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Acta Ophthalmologica Jun 2018To investigate the incidence of full-thickness macular holes (FTMHs) and their morphological features according to the International Vitreomacular Traction Study (IVTS)...
PURPOSE
To investigate the incidence of full-thickness macular holes (FTMHs) and their morphological features according to the International Vitreomacular Traction Study (IVTS) classification.
METHODS
The clinical records of all new patients with FTMH, referred between 2008 and 2014, were reviewed for demographics, cause of the FTMH, age at diagnosis, symptom duration, laterality, visual acuity (VA), axial length and lens status. A detailed analysis of the patients' spectral domain optical coherence tomography (SD-OCT) images was performed, and the primary FTMHs were classified in clinical stages according to the IVTS classification. From the SD-OCT, accurate macula drawings were made by means of a computer-drawing software. By merging these drawings and displaying them as colour-coded maps, the morphology and shape of the FTMH were visualized.
RESULTS
The study included 177 eyes (152 primary and 25 secondary FTMH) in 166 patients. In primary FTMH, the male-to-female ratio was 1:2.2. The age- and gender-adjusted annual incidences of primary FTMH were 7.9 eyes and 7.4 individuals per 100 000 inhabitants. Mean primary FTMH minimum linear diameter (MLD) and basal diameter (BD) were 435 μm and 872 μm, respectively, and 13% were classified as small, 31% as medium and 55% as large. Vitreomacular traction (VMT) and epiretinal membrane (ERM) were present in 34% and 36% of the eyes, respectively.
CONCLUSION
This study provides data on the incidence rates of FTMH adjusted to different standard populations. The morphological analysis and novel computational visualization technique offer new insight into the structural complexity of FTMH and how VMT and ERM significantly influence FTMH configuration.
Topics: Aged; Female; Follow-Up Studies; Humans; Incidence; Macula Lutea; Male; Middle Aged; Norway; Retinal Perforations; Retrospective Studies; Time Factors; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 29197164
DOI: 10.1111/aos.13618 -
Ophthalmologica. Journal International... 2014Since Kelly and Wendel [Arch Ophthalmol 1991;109:654-659] first reported successfully treating macular holes (MHs) using pars plana vitrectomy in 1991, MH surgery has... (Review)
Review
Since Kelly and Wendel [Arch Ophthalmol 1991;109:654-659] first reported successfully treating macular holes (MHs) using pars plana vitrectomy in 1991, MH surgery has been constantly improved. For example, introducing the removal of the internal limiting membrane considerably increased the closure rate of MHs, and the advent of microincision vitrectomy surgery reduced surgical trauma and decreased patient discomfort after surgery. As modern MH surgery can achieve a higher anatomical success rate and alleviate patients' postoperative distress, postoperative visual outcomes have lately become the primary concern. Informing patients of the expected visual acuity and visual improvement before surgery is ideal, but predicting postoperative visual outcomes is difficult because a large number of factors are associated with them. In this paper, we review previous studies and provide accumulating evidence for the relationship between individual prognostic factors and visual outcomes after MH surgery.
Topics: Endotamponade; Humans; Prognosis; Prone Position; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 24296852
DOI: 10.1159/000355492 -
Eye (London, England) Nov 2021To determine the demographic profile, clinical features and surgical outcomes of giant retinal tear (GRT) related retinal detachments (RD) in children.
OBJECTIVE
To determine the demographic profile, clinical features and surgical outcomes of giant retinal tear (GRT) related retinal detachments (RD) in children.
METHODS
In this retrospective study, medical records of children aged 14 years and below, who underwent surgery for RD at our centre in the last 5 years were reviewed. Among these, we selected medical records of children with RDs with GRT, and examined the coloured retinal drawings, ultrawidefield photographs and/or surgical videos.
RESULTS
Out of 1536 medical records, 91 eyes of 87 children (5.6% of all RDs) were included. Mean age was 10.21 ± 3.08 years with male:female ratio of 8.6:1. The most common aetiologies for GRTs were high myopia (28 cases-32.18%) and trauma (25 cases-28.73%). Bilateral RD were possibly present in 29/87 (33.3%) cases. Six months follow up data was available for 82/91 eyes. Overall retinal re-attachment was achieved in 52/82 (63.41%) eyes; in 33/82 (40.24%) eyes retinal attachment could be achieved by a single surgery. Absence of proliferative vitreoretinopathy (PVR) (OR: 2.44, p-value:0.03, 95%CI: 1.21-5.08) or PVR-A (OR: 3.62, p-value: 0.03, 95%CI: 1.52-12.26) and presence of preexisting posterior vitreous detachment (OR: 7.14, p-value: 0.02, 95%CI: 1.31-38.73) were associated with successful retinal re-attachment after single surgery. Median time to presentation of cases succeeding after 1 surgery was 10 days. Ambulatory vision (1/60 and better) at final followup could be achieved in 45/82 (54.88%) eyes.
CONCLUSION
GRT relatedRDs constitute a significant proportion of paediatric RDs. Anatomical success can currently be achieved in a large number of cases. Early surgery, absence of PVR and presence of PVD are associated with higher surgical success.
Topics: Adolescent; Child; Demography; Female; Humans; Male; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Treatment Outcome
PubMed: 34117398
DOI: 10.1038/s41433-021-01621-y -
Scientific Reports Jan 2024Even after idiopathic macular hole (MH) surgery and with successful closure of MH, aniseikonia is a common postoperative symptom. We investigated the correlation of MH...
Even after idiopathic macular hole (MH) surgery and with successful closure of MH, aniseikonia is a common postoperative symptom. We investigated the correlation of MH diameter, retinal displacement and retinal layer thicknesses with aniseikonia in 41 eyes of 41 patients undergoing MH surgery with internal limiting membrane peeling. Aniseikonia was measured with the New Aniseikonia Test. Retinal displacement (RD%) was defined as change of retinal distance between the temporal margin of the optic papilla and the intersection of the retinal vessels. Changes of thicknesses of the inner nuclear layer (INL%) and the outer retinal layer (OR%) were calculated. Aniseikonia improved postoperatively. Preoperative aniseikonia and their improvement at 6 months correlated with MH diameters (P = 0.004-0.046). Improvement of aniseikonia correlated with temporal RD% (P = 0.002-0.012). Improvement of vertical aniseikonia correlated with INL% at 2 weeks and with the nasal OR% at 1, 3, and 6 months (P = < 0.001-0.028). MH diameter and age were significant predictors for improvement of aniseikonia. The greater the temporal retina displacement, and the thinner the postoperative INL and OR, the greater the improvement of aniseikonia. MH diameter and age are strong predictors for improvement of aniseikonia after MH surgery.
Topics: Humans; Retinal Perforations; Aniseikonia; Epiretinal Membrane; Visual Acuity; Vitrectomy; Tomography, Optical Coherence; Retina; Retrospective Studies
PubMed: 38168792
DOI: 10.1038/s41598-023-51032-0 -
Graefe's Archive For Clinical and... Jun 2018
Topics: History, 19th Century; History, 20th Century; Humans; Ophthalmologic Surgical Procedures; Ophthalmology; Retinal Detachment; Retinal Perforations; Switzerland
PubMed: 29704064
DOI: 10.1007/s00417-018-3999-4 -
BMC Ophthalmology Oct 2023Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in...
BACKGROUND
Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in vivo studies. However, the clinical toxic effect of ICG during macular surgery has not been functionally evaluated. In this study, we evaluated functional and structural changes in retinal sensitivity and retinal thickness associated with ICG toxicity using microperimetry before and after ICG-assisted ILM peeling in patients with macular holes.
METHODS
ICG staining was performed only on the macular area below the horizontal line connecting the fovea and optic disc. ILM peeling was performed over the entire macular area inside the vascular arcade. Visual acuity assessment, spectral domain optical coherence tomography, and microperimetry were performed at baseline and one, three, and six months postoperatively. The mean retinal sensitivity of four macular areas was calculated and analyzed.
RESULTS
Eleven eyes were included. Macular holes were successfully closed in all patients. Six months postoperatively, retinal sensitivity improved insignificantly in Area 1 (ICG-/ILM-) and Area 2 (ICG-/ILM+) but decreased in Area 4 (ICG+/ILM-). Three months postoperatively, retinal sensitivity significantly decreased in Area 3 (ICG+/ILM+; 26.63 ± 1.80 vs. 25.52 ± 2.08 dB, p = 0.036). However, the statistical significance of this result was lost six months after the surgery (p = 0.059). The change of Gc-IPL thickness in Area 3 was significantly different compared to Area 2 at post-operative 3- and 6-months (p = 0.01, 0.05).
CONCLUSIONS
Retinal sensitivity decreased three months after ICG-assisted ILM peeling. However, the statistical significance was lost six months after surgery. ICG staining can be performed with caution during macular hole surgery.
Topics: Humans; Indocyanine Green; Retinal Perforations; Retrospective Studies; Coloring Agents; Vitrectomy; Staining and Labeling; Retina; Epiretinal Membrane; Basement Membrane
PubMed: 37875860
DOI: 10.1186/s12886-023-03161-3 -
Ophthalmology Dec 1997Retinal detachment complicates the course of cytomegalovirus (CMV) retinitis in nearly 30% of human immunodeficiency virus-infected patients. The study goal was to...
OBJECTIVE
Retinal detachment complicates the course of cytomegalovirus (CMV) retinitis in nearly 30% of human immunodeficiency virus-infected patients. The study goal was to evaluate laser photocoagulation in the treatment of CMV retinitis-related retinal detachments and retinal tears.
DESIGN
Nonrandomized, observational cohort study.
PARTICIPANTS
Sixty-three patients with CMV retinitis-related retinal detachments and nine patients with peripheral retinal tears in eyes with CMV retinitis were studied.
INTERVENTION
Of the 63 eyes with retinal detachment, 23 patients were treated with demarcating laser photocoagulation, 24 patients underwent vitrectomy with silicone oil, and 16 patients were observed without treatment. All nine patients with peripheral retinal tears received laser photocoagulation.
MAIN OUTCOME MEASURES
Time to progression of retinal detachment, final visual acuity, and need for vitrectomy surgery were studied.
RESULTS
Median time to progression of the retinal detachment in the laser-treated patients was 175 days versus 39 days in observed patients (P = 0.012). Both initial (P < 0.001) and final (P = 0.005) visual acuities were better in the patients with laser-treated detachment than in the observed or vitrectomy patients. The retinal detachment groups were comparable in follow-up, zone and location of detachment, and size of holes, but the vitrectomy and observed groups had more cases with extensive CMV retinitis. Vitrectomy surgery was required in 9 of 16 (56%) in the observed group and 7 of 23 (30%) in the laser group. Two of nine patients (22%) who failed to respond to laser treatment for retinal breaks required vitrectomy surgery.
CONCLUSIONS
Laser photocoagulation of selected retinal detachments and retinal tears delayed or avoided vitrectomy with silicone oil. It may be an important treatment modality for patients with nonmacular detachments and for those who are receiving local anti-CMV therapy with intravitreal injections or pellets, in whom silicone oil may affect the efficacy of the local treatment.
Topics: AIDS-Related Opportunistic Infections; Adult; Cohort Studies; Cytomegalovirus Retinitis; Disease Progression; Female; Humans; Laser Coagulation; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 9400765
DOI: 10.1016/s0161-6420(97)30059-1 -
BMC Ophthalmology Jul 2020Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this...
BACKGROUND
Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this study, we investigate the clinical characteristics, risk factors, and prognosis of total RRD.
METHODS
A retrospective chart review was performed on cases of 44 total RRD and an age- and sex-matched 88 partial RRD. Two groups were compared for clinical characteristics, risk factors, and prognosis.
RESULTS
The prevalence of total RRD in all cases of retinal detachment was 4.4%. Pseudophakic eye, ocular trauma, and proliferative vitreoretinopathy (PVR) were significantly associated with a risk of total RRD (P = .002, P = .003, and P < .001, respectively). In the total RRD group, retinal breaks were located in both superior and inferior parts of the retina, and macular holes and giant retinal tears were frequently found. The best-corrected visual acuity (log MAR) before surgery and final best-corrected visual acuity after surgery were 2.23 ± 0.45 and 1.88 ± 0.96, which was significantly poorer than in the partial RRD group (P < .001). The success rate after primary surgery was 75.0% in the total RRD group, which was significantly lower than partial RRD group (P < .001). Old age, pseudophakic eye, and macular hole as the type of retinal break were highly associated with low success rate. (P = .010, P = .0500, and P = .002).
CONCLUSIONS
Patients with total RRD had higher recurrence rate and poorer visual outcome after surgery than patients with focal RRD. Old age, pseudophakic eye, and presence of macular hole were important risk factors for recurrence after total RRD repair. Additional surgical procedures should be considered to combine with vitrectomy to achieve better surgical outcomes in these patients.
Topics: Case-Control Studies; Humans; Prognosis; Retinal Detachment; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 32660545
DOI: 10.1186/s12886-020-01560-4 -
Acta Ophthalmologica Scandinavica Dec 2002Macular hole is a retinal disease primarily affecting elderly women. Its overall prevalence in the Danish population is estimated to be 0.14%. The majority of cases are... (Review)
Review
BACKGROUND
Macular hole is a retinal disease primarily affecting elderly women. Its overall prevalence in the Danish population is estimated to be 0.14%. The majority of cases are unilateral. The fully developed macular hole evolves through a series of stages starting with an impending hole. About half of impending macular holes regress spontaneously. The remaining half progress to full thickness macular holes. In a patient with a macular hole in one eye, the risk of development of a macular hole in the fellow eye is less than 2% if posterior vitreous detachment is present. If the posterior vitreous is attached, the risk is approximately 15%. If an impending hole is found in the other eye, the risk rises to 50%.
TREATMENT AND OUTCOMES
Macular hole surgery is able to close full thickness macular holes in approximately 90% of cases. Visual acuity of 20/50 or better can be obtained in approximately half of patients with recent onset of symptoms. Complications include retinal detachment, endophthalmitis, late reopening of an initially successfully closed hole and retinal pigment epithelial abnormalities. Retinal detachment should be expected in less than 5% of cases.
Topics: Denmark; Humans; Prevalence; Retinal Perforations; Risk Factors; Sex Distribution
PubMed: 12485276
DOI: 10.1034/j.1600-0420.2002.800605.x -
Korean Journal of Ophthalmology : KJO Jun 2021To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.
PURPOSE
To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.
METHODS
The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis.
RESULTS
Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD.
CONCLUSIONS
Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.
Topics: Humans; Retinal Hemorrhage; Retinal Perforations; Retrospective Studies; Rosaniline Dyes; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 34120419
DOI: 10.3341/kjo.2020.0124