Macular Hole-associated Retinal Detachment Research Articles

Comparison of facedown and non-facedown positions after vitrectomy with fovea-sparing internal limiting membrane peeling and air tamponade for treating myopic foveoschisis with foveal detachment: A prospective, randomized interventional study

PurposeTo compare the anatomical and visual outcomes after vitrectomy with facedown (FD) or non-FD positions for treating myopic foveoschisis (MF) with foveal detachment. DesignProspective, randomized interventional study. Methods55 eyes with MF and foveal detachment that underwent vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling and air tamponade were randomized to either the postoperative FD (26 eyes) or non-FD (29 eyes) positions. Best-corrected visual acuity (BCVA) and optical coherence tomography were assessed at baseline, 2 weeks, 3 months, and 6 months after vitrectomy with fovea-sparing ILM peeling and air tamponade with the FD or non-FD positions. Logistic and linear regression analyses were performed to study correlations between clinical factors and foveoschisis resolution and postoperative BCVA. ResultsAll patients completed ≥6 months of follow-up. MF and foveal detachment were completely resolved in 22 eyes (92 %) in the FD group and 22 eyes (76 %) in the non-FD group (P = 0.160). Macular hole-associated retinal detachment occurred in one eye in the FD (4 %) and non-FD (3 %) groups. The postoperative best-corrected visual acuity (BCVA) at 6 months did not differ significantly between the two groups (P = 0.495). The BCVA improved by ≥0.3 logMAR in 14 eyes (58 %) in the FD group versus 17 eyes (59 %) in the non-FD group (P = 0.983). Central foveal thickness (CFT) and height of foveal detachment were significantly associated with foveoschisis resolution (P = 0.045 and 0.039, respectively). Better preoperative BCVA and foveoschisis resolution were significantly associated with better postoperative BCVA (P = 0.031 and 0.003, respectively). ConclusionsThe non-FD position appeared to be as effective as the FD position after vitrectomy with fovea-sparing ILM peeling and air tamponade for treating MF with foveal detachment.

PERSISTENT SUBRETINAL FLUID AFTER VITRECTOMY FOR MACULAR HOLE-ASSOCIATED RETINAL DETACHMENT.

To evaluate the incidence, associated factors, and outcome of persistent subretinal fluid (SRF) after vitrectomy for macular hole-associated retinal detachment (MHRD). A total of 158 eyes from 156 patients with MHRD who achieved macular hole closure after primary vitrectomy were included in the analysis; persistent SRF was defined as the presence of SRF for more than 1 month after first surgery. Preoperative and postoperative parameters were analyzed for their relationship with SRF development. Persistent SRF was observed in 19 eyes (12.0% of 158) postoperatively. Seven eyes (36.8% of 19) with persistent SRF eventually displayed complete absorption during follow-up. Univariate analysis revealed that eyes with persistent SRF were statistically associated with internal limiting membrane inverted flap, duration of symptoms, tamponade (perfluoropropane/silicone oil: 14/5 vs. 35/104, P < 0.001), and MHRD subtype (Type 1/Type 2/Type 3: 15/4/0 vs. 60/40/39, P = 0.003). In multivariate analysis, only internal limiting membrane inverted flap (odds ratio, 15.778, 95% confidence interval, 3.170-78.523; P = 0.001) was positively associated with persistent SRF. There were no significant differences in best-corrected visual acuity improvement ( P = 0.425) between the SRF involved foveal and without involved foveal groups and no significant differences between the SRF complete absorption and incomplete absorption groups. Absorption of persistent SRF may be more difficult in MHRD eyes than in ordinary rhegmatogenous retinal detachment eyes. The internal limiting membrane inverted flap in MHRD was associated with a greater likelihood of persistent SRF. The location and incomplete absorption of persistent SRF did not seem to be associated with the final visual outcome.

Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction.

To examine the effects of the temporal inverted internal limiting membrane (ILM) flap technique for foveal reconstruction in patients with highly myopic macular hole-associated retinal detachment (MHRD). A retrospective case series analysis of four patients (four eyes) with MHRD was conducted. The foveal optical coherence tomography changes following treatment using the temporal inverted ILM flap technique were evaluated. In Patient 1, the ILM bridged the macular hole and residual subretinal fluid on postoperative day 6, and complete retinal reattachment was achieved at 19 months. Patient 2 exhibited reduced retinal detachment, with visible ILM inversion and macular hole closure after 14 days. In Patient 3, macular hole closure and fovea formation had occurred by day 25, and the ILM flap was visible. At 2 months, the outer collagenous layer connection in the central fovea and recovery of the external limiting membrane and ellipsoid zone were observed. Patient 4 had a "white hole" MHRD, with macular hole closure achieved on postoperative day 20, albeit with a suboptimal foveal shape. The temporal inverted ILM flap technique in conjunction with vitrectomy facilitates foveal reconstruction in patients with successful treatment of MHRD, and this reconstruction process can be observed by optical coherence tomography.

Macular Hole-Associated Retinal Detachment in Autosomal Recessive Bestrophinopathy

Macular Hole-Associated Retinal Detachment in Autosomal Recessive Bestrophinopathy

Multiple Free Internal Limiting Membrane Flap Insertion in the Treatment of Macular Hole-Associated Retinal Detachment in High Myopia

Purpose: The aim of this paper was to evaluate the efficacy of multiple free internal limiting membrane (ILM) flap insertion in the management of macular hole-associated retinal detachment in high myopia. Procedures: Eyes receiving operation for macular hole-associated retinal detachment were retrospectively recruited. Those in the study group received ILM peeling and multiple free ILM flap insertion, while those in the control group received ILM peeling only. Postoperative anatomical outcomes and best-corrected visual acuity were compared between the 2 groups. Results: Twenty-seven eyes of 27 patients were recruited in this study (13 in the study group, 14 in the control group). After the operation, the retina was reattached in all cases in both groups. The macular hole closure rate was 100% in the study group but only 42.9% in the control group (adjusted p < 0.001). The eyes in the study group had better visual improvement (logMAR –0.58 ± 0.43) than those in the control group (logMAR –0.31 ± 0.50) with borderline significance (adjusted p = 0.078). Conclusions: For macular hole-associated retinal detachment in highly myopic eyes, the multiple free ILM flap insertion technique offers an effective way to close macular holes. Whether this result also means better visual outcome remains to be seen.

Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).1–3 Shimada et al4 described the progressive stages of MTM from...

Cytokine profiling in the sub-silicone oil fluid after vitrectomy surgeries for refractory retinal diseases

Silicone oil (SO) is an intraocular surgical adjuvant that reduces the surgical complications in refractory retinal diseases, although membrane and cellular proliferation is often seen even in SO-filled eyes. We hypothesised that the fluid in the space between the SO and the retina, named the “sub-silicone oil fluid (SOF)”, enhances these biological responses. We proposed a safe method for SOF extraction. We also analysed inflammatory cytokine expressions and SOF osmotic pressures from eyes with rhegmatogenous retinal detachment (RRD), proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR) and macular hole-associated retinal detachment (MHRD). Interleukin (IL)-10, IL-12p40, IL-6, monocyte chemotactic protein-1, and vascular endothelial growth factor (VEGF) in the SOF with PVR were significantly higher than in those with RRD or MHRD. Fibroblast growth factor-2, IL-10, IL-12p40, IL-8, VEGF, and transforming growth factor beta 1 levels in eyes with exacerbated PDR indicated a significantly higher expression than those with simple PDR. IL-6 and tumour necrosis factor alpha in eyes with exacerbated PVR demonstrated a significantly higher expression than in those with simple PVR. However, there was no difference in SOF osmotic pressure between group of each disease. These studies indicate that disease-specific SOF is a significant reflection of disease status.

Observation of single-layered inverted internal limiting membrane flap technique for macular hole with retinal detachment in high myopia

Objective: To compare the outcome of pars plana vitrectomy (PPV) with a single-layered inverted internal limiting membrane (ILM) flap versus PPV with ILM peeling for the treatment of macular hole associated retinal detachment (MHRD) in high myopia. Methods: In a retrospective cohort study, PPV with 2 kinds of adjuvant surgical procedures were used in 35 moderately high myopia eyes with MHRD. These eyes were divided into 2 groups: group 1 (17 eyes) receiving PPV and ILM peeling and group 2 (18 eyes) receiving PPV with a single-layered inverted ILM flap. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity (BCVA) were measured at 6 months after surgery. Results: The retina was successfully reattached in all cases. The difference of the retinal reattachment rate between the two groups was not statistically significant (Fisher's exact test, P=1.000). The rate of macular hole closure was 47.1% in group 1 (8 eyes) and 88.9% in group 2 (16 eyes). The difference of the macular hole closure rate between the two groups was statistically significant (Fisher's exact test, P= 0.012). Significant improvement in logarithm of minimal angle of resolution (logMAR) BCVA was achieved in both groups. There was no difference in the initial, final, or improved logMAR BCVA in the 2 groups. Conclusion: Single-layered inverted ILM flap technique effectively helps close the macular hole in moderately high myopia with MHRD. This may prevent the possible redetachment from the macular hole. (Chin J Ophthalmol, 2017, 53: 338-343).

Double Internal Limiting Membrane Insertion for Macular Hole-Associated Retinal Detachment.

Purpose To describe a modified technique of internal limiting membrane (ILM) insertion for macular hole- (MH-) associated retinal detachment (RD) in highly myopic eyes. Methods Nine eyes underwent pars plana vitrectomy, cortical vitreous removal, and fovea-sparing ILM peeling. Double ILM insertion into the hole was performed with inverted perifoveal ILM and a free ILM flap followed by air-fluid exchange. Results Two of the 9 eyes had perifoveal ILM partially torn after cortical vitreous or epiretinal removal. All eyes had the ILM plug stabilized within the MH after double ILM insertion. Postoperatively, MH was sealed with the retina reattached in all the eyes. Conclusion Double ILM insertion may further secure the ILM flap in place in the eyes with MH-associated RD, especially in cases in which insufficient perifoveal ILM was left. This trial is registered with the clinical registration number Clinicaltrials.gov NCT03174639.

Inverted internal limiting membrane flap technique as a useful procedure for macular hole-associated retinal detachment in highly myopic eyes

PurposeTo determine whether the inverted internal limiting membrane (ILM) flap technique contributes to high reattachment and closure rates in patients with macular hole-associated retinal detachment (MHRD).Patients and methodsIn all, 15 eyes of 15 patients with MHRD undergoing 25-gauge pars plana vitrectomy with the inverted ILM flap technique or ILM peeling. The patients were divided into the inverted ILM flap technique group (6 eyes) and ILM peeling group (9 eyes). The logarithm of minimal angle of resolution best-corrected visual acuity (BCVA) and retinal attachment and macular hole closure rates were compared between the two groups before and after surgery.ResultsNo significant differences were found in the pre- and postoperative BCVA at 1 and 3 months after surgery in either group (inverted ILM flap technique group, preoperatively 1.04±0.55, 1 month 0.95±0.30, 3 months 0.83±0.22; ILM peeling group, preoperatively 1.00±0.44, 1 month 1.05±0.38, 3 months 1.06±0.49; P>0.05, respectively). The postoperative BCVA at 6 months after surgery was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, 0.62±0.35; ILM peeling group, 1.02±0.41, P=0.045). The improvement in BCVA was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, –0.41±0.29; ILM peeling group, 0.02±0.36; P=0.021). The primary macular hole closure rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary reattachment rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary macular hole closure and reattachment rates were not significantly different in both groups (P=0.056, respectively).ConclusionThe inverted ILM flap technique is a useful procedure for MHRD in highly myopic eyes.

Myopic macular hole-associated retinal detachment with proliferative vitreoretinopathy

PurposeThe objective of this study was to report the clinical characteristics and surgical results of patients suffering from retinal detachment, which was induced by a myopic macular hole and complicated by proliferative vitreoretinopathy, but without previous vitreoretinal surgery. MethodsInterventional case series of 22 eyes in 20 patients with excessive myopia and macular hole-associated retinal detachment complicated with proliferative vitreoretinopathy were scrutinized retrospectively. All eyes had undergone par plana vitrectomy, including peeling of the epiretinal membrane, internal limiting membrane around the macular hole, and silicone oil or perfluoropropane (C3F8) retinal tamponade. An encircling buckle was also inserted in some of the eyes. Eyes with previous vitreoretinal surgery were excluded from this review. ResultsThe average age of patients was 68.3 ± 7.17 years, average duration of symptoms prior to seeing an ophthalmologist 8.36 ± 4.14 months, and average axial length 30.01 ± 1.81 mm. Nine of the 20 patients had bilateral retinal detachment. The average number of operations performed was 1.36 ± 0.58. The success rate of the initial surgery was 63.3%, which improved to 90.9% in subsequent procedures. ConclusionA macular hole with proliferative vitreoretinopathy is associated with retinal detachment for a long duration. Retinal reattachment and improved visual acuity could be achieved in most eyes after a surgical intervention.