Giant Macular Hole Research Articles

Clinical presentation and outcomes of trivial trauma-associated giant macular holes in children with Best vitelliform macular dystrophy

We present three cases of children with giant macular holes in relation to trivial trauma. These children had brittle retina secondary to Best vitelliform macular dystrophy (BVMD) which made them vulnerable to the irreversible complications. None of the three cases had any signs of trauma in the anterior segment pointing to trivial nature of the trauma. Two cases progressed to retinal detachment. This series highlights the importance of ocular protection and special care needed for children with BVMD.

Human amniotic membrane for the treatment of large and refractory macular holes: a retrospective, multicentric, interventional study

BackgroundThe purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful.MethodsRetrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values < 0.05 were considered statistically significant.ResultsNineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80–2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4–3.0) approximately 20/200 (p < 0.0001) with median of three lines of visual improvement.ConclusionThe use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.

Parafoveal retinal massage combined with autologous blood cover in the management of giant, persistent or recurrent macular holes.

To assess the efficacy and safety of parafoveal retinal massage combined with autologous whole blood cover in the treatment of refractory macular holes (MHs) and present the surgical procedure. Patients with giant (minimum diameter ≥800 µm), recurrent or persistent MHs who underwent PPV combined with parafoveal retinal massage and autologous whole blood cover using C3F8 as tamponade agent from February 2018 to May 2019 were enrolled in this retrospective study. After surgery, all patients were informed to maintain a prone position for at least 7d. Preoperative and postoperative best-corrected visual acuities (BCVAs) were compared and MH closure rate was measured as the main outcome. A total of 13 MH patients consisted of 6 giant MHs, 4 persistent holes and 3 recurrent holes (5 men and 8 women; average age was 56.40±11.72y) were enrolled in this study. MH closure was achieved in 11 eyes by this modified surgical technique while 2 eyes failed. Revitrectomy with autologous neurosensory retinal patch transplantations was applied for those 2 patients and then both holes were closed. No intraoperative complications were observed. BCVA improved from 1.73 logMAR to 0.74 logMAR at 6mo postoperation. There was significant difference in BCVA before versus after the surgery (P<0.05). There were no adverse events occurred during the follow-up period. With easier surgical procedure, parafoveal retinal massage combined with autologous whole blood cover is an effective addition to the surgical options for the management of refractory MHs.

Autologous Retinal Flap Transplantation of a Refractory Giant Macular Hole with Retinal Detachment

Autologous Retinal Flap Transplantation of a Refractory Giant Macular Hole with Retinal Detachment

Autologous Retinal Free Flap Transplantation for Recurrent Giant Macular Hole Retinal Detachment in High Myopia

ëª©ì  ê³ ë„ê·¼ì‹œì•ˆì—ì„œ 발생한 재발 거대황반원공 망막박리에서 시행한 ìžê°€ë§ë§‰íŒì´ì‹ìˆ ì˜ ìˆ˜ìˆ ì  기법과 ìž„ìƒì  결과를 ë³´ê³ í•˜ê³ ìž 한다. 증례요약 71세 여자 환자가 ê³ ë„ê·¼ì‹œì•ˆì—ì„œì˜ 황반원공에 의한 망막박리 진단하에 ìœ ë¦¬ì²´ì ˆì œìˆ , ë‚´ê²½ê³„ë§‰ë²—ê¹€ìˆ , 원공경계부의 ê´‘ì‘ê³ ìˆ ë° ì‹¤ë¦¬ì½˜ê¸°ë¦„ì£¼ìž ìˆ ì„ 시행받았다. ìˆ˜ìˆ í›„ 4개월째 ì‹¤ë¦¬ì½˜ê¸°ë¦„ì œê±°ìˆ ì„ ì‹œí–‰í•˜ì˜€ê³ , 빛간섭단층촬영검사에서 ë§ë§‰ìœ ì°©ì´ 확인되었다. ìˆ í›„ 8ë „ì§¸ 환자는 ì‹œë ¥ì €í•˜ë¥¼ 주소로 ë‚´ì›í•˜ì˜€ê³ , ì•ˆì €ê²€ì‚¬ì—ì„œ 황반원공에 의한 망막박리 재발이 관찰되었다. 이에 ìœ ë¦¬ì²´ì ˆì œìˆ ì„ ì‹œí–‰í•˜ì˜€ê³ , 박리된 상측 망막의 중간주변부에서 자가망막판 경계의 일부 부위(경첩부)를 ì œì™¸í•œ 나머지 경계를 잘랐다. ì•¡ì²´ê³µê¸°êµí™˜ìˆ í›„ 자가망막판의 경첩부를 주의깊게 분리하여 황반부 위에 ì íƒ„ë¬¼ì§ˆ 한 방울과 함께 위치시킨 후 자가망막판 채취부에 ì•ˆë‚´ë ˆì´ì €ì‘ê³ ìˆ ê³¼ ì‹¤ë¦¬ì½˜ê¸°ë¦„ì£¼ìž ìˆ ì„ 시행하였다. ìˆ í›„ 1주째에 빛간섭단층촬영검사에서 황반원공의 í•´ë¶€í•™ì  폐쇄가 확인되었으며, ìˆ í›„ 9개월이 지난 ì‹œì ê¹Œì§€ ì•ˆì •ì ìœ¼ë¡œ ìœ ì§€ë˜ì—ˆë‹¤. ê²°ë¡ ìž¬ë°œëœ 거대황반원공에 의한 망막박리 환자에서 ìžê°€ë§ë§‰íŒì´ì‹ìˆ ì„ 이용한 ìœ ë¦¬ì²´ì ˆì œìˆ ì€ íš¨ê³¼ì ì¸ 치료 방법으로 ê³ ë ¤í• ìˆ˜ 있다. Keywords: Autologous retinal free flap transplantation, Macular hole, Myopia, Retinal detachment

Efficacy of macular massage combined with negative pressure suction for giant idiopathic macular hole

Objective To evaluate the efficacy of 25 G vitrectomy combined with macular massage and negative pressure suction for the treatment of giant idiopathic macular hole. Methods Clinical data of 27 eyes of 27 patients with giant idiopathic macular hole, of which the diameter was 500-800 μm, from Apr.2016 to Dec.2018 in Hanyang Eyegood Ophthalmic Hospital was analyzed retrospectively. Macular massage and negative pressure suction with flute needle were performed after 25 G vitrectomy and peeling of the inner limiting membrane. Results Macular hole closure at 3-5 days postoperatively occurred in 25 eyes(92.6%). Best corrected visual acuity (BCVA, logMAR) at 3-5 days postoperatively were ameliorated from 1.28±0.30 to 1.04±0.37(t=3.860, P=0.032). The postoperative intraocular pressure (IOP) was similar to the preoperative IOP within normal limits(t=2.147, P=0.226). No complication such as iatrogenic injury of macular, bleeding, retinal detachment or secondary glaucoma was recorded in the intra-operative and the follow-up period. Conclusion 25 G vitrectomy combined with macular massage and negative pressure suction contributes to the anatomical repair and visual function recovery of patients with giant idiopathic macular hole. Key words: Vitrectomy; Massage, macular; Suction, negative pressure; Hole, macular, idiopathic, giant

Хирургическая тактика на основе личного опыта при лечении пациентов с большими и гигантскими сквозными макулярными разрывами

Хирургическая тактика на основе личного опыта при лечении пациентов с большими и гигантскими сквозными макулярными разрывами

Treatment of refractory giant macular hole by vitrectomy with internal limiting membrane transplantation and autologous blood.

To investigate the effect of internal limiting membrane transplantation and autologous blood on treating refractory giant macular hole. Thirty-seven eyes with giant macular hole of the smallest hole diameter >700 µm, the maximum diameter of the substrate >1000 µm and hole formation factor <0.6 underwent surgical treatment. The patients were randomly divided into two groups. Nineteen eyes with surgical flip of the internal limiting membrane in group A, 18 eyes with internal limiting membrane transplantation in group B who underwent the tamponade of internal limiting membrane into the hole, autologous plasma was used to seal the hole. The patients were followed up for 3mo, optical coherence tomography and best corrected visual acuity (BCVA) were recorded before and after operation, and the results were statistically analyzed. At 3mo after operation, BCVA of the two groups was significantly improved compared with that before operation (tA=4.192, tB=4.374, P<0.05). But there was no significant difference in visual acuity between the two groups (χ2=0.128, P>0.05). At 3mo after operation, the closure rate of group A was 68.4%, and 100% in group B. (χ2=5.628, P<0.05). The defect diameter of inner segment/outer segment at 3mo after the operation was significantly lower than that before operation (tA=12.287, tB=15.481, P<0.05), and the difference was statistically significant (t=2.552, P<0.05). Internal limiting membrane transplantation combined with autologous whole blood can improve the postoperative closure rate of the refractory large aperture, and can effectively improve the postoperative visual acuity.

Vitrectomy combined with internal limiting membrane annular peeling and transplantation for the treatment of idiopathic macular hole

Objective To investigate the efficacy of internal limiting membrane (ILM) annular peeling and transplantation in the treatment of giant idiopathic macular hole. Methods Data of 52 eyes of 52 cases with giant idiopathic macular hole(d>500 μm) from Jul.2015 to Dec.2016 were collected and analyzed retrospectively. They were divided randomly into 2 groups: group A, 25 cases, underwent pars plana vitrectomy combined with ILM peeling, and group B, 27 cases, received vitrectomy combined internal limiting membrane peeling and transplantation. After surgery the follow-up time was more than 3 months. Results The visual acuity at 3 months after surgery was 0.86±0.27 in group A and 0.62±0.16 in group B. The difference was statistically significant(t=4.000, P=0.030). Macular hole closure rate was 84% in group A and 100% in group B. The difference was statistically significant(χ2=4.680, P=0.047). Defect of ellipsoid zone was (842.08±146.64)μm in group A and (513.89±85.59)μm in group B. The difference was statistically significant(t=6.920, P=0.010). Conclusion Vitrectomy combined with annular ILM peeling and transplantation for the treatment of giant idiopathic macular hole can increase the rate of macular hole closure and improve the visual function. Key words: Retinal perforations; Vitrectomy; Peeling, limiting membrane, internal, annular; Transplantation, limiting membrane, internal

Giant Atypical Macular Hole after Vitrectomy for Needle Perforation.

Giant Atypical Macular Hole after Vitrectomy for Needle Perforation.

Giant Macular Hole Formation After Scleral Buckling and Vitrectomy Surgery

Giant Macular Hole Formation After Scleral Buckling and Vitrectomy Surgery

Ocular features in Alport syndrome: pathogenesis and clinical significance.

Alport syndrome is an inherited disease characterized by progressive renal failure, hearing loss, and ocular abnormalities. Mutations in the COL4A5 (X-linked), or COL4A3 and COL4A4 (autosomal recessive) genes result in absence of the collagen IV α3α4α5 network from the basement membranes of the cornea, lens capsule, and retina and are associated with corneal opacities, anterior lenticonus, fleck retinopathy, and temporal retinal thinning. Typically, these features do not affect vision or, in the case of lenticonus, are correctable. In contrast, the rarer ophthalmic complications of posterior polymorphous corneal dystrophy, giant macular hole, and maculopathy all produce visual loss. Many of the ocular features of Alport syndrome are common, easily recognizable, and thus, helpful diagnostically, and in identifying the likelihood of early-onset renal failure. Lenticonus and central fleck retinopathy strongly suggest the diagnosis of Alport syndrome and are associated with renal failure before the age of 30 years, in males with X-linked disease. Sometimes, ophthalmic features suggest the mode of inheritance. A peripheral retinopathy in the mother of a male with hematuria suggests X-linked inheritance, and central retinopathy or lenticonus in a female means that recessive disease is likely. Ocular examination, retinal photography, and optical coherence tomography are widely available, safe, fast, inexpensive, and acceptable to patients. Ocular examination is particularly helpful in the diagnosis of Alport syndrome when genetic testing is not readily available or the results are inconclusive. It also detects complications, such as macular hole, for which new treatments are emerging.

Giant macular hole with Best's disease in a young boy

An eight‐year‐old boy presented with decreased near and distance vision in both eyes. The right ocular fundus showed a giant macular hole surrounded by a vitelliform ring. Spectral domain optical coherence tomography (SD‐OCT) revealed a full‐thickness macular hole with cystic spaces at the edges. The left fundus had an egg‐yolk like appearance of 1.5‐disc diameter at the macular region. SD‐OCT showed an optically empty space between retinal pigment epithelium and the neurosensory retina. Fundus autofluorescence confirmed the presence of lipofuscin in both eyes. The Arden ratio was 1.38 for the right eye and 1.61 for the left. There was no surgical intervention because of the poor prognosis due to large size of the hole. Environmental modification and contrast‐enhancing measures were explained to the patient and his parents.

Un nouveau cas de trou maculaire géant chez un patient présentant un syndrome d’Alport

Alport syndrome is a progressive inherited glomerulonephritis leading to renal failure, hearing loss and ocular changes. To report the seventh case of giant macular hole in a patient with Alport syndrome, review the literature, and propose a pathophysiological mechanism. The case of a man with a giant macular hole of the right eye is described with visual acuity, fundus photographs and spectral domain ocular coherence tomography. A 56-year-old man with Alport syndrome and giant macular hole (2291 μm × 2265 μm) in his right eye, reducing the visual acuity to 20/200, complained of progressive visual loss in his contralateral eye. Fundus examination of the left eye revealed a circular perimacular atrophy. Giant macular holes are one possible retinal complication of Alport syndrome. Their pathogenesis differs from idiopathic macular holes and may result from the combination of collagen type IV abnormalities in the basement membranes of both Bruch's membrane and the internal limiting membrane, along with anomalous vitreo-retinal adhesion.

Centrifugal enlargement of macular hole and macular detachment in a patient with bilateral giant macular holes.

To report the detailed vitreomacular morphology of a case of progressive enlargement and macular detachment secondary to and several years after the development of bilateral giant macular holes using optical coherence tomography. Using optical coherence tomography, both eyes of a patient with bilateral giant macular holes were examined. A 33-year-old woman had bilateral giant macular holes at the first visit. At the 5-year follow-up visit, the macular hole had enlarged centrifugally in the right eye, and a macular detachment developed beyond the arcade vessels in the left eye. Optical coherence tomography showed retinoschisis in the right eye around the edges of the hole and a macular detachment in the left eye with vitreoretinal adhesion temporal to both holes. These optical coherence tomography findings suggested that vitreomacular traction at the temporal edge of the hole may have resulted in progressive centrifugal enlargement of the hole in both eyes and then the macular detachment occurred in the left eye.

Giant Macular Hole in Alport Syndrome

Purpose: To describe the evolution of a giant macular hole in a patient with Alport syndrome and review the literature.Methods: An observational case report is presented with serial clinical examination, visual acuity, fundus photographs, and ocular coherence tomography performed.Results: A man with Alport syndrome and a giant macular hole in one eye developed multiple, small lamellar macular holes which coalesced into a giant full thickness macular hole in the contralateral eye.Conclusions: Giant macular holes may occur in Alport syndrome. The mechanism and clinical progression appear to differ from that of idiopathic macular holes and, is likely related to an abnormality in Type IV collagen in basement membrane of retinal Muller cells. Anomalous vitreoretinal adhesion may also play a role. Previous cases of giant macular holes in the literature may not have been properly associated with Alport syndrome.

Optical coherence tomography findings in alport syndrome.

To describe the optical coherence tomography (OCT) findings of the macular area in patients with Alport syndrome (AS), a disease caused by mutations in genes coding for type IV collagen (Col4), which is the main component of the internal limiting membrane (ILM). We reviewed the files for six eyes of three patients with AS. All patients were evaluated by OCT throughout the macula. One patient had a giant macular hole surrounded by areas of loss of inner retinal tissue that had grown over time. The other two patients had focal zones of inner retinal thinning. We postulate that the structural abnormalities of the ILM due to altered Col4 play a more important role in macular hole formation than hemodynamic alterations characteristic of AS. Several hypotheses could be expounded. Future OCT macular studies involving asymptomatic patients with AS would be useful in detecting and monitoring macular alterations. They would also contribute to a greater knowledge of this disease.

Giant macular hole in Alport syndrome

Case report: A 29-year-old woman with Alport syndrome presented with unilateral visual deterioration over an 8-year period. She had the rare ocular complication of a giant macular hole. She developed a small macular hole in the other eye.Comments: The ocular features of Alport syndrome are described, including proposed mechanisms for hole formation.

Giant Macular Hole as an Atypical Consequence of a Toxoplasmic Chorioretinitis

Giant Macular Hole as an Atypical Consequence of a Toxoplasmic Chorioretinitis

Bilateral Giant Macular Hole in a Patient With Chronic Renal Failure

A 32-year-old woman with a medical history of chronic hypertension, chronic renal failure, and hearing deficit presented with bilateral giant macular holes. Possible mechanisms that cause giant macular holes and the relationship between renal failure and giant macular hole formation are discussed.