Persistent macular holes — what is the best strategy for revision?

Szurman, Peter; Wakili, Philip; Stanzel, Boris V.; Siegel, Rudolf; Boden, Karl; Rickmann, Annekatrin

doi:10.1007/s00417-021-05252-7

Cited by 14 publications

(19 citation statements)

References 37 publications

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“…Mahmoud and Thompson highlighted the need for a new classification of larger MHs because of the recent introduction of effective new treatments for this condition [ 42 ]. A recent retrospective series [ 43 ] on refractory MHs illustrated the need for a new classification. The authors could not establish any difference in outcomes between a revisional surgery with tamponade alone versus adjuvant manipulation (free flap, macular hydrodissection, hAM, ART, or autologous blood).…”

Section: Discussionmentioning

confidence: 99%

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group

et al. 2023

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Background The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making. Methods We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups. Results Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases. Conclusions The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400–550 µm) and X-Large (550–800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.

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Section: Discussionmentioning

confidence: 99%

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group

et al. 2023

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“…The closure rates after revisional surgery (49 to 89%) show a considerable variation in different studies, and the pooled estimate for anatomical closure was reported as 78% in a metanalysis 26 . Being a simple method, re-PPV with a tamponade was demonstrated not to be inferior to PPV with adjuvant techniques 13 , and more invasive methods like human amniotic membrane or free retinal graft transplantations were advised to be saved for complex holes like those associated with myopia or retinal detachment 9 .…”

Section: Discussionmentioning

confidence: 99%

Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure

Alagöz

Bektasoglu

Alagöz

et al. 2023

Klin Monbl Augenheilkd

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Purpose We aimed to report our surgical experience with repeat surgery as the next step after an unsuccessful hole closure with the primary single-layered temporal inverted flap technique (IFT). Methods We identified cases with persistent macular holes by reviewing the records of eyes that underwent IFT between October 2018 and October 2021. These cases were evaluated for hole features, anatomical closure, and visual improvement before and after the first and second surgeries. In addition, the technique applied in repeat surgery was recorded. Optical coherence tomography (OCT) images at follow-up were used to evaluate the flap position. Results A persistent hole was identified in 11 (6.4%) of 172 patients who underwent IFT. An inferotemporal displacement was observed in seven eyes, while no flap could be identified in the OCT images of the other four eyes. In the second surgery, the old flap was reinverted in one eye, and a new flap was created from the superior region in five eyes and the nasal region in the other five eyes and was stabilized under perfluorocarbon liquid. A gas tamponade (C3F8/SF6) was used in all patients at the end of surgery. The minimum hole diameter was > 400 µm in all eyes and 100% closure was achieved after the second surgery. Visual acuity gain of ≥ 3 lines was observed in 9 of the 11 eyes (81.8%). The mean visual acuity increase at the last follow-up was significant (p = 0.008). Conclusion With single-layer temporal IFT in the primary surgery of macular holes, unsuccessful results may be observed due to the flap displacement in the early period. In our series, IFT was applied again with the use of the old flap or the creation of a new flap in the second surgery of the persistent holes, and successful results were obtained.

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“…Among the various techniques for persistent MHs, such as tamponade alone, AMG, autologous blood, and retinal graft, Szurman et al . [ 18 ] found no technique which was superior to the other. Comparable results were noted in all.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 11 12 13 14 15 16 17 ] Results with ARG showed it to be comparable to the other techniques for refractory MHs, such as AMG, autologous blood, and re-tamponade with gas alone. [ 18 ] Tabandeh showed good uptake of the full-thickness retinal graft by demonstrating vascularization and reperfusion of the graft. [ 19 ] Good functional recovery with improvement in retinal sensitivity was shown on multifocal electroretinography (mfERG) and microperimetry.…”

mentioning

confidence: 99%

Comparison of three techniques of harvesting full-thickness retinal tissue for large or persistent macular holes

Dhami

Biswas

Dogra

et al. 2022

Indian J Ophthalmol

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Purpose: To evaluate the success rate of autologous retinal graft (ARG) for the closure of full-thickness macular holes (MHs) and compare the outcomes of three different techniques of harvesting the graft. Methods: Clinic files of all patients who had undergone ARG for MH using intraocular scissors, membrane loop, or retinal punch to harvest retinal tissue were retrospectively reviewed. All patients were evaluated for MH closure, retinal reattachment, and visual improvement. Results: Twenty-two eyes of 22 patients were included. ARG was done for 16 eyes (72.7%) with failed, large persistent MH, and six eyes (27.3%) also underwent simultaneous repair of retinal detachment. The basal diameter of MH was 1103.67 ± 310.09 (range 650–1529) mm. Intraocular scissors were used in 10 eyes (45.5%), a membrane loop in five eyes (22.7%), and a retinal punch in seven eyes (31.8%). Silicone oil tamponade was used in seven (31.8%) eyes and gas in 15 (68.1%) eyes. The follow-up ranged from 6 to 18 months. The hole closure rate was 72.7% (16/22). Visual improvement was noted in 18 eyes (81.8%). Retinal reattachment was seen in all eyes. Good graft integration with the surrounding area was seen in 17 eyes (77.3%). Graft retraction was seen in four eyes (18.18%) and graft loss in one eye (4.55%). No significant differences were noted among the three groups. Conclusion: ARG is successful in closing large, failed MH with and without retinal detachment. A membrane loop and retinal punch are equally useful in harvesting the graft, but scissors are preferable in case the retina is detached. With all three techniques, integration of the graft with the surrounding tissue can be achieved.

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Persistent macular holes — what is the best strategy for revision?

Cited by 14 publications

References 37 publications

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group

Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group

Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure

Comparison of three techniques of harvesting full-thickness retinal tissue for large or persistent macular holes

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