Modified Vitreous Surgery for Symptomatic Lamellar Macular Hole With Epiretinal Membrane Containing Macular Pigment

Shiraga, Fumio; Takasu, Ippei; Fukuda, Komei; Fujita, Tomoyoshi; Yamashita, Ayana; Hirooka, Kazuyuki; Shirakata, Yukari; Morizane, Yuki; Fujiwara, Atsushi

doi:10.1097/iae.0b013e31828bcb61

Cited by 59 publications

(55 citation statements)

References 14 publications

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“…In fact, previous study had reported a high incidence of FTMH formation after the LHEP was peeled in surgeries for LMH [3,4]. Shiraga et al [11] recommended inversion of the pigment containing tissue into the LMH to facilitate normalization of the foveal contour. We did not specifically perform this maneuver, but only emphasize the importance of gently handling the LHEP tissue.…”

Section: Discussionmentioning

confidence: 97%

Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings

Lai

Chen

Yang

2015

Graefes Arch Clin Exp Ophthalmol

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Section: Discussionmentioning

confidence: 97%

Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings

Lai

Chen

Yang

2015

Graefes Arch Clin Exp Ophthalmol

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“…Recent studies have observed some common morphological configurations of this unusual proliferation [121415]. It is most frequently observed in eyes with LH [8111316] and is associated with a large hole diameter and a thin fovea [14]. It does not appear to occur in eyes with an intact IS/OS junction, such as those with MPH [1215].…”

Section: Discussionmentioning

confidence: 99%

Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon

Son

Lee

et al. 2016

Korean J Ophthalmol

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PurposeTo discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue.MethodsSixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically.ResultsEPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining.ConclusionsEPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.

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“…Surgical peeling may cause the final loss of an already weak scaffolding property of the Müller cells. The double inverted flap technique aims to protect the fovea by limiting the removal of the membranes (ERM and ILM), following the hypothesis that AERM is partially composed of retinal tissue, and its removal may damage the fovea [38, 39]. In the double flap group, the foveal defect is filled by epiretinal tissue that appeared hyperreflective by OCT (Fig.…”

Section: Discussionmentioning

confidence: 99%

A Double Inverted Flap Surgical Technique for the Treatment of Idiopathic Lamellar Macular Hole Associated with Atypical Epiretinal Membrane

et al. 2019

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Objectives: To propose a new technique of a double inverted epiretinal membrane (ERM) and internal limiting membrane (ILM) flap (double flap group) for the treatment of idiopathic lamellar macular hole (LMH) with atypical ERM (AERM) and to compare surgical outcomes to those of the standard technique of ERM and ILM peeling of the fovea including LMH (control group). Methods: AERM was tomographically defined as a medium reflective thickened membrane above the retinal fiber layers without retinal traction signs. A series of patients affected by LMH with AERM were recruited. Preoperative parameters were: intraretinal cysts (IRC), intraretinal splitting diameter, residual foveal thickness, and ellipsoid zone integrity. Postoperative findings were: full-thickness macular hole (FTMH) development, and persistence or new appearance of IRC. Best-corrected visual acuity (BCVA) at baseline, first, third, and sixth postoperative month was evaluated. Results: A total of 48 eyes of 48 patients were included in this study. In the double flap group (30 eyes), a clear improvement of BCVA was noted (p = 0.004), and there were no complications. In the control group (18 eyes), BCVA did not improve and 3 patients developed postoperative FTMH. Conclusions: The double inverted flap technique is associated with better functional recovery compared to the standard technique and reduces the risk of postoperative FTMH development.

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Modified Vitreous Surgery for Symptomatic Lamellar Macular Hole With Epiretinal Membrane Containing Macular Pigment

Cited by 59 publications

References 14 publications

Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings

Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings

Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon

A Double Inverted Flap Surgical Technique for the Treatment of Idiopathic Lamellar Macular Hole Associated with Atypical Epiretinal Membrane

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