ObjectiveTo evaluate the full thickness idiopathic macular hole (IMH) closure rates in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). MethodsA computerized search was conducted in the PubMed, Chinese Biomedical Database, China National Knowledge Infrastructure, and VIP database. All the included studies were divided into NSP and FDP group. A total of 9 papers were included in this meta analysis, including 285 eyes (145 eyes with small hole ≤400 μm, 104 eyes with large hole >400 μm) in NSP group and 303 eyes (141 eyes with small hole and 124 eyes with large hole ). RevMan 4.2 software was applied for investigating heterogeneity and meta-analysis, and the risk of publication bias was evaluated. ResultsMeta analysis indicated that there was statistical significance on closure rates betwen NSP and FDP group. The difference of closure rates in small macular hole eyes between NSP and FDP group was statistically significant (OR=0.45, 95%CI 0.13-1.51;P=0.20). The difference of closure rates in large macular hole eyes between NSP and FDP group was statistically significant (OR=0.35, 95%CI 0.17-0.75;P=0.006). ConclusionNSP is equally effective as strict FDP in the repair of small macular hole. Post-operative FDP may improve the macular hole closure rates for holes larger than 400 μm.
Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P＜0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P＜0.01) and the last follow-up (r=−0.768, P＜0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P＜0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P＞0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
Objective To evaluate metamorphopsia and vision-related quality of life (VRQoL) and its influencing factor after vitrectomy for idiopathic macular hole (IMH). Methods This is a prospective and non-randomized clinical cohort study. Thirty eyes of 30 IMH patients who received vitrectomy and inner limited membrane (ILM) peeling were included. The best-corrected visual acuity (BCVA), medical refraction test and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The macular hole index (MHI) was measured using OCT. The average logMAR BCVA and MHI in suffering eyes at baseline were 1.02±0.07 and 0.47±0.02, respectively. The uncorrected visual acuity of the fellow eyes was less than 0.1. Follow-up period was longer than 6 months. At 6 months after surgery, the central retinal thickness (CRT) was measured by OCT; vertical and horizontal metamorphopsia were measured by metamorphopsia charts; VRQoL was evaluated by Chinese VRQoL-25. Spearman correlation analysis was performed to analyze the relationship of VRQoL and postoperative BCVA, metamorphopsia and preoperative MHI. Results At 6 months after surgery, macular hole closure was confirmed by OCT in all patients. The vertical and horizontal metamorphopsia were (0.17±0.03)° and (0.11±0.03)°, respectively. The VRQoL-25 composite score was 79.81±1.29. The average BCVA was 0.59±0.05. The average CRT was (155.10±6.27) μm. The postoperative VRQoL was positive correlated with preoperative MHI (r=0.491,P=0.002), and negative correlated with preoperative BCVA (r=−0.445,P=0.014), postoperative BCVA (r=−0.530,P=0.003) and postoperative metamorphopsia (r=−0.532,P=0.006), but not correlated with the postoperative CRT (r=0.231,P>0.05). Conclusions IMH patients improved their visual acuity after surgery, but still have metamorphopsia. VRQoL was negative correlated with metamorphopsia, positive correlated with preoperative MHI.
ObjectiveTo observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment (RRD) complicated with macular hole (MH).MethodsA retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females (13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ2=0.324) between the two groups were not statistically significant (P＞0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure.ResultsAt the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ. In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ. There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ2=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038).ConclusionVitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years, including the scleral buckling, simple intravitreal gas injection, pars plana vitrectomy (PPV), PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on. Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment. PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment. But for large holes with wide retinal detachment, PPV combined with ILM transplantation is necessary to improve the macular holes closure rate. If the ILM has been peeled before, the lens capsule could be a nice substitute for ILM. The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length. However, there is still no one surgery could deal with all the problems of high myopia, we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy.