Objective To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy. MethodsA retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed. ResultsBefore surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups (P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery (P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery (P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. ConclusionMB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.
Objective
To evaluate the successful rate of surgical treatment of retinal detachment due to macular hole in high myopia, and to analyze the relative reasons.
Methods
Eleven eyes of 11 high myopic patients with retinal detachment due to macular hole underwent vitrectomy combined with the adjunct of 18% C3F88or silicone oil. Strict prone position was conducted at least 2 weeks postoperatively.
Results
Macular hole closed and retina reattached in 10 eyes. Visual acuity was increased in 10 eyes, and no change in 1 eye. Postoperative complications mainly included nuclear sclerosis of the lens(1 eye), intraocular pressure elevation (1 eye), fibrosis exudates (2 eyes)，and diplopia (1 eye).
Conclusion
The use of vitrectomy combined with the adjunct of 18% C3F8or silicone oil is a safe and effective method in treating retinal deta chment due to macular hole in high myopia. Preoperative careful examination of o cular fundus, rational surgical design, and better surgical expertise are basic factors in treating this disease.
(Chin J Ocul Fundus Dis, 2001,17:90-92)
ObjectiveTo observe the morphological characteristics of dome-shaped macula (DSM) and macular hole (MH) in high myopia by optical coherence tomography (OCT), to further explore the correlation between DSM and MH. MethodsA retrospective case-control study. From April 2021 to December 2023, 963 eyes of 503 patients with high myopia (myopic diopter ≥6.00 D) in Department of Ophthalmology of the Fourth Hospital of Hebei Medical University were enrolled in the study. The age of patients ranged from 5 to 89 years old, with the mean age of (48.91±16.69) years. Diopter was ?6.00 to ?26.00 (?10.49±3.15) D. All eyes were examined by OCT. The width and height of DSM, subfoveal choroidal thickness (SFCT), inner port diameter and base diameter of MH were measured by software on OCT. According to the OCT image features, DSM was divided into horizontal and vertical oval-shaped DSM, and symmetrical round DSM. According to the presence or absence of DSM, the eyes were divided into DSM group and non-DSM group. Then, the affected eyes with MH were divided into DSM with MH group and non-DSM with MH group. The incidence of DSM, the incidence of MH in the DSM group and the non-DSM group, the inner port diameter of MH, the base diameter of MH, SFCT, and the location of retinoschisis (RS) in the DSM with MH group and the non-DSM with MH group were observed. Independent sample t test or non-parametric Mann-Whitney U test was used for comparison between groups. Pearson correlation analysis was used to analyze the related factors of MH inner port diameter, base diameter and DSM width, height, height/width ratio. ResultsAmong the 963 eyes, the DSM group and the non-DSM group were 266 (27.6%, 266/963) and 697 (72.4%, 697/963) eyes. Compared with the non-DSM group, patients in the DSM group were older (Z=?11.302), had higher degree of myopia (Z=?8.944), thinner SFCT (Z=?16.244), and higher incidence of MH (χ2=8.828), and the differences were statistically significant (P＜0.05). Compared with non-DSM with MH group, the patients in DSM with MH group were older (t=2.610), higher myopia diopter (t=3.593), and thinner SFCT (t=3.505), the differences were statistically significant (P＜0.05). There was no significant difference in the number of eyes in the epiretinal membrane between the two groups (χ2=0.119, P=0.730). In the DSM with MH group, RS mostly occurred in the outer retina with a large range, while in the non-DSM with MH group, RS mostly occurred in the outer and inner retina with a small range. There was a statistically significant difference in the number of eyes at different positions of RS between the two groups (χ2=25.131, P＜0.05). The results of correlation analysis showed that there was no correlation between the inner port and base diameter of MH and the width, height, height/width ratio of DSM (P＞0.05). ConclusionsCompared with high myopia patients without DSM, patients with DSM are older, have more severe myopia and thinner SFCT. In DSM patients with MH, RS often occurs in the outer retina and has a large range. There was no significant association between DSM morphology and MH size.
Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH). According to the appearance of vitreous and retina determined by optical coherence tomography, IMH can be classified as primary or secondary IMH, and IMH with or without vitreous attachment; Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction. According to the measured horizontal diameter, IMH can be classified as large, middle and small IMH. This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory, with a better description of the occurrence and development of IMH process. It should be used as the general principal to guide IMH classification, evaluation of surgical indications, selection of operative method, and estimation of surgical outcome. Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery. For complicated and large IMH, inverted ILM flapping can improve the closure rate; ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter. The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment, following the existing evidence-based medical evidence, and based on the new classification information, ocular and systemic features of each patient.
Purpose
To observe the clinical features and visual acuity of the eyes with idiopathic macular holes.
Methods
We reviewed the clinical materials of 23eyes of 18 patients with idiopathic macular holes and the follow up results from 6 to 120 months.
Results
In the initial examinations of 22 eyes,the numbers of eyes with stagesⅠ-Ⅳ macular holes were5,4,10,3 eyes respectively,and funds fluorescein angiography showed there were focal transmission of choroidal fluorescein in 17 eyes (stagesⅡ～Ⅳ).Macular hole ocurred in one eyes during follow up.At the final examination of 23 eyes,the numbers of eyes with stages Ⅰ～Ⅳ macular holes were 2,2,9,8 eyes respectively .Full-thickness macular hole of 2 eyes closed naturally after posterior vitreous detachment.The time interval of the subjective visual loss on stage Ⅰ was 5-8 months,stageⅡ8-20 months,stageⅢ12-126 months ,and the average visual acuity on stageⅠwas 0.7,stage 0.55,stageⅢ0.08,and stage Ⅳ0.08
Conclusion
Approximately 60% of impending (stage Ⅰ) hole progress to full thickness holes, the full thickness holes were usually enlarged and the visual acuity of affected eyes decreased as the natural course was prolonged . (Chin J Ocul Fundus Dis,1998,14:222-223)
PURPOSE:To inquire into diagnosis and differentiation method for full thickness macular hole,lamellar macular hole and cystoid macular degeneration. METHODS:Amsler grid,Watzke' s sign and laser aiming beam test were performed in the patients:30 with full-thickness macular hole, 12 with lamellar macular hole and 8 with cystoid macular degeneration. The results were analyzed statistically with method of four table precise probability. RESULTS:The positive rate of Amsler grid,watzke's sign and laser aiming beam test was 100% in ail of the full thickness macular holes,and it was 85%，65%and 0 in lamellar macular holes and cystoid macular degeneration respectively.
CONCLUSION: Amsler grid testing was sensitive but not specific,Watzke's sign was more sensitive and specific,and the laser aiming beam tesl was extremely sensitive and specific in clinical diagnosis of full thickness macular hole.
（Chin J Ocul Fundus Dis,1996,12: 208-210）
ObjectiveTo compare the efficacy of internal limiting membrane (ILM) flip coverage with ILM multilayer tamponade in the treatment of highly myopic macular hole-associated retinal detachment (MHRD). MethodsA retrospective clinical study. From November 2019 to June 2022, 53 cases and 53 eyes of MHRD patients who were examined and diagnosed at the Eye Centre of Renmin Hospital of Wuhan University were included in the study. Among them, 21 cases and 21 eyes were male and 32 cases and 32 eyes were female. The age was (55.28±11.40) years. The patients were categorized into two groups: the ILM coverage group (from November 2019 to September 2020) and the ILM multilayer tamponade group (from October 2020 to June 2022) based on their surgical procedures. The ILM coverage group comprised of 11 cases involving 11 eyes, while the ILM multilayer tamponade group comprised of 42 cases involving 42 eyes. Best-corrected visual acuity (BCVA) and optical coherence tomography were conducted. BCVA was measured using standardized international visual acuity charts and transformed to logarithmic minimum angle of resolution (logMAR) visual acuity for statistical analysis. The affected eyes were all treated with standard transciliary flattening three-channel 23-gauge vitrectomy. The inverted ILM flap technique was combined with flap coverage in the inverted group, while the ILM multilayer tamponade group used circular ILM stripping to preserve the ILM in the macular area and ILM flap around the macular hole with multilayer ILM tamponade. Postoperative follow-up was carried out for a minimum of 6 months. Relevant examinations were conducted during the follow-up using the same equipment and methods as those used before surgery. The BCVA, as well as the closure of macular hole, resurfacing of the retina, and development of macular hyperplasia, were observed. ResultsIn the ILM-covered group, the macular hole was closed in 7 out of 11 eyes after 1 week of surgery. At 1 month after surgery, the macular hole was closed in all treated eyes. At 6 months after surgery, the macular hole was closed in 9 eyes, while 2 eyes were reopened. In 42 eyes from the ILM-multilayer tamponade group, the macular hole closed after surgery in 41 eyes. At 6 months postoperatively, best corrected visual acuity (BCVA) of eyes in ILM-covered and ILM-multilayer tamponade groups was 0.91±0.29 and 1.05±0.39, respectively, with no statistically significant difference between the two groups (t=1.140, P=0.260). The BCVA of the eyes in both groups showed a significant improvement compared to the preoperative period with a statistically significant difference (t=8.490, 13.840; P＜0.000 1); 6 months after surgery, 10 out of 11 eyes in the ILM coverage group had a restored retina with no detectable macular hyperplasia; 42 eyes in the ILM multilayer tamponade group had a restored retina, but 19 of these eyes had detectable macular hyperplasia. ConclusionsEither ILM flap coverage or ILM multilayer tamponade contributes to high myopic MHRD closure and improved visual acuity. Compared to ILM flap coverage, ILM multilayer tamponade results in higher and earlier rates of macular hole closure and lower rates of macular hole reopening. However, ILM multilayer tamponade may lead to a higher proportion of macular hyperplasia formation without affecting visual acuity recovery at 6 months after surgery.
Objective To compare and observe the efficacy and safety of pars plana vitrectomy (PPV) combined with 41G ultrafine needle injection of balanced salt solution (BSS) and internal limiting membrane inversion and coverage in the treatment of large-diameter macular hole (MH). MethodsA prospective study. From April 2023 to April 2024, 42 patients (42 eyes) diagnosed with large-diameter MH at The Affiliated Eye Hospital of Nanchang University were included in the study. The substrate diameters (BD) of MH are all greater than 1 000 μm. All affected eyes underwent best corrected visual acuity (BCVA), microvisual field, optical coherence tomography (OCT), and OCT angiography (OCTA) examinations before surgery. BCVA examination was conducted using the international standard logarithmic visual acuity chart, and the statistics were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. Microfield-of-view examination records the mean retinal sensitivity (MS) within a 12° range of the fovea. The minimum diameter (MD) and BD of the hole were measured by OCT and the MH index (MHI) was calculated. OCTA measures the area and perimeter (PERIM) of the foveal avascular zone (FAZ) in the fovea centralis, as well as the retinal vessel length density (VLD) and vessel perfusion density (VPD) in the central area. The affected eyes were divided into the observation group (22 eyes, treated with PPV combined with 41G ultra-micro needle subretinal injection of BSS and the control group (20 eyes, treated with PPV combined with internal limiting membrane inversion and coverage) according to the random number table method. The patients were followed up for 6 months after the operation, and the above indicators were reexamined at 1, 3 and 6 months. The changes of BCVA, MS, FAZ parameters, VLD, VPD before and after the operation, as well as the closure of the hole and the occurrence of complications were compared between the two groups. The independent sample t test was used for comparison between groups. The correlation between postoperative indicators and preoperative structural parameters was analyzed using Pearson analysis. ResultsIn the 22 eyes of the observation group, the hole closure rate was 100.0% (22/22) 6 months after the operation, and the complete closure rate was 90.9% (20/22). In the control group of 20 eyes, the closure rate was 95.0% (19/20), and the complete closure rate was 90.0% (18/20). The hole closure rate of the affected eyes in the observation group was better than that in the control group, but the difference was not statistically significant (χ2=1.736, P=0.420). The logMAR BCVA, MS, FAZ area, PERIM, VLD and VPD at each time point after the operation in both groups were significantly improved compared with those before the operation, and the differences were statistically significant (P＜0.05). The results of Pearson correlation analysis showed that in the observation group, logMAR BCVA at 6 months after surgery was positively correlated with BD before surgery (r=0.340, P=0.029), and negatively correlated with MHI before surgery (r=?0.350, P=0.023). Six months after the operation, MS was positively correlated with the preoperative hole height and MHI (r=0.330, P=0.034). In the control group, 6 months after the operation, MS was negatively correlated with BD before the operation (r=?0.480, P=0.032), and positively correlated with MHI before the operation (r=0.510, P=0.027). Six months after the operation, the FAZ area of the affected eyes in the observation group [(0.17±0.09) mm2] was larger than that in the control group [(0.12±0.07) mm2], and the difference was statistically significant (t=?0.340, P=0.025). No complications such as abnormal intraocular pressure, retinal pigment epithelium injury or retinal detachment occurred in all the affected eyes after the surgery. ConclusionsPPV combined with 41G ultra-micro needle subretinal injection of BSS for the treatment of large-diameter MH has a high rate of hole closure and good safety. Larger BD and MD, lower MHI and hole height before surgery may affect the recovery of visual function after surgery.
Purpose
To evaluate the surgical effect of idiopathic macular hole (IMH)，with optical coherence tomography (OCT)．
Methods
To measure the diameter of holes and hole halos，the thickness of hole in edge，the changes of hole pattern in 19 cases (19 eyes) with IMH using OCT．
Results
By quantitatively measuring，OCT showed that after surgery the mean hole diameter lessened from （570．95plusmn;264．59 ）mu;m to （337．05plusmn;335．95）mu;m．The mean diameter of hole halo lessened from （1043．53plusmn;278．80）mu;m to （695．00plusmn;483．00）mu;m and the mean thickness of the hole edge thinned from （389．78plusmn;60．58）mu;m to （298．78plusmn;109．80）mu;m．In 17 eyes the holes become closed or reduced in size or the hole halo，and thinned in hole edge．The anatomic successful rate of the surgery is 89%．
Conclusion
OCT can objectively，accurately and effectively judge the anatomic effect of IMH surgery．
(Chin J Ocul Fundus Dis，2000，16：71-138)
The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
