Anterior chamber aqueous flare is not a predictor for surgical closure of full-thickness idiopathic macular holes

2019 ◽  
Vol 30 (5) ◽  
pp. 1127-1134 ◽  
Author(s):  
Friederike Schaub ◽  
Philip Enders ◽  
Paula Scholz ◽  
Philipp S Müther ◽  
Sascha Fauser ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Internal Limiting Membrane Peeling ◽  
Aqueous Flare ◽  
Macular Holes ◽  
Pars Plana ◽  
Idiopathic Macular Holes ◽  
Linear Diameter

Purpose: To investigate the predictive value of preoperative anterior chamber aqueous flare levels measured by laser flare photometry for surgical success of idiopathic macular holes in addition to preoperative anatomic characteristics. Methods: Records of 105 consecutive eyes with full-thickness idiopathic macular holes which underwent pars plana vitrectomy with internal limiting membrane peeling and sulfur hexafluoride 20% (SF620%) endotamponade were reviewed retrospectively. All patients underwent preoperative measurements of anterior chamber aqueous flare and anatomical idiopathic macular hole characteristics evaluated by optical coherence tomography: macular hole inner opening diameter, macular hole minimum linear diameter, macular hole base diameter, and macular hole height. Best-corrected visual acuity results were recorded pre- and postoperatively. Results: In 17 (16.2%) of 105 eyes primary closure of idiopathic macular hole failed, whereas in 88 eyes (83.8%) closure was achieved. Between both groups, preoperative macular hole minimum linear diameter (p = 0.001) and macular hole inner opening diameter (p = 0.006) were statistically different. Failure rates were significantly lower in eyes with macular hole minimum linear diameter < 400 µm (7.4% vs 32.4%; p = 0.013) and preoperative macular hole minimum linear diameter showed moderate correlation with pre- and postoperative best-corrected visual acuity results (r = 0.512; p < 0.001; r = 0.612; p < 0.001). Mean anterior chamber aqueous flare of 11.5 ± 9.9 pc/ms in eyes with anatomical closure and 11.8 ± 6.4 pc/ms in unclosed cases was comparable (p = 0.28) and did not correlate with anatomical or functional results. Conclusion: Eyes with idiopathic macular hole ⩾ 400 µm in size have a significantly higher failure rate following standardized pars plana vitrectomy with internal limiting membrane peeling and SF620% endotamponade. Preoperative macular hole minimum linear diameter and macular hole inner opening diameter seem to be associated with surgical outcome in idiopathic macular hole, whereas anterior chamber aqueous flare level does not provide additional predictive value.

scholarly journals Perspectives of Autologous Mesenchymal Stem-Cell Transplantation in Macular Hole Surgery: A Review of Current Findings

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Raffaele Nuzzi ◽  
Federico Tridico
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Internal Limiting Membrane ◽  
Mesenchymal Stem Cell Transplantation ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Feasible Alternative ◽  
Pars Plana ◽  
Surgical Failure ◽  
Idiopathic Macular Holes

The main treatment available for idiopathic macular holes is represented by pars plana vitrectomy with internal limiting membrane peeling. However, late-stage macular holes are affected by a higher risk of surgical failure. Although adjuvant techniques can be employed, a satisfactory functional recovery is difficult to achieve in refractory macular holes. Given their neuroprotective and antiapoptotic properties, mesenchymal stem cells (MSCs) may represent an appealing approach to treat these extreme cases. The purpose of this review is to highlight the findings regarding healing mechanisms exerted by mesenchymal stem cells and preliminary application in cases of refractory macular holes. When compared with MSCs, MSC-derived exosomes may represent a feasible alternative, given their reduced risk of undesired proliferation and easiness of use.

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

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

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.

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.

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

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 ◽  
Internal Limiting Membrane ◽  
Postoperative Outcomes ◽  
Aperture Diameter ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Pars Plana

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.

scholarly journals Recurrent Macular Hole: Causes, Risk Factors, and Treatment

2018 ◽  
pp. 293-295
Keyword(s):  
Risk Factors ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Head Positioning ◽  
Pars Plana ◽  
Risk Factors For Recurrence ◽  
Hole Closure

Idiopathic macular hole is a full-thickness defect of the retina which is caused by the tangential vitreomacular traction. Its prevalence is 8.7 per 100,000 people. Pars plana vitrectomy, internal limiting membrane peeling, gas tamponade, and face-down head positioning have a high success rate for primary hole closure. Improvements in small incision vitrectomy techniques reduce cystoid macular edema, epiretinal membrane formation, and also reopening of macular hole. Bilaterality, high myopia, intraoperative retinal breaks are well-known risk factors for recurrence. In this article, we reviewed the causes, risk factors, and current treatments of recurrent macular holes.

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.

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