Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes

Background. 25G or 27G three-port vitrectomy, followed by staining and removal of the internal limiting membrane with vitreous cavity air or gas tamponade, is one of the main modern vitreoretinal surgery principles for primary macular holes. However, not all patients manage to obtain a functional outcome when the anatomical outcome is achieved. Purpose. To present clinical cases of surgical treatment of idiopathic macular holes (IMH) exhibiting a differentiated approach.Matherials and methods. This article analyzes clinical cases of four patients with primary idiopathic macular holes, differing in terms of development, hole diameter and the presence of comorbidities. Results. The results of surgical treatment were evaluated 14 days and 1 month after surgery. In all clinical cases, surgical treatment resulted in a positive anatomical outcome by blocking a retinal defect. Best corrected visual acuity increased, on average, from 0.08 ± 0.05 to 0.4 ± 0.05.Conclusion. The analysis of the presented clinical cases clearly demonstrates the need for a timely and differentiated approach to the treatment of patients with IMH, that considers etiology of the pathological process, period of its existence as well as concomitant and general somatic pathologies.

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COMPARATIVE RESULTS OF SURGICAL TREATMENT OF LARGE IDIOPATHIC MACULAR HOLES

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/23715 ◽

2016 ◽

Vol 1 (6) ◽

pp. 19-23

Author(s):

Шпак ◽

Aleksandr Shpak ◽

Шкворченко ◽

Dmitriy Shkvorchenko ◽

Шилов ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Limiting Membrane ◽

New Technique ◽

Minimum Diameter ◽

Mean Values ◽

Vacuum Aspiration ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Comparative Results

The goal is to evaluate the effectiveness of the developed technique of the gradual forming of the internal limiting membrane (IML) fragment in the treatment of large macular holes (MH) in comparison with the standard methodol-ogy (using classical maculorhexis and rapprochement of MH edges by using of vacuum aspiration). Materials and methods: we observed 137patients (103women, 34men) aged from 54 to 78years with large MH (over 400μm). Duration of MH ranged from 3 to 60months. All the patients were divided into groups: 1 (new methodology) and 2 (standard method), and sub-groups: 1a and 2a – patients with MH with a minimum diameter 400–650μm; 1b and 2b – patients with MH with a minimum diameter more than 650μm. The new technique is performed in several stages, during which several series of ILM “petals” removal are made, leaving an intact area on the MH edge. The last ILM “petal” or fragment is inverted and placed on the MH. Results: In subgroup 1a, there was a statistically significant increase in best corrected visual acuity (BCVA) during all follow-up with the most pronounced growth in the first 6 months (from 0.15±0.06 to 0.55±0.14) (p<0.05). In subgroup 1b a statistically significant increase in mean values of BCVA was also observed especially during first 6month (from 0.13±0.06 to 0.36±0.12) (p<0.05). In group2 (a, b) BCVA was significantly lower (p<0.05). Conclusion: the new technique allows to reach higher functional-anatomical results in surgical treatment of MH.

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Platelet-rich plasma in surgery of various diameters idiopathic macular holes

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2021-1-51-53 ◽

2021 ◽

pp. 51-53

Author(s):

R.Z. Shamratov ◽

◽

L.S. Ramazanova ◽

O.A. Napylova ◽

◽

...

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Macular Hole ◽

Platelet Rich Plasma ◽

Internal Limiting Membrane ◽

Treatment Method ◽

Macular Holes ◽

Key Words Macular Hole ◽

Promising Treatment ◽

Idiopathic Macular Holes

The tactics of surgical treatment of the macular hole can be different and depends on the stage and diameter of the disease. Purpose. To study the results of surgical treatment of idiopathic macular detachments of various diameters with the use of autoplasma enriched with platelets. Material and methods. We observed 15 patients (15 eyes). Internal limiting membrane was peeled after vitrectomy. Platelet-rich autoplasmа was injected intravitreally. The observation period was 1 month. Results. As a result of surgical treatment, we were able to close the opening in all cases, restore the anatomy of the fovea and improve visual acuity in all patients. Conclusion. According to the assessment of the results obtained in the ongoing study, the use of this technology is an effective and promising treatment method based on the stimulation of the tissues' own regenerative potential. Key words: macular hole, surgical treatment, vitrectomy, platelet-rich plasma, visual acuity.

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The use of internal limiting membrane maculorrhexis in treatment of idiopathic macular holes

Korean Journal of Ophthalmology ◽

10.3341/kjo.1998.12.2.92 ◽

1998 ◽

Vol 12 (2) ◽

pp. 92 ◽

Cited By ~ 20

Author(s):

D W Park ◽

J H Lee ◽

W K Min

Keyword(s):

Internal Limiting Membrane ◽

Macular Holes ◽

Idiopathic Macular Holes

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Method of surgical treatment of small and medium diameter macular holes with the foveal-sparing internal limiting membrane peeling

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-213-216 ◽

2021 ◽

pp. 213-216

Author(s):

A.A. Shpak ◽

◽

A.I. Kolesnik ◽

F.A. Avakyan ◽

V.A. Pismenskaya ◽

...

Keyword(s):

Surgical Treatment ◽

Functional Results ◽

Internal Limiting Membrane ◽

Developed Countries ◽

Clear Understanding ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Macular Holes ◽

Air Tamponade ◽

Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.

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Morphofunctional analysis of the retina in the surgical treatment of idiopathic macular holes

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-48-52 ◽

2021 ◽

pp. 48-52

Author(s):

A.S. Zotov ◽

◽

A.S. Balalin ◽

S.V. Balalin ◽

S.M. Purshak ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Surgical Treatment ◽

Macular Hole ◽

Practical Importance ◽

Functional Results ◽

Hole Diameter ◽

Optical Coherence ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Morphofunctional Analysis

Purpose. To evaluate the role of microperimetry and optical coherence tomography (OCT) in the morphofunctional analysis of the retina after surgical treatment of idiopathic macular holes (IMH). Materials and methods. A retrospective study of 33 patient's treatment results (33 eyes) with IMH was carried out. All patients underwent minimally invasive with 25G or 27G vitrectomy. Best corrected visual acuity (BCVA), macular photosensitivity, fixation stability, macular neuroepithelial (NE) volume and minimal macular hole diameter were analyzed. Follow-up period: 6 months. Results. A complete closure of the macular hole was achieved in all cases post-op. The patients had reliable improvement of BCVA, retinal photosensitivity and decrease of macular NE volume. Based on a multifactor correlation analysis with the purpose to predict the results of surgical treatment, the dependence of post-op BCVA on the pre-op photosensitivity of the retina and the minimal diameter of the macular hole was revealed. Conclusions. Microperimetry and OCT are modern non-invasive research methods allowing to estimate anatomical and functional results of surgical IMH treatment. The study of retinal photosensitivity in the macula and minimal macular hole diameter pre-op allows to predict post-op BCVA, which has a practical importance. Keywords: idiopathic macular hole, vitrectomy, microperimetry, optical coherence tomography.

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Perspectives of Autologous Mesenchymal Stem-Cell Transplantation in Macular Hole Surgery: A Review of Current Findings

Journal of Ophthalmology ◽

10.1155/2019/3162478 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Raffaele Nuzzi ◽

Federico Tridico

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Internal Limiting Membrane ◽

Mesenchymal Stem Cell Transplantation ◽

Internal Limiting Membrane Peeling ◽

Macular Holes ◽

Feasible Alternative ◽

Pars Plana ◽

Surgical Failure ◽

Idiopathic Macular Holes

The main treatment available for idiopathic macular holes is represented by pars plana vitrectomy with internal limiting membrane peeling. However, late-stage macular holes are affected by a higher risk of surgical failure. Although adjuvant techniques can be employed, a satisfactory functional recovery is difficult to achieve in refractory macular holes. Given their neuroprotective and antiapoptotic properties, mesenchymal stem cells (MSCs) may represent an appealing approach to treat these extreme cases. The purpose of this review is to highlight the findings regarding healing mechanisms exerted by mesenchymal stem cells and preliminary application in cases of refractory macular holes. When compared with MSCs, MSC-derived exosomes may represent a feasible alternative, given their reduced risk of undesired proliferation and easiness of use.

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