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.

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

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.

Platelet-rich plasma in surgery of various diameters 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.

Characteristics of fixation patterns and their relationship with visual function of patients with idiopathic macular holes after vitrectomy

To analyze the relationships between the fixation location and the visual function of idiopathic macular hole (IMH) patients with macular integrity assessment (MAIA) examination preoperatively and 3 months postoperatively. This was a retrospective case analysis. Forty-three eyes of 43 patients diagnosed with IMH were included in this study. The best corrected visual acuity (BCVA) assessments, optical coherence tomography (OCT) and MAIA examinations were performed before surgery and 1 week, 1 month and 3 months after surgery. The relationships between MAIA parameters and visual acuity were assessed by correlation analysis. Grouping by fixation location with the foveola (2°) as the centre, the locations could be divided into five groups, including foveolar, temporal, nasal, inferior and superior fixation. The mean macular sensitivity (MMS) of the macular area was correlated with the BCVA in the IMH patients before and 3 months after surgery (before surgery P = 0.00, after surgery P = 0.00). The MMS could be used as a good indicator for evaluating visual function in IMH patients. There was a significant difference in fixation location before and after the operation (P = 0.01). The preoperative fixation location of IMH patients was mainly in the superior area, while postoperatively moved to the foveola and nasal areas. Paying attention to the changes of fixation locations in IMH patients may provide new clues for further improving postoperative visual function.

Role of Microperimetry in Observation and Treatment in Patients with 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.

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM: To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation (phaco-vitrectomy) in idiopathic macular holes (IMH). METHODS: A total of 56 eyes with IMH (IMH group) that underwent phaco-vitrectomy and 44 eyes with age-related cataract (ARC group) that underwent cataract surgery were retrospectively reviewed. The best corrective visual acuity (BCVA), predicted refractive error (PRE), actual refractive error (ARE), axial length (AL), were measured in both groups before and 6mo after operation. The power calculation of IOL and the predicted refractive error (PRE) were calculated according to the SRK/T formula. The difference of PRE and ARE between the two groups were compared and analyzed. RESULTS: In the IMH group, the diameters of macular holes were 271.73±75.85 μm, the closure rate was 100%. The pre- and post-operative BCVA were 0.80±0.35 and 0.40±0.35 logMAR. The PRE of A-ultrasound and IOL Master in the IMH group was -0.27±0.25 and 0.10±0.66 D. The postoperative mean absolute prediction error (MAE) was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound (P=0.758). The PRE and ARE of the IMH group were 0.10±0.66 D and -0.19±0.64 D (P=0.102). The PRE and ARE of the ARC group was -0.43±0.95 and -0.31±0.93 D (P=0.383). The difference between PRE and ARE was -0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups (P=0.021). The proportion of myopic shift was 67.9% in the IMH group and 27.3% in the ARC group (P=0.004). CONCLUSION: The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

Analysis of multiple cytokines in aqueous humor of patients with idiopathic macular hole

Background: Idiopathic macular holes are common ophthalmic manifestations with unknown pathogenesis. Thus far, there has been minimal research regarding the causes of idiopathic macular holes, especially with respect to the underlying immune mechanism. To provide clarity regarding the treatment and prognosis of idiopathic macular holes, specifically regarding the levels of cytokines in affected patients, this study examined and analyzed multiple cytokine levels in aqueous humor from patients with idiopathic macular holes.Methods: This comparative cross-sectional study included 38 patients in two groups: a cataract control group (n=17) and an idiopathic macular hole group (n=21). The levels of 48 cytokines in aqueous humor were detected by multiplex analysis with antibody-coupled magnetic beads. The Kolmogorov–Smirnov test was used to check whether the data were normally distributed; Student’s t-test and the Mann–Whitney U test were used to assess differences in cytokine levels between the two groups. Spearman correlation analysis was used to assess relationships among cytokine levels in the experimental group. Signaling pathways containing cytokines with significantly different expression in the experimental group were identified.Results: There were significant differences in aqueous humor cytokine levels between patients with idiopathic macular holes and patients in the cataract control group. Notably, hepatocyte growth factor (p=0.0001), GM-CSF (p=0.0111), and IFN-γ (p=0.0120) were significantly upregulated in the experimental group, while TNF-α (p=0.0032), GRO-α (p<0.0001), and MIF (p<0.0001) were significantly downregulated in the experimental group. Furthermore, the GM-CSF level showed significant positive correlations with levels of IL-1 (r=0.67904, p<0.001), IL-4 (r=0.76017, p<0.001), and IFN-γ (r=0.59922, p=0.004097) in the experimental group. Moreover, the levels of nerve growth factor and hepatocyte growth factor showed a significant positive correlation (r=0.64951, p=0.001441) in the experimental group.Conclusions: Patients with idiopathic macular holes showed significant variation in aqueous humor immune response after the onset of hole formation, including the recruitment of immune cells and regulation of cytokine expression. Our findings also suggest that it is not appropriate to use patients with macular holes as the control group in studies of aqueous humor cytokine levels in ophthalmic diseases.