Macular function assessment by multifocal electroretinogram and microperimetry in macular hole and correlation with visual acuity

Background: Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better assessment than the Snellen visual acuity alone. Objectives: To evaluate macular function with mfERG and microperimetry, and assess their correlation with visual acuity in MH. Materials and Methods: A prospective study was done in patients with unilateral,idiopathic full thickness MH. Standard surgery with vitrectomy, internal limiting membrane peeling and gas tamponade was done. Snellen and logMAR visual acuity, mfERG, microperimetry and optical coherence tomography were done pre and postoperatively. Results: Twenty six patients with unilateral macular hole and twenty five age matched controls were included. The mean age of patients was 59.92±9.39 years (range: 40 to 74 years). All the holes were closed after surgery (two required second surgery). The mean visual acuity improved from 0.77±0.34 logMAR to 0.43±0.36 (p =0.03). The mfERG amplitudes differed ring wise, but the average amplitude changed from 26.31±8.82 to 20.52±7.11 (p =0.03). The mean retinal sensitivity changed from 12.98±2.59 to 13.42±2.53 (p =0.11). There was significant correlation between visual acuity and mfERG amplitudes and retinal sensitivity. Regression equations to predict visual outcome could be derived. Conclusions: In MH, mfERG and microperimetry show reduced responses, delay in recovery of function. They show a strong correlation with visual acuity. It is possible to predict vision after surgery with the help of mfERG and MP. Improved ability to predict visual outcome can increase the utility of anatomic success predictors.

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Vitrectomy in the Management of Vitreomacular Traction Syndrome

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417749321 ◽

2018 ◽

Vol 2 (2) ◽

pp. 91-95

Author(s):

Zofia Michalewska ◽

Jerzy Nawrocki

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Long Term Results ◽

Vitreomacular Traction ◽

Study Group ◽

Vitreous Detachment ◽

Vitreomacular Traction Syndrome ◽

The Mean ◽

Final Visual Outcome

Purpose: To estimate long-term results after vitrectomy with internal limiting membrane peeling in vitreomacular traction syndrome (VMTS), as well as to estimate factors influencing final visual outcome. Methods: Medical records of all patients who underwent pars plana vitrectomy for idiopathic VMTS from 2007 through 2015 were assessed. Spectral domain optical coherence tomography was performed preoperatively and at least 6 months after surgery. The mean horizontal and vertical diameters of the vitreomacular traction (VMT) were measured. The area of vitreomacular attachment was calculated. Results: Twenty-four eyes of 22 patients (mean age, 74 years) were included in this study. Mean visual acuity improved significantly from 0.26 Snellen (0.69 logMAR) to 0.39 Snellen (0.43 logMAR) in the mean of 29 months after surgery (7-90 months; median, 25 months; P = .02, paired t test). Visual acuity improved in 18 eyes, remained unchanged in 2 cases, and decreased postoperatively in 4 eyes. Multiple regression analysis did not reveal any factors significant for determining final visual acuity. However, when regrouping the patients according to the International Vitreomacular Traction Study Group, we observed that final visual acuities were statistically significantly better in eyes with focal vitreous detachment compared to broad vitreous detachment ( P = .04). Conclusions: Despite the fact that VMT is a 3-dimensional disease, the calculated area of attachment was not greater than the vertical diameter of attachment. According to the current study, the classification of VMT proposed by the VMT Study Group might be an important tool in predicting the final visual outcome after vitrectomy.

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Functional and Morphologic Outcomes after Reoperation for Persistent Idiopathic Macular Hole

European Journal of Ophthalmology ◽

10.5301/ejo.5000857 ◽

2016 ◽

Vol 27 (2) ◽

pp. 231-234 ◽

Cited By ~ 3

Author(s):

Akira Hagiwara ◽

Takayuki Baba ◽

Tomoaki Tatsumi ◽

Eiju Sato ◽

Toshiyuki Oshitari ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Visual Recovery ◽

Ilm Peeling ◽

Tomographic Images ◽

Initial Surgery ◽

Second Surgery ◽

The Mean ◽

The Relationship

Purpose To determine the relationship between preoperative and postoperative characteristics and visual outcomes after successful surgery for unclosed macular hole (MH). Methods The medical charts of 166 eyes of 161 patients who underwent vitrectomy for a MH were reviewed. The MH was not closed in 9 eyes of 9 patients after the initial surgery. The second vitrectomy with additional internal limiting membrane (ILM) peeling and gas tamponade was performed. The preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomographic images, MH size, duration of MH before the first operation, and area of ILM peeling were studied. Results The MH was closed in all eyes after the second surgery. The BCVA significantly improved from 0.77 to 0.25 logMAR units (20/118 to 20/36, p = 0.002). The postoperative subfoveal ellipsoid zone (EZ) was distinct and continuous in 3 eyes with good visual recovery. The final BCVA was not significantly correlated with the baseline characteristics and area of ILM peeling but was correlated with the postoperative status of the EZ. Conclusions All MHs were closed and the mean postoperative visual acuity was significantly improved. The reason for poor visual recovery was the reduced microstructural recovery after the second surgery.

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Multifocal Electroretinography in Assessment of Macular Function after Internal Limiting Membrane Peeling in Macular Hole Surgery

Journal of Ophthalmology ◽

10.1155/2019/1939523 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

M. Y. Faria ◽

D. C. Sousa ◽

S. Mano ◽

R. Marques ◽

N. P. Ferreira ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Functional Results ◽

Internal Limiting Membrane ◽

Multifocal Electroretinography ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Macular Function ◽

Retinal Layers ◽

Snellen Visual Acuity

Purpose. Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods. Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. Results. All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P<0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P<0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). Conclusions. In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.

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Does Internal Limiting Membrane Peeling Size Matter?

Journal of VitreoRetinal Diseases ◽

10.1177/2474126416681222 ◽

2017 ◽

Vol 1 (1) ◽

pp. 27-33 ◽

Cited By ~ 14

Author(s):

David H. W. Steel ◽

Yunzi Chen ◽

James Latimer ◽

Kathryn White ◽

Peter J. Avery

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Consecutive Series ◽

Fiber Layer ◽

Postoperative Visual Acuity ◽

Wide Range ◽

The Mean ◽

Size Matter

Purpose: A variety of retinal topographical changes occur after internal limiting membrane (ILM) peeling for macular holes including a movement of the fovea toward the optic nerve. This study was carried out to assess the effect of the extent of ILM-peeled area on these changes and postoperative visual acuity. Methods: Prospective single-center study of a consecutive series of patients undergoing macular hole surgery. Preoperative and postoperative optical coherence tomography images were used to assess a variety of measures of retinal morphology. Transmission electron microscopy of the peeled ILM was used to assess residual retinal and vitreous side debris. The area of the ILM peeled was calculated from intraoperative images. Results: Fifty-six eyes of 56 patients were included. The mean area of ILM peeled was 9.5 mm2 (2.4-28.3 mm2). The mean disc-to-fovea distance (DFD) preoperatively was 3703 μm with a mean reduction of 52 μm postoperatively, representing a change of −1.29% with a wide range of −7.04% to 1.36%. Using stepwise linear regression, ILM-peeled area was significantly associated with a change in DFD ( P < .001), extent of a dissociated optic nerve fiber layer appearance ( P < .001), and postoperative visual acuity ( P = .025). Nasotemporal retinal thickness asymmetry was associated with the minimum linear diameter ( P < .001). Conclusion: The ILM-peeled area has a significant effect on changes in retinal topography and postoperative visual acuity separate from macular hole size. Further study is needed to assess the effect of ILM peeled size on visual function and to guide clinical practice.

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Contractility of inverted internal limiting membrane flap after vitrectomy for macular hole

10.21203/rs.3.rs-618406/v1 ◽

2021 ◽

Author(s):

Akira Hirata ◽

Keiko Mine ◽

Ken Hayashi

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Morphological Changes ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Rank Test ◽

Flap Technique ◽

Signed Rank ◽

Good Visual Outcome ◽

Signed Rank Test

Abstract We investigated the postoperative visual outcomes and morphological changes of the internal limiting membrane (ILM) flap, in patients who underwent the inverted ILM flap technique for macular hole (MH). Between August 2018 and February 2020, 22 eyes of 22 patients with idiopathic or myopic MH who underwent vitrectomy with ILM flap were included in this study and followed-up for more than six months. Postoperative MH status, comparison of best-corrected visual acuity (BCVA) before and six months after surgery, changes in the ILM flap area at one and six months postoperatively, and the factors related to changes in ILM flap size, were analyzed. MH closure was achieved in all of the patients. The BCVA at six months postoperatively (0.18 ± 0.15) was significantly better than the preoperative BCVA of 0.63 ± 0.37 (P = 0.000005, paired t-test). The area of the ILM flap decreased significantly from 3.25 ± 1.27 mm2 at one month to 3.13 ± 1.23 mm2 at six months (P = 0.024, Wilcoxon signed-rank test). Two eyes showed an ILM flap contraction of more than 20%, and one eye required re-operation due to an increase in metamorphopsia and decreased visual acuity. Among age, sex, ILM flap area at one month, preoperative BCVA, and axial length, ILM flap contraction was correlated with patient age and ILM flap area. Although vitrectomy with the inverted ILM flap technique confers a good visual outcome, the ILM flap may contract in younger patients.

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Plasma Rich in Growth Factors in Macular Hole Surgery

Clinics and Practice ◽

10.3390/clinpract12010007 ◽

2022 ◽

Vol 12 (1) ◽

pp. 57-69

Author(s):

Ronald M. Sánchez-Ávila ◽

Carlos A. Robayo-Esper ◽

Eva Villota-Deleu ◽

Álvaro Fernández-Vega Sanz ◽

Álvaro Fernández-Vega González ◽

...

Keyword(s):

Visual Acuity ◽

Growth Factors ◽

Adjuvant Therapy ◽

Macular Hole ◽

Silicone Oil ◽

Internal Limiting Membrane ◽

Internal Limiting Membrane Peeling ◽

Pars Plana ◽

The Mean

The aim of this study was to evaluate the use of PRGF (plasma rich in growth factors) as an adjuvant to PPV (pars plana vitrectomy) in recurrent, persistent, or poor prognosis MH (macular hole). Patients with MH were treated with PPV plus adjuvant therapy (PRGF membrane (mPRGF) and injectable liquid PRGF (iPRGF)). The anatomical closure of MH and postoperative BCVA (best-corrected visual acuity) were evaluated. Eight eyes (eight patients) were evaluated: myopic MH (MMH, n = 4), idiopathic MH (IMH, n = 2), iatrogenic n = 1, traumatic n = 1. The mean age was 53.1 ± 19.3 years. Hence, 66.7% (n = 4) of patients previously had internal limiting membrane peeling. Five patients (62.5%) received mPRGF and iPRGF, and three patients (37.5%) received iPRGF. Gas tamponade (C3F8) was placed in seven cases and one case of silicone oil. Anatomic closure of MH was achieved in seven eyes (87.5%) and BCVA improved in six cases. In the MMH group, visual acuity improved in two lines of vision. Follow-up time was 27.2 ± 9.0 months. No adverse events or MH recurrences were recorded during follow-up. The use of PRGF as an adjuvant therapy to PPV can be useful to improve anatomical closure and visual acuity in MH surgery.

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Pre-operative predicting factor in visual outcome after macular hole surgery

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.5.1995 ◽

2020 ◽

Vol 36 (5) ◽

Author(s):

Lubna Feroz ◽

Syed Fawad Rizvi ◽

Saliha Naz ◽

Tanweer Hassan Khan

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Full Thickness ◽

Macular Hole Surgery ◽

Creative Commons ◽

Full Thickness Macular Hole ◽

Hole Index ◽

Predicting Factor

Objective: To determine the effectiveness of macular hole index (MHI) as a predicting factor of visual outcome after full thickness macular hole surgery. Methods: This quasi-experimental study was conducted at LRBT Free Base Eye Hospital, Karachi from January 2018 to March 2019. Total 45 eyes of 45 patients with full thickness macular hole (FTMH) underwent preoperative Best Corrected Visual Acuity (BCVA) assessment with logMar chart and Optical Coherence Tomography (OCT) scanning, with measurement of base diameter and macular hole height. Values were calculated for the macular hole index (MHI), which was taken as the predictive factor. All patients had undergone 25+G trans-conjunctival three ports pars plana vitrectomy, internal limiting membrane peeling, and endo-tamponade of C3F8 (14%). The final visual outcome of all the patients was noted. Results: Forty-five patients were included for the study, out of which 10 (22.2%) were male and 35 (77.7%) were female. Age ranged from 45-70 years (mean age 57.20±6.47 years). The mean pre-operative visual acuity was 2.46±1.15 logMar and was 3.88±2.00 logMar, post-operatively. Moreover, 27(60.0%) out of 45 patients achieved BCVA (gain of 2 lines of the logMar chart). The average macular hole index was 1.55±0.50 and out of 45, 25 patients had MHI ≥0.5. It was found that patients with macular hole index ≥0.50 showed clinically significant improvement in BCVA in comparison to those who have macular hole index <0.50. Conclusion: Macular hole index can be used to predict functional success in macular hole surgery. doi: https://doi.org/10.12669/pjms.36.5.1995 How to cite this:Feroz L, Rizvi SF, Naz S, Khan MTH. Pre-operative predicting factor in visual outcome after macular hole surgery. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1995 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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Contractility of temporal inverted internal limiting membrane flap after vitrectomy for macular hole

Scientific Reports ◽

10.1038/s41598-021-99509-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Akira Hirata ◽

Keiko Mine ◽

Ken Hayashi

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Morphological Changes ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Rank Test ◽

Flap Technique ◽

Signed Rank ◽

Good Visual Outcome ◽

Signed Rank Test

AbstractWe investigated the postoperative visual outcomes and morphological changes of the internal limiting membrane (ILM) flap, in patients who underwent the temporal inverted ILM flap technique for macular hole (MH). Between August 2018 and February 2020, 22 eyes of 22 patients with idiopathic or myopic MH who underwent vitrectomy with ILM flap were included in this study and followed-up for more than 6 months. Postoperative MH status, comparison of best-corrected visual acuity (BCVA) before and 6 months after surgery, changes in the ILM flap area at 1 and 6 months postoperatively, and the factors related to changes in ILM flap size, were analyzed. MH closure was achieved in all of the patients. The BCVA at 6 months postoperatively (0.18 ± 0.15) was significantly better than the preoperative BCVA of 0.63 ± 0.37 (P < 0.001, paired t test). The area of the ILM flap decreased significantly from 3.25 ± 1.27 mm2 at 1 month to 3.13 ± 1.23 mm2 at 6 months (P = 0.024, Wilcoxon signed-rank test). Two eyes showed an ILM flap contraction of more than 20%, and one eye required reoperation due to an increase in metamorphopsia and decreased visual acuity. Among age, sex, ILM flap area at 1 month, preoperative BCVA, and axial length, ILM flap contraction was correlated with patient age and ILM flap area. Although vitrectomy with the inverted ILM flap technique confers a good visual outcome, the ILM flap may contract in younger patients.

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Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma

European Journal of Ophthalmology ◽

10.1177/1120672121992686 ◽

2021 ◽

pp. 112067212199268

Author(s):

Jorge Fernández-Engroba ◽

Muhsen Saman ◽

Jeroni Nadal

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Optic Disc ◽

Subretinal Fluid ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Subretinal Space ◽

Direct Closure ◽

Retinal Tears ◽

Optic Disc Coloboma

Purpose: To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). Methods: Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. Results: After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. Conclusion: We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences

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A New Sutureless Illuminated Macular Buckle Designed for Myopic Macular Hole Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2017/6742164 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Ahmed M. Bedda ◽

Ahmed M. Abdel Hadi ◽

Mohamed Lolah ◽

Muhammad S. Abd Al Shafy

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Hole ◽

High Myopia ◽

Terminal Part ◽

Macular Hole Retinal Detachment ◽

Myopic Macular Hole ◽

The Mean ◽

Visual Results

Purpose. To report the anatomic and visual results of a new sutureless illuminated macular buckle designed for patients with macular hole retinal detachment related to high myopia (MMHRD). Design. Prospective nonrandomized comparative interventional trial. Methods. Twenty myopic eyes of 20 patients (mean age, 51.4 years; range, 35–65 years) presenting with MMHRD with a posterior staphyloma, in whom the new buckle was used, were evaluated. The buckle used was assembled from a 5 mm wide sponge and a 7 mm wide silicone tire; it was fixed utilizing the sterile topical adhesive Histoacryl Blue (B Braun, TS1050044FP) which polymerizes in seconds upon being exposed to water-containing substances. The primary outcomes measured included aided visual acuity (BCVA) and optical coherence tomography (OCT) findings. The mean follow-up period was 6 months. Results. Postoperatively, the MH closure was identified by OCT in 8 (40%) eyes. The mean BCVA increased from 0.11 to 0.21 (p<0.005). The axial length of the eyes included decreased from 30.5 mm preoperatively to 29.8 mm (p=0.002) postoperatively. Conclusion. Preparation of the new sutureless macular buckle is simple and easy. Illumination of the terminal part of the buckle ensures proper placement. Histoacryl Blue is effective in fixing the buckle in its place for at least 6 months with no reported intra- or postoperative complications.

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