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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Lachance A, You E, Garneau J, Bourgault S, Caissie M, Tourville É, Dirani A. Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy. J Ophthalmol 2021; 2021:8832538. [PMID: 33520301 PMCID: PMC7817234 DOI: 10.1155/2021/8832538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the anatomical and functional outcomes of revision surgery after failed primary surgery for idiopathic macular hole (MH). METHODS All consecutive patients with MH were identified from a cohort of patients operated between 2014 and 2018 at the CHU de Québec-Université Laval (Québec). The clinical and anatomical features of patients with unclosed MH after primary surgery were retrospectively collected. Our primary outcome was MH nonclosure rate after revision surgery. Our secondary outcomes were best-corrected visual acuity (BCVA) with ETDRS scale and MH size of eyes with revision surgery preoperatively and at 3 and 12 months after revision surgery. RESULTS In our cohort of 1085 eyes, 926 eyes met inclusion criteria and were analyzed in the study. We identified 22 eyes with failed primary surgery (2.4%), of which 20 underwent revision surgery. We had no bilateral MH in these 22 eyes. The nonclosure rate of MH after revision surgery was 15%. The mean final BCVA for closed MH after revision surgery was 55 ± 19 letters. Compared to the initial presentation, the mean change in visual acuity (VA) for closed MH was +4 ± 31 letters and +16 ± 17 letters at 3 and 12 months after the revision surgery, respectively. At initial presentation, patients with failed primary surgery had a baseline MH size of 665 ± 226 μm. The mean MH size after failed primary surgery was 607 ± 162 μm and 546 ± 156 μm for the three unclosed MHs one month after revision surgery. CONCLUSION The success rate of revision surgery in eyes with unclosed MH is 85%. After successful revision surgery, eyes demonstrated an improvement in VA and closure of the MH.
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Affiliation(s)
- Alexandre Lachance
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Eunice You
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Jérôme Garneau
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Serge Bourgault
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Mathieu Caissie
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Éric Tourville
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Ali Dirani
- Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie–Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec City, Québec, Canada
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