“…Although Ezra21 indicated that 30% to 50% of stage 1 MH cases tend to close spontaneously, the closure rate was 94% in MH present for less than a year versus 47% in those present for more than a year, according to Jaycock et al22 Extended observation, however, is unreasonable, as the longer the MH is present, the lower the chance of a successful surgical result, according to Ryan and Gilbert 23. Pars plana vitrectomy with ILM removal is the standard surgical treatment for MH, and not only OCT but also ultrasonography may be useful for following and indicating surgical intervention in such eyes 24,25…”
The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.
“…Although Ezra21 indicated that 30% to 50% of stage 1 MH cases tend to close spontaneously, the closure rate was 94% in MH present for less than a year versus 47% in those present for more than a year, according to Jaycock et al22 Extended observation, however, is unreasonable, as the longer the MH is present, the lower the chance of a successful surgical result, according to Ryan and Gilbert 23. Pars plana vitrectomy with ILM removal is the standard surgical treatment for MH, and not only OCT but also ultrasonography may be useful for following and indicating surgical intervention in such eyes 24,25…”
The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.
“…Эхографические признаки витреоретинальных изменений при макулярных разрывах (МР) Результаты нашего исследования согласуются с данными J. Bottós и соавт. [10], K. Siahmed и соавт. [16], которые показали информативность высокочастотного линейного датчика 20 МГц для оценки витреоретинального интерфейса при МР.…”
Section: Discussionunclassified
“…Наличие сопутствующей патологии, сопровождающейся помутнением оптических сред глаза, является ограничением для применения OКT, что стимулирует поиск новых способов визуализации структур заднего отдела глаза с сопоставимо высоким уровнем детализации. В таких случаях единственным методом объективной оценки состояния сред и оболочек глаза, в том числе макулярной области, остается эхография [10,11].…”
unclassified
“…По сравнению со стандартными датчиками (8-10 МГц), которые наиболее часто применяются в офтальмологической практике, высокочастотные датчики (20 МГц) позволя-ют получить более четкое и детализированное изображение структур заднего полюса глаза [7]. С учетом высокой частоты и разнообразия случаев патологических изменений макулярной области (эпиретинальная мембрана с тракционным синдромом, влажная форма ВМД, макулярный разрыв, МР) использование высокочастотной эхографии приобретает большое значение в диагностике этой патологии при непрозрачных оптических средах глаза [10,12].…”
unclassified
“…По классификации J. Gass выделяют 4 стадии макулярного разрыва: от угрозы его образования (I стадия) до формирования отверстия на всю толщину сетчатки со скоплением субретинальной жидкости (IV стадия) [14]. В литературе имеются лишь единичные публикации, в которых высокочастотное ультразвуковое сканирование глаза рекомендуется для диагностики МР, в особенности в тех случаях, когда не может быть использован метод ОКТ [10].…”
Purpose: a comparative estimation of ultrasound examinations of the posterior eye pole of patients with a macular hole using a long-focus high-frequency (20 MHz) and a standard 10 MHz probe with optical coherence tomography (OCT).Materials and methods. 20 patients with a macular hole in at least one eye were examined using OCT of the macular area and B-mode echography with a standard 10 MHz probe and a long-focus high-frequency 20 MHz probe.Results. The complex OCT/ ultrasound examination detected a macular hole in 22 (100 %) eyes, while OCT alone confirmed the diagnosis in 20 eyes (91 %). OCT could not be performed in 2 eyes due to a dense cataract. Ultrasound examination with a 20-MHz probe detected a macular hole in 16 eyes (73 %), whilst the standard ultrasound method (10 MHz probe) could only detect it in 10 eyes (45 %).Conclusion. High-frequency ultrasound examination of the eye can be used for screening aimed at detecting a possible macular hole in cases of opacities of the optical media of the eye.
Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital "Sveti Duh", Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.
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