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Journal of Healthcare Engineering 2023To investigate anatomical and visual outcomes of macular hole (MH) after inverted internal limiting membrane (ILM) flap technique for idiopathic macular hole (IMH).
OBJECTIVE
To investigate anatomical and visual outcomes of macular hole (MH) after inverted internal limiting membrane (ILM) flap technique for idiopathic macular hole (IMH).
METHODS
A total of 13 IMH cases diagnosed in Shanxi Eye Hospital between January 2015 and June 2016 were included in the study. All patients underwent vitrectomy combined with indocyanine green-assisted inverted ILM flap technique. The MH closure rate, best-corrected visual acuity (BCVA), changes of ellipsoid zone (EZ), and external limiting membrane (ELM) were examined before operation and one, three, and six months after operation. Furthermore, 488 nm fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) were used to observe the dynamic changes in function of macular area after surgery.
RESULTS
One month after the surgery, the MH closure rate was 100% and the visual acuity (VA) was stable, with no recurrence. Additionally, the average logMAR BCVA before operation was 1.208 ± 0.158, and this value became 0.877 ± 0.105 one month after the operation, showing a significant decrease. Three months after surgery, the average logMAR BCVA was 0.792 ± 0.103, which was significantly lower than the level one month after the surgery but much higher than that six months after surgery (0.708 ± 0.131). Besides, the diameter of the EZ defect of the postoperative one month, three months, and six months was (1377.46 ± 198.65) m, (964.62 ± 336.26) m, and (817.08 ± 442.99) m, respectively. In postoperative one month, three months, and six months, the diameter of the ELM defect diameter was (969.62 ± 189.92) m, (649.92 ± 413.15) m, and (557.62 ± 412.50) m, respectively. The diameter of both EZ and ELM defects was significantly reduced with the passage of time after surgery.
CONCLUSION
Inverted ILM flap technique can reconstruct macular anatomical structure and improve VA. This technique is effective for the treatment of IMH with large MH minimum diameter and base diameter.
Topics: Humans; Retinal Perforations; Retrospective Studies; Retina; Visual Acuity; Surgical Flaps
PubMed: 36844949
DOI: 10.1155/2023/5816473 -
Disease Markers 2022We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical...
OBJECTIVE
We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA).
METHODS
This retrospective study included patients with idiopathic macular hole who were admitted to our hospital between 1st January 2019 and 31st October 2021. The control group was treated with internal limiting membrane tamponade, and the study group was treated with clamshell therapy. Treatment conditions (internal limiting membrane treatment duration and hole closure rate), best corrected visual acuity (BCVA) before and after surgery, OCTA measurements, and SD-OCT were assessed. The retinal nerve fiber layer (RNFL), retinal ganglion cell layer (GCL), and retinal pigment epithelium (RPE) thicknesses were also analyzed.
RESULTS
The treatment time and hole closure rate of the internal limiting membrane in the study group were higher than those in the control group. The curative effect of the study group was better than that of the control group. The postoperative DCP blood vessel density in both groups was higher than that before operation, and the study group was higher than the control group. The FAZ area and circumference were lower than those before surgery, and the study group was lower than the control group. At 3 months after operation, the thickness of DIOA, nasal temporal RNFL, and GCL were decreased in both groups, and the observed values in the study group were lower than those in the control group. At 3-month follow-up, there was no significant difference in RPE thickness between the two groups.
CONCLUSION
Flip and cover therapy is the most effective treatment. SD-OCT and OCTA provide an objective basis for clinical intervention by comparing the effects of different procedures on the retinal condition of patients.
Topics: Angiography; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35996716
DOI: 10.1155/2022/7749605 -
International Ophthalmology Apr 2021The development of degenerative lamellar macular holes (DLH) is largely unclear. This study was aimed at documenting with spectral-domain optical coherence tomography...
PURPOSE
The development of degenerative lamellar macular holes (DLH) is largely unclear. This study was aimed at documenting with spectral-domain optical coherence tomography the tractional development and morphological alterations of DLH.
METHODS
A retrospective case series of 44 eyes of 44 patients is described.
RESULTS
The development of DLH is preceded for months or years by tractional deformations of the fovea due to the action of contractile epiretinal membranes (ERM) and/or the partially detached posterior hyaloid, or by cystoid macular edema (CME). DLH may develop after a tractional stretching and thickening of the foveal center, from a foveal pseudocyst, after a detachment of the foveola from the retinal pigment epithelium, a disruption of the foveal structure due to CME, and after surgical treatment of tractional lamellar or full-thickness macular holes (FTMH). The foveal configuration of a DLH can be spontaneously reestablished after short transient episodes of CME and a small FTMH. A DLH can evolve to a FTMH by traction of an ERM. Surgical treatment of a DLH may result in an irregular regeneration of the foveal center without photoreceptors.
CONCLUSIONS
Tractional forces play an important role in the development of DLH and in the further evolution to FTMH. It is suggested that a DLH is the result of a retinal wound repair process after a tractional disruption of the Müller cell cone and a degeneration of Henle fibers, to prevent a further increase in the degenerative cavitations.
Topics: Epiretinal Membrane; Follow-Up Studies; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity
PubMed: 33433772
DOI: 10.1007/s10792-020-01674-0 -
Ophthalmologica. Journal International... 2023Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is...
INTRODUCTION
Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD.
METHODS
The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed.
RESULTS
A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break.
CONCLUSION
Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.
Topics: Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Retrospective Studies; Scleral Buckling; Visual Acuity; Vitrectomy; Infant, Newborn; Infant; Child, Preschool; Child; Adolescent; Adult; Aged; Aged, 80 and over
PubMed: 36282053
DOI: 10.1159/000527625 -
Ophthalmic Research 2023During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical...
INTRODUCTION
During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical significance of the photoreceptor outer segment disruption at the MH border remains unclear. This study aims to investigate the clinical features and surgical outcomes of MHs with photoreceptor outer segment disruption at the MH border.
METHODS
This study retrospectively reviewed 86 eyes from 85 patients who underwent vitrectomy combined with internal limiting membrane peeling for idiopathic MHs. Baseline and postoperative best-corrected visual acuity (BCVA) and foveal microstructure on optical coherence tomography images were compared between eyes with smooth and bumpy morphology, the latter of which was defined as those with an uneven and irregular surface with evident lumps and indentations at the MH border.
RESULTS
The bumpy morphology was identified in 59 of 86 eyes (68.9%). At baseline, eyes with a bumpy MH morphology had a significantly larger minimum linear diameter (p = 0.043), a longer external limiting membrane defect (p = 0.013), and a worse baseline BCVA (p = 0.017) than those with a smooth morphology. Postoperatively, in a multivariate regression model adjusting preoperative confounding effects, eyes with bumpy borders were associated with a longer ellipsoid zone defect (p = 0.006) and a thinner central fovea (p = 0.002) at 1 month, and a thinner central fovea (p = 0.005) and a worse BCVA (p = 0.015) at 10 months.
CONCLUSION
A severe photoreceptor outer segment loss is common at the MH border, which represents a chronic pathogenic process and may be an independent predictor for an incomplete photoreceptor recovery and worse long-term visual outcomes after surgery.
Topics: Humans; Retinal Perforations; Retrospective Studies; Prognosis; Fovea Centralis; Vitrectomy; Tomography, Optical Coherence
PubMed: 37926088
DOI: 10.1159/000534576 -
Eye (London, England) Jan 2021To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery.
OBJECTIVES
To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery.
DESIGN
Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma.
RESULTS
A higher proportion of operations were performed in eyes from females (71.1%) who were 'on average' younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD.
CONCLUSIONS
Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.
Topics: Basement Membrane; Female; Humans; Male; Prospective Studies; Retinal Perforations; Retrospective Studies; Treatment Outcome; United Kingdom; Visual Acuity; Vitrectomy
PubMed: 32231259
DOI: 10.1038/s41433-020-0844-x -
Medicine Nov 2022To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective...
To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective study included 25 patients diagnosed with IMH in Shanxi eye hospital from August 2019 to December 2021. The study was divided into 3 groups: IMH eyes, fellow eyes and normal eyes. All unilateral IMH eyes underwent vitrectomy. There were significant differences in superficial retinal blood flow density (SRBFD, P < .001) and choroidal blood flow density (CBFD) between IMH and healthy control eyes before operation (P < .05). There was significant difference in SRBFD between fellow eyes and normal eyes (P = .038). The changes of SRBFD and CBFD in IMH eyes before and after operation were statistically significant (P < .05). The CBFD at 6 months after operation is negatively correlated with LogMAR visual acuity, and the CBFD of the fellow eye is also negatively correlated with LogMAR visual acuity. The SRBFD and CBFD had no correlation with the diameter of macular hole before and after operation. SRBFD and CBFD increased after vitrectomy, indicating that the blood supply of retina and choroid were partially restored after vitrectomy. There was no correlation between SRBFD, CBFD and hole diameter, but there was correlation between choroidal blood flow and LogMAR visual acuity.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Prospective Studies; Angiography; Choroid
PubMed: 36451457
DOI: 10.1097/MD.0000000000031862 -
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 -
Retinal Cases & Brief Reports Mar 2022To evaluate the outcome of prolonged ozurdex-macular contact following vitrectomy for macular hole.
PURPOSE
To evaluate the outcome of prolonged ozurdex-macular contact following vitrectomy for macular hole.
METHODS AND PATIENTS
A 63-year-old woman with subtle vitreomacular traction and macula edema in the left eye underwent femto laser-assisted cataract surgery with lens implant and ozurdex injection. Postoperatively, patient developed macular hole for which she underwent vitrectomy.
RESULTS
The steroid implant that remained in contact with the fovea for 16 weeks disappeared on its own without causing any retinal toxicity, and the best-corrected visual acuity improved to 6/9.
CONCLUSION
Vitreomacular traction with edema may worsen after cataract surgery and ozurdex injection. Ophthalmologists should keep in mind this rare possible complication and make patients aware of the same.
Topics: Cataract Extraction; Dexamethasone; Female; Humans; Macular Edema; Middle Aged; Retinal Perforations; Treatment Outcome; Vitrectomy
PubMed: 31842045
DOI: 10.1097/ICB.0000000000000951 -
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