Macular Hole Closure Research Articles

Intraoperative closure of large full thickness macular holes with perfluorocarbon liquid.

To report the role of perfluorocarbon liquid (PFCL) and passive extrusion for management of large full thickness macular holes (FTMHs). A standard pars plana vitrectomy with induction of posterior vitreous detachment was performed for all patients. After internal limiting membrane (ILM) peel, a bubble of perfluorocarbon liquid (PFCL) was injected over the posterior pole and passive extrusion of fluid was performed with a backflush instrument below the PFCL bubble, without touching the FTMH edges, until the FTMH centre was reached. Intraoperative optical coherence tomography (OCT) showed formation of an inner retina roof in all cases and confirmed intraoperative FTMH closure. Complete PFCL removal was performed after fluid-air exchange and gas tamponade was utilised in all cases. Preoperative FTMH mean aperture size was 761um and standard deviation (SD) 100um (range 682-918um). FTMH closure was achieved in all eyes and visualised intraoperatively with OCT. After an average follow-up of 2 months, there was improvement in the mean BCVA and central scotoma. FTMH closure can be achieved intraoperatively with the use of PFCL and passive extrusion. The described surgical technique could be a valid alternative for repair of large FTMHs.

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap.

To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.

Duration of face down positioning following full-thickness macular hole repair: A protocol for a randomized pilot study.

Full-thickness macular holes (FTMH) are defects in the fovea involving all neural retinal layers. They reduce patients' visual acuity (VA) and impact their quality of life. FTMHs are repaired with pars plana vitrectomy (PPV) with intraocular gas tamponade and post-operative face-down positioning (FDP). There is no consensus regarding the ideal positioning requirements following FTMH repair and there lacks clear guidelines on the topic. While analysis of global practice patterns indicates that between 5-7 days is the most common duration suggested by surgeons, there is significant heterogeneity in surgeon preferences. There is, however, biological plausibility to support minimal or even no FDP following surgery and given the disabling nature of FDP for patients, there is a need to better assess key patient outcomes with different FDP durations. As such, this prospective randomized controlled pilot trial will compare 3-days of FDP to 7-days of FDP following PPV for FTMH. This single-centered, parallel-group randomized controlled pilot trial will randomize patients 1:1 following PPV to 3 days or 7 days of FDP. This investigation has been approved by the local ethics board (HiREB # 16100) and has been registered on clinicaltrials.gov (NCT06000111). The primary objective will be focused on assessing the feasibility of a larger trial; this will be determined through an assessment of the recruitment rate, retention rate, completion rate and recruitment time. The secondary outcomes involve assessment of the following patient-important outcomes a) macular hole closure rate, b) best-recorded VA, c) a general quality of life measure and vision-specific quality of life measure, d) patient compliance and e) complication rates. Outcomes will be evaluated at 3 months following surgery. The results of this pilot study will determine the feasibility of a larger-scale trial that will answer a patient important question with clinical equipoise.

Comparative analysis of internal limiting membrane peeling versus internal limiting membrane flap insertion for treating idiopathic macular holes

ObjectiveTo evaluate the clinical efficacy of internal limiting membrane (ILM) peeling combined with perimacular hole massage versus ILM flap insertion in the management of patients with idiopathic macular holes was conducted. Methods35 patients (total of 35 eyes) with idiopathic macular holes (with hole diameters ranging from 366 to 1430 μm) were divided into two groups—Group A consisted of 20 eyes that underwent pars plana vitrectomy (PPV) combined with ILM peeling and perimacular hole massage, while Group B comprised 15 eyes that underwent PPV combined with ILM flap insertion. Subsequent follow-up examinations were performed at 1 week, 1 month, and 3 months post-surgery. The study also involved a comparison of best corrected visual acuity (BCVA) and optical coherence tomography (OCT) classifications between both the patient groups. ResultsThe macular hole closure rates in Group A were 60 %, while in Group B, the closure rate was 93 %. There was significant difference in hiatus healing rate between the two groups (t = 4.843, p = 0.048). The difference in BCVA at 3 months post-operation between the two groups was statistically significant (t = 3.221, p = 0.003). Three months post-operatively, the BCVA in Group B demonstrated improvement compared to the pre-operative BCVA, with a statistically significant difference (p > 0.05). Three months post-operatively, the BCVA in Group A demonstrated improvement compared to the pre-operative BCVA, but this difference was not statistically significant (p > 0.05). ConclusionThe combination of PPV with ILM flap insertion demonstrates favorable therapeutic efficacy in the treatment of idiopathic macular holes, leading to improved visual acuity.

Combined retinal massage and autologous blood covering for persistent macular holes after vitrectomy in high myopia.

To evaluate the efficacy of retinal massage combined with autologous blood covering in the treatment of persistent macular holes following vitrectomy in eyes with high myopia. Retrospective, consecutive case series in a tertiary eye center. A total of 12 highly myopic eyes with persistent macular holes after vitrectomy and internal limiting membrane peeling received combined retinal massage, air/fluid exchange, autologous blood covering, and gas/silicone oil tamponade. Best-corrected visual acuity, axial length, and optical coherence tomographic images before and after the treatment were compared. The mean hole diameter before this intervention was 931.58 ± 244.58 Symbolm (range, 508-1270), and the axial length was 30.39 ± 2.13 mm (range, 27.08-34.64). During the 6-month follow-up period, hole closure was achieved in eight eyes (66.67%). The mean best-corrected visual acuity improved significantly from 1.40 ± 0.50 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.10 ± 0.30 logMAR (P < 0.05). No complications were observed. Combined retinal massage and autologous blood covering, which is easy to manipulate, can promote the closure of persistent macular holes after vitrectomy and improve vision in high myopia with an axial length less than 29 mm.

Inverted flap technique versus internal limiting membrane insertion for macular hole in eyes with extremely high myopia

BackgroundTo compare the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique and ILM insertion for macular hole (MH) without retinal detachment in eyes with extremely high myopia.MethodsIn this retrospective study, we analyzed 22 eyes with an axial length ≥ 30.0 mm that had underwent MH surgery between April 2015 and August 2021. The surgical procedures involved either an inverted ILM flap or ILM insertion. The outcomes were compared between the two techniques. Closure of the MH was confirmed by optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) was measured before and after surgery. Associated complications were documented.ResultsThe median of axial length was 30.64 mm (range, 30.0-34.42). The MH closed in 100% (22/22) eyes and did not recur with a median follow-up of 12.5 months. For the inverted ILM flap technique, the median BCVA improved significantly from 0.80 logarithm of the minimum angle of resolution (logMAR) (range, 0.40-2.00) before surgery to 0.70 logMAR (range, 0.09–1.52) after surgery (p = 0.002). In addition, the median of final BCVA was better for the inverted ILM flap than ILM insertion (0.7 logMAR V.S. 1.00 logMAR; p = 0.016).ConclusionsIn eyes with extremely high myopia, despite comparable effects on MH closure for both ILM insertion and the inverted ILM flap, the later technique achieved significantly better visual outcomes.

Improving Organizational Medical Care for Patients with Idiopathic Macular Hole: Impact on Quality of Life and Effectiveness of Modern Treatment Protocols

Background: IMH causes loss of central vision and it restricts the activities of a patient, therefore posing a threat to the patient’s quality of life. Modern developments in surgical interventions as well as the organization of medical care enhance the effectiveness of treatment while a detailed analysis of it is needed.Objective: Consequently, the purpose of this particular research is to examine organizational medical care among the specified population of patients with IMH, in regard to their quality of life and the efficacy of contemporary treatment regimens.Methods: To accomplish this, the current study applied narrative synthesis strategies and reviewed literature on IMH diagnosis, management for surgical solutions, and patient outcomes. This assessment encompassed previous and current therapy methods together with patient enlightenment and follow-up with impact on vision clarity and general quotient.Results: From the current review, it was evident that surgeons are now using facilities such as small-gauge vitrectomy and pharmaceutical substances including ocriplasmin, which enhance macular hole closure rates and near visual acuity levels. Teaching has been done to patients/clients and organized follow-ups as part of the organizational care to improve quality of life as perceived by patients from follow-up questionnaires representing a significant improvement in visual function and activities.Conclusion: This paper outlines that patients with IMH require a structured and coordinated, cross-professional approach to its management in conjunction with contemporary surgery revealing drastic enhancements to visual acuity levels and the overall wellbeing of a patient

COMPLEX MACULAR HOLE CLOSURE BY TEMPORAL INTERNAL LIMITING MEMBRANE FLAP WITHOUT ENDOTAMPONADE.

To evaluate the safety, efficacy, and imaging features of a novel surgical technique without endotamponade in repairing complex macular hole (MH). Retrospective review of consecutive cases with complex MH underwent pars plana vitrectomy with temporal internal limiting membrane flap, which was stabilized using perfluorocarbon liquid and viscoelastics. At the conclusion of surgery, perfluorocarbon liquid was removed, and no endotamponade agent would be used. Complex MH was defined as a basal linear diameter of ≥400 µm and/or associated with high myopia. Visual acuity, pattern of MH closure on optical coherence tomography, formation of epiretinal membrane, and operative complications were reported. Twenty-four eyes were included, and the mean basal linear diameter was 988.3 µm. MH closure was achieved in 24 (100%), of which, 8 (33%) achieved type 1A closure. The mean postoperative logarithm of the minimum angle of resolution visual acuity improved from 0.93 at baseline to 0.74, 0.51, 0.55, and 0.52 at 1-month, 3-month, 6-month, and last follow-up, respectively. Foveal gliosis was observed in 3 eyes (12.5%), and 10 (41.7%) developed nasal epiretinal membrane. One eye developed vitreous hemorrhage, which resolved spontaneously. This novel surgical technique that requires no endotamponade is effective in achieving complex MH closure. A substantial proportion of patients developed epiretinal membrane, and its clinical significance requires further investigation.

OPTICAL COHERENCE TOMOGRAPHY FEATURES ASSOCIATED WITH VITREOMACULAR TRACTION RELEASE AND MACULAR HOLE SIZE PROGRESSION FOLLOWING TREATMENT WITH OCRIPLASMIN.

To evaluate OCT features for vitreomacular traction (VMT) release and change in macular hole (MH) size after treatment with ocriplasmin. Patients who had undergone treatment with ocriplasmin for VMT with or without MH ≤400 µm were included. The main outcomes were VMT release and changes in minimum linear diameter MH size at 4 weeks in MHs that persisted. OCT features evaluated were central retinal thickness, vitreomacular adhesion length, posterior vitreous cortex (PVC) insertion angles 500 µm from the insertion points, and minimum linear diameter size. Sixty patients were included: 37 had isolated VMT and 23 VMT with a MH. Four weeks after ocriplasmin injection, the overall VMT release rate was 66.7% (40/60); 64.9% (24/37) in eyes with isolated VMT and 69.6% (16/23) in eyes with MH. VMT release was associated with younger age (P = 0.02). Macular hole closure was achieved in 26.1% (6/23) and was associated with a smaller ratio of the temporal to the nasal PVC angle (P < 0.01). Of the 17 persistent MHs, 76.5% (13/17) increased in minimum linear diameter size from baseline 186 (±78) to 358 (±133) µm (P < 0.001). Progression in minimum linear diameter size showed a negative linear association with the size of the nasal PVC angle (R2 = 0.39, P = 0.002) and a positive linear association with the ratio of the temporal to nasal PVC angle (R2 = 0.39, P = 0.002). In patients with VMT-associated MHs, the risk of MH enlargement following ocriplasmin is negatively correlated with the nasal PVC angle size and is increased if the ratio of the temporal to nasal angle is >1.

Spontaneous Closure of a Full-Thickness Macular Hole

Spontaneous Closure of a Full-Thickness Macular Hole

Clinical evidence of autologous platelet-rich plasma as treatment in macular holes

Abstract Background: A prospective observational study was conducted with the purpose of evaluating the role of autologous platelet-rich plasma (PRP) in the form of a clot as an adjunct in surgery for the closure of large full-thickness macular holes (&gt;400 μm). Methodology: Thirteen patients with a diagnosis of full-thickness macular hole larger than 400 μm, without associated pathologies or previous vitreoretinal surgeries, were selected. Each patient underwent a complete ophthalmological evaluation, including visual acuity (uncorrected or best corrected), optical coherence tomography (OCT Optovue), and in some cases, retinal photographs. On the day of the procedure, blood samples were taken to prepare PRP and form a clot according to institutional protocol. Patients were followed for 1 year with periodic evaluations that included OCT, retinal photographs, and assessments by a retina specialist and optometry. Results: Of the 13 patients, 46% (6 cases) had an epiretinal membrane as the triggering factor for the macular hole and 54% (7 cases) had vitreomacular traction. Complete closure of the macular hole was achieved in 92.31% (12 cases) and partial closure in 7.69% (1 case). Postoperative best-corrected visual acuity ranged from 20/30 to 20/200 according to the Snellen chart. No patient experienced a deterioration in visual acuity after the procedure. Conclusions: The use of PRP as an adjunct treatment for macular hole surgery in patients without previous vitreoretinal surgeries has proven to be effective in achieving complete or partial closure in a high percentage of cases. Pre-and postoperative changes in visual acuity, hole size, and type of closure provide valuable information on the efficacy of PRP treatment in these patients.

Spontaneous closure of macular holes in children

AIM: This study aimed to analyze clinical cases of spontaneous macular hole (MH) closure in children and determine the optimal approach for managing patients with this disease. MATERIAL AND METHODS: Data from 32 patients aged 6–17 years (average: 11.3 years) were evaluated, including 32 eyes with a full thickness macular hole and 1 eye with a lamellar macular hole. All patients were treated in the Department of Pediatric Ocular Pathology of the Helmholtz National Medical Research Center of Eye Diseases in 2013–2023. They underwent a comprehensive ophthalmological examination, including optical coherence tomography (OCT) of the macular area. RESULTS: Spontaneous MH closure was observed in five eyes (15.2%) of five patients (15.6%). The etiological factor of the disease was ocular contusion in two cases, photodamage in one case, and an inflammatory process in the posterior segment of the eye in two cases. A small diameter MH (100–261 µm) and its overgrowth soon after formation were common to all patients, that is, less than 2 months in 3 of 5 children and within 6 months in all patients. CONCLUSION: Spontaneous closure of MH with a small diameter and in the early stages after its formation is rare in pediatric patients. For MH with a diameter of up to 200 µm according to OCT and the absence of other indications for surgical treatment, a wait-and-see approach for 3 months with regular (once a month) examination is recommended. In cases with MH closure tendency, continued follow-up is crucial; if it persists after 3 months or increases at any period of follow-up, surgical treatment is indicated.

A Surgical Approach for Managing Refractory Macular Holes Using the Human Amniotic Membrane Patch Technique.

To introduce a novel surgical technique using the human amniotic membrane (hAM) patch technique to address refractory macular holes (MHs). After vitrectomy, the hAM patch was positioned on top of the MH with the chorion side facing downward. Viscoat (Alcon Laboratories) was applied on top of the hAM patch for better fixation. Fluid-air exchange was then performed and 20% SF6 or 10% C3F8 tamponade was administered after the surgery. Five patients with refractory MHs larger than 400 µm underwent the hAM patch technique. After a minimum 2-year follow-up, results showed 100% closure of MHs, 80% improvement in visual acuity, and a notable enhancement in best-corrected logMAR visual acuity from 0.98 to 0.72 (P = 0.039). Dislocation of hAM patch occurred among 3 out of 5 patients (60%). The hAM patch technique appears to be a promising approach for addressing refractory MHs. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Comparative Efficacy of Posterior Subtenon Kenacort Compared to Standard Surgical Treatment for Macular Hole Closure

Background: Macular holes cause significant vision loss, particularly in older adults. Although standard surgical treatment (SDT) has been successful, there is increasing interest in less invasive treatments that might offer better outcomes, especially in terms of best-corrected visual acuity (BCVA) and macular hole closure. Objective: This study aimed to determine the effectiveness of posterior subtenon Kenacort (SBT) in closing macular holes and to compare its efficacy with standard surgical treatment (SDT). Additionally, the study examined the impact of macular hole classification on treatment outcomes in both groups. Methods: An interventional study was conducted at Al-Shifa Trust Eye Hospital in Rawalpindi, involving 60 subjects aged 45 to 65 years with idiopathic macular holes. Participants were selected using non-probability sampling. Group A (30 eyes) received two SBT injections three months apart, while Group B (30 eyes) underwent SDT, which included pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. OCT imaging and logarithm of the minimum angle of resolution (LogMAR) measurements were obtained for all subjects before treatment, with follow-up assessments conducted six months post-treatment. Data analysis was performed using SPSS version 25.0, with quantitative variables expressed as mean ± SD and inferential statistics explored using ANOVA and paired sample t-tests. A p-value ≤ 0.05 was considered statistically significant. Results: Both treatment groups had thirty patients each with similar average macular hole sizes (SBT: 436 ± 126 µm, SDT: 439 ± 127 µm). In the SBT group, average BCVA improved from 1.48 to 0.846, while in the SDT group, it changed from 1.44 to 1.25. Macular hole classification significantly affected post-treatment BCVA scores in both groups (p &lt; 0.001). The SBT group showed significantly greater BCVA improvement compared to the SDT group. Conclusion: Posterior subtenon Kenacort effectively closed macular holes and improved BCVA more than standard surgical treatment. Macular hole classification influenced post-treatment BCVA scores in both treatment groups, highlighting its importance in predicting treatment outcomes.

Enhancing Inverted Internal Limiting Membrane Flap Stability in Macular Hole Retinal Detachment by the "Viscoelastic Agent Pool" Technique.

To evaluate the surgical, anatomical, and functional results of "viscoelastic agent pool" technique-assisted stability of inverted internal limiting membrane flap in macular hole retinal detachment. The innovative surgical technique was performed on 10 patients with macular hole retinal detachment. The primary outcomes included best-corrected visual acuity after surgery, rate of closure of macular hole, retinal reattachment, and occurrence of complications. The mean age of the individuals was 67.70 ± 8.75 (range, 55-84) years; mean axial length, 29.34 ± 1.53 (range, 27.10-30.93) mm; mean corrected MH diameter, 685.30± 345.65 (range, 172-1,325) µ m; and average follow-up period, 6.01 ± 1.71 (range, 3.10-8.4) months. In 6 eyes (60%), the postoperative best-corrected visual acuity showed improvement. All patients had macular hole closure, and the retinal reattachment rate was 100%. No postoperative complications were noted. The "viscoelastic agent pool" technique, an innovative surgical approach designed to enhance the stability of the internal limiting membrane flap, serves as an effective adjunctive procedure for the inverted internal limiting membrane flap technique. It presents a viable option for patients with macular hole retinal detachment.

Delayed Closure of Macular Hole with an Internal Limiting Membrane Flap After Intravitreal Triamcinolone Acetonide Injection: Case Report

Delayed Closure of Macular Hole with an Internal Limiting Membrane Flap After Intravitreal Triamcinolone Acetonide Injection: Case Report

Duration after Macular Hole Surgery for Stabilisation of Visual Acuity: A Long-term Retrospective Review

The purpose of the study is to determine the median duration for visual recovery to achieve visual stability and visual acuity gain after macular hole surgery in our local population. This was a retrospective study. Patients with full-thickness macular holes (FTMH) from surgical logs were included between January 2009 and December 2019. The patients' medical records were reviewed for pre-, intra-, and post-operative data collection. Patients who fulfilled the inclusion and exclusion criteria were recruited and analysed. Data collected from the medical record pre-operatively, which included baseline best corrected visual acuity (BCVA), interval of symptoms development to surgery, any ocular co-morbidities, optical coherence tomography (OCT) for size and stage of macular hole and central subfield thickness (CST). Intra-operative notes included whether vitrectomy with or without phacoemulsification and with the internal limiting membrane (ILM) peel or ILM flaps, types of dye, and tamponade agent used. Post-operative data included BCVA and CST on each visit, types of macular hole closure, or any complications. Data were analysed using SPSS.Thirty-one patients were diagnosed with FTMH. Sixteen patients who underwent pars plana vitrectomy (PPV) were included and analysed. Fifteen patients (93.75%) achieved successful macular hole closure after the primary operation. The median duration BCVA reached at stability was 19.5 months (IQR 9 – 26.25), and visual acuity gained by 0.44 LogMAR (IQR 0.165 – 0.565). Ten patients (62.5%) underwent combined PPV with phacoemulsification. CST showed improvement from baseline, 444 (IQR 347.5 – 519.75) to 273 (IQR 232 -285.5), 230 (IQR 221.5-255), and 270 (IQR 254-322) at the period interval of 0 to 3 months, 3 to 6 months, and 6 to 12 months respectively. Gas C3F8 and membrane blue were commonly used as tamponade agents and dyes, and PPV with ILM peel was the common surgery performed. Six patients (40%) achieved type 1 macular hole closure within 12 months of follow-up. Despite the small sample size, our study provided practical information regarding patient’s expectations of when their vision can become stable after macula hole surgery in our local population.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Efficacy of inverted inner limiting membrane flap technique for macular holes of ≤400 μm: A systematic review and meta-analysis.

To evaluate the efficacy of inverted internal limiting membrane (ILM) flap technique in full-thickness macular holes (MHs) with a size of ≤400 μm compared to the ILM peeling technique. Related literatures that compared inverted ILM flap and ILM peeling in MHs ≤ 400 μm were reviewed by searching electronic databases including Pubmed, EMbase, ClinicalTrials.gov, and Cochrane Library up to April 2023. The primary outcome measure was hole closure rate, and the secondary outcome measures were the mean postoperative best-corrected visual acuity (BCVA), retinal sensitivity, and outer status of the retinal layers, including the external limiting membrane and ellipsoid zone. The quality of the articles was assessed according to the revised version of the Cochrane risk-of-bias tool for randomized trials or the Newcastle-Ottawa scale. In the case of heterogeneity, a sensitivity analysis was conducted, and publication bias was visually evaluated using a funnel plot. This review included six studies with 610 eyes for the primary outcome and 385 eyes for the secondary outcomes, which were two randomized control trials and four retrospective studies. Pooled data revealed that the overall MH closure rate was 99.4% in the inverted ILM flap group and 96.2% in the ILM peeling group, without significant difference between the two groups (odds ratio = 3.91; 95% confidence interval, 0.82~18.69; P = 0.09). The inverted ILM flap technique did not have a favorable effect on the BCVA, retinal sensitivity, or recovery of the outer retinal layers. These results were consistent with those of the subgroup analysis of the different follow-up periods. No significant publication bias was observed. In eyes with MHs of ≤400 μm, both techniques demonstrated excellent surgical outcomes without significant differences. Therefore, surgical techniques can be selected according to surgeon preferences.

Relationship between lymphocytes and idiopathic macular hole

BackgroundAn idiopathic macular hole (IMH) is a full-thickness anatomic defect extending from the internal limiting membrane to the photoreceptor layer of the macula without any known cause. Recently, clinical laboratory markers of systemic inflammatory status derived from complete blood counts have been evaluated in ocular diseases. This study aimed to explore whether they could predict the development and progression of IMHs.MethodsA retrospective review of 36 patients with IMH and 36 sex-and-age-matched patients with cataracts was conducted. We collected complete blood counts of all participating individuals and calculated systemic immunoinflammatory indicators. The maximum base diameter of the IMH (BD), minimum diameter of the IMH (MIN), height of the IMH (H), area of the intraretinal cyst (IRC), and curve lengths of the detached photoreceptor arms were measured on optical coherence tomography (OCT) images. We used these values to calculate the macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI), hole form factor (HFF), and macular hole closure index (MHCI). We performed a receiver operating characteristic (ROC) curve analysis of 30 patients with IMH who were followed up 1 month after surgery.ResultsLymphocyte counts were significantly higher in the IMH group. No other significant differences were observed between the IMH and control groups. Lymphocyte counts in the IMH group were significantly negatively correlated with MIN and BD and were significantly positively correlated with MHI, THI, and MHCI. However, lymphocyte counts were not significantly correlated with H, IRC, DHI, and HFF. In the ROC analysis, BD, MIN, MHI, THI, and MHCI were significant predictors of anatomical outcomes. According to the cut-off points of the ROC analysis, lymphocyte counts were compared between the above-cut-off and below-cut-off groups. Lymphocyte counts were significantly higher in the MIN ≤ 499.61 μm, MHI ≥ 0.47, THI ≥ 1.2, and MHCI ≥ 0.81 groups. There were no significant differences between the above-cut-off and below-cut-off BD groups.ConclusionsAlthough inflammation may not be an initiating factor, it may be involved in IMH formation. Lymphocytes may play a relatively important role in tissue repair during the developmental and postoperative recovery phases of IMH.