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Mihalache A, Huang RS, Patil NS, Ahmed H, Popovic MM, Kertes PJ, Muni RH. PARS PLANA VITRECTOMY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEEL FOR MACULAR HOLE: A Systematic Review and Meta-Analysis. Retina 2024; 44:381-391. [PMID: 38166007 DOI: 10.1097/iae.0000000000004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
PURPOSE To compare the efficacy and safety of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for macular hole (MH). METHODS A systematic literature search on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar was performed from January 2000 to 2023. The primary outcome was the final best-corrected visual acuity (BCVA). Secondary outcomes included MH closure rates and the need for repeat surgery. The authors performed a random-effects meta-analysis on Review Manager 5.4. RESULTS Fourteen studies on 880 eyes were included. Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA ( P = 0.66). However, pars plana vitrectomy without ILM peeling achieved a significantly better final BCVA in eyes with closed MHs (WMD = 0.05 logMAR, 95% CI, 0.01-0.10, P = 0.02). Pars plana vitrectomy with ILM peeling achieved a significantly higher primary MH closure rate (RR = 1.21, 95% CI, 1.04-1.42, P = 0.02) and lower incidence of MH reoperation (RR = 0.19, 95% CI, 0.11-0.33, P < 0.001). The final MH closure rate ( P = 0.12) and incidence of MH recurrence ( P = 0.25) were similar between groups. CONCLUSION Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA. However, pars plana vitrectomy without ILM peeling achieved a better final BCVA in eyes with closed MHs. ILM peeling achieved a greater primary MH closure rate and reduced need for reoperation.
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Affiliation(s)
- Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nikhil S Patil
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Haleema Ahmed
- Faculty of Science, York University, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Wang F, Zhu Z, Yan H, Yang Y, Niu L, Liu J. Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series. BMC Ophthalmol 2024; 24:63. [PMID: 38350933 PMCID: PMC10863298 DOI: 10.1186/s12886-024-03324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Macular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD. METHODS Clinical records of patients undergoing SB surgery for treatment of RRD at the Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed. RESULTS Among 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients. CONCLUSIONS Patients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.
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Affiliation(s)
- Fangyu Wang
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), No. 21 Jiefang Road, Xincheng District, 710004, Xi'an, Shaanxi, China
| | - Zhongqiao Zhu
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), No. 21 Jiefang Road, Xincheng District, 710004, Xi'an, Shaanxi, China
| | - Hong Yan
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), No. 21 Jiefang Road, Xincheng District, 710004, Xi'an, Shaanxi, China
| | - Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No. 54 Xianlienan Road, Yuexiu District, 510060, Guangzhou, Guangdong, China
| | - Laxiao Niu
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), No. 21 Jiefang Road, Xincheng District, 710004, Xi'an, Shaanxi, China
| | - Jing Liu
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), No. 21 Jiefang Road, Xincheng District, 710004, Xi'an, Shaanxi, China.
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3
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Alsoudi AF, Anderson JT, Wong TP, Schefler AC. Prostaglandin-Induced Macular Hole: A Brief Report. Ophthalmic Surg Lasers Imaging Retina 2024; 55:112-115. [PMID: 38198605 DOI: 10.3928/23258160-20231205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This case series reports on two patients who developed macular holes while on prostaglandin analogs (PGA) therapy. The first case involves a 63-year-old woman with a history of a macular hole of the left eye that had spontaneously closed. After starting PGA therapy for elevated intraocular pressure, cystoid macular edema formed, which resulted in reopening of the macular hole. The second case involves a 64-year-old man with primary open-angle glaucoma, on PGA therapy, with a newly diagnosed small macular hole of the right eye that closed after cessation of the PGA therapy. These cases demonstrate an association between prostaglandin analogs and the formation or reopening of full-thickness macular holes. [Ophthalmic Surg Lasers Imaging Retina 2024;55:112-115.].
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Ye X, He S, Zhong X, Yu J, Yang S, Shen Y, Chen Y, Wang Y, Huang X, Shen L. OIMHS: An Optical Coherence Tomography Image Dataset Based on Macular Hole Manual Segmentation. Sci Data 2023; 10:769. [PMID: 37932307 PMCID: PMC10628143 DOI: 10.1038/s41597-023-02675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
Macular holes, one of the most common macular diseases, require timely treatment. The morphological changes on optical coherence tomography (OCT) images provided an opportunity for direct observation of the disease, and accurate segmentation was needed to identify and quantify the lesions. Developments of such algorithms had been obstructed by a lack of high-quality datasets (the OCT images and the corresponding gold standard macular hole segmentation labels), especially for supervised learning-based segmentation algorithms. In such context, we established a large OCT image macular hole segmentation (OIMHS) dataset with 3859 B-scan images of 119 patients, and each image provided four segmentation labels: retina, macular hole, intraretinal cysts, and choroid. This dataset offered an excellent opportunity for investigating the accuracy and reliability of different segmentation algorithms for macular holes and a new research insight into the further development of clinical research for macular diseases, which included the retina, lesions, and choroid in quantitative analyses.
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Affiliation(s)
- Xin Ye
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shucheng He
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xiaxing Zhong
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiafeng Yu
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | | | - Yingjiao Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yiqi Chen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Xingru Huang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK.
| | - Lijun Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
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5
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Tsui MC, Yang CM, Wang LC. Characteristics and outcomes of full-thickness macular holes created during vitrectomy for proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:3479-3490. [PMID: 37277662 DOI: 10.1007/s10792-023-02753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the clinical features, management, and prognosis of full-thickness macular holes (FTMHs) inadvertently created during vitrectomy for eyes with proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP). METHODS Eyes with PDR and FVP that had intraoperatively created FTMHs were retrospectively collected as the study group, and age- and sex-matched subjects with PDR and FVP who did not have intraoperative FTMHs were selected as the control group. Fundus abnormalities, optical coherence tomography (OCT) features, and anatomical and functional outcomes were compared between the two groups. RESULTS Eleven eyes of 11 patients (5 male and 6 female) were identified as the study group. Follow-up duration was 36.8 ± 47.2 months. FTMHs were managed by ILM peeling or the inverted ILM flap technique. Anatomical success and MH closure were achieved in 100% of eyes in the study group. In comparison to the control group, the study group had a higher proportion of condensed prefoveal tissue (63.6% vs. 22.7%, p = 0.028), and a higher ratio of silicone oil tamponade (63.6% vs. 18.2%, p = 0.014), whereas there were no differences in preoperative and final BCVA, and the severity, activity, and locations of FVP between the two groups. CONCLUSION Condensed prefoveal tissue was a risk factor of FTMHs created during operation for eyes with PDR and FVP. The ILM peeling or the inverted ILM flap technique may be beneficial for the treatment with favorable anatomical and functional outcomes.
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Affiliation(s)
- Mei-Chi Tsui
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu-Chun Wang
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou, Yunlin, Taiwan.
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Tarkova A, Jiraskova N, Dusova J, Marak J, Studnicka J. Changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole with macular peeling and one type of flap. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37114702 DOI: 10.5507/bp.2023.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole (IMD) with macular peeling and flap. METHODS A prospective study of 35 eyes in 34 patients who had undergone standard surgery. Evaluated parameters were best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CRT), macular volume (TMV) and vascular density of the superficial and deep capillary plexus. The follow-up period was one year. RESULTS We divided the total group into two: temporal and circular flap and total group. We compared the values after surgery with the preoperative values. In the total group, BCVA increased from 48.38 to 71.44 letters (P≤0.05). IOP changed from 15.24 to 14.76 mmHg (P>0.05). CRT decreased from 432.27 to 323.64 µm (P≤0.05). TMV changed from 0.26 to 0.25 mm3 (P>0.05). The vascular density of the superficial plexus decreased from 32 to 28% (P≤0.05). The intercapillary space of the superficial plexus increased from 68 to 72% (P≤0.05). The vascular density of the deep plexus increased from 17 to 23%. The intercapillary space of the deep vascular plexus decreased from 83 to 77%. Changes in vascular density and intercapillary space of the deep plexus were statistically significant for certain months after operations (P≤0.05). There were no significant differences between subgroups. CONCLUSION The superficial plexus vascular density is almost the same in the temporal flap and in the foveal-sparing flap is decreased, and the deep plexus vascular density increased statistically significantly during the follow-up period after surgery.
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Affiliation(s)
- Anna Tarkova
- Department of Ophthalmology, Faculty Hospital Nitra, Spitalska 6, Nitra, Slovak Republic
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Nada Jiraskova
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jaroslava Dusova
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
| | - Jan Marak
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
| | - Jan Studnicka
- Department of Ophthalmology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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7
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Lotfy A, AboQuella NM, Wang H. Mesenchymal stromal/stem cell (MSC)-derived exosomes in clinical trials. Stem Cell Res Ther 2023; 14:66. [PMID: 37024925 PMCID: PMC10079493 DOI: 10.1186/s13287-023-03287-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Mesenchymal stromal/stem cells (MSCs) are widely utilized in cell therapy because of their robust immunomodulatory and regenerative properties. Their paracrine activity is one of the most important features that contribute to their efficacy. Recently, it has been demonstrated that the production of various factors via extracellular vesicles, especially exosomes, governs the principal efficacy of MSCs after infusion in experimental models. Compared to MSCs themselves, MSC-derived exosomes (MSC-Exos) have provided significant advantages by efficiently decreasing unfavorable adverse effects, such as infusion-related toxicities. MSC-Exos is becoming a promising cell-free therapeutic tool and an increasing number of clinical studies started to assess the therapeutic effect of MSC-Exos in different diseases. In this review, we summarized the ongoing and completed clinical studies using MSC-Exos for immunomodulation, regenerative medicine, gene delivery, and beyond. Additionally, we summarized MSC-Exos production methods utilized in these studies with an emphasis on MSCs source, MSC-Exos isolation methods, characterization, dosage, and route of administration. Lastly, we discussed the current challenges and future directions of exosome utilization in different clinical studies as a novel therapeutic strategy.
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Affiliation(s)
- Ahmed Lotfy
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Noha M AboQuella
- International Graduate Program Medical Neuroscience, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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8
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Sabanci S, Erol MK, Gedik B, Yaprak L, Suren E. Are YouTube Videos on the Treatment of Macular Holes Useful for Patients? Cureus 2023; 15:e34767. [PMID: 36909057 PMCID: PMC10000336 DOI: 10.7759/cureus.34767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Objective In this study, we aimed to assess the effectiveness and quality of the YouTube videos for patients regarding the treatment of macular holes. Materials and methods The quality and effectiveness of the videos on macular hole treatment on YouTube were evaluated using the DISCERN, global quality score (GQS), Journal of the American Medical Association (JAMA), and usefulness index scoring systems. Results The median DISCERN score of 100 videos included in the study was 18 (range: 15-73), the median JAMA score was 3 (range: 0-4), the median global quality score was 1 (range: 1-5), and the median usefulness index score was 1 (range: 0-5). The JAMA scores of the videos uploaded by non-clinicians were found to be significantly lower than those of the videos uploaded by clinicians (p<0.001). However, the daily viewing rate and the number of comments and likes for the videos uploaded by non-clinicians were found to be significantly higher than those for the videos uploaded by clinicians (p<0.003). Conclusion Based on our findings, while all of the beneficial macular hole videos on YouTube were published by clinicians, the majority of them are not really helpful to patients.
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Affiliation(s)
- Senol Sabanci
- Ophthalmology, Antalya Training and Research Hospital, Antalya, TUR
| | | | - Birumut Gedik
- Ophthalmology, Antalya Serik State Hospital, Antalya, TUR
| | - Lütfiye Yaprak
- Ophthalmology, Antalya Training and Research Hospital, Antalya, TUR
| | - Elcin Suren
- Ophthalmology, Antalya Training and Research Hospital, Antalya, TUR
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Garg A, Ballios BG, Yan P. Spontaneous Closure of an Idiopathic Full-Thickness Macular Hole: A Literature Review. JOURNAL OF VITREORETINAL DISEASES 2022; 6:381-390. [PMID: 37006898 PMCID: PMC9954929 DOI: 10.1177/24741264211049873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work reviews the literature regarding spontaneous closure of idiopathic full-thickness macular holes (FTMHs). Methods: Literature on patients with spontaneous idiopathic FTMH closure was reviewed via Ovid MEDLINE, EMBASE, and PubMed through July 16, 2020. A total of 27 of 66 identified articles were included. Results: A total of 68 eyes had spontaneous closure. Of the patients, 62.7% were women and the average age was 67.5 years. Visual acuity improved from Snellen 20/78 to 20/33 post closure. The average hole diameter was 176.8 μm; the largest was 350 μm. Most were stage 2 according to Gass and of small size according to International Vitreomacular Traction Study Group (IVTS) staging. The predominant classification system in recent literature is IVTS staging. The average optical coherence tomography–observed closure time was 4.5 months. Conclusions: On review, reported spontaneous closure rates of all idiopathic FTMH range from 3% to 15%, and no demographic subgroups are more likely to have closure. Holes ≤250 µm have higher closure rates (22.2%) than those in the range of >250 to 400 µm (13.3%) and ≥400 µm (0%). Closure is associated with favorable visual outcomes, and retinal bridging via glial cells is likely critical to closure. These determinations were based on limited numbers; prospective studies are needed to further ascertain rate, mechanism, and characteristics. IVTS staging provides reliable reporting and insight into whether FTMH can be observed before surgery.
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Affiliation(s)
- Anubhav Garg
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Brian G. Ballios
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Kensington Vision and Research Centre, Toronto, Canada
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Gonzalez-Cortes J, Treviño-Herrera A, Gonzalez-Cantu J, Sudhalkar A, Hernandez-Da Mota S, Mohamed-Hamsho J. Sudden branch macular artery avulsion during internal limiting membrane peeling for idiopathic macular hole: A case report. Int J Surg Case Rep 2022; 97:107443. [PMID: 35933950 PMCID: PMC9403290 DOI: 10.1016/j.ijscr.2022.107443] [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: 06/25/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Macular Holes (MH) are variable thickness openings of the retina that develop in the fovea. This case presents a branch macular artery avulsion during internal limiting membrane (ILM) peeling for idiopathic macular hole management in an adult patient. The proper management of this complication along with the preventive measures is mentioned. CASE PRESENTATION A 65-year-old woman developed a branch macular artery avulsion during ILM peeling for MH. After cataract extraction by phacoemulsification with intraocular lens implantation and pars plana vitrectomy, during ILM peeling, a multifocal bleeding along a macular artery was noted indicating its avulsion. The intraocular pressure was raised to control hemorrhage, blood remnants were passively aspirated and ILM peeling was kindly completed under adequate visualization. CLINICAL DISCUSSION Branch macular artery avulsion is a potential complication even for experienced surgeons. Proper management of this complication involves the increase of intraocular pressure for hemostasia. If hemostasia and proper visualization are achieved, the surgery could be completed, and if it is not the case, the ILM peeling could be completed in a second procedure. This complication might be avoided by initiating the ILM peeling away from the macular vessels. CONCLUSION Branch macular artery avulsion is an intraoperative complication that might be avoided by initiating the ILM peeling away from the macular vessels.
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Affiliation(s)
- J.H. Gonzalez-Cortes
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico,Corresponding author at: Ophthalmology Department, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Avenida Francisco I Madero 3501 y Avenida José Eleuterio González (Gonzalitos) S/N, Colonia Mitras Centro, Monterrey, Nuevo León 64460, Mexico.
| | - A.B. Treviño-Herrera
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico
| | - J.E. Gonzalez-Cantu
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico
| | - A. Sudhalkar
- Alphavision Augenzentrum, Bremerhaven, Germany,Raghudeep Eye Hospital, Ahmedabad, India,MS Sudhalkar Medical Research Foundation, Baroda 390001, India
| | - S.E. Hernandez-Da Mota
- Clinica David, Unidad oftalmologica y Facultad de Medicina, Universidad Michoacana de San Nicolas de Hidalgo, Morelia 58280, Mexico
| | - J. Mohamed-Hamsho
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico
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Eye disorders associated with newer antiepileptic drugs: A real-world disproportionality analysis of FDA adverse event reporting system. Seizure 2022; 96:66-73. [DOI: 10.1016/j.seizure.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
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Full-thickness macular hole formation in proliferative diabetic retinopathy. Sci Rep 2021; 11:23839. [PMID: 34903770 PMCID: PMC8668955 DOI: 10.1038/s41598-021-03239-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/30/2021] [Indexed: 01/15/2023] Open
Abstract
Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.
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Wold AM, Justin GA, Hobbs SD, Baker KM, Brady DP, Aden JK, Ryan DS, Weichel ED, Colyer MH. POSTERIOR SEGMENT INJURIES IN OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM: 2001 to 2011. Retina 2021; 41:2564-2570. [PMID: 34050100 DOI: 10.1097/iae.0000000000003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To characterize the nature of posterior segment ocular injuries in combat trauma. METHODS Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open-globe versus closed-globe injuries and by zone of injury and the types of posterior segment injuries in open-globe versus closed-globe injuries were assessed. RESULTS Four hundred fifty-two of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. Sixty-one patients (13.5%) had a Zone I injury, 50 (11.1%) a Zone II injury, and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final visual acuity of 20/200 or better compared with patients with either a Zone II (P < 0.001) or Zone III injury (P = 0.007). Eyes with a closed-globe injury were more likely to have a final visual acuity of 20/200 or better compared with those with an open-globe injury (P < 0.001). Furthermore, closed-globe injury compared with open-globe injury had a lower risk of vitreous hemorrhage (odds ratio 0.32, P < 0.001), proliferative vitreoretinopathy (odds ratio 0.14, P < 0.001), and retinal detachment (odds ratio 0.18, P < 0.001) but a higher risk of chorioretinal rupture (odds ratio 2.82, P < 0.001) and macular hole (odds ratio 3.46, P = 0.004). CONCLUSION Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open-globe versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.
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Affiliation(s)
- Aaron M Wold
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland
| | - Samuel D Hobbs
- Department of Ophthalmology, Wilford Hall Eye Center, San Antonio, Texas
| | - Katherine M Baker
- Department of Ophthalmology, Wake Forest Medical Center, Winston-Salem, North Carolina
| | - Derek P Brady
- Department of Graduate Medical Education, Travis Air Force Base, Fairfield, California
| | - James K Aden
- Department of Graduate Medical Education, Brooke Army Medical Center, San Antonio, Texas
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia
| | - Eric D Weichel
- Retina Group of Washington District of Columbia, Greenbelt, Maryland; and
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington
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14
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FULL-THICKNESS MACULAR HOLE IN AGE-RELATED MACULAR DEGENERATION PATIENTS WITH TWO DISTINCT ENTITIES: A Multicenter Study. Retina 2021; 41:2066-2072. [PMID: 34310095 DOI: 10.1097/iae.0000000000003141] [Citation(s) in RCA: 2] [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 describe optical coherence tomography characteristics of full-thickness macular holes (FTMHs) in age-related macular degeneration patients. METHODS A multicenter, retrospective, observational case series of patients diagnosed with age-related macular degeneration and FTMHs seen between January 1, 2009, and January 3, 2020. Clinical charts and spectral-domain optical coherence tomography images were reviewed. Optical coherence tomography findings included FTMH-inverted trapezoid or hourglass appearance, central macular thickness (CMT), complete retinal pigment epithelium and complete retinal outer retinal atrophy, and presence of pigment epithelium detachment and epiretinal membrane. The mean outcome was the morphologic and functional characterization of different subtypes of FTMHs. RESULTS A total of 86 eyes of 85 consecutive patients, with mean age of 80.31 ± 8.06 and mean best-corrected visual acuity of 1.17 ± 0.58 logarithm of the minimal angle of resolution. Two different subtypes of FTMHs were identified: tractional and degenerative. Fifty (58%) degenerative FTMHs characterized with inverted trapezoid appearance and 36 (42%) tractional FTMHs characterized with hourglass appearance. Degenerative FTMHs presented with 66% of CMT < 240 µm, 14% of CMT > 320, and 70% of complete retinal outer retinal atrophy, in comparison with 41% of CMT < 240 µm, 42.9% of CMT > 320%, and 20% of complete retinal outer retinal atrophy in the tractional FTMH group (P = 0.002, 0.003, <0.001, respectively). The presence of epiretinal membrane and pigment epithelium detachment where significantly higher in tractional FTMHs (P = 0.02, 0.03, respectively). CONCLUSION Degenerative and tractional FTMHs may be two distinct clinical entities. Discerning degenerative from tractional FTMHs is possible by using optical coherence tomography features including shape of the FTMHs, CMT, internal-external ratio of FTMHs, and presence of complete retinal outer retinal atrophy, pigment epithelium detachment, and epiretinal membrane.
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15
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Ghoraba HH, Leila M, Zaky AG, Wasfy T, Maamoun Abdelfattah H, Elgemai EM, Mohamed El Gouhary S, Mansour HO, Ghoraba HH, Heikal MA. Results of Pars Plana Vitrectomy for Different Types of Macular Holes. Clin Ophthalmol 2021; 15:551-557. [PMID: 33603333 PMCID: PMC7886253 DOI: 10.2147/opth.s290404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare different types of macular holes regarding the anatomic and functional success following pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal. Methods A retrospective review of all patients with macular holes treated by PPV, ILM removal with gas tamponade from January 2014 to July 2017 in Magrabi Eye Hospital. Results One hundred fifty-seven eyes of 153 patients were analyzed. The eyes were classified according to the etiology of macular hole into four groups: 79 eyes with idiopathic macular hole (IMH), 51 eyes with traumatic macular hole (TMH), 16 eyes with macular hole in diabetic patients (DMH) and 11 eyes with myopic macular hole (MMH). We classified the IMH group based on the International Vitreomacular Traction Study Classification according to size into 3 subgroups; subgroup 1: ≤250µ, subgroup 2: >250 to 400µ and subgroup 3: ≥400 µ. All types of macular hole showed statistically significant postoperative improvement in BCVA compared to the baseline except cases with MMH. Anatomic postoperative hole closure was achieved in 86.1%, 60.7%, 43.65%, an 45.46% of eyes with IMH, TMH, DMH and MMH, respectively. In eyes with IMH, closure rate in subgroup 1 was significantly higher than in subgroups 2, and 3. Conclusion PPV, ILM peel and C2F6 technique yielded variable anatomic and functional outcomes in different types of macular holes. Anatomic results were most favorable in IMH and least favorable in MMH. The smaller the diameter of the hole the better the results. The underlying pathogenetic mechanisms that lead to different types of macular holes are pivotal in determining the final outcome.
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Affiliation(s)
- Hammouda Hamdy Ghoraba
- Ophthalmology Department, Tanta University, Tanta City, Gharbia, Egypt.,Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Cairo, Egypt
| | - Adel Galal Zaky
- Ophthalmology Department, Menoufia University, Shebein Elkoom City, Menoufia, Egypt
| | - Tamer Wasfy
- Ophthalmology Department, Tanta University, Tanta City, Gharbia, Egypt
| | - Haithem Maamoun Abdelfattah
- Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt.,Ophthalmology Department, Benha Teaching Hospital, Benha City, Qualuopia, Egypt
| | - Emad Mohamed Elgemai
- Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt.,Ophthalmology Department, Damanhour Teaching Hospital, Dmanhour City, Albehaira, Egypt
| | | | | | - Hashem Hammouda Ghoraba
- Ophthalmology Department, Tanta University, Tanta City, Gharbia, Egypt.,Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt
| | - Mohamed Amin Heikal
- Ophthalmology Department, Benha University, Benha City, Qualuopia, Egypt.,Vitreoretinal Department, Magrabi Eye Hospital, Khober City, Eastern Province, Kingdom of Saudi Arabia
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16
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FIRST FAILED MACULAR HOLE SURGERY OR REOPENING OF A PREVIOUSLY CLOSED HOLE: Do We Gain by Reoperating?-A Systematic Review and Meta-analysis. Retina 2021; 40:1-15. [PMID: 31335482 PMCID: PMC6924931 DOI: 10.1097/iae.0000000000002564] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Repeated idiopathic full-thickness macular hole surgery after primary failure or reopening of a previously closed hole seems beneficial both in terms of anatomical closure and improvement in best-corrected visual acuity. To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.
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17
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Wang H, Li Y, Han S, Niu T. Analysis of multiple cytokines in aqueous humor of patients with idiopathic macular hole. BMC Ophthalmol 2021; 21:27. [PMID: 33430811 PMCID: PMC7802234 DOI: 10.1186/s12886-020-01782-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Idiopathic macular holes are common ophthalmic manifestations with unknown pathogenesis. Thus far, there has been minimal research regarding the causes of idiopathic macular holes, especially with respect to the underlying immune mechanism. To provide clarity regarding the treatment and prognosis of idiopathic macular holes, specifically regarding the levels of cytokines in affected patients, this study examined and analyzed multiple cytokine levels in aqueous humor from patients with idiopathic macular holes. Methods This comparative cross-sectional study included 38 patients in two groups: a cataract control group (n = 17) and an idiopathic macular hole group (n = 21). The levels of 48 cytokines in aqueous humor were detected by multiplex analysis with antibody-coupled magnetic beads. The Kolmogorov–Smirnov test was used to check whether the data were normally distributed; Student’s t-test and the Mann–Whitney U test were used to assess differences in cytokine levels between the two groups. Spearman correlation analysis was used to assess relationships among cytokine levels in the experimental group. Signaling pathways containing cytokines with significantly different expression in the experimental group were identified. Results There were significant differences in aqueous humor cytokine levels between patients with idiopathic macular holes and patients in the cataract control group. Notably, hepatocyte growth factor (p = 0.0001), GM-CSF (p = 0.0111), and IFN-γ (p = 0.0120) were significantly upregulated in the experimental group, while TNF-α (p = 0.0032), GRO-α (p < 0.0001), and MIF (p < 0.0001) were significantly downregulated in the experimental group. Furthermore, the GM-CSF level showed significant positive correlations with levels of IL-1 (r = 0.67904, p < 0.001), IL-4 (r = 0.76017, p < 0.001), and IFN-γ (r = 0.59922, p = 0.004097) in the experimental group. Moreover, the levels of nerve growth factor and hepatocyte growth factor showed a significant positive correlation (r = 0.64951, p = 0.001441) in the experimental group. Conclusions Patients with idiopathic macular holes showed significant variation in aqueous humor immune response after the onset of hole formation, including the recruitment of immune cells and regulation of cytokine expression. Our findings also suggest that it is not appropriate to use patients with macular holes as the control group in studies of aqueous humor cytokine levels in ophthalmic diseases.
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Affiliation(s)
- Heping Wang
- Department of Ophthalmology, The Fourth Hospital of Shenyang, 110016, Shenyang, Liaoning, People's Republic of China
| | - Yuqi Li
- University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, Liaoning, People's Republic of China
| | - Song Han
- Department of Ophthalmology, The Fourth Hospital of Shenyang, 110016, Shenyang, Liaoning, People's Republic of China
| | - Tongtong Niu
- Department of Ophthalmology, The Fourth Hospital of Shenyang, 110016, Shenyang, Liaoning, People's Republic of China.
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18
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Huang P, Wang H, Chen F, Chen J, Hu Y, Sun J, Feng J, Zhu H. Functional evaluation with microperimetry in large idiopathic macular holes treated by a free internal limiting membrane flap tamponade technique. BMC Ophthalmol 2020; 20:302. [PMID: 32703197 PMCID: PMC7379782 DOI: 10.1186/s12886-020-01573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Free internal limiting membrane (ILM) flap tamponade technique is an alternative choice for treating large idiopathic macular holes (IMHs). However, the functional recovery related to this surgical approach is not well-characterized. This study aimed to evaluate morphological and microperimetric outcomes 6 months after free ILM flap tamponade technique for large IMHs. Methods Twenty-two patients (22 eyes) with large IMHs (minimal diameter > 400 μm) were retrospectively enrolled in this study. All patients underwent 23-gauge pars plana vitrectomy with ILM peeling and free ILM flap tamponade procedures. Snellen best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and MP-1 microperimetry were measured at baseline and 6 months after surgery. Associations of postoperative BCVA with retinal sensitivity were detected. Results Macular hole closure was achieved in 21 eyes (95.5%). Dislodgement of free ILM flap was found in non-closed eye. Mean logMAR BCVA improved from 1.10 ± 0.33 at baseline to 0.67 ± 0.32 at 6 months postoperatively (P < 0.001). The mean overall macular sensitivity and foveal fixation stability increased respectively from 8.58 ± 3.05 dB and 65.64 ± 17.28% before surgery to 11.55 ± 2.72 dB and 78.59 ± 13.00% at 6 months after surgery (P < 0.001). The mean change in foveal sensitivity (within 2°) was significantly greater than the change achieved for peri-foveal sensitivity (2° to 10°) by 1.50 ± 2.62 dB (P = 0.014). Linear regression analysis showed that postoperative logMAR BCVA was significantly associated with duration of symptom (B = 0.063, P = 0.001), preoperative logMAR BCVA (B = 0.770, P = 0.000), preoperative peri-foveal (B = − 0.065, P = 0.000) and foveal sensitivity (B = − 0.129, P = 0.000). Moreover, multiple regression model revealed that preoperative foveal sensitivity was independently associated with postoperative logMAR BCVA (B = − 0.430, P = 0.040). Conclusions Vitrectomy combined with ILM peeling and free ILM flap tamponade technique results in effective morphological and functional recovery for large IMHs. Preoperative foveal sensitivity might be a prognostic indicator for postoperative BCVA.
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Affiliation(s)
- Peirong Huang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China
| | - Fenge Chen
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Yifan Hu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Junran Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Jingyang Feng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China. .,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
| | - Hong Zhu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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19
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Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology 2019; 127:P184-P222. [PMID: 31757499 DOI: 10.1016/j.ophtha.2019.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
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20
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Nagaoka K, Inoda S, Takahashi H, Arai Y, Inoue Y, Takizawa Y, Fujioka S, Kawashima H. A Case of Giant Macular Hole Progression after Rupture of a Giant Retinal Pigment Epithelial Detachment. Case Rep Ophthalmol 2019; 10:195-199. [PMID: 31692603 PMCID: PMC6760363 DOI: 10.1159/000500803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022] Open
Abstract
We report a case of giant macular hole progression after rupture of giant retinal pigment epithelial detachment (PED). The patient was a 91-year-old man who had a giant PED in the left eye. He had bilateral hypermetropia (+2.00 dpt), and he had developed posterior vitreous detachment. The PED was 5,800 μm in diameter and 800 μm in height and ruptured during follow-up. A macular hole was formed, with a diameter of 400 μm, and the height of the PED had reduced to 360 μm. After 5 months, the macular hole expanded up to a diameter of 600 μm. Therefore, some cases of giant PED may lead to macular hole.
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Affiliation(s)
- Kosuke Nagaoka
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
- Totsuka Eye Clinic, Yokohama, Japan
- *Hidenori Takahashi, Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431 (Japan), E-Mail
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
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21
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Perspectives of Autologous Mesenchymal Stem-Cell Transplantation in Macular Hole Surgery: A Review of Current Findings. J Ophthalmol 2019; 2019:3162478. [PMID: 30918717 PMCID: PMC6409040 DOI: 10.1155/2019/3162478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/29/2019] [Accepted: 02/10/2019] [Indexed: 12/29/2022] Open
Abstract
The main treatment available for idiopathic macular holes is represented by pars plana vitrectomy with internal limiting membrane peeling. However, late-stage macular holes are affected by a higher risk of surgical failure. Although adjuvant techniques can be employed, a satisfactory functional recovery is difficult to achieve in refractory macular holes. Given their neuroprotective and antiapoptotic properties, mesenchymal stem cells (MSCs) may represent an appealing approach to treat these extreme cases. The purpose of this review is to highlight the findings regarding healing mechanisms exerted by mesenchymal stem cells and preliminary application in cases of refractory macular holes. When compared with MSCs, MSC-derived exosomes may represent a feasible alternative, given their reduced risk of undesired proliferation and easiness of use.
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22
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Xia S, Zhao XY, Wang EQ, Chen YX. Comparison of face-down posturing with nonsupine posturing after macular hole surgery: a meta-analysis. BMC Ophthalmol 2019; 19:34. [PMID: 30691441 PMCID: PMC6348675 DOI: 10.1186/s12886-019-1047-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
Background A few randomized controlled trials (RCTs) have evaluated face-down posturing (FDP) with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness macular holes (MHs). The objective of our study was to evaluate the efficacy of postoperative posturing on the anatomical and functional outcomes of MH surgery. Methods The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from their earliest entries through December 2016 to identify the studies that had evaluated the effects of postoperative posturing with FDP or NSP for patients with MH surgery. The PRISMA guidelines were followed. The relevant data were analyzed using StataSE 12.0 software. The weighted mean difference (WMD), relative risk (RR) and their 95% confidence intervals (95% CIs) were used to assess the strength of the association. Results Our search yielded 181 records from which 11 studies comprising 726 cases that had examined the effects of postoperative posturing with FDP for patients compared with NSP after MH surgery were included for review and analysis. Our meta-analyses showed that postoperative FDP could generally improve the overall MH closure rate compared to NSP (OR = 1.828, 95% CI: 1.063~3.143, P = 0.029). Subgroup analysis of the size of MH suggested a significant benefit of FDP for large MHs (≥400 μm) (OR = 4.361, 95% CI: 1.429~13.305, P = 0.010) while there was no difference in the MH closure rate for small MHs (< 400 μm) (OR = 1.731, 95% CI: 0.412~7.270, P = 0.453). Moreover, ILM peeling for large MHs could significantly increase the MH closure rate of the FDP group (OR = 2.489, 95% CI: 1.021~6.069, P = 0.045), while no difference existed for small MHs (OR = 3.572, 95% CI: 0.547~23.331, P = 0.184). Combined cataract surgery might not influence the MH closure rate under any circumstance (OR = 0.513, 95% CI: 0.089~2.944, P = 0.454). Conclusion Based on all the available evidence, our study found that FDP after MH surgery could generally improve the overall MH closure rate compared to NSP. For MHs larger than 400 μm, ILM peeling combined with FDP could significantly increase the MH closure rate. Combined cataract surgery might not influence the MH closure rate.
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Affiliation(s)
- Song Xia
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, 550000, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Er-Qian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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23
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Agarwal A, Pichi F, Invernizzi A, Gupta V. Disease of the Year: Differential Diagnosis of Uveitic Macular Edema. Ocul Immunol Inflamm 2018; 27:72-88. [DOI: 10.1080/09273948.2018.1523437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science ‘Luigi Sacco’, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Öhman T, Tamene F, Göös H, Loukovaara S, Varjosalo M. Systems pathology analysis identifies neurodegenerative nature of age-related vitreoretinal interface diseases. Aging Cell 2018; 17:e12809. [PMID: 29963742 PMCID: PMC6156470 DOI: 10.1111/acel.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/11/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022] Open
Abstract
Aging is a phenomenon that is associated with profound medical implications. Idiopathic epiretinal membrane (iEMR) and macular hole (MH) are the major vision-threatening vitreoretinal diseases affecting millions of aging people globally, making these conditions an important public health issue. iERM is characterized by fibrous tissue developing on the surface of the macula, which leads to biomechanical and biochemical macular damage. MH is a small breakage in the macula and is associated with many ocular conditions. Although several individual factors and pathways are suggested, a systems pathology level understanding of the molecular mechanisms underlying these disorders is lacking. Therefore, we performed mass spectrometry-based label-free quantitative proteomics analysis of the vitreous proteomes from patients with iERM and MH to identify the key proteins, as well as the multiple interconnected biochemical pathways, contributing to the development of these diseases. We identified a total of 1,014 unique proteins, many of which are linked to inflammation and the complement cascade, revealing the inflammation processes in retinal diseases. Additionally, we detected a profound difference in the proteomes of iEMR and MH compared to those of diabetic retinopathy with macular edema and rhegmatogenous retinal detachment. A large number of neuronal proteins were present at higher levels in the iERM and MH vitreous, including neuronal adhesion molecules, nervous system development proteins, and signaling molecules, pointing toward the important role of neurodegenerative component in the pathogenesis of age-related vitreoretinal diseases. Despite them having marked similarities, several unique vitreous proteins were identified in both iERM and MH, from which candidate targets for new diagnostic and therapeutic approaches can be provided.
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Affiliation(s)
- Tiina Öhman
- Institute of Biotechnology and Helsinki Institute of Life Science; University of Helsinki; Helsinki Finland
| | - Fitsum Tamene
- Institute of Biotechnology and Helsinki Institute of Life Science; University of Helsinki; Helsinki Finland
| | - Helka Göös
- Institute of Biotechnology and Helsinki Institute of Life Science; University of Helsinki; Helsinki Finland
| | - Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Markku Varjosalo
- Institute of Biotechnology and Helsinki Institute of Life Science; University of Helsinki; Helsinki Finland
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25
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Michalewska Z, Nawrocki J. Repeat Surgery in Failed Primary Vitrectomy for Macular Holes Operated With the Inverted ILM Flap Technique. Ophthalmic Surg Lasers Imaging Retina 2018; 49:611-618. [DOI: 10.3928/23258160-20180803-09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
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26
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Hocaoglu M, Muslubas IS, Ersoz MG, Arf S, Karacorlu M. First-Operated and Fellow Eyes With Bilateral Idiopathic Macular Hole: Comparison of Anatomical and Functional Postoperative Outcomes. Ophthalmic Surg Lasers Imaging Retina 2018; 49:571-578. [DOI: 10.3928/23258160-20180803-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022]
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Seyhan Karatepe A, Menteş J, Erakgün ET, Afrashi F, Nalçacı S, Akkın C, Ateş Y. Vitreoretinal Interface Characteristics in Eyes with Idiopathic Macular Holes: Qualitative and Quantitative Analysis. Turk J Ophthalmol 2018; 48:70-74. [PMID: 29755819 PMCID: PMC5938479 DOI: 10.4274/tjo.23327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives To determine the qualitative and quantitative vitreoretinal interface characteristics with spectral domain optical coherence tomography (SD-OCT) in eyes with macular hole (MH) and investigate their relation with best corrected visual acuity (BCVA) and MH duration. Materials and Methods Sixty-one eyes of 46 consecutive patients diagnosed with idiopathic MH were included in the study. The mean age of the patients was 66.7±7.5 (51-79) years. Complete ophthalmologic examination and SD-OCT examination were performed in all eyes and MH stages were determined according to SD-OCT findings. Qualitative characteristics of the vitreoretinal interface were investigated, including vitreomacular traction, vitreopapillary traction, maculopapillary traction, vitreoschisis, intraretinal cyst, presence of epiretinal membrane, and the integrity of the photoreceptor inner segment-outer segment junction (IS/OS) and external limiting membrane (ELM). In addition, MH diameter, MH base diameter (MHBD), ELM defect diameter, IS/OS defect diameter, and MH height were quantitatively measured and the MH index was calculated. Results Out of 61 eyes, 9.8% were classified as stage 1a, 19.7% as stage 1b, 18% as stage 2, 23% as stage 3, and 29.5% as stage 4. Mean BCVA was 0.28±0.24 (1 mps-1.0) Snellen and MH duration was 10.08±18.6 (1-108) months. The most common interface characteristics associated with MH were determined as intraretinal cyst (91.8%), IS/OS defect (78.7%) and ELM defect (63.9%). Duration and stage of MH were inversely proportional to BCVA but directly proportional to the presence and diameter of IS/OS and ELM defects. BCVA was significantly lower in eyes with IS/OS and ELM defects (p<0.0001; p<0.0001 Mann-Whitney U test). Conclusion We determined that the most important factors affecting BCVA in cases with idiopathic MH were MH stage, MH duration, MHBD, and the presence and diameter of IS/OS and ELM defects, which suggests that these parameters should be considered while making decisions about prognosis and treatment.
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Affiliation(s)
- Arzu Seyhan Karatepe
- Okan University Faculty of Medicine Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Jale Menteş
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - E Tansu Erakgün
- Kaşkaloğlu Eye Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Serhad Nalçacı
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Cezmi Akkın
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Yeşim Ateş
- Kaşkaloğlu Eye Hospital, Ophthalmology Clinic, İzmir, Turkey
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Choriocapillaris layer imaging with swept-source optical coherence tomography angiography in lamellar and full-thickness macular hole. Graefes Arch Clin Exp Ophthalmol 2017; 256:11-21. [DOI: 10.1007/s00417-017-3814-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/31/2017] [Accepted: 09/19/2017] [Indexed: 01/01/2023] Open
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Delas B, Julio G, Fernández-Vega Á, Casaroli-Marano RP, Nadal J. Reduction of foveal bulges and other anatomical changes in fellow eyes of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes. Graefes Arch Clin Exp Ophthalmol 2017; 255:2141-2146. [PMID: 28836231 DOI: 10.1007/s00417-017-3765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare the foveal characteristics in fellow eyes (FE) of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes with eyes of healthy controls. METHODS Forty-seven FE and 52 eyes of 52 age- and sex-matched healthy controls were studied. Quantitative assessment of the dome-shaped appearance of the hyperreflective lines that represent external limiting membrane (ELM_bulge) and inner outer segment junctions (IS/OS_bulge) were made by optical coherence tomography (OCT) images. Inner retinal complex thickness (IRCT) was quantitatively assessed at 1000 and 2000 μm of the foveal center in nasal and temporal quadrants. Presence of alterations in the inner retinal outer layers and central foveal thickness (CFT) were also analyzed. RESULTS Significantly lower ELM_bulge (p < 0.0001; Mann-Whitney test) and IS/OS_bulge (p < 0.001; student t test) and higher cases with COST alterations, expressed as a diffuse line (p < 0.006; Chi2 test) were found in FE than control eyes. IRCT were significantly reduced in FE at all the studied locations when comparing to control eyes (p < 0.05; student t test), maintaining anatomical proportionality among locations. CONCLUSION FE without pathologic vitreomacular interactions seems to present some central cone alterations that may be related to other causes than vitreomacular traction.
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Affiliation(s)
- Barbara Delas
- Department of Opthalmology, Hospital de Terrassa-Consorci Sanitari de Terrassa, Ctra Torrebonica s/n. Terrassa, 08227, Barcelona, Spain.
| | - Gemma Julio
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Optics and Optometry Department, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | - Ricardo P Casaroli-Marano
- Department of Surgery and Hospital Clinic de Barcelona (IDIBAPS), School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Jeroni Nadal
- Centro de Oftalmología Barraquer, Barcelona, Spain
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New insights into the pathoanatomy of macular holes based on features of optical coherence tomography. Surv Ophthalmol 2017; 62:506-521. [PMID: 28300548 DOI: 10.1016/j.survophthal.2017.03.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 11/20/2022]
Abstract
Various important findings related to the development and progression of idiopathic macular holes (MHs) have been described using optical coherence tomography since Gass first staged MH development using biomicroscopy in 1988 and 1995. We believe that a system for classifying and staging MHs should reflect the degree of disease status and its progression and have value not only from a practical point of view (by predicting the chance of closure or visual recovery), but also provide researchers and clinicians with insights into the pathogenesis and disease progression of MH. These data pave the way for the development of more effective strategies. In this review, we integrate the morphologic features of MHs observed by optical coherence tomography with Gass's biomicroscopic classification and anatomic interpretations. As a result, we propose a conceptual model of a modified classification system for MHs: (1) there are 2 types of MHs starting from the earliest developmental phases of the condition; (2) differences between the types of MHs result from the peculiar characteristics of Müller cells in the fovea; and (3) this classification system, which is based on the degree of preoperative tissue defects, determines closure patterns as well as visual outcomes after an MH is surgically repaired.
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Spectral versus time-domain OCT in detecting preoperative epiretinal membranes that accompany macular holes. Eur J Ophthalmol 2017; 27:185-189. [PMID: 27646327 DOI: 10.5301/ejo.5000862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the sensitivities of spectral-domain optical coherence tomography (SD-OCT) versus time-domain OCT (TD-OCT) in identifying epiretinal membranes (ERM) preoperatively in patients who underwent surgery for full-thickness macular holes (FTMH). METHODS This is an interventional retrospective case series of 59 eyes diagnosed with FTMHs who underwent 25-G pars plana vitrectomy with internal limiting membrane peeling between 2009 and 2015. Preoperative OCTs were obtained by SD-OCT (Spectralis, Heidelberg, Germany) or TD-OCT (Stratus, Carl Zeiss Meditec, Dublin, CA, USA). Volume scans were reviewed for ERM accompanying the FTMH. This was compared to indocyanine green-negative staining and intraoperative findings of ERM as the gold standard. RESULTS Baseline characteristics between the SD-OCT and TD-OCT groups were comparable. Mean duration of postoperative follow-up was 41.4 weeks (±49.0). Of 59 eyes, 33 (55.9%) exhibited an ERM intraoperatively. Four ERMs (SD-OCT group) compared to 12 (TD-OCT group) were not visualized on preoperative OCT (p = 0.003). Sensitivity and specificity of SD-OCT in ERM detection was 79% and 100% compared to 14% and 91% for TD-OCT. Visual acuity improved in both arms (0.5 and 0.3 logMAR units in SD-OCT and TD-OCT, respectively (p = 0.002, 0.0002). CONCLUSIONS We found that SD-OCT was superior to TD-OCT in identifying the presence of ERM preoperatively in patients who underwent macular hole surgery. Since ERMs may decrease the chance of successful pharmacologic vitreolysis, we recommend using SD-OCT over TD-OCT in the evaluation of patients with FTMH to more accurately identify ERMs and allow more comprehensive treatment decisions (pharmacologic versus surgical).
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Current Management of Traumatic Macular Holes. J Ophthalmol 2017; 2017:1748135. [PMID: 28239490 PMCID: PMC5292388 DOI: 10.1155/2017/1748135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further.
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Casini G, Loiudice P, De Cillà S, Radice P, Nardi M. Sulfur hexafluoride (SF 6) versus perfluoropropane (C 3F 8) tamponade and short term face-down position for macular hole repair: a randomized prospective study. Int J Retina Vitreous 2016; 2:10. [PMID: 27847628 PMCID: PMC5088452 DOI: 10.1186/s40942-016-0036-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/21/2016] [Indexed: 11/23/2022] Open
Abstract
Background To compare early visual and anatomical outcomes after either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) tamponade for macular hole repair. Methods 147 eyes affected by primary full-thickness macular hole underwent pars plana vitrectomy with dye assisted removal of the internal limiting membrane and gas tamponade. Prone position was prescribed for 48 h after surgery. All patients were divided into 3 groups depending on the size of the hole: small (<250 µm), medium (>250–<400 µm) or large (>400 µm). Eyes within the same group randomly received either SF6 (70 eyes) or C3F8 (77 eyes). A complete ophthalmic evaluation, including best corrected visual acuity and anatomic status of the macular holes, was conducted preoperatively, at 1 week and 1 month after surgery. Macular hole volume was calculated using optical coherence tomography scans. The Wilcoxon Signed Ranks Test, the Mann–Whitney Test, the Spearman’s rank-order correlation coefficient and the study of variance for repeated measures were used for statistical analysis. Results Mean best-corrected visual acuity improved from 0.92 logMAR to 0.28 logMAR (P < 0.001). A reduction of the dimensions of macular holes was observed in all cases, with a total repair of 90 % (63/70 eyes) in the SF6 group and 91 % in the C3F8 group (70/77 eyes). There was a negative correlation between the initial minor diameter, the volume of the hole and the rate of anatomic success. Conclusions Short-term anatomical and visual outcomes were similar in eyes treated with either SF6 or C3F8, independently of the stage of the macular hole. The initial volume and the minor diameter of the hole may be considered as valid tools for predicting surgical success. Age and gender did not appear to have influenced the prognosis.
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Affiliation(s)
- Giamberto Casini
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Pasquale Loiudice
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano De Cillà
- Eye Clinic, San Paolo Hospital, University of Milano, Milano, Italy
| | - Paolo Radice
- Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Marco Nardi
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Abstract
The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity.
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Correlation between foveal interdigitation zone band defect and visual acuity after surgery for macular pseudohole. Retina 2015; 35:908-14. [PMID: 25549072 DOI: 10.1097/iae.0000000000000414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for a macular pseudohole. METHODS Thirty-one eyes of 31 patients with a macular pseudohole underwent vitrectomy with internal limiting membrane removal. The foveal area was examined by spectral domain optical coherence tomography preoperatively and postoperatively. The correlations between the BCVA and the lengths of the photoreceptor interdigitation zone (IZ), the ellipsoid zone, and the external limiting membrane band defects, and central foveal thickness were determined. RESULTS The BCVA improved significantly and the length of the IZ band defect decreased significantly after the surgery. Simple linear regression analyses showed that the BCVA was significantly correlated with the length of the IZ band defect preoperatively and also at 1 to 12 months postoperatively (P < 0.001 for all). The BCVA was not significantly correlated with the length of the ellipsoid zone, external limiting membrane band defect, and the central foveal thickness. CONCLUSION The significant correlation between the length of the foveal IZ band defect and the BCVA preoperatively and postoperatively indicates that the foveal IZ band is related to the visual recovery in patients with macular pseudohole.
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Fischer C, Callizo J, Wetzel E, Feltgen N, Hoerauf H. [Importance of the Watzke-Allen test in diagnostics and staging of macular holes]. Ophthalmologe 2015. [PMID: 26205743 DOI: 10.1007/s00347-015-0102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Watzke-Allen test (WAT) is a simple diagnostic tool designed for the diagnosis of full thickness macular holes (FTMH) but due to the rapid progress of imaging diagnostics it was replaced by spectral domain optical coherence tomography (SD-OCT) of macular pathologies. The aim of this study was to examine if the WAT is able to distinguish between the different FTMH stages. METHODS In 57 eyes of 57 patients with clinical evidance of FTMH, the WAT was first performed followed by SD-OCT examination and a distinction was made between a negative (slit beam normal) and a positive sign (slit beam modified as groove and hourglass configuration or completely broken). RESULTS In 49 out of 57 patients the WAT was positive (hourglass 46 patients and broken 3 patients). Based on the SD-OCT results the following diagnoses were made: lamellar macular holes (LMH, 3 patients), vitreomacular traction (VMT, 4 patients), small macular hole (≤ 250 µm, 5 patients), medium sized macular hole (250-400 µm, 11 patients) and large macular hole (≥ 400 µm, 34 patients). In 91 % of the patients with medium and large FTMH, the WAT was positive, whereas the WAT was positive in only 67 % of patients with small FTMH, VMT and LMH. The sensitivity for large and medium FTMH was 93 % but the specificity was only 33 %. CONCLUSION The WAT was positive in a high percentage of patients with large and medium sized macular holes as well as patients with small macular holes and LMH. The sensitivity of certain indications for treatment was 93 % but the specificity was only 33 %; therefore, the WAT alone is not suitable for a certain preoperative differentiation of macular alterations.
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Affiliation(s)
- C Fischer
- Universitäts-Augenklinik, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland.
| | - J Callizo
- Universitäts-Augenklinik, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland
| | - E Wetzel
- Universitäts-Augenklinik, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland
| | - N Feltgen
- Universitäts-Augenklinik, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland
| | - H Hoerauf
- Universitäts-Augenklinik, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland
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Abstract
BACKGROUND A macular hole is an anatomic opening in the retina that develops at the fovea. Macular holes can be seen in highly myopic eyes or following ocular trauma, but the great majority are idiopathic. Pars plana vitrectomy was introduced to treat full-thickness macular holes, which if left untreated have a poor prognosis since spontaneous closure and visual recovery are rare.Vitrectomy is a surgical technique involving the removal of the vitreous body that fills the eye. The surgeon inserts thin cannulas into the eyes through scleral incisions to relieve traction exerted by the vitreous or epiretinal membranes to the central retina and to induce glial tissue to bridge and close the hole. OBJECTIVES The primary objective of this review was to examine the effects of vitrectomy for idiopathic macular hole on visual acuity. A secondary objective was to investigate anatomic effects on hole closure and other dimensions of visual function, as well as to report on adverse effects recorded in included studies. SEARCH METHODS We searched the Cochrane Eyes and Vision Group Trials Register (4 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to March 2015), EMBASE (January 1980 to March 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to March 2015), the Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1980 to March 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 March 2015. SELECTION CRITERIA We included randomised controlled trials comparing vitrectomy (with or without internal limiting membrane peeling) to no treatment (that is observation) for macular holes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently extracted the data. We estimated best corrected visual acuity and macular hole closure at 6 to 12 months of follow-up. MAIN RESULTS Three studies provided data on the comparison between vitrectomy and observation in eyes with macular hole and visual acuity less than 20/50. Two studies, conducted in the USA and published in 1996 and 1997, used a similar protocol and included participants with stage II macular hole (42 eyes randomised, 36 analysed, number of participants not reported) or participants with stage III/IV hole (129 eyes of 120 participants, 115 eyes in analyses). The third study, conducted in the UK and published in 2004, included 185 eyes of 174 participants with full-thickness macular hole (41 eyes with stage II holes and 74 eyes with stage III/IV holes in analyses). Studies were of good quality for randomisation and allocation concealment, whereas visual acuity measurement was unmasked.At 6 to 12 months, visual acuity was improved by about 1.5 Snellen lines (-0.16 logMAR, 95% confidence intervals -0.23 to -0.09 logMAR, 270 eyes, moderate-quality evidence). The chances of macular hole closure at 6 to 12 months were greatly increased using vitrectomy, yielding an odds ratio of 31.4 (95% confidence intervals 14.9 to 66.3, 265 eyes, high-quality evidence; raw sum data: 76% vitrectomy, 11% observation). Vitrectomy was beneficial both in smaller (stage II) and in larger (stage III/IV) macular holes.The largest study reported that cataract surgery was needed in about half of cases at two years after operation and that retinal detachment occurred in about 5% of operated eyes. AUTHORS' CONCLUSIONS Vitrectomy is effective in improving visual acuity, resulting in a moderate visual gain, and in achieving hole closure in people with macular hole. However, these results may not apply to modern surgery due to technological improvements in vitrectomy techniques.
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Affiliation(s)
- Mariacristina Parravano
- Fondazione G.B. Bietti per lo studio e la ricerca in Oftalmolologia‐IRCCSOphthalmologyVia Livenza n 3RomeItaly00198
| | - Fabrizio Giansanti
- University of FlorenceDepartment of Specialised Surgical SciencesVia le Morgagni 85FlorenceItaly50134
| | - Chiara M Eandi
- University of TorinoDepartment of Surgical Science, Eye ClinicVia Juvarra 19TorinoItaly
| | - Yew C Yap
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Stanislao Rizzo
- Azienda Ospedaliero Universitaria CareggiEye Clinic SOD OculisticaLargo Brambilla, 3FlorenceItaly50134
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
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Lai CT, Yang CM. Development of macular holes in diabetic retinopathy with fibrovascular proliferation: Report of four cases. Taiwan J Ophthalmol 2015; 5:85-89. [PMID: 29018673 PMCID: PMC5602733 DOI: 10.1016/j.tjo.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/21/2015] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
There are yet no reports in the literature describing the mechanism of macular hole (MH) formation associated with fibrovascular proliferation in proliferative diabetic retinopathy. We report four cases of MHs in diabetic retinopathy with fibrovascular proliferation; formation of MHs were studied using sequential pre-MH optical coherence tomography (OCT). In Case 1, initial OCT revealed tractional schisis and cysts with fovea detachment. An MH with bowl-shaped detachment was noted within 6 weeks. In Case 2, initial OCT revealed thickened posterior hyaloid membrane with vitreomacular traction. Five and a half years later, OCT showed MH formation with possible vitreomacular separation. Some epiretinal membrane was also noted in the macula area. In Case 3, initial OCT revealed tractional retinal elevation from the superonasal area to the fovea with macular thinning. An MH with detachment developed 7 weeks later. In Case 4, initial OCT revealed macula-involved retinal detachment with traction. An MH was noted 4 weeks later. The analysis of sequential OCT findings in these four cases suggests that strong vitreoretinal adhesion and traction of fibrovascular proliferation may induce an MH without going through the same evolutionary phases as those characteristic of idiopathic MHs.
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Affiliation(s)
- Chun-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Corresponding author. Department of Ophthalmology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Number 7, Chung Shan South Road, Taipei, Taiwan. E-mail address: (C.-M. Yang)
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Kim BS, Kim BJ, Han YS, Park JM, Chung IY. A Case of Postpartum Macular Hole in a Young Woman. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.3.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Byoung Seon Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byung Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Faghihi H, Ghassemi F, Falavarjani KG, Saeedi Anari G, Safizadeh M, Shahraki K. Spontaneous closure of traumatic macular holes. Can J Ophthalmol 2014; 49:395-8. [DOI: 10.1016/j.jcjo.2014.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/11/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Urías-Planella MB, García-Solis MV, Peñaflor-Siller J, García-Franco R. Cierre espontáneo de agujero macular traumático, seguimiento por OCT: presentación de un caso. REVISTA MEXICANA DE OFTALMOLOGÍA 2014. [DOI: 10.1016/j.mexoft.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Arevalo JF, Lasave AF, Arias JD, Serrano MA, Arevalo FA. Clinical applications of optical coherence tomography in the posterior pole: the 2011 José Manuel Espino Lecture - Part I. Clin Ophthalmol 2013; 7:2165-79. [PMID: 24235810 PMCID: PMC3825704 DOI: 10.2147/opth.s51098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Optical coherence tomography (OCT) is now a standard of care in ophthalmology and is considered essential for the diagnosis and monitoring of many retinal diseases. One of the major advances obtained with OCT was the understanding of the pathophysiology of macular holes. Non-full-thickness macular holes have been revisited because high-resolution OCT images can detect a lamellar macular defect that is not always visible clinically, and surgery has been advocated by some authors. OCT can be valuable in determining the need for and/or timing of surgical intervention on epiretinal membranes or vitreomacular traction syndrome. In addition, we can use this technology as a predictive factor in the prognosis and follow-up of the most common posterior pole pathologies.
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Affiliation(s)
- J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Spiteri Cornish K, Lois N, Scott N, Burr J, Cook J, Boachie C, Tadayoni R, la Cour M, Christensen U, Kwok A. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database Syst Rev 2013:CD009306. [PMID: 23740611 DOI: 10.1002/14651858.cd009306.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several observational studies have suggested the potential benefit of internal limiting membrane (ILM) peeling to treat idiopathic full-thickness macular hole (FTMH). However, no strong evidence is available on the potential benefit(s) of this surgical manoeuvre and uncertainty remains among vitreoretinal surgeons about the indication for peeling the ILM, whether to use it in all cases or in long-standing and/or larger holes. OBJECTIVES To determine whether ILM peeling improves anatomical and functional outcomes of macular hole surgery compared with the no-peeling technique and to investigate the impact of different parameters such as presenting vision, stage/size of the hole and duration of symptoms in the success of the surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) which contains the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to February 2013), EMBASE (January 1980 to February 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 February 2013.We searched reference lists of the studies included in the review for information about other studies on ILM peeling in macular hole surgery. We searched Proceedings for the following conferences up to February 2013: American Academy of Ophthalmology (AAO), Annual Meeting of the American Society of Retina Specialists (ASRS), Annual Meeting of the Retina Society, Congress of the Asia-Pacific Academy of Ophthalmology (APAO), European Association for Vision and Eye Research (EVER) Annual Congress, European Vitreoretinal Society (EVRS) Annual Meeting, Association for Research in Vision and Ophthalmology (ARVO) Meeting, International Vitreoretinal Meeting, and World Ophthalmology Congress. SELECTION CRITERIA Only randomised controlled trials (RCTs) comparing ILM peeling with the no-peeling counterpart were included. DATA COLLECTION AND ANALYSIS Two review authors (KSC and NL) independently assessed the titles and abstracts of all RCTs identified by electronic and manual searches.We obtained Individual patient data (IPD) from three of the four identified eligible trials. The fourth identified RCT had only been published in abstract form and no IPD were available; we included data from this published abstract for one outcome (macular hole closure).The primary outcome was distance visual acuity at six months. Secondary outcomes included distance and near visual acuity at three and 12 months postoperatively, near visual acuity at six months postoperatively, primary (after a single surgery) and final (following more than one surgery) macular hole closure, need for additional surgical interventions, vision-related quality of life and intraoperative and postoperative complications.We performed meta-analysis using standard techniques (the Mantel-Haenszel odds ratio (OR) for binary outcomes, mean difference (MD) for continuous outcomes) using a fixed-effect model. For two outcomes we also used the IPD to perform adjusted analyses using regression methods. MAIN RESULTS We identified and included four RCTs; these were conducted in Denmark, France, Hong Kong and the United Kingdom/Republic of Ireland and randomised 47, 80, 49 and 141 participants respectively.There was no evidence of a difference in the primary outcome (distance visual acuity at six months), nor in distance visual acuity at 12 months between randomised groups. However, there was evidence of improved best corrected distance visual acuity in the ILM peeling group at three months (WMD -0.09, 95% CI -0.17 to -0.02). We found no evidence for a difference in near vision between groups at any of the time points investigated.Overall, more participants in the ILM peeling group than in the no-peeling group had primary macular hole closure (OR 9.27, 95% CI 4.98 to 17.24); this held true when results were stratified by the stage of the macular hole. There was also evidence that those in the ILM peeling group were more likely to have final macular hole closure (OR 3.99, 95% CI 1.63 to 9.75). Fewer participants required further surgery in the ILM peeling group than in the no-peeling group (OR 0.11, 95% CI: 0.05 to 0.23).Rates of intraoperative and postoperative complications were similar in both groups.Based on the results of one study, there was no evidence that total VFQ-25 or EQ-5D scores differed between the groups at six months. Based on this same study, ILM peeling is highly likely to be cost-effective. AUTHORS' CONCLUSIONS Although we found no evidence of a benefit of ILM peeling in terms of the primary outcome (visual acuity at six months), ILM peeling appears to be superior to its no-peeling counterpart as it offers more favourable cost effectiveness by increasing the likelihood of primary anatomical closure and subsequently decreasing the likelihood of further surgery, with no differences in unwanted side-effects compared with no peeling.
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Choi YM, Oh J, Kim SW, Huh K. Delayed Sealing of Macular Hole after Vitrectomy with Silicone Oil Tamponade. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.4.686] [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)
- Yong-Min Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Kuhl Huh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Zeng J, Li J, Liu R, Chen X, Pan J, Tang S, Ding X. Choroidal thickness in both eyes of patients with unilateral idiopathic macular hole. Ophthalmology 2012; 119:2328-33. [PMID: 22892154 DOI: 10.1016/j.ophtha.2012.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/24/2012] [Accepted: 06/06/2012] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To compare the choroidal thickness in the macular area in eyes with an idiopathic macular hole (IMH) with that of unaffected fellow eyes and eyes of healthy controls. DESIGN A cross-sectional study. PARTICIPANTS Fifty patients with unilateral IMH and 50 healthy controls. METHODS Enhanced depth imaging was obtained by spectral-domain optical coherence tomography in all patients and controls. Eyes were divided into 3 groups: 50 eyes in group A (affected eyes with IMH), 48 eyes in group B (unaffected fellow eyes), and 50 eyes in group C (right eyes of age- and sex-matched controls). MAIN OUTCOME MEASURES Two independent graders individually measured the choroidal thickness. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid-scleral junction in the subfoveal area and 1 and 3 mm away from the fovea in the superior, inferior, nasal, and temporal regions. Apical and basal diameters of macular holes (MHs) were measured in eyes with IMH. Statistical analysis was conducted to compare mean choroidal thicknesses. RESULTS Choroidal thickness was significantly decreased in affected IMH eyes compared with unaffected fellow eyes in 48 patients (P = 0.005, paired t test). The mean subfoveal choroidal thickness (SFCT) was 206.82 ± 67.09 μm in group A, 228.34 ± 80.71 μm in group B, and 248.88 ± 63.10 μm in group C. The choroid was significantly thinner in group A (P = 0.002) than in group C. The SFCT in unaffected fellow eyes was lower than in controls, but without statistical significance (P = 0.177). The apical and basal size of the MH were not related to the underlying choroidal thickness (apical r=-0.267, P = 0.072; basal r = -0.259, P = 0.082). CONCLUSIONS Choroidal thickness was thinner in affected eyes with IMH and in fellow unaffected eyes. This may suggest a contributing role of the perfusion of the choroid in the pathogenesis of IMH. If these findings are confirmed, we suggest that the fellow eyes with thinner choroid may be prone to IMH and should be followed up frequently.
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Affiliation(s)
- Jing Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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