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Ophthalmic Surgery, Lasers & Imaging... Jun 2022To characterize the influence of race, ethnicity, and socioeconomic factors on idiopathic macular hole (IMH) presentation and surgical outcomes.
BACKGROUND AND OBJECTIVE
To characterize the influence of race, ethnicity, and socioeconomic factors on idiopathic macular hole (IMH) presentation and surgical outcomes.
PATIENTS AND METHODS
This retrospective cohort study of patients diagnosed with IMH who underwent surgical repair collected IMH data from optical coherence tomography scans as well as demographic information. Univariate and multivariate regression models interrogated relevant relationships.
RESULTS
Of 292 eyes analyzed, 223 (76.4%) patients were White and 53 (18.2%) were Black. Mean income was $57,076.9 ± 17,794.7. Black patients presented with 0.05 mm larger IMH area (95% CI, 0.01 to 0.09; = .01) and 69.07 µm wider minimum linear diameter (95% CI, 15.05 to 123.10; = .01). Patients with higher income presented with 3.76 µm narrower base diameter (95% CI, -6.42 to -1.09; = .006).
CONCLUSIONS
Black patients were associated with larger IMH at presentation, and higher income patients were associated with smaller IMH. .
Topics: Ethnicity; Humans; Retinal Perforations; Retrospective Studies; Socioeconomic Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 35724368
DOI: 10.3928/23258160-20220602-01 -
Current Eye Research Jun 2020: To assess the efficacy and safety of idiopathic macular hole (MH) surgery in elderly patients (≥ 80 years of age).: Prospective study enrolled consecutive patients...
: To assess the efficacy and safety of idiopathic macular hole (MH) surgery in elderly patients (≥ 80 years of age).: Prospective study enrolled consecutive patients who underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling under retrobulbar anesthesia between February 2016 and May 2018. Twenty-eight eyes of 28 patients aged 80 years or older were classified into the elderly group, a matched group of 56 eyes from 56 younger patients as the control group. The main outcome measures included best-corrected visual acuity (BCVA) and intraoperative and postoperative complications.: Statistically, there was no significant difference in visual acuity improvement and incidences of complications between the elderly group and the control group ( = .784 and = .712, respectively). No operation in either group was postponed or canceled due to complications associated with retrobulbar anesthesia, or physical discomfort before and during the operation. Moreover, no case suffered from myocardial infarction, stroke or death during the perioperative period. Except for one case of retinal detachment postoperatively in the control group, no case required a secondary surgery. All complications were successfully resolved or managed.: The results from our study indicate the efficacy and safety of vitrectomy for idiopathic macular hole in patients aged 80 years or older, and idiopathic MH surgery should not be denied on basis of patient age alone.
Topics: Aged; Aged, 80 and over; Basement Membrane; Female; Frail Elderly; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Prospective Studies; Retinal Perforations; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 31747306
DOI: 10.1080/02713683.2019.1695842 -
Graefe's Archive For Clinical and... Jan 2023To observe the characteristics of highly myopic macular holes (HMMHs) with macular retinoschisis (MRS) by optical coherence tomography (OCT) and explore the possible...
PURPOSE
To observe the characteristics of highly myopic macular holes (HMMHs) with macular retinoschisis (MRS) by optical coherence tomography (OCT) and explore the possible relationship between HMMHs and different types of MRS.
METHODS
We consecutively reviewed the clinical data and OCT images of the patients with HMMHs from June 2015 to February 2021. Then we picked eyes with MRS from these HMMHs for analysis. The minimum linear diameter (MLD), basal diameter (BD), and height (H) of HMMHs were measured. HMMHs were grouped according to the extent or layer involvement of the concomitant MRS and the characteristics were compared among groups. The impact of MRS on the MLD of macular hole was analyzed with multivariable linear regression.
RESULTS
We included 127 patients with MRS from 168 HMMHs (75.5%) for analysis. According to the different classification systems, the most frequent type of MRS in HMMHs was S3 (foveal but not entire macular area MRS) (62.2%) and both inner- and outer- (I/O-MRS) involved types. In our study, HMMHs with more extensive MRS had larger MLD, larger BD, larger H, and poorer best-corrected visual acuity (BCVA). Meanwhile, HMMHs with outer layer-involved MRS (outer MRS and I/O-MRS) had larger BD than HMMH with only inner layer-involved MRS. (All P < 0.05) Multivariable linear regression further illustrated only the extent of MRS was significantly associated with the MLD of HMMH, while there was no significant correlation between the involved retinal layers and the MLD of HMMH.
CONCLUSION
HMMH with MRS presented as a predominant type in HMMHs. The MRS was always with a relatively large extent and involved both inner and outer layers. MLD of HMMH was mainly affected by the extent of MRS.
Topics: Humans; Retinoschisis; Retinal Perforations; Myopia, Degenerative; Visual Acuity; Retrospective Studies; Tomography, Optical Coherence; Macular Degeneration
PubMed: 35867147
DOI: 10.1007/s00417-022-05766-8 -
International Ophthalmology Mar 2021Pars plana vitrectomy is the gold standard for the treatment of idiopathic macular hole. Several chromovitrectomy dyes have been used to improve the visualization of the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Pars plana vitrectomy is the gold standard for the treatment of idiopathic macular hole. Several chromovitrectomy dyes have been used to improve the visualization of the internal limiting membrane (ILM), including indocyanine green, trypan blue (TB), brilliant blue G (BBG), and triamcinolone acetonide (TA). We conducted a network meta-analysis (NMA) to establish the optimum concentration of chromovitrectomy dye-assisted ILM peeling for IMH.
METHODS
We searched PubMed, Embase, and Cochrane Library for relevant studies before January 2020. We performed a random-effects NMA using STATA version 15.1 to assess mean difference and odds ratios with 95% confidence intervals.
RESULTS
We identified twelve retrospective trails and five randomized controlled trials (RCTs), comprising 1 492 patients of IMH on stage II-IV for ILM peeling. The results of IMH closure rate show that the effect of ILM peeling without dye was better than 0.25% ICG, the effects of ILM peeling with 0.5% ICG or TA were better than without dye, and the effects of ILM peeling with 0.05% BBG, 0.15% TB, 0.5% ICG or 0.05% ICG were better than 0.25% ICG. Ranking probability analysis shows that the rates of IMH closure after ILM peeling with 0.15% TB or 0.05% BBG were better than nine other concentrations of chromovitrectomy dyes.
CONCLUSION
The 0.15% TB and 0.05% BBG were recommended as the better efficient treatment-assisted ILM peeling for IMH closure. For retina specialists who prefer to use ICG to assist ILM peeling, 0.05% ICG may be a good choice. However, high-quality large-scale RCTs are recommended to confirm the NMA results.
Topics: Basement Membrane; Coloring Agents; Epiretinal Membrane; Humans; Indocyanine Green; Network Meta-Analysis; Retina; Retinal Perforations; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 33392941
DOI: 10.1007/s10792-020-01656-2 -
Ophthalmology. Retina Dec 2022To identify the risk factors associated with myopic macular neovascularization (mMNV)-related complications in patients treated with intravitreal anti-VEGF agents.
PURPOSE
To identify the risk factors associated with myopic macular neovascularization (mMNV)-related complications in patients treated with intravitreal anti-VEGF agents.
DESIGN
Longitudinal cohort study.
PARTICIPANTS
Myopic eyes (n = 313) with active mMNV and median (interquartile range) follow-up of 42 months (interquartile range, 18-68 months) after initiation of anti-VEGF treatment.
METHODS
Data regarding patients' clinical and mMNV-related characteristics were collected at baseline. Subsequent OCT scans were inspected for mMNV-related complications. Best-measured visual acuity (BMVA) values were retrieved from each visit.
MAIN OUTCOME MEASURES
Incidence rate and hazard ratio (HR, with 95% confidence interval [CI]) of risk factors for fibrosis and macular atrophy calculated with Kaplan-Meier curves and Cox regression models. Crude incidence of macular hole (MH). Longitudinal BMVA changes.
RESULTS
Five-year incidence of fibrosis, atrophy, and MH were 34%, 26%, and 8%, respectively. The rate of fibrosis was 10.3 (95% CI, 8.25-12.6) per 100 person-years. Risk factors were subfoveal mMNV location (HR [95% CI] = 12.7 [2.70-56.7] vs. extrafoveal, P = 0.001) and intraretinal fluid at baseline (HR [95% CI] = 1.75 [1.05-2.98], P = 0.03). The rate of macular atrophy was 6.5 (95% CI, 5-8.3) per 100 person-years. Risk factors were diffuse (HR, 2.20 vs. tessellated fundus; 95% CI, 1.13-5.45; P = 0.02) or patchy chorioretinal atrophy (HR, 3.17 vs. tessellated fundus; 95% CI, 1.32-7.64; P = 0.01) at baseline and more numerous anti-VEGF injections before baseline (HR, 1.21; 95% CI, 1.06-1.38 for each treatment; P = 0.005). Eyes with fibrosis and macular atrophy had faster BMVA decay over follow-up. Twenty eyes (6%) developed MH. Two subtypes of MH were identified: "atrophic" and "tractional."
CONCLUSIONS
Myopic MNV-related complications are common in the long term despite initially successful treatment and have detrimental effects on visual acuity. Insights into their incidence and risk factors may help for future treatments to mitigate sight-threatening outcomes.
Topics: Humans; Incidence; Retinal Perforations; Longitudinal Studies; Retrospective Studies; Macular Degeneration; Myopia, Degenerative; Angiogenesis Inhibitors; Risk Factors; Fibrosis; Atrophy
PubMed: 35772693
DOI: 10.1016/j.oret.2022.06.009 -
Japanese Journal of Ophthalmology Nov 2022To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and...
PURPOSE
To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and without Brilliant Blue G (BBG) staining.
STUDY DESIGN
Retrospective, consecutive case series.
METHODS
A total of 49 eyes of 47 patients were enrolled: 23 eyes of 23 patients with MH who underwent ILM peeling without dyes (control group) and 26 eyes of 26 patients who underwent BBG staining (BBG group). The lengths of defects of the photoreceptor ellipsoid zone (EZ), external limiting membrane (ELM), and interdigitation zone (IZ) were measured.
RESULTS
The rate of MH closure after initial surgery was 95.6% (22/23 eyes) for the control group versus 100% (26/26 eyes) for the BBG group. In the 48 eyes with MH closure, the recovery rate of ELM deficiency and change in IZ deficiency showed no difference between the groups. The changes in EZ deficiency at 1 and 12 months were greater in the BBG group than in the control group. (P = 0.047 and 0.031). Visual acuity was better in the BBG group than in the control group during 12 months postoperatively (P < 0.001-0.038).
CONCLUSION
Eyes undergoing BBG-assisted MH surgery achieved faster recovery of the outer retinal structures and greater visual improvement than those of eyes without BBG.
Topics: Humans; Retinal Perforations; Vitrectomy; Retrospective Studies; Rosaniline Dyes; Basement Membrane; Tomography, Optical Coherence
PubMed: 36181645
DOI: 10.1007/s10384-022-00942-z -
BMC Ophthalmology Jun 2023The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH...
BACKGROUND
The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion.
METHODS
This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively.
RESULTS
For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group.
CONCLUSION
For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.
Topics: Humans; Retinal Perforations; Retrospective Studies; Fovea Centralis; Postoperative Period; Recovery of Function
PubMed: 37316769
DOI: 10.1186/s12886-023-03006-z -
Retina (Philadelphia, Pa.) Nov 2023To present representative cases of the most common complications associated with an autologous retinal transplant (ART) for macular hole repair. (Review)
Review
PURPOSE
To present representative cases of the most common complications associated with an autologous retinal transplant (ART) for macular hole repair.
METHODS
A retrospective, consecutive case series on patients who underwent an ART by a single provider (Tamer H. Mahmoud).
RESULTS
Four cases were included in this review. Each suffered an ART-specific complication, including graft displacement and dislocation, sub-ART perfluoron, and a delayed proliferative vitreoretinopathy-associated retinal detachment.
CONCLUSION
Because more surgeons use ART to treat atypical macular holes, an adequate understanding of surgery-specific complications and techniques to treat those complications is increasingly necessary.
Topics: Humans; Retrospective Studies; Vitrectomy; Visual Acuity; Retina; Retinal Detachment; Retinal Perforations; Postoperative Complications
PubMed: 34723900
DOI: 10.1097/IAE.0000000000003329 -
Canadian Journal of Ophthalmology.... Aug 2022
Topics: Anemia, Sickle Cell; Diabetic Retinopathy; Humans; Retinal Detachment; Retinal Diseases; Retinal Perforations; Vitrectomy
PubMed: 34560049
DOI: 10.1016/j.jcjo.2021.08.015 -
Scientific Reports May 2024To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This...
To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI - 0.661 to - 0.126), duration of RRD (p = 0.021, CI - 0.576 to - 0.048) and presence of PVR (p = 0.001, CI - 0.131 to - 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.
Topics: Humans; Tomography, Optical Coherence; Retinal Perforations; Retinal Detachment; Female; Male; Middle Aged; Visual Acuity; Aged; Retrospective Studies
PubMed: 38797771
DOI: 10.1038/s41598-024-61899-2