head-fixed sensor with data-logging function to measure compliance and head posture of patients after macular hole surgery based on the recommendation of a face-down position. Main outcome measures were the median inclination, the times with correct or incorrect head position and the acceptance/annoyance of a data-logging device. METHODS A small battery-driven electronic sensor device with gravity and tilt compensations was placed within a plastic box and fixed on a patient's head with a headband. Face-down position data were logged every half second for 24 h after macular hole surgery and were stored on a memory card. RESULTS Thirteen patients were involved (seven females, six males, median age, 68 years, range, 50-75 years), two cases with early dropout. Ten of 11 datasets could be evaluated showing a complete data record file. The average percentage for face-down >45° was 18% within 24 h and 17% in the daytime. The median inclination was -6.7° (min: -89.7° max: 90°). The sensor system was well tolerated and disturbance was rated low by all ten patients. CONCLUSIONS While the patients' face-down posture considerably varied over time in extent and continuity, the assessment might lead to optimizing the patients' compliance with the optimal position. Results showed an excellent acceptance of the motion sensor.
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Affiliation(s)
- Martin Alexander Leitritz
- Centre for Ophthalmology, University Eye-Hospital, Eberhard Karls University of Tuebingen, Schleichstr. 12, 72076, Tuebingen, Germany,
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Kusuhara S, Negi A. Predicting visual outcome following surgery for idiopathic macular holes. ACTA ACUST UNITED AC 2013; 231:125-32. [PMID: 24296852 DOI: 10.1159/000355492] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022]
Abstract
Since Kelly and Wendel [Arch Ophthalmol 1991;109:654-659] first reported successfully treating macular holes (MHs) using pars plana vitrectomy in 1991, MH surgery has been constantly improved. For example, introducing the removal of the internal limiting membrane considerably increased the closure rate of MHs, and the advent of microincision vitrectomy surgery reduced surgical trauma and decreased patient discomfort after surgery. As modern MH surgery can achieve a higher anatomical success rate and alleviate patients' postoperative distress, postoperative visual outcomes have lately become the primary concern. Informing patients of the expected visual acuity and visual improvement before surgery is ideal, but predicting postoperative visual outcomes is difficult because a large number of factors are associated with them. In this paper, we review previous studies and provide accumulating evidence for the relationship between individual prognostic factors and visual outcomes after MH surgery.
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Affiliation(s)
- Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Choi YM, Oh J, Kim SW, Huh K. Delayed Sealing of Macular Hole after Vitrectomy with Silicone Oil Tamponade. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.4.686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong-Min Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Kuhl Huh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Takahashi A, Yoshida A, Nagaoka T, Takamiya A, Sato E, Kagokawa H, Kameyama D, Sogawa K, Ishiko S, Hirokawa H. Idiopathic full-thickness macular holes and the vitreomacular interface: a high-resolution spectral-domain optical coherence tomography study. Am J Ophthalmol 2012; 154:881-892.e2. [PMID: 22958859 DOI: 10.1016/j.ajo.2012.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography. DESIGN Prospective cross-sectional case series. METHODS Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed. RESULTS Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum. CONCLUSIONS The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).
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Affiliation(s)
- Atsushi Takahashi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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