Macular Hole Closure With Internal Limiting Membrane Abrasion Technique

Macular hole surgery has been revolutionized since the 1990s’ with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.

Download Full-text

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i6.15419 ◽

2016 ◽

Vol 7 (6) ◽

pp. 43-46

Author(s):

Lalit Agarwal ◽

Nisha Agrawal ◽

Pratap Karki ◽

Abhishek Anand

Keyword(s):

Macular Hole ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Internal Limiting Membrane Peeling ◽

Chronic Stage ◽

Visual Improvement ◽

Macular Holes ◽

Pars Plana ◽

Hole Closure

Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

Download Full-text

Retrospective study on outcome of macular hole surgery

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v8i2.17002 ◽

2017 ◽

Vol 8 (2) ◽

pp. 139-143 ◽

Cited By ~ 2

Author(s):

S Singh ◽

R Byanju ◽

S Pradhan ◽

G Lamichhane

Keyword(s):

Macular Hole ◽

Surgical Complication ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Gas Tamponade ◽

Vitreous Cortex ◽

Intraocular Gas ◽

Hole Closure

Introduction: Macular hole is a common and treatable cause of central visual loss. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex removal and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. Objective: To determine and evaluate anatomical and visual outcome of macular hole surgery. Materials and methods: Retrospective analysis of all cases of macular hole surgery done by single surgeon between 2014 -2015. Results:16 eyes were analysed with follow up of 3 months. Macular hole closure after vitrectomy was 75% with visual improvement of two or more line in 62.5%.Post surgical complication included cataract 18.8%, Increased IOP 12.5% and retinal detachment 6.2%. Conclusion: Vitrectomy along with ILM peeling and Gas Tamponade with effective positioning improves in visual acuity and achieve hole closure in people with macular hole.

Download Full-text

Surgical Macular Hole Closure Without a Gas Tamponade

Journal of VitreoRetinal Diseases ◽

10.1177/24741264211018958 ◽

2021 ◽

pp. 247412642110189

Author(s):

Scott Grant ◽

Sean D. Adrean

Keyword(s):

Macular Hole ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Internal Limiting Membrane ◽

Gas Bubble ◽

Hole Size ◽

Gas Tamponade ◽

Pars Plana ◽

Visual Results ◽

Hole Closure

Purpose: This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade. Methods: Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results. Results: Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80– (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30–2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant ( P = .003). The hole that did not close initially without gas tamponade was the largest in the series. Conclusions: Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.

Download Full-text

Prognostic factors affecting macular hole closure types

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211009007 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110090

Author(s):

Gülşah Gümüş ◽

Gökhan Demir ◽

Beril Tülü Aygün ◽

Ali Demircan ◽

Zeynep Alkın ◽

...

Keyword(s):

Prognostic Factors ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Duration Of Symptoms ◽

Significant Difference ◽

Neurosensory Retina ◽

Closure Group ◽

Hole Closure

Purpose: In this study, we aimed to evaluate the relationship between macular hole closure types assessed by optical coherence tomography (OCT) and the preoperative prognostic factors. Materials and methods: In total, 183 patients who underwent pars plana vitrectomy and internal limiting membrane peeling for idiopathic macular hole between August 2014 and August 2019 were reviewed retrospectively. The preoperative measurements of the macular hole including minimum linear diameter (MLD), basal hole diameter (BHD) and hole height (HH) were measured on OCT images. The patients were divided into two closure types on the basis of postoperative OCT findings (type 1 closure: retinal edges were flat and there was no defect of the neurosensory retina on the fovea; type 2 closure: retinal edges were flat and there was a defect of the neurosensory retina on the fovea). The difference of prognostic factors such as age; duration of symptoms; preoperative best-corrected visual acuity (BCVA); preoperative macular hole measurements, including MLD, BHD and HH; and rate of reopening between two types were statistically analysed. Results: The mean age of patients was 66.33 ± 8.09 years (range: 48–88 years). According to OCT imaging, 117 eyes (63.9%) were classified into the type 1 closure group, and 66 eyes (36.1%) were classified into the type 2 closure group. There were no significant differences between two groups in age, duration of symptoms and preoperative BCVA ( p = 0.694, p = 0.092 and p = 0.15). MLD and BHD were significantly larger, and reopening was significantly more common in type 2 group ( p < 0.05, p = 0.04 and p < 0.005); however, there was no significant difference in HH between two groups ( p = 0.239). Conclusion: Preoperative horizontal measurements of macular hole may help to determine postoperative visual expectations and anatomical success, and predict the possibility of reopening.

Download Full-text

MACULAR HOLE CLOSURE OVER RESIDUAL SUBRETINAL FLUID BY AN INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE IN PATIENTS WITH MACULAR HOLE RETINAL DETACHMENT IN HIGH MYOPIA

Retinal Cases & Brief Reports ◽

10.1097/icb.0000000000000205 ◽

2016 ◽

Vol 10 (2) ◽

pp. 140-144 ◽

Cited By ~ 13

Author(s):

Tetsuhiko Okuda ◽

Tomomi Higashide ◽

Koh Kobayashi ◽

Yasushi Ikuno ◽

Kazuhisa Sugiyama

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

High Myopia ◽

Subretinal Fluid ◽

Internal Limiting Membrane ◽

Flap Technique ◽

Macular Hole Retinal Detachment ◽

Hole Closure

Download Full-text

Idiopathic macular hole closure toward the optic disc after internal limiting membrane peeling

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2013.f025.x ◽

2013 ◽

Vol 91 ◽

pp. 0-0

Author(s):

K OHTA ◽

A SATO ◽

E FUKUI

Keyword(s):

Macular Hole ◽

Optic Disc ◽

Internal Limiting Membrane ◽

Idiopathic Macular Hole ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Hole Closure

Download Full-text

Subfoveal triamcinolone acetonide following macular hole surgery

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7837 ◽

2013 ◽

Vol 5 (1) ◽

pp. 114-116

Author(s):

A Jindal ◽

A Bhawdekar ◽

A Pathengay

Keyword(s):

Macular Hole ◽

Triamcinolone Acetonide ◽

Harmful Effect ◽

Posterior Vitreous Detachment ◽

Internal Limiting Membrane ◽

Visual Recovery ◽

Vitreous Surgery ◽

Macular Hole Surgery ◽

Corrected Visual Acuity ◽

Hole Closure

Background: Triamcinolone acetonide (TA) is commonly used in vitreous surgery to visualize the posterior hyaloid and internal limiting membrane. Some TA can accumulate in the macular hole during surgery which can persist postoperatively. Case: A 17-year-old boy underwent successful macular hole surgery with TA-assisted induction of posterior vitreous detachment. Sub-foveal deposit of TA was observed postoperatively, which got absorbed at 7 weeks with complete closure of the macular hole, and best corrected visual acuity improved from 20/100 preoperatively to 20/60. Conclusion: Residual TA after macular hole surgery may not hamper the anatomical and functional outcome. Similar cases have been reported in the literature and most of them show no harmful effect of TA on macular hole closure and visual recovery. Nepal J Ophthalmol 2013; 5(9):114-116 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7837

Download Full-text