Partial posterior hyaloidectomy for macular disorders

Kim, J H; Kang, Se Woong; Kim, Y T; Kim, S J; Chung, Song Ee

doi:10.1038/eye.2013.117

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Kim et al suggested that partial posterior hyaloidectomy, as they had termed it, could minimize the traction on the vitreous base and therefore reduce the risk of iatrogenic retinal breaks. 121 They reported a reduction in retinal break formation from 21% to 5% compared with conventional 23 G surgery, although they did note two postoperative retinal detachments in the modified technique group. Cullinane and Cleary also suggested a similar technique, but primarily to reduce the incidence of symptomatic field defects after surgery.…”

Section: Other Advances In Surgical Techniques and Equipmentmentioning

confidence: 93%

Optimal management of idiopathic macular holes

Madi¹,

Masri²,

Steel³

2016

OPTH

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This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.

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Section: Other Advances In Surgical Techniques and Equipmentmentioning

confidence: 93%

Optimal management of idiopathic macular holes

Madi¹,

Masri²,

Steel³

2016

OPTH

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“…28,40,41 Furthermore, a partial posterior hyaloidectomy, where the hyaloid membrane is intentionally detached during vitrectomy, is performed routinely as part of macular hole surgery in patients with diabetic or idiopathic retinopathy in order to limit traction and improve visual outcomes. 42,43 In summary, pre-retinal delivery of rAAV appears to be well tolerated in the 13-LGS and, even at a considerably lower dose volume, results in increased retinal transduction compared to the deep vitreous intravitreal delivery route. If developed further, the pre-retinal injection route could represent a novel method by which to administer gene therapy for the treatment of inherited retinal disease, particularly in younger patients with intact posterior hyaloid membranes and solid un-liquified vitreous.…”

Section: Discussionmentioning

confidence: 95%

Pre-retinal delivery of recombinant adeno-associated virus vector significantly improves retinal transduction efficiency

Zhang

Sajdak

Merriman

et al. 2021

Molecular Therapy - Methods & Clinical Development

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Intravitreal injection is the most widely used injection technique for ocular gene delivery. However, vector diffusion is attenuated by physical barriers and neutralizing antibodies in the vitreous. The 13-lined ground squirrel (13-LGS), as in humans, has a larger relative vitreous body volume than the more common rodent models such as rats and mice, which would further reduce transduction efficiency with the intravitreal injection route. We report here a "pre-retinal" injection approach that leads to detachment of the posterior hyaloid membrane and delivers vector into the space between vitreous and inner retina. Vectors carrying a ubiquitously expressing mCherry reporter were injected into the deep vitreous or preretinal space in adult wild-type 13-LGSs. Then, adeno-associated virus (AAV)-mediated mCherry expression was evaluated with non-invasive imaging, immunofluorescence, and flow cytometry. Compared to deep vitreous delivery, pre-retinal administration achieved pan-retinal gene expression with a lower vector dose volume and significantly increased the number of transduced cone photoreceptors. These results suggest that pre-retinal injection is a promising tool in the development of gene therapy strategies in animal models and is a potential approach for use in human research, particularly in younger individuals with an intact posterior hyaloid membrane and stable vitreous.

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“…They reported successful results from 3 patients, without any significant complications. In another study, Kim et al [ 8 ] performed posterior hyaloid separation slightly beyond the temporal vascular arcade in 59 eyes with macular disorders and compared it with 57 eyes that underwent complete vitrectomy. The incidence of iatrogenic peripheral retinal breaks was significantly lower in eyes with the partial vitrectomy (3.4%), compared to complete vitrectomy (16%).…”

Section: Discussionmentioning

confidence: 99%

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial

Forlini

Date²,

DʼEliseo

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. Methods. In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. Results. We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p = 0.49 ). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group ( p = 0.22 ). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences ( p = 0.18 ). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group ( p < 0.001 ). Conclusion. A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

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Partial posterior hyaloidectomy for macular disorders

Cited by 11 publications

References 15 publications

Optimal management of idiopathic macular holes

Optimal management of idiopathic macular holes

Pre-retinal delivery of recombinant adeno-associated virus vector significantly improves retinal transduction efficiency

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial

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