Analysis of surgical treatment results of macular holes in the Samara region

Aim. Analysis of anatomical and functional results of surgical treatment of full-thickness macular holes. Methods. We conducted a retrospective analysis of medical records of 194 outpatients (194 eyes) on whom surgical treatment of macular hole was performed in Samara Clinical Ophthalmic Hospital n.a. T.I. Eroshevskiy during 2015-2016. Results. On day 5 after surgery in 96 (97.9%) patients with a hole of more than 400 µm operated according to inverted flap technique, and in 93 (96.9%) patients with hole of less than 400 µm, on whom removal of the internal limiting membrane around the hole was performed, we observed macular hole closure. The best corrected visual acuity of patients with the hole of more than 400 µm increased to 0.18±0.13 (p

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Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.2.689 ◽

2019 ◽

Vol 35 (2) ◽

Author(s):

Haroon Tayyab ◽

Asad Aslam Khan ◽

Sana Jahangir

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Creative Commons ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Best Corrected Visual Acuity ◽

Hole Closure ◽

Sd Oct

Objective: To evaluate the effectiveness of inverted internal limiting membrane flap in large idiopathic macular holes. Methods: Twelve patients diagnosed with idiopathic macular holes larger than 400um underwent 23 gauge Pars Plana Vitrectomy (PPV) with inverted internal limiting flap and gas tamponade at Al-Ehsan Eye Welfare Eye Hospital, Lahore from February 2017 to February 2018. All cases were diagnosed on Spectral Domain Optical Coherence Tomography (SD-OCT) and were followed up for 6 months. At every follow-up, best corrected visual acuity and SD-OCT was done. Results: We achieved macular hole closure in 91.6% (11/12) patients with idiopathic macular holes larger than 400um. Five out of 12 patients underwent combined phacoemulsification and PPV. One patient has flat hole closure which was considered failure. One patient was excluded from the study due to per-operative flap loss. This patient was not included in final data analysis of 12 patients. There was statistically significant gain in best corrected visual acuity after successful macular hole closure. We did not report any untoward events during or in the post-operative period. Conclusion: Inverted internal limiting flap is an effective method for repairing large macular holes. How to cite this:Tayyab H, Khan AA, Jahangir S. Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.689 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Surgical Treatment of Previously Unclosed Macular Holes

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-3-368-374 ◽

2020 ◽

Vol 17 (3) ◽

pp. 368-374

Author(s):

R. R. Faizrakhmanov ◽

E. A. Larina ◽

O. A. Pavlovskii

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Macular Hole ◽

Free Flap ◽

Inverse Correlation ◽

Functional Results ◽

Internal Limiting Membrane ◽

Morphological Parameters ◽

Photoreceptor Layer ◽

Macular Holes

Macular holes are the most often pathology leading to reduced vision among persons after 60 years. The macular hole is the acquired disease which is a defect of a foveola part of retina on all thickness from an internal limiting membrane to an external segment of a photoreceptor layer. The standard method of treatment is surgery method: a microinvasive vitrectomy with membrane peeling in macular area. There is a number of the techniques increasing efficiency of operative intervention. Even in case of successful surgical intervention macular holes are not always closed.The purpose: development and assessment of morphological parameters of the central retina with a new surgical method of closing earlier operated macula hole using a free flap.Material and methods. 40 patients (40 eyes, 28 women and 12 men) had participated in this study. All patients were operated about macular hole with negative anatomic result. By technology which were used earlier, patients were divided into 3 studied groups (with PRP mass using, with introverted flap using, with mechanical matching of edges of a hole). The main method of research was the optical coherent tomography. All patients were operated by an original technique. It’s purpose was a closing of earlier operated rigid macular hole using a free flap.Results. The defect of a photoreceptor component was closed with an additional expansion of earlier created macular rexis in patients of the 1st and 3rd groups at reoperation. The earlier created flap of an internal limiting membrane was used in patients of the 2nd group. In the analysis of dependence of change of visual acuity from morphological parameters of a macular hole after primary surgical treatment the inverse correlation relation from diameter of a macular hole on small and big radiuses is revealed. The highest visual acuity after a reoperation was reached at patients of the second group.Conclusions. It is necessary to consider the technique which was used earlier, diameter of a macular hole on small and big radiuses, postoperative edema in a parafovea zone for planning the surgical treatment and a forecast of functional results.

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

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-213-216 ◽

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.

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Morphofunctional analysis of the retina in the surgical treatment of idiopathic macular holes

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-48-52 ◽

2021 ◽

pp. 48-52

Author(s):

A.S. Zotov ◽

◽

A.S. Balalin ◽

S.V. Balalin ◽

S.M. Purshak ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Surgical Treatment ◽

Macular Hole ◽

Practical Importance ◽

Functional Results ◽

Hole Diameter ◽

Optical Coherence ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Morphofunctional Analysis

Purpose. To evaluate the role of microperimetry and optical coherence tomography (OCT) in the morphofunctional analysis of the retina after surgical treatment of idiopathic macular holes (IMH). Materials and methods. A retrospective study of 33 patient's treatment results (33 eyes) with IMH was carried out. All patients underwent minimally invasive with 25G or 27G vitrectomy. Best corrected visual acuity (BCVA), macular photosensitivity, fixation stability, macular neuroepithelial (NE) volume and minimal macular hole diameter were analyzed. Follow-up period: 6 months. Results. A complete closure of the macular hole was achieved in all cases post-op. The patients had reliable improvement of BCVA, retinal photosensitivity and decrease of macular NE volume. Based on a multifactor correlation analysis with the purpose to predict the results of surgical treatment, the dependence of post-op BCVA on the pre-op photosensitivity of the retina and the minimal diameter of the macular hole was revealed. Conclusions. Microperimetry and OCT are modern non-invasive research methods allowing to estimate anatomical and functional results of surgical IMH treatment. The study of retinal photosensitivity in the macula and minimal macular hole diameter pre-op allows to predict post-op BCVA, which has a practical importance. Keywords: idiopathic macular hole, vitrectomy, microperimetry, optical coherence tomography.

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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 ◽

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

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Differentiated Approach to Strategies of Surgical Treatment of Idiopathic Macular Holes

The Eye ◽

10.33791/2222-4408-2021-4-12-16 ◽

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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Autologous Retinal Transplant for Macular Hole

The Open Ophthalmology Journal ◽

10.2174/1874364102115010292 ◽

2021 ◽

Vol 15 (1) ◽

pp. 292-298

Author(s):

Sergio E. Hernández Da Mota ◽

Virgilio Morales-Cantón ◽

Sergio Rojas-Juárez ◽

Antonio López-Bolaños ◽

Abel Ramírez-Estudillo ◽

...

Keyword(s):

Macular Hole ◽

Multifocal Electroretinogram ◽

Case Series ◽

Macular Hole Surgery ◽

Closure Rate ◽

Retinal Transplantation ◽

Ovid Medline ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Hole Closure

We aim to review scientific literature concerning published studies on autologous retinal transplantation to treat macular hole patients. The following databases were searched: Medline and Medline Non-Indexed Items, Embase (1990–2020), Ovid Medline® (1990 to November 2020), Embase (1990 to November 2020), Ovid Medline® and Epub Ahead of Print, in-Process and Web of Science (all years). Search keywords included “autologous”, “retinal transplant”, “autologous neurosensory retinal free flap” “transplantation”, “macular hole”, and “macular hole surgery”. Eighteen case series and single case reports were reviewed. Preoperative and final best-corrected visual acuity, microperimetry and multifocal electroretinogram findings, macular hole closure rate, preoperative and postoperative ellipsoid zone, and external limiting membrane defects were obtained and analyzed. Indications of autologous retinal transplantation for macular hole surgery included refractory macular holes, conventional techniques, and large macular holes. The number of cases included in the different case series ranged from 2 to 130 cases, and prior macular hole surgeries of the patients ranged from 0 to 3. Overall, the published case series of autologous retinal transplants have reported a macular hole closure rate of 66.7 to 100%, as well as a significant improvement in best-corrected visual acuity. The most frequently reported complications included considerable intraoperative bleeding and postoperative dislocation of the graft. The presence of functionality in the graft area has also been documented by microperimetry and multifocal electroretinogram. In conclusion, the autologous retinal transplantation technique for macular hole patients has emerged as another surgical option, with a high macular hole closure rate and visual improvement.

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Clinical and functional results of closing macular holes with the foveal-sparing internal limiting membrane peeling

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-34-37 ◽

2021 ◽

pp. 34-37

Author(s):

A.I. Kolesnik ◽

◽

S.V. Kolesnik ◽

F.A. Avakyan ◽

A.A. Shpak ◽

...

Keyword(s):

Surgical Treatment ◽

Functional Results ◽

Internal Limiting Membrane ◽

Developed Countries ◽

Clear Understanding ◽

Internal Limiting Membrane Peeling ◽

Macular Holes ◽

Air Tamponade ◽

Anatomical Success ◽

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. Thus, the proposed low-traumatic method of treating IMH with the preservation of foveal ILM provides a stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea zone. Key words: macular rupture, internal limiting membrane, chromovitrectomy.

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Subfoveal triamcinolone acetonide following macular hole surgery

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7837 ◽

2013 ◽

Vol 5 (1) ◽

pp. 114-116

Author(s):

A Jindal ◽

A Bhawdekar ◽

A Pathengay

Keyword(s):

Macular Hole ◽

Triamcinolone Acetonide ◽

Harmful Effect ◽

Posterior Vitreous Detachment ◽

Internal Limiting Membrane ◽

Visual Recovery ◽

Vitreous Surgery ◽

Macular Hole Surgery ◽

Corrected Visual Acuity ◽

Hole Closure

Background: Triamcinolone acetonide (TA) is commonly used in vitreous surgery to visualize the posterior hyaloid and internal limiting membrane. Some TA can accumulate in the macular hole during surgery which can persist postoperatively. Case: A 17-year-old boy underwent successful macular hole surgery with TA-assisted induction of posterior vitreous detachment. Sub-foveal deposit of TA was observed postoperatively, which got absorbed at 7 weeks with complete closure of the macular hole, and best corrected visual acuity improved from 20/100 preoperatively to 20/60. Conclusion: Residual TA after macular hole surgery may not hamper the anatomical and functional outcome. Similar cases have been reported in the literature and most of them show no harmful effect of TA on macular hole closure and visual recovery. Nepal J Ophthalmol 2013; 5(9):114-116 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7837

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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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