scholarly journals Macular Hole: Etiology, Physiopathology, Diagnosis, Differential Diagnosis, and Treatment

2018 ◽  
pp. 273-282
Keyword(s):  
Macular Hole ◽  
Vitreoretinal Surgery ◽  
Idiopathic Macular Hole ◽  
Ilm Peeling ◽  
Retinal Surface ◽  
Full Thickness Macular Hole ◽  
Vitreous Cortex ◽  
Dynamic Forces ◽  
Vitreomacular Interface

Retinal defects evolving whole neural layers in the macular area especially in the fovea are being called macular hole (idiopathic macular hole; IMH). It causes painless central visual loss and deterioration of vision that is called metamorphopsia. Antero-posterior dynamic forces (vitreomacular traction; VMT) caused by tangential tractional vectors of the prefoveal vitreous cortex and progression to full-thickness macular hole due to weakening of the inner retinal layers are attributed for the etiology of macular hole. IMH is seen frequently unilaterally in females and patients > 65 years of age. An approach for IMH treatment, aiming to release the traction and closure of the macular hole by pharmacological vitreolysis is the use of ocriplasmin, which is a plasmin derivative. To release the synechia on the vitreomacular interface and to normalize the abnormalities of the retinal surface are the aims of IMH surgery. Besides, vitreoretinal surgery constitutes suitable conditions for the closure of the hole. Separation and detachment of the posterior hyaloid, core vitrectomy, removal of the peripheral vitreous, and Internal Limiting Membran (ILM) peeling are the standard stages of the classic IMH surgery. Condition of the other eye, presence of Epiretinal Membran (ERM), hole width, patient's age, and quality of life are important factors when evaluating the patients. Ocriplasmin alternative must be kept in mind in holes smaller than 400 μ especially if VMT is existent. IMH is such a pathology that can be treated successfully by vitrectomy and ILM peeling at the present situation.

Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment

2019 ◽  
Vol 3 (5) ◽  
pp. 341-345
Author(s):  
Matthew A. Cunningham ◽  
Samantha Fink ◽  
Jaya B. Kumar ◽  
Elias C. Mavrofrides ◽  
S.K. Steven Houston ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Case Series ◽  
Vitreoretinal Surgery ◽  
Visual Outcome ◽  
Full Thickness ◽  
Tractional Retinal Detachment ◽  
Full Thickness Macular Hole ◽  
Pars Plana

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.

scholarly journals Evaluation of vision-related quality of life with autologous internal limiting membrane transplantation for refractory macular hole.

2019 ◽  
Author(s):  
dongqing yuan ◽  
Weiwei Zhang ◽  
Songtao Yuan ◽  
Ping Xie ◽  
Qinghuai Liu
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Corrected Visual Acuity ◽  
Hole Index ◽  
Related Quality ◽  
Best Corrected Visual Acuity

Abstract Background: To evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane(ILM) transplantation for refractory macular hole． Methods: A prospective and nonrandomized clinical study was carried out. There were fourty eyes with refractory macular hole included and all eyes received 23G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded, including best corrected visual acuity (BCVA), intraocular pressure, central retinal thickness (CRT) measurement by Optical coherence tomography (OCT) examination, macular hole index (MHI) and operative complications. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the visual related quality of life of patients after operation. The correlation between the quality of life and the postoperative visual acuity and the size of the macular hole before operation was tested by Spearman rank correlation test. Results: All patients were followed up for three months after surgery, and 38 patients achieved anatomical closure. The mean postoperative logMAR BCVA was 1.09±0.33, which has significantly improved than that before operation (P=0.000). The vision-related quality of life of patients after surgery was closely related to the macular hole index (r=0.375, P=0.017), but was negatively correlated with the best corrected visual acuity before and after surgery (r=-0.495, P=0.001; r=-0.760，P=0.000). It was also found that the vision-related quality of life of patients positively correlated with the postoperative CRT ( r=0.414，P=0.008). Conclusions: The anatomical structure of refractory macular hole patients with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of the patients improved significantly. Meanwhile, the vision-related quality of life was significantly improved after surgery. Trial Registration: ChiCTR-INR-16008660, date of registration: 2016/06/17

scholarly journals Retrospective study on outcome of macular hole surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 139-143 ◽  
Author(s):  
S Singh ◽  
R Byanju ◽  
S Pradhan ◽  
G Lamichhane
Keyword(s):  
Macular Hole ◽  
Surgical Complication ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Macular Hole Surgery ◽  
Gas Tamponade ◽  
Vitreous Cortex ◽  
Intraocular Gas ◽  
Hole Closure

Introduction: Macular hole is a common and treatable cause of central visual loss. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex removal 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. Objective: To determine and evaluate anatomical and visual outcome of macular hole surgery. Materials and methods: Retrospective analysis of all cases of macular hole surgery done by single surgeon between 2014 -2015. Results:16 eyes were analysed with follow up of 3 months. Macular hole closure after vitrectomy was 75% with visual improvement of two or more line in 62.5%.Post surgical complication included cataract 18.8%, Increased IOP 12.5% and retinal detachment 6.2%. Conclusion: Vitrectomy along with ILM peeling and Gas Tamponade with effective positioning improves in visual acuity and achieve hole closure in people with macular hole. 

Sign in / Sign up

Export Citation Format

Share Document