Spontaneous closure of macular hole after posterior vitreous detachment

Macular holes can be treated with surgically-induced vitreous detachment and gas tamponade. The authors report a case of a macular hole that closed spontaneously after the development of posterior vitreous detachment (PVD). Optical coherence tomography (OCT) revealed a small full-thickness macular hole with perifoveal cystic changes in a 25-year-old female with a central scotoma at her initial visit. There was no evidence of PVD. Five months later, PVD was observed and the macular hole disappeared. OCT performed three months later showed macular hole closure and resolution of the perifoveal cystic changes. The physiologic pit was restored in the fovea. OCT is useful to detect and monitor the morphologic changes of a macular hole.     

Residual triamcinolone acetonide at macular hole after vitreous surgery

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.     

Tomographic assessment of vitreous surgery for diabetic macular edema

PURPOSE: To evaluate the retinal structure before and after vitrectomy for diabetic macular edema and to assess the correlation between thickness of neurosensory retina and best-corrected visual acuity. METHODS: Tomographic features of 13 eyes (nine patients) with diabetic macular edema were prospectively evaluated with optical coherence tomography before and after vitrectomy. The foveal thickness (the distance between the inner retinal surface and the retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) were measured by optical coherence tomography preoperatively and postoperatively. The correlation of the best-corrected visual acuity with foveal and retinal thickness was determined. RESULTS: All 13 eyes had retinal swelling with low intraretinal reflectivity. In addition to retinal swelling, there were cystoid spaces in five (38%) of 13 eyes, a serous retinal detachment in three (23%), and both cystoid spaces and serous detachment in three (23%). Six months postoperatively, the mean foveal thickness significantly decreased from 630 +/- 170 to 350 +/- 120 microm (P <.01, paired t test) and the mean thickness of neurosensory retina decreased from 540 +/- 160 to 320 +/- 140 microm (P <.01, paired t test). A serous retinal detachment occurred transiently in 3 eyes. Compared with the preoperative level, the postoperative best-corrected visual acuity level improved by more than 2 lines in five of the 13 eyes (38%), remained the same in seven eyes (54%), and decreased in one eye (8%). The postoperative thickness of neurosensory retina at the fovea and best-corrected visual acuity level at the sixth postoperative month had a strong negative correlation (correlation coefficient, -0.76; P <.01, Spearmans rank test). CONCLUSIONS: Vitrectomy was generally effective in treatment of diabetic macular edema. Optical coherence tomography demonstrated the intraretinal changes of macular edema and the process of edema absorption. During the process of macular edema absorption, intraretinal fluid appeared to move into the subretinal space in some cases. Best-corrected visual acuity improvement was greater in eyes with less preoperative increase in thickness of neurosensory retina.     

Tomographic features of a lamellar macular hole formation and a lamellar hole that progressed to a full-thickness macular hole

PURPOSE: To report optical coherence tomography of a lamellar macular hole and a lamellar macular hole that progressed to a full-thickness macular hole. METHODS: Case Reports. RESULTS: Case 1. In the right eye of a 66-year old man, a lenticular-shaped split was present in the inner neurosensory retina corresponding to the fovea. Three months later, an operculum formed anterior to the fovea where the retina was attenuated. Case 2. In the left eye of a 58-year old woman, a foveal cyst was seen in the inner neurosensory retina and the inner wall of the cyst was elevated, where a slightly detached posterior vitreous cortex was attached. One month later, the inner wall was operculated, leaving a thin foveal bottom. Four months later, the hole progressed to a full-thickness macular hole. CONCLUSION: Lamellar macular hole appears to form when the inner wall of a split or cyst in the neurosensory retina at the fovea is avulsed by vitreous traction.     

Thickness of retinal nerve fiber layer decreases after vitreous surgery for idiopathic macular hole

PURPOSE: To investigate the alteration of the retinal nerve fiber thickness (NFLT) before and after vitreous surgery for a macular hole in cases with or without visual field defects. METHODS: The NFLT of 23 eyes with idiopathic macular hole was measured with scanning laser polarimeter upto 12 months after surgery. The NFLT was divided into superior, inferior, nasal, and temporal quadrants. The mean NFLT of each quadrant was analyzed statistically and compared to the results of visual field tests. RESULTS: In all cases, the NFLT decreased significantly upto 3 months after surgery, but increased gradually upto 12 months. In cases with visual field loss, the thickness of the nerve fiber layer that corresponds to the visual field defect diminished strongly, in contrast with other quadrants. Even in cases without visual field loss, the NFLT decreased significantly a month after surgery, especially in the nasal and inferior quadrants. CONCLUSION: This study demonstrates that the thickness of retinal nerve fiber layer decreases at least one month after surgery, even in cases without visual field defect. This fact may suggest the existence of a subclinical complication of vitreous surgery.     

玻璃体手术治疗特发性黄斑裂孔的临床观察

目的:观察玻璃体切割、内界膜剥除联合玻璃体腔气体填充治疗特发性黄斑裂孔的手术疗效及影响因素。方法:对特发性黄斑裂孔患者22例23眼的临床资料进行回顾分析。患眼术前术后除常规检查外最后由光学相干断层扫描(OCT)确诊及测量黄斑裂孔形态。所有患眼均行玻璃体切割、内界膜剥除联合玻璃体腔气体(空气或惰性气体)填充术。观察患者术后视力和黄斑裂孔闭合率及手术并发症的发生情况。用SPSS 13.0统计软件分析患者年龄、病程、术前最佳矫正视力(BCVA)、黄斑裂孔直径、玻璃体腔填充气体种类与术后BCVA和黄斑裂孔闭合率的相关性。结果:术后OCT检查结果显示患者黄斑裂孔闭合率100%。其中术中使用空气进行玻璃体腔填充的14眼,一期黄斑裂孔闭合11眼(79%);术中使用惰性气体(100mL/L C3F8)进行玻璃体腔填充的9眼,一期黄斑裂孔全部闭合,闭合率100%,二者比较,差异无统计学意义(χ2=2.1214,P>0.05)。术后平均矫正视力0.23±0.12,与术前平均矫正视力0.11±0.05相比较,差异有统计学意义(t=4.023,P<0.05)。术后视力提高者术前黄斑裂孔直径小于术后视力不提高者,差异有统计学意义(t=3.92,P<0.05)。术后BCVA与患者年龄(r=-0.415,P=0.256)、病程(r=0.193,P=0.498)、术前BCVA(r=0.152,P=0.673)无相关性。结论:玻璃体切割、内界膜剥除联合玻璃体腔气体填充术治疗特发性黄斑裂孔疗效确切;黄斑裂孔直径是影响特发性黄斑裂孔术后闭合和视力预后的主要因素;而术前视力、年龄、病程对特发性黄斑裂孔术后闭合和视力预后的影响无相关性。     

黄斑孔患者手术后生活质量变化

目的评价黄斑孔手术对患者生活质量的影响。方法黄斑孔患者25例（25眼）行常规玻璃体切除术并注入C3F8。手术前和手术后5月完成中文版低视力者生活质量量表。结果1次手术黄斑孔解剖闭合率为84．00％（21／25）。手术眼视力及双眼并用视力在手术前和手术后5月差异无统计学意义（分别是P=0.206，P=0.283）。远视力、移动和光感以及读和精细工作2个指标和生活质量总分在手术前后差异有统计学意义（分别为P=0．043，P=0．034，P=0．035）。结论 黄斑孔手术能改善患者的生活质量。生活质量量表的应用结合传统的临床检查能较全面地反映手术干预后患者健康状况的变化。     

Spontaneous closure of traumatic macular hole

PURPOSE: To investigate the mechanism by which traumatic macular hole closes spontaneously. DESIGN: Consecutive observational case series of three patients with unilateral traumatic macular hole who consulted medical staff at the Kansai Medical University between 1997 and 2000. METHODS: Three patients who sustained unilateral blunt trauma to the eye and developed traumatic macular hole were followed with ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: Case 1 was an 11-year-old boy. He had neither a macular hole nor prominent macular edema at his first consultation, but a macular hole opened 3 weeks later. OCT showed macular edema and a full-thickness macular hole. The tissue around the edge of the macular hole protruded inward toward the center and finally closed spontaneously 18 weeks later. Case 2 was a 19-year-old man. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. OCT showed macular hole enlargement and worsening of the macular edema during follow up. The macular hole finally closed 4 months after injury. Case 3 was a 15-year-old boy. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. The macular hole finally closed 6 months after injury. CONCLUSION: Macular hole can be a result of severe damage from ocular concussion or damage to the retina. For 6 months following injury, traumatic macular hole should probably be observed rather than surgically repaired, because of the possibility that the macular hole may close spontaneously.     

Spontaneous macular hole closure in bilateral macular holes

The natural course of full thickness macular hole is progression in size and stage. There have been reports of spontaneous closure of unilateral idiopathic full thickness macular holes, but we report the first case of spontaneous closure of a full thickness macular hole in one eye in a patient with bilateral idiopathic full thickness macular holes. After macular hole surgery in the left eye of the patient, spontaneous closure of the macular hole in the right eye was observed during the follow-up period.