Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Idiopathic macular hole (IMH) refers to full thickness defects of retina in macular area with no clear reasons. The management of IMH includes vitrectomy combined with internal limiting membrane (ILM) peeling and pharmacological vitreolysis. But ILM peeling may damage the inner retina; novel techniques, such as inverted ILM flap technique and foveola non-peeling ILM surgery, autologous ILM transplantation had made the method of ILM peeling more diversified with less damage. Pharmacological vitreolysis targeting fibronectin and laminin is considered to work in a two-step mechanism, involving both vitreoretinal separation and vitreous liquefaction. Furthermore, IMH judgment and prognosis indicators like ellipsoid zone, macular hole index, hole formation factor, diameter hole index and tractional hole index based on spectral domain optical coherence tomography enriched the assessment of macular hole diameter, depth and shape. How to make full use of new interventions to reduce the incidence of macular hole and obtain a better visual acuity with closed holes is an important direction for future research.
Objective To evaluate the relevance of the macular hole index (MHI) and the visual outcomes of the idiopathic macular hole (IMH) after the retinal internal limiting membrane (ILM） peeling surgery.Methods Thirty IMH patients (30 eyes) undergoing vitrectomy and ILM peeling were included in this study. The IMH diagnosis was confirmed by best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscope and optical coherence tomography (OCT). The central retinal thickness, the height and the base diameter of macular holes were measured by OCT. The MHI was the ratio of the height and the base diameter of macular holes. The patients were divided into two groups (MHIge;0.5 group and MHI＜0.5 group) according to the MHI.The post-surgery follow-up was three to 24 months with an average of 10 months. Spearman correlation analysis was performed between BCVA (pre and post-surgery), age, disease duration and MHI. The differences in BCVA after surgery between the two MHI groups was further evaluated by independent samplest-test for quantitative data.Results All the macular holes in 30 eyes closed after surgery, closure rate was 100%. Postoperative BCVA was correlated with MHI by Spearman analysis (r=0.852,P＜0.001), but not correlated with age (r=0.001, P=0.804) and disease course (r=-0.001,P=0.579). Postoperative BCVA was better in the MHIge;0.5 group (t=5.552,P＜0.001). Conclusions The postoperative visual outcome of IMH patients was correlated with the MHI. MHI can be used as a prognostic factor of postoperative visual outcomes for IMH patients.
Retinal break is the cause of primary retinal detachment, which remains a main cause for visual loss, and closure of the breaks is the principle of treatment. Currently surgical treatment can successfully reattach the retina in most cases. However, some basic questions still beset treatment of the disease, such as the cause responsible for development of retinal breaks and how to prevent it, and how the visual recovery can be satisfactory after reattachment surgery. Recent research indicates that the development of retinal breaks is associated with the process of vitreous liquefaction, posterior vitreous detachment (PVD) and abnormal vitreoretinal adhesion and traction. The retinal breaks can occur in the posterior margin of the vitreous base in the eye with complete PVD. Partial PVD may cause posterior breaks especially in cases of myopic traction maculopathy associated with schisislike thickening in the outer retina (foveoschisis) and vitreomacular traction. It is known that microstructural changes and atrophy of the macula, and epiretinal membrane formation are the reasons for poor vision after the retina is reattached. Therefore, more attention should be paid to further understand the vitreous pathology and traction mechanism, to research for methods of its clinical evaluation and strategy of prevention and treatment, and to accelerate visual recovery after reattachment surgery, in order to raise the standard of the disease treatment.
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and internal limiting membrane (ILM) peeling for the treatment of moderate and extreme highly myopic macular hole retinal detachment (MHRD). Methods Forty-one highly myopic MHRD patients (41 eyes) who underwent PPV with TA assistance and ILM peeling were enrolled in this study. These eyes were divided into two groups according to different anatomic features: group A (24 eyes) had a consistent moderate long axial lengths (＜29 mm), quot;mildquot; retinal pigment epithelium (RPE) and chorioretinal atrophy, and posterior staphyloma (level 0 - 1 and depth le;2 mm); while group B (17 eyes) had a consistent extreme long axial lengths (ge;29 mm), quot;severequot; RPE and chorioretinal atrophy, and posterior staphyloma (level 2 - 3 and depth＞2 mm). All the patients underwent C3F8 tamponade at the end of PPV. The anatomic reattachment of the retina, macular hole closure, and visual acuity were observed at 12 months after surgery. Results The rates of retinal reattachment and macular hole closure were 91.67% and 58.33% in group A, 64.71% and 17.65 % in group B in the first time of surgery. The differences of rates of retinal reattachment (P=0.049) and macular hole closure (chi;2=6.787, P=0.009) between two groups were statistically significant. The rates of retinal reattachment and macular hole closure were 95.83% and 58.33% in group A, 88.23% and 29.53% in group B in the second time of surgery. The difference of retinal reattachment rate between two groups was not statistically significant (P=0.560). The difference of macular hole closure rate between two groups was statistically significant (chi;2=4.894, P=0.027). Twelve months after surgery, the vision acuity improved in 14 eyes, unchanged in nine eyes, and decreased in one eye in group A; the vision acuity improved in six eyes, unchanged in eight eyes, and decreased in three eyes in group B. The differences of vision result between two groups was not statistically significant (chi;2=0.209, P=0.647). Conclusion After PPV with TA assistance and ILM peeling, the rates of retinal reattachment and macular hole closure in eyes with moderate highly myopic MHRD are higher than that in eyes with extreme highly myopic MHRD, but there is no difference in visual acuity.