scholarly journals Update on surgical management of complex macular holes: a review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohd-Asyraaf Abdul-Kadir ◽  
Lik Thai Lim
Keyword(s):  
Surgical Treatment ◽  
Morphological Changes ◽  
Internal Limiting Membrane ◽  
Small Subset ◽  
Human Amniotic Membrane ◽  
Surgical Interventions ◽  
Long Term Study ◽  
Macular Holes ◽  
Surgical Options ◽  
Pars Plana

AbstractModern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.

scholarly journals Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Maurizio Mete ◽  
Alessandro Alfano ◽  
Emilia Maggio ◽  
Massimo Guerriero ◽  
Grazia Pertile
Keyword(s):  
Morphological Changes ◽  
Surgical Techniques ◽  
Positive Association ◽  
Internal Limiting Membrane ◽  
Flap Technique ◽  
Macular Holes ◽  
Pars Plana ◽  
Myopic Macular Hole ◽  
Strong Positive Association ◽  
Healing Processes

Purpose. To investigate the microstructural changes after successful myopic macular hole (MMH) surgery, comparing inverted ILM flap and complete ILM removal techniques, and their association with visual function. Methods. Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate both external limiting membrane (ELM) and ellipsoid zone (EZ) recovery in 40 eyes of 39 patients who underwent pars plana vitrectomy with either inverted internal limiting membrane flap technique (n=27) or complete ILM removal (n=13) to achieve MH closure. The association between ELM and EZ recovery and visual acuity was also investigated. The patients were followed up at 1 year. Results. ELM and EZ was recovered in 72% and 62% of cases, respectively, regardless of the surgical techniques 1 year after surgery. A strong positive association between the ELM and EZ recovery and the mean BCVA was found: regardless of the surgical technique, this was statistically significant at each time point (p<0.05). None of the baseline variables were found to act as predictive factors for either ELM or EZ. Conclusion. The inverted ILM flap technique did not affect the MMH healing processes compared to complete ILM removal. Thus, the presence of the ILM plug did not interfere with the restoration of both ELM and EZ, which correlated with functional recovery.

Method of surgical treatment of small and medium diameter macular holes with the foveal-sparing internal limiting membrane peeling

2021 ◽  
pp. 213-216
Author(s):  
A.A. Shpak ◽  
◽  
A.I. Kolesnik ◽  
F.A. Avakyan ◽  
V.A. Pismenskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Developed Countries ◽  
Clear Understanding ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Air Tamponade ◽  
Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.

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 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.

scholarly journals The Role of Single-Layered Flap in Temporal Inverted Internal Limiting Membrane Flap Technique for Macular Holes: Pros and Cons

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yasuyuki Takai ◽  
Masaki Tanito ◽  
Kazunobu Sugihara ◽  
Akihiro Ohira
Keyword(s):  
Internal Limiting Membrane ◽  
Japanese Patients ◽  
Symptom Duration ◽  
Prone Positioning ◽  
Flap Technique ◽  
Macular Holes ◽  
Pros And Cons ◽  
Pars Plana ◽  
Minimal Diameter

Purpose. To assess the safety and effectiveness of the single-layered inverted internal limiting membrane (ILM) flap technique for treating chronic, large, or highly myopic macular holes (MHs). Methods. The medical records of 20 eyes of 20 consecutive Japanese patients with large MHs n=6 (minimal diameter, >400 μm), chronic MHs n=2 (symptom duration, >24 months), MHs in high myopia n=11 (axial length, >26 mm), and MHs in a patient unable to maintain prone positioning postoperatively n=1 were reviewed retrospectively. All patients underwent 25-gauge pars plana vitrectomy and the temporal inverted ILM flap technique. A semicircular ILM notch was made temporally two disc diameters from the MH using a 25-gauge knife, and the ILM was peeled temporally to create a semicircular ILM flap using a 25-gauge forceps. The single-layered ILM flap was inverted in a nasal direction to cover the MH. When an epiretinal membrane (ERM) was present, it was peeled before the ILM flap was inverted. Results. The MHs closed successfully in all (100%) eyes postoperatively. In the MHs associated with an ERM, after hole closure, gradual foveal deformation occurred in both the area from which the ILM was not peeled and the ILM flap inverted side. Conclusions. The single-layered inverted ILM flap technique, a simple surgery to treat MHs, provides scaffolding for retinal gliosis and may facilitate bridge formation between the walls of the MH under the flap. Considering the 100% success rate of MH closure, this technique seems to be effective and safe for treating chronic, large, or highly myopic MHs and MHs in patients unable to maintain postoperative prone positioning. In the MHs associated with ERMs, gradual foveal deformation was observed after ERM peeling. Further studies are needed to minimize surgical complications and understand the mechanism of this technique. This trial is registered with UMIN000035091.

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience

2020 ◽  
Author(s):  
Nisa Silva ◽  
Natália Ferreira ◽  
Bernardete Pessoa ◽  
Nuno Correia ◽  
João Melo Beirão ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Limiting Membrane ◽  
Flap Technique ◽  
Macular Holes

Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes

2016 ◽  
Vol 132 (1) ◽  
pp. 23
Author(s):  
Yu. A. Belyy ◽  
A. V. Tereshchenko ◽  
D. O. Shkvorchenko ◽  
E. V. Erokhina ◽  
N. M. Shilov
Keyword(s):  
Surgical Treatment ◽  
Internal Limiting Membrane ◽  
Membrane Fragment ◽  
Macular Holes ◽  
Idiopathic Macular Holes

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

Differentiated Approach to Strategies of Surgical Treatment of Idiopathic Macular Holes

The Eye ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 12-16
Author(s):  
R. Z. Shamratov ◽  
L. Sh. Ramazanova ◽  
O. A. Napylova
Keyword(s):  
Surgical Treatment ◽  
Vitreoretinal Surgery ◽  
Internal Limiting Membrane ◽  
Pathological Process ◽  
Hole Diameter ◽  
Corrected Visual Acuity ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
Anatomical Outcome ◽  
Clinical Cases

Background. 25G or 27G three-port vitrectomy, followed by staining and removal of the internal limiting membrane with vitreous cavity air or gas tamponade, is one of the main modern vitreoretinal surgery principles for primary macular holes. However, not all patients manage to obtain a functional outcome when the anatomical outcome is achieved. Purpose. To  present clinical cases of surgical treatment of idiopathic macular holes (IMH) exhibiting a differentiated approach.Matherials and methods. This article analyzes clinical cases of four patients with primary idiopathic macular holes, differing in terms of development, hole diameter and the presence of comorbidities. Results. The results of surgical treatment were evaluated 14 days and 1 month after surgery. In all clinical cases, surgical treatment resulted in a positive anatomical outcome by blocking a retinal defect. Best corrected visual acuity increased, on average, from 0.08 ± 0.05 to 0.4 ± 0.05.Conclusion. The analysis of the presented clinical cases clearly demonstrates the need for a timely and differentiated approach to the treatment of patients with IMH, that considers etiology of the pathological process, period of its existence as well as concomitant and general somatic pathologies.

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