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Acta Ophthalmologica Jun 2020To assess the functional and structural outcomes of macular buckling using a silicone sponge-titanium exoplant for the treatment of foveoschisis (FS) and full-thickness...
BACKGROUND
To assess the functional and structural outcomes of macular buckling using a silicone sponge-titanium exoplant for the treatment of foveoschisis (FS) and full-thickness macular holes (FTMHs) in highly myopic eyes.
METHODS
Forty-nine consecutive patients with high myopia who underwent macular buckling for the treatment of FS and FTMHs were included. The outcomes measured included the anatomical success rate with FS resolution, retinal reattachment, MH closure, best corrected visual acuity (BCVA), axial length (AL) and complications of surgery. Moreover, the correlations between the BCVA at year three and series of factors, including age, duration of symptoms, baseline BCVA, AL, surgical type, preoperative macular status and severity of myopic maculopathy, were analysed.
RESULTS
This study involved 28 patients (28 eyes) with FS and 21 patients (21 eyes) with FTMHs with macular detachment. Retinal reattachment was achieved in 100% of cases, while MH closure was achieved in 76.19% of cases. The BCVA significantly improved one year after macular buckling in the FS cases and two years after macular buckling in the FTMH cases, and it remained stable throughout the rest of the follow-up period. The mean AL decreased by 2.09 mm postoperatively. No major perioperative complications were observed, although one patient needed to explant the buckling device due to intolerable diplopia.
CONCLUSION
Macular buckling with a silicone sponge-titanium exoplant may represent a safe and effective surgical option for the treatment of FS and FTMH in highly myopic eyes. Macular buckling showed a high closure rate and virtually no tendency to recur.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Macula Lutea; Male; Middle Aged; Myopia, Degenerative; Refraction, Ocular; Retinal Perforations; Retinoschisis; Retrospective Studies; Scleral Buckling; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity
PubMed: 31742899
DOI: 10.1111/aos.14305 -
BMC Ophthalmology Sep 2021To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that...
BACKGROUND
To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that precede MH formation in the fellow eye.
METHODS
A retrospective review of 229 patients treated for primary MH at Stavanger University Hospital, Norway, from January 2008 through December 2018. The patients were categorised into two groups according to subsequent development of MH in the fellow eye. The OCT findings of the two groups were compared, and associated risk factors for MH formation assessed.
RESULTS
Twenty cases of bilateral MH were identified. The overall bilateral disease risk was 8.8% (95% CI, 5.8-13.2%). Two patients were previously operated in the fellow eye, six patients presented with bilateral MH, and 12 patients subsequently developed MH in the fellow eye. The risk of subsequent MH development was 5.7% (95% CI, 3.3-9.8%). Although the extent of posterior vitreous detachment (PVD) tended to be more progressed in the bilateral group compared with the unilateral group, the difference was not statistically significant. In the bilateral group, 41.7% had outer retinal defects vs 6.6% in the unilateral group (p = 0.001), and 33.3% in the bilateral group had intraretinal pseudocysts vs 10.2% in the unilateral group (p = 0.036, not significant after multiple testing correction).
CONCLUSION
Outer retinal defects and intraretinal pseudocysts are associated with an increased risk of MH formation in the fellow eye, and complete PVD indicates a decreased risk of MH formation.
Topics: Humans; Retinal Perforations; Retrospective Studies; Risk Factors; Tomography, Optical Coherence; Vitreous Detachment
PubMed: 34587925
DOI: 10.1186/s12886-021-02111-1 -
PloS One 2021To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies. (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.
METHODS
PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.
RESULTS
Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).
CONCLUSION
Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.
Topics: Humans; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 33667237
DOI: 10.1371/journal.pone.0246667 -
BMJ Case Reports Mar 2015Various ophthalmic complications affecting the anterior and posterior segments have been identified due to lightning strike. We report the first case of an indirect...
Various ophthalmic complications affecting the anterior and posterior segments have been identified due to lightning strike. We report the first case of an indirect lightning-induced full thickness macular hole formation in the UK as evidenced by slit lamp examination and optical coherence tomography (OCT) scan in a 77-year-old woman presenting with sudden visual loss in her right eye and thermal skin injury affecting her scalp. Her best corrected visual acuities were LogMAR 0.46 and 0.12 in the right and left eyes, respectively. There were no other ocular manifestations observed in either eye. She was initially managed conservatively with non-steroidal anti-inflammatory drug eye drops but surgery was later advised due to minimal changes in the visual acuity and macular hole on follow-up. OCT scanning is important in diagnosing macular holes, which usually warrant surgical intervention.
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Disease Progression; Female; Humans; Lightning Injuries; Ophthalmologic Surgical Procedures; Referral and Consultation; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity
PubMed: 25827914
DOI: 10.1136/bcr-2014-207594 -
Photodiagnosis and Photodynamic Therapy Dec 2022To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by...
PURPOSE
To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by optical coherence tomography angiography (OCTA).
METHODS
A retrospective cases series study involving 20 unilateral eyes (20 patients) with IMH, the unaffected fellow eyes (n = 20) and 20 health controls, with age- and sex-matched, was conducted in Shanxi Eye Hospital from January 2019 to December 2021. VD of the retinal capillary plexuses measurements were obtained by OCTA.
RESULTS
Four quadrants of superficial capillary plexuses (SCP) in IMH eyes were not significant compared with that in the unaffected fellow eyes (all P > 0.05). The four quadrants of deep capillary plexuses (DCP) in IMH eyes were lower than that in the unaffected fellow eyes (all P < 0.05). Different regions retinal thickness in the IMH eyes was higher than that in the unaffected fellow eyes (all P < 0.05). a significant negative correlation between deep vessel density and retinal thickness in different quadrants among IMH eyes (all P < 0.05). Additionally, the correlation between the vascular density of SCP and retinal thickness was significant in macular fovea area (= 0.519, P = 0.019). <0.001.
CONCLUSIONS
The morphology of retina and choroid in idiopathic macular hole is different from that in fellow eye. The thickness of choroid in the fovea area of the unaffected eye also showed a decreasing trend. Taken together, the mechanism of macular hole may be further understood, that is, the decrease of choroid thickness may occur before the macular hole formation. It was verified again that the choroidal blood flow area in macular fovea of IMH patients was significantly lower than that in fellow eyes and healthy eyes.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Fluorescein Angiography; Retinal Vessels; Retrospective Studies; Visual Acuity; Photochemotherapy
PubMed: 36150634
DOI: 10.1016/j.pdpdt.2022.103131 -
Indian Journal of Ophthalmology Oct 2022
Topics: Humans; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 36190057
DOI: 10.4103/ijo.IJO_1732_22 -
BMC Ophthalmology Dec 2019After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery.
METHODS
Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0.
RESULTS
Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 μm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 μm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03).
CONCLUSIONS
Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 μm but may be highly recommended for MHs larger than 400 μm. Further RCTs with large sample sizes are warranted to validate these findings in future.
Topics: Aged; Endotamponade; Female; Fluorocarbons; Humans; Male; Middle Aged; Patient Positioning; Prone Position; Randomized Controlled Trials as Topic; Recovery of Function; Retinal Perforations; Sulfur Hexafluoride; Visual Acuity; Vitrectomy
PubMed: 31864333
DOI: 10.1186/s12886-019-1272-1 -
Korean Journal of Ophthalmology : KJO Apr 2019To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after... (Observational Study)
Observational Study
PURPOSE
To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after vitrectomy.
METHODS
This is a retrospective observational case review of 17 eyes with EP that underwent vitrectomy, EP dissection, and internal limiting membrane peeling between January 2013 and December 2016. Surgical specimens of EP tissue were successfully obtained from 5 cases and they were analyzed after immunohistochemical staining. Postoperative outcomes, including best-corrected visual acuity (BCVA) and macular configuration in spectral domain-optical coherence tomography, were reviewed.
RESULTS
Mean BCVA improved from 0.54 ± 0.36 logarithms of the minimum angle of resolution preoperatively to 0.32 ± 0.38 logarithms of the minimum angle of resolution postoperatively ( = 0.002). BCVA improved in 13 eyes and remained unchanged in four eyes. No cases experienced vision decline after surgery. All 17 patients' lamellar hole or macular hole were successfully closed. Despite hole closure, ellipsoid zone defects were not corrected in 11 of the 17 patients. In immunohistochemical analyses, anti-glial fibrillary acidic protein and pan-keratin (AE1/AE3) were positive, but synaptophysin, anti-α-smooth muscle actin, and anti-CD68 were negative.
CONCLUSIONS
The epiretinal proliferative membrane seems to originate from Müller cells, not from the vitreous. It is unclear whether retinal pigment epithelia also contribute to EP formation. Gentle handling and preservation of the epiretinal proliferative tissue is crucial for successful surgical outcomes.
Topics: Cell Proliferation; Ependymoglial Cells; Epiretinal Membrane; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 30977324
DOI: 10.3341/kjo.2018.0070 -
Indian Journal of Ophthalmology Jun 2020
Topics: Eye Diseases, Hereditary; Humans; Retinal Diseases; Retinal Dystrophies; Retinal Perforations
PubMed: 32461465
DOI: 10.4103/ijo.IJO_1346_19 -
Indian Journal of Ophthalmology Apr 2021The aim of this study was to report results of macular hole closure, visual benefit and longitudinal changes in foveal architecture over 1 year following macular hole...
PURPOSE
The aim of this study was to report results of macular hole closure, visual benefit and longitudinal changes in foveal architecture over 1 year following macular hole surgery with retinal massage.
METHODS
Records of patients with full thickness macular hole (FTMH) with minimum basal diameter of 550 μ who underwent vitrectomy, internal limiting membrane (ILM) peeling and retinal massage were drawn up. Retinal massage was performed after dye assisted ILM peeling, using a 27G flute needle with a long and soft silicone tip under air in a centripetal direction around the FTMH. At the end, 10% CF gas was used as tamponade. The foveal contour at 1 year follow up was recorded based on its cross sectional appearance on OCT and was classified into U, V and irregular types of closure as previously described.
RESULTS
Forty-one eyes of 41 patients with a mean age of 70.4 ± 6.9 years were included. The mean preoperative vision was 0.99 ± 0.07 logMAR and mean maximum basal diameter of the FTMH was 835 ± 208 μ. Macular hole closure was seen in all patients at 1-month follow up. The BCVA improved to 0.5 ± 0.1 log MAR at 6 months (P < 0.001) and then stabilized. The U shaped closure was the commonest pattern (n = 22, 54%), followed by V-shaped closure (n = 16, 39%) while irregular closure was seen in 3 eyes (7%).
CONCLUSION
Retinal massage after ILM peeling is a very simple, and as yet under-utilized manoeuvre that may improve hole closure rates and lead to potentially greater improvement in vision compared to existing techniques for large holes.
Topics: Aged; Basement Membrane; Cross-Sectional Studies; Epiretinal Membrane; Humans; Massage; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 33727455
DOI: 10.4103/ijo.IJO_1680_20