Treatment Of Persistent Macular Holes Research Articles

Relaxing radial retinal incisions for the treatment of persistent macular holes.

Various surgical techniques have been described for managing persistent macular holes after an unsuccessful vitrectomy with internal limiting membrane (ILM) peeling. However, the closure and functional improvement rates after these procedures are limited. Therefore, the aim of this study was to evaluate the usefulness of radial retinal incisions (retinotomies) in eyes with persistent large macula holes despite previous vitrectomy with ILM peeling. In a retrospective case series, closure rate and best-corrected visual acuity (BCVA) were evaluated in eyes with persistent macular holes after an unsuccessful vitrectomy that included posterior vitreous detachment and ILM peeling. 22 eyes of 22 patients (10 men and 12 women) underwent re-vitrectomy with radial retinal incisions. All the patients had undergone an unsuccessful surgery before. Small-incision re-vitrectomy with radial retinal incisions (retinotomies) and air tamponade was performed. For all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery; 1 week and 1 month after surgery; and at final follow-up. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 months after operation, and at the final follow-up visit were analyzed. The mean baseline macular hole diameter was 668.5 ± 226.8 μm. At the final examination, 16 (72.72%) of the 22 macula holes were closed. Visual acuity increased in 17 eyes, was stable in 3 eyes, and decreased in 2 eyes owing to central retinal atrophy in both. The mean BCVA increased from logMAR 1.04 ± 0.29 at baseline to 0.57 ± 0.31 (Snellen 0.11 ± 0.05 to 0.33 ± 0.18). In all successful cases, macula hole closure was attained after 3 days, and none of the eyes showed macula hole recurrence. The results of this limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery with ILM peeling increase the success rate of macula hole closure and results in a relevant increase in BCVA. However, as the number of eyes included in this series is limited, the results must be confirmed in a study with a larger sample size.

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.

A three-step approach to close refractory persistent macular holes: a releasing-closing-tapping approach

PurposeThe aim of this study was to assess the efficacy and safety of a novel releasing-closing-tapping approach in the treatment of persistent macular holes (PMHs) after initial surgery with internal limiting membrane (ILM) peeling.MethodsWe retrospectively analyzed patients with PMHs after initial surgery with ILM peeling who were treated with a novel releasing-closing-tapping approach. After repeated pars plana vitrectomy (PPV), the surgeon effectively released the adhesion between the edges and retinal pigment epithelium (RPE) by gently scraping the retinal neuroepithelium. Then, the hole was converted into a transverse slit, and the edges were gently tapped flat so that they attached to the RPE, and no space was left under the edges. Finally, air tamponade was carried out. The primary outcome measures included MH closure and the change in best-corrected visual acuity (BCVA) from preoperatively to postoperatively.ResultsThe study included 11 PMH patients with a mean age of 63.82 ± 3.31 years. The mean minimum linear diameter of PMHs was 666.3 ± 208.1 μm, and the mean basal diameter was 1547.2 ± 351.8 μm. MH closure was achieved in 90.9% (10/11) of eyes, with significant improvement of visual acuity from 1.19 ± 0.30 logMAR to 0.65 ± 0.29 logMAR postoperatively.ConclusionThe releasing-closing-tapping approach with repeated PPV is a simple, effective, and safe surgical procedure for refractory PMHs after initial surgery with ILM peeling that can significantly improve the visual outcome and achieve a high surgical success rate.

A neoteric approach for treatment of persistent macular hole using human amniotic membrane

A neoteric approach for treatment of persistent macular hole using human amniotic membrane

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.

Fluid-air exchange with single syringe for the treatment of persistent macular hole after vitrectomy

Objective To evaluate the efficacy of single syringe fluid-air exchange (SSFAE) for the treatment of persistent idiopathic macular hole(IMH) after vitrectomy. Methods The data of 11 eyes of 10 cases with persistent IMH after vitrectomy from Jan.2015 to Aug.2018 at Subei People’s Hospital Affiliated to Yangzhou University were retrospectively analyzed. All cases received SSFAE in outpatient department. The closure rate of macular hole and the changes of visual acuity after SSFAE were evaluated. Results The rate of macular hole closed after the first SSFAE was 63.63% (7/11), 72.72% (8/11) after the second SSFAE and 81.81% (9/11) after the third SSFAE. Conclusion SSFAE is a simple, safe and efficient method for the treatment of persistent IMH after vitrectomy. Key words: Hole, macular; Vitrectomy; Exchange, fluid-air, single syringe

Retrospective study of changes in ocular coherence tomography characteristics after failed macular hole surgery and outcomes of fluid-gas exchange for persistent macular hole.

Purpose:The aim is to study the changes in ocular coherence tomography (OCT) parameters of large (≥400 μ) full-thickness macular holes (FTMHs) after a failed surgery and evaluate the outcome of fluid-gas exchange (FGE) in the treatment of persistent macular hole and role of OCT in predicting outcome after the secondary intervention.Methods:Changes occurring in the OCT parameters of FTMH after a failed vitrectomy were evaluated. FGE was done in an operating room with three pars plana sclerostomy ports. The anatomical and functional outcomes of FGE for these persistent macular holes were also assessed. Anatomical closure was defined as the flattening of the hole with resolution of subretinal cuff of fluid. Anatomical success after FGE was defined as flattening of macular hole with the resolution of subretinal cuff of fluid and neurosensory retina completely covering the fovea. Functional success was defined as an improvement of at least one line of best-corrected visual acuity (BCVA).Results:Twenty-eight eyes (28 patients) were included in the study. After the failed vitrectomy, OCT showed an increase in the base diameter, opening diameter, and height of the hole. After the secondary procedure, anatomical closure was achieved in 89.3% eyes. Mean BCVA improved from logMAR 0.88 ± 0.24 (20/152) to logMAR 0.66 ± 0.24 (20/91) (P < 0.001). Eight (28.6%) patients achieved final BCVA ≥20/60. Functional success was obtained in 19 patients (67.9%). There was no association between anatomical success after FGE and any of the pre-FGE OCT parameters or indices.Conclusion:Unsuccessful surgery causes swelling of the outer and middle retinal layers with retraction of inner layers of the retina. Performing FGE while visualizing the retina is a good option for the treatment of large persistent macular holes as it causes complete drying of the macula, better success rates, and a reduced complication rate. Pre-FGE OCT does not help in predicting the outcome of FGE for persistent macular hole.

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.

Macular Detachment for Treatment of Persistent Macular Hole

The authors report a technique for treatment of persistent macular holes in cases refractory to traditional surgical techniques. With a standard pars plana vitrectomy approach, subretinal infusion of balanced salt solution was performed and followed by a fluid-air exchange. This intervention resulted in hole closure despite poor prognosis and may be considered as a treatment option for patients with persistent flat macular holes.

Does sulfur-hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, suffice for the treatment of retinal detachment associated with macular hole?

Objective: To evaluate the efficacy of sulfur hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, for the treatment of retinal detachment (RD) associated with macular hole (MH).Materials and methods: Our study was a retrospective interventional case series. We evaluated 9 phakic eyes of 9 consecutive patients with retinal detachment secondary to macular hole (MHRD) treated with 20-gauge (g) pars plana vitrectomy, which was followed with trypan blue–assisted internal-limiting-membrane peeling, fluid–air exchange, and 20% sulfur hexafluoride tamponade (SF6) gas exchange. All patients underwent optical coherence tomography, best-corrected visual acuity (BCVA) measurement, and dilated fundus examination with indentation, pre- and postoperatively.Results: The mean (± standard deviation) follow-up time was 13 ± 3 months (range 9–18). Postoperatively, all eyes demonstrated an attached retina, whereas MH closure was achieved in only 1 eye, and in a second eye after additional injection of gas and further posturing. The BCVA improved from 2.2 ± 0.4 logMAR (logarithm of the minimum angle of resolution) at baseline to 2.0 ± 0.5 logMAR at the end of follow-up (p = .05).Conclusion: The failure in MH closure in most of our cases strengthens the view that short-term tamponade with SF6 may not suffice for achieving MH closure, and either prolonged tamponade (with C3F8 or silicone oil) or additional photocoagulation may be a better option for eyes with MHRDs. In addition, it is possible that intravitreal injection of gas might be an option for the treatment of persistent MHs after vitrectomy for MHRD, especially when the MH is small. Further studies are required to evaluate the above findings, although the implementation of large series studies remains a challenge because of the rarity of cases with MHRDs.

Use of heavy silicone oil (Densiron‐68®) in the treatment of persistent macular holes

In this retrospective case series, we studied the effect of 'heavy' silicone oil on persisting macular holes. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade Densiron-68. Twelve patients with primary macular holes that persisted after pars plana vitrectomy, peeling of the internal limiting membrane and internal gas tamponade with SF6 (sulphur hexafluoride) were retreated with heavy silicone oil, Densiron-68, in the University Eye Hospital, Cologne. After 1.5-4 months the Densiron-68 was removed. Best corrected visual acuity (VA), slit-lamp examination, binocular fundus examination and optical coherence tomography (OCT) were used for evaluation pre- and postoperatively. The follow-up period was 3-7 months. Preoperatively, all patients displayed full-thickness macular holes, with a mean size of 502.25 microm (+/- 129.39 microm). Postoperatively, 11 of 12 macular holes were closed. One patient experienced a reopening of the macular hole. Mean VA was 20/250 (1.07 +/- 0.22 logMAR) prior to treatment with Densiron-68 and 20/160 (0.84 +/- 0.24 logMAR) postoperatively. Visual acuity increased from baseline in nine patients and decreased in one. Retreatment of persisting macular holes with the heavy, longterm tamponade Densiron-68 resulted in anatomical closure of the hole in 11 of 12 cases. This result was accompanied by a functional improvement in VA in nine of 12 patients.

Heavy silicone oil (Densiron-68) for the treatment of persistent macular holes

To evaluate the efficacy and safety of the use of Densiron-68 as intraocular endotamponade for the treatment of persisting macular holes (persistent MHs). Retrospective interventional case study on 23 consecutive eyes showing persistent MHs after unsuccessful primary surgery that underwent retreatment with pars plana vitrectomy and Densiron-68 filling. The main outcome measures were: anatomic closure evaluated with optical coherence tomography (OCT), final best-corrected visual acuity (BCVA), and postoperative complications. A total of 23 patients (52-88 years) were studied. Pre-operative OCT showed full-thickness MH (mean size 560 microm) in all patients. Densiron-68 was left in situ for 1.5-3 months. Final follow-up time was 12 months after the last surgery. Postoperative OCT showed the complete closure of the PMH in 20 of 23 eyes. Pre-operative BCVA ranged from 20/200 to 20/630 (1.50-1.00 logMAR, mean 1.14). Final postoperative BCVA ranged from 20/30 to 20/400 (0.18-1.30 logMAR, mean. 0.61). Nineteen eyes (82%) showed a significant increase in visual acuity by at least three lines: 11 (47%) patients gained at least four lines. Three eyes remained unchanged (13%). One case deteriorated by two lines (4%). No major complications were recorded. Retreatment with Densiron-68 filling was safe and achieved encouraging anatomic and functional results.

SUCCESSFUL TREATMENT OF PERSISTENT MACULAR HOLES USING “HEAVY SILICONE OIL” AS INTRAOCULAR TAMPONADE

Silicone oil tamponade has been suggested in the treatment of persistent macular hole, but visual outcome is often poor. We describe two patients who underwent reoperation for persistent macular hole using "heavy silicone oil" (HSO) tamponade. Two patients who underwent vitrectomy, removal of the posterior vitreous cortex, peeling of the internal limiting membrane, and long-acting gas tamponade had persistent macular hole 3 months after surgery. The patients underwent reoperation using an HSO (Oxane Hd, Bausch & Lomb) as internal tamponade. This tamponade did not require postoperative posturing and was removed after 3 months. Optical coherence tomography (OCT) was performed, and visual outcome was determined. OCT images showed that the HSO bubble conformed well with the retinal surface in the foveal region. Closure of the macular hole was achieved in both patients. Visual acuity increased from 20/100 to 20/40 in Patient 1 and from 20/600 to 20/100 in Patient 2. HSO can be a useful tool in the treatment of persistent macular hole. OCT images showed that the tamponade was effective in the upright position in the foveal region. OCT allowed determination of the time of tamponade removal according to the anatomical stage of hole closure.

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.