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Retina (Philadelphia, Pa.) Feb 2020To report the outcomes of eyes receiving surgical management for traumatic macular holes. To describe the preoperative and postoperative optical coherence tomography...
PURPOSE
To report the outcomes of eyes receiving surgical management for traumatic macular holes. To describe the preoperative and postoperative optical coherence tomography features of traumatic macular holes and to explore associations between preoperative clinical and optical coherence tomography features, and visual outcome.
METHODS
Retrospective study of patients undergoing vitrectomy for traumatic macular hole and entered into the Australian and New Zealand Society of Retinal Specialists surgical registry. Preoperative clinical data, surgical details, and 3-month postoperative outcomes were recorded prospectively. Longer-term outcomes at 12 months were requested retrospectively, as were preoperative and postoperative optical coherence tomography scans.
RESULTS
Hole closure was achieved in 91% (21/23) of patients with a single procedure. The average preoperative visual acuity was 20/120. At 3 months postoperatively, the mean visual acuity had improved to 20/70 (P < 0.001), 11/23 (48%) of eyes improved ≥15 letters, and the number of eyes with 20/40 acuity or better increased from 1/23 to 7/23. Eyes with worse visual outcomes (visual acuity < 20/80) had larger holes, worse preoperative acuity, and a greater extent of preoperative ellipsoid band attenuation than those with better postoperative visual acuity.
CONCLUSION
Eyes receiving surgical management for traumatic macular hole achieved good anatomical results and approximately half had a substantial improvement in acuity. Ellipsoid band attenuation on preoperative optical coherence tomography and worse preoperative acuity were associated with poorer visual outcomes.
Topics: Adolescent; Adult; Aged; Eye Injuries; Female; Humans; Macula Lutea; Male; Middle Aged; Postoperative Period; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Vitrectomy; Young Adult
PubMed: 31972799
DOI: 10.1097/IAE.0000000000002382 -
Indian Journal of Ophthalmology Jul 2020To investigate if the ratio of the preoperative nasal and temporal "arms" of the macular hole (MH) can have a predictive value in the magnitude of foveal displacement...
PURPOSE
To investigate if the ratio of the preoperative nasal and temporal "arms" of the macular hole (MH) can have a predictive value in the magnitude of foveal displacement postoperatively.
METHODS
This is retrospective interventional case series of eyes of 40 patients with full-thickness macular hole (FTMH), which underwent vitrectomy with internal limiting membrane (ILM) peeling and had Type 1 closure.All subjects underwent pre and postoperative optical coherence tomography (OCT, Heidelberg, Spectralis, Germany). Their pre and postoperative foveo-papillary distance (FPD) was measured and the magnitude of shift was calculated. The nasal and temporal arm lengths, their ratio (N/T ratio), and the hole base diameter were measured in the preoperative OCTs.The main outcome measure was the correlation of the N/T ratio with the postoperative foveal displacement.
RESULTS
We observed that in 25% (n = 10) the fovea shifted temporally; in 75% (n = 30) it shifted nasally. The shift did not show a significant correlation with either N/T ratio (r = 0.155, P = 0.34) or with base diameter (r = -0.008, P = 0.961). The odds ratio (OR) was 4.92 (P = 0.04) and the relative risk (RR) was 3.12 (P = 0.039) for a longer temporal segment to predict a temporal shift.
CONCLUSION
Both nasal and temporal shifts are possible after successful hole closure and temporal shifts can also occur in a significantly high proportion of patients. Temporal shifts are more likely in eyes with a longer temporal segment.
Topics: Basement Membrane; Fovea Centralis; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 32587184
DOI: 10.4103/ijo.IJO_1845_19 -
Documenta Ophthalmologica. Advances in... Dec 2023To characterize the genotype and phenotype of a patient with CAPN5-related neovascular inflammatory vitreoretinopathy (NIV) who have undergone surgery for macular holes.
PURPOSE
To characterize the genotype and phenotype of a patient with CAPN5-related neovascular inflammatory vitreoretinopathy (NIV) who have undergone surgery for macular holes.
METHODS
We observed a patient presenting with retinitis pigmentosa and posterior uveitis who later developed vitreoretinal macular traction and a macular hole. Genetic testing was performed using a targeted gene panel. Fundus photography and spectral-domain optical coherence tomography were also performed.
RESULTS
In a targeted gene panel, a monoallelic pathogenic variant, c.750G > T, p.Lys250Asn, in the CAPN5 gene was identified, and CAPN5-NIV was diagnosed. At the first visit, peripheral retinal degeneration and mild posterior uveitis were observed. At that time, neovascularization, epiretinal or fibrous membranes were not observed. After 5 years, vitreomacular traction developed and progressed to a full-thickness macular hole in both eyes. After pars plana vitrectomy, the macular hole was successfully closed without aggravation of uveitis.
CONCLUSION
In this case, a pathogenic variant of CAPN5 lead to a distinct phenotype of retinitis pigmentosa, posterior uveitis, vitreomacular traction, and macular hole without typical inflammatory neovascularization or tractional membranes. Therefore, the clinical variability of CAPN5-NIV and genetic diagnosis should be considered in cases of atypical retinitis pigmentosa with bilateral macular hole.
Topics: Humans; Retinal Perforations; Electroretinography; Retina; Vitrectomy; Tomography, Optical Coherence; Uveitis, Posterior; Retinitis Pigmentosa; Vision Disorders; Retrospective Studies
PubMed: 37668859
DOI: 10.1007/s10633-023-09946-7 -
Scientific Reports Dec 2021Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT)...
Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.
Topics: Adult; Aged; Diabetic Retinopathy; Epiretinal Membrane; Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence
PubMed: 34903770
DOI: 10.1038/s41598-021-03239-2 -
Indian Journal of Ophthalmology Jun 2022To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients...
PURPOSE
To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients with idiopathic full-thickness macular hole (FTMH).
METHODS
In this prospective study, pre and post-operative optical coherence tomography (OCT) scans of 36 eyes with idiopathic FTMH were analyzed. Hole indices and microstructural changes of all retinal layers such as ellipsoid zone (EZ), external limiting membrane (ELM) integrity, outer and inner retinal defects, and cystoid resolution were studied on follow-up visits.
RESULTS
Out of 36 eyes, type-1 closure was achieved in 23 eyes (65.7%) and type-2 closure in 11 eyes (31.42%), one eye showed persistent hole, and one eye was lost to follow-up. The mean minimum diameter of hole (P = 0.026), mean MHI (P = 0.001), DHI (P = 0.158), THI (P = 0.001), and HFF (P < 0.001) showed statistical significance with the type of hole closure. Postoperatively, eyes with intact ELM and EZ had better BCVA at the final visit. The BCVA was better by logMAR 0.73 ± 0.38 (P < 0.001) in patients with absent outer retinal defects. There was a significant difference in BCVA of 0.52 ± 0.35 at 1 month and 0.64 ± 0.34 at 6 months in eyes without inner retinal defects (P < 0.001). At 6 months, cystoid resolution was observed in 28 (80%) eyes. BCVA was significantly better at 1 month (P < 0.001) and at 6 months (P = 0.001) in eyes with no DONFL.
CONCLUSION
Macular hole indices determine the closure type. Postoperative regeneration of outer retinal layers and resolution of retinal defects significantly influence the final visual outcomes. ELM recovery is seen as a prerequisite for EZ regeneration with no new IRD after a period of 3 months.
Topics: Humans; Prospective Studies; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 35647986
DOI: 10.4103/ijo.IJO_192_22 -
The Libyan Journal of Medicine Dec 2022To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (MH) status at 9 months after vitrectomy and inverted flap internal limiting...
To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (MH) status at 9 months after vitrectomy and inverted flap internal limiting membrane (ILM) peeling surgery. This single center was conducted at Department A, Institute Hedi Raies of Ophthalmology, Tunis, Tunisia. The study included 114 patients. In total, 120 eyes underwent optical coherence tomography (OCT) and inverted flap ILM peeling for surgery. Then 510 B scan of macular OCT was acquired 9 months after surgery. MH diameter, basal MH diameter (b), nasal and temporal arm lengths and macular hole angle were measured. Indices including hole form factor, MH index, diameter hole index (DHI) and tractional hole, MH area index and MH volume index were calculated. Receiver operating characteristic (ROC) curves and cut‑off values were derived for each indices predicting closure or not of the MH. The area under the receiver operating characteristic curve (AUC) and kappa value were calculated to evaluate performance of the medical decision support system (MDSS) in predicting the MH closure. From the ROC curve analysis, it was derived that MH indices like MH diameter, diameter hole index (DHI), MH index, and hole formation factor were capable of successfully predicting MH closure while basal diameter, DHI and MH area index predicted none closure MH. The MDSS achieved an AUC of 0.984 with a kappa value of 0.934. Based on the preoperative OCT parameters, our ML model achieved remarkable accuracy in predicting MH outcomes after pars plana vitrectomy and inverted flap ILM peeling. Therefore, MDSS may help optimize surgical planning for full thickness macular hole patients in the future.
Topics: Basement Membrane; Humans; Machine Learning; Prognosis; Retinal Perforations; Retrospective Studies; Visual Acuity
PubMed: 35180831
DOI: 10.1080/19932820.2022.2034334 -
International Ophthalmology Clinics Apr 2024
Topics: Humans; Child; Retinal Perforations; Tomography, Optical Coherence; Vitrectomy
PubMed: 38525987
DOI: 10.1097/IIO.0000000000000494 -
Journal Francais D'ophtalmologie Oct 2021To establish the epidemiological and tomographic profile of macular holes in the Beninese subject.
PURPOSE
To establish the epidemiological and tomographic profile of macular holes in the Beninese subject.
PATIENTS AND METHODS
This cross-sectional study included consecutive patients seen for macular testing during the period from January 2016 to August 2017 at the St. Anthony of Padua Retinal Testing Center in Cotonou (Benin). All patients who had a macular hole and macular OCT were included. To define macular hole types, we used the 2013 DUKER New Classification and analyzed for each case: age sex, history, involved eye, fellow eye, visual acuity, hole type, hole diameter, status of the vitreous cortex, edge edema, mean macular thickness, presence of vitreomacular traction, epimacular membrane, and retrofoveal choroidal thickness. Patients with a pseudo-macular hole or lamellar hole were excluded.
RESULTS
During this study period, 401 patients underwent a macular OCT procedure at the Retinal Testing Center, with 22 patients having a macular hole, of which 15 women and 07 men for a sex ratio of 2.14 women to men. The mean age of the patients was 61±10 years, with a median age of 63 years. The mean diameter of the holes was 705μm±232μm. No small holes were found. The mean central macular thickness was 272μm±39μm. In 52.4% of cases, the condition of the felloweye indicated the presence of vitreomacular traction. The etiological profile of the macular hole found in 72.7% a primary origin, and a secondary origin (diabetic and traumatic) in 13.6% and 9.09% respectively.
DISCUSSION
The majority of the macular holes observed were large macular holes, which could be explained by the progressive course of these macular holes as well as late detection. Over half of the fellow eyes showed vitreomacular traction, reflecting the potential risk of bilateralization.
CONCLUSION
Macular hole is a pathology of the vitreomacular interface, tending to be large in our geographic context. On OCT, the data found remain comparable those reported in the literature.
Topics: Aged; Benin; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity
PubMed: 34366126
DOI: 10.1016/j.jfo.2021.04.004 -
Indian Journal of Ophthalmology Dec 2018Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm... (Review)
Review
Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm shift to the understanding of myopic macula, thereby helping in objective evaluation of the various manifestation of traction maculopathy. Staphyloma evaluation by ultrasound, wide-field fundus photography, and MRI scans along with OCT has led to the resurgence of MB surgery in the treatment of myopic traction maculopathy (MTM). Various surgical techniques with different buckle materials are being performed with encouraging anatomical and functional success rates. This article reviews the literature to explain the current concept of MB surgery based on its evolution, different kinds of buckle materials, rationale for planning MB surgery, and different surgical techniques for the management of MTM.
Topics: Humans; Macula Lutea; Myopia, Degenerative; Retinal Perforations; Retinoschisis; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 30451177
DOI: 10.4103/ijo.IJO_1126_18 -
Retina (Philadelphia, Pa.) Jul 2023To evaluate the long-term progression pattern of myopic tractional maculopathy and the risk factors.
PURPOSE
To evaluate the long-term progression pattern of myopic tractional maculopathy and the risk factors.
METHODS
The prevalence and grade of myopic tractional maculopathy were assessed with optical coherence tomography at enrollment and at the 2-year follow-up. The severity of posterior staphyloma and the presence of dome-shaped macula were also evaluated.
RESULTS
In total, 610 highly myopic eyes of 610 patients were analyzed. The prevalence of epiretinal membrane, myopic retinoschisis, and macular hole increased from 26.7%, 12.1%, and 4.4% at enrollment to 41.1%, 18.2%, and 9.5% at the 2-year follow-up, respectively. Epiretinal membrane progressed in 21.8% of eyes, but visual acuity did not decline significantly in these eyes. Myopic retinoschisis progressed in 6.8% of eyes, and macular hole progressed in 14.8% of eyes. Significantly greater best-corrected visual acuity reduction was detected in the eyes with myopic retinoschisis or macular hole progression than the rest ( P < 0.05). Multivariate analysis showed that longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were associated with myopic tractional maculopathy progression.
CONCLUSION
In highly myopic eyes, long-term visual acuity was relatively stable in those with epiretinal membrane, but was significantly affected by myopic retinoschisis or macular hole progression. Longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were risk factors for myopic tractional maculopathy progression.
Topics: Humans; Retinoschisis; Epiretinal Membrane; Retinal Perforations; Myopia, Degenerative; Scleral Diseases; Tomography, Optical Coherence; Macular Degeneration; Risk Factors; Retrospective Studies
PubMed: 36977327
DOI: 10.1097/IAE.0000000000003791