Extended Internal Limiting Membrane Peeling in the Management of Unusually Large Macular Holes

Sabti, Khalid Al; Kumar, Naveen; Azad, Raj Vardhan

doi:10.3928/15428877-20090301-03

Cited by 21 publications

(16 citation statements)

References 8 publications

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“…When MH closure fails, a repeat PPV with extended ILM peeling may be performed [8]. Other authors, however, have proposed changes to the standard surgical technique to improve functional and anatomic outcomes.…”

Section: Introductionmentioning

confidence: 99%

Autologous Internal Limiting Membrane Fragment Transplantation for Large, Chronic, and Refractory Macular Holes

et al. 2015

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Objective: To evaluate a technique of autologous internal limiting membrane (ILM) fragment transplantation for the treatment of large, chronic, and/or refractory macular holes (MH). Design: This was a 6-month prospective interventional case series. Method: Ten eyes of 10 patients with MH underwent pars plana vitretomy (PPV) and ILM peeling followed by transplantation of an autologous ILM fragment to the MH. Six patients had primary MH with an internal diameter greater than 500 µm and a duration of more than 18 months, including 1 patient with nonproliferative diabetic retinopathy previously treated with panretinal photocoagulation. Four eyes with MH had previously been submitted to PPV (i.e. 1 for retinal detachment and 3 to attempt to close large MH). One of the latter also displayed juxtapapillary choroidal neovascularization due to age-related macular degeneration. The primary and secondary outcomes were MH closure and improvement of the best corrected visual acuity (BCVA), respectively. Results: Complete MH closure was achieved in all cases. A statistically significant improvement in the average BCVA was observed after 6 months of follow-up (p = 0.018; paired t test). The BCVA improved in 8 eyes (80%), and in 6 of those eyes it improved by ≥15 letters. In 1 patient, the BCVA remained unchanged after the surgery, but the visual field reportedly improved. One patient experienced a slight worsening (0.16 logMAR). Two cases developed atrophy of the retinal pigment epithelium despite MH closure and BCVA improvement. Conclusion: Treatment with autologous ILM fragment transplantation seems to be an efficient alternative for large, chronic, and refractory MH.

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Section: Introductionmentioning

confidence: 99%

Autologous Internal Limiting Membrane Fragment Transplantation for Large, Chronic, and Refractory Macular Holes

et al. 2015

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“…5 How large does a macular hole have to be before it is too large for repair? 7 Both these patients had successful closure of their holes, ultimately experiencing improved visual acuity (20/400 and 20/50, respectively). One report describes vitrectomy and gas tamponade for a much larger hole (3580 mm).…”

Section: Discussionmentioning

confidence: 91%

Good Visual Outcome After Repair of a Very Large Macular Hole With Neurosensory Retinal Operculum

Fawzi

Recasens³

et al. 2014

RETINAL Cases &Amp; Brief Reports

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“…Since Kelly and Wendel’s pioneer treatment of macular holes,4 a combination of different treatment options has been described. ILM peeling plays a pivotal role in the successful management of macular hole surgery (MHS) 5,10,13–18. Although the use of indocyanine green during ILM peeling has been associated with both retinotoxicity and damage of the retinal tissues,16,19–21 it has been shown to achieve better anatomical and visual outcomes when compared with the nonpeeling technique10,13,14 especially in large and chronic holes 17–19.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of autologous platelets in macular hole surgery

Konstantinidis¹,

Hero²,

Nanos³

et al. 2013

OPTH

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The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

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Extended Internal Limiting Membrane Peeling in the Management of Unusually Large Macular Holes

Cited by 21 publications

References 8 publications

Autologous Internal Limiting Membrane Fragment Transplantation for Large, Chronic, and Refractory Macular Holes

Autologous Internal Limiting Membrane Fragment Transplantation for Large, Chronic, and Refractory Macular Holes

Good Visual Outcome After Repair of a Very Large Macular Hole With Neurosensory Retinal Operculum

Efficacy of autologous platelets in macular hole surgery

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