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Objective:To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C 3F 8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. Methods:A retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference ( P>0.05). PPV combined with ILM peeling and C 3F 8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. Results:After initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation ( P>0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month ( P=0.783, 0.358), but the difference was statistically significant at 3 months ( P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation ( P=0.687, 0.950). Conclusion:PPV combined with ILM peeling and C 3F 8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
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@# As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.
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A 44?year?old female with a vision of 10/200 in the right eye had double pits in the temporal segment of the optic disc with serous macular detachment. Spectral?domain optical coherence tomography (SD?OCT) confirmed serous retinal detachment, an outer layer hole, and double optic disc pits. The patient underwent pars plana vitrectomy with modified ILM flap surgery involving fovea?sparing internal limiting membrane peeling (FSIP) technique with inverted ILM flap tucking with gas tamponade. Post surgery, the communications between perineural and intraretinal spaces were obliterated with flaps of ILM covering the pits, with reduced serous macular detachment and BCVA of 20/120. FSIP with inverted internal limiting membrane flap tuck can be an effective technique to manage rare cases of double ODP?M
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Purpose: To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates. Methods: This is a single?center interventional case series. conducted between 2016 and 2020. The minimum follow?up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ?600 ?m) were enrolled; vertical hole diameters were also measured using spectral?domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc?diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best?corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t?test. IBM SPSS (ver. 26) was used for analysis. Results: The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 ?m (range: 600–1020 ?m) and 602 ?m (490–844 ?m), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow?up (mean: 28 months, median: 34 months; range 4–48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001). Conclusion: All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes
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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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Objective:To analyze the effect of vitrectomy combined with internal limiting membrane (ILM) peeling on the prevention of post-vitrectomy epiretinal membrane (ERM) in macular-off rhegmatogenous retinal detachment (RRD) and its influence on visual outcomes.Methods:A cohort study was conducted.Seventy-four patients (74 eyes) with macular-off RRD, who realized retinal reattachment after vitrectomy and silicone oil tamponade from January 2015 to January 2018 in Baoding NO.1 Central Hospital, were enrolled.The patients were divided into the non-ILM peeling group (36 cases, 36 eyes) and ILM peeling group (38 cases, 38 eyes) according to whether they received ILM peeling or not.The patients underwent silicone oil removal within 3 to 5 months after the surgery.Best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were examined before and at 1, 6 and 12 months after the surgery.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Baoding NO.1 Central Hospital (No.[2019]042). Written informed consent was obtained from each patient.Results:There was no ERM found in the two groups at 1 month after the operation.There were 3 eyes (8.33%) with ERM in the non-ILM peeling group and 2 eyes (5.26%) in the ILM peeling group at 6 months after the operation, with no statistically significant difference between them ( P=0.067). There were 9 eyes (25.00%) with ERM in the non-ILM peeling group and 4 eyes (10.53%) in the ILM peeling group at 12 months postoperatively, with no statistically significant difference between them ( χ2=2.674, P=0.102). There was a significant difference in BCVA between before and after the operation in the two groups ( Ftime=31.692, P<0.001). Postoperative 1-, 6-and 12-month BCVA were all significantly better than the preoperative BCVA in the two groups (all at P<0.05). There was no significant difference in BCVA between the two groups ( Fgroup=0.117, P=0.773). OCT images showed that there were 25 eyes (77.78%) and 30 eyes (78.95%) with the intact ellipsoid zone in the non-ILM peeling group and ILM peeling group at 12 months after the operation, respectively, with no statistically significant difference between them ( χ2=0.875, P=0.350). Conclusions:Compared with vitrectomy alone, the vitrectomy combined with ILM peeling does not show better efficacy in the prevention of ERM occurrence in macula-off RRD patients and has no obvious influence on postoperative visual acuity.
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Objective:To systematically evaluate the effect of pars plana vitrectomy (PPV) combined total peeling of internal limiting membrane (ILM) versus fovea-sparing peeling of ILM for myopic foveoschisis.Methods:A evidence-based medicine study. Chinese and English as search terms for myopic foveoschisis, vitrectomy, and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure, Wanfang database, VIP database, PubMed of National Library of Medicine, Medline, Embase, and Cochrane Library. The high myopic macular schisis was selected as the research object, the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1, 2010, and Jun 31, 2021. Incomplete or irrelevant literature and review literature were excluded. The method of Newcastle-Ottawa Scale system was used to evaluate the included literature. The literature was meta-analyzed by RevMan5.3 software. The mean difference ( MD) and a confidence interval ( CI) of 95% were used to describe the effect sizes of continuous data, fixed effects model was performed. The data including the best corrected visual acuity (BCVA), central fovea thickness (CFT), and postoperative macular hole (MH) were analyzed. Results:In those databases, 232 articles based search stratery were totally retrieved, and 10 articles (417 eyes) were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM. Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups (BCVA: MD=0.05, 95% CI 0.00-0.11; P>0.05; CFT: MD=-4.79, 95% CI -18.69-9.11, P>0.05). It was compared with the incidence of MH, the difference was statistically significant (odds ratio=5.70, 95% CI 2.22-14.61, P<0.05). Conclusion:BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis; compared with complete ILM peeling, the incidence of MH was lower after foveal-sparing ILM peeling.
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Objective:To observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH).Methods:A prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA ( t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) ( t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) ( t=1.255, 0.966) between two groups ( P>0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. Results:Six months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference ( P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant ( t=2.282, 3.101; P<0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant ( t=1.815, 2.302, 2.784; P<0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant ( P=0.007, <0.001, <0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant ( t=1.897, 2.250; P<0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance ( F=12.963, P<0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences ( F=12.374, 21.807, 5.695, 4.095; P<0.05). Conclusion:PPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
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@#AIM: To analyze the effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane(ILM)peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane(IMEM).<p>METHODS: Totally 88 patients(88 eyes)with IMEM admitted to the hospital were selected between January 2016 and January 2020. They were divided into group A and group B by random number table method with 44 eyes in each group. Patients in group A were treated with vitrectomy and macular epiretinal membrane dissection combined with ILM peeling, while patients in group B were treated with vitrectomy and macular epiretinal membrane dissection. The choroid thickness, vision, metamorphopsia, central macular thickness(CMT), ellipsoid zone(EZ)continuity were compared between the two groups.<p>RESULTS: Compared with preoperative, the sub-foveal choroidal thickness(SFCT), choroidal thickness 1 000μm from nasal side central of fovea(NFCT)and choroidal thickness 1 000μm from temporal side central of fovea(TFCT)were significantly reduced in the two groups at 3mo and 6mo after operation(<i>P</i><0.05), but there was no statistically significant difference between the groups(<i>P</i>>0.5). Compared with preoperative, the best corrected visual acuity(BCVA)LogMAR was reduced, while mean sensitivity(MS)was increased in the two groups. The number of scotoma points(SP)increased in group A and decreased in group B. Group A had significantly lower MS and higher SP than group B at 1mo, 3mo, and 6mo after operation(<i>P</i><0.05). Compared with preoperative, the M scores(Angle of view when horizontal and vertical variability begins to disappear)and average M scores of the two groups were significantly reduced at 3mo and 6mo after operation, without statistically significant differences between the groups(<i>P</i>>0.05). Compared with preoperative, CMT was significantly reduced in the two groups at 1, 3 and 6mo after operation. The ratio of EZ continuity in group A at 1mo after operation was significantly lower than that before operation. The CMT of group A was larger than that of group B at 3mo and 6mo after operation(<i>P</i><0.05). No statistically significant differences were found in the ratio of EZ continuity and the incidence of complications between the groups(<i>P</i>>0.05).<p>CONCLUSION: Vitrectomy and macular epiretinal membrane dissection combined with or without ILM peeling both can improve vision and metamorphopsia in patients with IMEM, with similar effects on choroid thickness and safety. However, combined use of ILM peeling will lower MS and increase SP as well as CMT. Therefore, it has no significant advantages in the treatment of patients with IMEM.
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@#AIM: To discuss the clinical effects of pars plana vitrectomy(PPV)combined with interal limiting membrane peeling(ILMP)for macular hole(MH)in pathological myopic eyes.<p>METHODS: This is a retrospective case study. Eighteen patients(19 eyes)with high myopic MH diagnosed in our hospital from January 2017 to January 2019 were enrolled in this study. All eyes were grouped for pathological myopia(9 patients 10 eyes)and non-pathological myopia groups(9 patients 9 eyes). All eyes were treated with PPV combined with ILMP surgery. Postoperative follow up was 3-23mo, the efficacy was determined at the final follow up, including BCVA, visual deformation symptoms and macular hole closure.<p>RESULTS: During the final follow up, BCVA was improved in 6 eyes,stable in 2 eyes, more severe in 2 eyes in pathological myopia group, and MH was fully closed in 7 eyes(70%), bareness-closed in 2 eyes(20%)and not closed in 1 eye(10%). In non-pathological myopia group, BCVA was improved in 6 eyes,stable in 2 eyes, more severe in 1 eyes, and MH was fully closed in 8 eyes(88%), not closed in 1 eye(11%). There were significant differences in the axial length between the two groups before surgery, axial length was negatively correlated with the macular hole closure rate at the last follow up(<i>rs</i>= -0.477, <i>P</i>=0.039).<p>CONCLUSION: PPV combined with ILMP for the treatment of MH in high myopia can effectively improve BCVA. However, the hiatal closure rate of pathological myopia patients was lower than that of non-pathological myopia patients.
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@#AIM: To explore the risk factors that affect visual function recovery in patients with idiopathic macular epiretinal membrane(IMEM)undergoing internal limiting membrane peeling(ILMP).<p>METHODS: This study retrospectively reviewed 118 patients(118 eyes)with IMEM who underwent ILMP in the hospital between January 2016 and April 2020. The patients were followed up for 6mo after surgery to evaluate curative effect. Changes in visual acuity before surgery and at 1, 3 and 6mo after surgery, metamorphopsia degree, mean central foveal thickness and volume of macular area were observed. The correlation of mean central foveal thickness and volume of macular area before and after surgery with postoperative visual acuity and metamorphopsia scores was analyzed. The risk factors for poor visual function recovery after surgery were evaluated.<p>RESULTS: In this study, 96 eyes obtained good visual function recovery, and the improvement rate was 81.4%. At 1, 3 and 6mo after surgery, visual acuity was significantly improved(<i>P</i><0.05), metamorphopsia score in horizontal direction, mean central foveal thickness and volume of macular area were significantly reduced(<i>P</i><0.05). The mean central foveal thickness and volume of macular area before surgery and at 6mo after surgery were negatively correlated with visual acuity at 6mo after surgery(<i>P</i><0.05), but positively correlated with metamorphopsia score in horizontal direction(<i>P</i><0.05). The course of IMEM, preoperative corrected visual acuity, preoperative horizontal or vertical metamorphopsia, and preoperative macular edema were influencing factors of visual function recovery after surgery(all <i>P</i><0.05). Poor preoperative corrected visual acuity(<i>OR</i>=3.062), horizontal metamorphopsia(<i>OR</i>=2.438)and preoperative macular edema(<i>OR</i>=2.000)were risk factors for poor visual function recovery.<p>CONCLUSION: The curative of ILMP is effect on IMEM, which can effectively improve visual acuity of operative eyes and reduce metamorphopsia. The longer the course of disease, the worse the preoperative corrected visual acuity, and the more severe the preoperative metamorphopsia, the worse the visual function recovery in patients with preoperative macular edema after ILMP.
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RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)
ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)
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Humans , Female , Aged , Retinal Perforations/diagnosis , Sulfur Hexafluoride/therapeutic use , Vitrectomy/methods , Tomography, Optical Coherence/methodsABSTRACT
@#AIM: To observe the clinical effect of vitrectomy(PPV)combined with internal limiting membrane(ILM)peeling in the treatment of refractory diabetic macular edema.<p>METHODS: The data of 56 eyes(56 patients)with refractory diabetic macular edema accepted PPV combined with ILM peeling were collected and retrospectively analyzed. The patients were divided into Group A(no posterior vitreous detachment): 35 cases(35 eyes)and Group B(with posterior vitreous detachment): 21 cases(21 eyes). The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and 1, 3, 6mo after operation were compared and analyzed.<p>RESULTS: The mean CMT and LogMAR BCVA of Group A at 1, 3 and 6mo after operation were significantly different from those before operation(<i>P</i><0.05); There was no significant difference in BCVA between those before and 1, 3, 6mo after operation in Group B(<i>P</i>>0.05). The mean CMT of 1mo after operation was significantly different from that before operation(<i>P</i><0.05). There was no significant difference in mean CMT between 3 and 6mo after operation and before operation(<i>P</i>>0.05). CMT and BCVA were significantly different between the two groups at 1,3 and 6mo postoperatively(<i>P</i><0.05).<p>CONCLUSION: PPV combined with ILM peeling can effectively treat refractory diabetic macular edema without posterior vitreous detachment, improve the patient's vision; However, PPV combined with ILM peeling was not effective in patients without posterior vitreous detachment.
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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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@#AIM: To observe the clinical effect of 25G vitrectomy combined with inner limiting membrane(ILM)peeling in the treatment of severe proliferative diabetic retinopathy(PDR)with macular displacement.<p>METHODS: Clinical data of 36 cases(36 eyes), diagnosed as severe proliferative diabetic retinopathy with macular displacement in Jiangsu Province Hospital were collected. Eighteen cases admitted from January to December 2016 were included in the control group(18 eyes, treated by 25G vitrectomy), while 18 cases admitted from January to December 2017 were included in the combined group(18 eyes, treated by 25G vitrectomy with ILM peeling). Best corrected visual acuity(BCVA), intraocular pressure(IOP), complications, and the thickness of macular center area(CMT)were examined during follow-up at 7d, 1mo, 3mo and 6mo postoperative.<p>RESULTS: BCVA showed a significant improvement at postoperative 6mo compared with baseline in both groups <i>(P</i><0.05). CMT of the combination group was thinner than that of the control group(<i>P</i><0.001). Two eyes(11%)had intraocular hypertension,and 1 eye(6%)had macular edema in the combined group, while post-operative complications included intraocular hypertension(6%),macular membrane(6%)and vitreous hemorrhage(6%)in the control group. No statistical difference was found in the complication rates between the two groups(all <i>P</i>=1.000).<p>CONCLUSION: In the treatment of severe PDR with macular displacement, 25G vitrectomy combined with ILM peeling can effectively and safely improve visual acuity and reduce the thickness of macular center area.
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PURPOSE: To report visual field changes after internal limiting membrane (ILM) peeling for macular epiretinal membrane (ERM) according to the severity of glaucoma. METHODS: A retrospective review of 37 eyes from 37 patients who underwent ILM peeling to treat ERM. Standard automated perimetry (Humphrey visual field 24-2 program) was performed preoperatively and postoperatively. Based on the Advanced Glaucoma Intervention Study (AGIS) scoring system of preoperative visual field, patients were classified into the early glaucoma (AGIS ≤ 1) group or the advanced glaucoma (AGIS ≥ 2) group. Postoperative visual field sensitivity at each point was compared with the preoperative value. RESULTS: Out of 37 eyes, 15 eyes had early glaucoma and 22 had advanced glaucoma. Eyes from both groups had poor postoperative visual field parameters. For eyes with advanced glaucoma, the visual field index was significantly reduced and the visual field damage was larger and wider compared to those with early glaucoma. In both groups, visual field impairment was greater on the nasal side than on the temporal side, and visual acuity was not significantly different. Postoperatively, the macular ganglion cell-inner plexiform layer thickness was decreased, especially on the temporal side of advanced glaucoma. CONCLUSIONS: Visual field impairment was greater and wider in eyes with advanced glaucoma than in those with early glaucoma after ILM peeling in patients with ERM.
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Humans , Epiretinal Membrane , Ganglion Cysts , Glaucoma , Membranes , Retrospective Studies , Visual Acuity , Visual Field Tests , Visual FieldsABSTRACT
Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons,and the combination of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) is a standard procedure for macular hole.This technique can improve anatomical success and reduce the tangential forces,and thus accelerating the macular hole closure.With increasing use of ILMP and vital dye,the controversial issue of the intentional ILMP has arisen.First,the earliest change in the macula after ILMP is postoperative swelling of the arcuate retinal nerve fiber layer and dissociated optic nerve fiber layer occurs later in the postoperative period;second,retinal thickness modification,such as the thinning of retinal nerve fiber layer (RNFL),ganglial cell layer (GCL) and inner plexiform layer (IPL);third,displacement of foveal area toward optic disc and decrease of the foveal avascular zone area decrease retinal sensitivity and changes of the focal macular electroretinogram.This article reviewed the effects of ILMP during macular hole surgery on retinal anatomical and functional outcomes.
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Objective To evaluate the therapeutic effects of flute-needle vacuum assistant hole closure technique for large idiopathic macular hole (IMH).Methods The clinical data of 25 eyes with IMH of 408-939 μm in 23 patients who received pars plana vitrectomy with internal limiting membrane (ILM) peeling and flute-needle vacuum assistant hole closure technique from Feburary in 2017 to June in 2018 in Peking University International Hospital were retrospectively analyzed.The changes of best corrected visual acuity (BCVA) before and after operation were evaluated.The shapes of the hole closure were categorized,and the manifestations of outer retina were observed by optical coherence tomography (OCT),including external limiting membrane (ELM) and ellipsoid zone(EZ).Results The hole closure rate after surgery were 100％ (25/25),with the U type closure in 16 eyes and V type closure in 9 eyes.The BCVA was 0.76 ± 0.27 after operation,which was significantly improved in comparison with 1.05 ±0.29 before operation (t =3.61,P =0.01).The ELM of OCT image was (1 050.00±380.39)μm before operation,and that after operation reduced to (623.32 ± 328.66) μm,showing a significant difference between them (t =6.63,P=0.00).A fully reduced EZ band was seen after operation in comparison with before operation ([1 147.28±354.41] μm versus ([818.28±247.33] μm) (t=4.12,P=0.00).Conclusions A combination procedure of vitrectomy with flute-needle vacuum assistant hole closure technique is effective for large IMH,which is beneficial to the anatomical repair and functional recovery of outer retina.
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@#AIM: To observe the clinical effects of different methods of internal limiting membrane peeling in vitrectomy in treatment of idiopathic macular hole(IMH)with macular hole closure index(MHCI)<0.7. <p>METHODS: Totally 88 patients(88 eyes)with MHCI<0.7 IMH admitted from May 2014 to May 2017 were randomly divided into group A(44 eyes underwent extended internal limiting membrane dissection)and group B(44 eyes underwent standard internal limiting membrane dissection). The closure of macular hole, best corrected visual acuity(BCVA), central scotoma and complications were observed between the two groups. <p>RESULTS: At 6mo after operation, the closure rate of macular hole in group A was significantly higher than that in group B(91% <i>vs</i> 75%, <i>P</i><0.05). At 6mo after operation, BCVA in group A was better than that in group B(0.47±0.05 <i>vs</i> 0.74±0.14, <i>P</i><0.05). The percentage of central scotoma eyes was lower than that in group B(4% <i>vs</i> 23%, <i>P</i><0.05), but there was no significant difference in the incidence of complications between the two groups(11% <i>vs</i> 9%, <i>P</i>>0.05).<p>CONCLUSION: Extended internal limiting membrane dissection is more effective than standard internal limiting membrane dissection in the treatment of IMH with MHCI < 0.7, and the former is better for the recovery of retinal function.
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Objective@#To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.@*Methods@#A retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients(15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index(MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.@*Results@#At 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).@*Conclusion@#Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).