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Li S, Zhang L, Yu JG. Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Insertion Technique for Large Macular Holes: A Meta-Analysis. Semin Ophthalmol 2023; 38:752-760. [PMID: 37129523 DOI: 10.1080/08820538.2023.2209167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Abstract
PURPOSES This meta-analysis aimed to compare and evaluate the morphological and functional outcomes between the inverted internal limiting membrane (ILM) flap and ILM insertion techniques in the treatment of large macular holes (MHs). METHODS The PubMed, Embase, and Cochrane Library databases were searched for relevant studies comparing the two techniques for the treatment of large MHs. The primary outcome measures included the MH closure rate, preoperative and postoperative best-corrected visual acuity (BCVA), MH closure patterns, and external limiting membrane (ELM) and ellipsoid zone (EZ) recovery. Statistical analyses were performed using RevMan 5.3 software. RESULTS Two randomized controlled trials and four retrospective studies were included in this meta-analysis. The MH closure rate did not significantly differ between the two groups (P = .93). Postoperative BCVA was not significantly different between the two groups at 3 months (P = .20) or 6 months (P = .51). ELM and EZ recovery were also similar between the two groups. However, the results for postoperative BCVA and outer retinal structure recovery tended to favor the ILM flap group based on the forest plot. There was no significant difference between the two groups for the U-shape (P = .26), V-shape (P = .65), and W-shape closure types (P = .38). CONCLUSIONS Our meta-analysis provides evidence that the MH closure rate and visual function outcomes are similar between the ILM flap and ILM insertion techniques in large MHs. However, based on the forest plot, postoperative BCVA and outer retinal layer reconstruction tended to favor the ILM flap technique. Further studies with larger sample sizes are required to confirm the superiority of the ILM flap to the ILM insertion technique.
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Affiliation(s)
- Shuang Li
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Zhang
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji-Guo Yu
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Correlations between Visual Performance and Chorioretinal Variables after Vitrectomy for the Idiopathic Macular Hole. J Ophthalmol 2022; 2022:6641956. [PMID: 36620525 PMCID: PMC9812597 DOI: 10.1155/2022/6641956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/29/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the relationships between visual function and the retinal and choroid microstructure in idiopathic macular hole patients after surgery. Methods A prospective study investigated changes in the fundus structure and visual function in 16 macular hole patients before and after surgery. Patients' best-corrected visual acuity (BCVA) and retinal sensitivity were measured by an EDTRS visual chart and microperimetry (MP1), respectively. The thickness of the retina and the blood supply to the retina and superficial choroid were detected by OCTA, and the choroidal capillary blood flow density was analysed with MATLAB. The thickness of the choroid and the aperture size of the macular hole were detected by Heidelberg OCT. Results Compared with before surgery and one month after surgery, the BCVA (3 months: 0.47 ± 0.27, before: 1.02 ± 0.22, 1 month: 0.66 ± 0.27, and P < 0.05) and the central sensitivity of the retina (3 months: 14.88 ± 2.87 dB, before: 8.76 ± 3.27 dB, 1 month: 12.22 ± 3.30 dB, and P < 0.05) were significantly improved three months after surgery. The change in BCVA was significantly correlated with the basal diameter (r = 0.677 and P = 0.004), the minimum diameter (r = 0.585 and P = 0.017), the macular hole cystoid height area index (r = -0.618 and P = 0.011), the central macular hole index (r = -0.727 and P = 0.001), the peripheral macular hole index (r = -0.758 and P = 0.001), the central tractional hole index (r = -0.717 and P = 0.002), the peripheral tractional hole index (r = -0.725 and P = 0.001), and changes in the peripheral blood vessel density of the choroid capillary layer (r = 0.585 and P = 0.0017). The change in central retinal sensitivity was correlated with the change in the superficial foveal avascular zone (FAZ; r = 0.520 and P = 0.039), change in the retinal superficial peripheral blood flow density (r = -0.503 and P = 0.047), change in the deep FAZ (r = 0.599 and P = 0.014), and change in the retinal deep peripheral blood flow density (r = -0.601 and P = 0.014). Conclusions The morphology of the macular hole as well as changes to the retinal and choroidal microstructure contributes to the recovery of visual function after surgery.
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Gao Y, Sun B, Li J, Wang W, Zhang X, Wang F, Zhou G. Choriocapillary regional characteristics in idiopathic macular holes using optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2022; 40:103131. [PMID: 36150634 DOI: 10.1016/j.pdpdt.2022.103131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by optical coherence tomography angiography (OCTA). METHODS A retrospective cases series study involving 20 unilateral eyes (20 patients) with IMH, the unaffected fellow eyes (n = 20) and 20 health controls, with age- and sex-matched, was conducted in Shanxi Eye Hospital from January 2019 to December 2021. VD of the retinal capillary plexuses measurements were obtained by OCTA. RESULTS Four quadrants of superficial capillary plexuses (SCP) in IMH eyes were not significant compared with that in the unaffected fellow eyes (all P > 0.05). The four quadrants of deep capillary plexuses (DCP) in IMH eyes were lower than that in the unaffected fellow eyes (all P < 0.05). Different regions retinal thickness in the IMH eyes was higher than that in the unaffected fellow eyes (all P < 0.05). a significant negative correlation between deep vessel density and retinal thickness in different quadrants among IMH eyes (all P < 0.05). Additionally, the correlation between the vascular density of SCP and retinal thickness was significant in macular fovea area (= 0.519, P = 0.019). <0.001. CONCLUSIONS The morphology of retina and choroid in idiopathic macular hole is different from that in fellow eye. The thickness of choroid in the fovea area of the unaffected eye also showed a decreasing trend. Taken together, the mechanism of macular hole may be further understood, that is, the decrease of choroid thickness may occur before the macular hole formation. It was verified again that the choroidal blood flow area in macular fovea of IMH patients was significantly lower than that in fellow eyes and healthy eyes.
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Affiliation(s)
- Yan Gao
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Bin Sun
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Jing Li
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Wenjuan Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Xiaodan Zhang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Fangfang Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China
| | - Guohong Zhou
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, No. 100 Fudong St, Xinghualing District, Taiyuan, Shanxi 030002, China.
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Li J, Wang W, Sun B, Zhang X, Cui T, Cheng P, Jia Z, Wang J, Zhou G. Functional features in patients with idiopathic macular hole treatment via OCT angiography. Medicine (Baltimore) 2022; 101:e31862. [PMID: 36451457 PMCID: PMC9704867 DOI: 10.1097/md.0000000000031862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective study included 25 patients diagnosed with IMH in Shanxi eye hospital from August 2019 to December 2021. The study was divided into 3 groups: IMH eyes, fellow eyes and normal eyes. All unilateral IMH eyes underwent vitrectomy. There were significant differences in superficial retinal blood flow density (SRBFD, P < .001) and choroidal blood flow density (CBFD) between IMH and healthy control eyes before operation (P < .05). There was significant difference in SRBFD between fellow eyes and normal eyes (P = .038). The changes of SRBFD and CBFD in IMH eyes before and after operation were statistically significant (P < .05). The CBFD at 6 months after operation is negatively correlated with LogMAR visual acuity, and the CBFD of the fellow eye is also negatively correlated with LogMAR visual acuity. The SRBFD and CBFD had no correlation with the diameter of macular hole before and after operation. SRBFD and CBFD increased after vitrectomy, indicating that the blood supply of retina and choroid were partially restored after vitrectomy. There was no correlation between SRBFD, CBFD and hole diameter, but there was correlation between choroidal blood flow and LogMAR visual acuity.
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Affiliation(s)
- Jing Li
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Wenjuan Wang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Bin Sun
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Xiaodan Zhang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Tong Cui
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Peini Cheng
- Department of School of the 1st Clinical Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhijie Jia
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Jingjing Wang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Guohong Zhou
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, China
- * Correspondence: Guohong Zhou, Department of Ophthalmology, Shanxi Eye Hospital, No. 100 Fudong St, Xinghualing District, Taiyuan 030002, Shanxi, China (e-mail: )
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Li J, Wang W, Zhang X, Liu J, Zhang H, Cui T, Wang F, Zhou G. Morphological and Functional Features in Patients with Idiopathic Macular Hole Treatment. Int J Gen Med 2022; 15:4505-4511. [PMID: 35509600 PMCID: PMC9059987 DOI: 10.2147/ijgm.s365886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. Patients and Methods This prospective study was conducted at Shanxi Eye Hospital from January 2019 to December 2021. Twenty-five eyes of 25 patients with unilateral IMH, the unaffected fellow eyes, and 30 eyes of healthy patients were investigated. All unilateral IMH eyes underwent vitrectomy. Results The IMH eyes had significantly delayed latency (rings 2-5) of mfERG compared with the healthy control eyes, and the amplitude density of all rings of mfERG was reduced (P < 0.05). When comparing the mfERG components before surgery and at the follow-up, the amplitude density of IMH eyes (ring 1, 3, 4 and 5) was increased significantly (P < 0.05). The delayed implicit times of the second and fifth ring were significantly shortened compared with those of preoperative eyes (P < 0.05). The mean delayed implicit time of mfERG in six months after surgery was negatively correlated with visual acuity (r = -0.890, P = 0.043). Significant differences of superficial retinal blood flow density (SRBFD, P < 0.001) and choroidal blood flow density (CBFD) (P < 0.05) got via OCTA were found between IMH before surgery and healthy control eyes. SRBFD of the fellow eyes were significantly different with the healthy control eyes (P = 0.038). Statistically significance of SRBFD and CBFD changes in IMH eyes were found before and after surgery (P < 0.05). Conclusion IMH eyes had a decreased amplitude density and a delayed implicit time in some regions. Additionally, SRBFD and CBFD were both increased after vitrectomy, which suggests that the blood supply of the retina and choroid is partially restored after vitrectomy.
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Affiliation(s)
- Jing Li
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Wenjuan Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Xiaodan Zhang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Jinxing Liu
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Haining Zhang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Tong Cui
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Fangfang Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
| | - Guohong Zhou
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, People's Republic of China
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Takeyama A, Imamura Y, Fujimoto T, Iida T, Komiya Y, Shibata M, Ishida M. Retinal displacement and intraretinal structural changes after idiopathic macular hole surgery. Jpn J Ophthalmol 2021; 66:173-182. [PMID: 34855121 DOI: 10.1007/s10384-021-00887-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the correlations of thickness of three retinal layers with retinal displacement after idiopathic macular hole surgery. STUDY DESIGN Retrospective, consecutive, case series. METHODS 42 eyes of 42 patients undergoing macular hole surgery with internal limiting membrane peeling were studied. Retinal distance was measured with near-infrared images between the optic nerve and the intersection of retinal vessels at four quadrants. Retinal thicknesses of inner retinal layer, inner nuclear layer and outer retinal layer were measured 1000 μm away from the central fovea using Spectralis. RESULTS Retinal distances other than the nasal quadrant decreased postoperatively (p < 0.001). Retinal displacement (%) correlated significantly with the change in inner nuclear layer thickness in the temporal sector at 1, 3, and 6 months, in the superior sector at 2 weeks, 1, and 6 months, and in the inferior sector at 3 and 6 months postoperatively (r = 0.319-0.570, p < 0.001-0.040), but not in the inner or outer retinal layers. CONCLUSION Internal limiting membrane peeling for macular hole enhances retinal displacement toward the optic disc, whose distances correlate with the changes in inner nuclear layer thickness.
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Affiliation(s)
- Asuka Takeyama
- Department of Ophthalmology, Toho University Ohashi Medical Center Ohashi, 2-22-36, Meguro-ku, Tokyo, 153-8515, Japan. .,Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan.
| | - Yutaka Imamura
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan
| | - Taichi Fujimoto
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan
| | - Toshiya Iida
- Department of Ophthalmology, Toho University Ohashi Medical Center Ohashi, 2-22-36, Meguro-ku, Tokyo, 153-8515, Japan
| | - Yuko Komiya
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan
| | - Masaki Shibata
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan
| | - Masahiro Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center Ohashi, 2-22-36, Meguro-ku, Tokyo, 153-8515, Japan.,Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan
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Savastano A, Bacherini D, Savastano MC, Finocchio L, Dragotto F, Lenzetti C, Moroni R, Caporossi T, Rizzo S. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS BEFORE AND AFTER VITRECTOMY FOR MACULAR HOLES: Useful or Useless? Retina 2021; 41:1379-1388. [PMID: 34137384 DOI: 10.1097/iae.0000000000003059] [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 investigate the vascular remodeling of optical coherence tomography angiography in full-thickness macular hole surgery. METHODS This retrospective, observational case series included 33 eyes of 33 patients with a full-thickness macular hole who underwent epiretinal membrane removal. Data were collected on best-corrected visual acuity, structural B-scan optical coherence tomography, and optical coherence tomography angiography preoperatively and at 1, 3, and 6 months postoperatively. Optical coherence tomography angiography was used to assess the retinal vascular density (VD) of the superficial vascular plexus and deep vascular plexus (DVP). Vascular density was assessed using the Early Treatment Diabetic Retinopathy Study grid for the whole, inner, and outer grids. RESULTS A statistically significant correlation was found between the VD (whole, inner, and outer grids) of the superficial vascular plexus alone from baseline to 1-month postoperatively (P < 0.001). Similarly, VD was correlated from baseline to 1, 3, and 6 months postoperatively to the whole (P < 0.0005, F = 23.22), inner (P < 0.0005, F = 28.23), and outer Early Treatment Diabetic Retinopathy Study grids of DVP (P = 0.033, F = 3.49). The best-corrected visual acuity and VD were significantly correlated with the superficial vascular plexus and DVP at baseline and 6 months (P < 0.05, all correlations). The most significant correlation was observed at 6 months between best-corrected visual acuity and DVP in the whole, inner, and outer Early Treatment Diabetic Retinopathy Study grids (P < 0.001). CONCLUSION Superficial vascular plexus and DVP are affected by full-thickness macular holes, with the most significant effects being on the DVP. Full-thickness macular hole surgery leads to an improvement in the best-corrected visual acuity in many eyes and the restoration of the VD, especially of the DVP.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore," Rome, Italy
| | - Daniela Bacherini
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria C Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore," Rome, Italy
| | | | - Francesco Dragotto
- Ophthalmology Unit, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy
| | - Chiara Lenzetti
- Ophthalmology Unit, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy
| | - Rossana Moroni
- Scientific Direction, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy ; and
| | - Tomaso Caporossi
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario "A. Gemelli" IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore," Rome, Italy
- National Research Council, Institute of Neuroscience, Pisa, Italy
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Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery. Sci Rep 2021; 11:11351. [PMID: 34059759 PMCID: PMC8167100 DOI: 10.1038/s41598-021-90955-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 12/04/2022] Open
Abstract
To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.
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Bacherini D, Mastropasqua R, Borrelli E, Capuano V, Iovino C, Dragotto F, Caporossi T, Rizzo S, Giansanti F. OCT-A in the Management of Vitreoretinal Diseases and Surgery. Asia Pac J Ophthalmol (Phila) 2021; 10:12-19. [PMID: 33512825 DOI: 10.1097/apo.0000000000000373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Optical coherence tomography angiography is a relatively new noninvasive technique that is changing our approach in the management of several retinal diseases such as neovascular age-related macular degeneration, occlusive retinal diseases, or diabetic retinopathy, but it could also be useful in nonprimary vascular retinal pathologies such as vitreoretinal interface surgical disorders.In idiopathic vitreoretinal interface disorders and surgical retinal diseases, the study of vascular involvement, not commonly assessed by invasive methods, could be useful to reveal specific vascular abnormalities. Such information may be useful for a more detailed phenotyping of each clinical picture before and after surgical treatment, providing potential new prognostic biomarkers.The review discusses the current and potential utility of optical coherence tomography angiography to study vitreoretinal pathologies of surgical interest.
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Affiliation(s)
- Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, AOU Careggi, Florence, Italy
- YORIS, Young Ophthalmologists Retinal Imaging Society
| | - Rodolfo Mastropasqua
- YORIS, Young Ophthalmologists Retinal Imaging Society
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Borrelli
- YORIS, Young Ophthalmologists Retinal Imaging Society
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vittorio Capuano
- YORIS, Young Ophthalmologists Retinal Imaging Society
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Claudio Iovino
- YORIS, Young Ophthalmologists Retinal Imaging Society
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Dragotto
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Tomaso Caporossi
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Stanislao Rizzo
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Fabrizio Giansanti
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, AOU Careggi, Florence, Italy
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Yao Y, Qu J, Dong C, Li X, Liang J, Yin H, Huang L, Li Y, Liu P, Pan C, Ding X, Song D, Sadda SR, Zhao M. The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54-week randomized clinical trial. Acta Ophthalmol 2019; 97:303-312. [PMID: 30187641 PMCID: PMC6585771 DOI: 10.1111/aos.13853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/20/2018] [Indexed: 11/02/2022]
Abstract
PURPOSE To compare the anatomical outcomes of different extents of internal limiting membrane (ILM) peeling in idiopathic macular hole surgery. METHODS Prospective, parallel-group, randomized clinical trial. A total of 121 eyes of 121 patients with idiopathic macular hole underwent pars plana vitrectomy, and peeling of the ILM with a diameter of two disk diameters (DD) or 4DD based on randomization. The main outcome was the proportion of eyes with complete hole closure at 12 months. The second outcome was the hole closure grading stratified by macular hole closure index (MHCI) at each visit. RESULTS At 12 months, there was no significant difference in anatomical outcomes with complete closure achieved in 52 (82.5%) of 63 eyes in the 2DD group and 53 (91.4%) of 58 eyes in the 4DD group (p = 0.15). For subjects with MHCI ≤0.5 (n = 24), complete closure rate was significantly lower in the 2DD group compared to the 4DD group (p = 0.012; 18.2% versus 75.9%, respectively). Average BCVA was lower in 2DD group than 4DD group (p = 0.014). By contrast, when MHCI was >0.5, the complete closure rate between the two groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (p = 0.185). CONCLUSION In patients with idiopathic full-thickness macular hole and MHCI ≤0.5, a larger ILM peel of 4DD tends to achieve better anatomical outcomes than a more limited 2DD peel.
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Affiliation(s)
- Yuou Yao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Jinfeng Qu
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Chongya Dong
- Department of Biostatistics Peking University Clinical Research Institute Beijing China
| | - Xiaoxin Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Jianhong Liang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Hong Yin
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Lvzhen Huang
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Yan Li
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
| | - Peipei Liu
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Chungting Pan
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Xue Ding
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Dan Song
- Department of Ophthalmology Peking University People's Hospital Beijing China
| | - Srinivas R. Sadda
- Doheny Eye Institute Los Angeles California USA
- Department of Ophthalmology David Geffen School of Medicine at University of California‐Los Angeles Los Angeles California USA
| | - Mingwei Zhao
- Department of Ophthalmology Peking University People's Hospital Beijing China
- Key Laboratory of Vision Loss and Restoration Ministry of Education Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases Beijing China
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Cicinelli MV, Marchese A, Bandello F, Coppola M. Inner Retinal Layer and Outer Retinal Layer Findings after Macular Hole Surgery Assessed by means of Optical Coherence Tomography. J Ophthalmol 2019; 2019:3821479. [PMID: 31061725 PMCID: PMC6466935 DOI: 10.1155/2019/3821479] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/24/2019] [Indexed: 11/18/2022] Open
Abstract
AIM To summarize the spectrum of optical coherence tomography (OCT) and OCT angiography (OCTA) features after full-thickness macular hole (MH) repair surgery. METHODS A PubMed engine search was carried out using the terms "Macular Hole," "Optical Coherence Tomography," and "Optical Coherence Tomography Angiography." All reports published in English up to October 2018, irrespective of their publication status, were included. Tomographic signs analyzed were divided according to the involved portion of the retina in "inner retinal layers" and "external retinal layers." Despite predominantly involving the inner retinal layers, cystoid macular edema (CME) has been treated as a separate entity. Finally, report on vessel density (VD) changes and the foveal avascular zone (FAZ) area modifications have been included. RESULTS Different clinical findings can be observed on OCT of patients who underwent MH repair surgery. There is general consent that retinal thinning involving primarily the retinal nerve fiber layer and the ganglion cell layer takes place after surgery. In the postoperative period, the outermost retinal layers get progressively restored. Persistent defects in the ellipsoid zone or in the external limiting membrane correlate with worse postoperative visual outcome. OCTA has globally demonstrated that eyes after MH closure show a reduction in macular and paramacular VD and smaller FAZ areas, compared with control or fellow eyes. CONCLUSION Clinicians should be aware of the most common tomographic findings to properly manage each condition. In addition, significant advantages for the postoperative application of OCT and OCTA include noninvasiveness, rapid and simple execution, repeatability, and precise measurements.
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Affiliation(s)
| | - Alessandro Marchese
- Department of Ophthalmology, Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy
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Wilczyński T, Heinke A, Niedzielska-Krycia A, Jorg D, Michalska-Małecka K. Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment. Clin Interv Aging 2019; 14:505-514. [PMID: 30880931 PMCID: PMC6413747 DOI: 10.2147/cia.s189417] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose To present optical coherence tomography (OCT) angiography features in patients with idiopathic full-thickness macular hole before and after vitrectomy. Study design Prospective case series study. Materials and methods Patients presenting with an idiopathic full-thickness macular hole (IMH) who underwent posterior vitrectomy with internal limiting membrane peeling and gas tamponade were included in the study. En face OCT and OCT angiography (OCTA) was performed pre- and postoperatively using 3×3 mm scans (Optovue, XR Avanti). Foveal avascular zone (FAZ) area, macular hole size (MHS), central retinal thickness (CRT), macular parafoveal choriocapillary flow area (MCFA), and fovea vessel density (FVDS) were measured and assessed using OCTA. Best-corrected visual acuity (BCVA) was examined before and 3 months after surgery. Results Twenty-eight eyes of 28 patients were included in the study. The mean age of patient group was 68.28 years. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of FAZ and increased CRT in foveal area. Mean preoperative FAZ area was 0.39±0.07 mm2. En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. BCVA was improved from 0.1±0.11 preoperatively to 0.42±0.17 postoperatively. Mean FAZ area was reduced to 0.24±0.07 mm2 postoperatively with resolution of macular hole and adjacent cystic areas. Mean CRT was reduced from 396±62.6 µm pre-operatively to 272±30.7 µm postoperatively. After vitrectomy, the parafoveal choriocapillary flow area and FVDS of IMH eyes increased compared with the preoperative measurements. Conclusion Quantitative evaluation of vascular and morphological changes following IMH surgery using OCTA shows the potential for recovery due to vascular and neuronal plasticity. OCTA showing vascular changes and their quantitative characteristics might be a useful tool for the assessment of macular holes before and after surgical treatment.
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Affiliation(s)
- Tomasz Wilczyński
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland,
| | - Anna Heinke
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland,
| | - Agata Niedzielska-Krycia
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland,
| | - Daria Jorg
- Department of Sexuology, Woman's Health Institute, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Michalska-Małecka
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland, .,Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland,
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The Distribution of the Photoreceptor Outer Segment Length in a Healthy Population. J Ophthalmol 2017; 2017:4641902. [PMID: 29410913 PMCID: PMC5749276 DOI: 10.1155/2017/4641902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the effects of age and sex on the photoreceptor outer segment (PROS) length in healthy eyes, using spectral-domain optical coherence tomography (SD-OCT). Methods A total of 97 eyes of 97 healthy participants (spherical equivalent < ±1 diopters [D]) were scanned with SD-OCT. The patients were divided into 3 groups by age: group 1 (0-20 years), group 2 (21-40 years), and group 3 (41-60 years). The PROS length was defined as the distance from the inner surface of IS/OS (inner segment/outer segment) band to the inner surface of retinal pigment epithelium (RPE). Results The mean PROS length was 52.01 ± 3.79 μm in females and 53.41 ± 3.37 μm in males (p = 0.061). The mean PROS length of the different groups was 53.70 ± 3.18 μm (0-20 years), 52.14 ± 3.64 μm (21-40 years), and 52.20 ± 3.95 μm (41-60 years) (p = 0.155; ANOVA test). Multiple linear regression analysis revealed a -0.039 μm decline in PROS length per year (p = 0.074) and a -1.408 μm decline in females (p = 0.055). Conclusion The difference in PROS length was not statistically significant neither for age nor for gender; females tended to have a lower PROS length than males, and PROS length was slightly higher in the first two decades of life.
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Kim YJ, Jo J, Lee JY, Yoon YH, Kim JG. Macular capillary plexuses after macular hole surgery: an optical coherence tomography angiography study. Br J Ophthalmol 2017; 102:966-970. [PMID: 28982954 DOI: 10.1136/bjophthalmol-2017-311132] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the structural changes of the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) using optical coherence tomography (OCT) angiography (OCTA) in patients with idiopathic macular hole (MH) after surgery, determine the factors related to changes of macular capillary plexuses and evaluate its association with postoperative visual outcomes. METHODS Thirty-three patients with unilateral MH who were followed for ≥6 months after surgery were included. Ophthalmologic evaluations included best corrected visual acuity (BCVA) and spectral-domain OCT before surgery and 6 months postsurgery. En face OCTA images were obtained for both eyes at 6 months postsurgery, and the postoperative foveal avascular zone (FAZ) area and parafoveal vascular density were identified. RESULTS Compared with fellow eyes, eyes after MH surgery had a smaller FAZ area in both SCP and DCP (p<0.05 for all). The FAZ area was positively correlated with postoperative foveal thickness of the whole, inner and outer layers (p<0.05 for all). In the parafoveal region, eyes after MH surgery had a tendency to have lower parafoveal vascular density, particularly in DCP (p=0.019). The parafoveal vascular density in DCP was positively correlated with retinal thickness of the whole, inner and outer layers (p<0.05 for all). Correlations between BCVA and FAZ area in both SCP and DCP were significant 6 months after MH surgery (p<0.05 for all). CONCLUSION Assessment of macular capillary plexuses using OCTA may be useful for monitoring retinal structural and functional changes in MH.
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Affiliation(s)
- Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - June-Gone Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Characteristics of retinal vessels in surgically closed macular hole: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2017; 255:1923-1934. [DOI: 10.1007/s00417-017-3742-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022] Open
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Demirel S, Abdullayev A, Yanık Ö, Batıoğlu F, Özmert E. Evaluation of Ganglion Cell-Inner Plexiform Layer Thickness after Vitreoretinal Surgery with Internal Limiting Membrane Peeling in Cases with Idiopathic Macular Hole. Turk J Ophthalmol 2017. [PMID: 28630788 PMCID: PMC5468526 DOI: 10.4274/tjo.34545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate macular retinal ganglion cell-inner plexiform layer (GCIPL) thickness after vitrectomy with internal limiting membrane (ILM) peeling for idiopathic macular holes using spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS Eighteen eyes of 18 patients with unilateral idiopathic macular hole who underwent vitrectomy with ILM peeling were retrospectively analyzed. Healthy fellow eyes of the patients and 18 eyes of 18 age-matched healthy individuals constituted the control group. The patients were evaluated at 1 day, 1 week, 1 month, and 3 months after surgery. The best corrected visual acuity (BCVA) measurements, biomicroscopic examination findings and SD-OCT measurements were recorded. Ganglion cell-inner plexiform layer thickness was evaluated with ganglion cell analysis software of Cirrus HD-OCT before surgery and at 1 month and 3 months after surgery and compared with control groups. Presence of dissociated optic nerve fiber layer (DONFL) was evaluated with C-scan mode. RESULTS Of the 18 patients, 9 were male and 9 were female with a mean age of 65.6±5.6 (55-77) years. Preoperative BCVA was 0.75±0.19 logMAR, while it was 0.44±0.17 logMAR and 0.36±0.15 logMAR at postoperative 1 and 3 months, respectively (p<0.001). Postoperative mean GCIPL thickness was 66.33±17.28 µm. There was a correlation between mean GCIPL thickness and BCVA at postoperative 3 months (p<0.01). When compared with the control group, GCIPL thickness was significantly thinner in all quadrants of all patients at postoperative 3 months. Dissociated optic nerve fiber layer appearance was observed on C-scan in 13 of 18 eyes postoperatively. There was no correlation between the presence of DONFL and BCVA (p>0.05). CONCLUSION Internal limiting membrane peeling during macular hole surgery may cause functional and/or structural changes that may be associated with visual acuity. Significant GCIPL thinning and DONLF appearance may occur postoperatively.
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Affiliation(s)
- Sibel Demirel
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ahmed Abdullayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Özge Yanık
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Figen Batıoğlu
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Emin Özmert
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Incidence and quantitative analysis of dissociated optic nerve fiber layer appearance: real loss of retinal nerve fiber layer? Eur J Ophthalmol 2017; 28:317-323. [PMID: 29148030 DOI: 10.5301/ejo.5001067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the association between appearance of dissociated optic nerve fiber layer (DONFL) after internal limiting membrane (ILM) peeling and changes in the macular nerve fiber layer (NFL) area by spectral-domain optical coherence tomography (SD-OCT). METHODS This study included 132 consecutive patients who had successfully undergone vitrectomy with ILM peeling for idiopathic epiretinal membrane or macular holes and had been followed up for ≥6 months. Two examiners evaluated macular 5-line raster horizontal SD-OCT images and categorized the patients on the basis of presence (group I) or absence (group II) of DONFL. The average macular NFL areas in both groups were measured using ImageJ at baseline and 1, 3, and 6 months after surgery. RESULTS Among the 132 eyes of 132 patients, DONFL was noted in 42 (31.8%), 104 (78.8%), 106 (80.3%), and 106 (80.3%) eyes at 1, 3, and 6 months and at the last visit (12.8 ± 6.5 months) after surgery. These layers appeared most commonly between 1 and 3 months after ILM peeling. There was no significant difference in average macular NFL area between groups I and II (3453.4 ± 125.3 and 3513.0 ± 100.2 pixels, respectively) at 6 months after surgery (p = 0.56). CONCLUSIONS Appearance of DONFL increased between postoperative months 1 and 3. Moreover, there was no significant difference in average NFL in terms of DONFL. Thus, appearance of DONFL might represent macular NFL rearrangement and reorganization rather than true mechanical damage to the NFL after ILM peeling.
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SUPERFICIAL FOVEAL AVASCULAR ZONE DETERMINED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER MACULAR HOLE SURGERY. Retina 2017; 37:444-450. [PMID: 28225721 DOI: 10.1097/iae.0000000000001205] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the size of the superficial foveal avascular zone (FAZ) by optical coherence tomography angiography before and after surgery for an idiopathic macular hole. METHODS A retrospective, observational case series, in which 16 eyes of 16 patients with an idiopathic macular hole were studied. Pars plana vitrectomy was performed with internal limiting membrane peeling. The foveal retinal vasculature was examined by optical coherence tomography angiography, and the area of the superficial FAZ was determined before, and at 1 and 3 months after the surgery. The area of the macular hole was also measured in the en face optical coherence tomography images. The central foveal thickness was measured to determine the relationship between the size of the superficial FAZ and foveal shape. The unaffected fellow eyes were used as controls. RESULTS The mean age of the patients was 68.9 years. The average preoperative superficial FAZ area was 0.45 ± 0.14 mm, which was significantly reduced to 0.23 ± 0.08 mm at 1 month (P < 0.001) and 0.25 ± 0.08 mm at 3 months postoperatively (P < 0.001). The size was smaller than that of the control eyes (0.36 ± 0.12 mm, P = 0.003). There was a significant inverse correlation between the area of the postoperative superficial FAZ and the central foveal thickness (r = -0.589, P = 0.016). The correlations between the visual acuity and the area of the superficial FAZ at 1 and 3 months postoperatively were not significant (P = 0.369 and 0.285). CONCLUSION The significant decrease in the superficial FAZ after the macular hole surgery indicates that there was a centripetal movement of the foveal tissue postoperatively.
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Kase S, Saito W, Mori S, Saito M, Ando R, Dong Z, Suzuki T, Noda K, Ishida S. Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique. Clin Ophthalmol 2016; 11:9-14. [PMID: 28031697 PMCID: PMC5179209 DOI: 10.2147/opth.s119762] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aims of this study were to analyze optical coherence tomography (OCT) imaging of large macular holes (MHs) treated with inverted internal limiting membrane (ILM) flap technique and to perform a histological examination of an ILM-like membrane tissue obtained during vitrectomy. PATIENTS AND METHODS This is a retrospective observational case study. Nine patients, comprising of five males and four females, showing large and myopic MHs, underwent pars plana vitrectomy (PPV) with inverted ILM flap technique assisted by brilliant blue G (BBG) staining. Ophthalmological findings including visual acuity and OCT were investigated based on medical records. Formalin-fixed paraffin-embedded tissue section of an ILM-like membrane was submitted for immunohistochemistry with glial fibrillary acidic protein (GFAP). RESULTS ILM was clearly stained with BBG in eight patients, whereas the ILM in one case revealed no staining with BBG during PPV. Visual acuities improved to >0.2 LogMAR in six patients. The complete closure of MH following PPV with inverted ILM technique was eventually achieved in all patients determined by OCT imaging (100%). Only one patient showed recovery of ellipsoid zone and interdigitation zone following the surgery. Elongation of outer nuclear layer was noted in three eyes. The ILM-like membrane not stained with BBG histologically revealed an amorphous structure admixed with GFAP-positive mononuclear cell infiltration. CONCLUSION PPV with inverted ILM flap technique achieved 100% closure rates with favorable configuration at an initial surgery in large MHs. Our histopathological data also suggest that even BBG staining-negative membrane may be a useful material for autologous transplantation to the hole.
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Affiliation(s)
- Satoru Kase
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shohei Mori
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryo Ando
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Zhenyu Dong
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomohiro Suzuki
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kousuke Noda
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Shahlaee A, Rahimy E, Hsu J, Gupta OP, Ho AC. Preoperative and postoperative features of macular holes on en face imaging and optical coherence tomography angiography. Am J Ophthalmol Case Rep 2016; 5:20-25. [PMID: 29503940 PMCID: PMC5758006 DOI: 10.1016/j.ajoc.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To characterize and quantify the pre- and postoperative foveal structural and functional patterns in full-thickness macular holes. Methods Subjects presenting with a full-thickness macular hole that had pre- and postoperative imaging were included. En face optical coherence tomography (OCT) and OCT angiography (OCTA) was performed. Foveal avascular zone (FAZ) area, macular hole size, number and size of perifoveal cysts were measured. Results Five eyes from 5 patients were included in the study. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of the FAZ and delineation of the holes within the FAZ. Mean preoperative FAZ area was 0.41 ± 0.104 mm2. Visual acuity was improved and mean FAZ area was reduced to 0.27 ± 0.098 mm2 postoperatively (P < 0.05) with resolution of the macular hole and adjacent cystic areas. En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. Smaller holes showed fewer but larger cystic areas and larger holes had more numerous but smaller cystic areas. Conclusions and importance Quantitative evaluation of vascular and cystic changes following macular hole repair demonstrates the potential for recovery due to neuronal and vascular plasticity. Perifoveal microstructural patterns and their quantitative characteristics may serve as useful anatomic biomarkers for assessment of macular holes.
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Affiliation(s)
- Abtin Shahlaee
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ehsan Rahimy
- Palo Alto Medical Foundation, San Francisco, CA, USA
| | - Jason Hsu
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omesh P Gupta
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen C Ho
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
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Retinal and Choroidal Thicknesses Measured with Swept-Source Optical Coherence Tomography after Surgery for Idiopathic Macular Hole. Eur J Ophthalmol 2016; 27:312-318. [DOI: 10.5301/ejo.5000851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate the changes in retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), retinal thickness (RT), and subfoveal choroidal thickness (SFCT) in eyes that received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH) and to compare these data with data from fellow eyes and healthy controls. Methods This cross-sectional study included 49 subjects. Eighteen eyes that underwent surgery for IMH, 18 fellow eyes, and 31 eyes of the healthy controls were designated as group 1, group 2, and group 3, respectively. The RNFLT, GCLT, RT, and SFCT were measured by using the swept-source optical coherence tomography (SS-OCT) device at last postoperative visit. Results The RNFLT was significantly lower in group 1 than group 2 and group 3 (p<0.05). The GCLT was significantly reduced in all sectors in group 1 as compared to group 2 and group 3 (p<0.05). The RT was found to be significantly lower (except in central field) in group 1 than group 2 and group 3 (p<0.05). The SFCT was significantly decreased in group 1 as compared to group 2 and group 3 (p<0.05). Conclusions A reduction in the RNFLT, GCLT, RT, and SFCT was observed following PPV with ILM peeling for IMH detected by SS-OCT.
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CORRELATIONS BETWEEN PREOPERATIVE RETINAL PIGMENT EPITHELIAL PROTRUSIONS AND POSTOPERATIVE OUTCOMES IN EYES WITH IDIOPATHIC MACULAR HOLES. Retina 2016; 37:472-476. [PMID: 27429383 DOI: 10.1097/iae.0000000000001194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To determine the relationship between the alterations in the preoperative morphology of the retinal pigment epithelium (RPE) and the postoperative recovery after surgery to close an idiopathic macular hole (MH). METHODS Retrospective interventional case series. Fifty-nine eyes of 59 patients with an idiopathic MH were studied. Pars plana vitrectomy was performed with the removal of the internal limiting membrane. The best-corrected visual acuity was measured, and the retinal morphology, including the presence of small RPE protrusions at the bottom of MH, was determined by spectral domain optical coherence tomography before and at 1, 3, and 6 months postoperatively. RESULTS The mean age of the patients was 66.7 years. Forty eyes (68%) had preoperative alterations of the RPE. The minimal (P < 0.001) and the base (P < 0.001) diameters of the MH were significantly larger in eyes with preoperative RPE alterations. The best-corrected visual acuity was significantly worse at baseline (P = 0.014) and at 6 months postoperatively (P = 0.048) in the eyes with RPE alterations. The defect of the ellipsoid zone was significantly longer in eyes with baseline RPE alterations at 1, 3, and 6 months postoperatively (P < 0.001, P = 0.001, and P = 0.032). CONCLUSION The presence of RPE protrusions at baseline was significantly correlated with slower morphologic recovery and poorer visual acuity after MH closure.
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Nakamura T, Ueda-Consolvo T, Oiwake T, Hayashi A. Correlation between outer retinal layer thickness and cone density in patients with resolved central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 254:2347-2354. [DOI: 10.1007/s00417-016-3403-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/27/2016] [Accepted: 05/25/2016] [Indexed: 01/03/2023] Open
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