Macular Hole Research Articles

Vitrectomy combined with inverted internal limiting membrane flap insertion or single-layered flap covering technique for highly myopic macular holes with macular retinoschisis.

To investigate the anatomical and visual outcomes of inverted internal limiting membrane (i-ILM) flap insertion versus single-layered i-ILM flap covering in highly myopic macular holes (HMMHs) associated with macular retinoschisis (MRS). A retrospective study compared 23G vitrectomy with i-ILM flap insertion (30 eyes) or covering (31 eyes) in HMMH patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis (MHS) was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA. The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group (P=0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group (P=0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared to the insertion group (1/28) finally (P=0.026). Final BCVA improved significantly in both groups (P<0.001), the BCVA was better in closed HMMHs in the covering group (P=0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β=0.386, P=0.001) and MHS stage (β=0.309, P=0.004) were independent predictive factors for the final BCVA. The single-layered i-ILM flap covering favored foveal structure recovery and provided a better visual prognosis in closed HMMHs compared with insertion. The preoperative BCVA and MHS stage were independent predictors of visual outcomes in patients with HMMHs.

Transplantation of human pluripotent stem cell-derived retinal sheet in a primate model of macular hole

Macular hole (MH) is a retinal break involving the fovea that causes impaired vision. Although advances in vitreoretinal surgical techniques achieve >90% MH closure rate, refractory cases still exist. For such cases, autologous retinal transplantation is an optional therapy showing good anatomic success, but visual improvement is limited and peripheral visual field defects are inevitable after graft harvesting. Here, using a non-human primate model, we evaluated whether human embryonic stem cell-derived retinal organoid (RO) sheet transplantation can be an effective option for treating MH. After transplantation, MH was successfully closed by continuous filling of the MH space with the RO sheet, resulting in improved visual function, although no host-graft synaptic connections were confirmed. Mild xeno-transplantation rejection was controlled by additional focal steroid injections and rod/cone photoreceptors developed in the graft. Overall, our findings suggest pluripotent stem cell-derived RO sheet transplantation as a practical option for refractory MH treatment.

Comparison of the Photoreceptor Mosaic Before and After Macular Hole Surgery with High Resolution Adaptive Optics Imaging

PurposeTo assess the photoreceptor mosaic in patients with idiopathic full thickness macular hole (MH) before and after pars plana vitrectomy (PPV) with adaptive optics enhanced retinal imaging (AO). DesignProspective case series. MethodsProspective cohort study of patients who presented at the Kensington Eye Institute, Toronto, Canada with a diagnosis of macular hole treated with PPV. Exclusion criteria: secondary MH, high myopia (axial length >26.5 mm), media opacity precluding OCT or AO imaging, previous intraocular surgery except for cataract extraction. Imaging using an AO fundus camera (Imagine Eyes, RTX1) was performed preoperatively and 3-months following successful MH repair in both eyes. Cone density (CD), regularity, dispersion, regularity, dispersion, and spacing were measured at 2° and 4° of eccentricity in 4 quadrants (superior, inferior, nasal, and temporal) with pre- and postoperative values compared. ResultsWe included 18 eyes of 9 patients. At 2° there was significant reduction in CD and increase in spacing and dispersion and a non-significant change in regularity post-operatively. Comparison between preoperative and postoperative measurements at 2° mean (Standard Error= SE) were: CD: 14612 ± 3003 and 12280 ± 4632 photoreceptors/mm2 [95%CIs= -2413 to -702] p=0.0004, regularity: 88 ± 7% and 84 ± 12% [95%CIs= -4.67 to 0.04] p=0.054, dispersion: 19 ± 6% and 23 ± 10% [95%CIs= 0.5 to 4.24] p=0.013, spacing: 9 ± 1 microns and 10 ± 2microns [95%CIs= 0.40 to 1.27] p=0.0002; at 4° was: CD: 13377 ± 4339 and 12770 ± 4391 photoreceptors/mm2 [95%CIs= -1368 to 252] p=0.176, regularity:87 ± 9% and 86 ± 12% [95%CIs= -4.65 to 0.08] p=0.74, dispersion: 20 ± 8% and 20 ±9 % [95%CIs= -2.11 to 1.5] p=0.74, spacing:10 ± 2 microns and 10 ± 3 microns [95%CIs= -0.23 to 0.58] p=0.39. ConclusionAdaptive optics imaging allows quantitative assessment of the photoreceptor mosaic pre- and post-PPV in patients with MH. There was a significant change to the photoreceptor mosaic related to the MH at 2° pre- and post-operatively. AO imaging enables high-resolution investigation of the photoreceptor remodeling process following surgery, which may allow for a more thorough assessment of surgical outcomes.

Preoperative Widefield Swept-Source Optical Coherence Tomography Versus Intraoperative Findings in Detecting Posterior Vitreous Detachment.

To assess the accuracy of swept-source optical coherence tomography (SS-OCT) in detecting complete posterior vitreous detachment (PVD) in comparison with intraoperative findings. The retrospective study included 145 eyes of 145 consecutive patients who underwent surgery for epiretinal membranes or macular holes. Within a week prior to surgery, PVD status was evaluated by SS-OCT with a depth of field of 3mm and a capture window of 16 × 8mm. Complete PVD was identified when the hyaloid condensation was visible clearly on any B-scan or when the vitreous cortex reflectivity was not visible on all 33 B-scans. Sensitivity, specificity, positive predictive value, and negative predictive value of SS-OCT for detection of complete PVD were then compared with those evaluated during a triamcinolone acetonide-assisted vitrectomy. Of the 101 eyes diagnosed as complete PVD by SS-OCT preoperatively, 97 eyes were found to have complete PVD and four eyes were found to have attached vitreous intraoperatively. Of the 44 eyes categorized as attached vitreous by SS-OCT preoperatively, 43 eyes were graded as attached vitreous and one eye was graded as complete PVD during surgery. The sensitivity of SS-OCT for detecting complete PVD was 99.0% and the specificity was 91.5%. The positive predictive value and the negative predictive value were 96.0% and 97.7%, respectively. Widefield (16 × 8mm) SS-OCT showed high accuracy for the diagnosis of complete PVD in patients with epiretinal membranes or macular holes. Widefield SS-OCT has great potential to evaluate PVD status preoperatively and explore the mechanisms of vitreoretinal diseases.

Temporal Changes in the Retinal Pigment Epithelium-Bruch's Membrane Complex Thickness After Autologous Retinal Transplantation in Myopic Eyes.

To investigate the association between the thickness of the retinal pigment epithelium (RPE)-Bruch's membrane (BM) complex and the development of retinal autograft edema as a postoperative complication following autologous retinal transplantation (ART). This retrospective study examined data from 28 eyes of 28 patients (14 males, 14 females; mean age, 61.5 ± 19.8 years) who underwent ART and were followed for 1 year. The RPE-BM complex thickness was measured 2000 µm from the fovea using Image J software. Additionally, the graft blood flow was also evaluated by optical coherence tomography angiography and fluorescein angiography. Macular hole (MH) diameters ranged from 711.2 ± 251.9 µm to 1299.9 ± 333.0 µm, with MH closure achieved in all patients. RPE-BM complex thickness decreased by 4.17 µm at 6 months and 4.34 µm at 1 year, showing significant differences from preoperative measurements (29.88 ± 4.99 µm; 6 months: 95% confidence interval [CI], 1.62-6.71, P = 0.0018; 1 year: 95% CI, 2.03-6.65 µm, P = 0.00044). The decrease was significantly greater in the edema-positive group (95% CI, -8.33 to -0.82, P = 0.020). Furthermore, the rates of ellipsoid zone (EZ) recovery, alignment of neurosensory layers (ANL), and graft reperfusion were lower in the edema-positive group (EZ, P = 0.017; ANL, P = 0.0098; reperfusion, P = 0.039). After ART, RPE-BM complex thickness decreases, particularly in cases with postoperative edema, suggesting a potential relationship between RPE function and postoperative outcomes, highlighting the importance of monitoring RPE-BM complex thickness after surgery.

Predictive relevance of optical coherence tomography indices in conjunction with visual acuity and surgical outcomes of idiopathic macular hole

Idiopathic macular hole (IMH) is a condition that arises from a combination of interactions among several forces on the fovea, remarkably from vitreous traction in the anteroposterior and tangential directions. Recent studies have highlighted the significance of microincision vitrectomy surgery, and IMH surgery was performed with minimal invasiveness, and visual improvement was an expected outcome. This study aimed to observe the pre-operative optical coherence tomography (OCT) indices correlated with visual acuity in the closure of IMH after surgery. Primarily, the findings were associated with clinical characteristics, including OCT indices, change in best corrected visual acuity (BCVA), clinical factors associated with IMH closure, and prognostic factors for the visual outcomes. This retrospective study included pre- and post-operative BCVA and OCT indices of 110 eyes with IMH. Each OCT variable was subjected to stepwise regression analysis regarding therapeutic factors that predict the need for IMH closure. Our results revealed that the hole form factor (HFF, r = 0.196), macular hole index (MHI, r = 0.669), and tractional hole index (THI, r = 0.085) had a positive correlation with visual acuity. However, basal hole diameter (BHD, r = −0.696) and minimum hole diameter (MHD, r = −0.407) showed a negative correlation. Out of them, HFF, MHI, BHD, and MHD were observed to be statistically significant (p < 0.05). The mean follow-up time was 149 ± 63.22 (85–300) days. The mean baseline BCVA was 0.75 ± 0.44 logMAR (Logarithm of the Minimum Angle of Resolution) units, which was improved to 0.29 ± 0.27 logMAR units at the final follow-up. The surgical success closure rate was 100 % among subjects with IMH. In conclusion, OCT indices were significant indicators of visual success rates in IMH, and OCT measurement could be employed as a single key index in predicting the IMH closure rate. Also, our findings suggested that OCT indices could be utilized as a safe and effective predictor of visual and anatomical outcomes in the case of IMH.

APPLICATIONS OF MULTIMODAL GENERATIVE ARTIFICIAL INTELLIGENCE IN A REAL-WORLD RETINA CLINIC SETTING.

This study evaluates a large language model, Generative Pre-trained Transformer 4 with vision, for diagnosing vitreoretinal diseases in real-world ophthalmology settings. A retrospective cross-sectional study at Bascom Palmer Eye Clinic, analyzing patient data from January 2010 to March 2023, assesses Generative Pre-trained Transformer 4 with vision's performance on retinal image analysis and International Classification of Diseases 10th revision coding across 2 patient groups: simpler cases (Group A) and complex cases (Group B) requiring more in-depth analysis. Diagnostic accuracy was assessed through open-ended questions and multiple-choice questions independently verified by three retina specialists. In 256 eyes from 143 patients, Generative Pre-trained Transformer 4-V demonstrated a 13.7% accuracy for open-ended questions and 31.3% for multiple-choice questions, with International Classification of Diseases 10th revision code accuracies at 5.5% and 31.3%, respectively. Accurately diagnosed posterior vitreous detachment, nonexudative age-related macular degeneration, and retinal detachment. International Classification of Diseases 10th revision coding was most accurate for nonexudative age-related macular degeneration, central retinal vein occlusion, and macular hole in OEQs, and for posterior vitreous detachment, nonexudative age-related macular degeneration, and retinal detachment in multiple-choice questions. No significant difference in diagnostic or coding accuracy was found in Groups A and B. Generative Pre-trained Transformer 4 with vision has potential in clinical care and record keeping, particularly with standardized questions. Its effectiveness in open-ended scenarios is limited, indicating a significant limitation in providing complex medical advice.

MIXED PATHOPHYSIOLOGIES OF LAMELLAR MACULAR HOLES AND RELATED DISEASES: A Multimodal Optical Coherence Tomography-Based Study.

To investigate the characteristics of mixed pathophysiologies in lamellar macular holes (LMHs) and related diseases using multimodal optical coherence tomography. Overall, 126 eyes diagnosed with LMH, epiretinal membrane foveoschisis, or macular pseudohole using the horizontal B-scan image according to the definition proposed by Hubschman et al in 2020 were analyzed using multimodal optical coherence tomography imaging including horizontal and vertical 5-line B-scan, radial scan, and macular three-dimensional volume scan images. If at least two diagnostic criteria for LMH, epiretinal membrane foveoschisis, or macular pseudohole were satisfied in these scans, the patient was diagnosed as having a "mixed type." Retinal traction force was quantitatively evaluated by measuring the maximum depth of the retinal folds using en-face images. Mixed types constituted 34.1% of the cases. The LMH-related mixed group demonstrated intermediate characteristics between the epiretinal membrane foveoschisis/macular pseudohole and true LMH groups in terms of retinal traction and LMH-specific features and had a significant positive correlation between the maximum depth of the retinal folds and mean M-CHARTS scores (P = 0.034). A thorough optical coherence tomography analysis is necessary to accurately diagnose LMH and related diseases. A significant positive correlation was observed between the maximum depth of the retinal folds and the degree of metamorphopsia in the LMH-related mixed group.

Resolution of Macular Confluent Drusen During the Development and Spontaneous Closure of an Eccentric Full-Thickness Macular Hole.

To describe a unique case of drusen resolution accompanying the spontaneous closure of an eccentric full-thickness macular hole (FTMH). This study is a case report. A 71-year-old male exhibited confluent drusen in the right eye beneath the fovea. During regular follow-up, an eccentric FTMH developed in the right eye and closed spontaneously. Concurrently, the confluent drusen showed rapid regression without signs of geographic atrophy or macular neovascularization. Visual acuity remained stable throughout the monitoring period. This case suggests that drusen regression can occur alongside spontaneous FTMH closure without surgical intervention. This adds to the current understanding of the pathology and treatment for drusen.

The effect of membrane peeling on the dynamics of anatomical changes in the inner layers of retina after surgical treatment of rhegmatogenous retinal detachment with macular hole

Objective: to determine the effect of membrane peeling on the dynamics of retinal inner layers anatomy changes after surgery for retinal detachment with macular hole. Material and methods. Patients of group 1 (20 patients, 20 eyes) underwent surgical treatment with repair of the rupture using an inverted flap of the internal limiting membrane. Patients of group 2 (20 patients, 20 eyes) did not undergo hole blocking during the first stage of surgery. All patients underwent optical coherence tomography to assess the condition of the inner layers of the retina. Results. One day after surgery, in patients of group 1, the thickness of retinal tissue in the parafoveal zone was 128.2±11.6 nm. In patients of group 2 it was 102.7±6.4 nm (p=0.041). These values remained until the silicone oil was removed. When comparing the indicator of the volume of retinal tissue in the parafoveal zone, there is a decrease in the indicator in patients who underwent membrane peeling, the indicator was 0.645±0.041 mm3, compared with the data of patients of the 1st group, where it was at the level of 0.787±0.52 mm3 (p=0.047). In the temporal quadrant, the difference in indicators persisted until one year after surgery. Conclusion. Membrane peeling leads to damage to the retinal tissue, local defects which can persist up to a year. The outer layers of the retina are damaged throughout the entire area of the macula due to the impact on the supporting plates of the Muller cells and the nerve fiber layer.

Full thickness macular hole after intravitreal brolucizumab injection in neovascular age-related macular degeneration.

To describe a case of full thickness macular hole after intravitreal brolucizumab injection in neovascular age-related macular degeneration, which has not been reported to date. A 65-year-old male patient received brolucizumab intravitreal injection therapy for neovascular macular degeneration of the right eye. He received multiple intravitreal anti-VEGF injections on a pro re nata regimen and developed a full thickness macular hole. Surgical treatment was performed with pars plana vitrectomy of the right eye. Full thickness macular hole was successfully treated. Although a full thickness macular hole following intravitreal brolucizumab injection is an uncommon complication, it requires caution.

Current treatment strategies for vitreomacular traction and macular holes: a survey of retinal specialists in Germany

To evaluate the different treatment strategies for eyes with vitreomacular traction (VMT) and macular holes (MF) regarding the indications and initiation of treatment. The aim of this study is to facilitate clinical decision making by presenting the opinions of experienced retinal specialists in the context of the current literature and the changed approval situation for ocriplasmin. Members of the German Retina Society (RG) were questioned in an online survey. Based on aliterature review a100-question questionnaire was created and sent to all members of the RG via an electronic link to the online platform "LimeSurvey". Voluntary participation was possible from 15October 2021 to 15November 2021. Data collection and statistical analysis were anonymized. The responses of the 115 participants were congruent with the presentation of the new S1guidelines on this topic. The indications for active treatment of focal VMT without MF were postponed in favor of watchful waiting, with the individual symptoms of the patient playing amajor role in the proposed temporal management. The results on the indications for vitrectomy are consistent and convincingly confirm the opinions on the efficacy and risk assessment of this therapeutic procedure. The results presented provide an overview of the consensus and controversies in the current treatment options for VMT and MF. With the help of ahomogeneous and experienced group of retinal experts, it was possible to develop individual treatment strategies.

Petaloid technique and prognostic significance of macular hole shapes by optical coherence tomography for full thickness macular hole.

Surgical advancements for full-thickness macular hole (FTMH) treatment include vitrectomy, membrane peeling, and the inverted flap technique (IFT). IFT, which involves inverting the internal limiting membrane (ILM) flap over the macular hole (MH) or into the MH, improves success rates and visual recovery. However, issues like mis-aspiration during flap handling have been problematic. We introduce the petaloid technique, to position the ILM flap under air during FTMH surgery to evaluate its outcomes. This retrospective study included 28 eyes, with a mean minimum linear diameter (MLD) 472.04 ± 199.7 μm and basal diameter (BD) of 834.95 ± 593.54 μm. Primary closure of MH was achieved in 96.42% of patients, with 3.57% showing persistent MH during the 6-month follow-up. The VA improved significantly from preoperative levels at each postoperative stage, with notable increases at 3 months (0.86 ± 0.49 logMAR; p = 0.0132) and 6 months (0.77 ± 0.41 logMAR; p = 0.000081). The new closure patterns showed Type A in 28.6%, B in 14.3%, C in 28.6%, and D in 25%. Among different types of closure patterns, although VA improved in all types, significant improvement in VA was noted for type A and type C, with notable improvements at the 6-month follow-up for Type A (0.60 ± 0.23 logMAR; p = 0.02) and at the 1-month follow-up for Type C (0.62 ± 0.28 logMAR; p = 0.02). For macular hole retinal detachment in 5 eyes, the average preoperative VA was 1.86 ± 0.19 logMAR, while the final mean postoperative VA showed a significant improvement to 1.1 ± 0.40 logMAR (p = 0.021, paired t-tests). Retinal reattachment was achieved in all cases (5/5) without recurrent detachment post-silicone oil removal. For the prognostic significance of MH shapes identified by OCT, it can be concluded that the shape of macular holes significantly influences visual acuity outcomes at 6 months post-surgery (p = 0.037). The shape of macular holes, particularly Flask-shaped, significantly impacts visual acuity compared to other shape. The modified petaloid technique for treating FTMH proved safe and effective, with no significant complications noted.

Prevalence of Fovea Plana in patients with rhegmatogenous retinal detachment

Purpose To assess the prevalence of fovea plana in patients with rhegmatogenous retinal detachment and compare characteristics of the detachment between patients with and without fovea plana. Methods This retrospective, cross-sectional, case–control study included individuals with rhegmatogenous retinal detachment. We collected demographics and data on the operated eye, spherical equivalent, best-corrected visual acuity, lens status, macula status, number of retinal holes or tears, and presence of intravitreal hemorrhage, macular hole, epiretinal membrane, posterior vitreous detachment and proliferative vitreoretinopathy. The type of surgery, the tamponade, and cataract surgery following retinal surgery were also recorded. Spectral-domain optical coherence tomography macular cubes were used to evaluate the fovea by using the Spectralis HRA-OCT device (Heidelberg Engineering, Germany). Images were graded by two different investigators and a third investigator in case of disagreement. Results We included 204 individuals; 35 (17.2%) had fovea plana, a proportion significantly higher than in the general population (p = 0.041). Individuals with and without fovea plana did not differ in any of the characteristics mentioned above apart from posterior vitreous detachment, which was more frequent in those with than without fovea plana (p = 0.038). Conclusion The prevalence of fovea plana is higher in patients with rhegmatogenous retinal detachment, which suggests an association between fovea plana and potential vitreoretinal interface changes.

Myopic traction maculopathy in fovea-involved myopic chorioretinal atrophy.

To assess the specific features of myopic traction maculopathy (MTM) in the context of myopic macular atrophy (MA). The evolution, surgical considerations, optimal surgical procedures, and results were studied. Retrospective, consecutive cases collection was performed for highly myopic eyes with MA (category 4, the classification system of META-analysis for Pathologic Myopia). Eighty-seven eyes of 75 patients with MA were included. The characteristics and evolution of the MTM were analyzed. Surgical indications and outcomes were evaluated and specific surgical features and techniques were assessed. Approximately half (50.6%) of the cases with MA presented with various stages of MTM. The majority were maculoschisis with a lamellar macular hole (LMH) and were characterized by an O-shaped LMH, high outer retinal schisis, thin floor, and a high percentage of thickened epiretinal tissue. Half (50%) of them either displayed maculoschisis progression (61%) or developed into macular hole with retinal detachment (39%), and all received surgical intervention. The inverted ILM flap technique, with or without fovea-sparing ILM peeling, was the most frequently used surgical technique (78%). Complete traction relief was achieved in most cases (94%). MA contributes to the specific configuration and evolution of MTM, and characteristic maculoschisis with LMH is a frequent presentation in MA patients. MHRD development and structural progression were two major reasons for surgical intervention. Vitrectomy with inverted ILM flap effectively stabilized the macular structure with few recurrences.

Outcomes of amniotic membrane transplant for refractory macular hole – an optical coherence tomography and autofluorescence long-term study

Outcomes of amniotic membrane transplant for refractory macular hole – an optical coherence tomography and autofluorescence long-term study

Machine Learning and Optical-Coherence-Tomography-Derived Radiomics Analysis to Predict the Postoperative Anatomical Outcome of Full-Thickness Macular Hole.

Full-thickness macular hole (FTMH) leads to central vision loss. It is essential to identify patients with FTMH at high risk of postoperative failure accurately to achieve anatomical closure. This study aimed to construct a predictive model for the anatomical outcome of FTMH after surgery. A retrospective study was performed, analyzing 200 eyes from 197 patients diagnosed with FTMH. Radiomics features were extracted from optical coherence tomography (OCT) images. Logistic regression, support vector machine (SVM), and backpropagation neural network (BPNN) classifiers were trained and evaluated. Decision curve analysis and survival analysis were performed to assess the clinical implications. Sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC) were calculated to assess the model effectiveness. In the training set, the AUC values were 0.998, 0.988, and 0.995, respectively. In the test set, the AUC values were 0.941, 0.943, and 0.968, respectively. The OCT-omics scores were significantly higher in the "Open" group than in the "Closed" group and were positively correlated with the minimum diameter (MIN) and base diameter (BASE) of FTMH. Therefore, in this study, we developed a model with robust discriminative ability to predict the postoperative anatomical outcome of FTMH.

Modified packing technique in large traumatic macular holes

Modified packing technique in large traumatic macular holes

Covering corneal stromal lenticule for macular hole in pathological myopia.

To evaluate the clinical effect of a new surgery technique (covering corneal stromal lenticule, CSL) for macular hole (MH) in pathological myopia. This was a prospective non-randomized series case study. Fourteen eyes of 14 patients whose axial length were more than 29 mm and suffered from MH and macular hole retinal detachment (MHRD) were included in this study. All cases were treated with 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, covering CSL and C3F8 gas tamponade. These cases were followed for 6mo, and the best-corrected visual acuity (BCVA), healing status of MH, the reattached rate of retinal detachment (RD), and reoperation rate were analyzed. All cases were successfully performed the surgery and the postoperative follow-up was completed. After surgery, MHs were healed in all 14 eyes (100%, 14/14) after assessed by optical coherence tomography. The reattachment of retina was achieved in all 6 eyes (100%, 6/6) with MHRD. BCVA was improved in 12 eyes (85.71%, 12/14), and had no significant change in 2 eyes (14.29%, 2/14). The overall mean BCVA was improved from 1.80±0.77 to 0.82±0.46 logMAR (F=10.46, P<0.01). No serious complications occurred in all cases. The new surgery technique (covering CSL) has high reattached rate of RD and high healing rate of MH in pathological myopia in the preliminary study. And it can effectively improve the visual function of patients. This new technique offers meaningful new ideas for treating refractory MH in pathological myopia.

The effect of inner limiting membrane peeling on visual fields: Unravelling a source of bias in glaucoma management

Abstract: Pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling aims to improve visual function. Previous studies have focused on visual acuity, often neglecting visual field (VF) changes. This systematic review examines VF changes after PPV with ILM peeling in patients with epiretinal membrane (ERM) or macular hole (MH), including those with glaucoma, who have preexisting VF damage, to identify potential biases in glaucoma management. The inclusion criteria were as follows: (A) Patients undergoing ILM peeling for ERM or MH and (B) VF outcomes assessed through standard automated perimetry (SAP) or Goldmann kinetic perimetry. Exclusions were non-English studies and those with fewer than 30 subjects. Data included retinal disease, demographics, VF outcomes (mean deviation [MD], pattern standard deviation, and central VF sensitivity [CVFS]), study design, and use of stains. Out of 612 studies, 23 met our criteria. Of these, four included glaucoma patients and seven involved concomitant phacoemulsification. In glaucoma patients, two studies showed MD improvement in the central 24°, while one showed deterioration in the central 10°, linked to worse preoperative MD and older age. Among studies without glaucoma patients, three of eight using SAP reported increased VF defects (VFDs); two showed lower outer nasal CVFS postoperatively. Indocyanine green staining was linked to higher VFD incidence while triamcinolone acetonide or tryptane blue staining led to no significant VFDs. The nasal half of the central VF was more affected, possibly due to retinal ganglion cell distribution. Further prospective studies, including randomized controlled trials, are needed to better understand ILM-peeling effects.