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Objective:To observe the treatment effect of 25-gauge pars plana vitretomy with the inverted internal limiting membrane (ILM) flap and autologous serum coverage in high myopia macular hole (HMMH) eyes.Methods:17 patients (17 eyes) with HMMH were selected from the Affiliated Hospital of Chinese Medicine Hospital of Xinjiang Medical University from June 2019 to March 2020. The minimum diameter of macular hole in all patients was ≤500 μm. They were diveded into group A (10 eyes) and group B (7 eyes) according to the random number table method. The group A underwent 25-gauge pars plana vitretomy + inverted ILM falp technique + autologous serum coverage; The group B (5 eyes) underwent 25-gauge pars plana vitretomy with ILM peeling technique. The best corrected visual acuity (BCVA) before and after surgey and the macualr hole closure rates were observed.Results:There was no significant difference in BCVA between the two groups before operation and at 6 months after operation ( P>0.05); The postoperative macular hole closure rate was 8/10 in group A and 4/7 in group B. There was no significant difference in macular hole closure rate between the two groups ( P>0.05); The BCVA of the two groups at the last follow-up after operation was significantly higher than that before operation ( P<0.05). Conclusions:Vitrectomy combined with inverted ILM falp technique is a safe and effective method in the treatment of high myopia macular hole with diameter ≤500 μm.
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Spontaneous closure of idiopathic full thickness macular hole is a rare case as it occurs in only 3.5% while awaiting vitrectomy surgery. There are few pathologies associated with it such as vitreomacular traction (VMT) and posterior vitreous detachment. We report a case in a 74-year-old man who presented with right eye painless, progressive blurring of vision with idiopathic stage 4 full thickness macular hole which was confirmed on optical coherence tomography. It closed spontaneously after sometimes while waiting for surgery. It is important to monitor closely for the possibility of spontaneous closure based on the optical coherence tomography findings.
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PURPOSE: We measured the thicknesses of the ganglion cell and inner plexiform layer (GCIPL), the macula, and the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography in patients with idiopathic macula holes to analyze the repeatability of these measurements and compare them with those of the fellow eye. METHODS: We evaluated 85 patients who visited our retinal clinic. The patients were divided into two groups according to their macular hole size: group A had a size of <400 µm, while group B had a size of ≥400 µm. Repeatability was determined by comparing the thicknesses of the GCIPL, macula, and RNFL with those of the normal fellow eye. RESULTS: The average central macular thickness in patients with macular holes was significantly thicker than that in the normal fellow eye (343.8 ± 78.6 vs. 252.6 ± 62.3 µm, p < 0.001). The average thickness of the GCIPL in patients with macular holes was significantly thinner than that in the normal fellow eye (56.1 ± 23.4 vs. 77.1 ± 12.8 µm, p < 0.001). There was no significant difference in the average RNFL thickness between eyes with macular holes and fellow eyes (92.4 ± 10.0 vs. 95.5 ± 10.7 µm, p = 0.070). There were also no significant differences in the thicknesses of the GCIPL and RNFL among the two groups (p = 0.786 and p = 0.516). The intraclass correlation coefficients for the macula and RNFL were 0.994 and 0.974, respectively, in patients with macular holes, while that for the GCIPL was 0.700. CONCLUSIONS: Macular contour change with macular hole results in low repeatability and a tendency of thinner measurement regarding GCIPL thickness determined via spectral-domain optical coherence tomography. The impact of changes in the macular shape caused by macular holes should be taken into consideration when measuring the GCIPL thickness in patients with various eye diseases such as glaucoma and in those with neuro-ophthalmic disorders.
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Humans , Eye Diseases , Ganglion Cysts , Glaucoma , Nerve Fibers , Retina , Retinal Perforations , Retinaldehyde , Tomography, Optical CoherenceABSTRACT
·AIM: To compare choroidal thickness at the macula in eyes with unilateral idiopathic full - thickness macular holes (FTMH) with that of unaffected fellow eyes, and eyes of normal control patients. ·METHODS: Cross-sectional study. Thirty patients with unilateral idiopathic FTMH and thirty age, sex, and race-matched controls were recruited. Axial lengths were measured using laser interferometry. Enhanced depth imaging optical coherence tomography images were obtained using Heidelberg spectral - domain optical coherence tomography. Choroidal thickness was measured at the fovea, and at 1 mm and 2 mm nasally, temporally, superiorly and inferiorly from the center of the fovea. Statistical analysis was performed using independent and paired t-tests, chi-square tests, and Pearson correlation tests (P<0.05). ·RESULTS:The mean subfoveal choroidal thickness was 201.0±44.0 μ m in the FTMH group,225.3± 51.4 μ m in the fellow eye group and 262.3±70.3 μ m in the control group. The choroid was thinner in FTMH eyes at all locations when compared to control eyes(P<0.05). The fellow eye group also had thinner choroids than the control group at all locations except at 1 mm and 2 mm nasal to the fovea (P<0.05). Choroidal thickness in the FTMH group was lower than in the fellow eye group, but the differences were not statistically significant (P > 0.05). Choroidal thickness was generally highest subfoveally and lowest nasally. Subfoveal choroidal thickness was negatively correlated with age (r = -0.278, P = 0.032), and axial length (r=-0.328,P=0.011). ·CONCLUSION:Choroidal thickness is lower in both eyes of patients with unilateral FTMH compared to healthy control eyes.
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Accompanying with the development of technological level,optical coherence tomography plays a more and more important role in predicting the surgical outcome for idiopathic macular hole.Preoperative morphologic parameters like minimum diameter,base diameter,maximum height,macular hole index,hole form factor,tractional hole index,macular hole closure index,photoreceptor inner-outer segment junction,cone outer segment tips line,central subfield retinal thickness and macular hole inner opening diameter were proved correlated to postoperative visual acuity and anatomical results.It has important application value to know these predictors to judge the surgical outcome and deepen understanding of idiopathic macular hole.
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Aim To compare quantitative data and imaging of inner lamellar macular holes (ILHs) and macular pseudoholes (MPHs) with normal foveal thickness, both associated with epiretinal membranes (ERM). Methods In 27 eyes (25 consecutive patients) with ERM at the macula and a clinical appearance of a macular hole or MPH, the foveal thickness and contour were evaluated with optical coherence tomography (OCT). At least two measurements offoveal thickness of ≥135 μμ m each at two different scans were prerequisites in these eyes for diagnosis of a MPH, and a foveal thickness ＜135 ＞0 μ m was diagnosed as an ILH. Eyes with MPH with foveal thickness ＞202 μ m, eyes with full-thickness macular holes and eyes with vitreo-macular adhesions or other macular abnormalities that could affect the data were excluded from the analysis. Results Inner lamellar macular holes were detected in 6 eyes (22.2 %) of 6 patients (mean age,56 ± 18 [s] years), and MPHs with normal foveal thickness (NT-MPHs) were diagnosed in 4 eyes (14.4%) of 4 patients (mean age, 70 ±9years). The minimal foveal thicknesses at the ILHs and NT-MPHs ranged from 74 to 108 μ m (mean, 87 ±12.6) and from 135 to 191 μμ m (mean, 166 ± 27), respectively. At the bases of each NT-MPH and of 4 of the 6 eyes with ILH cystoid changes were detected. All other 17eyes had a foveal thickness ＞203 μ m in each, associated with more prominent cystoid changes at the fovea. Conclusion The quantitative findings of the ILHs using OCT could differentiate them from NT-MPHs. The findings suggest that ILHs with cystoid changes may thicken to become MPH. The quantitative data and repeated evaluations during follow-up may prove objective changes that can help in decision-making regarding indication and timing of surgery for ERMs with cystic foveal changes.
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PURPOSE: This study aimed to assess the effect of gas injection and laser photocoagulation for patients with opened macular holes who had previously undergone trans pars plana vitrectomy. METHODS: A retrospective study for 6 patients (6 eyes) who had opened macular holes after vitrectomy were treated by an outpatient method consisting of laser photocoagulation to the foveal pigment epithelium followed by injection of 100% SF6 gas. Visual acuity, anatomic status of the macular hole, and complications were evaluated. RESULTS: The length of period of gas injection and laser photocoagulation was distributed to 1 month to 8months (mean 3.2 months) and follow up period was distributed to 8 months to 25 months (mean 14.3months). Three of six eyes with gas injection and laser photocoagulation achieved anatomic success and two of them achieved visual improvement by more than two lines. Three eyes among four phakic eyes developed nucleosclerosis of the lens and one eye developed transient elevation of intraocular pressure. CONCLUSIONS: The outpatient gas injection and laser photocoagulation appears to be a safe and cost-effective alternative to repeated surgery for opened macular holes after trans pars plana vitrectomy.