Secondary Vitrectomy with Internal Limiting Membrane Plug due to Persistent Full-Thickness Macular Hole OCT-Angiography and Microperimetry Features: Case Series

Abstract

Purpose. To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Methods. Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. Four patients were followed for 6 months with best corrected visual acuity (BCVA) measurement, SD-OCT and OCT-A, and microperimetry. The results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Results. ILM flap was integrated in all cases with V-shape of closure, and atrophy was found in one case, with the largest diameter of FTMH. BCVA improved in two cases and remained the same in two cases. In OCT-A, the area of foveal avascular zone (FAZ) was larger, and foveal vessel density (FVDS) was smaller in eyes after secondary PPV in comparison to fellow eyes. In microperimetry, retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Conclusion. Although the anatomical results of repeated surgeries of FTMH with ILM plug are favorable, visual function results may be limited. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. The trial is registered with NCT03701542.

Globotrioasylsphingosine Levels and Optical Coherence Tomography Angiography in Fabry Disease Patients

“…It is capable of delivering structural and angiographic analysis without invasive measures such as intravenous dye injection [ 24 ]. OCTA is able to provide quantitative microvascular information such as vessel density (VD) and vessel length density (VLD) [ 25 , 26 ]. Additionally, OCTA allows a clear and detailed visualization of retinal and choroidal microvasculature, and it is useful either for diagnostic purposes or for guiding treatment, and monitoring different retinal diseases [ 27 ].…”

Flap technique-assisted surgeries for advanced retinitis pigmentosa complicated with macular hole: a case report and literature review

“…A diameter of FTMH over 500 μm could be considered a risk factor for unclosure after primary vitrectomy and flap-related techniques can improve the closure rate [ 32 , 33 ]. However, if ILM was not available such as being peeled in previous surgeries or other causes, lens capsular flap transplantation, which has been first introduced by Yang in 2016, could be a good alternative to overcome the aforementioned difficulties.…”

Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair

“…The rate of macular hole closure was comparable with the 90 % or more reported in the literature [ 33 ]. The reason for failure may have been insufficient gas tamponade, poor patient compliance with prone position, residual epiretinal traction or incomplete removal of posterior hyaloid despite staining, large macular hole of more than 450 μm for which ILM Flap technique could have been considered, or no obvious causes [ 8 , 9 , 34 ].…”

“…The success of surgery in the treatment of primary FTMH has been reported in several studies [ 7 ]. The failure rate of primary surgery is less than 10 % but the nonclosure rate for large FTMH may be as high as 44 % [ 8 , 9 ]. Nevertheless, the optimal treatment for patients with both vitreoretinal and cataract disease is still a matter of debate [ 10 – 12 ].…”