Idiopathic Macular Hole Preferred Practice Pattern®

Flaxel, Christina J.; Adelman, Ron A.; Bailey, Steven T.; Fawzi, Amani A.; Lim, Jennifer I.; Vemulakonda, G. Atma; Ying, Gui Shuang

doi:10.1016/j.ophtha.2019.09.026

Cited by 19 publications

(7 citation statements)

References 175 publications

(209 reference statements)

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“…Idiopathic full-thickness macular holes (FTMHs) are anatomical defects of the neurosensory retina and a common cause of metamorphopsia and central vision loss among adults aged 55 years and older. 1 The first FTMH to be described in the literature was a traumatic case in 1869 2 ; however, our current understanding of idiopathic macular holes (MHs) is largely founded on clinical observations published by Gass more than 100 years later. 3 Although the pathogenesis of idiopathic MH remains unclear, imaging modalities including optical coherence tomography (OCT) have greatly enhanced our ability to visualize, diagnose, classify, and monitor MH in recent years.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Based on available evidence, vitrectomy is an effective method to improve anatomical and visual outcomes in patients with idiopathic MHs, and it represents the standard of care in current clinical practice. 1,10 Despite current advances in primary repair procedures, postoperative outcomes for large MHs (aperture diameter > 400 mm) are suboptimal compared with smaller defects, 11 and achieving long-term closure in persistent or recurrent MHs remains a surgical challenge. Several procedures involving inverted ILM flap techniques, autologous ILM transplant, lens capsular flap transplant, MH hydrodissection, autologous neurosensory retinal transplant, and human amniotic membrane plugs have been developed to promote the closure of large or refractory MHs [12][13][14][15][16][17] ; however, a consensus surgical approach has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Tsipursky

Byun

Jager

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Tsipursky

Byun

Jager

et al. 2021

Journal of VitreoRetinal Diseases

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“…Idiopathic macular hole (MH) affects approximately 8 in 100,000 people each year and is more prevalent in female patients [1]. From the early 1990s, MH surgery has undergone technical improvements that have increased the closure success rates up to 90% of MH cases.…”

Section: Introductionmentioning

confidence: 99%

“…From the early 1990s, MH surgery has undergone technical improvements that have increased the closure success rates up to 90% of MH cases. Nonetheless, there are cases in which MH closure and visual improvement are not achieved, including large, chronic MHs [1]. Hence, there has been a need to develop new treatment modalities and other surgical techniques that may increase MH surgery anatomic and functional success.…”

Section: Introductionmentioning

confidence: 99%

Autologous Retinal Transplantation with the Use of Air Tamponade for the Treatment of a Primary Large Chronic Macular Hole

Mota¹

2021

Case Rep Ophthalmol

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The purpose of this case report is to describe a chandelier-assisted bimanual autologous retinal transplantation (ART) with air tamponade technique for the treatment of a large macular hole (MH). A patient with a primary chronic large MH, who underwent chandelier-assisted bimanual ART with the use of air tamponade is described. The MH diameter was 888 μm. Changes in best-corrected visual acuity (BCVA) were measured postoperatively; clinical pictures and optical coherence tomography were analyzed. Baseline preoperative BCVA was 20/400. Closure of the MH was achieved. At 7 months, post-surgery BCVA improved to 20/50. Optical coherence tomography examinations showed the integration of the autologous transplant with the adjacent macular tissue and continuity preservation of the ellipsoid layer. In conclusion, chandelier-assisted bimanual ART with air tamponade technique was effective in achieving complete MH closure and long-term visual improvement.

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“…4,5 Numerous techniques aiming to address traction, alter tamponade agents, promote closure with adjuvant agents and/or growth factors, or use of scaffolds were developed to repair these challenging MHs. 3,6 Despite this, visual prognosis for these cases remains guarded compared with standard MH surgery.…”

mentioning

confidence: 99%

Autologous Neurosensory Retinal Transplantation

Patel

Mahmoud

Kazahaya

et al. 2021

Retina

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Purpose: To review the autologous retinal transplantation surgical technique, indications, rationale, and current outcomes of data published to date.Methods: Review of surgical technique, preoperative and postoperative best-corrected visual acuity, and macular hole (MH) closure rate in studies with at least five eyes.Results: The weighted average macular hole closure rate is 88%, with a MH closure rate ranging from 66.7% to 100%. The weighted average best-corrected visual acuity improved from mean logarithm of the minimum angle of resolution 1.35 (Snellen equivalent of 20/450) preoperatively to mean logarithm of the minimum angle of resolution 1.02 (Snellen equivalent of 20/210) postoperatively. From the largest autologous retinal transplantation case series, 37% of patients gained 3 or more lines of visual acuity after autologous retinal transplantation for primary or refractory MHs and 74% gained 3 or more lines of visual acuity after autologous retinal transplantation for MH-retinal detachments. Functional improvement including negative Watzke-Allen sign and conversion from positive to negative scotoma was reported in large case series.Conclusion: Autologous retinal transplantation is a promising technique for closure of large and refractory MHs otherwise difficult to repair with conventional techniques. This technique may allow for replacement of neural tissue in the macula through cell rehabilitation and regeneration through presumed ectopic synaptogenesis, retinal progenitor cell differentiation and integration, and/or retinal progenitor cell material transfer to host neurons.

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Idiopathic Macular Hole Preferred Practice Pattern®

Cited by 19 publications

References 175 publications

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

Autologous Retinal Transplantation with the Use of Air Tamponade for the Treatment of a Primary Large Chronic Macular Hole

Autologous Neurosensory Retinal Transplantation

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