Large Macular Holes Research Articles

Extended Internal Limiting Membrane Peeling in the Management of Unusually Large Macular Holes

This study was conducted to determine the feasibility, efficacy, and safety of internal limiting membrane peeling in the management of large macular moles. Two patients whose eyes had macular holes measuring 1,147 and 773 microns in diameter, respectively, were treated by pars plana vitrectomy with extended internal limiting membrane peeling and the injection of long-acting gas. Preoperative and postoperative assessment of the macular holes was done by optical coherence tomography. Postoperatively, the macular holes closed and there was improvement in visual acuity. Extended internal limiting membrane peeling can be performed to achieve surgical success in very large macular holes.

Optical coherence tomography for precise localization of inapparent retained foreign body in ocular coats.

To report the use of optical coherence tomography (OCT) for precise localization of inapparent, retained foreign body in ocular coats. A 30-year-old man presented with diminution of vision in left eye of 1 year duration. Visual acuity was 20/400. Ocular examination revealed a large macular hole. An impacted foreign body in the ocular coats was suspected and picked up with ultrasound B scan although orbital computed tomography scan failed to detect any foreign body. OCT helped in precise localization of intraocular foreign body, enabling its removal through the macular hole following vitrectomy. At 6 weeks follow-up, macular hole was closed and visual acuity improved to 20/100, N36. Repeat OCT did not reveal any foreign body. OCT is a useful adjunct for precise localization of retained, inapparent intraocular foreign body in the ocular coats.

Vitreomacular traction syndrome with an outer macular hole.

To describe a patient with a large idiopathic partial-thickness macular hole involving the outer layers of the retina. We performed complete ophthalmologic examination, including fluorescein angiography, B-scan ultrasonography, and optical coherence tomography, on an 81-year-old woman who was referred to our department with the clinical suspicion of a stage 3 full-thickness macular hole in the left eye. After complete ophthalmologic examination, the patient was diagnosed with vitreomacular traction syndrome due to a prefoveal partial posterior vitreous detachment causing tangential outward traction on the fovea. In this case, vitreomacular traction was associated with macular detachment and was complicated by retinoschisis and an idiopathic partial-thickness macular hole, in the absence of either high myopia or an optic nerve pit. To our knowledge, this is the first reported case of a large idiopathic partial-thickness macular hole sharing common features with macular schisis, in the absence of either high myopia or an optic disk pit.

Makulaforamenchirurgie heute - ein Überblick

Macular holes are staged according to the size of the hole and the presence or absence of a posterior vitreous detachment. Since the first report on successful macular hole surgery in 1991, surgical techniques have been refined and have helped to increase anatomic and functional success rates. Macular hole surgery today consists of vitrectomy, ILM peeling (especially in larger macular holes) with or without using vital dyes such as indocyanine green, trypan blue or as very recently suggested, brilliant blue, followed by endo-tamponade and prone position for a few days. Especially ICG staining has become a subject of controversial discussion as functional success might be diminished due to the phototoxic properties of the dye. Imaging techniques such as OCT may not only serve as prognostic factors for visual recovery, but may also help to explain unsatisfactory visual recovery despite anatomic hole closure. According to the current literature, macular hole surgery can be recommended independently from the preoperative visual acuity and duration of symptoms, as a significant visual improvement can be achieved in almost all cases.

Current and future concepts in macular hole surgery

Since the first report on successful macular hole surgery in 1991, surgical techniques have been refined and have helped to increase anatomical and functional success rates. Macular hole surgery today consists of vitrectomy, internal limiting membrane peeling (especially in larger macular holes) with or without the use of vital dyes, such as indocyanine green, trypan blue or, as very recently suggested, brilliant blue, followed by endotamponade and prone position for a few days. Indocyanine green staining, in particular, has become a controversial subject of discussion as functional success might be diminished due to the phototoxic properties of the dye. Imaging techniques, such as optical coherence tomography, may not only serve as prognostic factors for visual recovery, but may also help to explain unsatisfactory visual recovery despite anatomical hole closure.

FULL-THICKNESS MACULAR HOLE FORMATION IN IDIOPATHIC PARAFOVEAL TELANGIECTASIS

To describe the macular holes in patients with idiopathic parafoveal telangiectasis (IPT) and to propose a pathophysiologic explanation for their formation. Four eyes of two patients with IPT were evaluated with biomicroscopy and optical coherence tomography (OCT). One patient had a nearly full-thickness hole with preservation of only the internal limiting membrane (ILM), but had a 20/60 visual acuity. The other patient had a large full-thickness macular hole, but retained 20/40 visual acuity. Each patient had a fellow eye showing prominent central inner foveal cavitation under a very thin ILM, which was devoid of associated tissue. This report describes the findings of two patients with IPT who developed pronounced central foveal structural abnormalities. The induced anatomic changes noted in our patients suggest that there is a loss of the structural aspects afforded by Muller cells, particularly the Muller cell cone, in the central macula in patients with IPT. The preservation of good visual acuity in our patients implies that the holes were the result of lateral separation of the photoreceptors within the fovea and that there could not have been profound atrophy of the photoreceptors.

Macular hole surgery in alport syndrome.

Alport syndrome, an X-linked disease, includes progressive hematuric nephritis leading to renal failure, hearing loss, and ocular changes including macular holes. Females have a more variable systemic and ophthalmic course compared to males. Macular holes have been described mostly in males, but not with therapeutic attempts. A case report of a woman with large bilateral macular holes who underwent anatomically successful macular hole surgery in one eye. A 30-year-old woman with a 9-year history of decreased vision, probably due to bilateral macular holes, complained of progressive visual loss. Visual acuity was 20/400 in the right eye and 20/800 in the left. Optical coherence tomography showed large macular holes, measuring 1350 μm in the right eye and 2050 μm in the left. Visual acuity improved to 20/80 after macular hole surgery in the right eye using standard techniques. Abnormal collagen synthesis may account for many findings in Alport syndrome. Its role in macular hole pathogenesis may be to accelerate passage of fluid through a structurally abnormal Bruch membrane yielding microcystic cavities which may coalesce and rupture, or due to potentiated vitreoretinal traction at the vitreoretinal interface. Macular hole surgery may benefit selected patients.

Macular hole: Perceptual filling-in across central scotomas

The present study examined perceptual distortions of a vertical line before and after macular hole (MH) surgery in 25 eyes of 24 patients. Participants’ perceptual reports of distortions were classified as solid, bent right/left, thinned at the center, or broken. The majority of patients (72%) reported symmetrical distortions of the line pre-operatively. After surgery, participants with larger MHs were more likely to retain residual distortions. Of particular interest is the group reporting thinning of the line preoperatively, as the center should be perceptually missing. Examination of MH diameters in relation to the line perceptions indicated that the shape of the perceived line can be explained at the retinal level, while its continuity must be perceptually created at the cortical level.

Laser Photocoagulation as Adjuvant Therapy to Surgery for Large Macular Holes

PurposeTo evaluate the effectiveness of laser photocoagulation as adjuvant therapy in the treatment of large macular holes.MethodsA randomized clinical trial. Thirty-one eyes from 29 subjects with idiopathic macular holes of diameters larger than 400 µm were randomized into a laser group and a control group. All eyes underwent vitrectomy with peeling of the internal limiting membrane. Contrary to the control group eyes, the laser group eyes underwent laser photocoagulation at the center of the macular hole before vitrectomy. Visual acuity and anatomic outcomes assessed by optical coherence tomography (OCT) were analyzed 3 months after surgery.ResultsOn postoperative OCT, closure of the macular hole was noted in 17 of the 18 (94.4%) laser group eyes and 10 of the 13 (76.9%) control group eyes. Hole closure without bare retinal pigment epithelium was observed in 16 eyes in the laser group and 6 eyes in the control group (P<0.05). The amount of improvement in logMAR visual acuity 3 months after surgery was 0.40±0.29 in the laser group, and 0.19±0.23 in the control group (P<0.05).ConclusionsLaser photocoagulation constitutes a potent adjuvant therapy that may improve anatomical and visual outcomes of surgery for macular holes larger than 400 µm.

Severe ocular involvement in disseminated intravascular coagulation complicating meningococcaemia

Disseminated intravascular coagulation (DIC) is characterized by inappropriate widespread activation of coagulation leading to extensive microvascular thrombosis and haemorrhage. Ocular involvement typically manifests as fibrin-platelet clots in the choroidal vessels of the posterior pole with overlying serous retinal detachment and sparing of the retinal vessels. Case report. An 18-year-old female with meningococcal septicaemia and DIC developed bilateral dense vitreous haemorrhage. At vitrectomy multiple areas of sub-internal limiting membrane haemorrhage were evacuated and silicone oil injected. The patient developed bilateral large macular holes with inferior tractional retinal detachment. Two years later, final visual acuity was 6/36 OD and count fingers OS. Ocular involvement in DIC can be more extensive than choroidal vascular occlusion alone. Previous reports suggest that DIC associated with sepsis (especially meningococcaemia) may present with more severe manifestations. This may be due to sub-clinical endophthalmitis or haemorrhagic ischemia. Visual prognosis can be poor.

Spontaneous closure of a large traumatic macular hole in a young patient

PURPOSE: To report the spontaneous resolution of a traumatic macular hole that was considerably larger than in previously reported cases. DESIGN: Observational case report METHODS: The clinical and angiographic data of the patient were reviewed. RESULTS: A traumatic 600 × 400 μ macular hole was observed to spontaneously resolve 5 weeks after trauma in a 15-year-old patient. Visual acuity only slightly improved consequently (from counting fingers at 4 meters to 20/200). The clinical appearance of the fovea after macular hole resolution raised the suggestion that a postconcussion retinal necrosis was the mechanism behind the lesion formation in this case. CONCLUSIONS: Spontaneous resolution of a traumatic macular hole is an outcome not limited to small lesions. Larger macular holes may represent retinal tissue loss and consequently a less favorable visual prognosis.