Treatment Of Large Macular Holes Research Articles

Short-term results of surgical treatment in large idiopathic macular hole cases.

To evaluate results of the surgical treatment for large stage (Stage 3 and 4) idiopathic macular hole cases with and without ILM flap technique. Sixty eyes of 60patients diagnosed with idiopathic macular hole (MH) were included in the study. Complete ophthalmologic examination and SD-OCT examination were performed in all eyes. MH stages, MH base diameter, height and closest distance were measured quantitatively. Postoperative and 3months visits were evaluated. The mean age of the cases was 65.0 ± 8.0 (range 30-84) years, there were 31 (51.7%) female and 29 (48.3%) male patients with a mean follow-up period of 18.1 ± 16.7 (range 3-63)months. The mean best corrected visual acuity recorded at preoperative and third month control visits were 0.89 ± 0.40(preoperative) logMAR, 0.82 ± 0.60(3month) logMAR (p < 0.05). The mean MH index was 0.48 ± 0.16, the closest hole distance was 517.86 ± 210.89µm and mean basal diameter of holes was 947.78 ± 361.90µm and the average height was 448.93 ± 79.80 microns. There was no statistically significant difference between anatomic results of macular hole surgery with (n = 22) and without (n = 38) flap in terms of hole closure (86.4% vs. 92.1% p > 0.05). In 90% (54 cases) of the cases, closure was observed after the first surgery. Two eyes that failed macular hole surgery were reoperated. In one of these eyes, anatomical success was obtained with macular hole massage and mechanical cytumulation. However, anatomical success could not be achieved in the other eye. CONCLUSıON: In the treatment of large macular holes, pars plana vitrectomy, internal limiting membrane peeling with/without flap and gas tamponade demonstrated high anatomical and functional success.

Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Insertion Technique for Large Macular Holes: A Meta-Analysis

ABSTRACT Purposes This meta-analysis aimed to compare and evaluate the morphological and functional outcomes between the inverted internal limiting membrane (ILM) flap and ILM insertion techniques in the treatment of large macular holes (MHs). Methods The PubMed, Embase, and Cochrane Library databases were searched for relevant studies comparing the two techniques for the treatment of large MHs. The primary outcome measures included the MH closure rate, preoperative and postoperative best-corrected visual acuity (BCVA), MH closure patterns, and external limiting membrane (ELM) and ellipsoid zone (EZ) recovery. Statistical analyses were performed using RevMan 5.3 software. Results Two randomized controlled trials and four retrospective studies were included in this meta-analysis. The MH closure rate did not significantly differ between the two groups (P = .93). Postoperative BCVA was not significantly different between the two groups at 3 months (P = .20) or 6 months (P = .51). ELM and EZ recovery were also similar between the two groups. However, the results for postoperative BCVA and outer retinal structure recovery tended to favor the ILM flap group based on the forest plot. There was no significant difference between the two groups for the U-shape (P = .26), V-shape (P = .65), and W-shape closure types (P = .38). Conclusions Our meta-analysis provides evidence that the MH closure rate and visual function outcomes are similar between the ILM flap and ILM insertion techniques in large MHs. However, based on the forest plot, postoperative BCVA and outer retinal layer reconstruction tended to favor the ILM flap technique. Further studies with larger sample sizes are required to confirm the superiority of the ILM flap to the ILM insertion technique.

Влияние различных факторов на прогнозирование функционального результата при хирургии больших сквозных идиопатических макулярных разрывов

Purpose.To evaluate the effect of various factors on the prognosis of functional outcome after surgical treatment of large macular holes. Materials and methods. The results of surgical treatment of idiopathic macular holes (over 400 µm) in 47 patients (47 eyes) were analyzed. Endovitreal intervention of 25 or 27 G was performed with removal of epiretinal membrane and air tamponade. Results. Mean values of the best corrected visual acuity (BCVA) and retinal photosensitivity have been significant improved postoperatively: BCVA – from 0,12 ± 0,1 to 0,24 ± 0,18 (p&lt;0,01), photosensitivity – from 20,07 ± 3,85 dB to 21,43 ± 3,44 dB (p&lt;0,05). The mean value of the predicted BCVA according to the maximum hole diameter was 0.21 ± 0.0898. There was no dependence of BCVA on patients' age, duration of macular hole (more than 6 months) and anterior-posterior eyeball size (p&lt;0.05). Conclusion. Prediction of visual acuity after surgery is dependent by the initial retinal photosensitivity in the macular zone as well as the maximal diameter of the macular hole. Key words: idiopathic macular hole, microperimetry, vitrectomy, optical coherence tomography

Application of Platelet-Rich Fibrin Transplantation for Large Macular Hole

Purpose Large idiopathic macular hole (MH) has a lower closure rate and poor visual prognosis. To increase the closure rate and the visual outcome in patients with large MH, we evaluate a technique of platelet-rich fibrin (PRF) membrane transplantation for the treatment of large MH.Methods This was a prospective interventional study. Seventeen eyes of 17 patients (8 males and 9 females) with large MH (654.94 ± 188.08 μm) underwent pars plana vitrectomy and internal limiting membrane peeling followed by PRF transplantation between January 2019 and December 2020. The patients were followed up for at least 6 months. Preoperatively and postoperatively, all patients underwent comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, ultra-widefield retinal imaging, optical coherent tomography, and optical coherent tomography angiography.Results All the patients achieved complete and consistent hole closure after the surgery (100%). At 6 months follow-up, the external limiting membrane defects were observed in 3 eyes (17.64%), and the ellipsoid zone defects were observed in 10 eyes (58.82%). The preoperative BCVA was 1.21 ± 0.33 in logMAR. Postoperatively, the BCVA was significantly improved to 0.64 ± 0.22 in logMAR at 6 months (p < 0.001). The foveal avascular zone reduced significantly from 0.41 ± 0.08 mm2 to 0.26 ± 0.07 mm2 (p < 0.001). No complications were observed during or after the operation.Conclusions All patients in this study have achieved good anatomic and functional results, which indicate that the application of PRF transplantation is an effective and safe technique for large MH.

Опыт хирургического лечения больших макулярных разрывов без тампонады витреальной полости

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study.

Purpose:To compare the safety and efficacy of 25-gauge pars plana vitrectomy (PPV) with either platelet-rich plasma (PRP) or inverted internal limiting membrane (ILM) flap for the treatment of large macular hole.Methods:Pseudophakic patients with idiopathic macular holes with a minimum diameter (MD) of 600–1500 μm were randomized into two groups (30 patients each): 25-gauge PPV with either inverted ILM flap (group A) or PRP (group B).Results:Mean MD in groups A and B were 803.33 ± 120.65 μm and 784.73 ± 120.10 μm, respectively (P = 0.552). Mean base diameter in groups A and B was 1395.17 ± 240.57 μm and 1486.90 ± 281.61 μm, respectively (P = 0.180). The median presenting best-corrected visual acuity (BCVA) was logMAR 0.78 (range 0.78–1.00) and logMAR 0.78 (Range 0.60–1.00) in groups A and B, respectively (P = 0.103). Anatomical closure was achieved in 90% (n = 27/30) and 93.3% (n = 28/30) eyes in groups A and B, respectively (P = 0.158). Type 1 closure was achieved in 76.7% (n = 23/30) and 83.3% (n = 25/30) eyes in groups A and B, respectively. Median BCVA at postoperative 3-month in groups A and B was logMAR 0.60 (range 0.48–0.60) and logMAR 0.60 (range 0.48–0.78), respectively (P = 0.312). The average visual improvement was 2.0 and 2.5 early treatment diabetic retinopathy study (ETDRS) lines in groups A and B, respectively (P = 0.339). None of the patients developed postoperative exaggerated inflammatory reactions.Conclusion:Using platelets for the treatment of large macular holes is as safe and effective as an inverted ILM flap.

Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study

BackgroundInverted Internal Limiting Membrane (ILM)-flap technique would seem to lead to higher closure rate and better visual acuity than traditional procedure with ILM peeling for the treatment of large macular hole (LMH). Visual acuity recovery does not reveal many other functional changes related to surgical approach. Our purpose was to evaluate macular function and morphology over a 1-year follow-up after inverted ILM-flap technique for LMH by using microperimetry in order to predict visual prognosis.MethodsThis study was a prospective unrandomized single-center study. 23 eyes of 22 patients with idiopathic LMH, with a minimum diameter ranging from 400 to 1000 μm, were included. All patients underwent vitrectomy with inverted ILM-flap technique and gas tamponade. We analyzed macular hole closure rate and functional outcomes including best-corrected visual acuity (BCVA), macular sensitivity (MS) at central 12° and central macular sensitivity (CMS) at central 4°, and fixation behavior as bivariate contour ellipse area (BCEA, degrees2) at 68%, 95%, and 99% of fixation points measured by microperimeter, over a follow-up of 12 months.ResultsThe macular hole closure rate was 98%. The BCVA improved from 20/230 (Logmar, 1.06 ± 0.34) to 20/59 (logMar, 0.47 ± 0.45) at last follow-up (p < 0.001). Retinal sensitivity and BCEA significantly improved (MS, p = 0.001; CMS, p < 0.0001; BCEA: 68%, p < 0.01; 95%, p < 0.01; 99%, p = 0.001). Multiple stepwise regression analysis showed the final BCVA was significantly associated with macular hole size (β = 0.002, p = 0.03), preoperative MS (β = − 0.06, p = 0.001) and BCEA at 95% and 99% of fixation points (β = − 0.12, p = 0.01; β = 0.06, p = 0.01).ConclusionsInverted ILM-flap technique for LMH results in good morphologic and functional outcomes. Macular hole size and microperimetric parameters as preoperative MS and BCEA have a predictive role on post-surgical visual acuity.

Free autologous internal limiting membrane transplantation in the treatment of large macular hole.

We evaluated the clinical efficacy of free internal limiting membrane (ILM) flap transplantation for the treatment of large macular hole over 500 µm in 42 consecutive patients. Quantified evaluation of the post-operative macular anatomy restoration was performed by spectral-domain optical coherence tomography in the 12mo follow-up. The results showed 41 eyes achieved successful closure (97.6%). Postoperative best corrected visual acuity, ellipsoid layer, and external limiting membrane disruption were significantly improved at all follow-up time points. The central foveal thickness was significantly higher at 1mo. We concluded that free ILM flap transplantation proves to be effective to achieve anatomical and functional improvement for the treatment of large macular hole.

Non-inverted pedicle internal limiting membrane transposition for large macular holes.

The purpose of this study is to investigate the effectiveness of a new surgical technique of non-inverted pedicle internal limiting membrane (ILM) transposition for the treatment of eyes with large macular hole. This is a retrospective, consecutive, interventional case series. Twelve eyes of 12 consecutive patients who underwent vitrectomy for the treatment of a large macular hole (MH size > 400 µm) were treated. ILM was peeled and left with a pedicle attached to the superior temporal retina. The macular hole was covered by transposition of the pedicle ILM in a non-inverted way. Preoperative and postoperative best-corrected visual acuity (BCVA), SD-OCT image, macular sensitivity by microperimetry, and multifocal electroretinogram (mERG) response were evaluated. All of the patients were followed for more than 3 months. Postoperative OCT examination confirmed 11 of 12 macular hole closed (91.7%). Six macular hole filled with silicone oil closed as early as the next day. The postoperative BCVA significantly increased compared with preoperative BCVA (P = 0.002). The improvement of macular sensitivity within 2° and 8° circle was also statistical significant (P = 0.018 and P = 0.017, respectively). Fixation stability, shown as the percentage of fixation point within the 2° circle and 4° circle, was remarkably improved (P = 0.017 and P = 0.018, respectively). The R1/R2 and R1/R4 ring ratios also increased significantly as compared with that of baseline. These findings indicate that the non-inverted pedicle ILM transposition results in a high incidence of anatomic closure with good visual outcome for the treatment of large macular hole.

A retrospective analysis of the results of surgical treatment of large macular holes

Aim. A retrospective analysis of the results of surgical treatment of large idiopathic macular holes depending on the technique of surgical intervention.&#x0D; Methods. The results of surgical treatment of 60 patients (60 eyes) with idiopathic macular holes with a diameter of more than 800 μm were studied in the Republican clinical ophthalmology hospital of Kazan. The average age of the patients was 66.2±5.37 (61-74) years. The patients underwent complex ophthalmological examination before the surgery and 10 days and 1 month after the surgery, including visometry, tonometry and optical coherence tomography. Patients were divided into two groups (30 subjects each), comparable in clinical and epidemiological parameters: group 1 - standard surgical tactics, group 2 - surgical treatment according to the method proposed by professor A.N. Samoylov. Visual acuity with correction before surgery in group 1 was 0.11±0.05, in group 2 - 0.12±0.06.&#x0D; Results. Ten days after the surgery, group 1 had anatomical closure in 23 (76.7%) patients, anatomical result was not achieved in 7 (23.3%) patients. In group 2, complete closure of the rupture was achieved in 27 (90.0%) patients, incomplete - in 3 (10.0%) patients. In 1 month in group 1, complete closure of the macular rupture was observed in 22 (73.3%) patients, in 8 (26.7%) patients the result was not achieved. In group 2, complete closure of the rupture was determined in 28 (93.3%) patients, incomplete closure - in 2 (6.7%) patients. Visual acuity 1 month after the surgery in group 1 was 0.15±0.08, and in group 2 - 0.32±0.11 (p &lt;0.05).&#x0D; Conclusion. Surgical treatment of large idiopathic macular holes according to the modified technique of the inverted internal limiting membrane flap proposed by professor A.N. Samoylov, provides better anatomical and functional results in comparison with the standard technique (p &lt;0.05).

The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique

The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique

Анализ результатов хирургического лечения макулярных разрывов большого диаметра с применением различных модификаций методики «инвертированного лоскута» с использованием в качестве контрастирующего агента оригинальной суспензии «Витреоконтраст»

Анализ результатов хирургического лечения макулярных разрывов большого диаметра с применением различных модификаций методики «инвертированного лоскута» с использованием в качестве контрастирующего агента оригинальной суспензии «Витреоконтраст»

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.

Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole

양산부산대학교병원 안과학교실, 양산부산대학교병원 의생명융합연구소, 부산대학교병원 안과학교실, 부산대학교 의학전문대학원 안과학교실 Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea Department of Ophthalmology, Pusan National University Hospital , Busan, Korea Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

Inverted internal limiting membrane peeling technique with silicone oil tamponade for repair of recurrent large macular holes in vitrectomized Diabetic patients

Purpose : To present a new approach to treatment of large macular holes in already vitrectomized eyes of patients with proliferative diabetic retinopathy, whose ILM has not been removed during primary surgery. Patients and methods : Two eyes of two different patients with proliferative diabetic retinopathy which had undergone vitrectomy with endolaser 1.5 to 2 years before admittance to our department. No data for ILM peeling during surgery were available. Our OCT examinations showed macular holes with upper diameter of 765 I¼m in the first patient and 1160 I¼m in the second one. In both cases we combined two well-known surgical approaches: first, inverted ILM flap technique; second, long-term silicone oil tamponade for a period of 4 months. Results : The macula of both patients was followed up by photographs and regular OCT-s on day one, month one and three months after silicone oil removal. The macular holes remained closed after removal of the tamponade agent. BCVA was 0.5 three months after the last surgery in both patients. During the final examination, macular contour seemed almost normal. Discussion : Large, long-standing macular holes are less likely to be closed after pars plana vitrectomy. The inverted ILM flap technique has been recently reported to be successful in nearly 99% of patients with macular holes more than 400 I¼m in diameter. The position of the inverted ILM flap is much more controllable under silicone oil than under gas tamponade.

Arcuate Retinotomy for the Repair of Large Macular Holes

To present a case series to elucidate a novel technique that involves the creation of an arcuate retinotomy in the treatment of large macular holes after failed primary repair. retrospective chart review. Six eyes (six patients) with large macular holes, all of which had failed primary repair, underwent 25 gauge pars plana vitrectomy revision coupled with full thickness arcuate retinotomy temporal to the macular hole and fluid-gas exchange. The main outcome measure was anatomic macular hole closure based on optical coherence tomography (OCT), with visual acuity and visual field evaluation as secondary outcome measures. Five of the six patients (83%) had successful hole closure with three of the six patients (50%) exhibiting improvement in visual acuity. Arcuate retinotomy is a new approach that may aide in the repair of large macular holes not otherwise amenable to closure with traditional techniques.