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At least 505 records · Page 28Linked to original sources
PubMed2000

Quantitative measurements of changes of idiopathic stage 3 macular holes after vitrectomy using confocal scanning laser tomography.

PURPOSE: To perform quantitative three-dimensional analysis of changes of idiopathic full-thickness stage 3 macular holes following vitrectomy and gas tamponade using confocal scanning laser tomography to study the mechanism of repairing the holes and to correlate with visual recovery. METHODS: We studied 44 patients, 10 men and 34 women, aged between 40 and 76 years (mean 65.5 years) with stage 3 macular holes with symptoms of 1-4 months' duration (mean 2.7 months). Using the Heidelberg Retina Tomograph, we measured the macular area within 1 week before surgery (3.5+/-1.6 days), and between 2 and 4 weeks (2.4+/-0.6 weeks) and at least 3 months (3.8+/-00.8 months) after surgery. RESULTS: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. All the eyes showed small flat depressions that corresponded to each macular hole with the area of 0.027-0.184 mm2 (0. 110+/-0.042 mm2). Thirty-nine (89%) of 44 eyes showed large concave depressions that appeared to correspond to the preoperative retinal striae, with areas of 0.844 to 5.563 mm2 (3.688+/-1.263 mm2). The areas of the postoperative small depressions and large depressions were significantly correlated with the area, volume, and depth of the macular holes and the area of the cuff and retinal striae prior to treatment. Postoperative visual acuity showed significant correlations with the areas of the postoperative small depressions and large depressions. CONCLUSIONS: Confocal scanning laser tomography is potentially useful as a noninvasive diagnostic technique for quantitative measurements of changes of macular holes by vitrectomy and gas tamponade. Postoperative small depressions corresponding to the healed macular holes appeared to be caused by gliosis involving sealing of the holes. The large depressions and their concave shape may result from postoperative changes of the retina, including swelling of ganglion cells and loss of outer and inner segments of photoreceptor cells in regions of preoperative cuff and retinal striae.

Adult↗
PubMed2001

Exudative retinal detachment in macular hole surgery using platelet concentrates--a case report.

INTRODUCTION: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. CASE REPORT: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. CONCLUSION: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.

Aged↗
PubMed2001

Stereo acuity in patients with unilateral macular hole and after unilateral macular hole surgery.

PURPOSE: To investigate stereo acuity levels in patients with unilateral idiopathic macular hole and after surgical intervention. METHODS: In 31 consecutive patients with a unilateral macular hole and 46 consecutive patients who underwent successful unilateral macular hole surgery, complete ocular examinations, including orthoptic examinations and microperimetry using the scanning laser ophthalmoscope, were performed. RESULTS: A significantly positive correlation was found between VA and stereo acuity (r = 0.87, P < 0.01). After successful surgery, stereo acuity also correlated with the presence or absence of absolute and/or relative scotoma, and was best in eyes without scotomata. Patients with unilateral idiopathic macular hole, suppression, and symptom duration of 24 months or longer had no stereoscopic vision. CONCLUSIONS: The results indicated that in patients with unilateral idiopathic macular hole and after surgery, stereo acuity correlated with VA. Patients with unilateral macular hole should be operated upon as early as possible, resulting in better VA and better stereo acuity.

Aged↗
PubMed2001

Retinal pigment epithelial tear with vitreomacular attachment: a novel pathogenic feature.

BACKGROUND: The development of tears of the retinal pigment epithelium (RPE) has classically been described with or without choroidal neovascularization (CNV) or after laser treatment. Tangential shear forces within the RPE or CNV are usually considered to cause the dehiscence. METHODS: Three patients with CNV and spontaneous RPE tear and additional vitreomacular traction were examined by fluorescein angiography (FA), optical coherence tomography (OCT) and kinetic ultrasound. RESULTS: From the pre-tear to the tear stage a sudden decrease in vision was observed. Fluorescein angiographic images demonstrated RPE-tear formation with blocked filling in the area of the contracted RPE and a well-demarcated hyperfluorescence in the bed of the torn RPE. OCT-scans demonstrated vitreomacular traction at the foveal area in all three cases. Kinetic ultrasound revealed vitreous attachments at the optic disc and fovea. CONCLUSION: Magnitude, variation of mechanical forces, and the continuous shear stress of the aged vitreous gel transmitted across vitreoretinal attachments may cause a chronic stimulus to retina and RPE. Vitreomacular traction may contribute to the subsequent formation of RPE tears via mechanical or cell mediator pathways.

Aged↗
PubMed2001

Persistent indocyanine green (ICG) fluorescence 6 weeks after intraocular ICG administration for macular hole surgery.

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 epiretinal membranes and the ILM is an obstacle to successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. METHODS: In a case of stage IV macular hole, epiretinal membranes and ILM were intraoperatively 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 membranes were peeled. Autologous thrombocytes were applied to the macular hole, and the eye was endotamponaded with 20% SF6 gas. Six weeks postoperatively, visual acuity was measured and fundus photographs and autofluorescence images, as well as a multifocal ERG, were obtained. RESULTS: Intraoperatively, the ILM could be nicely visualized by ICG, which allowed immediate peeling. Six weeks after surgery, the visual acuity had improved from 0.1 to 0.7 and the macular hole was closed. Autofluorescence imaging at 795 nm revealed a strong signal. Multifocal ERG recording showed regular amplitudes. CONCLUSION: ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We did not observe any negative effect on retinal function; however, we were surprised to identify traces of ICG in retinal fluorescein angiography images 6 weeks postoperatively.

Basement Membrane↗
PubMed2001

Thinning and small holes at an impending tear of a retinal pigment epithelial detachment.

BACKGROUND: A tear of a retinal pigment epithelial detachment (PED) suddenly exposes a large area of bare Bruch's membrane. We report here the case of a patient whom we observed during the gradual, spontaneous development of a PED tear. METHOD: A 5.25-year case study of a 67-year-old woman with bilateral serous PEDs. RESULTS: Retinal pigment epithelial (RPE) thinning or small holes were seen along the PED margin in both eyes. Fluorescein angiograms showed intense hyperfluorescence without leakage, and indocyanine green angiography showed choroidal vessels through regions of RPE thinning or small holes. Optical coherence tomographs showed an interruption of a hyperreflective band corresponding to retinal pigment epithelium. A typical tear of the PED ensued later. CONCLUSION: Multiple, small regions of RPE thinning or holes along the margin of PED can be a sign of an impending PED tear.

Aged↗
PubMed2001

Internal limiting membrane ablation in pig eyes with the Er:YAG laser under perfluorodecalin.

PURPOSE: The aim of our study was to evaluate the in vivo feasibility of non-contact Er:YAG laser ablation of the internal limiting membrane (ILM), which is recommended for the treatment of macular holes. METHOD: Vitrectomy was performed in 16 eyes of 15 pigs. After perfluorodecalin filling, it was attempted to remove the ILM using a free-running fiber-guided Er:YAG laser (lambda=2.94 microm, pulse length 250 micros, repetition rate 1.7 Hz, radiant exposure 0.6-2.05 J/cm2). The eyes were enucleated either immediately (11 eyes, group 1) or 2 weeks after laser therapy (5 eyes, group 2). Furthermore, in one additional pig eye the retina was carefully treated with microforceps after vitrectomy to assess the damage produced by conventional techniques of ILM peeling. All eyes were examined histologically. RESULTS: Group 1: Nine eyes could be examined (problems with fixation in two eyes). In four of nine eyes, the ILM was either removed or detached, in one eye there was a superficial retinal hemorrhage, and in four eyes the ILM was still intact. In the latter cases, there was no intraoperative whitening or bleeding and no posterior vitreous detachment was present histologically. Group 2: Four eyes (problems with fixation in one eye) could be examined. The ILM was either removed or detached in three eyes. In one eye there was a superficial retinal hemorrhage. In one eye the ILM was not removed and there had neither been intraoperative whitening or hemorrhage nor histologically visible posterior vitreous detachment. In both groups, the nerve fiber layer in treated areas was thicker than in adjacent untreated retina. In one eye the retina was gently manipulated with microforceps in an attempt to perform ILM peeling. This led to damage to all layers of the retina. CONCLUSIONS: Removal of the ILM by Er:YAG laser is possible in vivo. However, the variability of the laser effects calls for further improvement such as a reliable indicator of ablation depth. In any case, any damage to the retina was lesser than that produced by microforceps.

Animals↗
PubMedDate not supplied

Prefoveolar membrane in macular hole opercula formation.

PURPOSE: To better understand the process of macular hole opercula formation by both optical coherence tomography and intraoperative observations. METHODS: Seventy-nine eyes of 71 consecutive patients with stages 1 to 3 idiopathic macular holes were studied using optical coherence tomography (OCT). In eyes with stage 1 or 2 holes undergoing vitrectomy, meticulous observation of the posterior hyaloid and the macular hole was carried out before and after peeling of the posterior hyaloid. RESULTS: In 6 of 12 eyes with stage 1 holes, OCT showed tiny steps on the anterior wall of the foveal cyst, connecting to the detached posterior hyaloid face. In eyes with stage 2 holes, opercula were incompletely detached and connected to the hole edge. In eyes with stage 1 holes that were operated on, a small semitransparent opacity was noted at the posterior hyaloid face after peeling of the posterior hyaloid in the absence of defects of the anterior wall of the cyst. In 10 of 12 eyes with stage 2 holes undergoing vitrectomy, the size of the foveal opening remained unchanged after peeling of the posterior hyaloid, and a semitransparent opacity was observed at the detached hyaloid face. All opercula in stage 3 holes that were clearly imaged by OCT were positioned above the plane of the posterior hyaloid face. CONCLUSIONS: These findings suggest that the anterior wall of an evolving macular hole is composed of two layers: a prefoveolar membrane and the inner retinal layer. The prefoveolar membrane may play an important role in both persistent vitreofoveal adhesion and macular hole opercula formation.

Adult↗
PubMedDate not supplied

Vitreous fluid levels of beta-amyloid((1-42)) and tau in patients with retinal diseases.

PURPOSE: A decrease in beta-amyloid(1-42) (Abeta42) and an increase in tau in the cerebrospinal fluid are reported to be characteristic phenomena in Alzheimer's disease patients. To test the idea that Abeta42 and tau contribute to the development of retinal diseases, we measured Abeta42 and tau concentrations in the vitreous fluid from patients with macular hole (n = 13), diabetic retinopathy (n = 15), or glaucoma concurrent with other ocular diseases (n = 8). METHODS: Vitreous samples were collected from patients who underwent vitrectomy, and sensitive and specific enzyme-linked immunosorbent assays were used to determine the concentrations of Abeta42 and tau. RESULTS: By comparison with the levels in the control macular-hole patients (33.9 +/- 7.1 pg/ml for Abeta42; 3.3 +/- 3.2 pg/ml for tau), there was a significant decrease in the Abeta42 level and a significant increase in the tau level in patients with diabetic retinopathy (1.8 +/- 1.9 pg/ml for Abeta42, P = 0.002; 153.7 +/- 71.6 pg/ml for tau, P = 0.041) or glaucoma concurrent with other ocular diseases (2.8 +/- 1.8 pg/ml for Abeta42, P = 0.006; 113.6 +/- 43.1 pg/ml for tau, P = 0.023). CONCLUSIONS: Our findings indicate the possibility of a role for Abeta42 and tau in the pathogenesis of some retinal diseases.

Aged↗
PubMedDate not supplied

A nontraumatic macular hole in a 10-year-old girl.

BACKGROUND: Full-thickness macular holes usually develop in the elderly population. To the best of our knowledge, there has been no written report of a nontraumatic macular hole in a pediatric patient. CASE: A 10-year-old girl noticed decreased central vision in her left eye without any history of trauma. OBSERVATIONS: Fundus examination of the left eye revealed a full-thickness macular hole and a thin fibrous membrane on the superior peripapillary retina. She underwent standard macular hole surgery with stripping of the membrane, resulting in closure of the hole. CONCLUSIONS: A full-thickness macular hole may develop in pediatric patients. Although the etiology of the macular hole in the present patient is unclear, tangential traction induced by contraction of the peripapillary membrane, presumed to be an incomplete regression of the Bergmeister papilla, might have been responsible for the formation of the macular hole.

Child↗
PubMedDate not supplied

Relation of posterior staphyloma in highly myopic eyes with macular hole and retinal detachment.

PURPOSE: To investigate whether the type of posterior staphyloma (PS) affects the development of macular hole and retinal detachment (MHRD) in high myopia. METHODS: Included in this retrospective study were 28 highly myopic eyes with MHRD (MHRD group) and 47 highly myopic eyes without MHRD (control group). The presence or absence of PS and the type of PS according to the classification of Curtin, the postoperative visual acuity, and the retinal reattachment rate were investigated. RESULTS: The percentage of eyes with PS was significantly higher in the MHRD group than in the control group (P < 0.001). The rate of type II PS was significantly higher in the MHRD group (P = 0.01). There were no significant differences among the types of PS regarding the retinal reattachment rates and visual outcome. CONCLUSIONS: Eyes with type II PS have a higher risk for the development of MHRD. However, the type of PS did not seem to affect the anatomic and visual outcome.

Adult↗
PubMedDate not supplied

Long-term retention of dye after indocyanine green-assisted internal limiting membrane peeling.

PURPOSE: To evaluate dye retention in the fundus after indocyanine green (ICG)-assisted internal limiting membrane peeling. METHODS: Ten eyes with stage 3 or 4 nondiabetic idiopathic macular hole (MH group) and six eyes with diffuse diabetic macular edema (DM group) were studied. The fundus was examined with 780-nm infrared illumination by a scanning laser ophthalmoscope (SLO) after ICG-assisted internal limiting membrane peeling. The postoperative follow-up period ranged from 6 to 12 months (mean+/-SD, 3.7+/-2.6 months). RESULTS: Fluorescence from ICG was detected in all studied eyes in both groups up to 6 months after surgery. At 9 months after surgery, ICG fluorescence was visible in all eyes of the DM group, but in only one-third of eyes of the MH group. No fluorescence was detected in fellow eyes that had not been operated on. CONCLUSION: The present study using SLO revealed that ICG remains in the fundus for over 6 months after surgery. The results also suggested that a longer time might be required for dye clearance from the diabetic retina than from the nondiabetic retina.

Aged↗
PubMedDate not supplied

Assessing responses of the macula in patients with macular holes using a new system measuring localized visual acuity and the mfERG.

PURPOSE: To evaluate acuity and multifocal electroretinogram (mfERG) responses from the macula in affected and unaffected fellow eyes of patients with macular holes. METHODS: We tested 10 eyes with macular hole and 10 fellow eyes from 11 patients. We measured local visual acuity thresholds at 27 discrete locations within 21 degrees diameter using the Functional Fundus Imaging System (FFIS), a psychophysical system that measures visual acuity as a function of visual field location, and local ERG responses within 45 degrees diameter using the mfERG. RESULTS: In the affected eyes, the mean FFIS visual acuity thresholds were significantly elevated within the central 21 degrees diameter area, compared to a group of control eyes. No significant differences were found between the acuities of the fellow eyes compared to those of the control group. The amplitudes of the first positive peak of the mfERG were reduced in the central 7.8 degrees in affected eyes. In the central 2 degrees , 4 out of 10 affected eyes showed non-measurable ERG signals. The remaining six eyes showed significantly reduced mean amplitudes, but not delayed implicit times, when compared to the control group. For the fellow eyes, the mean amplitudes of the mfERG and implicit times did not differ from the means of the control eyes. CONCLUSIONS: Both local psychophysical and electrophysiological testing demonstrated retinal dysfunction extending beyond the site of the macular holes in some patients (three of the patients had central mfERG amplitudes falling within the normal range).

Aged↗
PubMed2005

Foveolar choroidal blood flow in idiopathic macular hole.

PURPOSE: To measure choroidal blood flow from foveal region in the eyes with idiopathic macular hole. METHODS: Thirteen patients with macular hole and 20 age-matched healthy subjects were included into the study. While group 1 consisted of 13 eyes of idiopathic stage 4 macular hole, seven fellow eyes of the same patients with stage 1a macular hole formed the group 2. The control group (group 3) comprised the randomly selected eye of 20 age-matched healthy subjects. Mean values of blood perfusion parameters that were composed of volume, flow and velocity, were recorded from foveal region of fundus using Heidelberg Retinal Flowmeter (HRF). The differences between the three groups were compared with unpaired t-test, Wilcoxon Signed Rank and Fisher's Exact test using statistical package program. RESULTS: The mean blood volume and velocity in the eyes with stage 4 macular hole (group 1) and in the eyes with stage 1a macular hole (group 2) were both significantly lower than the eyes in control eyes (group 3) (p < 0.05, unpaired t-test). Although, the mean blood "flow" parameter of group 2 was significantly lower than group 3 ( p < 0.05, unpaired t-test), there was no statistical difference in the "flow" parameter between group 1 and group 3 (p > 0.05, unpaired t-test). The comparison between group 1 and group 2 revealed no significant difference in any perfusion parameter (p > 0.05, Wilcoxon Signed Rank Test). CONCLUSION: Although, it may be result of macular hole, not necessarily the cause of it, these findings suggest that the eyes with idiopathic macular hole are associated with reduced foveolar blood flow. The measurement of the foveolar blood flow from choriocapillaris may be useful for identifying the subjects who have increased risk of development of macular hole in future. The study showed the association of a decrease in foveolar choroidal blood flow in eyes with idiopathic macular hole using HRF. Authors suggested that quantitative measurement of foveolar choroidal blood flow may be helpful for identifying the subjects who have increased risk of development of idiopathic macular hole.

Aged↗
PubMed2006

Tamoxifen therapy conveys increased risk of developing a macular hole.

PURPOSE: To determine etiological factors in the development of, as well as anatomic success rate and visual outcome of a large consecutive series of macular hole surgeries. METHODS: Retrospective analysis of 300 consecutive cases of macular hole surgery by a single surgeon (RDB) between 1999 and 2003. Patients' medical and surgical histories were recorded and analysed for factors involved in aetiology and visual outcome. RESULTS: There were 8 (4.12%) women, on tamoxifen in the study, two of these women had bilateral macular holes. When this study prevalence of tamoxifen therapy (4.12%) was compared to the estimated percentage of women in the same age group in the Australian population on tamoxifen (0.82%), a statistically significant difference (p value 0.0001) was found. Analysis of the number of bilateral holes in the tamoxifen group compared to the non-tamoxifen group was suggestive of an increased incidence of bilateral holes but not to a significantly significant degree. CONCLUSION: Whilst no published reports link tamoxifen and macular holes, this may be due to the low incidence of the condition. Our study demonstrates a strong link between tamoxifen use and macular holes. Patients being commenced on tamoxifen should be advised of possible ocular complications and receive prompt ophthalmic review if symptoms develop.

Adult↗