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Ceska a Slovenska Oftalmologie :... 2024The main aim of this study is to evaluate the anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM),...
AIM
The main aim of this study is to evaluate the anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM), membrane blue staining and subsequent expansile gas tamponade (perfluoropropane) in the treatment of idiopathic macular hole (IMH).
MATERIAL AND METHODS
The retrospective analysis consisted of 100 eyes of a total of 100 patients (61 women and 39 men) with IMH, operated on at the Department of Ophthalmology of the Slovak Medical University and University Hospital Bratislava from 1 January 2021 to 1 January 2024, using 25-gauge PPV with ILM peeling and perfluoropropane tamponade (C3F8) of 15% concentration. After surgery, the patients were required to remain in a face-down position for at least one week. Best corrected visual acuity (BCVA), minimal linear diameter (MLD) on optic coherence tomography, macular hole closure type and occurrence of complications were evaluated. The obtained results were expressed with the use of arithmetic averages and displayed in graphs.
RESULTS
Primary closure of macular hole was achieved in 93 patients (93%). The most frequently occurring type of closure was 1A. After surgery, the BCVA of all patients improved, from an average value of 0.101 preoperatively to 0.300 one year after surgery. In all groups of patients (regardless of the size of the macular hole before surgery), during the one-year follow-up period there was a gradual increase in BCVA with its stabilization by 6 months. The main factors that influenced postoperative BCVA were the preoperative values of MLD and BCVA.
CONCLUSION
PPV with ILM peeling and perfluoropropane tamponade is an effective treatment for idiopathic macular holes with a success rate of more than 90%. This surgical procedure, associated with a relatively low number of complications, brings patients a definite improvement of BCVA.
Topics: Humans; Vitrectomy; Retinal Perforations; Female; Male; Retrospective Studies; Middle Aged; Aged; Fluorocarbons; Visual Acuity; Treatment Outcome
PubMed: 38925904
DOI: 10.31348/2024/20 -
Ceska a Slovenska Oftalmologie :... 2024To compare functional and anatomical outcomes between the inverted flap technique and conventional removal of the internal limiting membrane (ILM) in the surgical...
AIM
To compare functional and anatomical outcomes between the inverted flap technique and conventional removal of the internal limiting membrane (ILM) in the surgical management of idiopathic macular hole (IMH).
MATERIAL AND METHODS
We retrospectively evaluated the anatomical and functional results in 67 eyes of 65 patients operated on for IMH. The patients were operated on either using the conventional ILM peeling technique (first group) or with the inverted ILM flap technique (second group). 43 eyes of 41 patients were included in the first group, 24 eyes of 24 patients in the second group. We indicated for surgery only patients with IMH stage 2-4 according to the Gasse classification. Best corrected visual acuity (VA) was always determined before and two months after surgery. Furthermore, a comparison of both techniques was made according to the average letter gain after surgery, and the effect of surgery was evaluated using OCT with regard to whether IMH closure succeeded. For both techniques, 25G PPV with SF6 tamponade was performed.
RESULTS
Hole closure took place in 41 eyes with conventional ILM removal. In one eye, the hole did not close even after reoperation with the same technique. Median ETDRS letter gain was 7.0. VA remained the same in 2 eyes (4.7%), worsened in 7 cases (16.2%), and improved in all other cases (79.0%). In 16 eyes (37.2%), VA improved by 2 or more lines of ETDRS charts. Using the inverted flap technique, the hole was closed in all 24 monitored eyes. Median ETDRS letter gain was 9.5. VA remained the same in 2 eyes (8.3%), worsened in 2 cases (8.3%), and improved in all other cases (83.3%). In 12 eyes (50.0%), VA improved by 2 or more lines of ETDRS charts. There were no serious complications intraoperatively or postoperatively.
CONCLUSION
Our study demonstrated the safety and efficacy of both methods. Although the results were not statistically significant, the inverted flap technique recorded a greater ETDRS letter gain (9.5 vs. 7.0) and proportion of closed holes (100% vs. 95.3%) compared to the conventional ILM peeling technique in our set of eyes.
Topics: Humans; Surgical Flaps; Retrospective Studies; Retinal Perforations; Visual Acuity; Vitrectomy; Female; Male; Middle Aged; Aged
PubMed: 38925893
DOI: 10.31348/2024/31 -
International Journal of Retina and... Jun 2024The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for...
BACKGROUND
The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety.
METHODS
In total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system.
RESULTS
The average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports.
CONCLUSIONS
The EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery. TRIAL REGISTRATION NUMBER CLINICALTRIALS.GOV: : NCT05229094 Data 22/5/2021.
PubMed: 38915097
DOI: 10.1186/s40942-024-00563-3 -
International Journal of Retina and... Jun 2024Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing... (Review)
Review
Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.
PubMed: 38907361
DOI: 10.1186/s40942-024-00564-2 -
International Journal of Ophthalmology 2024To compare the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) and silicone oil or sterile air tamponade for the treatment of...
AIM
To compare the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) and silicone oil or sterile air tamponade for the treatment of myopic foveoschisis (MF) in highly myopic eyes.
METHODS
This retrospective study included 48 myopic eyes of 40 patients with MF and axial lengths (ALs) ranging from 26-32 mm treated between January 2020 and January 2022. All patients were underwent PPV combined with ILM peeling followed by sterile air or silicone oil tamponade and followed up at least 12mo. Based on the features on spectral-domain optical coherence tomography (SD-OCT), the eyes were divided into the MF-only group (Group A, =15 eyes), MF with central foveal detachment group (Group B, =20 eyes), and MF with lamellar macular hole group (Group C, =13 eyes). According to AL, eyes were further divided into three groups: Group D (26.01-28.00 mm, =12 eyes), Group E (28.01-30.00 mm, =26 eyes), and Group F (30.01-32.00 mm, =10 eyes). The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and complications were recorded.
RESULTS
The patients included 16 males and 24 females with the mean age of 56±9.82y. The BCVA and CFT improved in all groups after surgery (<0.01), while there was no significant difference of the CFT in Group A, B, and C postoperatively (>0.05). The intergroup differences of BCVA and CFT postoperatively were statistically significant in Group D, E, and F. Twenty eyes were injected with sterile air, and 28 eyes were injected with silicone oil for tamponade based on the AL. However, there was no statistically significant difference among Groups D, E, and F in terms of the results of sterile air or silicone oil tamponade. The mean recovery time was 5.9mo for MF patients subjected to silicone oil tamponade and 7.7mo for patients subjected to sterile air tamponade, and the difference was not statistically significant.
CONCLUSION
PPV and ILM peeling combined with silicone oil or sterile air tamponade can achieve good results for MF in highly myopic eyes with ALs≤32 mm.
PubMed: 38895672
DOI: 10.18240/ijo.2024.06.13 -
Journal of Clinical Medicine May 2024Ophthalmic three-dimensional (3D) digital surgery can reproduce high-definition surgical images; however, 3D digital surgery is limited by recording capacities. We...
Ophthalmic three-dimensional (3D) digital surgery can reproduce high-definition surgical images; however, 3D digital surgery is limited by recording capacities. We examined the relationship between the minimum image quality required to reproduce surgical images and recording capacity. Patients who underwent simultaneous vitrectomy and cataract surgery by the same surgeon using a 3D digital surgery system at Juntendo University Urayasu Hospital between February and October 2021 were evaluated. Various quality (Q) and frame rate (FR) settings were used for each case. Four vitreous surgeons evaluated the reproducibility of recorded images of macular manipulation for epiretinal membrane (ERM) and macular hole (MH) cases and those of peripheral retinal manipulation for rhegmatogenous retinal detachment (RRD) cases. The video bitrate and minimum settings required to reproduce surgical images and factors affecting surgical image reproducibility were examined. A total of 129 eyes of 129 patients were observed. The minimum image quality required to reproduce surgical images was 11.67 Mbps. The Q and FR for periretinal processing and Q for macular manipulation affected surgical image reproducibility ( = 0.025, = 0.019, and = 0.07, respectively). The minimum recording settings required to obtain highly reproducible images were Q = 3 and FR = 40. The total file size for vitrectomy video recordings with these settings was as compact as 3.17 GB for 28 min. During 3D digital surgery, highly reproducible surgical images can be obtained with a small storage capacity using settings of at least Q = 3 and FR = 40.
PubMed: 38892762
DOI: 10.3390/jcm13113051 -
Clinical features of primary and compound forms of wide macular posterior staphyloma in high myopia.BMC Ophthalmology Jun 2024To compare the ocular features of highly myopic eyes with posterior staphyloma of wide macular type according to its morphological complexity.
BACKGROUND
To compare the ocular features of highly myopic eyes with posterior staphyloma of wide macular type according to its morphological complexity.
METHODS
In this cross-sectional study, wide macular posterior staphyloma (WMPS) was classified into the primary (Curtin type I) and the compound (Curtin types VI to X) forms based on the configuration within the staphyloma. The grades of myopic maculopathy and the thicknesses of choroid and sclera were compared between the primary and compound forms of WMPS.
RESULTS
A total of 154 eyes (103 patients) with primary WMPS and 65 eyes (49 patients) with compound WMPS were included. Eyes with compound WMPS had worse visual acuity (P = 0.001) and greater axial length (P < 0.001) than those with primary WMPS. Compared to primary WMPS, compound WMPS had a higher grade of myopic macular degeneration (P < 0.001) and a higher frequency of lamellar or full-thickness macular hole associated with myopic traction (21.5% vs. 10.4%; P = 0.028) and active or scarred myopic choroidal neovascularization (33.8% vs. 20.1%; P = 0.030). On swept-source optical coherence tomography, eyes with compound WMPS had significantly thinner choroid and sclera.
CONCLUSIONS
The compound form of WMPS had more severe myopic macular changes and worse visual prognosis compared to the primary form of WMPS, and these were associated with more structural deformation in the posterior eyeball. Compound WMPS should be considered as an advanced form of staphyloma.
Topics: Humans; Female; Male; Cross-Sectional Studies; Myopia, Degenerative; Middle Aged; Visual Acuity; Tomography, Optical Coherence; Aged; Sclera; Retrospective Studies; Adult; Choroid; Scleral Diseases; Macula Lutea; Dilatation, Pathologic
PubMed: 38862935
DOI: 10.1186/s12886-024-03519-1 -
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 -
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 -
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