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Ophthalmic Surgery, Lasers & Imaging... Oct 2023
Topics: Humans; Retinal Perforations; Vitreous Hemorrhage; Retina; Epiretinal Membrane; Lasers; Vitrectomy; Basement Membrane; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37847162
DOI: 10.3928/23258160-20230919-01 -
JAMA Ophthalmology Mar 2020Autologous retinal transplant is a recently described treatment modality for myopic and other refractory macular holes (MH). Establishment of blood supply may influence...
IMPORTANCE
Autologous retinal transplant is a recently described treatment modality for myopic and other refractory macular holes (MH). Establishment of blood supply may influence survival of a transplanted tissue. However, there are currently no reports on the vascular status of a transplanted retinal graft.
OBJECTIVE
To report on vascularization and reperfusion of autologous retinal graft after transplant for giant MHs demonstrated by multimodal imaging.
DESIGN, SETTING, PARTICIPANTS
Two patients with giant MH (basal diameter ≥2000 μm) who underwent autologous retinal transplant at Retina-Vitreous Associates Medical Group in Los Angeles, California, in June 2018 and February 2019, respectively, were included.
MAIN OUTCOMES AND MEASURES
Status of MH, Snellen visual acuity, optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography findings.
RESULTS
Two eyes of 2 female patients were included. The mean age was 68.5 years. Baseline visual acuity was counting fingers and 20/200, and MHs measured 3441 μm and 2387 μm, respectively. Six weeks postoperatively, MHs were closed and the superficial inner retina blood vessels within the graft appeared perfused. Optical coherence tomography and optical coherence tomography angiography demonstrated early integration of the graft into the surrounding retina and perfused graft vasculature in both patients. Fluorescein angiography confirmed perfusion of retinal graft. At the last follow-up, visual acuity was 20/200 and 20/150, respectively, the MH was closed, and the retinal grafts were perfused.
CONCLUSIONS AND RELEVANCE
Autologous neurosensory retinal transplant may be used for the treatment of giant MHs. Vascularization and reperfusion of the retinal graft is observed within 6 weeks of transplant. It is hypothesized that visual improvement occurs as a result of flattening of the MH rim, partial centripetal migration of MH edges during the early healing phase, and further centripetal migration in the later phase associated with the shrinkage of the retinal graft.
Topics: Aged; Female; Fluorescein Angiography; Humans; Recovery of Function; Retina; Retinal Perforations; Retinal Vessels; Tomography, Optical Coherence; Transplantation, Autologous; Treatment Outcome; Visual Acuity
PubMed: 31944234
DOI: 10.1001/jamaophthalmol.2019.5733 -
BMC Ophthalmology Jul 2018To describe the patterns and outcomes of contusion maculopathy after ocular contusions resulting from accidental impact with sporting equipment.
BACKGROUND
To describe the patterns and outcomes of contusion maculopathy after ocular contusions resulting from accidental impact with sporting equipment.
METHODS
We conducted a retrospective study of interventional case series.
PATIENT POPULATION
Twenty-one eyes of 21 patients who sustained blunt ocular trauma while playing a sport. Intervention/Observation Procedure(s): Surgery or observation by optical coherence tomography (OCT).
MAIN OUTCOME MEASURE(S)
The morphologic changes within the macula in the early stages after injury and changes in visual function in the early and recovery stages after injury.
RESULTS
In the early stage, OCT visualized four injury patterns: type Ι, commotio retinae (14.3%, 3 eyes) with increased reflectivity of the ellipsoid zone and retinal pigment epithelium; type II, incomplete macular hole(38.1%, 8 eyes) with three structural changes, i.e., a partial V-shaped macular hole, a jar-shaped macular hole with retinal tissue at the bottom, and a connective bridge attached to retinal tissues; type III, full-thickness macular hole (33.3%, 7 eyes); and type IV, foveal hemorrhage (14.3%, 3 eyes). During recovery, OCT images of types Ι and II showed almost normal macular morphology with better visual acuity (mean ± SD,0.02 ± 0.1 and 0.14 ± 0.21logMAR.). In types III and IV, the visual prognosis was poor (0.52 ± 0.34 and 0.22 ± 0.16), OCT images showed retinal atrophy at the fovea despite vitrectomy and sulfur hexafluoride (SF6) gas tamponade.
CONCLUSION
Early OCT images identified four patterns of contusion maculopathy with different treatment outcomes. In types Ι and II, the visual function and retinal morphology remained intact. With types III and IV, respectively, the treatments of vitrectomy and SF6 gas tamponade for patients were effective.
Topics: Adolescent; Adult; Athletic Injuries; Child; Contusions; Equipment Design; Eye Injuries; Female; Humans; Macula Lutea; Male; Middle Aged; Retinal Perforations; Retinal Pigment Epithelium; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy; Young Adult
PubMed: 30012105
DOI: 10.1186/s12886-018-0843-x -
Acta Ophthalmologica Jun 2016To evaluate the impact of postoperative posturing with or without face-down on the anatomical and functional outcomes of macular hole surgery. (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To evaluate the impact of postoperative posturing with or without face-down on the anatomical and functional outcomes of macular hole surgery.
METHODS
A literature-based meta-analysis was conducted to identify studies relevant to posturing following macular hole surgery (MHS). PubMed and Web of Science databases were used to retrieve articles up to 1 June 2015. The primary measures included MH closure and ideal vision acuity improvement. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated in Review Manager.
RESULTS
Four randomized control trials (RCTs) comprising 251 cases were included in the final meta-analysis. No face-down posturing (FDP) after MHS revealed lower anatomic success rate compared to face-down posturing (OR = 0.33, 95% CI [0.13, 0.81], p = 0.02). For holes smaller than 400 μm in size, the subgroup meta-analysis indicated no significant effect of FDP on successful hole closure (OR = 0.29, 95% CI [0.01, 7.34], p = 0.45). However, when holes were larger than 400 μm, it seemed less effective on MH closure following surgery in no FDP group (OR = 0.23, 95% CI [0.07, 0.71]), and this was statistically significant (p = 0.01).
CONCLUSIONS
Our work found that no FDP was not inferior to its face-down counterpart for the success of MHS when macular holes were smaller than 400 μm in size. For macular holes larger than 400 μm, statistical analysis proved that FDP might be necessary. More well-conducted randomized control trials are needed to verify our findings.
Topics: Endotamponade; Fluorocarbons; Humans; Prone Position; Retinal Perforations; Vitrectomy
PubMed: 26385613
DOI: 10.1111/aos.12844 -
Acta Ophthalmologica Sep 2011To evaluate the functional and anatomical outcome of patients undergoing autologous transplant of retinal pigment epithelium (RPE) and choroid after RPE tear secondary...
PURPOSE
To evaluate the functional and anatomical outcome of patients undergoing autologous transplant of retinal pigment epithelium (RPE) and choroid after RPE tear secondary to age-related macular degeneration (AMD).
METHODS
Data from nine eyes of nine patients were analysed retrospectively. Examinations included fluorescein and indocyanine green angiography, fundus autofluorescence imaging, optical coherence tomography, microperimetry and determination of visual acuity (far and reading ability). Data regarding intraoperative and postoperative complications were recorded. Mean follow-up time was 18 months (range 4 months to 5 years).
RESULTS
After surgery, far visual acuity improved or remained stable (±3 lines) in three of nine eyes and for the near visual acuity in three of nine eyes. Visual acuity decreased postoperatively at the last follow-up in four eyes mainly because of postoperative complications, i.e. retinal detachment due to proliferative vitreoretinopathy, retinal artery occlusion, pucker and fibrosis of the graft. In one case, retinal stimuli were restored over the scotoma as seen in microperimetry.
CONCLUSION
Autologous transplant of RPE and choroid is a therapy option for RPE tears. Retinal stimuli can be restored in selected cases. Numerous intra- and postoperative complications compromise the functional prognosis and outcome.
Topics: Aged; Choroid; Coloring Agents; Endotamponade; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Indocyanine Green; Intraoperative Complications; Macular Degeneration; Male; Postoperative Complications; Retina; Retinal Perforations; Retinal Pigment Epithelium; Retrospective Studies; Subretinal Fluid; Tomography, Optical Coherence; Transplantation, Autologous; Visual Acuity; Visual Field Tests
PubMed: 21410906
DOI: 10.1111/j.1755-3768.2011.02143.x -
Medicine Nov 2022To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective...
To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective study included 25 patients diagnosed with IMH in Shanxi eye hospital from August 2019 to December 2021. The study was divided into 3 groups: IMH eyes, fellow eyes and normal eyes. All unilateral IMH eyes underwent vitrectomy. There were significant differences in superficial retinal blood flow density (SRBFD, P < .001) and choroidal blood flow density (CBFD) between IMH and healthy control eyes before operation (P < .05). There was significant difference in SRBFD between fellow eyes and normal eyes (P = .038). The changes of SRBFD and CBFD in IMH eyes before and after operation were statistically significant (P < .05). The CBFD at 6 months after operation is negatively correlated with LogMAR visual acuity, and the CBFD of the fellow eye is also negatively correlated with LogMAR visual acuity. The SRBFD and CBFD had no correlation with the diameter of macular hole before and after operation. SRBFD and CBFD increased after vitrectomy, indicating that the blood supply of retina and choroid were partially restored after vitrectomy. There was no correlation between SRBFD, CBFD and hole diameter, but there was correlation between choroidal blood flow and LogMAR visual acuity.
Topics: Humans; Retinal Perforations; Tomography, Optical Coherence; Prospective Studies; Angiography; Choroid
PubMed: 36451457
DOI: 10.1097/MD.0000000000031862 -
Translational Vision Science &... Oct 2022To evaluate the repeatability of macular hole (MH) diameter measurement on en face slab optical coherence tomography (OCT) reflectance images and assess its potential to...
PURPOSE
To evaluate the repeatability of macular hole (MH) diameter measurement on en face slab optical coherence tomography (OCT) reflectance images and assess its potential to predict visual acuity (VA).
METHODS
We enrolled 27 eyes with full-thickness MHs in this study. Preoperative en face slab OCT reflectance images were obtained. Image binarization, ellipse approximation, and uncorrected measurement of minimum diameter, min(ef_uc), and maximum diameter, max(ef_uc), were performed using ImageJ. In addition, magnification-corrected diameters were calculated as min(ef) and max(ef) using the Littman and modified Bennett formulas. Spectral-domain OCT horizontal images were used as the conventional method for the analysis: min(conv) and max(conv). The inter-rater reliability of the method was evaluated by calculating the intraclass correlation coefficient (ICC). The following relationships were analyzed: (1) between logMAR VA and min(ef_uc), min(ef), and min(conv); and (2) between logMAR VA and max(ef_uc), max(ef), and max(conv).
RESULTS
The min(ef) and max(ef) values were 439.4 ± 240.5 µm and 720.7 ± 346.1 µm, respectively. The ICC values were 0.985 and 0.999 for min(ef) and max(ef), and 0.885 and 0.909 for min(conv) and max(conv), respectively. Multivariate analysis suggested that min(ef), but not min(ef_uc) or min(conv), was associated with pre- and postoperative logMAR VA. Furthermore, max(ef), but not max(ef_uc) or max(conv), was also closely correlated with pre- and postoperative logMAR VA.
CONCLUSIONS
The MH diameter measured by our method is highly reproducible and closely associated with VA compared to that measured by the conventional method.
TRANSLATIONAL RELEVANCE
The MH diameter measured by this modality might serve as an accurate biomarker to predict visual function in eyes with MH.
Topics: Humans; Reproducibility of Results; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity
PubMed: 36201199
DOI: 10.1167/tvst.11.10.13 -
The British Journal of Ophthalmology Jan 2023To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN)...
AIMS
To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP).
METHODS
In this multicentre retrospective cohort study, a total of 330 MH eyes with 1082 optical coherence tomography (OCT) images and 3300 clinical data enrolled from four ophthalmic centres were used to train, validate and externally test the DL and MDFN models. 266 eyes from three centres were randomly split by eye-level into a training set (80%) and a validation set (20%). In the external testing dataset, 64 eyes were included from the remaining centre. All eyes underwent macular OCT scanning at baseline and 1 month after VILMP. The area under the receiver operated characteristic curve (AUC), accuracy, specificity and sensitivity were used to evaluate the performance of the models.
RESULTS
In the external testing set, the AUC, accuracy, specificity and sensitivity of the MH aetiology classification model were 0.965, 0.950, 0.870 and 0.938, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative MH status prediction model were 0.904, 0.825, 0.977 and 0.766, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative idiopathic MH status prediction model were 0.947, 0.875, 0.815 and 0.979, respectively.
CONCLUSION
Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH.
Topics: Humans; Retinal Perforations; Retrospective Studies; Deep Learning; Visual Acuity; Vitrectomy; Tomography, Optical Coherence
PubMed: 34348922
DOI: 10.1136/bjophthalmol-2021-318844 -
BMC Ophthalmology Nov 2022The goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral...
PURPOSE
The goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral laser photocoagulation retinopexy.
METHODS
Patients with retinal breaks, retinal holes, retinal dialysis, and lattice degenerations who required peripheral laser photocoagulation retinopexy were recruited in this prospective case series investigation. We performed preoperative and postoperative evaluations, including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) measurement, funduscopic examination, and macular and ONH optical coherence tomography (OCT).
RESULTS
Thirty-three eyes of the twenty-three patients enrolled in this study, 14 of which were female. The mean age of the sample was 45.12 ± 9.12 years. The mean refractive error was - 2.45 ± 1.12 Diopters (D). The most prevalent reason for peripheral laser photocoagulation retinopexy was retinal thinning with symptomatic lattice degeneration (90%), followed by retinal hole and break (7%) and retinal dialysis (3%). Between preoperative and postoperative (6-month) evaluation, there was no statistically significant difference in BCVA (P = 0.82), IOP (P = 0.54), central foveal thickness in macular OCT (P = 0.39), or global retinal nerve fiber layer (RNFL) thickness (P = 0.51). There was no association between changes in central foveal thickness and global RNFL thickness and total laser spot numbers (r = - 0.17 P = 0.21, r = 0.06 P = 0.60, respectively). None of patients developed cystoid macular edema (CME) or macular epiretinal membrane (ERM) .
CONCLUSION
We found that OCT parameters were not significantly affected by laser retinopexy in patients with high-risk peripheral retinal lesions, also none of our patients had developed ERM, vitromacular traction or CME at 6 months follow up periods.
Topics: Humans; Female; Adult; Middle Aged; Male; Retinal Perforations; Visual Acuity; Macular Edema; Laser Coagulation; Epiretinal Membrane; Nerve Fibers
PubMed: 36434550
DOI: 10.1186/s12886-022-02681-8 -
Indian Journal of Ophthalmology Oct 2022
Topics: Humans; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 36190057
DOI: 10.4103/ijo.IJO_1732_22