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German Medical Science : GMS E-journal 2022Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting... (Review)
Review
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 35813123
DOI: 10.3205/000309 -
Survey of Ophthalmology 1998A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Macular holes have been associated... (Review)
Review
A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Macular holes have been associated with myriad ocular conditions and originally were described in the setting of trauma. The pathogenesis of idiopathic, age-related macular holes remains unclear despite a litany of theories. Recently, Gass has described an updated biomicroscopic classification of macular holes and postulated that tangential vitreous traction may play a role. Cellular components surrounding the rim of macular holes may also contribute tangential traction forces and elevate the rim. Pseudomacular holes may be mistaken for macular hole lesions, despite careful clinical examination. Careful biomicroscopic examination with a contact lens and use of the Watzke and laser aiming beam tests help to ensure accurate diagnosis. Newer imaging technology, such as optical coherence tomography, helps distinguish true macular holes from pseudoholes and may provide additional insight into the pathogenesis of this condition. Surgical management with or without pharmacosurgical adjuncts can improve vision in select cases. The most common surgical complication is progressive lens opacification in phakic patients.
Topics: Aged; Aging; Diagnosis, Differential; Diagnostic Imaging; Humans; Macula Lutea; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 9548570
DOI: 10.1016/s0039-6257(97)00132-x -
Acta Ophthalmologica Feb 2015Prophylactic treatment of retinal breaks has been examined in several studies and reviews, but so far, no studies have successfully applied a systematic approach. In the... (Review)
Review
Prophylactic treatment of retinal breaks has been examined in several studies and reviews, but so far, no studies have successfully applied a systematic approach. In the present systematic review, we examined the need of follow-up after posterior vitreous detachment (PVD) - diagnosed by slit-lamp biomicroscopy or Goldmann 3-mirror examination - with regard to retinal breaks as well as the indication of prophylactic treatment in asymptomatic and symptomatic breaks. A total of 2941 publications were identified with PubMed and Medline searches. Two manual search strategies were used for papers in English published before 2012. Four levels of screening identified 13 studies suitable for inclusion in this systematic review. No meta-analysis was conducted as no data suitable for statistical analysis were identified. In total, the initial examination after symptomatic PVD identified 85-95% of subsequent retinal breaks. Additional retinal breaks were only revealed at follow-up in patients where a full retinal examination was compromised at presentation by, for example, vitreous haemorrhage. Asymptomatic and symptomatic retinal breaks progressed to rhegmatogenous retinal detachment (RRD) in 0-13.8% and 35-47% of cases, respectively. The cumulated incidence of RRD despite prophylactic treatment was 2.1-8.8%. The findings in this review suggest that follow-up after symptomatic PVD is only necessary in cases of incomplete retinal examination at presentation. Prophylactic treatment of symptomatic retinal breaks must be considered, whereas no unequivocal conclusion could be reached with regard to prophylactic treatment of asymptomatic retinal breaks.
Topics: Cryosurgery; Humans; Laser Coagulation; Retinal Detachment; Retinal Perforations; Slit Lamp; Vitreous Detachment
PubMed: 24853827
DOI: 10.1111/aos.12447 -
Indian Journal of Ophthalmology May 2022Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma...
BACKGROUND
Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare.
PURPOSE
To demonstrate the successful management of a post-traumatic posterior GRT and full-thickness macular hole (MH) associated retinal detachment (RD).
SYNPOSIS
A 21-year-old-male presented with sudden diminution of vision in the right eye (RE) following blunt-trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior-GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post-operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60.
HIGHLIGHTS
This video demonstrates the successful management of a posterior-GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.
VIDEO LINK
https://youtu.be/p04-_t0Wuuc.
Topics: Adult; Endotamponade; Humans; Male; Retinal Detachment; Retinal Perforations; Visual Acuity; Vitrectomy; Young Adult
PubMed: 35502118
DOI: 10.4103/ijo.IJO_1017_22 -
Acta Ophthalmologica Jun 2022To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage...
PURPOSE
To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina.
METHODS
We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol.
RESULTS
Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 10 μm (IQR: 22.77 × 10 -44.81 × 10 μm ), 8.42 × 10 μm (IQR: 4.86 × 10 -10.03 × 10 μm ) and 3.55 × 10 μm (IQR: 1.44 × 10 -7.94 × 10 μm ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02).
CONCLUSIONS
Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retina; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 34549889
DOI: 10.1111/aos.15023 -
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 -
Retina (Philadelphia, Pa.) Sep 2018To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE),...
PURPOSE
To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole.
METHODS
During vitrectomy, an RPE-choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE-choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE-choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases.
RESULTS
Mean follow-up was 7 ± 5.5 months (range 3-19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2-3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7-2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina-choroid-RPE free graft (n = 1).
CONCLUSION
Combined autologous RPE-choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.
Topics: Aged; Choroid; Female; Fluorescein Angiography; Follow-Up Studies; Free Tissue Flaps; Fundus Oculi; Humans; Male; Retinal Perforations; Retinal Pigment Epithelium; Time Factors; Transplantation, Autologous; Treatment Outcome; Visual Acuity; Vitrectomy; Wet Macular Degeneration
PubMed: 29210941
DOI: 10.1097/IAE.0000000000001914 -
BMC Ophthalmology Mar 2021To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).
BACKGROUND
To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).
METHODS
This retrospective study enrolled 10 patients who underwent vitrectomy for MHs caused by laser injury. Best corrected visual acuity (BCVA), macular spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were used for assessment.
RESULTS
Four patients were injured by unexpected expose of an yttrium aluminum garnet (YAG) laser, and six patients were accidentally injured by a handheld laser. The MH minimum diameters (MDs) ranged from 55 to 966 μm (mean = 548.00 ± 286.10 μm), and BCVA ranged from 20/400 to 20/50 (mean = logMAR 0.87 ± 0.29) preoperatively. All 10 eyes underwent PPV, internal limiting membrane (ILM) peeling, and gas tamponade. All eyes demonstrated closure of the MH with different degrees of discontinuity of the outer layer of the retina, and four eyes exhibited serious retinal pigment epithelium (RPE) destruction. Postoperative BCVA values were significantly improved (mean = logMAR 0.55 ± 0.33; P = 0.032, t = 2.234). The mean BCVA of the destroyed RPE group was significantly worse than that of the non-destroyed RPE group both before and after surgery (P = 0.019; Wilcoxon signed rank test). Further, OCTA indicated choroidal ischemia in the laser-induced MHs.
CONCLUSION
Vitrectomy can be successful in closing laser-induced full-thickness MHs and improving visual acuity. However, If RPE/choroid is involved in laser damage in addition to the outer retinal layer, this may indicate poor visual prognosis.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 33714272
DOI: 10.1186/s12886-021-01893-8 -
The British Journal of Ophthalmology Jun 1995
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The Cochrane Database of Systematic... Feb 2012A giant retinal tear is a full-thickness retinal break that extends circumferentially around the retina for 90 degrees or more in the presence of a posteriorly detached... (Review)
Review
BACKGROUND
A giant retinal tear is a full-thickness retinal break that extends circumferentially around the retina for 90 degrees or more in the presence of a posteriorly detached vitreous. It causes significant visual morbidity from retinal detachment and proliferative vitreoretinopathy. The fellow eye of patients who have had a spontaneous giant retinal tear has an increased risk of developing a giant retinal tear, a retinal detachment or both. Interventions such as 360-degree encircling scleral buckling, 360-degree cryotherapy and 360-degree laser photocoagulation have been advocated by some ophthalmologists as prophylaxis for the fellow eye against the development of a giant retinal tear and/or a retinal detachment, or to prevent its extension.
OBJECTIVES
To evaluate the effectiveness of prophylactic 360-degree interventions in the fellow eye of patients with unilateral giant retinal tear to prevent the occurrence of a giant retinal tear, a retinal detachment or both.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 11), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 December 2011. In addition, we searched the proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) up to 2008 for information about other relevant studies.
SELECTION CRITERIA
Prospective randomised controlled trials (RCTs) comparing one prophylactic treatment for fellow eyes of patients with giant retinal tear against observation (no treatment) or another form of prophylactic treatment. In the absence of RCTs, we planned to discuss case-control studies that met the inclusion criteria but we would not conduct a meta-analysis using these studies.
DATA COLLECTION AND ANALYSIS
We did not find any studies that met the inclusion criteria for the review and therefore no assessment of methodological quality or meta-analysis could be performed.
MAIN RESULTS
No studies met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
No strong evidence in the literature was found to support or refute prophylactic 360-degree treatments to prevent a giant retinal tear or a retinal detachment in the fellow eye of patients with unilateral giant retinal tears.
Topics: Humans; Retinal Detachment; Retinal Perforations
PubMed: 22336825
DOI: 10.1002/14651858.CD006909.pub3