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.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists. The surgical success rate reached 95.0% and above for vitrectomy, macular surgeries with ILM peeling, or local/total scleral buckling. However, the postoperative visual function recovery is nowhere near good enough. Specialists must pay more attention to the visual function recovery of those patients. Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time. At present, the postoperative visual acuity for macular hole depends on many factors, such as macular hole closure conditions, surgical procedures, microsurgical invasive ways, skills of membrane peeling, usage of dye staining, and tamponade material choice. It also depends on residual subretinal fluid under macular area for patients received scleral buckling. It is important for us to investigate these factors affecting recovery of macular anatomy and function, and thus develop some drugs to improve the macular function recovery.
ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.
ObjectiveTo compare the results of internal limiting membrane (ILM) peeling with and without ILM transplantation to treat idiopathic macular hole (IMH) with hole form factor (HFF)<0.6. MethodsForty patients (40 eyes) of IMH with HFF<0.6 who underwent pars plana vitrectomy (PPV) were enrolled in this study. 20 eyes was performed PPV combined with ILM peeling (ILM peeling group), the other 20 eyes was performed PPV combined with ILM peeling and ILM transplant (ILM transplant group). The follow-up was ranged from 3 to 6 months with an average of 4 months. The changes of closing rate of hole, best corrected visual acuity (BCVA), photoreceptor inner segment/outer segment (IS/OS) junction defect diameter and amplitude of wave P1 of ring 1 and ring 2 by multifocal electroretinogram (mfERG) were comparatively analyzed for the two groups. ResultsIn 3 months after surgery, the IMH closing rate was 70% (14/20) in the ILM peeling group, and 100% (20/20) in the ILM transplant group, the difference between these two groups was significant (χ2=7.059, P<0.05). Postoperative BCVA was improved obviously in the two groups compared to preoperative BCVA, the difference was significant (t=4.017, 4.430; P<0.05). The rate of BCVA improvement in the ILM peeling group and ILM transplant group were 80% and 85%, the difference was not significant (χ2=0.173, P>0.05). The rate of significantly BCVA improvement in the ILM peeling group and ILM transplant group were 35% and 70%, the difference was significant (χ2=4.912, P<0.05). IS/OS junction defect (t=6.368, 6.635; P<0.05) and amplitude of wave P1 of ring 1 (t=2.833, 4.235) and ring 2 (t=2.459, 4.270) by mfERG in the two groups were improved after operation. The differences of postoperative IS/OS junction defect (t=2.261, P<0.05) and amplitude of wave P1 of ring 2 between the two groups were significant (t=2.282, P<0.05), but the differences of postoperative amplitude of wave P1 of ring 1 between two groups was not different (t=1.800, P>0.05). ConclusionPPV combined with ILM peeling and ILM transplantation can significantly improve the closure rate and vision of IMH with HFF<0.6.
Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.
Objective To investigate the visual function of idiopathic macular hole before and after macular surgery. Methods Vitreous-retinal surgery was performed in 19 patients(19 eyes) with idiopthic macular hole.Among them,3 eyes belonged to stage 2，10 eyes stage 3 and 6 eyes were stage 4. The visual function including international standard visual acuity,laser retinal visual acuity,photopic ERG intensity responses- and Humphrey 30deg;-2 visual field were tested and compared before and after the surgery. Results (1)International standard visual acuity was from 0.01 to 0.1 preoperatively,and from 0.04 to 0.4 post operatively,the difference was not significant(P＞0.0 5).(2)Laser retinal visual acuity was from 0.12 to 0.4 preoperatively,and from 0.2 to 0.63 postoperatively,the difference was significant (P＜0.05).(3)In photopic ERG intensity responses:the Log K value of bwave decreased after surgery (P＜0.05),but no obvious change found in Rmax and n Value after operation.(4)Humphrey visual field examination revealed the thresholds for 0-10deg; increased after surgery(P＜0.05),but not obvious for 15-30deg;． Conclusion The visual function of the macular cones are increased by macular surgery for IMH. (Chin J Ocul Fundus Dis，2000，16：213-284)
Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group). In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group). The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was (1.67±1.28) and (7.65±1.42) days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant (Z=−6.784, P＜0.05). At 6 months after surgery, the hole closure was detected in 30 eyes (85.71%) in the SS-OCT group and in 27 eyes (93.10%) in the control group. There was no difference of hole closure rate between the two groups (χ2=0.889, P＞0.05). There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate.
Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P＜0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=−5.413, P＜0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.
ObjectiveTo observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not. MethodsForty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study. Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group). During the operation, a proper size of the ILM was removed and filled in the bottom of the macular hole. The age, duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P>0.05). Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined. There was no statistically significant difference in logMAR BCVA, average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128, 1.452, 1.321; P>0.05). The logMAR BCVA and SD-OCT were examined on 1, 3, 6, 12 months postoperatively. ResultsOn 1 month after the surgery, there was no statistically significant difference in logMAR BCVA, average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226, 1.435, 1.018; P>0.05). On 3, 6, 12 months after the surgery, compared with ILM removal group, the logMAR BCVA (t=2.059, 2.871, 2.415) increased and the average defect diameter of IS/OS (t=2.070, 2.110, 2.121) and ELM (t=2.034, 3.647, 3.556) significantly reduced in ILM transplantation group (P<0.05). On 1 month after the surgery, there was statistically significant difference in CRT between two groups (t=2.113, P<0.05). On 3, 6, 12 months after the surgery, there was no statistically significant difference in CRT between two groups (t=0.428, 0.847, 0.849; P>0.05). ConclusionCompared with vitrectomy combined with ILM peeling surgery, the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH.