Idiopathic Macular Hole Surgery Research Articles

Macular hole surgery follow-up with spectral domain-optical coherence tomography-guided facedown posturing.

The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP. Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded. Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260-max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed. OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.

Prediction of foveal microstructure and visual outcomes following surgery for idiopathic macular hole: An assessment using spectral-domain optical coherence tomography.

To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes. A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI. Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704. In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.

Insights into the pattern of choroidal vascularity index changes in idiopathic macular hole

This retrospective study aimed to investigate the changes in choroidal vascularity index (CVI) before and after surgery for idiopathic macular hole (MH). Enhanced depth imaging optical coherence tomography (EDI-OCT) images were analyzed at baseline and at 1-week, 1-month, and 3-month postoperative visits. A total of 97 patients (97 eyes) were included in the study. At baseline, overall CVI and macular CVI showed negative correlation with axial length (AL) and positive correlation with central corneal thickness (CCT). There were no significant differences in macular CVI or overall CVI between affected and healthy eyes, as well as in subgroup analysis of different stages of macular CVI. Following surgery, there was a significant decrease in CVI at 1 week postoperatively, followed by a gradual recovery to baseline levels over time. The observed changes in CVI may be attributed to factors such as air tamponade, pressure changes, and photoreceptor metabolism. This study provides insights into the pattern of CVI changes associated with MH surgery. The findings suggest that stage 4 MH is associated with decreased macular CVI in affected eyes. These results contribute to a better understanding of the effects of surgery on choroidal blood flow in MH patients.

Aniseikonia and retinal morphological changes in eyes undergoing macular hole surgery

Even after idiopathic macular hole (MH) surgery and with successful closure of MH, aniseikonia is a common postoperative symptom. We investigated the correlation of MH diameter, retinal displacement and retinal layer thicknesses with aniseikonia in 41 eyes of 41 patients undergoing MH surgery with internal limiting membrane peeling. Aniseikonia was measured with the New Aniseikonia Test. Retinal displacement (RD%) was defined as change of retinal distance between the temporal margin of the optic papilla and the intersection of the retinal vessels. Changes of thicknesses of the inner nuclear layer (INL%) and the outer retinal layer (OR%) were calculated. Aniseikonia improved postoperatively. Preoperative aniseikonia and their improvement at 6 months correlated with MH diameters (P = 0.004–0.046). Improvement of aniseikonia correlated with temporal RD% (P = 0.002–0.012). Improvement of vertical aniseikonia correlated with INL% at 2 weeks and with the nasal OR% at 1, 3, and 6 months (P = < 0.001–0.028). MH diameter and age were significant predictors for improvement of aniseikonia. The greater the temporal retina displacement, and the thinner the postoperative INL and OR, the greater the improvement of aniseikonia. MH diameter and age are strong predictors for improvement of aniseikonia after MH surgery.

Optical coherence tomography angiography features of the chorioretinal complex and choriocapillaris perfusion before and after vitrectomy with conventional versus fovea-sparing internal limiting membrane peeling for idiopathic macular hole

Purpose: To assess optical coherence tomography angiography (OCTA)-measured changes in the chorioretinal complex and choriocapillaris perfusion density in the macula before and after vitrectomy with fovea-sparing versus conventional internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Material and Methods: Eyes with stage-2 to stage-4 holes as per the classification by Gass received 25-G vitrectomy with conventional or fovea-sparing ILM peeling and gas tamponade with 20% SF6 or 15% С3F8. IMH diameter, foveal avascular zone (FAZ) area in the deep retinal plexus and choriocapillaris perfusion density (CPD) were assessed before and 1 month after surgery. Results: Totally, 70 patients had an IMH surgery in 71 eyes. The mean age ± standard deviation (SD) was 65.7 ± 6.8 years, median IMH duration (interquartile range or IQR), 3.0 (1.0-6.0) months, median best-corrected visual acuity or BCVA (IQR), 0.19 (0.1-0.25), and median maximum IMH diameter (IQR), 673.5 (549.5–1010.5) µm. In eyes with IMH and fellow eyes, the median FAZ area (IQR) was 0.51 (0.15–0.53) mm2, and 0.46 (0.10–0.74) mm2, respectively (р = 0.49), and mean CPD ± SD, 0.11 ± 0.06, and 0.29 ± 0.13 (р = 0.0001), respectively. Thirty-four eyes received conventional ILM peeling and 37 eyes, fovea-sparing ILM peeling, and there was no significant intergroup difference in baseline characteristics. One month after surgery, IMH closure was achieved in 63/71 eyes (i.e., the closure rate was 88.7% for total operated eyes, and 88.2% and 89.2%, respectively, for eyes in conventional ILM peeling and fovea-sparing ILM peeling groups), and median BCVA (IQR) improved to 0.60 (0.4–0.8) (р = 0.00001). After IMH closure, in operated eyes, median FAZ area (IQR) decreased to 0.30 (0.12–0.6) mm2, but the difference was not significant, whereas mean CPD ± SD increased significantly from 0.11 ± 0.06 to 0.25 ± 0.10 (р = 0.0001). No significant difference in OCTA-based retinal microcirculation and choriocappillaris characteristics was observed between the conventional ILM peeling and fovea-sparing ILM peeling groups. Conclusion: The presence of macular hole is accompanied by abnormal perfusion in the choriocapillaris, but the CPD recovers after IMH closure. Postoperative CPD recovery is not influenced by the type (conventional or fovea-sparing) of ILM peeling.

Surgery for idiopathic full-thickness macular holes within four months of symptom onset yields superior visual outcomes: Results from an Irish patient cohort.

To describe the anatomical, visual, and safety results of full-thickness macular hole (FTMH) repair surgery and determine factors influencing outcomes. A retrospective chart review was performed on all patients who underwent primary FTMH repair surgery by a single surgeon over a 3-year period. For comparisons, Snellen visual acuity (VA) was converted to logMAR equivalent. Anatomical hole closure, visual improvement, and final VA of ≤ 0.30 logMAR were the primary outcome measures. Twenty eyes of 19 patients were included. Mean patient age was 69years (range 55 to 80years) and 74% were female. Mean minimum linear diameter (MLD) was 440μm (range 170μm to 1200μm). Mean duration of symptoms before surgery was 16weeks (range 3 to 39weeks). 100% of eyes achieved successful anatomical FTMH closure. Mean VA improved from 1.03 ± 0.43 logMAR (Snellen 6/60) preoperatively to 0.35 ± 0.22 logMAR (Snellen 6/15) postoperatively (p = 0.0001). Patients with worse preoperative VA gained more vision than those with better preoperative VA (p = 0.01). Eyes operated on within 4months of symptom onset were more than twice as likely to achieve a postoperative VA of ≤ 0.30 logMAR (Snellen 6/12 or better) compared to eyes with a longer duration of symptoms (p = 0.03). FTMH repair surgery was safe and effective, with outcomes comparing favourably with published international studies. All patients benefited from surgery regardless of symptom duration, presenting VA or FTMH size. However, surgery performed within 4months of symptom-onset was particularly beneficial, highlighting the need for prompt referral and surgery.

Anatomical and functional outcomes of idiopathic macular hole surgery with fovea-sparing versus conventional internal limiting membrane peeling

Purpose: To compare fovea-sparing and conventional internal limiting membrane (ILM) peeling in idiopathic macular hole (IMH) surgery in terms of IMH closure type, hole closure incidence and visual outcome. Material and Methods: The ILM was peeled around the IMH in the conventional ILM peeling group. In the fovea-sparing ILM peeling group, an ILM flap was created temporally to the IMH (with an ILM remnant left attached to the margins of the IMH), folded over the hole and stabilized with viscoelastic. Gas tamponade with 20% SF6 or 15% С3F8 was used. In the postoperative period, IMH closure pattern was assessed. Thicknesses of the outer retinal layers, inner retinal layers and retinal nerve fiber layer in the macular region were measured at 1 and 3 months. Results: Totally, 70 patients (15 males and 55 females) had an IMH surgery in 71 eyes. The mean age (SD) was 65.7 (6.8) years. The median IMH duration (interquartile range (IQR)) was 3.0 (1.0-6.0) months, and the mean preoperative BCVA (standard deviation (SD)), 0.19 (0.16). Thirty-four eyes had an IMH surgery with conventional ILM peeling, and 37 eyes, an IMH surgery with fovea-sparing ILM peeling. The two groups were matched in terms of preoperative visual acuity and macular hole duration. IMH closure was achieved in 30/34 eyes (88.2%) in the conventional ILM peeling group and 33/37 eyes (89.2%) in the fovea-sparing ILM peeling group. Particularly, IMH closure was achieved in 13/17 eyes that received gas tamponade with 20% SF6 and 20/20 eyes that received that with 15% С3F8 in the latter group. The rate of correct IMH closure pattern was substantially higher (64% versus 47%) and median postoperative BCVA (IQR), significantly better (0.55 (0.35-0.7) versus 0.43 (0.35-0.6), р = 0.039) in the fovea-sparing ILM peeling group than in the conventional ILM peeling group. An analysis of variance found a significant effect of the type of IMH surgery and IMH closure pattern on the postoperative BCVA (F1 = 5.06, p = 0.027; F2 = 7.9, p = 0.0001). In both groups, we found a significant thinning of the total retinal thickness in the central 1-mm foveal zone at 3 months compared to 1 month after surgery. There was a significant thinning of the outer and inner retinal layers in the conventional ILM peeling group, and no significant thickness changes in the retinal layers in the fovea-sparing group. Conclusion: Our fovea-sparing ILM peeling technique is an effective treatment option for IMHs, and when used with gas tamponade with 15% С3F8, enabled a primary surgery IMH closure rate of 100%.

Fibrin-Glue-Assisted Surgery for Idiopathic Macular Holes

ABSTRACT Pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) and gas tamponade has been the standard of care for idiopathic macular holes (MHs). However, the use of tamponades like intraocular gases has their associated complications and more importantly a need for postoperative positioning which can be a challenge in elderly and people with orthopaedic problems. This study describes a novel surgical technique of utilising fibrin glue to obviate the problems associated with conventional gas tamponade and also to help in avoiding any postoperative positioning. Methods This pilot clinical trial included 10 eyes of 10 patients with idiopathic MH, where PPV along with ILMP was done. Fibrin glue was used as a tamponade, and no postoperative positioning was given to any patient. The primary outcome measure was successful anatomical closure of the MH. The secondary outcome measures were postoperative improvement in best-corrected visual acuity (BCVA) and any complications of the procedure. Results The median age of patients was 62.5 years. Eight eyes were pseudophakic and two were phakic. The mean basal diameter of the MH was 1193 microns. The mean minimal linear diameter was 652 microns. Successful anatomic closure of MH was achieved in eight cases. The median BCVA improved from a Snellen equivalent of 20/100 preoperatively to 20/60 at 1 month postoperatively. The median follow-up period was 4 months. Conclusion The findings of this study suggest that the use of fibrin glue can be useful in patients where postoperative positioning is difficult.

Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy.

Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure or restoration of visual acuity is more difficult to achieve in PIMH, surgical approaches that would yield the best outcomes remain to be elucidated. On paper, extended ILM peeling combined with silicone oil (SiO) tamponade is believed to be a feasible option for excellent macular hole closure. However, no studies on this combined treatment for PIMH is compared with simple air tamponade have been conducted. Thus, in this retrospective case series, we used spectral-domain optical coherence tomography (SD-OCT) and other technologies to investigate real-world evidence for the anatomical and functional outcomes of revisional PPV with either SiO or air tamponade for failed primary idiopathic macular hole surgery. We included the records of 76 patients with PIMH who had SD-OCT examinations and best-corrected visual acuity (BCVA). Regression analysis was performed to find factors affecting PIMH fracture closure. Seventy-six participants were allocated to a SiO group (n = 21, with an extended ILM peeling and SiO tamponade) or an air group (n = 55, with extended ILM peeling and air tamponade). Anatomical success was achieved in 18 (85.7%) and 40 (72.7%) eyes in the SiO and air groups, respectively (p = 0.37). BCVA was significantly improved in both subgroups of closed PIMH (SiO group: p = 0.041; air group: p < 0.001). Minimum linear diameter (MLD) was closely related to the closure rate (OR, 1.0; 95% CI (0.985-0.999); p = 0.03). MLD = 650 μm seemed like a cut-off point for closure rate (MLD ≤ 650 μm vs. MLD > 650 μm; 88.4% vs. 52%, p = 0.002). In conclusion, we demonstrated that extended ILM peeling combined with SiO or air tamponade is effective in PIMH treatment. Moreover, though not statistically significant herein, the anatomic closure rate was better for silicone-operated eyes than for air-operated eyes. MLD is the best predictor of PIMH closure; MLD ≤ 650 μm could achieve a significantly higher closure rate.

Evaluation of a New Monofocal Intraocular Lens in Patients Undergoing Cataract and Vitrectomy Surgery for Idiopathic Macular Hole

Purpose To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients who underwent combined cataract and pars plana vitrectomy (PPV) surgery for idiopathic macular hole (MH). Methods A prospective study was conducted on 89 eyes of 89 patients who underwent combined cataract and PPV surgery for MH. The patients were divided into two groups: Eyhance ICB00 and Tecnis ZCB00. Pre-operative characteristics, post-operative visual outcomes, contrast sensitivity, and complications were compared between the two groups. A univariate regression analysis was performed to identify the factors that may affect the postoperative visual outcomes. Results Both groups showed significant improvement in mean corrected distance visual acuity (CDVA) six months post-operation (p < 0.001). There was no significant difference in pre-operative characteristics or complications between the two groups. However, the Eyhance ICB00 group showed a significantly higher uncorrected intermediate visual acuity (UCIVA) value at 6 months after surgery than the Tecnis ZCB00 group (p = 0.014). Contrast sensitivity values were not significantly different between the two groups. The univariate regression analysis revealed a significant correlation between preoperative CDVA and minimum linear diameter of MH with postoperative UCIVA in the Eyhance ICB00 group. Conclusions The newly generated Eyhance ICB00 IOL showed promising results in terms of post-operative UCIVA, with no significant difference in complications or contrast sensitivity values compared to the Tecnis ZCB00 IOL. These findings suggest that the Eyhance ICB00 IOL may be a useful option for patients who undergo combined cataract and PPV surgery for idiopathic MH, particularly for those who require intermediate visual acuity.

Association of macular hole intraretinal fluid and visual acuity

ObjectifNotre étude visait à évaluer l'association entre l'aire du liquide intrarétinien (LIR) avant l'intervention et la meilleure acuité visuelle corrigée (MAVC) avant et après l'intervention en présence d'un trou maculaire (TM) idiopathique faisant l'objet d'une réparation chirurgicale. Notre étude s'est également penchée sur d'autres facteurs pronostiques en lien avec la réparation d'un TM qui pourraient aider les médecins à comprendre la prise en charge chirurgicale du TM. NatureÉtude de cohorte rétrospective réalisée dans un seul établissement. ParticipantsAu total, 251 patients ont subi une réparation chirurgicale du TM entre janvier 2012 et janvier 2021. MéthodesOn a procédé à une segmentation des images obtenues à la tomographie par cohérence optique (OCT) de 251 yeux présentant un TM et du LIR. L'analyse de corrélation de Spearman a permis d’évaluer les associations entre l'aire du LIR et la MAVC avant l'intervention de même que 1, 3 et 6 mois après cette dernière, ainsi que l’épaisseur du sous-champ central, le diamètre du TM, la détermination de son stade, sa fermeture et le type de fermeture avant et après l'intervention. RésultatsLa corrélation avec l'aire du LIR préopératoire était modérée pour la MAVC préopératoire (r = –0,32; p < 0,001) et négligeable pour la MAVC postopératoire mesurée après 1, 3 et 6 mois (r = –0,14; p = 0,026; r = –0,21; p < 0,001; r = –0,19; p < 0,001, respectivement). L'aire du LIR préopératoire était fortement corrélée avec le diamètre linéaire minimal du TM (r = 0,56; p < 0,001) et le diamètre de base du TM (r = 0,65; p < 0,001). Aucune autre association n'avait de signification statistique. ConclusionEn présence d'un TM idiopathique, la corrélation avec l'aire du LIR préopératoire était modérée pour la MAVC préopératoire et faible, voire négligeable, pour la MAVC postopératoire mesurée pendant une période pouvant atteindre 6 mois. Voilà qui laisse entendre que l'acuité visuelle n'a peut-être pas de lien clinique significatif avec la présence de LIR dans le contexte d'un TM.

Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis

ObjectifComparer la variation de la meilleure acuité visuelle corrigée (MAVC), la fermeture du trou maculaire idiopathique (TMI) et les complications chez des patients présentant un TMI qui font l'objet d'une chirurgie combinée phaco-vitrectomie ou d'une chirurgie séquentielle (vitrectomie suivie d'une phacoémulsification). NatureRevue de synthèse systématique et méta-analyse. MéthodesOn a procédé à une recherche dans 3 bases de données (PubMed, Ovid EMBASE et Cochrane Library) depuis leur date de création jusqu'en février 2022. Ont été incluses les études comparatives randomisées et les études d'observation qui présentaient des résultats au chapitre de la variation de la MAVC, de la fermeture du TMI et des complications chirurgicales. Une méta-analyse à effets aléatoires a servi à calculer les estimations de l'effet avec un intervalle de confiance (IC) à 95 %. RésultatsUne seule étude comparative randomisée et 7 études de cohorte regroupant un total de 585 patients ont été incluses. La méta-analyse portant sur la variation de la MAVC (différence moyenne : –0,03; IC à 95 % : –0,10–0,04) et la fermeture du TMI (rapport relatif : 1,04; IC à 95 % : 0,96–1,13) n'a fait ressortir aucune différence significative entre la chirurgie combinée phaco-vitrectomie et la chirurgie séquentielle. Les risques relatifs colligés en ce qui a trait aux diverses complications chirurgicales, notamment le décollement de rétine postopératoire, l'inflammation et la hausse de la pression intraoculaire, n'ont mis au jour aucune différence significative entre les 2 groupes. ConclusionsLe gain visuel et le taux de fermeture du TMI au décours d'une chirurgie combinée phaco-vitrectomie ou d'une chirurgie séquentielle étaient similaires, au même titre que les risques de complications. Les résultats anatomiques et fonctionnels de la chirurgie combinée phaco-vitrectomie n’étaient pas supérieurs à ceux de la chirurgie séquentielle. Nos résultats peuvent servir de référence pour la tenue d’études ultérieures.

Bidirectional Dimples After Internal Limiting Membrane Peeling for a Macular Hole.

To investigate microstructural changes and prognosis associated with retinal surface dimples after internal limiting membrane (ILM) peeling for macular holes (MHs). We analyzed swept-source optical coherence tomography (SS-OCT) images of patients who underwent surgery for idiopathic MHs. The inner retinal dimples on SS-OCT images were classified into three types: unidirectional, bidirectional, and complicated bidirectional dimples. Dimples were found in 97.1% of the 69 eyes (69 patients) during a mean follow-up period of 14.0 ± 11.9 months after MH surgery. Of the eyes with dimples, 83.6% had bidirectional dimples. The proportion of eyes with dimples increased from 55.3% at 1 month postsurgery to 95.5% at 3 months and 97.9% at 6 months postsurgery. However, the proportion of eyes with complicated bidirectional dimples gradually increased from 1 month (29.8%) to 3 months (46.3%) and 6 months (64.6%) postsurgery. In the multivariable generalized estimating equation model, complicated bidirectional dimples occurred more frequently in eyes with shorter axial length (P = 0.039) and longer follow-up duration (≥6 months; at 6 months: P = 0.001; at 12 months: P = 0.009). Changes in retinal layers associated with retinal surface dimples after ILM peeling can occur at different retinal depths and over different time courses. These findings suggest the progression of dimple-associated remodeling of the underlying retinal layer. Various types of dimples can be used as surrogates to evaluate structural changes and outcomes of MH surgery.

Macular morphology after macular hole surgery using the inverted internal limiting membrane flap technique.

To investigate the influence of an excess inverted internal limiting membrane (ILM) flap that covers the fovea in idiopathic macular hole (i-MH) surgery on postoperative visual acuity and macular morphology. This retrospective study included 66 patients with an i-MH who underwent vitrectomy using the inverted ILM flap technique. They were divided into three groups: normal morphology (N), detached ILM (D), or ILM proliferation (P) in the parafoveal area. They were followed up for at least 6 months, and their best-corrected visual acuity (BCVA), central retinal thickness (CRT), and parafoveal retinal thickness (PRT) were measured. There were no significant differences in pre- or postoperative mean BCVAs or postoperative CRTs among the groups. The postoperative inferior PRTs were 319.2±38.0, 377.1±60.6, and 373.1±67.3 μm in the N, D, and P groups, respectively (P vs. D group, p=0.963; P vs. N group, p=0.008; N vs. D group, p=0.004). Regardless of the postoperative morphology of the inverted ILM flap, there was no effect on postoperative BCVA or CRT.

Analysis of Retinal Microstructure in Eyes with Dissociated Optic Nerve Fiber Layer (DONFL) Appearance following Idiopathic Macular Hole Surgery: An Optical Coherence Tomography Study.

(1) Purpose: This study aimed to evaluate morphological changes of the retina in eyes with dissociated optic nerve fiber layer (DONFL) appearance following internal limiting membrane (ILM) peeling for full-thickness idiopathic macular hole (IMH) on spectral-domain optical coherence tomography (SD-OCT). (2) Methods: We retrospectively analyzed 39 eyes of 39 patients with type 1 macular hole closure after a vitrectomy with ILM peeling procedure at a six-month minimum postoperative follow-up. The retinal thickness maps and cross-sectional OCT images were obtained from a clinical OCT device. The cross-sectional area of the retinal nerve fiber layer (RNFL) on cross-sectional OCT images was manually measured by ImageJ software. (3) Results: The inner retinal layers (IRLs) thickness thinned down much more in the temporal quadrant than in nasal quadrants at 2 and 6 months postoperatively (p < 0.001). However, the cross-sectional area of the RNFL did not change significantly at 2 and 6 months postoperatively (p > 0.05) when compared to preoperative data. In addition, the thinning of the IRL did not correlate with the best-corrected visual acuity (BCVA) at 6 months postoperatively. (4) Conclusions: The thickness of the IRL decreased in eyes with a DONFL appearance after ILM peeling for IMH. The thickness of the IRL decreased more in the temporal retina than in the nasal retina, but the change did not affect BCVA during the 6 months after surgery.

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

Idiopathic macular hole surgery using inverted temporal internal limiting membrane flap technique

AbstractPurpose: To investigate the anatomic success rate of single‐layered, inverted temporal internal limiting membrane flap (ITF) cover technique for idiopathic macular hole (MH) surgery.Methods: Clinical records of idiopathic MH patients who underwent surgery using ITF technique. Two techniques were used. Group A had circular internal limiting membrane (ILM) peeling and ITF surgery. Group B had hemicircular ILM peeling and ITF surgery. Postop closure of MH was examined by optical coherence tomography.Results: Group A included 18 eyes and Group B included 42 eyes. Immediate postop closure of MH was observed in 83.3% (50 eye); 88.9% (16 eyes) in Group A and 81% (34 eyes) in Group B. Anatomic success rate of large MH was 88.9% (24/27 eyes). Among 10 eyes showing persistent MH after the surgery, 6 eyes had additional intravitreal gas injection treatment and MHs were closed. MHs in other 4 eyes were also closed after the second surgery. In two eyes, ITF flipped back to the original position was observed during the surgery, and reinverting the previous flap induced MH closure.Conclusions: Single‐layered ITF cover technique showed high anatomic success rate in idiopathic MH surgery. However, more attention is needed to prevent the flap flipping.

Negative effects of enlarging internal limiting membrane peeling for idiopathic macular hole surgery.

To observe the effects of the different extents of internal limiting membrane (ILM) peeling on the surgical success and anatomical and functional outcomes of idiopathic macular hole (IMH). In this retrospective cohort study, 36 patients were reviewed and divided into two groups according to the extent of ILM peeling: group A (18 patients), with the peeling area within one-half of the optic disc macular distance as the radius; group B (18 patients), with the peeling area larger than that of group A but did not exceed the optic disc macular distance as the radius. The main outcomes included the best corrected visual acuity (BCVA), light-adaptive electroretinography, macular hole (MH) closure rate, central macular thickness (CMT), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness [nine regions based on the Early Treatment of Diabetic Retinopathy Study (ETDRS) ring] before and 1, 3, and 6mo after surgery. The closure rate was 94.4% (17/18) both in groups A and B. The BCVA in both groups improved significantly compared with the preoperative values, but there was no difference between the two groups. The b-wave amplitude of the electroretinogram analysis was significantly improved in both groups compared to that of the preoperative period, with a greater increase in group A than in group B at 6mo (P=0.017). The CMT in both groups gradually decreased after surgery, and there was no difference between the two groups. The RNFL thickness of the temporal outer ring region in group B was significantly lower than that in group A at 3 and 6mo after surgery (P=0.010, 0.032). The GCC thickness of the temporal outer ring region in group B was significantly lower than that in group A at 6mo after surgery (P=0.038). Enlarging the extent of ILM peeling doesn't affect the IMH closure rate and visual acuity recovery, but the greater the extent of peeling, the greater the damage to the inner retinal structures.

A study of post-operative clinico-imaging status and visual outcome after idiopathic macular hole surgery with amniotic membrane plug.

Objective: The aim of this study was to determine the efficacy of hAM plug in the treatment of idiopathic macular hole and to see its post-operative visual improvement and anatomical apposition. Material and methods: 10 eyes of 10 patients who had idiopathic MH underwent a pars plana vitrectomy (PPV) with the hAM plug implanted in MH. The patients were followed up on 2nd day, 1st week, 3rd week, 6th week and 3rd month. Results: Final anatomical closure of MH was achieved in all the cases. BCVA improved from 0.91±0.11 logMAR to 0.28±0.06 logMAR after 3 months. No adverse event was documented in the specified period. Conclusion: hAM plug is an efficient method to treat and manage idiopathic MH with encouraging results both in terms of anatomical closure and visual acuity gain. Abbreviations: MH = Macular Hole, IOP = Intra Ocular Pressure, ILM = Internal Limiting Membrane, BCVA = Best Corrected Visual Acuity, OCT = Optical Coherence Tomography, LogMAR = Logarithm of Minimum Angle of Resolution, hAM = Human Amniotic Membrane, RPE = Retinal Pigment Epithelium.

Outer retinal microstructure and visual function after macular hole surgery with and without Brilliant Blue G.

To evaluate the outer retinal microstructure and visual function after idiopathic macular hole (MH) surgery using internal limiting membrane (ILM) peeling with and without Brilliant Blue G (BBG) staining. Retrospective, consecutive case series. A total of 49 eyes of 47 patients were enrolled: 23 eyes of 23 patients with MH who underwent ILM peeling without dyes (control group) and 26 eyes of 26 patients who underwent BBG staining (BBG group). The lengths of defects of the photoreceptor ellipsoid zone (EZ), external limiting membrane (ELM), and interdigitation zone (IZ) were measured. The rate of MH closure after initial surgery was 95.6% (22/23 eyes) for the control group versus 100% (26/26 eyes) for the BBG group. In the 48 eyes with MH closure, the recovery rate of ELM deficiency and change in IZ deficiency showed no difference between the groups. The changes in EZ deficiency at 1 and 12 months were greater in the BBG group than in the control group. (P = 0.047 and 0.031). Visual acuity was better in the BBG group than in the control group during 12 months postoperatively (P < 0.001-0.038). Eyes undergoing BBG-assisted MH surgery achieved faster recovery of the outer retinal structures and greater visual improvement than those of eyes without BBG.