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Journal of Ocular Pharmacology and... May 2017Macular pathology, including macular holes (MHs), epiretinal membranes (ERMs), and macular edema, is a cause of irreversible vision loss in the setting of uveitis.... (Review)
Review
PURPOSE
Macular pathology, including macular holes (MHs), epiretinal membranes (ERMs), and macular edema, is a cause of irreversible vision loss in the setting of uveitis. Medical management involves corticosteroids, immunomodulatory medications, and biologics to control inflammation. Pars plana vitrectomy (PPV) has been suggested as a therapy for uveitis, with reports of reduced inflammation and decreased dependence on medication postoperatively. Currently, PPV is reserved for retinal detachments, vitreous opacities, and ERMs, causing vitreomacular traction. However, little is known about the visual outcomes of PPV with ERM peel for MH, or in ERM without evidence of traction in the context of uveitis.
METHODS
Review of small case series and case reports support both conservative medical treatment and vitrectomy, independently, and in combination, in the management of macular pathology in the setting of uveitis.
RESULTS AND CONCLUSIONS
Further studies are required to study uveitic etiologies separately with respect to visual outcomes after vitreoretinal surgery and medical management.
Topics: Epiretinal Membrane; Humans; Retinal Perforations; Uveitis; Vitrectomy
PubMed: 28112568
DOI: 10.1089/jop.2016.0142 -
Ophthalmology. Retina Feb 2022
Topics: Humans; Macula Lutea; Myopia; Reproducibility of Results; Retinal Perforations; Tomography, Optical Coherence
PubMed: 35123728
DOI: 10.1016/j.oret.2021.10.009 -
Die Ophthalmologie Jun 2024Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If... (Review)
Review
Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If diagnosed and treatment is initiated at an early stage, surgery has a high success rate with respect to both hole closure and improvement of visual acuity. Optical coherence tomography (OCT)-based staging and sizing enables an estimation of the surgical outcome. The differential diagnostic distinction from clinically similar disorders, such as lamellar macular holes, macular pseudoholes, and foveoschisis is clinically relevant as the pathogenesis, prognosis and treatment are significantly different. While vitrectomy with peeling of the inner limiting membrane (ILM) and gas tamponade is established as the standard treatment for FTMH, some aspects of treatment are handled differently between surgeons, such as the timing of surgery, the choice of endotamponade and the type and duration of postoperative positioning. For FTMH associated with vitreomacular traction, alternative treatment options in addition to vitrectomy include intravitreal ocriplasmin injection and pneumatic vitreolysis. The current clinical guidelines of the German ophthalmological societies summarize the evidence-based recommendations for diagnosis and treatment of FTMH.
Topics: Humans; Retinal Perforations; Vitrectomy; Diagnosis, Differential; Practice Guidelines as Topic; Tomography, Optical Coherence; Germany; Endotamponade
PubMed: 38775987
DOI: 10.1007/s00347-024-02047-z -
Acta Ophthalmologica Sep 2022To analyse morpho-functional foveal changes in eyes with lamellar macular hole (LMH) by an integrated assessment of short-wavelength fundus autofluorescence (SW-FAF) and...
PURPOSE
To analyse morpho-functional foveal changes in eyes with lamellar macular hole (LMH) by an integrated assessment of short-wavelength fundus autofluorescence (SW-FAF) and microperimetry (SW-FAF/microperimetry integrated assessment) before and after treatment with a technique of double-inverted flaps of epiretinal proliferation (EP) and internal limiting membrane (ILM).
METHODS
Clinical and tomographic parameters were best-corrected visual acuity (BCVA), LMH size, central retinal thickness (CRT) and outer retinal layer integrity. SW-FAF/microperimetry integrated assessment allowed to analyse retinal sensitivity (RS) and FAF status of the fovea by an overlay of RS map on SW-FAF image. Follow-up was at baseline, 1, 3, 6 and 12 postoperative months.
RESULTS
Forty pseudophakic eyes. Hyper-FAF area was associated with larger LMH size (p = 0.0073) and inversely correlated with CRT (p = 0.021). Lower preoperative RS was observed in hyper-FAF than normo-FAF areas (p = 0.0117). External limiting membrane (ELM) defect was associated with worse BCVA (p = 0.0004). After surgery, BCVA improved (p = 0.001) and it was related to ELM recovery (p = 0.00483), hyper-FAF area decreased (p = 0.001), and RS increased (p = 0.440). Hyper-FAF points that normalized their FAF were associated with higher RS improvement compared to unchanged points.
CONCLUSION
Short-wavelength fundus autofluorescence/microperimetry integrated assessment provides important information on the entity of damage of LMH and on postoperative recovery. Double-inverted EP and ILM flap technique is safe and effective for LMH treatment.
Topics: Fovea Centralis; Humans; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 34897994
DOI: 10.1111/aos.15078 -
Der Ophthalmologe : Zeitschrift Der... Mar 2021Age, preoperative visual acuity and macular hole size have been reported to be prognostic markers for the postoperative outcome in patients with full thickness macular...
BACKGROUND
Age, preoperative visual acuity and macular hole size have been reported to be prognostic markers for the postoperative outcome in patients with full thickness macular holes (FTMH).
OBJECTIVE
A retrospective observational clinical study was performed in order to compare the postoperative course after conventional internal limiting membrane peeling (c-ILM) and inverted flap ILM peeling (i-ILM). Patients with i‑ILM peeling had preoperatively a significantly larger macular hole MATERIAL AND METHODS: In this study 45 consecutive patients with a full thickness macular hole (FTMH) were divided into two groups (c-ILM vs. i ILM) and evaluated with respect to the postoperative best corrected visual acuity (BCVA) and retinal morphology. Using spectral domain optical coherence tomography (SD-OCT) the integrity of the outer retinal layers, external limiting membrane (ELM), ellipsoid zone (EZ) and outer photoreceptor outer segments (OS) were analyzed postoperatively for at least 6 months.
RESULTS
The preoperative aperture in the i‑ILM group was significantly larger (i-ILM = 408.4 µm, SD = 157.5 µm; c‑ILM = 287.4 µm, SD = 104.9 µm; p = 0.01). The preoperative BCVA and postoperative BCVA after 1 month were significantly better in the group with c‑ILM peeling (p = 0.03 and p = 0.001). The postoperative BCVA after at least 6 months showed no significant difference between the two groups (p = 0.24). The ELM was the first of the outer retinal layers to show postoperative recovery in both groups.
CONCLUSION
Using the i‑ILM peeling technique in this consecutive series it seemed to be possible to achieve a similar postoperative visual outcome in patients with a large FTMH as for patients with a smaller FTMH operated on with the c‑ILM peeling technique.
Topics: Epiretinal Membrane; Humans; Prognosis; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 32666171
DOI: 10.1007/s00347-020-01178-3 -
Ophthalmology. Retina Apr 2020
Topics: Humans; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 32273111
DOI: 10.1016/j.oret.2019.11.012 -
Ophthalmology. Retina Jan 2023The importance of postoperative face-down positioning (FDP) to achieve anatomic and functional success after full-thickness macular hole (FTMH) surgery is explored in... (Meta-Analysis)
Meta-Analysis Review
TOPIC
The importance of postoperative face-down positioning (FDP) to achieve anatomic and functional success after full-thickness macular hole (FTMH) surgery is explored in this meta-analysis of randomized controlled trials (RCTs).
CLINICAL RELEVANCE
There is considerable variability in clinical practices regarding the need and length of FDP recommended to patients after FTMH surgery. There is also a lack of robust clinical guidelines on the topic. As such, an updated estimate of the effect size of FDP on clinically important outcomes is critical to inform practice.
METHODS
Ovid MEDLINE, EMBASE, CENTRAL, and SCOPUS databases were searched from inception to October 3, 2021, for RCTs evaluating FDP versus non-FDP (nFDP). Data were collected for 7 clinically important outcomes after macular hole surgery: closure rate, visual acuity (VA) improvement, recurrence of FTMH, visual function, quality of life, patient satisfaction, and complication rates. We used the Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias and followed the Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty in the evidence across outcomes. We conducted meta-analyses using random-effects modeling. Subgroup analyses were carried out based on hole size, type of gas, and duration of FDP.
RESULTS
Eight RCTs of 709 eyes were included. The relative risk (RR) of FTMH closure rate comparing FDP versus nFDP was RR 1.05 (95% confidence interval [CI]: 0.99, 1.12, P = 0.09, I = 44%, GRADE rating: LOW). The mean difference (MD) regarding VA improvement comparing FDP and nFDP was MD -0.07 (95% CI: -0.12 to 0.01, P = 0.03, I = 16%, GRADE rating: LOW).
CONCLUSION
The current review did not demonstrate a difference between FDP and nFDP with respect to FTMH closure, although the CIs were wide. There was a visual benefit to FDP; however, the CIs included values of trivial clinical significance. Subgroup analyses demonstrated that the VA benefit observed was driven by large holes. Limited data precluded analysis regarding the rate of FTMH recurrence, measures of visual function, quality of life measures, and patient satisfaction metrics. Further prospective trials are required to assess the gaps in the literature and improve the certainty of evidence for the outcomes examined.
Topics: Humans; Retinal Perforations; Visual Acuity; Eye; Vitrectomy; Prone Position
PubMed: 35781067
DOI: 10.1016/j.oret.2022.06.015 -
Vestnik Oftalmologii 2017The article reviews the literature on one of the topical problems of vitreoretinal surgery - idiopathic macular holes. The history, concept, classification and... (Review)
Review
The article reviews the literature on one of the topical problems of vitreoretinal surgery - idiopathic macular holes. The history, concept, classification and diagnostics, as well as surgical and alternative treatment methods of macular holes are explored.
Topics: History; Humans; Patient Positioning; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Vitreoretinal Surgery
PubMed: 29319680
DOI: 10.17116/oftalma20171336131-137 -
Japanese Journal of Ophthalmology Jul 2021To report characteristics of patients developing full-thickness macular hole (MH) after rhegmatogenous retinal detachment (RRD) repair surgery. We also compared patients...
PURPOSE
To report characteristics of patients developing full-thickness macular hole (MH) after rhegmatogenous retinal detachment (RRD) repair surgery. We also compared patients developing MH with and without accompanying RRD recurrence regarding anatomical and visual outcomes of MH repair.
DESIGN
Retrospective study.
METHODS
Medical records of patients who developed MH after RRD repair between January 2002 and January 2018 were reviewed.
RESULTS
We performed 1661 primary RRD operations during the study period and 14 of these developed MH, an incidence of 0.8%. Nine patients had their primary RRD repair surgery in another clinic and were referred to our clinic after development of MH. In total 23 patients with MH secondary to RRD repair were included in the study. The type of RRD repair surgery was scleral buckling only in 4 patients (17%), pars plana vitrectomy (PPV) only in 14 patients (61%), and sequential scleral buckling and PPV in 5 patients (22%). Nineteen patients (83%) had macula-off RRD. In 12 patients (52%), MH developed within 3 months after RRD repair. Surgery for MH repair was performed in 18 patients. Postoperative best corrected visual acuity (BCVA) was better than preoperative BCVA in the group with RRD recurrence as well as in the group without RRD recurrence (both P < 0.05). There wasn't a significant difference between these groups regarding postoperative visual gain and anatomical success (P > 0.05).
CONCLUSION
MH can develop after various surgical methods of RRD repair. Anatomic closure and visual acuity gain can be achieved even if patients have accompanying RRD recurrence.
Topics: Humans; Neoplasm Recurrence, Local; Retinal Detachment; Retinal Perforations; Retrospective Studies; Scleral Buckling; Vitrectomy
PubMed: 33733321
DOI: 10.1007/s10384-021-00833-9 -
Korean Journal of Ophthalmology : KJO Apr 2018To describe the visual recovery and prognostic factors after macular hole surgery.
PURPOSE
To describe the visual recovery and prognostic factors after macular hole surgery.
METHODS
A retrospective chart review was conducted. Charts of patients with idiopathic macular holes who underwent surgery by a single surgeon at Severance Hospital between January 1, 2013 and July 31, 2015 were reviewed. The best-corrected visual acuity (BCVA) score was recorded preoperatively and at 1 day and 1, 3, 6, 9, and 12 months after surgery. The variables of age, sex, macular hole size, basal hole diameter, choroidal thickness, and axial length were also noted.
RESULTS
Twenty-six eyes of 26 patients were evaluated. Twenty-five patients (96.2%) showed successful macular hole closure after the primary operation. The BCVA stabilized 6 months postoperatively. A large basal hole diameter (p = 0.006) and thin choroid (p = 0.005) were related to poor visual outcomes. Poor preoperative BCVA (p < 0.001) and a thick choroid (p = 0.020) were associated with greater improvement in BCVA after surgery.
CONCLUSIONS
Visual acuity stabilized by 6 months after macular hole surgery. Choroidal thickness was a protective factor for final BCVA and visual improvement after the operation.
Topics: Aged; Axial Length, Eye; Choroid; Female; Humans; Male; Middle Aged; Prognosis; Recovery of Function; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 29611371
DOI: 10.3341/kjo.2017.0085