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Asia-Pacific Journal of Ophthalmology... Jan 2021Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with... (Review)
Review
Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with success rates and limitations of different surgical techniques are reported.The pathogenesis, the definition and the management were clarified in a recent study(cit). The MTM Staging System (MSS) table summarizes all the stages of MTM offering insights on the pathogenesis and natural evolution of the disease.Guidelines of management of MTM were therefore proposed, but customized for each stage.Initial stages 1a and 2a, which define maculoschisis in the inner or inner-outer or only outer layers of the retina, should be observed. Stages 3a and 4a, defining macular detachment with and without associated schisis, should be treated with a macular buckle (MB).Stage 1b, which is a lamellar macular hole in a myopic eye, should be treated with pars plana vitrectomy (PPV) only in symptomatic cases. Stages 2b, 3b, and 4b should be treated with a MB and PPV should be added in a second step only if the presence of a lamellar macular hole requires intervention to improve visual function.Stage 1c, which is a full thickness macular hole in a myopic eye, should be treated with PPV. Stages 2c, 3c and 4c should be treated with a combination of simultaneous MB + PPV to treat both the retinal pattern of schisis or detachment and the full thickness macular hole.
Topics: Humans; Macular Degeneration; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity; Vitrectomy
PubMed: 33481391
DOI: 10.1097/APO.0000000000000347 -
Eye (London, England) Aug 2012To evaluate the visual and anatomical results of surgery for macular hole-related retinal detachment (MHRD) after phacoemulsification cataract extraction. (Review)
Review
PURPOSE
To evaluate the visual and anatomical results of surgery for macular hole-related retinal detachment (MHRD) after phacoemulsification cataract extraction.
METHODS
Data for all patients who underwent surgery for MHRD after phacoemulsification cataract extraction from 1 December 1998 to 30 September 2008 in one hospital were evaluated. Patient characteristics, best-corrected visual acuity (VA) preoperatively and at last examination, surgical technique, anatomical success, and follow-up period were extracted and analysed statistically.
RESULTS
A total of 13 625 eyes of 10 076 patients who had phacoemulsification cataract surgery were included. In the follow-up period, 10 cases of MHRD in nine patients were observed, of which seven eyes had high myopia. The mean axial length was 30.97 ± 1.36 mm (29.19, 32.97) and mean myopia was-19.35 ± 1.93 (-7.5,-3.5) dioptres. Overall anatomical success was achieved in 90% (9 out of 10 eyes). There was no statistically significant difference (P=0.240) between the logarithm of the MAR VA before the phacoemulsification cataract extraction and after MHRD surgical repair. VA increased in three eyes but decreased in the other seven after MHRD surgery.
CONCLUSIONS
As a primary procedure, vitreous surgery combined with other necessary adjunct procedures such as membrane peeling and retinal tamponade seems to be successful in achieving anatomical success. However, VA improvement is dependent on the type of macular lesion and not the surgical procedure.
Topics: Adult; Aged; Axial Length, Eye; Endotamponade; Female; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Pseudophakia; Retinal Detachment; Retinal Perforations; Retrospective Studies; Silicone Oils; Time Factors; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 22595907
DOI: 10.1038/eye.2012.87 -
Indian Journal of Ophthalmology Aug 2022Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI)...
PURPOSE
Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH).
METHODS
Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared.
RESULTS
Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16).
CONCLUSION
There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.
Topics: Choroid; Epiretinal Membrane; Eye Diseases; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35918960
DOI: 10.4103/ijo.IJO_440_22 -
Investigative Ophthalmology & Visual... Jul 2011When a patient suffers a retinal detachment and surgery is delayed, it is known clinically that bilaterally patching the patient may allow the retina to partially...
PURPOSE
When a patient suffers a retinal detachment and surgery is delayed, it is known clinically that bilaterally patching the patient may allow the retina to partially reattach or "settle." Although this procedure has been performed since the 1860s, there is still debate as to how such a maneuver facilitates the reattachment of the retina.
METHODS
Finite element calculations using commercially available analysis software are used to elucidate the influence of reduction in eye movement caused by bilateral patching on the flow of subretinal fluid in a physical model of retinal detachment.
RESULTS
It was found that by coupling fluid mechanics with structural mechanics, a physically consistent explanation of increased retinal detachment with eye movements can be found in the case of traction on the retinal hole. Large eye movements increase vitreous traction and detachment forces on the edge of the retinal hole, creating a subretinal vacuum and facilitating increased subretinal fluid. Alternative models, in which intraocular fluid flow is redirected into the subretinal space, are not consistent with these simulations.
CONCLUSIONS
The results of these simulations explain the physical principles behind bilateral patching and provide insight that can be used clinically. In particular, as is known clinically, bilateral patching may facilitate a decrease in the height of a retinal detachment. The results described here provide a description of a physical mechanism underlying this technique. The findings of this study may aid in deciding whether to bilaterally patch patients and in counseling patients on pre- and postoperative care.
Topics: Bandages; Binomial Distribution; Finite Element Analysis; Humans; Models, Biological; Retinal Detachment; Retinal Perforations; Subretinal Fluid
PubMed: 21666245
DOI: 10.1167/iovs.11-7249 -
Indian Journal of Ophthalmology Aug 2022To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.
PURPOSE
To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.
METHODS
This is a retrospective study analyzing medical records of consecutive patients with refractory macular hole (at least 1 prior surgery) and eyes with retinal detachment with coexisting macular holes (MH). Optical coherence tomography (OCT) of the macula was performed before and after surgery. The primary study outcome evaluated were the functional and anatomic macular hole closure, and secondary outcomes were improvement in visual acuity and restoration of the outer retinal bands, external limiting membrane, and ellipsoid zone in eyes with acquisition of autologous retinal transplant using Finesse Loop.
RESULTS
The study included eight eyes of eight patients; retinal autograft was performed in six (75.0%) and autologous retinal transplantation (ART) with rhegmatogenous retinal detachment (RRD) was performed in two (25.0%) eyes. The average MH basal diameter in the study was 1310.88 ± 138.63 μm. The successful hole closure rate was observed to be 75% (6 eyes) and 100% retinal reattachment was observed in ART with RRD. Statistically significant (P = 0.001) improvement was noted for preop and postop visual acuity gain for ART acquisition and postop macular hole closure. The restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) was observed in 37.5% (3 eyes) of patients.
CONCLUSION
Finesse™ Flex Loop can be used to harvest retinal tissue and it provides good anatomical and functional outcomes for failed macular hole.
Topics: Autografts; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35918967
DOI: 10.4103/ijo.IJO_3215_21 -
Journal Francais D'ophtalmologie Mar 2023The treatment of refractory macular holes is controversial, with human amniotic membrane grafts emerging recently as an attractive option. We performed a meta-analysis... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The treatment of refractory macular holes is controversial, with human amniotic membrane grafts emerging recently as an attractive option. We performed a meta-analysis and systematic review in this paper to assess the results of human amniotic membrane (hAM) in the treatment of refractory macular hole (MH).
METHODS
We searched the Cochrane Database of Systematic Reviews, Web of Science, PubMed, Embase, China National Knowledge Infrastructure databases, VIP database, Wanfang Data Knowledge Service Platform, Sinomed, Chinese Clinical Trial Registry, and Clinical Trials.gov. Studies reporting hAM for the treatment of refractory MH were included. The outcomes are MH closure rate, visual acuity (VA) improvement rate, and graft dislocation/contracture rate.
RESULTS
A total of 8 studies on 103 eyes were included, all of which had undergone failed vitrectomy and internal limiting membrane (ILM) peeling. In all studies, the VA improvement rate was 66% (95%CI: 45 to 84%), the MH closure rate was 94% (95%CI: 84 to 100%) and the hAM graft dislocation/contracture rate was 6% (95%CI: 0 to 15%). In the studies using cryopreserved hAM grafts, the MH closure rate was 99% (95%CI: 94 to 100%) and the hAM graft dislocation/contracture rate was 3% (0%, 10%). The VA improvement rates were 94% (95%CI: 79 to 100%) in the retinal detachment subgroup, 37% (95%CI: 20 to 56%) in the pathologic myopia subgroup, and 62% (95%CI: 14 to 100%) in the idiopathic MH subgroup.
CONCLUSION
Human amniotic membrane in the treatment of refractory MH results in visual improvement. It has a high macular hole closure rate and low dislocation/contracture rate. Cryopreserved hAM grafts might have better outcomes than dehydrated grafts.
Topics: Humans; Amnion; Basement Membrane; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 36739260
DOI: 10.1016/j.jfo.2022.07.001 -
Indian Journal of Ophthalmology Dec 2018Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm... (Review)
Review
Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm shift to the understanding of myopic macula, thereby helping in objective evaluation of the various manifestation of traction maculopathy. Staphyloma evaluation by ultrasound, wide-field fundus photography, and MRI scans along with OCT has led to the resurgence of MB surgery in the treatment of myopic traction maculopathy (MTM). Various surgical techniques with different buckle materials are being performed with encouraging anatomical and functional success rates. This article reviews the literature to explain the current concept of MB surgery based on its evolution, different kinds of buckle materials, rationale for planning MB surgery, and different surgical techniques for the management of MTM.
Topics: Humans; Macula Lutea; Myopia, Degenerative; Retinal Perforations; Retinoschisis; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 30451177
DOI: 10.4103/ijo.IJO_1126_18 -
Asia-Pacific Journal of Ophthalmology... Sep 2021
Topics: Animals; Humans; Jaw; Retinal Perforations; Sharks
PubMed: 34524138
DOI: 10.1097/APO.0000000000000412 -
Turkish Journal of Ophthalmology Apr 2022To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
OBJECTIVES
To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.
MATERIALS AND METHODS
Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.
RESULTS
The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients' median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).
CONCLUSION
Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.
Topics: Child, Preschool; Endotamponade; Female; Humans; Inflammation; Male; Prospective Studies; Retinal Detachment; Retinal Perforations; Retrospective Studies; Silicone Oils; Uveal Diseases; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 35481733
DOI: 10.4274/tjo.galenos.2021.83648 -
Eye (London, England) Jul 2014Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished... (Review)
Review
Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey-from initial referral to treatment-taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.
Topics: Critical Pathways; Delivery of Health Care; Disease Management; Fibrinolysin; Humans; Peptide Fragments; Practice Guidelines as Topic; Retinal Perforations; Vitrectomy; Vitreous Detachment
PubMed: 25008433
DOI: 10.1038/eye.2014.125