The Manchester Large Macular Hole Study: Is it Time to Reclassify Large Macular Holes?

Ch'ng, Soon Wai; Patton, Niall; Ahmed, Mahmoud Galal; Ivanova, Tsveta; Baumann, Carmen; Charles, Stephen; Jalil, Assad

doi:10.1016/j.ajo.2018.07.027

Cited by 119 publications

(94 citation statements)

References 29 publications

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“…Therefore, they suggested that ILM flaps should be reserved for macular holes >650 µm. The closure rate of our series was very high (97%) and is consistent with that reported by Ch’ng et al [7]. Even in the subgroup of eyes >650 µm, the closure rate was similar between ILM peeling and ILM flap eyes (with only 1 failure, in the ILM flap group).…”

Section: Discussionsupporting

confidence: 91%

“…The comparison with the traditional technique limited to ILM peeling found both supporters of ILM flap [3, 4] and detractors [5, 6]. A big step forward for the decision-making process about the choice of the most appropriate treatment for idiopathic MH >400 µm came from the Manchester Study [7]. The study showed that standard MH surgical repair (ILM peeling only) has a very high success rate (94%) in holes up to 650 µm in size.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the issue has been a matter of debate, with some papers favouring the inverted flap technique [3, 4] while others show no differences compared with the traditional ILM peeling for the treatment of idiopathic large MHs [5, 6]. Additionally, the Manchester Study recently revisited the definition of what constitutes a large MH and it showed that standard surgical repair with ILM peeling only may be successful in >90% of idiopathic MHs up to 650 µm in size [7].…”

Section: Introductionmentioning

confidence: 99%

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Large Idiopathic Macular Hole Surgery: Remodelling of Outer Retinal Layers after Traditional Internal Limiting Membrane Peeling or Inverted Flap Technique

et al. 2020

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Large Idiopathic Macular Hole Surgery: Remodelling of Outer Retinal Layers after Traditional Internal Limiting Membrane Peeling or Inverted Flap Technique

et al. 2020

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“…This study concluded that the standard MH surgical repair gained very high success rate of up to 650 µm. 68 Various techniques in combination with ILM peelings such as ILM flaps or retinal expansion techniques have been reported to improve the success rates.…”

Section: Application Of Novel Concepts In Challenging Casesmentioning

confidence: 99%

<p>Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole</p>

Ittarat¹,

Somkijrungroj²,

Chansangpetch³

et al. 2020

OPTH

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Purpose To summarize current surgical techniques for treating primary macular holes (MHs). Methods We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of >90%, even in large MH up to 650 µm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.

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“…Postoperative uncorrected VA was measured at 3 months postoperatively with a Snellen chart and was converted to the logarithm of the minimum angle of resolution (logMAR) VA for computational purposes. The following LogMAR cutoffs were used for non-numeric VA [11]: able to count fingers = 1.7 LogMAR; able to detect hand movement = 2.0 LogMAR; light perception = 2.3 LogMAR; no light perception = 3.0 LogMAR.…”

Section: Patientsmentioning

confidence: 99%

Novel use of an adjustable single 8–0 polypropylene suture of scleral fixation without conjunctival dissection

2020

BMC Ophthalmol

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Background: This report serves to describe the use of a novel adjustable single 8-0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach. Methods: In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8-0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8-0 polypropylene sutures were inserted into the eye guided by 10-0 polypropylene sutures of a long straight needle. The 8-0 suture was then used to fix the haptic IOs. Finally, these 8-0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence. Results: For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up. Conclusions: An adjustable single 8-0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation. Trial registration: Retrospective case series study, not applicable. NCT04476264.

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The Manchester Large Macular Hole Study: Is it Time to Reclassify Large Macular Holes?

Cited by 119 publications

References 29 publications

Large Idiopathic Macular Hole Surgery: Remodelling of Outer Retinal Layers after Traditional Internal Limiting Membrane Peeling or Inverted Flap Technique

Large Idiopathic Macular Hole Surgery: Remodelling of Outer Retinal Layers after Traditional Internal Limiting Membrane Peeling or Inverted Flap Technique

<p>Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole</p>

Novel use of an adjustable single 8–0 polypropylene suture of scleral fixation without conjunctival dissection

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