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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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Camenzind-Zuche H, Janeschitz-Kriegl L, Hasler P, Prünte C. Relaxing radial retinal incisions for the treatment of persistent macular holes. Eur J Ophthalmol 2024; 34:292-299. [PMID: 37700600 DOI: 10.1177/11206721231201662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE Various surgical techniques have been described for managing persistent macular holes after an unsuccessful vitrectomy with internal limiting membrane (ILM) peeling. However, the closure and functional improvement rates after these procedures are limited. Therefore, the aim of this study was to evaluate the usefulness of radial retinal incisions (retinotomies) in eyes with persistent large macula holes despite previous vitrectomy with ILM peeling. DESIGN In a retrospective case series, closure rate and best-corrected visual acuity (BCVA) were evaluated in eyes with persistent macular holes after an unsuccessful vitrectomy that included posterior vitreous detachment and ILM peeling. SUBJECTS 22 eyes of 22 patients (10 men and 12 women) underwent re-vitrectomy with radial retinal incisions. All the patients had undergone an unsuccessful surgery before. METHODS Small-incision re-vitrectomy with radial retinal incisions (retinotomies) and air tamponade was performed. MAIN OUTCOME MEASUREMENTS For all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery; 1 week and 1 month after surgery; and at final follow-up. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 months after operation, and at the final follow-up visit were analyzed. RESULTS The mean baseline macular hole diameter was 668.5 ± 226.8 μm. At the final examination, 16 (72.72%) of the 22 macula holes were closed. Visual acuity increased in 17 eyes, was stable in 3 eyes, and decreased in 2 eyes owing to central retinal atrophy in both. The mean BCVA increased from logMAR 1.04 ± 0.29 at baseline to 0.57 ± 0.31 (Snellen 0.11 ± 0.05 to 0.33 ± 0.18). In all successful cases, macula hole closure was attained after 3 days, and none of the eyes showed macula hole recurrence. CONCLUSION The results of this limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery with ILM peeling increase the success rate of macula hole closure and results in a relevant increase in BCVA. However, as the number of eyes included in this series is limited, the results must be confirmed in a study with a larger sample size.
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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 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
- Kantonsspital Baselland, Eye Clinic, Liestal, Switzerland
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Innauer F, Gabriel M, Mayer-Xanthaki C, Haas A. Closure rates and patterns after light silicone oil tamponade for persistent full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3481-3488. [PMID: 37642749 PMCID: PMC10667392 DOI: 10.1007/s00417-023-06215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To report outcomes of re-vitrectomy using light silicone oil (SO) tamponade for persistent macular holes (MHs). METHODS We reviewed cases of patients with full-thickness MHs that underwent pars plana vitrectomy (PPV) with air/gas and were re-vitrectomized using light SO tamponade after primary non-closure (persistent MHs). Outcome measures included anatomic closure rates and patterns confirmed by optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA). RESULTS A total of 42 eyes of 41 patients with unsuccessful primary PPV with air/gas were included. After re-vitrectomy with light SO (1000-centistoke), 29 (69%) eyes demonstrated type 1 closure without neurosensory defects in OCT scans, whereas 9 eyes (21%) showed type 2 closure with persisting neurosensory defects. Available data (n = 21) showed a significant mean improvement of BCVA from 0.99 logMAR (SD 0.25, range 0.7-1.3) preoperatively to 0.74 logMAR (SD 0.42, range 0.2-1.5) postoperatively (p = 0.035). CONCLUSION The treatment of persistent MHs with PPV and light SO tamponade resulted in high closure rates.
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Affiliation(s)
- Felix Innauer
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Maximilian Gabriel
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
| | - Christoph Mayer-Xanthaki
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Anton Haas
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
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Su T, He S, Mao P, Gu C, Meng C, Zhou C, Chen J, Zheng Z, Qiu Q. A three-step approach to close refractory persistent macular holes: a releasing-closing-tapping approach. Graefes Arch Clin Exp Ophthalmol 2023; 261:3415-3423. [PMID: 37561145 PMCID: PMC10667424 DOI: 10.1007/s00417-023-06197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE The aim of this study was to assess the efficacy and safety of a novel releasing-closing-tapping approach in the treatment of persistent macular holes (PMHs) after initial surgery with internal limiting membrane (ILM) peeling. METHODS We retrospectively analyzed patients with PMHs after initial surgery with ILM peeling who were treated with a novel releasing-closing-tapping approach. After repeated pars plana vitrectomy (PPV), the surgeon effectively released the adhesion between the edges and retinal pigment epithelium (RPE) by gently scraping the retinal neuroepithelium. Then, the hole was converted into a transverse slit, and the edges were gently tapped flat so that they attached to the RPE, and no space was left under the edges. Finally, air tamponade was carried out. The primary outcome measures included MH closure and the change in best-corrected visual acuity (BCVA) from preoperatively to postoperatively. RESULTS The study included 11 PMH patients with a mean age of 63.82 ± 3.31 years. The mean minimum linear diameter of PMHs was 666.3 ± 208.1 μm, and the mean basal diameter was 1547.2 ± 351.8 μm. MH closure was achieved in 90.9% (10/11) of eyes, with significant improvement of visual acuity from 1.19 ± 0.30 logMAR to 0.65 ± 0.29 logMAR postoperatively. CONCLUSION The releasing-closing-tapping approach with repeated PPV is a simple, effective, and safe surgical procedure for refractory PMHs after initial surgery with ILM peeling that can significantly improve the visual outcome and achieve a high surgical success rate.
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Affiliation(s)
- Tong Su
- Shandong Eye Hospital, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Jinan, China
| | - Shuai He
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Peiyao Mao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Chufeng Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Chunren Meng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Chuandi Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Jili Chen
- Shibei Hospital, Jing'an District, Shanghai, People's Republic of China.
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
- National Clinical Research Center for Eye Diseases; Shanghai Clinical Research Center for Eye Diseases; Shanghai Key Clinical Specialty; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China.
| | - Qinghua Qiu
- Department of Ophthalmology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, People's Republic of China.
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Lorenzi U, Mehech J, Caporossi T, Romano MR, De Fazio R, Parrat E, Matonti F, Mora P. A retrospective, multicenter study on the management of macular holes without residual internal limiting membrane: the refractory macular hole (ReMaHo) study. Graefes Arch Clin Exp Ophthalmol 2022; 260:3837-3845. [PMID: 35790571 PMCID: PMC9666308 DOI: 10.1007/s00417-022-05739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/09/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To evaluate the surgical management, outcomes and prognostic factors of full thickness macular holes without residual internal limiting membrane (NO-ILM FTMHs). Methods We performed a multicenter, retrospective study of 116 NO-ILM FTMHs. Human amniotic membrane (hAM) plug, autologous ILM free flap transplantation (AILMT), and autologous retinal graft transplantation (ART) were performed in 58, 48, and 10 patients, respectively. Data were collected before and up to 12 months after surgery. The primary outcomes were hole closure and final best-corrected visual acuity (BCVA). Results The final BCVA (0.78 ± 0.51 logMAR) was significantly better than and correlated with the initial BCVA (p < 0.0001 and p = 0.004, respectively). Hole closure was achieved in 92% of eyes. The minimum FTMH diameter was wider and final BCVA was lower in the ART group than in the other groups (p < 0.003 and p < 0.001, respectively). FTMHs with diameter > 680 μm had a higher closure rate with hAM than with AILMT (p = 0.02). Conclusions AILMT and hAM were the most frequently performed surgeries with both high closure rate and significant functional improvement. Preoperative BCVA was correlated with final BCVA. The minimum FTMH diameter may guide the treatment choice.
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Affiliation(s)
- Umberto Lorenzi
- Ophthalmology Unit, Centre Hospitalier Universitaire Charles-Nicolle, Rouen, France
- P 1.5 Group, 80, allée des Ormes, 06250, Mougins, France
| | - Joel Mehech
- Ophthalmology Unit, Centre Hospitalier Universitaire Charles-Nicolle, Rouen, France
| | - Tommaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Rocco De Fazio
- Ophthalmology Unit, Ospedale Santa Maria della Scaletta, Imola, Italy
| | - Eric Parrat
- P 1.5 Group, 80, allée des Ormes, 06250, Mougins, France
- Clinique Des Eaux Claires, Baie-Mahault, Guadeloupe, France
| | - Frédéric Matonti
- P 1.5 Group, 80, allée des Ormes, 06250, Mougins, France
- Centre Monticelli Paradis, Marseille, France
- Institut de Neuroscience de La Timone, Aix-Marseille University, Marseille, France
- Clinique Juge, Groupe Almaviva Santé, Marseille, France
| | - Paolo Mora
- Ophthalmology Unit, University Hospital of Parma, 43126, Parma, PR, Italy.
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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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Ahmed Khan S, Goldsmith C, Thandar So M. Aspiration of viscous plug in macular hole surgery: a case series. Ther Adv Ophthalmol 2022; 14:25158414211063288. [PMID: 35071982 PMCID: PMC8771736 DOI: 10.1177/25158414211063288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Macular hole surgery has been revolutionized since the 1990s’ with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.
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Affiliation(s)
- Shaheryar Ahmed Khan
- Ophthalmology Department, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK
| | - Craig Goldsmith
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK
| | - Mya Thandar So
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK
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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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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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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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Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmol Ther 2021; 10:1137-1153. [PMID: 34494236 PMCID: PMC8589910 DOI: 10.1007/s40123-021-00388-5] [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: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
Primary surgery for macular hole (MH) closure has a high success rate with current methods of pars plana vitrectomy and internal limiting membrane (ILM) peeling. When primary surgery fails, there are several options available for secondary repair, including extension of the ILM peel, creation of an ILM flap, pedunculated ILM flap, lens capsule flap transplantation, autologous retinal transplantation, use of a human amniotic membrane plug, adjuvant autologous platelet concentrate, induction of macular detachments with subretinal blebs, and creation of retinal incisions. In this review, we discuss the practical approach to each of these surgical techniques for the management of recurrent or persistent MHs.
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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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14
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Therapeutic Efficacy of Autologous Platelet Concentrate Injection on Macular Holes with High Myopia, Large Macular Holes, or Recurrent Macular Holes: A Multicenter Randomized Controlled Trial. J Clin Med 2021; 10:jcm10122727. [PMID: 34205522 PMCID: PMC8235760 DOI: 10.3390/jcm10122727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
We aimed to evaluate the anatomical and functional outcomes of pars-plana vitrectomy (PPV) with or without autologous platelet concentrate (APC) injection in patients with recurrent macular holes (MHs), large MHs, or MHs with high myopia. This multicenter, prospective, interventional randomized controlled trial was conducted from March 2017 to April 2020. Participants were randomly allocated to a PPV group or a PPV+APC group. All participants underwent standard 25-gauge PPV, and eyes in the PPV+APC group underwent PPV with intravitreal APC injection before air-gas exchange. A total of 117 patients were enrolled (PPV group: n = 59, PPV+APC group: n = 58). Hole closure was achieved in 47 participants (79.7%) in the PPV group and 52 participants (89.7%) in the PPV+APC group. There were no between-group differences in the anatomical closure rate or functional outcomes including best-corrected visual acuity, metamorphopsia, pattern-reversal visual evoked potential, or Visual Function Questionnaire-25 score. The use of APC injection does not improve the anatomical and functional outcomes of surgery for large MHs, recurrent MHs, or MHs with high myopia. The adjunctive use of APC can be considered in selected cases because it is not inferior to conventional MH surgery, is relatively simple to perform, and is not affected by the surgeon’s skill.
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15
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Ittarat M, Somkijrungroj T, Chansangpetch S, Pongsachareonnont P. Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole. Clin Ophthalmol 2020; 14:2171-2183. [PMID: 32801628 PMCID: PMC7398756 DOI: 10.2147/opth.s262877] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To summarize current surgical techniques for treating primary macular holes (MHs). Methods We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of >90%, even in large MH up to 650 µm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.
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Affiliation(s)
- Mantapond Ittarat
- Surin Hospital and Surin Medical Education Center, Department of Ophthalmology, Suranaree University of Technology, Surin, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thanapong Somkijrungroj
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Vitreoretinal Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Glaucoma Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pear Pongsachareonnont
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Vitreoretinal Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Degenhardt V, Busch C, Jochmann C, Meier P, Unterlauft JD, Mößner A, Edel E, Tewari R, Wiedemann P, Rehak M. Prognostic Factors in Patients with Persistent Full-Thickness Idiopathic Macular Holes Treated with Re-Vitrectomy with Autologous Platelet Concentrate. Ophthalmologica 2019; 242:214-221. [PMID: 31509827 DOI: 10.1159/000502386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify the predictors for anatomical and functional outcome after re-vitrectomy with application of autologous platelet concentrate (APC) in eyes with persistent idiopathic macular hole (MH). METHODS Retrospective study of 103 eyes with persistent MHs after vitrectomy with peeling of internal limiting membrane (ILM) and expansive gas. All patients underwent re-vitrectomy with APC and endotamponade. The anatomical MH closure rate and postoperative best-corrected visual acuity (BCVA) were evaluated. Further, predictive factors influencing the success of the surgery were analyzed. RESULTS Median BCVA (logMAR) before the surgery was 1.00 (interquartile range [IQR] 0.80-1.30) and the median of minimum diameter between hole edges was 508 µm (IQR 387-631). The final closure rate after re-vitrectomy with APC was 60.2% (62 of 103 eyes). The following predictors were identified to significantly influence the closure rate: tractional hole index (THI), axial length, time between first and second surgery, and the experience of the surgeon (p < 0.05). CONCLUSIONS Re-vitrectomy with APC led to the closure of 60.2% of the persistent MHs. The closure rate negatively correlates with increasing axial length, time between the first and second surgery, and the decreased THI. Further, experienced surgeons (with a history of >100 pars plana vitrectomies with ILM peeling) had significantly higher closure rates.
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Affiliation(s)
- Valentin Degenhardt
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany.,Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Catharina Busch
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Claudia Jochmann
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Petra Meier
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | | | - Andreas Mößner
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Elvira Edel
- Institute for Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Ruchir Tewari
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany.,Tewari Eye Centre, Ghaziabad, India
| | - Peter Wiedemann
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany,
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17
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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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18
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Wu AL, Chuang LH, Wang NK, Chen KJ, Liu L, Yeung L, Chen TL, Hwang YS, Wu WC, Lai CC. Refractory macular hole repaired by autologous retinal graft and blood clot. BMC Ophthalmol 2018; 18:213. [PMID: 30157808 PMCID: PMC6114829 DOI: 10.1186/s12886-018-0898-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the surgical technique using autologous retinal graft (ARG) and autologous blood clot (ABC) for the management of refractory macular holes (MHs). Methods This study was a retrospective, consecutive, interventional case series. Six eyes of 6 patients who underwent vitrectomy combined with ARG and ABC for the treatment of refractory MH were reviewed. Visual and anatomic outcomes were evaluated. Results The mean age was 59.0 ± 9.9 years. All cases had multiple vitreoretinal procedures including vitrectomy and gas fluid exchange before patient presentation. The average numbers of vitrectomies were 2.3 ± 0.5, and those of gas fluid exchange were 3 ± 1.7. Closure of the macular hole was achieved in four (66.7%) cases at last follow-up. The mean follow-up time was 25.2 ± 15.6 months. The averaged BCVA before and after 12 months of the surgery improved from 20/591 to 20/244. Conclusions This surgical technique using ARG and ABC provide an option for the treatment of refractory MHs. Electronic supplementary material The online version of this article (10.1186/s12886-018-0898-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Lan-Hsin Chuang
- College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, 635 west, 165th street, New York, NY, 10032, USA
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, No.5, Fu-Hsin Rd., Fuxing St., Guishan Dist, Taoyuan, 33375, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 333, Taiwan.
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19
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Michalewska Z, Nawrocki J. Repeat Surgery in Failed Primary Vitrectomy for Macular Holes Operated With the Inverted ILM Flap Technique. Ophthalmic Surg Lasers Imaging Retina 2018; 49:611-618. [DOI: 10.3928/23258160-20180803-09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
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Abstract
PURPOSE To evaluate the current surgical options available for the management of large (>400 μm), recurrent, or persistent macular holes (MHs). METHODS A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and surgical treatments of large, recurrent, or persistent MHs. Based on this review, a comprehensive overview was provided regarding the topic of large, recurrent, or persistent MHs and focused on recent surgical management updates. RESULTS For large MHs, variations of the inverted internal limiting membrane flap technique demonstrated promising rates of primary hole closure and significant visual acuity improvements. For recurrent or recalcitrant MHs, early repeat vitrectomy with extension of the internal limiting membrane peel remains the most straightforward and optimal surgical technique to achieve secondary closure. Regardless of the surgical approach, the goal of each technique described is to induce or aid in stimulating gliosis within the MH to maximize closure. CONCLUSION Despite the high success rate of modern MH surgery, large, recurrent, or persistent MHs remain a challenge for retinal surgeons. This review provides a detailed summary on the rationality and efficacy of current surgical options.
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21
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Lyu WJ, Ji LB, Xiao Y, Fan YB, Cai XH. Treatment of refractory giant macular hole by vitrectomy with internal limiting membrane transplantation and autologous blood. Int J Ophthalmol 2018; 11:818-822. [PMID: 29862182 DOI: 10.18240/ijo.2018.05.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/13/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effect of internal limiting membrane transplantation and autologous blood on treating refractory giant macular hole. METHODS Thirty-seven eyes with giant macular hole of the smallest hole diameter >700 µm, the maximum diameter of the substrate >1000 µm and hole formation factor <0.6 underwent surgical treatment. The patients were randomly divided into two groups. Nineteen eyes with surgical flip of the internal limiting membrane in group A, 18 eyes with internal limiting membrane transplantation in group B who underwent the tamponade of internal limiting membrane into the hole, autologous plasma was used to seal the hole. The patients were followed up for 3mo, optical coherence tomography and best corrected visual acuity (BCVA) were recorded before and after operation, and the results were statistically analyzed. RESULTS At 3mo after operation, BCVA of the two groups was significantly improved compared with that before operation (tA=4.192, tB=4.374, P<0.05). But there was no significant difference in visual acuity between the two groups (χ2=0.128, P>0.05). At 3mo after operation, the closure rate of group A was 68.4%, and 100% in group B. (χ2=5.628, P<0.05). The defect diameter of inner segment/outer segment at 3mo after the operation was significantly lower than that before operation (tA=12.287, tB=15.481, P<0.05), and the difference was statistically significant (t=2.552, P<0.05). CONCLUSION Internal limiting membrane transplantation combined with autologous whole blood can improve the postoperative closure rate of the refractory large aperture, and can effectively improve the postoperative visual acuity.
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Affiliation(s)
- Wen-Juan Lyu
- Department of Ophthalmology, No.474 Hospital of the People's Liberation Army (PLA), Urumqi 830011, the Xinjiang Uygur Autonomous Region, China
| | - Lei-Bing Ji
- Department of Ophthalmology, No.474 Hospital of the People's Liberation Army (PLA), Urumqi 830011, the Xinjiang Uygur Autonomous Region, China
| | - Yun Xiao
- Department of Ophthalmology, No.474 Hospital of the People's Liberation Army (PLA), Urumqi 830011, the Xinjiang Uygur Autonomous Region, China
| | - Yin-Bo Fan
- Department of Ophthalmology, No.474 Hospital of the People's Liberation Army (PLA), Urumqi 830011, the Xinjiang Uygur Autonomous Region, China
| | - Xue-Hong Cai
- Department of Ophthalmology, No.474 Hospital of the People's Liberation Army (PLA), Urumqi 830011, the Xinjiang Uygur Autonomous Region, China
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22
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Nowroozzadeh MH, Ashraf H, Zadmehr M, Farvardin M. Outcomes of Light Silicone Oil Tamponade for Failed Idiopathic Macular Hole Surgery. J Ophthalmic Vis Res 2018; 13:130-137. [PMID: 29719640 PMCID: PMC5905305 DOI: 10.4103/jovr.jovr_22_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To study the outcomes of redo macular hole surgery using light silicone oil tamponade. Methods: In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures. Results: Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open. Conclusions: Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes.
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Affiliation(s)
- M Hossein Nowroozzadeh
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ashraf
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Zadmehr
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Farvardin
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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23
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Relationship between Peeled Internal Limiting Membrane Area and Anatomic Outcomes following Macular Hole Surgery: A Quantitative Analysis. J Ophthalmol 2016; 2016:5641273. [PMID: 27413544 PMCID: PMC4928003 DOI: 10.1155/2016/5641273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To quantitatively evaluate the effects of peeled internal limiting membrane (ILM) area and anatomic outcomes following macular hole surgery using spectral domain optical coherence tomography (SD-OCT). Methods. Forty-one eyes in 37 consecutive patients with idiopathic, Gass stage 3-4 macular hole (MH) were enrolled in this retrospective comparative study. All patients were divided into 2 groups according to anatomic success or failure. Basal MH diameter, peeled ILM area, and MH height were calculated using SD-OCT. Other prognostic parameters, including age, stage, preoperative BCVA, and symptom duration were also assessed. Results. Thirty-two cases were classified as anatomic success, and 9 cases were classified as anatomic failure. Peeled ILM area was significantly wider and MH basal diameter was significantly less in the anatomic success group (p = 0.024 and 0.032, resp.). Other parameters did not demonstrate statistical significance. Conclusion. The findings of the present study show that the peeled ILM area can affect the anatomic outcomes of MH surgery.
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24
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Pires J, Nadal J, Gomes NL. Internal limiting membrane translocation for refractory macular holes. Br J Ophthalmol 2016; 101:377-382. [PMID: 27146153 DOI: 10.1136/bjophthalmol-2015-308299] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/27/2016] [Accepted: 04/16/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Closure is more difficult to achieve in macular holes that remain open following a previous unsuccessful pars plana vitrectomy (PPV). We present our results with the internal limiting membrane (ILM) translocation technique that is used to optimise outcomes in refractory macular holes. METHODS A prospective, interventional, case series was conducted. 12 eyes of 12 consecutive patients with incomplete sealing of the macular hole (open and type 2 closure) after a previous PPV with ILM peeling were included. Measured baseline parameters included best-corrected visual acuity (BCVA) and macular hole smallest diameter, base diameter and height. Surgeries were performed by harvesting a fragment of the ILM near the vascular arcades and subsequently placing it inside the hole. Postoperative measured outcomes included macular hole status, foveal contour, outer retina integrity, BCVA and surgery-related complications. RESULTS Anatomic closure occurred in 11 of 12 eyes (91%). This technique elicited a statistically significant improvement in BCVA (p=0.008). Mean BCVA was 20/400 at study baseline and 20/160 at final follow-up. However, less than 16.7% of cases had a final BCVA of ≥20/63. CONCLUSION The ILM translocation technique seems to facilitate persistent idiopathic macular hole closure, where primary surgery with PPV and ILM peeling failed.
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Affiliation(s)
- Joana Pires
- Department of Ophthalmology, Centro Hospitalar do Baixo Vouga, Porto, Portugal
| | - Jeroni Nadal
- Department of Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain
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