scholarly journals Recurrent Macular Hole: Causes, Risk Factors, and Treatment

2018 ◽  
pp. 293-295
Keyword(s):  
Risk Factors ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Head Positioning ◽  
Pars Plana ◽  
Risk Factors For Recurrence ◽  
Hole Closure

Idiopathic macular hole is a full-thickness defect of the retina which is caused by the tangential vitreomacular traction. Its prevalence is 8.7 per 100,000 people. Pars plana vitrectomy, internal limiting membrane peeling, gas tamponade, and face-down head positioning have a high success rate for primary hole closure. Improvements in small incision vitrectomy techniques reduce cystoid macular edema, epiretinal membrane formation, and also reopening of macular hole. Bilaterality, high myopia, intraoperative retinal breaks are well-known risk factors for recurrence. In this article, we reviewed the causes, risk factors, and current treatments of recurrent macular holes.

scholarly journals The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

2016 ◽  
Vol 7 (6) ◽  
pp. 43-46
Author(s):  
Lalit Agarwal ◽  
Nisha Agrawal ◽  
Pratap Karki ◽  
Abhishek Anand
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Chronic Stage ◽  
Visual Improvement ◽  
Macular Holes ◽  
Pars Plana ◽  
Hole Closure

Background:  A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

2021 ◽  
pp. 247412642098714
Author(s):  
Michael S. Tsipursky ◽  
Matthew Byun ◽  
Rama D. Jager ◽  
Veeral S. Sheth
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Postoperative Outcomes ◽  
Aperture Diameter ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Pars Plana

Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.

Anterior chamber aqueous flare is not a predictor for surgical closure of full-thickness idiopathic macular holes

2019 ◽  
Vol 30 (5) ◽  
pp. 1127-1134 ◽  
Author(s):  
Friederike Schaub ◽  
Philip Enders ◽  
Paula Scholz ◽  
Philipp S Müther ◽  
Sascha Fauser ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Internal Limiting Membrane Peeling ◽  
Aqueous Flare ◽  
Macular Holes ◽  
Pars Plana ◽  
Idiopathic Macular Holes ◽  
Linear Diameter

Purpose: To investigate the predictive value of preoperative anterior chamber aqueous flare levels measured by laser flare photometry for surgical success of idiopathic macular holes in addition to preoperative anatomic characteristics. Methods: Records of 105 consecutive eyes with full-thickness idiopathic macular holes which underwent pars plana vitrectomy with internal limiting membrane peeling and sulfur hexafluoride 20% (SF620%) endotamponade were reviewed retrospectively. All patients underwent preoperative measurements of anterior chamber aqueous flare and anatomical idiopathic macular hole characteristics evaluated by optical coherence tomography: macular hole inner opening diameter, macular hole minimum linear diameter, macular hole base diameter, and macular hole height. Best-corrected visual acuity results were recorded pre- and postoperatively. Results: In 17 (16.2%) of 105 eyes primary closure of idiopathic macular hole failed, whereas in 88 eyes (83.8%) closure was achieved. Between both groups, preoperative macular hole minimum linear diameter (p = 0.001) and macular hole inner opening diameter (p = 0.006) were statistically different. Failure rates were significantly lower in eyes with macular hole minimum linear diameter < 400 µm (7.4% vs 32.4%; p = 0.013) and preoperative macular hole minimum linear diameter showed moderate correlation with pre- and postoperative best-corrected visual acuity results (r = 0.512; p < 0.001; r = 0.612; p < 0.001). Mean anterior chamber aqueous flare of 11.5 ± 9.9 pc/ms in eyes with anatomical closure and 11.8 ± 6.4 pc/ms in unclosed cases was comparable (p = 0.28) and did not correlate with anatomical or functional results. Conclusion: Eyes with idiopathic macular hole ⩾ 400 µm in size have a significantly higher failure rate following standardized pars plana vitrectomy with internal limiting membrane peeling and SF620% endotamponade. Preoperative macular hole minimum linear diameter and macular hole inner opening diameter seem to be associated with surgical outcome in idiopathic macular hole, whereas anterior chamber aqueous flare level does not provide additional predictive value.

scholarly journals Inverted ILM Flap Technique

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Zofia Michalewska Jerzy Nawrocki
Keyword(s):  
Pars Plana Vitrectomy ◽  
Standard Treatment ◽  
Internal Limiting Membrane ◽  
Treatment Method ◽  
Vitreous Surgery ◽  
Internal Limiting Membrane Peeling ◽  
Initial Visual Acuity ◽  
Macular Holes ◽  
Pars Plana ◽  
Hole Closure

As recently as 30 years ago, macular holes were thought to be untreatable. Kelly and Wendel showed that this was not the case in 1991 when they published their pilot study on vitreous surgery for idiopathic macular holes1. In 1997, Eckardt et al. introduced internal limiting membrane (ILM) peeling2, following which, pars plana vitrectomy, internal limiting membrane peeling, fluid/gas exchange and face-down positioning were soon adopted as the standard treatment method for successful hole closure and BCVA improvement. Surgeons improved their own results by using smaller gauge instruments and, especially, by more qualified patient selection: earlier treatment, non-myopic eyes, better initial visual acuity, and smaller macular holes.

scholarly journals Macular Hole Surgery with Internal Limiting Membrane Peeling Facilitated by Membrane-Blue® versus Membrane-Blue-Dual®: A Retrospective Comparative Study

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Uri Soiberman ◽  
Daniel Shai ◽  
Anat Loewenstein ◽  
Adiel Barak
Keyword(s):  
Macular Hole ◽  
Retrospective Chart Review ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Study Population ◽  
Pars Plana ◽  
Retrospective Comparative Study ◽  
Visual Results ◽  
Hole Closure

Background. This study aims to compare the outcome of macular hole (MH) surgery with internal limiting membrane (ILM) peeling facilitated by two different vital dyes. Methods. This was a retrospective chart review. The group designated “group-MB” underwent pars plana vitrectomy with ILM peeling facilitated by Membrane-Blue (MB), whereas in “group-MBD,” the vital dye used was Membrane-Blue-Dual (MBD). Results. Seventy-four eyes comprised the study population: 53 in group-MB and 21 in group-MBD. There was no difference in the rate of macular hole closure in group-MB or group-MBD: 71.2% closed MHs compared to 66.7%, respectively (p=0.7). Postoperative visual improvement was of a higher magnitude in the MBD group compared to the MB group: −0.34±0.81 logMAR versus 0.01±0.06 logMAR, respectively (p=0.003). Conclusions. In this study, MBD led to better visual results that may be related to better staining characteristics or lesser toxicity compared to MB.

scholarly journals Perspectives of Autologous Mesenchymal Stem-Cell Transplantation in Macular Hole Surgery: A Review of Current Findings

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Raffaele Nuzzi ◽  
Federico Tridico
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Internal Limiting Membrane ◽  
Mesenchymal Stem Cell Transplantation ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Feasible Alternative ◽  
Pars Plana ◽  
Surgical Failure ◽  
Idiopathic Macular Holes

The main treatment available for idiopathic macular holes is represented by pars plana vitrectomy with internal limiting membrane peeling. However, late-stage macular holes are affected by a higher risk of surgical failure. Although adjuvant techniques can be employed, a satisfactory functional recovery is difficult to achieve in refractory macular holes. Given their neuroprotective and antiapoptotic properties, mesenchymal stem cells (MSCs) may represent an appealing approach to treat these extreme cases. The purpose of this review is to highlight the findings regarding healing mechanisms exerted by mesenchymal stem cells and preliminary application in cases of refractory macular holes. When compared with MSCs, MSC-derived exosomes may represent a feasible alternative, given their reduced risk of undesired proliferation and easiness of use.

scholarly journals An Internal Limiting Membrane Plug and Gas Endotamponade for Recurrent or Persistent Macular Hole

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Fabrizio Giansanti ◽  
Ruggero Tartaro ◽  
Tomaso Caporossi ◽  
Daniela Bacherini ◽  
Alfonso Savastano ◽  
...  
Keyword(s):  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Swept Source ◽  
Macular Holes ◽  
Small Gauge ◽  
Pars Plana ◽  
The Mean ◽  
23 Gauge ◽  
Anatomical Success

Introduction. Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods. This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results. The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion. In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.

Air vs Gas Tamponade During Macular Hole Repair Surgery

2020 ◽  
Vol 4 (5) ◽  
pp. 360-363
Author(s):  
Shriji N. Patel ◽  
Janice Law ◽  
Edward Cherney ◽  
Franco Recchia ◽  
Stephen J. Kim
Keyword(s):  
Macular Hole ◽  
Sulfur Hexafluoride ◽  
Final Analysis ◽  
Gas Tamponade ◽  
Macular Holes ◽  
Full Thickness Macular Hole ◽  
Significant Difference ◽  
Pars Plana ◽  
Operative Report ◽  
Hole Closure

Purpose: This work investigates the visual and anatomical outcomes of full-thickness macular hole (FTMH) repair surgery using air in comparison to gas tamponade. Methods: A retrospective consecutive review of medical records was undertaken of all patients undergoing pars plana vitrectomy for idiopathic FTMH at an academic practice from January 2010 to May 2017. Each operative report was reviewed to investigate the agent used for tamponade at the end of the surgery. Preoperative hole duration and size as measured using optical coherence tomography as well as successful postoperative hole closure were recorded. Use of gas or air was not randomized and was instilled at surgeon discretion. Results: The final analysis included 211 eyes. Gas was used as the tamponade agent in 171 of the 211 eyes; most of these eyes (144 of 171) received sulfur hexafluoride (SF6) and the remainder received perfluoropropane (C3F8). Forty eyes underwent only a complete fluid-air exchange without any gas placement following vitrectomy. There was no statistically significant difference between the 2 groups in mean preoperative macular hole size ( P = .43). Nine of the 171 macular holes receiving gas tamponade failed to close (5.3%). One of the 40 macular holes receiving only air failed to close (2.5%). There was no statistically significant difference in hole closure rates between the 2 groups ( P = .45). Conclusions: Air served as an equally efficacious internal tamponade agent in comparison to nonexpansile gas following idiopathic FTMH repair surgery.

Sign in / Sign up

Export Citation Format

Share Document