Retrospective study on outcome of macular hole surgery

Introduction: Macular hole is a common and treatable cause of central visual loss. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex removal and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. Objective: To determine and evaluate anatomical and visual outcome of macular hole surgery. Materials and methods: Retrospective analysis of all cases of macular hole surgery done by single surgeon between 2014 -2015. Results:16 eyes were analysed with follow up of 3 months. Macular hole closure after vitrectomy was 75% with visual improvement of two or more line in 62.5%.Post surgical complication included cataract 18.8%, Increased IOP 12.5% and retinal detachment 6.2%. Conclusion: Vitrectomy along with ILM peeling and Gas Tamponade with effective positioning improves in visual acuity and achieve hole closure in people with macular hole.

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Aspiration of viscous plug in macular hole surgery- a case series

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211063288 ◽

2022 ◽

Vol 14 ◽

pp. 251584142110632

Author(s):

Shaheryar Ahmed Khan ◽

Craig Goldsmith ◽

Mya Thandar So

Keyword(s):

Viscous Fluid ◽

Macular Hole ◽

Controlled Trial ◽

Standard Procedure ◽

Case Series ◽

Internal Limiting Membrane ◽

Control Group ◽

Macular Hole Surgery ◽

Gas Tamponade ◽

Hole Closure

Macular hole surgery has been revolutionized since the 1990s’ with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.

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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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Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

International Journal of Ophthalmology ◽

10.18240/ijo.2021.09.17 ◽

2021 ◽

Vol 14 (9) ◽

pp. 1408-1412

Author(s):

Jin Liu ◽

◽

Xin-Hua Zheng ◽

Yuan-Long Li ◽

Jun-Long Huang ◽

...

Keyword(s):

Macular Hole ◽

Influencing Factor ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Idiopathic Macular Hole ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Closure Rate ◽

Internal Limiting Membrane Peeling ◽

Significant Difference

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P<0.05). No significant difference was found in the T-OD, N-OD, S-OD, and I-OD between N-T group and T-N group. IMH closure rate was 100% both in N-T group and T-N group. There was no significant difference in BCVA between two groups (P<0.05). CONCLUSION: The macula slips toward the OD after successful macular hole surgery. The two different ILM peeling pattern show similar visual outcome and retinal displacement, which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

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Selective Amplitude Reduction of the PhNR after Macular Hole Surgery: Ganglion Cell Damage Related to ICG-Assisted ILM Peeling and Gas Tamponade

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.05-1481 ◽

2006 ◽

Vol 47 (8) ◽

pp. 3545 ◽

Cited By ~ 27

Author(s):

Shinji Ueno ◽

Mineo Kondo ◽

Chang-Hua Piao ◽

Kazuteru Ikenoya ◽

Yozo Miyake ◽

...

Keyword(s):

Ganglion Cell ◽

Macular Hole ◽

Cell Damage ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Gas Tamponade

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Internal retinal layer thickness and macular migration after internal limiting membrane peeling in macular hole surgery

European Journal of Ophthalmology ◽

10.5301/ejo.5001066 ◽

2017 ◽

Vol 28 (3) ◽

pp. 311-316 ◽

Cited By ~ 5

Author(s):

Mun Y. Faria ◽

Nuno P. Ferreira ◽

Sofia Mano ◽

Diana M. Cristóvao ◽

David C. Sousa ◽

...

Keyword(s):

Macular Hole ◽

Layer Thickness ◽

Optic Disc ◽

Internal Limiting Membrane ◽

Retinal Layer ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Internal Limiting Membrane Peeling ◽

Retinal Layers ◽

Sd Oct

Purpose: To provide a spectral-domain optical coherence tomography (SD-OCT)-based analysis of retinal layers thickness and nasal displacement of closed macular hole after internal limiting membrane peeling in macular hole surgery. Methods: In this nonrandomized prospective interventional study, 36 eyes of 32 patients were subjected to pars plana vitrectomy and 3.5 mm diameter internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Nasal and temporal internal retinal layer thickness were assessed with SD-OCT. Each scan included optic disc border so that distance between optic disc border and fovea were measured. Results: Thirty-six eyes had a successful surgery with macular hole closure. Total nasal retinal thickening (p<0.001) and total temporal retinal thinning (p<0.0001) were observed. Outer retinal layers increased thickness after surgery (nasal p<0.05 and temporal p<0.01). Middle part of inner retinal layers (mIRL) had nasal thickening (p<0.001) and temporal thinning (p<0.05). The mIRL was obtained by deducting ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness from overall thickness of the inner retinal layer. Papillofoveal distance was shorter after ILM peeling in macular hole surgery (3,651 ± 323 μm preoperatively and 3,361 ± 279 μm at 6 months; p<0.0001). Conclusions: Internal limiting membrane peel is associated with important alteration in inner retinal layer architecture, with thickening of mIRL and shortening of papillofoveal distance. These factors may contribute to recovery of disrupted foveal photoreceptor and vision improvement after IMH closure.

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Anatomical and visual outcome of macular hole surgery with infracyanine green-assisted peeling of the internal limiting membrane, endodrainage, and silicone oil tamponade

American Journal of Ophthalmology ◽

10.1016/j.ajo.2004.02.031 ◽

2004 ◽

Vol 137 (6) ◽

pp. 1162

Author(s):

Rita Gopwani ◽

Hunter K.l.yuen ◽

Dennis S.C. Lam

Keyword(s):

Macular Hole ◽

Silicone Oil ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Macular Hole Surgery ◽

Silicone Oil Tamponade ◽

Infracyanine Green

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Long-Term Observations of Thickness Changes of Each Retinal Layer following Macular Hole Surgery

Journal of Ophthalmology ◽

10.1155/2021/4624164 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Atsushi Tada ◽

Shigeki Machida ◽

Yuji Hara ◽

Satoshi Ebihara ◽

Masahiko Ishizuka ◽

...

Keyword(s):

Macular Hole ◽

Medical Records ◽

Retinal Thickness ◽

Internal Limiting Membrane ◽

Embedded Software ◽

Retinal Layer ◽

Ilm Peeling ◽

Macular Hole Surgery ◽

Baseline Values

Purpose. To determine the long-term changes of the thickness of each retinal layer following macular hole (MH) surgery combined with internal limiting membrane (ILM) peeling. Method. The medical records of 42 eyes of 42 patients (41 to 86 years of age) who underwent MH surgery with ILM peeling between February 2016 and October 2018 were reviewed. A single surgeon operated on all patients, and all were followed for at least 24 months postoperatively. Spectral-domain optical coherence tomography (OCT) was performed to obtain retinal thickness maps of the parafoveal region corresponding approximately to the ILM peeled area. Each retinal layer was automatically segmented by the embedded software, and thickness maps were constructed for the total retinal layer (TRL), inner RL (IRL), middle RL (MRL), and outer RL (ORL). The averaged value of each retinal layer thickness was analyzed in the temporal/upper, temporal/lower, nasal/upper, and nasal lower quadrants. Results. The TRL thickness was significantly decreased in the temporal areas postoperatively. The IRL thickness thinned progressively and significantly until 6 months without further thinning in the temporal quadrants. The MRL thickness of all areas was significantly thicker than the baseline values at 0.5 months and then gradually decreased in the temporal regions. However, the thickening in the nasal regions returned to the baseline values after 1.5 months. The ORL decreased transiently relative to the baseline values at 0.5 months in all areas. Conclusions. The ILM peeling does not affect only the thickness of the inner retina but also the middle and outer retinae in the parafoveal region. The chronological changes of the thickness after surgeries varied among the retinal layers and macular regions.

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