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German Medical Science : GMS E-journal 2022Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting... (Review)
Review
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 35813123
DOI: 10.3205/000309 -
Survey of Ophthalmology 1998A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Macular holes have been associated... (Review)
Review
A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Macular holes have been associated with myriad ocular conditions and originally were described in the setting of trauma. The pathogenesis of idiopathic, age-related macular holes remains unclear despite a litany of theories. Recently, Gass has described an updated biomicroscopic classification of macular holes and postulated that tangential vitreous traction may play a role. Cellular components surrounding the rim of macular holes may also contribute tangential traction forces and elevate the rim. Pseudomacular holes may be mistaken for macular hole lesions, despite careful clinical examination. Careful biomicroscopic examination with a contact lens and use of the Watzke and laser aiming beam tests help to ensure accurate diagnosis. Newer imaging technology, such as optical coherence tomography, helps distinguish true macular holes from pseudoholes and may provide additional insight into the pathogenesis of this condition. Surgical management with or without pharmacosurgical adjuncts can improve vision in select cases. The most common surgical complication is progressive lens opacification in phakic patients.
Topics: Aged; Aging; Diagnosis, Differential; Diagnostic Imaging; Humans; Macula Lutea; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 9548570
DOI: 10.1016/s0039-6257(97)00132-x -
Developments in Ophthalmology 2014Idiopathic macular hole is a disease that arises from adhesion in the vitreomacular interface and can theoretically be treated by vitrectomy surgery. Surgical techniques... (Review)
Review
Idiopathic macular hole is a disease that arises from adhesion in the vitreomacular interface and can theoretically be treated by vitrectomy surgery. Surgical techniques include removal of the vitreous with or without simultaneous peeling of the internal limiting membrane (ILM), fluid-air exchange, and gas tamponade. Since the advent of microincision vitrectomy surgery, macular hole surgery has been performed with minimal invasiveness, and significant visual improvement is a common outcome. This chapter describes the pathology of this disease, including presurgical evaluation using optical coherence tomography (OCT), and then shows the fundamental techniques required for the surgery. Also important is the understanding of the postsurgical 'healing' process of the disease, which may confirm the fact that the subjective improvement is closely related to the retinal imaging obtained by OCT. More recent advances are the inverted ILM peeling technique for larger macular holes and 27-gauge vitrectomy that can potentially minimize the surgical invasiveness mainly by smaller wound construction and the reduced volume of irrigation during surgery.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 25196764
DOI: 10.1159/000360461 -
Optometry Clinics : the Official... 1996Macular hole is a common cause of vision loss in older persons. Macular hole is formed by an actual hole through the neurosensory retina in the foveola area. The... (Review)
Review
Macular hole is a common cause of vision loss in older persons. Macular hole is formed by an actual hole through the neurosensory retina in the foveola area. The neurosensory retina adjacent to the hole is typically detached, which results in decreased central vision. Macular hole can be bilateral. Vitreous interactions with the posterior retinal surface are thought to be the essential cause of idiopathic macular hole formation. Until recently, no treatment was available for macular hole. Various surgical procedures are now being performed to repair macular hole and restore the neurosensory retina to its normal anatomical position. This paper presents the clinical characteristics of macular hole, reviews its incidence and its pathogenesis, and discusses the benefits and risks of surgical intervention in idiopathic macular hole formation.
Topics: Diagnosis, Differential; Humans; Incidence; Retinal Perforations
PubMed: 8963081
DOI: No ID Found -
Retinal Cases & Brief Reports May 2022To report the outcomes of topical difluprednate 0.05% use in the closure of full-thickness macular holes.
BACKGROUND AND OBJECTIVE
To report the outcomes of topical difluprednate 0.05% use in the closure of full-thickness macular holes.
PATIENTS AND METHODS
Retrospective chart review of 4 patients with full-thickness macular holes who received difluprednate drops 4 times daily for a minimum of 12 weeks. Main outcome measures were macular hole status assessed with optical coherence tomography, visual acuity, intraocular pressure, and complications of treatment.
RESULTS
All patients had macular hole closure within 12 weeks of difluprednate exposure. Mean time to macular hole closure was 5 weeks (range, 2-12 weeks). Visual acuity improved with macular hole closure. Average baseline visual acuity was 20/42. Average visual acuity after macular hole closure was 20/26 (P = 0.14). Two patients experienced increased intraocular pressure with topical steroid use.
CONCLUSION
Exposure to difluprednate in this cohort of patients with full-thickness macular holes was associated with reduced macular edema, macular hole closure, and visual improvement.
Topics: Humans; Macular Edema; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 32132390
DOI: 10.1097/ICB.0000000000000979 -
Ocular Immunology and Inflammation May 2022To present the success rate of nonsurgical management of full-thickness inflammatory macular hole (IMH). (Review)
Review
PURPOSE
To present the success rate of nonsurgical management of full-thickness inflammatory macular hole (IMH).
METHOD
Retrospective case series of five patients with IMH.
RESULT
Five eyes from five patients with IMH enrolled in the current case series. All five eyes had successful closure with corticosteroid in the form of topical, periocular, or intravitreal injections. Systemic immunomodulatory treatment was employed for two patients, in addition to local therapy. For local therapy, one patient received topical eye drops, subtenon injection of corticosteroid, and intravitreal injection of combination of corticosteroid and anti-VEGF was performed in two patients. The closed macular hole reopened in one patient after two years, which required pars plana vitrectomy and anatomical and visual success achieved.
CONCLUSION
Inflammatory macular holes can be closed with non-surgical interventions, although reopening may occur which requires surgery.
Topics: Humans; Reoperation; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 33826475
DOI: 10.1080/09273948.2020.1867871 -
European Journal of Ophthalmology Jan 2021To describe the clinical features and surgical outcomes of diabetic retinopathy-associated lamellar macular hole and compare them with those of idiopathic lamellar...
PURPOSE
To describe the clinical features and surgical outcomes of diabetic retinopathy-associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole.
METHODS
A total of 17 eyes with diabetic retinopathy-associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups.
RESULTS
Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy-associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both).
CONCLUSION
Compared with idiopathic group, diabetic retinopathy-associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.
Topics: Aged; Diabetic Retinopathy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 31595782
DOI: 10.1177/1120672119879665 -
International Ophthalmology Clinics 2014
Review
Topics: Humans; Patient Positioning; Prone Position; Retinal Perforations; Treatment Outcome; Vitrectomy
PubMed: 24613880
DOI: 10.1097/IIO.0000000000000015 -
Klinische Monatsblatter Fur... Aug 2019The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH...
The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH differs from that of the idiopathic macular hole (IMH). A sudden compression and expansion of the globe leads to vitreous traction, which can result in a TMH. The final visual acuity depends on the severity of the disruption of the photoreceptors and the retinal pigment epithelial cells. The posttraumatic approach is discussed controversially. A spontaneous closure and, therefore, a conservative approach should be considered in young patients with minor defects and good visual acuity without detachment of the posterior vitreous body. In these cases, it is advisable to wait for months. In the absence of adhesion at the edges of the hole and concomitant pathologies of the pigment epithelium, the spontaneous closure is improbable. In this case, a pars plana vitrectomy with removal of the vitreous and epiretinal membranes can lead to anatomical reconstruction and improvement of the visual acuity. The success of an operative intervention is complex and is associated with the experience of the surgeon as well as the characteristics of the trauma.
Topics: Epiretinal Membrane; Humans; Retinal Perforations; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 30005441
DOI: 10.1055/a-0608-4780 -
Seminars in Ophthalmology 2002Macular hole formation is a rare complication of cataract extraction. Although the exact etiology is unclear, macular holes can be classified into pre-existing holes... (Review)
Review
Macular hole formation is a rare complication of cataract extraction. Although the exact etiology is unclear, macular holes can be classified into pre-existing holes that may not have been visible prior to cataract surgery, early stage macular holes that progressed to a more advanced stage, symptomatic holes following cataract extraction, and de novo symptomatic macular holes. Antero-posterior (A-P) tractional forces as well as macular edema are thought to play a role in the pathogenesis of these macular holes. In the traction hypothesis, A-P forces are thought to induce either an acute detachment of the posterior cortical gel or significant traction of the vitreous gel around the fovea, resulting in formation, or rapid progression of, macular holes. In late reopening of macular holes after cataract extraction, subclinical macular edema and epiretinal membrane formation have been suggested as possible causes. Current treatment options, including combining cataract extraction with macular hole repair, are reviewed.
Topics: Cataract Extraction; Humans; Retinal Perforations; Risk Factors
PubMed: 12759850
DOI: 10.1076/soph.17.3.196.14775