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Eye (London, England) Aug 2021A variety of treatment strategies have been proposed for macular holes that persist or recur after surgery, and the debate about the best re-treatment approach is...
BACKGROUND
A variety of treatment strategies have been proposed for macular holes that persist or recur after surgery, and the debate about the best re-treatment approach is ongoing. To allow for a comparison with alternative surgical therapies, we assessed the anatomical and functional outcome of a temporary tamponade with conventional silicone oil in persistent or recurrent full-thickness macular holes.
METHODS
We retrospectively investigated consecutive patients with full-thickness macular holes that persisted or recurred following vitrectomy with internal limiting membrane peeling and gas tamponade. All patients received re-treatment by temporary tamponade of silicone oil and were allowed free postoperative positioning. Anatomical closure rate was assessed by optical coherence tomography, and change of best-corrected visual acuity (BCVA) was analyzed.
RESULTS
A total of 33 eyes of 33 consecutive patients were included. Macular hole closure following silicone oil tamponade was achieved in 30 of 33 eyes (90.9%). Median BCVA improved from 1.00 logMAR (interquartile range, 0.60-1.00) to 0.65 logMAR (0.49-1.00; p = 0.010) after silicone oil removal. In patients with macular hole closure, 61.3% exhibited functional improvement with median BCVA changing from 1.00 logMAR (0.70-1.00) to 0.60 logMAR (0.49-1.00; p = 0.0005). Mean minimal linear diameter of macular holes before primary surgery was 391.0 µm (±137.8; range 133-630), and 48.5% of macular holes were >400 µm in diameter.
CONCLUSIONS
Treatment of persistent or recurrent full-thickness macular holes by temporary conventional silicone oil tamponade without postoperative positioning results in a high closure rate and a significant mean improvement of visual acuity.
Topics: Humans; Retinal Perforations; Retrospective Studies; Silicone Oils; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 33087884
DOI: 10.1038/s41433-020-01228-9 -
Genes Oct 2022Retinal detachment (RD) is one of the most common, sight-threatening ocular conditions requiring emergency intervention. Posterior vitreous detachment (PVD) occurs in... (Review)
Review
Retinal detachment (RD) is one of the most common, sight-threatening ocular conditions requiring emergency intervention. Posterior vitreous detachment (PVD) occurs in the majority of an aging population whereby the vitreous body separates from the retina. It is well established that PVD is the common precursor to the most common forms of RD; however, it remains unknown why in most individuals PVD will cause no/few complications (physiological PVD) but in a small percentage will cause retinal tears and detachment (pathological PVD). Despite over 100 years of scientific research, the anatomical definitions of PVD and its pathogenesis remain controversial. Recent research has identified a novel cell population (laminocyte), present at significantly higher numbers in pathological PVD when compared to physiological PVD. We review and summarise the seven distinct clinical sub-groups of retinal breaks and focus on the role of the laminocyte in those secondary to PVD and the transcriptomic profile of this unique cell. Provisional whole transcriptome analysis using bulk RNA-Seq shows marked differentially expressed genes when comparing physiological PVD with PVD associated with RD. The limitations of bulk RNA-Seq are considered and the potential to address these using spatial transcriptomics are discussed. Understanding the pathogenesis of PVD-related retinal tears will provide a baseline for the development of novel therapeutic targets and prophylactic treatments.
Topics: Humans; Aged; Retinal Detachment; Retinal Perforations; Transcriptome; Pathology, Molecular; Vitreous Detachment
PubMed: 36292771
DOI: 10.3390/genes13101885 -
Investigative Ophthalmology & Visual... Apr 2020To determine the prevalence of a central hyperreflective line in eyes with full-thickness macular holes (FTMH) and lamellar macular holes (LMH) and to elucidate the... (Comparative Study)
Comparative Study
PURPOSE
To determine the prevalence of a central hyperreflective line in eyes with full-thickness macular holes (FTMH) and lamellar macular holes (LMH) and to elucidate the pathoanatomic importance of this optical coherence tomography (OCT) sign.
METHODS
This retrospective analysis evaluated patients with FTMH and LMH at the Stein Eye Institute. Clinical data was collected and SD-OCT volume scans were analyzed for the presence of a central vertical hyperreflective line in 3 separate cohorts: patients with SD-OCT preceding FTMH development, patients with SD-OCT after pars plana vitrectomy (PPVT) treatment for FTMH, and patients with SD-OCT of LMH.
RESULTS
In total, 93 eyes with FTMH and 88 eyes with LMH were identified. Of the 93 FTMH eyes, SD-OCT volume scans were available before development of the FTMH in 12 eyes. Of these, 6 (50%) displayed a vertical hyperreflective line preceding the development of the FTMH. Fifty-one eyes underwent PPVT with resolution of the FTMH, and 26 displayed a hyperreflective line after resolution (51%). Of the 88 eyes with LMH, 22 displayed a hyperreflective line (25%). All hyperreflective lines were noted at the central fovea.
CONCLUSIONS
SD-OCT illustrated the presence of a central vertical hyperreflective line preceding FTMH and after resolution of FTMH after PPVT in approximately one-half of cases, and concurrent with LMH in 25% of cases. This vertical hyperreflective line may represent an early SD-OCT marker for the development of FTMH, and may be a sign of central foveal dehiscence owing to disruption of the Muller cell cone.
Topics: Aged; Aged, 80 and over; Cohort Studies; Epiretinal Membrane; Female; Fovea Centralis; Humans; Male; Prognosis; Retinal Perforations; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 32347919
DOI: 10.1167/iovs.61.4.50 -
Eye (London, England) Nov 2021To determine the demographic profile, clinical features and surgical outcomes of giant retinal tear (GRT) related retinal detachments (RD) in children.
OBJECTIVE
To determine the demographic profile, clinical features and surgical outcomes of giant retinal tear (GRT) related retinal detachments (RD) in children.
METHODS
In this retrospective study, medical records of children aged 14 years and below, who underwent surgery for RD at our centre in the last 5 years were reviewed. Among these, we selected medical records of children with RDs with GRT, and examined the coloured retinal drawings, ultrawidefield photographs and/or surgical videos.
RESULTS
Out of 1536 medical records, 91 eyes of 87 children (5.6% of all RDs) were included. Mean age was 10.21 ± 3.08 years with male:female ratio of 8.6:1. The most common aetiologies for GRTs were high myopia (28 cases-32.18%) and trauma (25 cases-28.73%). Bilateral RD were possibly present in 29/87 (33.3%) cases. Six months follow up data was available for 82/91 eyes. Overall retinal re-attachment was achieved in 52/82 (63.41%) eyes; in 33/82 (40.24%) eyes retinal attachment could be achieved by a single surgery. Absence of proliferative vitreoretinopathy (PVR) (OR: 2.44, p-value:0.03, 95%CI: 1.21-5.08) or PVR-A (OR: 3.62, p-value: 0.03, 95%CI: 1.52-12.26) and presence of preexisting posterior vitreous detachment (OR: 7.14, p-value: 0.02, 95%CI: 1.31-38.73) were associated with successful retinal re-attachment after single surgery. Median time to presentation of cases succeeding after 1 surgery was 10 days. Ambulatory vision (1/60 and better) at final followup could be achieved in 45/82 (54.88%) eyes.
CONCLUSION
GRT relatedRDs constitute a significant proportion of paediatric RDs. Anatomical success can currently be achieved in a large number of cases. Early surgery, absence of PVR and presence of PVD are associated with higher surgical success.
Topics: Adolescent; Child; Demography; Female; Humans; Male; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Treatment Outcome
PubMed: 34117398
DOI: 10.1038/s41433-021-01621-y -
PloS One 2021We evaluated the clinical utility of ultra-widefield imaging as an adjunctive tool for training resident ophthalmologists in the detection of retinal breaks. This was a...
We evaluated the clinical utility of ultra-widefield imaging as an adjunctive tool for training resident ophthalmologists in the detection of retinal breaks. This was a prospective study conducted at a secondary health care center (Tri-Service General Hospital) in Taiwan. Participants were 44 patients (53 eyes) who were referred to our hospital after being diagnosed with retinal breaks. Patients first underwent an indirect ophthalmoscopy examination of the total fundus without scleral depression by our junior (first and second year) or senior (third and fourth year) resident ophthalmologist and then underwent an ultra-widefield imaging examination with a central image and four gaze-steered (up, down, nasal, and temporal) images to determine the number of retinal breaks in the total fundus and the four quadrants. Of the total 53 eyes, 31 were examined by junior residents and 22 were examined by senior residents. In the group of junior residents, ultra-widefield imaging was significantly better at detecting retinal breaks of the total fundus (49 vs. 33 retinal breaks, p < 0.001) and the temporal quadrant (17 vs. 10 retinal breaks, p = 0.018) than indirect ophthalmoscopy. In the group of senior residents, there was no significant difference in the ability to detect retinal breaks in the total fundus or each of the four quadrants with ultra-widefield imaging or indirect ophthalmoscopy. Our results indicate that, compared to indirect ophthalmoscopy, ultra-widefield imaging with a central image and four gaze-steered images has a better performance and is a useful adjunct tool for the detection of retinal breaks in junior resident training. Additionally, it could be a useful method for teaching indirect ophthalmoscopy examination to junior residents.
Topics: Adult; Aged; Female; Humans; Internship and Residency; Male; Middle Aged; Ophthalmology; Ophthalmoscopy; Prospective Studies; Retina; Retinal Perforations
PubMed: 34161357
DOI: 10.1371/journal.pone.0253227 -
JAMA Ophthalmology Jul 2020The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and...
IMPORTANCE
The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and macular abnormalities are lacking to date.
OBJECTIVE
To assess the association between the use of 5-ARI for treatment of benign prostate hypertrophy and/or androgenic alopecia in men and macular abnormalities on optical coherence tomography imaging.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective case-control, cross-sectional study included electronic health record data from 31 male patients who showed foveal cavitation on spectral-domain optical coherence tomography imaging from January 1, 2016, to June 30, 2019.
EXPOSURES
Receipt of 5-ARI for at least 2 years as treatment of benign prostate hypertrophy and/or androgenic alopecia.
MAIN OUTCOMES AND MEASURES
Clinical data and multimodal imaging findings and the proportion of 5-ARI users.
RESULTS
Among 31 male patients with foveal cavitation, 5-ARI was used for 10 of 14 patients (71.4%) with macular abnormalities of unknown origin and for 2 of 17 patients (11.8%) with macular abnormalities of well-known specific origin (P = .001). The mean age of these 14 patients was 74.7 years (range, 60.1-88.0 years). In the 15 eyes of 10 patients who had received 5-ARI for macular abnormalities of unknown origin, mean (SD) age was 72.8 (7.5) years, mean (SD) length of time receiving 5-ARI was 72.3 (39.2) months, and mean (SD) logMAR visual acuity was 0.08 (0.10) (Snellen equivalents, 20/24 [20/25]). Optical coherence tomography imaging showed a disease spectrum ranging from tiny foveal cavitation to an impending macular hole. Of the total male patients, 80.0% (8 of 10) had no symptoms.
CONCLUSIONS AND RELEVANCE
The findings suggest that macular abnormalities associated with 5-ARI are characterized by cystoid abnormalities and foveal cavitation in male patients, which may progress to outer foveal defect and macular hole. These macular abnormalities associated with a male sex hormone antagonist suggested by this investigation warrant further corroboration.
Topics: 5-alpha Reductase Inhibitors; Aged; Aged, 80 and over; Case-Control Studies; Cross-Sectional Studies; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Macula Lutea; Male; Middle Aged; Prostatic Hyperplasia; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence
PubMed: 32379286
DOI: 10.1001/jamaophthalmol.2020.1279 -
Graefe's Archive For Clinical and... Oct 2022This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid...
Visual improvement and regeneration of retinal layers in eyes with small, medium, and large idiopathic full-thickness macular holes treated with the inverted internal limiting membrane flap technique over a period of 12 months.
PURPOSE
This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid zone (EZ) in small ([Formula: see text] 250 μm), medium ([Formula: see text] 250 μm), and large ([Formula: see text] 400 μm) full-thickness macular holes (FTMH) treated with inverted internal limiting membrane (I-ILM) flap technique over a follow-up period of 12 months.
METHODS
Ninety-one eyes of 87 patients were enrolled in this retrospective study. BCVA and spectral-domain optical coherence tomography (SD-OCT) were conducted preoperatively as well as after 1, 3, 6, 9, and 12 months postoperatively. The defect length of the ELM and the EZ was measured using the caliper tool at each follow-up time point.
RESULTS
BCVA improved significantly in the group of small, medium, and large FTMH over the time of 12 months, whereby the improvement did not depend on FTMH size over 9 months. Only after 12 months, large FTMH showed significantly higher BCVA improvement compared to small and medium FTMH. The closure rate was 100% (91/91). The defect length of ELM and EZ reduced continuously over the period of 12 months. There was a significant correlation between defect length of ELM and EZ with postoperative BCVA.
CONCLUSION
The I-ILM flap technique has very good morphological and functional outcomes in small, medium, and large FTMH over a long-time period, indicating that it can be considered as a treatment option in small and medium FTMH. The defect length of ELM and EZ is directly connected to postoperative BCVA.
Topics: Basement Membrane; Humans; Regeneration; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35475915
DOI: 10.1007/s00417-022-05676-9 -
Acta Ophthalmologica Sep 2022To analyse morpho-functional foveal changes in eyes with lamellar macular hole (LMH) by an integrated assessment of short-wavelength fundus autofluorescence (SW-FAF) and...
PURPOSE
To analyse morpho-functional foveal changes in eyes with lamellar macular hole (LMH) by an integrated assessment of short-wavelength fundus autofluorescence (SW-FAF) and microperimetry (SW-FAF/microperimetry integrated assessment) before and after treatment with a technique of double-inverted flaps of epiretinal proliferation (EP) and internal limiting membrane (ILM).
METHODS
Clinical and tomographic parameters were best-corrected visual acuity (BCVA), LMH size, central retinal thickness (CRT) and outer retinal layer integrity. SW-FAF/microperimetry integrated assessment allowed to analyse retinal sensitivity (RS) and FAF status of the fovea by an overlay of RS map on SW-FAF image. Follow-up was at baseline, 1, 3, 6 and 12 postoperative months.
RESULTS
Forty pseudophakic eyes. Hyper-FAF area was associated with larger LMH size (p = 0.0073) and inversely correlated with CRT (p = 0.021). Lower preoperative RS was observed in hyper-FAF than normo-FAF areas (p = 0.0117). External limiting membrane (ELM) defect was associated with worse BCVA (p = 0.0004). After surgery, BCVA improved (p = 0.001) and it was related to ELM recovery (p = 0.00483), hyper-FAF area decreased (p = 0.001), and RS increased (p = 0.440). Hyper-FAF points that normalized their FAF were associated with higher RS improvement compared to unchanged points.
CONCLUSION
Short-wavelength fundus autofluorescence/microperimetry integrated assessment provides important information on the entity of damage of LMH and on postoperative recovery. Double-inverted EP and ILM flap technique is safe and effective for LMH treatment.
Topics: Fovea Centralis; Humans; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 34897994
DOI: 10.1111/aos.15078 -
Indian Journal of Ophthalmology Oct 2020
Topics: Eye Injuries; Humans; Retinal Detachment; Retinal Perforations
PubMed: 32971658
DOI: 10.4103/ijo.IJO_36_20 -
Ophthalmic Surgery, Lasers & Imaging... Jan 2022This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm.
MATERIAL AND METHODS
PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 μm. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole.
RESULTS
Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of -0.48 ± 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of -0.15 ± 0.17 and -0.14 ± 0.91 logMAR, respectively.
CONCLUSION
An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap. .
Topics: Basement Membrane; Free Tissue Flaps; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 34982003
DOI: 10.3928/23258160-20211210-03