Macular Hole In Eyes Research Articles

INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLES IN HIGH MYOPIA WITH AXIAL LENGTH ≥30 mm.

To evaluate the closure rate of macular holes in highly myopic eyes treated with the inverted internal limiting membrane flap technique. Retrospective study in 33 consecutive patients (33 eyes) with a myopic macular hole (axial length ≥30 mm) and no associated macular retinoschisis, undergoing 23-gauge pars plana vitrectomy combined with the inverted internal limiting membrane flap technique. Mean initial logarithm of the minimum angle of resolution best-corrected visual acuity was 0.59 (range, 0.22-1.8) (Snellen fraction, 20/80). At the 1-month postoperative control visit, the macular hole was closed in all patients. Reopening of the hole occurred in 2 patients. Visual acuity improved in 13 patients (39.4%): final mean ETDRS (Early Treatment Diabetic Retinopathy Study) improvement was +80 letters, and logarithm of the minimum angle of resolution was 0.4 (20/50). Staphyloma with macular involvement was present in all patients. Dissociated optic nerve fiber layer was observed in 25 patients (75.7%) and was absent in 2 (6.1%); in the remaining 6 patients, the layer could not be assessed. Gliosis was found in 14 patients (42.4%). Vitrectomy plus the inverted internal limiting membrane flap technique was effective for treating macular holes in eyes with axial length ≥30 mm and no associated retinoschisis.

Changes in Inner and Outer Retinal Layer Thicknesses after Vitrectomy for Idiopathic Macular Hole: Implications for Visual Prognosis.

PurposeTo investigate sequential post-operative thickness changes in inner and outer retinal layers in eyes with an idiopathic macular hole (MH).MethodsRetrospective case series. Twenty-four eyes of 23 patients who had received pars plana vitrectomy (PPV) for the closure of MH were included in the study. Spectral domain optical coherence tomography C-scan was used to automatically measure the mean thickness of the inner and outer retinal layers pre-operatively and up to 6 months following surgery. The photoreceptor outer segment (PROS) length was measured manually and was used to assess its relationship with best-corrected visual acuity (BCVA).ResultsCompared with the pre-operative thickness, the inner layers significantly thinned during follow-up (P = 0.02), particularly in the parafoveal (P = 0.01), but not perifoveal, area. The post-operative inner layer thinning ranged from the ganglion cell layer to the inner plexiform layer (P = 0.002), whereas the nerve fiber layer was unaltered. Outer layer thickness was significantly greater post-operatively (P = 0.002), and especially the PROS lengthened not only in the fovea but also in the parafovea (P < 0.001). Six months after surgery, BCVA was significantly correlated exclusively with the elongated foveal PROS (R = 0.42, P = 0.03), but not with any of the other thickness parameters examined.ConclusionsFollowing PPV for MH, retinal inner layers other than the nerve fiber layer thinned, suggestive of subclinical thickening in the inner layers where no cyst was evident pre-operatively. In contrast, retinal outer layer thickness significantly increased, potentially as a result of PROS elongation linking tightly with favorable visual prognosis in MH eyes.

Face-down posturing after idiopathic macular hole surgery: a meta-analysis

Objective To evaluate the full thickness idiopathic macular hole (IMH) closure rates in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). Methods A computerized search was conducted in the PubMed, Chinese Biomedical Database, China National Knowledge Infrastructure, and VIP database. All the included studies were divided into NSP and FDP group. A total of 9 papers were included in this meta analysis, including 285 eyes (145 eyes with small hole ≤400 μm, 104 eyes with large hole >400 μm) in NSP group and 303 eyes (141 eyes with small hole and 124 eyes with large hole ). RevMan 4.2 software was applied for investigating heterogeneity and meta-analysis, and the risk of publication bias was evaluated. Results Meta analysis indicated that there was statistical significance on closure rates betwen NSP and FDP group [odds ratio (OR)=0.47, 95% confidence interval (CI) 0.26 - 0.84, P=0.01]. The difference of closure rates in small macular hole eyes between NSP and FDP group was statistically significant (OR=0.45, 95%CI 0.13 - 1.51; P=0.20). The difference of closure rates in large macular hole eyes between NSP and FDP group was statistically significant (OR=0.35, 95%CI 0.17 - 0.75; P=0.006). Conclusion NSP is equally effective as strict FDP in the repair of small macular hole. Post-operative FDP may improve the macular hole closure rates for holes larger than 400 μm. Key words: Diabetic retinopathy/surgery; Prone position; Meta-analysis

The changes of retinal thickness in idiopathic macular hole eyes after vitrectomy combined with internal limiting membrane peeling surgery

Objective To observe the changes of retinal thickness in idiopathic macular hole eyes after vitrectomy combined with internal limiting membrane peeling. Methods The study included 40 eyes in 40 consecutive patients with idiopathic full-thickness macular holes who underwent vitrectomy and internal limiting membrane peeling. There were 10 males (10 eyes) and 30 female (30 eyes), the average age was (63.60±6.26) years, the average disease duration was (6.00±3.53) months. All patients were examined by spectral-domain optical coherence tomography to measure the foveal retinal thickness, parafoveal retinal thickness and every quadrant in 1, 3, 6 months after surgery. Results Compared foveal retinal thickness after 1 month with 3 month, the difference was significant (F=4.527, P=0.013). But foveal retinal thickness were not significantly different in 3 months and 6 months after surgery (F=2.031, P=0.971). The difference of average parafoveal retinal thickness between 1 month, 3 months and 6 months after surgery was not significant (F=2.011, P=0.139). The retinal thickness of the operated eyes were not significantly different from the normal fellow eyes in 1 month after surgery (t=0.651, P=0.519). And the foveal retinal thickness of the operated eyes and the normal fellow eyes are significantly different in 3 months and 6 months after surgery (t=-2.563, -2.524; P=0.015, 0.016). The thickness of temporal were thicker than other quadrant in 1 month, 3months and 6 months after surgery ( t=-3.701, -4.612, -4.125; P=0.014, 0.006, 0.009). Conclusion There is a transient increase in the foveal retinal thickness after macular hole surgery. Key words: Retinal perforations/surgery; Retina; Macula lutea; Tomography, optical coherence

Wider retinal artery trajectories in eyes with macular hole than in fellow eyes of patients with unilateral idiopathic macular hole.

PurposeTo determine whether the width of the retinal artery (RA) trajectory was associated with the presence of a macular hole (MH).MethodsA retrospective cross sectional case-control study was performed. The fundus photographs were rotated 90 degrees, and the coordinates of the best fit curve of the RA trajectory were determined automatically based on these plots using the ImageJ program. The converted coordinates were fit to a second degree polynomial (ax2/100 + bx + c) equation. The width and steepness of the RA trajectory, “a”, of the eyes with a MH eye were compared to that of the fellow eyes.ResultsOne hundred and ten eyes of 55 consecutive patients (30 women) with a unilateral MH and healthy fellow eyes were analyzed. The mean age was 64.9 years (range 47-81 years). The constant ‘a’ was significantly smaller in eyes with a MH than that of the fellow eyes (0.379 ± 0.094 vs 0.416 ± 0.121, P = 0.001, paired t test), indicating that the RA trajectory was wider in the MH eyes than in the fellow eyes. There was a significant correlation between the axial length and ‘a’ of the RA trajectory in the MH eyes (R = 0.273, P = 0.044) and in the fellow eyes (R = 0.356, P = 0.008; Spearman’s rank correlation coefficient).ConclusionsBecause eyes with a MH have a significantly wider and flatter RA trajectory, there may be greater traction on the fovea which is located between the RA arches. The causative role of this finding is still unclear.

English

PURPOSE: To pre-operatively stage macular hole based on OCT and to calculate Macular Hole Index and Hole Form Factor. To determine post-operative visual outcome and macular hole closure. METHODS: Prospectively reviewed 25 eyes of Macular Hole. All the patients with complain of diminution of vision and defective central field of vision were examined. Before and after surgery complete clinical examination and OCT was performed which included macular hole diameter at the level of RPE(base diameter) and at the minimal extent of hole(minimum diameter),Vertical Height, Horizontal Diameter, Left Arm Length, Right Arm Length ,Macular Hole Index and Hole Form Factor. 21 Gauge Pars Plana Vitrectomy with ILM peeling was performed in all patients. RESULTS: 25 eyes of 25 consecutive patients were studied. There were 14 (56%) men and 11(44%) women, with an average age of 60 years (50 to 75 years, median 60 years) Mean follow up time was 1 month. At 3 months 6 of 25 patients (24%) attained a visual acuity greater than or equal to 6/36. Patients of macular hole were found to be most in idiopathic (18/25, 72%) in nature .On OCT most of the macular hole in stage 3 and stage 4 were associated with subretinal fluid, epiretinal membrane.12% patients had Grade II,40% had Grade III, 48% had Grade IV Macular Hole.Negative co-relation was found between both the base and minimum diameterand post-operative visual acuity. Post-operative outcome is better in pateints with MHI >0.5, HFF>0.9.

Evaluating Dissociated Optic Nerve Fiber Layer Appearance Using En Face Layer Imaging Produced by Optical Coherence Tomography

Purpose: To investigate the incidence of and risk factors for a dissociated optic nerve fiber layer (DONFL) appearance after pars plana vitrectomy (PPV). Methods: We retrospectively reviewed 189 eyes that underwent PPV with internal limiting membrane removal and judged the presence/absence of an apparent DONFL based on en face layer images produced by spectral-domain optical coherence tomography (SD-OCT). Results: An apparent DONFL was observed in 47 (24.9%) eyes. The incidence of an apparent DONFL was significantly higher in the macular hole (MH) group (76.5%) than in the non-MH group (epiretinal membrane, diabetic macular edema, retinal vein occlusion, and others; 4.9%; p < 0.001). In the logistic regression analysis, surgical indication for MH was identified as the most significant DONFL risk factor (odds ratio 63.7; p = 1.05 × 10^-8). Conclusion: Postoperative OCT en face layer imaging clarified that MH eyes are liable to have an apparent DONFL following PPV.

Macular holes and central retinal detachment

Dear Editor, A macular hole is a retinal disease primarily affecting elderly patients with an overall prevalence of approximately 0.1%–0.2% (la Cour & Friis 2002; Wang et al. 2006). The pathogenesis of macular holes has been elucidated in recent studies employing optical coherence tomography and ultrasound. These studies have made it apparent that most patients with impending macular holes have a perifoveal vitreous detachment with focal attachment of the vitreous to the foveal umbo as well as a cystoid cleavage in the inner part of the umbo (Gaudric et al. 1999). Transition from an impending hole to a stage 2 full thickness hole starts with a dehiscence in the roof of the cystoid lesion. Centrifugal traction, the cause of which remains elusive, causes the dehiscence to spread outwards into the photoreceptor layer, causing a full thickness defect (Gass 1999; Gaudric et al. 1999). As a macular hole can be associated with a central retinal detachment, we performed the present study to assess the prevalence rate of a central retinal detachment in a group of subjects with macular holes and the association of a collateral retinal detachment with refractive error. The retrospective, interventional case series study included all patients with a macular hole, who were consecutively referred and treated by a primary pars plana vitrectomy in the same surgical unit. Patients with an ocular contusion or other ocular trauma as potential cause for the macular hole were excluded. In a retrospective chart research, we obtained preoperative data on best-corrected visual acuity, intraocular pressure, refractive error, lens status, and previous ocular surgeries. The statistical analysis was performed using a commercially available statistical analysis programme (SPSS, version 17.0; Chicago, IL, USA). The inclusion criteria were met by 171 eyes (167 patients; 108 women). The mean age was 69.5 ± 10.7 years (mean ± standard deviation) (median: 71.1 years; range: 49.5–86.0 years), the mean refractive error was −0.62 ± 4.11 dioptres (median: 0 dioptres; range: −22.4 to +7.0 dioptres), and the mean intraocular pressure measured 15.0 ± 3.2 mm Hg. A central retinal detachment defined as a detached macular area with a diameter of at least 2 disc diameters was present in 5 (2.9%) eyes. The refractive error was significantly (p <0.001) more myopic in the subgroup with a central retinal detachment (−15.7 ± 6.0 dioptres; range: −22.4 dioptres to −6.75 dioptres) than in the subgroup with the central retina attached (−0.10 ± 2.85 dioptres; range: −17.9 to +7.0 dioptres) (Fig. 1). Out of the 171 eyes, 38 (22%) eyes were pseudophakic. Boxplots showing the distribution of refractive error in eyes with macular holes without central retinal detachment and eyes with a central retinal detachment. The results confirm a recent investigation by Akiba et al. (1999) in which a retinal detachment was associated with a macular hole in severely myopic eyes. According to the study by Akiba et al., only highly myopic eyes with a posterior staphyloma appeared to be at risk for the development of a macular detachment around a macular hole. In our study, the cut-off point between the eyes with a central retinal detachment and those eyes with the central retina attached was at −7 dioptres to −8 dioptres (Fig. 1). Similar results were obtained in other studies in which −6 dioptres to −8 dioptres was the cut-off point between moderate myopia and high myopia with respect to the development of a secondary macrodisc, the presence of myopic retinopathy, and the development of a highly myopic type of normal-pressure glaucoma. The age-related low prevalence of 22% of pseudophakia in the eyes with a macular hole in our study may suggest that cataract surgery relatively often leading to a postoperative vitreous detachment may potentially prevent the development of a full macular hole. Correspondingly, the importance of the vitreous in the pathogenesis of macular holes has been emphasized in previous studies by a low frequency of macular holes in eyes with complete posterior vitreous detachment (Hikichi et al. 1993). Also, macular holes have been shown to be less prone to enlargement, with consequent better preservation of vision, if a posterior vitreous detachment was apparent at the time of diagnosis (Hikichi et al. 1993). In conclusion, a central retinal detachment was found in about 3% of eyes with a macular hole. A central retinal detachment was present only in highly myopic eyes beyond a myopic refractive error of approximately −7 dioptres. It agrees with other studies on a similar cut-off between medium myopia and high myopia. Future studies may address whether cataract surgery is associated with a reduced rate of development of macular holes.

Higher incidence of carotid stenosis in patients with central retinal artery occlusion

In our study, the cut-off point between the eyes with a central retinal detachment and those eyes with the central retina attached was at )7 dioptres to )8 dioptres (Fig. 1). Similar results were obtained in other studies in which )6 dioptres to )8 dioptres was the cut-off point between moderate myopia and high myopia with respect to the development of a secondary macrodisc, the presence of myopic retinopathy, and the development of a highly myopic type of normal-pressure glaucoma. The age-related low prevalence of 22% of pseudophakia in the eyes with a macular hole in our study may suggest that cataract surgery relatively often leading to a postoperative vitreous detachment may potentially prevent the development of a full macular hole. Correspondingly, the importance of the vitreous in the pathogenesis of macular holes has been emphasized in previous studies by a low frequency of macular holes in eyes with complete posterior vitreous detachment (Hikichi et al. 1993). Also, macular holes have been shown to be less prone to enlargement, with consequent better preservation of vision, if a posterior vitreous detachment was apparent at the time of diagnosis (Hikichi et al. 1993). In conclusion, a central retinal detachment was found in about 3% of eyes with a macular hole. A central retinal detachment was present only in highly myopic eyes beyond a myopic refractive error of approximately )7 dioptres. It agrees with other studies on a similar cut-off between medium myopia and high myopia. Future studies may address whether cataract surgery is associated with a reduced rate of development of macular holes.

Macular thickness measurements in macular hole using Fourier domain optical coherence tomography devices

Abstract Purpose To compare new Fourier‐domain optical coherence tomographies (OCT) for measuring retinal thickness in eyes with macular hole (MH). Methods Thirty‐eight eyes from 38 patients diagnosed of MH (17 men and 21 women, aged 51‐ 82 years) without other ophthalmic diseases, were prospective and consecutively studied. All of them underwent a ophthalmic examination including best corrected visual acuity, fundus examination, three Cirrus HD‐OCT (Carl Zeiss Meditec, Inc., Ca, USA) and three Spectralis OCT (Heidelberg Engineering, Germany). Comparisons of OCT measurements were done for the nine macular areas defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Correlations between OCT measures were studied by Pearson test. Results Mean total retinal thicknesses were 347.0 ± 67.78 μm using Cirrus HD and 344.71 ± 43.63 μm with Spectralis OCT. All retinal measurements showed significant differences between the two devices (p&lt;0.05), except in superior and nasal inner ETDRS area. The mean value for retinal thickness measurements was 21.44 µm less using Cirrus HD‐OCT. Cirrus and Spectralis OCT parameters showed good correlations. Conclusion MH eyes evaluated by Cirrus and Spectralis OCT show differences in their macular measurements.

Therapeutic effects of internal limiting membrane peeling on retinal detachment with macular hole in eyes with high myopia

Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment: 13 patients in group A had undergone conventional vitrectomy; 12 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by inert gas and kept in a face-down position for 7-15 days after the operation. The follow-up period was 6-18 months (average 10 months). LogMAR visual acuity, ocular fundus, B-scan uhrasonography and optical coherence tomography had been followed up. Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant (X2=4.427, P=0.046). The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (X2=5.940, P=0.020). The postoperative visual acuity increased significantly in both groups (Z=-2.045, 2.481; P=0.041, 0. 012), the difference of vision improvement was not significant between those two groups (Mann-Whitnay U= 51.5, P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia. Key words: Myopia; degenerative/complications; Retinal perforations/surgery; Retinal detachment/surgery; Vitrectomy

Changes in first- and second-order multifocal electroretinography in idiopathic macular hole and their correlations with macular hole diameter and visual acuity

To evaluate the first- and second-order multifocal electroretinography (mfERG) responses in patients with idiopathic macular hole, and their correlations with macular hole diameter measured by optical coherence tomography (OCT) and visual acuity. Twenty-four eyes of 24 patients with idiopathic macular hole underwent mfERG and OCT examinations. The response amplitudes and implicit times of the first- and second-order mfERG were analyzed and compared with 20 age-similar normal control subjects. Correlation analyses between visual acuity, apical and basal diameters of the macular hole, and the first- and second-order mfERG amplitudes and implicit times were performed. The first-order mfERG N1 and P1 amplitudes in the central two concentric rings were reduced in macular hole eyes compared with controls (p < 0.006). For the second-order mfERG, only the N1 mfERG amplitude was significantly reduced at ring 6 in macular hole eyes compared with controls (p = 0.030). Correlation analysis showed that apical diameter of macular hole was significantly correlated with the first-order N1 amplitude of rings 2 to 5 (p < 0.024), the first-order P1 amplitude of rings 2 to 6 (p < 0.05), as well as the second-order P1 mfERG amplitudes of rings 3 to 6 and N1 amplitudes of rings 3 to 5 (p < 0.05). LogMAR visual acuity showed significant correlation with apical diameter of the macular hole (p = 0.002), and also with the first-order P1 amplitude of ring 2 (p = 0.024). In eyes with idiopathic macular hole, reductions in first-order mfERG responses are limited to the central macula, while the second-order mfERG response abnormalities involved more of the peripheral macular region. OCT measurement of apical and not the basal diameter of macular hole correlated with the severity of retinal dysfunction assessed by both mfERG and visual acuity.

VITREO-PAPILLARY ADHESION IN MACULAR HOLE AND MACULAR PUCKER

Vitreo-macular pathology may be influenced by vitreo-papillary adhesion (VPA). Optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) was used to identify VPA in full-thickness macular hole, lamellar hole, and macular pucker (MP). Ultrasonography and OCT/SLO were performed in 55 subjects: 16 with macular hole, 11 with lamellar hole, and 28 with MP. The main outcome measures were the presence of posterior vitreous detachment by ultrasound, and the findings of VPA and intraretinal cysts by OCT/SLO. Posterior vitreous detachment was detected by ultrasound in 26/28 (92.9%) eyes with MP, 6/11 (54.5%) eyes with lamellar hole (P < 0.05), and 4/16 (25%) eyes with macular hole (P < 0.00001). Optical coherence tomography/scanning laser ophthalmoscopy detected VPA in 14/16 (87.5%) macular hole eyes, 4/11 (36.4%) lamellar hole eyes (P < 0.05), and 5/28 (17.9%) MP eyes (P < 0.00005). Intraretinal cysts were present in 4/5 (80%) MP eyes with VPA but only 1/23 (4.3%) MP eyes without VPA (P < 0.005). Vitreo-papillary adhesion was significantly more common in full-thickness macular hole than lamellar hole or MP. When present in MP, VPA was frequently associated with intraretinal cysts. Hence, VPA may have an important influence on the vectors of force at the vitreo-retinal interface inducing holes and cysts.

Development of Full-Thickness Macular Hole despite Previous Posterior Vitreous Detachment and Vitrectomy for Retinal Detachment: Two Cases

To report the delayed development of idiopathic full-thickness macular hole in eyes with previously documented complete posterior vitreous detachment that were vitrectomized during surgery for rhegmatogenous retinal detachment. Two interventional case reports with serial color fundus photographs and optical coherence tomography scans. Case 1: A 62-year-old man underwent vitrectomy, cryoretinopexy, and intraocular gas tamponade for rhegmatogenous retinal detachment associated with a complete posterior vitreous detachment. Three years later, he developed a full-thickness macular hole in the same eye. Peeling of the inner limiting membrane and gas tamponade resulted in complete closure of the macular hole with improvement in visual acuity. Case 2: A 70-year-old man presented with a macula-off inferior retinal detachment and counting fingers vision. Vitrectomy, cryoretinopexy to a single tear, and gas tamponade was successful and acuity improved to 6/9. He subsequently developed retinal redetachment associated with a new retinal tear and was treated by further vitrectomy and gas. He developed a full-thickness macular hole in the same eye 2 years later with acuity dropping to 1/60. Macular hole formation may occur in the context of vitrectomized eyes. These observations support the hypothesis that anteroposterior vitreomacular traction, while traditionally implicated, is not always essential for the development of macular holes.

Functional Macular Mapping in Patients with Vitreomacular Pathologic Features Before and After Surgery

To evaluate the potential benefit of microperimetry and preferential hyperacuity perimeter (PHP) to document visual performance objectively in patients with macular hole and macular pucker undergoing macular surgery. Observational case series. In 19 patients with macular hole and 18 with macular pucker, best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution units), central retinal sensitivity, and presence and extent of metamorphopsia were documented before and four and 12 weeks after surgery. Macular sensitivity (mean sensitivity decibel [dB], stability of fixation) was determined using MP1 microperimetry (Nidek, Padova, Italy). The PreView-PHP (Carl Zeiss Meditec, Dublin, California, USA) was used to quantify metamorphopsia. Before surgery, mean BCVA was 0.68 +/- 0.25 (macular holes) and 0.58 +/- 0.25 (macular pucker). Microperimetry demonstrated a mean retinal sensitivity of 11.3 +/- 2.5 dB (macular holes) and 10.7 +/- 2.8 dB (macular pucker). Twelve weeks after surgery, mean BCVA improved to 0.53 +/- 0.26 (macular holes) and 0.33 +/- 0.26 (macular pucker; P = .042 and P = .004). Accordingly, retinal sensitivity increased significantly with 12.8 +/- 1.9 dB (macular holes) and 12.7 +/- 2.5 dB (macular pucker; P = .04 and P = .02) as well as stability of fixation. At 12 weeks, 47.3% of macular hole eyes and 66.7% of macular pucker eyes improved in BCVA, but a significantly higher number (68.4% [macular holes] and 77.8% [macular pucker]) demonstrated improvement in microperimetry results. PHP results showed no significant change of scotomas, patient reliability, or presence of metamorphopsia at any interval. A higher number of patients improved in microperimetry than in visual acuity testing. Therefore, microperimetry highlights the value of functional macular mapping for these patients and indicates that BCVA may underestimate functional benefit of surgery.

Surgical repair of full-thickness idiopathic macular holes associated with significant macular drusen

Objective To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen. Design Retrospective noncomparative case series. Participants Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS). Intervention Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons. Main outcome measures Visual acuity, anatomic hole closure. Results Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen ( P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes ( P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes. Conclusions A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent.

Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation

Purpose To determine the long-term anatomic and functional results of temporary silicone oil tamponade coupled with laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in eyes with myopia higher than −10.0 diopters (D). Design Retrospective, noncomparative case series. Participants Eleven patients (9 female, 2 male; average age, 57 ± 3 years) with spontaneous retinal detachment due to macular hole. All patients had a myopia higher than −10.0 D and had no proliferative vitreoretinopathy and no history of trauma. The average myopia amounted to −17.7 ± 1.1 D, and in eight cases, a large posterior staphyloma was present. Follow-up was 69 ± 17 months. Intervention Patients underwent pars plana vitrectomy, temporary silicone oil tamponade, and laser photocoagulation of the macular hole rim. Silicone oil removal was performed after 2.8 ± 0.8 months. Main outcome measures Anatomic attachment of the retina was determined and visual acuity was measured. Results Final successful retinal attachment at the end of follow-up was achieved in ten eyes (91%). Average logarithm of the minimum angle of resolution (logMAR) visual acuity increased from 1.39 ± 0.12 before surgery to 1.18 ± 0.13 after surgery ( P < 0.05, Student’s t test for paired data). This corresponds to a mean increase of measured Snellen equivalents from 0.06 ± 0.03 to 1.11 ± 0.04. Intraocular pressures remained stable with 13.9 ± 1.8 millimeters of mercury (mmHg) before surgery and 16.6 ± 1.6 mmHg at the end of follow-up ( P > 0.05). Conclusions Primary vitrectomy with temporary silicone oil tamponade and laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in highly myopic eyes appears to provide a good long-term anatomic success and acceptable functional results.

Visual Acuity as a Prognostic Indicator in Stage I Macular Holes

To evaluate the role of initial visual acuity as a factor for progressive loss of vision or progression to a full-thickness macular hole in eyes with stage I macular holes (tractional foveal detachment without dehiscence). The study population included 35 patients with stage I macular holes with best-corrected visual acuity of 20/25 to 20/80 in one eye, and a full-thickness macular hole in the fellow eye. Eyes with stage I macular holes with best corrected visual acuity between 20/50 and 20/80 had a 66% (ten of 15 eyes) rate of progression to full-thickness macular hole, whereas eyes with best-corrected visual acuity of between 20/25 and 20/40 had a 30% (six of 20 eyes) risk of progression to full-thickness macular hole. The risk of progression to macular hole is significantly higher in eyes with stage I macular holes with best-corrected visual acuity of 20/50 or worse (P = .03).