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PloS One 2020To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as...
PURPOSE
To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole.
METHODS
Patients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole.
RESULTS
Among 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The 'LMH without retinoschisis' group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the "LMH with retinoschisis group", ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the "LMH without retinoschisis group", no associated factor was identified.
CONCLUSIONS
LMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening.
Topics: Aged; Disease Progression; Epiretinal Membrane; Female; Follow-Up Studies; Fovea Centralis; Humans; Male; Middle Aged; Myopia, Degenerative; Proportional Hazards Models; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity
PubMed: 32374792
DOI: 10.1371/journal.pone.0232852 -
Eye (London, England) Jan 2019To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH).
OBJECTIVE
To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH).
METHODS
Prospective interventional case series. Twenty-six eyes of 26 patients in Peking Union Medical College Hospital with primary FTMH underwent IVI of perfluoropropane (CF) 0.2 ml, followed by 7-14 days' face-down positioning. The macular hole closure rate, post-operative visual acuity, and the incidence of surgical complications were observed. The correlation between the patients' age, macular hole diameter, pre-operative best-corrected visual acuity (BCVA), status of the vitreous, and the macular hole closure rates were analyzed.
RESULTS
A total of 17 cases (65.4%) had hole closure after IVI of CF alone. The closure rate of small, medium, and large FTMH was 85.7, 80, and 33.3%, respectively. Pre-operative OCT examination showed that 10 cases (37%) had vitreomacular traction (VMT), and all of them achieved vitreous-macula separation after IVI of the gas. The diameters of the hole (P = 0.024) and the status of the vitreous (P = 0.038) had a significance difference for hole closure. The mean pre-operative and post-operative BCVA was 0.84 ± 0.29 and 0.49 ± 0.36 (logMAR), respectively (P < 0.01). One myope with persistent hole developed rhegmatogenous retinal detachment (RRD) 2 months after the surgery. Another myope with hole closure developed RRD 10 months after the surgery. They achieved hole closure and retinal reattachment after vitrectomy and scleral buckling, respectively.
CONCLUSION
Intravitreal injection of CF gas alone was an effective treatment for small-sized and medium-sized primary FTMH, but further large prospective studies are needed.
Topics: Adult; Aged; Endotamponade; Female; Follow-Up Studies; Humans; Intravitreal Injections; Macula Lutea; Male; Middle Aged; Postoperative Period; Prospective Studies; Retinal Perforations; Sulfur Hexafluoride; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 30185833
DOI: 10.1038/s41433-018-0098-z -
Indian Journal of Ophthalmology Nov 2021To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in...
PURPOSE
To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in eyes with proliferative diabetic retinopathy (PDR), and factors influencing the outcome.
METHODS
This retrospective study included the patients who underwent vitrectomy for FTMH secondary to PDR TRD from 2016 to 2020. Anatomical and visual outcomes were analyzed after six months along with the factors predicting the final outcome and duration of subretinal fluid (SRF) resolution.
RESULTS
Group A (macula-off combined RD, i.e., tractional and rhegmatogenous) included 10 eyes, while group B (macula-threatening TRD) included eight eyes. The mean best-corrected visual acuity improved from logMAR 1.21 (Snellen equivalent: 20/324) to logMAR 0.76 (Snellen equivalent: 20/115) (P = 0.008). Seventeen patients gained ≥1 line(s) of vision. Mean visual gain in groups A and B was 3.7 ± 1.9 and 1.9 ± 1.1 lines, respectively (P = 0.051). MH closed in 88.9% eyes. Type 1 anatomical closure was achieved in 88.9% of eyes. At 6 months, SRF and central macular thickness reduced from 479.6 ± 512.5 μm to 11.4 ± 23.5 μm (P = 0.002) and 874.3 ± 422.6 μm to 207.6 ± 81.7 μm (P = 0.0002), respectively. Finally, macular SRF resolved in all the patients. The mean duration for complete SRF resolution was 4.9 ± 3.2 months. Eyes with a shorter duration of diabetes mellitus (rho = -0.49, P = 0.040) and macula-off combined RD (P = 0.048) took a longer time for complete SRF resolution.
CONCLUSION
Good anatomical and visual outcomes can be achieved in eyes with PDR TRD-associated FTMH. The residual macular SRF resolves slowly after the surgery and extra intervention is not required. Macula-off combined RD is associated with worse outcome and a slower SRF resolution rate.
Topics: Diabetes Mellitus; Diabetic Retinopathy; Humans; Macula Lutea; Retinal Detachment; Retinal Perforations; Retrospective Studies; Treatment Outcome; Vitrectomy
PubMed: 34708793
DOI: 10.4103/ijo.IJO_1204_21 -
Indian Journal of Ophthalmology Jun 2020
Topics: Fluorescein Angiography; Humans; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence
PubMed: 32461474
DOI: 10.4103/ijo.IJO_1591_19 -
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 -
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 -
BMC Ophthalmology Jul 2020To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict...
BACKGROUND
To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict the restoration of retinal microstructure and visual outcomes.
METHODS
This retrospective case series study included 53 MH patients. One eye each was assessed with iOCT during vitrectomy after internal limiting membrane (ILM) peeling. The MHs were categorized into three groups according to the morphology of the hole edge. The Hole-Door group had vertical pillars of tissue that projected into the vitreous cavity after ILM peeling. The Foveal Flap group had a preoperative foveal flap that adhered to the hole edge after ILM peeling, and the Negative group had neither a hole-door nor a foveal flap. At 6 months after surgery, the retinal microstructure restoration and visual outcomes were compared among the groups.
RESULTS
All eyes had MH closure, and the postoperative best corrected visual acuity (BCVA) was significantly improved compared with the preoperative BCVA (P < 0.001). The Hole-Door group (n = 15) and Foveal Flap group (n = 14) had significantly better final visual acuity and postoperative restoration of the external limiting membrane (ELM) than the Negative group (n = 24) (P = 0.002, P = 0.012). For the group in which the MH diameter (MHD) was ≤400 μm (n = 25), there were no significant differences in ELM restoration, ellipsoid zone (EZ) restoration, or BCVA among the three groups (P = 0.516, P = 0.179, and P = 0.179 respectively). For the MHD > 400-μm group (n = 28, the Hole-Door group and Foveal Flap group had significantly better final visual acuity and restoration of ELM than the Negative group (P = 0.013, P = 0.005).
CONCLUSIONS
The novel use of iOCT during MH surgery confirmed the presence of hole edges configured as door-holes, foveal flaps, or neither. The data acquired by iOCT can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcome of MH, especially large ones.
Topics: Basement Membrane; Fovea Centralis; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 32652958
DOI: 10.1186/s12886-020-01541-7 -
Eye (London, England) Mar 2015To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes. (Observational Study)
Observational Study
PURPOSE
To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes.
PATIENTS AND METHODS
Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes.
RESULTS
Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection.
CONCLUSION
The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.
Topics: Adult; Aged; Aged, 80 and over; Endotamponade; Female; Fluorocarbons; Follow-Up Studies; Humans; Intravitreal Injections; Male; Middle Aged; Myopia, Degenerative; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 25572579
DOI: 10.1038/eye.2014.312 -
The British Journal of Ophthalmology Jul 2014Optical coherence tomography (OCT) imaging plays an essential role in the diagnosis and treatment of macular diseases, including those of the vitreomacular interface.... (Review)
Review
Optical coherence tomography (OCT) imaging plays an essential role in the diagnosis and treatment of macular diseases, including those of the vitreomacular interface. OCT enables accurate diagnosis and differentiation of full thickness macular hole, lamellar macular hole and epiretinal membrane, with or without the presence of vitreomacular adhesion. This information enables earlier diagnosis and treatment when necessary, and can guide the choice of therapy. OCT is useful to facilitate discussions with patients and manage the visual expectations. Postoperatively, OCT can be helpful to optimise patient comfort and visual outcomes. As the technology continues to improve, OCT will become increasingly critical for all aspects of care for patients with macular hole and epiretinal membrane.
Topics: Disease Progression; Epiretinal Membrane; Humans; Ophthalmologic Surgical Procedures; Postoperative Care; Preoperative Care; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity
PubMed: 24627250
DOI: 10.1136/bjophthalmol-2013-304447