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International Ophthalmology Apr 2024To evaluate results of the surgical treatment for large stage (Stage 3 and 4) idiopathic macular hole cases with and without ILM flap technique.
PURPOSE
To evaluate results of the surgical treatment for large stage (Stage 3 and 4) idiopathic macular hole cases with and without ILM flap technique.
METHODS
Sixty eyes of 60 patients diagnosed with idiopathic macular hole (MH) were included in the study. Complete ophthalmologic examination and SD-OCT examination were performed in all eyes. MH stages, MH base diameter, height and closest distance were measured quantitatively. Postoperative and 3 months visits were evaluated.
RESULTS
The mean age of the cases was 65.0 ± 8.0 (range 30-84) years, there were 31 (51.7%) female and 29 (48.3%) male patients with a mean follow-up period of 18.1 ± 16.7 (range 3-63) months. The mean best corrected visual acuity recorded at preoperative and third month control visits were 0.89 ± 0.40(preoperative) logMAR, 0.82 ± 0.60(3 month) logMAR (p < 0.05). The mean MH index was 0.48 ± 0.16, the closest hole distance was 517.86 ± 210.89 µm and mean basal diameter of holes was 947.78 ± 361.90 µm and the average height was 448.93 ± 79.80 microns. There was no statistically significant difference between anatomic results of macular hole surgery with (n = 22) and without (n = 38) flap in terms of hole closure (86.4% vs. 92.1% p > 0.05). In 90% (54 cases) of the cases, closure was observed after the first surgery. Two eyes that failed macular hole surgery were reoperated. In one of these eyes, anatomical success was obtained with macular hole massage and mechanical cytumulation. However, anatomical success could not be achieved in the other eye. CONCLUSıON: In the treatment of large macular holes, pars plana vitrectomy, internal limiting membrane peeling with/without flap and gas tamponade demonstrated high anatomical and functional success.
Topics: Humans; Female; Male; Child, Preschool; Child; Retinal Perforations; Eye; Postoperative Period; Surgical Flaps; Tomography, Optical Coherence
PubMed: 38643432
DOI: 10.1007/s10792-024-03121-w -
Medicine Apr 2024The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of...
RATIONALE
The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of experiencing multiple pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) tears. Photodynamic therapy (PDT) is a treatment for the bullous variant of CSC. RPE tear is a possible postoperative complication of PDT for eyes with PEDs. To our knowledge, no cases of giant RPE tears following PDT for the bullous variant of CSC have been reported previously. This case report presents the first instance of a giant RPE tear after half-time PDT for the bullous variant of CSC, accompanied by a series of images depicting the tear development.
PATIENT CONCERNS
A 63-year-old male patient presented with rapidly deteriorating vision in his left eye over a 3-month period. He also reported a previous episode of vision loss in his right eye 2 years prior. Best-corrected visual acuity (BCVA) in the left eye was 0.2.
DIAGNOSIS
The right eye was diagnosed with chronic non-bullous CSC, while the left eye was diagnosed with the bullous variant of CSC with a large PED.
INTERVENTIONS
Half-time PDT was administered to the left eye.
OUTCOMES
One month after half-time PDT, a giant RPE tear exceeding 3 clock-hours in size was confirmed in the lower temporal quadrant of the left eye. Three months after the initial half-time PDT, a second half-time PDT was performed owing to recurrent retinal detachment. Two months after the second half-time PDT, the retinal detachment resolved, and BCVA improved to 0.4, 6 months after the second half-time PDT.
LESSONS
In cases where the bullous variant of CSC is complicated by extensive PED, clinicians should consider the potential development of a giant RPE tear as a treatment complication.
Topics: Male; Humans; Middle Aged; Central Serous Chorioretinopathy; Retinal Detachment; Photochemotherapy; Visual Acuity; Retinal Perforations; Fluorescein Angiography; Retinal Pigments; Tomography, Optical Coherence; Photosensitizing Agents; Retrospective Studies
PubMed: 38640292
DOI: 10.1097/MD.0000000000037855 -
BMC Ophthalmology Apr 2024Kidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy... (Review)
Review
BACKGROUND
Kidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy and light-chain deposition disease. However, pigment epithelium tears associated with membranous nephropathy have not been reported or systematically analysed.
CASE PRESENTATION
A 68-year-old man presented with decreased right eye visual acuity. Optical coherence tomography (OCT) revealed cystic macular edema, localized serous detachment of the retina and loss of the outer retinal structure in the right eye and retinal pigment epithelium detachment (PED) combined with serous detachment of the retina in the left eye. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) revealed giant RPE tears in the right eye and exudative age-related macular degeneration in the left eye. The patient also suffered from severe membranous nephropathy-autoimmune glomerulonephritis. Renal biopsy immunofluorescence revealed a roughly granular pattern, with immunoglobulin G (IgA), immunoglobulin G (IgG), IgM, complement C3(Components 3), λ light chain and κ light chain subepithelial staining.
CONCLUSIONS
It is hypothesized that severe membranous nephropathy caused immune complex deposition on the surface of Bruch membrane, resulting in weakened adhesion between the RPE and Bruch membrane and impaired RPE pump function, combined with age-related macular degeneration, leading to giant RPE tears in the right eye. Close attention should be given to the ocular condition of patients with membranous nephropathy to facilitate timely treatment and avoid serious consequences.
Topics: Male; Humans; Aged; Retinal Pigment Epithelium; Glomerulonephritis, Membranous; Macular Degeneration; Fluorescein Angiography; Retinal Perforations; Retinal Detachment; Tomography, Optical Coherence; Epithelium; Immunoglobulin G
PubMed: 38632537
DOI: 10.1186/s12886-024-03426-5 -
International Ophthalmology Apr 2024The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down...
PURPOSE
The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP.
METHODS
Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded.
RESULTS
Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260-max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed.
CONCLUSIONS
OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Follow-Up Studies; Postoperative Period; Vitrectomy
PubMed: 38625598
DOI: 10.1007/s10792-024-03110-z -
Scientific Reports Apr 2024To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal...
To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.
Topics: Humans; Retinal Perforations; Retrospective Studies; Epiretinal Membrane; Vitrectomy; Tomography, Optical Coherence; Cell Proliferation; Basement Membrane
PubMed: 38589441
DOI: 10.1038/s41598-024-58449-1 -
Translational Vision Science &... Apr 2024The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using...
PURPOSE
The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using artificial intelligence (AI).
METHODS
Optomap UWF images of the database were annotated to four groups by two retina specialists: (1) retinal breaks without detachment, (2) retinal breaks with retinal detachment, (3) retinal detachment without visible retinal breaks, and (4) a combination of groups 1 to 3. The fundus image data set was split into a training set and an independent test set following an 80% to 20% ratio. Image preprocessing methods were applied. An EfficientNet classification model was trained with the training set and evaluated with the test set.
RESULTS
A total of 2489 UWF images were included into the dataset, resulting in a training set size of 2008 UWF images and a test set size of 481 images. The classification models achieved an area under the receiver operating characteristic curve (AUC) on the testing set of 0.975 regarding lesion detection, an AUC of 0.972 for retinal detachment and an AUC of 0.913 for retinal breaks.
CONCLUSIONS
A deep learning system to detect retinal breaks and retinal detachment using UWF images is feasible and has a good specificity. This is relevant for clinical routine as there can be a high rate of missed breaks in clinics. Future clinical studies will be necessary to evaluate the cost-effectiveness of applying such an algorithm as an automated auxiliary tool in a large practices or tertiary referral centers.
TRANSLATIONAL RELEVANCE
This study demonstrates the relevance of applying AI in diagnosing peripheral retinal breaks in clinical routine in UWF fundus images.
Topics: Humans; Retinal Detachment; Retinal Perforations; Artificial Intelligence; Deep Learning; Photography
PubMed: 38564203
DOI: 10.1167/tvst.13.4.1 -
Survey of Ophthalmology 2024The standard of care to treat small- and medium-sized macular holes (<400 µm diameter) consists of a conventional transconjunctival sutureless pars plana vitrectomy... (Review)
Review
The standard of care to treat small- and medium-sized macular holes (<400 µm diameter) consists of a conventional transconjunctival sutureless pars plana vitrectomy followed by ILM peeling and endotamponade, mainly with gas or in some cases with silicone oil, resulting in closure rates of over 90% and good functional results. Large (>400 µm diameter), chronic and persistent macular holes remain a surgical challenge since closure rates and functional results decrease with larger macular hole diameters. Various modifications of the conventional surgical technique were introduced to improve anatomic and functional success in refractory cases not suitable for conventional macular hole surgery. These techniques comprise the positioning of tissue at the top of the hole to improve closure as performed by an inner limiting membrane flap and free flap preparation or the transplantation of autologous retinal tissue, lens capsule or amniotic membrane. For the treatment of very large and persistent macular holes, the induction of a localized retinal detachment at the posterior pole by subretinal injection of balanced salt solution and a subsequent attenuation of the rim of the hole during fluid-air exchange has been suggested as a promising surgical technique. In particular, accurate patient education about the expected surgical outcome in this specific group of patients appears important.
Topics: Humans; Retinal Perforations; Vitrectomy; Endotamponade; Tomography, Optical Coherence; Visual Acuity; Surgical Flaps
PubMed: 38552678
DOI: 10.1016/j.survophthal.2024.03.010 -
International Ophthalmology Clinics Apr 2024
Topics: Humans; Child; Retinal Perforations; Tomography, Optical Coherence; Vitrectomy
PubMed: 38525987
DOI: 10.1097/IIO.0000000000000494 -
International Ophthalmology Clinics Apr 2024
Review
Topics: Humans; Retinal Perforations; Vitrectomy; Visual Acuity; Retinal Detachment
PubMed: 38525985
DOI: 10.1097/IIO.0000000000000491 -
Oman Journal of Ophthalmology 2024Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case...
Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case of a 75-year-old female who came with decreased vision in the left eye (LE) following cataract surgery under peribulbar block. Her visual acuity in the right eye (RE) was 6/24 and LE was 6/75. Fundus examination of LE showed vitreous hemorrhage with localized subretinal hemorrhage along the inferotemporal arcade suggestive of globe perforation. Optical coherence tomography (OCT, Spectralis. Heidelberg imaging, Germany) scan across the perforation site showed subretinal hemorrhage and full-thickness retinal tear. On follow-up, two more focal points of retinal whitening were noted in the inferotemporal equatorial region. The patient was kept under close monitoring, and 4 weeks later, vision improved to 6/9 and barrage laser was done around the perforation sites. Serial OCT scans and close follow-up in iatrogenic globe perforation can result in good visual outcomes.
PubMed: 38524350
DOI: 10.4103/ojo.ojo_38_22