Modern notions about the tactics of treatment of patients with non-full thickness macular holes: to observe or to operate?

In this review, the opinions of different authors on the problem of non-full thickness macular holes are discussed in detail. Currently, there are three different approaches to the management of this condition. Dynamic observation allows assessing the degree of their progression, to determine some or other anatomical indicators which influence the functional state of the retina and visual function. Pharmacological vitreolysis in some cases allows eliminating vertical and tangential traction in a least invasive mannor. To resolve this problem in a radical way is possible by surgical treatment posterior vitrectomy, but this is also related to certain surgical risks, and does not always lead to an increase in visual acuity. As a rule, it is recommended to patients with a significant decrease in visual acuity. Currently, indications for surgical treatment of patients with high visual function are ambiguous.

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A Retrospective Analysis of the Results of Microinvasive Posterior Vitrectomy in the Surgical Treatment of Non-Full Thickness Macular Holes

Ophthalmology in Russia ◽

10.18008/1816-5095-2018-2s-239-245 ◽

2018 ◽

Vol 15 (2S) ◽

pp. 239-245 ◽

Cited By ~ 1

Author(s):

Y. V. Bayborodov ◽

K. S. Zhogolev ◽

L. I. Balashevich ◽

I. E. Panova ◽

D. R. Mirsaitova

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Retrospective Analysis ◽

Retinal Thickness ◽

Maximum Diameter ◽

Full Thickness ◽

Ellipsoid Zone ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Before And After

Purpose:to study the effectiveness of the posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes on the basis of the retrospective analysis of the retina changes, identified by OCT, and functional outcomes of surgical treatment.Patients and Methods. A retrospective analysis of outcomes of posterior microinvasive vitrectomy was performed in 30 patients operated about non-full thickness macular holes. The following features were assessed: maximum diameter of the non-full thickness macular holes, the diameter at the base of the hole, the minimum thickness of the retina before and after operation, the maximum thickness of the retina before and after surgery. In addition, the configuration of the hole edges before surgery, the presence of intraretinal cysts before and after surgery, the integrity of the ellipsoid zone of the photoreceptors before and after the operation and the restoration of fovea centralis as a result of surgical treatment were assessed.Results. As a result of surgical treatment the closure of non-full thickness macular holes was reached in all cases. The most corrected visual acuity in the postoperative period was ranged from 0.1 to 1.0 (0,66 ± 0,04). The visual acuity improved in 20 cases (64.5%), remained at the same level in 8 cases (25.8%) and decreased in 3 cases (9.6%, in 1 case due to the development of cataracts). The results of correlation analysis has allowed to establish correlation between the initial BCVA and the maximum retinal thickness (R = –0.4), and residual retinal thickness in the area of the hole (R = –0.3). The increase in visual acuity after surgical treatment significantly affected the recovery of the ellipsoid zone of the photoreceptors (RD = 0.833), regression of the retinal thickness (R = 0.42). In addition, the initial diameter of non-full thickness macular holes, both external and at the base, also had an impact on the increase in BCVA (R = –0.3 and R = –0.25, respectively).Conclusion. Posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes is a highly effective method of treatment, as evidenced by the closure of the defect and improvement or stabilization of the most corrected visual acuity 90.4% cases. On the basis of the retrospective analysis it is found that the most significant increase in the most corrected visual acuity was increased in patients with low visual acuity. The recovery of the ellipsoid zone of photoreceptors, regression of the retinal thickness and the diameter of non-full thickness macular holes, both external and at the base mostly influences nn the recovery of the most corrected visual acuity.

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About a new approach to surgical treatment of corneal endothelial dystrophy

Ophthalmology journal ◽

10.17816/ov11178-84 ◽

2018 ◽

Vol 11 (1) ◽

pp. 78-84 ◽

Cited By ~ 3

Author(s):

Sergey Yu Astakhov ◽

Inna A Riks ◽

Sanasar S Papanyan ◽

Sergey A Novikov ◽

Georgiy Z Dzhaliashvili

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Conservative Treatment ◽

Functional State ◽

Clinical Case ◽

Corneal Dystrophy ◽

Cross Linking ◽

Common Disease ◽

New Approach ◽

Collagen Cross Linking

Primary endothelial dystrophy of the cornea is a fairly common disease in people older than 50 years. Well-developed methods of conservative treatment, as a rule, do not lead to improvement or stabilization of the functional state of the cornea. The choice of tactics of surgical treatment from the existing variety of techniques is complicated. There are isolated reports of the restoration of corneal transparency after descemet membrane removal. The author's method of endothelial corneal dystrophy treatment addressed in this particular clinical case - a combination of isolated descemetorhexis and collagen cross-linking - resulted in impressive increase in visual acuity and significant improvement in objective criteria for the morpho-functional state of the cornea. (For citation: Astakhov SYu, Riks IA, Papayan SS, et al. About a new approach to surgical treatment of corneal endothelial dystrophy. Ophthalmology Journal. 2018;11(1):78-84. doi: 10.17816/OV11178-84).

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25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

International Journal of Retina and Vitreous ◽

10.1186/s40942-020-00259-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Gordon T. Brown ◽

Sangeethabalasri Pugazhendhi ◽

Robert M. Beardsley ◽

John W. Karth ◽

Peter A. Karth ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Retrospective Analysis ◽

Epiretinal Membrane ◽

Internal Limiting Membrane ◽

Full Thickness ◽

Eligibility Criteria ◽

Macular Holes ◽

Corrected Distance Visual Acuity ◽

Vitrectomy Surgery

Abstract Background To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes. Methods Retrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months. Results For all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60). Conclusion Final visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

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Vitrectomy with the inverted internal limiting membrane flap technique in eyes with full-thickness macular hole and dry age-related macular degeneration

European Journal of Ophthalmology ◽

10.1177/1120672120921376 ◽

2020 ◽

pp. 112067212092137

Author(s):

Zofia Michalewska ◽

Jerzy Nawrocki

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Age Related Macular Degeneration ◽

Full Thickness ◽

Flap Technique ◽

Age Related ◽

Macular Holes ◽

Full Thickness Macular Hole

Purpose To present effects of the inverted internal limiting membrane flap technique in full-thickness macular holes coexisting with dry age-related macular degeneration. Methods Our database was retrospectively reviewed in order to spot patients with the simultaneous diagnosis of dry age-related macular degeneration and full-thickness macular hole. Vitrectomy with the inverted internal limiting membrane flap technique was performed. Inclusion criteria were full-thickness macular hole, drusen, vitrectomy performed, and spectral domain optical coherence tomography (Copernicus HR, Optopol, Poland) or swept source optical coherence tomography (Triton, Topcon, Japan) before surgery, then 1 week (±3 days), 1 month (±1 week), 3 months (±1 month), 6 months (±1 month), 12 months (±2 months), and 18 months to 12 years after surgery. Main outcome measures Closure of macular hole and visual acuity at the final control. Results A total of 18 eyes of 12 patients (mean age: 68 years) were included. Mean minimum macular hole diameter was 493 μm. Mean maximum macular hole diameter was 1072 μm. Macular hole was closed in 16 eyes after first surgery and in all eyes after second surgery. Improvement of visual acuity was statistically significant ( P = 0.05), but there was no statistical significant correlation observed between initial macular hole diameters and final visual acuity ( P > 0.1). Conclusion The inverted internal limiting membrane flap technique improves anatomical and functional results in eyes with coexisting dry age-related macular degeneration and full-thickness macular holes. Final development of choroidal neovascularization or geographic atrophy is possible in rare cases.

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Surgical treatment of full-thickness macular holes using autologous serum

Eye ◽

10.1038/eye.1996.136 ◽

1996 ◽

Vol 10 (5) ◽

pp. 593-599 ◽

Cited By ~ 31

Author(s):

John A Wells ◽

Zdenek J Gregor

Keyword(s):

Surgical Treatment ◽

Autologous Serum ◽

Full Thickness ◽

Macular Holes

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Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair

BMC Ophthalmology ◽

10.1186/s12886-021-01918-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christophe Valmaggia ◽

Filip Kostadinov ◽

Corina Lang ◽

Josef Guber

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Full Thickness ◽

Closure Rate ◽

Macular Holes ◽

Pars Plana ◽

23 Gauge ◽

N 93

Abstract Background To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH). Methods We retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications. Results Neither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001). Conclusions Combined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only. Trial registration The study was approved on 30th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033).

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Characteristics of fixation patterns and their relationship with visual function of patients with idiopathic macular holes after vitrectomy

Scientific Reports ◽

10.1038/s41598-021-87286-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuyan Liu ◽

Ying Wang ◽

Yi Dong ◽

Dongqing Liang ◽

Shiyong Xie ◽

...

Keyword(s):

Visual Acuity ◽

Visual Function ◽

Retrospective Case ◽

Integrity Assessment ◽

Fixation Location ◽

Macular Holes ◽

Significant Difference ◽

Before And After ◽

Fixation Locations ◽

Idiopathic Macular Holes

AbstractTo analyze the relationships between the fixation location and the visual function of idiopathic macular hole (IMH) patients with macular integrity assessment (MAIA) examination preoperatively and 3 months postoperatively. This was a retrospective case analysis. Forty-three eyes of 43 patients diagnosed with IMH were included in this study. The best corrected visual acuity (BCVA) assessments, optical coherence tomography (OCT) and MAIA examinations were performed before surgery and 1 week, 1 month and 3 months after surgery. The relationships between MAIA parameters and visual acuity were assessed by correlation analysis. Grouping by fixation location with the foveola (2°) as the centre, the locations could be divided into five groups, including foveolar, temporal, nasal, inferior and superior fixation. The mean macular sensitivity (MMS) of the macular area was correlated with the BCVA in the IMH patients before and 3 months after surgery (before surgery P = 0.00, after surgery P = 0.00). The MMS could be used as a good indicator for evaluating visual function in IMH patients. There was a significant difference in fixation location before and after the operation (P = 0.01). The preoperative fixation location of IMH patients was mainly in the superior area, while postoperatively moved to the foveola and nasal areas. Paying attention to the changes of fixation locations in IMH patients may provide new clues for further improving postoperative visual function.

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Role of Microperimetry in Observation and Treatment in Patients with Macular Holes

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-1-90-95 ◽

2021 ◽

Vol 18 (1) ◽

pp. 90-95

Author(s):

A. S. Zotov ◽

A. S. Balalin ◽

S. V. Balalin ◽

A. M. Marukhnenko ◽

T. G. Efremova

Keyword(s):

Surgical Treatment ◽

Fundus Photography ◽

Non Invasive ◽

Corrected Visual Acuity ◽

Dynamic Observation ◽

Macular Holes ◽

Before And After ◽

Idiopathic Macular Holes

Purpose: to assess the role of microperimetry in dynamic observation and treatment of patients with macular holes.Patients and Methods. Retrospective study of the microinvasive vitrectomy results using 25G or 27G technologies in 29 patients (29 eyes) with idiopathic macular holes (IMH). The examination included the determination of the best corrected visual acuity (BCVA), tonometry, perimetry, ultrasound biometry, optical coherence tomography, fundus photography, microperimetry.Results. After surgical treatment all patients have shown a significant improvement in BCVA and retinal photosensitivity (p < 0.05). A formula was derived for the dependence of BCVA after treatment on the initial retinal photosensitivity and the minimum IMH size, which can be applied to predict the results of surgical treatment.Conclusion. Microperimetry is a modern non-invasive examination method that allows with a higher density and resolution to localize central defects of the visual field and to carry out thorough monitoring before and after surgical treatment. The study of the retinal photosensitivity in the macular region and the minimum IMH size before treatment allow to predict BCVA in the postoperative period.

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The concept of the foveola anatomical reconstruction in the surgical treatment of full-thickness macular tears using intraoperative OCT control

Ophthalmology journal ◽

10.17816/ov10312-17 ◽

2017 ◽

Vol 10 (3) ◽

pp. 12-17 ◽

Cited By ~ 1

Author(s):

Jaroslav V Bayborodov

Keyword(s):

Surgical Treatment ◽

Anatomical Reconstruction ◽

Full Thickness ◽

Minimally Invasive Approach ◽

Macular Hole Surgery ◽

Invasive Approach ◽

Anatomical Structures ◽

Macular Holes ◽

Vitreomacular Interface ◽

Intraoperative Oct

Background. The concept of foveola anatomical reconstruction in surgical treatment of macular holes is a minimally invasive approach based on sparing principles of visualization and removal of transparent structures. Purpose. To estimate the practical value of high-resolution intraoperative OCT control (IOСT) at surgical treatment of macular holes. Materials and methods. The study included 95 patients (95 eyes) with macular holes from 400 to 900 microns in diameter, being during the period from September 2015 to October 2016. Results. IOСT control increases the anatomical and functional success of macular hole surgery, allowing determining more accurately the vitreomacular interface anatomical structures during the procedure and making more precise choice of tamponade agent to the end of it. Conclusion. The proposed foveola anatomical reconstruction in surgical treatment of full-thickness macular holes enhanced by intraoperative OCT control provides high functional and anatomic postoperative retinal indices. (For citation: Bayborodov YaV. The concept of the foveola anatomical reconstruction in the surgical treatment of full-thickness macular tears using intraoperative OCT control. Ophthalmology Journal. 2017;10(3):12-17. doi: 10.17816/OV10312-17).

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Surgical treatment of damage to the posterior capsule of the lens after laser vitreolysis

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-5-30-32 ◽

2021 ◽

pp. 30-32

Author(s):

А.А. Kozhukhov ◽

◽

О.V. Unguryanov ◽

О.А. Chukanin ◽

◽

...

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Key Words ◽

Clinical Case ◽

Vitreous Body ◽

Posterior Capsule ◽

Surgical Methods ◽

Initial Injury ◽

Capsule Material ◽

Decrease In Visual Acuity

Damage to the posterior capsule of the lens after laser vitreolysis causes the formation of traumatic cataracts and a decrease in visual acuity. The search for surgical methods of treating such complications is relevant. Purpose. To develop and improve the technique of posterior capsulorexis during phacoemulsification and implantation of IOL combined with vitrectomy in the presence of an initial injury of the posterior lens capsule. Material and methods. Clinical case - a patient came to the clinic with complaints about a decrease in visual acuity and quality after laser vitreolysis performed in another clinic. Observed the damage of the posterior capsule of the lens. The operation was performed according to the developed technique. Results. A method of primary posterior capsulorexis during phacoemulsification and implantation of IOL after vitreolysis, combined with vitrectomy, is proposed. Achieved high visual acuity after the operation, OD=1.0. Conclusions. 1) The developed technique of primary posterior capsulorexis is safe and allows partially preserving the posterior capsule of the lens, while forming a «window» in the area of damage, and implanting the IOL into a capsule bag. 2) The installation of scleral ports during primary posterior capsulorexis makes it possible to successfully combine this operation with vitrectomy and prevent the displacement of lens fragments to the fundus. Key words: сataract, posterior capsulorexis, laser vitreolysis, phacoemulsification, pseudophakia, IOL, vitrectomy, vitreous body.

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