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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 -
Turkish Journal of Ophthalmology Apr 2022To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
OBJECTIVES
To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
MATERIALS AND METHODS
Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.
RESULTS
The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients' median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).
CONCLUSION
Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.
Topics: Child, Preschool; Endotamponade; Female; Humans; Inflammation; Male; Prospective Studies; Retinal Detachment; Retinal Perforations; Retrospective Studies; Silicone Oils; Uveal Diseases; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 35481733
DOI: 10.4274/tjo.galenos.2021.83648 -
Current Eye Research Oct 2022This study aimed to define a novel metric for the area of the macular hole (MH) and cysts located around the hole using an optical coherence tomography (OCT) device.
PURPOSE
This study aimed to define a novel metric for the area of the macular hole (MH) and cysts located around the hole using an optical coherence tomography (OCT) device.
METHODS
This study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. Using the metrics of macular hole index (MHI), tractional hole index (THI), hole forming factor (HFF), macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and our novel metric, the cyst hole area index (CHAI) was calculated. The correlation of the CA, the HA, and the CHAI with other indexes were assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures.
RESULTS
The CA showed a strong positive correlation with the base MH size and the maximum MH height ( = 0.624, < 0.001; = 0.722, < 0.001, respectively). The HA showed a strong positive correlation with basal MH size and minimum MH size ( = 0.934, < 0.001; = 0.765, < 0.001). The HA showed a moderate positive correlation with maximum MH height ( = 0.483, < 0.001, respectively). CHAI showed a moderate positive correlation with minimum MH size ( = 0.297, = 0.02). CHAI and HA showed a moderate negative correlation with post-operative BCVA ( = -0.39, = 0.003; = -0.357, = 0.006; respectively). ROC curve analysis showed that MHI (0.823), THI (0.750), and HFF (0.722) predicted type 1 closure and that CHAI (0.769) and HA (0.709) predicted type 2 closures.
CONCLUSION
MHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively.
Topics: Humans; Prognosis; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35770860
DOI: 10.1080/02713683.2022.2096908 -
Journal Francais D'ophtalmologie Oct 2023
Topics: Humans; Retinal Perforations; Lenses, Intraocular; Lens Implantation, Intraocular
PubMed: 37085370
DOI: 10.1016/j.jfo.2023.01.013 -
Graefe's Archive For Clinical and... Dec 2020The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only "open" and "closed" statuses or is based on inner foveal...
BACKGROUND
The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only "open" and "closed" statuses or is based on inner foveal contour shape. Both classification types give no information on retinal layer reconstitution. Novel sophisticated surgical techniques lead to previously unknown MHCPs, outdating existing classifications and urging new ones. The purpose of the present study is to introduce a new classification allowing proper description of all MHCPs resulting from newer surgeries and based on the restoration of retinal layers.
METHODS
Retrospective analysis of patients undergoing MH surgery with five different surgical techniques was performed. MHCPs were classified according to spectral domain optical coherence tomography (SD-OCT). Type 0: open MH (0A: flat margin, 0B: elevated, 0C: oedematous); type 1: closed MHs (1A: reconstitution all retinal layers; 1B interruption of the external layers; 1C interruption of internal layers); type 2: MH closed with autologous or heterologous filling tissue interrupting the normal foveal layered anatomy (2A: filling tissue through all layers; 2B reconstitution of normal inner retinal layers; 2C reconstitution of normal outer retinal layers; 2D H-shaped bridging of filling tissue).
RESULTS
Closure rate was 95.2% (241/253). Surgical technique and vision correlated to closure pattern (p < 0.001). Type 1 MHCPs had the best post-operative visual acuity (VA) compared with type 2 and type 0 (p < 0.001). MHCPs 1A and 1C performed better than all others. MHCP at months 1 and 3 changed in 42/254 (16.5%) and remained stable in 212/254 (83.5%). Improvement in vision was higher in eyes with shifting closure pattern (0.57 ± 0.33 vs 0.51 ± 0.48 logMAR; p 0.021).
CONCLUSION
MHCP classification based on retinal layer restoration properly comprises post-operative anatomic morphologies. MHCPs correlate the surgical technique and post-operative visual outcomes.
Topics: Basement Membrane; Fovea Centralis; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 32910308
DOI: 10.1007/s00417-020-04920-4 -
Japanese Journal of Ophthalmology Nov 2022To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and...
PURPOSE
To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and without Brilliant Blue G (BBG) staining.
STUDY DESIGN
Retrospective, consecutive case series.
METHODS
A total of 49 eyes of 47 patients were enrolled: 23 eyes of 23 patients with MH who underwent ILM peeling without dyes (control group) and 26 eyes of 26 patients who underwent BBG staining (BBG group). The lengths of defects of the photoreceptor ellipsoid zone (EZ), external limiting membrane (ELM), and interdigitation zone (IZ) were measured.
RESULTS
The rate of MH closure after initial surgery was 95.6% (22/23 eyes) for the control group versus 100% (26/26 eyes) for the BBG group. In the 48 eyes with MH closure, the recovery rate of ELM deficiency and change in IZ deficiency showed no difference between the groups. The changes in EZ deficiency at 1 and 12 months were greater in the BBG group than in the control group. (P = 0.047 and 0.031). Visual acuity was better in the BBG group than in the control group during 12 months postoperatively (P < 0.001-0.038).
CONCLUSION
Eyes undergoing BBG-assisted MH surgery achieved faster recovery of the outer retinal structures and greater visual improvement than those of eyes without BBG.
Topics: Humans; Retinal Perforations; Vitrectomy; Retrospective Studies; Rosaniline Dyes; Basement Membrane; Tomography, Optical Coherence
PubMed: 36181645
DOI: 10.1007/s10384-022-00942-z -
BMC Ophthalmology Jun 2023The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH...
BACKGROUND
The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion.
METHODS
This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively.
RESULTS
For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group.
CONCLUSION
For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.
Topics: Humans; Retinal Perforations; Retrospective Studies; Fovea Centralis; Postoperative Period; Recovery of Function
PubMed: 37316769
DOI: 10.1186/s12886-023-03006-z -
Graefe's Archive For Clinical and... Aug 2018
Topics: Basement Membrane; Epiretinal Membrane; Humans; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Vitrectomy
PubMed: 29909575
DOI: 10.1007/s00417-018-4049-y -
Retina (Philadelphia, Pa.) Mar 2017To investigate the surgical results of macular hole surgery without gas tamponade or postoperative posturing in patients with Stage 3 and Stage 4 macular holes with...
PURPOSE
To investigate the surgical results of macular hole surgery without gas tamponade or postoperative posturing in patients with Stage 3 and Stage 4 macular holes with ≥500 μm mean base diameter.
DESIGN
Retrospective interventional case series.
PARTICIPANTS
Twenty-six patients with Stage 3 and Stage 4 macular holes.
METHODS
Twenty-six eyes of 26 patients with Stage 3 and Stage 4 macular holes and a mean base diameter of 892.8 ± 349 μm underwent pars plana 23-gauge vitrectomy with broad internal limiting membrane peel (ILM peel), inverted ILM flap repositioning (ILMR), and use of autologous gluconated blood clumps as a macular plug to close the macular hole. No fluid-air exchange, endotamponade, or postoperative posturing was used. The subjects were followed up for 12 months. The anatomical outcome of the procedure was evaluated by fundus examination and optical coherence tomography. Spectral domain optical coherence tomography was used to study the restoration of the outer retinal layer integrity in the postoperative period. The preoperative and postoperative best-corrected visual acuities in logMAR units were compared to evaluate functional outcome.
MAIN OUTCOME MEASURE
Macular hole closure and best-corrected visual acuity before and after surgery.
RESULTS
Twenty-six patients with mean age 62.8 ± 7.3 years, preoperative median best-corrected visual acuity 6/60 (1.0 logMAR units), and a mean base diameter of 892.8 ± 349 μm underwent surgery to close macular holes without gas tamponade or postoperative posturing. Twenty patients (76.9%) were phakic. Twenty eyes (76.92%) had Stage 3 macular holes and 6 eyes (23.10%) had Stage 4 macular holes. After a single surgery, hole closure was achieved in 100% of eyes. The median best-corrected visual acuity improved from 6/60 (1.0 logMAR units) to 6/18 (0.50 logMAR units) (P < 0.001). Three patients needed cataract surgery at 12-month follow-up. No major intraoperative or postoperative complications were observed.
CONCLUSION
Twenty-three-gauge pars plana vitrectomy combined with broad ILM peeling, use of ILMR and autologous gluconated blood clumps as a macular plug is effective in achieving satisfactory hole closure with statically significant functional improvement for large Stage 3 and Stage 4 macular holes.
Topics: Adult; Aged; Basement Membrane; Blood; Endotamponade; Epiretinal Membrane; Female; Fluorocarbons; Humans; Male; Middle Aged; Postoperative Care; Prone Position; Retinal Perforations; Retrospective Studies; Surgical Flaps; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 27491044
DOI: 10.1097/IAE.0000000000001206