Vitrectomy For Idiopathic Macular Hole Research Articles

Phacovitrectomy vs. consecutive vitrectomy for idiopathic macular holes: short and long-term outcomes and OCT image quality assessment

PurposeTo compare short- and long-term anatomical, functional, and refractive outcomes between combined phacovitrectomy (PVS) and consecutive vitrectomy (CVS) for idiopathic macular holes (MHs). Also, to evaluate the role of preoperative optical coherence tomography (OCT) image quality in guiding surgical selection.MethodsThis retrospective study analyzed 183 phakic MH eyes operated between 2012 and 23, with patients divided into PVS and CVS groups. Demographic and ocular data, MH features, visual acuity (VA), refraction changes and postoperative outcomes, and follow-up details were collected. Pre- and post-operative OCT scans were evaluated for MH characteristics, OCT image quality, and surgical outcomes at short-term (≤ 3 months) and long-term (≥ 5 years) intervals.ResultsThe study included 144 eyes in PVS group and 39 in CVS group. Median follow-up duration was 16 months for PVS group and 72 months for CVS group (p < 0.001). Both groups showed significant VA improvements and comparable MH closure rates at short-term follow-up. However, CVS group had significantly better postoperative VA at short-term (p = 0.001) and long-term (p = 0.017) intervals. The preoperative OCT quality index did not significantly differ between groups and was ineffective in assessing cataract grade or guiding surgical decisions. Both groups experienced a myopic refractive shift, with a higher magnitude in the PVS group (p = 0.04). Postoperative complications were similar between the groups.ConclusionCVS achieves better long-term VA than PVS following MH repair, despite similar anatomical outcomes. Preoperative OCT quality index is not effective for guiding surgical decisions, and careful refractive planning is essential, especially for PVS patients, to address postoperative myopic shifts.Clinical trial registration numberNot applicable.

Changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole with macular peeling and one type of flap.

The aim of this study was to evaluate changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole (IMD) with macular peeling and flap. A prospective study of 35 eyes in 34 patients who had undergone standard surgery. Evaluated parameters were best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CRT), macular volume (TMV) and vascular density of the superficial and deep capillary plexus. The follow-up period was one year. We divided the total group into two: temporal and circular flap and total group. We compared the values after surgery with the preoperative values. In the total group, BCVA increased from 48.38 to 71.44 letters (P≤0.05). IOP changed from 15.24 to 14.76 mmHg (P>0.05). CRT decreased from 432.27 to 323.64 µm (P≤0.05). TMV changed from 0.26 to 0.25 mm3 (P>0.05). The vascular density of the superficial plexus decreased from 32 to 28% (P≤0.05). The intercapillary space of the superficial plexus increased from 68 to 72% (P≤0.05). The vascular density of the deep plexus increased from 17 to 23%. The intercapillary space of the deep vascular plexus decreased from 83 to 77%. Changes in vascular density and intercapillary space of the deep plexus were statistically significant for certain months after operations (P≤0.05). There were no significant differences between subgroups. The superficial plexus vascular density is almost the same in the temporal flap and in the foveal-sparing flap is decreased, and the deep plexus vascular density increased statistically significantly during the follow-up period after surgery.

Clinical characteristics and surgical prognosis of idiopathic macular holes with epiretinal proliferation.

To investigate the clinical features and surgical outcomes of idiopathic macular holes (IMHs) with epiretinal proliferation (EP). This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for IMHs. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity (BCVA), and postoperative closure rate were compared between eyes with and without EP. EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P < 0.001), and a larger base diameter (P = 0.014) than those without EP. Additionally, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and thicker central fovea (P = 0.012) at 1 month postoperatively; a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively. The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G.

PurposeTo describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.MethodsThe medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis.ResultsMultiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD.ConclusionsMultiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for stage 3 and stage 4 idiopathic macular holes

AimsTo investigate characteristics of intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for idiopathic macular hole and classify the breaks based on their causes to analyse the risk factors.MethodsThis retrospective study...

Intraocular tumour necrosis factor ligand related molecule 1 A links disease progression of proliferative diabetic retinopathy after primary vitrectomy.

Tumour necrosis factor ligand related molecule 1 A (TL1A), a member of tumour necrosis factor superfamily, has been identified as a crucial regulator for vascular homeostasis and inflammation. However, the function of TL1A in diabetic retinopathy (DR) is largely unknown. This study aims to examine levels of TL1A in serum and intraocular fluid in patients with proliferative diabetic retinopathy (PDR), and to explore the correlation of intraocular TL1A with the prognosis of PDR progression after primary vitrectomy. Seventy-five patients (75 eyes) with PDR who underwent pars plana vitrectomy (PPV) and 19 patients (19 eyes) who received vitrectomy for idiopathic macular holes (IMH) as non-diabetic control group were enrolled in this prospective study. Serum, aqueous and vitreous fluid samples were collected during cataract and PPV surgery. Protein expressions of TL1A as well as other angiogenic and inflammatory cytokines in serum and intraocular fluid were measured. Correlations of intraocular TL1A concentrations with inflammatory cytokines were analyzed. We found both aqueous and vitreous TL1A levels were significantly higher in the PDR group than in control group (Paqueous =0.026; Pvitreous <0.001). Angiogenic and inflammatory cytokines such as VEGF, IL-6, IL-8, MCP-1, MIP-1α, and MIP-1β were significantly higher in intraocular fluid in PDR group than in controls, which MCP-1 and MIP-1α showed positive correlation with intraocular TL1A levels. There is no significant difference in the levels of serum TL1A as well as other inflammatory cytokines between PDR patients and controls. Intraocular levels of TL1A were significantly lower in PDR progression group than in the stable group (Paqueous <0.001; Pvitreous <0.001). Multivariate logistic regression analyses revealed that lower levels of intraocular TL1A was an important risk factor for predicting PDR progression after primary PPV (ORaqueous =0.717, Paqueous =0.001; ORvitreous =0.684; Pvitreous =0.002). In conclusion, TL1A and multiple inflammatory cytokines were highly enriched in the intraocular fluid of PDR patients compared with the controls. Lower levels of intraocular TL1A were associated with development of PDR complications after primary PPV and might be used as prognostic factor in predicting the vitrectomy outcome in PDR patients.

Vitrectomy for Idiopathic Macular Hole in Patients Aged 80 Years or Older: Efficacy and Safety

ABSTRACTPurpose: To assess the efficacy and safety of idiopathic macular hole (MH) surgery in elderly patients (≥ 80 years of age).Methods: Prospective study enrolled consecutive patients who underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling under retrobulbar anesthesia between February 2016 and May 2018. Twenty-eight eyes of 28 patients aged 80 years or older were classified into the elderly group, a matched group of 56 eyes from 56 younger patients as the control group. The main outcome measures included best-corrected visual acuity (BCVA) and intraoperative and postoperative complications.Results: Statistically, there was no significant difference in visual acuity improvement and incidences of complications between the elderly group and the control group (p = .784 and p = .712, respectively). No operation in either group was postponed or canceled due to complications associated with retrobulbar anesthesia, or physical discomfort before and during the operation. Moreover, no case suffered from myocardial infarction, stroke or death during the perioperative period. Except for one case of retinal detachment postoperatively in the control group, no case required a secondary surgery. All complications were successfully resolved or managed.Conclusions: The results from our study indicate the efficacy and safety of vitrectomy for idiopathic macular hole in patients aged 80 years or older, and idiopathic MH surgery should not be denied on basis of patient age alone.

The macular microstructure repair and predictive factors of surgical outcomes after vitrectomy for idiopathic macular hole.

To evaluate the macular microstructure repair and explore the factors related to those changes and visual improvement after vitrectomy for idiopathic macular hole (IMH). Totally 19 eyes of 18 IMH patients who underwent macular hole (MH) surgery were evaluated with best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) images. All 19 eyes closed at 6mo postoperatively. BCVA was observed gradually improved (P<0.001), with subretinal fluid (SRF) gradually absorbed (P=0.021) and the rate of external limiting membrane (ELM) defects gradually decreased (P=0.011) with follow-up time. Poorer postoperative logMAR BCVA correlated with larger MH minimum diameter (P<0.001), larger MH basal diameter (P=0.008), longer symptom duration (P=0.002) and poorer preoperative logMAR BCVA (P=0.010). More improvement in BCVA correlated only with poorer preoperative in logMAR BCVA (P=0.002). The earlier reconstruction of ELM was associated with smaller MH basal diameter (P=0.022) and shorter symptom duration (P=0.008). In conclusion, smaller basal diameter of MH and shorter symptom duration were key factors in earlier reconstruction of ELM.

Predictors of Visual Acuity Outcomes Following Vitrectomy for Idiopathic Macular Hole.

To investigate predictors of visual outcomes in patients who underwent vitrectomy for full-thickness macular hole (FTMH) with at least 1 year of follow-up. Retrospective, noncomparative, consecutive case series of 132 eyes of 122 patients who underwent surgical repair of idiopathic FTMH with at least 1 year of follow-up. Predictors of visual acuity (VA) outcomes were analyzed using linear regression. Mean follow-up time was 22.2 months. Twenty-three eyes (17.4%) had age-related macular degeneration (AMD), of which 17 (73.9%) cases were mild and nonexudative. At final follow-up, poor preoperative VA (P < .001), perioperative complications (P < .001), AMD (P < .001), and delay from preoperative evaluation to surgery (P = .037) were significant predictors of final VA. In multiple regression, these variables remained significant (P < .001, P = .011, P < .001, and P = .002, respectively). Poor preoperative VA, perioperative complications, AMD, and delay to surgery were significant predictors of final VA following FTMH repair. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:566-570.].

The relationship between the sizes of idiopathic macular hole and the healing types of fovea photoreceptor layer after vitrectomy

Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography(OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole(AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow- up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P 0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer. Key words: Retinal perforations/surgery; Photoreceptors, retinal; Tomography, optical coherence

An effectiveness comparison of extensive and standard internal limiting membrane peeling for idiopathic macular hole with closed index less than 0.7

Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index<0.7 and provide an alternative basis for IMH. Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index <0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (48 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA), central vision, direct ophthalmoscope examination, slit lamp microscope with preset lens, optical coherence tomography (OCT), intraocular pressure, Amsler grid table and fundus photography inspection were performed before surgery and 1 month, 6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image, U-like closure was thought to be normal fovea, V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure. Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation, 43 cases had U type closure, 1 case had V type closure and 1 case had W type closure in the extensive ILMP group, while 33 cases had U type closure, 1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month, 6 months and 12 months (all at P<0.05). Compared with preoperation BCVA, the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma: χ2=80.98, 56.99, both at P<0.05; paracentral scotoma: χ2=88.21, 80.98, both at P<0.05), and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (χ2=4.10, P<0.05). The closure rate of IMH was 93.75% in the extensive ILMP group and 77.08% in the standard ILMP group, showing a significant difference between the two groups (χ2=4.10, P<0.05). The corrected rate of Amsler grid abnormality was 93.75% in the extensive ILMP group, which was evidently higher than 75.00% in the standard ILMP group, with a significant difference between the two groups (χ2=5.06, P<0.05). Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI<0.7 are effective, and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP. Key words: Retinal perforations/surgery; Basement membrane/surgery; Tomography, optical coherence; Treatment outcome; Comparative studies; Retrospective studies; Idiopathic macular hole/surgery

Increased levels of alphaB-crystallin in vitreous fluid of patients with proliferative diabetic retinopathy and correlation with vascular endothelial growth factor.

AlphaB-crystallin has been shown to have angiogenic properties. The purpose of this study was to determine the levels of alphaB-crystallin in the vitreous fluid of patients with proliferative diabetic retinopathy and to confirm the association between the expression level of alphaB-crystallin and vascular endothelial growth factor. Vitreous samples were collected before vitrectomy from 46 eyes of 46 consecutive patients with proliferative diabetic retinopathy, and 19 patients without diabetes mellitus had vitrectomy for idiopathic macular hole. The concentrations of alphaB-crystallin and vascular endothelial growth factor were measured via enzyme-linked immunosorbent assay. The vitreous level (mean±SD) of alphaB-crystallin was significantly higher in patients with proliferative diabetic retinopathy (317.3±151.7ng/mL) than in control patients (idiopathic macular hole, 8.3±6.1ng/mL) (P<0.0001). The vitreous concentration of vascular endothelial growth factor was also significantly higher in patients with proliferative diabetic retinopathy (860.1±566.4pg/mL) than in control patients (9pg/mL) (P<0.0001). Meanwhile, both the expression levels of alphaB-crystallin and vascular endothelial growth factor were significantly higher in eyes with active proliferative diabetic retinopathy than in those with inactive proliferative diabetic retinopathy. Also, the vitreous concentration of alphaB-crystallin correlated significantly with that of vascular endothelial growth factor in vitreous fluid of proliferative diabetic retinopathy ([correlation coefficient], R=0.78, P<0.001). These results suggest a significant increase of alphaB-crystallin in the vitreous fluid of patients with proliferative diabetic retinopathy and present a crucial association between alphaB-crystallin and vascular endothelial growth factor with angiogenic activity in proliferative diabetic retinopathy.

RELATIONSHIP BETWEEN METAMORPHOPSIA AND INTRARETINAL CYSTS WITHIN THE FLUID CUFF AFTER SURGERY FOR IDIOPATHIC MACULAR HOLE.

To quantify metamorphopsia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to investigate the relationship between metamorphopsia and foveal microstructure. This is prospective, consecutive, interventional study. Fifty-one eyes of MH were included. Severity of metamorphopsia was quantified using the M-CHARTS and foveal microstructure was assessed with optical coherence tomography preoperatively and at 3 months, 6 months postoperatively. Based on the optical coherence tomography images, the authors quantified minimum and base diameters of MH, macular thickness, defect lengths of external limiting membrane, ellipsoid zone and interdigitation zone, and the area of intraretinal cysts within the fluid cuff. Mean metamorphopsia score was significantly improved from 0.82 to 0.44. Postoperative mean and horizontal metamorphopsia scores were correlated with preoperative base diameters of MH, defect lengths of external limiting membrane, and the area of cysts in fluid cuff. Multiple regression analysis revealed that postoperative mean and horizontal metamorphopsia scores were significantly positively relevant to the area of intraretinal cysts within the fluid cuff. Postoperative vertical metamorphopsia score was also correlated with the area of intraretinal cysts within the fluid cuff. Vitrectomy for MH improved metamorphopsia. Postoperative metamorphopsia was associated with the preoperative area of intraretinal cysts within the fluid cuff.

Analysis of factors affecting the visual outcome after vitrectomy for idiopathic macular hole

Objective To investigate the factors correlated with the visual outcome of idiopathic macular holes (IMH) after vitreoretinal surgery. Methods A total of 57 eyes of 57 patients with IMH were included. There were 43 females (43 eyes) and 14 male (14 eyes), mean age was (60.46±4.79) years. All the eyes underwent best corrected visual acuity (BCVA), slit-lamp microscope, three-mirror contact-lens and optical coherence tomography (OCT) examinations. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution (logMAR) acuity. The minimum diameter and base diameter of macular holes and central retinal thickness (CRT) were detected by OCT. The average logMAR BCVA of 57 eyes was 0.98±0.41. The minimum diameter and base diameter of macular holes were (479.53±164.16) μm and (909.14±278.65) μm. All the patients underwent pars plana vitrectomy combined with phacoemulsification cataract extraction and intraocular lens implantation. The mean follow-up period was (173.44±147.46) months. The relationships between final BCVA and these parameters were examined by single and multiple regression analysis. The valuable influence factors were filtrated and formulated using multiple linear regression models. Results At the final follow-up, the logMAR BCVA of 57 eyes was 0.44±0.31, the CRT was (158.79±86.96) μm. The final BCVA was positive related to minimum diameter of macular holes and preoperative BCVA (r=0.420, 0.448; P=0.001, 0.000), negative related to postoperative CRT (r=-0.371, P=0.004). There was no relationship between the final BCVA and base diameter of macular holes, age and follow-up (r=0.203, -0.015, 0.000; P=0.130, 0.913, 0.999). The incidence of preoperative BCVA for postoperative BCVA was bigger than preoperative minimum diameter of macular holes (P=0.008, 0.020). Conclusion The preoperative minimum diameter of macular holes and BCVA are related to postoperative BCVA in IMH eyes. Key words: Retinal perforations/surgery; Vitreoretinal surgery; Root cause analysis

Aniseikonia and Foveal Microstructure in Patients with Idiopathic Macular Hole

To quantify the severity of aniseikonia in patients undergoing vitrectomy for idiopathic macular hole (MH) and to examine any relationship between aniseikonia and the foveal microstructure. Prospective, consecutive, interventional case series. We included 56 eyes of 56 patients who underwent vitrectomy to treat idiopathic MH. We examined visual acuity, aniseikonia using the New Aniseikonia Test, and foveal structure using optical coherence tomography (OCT) before and 3, 6, and 12 months after surgery. Based on OCT images, minimum and base diameters of MH, height of MH, and defect lengths of the external limiting membrane (ELM), ellipsoid zone, and interdigitation zone were assessed. Degree of aniseikonia before and after surgery. The mean aniseikonia was-3.2±4.6%, ranging from-15.5% to+5.0%. Of the patients, 55% had micropsia, 7% had macropsia, and 38% had no aniseikonia. The mean absolute value of aniseikonia improved significantly from 3.8±4.1% before surgery to 1.0±1.5% at 12 months after surgery (P < 0.0001). The preoperative mean absolute value of aniseikonia showed a significant correlation with minimum diameters of MH (P < 0.01), base diameters of MH (P < 0.01), and the defect length of ELM (P < 0.05). In multivariate analysis, preoperative aniseikonia showed a significant correlation with the defect length of ELM (P < 0.05). In contrast, postoperative aniseikonia was not associated with any of the parameters. Approximately half of MH patients had micropsia. Vitrectomy for MH improved aniseikonia. Preoperative aniseikonia was associated with MH size and the defect length of ELM.

Changes in Inner and Outer Retinal Layer Thicknesses after Vitrectomy for Idiopathic Macular Hole: Implications for Visual Prognosis.

PurposeTo investigate sequential post-operative thickness changes in inner and outer retinal layers in eyes with an idiopathic macular hole (MH).MethodsRetrospective case series. Twenty-four eyes of 23 patients who had received pars plana vitrectomy (PPV) for the closure of MH were included in the study. Spectral domain optical coherence tomography C-scan was used to automatically measure the mean thickness of the inner and outer retinal layers pre-operatively and up to 6 months following surgery. The photoreceptor outer segment (PROS) length was measured manually and was used to assess its relationship with best-corrected visual acuity (BCVA).ResultsCompared with the pre-operative thickness, the inner layers significantly thinned during follow-up (P = 0.02), particularly in the parafoveal (P = 0.01), but not perifoveal, area. The post-operative inner layer thinning ranged from the ganglion cell layer to the inner plexiform layer (P = 0.002), whereas the nerve fiber layer was unaltered. Outer layer thickness was significantly greater post-operatively (P = 0.002), and especially the PROS lengthened not only in the fovea but also in the parafovea (P < 0.001). Six months after surgery, BCVA was significantly correlated exclusively with the elongated foveal PROS (R = 0.42, P = 0.03), but not with any of the other thickness parameters examined.ConclusionsFollowing PPV for MH, retinal inner layers other than the nerve fiber layer thinned, suggestive of subclinical thickening in the inner layers where no cyst was evident pre-operatively. In contrast, retinal outer layer thickness significantly increased, potentially as a result of PROS elongation linking tightly with favorable visual prognosis in MH eyes.

Visual function and vision-related quality of life after vitrectomy for idiopathic macular hole: a 12mo follow-up study.

To investigate the visual function and the relationship with vision-related quality of life (VRQOL) after macular hole repair surgery. Prospective case series. Thirty-six consecutive eyes in 36 patients who underwent pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling were included. The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by the participants before and 3 and 12mo after operation. Follow-up visits examinations included best-corrected visual acuity (BCVA), clinical examination, and central macular thickness (CMT) measured by optical coherence tomography (OCT). Macular-hole closure was achieved in 35 of 36 eyes (97.2%). At baseline and months 3 and 12, the logMAR BCVAs (mean±SD) were 1.15±0.47, 0.68±0.53 (P<0.0001 versus baseline), and 0.55±0.49 (P<0.001 versus baseline, P =0.273 versus month 3), respectively; the CMTs (µm) were 330±81, 244±62 (P<0.001 versus baseline), and 225±58 (P<0.001 versus baseline, P=0.222 versus month 3), respectively; the median preoperative VFQ-25 composite score of 73.50 (63.92-81.13) increased postoperatively to 85.50 (80.04-89.63) at 3mo (P<0.001) and 86.73(82.50-89.63) at 12mo (P<0.001) respectively. The improved BCVA was correlated with improvements in five subscales (r=-0.605 to -0.336, P<0.001 to P=0.046) at 12mo. PPV with ILM peeling improved anatomic outcome, visual function, and VRQOL. The improved BCVA was an important factor related to the improved VRQOL.

Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole.

PurposeTo compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice.MethodsIn this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy.ResultsThe MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\\126 (20 gauge), 20\\100 (23 gauge), and 20\\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\\60 (20 gauge), 20\\69 (23 gauge), and 20\\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053).ConclusionBased on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.

Vitrectomy for idiopathic macular hole.

A macular hole is an anatomic opening in the retina that develops at the fovea. Macular holes can be seen in highly myopic eyes or following ocular trauma, but the great majority are idiopathic. Pars plana vitrectomy was introduced to treat full-thickness macular holes, which if left untreated have a poor prognosis since spontaneous closure and visual recovery are rare.Vitrectomy is a surgical technique involving the removal of the vitreous body that fills the eye. The surgeon inserts thin cannulas into the eyes through scleral incisions to relieve traction exerted by the vitreous or epiretinal membranes to the central retina and to induce glial tissue to bridge and close the hole. The primary objective of this review was to examine the effects of vitrectomy for idiopathic macular hole on visual acuity. A secondary objective was to investigate anatomic effects on hole closure and other dimensions of visual function, as well as to report on adverse effects recorded in included studies. We searched the Cochrane Eyes and Vision Group Trials Register (4 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to March 2015), EMBASE (January 1980 to March 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to March 2015), the Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1980 to March 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 March 2015. We included randomised controlled trials comparing vitrectomy (with or without internal limiting membrane peeling) to no treatment (that is observation) for macular holes. We used standard methodological procedures expected by Cochrane. Two review authors independently extracted the data. We estimated best corrected visual acuity and macular hole closure at 6 to 12 months of follow-up. Three studies provided data on the comparison between vitrectomy and observation in eyes with macular hole and visual acuity less than 20/50. Two studies, conducted in the USA and published in 1996 and 1997, used a similar protocol and included participants with stage II macular hole (42 eyes randomised, 36 analysed, number of participants not reported) or participants with stage III/IV hole (129 eyes of 120 participants, 115 eyes in analyses). The third study, conducted in the UK and published in 2004, included 185 eyes of 174 participants with full-thickness macular hole (41 eyes with stage II holes and 74 eyes with stage III/IV holes in analyses). Studies were of good quality for randomisation and allocation concealment, whereas visual acuity measurement was unmasked.At 6 to 12 months, visual acuity was improved by about 1.5 Snellen lines (-0.16 logMAR, 95% confidence intervals -0.23 to -0.09 logMAR, 270 eyes, moderate-quality evidence). The chances of macular hole closure at 6 to 12 months were greatly increased using vitrectomy, yielding an odds ratio of 31.4 (95% confidence intervals 14.9 to 66.3, 265 eyes, high-quality evidence; raw sum data: 76% vitrectomy, 11% observation). Vitrectomy was beneficial both in smaller (stage II) and in larger (stage III/IV) macular holes.The largest study reported that cataract surgery was needed in about half of cases at two years after operation and that retinal detachment occurred in about 5% of operated eyes. Vitrectomy is effective in improving visual acuity, resulting in a moderate visual gain, and in achieving hole closure in people with macular hole. However, these results may not apply to modern surgery due to technological improvements in vitrectomy techniques.

Retained silicone tip of diamond-dusted membrane scraper during vitrectomy in a valved cannula system

To report a complication of retained silicone tip from a diamond-dusted membrane scraper (DDMS) that occurred while using a valved cannula vitrectomy system. Retrospective review of three cases that underwent 23 gauge (G) sutureless vitrectomy for idiopathic macular hole (cases 1 and 2) and myopic macular schisis (case 3). In all three cases following a standard vitrectomy, the internal limiting membrane (ILM) peeling was initiated by using a 23G DDMS. During the insertion of the DDMS, the flexible silicone tip of the 23G DDMS was detached from the metal shaft and was retained in the 23G valve system and in case 3, the silicone tip got dislodged from the valve onto the retina. Subsequent ILM peeling was completed by using an end-gripping forceps. All underwent intravitreal gas injection at the end. No other complications were noted. These three cases demonstrate an uncommon complication of retained silicone tip within the valved cannula vitrectomy system and this complication should be considered while using flexible instruments in valved cannula systems.