Retinal displacement after surgery for idiopathic macular hole

AIM: To review and summarize the mechanism hypothesis, influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole (IMH) surgery. METHODS: PubMed and Web of Science database was searched for studies published before April 2023 on “Retinal displacement”, “Idiopathic macular holes”, and “Macular displacement”. RESULTS: Recently, more academics have begun to focus on retinal displacement following idiopathic macular holes. They found that internal limiting membrane (ILM) peeling was the main cause of inducing postoperative position shift in the macular region. Moreover, several studies have revealed that the macular hole itself, as well as ILM peeling method, will have an impact on the result. In addition, this phenomenon is related to postoperative changes in macular retinal thickness, cone outer segment tips line recovery, the occurrence of dissociated optic nerve fiber layer (DONFL) and the degree of metamorphopsia. CONCLUSION: As a subclinical phenomenon, the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.     

Retinal displacement and intraretinal structural changes after idiopathic macular hole surgery

Japanese Journal of Ophthalmology - To investigate the correlations of thickness of three retinal layers with retinal displacement after idiopathic macular hole surgery. Retrospective, consecutive,...     

特发性黄斑裂孔患者手术前后中心视野的改变

目的 分析特发性黄斑裂孔患者手术前后的中心视野改变情况.方法 对2005～2006年在中山大学中山眼科中心接受玻璃体手术联合0.25%ICG辅助内界膜剥离治疗的特发性黄斑裂孔患者共19例(19只眼),用Octopns101全自动视野计M2程序观察手术前及手术后2个月、6个月、1年时患者中心10度视野平均缺损(MD)及中心4度平均敏感度(MS)的改变情况.结果 特发性黄斑裂孔手术后共有16例裂孔闭合(84.21%).经多元方差分析16例裂孔闭合的病人手术前及术后2月、6月、1年10度中心视野MD及4度中心视野MS四次测量结果之间的改变情况,趋势图显示术后2个月视野较术前差,随时间延长逐渐有所恢复.结论 特发性黄斑裂孔患者术后2个月时中心视野较术前变差,随时间延长逐渐接近术前水平.     

Characteristics of macular microvasculature before and after idiopathic macular hole surgery

AIM:To evaluate the macular microvasculature before and after surgery for idiopathic macular hole(MH)and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration.METHODS:Twenty eyes from 20 patients with idiopathic MH were enrolled.Optical coherence tomography angiography(OCTA)images were obtained before,2 wk,1,and 3 mo after vitrectomy with internal limiting membrane peeling.Preoperative foveal avascular zone(FAZ)area and perimeter and regional vessel density(VD)in both layers were compared according to the 3-month best-corrected visual acuity(BCVA).RESULTS:The BCVA improved from 0.98±0.59(log MAR,Snellen 20/200)preoperatively to 0.30±0.25(Snellen 20/40)at 3 mo postoperatively.The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group(all P<0.05).A significant reduction was observed in FAZ parameters and all VDs 2 wk postoperatively.Except for deep perifoveal VD,all VDs recovered only to their preoperative values.The postoperative FAZ parameters were lower during follow-up.Decreases in preoperative deep VDs were correlated with worse postoperative BCVA(Pearson’s r=-0.667 and-0.619,respectively).A larger FAZ perimeter(Spearman’s r=-0.524)and a lower deep perifoveal VD preoperatively(Pearson’s r=0.486)were associated with lower healing stage.CONCLUSION:The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH.Except for the deep perifoveal region,VD recovers only to preoperative levels.     

特发性黄斑裂孔术后的黄斑区视网膜厚度变化的远期观察

目的:对特发性黄斑裂孔患者进行玻璃体切割手术(pars plana vitrectomy,PPV)及内界膜(inner limiting membrane,ILM)剥除、气体眼内填充后,应用频域光学相干断层扫描仪(spectral domain optical coherence tomography,SD-OCT)观察黄斑裂孔术后的闭合黄斑孔的黄斑区视网膜厚度(retinal thickness,RT)变化。方法:非随机、回顾性临床病例研究。筛选我院2011-03-01/2013-06-30入院诊断为“特发性黄斑裂孔”的患者17例17眼,均为同一术者行25G-PPV和ILM剥除、短效气体填充、黄斑孔闭合良好、随访观察超过6mo以上者。所有患者术后均使用Topcon公司SD-OCT进行术眼及对侧正常眼的黄斑区线性扫描检测黄斑区视网膜厚度变化。黄斑区视网膜厚度根据ETDRS分成9个区域。术后观察随访时间分别为术后3~5wk(A期)、术后2~3mo(B期)、术后>6mo(C期)。结果:在A期中,OCT检查的黄斑区视网膜厚度:术眼C,IS,II,IN,OS,OI和ON较对侧眼相应区域的厚度增加(P<0.01),而IT和OT(291.58±18.97μm,250.83±21.21μm)较对侧眼(280.33±20.82μm,242.08±24.02μm)的差异无统计学意义(P>0.01)。在B期中,术眼II,IN,OS和ON区域较对侧眼相应区域视网膜厚度增加(P<0.01),而术眼C,IS,IT,OI和OT区域较对侧正常眼相应区域的视网膜厚度值差异无统计学意义(P>0.01)。C期中,除术眼IN区较对侧眼厚度增加外(P<0.01),余C,IS,II,IT,OS,OI,ON和OT较对侧眼相应区域厚度均无明显变化(P>0.01)。另外,C期的术眼ON和IT视网膜厚度较A期有明显下降(P<0.01)。结论:特发性黄斑裂孔术后出现黄斑区视网膜厚度的持续变化,可能与ILM的剥除导致黄斑区显微组织结构的变化有关。SD-OCT为黄斑裂孔术后随访观察提供了客观便捷的观察工具,为进一步研究ILM剥除对黄斑区视网膜的远期结构及对视功能的影响提供了依据。     

恰当开展特发性黄斑裂孔的手术治疗

特发性黄斑裂孔是近二十年来眼科手术治疗领域里较为引人注目的疾病,特别是近十年来,随着视网膜检查设备的更新和手术技术的发展,有关该病的发病机制、治疗对策和手术效果等方面均发生了很多变化,同时仍然存在一些有争议的技术问题。国内对该病的认识和治疗效果已部分接近或达到国际水平,但各地水平差异较大。本文目的旨在帮助国内同行提高对特发性黄斑裂孔发病本质及其手术技术的认识,恰当开展有关的手术治疗,避免盲目追求手术治疗或一味保守观察而错失手术时机。     

特发性黄斑裂孔手术治疗前后的视功能

目的 探讨特发性黄斑裂孔手术治疗前后患者的视功能。方法 19例(19只眼)特发性黄斑裂孔患者,其中2期3只眼,3期10只眼,4期6只眼。采用玻璃体视网膜手术治疗黄斑裂孔。术前和术后均进行国际标准视力、激光视网膜视力、明视强度反应ERG和Humphrey　30-2程序视野测定。 结果 (1)国际标准视力：术前视力0.01至0.1,术后视力0.04至0.4,术前术后视力改变差异无显著性的意义(p＞0.05)。(2)激光视网膜视力：术前激光视网膜视力0.12至0.4,术后激光视网膜视力 从0.2至0.63。术前和术后激光视网膜视力改变差异有显著性的意义(P＜0.05)。(3)ERG明视强度反应曲线：术前和术后b波最大振幅Rmax(μV)和代表曲线斜率的n值的改变差异均无显著性的意义(P＞0.05)。术后半饱合光刺激强度K(cd·sec/m2)的对数单位Log值,较术前降低,差异有显著性的意义(P＜0.05)。(4)Humphrey视野：术后 0～10° 较术前光阈值提高,差异 有显著性的意义(P＜0.05)。术前和术后15～30°光阈值差异无显著性的意义(P＞0.05)。 结论 手术治疗IMH能提高视网膜黄斑部视锥细胞功能。（中华眼底病杂志,2000,16：213-284）     

特发性黄斑裂孔手术前后黄斑区脉络膜厚度变化

目的：探讨玻璃体切除手术对特发性黄斑裂孔(IMH)黄斑区脉络膜血流的影响及脉络膜微结构变化在黄斑裂孔形成中的作用。

方法：选取2014-05/2015-12单眼IMH患者56例56眼纳入研究,所有患者均行三通道平坦部玻璃体切除+吲哚菁绿辅助内界膜剥除+12%C₃F₈气体填充术。晶状体混浊者联合超声乳化吸出+人工晶状体植入。术前及术后1、3、6mo行EDI SD-OCT检查,记录黄斑中心凹下及距中心凹上方、下方、鼻侧、颞侧各1、3mm处共9个位点的脉络膜厚度。

结果：术前黄斑中心凹下脉络膜厚度(SFCT)值为233.43±84.638μm,术后1、3、6mo SFCT分别为242.46±88.199,238.97±89.252,236.71±88.661μm,术后1mo与术前相比明显升高(P<0.05)。距中心凹下方3mm处的脉络膜厚度值(ICT_3mm)术前(170.89±57.040μm)与术后1、3、6mo(179.63±62.941、179.74±65.981、180.80±58.379μm)相比呈逐渐增高趋势,但各个测量时间点的ICT_3mm值两两比较无差异。 距中心凹下方1mm处的脉络膜厚度值(ICT_1mm)术前(207.37±67.502μm)与术后1、3、6mo(216.31±80.297、214.54±75.693、205.69±68.697μm)有差异(P<0.05),术后6mo与术后1mo相比有差异(P<0.05)。

结论：脉络膜厚度降低可能是黄斑裂孔形成的原因,IMH患者术后脉络膜厚度值变化与位置有关,可能与术中填塞气体的压迫作用有关。     

Characteristics of central visual field defect after macular hole surgery

AIM: To investigate the characteristics of postoperative central visual field defect (cVFD) in patients with macular hole (MH). METHODS: Eighteen eyes from 18 MH patients were involved in this retrospective study which reviewed square root of loss variance (sLV) and mean defect (MD) of the visual field test in all subjects. The relationship between cVFD and MH stage, as well as the postoperative ellipsoid zone disruption were evaluated using Spearman’s correlation test. RESULTS: Our analysis determined Spearman coefficient is 0.705 for the correlation between sLV and MH stage (P<0.01), 0.877 for the correlation between sLV and postoperative ellipsoid zone disruption (P<0.01) and 0.721 for the correlation between MD and postoperative ellipsoid zone disruption (P<0.01). A significant relationship was also detected between postoperative ellipsoid zone disruption and MH stage (r=0.470, P<0.05). Univariate regression analysis indicated that sLV and MD were associated with postoperative ellipsoid zone disruption (P<0.01, P<0.01, respectively). CONCLUSION: Postoperative cVFD is highly correlated with MH stage and postoperative ellipsoid zone disruption in patients with MH.     

Subtotal vitrectomy in idiopathic macular hole surgery

PurposeTo assess the outcomes of subtotal vitrectomy in idiopathic macular hole (IMH).MethodsThe patients with idiopathic IMH who had undergone vitreoretinal surgery and followed up for at least 12 months post-operatively were included. First the posterior hyaloid was detached, then cortical vitreous was removed incompletely by leaving anterior vitreous intact. Internal limiting membrane was peeled with the aid of brilliant blue. A non-expanding volume of perfluoropropane was used as a tamponade and face-down positioning for 5 days was suggested to the patients. The main outcome measure was the closure rate of IMH.ResultsForty-three eyes were included. The mean follow-up time was 15.0 ± 3.8 months after surgery. Single surgery anatomical success was 86.0%. The mean BCVA at baseline, month 1, 3, 6, 12 and at the last follow-up was 0.99 ± 0.33 LogMAR (0,5–1.80), 1.04 ± 0.33 LogMAR (0.5–1.8), 0.94 ± 0.46 LogMAR (0.3–3.0), 0.84 ± 0.33 LogMAR (0.3–1.5), 0.82 ± 0.35 (0.2–1.5), and 0.70 ± 0.34 (0.1–1.5) (p > 0.05, for all). The mean visual acuity increased by 2.9 lines at the last follow-up visit and 51.2% of the patients gained ≥ 3 lines of vision.ConclusionThe results of this study indicated limited core vitrectomy as a safe and effective surgical technique in the treatment of IMH, resulting in acceptable functional and anatomical outcomes without significant intra- and post-operative complications.     

Irregularity of photoreceptor layer after successful macular hole surgery prevents visual acuity improvement

PURPOSE: To investigate the association between a photoreceptor irregularity and visual acuity (VA) after macular hole (MH) surgery. DESIGN: Prospective observational case series. METHODS: Twenty-four eyes with an idiopathic MH that resolved after vitreous surgery were examined by new optical coherence tomography (OCT 3000). The images were divided into regular photoreceptor, detected as a straight line above the retinal pigment epithelium reflex, and irregular, which cannot be detected by it. RESULTS: Regular images were observed in 12 eyes (80%) and irregular images in 3 eyes (20%) with good VA (>or=0.7). Regular images were seen in 3 eyes (33%) and irregular images in 6 eyes (67%) with poor VA (<0.7). The percentage of regular images in the group with good VA was significantly higher than that in the group with poor VA (P <.05). CONCLUSION: A photoreceptor irregularity after MH surgery may prevent VA improvement.     

改良黄斑裂孔手术疗效分析

目的：比较改良黄斑裂孔手术与传统黄斑裂孔手术治疗特发性黄斑裂孔(idiopathic macular hole,IMH)的疗效。

方法：连续选取2014-04/2017-06就诊于我院的IMH患者28例28眼,接受我院同一医师独立完成的手术治疗,分为两组。A组13例为传统玻璃体切除内界膜剥除术联合C₃F₈填充治疗组(简称传统组),B组15例为改良吲哚菁绿染色内界膜剥除联合黄斑裂孔整复空气填充治疗组(简称改良组)。所有患者在术后1wk,1、3、6mo复查。比较两组患者术前和术后末次最佳矫正视力(best corrected visual acuity,BCVA)、手术时间、末次复查时裂孔的闭合率、俯卧时间。

结果：两组患者裂孔闭合率差异无统计学意义(P>0.05); 两组患者术后BCVA较术前均提高,差异有统计学意义(P<0.05),但两组间术前和术后BCVA比较差异均无统计学意义(P>0.05); B组手术时间较A组明显缩短,差异有统计学意义(P<0.05); B组俯卧时间较A组明显缩短,差异有统计学意义(P<0.05)。

结论：与传统组相比,改良吲哚菁绿染色内界膜剥除联合黄斑裂孔整复空气填充可以获得同样较高的裂孔闭合率,而且手术操作步骤简化,缩短了手术时间,减少器械进出切口的次数,从而减少并发症的发生。术后患者俯卧时间明显缩短,舒适度高、依从性好。     

频域相干光断层扫描观察特发性黄斑裂孔患者手术前后光感受器细胞层改变

目的 探讨特发性黄斑裂孔患者手术前后光感受器细胞层内外节的改变特征.方法 回顾性病例系列研究.收集32例(32只眼)确诊并接受手术治疗的特发性黄斑裂孔患者的临床资料进行回顾性分析,同时对其手术前后的高分辨率频域相干光断层扫描(OCT)图像进行对比研究.患者手术前与后logMAR视力和光感受器细胞层内外节被破坏区域直径比...     

Efficacy of autologous plasmin for idiopathic macular hole surgery

PURPOSE: To determine whether a single intravitreal injection of autologous plasmin or a combination of plasmin and intraocular gas without peeling the internal limiting membrane (ILM) will close idiopathic macular holes. METHODS: Eight eyes of seven patients with an idiopathic macular hole were studied. The degree of posterior vitreous detachment (PVD), vitreal liquefaction, closure of the macular hole, visual acuity, and complications following intravitreal plasmin or plasmin with gas were investigated. The removed ILM was examined by electron microscopy. RESULTS: A PVD was created in seven out of eight eyes exposed to plasmin or plasmin with gas, however, the macular hole was not closed by either. Closure occurred in two eyes using conventional vitrectomy after the plasmin with gas injection, but peeling the ILM was required in the remaining six eyes. Vitreal fibers and glial cells were not observed on the vitreal surface of the extracted ILM. CONCLUSIONS: A PVD was created safely and reliably although closure of the macular hole did not occur with either plasmin or with plasmin and gas injection. However, vitreous surgery became easier, and it required a shorter time to close the macular hole with intravitreal plasmin.     

Incomplete fluid-air exchange technique for idiopathic macular hole surgery

AIM: To explore an improved procedure involving incomplete fluid-air exchange for idiopathic macular hole (IMH), and the closure rate, visual function, and the visual field of macular holes (MHs) were evaluated. METHODS: This prospective randomized controlled study, included 40 eyes of 40 patients with IMH who were treated with pars plana vitrectomy and peeling of the internal limiting membrane. They were grouped by random digital table. Twenty-one eyes underwent incomplete fluid-air exchange (IFA) and 19 eyes underwent traditional complete fluid-air exchange (CFA) as the control group. Outcomes included best-corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography, light adaptive electroretinography, and visual field evaluations. RESULTS: All MHs <400 μm were successfully closed. BCVAs before and 6mo after surgery were 0.82±0.41 logMAR and 0.28±0.17 logMAR in IFA group and 0.86±0.34 logMAR and 0.34±0.23 logMAR in CFA group, respectively. The electroretinogram analysis of patients in IFA group revealed increases in b-wave amplitudes at 1, 3, and 6mo after surgery. Additionally, patients in IFA group showed an amplitude increase of 28.6% from baseline at 6mo (P<0.05), while no obvious improvements were noted in CFA group. Although there were no statistically significant improvements in either group, the IFA group showed a slight increase in mean sensitivity (P>0.05). CONCLUSION: IFA is a reliable method that offers comparable closure rate to CFA and facilitates improvements in visual function.