Refractory full thickness macular hole: current surgical management

Frisina, Rino; Gius, Irene; Tozzi, Luigi; Midena, Edoardo

doi:10.1038/s41433-020-01330-y

Cited by 34 publications

(28 citation statements)

References 168 publications

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“…The numbers were too small to perform statistical analysis. Frisina and colleagues [ 11 ] recently reviewed 10 different surgical techniques used to manage these MH. They concluded that closure rates were similar in all of these techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In their review they concluded that the use of human amniotic membrane gave the best visual acuity results. They argued that RE required a complex and unjustified surgical maneuver [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Larger and chronic MH have a much lower closure rate. Several techniques, including RE and AT-ILM among others, have been developed to address larger holes and those that have failed primary surgical repair [2,11]. The RE technique was originally described by Oliver and Wojcik [9] in 2011.…”

Section: Discussionmentioning

confidence: 99%

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A 24 month follow-up of refractory macular holes treated with an autologous transplantation of internal limiting membrane versus retina expansion technique

et al. 2021

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Background To compare the functional and anatomic outcomes at 24 months of eyes with a primary macular hole that failed to close after a prior surgery and were treated with either an autologous transplantation of internal limiting membrane (AT-ILM) or the retina expansion (RE) technique. Methods Retrospective, single center, comparative study of 28 eyes with a macular hole that failed to close after a prior vitrectomy. All eyes had a size of ≥ 500 μm. Participants were divided into two groups according to the type of intervention performed: AT-ILM group (n = 14) and RE group (n = 14). Main outcomes measured were the MH closure rate assessed by spectral-domain optical coherence tomography (SD-OCT) and the best-corrected visual acuity (BCVA) at 24 months after surgery. Results Patients in the AT-ILM group experienced a statistically significantly improved post-operative BCVA (median 49.50 letters, range 20–66 letters) over the pre-operative BCVA (median 39 letters, range 18–52 letters) (p-value = 0.006 Wilcoxon paired sample test). In contrast, patients in the RE group did not achieve a statistically significant improvement (p-value = 0.328, Wilcoxon paired sample test). The median pre-operative BCVA was 35 letters (range 18–52 letters), whereas the median post-operative BCVA was 39 letters (range 16–66 letters). At 24 months of follow-up, 85.7% of patients in the AT-ILM group achieved closure compared to 57.1% in the RE group (p-value = 0.209, Fisher’s exact test). Multivariate analysis showed that MH size and baseline BCVA were important determinants of post-operative BCVA. The baseline MH size was the only significant pre-operative factor that influenced MH closure. Conclusions This study demonstrates similar closure rates for both groups however better visual outcomes were obtained with the AT-ILM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A 24 month follow-up of refractory macular holes treated with an autologous transplantation of internal limiting membrane versus retina expansion technique

et al. 2021

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“…The close contact between the RPE and the graft protected the MH from vitreous and also promoted RPE proliferation and retinal restoration as per in vitro studies [ 108 , 111 ]. Nevertheless, the anatomical success rate between hAM and other autologous ILM and non-ILM grafts transplants was similar to close refractory MHs [ 112 ].…”

Section: Introductionmentioning

confidence: 99%

Update on surgical management of complex macular holes: a review

Abdul-Kadir

Lim

2021

Int J Retin Vitr

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Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.

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“…ese platelet features have been studied and applied as an autologous platelet concentrate in reconstructive and regenerative medicine (wound healing, maxillofacial bone defect, musculoskeletal soft tissue injuries), as well as in ophthalmology to treat refractive corneal ulcers [10][11][12][13][14][15][16] and to increase the closure rate of idiopathic full-thickness macular holes or optic pits after vitrectomy [17]. Activated platelets can also form pathogenic thrombi in patients with atherothrombotic disease [18].…”

Section: Introductionmentioning

confidence: 99%

Human Platelets Take up Anti-VEGF Agents

Sobolewska

Fehrenbacher

Münzer

et al. 2021

Journal of Ophthalmology

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Purpose. Growing evidence suggests different systemic exposure of anti-vascular endothelial growth factor (anti-VEGF) agents with repeated intravitreal application. Since the penetration of anti-VEGF agents through vascular barrier was reported, the interaction of anti-VEGF with nonresident platelets has become a topic of interest. The purpose of this study was to evaluate, with the help of visualization techniques, whether platelets take up the anti-VEGF agents ranibizumab, aflibercept, and bevacizumab. Methods. The uptake of anti-VEGF agents with or without VEGF treatment was investigated using immunofluorescence and immunogold staining in human platelets. The role of actin filaments and clathrin-coated vesicles in the transport of ranibizumab, aflibercept, and bevacizumab was evaluated by two pharmacologic inhibitors: staurosporine (protein kinase C inhibitor) and cytochalasin D. Results. All three anti-VEGF agents were taken up by platelets and colocalized with VEGF. Ranibizumab and aflibercept were mainly detected in alpha-granules; however, bevacizumab was equally localized in alpha-granules and in platelet vesicles. Both staurosporine and cytochalasin D completely inhibited the uptake of aflibercept into platelets. Both pharmacological inhibitors also decreased the transport of ranibizumab and bevacizumab into platelets. Bevacizumab was significantly more frequently colocalized within clathrin-coated vesicles than ranibizumab and aflibercept. Conclusion. All three anti-VEGF agents are taken up by platelets and internalized in alpha-granules, which may result in a higher local exposure of anti-VEGF after the activation of platelets, potentially contributing to arterial thromboembolic events. Clathrin-coated vesicles seem to be more prominent in the transport of bevacizumab than ranibizumab and aflibercept. Nevertheless, whether the different localization and transport of bevacizumab are truly related to specific differences of receptor-mediated endocytosis has to be revealed by further research.

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Refractory full thickness macular hole: current surgical management

Cited by 34 publications

References 168 publications

A 24 month follow-up of refractory macular holes treated with an autologous transplantation of internal limiting membrane versus retina expansion technique

A 24 month follow-up of refractory macular holes treated with an autologous transplantation of internal limiting membrane versus retina expansion technique

Update on surgical management of complex macular holes: a review

Human Platelets Take up Anti-VEGF Agents

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