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Retina (Philadelphia, Pa.) Jan 2021To evaluate retinal vessel density and retinal sensitivity (RS) after macular hole surgery with the superior inverted internal limiting membrane flap technique. (Observational Study)
Observational Study
PURPOSE
To evaluate retinal vessel density and retinal sensitivity (RS) after macular hole surgery with the superior inverted internal limiting membrane flap technique.
METHODS
Retrospective, observational case series. Twenty-one patients with idiopathic macular hole underwent 27-gauge vitrectomy with the superior inverted internal limiting membrane flap technique and triamcinolone acetonide. Measurements included RS, which was measured with microperimetry, as well as retinal vessel density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), which was measured with optical coherence tomography angiography. All parameters were evaluated in the superior and inferior sectors of the macula preoperatively and 1, 3, and 6 months postoperatively.
RESULTS
Six months postoperatively, retinal thickness in the inferior sector was unchanged, but retinal thickness in the superior sector decreased significantly (P < 0.01). SCP vessel density in both sectors was unchanged at all postoperative time points. DCP vessel density in both sectors increased very significantly at 3 months (P < 0.01) and returned to baseline at 6 months. RS in the inferior sector increased by 47% 3 months postoperatively and by 61% 6 months postoperatively (P < 0.05 and P < 0.001, respectively), but RS in the superior sector increased only at 6 months postoperatively and only by 22% (P < 0.05).
CONCLUSION
Lower recovery of RS in the superior sector suggests that internal limiting membrane peeling might affect the postoperative visual function.
Topics: Aged; Basement Membrane; Female; Humans; Macula Lutea; Male; Microvascular Density; Postoperative Period; Retinal Perforations; Retinal Vessels; Retrospective Studies; Surgical Flaps; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 32568985
DOI: 10.1097/IAE.0000000000002839 -
Ophthalmologica. Journal International... 2022The purpose of this study was to report the closure of macular hole without surgery in 7 cases using medical therapies.
PURPOSE
The purpose of this study was to report the closure of macular hole without surgery in 7 cases using medical therapies.
METHODS
The retrospective review of 7 cases of full-thickness macular holes, which closed after medical therapy without surgery.
RESULTS
Seven eyes of 7 patients developed full-thickness macular holes, which initially closed on medical therapy without surgery. Six patients were kept on maintenance therapy; 1 recurred and 5 did not develop recurrence. One patient was taken off of maintenance therapy and later developed recurrent macular hole requiring macular hole surgery.
CONCLUSIONS
Medical therapy to decrease macular edema may facilitate macular hole closure and should be considered, especially for small macular holes with significant edema. Reopening of macular holes may occur after stopping topical maintenance therapy for macular edema, which occurred at 10 weeks and 9 months after maintenance therapy was discontinued or markedly tapered.
Topics: Humans; Macular Edema; Retinal Perforations; Retrospective Studies; Vitrectomy
PubMed: 34182564
DOI: 10.1159/000516018 -
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 -
Canadian Journal of Ophthalmology.... Jun 2024This study investigates the association between preoperative intraretinal fluid (IRF) area and preoperative and postoperative best-corrected visual acuity (BCVA) in...
OBJECTIVE
This study investigates the association between preoperative intraretinal fluid (IRF) area and preoperative and postoperative best-corrected visual acuity (BCVA) in surgically repaired idiopathic macular holes (MH). This study further evaluates other prognostic indices related to MH repair that may assist clinicians' understanding of MH operative management.
DESIGN
Retrospective cohort study conducted at a single institution.
PARTICIPANTS
A total of 251 patients who underwent surgery for idiopathic MH between January 2012 and January 2021.
METHODS
Segmentation was performed on ocular coherence tomography scans of 251 eyes with MH and IRF. Associations between IRF area and preoperative and postoperative BCVA at 1, 3, and 6 months, preoperative and postoperative central subfield thickness, MH diameter, staging, closure status, and type of closure were evaluated using Spearman's correlation analysis.
RESULTS
Preoperative IRF area was moderately correlated with preoperative BCVA (r = -0.32; p < 0.001) and negligibly correlated with postoperative BCVA at 1, 3, and 6 months (r = -0.14, p = 0.026; r = -0.21, p < 0.001; and r = -0.19, p < 0.001, respectively). Preoperative IRF area was strongly correlated with MH minimum linear diameter (r = 0.56; p < 0.001) and MH base diameter (r = 0.65; p < 0.001). Other associations were not statistically significant.
CONCLUSION
Preoperative IRF area in patients with idiopathic MH demonstrated a moderate correlation with preoperative BCVA and a negligible or weak correlation with postoperative BCVA at up to 6 months, suggesting that vision may not have a clinically significant relationship with IRF in the setting of MH.
Topics: Humans; Visual Acuity; Retrospective Studies; Retinal Perforations; Tomography, Optical Coherence; Male; Female; Subretinal Fluid; Aged; Vitrectomy; Middle Aged; Follow-Up Studies; Postoperative Period
PubMed: 37321556
DOI: 10.1016/j.jcjo.2023.05.006 -
Retina (Philadelphia, Pa.) Apr 2023To compare the effects of macular intraretinal hemorrhage (IRH) and macular hole (MH) on best-corrected visual acuity (BCVA) after displacement of submacular hemorrhage...
PURPOSE
To compare the effects of macular intraretinal hemorrhage (IRH) and macular hole (MH) on best-corrected visual acuity (BCVA) after displacement of submacular hemorrhage (SMH) due to retinal arterial macroaneurysm (RAM) rupture.
METHODS
This multicenter retrospective study included 48 eyes with SMH due to RAM rupture. Cases underwent vitrectomy to displace SMH and were followed up for 6 months. We classified cases according to the presence of IRH and MH and compared the postoperative BCVA among the groups.
RESULTS
We classified the eyes into IRH(+)MH(+) group (10 eyes), IRH(+)MH(-) group (23 eyes), and IRH(-)MH(-) group (15 eyes). The postoperative BCVA was significantly worse in the IRH(+)MH(+) and IRH(+)MH(-) groups than in the IRH(-)MH(-) group (0.91 ± 0.41 in logarithm of the minimal angle of resolution units, Snellen equivalent 20/163, 0.87 ± 0.45, 20/148, and 0.18 ± 0.21, 20/30, respectively; P < 0.001). The postoperative central retinal thickness was significantly lower in the IRH(+) group (IRH(+)MH(+) and IRH(+)MH(-) groups combined) than in the IRH(-) group (IRH(-)MH(-) group) (121.4 ± 70.1 µ m and 174.3 ± 32.9 µ m, respectively, P = 0.008). The postoperative external limiting membrane and ellipsoid zone continuities were significantly discontinuous in the IRH(+) group ( P < 0.001, P = 0.001, respectively). The multiple linear regression analysis showed that both IRH(+)MH(+) and IRH(+)MH(-) were associated with the postoperative BCVA (regression coefficient, 0.799 and 0.711, respectively; P < 0.001 for both).
CONCLUSION
Both IRH and MH were poor prognostic indicators in cases with SMH due to RAM rupture.
Topics: Humans; Retinal Perforations; Retrospective Studies; Retinal Arterial Macroaneurysm; Retinal Hemorrhage; Prognosis; Vitrectomy; Tomography, Optical Coherence
PubMed: 36735920
DOI: 10.1097/IAE.0000000000003725 -
Journal Francais D'ophtalmologie Jun 2023
Topics: Humans; Retinal Perforations; Retina; Choroid Diseases; Choroidal Effusions; Retinal Detachment
PubMed: 37088631
DOI: 10.1016/j.jfo.2022.12.008 -
International Ophthalmology Apr 2022To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH).
PURPOSE
To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH).
METHODS
A retrospective review of patients with diagnosis of IMH from July 2016 to January 2020 at Peking Union Medical College Hospital. These patients were managed strictly according to our therapeutic strategy. Their comprehensive clinical data were collected and analyzed.
RESULTS
209 eyes suffering stage II to IV IMH were identified. For stage II IMH, the spontaneous closure rate was 8.9%, the initial success rate of intravitreal injections (IVI) of expansile gas and pars plana vitrectomy (PPV) + internal limiting membrane peeling (ILMP) + air tamponade was 84.2% and 100%, respectively. The initial success rate of PPV + ILMP + air tamponade for stage III and stage IV IMH was 89.8% and 86.4%, respectively. Following our intervention strategy, stage II IMH achieved a final IMH closure rate of 100%, stage III of 99% and stage IV of 97%. The final best corrected visual acuity was significantly improved (P < 0.05). Sitting position air-fluid (A-F) exchange alone successfully induced IMH closure in 7/19 eyes that did not achieve IMH closure by initial PPV. For three refractory cases that failed additional PPV + ILM stuffing, intraoperative OCT assisted PPV + sub-retinal BSS injection successfully induced the IMH closure. As the remaining three unclosed IMH cases were dry and stable, no more interventions were conducted.
CONCLUSION
The general IMH closure rate based on our therapeutic strategy was satisfactory with a favorable prognosis. IVI expansile gas and sitting position A-F exchange were effective and highly cost-effective under certain circumstances.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retina; Retinal Perforations; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 34743256
DOI: 10.1007/s10792-021-02099-z -
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 -
Nepalese Journal of Ophthalmology : a... Jan 2020Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better...
BACKGROUND
Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better assessment than the Snellen visual acuity alone.
OBJECTIVES
To evaluate macular function with mfERG and microperimetry, and assess their correlation with visual acuity in MH.
MATERIALS AND METHODS
A prospective study was done in patients with unilateral,idiopathic full thickness MH. Standard surgery with vitrectomy, internal limiting membrane peeling and gas tamponade was done. Snellen and logMAR visual acuity, mfERG, microperimetry and optical coherence tomography were done pre and postoperatively.
RESULTS
Twenty six patients with unilateral macular hole and twenty five age matched controls were included. The mean age of patients was 59.92±9.39 years (range: 40 to 74 years). All the holes were closed after surgery (two required second surgery). The mean visual acuity improved from 0.77±0.34 logMAR to 0.43±0.36 (p =0.03). The mfERG amplitudes differed ring wise, but the average amplitude changed from 26.31±8.82 to 20.52±7.11 (p =0.03). The mean retinal sensitivity changed from 12.98±2.59 to 13.42±2.53 (p =0.11). There was significant correlation between visual acuity and mfERG amplitudes and retinal sensitivity. Regression equations to predict visual outcome could be derived.
CONCLUSIONS
In MH, mfERG and microperimetry show reduced responses, delay in recovery of function. They show a strong correlation with visual acuity. It is possible to predict vision after surgery with the help of mfERG and MP. Improved ability to predict visual outcome can increase the utility of anatomic success predictors.
Topics: Adult; Aged; Electroretinography; Humans; Middle Aged; Prospective Studies; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity; Visual Field Tests; Vitrectomy
PubMed: 32799234
DOI: 10.3126/nepjoph.v12i1.25759 -
Asia-Pacific Journal of Ophthalmology... Sep 2021
Topics: Animals; Humans; Jaw; Retinal Perforations; Sharks
PubMed: 34524138
DOI: 10.1097/APO.0000000000000412