Macular Detachment for the Treatment of Persistent Full-Thickness Macular Holes

Fotis, Konstantinos; Alexander, Philip; Sax, James; Reddie, Ian; Kang, Chee Yiong; Chandra, Aman

doi:10.1097/iae.0000000000002370

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…15 Fotis reported visual acuity improvement in 90% of cases. 5 None of the patient in this study experienced deterioration of pre-existing vision which was similar to the study conducted by Wong R et al 16 There were no significant or long-term intra-operative or post-operative complications observed in this study. Sgiziato et al also mentioned no complicationas in their study.…”

Section: Discussionsupporting

confidence: 86%

“…An added benefit is that the removal of ILM also reduces the possibility of epiretinal membrane formation. 5 The theory behind the projected technique is that in cases of persistent holes, there is another force at play that impedes approximation of the hole edges, even after reprieve of the abnormal anteroposterior and tangential vitreous traction. This could be caused by the underlying retina, which is too inflexible to permit for edge closure.…”

Section: Discussionmentioning

confidence: 99%

“…An important condition for macular holes closing is mobility of the retina around holes. 5 Several researchers have also reported that macular holes with surrounding subretinal fluid were more likely to close. 10,11 Ideal anatomical and functional outcomes are achieved with a surgical technique that accomplishes the greatest extent of mobilization of macular hole edges, allowing them to re-approximate while causing minimal trauma to the retinal pigment epithelium during mechanical manipulation of the retina.…”

Section: Discussionmentioning

confidence: 99%

“…With modern surgical techniques, approximately 90% of FTMHs attain anatomical closure on primary surgery, with almost half of patients achieving visual acuity of 20/50 or better. 5 The closure rate and visual outcome of FTMHs depend on its size and chronicity. Therefore, large chronic FTMHs are known to have a less constructive outcome.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital

Khan¹,

Syed²,

Syed

et al. 2021

Pak J Med Sci

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Objective: To assess the anatomical and functional outcomes of treating chronic persistent large macular hole by macular hole hydrodissection technique in a tertiary eye care hospital. Methods: This interventional case series study was conducted in the Vitreoretinal department of LRBT Tertiary Teaching Eye Hospital, Karachi, from October 2017 to March 2018, with follow-ups till February 2019. The study included eighteen cases of chronic (symptoms of loss of central vision ≥ 2years), persistent (previously failed macular hole surgery), large (aperture diameter of ≥ 400µm) macular hole. Out of the eighteen patients, eight (44.4%) were males and ten (55.6%) were females. All operated patients underwent macular hole hydrodissection by balanced salt solution using a silicone soft tip extrusion cannula. Patients were followed up post operatively to assess post-operative complications and surgical results. Results: Among eighteen patients with a mean aperture diameter of 477.1±102.9 µm and basal diameter of 849.4± 92.6µm, complete anatomical closure was achieved in sixteen (88.8%). Five (27.7%) out of the eighteen patients achieved best corrected visual acuity improvement of 6/36, whereas seven (38.8%) patients reached up to a BCVA of 6/60, with maximum improvement of two lines. The mean post-operative follow-up was 332.3± 46.7 days. Conclusion: Macular hole hydrodissection is a relatively new emerging technique with promising results for the closure of chronic persistent large macular hole. doi: https://doi.org/10.12669/pjms.37.4.3618 How to cite this:Khan TH, Rizvi SF, Mahmood SA, Feroz L. Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3618 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital

Khan¹,

Syed²,

Syed

et al. 2021

Pak J Med Sci

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“…Induced macular detachment by application of subretinal fluid has been described to release adhesions between the retracted retina and adjacent retinal pigment epithelium and may approximate the edges of even very large holes [13]. Previous studies have described a satisfying hole closure rate, but only a moderate increase in visual acuity [13,36]. The largest study reported a 2.2-line improvement [13].…”

Section: Discussionmentioning

confidence: 99%

Persistent macular holes — what is the best strategy for revision?

Szurman

Wakili

Stanzel

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose This study aims to analyze the success rate and functional outcome after revision surgery of persistent idiopathic full-thickness macular holes in a large patient cohort and to identify the optimal tamponade strategy and the value of new adjunctive manipulation techniques for persistent macular hole (pMH) closure. Methods Retrospective, comparative, non-consecutive case series of all revisional surgeries for idiopathic pMH between 2011 and 2019 at the Eye Clinic Sulzbach were identified. Of 1163 idiopathic MH surgeries, 74 eyes of 74 patients had pMH. Of those, group 1 (n = 38) had vitrectomy with tamponade alone (20% sulfur hexafluoride gas, 15% hexafluoroethane gas, silicone oil 5000, Densiron®), while group 2 (n = 36) included tamponade with adjuvant manipulation (internal limiting membrane (ILM) translocation, subretinal fluid injection, epiretinal amniotic membrane, free retina graft, or autologous blood). Main statistical outcomes were anatomic closure rate, visual acuity (VA), minimum linear diameter (MLD), and base diameter (BD). Results Overall total anatomical success rate was 81.1% and mean VA improved 3.5 lines from LogMAR 1.03 ± 0.30 to 0.68 ± 0.38 (p < .001). Preoperative MLD or BD had no effect on total anatomic success (p = 0.074, p = 0.134, respectively). When comparing the two groups, slightly better anatomic success rates were achieved in group 1 (84.2%) compared to that in group 2 (77.8%) (p = 0.68). Final VA in group 1 (LogMAR 0.67 ± 0.39) outperformed group 2 (LogMAR 0.86 ± 0.38) (p = 0.03). Conclusions Revisional surgery for persistent idiopathic MH with tamponade alone had comparable anatomical closure but better VA outcomes, compared to tamponade with adjuvant manipulation.

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