Macular Break Research Articles

Autologous Tenon's capsule graft for the management of subfoveal detachment due to myopic paracentral macular break.

To report a novel surgical technique using an autologous Tenon capsule graft (ATG) after vitrectomy for treating paracentral breaks in pathological myopia. A single case report of a patient with incipient subfoveal detachment and a paracentral break. Pars plana vitrectomy was performed, and next, an ATG was harvested and tucked into the break, followed by final air endotamponade. After only two days, the ATG effectively plugged the paracentral break and optical coherence tomography demonstrated complete resolution of foveoschisis and subfoveal detachment. The ATG plug offers a promising alternative for the management of paracentral breaks in eyes with pathological myopia, especially those refractory or secondary to previous surgeries. Further studies will be necessary to evaluate its long-term outcomes and safety.

Хирургическое лечение больших идиопатических макулярных разрывов лепестками внутренней пограничной мембраны с насечками

Purpose. To study the results of surgical treatment of patients with large diameter idiopathic macular breaks by the proposed method of closing the defect with inverted petals of the internal limiting membrane with incisions. Material and methods. There were analyzed clinical results of surgical treatment of idiopathic macular breaks (IMB) by closing the defect with inverted lobes of the internal limiting membrane with incisions in 25 patients (25 eyes) between 45 and 63 years old. Men – 11 (44%), women – 14 (56%). Terms of treatment in the hospital since the appearance of changes in visual functions: 6 patients after 1.5-2 years, 19 patients after 6-8 months. Visual acuity at admission was: 0.01 in 4 patients; 0.02 in 5; 0.03 in 5; 0.06-0.09 in 6; 0.1-0.3 in 5. Macular ruptures were stage III, diameter from 450 to 730 microns (on average, 594.52± 114.06 microns). The follow-up period is 3 years. Results. In 25 patients underwent 25G endovitreal intervention with closing of the macular hole with the petals of internal limiting membrane. The visual acuity improvement was observed in 23 patients: up to 0,1 – 0,6 – in 20; up to 0,09 – in 3. In 2 patients visual acuity was 0.01-0.02, this may be due to incomplete closure of the macular opening and the duration of the disease. After 3 years of visual function remained stable. Conclusion. The use of inverted petals of internal limiting membrane in the treatment of large diameter IMB contributes to the closure of the macular breaks and restoration of the anatomical profile of the macular in 92% of cases. The increase of visual acuity up to 0.1 – 0.6 in 80% of cases. The stability of clinical results up to 3 years allows us to recommend this method of treatment in practice.

Первый опыт применения аутологичной кондиционированной плазмы в хирургии полных макулярных разрывов в БУЗ ВО «ВОКОБ»

Purpose. To evaluate the effectiveness of the use of autologous conditioned plasma in the surgical treatment of complete macular ruptures. Material and methods. During 2021, 4 patients with complete macular rupture were operated on at the center of ophthalmic microsurgical high-tech care of the Voronezh Regional Clinical Ophthalmological Hospital using autologous conditioned plasma. The BCVA was 0.01–0.3. The diameter of the macular breaks ranged from 214 to 817 µm. Blood samples were taken from the patients before the operation. Autologous conditioned plasma was prepared by centrifuging the patient's blood in a patented Arthrex ACP (Germany) double-circuit syringe. Surgical treatment was carried out according to the standard technique - microinvasive three-port 25G vitrectomy with removal of the BMR to the extreme periphery and IPM in the central part of the retina. After tamponade of the vitreous cavity with air, autologous conditioned plasma was injected intravitreally into the central and peripheral rupture in several layers until a visual film appeared. The follow-up period for patients after surgical treatment was 2 months. Results. When examining patients after 1 week, the edges of the macular foramen remained closed in all cases. All studied patients noted an improvement in visual functions, the absence of metamorphopsia, a decrease in the dark "spot" in front of the eye, visual acuity ranged from 0.2 to 0.7 (0.5 + 0.2) after surgery for a complete macular rupture, and 0.02 in patients after surgery for recurrent macular rupture. After 1 month, the visual acuity after the full macular rupture was repaired after 1 month was 0.3–0.8 (0.6 ± 0.2), which was significantly higher than the preoperative values, and did not change in the patient with recurrent macular rupture. Two months later - the results of optical coherence tomography and visometry without negative dynamics. Conclusions. The early results of clinical observation confirmed the high efficiency of the use of autologous conditioned plasma in the surgical treatment of complete macular ruptures, which allows to obtain high functional results and anatomical closure of the macular rupture, to increase the efficiency and safety of rehabilitation. Key words: macular rupture, autologous conditioned plasma.

Clinical characteristics and prognostic factors of posterior segment intraocular foreign body in a tertiary hospital

BackgroundTo identify the clinical characteristics, prognostic factors and visual outcomes in posterior segment IOFBs patients managed by PPV in a tertiary hospital.MethodsA retrospective chart review was performed for 56 patients, who had PPV for IOFBs removal between November 2013 and November 2015. The mechanisms of injury, the nature of the IOFBs, the BCVA before and after the surgery, the penetrating site and the complications of the surgery were all collected. Univariate analyses were conducted to evaluate the prognostic factors.ResultsThe mean age of the patients was 36.4 years. The nature of IOFBs was mainly metal. Most injuries were commonly caused by hammering the metal. The mean preoperative VA was 2.30 logMAR, and mean final VA was 0.92 logMAR. From univariate analysis, good visual outcome was correlated with the good visual acuity before surgery and poor visual outcome was correlated with the macular break and multiple surgeries.ConclusionsIn a tertiary hospital of eastern China, most cases of IOFBs were work-related. The prognosis of the patients was really well in the patients with good presenting visual acuity. Nevertheless the prognosis was not good for those patients who had macular injury or underwent several surgeries because of retinal detachment, epiretinal membrane or proliferative vitreous retinopathy. Good facilities for eye protection are urgently in demand for the workers indeed.

Case of retinal detachment due to retinal break splitting macula vertically in a patient with cognitive disorder

We report a patient with cognitive disorder who had a rhegmatogenous retinal detachment (RRD). A 17-year-old Japanese man presented with a RRD with a vitreous hemorrhage in his right eye. An unusual vertical splitting of the macula accompanied by a giant retinal tear was observed intraoperatively. The retina was successfully reattached by pars plana vitrectomy with silicone oil tamponade and scleral buckling. Visual function appeared to have improved from the behavior of the patient. Although the precise mechanism causing the break which split the macula was not determined, self-inflicted blunt trauma to the eye was suspected.

Cellular Migration Associated With Macular Hole

To elucidate the pathogenesis of macular hole formation, focusing in particular on the possible role of cellular migration on the cortical vitreous and internal limiting membrane (ILM) around the macular hole. To gain a comprehensive overview of the ILM excised in macular hole surgery (n = 36), the ILMs were carefully unfolded and spread out onto glass slides as continuous flat sheets that each contained a macular hole. The specimens were observed by light microscopy and transmission electron microscopy (n = 9), and the cellular distribution was analyzed by scanning electron microscopy in a quantitative manner (n = 27). Immunohistochemistry for glial fibrillary acidic protein and cytokeratin 18 was carried out for cellular characterization. Cellular proliferation was assessed by immunohistochemistry for proliferating cell nuclear antigen and Ki-67. Cellular migration was not apparent around the macular hole in the early stage of development of the macular hole (stage 2, 0 microm). As the macular hole passed through the later stages of development, cellular migration developed around the macular hole (stage 3, 84 microm) and the area of cellular migration gradually enlarged (stage 4, 420 microm). The immunophenotypic analysis showed that these cells were mainly glial fibrillary acidic protein-positive glial cells and cytokeratin 18-positive retinal pigment epithelial cells. The proliferating cell nuclear antigen and Ki-67 immunohistochemistry showed that some of these cells were proliferating on the ILM. Cellular migration on the ILM is not necessary for the initial formation of a macular break. Cellular migration developed after the macular break occurred, and the migration and proliferation increased gradually from the macular hole. This study provides a new method for understanding the ultrastructural analysis of the pathogenesis of the macular hole.

Combined system of biomicroscopic vitreous videography and photography.

To combine the techniques of biomicroscopic vitreous videography and vitreous photography when examining patients with age- or disease-related vitreous changes. We performed biomicroscopic vitreous videography and photography using the newly developed digital photo camera (one-half-inch three-charged coupled device camera with high resolution of 800 x 800 television lines) connected to a slit-lamp biomicroscope and compared it with conventional 35-mm slit-lamp photography in 24 consecutive eyes of 19 patients with idiopathic macular breaks. Stage 1 macular breaks were found in three eyes, stage 2 in four eyes, stage 3 in 11 eyes, and stage 4 in six eyes. Both vitreous videographs and still photographs were recorded and reviewed rapidly in one system. Using this system, dynamic vitreous changes and still vitreous images were documented clearly with real-time television monitoring without using flash illumination. The still images obtained from this system were better than those obtained using conventional 35-mm slit-lamp photography in cases with stage 1, 2, and 3 macular breaks (P = 0.0000000001 by Fisher's exact test). This combined system of biomicroscopic vitreous videography and photography may become the standard system of biomicroscopic vitreous examination.

Spontaneous Resolution of Foveal Detachments and Macular Breaks

To evaluate the mechanism of spontaneous resolution of foveal detachments and idiopathic macular breaks. We reviewed the records of 139 consecutive eyes (94 patients) with either a foveal detachment or a macular break in patients who were examined between 1989 and 1992. There were 26 men and 68 women (mean age, 66.9 +/- 6.9 years). They were either unoperated on or observed during the period that preceded surgery. Each patient underwent complete ophthalmic examination in addition to slit-lamp photography of the vitreomacular interface and microperimetry with the scanning laser ophthalmoscope. Eight eyes demonstrated spontaneous resolution. A foveal detachment was noted in five eyes (five patients) and a stage 2 macular break in three eyes (three patients). The mean duration of observation was 33 months (range, one to 144 months). Resolution of the foveal detachments occurred without the development of posterior vitreous detachment. In each eye, the presence of a pseudo-operculum, indicating vitreofoveal separation, was accompanied by flattening of the foveal detachment without detectable posterior vitreous detachment. The three eyes with stage 2 macular break resolved after premature development of a posterior vitreous detachment. Foveal detachment and macular break resolution seem to result from the release or weakening of vitreous traction on the fovea. Reattachment of the foveal retina preserves fair to good visual acuity. Surgical intervention is contraindicated (1) in eyes in which foveal detachment flattens and develops a pseudo-operculum and (2) when a posterior vitreous detachment develops in an eye with a stage 2 macular break. Careful biomicroscopic vitreous examination and microperimetry with the scanning laser ophthalmoscope are extremely useful methods for adequate examination of these patients.

Tractional Elevation of Henle's Fiber Layer in Idiopathic Macular Holes

We sought to clarify the morphologic features of macular hole development. Using scanning laser ophthalmoscopy, we examined 47 eyes with macular holes before and after vitrectomy. Cases included three eyes with stage 1B disease (foveal detachment), 14 with stage 2 (break at the fovea), 21 with stage 3 (full-thickness macular hole), and nine with stage 4 (detached operculum), according to Gass's classification. Ten eyes with central serous chorioretinopathy served as controls. Radiating striae of Henle's fibers were seen around the elevated rim of the macular cyst or hole when the intraretinal structures were illuminated by helium-neon laser. Granularity was observed on the macular hole floor. A granular reflex corresponding to the macular break or hole, but no radiating striae were seen by argon blue laser. In 40 eyes in which macular holes were successfully closed by vitrectomy, radiating striae of Henle's fiber layer disappeared, and the normal foveal depression was restored. The ten eyes with central serous chorioretinopathy had a normal foveolar depression and no detectable radiating striae of Henle's fiber layer, despite full-thickness retinal detachment in the macular area. Tractional elevation of Henle's fiber layer with intraretinal foveolar cyst formation is the initial feature of macular hole development. A macular hole is formed when the anterior cyst wall containing Henle's fiber layer is operculated. Remnants of the photoreceptor cell layer remain on the hole floor in the early stage of macular hole development and subsequently degenerate.

Bilateral Macular Holes in von Hippel-Lindau Disease

von Hippel-Lindau disease is a member of the group of phakomatoses. It is characterized by formation of angiomas or hemangioblastomas in the retina, cerebellum, and occasionally in other tissues. Pheochromocytoma and renal cell carcinoma may also occur. Polycythemia can be seen, usually with cerebellar hemangioblastomas, renal cell carcinomas, or pheochromocytomas.1 The retinal tumors usually enlarge, and exudation from these lesions may lead to retinal detachment. Less commonly, peripheral retinal breaks may occur, leading to rhegmatogenous detachment.2This may occur after treatment of an angioma. I have observed a case with several unusual features. Preretinal membranes were present in both eyes, with spontaneous peeling in one eye and peeling after treatment of a peripheral angioma in the other eye. In both eyes, macular breaks resulted. In the treated eye, rhegmatogenous detachment occurred as a result of the macular break, along with traction originating from the treated lesion. The patient

Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks.

Between 1975 and 1989, 11 eyes were treated for retinal detachments with both peripheral and full thickness macular breaks. Long term retinal reattachment was dependent on successful closure of peripheral retinal breaks. Direct treatment of the macular break was necessary in only one case, which redetached 3 months after vitrectomy. Vitrectomy is not the initial treatment of choice for uncomplicated retinal detachments with both peripheral and full thickness macular breaks, unless required for the closure of the peripheral retinal breaks.

Pneumatic Retinopexy: A Collaborative Report of the First 100 Cases

The preliminary experience of one surgeon, using pneumatic retinopexy for 20 consecutive cases of rhegmatogenous retinal detachment, was previously reported. The collaborative experience of six surgeons using pneumatic retinopexy for 100 cases is now reported. This series includes cases with pseudophakia, aphakia, macular detachment, macular breaks, vitreous hemorrhage, trauma, and old detachments. Initially, 91% were reattached, but seven recurrences yielded a 6-month follow-up cure rate of 84% with pneumatic retinopexy. With subsequent scleral buckling, 98% were reattached. Postoperative complications included proliferative vitreoretinopathy (3%), macular pucker (3%), and new/missed retinal breaks (7%). A review of the literature disclosed postoperative new/missed retinal breaks in nine series: 21, 3, 8, 4, 9, 7, 5, 4, and 13%. There were no cases of glaucoma, cataract, subretinal gas, endophthalmitis, or extention of the detachment into a previously attached macula. Pneumatic retinopexy offers the advantages of reduced tissue trauma, fewer complications, no hospitalization, and less expense. The major disadvantage is the need for postoperative positioning.

Vitreous changes and macular disease.

Strong adhesions exist normally between the vitreous cortex and the retina in the macula (1). They may play a role in the occurrence and prognosis of macular diseases, particularly macular breaks, preretinal macular fibrosis (idiopathic or secondary), and cystoid macular edema. These conditions are directly related to vitreous changes, especially those producing vitreous traction. Macular conditions unrelated to vitreous changes such as senile macular degeneration and hereditary macular degenerations are not discussed here. Macular changes that result from peripheral uveitis are described in Chapter 7.KeywordsMacular HoleCystoid Macular EdemaPosterior Vitreous DetachmentMacular DiseaseIdiopathic Macular HoleThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Intraocular Cysticercosis

We observed and photographed intraocular cysticercosis in a 50-year-old woman. The subretinal cysticercus in the macular area produced a macular break during its passage from the subretinal space into the vitreous cavity. The parasite was removed by closed vitrectomy, but the macular break was left untreated because there was no vitreous traction to the macula. The patient ultimately developed a subretinal scar in the macular area, and visual acuity improved from hand movements to counting fingers.

Biomicroscopic Study of the Vitreous in Macular Breaks

The vitreous in 74 eyes with macular breaks was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. Fifteen of the eyes had macular breaks secondary to various causes, and 59 eyes had idiopathic senile macular breaks. Vitreous traction, indicated by the presence of opercula or visible vitreous strands, was present in 29 (49%) of the idiopathic cases. In 17 of 31 eyes without posterior vitreous detachment (PVD), an operculum was seen. In these eyes, intravitreous traction was suspected to be the cause of macular breaks. Opercula were seen attached to the posterior hyaloid membrane in six of the nine eyes with partial PVD. An operculum corresponding to the macular break was observed on the posterior hyaloid membrane in only five of 19 eyes with complete PVD. Of the 15 eyes with macular breaks secondary to various causes, complete PVD was seen in 10 eyes, one of which had an operculum. One eye had no PVD, and four eyes had partial PVD. Opercula were detected in two of the latter eyes. In one eye of the senile group and one eye of the secondary group, partial PVD caused traction at the edges of the macular break, resulting in retinal detachment.

Dye laser in ophthalmic disease.

From September 1978 to May 1980, dye lasers have been used in the treatment of 56 cases of eye disease (60 eyes), including among others peripheral retinal breaks, macular breaks, prebreak stage degeneration, congenital iris residual membrane, incomplete surgical iridectomy, secondary glaucoma iris bombé, closed-angle glaucoma, vireous hemorrhage, periphlebitis retinae, Coats disease, thrombosis of central and branch retinal vein. Most of the results are satisfactory. Dye laser irradiation has the advantage in iridotomy. Only one pulse can perforate the iris and no serious complication has been encountered. There is a definite therapeutic effect in treatment of vitreous hemorrhage by dye laser.

Macular Breaks: 2. Management

Macular Breaks: 2. Management

Retinal detachment due to macular and small posterior holes.

This is a report concerning the management of 12 cases of retinal detachment due to macular and small posterior holes. There were 5 cases with macular holes alone; 3 with both macular and peripheral holes and 4 with small posterior holes. The latter are included because they represent similar problems in diagnosis and technique of operation. Retinal detachments due to macular holes are rare.¹The reported incidence is about 1% of all detachments.²Most macular "holes" are not accompanied by detachment.^{3 *,4,5†,6}Posterior detachments without holes are reported.⁷"Many published cases of successfully treated breaks in the macula undoubtedly show no true macular break because the relatively good postoperative vision reported is incompatible with such a lesion."¹ Of the many reported causes of macular holes, high myopia is thought to be the most frequent.3^‡,6,12 The methods of operation varied. Simple diathermy is used on,