Ellipsoid Zone Defect Research Articles

The Ellipsoid Zone Is a Structural Biomarker for Visual Outcomes in Diabetic Macular Edema and Macular Hole Management

Objectives: The goal was to study the ellipsoid zone (EZ) as a structural biomarker for final visual outcomes after pharmacological intervention in center-involving diabetic macular edema (DME) and surgical intervention for full-thickness macular holes (FTMHs). Methods: This was a tertiary care center-based retrospective study. After sample size calculations, data from 64 consecutive cases were collected, with subjects aged between 40 and 60 years. Thirty-two cases of DME with anti-vascular endothelial growth factor (VEGF) therapy and 32 cases of FTMHs with successful macular hole surgery (MHS) were studied. Spectral-domain optical coherence tomography (SD-OCT) data were collected. Measurements of EZ defects documented at the time of presentation and 12 weeks after intervention were analyzed using the caliper function of the machine. EZ restoration was graded, and a Pearson correlation analysis was performed. Results: Mean logMAR VA decreased after intravitreal therapy (IVT) from 1.12 ± 0.22 pre-intervention to 0.81 ± 0.41 post-intervention and after MHS, from 1.05 + 0.25 to 0.62 + 0.11 (p < 0.001). EZ disruption reduced from 73.4% to 19.4% after IVT and from 67% to 19.3% after MHS. DME and MHS postoperative visual acuity and residual EZ defect were observed to have a statistically significant linear correlation (r = 0.794, p < 0.001 and r = 0.894, p < 0.001, respectively). The EZ was found to be an excellent structural biomarker for final BCVA (area under curve = 0.95 for DME and 1.00 for MHS). Conclusion: Notable EZ restoration results were obtained from pharmacological and surgical interventions. The EZ proves to be a critical structural biomarker for predicting visual outcomes in center-involving DME and MHS.

Development and preliminary evaluation of a novel preoperative index for quantitative analysis of photoreceptor loss in full-thickness macular holes.

To identify novel quantitative parameters for evaluating photoreceptor loss in full-thickness macular holes (FTMH), exploring their potential clinical impact on postoperative functional and anatomical recovery. This pilot study enrolled 38 eyes from 38 patients diagnosed with FTMH. Preoperatively, eyes underwent analysis and were subsequently followed for six months post-surgery. Best-corrected visual acuity (BCVA) was recorded, and cross-sectional images of FTMH were obtained using B-scan optical coherence tomography (OCT) and en-face OCT. Quantitative assessment of ellipsoid zone (EZ) and external limiting membrane (ELM) integrity changes was conducted and correlated with postoperative anatomical and functional recovery. The photoreceptor Integrity Index (PIIN), calculated as the ratio of photoreceptor area to lumen hole area measured at customized segmentation, was correlated with the minimum and base diameters of the hole, positive change in BCVA, preoperative EZ defect (EZd), preoperative ELM defect (ELMd), and changes in EZ and ELM over the six-month follow-up period (∆-EZ and ∆-ELM). The main outcome measures focused on evaluating the effectiveness of PIIN in predicting postoperative anatomical and functional changes. A higher PIIN correlated with a greater BCVA change over six months (p < 0.001). Univariate regression analysis using the PIIN as a predictor for positive change in BCVA (|∆-BCVA| [logMAR]) over time yielded significant results (p < 0.001). Additionally, the PIIN significantly correlated with EZd at baseline, ELM at baseline, and ELMd change over the six-month follow-up period. The PIIN shows promise as a tool for evaluating photoreceptor loss in macular holes and estimating postoperative functional and anatomical recovery. What is known Previous studies have extensively used optical coherence tomography (OCT) to investigate various biomarkers for assessing patients with full-thickness macular hole (FTMH), without considering detailed MH ultrastructural features Existing indexes used to predict surgical outcomes for FTMH primarily depend on geometrical parameters and do not integrate detailed ultrastructural characteristics, such as cellular components. What is new A novel concept introduces the quantitative measurement of residual photoreceptors located at the edge of FTMH. The Photoreceptor Integrity Index (PIIN) integrates different ultrastructural components of macular holes, aiming to become a valuable clinical tool to predict both anatomical and functional recovery outcomes following surgical intervention for FTMH.

Analysis of Henle's fiber layer and outer retinal layers in cone dystrophy.

To evaluate Henle's Fiber Layer (HFL) thickness and volume parameters in patients with cone photoreceptor atrophy with directional optical coherence tomography (D-OCT). Macular 20°×20° standard and D-OCT images were acquired from patients diagnosed with hereditary cone dystrophy with evident foveal ellipsoid zone defect in OCT, and age-matched healthy controls. Thickness and volume parameters of HFL, outer nuclear layer (ONL) and retinal layers between ellipsoid zone and Bruch membrane complex (EZ-BM) were calculated from manual segmentation through D-OCT images and comparative analysis is performed. Twelve eyes of 6 patients were compared to 12 eyes of 6 age-matched healthy controls (mean age: 29.5±16.6 and 26.6±3.9 years respectively; P=0.162). Patients had lower total HFL volume (0.45±0.03 and 0.85±0.15 mm3; P<0.001) and mean HFL thickness (16.1±1.1 and 30.1±5.3 µm; P<0.001) than healthy controls. Central subfield, parafoveal and perifoveal ETDRS zone HFL parameters in patients were significantly lower than healthy controls. A centrifugal correlation was found between central ONL and the corresponding parafoveal HFL (Spearman's rho: 0.785; P<0.001). HFL assessment might be a useful OCT biomarker in patients with cone photoreceptor atrophy. HFL thinning is observed in foveal, parafoveal and perifoveal areas of patients with cone photoreceptor atrophy, while volume reduction in ONL and EZ-BM components were limited to central and parafoveal zones.

Функциональное восстановление фовеа после хирургического лечения сквозных макулярных разрывов: роль отдельных изменений морфологии и перфузии сетчатки в послеоперационном периоде

Purpose. To evaluate the relationship between changes in functional and structural indicators, indicators of retinal perfusion in the fovea after surgery of full-thickness macular holes (FTMH). Material and methods. A prospective study was conducted on 62 patients (62 eyes) with FTMH stages 1–4 who underwent surgical treatment. We studied BCVA, retinal sensitivity (RS) at fixation point (FP), the fixation zone area, the amplitude and implicit time of P1 at FP, the thickness of the macular complex of ganglion cells (mcGC), the ellipsoid zone (EZ) defect area, the foveal avascular zone (FAZ) area and vessel density in the superficial and deep capillary plexuses (SCP and DCP). The correlation of indicator changes in the period from the preoperative examination to 6 months after treatment and in the period from 1 to 6 months after treatment was studied. Results. Changes in BCVA in the period from the preoperative examination to 6 months after surgery significantly correlated with changes in mcGC thickness (R=0.39, p=0.004), EZ defect area (R= –029, p=0.001) and SCP and DCP vessel density (R=0.35 and R=0.29, p=0.002); RS changes at FP correlated with the changes in EZ defect area (R= –0.31, p=0.001), and P1 amplitude with the change in the EZ defect area (R= –0.34, p=0.001) and vessel density in DCP (R= –0.29, p=0.001). In the period from 1 to 6 months after closure of the FTMH, a more significant correlation of changes in BCVA, RS and P1 amplitude of mentioned above indicators was observed. Conclusion. Processes of functional restoration of the fovea after surgery of FTMH for at least 6 months is influenced by changes in such indicators as the mcGC thickness, the EZ defect area, and vessel density of SCP and DCP. In the late postoperative period, the importance of postoperative changes in retinal perfusion increases. Key words: Full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

Retinal photoreceptor ellipsoid zone is a structural biomarker for visual outcome after successful macular hole surgery: A novel grading system-based study.

To develop a novel external limiting membrane (ELM) and ellipsoid zone (EZ) restoration-based grading system after successful macular hole surgery (MHS) and to evaluate EZ as a structural biomarker for the final visual outcome. In a tertiary care center-based retrospective study, 34 consecutive cases of successful MHS for full-thickness macular holes (FTMHs) were included. Spectral domain optical coherence tomography (SD-OCT) cross-sectional analysis was performed on preoperative and postoperative data of weeks 1, 4, 12, and 24, respectively. Sequential measurements of FTMH size, ELM and EZ defect were performed using the caliper function of SD-OCT. MHS was uniquely graded as grade 0: persistence of ELM and EZ defect; grade 1: partial or complete restoration of ELM with shortening of EZ defect; and grade 2: complete restoration of ELM and EZ. Data were statistically analyzed on Statistical Package for the Social Sciences software-version 24. MHS was graded as grade 0 (n = 8), grade 1 (n = 15), and grade 2 (n = 11). Best corrected visual activity (BCVA) was found to be 1.13 ± 0.19 in grade 0, 0.59 ± 0.09 in grade 1, and 0.26 ± 0.06 in grade 2. One-way analysis of variance showed improvement in final BCVA among the three grades (P < 0.001) Postoperative visual acuity and residual EZ defect had a statistically significant linear correlation (r = 0.899, P < 0.001). EZ was found to be an excellent structural biomarker for final BCVA (area under the curve = 0.99). Successful MHS is associated with better visual outcomes in eyes with restored EZ. ELM restoration preceded EZ regeneration. MHS novel grading system is physician friendly, incorporates pathoanatomic aspects, and correlates well with visual outcomes.

Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials

BackgroundMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.MethodsWe searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsFour RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: −0.16, 0.23; P = 0.70 and SMD: −0.167; 95%CI: −1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups’ EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27).ConclusionMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.

The long-term outcome of eyes with unexplained visual loss after gas tamponade for macula-on retinal detachment.

To analyze the long-term outcome of eyes suffering from unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment (RRD). Cross-sectional analysis of all eyes with macula-on RRD experiencing an unexplained loss of vision after gas reabsorption that were treated and followed from 2010 to 2019. The investigational work-up included: best-corrected visual acuity (BCVA), clinical examination, spectral-domain optical coherence tomography (SD-OCT) and automated computerized perimetry. The 9 eyes of the 9 patients were analyzed after 5.9±2.4 years. BCVA improved by 0.54±0.50 logMAR from baseline, achieving a final value of 1.17±0.52 logMAR (∼20/320; p=0.0115). The thicknesses of the macula, of the macular ganglion cells and of the retinal nerve fiber layers were unchanged compared to the baseline, as well as the rate of ellipsoid zone defects (22.2%). The proportion of eyes with microcystoid macular edema (MME) significantly decreased to 44.4% (p=0.0294). Perimetry mean deviation increased from a baseline value of -18.06±2.72 to -17.23±2.29 dB (p=0.0390), with an unchanged pattern standard deviation (p=0.1289). In general, a reduction of the scotomata relative depth from baseline was evident in all eyes. Eyes with macula-on RRD suffering from unexplained visual loss after gas reabsorption, despite disclosing an overall unchanged structural macular morphology, showed a moderate, but significant, visual and perimetric improvement in the long-term.

Severe Recurrence and Retinal Inflammatory Infiltration After Cessation of Immunosuppression for Multifocal Choroiditis and Panuveitis.

To describe a severe recurrence of intraocular inflammation following the cessation of immunosuppression, previously administered for multifocal choroiditis and panuveitis (MCP). Retrospective chart review. A 27-year-old woman with MCP initially was treated with intravenous and oral corticosteroids and photodynamic therapy because of an active macular neovascularization in both eyes. Mycophenolate was soon started and the recurrences during tapering of the oral corticosteroids in the first months were treated with periocular corticosteroids and anti-vascular endothelial growth factor injections as they became available. After a decade of immunosuppression without recurrences, the patient, having relocated, discontinued mycophenolate upon the advice of a new ophthalmologist who diagnosed her with punctate inner choroidopathy. This led to a severe recurrence in both eyes, characterized by new inflammatory lesions, ellipsoid zone loss, and widespread inflammatory cell infiltration into the outer retina. Intravitreal triamcinolone injections resulted in the resolution of sub- and intraretinal inflammatory lesions and ellipsoid zone defects. The abrupt discontinuation of immunosuppression in a patient with MCP was associated with a rebound phenomenon, characterized by multi-level inflammatory activity in the posterior pole. This rebound phenomenon may offer clues as to the inflammatory targets in MCP.

Оценка изменения эллипсоидной зоны сетчатки до и после хирургического лечения сквозных макулярных разрывов

Relevance. Restoring the retinal integrity during surgical treatment of macular holes (MH) does not always guarantee a significant improvement in visual acuity in the postoperative period. The possibility of regeneration of the retinal ellipsoid zone (EZ), as well as the relationship between the structural restoration of the outer retina and the improvement of visual functions are very contradictory. Purpose. To assess the possibility and degree of repair of the ellipsoid zone in the early and long-term postoperative treatment of MH of medium and large diameters. Material and methods. A prospective study of 13 patients (13 eyes) – 12 women and 1 man with a MH of medium and large diameters was conducted. Patients were divided into 2 groups depending on the presence or absence of an EZ defect after 6 months postoperatively. The structure of the retina was evaluated according to OCT data and the visual acuity of patients in the distance before surgery, 1, 3 and 6 months after MR surgery. Results. In patients with complete restoration of retinal EZ, the initial size of the holes was 1.5 times smaller than in the comparison group, the time from the moment of diagnosis to surgery was 122.7±51.8 and 383.5±125.7 days, respectively. The defect of photoreceptors of the EZ by 1 month after surgery in patients of the first and second groups was 369.6±245.61 microns and 276.07±233.37 microns, respectively. By 6 months of follow–up in the first group, complete closure of the defect was observed, in the second group its decrease to 91.61±97.51 microns, while visual acuity in the first group was 0.46±0.83 by six months of followup and in 3 out of 5 cases it increased to 0.6–0.9, in the second group in all cases this indicator did not exceed 0.5. Conclusion. Complete regeneration of EZ was observed in 38.5% of cases 6 months after surgery, however, anatomical repair of the photoreceptor field of the macular area in the postoperative period does not guarantee improvement of visual functions in all patients. Key words: macular hole, ellipsoid zone, ellipsoid zone regeneration

Evaluation of Optic Disc, Retinal Vascular Structures, and Acircularity Index in Patients with Idiopathic Macular Telangiectasia Type 2.

We aimed to compare the retinal, optic disc vascular density (ODVD) values, and acircularity index (AI) of patients with idiopathic macular telangiectasia type 2 (IMT) and healthy individuals using the optical coherence tomography angiography (OCTA) device. The study included 39 patients with IMT and 37 healthy controls. The OCTA findings of the patients and controls were examined. The total, parafoveal and perifoveal vascular density of the superficial capillary plexus, choriocapillaris blood flow, inside-disc ODVD, retinal nerve fiber layer (RNFL), and retinal thicknesses were found to be statistically significantly lower, and the foveal avascular zone value was statistically significantly higher in the IMT group compared to the control group (p = 0.001, p = 0.01, p = 0.02, p = 0.01, p = 0.009, p = 0.002, p = 0.02, respectively). There was a statistically significant negative correlation between best-corrected visual acuity (BCVA) and AI (p = 0.02), and a statistically significant positive correlation between peripapillary vascular density and BCVA (p = 0.04). We consider that the lower retinal, choriocapillaris, ODVD values, and retinal and RNFL thicknesses in the patients with IMT compared to the controls were due to vascular damage, remodeling, fibrosis, proliferation, and Müller cell damage. Ellipsoid zone defect, AI, and peripapillary vascular density are important indicators in the evaluation of visual acuity in these patients.

Lamellar macular defects: are degenerative lamellar macular holes truly degenerative?

To investigate morpho-functional changes after surgical treatment for ERM foveoschisis or lamellar macular hole (LMH), and to evaluate whether the two entities are associated with different healing processes and long-term outcomes. Retrospective interventional case series. A total of 56 eyes, treated for lamellar macular defects and followed up for 24 months, were enrolled. The eyes were divided into two groups: 34 with ERM foveoschisis and 22 with LMH. Changes in the following features were evaluated and compared between the two groups: best-corrected visual acuity (BCVA), external limiting membrane (ELM) and ellipsoid zone (EZ) defects, central foveal thickness (CFT), and autofluorescence (FAF) diameter and area. After surgery, progressive BCVA improvement was observed with no significant difference between the two groups (p-value: 0.06). An increased number of eyes with intact outer-retinal layers was found both in the ERM foveoschisis and LMH groups. FAF diameter and area decreased significantly throughout the FU with no significant difference between the two groups (p-value: 0.2). In the present study, significant functional and microstructural improvements were observed after surgery for both ERM foveoschisis and LMH, demonstrating considerable repair potential in both types of lamellar defects. These findings question the true "degenerative" nature of LMH.

Relation of interdigitation zone changes and right-angle vessels in Macular Telangiectasia Type-2 (MacTel).

To study the relation between interdigitation zone (IDZ) and right-angle vessel (RAV) in Macular Telangiectasia Type-2 (MacTel). A total of 43 eyes of 38 patients with presence of definite RAV on colour fundus photograph (Gass and Blodi-only stage-3) were confirmed on multimodal imaging. The relation of IDZ changes and associated ellipsoid zone (EZ) alterations on spectral-domain optical coherence tomography (OCT) with RAV were studied at baseline and these OCT changes were followed up in 15 eyes over a mean of 3.86 years. A total of 58 RAVs were found in the 43 eyes and 53/58 (91.3%) RAVs were associated with IDZ alterations in 39 eyes. On follow-up, IDZ attenuation progressed to IDZ loss and subsequent EZ attenuation and loss. A pre-existing IDZ loss was associated with subsequent EZ defect (P = 0.002). In 36 eyes that had OCT angiography, eyes with RAV showed deep capillary plexus telangiectasia in all 36 (100%) eyes and 32/36 (89%) eyes showed IDZ changes with or without EZ loss. IDZ attenuation and/or loss are associated with RAV and may serve as predictor of EZ loss in MacTel.

Clinical Observation of Anatomical and Visual Outcomes of Macular Hole after Inverted Internal Limiting Membrane Flap in Patients with Idiopathic Macular.

To investigate anatomical and visual outcomes of macular hole (MH) after inverted internal limiting membrane (ILM) flap technique for idiopathic macular hole (IMH). A total of 13 IMH cases diagnosed in Shanxi Eye Hospital between January 2015 and June 2016 were included in the study. All patients underwent vitrectomy combined with indocyanine green-assisted inverted ILM flap technique. The MH closure rate, best-corrected visual acuity (BCVA), changes of ellipsoid zone (EZ), and external limiting membrane (ELM) were examined before operation and one, three, and six months after operation. Furthermore, 488 nm fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) were used to observe the dynamic changes in function of macular area after surgery. One month after the surgery, the MH closure rate was 100% and the visual acuity (VA) was stable, with no recurrence. Additionally, the average logMAR BCVA before operation was 1.208 ± 0.158, and this value became 0.877 ± 0.105 one month after the operation, showing a significant decrease. Three months after surgery, the average logMAR BCVA was 0.792 ± 0.103, which was significantly lower than the level one month after the surgery but much higher than that six months after surgery (0.708 ± 0.131). Besides, the diameter of the EZ defect of the postoperative one month, three months, and six months was (1377.46 ± 198.65) μm, (964.62 ± 336.26) μm, and (817.08 ± 442.99) μm, respectively. In postoperative one month, three months, and six months, the diameter of the ELM defect diameter was (969.62 ± 189.92) μm, (649.92 ± 413.15) μm, and (557.62 ± 412.50) μm, respectively. The diameter of both EZ and ELM defects was significantly reduced with the passage of time after surgery. Inverted ILM flap technique can reconstruct macular anatomical structure and improve VA. This technique is effective for the treatment of IMH with large MH minimum diameter and base diameter.

VOLUMETRIC ANALYSIS OF LAMELLAR MACULAR HOLE

To investigate the cavity of lamellar macular holes (LMH-CV) by using volumetric analysis of optical coherence tomography images. Single-center, retrospective, observational case series. The volume of the LMH-CV and epiretinal proliferation was determined. Best-corrected visual acuity, central macular thickness, maximum horizontal diameter and minimum horizontal diameter, and the presence of foveal bump and ellipsoid zone defect were noted. Forty-nine eyes of 46 patients (20 women) were included in the baseline analysis. The natural course group consisted of 25 patients (27 eyes) with a mean follow-up of 19.2 ± 15.7 months. The volume of LMH-CV was found to be a predictive factor for baseline best-corrected visual acuity (P = 0.038, ß-coefficient = 0.338, 95% CI: 0.275-8.893). Whereas no significant change at the last visit was observed in central macular thickness, minimum horizontal diameter, and maximum horizontal diameter, the LMH-CV and epiretinal proliferation volume increased significantly (P = 0.036, P < 0.001, respectively). Eyes with foveal bump had larger minimum horizontal diameter, maximum horizontal diameter, and LMH-CV volume (P = 0.008, P < 0.001, P = 0.024, respectively). Eyes with ellipsoid zone defect showed larger LMH-CV and epiretinal proliferation volume, but thinner central macular thickness (P = 0.038, P = 0.004, P = 0.012, respectively). Volumetric analysis of LMH-CV detects changes in the natural course of lamellar macular hole earlier than the measurement of horizontal diameters. Further studies will clarify whether volumetric analysis of the lamellar macular hole is useful as an additional biomarker in the management of lamellar macular hole.

Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Introduction: During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical significance of the photoreceptor outer segment disruption at the MH border remains unclear. This study aims to investigate the clinical features and surgical outcomes of MHs with photoreceptor outer segment disruption at the MH border. Methods: This study retrospectively reviewed 86 eyes from 85 patients who underwent vitrectomy combined with internal limiting membrane peeling for idiopathic MHs. Baseline and postoperative best-corrected visual acuity (BCVA) and foveal microstructure on optical coherence tomography images were compared between eyes with smooth and bumpy morphology, the latter of which was defined as those with an uneven and irregular surface with evident lumps and indentations at the MH border. Results: The bumpy morphology was identified in 59 of 86 eyes (68.9%). At baseline, eyes with a bumpy MH morphology had a significantly larger minimum linear diameter (p = 0.043), a longer external limiting membrane defect (p = 0.013), and a worse baseline BCVA (p = 0.017) than those with a smooth morphology. Postoperatively, in a multivariate regression model adjusting preoperative confounding effects, eyes with bumpy borders were associated with a longer ellipsoid zone defect (p = 0.006) and a thinner central fovea (p = 0.002) at 1 month, and a thinner central fovea (p = 0.005) and a worse BCVA (p = 0.015) at 10 months. Conclusion: A severe photoreceptor outer segment loss is common at the MH border, which represents a chronic pathogenic process and may be an independent predictor for an incomplete photoreceptor recovery and worse long-term visual outcomes after surgery.

Large hole in macular surgery

AbstractPurpose: To evaluate the anatomical and functional results in eyes with large macular holes using inverted flower ILM flap technique.Methods: This clinical study included 58 eyes with large macular holes, which were divided into 2 groups: first group included 36 eyes with idiopathic macular holes and second group – 22 eyes with myopic macular holes. In both groups diameter of the hole was more than 600 μm. All eyes were treated using an inverted flower flap technique, C3F8 gas tamponade and face‐down posturing. The hole closure, postoperative visual acuity and OCT data were analysed at 1 month and 6 month after the surgery.Results: The inverted flower ILM technique was successful in 100% of the cases. We could observe significant postoperative improvements of visual acuity (p &lt; 0.05) in all eyes. However, the first group showed better functional results compared to the second group. Complete resolution of ellipsoid zone defects was observed on 22 eyes (61.1%) in the first group and on 9 eyes (40.9%) in the myopic group.Conclusion: The inverted flower flap technique confirmed its effectiveness for the closure of large macular holes and good recovery of photoreceptor layers and, consequently, functional result improvement.

Large macular hole surgery using an inverted flower internal limiting membrane flap technique

AbstractPurpose: To evaluate the anatomical and functional results in eyes with large macular holes using inverted flower ILM flap technique.Methods: This clinical study included 58 eyes with large macular holes, which were divided into two groups: first group included 36 eyes with idiopathic macular holes and second group ‐ 22 eyes with myopic macular holes. In both groups, diameter of the hole was more than 600 μm. All eyes were treated using an inverted flower flap technique, C3F8 gas tamponade and face‐down posturing. The hole closure, postoperative visual acuity and OCT data were analysed at 1 and 6 month after the surgery.Results: The inverted flower ILM technique was successful in 100% of the cases. We could observe significant postoperative improvements of visual acuity (p &lt; 0.05) in all eyes. However, the first group showed better functional results compared to the second group. Complete resolution of ellipsoid zone defects was observed on 22 eyes (61.1%) in the first group and on 9 eyes (40.9%) in the myopic group.Conclusions: The inverted flower flap technique confirmed its effectiveness for the closure of large macular holes and good recovery of photoreceptor layers and, consequently, functional result improvement.

Comparative Study of Conventional Inverted ILM Flap Covering and ILM Flap Filling Technique in Idiopathic Macular Hole Treatment: A Meta-Analysis and Systematic Review.

Objective This meta-analysis was performed to evaluate the anatomical efficacy and functional improvement of the conventional inverted internal limiting membrane (ILM), flap covering technique, and ILM flap filling technique for patients with idiopathic macular hole (MH). Methods Literature from Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were comprehensively retrieved. The primary outcomes included the MH closure rate and postoperative best-corrected visual acuity (BCVA). The secondary outcomes were the proportion of external limiting membrane (ELM) and ellipsoid zone (EZ) defect recovery. Pooled odds ratios (ORs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated using STATA 17.0 software. Results 7 studies that contained 139 eyes in the inverted ILM flap covering group and 121 eyes in the ILM flap filling group were selected. Pooled data suggested that the surgical treatment resulted in an overall MH closure rate of up to 97.12% (135/139 eyes) in the inverted ILM flap covering group and 99.17% (120/121 eyes) in the filling group, with no significant difference between the 2 groups (OR = 1.98, 95% CI: 0.55 to 7.09, and P=0.29). Similarly, the 2 techniques demonstrated equal effectiveness on the anatomical closure in MH with the average diameter smaller than 650 μm (OR = 2.17, 95% CI: 0.48 to 9.77, and P=0.31) and larger than 650 μm (OR = 1.58, 95% CI: 0.14 to 17.37, and P=0.71). However, compared with the filling technique, the inverted ILM flap covering technique was superior in postoperative BCVA (WMD = 0.11, 95% CI: 0.04 to 0.18, and P=0.0017) and presented a significantly higher proportion of reconstitution of ELM (OR = 0.02, 95% CI: 0.00 to 0.08, and P < 0.0001) and EZ (OR = 0.11, 95% CI: 0.04 to 0.32, and P=0.0001). Conclusion The inverted ILM flap covering technique was associated with the superior reconstitution of outer layers of the retina, including ELM and EZ, and more improvement in postoperative BCVA than the ILM flap filling technique.

Sphingosine-1-phosphate expression in human epiretinal membranes

The abnormal posterior vitreous detachment (PVD) is speculated as an important mechanism of the development of the epiretinal membrane (ERM). However, there is only limited information about the molecular mechanism. Sphingosine-1-phosphate (S1P) is a mediator of the mechanosensitive response in several cell types that may have a role in the pathogenesis of ERM during abnormal PVD. Therefore, we evaluated the expression of S1P in the human ERM and the role of S1P in cultured human Muller glial cells. Among 24 ERM specimens, seven specimens (29.2%) exhibited S1P expression. Patients with secondary ERM or ellipsoid zone defects, which suggest abnormal PVD presented a significantly higher S1P+ cell density (secondary ERM: 128.20 ± 135.61 and 9.68 ± 36.01 cells, p = 0.002; EZ defects: 87.56 ± 117.79 vs 2.80 ± 8.85, p = 0.036). The addition of S1P increased the migrative ability and expression of N-cadherin and α-SMA in human Muller glial cells, suggesting S1P is a potential causative molecule for the development of ERM during abnormal PVD.

Анализ ганглиозных клеток сетчатки по данным оптической когерентной томографии у пациентов после витрэктомии по поводу регматогенной отслойки сетчатки

The study included 59 eyes after vitrectomy with silicone oil and gas tamponade. The 1st group (31 eyes) consisted of cases with silicone oil 1300 cSt tamponade, the 2nd group (28 eyes) – cases with C2F6 gas tamponade. Perpose. To compare changes in morphological parameters of ganglion cells and the morphological structure of the retina after vitrectomy with gas and silicone oil tamponade due to rhegmatogenous retinal detachment. Results. BCVA in the 1st group was reduced compared to the 2nd group, amounting to 0.4 [0.2; 0.5] in the 1st group and 0.5 [0.3; 0.6] (U = 242.500, p = 0.044) in the 2nd group. In the 1st group ERM occurred 4.1 times more often than in the 2nd group (χ² = 4.391, df = 1, p = 0.036). Macular edema in the outer nuclear layer was detected only in the 1st group in 16 % of cases (χ² = 4.766, df = 1, p = 0.029). Macular edema in the inner nuclear layer in the 1st group was 5.7 times more common than in 2nd group, amounting to 22.6 % and 4 %, respectively (χ² = 4.325, df = 1, p = 0.029). Ellipsoid zone defect was detected in 22.6 % of cases in the 1st group and in 32 % of cases in the 2nd group (χ² = 0.835, df = 1, p = 0.361). The focal loss volume of retinal ganglion cells in the 1st group was 8.5 times higher than in the 2nd group (U = 158.500, p = 0.009) A statistically significant difference was obtained for the Intra Eye GCC parameter, amounting to -5.0 [-8.25; 1.0]* in the 1st group and 0.0 [-3.0; 6.0] in the 2nd (U = 146.500, p = 0.004). Conclusion. According to visometry in the postoperative period for rhegmatogenous retinal detachment using silicone oi tamponade with a duration of 80.0 [59.0; 120.0] associated with a lower functional result compare to gas tamponade, accompanied by a more frequent formation of ERM, cystoid macular edema and an increase in focal loss volume of ganglion cell complex compared to gas tamponade.