Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy

Lachance, Alexandre; You, Eunice; Garneau, Jerome; Bourgault, Serge; Caissie, Mathieu; Tourville, Eric; Dirani, Ali

doi:10.1155/2021/8832538

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Recent studies have reported MH closure rates after a rst surgical procedure between 78% and 96% [4][5][6]. However, anatomical closure does not necessarily translate into visual improvement.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

Lachance

Hébert

You

et al. 2022

Journal of Ophthalmology

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Purpose. To identify predictive factors of visual outcomes in the eyes after successful macular hole (MH) surgery. Methods. It is a retrospective monocentric study of the eyes that underwent successful vitrectomy for full-thickness MH in an academic, tertiary care center (CHU de Québec–Université Laval, Québec, Canada) between 2014 and 2018. We included a single eye per patient and excluded the eyes with ocular comorbidities. Clinical and anatomical features of patients were collected, including demographics, MH duration, baseline MH size, baseline visual acuity (VA), and final VA. Multiple logistic regressions were performed to determine predictive factors of VA ≥70 ETDRS letters (Snellen equivalent: 20/40) and VA gain ≥15 ETDRS letters at final follow-up. Areas under the receiver operating characteristic curve (AUC) were used to determine the performance of each model and identify the Youden index maximizing performance at a given threshold. Results. A total of 460 eyes were included in this study; 274/460 eyes (60%) achieved final VA ≥70 ETDRS letters and 304/460 eyes (66%) had a VA gain ≥15 ETDRS letters at 24 months follow-up. Multiple logistic regression analyses showed that the main predictive factors for final VA ≥70 ETDRS letters (model AUC = 0.716) were baseline VA (OR = 1.064; p < 0.001 ), MH duration (OR = 0.950; p = 0.005 ), and age (OR = 0.954; p = 0.004 ). Predictors of VA gain ≥15 ETDRS letters at final follow-up (model AUC = 0.615) were baseline VA (OR = 0.878; p < 0.001 ), MH duration (OR = 0.940; p < 0.001 ), and MH size (OR = 0.998; p = 0.036 ). Thresholds for the final VA ≥70 ETDRS letters model and the VA gain ≥15 ETDRS letters model were VA ≥55.5 ETDRS letters (Snellen equivalent: 6/30) and MH size of 237 μm, respectively. Conclusion. The eyes with shorter MH duration, smaller MH size, and higher preoperative VA achieved better visual outcomes after successful MH surgery.

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Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

Lachance

Hébert

You

et al. 2022

Journal of Ophthalmology

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“…Although the primary success rate of these operations is as high as 90%, there are still some patients with macular holes (MH) that are not closed after surgery [2]. For patients with nonclosure of MH after primary PPV, the closure rate after reoperation is still as high as 85%, and visual acuity can still be partially improved [3].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of simple intravitreal gas injection for treating unclosed idiopathic macular holes after vitrectomy

Dou,

Han,

Zhao

2024

Preprint

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Background This study aimed to observe the efficacy of simple intravitreal injection of C3F8 in the treatment of unclosed idiopathic macular holes (IMH) in patients after primary pars plana vitrectomy (PPV). Methods This was a retrospective clinical observational study. Patients diagnosed with unclosed IMH who underwent primary PPV combined with internal limiting membrane peeling (ILMP) and air tamponade were included in the study. Optical coherence tomography (OCT) at 1 week after PPV revealed unclosed IMH with the "cuff" sign and intraretinal cysts. The next day, the patients were treated by simple intravitreal injection of C3F8. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus photography, and OCT before PPV and at 1 week, before and after intravitreal gas injection for 1 to 3 months. Results The minimum horizontal hole diameter (MHD) before PPV was 555.4 ± 104.8 µm, and that at 1 week after PPV was 335.1 ± 74.3 um, with statistically significant (t = 11.256, P < 0.001). The percentage of closed holes after air tamponade was 100%. The mean BCVA before PPV was 0.79 ± 0.26 logMAR (20/123), and that after air tamponade was 0.48 ± 0.19 logMAR (20/30) with statistical difference significantly (t = 5.303, P = 0.002). Conclusion For patients with enclosed IMH after primary PPV, if OCT reveals the "cuff" sign, retreatment can be performed through simple intravitreal gas injection. The method is simple, economical, practical, and effective.

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“…Idiopathic full-thickness macular hole (MH) is a discontinuation of the neurosensory retina at the fovea and results in significant visual impairment including reduced visual acuity (VA) and metamorphopsia. 1 Analysis of baseline optical coherence tomography (OCT) in patients with a MH can provide insight into surgical success and postoperative VA. 1 OCT is commonly used in ophthalmology for multiple reasons: it allows noncontact, noninvasive, and easy-to-use cross-sectional images for clinical staging of various retinal diseases, including MH, by showing foveal and vitreous microstructures.…”

Section: Introductionmentioning

confidence: 99%

“…Pars plana vitrectomy with internal limiting membrane (ILM) peeling is commonly used to treat MH, with recent studies reporting the MH closure rate after a primary surgical procedure between 78% and 96%. 1 – 3 Despite the high closure rate, functional outcomes after successful surgery are variable. 4 Several authors tried to predict visual outcomes in closed MH based on clinical and imaging factors (e.g.…”

Section: Introductionmentioning

confidence: 99%

Predicting Visual Improvement After Macular Hole Surgery: A Combined Model Using Deep Learning and Clinical Features

Lachance

Godbout

Antaki

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study was to assess the feasibility of deep learning (DL) methods to enhance the prediction of visual acuity (VA) improvement after macular hole (MH) surgery from a combined model using DL on high-definition optical coherence tomography (HD-OCT) B-scans and clinical features. Methods We trained a DL convolutional neural network (CNN) using pre-operative HD-OCT B-scans of the macula and combined with a logistic regression model of pre-operative clinical features to predict VA increase ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 6 months post-vitrectomy in closed MHs. A total of 121 MHs with 242 HD-OCT B-scans and 484 clinical data points were used to train, validate, and test the model. Prediction of VA increase was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 scores. We also extracted the weight of each input feature in the hybrid model. Results All performances are reported on the held-out test set, matching results obtained with cross-validation. Using a regression on clinical features, the AUROC was 80.6, with an F1 score of 79.7. For the CNN, relying solely on the HD-OCT B-scans, the AUROC was 72.8 ± 14.6, with a F1 score of 61.5 ± 23.7. For our hybrid regression model using clinical features and CNN prediction, the AUROC was 81.9 ± 5.2, with an F1 score of 80.4 ± 7.7. In the hybrid model, the baseline VA was the most important feature (weight = 59.1 ± 6.9%), while the weight of HD-OCT prediction was 9.6 ± 4.2%. Conclusions Both the clinical data and HD-OCT models can predict postoperative VA improvement in patients undergoing vitrectomy for a MH with good discriminative performances. Combining them into a hybrid model did not significantly improve performance. Translational Relevance OCT-based DL models can predict postoperative VA improvement following vitrectomy for MH but fusing those models with clinical data might not provide improved predictive performance.

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Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy

Cited by 7 publications

References 24 publications

Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

Efficacy of simple intravitreal gas injection for treating unclosed idiopathic macular holes after vitrectomy

Predicting Visual Improvement After Macular Hole Surgery: A Combined Model Using Deep Learning and Clinical Features

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