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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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A 43-year-old immunocompetent male presented with focal macular retinitis with overlying vitritis in the right eye. His BCVA was counting fingers close to face. OCT showed increased intraretinal thickness at the area of retinitis with adjacent hypo reflectivity of the choroid. Serology was positive for IgM and IgG antibodies for toxoplasma. He received oral clindamycin 300 mg 4 times/day for 8 weeks. At 6 weeks, his BCVA was CF 2 metres. Fundus showed complete resolution of retinitis with formation of near, full thickness macular hole with intact overlying ILM. A small hyper reflective scar was seen at the base of the 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 investigate the effects of par plana vitrectomy(PPV)+ inner limiting membrane(ILM)flat covering + vitreous cavity disinfected air filling and PPV + ILM stripping + vitreous cavity disinfected air filling on giant idiopathic macular hole(IMH)and high myopia macular hole(MH). <p>METHODS: The clinical data of giant IMH 40 eyes and giant high myopia MH 40 eyes were compared. Twenty patients with giant IMH underwent traditional ILM removal(Group A1), the remaining 20 underwent ILM flat transplantation(Group A2); 20 underwent traditional ILM removal(Group B1)for giant high myopic MH, and the remaining 20 underwent ILM flat transplantation(Group B2). The closure rate of MH and the improvement of best corrected visual acuity(BCVA)before and after operation were compared and analyzed. <p>RESULTS: There were significant differences in BCVA before and after operation in Group A(<i>F</i>=96.193, <i>P</i><0.001), between A1 and A2(<i>F</i>=4.971, <i>P</i>=0.03), and the interaction between different time points and groups after operation(<i>F</i>=18.772, <i>P</i><0.001). The results showed that there were significant differences of the two groups between any two time point(<i>P</i><0.05). The <i>t</i>-test results between the two groups at different time showed that there was no difference in preoperative vision between A1 and A2(<i>P</i>>0.05). There were significant differences in preoperative visual acuity between the two groups at 1, 3 and 6mo after operation(<i>P</i><0.05). There were significant differences in different time points before and after BCVA in Group B(<i>F</i>=136.150, <i>P</i><0.001), B1 and B2(<i>F</i>=5.179, <i>P</i>=0.029), and the interaction between different time points and groups after BCVA(<i>F</i>=7.079, <i>P</i>=0.001). The results showed that there were significant differences of the two groups between any two time point(<i>P</i><0.05). The results of <i>t</i>-test between the two groups at different time showed that there was no difference in preoperative visual acuity between B1 and B2(<i>P</i>>0.05), but there was significant difference in 1, 3 and 6mo after operation(<i>P</i><0.05). After 6-month follow-up, the closure rate of Group A1 was 80%, attached rate was 20%, closure rate of Group A2 was 100%. There was no significant difference in closure rate between Group A1 and Group A2(<i>P</i>=0.053). The closure rate of Group B1 was 70%, attached rate was 30%, closure rate of Group B2 was 90%, attached rate was 10%. There was no significant difference in closure rate between Group B1 and Group B2(<i>P</i>=0.118). There was significant difference in closure rate between retinal initial membrane stripping group and plaster group(75% <i>vs</i> 95%, <i>χ<sup>2</sup></i>=4.057, <i>P</i><0.05).<p>CONCLUSION: For giant IMH and giant high myopia MH, there was significant difference in closure rate and BCVA improvement between ILM stripping group and covering group, on which the former is better.
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Objective To compare the efficacy and safety of vitrectomy combined with internal limiting membrane flap and vitrectomy combined with internal limiting membrane peeling for the treatment of idiopathic macular hole with different sizes.Methods A total of 127 consective patients (127 eyes)were divided into two groups according to the size of the hole diameter of the smallest split points by less than or equal to 500 μm (small diameter macular hole group) and more than 500 μm (huge diameter macular hole group).According to different surgical methods the patients were divided into non ILM flap coverage group (peeling 1 group and peeling 2 group) and ILM flap cover group (covering 1 group and covering 2 group).All the patients underwent vitrectomy combined with internal limiting membrane peeling or vitrectomy combined with limiting membrane flap.Preoperative and postoperative best correct visual acuity,closure ratio of macular hole and postoperative major complications were observed and followed up.Results The postoperative best correct visual acuity improved in all the groups,there was no significance difference between small diameter macular hole group and huge diameter macuiar hole group (t =0.112 2,0.750 8;all P ＞0.05).The closure ratio of peeling 1 group and covering 2 group at postoperative 6 months were all 100％,there was no statistical difference (P ＞ 0.05),which in peeling 2 group and covering 2 group were 84.85％ and 100.00％,there was statistical difference (x2 =13.292,P ＜ 0.05).There was no statistical difference in preoperative defect diameter of the inner and outer junction between peeling 2 group and covering 2 groups (P ＞0.05),there was also no statistical difference between peeling 2 group and covering 2 groups at postoperative 1 months (P ＞ 0.05),but there were statistical differences at postoperative 3 months,6 months and 12 months (all P ＜ 0.05),the covering 2 group were less than the peeling 2 group.Conclusion ILM flap coverage helps to heal macular holes greater than 500 μm diameter,and has no extra effect on healing of diameter less than 500 μm.
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@#Idiopathic macular hole(IMH)is unequivocal inducement lead to limiting full-thickness defect of retinal neurepithelium layerin macular region. It's one of the most important fundus macular degeneration. According to the different causes and the anatomical site, the lesion has a different classification, and its etiology and pathogenesis are diverse and complex. But along with the continuous renewal of ophthalmologic examination instrument and the continuous improvement of surgical technique, treatment of IMH is diversified and treatment effect is more obvious. Not only that, IHM preventive treatment also gradually get used in clinical. In this paper, we reviewed the progress of IMH in terms of the pathogenesis, relative examination, surgical treatment, preoperative prognostic evaluation and so on.
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Objective To observe the efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane.Methods Forty-two patients (42 eyes) with secondary epiretinal membrane underwent vitretinal surgery in our hospital from June 2011 to June 2015 were retrospectively studied.All patients underwent pars plana vitrectomy + epiretinal membrane peeling + retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide.The follow-up time was from 3.0 months to 18.0 months,averaged (8.3 ± 2.4) months.Postoperative best corrected visual acuity (BCVA),macular morphology and complications were observed.Resules At the final follow-up,BCVA improved in 30 eyes,unchanged in 8 eyes and decreased in 4 eyes,and there was significant difference compared with that before operation (t =3.145,P =0.000).The preoperative and postoperative thickness of meuroepithelium in the centual macular area were(315.62 ±132.12) μm and (233.42 ± 146.32) μm,and there was significant difference(t =4.322,P =0.000).Small amount of retinal hemorrhage happened in 6 eyes after operation,vitreous hemorrhage was in 1 eye,transient high intraocular pressure was in 6 eyes;Prepheral retinal hole occurred in 3 eyes,which were cured by laser treatment and C3F8 tamponade.Conclusion Intravitreal injection of triamcinolone acetonide can reduce the macular edema,decrease the reoccurrence of epiretinal membrane and imporve the visual acuity.The retinal inner limiting membrane peeling in secondary macular epiretinal membrane surgery can release the macular pucker,lifting and traction on the fovea,improve the metabolism of macular local,is conducive to the recovery of macular function.
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PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.
Subject(s)
Humans , Depression , Epiretinal Membrane , Medical Records , Membranes , Retrospective Studies , Tomography, Optical Coherence , Vision Disorders , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.
Subject(s)
Humans , Depression , Epiretinal Membrane , Medical Records , Membranes , Retrospective Studies , Tomography, Optical Coherence , Vision Disorders , Visual Acuity , VitrectomyABSTRACT
BackgroundWhether the peeling of the inner limiting membrane (ILMP) increase the closure rate of idiopathic macular hole is still in controversy.Some ophthalmologist recommend vitrectomy combined with inner limiting membrane peeling for the treatment of idiopathic macular hole.However,the removal of ILMP is difficult because of its similar appearance to adjacent tissues.Objective This study was to investigate the efficacy of triamcinolone acetonide(TA) and indocyanine green(ICG) double staining-assisted vitrectomy combined with ILM peeling during the surgery.Methods A consecutive case- observational study was designed.The standardized vitrectomy was performed in 25 eye of 23 cases with IMH.During the vitrectomy,TA and ICG were injected into posterior pole vitreous to visualize and assist the ILM peeling.The dying effectiveness was observed,and the closure rate of macular hole,visual acuity,intraocular pressure and complications were evaluated after surgery.Written informed consent was obtained from each patient prior to operation.Results Posterior vitreous cortex and ILM were visible and the residual vitreous and cortex were removed clearly after dying of TA and ICG in all the 25 eyes.During the following-up duration of 3-8 months,the completely anatomical reattachment of the macular area was in 22 eyes ( 88.0％ ) and partially reattachment in 3 eyes( 12.0％ ).The best corrected vision was 0.07-0.60 in all of the operated eyes 2 months after surgery.Conclusions TA and ICG- assisted vitrectomy combined with ILM peeling appears to be a safe and effective method for IMH repair.