Großes Makulaforamen – immer eine schlechte Prognose?

Friedrich, Julia; Bleidißel, Nathalie; Klaas, Julian; Feucht, Nikolaus; Nasseri, Ali; Lohmann, Chris P.; Maier, Mathias

doi:10.1007/s00347-020-01178-3

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…1. A total of 153 articles were found after the preliminary literature search, after removing the duplicates the articles were shortlisted rst by the topics, then by reading the abstracts and nally by the way of full text review; this left us with a total 26 studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][34][35][36][37][38][39][40][41] which were included in this meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

Critical Analysis of Macular Hole Repair Techniques: A Comprehensive Systematic Review and Meta-analysis Comparing Internal Limiting Membrane Flap and Internal Limiting Membrane Peeling For Any Size of Macular Hole

Akhtar

Saleem

Rizvi

2023

Preprint

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Background: Macular holes are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. Internal limiting membrane (ILM) peeling is a successful surgical procedure to repair the defect. However, it doesn’t have good efficacy with larger macular holes. Internal limiting membrane (ILM) flap is a novel technique and shows promising results. Objective This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of macular hole. Methods A comprehensive literature search was conducted in the PubMed, Medline, Cochrane Library and Web of Science databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative visual acuity (VA). The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated. Results A total of 8 RCTs and 18 Retrospective studies were included in this meta-analysis, which involved 1052 eyes in the ILM flap group and 1050 eyes in the ILM peeling group. The overall MH closure rate came out to be in favor of ILM flap technique (OR=2.74, CI=1.62 TO 4.66; P = 0.0002). In overall analysis of postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400μm (MD = -0.13, 95% CI = -0.16 to -0.09; P < 0.00001) as well as on subgrouping based on follow-up months duration I.e. on all the 3, 6 and 12 months (MD=-0.11, 95% CI = -0.19 to -0.04; P = 0.003), (MD=-0.11, 95% CI = -0.18 to -0.04; P = 0.002) and (MD=-0.12, 95% CI = -0.16 to -0.08; P <0.00001) respectively. Conclusion ILM flap technique resulted in better anatomical outcomes as well as better visual outcomes specifically in larger macular holes and at all the follow-up months. Hence, it is recommended that the inverted internal limiting membrane (ILM) flap method should routinely be chosen as the preferred treatment for patients who have macular holes larger than 400 micrometers.

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Section: Study Characteristicsmentioning

confidence: 99%

Critical Analysis of Macular Hole Repair Techniques: A Comprehensive Systematic Review and Meta-analysis Comparing Internal Limiting Membrane Flap and Internal Limiting Membrane Peeling For Any Size of Macular Hole

Akhtar

Saleem

Rizvi

2023

Preprint

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iOCT in der klinischen Anwendung

et al. 2021

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Zusammenfassung Hintergrund Die Beurteilung der intraoperativen Veränderung der Netzhautmorphologie, insbesondere des vitreoretinalen Überganges, ist mithilfe der intraoperativen optischen Kohärenztomografie (iOCT) möglich geworden. Ziel der Arbeit Um die Bedeutung der intraoperativen Morphologie beim durchgreifenden Makulaforamen (MF) für das postoperative funktionelle Ergebnis zu evaluieren, wurde eine retrospektive, klinische Beobachtungsstudie durchgeführt. Material und Methoden Die Netzhautmorphologie wurde in 32 Augen von 32 konsekutiven Patienten mit durchgreifendem Makulaforamen mittels iOCT zu verschiedenen Zeitpunkten während der Operation beobachtet. Die Veränderungen wurden anschließend mit dem postoperativen funktionellen Ergebnis korreliert. Ergebnisse Nach Induktion der hinteren Glaskörperabhebung (HGA) reduzierte sich der Makulaforamen-Index (MHI) um −0,05 (p = 0,01), die basale Foramenbreite (FB) stieg um +99,4 μm (SD = 197,8 μm; p = 0,04). Die Verschlussrate betrug 100 % zum Zeitpunkt der ersten postoperativen Vorstellung nach im Mittel 73 Tagen, der postoperative Visus verbesserte sich signifikant (p < 0,05). Es zeigte sich eine signifikant positive Korrelation von intraoperativer Morphologie und postoperativem Ergebnis zwischen einem niedrigen MHI und einem besseren postoperativen Visus (SKK = 0,50; p = 0,02), zwischen einer großen FB und einem besseren postoperativen Visus (SKK = 0,43; p = 0,05) sowie zwischen einer breiten Apertur nach HGA und einem größeren Visusanstieg postoperativ (SKK = 0,44; p = 0,03). Diskussion Wir konnten eine Abflachung sowie eine Verbreiterung des MF durch Lösen der vitreoretinalen Zugkräfte beobachten. Aufgrund des Zusammenhangs zwischen einer großen intraoperativen FB mit einem besseren postoperativen Visus scheint die intraoperative Relaxierung der Netzhaut bedeutsam.

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Großes Makulaforamen – immer eine schlechte Prognose?

Cited by 2 publications

References 20 publications

Critical Analysis of Macular Hole Repair Techniques: A Comprehensive Systematic Review and Meta-analysis Comparing Internal Limiting Membrane Flap and Internal Limiting Membrane Peeling For Any Size of Macular Hole

Critical Analysis of Macular Hole Repair Techniques: A Comprehensive Systematic Review and Meta-analysis Comparing Internal Limiting Membrane Flap and Internal Limiting Membrane Peeling For Any Size of Macular Hole

iOCT in der klinischen Anwendung

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