Primary Macular Hole Research Articles

Surgical outcomes of inverted internal limiting membrane flap technique for primary rhegmatogenous retinal detachment coexisting with a macular hole.

This retrospective study aimed to evaluate the visual outcomes and foveal restoration in eyes with rhegmatogenous retinal detachment (RRD) and macular hole (MH) following surgery using the inverted internal limiting membrane (ILM) flap technique. We collected data on eyes with coexisting RRD and MH that underwent surgery using the inverted ILM flap technique between January 2016 and December 2018. The primary outcome measures were visual acuity (VA) and optical coherence tomography findings. Of 308 eyes with MH originating from various causes, 8 (2.6%) eyes diagnosed with coexisting RRD and MH treated using the inverted ILM flap technique were included. The average patient age and axial length were 65.00 ± 12.01 years and 23.66 ± 0.77 mm, respectively. The mean preoperative best-corrected VA (BCVA) was 1.84 (spherical equivalent [SE], counting finger) ± 0.32 logMAR and the mean final BCVA had improved significantly to 1.05 (SE, 20/223) ± 0.67 logMAR (P = .017). The primary retinal reattachment, MH closure, and secondary retinal attachment rates were 75% (6/8), 87.5% (7/8), and 100% (7/7), respectively. The inverted ILM flap technique led to significant improvements in anatomical and visual outcomes in patients with coexisting RRD and MH.

Comparative analysis of pre-operative findings and post-operative outcomes in primary and secondary macular holes at a tertiary eye hospital in South India

PurposeThis study aimed to compare demographics, clinical characteristics, and post-surgical outcomes between idiopathic and secondary full-thickness macular holes (MHs).MethodsA retrospective analysis of 348 eyes from 339 patients treated between June 2017 and December 2023 was conducted. The study included both idiopathic and secondary MHs, excluding cases where surgery was not performed or lacked sufficient follow-up. Demographic data, visual acuity (VA), ocular characteristics, and optical coherence tomography measurements were analyzed.ResultsIdiopathic MHs were identified in 308 eyes (89%), and secondary MHs in 40 eyes (11%). Idiopathic MH patients were older (mean age: 68.26 vs. 60.13 years; p = 0.001) and more commonly female (63% vs. 40%; p = 0.005). Post-surgical closure was achieved in 86% of all MHs, with a median VA improvement of 15 ETDRS letters (3 Snellen lines). However, secondary MHs had a lower closure rate (67% vs. 89%, p = 0.001) and less VA improvement (2 lines vs. 3 lines, p = 0.001) compared to idiopathic MHs. Significant differences in maximal basal diameter and diameter hole index were noted between the groups.ConclusionsSecondary MHs, accounting for 11% of surgical cases, show poorer anatomical and visual outcomes than idiopathic MHs. Despite lower success rates, early surgical intervention in secondary MHs is recommended to enhance outcomes. Differentiating between idiopathic and secondary MHs is crucial for optimal management.

RETINAL MIGRATION AND SURGICAL OUTCOME AFTER HEMI-TEMPORAL INTERNAL LIMITING MEMBRANE PEELING VERSUS CONVENTIONAL PEELING FOR MACULAR HOLE: A Multicenter, Randomized, Controlled Trial.

To investigate the anatomical changes and surgical outcomes of hemi-temporal internal limiting membrane (ILM) peeling and conventional ILM peeling for idiopathic macular hole (MH). This randomized controlled trial was conducted at 3 centers and included 50 participants with MHs of <400 µm in minimum diameter for a duration of <6 months. All participants had undergone vitrectomy with either hemi-temporal ILM peeling (Hemi group) or 360° ILM peeling (360° group) with an injection of 5% sulfur hexafluoride gas, with or without simultaneous cataract surgery, from July 2017 to January 2021. The rate of MH closure and distance of retinal migration were examined. Of 50 eyes randomized in the 3 centers, the Hemi group comprised 23 eyes, the 360° group 23 eyes, and 4 eyes were eliminated from final analysis. There was a significantly higher rate of primary MH closure in the 360° group (Hemi group: 73.9% vs. 360° group: 100%, P = 0.009). Retinal migration to the optic disk on the nasal side was significantly shorter in the Hemi group at 1, 3, and 6 months postoperatively than in the 360° group. There was no significant difference between the two groups in retinal migration to the optic disk on the temporal side. Nasal retinal migration in patients who underwent the hemi-temporal ILM peeling method was significantly less than in those who underwent the 360° ILM peeling method. However, less nasal retinal migration did not contribute to the MH closure rate.

Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit.

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm. Retrospective, monocentric, consecutive case series. Patients with primary MH operated at Lariboisière Hospital, Paris, France. Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed. Postoperative MH closure rate and visual acuity. 74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameterwas 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR. MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

PARS PLANA VITRECTOMY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEEL FOR MACULAR HOLE: A Systematic Review and Meta-Analysis.

To compare the efficacy and safety of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for macular hole (MH). A systematic literature search on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar was performed from January 2000 to 2023. The primary outcome was the final best-corrected visual acuity (BCVA). Secondary outcomes included MH closure rates and the need for repeat surgery. The authors performed a random-effects meta-analysis on Review Manager 5.4. Fourteen studies on 880 eyes were included. Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA ( P = 0.66). However, pars plana vitrectomy without ILM peeling achieved a significantly better final BCVA in eyes with closed MHs (WMD = 0.05 logMAR, 95% CI, 0.01-0.10, P = 0.02). Pars plana vitrectomy with ILM peeling achieved a significantly higher primary MH closure rate (RR = 1.21, 95% CI, 1.04-1.42, P = 0.02) and lower incidence of MH reoperation (RR = 0.19, 95% CI, 0.11-0.33, P < 0.001). The final MH closure rate ( P = 0.12) and incidence of MH recurrence ( P = 0.25) were similar between groups. Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA. However, pars plana vitrectomy without ILM peeling achieved a better final BCVA in eyes with closed MHs. ILM peeling achieved a greater primary MH closure rate and reduced need for reoperation.

Platelet rich plasma for primary macular hole: A case series.

To evaluate the anatomical and functional macular results and rate of complications following surgical treatment of primary macular hole (MH) with autologous platelet rich plasma (a-PRP) use. retrospective, interventional, non-randomized case series. A cohort of 9 consecutive patients from January 1, 2019 to August 31, 2021 who underwent vitrectomy with a-PRP use for primary MH were included. Anatomical results based on spectral domain- optical coherence tomography (SD-OCT) and visual acuity were analyzed. 10 pseudophakic eye of 9 patients were enrolled. Six patients were female and three patients were male. The mean age was 69.9 years ± 1.48. The baseline MH minimum diameter was 486.1 μm ± 37.1, and mean pre operative best-corrected visual acuity (BCVA) was 0.91 ± 0.03 logMAR (Snellen equivalent 20/160). Mean 1 month post operative BCVA was 0.81 ± 0.57 logMAR (Snellen equivalent 20/130; p = 1.000); mean 3 month post operative BCVA was 0.66 ± 0.04 logMAR (Snellen equivalent 20/90; p = 0.006); mean 6 month post operative BCVA was 0.6 ± 0.04 logMAR (Snellen equivalent 20/80; p < 0.001). In all eyes, 10/10 (100%), there was a complete MH closure at 6 months follow up: 5 eyes (50%) with a U-type closure pattern, 4 eyes (40%) with a V-type pattern and 1 eye (10%) with an irregular foveal contour closure at 6 month follow-up. No ocular and systemic complications were reported. The a-PRP use is a successful and promising vitreoretinal surgical technique option for primary MH.

VISUAL OUTCOMES AFTER INTERNAL LIMITING MEMBRANE PEELING VERSUS FLAP IN THE CLOSURE OF FULL-THICKNESS MACULAR HOLES.

To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full-thickness macular holes. Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close full-thickness macular hole at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow-up. Main outcome measures were type 1 primary full-thickness macular hole closure and postoperative best-corrected visual acuity in mean logMAR. One hundred thirty and 30 eyes underwent ILMP and ILMF, respectively. There were no significant differences in baseline characteristics between the groups. Ninety-six percent of ILMP eyes and 90% of ILMF eyes achieved primary hole closure ( P = 0.29). Among all eyes with primary hole closure, best-corrected visual acuity at 1 year was not different between the groups, but when stratified by lens status, it was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean best-corrected visual acuity (Snellen equivalent) (95% confidence interval) was 0.42 (20/50) (0.34, 0.49) in the ILMP group and 0.71 (20/100) (0.50, 0.92) in the ILMF group. Internal limiting membrane peeling and ILMF techniques yielded similarly high full-thickness macular hole closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse best-corrected visual acuity at 1 year.

Surgical treatment of small- and medium-sized primary macular holes with preservation of the internal limiting membrane in the papillomacular nerve fiber bundle area

Surgical treatment of small- and medium-sized primary macular holes with preservation of the internal limiting membrane in the papillomacular nerve fiber bundle area

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

BackgroundTo assess the safety and effectiveness of the exclusive use of 27-gauge instruments for all vitreoretinal diseases requiring vitrectomy.MethodsIn this retrospective study, 1020 consecutive surgeries were performed on 958 eyes of 848 patients using 27-gauge instruments from March 2017 to June 2021. Patients with a minimum follow-up of 3 months were included. Surgical case-mix, best-corrected visual acuity (BCVA), intraocular pressure (IOP), intra- and post-operative complications, and surgery times were recorded.ResultsThe study patients were followed up for averagely 11 months. Of the 1020 vitrectomies, 958 were primary procedures. Of the 148 retinal detachment (RD) cases, 138 (93%) required a single vitrectomy. Primary macular hole closure was achieved in 143 of 145 (99%) cases. The average surgical times were 55 and 38 min for RD surgeries and for all other indications, respectively. BCVA improved significantly at the final visit (20/49) compared with the pre-operative visit (20/78) (p < 0.01). IOP was similar at the pre-operative (14.8mmHg) and final (14.3mmHg) visits. Complications recorded include transient hypotony in 39 eyes, iatrogenic retinal breaks in 2 eyes, and a vitreous bleed in 1 other eye.ConclusionThis study revealed that 27-gauge vitrectomy instruments can be used for a wide range of indications, with exclusive use in certain settings. The outcomes were similar to other gauges, including for rhegmatogenous retinal detachment, with minimal complications.

Predictive value of ellipsoid zone-related angle parameters in primary surgery of large macular hole: a case control study

BackgroundTo explore the predictive value of Ellipsoid Zone (EZ) -related angle parameters for the outcome of primary macular hole surgery.MethodsThis was a retrospective study. Patients diagnosed with large macular hole (MH) (minimum diameter > 500 μm) between 2018 and 2021 were enrolled. All patients underwent 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling and air tamponade. Spectral-domain OCT (SD-OCT) and best corrected visual acuity (BCVA) were measured in preoperative and 2-week post-operative. Classic and angle related parameters were measured via ImageJ. Angle regularity (AR) were defined as the standard deviation of the angle parameters in vertical and horizontal direction.ResultsSeventy-six eyes were included for analysis; 24 eyes showed an unclosed macular hole at the 2-week postoperative and 52 eyes showed a closed hole. Preoperatively, MLD (P < 0.001), BD (P = 0.009) and diameter of EZ/ELM disruption (P = 0.002 and 0.025) in patients failed to close the hole after primary surgery were significantly larger than those succeeded. EZ-MH (P = 0.018), EZ-NFL (P = 0.006), EZ-GCL (P = 0.004), EZ-INL (P = 0.002), EZ-OPL (P = 0.009) and EZ-ONL (P = 0.011) angles were smaller in patients with unclosed hole. AR of the EZ-NFL (P = 0.009), EZ-GCL (P = 0.009), EZ-OPL (P = 0.023), EZ-ONL (P = 0.048) and Basal-NFL (P = 0.030) angles among the unclosed patients were significantly larger than those of the closed group. EZ-NFL (P = 0.015), EZ-GCL (P = 0.004), EZ-INL (P < 0.001), EZ-OPL (P < 0.001), EZ-ONL (P < 0.001), Basal (P = 0.023) and Basal-NFL (P < 0.001) angles of hole-unclosed patients enlarged significantly after the surgery.ConclusionsPatients with large macular holes and an increased EZ-related angle and angle AR are more likely to experience unsuccessful outcomes following primary MH surgery. Therefore, EZ-related angles hold potential as valuable parameters for predicting the surgical outcome.

Epiretinal implant of human amniotic membrane to treat highly myopic macular hole retinal detachments: A novel surgical technique.

To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient. A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days. Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up. Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.

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.

Интраоперационная индукция задней отслойки стекловидного тела без окрашивания задней гиалоидной мембраны как этап хирургического лечения витреоретинальной патологии

Purpose. To develop a technology for intraoperative induction of posterior vitreous detachment without staining the posterior hyaloid membrane and evaluate its clinical effectiveness. Material and methods. The study included 10 premature infants (18 eyes) with stages 3 (8 eyes) and 4a (10 eyes) of active ROP and 70 adult patients (70 eyes) with primary penetrating macular holes, 48 of them with medium (diameter 250–400 µm) and 22 large holes (more than 400 µm in diameter). According to the indications, all patients underwent vitreoretinal surgery using the technique of intraoperative induction of posterior vitreous detachment (PVD) developed in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. A vitreotome is used, while dyes are not used during vitreoretinal surgery. Results. It was possible to initiate the posterior vitreous detachment intraoperatively without the use of dyes and additional instruments for all patients included in the study. There were no complications at this stage of the operation in any case. In children with active ROP, posterior vitreous detachment was induced using the tip of a vitreotome, the posterior hyaloid membrane was separated from the adjacent retina almost along its entire length, and the maximum removal of the vitreum was performed. This was achieved in all 18 eyes. In adult patients with macular rupture after successful induction of posterior vitreous detachment, in all 70 cases it was possible to perform the operation completely, with the formation of the inner limiting membrane flap and the closure of the macular rupture. Conclusion. The developed technique for intraoperative induction of posterior vitreous detachment is effective in separating the posterior hyaloid membrane and posterior cortical layers of the vitreous body from the retina, reduces the duration and trauma of the operation, does not require special instruments or dyes, and can be successfully used as the initial stage of vitreoretinal operations to create access to the subsequent stages of surgery treatment. Key words: induction of posterior vitreous detachment, retinopathy of prematurity, macular rapture

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.

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.

MACULAR HOLE RECOVERY SURGERY USING AUTOLOGOUS PLATELET RICH PLASMA

The aim of this study was to evaluate the long-term outcomes of highly concentrated autologous platelet-rich plasma (PRP) used as an adjunct inmacular hole surgery. Materials and methods: 11 patients (11 eyes) were selected for surgical treatment, of which 9 patients were female and 2 males. 10 patients (10 eyes) had primary macular tears, of which 8 eyes had grade 4 and 2 eyes had grade 3 macular tears and one patient had post-traumatic macular tear. The age of patients with primary macular tear was 59-75 years, and the patient with traumatic macular tear was 32 years old. Visiometry, tonometry, ophthalmoscopy, biomicroscopy, echography of the eyeball, and optical coherence tomography of the retina were performed on all patients before the operation and in the postoperative period. The patients were operated under local anesthesia (2% 2ml Lidocaine and 0.75% 2ml Bupivacacaine) in the following way: 25 Gauge standard pars plana vitrectomy with mandatory removal of the posterior hyaloid membrane, after which peeling of the internal limiting membrane of the retina was performed with a large volume. Platelet-rich plasma was separated under sterile conditions in the operating theatre. It was introduced into the macular hole region in the end of surgery and 8% octafluoropropane gas (C3F8) was introduced into the eye. Results: There were no complications during surgery or in postoperative period. Optic coherence tomography of the macula was performed on the 7th day after surgery. In all 11 cases there was anatomical closure of the macular holes. Visual acuities were measured on days 14 and 3. On average there was an improvement in visual acuity by 2 lines according to Snellen chart, disappearance of metamorphopsia and image distortion. During the follow up the patients during 6 month there was no development cataract, retinal tears or detachment, late endophthalmitis or any other complications. Conclusion: During the surgical treatment of patients with primary and secondary macular holes the use of autologous platelet rich plasma promotes the anatomical closure of the holes, as a result of which metamorphopsias and central scotomas disappear and an increase in visual acuity is observed.

Vitrectomy for Macular Hole with Macular Foveoschisis in Myopic Tractional Maculopathy PPV for MH-MFS

Background: Macular Hole with Macular Foveoschisis (MH-MFS) represents one of the end stages of Myopic Traction Maculopathy (MTM). This study demonstrates the effectiveness of Pars Plana Vitrectomy (PPV) with appropriate Internal Limiting Membrane (ILM) peeling and use of an ILM flap without the conventional use of macular buckle for resolving this condition. Methods: Twelve highly myopic eyes with MH-MFS underwent PPV in a single institution. Careful fovea sparing Inner Limiting Membrane (ILM) peeling with inverted flap under repeated re-staining with brilliant blue was performed. Best Corrected Visual Acuity (BCVA) and rate of Macular Hole (MH) closure, as measured by Optic Coherence Tomography. Results: Primary MH closure was obtained in 90.9% of the cases. Best Corrected Visual Acuity (BCVA) improved in 9 patients (75%) from a baseline BCVA of 0.59 ± 0.26 log MAR (20/77) to a post-operatory BCVA of 0.35 ± 0.25 log MAR (20/44) with statistical significance (p=0.004). Foveoschisis resolution occurred as follows: 6 cases within the first month, and 9 cases by the first year. Partial resolution was achieved in 2 cases, while one failed to resolve during follow-up. Conclusions: PPV with ILM peeling and inverted flap is a safe and effective method for managing MH-MFS. Careful identification of ILM and a thorough understanding of the vitreomacular interface abnormalities is key to surgical success.

Retinal Morphologic Features in Patients with Large Macular Holes Treated by Autologous Neurosensory Retinal Transplantation

To investigate the time-courses of morphological changes in the transplanted grafts including the retinal layer, the ellipsoid zone (EZ) and the visual acuity (VA) after autologous retinal transplantation (ART) in patients with primary large macular holes (MH). Single-center, retrospective cohort study SUBJECTS: The study included 17 eyes of 17 patients who had undergone ART. All patients fulfilled the following criteria: (1) MH was the only disease causing anatomical abnormalities of the macula; (2) they could be followed up for at least 12 months after ART surgery; (3) they had no other systemic disorders; (4) the MH was more than 400 μm in diameter. Data of all the patients who underwent assessment of the VA and SD-OCT at 1,3, 6, and 12 months after the surgery were analyzed. The morphological features of the graft and the EZ were measured by SD-OCT. Changes in the morphological features of the graft (graft thickness, overall graft area, graft length, area of outer retina and EZ) and VA over one-year after surgery RESULTS: The mean minimum/maximum size of the MHs were 632.4 ± 120.9/1295.8 ± 276.9 μm. Closure of the MH was achieved in all patients. The VA was 0.59 ± 0.27 (logMAR) at one year post-surgery compared to 0.84 ± 0.22 before surgery (P < 0.05). The retinal layers gradually became smoothly connected. Although the decrease in graft thickness and overall graft area was observed, the length and area of outer retina was maintained throughout the follow-up period. Presence of the EZ was observed in 10 patients (59%) and our analyses revealed significantly greater improvement of VA in these patients, as compared to the patients without the EZ (P < 0.05). Moreover, the incidence of macular edema (ME) was higher in the group without the EZ (p = 0.04; chi-squared test). Patients showed significant improvements of the VA. Morphologically, the layers were gradually connected to each other, and the outer retina was particularly maintained. Especially, patients in whom an EZ was restored in the graft showed a low prevalence of ME and greater improvement of the VA.

Managing recurrent macular holes with ready‐to‐use freeze‐dried disks of human amniotic membranes

AbstractPurpose: Primary Macular Holes (MH) have a closure rate of 85%–90%. However, for large or recurrent MH, there is an ongoing debate regarding the best technique. Recent studies have highlighted the use of amniotic membrane in the treatment of recurrent MH. For this purpose, easy‐to‐use small disks of freeze‐dried and sterile human amniotic membrane (hAM) can be proposed. A phase II open and prospective clinical trial was conducted to evaluate the efficacy of a hAM in the closure of recurrent MHs.Methods: Patients between 18 and 75 years old with full thickness MHs of all etiologies that failed to close after previous pars plana vitrectomy were included. Small disks of 3 mm or 5 mm diameter of virally inactivated, freeze‐dried and sterile hAM, with intensive microbiological controls was proposed for this study. After inclusion, all patients underwent vitrectomy and hAM placement on the MH. Closure of recurrent MH (primary objective), clinical tolerance, functional restoration and impact of hAM on the retina area (secondary objectives) were assessed in the 6 months following the surgery.Results: Ten eyes of 10 patients with large recurrent MH of 412–1324 μm (mean = 715 μm) were treated in the study. Closure was complete in six eyes (60%). For two patients (20%), MH closed partially before recurring. Best corrected visual acuity improved for four of the six eyes who achieved complete MH closure (67%). No safety issue related to the hAM were reported. hAM can be persistent on MH after 6 months.Conclusions: Early results of the study suggest that freeze‐dried hAM is a safe and effective option for the treatment of recurrent MH.

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 &gt;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) &gt; 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.