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Journal Francais D'ophtalmologie Mar 2023The treatment of refractory macular holes is controversial, with human amniotic membrane grafts emerging recently as an attractive option. We performed a meta-analysis... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The treatment of refractory macular holes is controversial, with human amniotic membrane grafts emerging recently as an attractive option. We performed a meta-analysis and systematic review in this paper to assess the results of human amniotic membrane (hAM) in the treatment of refractory macular hole (MH).
METHODS
We searched the Cochrane Database of Systematic Reviews, Web of Science, PubMed, Embase, China National Knowledge Infrastructure databases, VIP database, Wanfang Data Knowledge Service Platform, Sinomed, Chinese Clinical Trial Registry, and Clinical Trials.gov. Studies reporting hAM for the treatment of refractory MH were included. The outcomes are MH closure rate, visual acuity (VA) improvement rate, and graft dislocation/contracture rate.
RESULTS
A total of 8 studies on 103 eyes were included, all of which had undergone failed vitrectomy and internal limiting membrane (ILM) peeling. In all studies, the VA improvement rate was 66% (95%CI: 45 to 84%), the MH closure rate was 94% (95%CI: 84 to 100%) and the hAM graft dislocation/contracture rate was 6% (95%CI: 0 to 15%). In the studies using cryopreserved hAM grafts, the MH closure rate was 99% (95%CI: 94 to 100%) and the hAM graft dislocation/contracture rate was 3% (0%, 10%). The VA improvement rates were 94% (95%CI: 79 to 100%) in the retinal detachment subgroup, 37% (95%CI: 20 to 56%) in the pathologic myopia subgroup, and 62% (95%CI: 14 to 100%) in the idiopathic MH subgroup.
CONCLUSION
Human amniotic membrane in the treatment of refractory MH results in visual improvement. It has a high macular hole closure rate and low dislocation/contracture rate. Cryopreserved hAM grafts might have better outcomes than dehydrated grafts.
Topics: Humans; Amnion; Basement Membrane; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 36739260
DOI: 10.1016/j.jfo.2022.07.001 -
Ophthalmologica. Journal International... 2022To describe retinal morphology and vision recovery after spontaneous closure of full-thickness macular hole (FTMH). (Observational Study)
Observational Study
PURPOSE
To describe retinal morphology and vision recovery after spontaneous closure of full-thickness macular hole (FTMH).
MATERIALS AND METHODS
Retrospective, observational study. From a database containing 750 FTMH, we included 23 cases. All patients had a complete ophthalmic examination. Swept-source optical coherence tomography angiography was performed.
RESULTS
Prior to spontaneous closure in 11 women and 12 men (mean age 67 years), the mean minimum FTMH diameter was 201 μm, and mean base FTMH diameter was 638 μm. Visual acuity improved from 0.29 Snellen to 0.47 Snellen (p = 0.001) after 6 months and showed no further improvement. Spontaneous closure of FTMH was associated with vitreous detachment in less than half of the cases. Irregularities in the deep vascular layer and hyporeflective areas in the choriocapillaris were noted.
DISCUSSION
Equal sex distribution of spontaneous closures (1:1) differs from the high prevalence of females seen in the literature. Complete visual recovery is uncommon in cases of spontaneous closure of FTMH. It might be explained by prolonged defects of the choriocapillaris layer. These findings, along with the evolution of the various morphologies reported in the study, could possibly suggest that delaying vitrectomy while hoping for spontaneous closure might not be justified.
Topics: Aged; Female; Humans; Male; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 33915537
DOI: 10.1159/000516768 -
Japanese Journal of Ophthalmology Jan 2024Vitreomacular traction (VMT) has unique presentations in eyes with diabetic retinopathy (DR). This study aimed to investigate the characteristics and clinical course of...
PURPOSE
Vitreomacular traction (VMT) has unique presentations in eyes with diabetic retinopathy (DR). This study aimed to investigate the characteristics and clinical course of VMT in DR.
STUDY DESIGN
A retrospective case series.
METHODS
Thirty eyes from 30 patients with DR and concurrent VMT were retrospectively enrolled. Baseline and final best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) characteristics were reported. Linear regression models were used to analyze the correlating factors for visual outcome.
RESULTS
Of the 30 eyes, a thickened posterior hyaloid membrane was noted in all cases and multi-layered traction from different directions in 14 eyes (46.7%). Twenty-one eyes (70%) had tractional macular retinoschisis, seven (23.3%) had foveal detachment, five (16.7%) had a lamellar macular hole, and three (10%) had a full-thickness macular hole, including two with macular hole retinal detachment. Three eyes had spontaneous release of the VMT within 3 months of observation. For the remaining 27 eyes receiving operations, the VMT, full-thickness macular hole, and serous foveal detachment all resolved postoperatively with residual macular schisis in 6 eyes (22.2%) only. None of the baseline OCT characteristics were associated with postoperative BCVA (P > .05).
CONCLUSIONS
VMT in DR had a thickened posterior hyaloid, and many of them had multi-layered traction and/or concurrent macular retinoschisis. Lamellar macular hole, full-thickness macular hole, or concurrent retinal detachment may also occur. Spontaneous resolution of VMT rarely occurred, and those who underwent operation for VMT had improved vision and macular structures with resolution of the macular hole and retinal detachment.
Topics: Humans; Diabetic Retinopathy; Retinal Perforations; Retrospective Studies; Vitreous Detachment; Retinal Detachment; Retinoschisis; Traction; Vision Disorders; Tomography, Optical Coherence; Diabetes Mellitus
PubMed: 38001367
DOI: 10.1007/s10384-023-01034-2 -
Indian Journal of Ophthalmology Oct 2023Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain...
BACKGROUND
Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain anatomical closure. However, there are still challenges when the hole is large and chronic (>400 microns) in nature. Here we describe a modified technique of internal limiting membrane (ILM) peeling which results in the successful closure of such macular holes.
PURPOSE
To demonstrate modified ILM flap techniques in management of chronic macular holes.
SYNOPSIS
Here we have described the role of modified ILM peeling techniques in three different cases such as chronic traumatic macular hole >400 microns, chronic idiopathic macular hole >400 microns and <400 microns.
HIGHLIGHTS
This modified ILM flap technique provides the benefit of an inverted ILM flap, which helps in glial proliferation and also relives tangential traction thereby aiding in successful macular hole closure in chronic cases.
VIDEO LINK
https://youtu.be/RKVLd1mSw08.
Topics: Humans; Retinal Perforations; Epiretinal Membrane; Basement Membrane; Vitrectomy; Surgical Flaps; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37787255
DOI: 10.4103/IJO.IJO_883_23 -
American Journal of Ophthalmology Feb 2020To report on the etiologies and prognosis of macular hole (MH) in children and to explore the indicators of spontaneous hole closure and poor final visual outcome...
PURPOSE
To report on the etiologies and prognosis of macular hole (MH) in children and to explore the indicators of spontaneous hole closure and poor final visual outcome (vision worse than 20/200).
DESIGN
Consecutive, retrospective case series.
METHODS
A consecutive series of patients aged less than 16 years with a full-thickness macular hole treated from 2013 to 2019 in a singer tertiary center was retrospectively reviewed. Data collected from charts included age, sex, best-corrected visual acuity (BCVA), etiology of MH, size of MH, clinical findings, operations, and anatomic and functional outcomes. Logistic regression models were built to establish the predisposing factors.
RESULTS
Forty eyes of 40 patients were included. Patients were predominantly male with a mean age of 8.3 years. Among the etiologies, trauma prevailed in 29 (72.5%) eyes. Twenty-nine patients underwent surgery, and 18 (62.1%) had traumatic MH. All had achieved hole closure. BCVA improved at the final visit. Spontaneous closure was found in 10 (25%) eyes after an average 2 months after trauma. Regression analysis showed that a relatively smaller macular hole (P = .006) was likely to experience spontaneous closure. Presence of macular lesions (P = .001) was identified as risk factor for poor final vision.
CONCLUSIONS
Most pediatric MH was caused by blunt trauma. BCVA improved after MH closed, regardless of surgery or spontaneous closure. Smaller MH secondary to trauma was more likely to experience spontaneous closure with an average time of 2 months. Presence of macular lesions was a risk factor for final poor vision.
Topics: Adolescent; Child; Child, Preschool; Endotamponade; Female; Humans; Infant; Logistic Models; Male; Prognosis; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Wounds, Nonpenetrating
PubMed: 31560879
DOI: 10.1016/j.ajo.2019.09.014 -
Journal of the College of Physicians... Jun 2022To evaluate the anatomical and functional results of macular hole surgery in patients with diabetes mellitus (DM) and hypertension (HT) without retinopathy.
OBJECTIVE
To evaluate the anatomical and functional results of macular hole surgery in patients with diabetes mellitus (DM) and hypertension (HT) without retinopathy.
STUDY DESIGN
Descriptive comparative study.
PLACE AND DURATION OF STUDY
Department of Ophthalmology, Health Sciences University Haydarpaşa Numune Training and Research Hospital, Turkey between January 2016 and December 2020.
METHODOLOGY
This study included 141 eyes of 139 patients who underwent pars plana vitrectomy for macular holes. The patients were divided into two groups according to the anatomic closure after surgery. Group 1 (cases) were patients with macular hole closure, and group 2 (controls) were patients whose macular hole was not closed. The patients with and without diabetes mellitus (DM) or hypertension (HT) were compared. All patients did not have retinopathy. After surgery, the anatomical closure rate of the macular hole and the amount of increase in visual acuity were measured. Significance of the difference between the groups was evaluated using chi-square test.
RESULTS
The best-corrected visual acuity (BCVA) was 1.30 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). While BCVA was 1.3 logMAR before surgery in the group with DM, it was 0.7 logMAR after surgery (p<0.001). In the group with HT, BCVA was 1.3 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). The anatomic success rate after surgery in patients with DM was similar to the group without DM (p=0.93). The anatomic success rate after surgery in patients with HT was similar to the group without HT (p=0.46).
CONCLUSIONS
In the absence of retinopathy there is no difference between the success rates of the macular hole surgery in patients with or without DM and HT.
KEY WORDS
Diabetes mellitus, Hypertension, Vitrectomy, Macular hole.
Topics: Diabetes Mellitus; Humans; Hypertension; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Vitrectomy
PubMed: 35686408
DOI: 10.29271/jcpsp.2022.06.758 -
Acta Medica Academica Dec 2019Postoperative eccentric macular hole formation is a rare complication after vitrectomy with internal limiting membrane peeling for a macular hole. We report a rare case...
OBJECTIVE
Postoperative eccentric macular hole formation is a rare complication after vitrectomy with internal limiting membrane peeling for a macular hole. We report a rare case of late eccentric macular hole formation following successful macular hole surgery.
CASE REPORT
A 73-year old woman was referred with a long standing full thickness macular hole in both eyes. The patient underwent sequential cataract surgery, 23 gauge sutureless pars plana vitrectomy with internal limiting membrane peeling and inverted flap in both eyes. Control examination six months after the surgery revealed best corrected visual acuity of 20/40 in both eyes, complete closure of the macular hole, with retinal atrophy in both eyes. Control examination eighteen months after the surgery revealed a stable finding in the right eye and an eccentric temporal macular hole in the left eye. The patient was closely observed for one year with no signs of visual acuity reduction or macular hole changes.
CONCLUSION
Postoperative eccentric macular holes may occur after a long follow up period. Most cases remain stable for a long period of time and do not require further surgical intervention. This case highlights the need for close monitoring of patients after macular hole surgery with internal limiting membrane peeling.
Topics: Aged; Female; Humans; Retinal Perforations; Tomography, Optical Coherence; Vitrectomy
PubMed: 32124631
DOI: 10.5644/ama2006-124.273 -
Japanese Journal of Ophthalmology Mar 2022To investigate the correlations of thickness of three retinal layers with retinal displacement after idiopathic macular hole surgery.
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.
Topics: Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 34855121
DOI: 10.1007/s10384-021-00887-9 -
BMC Ophthalmology Mar 2021To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).
BACKGROUND
To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).
METHODS
This retrospective study enrolled 10 patients who underwent vitrectomy for MHs caused by laser injury. Best corrected visual acuity (BCVA), macular spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were used for assessment.
RESULTS
Four patients were injured by unexpected expose of an yttrium aluminum garnet (YAG) laser, and six patients were accidentally injured by a handheld laser. The MH minimum diameters (MDs) ranged from 55 to 966 μm (mean = 548.00 ± 286.10 μm), and BCVA ranged from 20/400 to 20/50 (mean = logMAR 0.87 ± 0.29) preoperatively. All 10 eyes underwent PPV, internal limiting membrane (ILM) peeling, and gas tamponade. All eyes demonstrated closure of the MH with different degrees of discontinuity of the outer layer of the retina, and four eyes exhibited serious retinal pigment epithelium (RPE) destruction. Postoperative BCVA values were significantly improved (mean = logMAR 0.55 ± 0.33; P = 0.032, t = 2.234). The mean BCVA of the destroyed RPE group was significantly worse than that of the non-destroyed RPE group both before and after surgery (P = 0.019; Wilcoxon signed rank test). Further, OCTA indicated choroidal ischemia in the laser-induced MHs.
CONCLUSION
Vitrectomy can be successful in closing laser-induced full-thickness MHs and improving visual acuity. However, If RPE/choroid is involved in laser damage in addition to the outer retinal layer, this may indicate poor visual prognosis.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 33714272
DOI: 10.1186/s12886-021-01893-8 -
Digital Journal of Ophthalmology : DJO 2023Postoperative face-down positioning (FDP) for up to 2 weeks is believed to be necessary for successful closure of macular holes. FDP, however, can be disabling and...
BACKGROUND
Postoperative face-down positioning (FDP) for up to 2 weeks is believed to be necessary for successful closure of macular holes. FDP, however, can be disabling and uncomfortable and is a major burden for elderly patients. The aim of this study was to investigate how nonsupine posturing and macular hole size affect anatomical and functional success of macular hole closure.
METHODS
The medical records of patients with idiopathic macular holes who were treated surgically between 2016 and 2019 were reviewed retrospectively. Exclusion criteria included vitreomacular traction, previous retinal detachment, or chronic macular hole.
RESULTS
A total of 115 eyes of 115 patients were included. Average age was 69.2 ± 8.2 years; 63 patients (55%) were female. Anatomical success was achieved in 108 patients (94%) with a single operation. In small holes (<400 μm), closure was seen in 98% of cases (95% CI, 94%-100%); in large holes (≥400 μm), 90% of cases (95% CI, 76%-94%). Visual acuity remained stable or improved in 108 patients (92%). Average preoperative best-corrected visual acuity was 1.02 ± 0.45, with an overall improvement of 5 lines postoperatively. Small holes and large holes improved, with an average of 3 versus 7 lines gained, respectively.
CONCLUSIONS
In this study cohort, favorable anatomical and functional outcomes were achieved without postoperative FDP. These outcomes are comparable to the traditional FDP approach.
Topics: Humans; Female; Aged; Middle Aged; Male; Retinal Perforations; Retrospective Studies; Posture; Retina; Retinal Detachment; Vitrectomy; Treatment Outcome
PubMed: 37780038
DOI: 10.5693/djo.01.2023.05.001