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Alagoz C, Bektasoglu D, Alagoz N, Erdogdu E, Artunay Ö. Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure. Klin Monbl Augenheilkd 2023; 240:1413-1420. [PMID: 36827999 DOI: 10.1055/a-1946-5448] [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: 02/26/2023]
Abstract
PURPOSE We aimed to report our surgical experience with repeat surgery as the next step after an unsuccessful hole closure with the primary single-layered temporal inverted flap technique (IFT). METHODS We identified cases with persistent macular holes by reviewing the records of eyes that underwent IFT between October 2018 and October 2021. These cases were evaluated for hole features, anatomical closure, and visual improvement before and after the first and second surgeries. In addition, the technique applied in repeat surgery was recorded. Optical coherence tomography (OCT) images at follow-up were used to evaluate the flap position. RESULTS A persistent hole was identified in 11 (6.4%) of 172 patients who underwent IFT. An inferotemporal displacement was observed in seven eyes, while no flap could be identified in the OCT images of the other four eyes. In the second surgery, the old flap was reinverted in one eye, and a new flap was created from the superior region in five eyes and the nasal region in the other five eyes and was stabilized under perfluorocarbon liquid. A gas tamponade (C3F8/SF6) was used in all patients at the end of surgery. The minimum hole diameter was > 400 µm in all eyes and 100% closure was achieved after the second surgery. Visual acuity gain of ≥ 3 lines was observed in 9 of the 11 eyes (81.8%). The mean visual acuity increase at the last follow-up was significant (p = 0.008). CONCLUSION With single-layer temporal IFT in the primary surgery of macular holes, unsuccessful results may be observed due to the flap displacement in the early period. In our series, IFT was applied again with the use of the old flap or the creation of a new flap in the second surgery of the persistent holes, and successful results were obtained.
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Affiliation(s)
- Cengiz Alagoz
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Damla Bektasoglu
- Department of Ophthalmology, Igdir State Hospital, Igdir, Turkey
| | - Nese Alagoz
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Erdem Erdogdu
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Özgür Artunay
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Wang ZQ, Ni ZZ, Zhang XL, Lin XY, Hu XT, Zhang ZL, Zhang ZD, Pan QT. Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions. Acta Ophthalmol 2023. [PMID: 37818952 DOI: 10.1111/aos.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/03/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To identify prognostic factors for complete anatomical success (CAS) under different axial length (AL) conditions after vitrectomy plus internal limiting membrane (ILM) peeling for retinal detachment associated with macular hole (MHRD). METHODS This retrospective study included 243 patients (251 eyes) with MHRD who underwent primary vitrectomy plus ILM peeling. Multivariate logistic regression explored prognostic factors for CAS in AL <30 mm and ≥ 30 mm groups. RESULTS Overall, 113 eyes (45.0% of 251) exhibited complete CAS after initial surgery. Eyes with CAS had greater best-corrected visual acuity improvement than eyes without CAS (p < 0.001). CAS was more common in eyes with AL < 30 mm (50.3% of 155) than in eyes with AL ≥ 30 mm (36.5%, 35/96; p = 0.032). In the AL < 30 mm group, CAS was associated with ILM insertion (odds ratio [OR], 2.824, 95% confidence interval [CI], 1.189-6.710; p = 0.019), silicone oil (SO)/perfluoropropane (C3F8) tamponade (SO: OR, 0.408, 95% CI, 0.191-0.873; C3F8: OR, 2.448, 95% CI, 1.145-5.234; p = 0.021) and staphyloma (OR, 0.318, 95% CI, 0.143-0.707; p = 0.005). In the AL ≥30 mm group, CAS was associated with ILM insertion (OR, 11.621, 95% CI, 2.557-52.813; p = 0.001), SO /C3F8 tamponade (SO: OR, 5.305, 95% CI, 1.206-23.334; C3F8: OR, 0.188, 95% CI, 0.043-0.829; p = 0.027) and age (OR, 0.928, 95% CI, 0.876-0.983; p = 0.011). CONCLUSION Vitrectomy plus ILM peeling can effectively treat MHRD but has limited efficacy in eyes with AL ≥ 30 mm. ILM insertion was associated with more frequent CAS at any AL. C3F8 tamponade yielded better outcomes with AL < 30 mm; SO tamponade yielded better outcomes with AL ≥ 30 mm.
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Affiliation(s)
- Zi-Qi Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhao-Ze Ni
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Long Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Yan Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xu-Ting Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhao-Liang Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zong-Duan Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qin-Tuo Pan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Zhao X, Song H, Tanumiharjo S, Wang Y, Chen Y, Chen S, Huang X, Liu B, Lian P, Lu L. Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia. Eye (Lond) 2023; 37:2730-2735. [PMID: 36721053 PMCID: PMC10482839 DOI: 10.1038/s41433-023-02406-1] [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: 05/01/2022] [Revised: 11/29/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To compare the efficacy of macular buckling (MB) alone against a combined internal limiting membrane (ILM) inversion flap for full-thickness macular hole (FTMH)-associated macular detachment (MD) in patients with high myopia. METHODS This was a prospective interventional case series of patients with high myopia surgically treated with MB alone or combined with an inverted ILM flap for FTMH- associated MD. Best-corrected visual acuity (BCVA) at the 24-month postoperative follow-up, rate of initial retinal reattachment and macular hole closure were measured. RESULTS A total of 62 eyes from 62 participants (33 in the MB group, 29 in the combination group) were studied. Postoperative BCVA improved significantly in both the combination group (P < 0.001) and the MB group (P = 0.027). The postoperative BCVA at 12 months (P = 0.021) and 24 months (P = 0.041) was significantly better in the combination group than in the MB group. The postoperative BCVA was not significantly different between the eyes with closed and unclosed MH at each follow-up time point (P > 0.05). In the combination group, we observed earlier retinal reattachment and closure of the MH as well as a higher rate of MH closure (82.8% vs. 66.7%) than in the MB group, although this difference was insignificant (P = 0.248). CONCLUSION MB combined with the ILM flap inversion technique achieved better postoperative BCVA and a higher success rate of MH closure than MB alone. We believe that combination surgery should be preferentially recommended.
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Affiliation(s)
- Xiujuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Huiying Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Silvia Tanumiharjo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yanbing Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yuqing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Xia Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Bingqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China
| | - Ping Lian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, 510060, China.
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Sharma A, Wu L, Bloom S, Stanga P, Nehemy MB, Veloso CE, Nawrocka ZAA, Nawrocki J, Özdek Ş, Zeydanlı EÖ, Rezaei KA. RWC Update: Vitrectomy Surgery in a Pre-Phthisical Eye; Update on the Surgical Management of Macular Holes: The Inverted ILM Flap Technique and How It Revolutionized Macular Hole Surgery; Retinal Arteriovenous Malformation. Ophthalmic Surg Lasers Imaging Retina 2023; 54:321-328. [PMID: 37352400 DOI: 10.3928/23258160-20230516-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
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Glial-Plug Proliferation after Inverted Internal Limiting Membrane Flap Technique for Idiopathic Macular Hole. J Ophthalmol 2022; 2022:2919358. [PMID: 36237556 PMCID: PMC9553358 DOI: 10.1155/2022/2919358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to analyze the effect of multiple folded internal limiting membrane (ILM) flap in the inverted ILM flap technique on postoperative outcomes of patients with full-thickness macular hole (FTMH). Methods This retrospective study included 41 eyes of 41 patients with FTMH treated with vitrectomy using the inverted ILM flap technique. Complete ophthalmic examination was performed preoperatively, at 1 week, and at 1, 3, 6, 9, and 12 months after surgery. Results Postoperative SD-OCT confirmed macular hole (MH) closure in all patients. The mean BCVA improved from 0.7 LogMAR (20/100) preoperatively to 0.5 LogMAR (20/63) postoperatively. In two cases, 7 days after vitrectomy, flap closure was noted. At the final visit after 12 months, the following foveal contours were noted: 14 U-shape (34.1%), 12 irregular (W-shape) (29.3%), and 6 V-shape (14.6%). We observed a type of “plug closure” in 9 (22%) eyes in which hyperproliferation was noted in one eye. Conclusions The surgeons should be aware of potential hyperproliferation on the retinal surface after the multi-layered flap technique.
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Xu C, Feng C, Han M, He J, Zhang R, Yan T, Li X, Liu Y, Li Y, Wu J. Inverted internal limiting membrane flap technique for retinal detachment due to macular holes in high myopia with axial length ≥ 30 mm. Sci Rep 2022; 12:4258. [PMID: 35277581 PMCID: PMC8917174 DOI: 10.1038/s41598-022-08277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
To compare the efficacy of internal limiting membrane (ILM) flap covering to that of ILM flap insertion for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes with axial length (AL) ≥ 30 mm. We retrospectively analysed the medical records of 48 MHRD patients with high myopia (AL ≥ 30 mm). According to different surgical methods, the patients were divided into a covering group (23 eyes) and an insertion group (25 eyes). The rate of retinal reattachment and MH closure were compared between the two groups, and the related factors affecting the initial anatomical results were analysed. After primary vitrectomy and single silicone oil removal, there were 18 eyes (78.3%) in the covering group, and 20 eyes (80.0%) in the insertion group had retinal reattachment (P = 1.000). Moreover, 16 eyes (69.6%) in the covering group and 17 eyes (68.0%) in the insertion group had their MHs sealed (P = 0.907). The best-corrected visual acuity (BCVA) at 12 months and the improvement in BCVA postoperatively in the two groups were not statistically significant (P = 0.543, 0.955). Logistic regression analysis showed that elongated AL (OR = 1.844, 95% CI 1.037–3.280, P = 0.037) and higher choroidal atrophy (OR = 2.986, 95% CI 1.011–8.821, P = 0.048) were risk factors affecting initial anatomical success. For extremely high-myopia MHRD with AL ≥ 30 mm, ILM flap covering and insertion can both effectively seal the MH and promote retinal reattachment, but the visual function improvement may still be limited. The longer the AL and the higher the choroidal atrophy, the greater is the risk of initial anatomical failure.
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Affiliation(s)
- Changzhong Xu
- Department of Ophthalmology, The Second Xiangya Hospital, School of Ophthalmology, Central South University, Changsha, China
| | - Chao Feng
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Mengyao Han
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Junwen He
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Rui Zhang
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Tao Yan
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Xiangyun Li
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Yong Liu
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Yanzi Li
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Jianhua Wu
- Aier Eye Hospital of Wuhan University, No. 481 Zhongshan Road, Wuchang District, Wuhan, China.
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Kastl G, Heidenkummer P, Koss MJ. 360° inverted internal limiting membrane flap technique for idiopathic macular holes ≤ 250 µm, > 250 and ≤ 400 µm, and > 400 µm. Graefes Arch Clin Exp Ophthalmol 2022; 260:2183-2190. [PMID: 35182187 DOI: 10.1007/s00417-022-05587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study the functional and morphological results of the inverted internal limiting membrane (ILM) flap technique for the treatment of idiopathic macular holes (MHs) sized ≤ 250 µm, > 250 and ≤ 400 µm, and > 400 µm. METHODS Retrospective, nonrandomized interventional study of 65 eyes with primary idiopathic MHs who underwent pars plana vitrectomy (PPV) with the inverted ILM flap technique. Closure rate, best-corrected visual acuity (BCVA), and integrity of external limiting membrane (ELM) and ellipsoid zone (EZ) were analyzed by optical coherence tomography (OCT). RESULTS Total closure rate was 96.9% with 100% in the ≤ 250 µm group, 100% in the > 250 and ≤ 400 µm group, and 91.7% in the > 400 µm group. Mean BCVA significantly improved after treatment: from 0.7 to 0.3 LogMAR in the ≤ 250 µm group (n = 15, p < 0.001), from 0.9 to 0.4 LogMAR in the > 250 and ≤ 400 µm group (n = 26, p < 0.001), and from 1.0 to 0.5 LogMAR in the > 400 µm group (n = 24, p < 0.001). A total of 16 patients had follow-up over 14 months: BCVA increased from 0.9 LogMAR preoperatively to 0.4 after 1 month (p < 0.00001) and to 0.3 LogMAR after 14 months (p = 0.03). A recovered ELM could be observed in 56.3% after 1 month and in 87.5% after 14 months. A recovered EZ could be observed in 18.8% after 1 month and in 68.8% after 14 months. CONCLUSION The study demonstrates a high closure rate with corresponding restitution of outer retinal layers. In addition to its importance for the treatment of MHs > 400 µm, the inverted ILM flap technique also appears to be effective and safe for the treatment of MHs < 400 µm. TRIAL REGISTRATION WHO: DRKS00021241.
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Affiliation(s)
- Gregor Kastl
- Augenzentrum Nymphenburger Höfe, Nymphenburger Straße 4, 80335, Munich, Germany.
| | | | - Michael Janusz Koss
- Augenzentrum Nymphenburger Höfe, Nymphenburger Straße 4, 80335, Munich, Germany
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Factors Associated with Anatomic Failure and Hole Reopening after Macular Hole Surgery. J Ophthalmol 2021; 2021:7861180. [PMID: 34917414 PMCID: PMC8670966 DOI: 10.1155/2021/7861180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
A macular hole (MH), particularly an idiopathic macular hole (IMH), is a common cause of central vision loss. Risk factors for nonidiopathic MH include high myopia, cystoid macular edema, inflammation, and trauma. MH is primarily diagnosed using slit-lamp microscopy and optical coherence tomography (OCT). Half of the patients with stage I MHs are treated conservatively and may show spontaneous resolution. The main treatment methods for MHs currently include vitrectomy and stripping of the internal limiting membrane (ILM). However, in some patients, surgery does not lead to anatomical closure. In this review, we summarize the factors influencing the anatomical closure of MHs and analyze the potential underlying mechanisms.
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Yuan A, Yang D, Olmos de Koo L. Current Trends in Macular Hole Repair. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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HUMAN AMNIOTIC MEMBRANE TO CLOSE RECURRENT, HIGH MYOPIC MACULAR HOLES IN PATHOLOGIC MYOPIA WITH AXIAL LENGTH OF ≥30 mm. Retina 2021; 40:1946-1954. [PMID: 31868775 DOI: 10.1097/iae.0000000000002699] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of the human amniotic membrane plug for recurrent high myopic macular hole (MH) that already underwent pars plana vitrectomy with internal limiting membrane peeling and gas endotamponade. METHODS Sixteen eyes of 16 patients with recurrent high myopic MH were enrolled. A 23-gauge pars plana vitrectomy was performed. Human amniotic membrane plugs were implanted under the neuroretina inside the MH. Twenty percent sulfur hexafluoride or air was used as endotamponades. The patients were instructed to maintain facedown position for 5 days after surgery. RESULTS Optical coherence tomography examinations showed that the MHs closed in 15 of the 16 patients (93.75%) 2 weeks after one surgical intervention, and in 100% of patients after second intervention. Mean best-corrected visual acuity improved from 1 logarithm of the minimum angle of resolution (20/200) to 0.67 logarithm of the minimum angle of resolution (20/100) 6 months after surgery. Best-corrected visual acuity remained stable during the 12-month follow-up. One patient had human amniotic membrane plug dislocation after gas absorption that needed a second intervention with new AM plug implantation. No adverse events were reported during the 12-month follow-up. CONCLUSION The first case series of recurrent high myopic MH was reported, assessing the effectiveness of the human amniotic membrane plug to close recurrent MHs in pathologic myopia. All the cases were successful with encouraging best-corrected visual acuity recovery.
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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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Zhang RR, Yu Y, Hou YF, Wu CF. Intra- and interobserver concordance of a new classification system for myopic maculopathy. BMC Ophthalmol 2021; 21:187. [PMID: 33892678 PMCID: PMC8063469 DOI: 10.1186/s12886-021-01940-4] [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: 12/14/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. METHODS This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. RESULTS The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602-0.700), 0.734 (95% CI: 0.689-0.779), and 0.702 (95% CI: 0.649-0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. CONCLUSIONS The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments.
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Affiliation(s)
- Rong-Rong Zhang
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, 92 West Zheshan Road, Wuhu, 241001, Anhui Province, People's Republic of China
| | - Yan Yu
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, 92 West Zheshan Road, Wuhu, 241001, Anhui Province, People's Republic of China
| | - Yin-Fen Hou
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, 92 West Zheshan Road, Wuhu, 241001, Anhui Province, People's Republic of China
| | - Chang-Fan Wu
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, 92 West Zheshan Road, Wuhu, 241001, Anhui Province, People's Republic of China.
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Chatziralli I, Machairoudia G, Kazantzis D, Theodossiadis G, Theodossiadis P. Inverted internal limiting membrane flap technique for myopic macular hole: A meta-analysis. Surv Ophthalmol 2021; 66:771-780. [PMID: 33652002 DOI: 10.1016/j.survophthal.2021.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
A macular hole (MH) may be a significant complication in patients with high myopia. The recently reported inverted internal limiting membrane (ILM) flap technique is a promising alternative to treat myopic MHs. We performed a meta-analysis of the published anatomical and functional results of the "inverted ILM flap" technique for the treatment of myopic MH with or without retinal detachment (RD). Our results showed that the inverted ILM flap technique, either covering or insertion, is an effective method for treating myopic MH with or without RD and provides high MH closure, ranging from 91.8% to 97.1%. Despite the high MH closure rate, the pooled visual acuity improvement rate was 77.3% and 66.2% in patients with myopic MH without RD, while it was 95% and 80.3% in patients with myopic MHRD, using "covering" and "insertion" ILM flap technique, respectively. Potential complications included reopening or persistence of MH, development of RD, choroidal detachment, ocular hypertension, and chorioretinal atrophy.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece.
| | - Genovefa Machairoudia
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistian University of Athens, Athens, Greece
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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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Ikeda T, Nakamura K, Sato T, Kida T, Oku H. Involvement of Anoikis in Dissociated Optic Nerve Fiber Layer Appearance. Int J Mol Sci 2021; 22:ijms22041724. [PMID: 33572210 PMCID: PMC7914697 DOI: 10.3390/ijms22041724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Dissociated optic nerve fiber layer (DONFL) appearance is characterized by dimpling of the fundus when observed after vitrectomy with the internal limiting membrane (ILM) peeling in macular diseases. However, the cause of DONFL remains largely unknown. Optical coherence tomography (OCT) findings have indicated that the nerve fiber layer (NFL) and ganglion cells are likely to have been damaged in patients with DONFL appearance. Since DONFL appearance occurs at a certain postoperative period, it is unlikely to be retinal damage directly caused by ILM peeling because apoptosis occurs at a certain period after tissue damage and/or injury. However, it may be due to ILM peeling-induced apoptosis in the retinal tissue. Anoikis is a type of apoptosis that occurs in anchorage-dependent cells upon detachment of those cells from the surrounding extracellular matrix (i.e., the loss of cell anchorage). The anoikis-related proteins βA3/A1 crystallin and E-cadherin are reportedly expressed in retinal ganglion cells. Thus, we theorize that one possible cause of DONFL appearance is ILM peeling-induced anoikis in retinal ganglion cells.
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Affiliation(s)
- Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City 569-8686, Osaka, Japan; (T.S.); (T.K.); (H.O.)
- Correspondence: ; Tel.: +81-72-684-6434
| | | | - Takaki Sato
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City 569-8686, Osaka, Japan; (T.S.); (T.K.); (H.O.)
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City 569-8686, Osaka, Japan; (T.S.); (T.K.); (H.O.)
| | - Hidehiro Oku
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City 569-8686, Osaka, Japan; (T.S.); (T.K.); (H.O.)
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Avci R, Mavi Yildiz A, Yilmaz S. The Influence of Crescent-Shaped Selective Internal Limiting Membrane Staining on Vital Dye Toxicity in Temporal Inverted Flap Technique. Curr Eye Res 2021; 46:1363-1369. [PMID: 33445962 DOI: 10.1080/02713683.2021.1877312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To investigate the macular function and morphology after temporal inverted internal limiting membrane (ILM) flap technique with and without staining of the ILM flap in contact with the retinal pigment epithelium (RPE).Materials and Methods: This retrospective study included 30 patients with idiopathic macular hole (MH), who underwent 27 G vitrectomy and temporal inverted ILM flap technique with brillant blue G (BBG) assisted ILM staining. In Group 1 (n = 16), a large bubble of perfluorocarbon liquid (PFCL) measuring approximately 6-disc diameters was used to cover the hole and central part of the ILM flap whereas in Group 2 (n = 14), only a small drop of PFCL to merely cover the MH was used. Complete ophthalmic examination including microperimetry (MP), optical coherence tomography (OCT) was performed preoperatively, 6 months after surgery.Results: MH closure was achieved in all the eyes in both groups. The sizes of ellipsoid zone (EZ) and external limiting membrane (ELM) defect significantly decreased after surgery relative to the baseline width in both groups (p < .05 for all). The mean improvement in visual acuity (p = .896) and retinal sensitivity was similiar between groups (p = .409). Accordingly, the postoperative mean lengths of the EZ (p = .254) and ELM disruption (p = .406) on OCT scans were similiar between groups. However, 3 of the eyes in Group 2 developed cystoid macular edema between postoperative month-1 and month-6.Conclusion: The crescent-shaped selective staining of the ILM flap could prevent prolonged retinal toxicity of vital dyes in inverted ILM flap technique. Further studies involving larger number of patients with longer follow up are needed to determine the impact of this technique in the management of vital dye toxicity.
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Affiliation(s)
- Remzi Avci
- Ophthalmology Department, Bursa Retina Eye Hospital, Bursa, Turkey
| | | | - Sami Yilmaz
- Ophthalmology Department, Bursa Retina Eye Hospital, Bursa, Turkey
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Silva N, Ferreira N, Pessoa B, Correia N, Beirão JM, Meireles A. Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience. Int Ophthalmol 2020; 41:499-507. [PMID: 33057865 DOI: 10.1007/s10792-020-01600-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. METHODS Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011-2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectral-domain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of ≥ 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. RESULTS Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8 years-old. Median (range) follow-up was 21 (3-92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%). The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01-1.02) independently predicted a final BCVA (logMAR) < 0.3 units. CONCLUSION Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome.
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Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Natália Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Bernardete Pessoa
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Nuno Correia
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - João Melo Beirão
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
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EARLY AND LATE MACULAR CHANGES AFTER THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR A FULL-THICKNESS MACULAR HOLE. Retina 2020; 41:20-28. [DOI: 10.1097/iae.0000000000002796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bové Álvarez M, Sabaté S, Gómez-Resa M, García-Arumí J. ANATOMICAL AND VISUAL OUTCOMES OF INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS INTERNAL LIMITING MEMBRANE PEELING IN MYOPIC MACULAR HOLE WITHOUT RETINAL DETACHMENT: A Preliminary Retrospective Study. Retina 2020; 40:233-240. [PMID: 31972792 DOI: 10.1097/iae.0000000000002368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap for treating myopic macular hole without retinal detachment. METHODS Twenty-eight eyes of 28 patients undergoing vitrectomy with either ILM peeling (n = 16) or inverted ILM flap technique (n = 12) were included. Outcomes were myopic macular hole closure by optical coherence tomography and visual acuity at 6 months and at the end of follow-up. RESULTS Closure of myopic macular hole was achieved in 13 eyes (81.2%) of the ILM peeling group and in 11 eyes (91.7%) of the inverted ILM flap group. The median length of follow-up was 18 months in the peeling group and 10.3 in the inverted group. There were not statistically significant differences between restoration of the external limiting membrane, external limiting membrane and ellipsoid zone, and none of both layers between the two groups. The median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.25 (20/35 Snellen) in the peeling group and 0.4 (20/50) in the inverted group (P = 0.027). CONCLUSION Both techniques were associated with high closure rates of myopic macular hole but the small sample size and the retrospective design prevents any claims of superiority of one technique over the other.
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Affiliation(s)
| | - Sergi Sabaté
- Service of Anesthesiology, Fundació Puigvert, Barcelona, Spain
| | - María Gómez-Resa
- Service of Ophthalmology, Hospital Universitario Son Espases, Palma de Mallorca, Spain; and
| | - José García-Arumí
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
- Service of Ophthalmology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
PURPOSE Recent studies described that in approximately 14% to 16% of cases of macular holes treated with the inverted internal limiting membrane flap technique, the hole was closed only by a thin layer of inverted internal limiting membrane-"flap closure." The aim of this article was to describe the functional and anatomical results in flap closure macular holes and also the mechanism of flap closure. METHODS A retrospective observational study of 149 eyes of 139 patients treated with vitrectomy using the inverted internal limiting membrane flap technique was reviewed to aggregate eyes with flap closure. Complete ophthalmic examination was performed preoperatively and at 7 days, 1, 3, 6, and 12 months after surgery. RESULTS Flap closure (Group 1) was noted in 24 eyes and other closure types in 125 eyes (Group 2). The mean minimal and base diameters of the macular holes in the flap closure group were greater than those in Group 2 (P < 0.001). The mean postoperative best-corrected visual acuity in the flap closure group (20/100) was lower than that in Group 2 (20/50) (P < 0.001). CONCLUSION Flap closure probably enables closure of large macular holes with a higher probability of remaining open without the use of the inverted internal limiting membrane flap technique. Foveal architecture continuously improved.
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Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique. J Ophthalmol 2019; 2019:6723824. [PMID: 31205783 PMCID: PMC6530104 DOI: 10.1155/2019/6723824] [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: 01/31/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the results of vitrectomy with those of internal limiting membrane (ILM) peeling or inverted ILM flap for treating myopic or idiopathic macular hole. Methods Thirty-nine eyes of 39 patients undergoing vitrectomy with ILM peeling for macular hole (25 idiopathic and 14 myopic) and 27 eyes of 27 patients undergoing vitrectomy with inverted ILM flap (15 idiopathic and 12 myopic) were included. Outcome measures were macular hole closure by optical coherence tomography and visual acuity at 6 months. Results Closure was achieved in 25 (100%) idiopathic and 12 (86%) myopic macular holes in the ILM peeling group and in 14 (93%) idiopathic and 11 (91.77%) macular holes in the inverted ILM flap group. There were no statistically significant differences in restoration of the external limiting membrane and ellipsoid zone between the groups. Median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.22 (20/32 Snellen) in idiopathic and 0.4 (20/50) in myopic (P=0.042) patients in the ILM peeling group and 0.4 (20/50) in idiopathic and 0.4 (20/50) in myopic (P=0.652) patients in the inverted ILM flap group. Conclusion Both techniques were associated with high closure rates in myopic and idiopathic macular holes, with somewhat better visual outcomes in idiopathic cases. The small sample size may have provided insufficient power to support the superiority of one technique over the other in the two groups.
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SURGICAL OUTCOMES IN EYES WITH EXTREMELY HIGH MYOPIA FOR MACULAR HOLE WITHOUT RETINAL DETACHMENT. Retina 2019; 38:2051-2055. [PMID: 28796147 DOI: 10.1097/iae.0000000000001806] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The authors evaluated surgical outcomes in eyes with extremely high myopia for macular hole (MH) without retinal detachment. METHODS In this retrospective study, 14 eyes with axial lengths of ≥30.0 mm underwent vitrectomy and internal limiting membrane (ILM) peeling with or without inverted ILM flap insertion for MH without retinal detachment (October 2009-June 2016). Outcome measures were MH closure confirmed by optical coherence tomography, best-corrected visual acuity, and complications. RESULTS The mean axial length was 30.69 ± 0.76 mm. The overall final closure rate was 85.7% (12/14 eyes); the mean follow-up was 17.29 (±20.20) months. Primary anatomical MH closure after 1 operation was achieved in three of eight eyes (37.5%) without an inverted ILM flap and was achieved in six of six eyes (100%) with inverted ILM flap insertion (P = 0.031). There was no reopening of MH during follow-up. Mean visual acuity improved significantly from 1.10 ± 0.43 logarithm of the minimum angle of resolution (Snellen equivalent, 20/254) to 0.84 ± 0.50 logarithm of the minimum angle of resolution (Snellen equivalent, 20/138) (P = 0.046; 2-tailed, paired t-test). Only 1 eye developed an MH-associated retinal detachment 4.5 years after previously failed MH surgery; reattachment was achieved after a second operation. CONCLUSION Patients with extremely high myopia obtained anatomical and functional improvements from MH surgery; inverted ILM flap insertion achieved significantly higher primary success rates in MH closure.
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Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal. J Ophthalmol 2019; 2019:1314989. [PMID: 31275628 PMCID: PMC6589202 DOI: 10.1155/2019/1314989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the microstructural changes after successful myopic macular hole (MMH) surgery, comparing inverted ILM flap and complete ILM removal techniques, and their association with visual function. Methods Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate both external limiting membrane (ELM) and ellipsoid zone (EZ) recovery in 40 eyes of 39 patients who underwent pars plana vitrectomy with either inverted internal limiting membrane flap technique (n=27) or complete ILM removal (n=13) to achieve MH closure. The association between ELM and EZ recovery and visual acuity was also investigated. The patients were followed up at 1 year. Results ELM and EZ was recovered in 72% and 62% of cases, respectively, regardless of the surgical techniques 1 year after surgery. A strong positive association between the ELM and EZ recovery and the mean BCVA was found: regardless of the surgical technique, this was statistically significant at each time point (p < 0.05). None of the baseline variables were found to act as predictive factors for either ELM or EZ. Conclusion The inverted ILM flap technique did not affect the MMH healing processes compared to complete ILM removal. Thus, the presence of the ILM plug did not interfere with the restoration of both ELM and EZ, which correlated with functional recovery.
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Letter to the editor relating to Graefe's Arch Clin Exp Ophthalmol. 2018 May; 256(5): 863-877. "Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery". Graefes Arch Clin Exp Ophthalmol 2018; 257:429-430. [PMID: 30293164 DOI: 10.1007/s00417-018-4159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022] Open
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Alkabes M, Mateo C. Reply to the comments on "Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery". Graefes Arch Clin Exp Ophthalmol 2018; 257:431-432. [PMID: 30291436 DOI: 10.1007/s00417-018-4160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Micol Alkabes
- Azienda Ospedaliero-Universitaria "Maggiore della Carità", S.C.D.O. Oculistica, Corso Mazzini, 18, 28100, Novara, Italy. .,IMO - Instituto de Microcirugía Ocular, Barcelona, Spain.
| | - Carlos Mateo
- IMO - Instituto de Microcirugía Ocular, Barcelona, Spain
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Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole. PLoS One 2018; 13:e0203789. [PMID: 30212576 PMCID: PMC6136763 DOI: 10.1371/journal.pone.0203789] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The internal limiting membrane (ILM) is a normal part of the retina, and the outcomes of ILM removal have not been fully investigated. ILM flap inversion is a recently developed technique that increases the success rate of macular hole (MH) surgery. Thus, we compared the anatomical closure rate and visual outcome in patients undergoing microincision vitrectomy surgery (MIVS) with ILM flap inversion or conventional ILM peeling for the treatment of MH. METHODS The medical records of 90 eyes with MH were reviewed retrospectively. The patients were classified into two groups based on MIVS procedure (group 1: ILM flap inversion, 46 eyes; group 2: ILM peeling, 44 eyes). RESULTS Preoperative characteristics were similar in the two groups, and there were no significant differences in 1 month- or 6 month-postoperative VA between the groups (P = 0.25 and P = 0.42, respectively). However, the surgical success rate was significantly higher in group 1 than group 2 (P = 0.04; 46/46: 100% and 41/44: 93%, respectively). Multiple regression analysis revealed that axial length and MH diameter were independent factors predicting 6-month postoperative BCVA in group 2 (P = 0.001 and P = 0.03, respectively), and that MH diameter was an independent factor predicting 6-month postoperative VA in group 1 (P = 0.03). Logistic regression analysis revealed that axial length (OR = 2.11; P = 0.02; area under the curve: 0.94; cut off score: 28.4 mm) was an independent factor indicating surgical failure in group 2. CONCLUSION Our results suggest that MIVS with ILM flap inversion might be best suited to treat MH, particularly in patients with high myopia.
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INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP TECHNIQUE FOR TREATMENT OF FULL-THICKNESS MACULAR HOLES: A COMPARATIVE STUDY IN A LARGE SERIES OF PATIENTS. Retina 2018; 38 Suppl 1:S73-S78. [PMID: 29232338 DOI: 10.1097/iae.0000000000001985] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The inverted flap (IF) technique has recently been introduced in macular hole (MH) surgery. The IF technique has shown an increase of the success rate in the case of large MHs and in MHs associated with high myopia. This study reports the anatomical and functional results in a large series of patients affected by MH treated using pars plana vitrectomy and gas tamponade combined with internal limiting membrane (ILM) peeling or IF. METHODS This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic or myopic MH treated using small-gauge pars plana vitrectomy (25- or 23-gauge) between January 2011 and May 2016. The patients were divided into two groups according to the ILM removal technique (complete removal vs. IF). A subgroup analysis was performed according to the MH diameter (MH < 400 µm and MH ≥ 400 µm), axial length (AL < 26 mm and AL ≥ 26 mm), and the presence of chorioretinal atrophy in the macular area (present or absent). RESULTS We included 620 eyes of 570 patients affected by an MH, 300 patients underwent pars plana vitrectomy and ILM peeling and 320 patients underwent pars plana vitrectomy and IF. Overall, 84.94% of the patients had complete anatomical success characterized by MH closure after the operation. In particular, among the patients who underwent only ILM peeling the closure rate was 78.75%; among the patients who underwent the IF technique, it was 91.93% (P = 0.001); and among the patients affected by full-thickness MH ≥400 µm, success was achieved in 95.6% of the cases in the IF group and in 78.6% in the ILM peeling group (P = 0.001); among the patients with an axial length ≥26 mm, success was achieved in 88.4% of the cases in the IF group and in 38.9% in the ILM peeling group (P = 0.001). Average preoperative best-corrected visual acuity was 0.77 (SD = 0.32) logarithm of the minimum angle of resolution (20/118 Snellen) in the peeling group and 0.74 (SD = 0.33) logarithm of the minimum angle of resolution (20/110 Snellen) in the IF group (P = 0.31). Mean postoperative best-corrected visual acuity was 0.52 (SD = 0.42) logarithm of the minimum angle of resolution (20/66 Snellen) in the peeling group and 0.43 (SD = 0.31) logarithm of the minimum angle of resolution (20/53 Snellen) in the IF group (P = 0.003). CONCLUSION Vitrectomy associated with the inverted ILM flap technique seems to be effective surgery for idiopathic and myopic large MHs, improving both functional and anatomical outcomes.
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Chantarasorn Y, Wang JC, Roh M, Eliott D. Closure of Macular Hole Associated With Extreme High Myopia After Conventional Vitrectomy With ILM Peeling. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e99-e101. [PMID: 30222827 DOI: 10.3928/23258160-20180907-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
Macular hole associated with high myopia (MH-HM) and macular hole-associated retinal detachment (MH-RD) are two conditions found in eyes with pathologic myopia that often have poor postoperative outcomes. A discrepancy in size between the stretched retina and the posteriorly expanded sclera is a major factor in the pathogenesis. The authors report a case comprising both types of maculopathy, one in each eye. The eye with the MH-HM (right eye) represents the longest axial length ever reported to have successful macular hole closure by any technique. The authors conclude that traditional surgery can be an adequate treatment for such a challenging condition. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e99-e101.].
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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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A Review of Surgical Outcomes and Advances for Macular Holes. J Ophthalmol 2018; 2018:7389412. [PMID: 29850211 PMCID: PMC5932482 DOI: 10.1155/2018/7389412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/28/2018] [Accepted: 02/18/2018] [Indexed: 01/10/2023] Open
Abstract
The surgical outcomes of macular holes (MHs) have improved greatly in recent years. The closure rate is as high as 90-100%, but the outcomes of some special types of MHs remain unsatisfactory. Internal limiting membrane (ILM) peeling dramatically improves the anatomic success rate, but recent studies have found that it could also cause mechanical and subclinical traumatic changes to the retina. Dyes are widely used, and apart from indocyanine green (ICG), the toxicities of other dyes require further research. Face-down posturing is necessary for MHs larger than 400 μm, and the duration of this posture is determined by the type of tamponade and the case. The ellipsoid zone has been shown to be highly correlated with visual outcome and recovery. New surgical methods include the inverted ILM flap technique and the ILM abrasion technique. However, they require further research to determine their effectiveness.
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Nowroozzadeh MH, Ashraf H, Zadmehr M, Farvardin M. Outcomes of Light Silicone Oil Tamponade for Failed Idiopathic Macular Hole Surgery. J Ophthalmic Vis Res 2018; 13:130-137. [PMID: 29719640 PMCID: PMC5905305 DOI: 10.4103/jovr.jovr_22_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To study the outcomes of redo macular hole surgery using light silicone oil tamponade. Methods: In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures. Results: Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open. Conclusions: Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes.
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Affiliation(s)
- M Hossein Nowroozzadeh
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ashraf
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Zadmehr
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Farvardin
- Department of Ophthalmology, School of Medicine, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Coppola M, Rabiolo A, Cicinelli MV, Querques G, Bandello F. Vitrectomy in high myopia: a narrative review. Int J Retina Vitreous 2017; 3:37. [PMID: 29021916 PMCID: PMC5623972 DOI: 10.1186/s40942-017-0090-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.
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Affiliation(s)
- Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Desio e Vimercate, Desio, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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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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Ma J, Li H, Ding X, Tanumiharjo S, Lu L. Effectiveness of combined macular buckle under direct vision and vitrectomy with ILM peeling in refractory macular hole retinal detachment with extreme high axial myopia: a 24-month comparative study. Br J Ophthalmol 2017; 101:1386-1394. [PMID: 28292775 PMCID: PMC5629954 DOI: 10.1136/bjophthalmol-2016-310123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/03/2017] [Accepted: 02/10/2017] [Indexed: 12/05/2022]
Abstract
Purpose To evaluate the efficacy of a combined macular buckle under direct vision and 23-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in refractory macular hole retinal detachment (MHRD) with extreme high axial myopia. Design Prospective, randomised controlled study. Participants The study included 98 eyes of 98 patients of MHRD with extreme high axial (>30 mm) myopia. Intervention Patients were randomly assigned to undergo PPV with ILM peeling (group 1, n=52) or PPV with ILM peeling combined with macular buckle under direct vision (group 2, n=46). Main outcome measures Complete ocular examination included best-corrected visual acuity (BCVA) (LogMAR), applanation tonometry, optical biometry, slit-lamp biomicroscopy, colour fundus photography, ultrasound examination and optical coherence tomography at baseline and every follow-up visit. Results Initial retinal reattachment rate was significantly higher in group 2 than in group 1 at 12-month postoperatively (χ2 test, p=0.020). Macular hole closure rate in group 2 was significantly higher than that in group 1 at 3, 12, 18 and 24 months postoperatively (Fisher's exact test, p<0.05). In initial retinal reattachment cases, the mean BCVA decreased significantly in group 2 than in group 1 at 3 months postoperatively (Wilcoxon matched pairs signed rank test, p=0.036), and had increased significantly in group 2 than in group 1 since 6 months postoperatively (Wilcoxon matched pairs signed rank test, p<0.05). Mean axial lengths in group 2 were significantly shorter than that of group 1 at each follow-up time point (Wilcoxon matched pairs signed rank test, p<0.05). Conclusions Combined macular buckle under direct vision and PPV with ILM peeling is more effective in treatment of MHRD with extreme high axial (>30 mm) myopia.
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Affiliation(s)
- Jin Ma
- Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
| | - Honghui Li
- Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
| | - Xiaohu Ding
- Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
| | - Silvia Tanumiharjo
- Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
| | - Lin Lu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
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