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Journal of Vitreoretinal Diseases 2024To report a case of a macular pucker forming after macular hole (MH) repair with the inverted internal limiting membrane (ILM) flap technique, with resolution after...
To report a case of a macular pucker forming after macular hole (MH) repair with the inverted internal limiting membrane (ILM) flap technique, with resolution after secondary inverted ILM flap peeling. A single case was evaluated. A 76-year-old woman presented with reduced central vision (28 letters) in the right eye. Optical coherence tomography (OCT) identified an idiopathic full-thickness MH measuring 629 µm in diameter. The patient had pars plana vitrectomy with inverted ILM flap formation. One month postoperatively, the visual acuity (VA) in the right eye was 47 letters and OCT confirmed MH closure. However, the patient developed deterioration in the central vision 10 months postoperatively. A macular pucker in the inverted ILM flap region was found on OCT. Repeat vitrectomy with inverted ILM flap peeling was performed. Postoperatively, the VA in the right eye improved to 60 letters and OCT showed resolution of the macular pucker. A complication of the inverted ILM flap technique for MH is formation of a macular pucker in the region of the inverted ILM flap. Secondary inverted ILM flap peeling results in resolution of the macular pucker.
PubMed: 38770081
DOI: 10.1177/24741264241240330 -
Journal of Vitreoretinal Diseases 2024To characterize the visual outcomes and rate of macular hole (MH) closure with tractional retinal detachment (TRD) and proliferative diabetic retinopathy (PDR). Visit...
To characterize the visual outcomes and rate of macular hole (MH) closure with tractional retinal detachment (TRD) and proliferative diabetic retinopathy (PDR). Visit data of patients who had pars plana vitrectomy were retrospectively reviewed; patient demographics, other procedure(s), the MH closure rate, and visual outcomes were also collected. Paired , Fisher exact, and Mann-Whitney tests were performed. Ten patients (10 eyes) developed a TRD MH; 3 distinct MH presentations were identified. At the 3-month follow-up, 90% of MHs remained closed without the need for further reoperation (n = 6, type 1 closure; n = 3, type 2 closure). All MHs were closed 12 months after the initial surgery, with 1 eye requiring a single reoperation. The mean visual acuity (VA) at baseline and at 12 months was 20/235 and 20/138, respectively. MHs in the setting of fibrovascular proliferation resulting from PDR present with varied morphology. There is a high rate of MH closure and a trend toward improved VA.
PubMed: 38770075
DOI: 10.1177/24741264241239753 -
Journal of Vitreoretinal Diseases 2024To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). This series evaluated 3 cases of a persistent FTMH after pars...
To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.
PubMed: 38770064
DOI: 10.1177/24741264241238910 -
Archivos de La Sociedad Espanola de... May 2024To study the clinical characteristics of macular diplopia, treatment, and outcome.
OBJECTIVE
To study the clinical characteristics of macular diplopia, treatment, and outcome.
METHODS
Retrospective descriptive study of cases referred to the ocular motility section of a tertiary hospital with diplopia, diagnosed with macular diplopia between 2022-23. The etiology of the macular pathology and the type of associated strabismus were recorded. The result was considered good if the diplopia improved or was eliminated with the medical or surgical treatment. Follow-up time from the onset of diplopia until data collection was recorded.
RESULTS
a total of 19 cases comprised the sample (63.2% women), mean age: 67.16 years. Amblyopia (21.1%), high myopia (47.4%), epirretinal membrane (ERM) (36.8%), neovascular membrane (26.3%), macular hole (10.5%), and lamellar (15.8%), and age macular degeneration (5.3%) were registered. The 47.4% had vertical diplopia, horizontal: 5.3 and 47.4% mixed. The mean horizontal deviation was: 7.3 PD (prism diopters) and vertical: 6.22 PD. Ocular extorsion was observed in 26.3%, and intorsion: 5.3%. Torticollis was present in 15.8%. The treatment consisted of strabismus surgery + Botox (15.8%), strabismus surgery (47.4%), medical treatment with Fresnel prims or Scotch cellophane (36.8%). A 68.4% presented a good result at the end of the study. The mean follow-up was 55.58 months.
CONCLUSIONS
Misregistration of macular photoreceptors is the most common cause of binocular diplopia in patients with ERM or other macular pathologies. Most complains of vertical or mixed diplopia. Sensorimotor evaluation of these patients should be thorough. Early diagnosis prevents unnecessary prescription of prism glasses. Surgical and/or medical treatment achieves good results in most cases.
PubMed: 38768851
DOI: 10.1016/j.oftale.2024.05.003 -
Ophthalmic Surgery, Lasers & Imaging... May 2024
RWC Update: Different Surgical Techniques for Macular Hole Associated With Retinal Detachment; Diabetic Macular Edema - How Do You Treat Patients With Good Visual Acuity?; Benign Familial Fleck Retina.
Topics: Humans; Diabetic Retinopathy; Macular Edema; Retinal Detachment; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 38752801
DOI: 10.3928/23258160-20240425-01 -
Vestnik Oftalmologii 2024This article studies the relationship between structural changes according to the findings of optical coherence tomography (OCT) and OCT angiography (OCTA),...
PURPOSE
This article studies the relationship between structural changes according to the findings of optical coherence tomography (OCT) and OCT angiography (OCTA), microperimetry (MP), multifocal electroretinography (mfERG) parameters in topographically corresponding areas of the macular region in idiopathic full-thickness macular holes (FTMH).
MATERIAL AND METHODS
OCT, OCTA, MP and mfERG were performed in 14 eyes with FTMH stages I-IV according to Gass. In 13 points at a distance of 0-2.5°, 2.5-5.0°, and 5.0-10.0° from the fixation point, the light sensitivity (LS), amplitude and latency of the P1 component were compared with the size of the hole, the area of cystic changes (CC) at the level of the inner nuclear layer (INL) and the outer plexiform layer and Henle fiber layer complex (OPL+HFL), vessel density in the superficial and deep capillary plexus (SCP and DCP).
RESULTS
LS and P1 component amplitude were significantly reduced at a distance of up to 5.0° from the fixation point. LS correlates with the apical and basal diameter of the hole (> -0.53), the area of CC in the INL (> -0.62) and the OPL+HFL complex (> -0.55), the density of vessels in the SCP at a distance of up to 2.5° from the fixation point (>0.51) and in the DCP at a distance of up to 5° from the fixation point (>0.49). The P1 amplitude correlates with the basal diameter of the hole (= -0.38), the area of CC in the INL and the OPL+HFL complex (> -0.33) and vessel density in the SCP (=0.37) at a distance of up to 2.5° from the fixation point, as well as vessel density in the DCP at a distance of up to 5° from the fixation point (=0.47). Vessel density in the DCP is significantly lower in the presence of CC in the retina (<0.001).
CONCLUSION
In FTMH, there is a relationship between bioelectrical activity and LS, and structural disorders, capillary perfusion in different layers of the retina. A multimodal topographically oriented approach allows studying the relationship between structural and functional parameters in individual points of the retina and can be used in monitoring of FTMH after surgical treatment.
Topics: Humans; Tomography, Optical Coherence; Retinal Perforations; Female; Male; Electroretinography; Middle Aged; Aged; Macula Lutea; Visual Field Tests; Fluorescein Angiography; Multimodal Imaging
PubMed: 38742494
DOI: 10.17116/oftalma202414002114 -
Journal of Cutaneous and Aesthetic... 2024A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly...
A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly slipped over the plastic sheet that had been placed to avoid COVID-19 exposure after which she complained of sudden loss of vision. She was diagnosed as having vitreous hemorrhage in her right eye and was treated conservatively for one month. She then complained of central scotoma and was diagnosed to have developed a full-thickness macular hole, for which she was advised vitrectomy surgery. The purpose of this case report is to emphasize the importance of taking precautions during the COVID-19 era and while doing that making sure how to handle the machines so as not to inflict any accidental injury to the operating physician. Macular Holes following skin bleaching with Nd:YAG laser occurring in operating aesthetician is rare as compared to that occurring in the patients.
PubMed: 38736866
DOI: 10.4103/JCAS.JCAS_74_21 -
Harefuah May 2024Retinal detachment is visually impairing in children and adults. The treatment for retinal detachment is challenging, especially in children. There are many etiologies... (Review)
Review
Retinal detachment is visually impairing in children and adults. The treatment for retinal detachment is challenging, especially in children. There are many etiologies for retinal detachment such as retinal detachment due to retinal tear (rhegmatogenous), tractional retinal detachment and exudative detachment. It is crucial to understand retinal detachment etiology in the pediatric population as it affects treatment decisions. After the diagnosis of retinal detachment in a child, and its etiology, a long process of surgical treatment and recovery begins. The process may include more than one surgery, and therefore close follow-up is very important. Even with anatomic success, functional results are worse with children. The purpose of this article is to review the common etiologies for retinal detachment in children and present case studies that were treated in our department.
Topics: Child; Humans; Retinal Detachment; Retinal Perforations; Visual Acuity
PubMed: 38734940
DOI: No ID Found -
International Journal of Ophthalmology 2024To introduce the macular hole (MH) hydromassage technique as a potentially beneficial approach for the treatment of large or persistent MH.
AIM
To introduce the macular hole (MH) hydromassage technique as a potentially beneficial approach for the treatment of large or persistent MH.
METHODS
This retrospective observational case series comprised 16 consecutive patients (17 eyes) diagnosed with MH. Inclusion criteria involved a hole aperture diameter larger than 600 µm or the presence of an unclosed MH larger than 600 µm following the previous vitrectomy. Standard MH repair procedures were administered in all cases, involving the manipulation and aspiration of the hole margin through the application of water flow with a soft-tip flute needle. A comprehensive assessment was conducted for each case before and after surgery, and optical coherence tomography (OCT) images were captured at every follow-up point.
RESULTS
The mean preoperative aperture diameter was 747±156 µm (range 611-1180 µm), with a mean base diameter of 1390±435 µm (range 578-2220 µm). Following surgery, all cases achieved complete anatomical closure of MH, with 13 cases (76.5%) exhibiting type 1 closure and 4 cases (23.5%) demonstrating type 2 closure. No significant differences were observed in the preoperative OCT variables between the two closure types. Eyes with type 1 closure showed a significantly improved visual acuity (0.70±0.10, range 0.50-0.80) compared to those with type 2 closure (0.90±0.12, range 0.80-1.00, =0.014).
CONCLUSION
The MH hydromassage technique demonstrates promising results, achieving acceptable closure rates in cases of large or persistent MH. This technique may serve as an effective adjunctive maneuver during challenging MH surgery.
PubMed: 38721499
DOI: 10.18240/ijo.2024.03.18 -
Graefe's Archive For Clinical and... May 2024To identify optical coherence tomography (OCT) parameters that predict postoperative best corrected visual acuity (BCVA) and are based on recent understanding of the...
Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage.
PURPOSE
To identify optical coherence tomography (OCT) parameters that predict postoperative best corrected visual acuity (BCVA) and are based on recent understanding of the pathomechanism of idiopathic full thickness macular hole (iFTMH) formation and closure.
METHODS
A retrospective consecutive case series of patients who had macular hole (MH) surgery at our institution between 2016 and 2022 was performed. 32 eyes of 30 patients were selected with at least 12 months of follow-up, closed MH and good quality OCT at each visit. Univariate correlation analysis, multiple logistic regression with forward stepwise selection, and Akaike's Information Criterion (AIC) were used to identify the best predictors for postoperative BCVA at 6 and 12 months (M), and final (≥ 12 M) visits, and a new OCT index was created. Abilities of best models/indices to predict < 0.30 logMAR (> 20/40) BCVA were compared to macular hole index (MHI) using the area under the receiver operating curve (AU-ROC) analysis.
RESULTS
Statistical analysis revealed base diameter (B) (6 M), preoperative BCVA and B (12 M) and smaller ELM-GCL distance (A), and B (final visit) as predictors for postoperative BCVA. AU-ROC analysis indicated greatest AUC at 6 M for MHI and B (0.797, p = 0.004 and 0.836 p = 0.001, respectively) and for the new A/B index at 12 M and final visit (0.844, p = 0.002 and 0.913, p = 0.003, respectively).
CONCLUSION
Our study suggests that MHI and B can be useful predictors of short term BCVA while the new A/B index that incorporates OCT parameters indicating potential preoperative photoreceptor damage may be a good predictor for long term postoperative BCVA. Our findings support the theory that initial hole formation mechanisms and photoreceptor damage define visual prognosis.
PubMed: 38717606
DOI: 10.1007/s00417-024-06500-2