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Arya S, Akduman L, Saxena S. Surgery for macular hole with retinal detachment: An enigma. Indian J Ophthalmol 2023; 71:2308-2309. [PMID: 37202989 PMCID: PMC10391439 DOI: 10.4103/ijo.ijo_247_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Shilpi Arya
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
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2
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Lee CY, Yang CM, Yang CH, Hu FR, Chen TC. Flap technique-assisted surgeries for advanced retinitis pigmentosa complicated with macular hole: a case report and literature review. BMC Ophthalmol 2021; 21:322. [PMID: 34488687 PMCID: PMC8422608 DOI: 10.1186/s12886-021-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Full-thickness macular hole (FTMH) is a rare complication in retinitis pigmentosa (RP) patients and may increase intraoperative challenges. Furthermore, lens capsular flap transplantation and inverted internal limiting membrane (ILM) flap were reported to close complicated FTMH successfully. Here, we present a case of bilateral advanced RP complicated by a FTMH treated with a novel lens capsular flap transplantation and inverted internal limiting membrane flap. Case presentation A 46-year-old presented to our hospital with a complaint of progressively blurred vision and metamorphopsia in both eyes. Spectral-domain optical coherence tomography revealed a FTMH with retinoschisis in the right eye and another FTMH in the left eye. ILM peeling with inverted ILM flap technique was performed on the right eye and ILM peeling with anterior lens capsular flap technique was performed on the left eye. Post-operative follow-up showed successful closure of the FTMH and improved vision in both eyes. Conclusions In our present case, flap-assisted techniques for retinitis pigmentosa with macular hole result in excellent visual and anatomic outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02082-3.
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Affiliation(s)
- Chia-Ying Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, 7 Chung-Shan S. Road, Taipei, Taiwan.
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INTRAOPERATIVE AND POSTOPERATIVE MONITORING OF AUTOLOGOUS NEUROSENSORY RETINAL FLAP TRANSPLANTATION FOR A REFRACTORY MACULAR HOLE ASSOCIATED WITH HIGH MYOPIA. Retina 2021; 41:921-930. [PMID: 33079787 DOI: 10.1097/iae.0000000000003000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the intraoperative and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for a high myopia-related refractory macular hole (MH). METHODS This prospective interventional study enrolled five eyes of five patients (age range 54-84 years) with highly myopic refractory MHs who underwent ART. All cases were evaluated with intraoperative optical coherence tomography and postoperative optical coherence tomography, optical coherence tomography angiography, and microperimetry for at least 6 months postoperatively. RESULTS Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4 days to 6 days. Optical coherence tomography discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1,504 ± 684 µm preoperatively to 1,111 ± 356 µm postoperatively. The best-corrected visual acuity improved in two cases, was stable in two cases, and deteriorated in one case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In two eyes, choroidal neovascularization developed beneath the transplanted retinas. CONCLUSION Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Because choroidal neovascularization may develop, detailed monitoring is required.
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Li Y, Li Z, Xu C, Liu Y, Kang X, Wu J. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes. Acta Ophthalmol 2020; 98:e983-e990. [PMID: 32323479 DOI: 10.1111/aos.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. METHODS Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best-corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula. RESULTS At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow-up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post-BCVA was significantly better than the pre-BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t-test). CONCLUSION Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea.
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Affiliation(s)
- Yanzi Li
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | | | | | - Yong Liu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Xueqin Kang
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
| | - Jianhua Wu
- Aier School of Ophthalmology Central South University Changsha China
- Wuhan Aier Eye Hospital Wuhan China
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5
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Wu A, Ling K, Chuang L, Chen K, Chen Y, Yeung L, Wang N, Liu L, Chen T, Hwang Y, Wu W, Lai C. Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three-year results. Acta Ophthalmol 2020; 98:e839-e847. [PMID: 32243725 DOI: 10.1111/aos.14418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. METHODS Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications. RESULTS The mean patient age was 61.0 ± 11.4 years. The follow-up was 45.2 ± 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 ± 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and pre-existing disease of glaucoma (p = 0.006). CONCLUSIONS A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.
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Affiliation(s)
- An‐Lun Wu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- Department of Ophthalmology Mackay Memorial Hospital Hsinchu Taiwan
| | - Kiet‐Phang Ling
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- Department of Ophthalmology Sultanah Aminah Hospital Johor Malaysia
| | - Lan‐Hsin Chuang
- Department of Ophthalmology Chang Gung Memorial Hospital Keelung Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Kuan‐Jen Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yen‐Po Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Ling Yeung
- Department of Ophthalmology Chang Gung Memorial Hospital Keelung Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Nan‐Kai Wang
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
- Edward S. Harkness Eye Institute Department of Ophthalmology Columbia University New York NY USA
| | - Laura Liu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Tun‐Lu Chen
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yih‐Shiou Hwang
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Wei‐Chi Wu
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Chi‐Chun Lai
- Department of Ophthalmology Chang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
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Kim HY, Lee JJ, Kwon HJ, Park SW, Lee JE. Long-term Outcomes of Macular Hole Retinal Detachment in Highly Myopic Eyes after Surgical Reattachment. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:539-546. [PMID: 31833251 PMCID: PMC6911791 DOI: 10.3341/kjo.2019.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate visual acuity changes over 3 years following surgical reattachment of macular hole retinal detachment (MHRD) developed in high myopia. METHODS A retrospective analysis was performed using the medical records of patients with highly myopic eyes who underwent pars plana vitrectomy with internal limiting membrane peeling or the internal limiting membrane flap technique for MHRD. Changes in best-corrected visual acuity (BCVA) were measured at baseline, 6 months, 1 year, 2 years, and 3 years. RESULTS Of the 22 eyes analyzed, macular hole was closed in 13 and unclosed in nine. BCVA significantly improved from 1.61 ± 0.39 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.17 ± 0.43 logMAR at 6 months and 1.33 ± 0.48 logMAR at 2 years after MHRD surgery. At 3 years, BCVA significantly decreased compared with that at 6 months, and visual improvement from baseline was not significant. BCVA and proportion of vision loss ≥0.3 logMAR were not different between the closed and unclosed macular hole groups. CONCLUSIONS Visual improvement after surgical reattachment of MHRD in high myopia was not maintained, and favorable macular hole closure effects were not observed at 3-year follow-up.
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Affiliation(s)
- Hwa Yeong Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Jo Kwon
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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8
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Shroff D, Gupta P, Atri N, Gupta C, Shroff C. Inverted internal limiting membrane (ILM) flap technique for macular hole closure: patient selection and special considerations. Clin Ophthalmol 2019; 13:671-678. [PMID: 31118552 PMCID: PMC6498984 DOI: 10.2147/opth.s163089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 12/24/2022] Open
Abstract
This paper reviews the current status of the newer inverted internal limiting membrane flap technique for macular hole surgery. It gives an overview of the importance of patient selection and special considerations along with variations in technique. It discusses the pathophysiology and how the technique has been an important addition in the armamentarium of vitreoretinal surgeons to attain better anatomical as well as functional results in challenging situations.
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Affiliation(s)
- Daraius Shroff
- Shroff Eye Centre, Vitreoretinal Services, New Delhi 110048, India
| | - Priyanka Gupta
- Shroff Eye Centre, Vitreoretinal Services, New Delhi 110048, India
| | - Neelam Atri
- Shroff Eye Centre, Vitreoretinal Services, New Delhi 110048, India
| | - Charu Gupta
- Shroff Eye Centre, Vitreoretinal Services, New Delhi 110048, India
| | - Cyrus Shroff
- Shroff Eye Centre, Vitreoretinal Services, New Delhi 110048, India
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Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis. Eye (Lond) 2019; 33:1626-1634. [PMID: 31073163 DOI: 10.1038/s41433-019-0458-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia compared with that of ILM peeling. METHODS PubMed, EMBASE, Web of Science, MEDLINE, Ovid, Wan Fang and CNKI were systematically reviewed. The primary outcome parameters were the MH closure rate, retinal reattachment rate and postoperative BCVA. Secondary outcome parameters, included intraoperative or postoperative complications. RESULTS Seven retrospective comparative studies including 228 eyes were selected. No significant difference was detected in either postoperative BCVA (MD -0.07; 95% CI: -0.17 to 0.03; p = 0.16) or the improvement in postoperative BCVA (MD -0.17; 95% CI: -0.50 to 0.16; p = 0.32) between the ILM flap group and ILM peeling group. The retinal reattachment rate using inverted ILM flap was not significantly different from that using ILM peeling (odds ratio (OR) 2.24; 95% CI: 0.75-6.73; p = 0.15). The MH closure rate was higher with inverted ILM flap than with ILM peeling (OR 11.86; 95% CI: 5.65 to 24.92; p < 0.00001). There was no significant difference in intraoperative or postoperative complications, including concomitant cataract rate (OR 1.22; 95% CI: 0.42-3.58; p = 0.71). CONCLUSION The inverted ILM flap technique could contribute to a higher MH closure rate than ILM peeling, but visual improvement was similar. Both surgical methods could obtain a high-retinal reattachment rate with fewer intraoperative and postoperative complications.
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10
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Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
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Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group. Ophthalmology 2019; 126:1399-1408. [PMID: 30711606 DOI: 10.1016/j.ophtha.2019.01.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs). DESIGN Multicenter, retrospective, consecutive case series. PARTICIPANTS A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade. METHODS All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up. MAIN OUTCOME MEASURES Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed. RESULTS Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization. CONCLUSIONS The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.
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Affiliation(s)
- Dilraj S Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Barbara Parolini
- Department of Ophthalmology, Sant'Anna Institute, Brescia, Italy
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tamer H Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Associated Retinal Consultants, Royal Oak, Michigan.
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12
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Microstructural retinal regeneration after internal limiting membrane flap surgery for repair of large macular holes: a 1-year follow-up study. Int Ophthalmol 2018; 39:1277-1282. [PMID: 29744761 DOI: 10.1007/s10792-018-0941-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate long-term change in functional and structural outcomes after successful repair of large macular holes (MH) with internal limiting membrane (ILM) flap techniques. METHODS Eleven consecutive patients were reviewed over a 1-year time period after the successful repair of large MH with ILM flap techniques. SD-optical coherence tomography (SD-OCT) images were taken to assess the anatomical outcome after surgery, while the best-corrected visual acuity (BCVA) was tested using Snellen charts to evaluate the functional outcome. Each patient was evaluated at 1, 6 and 12 months after surgery, respectively. RESULTS All cases achieved complete anatomical closure. All patients showed a microstructural regeneration of the retina with a decrease in ellipsoid zone defects over the 1-year follow-up. Functionally, as compared to baseline, all of the patients showed improvements in best-corrected visual acuity of 1-4 lines at the final examination after 12 months post-operatively. CONCLUSIONS Long-term results show further improvement in the best-corrected visual acuity as well as further microstructural regeneration of the retina and decrease in ellipsoid zone defects over time. The exact mechanism, which promotes closure of the macular hole and reconstruction of the ellipsoid zone after internal Limiting Membrane autograft surgery, still remains unknown.
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Yuan J, Zhang LL, Lu YJ, Han MY, Yu AH, Cai XJ. Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis. BMC Ophthalmol 2017; 17:219. [PMID: 29179705 PMCID: PMC5704533 DOI: 10.1186/s12886-017-0619-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD). METHODS Pubmed, Cochrane Library, and Embase were systematically searched for studies that compared ILM peeling with inverted ILM flap technique for macular hole-induced retinal detachment. The primary outcomes are the rate of retinal reattachment and the rate of macular hole closure 6 months later after initial surgery, the secondary outcome is the postoperative best-corrected visual acuity (BCVA) 6 months later after initial surgery. RESULTS Four studies that included 98 eyes were selected. All the included studies were retrospective comparative studies. The preoperative best-corrected visual acuity was equal between ILM peeling and inverted ILM flap technique groups. It was indicated that the rate of retinal reattachment (odds ratio (OR) = 0.14, 95% confidence interval (CI):0.03 to 0.69; P = 0.02) and macular hole closure (OR = 0.06, 95% CI:0.02 to 0.19; P < 0.00001) after initial surgery was higher in the group of vitrectomy with inverted ILM flap technique than that in the group of vitrectomy with ILM peeling. However, there was no statistically significant difference in postoperative best-corrected visual acuity (mean difference (MD) 0.18 logarithm of the minimum angle of resolution; 95% CI -0.06 to 0.43 ; P = 0.14) between the two surgery groups. CONCLUSION Compared with ILM peeling, vitrectomy with inverted ILM flap technique resulted significantly higher of the rate of retinal reattachment and macular hole closure, but seemed does not improve postoperative best-corrected visual acuity.
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Affiliation(s)
- Jing Yuan
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Ling-Lin Zhang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Yu-Jie Lu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Meng-Yao Han
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Ai-Hua Yu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Xiao-Jun Cai
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.
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INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS COMPLETE INTERNAL LIMITING MEMBRANE REMOVAL IN MYOPIC MACULAR HOLE SURGERY. Retina 2017; 37:1923-1930. [DOI: 10.1097/iae.0000000000001446] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Kinoshita T, Onoda Y, Maeno T. Long-term surgical outcomes of the inverted internal limiting membrane flap technique in highly myopic macular hole retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1101-1106. [PMID: 28220252 DOI: 10.1007/s00417-017-3614-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/25/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Pars plana vitrectomy (PPV) procedures are used for the surgical treatment of macular hole retinal detachment (MHRD) associated with high myopia. Re-detachment of the retina has been reported in MHRD associated with high myopia. Our aim was to evaluate the 1-year outcomes of vitrectomy, performed using an inverted internal limiting membrane (ILM) flap technique with gas tamponade, in five cases of MHRD associated with high myopia. METHODS We performed a retrospective review of medical records of five consecutive cases of highly myopic MHRD. The following postoperative data were collected: refractive error, best-corrected visual acuity, intraocular pressure, ophthalmic fundus examination findings, ocular coherence tomography at 1, 3, 6, and 12 months postoperatively; duration of the follow-up period; and intra- and postoperative complications. The primary endpoint of the study was the rate of postoperative retinal reattachment and macular hole (MH) closure. Paired t-tests were conducted to evaluate postoperative changes. RESULTS Mean visual acuity improved significantly (P = 0.008), with an improvement of ≥2 lines on LogMAR value gained in three of the five eyes. Retinal reattachment was maintained in all cases, with no cases of MH reopening identified over the mean follow-up period of 20.2 months. No complications were identified in any eye. CONCLUSIONS The inverted ILM flap technique and gas tamponade provided primary retinal reattachment and MH closure over the ≥12-month follow-up period.
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Affiliation(s)
- Taiga Kinoshita
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan.
| | - Yasutaka Onoda
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba, 285-0841, Japan
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Sasaki H, Shiono A, Kogo J, Yomoda R, Munemasa Y, Syoda M, Otake H, Kurihara H, Kitaoka Y, Takagi H. Inverted internal limiting membrane flap technique as a useful procedure for macular hole-associated retinal detachment in highly myopic eyes. Eye (Lond) 2016; 31:545-550. [PMID: 27911448 PMCID: PMC5395991 DOI: 10.1038/eye.2016.263] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/26/2016] [Indexed: 01/22/2023] Open
Abstract
PurposeTo determine whether the inverted internal limiting membrane (ILM) flap technique contributes to high reattachment and closure rates in patients with macular hole-associated retinal detachment (MHRD).Patients and methodsIn all, 15 eyes of 15 patients with MHRD undergoing 25-gauge pars plana vitrectomy with the inverted ILM flap technique or ILM peeling. The patients were divided into the inverted ILM flap technique group (6 eyes) and ILM peeling group (9 eyes). The logarithm of minimal angle of resolution best-corrected visual acuity (BCVA) and retinal attachment and macular hole closure rates were compared between the two groups before and after surgery.ResultsNo significant differences were found in the pre- and postoperative BCVA at 1 and 3 months after surgery in either group (inverted ILM flap technique group, preoperatively 1.04±0.55, 1 month 0.95±0.30, 3 months 0.83±0.22; ILM peeling group, preoperatively 1.00±0.44, 1 month 1.05±0.38, 3 months 1.06±0.49; P>0.05, respectively). The postoperative BCVA at 6 months after surgery was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, 0.62±0.35; ILM peeling group, 1.02±0.41, P=0.045). The improvement in BCVA was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, -0.41±0.29; ILM peeling group, 0.02±0.36; P=0.021). The primary macular hole closure rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary reattachment rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary macular hole closure and reattachment rates were not significantly different in both groups (P=0.056, respectively).ConclusionThe inverted ILM flap technique is a useful procedure for MHRD in highly myopic eyes.
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Affiliation(s)
- H Sasaki
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - A Shiono
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - J Kogo
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - R Yomoda
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Y Munemasa
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - M Syoda
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - H Otake
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - H Kurihara
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Y Kitaoka
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
| | - H Takagi
- Department of Ophthalmology, St Marianna University School of Medicine, Kawasaki, Japan
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PARS PLANA VITRECTOMY AND WIDE INTERNAL LIMITING MEMBRANE PEELING WITH PERFLUOROPROPANE TAMPONADE FOR HIGHLY MYOPIC FOVEOSCHISIS-ASSOCIATED MACULAR HOLE. Retina 2016; 37:274-282. [PMID: 27429390 DOI: 10.1097/iae.0000000000001146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of pars plana vitrectomy and wide internal limiting membrane peeling with perfluoropropane tamponade (C3F8) for highly myopic foveoschisis-associated macular hole. METHODS Prospective consecutive cases with highly myopic foveoschisis-associated macular hole were recruited. All the patients underwent pars plana vitrectomy and indocyanine green-aided internal limiting membrane peeling, the range of internal limiting membrane peeling was broadened beyond the vascular arcades and to the nasal side of the optic disc. With tamponade of 16% C3F8, all the patients kept a face-down position postoperatively. The main outcomes were best-corrected visual acuity and primary anatomical success rate. RESULTS There were 25 patients (25 eyes) included, with a mean age of 54.8 ± 7.2 years. The mean follow-up duration was 14.2 ± 3.9 months. The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) was 1.489 ± 0.558 (20/617). The mean postoperative logarithm of the minimum angle of resolution best-corrected visual acuity at the final follow-up was 0.882 ± 0.522 (20/152), the difference being statistically significant with the preoperative one (P < 0.001). At the final follow-up, 17 eyes (68.0%) had vision improvement, and the primary anatomical success rate was 84.0% (21/25). CONCLUSION Pars plana vitrectomy and wide internal limiting membrane peeling with C3F8 tamponade is effective and safe to achieve a high anatomical success rate of highly myopic foveoschisis-associated macular hole closure and regain visual function.
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Ohno-Matsui K, Lai TY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res 2016; 52:156-87. [DOI: 10.1016/j.preteyeres.2015.12.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
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ADJUSTABLE MACULAR BUCKLING FOR FULL-THICKNESS MACULAR HOLE WITH FOVEOSCHISIS IN HIGHLY MYOPIC EYES. Retina 2016; 36:709-16. [PMID: 27018807 DOI: 10.1097/iae.0000000000000802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Autofluorescence and axial length as prognostic factors for outcomes of macular hole retinal detachment surgery in high myopia. Retina 2015; 35:423-8. [PMID: 25170859 DOI: 10.1097/iae.0000000000000335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the results of fundus autofluorescence and axial length as prognostic factors for surgical outcome of macular hole retinal detachment in high myopic patients. METHODS This is a retrospective, interventional, nonrandomized study. Patients were treated with posterior vitrectomy, internal limiting membrane peeling, and silicone oil tamponade. Best-corrected visual acuity, axial length, fundus autofluorescence, and spectral domain optical coherence tomography images were obtained. RESULTS Fifteen eyes from 15 patients (mean age, 69.4 years) were evaluated. The mean refractive error was -19 diopters, and the mean axial length was 29.9 mm. The mean best-corrected visual acuity (logMAR) improved from 2.17 to 1.42 (P = 0.02) after a mean follow-up of 19.3 months. Spectral domain optical coherence tomography scans showed retinal detachment resolution in 13 eyes (86.6%) and macular hole closure in 9 eyes (60%). Fundus autofluorescence showed macular hypoautofluorescence with foveal involvement (mean area of 9.7 mm2) in 10 eyes (66.6%). Postoperative best-corrected visual acuity was significantly worse in these eyes (P = 0.009). Axial length >30 mm was found in the 2 cases with recurrent retinal detachment and in 4 of the 6 cases without macular hole closure (66.6%). CONCLUSION Macular hole retinal detachment in high myopic patients can be successfully treated with vitrectomy, internal limiting membrane peeling, and silicone oil. Axial length >30 mm and macular hypoautofluorescence with foveal involvement seem to be prognostic factors for a worse anatomical and visual outcome.
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Su J, Liu X, Zheng L, Cui H. Vitrectomy with internal limiting membrane peeling vs no peeling for Macular Hole-induced Retinal Detachment (MHRD): a meta-analysis. BMC Ophthalmol 2015; 15:62. [PMID: 26091910 PMCID: PMC4475314 DOI: 10.1186/s12886-015-0048-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND we conducted our meta-analysis of published studies to assess existing evidence about the efficacy and safety of vitrectomy with ILM peeling vs. that of vitrectomy with no ILM peeling for Macular hole-induced retinal detachment. METHODS Databases, including Pubmed, Cochrane Library, Ovid, Web of Science, Wanfang and CNKI, were searched to identify studies comparing outcomes following vitrectomy with ILM peeling and that with no ILM peeling for macular hole-induced retinal detachment. The meta-analysis was performed by RevMan 5.1. RESULTS Six comparative studies comprising 180 eyes were identified. It was indicated that the rate of retinal reattachment (Odds ratio (OR) = 3.03, 95 % Confidence interval (CI):1.35 to 6.78; P = 0.007) and macular hole closure (OR = 6.74, 95 % CI:3.26 to 13.93; P < 0.001) after initial surgery was higher and the rate of recurrent retinal detachment (OR = 0.08, 95 % CI:0.02 to 0.30; P = 0.0002) was lower in the group of vitrectomy with ILM peeling than that in the group of vitrectomy with no ILM peeling. However, the improved BCVA (Weighted mean difference (WMD) = 0.14, 95 % CI: -0.20 to 0.47; P = 0.42) and the rate of postoperative complications were similar between the two groups. CONCLUSION Vitrectomy with internal limiting membrane peeling is an efficient and safe procedure for macular hole-induced retinal detachment.
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Affiliation(s)
- Jing Su
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Xinquan Liu
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Lijun Zheng
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, P.R. China.
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University, No.150 Jimo Road, Shanghai, 200120, P.R. China.
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Lin CW, Ho TC, Yang CM. The development and evolution of full thickness macular hole in highly myopic eyes. Eye (Lond) 2015; 29:388-96. [PMID: 25572579 DOI: 10.1038/eye.2014.312] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/28/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes. PATIENTS AND METHODS Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes. RESULTS Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection. CONCLUSION The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.
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Affiliation(s)
- C-W Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - T-C Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-M Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Treatment of retinal detachment secondary to macular hole in highly myopic eyes: pars plana vitrectomy with internal limiting membrane peel and silicone oil tamponade. Retina 2014; 34:470-6. [PMID: 23881229 DOI: 10.1097/iae.0b013e31829d004b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate efficacy of vitrectomy with internal limiting membrane peel and silicone oil tamponade in highly myopic eyes with retinal detachment secondary to macular hole (MH). METHODS Twenty-one consecutive cases of MH-retinal detachment in highly myopic eyes were retrospectively reviewed. Eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade. A face-down or side-lying position was maintained postoperatively. Silicone oil was removed 3 months to 12 months later. Outcomes included MH closure and retinal reattachment rates, best-corrected visual acuity, and complication rates. RESULTS Mean patient age was 59.3 ± 6.5 years and mean spherical equivalent was -15.2 ± 4.3 diopters. After silicone oil removal, 18 eyes (86%) had MH closure with retinal reattachment and 2 eyes needed reattachment with endolaser photocoagulation and fluid/gas exchange, and 1 patient refused further treatment. At the last follow-up, median best-corrected visual acuity was +1.48 ± 0.12, up from preoperative +2.11 ± 0.17 (P = 0.03). Transient intraocular pressure elevation was observed in 11 eyes (52%). Iatrogenic retinal break occurred in one case. CONCLUSION Combining pars plana vitrectomy with internal limiting membrane peel and silicone oil tamponade was safe and effective in treating MH-retinal detachment in highly myopic eyes. Silicone oil tamponade may improve initial anatomical success rates because of longer tamponade duration.
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Tamponade or filling effect: changes of forces in myopic eyes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:618382. [PMID: 25101290 PMCID: PMC4101978 DOI: 10.1155/2014/618382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/22/2014] [Indexed: 02/05/2023]
Abstract
Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye.
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Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment: a review. Graefes Arch Clin Exp Ophthalmol 2014; 252:191-9. [DOI: 10.1007/s00417-013-2555-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023] Open
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Efficacy of vitrectomy with triamcinolone assistance versus internal limiting membrane peeling for highly myopic macular hole retinal detachment. Retina 2013; 33:1151-7. [PMID: 23508079 DOI: 10.1097/iae.0b013e31827b6422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the outcomes of pars plana vitrectomy (PPV) with or without the adjuvant surgical procedures: triamcinolone acetonide (TA) assistance and/or internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD). DESIGN Case-control study. METHODS Pars plana vitrectomy combined with 2 kinds of adjuvant surgical procedures were used on 96 highly myopic eyes with MHRD. These eyes were assigned to 4 groups randomly: Group 1, non-TA-assisted PPV and without ILM peeling; Group 2, non-TA-assisted PPV with ILM peeling; Group 3, TA-assisted PPV and without ILM peeling; Group 4, TA-assisted PPV with ILM peeling. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity were measured. RESULTS The rates of both retinal reattachment and macular hole closure were higher in Group 2 (84.0 and 44.0%) and Group 3 (80.8 and 46.2%) than Group 1 (73.9 and 17.4%); however, there were no differences between Group 2 and Group 3 (P > 0.05). The rates of macular hole closure were extremely low in Group 1 and also in eyes with extreme long axial lengths (≥29.0 mm), "severe" chorioretinal atrophy, and posterior staphyloma. CONCLUSION Pars plana vitrectomy with either TA assistance or ILM peeling was effective for the treatment of highly myopic MHRD. If you peel the ILM, adding TA does not affect closure rates; and if TA is used to visualize the vitreous, ILM peeling may not be necessary in MHRD. There was a lower anatomical success rate in MHRD with extreme long axial lengths, severe chorioretinal atrophy, and posterior staphyloma.
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Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol 2013; 252:571-81. [PMID: 24158373 DOI: 10.1007/s00417-013-2497-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/02/2013] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes. METHODS In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula. RESULTS Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them. CONCLUSIONS Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.
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Alkabes M, Padilla L, Salinas C, Nucci P, Vitale L, Pichi F, Burès-Jelstrup A, Mateo C. Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis. Graefes Arch Clin Exp Ophthalmol 2013; 251:2521-7. [PMID: 23695656 DOI: 10.1007/s00417-013-2347-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prognostic factors in myopic macular hole (MMH) surgery. METHODS In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > -6.00 D) who underwent pars plana vitrectomy with internal limiting membrane peeling for MMH without foveoschisis. Statistical analysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI). RESULTS Primary and final anatomical success rate were 83.3% (35/42) and 90.5% (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4%) patients, worsened in 7/42 (16.7%) and remained unchanged in 13/42 (30.9%). Only MH minimum diameter (P = 0.03) and HFF (P = 0.02) correlated significantly with postoperative BCVA. CONCLUSIONS Minimum diameter and HFF are strongly correlated with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT.
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Affiliation(s)
- Micol Alkabes
- IMO-Instituto de Microcirugía Ocular, c/ Josep Maria Llado, 3, Barcelona, Spain,
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Primary vitrectomy for the treatment of retinal detachment in highly myopic eyes with axial length over 30 mm. Eur J Ophthalmol 2013; 23:564-70. [PMID: 23539456 DOI: 10.5301/ejo.5000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in highly myopic eyes with axial length over 30 mm. METHODS In this retrospective, interventional case series, we evaluated the outcome of primary vitrectomy without scleral buckling in 67 highly myopic patients (67 eyes) with RRD. Anatomical success rate was defined as complete reattachment of the retina without definitive silicone oil tamponade. RESULTS Retinal reattachment was achieved with a single surgery in 49 of 67 eyes (73.1%) and after 2 or 3 surgeries in 54 eyes (80.6%). The characteristics of retinal tears did not influence the final outcome. Multivariate analysis revealed that a longer axial length was the only factor associated with a higher failure rate, p = 0.0061. Mean preoperative visual acuity significantly increased after surgery, p = 0.0003. CONCLUSION The study demonstrated fair efficacy of vitrectomy and fluid-gas exchange in the treatment of retinal detachment in highly myopic eyes with an axial length over 30 mm.
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Khan IJ, Elaraoud I, Mahmood U. Sequential surgical repair of a macular hole-related retinal detachment in a hyperopic patient. Retin Cases Brief Rep 2013; 7:347-349. [PMID: 25383822 DOI: 10.1097/icb.0b013e318293149a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of macular hole-related retinal detachment in a hyperopic patient and a sequential surgical approach to repair. METHODS Case report. PATIENTS A single patient with acute macular hole-related retinal detachment. CONCLUSION Retinal detachment secondary to macular hole typically occurs in highly myopic patients and is rare in patients with hypermetropia. Surgical repair may involve a combined or sequential approach to close the macular hole.
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Affiliation(s)
- Imran J Khan
- Department of Ophthalmology, University Hospital of North Staffordshire, Royal Infirmary, Staffordshire, United Kingdom
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Xie A, Lei J. Pars Plana Vitrectomy and Silicone Oil Tamponade as a Primary Treatment for Retinal Detachment Caused by Macular Holes in Highly Myopic Eyes: A Risk-Factor Analysis. Curr Eye Res 2012; 38:108-13. [DOI: 10.3109/02713683.2012.722742] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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MACULAR VITREORETINAL INTERFACE ABNORMALITIES IN HIGHLY MYOPIC EYES WITH POSTERIOR STAPHYLOMA. Retina 2012; 32:1531-8. [DOI: 10.1097/iae.0b013e318255062c] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Siam ALH, El Maamoun TA, Ali MH. MACULAR BUCKLING FOR MYOPIC MACULAR HOLE RETINAL DETACHMENT. Retina 2012; 32:748-53. [DOI: 10.1097/iae.0b013e3182252a75] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lim SJ, Kwon YH, Kim SH, You YS, Kwon OW. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis. Graefes Arch Clin Exp Ophthalmol 2012; 250:1573-7. [DOI: 10.1007/s00417-012-1983-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022] Open
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Park DY, Kim JH, Ha HS, Kang SW. The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.7.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Shin Ha
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Recent trends in the management of maculopathy secondary to pathological myopia. Graefes Arch Clin Exp Ophthalmol 2011; 250:3-13. [DOI: 10.1007/s00417-011-1889-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/30/2011] [Accepted: 09/06/2011] [Indexed: 10/14/2022] Open
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Clinical presentation and surgical outcomes in primary myopic macular hole retinal detachment. Eur J Ophthalmol 2011; 22:450-5. [DOI: 10.5301/ejo.5000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2011] [Indexed: 11/20/2022]
Abstract
Purpose To describe the clinical presentation of primary macular hole retinal detachment (MHRD) secondary to high myopia and to evaluate the surgical outcomes. Methods Nine eyes of 9 patients with primary myopic MHRD (axial length ≥26.5 mm) were enrolled. A standardized surgical protocol was performed using vitrectomy with preservative-free triamcinolone acetonide–assisted internal limiting membrane (ILM) peeling and silicone oil tamponade and were followed for at least 6 months from the first surgery. Results There were 6 women and 3 men with a median age of 52 years. Six (66.6%) patients presented with inferior bullous configuration and 3 had subtotal retinal detachment. The mean preoperative refractive error (spherical equivalent) and mean axial length was 12±3.553 D (range 8.50-19.50) and 28.13±1.65 mm (range 26.50-31.50), respectively. The patients were followed up for a period of at least 6 months. The retina was attached and macular hole closed in all the eyes. There was significant visual acuity improvement from mean preoperative visual acuity of logMAR 1.85±0.11 (range 1.76-1.93) to postoperative visual acuity of logMAR 0.95±0.14 (range 0.84-1.06) (p<0.001). Conclusions Retinal detachment in highly myopic eyes can often be secondary to a macular hole with predominance of inferior bullous configuration and primary vitrectomy with ILM peeling with silicone oil tamponade results in good anatomic and functional outcomes.
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Qian J, Jiang YR. Anatomic evaluation of macular holes with silicone oil tamponades in highly myopic eyes using optical coherence tomography. Eur J Ophthalmol 2010; 20:938-44. [PMID: 20383851 DOI: 10.1177/112067211002000520] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To observe the postoperative status of the macula after vitrectomy with silicone oil tamponade for macular hole-related retinal detachment in highly myopic eyes by optical coherence tomography (OCT), to analyze the factors associated with anatomic success, and to evaluate the possibility of successful silicone oil removal. METHODS OCT was used to follow the postoperative changes in the macular area of 51 highly myopic eyes, and other information was obtained from patient records. RESULTS OCT confirmed that successful retinal reattachment was achieved in 41 eyes (80.4%) after the initial surgery, and all of them underwent silicone oil removal postoperatively. The macular holes were closed in 20 eyes (20/41), all of which remained retina attached after silicone oil removal. In 21 (21/41) macular hole nonclosed eyes, recurrent retinal detachment (RRD) occurred in 8 eyes (8/21) after silicone oil removal. There were statistically significant association between posterior staphyloma and the presence of macular hole (p<0.001). Macular hole closure significantly increased the chances of successful silicone oil removal (p=0.003). Improved postoperative best-corrected visual acuity was significantly associated with macular hole closure (p=0.012). CONCLUSIONS OCT helps predict anatomic and functional outcomes of highly myopic eyes with macular hole-related retinal detachment. Posterior staphyloma may prevent macular hole closure. Silicone oil removal can be performed when macular hole closure was confirmed by OCT, while in eyes with nonclosed macular holes, silicone oil removal may lead to RRD.
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Affiliation(s)
- Jing Qian
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China.
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Li KKW, Tang EWH, Li PSH, Wong D. Double peel using triamcinolone acetonide and trypan blue in the management of myopic macular hole with retinal detachment: a case-control study. Clin Exp Ophthalmol 2010; 38:664-8. [PMID: 20497431 DOI: 10.1111/j.1442-9071.2010.02333.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of double peel using triamcinolone acetonide (TA) and trypan blue (TB) in removing epiretinal tissues in vitrectomy for myopic macular hole with retinal detachment (MHRD). METHODS Prospective interventional case control study. Patients with myopic MHRD underwent vitrectomy with TA-assisted adherent cortical vitreous (ACV) removal followed by TB-assisted internal-limiting membrane (ILM) peeling and gas tamponade. The results were compared with historical control group without the use of any vital dye or TA. RESULTS Ten eyes of 10 study cases were compared with nine eyes of nine control cases. Mean axial length was 28.3 ± 1.4 mm and 29.6 ± 2.4 mm and mean follow-up period was 15 months and 42 months for the study group and the control group, respectively. Reattachment rate was 70% in the study group and 44% in the control group. Mean logMAR visual acuity improvement was 0.02 at 6 months and 0.01 at 12 months for the study group (P < 0.05). Transient intraocular pressure rise was observed in seven eyes in the study group and five eyes in the control group. No other complication was noted. CONCLUSION Double peel using TA and TB appeared safe and effective in facilitating removal of ACV and ILM in MHRD. It has higher surgical success rate compared with conventional vitrectomy with epiretinal membrane peeling and gas tamponade.
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Affiliation(s)
- Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, and Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR, China.
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Yu J, Wang F, Cao H, Fan Y, Zhang X. Combination of Internal Limiting Membrane Peeling and Endophotocoagulation for Retinal Detachment Related to High Myopia in Patients with Macular Hole. Ophthalmic Surg Lasers Imaging Retina 2010; 41:215-21. [DOI: 10.3928/15428877-20100303-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2009] [Indexed: 11/20/2022]
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Li X, Wang W, Tang S, Zhao J. Gas Injection versus Vitrectomy with Gas for Treating Retinal Detachment Owing to Macular Hole in High Myopes. Ophthalmology 2009; 116:1182-87.e1. [DOI: 10.1016/j.ophtha.2009.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/08/2008] [Accepted: 01/07/2009] [Indexed: 10/20/2022] Open
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Ripandelli G, Coppé AM, Parisi V, Stirpe M. Fellow Eye Findings of Highly Myopic Subjects Operated for Retinal Detachment Associated with a Macular Hole. Ophthalmology 2008; 115:1489-93. [DOI: 10.1016/j.ophtha.2008.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 02/07/2008] [Accepted: 02/18/2008] [Indexed: 11/28/2022] Open
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Nakanishi H, Kuriyama S, Saito I, Okada M, Kita M, Kurimoto Y, Kimura H, Takagi H, Yoshimura N. Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study. Am J Ophthalmol 2008; 146:198-204. [PMID: 18547540 DOI: 10.1016/j.ajo.2008.04.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/11/2008] [Accepted: 04/14/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To detect the prognostic factors associated with initial reattachment after primary pars plana vitrectomy (PPV) with gas tamponade for retinal detachment attributable to macular hole (MHRD). DESIGN Retrospective, multicenter, interventional case series. METHODS This study included 49 eyes of 48 patients with MHRD in high myopia (axial length more than 28.0 mm). All eyes underwent PPV with gas tamponade. We retrospectively reviewed the medical records and performed univariate analysis to detect the presence of any difference between eyes with a successful initial reattachment and those that failed. We performed multivariate logistic regression analysis to assess the influence of each preoperative factor on initial success. RESULTS Success rate of initial reattachment was 69%. Postoperative best-corrected visual acuity (BCVA) of 34 eyes with initial success was significantly better than those of 15 eyes with initial failure (P < .05); preoperative BCVA was not significantly different (P = .43). The axial length of eyes with initial success (29.26 +/- 0.94 mm) was shorter than that of eyes with initial failure (30.04 +/- 1.49 mm) with borderline significance (P = .049). There were no significant differences noted for other factors such as use of ILM peeling (P = .43) or type of tamponade gas (P = .99). Multiple logistic regression analysis using preoperative factors indicated that only axial length was significantly associated with initial success (odds ratio, 0.49; 95% confidence interval, 0.26 to 0.93; P < .05). CONCLUSIONS Initial reattachment is important for visual prognosis, and axial length is a prognostic factor for initial reattachment after PPV with gas tamponade for MHRD in high myopia.
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Affiliation(s)
- Hideo Nakanishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Anatomical and visual outcome after vitrectomy with triamcinolone acedonide-assisted epiretinal membrane removal in highly myopic eyes with retinal detachment due to macular hole. Eye (Lond) 2008; 23:248-54. [DOI: 10.1038/eye.2008.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Chen MS, Ho TC, Chang CC, Liu KR, Hou PK. Gas Tamponade and Macular Grid Laser Photocoagulation in the Management of Recurrent Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2008; 39:186-90. [DOI: 10.3928/15428877-20080501-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Higashide T, Nishimura A, Torisaki M, Sugiyama K. Retinal redetachment involving a macular hole resulting from hypotony after trabeculectomy in a highly myopic eye. Ophthalmic Surg Lasers Imaging Retina 2007; 38:406-9. [PMID: 17955848 DOI: 10.3928/15428877-20070901-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 57-year-old woman with high myopia underwent trabeculectomy 21 months after a successful vitrectomy with peeling of the internal limiting membrane to treat a bullous retinal detachment associated with a macular hole. A shallow retinal detachment involving the macular hole developed on the sixth postoperative day after a 3-day period of hypotony. This case was unique because recurrence of the retinal detachment involving a macular hole in a highly myopic eye occurred in association with hypotony after glaucoma filtering surgery, with the retinal detachment resolving spontaneously following normalization of intraocular pressure even though the macular hole remained open.
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Affiliation(s)
- Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School ofMedical Science, Kanazawa, Japan
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Wolf S. Results of high-density silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia. Br J Ophthalmol 2007; 91:706-7. [PMID: 17510473 PMCID: PMC1955601 DOI: 10.1136/bjo.2007.114033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Huynh TH, Johnson MW. THE BEHAVIOR OF SURGICALLY REPAIRED IDIOPATHIC MACULAR HOLES IN THE SETTING OF SUBSEQUENT CYSTOID MACULAR EDEMA. Retina 2007; 27:759-63. [PMID: 17621187 DOI: 10.1097/iae.0b013e318030c449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To report findings for eyes with surgically repaired idiopathic macular hole that subsequently developed cystoid macular edema (CME). METHODS This study was a retrospective chart review of six eyes of six consecutive patients evaluated between January 1997 and October 2000 who had successful macular hole repair and subsequently developed CME. Patient demographic data, cause and time course of CME, treatment, and outcomes, including macular hole reopening, were recorded. RESULTS CME developed after cataract extraction in five eyes and after macular hole surgery alone in one eye. Average time from macular hole surgery to diagnosis of CME was 11.2 months (range, 2.5-23.0 months). Average duration of CME was 5.5 months (range, 1.5-17.0 months). Five (83%) of 6 eyes had sustained closure of the macular hole throughout a mean follow-up period of 31.8 months (range, 9.5-62.0 months). Patients were treated with topical antiinflammatory therapy, and all had resolution of CME. CONCLUSIONS CME developing in eyes with surgically repaired idiopathic macular holes responds well to conventional topical antiinflammatory therapy and is not associated with a high incidence of macular hole reopening. These results suggest that in most eyes the reparative mechanisms involved in macular hole closure confer sufficient strength to withstand the tensile forces associated with CME.
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Affiliation(s)
- Tony H Huynh
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA
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Le Rouic JF, Ducournau D, Becquet F. [Triamcinolone-assisted vitrectomy in the treatment of recurrent retinal detachment due to myopic macular hole]. J Fr Ophtalmol 2007; 29:829-34. [PMID: 16988635 DOI: 10.1016/s0181-5512(06)73854-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the use of triamcinolone-assisted vitrectomy to assess the cause of vitrectomy failure in the treatment of retinal detachment due to myopic macular hole. OBSERVATIONS We report the cases of three myopic patients presenting with recurrent retinal detachment due to macular hole after initial vitrectomy treatment with posterior vitreous detachment, a systematic attempt at membrane peeling, and gas injection (SF6). No retinal traction or tear other than the macular hole was observed. The recurrence of retinal detachment was treated with vitrectomy and intraoperative use of triamcinolone, which demonstrated persistent posterior hyaloid and thin and strongly adherent membrane remnants in each case. Anatomic success was obtained after peeling these structures. CONCLUSION Intraoperative use of triamcinolone reduces the risk of overlooking hyaloid or membrane remnants during vitrectomy for the treatment of myopic retinal detachment. Transparent remnants of posterior hyaloid and membranes were visualized by triamcinolone-assisted vitrectomy. They could lead to traction on the retina and explain the failure of the initial vitrectomy. Anatomic success was obtained after peeling these structures.
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Affiliation(s)
- J-F Le Rouic
- Département de Chirurgie Vitréo-Rétinienne, Clinique Sourdille, 8, rue Camille, Flammarion, 44000 Nantes
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