Improving morphological outcome in lamellar macular hole surgery by using highly concentrated autologous platelet-rich plasma

Abstract Purpose To evaluate the use of highly concentrated autologous platelet-rich plasma (PRP) in lamellar macular hole (LMH) surgery with regard to function and morphology. Methods We included 12 eyes of 12 patients with progressive LMH in this interventional case series. After 23/25-gauge pars plana vitrectomy, 0.1ml highly concentrated autologous platelet-rich plasma was applied under air tamponade. Induction of posterior vitreous detachment and peeling of tractive epiretinal membranes were performed whenever present. Phacovitrectomy was undertaken in cases of phakic lens status. Postoperatively, all patients were instructed to rest in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT), and fundus photography were carried out preoperatively and 6 months postoperatively. Results Foveal configuration was restored in 10 of 12 patients (83.3%) at 6 months postoperatively. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (Wilcoxon: p=0.028). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p=0.67). No patient experienced vision loss after surgery, and no significant intra- or postoperative complications occurred. Conclusion The application of PRP in the surgical therapy of LMH results in good morphological and functional outcomes. Additional peeling of the ILM seems to be mandatory when using PRP to prevent the recurrence of LMH. Strict postoperative supine positioning for 2 h avoids PRP dislocation. Larger sample sizes are needed to confirm the results.

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Lamellar macular hole in diabetic retinopathy

European Journal of Ophthalmology ◽

10.1177/1120672119879665 ◽

2019 ◽

pp. 112067211987966

Author(s):

Bo-I Kuo ◽

Chung-May Yang ◽

Yi-Ting Hsieh

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Diabetic Retinopathy ◽

Macular Hole ◽

Surgical Outcomes ◽

Lamellar Macular Hole ◽

Corrected Visual Acuity ◽

Visual Improvement ◽

Anatomical Outcomes ◽

Best Corrected Visual Acuity

Purpose: To describe the clinical features and surgical outcomes of diabetic retinopathy–associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole. Methods: A total of 17 eyes with diabetic retinopathy–associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups. Results: Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy–associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both). Conclusion: Compared with idiopathic group, diabetic retinopathy–associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.

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Highly Concentrated Autologous Platelet-Rich Plasma Restores Foveal Anatomy in Lamellar Macular Hole Surgery

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1409-9268 ◽

2021 ◽

Author(s):

Felix Hagenau ◽

Matthias Nobl ◽

Denise Vogt ◽

Benedikt Schworm ◽

Jakob Siedlecki ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Posterior Vitreous Detachment ◽

Case Series ◽

Fundus Photography ◽

Epiretinal Membranes ◽

Air Tamponade ◽

Autologous Platelet Rich Plasma ◽

23 Gauge ◽

Autologous Platelet ◽

Sd Oct

Abstract Background Lamellar macular holes (LMHs) are an entity of a progressive disease in which the efficacy of the therapy of choice, vitrectomy, seems to be reduced. It is unknown whether highly concentrated autologous platelet-rich plasma (PRP) is of value in the therapy of LMHs. The purpose of this study was to gauge the potential of highly concentrated PRP to restore foveal anatomy in LMH surgery. Patients and Methods In this interventional case series, eight eyes of eight patients with progressive LMH were included. All patients underwent a 23-gauge pars plana vitrectomy with induction of a posterior vitreous detachment and peeling of tractive epiretinal membranes whenever present. Under air tamponade, 0.1 mL of highly concentrated autologous PRP was applied. Subsequently, a gas or air tamponade was performed. All patients were instructed to rest in the supine position for the first 1 to 2 postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT) and fundus photography were performed prior to and 3 months after surgery. Results SD-OCT showed closure of the macular defect with restoration of a normal foveal configuration in all (8 of 8) patients 3 months postoperatively. BCVA improved significantly, from 0.28 ± 0.08 to 0.12 ± 0.14 logMAR (Wilcoxon: p = 0.03). Microperimetry remained unchanged (24.13 ± 1.96 vs. 23.7 ± 1.54 dB; p = 0.46). No clinically significant intra- or postoperative complications were observed. Conclusion The use of highly concentrated PRP enables excellent anatomical and functional outcomes in the surgical therapy of LMH. Further prospective comparative trials are warranted to compare this promising technique with existing surgical strategies.

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Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity

10.21203/rs.2.9497/v1 ◽

2019 ◽

Author(s):

Hiroyuki Nakashizuka ◽

Yorihisa Kitagawa ◽

Yu Wakatsuki ◽

Koji Tanaka ◽

Koichi Furuya ◽

...

Keyword(s):

Visual Acuity ◽

Foveal Thickness ◽

Mixed Effect ◽

Epiretinal Membranes ◽

Central Foveal Thickness ◽

Mixed Effect Models ◽

Corrected Visual Acuity ◽

Good Group ◽

Final Observation ◽

Best Corrected Visual Acuity

Abstract Purpose: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). Methods: This prospective case study compared 37 subjects with preoperative BCVA≦logMAR0.046 (Good group) to 35 patients with logMAR BCVA 0.52–0.10 (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. Results: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. Conclusions: Early epiretinal surgery was effective for MH, BCVA, aniseikonia, and QOL.

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Surgical management of a case of contractile peripapillary staphyloma with retinal detachment and macular hole

European Journal of Ophthalmology ◽

10.1177/1120672120920227 ◽

2020 ◽

pp. 112067212092022

Author(s):

Sofía H Vidal ◽

Diego Bueso Ponce ◽

Juan Esteban Unigarro ◽

Sergio Arrascue Limo ◽

Carlos Abdala Caballero

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Hole ◽

Retinal Pigment ◽

Silicon Oil ◽

Corrected Visual Acuity ◽

Intraocular Gas ◽

Best Corrected Visual Acuity ◽

Peripapillary Staphyloma

A healthy 4-year-old male presented a fundus examination with a unilateral contractile peripapillary staphyloma surrounded by redundant retina and retinal pigment epithelium atrophy. Five years later, best-corrected visual acuity decreased to hand motion due to a retinal detachment with macular hole. One month after first vitrectomy, scleral buckle and intraocular gas, retina re-detached. Second surgery was performed with silicon oil tamponade and lensectomy without intraocular lens (IOL). Subretinal silicon oil was detected at the third month of follow-up when vitrectomy, inferior retinectomy, and laser photocoagulation of temporal border of staphyloma with silicon oil tamponade were performed. The retina remained attached and best-corrected visual acuity was 20/600 with intraocular silicon oil. A fourth surgery was performed for emulsified silicon oil extraction replaced with intraocular gas. At 6 months of follow-up, the retina re-detached again. This is a challenging vitreoretinal surgery in which re-detachments were due to retinal folds around the contractile staphyloma that raised macular hole. This is the first report of the combined presentation of contractile peripapillary staphyloma, retinal detachment and macular hole with a long-time follow-up period of years.

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Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity

10.21203/rs.2.9497/v3 ◽

2019 ◽

Author(s):

Hiroyuki Nakashizuka ◽

Yorihisa Kitagawa ◽

Yu Wakatsuki ◽

Koji Tanaka ◽

Koichi Furuya ◽

...

Keyword(s):

Visual Acuity ◽

Foveal Thickness ◽

Mixed Effect ◽

Epiretinal Membranes ◽

Central Foveal Thickness ◽

Mixed Effect Models ◽

Corrected Visual Acuity ◽

Good Group ◽

Final Observation ◽

Best Corrected Visual Acuity

Abstract Backgroud: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). Methods: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10 - 0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. Results: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. Conclusions: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia.

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Evaluation of vision-related quality of life with autologous internal limiting membrane transplantation for refractory macular hole.

10.21203/rs.2.10310/v2 ◽

2019 ◽

Author(s):

dongqing yuan ◽

Weiwei Zhang ◽

Songtao Yuan ◽

Ping Xie ◽

Qinghuai Liu

Keyword(s):

Quality Of Life ◽

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Corrected Visual Acuity ◽

Hole Index ◽

Related Quality ◽

Best Corrected Visual Acuity

Abstract Background: To evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane(ILM) transplantation for refractory macular hole． Methods: A prospective and nonrandomized clinical study was carried out. There were fourty eyes with refractory macular hole included and all eyes received 23G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded, including best corrected visual acuity (BCVA), intraocular pressure, central retinal thickness (CRT) measurement by Optical coherence tomography (OCT) examination, macular hole index (MHI) and operative complications. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the visual related quality of life of patients after operation. The correlation between the quality of life and the postoperative visual acuity and the size of the macular hole before operation was tested by Spearman rank correlation test. Results: All patients were followed up for three months after surgery, and 38 patients achieved anatomical closure. The mean postoperative logMAR BCVA was 1.09±0.33, which has significantly improved than that before operation (P=0.000). The vision-related quality of life of patients after surgery was closely related to the macular hole index (r=0.375, P=0.017), but was negatively correlated with the best corrected visual acuity before and after surgery (r=-0.495, P=0.001; r=-0.760，P=0.000). It was also found that the vision-related quality of life of patients positively correlated with the postoperative CRT ( r=0.414，P=0.008). Conclusions: The anatomical structure of refractory macular hole patients with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of the patients improved significantly. Meanwhile, the vision-related quality of life was significantly improved after surgery. Trial Registration: ChiCTR-INR-16008660, date of registration: 2016/06/17

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Αγγειοειδείς ταινίες

10.12681/eadd/24929 ◽

2006 ◽

Author(s):

Ηλίας Γεωργαλάς

Keyword(s):

Visual Acuity ◽

Photodynamic Therapy ◽

Laser Photocoagulation ◽

Age Related Macular Degeneration ◽

Fundus Photography ◽

Angioid Streaks ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity ◽

Group 1

Angioid streaks are irregular crack like dehiscences in Bruch's membrane that invariably radiate outward from the peripapillary area in all directions9. They are associated with a wide variety of systemic diseases, such as pseudoxanthoma elasticum, Ehler-Danlos syndrome, Paget's disease and sickle-cell hemoglobinopathies9.The prognosis in patients with angioid streaks is guarded because visual impairment occurs in 70% to 86% due to the occurrence of macular choroidal neovascularization (CNV)9,15,51. The natural history of such lesions is poor, with most resulting in fovea involvement and central vision loss9,187. Laser photocoagulation treatment of CNV may be beneficial in selected cases169,171,189,191. However, the recurrence rate is higher than with CNV associated with other macular disorders168,170 and the final results reported in the literature as being rather disappointing9. Recently, limited macular translocation176,177, as well as photodynamic therapy with verteporfin (PDT)151,152,154,155,157,182 were searched as alternative treatment modalities for subfoveal CNV due to angioid streaks in small series of patients with controversial results.The purpose of this study is to evaluate the effectiveness of conventional PDT with verteporfin in a large series of patients with subfoveal or juxtafoveal CNV due to angioid streaks and to compare it to the effectiveness of early retreatment PDT (8 weeks following initial therapy) in patients who experienced disease progression.MATERIALS AND METHODSA prospective analysis of 36 eyes of 33 consecutive patients with subfoveal or juxtafoveal CNV secondary to angioid streaks that were treated with PDT from January 2001 through January 2005 and completed at least 18 months of the follow-up time, was conducted. The greatest linear dimension of the entire lesion had to be 6000 pm or less. Eyes with best corrected visual acuity of less than 20/400 were not treated. None of the eyes had been previously treated by conventional laser photocoagulation for the macular CNV.Prior to the treatment, each patient had undergone a complete ocular examination including contact lens fundus biomicroscopy, color or red-free fundus photography, and digital fluorescein angiography (FA) using the Topcon Imagenet 2000 Digital Imaging System with TRC-50IA fundus camera (Topcon Corporation, Paramus, New Jersey, USA). Fluorescein angiograms were evaluated for lesion size and leakage of the neovascular membrane. Best-corrected visual acuity was determined in all patients using standard Snellen charts.Patients were divided in 2 groups. In group 1, retreatments were performed according to the standard protocol followed in the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Investigation (TAP) every 12 weeks107, 146. During this time, 17 eyes of 15 patients were included in the study in Group 1. In Group 2, 19 eyes of 17 patients received early retreatments (8 weeks after the previous PDT) when indicated according to the criteria of the TAP study for conventional 3-month retreatment.The follow-up time of the patients ranged from 18 to 66 months (mean 37.6 months). The re-examinations followed the same procedure as the first examination. Informed consent for examination and treatment was obtained from each patient after a full explanation of the procedure.Numerical data in the text and the tables are presented as mean (±SD). Improvement or decline of visual acuity was defined as a change of at least two lines.

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Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

10.21203/rs.2.18331/v7 ◽

2020 ◽

Author(s):

hanyue xu ◽

Ling Qin ◽

Yifan Zhang ◽

Yinan Xiao ◽

Ming Zhang

Keyword(s):

Visual Acuity ◽

Meta Analysis ◽

Epiretinal Membranes ◽

Random Effects Models ◽

Ellipsoid Zone ◽

Corrected Visual Acuity ◽

Significant Difference ◽

The Stability ◽

Best Corrected Visual Acuity ◽

Lamellar Hole

Abstract Background: Given the two different kinds of epiretinal membranes, this study aimed to compare both the structural and functional outcomes of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation (LHEP) after surgery.Method: Publications up to July 2020 that compared the surgical outcomes of lamellar macular hole with and without LHEP were included. Forest plots were created by using a weighted summary of proportion meta-analysis. Fixed or random effects models were used on the basis of I2 heterogeneity estimates. Meanwhile, to evaluate the stability of the meta-analysis, a sensitivity analysis was carried out.Results: Eight pertinent publications that contained a total of 176 eyes without LHEP and 173 eyes with LHEP were included. They were all retrospective studies and had a follow-up of at least 6 months. In all studies, the preoperative best corrected visual acuity showed no significant differences between the two groups, and the visual acuity improved in both groups after surgery. The pooled result for the improved best corrected visual acuity was 0.18 (95% confidence interval (CI), 0.10 to 0.26; P< 0.01) between the with and without LHEP groups. The restored ellipsoid zone odds ratio was 0.80 (95% CI, 0.26 to 2.44; P= 0.69) for the group with LHEP compared to the group without LHEP.Conclusion: Patients without LHEP had better postoperative visual acuity than patients with LHEP. No significant difference in restored ellipsoid zone was found between the two groups.

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Macular Hole Progression following Ocriplasmin Intravitreal Injection

Case Reports in Ophthalmological Medicine ◽

10.1155/2014/403461 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Edward Casswell ◽

Guillermo Fernandez-Sanz ◽

Danny Mitry ◽

Sheila Luk ◽

Rahila Zakir

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intravitreal Injection ◽

Macular Hole ◽

Optical Coherence ◽

Vitreomacular Adhesion ◽

Blurred Vision ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Ocriplasmin is a protease which has been approved for the treatment of symptomatic vitreomacular adhesion (VMA). A 63-year-old presented with blurred vision in the left eye and a best corrected visual acuity of 6/18. Optical coherence tomography revealed VMA with an underlying macular hole and she subsequently underwent a left intravitreal ocriplasmin injection. One week after the injection, VMA had been released but with enlargement of the macular hole and a drop in her BCVA to 6/60. This persisted at 1 month after the injection. It is important to warn patients that ocriplasmin may lead to an enlargement of their macular hole with resultant loss in visual acuity.

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Clinical Efficacy of Platelet-Rich Plasma in the Treatment of Neurotrophic Corneal Ulcer

Journal of Ophthalmology ◽

10.1155/2018/3538764 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Dominika Wróbel-Dudzińska ◽

Jorge Alio ◽

Alejandra Rodriguez ◽

Ewa Suchodoła-Ratajewicz ◽

Ewa Kosior-Jarecka ◽

...

Keyword(s):

Visual Acuity ◽

Platelet Rich Plasma ◽

Autologous Blood ◽

Corneal Thickness ◽

Anterior Segment ◽

Subjective Symptoms ◽

Nerve Paralysis ◽

Autologous Platelet Rich Plasma ◽

Autologous Platelet ◽

Neurotrophic Keratopathy

Purpose. Platelet-rich plasma (PRP) is an autologous blood product without preservatives and rich in proteins and growth factors which make it possible for cells to differentiate, proliferate, and migrate, thus stimulating healing and regeneration of tissues. The aim of this study was to evaluate the efficiency of autologous platelet-rich plasma in the treatment of neurotrophic keratopathy. Methods. The study group consists of 25 patients with nonhealing corneal ulcers due to herpes simplex or herpes zoster infection and facial nerve or trigeminal nerve paralysis as a result of a neurosurgical operation caused by a tumour or stroke. The patients were given autologous platelet-rich plasma drops five times a day and additionally preservative-free artificial tears and a vitamin A ointment at night for maximum 3 months. The following were evaluated: best corrected visual acuity (BCVA), healing of corneal surface, subjective symptoms, and changes in corneal thickness with the use of anterior segment optical coherent tomography (AS-OCT). Results. BCVA before the treatment was 0.10 ± 0.14, and after the treatment it was –0.3 ± 0.27 (p=0.001). Improved visual acuity and less subjective symptoms were observed in all patients. Complete healing of the ulceration was observed in 20 patients (80%). Four patients (16%) experienced considerable improvement of their clinical condition (reduced size and depth of the ulceration and inflammatory state: smaller conjunctival injection and swelling, improved visual acuity, and less subjective symptoms). In one of the patients, an amniotic membrane was transplanted due to the lack of improvement of his local condition. In all patients, the progression of corneal thinning was stopped. An average corneal thickness in its thinnest point was 322.3 ± 125.8 µm before the treatment, and 404.5 ± 118.7 µm (p<0.05) after the treatment. None of the patients reported general or local side effects of the treatment. Conclusions. Autologous platelet-rich plasma is a blood-based product which seems efficient in the treatment of neurotrophic keratopathy.

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