Differentiated Approach to Strategies of Surgical Treatment of Idiopathic Macular Holes

Background. 25G or 27G three-port vitrectomy, followed by staining and removal of the internal limiting membrane with vitreous cavity air or gas tamponade, is one of the main modern vitreoretinal surgery principles for primary macular holes. However, not all patients manage to obtain a functional outcome when the anatomical outcome is achieved. Purpose. To present clinical cases of surgical treatment of idiopathic macular holes (IMH) exhibiting a differentiated approach.Matherials and methods. This article analyzes clinical cases of four patients with primary idiopathic macular holes, differing in terms of development, hole diameter and the presence of comorbidities. Results. The results of surgical treatment were evaluated 14 days and 1 month after surgery. In all clinical cases, surgical treatment resulted in a positive anatomical outcome by blocking a retinal defect. Best corrected visual acuity increased, on average, from 0.08 ± 0.05 to 0.4 ± 0.05.Conclusion. The analysis of the presented clinical cases clearly demonstrates the need for a timely and differentiated approach to the treatment of patients with IMH, that considers etiology of the pathological process, period of its existence as well as concomitant and general somatic pathologies.

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

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-48-52 ◽

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.

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Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes

Vestnik oftal mologii ◽

10.17116/oftalma2016132123-30 ◽

2016 ◽

Vol 132 (1) ◽

pp. 23

Author(s):

Yu. A. Belyy ◽

A. V. Tereshchenko ◽

D. O. Shkvorchenko ◽

E. V. Erokhina ◽

N. M. Shilov

Keyword(s):

Surgical Treatment ◽

Internal Limiting Membrane ◽

Membrane Fragment ◽

Macular Holes ◽

Idiopathic Macular Holes

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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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Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.2.689 ◽

2019 ◽

Vol 35 (2) ◽

Author(s):

Haroon Tayyab ◽

Asad Aslam Khan ◽

Sana Jahangir

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Creative Commons ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Best Corrected Visual Acuity ◽

Hole Closure ◽

Sd Oct

Objective: To evaluate the effectiveness of inverted internal limiting membrane flap in large idiopathic macular holes. Methods: Twelve patients diagnosed with idiopathic macular holes larger than 400um underwent 23 gauge Pars Plana Vitrectomy (PPV) with inverted internal limiting flap and gas tamponade at Al-Ehsan Eye Welfare Eye Hospital, Lahore from February 2017 to February 2018. All cases were diagnosed on Spectral Domain Optical Coherence Tomography (SD-OCT) and were followed up for 6 months. At every follow-up, best corrected visual acuity and SD-OCT was done. Results: We achieved macular hole closure in 91.6% (11/12) patients with idiopathic macular holes larger than 400um. Five out of 12 patients underwent combined phacoemulsification and PPV. One patient has flat hole closure which was considered failure. One patient was excluded from the study due to per-operative flap loss. This patient was not included in final data analysis of 12 patients. There was statistically significant gain in best corrected visual acuity after successful macular hole closure. We did not report any untoward events during or in the post-operative period. Conclusion: Inverted internal limiting flap is an effective method for repairing large macular holes. How to cite this:Tayyab H, Khan AA, Jahangir S. Efficacy of inverted internal limiting membrane flap for large idiopathic macular holes. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.689 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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Hole Diameter ratio (HDR) for prediction of anatomical outcomes in stage III and IV idiopathic macular holes

10.21203/rs.3.rs-29158/v1 ◽

2020 ◽

Author(s):

Yue Qi ◽

Yanping Yu ◽

Zengyi Wang ◽

Jing Wang ◽

Wu Liu

Keyword(s):

Predictive Factor ◽

Diameter Ratio ◽

Hole Diameter ◽

Stage Iii ◽

Maximum Diameter ◽

Ilm Peeling ◽

Macular Holes ◽

Air Tamponade ◽

Idiopathic Macular Holes ◽

Anatomical Outcome

Abstract Summary: In this study, we reviewed 101 eyes with stage III or IV IMHs treated by PPV combined with ILM peeling and room air tamponade, took the ratio of minimum diameter to maximum diameter (hole diameter ratio, HDR) as the predictive factor and found HDR<0.6(“A” type IMH) can be a predictive factor for a good anatomical outcome.Purpose: To identify hole diameter ratio (HDR) as the predictive factor for unclosed stage III and IV idiopathic macular holes (IMHs) by the use of preoperative optical coherence tomography (OCT).Methods: 101 eyes with stage III or IV IMH were included in this retrospective case series study. All cases were treated with vitrectomy combined with ILM peeling and room air tamponade. The MH minimum and maximum diameter, the ratio of the minimum to the maximum diameter (which defined as HDR) were performed. Results: 81 eyes (80.2%) got a Type I closure after surgery (group A). Postoperative unclosed MHs were found in 20 eyes (19.8%) (group B). The minimal diameter of IMHs (703.6±116.1um VS 597.6±120.1um, P<0.01) and HDR (0.6±0.1 VS 0.5±0.1, P=0.01) were both significantly different between two groups. The cutoff value of the receiver operating characteristic curve was 0.6. The IMH with the HDR that less than 0.6 were defined as “A” type IMH and the others were defined as “H” type IMH. The closure rate of two type IMHs were 90.2% and 65.0% respectively. It had significant differences. (P=0.002) Conclusions: HDR<0.6(“A” type IMH) can be a predictive factor for a good anatomical outcome in stage III and IV IMHs after vitrectomy combined with LM peeling and room air tamponade.

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COMPARATIVE RESULTS OF SURGICAL TREATMENT OF LARGE IDIOPATHIC MACULAR HOLES

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/23715 ◽

2016 ◽

Vol 1 (6) ◽

pp. 19-23

Author(s):

Шпак ◽

Aleksandr Shpak ◽

Шкворченко ◽

Dmitriy Shkvorchenko ◽

Шилов ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Limiting Membrane ◽

New Technique ◽

Minimum Diameter ◽

Mean Values ◽

Vacuum Aspiration ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Comparative Results

The goal is to evaluate the effectiveness of the developed technique of the gradual forming of the internal limiting membrane (IML) fragment in the treatment of large macular holes (MH) in comparison with the standard methodol-ogy (using classical maculorhexis and rapprochement of MH edges by using of vacuum aspiration). Materials and methods: we observed 137patients (103women, 34men) aged from 54 to 78years with large MH (over 400μm). Duration of MH ranged from 3 to 60months. All the patients were divided into groups: 1 (new methodology) and 2 (standard method), and sub-groups: 1a and 2a – patients with MH with a minimum diameter 400–650μm; 1b and 2b – patients with MH with a minimum diameter more than 650μm. The new technique is performed in several stages, during which several series of ILM “petals” removal are made, leaving an intact area on the MH edge. The last ILM “petal” or fragment is inverted and placed on the MH. Results: In subgroup 1a, there was a statistically significant increase in best corrected visual acuity (BCVA) during all follow-up with the most pronounced growth in the first 6 months (from 0.15±0.06 to 0.55±0.14) (p<0.05). In subgroup 1b a statistically significant increase in mean values of BCVA was also observed especially during first 6month (from 0.13±0.06 to 0.36±0.12) (p<0.05). In group2 (a, b) BCVA was significantly lower (p<0.05). Conclusion: the new technique allows to reach higher functional-anatomical results in surgical treatment of MH.

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Inverted ILM-flap techniques variants for macular hole surgery: randomized clinical trial to compare retinal sensitivity and fixation stability

Scientific Reports ◽

10.1038/s41598-020-72774-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Andrea Cacciamani ◽

Aldo Gelso ◽

Marta Di Nicola ◽

Fabio Scarinci ◽

Guido Ripandelli ◽

...

Keyword(s):

Internal Limiting Membrane ◽

Retinal Sensitivity ◽

Trial Registry ◽

Closure Rate ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Fixation Stability ◽

Idiopathic Macular Holes ◽

To Receive ◽

Registration Date

Abstract To report closure rate, Best Corrected Visual Acuity (BCVA), Retinal Sensitivity (RS) and Fixation Stability (FS) of idiopathic Macular Holes (MH) randomized to Cover Group (CG) or Fill Group (FG) of the Inverted Internal Limiting Membrane (ILM) flap surgical procedure. Twenty-eight patients were randomized (1:1) to receive a vitrectomy with either Cover or Fill ILM flap technique. All patients underwent BCVA, RS and FS assessment at baseline, 1-month and 3-months after surgery. MH closed in all patients. BCVA rose from 20/100 (baseline) to 20/33 (1-month) in both groups, to 20/28 in CG versus 20/33 in FG (3-months) (p < 0.05). The central 4° RS rose from 11.5 and 12 dB to 19 and 19.5 dB (1-month) and to 22 and 20 dB (3-months), respectively, in CG and FG (p < 0.001). The central 10° RS rose from 11 and 15 dB to 22 and 20 dB (1-month) and to 23 and 20 dB (3-months), respectively, in CG and FG (p < 0.001). FS increased significantly more in CG. CG improved significantly more than FG in terms of BCVA, RS and FS. The average MH diameter was relatively small (397 µm); larger MHs may behave differently. Trial registration: Trial Registry: https://www.clinicaltrials.gov; Identifier: NCT04135638. Registration date 22/10/2019.

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

Kazan medical journal ◽

10.17750/kmj2017-397 ◽

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

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

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2021-1-51-53 ◽

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.

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Dynamics of changes in microperimeric parameters of retina in various methods of closing macular breaks based on autoplasty of internal limiting membrane

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-132-136 ◽

2021 ◽

pp. 132-136

Author(s):

M.M. Shishkin ◽

◽

O.А. Pavlovskiy ◽

E.A. Larina ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Vitreoretinal Surgery ◽

Functional Results ◽

Internal Limiting Membrane ◽

Light Sensitivity ◽

Original Method ◽

Retinal Layers ◽

Macular Holes ◽

Group 2 ◽

A New Technique

Currently, vitreoretinal surgery is one of the most effective methods of treating macular holes that can improve the quality of vision, and the most common method of such treatment is vitrectomy with the removal of the internal border membrane around the rupture and the use of autoplasty of the internal border membrane. Microperimetric retinal testing measures the sensitivity of the retina at certain points on a larger surface and detects relative or absolute microscotomas, which allows you to objectively assess the state of the central part of the retina. At the same time, the search for ways to reduce the risk of macular surgery complications and improve functional results continues. Purpose. To propose a new technique for macular tear surgery, which is based on autoplasty of the VPM and reduction of microtraumatization of the retinal layers. Material and methods. The results of surgical treatment of 240 patients (240 eyes) with a diagnosis of macular holes were analyzed. All patients underwent surgical treatment for MH. Depending on the method of closing the macular hole, the patients were divided into two groups: group 1 – patients who underwent surgical treatment using the standard introverted flap technique. Group 2 – patients who were operated on according to the original method with partial peeling of ILM in the macular area. All parameters in the preoperative period were statistically comparable. Results. The most significant are the results obtained on the 30th day after surgical treatment. According to the results of surgical treatment, there was a significant excess of light sensitivity parameters in the nasal part of the pattern used: the upper-nasal and lower-nasal quadrants, where peeling was not performed. Conclusion. During this technique, there is a preservation ILM, which reduces the risk of intraoperative damage to the retinal layers. A higher functional result was obtained. Key words: microperimetry, macular rupture, ILM peeling.

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