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Common Vitreoretinal Procedures
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Like a retinal hole, a macular hole is also a full-thickness breach in the neurosensory retina albeit located at the foveal centre. However, the term full-thickness macular dehiscence may be better suited to describe this condition rather than macular hole. The reasons for this are that other than the fact that it is a full-thickness defect in the retina, there are many features dissimilar to a retinal hole. These include the documentation of precursor stages, the ability to close spontaneously, the rarity with which it results in retinal detachment, and the ability to close completely following removal of the hyaloid and ILM. None of these are features of a retinal hole elsewhere in the retina.
Wavy Lines, Distorted Vision and Blur
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Macular holes and epiretinal membranes: Should be referred to your vitreo-retinal service for consideration of surgery, if the patient would consider it. A full thickness macular hole generally requires surgery and should be referred to be seen within about 6 weeks or so, as the prognosis is affected by the duration of the morbidity, pre-operative vision and size of macular hole. Depending on patient's level of visual disturbance, visual acuity and rate of progression, epiretinal membranes do not always require treatment. The decision of treatment can be made by the patient with their vitreo-retinal surgeon after the discussion of the associated risk and benefits. Ideally these patients would be sent directly to VR services, avoiding the eye casualty if diagnosed by an optometrist in the community.
Surgical treatment of macular holes
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Kamal Kishore, Gholam A Peyman
Progression is believed to involve additional contraction of prefoveal vitreous that causes a 360° tear in the condensed vitreous cortex at the edge of the retinal hole.9 The underlying retinal defect also continues to enlarge, presumably because of centrifugal retraction of retinal tissue. The patient’s vision worsens during progression of the macular hole. Distortion described by patients with early macular hole lesions is generally of ‘pincushion’ type, wherein the lines on the Amsler grid appear to be pulled in toward the fixation (Fig. 33.4). It is caused by centrifugal displacement of photoreceptors.21 All stages of enlargement are considered stage 2. Because a fully developed hole usually measures between 400 and 600μm, Gass9 has suggested that all holes less than 400μm in diameter without a PVD should be considered stage 2 lesions.
Foveal Displacement following Temporal Inverted Internal Limiting Membrane Technique for Full Thickness Macular Holes: 12 Months Results
Published in Current Eye Research, 2021
Sami Yilmaz, Aysegul Mavi Yildiz, Remzi Avci
High-speed, simultaneous confocal scanning laser ophthalmoscopy (cSLO) and SD-OCT images were obtained using Spectralis SD-OCT. Radial line scan protocol which consists of 24 equally spaced B scan images and MC images were captured at 30°. Papillofoveal distance and minimum hole diameter were measured using a manual caliper parallel to the retinal pigment epithelium (RPE) on the horizontal B-scans of SD-OCT. We first identified the center of the MH and postoperative presumed foveal center. The center of the macular hole was identified as the anatomical center of the hole preoperatively on SD-OCT and composite MC images. The center of a closed macular hole was defined as the hyperreflective junction of the closed macular hole or the center of foveal depression in the horizontal B-scans OCT images and prominent orange area on composite MC images. Then we identified three landmarks on the retina: the first retinal vascular bifurcation or crossover region located superonasal and inferonasal to the fovea and ciliary vessel at the temporal margin of the optic disc.
Surgical Outcomes of Vitrectomy for Macular Hole-induced Retinal Detachment According To Various Surgical Methods: A Multicenter Retrospective Study
Published in Seminars in Ophthalmology, 2021
Dong Yoon Kim, Young Joon Jo, Jung-Yeul Kim, Ju Byung Chae, In Hwan Cho, Hoon Dong Kim, Young Seung Seo, Jeong Ah Shin, Seungbum Kang, Young Suk Chang, Young Hoon Lee
The visual and anatomical outcomes, associated with a persistent macular hole after the vitrectomy, are shown in Figure 3. In eyes with persistent macular holes, the BCVA improvement was not significantly different compared with eyes without persistent macular holes (LogMAR 0.39 ± 0.60 and 0.35 ± 0.51, respectively; p = .826). The BCVA significantly improved after vitrectomy, even in eyes with the persistent macular hole, from 1.74 ± 0.52 to 1.40 ± 0.45 (p= .013). However, MHRD recurred in five eyes (14.8%) after the vitrectomy; this only occurred in eyes with persistent macular holes. The recurrence rate after vitrectomy was significantly higher in eyes with persistent macular holes than in eyes without them (29.4% and 0%, respectively; p= .015). As the presence of persistent macular hole after vitrectomy was not affected by surgical methods, the recurrence of MHRD after vitrectomy might also be independent to the surgical method. The mean time for recurrence after the vitrectomy was 6.00 ± 3.00 months. Figure 4 shows a representative case of a patient with a persistent macular hole after vitrectomy.
Autologous retinal graft for the management of large macular holes associated with retinal detachment
Published in Libyan Journal of Medicine, 2023
Hsouna Zgolli, Hamad K H Elzarrug, Chiraz Abdelhedi, Sonya Mabrouk, Olfa Fekih, Ines Malek, Imen Zghal, Leila Nacef
Since its description by Kelly and Wendel [5], gas vitrectomy has become the gold standard for treating macular holes. This technique is efficient to treat small holes. However, it can be insufficient for large and chronic macular holes. Therefore, improvements and modifications of this technique continue to be described. In 2010, Michalewska and associates [4] reported the inverted ILM flap technique and the temporal inverted ILM flap technique, reporting a higher macular hole closure rate. Free ILM patch graft has also been tried with a patch placed in the macular hole without any attachment and fixed by various methods such as hyaluronate-based viscoelastic [6], autologous blood [7], and perfluorocarbon liquid [8].