-
BMC Ophthalmology Nov 2017To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular... (Meta-Analysis)
Meta-Analysis Review
Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis.
BACKGROUND
To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD).
METHODS
Pubmed, Cochrane Library, and Embase were systematically searched for studies that compared ILM peeling with inverted ILM flap technique for macular hole-induced retinal detachment. The primary outcomes are the rate of retinal reattachment and the rate of macular hole closure 6 months later after initial surgery, the secondary outcome is the postoperative best-corrected visual acuity (BCVA) 6 months later after initial surgery.
RESULTS
Four studies that included 98 eyes were selected. All the included studies were retrospective comparative studies. The preoperative best-corrected visual acuity was equal between ILM peeling and inverted ILM flap technique groups. It was indicated that the rate of retinal reattachment (odds ratio (OR) = 0.14, 95% confidence interval (CI):0.03 to 0.69; P = 0.02) and macular hole closure (OR = 0.06, 95% CI:0.02 to 0.19; P < 0.00001) after initial surgery was higher in the group of vitrectomy with inverted ILM flap technique than that in the group of vitrectomy with ILM peeling. However, there was no statistically significant difference in postoperative best-corrected visual acuity (mean difference (MD) 0.18 logarithm of the minimum angle of resolution; 95% CI -0.06 to 0.43 ; P = 0.14) between the two surgery groups.
CONCLUSION
Compared with ILM peeling, vitrectomy with inverted ILM flap technique resulted significantly higher of the rate of retinal reattachment and macular hole closure, but seemed does not improve postoperative best-corrected visual acuity.
Topics: Epiretinal Membrane; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Surgical Flaps; Vitrectomy
PubMed: 29179705
DOI: 10.1186/s12886-017-0619-8 -
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 -
Journal of Ayub Medical College,... 2021The surgery of macular hole is a complex and intricate micro-surgery and chances of recurrence of macular hole are always high. Therefore, in order to provide a medium...
BACKGROUND
The surgery of macular hole is a complex and intricate micro-surgery and chances of recurrence of macular hole are always high. Therefore, in order to provide a medium to close this hole, we carried out this research on subjects using amniotic membrane, in light of the studies being conducted around the world. This in turn led to benefitting the patients by improving their vision over time.
PURPOSE
To assess the rate of recurrent macular hole closure with amniotic membrane plug. It was a Quasi-experimental study, conducted at Layton Rahmatullah Benevolent Trust (LRBT) Free Eye Hospital Karachi, from January 2019 to January 2020.
METHODS
This study was conducted using 13 eyes of 13 patients with recurrent macular hole who underwent amniotic membrane plugging via pars plana approach. Outcomes measured were changes in best corrected visual acuity (BCVA) and change in hole size with the help of optical coherence tomography (OCT).
RESULTS
Anatomic closure was attained in 100% of the cases whereas BCVA improved from 1.7±0.33 (6/300) to 0.9±0.15 (6/48).
CONCLUSIONS
The use of AM is a functional method for management of large RMH.
Topics: Adult; Aged; Amnion; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 34137524
DOI: No ID Found -
Scientific Reports May 2024To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This...
To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI - 0.661 to - 0.126), duration of RRD (p = 0.021, CI - 0.576 to - 0.048) and presence of PVR (p = 0.001, CI - 0.131 to - 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.
Topics: Humans; Tomography, Optical Coherence; Retinal Perforations; Retinal Detachment; Female; Male; Middle Aged; Visual Acuity; Aged; Retrospective Studies
PubMed: 38797771
DOI: 10.1038/s41598-024-61899-2 -
European Review For Medical and... Apr 2022Herein, we introduce the infusion direction manipulation technique and the infusion off technique. These relatively simple methods control intra-vitreal fluid flow...
OBJECTIVE
Herein, we introduce the infusion direction manipulation technique and the infusion off technique. These relatively simple methods control intra-vitreal fluid flow direction and turbulence and release negative pressure in the microforceps to facilitate handling of the internal limiting membrane. The aim of this study is to introduce an effective and uncomplicated method to handle the internal limiting membrane (ILM) during the temporal inverted ILM flap and free ILM flap techniques in macular hole surgery by controlling the direction and status of the infusion.
MATERIALS AND METHODS
The direction of the infusion flow was controlled with a free finger (usually the 4th finger) during the inverted ILM flap surgery to stabilize the flap location during the fluid-air exchange. A valved trocar was used, and the infusion was discontinued during the free ILM flap surgery. Turbulence was minimized, and negative pressure around the head-shaft junction of the microforceps was released.
RESULTS
The ILM flap remained stable in all patients who underwent macular hole surgery with our technique.
CONCLUSIONS
Infusion direction manipulation technique and infusion off technique are efficient and simple methods to handle the ILM during ILM surgery.
Topics: Basement Membrane; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35442493
DOI: 10.26355/eurrev_202204_28471 -
Current Eye Research Aug 2020The size of a macular hole helps determine treatment planning and postoperative prognosis. The aim of this study was to examine intra- and inter-individual agreement in...
PURPOSE
The size of a macular hole helps determine treatment planning and postoperative prognosis. The aim of this study was to examine intra- and inter-individual agreement in the measurement of full thickness macular hole (FTMH) size using optical coherence tomography (OCT) images.
METHODS
Thirty OCT scans of FTMHs were reviewed by three vitreoretinal consultants and three vitreoretinal fellows. The FTMH size was recorded by each clinician independently and they repeated the measurements 3 weeks later. The repeatability of measurements was analysed using techniques of agreement measurement.
RESULTS
The Coefficients of Repeatability (CR) for the intra-individual agreement were 46 µm, 73 µm and 60 µm for the consultant group and 44 µm, 60 µm and 57 µm for the fellow group. The Coefficients of Variation (CoV) of intra-individual repeatability were 3.8%, 5.9%, and 5.1% for the consultants and 3.5%, 5.2%, and 4.9% for the fellows. The CR for inter-individual agreement varied from 62 µm to 122 µm. There was no significant difference in repeatability of measurements between the consultant and the fellow groups (chi-squared, = .95).
CONCLUSIONS
Manual OCT FTMH diameter measurements show poor intra- and inter-individual repeatability. Future work should aim to develop an automated method for measuring macular holes.
Topics: Aged; Female; Humans; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence
PubMed: 31880476
DOI: 10.1080/02713683.2019.1708956 -
Seminars in Ophthalmology Jan 2022Vitrectomy with brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling is the standard operational technique in macular hole surgeries. However, BBG...
PURPOSE
Vitrectomy with brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling is the standard operational technique in macular hole surgeries. However, BBG dye, though considered safe and nontoxic, can also occasionally lead to macular toxicity. This study aims to describe the clinical features and characteristics of four eyes who developed macular toxicity after following surgery for macular hole repair.
METHODS
Retrospective review of four consecutive cases of macular toxicity after conventional BBG assisted ILM peeling. All the cases reviewed, their operative surgical notes were retrieved and analyzed. The ILM was stained twice during surgery with prolonged intraoperative surgical time.
RESULTS
All four cases had a prolonged surgical time and the ILM was stained twice during surgery in all cases. The area of macular toxicity was corresponding to the area of ILM peeling which had been exposed to repeated staining by BBG dye. By the end of one month, all four cases had foveal thinning along with choriocapillary atrophy. The mean BCVA was 20/80 before surgery and the final mean visual acuity was <20/800.
CONCLUSION
This report highlights the occurrence of macular and choriocapillary atrophy due to prolonged focal endoillumination and the increased risk of toxicity with repeated dye staining.
Topics: Coloring Agents; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Rosaniline Dyes; Vitrectomy
PubMed: 34010087
DOI: 10.1080/08820538.2021.1928717 -
Medicine Nov 2022To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective...
To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective study included 25 patients diagnosed with IMH in Shanxi eye hospital from August 2019 to December 2021. The study was divided into 3 groups: IMH eyes, fellow eyes and normal eyes. All unilateral IMH eyes underwent vitrectomy. There were significant differences in superficial retinal blood flow density (SRBFD, P < .001) and choroidal blood flow density (CBFD) between IMH and healthy control eyes before operation (P < .05). There was significant difference in SRBFD between fellow eyes and normal eyes (P = .038). The changes of SRBFD and CBFD in IMH eyes before and after operation were statistically significant (P < .05). The CBFD at 6 months after operation is negatively correlated with LogMAR visual acuity, and the CBFD of the fellow eye is also negatively correlated with LogMAR visual acuity. The SRBFD and CBFD had no correlation with the diameter of macular hole before and after operation. SRBFD and CBFD increased after vitrectomy, indicating that the blood supply of retina and choroid were partially restored after vitrectomy. There was no correlation between SRBFD, CBFD and hole diameter, but there was correlation between choroidal blood flow and LogMAR visual acuity.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Prospective Studies; Angiography; Choroid
PubMed: 36451457
DOI: 10.1097/MD.0000000000031862 -
Ophthalmology Feb 2020
Topics: Academies and Institutes; Age Factors; Diagnosis, Differential; Early Diagnosis; Female; Fibrinolysin; Humans; Male; Middle Aged; Ophthalmology; Peptide Fragments; Practice Patterns, Physicians'; Retinal Perforations; Sex Factors; Societies, Medical; United States; Vitreoretinal Surgery
PubMed: 31757499
DOI: 10.1016/j.ophtha.2019.09.026 -
Graefe's Archive For Clinical and... Nov 2016To study morphological and functional characteristics of myopic lamellar macular hole (LMH) with posterior staphyloma. (Observational Study)
Observational Study
PURPOSE
To study morphological and functional characteristics of myopic lamellar macular hole (LMH) with posterior staphyloma.
METHODS
Retrospective observational longitudinal study. Forty myopic eyes affected by LMH and posterior staphyloma have been examined. Pathological myopia was defined as axial length equal or superior to 26.5 mm. LMH was defined on the basis of the following characteristics: irregular foveal contour, inner retinal defect with or without intraretinal splitting and absence of full thickness retinal defect. Demographic and functional parameters were: age, sex, status of lens and best corrected visual acuity (BCVA). Tomographic parameters were: type of LMH, macular retinoschisis (MRS), posterior vitreous detachment (PVD), type of epiretinal membrane (ERM), integrity of ellipsoid zone (EZ) and external limiting membrane (ELM), residual foveal thickness (RFT) and maximal diameter of intraretinal splitting (MDIRS).
RESULTS
The statistical analysis showed a significant prevalence of posterior vitreous adherence in the atypical ERM subgroup (P = 0.001). EZ (P = 0.006) and ELM (P = 0.007) damages were significantly associated with the atypical ERM subgroup. RFT was statistically lower in the atypical ERM subgroup compared to the conventional ERM subgroup (P = 0.015). During the follow-up, the statistical analysis showed a significant reduction of RFT in the atypical ERM subgroup (P = 0.041).
CONCLUSIONS
Myopic lamellar macular hole (LMH) associated with atypical ERM is a more severe clinical entity than myopic LMH associated with conventional ERM.
Topics: Adult; Aged; Aged, 80 and over; Epiretinal Membrane; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myopia, Degenerative; Posterior Eye Segment; Refraction, Ocular; Retinal Perforations; Retrospective Studies; Scleral Diseases; Time Factors; Tomography, Optical Coherence; Visual Acuity
PubMed: 27122245
DOI: 10.1007/s00417-016-3371-5