Idiopathic full thickness macular hole: natural history and pathogenesis

Ezra, Eric

doi:10.1136/bjo.85.1.102

Cited by 130 publications

(102 citation statements)

References 64 publications

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“…Kim et al20 demonstrated that approximately 75% of stage 2 MH cases progress to stage 3 or 4. Although Ezra21 indicated that 30% to 50% of stage 1 MH cases tend to close spontaneously, the closure rate was 94% in MH present for less than a year versus 47% in those present for more than a year, according to Jaycock et al22 Extended observation, however, is unreasonable, as the longer the MH is present, the lower the chance of a successful surgical result, according to Ryan and Gilbert 23. Pars plana vitrectomy with ILM removal is the standard surgical treatment for MH, and not only OCT but also ultrasonography may be useful for following and indicating surgical intervention in such eyes 24,25…”

Section: Resultsmentioning

confidence: 99%

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Stefanini¹,

Maia²,

Falabella³

et al. 2014

OPTH

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The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.

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Section: Resultsmentioning

confidence: 99%

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Stefanini¹,

Maia²,

Falabella³

et al. 2014

OPTH

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“…Although theories involving antero-posterior and tangential tractions have been proposed as a possible explanation of this pathology's origin [4], no definite conclusions have yet been reached, and the disease is still regarded as idiopathic. However, it is demonstrated that patients with unilateral IMH have an increased risk (by up to 29% [2], [5]) of developing the same condition on their fellow eye. In this work we aim to take advantage of this predisposition to determine if an eye is at risk of developing IMH.…”

Section: Introductionmentioning

confidence: 96%

“…Nonetheless, the probability of the disease progressing to a full-thickness macular hole increases as time elapses. Full-thickness macular holes can be treated through surgery (with a success rate of 82% [2]) or, more recently, with an intravitreal injection, that despite having had encouraging results is still not as effective as the surgical option [3].…”

Section: Introductionmentioning

confidence: 99%

Unveiling preclinical idiopathic macular hole formation using support vector machines

Silva

Figueira²,

Simão

et al. 2014

IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI)

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Macular holes are ruptures in the central part of the retina that if left untreated may lead to serious vision loss. Although there is a lot yet to know about this pathology, it is established that if one suffers from unilateral idiopathic macular hole (IMH), then there is an increased risk of developing the same condition in the fellow eye. The goal of this work is to use optical coherence tomography (OCT) scans and, resorting to automatic pattern recognition algorithms, develop a classifier that distinguishes eyes at risk of developing IMH from healthy controls. From the collected data we were able to estimate a set of parameters that allow for the classification of eyes into the group of eyes at risk or healthy controls with an accuracy of 95.1%, sensitivity of 96.9% and specificity of 93.1%.

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“…As newer and more advanced modalities for imaging the posterior vitreous face and retina have become available, a clearer understanding of the causative mechanisms has evolved. Particular interest has focused on the posterior hyaloid membrane and age-related posterior vitreous detachment [4][5][6]. Several studies using techniques such as ocular coherence tomography (OCT, OCT 2, Carl Zeiss Meditec Inc., Jena, Germany), ultrasonography and Heidelberg retinal tomography (HRT, Heidelberg Engineering, Heidelberg, Germany) have proposed essentially a two-stage process in idiopathic macular hole formation [1,2,[5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Particular interest has focused on the posterior hyaloid membrane and age-related posterior vitreous detachment [4][5][6]. Several studies using techniques such as ocular coherence tomography (OCT, OCT 2, Carl Zeiss Meditec Inc., Jena, Germany), ultrasonography and Heidelberg retinal tomography (HRT, Heidelberg Engineering, Heidelberg, Germany) have proposed essentially a two-stage process in idiopathic macular hole formation [1,2,[5][6][7][8][9]. The first being perifoveal vitreous detachment with central foveolar dehiscence as a result of anteroposterior (AP) traction; and the second, enlargement of this defect as a result of tangential traction [9,10].…”

Section: Introductionmentioning

confidence: 99%

Is axial length a risk factor for idiopathic macular hole formation?

2012

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Current theories for macular hole formation implicate antero-posterior and tractional forces at the vitreofoveal interface. It is thought that localized perifoveal defects enlarge from centrifugal forces acting about the axis of ocular rotation. If this is true, eyes with longer axial lengths should have an increased incidence of macular holes. The aim of this study was to determine if axial length is a risk factor for macular hole development. The study group comprised 40 patients with refractive errors from hyperopia to myopia with stage 3 and 4 idiopathic macular holes. Controls matched for age, gender and spherical equivalent (SE) were used for statistical comparison. Axial length (AL) was analyzed using SPSS 13.0 statistical software and compared using Student's t test. P < 0.05 was considered significant. SE ranged from -8.88 to +3.63 dioptres in the macular hole group and -8.50 to +3.63 in controls. In the macular hole group, mean AL ± standard deviation was 23.62 ± 1.20 mm (21.81-27.51); in controls, 23.09 ± 1.16 mm (21.31-26.58). Univariate analysis showed that higher AL is associated with macular hole formation. The mean difference in AL was 0.531 mm (95 % confidence interval -0.1596 to -0.9024). Two-tailed t test: P < 0.006. This study showed that increasing ocular AL is significantly associated with macular holes. Dynamic forces at the macula would be greater in these eyes suggesting this may play a causative role in macular hole formation.

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Idiopathic full thickness macular hole: natural history and pathogenesis

Cited by 130 publications

References 64 publications

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Unveiling preclinical idiopathic macular hole formation using support vector machines

Is axial length a risk factor for idiopathic macular hole formation?

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