Surgical Treatment Of Macular Holes Research Articles

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience.

To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011-2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectral-domain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of ≥ 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8years-old. Median (range) follow-up was 21 (3-92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%). The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01-1.02) independently predicted a final BCVA (logMAR) < 0.3 units. Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome.

Морфологические изменения слоев сетчатки при оперативном лечении макулярного разрыва

Морфологические изменения слоев сетчатки при оперативном лечении макулярного разрыва

Surgical Treatment of Macular Hole without Postoperative Vitreous Cavity Tamponade

Purpose. To present the technique of macular hole surgery without vitreous cavity tamponade with gas or another vitreous substitute in post-op period. Patients and Methods . Frequency of the disease is 3 cases per 10,000, more often after 55 years — 3–3.3 cases per 1000, and the peak occurs at the age of 60 years and older. According to current data, the frequency of closure MH after vitreous surgery varies from 68 to 98 %. Sixteen eyes of 16 patients were operated on for full-thickness macular holes 100 to 932 (558.5 ± 50.9) microns in diameter. BCVA was 0.04 to 0.2 (0.09 ± 0.01). Follow-up period of the patients was 9 ± 6.3 weeks. Results . No intraoperative and postoperative complications were seen. In the result of surgery complete closure of the macular hole and anatomical restoration of the macula was achieved in 15 of 16 cases (92.8%). Postoperative BCVA was 0.2 to 0.6 (0.4 ± 0.04). A recurrence in one case was associated with a violation of operation technology when a partial mechanical displacement of the fibrin film with a cannula during PFCL exchange for air occurred. Conclusions . The suggested method of macular hole surgery without postoperative tamponade of the vitreous cavity with gas or another vitreous substitute may be used in routine clinical practice: Without face down positioning, reduced risk of cataract and increased IOP, air flight and climb to a height in the early post-op period.

OCT Angiography in Evaluation of the Macular Holes Treatment Results

Purpose:to assess the structure of the avascular zone and Vessel Density Retina in fovea using optical coherence tomography with angiography (OCT-angiography) after surgical treatment of macular hole, (MН) with platelet-rich plasma (PRP).Patients and methods.We examined and operated 32 patients (32 eyes) with macular hole. During surgery, after posterior hyaloid and internal limiting membrane (ILM) removing the platelet–rich plazma was appliqué on the region of the hole. Оphthalmologic diagnosis and OCT angiography were performed before and in 1 and 3 months after surgery, evaluate the area of the avascular zone and Vessel Density Retina in fovea. We compared this information with a healthy eye.Results and discussion.Аll patients had significantly visual acuity increasement. Anatomical closure was confirmed in all cases. Аfter surgery, we note a decreasement in the size of the avascular zone and increasement of the Vessel Density Retina in fovea.Conclusions.OCT angiography allows to evaluate the decreasement in the size of avascular areas and increasement of the Vessel Density Retina in fovea in postoperative period.

Структурные изменения макулярной области после хирургического лечения макулярных разрывов с применением богатой тромбоцитами плазмы крови

Purpose. Evaluation of structural changes in the macular area after surgical treatment of idiopathic macular holes (MH) with the use of autologous platelet-rich plasma (PRP) in terms up to 12 months. Material and methods. We examined 41 persons (45 eyes) with idiopathic MH; patients were under observation at least 12 (up to 24) months after surgery with application of PRP to MH region. Twelve eyes with a minimum diameter of MH of at least 440 µm were allocated to the subgroup «≥440 µm». For it the control group was formed of 19 patients (19 eyes) with MH of similar sizes, successfully operated earlier by standard technology. Optical coherence tomography (OCT) and other examinations were performed at 1, 3, 6 and 12 months after operation. Results. One month after the operation with the use of a PRP, OCT demonstrated in the region of the MH an area of increased optical density and a defect of the ellipsoid zone of photoreceptors. In the eyes with a minimum diameter of MH 440 µm or more, these changes by 12 months were mostly preserved, although the defect of the ellipsoid zone was significantly reduced. In the eyes with MH less than 360µm the normal structure of the retina was restored up to 3-12 months. In the eyes with MH of 360-439 µm both variants of changes were observed. In the subgroup «≥440 µm», despite a significantly larger size of the MH, the visual functions at the end of the observation period did not differ much from the control group. Conclusion. One month after surgical treatment of MH with the use of PRP, OCT demonstrated in the region of hole the area of increased optical density and the defect of the ellipsoid zone of photoreceptors, which by 12 months decreased in size, and at MH with a minimum diameter less than 360 µm were not determined. In comparison with the standard surgical technology, the use of PRP did not have a negative impact on the functional outcome of the operation.

Surgical treatment of macular holes using platelet rich plasma

Surgical treatment of macular holes using platelet rich plasma

Сравнительная эффективность хирургического лечения макулярных разрывов с применением богатой тромбоцитами плазмы крови

Сравнительная эффективность хирургического лечения макулярных разрывов с применением богатой тромбоцитами плазмы крови

The concept of the foveola anatomical reconstruction in the surgical treatment of full-thickness macular tears using intraoperative OCT control

Background. The concept of foveola anatomical reconstruction in surgical treatment of macular holes is a minimally invasive approach based on sparing principles of visualization and removal of transparent structures.&#x0D; Purpose. To estimate the practical value of high-resolution intraoperative OCT control (IOСT) at surgical treatment of macular holes.&#x0D; Materials and methods. The study included 95 patients (95 eyes) with macular holes from 400 to 900 microns in diameter, being during the period from September 2015 to October 2016.&#x0D; Results. IOСT control increases the anatomical and functional success of macular hole surgery, allowing determining more accurately the vitreomacular interface anatomical structures during the procedure and making more precise choice of tamponade agent to the end of it.&#x0D; Conclusion. The proposed foveola anatomical reconstruction in surgical treatment of full-thickness macular holes enhanced by intraoperative OCT control provides high functional and anatomic postoperative retinal indices.

Analysis of surgical treatment results of macular holes in the Samara region

Aim. Analysis of anatomical and functional results of surgical treatment of full-thickness macular holes. &#x0D; Methods. We conducted a retrospective analysis of medical records of 194 outpatients (194 eyes) on whom surgical treatment of macular hole was performed in Samara Clinical Ophthalmic Hospital n.a. T.I. Eroshevskiy during 2015-2016. &#x0D; Results. On day 5 after surgery in 96 (97.9%) patients with a hole of more than 400 µm operated according to inverted flap technique, and in 93 (96.9%) patients with hole of less than 400 µm, on whom removal of the internal limiting membrane around the hole was performed, we observed macular hole closure. The best corrected visual acuity of patients with the hole of more than 400 µm increased to 0.18±0.13 (p

Quantitative analysis of external limiting membrane, ellipsoid zone and interdigitation zone defects in patients with macular holes.

To investigate the correlation between the length of external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IZ) defects and visual prognosis in patients undergoing macular hole (MH) surgery, using spectral-domain optical coherence tomography (SD-OCT). This is a retrospective, consecutive, observational case series study. Fifty-two eyes of 52 patients with primary MH were evaluated. A quantitative analysis of ELM, EZ and IZ defects was performed preoperatively and at 3 and 6 months postoperatively using SD-OCT. The correlation between pre- and postoperative ELM, EZ and IZ defects and the best-corrected visual acuity (BCVA) was investigated. The lengths of ELM, EZ and IZ defects correlated significantly with BCVA in each study period (P < 0.001). Preoperative measures of these band defects were also associated with visual outcomes 3 and 6 months after surgery (P < 0.05). Considering all preoperative parameters, the length of the ELM defect was the factor most strongly correlated with BCVA at 6 months (β = 0.643, P < 0.012). The integrity of the ELM was the only factor significantly associated with BCVA at 6 months (β = 0.427; P = 0.004). The preoperative length of the ELM defect is the strongest predictor of visual acuity after MH surgery. Postoperative integrity of the ELM is significantly associated with visual restoration after surgical treatment of MH.

СРАВНИТЕЛЬНЫЕ РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬШИХ ИДИОПАТИЧЕСКИХ МАКУЛЯРНЫХ РАЗРЫВОВ

The goal is to evaluate the effectiveness of the developed technique of the gradual forming of the internal limiting membrane (IML) fragment in the treatment of large macular holes (MH) in comparison with the standard methodol-ogy (using classical maculorhexis and rapprochement of MH edges by using of vacuum aspiration). Materials and methods: we observed 137patients (103women, 34men) aged from 54 to 78years with large MH (over 400μm). Duration of MH ranged from 3 to 60months. All the patients were divided into groups: 1 (new methodology) and 2 (standard method), and sub-groups: 1a and 2a – patients with MH with a minimum diameter 400–650μm; 1b and 2b – patients with MH with a minimum diameter more than 650μm. The new technique is performed in several stages, during which several series of ILM “petals” removal are made, leaving an intact area on the MH edge. The last ILM “petal” or fragment is inverted and placed on the MH. Results: In subgroup 1a, there was a statistically significant increase in best corrected visual acuity (BCVA) during all follow-up with the most pronounced growth in the first 6 months (from 0.15±0.06 to 0.55±0.14) (p&amp;#60;0.05). In subgroup 1b a statistically significant increase in mean values of BCVA was also observed especially during first 6month (from 0.13±0.06 to 0.36±0.12) (p&amp;#60;0.05). In group2 (a, b) BCVA was significantly lower (p&amp;#60;0.05). Conclusion: the new technique allows to reach higher functional-anatomical results in surgical treatment of MH.

Surgical treatment of macular holes with multiple recurrences

Purpose To evaluate the results of a third macular hole surgery in eyes with recurrent macular holes and two prior macular hole surgeries. Design Retrospective consecutive noncomparative case series. Participants Sixteen eyes of sixteen patients with two prior macular hole surgeries with recurrent macular hole. Intervention A third vitreous surgery was performed in each eye using a long-acting gas bubble. Main outcome measure Closure of the macular hole and change in visual acuity. Results The macular hole was closed in 12 of 16 eyes (75%) at 3 months after the third surgery. Visual acuity improved 2 or more Snellen lines in 9 of 16 eyes (56%), and 5 of 16 eyes (31%) achieved 20/40 or better vision. Six eyes (37.5%) had cataract surgery after the third macular hole surgery, and visual acuity results were similar in eyes with or without cataract surgery. Successful closure of the macular hole improved the visual acuity from 20/80 −1 to 20/50 +1 ( P < 0.001). Eyes in which one of the previous surgeries had been temporarily successful in closing the macular hole improved from a mean of 20/80 to 20/40 ( P = 0.003). Eyes in which both prior macular hole surgeries had been primary failures had minimal benefit with a preoperative visual acuity of 20/100 +1 and a postoperative visual acuity of 20/100 +2 ( P = 0.67). Conclusions Repeat macular hole surgery should be considered in eyes with recurrent macular holes and two prior surgeries when the macular hole was temporarily closed by at least one of the two previous surgeries. Successful closure of a macular hole in such cases usually results in significant visual acuity improvement.

Surgery for idiopathic full-thickness macular holes.

Idiopathic full-thickness macular holes (FTMH) are an important cause of loss of central vision in the elderly. Improved understanding of the natural history and pathophysiology of FTMH has led to recent advances in the surgical management of patients with this hitherto untreatable condition. The current concepts of the natural history and surgical treatment are reviewed. Pilot studies of vitrectomy undertaken to relieve the tangential traction at the vitreomacular interface and the role of growth factors as promoters of a limited healing response are reviewed and illustrated by the results of surgical treatment of macular holes obtained by the author and others. Whereas early pilot studies of vitrectomy of impending (stage I) macular hole suggested beneficial results (80-95% of operated eyes did not progress to FTMH), no such benefit could be demonstrated by a subsequent randomised treatment trial. In a study of early vitrectomy and partial fluid-gas exchange hole closure was achieved in 88% of patients with stage II FTMH with visual improvement in 67%. In other studies of FTMH (stages II-IV) the addition of adjunctive substances such as growth factors, autologous serum, plasma or platelet concentrate has resulted in closure in 77-100% of cases. However, similar results have also been reported with vitrectomy and gas tamponade alone. Histologically the closure of the FTMH is associated with glial proliferation. Vitrectomy and intraocular tamponade appear to be beneficial in patients with FTMH. The role of adjunctive substances, such as growth factors and other promoters of the healing response, requires clarification by randomised treatment trials.

TREATMENT OF RETINAL DETACHMENT

To the Editor. —I read with interest the article of Drs. G. M. Howard and C. J. Campbell entitled, Surgical Repair of Retinal Detachments Caused by Macular Holes, which appeared in the March issue of theArchives, on page 317. Undoubtedly, the suction retractor devised by Dr. Howard will prove useful not only for the treatment of macular holes, but for retinal detachment surgery in general. I agree with the statement of the authors that simple retinopexy suffices for the surgical treatment of macular holes with frank retinal detachment. This was also the conclusion of the pioneers of retinal detachment surgery, A. Vogt and K. Lindner more than 35 years ago, and they treated these cases accordingly. In the midthirties, A. Vogt 1-3 developed the treatment of holes at the posterior pole with catholysis current, which produces much finer scars than diathermy,and K.Lindner 1(p371),2(p483),3(p438) developed his undermining technique in which