EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY

Retina ◽  
2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Carmen Baumann ◽  
Stephen Kaye ◽  
Danilo Iannetta ◽  
Ziyaad Sultan ◽  
Rahul Dwivedi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Macular Hole Surgery ◽  
Closure Rate ◽  
Postoperative Visual Acuity ◽  
Retinal Layers

scholarly journals Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
M. Y. Faria ◽  
D. C. Sousa ◽  
S. Mano ◽  
R. Marques ◽  
N. P. Ferreira ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Multifocal Electroretinography ◽  
Ilm Peeling ◽  
Macular Hole Surgery ◽  
Macular Function ◽  
Retinal Layers ◽  
Snellen Visual Acuity

Purpose. Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods. Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. Results. All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P<0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P<0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). Conclusions. In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

scholarly journals A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for Idiopathic Macular Hole of different hole diameters with Air or C3F8 Intraocular Tamponade

2019 ◽  
Author(s):  
Yong Ping Tang ◽  
Bei Lei Wu ◽  
Zhong Lin ◽  
Ronghan Wu
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Hole Diameter ◽  
Idiopathic Macular Hole ◽  
Macular Hole Surgery ◽  
Membrane Peeling ◽  
Intraocular Tamponade ◽  
Significant Difference

Abstract Background：Vitrectomy and membrane peeling followed by gas filling technique has become a standard procedure of macular hole surgery, the outcomes are affected by many factors, and which kind of intraocular tamponade is the best choice still has some conflicts. The purpose of this study is to investigate whether air filling can achieve comparable effects to long-acting inert gases when different macular hole sizes are enrolled. Methods：116 patients with idiopathic macular hole were enrolled in this retrospective study, 44 received C3F8 tamponade and 72 received sterile air tamponade. Before and after vitrectomy surgery, the best corrected visual acuity, slit lamp examination, fundus examination and intraocular pressure were analyzed. Results：No statistically significant difference was fund in age, gender, axial length, intraocular pressure, or preoperative visual acuity between groups. After the surgery, the closure rates of air group and C3F8 group with macular hole diameter ≤400 microns were 94.4% and 100.0%, with no significant difference between the two groups (P = 0.701). The closure rates of macular hole diameters lager than 400 microns are 66.7% and 91.3%, P = 0.029. The total closure rates of the two groups are 80% and 95.6%, P =0.018. Conclusions：In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material is similar to that of C3F8 in macular hole with diameters less than 400 microns. In patients with larger macular hole (diameter over 400 microns) performed therapeutic surgery with air filling, internal limiting membrane insertion or flap inversion may be recommended get better outcomes.

scholarly journals Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

2021 ◽  
Vol 14 (9) ◽  
pp. 1408-1412
Author(s):  
Jin Liu ◽  
◽  
Xin-Hua Zheng ◽  
Yuan-Long Li ◽  
Jun-Long Huang ◽  
...  
Keyword(s):  
Macular Hole ◽  
Influencing Factor ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Ilm Peeling ◽  
Macular Hole Surgery ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Significant Difference

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P<0.05). No significant difference was found in the T-OD, N-OD, S-OD, and I-OD between N-T group and T-N group. IMH closure rate was 100% both in N-T group and T-N group. There was no significant difference in BCVA between two groups (P<0.05). CONCLUSION: The macula slips toward the OD after successful macular hole surgery. The two different ILM peeling pattern show similar visual outcome and retinal displacement, which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

Tomographic Structural Changes of Retinal Layers after Internal Limiting Membrane Peeling for Macular Hole Surgery

2017 ◽  
Vol 59 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Mun Yueh Faria ◽  
Nuno P. Ferreira ◽  
Diana M. Cristóvao ◽  
Sofia Mano ◽  
David Cordeiro Sousa ◽  
...  
Keyword(s):  
Macular Hole ◽  
Structural Changes ◽  
Internal Limiting Membrane ◽  
Macular Hole Surgery ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Retinal Layers

Internal retinal layer thickness and macular migration after internal limiting membrane peeling in macular hole surgery

2017 ◽  
Vol 28 (3) ◽  
pp. 311-316 ◽  
Author(s):  
Mun Y. Faria ◽  
Nuno P. Ferreira ◽  
Sofia Mano ◽  
Diana M. Cristóvao ◽  
David C. Sousa ◽  
...  
Keyword(s):  
Macular Hole ◽  
Layer Thickness ◽  
Optic Disc ◽  
Internal Limiting Membrane ◽  
Retinal Layer ◽  
Ilm Peeling ◽  
Macular Hole Surgery ◽  
Internal Limiting Membrane Peeling ◽  
Retinal Layers ◽  
Sd Oct

Purpose: To provide a spectral-domain optical coherence tomography (SD-OCT)-based analysis of retinal layers thickness and nasal displacement of closed macular hole after internal limiting membrane peeling in macular hole surgery. Methods: In this nonrandomized prospective interventional study, 36 eyes of 32 patients were subjected to pars plana vitrectomy and 3.5 mm diameter internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Nasal and temporal internal retinal layer thickness were assessed with SD-OCT. Each scan included optic disc border so that distance between optic disc border and fovea were measured. Results: Thirty-six eyes had a successful surgery with macular hole closure. Total nasal retinal thickening (p<0.001) and total temporal retinal thinning (p<0.0001) were observed. Outer retinal layers increased thickness after surgery (nasal p<0.05 and temporal p<0.01). Middle part of inner retinal layers (mIRL) had nasal thickening (p<0.001) and temporal thinning (p<0.05). The mIRL was obtained by deducting ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness from overall thickness of the inner retinal layer. Papillofoveal distance was shorter after ILM peeling in macular hole surgery (3,651 ± 323 μm preoperatively and 3,361 ± 279 μm at 6 months; p<0.0001). Conclusions: Internal limiting membrane peel is associated with important alteration in inner retinal layer architecture, with thickening of mIRL and shortening of papillofoveal distance. These factors may contribute to recovery of disrupted foveal photoreceptor and vision improvement after IMH closure.

scholarly journals Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Roth ◽  
N. Schön ◽  
L. Jürgens ◽  
D. Engineer ◽  
K. Kirchhoff ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Macular Hole ◽  
Univariate Analysis ◽  
Postoperative Outcome ◽  
Macular Hole Surgery ◽  
Closure Rate ◽  
Surgical Success ◽  
The Mean ◽  
Linear Diameter

Abstract Background The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany. Methods and material This was a retrospective analysis of all patients who underwent surgery because of idiopathic MH between 2011 and 2017 in Augenklinik Tausendfensterhaus, Duisburg, Germany. Statistical evaluation of clinical and OCT-based parameters, including the areas of intraretinal pseudocysts, was conducted. The main statistical outcomes were surgical success and visual acuity. Only parameters with a highly significant correlation to the outcome parameters (postoperative visual acuity (VA); surgical success) in univariate analysis were entered in linear and logistic regression analyses. Results A total of 189 eyes of 178 patients (71.4% female; mean age 67.5 ± 8.2 a) who underwent surgery because of MH were included. The overall closure rate was 86.8%. The mean best corrected VA increased from 0.7 ± 0.3 logMAR before surgery to 0.5 ± 0.3 logMAR (p < 0.0001). While several clinical and OCT-based parameters as well as calculated indices showed a significant correlation with the outcome measures, the regression analysis showed that the minimum linear diameter was the only parameter that both predicted surgical success (p = 0.015) and was correlated with postoperative VA (p < 0.001). Conclusion The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis.

Autologous internal limiting membrane transplant for recurrent idiopathic macular holes

2020 ◽  
pp. 112067212090639 ◽  
Author(s):  
Tommaso Rossi ◽  
Carlandrea Trillo ◽  
Guido Ripandelli
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Outer Segment ◽  
Internal Limiting Membrane ◽  
Control Group ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Macular Holes ◽  
Idiopathic Macular Holes

Purpose: To report a series of recurrent idiopathic macular holes treated by means of a free autologous internal limiting membrane flap and compare visual and anatomic results to a control group undergoing further internal limiting membrane peeling and novel gas tamponade. Methods: Retrospective surgical series of 15 consecutive patients receiving autologous internal limiting membrane flap compared to 14 patients operated on for internal limiting membrane peeling enlargement. Autologous internal limiting membrane flap was created after brilliant blue G staining, internal limiting membrane lifting, perfluorocarbon bubble injection and creation of a wide internal limiting membrane free flap translocated underneath perfluorocarbon liquid, to the macular hole bed. Both groups were tamponated with 20% SF6 and positioned face down for 4 h a day for 3 days. Results: Macular hole closed in 14/15 (93.3%) patients of the autologous internal limiting membrane group and 9/14 (64.2%) controls (p < 0.05). Visual acuity increased from 0.05 ± 0.03 to 0.23 ± 0.13 Snellen in the autologous internal limiting membrane group and from 0.05 ± 0.03 to 0.14 ± 0.10 Snellen of controls (p < 0.05 for both). Vision of the autologous internal limiting membrane group improved more than controls at 1 month (p = 0.043) and 3 months (p = 0.045). Inner segment/outer segment interruption at 3 months was smaller in the autologous internal limiting membrane group than controls, reducing from 1230 ± 288 µm at baseline to 611 ± 245 and 547 ± 204 µm at 3 months versus 1196 ± 362, 745 ± 222 and 705 ± 223 µm, respectively (p < 0.05). Conclusion: Autologous internal limiting membrane flap can effectively close recurrent idiopathic macular holes with a higher closure rate, smaller residual inner segment/outer segment line interruption and higher visual acuity at 3 months than previous standard of care.

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