Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes

Ghoraba, Hammouda Hamdy; Leila, Mahmoud; Ghoraba, Hashem; Heikal, Mohamed Amin; Elgemai, Emad Eldin Mohamed

doi:10.1155/2019/1959082

Cited by 10 publications

(18 citation statements)

References 31 publications

(24 reference statements)

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“…Conversely, if the preoperative visual acuity is as a result of the retinal injury from the MH, the postoperative Table 2. Baseline characteristics of patients with initial surgically closed traumatic macular hole visual acuity may indeed be correlated with it, as in our study and others [12,13]. We also found the mean macular height was lower in eyes with poor postoperative visual acuity, proved by Huang et al [17] in TMHs without surgery.…”

Section: Discussionsupporting

confidence: 86%

Surgical Treatment for Traumatic Macular Holes: Reconstructive Changes in Foveal Microstructures and Visual Predictors Analysis

Wang

et al. 2020

Ophthalmologica

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Purpose: To investigate the reconstructive changes in foveal microstructures postoperatively and analyze the visual predictors in eyes with surgically closed traumatic macular holes (TMHs). Methods: Seventy-one eyes with TMHs that underwent vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade were reviewed. Clinical data, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) images were recorded. The length of the ellipsoid zone (EZ) defect and the integrity of postoperative external limiting membrane (ELM) were measured. Preoperative and 1-month postoperative features were analyzed, respectively, as potential predictors of visual acuity at 6 months postoperatively. Results: The primary hole closure rate was 90.14% (64/71). In 43 cases of initially closed TMHs with SD-OCT scans preoperatively and at 1 and 6 months postoperatively, the number of eyes with intact ELM increased from 18 (41.86%) at 1 month to 26 (60.47%) at 6 months (p = 0.08), while the number of eyes with a restored EZ band remained the same in 2 eyes (4.65%). The mean length of the EZ defect progressively decreased postoperatively (p < 0.001). Poorer preoperative visual acuity (p = 0.002), lower mean macular hole (MH) height (p = 0.012), and greater preoperative mean length of EZ defect (p < 0.001) were associated with worse visual acuity 6 months postoperatively, but only the preoperative length of the EZ defect was proved to be a predictor, with the cutoff value of 1,800 μm provided by the receiver-operating characteristics (ROC) curve. Worse visual acuity and greater mean length of the EZ defect at 1 month were also associated with worse final visual acuity. Conclusions: The mean length of the EZ defect both preoperatively and 1 month postoperatively were predictors of visual outcomes at 6 months postoperatively.

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Section: Discussionsupporting

confidence: 86%

Surgical Treatment for Traumatic Macular Holes: Reconstructive Changes in Foveal Microstructures and Visual Predictors Analysis

Wang

et al. 2020

Ophthalmologica

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“…In a previously published comparative study, we reported our findings on the outcomes of comparing the modified IFT and conventional ILM peel in TMH. We found that modified IFT yielded superior hole closure rate (92% vs 75%), and better final BCVA (5 lines gain vs 2.5 lines gain) than conventional ILM peel approach 12. We acknowledge the limitations of the present study that included its retrospective design, which caused inhomogeneity of the baseline characteristics of recruited patients in terms of baseline MLD, time lapse prior to surgery, and duration of follow-up.…”

Section: Discussionmentioning

confidence: 81%

“…The surgical technique used in the present study was described in detail in a previous publication 12. Briefly the technique consisted of standard 3-port 23-gauge PPV and posterior hyaloid dissection (PHD), followed by modified ILM flap technique (IFT).…”

Section: Methodsmentioning

confidence: 99%

Optical Coherence Tomography Morphological Features Following Modified Internal Limiting Membrane Surgical Technique In Traumatic Macular Holes

Ghoraba

Leila

Ghoraba

et al. 2019

OPTH

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ObjectiveTo describe the optical coherence tomography (OCT) findings in terms of macular hole closure and ellipsoid zone (EZ) recovery following modified internal limiting membrane (ILM) surgical technique in traumatic macular holes (TMH).MethodsThe study was a retrospective case series that recruited 16 consecutive patients with TMH. Following vitrectomy (PPV), we performed modified ILM surgical technique (IFT) in which ILM peel was stopped at the edges of the hole forming a floating ILM flap. Primary outcome measures were pattern of TMH closure and recovery of EZ. Student’s T-test and Pearson’s correlation coefficient were used for statistical analysis.ResultsThe study had 16 eyes of 16 patients. Mean baseline minimum linear diameter (MLD) was 562µ. Mean baseline best-corrected visual acuity (BCVA) was 1.4 logMAR. U-pattern closure occurred in 50% of eyes, V-pattern closure occurred in 31.2% of eyes, whereas W-pattern closure occurred in 18.7% of eyes. Mean BCVA improvement was 5 lines (p 0.02). Failure of recovery of EZ was detected in 75% of eyes. In the present series, neither pre-operative MLD nor time lapse prior to surgery were significant factors in determining the closure pattern of TMH, the grade of EZ recovery or final BCVA.ConclusionModified IFT is effective in promoting macular hole closure and improving visual acuity in patients with TMH. The technique does not promote recovery of EZ.

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“…18 Ghoraba et al showed inverted flap group has a significantly better anatomic and functional outcome than ILM peel in traumatic FTMH. 19…”

Section: Discussionmentioning

confidence: 99%

A novel video overlay guided enlargement of area of ILM peeled versus inverted flap technique: A long-term study in large macular holes

Boral¹,

Agarwal²,

Das³

et al. 2020

European Journal of Ophthalmology

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Background/Aim: To compare the intra-operative video overlay guided enlargement of Area of ILM peeled (AIP) more than three Disc Diameter (DD) versus the inverted flap technique in large (>400 µm ) Full Thickness Macular Holes (FTMH). Methods: Retrospectively, 127 cases of large FTMHs divided into two groups (i) Group A ( n = 62)—intra-operative video-overlay guided enlargement of AIP > 3DD performed and (ii) Group B ( n = 65)—Inverted flap technique was done. Mean Best Corrected Visual Acuity (BCVA), hole closure rate and postoperative foveal anatomy were noted on Optical Coherence Tomography (OCT). Results: Mean Minimal Diameter of Macular Hole (MDMH) were 632.05 ± 146.62 µm (A) and 677.24 ± 152.08 µm (B). Hole closure rate were 93.55% (A) and 96.92% (B). Mean preoperative BCVA was 1.07 ± 0.37 Log MAR (A) and 0.94 ± 0.23 Log MAR (B). Mean postoperative BCVA at 3 months were 0.73 ± 0.22 Log MAR (A) and 0.83 ± 0.24 Log MAR (B). One-way ANOVA test showed statistically better visual improvement in Group A at 3 months ( p = 0.02), 6 months ( p = 0.045), 12 months ( p = 0.002), and 24 months ( p = 0.011). Chi square test revealed Type I pattern of hole closure was statistically more in Group B ( p < 0.001). Delayed Recovery of Outer Retinal Layers was more in group B (Pearson Chi square test, p = 0.039). Conclusion: Anatomically, macular hole closure rate as well as closure pattern was better in Group B. But functional improvement was better in Group A.

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Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes

Cited by 10 publications

References 31 publications

Surgical Treatment for Traumatic Macular Holes: Reconstructive Changes in Foveal Microstructures and Visual Predictors Analysis

Surgical Treatment for Traumatic Macular Holes: Reconstructive Changes in Foveal Microstructures and Visual Predictors Analysis

<p>Optical Coherence Tomography Morphological Features Following Modified Internal Limiting Membrane Surgical Technique In Traumatic Macular Holes</p>

A novel video overlay guided enlargement of area of ILM peeled versus inverted flap technique: A long-term study in large macular holes

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