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Eye (London, England) Jan 2019To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH).
OBJECTIVE
To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH).
METHODS
Prospective interventional case series. Twenty-six eyes of 26 patients in Peking Union Medical College Hospital with primary FTMH underwent IVI of perfluoropropane (CF) 0.2 ml, followed by 7-14 days' face-down positioning. The macular hole closure rate, post-operative visual acuity, and the incidence of surgical complications were observed. The correlation between the patients' age, macular hole diameter, pre-operative best-corrected visual acuity (BCVA), status of the vitreous, and the macular hole closure rates were analyzed.
RESULTS
A total of 17 cases (65.4%) had hole closure after IVI of CF alone. The closure rate of small, medium, and large FTMH was 85.7, 80, and 33.3%, respectively. Pre-operative OCT examination showed that 10 cases (37%) had vitreomacular traction (VMT), and all of them achieved vitreous-macula separation after IVI of the gas. The diameters of the hole (P = 0.024) and the status of the vitreous (P = 0.038) had a significance difference for hole closure. The mean pre-operative and post-operative BCVA was 0.84 ± 0.29 and 0.49 ± 0.36 (logMAR), respectively (P < 0.01). One myope with persistent hole developed rhegmatogenous retinal detachment (RRD) 2 months after the surgery. Another myope with hole closure developed RRD 10 months after the surgery. They achieved hole closure and retinal reattachment after vitrectomy and scleral buckling, respectively.
CONCLUSION
Intravitreal injection of CF gas alone was an effective treatment for small-sized and medium-sized primary FTMH, but further large prospective studies are needed.
Topics: Adult; Aged; Endotamponade; Female; Follow-Up Studies; Humans; Intravitreal Injections; Macula Lutea; Male; Middle Aged; Postoperative Period; Prospective Studies; Retinal Perforations; Sulfur Hexafluoride; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 30185833
DOI: 10.1038/s41433-018-0098-z -
Eye (London, England) Oct 2013Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that... (Review)
Review
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.
Topics: Aged; Diagnostic Imaging; Epiretinal Membrane; Fibrinolysin; Humans; Ophthalmic Solutions; Patient Positioning; Peptide Fragments; Retinal Perforations; Risk Factors; Tissue Adhesions; Treatment Outcome; Vitrectomy; Vitreous Detachment; Watchful Waiting
PubMed: 24108069
DOI: 10.1038/eye.2013.212 -
Indian Journal of Ophthalmology Nov 2021To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in...
PURPOSE
To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in eyes with proliferative diabetic retinopathy (PDR), and factors influencing the outcome.
METHODS
This retrospective study included the patients who underwent vitrectomy for FTMH secondary to PDR TRD from 2016 to 2020. Anatomical and visual outcomes were analyzed after six months along with the factors predicting the final outcome and duration of subretinal fluid (SRF) resolution.
RESULTS
Group A (macula-off combined RD, i.e., tractional and rhegmatogenous) included 10 eyes, while group B (macula-threatening TRD) included eight eyes. The mean best-corrected visual acuity improved from logMAR 1.21 (Snellen equivalent: 20/324) to logMAR 0.76 (Snellen equivalent: 20/115) (P = 0.008). Seventeen patients gained ≥1 line(s) of vision. Mean visual gain in groups A and B was 3.7 ± 1.9 and 1.9 ± 1.1 lines, respectively (P = 0.051). MH closed in 88.9% eyes. Type 1 anatomical closure was achieved in 88.9% of eyes. At 6 months, SRF and central macular thickness reduced from 479.6 ± 512.5 μm to 11.4 ± 23.5 μm (P = 0.002) and 874.3 ± 422.6 μm to 207.6 ± 81.7 μm (P = 0.0002), respectively. Finally, macular SRF resolved in all the patients. The mean duration for complete SRF resolution was 4.9 ± 3.2 months. Eyes with a shorter duration of diabetes mellitus (rho = -0.49, P = 0.040) and macula-off combined RD (P = 0.048) took a longer time for complete SRF resolution.
CONCLUSION
Good anatomical and visual outcomes can be achieved in eyes with PDR TRD-associated FTMH. The residual macular SRF resolves slowly after the surgery and extra intervention is not required. Macula-off combined RD is associated with worse outcome and a slower SRF resolution rate.
Topics: Diabetes Mellitus; Diabetic Retinopathy; Humans; Macula Lutea; Retinal Detachment; Retinal Perforations; Retrospective Studies; Treatment Outcome; Vitrectomy
PubMed: 34708793
DOI: 10.4103/ijo.IJO_1204_21 -
BMC Ophthalmology Jan 2022To determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is...
BACKGROUND
To determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is present.
METHODS
Case-control study. Patients with idiopathic FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were retrospectively reviewed. Preoperative spectral-domain optical coherence tomography was undertaken in all patients. The new parameter, macular hole closing factor (MHCF) was defined as the base diameter - (arm length + IRC height) by adding IRC to the existing parameter. After surgery, patients were classified and analyzed according to the type of hole closure and the damage of photoreceptor.
RESULTS
Of the 35 patients, 28 (80.00%) had type 1 closure and seven (20.00%) had type 2 closure. There was a significant difference in postoperative BCVA (P < 0.01), base diameter (P = 0.037), arm length (P = 0.045), and IRC height (P = 0.011) between the two groups. In the type 1 closure, they were further divided into two subgroups according to photoreceptor damage, and it was confirmed that there were significant differences in postoperative BCVA (P = 0.045), hole height (P = 0.048), and IRC height (P = 0.046) in the two subgroups. As for the new parameters, a significant difference between the three groups was confirmed (P < 0.01).
CONCLUSION
IRC may help predict hole closure along with the known horizontal parameters. Therefore, the new parameter containing both two factors can help predict not only hole closure but also damage to photoreceptors that affects postoperative visual prognosis.
Topics: Case-Control Studies; Cysts; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 34980033
DOI: 10.1186/s12886-021-02204-x -
Disease Markers 2022We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical...
OBJECTIVE
We aimed to determine the efficacy of different idiopathic macular hole treatment methods to improve recovery time and patient outcomes using Frequency Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA).
METHODS
This retrospective study included patients with idiopathic macular hole who were admitted to our hospital between 1st January 2019 and 31st October 2021. The control group was treated with internal limiting membrane tamponade, and the study group was treated with clamshell therapy. Treatment conditions (internal limiting membrane treatment duration and hole closure rate), best corrected visual acuity (BCVA) before and after surgery, OCTA measurements, and SD-OCT were assessed. The retinal nerve fiber layer (RNFL), retinal ganglion cell layer (GCL), and retinal pigment epithelium (RPE) thicknesses were also analyzed.
RESULTS
The treatment time and hole closure rate of the internal limiting membrane in the study group were higher than those in the control group. The curative effect of the study group was better than that of the control group. The postoperative DCP blood vessel density in both groups was higher than that before operation, and the study group was higher than the control group. The FAZ area and circumference were lower than those before surgery, and the study group was lower than the control group. At 3 months after operation, the thickness of DIOA, nasal temporal RNFL, and GCL were decreased in both groups, and the observed values in the study group were lower than those in the control group. At 3-month follow-up, there was no significant difference in RPE thickness between the two groups.
CONCLUSION
Flip and cover therapy is the most effective treatment. SD-OCT and OCTA provide an objective basis for clinical intervention by comparing the effects of different procedures on the retinal condition of patients.
Topics: Angiography; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35996716
DOI: 10.1155/2022/7749605 -
BMC Ophthalmology Dec 2019After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery.
METHODS
Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0.
RESULTS
Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 μm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 μm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03).
CONCLUSIONS
Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 μm but may be highly recommended for MHs larger than 400 μm. Further RCTs with large sample sizes are warranted to validate these findings in future.
Topics: Aged; Endotamponade; Female; Fluorocarbons; Humans; Male; Middle Aged; Patient Positioning; Prone Position; Randomized Controlled Trials as Topic; Recovery of Function; Retinal Perforations; Sulfur Hexafluoride; Visual Acuity; Vitrectomy
PubMed: 31864333
DOI: 10.1186/s12886-019-1272-1 -
The British Journal of Ophthalmology Jan 2001
Review
Topics: Disease Progression; Humans; Retinal Perforations; Tomography
PubMed: 11133724
DOI: 10.1136/bjo.85.1.102 -
Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery.Scientific Reports May 2021To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery...
To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.
Topics: Female; Humans; Male; Retina; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity
PubMed: 34059759
DOI: 10.1038/s41598-021-90955-4 -
The British Journal of Ophthalmology Nov 2002To study a correlation between age at the onset and myopic refraction and axial length in patients with idiopathic macular hole and to evaluate a correlation of the size...
AIM
To study a correlation between age at the onset and myopic refraction and axial length in patients with idiopathic macular hole and to evaluate a correlation of the size and surgical outcome of macular hole with axial length.
METHODS
In a prospective clinical study, 94 eyes of 91 patients with stage III and IV idiopathic macular hole were enrolled. A standardised surgical protocol was performed using vitrectomy and gas tamponade. This study evaluated the size of macular hole and the rate of anatomical and functional success of surgery. To assess dimensions of macular hole, confocal laser scanning tomography was employed.
RESULTS
Age at the onset showed a significant increase in relation to myopic refraction and axial length (r = 0.689, p <0.0001; r = 0.723, p <0.0001). Mean age was 52.1 (SD 10.3) years in eyes with axial length of 26.0 mm and longer, 64.5 (8.5) years in eyes with 23.0 to 25.99 mm, and 69.8 (5.7) years in eyes with shorter than 23.0 mm. In stage III macular holes, mean area of macular hole was 0.291 (0.134) mm(2) in eyes with 26.0 mm and longer, 0.283 (0.170) mm(2) in eyes with 23.0 to 25.99 mm, and 0.296 (0.160) mm(2) in eyes with shorter than 23.0 mm. No significant difference was found in area, volume, and depth of macular hole, and area of cuff and retinal striae among the three groups. Overall anatomical success rate and logMAR visual improvement in stage III macular holes were 100% (19 of 19 eyes) and -0.575 (0.174) in eyes with 26.0 mm and longer, 100% (16 of 16 eyes) and -0.536 (0.174) in eyes with 23.0 to 25.99 mm, and 95% (40 of 42 eyes) and -0.599 (0.201) in eyes with shorter than 23.0 mm; there was no significant difference.
CONCLUSIONS
Macular hole develops in eyes with the severer myopia at the younger age. Myopic refraction appears not to influence the size and surgical outcomes of macular holes. Further investigation on more cases is needed.
Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Female; Humans; Japan; Male; Middle Aged; Myopia; Prospective Studies; Retinal Perforations; Treatment Outcome
PubMed: 12386087
DOI: 10.1136/bjo.86.11.1269 -
Journal Francais D'ophtalmologie Apr 2022Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement...
Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.
Topics: COVID-19; Chorioretinitis; Humans; Inflammation; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence; Toxoplasma; Toxoplasmosis, Ocular; Vitrectomy
PubMed: 35034856
DOI: 10.1016/j.jfo.2021.12.004