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At least 451 records · Page 25Linked to original sources
PubMed1996

[Changes in the vitreomacular border of the partner eye in macular foramina].

The incidence of a macular hole in the fellow eye of patients with macular hole stage I-IV according to Gass is observed in 3-14% of cases. The development of a macular hole over a period of 19-54 months is reported to occur in 1-22% of patients. Our clinical impression made us suspect a much higher number of changes at the vitreomacular interphase in the generally asymptomatic "second eye" already at first presentation in the hospital. We retrospectively examined 88 patients who presented with a macular hole between January and October 1994. We investigated the frequency of a macular hole or macular pucker in the fellow eye, taking into consideration that many common pathogenetic factors were described for these changes of the vitreoretinal interphase. We further examined the difference in number and appearance of macular pathology in the fellow eye between patients who had macular hole surgery in their "first eye" and patients whose "first eye" was observed. The group of patients whose "first eye" was operated on showed a macular hole stage I or stage II in 8% each in the "second eye", and a macular hole stage III/IV in 6% of cases. Patients whose "first eye" was observed were found to have only early macular holes in 18% of fellow eyes. Altogether, the fellow eye of patients with macular hole exhibited also a macular hole in 21% of patients and a macular pucker in 7% of patients. The incidence of pathological changes at the vitreomacular interface in 28% of the fellow eyes of patients with macular hole is higher than ever reported in the literature. The presence of early macular holes as well as early macular puckers supports clinically the thesis of common factors in the pathogenesis of these two disorders. As we only reviewed the incidence of pathological charges in this study, a much higher number of developing macular holes and macular puckers has to be expected in the fellow eye of patients with macular hole over a certain time period.

Adult↗
PubMed1996

[Morphologic analysis of epiretinal membranes in surgically treated idiopathic macular foramina. Results of light and electron microscopy].

Anteroposterior and tangential traction on the central retina is an important factor in the pathogenesis of idiopathic macular hole formation. Histological studies have shown that macular holes of different stages can be associated with epiretinal membranes. Such membranes can be removed during surgery for macular holes. We investigated such tissue samples of 11 patients with macular holes in stages II-IV. Light microscopically, the tissue consisted of a thin collagen layer mostly covered by a thin layer of cells. Ultrastructural analysis revealed glial cells and macrophages as cellular components. The collagen can be ascribed to vitreous, inner limiting membrane and newly formed collagen. According to the morphological findings a multilayered tissue structure can be assumed. Macrophages were found on the retinal side of the inner limiting membrane and at the vitreal side of the tissue. Therefore, the macrophages probably originate from the retina as well as from the vitreous as so-called resident hyalocytes. Glial cells covered the inner limiting membrane forming pericellular collagen to which outer vitreous collagen fibrils can be attached. The multilayered membrane structure might possibly be the cause for only partial laminar surgical extraction so that contractile or potentially proliferative tissue residues might be one of the reasons for surgical failures after incomplete membrane peeling.

Aged↗
PubMed1997

[Removal of the internal limiting membrane in macular holes. Clinical and morphological findings].

UNLABELLED: The recommended treatment for full-thickness macular holes is removal of the posterior hyaloid and sometimes the epiretinal membrane from the retina during vitrectomy in order to release the assumed intravitreous traction. We have employed a technique involving the additional removal of the membrana limitans interna (MLI) from the retina in the vicinity of the macular hole. We report on our clinical results and ultrastructural findings. MATERIALS AND METHODS: Between December 1995 and July 1996, we performed vitrectomies on 39 eyes of 37 patients with full-thickness macular hole. After removal of the attached posterior hyaloid, a specially developed forceps was used to remove a circular area of the MLI approximately three to four disc diameters in size. At the conclusion of the operation, 20% C3F8 gas was injected and the patient instructed to stay in a prone position for 8 days. RESULTS: Intraoperatively, "rhexis" of the MLI only rarely produced bleeding or recognizable retinal edema. Complete closure of the hole was observed postoperatively in 36 of the 39 eyes (92%). A visual improvement of at least two lines was achieved in 77% of eyes with successful closure. Pigment irregularities or edematous changes could not be detected either clinically or by fluorescein angiography in any of the 39 eyes. Electron microscopy was performed on 23 of the membranes. The salient feature was the MLI. Canals leading from the inner to the outer surface of the MLI contained Müller cell processes with clear signs of necrosis or degeneration. On the vitreous side, the MLI usually exhibited myofibroblasts. CONCLUSIONS: The MLI was successfully removed in all 39 eyes with a full-thickness macular hole. This procedure led to very good anatomic and functional results. It remains for future studies to determine the pathogenic significance of the necrotic processes detected by electron microscopy in the MLI canals.

Adult↗
PubMed1997

[Autologous thrombocyte administration in treatment of idiopathic macular foramen].

BACKGROUND: Recent studies have shown the usefulness of pars plana vitrectomy with the use of growth factors in the treatment of macular holes. Autologous platelet concentrates contain many growth factors to stimulate glial wound healing. PATIENTS: Nineteen patients with idiopathic macular hole underwent vitrectomy, membrane peeling, air injection and installation of autologous platelet concentrate (0.1 ml). The platelet concentrate contained a mean of 1.8 x 10(9) platelets/ml. RESULTS: The anatomic success rate in stage 2 macular hole was 100%, in stage 3, 82% and in stage 4, 50%. Visual acuity improved in all patients with stage 2 (two lines) and in 73% of stage 3 at least (one line). CONCLUSION: Platelets are effective in the treatment of macular holes due to the high amount of different growth factors (PDGF, EGF, bFGF, IGF-1) which have a high affinity binding to Müller cells helping to seal the hole by photoreceptor adaption.

Aged↗
PubMed1998

[Prognostic factors in surgery of macular holes].

UNLABELLED: Idiopathic macular holes are today treated surgically with good results. The prognostic value of factors predictive for the anatomical and functional outcome has not been completely evaluated. PATIENTS AND METHODS: One hundred and thirty-five eyes with penetrating macular holes (stage II-IV) were investigated prospectively. The mean follow-up was 19.5 months (6-50 months). RESULTS: In 86% of cases the hole was closed postoperatively. The age of the macular hole proved to be a significantly predictive factor for the outcome; the age of the patient did not. The diameter of the hole showed no influence on the results. Application of autologous serum in front of the hole did not significantly improve the anatomical, but the functional results. The strongest improvement of visual acuity was seen in eyes with poor preoperative function. In 118 eyes a prefoveal membrane could be peeled off. Seventeen eyes without detectable membrane showed identical results. CONCLUSION: Some predictive factors in macular hole surgery are proven, others remain uncertain. Identical results in eyes with and without prefoveal membranes support the assumption of different pathomechanisms in macular hole formation.

Follow-Up Studies↗
PubMed2000

[Findings of optical coherence tomography (OPT) before and after macular hole surgery].

PURPOSE: We used optical coherence tomography (OCT) for the staging of macular holes and compared our results with clinical and intraoperative findings. PATIENTS: Between 1 January 1997 and 15 October 1998, 80 patients underwent vitrectomy for idiopathic macular holes. In 36 cases we could record an OCT preoperatively and in 24 cases also postoperatively. OCT measurements were analyzed in a blind fashion independent of the clinical pre- and intraoperative findings. RESULTS: Preoperative OCT staging was in agreement with the intraoperative findings in 24 of 36 cases. However, in 8 cases, the macular hole was judged as stage 3 intraoperatively, while OCT revealed a stage 4 hole. Postoperatively, OCT results were consistent with the clinical findings in all 24 cases. CONCLUSION: OCT scans are a valuable adjunct for the pre- and postoperative analysis of idiopathic macular holes. As the posterior hyaloid surface cannot always be reliably identified in OCT, discrimination between stage 3 and 4 is difficult.

Humans↗
PubMed2000

[Imaging of vitreoretinal adhesions in the partner eye of patients with penetrating macular foramina in optical coherence tomography].

BACKGROUND: Vitreoretinal adhesions play a crucial role in the development of a macular hole. To visualize vitreoretinal adhesion we used optical coherence tomography to investigate fellow eyes of patients with macular holes. METHODS: In a prospective study we scanned the retina in 188 patients with a macular hole stage III or IV (Gass classification). The foveal shape and vitreous were classified into grades. RESULTS: Of the 188 patients 45% showed no vitreous reflex, 45% a partial vitreous detachment with foveolar adhesions, and 10% a vitreous detachment with complete separation from the fovea. While eyes with normal foveolar shape displayed partial vitreous detachment in 33%, this figure rose to 66% in eyes with a macular hole stage I. CONCLUSION: Diffuse thickening of the fovea is followed by an intraretinal split and formation of a cyst. The shape of the foveolar adhesion suggests that continuing anteroposterior vitreal traction leads to a retinal break and formation of a full-thickness macular hole.

Aged↗
PubMed2001

[Preoperative scanning laser ophthalmoscopy: findings in idiopathic macular foramen].

BACKGROUND: The aim of our study was a detailed morphological and functional assessment of macular foramen stages II-IV by scanning laser ophthalmoscopy (SLO) and fundus perimetry including a correlation with clinical findings. METHODS AND MATERIALS: Included in this prospective study were 78 patients where SLO imaging and fundus perimetry were performed with the SLO-105 (Rodenstock) prior to pars plana vitrectomy for macular foramen on one eye. Both the size and shape the of macular foramen were assessed. Deep (0 dB) and relative (12 dB) scotomata were tested using the Goldmann II stimulus in the 20 degrees field of the SLO. Imaging was performed with the infrared laser and confocal aperture C2. RESULTS: The size of macular foramen ranged from 140 microns to 800 microns (median: 420 microns) and 20 (26%) had irregular, polycyclic borders. In 21 patients (27%) a bright sector could be seen just outside the hole. Deep scotomata were notably smaller than the visible macular hole in 4 patients (6%) and 18 deep scotomata (25%) extended beyond the hole. There was a weak inverse correlation between the size of deep, relative scotomata and the diameter of the macular holes with the visual acuity (r = -0.46; r = -0.39 or r = -0.53), but no correlation with the duration of symptoms could be demonstrated. CONCLUSION: Polycyclic borders were seen as a new feature of some idiopathic macular foramen. This may be due to asymmetric traction or adhesions on the macular area. Also, deep scotomata either smaller or larger than the visible macular hole were found.

Aged↗
PubMed2001

[Conventional ablation surgery or primary vitrectomy in complicated retinal holes].

BACKGROUND: We retrospectively evaluated 100 difficult cases out of 803 consecutive eyes with retinal detachment in order to determine the best surgical procedure in cases with difficult break configurations such as multiple, large, and central holes. METHODS: We treated the eyes either with conventional buckling surgery (n = 60) encircling buckle (EB) plus sponge exoplant (SP) (n = 45) or multiple sponge exoplants (n = 15) or with primary vitrectomy (PV) (n = 40). From the 40 patients in the PV group, 10 underwent vitrectomy plus intraocular gas only, in the other cases an encircling band was used (n = 30). RESULTS: In the EB/SP group the retina was attached directly after surgery in 59/60 cases. During a mean follow-up of 14.5 months redetachment occurred in 4/60 cases. In the PV group the retina was attached in 37/40 cases after resorption of gas and during the mean follow-up of 9.3 months redetachment occurred in an additional 4/40 cases. Complications during surgery in the EB/SP group were retinal incarceration (n = 2) and subretinal hemorrhage (n = 2). In the PV group intraoperative complications included choroidal detachment (n = 1) and iatrogenic holes (15%). Postoperative complications were choroidal detachment in 6/60 vs 0/40, transitory increased intraocular pressure (30% vs 68%). Double vision, however correctable by means of prisms, occurred in 4/60 vs 0/40. CONCLUSIONS: The primary attachment rate is high and similar with both procedures. The spectrum of intra- and postoperative complications is however different between both groups.

Aged↗
PubMed2002

Multiple retinal holes in the macular region: a case report.

PURPOSE: To describe the first case of multiple retinal holes in the macular region successfully treated with vitrectomy. METHOD: A single case report. A 44-year-old man was treated for impaired vision caused by multiple macular holes in the right eye. RESULTS: Fundus examinations detected six retinal holes in the right macula and a giant macular hole in the left eye. Optical coherence tomography disclosed multiple vitreoretinal adhesions in the right macula. We vitrectomized the right eye to produce posterior vitreous detachment and then tamponaded the vitreous cavity with 20% SF(6) gas, resulting in closure of holes and improvement of the vision. CONCLUSION: Multiple macular holes may be treated by surgical posterior detachment combined with gas tamponade. Vitreoretinal adhesions are a possible cause of these holes. Similar multiple holes may have coalesced into one giant hole in this patient's left eye.

Adult↗
PubMed2002

Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery--a follow-up study.

BACKGROUND: Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of the ILM is an obstacle for successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. PATIENTS AND METHODS: Eighteen eyes with macular holes stages 2-4 were included. Intraoperatively, the ILM was stained with three drops of 1:9-diluted ICG. After 1 min incubation, the vitreous cavity was rinsed with Ringer's lactate solution, and the ILM was peeled. Autologous thrombocytes were applied to the macular hole and the eye was endotamponaded with 20% SF-6 gas. Preoperatively, 6 weeks postoperatively, and in 3-month intervals thereafter, visual acuity, fundus photographs, scanning laser ophthalmoscope imaging, and Humphrey 24-2 static perimetry was performed. RESULTS: Intraoperatively, the ILM could be nicely visualized by ICG, which allowed easier and less traumatic peeling. At 6 weeks follow-up, visual acuity had improved in 14 of 18 patients, and the macular hole was closed 6 weeks after surgery. Scanning laser imaging revealed a strong signal. During prolonged follow-up, visual acuity declined due to cataract formation. CONCLUSION: ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We observed no negative effects on retinal function, but patients should be followed.

Cataract↗
PubMed2003

Pars plana vitrectomy with or without silicone oil endotamponade in post-traumatic endophthalmitis.

BACKGROUND: Results of core vitrectomy in post-traumatic endophthalmitis are poor. Our initial results of complete vitrectomy with primary silicone oil endotamponade were promising. A comparative study of this procedure with conventional core vitrectomy was therefore carried out. METHODS: A prospective randomized controlled study of 24 consecutive cases of post-traumatic endophthalmitis was conducted. Patients were randomized into two groups in the absence of clinical improvement after primary tap and treatment with intravitreal vancomycin and amikacin: group 1 consisted of patients who underwent core vitrectomy alone, group 2 of patients who underwent complete vitrectomy with silicone oil endotamponade. All patients included in the study received intravenous antibiotics and underwent lensectomy. Patients were followed up 1, 2, 4 and 12 weeks postoperatively. In all patients of group 2, silicone oil was removed 6 weeks after primary surgery. The mean duration of follow-up was 112+/-55 days. RESULTS: Vision of 20/400 or better was obtained in 58.33% of cases (14/24). Visual acuity of only one patient in group 1 was >or=20/200, compared with that of 58.3% of patients (7/12) in group 2 ( P=0.02). Intra-operative retinal breaks were found in 50% (6/12) of the patients belonging to group 1, but did not affect the final visual outcome. In group 1, 33.33% (4/12) developed rhegmatogenous retinal detachment in the immediate post-operative period. Only one of these patients had useful final visual outcome after resurgery. CONCLUSION: Complete vitrectomy with primary silicone oil endotamponade is a useful treatment modality which improves the anatomical and functional results in post-traumatic endophthalmitis.

Adolescent↗
PubMed2003

Clinical findings in macular hole surgery with indocyanine green-assisted peeling of the internal limiting membrane.

PURPOSE: Indocyanine green (ICG) staining of the internal limiting membrane has facilitated ILM peeling in macular hole surgery. However, it has been reported that ICG-assisted peeling of the ILM may result in retinal damage and unfavorable functional outcome. Therefore, we analyzed our visual and anatomical results of ICG assisted macular hole surgery. METHODS: In a retrospective study the records of a consecutive series of 37 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a standard three-port vitrectomy with surgically induced posterior vitreous detachment, staining of the ILM with ICG, peeling of the ILM in a circular manner around the fovea, and SF6 20% endotamponade. RESULTS: A total of 37 patients (37 eyes) were included in the study. The mean age was 69+/-7 years (range 52-81 years), and there were 26 women and 11 men. The follow-up ranged from 6 to 30 months (mean 18+/-6 months). At baseline visual acuity ranged from 20/400 to 20/40. Anatomically, 13 eyes had stage 2 holes, 21 eyes (57%) stage 3 holes, and three eyes stage 4 holes. At the postoperative visit (8-12 weeks after surgery) anatomical closure of the macular hole was achieved in 36 eyes. Visual acuity ranged between 20/400 and 20/20. At the last follow-up after initial surgery the macular hole was closed in all eyes. Visual acuity ranged from 20/200 to 20/20. CONCLUSION: In our retrospective series anatomical and functional results of macular hole surgery with ICG-assisted peeling of the ILM are satisfactory. Primary hole closure was achieved in 97% of eyes and visual acuity increased in 62% of eyes in our series.

Aged↗
PubMed2003

Sub-retinal hemorrhage during internal limiting membrane peeling for a macular hole.

PURPOSE: To report the occurrence of sub-retinal hemorrhage during peeling of the internal limiting membrane (ILM). CASE REPORTS: In case 1, a three-port pars plana vitrectomy was performed on a 57-year-old woman with a macular hole. Following the staining of the ILM with indocyanine green, the ILM was peeled with forceps, and a sub-retinal and vitreous hemorrhage resulted from a vein during the peeling. The bleeding was stopped by elevating the intraocular pressure. The final visual acuity was 20/30. In case 2, similar procedures were performed on a 68-year-old woman with a macular hole. A sub-retinal hemorrhage occurred while peeling the ILM. The pre-operative visual acuity was 20/300, and final visual acuity was 20/200. CONCLUSIONS: Surgeons should be aware that sub-retinal and vitreous hemorrhage can be a complication of ILM peeling.

Aged↗
PubMed2003

Functional outcome of macular hole surgery with and without indocyanine green-assisted peeling of the internal limiting membrane.

PURPOSE: To describe the impact of indocyanine green (ICG) staining of the internal limiting membrane (ILM) on the functional outcome of anatomically successful macular hole surgery by comparing consecutive patient series with and without ILM staining. METHODS: Eighteen consecutive patients who had undergone ICG-assisted vitrectomy (0.05%) for idiopathic macular hole were retrospectively analysed (visual acuity, gain in lines, Goldmann perimetry) and compared with two consecutive series of patients who had undergone macular hole surgery without the use of ICG immediately before (n=22) and after (n=17) the introduction of ICG in our institution. The osmolarity of the ICG solution applied was 275 mosmol, pH was 7.5. RESULTS: Although there was no statistically significant difference in duration of preoperative symptoms (P>0.3) and preoperative visual acuity (P>0.5), the functional outcome in patients after ICG-assisted vitrectomy was significantly lower (P<0.001 for visual acuity). The incidence of visual field defects was 50% (9/18) in patients after ICG application. CONCLUSION: Our findings suggest potential damage to the neurosensory retina in association with the intraoperative administration of the ICG solution. Whether this is caused by toxic effects of the dye itself, mechanical trauma to the retina or other mechanisms remains unknown.

Aged↗
PubMed2003

Better success of retinal reattachment with long-standing gas tamponade in highly myopic eyes.

BACKGROUND: To evaluate the efficacy of long-term gas tamponade after pars plana vitrectomy (PPV) for retinal detachment (RD) due to a macular hole (MH) in highly myopic eyes. METHODS: A retrospective study was conducted at two institutions. The study included 25 highly myopic eyes with RD resulting from a MH. C3F8 gas tamponade was used in 13 eyes (C3F8 gas group), and SF6 gas tamponade was used in 12 eyes (SF6 gas group) following PPV. C3F8 gas has a longer half-life time in the vitreous cavity than SF6 gas. The main outcome measures were the anatomic reattachment rate and the visual acuity (VA). Follow-up periods were at least 24 months. RESULTS: The anatomic reattachment rate and MH closure following the initial surgery were significantly higher in the C3F8 gas group (100%) than in the SF6 gas group (66.7%; P=0.039). The differences in the postoperative VAs were not significant both for all eyes and only for eyes with initial anatomic success. (P=0.42 and P=0.54, respectively). In addition, no significant difference was found in the improvement of VA both for all eyes and for the initial success eyes (P=0.66 and P=0.56, respectively). CONCLUSION: We conclude that the longer duration of tamponade with C3F8 gas results in a higher rate of successful closure and that C3F8 gas tamponade is an effective treatment for MH with RD in highly myopic eyes.

Aged↗