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Indian Journal of Ophthalmology May 2022Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma...
BACKGROUND
Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare.
PURPOSE
To demonstrate the successful management of a post-traumatic posterior GRT and full-thickness macular hole (MH) associated retinal detachment (RD).
SYNPOSIS
A 21-year-old-male presented with sudden diminution of vision in the right eye (RE) following blunt-trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior-GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post-operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60.
HIGHLIGHTS
This video demonstrates the successful management of a posterior-GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.
VIDEO LINK
https://youtu.be/p04-_t0Wuuc.
Topics: Adult; Endotamponade; Humans; Male; Retinal Detachment; Retinal Perforations; Visual Acuity; Vitrectomy; Young Adult
PubMed: 35502118
DOI: 10.4103/ijo.IJO_1017_22 -
Ophthalmologica. Journal International... 2022The purpose of this study was to report the closure of macular hole without surgery in 7 cases using medical therapies.
PURPOSE
The purpose of this study was to report the closure of macular hole without surgery in 7 cases using medical therapies.
METHODS
The retrospective review of 7 cases of full-thickness macular holes, which closed after medical therapy without surgery.
RESULTS
Seven eyes of 7 patients developed full-thickness macular holes, which initially closed on medical therapy without surgery. Six patients were kept on maintenance therapy; 1 recurred and 5 did not develop recurrence. One patient was taken off of maintenance therapy and later developed recurrent macular hole requiring macular hole surgery.
CONCLUSIONS
Medical therapy to decrease macular edema may facilitate macular hole closure and should be considered, especially for small macular holes with significant edema. Reopening of macular holes may occur after stopping topical maintenance therapy for macular edema, which occurred at 10 weeks and 9 months after maintenance therapy was discontinued or markedly tapered.
Topics: Humans; Macular Edema; Retinal Perforations; Retrospective Studies; Vitrectomy
PubMed: 34182564
DOI: 10.1159/000516018 -
Retina (Philadelphia, Pa.) Aug 2022To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana... (Review)
Review
PURPOSE
To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique.
METHODS
Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported.
RESULTS
The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent).
CONCLUSION
Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.
Topics: Basement Membrane; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35439799
DOI: 10.1097/IAE.0000000000003509 -
Asia-Pacific Journal of Ophthalmology... Sep 2021
Topics: Animals; Humans; Jaw; Retinal Perforations; Sharks
PubMed: 34524138
DOI: 10.1097/APO.0000000000000412 -
Der Ophthalmologe : Zeitschrift Der... Feb 2021Large, persistent or chronic macular holes still represent a surgical challenge, which can be addressed using the presented surgical technique. A subretinal injection... (Review)
Review
Large, persistent or chronic macular holes still represent a surgical challenge, which can be addressed using the presented surgical technique. A subretinal injection of balanced salt solution (BSS) at the posterior pole of the macular region is performed during transconjunctival pars plana vitrectomy in order to induce an elevation of the neurosensory retina in the macular region. The hole is then attenuated during fluid-air exchange, followed by a gas or silicone oil tamponade. The presented technique appears to be useful for large and persistent macular holes, which are not suitable for conventional macular hole surgery. The exact patient information on the potential outcome of surgery in this specific group of patients seems particularly important.
Topics: Endotamponade; Humans; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Vitrectomy
PubMed: 33331962
DOI: 10.1007/s00347-020-01278-0 -
Asia-Pacific Journal of Ophthalmology... Jan 2021Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with... (Review)
Review
Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with success rates and limitations of different surgical techniques are reported.The pathogenesis, the definition and the management were clarified in a recent study(cit). The MTM Staging System (MSS) table summarizes all the stages of MTM offering insights on the pathogenesis and natural evolution of the disease.Guidelines of management of MTM were therefore proposed, but customized for each stage.Initial stages 1a and 2a, which define maculoschisis in the inner or inner-outer or only outer layers of the retina, should be observed. Stages 3a and 4a, defining macular detachment with and without associated schisis, should be treated with a macular buckle (MB).Stage 1b, which is a lamellar macular hole in a myopic eye, should be treated with pars plana vitrectomy (PPV) only in symptomatic cases. Stages 2b, 3b, and 4b should be treated with a MB and PPV should be added in a second step only if the presence of a lamellar macular hole requires intervention to improve visual function.Stage 1c, which is a full thickness macular hole in a myopic eye, should be treated with PPV. Stages 2c, 3c and 4c should be treated with a combination of simultaneous MB + PPV to treat both the retinal pattern of schisis or detachment and the full thickness macular hole.
Topics: Humans; Macular Degeneration; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity; Vitrectomy
PubMed: 33481391
DOI: 10.1097/APO.0000000000000347 -
Retina (Philadelphia, Pa.) Apr 2016To assess the literature regarding macular hole reopening rates stratified by whether the internal limiting membrane (ILM) was peeled during vitrectomy surgery. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the literature regarding macular hole reopening rates stratified by whether the internal limiting membrane (ILM) was peeled during vitrectomy surgery.
METHODS
Systematic review and meta-analysis of studies reporting on macular hole reopenings among previously surgically closed idiopathic macular holes. A comprehensive literature search using the National Library of Medicine PubMed interface was used to identify potentially eligible publications in English. The minimum mean follow-up period for reports to be included in this study was 12 months. Analysis was divided into eyes that underwent vitrectomy with and without ILM peeling. The primary outcome parameter was the proportion of macular hole reopenings among previously closed holes between the two groups. Secondary outcome parameters included duration from initial surgery to hole reopening and preoperative and postoperative best-corrected correct visual acuities among the non-ILM peeling and ILM peeling groups.
RESULTS
A total of 50 publications reporting on 5,480 eyes met inclusion criteria and were assessed in this meta-analysis. The reopening rate without ILM peeling was 7.12% (125 of 1,756 eyes), compared with 1.18% (44 of 3,724 eyes) with ILM peeling (odds ratio: 0.16; 95% confidence interval: 0.11-0.22; Fisher's exact test: P < 0.0001). There were no other identifiable associations or risk factors for reopening.
CONCLUSION
The results of this meta-analysis support the concept that ILM peeling during macular hole surgery reduces the likelihood of macular hole reopening.
Topics: Basement Membrane; Humans; Recurrence; Retinal Perforations; Vitrectomy
PubMed: 26441264
DOI: 10.1097/IAE.0000000000000782 -
Disease Markers 2022We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical...
OBJECTIVE
We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA).
METHODS
This retrospective study included patients with idiopathic macular hole who were admitted to our hospital between 1st January 2019 and 31st October 2021. The control group was treated with internal limiting membrane tamponade, and the study group was treated with clamshell therapy. Treatment conditions (internal limiting membrane treatment duration and hole closure rate), best corrected visual acuity (BCVA) before and after surgery, OCTA measurements, and SD-OCT were assessed. The retinal nerve fiber layer (RNFL), retinal ganglion cell layer (GCL), and retinal pigment epithelium (RPE) thicknesses were also analyzed.
RESULTS
The treatment time and hole closure rate of the internal limiting membrane in the study group were higher than those in the control group. The curative effect of the study group was better than that of the control group. The postoperative DCP blood vessel density in both groups was higher than that before operation, and the study group was higher than the control group. The FAZ area and circumference were lower than those before surgery, and the study group was lower than the control group. At 3 months after operation, the thickness of DIOA, nasal temporal RNFL, and GCL were decreased in both groups, and the observed values in the study group were lower than those in the control group. At 3-month follow-up, there was no significant difference in RPE thickness between the two groups.
CONCLUSION
Flip and cover therapy is the most effective treatment. SD-OCT and OCTA provide an objective basis for clinical intervention by comparing the effects of different procedures on the retinal condition of patients.
Topics: Angiography; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35996716
DOI: 10.1155/2022/7749605 -
Retina (Philadelphia, Pa.) Apr 2018To compare the surgical outcome of a lamellar macular hole (LMH) depending on lamellar hole-associated epiretinal proliferation (LHEP) and full-thickness macular hole.
PURPOSE
To compare the surgical outcome of a lamellar macular hole (LMH) depending on lamellar hole-associated epiretinal proliferation (LHEP) and full-thickness macular hole.
METHODS
This is a retrospective chart review. Thirty-three patients were enrolled for this study. The patients were divided into three groups depending on the type of macular hole and presence of LHEP. Group 1 had epiretinal membranes with LMH without LHEP, Group 2 had LMH with LHEP, and Group 3 had full-thickness macular hole with LHEP. The best-corrected visual acuity was recorded and optical coherence tomography scans were obtained.
RESULTS
Preoperative best-corrected visual acuity showed no significant difference between groups (P = 0.968). Final visual acuity of Group 1 was better than that of Group 2 (P = 0.009). Group 1 showed less postoperative ellipsoid zone disruption compared with Group 2 (P = 0.010), and the duration of LHEP to surgery had no significant correlation with postoperative visual acuity (P = 0.629).
CONCLUSION
Lamellar macular hole with LHEP showed poorer visual outcomes compared with those with highly reflective epiretinal membranes. Lamellar macular hole with LHEP showed a greater chance of ellipsoid zone disruption. These findings may explain the wide variability of visual outcomes previously reported after vitrectomy for LMH.
Topics: Adult; Aged; Aged, 80 and over; Epiretinal Membrane; Female; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 28301339
DOI: 10.1097/IAE.0000000000001591 -
Ophthalmic Surgery, Lasers & Imaging... Apr 2018A 72-year-old female with neovascular macular degeneration refractory to anti-vascular endothelial growth factor injections underwent photodynamic therapy and...
A 72-year-old female with neovascular macular degeneration refractory to anti-vascular endothelial growth factor injections underwent photodynamic therapy and subsequently developed a macular hole (MH) associated with vitreomacular traction. After a period of observation, the MH enlarged. Pars plana vitrectomy was performed, and the MH was closed successfully. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:270-272.].
Topics: Aged; Female; Humans; Macula Lutea; Photochemotherapy; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Wet Macular Degeneration
PubMed: 29664985
DOI: 10.3928/23258160-20180329-10