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BMC Ophthalmology Sep 2022To report the clinical presentations and outcome of early intravitreal injection (IVI) of octafluoropropane (CF) for persistent macular holes (MH) after primary pars...
PURPOSE
To report the clinical presentations and outcome of early intravitreal injection (IVI) of octafluoropropane (CF) for persistent macular holes (MH) after primary pars plana vitrectomy with the internal limiting membrane (ILM) peeling technique.
METHODS
Nineteen eyes of 18 patients with persistent MH after vitrectomy underwent intravitreal injection of CF between 11 and 21 days after the initial surgery (intravitreal gas injection group). Another nine eyes with a persistent MH without additional IVI CF were included (non-intravitreal gas injection group). Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) features including size and configuration of MH, and time duration between the 2 surgeries were compared between the MH closure and open groups. The closure rate of persistent MHs was compared between the intravitreal gas injection group and non-intravitreal gas injection group.
RESULTS
Twelve of 19 eyes (63%) achieved MH closure after 1 to 3 times IVI CF. The final BCVA after vitrectomy and IVI gas was significantly better in the MH closure group (P = .005). Nine of 12 patients (75%) in the MH closure group had a visual acuity improvement of more than 2 lines. Original MHs with smaller minimal diameter, higher macular hole index (MHI) and higher tractional hole index (THI); and persistent MHs with smaller minimal diameter, higher THI, and lower diameter hole index (DHI) showed higher MH closure rate. None of the persistent MHs closed in the non-intravitreal gas injection group (0/9 eyes).
CONCLUSION
Early intravitreal injection of CF can be a cost-effective first-line treatment for early persistent MHs after primary surgery, especially in eyes with favorable OCT features.
Topics: Humans; Intravitreal Injections; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 36115940
DOI: 10.1186/s12886-022-02599-1 -
Turkish Journal of Ophthalmology Oct 2020To assess changes in reflectivity of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) on spectral domain-optical coherence...
OBJECTIVES
To assess changes in reflectivity of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) on spectral domain-optical coherence tomography (SD-OCT) images and the effects of reflectivity changes on visual acuity improvement after vitrectomy in macular hole patients.
MATERIALS AND METHODS
Twenty-four eyes of 24 patients with idiopathic full-thickness macular hole closed after vitrectomy were retrospectively reviewed. The "plot profile" function of the medical imaging software was used by a single masked physician to analyze RPE, EZ, and ELM reflectivity on OCT images at postoperative 1 month and 12 months.
RESULTS
Absolute and relative EZ reflectivity showed highly significant increases at postoperative 12 months compared to 1 month (p<0.001 and p<0.001, respectively). Absolute and relative EZ reflectivity changes from postoperative month 1 to month 12 after macular hole surgery were significantly correlated with best corrected visual acuity improvement (p=0.012 and p=0.020, respectively).
CONCLUSION
EZ reflectivity can be a predictor of functional and anatomical improvement after macular hole surgery.
Topics: Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Period; Recovery of Function; Retinal Perforations; Retinal Pigment Epithelium; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 33342195
DOI: 10.4274/tjo.galenos.2020.21456 -
Indian Journal of Ophthalmology Jan 2022To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates.
PURPOSE
To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates.
METHODS
This is a single-center interventional case series. conducted between 2016 and 2020. The minimum follow-up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ≥600 μm) were enrolled; vertical hole diameters were also measured using spectral-domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc-diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best-corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t-test. IBM SPSS (ver. 26) was used for analysis.
RESULTS
The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 μm (range: 600-1020 μm) and 602 μm (490-844 μm), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow-up (mean: 28 months, median: 34 months; range 4-48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001).
CONCLUSION
All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Vitrectomy
PubMed: 34937234
DOI: 10.4103/ijo.IJO_906_21 -
Scientific Reports Jan 2023Metamorphopsia is an important visual symptom of macular disease. We determined predictors for metamorphopsia investigating the relationships of macular hole (MH)...
Metamorphopsia is an important visual symptom of macular disease. We determined predictors for metamorphopsia investigating the relationships of macular hole (MH) diameter and retinal layer thicknesses with metamorphopsia after MH surgery. Forty-two eyes of 42 consecutive patients undergoing MH surgery were retrospectively studied. Metamorphopsia was measured with M-CHARTS. Inner nuclear layer (INL) and outer retinal layer (OR) thicknesses were measured 1000 μm away from central fovea at using Spectralis. Preoperative M-CHARTS scores correlated with MH diameters (P = 0.007-0.031) and changes of temporal OR thickness (P = 0.008-0.010). Postoperative M-CHARTS score at 3 months correlated with preoperative nasal and inferior OR thicknesses (P = 0.003 and 0.016) and with changes of superior INL at 3 and 6 months (P = 0.011 and 0.025), and score at 1 month with change of temporal OR at 6 months (P = 0.033). Postoperative improvement of M-CHARTS scores correlated with changes of temporal INL and superior OR (P = 0.026 and 0.002). Multiple regression analysis revealed that MH diameter was a significant predictor for metamorphopsia. Photoreceptor displacement and inner retinal change may generate metamorphopsia in MH undergoing surgery, however MH diameter is the most powerful predictor.
Topics: Humans; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy; Tomography, Optical Coherence; Vision Disorders
PubMed: 36646835
DOI: 10.1038/s41598-023-28031-2 -
Graefe's Archive For Clinical and... Jul 2021To investigate morphological and functional outcomes of the inverted internal limiting membrane (I-ILM) flap technique in large (≥ 400 μm) idiopathic...
PURPOSE
To investigate morphological and functional outcomes of the inverted internal limiting membrane (I-ILM) flap technique in large (≥ 400 μm) idiopathic full-thickness macular holes (FTMH) over a follow-up period of 12 months.
METHODS
In this retrospective study, 55 eyes of 54 consecutive patients were enrolled. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT, Heidelberg, Spectralis) were performed preoperatively as well as 1, 3, 6, 9, and 12 months postoperatively. Special focus was put on the reintegration of outer retinal layers and the different ILM flap appearances.
RESULTS
FTMH closure rate was 100% (55/55). BCVA significantly improved over the follow-up period of 12 months from 0.98 ± 0.38 LogMAR preoperatively to 0.42 ± 0.33 LogMAR at 12 months postoperatively (p < 0.001). There was no significant correlation between the three different ILM flap appearances and BCVA. Better preoperative BCVA, complete restoration of the external limiting membrane (ELM), higher macular hole index (MHI), and smaller MH base diameter were associated with higher improvement of BCVA.
CONCLUSION
Our study highlights the favorable morphological and functional outcomes of the I-ILM flap technique in the short as well as in the long term. While complete ELM restoration revealed to be an important factor for improvement in BCVA, the different postoperative ILM flap appearances seem not to be related to BCVA.
Topics: Basement Membrane; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 33512612
DOI: 10.1007/s00417-021-05082-7 -
Acta Ophthalmologica May 2017To report the clinical findings and surgical outcomes of lamellar macular holes (LMHs) with and without lamellar hole-associated epiretinal proliferation (LHEP).
PURPOSE
To report the clinical findings and surgical outcomes of lamellar macular holes (LMHs) with and without lamellar hole-associated epiretinal proliferation (LHEP).
METHODS
A retrospective review was performed of 73 eyes of 73 patients who underwent vitrectomy for LMH. Patients were grouped according to the presence of LHEP on preoperative spectral-domain optical coherence tomography (SD-OCT). Postoperative best-corrected visual acuity (BCVA) and OCT features were compared between LMH patients with and without LHEP.
RESULTS
Lamellar hole-associated epiretinal proliferation (LHEP) was found in 15 of 73 eyes with LMHs (20.5%). The mean age was 65.0 years. The mean follow-up duration was 21.5 months. Preoperatively, eyes with LHEP were characterized by a greater hole diameter (p = 0.007), thinner fovea (p = 0.002) and greater incidence of outer retinal disruption (p < 0.001). Best-corrected visual acuity (BCVA) significantly improved after surgery in eyes without LHEP (p < 0.001), but showed no change in eyes with LHEP (p = 0.185). Initial BCVA was not different between the two groups; however, final BCVA was better in eyes without LHEP (logarithm of the minimum angle of resolution (logMAR) BCVA, 0.10 ± 0.10 versus 0.33 ± 0.40, p = 0.003). OCT evaluations of postoperative foveal configurations showed no difference between the two groups (p = 0.171). No case developed a full-thickness macular hole after surgery.
CONCLUSION
There was no visual benefit after surgery in LMH patients with LHEP. Different surgical indications for LMHs may be warranted based on the presence of LHEP-associated pathology.
Topics: Aged; Epiretinal Membrane; Female; Follow-Up Studies; Fovea Centralis; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 27647708
DOI: 10.1111/aos.13245 -
Acta Ophthalmologica Dec 2018The purpose of this study was to compare the surgical outcomes of vitrectomy with conventional internal limiting membrane (C-ILM) peeling to that with the inverted ILM... (Review)
Review
The purpose of this study was to compare the surgical outcomes of vitrectomy with conventional internal limiting membrane (C-ILM) peeling to that with the inverted ILM (I-ILM) flap technique for large macular holes (MHs). This was a retrospective chart review of consecutive cases with a large MH at nine hospitals in Japan. Among the 1342 eyes, 165 eyes of 165 cases met the inclusion criteria. The results for medium-large MHs with a diameter 400-550 μm were compared to that of eyes with an extra-large MH with a diameter >550 μm. In addition, the results of C-ILM peeling were compared to that of the I-ILM technique. In medium-large MHs, the closure rate was 95.2% (59/62) by C-ILM peeling and 100% (19/19) by the I-ILM technique. In extra-large MHs, the closure rate was 88.4% (38/43) by C-ILM peeling and 100% (41/41) by I-ILM. Although the difference between the two methods was not significant, the I-ILM technique was successful in 100% of the cases. Multiple logistic regression analysis showed the best-corrected visual acuity (BCVA) at 6 months was significantly associated with the preoperative BCVA, MH size, age and sex of the patient. Analyses of the eyes with extra-large MHs show that the surgical success is high, and the I-ILM technique is more effective for closure in eyes with extra-large MHs.
Topics: Humans; Japan; Macula Lutea; Multicenter Studies as Topic; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 29671948
DOI: 10.1111/aos.13795 -
Eye (London, England) Feb 2023
Topics: Humans; Retinal Perforations; Vitrectomy; Tomography, Optical Coherence
PubMed: 36115885
DOI: 10.1038/s41433-022-02257-2 -
Indian Journal of Ophthalmology May 2023To analyze and describe the proteome of the vitreous humour in eyes with idiopathic macular holes.
Profiling of idiopathic macular hole vitreous proteome identifies the role of extracellular matrix remodelling, epithelial-mesenchymal transformation and unfolded protein-response pathways.
PURPOSE
To analyze and describe the proteome of the vitreous humour in eyes with idiopathic macular holes.
METHODS
We performed mass spectrometry (MS)-based label-free quantitative analysis of the vitreous proteome of idiopathic macular hole (IMH) and control donor vitreous. Comparative quantification was performed using SCAFFOLD software which calculated fold changes of differential expression. Bioinformatics analysis was performed using DAVID and STRING software.
RESULTS
A total of 448 proteins were identified by LC-MS/MS in IMH and cadaveric eye vitreous samples, of which 199 proteins were common. IMH samples had 189 proteins that were unique and 60 proteins were present only in the control cadaveric vitreous. We found upregulation of several extracellular matrix (ECM) and cytoskeletal proteins, namely collagen alpha-1 (XVIII) chain, N-cadherin, EFEMP1/fibulin-3, basement membrane-specific heparan sulfate proteoglycan core protein, and target of Nesh-3. Several cytoskeleton proteins, namely tubulin, actin, and fibronectin levels, were significantly lower in IMH vitreous, probably reflecting increased ECM degradation. IMH vitreous also had a downregulation of unfolded protein response-mediated-mediated apoptosis proteins, possibly related to a state of increased cell survival and proliferation, along with a remodelling and aberrant production of ECM contents.
CONCLUSION
The pathogenesis of macular holes may involve ECM remodelling, epithelial-mesenchymal transformation, downregulation of apoptosis, protein folding defects, and complement pathway. The vitreo-retinal milieu in macular holes contain molecules related to both ECM degradation and inhibition of the same, thereby maintaining a homeostasis.
Topics: Humans; Retinal Perforations; Proteome; Epithelial-Mesenchymal Transition; Chromatography, Liquid; Tandem Mass Spectrometry; Extracellular Matrix; Cadaver; Extracellular Matrix Proteins
PubMed: 37203077
DOI: 10.4103/ijo.IJO_2068_22 -
Scientific Reports Sep 2023This study aimed to investigate the relationship between macular shape and idiopathic macular hole (MH) findings using an objective method. We present retrospective... (Observational Study)
Observational Study
This study aimed to investigate the relationship between macular shape and idiopathic macular hole (MH) findings using an objective method. We present retrospective observational case series on patients with MH. The shape of the macular area was quantified using quadratic equations, and the ocular shape (OS) index was calculated. The correlation between the OS index and macular hole findings for each stage was evaluated. Pearson's correlation coefficient showed a significant correlation between the OS index and horizontal hole diameter (p = 0.044), bottom diameter (p = 0.006), and vertical bottom diameter (p = 0.024) in stage 2. For stage 4, there was a negative and significant correlation between the OS index and age (p = 0.037), and horizontal (p = 0.021) and vertical (p = 0.027) bottom diameter. Multiple regression analysis showed that the horizontal (p = 0.0070) and vertical (p = 0.031) bottom diameter and OS index were independently and positively correlated in stage 2. In stage 4, the OS index was independently and negatively correlated with the horizontal (p = 0.037) and vertical (p = 0.048) bottom diameter. The ocular shape of the macula affects MH findings, and its impact depends on its stage.
Topics: Humans; Face; Kidney Tubules; Macula Lutea; Retinal Perforations; Retrospective Studies
PubMed: 37717123
DOI: 10.1038/s41598-023-42509-z