1
|
Muller YG, Soudier G, Olteanu S, Lenoble P. [Effects of internal limiting membrane peeling in epiretinal membrane surgery on OCT-angiography]. J Fr Ophtalmol 2023; 46:896-907. [PMID: 37625996 DOI: 10.1016/j.jfo.2023.03.022] [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: 12/03/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To assess macular microvascular parameters using OCT-angiography (OCT-A) in idiopathic epiretinal membrane surgery with or without internal limiting membrane peeling. MATERIALS AND METHODS We retrospectively studied 17 eyes of 17 patients who underwent vitrectomy surgery for idiopathic epiretinal membrane with (n=10) or without (n=7) internal limiting membrane peeling. Patients operated on between July 2020 and June 2022 at the Colmar Hospital (France) by a single surgeon were evaluated before and 1 month after surgery, using OCT-A (Spectralis OCT-A module, Heidelberg Engineering®, Germany). The parameters studied were the area, perimeter and acircularity index of the foveal avascular zone (FAZ), the foveolar (FVD) and parafoveolar (PRVD) perfusion density and the macular vessel density ratio (MVR) in the superficial vascular complex (SVC) and the deep vascular complex (DVC). These parameters were measured using ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). RESULTS We found no statistically significant difference between the two groups postoperatively in either area, perimeter, or acircularity index of the FAZ, FVD, PRVD, or MVR in either the SVC or DVC. CONCLUSION Our results with regard to macular microvasculature demonstrate no difference related to peeling of the internal limiting membrane and thus do not argue against this practice during epiretinal membrane surgery.
Collapse
Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - G Soudier
- Centre ophtalmologique Dromson, Sélestat, France
| | - S Olteanu
- Hôpital Pasteur, 68000 Colmar, France
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
| |
Collapse
|
2
|
Muller YG, Lenoble P. [Clinical and pathophysiological contribution of OCT-angiography to epiretinal membranes]. J Fr Ophtalmol 2023; 46:776-790. [PMID: 37164872 DOI: 10.1016/j.jfo.2023.01.028] [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: 06/27/2022] [Accepted: 01/30/2023] [Indexed: 05/12/2023]
Abstract
Epiretinal membranes may lead to centripetal contraction forces on the retina and its vessels. OCT-Angiography (OCT-A) is a recent tool which permits a non-invasive understanding of these vascular changes. This review focuses on the OCT-A findings in idiopathic epiretinal membranes, before and after surgery, and the role of internal limiting membrane peeling. It appears that contraction of the epiretinal membrane is associated with both a reduction in the area and perimeter of the foveal avascular zone and alterations in the superficial and deep capillary plexuses. These changes mainly reflect a vascular shift from the perifoveal to the foveal region, increasing with retinal deformation, but also probable dynamic changes in vascular flow. Membrane peeling allows at least partial improvement of these microvascular parameters. Nevertheless, some limitations of OCT-A, such as segmentation errors on a retina with highly modified architecture, can lead to a selection bias in the studies and should call for caution in the interpretation of the results. Finally, internal limiting membrane peeling contributes to changes in the retinal architecture after surgery, in particular by causing a centripetal movement of the macular capillaries and a displacement of the fovea toward the optic nerve head. This role should be clarified in future studies.
Collapse
Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
| |
Collapse
|
3
|
Kalur A, Muste J, Singh RP. A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes. Ophthalmic Surg Lasers Imaging Retina 2022; 53:52-61. [PMID: 34982003 DOI: 10.3928/23258160-20211210-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm. MATERIAL AND METHODS PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 μm. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole. RESULTS Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of -0.48 ± 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of -0.15 ± 0.17 and -0.14 ± 0.91 logMAR, respectively. CONCLUSION An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:52-61.].
Collapse
|
4
|
Shukla D, Kalliath J. Internal limiting membrane peeling for large macular hole: Tailoring the rhexis to the shape of the hole. Indian J Ophthalmol 2021; 70:182-186. [PMID: 34937234 PMCID: PMC8917519 DOI: 10.4103/ijo.ijo_906_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates. Methods: This is a single-center interventional case series. conducted between 2016 and 2020. The minimum follow-up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ≥600 μm) were enrolled; vertical hole diameters were also measured using spectral-domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc-diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best-corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t-test. IBM SPSS (ver. 26) was used for analysis. Results: The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 μm (range: 600–1020 μm) and 602 μm (490–844 μm), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow-up (mean: 28 months, median: 34 months; range 4–48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001). Conclusion: All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes.
Collapse
Affiliation(s)
- Dhananjay Shukla
- Retina-Vitreous Service, Ratan Jyoti Netralaya, Gwalior, Madhya Pradesh, India
| | - Jay Kalliath
- Department of Ophthalmology, NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| |
Collapse
|
5
|
Face-Down Posture versus Non-Face-Down Posture following Large Idiopathic Macular Hole Surgery: A Systemic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10214895. [PMID: 34768415 PMCID: PMC8584827 DOI: 10.3390/jcm10214895] [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: 09/25/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Evidence regarding the effect of a face-down posture (FDP) for large idiopathic macular hole (IMH) is inconsistent. We conducted a systematic review and meta-analysis to determine whether a postoperative FDP is required for the treatment of large IMH. Eligible randomized controlled trials published before September 2021 were retrieved from the Medline, Embase, and Cochrane Library databases. The efficacy outcome was the IMH closure rate and the visual acuity improvement rate. A meta-analysis was performed using a random effects model. The “Grading of Recommendations Assessment, Development, and Evaluation” approach was implemented, and the numbers needed-to-treat (NNTs) were calculated. Seven studies comprising 640 patients were included. We performed a predefined subgroup analysis of IMH size using a cut-off point of 400 µm. Compared with non-FDP, a significant effect of FDP was found in the IMH > 400 µm group (OR = 3.34; 95% CI = 1.57–7.14; trial sequential analysis-adjusted CI = 1.20–11.58; NNTs = 7.9). After stratifying by the posturing periods, the beneficial effect of FDP lasting at least five days, but not three days was observed for large IMH. Maintaining a FDP for at least five days postoperatively is an effective strategy (certainty of evidence: “moderate”) for treating large IMH.
Collapse
|
6
|
Fallico M, Jackson TL, Chronopoulos A, Hattenbach L, Longo A, Bonfiglio V, Russo A, Avitabile T, Parisi F, Romano M, Fiore T, Cagini C, Lupidi M, Frisina R, Motta L, Rejdak R, Nowomiejska K, Toro M, Ventre L, Reibaldi M. Factors predicting normal visual acuity following anatomically successful macular hole surgery. Acta Ophthalmol 2021; 99:e324-e329. [PMID: 32833307 DOI: 10.1111/aos.14575] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/18/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the incidence of normal vision following anatomically successful macular hole surgery and associated clinical variables. METHODS Multicentre, retrospective chart review. Preoperative, intraoperative and postoperative clinical data were extracted from electronic medical records from seven European vitreoretinal units. Inclusion criteria were as follows: eyes undergoing primary vitrectomy for idiopathic full-thickness macular hole from January 2015 to January 2018; postoperative macular hole closure confirmed by spectral domain optical coherence tomography (OCT); preoperative pseudophakia or phakic eyes receiving combined cataract surgery; one-year follow-up. The primary outcome was 'normal vision' defined as a final best-corrected visual acuity (BCVA) ≥ 20/25. Univariate, multivariate and decision-tree analyses were conducted to evaluate the clinical variables associated with 'normal vision'. Odds ratios (OR) and confidence intervals (CIs) were calculated. RESULTS Of 327 eligible cases, 91 (27.8%) achieved 'normal vision' at 1 year. Multivariate analysis identified variables significantly associated with 'normal vision': shorter symptom duration (odds ratio [OR]=1.05; 95% confidence interval [CI]:1.02-1.09; p = 0.002), smaller preoperative OCT minimum linear diameter (OR per 100-micron increase = 1.65; 95%CI:1.31-2.08; p < 0.001) and better mean preoperative BCVA (OR = 15.13; 95%CI: 3.59-63.65; p < 0.001). The decision-tree analysis found that the most significant variable associated with 'normal vision' was symptom duration. 'Normal vision' was achieved in 70.6% of eyes operated within one week from symptom onset and in 45% of eyes with symptom duration between 1 and 3 weeks. CONCLUSIONS These findings suggested urgent surgery is justified for small macular holes of short duration.
Collapse
Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
| | - Timothy L. Jackson
- Department of Ophthalmology King's College HospitalKing's College London London UK
| | | | | | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | | | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | | | - Mario Romano
- Department of Ophthalmology Gavazzeni ‐ Castelli HospitalHumanitas University Rozzano Italy
| | - Tito Fiore
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia HospitalUniversity of Perugia Perugia Italy
| | - Carlo Cagini
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia HospitalUniversity of Perugia Perugia Italy
| | - Marco Lupidi
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia HospitalUniversity of Perugia Perugia Italy
| | - Rino Frisina
- Department of Ophthalmology University of Padova Padova Italy
| | - Lorenzo Motta
- Department of Ophthalmology King's College HospitalKing's College London London UK
| | - Robert Rejdak
- Department of General Ophthalmology Medical University of Lublin Lublin Poland
| | | | - Mario Toro
- Department of General Ophthalmology Medical University of Lublin Lublin Poland
| | - Luca Ventre
- Department of Surgical Sciences Eye Clinic Section University of Turin Turin Italy
| | - Michele Reibaldi
- Department of Surgical Sciences Eye Clinic Section University of Turin Turin Italy
| |
Collapse
|
7
|
Tsuboi K, Fukutomi A, Sasajima H, Ishida Y, Kusaba K, Kataoka T, Kamei M. Visual Acuity Recovery After Macular Hole Closure Associated With Foveal Avascular Zone Change. Transl Vis Sci Technol 2020; 9:20. [PMID: 32855867 PMCID: PMC7422767 DOI: 10.1167/tvst.9.8.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm2 at the preoperative visit, 0.25 ± 0.091 mm2 at the first postoperative visit and 0.31 ± 0.11 mm2 at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.
Collapse
Affiliation(s)
- Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Akira Fukutomi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Hirofumi Sasajima
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Yuichiro Ishida
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Kiichiro Kusaba
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Takuya Kataoka
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
8
|
Infracyanine Green vs. Brilliant Blue G in Inverted Flap Surgery for Large Macular Holes: A Long-Term Swept-Source OCT Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56010043. [PMID: 31968622 PMCID: PMC7022749 DOI: 10.3390/medicina56010043] [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: 12/08/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives: To compare the long-term toxicity of infracyanine green (IFCG) to brilliant blue G (BBG) in inverted internal limiting membrane flap surgery (I-ILMFS) for large, full-thickness macular holes (FTMHs). Materials and Methods: Prospective randomized study including 39 eyes with ≥ 400 µm idiopathic FTMH who underwent I-ILMFS with either IFCG or BBG. Postoperative 6- and 12-month corrected distance visual acuity (CDVA), closure rate, and swept-source optical coherence tomography parameters, including ellipsoid zone (EZ) and external limiting membrane (ELM) mean defect length, central foveal thicknesses (CFT), parafoveal macular thickness (MT), ganglion cells and inner plexiform layer (GCL++) thickness, and peripapillary nerve fiber layer (pRNFL) thickness, were compared. Results: Nineteen eyes were included in the IFCG group and 20 eyes in the BBG group. In all cases a FTMH closure was found. CDVA improved at 6 and 12 months in both groups (p < 0.0005); the increase at 12 months was greater in the BBG group (p = 0.036). EZ and ELM defects did not differ between groups at either follow-up time. CFT at 12 months was greater in the BBG group (p = 0.041). A 12-months compared to 6-months MT decrease was present in both groups (p < 0.01). The GCL++ superior inner sector was thicker in the BBG group at 12 months (p = 0.036), as were the superior outer sector (p = 0.039 and p = 0.027 at 6 and 12 months, respectively) and inferior outer sector (p = 0.011 and p = 0.009 at 6 and 12 months, respectively). Conclusion: In our study BBG in I-ILMFS exhibits better long-term CDVA and retinal thickness than does IFCG, suggesting a lesser toxicity from BBG. These findings support the use of BBG over IFCG in I-ILMFS.
Collapse
|
9
|
FOVEAL AVASCULAR ZONE AREA AFTER INTERNAL LIMITING MEMBRANE PEELING FOR EPIRETINAL MEMBRANE AND MACULAR HOLE COMPARED WITH THAT OF FELLOW EYES AND HEALTHY CONTROLS. Retina 2018; 38:1786-1794. [PMID: 28767555 DOI: 10.1097/iae.0000000000001778] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure the foveal avascular zone (FAZ) area after internal limiting membrane (ILM) peeling and to determine the factors significantly correlated with the FAZ area. METHODS This was a retrospective, observational, and cross-sectional study. The affected and normal fellow eyes of 102 patients with unilateral macular diseases and 169 healthy subjects were studied. The patients underwent successful vitrectomy with internal limiting membrane peeling for an epiretinal membrane (n = 56) or a macular hole (n = 46). The superficial FAZ area and average foveal (within 1 mm) thickness were measured. The main outcome measures were the en face FAZ area measured in the optical coherence tomography angiographic images. RESULTS The FAZ area in the epiretinal membrane group (0.148 ± 0.094 mm) and in the macular hole group (0.255 ± 0.111 mm) were significantly smaller than that in the healthy control group (0.358 ± 0.118 mm; all, P < 0.0001). Multiple regression analysis showed that a thicker fovea was significantly correlated with a smaller FAZ area in the epiretinal membrane group (r = -0.799, P < 0.0001), macular hole group (r = -0.473, P = 0.0042), and control group (r = -0.612, P < 0.0001). CONCLUSION The FAZ area after internal limiting membrane peeling was smaller than that of the controls. A smaller FAZ area was correlated with a thicker fovea both in internal limiting membrane-peeled eyes and normal eyes.
Collapse
|
10
|
Kim SH, Kim HK, Yang JY, Lee SC, Kim SS. Visual Recovery after Macular Hole Surgery and Related Prognostic Factors. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:140-146. [PMID: 29611371 PMCID: PMC5906399 DOI: 10.3341/kjo.2017.0085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe the visual recovery and prognostic factors after macular hole surgery. METHODS A retrospective chart review was conducted. Charts of patients with idiopathic macular holes who underwent surgery by a single surgeon at Severance Hospital between January 1, 2013 and July 31, 2015 were reviewed. The best-corrected visual acuity (BCVA) score was recorded preoperatively and at 1 day and 1, 3, 6, 9, and 12 months after surgery. The variables of age, sex, macular hole size, basal hole diameter, choroidal thickness, and axial length were also noted. RESULTS Twenty-six eyes of 26 patients were evaluated. Twenty-five patients (96.2%) showed successful macular hole closure after the primary operation. The BCVA stabilized 6 months postoperatively. A large basal hole diameter (p = 0.006) and thin choroid (p = 0.005) were related to poor visual outcomes. Poor preoperative BCVA (p < 0.001) and a thick choroid (p = 0.020) were associated with greater improvement in BCVA after surgery. CONCLUSIONS Visual acuity stabilized by 6 months after macular hole surgery. Choroidal thickness was a protective factor for final BCVA and visual improvement after the operation.
Collapse
Affiliation(s)
- Soo Han Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hong Kyu Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
11
|
Cho JH, Yi HC, Bae SH, Kim H. Foveal microvasculature features of surgically closed macular hole using optical coherence tomography angiography. BMC Ophthalmol 2017; 17:217. [PMID: 29179702 PMCID: PMC5704531 DOI: 10.1186/s12886-017-0607-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background To describe the features of foveal microvasculature using optical coherence tomography angiography (OCTA) and to determine the related clinical factors in eyes with surgically closed macular hole (MH). Methods A retrospective case series of 18 patients with unilateral MH was reviewed. The patients maintained complete hole closure after vitrectomy with inner limiting membrane (ILM) peeling for at least 12 months. The healthy fellow eyes were studied as controls. The foveal microvasculature of both eyes was examined by OCTA. The area of the foveal avascular zone (FAZ) and the vascular density (VD) ratio in the superficial and deep capillary plexuses (SCP and DCP) were determined after surgery. Several clinical factors including age, stage and dimensions of MH, papillofoveal distance, the extent of nasal displacement of the fovea after surgery, postoperative central foveal thickness, and outer-retina integrity were evaluated to determine any relationships with the OCTA parameters. Results The mean FAZ area in both the SCP and DCP (0.29 ± 0.11 mm2 and 0.39 ± 0.14 mm2) was significantly smaller than those of the controls (0.45 ± 0.14 mm2 and 0.62 ± 0.22 mm2) (p = 0.001 and <0.001, respectively). The mean VD ratio in the SCP (0.270 ± 0.349) was similar to that of the controls (0.321 ± 0.189) (p = 0.231); however, that in the DCP (0.321 ± 0.189) was significantly lower than that of the controls (0.331 ± 0.119) (p = 0.025). Only the extent of nasal displacement of the fovea was correlated with the DCP FAZ-area difference values between the study group and the controls (correlation coefficient = 0.577; p = 0.012). Conclusions After successful MH surgery, the FAZ area in both the SCP and DCP was smaller and the VD ratio of the DCP was lower, suggesting a possible DCP vulnerability to tractional stress. As the FAZ area of the DCP in closed-MH eyes became smaller than that in the controls, the fovea was less displaced toward the optic disc, possibly reflecting a lack of retinal redundancy caused by horizontal stretching accompanied by foveal displacement. Electronic supplementary material The online version of this article (10.1186/s12886-017-0607-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joon Hee Cho
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Ho Chul Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - So Hyun Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea.
| | - Hakyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| |
Collapse
|
12
|
Kim YJ, Jo J, Lee JY, Yoon YH, Kim JG. Macular capillary plexuses after macular hole surgery: an optical coherence tomography angiography study. Br J Ophthalmol 2017; 102:966-970. [PMID: 28982954 DOI: 10.1136/bjophthalmol-2017-311132] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the structural changes of the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) using optical coherence tomography (OCT) angiography (OCTA) in patients with idiopathic macular hole (MH) after surgery, determine the factors related to changes of macular capillary plexuses and evaluate its association with postoperative visual outcomes. METHODS Thirty-three patients with unilateral MH who were followed for ≥6 months after surgery were included. Ophthalmologic evaluations included best corrected visual acuity (BCVA) and spectral-domain OCT before surgery and 6 months postsurgery. En face OCTA images were obtained for both eyes at 6 months postsurgery, and the postoperative foveal avascular zone (FAZ) area and parafoveal vascular density were identified. RESULTS Compared with fellow eyes, eyes after MH surgery had a smaller FAZ area in both SCP and DCP (p<0.05 for all). The FAZ area was positively correlated with postoperative foveal thickness of the whole, inner and outer layers (p<0.05 for all). In the parafoveal region, eyes after MH surgery had a tendency to have lower parafoveal vascular density, particularly in DCP (p=0.019). The parafoveal vascular density in DCP was positively correlated with retinal thickness of the whole, inner and outer layers (p<0.05 for all). Correlations between BCVA and FAZ area in both SCP and DCP were significant 6 months after MH surgery (p<0.05 for all). CONCLUSION Assessment of macular capillary plexuses using OCTA may be useful for monitoring retinal structural and functional changes in MH.
Collapse
Affiliation(s)
- Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - June-Gone Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
Kumagai K, Furukawa M, Suetsugu T, Ogino N. Increase in average foveal thickness after internal limiting membrane peeling. Clin Ophthalmol 2017; 11:605-611. [PMID: 28435209 PMCID: PMC5388209 DOI: 10.2147/opth.s134909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report the findings in three cases in which the average foveal thickness was increased after a thin epiretinal membrane (ERM) was removed by vitrectomy with internal limiting membrane (ILM) peeling. METHODS The foveal contour was normal preoperatively in all eyes. All cases underwent successful phacovitrectomy with ILM peeling for a thin ERM. The optical coherence tomography (OCT) images were examined before and after the surgery. The changes in the average foveal (1 mm) thickness and the foveal areas within 500 μm from the foveal center were measured. The postoperative changes in the inner and outer retinal areas determined from the cross-sectional OCT images were analyzed. RESULTS The average foveal thickness and the inner and outer foveal areas increased significantly after the surgery in each of the three cases. The percentage increase in the average foveal thickness relative to the baseline thickness was 26% in Case 1, 29% in Case 2, and 31% in Case 3. The percentage increase in the foveal inner retinal area was 71% in Case 1, 113% in Case 2, and 110% in Case 3, and the percentage increase in foveal outer retinal area was 8% in Case 1, 13% in Case 2, and 18% in Case 3. CONCLUSION The increase in the average foveal thickness and the inner and outer foveal areas suggests that a centripetal movement of the inner and outer retinal layers toward the foveal center probably occurred due to the ILM peeling.
Collapse
Affiliation(s)
| | - Mariko Furukawa
- Department of Ophthalmology, Kami-iida Daiichi General Hospital
| | | | - Nobuchika Ogino
- Department of Ophthalmology, Nishigaki Eye Clinic, Aichi, Japan
| |
Collapse
|
14
|
Kumagai K, Uemura A, Furukawa M, Suetsugu T, Ogino N. Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study. Int Med Case Rep J 2017; 10:81-85. [PMID: 28331373 PMCID: PMC5349704 DOI: 10.2147/imcrj.s129174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a patient whose foveal avascular zone (FAZ) decreased after vitrectomy with internal limiting membrane (ILM) peeling. METHODS A 58-year-old woman underwent successful phacovitrectomy with ILM peeling for a thin epiretinal membrane in an eye with a normal foveal contour. Optical coherence tomography angiographic en face images of the 3 mm×3 mm superficial and deep inner retinal vascular plexuses were examined preoperatively, and on days 1, 2, 9, and 37 postoperatively. The changes in the FAZ areas and the thicknesses of the parafoveal retinal layers at 500 μm from the foveal center were assessed in the vertical and horizontal B-scan images. RESULTS The areas of the superficial and deep FAZ decreased after the surgery. The course of the postoperative decrease of the FAZ area in the superficial plexus can be fit by a hyperbolic curve (R2=0.993). An increase in the thicknesses of the retinal nerve fiber layer, ganglion cell-inner plexiform layer, and inner nuclear layer was observed at all times postoperatively. CONCLUSIONS We observed one case that the FAZ area decreased and the parafoveal inner retinal thickness increased after the vitrectomy with ILM peeling. The decrease in the FAZ area suggests that a centripetal movement of the inner retinal layer is probably due to the ILM peeling.
Collapse
Affiliation(s)
- Kazuyuki Kumagai
- Department of Ophthalmology, Kami-iida Daiichi General Hospital, Aichi
| | - Akinori Uemura
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima
| | - Mariko Furukawa
- Department of Ophthalmology, Kami-iida Daiichi General Hospital, Aichi
| | | | - Nobuchika Ogino
- Department of Ophthalmology, Nishigaki Eye Clinic, Aichi, Japan
| |
Collapse
|
15
|
POSTOPERATIVE INNER NUCLEAR LAYER MICROCYSTS AFFECTING LONG-TERM VISUAL OUTCOMES AFTER EPIRETINAL MEMBRANE SURGERY. Retina 2016; 36:2377-2383. [DOI: 10.1097/iae.0000000000001100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
|
17
|
|
18
|
Woo IH, Hong JG, Jang JH. Recovery Course of Macular Structure after Macular Hole Surgery: Using a Spectral Domain Optical Coherence Tomography Image. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- In Ho Woo
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Jun Gi Hong
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Ji Hye Jang
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| |
Collapse
|
19
|
Abstract
Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications.
Collapse
|
20
|
Correlation between central retinal thickness after successful macular hole surgery and visual outcome. Jpn J Ophthalmol 2015; 59:394-400. [PMID: 26314745 DOI: 10.1007/s10384-015-0406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the correlation between central retinal thickness (CRT) after vitreous surgery and final visual outcome in eyes with idiopathic macular holes (MH). METHODS A prospective analysis was performed of patients who had undergone surgical treatment for MH. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters including CRT, minimum and base diameters of the MHs were analyzed pre- and postoperatively. The relationships between final visual outcome and the OCT parameters were examined by single and multiple regression analysis. RESULTS Forty-one MHs cases were successfully closed postoperatively. BCVA gradually improved, and CRT decreased during the observation period following MH surgery. There were significant positive correlations between CRT at 1 month and visual acuity at 12 months after vitreous surgery (P < 0.0001). MH diameter was positively correlated with CRT at 1 month after surgery and negatively with postoperative visual acuity. CONCLUSIONS CRT at 1 month after MH surgery was related to preoperative MH diameter and visual acuity at 12 months postoperatively. Our data suggest that the increased CRT at the early postoperative period may result in better visual prognosis.
Collapse
|
21
|
Andréasson S, Ghosh F. Cone implicit time as a predictor of visual outcome in macular hole surgery. Graefes Arch Clin Exp Ophthalmol 2014; 252:1903-9. [PMID: 24789462 DOI: 10.1007/s00417-014-2628-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate whether preoperative retinal function measured by full-field ERG and multifocal ERG is correlated to postoperative visual acuity after macular hole surgery. METHODS Standard pars plana vitrectomy with removal of the internal limiting membrane (ILM) was performed on 19 consecutive patients undergoing macular hole surgery. Intraocular gas tamponade with a C2F6 gas-air mixture was employed, followed by a face-down position for at least 5 days. The patients were examined with the ETDRS chart, full-field ERG (Espion), multifocal ERG (Veris 6), and optical coherence tomography (OCT) preoperatively, and 6 weeks, 6 months, and 18 months after surgery. RESULTS The cone 30-Hz flicker implicit time in the full-field ERG reflecting retinal function was prolonged (p = 0.016) before surgery compared to aged-matched controls. After macula hole surgery, longstanding alteration of cone function reflected by mfERG and full-field ERG was verified 18 months after surgery. The prolonged cone 30-Hz flicker implicit time in the full-field ERG before surgery was significantly correlated to the ETDRS visual acuity 6 months postoperatively (p = 0.03). CONCLUSIONS Preoperative evaluation of retinal function with multifocal ERG and full-field ERG improves the understanding of the retinal recovery process after macular hole surgery. The cone implicit time in full-field 30-Hz flicker ERG could be a valid predictor of long-term visual outcome, which may be useful for selecting patients suitable for surgery.
Collapse
Affiliation(s)
- Sten Andréasson
- Department of Ophthalmology, University of Lund, 221 85, Lund, Sweden,
| | | |
Collapse
|