-
Macular hole as a complication of type 2 macular telangiectasia: Case report and surgical technique.Journal Francais D'ophtalmologie May 2024
PubMed: 38824034
DOI: 10.1016/j.jfo.2024.104218 -
Die Ophthalmologie Jun 2024Vitreomacular traction is a tractive foveolar adhesion of the posterior vitreous limiting membrane, resulting in pathological structural alterations of the... (Review)
Review
Vitreomacular traction is a tractive foveolar adhesion of the posterior vitreous limiting membrane, resulting in pathological structural alterations of the vitreomacular interface. This must be differentiated from physiological vitreomacular adhesion, which exhibits a completely preserved foveolar depression. Symptoms depend on the severity of the macular changes and typically include reduced visual acuity, reading problems and metamorphopsia. High-resolution spectral domain optical coherence tomography (SDOCT) imaging enables classification of the sometimes only subtle morphological changes. If pronounced vitreomacular traction is accompanied by epiretinal gliosis and alterations to the outer retina, it is referred to as a vitreomacular traction syndrome. Vitreomacular traction has a high probability of spontaneous resolution within 12 months. Therefore, treatment should only be carried out in cases of undue suffering of the patient and with symptoms during bilateral vision and a lack of spontaneous resolution. In addition to pars plana vitrectomy, alternative treatment options, such as intravitreal injection of ocriplasmin and pneumatic vitreolysis are discussed for vitreomacular traction with an associated macular hole; however, ocriplasmin is no longer available in Germany. The best anatomical results in comparative investigations were achieved by vitrectomy. Pneumatic vitreolysis is controversially discussed due to the increased risk of retinal tears. In one of the current S1 guidelines of the German ophthalmological societies evidence-based recommendations for the diagnostics and treatment of vitreomacular traction are summarized.
Topics: Humans; Practice Guidelines as Topic; Tomography, Optical Coherence; Retinal Diseases; Vitrectomy; Vitreous Detachment; Ophthalmology; Vitreous Body; Germany; Evidence-Based Medicine; Tissue Adhesions
PubMed: 38809382
DOI: 10.1007/s00347-024-02042-4 -
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 -
Die Ophthalmologie Jun 2024Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If... (Review)
Review
Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If diagnosed and treatment is initiated at an early stage, surgery has a high success rate with respect to both hole closure and improvement of visual acuity. Optical coherence tomography (OCT)-based staging and sizing enables an estimation of the surgical outcome. The differential diagnostic distinction from clinically similar disorders, such as lamellar macular holes, macular pseudoholes, and foveoschisis is clinically relevant as the pathogenesis, prognosis and treatment are significantly different. While vitrectomy with peeling of the inner limiting membrane (ILM) and gas tamponade is established as the standard treatment for FTMH, some aspects of treatment are handled differently between surgeons, such as the timing of surgery, the choice of endotamponade and the type and duration of postoperative positioning. For FTMH associated with vitreomacular traction, alternative treatment options in addition to vitrectomy include intravitreal ocriplasmin injection and pneumatic vitreolysis. The current clinical guidelines of the German ophthalmological societies summarize the evidence-based recommendations for diagnosis and treatment of FTMH.
Topics: Humans; Retinal Perforations; Vitrectomy; Diagnosis, Differential; Practice Guidelines as Topic; Tomography, Optical Coherence; Germany; Endotamponade
PubMed: 38775987
DOI: 10.1007/s00347-024-02047-z -
JAMA Ophthalmology May 2024
Topics: Humans; Retinal Perforations; Male; Middle Aged; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 38770960
DOI: 10.1001/jamaophthalmol.2023.4933 -
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