scholarly journals Viscoat Assisted Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes Associated with High Myopia

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Zongming Song ◽  
Mei Li ◽  
Junjie Liu ◽  
Xuting Hu ◽  
Zhixiang Hu ◽  
...  
Keyword(s):  
High Myopia ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Flap Technique ◽  
Initial Surgery ◽  
Macular Holes ◽  
Minimum Angle ◽  
The Mean

Purpose. To investigate the surgical outcomes of Viscoat® assisted inverted internal limiting membrane (ILM) flap technique for large macular holes (MHs) associated with high myopia.Design. Prospective, interventional case series.Methods. Fifteen eyes of 15 patients with high myopia underwent vitrectomy and Viscoat assisted inverted ILM flap technique to treat MH without RD. Patients were followed up over 6 months. The main outcome measures were MH closure evaluated by optical coherence tomography (OCT) and best-corrected visual acuities (BCVAs).Result. MH closure was observed in all eyes (100%) following the initial surgery. Type 1 closure was observed in 13 eyes (86.7%); type 2 closure was observed in the remaining 2 eyes (13.3%). Compared to the preoperative baseline, the mean BCVA (logarithm of the minimum angle of resolution) improved significantly at 3 months and 6 months after surgery (P=0.025, 0.019, resp.). The final BCVA improved in 10 eyes (66.7%), remained unchanged in 3 eyes (20.0%), and worsened in 2 eyes (13.3%).Conclusion. Vitrectomy combined with Viscoat assisted inverted ILM flap technique is an effective treatment for large MHs in highly myopic eyes. It may increase the success rate of the initial surgery and enhance the anatomical and functional outcomes.

scholarly journals Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

2018 ◽  
Vol 1 (1) ◽  
pp. 07-13
Author(s):  
Ogugua Ndubuisi Okonkwo ◽  
Adekunle Olubola Hassan ◽  
Olufemi Oderinlo
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Vital Role ◽  
Symptom Duration ◽  
Flap Technique ◽  
Macular Holes ◽  
Snellen Visual Acuity ◽  
Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

scholarly journals An Internal Limiting Membrane Plug and Gas Endotamponade for Recurrent or Persistent Macular Hole

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Fabrizio Giansanti ◽  
Ruggero Tartaro ◽  
Tomaso Caporossi ◽  
Daniela Bacherini ◽  
Alfonso Savastano ◽  
...  
Keyword(s):  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Swept Source ◽  
Macular Holes ◽  
Small Gauge ◽  
Pars Plana ◽  
The Mean ◽  
23 Gauge ◽  
Anatomical Success

Introduction. Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods. This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results. The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion. In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.

Evaluation of inner retinal dimples and internal limiting membrane flap configuration after temporal inverted ILM flap technique

2020 ◽  
pp. 112067212094098
Author(s):  
Remzi Avci ◽  
Aysegul Mavi Yildiz ◽  
Sami Yilmaz
Keyword(s):  
Structural Changes ◽  
Imaging Modality ◽  
Internal Limiting Membrane ◽  
Fiber Layer ◽  
Flap Technique ◽  
Initial Surgery ◽  
En Face Oct ◽  
En Face ◽  
The Mean ◽  
Blue Reflectance

Purpose: To quantitatively evaluate structural changes associated with inner retinal dimples (IRDs) and qualitatively classify the internal limiting membrane (ILM) flap configuration after temporal inverted ILM flap technique using spectral domain optical coherence tomography (SD-OCT). Methods: Twenty-three eyes of 23 patients with successfully closed idiopathic, large (>400 μm) macular hole were enrolled. Patients were treated with pars plana vitrectomy followed by temporal inverted ILM flap technique. A complete ophthalmologic examination including cross sectional and en face OCT in addition to multicolor blue reflectance imaging of confocal scanning laser ophthalmoscopy (cSLO) was performed preoperatively and at postoperative month-12. The location, number, depth, and width of the IRDs were analyzed using blue reflectance images of multicolor cSLO and en face OCT. The ILM flap is also classified as smooth, wrinkled, and folded with en face OCT. Results: The mean number of IRDs visualized on en face OCT ( n = 23.08 ± 22.05) was statistically significantly higher compared with multicolor cSLO blue reflectance module (5.91 ± 10.58; p < 0.001). The mean depth of IRDs measured on en face OCT was 8.08 ± 3.1 μm (3–14 μm) which referred to the nerve fiber layer. The final visual acuity was associated with neither ILM flap configuration ( p = 0.408), nor number of the IRDs on en face OCT ( p = 0.112). Conclusion: En face OCT is a novel imaging modality that offers improved visualization and accuracy in identifying the features of the IRDs and the ILM flap. Additionally, it provides clear visualization of the vitreoretinal interface to distinguish whether ILM was peeled or not in the initial surgery.

scholarly journals Outcomes of Inverted Internal Limiting Membrane Flap Technique for Large Idiopathic Macular Holes Surgery in Patients at A Tertiary Care Hospital

2019 ◽  
Vol 57 (217) ◽  
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokhrel ◽  
Om Krishna Malla
Keyword(s):  
Visual Acuity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Internal Limiting Membrane ◽  
Care Hospital ◽  
Base Diameter ◽  
Flap Technique ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
The Mean

Introduction: Large macular holes cause significant reduction in central visual acuity. The aim ofthe study is to find out short term anatomical and visual outcomes of inverted internal limitingmembrane flaps technique for large macular holes (base diameter>1000μm) surgery in patientsat a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital fromJanuary 2018 to December 2018 after ethical clearance from the institutional review committee.The study was done in 12 patients with idiopathic macular holes (base diameter>1000μm), theywere repaired with 25 gauge pars plana vitrectomy with brilliant blue assisted large invertedinternal limiting membrane flap technique. Statistical analyses were performed using SPSS 19.0. Results: All twelve eyes had complete anatomical closure. Mean best corrected visualacuity preoperatively was 1.48 logMAR±0.246. The mean macular hole base diameter was1217.0±196.77μm. The mean age of patients was 68.75±4.97 years. Postoperatively,mean best corrected visual acuity was 0.978 logMAR±0.12. There were no postoperativecomplications. All the patients perceived decreased size of central scotoma. Conclusions: Inverted internal limiting membrane flaps for large macular holes is suitable methodfor closure of the very large hole, restoration of functional vision and decreased size of centralscotoma.

Removal of Sticky Silicone Oil Adhered to the Retinal Surface: Comparison of Methodological Safety and Effectiveness

2021 ◽  
Author(s):  
Ziqi Wang ◽  
Zongduan Zhang ◽  
Xuting Hu ◽  
Zhaoliang Zhang ◽  
Qintuo Pan
Keyword(s):  
Silicone Oil ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Retinal Surface ◽  
Disc Diameter ◽  
Minimum Angle ◽  
Oil Residue ◽  
The Mean ◽  
23 Gauge

Abstract Purpose: To compare safety and effectiveness among methods to remove sticky silicone oil bubbles adhered to the retinal surface. Methods: This retrospective nonrandomised case series included 14 eyes of 14 patients who had sticky silicone oil residue during silicone oil removal surgery. For small sticky silicone oil bubbles (<2-disc diameter), aspiration was performed with a 23-gauge vitreous cutter. Residual tiny oil bubbles were then removed with a silicone-tipped flute needle or internal limiting membrane (ILM) peeling. For large sticky silicone oil bubbles (≥2-disc diameter) that could not be removed with a 23-gauge vitreous cutter, we devised a more efficient active removal method involving a modified 22-gauge venous indwelling cannula device. Results: The mean preoperative best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]) significantly improved from 1.28±0.63 logMAR to 0.77±0.58 logMAR (p=0.014). The postoperative BCVA and improvement in BCVA were significantly better in the ILM peeling group than in the non-ILM peeling group (p=0.004 and p=0.045, respectively). Postoperative complications included residual sticky silicone oil bubbles in seven eyes without ILM peeling (50.0%), retinal neuroepithelial layer damage in two eyes (14.3%), and temporary hypotony in five eyes (35.7%). Conclusion: Various methods can safely and efficiently remove sticky silicone oil bubbles adhered to the retinal surface. A 22-gauge venous indwelling cannula enabled simple and safe removal of large sticky silicone oil bubbles, while small residual sticky silicone oil bubbles could be completely removed by ILM peeling.

scholarly journals Pedicle internal limiting membrane flap technique for very large macular holes: a preliminary report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
José Edísio da Silva Tavares Neto ◽  
Igor Neves Coelho ◽  
Rodrigo Jorge ◽  
David Leonardo Cruvinel Isaac ◽  
Marcos Pereira de Ávila
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Sao Paulo ◽  
Functional Improvement ◽  
São Paulo ◽  
Flap Technique ◽  
Macular Holes ◽  
Linear Diameter

Abstract Background Conventional vitrectomy technique for macular hole surgery has a good outcome in small and medium macular holes, but for very large macular holes (minimum linear diameter higher than 700 μm) other techniques were developed aiming to achieve greater rates of closure and visual acuity gain. The purpose of this article is to report the anatomical and functional outcomes of four very large macular hole (MH) cases which have undergone vitrectomy with the pedicle internal limiting membrane (ILM) flap technique. Methods This is a retrospective series of four patients with large MH who were treated with vitrectomy and the pedicle ILM flap technique. Comprehensive ophthalmologic evaluation was performed before surgery and included ETDRS best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) for MH measures: height, minimum linear diameter (MLD) and external base diameter. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole and subsequently trimmed with the vitrectomy probe using the scissors mode. Results Four patients with very large MH underwent PPV and the pedicle ILM flap technique was used to pursue macular closure. Median preoperative BCVA was 20/400 (range: 20/320 to 20/400) and median postoperative BCVA was 20/200 (range: 20/320 to 20/200). Of the 4 cases reported, 3 obtained anatomical closure (75%), and also presented BCVA improvement after surgery, considering the last follow-up visit of each case. No additional procedures were performed in either case. One patient demonstrated no anatomic and functional improvement. Conclusion The present study describes the first Brazilian case series of very large MH treated by the inverted pedicle ILM flap technique. This technique was associated with anatomic and visual improvement in most cases, and represents an alternative therapeutic approach for large macular holes. Trial Registration Project registered in Plataforma Brasil with CAAE number 30163520.0.0000.5440 and approved in ethics committee   from  Ribeirão Preto Medical School Clinics Hospital, University of São Paulo—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.948.426 gave the approval).

Conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular holes

2019 ◽  
pp. 112067211989242 ◽  
Author(s):  
Remzi Avci ◽  
Aysegul Mavi Yildiz ◽  
Sami Yilmaz
Keyword(s):  
Case Series ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Flap Technique ◽  
Macular Holes ◽  
Complete Restoration ◽  
Group 2 ◽  
Papillomacular Bundle ◽  
Group 1

Purpose: To compare the functional, anatomical, and morphological results of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap technique for the treatment of macular holes larger than 400 μm. Design: Retrospective, comparative case series. Methods: A total of 33 patients were included, of whom 18 were treated with internal limiting membrane peeling (Group 1) and 15 were treated with temporal inverted internal limiting membrane flap technique (Group 2). Complete ophthalmic examination, such as microperimetry and optical coherence tomography, was performed preoperatively and at 12 months after surgery. Results: The closure rates accomplished in Groups 1 and 2 were 72.2% and 100%, respectively (p = 0.036). The mean improvement in best-corrected visual acuity was logMAR 0.49 ± 0.17 in Group 1 and logMAR 0.91 ± 0.15 in Group 2 (p = 0.037). U-shaped closure was achieved in one eye in Group 1 and 12 eyes in Group 2 (p < 0.001). Complete restoration of external limiting membrane and ellipsoid zone rates were significantly higher in Group 2 (p = 0.027 and p = 0.001, respectively). Conclusion: The single-layered temporal inverted internal limiting membrane flap technique improves not only anatomical and morphological but also functional outcomes of surgery for large macular holes. Furthermore, this technique seems to minimize the risk of iatrogenic trauma to the nasal part of the fovea and the corresponding papillomacular bundle fibers.

scholarly journals A short term anatomical and visual outcomes of large idiopathic macular holes surgery following inverted internal limiting membrane flap technique

2019 ◽  
Vol 11 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokharel ◽  
Om Krishna Malla
Keyword(s):  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Hole Filling ◽  
Flap Technique ◽  
Macular Holes ◽  
Snellen Chart ◽  
Pars Plana ◽  
Idiopathic Macular Holes ◽  
The Mean

Introduction: Large macular holes are not uncommon among Nepalese women population causing severe visual problem. Objective: To evaluate the technique of inverted internal limiting membrane (ILM) flaps for the repairment of large macular holes. Methods: All 10 macular holes (diameter > 400 μm) were treated with pars planavitrectomy with inverted ILM flap technique. The procedure for macular hole surgerywas pars plana vitrectomy, posterior vitreous removal, internal limiting membrane(ILM) peeling with brilliant blue assisted, inverting ILM flap into macular hole, filling of the vitreous cavity with a gas bubble(C3 F8) and post-operative face-down positioning for 1 week. SD OCT images were taken preoperative and postoperative 1 month and 3 months follow up to assess the anatomical outcome of surgery and best corrected visual acuity (BCVA) was used to evaluate the functional outcome during each visit. The BCVA was recorded using the Snellen chart and was converted to the logarithm of the minimum angle of resolution (LogMAR) equivalents. Results: All 10 eyes had complete anatomical closure. The mean age of patients was 64.3 ± 7.53 years. The mean macular hole base diameter was 1039.4 μm (663-1526μm). Mean BVCA pre-operatively was 1.29 log MAR ±SD 0.25. Post-operatively, mean BCVA was 0.925 log MAR ±SD 0.143 (p= 0.002). There were no intra operative or post-operative complications. All the patients were followed up for a period of 3months. Conclusions: Inverted ILM flaps is effective for closure of the large macular hole and restoration of functional vision.

scholarly journals Surgical Outcomes in Macular Telangiectasia Type 2-Related Macular Holes: A Report on Four Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Kinza T. Ahmad ◽  
Joseph Chacko ◽  
Ahmed B. Sallam ◽  
David B. Warner ◽  
Sami H. Uwaydat
Keyword(s):  
Macular Hole ◽  
Surgical Outcomes ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Imaging Data ◽  
Closure Rate ◽  
Macular Telangiectasia ◽  
Macular Holes ◽  
Hole Closure

Introduction. The few published studies that exist on the surgical outcomes of full-thickness macular hole (FTMH) repair in Macular Telangiectasia (MacTel) Type 2 report poor rates of hole closure of around 30%. This study is the largest case series of patients with FTMH in MacTel Type 2 and describes an 80% hole closure rate. Purpose/Aim. To describe the outcomes of four patients who underwent surgery for FTMH associated with MacTel Type 2. Methods. A retrospective review of clinical, surgical, and imaging data of five eyes in four patients with MacTel Type 2 FTMH who underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and 30% SF6 or 15% C3F8 gas tamponade within 3-9 months of initial vision decline. Results. Visual acuity (VA) at the time of surgery ranged from 20/50 to 20/200. Successful hole closure was achieved in four out of five eyes, and final VA ranged from 20/20 to 20/40 at follow-up visits greater than 20 months postoperatively. The single eye that did not achieve hole closure had a final VA of 20/60. Conclusion. Our case series describes higher hole closure rates and better final VA than previously published reports for macular hole surgery in patients with MacTel Type 2 FTMH.

Sign in / Sign up

Export Citation Format

Share Document