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Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.
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Objective@#This small case series demonstrated pars plana vitrectomy and silicone tamponade without internal limiting membrane (ILM) peeling to be a simple, safe, and effective surgical technique for the treatment of myopic traction maculopathy (MTM).@*Methods@#This is a small case series consisting of 3 eyes with MTM. In all eyes, pars plana vitrectomy with silicone oil tamponade was performed by a single vitreoretinal surgeon. Functional and anatomic outcomes are reported.@*Results@#All 3 eyes had improved visual acuity with no noted short-term complications such as iatrogenic macular hole and retinal detachment. Although foveoschisis was only partly anatomically resolved in 2 out of the 3 cases, functional outcome, in terms of visual acuity at last visit, was satisfactory.@*Conclusion@#Vitrectomy with silicone oil tamponade without ILM peeling is a simple, effective, and safe optional surgical technique to treat MTM.
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Background: Vitreomacular traction (VMT) is a commonly encountered entity in our routine practice. The key question is whether to observe or operate by clinical and imaging based judgement of the visual prognosis in every case. Purpose: This video encapsulates diagnostics, surgical method, and prognosis in a case of VMT released with vitrectomy. Synopsis: A 56-year-old businessman was diagnosed with VMT in the OPD and was advised surgical release of the same. The patient was extremely keen to know the visual prognosis, where the OCT imaging helped. The surgical method demonstrates the method to find the edge of the PVD to release the traction. Also, a simple ILM peel procedure has been described to reduce recurrences in cases like these. Highlights: 1. Judging the prognosis in VMT cases on basis of imaging. 2.Finding the edge (FTE) method of inducing the PVD. 3. ILM peeling simplified
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Background: Falciform folds are congenital tractional retinal folds due to strong contractile forces and hyperextensibility of retina resulting in temporal dragging of the macula and often associated with familial exudative vitreoretinopathy and retinal detachment (RD). Retinologists are reluctant to treat these entities in view of their poor visual recovery. Purpose: To describe a novel surgical technique to unfold the falciform folds. Synopsis: This video demonstrates innovative surgical techniques to remove both pre?retinal and sub?retinal adhesions and unfold these folds, managing its consequences and visual recovery. We describe cases of congenital falciform folds with poor visual acuity, where we did vitrectomy, membrane adhesion removal, peeling of the internal limiting membrane (ILM) the macula, mechanical stretching of the folded retina by Tanno scraper or Finesse flex loop, then sub?retinal injection of balanced salt solution (BSS) by 38 gauge sub?retinal needle o create multiple blebs around the folded retina and finally sulphur hexafluoride tamponade. Post? operative macular hole with RD can be a complication. When this falciform fold is complicated by RD, there is risk of intraoperative subretinal migration of infusion cannula and therefore the need for peripheral relaxing retinectomy for redundant retinal fold as well as silicone oil as endotamponade. Vision improved in all our patients after the surgery. Highlights: Both long?standing pre? retinal adhesions as well as sub?retinal adhesions are responsible for he tformation of congenital falciform folds. For pre?retinal adhesions, vitrectomy with removal of all the adhesions along with peeling of the sticky ILM and then mechanical stretching of folded retina by Tanno scraper or Finesse flex loop are necessary. To remove sub?retinal adhesions, sub?retinal injection of BSS is necessary to stretch the folded retina from behind, but it should be done away from the retina to avoid formation of macular hole.
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Purpose: To evaluate the outcome of vitrectomy with multilayered inverted internal limiting membrane flap technique (ML?IILM) versus vitrectomy with standard ILM peeling for large macular holes in terms of visual acuity and anatomical closure. Methods: A hospital?based, prospective, randomized, interventional study was conducted during three calendar years with a total 150 eyes (75 in each group) in two groups—vitrectomy with ILM peeling (Group A) and vitrectomy with ML?IILM flap technique (Group B) after informed consent of study participants who met the inclusion criteria. Results: The mean minimum and maximum diameter of macular hole did not differ statistically in both the groups. Macular hole index had no significant difference between both groups Pre?operative visual acuity was not statistically significantly different between the two groups. During follow?up, best corrected visual acuity (BCVA) at 1 month, 3 months, 6 months, and 12 months was significantly better in Group B (0.12 ± 0.07 at 1 month, 0.14 ± 0.10 at 3 months, 0.18 ± 0.11 at 6 months, and 0.19 ± 0.12 at 12 months) compared to Group A (0.20 ± 0.11 at 1 month, 0.22 ± 0.13 at 3 months, 0.30 ± 0.12 at 6 months, and 0.31 ± 0.14 at 12 months) (P = 0.001 for each). Type 1 anatomical closure (flattening of cuff and opposition of edges of hole) was achieved in 78.66% (59/75) cases in Group A and 93.33% (70/75) cases in Group B (P 0.0016). Conclusion: Vitrectomy with multilayered inverted ILM flap technique had significantly higher anatomical closure and better visual outcome than vitrectomy with standard ILM peeling
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PURPOSE: To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery. METHODS: The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. 'Asymmetric elongation' was defined as non-uniform elongation of the foveal tissue in certain directions. RESULTS: Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 +/- 88.54 / 404.92 +/- 78.55 microm; group A, 421.33 +/- 109.97 / 404.14 +/- 120.9 microm; and C group, 389.25 +/- 48.75 / 400 +/- 52.23 microm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 +/- 65.64 / 103.92 +/- 73.37 microm; group A, 88.11 +/- 41.57 / 75.89 +/- 53.18 microm; and group C, 140.25 +/- 68.51 / 83.63 +/- 56.62 microm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups. CONCLUSIONS: Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.
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Humans , Medical Records , Membranes , Retinal Perforations , Retrospective Studies , Tomography, Optical Coherence , VitrectomyABSTRACT
PURPOSE: To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery. METHODS: The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. 'Asymmetric elongation' was defined as non-uniform elongation of the foveal tissue in certain directions. RESULTS: Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 +/- 88.54 / 404.92 +/- 78.55 microm; group A, 421.33 +/- 109.97 / 404.14 +/- 120.9 microm; and C group, 389.25 +/- 48.75 / 400 +/- 52.23 microm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 +/- 65.64 / 103.92 +/- 73.37 microm; group A, 88.11 +/- 41.57 / 75.89 +/- 53.18 microm; and group C, 140.25 +/- 68.51 / 83.63 +/- 56.62 microm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups. CONCLUSIONS: Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.
Subject(s)
Humans , Medical Records , Membranes , Retinal Perforations , Retrospective Studies , Tomography, Optical Coherence , VitrectomyABSTRACT
PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) removal during vitrectomy in proliferative diabetic retinopathy (PDR) patients. METHODS: Seventy-four eyes of 74 PDR patients who underwent vitrectomy were enrolled. All patients had been followed for at least one year. Thirty-three patients who underwent vitrectomy without ILM peeling from January 2004 to February 2005 were assigned to Group A and 41 patients who underwent vitrectomy with ILM peeling from March 2005 to October 2005 were assigned to Group B. Visual acuity (LogMAR), central macular thickness measured by optical coherent tomography (OCT), and presence or absence of macular edema were compared between the two groups at six months and one year after surgery. RESULTS: Postoperative mean best corrective visual acuity (BCVA; LogMAR) were improved significantly in both groups at six months and one year after surgery. However, the overall amount of improvement in vision was not different between the two groups. The mean central forveal thickness in Group B was significantly thinner than in Group A at six months and one year after surgery. There was no difference between the two groups in macular edema incidence at that time. There were no serious complications in Group B by one year after surgery. CONCLUSIONS: There was no difference in visual acuity between the Group A and Group B However, the central forveal thickness measured by OCT was thinner in the ILM peeling group, and there were no serious complications in ILM peeling group. Routine ILM peeling during vitrectomy in PDR will help to maintain the structural stability of the macula postoperatively.