Persistent Full-thickness Macular Holes Research Articles

Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole.

Purpose: To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). Methods: This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. Results: The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. Conclusions: An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.

Autologous internal limiting membrane transplantation achieves anatomic closure and functional improvement in the treatment of large, persistent macular holes

PurposeTo evaluate the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair.MethodsRetrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling.Main outcome measurementsFor all eyes, high-definition spectral domain optical coherence tomography scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best‐corrected visual acuity (BCVA) at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed.ResultsAnatomic closure was achieved in all 13 cases (100% success rate). Closure pattern was classified in accordance with to Rossi et al. (Graefe’s Arch Clin Exp Ophthalmol 258(12):2629–2638, 2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. No re-opening occurred during the observation period.ConclusionsPlacing an autologous ILM-transplant in the subretinal space beneath the margin of the FTMH can support anatomic restauration and functional improvement in large, persistent FTMHs.

Hydromassage of macular hole edges for large and persistent full-thickness macular holes.

To introduce the macular hole (MH) hydromassage technique as a potentially beneficial approach for the treatment of large or persistent MH. This retrospective observational case series comprised 16 consecutive patients (17 eyes) diagnosed with MH. Inclusion criteria involved a hole aperture diameter larger than 600 µm or the presence of an unclosed MH larger than 600 µm following the previous vitrectomy. Standard MH repair procedures were administered in all cases, involving the manipulation and aspiration of the hole margin through the application of water flow with a soft-tip flute needle. A comprehensive assessment was conducted for each case before and after surgery, and optical coherence tomography (OCT) images were captured at every follow-up point. The mean preoperative aperture diameter was 747±156 µm (range 611-1180 µm), with a mean base diameter of 1390±435 µm (range 578-2220 µm). Following surgery, all cases achieved complete anatomical closure of MH, with 13 cases (76.5%) exhibiting type 1 closure and 4 cases (23.5%) demonstrating type 2 closure. No significant differences were observed in the preoperative OCT variables between the two closure types. Eyes with type 1 closure showed a significantly improved visual acuity (0.70±0.10, range 0.50-0.80) compared to those with type 2 closure (0.90±0.12, range 0.80-1.00, P=0.014). The MH hydromassage technique demonstrates promising results, achieving acceptable closure rates in cases of large or persistent MH. This technique may serve as an effective adjunctive maneuver during challenging MH surgery.

Long-Term Use of Topical Carbonic Anhydrase Inhibitor Combined with an Initiation of the Two Different Eyedrops for Persistent Macular Hole Following Vitrectomy Combined with Internal Limiting Membrane Peeling: A Case Report

The authors present a long-term course of a woman in her late 50s with persistent full-thickness macular hole (FTMH) after vitrectomy combined with internal limiting membrane peeling subsequently achieved MH closure after receiving topical therapy. Specifically, successful MH closure was observed at eight weeks following an initiation of topical nepafenac, prednisolone acetate, and carbonic anhydrase inhibitor (CAI). Thereafter, the patient was maintained on topical CAI only and achieved 20/32 vision OS with nearly complete restoration of ellipsoidal layers at 18 months postoperative. To conclude, topical therapy may be considered as a non-invasive approach for persistent, cystic, small-apertured MH after vitrectomy procedures. Continuous uses of topical CAI may be of value for sustaining the long-term results. Keywords: Macular hole; Internal limiting membrane; Cystoid macular edema; Topical carbonic anhydrase inhibitor; Topical NSAID

Closure rates and patterns after light silicone oil tamponade for persistent full-thickness macular holes

PurposeTo report outcomes of re-vitrectomy using light silicone oil (SO) tamponade for persistent macular holes (MHs).MethodsWe reviewed cases of patients with full-thickness MHs that underwent pars plana vitrectomy (PPV) with air/gas and were re-vitrectomized using light SO tamponade after primary non-closure (persistent MHs). Outcome measures included anatomic closure rates and patterns confirmed by optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA).ResultsA total of 42 eyes of 41 patients with unsuccessful primary PPV with air/gas were included. After re-vitrectomy with light SO (1000-centistoke), 29 (69%) eyes demonstrated type 1 closure without neurosensory defects in OCT scans, whereas 9 eyes (21%) showed type 2 closure with persisting neurosensory defects. Available data (n = 21) showed a significant mean improvement of BCVA from 0.99 logMAR (SD 0.25, range 0.7–1.3) preoperatively to 0.74 logMAR (SD 0.42, range 0.2–1.5) postoperatively (p = 0.035).ConclusionThe treatment of persistent MHs with PPV and light SO tamponade resulted in high closure rates.

TREATMENT OF PERSISTENT MACULAR HOLES WITH HEAVY SILICONE OIL.

To determine anatomical success and best-corrected visual acuity after secondary surgery with heavy silicone oil tamponade in patients with persistent full-thickness macular holes. In this retrospective study, 63 eyes with persistent full-thickness macular holes after primary pars plana vitrectomy and internal limiting membrane peeling underwent secondary surgery with heavy silicone oil tamponade. Macular spectral domain optical coherence tomography and best-corrected visual acuity measurements were performed during the follow-up. Fifty of 63 eyes (79.4%) achieved anatomical success. In eyes achieving anatomical success, best-corrected visual acuity before primary vitreoretinal surgery was significantly better (0.77 [∼20/125 Snellen] ± 0.24 [1.3-0.3] logarithm of the minimum angle of resolution) compared with eyes not achieving anatomical success (0.88 [∼20/160 Snellen] ± 0.17 [1.1-0.6] logarithm of the minimum angle of resolution, P = 0.044). Minimum linear diameter of full-thickness macular holes was significantly smaller in eyes achieving anatomical success, both before primary (403.4 ± 128.7 [199.0-707.0] µ m vs. 568.1 ± 209.1 [307.0-953.0] µ m, P = 0.009) and secondary surgery (464.1 ± 215.0 [178.0-1,521.0] µ m vs. 663.3 ± 228.5 [451.0-1,301.0] µ m, P = 0.010). Patients remaining phakic during all three surgeries did not benefit from best-corrected visual acuity improvement, although anatomical success was achieved. Heavy silicone oil tamponade in secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. Best-corrected visual acuity and minimum linear diameter before surgery may be indicators for anatomical success.

What is the best way to treat refractory macular hole?

AbstractBackground: Despite the abundance of surgical approaches proposed for persistent full thickness macular hole (PFTMH) treatment the choice of the optimal technique remains debatable.Purpose: to analyse the anatomical and functional outcome of surgery for persistent macular holes and to determine significant risk factors for failure of primary 25‐g vitrectomy with ILM peeling and gas tamponade for treatment of FTMH.Patients and Methods: Thirty‐eight eyes of thirty‐seven patients with FTMH that underwent primary 25‐gauge PPV, ILM peeling and gas tamponade (GT) were recruited to this retrospective, consecutive, interventional study. Four eyes with persistent holes underwent a re‐operation and outcome‐related factors were discussed.Results: The primary closure rate was 89.5% (34/38). In all failed to close (FTC) cases in this study we used the novel technique recently described by us previously. This manoeuvre included the combination of a subretinal‐fluid application technique with centripetal displacement of the macula and ILM flap technique (inverted pedicle ILM flap technique was used in 3 cases and free ILM flap in 1 case). Four eyes that underwent the repeated surgery obtained final closure. A hole size of >500 μm has a statistically significant effect on the primary macular hole closure (F = 0.048; φ = 0.38; p ˂ 0.05). In the Group 2 with primary unclosed holes, 75% of the eyes (3/4) had an axial length (AL) > 26 mm, while in Group 1 with primary closed holes such eyes were 12.5 times less (2/34) 5.9% (F = 0.004; φ = 0.63; р ˂ 0.01).Conclusion: The combination of a SR‐fluid application technique with centripetal displacement of the macula and ILM flap technique for refractory FTMH provide satisfactory morphologic and functional outcomes. Elongated AL, large diameter of MH and long duration of symptoms are the risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.

A Modified Surgical Technique for Submacular Injection.

To describe a modified simple surgical technique for submacular injection. The technique involves pars plana vitrectomy, a viscous fluid control (VFC) system for semi-automatic subretinal injection of tissue plasminogen activator (tPA), bevacizumab, and air and intravitreal gas injection for submacular hemorrhage (SMH), or subretinal balanced salt solution (BSS) for submacular perfluorocarbon (PFC) bubbles or persistent macular holes. This technique was successfully performed for SMH (five patients), a subfoveal PFC bubble (two patients), and persistent full-thickness macular hole (FTMH) (one patient). The single surgical complication was an FTMH in a PFC bubble. Four SMH patients had postoperative displacement of the hemorrhage. The FTMH was partially closed. Semi-automatic subretinal injection of tPA, bevacizumab, and air with the VFC system promoted displacement and clearance of SMH without complications. A subretinal BSS injection is effective for removing subfoveal PFC bubbles and for closing persistent FTMH. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:551-555.].

Secondary Vitrectomy with Internal Limiting Membrane Plug due to Persistent Full-Thickness Macular Hole OCT-Angiography and Microperimetry Features: Case Series.

Purpose To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Methods Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. Four patients were followed for 6 months with best corrected visual acuity (BCVA) measurement, SD-OCT and OCT-A, and microperimetry. The results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Results ILM flap was integrated in all cases with V-shape of closure, and atrophy was found in one case, with the largest diameter of FTMH. BCVA improved in two cases and remained the same in two cases. In OCT-A, the area of foveal avascular zone (FAZ) was larger, and foveal vessel density (FVDS) was smaller in eyes after secondary PPV in comparison to fellow eyes. In microperimetry, retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Conclusion Although the anatomical results of repeated surgeries of FTMH with ILM plug are favorable, visual function results may be limited. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. The trial is registered with NCT03701542.

Macular Detachment for the Treatment of Persistent Full-Thickness Macular Holes.

Macular Detachment for the Treatment of Persistent Full-Thickness Macular Holes.

Silicone oil tamponade in the treatment of persistent macular holes

PurposeSeveral studies have shown that a pars plana vitrectomy with ILM‐ Peeling and SF6‐gas tamponade can close most of the macular holes. Yet some persist so that it is necessary to perform a pars plana vitrectomy again.MethodsA retrospective study of 36 eyes of 34 patients with a persistent full thickness macular hole after initial pars plana vitrectomy with ILM‐ Peeling and SF6‐gas tamponade who were retreated with silicone oil. Patients were followed for anatomical and functional outcomes.ResultsMean age was 73 years. Twenty‐seven women and seven men were included. Anatomical closure of the macular hole was found in 86% after silicone oil tamponade. A significant improvement of the visual acuity was noticed comparing the visual acuity before and after silicone oil. The mean follow up time was 15 months.ConclusionsA retreatment with silicone oil in patients with persistent full thickness macular holes can lead to a high closure rate and improvement of visual acuity.

Photocoagulation and fluid—gas exchange to treat persistent macular holes after prior vitrectomy: A pilot study

Objective This study aimed to determine the efficacy of photocoagulation to the retinal pigment epithelial (RPE) cells and fluid-gas exchange (FGX) in the treatment of persistent macular holes. Design A clinical trial. Participants Thirteen eyes of 12 patients who had undergone photocoagulation to the RPE and FGX for persistent macular holes after initial vitrectomy and gas tamponade were examined. All eyes had persistent full-thickness macular holes (diameter range, 290–820 μm; 610 ± 190, mean ± standard deviation) and no vitreous cortex around the holes on biomicroscopic examination. Intervention Argon laser photocoagulation was applied to the RPE in the hole bed, and FGX with 20% sulfur hexafluoride was then performed, followed by 2 weeks with the patient in a prone position. The follow-up period of the patients ranged from 3 to 18 months (10.2 ± 4.2; mean ± standard deviation). Main outcome measures Anatomic success and final visual outcome were measured. Results Macular holes were closed successfully after treatment in 12 (92%) of 13 eyes, and visual acuity improved 2 or more lines in 6 eyes (46%). Two eyes (15%) attained visual acuities of 20/40 or better, and seven eyes (54%) attained 20/67 or better visual acuity. There were no intraoperative complications. Cataract formation or progression was recognized during follow-up in five (83%) of six phakic eyes. Conclusions Although this study includes only a small number of patients, it suggests that photocoagulation and FGX can be effective in the treatment of persistent macular holes.

Retreatment of Full-thickness Macular Holes Persisting after Prior Vitrectomy: A Pilot Study

Vitrectomy with fluid-gas exchange has been shown to close more than one half of full-thickness macular holes, with improvement in visual acuity. By adding the appropriate dose of transforming growth factor-beta 2, a higher success rate has been reported. However, there still remain cases of macular holes that fail to close after vitreous surgery. The current pilot study is designed to determine whether reoperation may have a role in the management of cases that fail after vitreous surgery. Twelve eyes with persistent full-thickness macular holes that failed to close after an initial vitrectomy underwent reoperation using 1330 ng transforming growth factor-beta 2. After the second operation, closure occurred in 12 (100%) of 12 eyes. Follow-up ranged from 8 to 16 months. Visual acuity also improved by two or more lines in 5 (42%) of 12 patients. Increased nuclear sclerosis occurred in nine (90%) of the ten phakic eyes. Of the five eyes showing visual improvement, four required cataract extraction and intraocular lens implantation. Retreatment of persistent full-thickness macular holes with transforming growth factor-beta 2 appears to have a beneficial effect on both neurosensory retinal flattening and visual outcome.