Idiopathic Macular Hole Research Articles

The Outcome Of The Inverted Internal Limiting Membrane Flap Technique For The Repair Of Large Idiopathic Macular Holes.

Full-thickness macular hole is defined as an anatomical defect in the fovea that spans from the internal limiting membrane to the retinal pigment epithelium, assessed by spectral domain optical coherence tomography. The Objectives of the study are to determine the anatomical and visual outcome in patients undergoing pars plana vitrectomy along with inverted internal limiting flap closure in large idiopathic full-thickness macular holes (>400 μm). A prospective interventional study was conducted at a tertiary teaching eye hospital in Karachi, where patients of either gender and having macular holes greater than >400 μm were recruited. The study was conducted From January 9 to July 8, 2022, and all patients underwent pre-operative fundus examination and pars plana vitrectomy with inverted ILM flap closure. Data was entered and analyzed using SPSS 23. Follow-ups were conducted at 1 and 3 months. A total of 94 patients were enrolled with a mean age of 49.17±13.8 years. The mean duration of symptoms was 3.1±1.4 months. The mean pre-operative macular hole diameter was 854.31±08.36 μm and Stage 3 and 4 MH was present in 36.2% and 63.8% of patients, respectively. Anatomical closure was achieved in 93.6% of eyes (n=88/94). Pre-operative mean BCVA was LogMAR 0.90±0.24, which improved to LogMAR mean 0.70±0.27 at the final follow-up. As of the last follow-up, 92.6% of patients showed improved visual outcomes, with a mean three-line improvement in Snellen lines. After data stratification, no statistically significant result was obtained. The use of the inverted ILM flap technique resulted in improved anatomical and visual outcomes, in cases of large idiopathic macular holes.

Perfluoro-n-octane-assisted Superior Inverted ILM Flap without Using the Peeling-off Technique for Large Macular Holes

Purpose: To evaluate the surgical outcomes of a perfluoro-n-octane (PFO)-assisted superior inverted internal limiting membrane (ILM) flap without the peeling-off technique for the treatment of a large macular hole (MH).Methods: This retrospective interventional case series examined 13 eyes with a MH ≥ 400 μm. All eyes underwent 25-gauge pars plana vitrectomy. An ILM flap stained with 0.025% brilliant blue G was made in the superior area of the hole. The ILM in the temporal, nasal, and inferior areas around the hole was not peeled off. The hole was gently covered using the inverted ILM flap, which was stabilized using a small amount of PFO. Fluidair exchange was performed slowly. The small amount of residual PFO was removed by evaporation. The patients were instructed to maintain a facedown position for 1 day postoperatively. Anatomical closure of the hole and visual acuity were assessed postoperatively.Results: The average hole size was 605.08 ± 102.41 μm. Nine eyes had an idiopathic MH, two exhibited age-related macular degeneration, and one each had high myopia and a traumatic MH. All eyes achieved type I closure. The foveal contour improved gradually during follow-up: 92.3% of eyes had a U-shaped fovea, and 61.5% exhibited complete recovery of the ellipsoid zone. The visual acuity improved from 0.91 to 0.55 logarithm of the minimum angle of resolution (<i>p</i> = 0.003).Conclusions: The PFO-assisted superior inverted ILM flap without peeling-off was effective for stabilizing the flap over the hole and consequently achieving good anatomical and visual outcomes in large MHs.

Reducing time to surgery in patients affected by idiopathic full thickness macular holes.

Reducing time to surgery in patients affected by idiopathic full thickness macular holes.

Clinical characteristics and surgical prognosis of idiopathic macular holes with epiretinal proliferation.

To investigate the clinical features and surgical outcomes of idiopathic macular holes (IMHs) with epiretinal proliferation (EP). This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for IMHs. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity (BCVA), and postoperative closure rate were compared between eyes with and without EP. EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P < 0.001), and a larger base diameter (P = 0.014) than those without EP. Additionally, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and thicker central fovea (P = 0.012) at 1 month postoperatively; a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively. The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.

Reply to comment on: Conventional internal limiting membrane peeling versus inverted flap for small-to-medium idiopathic macular hole: a randomized trial.

Ventre, Luca MD*; Fallico, Matteo MD, PhD†; Longo, Antonio MD, PhD†; Parisi, Guglielmo MD*; Russo, Andrea MD, PhD†; Bonfiglio, Vincenza MD‡; Marolo, Paola MD*; Caselgrandi, Paolo MD*; Avitabile, Teresio MD†; Borrelli, Enrico MD§; Reibaldi, Michele MD, PhD* Author Information

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.

Влияние различных факторов на прогнозирование функционального результата при хирургии больших сквозных идиопатических макулярных разрывов

Purpose.To evaluate the effect of various factors on the prognosis of functional outcome after surgical treatment of large macular holes. Materials and methods. The results of surgical treatment of idiopathic macular holes (over 400 µm) in 47 patients (47 eyes) were analyzed. Endovitreal intervention of 25 or 27 G was performed with removal of epiretinal membrane and air tamponade. Results. Mean values of the best corrected visual acuity (BCVA) and retinal photosensitivity have been significant improved postoperatively: BCVA – from 0,12 ± 0,1 to 0,24 ± 0,18 (p&lt;0,01), photosensitivity – from 20,07 ± 3,85 dB to 21,43 ± 3,44 dB (p&lt;0,05). The mean value of the predicted BCVA according to the maximum hole diameter was 0.21 ± 0.0898. There was no dependence of BCVA on patients' age, duration of macular hole (more than 6 months) and anterior-posterior eyeball size (p&lt;0.05). Conclusion. Prediction of visual acuity after surgery is dependent by the initial retinal photosensitivity in the macular zone as well as the maximal diameter of the macular hole. Key words: idiopathic macular hole, microperimetry, vitrectomy, optical coherence tomography

Особенности хирургического лечения макулярного отверстия с атипичной эпиретинальной тканью: серия клинических случаев

Purpose. To present the surgical features of successful repair of macular hole with atypical epiretinal proliferation. Material and methods. A retrospective analysis of the treatment of 4 patients with macular hole-associated epiretinal proliferation. All patients underwent a preoperative examination – a standard ophthalmological examination, optical coherence tomography of the macular area with hole diameter measurement, confirmation of the presence of epiretinal tissue. Surgery consisted of the stages: vitrectomy, staining of the epiretinal tissue, its careful exfoliation with end-griping forceps, cutting off the floating part by a vitrector using «shaving» mode and preserving the remnants of the tissue around the edges of the hole, finishing with air tamponade. During the postoperative period the patient followed the «face down» position continuously for 3 hours. Results. In all cases the best corrected visual acuity (BCVA) increased and closure of the macular hole was achieved. Conclusions. 1. Surgical treatment of a macular hole with atypical epiretinal tissue has specific features that are not characteristic of the traditional treatment of an idiopathic macular hole. 2. The presence of a fixed perifoveal border of epiretinal tissue is an intraoperative feature. 3. Preservation of the perifoveolar border of epiretinal proliferation contributes to the closure of the macular hole without any additional mechanical manipulations or the use of biological adjuvants. 4. For a better understanding of the regenerative properties of epiretinal proliferation, it is necessary to increase the study sample, as well as to conduct histological studies of this tissue. Keywords: macular hole, epiretinal proliferation, atypical tissue, yellow tissue, perifovea corona phenomenon

Expression levels of ROS and Atg proteins in the vitreous in rhegmatogenous retinal detachment.

To detect the concentrations of reactive oxygen species (ROS), transient receptor potential mucin-1 (TRPML1), and autophagy-related (Atg) proteins (LC3-I, LC3-II, and Beclin1) in vitreous humor of patients with simple rhegmatogenous retinal detachment (RRD). RRD patients enrolled as the RRD group, and patients with idiopathic macular hole (IMH) and idiopathic macular epiretinal membrane (IMEM) were enrolled as control group. The levels of ROS, TRPML1, LC3-I, LC3-II, and Beclin1 in vitreous humor of patients in the RRD and control groups were detected by enzyme-linked immunosorbent assay (ELISA). The RRD group included 28 eyes 28 patients and had a higher concentration of ROS in vitreous humor (631.86±18.05 vs 436.34±108.22 IU/mL, P<0.05). The ROS level in patients with a wide retinal detachment (RD) extent (RD range ≥1/2) was higher than that with a narrow RD extent (RD range<1/2, P<0.05). ROS concentration was negatively correlated with RD time (r=-0.46, P=0.01). The expression levels of LC3-I and Beclin1 significantly decreased in RRD (P<0.05), but there were no correlations with the RD time, RD extent, or macular involvement. In eyes with RRD, the concentration of ROS in vitreous humor increases and the expression levels of Atg proteins decrease, reflecting possibly that autophagy is inhibited.

Association between Systemic Factors and Vitreous Fluid Cytokines in Proliferative Diabetic Retinopathy.

Proliferative diabetic retinopathy (PDR) is a vision-threatening complication of diabetes mellitus (DM). Systemic and intraocular factors are intricately related to PDR, and vitreous fluid (VF) cytokines are representative intraocular biomarkers. However, the associations between systemic factors and VF cytokines and their influence on PDR pathology are unclear. This study aimed to examine the correlation between systemic factors and VF cytokines and analyze their contributions to the pathology of PDR using multivariate analyses. We conducted a retrospective observational study on 26 PDR eyes of 25 patients with type 2 DM, and 30 eyes of 30 patients with idiopathic macular hole or epiretinal membrane as controls. Fifteen systemic and laboratory tests including blood pressure (BP) and body mass index (BMI), and 27 cytokines in VF were analyzed. BP and BMI correlated positively with VF levels of IL-6 and IP-10 in PDR patients, while no significant correlation was found between systemic factors and VF cytokines in controls. MCP-1 and VEGF-A in VF separately clustered with different systemic factors in controls, but these cytokines lost the property similarity with systemic factors and acquired property similarity with each other in PDR. Systemic factors contributed to only 10.4%, whereas VF cytokines contributed to 42.3% out of 52.7% variance of the whole PDR dataset. Our results suggest that intraocular factors play a major role in the pathology of PDR, whereas systemic factors may have limited effects, and that BP and BMI control in PDR could be useful interventions to improve intraocular immune condition.

Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery.

To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.

Mechanisms of the therapeutic effect of platelet-rich plasma in macular hole surgery

Purpose: to describe the mechanisms of the therapeutic effect of platelet-rich plasma (PRP) components on the retina in macular hole (MH) surgery. Material and methods. The results of autologous PRP use in 36 cases of surgical treatment of eyes with idiopathic full-thickness MH sized 96 to 932 mm (ave. 546.4 ± 49.8 mm) are presented. Corrected visual acuity before surgery was 0.04 to 0.2 (0.09 ± 0.01). The quantity of cell elements in PRP fractions was determined using a hematological analyzer Sysmex XS-500i (Germany). Results: 2 months after the operation, all retinal layers in the MH area were found to restore in all patients, who showed an increase in visual acuity to 0.2–0.6 (0.40 ± 0.04). 35 patients (97 %) had no MH relapse over the 6-month post-surgery period. A technique was proposed to evaluate the quality of PRP by the presence of large platelets. The mechanisms of the therapeutic effect of PRP components on the retina were presented. Conclusion. The collection of data on the effectiveness of PRP components is instrumental in planning its wider use in the treatment of degenerative, infectious, post-traumatic and other disorders of eye structures. The evaluation of PRP quality by the content of functionally active platelets will also contribute to more effective PRP use in ophthalmology.

Aberrant lncRNA expression in patients with proliferative diabetic retinopathy: preliminary results from a single-center observational study

BackgroundDiabetic retinopathy (DR) is a leading cause of blindness. Vision threat is particularly severe in patients with retinal neovascularization. However, little is known about the role of long noncoding RNAs (lncRNAs) in proliferative diabetic retinopathy (PDR). The goal of this study was to identify lncRNAs involved in PDR.MethodsWe compared lncRNA expression profiles in the vitreous between patients with PDR and those with idiopathic macular hole (IMH) and between patients with PDR who had received anti-vascular endothelial growth factor (VEGF) therapy and those who had not. Vitreous samples from patients with PDR and IMH were screened for lncRNAs using microarray-based analysis, and quantitative real-time polymerase chain reaction (qRT-PCR) was used to confirm the microarray results. Bioinformatic analysis was also performed. Moreover, the effect of anti-VEGF therapy was investigated in vitreous samples of patients with PDR treated with anti-VEGF therapy and those who were not.ResultsA total of 1067 differentially expressed noncoding RNA transcripts were found during screening in the vitreous humor of patients with PDR than in those with IMH. Five lncRNAs were subjected to qRT-PCR. RP11-573 J24.1, RP11-787B4.2, RP11-654G14.1, RP11-2A4.3, and RP11-502I4.3 were significantly downregulated; this was validated by the comparison using the microarray data. In addition, 835 differentially expressed noncoding RNA transcripts were found during screening in the vitreous humor of patients with PDR treated with anti-VEGF therapy compared with untreated PDR patients. RP4-631H13.2 was significantly upregulated, which is consistent with the trend of the microarray analysis.ConclusionsThere were systemic expression differences in the vitreous at the microarray level between patients with PDR and those with IMH and between patients with PDR after anti-VEGF treatment and those that did not receive anti-VEGF treatment. LncRNAs identified in the vitreous humor may be a novel research field for PDR.

Stage or size? The identity of anatomical and visual outcomes in stage 3 and stage 4 idiopathic macular holes after vitrectomy

BackgroundSeveral previous reports suggested that stage 4 idiopathic macular holes (IMHs) may exhibit lower rate of anatomical success and poorer functional results comparing with stage 3 IMHs, while some others showed no differences. Actually, few studies focused on comparison of prognosis between stage 3 and stage 4 IMHs. Our previous study found that IMHs of these two stages demonstrate similar preoperative characteristics, and this study aims to compare anatomical and visual outcomes of IMHs between stage 3 and stage 4, and tries to figure out the outcome-associated factors.MethodsThis retrospective consecutive case series reviewed 317 eyes with IMHs of stage 3 and stage 4 from 296 patients who underwent vitrectomy with internal limiting membrane peeling. Preoperative characteristics like age, gender, and hole size, and intraoperative interventions such as combined cataract surgery were evaluated. Outcome measures included the primary closure rate (type 1), best-corrected visual acuity (BCVA), foveal retinal thickness (FRT) and prevalence of outer retinal defect (ORD) at the last visit. The pre-, intra-, and post-operative information were respectively compared between stage 3 and stage 4.ResultsThe preoperative characteristics and intraoperative interventions exhibited no significant differences between stages. With comparable follow-up durations (6.6 vs. 6.7 months, P = 0.79), IMHs of the two stages exhibited similar primary closure rate (91.2% vs. 91.8%, P = 0.85), BCVA (0.51 ± 0.12 vs. 0.53 ± 0.11, P = 0.78), FRT (134.8 ± 55.5 μm vs. 138.8 ± 60.7 μm, P = 0.58), and prevalence of ORD (55.1% vs. 52.6%, P = 0.39). IMHs, either < 650 μm or larger, exhibited no significant difference in outcomes between the two stages. However, smaller IMHs (< 650 μm) demonstrated higher rate of primary closure (97.6% vs. 80.8%, P < 0.001), better postoperative BCVA (0.58 ± 0.26 vs. 0.37 ± 0.24, P < 0.001), and thicker postoperative FRT (150.2 ± 54.0 vs. 104.3 ± 52.0, P < 0.001) comparing with larger ones regardless of stage.ConclusionIMHs of stage 3 and stage 4 exhibited considerable identity of anatomical and visual outcomes. In large IMHs, the hole size, instead of stage, may be more important for prediction of surgical outcomes and choice of surgical techniques.

Corneal densitometry: an innovative method to quantitatively evaluate corneal changes after phacovitrectomy

BackgroundTo quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy.MethodsThirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy.ResultsECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0–2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2–6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0–2 mm zone was positively correlated with CCT. Posterior CD in the 0–2 mm zone was negatively correlated with ECD and HEX.ConclusionsCD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair.Trial registrationThis study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554).

PREDICTION OF MACULAR HOLE SIZE PROGRESSION BASED ON BASELINE OPTICAL COHERENCE TOMOGRAPHY FINDINGS.

To quantify the rate of idiopathic macular hole progression from presentation and identify factors that may influence stratification and urgency for surgical listing based on the initial optical coherence tomography scans. The minimal linear diameter (MLD), base diameter (BD), and hole height on nasal and temporal sides of idiopathic macular hole were measured on spectral domain optical coherence tomographies, on initial presentation and just before surgery. Mean hole height, hole height asymmetry (absolute difference between nasal and temporal height), MLD/BD, and MLD change per day (MLD/day) were calculated for each patient. Multivariable linear regression analysis with MLD/day as the dependent variable was performed to identify significant risk factors for MLD progression. Minimal linear diameter was grouped to quintiles: 1: ≤290 µ m, 2: >290 µ m and ≤385 µ m, 3: >385 µ m and ≤490 µ m, 4: >490 µ m and ≤623 µ m, and 5: >623 µ m. In 161 eyes (157 patients), we report significant associations with MLD/day: 1) MLD/BD ( P = 0.039) (i.e., wide BD relative to MLD lead to faster progression of MLD), 2) hole height asymmetry ( P = 0.006) (larger absolute difference between nasal and temporal hole height lead to faster progression), and 3) days between scans ( P < 0.001) (longer duration between scans had reduced MLD/day, indicating more rapid increase initially then plateaux), and relative to MLD Quintile 1, MLD Quintile 3 ( P = 0.002) and MLD Quintile 4 ( P = 0,008), and MLD Quintile 5 ( P < 0.001) all lead to a reduced MLD/day rate on multivariable regression. In addition to finding that the previously reported initial smaller MLD is a risk factor for rapid MLD progression, we report two novel findings, large hole height asymmetry and a low MLD/BD (wide base relative to MLD), that represent significant risk factors. These factors should be taken into consideration on presentation to stratify timing of surgery.

The effect of retinal perfusion on the bioelectric activity of the retina in full-thickness macular holes

BACKGROUND: Information on retinal capillary perfusion in idiopathic full-thickness macular hole (FTMH) is limited, and there are no data on the possible effect of blood supply to individual areas and layers of the retina on their functional activity.&#x0D; AIM: To study the relationship between vascular perfusion in the superficial and deep capillary plexuses (SCP and DCP) and the bioelectrical activity of the retina in full-thickness macular hole.&#x0D; MATERIALS AND METHODS: Multifocal electroretinography (mfERG), optical coherence tomography (OCT), and OCT-angiography (OCTA) were performed in 18 eyes with FTMH and 10 intact eyes. In the projection of individual hexagons of the mfERG pattern, parameters of bioelectrical activity were compared with structural changes (hole, cystic changes), capillary density in the SCP and DCP.&#x0D; RESULTS: In the FTMH group, the density of capillaries in the superficial capillary plexuses correlated with P1 implicit time in the R2 ring hexagons (R = 0.23, p 0.05), in the hole zone and intraretinal cystic changes (R = 0.21 and R = 0.22, p 0.05), P1 amplitude in the hole zone (R = 0.24, p 0.05). In deep capillary plexuses, the capillary density correlated with N1 implicit time at the fixation point and the hole zone (R = 0.57 and R = 0.19, p 0.05), P1 implicit time at the hole zone (R = 0.2, p 0.05), P1 amplitude in the hexagons of the R2 and R3 rings (R = 0.46 and R = 0.44, p 0.05), more pronounced in the hole zone and cystic changes (R = 0.54 and R = 0.29, p 0.05).&#x0D; CONCLUSIONS: There is a correlation between capillary perfusion in different layers of the retina and its bioelectrical activity in FTMH. A decrease in perfusion in the deep capillary plexus of the macula with a chronic macular hole may be a predictor of a low functional prognosis in the outcome of surgical treatment of FTMH.

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.

The effect comparison of ILM flap and traditional ILM peeling in iMH.

To compare the changes in anatomical structure and visual function after idiopathic macular hole (iMH) treatment with internal limiting membrane (ILM) peeling and inverted ILM flap and determine the value of the inverted ILM flap for the treatment of iMH. Forty-nine patients with iMH (49 eyes) were included in this study and followed up for 1 year (12 months) after treatment with inverted ILM flap and ILM peeling respectively. The main foveal parameters assessed included the preoperative minimum diameter (MD), intraoperative residual fragments, and postoperative ELM reconstruction. Visual function was assessed using best-corrected visual acuity. The hole closure rate was 100% for 49 patients; 15 patients were treated with the inverted ILM flap, and 34 patients underwent ILM peeling. There were no differences between the postoperative best-corrected visual acuities and the rates of ELM reconstruction for the flap and peeling groups with different MDs. In the flap group, ELM reconstruction was associated with the preoperative MD, presence of an ILM flap, and hyperreflective changes in the inner retina 1 month after surgery. In the peeling group, ELM reconstruction was associated with the preoperative MD, intraoperative residual fragments at the hole edge, and hyperreflective changes in the inner retina. The inverted ILM flap and the ILM Peeling were both able to obtain high closure rate. However, the inverted ILM flap showed no obvious advantages related to anatomical morphology and visual function over ILM peeling.

Long-term effects of combined brilliant blue G and xenon light induced retinal toxicity following macular hole repair surgery

BackgroundThe purpose of this study was to look at the long-term effects of retinal phototoxicity after macular hole repair surgery using xenon endolight illumination and Brilliant blue G (BBG) dye.Case presentationAn elderly man in his late seventies underwent para plana vitrectomy with BBG dye to repair an idiopathic full-thickness macular hole (MH) in his right eye. Prior to macular hole surgery, his visual acuity in the right eye was 6/60, N24 at the time of presentation. The MH closed with type 1 closure immediately after surgery, but there was extensive damage to the outer retinal layers and retinal pigment epithelium (RPE) at the macula, resulting in a reduction in visual acuity to 2/60. We presumed that the combination of BBG and xenon light, is the probable reason of retinotoxicity in the current patient. There was a progressive increase in the area of retinal and RPE layer damage and choroidal thinning over a 4-year period.ConclusionDue to combined BBG-induced dye and endoilluminator toxicity, a rare case of continuously progressing RPE layer damage with choroidal thinning over a long follow-up interval was described. Such long-term effects of BBG and endolight induced retinotoxicity have not been reported in the literature, to the best of our knowledge.