A Female Case of X-Linked Retinoschisis with Macular Hole Bilaterally

Purpose. We aimed at reminding that X-linked retinoschisis may also be seen in female patients and share our vitreoretinal surgical experience. Methods. The patient underwent pars plana vitrectomy including the closure of the macular holes with inverted ILM flap technique bilaterally. Lens extractions were performed by phacoemulsification during the removal of silicone oil endotamponade. Patient. An 18-year-old girl with X-linked retinoschisis and large macular holes in both eyes presented to the clinic of ophthalmology. It was confirmed that the patient had RS1 mutation Results. Nine-month-follow-up was uneventful for retinal findings. Significant improvement in visual acuity was achieved, and macular holes were remained closed. Conclusion. In cases with large macular holes due to XLR, an inverted ILM flap technique might be safe and effective. Four-month-silicone-endotamponade might be sufficient.

Inverted ILM Flap Technique in a Pediatric Traumatic Macular Hole—A Case Report

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417714653 ◽

2017 ◽

Vol 1 (5) ◽

pp. 338-340 ◽

Cited By ~ 1

Author(s):

Tommaso Nuzzo ◽

Fabio Patelli ◽

Giovanni Esposito ◽

Leonardo Colombo ◽

Luca Rossetti

Keyword(s):

Visual Acuity ◽

Case Report ◽

Macular Hole ◽

Pediatric Patient ◽

Pars Plana Vitrectomy ◽

Flap Technique ◽

Initial Visual Acuity ◽

Counting Finger ◽

Purpose: To report and describe the clinical course of a pediatric traumatic macular hole (TMH) case and its management. Case Report: A pediatric patient presented a macular hole following blunt ocular trauma. The patient was followed every 2 weeks for 4 months. After the worsening of the macular hole reported by optical coherence tomography (OCT), pars plana vitrectomy with inverted flap technique plus SF6 gas tamponade was performed. Traumatic macular hole appeared closed at the OCT during follow-up. Initial visual acuity was counting finger at 30 cm. After surgery, the patient achieved a visual acuity of 20/100 at 3-month follow-up. Conclusion: This case shows a good anatomic and functional success performing a pars plana vitrectomy with inverted flap technique in a large TMH in a pediatric patient. We underline the importance of the surgical timing in the management of similar cases.

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420987145 ◽

2021 ◽

pp. 247412642098714

Author(s):

Michael S. Tsipursky ◽

Matthew Byun ◽

Rama D. Jager ◽

Veeral S. Sheth

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Postoperative Outcomes ◽

Aperture Diameter ◽

Internal Limiting Membrane Peeling ◽

Macular Holes ◽

Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.

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 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

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

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25414 ◽

2019 ◽

Vol 11 (1) ◽

pp. 29-32 ◽

Cited By ~ 1

Author(s):

Kiran Shakya ◽

Ram Prasad Pokharel ◽

Om Krishna Malla

Keyword(s):

Macular Hole ◽

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.

Eccentric Macular Hole after Pars Plana Vitrectomy for Idiopathic Macular Hole: A Case Report

Case Reports in Ophthalmology ◽

10.1159/000457830 ◽

2017 ◽

Vol 8 (1) ◽

pp. 116-119 ◽

Cited By ~ 1

Author(s):

Irini Chatziralli ◽

George Theodossiadis ◽

Maria Douvali ◽

Alexandros A. Rouvas ◽

Panagiotis Theodossiadis

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Ilm Peeling ◽

Pars Plana ◽

23 Gauge ◽

Retinal Hole ◽

The Right

Introduction: Postoperative eccentric macular hole (MH) formation is an uncommon complication after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane or MH treatment. Herein, we present a case of eccentric MH formation after PPV with ILM peeling for MH. Case Description: A 72-year-old female patient underwent 23-gauge PPV with ILM peeling for idiopathic MH in her right eye. The visual acuity was 6/24 in the right eye. One week postoperatively the retina was attached and the MH seemed to be closed, while visual acuity was 6/12. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by OCT. The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted, and at the 6-month follow-up the visual acuity and the size of the eccentric MH remained stable. Conclusions: Eccentric MHs can develop after PPV and are usually managed conservatively by observation.

Microincision 25G Pars Plana Vitrectomy with Peeling of the Inner Limiting Membrane and Air Tamponade in Idiopathic Macular Hole

European Journal of Ophthalmology ◽

10.5301/ejo.5000815 ◽

2016 ◽

Vol 27 (1) ◽

pp. 93-97 ◽

Cited By ~ 7

Author(s):

Libor Hejsek ◽

Alexandr Stepanov ◽

Jaroslava Dusova ◽

Jan Marak ◽

Jana Nekolova ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Invasive Technique ◽

Idiopathic Macular Hole ◽

Inner Limiting Membrane ◽

Pars Plana ◽

Air Tamponade ◽

Age Range

Purpose To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH). Methods We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17). Results Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon). Conclusions The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.

A pilot study on vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis—2y follow-up results

International Journal of Ophthalmology ◽

10.18240/ijo.2021.02.13 ◽

2021 ◽

Vol 14 (2) ◽

pp. 263-268

Author(s):

Peng Zhang ◽

◽

Ling-Xin Hou ◽

Yu-Hua Hao ◽

Kun Wang ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Macular Retinoschisis ◽

Corrected Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Best Corrected Visual Acuity

AIM: To evaluate the effect of vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis. METHODS: Thirty-seven patients with myopic macular retinoschisis who underwent pars plana vitrectomy (PPV) combined with scleral shortening were reviewed. Axial length (AL), the height of macular retinoschisis, the height of retinal detachment if existed, the diameter of macular hole if existed and best corrected visual acuity (BCVA) were obtained. The preoperative and postoperative parameters were compared. RESULTS: At postoperative 24mo, the mean AL and height of macular retinoschisis were reduced significantly by 0.79 mm and 256.51 μm (t=8.064, P<0.0001; Z=-5.086, P<0.0001) respectively. In addition, the mean height of retinal detachment and diameter of macular hole were also reduced significantly by 365.38 μm and 183.68 μm (Z=-4.457, P=0.000008; Z=-2.983, P=0.003) respectively. Meanwhile, the postoperative BCVA was improved markedly (Z=-2.126, P=0.033). CONCLUSION: Vitrectomy combined with scleral shortening is an effective surgical method for eyes with myopic macular retinoschisis, whether or not macular hole and retinal detachment are present.

A Human Amniotic Membrane Plug to Treat Persistent Macular Hole

Case Reports in Ophthalmology ◽

10.1159/000509339 ◽

2020 ◽

Vol 11 (2) ◽

pp. 442-447

Author(s):

Luca Ventre ◽

Paola Marolo ◽

Michele Reibaldi

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Amniotic Membrane ◽

Functional Results ◽

Human Amniotic Membrane ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Critical Issues ◽

The human amniotic membrane (hAM) has lately demonstrated interesting potential in its retinal applications. Nowadays, the treatment of persistent macular holes is still a challenge. In this paper, we present a case of a hAM plug used to treat a persistent macular hole, with the purpose of highlighting the critical issues of this new surgical procedure. We performed a 23-G pars plana vitrectomy and inserted a hAM plug (diameter of 1.5 mm) under the neuroretinal margins of the hole (diameter of 657 μm). A complete ophthalmic examination with the assessment of best-corrected visual acuity (logMAR units, ETDRS letter score) and optical coherence tomography (OCT) scans were collected at 1, 4, 6, and 10 weeks after surgery. Visual acuity changed from logMAR 1.0 (1) preoperatively to logMAR 1.0 (2), 1.0 (4), 0.9 (9), and 0.9 (10) at 1, 4, 6, and 10 weeks of follow-up, respectively. The 1 week postoperative OCT did not show neuroretinal adhesion over the plug, but the following visits showed reattachment of the margins with partial neuroretinal ingrowth. These findings suggest that the correct adaptation of the size of the hAM plug to the macular hole is essential to allow the anatomical closure of the hole and potential functional results.

Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study

BMC Ophthalmology ◽

10.1186/s12886-021-01973-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xianggui Wang ◽

Xuezhi Zhou ◽

Ying Zhu ◽

Huizhuo Xu

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Posterior Pole ◽

Macular Holes ◽

Macular Hole Retinal Detachment ◽

Pars Plana ◽

Silicone Oil Tamponade ◽

Hole Closure

Abstract Background To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients. Methods We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated. Results There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5–3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy. Conclusion Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients.

Pars plana vitrectomy with silicone oil tamponade for primary and secondary macular hole closure: Is it still a useful procedure?

European Journal of Ophthalmology ◽

10.1177/1120672117752423 ◽

2018 ◽

Vol 28 (5) ◽

pp. 503-514 ◽

Cited By ~ 2

Author(s):

Janusz Pieczynski ◽

Patrycja Kuklo ◽

Andrzej Grzybowski

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Surgical Techniques ◽

Successful Outcome ◽

Gas Tamponade ◽

Pars Plana ◽

Silicone Oil Tamponade ◽

Hole Closure

Purpose: To evaluate usefulness of posterior vitrectomy with silicone oil tamponade for primary and secondary macular hole closure. Methods: We searched for publications on the surgical treatment of full-thickness idiopathic and recurrent macular hole. We divided reports into two groups: primary macular hole repair and recurrent macular hole repair with silicone oil tamponade. Results: In primary macular hole treatment, different authors confirmed effectiveness of silicone oil tamponade. They suggest that the most important factor for successful outcome was completeness of vitreous cavity filling with oil. Complications after this method were comparable to those after gas tamponade. However, even if good anatomical results are achieved in secondary macular hole closure, visual acuity is sometimes less rewarding. Conclusion: There are reports on good efficacy of silicone oil tamponade for primary and recurrent macular hole closure. Anatomical closure and visual acuity rates in pars plana vitrectomy with silicone oil and with gas filling are comparable. Gas tamponade seems to be safer and needs no more surgery. Postoperative complications in both methods are similar, but all patients with silicone oil filling need to undergo a reoperation to have the silicone removed. There are also other surgical techniques for primary macular hole closure as well as for unsuccessful primary macular hole procedures. We think that primary macular hole closure should be performed with gas tamponade, supported with different adjuvants, as a method of choice. Silicone oil tamponade could be still an alternative in cases, when there are no more efficient techniques or possibilities to treat with success recurrent macular hole.