Search

Abdulaziz A Al Taisan Department of Surgery, King Faisal University, Al-Ahsa, Saudi ArabiaCorrespondence: Abdulaziz A Al Taisan, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia, Email dr.altaisan@gmail.comPurpose: To report a case of partial detachment of an inverted internal limiting membrane (ILM) flap following a successful closure of a full-thickness traumatic macular hole.Observations: A 24-year-old male patient presented with a history of a blunt trauma and a full-thickness macular hole. Visual acuity was (20/50) then deteriorated to (20/100) prior to surgery. He underwent pars plana vitrectomy with an inverted ILM flap and gas tamponade. Postoperatively, successful closure of the hole was noted with a visible hinged ILM flap observed over the retina in optical coherence tomography (OCT). Three months later, the patient presented with a complaint of a central floater. Visual acuity was (20/30) and a partially detached ILM flap was noted in the OCT.Conclusions and Importance: Inverted ILM flap might detach from the retinal surface after gas resolution and successful closure of a full-thickness macular hole.Keywords: ILM flap, ILM inverted flap, full thickness macular hole, macular hole

Purpose: To report a case of partial detachment of an inverted internal limiting membrane (ILM) flap following a successful closure of a full-thickness traumatic macular hole. Observations: A 24-year-old male patient presented with a history of a blunt trauma and a full-thickness macular hole. Visual acuity was (20/50) then deteriorated to (20/100) prior to surgery. He underwent pars plana vitrectomy with an inverted ILM flap and gas tamponade. Postoperatively, successful closure of the hole was noted with a visible hinged ILM flap observed over the retina in optical coherence tomography (OCT). Three months later, the patient presented with a complaint of a central floater. Visual acuity was (20/30) and a partially detached ILM flap was noted in the OCT. Conclusions and Importance: Inverted ILM flap might detach from the retinal surface after gas resolution and successful closure of a full-thickness macular hole. [ABSTRACT FROM AUTHOR]

Purpose: Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. Methods: In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. Results: Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan–Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. Conclusion: The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the clinical features and surgical outcomes of full-thickness macular hole (FTMH) with epiretinal proliferation (EP) diagnosed by both en-face and B-mode optical coherence tomography (OCT). Method: This retrospective cohort study classified idiopathic FTMHs into two groups, based on B-scan and en-face OCT imaging: FTMH with EP (EP group) and without EP (non-EP group). The preoperative features, as well as postoperative outcomes up to 12 months, were compared between the two groups. Result: Among 318 eyes of idiopathic FTMH that met the inclusion criteria, 59 eyes (18.6%) were in the EP group, and others were in the non-EP group. In 9 eyes (15.3%) out of the EP group, EP was not detected in the preoperative B-mode OCT but was identified through the en-face OCT. Baseline features showed a higher male proportion (47.5% vs. 27.8%, P = 0.005) and a lower incidence of vitreofoveal traction (P < 0.001) in the EP group than in the non-EP group. The EP group showed worse visual recovery than the non-EP group (− 0.23 vs. − 0.41 logarithm of the minimum angle of the resolution at 12 months, P = 0.001). Conclusion: The en-face OCT enhances diagnostic accuracy of EP in FTMH eyes, especially in the case with smaller extent of EP. Eyes with FTMH with EP showed a worse visual recovery than FTMH without EP. [ABSTRACT FROM AUTHOR]

Surgical advancements for full-thickness macular hole (FTMH) treatment include vitrectomy, membrane peeling, and the inverted flap technique (IFT). IFT, which involves inverting the internal limiting membrane (ILM) flap over the macular hole (MH) or into the MH, improves success rates and visual recovery. However, issues like mis-aspiration during flap handling have been problematic. We introduce the petaloid technique, to position the ILM flap under air during FTMH surgery to evaluate its outcomes. This retrospective study included 28 eyes, with a mean minimum linear diameter (MLD) 472.04 ± 199.7 μm and basal diameter (BD) of 834.95 ± 593.54 μm. Primary closure of MH was achieved in 96.42% of patients, with 3.57% showing persistent MH during the 6-month follow-up. The VA improved significantly from preoperative levels at each postoperative stage, with notable increases at 3 months (0.86 ± 0.49 logMAR; p = 0.0132) and 6 months (0.77 ± 0.41 logMAR; p = 0.000081). The new closure patterns showed Type A in 28.6%, B in 14.3%, C in 28.6%, and D in 25%. Among different types of closure patterns, although VA improved in all types, significant improvement in VA was noted for type A and type C, with notable improvements at the 6-month follow-up for Type A (0.60 ± 0.23 logMAR; p = 0.02) and at the 1-month follow-up for Type C (0.62 ± 0.28 logMAR; p = 0.02). For macular hole retinal detachment in 5 eyes, the average preoperative VA was 1.86 ± 0.19 logMAR, while the final mean postoperative VA showed a significant improvement to 1.1 ± 0.40 logMAR (p = 0.021, paired t-tests). Retinal reattachment was achieved in all cases (5/5) without recurrent detachment post-silicone oil removal. For the prognostic significance of MH shapes identified by OCT, it can be concluded that the shape of macular holes significantly influences visual acuity outcomes at 6 months post-surgery (p = 0.037). The shape of macular holes, particularly Flask-shaped, significantly impacts visual acuity compared to other shape. The modified petaloid technique for treating FTMH proved safe and effective, with no significant complications noted.

Ogugua N Okonkwo,1,2 Toyin Akanbi,2 Chineze T Agweye3 1Eye Foundation Retina Institute, Lagos, Nigeria; 2Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria; 3Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, NigeriaCorrespondence: Ogugua N Okonkwo, Eye Foundation Retina Institute, Lagos, Nigeria, Tel +234 803 502 7308, Email o_okonkwo@yahoo.comPurpose: To report incidence, clinical presentation, and treatment outcome of full-thickness macular hole (FTMHs) diagnosed post pars plana vitrectomy.Methods: We retrospectively reviewed the demographics, best-corrected visual acuity (BCVA), indication for the primary vitrectomy, time to diagnose the secondary FTMH, optical coherence tomographic (OCT) appearance, and treatment outcome of FTMHs, occurring after vitrectomy performed between January 2019 and December 2020.Results: Six of 523 vitrectomized eyes developed FTMHs, an incidence of 1.1%. There were five females and one male, mean age of 56.5 years (range 37– 85). The indication for primary vitrectomy was rhegmatogenous retinal detachment (RRD) in three eyes, one eye each for sub internal limiting membrane hemorrhage from a ruptured macroaneurysm, vitreous hemorrhage from polypoidal choroidal vasculopathy (PCV), and pre-insertion of Ahmed glaucoma drainage device (GDD). FTMHs occurred within one week to three months after vitrectomy (time from primary vitrectomy to the identification of the secondary MH was a mean of 1.03 months). Mean BCVA in all six MH eyes was log MAR 0.9 (Snellen: 6/54). Anatomical closure was achieved after one surgery in three eyes, two surgeries in 1 eye, after photodynamic therapy (PDT) in the PCV eye, and one patient declined surgery. The mean BCVA in the four surgically closed MH eyes improved marginally from log MAR 0.82 (Snellen: 6/38) to log MAR 0.72 (Snellen: 6/30), mean follow-up 7.6 months.Conclusion: Post-vitrectomy FTMH is rare, and RRD was the commonest indication for initial vitrectomy. We observed that all secondary MHs were closed successfully using the inverted internal limiting membrane (ILM) flap technique with limited improvement in vision. The visual outcome of these secondary MHs trails behind that of idiopathic MHs.Keywords: full thickness macular hole, vitrectomy, complications of vitrectomy, epiretinal membrane, optical coherence tomogram, inverted internal limiting membrane flap

Purpose: To describe the morphology and provide anatomical correlations of supra-retinal pigment epithelium (RPE) granular deposits in full thickness macular holes (FTMHs)., Design: Retrospective, observational, single-center study PARTICIPANTS: Patients with idiopathic FTMH presenting to University of Florence Eye clinic METHODS: Thirty-six eyes of 34 patients with diagnosis of treatment-naive FTMH, scheduled for surgery, underwent multimodal imaging including spectral-domain optical coherence tomography (SD-OCT), en-face OCT and adaptive optics ophthalmoscopy (AOO). Different methodologies were evaluated to determine location and topographical correspondence of granulations. Total volume of supra-RPE granular deposits was correlated to MH characteristics and SD-OCT markers of photoreceptor damage with Spearman correlation coefficient (CC)., Results: Using AOO, supra-RPE granular deposits appeared as hyper-reflective structures, mostly found within the minimum linear diameter (MLD) (104/139 deposits,74%). Different imaging techniques were equally effective in the topographical identification of supra-RPE granular deposits (p>0.30). The total volume of supra-RPE granular deposits significantly increased with stages B and C of FTMH, inversely correlated to the corrected ellipsoid zone (EZ) reflectivity (CC=-0.62) and positively correlated to the length of EZ defect (CC=+0.41), MH diameter at the base (CC=+0.35) and MLD (CC=+0.42)(all p<0.05)., Conclusions: Supra-RPE granular deposits can be identified accurately using AOO and en-face OCT. Characteristics using AOO and anatomical correlations at SD-OCT indicate supra-RPE granular deposits as signs of photoreceptor degeneration., (Copyright © 2025. Published by Elsevier Inc.)

Purpose: To evaluate the surgical management, outcomes and prognostic factors of full thickness macular holes without residual internal limiting membrane (NO-ILM FTMHs). Methods: We performed a multicenter, retrospective study of 116 NO-ILM FTMHs. Human amniotic membrane (hAM) plug, autologous ILM free flap transplantation (AILMT), and autologous retinal graft transplantation (ART) were performed in 58, 48, and 10 patients, respectively. Data were collected before and up to 12 months after surgery. The primary outcomes were hole closure and final best-corrected visual acuity (BCVA). Results: The final BCVA (0.78 ± 0.51 logMAR) was significantly better than and correlated with the initial BCVA (p < 0.0001 and p = 0.004, respectively). Hole closure was achieved in 92% of eyes. The minimum FTMH diameter was wider and final BCVA was lower in the ART group than in the other groups (p < 0.003 and p < 0.001, respectively). FTMHs with diameter > 680 μm had a higher closure rate with hAM than with AILMT (p = 0.02). Conclusions: AILMT and hAM were the most frequently performed surgeries with both high closure rate and significant functional improvement. Preoperative BCVA was correlated with final BCVA. The minimum FTMH diameter may guide the treatment choice. [ABSTRACT FROM AUTHOR]

Myopic traction maculopathy (MTM), one of the complications of pathologic myopia, is a spectrum of pathological conditions that are attributed to tractional changes in the eye characterized by retinoschisis, lamellar or full thickness macular hole, and foveal retinal detachment. Considering the global public health burden of MTM and pathologic myopia, it is important to understand these sight-threatening complications and their associations. We conducted an evidence-based review of the prevalence and natural history of MTM and associated risk factors. The prevalence of MTM in the general population is low, but is increased among high myopes. MTM is associated with preretinal tractional structures, myopic refractive error and axial elongation, posterior staphyloma, dome-shaped macula, chorioretinal atrophy, and myopic macular degeneration. The clinical course of MTM tends to be stable; however, MTM may progress, resulting in visual acuity deterioration, although spontaneous improvement also occurs. The associations of MTM progression include vitreous traction, location, and extent of MTM, and lamellar macular hole-specific factors. More high-quality population-based studies that assess MTM prevalence and natural history are needed. [ABSTRACT FROM AUTHOR]

Abstract Currently the term lamellar macular hole (LMH) alludes to a wide spectrum of macular conditions including distinct clinical entities with different pathomorphologies. Classifications into subtypes, tractional and degenerative or based on the associated preretinal tissue had been proposed. Recent insights suggest that only lesions with tissue loss should be considered ‘true’ LMH and not those morphological changes caused by tractional forces. Inclusion of lesions with foveoschisis with contractile epiretinal membrane (ERM) in earlier studies on LMHs has resulted in imprecise information about its clinical course. This review provides an overview of the evolving concepts of LMHs and analyses its natural history from study cases in previously published literature.

Purpose: To calculate AIP and to find correlation between hole closure pattern with AIP in idiopathic full thickness macular hole (FTMH) cases. Methods: In this prospective, non-randomized, interventional single blind study, 105 eyes of symptomatic FTMH (400μ, n = 75) and Group II (3DD in both groups. Intra-operatively using video overlay, surgeons can increase the diameter of AIP to get better closure pattern.

Objectives: The objective of this study was to assess the utility of novel macular hole indices of Optical Coherence Tomography (OCT) and predicting the functional outcome of surgery. Methods: This was a retrospective chart review of 28 eyes who underwent surgery for idiopathic Full Thickness Macular Hole (FTMH) at The Aga Khan University Hospital (AKUH), Karachi from January 2016 to March 2020. Data of preoperative OCTs were recovered from data server of OCT machine. Measurements of the pre-operative OCTs were calculated using caliper function of OCT software by two independent technicians. Parameters included Macular Hole Index (MHI), Traction Hole Index (THI), Hole Form Factor (HFF) and Diameter Hole Index (DHI) were recorded. Receiver operating characteristic (ROC) curve was used to evaluate the performance of DHI, THI, HFF and MHI for improved BCVA after surgery, by looking at sensitivity, specificity and area under curve (AUC). P-value of <0.05 was considered significant. Results: Out of 30 eyes, final data analysis was done for 28 eyes. Mean age was 61.5 - 6.2 years. Mean pre-operative and 6 months post-operative LogMAR best corrected visual acuity (BCVA) was 0.84 - 0.23 and 0.32 - 0.30 (p-value <0.001). Area under the curve with 95% confidence interval estimated for DHI, THI, HFF, and MHI was [0.750 (0.559 to 0.889)], [0.827 (0.637 to 0.943)], [0.846 (0.660 to 0.954)], [0.827 (0.637 to 0.943)]. Cut off values for predicting good functional outcome (post-op BCVA equal or better that 0.4) for DHI, THI, HFF and MHI were 0.454, 1.086, 0.856 and 0.501 respectively. All ROC value of less than 0.5 were considered unlikely to predict functional outcomes with macular hole indices. Conclusion: Novel macular hole indices can be used as a tool to predict the functional outcomes of macular hole surgery. Larger studies may be required to assess their wider effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: To report an unusual non-iatrogenic case of central macular and posterior full-thickness retinal holes (FTRHs). Observations: A 60-year-old man presented with a progressive visual loss in the right eye. A complete ophthalmological evaluation including best corrected visual acuity (BCVA) measurement, fundus examination and spectral - domain optical coherence tomography (SD–OCT) was performed.Fundus examination and SD-OCT confirmed the presence of simultaneous macular and posterior FTRHs. A 25-gauge vitrectomy was performed and the internal limiting membrane (ILM) was grasped and peeled off around the two holes. A fragment of the peeled-off ILM anchored on the FTRHs edges was left and inserted into the gaps.Closure of both retinal holes was achieved at 1-month, and BCVA improved from 20/630 at baseline to 20/63 at month 3. No intraoperative or postoperative complications were recorded. Conclusions and Importance: Inverted ILM flap technique represents a good treatment option in this rare non-iatrogenic condition, allowing a good anatomical and functional recovery.

Purpose: To evaluate sequential changes in the inner retinal surface using en face spectral domain optical coherence tomography (SD-OCT) following internal limiting membrane (ILM) peeling for idiopathic full thickness macular holes. Methods: Retrospective, interventional study on 45 eyes of 42 patients with type 1 macular hole closure after a single procedure and a minimum post-operative follow up of 6 months. Best corrected visual acuity (BCVA), fundus photographs, B scan and en face SD-OCT scans were analysed pre-operatively, at 2, 6, 12 months post-operatively and then yearly. The presence or absence of concentric macular dark spots (CMDS) on the ILM slab of en face SD-OCT, their distribution pattern and course in terms of number and size of the dark spots was qualitatively assessed at each follow up. Results: CMDS was identified in a total of 26 eyes (57.78%). Of these, it was detected in 21 eyes at 2 months and the remaining by 6 months. At the time of first detection, the distribution was classified as type 1 in 9 eyes (35%), type 2 in 7 eyes (27%) and type 3 in 10 eyes (38%). There was apparent increase in the number and size of the CMDS in 16 eyes (62%) no later than 12 months follow up, while 10 eyes (38%) remained stable. There was no decrease or resolution noted in any patient. The mean post-operative follow up was 19.4 months (range 6–69 months). Conclusion: Inner retinal defects in the form of CMDS can be picked up on en face SD-OCT between 2–6 months post-operatively. They remain stable or become more prominent upto 12 months follow up, but do not regress once present. En face SD-OCT is recommended in all cases where ILM is peeled to assess CMDS. [ABSTRACT FROM AUTHOR]

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than – 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 1-year visual acuity predictive performance of an artificial intelligence (AI) based model applied to optical coherence tomography angiography (OCT-A) vascular layers scans from eyes with a full-thickness macular hole (FTMH). Methods: In this observational cross-sectional, single-center study, 35 eyes of 35 patients with FTMH were analyzed by OCT-A before and 1-year after surgery. Superficial vascular plexus (SVP) and deep vascular plexus (DVP) images were collected for the analysis. AI approach based on convolutional neural networks (CNN) was used to generate a continuous predictive variable based on both SVP and DPV. Different pre-trained CNN networks were used for feature extraction and compared for predictive accuracy. Results: Among the different tested models, the inception V3 network, applied on the combination of deep and superficial OCT-A images, showed the most significant differences between the two obtained image clusters defined in C1 and C2 (best-corrected visual acuity (BCVA) C1 = 66.67 (16.00 SD) and BCVA C2 = 49.10 (18.60 SD, p = 0.005). Conclusions: The AI-based analysis of preoperative OCT-A images of eyes affected by FTMH may be a useful support system in setting up visual acuity recovery prediction. The combination of preoperative SVP and DVP images showed a significant morphological predictive performance for visual acuity recovery.

Purpose: To calculate AIP and to find correlation between hole closure pattern with AIP in idiopathic full thickness macular hole (FTMH) cases.Methods: In this prospective, non-randomized, interventional single blind study, 105 eyes of symptomatic FTMH (<6 month duration) were operated. Minimal diameter of macular hole (MDMH) was calculated on OCT, divided into Group I (>400μ, n = 75) and Group II (<400μ, n = 30). 23G vitrectomy with ILM peeling and gas injection were done in all and recorded. Final area of ILM peeled (AIP) was calculated using Adobe Photoshop CS2 (PSD format) in disc diameters (DD) from still frame. Follow up was done at 6 monthly interval up to a maximum of 5 years after surgery.Results: Macular holes were closed in 92.38% eyes. In Group I, mean pre-operative BCVA was 1.14 ± 0.39 log MAR and was improved to 0.79 ± 0.26 log MAR post-operatively at 6 months. In Group II, mean pre-operative BCVA was 0.95 ± 0.44 log MAR and was improved to 0.60 ± 0.24 log MAR after surgery. When AIP was more than 3DD, Type I and Type II closure were 72.77% and 27.27% in Group I (P value <0.01) and 84.21% and 15.79% in Group II (P value <0.01).Conclusion: AIP can be calculated using Adobe Photoshop CS2. Type I closure was significantly high with AIP >3DD in both groups. Intra-operatively using video overlay, surgeons can increase the diameter of AIP to get better closure pattern. [ABSTRACT FROM AUTHOR]

Intrachoroidal cavitation (ICC) is a morphological feature outlined by optical coherence tomography and is characterized by presence of a hyporeflective space beneath the unaltered retinal pigment epithelium. It can be peripapillary or macular in location. Macular ICCs are reported in both myopic and non-myopic eyes. We report a case of full thickness macular hole with retinal incarceration into the macular ICC in a patient with pathological myopia. The term "Peripapillary sink hole" has been described in the literature. We propose the use of term "Macular sink hole" for our case owing to similar findings in the macula. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objective: A full-thickness macular hole ("FTMH") is a foveal lesion caused by a defect in the full thickness of the neurosensory retina. Its diagnosis and the indication for surgical treatment take into account the measurement of the hole according to the tool provided by the OCT. This measurement can be performed by several ophthalmologists during the follow-up of a patient. The aim of this study is to find out whether there is intra-individual and inter-individual variability in these measurements., Material and Methods: Retrospective review of OCT b-scan images with a diagnosis of FTMH. Measurements of the minimum diameter of the FTMH were performed using the hand-held tool available on the DRI-Triton (Topcon, Japan) at 1:1 and 1:2 scales, on different days, by 2 retina specialists and 2 residents. These measurements were compared to assess inter-observer and intra-observer correspondence., Results: Thirty-four images were analysed. For intra-observer variability, a correlation index higher than 0.98 was obtained in all cases. For inter-observer variability, the intra-class correlation coefficient was 0.94 (95% CI: 0.91-0.97) for the 1:1 scale, and 0.94 (95% CI: 0.91-0.97) for the 1:2 scale., Conclusions: OCT-measured AMEC size values are reproducible between ophthalmic specialists and residents and are independent of the imaging scale at which the measurement is made., (Copyright © 2023 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Cat scratch disease is a febrile illness caused by Bartonella henselae and is associated with rash at the site of cat bite or scratch and regional lymphadenopathy. Various ocular manifestations of cat scratch disease have been described, mainly retinochoroiditis, optic disc swelling, neuroretinitis, vascular occlusive events, serous retinal detachment, vitreous hemorrhage, intermediate uveitis, inflammatory lesions of the optic nerve head and rarely full thickness macular hole. We describe a case of an 11-year-old girl who presented 2 weeks after the onset of symptoms, with B. Henselae neuroretinitis with full thickness macular hole at presentation.

Purpose To determine the incidence of full thickness macular hole in the Tasmanian population. Design A whole population retrospective case series in Tasmania, Australia. Methods Patients diagnosed with full thickness macular hole (confirmed by optical coherence tomography (OCT) imaging) of both idiopathic and secondary causes were identified from April 2005 to April 2011 by a sole vitreoretinal surgeon servicing Tasmania. Baseline characteristics were recorded. The six-year incidence rate was calculated, based on the 2006 and 2011 Tasmanian census data. Incidence rates were age and sex standardized. Participants One hundred forty-seven eyes of 136 patients. Main Outcome Measures To determine the incidence (age and sex standardized) of full thickness macular holes in Tasmania, Australia. Results Idiopathic macular holes comprised 128 (87.1%). There were 116 cases of idiopathic Full Thickness Macular Hole in one or both eyes between 1 April 2005 and 31 April 2011. The six-year incidence of idiopathic full-thickness macular holes was 24.3 per 100 000 people, 4.05 per 100 000 per year, with the highest six-year incidence observed among women aged 70-79 years. Conclusion This is the first global study to report OCT confirmed incidence rates of full thickness macular holes in a relatively static Australian population sub-group. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A Full Thickness Macular Hole (FTMH) is often associated with vitreomacular traction, and this can be asymmetric with vitreomacular traction on one side of the hole but not the other. In cross-section, the elevated retinal rim around a developed FTMH is seen as a drawbridge elevation, and this drawbridge elevation may be used as a measure of morphological change. Examination of the drawbridge elevation of the retinal rim in FTMH with asymmetric vitreomacular traction may help to clarify the role of vitreomacular traction in the development of FTMH. Method: Cases of FTMH were identified with an initial OCT scan showing vitreomacular traction on one side of the hole only and that had a follow-up OCT scan showing progression of the hole. A tangent to the retinal surface at a distance of 700 microns from the axis of the hole was used as a marker of the drawbridge elevation of the retinal rim around the macular hole. Comparisons of the drawbridge elevation and change in drawbridge elevation between the sides with and without initial vitreomacular traction were made. Results: There was no significant difference between the drawbridge elevation, or change in drawbridge elevation, on the side of the hole with initial vitreomacular traction compared to the side without initial traction. Conclusion: There is some intrinsic mechanism within the retina to link the morphological changes on the two sides of a FTMH. A bistable hypothesis of FTMH formation and closure is postulated to explain this linkage. [ABSTRACT FROM AUTHOR]

Full thickness macular hole is an eye disease, which can cause permanent visual impairment. Current advancement in vitreoretinal surgery has high success rates in repairing them, leading to a significant visual improvement, especially if patient presents early. In this article, three cases of idiopathic full thickness macular hole with different visual outcomes have been presented. All cases were referred by the primary care practitioners and had undergone macular hole surgery with the same vitreoretinal surgeon. The visual outcome was best in the patient who had the earliest presentation and referral. Early detection and referral of these patients is vital so that early surgical intervention can be carried out to improve their vision. [ABSTRACT FROM AUTHOR]

The study is intended to examine the development of macular hole in idiopathic conditions. A 2-year case file of optical coherence tomography (OCT) with the initial diagnosis of idiopathic impending hole (IH) or lamellar hole (LH) was reviewed. All cases of IH or LH were sequentially examined for more than 9 months. All cases with IH had vitreo-foveal adhesion, and were separated into type A (foveal detachment ± inner retinal cysts) and type B (inner retinal cysts only). Eight cases had type A IH, 15 cases had type B IH, and 27 cases had LH. Seven cases of type A IH developed full-thickness macular hole (FTMH) at an average of 5.1 ± 2.2 months, and the one other case was operated. Five cases of type B IH were operated. For the other ten cases, at an average of 11.4 ± 3.5 months, none had developed foveal detachment or FTMH, but five had developed LH. Three cases with initial LH subsequently developed FTMH. In idiopathic cases, vitreo-foveal traction with foveal detachment may lead to FHMH, while inner cysts only without foveal detachment seem tend to evolve into LH instead of FHMH. Furthermore, LH may develop into FTMH. [ABSTRACT FROM AUTHOR]

Background: Outer retinal defects (ORDs) may occur after surgical closure of full thickness macular holes (FTMH) and be associated with delayed visual recovery. This may be due to the nature of the subretinal fluid (SRF) cuff and/or the loss of retinal elements. Methods: Vitrectomy with internal limiting membrane (ILM) peel was performed for FTMH. After fluid-air exchange, SRF was either aspirated from the hole (group 1) or left in situ (group 2). The SRF specimens obtained were examined by light microscopy and correlated with optical coherence tomography (OCT). Results: In group 1, cellular material was found in 6 out of 12 cases. Photoreceptors were seen in 3 and macrophages in 3 cases. Nine of 12 holes closed and ORDs were seen in 3 of these. In group 2, 7 out of 8 holes closed, with 4 having ORD. There was no difference in visual acuity (LogMAR) for closed holes at 3 months between groups 1 (0.61, range 0.3–1) and 2 (0.51, range 0.3–0.78) nor between patients with ORD (0.57, range 0.3–1.0) or without ORD (0.57, range 0.3–1.0). Conclusions: SRF from FTMH may contain macrophages and photoreceptors. Such photoreceptor loss may contribute to reduced retinal function. ORDs occur commonly in spite of fluid aspiration, but their presence is still compatible with good vision. Aspiration of SRF did not appear to confer added benefit in this series. [ABSTRACT FROM AUTHOR]

Cat scratch disease is a febrile illness caused by Bartonella henselae and is associated with rash at the site of cat bite or scratch and regional lymphadenopathy. Various ocular manifestations of cat scratch disease have been described, mainly retinochoroiditis, optic disc swelling, neuroretinitis, vascular occlusive events, serous retinal detachment, vitreous hemorrhage, intermediate uveitis, inflammatory lesions of the optic nerve head and rarely full thickness macular hole. We describe a case of an 11-year-old girl who presented 2 weeks after the onset of symptoms, with B. Henselae neuroretinitis with full thickness macular hole at presentation. [ABSTRACT FROM AUTHOR]

Currently the term lamellar macular hole (LMH) alludes to a wide spectrum of macular conditions including distinct clinical entities with different pathomorphologies. Classifications into subtypes, tractional and degenerative or based on the associated preretinal tissue had been proposed. Recent insights suggest that only lesions with tissue loss should be considered 'true' LMH and not those morphological changes caused by tractional forces. Inclusion of lesions with foveoschisis with contractile epiretinal membrane (ERM) in earlier studies on LMHs has resulted in imprecise information about its clinical course. This review provides an overview of the evolving concepts of LMHs and analyses its natural history from study cases in previously published literature. [ABSTRACT FROM AUTHOR]

The author describes a customized posterior scleral reinforcement, its manufacturing method, the rationale of its therapeutic effect, and the surgical technique of its implantation. A 54-year-old female patient with a case history of myopic macular hole with retinal detachment and posterior staphyloma, refractory to pars plana vitrectomy and peeling of internal limiting membrane, underwent posterior scleral reinforcement treatment. Retinal reattachment and macular hole closure were obtained. Best corrected visual acuity increased from light perception to 20/160 Snellen. The pars plana vitrectomy is mandatory to remove vitreoretinal tractions and epiretinal membranes; furthermore, the internal limiting membrane peeling makes retina less rigid. However, it may not be sufficient to allow retinal reattachment and it plays no preventive role in limiting posterior staphyloma progression. The rationale of posterior scleral reinforcement is to reduce retinal stretching, to contain posterior staphyloma, and to limit its progression over time.

statement: Surgical technique: an innovative way of using cohesive viscoelastic to stabilize the ILM flap during the cover inverted-flap and free-flap procedures. Summary statement: Surgical technique: an innovative way of using cohesive viscoelastic to stabilize the ILM flap during the covering step in the inverted-flap and free-flap procedures.

Aflibercept is an intravitreally injected anti-vascular endothelial growth factor, commonly used in patients with several retinal pathologies, including neovascular age-related macular degeneration. We report a case series of three patients under treatment with an aflibercept regime for neovascular age-related macular degeneration, who were referred to vitreoretinal service between 2015-2016. In all cases, pre-existing vitreomacular traction was detected with an optical coherence tomography scan. All of them developed full-thickness macular hole after aflibercept intravitreal injections. The combined cataract and macular hole surgery was successful, with improvement in visual acuity. We suggest that dynamic alterations of the size of the pigment epithelium detachment resulting from intravitreal injections might intensify the pre-existing pathological adhesion of the vitreous-retinal interface and subsequently cause the formation of a full-thickness macular hole. Therefore, all practitioners treating patients with aflibercept intravitreal injections and pre-existing vitreomacular traction should be aware of the possible macular hole formation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Karamitsos et al.)

Macular holes are common. Lightening, direct electric shock induced and laser beam induced macular holes are though rare. Reporting a case of spark flashlight (Arc Flash) induced macular hole in an electrician, which has never been reported. A 19 year old male electrician by profession presented to our clinic with a history of exposure to a bright flash light from spark of wires while at work that led to decrease of vision in his both eyes. Examination revealed a full thickness macular hole in his right eye and loss of foveal photoreceptors in the left eye. Arc flash light exposure in electricians can lead to macular holes too adding a new entity to the already existing types of macular holes.

Purpose: To report a blue laser-induced full thickness macular hole (FTMH) with delayed spontaneous closure without surgical intervention., Observations: A 14-year old male developed full thickness macular hole after momentary exposure to a high-power handheld blue laser device. The macular hole closed spontaneously over a long period of observation., Conclusion: Despite an initial enlargement in size, small FTMH caused by blue lasers may close spontaneously over an extended period of observation.

Case Report: A 14 year-old boy attended our clinic complaining of a scotoma after an accidental exposure to a 10W, 450nm laser beam from a blue-light handheld laser device. Optical coherence tomography confirmed a full thickness macular hole. As visual acuity (VA) remained 20/20 Snellen, observation was decided. Spontaneous closure was confirmed after one month., Discussion: Reckless use of high-power handheld laser devices may induce severe retinal lesions, including full thickness macular holes. Observation is a sensible treatment option in this type of macular hole, especially when VA is preserved. The pathophysiology of these cases differs from senile full thickness macular holes., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Full thickness macular hole is an eye disease, which can cause permanent visual impairment. Current advancement in vitreoretinal surgery has high success rates in repairing them, leading to a significant visual improvement, especially if patient presents early. In this article, three cases of idiopathic full thickness macular hole with different visual outcomes have been presented. All cases were referred by the primary care practitioners and had undergone macular hole surgery with the same vitreoretinal surgeon. The visual outcome was best in the patient who had the earliest presentation and referral. Early detection and referral of these patients is vital so that early surgical intervention can be carried out to improve their vision.