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PloS One 2020To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as...
PURPOSE
To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole.
METHODS
Patients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole.
RESULTS
Among 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The 'LMH without retinoschisis' group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the "LMH with retinoschisis group", ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the "LMH without retinoschisis group", no associated factor was identified.
CONCLUSIONS
LMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening.
Topics: Aged; Disease Progression; Epiretinal Membrane; Female; Follow-Up Studies; Fovea Centralis; Humans; Male; Middle Aged; Myopia, Degenerative; Proportional Hazards Models; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity
PubMed: 32374792
DOI: 10.1371/journal.pone.0232852 -
Retina (Philadelphia, Pa.) Aug 2022To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana... (Review)
Review
PURPOSE
To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique.
METHODS
Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported.
RESULTS
The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent).
CONCLUSION
Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.
Topics: Basement Membrane; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35439799
DOI: 10.1097/IAE.0000000000003509 -
Indian Journal of Ophthalmology Jun 2020
Topics: Fluorescein Angiography; Humans; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence
PubMed: 32461474
DOI: 10.4103/ijo.IJO_1591_19 -
The Libyan Journal of Medicine Dec 2022To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (MH) status at 9 months after vitrectomy and inverted flap internal limiting...
To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (MH) status at 9 months after vitrectomy and inverted flap internal limiting membrane (ILM) peeling surgery. This single center was conducted at Department A, Institute Hedi Raies of Ophthalmology, Tunis, Tunisia. The study included 114 patients. In total, 120 eyes underwent optical coherence tomography (OCT) and inverted flap ILM peeling for surgery. Then 510 B scan of macular OCT was acquired 9 months after surgery. MH diameter, basal MH diameter (b), nasal and temporal arm lengths and macular hole angle were measured. Indices including hole form factor, MH index, diameter hole index (DHI) and tractional hole, MH area index and MH volume index were calculated. Receiver operating characteristic (ROC) curves and cut‑off values were derived for each indices predicting closure or not of the MH. The area under the receiver operating characteristic curve (AUC) and kappa value were calculated to evaluate performance of the medical decision support system (MDSS) in predicting the MH closure. From the ROC curve analysis, it was derived that MH indices like MH diameter, diameter hole index (DHI), MH index, and hole formation factor were capable of successfully predicting MH closure while basal diameter, DHI and MH area index predicted none closure MH. The MDSS achieved an AUC of 0.984 with a kappa value of 0.934. Based on the preoperative OCT parameters, our ML model achieved remarkable accuracy in predicting MH outcomes after pars plana vitrectomy and inverted flap ILM peeling. Therefore, MDSS may help optimize surgical planning for full thickness macular hole patients in the future.
Topics: Basement Membrane; Humans; Machine Learning; Prognosis; Retinal Perforations; Retrospective Studies; Visual Acuity
PubMed: 35180831
DOI: 10.1080/19932820.2022.2034334 -
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 -
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 -
Clinical Interventions in Aging 2019To present optical coherence tomography (OCT) angiography features in patients with idiopathic full-thickness macular hole before and after vitrectomy.
PURPOSE
To present optical coherence tomography (OCT) angiography features in patients with idiopathic full-thickness macular hole before and after vitrectomy.
STUDY DESIGN
Prospective case series study.
MATERIALS AND METHODS
Patients presenting with an idiopathic full-thickness macular hole (IMH) who underwent posterior vitrectomy with internal limiting membrane peeling and gas tamponade were included in the study. En face OCT and OCT angiography (OCTA) was performed pre- and postoperatively using 3×3 mm scans (Optovue, XR Avanti). Foveal avascular zone (FAZ) area, macular hole size (MHS), central retinal thickness (CRT), macular parafoveal choriocapillary flow area (MCFA), and fovea vessel density (FVDS) were measured and assessed using OCTA. Best-corrected visual acuity (BCVA) was examined before and 3 months after surgery.
RESULTS
Twenty-eight eyes of 28 patients were included in the study. The mean age of patient group was 68.28 years. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of FAZ and increased CRT in foveal area. Mean preoperative FAZ area was 0.39±0.07 mm. En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. BCVA was improved from 0.1±0.11 preoperatively to 0.42±0.17 postoperatively. Mean FAZ area was reduced to 0.24±0.07 mm postoperatively with resolution of macular hole and adjacent cystic areas. Mean CRT was reduced from 396±62.6 µm pre-operatively to 272±30.7 µm postoperatively. After vitrectomy, the parafoveal choriocapillary flow area and FVDS of IMH eyes increased compared with the preoperative measurements.
CONCLUSION
Quantitative evaluation of vascular and morphological changes following IMH surgery using OCTA shows the potential for recovery due to vascular and neuronal plasticity. OCTA showing vascular changes and their quantitative characteristics might be a useful tool for the assessment of macular holes before and after surgical treatment.
Topics: Aged; Female; Fluorescein Angiography; Fovea Centralis; Humans; Male; Postoperative Period; Prospective Studies; Regional Blood Flow; Retinal Perforations; Retinal Vessels; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 30880931
DOI: 10.2147/CIA.S189417 -
Indian Journal of Ophthalmology Oct 2023Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain...
BACKGROUND
Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain anatomical closure. However, there are still challenges when the hole is large and chronic (>400 microns) in nature. Here we describe a modified technique of internal limiting membrane (ILM) peeling which results in the successful closure of such macular holes.
PURPOSE
To demonstrate modified ILM flap techniques in management of chronic macular holes.
SYNOPSIS
Here we have described the role of modified ILM peeling techniques in three different cases such as chronic traumatic macular hole >400 microns, chronic idiopathic macular hole >400 microns and <400 microns.
HIGHLIGHTS
This modified ILM flap technique provides the benefit of an inverted ILM flap, which helps in glial proliferation and also relives tangential traction thereby aiding in successful macular hole closure in chronic cases.
VIDEO LINK
https://youtu.be/RKVLd1mSw08.
Topics: Humans; Retinal Perforations; Epiretinal Membrane; Basement Membrane; Vitrectomy; Surgical Flaps; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37787255
DOI: 10.4103/IJO.IJO_883_23 -
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 -
Ophthalmologica. Journal International... 2011Since the first reports on surgical repair of macular holes, postoperative face-down posturing (FDP) has been part of the management regime. However, prone positioning... (Review)
Review
Since the first reports on surgical repair of macular holes, postoperative face-down posturing (FDP) has been part of the management regime. However, prone positioning is unpleasant for patients, and has adverse effects. Over the last decade some vitreoretinal surgeons have reduced the duration of FDP, or even abandoned it altogether. There have been few non-randomised, and even fewer randomised trials addressing this controversy. With high success rates for macular hole surgery and multiple different surgical strategies such as internal limiting membrane peeling, combining macular hole and cataract surgery, and different durations of gas tamponade, analysing the effects of individual factors is difficult. This paper discusses the mechanisms of surgical repair as well as the role of postoperative FDP, and reviews the studies that have attempted to determine its effect on the success of macular hole surgery.
Topics: Endotamponade; Fluorocarbons; Humans; Postoperative Care; Prone Position; Retinal Perforations; Vitrectomy
PubMed: 21778774
DOI: 10.1159/000328204