Characteristics of macular microvasculature before and after idiopathic macular hole surgery

AIM: To evaluate the macular microvasculature before and after surgery for idiopathic macular hole (MH) and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration. METHODS: Twenty eyes from 20 patients with idiopathic MH were enrolled. Optical coherence tomography angiography (OCTA) images were obtained before, 2wk, 1, and 3mo after vitrectomy with internal limiting membrane peeling. Preoperative foveal avascular zone (FAZ) area and perimeter and regional vessel density (VD) in both layers were compared according to the 3-month best-corrected visual acuity (BCVA). RESULTS: The BCVA improved from 0.98±0.59 (logMAR, Snellen 20/200) preoperatively to 0.30±0.25 (Snellen 20/40) at 3mo postoperatively. The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group (all P<0.05). A significant reduction was observed in FAZ parameters and all VDs 2wk postoperatively. Except for deep perifoveal VD, all VDs recovered only to their preoperative values. The postoperative FAZ parameters were lower during follow-up. Decreases in preoperative deep VDs were correlated with worse postoperative BCVA (Pearson's r=-0.667 and -0.619, respectively). A larger FAZ perimeter (Spearman's r=-0.524) and a lower deep perifoveal VD preoperatively (Pearson's r=0.486) were associated with lower healing stage. CONCLUSION: The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH. Except for the deep perifoveal region, VD recovers only to preoperative levels.

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EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY

Retina ◽

10.1097/iae.0000000000002707 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 4

Author(s):

Carmen Baumann ◽

Stephen Kaye ◽

Danilo Iannetta ◽

Ziyaad Sultan ◽

Rahul Dwivedi ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Idiopathic Macular Hole ◽

Macular Hole Surgery ◽

Closure Rate ◽

Postoperative Visual Acuity ◽

Retinal Layers

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A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for Idiopathic Macular Hole of different hole diameters with Air or C3F8 Intraocular Tamponade

10.21203/rs.2.18974/v1 ◽

2019 ◽

Author(s):

Yong Ping Tang ◽

Bei Lei Wu ◽

Zhong Lin ◽

Ronghan Wu

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Hole Diameter ◽

Idiopathic Macular Hole ◽

Macular Hole Surgery ◽

Membrane Peeling ◽

Intraocular Tamponade ◽

Significant Difference

Abstract Background：Vitrectomy and membrane peeling followed by gas filling technique has become a standard procedure of macular hole surgery, the outcomes are affected by many factors, and which kind of intraocular tamponade is the best choice still has some conflicts. The purpose of this study is to investigate whether air filling can achieve comparable effects to long-acting inert gases when different macular hole sizes are enrolled. Methods：116 patients with idiopathic macular hole were enrolled in this retrospective study, 44 received C3F8 tamponade and 72 received sterile air tamponade. Before and after vitrectomy surgery, the best corrected visual acuity, slit lamp examination, fundus examination and intraocular pressure were analyzed. Results：No statistically significant difference was fund in age, gender, axial length, intraocular pressure, or preoperative visual acuity between groups. After the surgery, the closure rates of air group and C3F8 group with macular hole diameter ≤400 microns were 94.4% and 100.0%, with no significant difference between the two groups (P = 0.701). The closure rates of macular hole diameters lager than 400 microns are 66.7% and 91.3%, P = 0.029. The total closure rates of the two groups are 80% and 95.6%, P =0.018. Conclusions：In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material is similar to that of C3F8 in macular hole with diameters less than 400 microns. In patients with larger macular hole (diameter over 400 microns) performed therapeutic surgery with air filling, internal limiting membrane insertion or flap inversion may be recommended get better outcomes.

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Сlinical Case of Macular Hole Recurrence after Surgical Treatment with Platelet-Rich Plasma

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-3-513-518 ◽

2020 ◽

Vol 17 (3) ◽

pp. 513-518

Author(s):

D. V. Cherepov ◽

S. J. Goziev

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Macular Hole ◽

Clinical Examination ◽

Platelet Rich Plasma ◽

Topical Steroid ◽

Internal Limiting Membrane ◽

Eye Drops ◽

Before And After ◽

Repeated Surgery

Purpose: presentation of a clinical case of an idiopathic macular hole (IMH) recurrence after its successful closure augmented with platelet-rich plasma (PRP) and the results of repeated surgical treatment.Methods. The patient underwent clinical examination and optical coherence tomography (OCT) of the retina before and after surgical treatment. А 2-stage surgical treatment of the left eye with an interval of 7 days: phacoemulsification (PE) followed by microinvasive vitrectomy with Internal limiting membrane peeling (ILM) and closure with the use of PRP. The patient was discharged with improved visual acuity and closure of the macular hole (MH). After 2 weeks vision deterioration was noted by the patient in the operated eye. Clinical examination revealed macular edema (ME) and recurrence of MH. Topical steroid eye drops were used to no avail, with increase of ME and MH via OCT control. Revision of the vitreal cavity augmented with PRP was performed.Results. In follow-up a complete closure of the MH, resolution of ME and improvement in visual acuity after repeated surgery was confirmed.Conclusions. A case of recurrent MH after primary closure with PRP is described. The case suggests a possibility of clinical improvement after repeated MH closure augmented with PRP. The causes and mechanisms of the recurrence of MH are still not clear. Despite the positive results of surgery subsequent OCT retina examination is necessary.

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Internal Limiting Membrane Peeling and Flap Inverting under Air in Large Idiopathic Macular Hole Surgery

Journal of Ophthalmology ◽

10.1155/2021/2003001 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Yuan Zong ◽

Kaicheng Wu ◽

Jian Yu ◽

Changbo Zhou ◽

Chunhui Jiang

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Idiopathic Macular Hole ◽

Ilm Peeling ◽

Minimum Diameter ◽

Measurement Results ◽

Pars Plana ◽

23 Gauge

Purpose. To evaluate the efficacy of internal limiting membrane (ILM) peeling combined with modified flap inverting under air in the treatment of large idiopathic macular hole (MH). Methods. Eyes with a large idiopathic MH (minimum diameter >550 μm) were included in this study. The surgical procedure included standard 23-gauge pars plana vitrectomy (PPV), ILM peeling, complete fluid-gas exchange, and ILM flap inversion under air. The patients underwent follow-up exam including optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) measurement. Results. Sixteen eyes from 16 patients were included. Mean MH diameter was 681.43 ± 112.12 μm. After a mean follow-up time of 6.25 ± 2.65 months, in all cases, the MH was closed, and the ILM flap could be seen at the inner surface of the fovea. U-shaped and V-shaped MH closure was achieved in 11 and 5 cases, respectively. The BCVA improved significantly from 1.49 ± 0.35 logMAR to 0.89 ± 0.35 logMAR ( p < 0.05 ), and visual acuity of 20/100 or better was achieved in 8 eyes. Conclusion. ILM flap inverting under air was helpful in improving the functional and anatomic outcomes of vitrectomy for large idiopathic MH.

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