scholarly journals Surgical Treatment of Previously Unclosed Macular Holes

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. 

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

2017 ◽  
Vol 98 (3) ◽  
pp. 397-400
Author(s):  
D V Petrachkov ◽  
A V Zolotarev ◽  
P A Zamytskiy ◽  
E V Karlova ◽  
I S Kazakov
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
Medical Records ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Aim Analysis ◽  
Corrected Visual Acuity ◽  
Macular Holes ◽  
Ophthalmic Hospital ◽  
Hole Closure

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

Platelet-rich plasma in surgery of various diameters idiopathic macular holes

2021 ◽  
pp. 51-53
Author(s):  
R.Z. Shamratov ◽  
◽  
L.S. Ramazanova ◽  
O.A. Napylova ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Macular Hole ◽  
Platelet Rich Plasma ◽  
Internal Limiting Membrane ◽  
Treatment Method ◽  
Macular Holes ◽  
Key Words Macular Hole ◽  
Promising Treatment ◽  
Idiopathic Macular Holes

The tactics of surgical treatment of the macular hole can be different and depends on the stage and diameter of the disease. Purpose. To study the results of surgical treatment of idiopathic macular detachments of various diameters with the use of autoplasma enriched with platelets. Material and methods. We observed 15 patients (15 eyes). Internal limiting membrane was peeled after vitrectomy. Platelet-rich autoplasmа was injected intravitreally. The observation period was 1 month. Results. As a result of surgical treatment, we were able to close the opening in all cases, restore the anatomy of the fovea and improve visual acuity in all patients. Conclusion. According to the assessment of the results obtained in the ongoing study, the use of this technology is an effective and promising treatment method based on the stimulation of the tissues' own regenerative potential. Key words: macular hole, surgical treatment, vitrectomy, platelet-rich plasma, visual acuity.

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 Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

2018 ◽  
Vol 1 (1) ◽  
pp. 07-13
Author(s):  
Ogugua Ndubuisi Okonkwo ◽  
Adekunle Olubola Hassan ◽  
Olufemi Oderinlo
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Vital Role ◽  
Symptom Duration ◽  
Flap Technique ◽  
Macular Holes ◽  
Snellen Visual Acuity ◽  
Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

Assessment of the clinical effectiveness of idiopathic macular ruptures surgical treatment of a large and medium diameter using modified inverted flap technology of internal limiting membrane (preliminary results)

2021 ◽  
pp. 20-25
Author(s):  
D.I. Bronskiy ◽  
◽  
V.A. Zaika ◽  
A.P. Yakimov ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Free Flap ◽  
Large Diameter ◽  
Clinical Effectiveness ◽  
Internal Limiting Membrane ◽  
Treatment Method ◽  
Retinal Blood Flow ◽  
Photoreceptor Layer ◽  
Layer 4 ◽  
A Prospective Study

Purpose. To assess the clinical effectiveness of surgical treatment of medium-and large-diameter idiopathic macular ruptures (IMR) using a modified technology by inversion and fixation of a free flap of the internal limiting membrane (ILM). Methods. A prospective study was conducted in 11 patients (11 eyes), 9 women and 2 men with medium-and large-diameter IMR. Mean age - 67.3 ± 5.38 (55-80) years. Patients with penetrating IMR of 2-4 stages according to the J. Gass classification. All patients underwent optical coherence tomography (OCT) along with traditional ophthalmological methods. The scans were performed in Retina Map, Cross line, Radial line, and Angio Retina modes. The obtained images were used to measure the parameters of the macular rupture (MR) of the retina manually. All patients underwent surgical treatment of IMR according to the proposed method. Results. In all cases, 1 day after the surgery, the closure of the gap was achieved according to ophthalmoscopy. 1 month after the surgery, according to OCT, 3 patients (27.2%) had a defect in the photoreceptor layer, 4 patients (36.3%) had deformity or peripheral non-attachment of the edges of the ILM flap, and 2 patients (18.1%) had a combination of these defects. According to OCT data in the Angio Retina mode, changes in the parameters of retinal blood flow were noted: there was a significant, moderate expansion of the avascular zone, accompanied by a moderate decrease in retinal perfusion. Despite this, there was a significant increase in visual acuity in the postoperative period. Conclusion. Endovitreal intervention for medium-and large-diameter macular ruptures using a modified technology by inversion and fixation of an ILM free flap is highly effective, as well as a low-traumatic treatment method that allows achieving anatomical closure of the macular defect and improving visual functions.

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

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.

scholarly journals Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Federico Peralta Iturburu ◽  
Claudia Garcia-Arumi ◽  
Maria Bové Alvarez ◽  
Jose Garcia-Arumi
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Small Sample Size ◽  
Internal Limiting Membrane ◽  
Small Sample ◽  
Ilm Peeling ◽  
Visual Outcomes ◽  
Macular Holes ◽  
Idiopathic Macular Holes

Purpose. To compare the results of vitrectomy with those of internal limiting membrane (ILM) peeling or inverted ILM flap for treating myopic or idiopathic macular hole. Methods. Thirty-nine eyes of 39 patients undergoing vitrectomy with ILM peeling for macular hole (25 idiopathic and 14 myopic) and 27 eyes of 27 patients undergoing vitrectomy with inverted ILM flap (15 idiopathic and 12 myopic) were included. Outcome measures were macular hole closure by optical coherence tomography and visual acuity at 6 months. Results. Closure was achieved in 25 (100%) idiopathic and 12 (86%) myopic macular holes in the ILM peeling group and in 14 (93%) idiopathic and 11 (91.77%) macular holes in the inverted ILM flap group. There were no statistically significant differences in restoration of the external limiting membrane and ellipsoid zone between the groups. Median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.22 (20/32 Snellen) in idiopathic and 0.4 (20/50) in myopic (P=0.042) patients in the ILM peeling group and 0.4 (20/50) in idiopathic and 0.4 (20/50) in myopic (P=0.652) patients in the inverted ILM flap group. Conclusion. Both techniques were associated with high closure rates in myopic and idiopathic macular holes, with somewhat better visual outcomes in idiopathic cases. The small sample size may have provided insufficient power to support the superiority of one technique over the other in the two groups.

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.

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

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.

scholarly journals Diagnosis and Management of Macular Holes Traumatic

2019 ◽  
Vol 2 (1) ◽  
pp. 38-45
Author(s):  
Reny Violeta ◽  
AK Ansyori ◽  
Ramzi Amin
Keyword(s):  
Macular Hole ◽  
Blunt Trauma ◽  
Internal Limiting Membrane ◽  
Photoreceptor Layer ◽  
Macular Holes ◽  
Younger Age ◽  
History Of ◽  
Amsler Grid ◽  
The Right ◽  
First Time

Introduction. Macular hole is a defect in the retina involving the macula and fovea, in the form of damage to full thickness from the internal limiting membrane (ILM) to the outermost part of the photoreceptor layer . It was more often found in women. In patients with myopia disorders can be found at a younger age. In this case we report the macular hole caused by blunt trauma, as was the first time a macular hole case was discovered. Case Presentation. A man 24-year-old, Mr. C, came to Palembang RSMH eye clinic on August 15, 2014 with complaints of blurred right eye vision. Main Complaints: Right eye blurred. History Disease: Right eye blurred for about 3 months before entering the hospital. Blur is felt after the patient had a motorcycle accident 3 months ago. At that time the collision sufferer avoided the truck, the right eye hit the motorcycle handlebar, the patient then fell from the motorcycle and hit the highway head. A history of frequent headaches is denied, nausea, vomiting is denied, history of seeing in tunnels is denied. Supporting examination is Amsler Grid Oculi Dextra: there is a black hole in the middle of the image. differential diagnosis is Traumatic Macular Hole OD, Lamellar Macular Hole OD, work diagnosis is Traumatic Macular Hole stage 3 OD. Conclusion. Traumatic macular holes can occur immediately after blunt trauma to the eyeball, the accuracy of the diagnosis and the speed of the timing for surgery, greatly determining the prognosis. Vitrectomy and combined with internal limiting membrane peeling have been shown to provide excellent results in macular surgery in macular hole cases.

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