[Transitory reduction of vision without metamorphopsia].
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Diagnosis, Differential↗
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Results for “Retinal Perforations”
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[Retinal ICG-accumulation after ILM-staining during macular hole surgery?].
BACKGROUND: In earlier animal studies retinal accumulation of ICG after intravitreous application with subsequent transport to the optic nerve could be observed. In order to evaluate the possible retinal accumulation of ICG after ILM staining during macular hole surgery and to examine the potential changes in optic nerve function, a prospective study was initiated. METHODS: In 20 patients with macular holes grade 3, vitrectomy with ICG staining of the ILM (0.3 ml of a 1:10 diluted ICG solution under air), consecutive ILM peeling, and finally gas tamponade were performed. Preoperatively and 2, 4, 8, 12, and 24 weeks after vitrectomy, all patients underwent normal ophthalmological examination, native ICG picture, VEP examinations, and central visual field examination. RESULTS: Retinal ICG accumulation in the area of the macular hole, in the retinal axons at the temporal arcades, and around the optic disc could be observed in all 20 patients. This staining with ICG was progressively transformed towards the optic disc at the 4- and 8-week examinations. At the 12-week examination, ICG staining around the optic disc was still visible in all patients. The function of the optic nerve (VEP) demonstrated only minor changes during follow-up, and in the visual field examinations no peripheral changes could be observed. CONCLUSIONS: After ILM staining with ICG during macular hole surgery even with highly diluted ICG solutions an accumulation of ICG in the retinal ganglion axons was observed. This accumulation was visible shortly after surgery at the macular hole, temporal arcades, and the optic disc. The predominant staining of ICG at the optic disc during follow-up can be interpreted as transport of the accumulated ICG in the retinal axons and optic nerve. There seem to be no functional implications for optic nerve function and visual field examinations.
Female↗
[OCT in macular holes].
The traditional Gass classification of macular holes can now be supplemented by additional and more detailed morphologic information obtained with optical coherence tomography (OCT). The perifoveal vitreous detachment and subsequent anterior foveal traction is considered to be the primary pathomechanism of macular hole formation. In cases of persistent traction on the fovea it may lead to foveal dehiscence. A possible explanation for intraretinal cyst formation may be secondary vitreous body fluid accumulation within the retina. A classification of macular holes based on additional information from OCT images is possible. Thus, OCT is a valuable tool for differential diagnosis of a pseudo macular hole versus macular hole, precise stage classification, therapy decision making process, outcome control after macular surgery, and prognosis prediction.
Diagnosis, Differential↗
[OCT in epiretinal gliosis].
Biomorphometric studies using optical coherence tomography (OCT) in patients with epiretinal membranes reveal a highly reflective membrane, a significant foveal thickening, loss of the foveal depression, and the presence of intraretinal cysts. Epiretinal membranes are more frequently totally adherent than separated with focal points of adherence. Visual acuity correlates with foveal thickness prior to and 6 months after vitrectomy and surgical removal of epiretinal membranes. Foveal thickening regresses postoperatively, but normal values are seldom reached. Marked foveal thickening, nonexistent foveal depression, and extensive cyst formation are supposed to correlate with a rather poor visual outcome. OCT plays a pivotal role in the differential diagnosis of pseudomacular hole in epiretinal membranes and of full-thickness macular hole. In addition to biomicroscopy and fluorescein angiography, OCT images provide valuable information for a structural assessment of the macula, especially in evaluating the postoperative course of macular surgery.
Epiretinal Membrane↗
[Anatomical and functional results after elective macular surgery].
PURPOSE: The purpose of this paper is to assess the anatomical and functional results after macular surgery in a large group of patients. METHODS: Between June 1995 and December 2001, 381 eyes underwent vitreous surgery for macular pucker (n=244) or macular holes (n=137) with a standard pars plana vitrectomy (PPV) with induction of posterior vitreous separation, membrane peeling, peeling of the internal limiting membrane (no ICG staining was used), and gas instillation (SF(6)). RESULTS: A second surgical intervention due to vision-threatening complications after PPV had to be performed in 8 of 381=2.1%. In the macular pucker group, metamorphopsias improved in 46.6% and the median of visual acuity (VA) improved from preoperative 0.3 to postoperative 0.5. Hole closure of macular holes was obtained in 92.2%; the median of VA improved in this group from preoperative 0.2 to postoperative 0.4. CONCLUSION: In our group a second vitreoretinal procedure due to vision-threatening complications had to be performed in 2.1%. Compared to the spontaneous course, PPV for macular pucker or macular hole has a very positive influence on functional parameters.
Aged↗
[Acute visual deterioration after "alternative therapy" in Russia].
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Acute Disease↗
[Macular hole. Survey and relevant surgical concepts].
The theory of macular hole pathogenesis, which had so far been based on biomicroscopy, has been considerably altered by optical coherence tomography. The precise presentation of vitreofoveal pathology shows that forces acting in different directions are associated with different stages of the disease, making surgical treatment adapted to the different stages possible. Some surgical procedures are still controversial, and there is still no gold standard in macular hole surgery. Especially no agreement exists on the benefit of internal limiting membrane peeling, possibly assisted by staining with indocyanine green. Also details of endotamponade and postoperative positioning are controversial. Therefore, the method of surgical treatment depends a lot on the individual surgeon. This review summarizes the broad spectrum of the literature and the present knowledge in this field.
Animals↗
[Vision loss after contusio bulbi].
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Adolescent↗
[Long-term functional results after macular hole surgery. Results of a prospective study].
PURPOSE: This study reports on the long-term results of macular hole surgery with peeling of the ILM. METHODS: A total of 88 consecutive patients (71 female, 17 male, mean age 67 years) were prospectively evaluated. All patients underwent a standard pars plana vitrectomy with removal of the ILM and an intraocular gas tamponade. Preoperatively, as well as on each follow-up visit, a clinical examination including measurement of best corrected visual acuity, Goldman perimetry, and OCT was performed. RESULTS: The mean postoperative follow-up was 49 months; 83 (94%) patients were pseudophakic at the last examination. Anatomic closure was achieved in 84 (95%) patients. No late reopening of the macular hole was observed. Best corrected visual acuity improved in 82 patients (93%), remained unchanged in 2, and deteriorated in 4 patients. Best corrected visual acuity improved from a median of 0.2 preoperatively to a median of 0.6 postoperatively (p<0.001). Duration of symptoms as well as low preoperative visual acuity had no significant impact on anatomic and functional success. CONCLUSIONS: Macular hole surgery leads to good functional and anatomical results, even in the long term. A long history of visual impairment and low visual acuity before surgery are not contraindications to surgical intervention.
Aged↗
[Comparison of ILM peeling with and without the use of indocyanine green. Functional results for idiopathic macular hole after pars plana vitrectomy].
BACKGROUND: Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the best known therapy for idiopathic macular holes. Indocyanine green (ICG) is useful for staining the ILM, although there is a dose related toxic effect on the inner retinal layers. We compared outcome results with and without the use of ICG. METHOD: Data from 61 patients with idiopathic macular holes, who underwent macular hole surgery were analyzed retrospectively. ICG was used on 36 eyes while for 25 eyes it was not used. After calculating logMAR, differences in visual acuity between both groups were analyzed for significance using the Mann-Whitney-U-Test. RESULTS: The logMAR for the entire group was 0.71+/-0.30 (20/100) preoperatively, after 1 month 0.71+/-0.36 (20/100), after 3 months 0.57+/-0.26 (20/80), after 6 months 0.54+/-0.38 (20/66) and after 12 months 0.36+/-0.32 (20/50). There were no significant differences between groups. CONCLUSION: There seem to be no significant differences in the development of visual acuity and the occlusion rate between patients treated with or without the use of ICG.
Aged↗
[Diagnostics of metamorphopsia in retinal diseases of different origins].
We investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the chi(2)-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.
Adult↗
[Staining techniques in macular surgery].
Over recent years, evolving surgical experience and the development of techniques in surgery for macular hole, macular pucker and other vitreoretinal diseases have improved anatomic and functional success rates. Today, there is common agreement by many surgeons that removal of the internal limiting membrane (ILM) is an effective and safe treatment option for conditions that involve the vitreoretinal interface.However, the ILM is a delicate and barely visible structure and its removal represents a challenge to the vitreoretinal surgeon. The introduction of vital dyes for ILM staining has led to better visibility of the ILM and epiretinal membranes, potentially making ILM peeling more controllable, easier and safer. It has opened the door, especially for the less experienced surgeon, to follow the principle of ILM removal in macular surgery. While the use of trypan blue and triamcinolone during such surgery seems to be safe, questions of the potential toxicity of indocyanine green (ICG) are currently being discussed. However, the underlying pathomechanisms are not yet completely understood. Whether the observations made on ICG-related toxicity will be sufficient to call ICG a "toxic adjunct" is currently under investigation. Further studies are required to better understand the safety margins of ICG and to investigate other vital dyes offering equal staining characteristics and a better safety profile.
Drug-Related Side Effects and Adverse Reactions↗
[Current strategies for macular hole surgery in Germany, Austria and Switzerland].
BACKGROUND: Main aim of this study was to determine how macular hole surgery is currently being performed in Germany, Austria and Switzerland. METHODS: A questionnaire concerning the different aspects of surgery for stage 3 macular hole was developed and sent out to the 380 members of the German Retina Society. RESULTS: This analysis is based on 129 returned questionnaires from colleagues who perform macular hole surgery. A total of 95% (n=123) of the surgeons routinely perform vitrectomy with posterior vitreous detachment, peeling of epiretinal tissue and internal limiting membrane (ILM) peeling. Some 86% (n=106) stain the ILM, with 80% of these (n=85) using indocyanine green (ICG) in concentrations ranging from 0.005% up to 10%. Fourteen percent of ICG users perform a fluid-air exchange before applying the dye. Platelet concentrate is used by 8% of the surgeons with 97% (n=125) performing a gas tamponade using SF6 (53%), C3F8 (22%), C2F6 (16%) or just air (5%) (multiple answers: 4%). Simultaneous cataract surgery is routinely performed by 8%; by 73% only if there is significant cataract. CONCLUSIONS: There is common consent on the basic surgical steps, but several surgical details, e.g. ILM staining, are performed in substantially different ways.
Austria↗
[Functional results after anatomically successful surgery for stage III/IV macular hole].
PURPOSE: To report the functional results after anatomically successful surgery for stage III/IV macular hole. METHODS: Follow-up examinations (ETDRS charts, Birkhäuser near visual acuity charts, OCT) were carried out in 29 patients 11+/-5 months after surgery for stage III/IV macular hole (hole size >400 microm); in all cases the foveal contour had been restored postoperatively . The surgery performed also included cataract surgery (n=26), vitrectomy, ICG-assisted ILM peeling (in which perfluorcarbon liquid was used to prevent ICG from coming in contact with the retinal pigment epithelium) and tamponade with intraocular gas (n=16) or silicone oil (n=13). Silicone oil had been removed by the time of the follow-up evaluation. RESULTS: Preoperative mean BCVA was 0.2 (0.64 logMAR+/-0.24) and postoperative BCVA, 0.5 (0.3 logMAR+/-0.19). None of the patients experienced any deterioration in sight; the average improvement in visual acuity was 3.5+/-2 lines. In 70% (n=20) of the patients the postoperative BCVA was > or =0.5. Visual acuity for near sight was 0.45+/-0.2. In 66% (n=19) a visual acuity of > or =0.4 was achieved for close work. The improvement in visual acuity was not related to the kind of endotamponade or to the size of the macular hole. Patients with macular hole diameters of 400-800 microm (n=20) gained 3.5+/-2.,4 lines, while in patients with macular hole diameters of 800-1135 microm the average gain was 3.6+/-1.3 lines. CONCLUSIONS: Anatomically successful macular hole stage III/IV surgery with ICG-assisted ILM peeling and protection of the retinal pigment epithelium from contact with ICG by perfluorcarbon liquid can yield good functional results.
Aged↗
[Introduction to the topic: macular hole surgery].
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Epiretinal Membrane↗
[Bilateral serous detachment of the neurosensory retina and retinal pigment epithelium with rip of the peripheral pigment epithelium].
HISTORY: A 52-year-old patient with atypical plasmocytoma presented with a bilateral serous detachment of the retina as well as a huge detachment of the pigment epithelium (PE) in the periphery. Shortly thereafter the PE ruptured. In the left eye this led to substantial central macular fibrosis. DIAGNOSIS: The clinically healthy patient showed a nephrotic syndrome; neither typical monoclonality was detectable nor was erythropoiesis or myelopoiesis reduced. THERAPY: To avoid further reduction of VA pars plana vitrectomy (ppV) with silicone oil tamponade and laser coagulation was performed. Clinical findings were reduced significantly and VA was stabilized for 2.5 years. DISCUSSION: PE detachments and serous retinal detachments in patients with nephrotic syndrome are only mentioned in a few cases. However, a peripheral rupture of the PE to this extent seems to be very rare. Early ppV with silicone oil and laser coagulation may prevent further macular fibrosis.
Antineoplastic Combined Chemotherapy Protocols↗
[Surgical management of complete macular foramina].
UNLABELLED: Recently, good functional and anatomical results have been reported in treating full thickness macular holes. Only a few studies describe a removal of a membrane at the vitreoretinal interface after having removal of the vitreous and its cortex. To demonstrate the beneficial effects of removing this membrane at the vitreoretinal interface we present our functional and anatomical results in this retrospective study. PATIENTS: Altogether, 42 patients (27 women, 15 men) with an average age of 66.7 years and full thickness idiopathic macular holes stage II and III/IV (21 patients respectively) were retrospectively analysed. The minimum follow-up was 6 months. To reattach the macular, an intraocular gas tamponade was used in 36 patients (15% C2F6) and 6 patients were treated with an 20% SF6 gas tamponade. RESULTS: Six months after operation, patients in the main group (42 patients) showed visual improvement in 53% (22 patients): 26% (11 patients) showed no change in visual acuity before and after operation. A deterioration was present in 21% (9 patients). In the group of patients in which a membrane at the vitreoretinal interface had been removal 68% (22 patients) showed improved visual acuity. In all 26% (8 patients) showed no change and in one case a deterioration was noticed. After removal of a membrane at the vitreoretinal interface no further macular hole was seen in 80% (25 patients). In this group, 90% (28 patients) complained of metamorphosia before operation. In the group of patients in which were no membrane at the vitreoretinal interface had been removed (11 patients), 73% (8 patients) showed a deterioration in visual acuity, no patient showed improved visual acuity and 27% (3 patients) retained the same level of visual acuity. No macular hole was noticed 6 months postoperatively in 27% (3 patients) in this group. In all 36% (4 patients) in this group complained of metamorphopsia before operation. CONCLUSION: Removal of a membrane at the vitreoretinal interface in patients with idiopathic macular holes stage II in IV improves functional and anatomical results. Metamorphosia is reduced significantly after removal of that membrane. According to our studies, metamorphosia is an indicator for the presence of a membrane at the vitreoretinal interface. Our results suggest that there are different types of idiopathic macular holes with a different pathogenesis in those where a membrane at the vitreoretinal interface could not be removed and those where it is possible to remove it. Cases where removal of this structure should be attempted show better functional and anatomical results. Studies using adjuvants, e.g. autologous platelet concentrate or transforming growth factor beta 2, should take into account that two different types of idiopathic macular holes exist.
Adult↗
[Change in hole size and area of retinal detachment after pars plana vitrectomy in Gass stage III macular foramina].
UNLABELLED: In 15 patients with a stage III macular hole a pars plana vitrectomy with membrane peeling was performed. At the end of the operation a gas/air exchange was performed and patients had to lie face down for some days. METHODS: Before and 4-7 months after the operation a picture of the posterior pole was taken with a Zeiss fundus camera. Pictures were digitized, and the area of the hole and of the surrounding detached retina was measured using a special image analyzer software. RESULTS: In seven cases an improvement of visual acuity was found; in the remaining eight cases visual acuity remained unchanged. In five cases (33%) the retina was totally attached around the hole. In eight cases the detached area had become smaller, in two cases larger, and in two cases we could no longer observe the rim of the hole. In the remaining cases the area of the holes changes by less than 10%. CONCLUSIONS: The results show that even in cases where total attachment of the surrounded retina cannot be achieved, reduction of the detached area can be expected in most cases. Simultaneously, a reduction of metamorphopsia can be observed. However, the improvement of visual acuity is not very high. That is why we will perform pars plana vitrectomy in stage III holes only in exceptional cases.
Follow-Up Studies↗