Unilateral Full Thickness Macular Holes Research Articles

Medical Therapy for Large Idiopathic Full-Thickness Macular Holes.

To describe the characteristics and outcomes of eyes with idiopathic full-thickness macular holes (FTMH) that underwent initial medical management. This retrospective study included eyes with FTMH that were initially managed with one month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary endpoints was hole closure at one month and secondary endpoint was change in best-corrected visual acuity (BCVA). Ten subjects (mean age: 62.80 years; female: 50%) with unilateral FTMH were studied. The mean basal diameter of the entire cohort at baseline was 824.1 µm (median 828 µm). Four (40%) of the smaller holes (mean 698 µm; median 698.50 µm) closed after one month of topical therapy, whereas larger holes (mean 908.17µm; median 889.50 µm) did not close. In one eye, the hole reopened 4 months after stopping the medication, but closed again at one month after re-starting the topical treatment. Median BCVA improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at one month in eyes that did not close. Topical corticosteroid, non-steroidal anti-inflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small FTMHs, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreo-retinal surgery without compromising visual outcomes. Macular hole may re-open after stopping the topical therapy.

Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders.

Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH). Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared. Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16). There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.

Choriocapillaris layer imaging with swept-source optical coherence tomography angiography in lamellar and full-thickness macular hole.

To present characteristics of choriocapillaris layer imaging with swept-source optical coherence tomography angiography (SS-OCTA) in eyes with macular hole (MH). Patients with MH were included. Vascular density of choriocapillaris (VDC) and central flow void areas were obtained using SS-OCTA. Data were compared with age- and gender-matched normal controls. Fifty-one patients with MH and 51 controls were included. Among the 51 patients with MH, 19 had lamellar MH (LMH) and 32 had full-thickness MH (FTMH). While VDC in LMH (79.26±4.06%) was not significantly different from that seen in fellow eyes (79.88±4.28%, P=0.729) and normal controls (80.53±4.21%, P=1.000), VDC in surgically closed FTMH (74.60±7.37%) was similar to that of fellow eyes (75.45±7.39%, P=0.400) but lower than that of controls (78.37±7.13%, P=0.011). On univariate analysis of 32 patients with unilateral sealed FTMH, VDC was not correlated with basal hole area (P=0.797) or preoperative area of disrupted ellipsoid zone (P=0.863). Central flow void was detected in 32 eyes. Mean central flow void area was 0.82±0.84mm2, which correlated with preoperative area of disrupted ellipsoid zone (P=0.001). Choriocapillaris layer imaging using SS-OCTA showed that choriocapillaris in both eyes of patients with unilateral FTMH had different characteristics from eyes with LMH or normal controls. These results suggest that variation in choriocapillaris layer flow is involved in the pathogenesis of MH.

Choroidal thickness in macular holes: a case-control study.

To evaluate choroidal thickness of patients with unilateral full-thickness macular holes (FTMHs) and contralateral vitreomacular adhesion (VMA) and healthy eyes. A retrospective case-control study of patients with unilateral FTMH and contralateral VMA and matched healthy controls was performed. Choroidal thickness was measured at five locations (subfoveal and 1 mm and 2 mm from the center of the fovea nasally and temporally) and compared between groups. Nineteen case patients and 19 control patients were analyzed. Eyes with FTMH had thinner choroids compared with the contralateral eyes with VMA and the control eyes at all locations except 2 mm temporal from the fovea. Eyes with VMA had thinner choroids nasally from the fovea compared with control eyes. Choroidal thickness was significantly decreased in eyes with FTMH except at 2 mm temporal to the fovea and decreased in contralateral eyes with VMA in the nasal directions, suggesting an association between choroidal thinning and macular hole.

Morphision: A method for subjective evaluation of metamorphopsia in patients with unilateral macular pathology (i.e., full thickness macular hole and epiretinal membrane)

Background:Lack of clinical tests to quantify spatial components of distortion in patients with full thickness macular holes (FTMH) and epiretinal membranes (ERM).Aim:To develop a test for subjective evaluation of visual distortion in the central visual field around fixation in patients with unilateral FTMH or ERM.Settings and Design:Prospective case-control study carried out at tertiary referral center.Materials and Methods:Twenty-five patients with unilateral macular disease (13 macular epiretinal membranes, 12 full-thickness macular holes), and nine controls (without ocular pathology) underwent ophthalmological examination with logMAR ETDRS visual acuity, near vision and contrast sensitivity assessed. Macular optical coherence tomography and metamorphopsia assessment using Morphision test was also carried out. This test consists of a set of modified Amsler charts for detection, identification, and subjective quantification of visual distortion in the central visual field around fixation. Morphision test content and construct validity, and reliability (test-retest method) were evaluated. Sixteen patients completed an unstructured survey on test performance and preference.Results:Every patient with unilateral FTMH or ERM identified a particular chart using Morphision test (content validity). None of the normal subjects without symptoms of metamorphopsia identified any distortion (construct validity). Test-retest showed a 100% consistency for frequency and 67% for amplitude. The mean amplitude difference between measurements was 0.02 degrees (SD = 0.038). The coefficient of repeatability was 0.075. There was a correlation between Morphision amplitude score and visual acuity and contrast sensitivity, individually.Conclusions:Morphision test allowed detection and subjective quantification of metamorphopsia in the clinical setting in our patients with unilateral macular epiretinal membranes and full thickness macular holes.

Macular Hole Formation in Fellow Eyes With a Perifoveal Posterior Vitreous Detachment of Patients With a Unilateral Macular Hole

To estimate the rate of macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment (PVD) and early stage 1 intrafoveal lesions in patients with a unilateral idiopathic full-thickness macular hole (MH) using optical coherence tomography (OCT). Retrospective observational case series. Fellow eyes of consecutive patients with a unilateral full-thickness MH were examined on OCT. A subset of fellow eyes with a perifoveal PVD had been followed to investigate the rates of macular hole formation in fellow eyes with early stage 1 intrafoveal lesions. Of 176 patients with a unilateral full-thickness MH, 42 fellow eyes (42 patients) with a perifoveal PVD were identified. During follow-up, a foveolar detachment was seen in 16 eyes, and 4 eyes had a foveal pseudocyst alone. In the 16 eyes with a foveolar detachment, 9 eyes had concurrent inner foveal splits. Within another 2 years of follow-up, OCT showed that 5 of 16 fellow eyes (31%) with a foveolar detachment developed a second full-thickness MH and 5 of 9 fellow eyes with a foveolar detachment and inner foveal splits developed a second full-thickness MH. Two of 4 eyes with a foveal pseudocyst alone developed vitreofoveal separation without hole formation. The remaining 2 eyes with a foveal pseudocyst alone remained stable at the last follow-up visit. Fellow eyes with a foveolar detachment and a perifoveal PVD may be at high risk, and fellow eyes with a foveolar detachment and inner foveal splits might be at higher risk for progression to macular hole formation.

Early foveal recovery after macular hole surgery

Aims:To evaluate morphological and functional recovery after macular hole surgery using pars plana vitrectomy (PPV), inner limiting membrane (ILM) peeling, air-tamponade and short-time limited face-down positioning.Design:Retrospective, interventional, non-comparative consecutive case...

Prevalence of Full-Thickness Macular Holes in Urban and Rural Adult Chinese: The Beijing Eye Study

To determine the prevalence of full-thickness macular holes in the elderly Chinese population. Population-based, cross-sectional cohort study. The Beijing Eye Study included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) aged 40 years or older. The present investigation consisted of 8653 (97.9%) eyes of 4346 subjects for whom readable fundus photographs were available. Full-thickness macular holes were found in eight (0.092%) eyes of seven (0.16%) patients (six women). Prevalence was 0.09 +/- 3.04% [95% confidence interval (CI): 0.03, 0.16%]. Full-thickness macular holes may be present in approximately 1.6 out of 1000 elderly Chinese in Northern China. Calculated for the entire population in China, the figure would be approximately 750,000 patients with unilateral full-thickness macular holes [n = 650,000 (95% CI: 217,000 to 1,156,000)] or bilateral full-thickness macular holes [n = 100,000 (95% CI: 33,000 to 178,000)].