The Effect of Macular Hole Duration on Surgical Outcomes

Murphy, Declan C; Al-Zubaidy, Mohaimen; Lois, Noemi; Scott, Neil; Steel, David

doi:10.1016/j.ophtha.2022.08.028

Cited by 16 publications

(14 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Murphy et al [21] reported that symptom duration might be an independent factor for the postsurgical anatomical and visual outcomes. Moreover, a longer symptom duration is associated with a higher incidence of A-type glial proliferation after surgery [14, 17].…”

Section: Discussionmentioning

confidence: 99%

The Evolution and Visual Prognosis of Glial Proliferation with Different Grades after Macular Hole Surgery: An Optical Coherence Tomography-Based Study

Qi,

Yu,

Yang

et al. 2023

Ophthalmologica

View full text Add to dashboard Cite

Introduction: The glial proliferation after macular hole (MH) surgery was divided into two types previously: thos replacing the entire intraretinal laye and those involving only the inner foveal layers. The evolution and prognosis of the former type was elaborated in previous studies, but the latter one has received limited attention. Therefore, this study aims to investigate the evolution of glial proliferation with varying grades after MH surgery and its effects on foveal microstructure and best-corrected visual acuity (BCVA). Methods: In this retrospective research, we reviewed 202 eyes from 196 consecutive patients who underwent a successful idiopathic MHs repair. Based on optical coherence tomography images, glial proliferation was classified into three types: A-type, which replaced the entire intraretinal layer; B-type, located at the level of and above the external limiting membrane (ELM); and C-type, situated above the ELM. Results: Of the 67 eyes that attended the 1-, 4-, and 10-month follow-up, A-type, B-type, C-type, and no glial proliferation were identified in 27 (40.3%), 17 (25.4%), 20 (29.8%), and 3 eyes (4.5%), respectively, at 1 month. Within 10 months, the prevalence of A-type glial proliferation significantly decreased (P<0.001), but the changes in B-type (P=0.261), C-type (P=0.151), and no glial proliferation (P=0.492) were not significant. In 32 of the 67 eyes, the grade of glial proliferation gradually improved, with A-type transforming into B- or C-type in 19 of 27 eyes (70.4%), B-type into C-type or no glial proliferation in 11 out of 17 eyes (64.7%), and C-type gradually disappearing in 2 out of 20 eyes (10.0%). Among the eyes that attended at least one follow-up (1M, 202 eyes; 4M, 161 eyes; 10M, 97 eyes), those with A-type glial proliferation showed the most defective outer retinal layers, worst BCVA, and thinnest central fovea compared with the other two types at all follow-up time points (P<0.001). Eyes with C-type glial proliferation exhibited significantly better photoreceptor layer status and BCVA compared with those with B-type glial proliferation. A-type glial proliferation at 1 month, which showed significant association with BCVA at 10 months, could be accurately predicted by the minimum linear diameter with a cut-off > 547.5 μm (P<0.001). Conclusion: Within 10 months, A-type glial proliferation substantially resolves but the prevalence of B- and C-type remains unchanged. B-type glial proliferation hinders the restoration of photoreceptors and impairs visual recovery despite being located within the inner retina.

show abstract

Section: Discussionmentioning

confidence: 99%

The Evolution and Visual Prognosis of Glial Proliferation with Different Grades after Macular Hole Surgery: An Optical Coherence Tomography-Based Study

Qi,

Yu,

Yang

et al. 2023

Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…1,2 With the progression of IMH, the best-corrected visual acuity (BCVA) would typically decrease to 20/200 (Snellen), causing serious vision impairment. 3 Pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) and intravitreal gas tamponade is the standard treatment for IMH, with a high anatomical closure rate of 80-100%. 4,5 And ILMP is one of the key steps, which can remove the tangential traction exerted by ILM.…”

Section: Introductionmentioning

confidence: 99%

“…The overall incidence is approximately 4 to 8.7 cases per 100,000 people per year, which would be much higher among women and the elderly 1,2 . With the progression of IMH, the best‐corrected visual acuity (BCVA) would typically decrease to 20/200 (Snellen), causing serious vision impairment 3 . Pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) and intravitreal gas tamponade is the standard treatment for IMH, with a high anatomical closure rate of 80–100% 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Shen,

Ye,

et al. 2023

VIEW

View full text Add to dashboard Cite

Idiopathic macular hole (IMH) is a vitreoretinal disease that causes severe visual impairment, and the pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) is the traditional treatment for IMH. Since the dissociated optical nerve fiber layer (DONFL) is observed in the eyes after the surgery, a modified surgery is put forward to minimize the injury. However, the extent to which the modified surgery reduced damage is not clear. A novel automated image processing system was developed in this study to quantify the damage after the surgery, revealing how the modified surgery reduced the DONFL. Optical coherence tomography (OCT) images and visual acuity were collected from 65 eyes that underwent a vitrectomy with traditional and modified ILM peeling procedure at Zhejiang Provincial People’s Hospital preoperatively. We found that DONFL occurred in all 65 eyes of both the traditional and modified ILM peeling groups. The concentric macular dark spots (CMDS) were automatically measured by the image processing system. The mean total area of CMDS was smaller in the modified ILM peeling group (0.224 ± 0.110 mm2) than that of the traditional ILM peeling group (0.385 ± 0.237 mm2), and there is a significant difference between the two groups (p < .05). The morphological difference in the temporal quadrant of CMDS between the two surgery technology groups was significant (p < .001). This study will provide a clinical research basis for the improvement of macular hole surgery.

show abstract

“…Anatomical closure rates after idiopathic macular hole (MH) surgery have improved with peeling of the internal limiting membrane (ILM). 1 Success rates, however, decline for MHs with a minimum linear diameter (MLD) over 500 µ m. 2,3 Many surgeons, therefore, use an inverted internal limiting membrane flap (IF) as an adjuvant technique to increase anatomical success in larger MHs, and some even in medium-sized and small-sized MHs, 4–8 in particular in the presence of other risk factors for anatomical failure, such as longer duration, 9 flat MH edges, 10,11 or patient's inability to postoperatively maintain a face-down posture. 12–14…”

mentioning

confidence: 99%

“…1 Success rates, how-ever, decline for MHs with a minimum linear diameter (MLD) over 500 mm. 2,3 Many surgeons, therefore, use an inverted internal limiting membrane flap (IF) as an adjuvant technique to increase anatomical success in larger MHs, and some even in medium-sized and small-sized MHs, [4][5][6][7][8] in particular in the presence of other risk factors for anatomical failure, such as longer duration, 9 flat MH edges, 10,11 or patient's inability to postoperatively maintain a face-down posture. [12][13][14] Although closure of MH can now be achieved in most patients, functional outcomes are still often unsatisfactory.…”

mentioning

confidence: 99%

Vertical and horizontal metamorphopsia one year after surgery for macular holes ≤ 500 µm with and without inverted ILM-Flap

Baumann,

Maier,

Johannigmann-Malek

et al. 2023

Retina

View full text Add to dashboard Cite

Purpose: To investigate the effect of an inverted internal limiting membrane flap (IF) and other factors on metamorphopsia after macular hole surgery Methods: Prospective case series of patients undergoing pars-plana vitrectomy with gas tamponade, with either conventional internal limiting membrane (ILM) peeling (CP) or with an inverted ILM-flap (IF), for primary idiopathic macular holes (MH) ≤ 500 µm. Vertical and horizontal metamorphopsia were measured as M-scores (degrees) using M-charts preoperatively and at 2, 6 and 12 months postoperatively. Results: Fifty-three eyes of 53 patients were included of whom 27 underwent CP and 26 were treated with an IF. After MH surgery, all patients were pseudophakic. Vertical and horizontal metamorphopsia improved from 1.08 (±0.51) and 0.98 (±0.70) preoperatively to 0.58 (±0.37) and 0.45 (±0.36) at 2 months (p<0.01), with no further significant improvement at 6 months (0.39 (±0.31), p=0.07, and 0.31 (±0.28), p=0.18) or at 12 months (0.37 (±0.30), p=0.72 and 0.28 (±0.28), p=0.99). There was no significant difference in mean vertical and horizontal metamorphopsia between patients with CP and with an IF at 2 months (p=0.063, p=0.10), 6 months (p=0.25, p=0.16) or 12 months (p=0.62, p=0.22). Preoperative vertical M-score improved at 12 months after MH surgery by 61 % and 64% in the CP and IF groups (p=0.84), and the horizontal M-score by 65 % and 71% (p=0.98). Conclusion: The use of an IF has no evident bearing on the degree of postoperative metamorphopsia 12 months after surgical repair of MHs ≤ 500 µm.

show abstract

The Effect of Macular Hole Duration on Surgical Outcomes

Cited by 16 publications

References 52 publications

The Evolution and Visual Prognosis of Glial Proliferation with Different Grades after Macular Hole Surgery: An Optical Coherence Tomography-Based Study

The Evolution and Visual Prognosis of Glial Proliferation with Different Grades after Macular Hole Surgery: An Optical Coherence Tomography-Based Study

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Vertical and horizontal metamorphopsia one year after surgery for macular holes ≤ 500 µm with and without inverted ILM-Flap

Contact Info

Product

Resources

About