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Clemens CR, Obergassel J, Heiduschka P, Eter N, Alten F. Imaging the Area of Internal Limiting Membrane Peeling after Macular Hole Surgery. J Clin Med 2024; 13:3938. [PMID: 38999503 PMCID: PMC11242654 DOI: 10.3390/jcm13133938] [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: 05/24/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The aim of this study was to compare en-face optical coherence tomography (OCT) imaging and confocal scanning laser ophthalmoscopy (cSLO) imaging at different wavelengths to identify the internal limiting membrane (ILM) peeling area after primary surgery with vitrectomy and ILM peeling for macular hole (MH). Methods: In total, 50 eyes of 50 consecutive patients who underwent primary surgery with vitrectomy and ILM peeling for MH were studied. The true ILM rhexis based on intraoperative color fundus photography was compared to the presumed ILM rhexis identified by a blinded examiner using en-face OCT imaging and cSLO images at various wavelengths. To calculate the fraction of overlap (FoO), the common intersecting area and the total of both areas were measured. Results: The FoO for the measured areas was 0.93 ± 0.03 for en-face OCT, 0.76 ± 0.06 for blue reflectance (BR; 488 nm), 0.71 ± 0.09 for green reflectance (GR; 514 nm), 0.56 ± 0.07 for infrared reflectance (IR; 815 nm) and 0.73 ± 0.06 for multispectral (MS). The FoO in the en-face OCT group was significantly higher than in all other groups, whereas the FoO in the IR group was significantly lower compared to all other groups. No significant differences were observed in FoO among the MS, BR, and GR groups. In en-face OCT, there was no significant change in the ILM peeled area measured intraoperatively and postoperatively (8.37 ± 3.01 vs. 8.24 ± 2.81 mm2; p = 0.8145). Nasal-inferior foveal displacement was observed in 38 eyes (76%). Conclusions: En-face OCT imaging demonstrates reliable postoperative visualization of the ILM peeled area. Although the size of the ILM peeling remains stable after one month, our findings indicate a notable inferior-nasal shift of the overall ILM peeling area towards the optic disc.
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Affiliation(s)
- Christoph R. Clemens
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
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Qi B, Zhang K, Yang X, Wu X, Wang X, Liu W. Comparison of Different Internal Limiting Membrane Peeling Sizes for Idiopathic Macular Holes: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:1071-1084. [PMID: 37586342 PMCID: PMC10614454 DOI: 10.1159/000531510] [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: 04/12/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Although internal limiting membrane (ILM) peeling facilitates macular hole (MH) closure and reduces late hole reopening, it brings some detrimental consequences to the retinal microstructure and functional outcomes. So far, previous studies have not reached a consensus on the optimal ILM peeling size. OBJECTIVES The objective of this study was to evaluate the outcomes of different ILM peeling sizes for idiopathic MHs. METHODS PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WANFANG were searched until April 10, 2022. Studies in English or Chinese that compare the effects of two ILM peeling sizes (>2 disk diameters [DDs] vs. ≤2DD) for idiopathic MHs were included. The overall closure rate, postoperative best-corrected visual acuity (BCVA), type 1 closure, and adverse events were extracted. BCVA was converted to logarithm of the minimum angle of resolution (LogMAR). RESULTS Seven eligible studies (560 eyes) including 3 randomized clinical trials, 3 prospective trials, and one retrospective cohort were included. Pooled results showed a significantly better postoperative BCVA (mean difference = -0.16; 95% confidence interval [CI]: -0.27 to -0.04; LogMAR) and higher type 1 closure rate (risk ratio [RR] = 1.24; 95% CI: 1.08-1.43) in eyes with ILM peeling >2DD than those with peeling ≤2DD. No significant difference was found in overall closure rate and adverse events between the two groups. Subgroup analysis indicated that in MHs >400 μm, peeling >2DD helped obtain a better postoperative BCVA (mean difference = -0.17; 95% CI: -0.29 to -0.04; LogMAR) and higher frequency of type 1 closure (RR = 1.25; 95% CI: 1.03-1.51). CONCLUSIONS Peeling >2DD shares similar safety level with peeling ≤2DD and has a superiority of facilitating visual recovery. Larger ILM peeling may be more beneficial for large MHs.
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Affiliation(s)
- Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xijin Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xinbo Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Foveal morphology of normal fellow eyes of patients with unilateral macular hole. Ophthalmol Retina 2022; 6:361-368. [PMID: 34999016 DOI: 10.1016/j.oret.2021.12.022] [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: 11/02/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the morphology of the fovea in the ophthalmoscopically and tomographically normal fellow eyes of patients with unilateral idiopathic macular hole (MH) and to determine the association between the foveal morphological parameters and the foveal outer nuclear layer (ONL) thickness. DESIGN Retrospective observational study. PARTICIPANTS Two hundred three normal fellow eyes of patients with unilateral MH and 216 normal eyes of 216 healthy subjects. METHODS All eyes were examined by swept source optical coherence tomography (OCT). The built-in software measured the average retinal and choroidal thickness in the center and in the inner four subfields defined in the Early Treatment Diabetic Retinopathy Study. The total retinal thickness and the three retinal layers at the fovea and parafovea (0.25- and 0.5-mm nasal and temporal from fovea) and foveal floor width (FFW) were measured in the image of a horizontal scan passing through the center of the fovea. We defined the thickness between the internal limiting membrane and outer plexiform layer as the inner retinal thickness, and the thickness between the external limiting membrane and retinal pigment epithelium as the outer retinal thickness. Multiple regression analyses were performed with the age, sex, axial length, and the presence of a posterior vitreous detachment as the dependent variables. MAIN OUTCOME MEASURES OCT measurements and correlations between the foveal parameters and foveal ONL thickness. RESULTS The fellow eyes had a thinner central retinal subfield, thinner fovea, thinner ONL at all points except 0.5 mm nasal, significantly thicker outer retina at all points, and a wider FFW (P=.040 to P<.0001). The foveal ONL thickness was significantly and positively correlated with the central subfield retinal thickness and foveal thickness and negatively with the FFW (all P< .0001). CONCLUSIONS The thinner and deeper fovea and the thinner ONL of the fellow eyes of patients with a unilateral MH makes these eyes more susceptible to forming MH.
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INVERTED INTERNAL LIMITING MEMBRANE-FLAP TECHNIQUE FOR OPTIC DISK PIT MACULOPATHY: MORPHOLOGIC AND FUNCTIONAL ANALYSIS. Retin Cases Brief Rep 2021; 15:31-37. [PMID: 29474223 DOI: 10.1097/icb.0000000000000731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze morphologic and functional changes after inverted internal limiting membrane-flap technique for optic disk pit maculopathy using optical coherence tomography, multifocal electroretinography, and microperimetry. METHODS One case report. RESULTS A 30-year-old woman presented us with decreased visual acuity (20/63) in the left eye because of retinoschisis and serous macular detachment associated with optic disk pit. Optical coherence tomography did not localize the source of intraretinal and subretinal fluid. A partial flattening of serous detachment after vitrectomy with internal limiting membrane peeling, inverted internal limiting membrane-flap technique, and gas tamponade was reported. Visual acuity and multifocal electroretinography improved while retinal sensitivity decreased at microperimetry during 3 months of follow-up. CONCLUSION Optical coherence tomography is helpful to assess the effectiveness of surgical maneuvers to treat optic disk pit maculopathy. Multifocal electroretinography and microperimetry might offer additional tools for follow-up analysis of retinal function after surgery.
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FOVEAL SPARING INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC MACULAR HOLES: EFFECTS ON ANATOMICAL RESTORATION OF THE FOVEA AND VISUAL FUNCTION. Retina 2021; 40:2127-2133. [PMID: 31860521 DOI: 10.1097/iae.0000000000002724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Muller cells seem to be important in maintaining foveal morphology through connections between their foot processes and the internal limiting membrane (ILM). Internal limiting membrane peeling causes Muller cell trauma. We hypothesized that leaving a rim of unpeeled ILM around idiopathic macular holes undergoing vitrectomy surgery would improve postoperative foveal morphology and vision. METHODS Prospective pilot study of fovea-sparing ILM peeling in a consecutive cohort of patients with macular holes over a 12-month period. Spectral-domain optical coherence tomography and Early Treatment Diabetic Retinopathy Study letters best-corrected visual acuity were assessed preoperatively and postoperatively, and foveal morphology and metamorphopsia postoperatively. The foveal sparing group was compared with a second consecutive cohort who received standard ILM peeling (control group). RESULTS Thirty-four eyes of 34 patients were included in each group. Groups showed no significant preoperative differences. 34/34 holes were successfully closed with surgery in the foveal sparing group and 32/34 in the control group. The foveal sparing group showed better postoperative best-corrected visual acuity (67.7 vs. 63.8, P = 0.003) and best-corrected visual acuity improvement (25.1 vs. 20.2, P = 0.03). The foveal sparing group demonstrated thicker minimum foveal thickness (211 vs. 173 μm, P = 0.002) and less steep foveal depression (158 vs. 149, P = 0.002). CONCLUSION Preserving nonpeeled ILM around macular holes resulted in a high closure rate, improved foveal morphology, and better postoperative best-corrected visual acuity. An appropriately powered randomized controlled study is warranted.
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Han GH, Han DJ, Lee JH, Byeon SH, Shin JY. Tomographic Structural Changes of the Inner Retina after Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:235-241. [PMID: 32495532 PMCID: PMC7269741 DOI: 10.3341/kjo.2019.0126] [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: 10/22/2019] [Revised: 01/10/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the tomographic structural changes in the retinal layers after internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM). Methods Sixty-nine eyes treated with vitrectomy and ILM peeling for idiopathic ERM were analyzed. Parafoveal retinal thickness was measured at baseline and 6 months after surgery. Results Total retinal thickness decreased significantly in the nasal and temporal subfields after surgery (p < 0.001), whereas the inner nuclear layer and outer nuclear layer showed nasal thickening (all, p < 0.001). The postoperative temporal/nasal subfield thickness ratio of each layer was significantly lower than that of fellow eyes. Eyes with larger ILM peeling showed a significantly lower temporal/nasal subfield thickness ratio (p = 0.033) than those with smaller sizes. Conclusions The retinal thickness of each layer showed anatomical changes from ILM peeling and ERM removal. Nasal parafoveal thickening and temporal thinning occurred in the inner retinal architecture, which might be affected by ILM peeling size.
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Affiliation(s)
- Ga Hee Han
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Dong Jin Han
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Youn Shin
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.,Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
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Sinawat S, Srihatrai P, Sutra P, Yospaiboon Y, Sinawat S. Comparative study of 1 DD and 2 DD radius conventional internal limiting membrane peeling in large idiopathic full-thickness macular holes: a randomized controlled trial. Eye (Lond) 2020; 35:2506-2513. [PMID: 33159177 DOI: 10.1038/s41433-020-01259-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the surgical outcomes of 1-disc diameter (DD) and 2-DD conventional internal limiting membrane peeling (C-ILMP) in large full-thickness macular holes (FTMHs). MATERIALS AND METHODS A prospective randomized controlled trial. One hundred patients with large idiopathic full-thickness macular hole (FTMH) were randomized into C-ILMP and extended C-ILMP (EC-ILMP) groups. The primary outcome was closure rate at 6 months after surgery. Secondary outcomes were visual acuity (VA), closure type, consequence of ILMP and complications. RESULTS The mean symptom duration was 12.19 ± 9.64 months. Mean preoperative VA was 1.25 ± 0.37 logMAR. The average minimum linear diameter was 633.05 ± 129.82 µm and basal linear dimension was 1158.49 ± 249.07 µm. The two groups did not differ in term of demographic data. Closure rate was significantly higher in the EC-ILMP group (76.47% vs. 51.02%, 95% CI 7.24-43.66; p = 0.008). There were also no significant differences in closure type, central foveal thickness, dissociated optic nerve fibre layer detection, or change in fovea-to-disc distance. There were also no significant differences in postoperative VA (p = 0.069) or visual improvement (mean 0.39 ± 0.43 logMAR; p = 0.286). According to subgroup analysis, EC-ILMP resulted in a higher closure rate in patients with chronic FTMH for >6 months, (p = 0.008). Furthermore, EC-ILMP resulted in better anatomical closure and visual result in patients with FTMH with macular hole closure index ≤0.5, p = 0.003 and p = 0.010, respectively. CONCLUSION Extended C-ILMP yielded a significantly higher closure rate in large FTMHs, but visual outcome did not differ significantly. According to subgroup analysis, extended C-ILMP was more effective in chronic large FTMH with MHCI ≤ 0.5.
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Affiliation(s)
- Suthasinee Sinawat
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Parinya Srihatrai
- Department of Ophthalmology, Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand
| | - Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supat Sinawat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Boral SK, Das A, Sinha TK. A novel standardized reproducible method to calculate the area of internal limiting membrane peeled intra-operatively in macular hole surgery by using a video overlay-A long-term study in cases of idiopathic macular holes. Indian J Ophthalmol 2020; 68:157-161. [PMID: 31856496 PMCID: PMC6951151 DOI: 10.4103/ijo.ijo_589_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To calculate AIP and to find correlation between hole closure pattern with AIP in idiopathic full thickness macular hole (FTMH) cases. Methods: In this prospective, non-randomized, interventional single blind study, 105 eyes of symptomatic FTMH (<6 month duration) were operated. Minimal diameter of macular hole (MDMH) was calculated on OCT, divided into Group I (>400μ, n = 75) and Group II (<400μ, n = 30). 23G vitrectomy with ILM peeling and gas injection were done in all and recorded. Final area of ILM peeled (AIP) was calculated using Adobe Photoshop CS2 (PSD format) in disc diameters (DD) from still frame. Follow up was done at 6 monthly interval up to a maximum of 5 years after surgery. Results: Macular holes were closed in 92.38% eyes. In Group I, mean pre-operative BCVA was 1.14 ± 0.39 log MAR and was improved to 0.79 ± 0.26 log MAR post-operatively at 6 months. In Group II, mean pre-operative BCVA was 0.95 ± 0.44 log MAR and was improved to 0.60 ± 0.24 log MAR after surgery. When AIP was more than 3DD, Type I and Type II closure were 72.77% and 27.27% in Group I (P value <0.01) and 84.21% and 15.79% in Group II (P value <0.01). Conclusion: AIP can be calculated using Adobe Photoshop CS2. Type I closure was significantly high with AIP >3DD in both groups. Intra-operatively using video overlay, surgeons can increase the diameter of AIP to get better closure pattern.
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Affiliation(s)
- Subhendu K Boral
- Disha Eye Hospitals Private Limited, Kolkata, West Bengal, India
| | - Arnab Das
- Disha Eye Hospitals Private Limited, Kolkata, West Bengal, India
| | - Tushar K Sinha
- Disha Eye Hospitals Private Limited, Kolkata, West Bengal, India
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Outcomes of Idiopathic Full-Thickness Macular Hole Surgery: Comparing Two Different ILM Peeling Sizes. J Ophthalmol 2020; 2020:1619450. [PMID: 32908679 PMCID: PMC7450298 DOI: 10.1155/2020/1619450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aimed to show the impact of different extents of internal limiting membrane (ILM) peeling on visual and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery. Methods In this single-center prospective study, patients with idiopathic FTMH underwent standard pars plana vitrectomy with two different extents of ILM peeling: 2-disc diameters (DD) or 4 DD. The main outcome measures were the closure rate of the holes based on optical coherence tomography (OCT) findings at three months after surgery. Results Forty eyes from 39 patients were enrolled in the study. After three months, anatomical closure was achieved in 78% and 76% eyes in 2 DD peel and 4 DD peel groups, respectively. From 29 eyes with macular hole index (MHI) ≤ 0.5, type 1 closure was achieved in 42% eyes receiving a 2 DD ILM peel, compared to 66% eyes receiving a 4 DD peel (p=0.041). In comparison, this significant difference was not seen in the subgroup of MHI > 0.5 (p=061). In the subgroup of subjects with baseline MHI ≤ 0.5, visual improvement was significantly more in eyes with 4 DD ILM peeling (p=0.034), which was not seen in the MHI > 0.5 subgroup (p=0.61). Conclusion In patients with idiopathic full‐thickness macular hole (MHI ≤ 0.5), a larger ILM peel of 4 DD appears to yield better anatomical outcomes than a more limited 2 DD peel.
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Sborgia L, Niro A, D'Oria F, Sborgia G, Sborgia A, Furino C, Giuliani G, Ferrari LM, Boscia F, Recchimurzo N, Alessio G. Perfluorocarbon liquid-assisted inverted inner limiting membrane-flap for large macular hole after recurrent rhegmatogenous retinal detachment. Taiwan J Ophthalmol 2020; 11:193-196. [PMID: 34295629 PMCID: PMC8259532 DOI: 10.4103/tjo.tjo_13_20] [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: 12/09/2019] [Accepted: 02/23/2020] [Indexed: 11/27/2022] Open
Abstract
A 45-year-old Caucasian myopic woman with a severe vision impairment (20/320) in the left eye due to a macula-off rhegmatogenous retinal detachment (RRD) underwent vitrectomy with silicone oil tamponade followed by an inferior relaxing retinectomy with heavy silicone oil tamponade during the second procedure for recurrence of RRD due to proliferative vitreoretinopathy. Four weeks after the second surgery, visual acuity was 20/200 and the patient complained metamorphopsia in the same eye due to a large full-thickness macular hole. A perfluorocarbon liquid-assisted inverted inner limiting membrane-flap technique was performed. Visual acuity improved to 20/80 after closing of macular hole and partial recovery of outer retinal layers at 3 months from the last surgery.
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Affiliation(s)
- Luigi Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. Moscati", ASL TA, Taranto, Italy
| | - Francesco D'Oria
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | | | - Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Luisa Micelli Ferrari
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Nicola Recchimurzo
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
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Theodossiadis G, Theodossiadis P, Chatziralli I. Thoughts and Challenges for the Current Treatment of Optic Disc Pit Maculopathy. Semin Ophthalmol 2020; 35:232-236. [PMID: 32809892 DOI: 10.1080/08820538.2020.1809684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The present review describes the procedures that intervene directly in covering and stuffing the optic disc pit (ODP). METHODS We made a comprehensive review of the literature regarding the new treatment modalities for the treatment of ODP maculopathy, mainly concentrated on covering and stuffing of the ODP. We presented the anatomical and functional outcomes of these techniques in patients with ODP maculopathy, while potential risks and complications of these techniques are also discussed. RESULTS The most commonly used treatment alternative for ODP maculopathy is vitrectomy, which seems to be more successful if it is associated with the covering of the ODP by internal limiting membrane (ILM) inverted flapping. The results of the procedure are successful, if the origin of the fluid comes from the vitreous cavity. Another new procedure aims at the stuffing of the ODP by rolled ILM-flap, autologous scleral tissue or human amniotic membrane, providing promising anatomical results. The so far anatomical and functional results are discussed in detail. The literature, however, is limited regarding these techniques and based mainly on case reports with short-term follow-up. Additionally, the stuffing technique is possible to provoke further damage of optic nerve tissue and remain challenging in its use. CONCLUSIONS Both covering and stuffing techniques of the ODP seem to have promising results, when used as adjunct to vitrectomy. One should take into account special considerations and possible further complications for their use in the treatment of ODP maculopathy.
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Affiliation(s)
- George Theodossiadis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens , Athens, Greece
| | | | - Irini Chatziralli
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens , Athens, Greece
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Ramasamy K, Mishra C. Commentary: A novel, standardized, reproducible method to calculate the area of internal limiting membrane peeled intraoperatively in macular hole surgery using a video overlay: A long-term study in cases of idiopathic macular holes. Indian J Ophthalmol 2020; 68:163. [PMID: 31856498 PMCID: PMC6951172 DOI: 10.4103/ijo.ijo_1526_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sborgia G, Niro A, Coassin M, Sborgia L, D'Oria F, Pastore V, Albano V, Tritto T, Sborgia A, Boscia F, Alessio G. Inverted internal limiting membrane-flap technique to treat a full-thickness macular hole complicating idiopathic macular telangiectasia type 2. Eur J Ophthalmol 2019; 31:NP81-NP85. [PMID: 31690102 DOI: 10.1177/1120672119886177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Full-thickness macular hole is a complication of idiopathic macular telangiectasia type 2 with a low surgical closure rate and a poor functional recovery. We analyze morphologic and functional outcomes after an inverted internal limiting membrane-flap technique for full-thickness macular hole complicating idiopathic macular telangiectasia type 2 using optical coherence tomography and microperimetry. CASE REPORT A 77-year-old man presented us complaining visual impairment in the left eye (20/40) due to a full-thickness macular hole complicating idiopathic macular telangiectasia type 2. The patient underwent vitrectomy with an inverted internal limiting membrane-flap technique and injection of 22% SF6 gas. Optical coherence tomography and functional analysis, including visual acuity test and microperimetry, were performed before surgery and over 3 months. Optical coherence tomography scans revealed macular hole closure at 1-month follow-up. Visual acuity and retinal sensitivity improved from 20/40 to 20/20 and from 13.1 to 14.9 dB, respectively. Fixation stability (bivariate contour ellipse area) improved from 2.02 to 1.58 deg2, from 5.44 to 4.24 deg2 and from 9.72 to 7.58 deg2, at 68%, 95%, and 99% of fixation points, respectively. CONCLUSION Inverted internal limiting membrane-flap technique may be an alternative approach in patients with full-thickness macular hole complicating diopathic macular telangiectasia type 2, and microperimetry may be a useful tool to analyze related functional changes.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI," ASL TA, Statte, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luigi Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Francesco D'Oria
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Valentina Pastore
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Valeria Albano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Tiziana Tritto
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Alessandra Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy.,Eye Clinic, Hospital "S. G. MOSCATI," ASL TA, Statte, Italy
| | - Francesco Boscia
- Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Giovanni Alessio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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14
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Yao Y, Qu J, Dong C, Li X, Liang J, Yin H, Huang L, Li Y, Liu P, Pan C, Ding X, Song D, Sadda SR, Zhao M. The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54-week randomized clinical trial. Acta Ophthalmol 2019; 97:303-312. [PMID: 30187641 PMCID: PMC6585771 DOI: 10.1111/aos.13853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/20/2018] [Indexed: 11/02/2022]
Abstract
PURPOSE To compare the anatomical outcomes of different extents of internal limiting membrane (ILM) peeling in idiopathic macular hole surgery. METHODS Prospective, parallel-group, randomized clinical trial. A total of 121 eyes of 121 patients with idiopathic macular hole underwent pars plana vitrectomy, and peeling of the ILM with a diameter of two disk diameters (DD) or 4DD based on randomization. The main outcome was the proportion of eyes with complete hole closure at 12 months. The second outcome was the hole closure grading stratified by macular hole closure index (MHCI) at each visit. RESULTS At 12 months, there was no significant difference in anatomical outcomes with complete closure achieved in 52 (82.5%) of 63 eyes in the 2DD group and 53 (91.4%) of 58 eyes in the 4DD group (p = 0.15). For subjects with MHCI ≤0.5 (n = 24), complete closure rate was significantly lower in the 2DD group compared to the 4DD group (p = 0.012; 18.2% versus 75.9%, respectively). Average BCVA was lower in 2DD group than 4DD group (p = 0.014). By contrast, when MHCI was >0.5, the complete closure rate between the two groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (p = 0.185). CONCLUSION In patients with idiopathic full-thickness macular hole and MHCI ≤0.5, a larger ILM peel of 4DD tends to achieve better anatomical outcomes than a more limited 2DD peel.
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Affiliation(s)
- Yuou Yao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Jinfeng Qu
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Chongya Dong
- Department of Biostatistics Peking University Clinical Research Institute Beijing China
| | - Xiaoxin Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Jianhong Liang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Hong Yin
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Lvzhen Huang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Yan Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Peipei Liu
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Chungting Pan
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Xue Ding
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Dan Song
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Srinivas R. Sadda
- Doheny Eye Institute Los Angeles California USA
- Department of Ophthalmology David Geffen School of Medicine at University of California‐Los Angeles Los Angeles California USA
| | - Mingwei Zhao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
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15
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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16
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Cho JH, Yi HC, Bae SH, Kim H. Foveal microvasculature features of surgically closed macular hole using optical coherence tomography angiography. BMC Ophthalmol 2017; 17:217. [PMID: 29179702 PMCID: PMC5704531 DOI: 10.1186/s12886-017-0607-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background To describe the features of foveal microvasculature using optical coherence tomography angiography (OCTA) and to determine the related clinical factors in eyes with surgically closed macular hole (MH). Methods A retrospective case series of 18 patients with unilateral MH was reviewed. The patients maintained complete hole closure after vitrectomy with inner limiting membrane (ILM) peeling for at least 12 months. The healthy fellow eyes were studied as controls. The foveal microvasculature of both eyes was examined by OCTA. The area of the foveal avascular zone (FAZ) and the vascular density (VD) ratio in the superficial and deep capillary plexuses (SCP and DCP) were determined after surgery. Several clinical factors including age, stage and dimensions of MH, papillofoveal distance, the extent of nasal displacement of the fovea after surgery, postoperative central foveal thickness, and outer-retina integrity were evaluated to determine any relationships with the OCTA parameters. Results The mean FAZ area in both the SCP and DCP (0.29 ± 0.11 mm2 and 0.39 ± 0.14 mm2) was significantly smaller than those of the controls (0.45 ± 0.14 mm2 and 0.62 ± 0.22 mm2) (p = 0.001 and <0.001, respectively). The mean VD ratio in the SCP (0.270 ± 0.349) was similar to that of the controls (0.321 ± 0.189) (p = 0.231); however, that in the DCP (0.321 ± 0.189) was significantly lower than that of the controls (0.331 ± 0.119) (p = 0.025). Only the extent of nasal displacement of the fovea was correlated with the DCP FAZ-area difference values between the study group and the controls (correlation coefficient = 0.577; p = 0.012). Conclusions After successful MH surgery, the FAZ area in both the SCP and DCP was smaller and the VD ratio of the DCP was lower, suggesting a possible DCP vulnerability to tractional stress. As the FAZ area of the DCP in closed-MH eyes became smaller than that in the controls, the fovea was less displaced toward the optic disc, possibly reflecting a lack of retinal redundancy caused by horizontal stretching accompanied by foveal displacement. Electronic supplementary material The online version of this article (10.1186/s12886-017-0607-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joon Hee Cho
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Ho Chul Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - So Hyun Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea.
| | - Hakyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
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17
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Coppola M, Rabiolo A, Cicinelli MV, Querques G, Bandello F. Vitrectomy in high myopia: a narrative review. Int J Retina Vitreous 2017; 3:37. [PMID: 29021916 PMCID: PMC5623972 DOI: 10.1186/s40942-017-0090-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.
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Affiliation(s)
- Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Desio e Vimercate, Desio, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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