Macular Hole Repair by Vitrectomy and Internal Limiting Membrane Peeling in Highly Myopic Eyes

Chuang, Lan-Hsin; Chen, Yen‐Po; Wang, Nan-Kai; Yeung, Ling; Chen, Kuan‐Jen; Hwang, Yih‐Shiou; Wu, Wei‐Chi; Chen, Tun-Lu; Lai, Chi-Chun

doi:10.1097/iae.0000000000000183

Cited by 17 publications

(10 citation statements)

References 43 publications

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“…Last but not least, cytotoxicity of ICG may cause damage to the RPE and neurosensory retina, which could result in worsening the myopic maculopathy (Lai et al 2005;Gandorfer et al 2008). Thus, new dyes, dye-free techniques and prevention of dye leakage into the subretinal space through MHs have become important subjects to facilitate ILM removal and preservation in chromovitrectomy (Chuang et al 2014). Using a macular plug to repair highly myopic MHRD in a pre-existing glaucomatous eye was associated with visual deterioration lasting between 12 and 36 months.…”

Section: Discussionmentioning

confidence: 99%

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three‐year results

Ling

Chuang

et al. 2020

Acta Ophthalmologica

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To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. Methods: Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications. Results: The mean patient age was 61.0 AE 11.4 years. The follow-up was 45.2 AE 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 AE 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and preexisting disease of glaucoma (p = 0.006). Conclusions: A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.

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Section: Discussionmentioning

confidence: 99%

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three‐year results

Ling

Chuang

et al. 2020

Acta Ophthalmologica

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“…[ 15 ] Large MHs (minimum diameter >400 μm), however, usually had an increased risk of surgical failure, and the closure rate of MHs with high myopia, reported between 83% and 87%, appeared to be lower than the idiopathic forms. [ 16 17 ] In addition, about 19–39% of the so-called anatomically closed large MHs were actually flat-open. [ 6 7 8 ] This is not hard to understand considering that the traditional ILM peeling might only release the tangential traction, but cannot compensate for tissue shortening in large MHs.…”

Section: Discussionmentioning

confidence: 99%

Inverted Internal Limiting Membrane Flap Technique for Repair of Large Macular Holes

Chen

Zhao

et al. 2016

Chinese Medical Journal

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Background:Inverted internal limiting membrane (ILM) flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes (MHs) with fair MH closure rates as well as gains in visual acuity. In the current study, longitudinal changes in multi-focal electroretinogram (mfERG) responses, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated in eyes with large MHs managed by this technique.Methods:A prospective noncontrolled interventional study of eight patients (eight eyes) with large MHs (minimum diameter >400 μm) was conducted. All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique. SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results:All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure. Partial microstructural reconstruction, demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone, was observed in all cases as early as 1 month after surgery. Functionally, as compared to baseline, all patients showed improvements in BCVA and all but one in mfERG response during follow-up. However, Pearson's test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions:Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results. Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response, of which the latter might be a supplement for the former in postoperative functional follow-up.

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“…In high myopic eyes, macular holes occur earlier 19 and evolve faster than in non-myopic eyes 20 due to longer axial length 20 and thinner retina thickness 21 because these two factors may exacerbate the impact of traction forces on highly myopic eyes. 22 In the present study, the foveal retina thickness of IMH eye before disease was unable to know owing to the hole, so CMT of the fellow eye was measured to represent. The results showed that AXL was longer and CMT was thicker in male than in female, which were in accordance with previous reports 23,24 but seemed to be a contradiction concerning their opposite effects on development of macular holes.…”

Section: Discussionmentioning

confidence: 85%

Pre- and Post-operative Differences Between Genders in Idiopathic Macular Holes

Wang

Liang

et al. 2020

Preprint

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Background: To compare idiopathic macular holes (IMHs) between male and female before and after surgery.Methods: Patients with IMHs of stage 3 and stage 4 who underwent 23-gauge vitrectomy were retrospectively enrolled. Pre-operative clinical features like age of onset, and best-corrected visual acuity (BCVA) were reviewed. Optical coherence tomography parameters including minimum linear diameter (MLD), central macular thickness and some other indexes were measured and calculated. Main surgical outcomes included the primary closure rate, the highest BCVA during follow-up, and the recovery duration. All the metrics mentioned above were compared between genders with appropriate statistical methods. Results: A total of 298 eyes from 280 patients (male: 51; female: 229) were enrolled. Compared with men, women demonstrated a significantly higher ratio of stage3/stage4 (P=0.045), larger horizontal MLD (P=0.009), but similar surgical outcomes except for a relatively longer recovery duration (P=0.024). For stage 3 IMHs, women exhibited significantly younger age of onset (P=0.023), larger MLD (P=0.003), and smaller height of the hole (P=0.029). However, for stage 4 IMHs, all the pre- and post-operative metrics showed no differences between genders.Conclusions: Female IMHs seem to demonstrate an earlier age of onset and larger size of hole, especially in IMHs of stage 3. However, these differences, which may owe to normal gender-related variations, have limited influence on the surgical outcomes.

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Macular Hole Repair by Vitrectomy and Internal Limiting Membrane Peeling in Highly Myopic Eyes

Cited by 17 publications

References 43 publications

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three‐year results

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three‐year results

Inverted Internal Limiting Membrane Flap Technique for Repair of Large Macular Holes

Pre- and Post-operative Differences Between Genders in Idiopathic Macular Holes

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