Home About us Contact
|
Home About us Contact | ||
|
|
||
Macular Holes (macular + hole)
Kinds of Macular Holes Terms modified by Macular Holes Selected AbstractsMacular hole following intravitreal ranibizumab injection for choroidal neovascular membrane caused by age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 2 2009Giuseppe Querques [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] Retinal 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] 1263: Symptoms and signs of posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010M KHAIRALLAH Purpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement. Methods Review of symptoms and signs of PU. Results The onset of PU can be sudden or less frequently insidious. Most common ocular symptoms include blurred vision, loss of vision, and floaters. Some patients with PU may have no symptoms, especially if inflammatory process is asymmetric. PU is usually associated with vitritis that can vary from mild to severe. Vitritis should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities. It can involve retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Maculopathy is common patients with PU. It may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement that can occur in association with PU include optic disc hyperemia/edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma. Conclusion Clinical examination is a key step in the diagnostic approach to PU. Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting the differential diagnosis. [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] Longterm results after phacovitrectomy and foldable intraocular lens implantationACTA OPHTHALMOLOGICA, Issue 8 2009Wensheng Li Abstract. Purpose:, This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. Methods:, We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results:, The most common indications for surgery were non-diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by , 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow-up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions:, Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co-existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract. [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] Protein screening in vitreous samples of patients with retinal vein occlusionACTA OPHTHALMOLOGICA, Issue 2009HT AGOSTINI Purpose The aim of the study was to identify proteins involved in the pathogenesis of retinopathy after retinal vein occlusion. In retinal vein occlusion, proteins penetrate from leaky vessels into the vitreous. Alternatively, retinal cells produce protein factors and release them into the vitreous. Methods Vitreous and plasma samples of patients with retinal vein occlusion or macular pucker / macular hole were analyzed by antibody microarrays and ELISA. Results An antibody based microarray with more than 500 target for screening vitreous samples initially was less enlightening than antibody arrays providing the possibility to quantify up to 30 proteins in an ELISA-like microassay. Standard curves of antibody microarrays are as linear as those of ELISAs. VEGF values were similar to values measured by ELISA. Conclusion In our screen, we found some candidate factors which are currently investigated for their potential of influencing retinopathy after retinal vein occlusion. The use of microarrays to identify protein factors involved in retinal disease in the vitreous will be discussed. [source] IL-8 vitreous levels in proliferative diabetic retinopathyACTA OPHTHALMOLOGICA, Issue 2007M GLOBOCNIK PETROVIC Purpose: To determine the levels of interleukin 8 (IL-8) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and the role of IL-8 as a marker of visual prognosis after vitrectomy. Methods: Vitreous fluid samples were obtained at vitreoretinal surgery from 71 patients with diabetes type 2 and PDR, and from 17 age-matched non-diabetic patients with a macular hole (control group). PDR was classified as active and inactive, and subdivided according to the extent of large vessel gliotic obliteration. The cytokine levels were measured by Cytometric Bead Array method. To determine the role of IL-8 as visual prognostic marker after vitrectomy we investigated whether the vitreous levels of IL-8 were associated with poor visual outcome. Poor outcome was defined by visual acuity less than 20/200 at least 8 months after vitrectomy. Clinical and preoperative eye characteristics (visual acuity, iris neovascularisation, vitreous hemorrhage, macular detachment, macular edema, active neovascularisation, neovascularisation of the disk, and the presence of panretinal photocoagulation) were additionally analyzed. Results: The vitreous levels of IL-8 were significantly higher in patients with PDR in comparison to the control (P<0.001), in eyes with higher extent of large vessel gliotic obliteration (P<0.001) and was not significantly higher in eyes with active neovascularisation (P=0.9). After multiple logistic regression analysis, vitreous level of IL-8 (P=0.028) and macular detachment (P=0.039) were predictors for the poor visual outcome after vitrectomy. Conclusions: The vitreous level of IL-8 was associated with the higher extent of large vessel gliotic obliteration and with the poor visual outcome after vitrectomy. [source] Comparison of visual acuity measurements and Purkinje's vessel shadow perception for prediction of postoperative visual acuity in different ophthalmological diseasesACTA OPHTHALMOLOGICA, Issue 2 2007Stephan Schulze Abstract. Purpose:, Prediction of postoperative visual acuity (VA) is extremely important to the patient and highly relevant to the surgeon. However, objective evaluation of the macula is frequently impossible in cases such as mature cataract, cataract in high myopia or vitreous haemorrhage. This study compares different preoperative examination techniques used to predict postoperative VA. Methods:, We retrospectively evaluated the charts of all patients who underwent any of the following procedures at our hospital in 2004: phacoemulsification for mature cataract or cataract in high myopia; vitrectomy for diabetic vitreous haemorrhage; macular pucker, and macular hole. The following methods were evaluated: preoperative distance and reading VA; laser interferential VA; Purkinje's vessel shadow perception, and postoperative distance VA. Results:, Complete documentation was available for 136 patients (29 mature cataracts, 25 immature cataracts in high myopia, 42 vitreous haemorrhages, 19 macular puckers, 21 macular holes). In cases of preoperative mature cataract, a positive Purkinje's vessel shadow perception predicted a postoperative VA , 20/50 (odds ratio 11.2). In cases of high myopia, interferential VA correlated best with visual outcome (p < 0.05). In macular surgery laser interferential VA predicted postoperative VA to be better and preoperative reading VA predicted it to be worse than it actually turned out after surgery. Laser interferential VA and last known VA prior to vitreous haemorrhage (mean of 20 months previously) correlated best with postoperative VA (p < 0.05) in cases of vitreous haemorrhage. Purkinje's vessel shadow perception , if positive , predicted a postoperative VA , 20/300 in these cases (odds ratio 15.0). Conclusions:, Postoperative VA after vitrectomy for macular pucker or macular hole and in cases of cataract in high myopia is best predicted by laser interferential VA. Postoperative VA after vitrectomy for diabetic vitreous haemorrhage is best predicted by prehaemorrhage VA or laser interferential VA, especially when prehaemorrhage VA is unknown. Positive Purkinje's vessel shadow perception is an excellent method of predicting postoperative VA , 20/300 in cases of vitreous haemorrhage and VA = 20/50 in mature cataract. [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] Prevalence of idiopathic macular hole in adult rural and urban south Indian populationCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2008Parveen Sen MS Abstract Background:, This study was undertaken to evaluate the prevalence of idiopathic macular hole in a defined community in Southern India. Methods:, In all, 7774 of the 9546 enumerated (81.43%) subjects availed themselves for an ophthalmic assessment which included a detailed ophthalmic examination and fundus photography. All data were entered and stored in a secure computerized database and statistical analysis was performed using spss for Windows. Results:, Thirteen subjects comprising six males and seven females were diagnosed with macular holes equating to a risk of 0.17%. Bilateral macular holes were found in two subjects. The mean age of subjects with a macular hole was 67 years. Increasing age and history of cataract surgery was strongly associated with an increased prevalence of macular holes (P < 0.0001). There was no difference in the prevalence of macular hole between the rural and urban communities. The mean logMAR visual acuity of subjects in the eye with a macular hole was 1.31 ± 0.45 whereas the acuity in the unaffected fellow eye was 0.70 ± 0.51. The mean spherical equivalent in the subjects with macular hole was ,0.56 ± 1.92 (,4.25 to +1.00). Conclusion:, Prevalence rate of idiopathic macular hole in South India appears to be comparable to that seen worldwide. [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] The macular hole: report of an Australian surgical series and meta-analysis of the literatureCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2000H K Kang MB BS ABSTRACT Purpose: To report an Australian series of macular hole surgery by pars plana vitrectomy and fluid-gas exchange, and to identify factors influencing the outcome of the surgery through meta-analysis of the literature. Methods: Fifty-six consecutive cases of macular hole were treated by pars plana vitrectomy, fluid-gas exchange and face-down positioning for at least 7 days, and prospectively followed for 3,12 months. Thirty-six reports of macular hole surgery were reviewed. A meta-analysis on the pre- and postoperative parameters was performed on 389 cases, in which case-specific data-points were available. Results: In the current series, anatomical closure was achieved in all (100%) of 16 stage 2, and in 35 (87.5%) of 40 stage 3 or 4 macular holes. At least 2 logMAR lines of improvement in visual acuity were seen in 10 (62.5%) stage 2 and 20 (50.0%) stage 3 or 4 holes. Postoperative visual acuity was 6/12 or better in 10 (62.5%) stage 2 and 17 (42.5%) stage 3 or 4 holes. In both the current series and the meta-analysis, favourable surgical outcomes were associated with stage 2 macular holes, better preoperative visual acuity, and shorter preoperative duration. Adjuvant use was associated with a higher rate of anatomical closure but there was no clear benefit in terms of postoperative visual acuity. Conclusion: Our experience and the results of the meta-analysis suggest that macular hole surgery should be offered as early as possible once full-thickness neuroretinal defect occurs. [source] Retinal 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] 1233: How to choose the best surgical procedure?ACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Dealing to the localization and sealing retinal breaks, the surgical success rate for the cure of rhegmatogenous retinal detachment greatly changed with the introduction of scleral buckling (SB), intraocular gas injection, and pars plana vitrectomy (PPV). Methods In localized cases, pneumatic retinopexy and scleral buckling surgery (SB) remains the most popular surgical methods. Complicated cases with PVR grade B or C, giant tears, or macular holes are most commonly treated with primary pars plana vitrectomy. A large group of rhegmatogenous RDs with medium severity that comprise about 30% of all primary rhegmatogenous RDs in the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment recruitment study, were treated by SB and PPV. Advances in vitrectomy instrumentation and wideangle imaging systems have increased the popularity of PPV. Results The decision by the surgeon to use scleral buckling rather than PPV depends on a number of factors, including the lens status, size and location of breaks, patient compliance, and individual experience. Initial PPV may be successful for phakic patients. However, the SPR study shows a benefit of SB in phakic eyes with respect to BCVA improvement. Although no difference in BCVA was demonstrated in the pseudophakic trial, PPV was recommend for pseudophakic RD based on a better anatomical outcome. Conclusion There was a significant trend towards more frequently employing primary PPV (with or without SB) for the management of primary RRD. A significant improvement in the primary success rates for RD, were shown for all retinal surgical modalities applied for the treatment of rhegmatogenous retinal detachment. [source] Anatomical and functional outcome in brilliant blue G assisted chromovitrectomyACTA OPHTHALMOLOGICA, Issue 5 2010Paul B. Henrich Abstract. Purpose:, To evaluate the potential of brilliant blue G (BBG) for intraoperative staining of the inner limiting membrane (ILM) with respect to staining properties and surgical outcome. Methods:, In a retrospective, non-comparative clinical case series, we analysed 17 consecutive chromovitrectomy interventions for surgery of macular holes, ERMs, vitreoretinal traction syndromes and cystoid macular oedema. Following complete posterior vitreous detachment, BBG was injected into the vitreous cavity at a concentration of 0.25 mg/ml, followed by immediate washout. Main outcome measures were staining properties, visual acuity, central visual field testing and optical coherence tomography (OCT) measurements over a mean follow-up period of 3 months. Results:, ILM staining was somewhat less intensive for BBG than for average indocyanine green (ICG) chromovitrectomy. However, the ILM was removed successfully without additional ICG in 15/17 patients. Postoperative visual acuity was improved in 16/17 patients and remained unchanged in one patient. Central retinal OCT thickness showed a postoperative reduction, with values ranging from +7 to ,295 ,m (median ,89 ,m). Neither visual field defects nor any other adverse events were recorded. Conclusion:, BBG permits sufficient staining for safe ILM removal. In this short-term study, good anatomical and functional results were achieved and no adverse events were observed. [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] New perspectives of optical coherrence tomography in diagnosis and follow-up of macular holesACTA OPHTHALMOLOGICA, Issue 2009SA KABANAROU Purpose To compare Time Domain (TD) with Spectral Domain (SD) OCT for imaging macular holes, identify retinal pathology and correlate anatomical morphology after surgical intervention for hole closure with visual outcome. Methods 34 eyes of 34 patients with idiopathic macular holes stage II- IV were included in this study. Comparative studies were performed with both SD OCT (Heidelberg, Germany) and TD OCT (Stratus) using standard scanning protocols of 6 radial 6-mm scans through the fovea. All patients underwent a standard three port- pars plana vitrectomy. Postoperatively, all patients were evaluated using both OCTs. ETDRS visual acuities were recorded pre- and post-operatively. Results In general TD and SD OCTs showed comparable images of macular holes. However, the boundary line between the inner and outer segments of the photoreceptors was better imaged with the SD OCT preoperatively and postoperatively. Poor visual acuity postoperatively was measured mainly in cases with morphological disruption in this boundary line despite hole closure. Conclusion SD OCT imaging enhances the visualization of retinal anatomy in macular holes relative to TD OCT. [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] Transthyretin levels in the vitreous correlate with change in visual acuity after vitrectomyACTA OPHTHALMOLOGICA, Issue 2009E VAN AKEN Purpose Little is known about biochemical markers related to change in visual acuity after vitrectomy. We investigated the potential use of transthyretin (TTR), a carrier of the retinol/retinol-binding protein, as a biochemical marker protein. Methods We measured TTR using immunonephelometry in a group of patients (n=77) in longstanding (> 1 week) retinal detachment (n=29), fresh (< 1 week) retinal detachment (n=17), macular holes (n=20), or diabetic retinopathy (n=11). Vitreous samples were taken at the start of every vitrectomy procedure. For reference values, cadaver specimens (n=73) were used. Results Reference values for vitreous TTR (median 18 mg/l; IQR 4-24 mg/l) comprised 2.2% of reference values for vitreous protein levels (median 538 mg/l; IQR 269-987 mg/l). Vitreous TTR values of patients were comparable in all disorders. Vitreous TTR values were higher in phakic (median 22.5 mg/l; IQR 10-27 mg/l) than in pseudophakic patients (median 12 mg/l; IQR 8-19 mg/l)(p=0.06). Postoperative change in visual acuity correlated well with vitreous TTR values found peroperatively (rs=0.408; p=0.012). Both change in visual acuity and lens status were the only variables which proved to explain the variance of TTR (multiple correlation coefficient: 0.494; phakic status: t=2.767; p=0.0084; and change in visual acuity t=2.924: p=0.0056). Conclusion Vitreous fluid concentrations of TTR can be regarded as a biochemical marker for retinal function. [source] Comparison of visual acuity measurements and Purkinje's vessel shadow perception for prediction of postoperative visual acuity in different ophthalmological diseasesACTA OPHTHALMOLOGICA, Issue 2 2007Stephan Schulze Abstract. Purpose:, Prediction of postoperative visual acuity (VA) is extremely important to the patient and highly relevant to the surgeon. However, objective evaluation of the macula is frequently impossible in cases such as mature cataract, cataract in high myopia or vitreous haemorrhage. This study compares different preoperative examination techniques used to predict postoperative VA. Methods:, We retrospectively evaluated the charts of all patients who underwent any of the following procedures at our hospital in 2004: phacoemulsification for mature cataract or cataract in high myopia; vitrectomy for diabetic vitreous haemorrhage; macular pucker, and macular hole. The following methods were evaluated: preoperative distance and reading VA; laser interferential VA; Purkinje's vessel shadow perception, and postoperative distance VA. Results:, Complete documentation was available for 136 patients (29 mature cataracts, 25 immature cataracts in high myopia, 42 vitreous haemorrhages, 19 macular puckers, 21 macular holes). In cases of preoperative mature cataract, a positive Purkinje's vessel shadow perception predicted a postoperative VA , 20/50 (odds ratio 11.2). In cases of high myopia, interferential VA correlated best with visual outcome (p < 0.05). In macular surgery laser interferential VA predicted postoperative VA to be better and preoperative reading VA predicted it to be worse than it actually turned out after surgery. Laser interferential VA and last known VA prior to vitreous haemorrhage (mean of 20 months previously) correlated best with postoperative VA (p < 0.05) in cases of vitreous haemorrhage. Purkinje's vessel shadow perception , if positive , predicted a postoperative VA , 20/300 in these cases (odds ratio 15.0). Conclusions:, Postoperative VA after vitrectomy for macular pucker or macular hole and in cases of cataract in high myopia is best predicted by laser interferential VA. Postoperative VA after vitrectomy for diabetic vitreous haemorrhage is best predicted by prehaemorrhage VA or laser interferential VA, especially when prehaemorrhage VA is unknown. Positive Purkinje's vessel shadow perception is an excellent method of predicting postoperative VA , 20/300 in cases of vitreous haemorrhage and VA = 20/50 in mature cataract. [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] Prevalence of idiopathic macular hole in adult rural and urban south Indian populationCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2008Parveen Sen MS Abstract Background:, This study was undertaken to evaluate the prevalence of idiopathic macular hole in a defined community in Southern India. Methods:, In all, 7774 of the 9546 enumerated (81.43%) subjects availed themselves for an ophthalmic assessment which included a detailed ophthalmic examination and fundus photography. All data were entered and stored in a secure computerized database and statistical analysis was performed using spss for Windows. Results:, Thirteen subjects comprising six males and seven females were diagnosed with macular holes equating to a risk of 0.17%. Bilateral macular holes were found in two subjects. The mean age of subjects with a macular hole was 67 years. Increasing age and history of cataract surgery was strongly associated with an increased prevalence of macular holes (P < 0.0001). There was no difference in the prevalence of macular hole between the rural and urban communities. The mean logMAR visual acuity of subjects in the eye with a macular hole was 1.31 ± 0.45 whereas the acuity in the unaffected fellow eye was 0.70 ± 0.51. The mean spherical equivalent in the subjects with macular hole was ,0.56 ± 1.92 (,4.25 to +1.00). Conclusion:, Prevalence rate of idiopathic macular hole in South India appears to be comparable to that seen worldwide. [source] Vitrectomy without postoperative posturing for idiopathic macular holesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2007Adrian Rubinstein MRCSEd Abstract Purpose:, To determine the success of vitrectomy with ILM peeling and C3F8 tamponade for macular holes without the need for postoperative face-down posturing. Methods:, Twenty-four eyes of 24 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and C3F8 tamponade without prone posturing were included in the study. All patients had follow up on 1 day, 2 weeks and 3 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre- and postoperatively. Results:, Of the 24 eyes recruited, two (8%) had stage II, 17 (71%) had stage III and five (21%) had stage IV macular holes. Nineteen (79%) eyes were phakic and five (21%) eyes were pseudophakic at the time of surgery. The macular holes had been present for an average of 7.5 months (range 3,18 months). At 3-month follow up, 22/24 (91.6%) holes were closed. Both of the two holes that failed to close were stage IV macular holes. Preoperative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Postoperative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Eighteen eyes had improvement of visual acuity of at least one line on the Snellen chart, six eyes had no improvement. No eyes had worse vision postoperatively. Conclusion:, Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing. [source] The macular hole: report of an Australian surgical series and meta-analysis of the literatureCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2000H K Kang MB BS ABSTRACT Purpose: To report an Australian series of macular hole surgery by pars plana vitrectomy and fluid-gas exchange, and to identify factors influencing the outcome of the surgery through meta-analysis of the literature. Methods: Fifty-six consecutive cases of macular hole were treated by pars plana vitrectomy, fluid-gas exchange and face-down positioning for at least 7 days, and prospectively followed for 3,12 months. Thirty-six reports of macular hole surgery were reviewed. A meta-analysis on the pre- and postoperative parameters was performed on 389 cases, in which case-specific data-points were available. Results: In the current series, anatomical closure was achieved in all (100%) of 16 stage 2, and in 35 (87.5%) of 40 stage 3 or 4 macular holes. At least 2 logMAR lines of improvement in visual acuity were seen in 10 (62.5%) stage 2 and 20 (50.0%) stage 3 or 4 holes. Postoperative visual acuity was 6/12 or better in 10 (62.5%) stage 2 and 17 (42.5%) stage 3 or 4 holes. In both the current series and the meta-analysis, favourable surgical outcomes were associated with stage 2 macular holes, better preoperative visual acuity, and shorter preoperative duration. Adjuvant use was associated with a higher rate of anatomical closure but there was no clear benefit in terms of postoperative visual acuity. Conclusion: Our experience and the results of the meta-analysis suggest that macular hole surgery should be offered as early as possible once full-thickness neuroretinal defect occurs. [source] | ||||||||||