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At least 577 records · Page 32Linked to original sources
PubMed2004

Internal limiting membrane peeling using triamcinolone acetonide: histopathologic confirmation.

PURPOSE: To report histopathologic confirmation of the internal limiting membrane (ILM) using triamcinolone acetonide (TA). DESIGN: Interventional case report. METHODS: One eye of one patient who underwent macular hole repair using TA suspension to help visualize the internal limiting membrane (ILM). The specimen was sent to pathology. RESULTS: Triamcinolone acetonide greatly improved the visualization of the ILM; the peeled area was seen as an area lacking white specks. The macular hole closed with an improvement in vision. No adverse effects were observed during the follow-up period. The specimen was identified as ILM by histopathologic examination. CONCLUSION: Peeling of the ILM is facilitated by the use of TA. Microscopic confirmation of ILM was made.

Basement Membrane↗
PubMed2004

Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes.

PURPOSE: To evaluate whether an index based on hole configuration can be used to predict visual outcome in eyes with idiopathic macular holes. DESIGN: Prospective interventional case series. METHODS: Thirty-five eyes of 32 patients with idiopathic stage 2 or 3 macular hole were enrolled in this study. The best-corrected visual acuity (BCVA), cross-sectional image of the macular hole by optical coherence tomography (OCT), and retinal thickness in the central (<1000 microm), inner (1000 to 2220 microm), and outer ring areas (2220 to 3450 microm) as defined by the OCT retinal mapping program were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. The change in retinal thickness of the inner ring area at the 6-month postoperative period was used to evaluate the degree of preoperative retinal deformation. The macular hole index (MHI) (ratio of hole height to base diameter of hole) was calculated and correlated with minimum diameter of hole, base diameter of hole, the postoperative decrease in macular thickness, and the postoperative BCVA. The postoperative BCVA was further evaluated in two patient-matched groups. RESULTS: Retinal thickness values in the inner ring area were decreased at the 1-month postoperative period. MHI significantly correlated with the postoperative decrease in macular thickness in the inner ring area at 6 months (correlation coefficient = -0.632, P = .030, Spearman analysis) and with the postoperative BCVA (P = .013, multiple regression analysis). Postoperative BCVA in the MHI >/=0.5 group was better than that in the MHI <0.5 group (P = .032, Mann-Whitney test). CONCLUSIONS: The MHI is a ratio easily calculated from OCT transverse images of the macular area. The MHI represents the preoperative configuration of a macular hole and is a prognostic factor for visual outcome.

Aged↗
PubMed2004

Familial idiopathic macular hole.

PURPOSE: To report macular hole formation among siblings within four families. DESIGN: Observational case series. METHODS: Four families were identified who had macular holes among siblings from within three multiphysician tertiary-care referral retina practices. RESULTS: In the first family, two sisters in their seventh decade developed Stage 2 macular holes requiring surgical intervention; two male siblings were unaffected. In a second family, three of four siblings were affected, including one brother with a Stage 4 macular hole, one sister with a Stage 3 macular hole, and a third sister with a lamellar macular hole. In a third family, two siblings (one man, one woman) developed macular holes within 1 year of each other. Three years later, the male sibling developed a macular hole in the fellow eye. In the last family, twin sisters developed macular holes (unilateral in one sister, bilateral in the other), and their deceased father may also have had bilateral macular holes. CONCLUSIONS: The occurrence of macular holes in these four sets of siblings suggests a possible genetic component in the formation of macular holes in these individuals.

Aged↗
PubMed2004

Indocyanine green-assisted ILM peeling in macular hole surgery revisited.

PURPOSE: To report visual outcomes after peeling of the internal limiting membrane (ILM) using a brief application of low dose indocyanine green (ICG) for macular hole repair. DESIGN: Prospective, nonrandomized interventional case series. METHODS: A consecutive series of 16 eyes of 14 patients with full-thickness macular hole underwent vitrectomy and peeling of the ILM with an intravitreal application of 0.05% ICG for less than 10 seconds. RESULTS: The ILM could be removed uneventfully in 5 of 16 cases after a single ICG application and in 11 cases after a second ICG application. The macular hole was closed in 15 (93.7%) of 16 cases after a single surgery and in one case after a repeat surgery, as evaluated by optical coherence tomography. A significant visual acuity improvement was achieved as the mean logarithm of the minimum angle of resolution was from 0.600 preoperatively (equivalent to approximately 5/20 in the conventional 20 foot numerator form) to 0.213 (12/20) at the end of follow-up (P < .0001). None of the cases developed peripheral visual field defect. Ophthalmoscopies or optic coherence tomographic images did not reveal any disruption at the level of the retinal pigment epithelium. CONCLUSIONS: A brief intravitreal application of low dose ICG may provide a safe ILM peeling in vitreomacular surgeries.

Aged↗
PubMed2004

Posterior vitreous detachment and macular hole formation in myopic foveoschisis.

PURPOSE: To report two cases of macular hole (MH) associated with myopic foveoschisis (MF). DESIGN: Interventional case report. METHODS: Two women presented with metamorphopsia. Preoperative optical coherence tomography (OCT) showed an MH and MF. We performed vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. RESULTS: Preoperative OCT examination and intraoperative microscopic observation revealed partial posterior vitreous detachment (PVD) at the posterior retina and vitreous strands adhering to the edge of the MHs. The MF resolved in both patients, but the MHs remained open postoperatively. CONCLUSIONS: Although the contribution of tangential traction cannot be excluded, the mechanism of MH formation in eyes with MF may be anteroposterior traction via abnormal vitreofoveal adhesion resulting from partial PVD.

Aged↗
PubMed2004

Multiple components of epiretinal tissues detected by triamcinolone and indocyanine green in macular hole and retinal detachment as a result of high myopia.

PURPOSE: To examine three layers of membranes detected by triamcinolone acetonide (TA) and indocyanine green (ICG) during surgery for macular hole and retinal detachment (MHRD) as a result of high myopia. DESIGN: Histologic study. METHODS: We excised three layers of membranes visualized with TA and ICG that were tightly adhering to the retinal surface during vitrectomy and examined them by transmission electron microscopy. RESULTS: The first membrane was made of acellular collagen fibers, suggestive of vitreous, and the second was comprised of parts of fibroblast-like cells and collagen fibrils, suggesting a proliferative epiretinal membrane. The third membrane was an internal limiting membrane. CONCLUSIONS: Multiple components of epiretinal tissue could be delaminated with the assistance of TA and ICG during surgery for myopic MHRD.

Aged↗
PubMed2005

Persistent outer retinal defect after successful macular hole repair.

PURPOSE: To report two cases of a persistent outer retinal defect evident by optical coherence tomography (OCT) after clinically successful macular hole surgery. DESIGN: Retrospective case series. METHODS: A retrospective case series of two patients who had a persistent outer retinal defect by OCT and excellent visual acuity after clinically successful macular hole surgery. RESULTS: Two patients with stage 2 macular holes and preoperative visual acuity of 20/70 and 20/60, respectively, underwent macular hole surgery. Although the macular holes were closed on clinical evaluation, a persistent outer retinal defect was identified by OCT in both patients. At 5 to 6 months postoperatively, the outer retinal defect became less prominent and the visual acuity remained at 20/20 in both patients. CONCLUSIONS: An outer retinal defect by OCT may occur in the early postoperative period after macular hole surgery. Despite this defect, good visual acuity is possible.

Basement Membrane↗
PubMed2004

Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomography.

PURPOSE: To assess the usefulness of optical coherence tomography (OCT) for better differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH). DESIGN: Observational case series. METHODS: setting: Institutional practice. patients: We reviewed the files of 71 eyes of 70 consecutive patients who were diagnosed as having a pseudohole or lamellar hole on OCT examination. All patients referred for suspected pseudohole or lamellar hole on biomicroscopy were evaluated by OCT. main outcome measures: Each eye underwent six radial 3-mm OCT scans centered on the macula, one 6-mm vertical and one 6-mm horizontal scan. Retinal thickness was measured at the foveal center and 750 microm from the center, vertically, and horizontally. The diameter of the macular contour was also measured on vertical and horizontal scans. RESULTS: In 40 cases, OCT showed a macular profile characteristic of MPH: a steepened foveal pit combined with thickened foveal edges and a small foveal pit diameter. Central foveal thickness was normal or slightly increased (167 +/- 42 microm). Mean perifoveal thickness was greater than normal (363 +/- 65 microm). In 29 other cases corresponding to LMH, OCT showed a profile characterized by a thin irregular foveal floor, split foveal edges, and near-normal perifoveal retinal thickness. Central foveolar thickness was thinner than normal (72 +/- 19 microm). Mean perifoveal thickness was near normal (283 +/- 36). Optical coherence tomography did not allow the classification of the remaining two cases. CONCLUSIONS: Optical coherence tomography is very useful in distinguishing MPH attributable to epiretinal membrane contraction from LMH because of partial opening of a macular cyst.

Adolescent↗
PubMed2005

Ultrastructure of internal limiting membrane in myopic foveoschisis.

PURPOSE: To reveal the pathogenesis of myopic foveoschisis (MF). DESIGN: Clinicopathological report. METHODS: Internal limiting membranes (ILMs) were collected from ten patients with MF and five patients with idiopathic macular hole (IMH) as a control. Samples were subjected to transmission electron microscopic study. Characteristics of the ILM were compared between the two groups. RESULTS: Collagen fiber and cell debris were identified on the inner surface of ILM in seven eyes (70%) with MF, significantly more (P < .05) than found in IMH subjects (0%). More fibrous glial cells were likely to be found on the inner surface of ILM. No significant difference in fibroblast-like cell adhesion was observed. CONCLUSIONS: Collagen fiber and cellular component are suggested to play an important role in developing MF. ILM peeling may be essential for vitrectomy for MF.

Aged↗
PubMed2005

Morphologic analysis of stage 3 and stage 4 macular holes: implications for treatment.

PURPOSE: To determine whether the observed anatomy of macular holes can be explained by a hydrodynamic model in which fluid flow through the hole is balanced by fluid pumping across the retinal pigment epithelium. We use this model to draw conclusions about the possible role of vitreomacular traction in determining the anatomy of macular holes and their resolution after vitreous surgery. DESIGN: Cross sectional. METHODS: Retrospective study in a clinical practice. The study included 42 eyes of 42 patients with a stage 3 or 4 macular hole (Gass classification). We measured the radius of the macular hole and the radius of the surrounding cuff of subretinal fluid from color or red-free fundus photographs and determined the relationship between these two variables. RESULTS: The mean age of the patients was 68.0 +/- 7 years (range, 51 to 80). Twenty-five patients had stage 3 macular holes and 17 patients had stage 4 macular holes. The neurosensory detachment radius was related to the square of the macular hole radius for stage 3 and stage 4 holes, with no significant difference between the stage 3 and stage 4 linear trend lines (P = .999). There was no correlation between patient age and the area of the macular hole (r = 0.0645) or neurosensory detachment plus hole (r = 0.156) over the range of age in this study. However, the area of the doughnut-shaped cuff of subretinal fluid increased with increasing patient age (P = .0493), thus suggesting an age-dependent decline in the pumping ability of the retinal pigment epithelium. CONCLUSIONS: Our data are consistent with a hydrodynamic model in which macular hole anatomy is determined by a balance between fluid flow through the hole and fluid outflow across the retinal pigment epithelium. Because stage 3 and stage 4 macular holes exhibit a similar relationship between the size of the macular hole and the size of the cuff of subretinal fluid around the hole, simple relief of vitreomacular traction would not lead to resolution of the subretinal fluid cuff unless it is accompanied by a reduction in hole diameter due to approximation of wound edges.

Aged↗
PubMed2005

Macular hole secondary to epiretinal membrane in a juvenile patient.

PURPOSE: To report a macular hole secondary to an idiopathic epiretinal membrane in a 14-year-old girl. DESIGN: Interventional case report. METHODS: A 3-year-old girl who failed a public visual-screening test was examined. Since then, she had been followed-up for her epiretinal membrane, which began to peel spontaneously in the left eye for 11 years until a macular hole was observed. She was treated by vitrectomy and membranectomy, and the membrane was histologically examined. RESULT: The macular hole was successfully closed, and her visual acuity improved. The membrane appeared to have a homogenous structure and contained no cells. CONCLUSIONS: The juvenile idiopathic epiretinal membrane sometimes peels spontaneously. However, long-term follow-up is needed because vitreous traction of the membrane by intraocular aging change may result in a macular hole.

Child, Preschool↗
PubMed2004

Visual function and subjective perception of visual ability after macular hole surgery.

PURPOSE: To evaluate the functional and anatomical results of macular hole surgery and to explore its effect on patients' Health-Related Quality Of Life (HR-QOL) and to investigate the associations between self-reported HR-QOL and conventional measures of visual function. DESIGN: Case series. METHODS: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 36-Item Short-Form Health Survey (SF-36) were self-administered by 30 patients before and 4 months after macular hole surgery. Preoperative, intraoperative, and postoperative clinical data were collected including visual acuity, contrast sensitivity, and metamorphopsia. Multi-item scales rating different aspects of HR-QOL were compared before and after surgery, and their correlation with traditional methods of outcome evaluation was analyzed. RESULTS: Macular hole closure was achieved in 26 patients (87%). Mean LogMAR visual acuity improved by 6 +/- 10 letters for distance and 7 +/- 12 letters for near. Metamorphopsia was reduced by a mean of 35 +/- 70 squares on Amsler chart, and Pelli-Robson contrast sensitivity decreased by a mean of -0.09 +/- 0.3 log units postoperatively. The VFQ-25 composite score as well as scale scores associated with general vision, near vision, vision-related mental health, and role difficulties were significantly improved (P < .05) after successful closure of macular hole. Conversely out of the eight SF-36 health concepts, limitation in usual role activities because of emotional problems was the only one that significantly improved postoperatively. Both baseline and postoperative best-corrected visual acuity significantly correlated with most of the VFQ subscale scores before and after surgery, respectively. CONCLUSIONS: In this case-series, macular hole surgery appears to have a beneficial effect on patients' subjective perception of visual function. The use of vision-targeted health status questionnaires in conjunction with detailed clinical examination provides a more comprehensive overview of individuals' daily well-being after surgical intervention. Further controlled studies are required to confirm our findings.

Aged↗
PubMed2005

Idiopathic macular hole with extensive subretinal fluid: clinical and optical coherence tomography features before and after surgery.

PURPOSE: To report clinical and optical coherence tomography (OCT) features in patients with idiopathic macular hole and extensive subretinal fluid (extending at least 1 disk diameter from the center of the hole). DESIGN: Retrospective, consecutive, noncomparative case series. METHODS: The case records of two patients with idiopathic macular holes with extensive subretinal fluid were reviewed. RESULTS: Both patients presented with reduced visual acuity (20/200 and 20/400). OCT demonstrated attachment of the posterior hyaloid to the inner retina, a full-thickness macular hole, cystoid macular edema (CME), and extensive subretinal fluid. After surgery, both patients achieved macular hole closure and improvement in visual acuity (20/60 and 20/30). Postoperatively, OCT showed a normal foveal contour, complete hole closure, and resolution of the CME and subretinal fluid. CONCLUSIONS: In patients with macular hole and extensive subretinal fluid, improved visual acuity and hole closure can be achieved. Preoperative OCT in these patients demonstrates vitreoretinal interface abnormalities, CME, and extensive subretinal fluid. These changes resolve postoperatively.

Aged↗