Vitreous Surgery for Idiopathic Macular Holes

Kelly, Neil E.

doi:10.1001/archopht.1991.01080050068031

Cited by 1,155 publications

(280 citation statements)

References 13 publications

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“…IMH were considered incurable until the first report by Kelly and Wendel[16]. Since then, the standard technique to treat an IMH has been pars plana vitrectomy, removal of the posterior hyaloid, fluid-gas exchange, injection of a long-acting gas, and maintenance of a face-down position by the patient after surgery.…”

Section: Surgical Removal Of the Ilmmentioning

confidence: 99%

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Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Rodrigues¹,

Meyer²,

Farah³

et al. 2005

Ophthalmologica

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Surgical management of macular holes consists of pars plana vitrectomy, removal of the posterior hyaloid facia, and peeling of the epiretinal membranes (ERM). Additionally, removal of the internal limiting membrane (ILM) may enable an increase in the anatomic and functional success rates. However, recognition of fine ILM is difficult thus increasing the time that the macula is exposed to intraoperative light. Staining the ILM with indocyanine green (ICG) dye during vitrectomy facilitates recognition of the ILM and assures that all adjacent ERM are removed. Therefore, ICG-assisted ILM peeling has gained worldwide popularity among vitreoretinal surgeons. However, there are some concerns about the intravitreal ICG application. Reports in the literature described a variety of application techniques using different concentrations. The postoperative outcomes were controversial reporting heterogeneous anatomical and functional outcomes after ICG application, as well as descriptions of adverse effects related to the dye. We discuss the indications, techniques, surgical results, and complications after intravitreal ICG injection for the treatment of macular holes.

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Section: Surgical Removal Of the Ilmmentioning

confidence: 99%

“…ILM peeling to treat macular holes was first described by Eckardt et al[ 19] in 1997. With this advanced technique, closure rates around 95% were reported [19,20,21,22], compared with 58–94% closure rates in eyes without ILM peeling [16,23,24,25]. …”

Section: Surgical Removal Of the Ilmmentioning

confidence: 99%

Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Rodrigues¹,

Meyer²,

Farah³

et al. 2005

Ophthalmologica

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“…Since Kelly and Wendel [1]reported successful closure of macular holes with visual improvement by vitrectomy with fluid-gas exchange, several modifications of the surgical technique have been proposed [2, 3, 4, 5, 6, 7]. The pathogenesis of idiopathic macular hole is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Double Visualization Using Triamcinolone Acetonide and Trypan Blue during Stage 3 Macular Hole Surgery

Yamamoto

Ozaki²,

Murakami³

2004

Ophthalmologica

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Purpose: To study the usefulness of intravitreal injection of triamcinolone acetonide and trypan blue for facilitating visualization and dissection of the posterior vitreous cortex and internal limiting membrane (ILM) during vitrectomy in idiopathic stage 3 macular holes. Methods: Pars plana vitrectomy was performed in 10 eyes of 10 patientswith idiopathic stage 3 macular holes. After core vitrectomy had been performed, triamcinolone acetonide was injected over the posterior pole. After separation of the visualized posterior vitreous cortex, trypan blue was injected over the macular area. Excised specimens were examined by electron microscopy. Results: Upon injection of triamcinolone acetonide, the posterior vitreous cortex and residual vitreous cortex could be visualized in all patients. The posterior vitreous cortex and residual vitreous cortex were completely removed. The ILM of the retina was stained faint blue and was successfully removed in all patients. Electron microscopy revealed that the triamcinolone-acetonide-visualized layer and the trypan-blue-stained layer had different histological features. No complications related to the use of triamcinolone acetonide and trypan blue were encountered. Conclusion: Double visualization of the posterior vitreous cortex and ILM using triamcinolone acetonide and trypan blue during vitrectomy may facilitate separation of the posterior vitreous cortex from the retina and removal of the ILM around the macular hole in patients withidiopathic stage 3 macular holes.

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“…In 1988, Johnson and Gass [2]published a classification of macular holes and proposed that the tangential vitreous traction exerted on the fovea played an important role in the pathogenesis of macular hole formation. In 1991, Kelly and Wendle [3]reported successful closure of macular holes with visual improvement using pars plana vitrectomy with gas-fluid exchange. Since then, there have been several variations of macular hole surgery performed that include the use of adjuvants, tamponades and membrane peeling techniques [4, 5, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Study of the Idiopathic Macular Hole: Comparison of Epiretinal Membrane Peeling and Internal Limiting Membrane Peeling

et al. 2003

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The aim of this study was to identify the internal limiting membrane (ILM) and epiretinal membrane (ERM) harvested during macular hole surgery under light microscopy and electron microscopy and to evaluate the difference in specimen loss rate with and without the aid of indocyanine green (ICG) staining. Thirty-two consecutive patients (34 eyes) with stage 2–4 macular holes were included. ERM peeling (macular hole with ERM) or ILM peeling (macular hole without ERM), with or without the use of ICG, was used during macular hole surgery with vitrectomy. There were 26 specimens for pathology; 12 specimens (46%) were lost during processing. ICG staining did not reduce the specimen loss rate. The specimens harvested from intentional ILM peeling displayed a smooth, translucent ILM. The specimens harvested from ERM peeling showed moderate cellular proliferation abutting on the ILM, and all specimens had an ILM. The pathological findings confirmed the clinical observations in all the cases studied. The ILM appeared in all specimens harvested by ERM peeling during macular hole surgery. ICG staining does not alter the specimen loss rate during pathological processing.

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Vitreous Surgery for Idiopathic Macular Holes

Cited by 1,155 publications

References 13 publications

Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Double Visualization Using Triamcinolone Acetonide and Trypan Blue during Stage 3 Macular Hole Surgery

Clinicopathological Study of the Idiopathic Macular Hole: Comparison of Epiretinal Membrane Peeling and Internal Limiting Membrane Peeling

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