Surgical Treatment of Idiopathic Macular Hole Using Different Types of Tamponades and Different Postoperative Positioning Regimens

Purpose. To compare the effect of different types of intraocular tamponade and different types of postoperative positioning on the closure of idiopathic macular hole (IMH). Methods. Prospective randomized clinical trial enrolling 104 eyes of 100 patients (age, 57–87 years) undergoing MH surgery. All patients were operated on by an experienced surgeon using 25-gauge pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Patients were randomized according to the type of intraocular tamponade and postoperative positioning into the following four groups: SF6 + nonsupine reading position (n = 26) (group 1), air + nonsupine reading position (n = 25) (group 2), air + prone position (n = 26) (group 3), or SF6 + prone position (n = 27) (group 4). The follow-up period was 6 months. Results. MH closure was achieved in 87 eyes (83.7 %) in the overall sample after the first surgery, with closure rates of 100%, 56%, 84.6%, and 92.6% in groups 1, 2, 3, and 4, respectively. The group 2 was significantly less successful compared to the other three groups ( p < 0.05). MH of sizes ≤400 µm was closed in 97.2% of cases after the first surgery, with no significant differences between groups ( p = 0.219). MH with sizes over 400 µm was closed in 70.9% of cases after the first surgery, with both groups with air tamponade being significantly less successful than group 1. The nonsupine reading position was subjected to a better subjective evaluation in terms of postoperative comfort and quality of sleep, with no differences between air and SF6 tamponade tolerance. Conclusion. PPV with ILM peeling, intraocular tamponade, and positioning remains the basic surgical approach in the treatment of IMH. For MH ≤ 400 µm, a high closure rate can be achieved by combining air tamponade and nonsupine reading position. For macular holes >400 µm, the greatest anatomical success can be achieved by using the SF6 tamponade in combination with the nonsupine reading position.

Clinical characteristics and surgical outcome of pediatric and early adulthood retinal detachment

Objective: The aim of this study was to evaluate and compare the underlying pathologies, demographic and retinal detachment characteristics in pediatric and early adulthood retinal detachment. Methods: Patients with rhegmatogenous, serous, or tractional retinal detachment aged 0–26 years were retrospectively reviewed. The preschool group (n = 4) comprised children aged 0–6 years, the pediatric group (n = 19) comprised children aged 7–16 years, and the early adulthood group (n = 13) aged 17–26 years. Demographic information and retinal detachment characteristics, type of surgery, and intraocular tamponade were analyzed. Postoperatively, the functional outcome, anatomic success, and ocular adverse events were evaluated. Due to the low patient number in the preschool group, statistical analysis was performed for pediatric group and early adulthood group only. Results: All causes of retinal detachment were present in the pediatric group, but only rhegmatogenous retinal detachment in the early adulthood group. In both groups, the main type of surgical intervention was pars plana vitrectomy (pediatric group: 52%, early adulthood group: 38%; p = 0.36). The type of intraocular tamponade varied statistically significantly between the groups (p = 0.014). Silicone oil was the main intraocular tamponade in the pediatric group (48%), whereas no tamponade (54%) followed by gas tamponade (46%) in the early adulthood group. Final attachment rate was similar in both groups (pediatric group: 89%, early adulthood group: 100%; p = 0.35). Re-detachment occurred significantly sooner in the pediatric group (1.3 ± 0.3 months) than in the early adulthood group (4.3 ± 1.4 months; p = 0.03). Conclusion: In pediatric and early adulthood retinal detachment, pars plana vitrectomy appeared as a successful surgical intervention. Re-attachment rate and re-treatment were similar in both groups with a better functional outcome observed in cases of retinal detachment in early adulthood and poorer results in young children.

A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for Idiopathic Macular Hole of different hole diameters with Air or C3F8 Intraocular Tamponade

Background：Vitrectomy and membrane peeling followed by gas filling technique has become a standard procedure of macular hole surgery, the outcomes are affected by many factors, and which kind of intraocular tamponade is the best choice still has some conflicts. The purpose of this study is to investigate whether air filling can achieve comparable effects to long-acting inert gases when different macular hole sizes are enrolled. Methods：116 patients with idiopathic macular hole were enrolled in this retrospective study, 44 received C3F8 tamponade and 72 received sterile air tamponade. Before and after vitrectomy surgery, the best corrected visual acuity, slit lamp examination, fundus examination and intraocular pressure were analyzed. Results：No statistically significant difference was fund in age, gender, axial length, intraocular pressure, or preoperative visual acuity between groups. After the surgery, the closure rates of air group and C3F8 group with macular hole diameter ≤400 microns were 94.4% and 100.0%, with no significant difference between the two groups (P = 0.701). The closure rates of macular hole diameters lager than 400 microns are 66.7% and 91.3%, P = 0.029. The total closure rates of the two groups are 80% and 95.6%, P =0.018. Conclusions：In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material is similar to that of C3F8 in macular hole with diameters less than 400 microns. In patients with larger macular hole (diameter over 400 microns) performed therapeutic surgery with air filling, internal limiting membrane insertion or flap inversion may be recommended get better outcomes.

Retinal and optic nerve functional activity after vitrectomy for vitreomacular traction syndrome

Background. Impacts of vitrectomy for vitreomacular traction syndrome on retinal and optic nerve functional activity are analyzed. Materials and methods. The electrophysiological monitoring was carried out before vitrectomy and on Days 1, 3, 7, 14, 30, 60, 180 after surgery in 59 patients (59 eyes). Patients were divided into three groups depending on the intraocular tamponade type: the first group air tamponade, the second group gas (C3F8) tamponade, the third group BSS (balanced salt solution). Results. A significant inhibition of the functional activity of neurons of internal layers of the retina and of the optic nerve was revealed on the Day 1 after surgery compared to baseline data (р 0.001). In groups I and III, the functional activity of inner layers of the retina and of the optic nerve restored twice as actively as that in the second group. Conclusions. Vitrectomy causes a reversible and significant inhibition of functional activity of retina and optic nerve. The duration of vitrectomy procedure is a significant negative factor determining the degree of depression of the functional activity of inner layers of the retina and of the optic nerve in the post-op period. The gas tamponade of the vitreous cavity with perfluoropropane-air mixture, compared to air and BSS tamponades, is a significant negative factor influencing the degree of functional activity inhibition of retina and optic nerve after surgery.

Watch out for the special location of intraventricular silicone oil following an intraocular tamponade - a 10-year follow-up case report based on CT/MRI

Background Intraventricular silicone oil is a relatively rare complication resulted from silicone oil tamponade to treat retinal detachment. It is occasionally reported in previous literature. To the best of our knowledge, the long-term longitudinal comparisons of silicone oil both in the brain and in the postoperative eyeball based on CT/MRI were lacking, and intraventricular silicone oil accumulation beside lesions has been reported rarely. Case presentation A 63-year-old male patient underwent an intraocular tamponade with silicone oil in June 2009. Eight CT examinations and 2 MRI examinations were acquired between 2011 and 2018.The changes of silicone oil in the brain in CT/MRI as below: Silicone oil initially migration to bilateral lateral ventricular anterior horn was found in November 2011, it was aslo found at right side of suprasellar cisterna, and there was no change in location 6 h later; Silicone oil at the anterior horn of right lateral ventricle disappeared but remained at left lateral ventricle and right side of suprasellar cisterna in July 2014, and there was no change in location in a short-term reexamination. It was found at the middle of left lateral ventricle (adjacent to the real cause) in march 2018, but disappeared 3 months later, while remained at anterior horn of left lateral ventricular and right side of suprasellar cisterna all the time. There was no change in location in the next 2 follow-up (September and October in 2018). The CT values of silicone oil distributed throughout the brain were dynamically changed with time. Conclusion It is important to recognize intraventricular silicone oil in a particular location.More important is to discover “the real murderer”, which is the main cause of symptoms in the vicinity of special location. Moreover, the migration of silicone oil between eyeball and brain may not be always in a single direction.

Intravitreal Silicone Oil Migration Into the Lateral Cerebral Ventricles

Purpose: Silicone oil (SO) is often used as an intraocular tamponade in repairs of retinal detachments. It may be associated with complications such as cataract, glaucoma, keratopathy, subretinal migration of oil, fibrous epiretinal and sub retinal proliferations, and oil emulsification. The purpose of this report is to describe a rare phenomenon of intraocular silicone oil migration into the cerebral ventricles, which may later be mistaken for intraventricular hemorrhages on neuroimaging. Methods: Case report with literature review. Results: A patient with a history of retinal detachment repair with intraocular SO presented with headaches. Neuroimaging revealed SO migration to the cerebral ventricles. The patient was treated conservatively with symptom management and headaches resolved. Conclusions: We present a case of intraocular SO migration to the cerebral ventricles and review the current literature. We also propose two mechanisms for this phenomenon.

A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for the Treatment of Idiopathic Macular Hole with Air or C3F8 Intraocular Tamponade

Purpose. The treatment of idiopathic macular holes has been basically modeled, and vitreoretinal surgery is recognized as an effective treatment. However, the postoperative tamponade of gas will still make the patient uncomfortable and may have related complications. The purpose of this study is to investigate whether air as an intraocular tamponade is equivalent to gas and what advantages may exist. Methods. A retrospective study was performed in one hundred and ninety-eight patients from 2013 to 2017; 112 received gas tamponade and 86 received air tamponade. After receiving retinal surgery, the outcomes of best corrected visual acuity, intraocular pressure, slit lamp examination, fundus examination, and imaging of the macula by spectral-domain optical coherence tomography were analyzed. Results. Before operation, there was no statistically significant difference in age, sex, macular hole diameter, or visual acuity between groups. The median follow-up period for the C3F8 group was 26 months, and the median follow-up for the air group was 25 months. After the operation, the best corrected visual acuity and macular hole closure rate were not significantly different between the two groups. The face-down time after the operation, the incidence of lens opacity on the third postoperative day, the intraocular pressure on the third postoperative day, and the operation time were significantly different between the two groups. Conclusions. In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material can be similar to that of C3F8 but has fewer complications. In particular, it is a better choice for patients for whom the face-down position is not suitable.