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Introducción: El agujero macular idiopático se caracteriza como la pérdida central de la agudeza visual. La presentación bilateral se presenta con una frecuencia desde el 4,8 hasta el 30 por ciento y el cierre espontáneo para diámetros menores a 250 um es de 3,5 por ciento. Objetivo: Describir las formas de presentación y tratamientos alternativos en pacientes con agujero macular idiopático. Presentación de caso: Paciente mujer de 66 años sin antecedentes médicos que presenta un agujero macular idiopático bilateral y simultáneo. En el examen de tomografía de coherencia óptica del ojo derecho presentó 190 um y del ojo izquierdo 210 um. En el ojo izquierdo se le realizó intervención quirúrgica y en el ojo derecho presentó un cierre espontáneo con evolución favorable anatómica y funcional. Conclusiones: Los agujeros maculares idiopáticos se pueden presentar de manera bilateral. Las opciones terapéuticas y el manejo quirúrgico son algunas de las alternativas para su atención(AU)
Introduction: Idiopathic macular hole is characterized as central loss of visual acuity. Bilateral presentation occurs with a frequency from 4.8 percent to 30 percent and spontaneous closure for diameters less than 250 um is 3.5 percent. Objective: To describe the forms of presentation and alternative treatments in patients with idiopathic macular hole. Case presentation: We present a case of a 66-year-old female patient with no medical history presenting with a simultaneous bilateral idiopathic macular hole. Optical coherence tomography examination of the right eye showed 190 um and of the left eye 210 um. In the left eye she underwent surgical intervention and in the right eye she presented spontaneous closure with favorable anatomical and functional evolution. Conclusions: Idiopathic macular holes can present bilaterally and therapeutic options and surgical management are some of the alternatives for their care(AU)
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Humans , Female , Aged , Retinal Perforations/therapyABSTRACT
AIM: To analyze the application value of spectral domain-optical coherence tomography(SD-OCT)parameters on evaluating visual acuity improvement after internal limiting membrane peeling of macular hole.METHODS: The retrospective analysis was performed on the clinical data of 82 patients(82 eyes)with idiopathic macular hole(IMH)who underwent vitrectomy + internal limiting membrane peeling + long-acting gas tamponade in the hospital between May 2019 and February 2021. The correlation between IMH closure and SD-OCT parameters at 3mo after surgery was analyzed, and the risk factors for poor postoperative visual acuity improvement were evaluated.RESULTS: Spearman rank correlation coefficient analysis showed that IMH closure at 3mo after operation was positively correlated with preoperative external limiting membrane(ELM)defect diameter(rs=0.308, P<0.05), and it was negatively correlated with preoperative macular hole index(MHI; rs=-0.266, P<0.05). Logistic regression analysis revealed that preoperative MHI≥0.5 was a protective factor affecting poor postoperative visual acuity improvement(OR=0.691, P<0.05).CONCLUSION: SD-OCT can predict the surgical efficacy by detecting the preoperative MHI and ELM defect diameter, and it is beneficial to judging the improvement of visual function.
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@#AIM:To investigate the efficacy and safety of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap and PPV combined with ILM tamping in the treatment of large basal diameter idiopathic macular hole(IMH), and to analyze the correlation between postoperative visual acuity and preoperative parameters. <p>METHODS:This study is a retrospective clinical study. Totally 56 patients(57 eyes)with macular hole bottom diameter greater than 1 000μm, who treated in Joint Shantou International Eye Center from January 2018 to December 2020, were enrolled in this study. Thirty eyes were involved in PPV combined with inverted ILM flap(Group 1)and 27 eyes were involved in PPV combined with ILM tamping(Group 2). The best corrected visual acuity(BCVA), the closure of the macular hole, thickness of foveal neurosensory layer and complications were compared between the two groups at 1wk and 1mo after the surgery. Person correlation analysis was used to explore the correlation between preoperative parameters and BCVA at 1mo after operation.<p>RESULTS: There was no significant difference in gender, age, eye type, course of disease, preoperative BCVA, postoperative macular hole healing classification, preoperative hole bottom diameter and eye axis between the two groups(P>0.05). The closure rate of macular hole in Group 1 was 97%, of which type 1 closure was 80%. The closure rate of macular hole in Group 2 was 100%, of which type 1 closure was 78%, and there was no significant difference in the closure rate(P=0.99). The postoperative follow-up BCVA of patients in both groups was better than that before operation(all P<0.01). The BCVA of Group 1 was better than Group 2 at 1mo after operation, and the difference was statistically significant(t= -2.20, P=0.03). There was no significant difference in the thickness of foveal neurosensory layer between two groups at 1mo after operation(t=0.407, P=0.69). The BCVA at 1mo after operation was positively correlated with the hole diameter and preoperative BCVA(r=0.435, P=0.004; r=0.440, P=0.001). There was no complication in both groups during and after operation. <p>CONCLUSION:PPV combined with inverted ILM flap and PPV combined with ILM tamping can improve the closure rate of the hole. The long-term visual acuity of PPV combined with inverted ILM flap is better than that of PPV combined with ILM tamping. There is a significant positive correlation between postoperative BCVA and the bottom diameter of the hole and preoperative BCVA. Preoperative bottom diameter can be used as one of the basis for clinical prognosis.
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Objective:To observe the changes of visual acuity and fixation properties of eyes with idiopathic macular hole (IMH) before and after surgery.Methods:A prospective clinical study. From September 2019 to December 2020, 25 patients with 25 eyes of IMH diagnosed in Department of Ophthalmology of The Fourth People's Hospital of Shenyang were included in the study. All patients underwent pars plana vitrectomy (PPV) combined with internal limiting membrane stripping. All eyes underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and microperimetry before and after surgery. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into logarithmic minimum resolution angle (logMAR) visual acuity during statistics. The 12° macular sensitivity (MS) and bivariate contour ellipse area (BCEA) were measured by MP-3 microperimetry. The minimum diameter (MIN) and base diameter (BASE) of the macular hole were measured by OCT; the distance between the preferred retinal location (PRL) and the center of the fovea was measured by Image-proplus 6.0 image processing software. At 1 and 3 months follow-up after surgery, the same equipment and methods as before surgery were used to conduct related examinations. The changes of BCVA, PRL distance from the fovea, MS, BCEA, and macular hole shape before and after surgery were compared and observed. One-way analysis of variance was used to compare the indicators before and after surgery. Pearson correlation analysis was used for the correlation between BCVA and preoperative BCVA, PRL and foveal center distance at 3 months after surgery. The correlation between MIN, BCVA, PRL and foveal center before surgery distance, MS, BCEA and BCVA at 3 months after surgery were analyzed by multiple linear regression.Results:Among 25 eyes of 25 cases, 1 male had 1 eye, and 24 females had 24 eyes. The macular hole in stage Ⅲ and Ⅳ were 11 eyes and 14 eyes, respectively. MIN and BASE were 537.68±200.09 and 905.48±278.79 μm, respectively. One month after surgery, the hiatus was closed. Before surgery and 1 and 3 months after surgery, the logMAR BCVA of the affected eyes were 0.80±0.17, 0.70±0.21, 0.60±0.25, and the MS were 22.20±3.86, 23.60±3.14, 24.38±2.68 dB, the distances between PRL and the center of the fovea were 537.72±426.05, 402.00±395.06, 236.80±219.54 μm, and BCEA were 7.90±3.43, 6.40±2.67, 4.80±2.32 deg 2. Compared with before operation, BCVA ( F=7.047, 20.104) and MS ( F=1.980, 5.390) were significantly improved at different time after operation, the distance between PRL and fovea center ( F=1.265, 9.530), BCEA ( F=2.762, 13.617) were decreased, the difference were statistically significant ( P<0.05). The results of correlation analysis showed that BCVA at 3 months after surgery was significantly associated with preoperative MIN ( r=0.810), BASE ( r=0.664), BCVA before surgery and 1 month after surgery ( r=0.854, 0.940), preoperative and surgical MS at 1 month after surgery ( r=-0.548, -0.578), distance between PRL and foveal center before surgery and at 1 month after surgery ( r=0.833, 0.915), BCEA before surgery and at 1 month after surgery ( r=0.636, 0.732) were significantly correlated ( P<0.05). The results of multiple linear regression analysis showed that the distance between PRL and foveal center before surgery and BCVA were risk factors for poor prognosis of BCVA at 3 months after surgery. Conclusions:The BCVA and MS of eyes with IMH are significantly improved after surgery, and the distance between PRL and foveal center and BCEA decreased. BCVA, PRL and foveal center distance before surgery are risk factors for poor visual acuity after surgery.
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@#AIM:To investigate the efficacy and safety of different fillers combined with vitrectomy and internal limiting membrane stripping in the treatment of idiopathic macular hole(IMH).<p>METHODS: This retrospective study included 117 patients(117 eyes)with IMH who were admitted to the department of ophthalmology in the hospital between July 2018 and March 2020. Both groups were treated with vitrectomy combined with internal limiting membrane stripping. Sixty-five patients(65 eyes)receiving air filling were included in the air group, while 52 cases(52 eyes)receiving C3F8 filling were included in the C3F8 group. Re-examination was performed before operation and at 1, 2, and 3mo after operation. The rate of hole closure, closed shape, visual acuity, central macular thickness(CRT), exterior limiting membrane(ELM)defect diameter, ellipsoid band defect diameter, intraocular pressure, and the incidence of postoperative complications at the last follow-up were counted. <p>RESULTS: The postoperative air absorption time of air group and C3F8 group was 8.55±2.17d and 25.74±7.41d, respectively(<i>P</i><0.05). The macular hole closure rates in air group and C3F8 group were 95.4% and 98.1%, respectively(<i>P</i>>0.05). There were no significant differences in the proportions of different shapes of closed holes between the two groups(<i>P</i>>0.05). Visual acuity of the two groups was significantly improved at 3mo after operation(<i>P</i><0.001). There were no significant differences in LogMAR visual acuity and visual acuity changes between air group and C3F8 group(<i>P</i>>0.05). The CRT was increased significantly after operation(<i>P</i><0.001), and the diameters of ELM defect and ellipsoid band defect were reduced(<i>P</i><0.001). There were no significant differences in above indicators between the two groups(<i>P</i>>0.05). There was no significant difference in intraocular pressure between the two groups before and after treatment(<i>P</i>>0.05). No serious complications were observed in the two groups. <p>CONCLUSION: Vitrectomy and internal limiting membrane stripping combined with air filling and C3F8 filling are effective and safe in the treatment of IMH. Clinically, the operation mode can be selected according to the actual situation.
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@#AIM: To explore the safety and efficacy of air tamponade in the closure of large idiopathic macular holes(IMHs).<p>METHODS: A retrospective study. Nine eyes of eight patients with large IMH were admitted to our hospital from June 2017 to may 2018. Mean macular hole(MH)minimum diameter >700 μm and mean MH basal diameter >1 300 μm. All the patients were underwent 25G phacovitrectomy, internal limiting membrane flaptuck, and sterilized air tamponade in the vitreous cavity. With a mean follow up of 12mo, the best-corrected visual acuity(BCVA)and macular hole closure were compared before and after operation.<p>RESULTS: At the last follow up, all the patients obtained MH closure. The SD-OCT showed that the postoperative MH closure rate was 100%(9/9). Postoperative BCVA improved significantly compared with the preoperative(0.83±0.26 <i>vs</i> 1.27±0.28), the difference was statistically significant(<i>P</i>=0.007). No complications occurred during and after the operation.<p>CONCLUSION: Sterilized air tamponade might provide a safe and efficient effect on the closure of large IMHs.
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@#AIM: To observe the effect of pars plana vitrectomy(PPV)internal limiting membrane(ILM)insertion and nerve growth factor(NGF)injection in the treatment of large idiopathic macular hole(IMH). <p>METHODS: This was a retrospective clinical study which included 16 patients(16 eyes)with large IMH diagnosed in the Affiliated Eye Hospital of Nanjing Medical University from May 2018 to May 2020. All patients were treated with PPV combined with ILM insertion and NGF injection and the follow-up period was at least 6mo. Macular hole closure rates, best-corrected visual acuity(BCVA)(LogMAR), and optical coherence tomography(OCT)findings including ellipsoid zone(EZ)and external limiting membrane(ELM)were analyzed, the complications were also observed postoperatively.<p>RESULTS: The BCVA was 1.15±0.21 before operation, and the follow-up of BCVA was 1.02±0.19 and 0.87±0.24 respectively at 3 and 6mo after operation(<i>F</i>=34.966, <i>P</i><0.01); The BCVA was improved 3 and 6mo after operation(<i>P</i><0.01), and the BCVA at 6mo after operation was better than that at 3mo(<i>P</i><0.01). The closure rate of the MH was 100% and 11 eyes showed U-shaped closure in OCT(69%), 3 eyes were V-shaped closure(19%)and 2 eyes were irregular closure(13%). The BCVA of U-shaped closure group, V-shaped closure group and irregular closure group were 0.75±0.18, 1.1±0.19, and 1.20±0.00 respectively(<i>F</i>=6.937, <i>P</i><0.01). The recovery of BCVA in U-shaped closure group was significantly better than that in V-shaped closure group and irregular closure group(<i>P</i>=0.027, 0.007). Six months after operation, 10 eyes(91%)of ELM and 7 eyes(64%)of ellipsoid zone resumed continuity in U-shaped closure group, 2 eyes(67%)of ELM and 1 eye(33%)of resumed continuity in V-shaped closure group. ELM and ellipsoidal zone were not recovered continuously in irregular closure group(<i>P</i><0.05). During the follow-up period, we found no ocular or systemic complications.<p>CONCLUSION: PPV combined with ILM insertion and NGF injection is safe and effective in treating large IMH. The synergetic effect of NGF and ILM can obviously promote the closure of IMH, which is beneficial to the recovery of photoreceptor layer integrity and the improvement of visual function after operation.
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@#AIM: To explore the effects of internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling in treatment of idiopathic macular hole(IMH)and the influence on macular structure and choroidal thickness.<p>METHODS: Clinical data of patients with IMH who were treated in the hospital between January 2017 and December 2019 were retrospectively analyzed. All patients were treated with standard vitrectomy combined with internal limiting membrane stripping and gas-liquid exchange. On this basis, patients treated with internal limiting membrane transplantation(28 cases, 29 eyes), inverted internal limiting membrane flap(26 cases, 28 eyes)and autologous blood filling(25 cases, 25 eyes)were included in the internal limiting membrane transplantation group, inverted internal limiting membrane flap group and autologous blood filling group, respectively. The situation of hole closure and shape of the closed hole were observed. The best corrected visual acuity(BCVA), hole photoreceptors inner segment/outer segment ellipsoid zone(EZ)and external limiting membrane(ELM)defect diameter, perimeter of foveal avascular zone(PERIM), superficial capillary plexus(SCP)blood flow density, subfoveal choroidal thickness(SFCT), temporal choroidal thickness(TCT)and nasal choroidal thickness(NCT)were determined. <p>RESULTS: All patients in the 3 groups successfully completed the surgery. The BCVA of internal limiting membrane transplantation group and inverted internal limiting membrane flap group was better than that of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in macular hole closure rate and ellipsoid closure rate among the 3 groups(<i>P</i>>0.05). However, there were significant differences in morphological classification of the closed macular hole(<i>P</i><0.05), and the proportion of U-shaped hole was the highest in inverted internal limiting membrane flap group. The diameters of EZ defect and ELM defect of internal limiting membrane transplantation group and inverted internal limiting membrane flap group were smaller than those of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in PERIM, SCP blood flow density, SFCT, TCT and NCT among the 3 groups before and after surgery(<i>P</i>>0.05). <p>CONCLUSION:Internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling can restore the closure of the macular hole. However, internal limiting membrane transplantation and inverted internal limiting membrane flap can better restore the macular structure and improve visual acuity, compared with autologous blood filling.
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Macular hole in the pediatric age group is usually post-traumatic unlike, the adult counterpart. Herein we describe a case of idiopathic macular hole occurring in a 9-year-old male who presented to us with complaints of diminution of vision in OD (oculus dextrus) for 2 months. The child underwent 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. On follow-up his best-corrected visual acuity improved with type 1 closure of macular hole.
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@#AIM: To investigate the efficacy of pars plana vitrectomy(PPV)with inner limiting membrane(ILMP)flap peeling and flute needle drawing in the treatment of idiopathic macular hole(IMH)without staining dye.<p>METHODS: A retrospective non-randomized case study on 76 patients(76 eyes)were diagnosed with IMH in our hospital from January 2018 to January 2019, 38 eyes were treated with PPV combined with ILMP and air tamponade without staining(group A), the remaining 38 eyes were treated with PPV combined with ILMP, needle drawing the Hole edge and air tamponde without staining(group B). The patients were followed up for more than 6mo, the macular hole closure, the best correct visual acuity(BCVA)and postoperative complication were analyzed in the two groups.<p>RESULTS: At 6mo after surgery, the closure rate of MH and BCVA improvement rate in group A were significantly lower than those in the group B(84% <i>vs</i> 100%, 76% <i>vs</i> 95%, <i>P</i><0.05). With the passage of postoperative time after surgery, the BCVA of two groups of patients gradually improved, and the BCVA of group B was better than that of group A at 7, 14d, and 1, 3, 6mo after surgery(<i>P</i><0.05). There were no postoperative complications in two groups.<p>CONCLUSION: PPV combined with ILM peeling without staining agent and flute needle drawing is effective in treating IMH, which is better than ILM-P group in both closure rate and BCVA improvement.
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@#AIM: To explore changes of choroidal blood flow post vitrectomy in idiopathic macular hole(IMH), and to discuss the role of choroidal microstructure changes abnormality in macular hole formation.<p>METHODS: Totally 56 eyes of 56 patients diagnosed with unilateral IMH were included(2014-05/2015-12). All patients received pars planar vitrectomy, indocyanine green assisted inner limiting membrane peeling combined with intraocular +12%C3F8 tamponade. Patients with cataract received phacoemulsification and intraocular lens implantation. Choroidal thicknesses were measured at 9 points before and at 1, 3 and 6mo after the surgery, namely the fovea, 1mm and, 3mm above, below, nasal and temporal to the fovea.<p>RESULTS: Preoperative SFCT value was 233.43±84.638μm, and at 1, 3, 6mo follow-up SFCT were 242.46±88.199μm, 238.97±89.252μm, and 236.71±88.661μm, respectively. SFCT at 1mo after surgery was significantly increased compared to preoperative thickness(<i>P</i><0.05). 1, 3, and 6mo after the surgery the choroidal thickness at 3mm below the fovea(ICT3mm)(179.63±62.941μm, 179.74±65.981μm, 180.80±58.379μm)gradually increased compared with those before the surgery(170.89±57.040μm). However, there was no significant difference between ICT3mm values at each time point. 1, 3, and 6mo after the surgery the choroidal thickness at 1mm below the fovea(ICT1mm)(216.31±80.297μm, 214.54±75.693μm, 205.69±68.697μm)compared with those before the surgery(207.37±67.502μm)have statistical significance. Compared 6mo after the surgery with 1mo after the surgery have statistical significance with ICT1mm values at each time point(<i>P</i><0.05).<p>CONCLUSION: SFCT of the study eyes showed a transient increase at 1mo follow up, then gradually returned to the base line. As the macular hole successfully closed, the choroidal thickness didn't not show difference compared with baseline, indicating that the decreasing in choroidal thickness is possibly the cause to the formation of the macular hole, not the results. IMH postoperative choroidal thickness values change by location, which may be due to the oppression by the injected gas in the macular hole surgery.
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@#Idiopathic macular hole(IMH)refers to a full-thickness tissue defect of the retinal neuroepithelial layer in the macular region without obvious etiology. At present, with the gradual deepening of the understanding of IMH and the continuous innovation and improvement of its treatment methods, its treatment technology has also matured and diversified. Studies have shown that early IMH with small diameter can be observed and followed up. The Ocriplasmin has been approved for use in patients with small to medium sized macular holes and vitreomacular adhesion(VMA); internal limiting membrane(ILM)removal can improve anatomical closure rate. However, for IMH with a diameter of less than 250μm, it is uncertain whether ILM removal is always required. This paper discusses the pathogenesis, stages, classification and current treatment of IMH. Based on the characteristics of IMH and patient differences, an evidence-based medicine method is proposed to select the best and most practical treatment plan for individual patients.
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@#Idiopathic macular hole(IMH)refers to the defect of retinal nerve epidermis in macular area with unknown pathogenesis. As present, pars plana vitrectomy combined with internal limiting membrane peeling has become a normal operation for the treatment of IMH, which enables most IMH patients to achieve anatomic healing, however, it is still unclear about the healing mechanism. The role of the glial cell activation in the pathological process of nervous system injury and disease has paid more and more attention. Nearly all the injuries and diseases of nervous system(including retina)are accompanied by the activation of glial cells; and Müller cells are the main type of glial cells in the human retina. In terms of anatomy and function, they are widely related to the cell bodies and processes of neurons in all layers of the retina, and play a supporting, nutritional and information transmission role in neurons. Numerous studies have shown that the activation and proliferation of Müller cells play a leading role in closed MH. It is reviewed in this paper that the role and its related mechanisms of Müller cells in the formation and healing of IMH.
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Objective@#To analyze the efficacy and safety of inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation for idiopathic macular hole (IMH) with cataract.@*Methods@#From January 2018 to July 2018, fifty-seven patients (57 eyes) with IMH treated with 23G vitrectomy in Renmin Hospital of Wuhan University, were included. The patients were divided into 2 groups. 41 eyes underwent inverted internal limiting membrane flap technique (A group), and 16 eyes underwent inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation (B group). The visual acuity recovery, macular hole changes and the incidence of complications were analyzed retrospectively.@*Results@#The best corrected visual acuity of the two groups was significantly improved after 6 months (P < 0.01), and there was no significant difference between group A and group B (P= 0.43). The closure rate of macular hole was 100.0% in both groups. There were 11 eyes (26.8%, 11/41) of group A and 5 eyes (5/16) of group B with temporarily increased intraocular pressure (P= 0.75), and 4 eyes (9.8%, 4/41) of group A and 6 eyes (6/16) of group B with temporary corneal edema (P < 0.01). Complicated cataract was found in 7 eyes of group A (17.1%, 7/41). Concurrently, posterior capsular opacity occurred in 1 case (1/16) of group B. No iatrogenic retinal breaks, macular edema, choroidal neovascularization or infective endophthalmitis occurred in both groups.@*Conclusions@#Inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation for IMH with cataract can achieve higher anatomical reduction rate and hole healing rate, and significantly improve the visual acuity of patients while avoiding secondary surgery. It is a safe and effective surgical operation.
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@#AIM:The repair of macular structure after 23G vitrectomy was performed in patients with idiopathic macular hole, and the changes of retinal thickness in vision and macular area were analyzed.<p>METHODS: A total of 85 patients(85 eyes)with monocular idiopathic macular hole who underwent elective surgery in our hospital from June 2016 to December 2017 were included in the study, of which 37 were male and 48 were female, with an average age of(64.7±10.1)years. All subjects underwent 23G vitrectomy were observed the closure of macular hole after operation, and the changes of retinal thickness in macular forea were observed preoperatively and postoperatively by optical coherence tomography(OCT). To observe the changes of the best corrected visual acuity(BCVA)in preoperative, 1mo, 3mo and 6mo after operation.<p>RESULTS: All subjects underwent postoperative examinations had good macular hole closure. The average BCVA of 3mo and 6mo after operation were significantly higher than that of preoperative and 1mo after operation(<i>P</i><0.05); the average BCVA in 6mo after operation was significantly higher than the average BCVA of 6mo after operation, with statistically significant differences(<i>t</i>=7.983, <i>P</i>=0.037). The macular central fovea thickness in 1mo after operation was significantly higher than preoperative and 3mo, 6mo after operation(<i>P</i><0.05); The retinal thickness of the macular fovea thickness in 3mo and 6mo after operation were significantly lower than that of preoperative.<p>CONCLUSION:The treatment of idiopathic macular hole with 23G vitrectomy had a high degree of successful closure rate of fracture hole and the visual acuity of patients was obviously improved.
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Objetivo: identificar la aparición de signos tempranos para el desarrollo de agujero macular idiopático en el ojo contralateral, mediante tomografía de coherencia óptica. Métodos: se realizó un estudio longitudinal, prospectivo-descriptivo de serie de casos. Se estudiaron 208 ojos de 104 pacientes con diagnóstico de agujero macular idiopático atendidos en la consulta externa del Servicio de Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre diciembre del año 2008 y diciembre de 2011. Los pacientes fueron estudiados posteriormente por un periodo de cinco años. Se evaluaron las variables demográficas, la agudeza visual mejor corregida, los estadios de agujero macular por tomografía de coherencia óptica y se determinó la estabilidad, la progresión o la regresión de los hallazgos al año y a los cinco años en el ojo contralateral. En el análisis estadístico se empleó el porcentaje y las comparaciones de frecuencias, para lo cual se utilizó el estadígrafo Chi cuadrado con un nivel de significación del 95 por ciento. Resultados: la edad promedio fue de 65,8 y predominó el sexo femenino. El 43,3 por ciento del ojo contralateral tenía alteraciones en la interfase vitreomacular al inicio del estudio. En la evolución al año y a los cinco años se observaron diferencias significativas (p= 0,000) en la distribución de casos en los diferentes estadios. Al año se mostró estabilidad en el 78,3 por ciento comparado con el 54,6 por ciento a los cinco años. La progresión a estadios más avanzados fue escasa y similar en los dos periodos de estudio (8,2 y 7,2 por ciento respectivamente). Hubo regresión de un 13,4 por ciento al año y 38,1 por ciento a los cinco años. El desprendimiento posterior del vítreo completo lo presentaron más del 60 por ciento de los ojos al final del estudio. Desarrollaron agujero macular idiopático de espesor completo el 4,8 por ciento de los ojos contralaterales. Existió disminución de la visión en aquellos pacientes con progresión a estadios más avanzados (p= 0,001). Conclusiones: la tomografía de coherencia óptica resulta un método diagnóstico efectivo para la evaluación de los cambios anatómicos en los pacientes con agujero macular idiopático. Es necesario el seguimiento periódico para lograr una conducta quirúrgica temprana y una recuperación visual óptima, ya que se trata del segundo ojo afectado(AU)
Objective: identify the appearance of early signs of the development of idiopathic macular hole in the contralateral eye using optical coherence tomography. Methods: a prospective longitudinal descriptive study was conducted of a case series. The study sample was 208 eyes of 104 patients diagnosed with idiopathic macular hole attending outpatient consultation at the Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from December 2008 to December 2011, after which period the patients were followed-up for five years. Evaluation was carried out of demographic variables, best corrected visual acuity and macular hole stage by optical coherence tomography, determining the stability, progression or regression of findings one and five years later in the contralateral eye. Statistical analysis was based on percentage and frequency comparisons, using the chi square statigram with a significance level of 95 percent. Results: mean age was 65.8 years. Female sex prevailed. At the start of the study, 43.3 percent of the contralateral eyes presented alterations in the vitreo-macular interface. Significant differences were found between evolution at one and five years (p= 0.000) regarding the distribution of cases in the various stages. Stability was 78.3 percent at one year and 54.6 percent at five. Progression to more advanced stages was scant, with similar values in the two study periods (8.2 percent and 7.2 percent, respectively). Regression was 13.4 percent at one year and 38.1 percent at five. Posterior detachment of the entire vitreous was present in more than 60 percent of the eyes at the end of the study. Full thickness idiopathic macular hole developed in 4.8 percent of the contralateral eyes. There was vision reduction in patients with progression to more advanced stages (p= 0.001). Conclusions: optical coherence tomography is an effective diagnostic method to evaluate anatomical changes in patients with idiopathic macular hole. Periodic follow-up is required for early determination of the most appropriate surgical management to achieve optimal visual recovery, since this is the second eye affected(AU)
Subject(s)
Humans , Female , Middle Aged , Retinal Perforations/diagnosis , Tomography, Optical Coherence/methods , Epidemiology, Descriptive , Prospective Studies , Longitudinal StudiesABSTRACT
Objective:To study the foveal displacement during the closure of idiopathic macular holes (MHs).Methods:Thirty-seven idiopathic MH patients treated by pars plana vitrectomy and internal limiting membrane peeling were studied prospectively. Locations of MH center and foveal pit were measured by optic coherence tomography. Retinal displacement was observed using confocal scanning laser ophthalmoscopy.Results:A total of 40 eyes were included in this study and MHs were closed in 37 eyes (92.5%). The confocal scanning laser ophthalmoscopy showed that all of the retinal capillaries in the superior, inferior, nasal and temporal sides of the MHs moved toward the optic nerve head (ONH). The optic coherence tomography results showed that the mean nasal displacements of foveal pits were (102.9±61.2), (109.6±53.1), and (137.0±52.0) μm at 3, 6 and 12 months, respectively. And the mean vertical displacements were (55.9±49.4), (61.4±57.8) and (67.8±54.3) μm, respectively. Post-operative foveal pits were located in the nasal side of the MH centers. The extension of retina and nasal to the MH were in opposite directions: the nasal hole margin moved toward the MH, but the retina located closer to the ONH moved toward the ONH. The fellow eyes of three patients developed into idiopathic MH during the follow-up period and operations were performed for all of the three patients.Conclusion:Our results showed that center of macula does not move when an idiopathic MH develops, but it moves toward ONH during closure of hole; thus, new fovea is in nasal side of original fovea.
ABSTRACT
Objective: To study the foveal displacement during the closure of idiopathic macular holes (MHs). Methods: Thirty-seven idiopathic MH patients treated by pars plana vitrectomy and internal limiting membrane peeling were studied prospectively. Locations of MH center and foveal pit were measured by optic coherence tomography. Retinal displacement was observed using confocal scanning laser ophthalmoscopy. Results: A total of 40 eyes were included in this study and MHs were closed in 37 eyes (92.5%). The confocal scanning laser ophthalmoscopy showed that all of the retinal capillaries in the superior, inferior, nasal and temporal sides of the MHs moved toward the optic nerve head (ONH). The optic coherence tomography results showed that the mean nasal displacements of foveal pits were (102.9±61.2), (109.6±53.1), and (137.0±52.0) μm at 3, 6 and 12 months, respectively. And the mean vertical displacements were (55.9±49.4), (61.4±57.8) and (67.8±54.3) μm, respectively. Post-operative foveal pits were located in the nasal side of the MH centers. The extension of retina and nasal to the MH were in opposite directions: the nasal hole margin moved toward the MH, but the retina located closer to the ONH moved toward the ONH. The fellow eyes of three patients developed into idiopathic MH during the follow-up period and operations were performed for all of the three patients. Conclusion: Our results showed that center of macula does not move when an idiopathic MH develops, but it moves toward ONH during closure of hole; thus, new fovea is in nasal side of original fovea.
ABSTRACT
Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons, and par plana vitrectomy with internal limiting membrane peeling (ILMP) has been routine operation to treat IMH. There are many possible factors influencing the prognosis of surgery, including age, sex, duration of disease, visual acuity before operation, stage and diameter of IMH, various MH index, surgical techniques, dyeing agent, vitreous tamponade, head position after operation, recoverment of ellipsoid zone, and so on. A comprehensive analysis of these prognostic factors could contribute to predict the patients' recoverment and communicate better with patients. It could also help to exclude confounding factors when the new clinical trials were conducted. Furthermore, more prospective clinical trials are needed to obtain high quality evidence.
ABSTRACT
Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index＜0.7 and provide an alternative basis for IMH.Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index ＜0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (4-8 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA),central vision,direct ophthalmoscope examination,slit lamp microscope with preset lens,optical coherence tomography (OCT),intraocular pressure,Amsler grid table and fundus photography inspection were performed before surgery and 1 month,6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image,U-like closure was thought to be normal fovea,V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation,43 cases had U type closure,1 case had V type closure and 1 case had W type closure in the extensive ILMP group,while 33 cases had U type closure,1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month,6 months and 12 months (all at P＜0.05).Compared with preoperation BCVA,the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma:x2 =80.98,56.99,both at P＜0.05;paracentral scotoma:x2 =88.21,80.98,both at P＜0.05),and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (x2 =4.10,P＜0.05).The closure rate of IMH was 93.75％ in the extensive ILMP group and 77.08％ in the standard ILMP group,showing a significant difference between the two groups (x2 =4.10,P＜0.05).The corrected rate of Amsler grid abnormality was 93.75％ in the extensive ILMP group,which was evidently higher than 75.00％ in the standard ILMP group,with a significant difference between the two groups (x2 =5.06,P＜0.05).Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI＜0.7 are effective,and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.