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Murillo SA, Romero RM, Medina SP. Bilaminar Graft of the Anterior Capsule and Internal Limiting Membrane: A Novel Surgical Technique for the Treatment of Macular Hole and Focal Macular Detachment Associated with High Myopia and Posterior Staphyloma. Case Rep Ophthalmol 2022; 13:783-788. [PMID: 36845456 PMCID: PMC9944213 DOI: 10.1159/000526151] [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: 03/27/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
This case report describes a novel surgical technique for the treatment of macular hole and focal macular detachment associated with high myopia and posterior staphyloma. A 65-year-old female presented with a stage 3C myopic traction maculopathy and VA of 20/600. OCT examination confirmed a macular hole of 958 μm diameter, posterior staphyloma, and macular detachment. We performed combined phacoemulsification surgery with 23G pars plana vitrectomy; the anterior capsule was preserved and divided into two equal circular laminar flaps. We proceeded with central and peripheral vitrectomy, brilliant blue staining, and partial ILM peeling; capsular sheets were introduced sequentially in the vitreous chamber, the first one was implanted below the hole and attached to pigment epithelium, the second lamina was inserted into the hole, and the remaining portion of ILM was implanted crosswise below the edges of the hole. Macular-hole closure and progressive reapplication of the macular detachment were obtained, with a final VA of 20/80. Treatment of macular holes and focal macular detachment in high myopic eyes is complex, even for experienced surgeons. We propose a new technique with additional mechanisms based on anterior lens capsule and internal limiting membrane tissue properties that showed functional and anatomical improvement and could be considered an alternative treatment.
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Affiliation(s)
| | - Rosa Maria Romero
- bCentro de Investigación de Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico,*Rosa Maria Romero,
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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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Marlow ED, Mahmoud TH. Current management strategies for atypical macular holes. Taiwan J Ophthalmol 2021; 11:221-231. [PMID: 34703737 PMCID: PMC8493981 DOI: 10.4103/tjo.tjo_26_20] [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: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Abstract
This review evaluates the current surgical management options for refractory and atypical macular holes (MH) and proposes a treatment paradigm for approaching complex cases. A review of literature was performed to deliver a thorough discussion of the epidemiology and pathophysiology of MH as well as the historic evolution of surgical management strategies. With this context established, an update on recent surgical advances for management of large, chronic, and highly myopic MH is provided. New small MH may be adequately treated with pars plana vitrectomy, while those ≥300 μm should undergo internal limiting membrane (ILM) peel. For MH ≥400 μm with risk factors for failure, primary intervention should involve creation of an ILM flap and various methods of flap creation are discussed. For very large MH ≥700 μm or in refractory cases, autologous retinal transplants and other recently proposed procedures should be considered. While typical MHs enjoy high initial surgical success rates, atypical and refractory MH require additional intraoperative and postoperative considerations to maximize surgical success and optimize vision. With many techniques at the surgeon's disposal, patient selection becomes critical to improving outcomes.
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Affiliation(s)
| | - Tamer H. Mahmoud
- Associated Retinal Consultants, P.C., Royal Oak, MI, USA
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Chen YC, Chen SN. Human amniotic membrane grafts for retinal breaks in diabetic tractional retinal detachment and combined tractional and rhegmatogenous retinal detachment. Sci Rep 2021; 11:8035. [PMID: 33850166 PMCID: PMC8044097 DOI: 10.1038/s41598-021-86804-z] [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: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
To describe the surgical outcomes of using human amniotic membrane (hAM) grafts in the management of retinal breaks in diabetic tractional detachment (TRD) and combined tractional and rhegmatogenous retinal detachment (CTRRD). A retrospective case series of 10 eyes with TRD or CTRRD receiving pars plana vitrectomy with hAM grafts implantation, compared with 13 controls receiving the same surgery without hAM grafts. Best-corrected visual acuity (BCVA) and re-detachment rate were compared between two groups. Postoperatively, all eyes in the hAM group had retina attachment without recurrence, while 9 eyes in the control group had retina re-detachment and required additional surgery (0% vs 69.2%, p = 0.003). The BCVA significantly improved in the hAM group (from 1.96 ± 0.95 to 1.44 ± 0.77 in log MAR, p = 0.03), but not improved in control group (p = 0.20). Postoperative optical coherence tomography of the eyes receiving hAM grafts demonstrated glial tissue regeneration and restoration of ellipsoid zone. In diabetic TRD or CTRRD, hAM grafts could be an effective method, with promising outcome. Compared to standard surgery, it could result in higher retina reattachment rate and significant visual improvement. Moreover, it may offer the adjunctive benefit in tissue regeneration and fasten ellipsoid zone restoration.
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Affiliation(s)
- Yen-Chih Chen
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao Street, Changhua City, Taiwan.,Department of Ophthalmology, Yunlin Christian Hospital, Xiluo, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao Street, Changhua City, Taiwan. .,School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Optometry, Da-Yeh University, Changhua, Taiwan.
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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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Central posterior lens capsule used instead of inverted ILM flap: a clinic-pathological case report. Retin Cases Brief Rep 2020; 16:601-605. [PMID: 32568960 DOI: 10.1097/icb.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present immunocytochemical characterization of a surgically excised central posterior lens capsule (PLC) that was transplanted to close a secondary refractory full-thickness macular hole (FTMH) as an epiretinal flap. For comparison, tissue of both an unaffected internal limiting membrane (ILM) and unexposed PLC was processed. METHODS Clinical-pathological case report. RESULTS We report of a 38-year-old patient who underwent pars plana vitrectomy (PPV) with PLC tissue for patching secondary FTMH and silicone oil tamponade after tractional retinal detachment. The PLC was peeled off during a vitrectomy one year after positioning. For immunocytochemistry, the removed PLC was prepared as flat-mount and showed a positive immunofluorescence of the Müller cells marker glutamine synthetase (GS) and for vimentin. The microglia marker IBA and the neuroprotective neurotrophic marker glia cell-derived neurotrophic factor (GDNF) were tested positive, too. There was no immunoreactivity of cellular retinaldehyde-binding protein (CRALBP) and glial fibrillary acidic protein (GFAP). In comparison, tissue of a control ILM that was obtained during standard FTMH surgery showed few single cells that were likewise positive for GS, GDNF and IBA. The control specimen of unexposed PLC showed rarely cells that were without positive immunostaining for the tested markers. CONCLUSION Our analysis revealed positive immunoreactivity of macro- and microglia cells of PLC tissue that was used to patch a refractory FTMH. Similar immunostaining of PLC material and ILM suggests the PLC transplantation as an alternative treatment option for refractory FTMH.
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