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Arya S, Akduman L, Saxena S. Surgery for macular hole with retinal detachment: An enigma. Indian J Ophthalmol 2023; 71:2308-2309. [PMID: 37202989 PMCID: PMC10391439 DOI: 10.4103/ijo.ijo_247_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Shilpi Arya
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
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2
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Tyagi M, Sahoo NK, Belenje AS, Desai A. Fovea sparing internal limiting membrane peeling for idiopathic macular holes—Report of unfavourable outcomes of a surgical technique. Eur J Ophthalmol 2022; 33:1467-1472. [PMID: 36524252 DOI: 10.1177/11206721221145052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To describe the outcomes of fovea-sparing internal limiting membrane peeling for idiopathic macular holes. Method This was a prospective, interventional case series in patients with idiopathic macular holes. Patients underwent fovea-sparing internal limiting membrane (ILM) peeling with the help of a finesse loop. The primary outcome measure was successful anatomical closure. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) or any surgical complications. Results The study included 22 eyes of 22 patients (median age of 61 (IQR 58 to 66) years). The median basal diameter of the holes was 1054 (IQR 961.5 to 1278) microns, while the median minimal linear diameter was 697 (IQR 461.5 to 786) microns. Successful anatomic closure was achieved in nine cases out of 22 (40.9%). BCVA improved from 20/125 preoperatively to 20/80 at the end of the follow-up. There was no difference in baseline parameters between eyes with closure, versus eyes with an open hole. One eye had an iatrogenic break in an attempt to reinitiate peeling and create a fovea-sparing flap. One of the eyes had an ERM formation at end of 3 months. Conclusion Our outcomes of fovea-sparing ILM peeling in idiopathic macular holes were unfavourable. The residual ILM could be causing tangential traction resulting in non-closure.
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Affiliation(s)
- Mudit Tyagi
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Niroj Kumar Sahoo
- Department of Retina and Vitreous, LV Prasad Eye Institute, Vijayawada, India
| | - Akash S Belenje
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Arjun Desai
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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3
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Lee CY, Yang CM, Yang CH, Hu FR, Chen TC. Flap technique-assisted surgeries for advanced retinitis pigmentosa complicated with macular hole: a case report and literature review. BMC Ophthalmol 2021; 21:322. [PMID: 34488687 PMCID: PMC8422608 DOI: 10.1186/s12886-021-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Full-thickness macular hole (FTMH) is a rare complication in retinitis pigmentosa (RP) patients and may increase intraoperative challenges. Furthermore, lens capsular flap transplantation and inverted internal limiting membrane (ILM) flap were reported to close complicated FTMH successfully. Here, we present a case of bilateral advanced RP complicated by a FTMH treated with a novel lens capsular flap transplantation and inverted internal limiting membrane flap. Case presentation A 46-year-old presented to our hospital with a complaint of progressively blurred vision and metamorphopsia in both eyes. Spectral-domain optical coherence tomography revealed a FTMH with retinoschisis in the right eye and another FTMH in the left eye. ILM peeling with inverted ILM flap technique was performed on the right eye and ILM peeling with anterior lens capsular flap technique was performed on the left eye. Post-operative follow-up showed successful closure of the FTMH and improved vision in both eyes. Conclusions In our present case, flap-assisted techniques for retinitis pigmentosa with macular hole result in excellent visual and anatomic outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02082-3.
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Affiliation(s)
- Chia-Ying Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.
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4
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Parolini B, Palmieri M, Finzi A, Besozzi G, Frisina R. Myopic Traction Maculopathy: A New Perspective on Classification and Management. Asia Pac J Ophthalmol (Phila) 2021; 10:49-59. [PMID: 33481391 DOI: 10.1097/apo.0000000000000347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
ABSTRACT 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.
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Affiliation(s)
| | | | - Alessandro Finzi
- Policlinico St. Orsola-Malpighi, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | - Rino Frisina
- Department of Ophthalmology, University of Padova, Italy
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5
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Zhu K, Lei B, Wong W, Zhang J, Guo Y, Chen H, Song F, Chang Q, Xu G, Zhang Y. COMPARISON OF THE INTERNAL LIMITING MEMBRANE INSERTION TECHNIQUE AND THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE WITH VITRECTOMY TO TREAT MACULAR HOLE-ASSOCIATED RETINAL DETACHMENT. Retina 2021; 41:37-44. [PMID: 32310627 DOI: 10.1097/iae.0000000000002804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the anatomical and functional outcomes of macular hole (MH)-associated retinal detachment after vitrectomy with the internal limiting membrane (ILM) insertion technique or the inverted ILM flap technique. METHODS In this retrospective observational study, we reviewed the medical records of 49 eyes with MH-associated retinal detachment that underwent vitrectomy with the ILM insertion (26 eyes) or ILM flap (23 eyes) technique. RESULTS The MH closure rate at 12 months was greater in the ILM flap group versus the ILM insertion group (95% vs. 73%, respectively, P = 0.059). The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better in the ILM flap group (P = 0.014). All eyes (100%) showed an improvement in the BCVA of ≥0.3 logarithm of the minimum angle of resolution (15 Early Treatment Diabetic Retinopathy Study letters) in the ILM flap group versus 20 eyes (77%) in the ILM insertion group (P = 0.026). The preoperative BCVA and the ILM flap technique were significantly correlated with the postoperative BCVA (P = 0.028 and 0.027, respectively) and BCVA improvement (≥0.3 logarithm of the minimum angle of resolution [15 Early Treatment Diabetic Retinopathy Study letters]; P = 0.003 and 0.026, respectively). CONCLUSION The inverted ILM flap technique was more effective in improving the postoperative BCVA in patients with MH-associated retinal detachment when compared with the ILM insertion technique. The preoperative BCVA and the ILM flap technique were independent prognostic factors for visual outcomes in patients with MH-associated retinal detachment.
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Affiliation(s)
- Ke Zhu
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Boya Lei
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wenghang Wong
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Juan Zhang
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yue Guo
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Han Chen
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Fang Song
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yanqiong Zhang
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China ; and
- NHC Key Laboratory of Myopia, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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6
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Frisina R, Gius I, Palmieri M, Finzi A, Tozzi L, Parolini B. Myopic Traction Maculopathy: Diagnostic and Management Strategies. Clin Ophthalmol 2020; 14:3699-3708. [PMID: 33173268 PMCID: PMC7646438 DOI: 10.2147/opth.s237483] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than - 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology of University of Padova, Padova, Italy
| | - Irene Gius
- Department of Ophthalmology of University of Padova, Padova, Italy
| | | | | | - Luigi Tozzi
- Department of Ophthalmology of University of Padova, Padova, Italy
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Matsumae H, Morizane Y, Yamane S, Yanagisawa S, Sakurai T, Kobori A, Imai H, Kanzaki Y, Suzuki E, Kadonosono K, Hayashi A, Shiraga F, Kuriyama S. Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Peeling for Macular Hole Retinal Detachment in High Myopia. ACTA ACUST UNITED AC 2020; 4:919-926. [DOI: 10.1016/j.oret.2020.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
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8
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Alsulaiman SM, Al-Abdullah AA, Alakeely A, Aldhibi H, Engelbrecht L, Ghazi NG, Mura M. Macular Hole-Related Retinal Detachment in Children with Knobloch Syndrome. Ophthalmol Retina 2020; 4:498-503. [PMID: 32111543 DOI: 10.1016/j.oret.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the findings and the management of macular hole (MH)-related retinal detachment (RD) in children with Knobloch syndrome. DESIGN Retrospective interventional case series. PARTICIPANTS Patients with Knobloch syndrome who presented with MH-related RD. METHODS Retrospective chart review of patients with Knobloch syndrome who presented with MH-related RD from January 2012 to December 2018. Interventions included pars plana vitrectomy and silicone oil tamponade with or without scleral buckle, drainage retinotomy, or relaxing retinectomy. MAIN OUTCOME MEASURES MH characteristics and surgical anatomical outcome. RESULTS The study included 9 eyes of 5 patients (age range 2 months to 5 years; median age 5.5 months). Presenting symptoms were poor fixation and nystagmus. The fellow eye of 1 patient had RD due to peripheral breaks. The MH was clinically visible in 8 eyes and detected only by OCT in 1 eye. The RD was shallow and extended to the anterior equator in 7 eyes and localized to a punched-out atrophic lesion in 1 eye. Seven eyes underwent surgical repair. At the last follow-up examination (follow-up range 11 to 42 months; mean 24 months, standard deviation 11.8 months), retinal reattachment with MH closure was achieved in 5 eyes along with marked improvement in fixation. CONCLUSION Patients with Knobloch syndrome may develop MH-related RD as early as infancy. The condition may be easily overlooked in children but should be suspected in the setting of high myopia, vitreoretinal degeneration, and encephalocele.
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Affiliation(s)
| | | | - Adel Alakeely
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hassan Aldhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Leonore Engelbrecht
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nicola G Ghazi
- Lebanese American University School of Medicine and the Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Marco Mura
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Moharram HM, Moustafa MT, Mortada HA, Abdelkader MF. Use of Epimacular Amniotic Membrane Graft in Cases of Recurrent Retinal Detachment Due to Failure of Myopic Macular Hole Closure. Ophthalmic Surg Lasers Imaging Retina 2020; 51:101-108. [DOI: 10.3928/23258160-20200129-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023]
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10
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Kim HY, Lee JJ, Kwon HJ, Park SW, Lee JE. Long-term Outcomes of Macular Hole Retinal Detachment in Highly Myopic Eyes after Surgical Reattachment. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:539-546. [PMID: 31833251 PMCID: PMC6911791 DOI: 10.3341/kjo.2019.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate visual acuity changes over 3 years following surgical reattachment of macular hole retinal detachment (MHRD) developed in high myopia. METHODS A retrospective analysis was performed using the medical records of patients with highly myopic eyes who underwent pars plana vitrectomy with internal limiting membrane peeling or the internal limiting membrane flap technique for MHRD. Changes in best-corrected visual acuity (BCVA) were measured at baseline, 6 months, 1 year, 2 years, and 3 years. RESULTS Of the 22 eyes analyzed, macular hole was closed in 13 and unclosed in nine. BCVA significantly improved from 1.61 ± 0.39 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.17 ± 0.43 logMAR at 6 months and 1.33 ± 0.48 logMAR at 2 years after MHRD surgery. At 3 years, BCVA significantly decreased compared with that at 6 months, and visual improvement from baseline was not significant. BCVA and proportion of vision loss ≥0.3 logMAR were not different between the closed and unclosed macular hole groups. CONCLUSIONS Visual improvement after surgical reattachment of MHRD in high myopia was not maintained, and favorable macular hole closure effects were not observed at 3-year follow-up.
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Affiliation(s)
- Hwa Yeong Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Jo Kwon
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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Cao K, Wang J, Zhang J, Yusufu M, Jin S, Zhu G, He H, Qi Y, Wan XH. The effectiveness and safety of posterior scleral reinforcement with vitrectomy for myopic foveoschisis treatment: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2019; 258:257-271. [PMID: 31823060 DOI: 10.1007/s00417-019-04550-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/10/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the effectiveness and safety of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis (MF) treatment. METHODS We conducted a systematic review and meta-analysis. We evaluated the improvement of best-corrected visual acuity (BCVA) in logMAR unit, the percentage of patients with improved or stabled BCVA, benefit on axial length (AL), the retinal reattachment rate, the macular hole (MH) closure rate, as well as the complication rate. RESULTS Fourteen studies (311 eyes) were included. Overall, patients' BCVA improved - 0.46 (95% confidence interval [CI] - 0.52, - 0.40) logMAR unit, with 80% (95%CI 74%, 85%) benefiting from BCVA improvement and 6% (95%CI 3%, 10%) suffering from BCVA loss. Patients' AL was shortened by - 1.74 (95%CI - 2.92, - 0.57) mm, and for patients whose AL was ≥ 30 mm, the average benefit reached - 3.68 (95%CI - 4.59, - 2.77) mm. Ninety-three percent (95%CI 89%, 96%) of the patients achieved retinal reattachment, and 65% (95%CI 47%, 80%) of the MH was closed. Patients' central foveal thickness decreased; the MD was - 187.32 (95%CI - 206.25, - 168.40) mm. The pooled complication rate was 9% (95%CI 8%, 19%), with extrusion, choroidal atrophy, and choroidal neovascularization being the most common complications. Subgroup analysis indicated no statistical difference in BCVA improvement, AL change, retinal reattachment rate, and complication rate between patients with or without MH. Subgroup analysis indicated no statistical difference in the above four outcomes between the primary and the recurrent patients either. There was no statistical difference in the above four outcomes no matter ILM peeling was combined or not. CONCLUSION PSR combined with vitrectomy helps improve 80% MF patients' BCVA; the average benefit on BCVA is - 0.46 logMAR unit. The average change in AL is - 1.74 mm; patients with AL ≥ 30 mm benefit much more than the patients with AL < 30 mm. The retinal reattachment rate is up to 93%; the MH closure rate is 65%. About 9% patients will suffer from extrusion, choroidal atrophy, choroidal neovascularization, and other complications. The outcomes were not influenced by presence of MH, disease recurrence, or ILM peeling.
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Affiliation(s)
- Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Jinda Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Jingshang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Shanshan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Guyu Zhu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Hailong He
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China
| | - Yue Qi
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China.
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12
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Kakinoki M, Araki T, Iwasaki M, Ueda T, Sano H, Hirano Y, Moriya Y, Sawada O, Takamura Y, Sakamoto T, Kanda T, Ohji M. Surgical Outcomes of Vitrectomy for Macular Hole Retinal Detachment in Highly Myopic Eyes. ACTA ACUST UNITED AC 2019; 3:874-878. [DOI: 10.1016/j.oret.2019.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/14/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
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13
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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14
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INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR TREATMENT OF MACULAR HOLE RETINAL DETACHMENT IN HIGHLY MYOPIC EYES. Retina 2018; 38:2317-2326. [DOI: 10.1097/iae.0000000000001898] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Wakabayashi T, Ikuno Y, Shiraki N, Matsumura N, Sakaguchi H, Nishida K. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study. Graefes Arch Clin Exp Ophthalmol 2018; 256:1387-1393. [PMID: 29911271 DOI: 10.1007/s00417-018-4046-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/05/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the efficacy of pars plana vitrectomy with inverted internal limiting membrane (ILM) insertion for macular hole retinal detachment (MHRD) in high myopia. METHODS We studied 49 eyes of 49 consecutive patients who underwent vitrectomy for MHRD and were followed for more than 12 months postoperatively. Eyes that underwent vitrectomy with inverted ILM insertion from October 2013 to August 2015 were compared with eyes that underwent standard ILM peeling from October 2006 to September 2013. Macular hole closure rate, retinal reattachment, and postoperative visual acuity (VA) at 6 and12 months were retrospectively evaluated. RESULTS This series included 13 eyes in the inverted ILM insertion group and 36 eyes in the standard ILM peeling group. The MH closure rate was significantly better in the inverted ILM group (92 vs 39%) (P = 0.003). The initial and final retinal reattachment rates (92% vs. 86%, and 100% in both groups, respectively) did not differ significantly between groups. Although the mean preoperative VA did not differ significantly between the groups, postoperative VA tended to be better in the inverted ILM group at 12 months (P = 0.059). The rate of visual improvement of three or more lines in the inverted ILM insertion group (85%) was higher than that in the standard ILM peeling group (47%) at 12 months (P = 0.045). CONCLUSION Compared to conventional ILM peeling, inverted ILM insertion has a higher MH closure rate and tendency of better postoperative VA in patients with MHRD.
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Affiliation(s)
- Taku Wakabayashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan.
| | - Yasushi Ikuno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan
| | - Nagakazu Matsumura
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan
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Facino M, Mochi B, Lai S, Terrile R. A Simple way to Prevent Indocyanine Green from Entering the Subretinal Space during Vitrectomy for Retinal Detachment Due to Myopic Macular Hole. Eur J Ophthalmol 2018; 14:269-71. [PMID: 15206655 DOI: 10.1177/112067210401400314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To present a safe and simple method of preventing indocyanine green (ICG) from entering the subretinal space in patients undergoing vitrectomy for retinal detachment caused by myopic macular hole. PATIENTS AND METHODS Four consecutive highly myopic eyes (three phakic, one Pseudophakic) with retinal detachment due to myopic macular hole were operated on by pars plana vitrectomy. The ICG-assisted peeling of the internal limiting membrane was performed after temporarily closing the macular hole by means of a small bubble of perfluorocarbon liquid (PFCL) in order to prevent ICG from entering the subretinal space. Results Retinal reattachment was successful in all patients, and anatomic closure of the macular hole occurred during the follow-up period (range 3 to 10 months). CONCLUSIONS A small bubble of PFCL prevents ICG dye from entering the subretinal space during vitrectomy for retinal detachment due to macular hole in highly myopic eyes.
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Affiliation(s)
- M Facino
- Department of Ophthalmology, Padre Antero Micone Hospital, Genova Sestri Ponente, Genova, Italy.
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Uchida A, Srivastava SK, Ehlers JP. Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study. Invest Ophthalmol Vis Sci 2017; 58:3440-3444. [PMID: 28692739 PMCID: PMC5505120 DOI: 10.1167/iovs.17-21584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigate acute retinal alterations identified on intraoperative optical coherence tomography (iOCT) immediately following surgical intervention with the Finesse Flex Loop for vitreoretinal interface disorders. Methods The Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualization during En face Retinal and ophthalmic surgery (DISCOVER) study is a prospective multisurgeon intraoperative OCT clinical study. Subjects who had participated in the DISCOVER study and had undergone macular surgery with the membrane flex loop from August 2014 to July 2016 were identified. iOCT images and video sequences were evaluated at various surgical time points. Subjects were excluded if iOCT images were not obtained over the area of membrane peeling performed with the membrane flex loop. Qualitative characteristics of intraoperative changes in retinal images were analyzed, with particular focus on the retinal layers within the bed of membrane peeling performed specifically with the membrane flex loop. Results We studied 34 eyes of 34 patients, with a mean age of 72.7 (± 6.4) years, 25 of whom were women. The intraoperative diagnosis was full thickness macular hole in 21 eyes (62%) and epiretinal membrane in 13 (38%). All eyes had successful indocyanine green–assisted inner limiting membrane (ILM) flap initiation using the membrane loop. Intraoperative OCT demonstrated expansion of the ellipsoid zone-to-RPE distance in 3 eyes (9%), definitive subretinal fluid accumulation in 1 eye (3%), and hyperreflectivity of the inner retinal layers associated with retinal hemorrhage in 10 eyes (29%). Retinal breaks were not observed in any eye. Conclusions Acute retinal alterations after ILM peeling with the membrane flex loop were visualized at a frequency of less than 10%. Additional research is needed to understand the clinical impact, if any, of these architectural alterations.
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Affiliation(s)
- Atsuro Uchida
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Sunil K Srivastava
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Baba R, Wakabayashi Y, Umazume K, Ishikawa T, Yagi H, Muramatsu D, Goto H. EFFICACY OF THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE WITH VITRECTOMY FOR RETINAL DETACHMENT ASSOCIATED WITH MYOPIC MACULAR HOLES. Retina 2017; 37:466-471. [DOI: 10.1097/iae.0000000000001211] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kinoshita T, Onoda Y, Maeno T. Long-term surgical outcomes of the inverted internal limiting membrane flap technique in highly myopic macular hole retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1101-1106. [PMID: 28220252 DOI: 10.1007/s00417-017-3614-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/25/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Pars plana vitrectomy (PPV) procedures are used for the surgical treatment of macular hole retinal detachment (MHRD) associated with high myopia. Re-detachment of the retina has been reported in MHRD associated with high myopia. Our aim was to evaluate the 1-year outcomes of vitrectomy, performed using an inverted internal limiting membrane (ILM) flap technique with gas tamponade, in five cases of MHRD associated with high myopia. METHODS We performed a retrospective review of medical records of five consecutive cases of highly myopic MHRD. The following postoperative data were collected: refractive error, best-corrected visual acuity, intraocular pressure, ophthalmic fundus examination findings, ocular coherence tomography at 1, 3, 6, and 12 months postoperatively; duration of the follow-up period; and intra- and postoperative complications. The primary endpoint of the study was the rate of postoperative retinal reattachment and macular hole (MH) closure. Paired t-tests were conducted to evaluate postoperative changes. RESULTS Mean visual acuity improved significantly (P = 0.008), with an improvement of ≥2 lines on LogMAR value gained in three of the five eyes. Retinal reattachment was maintained in all cases, with no cases of MH reopening identified over the mean follow-up period of 20.2 months. No complications were identified in any eye. CONCLUSIONS The inverted ILM flap technique and gas tamponade provided primary retinal reattachment and MH closure over the ≥12-month follow-up period.
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Affiliation(s)
- Taiga Kinoshita
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan.
| | - Yasutaka Onoda
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan
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Ramírez-Estudillo JA, Sánchez-Ramos JA, Pérez-Montaño CR, González-Cortés JH. [Intraoperative use of coherence tomography in vitreoretinal surgery]. CIR CIR 2016; 85:21-26. [PMID: 27324930 DOI: 10.1016/j.circir.2016.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optical coherence tomography is a useful tool in several diseases. Its intraoperative use with the intention of improving anatomical results has recently been described. PURPOSE To determine the usefulness and safety of optical coherence tomography during pars plana vitrectomy for several vitreo-retinal diseases. MATERIAL AND METHODS A prospective case series is reported, in which the decision that influenced the use of the optical coherence tomography imaging during pars plana vitrectomy is evaluated. A RESCAN 700 microscope that includes a spectral domain tomography was used to obtain the images. At the end of each procedure the surgeons completed a questionnaire to determine if the tomographic image had an influence when making decisions during the surgery, or change the decision during the procedure. RESULTS Thirteen patients with pars plana vitrectomy were included, with cataract surgery also performed in 6 patients. The surgeon considered that the intraoperative image influenced the decision during the procedure in 8 cases. CONCLUSION Intraoperative optical coherence tomography is helpful for a safe patient diagnosis. It does not affect the surgery time, and in some cases it is useful for optimising the procedure in vitreous-retinal surgery.
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Affiliation(s)
| | | | - Carla Rocío Pérez-Montaño
- Departamento de Retina y Vítreo, Fundación Hospital Nuestra Señora de la Luz, Ciudad de México, México
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Ohno-Matsui K, Lai TY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res 2016; 52:156-87. [DOI: 10.1016/j.preteyeres.2015.12.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
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ADJUSTABLE MACULAR BUCKLING FOR FULL-THICKNESS MACULAR HOLE WITH FOVEOSCHISIS IN HIGHLY MYOPIC EYES. Retina 2016; 36:709-16. [PMID: 27018807 DOI: 10.1097/iae.0000000000000802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hong N, Huang BS, Tong JP. Primary silicone oil tamponade and internal limiting membrane peeling for retinal detachment due to macular hole in highly myopic eyes with chorioretinal atrophy. BMC Ophthalmol 2015; 15:165. [PMID: 26560878 PMCID: PMC4642637 DOI: 10.1186/s12886-015-0154-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/04/2015] [Indexed: 01/14/2023] Open
Abstract
Background Retinal detachment (RD) secondary to macular hole (MH) is a common complication in highly myopic eyes, usually leading to a poor visual prognosis. The purpose of this study was to evaluate the surgical outcome of silicone oil (SO) tamponade and internal limiting membrane (ILM) peeling in the treatment of RD caused by MH (MHRD) in highly myopic eyes with chorioretinal atrophy, and to identify clinical factors associated with the anatomical outcomes. Methods We retrospectively reviewed 21 eyes of 21 highly myopic patients affected by RD secondary to MH and chorioretinal atrophy. All eyes were treated with pars plana vitrectomy (PPV) with ILM peeling and SO tamponade. Anatomical success was defined as reattachment of the retina with the closure of the MH, as assessed by optical coherence tomography (OCT), after SO removal. Logistic regression was performed to determine the clinical factors influencing anatomical success. Results The mean patient age was 59.95 years [standard deviation (SD), 10.39; range, 34–77 years] and the mean axial length was 30.58 mm (SD, 1.52; range, 27.99–34.51 mm). After the first surgical procedure, the anatomical success rate was 61.9 % (13 eyes in 21 eyes), with initial retinal attachment of16 eyes (76.2 %). A second surgical approach was performed for the five eyes with persistent or recurrent RD, and the final retinal reattachment rate was 100 % (21/21). Logistic regression analysis showed that no specific factors were significantly associated with anatomical success. Conclusions Primary silicone oil tamponade and ILM peeling can be a practical treatment for repairing MHRD in highly myopic eyes with chorioretinal atrophy.
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Affiliation(s)
- Nan Hong
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
| | - Bai-shuang Huang
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
| | - Jian-ping Tong
- Department of Ophthalmology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China.
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Su J, Liu X, Zheng L, Cui H. Vitrectomy with internal limiting membrane peeling vs no peeling for Macular Hole-induced Retinal Detachment (MHRD): a meta-analysis. BMC Ophthalmol 2015; 15:62. [PMID: 26091910 PMCID: PMC4475314 DOI: 10.1186/s12886-015-0048-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND we conducted our meta-analysis of published studies to assess existing evidence about the efficacy and safety of vitrectomy with ILM peeling vs. that of vitrectomy with no ILM peeling for Macular hole-induced retinal detachment. METHODS Databases, including Pubmed, Cochrane Library, Ovid, Web of Science, Wanfang and CNKI, were searched to identify studies comparing outcomes following vitrectomy with ILM peeling and that with no ILM peeling for macular hole-induced retinal detachment. The meta-analysis was performed by RevMan 5.1. RESULTS Six comparative studies comprising 180 eyes were identified. It was indicated that the rate of retinal reattachment (Odds ratio (OR) = 3.03, 95 % Confidence interval (CI):1.35 to 6.78; P = 0.007) and macular hole closure (OR = 6.74, 95 % CI:3.26 to 13.93; P < 0.001) after initial surgery was higher and the rate of recurrent retinal detachment (OR = 0.08, 95 % CI:0.02 to 0.30; P = 0.0002) was lower in the group of vitrectomy with ILM peeling than that in the group of vitrectomy with no ILM peeling. However, the improved BCVA (Weighted mean difference (WMD) = 0.14, 95 % CI: -0.20 to 0.47; P = 0.42) and the rate of postoperative complications were similar between the two groups. CONCLUSION Vitrectomy with internal limiting membrane peeling is an efficient and safe procedure for macular hole-induced retinal detachment.
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Affiliation(s)
- Jing Su
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Xinquan Liu
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Lijun Zheng
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, P.R. China.
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University, No.150 Jimo Road, Shanghai, 200120, P.R. China.
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Lin CW, Ho TC, Yang CM. The development and evolution of full thickness macular hole in highly myopic eyes. Eye (Lond) 2015; 29:388-96. [PMID: 25572579 DOI: 10.1038/eye.2014.312] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/28/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes. PATIENTS AND METHODS Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes. RESULTS Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection. CONCLUSION The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.
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Affiliation(s)
- C-W Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - T-C Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-M Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Park JH, Kim MH, Sagong M, Chang WH. Silicone Oil with Short-Term Prone Position in Macular Hole Retinal Detachment Surgery in High Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.10.1566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ju Hong Park
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Moo Hyun Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo Hyok Chang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Treatment of retinal detachment secondary to macular hole in highly myopic eyes: pars plana vitrectomy with internal limiting membrane peel and silicone oil tamponade. Retina 2014; 34:470-6. [PMID: 23881229 DOI: 10.1097/iae.0b013e31829d004b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate efficacy of vitrectomy with internal limiting membrane peel and silicone oil tamponade in highly myopic eyes with retinal detachment secondary to macular hole (MH). METHODS Twenty-one consecutive cases of MH-retinal detachment in highly myopic eyes were retrospectively reviewed. Eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade. A face-down or side-lying position was maintained postoperatively. Silicone oil was removed 3 months to 12 months later. Outcomes included MH closure and retinal reattachment rates, best-corrected visual acuity, and complication rates. RESULTS Mean patient age was 59.3 ± 6.5 years and mean spherical equivalent was -15.2 ± 4.3 diopters. After silicone oil removal, 18 eyes (86%) had MH closure with retinal reattachment and 2 eyes needed reattachment with endolaser photocoagulation and fluid/gas exchange, and 1 patient refused further treatment. At the last follow-up, median best-corrected visual acuity was +1.48 ± 0.12, up from preoperative +2.11 ± 0.17 (P = 0.03). Transient intraocular pressure elevation was observed in 11 eyes (52%). Iatrogenic retinal break occurred in one case. CONCLUSION Combining pars plana vitrectomy with internal limiting membrane peel and silicone oil tamponade was safe and effective in treating MH-retinal detachment in highly myopic eyes. Silicone oil tamponade may improve initial anatomical success rates because of longer tamponade duration.
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Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment. Retina 2014; 34:670-8. [PMID: 24013260 DOI: 10.1097/iae.0b013e3182a487ea] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the effect of 360° scleral band in combination with pars plana vitrectomy (PPV) and silicone oil tamponade on the anatomical success and on the closure of macular hole (MH) in cases of myopic macular hole retinal detachment. METHODS A retrospective consecutive interventional study from medical records on patients who had pars plana vitrectomy and silicone oil. with or without 360° scleral band for the treatment of retinal detachment associated with MH. The cases were operated in the period from February 2006 to May 2012. The included cases were classified into two groups: the first group with scleral band and the second group without scleral band. The primary anatomical success and optical coherence tomography patterns of MH closure were the main outcomes. RESULTS After the first procedure, the overall success rate was 90.6% (in both groups). In 9.4%, there was recurrent retinal detachment. In the first group the success rate was 89.5%, and in 10.5% there was recurrent retinal detachment. In the second group 92.5% was success and 7.5% was recurrent retinal detachment. After the second interference, the success rate was 98.4% in both groups. Closure of MH was achieved in 45.2% in both groups. In the first group, there was closure of MH in 43.5%, while in 47.8% the hole remained open flat, in 4.3% the hole closed partially and in 4.3% there was macular scar. In the second group, MH closure was achieved in 47.4%, whereas in 52.6% the hole was open flat. CONCLUSION The use of 360° band in combination with pars plana vitrectomy and silicone oil offered no additional effect on either the anatomical success or the rate of MH closure in the management of myopic macular hole retinal detachment. Four patterns of MH were reported closed MH, partial thickness MH, open flat MH, and macular scar.
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Tamponade or filling effect: changes of forces in myopic eyes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:618382. [PMID: 25101290 PMCID: PMC4101978 DOI: 10.1155/2014/618382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/22/2014] [Indexed: 02/05/2023]
Abstract
Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye.
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Efficacy of vitrectomy with triamcinolone assistance versus internal limiting membrane peeling for highly myopic macular hole retinal detachment. Retina 2013; 33:1151-7. [PMID: 23508079 DOI: 10.1097/iae.0b013e31827b6422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the outcomes of pars plana vitrectomy (PPV) with or without the adjuvant surgical procedures: triamcinolone acetonide (TA) assistance and/or internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD). DESIGN Case-control study. METHODS Pars plana vitrectomy combined with 2 kinds of adjuvant surgical procedures were used on 96 highly myopic eyes with MHRD. These eyes were assigned to 4 groups randomly: Group 1, non-TA-assisted PPV and without ILM peeling; Group 2, non-TA-assisted PPV with ILM peeling; Group 3, TA-assisted PPV and without ILM peeling; Group 4, TA-assisted PPV with ILM peeling. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity were measured. RESULTS The rates of both retinal reattachment and macular hole closure were higher in Group 2 (84.0 and 44.0%) and Group 3 (80.8 and 46.2%) than Group 1 (73.9 and 17.4%); however, there were no differences between Group 2 and Group 3 (P > 0.05). The rates of macular hole closure were extremely low in Group 1 and also in eyes with extreme long axial lengths (≥29.0 mm), "severe" chorioretinal atrophy, and posterior staphyloma. CONCLUSION Pars plana vitrectomy with either TA assistance or ILM peeling was effective for the treatment of highly myopic MHRD. If you peel the ILM, adding TA does not affect closure rates; and if TA is used to visualize the vitreous, ILM peeling may not be necessary in MHRD. There was a lower anatomical success rate in MHRD with extreme long axial lengths, severe chorioretinal atrophy, and posterior staphyloma.
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Editorial. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Lim LS, Tsai A, Wong D, Wong E, Yeo I, Loh BK, Ang CL, Ong SG, Lee SY. Prognostic factor analysis of vitrectomy for retinal detachment associated with myopic macular holes. Ophthalmology 2013; 121:305-310. [PMID: 24139155 DOI: 10.1016/j.ophtha.2013.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To describe the anatomic and functional outcomes in a cohort of subjects undergoing vitrectomy for retinal detachment (RD) resulting from myopic macular hole (MH) and to analyze the prognostic and surgical factors predicting retinal reattachment and MH closure. DESIGN Retrospective case series. PARTICIPANTS All patients who underwent vitrectomy for RD resulting from myopic MH between 2000 and 2009 at our center. METHODS Case records were reviewed at 6 months after surgery. Retinal reattachment and complete anatomic success, defined as retinal reattachment with MH closure, were assessed. Multivariate logistic regression models, including age, gender, duration of symptoms, spherical equivalent refraction (SE), internal limiting membrane peeling, tamponade choice, and concurrent scleral buckling, were constructed to assess associations with covariates. MAIN OUTCOME MEASURES Retinal reattachment and complete anatomic success (retinal reattachment with MH closure). RESULTS In total, 114 subjects were analyzed. Most were women (n = 79 [69.3%]), and the mean age was 57.5±13.3 years. The mean SE was -9.88±6.37 diopters. At 6 months, 98 subjects (86.0%) demonstrated retinal reattachment, of whom 93 subjects required only 1 operation. Complete anatomic success was achieved in 61 subjects (53.5%), of whom 55 needed only 1 operation. Subjects with retinal reattachment had better best-corrected visual acuity (BCVA; mean BCVA, 1.22±0.81 logarithm of the minimum angle of resolution [logMAR] units) than those without (mean BCVA, 1.98±1.26 logMAR units; P < 0.001), and subjects with complete anatomic success had better BCVA (mean BCVA, 1.05±0.87 logMAR units) than those without (mean BCVA, 1.62±0.87 logMAR units; P < 0.001). In multivariate analyses, increasing age and the use of perfluoropropane (C3F8) tamponade were predictive of anatomic success (per 1-year increase: odds ratio [OR], 1.049; 95% confidence interval [CI], 1.002-1.099; P = 0.04; and for tamponade: OR, 10.71; 95% CI, 1.08-106.29; P = 0.04). CONCLUSIONS Vitrectomy is effective in the repair of RD resulting from MH in myopic eyes, with retinal reattachment achieved more frequently than MH closure. Retinal reattachment and MH closure are important for improving visual outcomes. Greater age at presentation and use of C3F8 are associated with a greater likelihood of anatomic success.
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Affiliation(s)
- Laurence Shen Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Tsai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Doric Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Edmund Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ian Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Boon Kwang Loh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Chong Lye Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sze Guan Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore.
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Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 2013; 156:125-131.e1. [PMID: 23622567 DOI: 10.1016/j.ajo.2013.02.014] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the effect of pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap technique for macular hole with or without retinal detachment in highly myopic eyes. DESIGN Retrospective, interventional case series. METHODS Ten eyes of 10 patients with macular hole with (4 eyes) or without (6 eyes) retinal detachment in high myopia (axial length more than 26.5 mm) were treated by PPV with inverted ILM flap technique. RESULTS Macular hole closure was observed in 8 eyes (80%) following the initial surgery (in 5 eyes without retinal detachment and in 3 eyes with retinal detachment). In 4 eyes with retinal detachment caused by macular hole, retinas of 3 eyes were reattached by the initial surgery. Postoperative best-corrected visual acuity improved by more than 2 lines in 5 eyes (50%), was unchanged in 4 eyes (40%), and worsened by more than 2 lines in 1 eye (10%). CONCLUSIONS Inverted ILM flap technique might contribute to a high closure rate of macular hole and be a preferable adjuvant to the treatment of macular hole in high myopia with or without retinal detachment.
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Primary vitrectomy for the treatment of retinal detachment in highly myopic eyes with axial length over 30 mm. Eur J Ophthalmol 2013; 23:564-70. [PMID: 23539456 DOI: 10.5301/ejo.5000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in highly myopic eyes with axial length over 30 mm. METHODS In this retrospective, interventional case series, we evaluated the outcome of primary vitrectomy without scleral buckling in 67 highly myopic patients (67 eyes) with RRD. Anatomical success rate was defined as complete reattachment of the retina without definitive silicone oil tamponade. RESULTS Retinal reattachment was achieved with a single surgery in 49 of 67 eyes (73.1%) and after 2 or 3 surgeries in 54 eyes (80.6%). The characteristics of retinal tears did not influence the final outcome. Multivariate analysis revealed that a longer axial length was the only factor associated with a higher failure rate, p = 0.0061. Mean preoperative visual acuity significantly increased after surgery, p = 0.0003. CONCLUSION The study demonstrated fair efficacy of vitrectomy and fluid-gas exchange in the treatment of retinal detachment in highly myopic eyes with an axial length over 30 mm.
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ANATOMICAL AND FUNCTIONAL RESULTS OF MACULAR HOLE RETINAL DETACHMENT SURGERY IN PATIENTS WITH HIGH MYOPIA AND POSTERIOR STAPHYLOMA TREATED WITH PERFLUOROPROPANE GAS OR SILICONE OIL. Retina 2013; 33:586-92. [DOI: 10.1097/iae.0b013e3182670fd7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ouyang PB, Duan XC, Zhu XH. Diagnosis and treatment of myopic traction maculopathy. Int J Ophthalmol 2012; 5:754-8. [PMID: 23275913 DOI: 10.3980/j.issn.2222-3959.2012.06.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 11/05/2012] [Indexed: 11/02/2022] Open
Abstract
In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of myopic traction maculopathy (MTM). Here, we review the latest developments in the diagnosis and treatment of MTM, including its conception, clinical characteristics, pathogenesis, clinical stages, and the options for surgical treatment.
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Affiliation(s)
- Ping-Bo Ouyang
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, No.139 of Middle Rinmin Road, Changsha 410011, Hunan Province, China
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Nadal J, Verdaguer P, Canut MI. Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade. Retina 2012; 32:1525-30. [PMID: 22466478 DOI: 10.1097/iae.0b013e3182411cb8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the rates of retinal reattachment and the closure of myopic macular hole because of posterior pole retinal detachment after treatment with pars plana vitrectomy and subsequent dissection of the inner limiting membrane. METHODS Prospective noncomparative study of 27 eyes from 27 phakic patients diagnosed with posterior pole retinal detachment as a result of myopic macular hole. All underwent pars plana vitrectomy with dissection of the inner limiting membrane and intravitreal silicone oil tamponade performed by the same surgeon. The main variables assessed were visual acuity, retinal reattachment, and macular hole closure determined by optical coherence tomography. RESULTS Of the 27 eyes, 16 (59.3%) were right eyes and 11 (40.7%) were left eyes. Mean age was 50.5 years. Myopia ranged from -9 diopters (D) to -27 diopters (mean, -18 diopters), and axial length ranged from 28.5 mm to 35.6 mm (mean, 32.05 mm). After a mean postoperative period of 12 months, retinal reattachment was found in 85.1% of the patients and anatomical closure of the macular hole in 51.9%. CONCLUSION This technique offers good rates of retinal reattachment and macular hole closure, although seldom increases the final visual acuity. It showed limited effectiveness in eyes with an axial length >30 mm.
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Affiliation(s)
- Jeroni Nadal
- Centro de Oftalmología Barraquer, C/Muntaner 314, Barcelona, Spain
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Xie A, Lei J. Pars Plana Vitrectomy and Silicone Oil Tamponade as a Primary Treatment for Retinal Detachment Caused by Macular Holes in Highly Myopic Eyes: A Risk-Factor Analysis. Curr Eye Res 2012; 38:108-13. [DOI: 10.3109/02713683.2012.722742] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zheng Q, Yang S, Zhang Y, Wu R, Pang J, Li W. Vitreous surgery for macular hole-related retinal detachment after phacoemulsification cataract extraction: 10-year retrospective review. Eye (Lond) 2012; 26:1058-64. [PMID: 22595907 DOI: 10.1038/eye.2012.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Q Zheng
- Eye Hospital, Wenzhou Medical College, Wenzhou, PR China
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Lim SJ, Kwon YH, Kim SH, You YS, Kwon OW. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis. Graefes Arch Clin Exp Ophthalmol 2012; 250:1573-7. [DOI: 10.1007/s00417-012-1983-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022] Open
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Park DY, Kim JH, Ha HS, Kang SW. The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.7.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Shin Ha
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Clinical presentation and surgical outcomes in primary myopic macular hole retinal detachment. Eur J Ophthalmol 2011; 22:450-5. [DOI: 10.5301/ejo.5000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2011] [Indexed: 11/20/2022]
Abstract
Purpose To describe the clinical presentation of primary macular hole retinal detachment (MHRD) secondary to high myopia and to evaluate the surgical outcomes. Methods Nine eyes of 9 patients with primary myopic MHRD (axial length ≥26.5 mm) were enrolled. A standardized surgical protocol was performed using vitrectomy with preservative-free triamcinolone acetonide–assisted internal limiting membrane (ILM) peeling and silicone oil tamponade and were followed for at least 6 months from the first surgery. Results There were 6 women and 3 men with a median age of 52 years. Six (66.6%) patients presented with inferior bullous configuration and 3 had subtotal retinal detachment. The mean preoperative refractive error (spherical equivalent) and mean axial length was 12±3.553 D (range 8.50-19.50) and 28.13±1.65 mm (range 26.50-31.50), respectively. The patients were followed up for a period of at least 6 months. The retina was attached and macular hole closed in all the eyes. There was significant visual acuity improvement from mean preoperative visual acuity of logMAR 1.85±0.11 (range 1.76-1.93) to postoperative visual acuity of logMAR 0.95±0.14 (range 0.84-1.06) (p<0.001). Conclusions Retinal detachment in highly myopic eyes can often be secondary to a macular hole with predominance of inferior bullous configuration and primary vitrectomy with ILM peeling with silicone oil tamponade results in good anatomic and functional outcomes.
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Chen FT, Yeh PT, Lin CP, Chen MS, Yang CH, Yang CM. Intravitreal gas injection for macular hole with localized retinal detachment in highly myopic patients. Acta Ophthalmol 2011; 89:172-8. [PMID: 19832732 DOI: 10.1111/j.1755-3768.2009.01649.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate treatment effects of intravitreal gas for macular hole with localized retinal detachment (RD) in highly myopic eyes and to examine how the vitreomacular relationship and other factors may influence treatment outcomes. METHODS Twenty highly myopic patients with macular holes and localized posterior RD, treated initially with intravitreal injection of C(3) F(8) , were prospectively studied. Recurrent disease was treated with repeated gas injection or vitrectomy according to the extent of detachment. Length of follow-up was ≥ 12 months. Vitreomacular conditions were determined before and within 2 months after gas injection by standard optical coherence tomography. Demographics, refractive errors, axial length, the extent of chorioretinal (CR) atrophy and visual acuity were recorded. RESULTS The success rate after primary gas injection was 70%. The remaining 30% of patients achieved anatomic success after further treatment, including vitrectomy with gas or silicone oil tamponade and/or scleral buckling. All cases achieved anatomic success after a mean of 1.4 surgeries. Univariate analysis showed that the patterns of the posterior vitreoretinal relationship did not differ significantly between those successfully treated with gas only (group 1) and those requiring vitrectomy (group 2) (p = 1.000). Logistic regression showed no statistically significant differences in any characteristics between groups 1 and 2. CONCLUSIONS Intravitreal gas tamponade alone may achieve anatomic success in more than two-thirds of highly myopic patients with macular holes and localized RD. Patients with different clinical characteristics and vitreoretinal relationships seem to have similar opportunities to achieve reattachment through this relatively non-invasive surgery.
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Affiliation(s)
- Fang-Ting Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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HEAVY VERSUS STANDARD SILICONE OIL IN THE MANAGEMENT OF RETINAL DETACHMENT WITH MACULAR HOLE IN MYOPIC EYES. Retina 2011; 31:540-6. [DOI: 10.1097/iae.0b013e3181ec80c7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Mete M, Parolini B, Maggio E, Pertile G. 1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole. Graefes Arch Clin Exp Ophthalmol 2010; 249:821-6. [PMID: 21080197 DOI: 10.1007/s00417-010-1557-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/16/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared. METHODS Forty-two eyes affected by RD associated with MMH were included. The surgical technique involved standard 3-port 20-gauge PPV with long-term tamponade. The patients were divided into two groups, according to the intraocular tamponade: SO in group 1 (n = 17), and HSO in group 2 (n = 25). Internal limiting membrane (ILM) removal was performed in 15 cases of group 1 and 20 cases of group 2. Tamponade removal was performed 2 to 5 months after primary surgery. The patients were assessed 1 week and 1 month after primary surgery, and then 1 week and 1 month after tamponade removal or after further surgery if macular redetachment had occurred. The patients were also visited every 2 months for at least 1 year after final tamponade removal. Follow-up was considered closed at 1 year after final tamponade removal. RESULTS Preoperative best-corrected visual acuity (BCVA), expressed as LogMar, was 2.8 ± 0.77 for group 1 and 2.1 ± 0.94 for group 2. At the last visit, the BCVA was 1.41 ± 0.96 and 1.48 ± 0.77 for groups 1 and 2 respectively. Retinal reattachment was achieved with one operation in 13 eyes of group 1 (76.5%) and 18 of group 2 (81.8%) (P = 0.69). The average number of surgery needed to achieve retinal attachment by patients of group 1 and 2 was respectively 1.36 ± 0.63 and 1.46 ± 0.59 (P = 0.77). Five patients of group 1 and four of group 2 developed a chronic glaucoma (P = 0.238). CONCLUSIONS PPV with ILM peeling and long-term tamponade was demonstrated to be a good surgical option to treat RD due to MMH; SO and HSO seemed to be equally effective, although the success rates remained far from an ideal 100%.
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Affiliation(s)
- Maurizio Mete
- Department of Ophthalmology, Ospedale Sacro Cuore - Don Calabria, Via don A. Sempreboni 5, 37024, Negrar, VR, Italy.
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Hirakata A, Inoue M, Oshitari K, Okada AA, Nagamoto T, Tano Y. Histopathological examination of internal limiting membrane surface after scraping with diamond-dusted membrane scraper. Acta Ophthalmol 2010; 88:e293-4. [PMID: 19878124 DOI: 10.1111/j.1755-3768.2009.01730.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Georgalas I, Ladas I, Petrou P, Gotzaridis E, Papaconstantinou D, Rouvas A, Koutsandrea C. Does sulfur-hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, suffice for the treatment of retinal detachment associated with macular hole? Cutan Ocul Toxicol 2010; 29:288-92. [PMID: 20860494 DOI: 10.3109/15569527.2010.511368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the efficacy of sulfur hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, for the treatment of retinal detachment (RD) associated with macular hole (MH). MATERIALS AND METHODS Our study was a retrospective interventional case series. We evaluated 9 phakic eyes of 9 consecutive patients with retinal detachment secondary to macular hole (MHRD) treated with 20-gauge (g) pars plana vitrectomy, which was followed with trypan blue-assisted internal-limiting-membrane peeling, fluid-air exchange, and 20% sulfur hexafluoride tamponade (SF(6)) gas exchange. All patients underwent optical coherence tomography, best-corrected visual acuity (BCVA) measurement, and dilated fundus examination with indentation, pre- and postoperatively. RESULTS The mean (± standard deviation) follow-up time was 13 ± 3 months (range 9-18). Postoperatively, all eyes demonstrated an attached retina, whereas MH closure was achieved in only 1 eye, and in a second eye after additional injection of gas and further posturing. The BCVA improved from 2.2 ± 0.4 logMAR (logarithm of the minimum angle of resolution) at baseline to 2.0 ± 0.5 logMAR at the end of follow-up (p = .05). CONCLUSION The failure in MH closure in most of our cases strengthens the view that short-term tamponade with SF(6) may not suffice for achieving MH closure, and either prolonged tamponade (with C(3)F(8) or silicone oil) or additional photocoagulation may be a better option for eyes with MHRDs. In addition, it is possible that intravitreal injection of gas might be an option for the treatment of persistent MHs after vitrectomy for MHRD, especially when the MH is small. Further studies are required to evaluate the above findings, although the implementation of large series studies remains a challenge because of the rarity of cases with MHRDs.
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Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, University of Athens, Athens, Greece.
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Li KKW, Tang EWH, Li PSH, Wong D. Double peel using triamcinolone acetonide and trypan blue in the management of myopic macular hole with retinal detachment: a case-control study. Clin Exp Ophthalmol 2010; 38:664-8. [PMID: 20497431 DOI: 10.1111/j.1442-9071.2010.02333.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of double peel using triamcinolone acetonide (TA) and trypan blue (TB) in removing epiretinal tissues in vitrectomy for myopic macular hole with retinal detachment (MHRD). METHODS Prospective interventional case control study. Patients with myopic MHRD underwent vitrectomy with TA-assisted adherent cortical vitreous (ACV) removal followed by TB-assisted internal-limiting membrane (ILM) peeling and gas tamponade. The results were compared with historical control group without the use of any vital dye or TA. RESULTS Ten eyes of 10 study cases were compared with nine eyes of nine control cases. Mean axial length was 28.3 ± 1.4 mm and 29.6 ± 2.4 mm and mean follow-up period was 15 months and 42 months for the study group and the control group, respectively. Reattachment rate was 70% in the study group and 44% in the control group. Mean logMAR visual acuity improvement was 0.02 at 6 months and 0.01 at 12 months for the study group (P < 0.05). Transient intraocular pressure rise was observed in seven eyes in the study group and five eyes in the control group. No other complication was noted. CONCLUSION Double peel using TA and TB appeared safe and effective in facilitating removal of ACV and ILM in MHRD. It has higher surgical success rate compared with conventional vitrectomy with epiretinal membrane peeling and gas tamponade.
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Affiliation(s)
- Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, and Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR, China.
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Li X, Wang W, Tang S, Zhao J. Gas Injection versus Vitrectomy with Gas for Treating Retinal Detachment Owing to Macular Hole in High Myopes. Ophthalmology 2009; 116:1182-87.e1. [DOI: 10.1016/j.ophtha.2009.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/08/2008] [Accepted: 01/07/2009] [Indexed: 10/20/2022] Open
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