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Internal Limiting Membrane (internal + limiting_membrane)
Selected AbstractsRetinal sensitivity and fixation changes 1 year after triamcinolone acetonide assisted internal limiting membrane peeling for macular hole surgery , a MP-1 microperimetric studyACTA OPHTHALMOLOGICA, Issue 6 2010Hakan Ozdemir Acta Ophthalmol. 2010: 88: e222,e227 Abstract. Purpose:, To evaluate microperimetric changes 1 year after macular hole surgery with triamcinolone acetonide assisted internal limiting membrane (ILM) peeling. Methods:, Twenty-two eyes of 22 patients with stage 3 and 4 idiopathic macular holes of <6 months' duration underwent vitrectomy with triamcinolone acetonide assisted ILM peeling. Best corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution), and central retinal sensitivity were documented before and 1, 3, 6, and 12 months after surgery. Macular sensitivity (mean sensitivity in decibels -dB), and stability and location of fixation (preferred retinal locus) were determined using MP-1 microperimetry (Nidek). The MP-1 microperimetry sensitivity map was overlaid onto infrared images recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the fixation location before surgery. Anatomical success was evaluated with optical coherence tomography (OCT). Optical coherence tomography scans were recorded on an OCT 3000 scanner. Results:, Anatomical success was achieved in all 22 eyes. All patients completed 1 year follow-up. No recurrence of macular hole was seen in any patients in the follow-up period. The mean BCVA improved from 0.75 ± 0.2 before surgery to 0.31 ± 0.1 logMAR at the last visit (p < 0.001). Mean sensitivity improved from 3.7 ± 0.6 to 5.3 ± 1.0 dB at the last visit (p < 0.001). Before surgery, the preferred retinal locus was located on the margin of the hole in all, in 18 eyes on its upper part and in four eyes to the side or on its lower part. Preoperatively, 12 eyes were stable and 10 were relatively unstable, but 12 month after surgery, fixation stability had improved, and 20 eyes were stable and two were relatively unstable. Conclusions:, MP-1 microperimetry sensitivity map overlaid onto an infrared image using dedicated MP-1 software can be used successfully to evaluate fixation location in patients with a macular hole before surgery. With microperimetry findings, we can also measure functional macular changes more precisely than using BCVA alone after macular hole surgery. Our results also showed that retinal sensitivity and fixation properties were improved after vitrectomy with triamcinolone acetonide assisted ILM peeling in patients with idiopathic macular hole. [source] Use of heavy silicone oil (Densiron-68®) in the treatment of persistent macular holesACTA OPHTHALMOLOGICA, Issue 8 2009Alexandra Lappas Abstract. Purpose:, In this retrospective case series, we studied the effect of ,heavy' silicone oil on persisting macular holes. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade Densiron-68®. Methods:, Twelve patients with primary macular holes that persisted after pars plana vitrectomy, peeling of the internal limiting membrane and internal gas tamponade with SF6 (sulphur hexafluoride) were retreated with heavy silicone oil, Densiron-68®, in the University Eye Hospital, Cologne. After 1.5,4 months the Densiron-68® was removed. Best corrected visual acuity (VA), slit-lamp examination, binocular fundus examination and optical coherence tomography (OCT) were used for evaluation pre- and postoperatively. The follow-up period was 3,7 months. Results:, Preoperatively, all patients displayed full-thickness macular holes, with a mean size of 502.25 ,m (± 129.39 ,m). Postoperatively, 11 of 12 macular holes were closed. One patient experienced a reopening of the macular hole. Mean VA was 20/250 (1.07 ± 0.22 logMAR) prior to treatment with Densiron-68® and 20/160 (0.84 ± 0.24 logMAR) postoperatively. Visual acuity increased from baseline in nine patients and decreased in one. Conclusions:, Retreatment of persisting macular holes with the heavy, longterm tamponade Densiron-68® resulted in anatomical closure of the hole in 11 of 12 cases. This result was accompanied by a functional improvement in VA in nine of 12 patients. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation 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. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] Macular hole surgery with and without internal limiting membrane peelingACTA OPHTHALMOLOGICA, Issue 2009C KOURENTIS Purpose To compare the results of surgery for idiopathic macular hole with or without the surgical removal of the internal limiting membrane (ILM) and the effect on anatomical and functional success rates. Methods 41 consecutive patients with idiopathic macular hole stage II (n=11), III (n=22) and IV (n=8) underwent pars plana vitrectomy and intraocular gas tamponade in this study. The surgery was performed either with ILM peeling,Group A (n=28), or without, Group B (n=13). Ocular coherence tomography and ETDRS visual acuity were measured pre- and postoperatively to assess macular hole size and anatomical hole closure as well as visual function. Results The postoperative macular hole closure rate was 100% (28/28) in Group A and 84,6% (11/13) in Group B. The 2 cases that failed to close with primary surgery had a hole size greater than 400µm. There was no significant difference between the two groups in the postoperative visual outcome once anatomical success was achieved. Conclusion The study suggests that more evidence based trials are necessary to investigate the benefit of ILM peeling especially in the treatment of larger macular holes. [source] Internal limiting membrane stainingACTA OPHTHALMOLOGICA, Issue 2009J KATSIMPRIS Purpose To describe the different modalities of internal limiting membrane (ILM) staining for the treatment of idiopathic macular hole (IMH). Methods Search of the MEDLINE database by using Medical Subject Heading search terms and key words related to ILM staining, macular hole surgery. Results ILM removal has been closely related with increased closure rates. However, because of poor ILM visibility the surgical removal of ILM is very difficult and poses serious complications. To obtain better visibility of ILM some special techniques have been developed using specific dyes such as, trypan blue (TB), indocyanine green (ICG), infracyanine green or triamsinolone acetonide(TA). Anatomic success rates with one surgery have increased (>90%) however, concern for toxicity has emerged. Patients with ICG-assisted ILM peeling appear to have a depressed recovery of visual acuity compared to those not using ICG. Concentrations of ICG that are <0.5 mg/mL have been shown to be non-toxic in cultures of RPE cells. Infracyanine green is a similar molecule that does not contain iodine and is less likely to induce osmolarity related toxic effects on the PRE cells when compared to ICG. It has been used also for ILM staining in combination with trypan(TB). TB is a second generation vital dye that stains epiretinal membranes (ERMs) directly and ILM to a lesser extent. Thus TB is useful for both macular hole and macular pucker surgery. TA may be also used to help highlight the ILM, although it is not a dye. It does adhere to the posterior hyaloid, making the detection of ILM easier. Conclusion This review largely reflects the great advent of different techniques for ILM staining. The use of ICG is more toxic when compared with TB. For TA long-term effects have not been well studied. [source] Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?ACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non-ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed. Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity. Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A-V sheathotomy combined with intravenous t-PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease. [source] Temporal changes in retinal thickness after removal of the epiretinal membraneACTA OPHTHALMOLOGICA, Issue 4 2009Hitoshi Aso Abstract. Purpose:, We aimed to study the temporal aspects of the postoperative reduction of retinal thickness in eyes with epiretinal membrane after vitrectomy with peeling of the epiretinal membrane and internal limiting membrane. Methods:, In a retrospective study performed as a non-comparative, interventional case series, 16 eyes from 15 patients with idiopathic epiretinal membrane who underwent vitrectomy and removal of the epiretinal membrane were followed up using optical coherence tomography measurements. Retinal thickness in the macular area was assessed by the foveal thickness and macular volume in a circle 6 mm in diameter. Results:, Scattergrams of the foveal thickness and macular volume were best fitted with exponential curves. The average time constants of the exponential curve for foveal thickness and macular volume changes were 31 days (range 4,109 days) and 36 days (range 5,100 days), respectively. The average expected final values for foveal thickness and macular volume were 334 ,m (range 206,408 ,m) and 7.53 mm3 (range 6.57,8.66 mm3), respectively, which were significantly greater than those in normal controls (p < 0.0001, t -test). Conclusions:, Retinal thickness decreases rapidly immediately after surgical removal of the epiretinal membrane and the reduction rate gradually slows thereafter. Approximation of the exponential curve provides an estimation of final retinal thickness after surgical removal of the epiretinal membrane; final thickness is expected to be greater than in normal eyes. [source] Vitreous surgery for macular hole in patients with Vogt-Koyanagi-Harada diseaseCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 9 2008Izumi Kobayashi MD Abstract We describe two patients with Vogt-Koyanagi-Harada (VKH) disease, both in the convalescent stage, who presented with unilateral macular holes together with clinically significant epi-retinal membranes. Vitreo-retinal surgery was performed on the affected eyes and the surgical technique involved a standard three-port vitrectomy, peeling of the epi-retinal and internal limiting membrane (ILM). In both cases the retinae were tamponaded with air resulting in anatomical closure of the macular holes. The histology of the excised membrane was available in one case and this revealed multiple layers of presumed retinal pigment epithelial cells with cytoplasmic processes and intercellular junctions forming a basal lamina attached to the smooth surface of the ILM. Our findings demonstrate that macular holes can develop in patients with VKH but that the hole can be successfully closed with vitreo-retinal surgery. The convalescent stage tends to occur several weeks after the acute stage when the uveitic process has subsided and is characterized by choroidal depigmentation, producing a sunset glow appearance to the ocular fundus. Patients may also demonstrate varying degrees of cutaneous hypopigmentation, poliosis and/or alopecia. Macular holes have also been reported previously in patients during the convalescent stage of VKH and this communication describes the outcome of two patients who underwent vitreo-retinal surgery for this problem. [source] Protecting the retinal pigment epithelium during macular hole surgeryCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2005Jeffrey L Olson MD Abstract Herein a new surgical technique used during pars plana vitrectomy with internal limiting membrane peeling for macular hole surgery is reported. Perfluorocarbon liquid is used to tamponade the macular hole in order to prevent indocyanine green contact with the retinal pigment epithelium. [source] | ||||||||||