Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma. Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study. All the patients were examined for corrected visual acuity (CVA), slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography (OCT) and intraocular pressure examination. The average axial length was (29.1plusmn;1.8) mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The average logMAR CVA was 1.93plusmn;0.37. All the patients were treated with PPV and triamcinolone acetonide or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was (6.2plusmn;1.6) months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34plusmn;0.48 after surgery, which significantly improved compared to that before surgery (t=39.38, P＜0.01). The CVA after surgery was independent of axial length (r=0.142, P＞0.05), choroid atrophy (t=0.23, -0.165,P＞0.05) and macular hole closure (t=0.12, -0.005, P＞0.05). The retina reattached in 79 eyes (92.9%) and recurrence of retinal detachment occurred in six eyes (7.1%). Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment, proliferative vitroretinopathy, axial length, choroid atrophy and ILMP (OR=1.428, 5.039, 0.815, 2.578, 0.432; P＞0.05). Of these 85 eyes, macular hole closed in ten eyes (11.8%), macular hole did not close in 75 eyes (88.2%). There were 24 eyes (28.2%) experienced high intraocular pressure during the first 2 weeks after surgery, all of them were under control with drugs. There were 12 eyes (14.1%) presented with high intraocular pressure before the silicone oil removal, all of them were under control only by silicone oil removal. Conclusion For the treatment of MHRD with posterior staphyloma, PPV combined with ERMP and (or) ILMP and silicone oil tamponade show a high retinal reattachment rate.
Objective To compare the outcome of C3F8 versus silicone oil intraocular tamponade after pars plana vitrectomy (PPV) for the treatment of severe highly myopic macular hole retinal detachment (MHRD). Methods Thirty-two highly myopic MHRD patients (32 eyes) with extreme long axial lengths (ge;29.0 mm), quot;severequot; retina pigment epithelium (RPE) and chorioretinal atrophy, and posterior staphyloma who underwent PPV, were enrolled in this study. The patients were divided into two groups according to different intraocular tamponade agents: C3F8 (group A, 15 eyes) and silicone oil (group B, 17 eyes). The patients with retinal re-detachment after surgery received PPV again. The differences of sex (P=1.000), age (t=0.444, P=0.660), best-corrected visual acuity (t=0.084, P=0.934), diopter (t=0.449, P=0.978), lens state (P=1.000), time of the symptoms (t=0.375, P=0.710) and degree of retinal detachment (chi;2=0.014, P=0.907) between group A and B were not statistically significant. The anatomic reattachment of the retina, macular hole closure, and vision acuity were observed at one week, one, three, six and 12 months after surgery. Results The rates of retinal reattachment and macular hole closure were 60.00% and 13.33 % in group A, 82.35% and 29.41% in group B in the first time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.243, 0.402). The rates of retinal reattachment and macular hole closure were 86.67% and 20.00% in group A, 94.12% and 29.41% in group B in the second time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.589, 0.691). Twelve months after surgery, the vision acuity improved in five eyes, unchanged in seven eyes , and decreased in three eyes in group A; the vision acuity improved in seven eyes , unchanged in eight eyes , and decreased in two eyes in group B. The differences of vision result was not statistically significant between two groups (chi;2=0.209, P=0.647). Conclusion The rates of retinal reattachment and macular hole closure with silicone oil tamponade was higher than that with C3F8 tamponade in eyes with severe highly myopic MHRD, but the differences are not statistically significant.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
ObjectiveTo observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.MethodsA retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients (15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index (MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.ResultsAt 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=?0.536, ?0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).ConclusionInternal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).
ObjectiveTo observe the healing morphology, macular microstructure and visual function of idiopathic macular hole (IMH) after pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) flap.MethodsRetrospective case study. From 2016 to 2018, 39 eyes of 39 patients with IMH diagnosed in Tianjin Eye Hospital were included in the study. Among them, there were 4 eyes in 4 males and 35 eyes in 35 females, with an average age of 64.56±7.2 years. BCVA, OCT, OCT angiography (OCTA) and MAIA microperimetry examination were performed in all patients. BCVA examination was performed with the international standard visual acuity chart, which was converted to logMAR visual acuity when recording. All patients underwent PPV combined with ILM flap covering and air tamponade. According to the characteristics of OCT images postoperatively, the eyes were divided into U-shaped closed group, V-shaped closed group, irregular closed group and flat closed group, with 26, 5, 7 and 1 eyes respectively. There was a significant difference in the minimum hole diameter (F=5.118, P=0.005) and macular hole classification (F=3.608, P=0.024). The shallow capillary layer (SCP) blood flow density in the U-shaped closure group was significantly higher than that in the V-shaped closure group, the irregular closure group and the flat closure group (t=2.079, 2.368; P=0.047, 0.025). At 1, 3, 6 months after the operation, the same equipment and methods were used for relevant examination. The blood flow density of BCVA, SCP, perimeter of foveal avascular zone (PERIM) and mean sensitivity (MS) were compared before and after operation. Independent sample t-test was used for quantitative data comparison between different groups, and χ2 test was used for counting data comparison.ResultsSix months after operation, the logMAR of the eyes in the U-shaped closure group was －0.75±0.29 higher than that before operation, and was better than that in the V-shaped closure group, the irregular closure group and the flat closure group (t=－2.974, －2.518; P=0.006, 0.018). The integrity of external limiting membrane (ELM) and ellipsoid in U-shaped closed group was significantly higher than that in V-shaped closed group, irregular closed group and flat closed group (χ2=15.229, 10.809; P=0.020, 0.013). The percentage of macular central fovea reflex mass in the U-shaped closed group was significantly lower than that in the V-shaped closed group, irregular closed group and flat closed group (χ2=20.107, P=0.000). PERIM in U-shaped closure group was smaller than that in V-shaped closure group, irregular closure group and flat closure group, and the difference was statistically significant (t=－3.391, －2.427; P=0.002, 0.022). The total MS of macular area 10 °in the U-shaped closure group was significantly higher than that in the other V-shaped closure group, irregular closure group and flat closure group (t=2.939, 2.811; P=0.001, 0.001).ConclusionAfter IMH operation, the U-shaped closure showed better BCVA and macular light sensitivity, the proportion of ELM and ellipsoid to restore structural integrity are higher, PERIM is smaller, and there are fewer macular fovea strong reflex masses.
Purpose To explore the role of scanning laser tomography in the assessment of macular hole surgery. Methods Fifteen eyes of 14 patients with macular holes underwent scanning of their affected macular area using the Heidelberg retina tomograph (HRT). The significance of topographic changes postoperatively were determined in eleven eyes which received vitrectomy surgery. The scan field was set at 15°of the retina and the depth was set to 1.5 mm or 2.0 mm. All the measurements were taken for 3 times and the average value of the 3 measurements was used. Results The average hole area was (0.499±0.34) mm 2 and the maximal depth of the hole was (0.284±0.11) mm. Topographic difference analysis of the eleven eyes showed a significant reduction in the height of the retina after vitrectomy. The maximal depth of the hole was (0.063±0.04) mm postoperatively. Conclusion Scanning laser tomography provides an objective evaluation of the anatomic outcome of the macular hole surgery. (Chin J Ocul Fundus Dis, 2002, 18: 125-127)
Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group). In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group). The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was (1.67±1.28) and (7.65±1.42) days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant (Z=?6.784, P＜0.05). At 6 months after surgery, the hole closure was detected in 30 eyes (85.71%) in the SS-OCT group and in 27 eyes (93.10%) in the control group. There was no difference of hole closure rate between the two groups (χ2=0.889, P＞0.05). There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate.
ObjectiveTo observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.MethodsA retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males (5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.ResultsIn ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).ConclusionsInverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
ObjectiveTo observe the electroretinogram (ERG) photopic negative response (PhNR) of idiopathic macular hole (IMH) in stage 2 by vitrectomy with or without internal limiting membrane peeling (ILMP).MethodsTwenty-three stage 2 IMH patients (23 eyes) were enrolled in this prospective study. All patients received the best corrected visual acuity (BCVA), optical coherence tomography and flash-ERG examinations. The patients were randomly divided into group A (11 eyes, vitrectomy) and B (12 eyes, vitrectomy with ILMP). There was no significant difference in BCVA (t=0.96, P=0.350), diameter of macular hole (MH) (t=3.21, P=0.580) and the PhNR amplitude (t=0.98, P=0.353) in group A and B. All patients underwent 25G vitrectomy, ILMP was carried out in group B. The follow-up time was 3 to 6 months, with the mean follow-up time of 4.3 months. BCVA, MH closure rate and PhNR amplitude in group A and B were analyzed before and after surgery.ResultsThree months after surgery, 10 eyes (90.9%) gained MH closure but 1 eye (9.1%) failed in group A. In group B, 12 eyes (100.0%) gained MH closure. There was no significant difference in MH closure rate between the two groups (P=0.462). The mean BCVA of group A and B was 0.69±0.24 and 0.65±0.22, there was no significant difference between the two groups (t=0.49, P=0.722). The amplitude of PhNR in group A was (36.6±7.4) μV, which was lower than the pre-surgery PhNR, but the difference was not significant (t=0.73, P=0.472). The amplitude of PhNR in group B was (27.1±12.4) μV, which was lower than that the pre-surgery PhNR, and the difference was significant (t =3.56, P =0.002). The difference of PhNR amplitude in group A and B was statistically significant (t=2.17, P=0.042).ConclusionCompared with non-ILMP, vitrectomy combined with ILMP will significantly reduce the PhNR amplitude of IMH in stage 2.
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)