Macular Hole Surgery Research Articles

Биологические эффекты богатой тромбоцитами плазмы в лечении макулярного разрыва

Aim of the work is to describe the mechanisms of therapeutic effect of platelet-rich plasma (PRP) components on the retina in macular hole (MH) surgery. Methods. This study presents the results of 36 cases of surgical treatment of MH and the use of autologous PRP. Cellular composition of PRP of 24 patients was analyzed. Results. 2 months after the operation, all the patients had restoration of all retinal layers in the MH region and positive dynamics of visual acuity in comparison with preoperative period. After follow-up for 6 months after surgery, no cases of MH relapse were detected. Conclusion. The accumulation of data on the effective use of PRP components makes it possible to plan its wider and more effective use in the treatment of degenerative, infectious, post-traumatic and other disorders of the structures of the eye. Key words: macular hole; platelet-rich plasma.

VERTICAL AND HORIZONTAL METAMORPHOPSIA ONE YEAR AFTER SURGERY FOR MACULAR HOLES ≤ 500 µ m WITH AND WITHOUT INVERTED INTERNAL LIMITING MEMBRANE FLAP.

To investigate the effect of an inverted internal limiting membrane flap (IF) and other factors on metamorphopsia after macular hole surgery. Prospective case series of patients undergoing pars plana vitrectomy with gas tamponade, with either conventional internal limiting membrane peeling (CP) or an IF, for primary idiopathic macular holes ≤ 500 µ m. Vertical and horizontal metamorphopsia were measured as M-scores (degrees) using M-charts preoperatively and at 2, 6, and 12 months postoperatively. Fifty-three eyes of 53 patients were included of whom 27 underwent CP and 26 were treated with an IF. After macular hole surgery, all patients were pseudophakic. Vertical and horizontal metamorphopsia improved from 1.08 (±0.51) and 0.98 (±0.70) preoperatively to 0.58 (±0.37) and 0.45 (±0.36) at 2 months ( P < 0.01), with no further significant improvement at 6 months (0.39 [±0.31], P = 0.07 and 0.31 [±0.28], P = 0.18) or at 12 months (0.37 [±0.30], P = 0.72 and 0.28 [±0.28], P = 0.99). There was no significant difference in the mean vertical and horizontal metamorphopsia between patients with CP and with an IF at 2 months ( P = 0.063, P = 0.10), 6 months ( P = 0.25, P = 0.16), or 12 months ( P = 0.62, P = 0.22). Preoperative vertical M-score improved at 12 months after macular hole surgery by 61% and 64% in the CP and IF groups, respectively ( P = 0.84), and the horizontal M-score by 65% and 71%, respectively ( P = 0.98). The use of an IF has no evident bearing on the degree of postoperative metamorphopsia 12 months after surgical repair of macular holes ≤ 500 µ m.

Bilateral macular hole in a patient with CAPN5-related neovascular inflammatory vitreoretinopathy.

To characterize the genotype and phenotype of a patient with CAPN5-related neovascular inflammatory vitreoretinopathy (NIV) who have undergone surgery for macular holes. We observed a patient presenting with retinitis pigmentosa and posterior uveitis who later developed vitreoretinal macular traction and a macular hole. Genetic testing was performed using a targeted gene panel. Fundus photography and spectral-domain optical coherence tomography were also performed. In a targeted gene panel, a monoallelic pathogenic variant, c.750G > T, p.Lys250Asn, in the CAPN5 gene was identified, and CAPN5-NIV was diagnosed. At the first visit, peripheral retinal degeneration and mild posterior uveitis were observed. At that time, neovascularization, epiretinal or fibrous membranes were not observed. After 5 years, vitreomacular traction developed and progressed to a full-thickness macular hole in both eyes. After pars plana vitrectomy, the macular hole was successfully closed without aggravation of uveitis. In this case, a pathogenic variant of CAPN5 lead to a distinct phenotype of retinitis pigmentosa, posterior uveitis, vitreomacular traction, and macular hole without typical inflammatory neovascularization or tractional membranes. Therefore, the clinical variability of CAPN5-NIV and genetic diagnosis should be considered in cases of atypical retinitis pigmentosa with bilateral macular hole.

Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study

To report on macular hole repair in macular telangiectasia type 2 (MacTel2). Global, multicenter, retrospective case series. Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). Standardized data collection sheet distributed to all surgeons. Anatomic closure and visual outcomes of MTMH. Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34-573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97-697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132-687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P=0.08). Visual acuity improved at least 2 lines in 25%. Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Prognostic factors for visual recovery after successful large macular hole surgery using the inverted flap technique

The goal of our study is to describe the functional results and preoperative factors predicting visual recovery after successful inverted flap technique and closure of large full-thickness macular holes (FTMH) and to evaluate the correlations between microstructural foveal changes and final visual acuity. Retrospective, descriptive, analytical study including 80eyes of 78patients with large FTMH; operated by inverted flap technique with successful closure of the macular hole after surgery. All eyes underwent a full preoperative ophthalmic examination and macular B-scan SD-OCT. We performed the classic inverted flap technique for all patients. Postoperatively, all patients were examined at 7days, 1, 3, 6, 9 and 12months after surgery. SD-OCT was performed for all patients on each follow-up. Preoperatively, best-corrected visual acuity (BCVA), FTMH size and basal hole diameter were the main outcome measures. Postoperatively, BCVA, macular thickness, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) were recorded. Mean age was 62±8.42years with female predominance. Mean size of the FTMH was 692.59μm, and mean basal hole diameter was 1436.06μm. Mean BCVA improved from 1.06±0.491 LogMAR preoperatively to 0.52±0.32 at 9months following surgery (P<0.001). At 9months, the ELM was absent, partial or fully restored in 6.67, 10 and 83.33% respectively. The EZ was absent, partial or fully restored in 6.67, 33 and 63.33% respectively. ELM regeneration always preceded EZ regeneration at every point of follow-up. Final BCVA was statistically correlated with initial hole size (P=0.006, OR=1.056; CI [1.016-1.098]) and mean symptom duration prior to surgery (P=0.001. OR=0.987; CI [0.976-0.998]). Analysis of the ROC curve demonstrated that a hole diameter>478.5μm and symptom duration>5weeks were correlated with non-improvement of visual acuity, with 81.3% sensibility and 18.7% specificity. We report tomographic microstructural foveal changes and functional results following successful large idiopathic FTMH surgery using the classic inverted flap technique. Preoperative parameters such as initial FTMH diameter and mean symptom duration prior to surgery are crucial prognostic factors influencing final visual results.

THERAPEUTIC EFFECT OF USING AUTOLOGOUS PLATELET CONCENTRATE IN VITRECTOMY FOR MACULAR HOLE: A Systematic Review and Meta-Analysis.

To summarize the current evidence regarding the therapeutic effect of using autologous platelet concentrate (APC) in vitrectomy for macular hole (MH). The PubMed, Web of Science, and Embase databases were searched according to the PROSPERO protocol (CRD42022366202). Controlled trials comparing whether APC was used in the vitrectomy of MH were included. The primary outcome was the closure rate of MH and postoperative best-corrected visual acuity, and the secondary outcome was the incidence of different types of complications. Seven studies that included 634 eyes were eligible. For the primary outcome, the usage of APC significantly improved the closure rate of MH in vitrectomy (odds ratio [OR] = 5.34, 95% confidence interval, 2.83-10.07, P < 0.001). Postoperative visual acuity did not significantly differ between the APC group and similar baseline controls (SMD = -0.07, 95% confidence interval, -0.35 to 0.22, P = 0.644). For the secondary outcome, using APC did not result in additional complications regarding postoperative retinal detachment or the recurrence of MH. The use of APC in vitrectomy was associated with a superior closure rate of the hole and no additional complications; therefore, it is effective and safe in MH surgery.

Swept Source-Optical Coherence Tomography-Guided Facedown Posturing to Minimize Treatment Burden and Maximize Outcome after Macular Hole Surgery.

We evaluated the closure of full-thickness macular holes (MHs) the day after surgery in minimizing the burden and maximizing patient outcomes. Herein, 25-gauge pars plana vitrectomy, internal limiting membrane peeling, and fluid-gas (20% sulfur hexafluoride) were performed for the treatment. Patients were instructed to remain in the facedown position until the confirmation of MH closure, and the position was discontinued in cases where the closure was confirmed. In total, 43 eyes of 43 patients, whose average age was 69.7 ± 8.6 years, were enrolled in this study. We used swept source (SS)-optical coherence tomography (OCT) for the confirmation of MH closure for gas-filled eyes and used spectral domain (SD)-OCT for the reconfirmation of MH closure after the gas volume was reduced to less than half of the vitreous cavity. MH closure was confirmed in 40 eyes (93%, the closure group) on the next day after surgery. The time from surgery to SS-OCT imaging was 24.7 h. Although facedown positioning was terminated in cases where MH closure was confirmed, there were no cases in which the MH was re-opened afterward. The basal and minimum MH size was significantly larger in the non-closure group than that in the closure group (p = 0.027, p = 0.043, respectively). Therefore, checking with SS-OCT the day after surgery and terminating facedown positioning in cases where MH closure was confirmed would be a useful method, removing a great burden for the elderly without sacrificing the MH closure rate.

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

AbstractIdiopathic macular hole (IMH) is a vitreoretinal disease that causes severe visual impairment, and the pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) is the traditional treatment for IMH. Since the dissociated optical nerve fiber layer (DONFL) is observed in the eyes after the surgery, a modified surgery is put forward to minimize the injury. However, the extent to which the modified surgery reduced damage is not clear. A novel automated image processing system was developed in this study to quantify the damage after the surgery, revealing how the modified surgery reduced the DONFL. Optical coherence tomography (OCT) images and visual acuity were collected from 65 eyes that underwent a vitrectomy with traditional and modified ILM peeling procedure at Zhejiang Provincial People’s Hospital preoperatively. We found that DONFL occurred in all 65 eyes of both the traditional and modified ILM peeling groups. The concentric macular dark spots (CMDS) were automatically measured by the image processing system. The mean total area of CMDS was smaller in the modified ILM peeling group (0.224 ± 0.110 mm2) than that of the traditional ILM peeling group (0.385 ± 0.237 mm2), and there is a significant difference between the two groups (p &lt; .05). The morphological difference in the temporal quadrant of CMDS between the two surgery technology groups was significant (p &lt; .001). This study will provide a clinical research basis for the improvement of macular hole surgery.

Retinal phototoxicity after macular hole surgery in a patient under paclitaxel

BackgroundThe purpose is to report the second case, to our knowledge, of suspected paclitaxel-induced phototoxic maculopathy following pars plana vitrectomy surgery.Case presentation63-year-old phakic female who underwent an uneventful phaco-vitrectomy to treat a complete macular hole, developing macular phototoxicity in the post-operatively period that could not be explained by the surgery itself and could only be attributed to a possible photosensitization induced by the previous use of paclitaxel.ConclusionsThe use of paclitaxel has been widely extended as a chemotherapy drug to treat breast cancer. It works by altering the intracellular microtubular reorganization and, based on this mechanism of action, photosensitivity has been previously described. We report a case of suspected paclitaxel-induced macular phototoxicity following ocular endoillumination during vitrectomy surgery.

Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy.

Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure or restoration of visual acuity is more difficult to achieve in PIMH, surgical approaches that would yield the best outcomes remain to be elucidated. On paper, extended ILM peeling combined with silicone oil (SiO) tamponade is believed to be a feasible option for excellent macular hole closure. However, no studies on this combined treatment for PIMH is compared with simple air tamponade have been conducted. Thus, in this retrospective case series, we used spectral-domain optical coherence tomography (SD-OCT) and other technologies to investigate real-world evidence for the anatomical and functional outcomes of revisional PPV with either SiO or air tamponade for failed primary idiopathic macular hole surgery. We included the records of 76 patients with PIMH who had SD-OCT examinations and best-corrected visual acuity (BCVA). Regression analysis was performed to find factors affecting PIMH fracture closure. Seventy-six participants were allocated to a SiO group (n = 21, with an extended ILM peeling and SiO tamponade) or an air group (n = 55, with extended ILM peeling and air tamponade). Anatomical success was achieved in 18 (85.7%) and 40 (72.7%) eyes in the SiO and air groups, respectively (p = 0.37). BCVA was significantly improved in both subgroups of closed PIMH (SiO group: p = 0.041; air group: p < 0.001). Minimum linear diameter (MLD) was closely related to the closure rate (OR, 1.0; 95% CI (0.985-0.999); p = 0.03). MLD = 650 μm seemed like a cut-off point for closure rate (MLD ≤ 650 μm vs. MLD > 650 μm; 88.4% vs. 52%, p = 0.002). In conclusion, we demonstrated that extended ILM peeling combined with SiO or air tamponade is effective in PIMH treatment. Moreover, though not statistically significant herein, the anatomic closure rate was better for silicone-operated eyes than for air-operated eyes. MLD is the best predictor of PIMH closure; MLD ≤ 650 μm could achieve a significantly higher closure rate.

USE OF ADDITIONAL FACEDOWN POSITIONING WITH SILICONE OIL TAMPONADE FOR THE TREATMENT OF RETINAL REDETACHMENT.

The purpose of this study was to highlight a potential alternative to additional surgery for management of retinal redetachment through the use of additional facedown positioning with silicone oil tamponade. Retrospective case series of two patients evaluated with examination, multimodal imaging, including fundus photography, optical coherence tomography, and fluorescein angiography. In Case 1, a 70-year-old female patient underwent surgery for a full-thickness macular hole with associated macula-off retinal detachment, but experienced a recurrent detachment and underwent a second surgery with silicone oil placement. Another recurrent detachment was found. The case was managed conservatively with facedown positioning, resulting in resolution of subretinal fluid and improvement in vision. At follow-up, the retina remained attached with stable vision. In Case 2, a 25-year-old male patient underwent a surgical repair for proliferative vitreoretinopathy retinal detachment with a scleral buckle, cryotherapy, and external drainage. After multiple redetachment surgeries with retinectomy and oil placement, another tractional redetachment of the fovea was noted. Management was with facedown positioning, and follow-up evaluation showed resolution of the subretinal fluid and improvement in vision with stability for greater than 2 months. For recurrent retinal redetachments with silicone oil in place, an additional week of facedown positioning can result in anatomical success and be a viable alternative or bridge to invasive surgical interventions. This approach may have greatest utility for patients who are poor surgical candidates without new peripheral pathology.

Sequential restoration of external limiting membrane and ellipsoid zone on SD-OCT after macular hole surgery

Sequential restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) after macular hole (MH) surgery, over a period of 12 weeks, is reported for the first time. This case highlights the patho-anatomical process of restoration of ELM and EZ after successful macular hole surgery (MHS).

Using a commercial fibrin sealant (TISSEEL) as an adjuvant for full-thickness macular hole closure surgery: A case series

A retrospective interventional case series was performed to evaluate the anatomical and visual outcomes of macular hole surgery aided with TISEEL commercial fibrin sealant. Seven eyes of seven patients were included: three with a recurrent macular hole, one with a traumatic macular hole, and three with primary macular holes. All eyes underwent vitrectomy, internal limiting membrane peeling, fluid air exchange, instillation of 1–2 drops of the commercial fibrin sealant on the hole, and C3F8 gas injection. The macular hole was closed in all seven patients; they showed significant improvement in visual acuity and no ocular or systemic complications.

Possibilities of Applying Viscoelastics in Vitreoretinal Surgery

Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.

Evaluation of a New Monofocal Intraocular Lens in Patients Undergoing Cataract and Vitrectomy Surgery for Idiopathic Macular Hole

Purpose To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients who underwent combined cataract and pars plana vitrectomy (PPV) surgery for idiopathic macular hole (MH). Methods A prospective study was conducted on 89 eyes of 89 patients who underwent combined cataract and PPV surgery for MH. The patients were divided into two groups: Eyhance ICB00 and Tecnis ZCB00. Pre-operative characteristics, post-operative visual outcomes, contrast sensitivity, and complications were compared between the two groups. A univariate regression analysis was performed to identify the factors that may affect the postoperative visual outcomes. Results Both groups showed significant improvement in mean corrected distance visual acuity (CDVA) six months post-operation (p < 0.001). There was no significant difference in pre-operative characteristics or complications between the two groups. However, the Eyhance ICB00 group showed a significantly higher uncorrected intermediate visual acuity (UCIVA) value at 6 months after surgery than the Tecnis ZCB00 group (p = 0.014). Contrast sensitivity values were not significantly different between the two groups. The univariate regression analysis revealed a significant correlation between preoperative CDVA and minimum linear diameter of MH with postoperative UCIVA in the Eyhance ICB00 group. Conclusions The newly generated Eyhance ICB00 IOL showed promising results in terms of post-operative UCIVA, with no significant difference in complications or contrast sensitivity values compared to the Tecnis ZCB00 IOL. These findings suggest that the Eyhance ICB00 IOL may be a useful option for patients who undergo combined cataract and PPV surgery for idiopathic MH, particularly for those who require intermediate visual acuity.

Исследование клеточного состава богатой тромбоцитами плазмы для оптимизации ее использования в хирургии макулярных разрывов. Часть 1

Currently, the use of platelet-rich plasma (PRP) is one of the successful areas of tissue engineering and cell therapy. In medicine PRP is widely used in ophthalmosurgery, in particular for macular hole (MH) closure. Purpose. To evaluate cellular composition of PRP in order to optimize its use in macular hole surgery. Material and methods. This study included platelet-rich plasma analysis of 20 patients (6 male and 14 female) who underwent surgical treatment of macular hole in Eye Microsurgery Center in the period from April till July 2021. Patients' age ranged from 57 to 82 (69,0±1.2) years. Ycellbio-Kit was used to obtain PRP. As a result of centrifugation 2 main blood fractions were obtained: plasma and erythrocyte layer. The study of the contents of the test tube was performed on 4 levels. The main attention was paid to the quantitative composition of platelets and leukocytes, which are the most important and significant in MH surgery. Results. The following platelet and leukocyte count in the general blood test and PRP were obtained as a result of the study. General blood test – platelet concentration was 140 to 285•10³/µL (215.85±9.23), P-PRP (pure platelet-rich plasma) – 699 to 5681•10³/µL (2600.4±329.9), L-PRP (plasma containing platelets and leukocytes) – 1995 to 9989•10³/µL (6555.8±506.7) (p&lt;0.001). General blood test – white blood cell concentration was 3.83 to 7.73•10³/µL (5.58±0.29), P-PRP was 0.02 to 7.08•10³/µL (1.49±0.58), L-PRP was 6.12–494.69•10³/µL (99.3±38.1) (p&lt;0.01). Conclusion. Platelet-rich plasma has regenerative activity and contractile properties in both fractions – in P-PRP and L-PRP, which simplifies the process of PRP extraction from the test tube and expands the possibilities for its use in MH surgery and other retinal pathologies associated with retinal tears. Given the lowest leukocyte concentration, the P-PRP fraction may be optimal for MH surgery. Key words: macular rupture, platelet-enriched plasma, platelets, leukocytes

MACULAR HOLE IN A PATIENT WITH PENTOSAN POLYSULFATE MACULOPATHY.

Pentosan polysulfate (PPS), a drug used for interstitial cystitis, has recently been detected to cause maculopathy in a dose-dependent manner. Outer retinal atrophy is the hallmark of this condition. History, examination, and multimodal imaging were used to guide diagnosis and management. We report a case of PPS-related maculopathy in a 77-year-old lady, who presented with florid retinal atrophy at the posterior pole in both eyes, and a concurrent macular hole in the left eye. She had been diagnosed with interstitial cystitis several years before for which she was prescribed PPS (Elmiron). She had noticed a drop in vision 5 years after initiation of PPS and self-discontinued the drug after 24 years of use. A diagnosis of PPS-related maculopathy with a macular hole was made. She was counselled regarding the prognosis and was advised to avoid PPS. Surgery for macular hole was deferred in view of the severe retinal atrophy. Pentosan polysulfate-related maculopathy can lead to severe retinal atrophy and a subsequent degenerative macular hole. A high index of suspicion is required for early detection and cessation of drug to prevent this irreversible vision loss.

Association of macular hole intraretinal fluid and visual acuity

ObjectifNotre étude visait à évaluer l'association entre l'aire du liquide intrarétinien (LIR) avant l'intervention et la meilleure acuité visuelle corrigée (MAVC) avant et après l'intervention en présence d'un trou maculaire (TM) idiopathique faisant l'objet d'une réparation chirurgicale. Notre étude s'est également penchée sur d'autres facteurs pronostiques en lien avec la réparation d'un TM qui pourraient aider les médecins à comprendre la prise en charge chirurgicale du TM. NatureÉtude de cohorte rétrospective réalisée dans un seul établissement. ParticipantsAu total, 251 patients ont subi une réparation chirurgicale du TM entre janvier 2012 et janvier 2021. MéthodesOn a procédé à une segmentation des images obtenues à la tomographie par cohérence optique (OCT) de 251 yeux présentant un TM et du LIR. L'analyse de corrélation de Spearman a permis d’évaluer les associations entre l'aire du LIR et la MAVC avant l'intervention de même que 1, 3 et 6 mois après cette dernière, ainsi que l’épaisseur du sous-champ central, le diamètre du TM, la détermination de son stade, sa fermeture et le type de fermeture avant et après l'intervention. RésultatsLa corrélation avec l'aire du LIR préopératoire était modérée pour la MAVC préopératoire (r = –0,32; p < 0,001) et négligeable pour la MAVC postopératoire mesurée après 1, 3 et 6 mois (r = –0,14; p = 0,026; r = –0,21; p < 0,001; r = –0,19; p < 0,001, respectivement). L'aire du LIR préopératoire était fortement corrélée avec le diamètre linéaire minimal du TM (r = 0,56; p < 0,001) et le diamètre de base du TM (r = 0,65; p < 0,001). Aucune autre association n'avait de signification statistique. ConclusionEn présence d'un TM idiopathique, la corrélation avec l'aire du LIR préopératoire était modérée pour la MAVC préopératoire et faible, voire négligeable, pour la MAVC postopératoire mesurée pendant une période pouvant atteindre 6 mois. Voilà qui laisse entendre que l'acuité visuelle n'a peut-être pas de lien clinique significatif avec la présence de LIR dans le contexte d'un TM.

RWC Update: Vitrectomy Surgery in a Pre-Phthisical Eye; Update on the Surgical Management of Macular Holes: The Inverted ILM Flap Technique and How It Revolutionized Macular Hole Surgery; Retinal Arteriovenous Malformation.

RWC Update: Vitrectomy Surgery in a Pre-Phthisical Eye; Update on the Surgical Management of Macular Holes: The Inverted ILM Flap Technique and How It Revolutionized Macular Hole Surgery; Retinal Arteriovenous Malformation.

Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis

ObjectifComparer la variation de la meilleure acuité visuelle corrigée (MAVC), la fermeture du trou maculaire idiopathique (TMI) et les complications chez des patients présentant un TMI qui font l'objet d'une chirurgie combinée phaco-vitrectomie ou d'une chirurgie séquentielle (vitrectomie suivie d'une phacoémulsification). NatureRevue de synthèse systématique et méta-analyse. MéthodesOn a procédé à une recherche dans 3 bases de données (PubMed, Ovid EMBASE et Cochrane Library) depuis leur date de création jusqu'en février 2022. Ont été incluses les études comparatives randomisées et les études d'observation qui présentaient des résultats au chapitre de la variation de la MAVC, de la fermeture du TMI et des complications chirurgicales. Une méta-analyse à effets aléatoires a servi à calculer les estimations de l'effet avec un intervalle de confiance (IC) à 95 %. RésultatsUne seule étude comparative randomisée et 7 études de cohorte regroupant un total de 585 patients ont été incluses. La méta-analyse portant sur la variation de la MAVC (différence moyenne : –0,03; IC à 95 % : –0,10–0,04) et la fermeture du TMI (rapport relatif : 1,04; IC à 95 % : 0,96–1,13) n'a fait ressortir aucune différence significative entre la chirurgie combinée phaco-vitrectomie et la chirurgie séquentielle. Les risques relatifs colligés en ce qui a trait aux diverses complications chirurgicales, notamment le décollement de rétine postopératoire, l'inflammation et la hausse de la pression intraoculaire, n'ont mis au jour aucune différence significative entre les 2 groupes. ConclusionsLe gain visuel et le taux de fermeture du TMI au décours d'une chirurgie combinée phaco-vitrectomie ou d'une chirurgie séquentielle étaient similaires, au même titre que les risques de complications. Les résultats anatomiques et fonctionnels de la chirurgie combinée phaco-vitrectomie n’étaient pas supérieurs à ceux de la chirurgie séquentielle. Nos résultats peuvent servir de référence pour la tenue d’études ultérieures.