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Liu L, Wang Z, Yu Y, Yang X, Qi B, Zhang K, Liu W. Microstructural and microperimetric comparison of internal limiting membrane peeling and insertion in large idiopathic macular hole. BMC Ophthalmol 2023; 23:274. [PMID: 37316769 DOI: 10.1186/s12886-023-03006-z] [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: 11/14/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion. METHODS This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively. RESULTS For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group. CONCLUSION For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.
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Affiliation(s)
- Lingzi Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China.
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
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Macular Holes: Main Clinical Presentations, Diagnosis, and Therapies. J Ophthalmol 2022; 2022:2270861. [PMID: 35450323 PMCID: PMC9017549 DOI: 10.1155/2022/2270861] [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: 12/30/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Macular holes are a spectrum of retinal diseases that comprehends full-thickness macular holes (FTMHs), refractory/recurrent macular holes, lamellar macular holes (LMHs), myopic macular holes (MMHs), traumatic macular holes, and macular holes secondary to other retinal pathologies or injuries. There are various classifications of the subtypes of macular hole, and only in recent times researchers defined a common nomenclature, especially thanks to the evolution in retinal imaging, offered by new instruments like the swept-source OCT. The proposed therapies for macular holes are different and range from a “wait-and-see” approach to the vitrectomy, with different results in each subtype of macular hole. This narrative review has the purpose to investigate the available evidence in literature to give a summary of the knowledge about these retinal pathologies.
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Caporossi T, Ripa M, Governatori L, Scampoli A, Gambini G, Rizzo C, Kilian R, Rizzo S. The current surgical management of refractory full-thickness macular holes. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2045951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Lorenzo Governatori
- University Hospital Careggi Department of Ophthalmology Firenze, Toscana, Italy
| | - Alessandra Scampoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit,Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University “Sacro Cuore”, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Abdul-Kadir MA, Lim LT. Update on surgical management of complex macular holes: a review. Int J Retina Vitreous 2021; 7:75. [PMID: 34930488 PMCID: PMC8686572 DOI: 10.1186/s40942-021-00350-4] [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: 04/29/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.
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Affiliation(s)
| | - Lik Thai Lim
- Department of Ophthalmology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
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Caporossi T, Governatori L, Verdina T, Rizzo S. Human amniotic membrane for failed macular hole. A case of initial unsuccessful outcome that resolved after amniotic membrane exchange. Eur J Ophthalmol 2021; 32:11206721211058996. [PMID: 34779681 DOI: 10.1177/11206721211058996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We described a case of initial unsuccessful outcome of failed macular hole treated with amniotic membrane, that resolved after amniotic membrane exchange and silicone oil injection. CASE DESCRIPTION a woman affected by a high myopic macular hole that had failed to close after multiple surgeries, had been treated using an amniotic membrane graft and 20% sulfur hexafluoride but, after the gas reabsorption, the macular hole was still open, and the amnioticmembrane. A second surgery with a second amniotic membrane patch and silicone oil was carried out. Two weeks after the procedure the macular hole closed, and the final visual acuity improved from 20/400 to 20/100. CONCLUSIONS In this case, a second surgery, using a new amniotic membrane graft and a longer-lasting endotamponade, closed the hole and improved the visual acuity.
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Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, 96983Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy
| | - Lorenzo Governatori
- Department of Neurofarba, Ophthalmology, 9300University of Florence, Florence, Italy
| | - Tommaso Verdina
- Institute of Ophthalmology, 9306University of Modena and Reggio Emilia, Modena, Italy
| | - Stanislao Rizzo
- Department of Ophthalmology, 96983Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy
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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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Park SM, Kim JW, Kim CG, Lee DW, Yoo SJ, Cho HJ, Kim JH. Long-term Clinical Outcomes of Macular Hole Surgery Using Internal Limiting Membrane Flap or Insertion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.3.329] [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]
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