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Tang ZY, Qiao G, Zhang XJ, Xie LJ, Zou QX, He CM, Zhao L, Yang HQ, Quan Y, Cao K, Jiang H, He YK. Covering corneal stromal lenticule for macular hole in pathological myopia. Int J Ophthalmol 2024; 17:1675-1680. [PMID: 39296571 PMCID: PMC11367423 DOI: 10.18240/ijo.2024.09.15] [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: 01/18/2024] [Accepted: 05/24/2024] [Indexed: 09/21/2024] Open
Abstract
AIM To evaluate the clinical effect of a new surgery technique (covering corneal stromal lenticule, CSL) for macular hole (MH) in pathological myopia. METHODS This was a prospective non-randomized series case study. Fourteen eyes of 14 patients whose axial length were more than 29 mm and suffered from MH and macular hole retinal detachment (MHRD) were included in this study. All cases were treated with 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, covering CSL and C3F8 gas tamponade. These cases were followed for 6mo, and the best-corrected visual acuity (BCVA), healing status of MH, the reattached rate of retinal detachment (RD), and reoperation rate were analyzed. RESULTS All cases were successfully performed the surgery and the postoperative follow-up was completed. After surgery, MHs were healed in all 14 eyes (100%, 14/14) after assessed by optical coherence tomography. The reattachment of retina was achieved in all 6 eyes (100%, 6/6) with MHRD. BCVA was improved in 12 eyes (85.71%, 12/14), and had no significant change in 2 eyes (14.29%, 2/14). The overall mean BCVA was improved from 1.80±0.77 to 0.82±0.46 logMAR (F=10.46, P<0.01). No serious complications occurred in all cases. CONCLUSION The new surgery technique (covering CSL) has high reattached rate of RD and high healing rate of MH in pathological myopia in the preliminary study. And it can effectively improve the visual function of patients. This new technique offers meaningful new ideas for treating refractory MH in pathological myopia.
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Affiliation(s)
- Zi-Yan Tang
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Gang Qiao
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Xiao-Juan Zhang
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Li-Jun Xie
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Qiang-Xing Zou
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Chun-Mei He
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Long Zhao
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Hua-Qing Yang
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Yu Quan
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Kui Cao
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Hui Jiang
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
| | - Yu-Kun He
- Wanjiang Eye Hospital of Mianyang, Mianyang 621000, Sichuan Province, China
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Hanai M, Amaral DC, Jacometti R, Aguiar EHC, Gomes FC, Cyrino LG, Alves MR, Monteiro MLR, Fuganti RM, Casella AMB, Louzada RN. Large macular hole and autologous retinal transplantation: a systematic review and meta-analysis. Int J Retina Vitreous 2024; 10:56. [PMID: 39175026 PMCID: PMC11340077 DOI: 10.1186/s40942-024-00573-1] [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: 06/22/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes. METHODS We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software. RESULTS We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I2 = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I2 = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I2 = 59%). CONCLUSION ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.
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Affiliation(s)
- Mário Hanai
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Dillan Cunha Amaral
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raiza Jacometti
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Laura Goldfarb Cyrino
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Milton Ruiz Alves
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Mário Luiz Ribeiro Monteiro
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Noguera Louzada
- Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
- Instituto de Olhos São Sebastião, Largo do Machado 54, 1208, Rio de Janeiro, RJ, 22221-020, Brazil.
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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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Camenzind-Zuche H, Janeschitz-Kriegl L, Hasler PW, Prünte C. Autologous internal limiting membrane transplantation achieves anatomic closure and functional improvement in the treatment of large, persistent macular holes. Int J Retina Vitreous 2024; 10:7. [PMID: 38238805 PMCID: PMC10797851 DOI: 10.1186/s40942-023-00524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To evaluate the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair. METHODS Retrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling. MAIN OUTCOME MEASUREMENTS For all eyes, high-definition spectral domain optical coherence tomography scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed. RESULTS Anatomic closure was achieved in all 13 cases (100% success rate). Closure pattern was classified in accordance with to Rossi et al. (Graefe's Arch Clin Exp Ophthalmol 258(12):2629-2638, 2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. No re-opening occurred during the observation period. CONCLUSIONS Placing an autologous ILM-transplant in the subretinal space beneath the margin of the FTMH can support anatomic restauration and functional improvement in large, persistent FTMHs.
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Affiliation(s)
- Hanna Camenzind-Zuche
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.
| | - Lucas Janeschitz-Kriegl
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Pascal W Hasler
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Christian Prünte
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
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Zhang L, Xi H, Chen J, Sheng A, Fan W, Li S, Liu H. Inverted Pedicled Internal Limiting Membrane Flap Attached to an Optic Disc with Autologous Blood Clot for Large Macular Holes. J Ophthalmol 2023; 2023:7640476. [PMID: 37483314 PMCID: PMC10361828 DOI: 10.1155/2023/7640476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose An inverted ILM flap might be accidentally separated from the retina or sucked away during surgery for large macular holes (MHs). This article is to determine the efficacy of a new inverted pedicled internal limiting membrane (ILM) flap attached to an optic disc with an autologous blood clot (ABC) technique for the treatment of large MHs. Methods An inverted pedicled ILM flap connected to the optic disc with ABC was used to treat 12 consecutive patients with significant macular holes (>600 m). The ILM was first peeled off around MH as a semidiameter of about 1.5 diameters of the optic disc. The superior residual ILM was used to produce a pedicled ILM flap that was connected to the optic disc and was later inverted to cover the MH. The macular hole was covered with a repositioned flap larger than 2 MH diameters in an inverted way. ABC was used to fasten the flap, followed by fluid-air exchange with air or C3F8 as tamponade. Spectral domain-optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) were performed at each postoperative follow-up. Results The mean aperture and base macular hole diameters were 737.9 ± 109.6 µm (range, 607-982 µm) and 1244.3 ± 227.4 µm (range, 975-1658 µm). All macular holes (100%) were closed after a single surgery without intraoperative or postoperative complications related to the ILM transposition technique. At the last postoperative visit, we found one eye with a U-shaped closure, three eyes with W-shaped closures, and eight eyes with V-shaped closures. No postoperative flap closures were noted in all cases. The preoperative mean BCVA was 1.5 ± 0.3 (range, 1.1-2.0). After a mean follow-up of 5.3 ± 4.8 (range, 3-16) months, the postoperative mean BCVA was 0.8 ± 0.2 (range, 0.6-1.1), and the difference was statistically significant (p < 0.05). Conclusion This novel technique is safe and suitable for large MHs and can be an alternative option for accidental ILM flap loss during other inverted ILM flap operations.
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Affiliation(s)
- Lishuai Zhang
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Huiyu Xi
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Jiayu Chen
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Aiqin Sheng
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Wei Fan
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Suyan Li
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
| | - Haiyang Liu
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China
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Siotto-Pintor E, Tatti F, Peiretti E. AMNIOTIC MEMBRANE TRANSPLANT IN A PATIENT WITH RECURRENT MACULAR HOLE AND ATROPHIC AGE-RELATED MACULAR DEGENERATION. Retin Cases Brief Rep 2023; 17:482-485. [PMID: 37364214 DOI: 10.1097/icb.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a case of a recurrent macular hole (MH) and atrophic age-related macular degeneration in a patient, treated with human amniotic membrane transplant. METHODS Interventional case report. RESULTS A 72-year-old man was referred to our Retina Unit for a recurrent MH associated with atrophic age-related macular degeneration. The patient was already operated for a full-thickness MH without any anatomical and functional benefit. A 25-gauge vitrectomy, under local anesthesia was performed. A human amniotic membrane patch was transplanted under the retina through a 180° retinectomy to close the MH and eventually exploit his regenerative effects on the atrophic pigment epithelium. Follow-up was taken at 1, 3, and 6 months and 1 year. No intra- or postoperative complications were recorded. At 1 month, a complete MH closure was achieved, and best-corrected visual acuity increased from 20/400 to 20/320. Unfortunately, after 1 year, the macular atrophic area increased and the best-corrected visual acuity came back to 20/400. CONCLUSION A human amniotic membrane was used to close a MH in a patient with atrophic age-related macular degeneration, although progression of the geographic atrophy continued after MH closure.
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Optical Coherence Tomography Angiography in Macular Holes Autologous Retinal Transplant. J Clin Med 2023; 12:jcm12062350. [PMID: 36983350 PMCID: PMC10056546 DOI: 10.3390/jcm12062350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 03/22/2023] Open
Abstract
In this paper, we compare the post-operative macular microvascular parameters (vascular density and foveal avascular zone) in eyes with refractory macular hole (MH) that underwent pars plana vitrectomy and autologous retinal transplant (ART) with the fellow unoperated eye. We conducted a retrospective case control study of six consecutive patients who underwent pars plana vitrectomy and ART with at least six months of post-operative follow-up. Pre-operatively, all eyes underwent SD-OCT (Spectral Domain Optical Coherence Tomography) examination. Post-operative OCT-A analyses included vascular density (VD) and the foveal avascular zone (FAZ) area. Six patients with a mean age of 63.7 ± 14.3 years were included. The mean follow-up was 24 months (range 6–30 months). The pre-operative BCVA (best-corrected visual acuity) was 0.99 ± 0.46 logMAR and 1.02 ± 0.23 logMAR at the last post-operative visit (p = 1.00). The mean MH diameter was 966 ± 620 µm. VD in the MH group was 28.1 ± 7.3% compared to 20.2 ± 2.9% in the fellow eyes group (p < 0.05). The mean post-operative FAZ area in the MH group was 109.8 ± 114.6 mm2 compared to 41.5 ± 10.4 mm2 in the control group (p < 0.05). In all six eyes, MH closure was obtained. The post-operative visual acuity did not improve after ART. Eyes with a closed MH showed a bigger FAZ with a higher VD compared to the fellow healthy eye.
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Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, Bacherini D, Rodrigues EB, Meyer CH, Caporossi T, Mahmoud TH, Rizzo S, Johnson MW, Duker JS. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous 2023; 9:4. [PMID: 36717928 PMCID: PMC9885593 DOI: 10.1186/s40942-022-00439-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making. METHODS We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups. RESULTS Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases. CONCLUSIONS The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400-550 µm) and X-Large (550-800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.
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Affiliation(s)
- Flavio A. Rezende
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Bruna G. Ferreira
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Emmanouil Rampakakis
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - David H. Steel
- grid.1006.70000 0001 0462 7212Sunderland Eye Infirmary, Sunderland, and Newcastle University, Newcastle-Upon-Tyne, UK
| | - Michael J. Koss
- Augenzentrum Nymphenburger Höfe/Augenklinik Herzog Carl Theodor, Munich, Germany
| | | | - Daniela Bacherini
- grid.8404.80000 0004 1757 2304Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, Florence, Italy
| | - Eduardo B. Rodrigues
- grid.262962.b0000 0004 1936 9342Department of Ophthalmology, St. Louis University, St. Louis, MO USA
| | | | - Tomaso Caporossi
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Tamer H. Mahmoud
- grid.261277.70000 0001 2219 916XAssociated Retinal Consultants, Beaumont Neuroscience Center, Oakland University William Beaumont School of Medicine, Royal Oak, MI USA
| | - Stanislao Rizzo
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Mark W. Johnson
- grid.214458.e0000000086837370Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI USA
| | - Jay S. Duker
- grid.67033.310000 0000 8934 4045New England Eye Center, Tufts Medical Center, Boston, MA USA ,grid.67033.310000 0000 8934 4045Department of Ophthalmology, Tufts Medical Center, Boston, MA USA
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Güven D, Gül C, Yılmaz Z, Karataş ME. Logbook of a Retinal Autograft. Turk J Ophthalmol 2022; 52:360-365. [PMID: 36317828 PMCID: PMC9631507 DOI: 10.4274/tjo.galenos.2022.52333] [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] [Indexed: 11/07/2022] Open
Abstract
This study aimed to evaluate the prognosis of a retinal autograft that was used to treat a macular hole that occurred after repeated vitreoretinal surgeries. A patient underwent repeated vitreoretinal surgery due to retinal detachment in the right eye, and the internal limiting membrane was also removed during the surgeries. After silicone oil removal, the patient developed recurrent retinal detachment and macular hole, and for this reason a retinal autograft was applied to the macular hole and silicone tamponade was administered. The silicone oil was removed at postoperative 7 months, and the macular hole was observed to be closed on fundus examination at 18 months. The final visual acuity was 5/100. On optical coherence tomography (OCT), the hole in the detached retina was measured as 600 µm in diameter preoperatively, 1020 µm on the first postoperative day, gradually narrowed to 765 µm, and graft integration occurred. During follow-up, the accumulation of hyperreflective spots persisted on the inner surface of the graft tissue and in all vertically extending sections. In en face sections, it appeared as a hyperreflective arc between the graft and host retina with a shadowing artefact. In OCT angiography evaluation, a punctate multiple blood flow signal in the vertical axis of the graft was detected in the early phase at 3 months. This finding persisted at 1 month after silicone removal, and the flow signal disappeared with resorption of the cystic edema. These flow signals were in the same location as the areas of hyperreflective spots on structural OCT. In conclusion, structural OCT and OCT angiography are effective methods for the follow-up of retinal autograft integration into host tissue.
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Affiliation(s)
- Dilek Güven
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Cengiz Gül
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Zeynep Yılmaz
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Mehmet Egemen Karataş
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
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10
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Dhami A, Biswas RK, Dogra M, Singh R, Mittal S, Ratra D. Comparison of three techniques of harvesting full-thickness retinal tissue for large or persistent macular holes. Indian J Ophthalmol 2022; 70:3610-3616. [PMID: 36190056 PMCID: PMC9789844 DOI: 10.4103/ijo.ijo_743_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the success rate of autologous retinal graft (ARG) for the closure of full-thickness macular holes (MHs) and compare the outcomes of three different techniques of harvesting the graft. Methods Clinic files of all patients who had undergone ARG for MH using intraocular scissors, membrane loop, or retinal punch to harvest retinal tissue were retrospectively reviewed. All patients were evaluated for MH closure, retinal reattachment, and visual improvement. Results Twenty-two eyes of 22 patients were included. ARG was done for 16 eyes (72.7%) with failed, large persistent MH, and six eyes (27.3%) also underwent simultaneous repair of retinal detachment. The basal diameter of MH was 1103.67 ± 310.09 (range 650-1529) μm. Intraocular scissors were used in 10 eyes (45.5%), a membrane loop in five eyes (22.7%), and a retinal punch in seven eyes (31.8%). Silicone oil tamponade was used in seven (31.8%) eyes and gas in 15 (68.1%) eyes. The follow-up ranged from 6 to 18 months. The hole closure rate was 72.7% (16/22). Visual improvement was noted in 18 eyes (81.8%). Retinal reattachment was seen in all eyes. Good graft integration with the surrounding area was seen in 17 eyes (77.3%). Graft retraction was seen in four eyes (18.18%) and graft loss in one eye (4.55%). No significant differences were noted among the three groups. Conclusion ARG is successful in closing large, failed MH with and without retinal detachment. A membrane loop and retinal punch are equally useful in harvesting the graft, but scissors are preferable in case the retina is detached. With all three techniques, integration of the graft with the surrounding tissue can be achieved.
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Affiliation(s)
| | - Rupak Kanti Biswas
- Netralayam- The Superspeciality Eye Care Centre, Kolkata, West Bengal, India
| | - Mohit Dogra
- Department of Vitreoretinal Diseases, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Vitreoretinal Diseases, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sangeet Mittal
- Department of Vitreoretinal Diseases, Thind Eye Hospital, Jalandhar, Punjab, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India,Correspondence to: Dr. Dhanashree Ratra, Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai - 600 006, Tamil Nadu, India. E-mail:
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11
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Dhami A, Sharma P, Dhami NB, Dhami GS. To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes. Indian J Ophthalmol 2022; 70:3033-3037. [PMID: 35918967 DOI: 10.4103/ijo.ijo_3215_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes. Methods This is a retrospective study analyzing medical records of consecutive patients with refractory macular hole (at least 1 prior surgery) and eyes with retinal detachment with coexisting macular holes (MH). Optical coherence tomography (OCT) of the macula was performed before and after surgery. The primary study outcome evaluated were the functional and anatomic macular hole closure, and secondary outcomes were improvement in visual acuity and restoration of the outer retinal bands, external limiting membrane, and ellipsoid zone in eyes with acquisition of autologous retinal transplant using Finesse Loop. Results The study included eight eyes of eight patients; retinal autograft was performed in six (75.0%) and autologous retinal transplantation (ART) with rhegmatogenous retinal detachment (RRD) was performed in two (25.0%) eyes. The average MH basal diameter in the study was 1310.88 ± 138.63 μm. The successful hole closure rate was observed to be 75% (6 eyes) and 100% retinal reattachment was observed in ART with RRD. Statistically significant (P = 0.001) improvement was noted for preop and postop visual acuity gain for ART acquisition and postop macular hole closure. The restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) was observed in 37.5% (3 eyes) of patients. Conclusion Finesse™ Flex Loop can be used to harvest retinal tissue and it provides good anatomical and functional outcomes for failed macular hole.
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Affiliation(s)
- Abhinav Dhami
- Vitreo Retina, Dhami Eye Care Hospital, Ludhiana, Punjab, India
| | - Pragya Sharma
- Medical Retina Services, Dhami Eye Care Hospital, Ludhiana, Punjab, India
| | - Nimrata B Dhami
- Cataract, Refractive and Cornea, Dhami Eye Care Hospital, Ludhiana, Punjab, India
| | - Gobinder S Dhami
- Medical Director, Dhami Eye Care Hospital, Ludhiana, Punjab, India
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12
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Chakraborty D, Mondal S. Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes. Indian J Ophthalmol 2022; 70:3037-3039. [PMID: 35918968 PMCID: PMC9672763 DOI: 10.4103/ijo.ijo_869_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Debdulal Chakraborty
- Department of Vitreo-Retina Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Soumen Mondal
- Department of Vitreo-Retina Services, Disha Eye Hospitals, Kolkata, West Bengal, India
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13
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Frisina R, Gius I, Tozzi L, Midena E. Refractory full thickness macular hole: current surgical management. Eye (Lond) 2022; 36:1344-1354. [PMID: 33479488 PMCID: PMC9232562 DOI: 10.1038/s41433-020-01330-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
This review aims to collect the proposed surgical techniques for treating full thickness macular hole (FTMH) refractory to pars plana vitrectomy and internal limiting membrane (ILM) peeling and to analyse and compare anatomical and functional outcomes in order to evaluate their efficacy. The articles were grouped according to the surgical techniques used. Refractory FTMH closure rate and best-corrected visual acuity (BCVA) gain were the two analysed parameters. Thirty-six articles were selected. Ten surgical technique subgroups were defined: autologous platelet concentrate (APC); lens capsular flap transplantation (LCFT); autologous free ILM flap transplantation (free ILM flap); enlargement of ILM peeling, macular hole hydrodissection (MHH), autologous retinal graft (ARG), silicon oil (SO), human amniotic membrane (hAM), perifoveal relaxing retinotomy, arcuate temporal retinotomy. Refractory FTMH closure rate was similar among subgroups, not significant heterogeneity emerged (p = 0.176). BCVA gain showed a significant dependence on surgical technique (p < 0.0001), significant heterogeneity among subgroups emerged (p < 0.0001). Three sets of surgical technique subgroups with a homogeneous BCVA gain were defined: high BCVA gain (hAM); intermediate BCVA gain (APC, ARG, LCFT, MHH, SO); low BCVA gain (free ILM flap, enlargement of peeling, arcuate temporal retinotomy). In terms of visual recovery, the most efficient technique for treating refractory FTMH is hAM, lens capsular flap and APC that allow to obtain better functional outcomes than free ILM flap. MHH, ARG, perifoveal relaxing and arcuate temporal retinotomy require complex and unjustified surgical manoeuvres in view of the surgical alternatives with overlapping anatomical and functional results.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology of University of Padova, Padova, Italy.
| | - Irene Gius
- Department of Ophthalmology of University of Padova, Padova, Italy
| | - Luigi Tozzi
- Department of Ophthalmology of University of Padova, Padova, Italy
| | - Edoardo Midena
- Department of Ophthalmology of University of Padova, Padova, Italy
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Yang N, Zeng S, Yang J, Lu G, Du L. Application of Platelet-rich Fibrin Transplantation for Large Macular Hole. Curr Eye Res 2022; 47:770-776. [PMID: 35179414 DOI: 10.1080/02713683.2022.2029906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose Large idiopathic macular hole (MH) has a lower closure rate and poor visual prognosis. To increase the closure rate and the visual outcome in patients with large MH, we evaluate a technique of platelet-rich fibrin (PRF) membrane transplantation for the treatment of large MH.Methods This was a prospective interventional study. Seventeen eyes of 17 patients (8 males and 9 females) with large MH (654.94 ± 188.08 μm) underwent pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling followed by PRF transplantation between January 2019 to December 2020. The patients were followed up for at least 6 months. Preoperatively and postoperatively, all patients underwent comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, ultra-widefield retinal imaging, optical coherent tomography (OCT), and optical coherent tomography angiography (OCTA).Results All the patients achieved complete and consistent hole closure after the surgery (100%). At six months follow-up, the external limiting membrane (ELM) defects were observed in 3 eyes (17.64%), and the ellipsoid zone (EZ) defects were observed in 10 eyes (58.82%). The preoperative BCVA was 1.21 ± 0.33 in logMAR. Postoperatively, the BCVA was significantly improved to 0.64 ± 0.22 in logMAR at 6 months (P < 0.001). The foveal avascular zone (FAZ) reduced significantly from 0.41 ± 0.08 mm2 to 0.26 ± 0.07 mm2 (P < 0.001). No complications were observed during or after the operation.Conclusions All patients in this study have achieved good anatomic and functional results, which indicate that the application of PRF transplantation is an effective and safe technique for large MH.
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Affiliation(s)
- Ning Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, China
| | - Siyu Zeng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, China
| | - Juan Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, China
| | - Guojing Lu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, China
| | - Lei Du
- Department of Ophthalmology, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, China
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15
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Romano MR, Rossi T, Borgia A, Catania F, Sorrentino T, Ferrara M. Management of refractory and recurrent macular holes: A comprehensive review. Surv Ophthalmol 2022; 67:908-931. [DOI: 10.1016/j.survophthal.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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16
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Kalur A, Muste J, Singh RP. A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes. Ophthalmic Surg Lasers Imaging Retina 2022; 53:52-61. [PMID: 34982003 DOI: 10.3928/23258160-20211210-03] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm. MATERIAL AND METHODS PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 μm. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole. RESULTS Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of -0.48 ± 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of -0.15 ± 0.17 and -0.14 ± 0.91 logMAR, respectively. CONCLUSION An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:52-61.].
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17
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Da Mota SEH, Morales-Cantón V, Rojas-Juárez S, López-Bolaños A, Ramírez-Estudillo A, Macouzet LB. Autologous Retinal Transplant for Macular Hole. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We aim to review scientific literature concerning published studies on autologous retinal transplantation to treat macular hole patients. The following databases were searched: Medline and Medline Non-Indexed Items, Embase (1990–2020), Ovid Medline® (1990 to November 2020), Embase (1990 to November 2020), Ovid Medline® and Epub Ahead of Print, in-Process and Web of Science (all years). Search keywords included “autologous”, “retinal transplant”, “autologous neurosensory retinal free flap” “transplantation”, “macular hole”, and “macular hole surgery”. Eighteen case series and single case reports were reviewed.
Preoperative and final best-corrected visual acuity, microperimetry and multifocal electroretinogram findings, macular hole closure rate, preoperative and postoperative ellipsoid zone, and external limiting membrane defects were obtained and analyzed. Indications of autologous retinal transplantation for macular hole surgery included refractory macular holes, conventional techniques, and large macular holes. The number of cases included in the different case series ranged from 2 to 130 cases, and prior macular hole surgeries of the patients ranged from 0 to 3. Overall, the published case series of autologous retinal transplants have reported a macular hole closure rate of 66.7 to 100%, as well as a significant improvement in best-corrected visual acuity. The most frequently reported complications included considerable intraoperative bleeding and postoperative dislocation of the graft. The presence of functionality in the graft area has also been documented by microperimetry and multifocal electroretinogram.
In conclusion, the autologous retinal transplantation technique for macular hole patients has emerged as another surgical option, with a high macular hole closure rate and visual improvement.
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Abdul-Kadir MA, Lim LT. Update on surgical management of complex macular holes: a review. Int J Retina Vitreous 2021; 7:75. [PMID: 34930488 PMCID: PMC8686572 DOI: 10.1186/s40942-021-00350-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.
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Affiliation(s)
| | - Lik Thai Lim
- Department of Ophthalmology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
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19
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Patel SN, Mahmoud TH, Kazahaya M, Todorich B. AUTOLOGOUS NEUROSENSORY RETINAL TRANSPLANTATION: Bridging the Gap. Retina 2021; 41:2417-2423. [PMID: 33990116 DOI: 10.1097/iae.0000000000003210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the autologous retinal transplantation surgical technique, indications, rationale, and current outcomes of data published to date. METHODS Review of surgical technique, preoperative and postoperative best-corrected visual acuity, and macular hole (MH) closure rate in studies with at least five eyes. RESULTS The weighted average macular hole closure rate is 88%, with a MH closure rate ranging from 66.7% to 100%. The weighted average best-corrected visual acuity improved from mean logarithm of the minimum angle of resolution 1.35 (Snellen equivalent of 20/450) preoperatively to mean logarithm of the minimum angle of resolution 1.02 (Snellen equivalent of 20/210) postoperatively. From the largest autologous retinal transplantation case series, 37% of patients gained 3 or more lines of visual acuity after autologous retinal transplantation for primary or refractory MHs and 74% gained 3 or more lines of visual acuity after autologous retinal transplantation for MH-retinal detachments. Functional improvement including negative Watzke-Allen sign and conversion from positive to negative scotoma was reported in large case series. CONCLUSION Autologous retinal transplantation is a promising technique for closure of large and refractory MHs otherwise difficult to repair with conventional techniques. This technique may allow for replacement of neural tissue in the macula through cell rehabilitation and regeneration through presumed ectopic synaptogenesis, retinal progenitor cell differentiation and integration, and/or retinal progenitor cell material transfer to host neurons.
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Affiliation(s)
- Saagar N Patel
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Tamer H Mahmoud
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan; and
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20
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Yuan A, Yang D, Olmos de Koo L. Current Trends in Macular Hole Repair. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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HUMAN AMNIOTIC MEMBRANE TO CLOSE RECURRENT, HIGH MYOPIC MACULAR HOLES IN PATHOLOGIC MYOPIA WITH AXIAL LENGTH OF ≥30 mm. Retina 2021; 40:1946-1954. [PMID: 31868775 DOI: 10.1097/iae.0000000000002699] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of the human amniotic membrane plug for recurrent high myopic macular hole (MH) that already underwent pars plana vitrectomy with internal limiting membrane peeling and gas endotamponade. METHODS Sixteen eyes of 16 patients with recurrent high myopic MH were enrolled. A 23-gauge pars plana vitrectomy was performed. Human amniotic membrane plugs were implanted under the neuroretina inside the MH. Twenty percent sulfur hexafluoride or air was used as endotamponades. The patients were instructed to maintain facedown position for 5 days after surgery. RESULTS Optical coherence tomography examinations showed that the MHs closed in 15 of the 16 patients (93.75%) 2 weeks after one surgical intervention, and in 100% of patients after second intervention. Mean best-corrected visual acuity improved from 1 logarithm of the minimum angle of resolution (20/200) to 0.67 logarithm of the minimum angle of resolution (20/100) 6 months after surgery. Best-corrected visual acuity remained stable during the 12-month follow-up. One patient had human amniotic membrane plug dislocation after gas absorption that needed a second intervention with new AM plug implantation. No adverse events were reported during the 12-month follow-up. CONCLUSION The first case series of recurrent high myopic MH was reported, assessing the effectiveness of the human amniotic membrane plug to close recurrent MHs in pathologic myopia. All the cases were successful with encouraging best-corrected visual acuity recovery.
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22
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Marlow ED, Mahmoud TH. Current management strategies for atypical macular holes. Taiwan J Ophthalmol 2021; 11:221-231. [PMID: 34703737 PMCID: PMC8493981 DOI: 10.4103/tjo.tjo_26_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Abstract
This review evaluates the current surgical management options for refractory and atypical macular holes (MH) and proposes a treatment paradigm for approaching complex cases. A review of literature was performed to deliver a thorough discussion of the epidemiology and pathophysiology of MH as well as the historic evolution of surgical management strategies. With this context established, an update on recent surgical advances for management of large, chronic, and highly myopic MH is provided. New small MH may be adequately treated with pars plana vitrectomy, while those ≥300 μm should undergo internal limiting membrane (ILM) peel. For MH ≥400 μm with risk factors for failure, primary intervention should involve creation of an ILM flap and various methods of flap creation are discussed. For very large MH ≥700 μm or in refractory cases, autologous retinal transplants and other recently proposed procedures should be considered. While typical MHs enjoy high initial surgical success rates, atypical and refractory MH require additional intraoperative and postoperative considerations to maximize surgical success and optimize vision. With many techniques at the surgeon's disposal, patient selection becomes critical to improving outcomes.
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Affiliation(s)
| | - Tamer H. Mahmoud
- Associated Retinal Consultants, P.C., Royal Oak, MI, USA
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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23
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Lumi X, Petrovic Pajic S, Sustar M, Fakin A, Hawlina M. Autologous neurosensory free-flap retinal transplantation for refractory chronic macular hole-outcomes evaluated by OCT, microperimetry, and multifocal electroretinography. Graefes Arch Clin Exp Ophthalmol 2021; 259:1443-1453. [PMID: 33090282 DOI: 10.1007/s00417-020-04981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the safety, anatomical and functional outcomes of autologous neurosensory retinal transplant in patients with a refractory large unclosed macular hole. PATIENTS AND METHODS This is a prospective case series of four patients with large chronic macular hole that underwent vitrectomy and free-flap neurosensory retinal transplantation surgery with silicone oil tamponade. The hole was closed with an autologous retinal transplant of an approximate diameter of 1.5-1.8 mm, harvested outside the vascular arcades. Anatomical and functional outcomes were assessed using best-corrected visual acuity (BCVA-Snellen), optical coherence tomography (OCT), OCT angiography, microperimetry (MP), and multifocal electroretinography (mfERG). RESULTS There were 2 male and 2 female patients with median age of 73 (60-81) years. The median follow-up period was 17 (13-23) months. The median preoperative size of the macular hole was 1872.5 (868-2591) μm at the widest basal diameter and 828 (556-1099) μm at the minimum diameter. Surgery resulted in the anatomical closure of the macular hole in all cases. The OCT showed structural integration of the transplant and reappearance of the inner segment ellipsoid to different extents. The BCVA improved from preoperative 0.1 (6/60; + 1.0 logMAR), 0.1 (6/60; + 1.0 logMAR), 0.05 (6/120; + 1.3 logMAR), and 0.005 (6/1200; + 2.3 logMAR) to 0.2 (6/30; + 0.7 logMAR) postoperatively in cases 1, 2, and 4, and to 0.1 (6/60; + 1.0 logMAR) in case 3. MP showed retinal function in the region corresponding to the area of the transplant (circle of 1.8 mm in diameter) in all patients after the surgery (median sensitivity in that region was 4.0 dB, range 1.8-12.4 dB). Improvement was noted in the patient that had MP performed before the surgery (mean sensitivity improved from 0 to 1.8 dB). Detectable function was mostly located in the peripheral regions of the transplant. Multifocal ERG showed abnormal function of the central ring and normal function of the second ring in 3 of 4 cases. The OCT angiography showed normal perfusion, without signs of neovascularization. There were no intra- or postoperative complications. CONCLUSION Autologous retinal transplantation surgery is a successful technique for closing of large refractory macular holes. The procedure is safe and provides good anatomical results. Visual acuity, microperimetry, and mfERG suggest some gradual functional integration of outer regions of the transplants, but no central functional restitution has been detected as yet.
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Affiliation(s)
- Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
| | - Sanja Petrovic Pajic
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
- Clinic for Eye Diseases, Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Maja Sustar
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
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Chakraborty D, Sengupta S, Mukherjee A, Majumdar S. Anatomical and functional outcomes one year after vitrectomy and retinal massage for large macular holes. Indian J Ophthalmol 2021; 69:895-899. [PMID: 33727455 PMCID: PMC8012922 DOI: 10.4103/ijo.ijo_1680_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to report results of macular hole closure, visual benefit and longitudinal changes in foveal architecture over 1 year following macular hole surgery with retinal massage. Methods Records of patients with full thickness macular hole (FTMH) with minimum basal diameter of 550 μ who underwent vitrectomy, internal limiting membrane (ILM) peeling and retinal massage were drawn up. Retinal massage was performed after dye assisted ILM peeling, using a 27G flute needle with a long and soft silicone tip under air in a centripetal direction around the FTMH. At the end, 10% C3F8 gas was used as tamponade. The foveal contour at 1 year follow up was recorded based on its cross sectional appearance on OCT and was classified into U, V and irregular types of closure as previously described. Results Forty-one eyes of 41 patients with a mean age of 70.4 ± 6.9 years were included. The mean preoperative vision was 0.99 ± 0.07 logMAR and mean maximum basal diameter of the FTMH was 835 ± 208 μ. Macular hole closure was seen in all patients at 1-month follow up. The BCVA improved to 0.5 ± 0.1 log MAR at 6 months (P < 0.001) and then stabilized. The U shaped closure was the commonest pattern (n = 22, 54%), followed by V-shaped closure (n = 16, 39%) while irregular closure was seen in 3 eyes (7%). Conclusion Retinal massage after ILM peeling is a very simple, and as yet under-utilized manoeuvre that may improve hole closure rates and lead to potentially greater improvement in vision compared to existing techniques for large holes.
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Affiliation(s)
| | - Sabyasachi Sengupta
- Consultant Vitreoretinal Surgeon, Future Vision Eye Care and Research Centre, Mumbai, India
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INTRAOPERATIVE AND POSTOPERATIVE MONITORING OF AUTOLOGOUS NEUROSENSORY RETINAL FLAP TRANSPLANTATION FOR A REFRACTORY MACULAR HOLE ASSOCIATED WITH HIGH MYOPIA. Retina 2021; 41:921-930. [PMID: 33079787 DOI: 10.1097/iae.0000000000003000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the intraoperative and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for a high myopia-related refractory macular hole (MH). METHODS This prospective interventional study enrolled five eyes of five patients (age range 54-84 years) with highly myopic refractory MHs who underwent ART. All cases were evaluated with intraoperative optical coherence tomography and postoperative optical coherence tomography, optical coherence tomography angiography, and microperimetry for at least 6 months postoperatively. RESULTS Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4 days to 6 days. Optical coherence tomography discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1,504 ± 684 µm preoperatively to 1,111 ± 356 µm postoperatively. The best-corrected visual acuity improved in two cases, was stable in two cases, and deteriorated in one case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In two eyes, choroidal neovascularization developed beneath the transplanted retinas. CONCLUSION Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Because choroidal neovascularization may develop, detailed monitoring is required.
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MANAGEMENT OF LARGE OR RECURRENT MACULAR HOLES. CURRENT OPHTHALMOLOGY REPORTS 2021; 8:62-68. [PMID: 33585076 DOI: 10.1007/s40135-020-00231-3] [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: 10/24/2022]
Abstract
Purpose of Review To review and critically appraise the recent literature about new surgical techniques for the management of large or recurrent macular holes. Recent Findings A variety of surgical approaches have recently been developed ranging from autologous retinal grafts to amniotic membrane transplant with varying levels of anatomical and visual success. Summary More data is needed to determine if one technique is superior to others. However, with a variety of grafts, adhesives, and tamponades at their disposal, vitreoretinal surgeons have an extensive array of options to approach complex macular holes.
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Sonmez K. Autologous neurosensory retinal transplantation for large refractory idiopathic macular hole. Int Ophthalmol 2021; 41:1415-1425. [PMID: 33475907 DOI: 10.1007/s10792-021-01716-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the structural and functional reconstruction of the macula after autologous neurosensory retinal-free flap transplantation (ANRFFT) in eyes with large refractory idiopathic macular holes (IMHs). METHODS Patients with refractory IMHs after multiple surgeries who underwent ANRFFT were retrospectively reviewed. The main outcomes were anatomic closure of MH, change in external limiting membrane (ELM) defect on optical coherence tomography (OCT) and best-corrected visual acuity (BCVA). RESULTS A total of 7 patients (4 female and 3 male; mean age 60.6 ± 8.6 years) were included in the study. Mean preoperative largest basal diameter was 1146.7 ± 413.7 µm (range, 653-1768 µm), and mean narrowest inner-opening diameter was 788.9 ± 148.8 µm (range, 644-1100 µm). Mean BCVA (logarithm of the minimum angle of resolution [logMAR]) significantly improved from 1.53 ± 0.16 (range, 1.3-1.7) to 0.89 ± 0.23 (range, 0.6-1.3) at the final follow-up (P < 0.001). OCT revealed complete closure of MH in all eyes. Mean preoperative ELM defect significantly decreased from 1450.3 ± 306.5 µm (range, 1044-1908 mm) to 533.1 ± 399.2 µm (range, 0-1156 µm, P = 0.001). Postoperative complications included retinal detachment (n = 1), cystoid macular edema like changes in the graft (n = 1) and reactive pigment epithelial hyperplasia (n = 1). CONCLUSION Although some postoperative complications did occur, ANRFFT seems to be an effective treatment for large refractory IMHs, and can promote recovery of the outer retinal structure resulting in functional improvement.
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Affiliation(s)
- Kenan Sonmez
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Kale Mh. Ulucanlar Cd. No: 59, Altındag, 06250, Ankara, Turkey.
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Lachance A, You E, Garneau J, Bourgault S, Caissie M, Tourville É, Dirani A. Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy. J Ophthalmol 2021; 2021:8832538. [PMID: 33520301 PMCID: PMC7817234 DOI: 10.1155/2021/8832538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the anatomical and functional outcomes of revision surgery after failed primary surgery for idiopathic macular hole (MH). METHODS All consecutive patients with MH were identified from a cohort of patients operated between 2014 and 2018 at the CHU de Québec-Université Laval (Québec). The clinical and anatomical features of patients with unclosed MH after primary surgery were retrospectively collected. Our primary outcome was MH nonclosure rate after revision surgery. Our secondary outcomes were best-corrected visual acuity (BCVA) with ETDRS scale and MH size of eyes with revision surgery preoperatively and at 3 and 12 months after revision surgery. RESULTS In our cohort of 1085 eyes, 926 eyes met inclusion criteria and were analyzed in the study. We identified 22 eyes with failed primary surgery (2.4%), of which 20 underwent revision surgery. We had no bilateral MH in these 22 eyes. The nonclosure rate of MH after revision surgery was 15%. The mean final BCVA for closed MH after revision surgery was 55 ± 19 letters. Compared to the initial presentation, the mean change in visual acuity (VA) for closed MH was +4 ± 31 letters and +16 ± 17 letters at 3 and 12 months after the revision surgery, respectively. At initial presentation, patients with failed primary surgery had a baseline MH size of 665 ± 226 μm. The mean MH size after failed primary surgery was 607 ± 162 μm and 546 ± 156 μm for the three unclosed MHs one month after revision surgery. CONCLUSION The success rate of revision surgery in eyes with unclosed MH is 85%. After successful revision surgery, eyes demonstrated an improvement in VA and closure of the MH.
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Affiliation(s)
- Alexandre Lachance
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Eunice You
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Jérôme Garneau
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Serge Bourgault
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Mathieu Caissie
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Éric Tourville
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Ali Dirani
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
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Okonkwo ON, Hassan AO, Akanbi T. Autologous Neurosensory Retinal Transplantation: A Report of Three Cases. J Ophthalmic Vis Res 2021; 16:68-76. [PMID: 33520129 PMCID: PMC7841287 DOI: 10.18502/jovr.v16i1.8252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To present the anatomical and functional outcomes of autologous surgical transplantation of a free neurosensory retinal graft in three cases of recurrent and chronic full thickness macular hole (MH). METHODS A retrospective case series, reporting the profile, preoperative presentation, surgical technique, and postoperative outcome of three consecutive eyes of three patients who had autologous retina transplantation (ART) surgery for recurrent and chronic MHs, and had a minimum of six months follow-up. The technique involved excision of a free neurosensory graft after laser demarcation of the harvest site. The graft was slid under perfluorocarbon liquid (PFCL) into the MH. A five-day tamponade with PFCL was used to secure the graft within the MH and then exchanged with air. RESULTS The patients were one female and two males aged 60, 44, and 67 years, respectively. All eyes had successful surgery. Postoperative vision improved from 6/36 to 6/18 in patient 1 and remained same as preoperative vision in the other two eyes. No eye lost vision postoperatively. The main complication of surgery was occurrence of retinal and vitreous hemorrhage in one eye (this did not appear to jeopardize the outcome) and retraction of graft tissue in two eyes. CONCLUSION ART appears to be a safe and effective treatment for difficult MHs. Our results are comparable to previous studies. Short-term use of PFCL can be useful to secure the graft within the MH. Methods of improving visual function should be the focus of further research in this promising area.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Eye Foundation Hospital, Apo. Abuja, Nigeria
- Eye Foundation Retina Institute, Ikeja. Lagos, Nigeria
| | - Adekunle Olobola Hassan
- Eye Foundation Hospital, Apo. Abuja, Nigeria
- Eye Foundation Retina Institute, Ikeja. Lagos, Nigeria
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Li Y, Li Z, Xu C, Liu Y, Kang X, Wu J. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes. Acta Ophthalmol 2020; 98:e983-e990. [PMID: 32323479 DOI: 10.1111/aos.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. METHODS Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best-corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula. RESULTS At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow-up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post-BCVA was significantly better than the pre-BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t-test). CONCLUSION Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea.
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Affiliation(s)
- Yanzi Li
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | | | | | - Yong Liu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Xueqin Kang
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Jianhua Wu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
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Wang H, Ji M, Di R, Qi Y, Pei C, Gao S, Liu SW, Xie AM, Cheng YH. Parafoveal retinal massage combined with autologous blood cover in the management of giant, persistent or recurrent macular holes. Int J Ophthalmol 2020; 13:1773-1779. [PMID: 33215009 DOI: 10.18240/ijo.2020.11.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the efficacy and safety of parafoveal retinal massage combined with autologous whole blood cover in the treatment of refractory macular holes (MHs) and present the surgical procedure. METHODS Patients with giant (minimum diameter ≥800 µm), recurrent or persistent MHs who underwent PPV combined with parafoveal retinal massage and autologous whole blood cover using C3F8 as tamponade agent from February 2018 to May 2019 were enrolled in this retrospective study. After surgery, all patients were informed to maintain a prone position for at least 7d. Preoperative and postoperative best-corrected visual acuities (BCVAs) were compared and MH closure rate was measured as the main outcome. RESULTS A total of 13 MH patients consisted of 6 giant MHs, 4 persistent holes and 3 recurrent holes (5 men and 8 women; average age was 56.40±11.72y) were enrolled in this study. MH closure was achieved in 11 eyes by this modified surgical technique while 2 eyes failed. Revitrectomy with autologous neurosensory retinal patch transplantations was applied for those 2 patients and then both holes were closed. No intraoperative complications were observed. BCVA improved from 1.73 logMAR to 0.74 logMAR at 6mo postoperation. There was significant difference in BCVA before versus after the surgery (P<0.05). There were no adverse events occurred during the follow-up period. CONCLUSION With easier surgical procedure, parafoveal retinal massage combined with autologous whole blood cover is an effective addition to the surgical options for the management of refractory MHs.
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Affiliation(s)
- Hua Wang
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,Ankang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi Province, China
| | - Meng Ji
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,Ankang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi Province, China
| | - Rong Di
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yun Qi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Cheng Pei
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Shan Gao
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Si-Wei Liu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - An-Ming Xie
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yu-Hong Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Tabandeh H. Vascularization and Reperfusion of Autologous Retinal Transplant for Giant Macular Holes. JAMA Ophthalmol 2020; 138:305-309. [PMID: 31944234 DOI: 10.1001/jamaophthalmol.2019.5733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Autologous retinal transplant is a recently described treatment modality for myopic and other refractory macular holes (MH). Establishment of blood supply may influence survival of a transplanted tissue. However, there are currently no reports on the vascular status of a transplanted retinal graft. Objective To report on vascularization and reperfusion of autologous retinal graft after transplant for giant MHs demonstrated by multimodal imaging. Design, Setting, Participants Two patients with giant MH (basal diameter ≥2000 μm) who underwent autologous retinal transplant at Retina-Vitreous Associates Medical Group in Los Angeles, California, in June 2018 and February 2019, respectively, were included. Main Outcomes and Measures Status of MH, Snellen visual acuity, optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography findings. Results Two eyes of 2 female patients were included. The mean age was 68.5 years. Baseline visual acuity was counting fingers and 20/200, and MHs measured 3441 μm and 2387 μm, respectively. Six weeks postoperatively, MHs were closed and the superficial inner retina blood vessels within the graft appeared perfused. Optical coherence tomography and optical coherence tomography angiography demonstrated early integration of the graft into the surrounding retina and perfused graft vasculature in both patients. Fluorescein angiography confirmed perfusion of retinal graft. At the last follow-up, visual acuity was 20/200 and 20/150, respectively, the MH was closed, and the retinal grafts were perfused. Conclusions and Relevance Autologous neurosensory retinal transplant may be used for the treatment of giant MHs. Vascularization and reperfusion of the retinal graft is observed within 6 weeks of transplant. It is hypothesized that visual improvement occurs as a result of flattening of the MH rim, partial centripetal migration of MH edges during the early healing phase, and further centripetal migration in the later phase associated with the shrinkage of the retinal graft.
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Wu AL, Liu YT, Chou HD, Chuang LH, Chen KJ, Chen YP, Liu L, Yeung L, Wang NK, Hwang YS, Wu WC, Lai CC. Role of growth factors and internal limiting membrane constituents in müller cell migration. Exp Eye Res 2020; 202:108352. [PMID: 33166502 DOI: 10.1016/j.exer.2020.108352] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
This study investigated the effects of growth factors and internal limiting membrane components on Müller cell migration. We studied the effects of epidermal growth factor (EGF), fibroblast growth factor (FGF), somatomedin (IGF-1), platelet derived growth factor (PDGF), and stromal cell-derived factor-1 alpha (SDF-1α) as well as collagen IV, laminin, and fibronectin on the proliferative and migratory activities of rat Müller cells in vitro. A water soluble tetrazolium-1 assay was used to quantify the viability of Müller cells in respective cultures, and analysis was performed using an enzyme-linked immunosorbent assay reader. All the factors examined had significant proliferative effects on cultured Müller cells (p < .05). A two-well Ibidi silicone culture insert was used to assess Müller cell migration. Müller cells cultured in EGF, FGF, IGF-1, collagen IV, and laminin but not in SDF, PDGF, or fibronectin effectively increased the cell migratory activity (p < .001). In addition, combined EGF and collagen IV, combined FGF and collagen IV, and combined IGF-1 and laminin exhibited more significant (p < .001) effects on Müller cell migration compared with culture a single factor. In summary, this study revealed the combinatorial effects of various growth factors and individual internal limiting membrane constituents. This may assist Müller cell migration together with the macular hole healing process.
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Affiliation(s)
- An-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Ya-Tung Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Hsin Chuang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Autologous Retinal Transplantation for Primary and Refractory Macular Holes and Macular Hole Retinal Detachments: The Global Consortium. Ophthalmology 2020; 128:672-685. [PMID: 33045315 DOI: 10.1016/j.ophtha.2020.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report the anatomic and functional outcomes of autologous retinal transplantation (ART). DESIGN Multicenter, retrospective, interventional, consecutive case series. PARTICIPANTS One hundred thirty eyes of 130 patients undergoing ART for the repair of primary and refractory macular holes (MHs), as well as combined MH-rhegmatogenous retinal detachment (MH-RRD), between January 2017 and December 2019. METHODS All patients underwent pars plana vitrectomy and ART, with surgeon modification of intraoperative variables. A large array of preoperative, intraoperative, and postoperative data was collected. Two masked reviewers graded OCT images. Multivariate statistical analysis and subgroup analysis were performed. MAIN OUTCOME MEASURES Macular hole closure rate, visual acuity (VA), external limiting membrane and ellipsoid zone (EZ) band integrity, and alignment of neurosensory layers (ANL) on OCT. RESULTS One hundred thirty ART surgeries were performed by 33 vitreoretinal surgeons worldwide. Patient demographics were: mean age of 63 ± 6.3 years, 58% female, 41% White, 23% Black, 19% Asian, and 17% Latino. Preoperative VA was 1.37 ± 0.12 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/500), which improved significantly to 1.05 ± 0.09 logMAR (Snellen equivalent, approximately 20/225; P < 0.001) after surgery (mean follow-up, 8.6 ± 0.8 months). Autologous retinal transplantation was performed for primary MH repair in 27% of patients (n = 35), for refractory MH in 58% of patients (n = 76; mean number of previous surgeries, 1.6 ± 0.2), and for MH-RRD in 15% of patients (n = 19). Mean maximum MH diameter was 1470 ± 160 μm, mean minimum diameter was 840 ± 94 μm, and mean axial length was 24.6 ± 3.2 mm. Overall, 89% of MHs closed (78.5% complete; 10% small eccentric defect), with a 95% closure rate in MH-RRD (68.4% complete; 26.3% small eccentric defect). Visual acuity improved by at least 3 lines in 43% of eyes and by at least 5 lines in 29% of eyes. Reconstitution of the EZ (P = 0.02) and ANL (P = 0.01) on OCT were associated with better final VA. Five cases of ART graft dislocation (3.8%), 5 cases of postoperative retinal detachment (3.8%), and 1 case of endophthalmitis (0.77%) occurred. CONCLUSIONS In this global experience, patients undergoing ART for large primary and refractory MHs and MH-RRDs achieved good anatomic and functional outcomes, with low complication rates despite complex surgical pathologic features.
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Applications of the Amniotic Membrane in Vitreoretinal Surgery. J Clin Med 2020; 9:jcm9082675. [PMID: 32824838 PMCID: PMC7463634 DOI: 10.3390/jcm9082675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022] Open
Abstract
Recently, the use of the human amniotic membrane (hAM) has been extended to treat retinal disorders, such as macular holes that failed to close and retinal tears. The hAM has demonstrated the induction of a recovery process of the external retinal layers involving the external limiting membrane (ELM) and the ellipsoid zone (EZ). After that, the application of the hAM for retinal pathologies was extended to large macular tears, high myopic retinal detachment associated with MH, paravascular tears, serous macular detachment associated with optic pit, complicated retinal detachment and advanced age-related macular degeneration (AMD). The hAM has shown a potential in repairing retinal tissue through a regeneration process. This review aims to highlight the use of the hAM in various vitreo-retinal surgical fields, and to confront it with other cutting-edge surgical techniques used to treat challenging vitreo-retinal pathologies.
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Comparison between Cryopreserved and Dehydrated Human Amniotic Membrane Graft in Treating Challenging Cases with Macular Hole and Macular Hole Retinal Detachment. J Ophthalmol 2020; 2020:9157518. [PMID: 32724671 PMCID: PMC7364261 DOI: 10.1155/2020/9157518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose To evaluate the surgical outcomes of cryopreserved and dehydrated human amniotic membrane (hAM) graft transplantation for macular hole (MH) and macular hole retinal detachment (MHRD) repair. Materials and Methods This retrospective, interventional case series was conducted in two hospitals. Two types of hAM grafts, namely, the dehydrated form (AmnioGen, HCT Regenerative, Taiwan) and the cryopreserved form (AmnioGraft, Bio-Tissue, Miami, FL), were consecutively used in MH surgeries. Anatomical and functional outcomes between the 2 types of hAM grafts were compared. Results Seventeen patients (mean age: 62.1 ± 10.0 years, 9 (52.9%) males) were enrolled. Of them, 11 patients had persistent MH, 3 had MH without prior surgery, and 3 had MHRD. A cryopreserved hAM graft was used in 10 patients, and a dehydrated hAM graft was used in 8 patients. One patient used a cryopreserved hAM in the first MH surgery and a dehydrated hAM in the second surgery for extramacular hole with retinal detachment. After a 6-month follow-up, 13 (76.5%) patients had sealed MHs. The average visual acuity (VA) of cases with sealed MHs improved from 1.38 ± 0.62 to 1.12 ± 0.47 logMAR (p=0.03). In the other 4 cases with persistent MH, 3 had graft dislocation and 1 had a reopened MH with graft contraction. There were no significant differences in closure rate (80.00% vs. 71.43%, p=0.68) or VA improvement (0.19 ± 0.37 logMAR vs. 0.15 ± 0.41 logMAR, p=0.85) between the 2 kinds of hAM graft. Conclusion This preliminary case series showed that both cryopreserved hAM and dehydrated hAM are feasible alternative grafts for either persistent or recurrent MH. Both approaches have similar anatomical and functional outcomes.
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Caporossi T, Angelis L, Pacini B, Tartaro R, Finocchio L, Barca F, Rizzo S. A human Amniotic Membrane plug to manage high myopic macular hole associated with retinal detachment. Acta Ophthalmol 2020; 98:e252-e256. [PMID: 31318489 DOI: 10.1111/aos.14174] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the efficacy of the human amniotic membrane (hAM) to treat (HMMH) associated with retinal detachment (RD). MATERIAL AND METHODS Ten eyes of 10 patients with recurrent HMMH and RD, who had already undergone one or more pars plana vitrectomy (PPV), underwent a PPV with an hAM plug implanted in the macular hole. The initial five patients enrolled were tamponaded with (SO) while the subsequent five patients with 10% octafluoropropane (C3 F8 ). Silicon oil was removed in all five patients 2 months later. No statistical differences were reported between the two groups. RESULTS Final retinal reattachment was achieved in all the patients. BCVA improved from 1.73 logMAR to 0.94 logMAR after 6 months. No adverse events were registered during follow-up. CONCLUSION An hAM plug is an efficient substrate to manage HMMH associated with RD resulting in encouraging visual acuity recovery.
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Affiliation(s)
- Tomaso Caporossi
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Lorenzo Angelis
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Bianca Pacini
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Ruggero Tartaro
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Lucia Finocchio
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Francesco Barca
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
| | - Stanislao Rizzo
- Department of Translational Surgery and Medicine, Ophthalmology University of Florence Careggi, Florence Italy
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Moharram HM, Moustafa MT, Mortada HA, Abdelkader MF. Use of Epimacular Amniotic Membrane Graft in Cases of Recurrent Retinal Detachment Due to Failure of Myopic Macular Hole Closure. Ophthalmic Surg Lasers Imaging Retina 2020; 51:101-108. [DOI: 10.3928/23258160-20200129-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023]
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MANAGEMENT OF REFRACTORY LARGE MACULAR HOLE WITH AUTOLOGOUS NEUROSENSORY RETINAL FREE FLAP TRANSPLANTATION. Retina 2019; 40:2134-2139. [DOI: 10.1097/iae.0000000000002734] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Modern macular hole surgery results in high closure rates of over 90% and good functional results especially in macular holes up to 400 µm in diameter. The standard of care in most of these cases consists of transconjunctival sutureless pars plana vitrectomy, peeling of the inner limiting membrane (ILM) around the hole, followed by gas tamponade and positioning of the patient. As closure rates and functional results decrease with larger macular hole diameters over approximately 400 µm, alternative surgical techniques have been introduced to improve anatomical and functional results in these cases. These techniques include the positioning of tissue within the macular hole to improve hole closure. This can be performed using an ILM flap or free flap technique and the transplantation of autologous retinal tissue, lens capsule or homologous amniotic tissue in or under the defect. An alternative promising approach is the attenuation of the rim of the hole by induction of a localized retinal detachment at the posterior pole which is achieved by subretinal injection of balanced salt solution (BSS) using a 41 gauge needle. The operation is completed by an endotamponade using gas or silicone oil.
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Affiliation(s)
- Christos Haritoglou
- Augenklinik Herzog Carl Theodor, Nymphenburger Str. 43, 80335, München, Deutschland.
| | - Armin Wolf
- Augenklinik, Ludwig-Maximilians-Universität, München, Deutschland
| | - Joachim Wachtlin
- Sankt Gertrauden Krankenhaus, Berlin, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
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Singh SR, Narayanan R. Functional and morphological evaluation of autologous retinal graft in large traumatic macular hole. Indian J Ophthalmol 2019; 67:1760-1762. [PMID: 31546557 PMCID: PMC6786180 DOI: 10.4103/ijo.ijo_312_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 7-year-old boy presented with history of blunt trauma 1 month back. Best corrected visual acuity (BCVA) was 20/200 with optical coherence tomography (OCT) showing a large macular hole. Spontaneous closure of the macular hole seemed unlikely following a month of observation. Pars plana vitrectomy along with autologous retinal graft was performed. At subsequent follow up, hole appeared closed with nasal shrinkage of graft and BCVA improved to 20/100. OCT showed mechanical integration of the graft with adjoining retina. Autologous retinal graft is a feasible option in cases where conventional internal limiting membrane peeling shows lower anatomical success.
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Affiliation(s)
- Sumit R Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Frisina R, Tozzi L, Sabella P, Cacciatori M, Midena E. Surgically Induced Macular Detachment for Treatment of Refractory Full-Thickness Macular Hole: Anatomical and Functional Results. Ophthalmologica 2019; 242:98-105. [PMID: 31220838 DOI: 10.1159/000500573] [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: 12/26/2018] [Accepted: 04/25/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the efficacy and safety of surgically induced macular detachment (MD) for the treatment of refractory full-thickness macular hole (FTMH). MATERIALS AND METHODS Clinical data were age, gender, lens status, and best corrected visual acuity (BCVA). Preoperative tomographic parameters were: FTMH morphology (intraretinal cyst and elevated or flat edges) and FTMH diameter. Postoperative FTMH closure and outer retinal layer (ORL) restoration were evaluated. Fundus autofluorescence (FAF), optical coherence tomography (OCT) findings, and BCVA were analyzed at the 1st, 3rd, and 6th postoperative month. The interval between the first surgery for idiopathic FTMH and the surgically induced MD for refractory FTMH was collected (intersurgical interval, days). RESULTS Ten eyes of 10 patients were included. The mean age was 68.8 ± 6.8 years. FTMH closure was obtained in 9 patients; in 8 patients, ORL restoration was detected. BCVA improved from 1.06 ± 0.1 (baseline) to 0.56 ± 0.2 (final) logMAR (p = 0.0001). A negative correlation between the intersurgical interval and postoperative visual gain was demonstrated (r = -0.3618). FAF and OCT showed a permanent retinal pigment epithelium (RPE) damage corresponding to the retinotomy points. CONCLUSION This study demonstrates the efficacy of this technique and highlights the risk of RPE damage, suggesting the need to perform the retinotomy points outside the macula.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Padova, Italy,
| | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
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Frisina R, Parrozzani R, Pilotto E, Midena E. A Double Inverted Flap Surgical Technique for the Treatment of Idiopathic Lamellar Macular Hole Associated with Atypical Epiretinal Membrane. Ophthalmologica 2019; 242:49-58. [PMID: 30739110 DOI: 10.1159/000496297] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To propose a new technique of a double inverted epiretinal membrane (ERM) and internal limiting membrane (ILM) flap (double flap group) for the treatment of idiopathic lamellar macular hole (LMH) with atypical ERM (AERM) and to compare surgical outcomes to those of the standard technique of ERM and ILM peeling of the fovea including LMH (control group). METHODS AERM was tomographically defined as a medium reflective thickened membrane above the retinal fiber layers without retinal traction signs. A series of patients affected by LMH with AERM were recruited. Preoperative parameters were: intraretinal cysts (IRC), intraretinal splitting diameter, residual foveal thickness, and ellipsoid zone integrity. Postoperative findings were: full-thickness macular hole (FTMH) development, and persistence or new appearance of IRC. Best-corrected visual acuity (BCVA) at baseline, first, third, and sixth postoperative month was evaluated. RESULTS A total of 48 eyes of 48 patients were included in this study. In the double flap group (30 eyes), a clear improvement of BCVA was noted (p = 0.004), and there were no complications. In the control group (18 eyes), BCVA did not improve and 3 patients developed postoperative FTMH. CONCLUSIONS The double inverted flap technique is associated with better functional recovery compared to the standard technique and reduces the risk of postoperative FTMH development.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Padova, Italy,
| | | | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
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Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group. Ophthalmology 2019; 126:1399-1408. [PMID: 30711606 DOI: 10.1016/j.ophtha.2019.01.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs). DESIGN Multicenter, retrospective, consecutive case series. PARTICIPANTS A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade. METHODS All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up. MAIN OUTCOME MEASURES Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed. RESULTS Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization. CONCLUSIONS The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.
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Affiliation(s)
- Dilraj S Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Barbara Parolini
- Department of Ophthalmology, Sant'Anna Institute, Brescia, Italy
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tamer H Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Associated Retinal Consultants, Royal Oak, Michigan.
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