Objective To determine the anatomical and visual outcome of indocy anine-green（ICG）-assisted internal limiting membrane（ILM） peeling for idiopathic macular holes. Methods Thirty-one eyes of 31 patients with 3- (14 eyes，45.2%) and 4-staged (17 eyes, 54.8%) primary idiopathic macular holes were analyzed. All the patients underwent the subtotal pars plana vitrectomy with removal of the posterior vitreous. ICG solution with the concentration of 1.25 mg/ml was injected into vitreous cavity. The ILM was stained and removed in a circular fashion of 2 to 3 disc-diameter from the edge of the hole. At the end of the surgery, 14% C-3F-8 mixed gas was used and the patients were required to maintain a prostrate posture for two weeks postoperatively. The mean follow-up duration was 9.1 months. Results The preoperative median visual acuity was 20/200. In the final follow-up, 28 eyes (90.3%) had anatomical restoration of the macular holes, 21 eyes had improvement of two lines or more of visual acuity. There was no direct complication or toxicity related to ICG-assisted ILM peeling except one patient with retinal detachment caused by peripheral retinal hole.Conclusion ICG-assisted retinal ILM removal appears beneficial and safe for primary idiopathic 3- and 4-staged macular holes. (Chin J Ocul Fundus Dis，2003，19：137-140)
Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Retinal break is the cause of primary retinal detachment, which remains a main cause for visual loss, and closure of the breaks is the principle of treatment. Currently surgical treatment can successfully reattach the retina in most cases. However, some basic questions still beset treatment of the disease, such as the cause responsible for development of retinal breaks and how to prevent it, and how the visual recovery can be satisfactory after reattachment surgery. Recent research indicates that the development of retinal breaks is associated with the process of vitreous liquefaction, posterior vitreous detachment (PVD) and abnormal vitreoretinal adhesion and traction. The retinal breaks can occur in the posterior margin of the vitreous base in the eye with complete PVD. Partial PVD may cause posterior breaks especially in cases of myopic traction maculopathy associated with schisislike thickening in the outer retina (foveoschisis) and vitreomacular traction. It is known that microstructural changes and atrophy of the macula, and epiretinal membrane formation are the reasons for poor vision after the retina is reattached. Therefore, more attention should be paid to further understand the vitreous pathology and traction mechanism, to research for methods of its clinical evaluation and strategy of prevention and treatment, and to accelerate visual recovery after reattachment surgery, in order to raise the standard of the disease treatment.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P＜0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P＜0.01) and the last follow-up (r=−0.768, P＜0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P＜0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P＞0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
Objective To observe the changes of visual acuity and multifocal electroretinogram （mfERG）before and after pars plana vitrectomy (PPV) combined with internal limiting membrane（ILM）peeling with ICG on idiopathic macular hole surgery. Methods The clinical data of 19 patients (19 eyes) with idiopathic macular hole（IMH） who had undergone PPV combined with ILM peeling assisted by 0.25% ICG from Zhongshan Ophthalmic Center were retrospectively analyzed. The closure of macular holes was confirmed by OCT two months after surgery. VERIS Science 4.9 visual evoked response image system was used to record the amplitude density of P1 waves according to six concentric rings before and two,six,twelve months after surgery, meanwhile compared and analyzed best corrected visual acuity（BCVA）before and after surgery. Results The results of OCT showed that 16 eyes (84.21%) had anatomic closure of the macular hole two months after the surgery while three eyes (15.79%) failed in the closure. The BCVA after surgery improved significantly which was more obvious at the second month (F=6.389，Plt;0.05). Compared with before surgery, the responses were depressed severely in P1 wave amplitude densities in six rings, the differences were statistically significant (t=6.140，Plt;0.05). Conclusion The postoperative BCVA of IMH patients improved but the amplitude densities of P1 wave depressed compared with before surgery.
Objective To evaluate the safety and efficacy of brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling on pathological myopic macular holes with retinal detachment.Methods This is a prospective and noncontrolled study. Twenty-seven high myopia patients （27 eyes） with macular holes and retinal detachment were enrolled. Routine examination was performed, including the best corrected visual acuity （BCVA）, intraocular pressure, slit lamp microscope with +90 D pre-set lens, A- or B-ultrasound,optical coherence tomography (OCT) and visual field. All patients received vitrectomy with BBG-assisted ILM peeling and C3F8 gas tamponade. The 5 followup visits were at the first day, the seventh day, the first month, the third month and the sixth month after surgery. The BCVA, intraocular pressure, visual field, macular hole and retinal reattachment were comparatively analyzed.Results The ILM of all patients were peeled completely by BBG staining. There were no major complications such as corneal edema, anterior chamber reaction, elevated intraocular pressure, visual field defects. At the first month after surgery, macular hole closed and retina reattached in 26 eyes （96.3%）, the macular hole did not close and retina redetached in one eye （25.9%）. At the sixth month after surgery, BCVA of 25 eyes （92.6%） increased, two eyes （7.4%） didnprime;t change, the difference was statistically significant （t＝6.08，Plt;0.05）.Conclusions BBG can fully stain ILM without any side effects. Vitrectomy with BBG-assisted ILM peeling is a safe and effective treatment for pathological myopic macular holes with retinal detachment.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and with or without internal limiting membrane (ILM) peeling for retinal reattachment and macular hole closure of moderate highly myopic macular hole retinal detachment (MHRD). Methods Forty-three moderate highly myopic MHRD patients (43 eyes) with proliferative vitroretinopathy in class A or B, moderate long axial lengths (ge;26 mm but ＜29 mm), mild retina pigment epithelium and chorioretinal atrophy, and posterior staphyloma (0 - 1 level and le;2 mm) were enrolled in this study. The patients were divided into two groups according to surgical options: TA-assisted PPV with ILM peeling (group A, 24 eyes), TA-assisted PPV without ILM peeling (group B, 19 eyes). The anatomic reattachment of the retina, macular hole closure, and corrected visual acuity (CVA) were observed at one week, one, three, six and 12 months after surgery. Results Twelve months after surgery, retinal reattachment was achieved in 22 eyes (91.67%) and 18 eyes (94.74%) in group A and B, respectively. The difference of retinal reattachment rate between two groups was not statistically significant (Fisherprime;s exact test, P=1.000). Macular hole closure was in 14 eyes (58.33%) and 11 eyes (57.89%) in group A and B, respectively. The difference of macular hole closure rate between two groups was not statistically significant (chi;2=0.049，P=0.824). The differences of CVA between two groups was not statistically significant (chi;2=0.001, P=0.977). Conclusion ILM peeling may not be necessary in the surgery of TA-assisted PPV for moderate highly myopic MHRD.