Closing Macular Holes With “Macular Plug” Without Gas Tamponade and Postoperative Posturing

Chakrabarti, Meena; Benjamin, Preethi; Chakrabarti, Keya; Chakrabarti, Arup

doi:10.1097/iae.0000000000001206

Cited by 42 publications

(38 citation statements)

References 29 publications

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“…Although we could not obtain data of the duration of MHs, the results may be because important components of the retina probably had degenerated during the period of the MH. Chakrabarti et al (2017) treated MHs by gluconated blood clumps without gas tamponade or postoperative posturing, and they reported that the visual recovery was good after surgery even for large MHs which is not consistent with our results. However, the basal diameter of MH in their study was 892.8 lm, while it was 1036 lm in our study (Table 1).…”

Section: Discussioncontrasting

confidence: 88%

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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Section: Discussioncontrasting

confidence: 88%

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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“…41 Similarly, autologous whole blood, serum and platelet concentrates, thrombin, and gluconated blood clumps have been used in various studies with variable outcomes. [42][43][44][45][46][47][48] These adjuvant agents circumvent the use of ILM peeling, thus minimizing the retinal trauma and obviate the need for any tamponade agents or postoperative positioning. However, the benefit of these adjuvants has not been proven in large studies.…”

Section: Adjuvant Agentsmentioning

confidence: 99%

Current Management of Macular Hole

Singh¹,

Narayanan²

2019

Ophthalmic Surg Lasers Imaging Retina

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In this issue's Practical Retina column, Sumit Randhir Singh, MD, and Raja Narayanan, MD, MBA, from the LV Prasad Eye Institute in Hyderabad, India, discuss the current therapeutic options for repairing macular holes (MHs). We are all aware that there is great discussion and wide variability in thinking among our colleagues regarding approaches to close a MH. Common controversies include when and if internal limiting membrane peeling is necessary, as well as what to do with it after it is peeled (fully or partially to create a flap). Other discussions include choice of tamponade, duration of positioning, and use of retinal grafts. Choice of adjuvants have also been discussed and will be addressed in this article. Drs. Singh and Narayanan tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on the strength of the evidence in the literature. I am certain that their insights will be very valuable for maximizing outcomes in patients with MHs.

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“…The fresh blood soon became a clot on the surface of the ILM within 1-2 min and followed by intravitreous injection of C3F8. Autologous blood clot has also been reported to assist the inverted ILM technique [6] and the treatment of MH retinal detachment [19]. Our findings indicated that silicon oil could be replaced by autologous blood clot to avoid the displacement of the transposition ILM after surgery.…”

Section: Discussionmentioning

confidence: 62%

“…The inverted ILM flap technique, first reported by Michalewska et al [4], has shown improved functional and anatomical outcomes for those cases. This technique was then modified by injecting viscoelastic into the MH as a "viscoelastic cap" or employing autologous gluconated blood clumps as a "macular plug" to facilitate the closure of MH [5,6]. For the recurrent MH, Park et al [7] used a free ILM flap, which was collected from the residual ILM, to cover the MH with the assistance of perfluoro-n-octane.…”

Section: Introductionmentioning

confidence: 99%

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Non-inverted pedicle internal limiting membrane transposition for large macular holes

et al. 2018

Eye

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Closing Macular Holes With “Macular Plug” Without Gas Tamponade and Postoperative Posturing

Abstract: Twenty-three-gauge pars plana vitrectomy combined with broad ILM peeling, use of ILMR and autologous gluconated blood clumps as a macular plug is effective in achieving satisfactory hole closure with statically significant functional improvement for large Stage 3 and Stage 4 macular holes.

Cited by 42 publications

References 29 publications

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

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

Current Management of Macular Hole

Non-inverted pedicle internal limiting membrane transposition for large macular holes

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