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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 -
Eye (London, England) Apr 2020To describe the features and surgical outcomes of macular holes (MHs) in patients with retinitis pigmentosa (RP). (Review)
Review
OBJECTIVE
To describe the features and surgical outcomes of macular holes (MHs) in patients with retinitis pigmentosa (RP).
METHODS
A review of consecutive series of 110 patients (206 eyes) with RP who underwent comprehensive ophthalmic examinations was conducted. Eleven eyes of ten RP patients were identified with MHs (full thickness or lamellar). Atypical epiretinal membrane, which appeared on spectral-domain optical coherence tomography (SD-OCT) images as a thick homogenous layer of moderately reflective material that was present on the inner retinal layer, was considered to be lamellar hole-associated epiretinal proliferation (LHEP). Five eyes underwent modified vitreoretinal surgery, where hole margin LHEP tissue was retained.
RESULTS
Nine eyes exhibited a lamellar macular hole (LMH), one exhibited a full-thickness macular hole (FTMH), and one exhibited both FTMH and LMH. LHEP was found in all eyes, identified intraoperatively as yellowish, sticky epiretinal membrane with internal limiting membrane beneath it. Two eyes experienced spontaneous closure of MHs without visual acuity (VA) improvement. Five eyes that underwent surgery achieved sealed MHs post-operatively and demonstrated improved, but limited, vision at their latest follow-up.
CONCLUSIONS
LHEP is common in MHs associated with RP. While some eyes could achieve spontaneous closure without any VA changes, a conservative vitreoretinal surgery approach, in which the hole margin LHEP tissue is spared, can effectively repair these MHs with limited VA improvement.
Topics: Epiretinal Membrane; Humans; Retinal Perforations; Retinitis Pigmentosa; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 31455903
DOI: 10.1038/s41433-019-0563-3 -
BMC Ophthalmology Aug 2018To evaluate the surgical technique using autologous retinal graft (ARG) and autologous blood clot (ABC) for the management of refractory macular holes (MHs).
BACKGROUND
To evaluate the surgical technique using autologous retinal graft (ARG) and autologous blood clot (ABC) for the management of refractory macular holes (MHs).
METHODS
This study was a retrospective, consecutive, interventional case series. Six eyes of 6 patients who underwent vitrectomy combined with ARG and ABC for the treatment of refractory MH were reviewed. Visual and anatomic outcomes were evaluated.
RESULTS
The mean age was 59.0 ± 9.9 years. All cases had multiple vitreoretinal procedures including vitrectomy and gas fluid exchange before patient presentation. The average numbers of vitrectomies were 2.3 ± 0.5, and those of gas fluid exchange were 3 ± 1.7. Closure of the macular hole was achieved in four (66.7%) cases at last follow-up. The mean follow-up time was 25.2 ± 15.6 months. The averaged BCVA before and after 12 months of the surgery improved from 20/591 to 20/244.
CONCLUSIONS
This surgical technique using ARG and ABC provide an option for the treatment of refractory MHs.
Topics: Adult; Aged; Blood; Endotamponade; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Transplantation, Autologous; Vitrectomy
PubMed: 30157808
DOI: 10.1186/s12886-018-0898-8 -
Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery.Scientific Reports May 2021To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery...
To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.
Topics: Female; Humans; Male; Retina; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity
PubMed: 34059759
DOI: 10.1038/s41598-021-90955-4 -
Eye (London, England) Oct 2021To compare the macular microvasculature differences in cases with idiopathic macular hole (MH) after vitrectomy when using internal limiting membrane (ILM) removal or...
Macular microvasculature differences in patients with macular hole after vitrectomy with internal limiting membrane removal or single-layered temporal inverted flap technique.
PURPOSE
To compare the macular microvasculature differences in cases with idiopathic macular hole (MH) after vitrectomy when using internal limiting membrane (ILM) removal or temporal inverted ILM flap technique (IFT).
METHOD
A total of 34 patients were included, of whom 20 were treated vitrectomy with ILM removal (group 1), and 14 were treated with IFT (group 2). The OCTA (RTVue; Optovue, Fremont, CA) parameters, including foveal avascular zone (FAZ), vessel density (VD) ratios in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were evaluated at baseline and 6 months follow-up. The VD measurements in DCP and inner retinal thickness (IRT) in temporal and nasal sectors were compared in subanalyses.
RESULTS
There was no significant difference in means of post-operative BCVA and FAZ between the two groups (p = 0.943, p = 0.760). The mean VDs of the DCP was significantly decreased at 6 months postoperatively in both groups (p < 0.001, p < 0.001). The mean post-operative temporal VDs of DCP were similar in the two groups, but the mean post-operative nasal VDs of the DCP was lower in group 1 than in group 2 (p = 0.005 and p = 0.03 for parafovea and perifovea, respectively). The mean temporal IRTs were similar in the two groups, but paranasal and perinasal IRTs were significantly thinner in group 1 than in group 2 (p < 0.001, p < 0.001). The mean post-operative VDs of parafoveal and perifoveal temporal and nasal quadrants in DCP significantly and positively correlated with the IRTs.
CONCLUSION
Single-layered temporal IFT causes fewer VD changes when compared to complete ILM removal, especially in the DCP.
Topics: Humans; Microvessels; Retinal Perforations; Retinal Vessels; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 33235343
DOI: 10.1038/s41433-020-01301-3 -
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 -
JAMA Ophthalmology Jul 2020The value of facedown positioning following surgery for large full-thickness macular holes is unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The value of facedown positioning following surgery for large full-thickness macular holes is unknown.
OBJECTIVE
To determine whether advice to position facedown postoperatively improves the outcome for large macular holes.
DESIGN, SETTING, AND PARTICIPANTS
This randomized, parallel group superiority trial with 1:1 randomization stratified by site with 3 months' follow-up was conducted at 9 sites across the United Kingdom and included participants with an idiopathic full-thickness macular hole of at least 400 μm minimum linear diameter and a duration of fewer than 12 months. All participants had vitrectomy surgery with peeling of the internal limiting membrane and injection of perfluoropropane (14%) gas, with or without simultaneous surgery for cataract.
INTERVENTIONS
Following surgery, participants were randomly advised to position either facedown or face forward for 8 hours daily for 5 days.
MAIN OUTCOMES AND MEASURES
The primary outcome was closure of the macular hole determined 3 months following surgery by masked optical coherence tomography evaluation. Secondary outcome measures at 3 months were visual acuity, participant-reported experience of positioning, and quality of life measured by the National Eye Institute Visual Function Questionnaire 25.
RESULTS
A total of 185 participants (45 men [24.3%]; 156 white [84.3%]; 9 black [4.9%]; 10 Asian [5.4%]; median age, 69 years [interquartile range, 64-73 years]) were randomized. Macular hole closure was observed in 90 (85.6%) who were advised to position face forward and 88 (95.5%) advised to position facedown (adjusted odds ratio, 3.15; 95% CI, 0.87-11.41; P = .08). The mean (SD) improvement in best-corrected visual acuity at 3 months was 0.34 (0.69) logMAR (equivalent to 1 Snellen line) in the face-forward group and 0.57 (0.42) logMAR (equivalent to 3 Snellen lines) in the facedown group (adjusted mean difference, 0.22 [95 % CI, 0.05-0.38]; equivalent to 2 Snellen lines); 95% CI, 0.05-0.38; P = .01). The median National Eye Institute Visual Function Questionnaire 25 score was 89 (interquartile range, 76-94) in the facedown group and 87 (interquartile range, 73-93) in the face-forward group (mean [SD] change on a logistic scale, 0.08 [0.26] face forward and 0.11 [0.25] facedown; adjusted mean [SD] difference on a logistic scale, 0.02; 95% CI, -0.03 to 0.07; P = .41).
CONCLUSIONS AND RELEVANCE
The results do not prove that facedown positioning following surgery is more likely to close large macular holes compared with facing forward but do support the possibility that visual acuity outcomes may be superior.
TRIAL REGISTRATION
Isrctn.org Identifier: 12410596.
Topics: Aged; Female; Humans; Macula Lutea; Male; Middle Aged; Postoperative Care; Prone Position; Quality of Life; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 32379288
DOI: 10.1001/jamaophthalmol.2020.0987 -
Indian Journal of Ophthalmology Aug 2022Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI)...
PURPOSE
Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH).
METHODS
Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared.
RESULTS
Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16).
CONCLUSION
There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.
Topics: Choroid; Epiretinal Membrane; Eye Diseases; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35918960
DOI: 10.4103/ijo.IJO_440_22