Differences in Surgical Performance of Internal Limiting Membrane Peeling for Macular Hole Repair Between Supervised Vitreoretinal Fellows and Vitreoretinal Faculty at a Single Institution

Purpose: To investigate the differences in surgical maneuvers between vitreoretinal fellows and experienced vitreoretinal surgeons (attendings) when performing internal limiting membrane (ILM) peel during macular hole (MH) surgery and repair. Methods: Prospective case series. Macular hole surgeries performed by fellows and attendings at St Michael’s Hospital (Toronto, Canada) were recorded during a 12-month period. Evaluation of recordings was masked. Total peel time (TPL) in seconds, total movement attempts initiating and extending ILM flaps, intrasurgical complications, and surgical efficiency (ratio of approaches leading to case progression to total approaches) were quantified. Results: A total of 145 surgeries were evaluated; 44 met inclusion and exclusion criteria. Of the 44 cases, 25 were performed by fellows and 19 by attendings. Mean TPL was shorter for attendings (336 vs 506 seconds, P = .0032). Attendings had a lower average total movement attempts (32.2 vs 43.2, P = .045) and average flap initiation attempts (16.1 vs 23.3, P = .042). Surgical efficiency was better for attendings (45% vs 37% of approaches led to case progression, P = .038). There was no significant difference between groups in total flap extension attempts or intrasurgical complications. Conclusions: Compared to fellows, attendings peel ILM in MH surgery faster, more efficiently with a lower number of flap initiation attempts and total movements.

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Internal limiting membrane flap transposition for surgical repair of macular holes in primary surgery and in persistent macular holes

European Journal of Ophthalmology ◽

10.5301/ejo.5001037 ◽

2017 ◽

Vol 28 (2) ◽

pp. 225-228 ◽

Cited By ~ 5

Author(s):

Christoph Leisser ◽

Nino Hirnschall ◽

Birgit Döller ◽

Ralph Varsits ◽

Marlies Ullrich ◽

...

Keyword(s):

Macular Hole ◽

Surgical Repair ◽

Case Series ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Gas Tamponade ◽

Primary Surgery ◽

Macular Holes ◽

Prospective Case Series ◽

Hole Closure

Purpose: Classical or temporal internal limiting membrane (ILM) flap transposition with air or gas tamponade are current trends with the potential to improve surgical results, especially in cases with large macular holes. Methods: A prospective case series included patients with idiopathic macular holes or persistent macular holes after 23-G pars plana vitrectomy (PPV) and ILM peeling with gas tamponade. In all patients, 23-G PPV and ILM peeling with ILM flap transposition with gas tamponade and postoperative face-down position was performed. Results: In 7 of 9 eyes, temporal ILM flap transposition combined with pedicle ILM flap could be successfully performed and macular holes were closed in all eyes after surgery. The remaining 2 eyes were converted to pedicle ILM flap transposition with macular hole closure after surgery. Three eyes were scheduled as pedicle ILM flap transposition due to previous ILM peeling. In 2 of these eyes, the macular hole could be closed with pedicle ILM flap transposition. In 3 eyes, free ILM flap transposition was performed and in 2 of these eyes macular hole could be closed after surgery, whereas in 1 eye a second surgery, performed as pedicle ILM flap transposition, was performed and led to successful macular hole closure. Conclusions: Use of ILM flaps in surgical repair of macular hole surgery is a new option of treatment with excellent results independent of the diameter of macular holes. For patients with persistent macular holes, pedicle ILM flap transposition or free ILM flap transposition are surgical options.

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Macular toxicity following brilliant blue G-assisted macular hole surgery – a report of three cases

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v6i1.10779 ◽

2014 ◽

Vol 6 (1) ◽

pp. 98-101 ◽

Cited By ~ 6

Author(s):

Animesh Jindal ◽

Avinash Pathengay ◽

Kopal Mithal ◽

Jay Chhablani ◽

Rajeev Reddy Pappuru ◽

...

Keyword(s):

Macular Hole ◽

Case Series ◽

Internal Limiting Membrane ◽

Brilliant Blue ◽

Idiopathic Macular Hole ◽

Brilliant Blue G ◽

Macular Hole Surgery ◽

Internal Limiting Membrane Peeling ◽

Corrected Visual Acuity ◽

Unusual Occurrence

Introduction: Brilliant blue G is a new dye used for staining the internal limiting membrane to ease its peeling in cases like a macular hole. Cases: Three patients presented with full-thickness idiopathic macular hole. They underwent pars planavitrectomy, Brilliant Blue G (BBG) stained internal limiting membrane peeling and fluid gas exchange. Observations: Postoperatively,the macular hole closed but foveal thinning and perifoveal hyperpigmentation presumably due to BBG toxicity were observed in all three patients. All of them had a subnormal final best corrected visual acuity. Conclusion:This case series highlights the unusual occurrence of macular toxicity following brillantblue G-assisted macular hole surgery. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10779 Nepal J Ophthalmol 2014; 6 (2): 98-101

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

International Journal of Ophthalmology ◽

10.18240/ijo.2021.09.17 ◽

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.

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Clinical, Radiographic, and Histomorphometric Evaluation of a Vertical Ridge Augmentation Procedure Using a Titanium-Reinforced Microporous Expanded Polytetrafluoroethylene Emrane: A Prospective Case Series with 1-Year Follow-Up

Materials ◽

10.3390/ma14143828 ◽

2021 ◽

Vol 14 (14) ◽

pp. 3828

Author(s):

Jung-Gu Ji ◽

Jung-A Yu ◽

Seong-Ho Choi ◽

Dong-Woon Lee

Keyword(s):

Case Series ◽

Graft Material ◽

Ridge Augmentation ◽

Expanded Polytetrafluoroethylene ◽

Implant Placement ◽

Significant Difference ◽

Staged Approach ◽

Height Change ◽

Prospective Case Series ◽

Augmentation Procedure

Vertical ridge augmentation for long-term implant stability is difficult in severely resorbed areas. We examined the clinical, radiological, and histological outcomes of guided-bone regeneration using novel titanium-reinforced microporous expanded polytetrafluoroethylene (MP-ePTFE) membranes. Eighteen patients who underwent implant placement using a staged approach were enrolled (period: 2018–2019). Vertical ridge augmentation was performed in areas with vertical bone defects ≥ 4 mm. Twenty-six implant fixtures were placed in 14 patients. At implant placement six fixtures had relatively low stability. On cone-beam computed tomography, the average vertical changes were 4.2 ± 1.9 (buccal), 5.9 ± 2.7 (central), and 4.4 ± 2.8 mm (lingual) at six months after vertical ridge augmentation. Histomorphometric analyses revealed that the average proportions of new bone, residual bone substitute material, and soft tissue were 34.91 ± 11.61%, 7.16 ± 2.74%, and 57.93 ± 11.09%, respectively. Stable marginal bone levels were observed at 1-year post-loading. The residual bone graft material area was significantly lower in the exposed group (p = 0.003). There was no significant difference in the vertical height change in the buccal side between immediately after the augmentation procedure and the implant placement reentry time (p = 0.371). However, all implants functioned well regardless of the exposure during the observation period. Thus, vertical ridge augmentation around implants using titanium-reinforced MP-ePTFE membranes can be successful.

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Effect of bandaging on postoperative swelling after tibial plateau levelling osteotomy

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-09-04-0046 ◽

2010 ◽

Vol 23 (04) ◽

pp. 240-244 ◽

Cited By ~ 7

Author(s):

J.K. Roush ◽

K. L. Bilicki ◽

G.Baker. Baker ◽

M.D. Unis

Keyword(s):

Tibial Plateau ◽

Case Series ◽

Small Animal ◽

Significant Linear Correlation ◽

Significant Difference ◽

Group 2 ◽

Prospective Case Series ◽

Distal Aspect ◽

Postoperative Swelling ◽

Group 1

Summary Objective: To compare the effects of bandaging on immediate postoperative swelling using a modified Robert-Jones bandage after tibial plateau levelling osteotomy (TPLO) in dogs. Study design: Prospective case series. Methods: Dogs undergoing a TPLO were randomly placed into two groups. Group 1 received a modified Robert-Jones bandage postoperatively for a 24 hour period and Group 2 was not bandaged. Hindlimb circumference was measured at the level of the mid-patella, the distal aspect of the tibial crest, the midpoint of the tibial diaphysis and the hock. Measurements were recorded and compared in each group preoperatively and at 24 hours and 48 hours post-operatively. Interobserver variability was compared between the two observers. Results: There was no significant difference in postoperative swelling, as measured by the percentage change in circumference, between bandaged and unbandaged operated limbs after the TPLO at 24 and 48 hours at any site. Some significant differences in measurement at particular sites were observed between the two different observers, but there was a significant linear correlation at all sites between observers. The observer with the least experience consistently had slightly higher measurements at these sites. Clinical relevance: The use of a modified Robert-Jones bandage after TPLO did not prevent statistically significant postoperative swelling, and thus may not be indicated for this purpose. Postoperative bandages placed to control swelling after other small animal orthopaedic procedures should be evaluated individually for efficacy.

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