Autologous Free Internal Limiting Membrane Flap for Optic Nerve Head Pit With Maculopathy

D’Souza, Palmeera; Babu, Upendra; Narendran, Venkatapathy

doi:10.3928/23258160-20170329-11

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…However, contrary to the quick improvement of the foveal anatomy obtained by D’Souza et al [16] and Nawrocki et al [17], our results showed that foveal reattachment might take a very long time, as 44% of our patients remained with unattached macula at the time of their final examination. Also, of the patients with attached macula, 80% required more than 180 days for reattachment to occur.…”

Section: Discussioncontrasting

confidence: 99%

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Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

et al. 2019

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Purpose: To compare the anatomical and functional outcome of adjuvant pars plana vitrectomy (PPV) procedures using the techniques of translocation of an internal limiting membrane (ILM) flap and transplantation of an inverted ILM flap for the treatment of chronic and/or refractory optic disc pit (ODP) maculopathy. Methods: In this prospective interventional case series study, 9 patients (9 eyes) with chronic and/or refractory ODP maculopathy underwent PPV with either translocation of an ILM flap or transplantation of an inverted ILM flap as adjuvant techniques along with gas tamponade. The anatomical success, rates of macular reattachment, and visual improvement were assessed. Results: The mean preoperative central retinal thickness (CRT) was 723.4 µm (range: 366–1,151). The mean postoperative CRT was 398.1 ± 212.2 µm (range: 210–758). An increased preoperative CRT was associated with a lower chance of postoperative reattachment of the macula (p = 0.047). The overall reattachment rate at the end of the follow-up period was 56% (n = 5). The mean preoperative visual acuity (logMAR unit [Snellen acuity]) was 0.48 (20/60) (range: 1.30 [20/400] to 0.10 [20/25]). The mean change in best corrected visual acuity (BCVA) was 0.48 ± 0.233 logMAR units (approx. 3 lines of visual improvement). Conclusions: ILM flap techniques are logical and straightforward approaches as adjuvants to PPV treatment of ODP maculopathy. They could be viable adjuvant treatments for improvement in BCVA and CRT in patients with ODP maculopathy.

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Section: Discussioncontrasting

confidence: 99%

“…This compares favourably with other functional results [10-14, 19, 22, 25-31]. Similar functional outcomes have been reported by D’Souza et al [16] and Nawrocki et al [17] using the same surgical procedure. However, 50% of our patients required more than 180 days to achieve a gradual visual improvement.…”

Section: Discussionsupporting

confidence: 90%

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

et al. 2019

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“…A myopic MH was treated successfully by the ILM flap technique (Kuriyama et al 2013), and a MH retinal detachment was also treated successfully by the ILM flap technique (Baba et al 2017). Eyes with a disc pit-macular syndrome were also treated by this technique (D'Souza et al 2017;Hara et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

Yamashita

Sakamoto

Terasaki

et al. 2018

Acta Ophthalmologica

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The purpose of this study was to compare the surgical outcomes of vitrectomy with conventional internal limiting membrane (C-ILM) peeling to that with the inverted ILM (I-ILM) flap technique for large macular holes (MHs). This was a retrospective chart review of consecutive cases with a large MH at nine hospitals in Japan. Among the 1342 eyes, 165 eyes of 165 cases met the inclusion criteria. The results for medium-large MHs with a diameter 400-550 μm were compared to that of eyes with an extra-large MH with a diameter >550 μm. In addition, the results of C-ILM peeling were compared to that of the I-ILM technique. In medium-large MHs, the closure rate was 95.2% (59/62) by C-ILM peeling and 100% (19/19) by the I-ILM technique. In extra-large MHs, the closure rate was 88.4% (38/43) by C-ILM peeling and 100% (41/41) by I-ILM. Although the difference between the two methods was not significant, the I-ILM technique was successful in 100% of the cases. Multiple logistic regression analysis showed the best-corrected visual acuity (BCVA) at 6 months was significantly associated with the preoperative BCVA, MH size, age and sex of the patient. Analyses of the eyes with extra-large MHs show that the surgical success is high, and the I-ILM technique is more effective for closure in eyes with extra-large MHs.

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“…[9][10][11][12][13][14][41][42][43][44][45][46][47][48][49][50][51] Our experience using the ILM flap technique in nine consecutive patients suggested a moderate rate of anatomical success, as 44% of our patients remained with unattached macula even 6 months after the surgery. 14 However, published studies 44,45 using the same technique have reported quick improvements and promising functional outcomes. Such differences might be related to the reduced function of the retinal pigment epithelium-Bruch's membrane complex, as well as by degeneration within the retinal layers in chronic and/or refractory macular detachment patients.…”

Section: Surgical Treatment Optionsmentioning

confidence: 63%

“…42 Maybe in those cases, the key point for obtaining a successful surgery could be the emergence of recent adjuvant treatments that are principally focused on sealing the pit. The justification for sealing the ODP with different materials such as ILM flap (Figure 1), 14,[41][42][43][44][45][46] fibrin glues 47,48 or autologous fibrin, 49 homologous scleral tissue 50 or even silicone lacrimal plug, 51 is based on the recent hypothesis postulated by Jain and Johnson, 7 in which different pressure ranges between the eye and intracranial pressure can lead to migration of fluid from the vitreous cavity or CSF to intraretinal or subretinal space due to a defect either in the lamina cribrosa or the juxtapapillary area. 7 Therefore, from a theoretical point of view, a procedure to create a "broad plug" along the "involved" disc margin could prevent the translaminar difference of pressure or block the outflow of fluids to the retinal layers or subretinal space.…”

Section: Surgical Treatment Optionsmentioning

confidence: 99%

<p>Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies</p>

Pastor‐Idoate¹,

Fusté²,

García-Onrubia³

et al. 2020

OPTH

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Optic disc pit (ODP) is a rare congenital optic nerve head abnormality, which can be complicated by intraretinal and subretinal fluid at the macula (ODP-maculopathy) with progressive visual loss. The source of this fluid remains unclear and the most dominant hypotheses have pointed to vitreous cavity or cerebrospinal fluid. Although spontaneous resolution has been reported, the majority of untreated cases of ODP-maculopathy result in final visual acuity less than 20/200 or worse. A wide array of interventions, either individually or in combination with adjuvant treatments, have been tried with varying degrees of success. Recently, different surgical procedures to fill the ODP by self-sealing materials in combination with pars plana vitrectomy have been reported as an effective adjuvant treatment. However, given the relative rarity of this condition, the majority of reports describe a small retrospective case series, making it difficult to compare among different treatments options and create a consensus regarding the optimal treatment for ODP-maculopathy. In this situation, a mini-review about surgical treatment modalities and their results can be a useful approach to identify the most effective surgical option in the management of ODP-maculopathy.

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Autologous Free Internal Limiting Membrane Flap for Optic Nerve Head Pit With Maculopathy

Cited by 16 publications

References 14 publications

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

<p>Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies</p>

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