Idiopathic Macular Hole Surgery Research Articles

Retinal Displacement after Idiopathic Macular Hole Surgery: Layer by Layer Analysis.

To measure the displacement of retinal vascular plexi and choriocapillaris after Pars Plana Vitrectomy (PPV) for idiopathic Macular Hole (MH), using Optical Coherence Tomography Angiography (OCTA) and correlate it with clinical data. Retrospective series with 6-month follow-up. Records included best-corrected visual acuity (BCVA), M-charts, structural OCT and OCTA. Coronal displacement was calculated comparing consecutive images across the 6.4 mm x 6.4 mm field and concentric circular regions of 0.5, 1.5 and 3.0mm radii. Each circular region was further divided in four quadrans indicated as follows: ST=SuperoTemporal; SN=SuperNasal; IT=InferoTemporal; IN=InferoNasal. The study comprised 33 patients (11 males and 22 females) with 68.9 ± 10.2 years mean age, similar among sexes. MH closed in 31/33 (93.9%) of cases and BCVA improved from mean 20/62 (0.50±0.62 logMAR) to 20/47 (0.23±0.63 logMAR; p=0.0064). Vertical and horizontal metamorphopsia decreased from 0.98±0.68 to 0.51±0.59 degrees (p=0.0028) and 0.84±0.63 to 0.29±0.45 degrees (p<0.001), respectively. The average retinal displacement was 81.2±44.1 μm for the superficial plexus and 79.4±45.7 μm for the deep one, both greater than the choriocapillaris displacement (60.9±20.2 μm; p<0.05). The temporal and superior quadrants displaced more than the others (p<0.05). MH size correlated to retinal displacement within the central 0.5 mm radius area at all layers (p<0.05 in all cases). MH closure is associated with significant retinal displacement of all retinal layers as well as choriocapillaris remodelling. Surgical peeling removes the constraining effect of the Internal Limiting Membrane and promotes a multi-layered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the Retinal Nerve Fiber Layer.

Predictive relevance of optical coherence tomography indices in conjunction with visual acuity and surgical outcomes of idiopathic macular hole

Idiopathic macular hole (IMH) is a condition that arises from a combination of interactions among several forces on the fovea, remarkably from vitreous traction in the anteroposterior and tangential directions. Recent studies have highlighted the significance of microincision vitrectomy surgery, and IMH surgery was performed with minimal invasiveness, and visual improvement was an expected outcome. This study aimed to observe the pre-operative optical coherence tomography (OCT) indices correlated with visual acuity in the closure of IMH after surgery. Primarily, the findings were associated with clinical characteristics, including OCT indices, change in best corrected visual acuity (BCVA), clinical factors associated with IMH closure, and prognostic factors for the visual outcomes. This retrospective study included pre- and post-operative BCVA and OCT indices of 110 eyes with IMH. Each OCT variable was subjected to stepwise regression analysis regarding therapeutic factors that predict the need for IMH closure. Our results revealed that the hole form factor (HFF, r = 0.196), macular hole index (MHI, r = 0.669), and tractional hole index (THI, r = 0.085) had a positive correlation with visual acuity. However, basal hole diameter (BHD, r = −0.696) and minimum hole diameter (MHD, r = −0.407) showed a negative correlation. Out of them, HFF, MHI, BHD, and MHD were observed to be statistically significant (p < 0.05). The mean follow-up time was 149 ± 63.22 (85–300) days. The mean baseline BCVA was 0.75 ± 0.44 logMAR (Logarithm of the Minimum Angle of Resolution) units, which was improved to 0.29 ± 0.27 logMAR units at the final follow-up. The surgical success closure rate was 100 % among subjects with IMH. In conclusion, OCT indices were significant indicators of visual success rates in IMH, and OCT measurement could be employed as a single key index in predicting the IMH closure rate. Also, our findings suggested that OCT indices could be utilized as a safe and effective predictor of visual and anatomical outcomes in the case of IMH.

Long-term Visual Outcomes in Patients With Idiopathic Macular Hole Surgery.

This study assesses long-term outcomes following surgical repair of idiopathic full-thickness macular holes (FTMHs) in patients with at least 5 years of postoperative follow-up. A retrospective study evaluated patients diagnosed with idiopathic FTMH who received surgical repair at a single tertiary center with at least 5 years of postoperative follow-up. Data collection included demographic and preoperative characteristics along with macular hole structural integrity as determined by spectral-domain optical coherence tomography (OCT). Functional and structural improvement were assessed by collection of visual acuity and findings on OCT at determined time points until 9 years of follow-up. The study comprised 90 eyes of 80 patients with a mean age of 67.2 ± 6.8 years, with an average postoperative follow-up of 80.8 ± 17.4 months (range 54 to 130 months). The mean macular hole diameter was 239.7 µm ± 92.2. Macular hole reoperation occurred in four eyes (4%) at a mean duration of 5.5 ± 6 months (range 0.3 to 13 months). Over the study duration, ellipsoid zone (EZ) integrity was maintained in 67.8% of eyes, with an absence of intraretinal fluid (IRF) in 96% on final OCT. The preoperative mean Early Treatment Diabetic Retinopathy Study (ETDRS) best visual acuity (BVA) of 51 improved to a mean BVA of 76 at 5 years postoperatively, with an average gain of 24 letters at one year that remained stable over 5 years (P < 0.05). Eight years after surgical repair, more than 80% of patients achieved a BVA > 65. Vitreoretinal surgery for idiopathic FTMH resulted in successful hole closure and sustained visual acuity improvement over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

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.

Retinal displacement after surgery for idiopathic macular hole.

To review and summarize the mechanism hypothesis, influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole (IMH) surgery. PubMed and Web of Science database was searched for studies published before April 2023 on "Retinal displacement", "Idiopathic macular holes", and "Macular displacement". Recently, more academics have begun to focus on retinal displacement following idiopathic macular holes. They found that internal limiting membrane (ILM) peeling was the main cause of inducing postoperative position shift in the macular region. Moreover, several studies have revealed that the macular hole itself, as well as ILM peeling method, will have an impact on the result. In addition, this phenomenon is related to postoperative changes in macular retinal thickness, cone outer segment tips line recovery, the occurrence of dissociated optic nerve fiber layer (DONFL) and the degree of metamorphopsia. As a subclinical phenomenon, the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.

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.

Choroidal hypertransmission width on optical coherence tomography: a prognostic biomarker in idiopathic macular hole surgery

PurposeTo test the hypothesis that optical coherence tomography (OCT) choroidal hypertransmission width (CHW) is a prognostic biomarker in idiopathic macular hole (MH) surgeryMethodsRetrospective cohort study of consecutive patients undergoing successful pars plana vitrectomy for idiopathic MH. We collected demographic, clinical, and OCT variables at the preoperative and last available visits. Two investigators assessed the following OCT parameters: MH minimum diameter, base diameter, CHW, ellipsoid zone, and external limiting membrane status (absent vs. present). Delta CHW was calculated as the difference between CHW and MH minimum diameter. Linear models were used to investigate factors associated with postoperative best-corrected visual acuity (BCVA) and BCVA change.ResultsThirty-six eyes (36 patients) with a median (interquartile range (IQR)) follow-up of 9 (8–11) months were included. The median BCVA (IQR) improved from 0.75 (1–0.6) logMAR preoperatively to 0.2 (0.6–0.1) logMAR at the last visit (p < 0.001). Preoperative MH minimum diameter (for a 10-μm increase, estimate (standard error (SE)): 0.009 (0.003) logMAR, p = 0.003), base diameter (for a 10-μm increase, 0.003 (0.001) logMAR, p = 0.032), CHW (for a 10-μm increase, 0.008 (0.002) logMAR, p < 0.001), and delta CHW (for a 10-μm increase, 0.013 (0.005) logMAR, p = 0.009) were significantly associated with postoperative BCVA. The proportion of variance explained was the highest for MH CHW (R2 0.35), followed by minimum MH diameter (R2 0.24), delta CHW (R2 0.19), and MH base diameter (R2 0.14). None of the study variables was associated with delta BCVA.ConclusionPreoperative CHW is associated with postoperative visual acuity in patients undergoing successful idiopathic MH surgery and may be a useful OCT prognostic biomarker.

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.

Evaluation of the changes in the ganglion cell complex and visual prognostic factors after vitreoretinal surgery for idiopathic macular hole

Evaluation of the changes in the ganglion cell complex and visual prognostic factors after vitreoretinal surgery for idiopathic macular hole

Comparison of Techniques: Inverted Flap and Conventional Internal Limiting Membrane Removal in Idiopathic Macular Hole Surgery

To compare functional and anatomical outcomes between the inverted flap technique and conventional removal of the internal limiting membrane (ILM) in the surgical management of idiopathic macular hole (IMH). We retrospectively evaluated the anatomical and functional results in 67 eyes of 65 patients operated on for IMH. The patients were operated on either using the conventional ILM peeling technique (first group) or with the inverted ILM flap technique (second group). 43 eyes of 41 patients were included in the first group, 24 eyes of 24 patients in the second group. We indicated for surgery only patients with IMH stage 2-4 according to the Gasse classification. Best corrected visual acuity (VA) was always determined before and two months after surgery. Furthermore, a comparison of both techniques was made according to the average letter gain after surgery, and the effect of surgery was evaluated using OCT with regard to whether IMH closure succeeded. For both techniques, 25G PPV with SF6 tamponade was performed. Hole closure took place in 41 eyes with conventional ILM removal. In one eye, the hole did not close even after reoperation with the same technique. Median ETDRS letter gain was 7.0. VA remained the same in 2 eyes (4.7%), worsened in 7 cases (16.2%), and improved in all other cases (79.0%). In 16 eyes (37.2%), VA improved by 2 or more lines of ETDRS charts. Using the inverted flap technique, the hole was closed in all 24 monitored eyes. Median ETDRS letter gain was 9.5. VA remained the same in 2 eyes (8.3%), worsened in 2 cases (8.3%), and improved in all other cases (83.3%). In 12 eyes (50.0%), VA improved by 2 or more lines of ETDRS charts. There were no serious complications intraoperatively or postoperatively. Our study demonstrated the safety and efficacy of both methods. Although the results were not statistically significant, the inverted flap technique recorded a greater ETDRS letter gain (9.5 vs. 7.0) and proportion of closed holes (100% vs. 95.3%) compared to the conventional ILM peeling technique in our set of eyes.

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.